CARTOONpwilliams.jpg
Illustrated by P.Williams

North warms to new arrivals, while scientists ponder their impact for future challenges in health for Arctic residents.”
16th May 2009
Written and illustrated by Paula Williams
In the wake of new arrivals of infectious diseases the heat is on for future health scientists and epidemiologist facing the challenges of a warming North.Change management gurus like Kotter and Rathgeber might well have found a simple solution with the fable ‘Our Iceberg is Melting’ for changing and succeeding under any condition. But, this is quite a different story for epidemiologists and health government bodies facing a much more complex challenge in the Arctic when we discuss the onset of increase infectious disease. In particular, vector-borne infectious disease in response to the warming North. The Centre for Disease Control (CDC) has already reported that the average Arctic temperature has risen at almost twice the rate from the rest of the world in the last 2 decades. This could potentially cause marked changes in the incidence and geographic distribution of infectious diseases already present in the Arctic region.

The warmest year in the Arctic on record was reported in 2007. Hence, according to the world's leading authority on global warming, the Intergovernmental Panel on Climate Change (IPCC) has concluded that unchecked global warming will cause in the near future a significant increase in human mortality due to extreme weather and infectious disease. No country, even industrialized nations they say will escape these impacts. So what are the effects of climate change relating to infectious diseases in the warming North? Rather, how does this impact on the health and wellbeing of Arctic residents anymore than it has historically in the past? Rising temperatures patterns has been noticed over the past 40 years. So one ponders why only now the sudden concern, surely this has been noted as a trend evolving?

Though Arctic populations have for centuries long endured the devastating effects of both endemic and epidemic infectious diseases there are now great concerns to governments and public health authorities including Centres for Disease Control and Prevention of all Arctic countries for the potential onset of pandemic influenza reaching the Arctic. For example: Avian influenza, and more recently Swine influenza type A (H1N1) and other sudden emergence of new viral pathogens such as severe acute respiratory syndrome (SARS).Hence, Arctic networks such as International Circumpolar Surveillance (ICS), for the Surveillance of Infectious Diseases is just one of many International bodies looking at the future key challenges to human health impact from the effects of global warming in the North. Part of the Arctic Human Health Initiative (AHHI) is for research activities to be conducted on regional and inter-continentally transported anthropogenic pollution in Arctic regions. Researching, especially the contaminants and zoonotic infectious diseases on the traditional food supply. Rather the loss of biodiversity from rising temperatures and increase vector-borne diseases effects on subsistence – species for harvesting by indigenous communities.Hence AHHI will be examining climate variability on human health and the provision of traditional food. Other areas of surveillance are on infectious diseases in particular, the increase emergence of tuberculosis, HIV/AIDS, hepatitis, vaccine preventable diseases, and the emerging infectious diseases like SARS and others that might likely evolve due to rising temperatures in the North. Climate change in the future will have significant impacts on biodiversity, not to mention the ecosystems according to Alaska Native Tribal Health Consortium, who claim that climate change is already affecting Arctic species including infectious disease agents, and fear that greater changes are to be expected.

Recently, in the North studies have been conducted for the effects of Avian influenza in response to the changing Arctic environment especially on the ecosystems, and emergence of zoonotic disease and the increase of vector-borne diseases. In July 2004 there was a case of an outbreak of related gastroenteritis caused by Vibrio parahemolyticus which was reported among cruise ship passengers in the Prince William Sound area of Alaska that was traced back to consumed raw, farmed oysters.Interestingly, this incident occurred >1,000 km further north than previous reported outbreaks. After much investigation it was found that the ocean warming trend was responsible for this outbreak. For the first time temperatures that summer in 2004 recorded the mean water temperature had actually exceeded 15°C. Ostensibly, this was the threshold temperature for the harvest of the infected oysters consumed on the cruise ship.With increased air and water temperatures pathogens like Vibrio improves their survival and proliferation.Consequently, this made the oyster farm rife for these conditions as apparently the July-August water temperature of the oyster farm had increased steadily with 0.21°C per year since 1997.

