摘要：There is scientific consensus that the global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to have substantial impacts on human health. There are known, effective public health responses for many of these impacts, but the scope, timeline, and complexity of climate change are unprecedented. We propose a public health approach to climate change, based on the essential public health services, that extends to both clinical and population health services and emphasizes the coordination of government agencies (federal, state, and local), academia, the private sector, and nongovernmental organizations. Weather and climate have been known to affect human health since the time of Hippocrates. 1 Heat causes hyperthermia, 2 , 3 cold causes hypothermia, 4 and droughts cause famine. 5 Injuries, displacement, and death result from floods, 6 , 7 hurricanes, 8 tornadoes, 9 and forest fires. 10 An entire category of diseases—the tropical diseases—is named for a particular climate; climate and weather affect the distribution and risk of many vector-borne diseases, such as malaria, 11 Rift Valley fever, 12 plague, 13 and dengue fever. 14 Weather also affects the risk of foodborne 15 and water-borne 16 , 17 diseases and of emerging infectious diseases such as hantavirus, 18 Ebola hemorrhagic fever, 19 and West Nile virus. 20 There is a well-established if less intuitive association between weather and mortality from cardiovascular and respiratory disease. 21 , 22 The world’s climate has been relatively stable for thousands of years, with a strong temperate central tendency and a nearly constant atmospheric level of carbon dioxide (CO2). 23 For more than a century, however, levels of CO2, methane, and other greenhouse gases have been rising, a trend associated with changes in climate and other earth systems. For example, global mean temperature has increased approximately 0.6°C since 1860, 23 rainfall patterns have changed in many regions, 23 and sea levels have risen. 24 There is evidence that severe storms have become more common, 25 , 26 although the science on this point is not settled. 27 , 28 Global emissions of CO2 continue to increase, and CO2 persists in the atmosphere for approximately 100 years, so the climate will continue to change into the foreseeable future. 29 Models predict that by the year 2100, the world’s mean temperature will rise an additional 1.8 to 4.0°C, sea levels will rise 0.18 to 0.59 m, and weather variability will increase significantly. 23 The potential health effects of climate change have been extensively reviewed. 30 – 35 Principal concerns include injuries and fatalities related to severe weather events and heat waves; infectious diseases related to changes in vector biology, water, and food contamination; allergic symptoms related to increased allergen production; respiratory and cardiovascular disease related to worsening air pollution; and nutritional shortages related to changes in food production. Indirect concerns, for which data to support projections are less available and uncertainties are greater, include mental health consequences, population dislocation, and civil conflict. In addition, changes in the patterns of pests, parasites, and pathogens affecting wildlife, livestock, agriculture, forests, and coastal marine organisms can alter ecosystem composition and functions, and changes in these life-support systems carry implications for human health. 36 These health effects, summarized in Table 1 ▶ , are not discussed in detail here. In the United States, the burden of these conditions is expected to increase as climate change advances. TABLE 1— Anticipated Health Effects of Climate Change in the United States Weather Event Health Effects Populations Most Affected Additional US Health Burden Nonclimate Determinants Adaptation Measures Health Data Sources for Surveillance Meteorological and Other Data for Surveillance Heat waves Heat stress The very old; athletes; the socially isolated; the poor; those with respiratory disease Low to moderate Acclimation; built environment Architecture; air conditioning; warning systems; distributed, resilient, “smart power grid”; community response ED and ambulatory visits; hospital admissions; mortality Daily minimum and maximum temperatures; humidity; soil moisture Extreme weather events Injuries; drowning Coastal, low-lying land dwellers; the poor Uncertain: likely moderate Engineering; zoning and land-use policies Architecture; engineering; planning; early warning systems Attributed risk; ED visits; hospital admissions; FEMA records; mortality Meteorological event data: extent, timing, severity, return time for rare events Winter weather anomalies (e.g., rain, ice) Slips and falls; motor vehicle crashes Dwellers in northern climates; elderly people; drivers Public education; mass transit ED visits Meteorological event data Sea-level rise Injuries; drowning; water and soil salinization; ecosystem and economic disruption Coastal dwellers; those with low SES Low Water pollution; storms; coastal development; land-use policies Sea walls and levees; abandonment Attributed risk; ED and ambulatory visits; mental health measures (indirect Effects) Satellite mapping of coastal areas; sea level and tidal surge records Increased ozone and pollen formation Respiratory disease exacerbation (e.g., COPD, asthma, allergic rhinitis, bronchitis) The elderly; children; those with respiratory disease Low to moderate Smoking; air quality; respiratory infections; industrial activity; electric demand and production mode; access to health care Pollution controls; air conditioning; education; medical therapy ED and ambulatory visits; hospital admissions Daily and weekly temperature; rainfall; pollen counts; ozone levels; particulate measures Drought, ecosystem migration Food and water shortages; malnutrition Those with low SES; elderly; children Low Population growth; food distribution systems; economic and trade issues; biotechnology; petroleum cost Technological advances; enhanced delivery systems; trade negotiations Growth monitoring; food insecurity data Crop yields; rainfall patterns; data on food sources and marketing Droughts, floods, increased mean temperature Food- and waterborne diseases Swimmers; multiple populations at risk depending on outcome of interest Low to moderate Travel; land use; water treatment and quality; housing quality; food-handling practices Public education; water treatment; medical treatment; watershed management Disease surveillance; ED and ambulatory visits; seasonal patterns in incidence; focused observations at geographic margins Temperature and rainfall data; vector population and habitat/range monitoring Droughts, floods, increased mean temperature Vector-borne disease Outdoor workers; people pursuing outdoor recreation; the poor (without air conditioning/window screens) Low to moderate Travel; vector and animal host distribution; habitat change; land use Public education; vector control; medical prophylaxis and treatment; vaccination Disease surveillance; ED and ambulatory visits; focused observations at geographic margins Temperature and rainfall data; vector population and habitat/range monitoring Extreme weather events; drought Mass population movement; international conflict General population Uncertain: potentially moderate to high Sociopolitical factors; resource use and conflicts; economic development Negotiation and conflict mediation; postdisaster response Event and population movement monitoring; mental health outcomes surveillance Meteorological event data; regional economic and resource use data Climate change generally; extreme events Mental health The young; the displaced; those with depression or anxiety Uncertain: potentially moderate Baseline mental health disease burden Health communication; postdisaster mental health outreach; various therapeutic and medical management options Mental health outcomes surveillance Correlation of mental health outcomes with regional variable responses to extreme events; climate change as a whole Open in a separate window Source. Adapted from Patz et al. 37 and Balbus and Wilson. 38 Note. ED=emergency department; FEMA=Federal Emergency Management Agency; SES=socioeconomic status; COPD=chronic obstructive pulmonary disease. There is evidence that climate change has already affected human health. The World Health Organization (WHO) estimates that by 2000, the global burden of disease from climate change had exceeded 150 000 excess deaths per year. 31 , 39 Although individual weather events cannot be attributed to climate change, the rising burden of storms such as Hurricane Katrina suggests that climate change has already affected public health in the United States. Public health planners and professionals at the state and local level, policymakers, and members of the public all need to consider health a central dimension of climate change and to plan and act accordingly. We propose a public health approach to climate change.
