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“The seminal work of Tony McMichael has led to the growing recognition that human health is threatened by unsustainable global environmental trends. This book is essential reading for those concerned with the future of humanity in the Anthropocene epoch. It compellingly describes how human health will be undermined in the absence of decisive and prompt action but also articulates a visionary way forward through policies which can reduce the environmental footprint of humanity whilst safeguarding health and creating more resilient societies.”
—Professor Sir Andy Haines, London School of Hygiene and Tropical Medicine
“Just as ‘nothing in biology makes sense except in the light of evolution’ (Dobzhansky), nothing in the health of human societies makes sense except in the light of material flows, energy flows, and climate. This magisterial work illuminates that framework, combining historical sweep, environmental, biomedical and epidemiologic insight, common sense, and great compassion. McMichael— one of our greatest health thinkers—has given us an indispensable book.”
—Howard Frumkin, Dean, School of Public Health, University of Washington, Seattle, USA
“The greatest risks of climate change may well be those it poses to human health. Tony McMichael helps us face the future by understanding the past: this is an unprecedented investigation into the interactions between climate and human wellbeing over the entire life of our species. That McMichael’s colleagues have brought his final work to publication is fitting tribute to a lifetime of pioneering research and teaching in climate change and medical science.”
—Sir David King, UK Foreign Secretary’s Special Representative for Climate Change; Former UK Government Chief Scientific Adviser’.
“Tony McMichael was a master at mixing solid research with a good dose of inspiration. He told us that the Earth is no longer able to sustain our avid desire to consume. After reading this book you too may be inspired to become a visionary campaigner, as was Tony, to protect our health from unsustainable environmental trends.”
—Maria Neira, Director of the Department of Public Health, Environmental and Social Determinants of Health, World Health Organization
“For decades Tony McMichael has been among the most insightful authorities on global health and environmental issues. In this book, he provides a guide to the linkages between climate change and human health through the ages. In stirring prose, McMichael carries the story from climate’s role in early human evolution to the current health impacts of a warming Earth. No book could be more timely.”
—J.R. McNeill, Georgetown University; author of Something New Under the Sun: An Environmental History of the Twentieth-century World
“This book constitutes the third in the McMichael trilogy on climate and health. The earlier books described the effects of climate change on human health; this latest volume documents impacts on the health of societies throughout history from changes in climate. While we now better understand how climate has shaped humans and their world in the past, this book gives a sobering and, in the end, frightening vision of where we might be headed in the future.”
—Kirk R. Smith, Professor of Global Environmental Health, School of Public Health, University of California, Berkeley, USA
“Tony McMichael clarifies our thoughts about climate change by shifting the focus from the physics of what’s happening in the oceans and atmosphere to the long term consequences for health, well-being and the future of our (and other) species. Seen through that prism, the need for immediate and meaningful corrective action is obvious.”
—Peter Doherty, Laureate Professor, The Peter Doherty Institute for Infection & Immunity, Melbourne University
“The untimely death of Tony McMichael robbed us of the major source of wisdom about the health impacts, not just of climate change, but of how uncontrolled consumption by homo-sapiens is damaging all our futures. This scholarly book of the historical interplay between climate, human activity and health is his last magnum opus; I hope that politicians read it!”
—Fiona Stanley AC, FAA, FASSA
CLIMATE CHANGE AND THE HEALTH OF NATIONS Q
CLIMATE CHANGE AND THE HEALTH OF NATIONS
Q
FAMINES, FEVERS, AND THE FATE OF POPULATIONS
A NTHONY J . M C M ICHAEL WITH A LISTAIR W OODWARD AND C AMERON M UIR
1Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above.
You must not circulate this work in any other form and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: McMichael, A. J. (Anthony J.), author. | Woodward, Alistair, author. | Muir, Cameron.
Title: Climate change and the health of nations : famines, fevers, and the fate of populations / Anthony J. McMichael with Alistair Woodward and Cameron Muir.
