Presented to: Healing the Planet: Creating a Peaceful and Sustainable Future September 26, 2009

1. Presented to: Healing the Planet: Creating a Peaceful and Sustainable FutureSeptember 26, 2009 Greenhouse Gases, Outdoor Air Pollution and Public Health

2. Stéphane Perron, MD, MSc, FRCPC Direction de santé publique, MontréalProfesseur adjoint, DMSP, UdeMsperron@santepub-mtl.qc.ca514-528-2400, poste 3291 Louis Jacques, MD, FRCPC Direction de santé publique, Montréal Hôpital thoracique de Montréal, CISTE Professeur agrégé, DMSP, UdeM ljacques@santepub-mtl.qc.ca 514-528-2400, poste 3305

3. Presentation Outline • Climate Change • Quebec Emissions • Health Impacts • Oppressive Heat • Extreme Climate Events • Outdoor Air Pollution • Health Impacts • Ragweed • Public Health Approach

4. Climate Change

6. Climate Change Quebec Emissions

7. Fig.1 – Distribution of GHG Emissions in Quebec, by Activity Sector Source : MDDEP, 2008

8. Fig. 2 – Distribution of GHG Emissions in Quebec, 2006, by Gas Type Source : MDDEP, 2008

9. Figure 4 – GHG Emissions in Quebec, by Activity Sector, from 1990 to 2006 (Mt, CO2 equivalent) Source : MDDEP, 2008

10. Climate Change Health Impacts

11. Health ImpactsClimate-related mortalityInfectious diseasesAir quality / respiratory and cardiovacular diseases Agricultural ImpactsAgricultural yieldsIrrigation needs Forest ImpactsForest type changeSpecies migration Water ImpactsDrinking water reservesWater qualityCompetition for the resource Coastal Region ImpactsCoastal erosionCoastal floodingCost vs coastal community protection Natural Spaces and SpeciesEcological zone changesNatural space distances Potential Impacts of Climate Change – International Perspective

12. Climate Change Quebec Perspective • Oppressive Heat Episodes • Extreme Climate Events

13. Oppressive Heat

14. Daily Mortality and Average Temperatures in Major Cities – North America (solid lines) and South America (dotted lines)

15. Daily Deaths vs Mean Temperature Paris, 2003 and 1999-2002

16. Montreal – June 1994 Heat Wave

17. Local Variation of Thermal and Vegetation Zones CSSS Cavendish

18. Oppressive Heat Main Health Impacts of Oppressive Heat Episodes • Direct Impacts: • Muscular cramps • Heat exhaustion • Heatstroke mortality • Indirect Impacts: • Significant increase in death and hospitalization rates among elderly, chronically-ill persons

19. Vulnerable Persons • Hospitalized persons – 75 % of Quebec mortalities • Children aged 0 to 4 • Chronically-ill, elderly people (65 and over) • Cardiovascular, respiratory, stroke, kidney, neurological, diabetes • Taking medication • Living alone downtown • Urban Heat Islands • Mentally-ill persons

20. Housing with no air conditioning Sudden early summer heat wave with high humidity (acclimatization) Lasting several days, with high nighttime temperatures (>25 oC) Heat/pollen/smog/photochemical pollution interaction Health Impacts – Environmental Risk Factors

21. Prevention Strategies Population • Information and education on preventive measures (hydration, air conditioning) • Warning (monitoring) and alert (mobilization) systems • A call for vigilance Health Establishments • Develop techniques to reduce room heat loads • Emergency action plans • Early medical intervention

22. Normal Temperature • Preventive measure implementation • WarningTo 30 oC & Humidex 40 oC • Information on preventive strategies • Public health warning • Alert To 30 oC & Humidex 40 oC 5 consecutive days & 5 consecutive nights • Emergency Action Plan Action Strategies and Temperature

23. Protection Measures:Crisis Management • Activate network emergency action plans • Operation Solidarity: search for persons at risk and offer assistance • Make cooling-off locations available (municipal shelters, shopping centres, etc.) • Take charge of people at risk, as required • Distribute water to the homeless • Manage overcrowded hospital emergency rooms

24. Extreme Climate Events

25. 1998 ice storm Carbon monoxide poisoning epidemic Will power outages become more frequent?

26. Outdoor Air Pollution

27. Outdoor Air Pollutants • Smog: chemical pollution which occurs mainly in urban areas, under certain weather conditions (hot day, low wind and temperature inversion) • Ozone: occurs mainly when heat, NOx, VOCs and other pollutants react in the presence of UV • Pollutants can be: • Particulate matter: PM10, PM2.5, ultrafine particles • Gases : O3, NOx, SO2, CO, COV, …

28. Smog Day

29. Evolution of Pollutant Levels • In the last few decades (~30 years), there has been a decrease in the average concentration of certain pollutants: SO2, CO, Pb and PM • Somewhat stable levels: O3, NO2, COV, H2S • Rising level: CO2 • Levels sometime exceed standards in some places and times (ex. : O3) • Current standards are too weak to protect vulnerable persons.

