Air Quality, Climate Change and Public Health

Air Quality, Climate Change and Public Health Minnesota Climate and Health Program Minnesota Department of Health Environmental Impacts Analysis Unit October 2012 Air Quality Climate Change Training Module 625 Robert Street North PO Box 64975 St. Paul, MN 55164-0975

Notice MDH developed this presentation based on scientific research published in peer-reviewed journals. References for information can be found in the relevant slides and/or at the end of the presentation.

Outline • Introduction to Air Quality and Public Health • Climate Changes in MN • Climate Change and Air Quality • Particulate matter • Ground-level ozone • Allergens • Public Health/Government Strategies

Air Quality and Public Health • History • In the twelfth century, air pollution was already associated with urban environments and their higher population densities • 1948, Donora, PA smog event: • 20 dead, 4,000 hospitalized • 1952, “Great Smog” in London, England • 4,000+ excess deaths during 5 day event (Dec 5 – 9, 1952) • 12,000+ excess deaths estimated due to persisting effects between Dec 1952 – Feb 1953 Donora, Oct 26-29, 1948 London, Dec 5-9, 1952

Air Quality and Public Health • Air quality has been improving • From 2001 to 2012: • Ground-level ozone is 13% lower • Year-round particle pollution is 24% lower • Short-term particle pollution is 28% lower • However, we still have a ways to go • Health impacts occur at lower levels of air pollutants than previously thought • 41% of U.S. population lives in counties that have unhealthful levels of either ground-level ozone or particle pollution • Ramsey County received an “F” in the American Lung Association 2012 State of the Air report for short-term particle pollution

Air Quality and Public Health • People can be affected by poor air quality • because of exposure and/or sensitivity • Persons affected due to exposure: • Certain occupations, such as professional drivers (trucks, taxis), parking lot attendants, construction workers and others living and working near pollution sources • Athletes and outdoor workers on high pollution days • Persons affected due to sensitivity: • Have existing health conditions: • Asthma • Chronic Obstructive • Pulmonary Disease (COPD) • Heart disease • Allergies • Young children • Elderly

Introduction to Air Quality and Public Health • Climate Changes in Minnesota • Climate Changes and Air Quality • Particulate matter • Ground-level ozone • Allergens • Public Health/Government Strategies

Weather versus Climate • Weather: conditions of the atmosphere over a short period of time • Climate: conditions of the atmosphere over long periods of time (30-year standard averaging period)

Climate Changes There have been three recent significant observed climate trends in Minnesota: • The average temperature is increasing • The average number of days with a high dew point may be increasing • The character of precipitation is changing

Climate Changes: Temperature Temperature has been rising in Minnesota.

Climate Changes: Temperature Three significant observations in this overall warming: • Winter temperatures have been rising about twice as fast as annual average temperatures • Minimum or 'overnight low' temperatures have been rising faster than the maximum temperature, or ‘daytime high’ • Since the early 1980s, the temperature has risen slightly over 1°F in southern Minnesota to a little over 2°F in much of the northern part of the state

Climate Changes: Dew Point • Dew point definition: Dew point is a measure of water vapor in the air • The higher the dew point, the more difficult it is for people's sweat to evaporate, which is how we cool ourselves • The number of days with high dew point temperatures (≥ 70°F) may be increasing in Minnesota

Climate Changes: Dew Point Source: Dr. Mark Seeley, Climatologist, University of Minnesota

Climate Changes: Precipitation On average, the total precipitation in the state has increased since the Dust Bowl era of the 1930s.

Climate Changes: Precipitation • The character of precipitation in Minnesota is changing • More localized, heavy precipitation events • Potential to cause both increased flooding and drought

Climate Changes • What do the trends mean? • Extreme Weather: • Increased extreme heat events and reduced cooling overnight • Increased intense, localized storms and flooding • Increased localized drought and fires • Changing ecosystems: • Earlier ice out • Earlier flowering and longer growing season

Climate Change Climate changes have not only brought Minnesota an earlier growing season but changes in the types of plants that will thrive here

Outline • Introduction to Air Quality and Public Health • Climate Change in Minnesota • Climate Change and Air Quality • Particulate matter • Ground-level ozone • Allergens • Public Health/Government Strategies

