Global Public Health in the Face of Climate Change

“Climate change” is the buzz-word of the decade. More and more research is being done, more information is being disseminated, and more public health programs are being put into place. Climate change is an international challenge, it has implications for humanity, ecosystems, and environments at large. Climate is the interaction of solar radiation and the five Earth-based components of climate- atmosphere, biosphere, lithosphere, hydrosphere, and cryosphere (1). There are natural shifts in climate as well as external factors that can cause change. The changes caused by humans are called anthropogenic changes (1). Anthropogenic changes include atmospheric changes through gas emissions, changes in land use (deforestation), and urbanization to name a few (1). Therefore, climate change can be defined as any change of the five Earth-based components of climate that persists for decades or longer and can be accredited to human activity directly or indirectly (1). In the following, I will discuss anthropogenic changes that cause climate change, the effect of climate change on public health, and interventions that can be implemented to help decrease the health risks of global warming.

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Anthropogenic Sources of Climate Change
Greenhouse gases naturally warm the Earth, humans have been increasing the concentration of greenhouses gases in the atmosphere causing the average temperature of the Earth to warm more than normal (1). The main greenhouses gases are carbon dioxide, methane gas, and nitrous oxide (1). Carbon dioxide comes from burning oil, coal, and gas to produce heat, electricity, and energy for transportation(1). Carbon dioxide is also emitted through burning trees and other industrial manufacturing processes like cement production (1). Methane gas is common with raising livestock, the breakdown of garbage in landfills, and coal mining (1). Lastly, nitrous oxide is a greenhouse gas that is emitted from sewage treatments, farming practices, and industrial manufacturing processes(1). All of these human practices that contribute to climate change are concerns that need to be addressed on a global scale in order to mitigate future problems. 
Relative Emissions of Countries
 Greenhouse gases have decade to century long half-lives in the atmosphere causing exponential build up in the air (2). Carbon dioxide, for instance, has increased by 31% from pre-historic times to today, and half of that increase has been since 1965 (2). The continued acceleration of climate change predicts an increase in a mean global temperature of 1.7-4.9°C by the end of the century (2) . Research has found that in the past, global warming caused heat waves, weather disasters, malaria, dengue fever, and diarrheal diseases (3). Present concerns include enteric infections (seasonal food poisoning), vector-borne disease patterns, and extreme events (heat waves, floods, cyclones) (3). Anticipated effects in the future entail concerns with grain yields, malaria, and dengue fever (3). Research conducted by Mendelsohn and colleagues finds that climate change damages increase with income (4). Therefore, it can be concluded that higher income countries create disproportionately more emissions through their process than their lower income counterparts. They found that poorer nations would suffer more damages from climate change even though the rich countries caused majority of the problem, this is because poorer countries are located in low latitudes with hot temperatures (4). The wealthiest quarter of the world’s population includes 52 countries in North America, Europe, and the Middle East; most of these countries are in the mid-high latitudes and have cooler climates (4). 
Three Ways Climate Change Impacts Public Health
Global warming is a global concern which automatically categorizes it as a public health matter. The three most concerning public health issues due to climate change are infectious disease, food insecurity, and sea level rise (5). Above, we saw predictions for greater risk for malaria and dengue fever, but there seems to be evidence for increased viral encephalitis, trypanosomiasis, and schistosomiasis as well (5). The theory is that increased temperatures and changes in rainfall will affect the behavior of vector organisms and hosts, thus changing the viability and maturation of infectious agents (5). There have already been reports of malaria and dengue fever moving upwards from malaria prone areas as the glaciers retreat (5). Currently, about 45% of the world lives in areas of potential malaria transmission, by the end of the next century it will be closer to 60% (5). Low temperatures and low rainfall can create an ecological imbalance in certain areas that can trigger epidemics of vector-borne diseases (6). Salmonella and cholera bacteria grow more rapidly in high temperatures (6). Cholera outbreaks have been seen in Bangladesh due to the changing climate (6). Recent reports have shown tick-borne (viral) encephalitis in Sweden has increased due to successive warm winters over two decades (6). These examples depict the global burden of disease caused by climate change. 
For decades, food supply has been a concern, questioning whether we will be able to meet the global demand for food in the future. This question has now been complicated by issues posed by global warming. Developing countries may fare worse, as changes in climate may cause worsening conditions such as prolonged dry periods, limited water for irrigation, increased pests and diseases on livestock, all symptoms of environmental degradation (7). A study considered the possibility of heart disease and cancer becoming more prevalent in developed countries due to the change in food consumption patterns (8). Changes in temperature, fertilization, soil moisture, and pest and pathogen activity will change traditional agriculture practices and have a negative net impact (5). The population in developing countries will have reduced agricultural yields leading to hunger and malnutrition, in turn, increasing the risk of infant/child mortality and lowering life expectancy (5). Asia and Africa are likely to be hit hard because they do not have the means to provide nutritious food to their immensely large population (8). If we look more locally, it seems rural populations that do not have the means to obtain food in an alternative manner will also be negatively affected. Food insecurity can lead to numerous public health consequences including mental health impairment and civil strife (5). This shows that regardless of where you live, the consequences of global warming are real.  
