published_or_final_version / Community Medicine / Master / Master of Public Health

The complex interplay between climate change, demographics and socioeconomic conditions is transforming the global environmental health landscape. In the aftermath of recent heat waves around the world, especially the 2003 heat wave in Europe, heat is being recognized as an emerging public health issue worldwide, particularly in urban areas. This work explores the historical and future heat-related mortality in New York City, from the beginning of the 20th until the end of the 21st century. New York City is among the largest cities in the world and has been a thriving metropolis over the entire period covered by this study. The unique makeup of the city makes it particularly suitable for studying the impacts of heat over an extended period of time. The presented work encompasses multiple domains of knowledge and illustrates the necessity for applying highly interdisciplinary approaches in addressing the emerging challenges of our time. The background chapter provides an overview of methodological approaches and findings from previous studies with direct relevance to the specific aims of this work. Chapter I is focused on characterizing the impacts of heat on daily mortality since 1900. Here, heat effects are presented in a historical context and changes over time are analyzed and discussed. Chapter II provides a comparative assessment of recent historical and heat impacts until 2100 in New York City, Boston and Philadelphia. This analysis illustrates the differences and similarities between heat impacts in New York City and the other two major urban areas in the U.S. Northeast. Chapter III provides a more comprehensive assessment of future heat-related mortality in New York City under a number of adaptation, climate change and demographic scenarios. The concluding chapter presents a summary of findings and recommendations for future research.

The complex interplay between climate change, demographics and socioeconomic conditions is transforming the global environmental health landscape. In the aftermath of recent heat waves around the world, especially the 2003 heat wave in Europe, heat is being recognized as an emerging public health issue worldwide, particularly in urban areas. This work explores the historical and future heat-related mortality in New York City, from the beginning of the 20th until the end of the 21st century. New York City is among the largest cities in the world and has been a thriving metropolis over the entire period covered by this study. The unique makeup of the city makes it particularly suitable for studying the impacts of heat over an extended period of time. The presented work encompasses multiple domains of knowledge and illustrates the necessity for applying highly interdisciplinary approaches in addressing the emerging challenges of our time. The background chapter provides an overview of methodological approaches and findings from previous studies with direct relevance to the specific aims of this work. Chapter I is focused on characterizing the impacts of heat on daily mortality since 1900. Here, heat effects are presented in a historical context and changes over time are analyzed and discussed. Chapter II provides a comparative assessment of recent historical and heat impacts until 2100 in New York City, Boston and Philadelphia. This analysis illustrates the differences and similarities between heat impacts in New York City and the other two major urban areas in the U.S. Northeast. Chapter III provides a more comprehensive assessment of future heat-related mortality in New York City under a number of adaptation, climate change and demographic scenarios. The concluding chapter presents a summary of findings and recommendations for future research.

Background Climate variation has affected diverse physical and biological systems worldwide. Population health is one of the most important impacts of climate variation. Although the impact of climate variation on infectious diseases has been of significant concern recently, the relationship between climate variation and infectious diseases, including vector-borne diseases and enteric infections, needs greater clarification. Australia is grappling with developing politically acceptable responses to global warming. In China, few studies have been conducted to examine the effect of climate variation, including global warming, on population health. As residents of developing countries may suffer more from climate change compared with people living in more developed countries, this thesis has significance for both countries. Aims This study aims to contribute to a better understanding of the impact of climate variation on population health, and to provide scientific evidence for policy makers, researchers, public health practitioners and local communities in the development of public health strategies at an early stage, in order to prevent or reduce future risks associated with ongoing climate change. The objectives of this study include: (1) to quantify the association between climate variation and selected vectorborne diseases and enteric infections in different climatic regions in Australia and China; (2) to project the future burden of selected vector-borne diseases and enteric infections based on climate change scenarios in different climatic regions in Australia and China. Methods This ecological study has two components. The first uses time-series analyses to quantify the relationship between meteorological variables and infectious diseases, whereas the second projects the burden of selected infectious diseases using future climate and population scenarios. Temperate and subtropical climatic zones in both Australia and China were selected as the primary study areas, and a study of an Australian tropical region was also