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Draft Briefing Paper 01-1-95

IMPLICATIONS FOR HUMAN HEALTH

Summary of the Problem

Global environmental changes have become more critical to human health than we appreciated in the past, when local issues predominated in our thinking. Human activities in the modern economy have resulted in a variety of changes in the Earth system, including greenhouse-effect-related changes in climate, ecosystems and biogeochemical cycles, stratospheric ozone depletion and increased ultraviolet radiation, land degradation, loss of biodiversity, pollution in various environmental media including acid rain, demographic change, natural resource depletion and other effects. The profound implications on human health arising from these changes could be either direct or indirect, mediated by social changes.

Recommendations Regarding the Role of Health Professionals in the Global Environmental Arena: 1-8

• Recognizing the importance of human health issues related to global environmental changes, and understanding root causes;
• Enhancing our capability to deal with and control the present and potential health problems arising from global environmental changes;
• Advocating for and developing measures that promote environmental responsibility;
• Participating in activities that clarify issues, identify and monitor the human health effects of global changes, collect evidence on these effects, conduct research on these issues, and develop alternatives to existing practices, that will minimize the damage to human and ecosystem health;
• Informing public about environmental health issues;
• Providing assistance in helping development of more prudent environmental and health policies by using technical and scientific knowledge. 

Comparatively little attention has been paid so far to the possible effects of global environmental changes on human health, despite the important implications of these changes for human health. In general, the implications for human health of large-scale ecological change are far from obvious and are likely to be largely indirect.

Expert opinions about present trends and future scenarios are worrisome.9-10 What remains to be defined, particularly for health professionals, is what is to be done.11-13 In ecology, not much is obvious and environmental interactions made with the best of intentions may be misguided or ineffective.

Changes in Eastern Europe opened to view examples of regional ecological destruction on an unprecedented scale resulting from forced industrialization without environmental controls.14 Some environmental problems, such as the human and medical wastes observed in the ocean bathing the coastline of Northeastern United States several years ago, have represented extreme examples of more traditional environmental and public health problems. Others, such as chemical degradation of the ozone layer and the suspected "greenhouse effect" of global warming, are qualitatively different and on a scale far beyond our collective experience. Many of these problems are by nature international or regional (such as acid rain) and many involve developing nations (such as deforestation by burning). The degradation of the environment has become a major global problem, outstripping its local public health dimensions and becoming a serious threat perhaps even to human survival. There have been many individual articles in the scientific literature that describe the most likely health outcomes and that promote action in response.1,4,11-28 These efforts have been hampered by the lack of accessible, reliable information on the specific regional changes to be expected.

The impacts of global changes for Canada have immeasurable consequences in environment, economic, social welfare, human and ecosystem health, and policy. Canada will probably experience some of the effects in the future, such as more frequent floods and droughts, crop failure, loss of some species in plants and animals, decrease of water resource, natural resource depletion, more extreme health and behavior events associated with heat waves, and increased rates in respiratory diseases and skin cancer.29-35

The direct effects may be less significant in the end than indirect effects, however. In the past several years, we have become more aware of the links between human health, social interaction and support, personal income, and dysfunctional family and social units. If global change results in poverty, diminished productivity, population migration, social stress, and increased strain on families in agriculture and the fisheries, the result could be increasing levels of substance abuse, family violence, delayed or deferred health care, and stress-mediated illness. An example of how this might happen in unfolding today is the collapse of the Grand Banks cod fishery, apparently from a combination of ecological factors and over-fishing. The widespread social disruption observed in communities in Newfoundland dependent on the resource has added to the community stress and may have reduced the capacity of the communities involved to response effectively. To date, there has been no extensive study of the health implications associated with the economic catastrophe but one is needed.