Description: New York, NY, United States of America : Oxford University Press, [2017] | Includes bibliographical references.
Identifiers: LCCN 2016034533 | ISBN 9780190262952
Subjects: LCSH: Human beings—Effect of climate on. | Climatic changes—Health aspects.
Classification: LCC GF71 .M46 2017 | DDC 304.2/5—dc23 LC record available at https://lccn.loc.gov/2016034533 1 3 5 7 9 8 6 4 2
Printed by Sheridan Books, Inc., United States of America
To the grandchildren of our world
List of Illustrations xi
Preface xv
Acknowledgments xix
1. Introduction 1
2. A Restless Climate 22
3. Climatic Choreography of Health and Disease 51
4. From Cambrian Explosion to First Farmers: How Climate Made Us Human 80
5. Spread of Farming, New Diseases, and Rising Civilizations: Mid-Holocene Optimum 108
6. Eurasian Bronze Age: Unsettled Climatic Times 126
7. Romans, Mayans, and Anasazi: The Classical Optimum to Droughts in the Americas 141
8. Little Ice Age: Europe, China, and Beyond 174
Contents
9. Weather Extremes in Modern Times 207
10. Humans throughout the Holocene 227
11. Facing the Future 254
Notes 281 Index 355
LIST OF ILLUSTRATIONS
1.1 Reconstructed global temperature variations during the 11,000 years of the Holocene 2
1.2 Schematic diagram of the main paths, direct and indirect, by which climatic changes affect human health 7
1.3 Variations in average Northern Hemisphere temperature during the past 12,000 years 11
1.4 Changes in globally averaged daily energy use per person during the Holocene 16
1.5 Relationships between temperature and malaria cases in the Solomon Islands, and rainfall and diarrhea cases in Suva, Fiji 20
2.1 The Milankovitch cycles in Earth’s orbital and axial geometry 26
2.2 Schematic representation of the Hadley (three-cell) Circulation, plus main winds, and high- and low-pressure regions 28
2.3 Map of world climate oscillations 30
2.4 Global land-ocean surface temperature trend during 1880–2012, shown as deviations from the 1951–1980 average global temperature 44
3.1 Graph of daily death rate in relation to maximum daily temperature, New York City 54
3.2 Westerly wind strength and rates of Kawasaki Disease in Japan: 1996–2006, by month 64
3.3 Bimodal responses to temperature change: The “Goldilocks Zones” for two critical biological components of malaria transmission in relation to temperature 70
3.4 Relationship between late-spring normalized (soil) water balance (a function of temperature and rainfall) and barley yields in the Czech Republic during the past century 78
4.1 Relationship between temperature and the five major natural extinction events since the Cambrian “explosion” 540–510 million years ago 82
4.2 Time-trends in global temperature and global ice volume during the past 450,000 years, showing changes during four glacial periods and four interglacial periods 83
4.3 Evolution of Homo genus 86
4.4 Map of the presumed deadly zone of the Toba eruption 74,000 years ago 93
4.5 Map of Natufian sites in the Eastern Mediterranean 101
5.1 Rock art from Teshuinat II rock shelter, southwest Libya 112
5.2 A timeline during 6000 to 0 b.c.e., focused on climate change (in Eurasia and Egypt), the growth of those early civilizations, and the successive technological ages 116
5.3 The Fertile Crescent region, indicating the civilizations of early Egypt and Mesopotamia 118
6.1 Periods of peak drought stress in early Near Eastern agricultural settlements, estimated from the isotopic composition of extant barley grains 127
6.2 Northern hemisphere summer-winter oscillation of the Inter-Tropical Convergence Zone (ITCZ) as it follows the interseasonal north-south excursion of the sun 128
6.3 Hammurabi’s Babylonia, showing the imperial territory at his ascension (1792 b.c.e.) and death (1750 b.c.e.) 132
6.4 Early and mature Harappan sites (3200–2500 b.c.e.; 2500–1900 b.c.e.) 134
6.5 The Sea Peoples migrations into and around the Eastern Mediterranean during the second millennium b.c.e 136
7.1 Map of main invasion routes of major barbarian tribes during the third to sixth centuries 149
7.2 The northern Silk Road and southern Spice (Eastern) trade routes 154
7.3 Fluctuations in annual temperature in Western Europe and Scandinavia during 450 to 650 c.e. (based on tree ring data from seven regional sites) 156
