Discussion on Integrating Sources

International Institute for Sustainable Development (IISD)

Report Part Title: Understanding the Health Impacts of Climate Change and Coal Energy Consumption in China

Report Title: Health Co-Benefits from NDC Implementation in China

Report Author(s): Hanjie Wang and Lourdes Sanchez

International Institute for Sustainable Development (IISD) (2019)

Stable URL: http://www.jstor.com/stable/resrep21936.4

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Health Co-Benefits from NDC Implementation in China

2.0 Understanding the Health Impacts of Climate Change and Coal Energy Consumption in China

Climate change affects human health in a variety of ways. According to the Intergovernmental Panel on Climate Change’s report, Climate Change 2014: Impacts Adaptation, and Vulnerability (Smith et al., 2014), there are three main ways in which climate change impacts human health:

1. Direct impacts, which refer to health impacts resulting from changes in frequency of extreme weather, such as heat, drought and heavy rainfall.

2. Ecosystem-mediated impacts, also called indirect impacts. These refer to increased morbidity and mortality from increased exposure to vector-borne and other infectious diseases, food- and water-borne infections, air pollution and aeroallergens.

3. Human-mediated impacts, for example from poor nutrition, occupational health, mental health, violence and conflict.

The combustion of fossil fuels for the generation of electricity, heating or transportation is a major cause of air pollution and climate change, which are also interrelated. Fossil fuel energy use is related to climate change as the primary source of carbon dioxide emissions.1 Climate change induces higher temperatures, which increase the harm of small particles released by the combustion of fossil fuels. Therefore, climate change exacerbates air quality issues and is projected to lead to an increase in premature deaths (Silva et al., 2017). It is estimated that, in 2013, 99.6 percent of the Chinese population lived in areas where the World Health Organization’s (WHO) fine particulate matter (PM2.5) guideline of 10 µg/m3 was exceeded (GBD MAPS Working Group, 2016).

Table 1 summarizes the main environmental health impacts and diseases that are relevant to China. Vulnerable population groups—that is, children, young people, pregnant women, the elderly and the poor—are at increased risk of suffering from climate-related injury and illness (Smith et al., 2014).

Table 1. List of main climate change-related diseases and health impacts in China

Health impacts of climate change

Main cause Source

Cardiovascular disease (CVD), including diseases that pertain to the heart and blood vessels, such as stroke, ischemic heart disease and heart attack

Risk of CVD is increased by air pollution and extreme temperatures. For instance, climate change is responsible for extreme cold and extreme heat, increased ozone formation and concentration due to higher temperatures, and increased particulate matter. These factors all directly affect the occurrence of CVD.

Friel et al., 2011; National Institute of Environmental Health Sciences, 2017a; WHO, n.d.a.

1 In China, due to the heavy dependence on coal, the energy sector remains the largest carbon emitter (NDRC, 2016; Liu et al., 2018).

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Health Co-Benefits from NDC Implementation in China

Health impacts of climate change

Main cause Source

Respiratory diseases, including asthma, respiratory allergies and airway diseases such as chronic obstructive pulmonary disease (COPD)

Respiratory health is influenced by air quality, notably through allergens, ozone, fine particles and dust. In general, changing climate conditions and increasing temperatures will compromise outdoor air quality by increasing the production of tropospheric ozone. Ozone exposure contributes to increased respiratory tract irritation, chronic pulmonary disease hospitalizations, lung diseases and asthma. The fine particulate air pollution arising from the combustion cycles for fossil fuels enters the respiratory tract, increasing the risk of acute respiratory infections, including asthma.

Friel et al., 2011; D’Amato et al., 2013; National Institute of Environmental Health Sciences, 2018; WHO, n.d.a.

Cancer in respiratory tracts (lunch, trachea and bronchus)

Burning fossil fuels (such as coal for electricity, diesel and gasoline for transportation) releases fine particles (PM2.5 and smaller) that can enter the lungs and have been associated with cancer of the lungs and other respiratory tracts (trachea and bronchus). Higher temperatures associated with climate change increase the volatilization of toxic chemicals and air pollutants, worsening their effects on human health.

Friel et al., 2011; National Institute of Environmental Health Sciences, 2018; WHO, n.d.a.

Infectious diseases, including water- borne, food-borne and air-borne diarrheal diseases

Climate change has an impact on both pathogens and the transmission of infectious diseases. Higher temperatures may extend the life cycle of pathogens. While changes in precipitation can have an effect on the dissemination of water- borne pathogens, humidity can further be a factor in the transmission of air-borne diseases. The indirect impact of climatic change on human systems (e.g., food and water storage) can change transmission patterns and disease burden.

Wu et al., 2016; Palmgren, 2009; Smith et al., 2014.

Skin cancer Global climate change affects ultraviolet radiation, temperature, precipitation and cloud coverage, which all alter sun exposure behaviour. Ultraviolet radiation and sun exposure are linked to ultraviolet-related health outcomes, including skin cancer.

National Institute of Environmental Health Sciences, 2018.

