 National Centre for Epidemiology and Population Health (NCEPH)
Australian National University (ANU)
AbstractAddressing the Health Risks of Climate Change: Are classical reductionism, systems science, and future scenarios miscible?Historically, epidemiological research has primarily sought explanations for changes in rates of disease within a population (e.g. Snow’s studies of cholera in1850s London; studies of lung cancer and smoking in the 1950s), or to test hypotheses about the health risks of newly-encountered physico-chemical ‘exposures’ (e.g., trihalomethanes in drinking water; mobile phones). Most environmental hazards thus studied have been of a specific, localised, kind, acting via direct toxicological or microbiological ‘insult’. Climate change looms as a qualitatively different source of risk to health – present and future. Climatic conditions vary naturally, by place and time, and thus have ongoing ‘background’ influences on health and disease: winter viral infections, heatwave deaths, flood-related cholera outbreaks, malnutrition due to crop failures, and so on. These climatic hazards to health have long been viewed as part of the ‘natural order’; we cannot modify the climate. Or so we once thought. Now we are, indeed, changing it inadvertently, thereby creating an unfamiliar and evolving shift in worldwide climatic conditions, environmental sequelae and risks to health. Since the advent of agrarianism humans have not encountered a systemic global shift in fundamental environmental conditions. Not surprisingly, we are finding it difficult to understand the full significance of human-induced climate change and to slow its advance. Meanwhile it threatens the foundations of population health – food yields, freshwater flows, the stability of infectious disease patterns, the protection afforded by nature’s buffers (reefs, mangroves, forests, wetlands, etc.) against extreme events, and social stability. The economic and social disruptions due to adverse climatic impacts will affect community morale, social institutions, livelihoods, incomes, security and, hence, health – mental and physical. The population health sciences have the multi-faceted task of identifying the risks to health from climate change, estimating current and future health impacts, determining who/where is most vulnerable, seeking to factor this information into central policy-making about climate change mitigation (abatement), and, meanwhile, framing and advising on adaptation strategies to lessen the adverse health impacts of unavoidable (existing and pending) climate change. Here lies an exquisite research challenge. We wish, as ever, to provide scientific evidence, information and policy guidance that enable disease prevention and gains in population health. Most such social inputs, over the past century, have come from increasingly sophisticated quasi-experimental and tightly focused research. Randomised controlled trials, where possible, are extolled as the high-water mark of evidence. Then along comes “climate change”, compounded by the possibility of much greater ‘change’ in future – perhaps even broaching exposure conditions that cannot yet be foreseen because of latent thresholds that lie ahead. Research problems – conceptual, strategic, technical – abound. Studying climate change and health risks must draw on the best appropriate methods and experience of population health research, extend the collaborative engagement of the discipline, and improve communication to public and policy-makers. We are dealing, now, with the risks posed by system disruption, on a research landscape of complexity, uncertainty and a long reach into the future. BiographyTony McMichael, medical graduate and epidemiologist, was previously Professor of Epidemiology at the London School of Hygiene and Tropical Medicine, UK (1994-2001). He currently holds an Australia Fellowship (2007-2012) from the National Health and Medical Research Council, is Honorary Professor in Climate Change and Human Health at the University of Copenhagen, and Honorary Fellow, London School of Hygiene and Tropical Medicine. During 2008-09 he was President of the International Society of Environmental Epidemiology.