30. Pollutant Sources • Fixed: industry, housing, incinerators, … • Mobile: transportation • Linked to: • Motor vehicles (gasoline, diesel) • Industrial activity • Thermal power plants (coal, natural gas,…) • Fossil fuel heating (wood, oil, natural gas, …) • Waste incineration • Fires • …

31. WOOD HEATING Households With Wood Heating, Montreal Island (DSP Montréal, 2001)

32. Health and Outdoor Air Pollution

33. Toxicity Mechanisms • Inflammatory reaction • Autonomous nervous system reaction • Increased blood viscosity and blood clot formation • CO-generated Hypoxaemia (affects persons with a heart failure condition) • Possible causes: fine and ultra-fine particulate matter, NOx, ozone, etc.

34. Health Impacts (Heart and Lung) Linked to Air Pollution 1 540 par année, à Montréal

35. Leading Health Problems Linked to Air Pollution • Increased mortality • Heart disease • Respiratory diseases, including COPD (Chronic Obstructive Pulmonary Disease), asthma, infections, allergic rhinitis • Cancers, including lung and skin

36. Health Impacts • Numerous epidemiological studies • Clearly demonstrated impacts for respirable particle matter (particularly fines) • No known threshold • Long-term impacts more severe than short-term impacts • Important to reduce average exposure levels • An increase in long-term cardio-respiratory mortality (6 %), including lung cancer (8 %), is linked to a 10µg/m3 increase in the average PM2.5 concentration

37. Main Health Impacts • Short-term impacts: • Worsening asthma • Worsening cases of CVD (including death) and COPD • Increased risk of respiratory tract infections • Long-term impacts: • Lung development and respiratory functions are affected • Increased mortality (particularly from PM2.5): from all causes, CVD, COPD and lung cancer

38. Most Vulnerable Persons • Young children • Elderly people • The chronically-ill • Heart and stroke • Respiratory • Diabetes • People living near major thoroughfares

40. Ultrafine Particles • Health impacts on people living near a major thoroughfare, with increased exposure to fine particles and Nox • 53 % mortality increase for people aged 55 to 77, living 100 metres from a freeway. This rate increase is due to cardiorespiratory mortality (Hoek et al, 2002) • People 60 and over, living along busy highways, are 21% more likely to be hospitalized for respiratory problems (Smargiassi et al, Montreal, 2006) • Pregnant women living less than 200 meters from a freeway are 17% more likely to give birth to an underweight baby. (Généreux et al, Montreal, 2007) • Several other studies have documented the link between traffic intensity near the place of residence and myocardial infractions, respiratory problems and otitis.

41. What to do? • Individual treatment • Recommend measures to stop or reduce exposure: • Measures controlled by patient or family • Measures controlled by others

42. Public Health Actions • Alert System: Info-smog • Quantify health/social impacts • Awareness campaigns for the public and decision makers • Promote emission reduction actions (transportation, industry, wood heating), through: • Laws and regulations (revise emission standards…) • Tax incentives and disincentives • Public and active transport promotion policies • Policies to assist the purchase of greener vehicles and equipment • Vehicle maintenance programs…

43. Preventive Medicine Practices • Identify patients who are the most vulnerable to pollution events • Elderly people, heart disease, heart failure, asthma, chronic bronchitis, emphysema • Inform them of the personal measures that can reduce health risks: • Monitor smog warnings • Reduce outdoor physical activity during smog events, particularly during the most critical periods (late afternoon) • Avoid the most polluted places and other pollution sources (tobacco) • Action plan for Rx use

44. Ragweed

45. Allergic Rhinitis and Ragweed • Affects > 10 % of the population • 5th most-declared health problem in Quebec • Ragwood might be responsible for most cases of allergic rhinitis • Associated allergic manifestations: • Rhinitis • Conjonctivitis • Asthma • Upward trend: due to global warming?

46. Figure 5.3 – Pollen concentration for 5 plants under study, Montreal and Quebec City, 1994 to 2002 Garneau M et al.

47. Figure 5.1: Length of Pollinic Seasons for Ambrosia spp, Montreal, 1994-2002 Garneau, M. et al.

48. Fig. 4.1: Mean Medical Consultation Rate for Allergic Rhinitis, Montreal & Quebec City, 1994-2002 Garneau, M. et al.

49. Ragweed Infestation Index, Montreal Island, 2006

50. Allergic Symptom Prevalence in Children Aged 6 Months to 12 Years, by CLSC Territory – Montreal, 2006