Climate Change and Health Rising to the challenge in Washington

1. Climate Change and Health Rising to the challenge in Washington CIG Seminar, November 29, 2007 J. Elizabeth Jackson Department of Family Medicine Department of Sociology

2. Two WA State Initiatives • House Bill 1303 (Climate change scenarios and sector impacts) • Governor’s Climate Challenge (Preparation and Adaptation Work Groups: PAWGs) Objective: estimate impacts of climate change in Washington State in near, mid and long term

3. Climate Change and Human Health Impact Team (CHIT) • Coordinates the efforts of the Human Health PAWG and the HB1303 health sector • Roger Rosenblatt, UW Family Medicine • Gregg Grunenfelder, WA Dept. of Health • Multidisciplinary team composed of five researchers, each leading a topic area

4. Source: Executive summary of the report of the health sector of the U.S. National Assessment (Patz et al. 2000)

5. Human Health Impact Areas • Heat/Thermal Stress • Degradation of Air Quality • Infectious Disease (food- and waterborne + vector borne disease) • Extreme Weather Events: storms, coastal erosion, flooding • Social Disruption, Stress and Economic Disparities

6. Heat and Thermal Stress • Mean annual temps estimated to increase 2.1-2.3° F by the 2020s, 3.0-4.1° F by the 2040s, & 4.9-7.1° F by the 2080s (CIG, 2007) • Centers for Disease Control (CDC) define a heat wave as 3 consecutive days where temperatures remain at or above 90° F • As mean temperatures rise we can expect an increase in frequency, duration and intensity of heat waves (Meehl, 2004)

7. Heat and Thermal Stress, cont. • Hyperthermia is a condition that arises when the body cannot dissipate heat absorbed from the environment (CDC, 2005) • Usual cause of death is a cardiovascular event, e.g., heart failure

8. Heat and Thermal Stress, cont. • Most devastating loss of life from weather events over last 30 years have been due to heat waves (Klinenberg, 2002; Naughton, 2002; Kaiser, 2007) • Chicago, 1995: estimated 700 deaths • Europe, 2003: estimated 30,000 deaths • UK, 2003: estimated 2,000 deaths • Deaths from heat are likely underreported (Wolfe, 2001; CDC, 2006)

9. Heat and Thermal Stress, cont. Major cities of Washington State are particularly at risk for high mortality during heat waves (Medina-Ramon, 2007) • Milder summers • Little residential air conditioning • High density • Eastern Washington’s already hot summers will get hotter

10. Heat and Thermal Stress, cont. Vulnerable groups • The elderly (Borrell, 2006; Basu, 2005; CDC, 2005) • Urban residents (Grimmond, 1999; DeGaetano, 2002; Smoyer, 2000) • Those with chronic illnesses (Medina-Ramon, 2006) • Racial/ethnic minorities, the poor, the socially-isolated (Greenberg, 1983; Browning, 2006; McGeehin, 2001; Naughton, 2002) • Mentally ill (Kaiser, 2001)

11. Degradation of Air Quality • CIG scenario for WA translates into expected increases in ambient concentrations of • ozone (O3) • fine particulate matter (PM2.5) • In addition, there is growing evidence that elevated temperatures contribute to a longer pollen season and increased allergenicity of some pollens (Beggs, 2004)

12. Degradation of Air Quality, cont. • Sources of PM2.5 • Wood burning (e.g., stoves, wildfires) • Vehicle exhaust • Atmospheric chemical reactions of pollutant gases • Higher temperatures in PNW would likely increase the frequency of favorable conditions for wildfires (McKenzie et al., 2004; Littell 2006)

13. Degradation of Air Quality, cont. Demonstrated health effects of O3 and PM2.5 (Yu, 2000; Norris, 1999) • Worsened asthma and chronic obstructive pulmonary disease (COPD) • Low birth weight/prematurity in newborns • Respiratory infections • Lung cancer • Cardiovascular disease • Higher rates of infant mortality and premature death in adults

