Beating the Heat: Public Health and Climate Change

1. Beating the Heat: Public Health andClimate Change Jonathan E. Fielding, MD, MPH, MBA Director and Health Officer Los Angeles County Department of Public Health APHA Annual Meeting and Exposition San Diego, CA - October 27, 2008

2. Presenter Disclosures Dr. Jonathan E. Fielding No relationships to disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Climate Change is Happening Now Source: IPCC 2007 (4th Assessment)

4. IPCC 2007: Human Impact is Evident Source: IPCC 2007 (4th Assessment)

5. Global Contributors to Greenhouse Gas Emissions • Leading sources of greenhouse gas emissions are combustion of fossil fuels: coal, oil, and natural gas • More than 60% of the annual global industrial carbon dioxide emissions come from industrialized countries, accounting for 20% of the world’s population • U.S. per capita emissions of carbon are over 20 times higher than India, 12 times higher than Brazil, and 7 times higher than China • These per capita rates expected to change significantly as China, India, and other countries continue to develop economically • China is now the #1 carbon emitter, surpassing the U.S. • Global carbon dioxide emissions are projected to increase by at least 50% over the next 25 years under current conditions

6. Annual Carbon Dioxide Emissions - 2005 Total CO2 – measured in thousands of metric tons The most current estimates state that China is about to surpass the US in emissions and its rate of emissions is accelerating. Source: U.S. Greenhouse Gas Emissions Inventory

7. U.S. CO² Emissions from Fossil Fuel Source: U.S. Greenhouse Gas Emissions Inventory

8. Why Should Public Health Care? • It is our job to protect the public’s health • WHO estimates that in the year 2000, there were 150,000 excess deaths per year due to climate change • Climate change is already affecting health around the world, and its impact on health will continue to grow • Fighting climate change is aligned with protecting and promoting health • Many of the proposed solutions for climate change are healthy for everyone • We have the appropriate skills • Public Health has the skills to effect behavior change, and those skills can help people adopt greener behaviors too • Public Health has policy and advocacy skills that will help encourage organizational and societal changes • We can be role models

9. Projected Impacts of GlobalTemperature Change 0°C 1°C 2°C 3°C 4°C 5°C Food Falling crop yields in many areas, particularly developing regions Falling yields in many developed regions Possible rising yields in some high latitude regions 450 ppm CO2 eq Water Significant decreases in water availability in many areas, including Mediterranean and Southern Africa Small mountain glaciers disappear – water supplies threatened in several areas Sea level rise threatens major cities Ecosystems Extensive Damage to Coral Reefs Rising number of species face extinction 650 ppm CO2 eq Extreme Weather Events Rising intensity of storms, forest fires, droughts, flooding and heat waves Risk of Abrupt and Major Irreversible Changes Increasing risk of dangerous feedbacks and abrupt, large-scale shifts in the climate system Source: L. Rudolph, 2008

10. Climate Change’s Impacts on Health Source: Haines, et al, JAMA 2004

11. Extreme Weather Events & Disease Clusters Source: Epstein, Harvard Center for Health & Global Environment

12. Expected Environmental Impacts in So.Cal. of Climate Change: Sea Level Rise • Effects of rising sea level • Coastal areas will become vulnerable to storms and flooding • Loss of coastal wetlands and erosion of beaches • Saltwater contamination of drinking water • Potential damage to roads, highways, and other infrastructures near coastal areas

13. Expected Environmental Impacts in CA of Climate Change: Floods & Droughts • Warmer temperatures can result in premature and rapid snowmelt in the Sierra snow pack, which alters the timing of run-off water supplies for ½ of CA’s surface water • Severe flooding may occur during winter and spring, with slower water flow during summer seasons • Drought risk may be acutely elevated during the summer months • June 2008 – Governor Schwarzenegger declares state drought

14. Health Impacts of Heat Waves • Los Angeles projected to have an increase of 62% - 88% in heat-related mortality by 2080 • Health impacts likely to be seen 1 to 3 days after the onset of the heat waves • Health effects of extreme and prolonged heat exposure include: heat cramps, heat exhaustion, heat stroke, heat syncope (fainting) • Devastating heat waves seen elsewhere recently • 5-day heat wave in Chicago in 1995: 700 excess deaths, most attributed to the heat • August 2003 European heat wave: 35,000 excess deaths

15. Heat Waves: Vulnerable Populations • Greater risk for people who do not have access to air conditioning • May not be able to afford air conditioning • For populations unaccustomed to heat waves, people may have air conditioning but chose not to use it, not realizing danger • Two vulnerable populations during heat waves: • Elderly: Population of senior citizens (> 60 years old) in Los Angeles County is expected to increase by 83% by the year 2020 • Low SES: Over 16% of LA County residents under 100% FPL