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Health Co-Benefits from NDC Implementation in China

Health impacts of climate change

Main cause Source

Parasitic and vector- borne diseases (e.g., malaria, dengue fever, yellow fever, Japanese encephalitis, Lyme disease, tick- borne encephalitis, echinococcosis and schistosomiasis)

Changes in local temperatures, humidity, wind and precipitation can have an influence on the ecology of vectors and parasites and might, for example, extend transmission cycles and geographic spread of vector-borne diseases in previously colder regions or higher latitudes. The indirect effects of climate change on human systems and practices (e.g., changes in agricultural practices, irrigation and population movement) will additionally affect vectors and human exposure to parasitic and vector-borne diseases. Interaction of these factors is complex and the effect of climate change on disease burden will vary across diseases and locations.

Campbell-Lendrum et al., 2015 ; Wu et al., 2016; Bai, Morton & Liu, 2013; Tokarevich et al., 2011; Zhou et al., 2008.

Health impacts from extreme weather events and natural disasters (e.g., heat wave- related diseases such as heat stroke and kidney diseases; diseases and injuries caused by natural disasters such as physical injuries and post-traumatic stress syndrome)

Climate change increases the frequency of extreme weather events and related natural disasters such as floods, storms and droughts.

“Prolonged exposure to extreme heat can cause heat exhaustion, heat cramps, heat stroke, and death, as well as exacerbate pre-existing chronic conditions, such as various respiratory, cerebral, and cardiovascular diseases” (Muanya, 2019). Recurrent dehydration and heat stress can further cause acute renal failure and exacerbate existing chronic kidney diseases.

Natural disasters from extreme weather events creates threats of traumatic injuries (e.g., cuts, bruises, wound infections) and drowning. Victims of natural disasters may additionally suffer from post-traumatic stress disorders. Extreme weather events and overcrowding due to displacement in the aftermath of a disaster can sometimes cause or exacerbate the outbreak of infectious diseases, yet impacts are hard to predict.

National Institute of Environmental Health Sciences, 2017b; Kjellstrom et al., 2010; Ghazali et al., 2018.

Indirect human- mediated health impacts (e.g., nutritional deficiencies, mental health conditions, occupational health, violence and conflict)

Indirect human-mediated impacts of climate change on society and the human environment can have various health consequences that are hard to predict. Climate impacts on the agricultural system can have a detrimental influence on the quality and quantity of agricultural produce and may lead to food insecurity and undernutrition in some populations.

Climatic changes can further cause or exacerbate occupational health risks, particularly heat strain and heat exhaustion. Forced displacement due to climate change may entail stress-related psychiatric and anxiety disorders and spark violence and conflict with potentially severe effects on health and society.

Smith et al., 2014; Ghazali et al., 2018.

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Health Co-Benefits from NDC Implementation in China

While it is likely that climate change has already had an impact on human health, the current global burden of ill health from climate change is comparatively small compared to other stressors and not yet well quantified (Smith et al., 2014, p. 713). This is also the case for China. Given the lack of quantifiable data on disease-specific health burdens attributable to climate change and air pollution, Figure 1 draws from the total health burden of the main diseases and impacts depicted in Table 1 and shows their relative importance for China in 2016 (as a percentage of total Disability-Adjusted Life Years [DALYs2] and premature deaths). The data mean that, for example, almost 20 per cent of all the deaths estimated in China in 2016 were caused by a stroke.

Figure 1. Estimated DALYs and deaths in China in 2016 from different causes of disease that could be linked to climate change and air pollution3 (in percentage of total DALYs and total deaths, respectively).

Source: Authors’ elaboration of data from WHO, 2018a.

2 One DALY is considered one year of “healthy life” lost. It is a measure for the burden of a specific disease, considered as “the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability” (WHO, n.d.b). 3 Figure 1 is based on the total number of cases for the respective diseases from all possible causes, including (but not limited to) climate change and air pollution. The total burden of the diseases presented in Figure 1 in 2016 in China was 6.5 million deaths (WHO, 2018a).

0% 5% 10% 15% 20%

Stroke

Natural disasters

Diarrhoeal diseases

Nutritional deficiencies

Parasitic and other skin cancers

Melanoma and other skin infections

Respiratory infections

Kidney diseases

Other cardiovascular diseases

Trachea, bronchus, lung cancers

Respiratory diseases (including COPD and asthma)

Ischaemic heart disease

Estimated deaths in China, 2016Estimated DALYs in China, 2016

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Health Co-Benefits from NDC Implementation in China

Stroke, ischemic heart disease, COPD and lung cancer were among the top causes of death in China in 2016 (IHME, 2018; WHO, 2018a). These diseases are strongly linked to air pollution caused by particles released by the combustion of fossil fuels, including particulate matter of 2.5 micrometres or less in diameter (PM2.5), which can access human respiratory and cardiovascular systems. More than 70 per cent of China’s electricity is sourced from coal (World Bank, 2017), which is associated with more particulate emissions than any other major source of electricity generation. The WHO (2018b) estimates that ambient air pollution contributed to 1.1 million deaths in 2016 in China.4 The emissions from coal are likely to account for a significant proportion of these deaths, though it is extremely challenging to reliably quantify the impact on public health from coal-related emissions.

4 The WHO estimate indicates 81 deaths attributable to ambient air pollution in China in 2016 per 100,000 inhabitants. China’s population in 2016 was 1.379 billion.

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