7.4 The main lowland and highland Classic Maya centers 160
7.5 Annual rainfall during the Classic Maya civilization 165
7.6 Variations in drought conditions over 2.5 millennia, based on lake-floor sediment isotope profile, Pyramid Lake, Nevada, United States Southwest 167
7.7 Range and severity of the mid-12th-century drought in southwest America 168
8.1 Variations in European temperature (relative to 20th-century average) and in solar activity during 900–2000 c.e 175
8.2 Annual variations in the grain price and estimated rates of marriage and death in southern England during the Great European Famine, 1315–1322 178
8.3 The spread of the Black Death in Europe during 1346–1353, including western Russia, the Middle East, and North Africa 183
8.4 Yearly distribution of 6,929 documented bubonic plague outbreaks in the greater European region during 1347–1900 184
9.1 Length of yearly growing season in southern Maine. In 1816, “the year without a summer,” the growing season was half the normal duration 211
9.2 Bubonic plague, the Third Pandemic. Graph of annual incidence in China, ca. 1850–1950, and map of outbreak sites in annual rainfall zones 218
9.3 Time trend in the annual percentage growth rate of world population: actual 1950–2010 221
10.1 Temporal background to climatic influences on evolution of human biology and culture 228
PREFACE q
This book is about how climate has played upon the health and fates of populations throughout the 200,000-year odyssey of the human species. You may ask: “Why write a book about the past when today’s big challenge is to avert future climate change?” My answer is that knowledge about past human experiences of natural climate shifts alerts us to the risks that humankind faces. The landscapes of past millennia are littered with famines and fevers, often provoked by natural changes in climate systems. The future prospect may be darker if, as now seems likely, unusually large and rapid climate change, accompanied by extreme weather variability, lies ahead.
“Histories are written to help explain how we got where we are,”1 and I argue that history can also help explain where we may be heading. Earth’s biography offers us a natural historical analog of future climate change—albeit one that cannot clearly predict the consequences of the more extreme forms of climate change that may occur later this century.
But historical insights may help jolt us out of policy-paralyzing complacency and deferral of responsibility—the “moral economy of inaction.”2
Naive assumptions that incremental technical adjustments and adaptations will allow us to pursue business as usual reflect a deep ignorance about the complex nature of the real world. Yet I believe
that there is still cause for optimism. Global information flows are heightening awareness of the causes, processes, and consequences of climate change. Young researchers, willing to look beyond the conventional bounds of their disciplines, are now engaging with this topic, responding to challenges, and knowing that their work is contributing to the global common good at this epochal time. As people’s knowledge about, and experiences of, climate change accumulate, as climate science strengthens, and with a reality check garnered from history’s archives, we humans may yet take extraordinary international action. Many national governments now see that their future economic security is threatened by climate change—and that responding to it provides social and economic opportunities.
Despite the economic stranglehold exerted by the fossil fuel industry, for example, renewable energy systems are now evolving rapidly.
As an environmental epidemiologist3 and medical graduate, my interest in this topic began when writing an Australian national newspaper column, Spaceship Earth, in the early 1970s—a time of rising concerns about “limits to growth” and the environmental hazards associated with industrial expansion.4 There was much concern about direct chemical toxicity and the spread of synthetic pesticides through nature’s food chains, but concern also was growing that human intrusion on the natural environment was endangering living organisms and their ecosystems.