Climate Change and Air Quality One study estimates that each one degree Celsius (1.8°F) increase in temperature would cause about 1,000 additional deaths in the US associated with air pollution. (Jacobson, 2008)

Climate Change and Air Quality • Climate change may affect exposures to air pollutants by: • Creating both more windiness and more air stagnation events • Increasing temperatures which . . . • Increase pollution from fossil fuel combustion to meet electricity demand for increased air conditioner use • Increase production of natural sources of air pollutant emissions • Increase formation of ground-level ozone • Lengthening the allergy season, creating more potent allergens

Particulate Matter • Particulate matter is a major pollutant for which concentrations are anticipated to be affected by climate change, and is therefore emphasized for public health impacts. • Particulate matter comes in different sizes (coarse and fine) from a number of sources including: • Dust and other small particles from construction, mining and agriculture • Pollen • Fine particles from burning fossil fuels in factories, power plants, and diesel- and gasoline-powered motor vehicles

Particulate Matter Particulate matter (PM) can have serious health impacts • Effects of acute exposure : • Short-term decrease in lung function • Exacerbation of respiratory and cardiovascular diseases • Hospitalizations and deaths • Effects of long term exposure: • Respiratory and cardiovascular diseases • Cardiopulmonary and lung cancer deaths

Particulate Matter Populations at risk of health effects from particulate matter • At risk from exposure: • Persons living or working in urban areas, especially near high-traffic corridors and/or stationary sources of PM (such as factories or power plants) • At risk from sensitivity: • Persons with respiratory and cardiovascular diseases • Elderly and children • Persons with asthma and/or allergies

Particulate Matter • Climate change may affect exposures to PM by: • Increasing emissions from fossil fuel-fired power plants due to demand for electricity for cooling • Increasing natural sources of air pollutant emissions • Wildfire smoke induced • by drought and heat

Particulate Matter 2011 Boundary Waters Canoe Area wildfire burned nearly 145 square miles and costs reached $21 million. Smoke and ash spread as far as northeast Wisconsin and Traverse City, Michigan. (MPR News, 2011)

Ground-Level Ozone • Ground-level ozone is a main pollutant for which concentrations are anticipated to be affected by climate change, and is therefore emphasized for public health impacts. • Ground-level ozone is formed by the reaction of volatile organic compounds (VOCs) and nitrogen oxide (NOx) in the presence of sunlight and heat. Source: American Lung Association

Ground-Level Ozone Ground-level ozone exposure is linked to harmful respiratory conditions and cardiopulmonary impacts • Short-term exposure to elevated ozone can lead to hospitalizations or death • Long-term exposure to lower levels of ozone can decrease lung function, and may also cause new-onset asthma • Elevated ozone levels can exacerbate other conditions, such as asthma and allergies

Ground-Level Ozone Populations at risk of health effects from ground-level ozone: • At risk from exposure: • Healthy people, especially athletes and outdoor workers in landscape and construction who may be exposed to higher levels of ozone for longer periods of time on high pollution days • At risk from sensitivity: • Persons with respiratory and cardiovascular diseases • Older adults and children

Ground-Level Ozone • Climate change could significantly increase summertime ground-level ozone by: • Increasing temperatures • Creating stagnant air conditions • Affecting natural sources of air pollutant emissions (biogenic VOCs) • Overall, increase poor air quality index (AQI) days • Effect is most likely during the summer months, downwind of urban areas Minnesota Pollution Control Agency Air Quality Index http://aqi.pca.state.mn.us/

Allergens • An allergy is the body’s immune system overreacting to certain substances • Common allergens that may be affected by climate changes include: • Pollen • Mold • Approximately 25 million Americans suffer from hay fever (allergic rhinitis) • It costs approximately $11.2 billion per year to treat allergic rhinitis in the U.S. Giant Ragweed plant Source: Mary Jelks, MD, AAAAI

Allergens • Allergens can affect persons with allergies and asthma • Allergens can interact with air pollution to amplify their individual effects: • When ground-level ozone levels are high, it takes much less ragweed pollen to trigger an asthmatic or allergic response • Particulate matter also increases allergic responses by extending how long the allergens stay in the body

