COPING WITH CLIMATE CHANGE MANIFESTATIONS ON WATER AND HEALTH

1. COPING WITH CLIMATE CHANGE MANIFESTATIONS ON WATER AND HEALTH Konstantinos C. Makris and Syam S. Andra CYPRUS UNIVERSITY OF TECHNOLOGY Cyprus International Institute for Environmental and Public Health in association with the Harvard School of Public Health

2. Disruption What is the cost of avoiding climate change? If we do everything we can now to reduce global greenhouse gas emissions and ensure we adapt to the future effects of climate change, the average estimated cost is 2% of the world annual gross domestic product (GDP). However, if we do nothing, effects of climate change could cost 5–20% of the annual world GDP. • Little work has been conducted on Sb endocrine disrupting effects. • However, recent evidence suggests that Sb may be at least partially responsible for estrogenic effects. Choe et al. (2003) reported that antimony chloride has “high estrogenicity” in two bioassays. In an estrogen-receptor dependent transcriptional expression assay using human breast cancer cells, 1 µM antimony chloride had estrogenic activity that was 61% equivalent to 1 nM 17β-estradiol. Stern N. The economics of climate change. Cambridge: Cambridge University Press, 2007.

3. Perception of Cypriot Society on Climate Change • In the EU, just over half (51%) of respondents consider climate change one of the world's most serious problems (and 20% feel it is the single most serious problem). • It is seen as the second most serious issue facing the world, after poverty, hunger and lack of drinking water, and a more serious problem than the economic situation. (Special Eurobarometer report, October 2011)

4. Chemical Leaching • Plasticizer molecules like antimony, BPA and phthalates from plastic wall skeleton, could move through the solid polymer matrix via the following mechanisms: • i. Diffusion • ii. Photodegradation • iii. Relaxation • iv. hydrolysis

5. Climate Change and HealthReduced Health Risk compared with Tap Water? A Human Health Perspective on Climate Change: A Report Outlining the Research Needs on the Human Health Effects of Climate Change April 22, 2010, NIEHS, USA.

6. How we STORE, TREAT and USE WATER will be key in adapting to climate change challenges Desalinated Water Hydrogeologic Cycle Surface Water Coastal Water Ground Water Recycled Water (Bottled) Spring Water

7. Assess Adjust Plan The Adaptive Climate Cycle Evaluate Implement Monitor Hess et al., 2011,EHP

8. How WE STORE, TREAT AND USE WATER will be key in adapting to climate change challenges Desalinated Water • Supply Reduction • Algal Blooms-Toxins-Treatment costs • Pathogen maturation rates (Cholera) • Runoff discharge • Temperature-driven volatility, solubility, biodegradation effects on POP bioavailability • Food supply contamination from irrigation Hydrogeologic Cycle Surface Water Coastal Water Recycled Water Ground Water Bottled Spring Water

9. How WE STORE, TREAT AND USE WATER will be key in adapting to climate change challenges Desalinated Water • Fish productivity-Species extinction/migration • Algal blooms-Cladophora spp. • Dissolved O2 reduction-Hypoxia-Fish kills • Coral reef bleaching-zooplankton reduction • Shell calcification reduction-Ocean acidification • Coastal flooding by sea level rise(?) Hydrogeologic Cycle Surface Water Coastal Water Recycled Water Ground Water (Bottled) Spring Water

10. Desalinated Water Seawater pollution with algae and petroleum products might endanger the quality of desalinated water, while treatment cost may be exacerbated. Infrastructure risk due to sea level for on-shore plants. Hydrogeologic Cycle Surface Water Coastal Water Recycled Water Ground Water (Bottled) Spring Water

11. Potable Water in Urban Pipe Networks Finished water under quality deterioration (DBP formation, biofilm/scales release, Legionella spp. outbreaks). Stagnation and intermittent flow in drinking water distribution systems enhance biofilm growth. Changes in hydrostatic pressure within drinking water pipes may facilitate pipe leakage and soil/contaminants intrusion. Wet/dry alterations cause soil movement (swelling) impacting pipe physical condition failures/leakages. Backflow and wastewater intrusion into pipes of drinking water systems poses serious health risk.

12. How WE STORE, TREAT AND USE WATER will be key in adapting to climate change challenges Desalinated Water • Low aquifer and river flow (anoxic zones) deteriorate water quality and increase treatment costs. • Seawater intrusion-Brackish waters • Salting-out effect for increased bioavailability of POPs • Deeper water table pumping—higher costs Hydrogeologic Cycle Surface Water Coastal Water Recycled Water Ground Water (Bottled) Spring Water

13. How WE STORE, TREAT AND USE WATER will be key in adapting to climate change challenges Desalinated Water • Increased demand • Treated water quality reduction (xenobiotics) • Urban storms may increase the contaminant load in treatment plants. Hydrogeologic Cycle Surface Water Coastal Water Recycled Water Ground Water (Bottled) Spring Water