conducted. Study of Australia’s temperate zones was conducted in Adelaide, South Australia, as well as the Murray River region in that State. The study of China’s temperate zone was carried out in Jinan, Shandong Province. Subtropical studies were conducted in Baoan, Guangdong Province, China, and Brisbane in Queensland, whilst research for the tropics centred on Townsville, also in Queensland, Australia. The selected infectious diseases - one vector-borne disease and one enteric infection in each country - are Ross River Virus (RRV) infection and salmonellosis in Australia, and malaria and bacillary dysentery in China. Study periods vary from eight to sixteen years (depending upon the availability of data). Climate data, infectious disease surveillance data and demographic data were collected from local authorities. Data analyses conducted in the ecological studies include Spearman correlation analysis, time-series adjusted Poisson regression and the Seasonal Autoregressive Integrated Moving Average (SARIMA) model with consideration of lag effects, seasonality, long-term trends, and autocorrelation, on a weekly or monthly basis depending on data availability, and Hockey Sticky model to detect potential threshold temperatures. In the burden of disease component, analyses include the calculation of an indicator of the burden of disease - Years Lost due to Disabilities (YLDs) - and use scenario-based models to project YLDs for the selected diseases in 2030 and 2050 in Australia and 2020 and 2050 in China respectively. The projections consider both different scenarios of projected temperature and future population change. Results Relationship between climate variation and selected infectious diseases In all the study regions in Australia, maximum temperature, minimum temperature, rainfall and humidity are all significantly related to the number of RRV infections, with lag effects varying from 0 to 3 months. Additionally, high tides in the two seaside regions with tropical (Townsville) or subtropical (Brisbane) climates, and river flow in the temperate region (Murray River region), are related to the number of cases without any lag effects. A potential 1°C increase in maximum or minimum temperature may cause 4%~23% extra cases of RRV infection in the temperate region, 5~8% in the subtropical region, and 6%~15% in the tropical region. Maximum temperature, minimum temperature, humidity and air pressure are significantly related to malaria cases in the temperate city Jinan and subtropical city Baoan in China, with a lag effect range of 0 to 1 month. An association between rainfall and malaria cases was not detected in either region. A potential 1°C increase in maximum or minimum temperature may lead to 4%~15% extra malaria cases in the temperate region, and 12%-18% in the tropical region in China. Maximum temperature, minimum temperature, rainfall and humidity are all significantly related to the number of salmonellosis cases in the three study cities in Australia, with lag effects varying from 0 to 1 month. A potential 1°C increase in maximum or minimum temperature may cause 6%~19% extra salmonellosis cases in the temperate region (Adelaide), 5%~10% in the subtropical region (Brisbane), and 4%~15% in the tropical region (Townsville). The thresholds for the effects of maximum and minimum temperatures are 20ºC and 12ºC respectively in Adelaide. No threshold temperatures are detected in Townsville and Brisbane. Maximum temperature, minimum temperature, humidity, air pressure and rainfall are significantly related to bacillary dysentery cases in the temperate city Jinan and subtropical city Baoan in China, with the lag effect range of 0 to 2 months. A potential 1°C increase in maximum or minimum temperature may cause 7%~15% extra bacillary dysentery cases in the temperate region and 10% ~ 19% in the subtropical region in China. The thresholds for the effects of maximum and minimum temperatures on bacillary dysentery are 17ºC and 8ºC respectively in Jinan. No threshold temperatures are detected in Baoan. Projection of YLDs from target diseases In Australia, considering both climatic and population scenarios, if other factors remain constant, compared with the YLDs observed in 2000, the YLDs for salmonellosis might increase by up to 48% by 2030, and nearly double by 2050 in South Australia, while the YLDs might double by 2030 and increase by up to 143% by 2050 in Brisbane, Queensland. The YLDs for RRV infection might increase by up to 66% by 2030, and nearly double by 2050 in South Australia. They might increase by up to 61% by 2030 and double by 2050 in Brisbane, Queensland. In China, considering both climatic and population scenarios, if other factors remain constant, compared with the YLDs observed in 2000, the YLDs for bacillary dysentery might double by 2020 and triple by 2050 in both Jinan and Baoan. The YLDs for malaria might increase by up to 108% by 2020 and nearly triple by 2050 in Jinan, the temperate city, and increase by up to 144% by 2020 and nearly triple by 2050 in Baoan, the subtropical city. Conclusions 1. Both maximum and minimum temperatures are important in the transmission of vector-borne diseases in various climatic regions in both Australia and China. River flow or high tides may also play an important role in the transmission of such diseases. 2. Both maximum and minimum temperatures play an important role in the transmission of enteric infections in various climatic regions in both Australia and China, with a threshold temperature detected in the temperate regions but not in subtropical and tropical regions. 3. The effects of rainfall and relative humidity on selected infectious diseases vary in different study areas in Australia and China. 