Beating the Heat: Public Health and Climate Change Jonathan E. Fielding, MD, MPH, MBA Director and...
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Transcript of Beating the Heat: Public Health and Climate Change Jonathan E. Fielding, MD, MPH, MBA Director and...
Beating the Heat: Public Health andClimate Change
Jonathan E. Fielding, MD, MPH, MBADirector and Health Officer
Los Angeles County Department of Public Health
APHA Annual Meeting and ExpositionSan Diego, CA - October 27, 2008
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Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Dr. Jonathan E. Fielding
No relationships to disclose
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Climate Change is Happening Now
Source: IPCC 2007 (4th Assessment)
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IPCC 2007: Human Impact is Evident
Source: IPCC 2007 (4th Assessment)
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Global Contributors to Greenhouse Gas Emissions
Leading sources of greenhouse gas emissions are combustion of fossil fuels: coal, oil, and natural gas
More than 60% of the annual global industrial carbon dioxide emissions come from industrialized countries, accounting for 20% of the world’s populationU.S. per capita emissions of carbon are over 20 times higher than
India, 12 times higher than Brazil, and 7 times higher than ChinaThese per capita rates expected to change significantly as China,
India, and other countries continue to develop economicallyChina is now the #1 carbon emitter, surpassing the U.S.
Global carbon dioxide emissions are projected to increase by at least 50% over the next 25 years under current conditions
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Annual Carbon Dioxide Emissions - 2005
Source: U.S. Greenhouse Gas Emissions Inventory
The most current estimates state that China is about to surpass the US in
emissions and its rate of emissions is accelerating.
22.4%
18.4%
11.4%
5.6%
4.9%
4.6%
32.7%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%
U.S.
China
Russia
EU
India
Japan
Others
Total CO2 – measured in thousands of metric tons
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Source: U.S. Greenhouse Gas Emissions Inventory
U.S. CO² Emissions from Fossil Fuel
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Why Should Public Health Care?
• It is our job to protect the public’s health– WHO estimates that in the year 2000, there were 150,000 excess deaths
per year due to climate change– Climate change is already affecting health around the world, and its
impact on health will continue to grow
• Fighting climate change is aligned with protecting and promoting health– Many of the proposed solutions for climate change are healthy for
everyone
• We have the appropriate skills– Public Health has the skills to effect behavior change, and those skills
can help people adopt greener behaviors too– Public Health has policy and advocacy skills that will help encourage
organizational and societal changes
• We can be role models
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1°C 2°C 5°C4°C3°C
Sea level rise threatens major cities
Falling crop yields in many areas, particularly developing regions
FoodFood
WaterWater
EcosystemsEcosystems
Risk of Abrupt and Risk of Abrupt and Major Irreversible Major Irreversible ChangesChanges
0°C
Falling yields in many developed regions
Rising number of species face extinction
Increasing risk of dangerous feedbacks and abrupt, large-scale shifts in the climate system
Significant decreases in water availability in many areas, including Mediterranean and Southern Africa
Small mountain glaciers disappear – water supplies threatened in several areas
Extensive Damage to Coral Reefs
Extreme Extreme Weather Weather EventsEvents
Rising intensity of storms, forest fires, droughts, flooding and heat waves
Possible rising yields in some high latitude regions450 ppm CO2 eq
650 ppm CO2 eq
Projected Impacts of GlobalTemperature Change
Source: L. Rudolph, 2008
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Climate Change’s Impacts on Health
Source: Haines, et al, JAMA 2004
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Extreme Weather Events & Disease Clusters
Source: Epstein, Harvard Center for Health & Global Environment
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Expected Environmental Impacts in So.Cal. of Climate Change: Sea Level Rise
Effects of rising sea level• Coastal areas will become
vulnerable to storms and flooding
• Loss of coastal wetlands and erosion of beaches
• Saltwater contamination of drinking water
• Potential damage to roads, highways, and other infrastructures near coastal areas
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Expected Environmental Impacts in CA of Climate Change: Floods & Droughts
Warmer temperatures can result in premature and rapid snowmelt in the Sierra snow pack, which alters the timing of run-off water supplies for ½ of CA’s surface water
Severe flooding may occur during winter and spring, with slower water flow during summer seasons
Drought risk may be acutely elevated during the summer months
June 2008 – Governor Schwarzenegger declares state drought
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Health Impacts of Heat WavesLos Angeles projected to have an increase of 62% -
88% in heat-related mortality by 2080Health impacts likely to be seen 1 to 3 days after the
onset of the heat waves Health effects of extreme and prolonged heat exposure
include: heat cramps, heat exhaustion, heat stroke, heat syncope (fainting)
Devastating heat waves seen elsewhere recently5-day heat wave in Chicago in 1995: 700 excess deaths,
most attributed to the heatAugust 2003 European heat wave: 35,000 excess deaths
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Heat Waves: Vulnerable Populations
Greater risk for people who do not have access to air conditioningMay not be able to afford air
conditioningFor populations unaccustomed to heat
waves, people may have air conditioning but chose not to use it, not realizing danger
Two vulnerable populations during heat waves:Elderly: Population of senior citizens (> 60 years old) in Los Angeles
County is expected to increase by 83% by the year 2020Low SES: Over 16% of LA County residents under 100% FPL
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Potential Environmental Impacts in So.Cal. of Climate Change: Wildfires
Wildfires are common in Southern California Characteristic of the area since
prehistoric times Santa Ana winds may drive heat waves,
prolong wildfires, and prevent wildfire control in this region
Climate models predict the summer months will be longer, and hotter, due to global warming
Result: dry soil and vegetation become fuel for wildfires
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Potential Environmental Impacts in So.Cal. of Climate Change: Air Quality
Increased temperature and increased carbon dioxide in atmosphere leads to Increase in formation of ground-
level ozone (and smog) Increased allergen production (e.g.
