title: Planning for climate change: The need for mechanistic systems-based approaches to study climate change impacts on diarrheal diseases.
abstract: Increased precipitation and temperature variability as well as extreme events related to climate change are predicted to affect the availability and quality of water globally. Already heavily burdened with diarrheal diseases due to poor access to water, sanitation and hygiene facilities, communities throughout the developing world lack the adaptive capacity to sufficiently respond to the additional adversity caused by climate change. Studies suggest that diarrhea rates are positively correlated with increased temperature, and show a complex relationship with precipitation. Although climate change will likely increase rates of diarrheal diseases on average, there is a poor mechanistic understanding of the underlying disease transmission processes and substantial uncertainty surrounding current estimates. This makes it difficult to recommend appropriate adaptation strategies. We review the relevant climate-related mechanisms behind transmission of diarrheal disease pathogens and argue that systems-based mechanistic approaches incorporating human, engineered and environmental components are urgently needed. We then review successful systems-based approaches used in other environmental health fields and detail one modeling framework to predict climate change impacts on diarrheal diseases and design adaptation strategies.
authors.affiliation: Department of Civil and Environmental Engineering, University of Connecticut, 261 Glenbrook Road, Storrs, CT 06269-3037, USA. Electronic address: mellor@engineer.uconn.edu.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Mellor
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Levy
authors.affiliation: Department of Chemical and Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Zimmerman
authors.affiliation: Department of Civil, Construction and Environmental Engineering, The College of Engineering, University of Alabama, Tuscaloosa, AL, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Elliott
authors.affiliation: Water Institute, Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bartram
authors.affiliation: Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado at Denver, Aurora, CO, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carlton
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
authors.affiliation: The Center for Global Health, University of Virginia, Charlottesville, VA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dillingham
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Eisenberg
authors.affiliation: The Center for Global Health, University of Virginia, Charlottesville, VA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Guerrant
authors.affiliation: Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Lantagne
authors.affiliation: Department of Civil and Environmental Engineering, The College of Engineering, University of South Florida, Tampa, FL, USA.
authors.forename: James
authors.initials: J
authors.lastname: Mihelcic
authors.affiliation: Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Nelson
mesh_terms: D057231:Climate Change; D003967:Diarrhea / Q000453:epidemiology*; D004782:Environmental Health / Q000379:methods*; D006801:Humans; D012499:Sanitation; D013597:Systems Analysis
keywords: Climate change; Complex systems; Coupled systems; Diarrhea; Health; Water