It is no wonder disease patterns like this case where temperatures are causing new migratory pathways for pathogens and changes in the populations of new species, and range of animal hosts and insect vectors that transmit them are of great concern to research scientists. The challenges in the future will be to identify the propensity and incidence data of these disease influences which benefit from warming that may result in an increase in other temperature-sensitive food-borne diseases, and affect the prevalence of zoonotic and vector-borne infectious diseases. Ideally finding ways of forecasting before they happen, through some sort of mechanism or computerised model of prediction based on surveillance patterns and geographical biodiversity case studies over time. However, the greatest challenge for now is the complexity of host-agent environment relationships. So how much do we know about the so called ‘new arrivals’ and prevalence of infectious disease in the North, that are a direct impact of climate change? We can of course gauge through existing knowledge about the known effects of weather and climate on known influences of disease and thus this provides a ‘spectre model’ for some form of extrapolation to potential challenges that may impact on human health under these possible changing conditions in the future. For instance according to the Canadian Medical Association (2008) we know that increased temperature shortens pathogen development duration in vectors which lends to increases in the duration of infectiousness, thus allowing for longer periods of transmission to humans. This can be seen in zoonotic and vector - borne diseases with ticks and mosquitoes such as Lyme disease, West Nile virus a prevalent increase seen recently now in Russia, Dengue, Jungle or Gold fever as seen in the North and other more recently such as Malaria, Chikungunya, Tularaemia and Rabies to name a few. We can therefore forecast that increased temperatures, rainfall variability and altered dynamics of reservoir populations can be predicted and hence be known to increase the transmission of these types of zoonotic and or vector- borne diseases and rodent –borne diseases. Not long ago in fact just last century, regions like the Arctic were previously unsuitable to support their endemic occurrence but now the North warms to the arrivals of newly imported infectious diseases. Alas the warming North has now permitted such novel visitors the honorary transmission. However, in so doing these changes will vary geographically even though the biodiversity of a specific geographical location can change, so can the transmission. Basically warming trends promote northern expansion of insect-borne diseases especially for mosquitoes and so ecosystems change as a result. The reason why this happens is because changes in climate may expand the geographic range and abundance in both vectors and reservoir hosts.

As we are noticing today nothing now is ‘typically’ a seasonal weather pattern. Rather differential weathering is occurring and increasing around the world. The North is prevalent to global warming more than any other region in the world because of its snow and ice melt, darker land and ocean surfaces absorb more solar energy. Hence more of the trapped energy goes directly into warming. The atmosphere has less to warm because the surface is shallower and so as sea ice retreats solar heat absorbed by oceans in summer is sent to the atmosphere in winter and hence atmospheric and oceanic circulation can increase warming. In the past when seasons came they had consistent patterns. Whereby, ecosystems adhered to those known changes where matter and energy cycles exchange to weave the ‘web of life’ accordingly. But now warming and altered rainfall patterns have started to increase populations of reservoir animals and their predators and hence early onset of favourable transmission conditions may well prolong transmission cycles. With climate warming you get imbalance weather patterns causing flooding and droughts cyclones, dust storms and forest fires. Flooding provides breeding habitats for vectors and reservoir hosts hence increasing their population and biodiversity as well as geographic region. Ultimately this lends to more prevalence of outbreaks of disease.

On Baffin Island, in Nunavut, Canada, the loss of ice and permafrost due to warming is affecting daily life of Inuits. Winter hunting and fishing is limited severely by loss of ice. In summer, permafrost is thawing, creating more erosion, and ice that once covered the surrounding mountains for centuries is nearly all melted. Elders in the village of Pangnirtung report that winds have shifted and winters are getting much shorter. In the North the permafrost melting on coastal regions and loss of sea ice has been greatly affected by warming.Such outcomes affect water availability and quality because flooding facilitates rapid transportation of disease causing pathogens into water supplies such as Salmonella, Escherichia coli. Warm, dry summers such as those experienced across the arctic region especially in Russia and Alaska in combination with heavy wintertime precipitation provide optimal conditions for infectious fungal diseases from invasive fungal pathogens such as Coccidioides immitis and Blastomyces dermatitidis.