4. The burden of temperature-related infectious diseases may greatly increase in the future if there is no effective preventive intervention. Public health implications 1. Implication for health practice • Public health practitioners, together with relevant government organisations, should monitor trends in infectious diseases, as well as other relevant indexes, such as vectors, pathogens, and water and food safety. They should advise policy makers of the potential risks associated with climate change and develop public health strategies to prevent and reduce the impact of infectious disease associated with such change. • Doctors and other clinical practitioners should be prepared and supported in the provision of health care for any expected extra cases associated with climate variation and should play an important role in relevant health education on climate change. • Community participation is of significance to adapt to and mitigate the risk of climate change on population health. Community involvement helps to deliver programmes which more accurately target local needs. Therefore, community should be involved in the partnerships of climate change as early as possible. • Relevant education programs on the potential health impact of climate change should be conducted by government at all levels for different stakeholders, including industries, governments, communities, clinicians and researchers. • Advocacy for adapting to and mitigating climate change should be a longstanding public health activity. 2. Implication for researchers • The main task for researchers is to identify the independent contribution made by key climatic variables and whether there are exposure thresholds for infectious disease transmission. Further studies should include various infectious diseases in different climatic regions. • Developing countries and rural regions are more vulnerable to the impact of climate change so more research should be conducted for people living in those regions. • Studies using summary measures that combine prevalence of disease, quality of life and life expectancy, such as Disability Adjusted Life Years (DALYs), to assess the burden of disease due to climate change is necessary to assist in decision making. • More research should be conducted on the assessment of adaptive strategies and mitigation to future climate change. 3. Implication for policies • Public and preventive health strategies that consider local climatic conditions and their impact on vector and food borne diseases are important in reducing such impact due to climate change in the future. • The extra health burden that may be caused by future climate change may have a great impact on the currently overloaded public health system in both developed and developing countries. Long-term planning about health resource allocation, infrastructure establishment, and relevant response mechanisms should be developed at relevant government levels. • Effective prevention and intervention strategies will be possible only if the efforts of relevant sectors, including governments, communities, industries, research institutions, clinical professionals and individuals, have coordinated responses. • International and regional collaborations are necessary to address this global issue. In addition, strategies of an international dimension should be translated into regional and local actions. This is extremely important to developing countries such as China and India. • Sustainable development policies with consideration given to reducing green house gases and environmental degradation need immediate action which will benefit future generations. Health priorities should include the prevention of climate change. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1290777 / Thesis(Ph.D.)-- School of Population Health and Clinical Practice, 2007

Scholars agree that global climate change is a major threat to the physical environment, affecting all aspects of life on the planet. However, the general public do not feel that climate change is a major risk or threat, especially to humans. It is important to understand the public’s perception and opinions of climate change as it affects and influences the creation and passing of climate change adaptation and mitigation policies. Specifically, little is known about public perceptions in regards to the greater health risk imposed by global climate change. This study examines the public's perception of health risks related to climate change in Broward County, Florida by using mixed methods. An online survey was conducted along with in-person interviews with the general public and a physician. The study found majority of respondents to believe climate change affects health, but lacked an understanding of how it is harmful to their health. It also found that gender affects their perceptions and political ideology appears to have an effect, but the effect of socioeconomic status on their perceptions were unable to be determined at this time. Broward is just developing policies to adapt and mitigate the health effects of climate change. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Thesis (DPhil (Geography and Environmental Studies))—University of Stellenbosch, 2007. / Background The Disaster Management Act (Act 57 of 2002) instructs a paradigm shift from preparedness, response and recovery towards risk reduction. In order to plan for and mitigate risks, all spheres of government must firstly assess their hazards, vulnerabilities, capacity to cope and therefore risks. Studies in this regard, in South Africa, have however only focussed on current risks. Climate Change has now been accepted by leading international studies as a reality. Climate change can impact upon many aspects of life on earth. Studies to quantify the impact of climate change on water resources, biodiversity, agriculture and sustainable development are steadily increasing, but human health seem to have been neglected. Only general predictions, mostly