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1.  Health Impacts of Climate Change in Pacific Island Countries: A Regional Assessment of Vulnerabilities and Adaptation Priorities 
Environmental Health Perspectives  2015;124(11):1707-1714.
Background:
Between 2010 and 2012, the World Health Organization Division of Pacific Technical Support led a regional climate change and health vulnerability assessment and adaptation planning project, in collaboration with health sector partners, in 13 Pacific island countries—Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu.
Objective:
We assessed the vulnerabilities of Pacific island countries to the health impacts of climate change and planned adaptation strategies to minimize such threats to health.
Methods:
This assessment involved a combination of quantitative and qualitative techniques. The former included descriptive epidemiology, time series analyses, Poisson regression, and spatial modeling of climate and climate-sensitive disease data, in the few instances where this was possible; the latter included wide stakeholder consultations, iterative consensus building, and expert opinion. Vulnerabilities were ranked using a “likelihood versus impact” matrix, and adaptation strategies were prioritized and planned accordingly.
Results:
The highest-priority climate-sensitive health risks in Pacific island countries included trauma from extreme weather events, heat-related illnesses, compromised safety and security of water and food, vector-borne diseases, zoonoses, respiratory illnesses, psychosocial ill-health, non-communicable diseases, population pressures, and health system deficiencies. Adaptation strategies relating to these climate change and health risks could be clustered according to categories common to many countries in the Pacific region.
Conclusion:
Pacific island countries are among the most vulnerable in the world to the health impacts of climate change. This vulnerability is a function of their unique geographic, demographic, and socioeconomic characteristics combined with their exposure to changing weather patterns associated with climate change, the health risks entailed, and the limited capacity of the countries to manage and adapt in the face of such risks.
Citation:
McIver L, Kim R, Woodward A, Hales S, Spickett J, Katscherian D, Hashizume M, Honda Y, Kim H, Iddings S, Naicker J, Bambrick H, McMichael AJ, Ebi KL. 2016. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 124:1707–1714; http://dx.doi.org/10.1289/ehp.1509756
doi:10.1289/ehp.1509756
PMCID: PMC5089897  PMID: 26645102
2.  Extreme weather events and infectious disease outbreaks 
Virulence  2015;6(6):543-547.
Human-driven climatic changes will fundamentally influence patterns of human health, including infectious disease clusters and epidemics following extreme weather events. Extreme weather events are projected to increase further with the advance of human-driven climate change. Both recent and historical experiences indicate that infectious disease outbreaks very often follow extreme weather events, as microbes, vectors and reservoir animal hosts exploit the disrupted social and environmental conditions of extreme weather events. This review article examines infectious disease risks associated with extreme weather events; it draws on recent experiences including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods, and historical examples from previous centuries of epidemics and ‘pestilence’ associated with extreme weather disasters and climatic changes. A fuller understanding of climatic change, the precursors and triggers of extreme weather events and health consequences is needed in order to anticipate and respond to the infectious disease risks associated with human-driven climate change. Post-event risks to human health can be constrained, nonetheless, by reducing background rates of persistent infection, preparatory action such as coordinated disease surveillance and vaccination coverage, and strengthened disaster response. In the face of changing climate and weather conditions, it is critically important to think in ecological terms about the determinants of health, disease and death in human populations.
doi:10.4161/21505594.2014.975022
PMCID: PMC4720230  PMID: 26168924
climate change, extreme weather events, health, infectious disease, population health,vector-borne disease
3.  Will Global Climate Change Alter Fundamental Human Immune Reactivity: Implications for Child Health? 
Children  2014;1(3):403-423.
The human immune system is an interface across which many climate change sensitive exposures can affect health outcomes. Gaining an understanding of the range of potential effects that climate change could have on immune function will be of considerable importance, particularly for child health, but has, as yet, received minimal research attention. We postulate several mechanisms whereby climate change sensitive exposures and conditions will subtly impair aspects of the human immune response, thereby altering the distribution of vulnerability within populations—particularly for children—to infection and disease. Key climate change-sensitive pathways include under-nutrition, psychological stress and exposure to ambient ultraviolet radiation, with effects on susceptibility to infection, allergy and autoimmune diseases. Other climate change sensitive exposures may also be important and interact, either additively or synergistically, to alter health risks. Conducting directed research in this area is imperative as the potential public health implications of climate change-induced weakening of the immune system at both individual and population levels are profound. This is particularly relevant for the already vulnerable children of the developing world, who will bear a disproportionate burden of future adverse environmental and geopolitical consequences of climate change.
