Climate, poverty, health: time for preventive medicine

Larry Brilliant, MD, MPH Co-Founder, Seva Foundation Executive Director, google.org The significant problems we face cannot be solved at the same level of thinking we were at when we created them.

- Albert Einstein Sea Levels Rise

Source: IPCC Climate Change 2001 – Synthesis Report The poor are likelier to be sick. The sick are likelier to be poor. Without intervention, the poor get sicker and the sick get poorer.

- Dr. Jack Geiger, Tufts Medical School Physicians for Social Responsibility …and as the climate crisis deepens, there will be many more sick, and many more poor. Bangladesh: The Canary in the Coal Mine The last case of Variola Major “in nature” was Rahima Banu, who developed rash October 17 1975 Bhola Island, Bangladesh 7 Smallpox and Bioterrorism: Larry B illi MD MPH History of Smallpox

• Most deaths of any infectious disease • ~500 million deaths in 20 th Century • ~2 million deaths in 1967 • Known in ancient times • Natural disease eradicated • Last U. S. case – 1949 (imported) • Last international case – 1978 • Declared eradicated in 1979

8 Smallpox and Bioterrorism: Larry B illi MD MPH What we learned Day 8 from the smallpox campaign was: “early detection, early response, early containment” Each “incubation period” without action led to explosive spread to new states and to new countries.

9 Smallpox and Bioterrorism: Larry B illi MD MPH

Following the removal of the malarial forest, the population boom in the Terai region of Nepal caused massive deforestation resulting in natural disasters in Bangladesh. Climate Change and Malaria As a result of global warming the percentage of the world’s population who will be susceptible to malaria will increase from 45% to 60%, an increase of one billion people. Global Distribution of Malaria Transmission Risk

Source: World Health Organization, 2003

Source: Jones, Kakkilaya, 2006 30 New Emerging Communicable Diseases

SARS

Anthrax

SOURCE: National Institute of Health Sovereigns Killed by Smallpox

• Pharaoh Ramses V of Egypt in • Emperor Ferdinand IV of Austria 1157 BC, in 1654; • Marcus Aurelius, 180 AD • Emperors Gokomyo and • Caliph Abbul al-Abbas al-Saffah in Higashiyama in Japan 754; • Emperor Fu-lin of China • King Thadominbya of Burma • Queen Mary II • Aztec Emperor Ciutláhuac • Emperor Joseph I of Austria in • Inca Emperor, Huayna Capac 1711; • King Boramaraja IV of Siam in 1534 • King Louis I of Spain • King Karalliyaddë Bandãra of • Tsar Peter II of Russia Ceylon, the Queen and all of their • Queen Ulrika Eleanora of Sweden sons in 1582 in 1741; • William II of Orange in 1650 • King Louis XV of France More people, more money, more stuff: bigger footprints on the earth There are more of us…. In 1900 the world’s population was 1.6 billion and today it is nearly 6.5 billion, which has negatively impacted the green belt resulting in 30 new zoonoses.

And we are wealthier and consume even more than our numbers….. Time for Preventive Medicine Seven Prescriptions

1. Reduce population growth through improving child survival, girls’ education, availability of choices 2. Prioritize global health planning not only by today’s prevalence rates, but tomorrow’s warmer world: bring back the E word for malaria and consider the D word 3. Increase global disaster preparedness and systems 4. Introduce “peak water” concept. “Manhattan project” for low energy low cost desalinization processes 5. Green revolution for a brackish world 6. Study the unintended consequences of past interventions and learn from them. 7. “Cap and fair trade.” Radical new funding methods for “secondary prevention,” “adaptation,” or risk mitigation Climate change will affect the poor and the sick more than the healthy and rich. An innovative funding mechanism for “cap and trade” systems that contributes to both primary and secondary prevention is one way to balance the needs of present and future, rich and poor. Thank You!