regarding vector-borne disease and injury related to natural disasters are found in literature. Studies in South Africa have only focussed on malaria distribution. Most studies, internationally and the few in South Africa, were based on determining empirical relationships between weather parameters and disease incidence, therefore assessing only the hazard, and not the disaster risk. Methodology This study examines the impact of climate change on human health in the Western Cape, within the context of disaster management. A qualitative approach is followed and includes: · A literature overview examining predicted changes in climate on a global and regional scale, · A discussion on the known relationships and possible impacts climate change might have on human health, · A disaster risk assessment based on the status quo for a case study area, the Cape Winelands District Municipality, · An investigation into the future risks in terms of health, taking into account vulnerabilities and secondary impacts of climate change, resulting in the prioritisation of future risks. · Suggestions towards mitigation within the South African context. Results The secondary impacts of climate change were found to have the larger qualitative impact. The impact of climate change on agriculture, supporting 38% of the population can potentially destroy the livelihoods of the workforce, resulting in poverty-related disease. Other impacts identified were injuries and disease relating to temperature, floods, fire and water quality. Conclusion Risk is a function of hazard, vulnerability and capacity to cope. The impact of an external factor on a ‘spatial system’ should be a function of the impacts on all these factors. Disasters are not increasing because of the increase in the frequency of hazards, but because of the increasing vulnerability to hazards. This study illustrated that the major impacts of the external factor could actually be on the vulnerabilities and the indirect impacts, and not on the hazard itself. Climate change poses a threat to many aspects of the causative links that should be addressed by disaster management, and its impacts should be researched further to determine links and vulnerabilities. This research also illustrates that slow onset disasters hold the potential to destroy just as much as extreme events such as Katrina, Rita or a tsunami. It also reiterates that secondary impacts may not be as obvious, but are certainly not of secondary importance.

Climate change is regarded as the greatest threat facing the world today. The Intergovernmental Panel on Climate Change (IPCC) concluded that climate change is caused by human activities, as a result of greenhouse gases (GHGs) being emitted into the atmosphere. Scientific literature on the impact of climate change is well documented, especially for the health sector. The mission of the Gauteng Department of Health (GDoH) is to “contribute towards the reduction of the burden of diseases in all the communities in Gauteng”. Ekurhuleni Health District is part of GDoH and shares a similar mission. However, this mission is under threat due to the direct and indirect impact of climate change on the public health sector. Therefore, it is essential for Ekurhuleni Health District and Provincial Clinics to take measures to reduce their contribution to climate change in the light of improving the health of their constituent. This study estimates the carbon footprint of the employees of Ekurhuleni Health District and Provincial Clinics and determines the knowledge and perception of climate change among managers and operational employees. The methodologies of the Greenhouse Gas Protocol (GHGP) and the Department of Environmental Forestry and Rural Affairs (DEFRA) were used to quantify the carbon footprints of the employees of the Ekurhuleni Health District and Provincial Clinics. A content analysis was applied to determine the knowledge and perception of climate change. The study revealed that Scope 2, indirect emissions (electricity), accounts for 92% (35150 t CO2e) of the total carbon footprints for the period of five years, 2010-2014. Scope 1, direct emission (vehicles), is responsible for 4% (1362 t CO2e) and Scope 3, indirect emissions for ICT, for 2% (862 t CO2e), office paper 1% (181 t CO2e) and air conditioners 1% (458 t CO2e). The majority of employees demonstrated basic knowledge of climate change. However, the concept of GHGs was unfamiliar to most of the employees. In terms of perceptions of climate change, the majority of employees were concerned about the future of the planet and climate change and believed that climate change will impact their job description. The study recommends the following mitigation measures, among others, to reduce carbon footprints: (1) electrical vehicles; (2) substituting personal desktops with laptops; and (3) substituting HFC-23 air conditioner refrigerant with R410A. These recommendations have the potential to reduce the carbon emissions by 2445 t CO2e for the period of five (5) years and save R7 875 089 from fuel and power consumption. Furthermore, the District Office and Provincial Clinics can generate a revenue of R293 400 by registering for a CMD project for five years or R1 173 600 for the duration of the project (20 years). / Environmental Sciences / M. Sc. (Environmental Management)