14. How WE STORE, TREAT AND USE WATER will be key in adapting to climate change challenges Desalinated Water • Increased withdrawal-Spring capacity issues-Shift to bottled water • Water quality reduction-Brackish waters • Plasticizer leaching Hydrogeologic Cycle Surface Water Coastal Water Recycled Water Ground Water (Bottled) Spring Water

15. Neglected Water Compartment—URBAN STORMWATER Desalinated Water Hydrologic Cycle Coastal Water Surface Water STORM Water Recycled Water Ground Water (Bottled) Spring Water

16. Extreme Rainfall-Induced Health Hazards

17. EXTREME WEATHER EVENTS URBAN STORMAWATER MANAGEMENT More than 50% of waterborne disease outbreaks were preceded by intense rainfall events in the USA above the 90th percentile (Curriero et al., 2001, AJPH). In need of stormwater urban collection ponds and deployable portable filters for contaminants 1. Erosion-Sedimentation 2. Increase downstream pollution from Brownfields’ contaminant release 3. Unwanted mixing of freshwater with sewage during floods and downstream runoff 4. Pump station failure, power outage, possible loss of water supply Venice, IT, summer 2006 Kris Snibbe/Harvard Staff Photographer, Harvard Gazette, October 27, 2011

18. Αccess to improved water source, GDPand infant mortality Hunter et al., 2010. Water Supply and Health. PLoS Med 7(11): e1000361

19. Sea Rise and SaltWater Intrusion • Average estimated sodium intakes from drinking water ranged from 5 to 16 g day-1 in the dry season, compared with 0.6–1.2 g day-1 in the rainy season. The annual hospital prevalence of hypertension in pregnancy was higher in the dry season (OR = 12.2%; 95% CI, 9.5–14.8) than in the rainy season (OR = 5.1%; 95% CI, 2.91–7.26) (Khan et al., 2011, EHP). • Increases in water salinity may increase POP/pesticide bioavailability due to salting out effect.

20. Water and Health -- Adaptation Measures 1. Climate change effects on water sectors before hitting hard our economy need to be classified and hierarchically addressed by pertinent agencies 2. Interdisciplinary efforts need to be initiated by engaging plethora of expertises, ranging from engineers, economists, health scientists, biologists, environmental scientists, and others as needed 3. Coastal infrastructure sustainability and maintenance, Sea level rise? 4. Disaster management and preparedness plans 5. Climate change and public health education and learning

21. Acknowledgement • We would like to thank the Harvard-Cyprus program of the Harvard School of Public Health for partially funding and supporting of this study.

22. Extended Heat Periods and Heat Waves 1. Heat Stress may be overwhelming for patients suffering with cardiovascular or respiratory disease, diabetes, and other chronic diseases. 2. Need to estimate heat related mortality and compare it with the increased air pollution mortality due to the use of air conditioning in Peak demand seasons (summer). Example of the impact of the average air temperature on daily mortality in humans. These data represent the mortality (324.7 deaths per day) in The Netherlands from 1979 to 1987. The size of each block is proportional to the sample size. Data and graph modified from Kunst et al. (1993).

23. Shortened Gestational Age with Heat Stress Periods • Gestational age at delivery determines fetal maturity at birth. • Shorter gestational age at delivery was documented to be the primary cause of perinatal mortality, both in Europe and US. • Risk increases with decrease in gestational age. • A 5-day reduction in gestational age was observed when subjects were exposed to 32 °C (Heat Index) on the day before delivery (p = 0.03) Dadvand et al., 2011. Climate Extremes and the Length of Gestation. Environmental Health Perspectives.

24. Stress-Pollution Interactions • Temperature effects may be acting as an effect modifier towards the toxicity of a pesticide during an animal study (Gordon C.J., 2003, Environ. Res.). For example, toxicological experiments with rodents for a pesticide showed no-effect level at 5 mg/kg at relatively warm ambient temperatures when literature showed 75 mg/kg as a no-effect level. (Gordon C.J., 2003, Environ. Res.)

25. Heat-Related Interventions-Dilemmas • Identification of elderly and children while provisioning them with access to air conditioning. Could increased use of air conditioning serve as a cost-effective intervention measure when their use leads to air pollution and risk for power outage in the summer? • Both health (exposure and toxicologic) and economic-based risk assessment plans. • Socioeconomic status and the built environment may be extremely important factors of susceptibility to heat waves and heat stress on morbidity/mortality in Cyprus.

26. Microplastics in the marine environment and Climate Change • Physiological effects on marine biota induced by bioavailable compounds desorbed from ingested plastics are being investigated, since mass of ingested plastic in Great Shearwaters (Γλάροι) was positively correlated with PCBs in their fat and eggs. • There is also potential danger to marine ecosystems from the accumulation of plastic debris on the sea floor. The accumulation of such debris can inhibit gas exchange between the overlying waters and the pore waters of the sediments, and disrupt inhabitants of the benthos (Moore, C.J., 2008, Environ. Res.). Laysan albatross chick, Kure Atoll, 2002, photo: Cynthia Vanderlip, AMRF.

