Urbanisation + climate change 2.6-2.10 Flashcards
1
Q
Which factors will influence infectious diseases?
A
Climate change - water, vectors e.g. Dengue, malaria
Urbanisation, population growth
Air quality + pollution
Conflict
Finance, poverty + inequality
Drug resistance
Medical advances - access to vaccines, drugs and diagnostics
Consensus that climate change will alter the nature of IDs seen globally but little consensus on the overall impact
2
Q
What is the impact of climate change on DALYs?
A
Increased DALYs mostly in Africa, SE Asia and Eastern Mediterranean regions
3
Q
Name 3 infectious diseases with the evidence for a link with climate change (WHO)
A
Dengue
Malaria
Leishmaniasis
4
Q
What effect will local warming have on vectors?
A
Increased pathogen replication + growth within mosquitoes e.g. WNV, dengue, malaria, tick-borne encephalitis
Insect/vector density increases
5
Q
Where and why has there been a rise in dengue fever?
A
Substantial rise in dengue fever in the last 50 years
Most in SE Asia due to:
Increased urbanisation
Increased population growth/density
Association between rainfall, temperature + humidity and incidence
Effect primarily mediated through effect on aedes population but climate isn’t the only reason
6
Q
What is the vector for dengue fever?
A
Aedes aegypti
7
Q
What regions have an increased risk of transmission of dengue fever and why?
A
Subequatorial regions e.g. Central + S America; SSA; India or SE Asia
Usually in and around these regions due to temperature
8
Q
Name arboviruses on the rise
A
Chikungunya
Zika
West Nile virus
9
Q
What is an arbovirus?
A
Any virus that is transmitted by arthropod vectors (invertebrate with exoskeleton)
80% are asymptomatic with around 20% w/ moderate infection
10
Q
What symptoms do you get with an arbovirus?
A
Fever Flu-like illness Rash Generalised lymphadenopathy Meningoencephalitis in patients > 50 y/o
11
Q
What effect does climate change have on West Nile virus?
A
Warm winters and dry summers favours breeding of city dwelling mosquitoes
Mosquito predators decline with drought
Birds congregate around reduced water sites + birds and mosquitoes mix
WNV mainly transmitted by mosquitoes and primary host are birds i.e. bird-mosquito-bird transmission
12
Q
Why is the UK environment increasingly able to support mosquitoes?
A
Stagnant water especially in water tanks
13
Q
Which HIC is WNV particularly prevalent in?
A
USA
Severe disease can occur in horses but there are vaccinations available for this
14
Q
What impact does climate change have on tick borne diseases?
A
Changes in exposure e.g .increased outdoor leisure activity, travel
Global increase in disease e.g. Lyme
Rise of tick borne encephalitis in central Europe
Congo-Crimean Haemorrhagic Fever
15
Q
What is the current distribution of malaria prevalence and how will climate change affect this?
A
Currently, malaria can be found in subequatorial regions but by 2050 it is estimated that malaria cases will spread outside of these regions and breach into more northern latitudes
16
Q
What are the predicted trends of climate change in the UK?
A
Increase by 2.5-3 degrees by the end of the century
Periods of cold weather less common
More extreme events e.g. floods, droughts
17
Q
What effects will the predicted trends of climate change have in the UK?
A
Increase in food borne, water borne and vector borne diseases
Increase malarial transmission in the UK
18
Q
What climate-related factors affect diarrhoeal disease?
A
Weather (short term) and climate (long term)
19
Q
What methods can be used to assess the weather and what use will this data be for?
A
Time-series analysis; weather exposure + outcome at usually one location
Use: early warning systems
20
Q
What methods can be used to assess the climate and what use will this data be for?
A
Cross-sectional analysis, use of mean values over longer time periods; multilocational
Use: infrastructure planning
21
Q
What is the trend between food poisoning and climate change?
A
Increased food poisoning as mean temperatures increase
22
Q
When does (a) Campylobacter and (b) Salmonella peak?
A
Campylobacter peaks in November
Salmonella peaks in March
23
Q
What is the association between diarrhoea and El Nino?