Livelihood stressors in southern Africa, such as HIV/Aids and climate change, do not act in isolation but rather interact concurrently in complex socio-ecological systems with diverse, interrelated and compounded affects. Households experience differential vulnerability to such stressors based on contextual factors such as geographical location, income level and the gender and age of its members. Households’ differential experiences of vulnerability are further defined by the households’ use of their capital stocks: the human, social, natural, financial and physical capital available to the household to form livelihoods and resist the detrimental effects of a stressor. The capital stocks of 340 households were measured in two sites in the Eastern Cape, South Africa, using a household survey. These data were analysed to determine differences between the sites, households with heads of different gender and households of different income levels. Further data relating to the drivers and interactions of stressors over temporal and spatial scales, as well as the perceived value of various forms of capital by different social groups in the two sites, were collected via Participatory Learning and Action (PLA) methods including timelines, mental modelling and pair-wise ranking. Although the two sites have similar levels of income and fall within the same province, many significant differences emerged. The two sites showed different distributions of household head genders and different stressors and perceptions of vulnerability, perhaps owing to differences in their capital stocks, acting alongside the influence of culture and access on a shifting rural-urban continuum. These discrepancies further transpired to reflect crucial differential experiences along gender lines and income levels in each site. Vulnerability was often context specific, not only because of unique drivers of stress in different areas, but also because socio-economic groups and localities often had characteristics that could potentially exacerbate vulnerability, as well as characteristics that can potentially facilitate adaptive capacity. Stressors were found to have depleted multiple forms of capital over time, while new stressors were emerging, raising concerns over the most appropriate means of social protection within these contexts.

Climate change and the HIV/AIDS epidemic are two of the most critical long-term global challenges, especially for Africa and even more so Southern Africa. There is great concern that the poor will be unable to adapt to the impacts of climate variability and change while HIV/AIDS will exacerbate the impacts of such stressors and deepen the insecurities of many communities already affected by this disease. Studies that consider the interlinked effects of climate change and HIV/AIDS along with other multiple stressors are increasingly needed. This study, located in two rural communities in the Eastern Cape Province of South Africa, namely Lesseyton and Willowvale, assessed the responses of vulnerable households to the linked shocks and stressors of climate change and HIV/AIDS. This involved assessing, through household surveys, life history interviews and Participatory Learning and Action (PLA), the way in which multiple stressors interacted and affected vulnerable households, the way in which these households responded to and coped with such shocks and stressors, and the barriers which prevented them from coping and adapting effectively. Unemployment emerged as the dominant stress amongst households. The lack of development and having too few opportunities for employment has limited vulnerable households from being able to invest in assets, such as education or farming equipment. This, in combination with the impacts of increased food and water insecurity from recent drought, has created an extremely vulnerable environment for these households. They rely largely on two important safety-nets, namely social capital and the use of natural and cultivated resources; however the latter has been limited due to the impacts of water scarcity and an inability to farm. It was evident that there was little planned long-term adaptation amongst households and from government. Maladaptive short-term coping strategies, such numerous household members depending on one social grant and transactional sex, were too often relied upon, and although they may have helped relieve the stress of shocks momentarily, they did not provide for the long-term well-being of individuals and households. Poor communication and capacity between the different levels of government and between the government (especially at the local level) and the two rural communities has created an environment full of uncertainty and lacking in advocacy. Local government needs increased human, informational, and financial capacity and a clear delegation of responsibilities amongst the different departments in order for the two communities to benefit from the implementation of support strategies. There is also a great need for educational programmes and capacity development within the two rural communities, particularly based on improved coping and longer-term adaptation strategies in response to climate change in order for households to better prepare themselves for the future.

Indiana University-Purdue University Indianapolis (IUPUI) / In the United States extreme heat events have grown in size and stature over the past 20 years. Urban Heat Islands exacerbate these extreme heat events leaving a sizable portion of people at risk for heat related fatalities. The evidence of this is seen in the Chicago heat wave of 1995 which killed 500 people over the course of a week and the European heat wave of 2003 which killed 7,000 people in the course of a month. The main guiding questions then become how government and the media can most effectively warn people about the occurrence of extreme heat events? Should extreme heat warnings be issued by T.V., newspaper or by radio? Even if warnings are issued will the population at large still change their behavior? Another possible question is whether people most vulnerable to extreme heat will change their behavior? A survey in 2010 by NASA will be the main basis for this analysis. This survey set out to see how well people in Phoenix, Philadelphia, and Dayton responded to extreme heat alerts by changing their behavior.