doi:10.3390/children1030403
PMCID: PMC4928742  PMID: 27417487
children; paediatrics; climate change; immunity; ultraviolet radiation; heat stress; psychological stress; malnutrition
4.  Keyhole limpet haemocyanin – a model antigen for human immunotoxicological studies 
Immunization with a T-cell dependent antigen has been promoted as a reliable and sensitive tool for assessing the influence of putative immunotoxic exposures or agents on immune function. Keyhole limpet haemocyanin (KLH) is a very large, copper-containing protein molecule derived from the haemolymph of the inedible mollusc, Megathura crenulata. KLH is a highly immunogenic T-cell dependent antigen that is used increasingly in immunotoxicological studies, particularly in those involving animals. This report systematically reviews the human clinical studies that have used trans-cutaneous KLH immunization for assessment of the influence of various physiological and disease states and exposures on immune function over the last 20 years (1994–2013). These studies varied in their immunization protocols, formulation of KLH, dose, site and route of administration and immunoassay platforms developed to assess KLH-specific responses. KLH immunization has been well tolerated with only mild to moderate adverse effects reported. Though very promising as a model antigen candidate in immunotoxicology research, more work on standardizing immunization and immunoassay protocols is required.
doi:10.1111/bcp.12422
PMCID: PMC4243888  PMID: 24833186
clinical studies; immunization; immunotoxicology; keyhole limpet haemocyanin; KLH
5.  Earth as humans’ habitat: global climate change and the health of populations 
Human-induced climate change, with such rapid and continuing global-scale warming, is historically unprecedented and signifies that human pressures on Earth’s life-supporting natural systems now exceed the planet’s bio-geo-capacity. The risks from climate change to health and survival in populations are diverse, as are the social and political ramifications. Although attributing observed health changes in a population to the recent climatic change is difficult, a coherent pattern of climate- and weather-associated changes is now evident in many regions of the world. The risks impinge unevenly, especially on poorer and vulnerable regions, and are amplified by pre-existing high rates of climate-sensitive diseases and conditions. If, as now appears likely, the world warms by 3-5oC by 2100, the health consequences, directly and via massive social and economic disruption, will be severe. The health sector has an important message to convey, comparing the health risks and benefits of enlightened action to avert climate change and to achieve sustainable ways of living versus the self-interested or complacent inaction.
doi:10.15171/ijhpm.2014.03
PMCID: PMC3937947  PMID: 24596901
Climate Change; Sustainability; Population Health; Anthropocene
6.  Climate change threats to population health and well-being: the imperative of protective solutions that will last 
Global Health Action  2013;6:10.3402/gha.v6i0.20816.
Background
The observational evidence of the impacts of climate conditions on human health is accumulating. A variety of direct, indirect, and systemically mediated health effects have been identified. Excessive daily heat exposures create direct effects, such as heat stroke (and possibly death), reduce work productivity, and interfere with daily household activities. Extreme weather events, including storms, floods, and droughts, create direct injury risks and follow-on outbreaks of infectious diseases, lack of nutrition, and mental stress. Climate change will increase these direct health effects. Indirect effects include malnutrition and under-nutrition due to failing local agriculture, spread of vector-borne diseases and other infectious diseases, and mental health and other problems caused by forced migration from affected homes and workplaces. Examples of systemically mediated impacts on population health include famine, conflicts, and the consequences of large-scale adverse economic effects due to reduced human and environmental productivity. This article highlights links between climate change and non-communicable health problems, a major concern for global health beyond 2015.
Discussion
Detailed regional analysis of climate conditions clearly shows increasing temperatures in many parts of the world. Climate modelling indicates that by the year 2100 the global average temperature may have increased by 3-4°C unless fundamental reductions in current global trends for greenhouse gas emissions are achieved. Given other unforeseeable environmental, social, demographic, and geopolitical changes that may occur in a plus-4-degree world, that scenario may comprise a largely uninhabitable world for millions of people and great social and military tensions.
Conclusion
It is imperative that we identify actions and strategies that are effective in reducing these increasingly likely threats to health and well-being. The fundamental preventive strategy is, of course, climate change mitigation by significantly reducing global greenhouse gas emissions, especially long-acting carbon dioxide (CO2), and by increasing the uptake of CO2 at the earth's surface. This involves urgent shifts in energy production from fossil fuels to renewable energy sources, energy conservation in building design and urban planning, and reduced waste of energy for transport, building heating/cooling, and agriculture. It would also involve shifts in agricultural production and food systems to reduce energy and water use particularly in meat production. There is also potential for prevention via mitigation, adaptation, or resilience building actions, but for the large populations in tropical countries, mitigation of climate change is required to achieve health protection solutions that will last.