A
Frequency of diarrhoea admissions associated with El Nino in Peru
El Nino is the warm phases of the warm and cold temperatures as measured by sea surface temperatures of tropical central and eastern Pacific Ocean and increased air pressure in West Pacific and decreased air pressure in East Pacific
24
Q
What is the effect of climate change on severe weather events?
A
Climate change likely to increase the frequency of extreme weather events
Especially, flooding - important effect on infectious diseases
25
What important effects will flooding have on infectious diseases?
Temporary reduction in vector populations
6-8 weeks later, vectors will return and may be a rise in malaria
El Nino rains associated with increase in dengue fever and malaria in Americas
Rise in WNV associated with heavy rains in Europe
Water-borne diseases can be more common - direct contact with polluted water
Epidemic potential e.g. leptospirosis or no. of outbreaks due to increase in rat populations
Population displacement e.g. Sudan (1980) diarrhoeal disease
Flood water can contaminate water supplies
26
Which areas of the world still have high proportions of the population with poor access to safe water?
Asia and Middle East have 1.1 billion people without an improved water source (=wells or public pipes; 20L a day, accessible with a few minutes walk)
27
What is the impact of AMR?
Direct human costs - morbidity and mortality
Economic costs - productivity, GDP growth etc
Indirect costs - "a return to the dark ages" of surgery
28
What are the different approaches to defining urbanisation?
Administrative definition i.e. in the capital
Size or density of population
Definition of economic activity
There is a global trend towards urbanisation
29
Where are the greatest changes of urbanisation taking place? Developing or developed?
Developing countries - transition in the next 20 years when the majority of individuals will live in urban environments
In developed, urban populations are the majority and are likely to grow slowly
Evolution of mega-cities
30
What is the estimated increase in worlds urban population?
From 3.3 billion to 6.3 billion in 2050 (UN, 2008)
31
Which countries will the growth of cities be in?
Mainly in China and India
| Tokyo has the most number of people - 36.4 million people by 2025
32
What are the drivers to urbanisation?
Natural population growth
Significant rural to urban migration
Reasons for migration (economic, conflict etc)
33
What are the consequences of urbanisation?
Rise of morbidity and mortality due to NCDs (HICs)
| Transmission of some IDs whilst reducing some (LICs)
34
What are the effects of ID in rural areas?
New diseases can emerge in urban settings
Emerging disease can spread rapidly in urban settings
Diseases previously seen in rural areas can adapt to urban ones
Certain behaviours more linked to dense populations e.g. IDU for HepC
Greater interaction between human + animal populations
Urban populations are often migratory + linked via travel patterns to many parts of the world
35
Which two types of disease will an increased population density increase the transmission of?
Airborne/respiratory infectious diseases e.g. Flu, measles, TB, SARS
Food/water borne IDs e.g. diarrhoeal disease, cholera
36
Why are informal settlements important to urban health?
Informal settlements are a far greater challenge to urban health in developing countries + can create conditions for spread of ID
Social inequality and health in the urban setting e.g. slums next to rich housing
37
What aspects of the urban physical environment will affect disease transmission and incidence?
Access to clean water and adequate sanitation is sometimes limited e.g. in Lagos 9% individuals have access to piped water
Condition for diarrhoeal disease - cholera
High levels of parasitic infection e.g. soil-transmitted helminths
Poor sanitation - increases rodent population - increases leptospirosis, plague
Large quantities of solid waste - pollution, mosquitoes (aedes for WNV)
38
What effect can urbanisation have on the vector population?
Air and water pollution can hinder vector proliferation
Many species of mosquitoes have adapted to urban environments and can breed in stagnant water (old tyres, tins, plastic containers) e.g. anopheles mosquitoes w malaria
Leishmaniasis - populations can expand into areas where disease is endemic or vectors can adapt to environments where transmission is more likely
39
What effect can deforestation have on infectious diseases?
Increase in displaced populations of vectors e.g. bats which increases ebola
40
What effects can international migration have on infectious diseases?
Migrants to urban areas can be vulnerable to infectious due to imported susceptibility rather than imported infection
In LICs, immunity might be acquired through childhood illness rather than vaccination
41
Give 2 examples of outbreaks which were exacerbated by international migration?
Swine flu
| SARS 2003 - 26 countries affected and 774 deaths
42
What is the definition of a hazard?
