+Case #1

You are part of an Environmental Health Team at a local public health unit.

The combination of weather and air pollution is resulting in a high Air Quality Health Index reading for your community.

What information do you need to successfully inform your community of the health risks of air quality, and to address policy issues related to air quality?

Questions Who is at highest risk for health impacts from air pollution? What are the main contributors to air pollution? How is AQHI measured? How is air quality impacted by climate change?

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+AQHI

Health effects at low pollutant concentrations

Mix of multiple pollutants

NO2

ozone PM2.5/10

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Health Risk

Air Quality Health Index

Health Messages

At Risk Population* General Population

Low Risk 1 - 3Enjoy your usual outdoor activities. Ideal air quality for outdoor activities.

Moderate Risk 4 - 6

Consider reducing or rescheduling strenuous activities outdoors if you are experiencing symptoms.

No need to modify your usual outdoor activities unless you experience symptoms such as coughing and throat irritation.

High Risk 7 - 10

Reduce or reschedule strenuous activities outdoors. Children and the elderly should also take it easy.

Consider reducing or rescheduling strenuous activities outdoors if you experience symptoms such as coughing and throat irritation.

Very High Risk

Above 10

Avoid strenuous activities outdoors. Children and the elderly should also avoid outdoor physical exertion.

Reduce or reschedule strenuous activities outdoors, especially if you experience symptoms such as coughing and throat irritation.

Health Canada: Airhealth.ca

+Health effects of longterm air pollution increased risk of stroke

increased risk of heart disease

increased risk of chronic and acute respiratory infections, including asthma

increased incidence of lung cancer

WHO - outdoor air pollution is a Group I carcinogen (2013)

delayed development of the lungs

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+Case #2

You are a Medical Officer of Health for a medium-sized city. Average summer temperatures have been increasing, with several heat-related deaths the previous year. The following week is predicted to meet criteria for declaring a heat alert.

What steps should be taken to develop a Heat Alert and Response System?

Questions Why is increasing heat a health issue? What are the key components of a Heat Alert and Response System? What public health interventions are important?

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Heat Alert and Response Systems to Protect health: Best Practices Guidebookhttp://www.hc-sc.gc.ca/ewh-semt/pubs/climat/response-intervention/index-eng.php

+French Heat Wave 2003 Daily Mortality, Paris

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Source: INVS, 2003

Relationship between daily maximum temperatures in June, July and August, and all non-traumatic deaths for selected Canadian cities, 1986–2005

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Heat Alert & Response Systems to Protect Health: Best Practices HandbookHealth Canada, 2012

+Heat Alert & Response System

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Heat Alert & Response Systems to Protect Health: Best Practices HandbookHealth Canada, 2012

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+Case #3

You are a public health consultant working with the health department in the Northwest Territories on climate change issues. Through a community consultation process you have noted that a key priority is the impact of climate change on food security.

Questions What aspects of food security will be impacted by climate

change? What are the health impacts of climate change on food

security in Canada’s north? What are the real and potential health impacts of climate

change on food security globally?

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UN Special Rapporteur on the right to food: Canada already has problems

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“ In 2007/2008: 7.7% of households in Canada reported experiencing moderate or severe food

insecurity

“a staggering 1 in 10 families, 10.8%, with at least one child under the age of six were food insecure

during the same period.”

“deep and severe food insecurity faced by aboriginal peoples across Canada…17.8% of First Nations adults (age 25–39) reported being hungry but did not eat due

to lack of money for food in 2007/2008.”

Olivier De Schutter, Special Rapporteur on the right to food: Visit to Canada from 6 to 16 May 2012

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Health Effects of Climate Change in Canada’s North- Food Insecurity More difficult access to country food

Rising store-bought food prices secondary to poor crop yields.

Decreased safety of travel on the land/ice

Cultural dislocation/stress

Damage to infrastructure

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Health Canada-Séguin, J. Human Health in a Changing Climate:A Canadian Assessment of Vulnerabilities and Adaptive CapacityHer Majesty the Queen in Right of Canada, represented by the Minister of Health, 2008

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Country Food: Adapting to Climate change to protect food security Move hunting camps & fishing sites in response to environmental

changes to migration patterns

Increase flexibility in hunting schedule & species

Refer to Traditional Knowledge to understand cycles in nature & stewardship

Increase representation in institutions that influence the environment(GNWT, EconDev)

Increase in Advocacy at national & international levels

(Slide from Nelida Duran’s presentation to the Yellowknives Dene)

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Climate change: increasing food insecurity - case study - Djibouti.

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MSF Balbala Slum Malnutrition Project

High World Food prices in 2008 led to a malnutrition emergency in Djibouti, a very hot country where sig agriculture is not possible.