The risks posed by climate change to human health and physical survival are now better known. Since the early 1990s, I have contributed to the assessment of health risk by the UN Intergovernmental Panel on Climate Change (IPCC), and have done likewise in Asian and Pacific countries for the World Health Organization. My knowledge of this field has benefited greatly from working with colleagues who are experts on diverse aspects of climate change, the physical and social sciences, and population health.
My hope for this book is that better insights into the influence of climate change on human populations and their societies will help motivate more effective changes in how we live and how we care for the planet. Exposure to unusual climatic fluctuations and shifts over the past two million years accelerated the evolution of a powerful, flexible, and creative human brain. Having long used that brain to satisfy the
basic urges to own, acquire, control, and consume, we must now apply our collective brainpower to halting the unusual change in climatic behavior that our creative and acquisitive actions have caused.
Tony McMichael, Australian National University, Canberra, July 2014
My husband, Tony McMichael, worked on this book in between other commitments from around 2011 to September 2014. The book stems from Tony’s keen interest in the long history of health and disease and upon his pioneering work, stretching over more than 20 years, on the impact of climate change on human populations. He wanted this book to contribute to a better understanding of the intertwined relationship between humans and their environment, and to how human populations are impacted by, and impact upon, the life support systems of our planet. A full manuscript was submitted to Oxford University Press in early 2014 and was subsequently accepted subject to attention to reviewer comments and a reduction in length. Tony was looking forward happily to completing the book, but he died unexpectedly on September 26, 2014.
The book has been revised and edited, therefore, by Alistair Woodward and Cameron Muir. Alistair, a longstanding colleague of Tony’s and his successor as a coordinating lead author for the Intergovernmental Panel on Climate Change, applied his population health perspective. Cameron brought his knowledge of environmental history and overall editing expertise.
My family, as well as Tony’s many friends and colleagues, miss him sorely. We are happy that this, his last book, has been published and joins his many other publications in expanding our understanding of the intersections between environments and human well-being and the grave risks that we humans face in a warming world.
Judith Healy, Australian National University, Canberra, January 1, 2017
ACKNOWLEDGMENTS
Tony McMichael enjoyed discussing aspects of this wide-ranging book with many people during its gestation, and some people read and commented upon early drafts of the whole book or particular chapters. Tony did not keep an up-to-date list, however, of the many people whom he consulted, since he knew who they were, what suggestions they had made, and the lines of inquiry along which they directed him. We are embarrassed, therefore, that the following acknowledgments are very partial and hope that the many people not mentioned will understand.
Tony appreciated the support given him by the Australian National University and by his colleagues at the National Centre for Epidemiology and Population Health, whose director he was from 2001 to 2007, then as an NHMRC Australia Fellow and latterly as emeritus professor. The Rockefeller Foundation Bellagio Center offered a stimulating environment for researching and presenting his ideas during a residency in 2012. Tony also appreciated the steadfast assistance of Andrew Schuller in shepherding the book through to a publisher—as did we during the later stages of the book. We are also grateful to Laura Ford for checking and completing the references.
Many other people assisted in various ways, and as acknowledged, the following is a very incomplete (in family name alphabetic order) roll call: Phillip Baker, John Brooke, Colin Butler, Andrew Glikson,
Billy Griffiths, Andy Haines, Adrian Hayes, Clive Hilliker, Allen Isaacmann, Allan Kearns, Tord Kjellstrom, Sari Kovats, Philip McMichael, John McNeill, Jonathan Patz, Eric Richards, Kirk Smith, Robin Weiss, and Steve Zavestoski.
Judith Healy, Australian National University, Canberra, January 1, 2017
Introduction
Trends in global greenhouse emissions during the first two decades of this twenty-first century are leading us to a much hotter world by 2100, perhaps 3°C–4°C above the late-twentieth-century average temperature1,2 and hotter than at any time in the last 20–30 million years. Further, the rate of heating would be about 30 times faster than when Earth emerged from the most recent ice age, between 17,000 and 12,000 years ago. At that speed, environmental changes may outstrip the capacity of many species to evolve and adapt.