doi:10.3402/gha.v6i0.20816
PMCID: PMC3617647  PMID: 23561024
climate change; health; well-being; adaptation; mitigation
7.  IARC Monographs: 40 Years of Evaluating Carcinogenic Hazards to Humans 
Pearce, Neil | Blair, Aaron | Vineis, Paolo | Ahrens, Wolfgang | Andersen, Aage | Anto, Josep M. | Armstrong, Bruce K. | Baccarelli, Andrea A. | Beland, Frederick A. | Berrington, Amy | Bertazzi, Pier Alberto | Birnbaum, Linda S. | Brownson, Ross C. | Bucher, John R. | Cantor, Kenneth P. | Cardis, Elisabeth | Cherrie, John W. | Christiani, David C. | Cocco, Pierluigi | Coggon, David | Comba, Pietro | Demers, Paul A. | Dement, John M. | Douwes, Jeroen | Eisen, Ellen A. | Engel, Lawrence S. | Fenske, Richard A. | Fleming, Lora E. | Fletcher, Tony | Fontham, Elizabeth | Forastiere, Francesco | Frentzel-Beyme, Rainer | Fritschi, Lin | Gerin, Michel | Goldberg, Marcel | Grandjean, Philippe | Grimsrud, Tom K. | Gustavsson, Per | Haines, Andy | Hartge, Patricia | Hansen, Johnni | Hauptmann, Michael | Heederik, Dick | Hemminki, Kari | Hemon, Denis | Hertz-Picciotto, Irva | Hoppin, Jane A. | Huff, James | Jarvholm, Bengt | Kang, Daehee | Karagas, Margaret R. | Kjaerheim, Kristina | Kjuus, Helge | Kogevinas, Manolis | Kriebel, David | Kristensen, Petter | Kromhout, Hans | Laden, Francine | Lebailly, Pierre | LeMasters, Grace | Lubin, Jay H. | Lynch, Charles F. | Lynge, Elsebeth | ‘t Mannetje, Andrea | McMichael, Anthony J. | McLaughlin, John R. | Marrett, Loraine | Martuzzi, Marco | Merchant, James A. | Merler, Enzo | Merletti, Franco | Miller, Anthony | Mirer, Franklin E. | Monson, Richard | Nordby, Karl-Cristian | Olshan, Andrew F. | Parent, Marie-Elise | Perera, Frederica P. | Perry, Melissa J. | Pesatori, Angela Cecilia | Pirastu, Roberta | Porta, Miquel | Pukkala, Eero | Rice, Carol | Richardson, David B. | Ritter, Leonard | Ritz, Beate | Ronckers, Cecile M. | Rushton, Lesley | Rusiecki, Jennifer A. | Rusyn, Ivan | Samet, Jonathan M. | Sandler, Dale P. | de Sanjose, Silvia | Schernhammer, Eva | Costantini, Adele Seniori | Seixas, Noah | Shy, Carl | Siemiatycki, Jack | Silverman, Debra T. | Simonato, Lorenzo | Smith, Allan H. | Smith, Martyn T. | Spinelli, John J. | Spitz, Margaret R. | Stallones, Lorann | Stayner, Leslie T. | Steenland, Kyle | Stenzel, Mark | Stewart, Bernard W. | Stewart, Patricia A. | Symanski, Elaine | Terracini, Benedetto | Tolbert, Paige E. | Vainio, Harri | Vena, John | Vermeulen, Roel | Victora, Cesar G. | Ward, Elizabeth M. | Weinberg, Clarice R. | Weisenburger, Dennis | Wesseling, Catharina | Weiderpass, Elisabete | Zahm, Shelia Hoar
Environmental Health Perspectives  2015;123(6):507-514.
Background: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.
Objectives: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process to determine the validity of these concerns. Here, we present the results of that examination, review the history of IARC evaluations, and describe how the IARC evaluations are performed.
Discussion: We concluded that these recent criticisms are unconvincing. The procedures employed by IARC to assemble Working Groups of scientists from the various disciplines and the techniques followed to review the literature and perform hazard assessment of various agents provide a balanced evaluation and an appropriate indication of the weight of the evidence. Some disagreement by individual scientists to some evaluations is not evidence of process failure. The review process has been modified over time and will undoubtedly be altered in the future to improve the process. Any process can in theory be improved, and we would support continued review and improvement of the IARC processes. This does not mean, however, that the current procedures are flawed.
Conclusions: The IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public’s health.
