Climate Change Public Health Impacts Helene G Margolis

Climate Change Public Health Impacts Helene G. Margolis, Ph. D Source: NASA California Public Health Association – North 2008 Annual Meeting UC Davis, California March 14, 2008 Environmental Health Investigations Branch Division of Environmental & Occupational Disease Control University of California, Davis Department of. Medicine Internal

Overview • Changing Planet: Net Results • Public Health Impacts: Opening Thoughts – Comment on the current ‘big picture’ – Taking a broad perspective on “Vulnerability” • Direct Effects • Effects Arising from Ecological Shifts & Environmental Degradation • Public Health Impacts: Closing Thoughts

Our Changing Planet: Net Results Predicted Weather-related Consequences “Virtually certain” Over most land areas • Warmer and fewer cold days and nights • Warmer and more frequent hot days and nights “Very Likely” Over most areas • Warm spells / heat waves. Frequency increases • Heavy precipitation events. Frequency (or proportion of total rainfall from heavy falls) increases → increased risk of floods and/or damage to buildings hgm “Likely” • Area affected by droughts increases • Intense tropical cyclone activity increases • Source: Increased incidence of. Theextreme high sea level (excludes IPCC Climate Change 2007: Physical Science Basis: Summary for tsunamis) Policymakers

Public Health Impacts: Opening Thoughts Climate change will lead to amplification of: v Most existent public health challenges. . Serious consequences in developed nations, catastrophic consequences in struggling nations. v Including health risks known to be associated with outdoor and indoor environments…. Currently no great surprises. However, amplification will highlight and/or reveal weaknesses in public health and societal infrastructures. Those weaknesses reflect vulnerabilities – at level of nations, regions, State, local (County, community, neighborhood), populations & individuals Identification of those vulnerabilities in advance of crisis will serve us well in mitigation of climate change impacts.

Vulnerability: Conceptual Framework As for most public health issues… There are disparities in how climate change will impact different sub-populations, . e. g. , lower socioeconomic groups, elderly, people of color. The relative impacts are a function of individual & population The impact of environmental factors on populations… begins with Vulnerability impacts on individuals.

Environmental Impacts of Global Warming & Sequelae Greenhouse Gases => ◊ Changing Climate ↑ Long-term Ave. Temp. ↑ Freq. Hot Days/Nights (& Heat Waves) ↓ Freq. Cold Days/Nights ↑ Heavy Rainfall Events (without ↑ in total annual precipitation) ↓ Snowfall & Snow pack ↓ Mountain Glaciers ↑ Drought (Areas, Freq. & Duration) “Exposures” Extreme Weather Events Heat Waves Floods Droughts Wildfires Air Pollution (O 3, PM, GHG) Nuisance Plants Allergens Pesticides “Public Health Impacts” Acute Morbidity/Mortality Injury Heat-related illness Chronic dz. acute events Toxin-related illnesses Chronic Disease Respiratory Ecological Shifts => (Asthma, COPD, Allergy) Distribution & abundance of : hosts, vectors, pathogens of Vector. Borne Diseases Water-Borne Pathogens Cardiovascular (Atherosclerosis, . . . Communicable Disease V-B: West-Nile, malaria, dengue, encephalitis, Water-Food Supply & ↑ Tropical Cyclones & The Source: IPCC Climate Change 2007: Physical Science Basis: Summary for hantavirus, Rift Valley

Public Health Impacts: Direct Effects • Extreme weather events (Heat waves, storms, floods, droughts, hurricanes, tornadoes) – Short-time course events present immediate risk of • Death • Injury & complications of injuries (e. g. , wound infections) • Infectious disease outbreaks – Hurricane Katrina: ~1000 cases of diarrheal diseases (e. g. , norovirus) among evacuees in Texas & Mississippi. • Increased risk of exposures to toxic agents • Psychosocial stress • Disruption & Displacement – Longer-time course events (e. g. , droughts) • Greater adaptive capacity; Still pose risks to public health