Something with the potential to do harm
43
What is the definition of a risk?
The likelihood of something doing harm in a given scenario
44
What is the definition of a hazardous chemical?
Any chemical whose presence or use is a physical hazard or a health hazard
45
Give examples of physical hazards
```
Combustible liquids
Compressed gases, explosives, flammables
Organic peroxides
Oxidizers
Pyrophorics
Unstable or water-reactive chemicals
```
46
What are health hazards?
Those that cause either acute or chronic health effects due to exposure by inhalation, ingestion or direct skin or eye contact
Includes chemicals which are carcinogens, reproductive toxins, irritants, corrosives, sensitizers and chemicals that damage a specific organ or system e.g. hepatotoxins, nephrotoxins
47
What were the main hazards for ill health before the industrial revolution in 18th+19th century?
Infection + deficiencies
48
Describe how the industrial revolution and continued industrialisation around the world has influenced chemical hazards and exposure
Massive increase in industrial processes: large scale manufacturing; construction and agriculture etc
Period of growth worldwide (not everywhere was equal) - generated waste products - little knowledge of effects of exposure
New chemicals/materials still emerging e.g. manufactured nanoparticles
Policy + legislation often country/region specific - exposure to chemical hazards are limited in one area may still be high in others - often contrasting between LICs and HICs
49
Give an example case study of air pollution
Great Smog of London, 1952
Open coal fires led to smoke mixing with dense fog = smog
Visibility reduced to 0 and mortality increased (4000 excess deaths, recently revised to 12 000)
50
What policy/legislation followed the Great Smog of London 1952?
Clean Air Act, 1956
Aim to reduce city smoke - prohibit burning of smoke-producing fuel in certain areas
Updated in the Clean Air Act 1993
51
What policy has London implemented to reduce emissions?
London Low Emission Zone
Feb 2008
Targets larger, heavy, diesel-powered vehicles
To reduce use of these vehicles and therefore reduce PM10 (particulates) and NOx
52
Why was asbestos used?
Used as a building material as it has favourable physical properties e.g. tensile strength, heat resistance
Affects men more than women due to exposure related jobs
53
Why is asbestos not used now?
Some/most forms are toxic - fibres can cause lung damage --> mesothelioma
Long latency - cessation will have an effect on death rate
Worldwide only 60 countries have banned its use, despite health implications
In UK, around 4000-5000 asbestos-related deaths
54
By 2025, how much of the world's population will be living in a condition of serious scarcity?
More than half the population
55
What sign can be used as an example of inequity?
Climate change - CO2 emissions
| There was tension between HICs and LICs during the Paris Agreement
56
Which 2 countries had the highest climate-related deaths in 2000?
South Africa and India
57
Why can droughts affect health?
Related to globalisation and exacerbated by climatic change - represented by fluctuations in food prices
58
Give one case study example of how a drought affected food prices
Russian drought in 2010
17% of total crop area of country was affected - national decline of 33% in the wheat harvest
Ban of wheat export causing 60-80% increase in global prices - major increases in wheat and bread prices in importing countries e.g. Egypt, Syria and Yemen
Causality related to prevention - climate change increases instability
59
What case study was used to illustrate increasing salinity level in coastal areas due to sea level rise?
Bangaldesh
60
Why is Bangladesh vulnerable to natural hazards and the future effects of climate change?
It is situated on a vast river delta for the Ganges, Brahmaputra and Meghna Rivers
Suffers from acute climate events e.g. floods, droughts, cyclones
Long-term environmental degradation e.g. Salinization + soil degradation, river erosion
Effects likely to be exacerbated by climate change and sea level rise
61
What is the effect of rising seawater salinity on human health in Bangladesh?
People consume water mainly from rivers and ponds
62
Why do women suffer disproportionately more during disasters?
70% of world's poor are women
Account for majority of climate-related deaths
Biological vulnerabilities e.g. nutrition, reproductive health
Social vulnerabilities e.g. poverty, discrimination, stigma, sexual violence
63
What is an alternative source of fresh drinking water?
Rainwater
| No or very little facilities for storage
64
Which 3 areas are hotspots for increased salinity?
