Beating the Heat: Public Health and Climate Change

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Beating the Heat Public Health andClimate
Change
Jonathan 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
Dr. Jonathan E. Fielding

• (1) The following personal financial
  relationships with commercial interests relevant
  to this presentation existed during the past 12
  months

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 worlds
  population
• U.S. per capita emissions of carbon are over 20
  times higher than India, 12 times higher than
  Brazil, and 7 times higher than China
• These per capita rates 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 least 50 over the next 25 years
  under current conditions

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Annual Carbon Dioxide Emissions - 2005
Total CO2 measured in thousands of metric tons
The most current estimates state that China is
about to surpass the US in emissions and its
rate of emissions is accelerating.
Source U.S. Greenhouse Gas Emissions Inventory
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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 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 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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Projected Impacts of GlobalTemperature Change
1C
2C
5C
4C
3C
0C
Food
Falling crop yields in many areas, particularly
developing regions
Falling yields in many developed regions
Possible rising yields in some high latitude
regions
450 ppm CO2 eq
Water
Significant decreases in water availability in
many areas, including Mediterranean and Southern
Africa
Small mountain glaciers disappear water
supplies threatened in several areas
Sea level rise threatens major cities
Ecosystems
Extensive Damage to Coral Reefs
Rising number of species face extinction
650 ppm CO2 eq
Extreme Weather Events
Rising intensity of storms, forest fires,
droughts, flooding and heat waves
Risk of Abrupt and Major Irreversible Changes
Increasing risk of dangerous feedbacks and
abrupt, large-scale shifts in the climate system
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 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 CAs 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 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 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 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 do not have access to
  air conditioning
• May not be able to afford air conditioning
• For 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 (gt 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 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 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 change
• Similar 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?

• Mitigation reduce GHG emissions
• Reduce energy usage and Reduce, Reuse, Recycle
• As individuals, at home
• As organizations, at work
• Adaptation prepare for impact of climate change
• Emergency preparedness
• As individuals/families
• As local health department
• Mitigation and adaptation advocate for healthy
  policies
• Support legislation that reduces GHG emissions
• 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 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-benefits of 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 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
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

• 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

• Increases
• 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 dont 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
  wildfires
• Good news preparing for one type of emergency
  prepares us for all types of emergencies
• Preparation minimizes impact of disasters and
  fear/anxiety
• We 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 nations electricity
  and more GHG than transportation or industry
• Recycling, waste management and pollution control
• Securing safe water supplies

• 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

Source US Dept of Energy, 2007
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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 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 obligation if we care about the health of
  our 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 her slides