Public Health Impacts: Direct Effects • Temperature-related Illness and Mortality – Fewer cold- and heat-related deaths in past 30 yrs (US) • Attributed to higher % of homes with central heat & AC – Heat Wave: National Weather Service definition (e. g. ) ≥ 3 consecutive days with temperatures ≥ 90°F (32. 2°C) Heat stress & exhaustion Risk Factors Cramping Heavy perspiration Weakness Exertion Dehydration Children ≤ 5 years or Age >60 years Lack of air conditioning Social isolation Chronic diseases (CVD, COPD) Cognitive and mobility impairments Low socio-economic status Housing characteristics Heat Stroke Core body temperature >104°F Multi-organ system dysfunction Often fatal despite treatment

Public Health Impacts: Direct Effects • Prevention requires knowledge not assumptions – Heat-related morbidity/mortality risk is greater in cooler climates than in warmer climates • More northern latitudes and higher elevations • Attributed to less capacity to acclimatize through physiological, behavioral, technological means. – Built environment – Access/Use of AC • Example: Weather-related influence on hospitalizations for cardiovascular diseases & stroke greater in San Francisco than in Los Angeles (Ebi KL et al. Int J Biometeorol 2004; 49(1): 48 -58) – Fans may contribute to heat stress & illness when high humidity (> ~33%) and high temperatures (≥ 90°F (32. 2°C)) or temperatures ≥ 100°F (37. 8°C).

Public Health Impacts: Simultaneous Risks uilt Environment & Co-Exposures: Heat Islands, Topography & Ozo El Dorado County Built-up rural area

Public Health Impacts: Direct Effects 2006 Heat Wave in California Heat-Related Deaths in Counties with ≥ 10 Deaths July 15 – August 1, 2006 99% of cases lived in zip codes where > 50% of residents live below Poverty Guide Line Source: R. Trent, T. Kim. 2007. CDPH

Public Health Impacts: Indirect Impacts of Direct Effects • Economic impacts of heat wave on dairy industry ~ $1 Billion. 2006 California heat wave kills 16, 500 dairy cows statewide. (Other estimates – 25, 000 in Central Valley or 1% of State’s Dairy Herd succumbed plus 70, 000 poultry (Source: http: //news. bbc. co. uk/1/hi/world/americas/5223172. stm) Central Valley saw disruption of animal breeding and >10% reduction in milk-production. Source: Fresno Bee: Mark Crosse • Wide array of potential “downstream” public health risks Misters give cows e. g. , water quality, communicable disease, some psychosocial stress relief at Pacheco Dairy in Kerman, Fresno County. Source: Fresno Bee/Mark Crosse Source: Modesto Bee/Marty Bicek

Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation • Insect- & Animal-Borne Diseases Temp, humidity, rainfall & sea level influence geographic distributions & population growth of infectious disease-causing pathogens (e. g. , viruses, bacteria) & reservoir hosts (e. g. , rodents, deer, birds) & vectors (e. g. , mosquitoes, ticks, fleas) which exist in complex ecologic relationships Examples: § 1992/1993 Hanta Virus outbreak (HV pulmonary syndrome) (New Mexico, Arizona, Colorado, Utah) drought followed by El-Nino related heavy rainfall; ↑ mouse population & movement indoors § 1999 West Nile Virus (WNV) – Arbovirus (mosquito-borne virus) associated with drought conditions First US cases in NY during hottest summer on record to that date

Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation • Emergent & Re-emerging Infectious Diseases – Potentially: • Malaria • Dengue • Viral encephalitides • Cholera • etc, etc. http: //www 3. niaid. nih. gov/research/topics/emerging/default. htm

Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation • Water- & Food-Borne Diseases (Longer-term changes & extreme weather events) Naturally occurring toxins (e. g. , phytoplankton – red tides) Infectious disease pathogens • Relatively rare in U. S. Adequate food safety systems Good drinking water supply systems • One failure can be costly 1993 Cryptosporidiosis outbreak in Milwaukee 400, 000 people infected $96 million ($32 M direct medical; $65 M lost productivity) Attributed to drinking water contamination Coincided with Mississippi River flooding • Reduced snow pack, altered rainfall…. ↓ water supply (surface & groundwater) ↓ water quality

Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation • ↑ Temperature + ↑ UV radiation + primary emissions = ↑ secondary air pollutants (ground-level ozone, particulates) • Predicted ↑ extreme heat episodes = ↑ electric power use (= ↑ emissions & pollutant formation) • Particulate Matter (PM) ≤ 10 (PM 2. 5, PM 10 -2. 5) associated with premature deaths Annual CA: 8800 (3000, 15, 000 probable range) hospitalizations Annual CA: 9500 (4600, 14, 000 probable range) California Air Resources Board • Ozone associated with 3 -fold increased risk of new onset asthma among children who participate in ≥ 3 team sports Mc. Connell et al. , Lancet 359: 386 -391, 2002. • Nitrogen dioxide & other combustion-related pollutants associated with permanent deficits in children’s lung function growth. Gauderman et al. New Engl. J. Med. 351(11): 1057 -67, 2004.

Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation • Increases in Aeroallergens & Plant Biomass • CO 2 is essential to photosynthetic processes promotes plant growth • ↑ CO 2 = ↑ Invasive plant species • ↑ Temperatures + ↑ CO 2 = ↑ Ragweed in urban locations (grew faster, flowered earlier, greater above-ground biomass & pollen) Ziska LH et al. J Allergy Clin Immunol 2003; 111(2): 290 -5. • ? Increase in asthma & allergy in urban communities? (↑ exposures to allergens or allergen+ diesel emissions) Diaz-Sanchez, D. et al. Current Allergy and Asthma Reports 2003; 3(2): 146 -52. • ↑ Biomass + more arid conditions = ↑ risk of wildfires (↑ risk of injury & ↑ air pollution)

Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation • Increased Risk of Exposure to Pesticides & Herbicides – Response to shifts in distributions of vector species, agricultural pests and nuisance or invasive plants will likely lead to increased use of pesticides & herbicides – ↑ Use in urban areas (e. g. , West Nile Virus eradication programs short-term use may have + cost-benefits long-term/frequent use cost-benefits unknown. ) – Residential developments near agricultural areas

Public Health Impacts: Closing Thoughts Vulnerability, Disparities & Social Responsibility To reduce vulnerability at individual, population or community levels: Promote good health (reduces risk, increases resilience) Ensure access to health care, medical management Improve standard of care for all groups (Increase physician awareness) Reduce potential exposure (individual, community) Prevention & Response Ensure response is adequate & does no harm (e. g. , cooling centers & transportation; not fans) In developing/applying solutions think about unintended consequences. Investment of resources to mitigate climate-change health

Public Health Impacts: Closing Thoughts Actions Public health networks – Develop a comprehensive and coordinated strategy to prevent or mitigate the hazards posed. – Strategies can capitalize on existing surveillance systems and databases to detect, track, evaluate, prepare for and respond to those hazards with optimum adaptive strategies. – Capitalize on existing public health, clinical and societal infrastructure to apply adaptive strategies. – Identify weaknesses in infrastructure/strategies & fix.

Public Health Impacts: Closing Thoughts Actions – Public health and environmental protection strategies need to be integrated, complementary. . . • For example – Community actions to increase air conditioning in residences, need to be accompanied by actions that promote more green-energy production strategies. – Public health and environmental protection strategies need to be Equitable. – Public health community needs to be a partner in promotion of ‘climate change solutions. ’ – Education & Outreach • Get the messages right & get them coordinated.

Public Health Impacts: Closing Thoughts Global Responsibility Source: Patz, J. Nature: 438 (November 2005)

“Climate Change Public Health Impacts Assessment and Response Work Group” CDPH: EHIB Helene Margolis, Ph. D. , M. A. Paul English, Ph. D. , M. P. H. Thomas Kim, M. D. Kathleen Fitzsimmons, M. P. H. CDPH: EPIC Roger Trent, Ph. D. CDPH: DCDC Anne Kjemtrup, D. V. M. , Ph. D. Jonathan Kwan, Ph. D. CDPH: EHLB – IAQS Jed Waldman, Ph. D. OEHHA Bart Ostro, Ph. D. Scripps Institution of Oceanography Alexander Gershunov, Ph. D. UC Berkeley/LBNL Thomas Mc. Kone, Ph. D. Richard Jackson, M. D. NRDC Gina Solomon, M. D. , M. P. H. Miriam Rotkin-Ellman, Ph. D. Zev Ross Spatial Analysis Ithaca, NY

Contact Information: Helene G. Margolis, Ph. D. , M. A. hmargoli@cdph. ca. gov helene. margolis@ucdmc. ucdavis. edu 916 -552 -9837 Thank You!