One of the greatest concerns to changes in climate is the contaminated waterways as seen in the North due to melting of permafrost which increases the prevalence of more re emergence of diseases such as Typhus, Cholera, Hepatitis, Leptospirosis, Borreliosis and Ricketsiosis. As a result of sea level rises and permafrost melting and increased storm activity we will begin to see if not already substantial health effects following population displacement. According to the IPCC there will be greater frequency of infectious disease epidemics following floods and storms and for each potential impact of climate change, certain groups will be particularly vulnerable to disease and injury. There are also increase risks of water and food – borne disease transmission associated with the displacement of environmental populations and migration of communities following floods and extreme weather events. According to the Canadian Medical Association (CMA)in 2008 these risks are particularly elevated in the far North as increased temperature and rainfall predicts to increase the intensity and prevalence of water and food-borne diseases such as Escherichia coli, Salmonella, Vibrio, Clostridium botulinum, Giardia, and Cryptosporidium. Heavy rainfall and flooding are ideal environments for facilitating the rapid transportation of these disease causing pathogens into water supplies affecting the water availability and quality in catchment areas. However, associated change in weather patterns and other environmental exposures brings another disease aspect and that is the onset of chronic disease. These are mainly stress- disease related such as cancer, cardiovascular diseases, obesity and diabetes. This also includes the mental health impact of behavioural health issues, such as suicide, interpersonal violence and substance abuse, and accidental injuries.

Mostly affected by the impact of a warming North are the Indigenous communities because warming is affecting traditional harvesting and subsistence-species are becoming scarce and/ or infected with loss of biodiversity and changing ecosystems. Areas such as the indigenous communities in Alaska, Canada, Scandinavia and Russia are reporting high suicide because cultural traditional subsistence ways with the environment and identity are being lost. In the Northern regions there is now an increase mortality rate, due to heat, injuries on the unpredicted ice which is becoming less readable, coupled with severe frostbite.

The ‘flipside’ to this is the increase incidence of melanoma and other skin cancers from prolonged and intense UV exposure which have in the past been consistent with the southern hemisphere. Now this occurrence is being detected in the North especially in Russia after the recent heat waves. Heat waves in the North and South are affecting mental states in social communities causing rise in anger management, such as homicides, road fatalities and suicides resulting with increase mortality and sadly low life expectancy. In addition, increase atmospheric pollutants are causing respiratory and cardiovascular diseases. All these conditions affect human health status. With suppressed immune systems brings about susceptibility to circulating infectious disease let alone the transmittable endemic and pandemics such as Swine flu A/ (H1N1)[3] that could potentially be fatal.

Because of forced migration from natural disaster there can be an increase in the propensity for populations to contract communicable respiratory diseases such influenza, respiratory syncital virus (RSV), Streptococcus pneumonia. This displacement of population enhances the transmission of disease through intermingling into non immune communities and cross contamination into larger populations. Future challenges will be the surveillance of these communicable diseases. The vulnerability of certain human groups and communities will depend on factors such as population density, socio-economic development, food availability, pre existing health and availability of health care, hospital services and primary and preventative care services and education. This is especially required for isolated and remote populations in the North where the overcrowding housing conditions are literally breeding grounds for transmittable diseases where not only are respiratory transmittable diseases but vector-borne and rodent-borne infectious disease is also affected by human population movement and density. Because of technology and air travel including increase shipping access through the North West passage as the sea ice melts we see greater movement of transient populations in the Arctic. New demographics and the increase of tourism will slowly start to affect the once uninhibited remote communities to be exposed to global infectious diseases as ‘globe trotters’ weave in and out of these once isolated regions. This coupled with deforestation through fires or clearance and biodiversity losses cause disruption to the whole food web cycle for local communities. In addition this contributes to the transmission of new infectious disease that affects human health as a consequence of climate change to the Northern environment.