Lastly, as the ocean takes up heat and ice starts to melt, the sea level begins to rise. The sea level has risen approximately 3.4 millimeters/year per °C, this estimate projects an increase of 0.5 to 1.4 meters above the 1990 level by 2100 (9). This is of importance as over half of the world’s population lives within 60km of the sea (5). This rise has the power to displace coastal habitants and island dwellers and wipe out resources. This population would be disproportionately at risk for impacts of global warming. A rise in sea level, warming of the oceans, and changes in the currents will also alter marine ecosystems resulting in concerns with algal blooms (aiding in the transmission of cholera) and production of toxins in seafood (5). Sea level rise will cause inundation, erosion, flooding, salt water intrusion, and wetland loss (10). In the end, resulting in land loss which will take a toll on agriculture with higher prices and lower production. The loss of land then causes a trickle effect to the rest of the economy, lowering prices for oil, gas, coal, and electricity (10). The shrinking land mass, infectious disease prevalence, and food insecurity will, therefore, have a global effect on health and economy but will disproportionately affect certain populations. 
Informing Public of Risks of Climate Change
Considering the enormous effect climate change will have on humanity, it is necessary for the public to be informed of what climate change means for them and for future generations. At present, it seems people have a general idea about climate change and the negative connotation that comes with it, however, the general public does not have much of an understanding of the possible health effects and the changes it will bring to every aspect of life. Surveys completed in Canada, the United States, and Malta show that very few people can describe what climate change is and fewer are able to state health effects on humans (11). If information is not disseminated in a timely fashion, it may be too late to affect change, considering damage has already been done and continues to be done as we speak. It is necessary to inform the public of key messages for limiting effects of global warming such as using cleaner and more efficient energy sources and means of transportation (11). Increasing consumption of fruits and vegetables and reducing intake of meat is another way in which individuals can help (11). If people are not aware of the concerns, how can they be expected to aid in mitigating the ramifications of climate change? For this reason, the public should be completely informed about future issues that will arise due to climate change. Since anthropogenic sources are causing excessive warming of the Earth, humans must be the ones to reduce greenhouse gas emissions any way possible. The goal is to get people to the self-mobilization stage where they are able to take initiative to make a difference, independently of external agencies (12). It has been shown that bottom up decision making is more successful than top-down styles (12) . Empowering stakeholders and allowing them to participate in action, results in much more success than outside agencies enforcing action. 
Public Health Interventions
In order to get the global populous to aid in minimizing the anthropogenic sources of climate change we must prove to enough people that global warming is a serious concern and that they must act to help mitigate the effects. To address this concern, public health practitioners must inform, educate, and empower people about health issues related to climate change on a local level. Health communications will be used to inform the public and policymakers of possible health effects and what actions should be taken for risk reduction. Communications should be tailored to specific populations to ensure comprehension. Possible topics would include lessening domestic energy/water usage, decreasing waste through recycling and composting, changing diets, using energy efficient vehicles, and reducing use of fossil-burning vehicles(13). Public health campaigns can include resources such as the “What You Can Do” Webpage by the Environmental Protection Agency which provides tips for small changes that you can make to reduce greenhouse gas emissions, as well as, a calculator to calculate your household’s carbon footprint. Health Canada regularly puts out a publication entitled “Your Health and a Changing Climate,” which provides up-to-date knowledge of how Canadians are affected by the climate and what lies ahead with global warming. If these resources were better utilized and information and was communicated appropriately to different sub-populations, perhaps change would begin from within small communities. 
Looking at the national level, we consider changes that can be made country-wide to help mitigate global warming outcomes. Presently, there are many initiatives for recycling, conserving water, conserving energy, and reducing emissions. Nationally, these initiatives to “Go Green,” should become the norm, and not an option. It will not be an overnight change, but the government should foster a green environment, and not allow people to choose the role of environmentalist. For example, energy reducing and water saving residential items should be mandatory, there should only be LED lights and eco-toilets and water-saving shower heads available for purchase on the market; production/import of non-eco-friendly products should be banned. All new buildings and homes should be built in every eco-friendly manner possible. Hybrid and electric vehicles should become the norm and not a rare vision. If the government enforced “green living” it would reduce society’s carbon dependence and create a pro-environmentalist self-identity for the nation (13). A green nation would have to make public transportation more affordable and create more options for not using vehicles such as bike lanes, accessible transit, and more. The key is to be creative, in 2014, Beijing started taking plastic bottles as credit for train fare; though it may not make a significant difference in the amount of recycling, it raises awareness and gives people an opportunity to recycle (14). If governments take the initiative to not only encourage a greener lifestyle, but also ban products that increase our carbon footprint, industry will have to follow suite. It is the technological revolution, anything is possible. 
Globally, countries are already working towards to cutting down emissions and combating climate change through the Paris Climate Agreement. The agreement is aimed at diminishing effects of global warming and cutting down the global carbon footprint. This may be a step in the right direction, however, damage has already been done. As a global populous, we must address problems that will be of concern regardless of climate change efforts being made now. Food insecurity is one of these concerns. Global warming will cause food insecurity on account of changing yields due to changing temperatures and rainfall amounts, access to fruits, vegetables, and protein, as well as, access to clean drinking water. There may also be reduced water available for irrigation, conditions promoting pests and disease on crops and livestock, soil erosion, and desertification (7). Sustainable development goals were integrated into the millennium development goals (MDG) at the Rio +20 summit in 2012, including a food security goal. The difficulty is finding opportunities and solutions for global food security. It begins with education, investment in people to enhance the ability for farmers to adopt more advanced technologies and crop-management techniques to obtain higher return on their land (7). Education and research on water harvesting and conservation can also aid in increasing crop productivity (7). An increases of 2 to 3 times in crop yields for water harvesting trials in Burkina Faso, Kenya, Niger, Sudan, and Tanzania was seen, compared to dryland farming techniques (7). These innovative farming techniques not only aid in increasing food yields, they also reduce pollution and ensure habitat quality through proper management of soil, water, and natural vegetation (7). We can see the benefits of implementing new farming practices around the world, however, funding is not necessarily available. Whether it is monetary support or better trade policies, international leaders and agencies must come together to support one another to ensure global food security. 
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