Vietnam, Shenzhen + Mumbai (India)
65
Define the term 'Anthropocene'
The current geological age whereby human activity has been the dominant influence on climate and the environment
66
How has the Anthropocene period impacted on the burden of 'planetary illness'?
It has increased the burden of planetary illness
| Human health has improved at the expense of planetary health
67
What does the term 'safe operating space' mean?
In order to keep earth hospitable, we need to live within 9 specific limits (the safe operating space)
68
What are the Planetary Boundaries? x9
```
Rockstrom et al., 2009
Climate change
Biodiversity
Pollutants
Deforestation
Aerosol emission
Ozone depletion
Ocean acidification
Fresh water use
Waste
Top 4 boundaries have already been exceeded
```
69
What is the estimated number of excess deaths per year due to climate change?
250 000 additional deaths per year during 2030-50
| Additional costs $2-4 billion per year by 2030
70
What is 'human footprint'?
Net impact of humans on the planet
71
Give 2 quotes regarding the impact of climate change
Climate change is the biggest GH threat of the 21st century - Lancet Commission 2009
The World Economic Forum 2018 estimated that the most likely event with the highest impact would be environmental
72
How much has the world temperature increased by?
Around 0.85 degrees Celsius (WHO)
The last 3 decades have been the warmest on record
- follows the increase in CO2
73
What impact does climate change have on the mean and variance of climate trends?
Climate change will increase the mean and variance of climate trends i.e. more frequent extreme weather events
74
How reliable/true is the evidence on our projected understanding of future risks due to climate change?
Climate models can reproduce
| However, they don't take into account human GHG emissions so if anything, it's been greater in models
75
What agreement is within the United Nations Framework Convention on CC?
Paris Agreement 2015
| It will start in 2020
76
What does the Paris Agreement entail?
195 countries have signed the Paris Agreement
Aim: to keep the increase in global average temperature to well below 2 degrees Celsius above pre-industrial levels
To limit the increase to 1.5 degrees Celsius - to reduce the risks and effects of CC
77
What formal report identifies + assesses scientific, technical and socioeconomic information concerning CC?
The UN's Intergovernmental Panel on Climate Change (IPCC) report
Established in 1988 by World Meteorological Organisation (WMO) - looks at options for adaptation and mitigation
78
What are the key points from IPCC about health?
Health is sensitive to shifts in weather patterns and other aspects of CC
CC is already adding to the burden of disease and illness, world-wide
Most vulnerable are those whose health is most affected by the present day climate
Largest risks: under-nutrition, extreme weather evens + IDs
79
What are the largest risks from CC according to IPCC about health?
Under-nutrition
Extreme weather events
Infectious diseases
80
What mitigation and adaptations may reduce impacts of CC on human health?
Sustainable diets - Planetary Health Diet/2019 - Could avert 11million deaths per year
Floods - flood protection; restoring wetlands for crop fields
Vector borne diseases - achieve development goals, WASH + vulnerability mapping
Heatwaves - public cooling facilities; warning systems; social care networks; communal urban green space
Droughts - preparedness; water re-use; reservoirs
81
What are the health impacts of climate change? x 3
Potentially catastrophic for human survival
Undermine the last half-century of gains in development and GH
A medical emergency
82
What is a heat wave?
A period of excessively hot weather which may be accompanied by high humidity, especially in oceanic climate countries
83
What are the possible health impacts of heat waves?
3 billion at risk in heatwaves
1.4 billion affected by droughts caused by heatwaves
Met Office 2018 stated that we are likely to exceed 1 degree celsius and reach 1.5 degree celsius threshold
Allergen exposure e.g. asthmatics
Heat waves are more likely to impact HICs more than LICs out of all the CC events
84
Give a case study of a heatwave in Europe
Summer 2003 heat wave in Europe
> 70 000 excess deaths occurred in 16 EU countries
Considered one of the worst natural disasters of the last 10 years
A dose relationship between an increase in temperature and mortality can be seen
85
Explain the concept of the harvesting effect
AKA Mortality displacement = a temporary increase in the mortality rate in a given population
Usually attributable to environmental phenomena e.g. heat waves, cold spells, epidemics and pandemics, especially influenza pandemics, famine or war
During heat waves, there are often additional deaths observed in the population, affecting the elderly and the sick. After periods w/ excess mortality, observed decrease in overall mortality during subsequent weeks
86
Who are the susceptible populations during a heat wave?