Citation: Pearce N, Blair A, Vineis P, Ahrens W, Andersen A, Anto JM, Armstrong BK, Baccarelli AA, Beland FA, Berrington A, Bertazzi PA, Birnbaum LS, Brownson RC, Bucher JR, Cantor KP, Cardis E, Cherrie JW, Christiani DC, Cocco P, Coggon D, Comba P, Demers PA, Dement JM, Douwes J, Eisen EA, Engel LS, Fenske RA, Fleming LE, Fletcher T, Fontham E, Forastiere F, Frentzel-Beyme R, Fritschi L, Gerin M, Goldberg M, Grandjean P, Grimsrud TK, Gustavsson P, Haines A, Hartge P, Hansen J, Hauptmann M, Heederik D, Hemminki K, Hemon D, Hertz-Picciotto I, Hoppin JA, Huff J, Jarvholm B, Kang D, Karagas MR, Kjaerheim K, Kjuus H, Kogevinas M, Kriebel D, Kristensen P, Kromhout H, Laden F, Lebailly P, LeMasters G, Lubin JH, Lynch CF, Lynge E, ‘t Mannetje A, McMichael AJ, McLaughlin JR, Marrett L, Martuzzi M, Merchant JA, Merler E, Merletti F, Miller A, Mirer FE, Monson R, Nordby KC, Olshan AF, Parent ME, Perera FP, Perry MJ, Pesatori AC, Pirastu R, Porta M, Pukkala E, Rice C, Richardson DB, Ritter L, Ritz B, Ronckers CM, Rushton L, Rusiecki JA, Rusyn I, Samet JM, Sandler DP, de Sanjose S, Schernhammer E, Seniori Costantini A, Seixas N, Shy C, Siemiatycki J, Silverman DT, Simonato L, Smith AH, Smith MT, Spinelli JJ, Spitz MR, Stallones L, Stayner LT, Steenland K, Stenzel M, Stewart BW, Stewart PA, Symanski E, Terracini B, Tolbert PE, Vainio H, Vena J, Vermeulen R, Victora CG, Ward EM, Weinberg CR, Weisenburger D, Wesseling C, Weiderpass E, Zahm SH. 2015. IARC Monographs: 40 years of evaluating carcinogenic hazards to humans. Environ Health Perspect 123:507–514; http://dx.doi.org/10.1289/ehp.1409149
doi:10.1289/ehp.1409149
PMCID: PMC4455595  PMID: 25712798
8.  Planetary Stewardship in an Urbanizing World: Beyond City Limits 
Ambio  2012;41(8):787-794.
Cities are rapidly increasing in importance as a major factor shaping the Earth system, and therefore, must take corresponding responsibility. With currently over half the world’s population, cities are supported by resources originating from primarily rural regions often located around the world far distant from the urban loci of use. The sustainability of a city can no longer be considered in isolation from the sustainability of human and natural resources it uses from proximal or distant regions, or the combined resource use and impacts of cities globally. The world’s multiple and complex environmental and social challenges require interconnected solutions and coordinated governance approaches to planetary stewardship. We suggest that a key component of planetary stewardship is a global system of cities that develop sustainable processes and policies in concert with its non-urban areas. The potential for cities to cooperate as a system and with rural connectivity could increase their capacity to effect change and foster stewardship at the planetary scale and also increase their resource security.
doi:10.1007/s13280-012-0353-7
PMCID: PMC3492563  PMID: 23076974
Urban; Rural; Resources; Sustainability; Planetary stewardship; Global; Governance
9.  Comparative Assessment of the Effects of Climate Change on Heat- and Cold-Related Mortality in the United Kingdom and Australia 
Environmental Health Perspectives  2014;122(12):1285-1292.
Background: High and low ambient temperatures are associated with increased mortality in temperate and subtropical climates. Temperature-related mortality patterns are expected to change throughout this century because of climate change.
Objectives: We compared mortality associated with heat and cold in UK regions and Australian cities for current and projected climates and populations.
Methods: Time-series regression analyses were carried out on daily mortality in relation to ambient temperatures for UK regions and Australian cities to estimate relative risk functions for heat and cold and variations in risk parameters by age. Excess deaths due to heat and cold were estimated for future climates.
Results: In UK regions, cold-related mortality currently accounts for more than one order of magnitude more deaths than heat-related mortality (around 61 and 3 deaths per 100,000 population per year, respectively). In Australian cities, approximately 33 and 2 deaths per 100,000 population are associated every year with cold and heat, respectively. Although cold-related mortality is projected to decrease due to climate change to approximately 42 and 19 deaths per 100,000 population per year in UK regions and Australian cities, heat-related mortality is projected to increase to around 9 and 8 deaths per 100,000 population per year, respectively, by the 2080s, assuming no changes in susceptibility and structure of the population.
Conclusions: Projected changes in climate are likely to lead to an increase in heat-related mortality in the United Kingdom and Australia over this century, but also to a decrease in cold-related deaths. Future temperature-related mortality will be amplified by aging populations. Health protection from hot weather will become increasingly necessary in both countries, while protection from cold weather will be still needed.
Citation: Vardoulakis S, Dear K, Hajat S, Heaviside C, Eggen B, McMichael AJ. 2014. Comparative assessment of the effects of climate change on heat- and cold-related mortality in the United Kingdom and Australia. Environ Health Perspect 122:1285–1292; http://dx.doi.org/10.1289/ehp.1307524
doi:10.1289/ehp.1307524
PMCID: PMC4256046  PMID: 25222967
10.  Non-heat related impacts of climate change on working populations 
Global Health Action  2010;3:10.3402/gha.v3i0.5640.
