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Road from Kyoto : hearing before the Committee on Science, U.S. House of Representatives, One Hundred Fifth Congress, second session (Volume pt. 2) online

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violet radiation (UVP). including much cf the I'V-B and all of
the highest-energy UV-C. Sustained exposure to UV-B radia-
tion is harmful to humans and many other organisms (UNEP,
1994). It can damage the genetic (DNA) material of living
cells and can induce skin cancers in experimental animals.
UV-B is implicated in the causation of human skin cancer and
lesions of the conjunctiva, cornea, and lens; it may also impair
the body's immune system (Jeevar. and Kripke, 1993;
Armstrong, 1994; UNEP, 1994).



18.4.1. Skill Cancers

Solar radiation has been consistently implicated in the causa-
tion of nonmelanocytic and melanocytic skin cancers in fair-
skinned humans (lARC. 1992; WHO. 1994b).

Nonmelanocytic skin cancers (NMSCs) comprise basal cell
carcinoma (BCC) and squamous cell carcinoma (SCC). The
incidence rates, especially of squamous cell carcinoma, corre-
late with cumulative lifetime exposure to solar radiation
(lARC. 1992; Kricker et al.. 1995). Studies of the action spec-
trum (i.e.. the relative biological effect of different wave-
lengths) for skin carcinogenesis In mice indicate that the UV-B
band Is primarily responsible for NMSC (Tyrrell. 1994).
Malignant melanoma arises from the pigment-producing cells
(melanocytes) of the skin. Although solar radiation is substan-
tially Involved In melanoma causation (lARC. 1992;
Armstrong and Kricker, 1993), the relationship is less straight-
forward than for NMSC; exposure in early life appears to be a
major source of Increased risk. The marked Increases in inci-
dence of melanoma in Western populations over the past two
decades (Coleman et al.. 1993) probably reflect increases in
personal exposure to solar radiation due to changes In patterns
of recreation, clothing, and occupation (Armstrong and
Kricker, 1994).



18.4. Stratospheric Ozone Depletion and Ultraviolet
Radiation: Impacts on Health

Stratospheric ozone depletion is a quite distinct process
from accumulation of greenhouse gases In the lower atmos-
phere (troposphere). Depletion of stratospheric ozone has
recently occurred In both hemispheres, from polar regions
to mid-lalltudes (Kerr and McElroy, 1993; see also IPCC
Working Group I volume). The major cause of this ongoing
depletion is human-made gases, especially the halocarbons
(UNEP, 1994).



The UN Environment Programme predicts that an average
10% loss of ozone (such as occurred at middle-to-high lati-
tudes over the past decade), if sustained globally over several
decades, would cause approximately 250,000 additional cases
of NMSC woridwide each year (UNEP, 1994). This prediction
assumes that a \% depletion of stratospheric ozone results in a
2.0% (±0.5%) increase in NMSC incidence (80% of which are
BCC). Another estimation of this "amplification factor" gives
a figure of 2.25% (Slaper et al.. 1992; den Elzen, 1994). At
higher geographic resolution, Madronich and de Gruijl (1993)
predict that persistence of the ozone losses of the 1979-92



424



Human Population Health

period for several decades would cause Ihe incidence of BCC
10 increase by 1-2% at low latitude (5°), 3-5% at 15-25°.
8-12% at 35-45°, and, at 55-65°, by I3-I5"i^ in the northern
hemisphere and 20-30% in the south They estimate thai the
percentage increases for SCC would be approximately double
those for BCC.



18.4-2. Cataracts and Other Damage to the Eye

The external epithelial (keralotic) layer of the eye, comprising
cornea and conjunctiva, absorbs virtually all UVR of less than
290 nm wavelength. Corneal photokeralitis. pterygium (a
growth of the conjunctival epithelium), and climatic droplet
keratopathy are thought to be U VR-related (Taylor ci ui. 1 989;
Gray et ai. 1992; WHO, 1994b). Inside the eye. the lens
absorbs much of the residual UVR, and this absorbed radiation
may cause cataracts (Taylor ei al., 1988; Dahlback el iil.. 1989;
West f/ a/., 1989; WHO, 1994b).

