GEO-6 Regional Assessment for Asia and the Pacific


Ecosystems have been altered for millennia in Asia and the Pacific, with a net increase in provisioning ecosystem services from, for example, farmland, aquaculture and plantations, but with declines in regulating and cultural ecosystem services from, for example, intact forests that reduce erosion, or associated declines in biodiversity that many humans value (Millennium Ecosystem Assessment, 2005). Some important diseases have emerged from ecosystem change, including HIV/AIDS. Examples in Asia and the Pacific include Hendra virus in Australia, from bats via horses to people, and Nipah virus, from bats to people, sometimes via pigs.


1.4.5 Climate change and health


There is increasing recognition that global health is endangered by climate change, especially if the average global temperature rises more than 2 ºC degrees above pre-industrial levels (Watts et al. 2015; Butler 2014). Early concerns about climate change and health focused on heat stress and changes in the range of vector-borne diseases, especially malaria. Concerns about the relationship between climate change and more indirect health effects, including through food production, conflict and migration, are, however, becoming more prominent (King et al. 2015; Butler 2014). There is also growing recognition that heat


stress, exacerbated by the urban heat island effect, harms occupational productivity and can increase the risk of injuries (King et al. 2015). The elderly, the poor and those with mental illness and chronic disease, especially cardiac ones and dementia, are also at risk from excessive heat, especially at night and if persisting for several days (Oudin Åström et al. 2011). Disasters, exacerbated by sea-level rise, also harm health and are climate change related. Many cities and regions in Asia and the Pacific are vulnerable to natural disasters, with many informal settlements located in fragile environmental areas on shorelines and major river basins.


Although disputed by some, it is highly likely that climate change, together with other aspects of environmental change, is making diseases such as malaria, dengue, chikungunya and Zika harder to manage (Box 1.4.1). Flooding, which can also be worsened by climate change (with other anthropogenic factors), increases the risk of leptospirosis, a rodent-carried disease that can be acquired by walking through flood water that is prevalent in the Philippines and parts of Thailand. Ciguatera fish poisoning, which occurs in the Pacific, has been linked with higher ocean temperatures and with storms (Barrett 2014). Climate change may also alter the frequency and intensity of the El Niño-Southern Oscillation, with consequences including intensified droughts and floods, worse fires in Southeast Asia


Box 1.4.1: Dengue in Japan and Singapore Japan and Singapore are both highly developed, densely populated nations. Even so, neither is free of dengue


fever. In 2014 an outbreak of locally transmitted dengue fever occurred in Tokyo, the first in Japan for at least 70 years (Kutsuna et al. 2015). Climate change is expanding the range of dengue transmission further north in Japan, by creating suitable temperatures for the mosquito vector. Nevertheless, the temperate climate in Japan, which


means that there are long periods each year when no dengue transmission is possible, combined with the advanced state of public health, means that dengue is unlikely to become more than a nuisance, even if future autochthonous outbreaks occur. In Singapore, however, disease transmission is possible all year round. Despite intensive efforts that have successfully kept mosquito populations fairly low, complete eradication of the vector has proved impossible, and dengue cases continue to occur. Although the disease is now less common in children (Ooi et al. 2006), it is possible, as


with many other viral infections, that a later age of acquisition could actually be more problematic. 38


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