A pediatric malnutrition project was set up in the large slum, Balbala, adjacent to Djibouti city.

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Severe Acute Malnutrition:

-Immunocompromise

-Delayed and stunted growth

-High acute mortality from opportunistic infections (diarrhea, pneumonia) (Median <5 fatality rate =30-50%)

-Poor long-term neurodevelopmental outcomes.

Mortality much-decreased with inpt treatment: MSF Target = <5%(MSF-Djibouti=1-2%)

“rising incomes and growth in the global population, expected to create 2 billion more mouths to feed by 2050, will drive food prices higher by 40-50%. Climate change may add a further 50% to maize prices and slightly less to wheat, rice and oil seeds.” http://www.wfp.org/content/climate-change-how-warming-world-threat-our-food-suppliesClimate

20% more people will be at risk of hunger by 2050 due to the changing climate.” (World Food Program: http://www.wfp.org/climate-change)

FOOD INSECURITY SECONDARY TO CLIMATE CHANGE

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• Spikes in food prices in 2008 and 2011 led to food riots around the world: potential for further health problems secondary to conflict

• Improving food security needs to be a national and international priority.

Case #4

What may be the single most cost-effective way to reduce GHG in a way that also improves health outcomes?

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+Meeting unmet contraception needs

May be more effective in controlling climate change than most low-carbon technologies1,2

-each $7 spent on meeting unmet contraception needs reduces CO2 by >1 tonne1

-meanwhile, it costs up to $32 to reduce CO2 by 1 tonne using low-carbon technologies 1

Health co-benefits

decreased maternal mortality, prematurity, infant mortality, increased education, female empowerment 2

1-(Master’s Dissertation, Thomas Wire, London School of Economics)http://www.populationmatters.org/documents/reducing_emissions.pdphpMyAdmin=e11b8b687c20198d9ad050fbb1aa7f2f2-WHO: Family planning: a health and development issue, a key intervention for the survival of women and children.

http://apps.who.int/iris/bitstream/10665/75165/1/WHO_RHR_HRP_12.23_eng.pdf

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+Case #5 – Small group discussion – Shale Gas Development

Sources of energy

Coal

Hydroelectric

Nuclear

Natural Gas

Renewables - i.e. solar, wind, biomass

Each source needs to be considered for health impacts

Current issue: Shale gas development (Fracking)

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What is Hydraulic Fracturing?

A technology that has allowed access to large volumes of shale gas that were previously inaccessible/uneconomical to produce

Injection of large volumes of water, sand and chemicals / additives at high pressure down and acres into horizontally drilled wells thousands of meters below the surface, causes rock layer to fissure

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What are community concerns about shale gas development?

From: Council of Canadian Academies, 2014. Environmental Impacts of Shale Gas Extraction in Canada. Ottawa (ON): The Expert Panel on Harnessing Science and Technology to Understand the Environmental Impacts of Shale Gas Extraction, Council of Canadian Academies http://www.scienceadvice.ca/uploads/eng/assessments%20and%20publications%20and%20news%20releases/shale%20gas/shalegas_fullreporten.pdf

Unknowns27

“Several important uncertainties concerning the environmental implications…”

absence of…baseline information about geological & environmental conditionsperformance of key components of…technologypathways, fate, and behaviour of industry-related contaminants in ground water

Unknowns - Human Health28

“…gaps in knowledge of the effects of large-scale shale gas development on human health:”

Mixtures of chemicals…generally unknown and untestedAdditives will change due to reactionsPathways of fracturing chemicals in the environment…including [exposure] routes…unclearTypical exposure…not fully established…health impacts difficult to predict or quantifyCalculations of additive risk for specific compounds/cumulative risks from several compounds not availablePublic health surveillance…or rigourous health impact assessments…have not been conductedLack of baseline monitoring

Role of Public Health

Toxicology

Cluster analyses

Research

Policy analysis

GIS

Evidence from similar industries

Risk assessment and risk management

Health Impact Assessment

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Health Impact Assessment Means of assessing

the health impact of policies, plans and projects in diverse economic sectors, using quantitative, qualitative and participatory techniques (WHO 2011. http://www.who.int/hia/en/)

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+Case #5 – Small group discussion – Shale Gas Development

You are living in a medium-sized province where shale gas development is being considered. The community has many individuals and several groups who would like a ban or a moratorium. There are also many who would like to proceed with development. Others are uncertain about the best course of action for the province.

A community meeting has been organized to help inform the provincial government review process.

You are playing the role of the individual described on your card.

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Instructions

- Take two minutes to outline your thoughts

- Each person takes one to two minutes to present to the group

- Debate / discuss these questions for five minutes:

- What course of action would you recommend to the province? Can you come to a group consensus?

- What further information do you need to inform your recommendation?