Cataracts (lens opacities) are independent of skin pigmentation
(unlike skin cancer). They occur predominantly in old age and
cause more than half of the world's estimated 25-35 million
cases of blindness (Harding, 1991). In Western countries.
5-10% of people aged over 65 have cataracts (Klein et al..
1992). The prevalence often is much higher among elderly,
malnourished persons in poor countries, where micronutrienl
deficiencies and the metabolic consequences of severe diar-
rheal episodes may contribute to cataract formation (Harding,
1992). Scientific debate persists over the extent of the influ-
ence of UV-B upon cataract formation (Dolin, 1994; WHO,
1994b); some epidemiological studies have found clear-cut
positive results, but others have not. The relationship is most
evident for cortical and posterior subcapsular cataracts but less
so for the more commonly occurring nuclear cataracts.

Ocular photodamage by UVR is enhanced by certain clinical
drugs used in photochemical therapy that can cause photosensitiz-
ing reactions (Lerman, 1988). Various other photosensitizing med-
ications would render individuals generally more susceptible to
adverse health effects from increased exposure to UVR; these
medications include psoralens, thiazides, phenothiazines, barbitu-
rates, allopurinol, and retinoic acid compounds (Lerman, 1986).



18.4.3. Alteration oflnr.nane Function

Human and animal evidence indicates that UV-B irradiation of
skin at quite modest levels causes local and, probably, systemic
suppression of immunity (Morison, 1989; Noonan and DeFabo,
1990; Jeevan and Kripke, 1993). Most of the evidence is for
local immunosuppression, in which the skin's contact hyper-
sensitivity response is impaired (Giannini, 1986; Yoshikawa ei
al., 1990; UNEP, 1994). UV-B exposure disturbs the function of
the skin's Langerhan cells and stimulates the release of certain
cytokines (messenger chemicals) that promote the activity of
suppressor T lymphocytes, thus dampening the local immune
system (UNEP. 1994).



579



Evidence for more generalized (i.e., systemic) suppression of
immunity comes from studies in humans, which show that sun-
light exposure increases the suppressor T cells in blood
(Hersey el ai, 1983). Although there is evidence in humans of
UV-induced changes in the profile of circulatmg immunologi-
cally active lymphocytes for several days to weeks, the extent
of systemic immune suppression involved remains uncertain
(de Gruijl and van der Leun, 1993). Systemic suppression also
occurs in UV-irradiated mice (Kripke, 1981; Jeevan and
Kripke, 1990).

Immune suppression would alter susceptibility to infectious
diseases (Armstrong, 1994). Exposure to UV-B modifies vari-
ous immunological reactions in mice that influence the patho-
genesis of infectious diseases, such as those due to Herpes sim-
plex viruses (Otani and Mori. 1987; Yasumoto et ai, 1987),
leishmania (Gianinni, 1986; Giannini and DeFabo. 1989). Can-
dida (Denkins et ai, 1989), and mycobacteria (Jeevan and
Kripke. 1989). The relevance of these findings for naturally
occurring infectious di.seases, and for vaccination efficacy, in
humans remains unknown. UNEP (1994) concluded that; "It
will be very difficult to assess the role of UV-B radiation iin
natural infections in human populations. Based on current
knowledge, we would predict that an effect of UV-B radiation
would manifest as an increase in the severity or duration of dis-
ea.se and not necessarily as an increase in disease incidence."



18,4.4. Indirect Effects of Ozone Depletion
upon Human Health

An increase in UV-B irradiance is predicted to impair photo-
synthesis on land and sea (UNEP. 1994). Although the magni-
tude is uncertain, and may well not be large, there would be at
least a marginal reduction in crop yields (Worrest and Grant.
1989) and in the pholosynthetic production of biomass by
marine phytoplankton. the basis of the aquatic food chain
(Smith and Baker. 1989; Smith et ai, 1992). Thus, adverse
effects of UV-B upon photosynthesis would, to .some extent,
reduce global food production.



18.5. Options for Adaptation

Various adaptation strategies are possible to reduce the impacts
of climaie cliange oii humfin health Such aiiapt'ition could Uc
developed at 'be popiilation or individual level. The feasibility
of adaptation would be constrained for many of the world's
populations by a lack of local resources.

At the population level, environmental management of ecosys-
tems (e.g.. freshwater resources, wetlands, and agricultural
areas sensitive to invasion by vectors), public health surveil-
lance and control programs (especially for infectious diseases),
and introduction of protective technologies (e.g., insulated
buildings, air conditioning, strengthened sea defences, disaster
warning systems) would be important. Improved primary
health care for vulnerable populations could play a significant



425



580



Human Population Health



role in reducing a range of health impacts, including some
vectoi-bome and other communicable diseases, and the
effects of extreme events. One example is extension of vacci-
nation coverage, although no suitable vaccines exist for some
of the diseases most sensitive to climate change (e.g.. dengue
and schistosomiasis) or for many of the newly emerging
infections.

