DIAGNOSIS –– CLIMATE CHANGE

Global warming ad-versely affects human health - this is beyond doubt.  However, it manifests itself in different ways in different countries. Which diseases are most dependent on climate change?  Which other factors affect public health in our country? Answers to these questions were supplied in the process of the preparation of Azerbaijan's Second National Report on Climate Change. The Ekosfera Scientific Production Association, headed by Camila Ahmadova, works on these issues with support from the Environment and Natural Resources Ministry and UNDP. Ahmadova headed a workgroup which assessed the implications of climate change for human health and which was part of a group of researchers studying adaptation to global warming.

Is Nature quaking?

Despite all the immense advantages, and just as immense disadvantages, of the technological revolution, humankind still remains quite dependent on external factors beyond its control. In particular, global warning is another indication for the overly self-reliant Homo sapiens that it was probably too early for him to try on the crown as king of nature. The adverse effects of climate change have already caught up with other traditional factors which shorten human life, such as alcohol, nicotine, sedentary lifestyles and extra weight. It directly provokes an explosion of the diseases which top the sad list of causes of human death - first and foremost, cardiovascular and oncological diseases.

Furthermore, partly due to the effects of global warming, diseases whose names already seemed anachronistic in this day and age, have resurfaced. Some of the ailments which were considered scourges of God in the 19th century and declared valiantly eradicated in the 20th are again painfully widespread. But should a man of the computer age die of dysentery like George Washington? There was simply no cure for the disease back when the prominent American statesman lived, but now medical professionals have an extensive arsenal of all types of medication at their disposal.  Nonetheless, dysentery and a number of its "sisters" - measles, German measles, malaria and others - have re-emerged in recent years. The only difference is that from widespread diseases affecting the general population, they have become diseases within specific groups among the population, in other words, they have "slipped" down to the lower, least protected, social strata.

Research by Camila Ahmadova's workgroup is aimed precisely at the detection of the particular combinations of climatic and all other factors which have contributed to the sudden spread of different diseases in our country during the last decade and a half. They also want to calculate the most effective ways of adapting to the changing natural environment, including the economic component of adaptive measures.

Victims of skyscrapers and air conditioners

Over the last century, climate change manifested itself in an average temperature rise of about 0.3-0.6 degrees Celsius on the planet. In Azerbaijan, the temperature change was 0.5-0.6 degrees, said C. Ahmedova. By the end of this century, the average annual air temperature according to the plan will rise by a further 1.4-5.8 degrees according to the forecasts of the international group of UN experts. And, of course, Azerbaijan is going to be no exception; it might, moreover, overtake many other countries in terms of this not-too-pleasant indicator because of its climatic conditions. In different experts' assessments (our researchers tested five different climate change forecasting models) the average annual temperature will rise by 2.0-5.8 degrees in the Republic of Azerbaijan.

In general, this is a major temperature rise - our summers are already hot, after all. But, on the other hand, precisely the fact that our population is used to scorching heat will help it adapt to global warming. In the summer 2003, for example, when a huge heat wave spread throughout the world and claimed thousands of lives, mortality increased by 16% in Britain, by 26% in Portugal, and by as much as 60% in France, whereas in Azerbaijan, there was only a 3% rise. Even in Italy, which lies on the same latitude as Azerbaijan, the tragic indicator was 15%.

Perhaps one of the reasons for such a difference was the relative scarcity of air conditioners in Azerbaijan's provinces, whereas urban populations cannot imagine spending the summer without them. Most of the extra calls to the ambulance service, which accounted for the above-average statistic that summer, were registered precisely in towns and cities, where people constantly experienced detrimental fluctuations of temperatures, between 35 degrees centigrade in the open and 20-degrees in apartments and offices.

It is not surprising, therefore, that the reason for the majority of calls for an ambulance, and fatalaties, were cardiovascular diseases and, first and foremost, strokes. Incidentally, the majority of victims were men, which again confirmed popular scientific theories about the greater adaptability of females compared to males.

As for other diseases whose aggravations are most often caused by extreme heat, their list is headed by respiratory diseases, mental disorders and malignant tumours.

City dwellers are helpless in the face of global warming for yet another reason: it seems that the situation is aggravated by the very architectural divisions of cities, especially metropolitan areas. At present, even in Baku, our "city of winds," where different streams of air in different seasons of the year have saved its residents from merciless heat or excessive humidity for centuries, nature is no longer able to save man, its unwise creation. Because man, in his pursuit of profit, started to erect high-rise buildings chaotically, and the last thing the new, disorderly layout of the city takes into account is the natural circulation of air in this particular area.

Our ancestors were much cleverer in this respect. Why are the narrow streets of one- or two-storey buildings in Iceri Sahar always cooler in summer than the sticky labyrinths of the modern high-rise buildings? Because the builders of old would always take into account the wind rose diagram when they planned to build a block, a street, or even a single house. They not only made wind a factor contributing to the resident's comfort, but also put it to the service of public health, making it improve the hygienic environment and prevent diseases. The wind cooled the streets, but also eliminated smells and dried dirt on block roads. And their calculations were only guess-work, with no computers involved. But how precise their work was! We still have proof of their skills in the form of the unique Old City right in the centre of the capital.

