Global warming (PSM university exam )

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Global Warming - PSM University Exam Notes

(Sources: Park's Textbook of Preventive and Social Medicine; Harrison's Principles of Internal Medicine 22e)

1. Definition

Global warming refers to the long-term rise in the average surface temperature of the Earth, primarily due to the increasing concentration of greenhouse gases (GHGs) in the atmosphere as a result of human industrial and agricultural activity since the Industrial Revolution.

2. The Greenhouse Effect (Mechanism)

The greenhouse effect is the fundamental mechanism driving global warming:
  1. The Sun emits solar radiation (short-wave) that passes through the atmosphere and is absorbed by the Earth's surface.
  2. The Earth re-emits this energy as infrared (long-wave) radiation back toward space.
  3. Greenhouse gases in the atmosphere absorb this infrared radiation and re-emit it in all directions, trapping heat - like a blanket around the Earth.
  4. This raises the Earth's surface temperature above what it would otherwise be.
Park's PSM: "Atmospheric trapping of thermal radiation from the Earth's surface is known as the greenhouse effect."

3. Greenhouse Gases (GHGs) - Sources and Sinks

GHGHuman SourcesNatural SinkRadiative Forcing
Carbon dioxide (CO₂)Fossil fuel combustion, deforestationOceans (~30%), plantsHighest overall effect
Methane (CH₄)Fossil fuel production, ruminant animals, landfillsHydroxyl radicals (troposphere)~25x more potent than CO₂
Nitrous oxide (N₂O)Fertilizers, fossil fuel combustion, livestock manurePhotolysis in stratosphereVery potent
Halocarbons (CFCs, HFCs)Refrigerants, electrical insulation, aluminium productionUV light in stratospherePotent; also destroy ozone
Water vapourNatural; indirectly amplified by warmingShort atmospheric lifespanMost abundant but not a major driver
  • CO₂ concentration has been rising sharply since the Industrial Revolution.
  • Methane concentrations have more than doubled from the 19th century to 2023 (Harrison's 22e).
  • CO₂ and CH₄ are the two most important anthropogenic GHGs.

4. Evidence and Scale of Warming

  • The average surface temperature of Earth has increased by 1.09°C from 1850-1900 to 2010-2019 (IPCC Sixth Assessment Report).
  • The current rate of warming is unprecedented in the last 50 million years (Harrison's).
  • The 5°C of warming at the end of the last ice age (~12,000 years ago) took ~5000 years; a similar increment may happen within 150 years if GHG emissions are not reduced.
  • Park's predicts an increase of ~3°C in average global surface temperature by 2030 and a sea level rise of 0.1-0.3 m by 2050.

5. Consequences / Effects of Global Warming

A. Physical / Environmental Effects

EffectDetails
Rising temperaturesHotter summers; "heat island" effect in cities makes urban areas even hotter
Sea level rise~13-20 cm since 1900; glacial ice melt + thermal expansion of oceans
Extreme weather eventsMore frequent cyclones, heat waves, droughts, heavy rainfall
Altered rainfall patternsChanged jet streams and ocean currents; some areas wetter, others drier
Soil moisture declineReduced moisture in temperate zones impairs grain production
Changed vegetationShift in distribution of forests and crops
Ocean acidificationCO₂ absorbed by oceans forms carbonic acid

B. Health Effects (PSM High-Yield)

1. Heat-related Illness
  • Global warming increases frequency and severity of heat waves.
  • Leads to: heat exhaustion, heat stroke, dehydration, excess cardiovascular and respiratory deaths.
  • Vulnerable groups: elderly, outdoor workers, urban populations.
2. Vector-borne Diseases (Very Important)
  • Warmer temperatures expand the geographic range of disease vectors.
  • Malaria: range expanding to higher altitudes and latitudes.
  • Dengue fever: Aedes aegypti distribution expanding globally; epidemic potential increasing.
  • Lyme disease: Tick vector (Ixodes scapularis) range expanding northward into Canada; annual peak cases arriving ~6 weeks earlier than 25 years prior.
  • Babesiosis, West Nile virus, Chikungunya: all expanding geographically.
3. Waterborne Diseases
  • Increased heavy rainfall events contaminate water supplies.
  • 51% of waterborne disease outbreaks in the USA were preceded by precipitation above the 90th percentile.
  • Pathogens most commonly involved: Vibrio and Leptospira species.
  • Combined sewer overflows increase with heavy rains, causing release of untreated sewage.
4. Air Quality and Respiratory Diseases
  • Higher temperatures increase ground-level ozone (smog) formation.
  • Wildfire smoke increases particulate matter (PM2.5) exposure.
  • Worsens asthma, COPD, allergies.
  • Longer pollen seasons due to warmer weather worsen allergic respiratory disease.
5. Food Security and Malnutrition
  • Reduced agricultural output due to drought, heat stress, and altered rainfall.
  • Flooding destroys crops.
  • Changes in fisheries affect nutrition.
6. Mental Health
  • Displacement from floods, loss of livelihoods, and trauma from extreme weather events cause anxiety, depression, and PTSD.
  • "Eco-anxiety" - chronic fear about environmental destruction.
7. Vulnerable Populations
  • Low-income countries, indigenous communities, children, elderly, pregnant women, and people with chronic diseases bear the greatest burden.

