氣候變遷與傳染病的流行趨勢：公共衛生的挑戰、因應及管理

Climate Change and Trend of Infectious Diseases: Public Health Challenges, Responses and Management

中國歷史上，極端氣候變遷曾造成旱災、農作物歉收、饑荒、洪水、大量人口遷徙、傳染病跨地流行及民不聊生，有時甚而加速改朝換代的政治、社會大變動。換言之，氣候變遷衝擊人類文明進展甚鉅，已史有明訓。全球氣候變遷（global climate change）在此氛圍下，改變糧食生產、水資源分布、自然生態破壞與擴大傳染病的流行幅度與嚴重度，已直接或間接危及人類的健康、安全與生存。21 世紀初，不同新興傳染病的接踵而至與迅速跨國、跨洲的大流行，加上近幾年全球氣候變遷惡化加速，極端氣候頻率竄升，引發的各地災害與島國滅頂之危，已時有所聞。本文將嘗試以更寬廣的視野引介氣候變遷與傳染病的流行趨勢，更重要的是提出公共衛生多方面的努力方向，包括：（1）改進傳染病偵測系統，自下而上大眾化，一反過去「自上而下」的模式，以提升其當地社區的防控效能；（2）強化傳染流行病學的整合人才訓練，及時掌握傳染病的人、時、地變遷與其危險因素分析；（3）納入流行病學的危險因素與天氣以建立重要傳染病的流行預測統計模式；及（4）明瞭民眾的認知、態度與誠相配合作法，從而推動更具宏效的風險溝通模式、跨部會的公共衛生管理與防疫策略。

Historically, extreme weather events in China had resulted in drought, poor harvest in farm plants, famine, population displacement, cross-area epidemics of infectious diseases and conflicts over dwindling resources, sometimes even leading to the revolutionary alteration of political systems and tremendous social changes. In other words, climate change has historically played an important role in the destabilization of human civilizations. Global climate change leading to reduced food yields and water supply, ecological destruction of natural resources, and an increased magnitude and severity of infectious disease epidemics, has directly and indirectly produced many risks to human health, safety and survival. In the beginning of the 21st Century, several novel agents of emerging infectious diseases have swiftly spread across different countries and continents as large-scale epidemics or pandemics. In addition, global climate change, including the increased frequency of extreme weather events that have induced many climate disasters, has further aggravated the impact of these infectious agents in recent years, particularly for those people living on island nations. This article uses a broader view to introduce climate change and its impact on the trends in infectious disease epidemics. Several public health efforts to counteract such challenges are proposed, including: (1) improving a bottom-up, rather than the traditional top-down, public participation approach in infectious disease surveillance systems for enhancing its effectiveness in prevention and control of infectious diseases at the level of the local community; (2) strengthening the training program of infectious disease epidemiologists with a better integrated system for timely monitoring and analyzing the temporal and spatial changes of infectious diseases and the involved risk factors; (3) establishing epidemic prediction statistical models for infectious diseases with public health significance by considering both important daily meteorological variables and epidemiologically related risk factors; and (4) understanding the knowledge, attitudes and practices (KAP) of those climate disaster-vulnerable populations for the implementation of more effective risk communication channels, interdepartmental integrated management command flow, and strategies in prevention and control of epidemics.