Having once relied on fires in caves, humans in the late eighteenth and nineteenth centuries increasingly began to burn fossil fuels to release vastly more energy—and, inadvertently, vastly more carbon dioxide. About 600 billion metric tons of that invisible, stable, and odorless gas have been emitted since 1750, about two- thirds of which will persist in the atmosphere for centuries. The resulting 40 percent increase in atmospheric carbon dioxide concentration is the main cause of human-driven climate change. We have wrapped another heat-retaining blanket around the planet, causing warming of Earth’s surface at a rate that far outpaces nature’s rhythms.
Humans have lived in climatically congenial times for the past 11,000 years of the Holocene geological epoch compared with the rigors of the preceding ice age. Figure 1.1 shows the world’s estimated average surface temperature over that era, and the right-hand side of the graph shows the likely global warming by 2100 averaged across many
published modeled projections. The difference between the peak temperature of 7,000 years ago and the nadir of the Little Ice Age 350 years ago is 0.7°C. By early in this twenty-first century, the global average temperature had edged higher than for the past 11,000 years—by 0.6°C in six decades.3,4 If the world’s temperature were to rise by 3°C–4°C within just three generations, our descendants might struggle to remain healthy, raise families, and survive within stable societies. I am certainly not the first to say this …
A 4°C temperature increase probably means a global carrying capacity below 1 billion people. (Hans Joachim Schellnhuber, Director, Potsdam Institute for Climate Impact Research, at the Copenhagen Climate Change Conference in 2009)5
In such a 4°C world, the limits for human adaptation are likely to be exceeded in many parts of the world, while the limits for adaptation for natural systems would largely be exceeded throughout the world. (Rachel Warren in Philosophical Transactions of the Royal Society 2011)6
Figure 1.1 Reconstructed global temperature variations during the 11,000 years of the Holocene. Marcott, et al., “A Reconstruction of Regional and Global Temperature for the Past 11,300 Years.”7
Permission received from AAAS.
Piecing together an untold story
No one has yet told the full story of the historical interplay between climate change, human health, disease, and survival. Scholars have written about parts of the story, in some parts of the world, but a comprehensive account was not possible before recent advances in understanding of the climate system and the high-tech and detailed reconstructions of past climates.8,9,10 Also, more information is emerging about population health, from sources such as high-resolution identification of food traces in pottery fragments and genotyping of bacterial DNA in human skeletal samples.
Ecologists are using past situations of natural climate change to learn how species and ecosystems responded.11 Modern technologies, particularly those of molecular biology, are enabling us to learn from past human experiences about aspects of our species’ biological vulnerability, such as the consequence for the immune systems of gene exchanges via interbreeding between Homo sapiens and our Neanderthal and Denisovan cousins around 40,000 years ago.
The field of climate science has expanded enormously, and scholars have produced a large amount of literature on the science of past and present climate change and future climate projections. This includes the pivotal synthesizing work of the Intergovernmental Panel on Climate Change (IPCC), a large international scientific body established by the United Nations in 1988 in response to the anticipated damages from human- caused climate change.12 The IPCC’s flagship series of five Assessment Reports on the science and impacts of climate change, published during 1990–2014, are a key source of information.
Even so, much less has been written about the likely risks to humans and their communities—especially the risks to population health, survival, and social stability.13,14 In this book, I aim to weave historical threads together to gain a better understanding of how climate change affects human populations. Unlike the other momentous human-induced global environmental changes that now press on the living world, such as stratospheric ozone depletion, there is a historical analog of today’s human-driven climate change. The world’s climate has always varied naturally, a fluctuating and sometimes turbulent platform for the
evolution of life and for the emergence of human cultures and societies, and the health of their populations.
