date: Fri, 09 Jul 2004 10:56:51 +0100
from: "Paul Wilkinson" <Paul.WilkinsonatXYZxyztm.ac.uk>
subject: Tyndall phase 2 - scoping exercise
I realize this probably comes too late for your meeting, but here anyway are a few thoughts
on your research matrix and scoping exercise. I focus mainly on the health aspects, of
First of all, I am not sure whether, from a health perspective, your framework has to fit
the MRC/Wellcome agenda. Whether it does or not, it is relevant to note that health
researchers tend to be conservative and focused on 'hard science'. Funding bodies are
therefore generally more comfortable with epidemiological work that examines analysable
data - i.e. past events, patterns etc - rather than, say, developing models, although my
impression would be that models are fine if they allow some form of testing.
Thus, I see the main area of interest as being the further study of weather-health
relationships based on:
- defined events (e.g. heat weaves, floods, unusual seasonal patterns)
- long time-series (decades +)
- geographical comparisons
Note that the key questions often realte to populations outside the UK.
These might be in any of the main areas of weather-senstivie disease, i.e:
- direct effects of heat and cold
- extreme weather events: floods, droughts, storms
- food- and water-borne disease
- vector borne disease
- effects of altered patterns of aero-allergens
- air pollution-weather interactions
Because it is less open to reductionist analysis, I judge there would be less interest in
health aspects of socio-economic disruption, impariment of productivity, environmental
In general, the main types of questions would include:
- better quantification of weather-sensitivity of disease
- assessment of the modulating influences of non-climate factors: population
factors, infra-structural influences, acclimatization
- appraisal of adaptative/protective measures (health warning schemes, new surveillance
systems, housing/urban design)
Relating these general points to your matrix (column on "ensuring human well-being"), I
have the following comments:
These might address any of the main health impacts (heat, severe weather, VBD, water-borne
disease etc). They would need to be targeted at specific testable questions - for
example, weather influences on VBD outbreaks, variation in mortality impacts of extreme
temperatures, protection by adaptive measures (why are some populations more vulnerable
than others to the same weather insult), monitoring to detect health impacts and the needed
surveillance systems. In most such work, more emphasis needs to be placed on the non
weather influences that modify the weather (climate) influences. There is much to be
learnt from understanding varaition in vulnerability at all levels of analysis.
Some strategic assessments have already been made for the UK, and I think there would be
only moderate mileage in simply up-dating these. The greater interest is in Eruope and the
world more generally as the main vulnerabilities to health impacts are likely to be in low-
and middle-income populations, and those on the edge of the distribution of current endemic
areas where public health infra-sttructure is poor (latitude spread of maraia etc.).
However, I would put most emphasis on trying to examine particular issues in depth, rather
than, say, doing another Global Burden of Disease assessment (which, as you know, has also
been done (in fairly simplistic fashion) for the World Health Organization).
Mainly because of the inherent uncertainties, I think integrative assessment models are of
limited interest to UK funding bodies, unless a very clear analytical case can be made.
But something that concentrates on methodological development might be fundable if the
emphasis were on appraisal of scientific evidence and assessment of practical public health
questions. One possibility might be in relation to housing quality and urban
infrastructure (see "solution proposals" below)
Although there have been a number of initiatives on reviewing evidence (e.g. Roger's floods
work, the cCASHh project) I still see there is scope for expert panels and reviews to
define uncertainties and research priorities in a number of climate change and health
areas. Vector-borne disease would be one. Adaptation to heat might be another.
These would be of interest where the case can be clearly made that action is merited now on
the basis of exisiting knowledge. Two obvious suggestions include:
- public health responses to extreme weather (heat waves, floods etc.)
- examination of building design to protect health (we have some unique evidence in
relation to the potential health benefits (against cold) of improving domestic energy
efficiency, for example, and this could be extended to consider heat as well). This area
would be suitable both for analytical epidemiology (analysis of variations in vulnerability
according to building type) and also for some forms of modelling - e.g. the benefits of
different housing policies in the UK.
For epidemics, I see the primary issue as one of surveillance, though control/abatement
is also important.
Dr Paul Wilkinson
Head of Unit
Public and Environmental Health Research Unit
London School of Hygiene & Tropical Medicine
Tel: +44 (0)20 7927 2444
Fax: +44 (0)20 7580 4524
++ Note change of unit name
Attachment Converted: "c:\eudora\attach\Paul Wilkinson.vcf"