Climate Change Impacts on Pollen Climate change impacts on pollen: • Increased pollen production, longer pollen season, increased potency airborne allergens • Proliferation of weedy plant species that are known producers of allergenic pollen • Introduction of new allergen-producing plant species Temperature Carbon dioxide Precipitation

Allergens: Pollen • Allergenic pollen will be worse in urban areas: up to 7x higher than surrounding rural areas • Minneapolis has already experienced a 16 day increase in length of ragweed pollen season from 1995 to 2009 Check pollen report at http://pollen.aaaai.org/

Allergens: Pollen Source: National Wildlife Federation, 2010

Allergens: Mold • Mold growth is enhanced by moisture • Increase in precipitation/floods • Increase in temperature and/or humidity • Increase in plant growth/plant biomass decay (leaf litter) • Improper installation or management of air conditioning systems can create conditions ripe for mold • Mold can cause coughing, wheezing, nasal and throat conditions, and adversely affect persons with asthma or weakened immune systems Extensive mold contamination of ceiling and walls (Source Terry Brennan, http://www.epa.gov/mold/moldcourse/imagegallery5.html)

Public Health/Gov’t Strategies • Mitigation • Effective policies to mitigate • health impacts from exposure • to air pollutants focus on the • reduction of air pollutant • emissions • Reduce production of harmful air pollutants • Improve energy efficiency • Use alternatives to fossil fuels • Reduce combustion of fossil fuels • Reduce urban heat island effect • Maintain green space Example of urban heat island mitigation: Target Center Green Roof Minneapolis, MN

Public Health/Gov’t Strategies • Adaptation • Policies/strategies to adapt to health impacts from exposure to air pollutants include: • Monitor AQI days • Promote awareness • Support public health tracking of diseases such as asthma and allergic disease • Utilize low allergenic pollen producing plants for landscaping

Summary • Minnesota’s climate is changing: • Increases in temperature • Increases in high dew point temperatures • Increases in extreme precipitation events • Climate changes will likely increase: • Particulate matter • Formation of ozone • Pollen and mold • Certain populations are at greater risk from exposure to pollution and allergens, especially those with existing respiratory and cardiovascular conditions, the elderly, and children • Public health awareness, education and coordinated mitigation planning with other agencies can reduce the health impacts

Thank You Questions? Contact Minnesota Climate and Health Program: 651-201-4893 health.climatechange@state.mn.us http://www.health.state.mn.us/divs/climatechange/index.html October 3, 2012

Acknowledgements This work was supported by cooperative agreement 5UE1EH000738 from the Centers for Disease Control and Prevention Special thanks to the following people for their contributions to the creation of this training module: Wendy Brunner, Minnesota Department of Health Hillary Carpenter, Minnesota Department of Health Anne Claflin, Minnesota Pollution Control Agency Gregory Pratt, Minnesota Pollution Control Agency Naomi Shinoda, Minnesota Department of Health