At the individual level, people should be encouraged to
refrain from or to limit dangerous exposures (e.g., by use of
domestic cooling, protective clothing, mosquito nets). Such
behavioral responses could complement any physiological
adaptation that might occur spontaneously through acclima-
tization (to heat stress) or acquired immunity (to infectious
diseases).



risks, the evaluation of alternative indices for moni-
toring health (including the use of sensitive species as
bioindicators). and the opportunity to detect and/or
examine previously unsuspected or undocumented
environment-health relationships.
Some specific research needs include:

Comparison of impacts of heat waves in urban
and rural populations, to clarify the relative
importance of thermal stress and air pollutants

- Examination of the interplay between climatic
impacts on forests and other terrestrial ecosystems
on the range ana dynaimcs of vectoi-bome disease

- Study of factors iRfiucncii'.g populatioti vulnera-
bility to climate change.



In view of limitations to the forecasting of health impacts at
this stage of our knowledge, an important and practical form of
adaptation would be to improve large-scale monitoring and
surveillance systems, especially for vulnerable populations and
areas. Recently initiated efforts to observe and monitor aspects
of the Earth's environment and ecosystems in relation to cli-
mate change now should incorporate health-related monitoring
(Haines et ai. 1993). Advances in climate forecasting and in
the regional integration of ecological and health monitoring
(including local vulnerability factors) will facilitate develop-
ment of early-warning systems.

Finally, if health impacts of climate change are probable and
serious, then the only effective long-term basis for mitigation
lies in primary prevention at the societal level. This would
require acceptance of the Precautionary Principle as the foun-
dation of policy response. T;;is. in turn, would suggest some
fundamental, and therefore difficult, reorientations of social,
economic, and political priorities. Meanwhile, care must be
taken that alternative technologies do not introduce new
health hazards.



18.6. Research Needs

• Development and validation of integrated mathemat-
ical models for the prediction of health impacts
Such models must draw on multiple scientific disci-
plines and should take maximal account of regional
and local influences on the effects being modeled
and on their interaction with other environmental
stresses.

• Identification and analysis of current or recent set-
tings in which the health impacts of local or regional
climate changes (occurring for whatever reason) can
be studied. The apparent recent changeable patterns of
infectious diseases around the world may afford good
opportunities for clarifying and quantifying the influ-
ences of climatic factors

• Incorporation of health-related measurements in glob-
al, regional, and local monitoring activities. This
would enhance the early detection of shifts in health



18.7. Concluding Remarks

Forecasting the health impacts of global climate change
entails unavoidable uncertainty and complexity. Human popu-
lations vary greatly in their vulnerability to climate changes
and in their resources for protection and mitigation. Likewise,
the responses of infectious disease vectors to changes in cli-
mate depend greatly on other concomitant environmental
stresses and the adequacy of control measures and health care
systems. Meanwhile, population health status continues to be
influenced by a rich mix of cultural and socioeconomic fac-
tors. Hence, assessing the health impact of climate change
requires a systems-based modeling approach that integrates
information about climatic factors, other environmental
stresses, ecological processes, and social-economic-political
inputs and responses.

Alongside the need for improved health impact assessment
capability is a precautionary need to develop global, region-
al, and local monitoring systems for the early detection of
climate-induced changes in human health. There have,
indeed, been various recent events that, plausibly, might be
early signals of such change. The increased heat-related
deaths in India in- 1995; the changes in geographic range of
some vector-borne diseases; the coastal spread of cholera;
Could these be early indications of shifts in population
health risk in response to aspects of climate change? Of
course, it is not possible to attribute particular, isolated
events to a change in climate or weather pattern; other plau-
sible explanations exist for each of them, and a number of
different factors may combine to produce each event.
However, it is important that we begin to assess patterns of
change in the various indices of human health that will pro-
vide early insight and will assist further the development of
predictive modeling.

^There is thus a clear need for enhanced research and monitor-
ing activities. This need reflecis the assessment that the poten-
tial health impacts of climate change, particularly if sustained
in the longer term and if generally adverse, could be a senou
consequence of the ongoing anthropogenic changes in •"
composition of Earth's atmosphere.



\



426



fluinan Population Health
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