14. Degradation of Air Quality, cont. Allergic diseases affected by pollen have increased over the last several decades • Asthma • Seasonal allergic rhinitis (allergies) • Co-exposures to allergens (pollens) and other air pollutants may raise the risk of developing the disease and increase severity of allergic response (Wyler, 2000)

15. Degradation of Air Quality, cont. Air pollution-related illnesses are already important public health concerns in WA • Heart disease is leading cause of death in those over 65 (WA DoH Data Book, 2005) • Prematurity and low birth weight are leading causes of infant mortality (WA DoH Data Book, 2005) • WA asthma rate among highest in the US (WA DoH Asthma Program, 2007) • Vulnerable groups include children and infants, the elderly, the poor, and those who work or exercise outdoors

16. Infectious Disease Climate factors hypothesized to affect infectious disease (ID) include temperature, precipitation and flooding • Annual mean temperatures for WA are projected to increase • Annual precipitation for WA projected to increase by about 2% by mid-century; autumn and winter precipitation may increase by as much as 4% (CIG, 2007)

17. Infectious Disease, cont. Two groups of ID relevant to climate change • Food- and waterborne diseases • A significant source of morbidity in the US and greatly underreported (Mead et al., 1999) • Many are “summer-peak” illnesses • Mainly transmitted via the fecal-oral route • Climate may influence pathogen directly, or • illness may result through a combination of a weather event and a land use practice

18. Infectious Disease, cont. • Vectorborne and zoonotic diseases (VBZ) • Very complex transmission dynamics • Large number of climate sensitive variables will make modeling difficult (National Research Council, 2001)

19. Infectious Disease, cont. ID transmission schema Source: Under the Weather: Climate, Ecosystems, and Infectious Disease (National Research Council 2001, p. 31)

20. Infectious Disease, cont. Examples of food- and water borne illnesses in WA • Salmonellosis (Salmonella) • Campylobacteriosis (Campylobacter jejuni) • Enterohemorrhagic/toxigenic E. coli (Escherichia coli) • Cryptosporidiosis (Cryptosporidium parvum) & giardiasis (Giardia lamblia) • Viral gastroenteritis (e.g., norovirus, rotavirus) • Vibriosis (Vibrio parahaemolyticus)

21. Infectious Disease, cont. Examples of VBZ in WA • Malaria (Plasmodium falciparum, others) • West Nile Virus (WNV) • Western Equine Encephalitis, St. Louis Encephalitis • Hantavirus Pulmonary Syndrome (Sin Nombre virus, others) • Vibriosis

22. Infectious Disease, cont. Specific vulnerabilities • Young children & infants: food- & waterborne disease, especially Salmonella and E. coli • The elderly: food- & waterborne disease • Those with compromised immune systems: food- & waterborne disease, especially giardia and cryptosporidium • Rural poor and outdoor laborers: vector-borne diseases and hantavirus • Socioeconomically disadvantaged groups: infectious disease of all kinds

23. Extreme Weather Events • Severe weather events, e.g., floods and storm surges, will become more frequent with climate change (Greenough et al., 2001; Ashley et al., 2005) • Rising sea levels will contribute to coastal erosion (Moser and Tribbia, 2006) • Rising temperatures earlier in the year will result in more rain-on-snow events (Hoo and Sumitani, 2005)

24. Extreme Weather Events, cont. • Washington’s topography shapes the effects of these weather events • Large coastal terrain adjacent to the Pacific Ocean, especially bluffs • Large number and area of estuaries and bays • Mountains, which collect snow and feed melt water into rivers • The bulk of Washington’s population lives near large bodies of water; this population projected to grow

25. Extreme Weather Events, cont. • Geophysical mechanisms… • Inland flooding from rain-on-snow events • Coastal flooding from storm surges • Sea-level rise in combination with bluff erosion • …leading to deaths and injuries • Destruction of buildings and roads from flooding directly • Landslides and avalanches causing same • Complicates evacuation and recovery efforts

