Case #1

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? + 1 Case #1

2. Health effects at low pollutant concentrations Mixof multiple pollutants NO2 ozone PM2.5/10 7 AQHI

3. Health Messages Air Quality Health Index At Risk Population* General Population Health Risk 8 Enjoy your usual outdoor activities. Ideal air quality for outdoor activities. 1 - 3 Low Risk 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. Moderate Risk 4 - 6 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. 7 - 10 High Risk 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. Above 10 Very High Risk Health Canada: Airhealth.ca

4. 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 9 Health effects of longterm air pollution

5. 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? + 2 Case #2 Heat Alert and Response Systems to Protect health: Best Practices Guidebook http://www.hc-sc.gc.ca/ewh-semt/pubs/climat/response-intervention/index-eng.php

6. 19 French Heat Wave 2003 Daily Mortality, Paris Source: INVS, 2003

7. 7 Relationship between daily maximum temperatures in June, July and August, and all non-traumatic deaths for selected Canadian cities, 1986–2005 Heat Alert & Response Systems to Protect Health: Best Practices Handbook Health Canada, 2012

8. 8 Heat Alert & Response System Heat Alert & Response Systems to Protect Health: Best Practices Handbook Health Canada, 2012

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10. 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? + 3 Case #3

11. 11 29 UN Special Rapporteur on the right to food: Canada already has problems “ 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

12. 30 12 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 Health Canada-Séguin, J. Human Health in a Changing Climate: A Canadian Assessment of Vulnerabilities and Adaptive Capacity Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2008

13. 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 31 Country Food: Adapting to Climate change to protect food security (Slide from Nelida Duran’s presentation to the Yellowknives Dene)

14. 32 14 Climate change: increasing food insecurity - case study - Djibouti.

15. 33 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.

16. 34 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%)

17. FOOD INSECURITY SECONDARY TO CLIMATE CHANGE “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)

18. 36 • 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.

19. 19 Case #4 • What may be the single most cost-effective way to reduce GHG in a way that also improves health outcomes?

20. 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=e11b8b687c20198d9ad050fbb1aa7f2f 2-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 + 43 Meeting unmet contraception needs

21. 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) + 5 Case #5 – Small group discussion – Shale Gas Development

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23. 23 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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26. 26 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

27. 27 Unknowns • “Several important uncertainties concerning the environmental implications…” • absence of…baseline information about geological & environmental conditions • performance of key components of…technology • pathways, fate, and behaviour of industry-related contaminants in ground water

28. 28 Unknowns - Human Health • “…gaps in knowledge of the effects of large-scale shale gas development on human health:” • Mixtures of chemicals…generally unknown and untested • Additives will change due to reactions • Pathways of fracturing chemicals in the environment…including [exposure] routes…unclear • Typical exposure…not fully established…health impacts difficult to predict or quantify • Calculations of additive risk for specific compounds/cumulative risks from several compounds not available • Public health surveillance…or rigourous health impact assessments…have not been conducted • Lack of baseline monitoring

29. 29 Role of Public Health • Toxicology • Cluster analyses • Research • Policy analysis • GIS • Evidence from similar industries • Risk assessment and risk management • Health Impact Assessment

30. 30 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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32. 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. + 5 Case #5 – Small group discussion – Shale Gas Development • 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?