Age - elderly, young children
Gender - female (nutrition, reproductive health)
Chronic illness - CVS, resp, subjects on meds
Poor social conditions - SE status, isolation; socially isolated
Urban heat island
Individual preventive measures - A/C; changes in behaviour
87
What is the IPCC report split into?
Direct effects
Indirect effects
Social dynamics
Health impacts
88
What are the direct effects included in the IPCC?
Storms
Droughts
Flood
Heat waves
89
What are the indirect effects included in the IPCC?
Water
Air
Land use
Ecological change
90
What are the social dynamics included in the IPCC?
```
Age + gender
Health status
Socioeconomic status
Capital
Health system
Conflict
```
91
What are the health impacts of climate change included in the IPCC report?
```
Injury
CVD/resp disease
Nutrition
Infectious disease
Mental illness
Poisoning
```
92
Give a case study of a drought
Russia 2010
Average temperature increase of 8 degrees Celsius
33% decrease in wheat yield
60-80% increase in global prices
Lack of freshwater supply leading to poor WASH
93
Define epigenetics
The study of inherited changes in phenotype (appearance) or gene expression caused by mechanisms other than changes in the underlying DNA sequence i.e. changes in gene expression that do not involve alterations in DNA base sequence
94
What are the different types of epigenetic modifications which regulate gene expression?
DNA Methylation
Histone modification e.g. acetylation, methylation
Non-coding RNAs e.g. microRNA
95
Describe the importance of epigenetics in relation to cancer
Growing data on importance of epigenetics in aetiology + pathogenesis of cancer
DNA methylation - gene specific and genome wide
Histone modification - active vs inactive histone marks, polycomb group gene silencing
Many cancer risk factors cause epigenetic modifications
96
What is the cancer epigenetics paradox?
Global loss of DNA methylation in addition to locus-specific gain in methylation are causally linked to human cancer
97
Describe the significance of epigenetics on the environment
Endocrine disrupters trigger fertility problems in multiple generations - can alter how genes are expressed in subsequent generations but w/o mutating DNA
Smoking intensity directly correlated w/ hypomethylation at AHRR + 2q37.1 (Shenker et al)
98
Describe the impact of epigenetics on socioeconomic status
Low SE status across lifecourse has been associated with greater diurnal cortisol production, increased inflammatory activity, higher circulatory Abs for several pathogens, reduction in prefrontal cortical grey matter + greater amygdale reactivity to threat
Life expectancy decreases as you go further into central London
99
What are the MDGs and why were they set up?
Millennium Development Goals
Developed in 2008, by 189 countries - driven by the UN Development Programme
Had 15 years to achieve these targets
100
Describe the 8 MDGs
```
Eradicate extreme poverty + hunger
Achieve universal primary education
promote gender equality + empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development
```
101
What was MDG 5?
```
5a = reduce maternal mortality ratio by 75% between 1990-2015
5b = achieve universal access to reproductive health by 2015
```
102
What were the issues with MDG5?
Strategies were broad
Ownership not specified
Insufficient progress had been made in meeting MDG5 (Waage et al., Lancet 2010)
Many outcomes depend on education + deep set beliefs within community
103
What is the global pattern of MDG5?
SE Asia, MMR decreased by 64% 1990-2013
104
What is the success of MDG5 dependent on?
Achievement of the goal is inextricably linked to human development + poverty eradication
105
Which SDGs were focused on maternal health and gender health?
SDG 3 = Healthy lives + wellbeing - reduce MMR to < 70/100 000 live births
SDG 5 = Gender equality - ensure universal access to sexual and reproductive health rights
106
What were the main challenges with MDGs?
Gaps + fragmentation in MDGs - formed independently and then grouped together + edited for political sensitivity
Different definitions of wellbeing
MDGs primarily aimed at the poor but should be applicable to everyone
Not relevant for modern day life as originated from Cold War so not equipped for growing population, environmental effects + limitations of growth based on capitalism