The overcrowding dwellings conditions among Indigenous communities in the North are indirectly a consequence of climate change and sadly indirectly these overcrowded conditions give rise to acquired chronic diseases. Uptake of substance abuse as coping mechanisms for changed traditional lifestyle such as alcohol and especially tobacco are causing a high incident of lung cancers not to mention the damages of passive smoking has for the very young in overcrowded dwellings. Canada and the Arctic regions have the most significant incidence of lung cancer among the indigenous populations. Another infectious transmittable disease that is prevalent is cervical cancer because of sexually transmittable disease of Human Papilloma Virus (HPV) in young indigenous girls. So indirectly climate warming in the North is affecting other types of diseases those of chronic diseases, and not necessarily infectious but acquired as a result of changed lifestyle patterns. Mainly from traditional cultural ways and changed subsistence species of traditional food supply to westernised eating habits causing obesity and acquired diabetes.

So what are the concluding thoughts about the future challenges of health and the impact of infectious disease on Arctic residents in the warming North? We know that Scientists are aware that the North is experiencing warmer temperatures and increased rainfall patterns are unfortunately going to increase the range and prevalence of zoonotic and vector-borne infectious diseases ubiquitously. Climate warming may trigger the release of persistent environmental pollutants some of which can affect the immune system and may even exacerbate the condition with increased rates of some new diseases. Altered patterns of rainfall and increased frequency of extreme weather events are most certainly going to influence the incidence of water-borne gastrointestinal and respiratory diseases globally. It is a matter of time that with increased temperature we will experience increased pathogen growth and increased pathogen survival. Furthermore, increased precipitation will cause increased spread of pathogen-water run-off and more nutrients in the environment which will again increase pathogen growth and density. Warming and increased precipitation will increase the amount of persistent organic chemicals and mercury that are deposited on the Arctic. When temperatures rise these contaminants contained in the snow, ice and permafrost will melt releasing them into water ways, run offs such as rivers and ponds and catchments. The outcome may have harmful effects on aquatic plants and animals and also contaminate sea waters.