Professor McMichael’s primary research focus is on global climate change, environmental conditions and human health – with studies at local, national and international levels. His early research and writing on the health risks of climate change, in the 1990s, led on to his role in health risk assessment for the UN's Intergovernmental Panel on Climate Change (IPCC, 1993-2007). During 2001-07, as Director of NCEPH, he developed research programs on the health impacts of large-scale environmental and climatic changes, environmental influences on autoimmune diseases, and relationships between urban environments, human ecology and health. His team’s program on climate change and health is one of the largest and most internationally active in the world. He has been an advisor on environmental health issues to WHO (with whom he works closely on climate change), the UN Environment Program, the World Bank, the Tropical Diseases Research Program (TDR) and other international bodies. His interests in environmental, social, cultural and evolutionary influences on disease patterns underpin a further research involvement in relation to emerging infectious diseases, in this 'renaissant' microbial era. Research Interests Climate change and human health: studies of current, emerging and estimated future risks, and adaptive strategies to lessen risks (See details NCEPH/Research Areas) Environmental and social influences on the ecology of infectious disease emergence and occurrence Urban environment, health and sustainability: social and physical influences on patterns of health, with particular reference to food systems, transport systems and energy use Food systems, nutrition, energy balance and health: population and individual aspects
Selected Recent Publications McMichael AJ. Human population health: Sentinel criterion of environmental sustainability. Current Opinion in Environmental Sustainability, 2009. 1(1): 101-106. McMichael AJ, Neira M, Bertollini R, Campbell-Lendrum D, Hales S. Climate change: A time of need and opportunity for the health sector. Lancet 2009; 374: 2123-2125: doi 10.1016/S0140-6736(09)62031-6 Corbett SJ, McMichael AJ, Prentice AM. Type 2 Diabetes, Cardiovascular Disease and the Evolutionary Paradox of the Polycystic Ovary Syndrome: A Fertility First Hypothesis. Am J Human Biol 2009 doi: 10.1002/ajhb.20937 McMichael AJ, Friel S, Nyong T, Corvalan C. Global environmental change and health: impacts, inequalities, and the health sector. Brit Med J 2008; 336:191-194. http://www.bmj.com/cgi/content/short/336/7637/191 Frumkin H, McMichael AJ. Climate change and public health: thinking, communicating, acting. Am J Prev Med. 2008; 35: 403-10. http://www.bvsde.paho.org/bvsacd/cd68/HFrumkin.pdf McMichael AJ, Wilkinson P, Kovats S, et al. International study of temperature, heat and urban mortality: the ISOTHURM project. Int J Epidemiol 2008; 37: 1121-32. http://ije.oxfordjournals.org/cgi/content/abstract/dyn086 Friel S, Marmot M, McMichael AJ, Kjellstrom T, Vagero D. Global health equity and climate stabilisation - need for a common agenda. Lancet 2008; 372: 1677-83. doi:10.1016/S0140-6736(08)61692-X http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2808%2961692-X/fulltext McMichael AJ, Woodruff R. Climate Change and Infectious Disease. Chapter in: Mayer K H, Pizer H (eds) Social Ecology of Infectious Disease. NY: Academic Press, 2008, pp 378-407. McMichael AJ, Powles J, Butler CD, Uauy R. Food, livestock production, energy, climate change and health. Lancet 2007; 370:1253-1263. http://www.thelancet.com/journals/lancet/article/PIIS0140673607612562/fulltext McMichael AJ, Woodruff R, Hales S. Climate change and human health: Present and future risks. Lancet 2006; 367: 859-69. (http://www.thelancet.com/journals/lancet/article/PIIS0140673606680793/fulltext McMichael AJ. Integrating nutrition and ecology: Balancing the health of humans and biosphere. Public Health Nutrition, 2005; 8: 706-715. doi:10.1079/PHN2005769 Weiss R, McMichael AJ. Social and environmental risk factors in the emergence of infectious diseases. Nature Medicine 2004; 10: S70-76. doi:10.1038/nm1150 http://www.nature.com/nm/journal/v10/n12s/full/nm1150.html McMichael AJ, Campbell-Lendrum D, Ebi K, Githeko A, Scheraga J, Woodward A (eds). Climate Change and Human Health: Risks and Responses. [book] Geneva: WHO, 2003, 322pp. McMichael AJ. Human population health: Sentinel criterion of environmental sustainability. Current Opinion in Environmental Sustainability, 2009. 1(1): 101-106. McMichael AJ, Neira M, Bertollini R, Campbell-Lendrum D, Hales S.Climate change: A time of need and opportunity for the health sector. Lancet 2009; 374: 2123-2125 doi 10.1016/S0140-6736(09)62031-6 Corbett SJ, McMichael AJ, Prentice AM. Type 2 Diabetes, Cardiovascular Disease and the Evolutionary Paradox of the Polycystic Ovary Syndrome: A Fertility First Hypothesis. Am J Human Biol 2009 doi: 10.1002/ajhb.20937
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