pollen) Longer seasons for allergen
producing weeds
Senior citizens, children, and people with respiratory and chronic diseases are most vulnerable to high levels of ozone and increased allergens
Health effects of high levels of ozone exposure include: Reduced lung function Respiratory discomfort Exacerbation of chronic respiratory illnesses (e.g. asthma)
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Summary of Health Effects of Air Pollution• Amount of goods transported
through California projected to nearly quadruple between 2000 and 20201
• Will have significant impact on air quality and health2
• Diesel particulate matter (PM)– concentrated around ports,
railyards, and heavily trafficked roads3
premature deaths cancer respiratory disease lost workdays global warming (2nd to CO2)
Annual Health Impacts in CA from PM and Ozone4
1 (Cal EPA, 2005); 2 (Pacific Institute, 2006)3 (CA/EPA Air Resources Board); 4 (CA/EPA Air Resources Board, 2004)
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The Time for Inaction Has Past• Scale of threat is global: touches all, everywhere
• Intensity of the threat: threatens all of our basic survival mechanisms -- food, water, shelter, and health.
• Scale of response: must engage every sector of society
• Timeframe for response: “…we have at most 10 years -- not 10 years to decide upon action, but 10 years to alter fundamentally the trajectory of global greenhouse emissions."
• “There is still time, but just barely.” (Dr. James Hansen, director of NASA Goddard Institute for Space Studies)
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A Public Health Responseto Climate Change
Public health already utilizes a multi-level prevention approach – analogous approach can be taken to respond to climate changePrimary prevention = climate change mitigation
Efforts to slow, stabilize, reverse climate change by reducing GHG emissionsEfforts will occur in sectors other than PH, such as energy and transportation
Secondary/tertiary prevention = climate change adaptationEfforts to prepare for, and minimize health burden of, climate changeSimilar to public health preparedness for other uncertainties (e.g. pandemic
flu, bioterrorist attack), so likely that PH as sector will be involved in adaptation efforts
Source: Frumkin, et al., AJPH 3/08
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What Should We Do?1. Mitigation = reduce GHG emissions
1. Reduce energy usage and Reduce, Reuse, Recycle1. As individuals, at home2. As organizations, at work
2. Adaptation = prepare for impact of climate change1. Emergency preparedness
1. As individuals/families2. As local health department
3. Mitigation and adaptation = advocate for healthy policies
1. Support legislation that reduces GHG emissions2. Support sustainable lifestyles & communities
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Realizing the Co-benefits ofReducing GHG Emissions
• Primary benefits– reductions in the expected long-term consequences of global warming;
avoided damages of climate change
• Co-benefits (or ancillary benefits)– economic, social, environmental, public health and other benefits
independent of any direct benefits from mitigating climate change
• Health co-benefits– Benefits of climate change mitigation strategies that have a positive
effect on health– Example: promote cleaner energy production and cleaner fuels
Primary result = reduced GHG emissions from energy productionCo-benefit = less air pollution = less respiratory distress
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Realizing the Co-benefits ofReducing GHG Emissions
Important to realize the co-benefits of climate change responses = certain efforts to address climate change often yield other health benefits tooStrategy: reducing vehicle miles traveled
Primary result = lower motor vehicle GHG emissionsCo-benefit = higher physical activity rates
Strategy: promote cleaner energy production and cleaner fuelsPrimary result = reduced GHG emissions from energy productionCo-benefit = less air pollution = less respiratory distress
Source: Frumkin, et. al., AJPH March ‘08
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Key Mitigation Technologies& Practices*
• Transport– Fuel efficiency– Hybrids– Road to rail– Public transport– Non-motorized transport– Land-use planning
• Buildings– Daylighting– Energy efficiency– Improved cook stoves– Solar heating & cooling
• Agriculture– Crop & land management– Livestock & manure
management– Improved N fertilizer use
• Industry– Energy efficiency– Heat & power recovery
• Energy supply– Coal to gas– Nuclear power– Renewable energy
* Items in green have health co-benefits!
