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

2

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

3

Climate Change is Happening Now

Source: IPCC 2007 (4th Assessment)

4

IPCC 2007: Human Impact is Evident

Source: IPCC 2007 (4th Assessment)

5

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

6

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

7

Source: U.S. Greenhouse Gas Emissions Inventory

U.S. CO² Emissions from Fossil Fuel

8

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

9

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

10

Climate Change’s Impacts on Health

Source: Haines, et al, JAMA 2004

11

Extreme Weather Events & Disease Clusters

Source: Epstein, Harvard Center for Health & Global Environment

12

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

13

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

14

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

15

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

16

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

17

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)

18

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)

19

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)

20

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

21

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

22

23

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

24

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

25

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!

26

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)

27

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

28

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

29

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

30

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%

31

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

32

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

33

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

34

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