Environmental and social changes associated with climate change are likely to have impacts on the well-being, health, and productivity of many working populations across the globe. The ramifications of climate change for working populations are not restricted to increases in heat exposure. Other significant risks to worker health (including physical hazards from extreme weather events, infectious diseases, under-nutrition, and mental stresses) may be amplified by future climate change, and these may have substantial impacts at all scales of economic activity. Some of these risks are difficult to quantify, but pose a substantial threat to the viability and sustainability of some working populations. These impacts may occur in both developed and developing countries, although the latter category is likely to bear the heaviest burden.
This paper explores some of the likely, non-heat-related health issues that climate change will have on working populations around the globe, now and in the future. These include exposures to various infectious diseases (vector-borne, zoonotic, and person-to-person), extreme weather events, stress and mental health issues, and malnutrition.
doi:10.3402/gha.v3i0.5640
PMCID: PMC3009583  PMID: 21191440
climate change; workers; vector-borne diseases; zoonoses; mental health; malnutrition; emergency workers; farmers
12.  Climate Change and Children: Health Risks of Abatement Inaction, Health Gains from Action 
Children  2014;1(2):99-106.
As human-driven climate change advances, many adults fret about the losses of livelihoods, houses and farms that may result. Children fret about their parents’ worries and about information they hear, but do not really understand about the world’s climate and perhaps about their own futures. In chronically worried or anxious children, blood cortisol levels rise and adverse changes accrue in various organ systems that prefigure adult-life diseases. Meanwhile, for many millions of children in poor countries who hear little news and live with day-to-day fatalism, climate change threatens the fundamentals of life—food sufficiency, safe drinking water and physical security—and heightens the risks of diarrhoeal disease, malaria and other climate-sensitive infections. Poor and disadvantaged populations, and especially their children, will bear the brunt of climate-related trauma, disease and premature death over the next few decades and, less directly, from social disruption, impoverishment and displacement. The recent droughts in Somalia as the Indian Ocean warmed and monsoonal rains failed, on top of chronic civil war, forced hundreds of thousands of Somali families into north-eastern Kenya’s vast Dadaab refugee camps, where, for children, shortages of food, water, hygiene and schooling has endangered physical, emotional and mental health. Children warrant special concern, both as children per se and as the coming generation likely to face ever more extreme climate conditions later this century. As children, they face diverse risks, from violent weather, proliferating aeroallergens, heat extremes and mobilised microbes, through to reduced recreational facilities, chronic anxieties about the future and health hazards of displacement and local resource conflict. Many will come to regard their parents’ generation and complacency as culpable.
doi:10.3390/children1020099
PMCID: PMC4928726  PMID: 27417469
climate change; health; children
13.  In an interconnected world: joint research priorities for the environment, agriculture and infectious disease 
In 2008 the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) commissioned ten think-tanks to work on disease-specific and thematic reference groups to identify top research priorities that would advance the research agenda on infectious diseases of poverty, thus contributing to improvements in human health. The first of the thematic reference group reports – on environment, agriculture and infectious diseases of poverty – was recently released. In this article we review, from an insider perspective, the strengths and weaknesses of this thematic reference group report and highlight key messages for policy-makers, funders and researchers.
doi:10.1186/2049-9957-3-2
PMCID: PMC3906909  PMID: 24472225
Agriculture; Environment; Infectious disease; Research priorities; TDR
14.  Impediments to Comprehensive Research on Climate Change and Health 
During every climatic era Life on Earth is constrained by a limited range of climatic conditions, outside which thriving and then surviving becomes difficult. This applies at both planetary and organism (species) levels. Further, many causal influences of climate change on human health entail changes—often disruptive, sometimes irreversible—in complex system functioning. Understanding the diverse health risks from climate change, and their influence pathways, presents a challenge to environmental health researchers whose prior work has been in a more definable, specific and quantitative milieu. Extension of the research agenda and conceptual framework to assess present and future health risks from climate change may be constrained by three factors: (i) lack of historically-informed understanding of population-health sensitivity to climatic changes; (ii) an instinctual ‘epidemiologising’ tendency to choose research topics amenable to conventional epidemiological analysis and risk estimation; and (iii) under-confidence in relation to interdisciplinary collaborative scenario-based modeling of future health risks. These constraints must be recognized and remedied. And environmental researchers must argue for heightened public attention to today’s macro-environmental threats to present and future population health—emphasising the ecological dimension of these determinants of long-term health that apply to whole populations and communities, not just to individuals and social groupings.
doi:10.3390/ijerph10116096
PMCID: PMC3863889  PMID: 24225646
climate change; health; public health; research; history; modeling; policy; Goldilocks
15.  A multi-layered governance framework for incorporating social science insights into adapting to the health impacts of climate change 
Global Health Action  2013;6:10.3402/gha.v6i0.21820.