But blocks of high-rise buildings stretch for miles around the Old City, hopelessly affected by the ailment of modern cities - "isles of heat." These "cancer cells" of cities spring up in areas where clusters of buildings, especially high-rise ones, effectively completely cut off the natural movement of fresh air. Smog accumulates in those areas in the winter and, in the summer, the temperature rises catastrophically to boot. The difference in temperatures between these "isles" and the better "ventilated" outskirts in a hot summer sometimes reaches 5 degrees centigrade!

So, city dwellers are a risk group in the face of the threat of global warming. And male city dwellers are more likely to be affected. But there are also other groups among the population which are traditionally considered more vulnerable if the climate changes. These are old people, children, people with chronic diseases, and the poor. As we can see, natural factors are closely intertwined with natural phenomena here.

The old drains saga

In rural areas, people experience different problems in connection with climate change. If urban populations, especially the populations of major cities, are susceptible to cardiovascular disorders because of global warming, for country people it manifests itself in the form of infectious and parasitic diseases. However, the system of measures conducted in the public health sector of Azerbaijan over the last 10 years has now made it possible to considerably improve the situation since the early 1990's, when many infectious diseases broke loose like a genie from the lamp. Whereas in 1990 there were 30 patients with infectious diseases in every 1,000 people, 15 years later the indicator is half that value.

Nonetheless, even now there are sporadic spikes in the spread of infectious diseases in the provinces. Their reasons are again a tangle of purely climatic and purely social problems. The first thing that catches the eye among general trends is the frightening stability of the number of patients with acute intestinal infections (more than 10,000 cases a year). The causes are right there, on the surface: poor-quality food and inadequate water purification systems.

Global warming aggravates these problems. Firstly, it complicates the already grave problem of food storage which people experience in many regions, especially in the Aran area. And secondly, it triggers more landslides and floods, because glaciers in the mountains melt at a faster rate. This, for its part, acts as an additional burden on worn-out water supplies and sewage systems in the provinces. Some sections of these grids are in disrepair, and sewage water purification technology is long obsolete in many of the districts.

The Samux District can be cited as a hackneyed example in support of the theoretical research by our scientists. Everyone who has ever visited any of the bazaars in Ganca had to quickly become aware of a specific problem: residents of Samux have to keep the area of origin of their goods secret from customers when they bring their fruits or vegetables to the market in Ganca. This happens because the residents of Ganca know: sewage water from the city and its suburbs is dumped precisely in this neighbouring district. The fact itself is nothing special: sewage has to go somewhere. The problem is, however, that the service life of the sewage grid and sewage purification system in Samux expired long ago, so farmland there is fertilized not just by fertilizers…

Syringe against Anopheles

The situation with regard to the prevention of another, once quite widespread, infectious disease - malaria - is much better in Azerbaijan. And it is much better regardless of the fact that environmental conditions in many districts of the country are potential causes of the spread of the disease. After all, more than a half of the territory of Azerbaijan is vast plains, of which 18% are below sea level. In addition, Azerbaijan has its subtropics, where an extremely warm climate is favourable to the active growth and reproduction of the malarial mosquito. Lastly, our land is rich in rivers, many of which tend to inundate their valleys. And the consequences of the freshets, especially the swamping of large areas, is a potential cause of the spread of Anopheles, which often becomes an actual cause because of wear and tear on the irrigation systems and collector drains in different districts.

However, of the four types of malaria, only one - the tertian malaria - is found in Azerbaijan in residual loci. In other words, the disease has effectively been defeated in our country. And this means that when we want to, we can curb rampant infection. And what was the secret of this victory? After all, major efforts were made to defeat acute intestinal infections too. Apparently, the key here is the specificity of the life cycle of malaria, in which, in the opinion of many researchers, the human factor, or to be more precise, the purely social factor, rather than economic and climatic factors, as in acute intestinal infections, plays an important role.

Incidentally, the climatic factor is not so important in the spread of malaria. After all, the above-mentioned environmental diversity of our country is a great boon. In general, everything that we thought about malaria - that it is one of the diseases whose spread is most often triggered by natural conditions and that very little depends on humans - was refuted right before our eyes. And we passed this test.

The same can be said about some other infectious diseases, which by now have been mostly "harnessed" by medical professionals:  Diphtheria, measles, German measles. They were quite widespread in our country in the mid-1990's. In 1995, for example, we had a peak in diphtheria morbidity (the number of patients was 883). But large-scale preventive measures (in other words, compulsory vaccinations) played a decisive role. The same diphtheria, for instance, has not been encountered in Azerbaijan since 2001. To summarize the issue of infectious diseases, it has to be noted that, although in researchers' opinions not only demographic, but also environmental factors played an important part in the spread of these diseases in the past, in general anthropogenic factors are still the main influence.

So, we have learned how to defeat the human factor in everyday-life in the battle for the health of the nation - or at least this is what may be concluded from our successful experience of curbing malaria, diphtheria, measles and German measles. At the economic level, however, combating the human factor in the fight for good public health is much more difficult: both the chaotic urban development of the capital city and disintegrating irrigation systems in the provinces are glaring examples of this. And as for the fight with nature itself, the entire history of human civilization shows that humankind will never win this battle. Because we should seek nature's advice, not fight it. But we are slow learners here. And it seems that we do not want to learn either…