The Public Health Impacts of Climate Change

Laura Wenzel

Medical Advocates for Healthy Air

Carolinas Climate Resiliency Conference

September 13, 2016

laura@cleanaircarolina.orgMedicalAdvocatesforHealthyAir.org

Medical Advocates for Healthy Air

• Program of Clean Air Carolina

• Air quality in NC

• Education and Advocacy

• Heath professionals –stories and credibility

MAHA presentation at Charlotte AHEC October 24, 2016Register at MedicalAdvocatesforHealthyAir.org

Structure of presentation• Climate impact on

health in US

• Data on health impacts in NC (and SC)

• Behavioral and policy solutions

• How medical and health professionals can advocate

Health Impacts of Climate Change - US

• EPA Quiz

https://www3.epa.gov/climatechange/impacts/health-assessment-quiz.html

• US Global Climate Change Research Program Climate and Health Assessment

• Vulnerability factors

Exposure

Sensitivity

Adaptive capacity

NC Climate and Health Profile• Respiratory Diseases

• Heat-related Deaths and Illness

• Mental Health Impacts

• Storm Deaths and Injuries

• Water- and Food-borne Diseases

• Flood Deaths and Injuries

• Vector-borne Diseases

Health Risks in the Carolinas• Drought -> wildfires, wind-blown dust

-> increase levels of Ozone and Particulate Matter pollution -> asthma, heart attack, depression

• Rising levels of CO2 -> more potent allergens in pollens -> asthma, allergies

• Longer periods of warmth -> pollens more prevalent -> asthma, allergies

• Standing water + warmer winters -> mold, ticks, mosquitos -> asthma, allergies, vector-borne disease?

• Flooding -> water contamination -> GI illness

Increase in weeks with risk of very large fires (%) US GCCRP Health Assessment

Rocky Mountain Spotted Fever, Cases per million in 2010

http://www.cdc.gov/rmsf/stats/

Asthma in the Carolinas

South Carolina 2012~18% boys, ~13% girls*Map:2012 Rate of hospitalizations for asthma ages 0-14

*http://www.scdhec.gov/Health/docs/CHAS/Asthma/Ever%20Told%20Have%20Asthma.pdf

North Carolina10.9% of children

Map: 2014 Childhood Asthma Hospital Discharge Rates

ǂper 100,000

0-54ǂ

54-119119-189189-303303-390

NC State Center for Health Statisticshttp://www.schs.state.nc.us/data/databook/CD15%20Asthma%20hospitalizations%20by%20county.html

SC Map: http://infoweb02.dhec.sc.gov/epht/

Leading medical cause of absence from school

Mental and Social Health• Disasters -> displacement, stress, PTSD, depression,

grief, anxiety, lack of access to mental health care

• Changes to local environment -> loss of livelihood (agriculture, tourism)

• Heat -> Psychiatric medications increase sensitivity

• Groups at risk: children, the elderly, women (esp. pregnant and post-partum), people with preexisting mental illness, the poor, first responders

• Potential for post-traumatic growth

Impact on Health Care Systems• Access – road damage, communication problems,

power outages, water contamination, language barriers – during storms, floods, extreme heat

• Knowledge –familiarity with novel diseases like zika

• Stress – on patients and their families and on first responders

Solutions• Disease management and education

• Resilient healthcare facilities and systems

• Trauma stewardship –self-care

• Addressing climate change

Resilience Planning• NC Climate Health and Adaptation Program (CDC)ǂ

• Heat, wildfire impacts in specific counties

• Resilient health care facilities (US DHHS)* • Healthcare facilities -> community centers

• Provide for healthcare workers and their families

• Energy and water efficiency, on-site renewable energy

• We are at our best when we have imagined and accounted for the worst.

