Water Health and Climate Change Linda Rudolph MD

Water, Health, and Climate Change Linda Rudolph, MD, MPH May 27, 2015

Water is essential for life. Water is a human right. * * * 2012 California Human Right to Water bill “…every human being has the right to safe, clean, affordable, and accessible water adequate for human consumption, cooking, and sanitary purposes. ”

What do we use water for? • SUSTAIN LIFE • Stay hydrated • Grow food, fiber, trees • Sanitation and hygiene • Sewer systems • Wash hands, bodies, food, homes • Hydropower • Transportation • Aquatic and riparian habitat • Cultural and spiritual • Recreation • Aesthetics • Landscaping

Water for Life • Sufficient: Between 50 and 100 liters of water person per day are needed to ensure that most basic needs are met and few health concerns arise. • Safe: free from micro-organisms, chemical substances and radiological hazards that constitute a threat to a person's health • Acceptable in color, odor and taste for use • Accessible: the water source has to be within 1, 000 meters (0. 6 mi) of the home and collection time should not exceed 30 minutes • Affordable: water costs should not exceed 3 per cent of household income. http: //www. un. org/waterforlifedecade/human_right_to_water. shtml

: Sanitation and Safe Drinking Water • Among the great public health achievements of the 20 th century • Chlorination and other drinking water treatment • Sewage disposal • Solid waste disposal • Food safety • Public hygiene education

But…. . • 1. 1 billion people (1/6) do not have access to a safe and adequate water supply. • May increase to 2. 3 billion by 2025 • 2 – 3. 5 million people – mostly children < age 5 in developing nations – die each year from diseases due to unsafe drinking water, inadequate sanitation, or poor hygiene • Water withdrawals tripled over the last 50 years • Demand for water food production is projected to double by 2050 In 2010, nearly all megacities were facing water scarcity • Almost half world population will be living in areas of high water stress by 2030 • Climate change increases high water stress • Global water availability is sufficient to meet the personal and domestic needs of all human beings. But as demand for water from all sectors exceeds availability, prioritization of uses becomes all the more important. http: //www. zaragoza. es/contenidos/medioambiente/onu/1048 -eng_report_of_special_rpp. P rteur_on_human_right_to_safe_drinking_water_and_sanitation. pdf https: //www. facingthefuture. org/Issues. Solutions/Fast. Facts. Quick. Actions/Water. Security/tabid/185/Default. aspx#. VWUHNcb. D 7 Sk

Africa Average 5 gpcd USA Average 100 -176 gpcd http: //www. mercurynews. com/science/ci_25090363/california-drought-water-use-varies-widely-around-state

Climate change impacts on water in California Drier Dries Higher Highs Reduced Runoff Hotter Hots Wetter Wets

What are the health impacts of climate-change impacts on water? • Water availability and cost • Water quality • Water and food production • Flooding • Infectious diseases • Water infrastructure • Mental health

Drought & Climate Change • Warming temperatures due to climate change • Larger fraction of precipitation falls in downpours • More storm water lost to storm runoff (vs absorbed in soil) • Larger fraction of mountain precipitation fall as rain rather than snow • Snowpack melts earlier due to warming • Reduced stream flows in late-spring, summer • Higher evaporation rates • Losses of water from reservoirs • Drier soil • Arctic ice loss may change the jet stream

How bad is this drought? May 19, 2015

Drought Health Impacts • Water Quality • Water Availability and Affordability • Food Costs and Insecurity • Vector-borne disease • Stagnant pools • Improper water storage • Wildfire • Air Quality • Increased dust and particulate levels • Increased pollen • Wildfire smoke • Airborne toxins from freshwater algal blooms (cyanobacteria) • Recreational risks • Unemployment & economic impacts • 1/3 CV jobs related to farming

Water quantity • Most communities in California not reliant on a single source of water, but some are • Some groundwater reliant on annual rainfall • Some small systems reliant on stream flow • Some communities facing acute water shortages now

Water quality • Increase concentration of pollutants and contaminants in groundwater and surface water • Toxics and metals • Bacteria, protozoa, amoeba (warming and concentration) • Over 21 million Californians rely on contaminated groundwater as primary source of drinking water • Over 4 million people (especially in rural areas) highly vulnerable to groundwater contamination • Use of recycled water food irrigation/processing may increase risks of E. coli and Salmonella • Clean-up of contaminated water very costly • Reduced stream and river flows can cause stagnation & low O 2 levels • US EPA estimates California will need to spend approximately $40 Billion on infrastructure improvements to ensure delivery of safe drinking water over next 20 years

Drought and Food • Limits in growing season • Reduced yields due to crop loss or fallowing • Conditions that encourage insect and disease infestation in some crops • Low crop yields can result in rising food prices and shortages, • Food insecurity associated with diabetes, obesity. • Affects health of livestock and cost of feed • Herd culling can increase meat and dairy prices • Impacts on fisheries

http: //www. motherjones. com/environment/2014/02/wheres-californias-water-going

http: //www. motherjones. com/environment/2014/02/w heres-californias-water-going