References Amann, Swart, Raes, Tuinstra. 2004. A good climate for clean air: linkages between climate change and air pollution. Climatic Change 66: 263– 269. American Lung Association. 2012a. Asthma fact sheets. Accessed online May 7, 2012: http://www.lung.org/lung-disease/asthma/resources/ American Lung Association. 2012b. COPD. Accessed online May 7, 2012: http://www.lung.org/lung-disease/copd/about-copd/understanding-copd.html American Lung Association. 2012c. Particle Pollution: State of the Air 2011. Accessed online May 7, 2012: http://www.stateoftheair.org/2012/health-risks/health-risks-particle.html Bell ML, Dominici F, and Samet JM. 2005. A Meta-Analysis of Time-Series Studies of Ozone and Mortality with Comparison to the National Morbidity, Mortality, and Air Pollution Study. Epidemiology 2005; 16:436-445. Bernard SM, Samet JM, Grambsch A, Ebi KL, Romieu I. 2001. The potential impacts of climate variability and change on air pollution-related health effects in the United States. Environmental Health Perspectives Vol 109, Supplement 2, pp 199-209. California Department of Public Health. 2008. Public Health Climate Change Adaptation Strategy for California. Available online: http://www.cdph.ca.gov/programs/CCDPHP/Documents/CA_Public_Health_Adaptation_Strategies_final.pdf Centers for Disease Control and Prevention (CDC). 2012. Climate and Health, Aero-allergens (website). Accessed May 8, 2012: http://www.cdc.gov/climatechange/effects/allergens.htm Chan C-C, Wu T-H. 2005. Effects of Ambient Ozone Exposure on Mail Carriers’ Peak Expiratory Flow Rates.Environ Health Perspec 2005; 113:735-738. Clean Air Taskforce. 2010. The Toll from Coal: An Updated Assessment of Death and Disease from America’s Dirtiest Energy Source. Available online: http://www.catf.us/resources/publications/files/The_Toll_from_Coal.pdf Gaffney JS, Marley NA. 2009. The impacts of combustion emissions on air quality and climate – From coal to biofuels and beyond. Atmospheric Environment Vol. 43, 23-36. Horstmeyer, SL. 2008. Relative humidity . . . Relative to what? The dew point temperature . . . a better approach. Available online: http://www.shorstmeyer.com/wxfaqs/humidity/humidity.html Jacob DJ, Winner DA. 2009. Effect of climate change on air quality. Atmospheric Environment ,Vol 34, pp. 51-63. Jacobson M. 2008. On the causal link between carbon dioxide and air pollution mortality. Geophysical Research Letters Vol 35, L03809, doi:10.1029/2007GL031101 Leung LR, Gustafson Jr WI. 2005. Potential regional climate change and implications to US air quality. Levy et al. 2010. Evaluation of the public health impacts of traffic congestion: a health risk assessment. Environmental Health 2010 9:65. Available online: http://www.ehjournal.net/content/9/1/65

References Minnesota Public Radio News. 2011. Pagami fire smoke visible deep into Wis., Mich. September 13, 2011. Available online: http://minnesota.publicradio.org/display/web/2011/09/13/pagami-fire-smoke-visible-deep-into-wisconsin/ Costs of fighting BWCA forest fire reach $21M. October 17, 2011. Available online: http://minnesota.publicradio.org/display/web/2011/10/17/pagami-creek-fire-costs/ National Academy on an Aging Society. 1999. Chronic Conditions: A Challenge for the 21st Century. Number 1, November 1999. Available online: http://www.agingsociety.org/agingsociety/pdf/chronic.pdf National Aeronautics and Space Administration (NASA). 2005. What’s the Difference Between Weather and Climate? Available online: http://www.nasa.gov/mission_pages/noaa/climate/climate_weather.html National Wildlife Federation. 2010. Extreme Allergies and Global Warming. Available online: www.nwf.org/extremeweather Parker JD, Akinbami LJ, Woodruff TJ. 2009. Air Pollution and Childhood Respiratory Allergies in the United States. Environ Health Perspect 2009; 117: 140-147. Patz JA. 2000. Climate change and health: new research challenges. Ecosyst Health 6:52–58. Pope CA, Thun MJ, Namboodiri MM, Dockery DW, Evans JS, Speizer FE, Heath CW. 1995. Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am. J. Respir. Crit. Care Med. vol. 151 no. 3 669-674 Pope CA III. 2000. Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who’s at risk? Environ Health Perspect; 108:Supple 4:713-23. Rogers, CA, PM Wayne, EA Macklin, et al. 2006. Interaction of the onset of spring and elevated atmospheric CO2 on ragweed pollen production. Environmental Health Perspectives 114: 865-869. Seeley M. 2012. Climate Trends and Climate Change in Minnesota: A Review. Minnesota State Climatology Office. Available online: http://climate.umn.edu/seeley/ Shea K et al. 2008. Climate change and allergic disease. American Academy of Allergy, Asthma & Immunology. Doi:10.1016/j.jaci.2008.06.032 State Climatology Office. Department of Natural Resources – Division of Ecological and Water Resources and the University of Minnesota – Department of Soil, Water, and Climate. Available online: http://climate.umn.edu/ Dew Point (http://climate.umn.edu/doc/twin_cities/mspdewpoint.htm) Dew Point July 19, 2011 Technical Analysis (http://climate.umn.edu/pdf/july_19_2011_ technical.pdf) Tager IB, Balmes J, Lurmann F, Ngo L, Alcorn S, and Küenzli N. 2005. Chronic Exposure to Ambient Ozone and Lung Function in Young Adults. Epidemiology 2005; 16:751-759. Union of Concerned Scientists. 2011. Climate Change and Your Health: Rising Temperatures, Worsening Ozone Pollution. Available online: www.ucsusa.org/climateandozonepollution.