27. High Air and Water Temperatures • Solvent Switching is defined as contaminant partitioning into different phases towards thermodynamic equilibrium. Temperature-driven effects on Henry constant for various organics. Concentrations of contaminants may not exceed thermodynamic constraints. • Solvent Depletion is an energy-intensive process that increases fugacity since solvent concentrations decrease. Food web alterations, organic carbon changes, biomagnification). Concentrations of contaminants may exceed thermodynamic constraints. (McDonald et al., 2002, ES&T)

28. Greenhouse gases + sunlight O3 T Secondary PM and photodegradation

29. Harmful and Nuisance Algal Blooms Cyanobacteria (blue-green algae) produce toxins (microcystins, nodularins, saxitoxins, anatoxin-a, anatoxin-a(s) , cylindrospermopsin) whose health effects range from liver damage, including liver cancer, to neurotoxicity. Nuisance algal blooms like those of Cladophora spp. are expected to grow in frequence in Cyprus coasts.

30. CLIMATE CHANGE IN A NUTSHELL Manifestations Melting Ice Cap Factors • Ocean Circulation • Water Temperature • Salinity • Transportation • Industry • Agriculture • Heating Processes Rainfall Variations Temperature Rise Greenhouse Effect CO2 CH4 N2O Land Use Changes Consequences • Disasters • Floods • Cyclones • Heat Waves • Droughts Sea Level Rise Fossil Fuel Burning • Urbanization • Deforestation • Outcome • Casualties • Famines • Diseases Spread • Biodiversity Losses • Economic Losses Reference: Modified from UNFCCC 2007.

31. CLIMATE CHANGE – BROADER IMPACTS • WATER, AIR, WEATHER, ECOSYSTEMS, OCEANS Reference: 1) USEPA , 2) UNEP/GRID-Arendal, Potential climate change impacts , UNEP/GRID-Arendal Maps and Graphics Library, http://maps.grida.no/go/graphic/potential-climate-change-impacts (Accessed 13 October 2011)

32. Cyprus-Specific Synoptic Plan • Current and foreseeable climate change (CC) environmental manifestations • Water-Related, but not visually observed CC Environmental Manifestations • CC-Impacted Health Categories and Water • Hydrologic Cycle Alterations due to CC • Water-Related CC Health Impacts • Water-Mediated CC Heath Impacts • Synthesis and Adaptation Plans • What is Next for Cyprus

33. Climate Change and Health Effects 2 9 2 | N AT U R E | VO L 4 7 2 | 2 1 A P R I L 2 0 1 1 Heat Periods and Waves, Storms/Hurricanes, Floods, Drought, Nutrition, Food Safety, Air Pollution, Aerosolized Allergens, Infectious Diseases, Occupational Health, UV Radiation.

34. Key Population Health Terms Susceptibility: Intrinsic biological factors that can increase health risk of individual such as medical history genetic variants and stage in life. Vulnerability: Human populations at higher risk due to environmental or personal-socioeconomic factors. Both susceptible and vulnerable populations are called sensitive. J. Estrin, NY Times, March, 2010

35. Sea Level Rise Between 1870-2006 http://maps.grida.no/go/graphic/trends-in-sea-level-1870-2006

36. Climate Change and Aflatoxins Reference: 1Patterson and Lima, 2010. How will climate change affect mycotoxins in food? Food Research International 43 (2010) 1902–1914; 2CAST. (2003). Mycotoxins: Risks in plant, animal, and human systems. Ames IA, Council for Agricultural Science and Technology.

37. Climate change affects fisheries industry http://maps.grida.no/go/graphic/vulnerability-of-national-economies-to-potential-climate-induced-changes-in-fisheries

38. Ocean Acidification and Climate Change http://maps.grida.no/go/graphic/acidification-due-to-climate-change-impacts-for-oceans-and-coral-reefs

39. High Air and Water Temperatures • Decrease dissolved oxygen levels • Increase contaminant load to water bodies (both chemical and microbial) • Reduce stream and river flows • Foster algal blooms • Increase the likelihood of saltwater intrusion near coastal regions • Increase disinfection by product formation in potable water supplies • Ozone formation • Enhance ice/snow melt and possible release of POPs, e.g., PAH, PCB, Dioxins, EDC • Volatility, Solubility, Biodegradation • Increase incidence cases of Legionella spp. outbreaks due to prevailing of thermophila bacteria in higher ambient temperature environments Reference by Noyes et al., 2009, Environ. International

40. Concentrations of target compounds (ng L-1) and minimum reporting levels (MRL) in wastewater samples from Larnaca, CY (Makris and Snyder, 2011). Recycled Water Tremendous pressure on increased recycled water production in light of climate change effects. Xenobiotics in recycled water need to be treated prior land application.