Climate change in the Great Lakes Region: Key Vulnerabilities to Public Health

1. Climate changein the Great Lakes Region: Key Vulnerabilities to Public Health Climate Change Webinar Series Ohio State University Sept. 28, 2010 Jonathan Patz, MD, MPH Nelson Institute & Dept. Population Health Sciences University of Wisconsin - Madison

2. HEALTH EFFECTS OF CLIMATE CHANGE Heat Stress Cardiorespiratory failure Respiratory diseases, e.g., COPD & Asthma Malaria Dengue Encephalitis Hantavirus Rift Valley Fever Cholera Cyclospora Cryptosporidiosis Campylobacter Leptospirosis Malnutrition Diarrhea Toxic Red Tides Forced Migration Overcrowding Infectious diseases Human Conflicts Urban Heat Island Effect Air Pollution & Aeroallergens Vector-borne Diseases Water-borne Diseases Water resources & food supply Mental Health & Environmental Refugees CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes 13°C by yr. 2100 240 cm“ “ IPCC estimates Patz, 1998

3. 2057 2007 Probabilities of future extremes can be estimated given projections of mean temperature Peterson et al., 2007

4. Heatwave morbidity -Milwaukee Li, et al. , unpublished (EPA STAR grant, J. Patz, PI)

5. By 2050, warming alone mayincrease by 68% the number of Red Ozone Alert daysacross the Eastern US. (IPCC, 2007 -Bell et al, 2006) • “The severity and duration of summertime regional air pollution episodes are projected to increase in the Northeast and Midwest US by 2045-2052 due toclimate-change-induced decreases in the frequency of surface cyclones.” (IPCC, 2007)

6. Days per summer (June, July, August) with O3 above the NAAQS limit of 84 ppb. Colored, solid lines reflect the 10-year running mean of exceedances for each model (mean across SDSM ensembles, and across the study sites). Colored dotted lines reflect year-to-year exeedance values (mean across SDSM ensembles, and across the study sites). Holloway et al. 2009

7. USA: Combined sewer overflows (CSOs)Courtesy: Kellogg Schwab 1.2 trillion gal of sewage & stormwater a year discharged during combined sewer overflows – would keep Niagara Falls roaring for 18 days Center for Water & Health, JHU Bloomberg School of Public Health

8. CSS Communities 770 systems serve around 40 million people Past Precipitation Trends Source: EPA Source: National Climatic Data Center/NESDIS/NOAA Combined Sewer Systems & Past Precipitation Trends Source: EPA (Courtesy– J. Scheraga)

9. Sewage overflows in the Great Lakes • Intense storm events result in combined sewer overflows (CSO’s) • Great Lakes provides drinking water to 40M people and has >500 beaches • Sewage contains human pathogens including viruses, protozoan, and pathogenic bacteria • The EPA has estimated 140 communities release 150 billion liters of combined sewage each year

10. E. coli CFU/100 ml 0-100 100-235 235-999 1000-9999 10,000-20,000 Bradford Beach South Shore Beach Rainfall Urban stormwater Sewage overflow Courtesy: Sandra McLellan UW-Milwaukee Bradford and South Shore Beach on Lake Michigan

11. Reported waterborne diseases, US, from 1948-1994 • 67% of waterborne disease outbreaks were preceded by precipitation above the 80th percentile (across a 50 yr. climate record), p < 0.001 • 51% of outbreaks were preceded by precipitation above the 90th percentile, p < 0.002 • Surface water-related outbreaks had strongest correlation with extreme precipitation in the month of outbreak; groundwater-related outbreaks lagged 2 months following extreme precipitation. Curriero, Patz, et al, 2001.

12. Globally Averaged U.S. CCSP, 2008

13. Projected Change in the Frequency of 2" Precipitation Events (days/decade) from 1980 to 2055 based on downscaled climate models (http://www.wicci.wisc.edu)

14. Courtesy: Steve Vavrus (UW-Madison

15. Courtesy: Steve Vavrus (UW-Madison)

16. The Good News about climate change and our health

17. The opportunity for improving health determinants We can reduce: The 1,000,000 annual deaths from urban air pollution The loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity WHO, 2007

18. Ten Leading Causes of US Deaths per Year (CDC, 2004)

19. Asthma and Air Pollution • Natural experiment during 1996 Summer Olympic games in Atlanta • Peak morningtraffic decreased 23% and peak ozonelevels decreased 28% • Asthma-related emergency room visits by children decreased 42% • Children’s emergency visits for non-asthma causes did not change during same period Friedman et al. JAMA 2001;285:897

20. Comparative Scenario The Natl. Personal Transportation Survey reports median trip length in urban and suburban areas of the region to be 4-8 km, representing ~20% of VMT for the region. Our alternative scenario thus assumes that all round trips of 8 km or less could be accomplished through alternative modes of (non ICE) transportation. Grabow et al (in review)

21. hundreds of lives saved • Thousands of Hospital admissions avoided • Billions reduction in health care costs 20% fewer car trips:Change in O3 & PM 2.5 Grabow et al (in review)

22. Value of co-benefits is large $2 – 196 /tCO2 with a mean of $49/tCO2 Fig 1 and fig 2 Compare to cost of climate policy: almost always <$30/tCO2 Nemet G F, Holloway T and Meier P 2010 “Implications of incorporating air-quality co-benefits into climate change policymaking” Environmental Research Letters 014007 Nemet et al. 2010

23. Decision Support • In adapting to climate change, we need to include health co-benefits stemmingfrom mitigation policies; thus far, one-sided discussions of costs

24. Thank you! patz@wisc.edu www. sage.wisc.edu Educational website: www.ecohealth101.org