There are a number of global change programs in the world from which scientists can be constructed in order to project health implications.36 The Canadian Global Change Program created a Health Issues Panel in 1992 specifically to address these issues from a Canadian perspective and to fill the gap in authoritative analysis relevant to Canada.17 The report of this body is due shortly.1 A major report from the Canadian Public Health Association explored the complicated relationship between "ecosystem health" (the integrity of environmental systems) and human health.4 Australia has been particularly well represented in this emerging literature, reflecting a regional concern over ozone depletion in particular.23-24,39-41 The United Nations World Commission on Environment and Development alerted us to the outlines of the dilemma several years ago in Our Common Future (1987)42 but this otherwise comprehensive treatise had very little to say about health. The World Health Organization has produced the most authoritative reports so far on global climate change and health in a traditional sense.16,43 A major new book on the topic by a team of writers associated with Physicians for Social Responsibility has just been released.44 Reports prepared in 1989 by the U.S. Environmental Protection Agency45-46 and the U.S. Department of Energy47 have relevance to Canada. The Canadian Association of Physician for the Environment has produced the series of briefing papers, adopted and updated from a peer-reviewed review article48 based on authoritative source.

References

1. The Royal Society of Canada. Implications of Global Change for Human Health: Final Report of the Health Issues Panel to the Canadian Global Change Program. Canadian Global Change Program Technical Report Series. (Draft), August 1994.
2. Litsios S. Sustainable Development is Healthy Development. World Health Forum 1994; 15:193-195.
3. Canadian Medical Association. Health, the Environment, and Sustainable Development. The Role of the Medical Profession. A Policy Paper for the Canadian Medical Association. Council on the Health Care and Department of Health Services, Canadian Medical Association, August 1991.
4. Canadian Public Health Association. Human & Ecosystem Health. Canadian Perspectives, Canadian Action. Canadian Public Health Association, 1992.
5. Raub WF. Public Health and Responsible Environmental Stewardship: Some Opportunities for Leadership by Physicians. Otolaryngol Head Neck Surg 1993: 109:808-810.
6. Goldstein BD. Global Issues in Environmental Medicine. JOM 1993: 35:260-264.
7. Ruckelshaus WD. The Role of the Medical Profession in the Environmental Arena. Academic Med 1992; 67:146-150.
8. Goldsmith JR. The Role of the Physician in Environmental Health. SAJM 1992; 81:538-539.
9. Nordhaus WD. Expert Opinion on Climate Change. Am Sci 1994; 82:45-51.
10. Beckerman W. Economic Growth and the Environment: Whose Growth? Whose Environment? World Development 1992; 20:481-496.
11. Last JM. A Vision of Health in the Twenty first Century: Medical Response to the Greenhouse Effect. Can Med Assoc J 1989;140:1277-1279.
12. Leaf A. Potential Health Effects of Global Climatic and Environmental Changes. N Engl J Med 1989;321:1577-1583.
13. McCally M, Cassel CK. Medical Responsibility and Global Environmental Change. Annals of Internal Medicine 1990;113:467-473.
14. Hertzman C. Environment and Health in Central and Eastern Europe. Washington DC: World Bank, 1993, in press.
15. Longstreth JD. Global Warming: Clues to Potential Health Effects. J Environ Sci Health [C] Environ Carcinog Rev 1990; 8:139-169.
16. Potential Health Effects of Climatic Change: Report of a WHO Task Group. Geneva: World Health Organization, 1990.
17. Last JM. Global change: A Challenge for the Medical Profession. Ann R Coll Phys Surg Can 1993; 26:13-16.
18. Last JM. Global Change: Ozone Depletion, Greenhouse Warming, and Public Health. Annu Rev Publ Health 1993; 14:115-136.
19. Last JM, Guidotti TL. Implications for Human Health of Global Ecological Changes. Pub Health Rev 1990/91; 18:49-67.
20. Guidotti TL, Last JM. Implications for Human Health of Global Atmospheric Change. Trans R Soc Can 1993; Series 6, v.II:223-239.
21. Last JM. Global Environment, Health, and Health Services. In: Last JM, ed. Maxcy-Rosenau-Last Public Health. New York: Appleton-Century-Croft, 1992.