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GHG Mitigation Strategies,Air Pollution, & Health
• Globally ancillary benefits may be 30% – 100% abatement costs
• Public health improvement and “knock-on” effect to health services from reductions in air pollutants account for approximately 80% total value ancillary benefits in US
• Canada proposed GHG emissions reductions would also reduce– SO2 by 9%, NOx by 7% of annual emissions
– 3,300 premature deaths per year avoided in Canada w/15% GHG reduction (based on PM reduction only)
• GHG reductions in 4 cities would avoid (through 2020)– 64,000 premature deaths
– 65,000 chronic bronchitis cases
– 37 million person-days of restricted activity or work loss
Sources: IPCC (2001); Caton (2000); Blomqvist (2000); Cifuentes (2001)
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Climate & Health Co-benefits of Decreased Auto Use
Reductions
• Greenhouse gas emissions
• Air pollution
• Noise
• Infrastructure costs
• Community Severance
Increases
• Physical Activity
• Social Capital
Reductions
• Respiratory disease
• Traffic injuries
• Heart disease
• Depression
• Osteoporosis
• Diabetes
• Cancer
• Stress
Borrowed from L. Rudolph
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Climate & Health Benefits of Reduced Meat Consumption
Reductions
• Greenhouse gas emissions
• Antibiotic use
• Water pollution (nitrates)
• Air pollution
• Soil erosion
• Unsustainable H2O consumption
• Pesticide Use
Reductions• Ischemic heart disease • Obesity• Colorectal cancer• Breast & prostate cancers • Type II Diabetes • Antibiotic resistance• Respiratory disease• Pesticide health effects
Average American diet requires the production of extra 1.5 CO2e compared to a strictly vegetarian diet.
2.2 pounds beef = CO2e of 155 miles driving
Meat consumption reduction of 20% = switch from Camry sedan to PriusIncreases• Biodiversity• Global food security• Protein intake equity• Rural community
strength
Borrowed from L. Rudolph
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Mitigation: What Can We Do In Our Homes& Workplaces to Combat Global Warming?
Establish recycling programs in the workplace and home Recycling half of your household waste = hundreds of
lbs. of CO2 saved per year
Promote energy efficiency in the home and workplace Changing regular light bulbs to compact fluorescent
bulb throughout your house = hundreds of lbs of CO2/yr
Make “small energy” use changes on a broad scale E.g. replacing all light bulbs with energy efficient light
bulbs in all County buildings
Encourage renewable energy power sources (solar energy and wind energy) and responsible use of energy Turning off your TV, computer, and other electronics =
thousands of lbs. of CO2 saved per year
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Mitigation: What Can We Do In Our Homes& Workplaces to Combat Global Warming?
Try to drive less and walk more! You save gas money and keep our air
cleaner for every mile you don’t drive Most car trips taken in your neighborhood
are short enough to walk or bike Encourage carpooling to
work/school Encourage public transportation
use
Provide incentives for employees to purchase fuel-efficient vehicles (e.g. electric, hybrid, CNG vehicles) Every gallon of gas saved = tens of lbs. of CO2 saved
If you do take a car, maintain it Properly inflated tires can improve gas mileage by 3%
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Adaptation: Emergency Preparedness
We need to prepare now for the inevitable effects of climate change, such as heat waves and wildfiresGood news: preparing for one type of emergency
prepares us for all types of emergenciesPreparation minimizes impact of disasters and
fear/anxietyWe need to prepare ourselves as individuals
and as health agencies
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Promote Healthy Policies Support policies related to sustainable communities
Mixed use development, jobs near housing, transit-oriented design, bike lanes and sidewalks, parks and green
Development and utilization of useful public transportation
Energy efficient "green" buildings and LEED certification
Buildings consume 72% of the nation’s electricity and more GHG than transportation or industry*
Recycling, waste management and pollution control
Securing safe water supplies
Source: US Dept of Energy, 2007
These policy decisions occur at all levels of government, so many opportunities for Public Health to give input
Health Impact Assessments Surveillance data tracking spread of vectors and diseases
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What Should We Do?• Educate – ourselves, public, and policy makers • Partnerships and collaboration • Lend PH credibility and experience in driving policy & behavior change• Advocate for aggressive government and business mitigation policies &
strategies that also promote health• PH leadership in advocating for personal, organizational, local government
carbon footprint reduction• Increase understanding and research re: health co-benefits• Ensure health co-benefits included in policy and cost assessments (e.g. HIAs)• Protect vulnerable populations
– Advocate for equity in mitigation• Monitor health impacts of climate change• Preparedness and adaptation
Borrowed from L. Rudolph
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We Can’t Do It Alone
So why should we bother?Efforts will yield long-term savingsWill make our economy more competitiveThe co-benefits are greatWill improve the sustainability of our
communitiesMoral obligation – if we care about the health of
our communities, then we need to do our part
Jonathan E. Fielding, MD, MPH
Public Health Director and
Health OfficerLos Angeles County
Department of Public Health
Special thanks to Linda Rudolph for use of some of her slides