16. Potential Environmental Impacts in So.Cal. of Climate Change: Wildfires • Wildfires are common in Southern California • Characteristic of the area since prehistoric times • Santa Ana winds may drive heat waves, prolong wildfires, and prevent wildfire control in this region • Climate models predict the summer months will be longer, and hotter, due to global warming • Result: dry soil and vegetation become fuel for wildfires

17. Potential Environmental Impacts in So.Cal. of Climate Change: Air Quality • Increased temperature and increased carbon dioxide in atmosphere leads to • Increase in formation of ground-level ozone (and smog) • Increased allergen production (e.g. pollen) • Longer seasons for allergen producing weeds • Senior citizens, children, and people with respiratory and chronic diseases are most vulnerable to high levels of ozone and increased allergens • Health effects of high levels of ozone exposure include: • Reduced lung function • Respiratory discomfort • Exacerbation of chronic respiratory illnesses (e.g. asthma)

18. Summary of Health Effects of Air Pollution Annual Health Impacts in CA from PM and Ozone4 • Amount of goods transported through California projected to nearly quadruple between 2000 and 20201 • Will have significant impact on air quality and health2 • Diesel particulate matter (PM) • concentrated around ports, railyards, and heavily trafficked roads3 • premature deaths • cancer • respiratory disease • lost workdays • global warming (2nd to CO2) 1 (Cal EPA, 2005); 2 (Pacific Institute, 2006) 3 (CA/EPA Air Resources Board); 4 (CA/EPA Air Resources Board, 2004)

19. The Time for Inaction Has Past • Scale of threat is global: touches all, everywhere • Intensity of the threat: threatens all of our basic survival mechanisms -- food, water, shelter, and health. • Scale of response: must engage every sector of society • Timeframe for response: “…we have at most 10 years -- not 10 years to decide upon action, but 10 years to alter fundamentally the trajectory of global greenhouse emissions." • “There is still time, but just barely.” (Dr. James Hansen, director of NASA Goddard Institute for Space Studies)

20. A Public Health Responseto Climate Change • Public health already utilizes a multi-level prevention approach – analogous approach can be taken to respond to climate change • Primary prevention = climate change mitigation • Efforts to slow, stabilize, reverse climate change by reducing GHG emissions • Efforts will occur in sectors other than PH, such as energy and transportation • Secondary/tertiary prevention = climate change adaptation • Efforts to prepare for, and minimize health burden of, climate change • Similar to public health preparedness for other uncertainties (e.g. pandemic flu, bioterrorist attack), so likely that PH as sector will be involved in adaptation efforts Source: Frumkin, et al., AJPH 3/08

21. What Should We Do? • Mitigation = reduce GHG emissions • Reduce energy usage and Reduce, Reuse, Recycle • As individuals, at home • As organizations, at work • Adaptation = prepare for impact of climate change • Emergency preparedness • As individuals/families • As local health department • Mitigation and adaptation = advocate for healthy policies • Support legislation that reduces GHG emissions • Support sustainable lifestyles & communities

23. Realizing the Co-benefits ofReducing GHG Emissions • Primary benefits • reductions in the expected long-term consequences of global warming; avoided damages of climate change • Co-benefits (or ancillary benefits) • economic, social, environmental, public health and other benefits independent of any direct benefits from mitigating climate change • Health co-benefits • Benefits of climate change mitigation strategies that have a positive effect on health • Example: promote cleaner energy production and cleaner fuels • Primary result = reduced GHG emissions from energy production • Co-benefit = less air pollution = less respiratory distress

24. Realizing the Co-benefits ofReducing GHG Emissions • Important to realize the co-benefits of climate change responses = certain efforts to address climate change often yield other health benefits too • Strategy: reducing vehicle miles traveled • Primary result = lower motor vehicle GHG emissions • Co-benefit = higher physical activity rates • Strategy: promote cleaner energy production and cleaner fuels • Primary result = reduced GHG emissions from energy production • Co-benefit = less air pollution = less respiratory distress Source: Frumkin, et. al., AJPH March ‘08

25. Transport Fuel efficiency Hybrids Road to rail Public transport Non-motorized transport Land-use planning Buildings Daylighting Energy efficiency Improved cook stoves Solar heating & cooling Agriculture Crop & land management Livestock & manure management Improved N fertilizer use Industry Energy efficiency Heat & power recovery Energy supply Coal to gas Nuclear power Renewable energy Key Mitigation Technologies& Practices* * Items in green have health co-benefits!