22. Longstreth J. Anticipated Public Health Consequence of Global Climate Change. Environ Health Persp 1991; 96:139-144.
23. McMichael AJ. Global Environmental Change and Human Population Health: a Conceptual and Scientific Challenge for Epidemiology. Int J Epidemiol 1993; 22:1-8.
24. Butler CD. Global Warming, Ecological Disruption, and Human Health. Med J Aust 1991; 155:351.
25. Haines A, Fuchs C. Potential Impacts on Health of Atmospheric Change. J Publ Health Med 1991; 13:69-80.
26. Marks R. Freckles, Moles, Melanoma, and the Ozone Layer: a Tale of the Relationship between Humans and their Environment. Med J Aust 1989; 151:611-613.
27. Haines A, Parry M. Climate Change and Human Health. J Roy Soc Med 1993; 86:707-711.
28. Haines A, Epstein PR, McMicheal AJ. Global Health watch: Monitoring Impacts of Environmental Change. Lancet 1993; 342:1464-1469.
29. Environment Canada. A Matter of Degrees: a Primer on Global Warming. The Environmental Citizenship Series. Environment Canada, En1-21/1-1993E.
30. Hengeveld H. Understanding Atmospheric Change. A Survey of the Background Science and Implications of Climate Change and Ozone Depletion. A State of the Environment Report, No. 91-2, 1991.
31. RhÈaume G. The Challenge of Climate Change. Policy Options for Canada. A Conference Board of Canada Report 112-93, 1993.
32. Jackson CI. Global Warming: Implications for Canadian Policy. Prepared for Climate Change Digest, Atmospheric Environment Service. A State of Environment Report, Environment Canada, EN57-27/1992-1.
33. Nuttle WK. Adaptation to Climate Change and Variability in Canadian Water Resources. Prepared for Climate Change Digest, Atmospheric Environment Service. A State of Environment Report, Environment Canada, 1992.
34. Canadian Climate Program Board. Climate Change and Canadian Impacts: The Scientific Perspective. Prepared for Climate Change Digest, Atmospheric Environment Service. A State of Environment Report, Environment Canada, 1991.
35. Health and Welfare Canada. A Vital Link: Health and the Environment in Canada. Health and Welfare Canada, 1992.
36. Organisation for Economic Co-operation and Development (OECD). Global Change of Planet Earth. OECD, France, 1994.
37. Hengveld H. The Global Warming Challenge. Understanding and Coping with Climate Change in Canada. Environ Sci Technol 1994; 28:519A-523A.
38. Kerr JB. decreasing Ozone Causes Health Concern. How Canada Forecasts Ultraviolet-B Radiation. Environ Sci Technol 1994; 28:514A-518A
39. Gray PE. Potential Health Effects of Greenhouse Effect and Ozone Layer Depletion in Australia. Med J Aust 1991;155:207.
40. Ewan C, Bryant EA, Calvert GD, Marthick J, Condon-Paoloni D. Potential Health Effects of Greenhouse Effect and Ozone Depletion in Australia. Med J Aust 1991;154:554-559.
41. McMichael AJ. Global Warming, Ecological Disruption, and Human Health: the Penny Drops. Med J Aust 1991; 154:499-501.
42. United Nations Commission on Environment and Development. Our Common Future. Oxford and New York: Oxford University Press, 1987.
43. WHO Commission on Health and Environment. Our Planet, Our Health. Geneva: World Health Organization, 1992.
44. Chivian E, McCally M, Hu H, Haines A. Critical Condition: Human Health and the Environment. Cambridge: MIT Press, 1993.
45. Office of Policy, Planning, and Evaluation, U.S. EPA. The Potential Effects of Global Climate Change on the United States. Appendix G: Health. Washington DC, Environmental Protection Agency, EPA-230-05-89-057, 1989.
46. Campbell D, Stockton M, Buchanan S, McLean J, Pandullo R, Peer R, Probert JA. Literature Review of Greenhouse Gas Emissions from Biogenic Sources. Report prepared by the Radian Corporation (Research Triangle Park, North Carolina) for the Office of Research and Development, US Environmental Protection Agency. Springfield VA, US National Technical Information Service, EPA-600/8-90-071, 1990.
47. DOE Multi-Laboratory Climate Change Committee. Energy and Climate Change. Washington, DC, U.S. Department of Energy, UCRL-102476, 1989.
48. Guidotti TL. Global Climate Change and Human Ecology. The PSR Quarterly [now renamed: Medicine and Global Survival] 1993; 3(4):166-177.

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