Public Health and ClimateChange

8/10/2019 Public Health and ClimateChange

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Beating the Heat:Public Health and

Climate ChangeJonathan E. Fielding, MD, MPH, MBA

Director and Health Officer

Los Angeles County Department of Public Health

APHA Annual Meeting and Exposition

San Diego, CA - October 27, 2008


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Presenter Disclosures

(1) The following personal financial relationships with

commercial interests relevant to this presentation existedduring the past 12 months:

Dr. Jonathan E. Fielding

No relationships to disclose


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Climate Change is Happening Now

Source: IPCC 2007 (4thAssessment)


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IPCC 2007: Human Impact is Evident

Source: IPCC 2007 (4thAssessment)


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Global Contributors toGreenhouse Gas Emissions

Leading sources of greenhouse gas emissions are combustion of fossilfuels: coal, oil, and natural gas

More than 60% of the annual global industrial carbon dioxideemissions come from industrialized countries, accounting for 20% ofthe worlds population

U.S.per capitaemissions of carbon are over 20 times higher thanIndia, 12 times higher than Brazil, and 7 times higher than China

Theseper capitarates expected to change significantly as China,India, and other countries continue to develop economically

China is now the #1 carbon emitter, surpassing the U.S.

Global carbon dioxide emissions are projected to increase by at least50% 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 CO2measured in

thousands of metric tons


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Source: U.S. Greenhouse Gas Emissions Inventory

U.S. CO Emissions from Fossil Fuel


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Why Should Public Health Care?

It is our job to protect the publics 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 itsimpact on health will continue to grow

Fighting climate change is aligned with protecting andpromoting health

Many of the proposed solutions for climate change are healthy foreveryone

We have the appropriate skills

Public Health has the skills to effect behavior change, and those skillscan help people adopt greener behaviors too

Public Health has policy and advocacy skills that will help encourageorganizational and societal changes

We can be role models


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1C 2C 5C4C3C

Sea level rise

threatens major cities

Falling crop yields in many areas, particularlydeveloping regionsFood

Water

Ecosystems

Risk of Abrupt and

Major Irreversible

Changes

0C

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

ExtremeWeather

Events

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 Changes 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 becomevulnerable to storms and

flooding Loss of coastal wetlands and

erosion of beaches

Saltwater contamination of

drinking water Potential damage to roads,

highways, and otherinfrastructures near coastalareas


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Expected Environmental Impacts inCA of Climate Change: Floods & Droughts

Warmer temperatures can result inpremature and rapid snowmelt in theSierra snow pack, which alters thetiming of run-off water supplies for of

CAs surface waterSevere flooding may occur during

winter and spring, with slower waterflow during summer seasons

Drought risk may be acutely elevated during the summer months

June 2008Governor Schwarzenegger declares state drought


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Health Impacts of Heat Waves

Los Angeles projected to have an increase of 62% -88% in heat-related mortality by 2080

Health impacts likely to be seen 1 to 3 days after theonset of the heat waves

Health effects of extreme and prolonged heat exposureinclude: heat cramps, heat exhaustion, heat stroke, heatsyncope (fainting)

Devastating heat waves seen elsewhere recently

5-day heat wave in Chicago in 1995: 700 excess deaths,most attributed to the heat

August 2003 European heat wave: 35,000 excess deaths


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Heat Waves: Vulnerable Populations

Greater risk for people who donot have access to airconditioningMay not be able to afford air

conditioning

For populations unaccustomed to heatwaves, people may have airconditioning 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 2020

Low 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 SouthernCalifornia Characteristic of the area since

prehistoric times

Santa Ana winds may drive heat waves,

prolong wildfires, and prevent wildfirecontrol in this region

Climate models predict the summermonths will be longer, and hotter,

due to global warming

Result: dry soil and vegetationbecome fuel for wildfires


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Potential Environmental Impacts in So.Cal. of Climate Change: Air Quality

Increased temperature andincreased carbon dioxide inatmosphere 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 diseasesare 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 transportedthrough California projected tonearly quadruple between 2000and 20201

Will have significant impact onair quality and health2

Diesel particulate matter (PM) concentrated around ports,

railyards, and heavily traffickedroads3

premature deaths

cancer

respiratory disease

lost workdays

global warming (2ndto CO2)

Annual Health Impacts in CAfrom 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 preventionapproachanalogous approach can be taken to respond to

climate change

Primary prevention = climate change mitigation

Efforts to slow, stabilize, reverse climate change by reducing GHG

emissions

Efforts will occur in sectors other than PH, such as energy and transportation

Secondary/tertiary prevention = climate change adaptation

Efforts 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 emissions1. Reduce energy usage and Reduce, Reuse, Recycle

1. As individuals, at home

2. As organizations, at work

2. Adaptation = prepare for impact of climate change1. Emergency preparedness

1. As individuals/families

2. As local health department

3. Mitigation and adaptation = advocate for healthy

policies1. 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 benefitsindependent of any direct benefits from mitigating climate change

Health co-benefits

Benefits of climate change mitigation strategies that have a positiveeffect on health

Example: promote cleaner energy production and cleaner fuelsPrimary result = reduced GHG emissions from energy production

Co-benefit = less air pollution = less respiratory distress


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Realizing the Co-benefits ofReducing GHG Emissions

Important to realize the co-benefitsof climate change

responses = certain efforts to address climate change often

yield other health benefits too

Strategy: reducing vehicle miles traveled

Primary result = lower motor vehicle GHG emissions

Co-benefit = higher physical activity rates

Strategy: promote cleaner energy production and cleaner fuels

Primary result = reduced GHG emissions from energy production

Co-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 & manuremanagement

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 SO2by 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)

li l h b fi


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Climate & Health Co-benefitsof 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 ReducedMeat 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 Prius

Increases

Biodiversity

Global food security

Protein intake equity

Rural community

strength



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Mitigation: What Can We Do In Our Homes& Workplaces to Combat Global Warming?

Establish recycling programs in the workplace andhome Recycling half of your household waste = hundreds of

lbs. of CO2saved per year

Promote energy efficiency in the home and workplace

Changing regular light bulbs to compact fluorescentbulb 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 (solarenergy and wind energy) and responsible use ofenergy Turning off your TV, computer, and other electronics =

thousands of lbs. of CO2saved per year
http://systemsintegrationtechnologies.com/images/recycle.jpg


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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 dont drive

Most car trips taken in your neighborhoodare short enough to walk or bike

Encourage carpooling towork/school

Encourage public transportationuse

Provide incentives for employees to purchase fuel-efficient vehicles

(e.g. electric, hybrid, CNG vehicles) Every gallon of gas saved = tens of lbs. of CO2saved

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 inevitableeffects of climate change, such as heat wavesand wildfires

Good news: preparing for one type of emergencyprepares us for all types of emergencies

Preparation minimizes impact of disasters andfear/anxiety

We need to prepare ourselves as individualsand 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 andsidewalks, parks and green

Development and utilization of useful publictransportation

Energy efficient "green" buildings and LEEDcertification

Buildings consume 72% of the nationselectricity and more GHG thantransportation or industry*

Recycling, waste management and pollutioncontrol

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?

Educateourselves, 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 governmentcarbon 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



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We Cant Do It Alone

So why should we bother?

Efforts will yield long-term savings

Will make our economy more competitive

The co-benefits are great

Will improve the sustainability of our

communities

Moral obligationif we care about the health ofour communities, then we need to do our part


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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 herslides

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