26. Societal Disruption, Stress, & Disparities The effects of climate change on human welfare as mediated through social institutions • Migration, population displacement • Demand for social services • Energy demand and production • Employment, production and tax base • Emergency management, disaster recovery • Social alienation and civic unrest

27. Stress and Disparities, cont. Persons of low socioeconomic status are already at a disadvantage with respect to health • Worse health behaviors • Frequently live in more polluted areas • Substandard housing • Higher prevalence of many chronic illnesses • Inadequate access to health care

28. Stress and Disparities, cont. Migration and Population displacement • Climate refugees globally will reach 50 million by 2010 (UNU, 2005) and 150 million by 2050 (Meyers, 1994) • Katrina displaced 1 million residents; 1 year later 250K were still gone (Brown, 2006) • Decreased agricultural and industrial production may contribute to job loss in some areas (DFID, 2004) • Two streams of migration to consider: internal displacement and inflows into WA

29. Stress and Disparities, cont. Social Services and Public Health • Population displacement puts strain on social services • Mitigation of growing risks to health from climate will require additional resources • Need to address other climate change impacts will compete with public health for funding, e.g., transportation (Hoo & Sumitani, 2005) , wildfires (Bauman et al., 2006) • Competition could negatively impact emergency preparedness

30. Stress and Disparities, cont. Economic Impacts • Reduced agricultural and industrial output, lower labor productivity, and reduced tax revenues (DFID, 2006; Bauman, et al., 2006) • WA industries at risk include forest products, fisheries, recreation and agriculture (Bauman, et al., 2006, DeLoach & Lillie, 2007) • Direct and indirect costs of health impacts • Rising cost of property insurance (Larsen, 2006)

31. Stress and Disparities, cont. Energy Demand • Increased demand for energy in the summer • Hydroelectric power capacity will peak earlier in the year (Bauman, et al., 2006 ) • Heat waves in other states have resulted in power failures, e.g., Chicago 1995 • Petroleum shortfalls may jeopardize emergency operations (Frumkin et al., 2007)

32. Stress and Disparities, cont. Stress, Alienation and Health • Psychological stress occurs when “an individual perceives that environmental demands tax or exceed his or her adaptive capacity” (Cohen et al., 1995) • The effects of stress on health are well-established (Cohen et al., 2007) • Reduced public safety (Vowell & May, 2000; Baron & Hartnagel, 1997) and civic engagement (Uslaner & Brown, 2005) • Further reduced access to health care

33. Recommended Mitigations for WA • Enhanced public health surveillance • Vector-borne and zoonotic diseases • Air quality • Notifiable conditions • Enhanced emergency preparedness and response • Improve heat emergency response • Includes establishing cooling centers, plans for dealing with power failures

34. Recommended Mitigations , cont. • Enhance policies targeted towards the built environment • Land use planning, building codes, zoning • Reduce greenhouse gas emissions • Mitigate deleterious effects on health

35. Research Needs and Challenges • Retrospective epidemiologic studies of health effects of heat waves • Integrated air quality modeling under differing climate change scenarios • Develop models linking VBZ with climate change • Develop economic models linking climate change to employment, wages and cost of living

36. Research Needs and Challenges, cont. • Establish plausible population projections • Unable to predict frequency/magnitude of extreme weather events

37. Plans for Studies • Heat waves and mortality • Air quality: wildfires and health • VBZ: water temperatures, shellfish, and Vibrio incidence • Others?

38. Acknowledgements CHIT Roger Rosenblatt, UW Family Medicine Catherine Karr, UW Pediatrics Ann Marie Kimball, UW Epidemiology Richard Fenske, UW Environmental & Occupational Health Sciences JISAO/CIG Phil Mote Eric Salathe Lara Whitely Binder