References U.S. EPA. 2003. Ozone: good up high, bad nearby. Office of Air and Radiation. EPA-451/K-03-001 . http://www.epa.gov/glo/pdfs/ozonegb.pdf U.S. EPA. 2008. A Review of the Impact of Climate Variability and Change on Aeroallergens and Their Associated Effects (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-06/164F, 2008. Available online: http://www.epa.gov/research/gems/scinews_aeroallergens.htm U.S. EPA. 2011. Chronic Obstructive Pulmonary Disease Prevalence and Mortality. Accessed online May 8, 2012: http://cfpub.epa.gov/eroe/index.cfm?fuseaction=detail.viewInd&lv=list.listByAlpha&r=235293&subtop=381 U.S. EPA. 2012. Ground-level ozone: Health effects. Accessed May 8, 2012: http://www.epa.gov/air/ozonepollution/health.html Western Regional Climate Center. (WRCC) 2011a. Minnesota Temperature 1890 – 2010: 12 month period ending in December. Generated online November 2011. Available online: http://www.wrcc.dri.edu/spi/divplot1map.html Western Regional Climate Center. (WRCC) 2011b. Minnesota Precipitation 1890 – 2010: 12 month period ending in December. Generated online November 2011. Available online: http://www.wrcc.dri.edu/spi/divplot1map.html Zandlo, Jim 2008. Observing the climate. Minnesota State Climatology Office. Available online: http://climate.umn.edu/climateChange/climateChangeObservedNu.htm Ziska L, et al. 2011. Recent warming by latitude associated with increased length of ragweed pollen season in central North America. PNAS vol 108 no 10.

Photo Credits • Slide 4: Top image of Donora, PA smog event of 1948 from Prints and Photographs Collection, History of Medicine Division, National Library of Medicine, as cited in Helfand et al. 2001. “Donora , Pennsylvania: An Environmental Disaster of the 20th Century,” American Journal of Public Health Vol 91, No 4, pp553. Bottom image of London, UK smog event of 1952 from Wikipedia “Great Smog”, available online: http://en.wikipedia.org/wiki/Great_Smog • Slide 6: Image source – Microsoft Clip Art • Slide 8: Image source – Microsoft Clip Art • Slide 15: Image source – Microsoft Clip Art • Slide 17: 2006 The National Arbor Day Foundation, taken from “Extreme Allergies and Global Warming: National Wildlife Federations 2010” available online at: http://www.nwf.org/~/media/PDFs/Global-Warming/Reports/NWF_AllergiesFinal.ashx • Slide 19: Image source – Microsoft Clip Art • Slide 20: Top Image source – Microsoft Clip Art; Bottom Image source – Microsoft Clip Art • Slide 22: Image source – U.S. EPA, available online: http://www.epa.gov/airscience/air-particulatematter.htm • Slide 24: Image source – Microsoft Clip Art • Slide 25: Image source – Microsoft Clip Art • Slide 26: Image source – Microsoft Clip Art • Slide 28: Image source – American Lung Association, available online: http://www.stateoftheair.org/2012/health-risks/health-risks-ozone.html • Slide 29: Image source – Microsoft Clip Art • Slide 30: Image source – Microsoft Clip Art • Slide 31: AQI image source – Minnesota Pollution Control Agency, available online: http://aqi.pca.state.mn.us/ • Slide 33: Giant Ragweed plant image source – Mary Jelks, MD, AAAAI, available online: http://www.aaaai.org/about-the-aaaai/newsroom/media-gallery/photos---graphics--plants.aspx • Slide 34: Image source – Microsoft Clip Art • Slide 36: Screen shot of AAAAI pollen report • Slide 37: Image source - National Wildlife Federation, 2010 • Slide 38: Image source – Source Terry Brennan, http://www.epa.gov/mold/moldcourse/imagegallery5.html • Slide 40: Image source – Pam Blixt, City of Minneapolis

Air Quality, Climate Change and Public Health