• 427 Climate Solutions• Hospital Dashboard**

ǂhttp://epi.publichealth.nc.gov/oee/programs/climate.html*https://toolkit.climate.gov/sites/default/files/SCRHCFI%20Best%20Practices%20Report%20final2%202014%20Web.pdf**http://427mt.com/2016/02/resilient-hospitals-dashboard/

Cultivating Resilient Staff• Human resilience is skills-based

• Awareness of how events can affect mind and body

• Knowledge of techniques such as simple breathing, mindset, and psychosocial skills can build capacity

• Five directions of trauma stewardship• Keep in mind “why” we are doing this – shared goal

• “Resourcing” – remember positive experiences

• Create “microculture” of support, compassion for self

• Remember nothing is permanent, gratitude for what exists

• Daily practice of centering, awareness of intention

Educational & Behavioral Solutions

• Air Quality Flag Program

• Turn Off Your Engine Signs

• AQI Index Handouts

• Ozone Gardens

• Citizen Science Air Monitoring

• Promote biking, walking or carpooling

• Support electric/hybrid vehicles

• Facilitate increased energy efficiency

• Promote and facilitate recycling

• Promote eating less meat

Clean Air Policies Work2002 NC Clean Smokestacks ActSignificant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina

Kravchenko et al. 2014.http://dx.doi.org/10.2147/COPD.S59995

Ozone monitoring in the Carolinas

http://www.scdhec.gov/Health/DiseasesandConditions/ChronicDiseaseData/AsthmaHeartAttackData/

Annual Number of Days with Maximum 8-hour Average Ozone Concentration Over the NAAQS by County in South Carolina, 2012

NC Ozone Design Values, 2012-2014

https://ncdenr.s3.amazonaws.com/s3fs-public/Air%20Quality/planning/attainment/mapping/NC_Ozone_Design_Values_2012-2014.jpg

Advocate for Policy Solutions

• Clean Renewable Energy• EPA Clean Power Plan• State Renewable Energy Policies

• Energy Efficiency• Smart Growth/Transit• Regulate heavy duty diesel vehicles

Advocacy

• Local, state, federal policy

• Prepare for and address climate change

• Frontline workers tell compelling stories

• Empowerment averts despair

References427 Climate Solutions. http://427mt.com/

Centers for Disease Control. Rocky Mountain Spotted Fever Statistics and Epidemiology. http://www.cdc.gov/rmsf/stats/

Kravchenko, J. et al. 2014. Long-term dynamics of death rates of emphysema, asthma and pneumonia, and improving air quality. International Journal of Chronic Obstructive Pulmonary Disease 9 (1). http://dx.doi.org/10.2147/COPD.S59995

Lipsky, LVD. 2009. Trauma Stewardship: An everyday guide to caring for self while caring for others. San Francisco: Barret-Koehler.

Medical Advocates for Healthy Air. 2016. Protecting Your Patients from Air Pollution. http://medicaladvocatesforhealthyair.org/

National Resilience Institute Http://www.nationalresilienceinstitute.org/

NC Department of Environmental Quality. Ozone Design Values 2012-2014. https://ncdenr.s3.amazonaws.com/s3fs-public/Air%20Quality/planning/attainment/mapping/NC_Ozone_Design_Values_2012-2014.jpg

NC Department of Health and Human Services. 2015. Occupational & Environmental Health. Climate & Health. http://epi.publichealth.nc.gov/oee/programs/climate.html

NC DHHS. 2015. North Carolina Climate and Health Profile. http://epi.publichealth.nc.gov/oee/climate/ClimateAndHealthProfile.pdf

NC State Center for Health Statistics. 2014 Childhood Asthma Discharge Rates. http://www.schs.state.nc.us/data/databook/CD15%20Asthma%20hospitalizations%20by%20county.html

SC Department of Health & Environmental Control. 2012. Annual Number of Days with Maximum 8-hour Average Ozone Concentration Over the NAAQS by County http://www.scdhec.gov/Health/DiseasesandConditions/ChronicDiseaseData/AsthmaHeartAttackData/

SC DHEC. 2012. South Carolina Statewide CHAS Survey Results. http://www.scdhec.gov/Health/docs/CHAS/Asthma/Ever%20Told%20Have%20Asthma.pdf

US Department of Health and Human Services. 2014. Primary Protection: Enhancing Health Care Resilience for a Changing Climate.https://toolkit.climate.gov/sites/default/files/SCRHCFI%20Best%20Practices%20Report%20final2%202014%20Web.pdf

US Global Climate Change Research Program. 2016. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. https://health2016.globalchange.gov/

Discussion