Background
Addressing climate change and its associated effects is a multi-dimensional and ongoing challenge. This includes recognizing that climate change will affect the health and wellbeing of all populations over short and longer terms, albeit in varied ways and intensities. That recognition has drawn attention to the need to take adaptive actions to lessen adverse impacts over the next few decades from unavoidable climate change, particularly in developing country settings. A range of sectors is responsible for appropriate adaptive policies and measures to address the health risks of climate change, including health services, water and sanitation, trade, agriculture, disaster management, and development.
Objectives
To broaden the framing of governance and decision-making processes by using innovative methods and assessments to illustrate the multi-sectoral nature of health-related adaptation to climate change. This is a shift from sector-specific to multi-level systems encompassing sectors and actors, across temporal and spatial scales.
Design
A review and synthesis of the current knowledge in the areas of health and climate change adaptation governance and decision-making processes.
Results
A novel framework is presented that incorporates social science insights into the formulation and implementation of adaptation activities and policies to lessen the health risks posed by climate change.
Conclusion
Clarification of the roles that different sectors, organizations, and individuals occupy in relation to the development of health-related adaptation strategies will facilitate the inclusion of health and wellbeing within multi-sector adaptation policies, thereby strengthening the overall set of responses to minimize the adverse health effects of climate change.
doi:10.3402/gha.v6i0.21820
PMCID: PMC3772341  PMID: 24028938
climate change adaptation; global health; multi-sectoral; social networks; governance; social sciences; methods
16.  Land-Use Change and Emerging Infectious Disease on an Island Continent 
A more rigorous and nuanced understanding of land-use change (LUC) as a driver of emerging infectious disease (EID) is required. Here we examine post hunter-gatherer LUC as a driver of infectious disease in one biogeographical region with a compressed and documented history—continental Australia. We do this by examining land-use and native vegetation change (LUCC) associations with infectious disease emergence identified through a systematic (1973–2010) and historical (1788–1973) review of infectious disease literature of humans and animals. We find that 22% (20) of the systematically reviewed EIDs are associated with LUCC, most frequently where natural landscapes have been removed or replaced with agriculture, plantations, livestock or urban development. Historical clustering of vector-borne, zoonotic and environmental disease emergence also follows major periods of extensive land clearing. These advanced stages of LUCC are accompanied by changes in the distribution and density of hosts and vectors, at varying scales and chronology. This review of infectious disease emergence in one continent provides valuable insight into the association between accelerated global LUC and concurrent accelerated infectious disease emergence.
doi:10.3390/ijerph10072699
PMCID: PMC3734451  PMID: 23812027
emerging infectious disease; zoonoses; wildlife; livestock; vector; environment; land-use; Australia
17.  An Ill Wind? Climate Change, Migration, and Health 
Environmental Health Perspectives  2012;120(5):646-654.
Background: Climate change is projected to cause substantial increases in population movement in coming decades. Previous research has considered the likely causal influences and magnitude of such movements and the risks to national and international security. There has been little research on the consequences of climate-related migration and the health of people who move.
Objectives: In this review, we explore the role that health impacts of climate change may play in population movements and then examine the health implications of three types of movements likely to be induced by climate change: forcible displacement by climate impacts, resettlement schemes, and migration as an adaptive response.
Methods: This risk assessment draws on research into the health of refugees, migrants, and people in resettlement schemes as analogs of the likely health consequences of climate-related migration. Some account is taken of the possible modulation of those health risks by climate change.
Discussion: Climate-change–related migration is likely to result in adverse health outcomes, both for displaced and for host populations, particularly in situations of forced migration. However, where migration and other mobility are used as adaptive strategies, health risks are likely to be minimized, and in some cases there will be health gains.
Conclusions: Purposeful and timely policy interventions can facilitate the mobility of people, enhance well-being, and maximize social and economic development in both places of origin and places of destination. Nevertheless, the anticipated occurrence of substantial relocation of groups and communities will underscore the fundamental seriousness of human-induced climate change.
doi:10.1289/ehp.1104375
PMCID: PMC3346786  PMID: 22266739
climate change; displacement; health; migration; resettlement
18.  Governing for a Healthy Population: Towards an Understanding of How Decision-Making Will Determine Our Global Health in a Changing Climate 
Enhancing the adaptive capacity of individuals, communities, institutions and nations is pivotal to protecting and improving human health and well-being in the face of systemic social inequity plus dangerous climate change. However, research on the determinants of adaptive capacity in relation to health, particularly concerning the role of governance, is in its infancy. This paper highlights the intersections between global health, climate change and governance. It presents an overview of these key concerns, their relation to each other, and the potential that a greater understanding of governance may present opportunities to strengthen policy and action responses to the health effects of climate change. Important parallels between addressing health inequities and sustainable development practices in the face of global environmental change are also highlighted. We propose that governance can be investigated through two key lenses within the earth system governance theoretical framework; agency and architecture. These two governance concepts can be evaluated using methods of social network research and policy analysis using case studies and is the subject of further research.
doi:10.3390/ijerph9010055
PMCID: PMC3315069  PMID: 22470278
global health; climate change; adaptive capacity; equity; governance; decision-making
19.  Paleoclimate and bubonic plague: a forewarning of future risk? 
BMC Biology  2010;8:108.