Some argue that it is the fact that the future may be like the past that makes science possible, while the fact that the future may not be like the past makes science necessary.15 Although climate change this century will differ greatly in speed and extent from natural climate changes over past epochs, thus making new modes of science necessary, I believe insights from studying past climatic experiences will help us anticipate the scale and nature of hazards that may lie ahead.
Historian Geoffrey Parker concludes from his research on the global crisis of the seventeenth century that Europe’s dire climate at that time strongly influenced the health and survival of communities and their social and political stability. He wrote:16
“We have only two ways to anticipate the impact of a future catastrophic climate change … Either we ‘fast- forward’ the tape of history and predict what might happen on the basis of current trends; or we ‘rewind the tape’ and learn from what happened during global catastrophes in the past. Although many experts (mainly climatologists, sociologists, and political scientists) have tried the former, few have systematically attempted the latter [my emphasis] … [from which] we may learn some valuable lessons for dealing with the climate challenges that undoubtedly await us and our children.”
The history of natural climate changes over the past six or seven millennia should shed light on how those changes influenced the health and survival of human societies. Interesting questions abound. Did climate change during the approaching depth of the glacial period around 23,000 years ago b.c.e. (Before Current Era) hasten the demise of our cousins, the Neanderthals? How did the prolonged drying of the Sahara 5,500 years ago, or of southern Mesopotamia 4,000 years ago, affect food yields and hence the health and the viability of those societies? How did climatic fluctuations influence the outbreaks of the first two bubonic plague pandemics in the sixth and fourteenth centuries c.e. (Current Era) respectively?17 Did the five dynastic collapses in
China over the past millennium mostly occur after periods of unusually adverse climatic conditions?
Other exogenous environmental factors, such as regional differences in soil fertility, water supplies, numbers of plants and animal species amenable to domestication, and access to trade routes, influenced the long-term development, wealth, technical sophistication, and power of societies.18 The same can be said of the natural shifts, cycles, and fluctuations in the climate. Examples include:
• The 500-year Roman Warm, particularly the temporary northward excursion of the Mediterranean climate zone in Europe that facilitated the Roman Empire’s expansive phase by, for instance, boosting agricultural productivity.
• The wild rodent expansion in Central Asia around 1300 c.e. associated with climatic change, setting in motion the sequence of events leading to outbreaks of bubonic plague in China and subsequent epidemics in Europe in the 1340s.
• The influence early in seventeenth-century Europe of the unusually cold and wet weather on food crises, starvation, deaths, epidemics, social disorder, conflict, and warfare, most notably the chaotic Thirty Years’ War.
But are the past and future comparable? Does today’s global connectedness, for example, offset the risks that once applied to regionally isolated societies? Have rich urban-industrial populations buffered themselves against the main risks of climate change? The answers may surprise us unpleasantly. The OECD warns, for example, that modern hyper-integrated IT-dependent urban populations have become increasingly vulnerable to the potential havoc caused by major external environmental stressors.19 The partial collapse of New York’s infrastructure caused by Superstorm Sandy in late 2012 underscores that point.
Avoiding the shoals of “climatic determinism”
Changes in climate rarely act alone. Typically, climate change acts as a contributor or an amplifier. It may be the dominant causal factor in a
surge of deaths during an extreme heat wave; it may be a contributory factor to a decades-long downturn in regional crop yields with downstream effects on nutritional health and mortality; it may be a predisposing factor in a community’s decision to migrate.