In summary, change in relationship between microbes, insect vectors, animal reservoirs of infectious diseases and humans are predicted to increase with temperatures rising affecting the biodiversity and ecosystems in the North. Ostensibly temperature is the major limiting factor in how far north insect-borne diseases occur. Hence the warming trends will in time promote northern expansion of insect-borne diseases considerably. Recently, investigations of emerging infectious diseases associated with parasites in northern wildlife explored the interface for hosts, parasites, and the environment. It was found that the emergence of parasitic disease was linked to geographic expansion, host switching, resurgence due to climate change, and newly recognized parasite species. Such integrative approaches serve as cornerstones for detection, prediction, and potential mitigation of emerging infectious diseases in wildlife and persons in the North and elsewhere under a changing global climate. Population-based surveillance of infectious diseases of concern is organised by numerous public health agencies situated across Sweden, Finland, Norway, Greenland, Iceland and Canada. Collaborative networks like these across the circumpolar region are liaising with hospitals, public health organisations and diagnostic laboratories to gather and analyse epidemiologic data on infectious disease of concern so as to build a systematic approach to implement prevention and control strategies. Yes, the future challenges for health will impact on the Arctic residents which will change the current focus of communicable infectious diseases of public health importance. The best defence against increases in infectious disease burden related to climate change lies not only in strengthening existing public health infrastructure but collecting data to monitor climate impacts on health. According to the World Health Organisation (WHO) we need to understand how decisions are made about adaptation, including the roles of individuals, communities, nations, institutions and private sector. Ideally all health related professionals and communities, not just government health authorities can become opinion leaders to inform policy decisions on the extent of disease caused by climate change.
Realistically, the future challenges in health for Arctic region is the question of how much infectious disease has been caused from a warming North? Maybe, we all need to read Kotter’s book, ‘Our Iceberg is Melting‘, so to enhance our negotiating, advocacy and influencing skills to succeed under these difficult decision making conditions and times.The ability for everyone to change management, and influence public policy and local government of how much climate-attributed infectious disease burden could be avoided by emissions reduction and help implement health-protective strategies would be a very good place to start.
Bibliography:
·Arctic human development report. Akureyri, Iceland: Stefansson Arctic Institute; 2004
·Bradley MJ, Kutz SJ, Jenkins E, O'Hara TM. The potential impact of climate change on infectious diseases of Arctic fauna. Int J Circumpolar Health. 2005;64:468–77 Alaska Native Tribal Health Consortium
·CMAJ • March 11, 2008; 178 (6). doi:10.1503/cmaj.081325. Canadian Medical Association ·Hoberg E P,et al(2008) ‘Climate Change 2007:Synthesis Report’; Integrated approaches and empirical models for investigation of parasitic diseases in northern wildlife: Emerg Infect Dis. Jan;14(1):10-7.
·IPCC- An Assessment of the Intergovernmental Panel on Climate Change (An underlying report, adopted section by section at IPCC Plenary XXVII (Valencia, Spain, 12-17 November 2007), represents the formally agreed statement of the IPCC concerning key findings and uncertainties contained in the Working Group contributions to the Fourth Assessment Report. http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf
·Kotter,Jand Rathgeber, H( 2006 ) Our Iceberg Is Melting Changing And Succeeding Under Any Conditions·Kutz SJ, Hoberg EP, Polley L, Jenkins EJ. Global warming is changing the dynamics of Arctic host-parasite systems. Proc Biol Sci. 2005;272:2571–6.
·McLaughlin JB, Depoala A, Bopp CA, Martinek KA, Napiolilli NP, Allison CG, et al. Emergence of Vibrio parahaemolyticus gastroenteritis associated with consumption of Alaskan oysters and its global implications. N Engl J Med 2005;353:1463–70 10.1056/NEJMoa051594 [PubMed]
·Parkinson,A J. et al (2008)and the International Circumpolar Surveillance Steering Committee,An Arctic Network for the Surveillance of Infectious Diseases; 2008 Jan;14(1):10-7 NCBIU.S. National Library of Medicine and the National Institutes of Health; PubMed
·Parkinson AJ et al (2006) International Journal of Circumpolar Health65:4- Arctic Human Health Initiative (AHHI)
·Parkinson AJ. The International Polar Year, 2007–2008, an opportunity to focus on infectious diseases in Arctic regions. Emerg Infect Dis. [serial on the Internet]. 2008 Jan [date cited]. Available from http://www.cdc.gov/EID/content/14/1/1.htm
·Swine Flu Arctic Bound Swine Influenza A/(H1N1) Yukon Territory 5/13/2009http://newsinfo.inquirer.net/breakingnews/world/view/20090513-204793/AH1N1-flu-Arctic-bound
·WHO, World Health Report(2003) ‘Climate change and human health: risks and responses . Summary’ Ch:4;Disease Transmission, WHO Library Cataloguing-in-Publication Data, Geneva

Podcasts


Kirsi Vahakangas- Environmental health -basic concepts (pending)

Kirsi Vahakangas - Global and ethical aspects (pending)

Listen to Mattii Viluksela on Health Effects of POP's

More resources:


Case Studies

​ Arctic Cases


Australian Cases

Environmental health – basic concepts

http://www.hreoc.gov.au/Social_Justice/nt_report/ntreport08/pdf/appendix6.pdf

A copy of the AEA constitution may be downloaded here.|AEA Aims, Governance, Policies

Primary Health Care Research Information Service http://www.phcris.org.au/information/policy.php

Team work (weeks 2 and 3, deadline 25.9.)Week 2- 3: Team work continues..View Williams & Oslen essay 1:

Week 4: Individual written examination, time period 28.9.-3.10.