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Delays in reducing waterborne and water-related infectious diseases in China under climate change


Despite China’s rapid progress in improving water, sanitation and hygiene (WSH) access, in 2011, 471 million people lacked access to improved sanitation and 401 million to household piped water. As certain infectious diseases are sensitive to changes in both climate and WSH conditions, we projected impacts of climate change on WSH-attributable diseases in China in 2020 and 2030 by coupling estimates of the temperature sensitivity of diarrhoeal diseases and three vector-borne diseases, temperature projections from global climate models, WSH-infrastructure development scenarios, and projected demographic changes. By 2030, climate change is projected to delay China’s rapid progress towards reducing WSH-attributable infectious disease burden by 8–85 months. This development delay summarizes the adverse impact of climate change on WSH-attributable infectious diseases in China, and can be used in other settings where a significant health burden may accompany future changes in climate even as the total burden of disease falls owing to non-climate reasons.

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Figure 1: Conceptual diagram of the development delay (highlighted) attributable to climate change in 2030.
Figure 2: Distribution of population-weighted provincial temperature deviations, ΔTρ, from 2008 under RCP 4.5 and RCP 8.5.
Figure 3: Province-specific development delay values shown as a function of the temperature deviation from 2008 to 2030.


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This work was supported in part by the Chemical, Bioengineering, Environmental, and Transport Systems Division of the National Science Foundation under grant no. 1249250, by the Division of Earth Sciences of the National Science Foundation under grant no. 1360330, by the National Institute for Allergy and Infectious Disease (K01AI091864) and by the Global Health Institute at Emory University. Y.L. was supported in part by the Centers for Disease Control and Prevention (U01EH000405) and the National Institutes of Health (R21ES020225). S.L. was supported in part by US EPA Science to Achieve Results grant (RD835192010) and by Emerging Pathogens Institute, University of Florida. Y.G. was supported in part by the Office of Science of the U.S. Department of Energy as part of the Regional and Global Climate Modeling Program. The Pacific Northwest National Laboratory is operated for DOE by Battelle Memorial Institute (DE-AC05-76RL01830).

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M.H., J.H.B., E.J.C., S.L., H.L., W.L., J.J.H. and J.V.R. conceived and designed the experiments; M.H., J.H.B., S.L., Y.G. and J.V.R. performed the experiments; M.H., J.H.B., Y.G. and J.V.R. analysed the data; M.H., J.H.B., E.J.C., S.L., H.L., W.L., M.C.F., Y.L., J.J.H. and J.V.R. contributed materials/analysis tools; and M.H., J.H.B., E.J.C., S.L., H.L., W.L., M.C.F., Y.L., Y.G., J.J.H. and J.V.R. wrote the paper.

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Correspondence to Justin V. Remais.

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Hodges, M., Belle, J., Carlton, E. et al. Delays in reducing waterborne and water-related infectious diseases in China under climate change. Nature Clim Change 4, 1109–1115 (2014).

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