26. GHG Mitigation Strategies,Air Pollution, & Health • Globally ancillary benefits may be 30% – 100% abatement costs • Public health improvement and “knock-on” effect to health services from reductions in air pollutants account for approximately 80% total value ancillary benefits in US • Canada proposed GHG emissions reductions would also reduce • SO2 by 9%, NOx by 7% of annual emissions • 3,300 premature deaths per year avoided in Canada w/15% GHG reduction (based on PM reduction only) • GHG reductions in 4 cities would avoid (through 2020) • 64,000 premature deaths • 65,000 chronic bronchitis cases • 37 million person-days of restricted activity or work loss Sources: IPCC (2001); Caton (2000); Blomqvist (2000); Cifuentes (2001)

27. Reductions Greenhouse gas emissions Air pollution Noise Infrastructure costs Community Severance Increases Physical Activity Social Capital Reductions Respiratory disease Traffic injuries Heart disease Depression Osteoporosis Diabetes Cancer Stress Climate & Health Co-benefits of Decreased Auto Use Borrowed from L. Rudolph

28. Reductions Greenhouse gas emissions Antibiotic use Water pollution (nitrates) Air pollution Soil erosion Unsustainable H2O consumption Pesticide Use Reductions Ischemic heart disease Obesity Colorectal cancer Breast & prostate cancers Type II Diabetes Antibiotic resistance Respiratory disease Pesticide health effects Climate & Health Benefits of Reduced Meat Consumption Average American diet requires the production of extra 1.5 CO2e compared to a strictly vegetarian diet. 2.2 pounds beef = CO2e of 155 miles driving Meat consumption reduction of 20% = switch from Camry sedan to Prius • Increases • Biodiversity • Global food security • Protein intake equity • Rural community strength Borrowed from L. Rudolph

29. Mitigation: What Can We Do In Our Homes& Workplaces to Combat Global Warming? • Establish recycling programs in the workplace and home • Recycling half of your household waste = hundreds of lbs. of CO2 saved per year • Promote energy efficiency in the home and workplace • Changing regular light bulbs to compact fluorescent bulb throughout your house = hundreds of lbs of CO2/yr • Make “small energy” use changes on a broad scale • E.g. replacing all light bulbs with energy efficient light bulbs in all County buildings • Encourage renewable energy power sources (solar energy and wind energy) and responsible use of energy • Turning off your TV, computer, and other electronics = thousands of lbs. of CO2 saved per year

30. Mitigation: What Can We Do In Our Homes& Workplaces to Combat Global Warming? • Try to drive less and walk more! • You save gas money and keep our air cleaner for every mile you don’t drive • Most car trips taken in your neighborhood are short enough to walk or bike • Encourage carpooling to work/school • Encourage public transportation use • Provide incentives for employees to purchase fuel-efficient vehicles (e.g. electric, hybrid, CNG vehicles) • Every gallon of gas saved = tens of lbs. of CO2 saved • If you do take a car, maintain it • Properly inflated tires can improve gas mileage by 3%

31. Adaptation: Emergency Preparedness • We need to prepare now for the inevitable effects of climate change, such as heat waves and wildfires • Good news: preparing for one type of emergency prepares us for all types of emergencies • Preparation minimizes impact of disasters and fear/anxiety • We need to prepare ourselves as individuals and as health agencies

32. Promote Healthy Policies • Support policies related to sustainable communities • Mixed use development, jobs near housing, transit-oriented design, bike lanes and sidewalks, parks and green • Development and utilization of useful public transportation • Energy efficient "green" buildings and LEED certification • Buildings consume 72% of the nation’s electricity and more GHG than transportation or industry* • Recycling, waste management and pollution control • Securing safe water supplies • These policy decisions occur at all levels of government, so many opportunities for Public Health to give input • Health Impact Assessments • Surveillance data tracking spread of vectors and diseases Source: US Dept of Energy, 2007

33. What Should We Do? • Educate – ourselves, public, and policy makers • Partnerships and collaboration • Lend PH credibility and experience in driving policy & behavior change • Advocate for aggressive government and business mitigation policies & strategies that also promote health • PH leadership in advocating for personal, organizational, local government carbon footprint reduction • Increase understanding and research re: health co-benefits • Ensure health co-benefits included in policy and cost assessments (e.g. HIAs) • Protect vulnerable populations • Advocate for equity in mitigation • Monitor health impacts of climate change • Preparedness and adaptation Borrowed from L. Rudolph

34. We Can’t Do It Alone • So why should we bother? • Efforts will yield long-term savings • Will make our economy more competitive • The co-benefits are great • Will improve the sustainability of our communities • Moral obligation – if we care about the health of our communities, then we need to do our part

35. Jonathan E. Fielding, MD, MPHPublic Health Director and Health OfficerLos Angeles County Department of Public Health Special thanks to Linda Rudolph for use of some of her slides