6. The "Heat Island" Effect

Cities are warmer than surrounding rural areas due to:
  • Concrete and asphalt absorbing and retaining heat.
  • Reduced vegetation and evaporative cooling.
  • Waste heat from vehicles, industry, air conditioning.
Global warming amplifies the heat island effect, leading to more severe and prolonged heat waves in urban areas.

7. Impact on Ecosystems (Park's PSM)

  • Changes in jet streams, ocean currents, and prevailing winds alter rainfall distribution.
  • Affects local, regional, and global ecosystems.
  • Change in insect vector distribution (disease implication).
  • Temperature rise overwhelms many species' capacity to adapt.
  • Catastrophe theory - small additional changes in existing trends could have massive, disproportionate consequences.

8. Control and Prevention of Global Warming

Primary Prevention (Mitigation)

  1. Reduce fossil fuel combustion - shift to renewable energy (solar, wind, hydro, nuclear).
  2. Reduce deforestation - protect forests; afforestation and reforestation programs.
  3. Energy efficiency - fuel-efficient vehicles, green buildings, efficient appliances.
  4. Reduce methane emissions - improve landfill management, reduce livestock methane.
  5. Replace HFCs - phase out ozone-depleting/GHG-producing refrigerants (Montreal Protocol + Kigali Amendment).
  6. International agreements: Kyoto Protocol, Paris Agreement (limiting warming to 1.5°C above pre-industrial levels).

Secondary Prevention (Adaptation)

  1. Early warning systems for extreme heat events.
  2. Vector control programs as disease ranges expand.
  3. Improved water treatment infrastructure.
  4. Urban heat island mitigation - green spaces, cool roofs, urban trees.
  5. Crop variety adaptation - heat-tolerant and drought-resistant crops.
  6. Flood preparedness and coastal defense infrastructure.

9. Key International Agreements (for MCQs)

AgreementYearKey Point
Kyoto Protocol1997First binding treaty to reduce GHG emissions
Paris Agreement2015Limit warming to well below 2°C, preferably 1.5°C
Montreal Protocol1987Phase-out of ozone-depleting substances (CFCs)
Kigali Amendment2016Phase-down of HFCs (potent GHGs)
IPCC1988Intergovernmental Panel on Climate Change - assesses climate science

10. Quick-Recall Facts (MCQ Targets)

  • Most important GHG by overall warming effect: CO₂
  • Most abundant GHG: Water vapour
  • Most potent per molecule (common GHGs): Methane > CO₂
  • Temperature increase since pre-industrial: ~1.09°C (to 2019)
  • Park's predicted temperature rise by 2030: ~3°C
  • Park's predicted sea level rise by 2050: 0.1-0.3 metres
  • Vector-borne disease most commonly reported in North America: Lyme disease (~60,000 cases/year)
  • 51% of waterborne outbreaks preceded by: precipitation above 90th percentile
  • Main pathogen after heavy precipitation: Vibrio and Leptospira

11. Sample Long-Answer Framework (University Exam)

Q: Define global warming. Describe its causes, effects on health, and preventive measures.
Introduction: Define global warming and greenhouse effect. Causes: List GHGs with sources (table helps). Evidence: IPCC data, temperature rise figures. Effects: Divide into environmental + health (vector-borne, heat illness, waterborne, respiratory, food insecurity, mental health). Prevention: Mitigation (energy, deforestation) + Adaptation (early warning, vector control) + International agreements. Conclusion: Emphasize that climate change is the "defining public health challenge of the 21st century."

Sources: Park's Textbook of Preventive and Social Medicine (p. 849-850); Harrison's Principles of Internal Medicine 22e, Chapter 474; Goldman-Cecil Medicine.
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