Pandemics of bubonic plague have occurred in Eurasia since the sixth century ad. Climatic variations in Central Asia affect the population size and activity of the plague bacterium's reservoir rodent species, influencing the probability of human infection. Using innovative time-series analysis of surrogate climate records spanning 1,500 years, a study in BMC Biology concludes that climatic fluctuations may have influenced these pandemics. This has potential implications for health risks from future climate change.
See research article http://www.biomedcentral.com/1741-7007/8/112
doi:10.1186/1741-7007-8-108
PMCID: PMC2929224  PMID: 24576348
20.  Environmental change, climate and population health: a challenge for inter-disciplinary research 
doi:10.1007/s12199-008-0031-3
PMCID: PMC2698234  PMID: 19568904
Climate change; Environmental health; Global environmental change; Research needs; Sustainability
21.  Climate Variability, Social and Environmental Factors, and Ross River Virus Transmission: Research Development and Future Research Needs 
Environmental Health Perspectives  2008;116(12):1591-1597.
Background
Arbovirus diseases have emerged as a global public health concern. However, the impact of climatic, social, and environmental variability on the transmission of arbovirus diseases remains to be determined.
Objective
Our goal for this study was to provide an overview of research development and future research directions about the interrelationship between climate variability, social and environmental factors, and the transmission of Ross River virus (RRV), the most common and widespread arbovirus disease in Australia.
Methods
We conducted a systematic literature search on climatic, social, and environmental factors and RRV disease. Potentially relevant studies were identified from a series of electronic searches.
Results
The body of evidence revealed that the transmission cycles of RRV disease appear to be sensitive to climate and tidal variability. Rainfall, temperature, and high tides were among major determinants of the transmission of RRV disease at the macro level. However, the nature and magnitude of the interrelationship between climate variability, mosquito density, and the transmission of RRV disease varied with geographic area and socioenvironmental condition. Projected anthropogenic global climatic change may result in an increase in RRV infections, and the key determinants of RRV transmission we have identified here may be useful in the development of an early warning system.
Conclusions
The analysis indicates that there is a complex relationship between climate variability, social and environmental factors, and RRV transmission. Different strategies may be needed for the control and prevention of RRV disease at different levels. These research findings could be used as an additional tool to support decision making in disease control/surveillance and risk management.
doi:10.1289/ehp.11680
PMCID: PMC2599750  PMID: 19079707
climate variability; early warning system; Ross River virus transmission; social and environmental factors
22.  Weather Variability, Tides, and Barmah Forest Virus Disease in the Gladstone Region, Australia 
Environmental Health Perspectives  2005;114(5):678-683.
In this study we examined the impact of weather variability and tides on the transmission of Barmah Forest virus (BFV) disease and developed a weather-based forecasting model for BFV disease in the Gladstone region, Australia. We used seasonal autoregressive integrated moving-average (SARIMA) models to determine the contribution of weather variables to BFV transmission after the time-series data of response and explanatory variables were made stationary through seasonal differencing. We obtained data on the monthly counts of BFV cases, weather variables (e.g., mean minimum and maximum temperature, total rainfall, and mean relative humidity), high and low tides, and the population size in the Gladstone region between January 1992 and December 2001 from the Queensland Department of Health, Australian Bureau of Meteorology, Queensland Department of Transport, and Australian Bureau of Statistics, respectively. The SARIMA model shows that the 5-month moving average of minimum temperature (β = 0.15, p-value < 0.001) was statistically significantly and positively associated with BFV disease, whereas high tide in the current month (β = −1.03, p-value = 0.04) was statistically significantly and inversely associated with it. However, no significant association was found for other variables. These results may be applied to forecast the occurrence of BFV disease and to use public health resources in BFV control and prevention.
doi:10.1289/ehp.8568
PMCID: PMC1459919  PMID: 16675420
Barmah Forest virus; control; forecasting; Gladstone region; risk factors; time series modeling
23.  Nonstationary Influence of El Niño on the Synchronous Dengue Epidemics in Thailand 
PLoS Medicine  2005;2(4):e106.