Nutritional recommendations

Drought and Mental Health • Drought stress may be different than stress in other disasters • • extended event with no single moment of impact anxiety builds over time and becomes chronic less noticeable to self and others may not be viewed as seriously because damage not as visible • Impact is worst for already stressed farm families and communities • May be greater for young farmers, farmers with second off-farm job, women in farm families • Drought and suicide • Australia • U. S. Mid-west http: //www. health. vic. gov. au/pcps/downloads/planning_practice_guide. pdf

Warmer Water Temperatures Coastal and Inland Water Bodies • Naturally occurring pathogens and toxin-producing harmful algae • Expand seasonal windows of growth • Expand geographic range • Expansion northward of invasive species • Changes in fish populations • Increase mercury contamination in fish • Reduce dissolved oxygen, incomplete mixing • Increase vectors

Extreme Precipitation & Flooding • Warmer air holds more moisture • Rain falling in more concentrated episodes • Risk: overwhelm capacity of • Combined sewer systems • Water treatment facilities

Orange County Hospital, 1938 Anaheim, 1938

Public Health Issues Precipitation Extreme Precipitation Sewage overflow s Physical injuries and destruction of property Increased runoff: sediment, contaminants, nitrate, etc. Contamination of surface and groundwater Waterborne disease outbreaks from drinking water or recreational contact (beachgoers): Giardiasis, E coli, Cryptosporidium 24

Flooding Health Effects • Acute injuries & fatalities • Contamination • Drowning, trauma • Increase pathogen loads from urban, agricultural, and wildlife sources • Impacts drinking water/waste water/sewage treatment and storm water • Mental Health • Disruption social networks & support • Respiratory illness • Chronic disease, dermatitis, arthritis • Disruption in medications • Soil erosion/loss • Increased risk failure/damage • Water infrastructure breakdown exacerbates risk (especially aging infrastructure) • PTSD, depression, anxiety, access to mental health services • Asthma, respiratory infection, mold • Agriculture and aquatic habitat impacts 25

Waterborne Disease Outbreaks in U. S. • Inadequate, interrupted, or intermittent water treatment associated with waterborne disease outbreaks • • • Number of pathogens in the source water Age of the distribution system Quality of the delivered water Climatic events that tax treatment plant operations ½ of waterborne disease outbreaks from 1948 – 1994 associated with extreme precipitation • 1993 Milwaukee Cryptosporidium Outbreak • 1. 61 M people were affected; over 400, 000 w/ significant symptoms; 100 people died • 1971 to 2002: 764 documented waterborne outbreaks associated with drinking water • 575, 457 cases of illness, 79 deaths • Estimated number of waterborne illnesses/year: 19. 5 M/yr. all health outcomes • GI illness only: estimates 12 M – 16 M/year http: //www. ncbi. nlm. nih. gov/pubmed/18020305

Transportation Impacts 27

Sea Level Rise & Storm Surge • LA region sea level rise projected: • 5 – 24 inches) from 2000 to 2050 • 17 – 66 inches from 2000 to 2100. • Roads, water systems, health facilities at risk • Saline intrusion • Sacramento-San Joaquin Delta http: //c-change. la/sealevelrise/

Displacement and Migration 29

Public Health Role • Educate the public about water, climate change, and health • Advocate for health, equity, and sustainability in water policies and programs • Protect our precious water resources from further contamination • Support actions to enhance water supply sustainably, mindful of health concerns • Increase monitoring for water-related health risks and outcomes

Public Health Role • Ensure access to adequate supplies of safe and clean drinking water, water for sanitation and hygiene, and water for healthy food production • Educate the public about water, climate change, and health • Advocate for health, equity, and sustainability in water policies and programs • Protect our precious water resources • Support policies, programs, funding, and infrastructure to enhance water supply sustainability • Source protection, pollution protection, replenishment • • • Water conservation and efficiency Water recycling and reuse (e. g. gray water) Repaired and expanded infrastructure (green and gray) Water and soil management Safety net systems (e. g. lifeline water rates) • Increase monitoring for water-related health risks and outcomes • Enhance public health preparedness for water impacts of climate change

Public Health has an important role. Join the webinar series to learn more! http: //phasocal. org/water-initiative/

http: //climatehealthconnect. org/climate-and-health-alliance/ Linda Rudolph, MD MPH linda. rudolph@phi. org http: //www. phi. org/uploads/application/files/h 7 fjouo 1 i 38 v 3 tu 427 p 9 s 9 kcmhs 3 oxsi 7 tsg 1 fovh 3 y esd 5 hxu. pdf 33