Contending academic disciplines see the world differently; the debate over “environmental determinism” is a prime example. During the nineteenth and early twentieth centuries, there was strong support for the idea that “a society’s physical environment can control its cultural development,”20 especially among anthropologists and archaeologists. But many social scientists and historians were hostile to this view. In the mid-1950s, Swedish economic historian Gustaf Utterström broke ranks, arguing that the cold and adverse climate in the sixteenth and seventeenth centuries accounted for much of Scandinavia’s demographic and economic setback at that time.21 The French historian Fernand Braudel also acknowledged that changes in climate had played an important role, particularly as part of what he called the longue durée changes in population profiles, environment, and climate—that is, the great undercurrents that shaped the fates of civilizations, their cultures, ideologies, and power structures.22
Other scholars who argued that social historians should take climate into account include Emmanuel Le Roy Ladurie in his seminal book Times of Feast, Times of Famine, published in 1972.23 Subsequently, several contemporary historians have argued that their discipline should be foregrounding climate as an influence on human affairs.24,25 For example, John Brooke writes, “Over the very long term, the history of a volatile and changing earth has driven biological and human evolution: it has been a rough journey, and we are products of that journey.”26
Still others have raised questions about the “environmentalist’s paradox.”27 Why has human life expectancy continued to increase while our erosion of much of the planet’s resource base and life support system has been increasing? Well, there is no real paradox; it is mostly a problem of inappropriate time horizons. The example of land use is helpful. During the past five millennia, human populations have cut down about half the world’s temperate and tropical forests,
transformed nearly half the non-ice non-desert landscape to croplands or pasture, and built almost one million dams, many of which impede natural river flow.28 Some of these changes clearly have been associated with major benefits for public health, including increased food yields. Over time, many negative impacts of land use change have also occurred. For example, dams and irrigation projects have boosted the occurrence of vector-borne infectious diseases, including malaria and schistosomiasis in parts of Africa and South Asia.29,30 But the full impacts of large-scale human colonization of the planet, such as loss of species and disruption of the global nitrogen cycle, have not yet become apparent.31
Pathways by which climatic changes affect human health
Climate change does not exist, or act, in isolation. Some health impacts of climate change occur directly, from extreme climaterelated exposures (see Figure 1.2). For example, heat waves and
Change: Health Impact Pathways
rivers
In uences on natural biophysical systems Ecological changes: food yields, water quality, mosquito populations, etc.
In uences on biological and ecological processes In uences on social and economic conditions
Impacts
Figure 1.2 Schematic diagram of the main paths, direct and indirect, by which climatic changes affect human health. McMichael, “Globalization, Climate Change, and Human Health.”
Source: Author.32
Permission received from Massachusetts Medical Society.
floods directly kill thousands of people every year. Most climaterelated health risks, however, are mediated by less direct pathways and therefore are modulated by a host of environmental and social factors— and are likely to have much greater adverse consequences for health and survival than the direct- acting risks. Indirect health effects arise via impacts on food yields, water flows, patterns and ranges of infectious disease occurrence, stresses on housing and settlements, impoverishment of the vulnerable, and the movement, sometimes displacement, of groups and populations. In the Horn of Africa, for example, recent surface warming of the western Indian Ocean by up to 2°C, and the associated shifts in patterns of ocean water circulation and easterly moisture- laden winds, have contributed to the emergence of long- term regional droughts and lethal food shortages. 33 ,34 ,35 Climate changes may also undermine the integrity of natural and human- built protection against natural disasters (for instance, coral reefs, mangroves, and storm water systems in big cities).
It is important to identify factors that aggravate or diminish the impacts of climate change, since this knowledge may help us understand the magnitude and distribution of health risks in the future, and also points to practical steps that may be taken to protect those who are most vulnerable. For example, food yields and the downstream effects on nutritional status are sensitive not only to climate extremes such as drought and heat waves, but are affected also by local biodiversity, soil quality, the vigor and health of farmworkers, and stable, functioning food markets. 36
Changes in climate, environment, and ecosystems generally occur on a large spatial scale, and the consequent health (and other) risks impinge at the level of whole communities or populations. These relationships, in their internal interactive dynamics and their scale, are therefore essentially ecological, so we must put aside our usual preoccupation with how specific discrete environmental exposures and personal behaviors can affect an individual’s health. Climate change and its accompanying environmental changes require an ecological reframing of our understanding of how groups
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