Background
Several factors, including environmental and climatic factors, influence the transmission of vector-borne diseases. Nevertheless, the identification and relative importance of climatic factors for vector-borne diseases remain controversial. Dengue is the world's most important viral vector-borne disease, and the controversy about climatic effects also applies in this case. Here we address the role of climate variability in shaping the interannual pattern of dengue epidemics.
Methods and Findings
We have analysed monthly data for Thailand from 1983 to 1997 using wavelet approaches that can describe nonstationary phenomena and that also allow the quantification of nonstationary associations between time series. We report a strong association between monthly dengue incidence in Thailand and the dynamics of El Niño for the 2–3-y periodic mode. This association is nonstationary, seen only from 1986 to 1992, and appears to have a major influence on the synchrony of dengue epidemics in Thailand.
Conclusion
The underlying mechanism for the synchronisation of dengue epidemics may resemble that of a pacemaker, in which intrinsic disease dynamics interact with climate variations driven by El Niño to propagate travelling waves of infection. When association with El Niño is strong in the 2–3-y periodic mode, one observes high synchrony of dengue epidemics over Thailand. When this association is absent, the seasonal dynamics become dominant and the synchrony initiated in Bangkok collapses.
In Thailand, dengue transmission patterns are complex, with El Nino showing an association with some epidemics only; other reasons will need to be found for the initiation of other outbreaks
doi:10.1371/journal.pmed.0020106
PMCID: PMC1087219  PMID: 15839751
24.  Vulnerability to winter mortality in elderly people in Britain: population based study 
BMJ : British Medical Journal  2004;329(7467):647.
Objective To examine the determinants of vulnerability to winter mortality in elderly British people.
Design Population based cohort study (119 389 person years of follow up).
Setting 106 general practices from the Medical Research Council trial of assessment and management of older people in Britain.
Participants People aged ≥ 75 years.
Main outcome measures Mortality (10 123 deaths) determined by follow up through the Office for National Statistics.
Results Month to month variation accounted for 17% of annual all cause mortality, but only 7.8% after adjustment for temperature. The overall winter:non-winter rate ratio was 1.31 (95% confidence interval 1.26 to 1.36). There was little evidence that this ratio varied by geographical region, age, or any of the personal, socioeconomic, or clinical factors examined, with two exceptions: after adjustment for all major covariates the winter:non-winter ratio in women compared with men was 1.11 (1.00 to 1.23), and those with a self reported history of respiratory illness had a winter:non-winter ratio of 1.20 (1.08 to 1.34) times that of people without a history of respiratory illness. There was no evidence that socioeconomic deprivation or self reported financial worries were predictive of winter death.
Conclusion Except for female sex and pre-existing respiratory illness, there was little evidence for vulnerability to winter death associated with factors thought to lead to vulnerability. The lack of socioeconomic gradient suggests that policies aimed at relief of fuel poverty may need to be supplemented by additional measures to tackle the burden of excess winter deaths in elderly people.
doi:10.1136/bmj.38167.589907.55
PMCID: PMC517639  PMID: 15315961
25.  Ecologic analysis of some immune-related disorders, including type 1 diabetes, in Australia: latitude, regional ultraviolet radiation, and disease prevalence. 
Environmental Health Perspectives  2003;111(4):518-523.
The apparent immune-suppressive effect of ultraviolet radiation (UVR) has suggested that this environmental exposure may influence the development of immune-related disorders. Self-reported prevalence rates of type 1 diabetes mellitus, rheumatoid arthritis (RA), eczema/dermatitis, and asthma, from the 1995 Australian National Health Survey, were therefore examined by latitude and ambient level of UVR. A positive association of type 1 diabetes mellitus prevalence was found with both increasing southern latitude of residence (r = 0.77; p = 0.026) and decreasing regional annual ambient UVR (r= -0.80; p = 0.018); a 3-fold increase in prevalence from the northernmost region to the southernmost region was evident. In contrast, asthma correlated negatively with latitude (r = -0.72; p = 0.046), although the change in asthma prevalence from the north to the south of Australia was only 0.7-fold. For both RA and eczema/dermatitis, there were no statistically significant associations between latitude/UVR and disease prevalence. These ecologic data provide some support for a previously proposed beneficial effect of UVR on T-helper 1-mediated autoimmune disorders such as type 1 diabetes. The inverse association of type 1 diabetes prevalence with UVR is consistent with that previously reported for another autoimmune disease, multiple sclerosis, in Australia, and also with type 1 diabetes latitudinal gradients in the Northern Hemisphere. The finding also accords with photoimmunologic evidence of UVR-induced immunosuppression and may suggest a beneficial effect of UVR in reducing the incidence of such autoimmune conditions. In light of this study, analytic epidemiologic studies investigating risk of immune disorders in relation to personal UVR exposure in humans are required.
PMCID: PMC1241438  PMID: 12676609

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