climate change public health impacts helene g. margolis, phd environmental health investigations...
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Climate Change Public Health ImpactsClimate Change Public Health Impacts
Helene G. Margolis, PhD
Environmental Health Investigations Branch Division of Environmental &Occupational Disease Control
Source: NASA
California Public Health Association – North
2008 Annual MeetingUC Davis, Davis, California
March 14, 2008
University of California, DavisDepartment of Internal Medicine
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• Increased incidence of extreme high sea level (excludes tsunamis)
Source: IPCC Climate Change 2007: The Physical Science Basis: Summary for Policymakers
Public Health Impacts: Opening Thoughts Climate change will lead to amplification of: Most existent public health challenges....
Serious consequences in developed nations,catastrophic consequences in struggling nations.
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 Vulnerability Vulnerability
In a lifetime everyone passes through stages of vulnerability.
Biological/Genetic Factors Physical Environmental Physical Environmental
FactorsFactorsSocial/Behavioral Social/Behavioral
FactorsFactors
’Individual’s Response
Exposure & Dose
Potential for Elevated Potential for Elevated Exposure & DoseExposure & DoseMost VulnerableMost VulnerableBiological Biological
SusceptibilitySusceptibility
The impact of environmental factors on populations… begins with impacts on individuals.
Environmental Impacts of Global Warming & SequelaeEnvironmental Impacts of Global Warming & Sequelae Greenhouse Gases =>Greenhouse Gases =>◊ ◊ Changing ClimateChanging 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)↑ Tropical Cyclones &
Hurricanes (Freq. & Intensity)
↑ Extreme High Sea Level ◊ ◊ Plant Growth (COPlant Growth (CO22))◊ ◊ Ozone & photochemicalsOzone & photochemicals
““Exposures”Exposures”Extreme Weather Events
Heat WavesFloodsDroughts
WildfiresAir Pollution (O3, PM, GHG)Nuisance Plants
AllergensPesticides
Ecological Shifts =>Distribution & abundance of :
hosts, vectors, pathogens of Vector-Borne DiseasesWater-Borne Pathogens
Water-Food Supply & Quality
Malnutrition, diarrhea, harmful algal blooms
““Public Health Impacts”Public Health Impacts”Acute Morbidity/Mortality
InjuryHeat-related illnessChronic dz. acute eventsToxin-related illnesses
Chronic DiseaseRespiratory (Asthma, COPD, Allergy)
Cardiovascular (Atherosclerosis, ...
Communicable DiseaseV-B: West-Nile, malaria, dengue, encephalitis, hantavirus, Rift Valley feverW-B: Cholera, cryptosporidiosis, campylobacter, leptospirosis
Population DisplacementPsychosocial
Source: IPCC Climate Change 2007: The Physical Science Basis: Summary for Policymakers
• 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 & exhaustionCrampingHeavy perspirationWeakness
Heat StrokeCore body temperature >104°FMulti-organ system dysfunctionOften fatal despite treatment
Public Health Impacts: Direct Effects
Risk Factors ExertionDehydrationChildren ≤ 5 years or Age >60 yearsLack of air conditioning Social isolationChronic diseases (CVD, COPD)Cognitive and mobility impairmentsLow socio-economic statusHousing characteristics
• 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: Direct Effects
Built Environment & Co-Exposures: Heat Islands, Topography & Ozone
El Dorado CountyBuilt-up rural area
Public Health Impacts: Simultaneous Risks
Heat-Related Deaths in Counties with ≥10 DeathsJuly 15 – August 1, 2006
Source: R. Trent, T. Kim. 2007. CDPH
99% of cases lived in zip codes where > 50% of residents live below Poverty Guide Line
Public Health Impacts: Direct Effects 2006 Heat Wave in California
• 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 succumbedplus 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 e.g., water quality, communicable disease, psychosocial stress
Misters give cows some relief at Pacheco Dairy in Kerman, Fresno County.
Source: Modesto Bee/Marty BicekSource: Fresno Bee/Mark Crosse
Public Health Impacts: Indirect Impacts of Direct Effects
• Insect- & Animal-Borne DiseasesTemp, 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 CA -- by 2004 – 830 human cases across 58 counties
Public Health Impacts: Effects Arising from Ecological Shifts & Environmental Degradation
• Emergent & Re-emerging Infectious Diseases
– Potentially: • Malaria• Dengue• Viral encephalitides• Cholera• etc, etc., etc.
http://www3.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 costly1993 Cryptosporidiosis outbreak in Milwaukee
400,000 people infected$96 million ($32M direct medical; $65M 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 (PM2.5, PM10-2.5) 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
McConnell 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
• CO2 is essential to photosynthetic processes promotes plant growth
• ↑ CO2 = ↑ Invasive plant species
• ↑ Temperatures + ↑ CO2 = ↑ 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: Effects Arising from Ecological Shifts & Environmental Degradation
To reduce vulnerability at individual, population or community levels:Promote good health (reduces risk, increases resilience)Ensure access to health care, medical managementImprove standard of care for all groups (Increase physician awareness)
Reduce potential exposure (individual, community)Prevention & ResponseEnsure response is adequate & does no harm(e.g., cooling centers & transportation; not fans)
In developing/applying solutions think about unintended consequencesunintended consequences. .
Investment of resources to mitigate climate-change health impacts can also contribute significantly to improvement of overall health of the public.
Public Health Impacts: Closing Thoughts Vulnerability, Disparities & Social Responsibility
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 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 ThoughtsActions
Source: Patz, J. Nature: 438 (November 2005)
Public Health Impacts: Closing Thoughts Global Responsibility
“Climate Change Public Health Impacts Assessment and Response Work Group”
CDPH: EHIBCDPH: EHIBHelene Margolis, Ph.D., M.A.Paul English, Ph.D., M.P.H.Thomas Kim, M.D.Kathleen Fitzsimmons, M.P.H.
CDPH: EPICCDPH: EPICRoger Trent, Ph.D.
CDPH: DCDCCDPH: DCDCAnne Kjemtrup, D.V.M., Ph.D.Jonathan Kwan, Ph.D.
CDPH: EHLB – IAQSCDPH: EHLB – IAQSJed Waldman, Ph.D.
OEHHAOEHHABart Ostro, Ph.D.
Scripps Institution of Scripps Institution of OceanographyOceanography
Alexander Gershunov, Ph.D.
UC Berkeley/LBNLUC Berkeley/LBNLThomas McKone, Ph.D.Richard Jackson, M.D.
NRDCNRDC
Gina Solomon, M.D., M.P.H.
Miriam Rotkin-Ellman, Ph.D.
Zev Ross Spatial AnalysisZev Ross Spatial AnalysisIthaca, NY
Contact Information:
Helene G. Margolis, Ph.D., M.A. Helene G. Margolis, Ph.D., M.A.
[email protected]@ucdmc.ucdavis.edu 916-552-9837
Thank You!