Societal Risks and Responses: climate and health in a Risk Assessment Framework

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Societal Risks and Responses climate and health
in a Risk Assessment Framework
Summer Colloquium on Climate and Health July
17-21, NCAR, Boulder

• Jonathan Patz, MD, MPH
• University of Wisconsin - Madison

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• Risk is defined as the probability that an event
  will occur. It can also be defined as the
  probability that a health effect will occur after
  an individual has been exposed to a specified
  amount of a hazard. Risk assessment is the
  process of gathering all available information on
  the toxic or adverse effects of a physical,
  chemical or biological agent and evaluating it to
  determine the possible risks associated with
  exposure.

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Elements of Risk Assessment and Risk Management
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4 Steps of Risk Assessment

• Hazard identification
• Does the agent cause adverse effects?
• Dose-response assessment
• What is the relationship btw dose and adverse
  outcomes
• Exposure assessment
• What are the types of and pathways and levels
  of exposure

Risk characterization What is the estimated
probability or incidence of adverse effects? How
robust is evidence? How certain is the evaluation?
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Assess the Risks Here!
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Dose-response
Response
Linear
Threshold
Dose
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Exposure-dose-effect continuum
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HEALTH EFFECTS OF CLIMATE CHANGE
Heat Stress Cardiorespiratory
failure Respiratory diseases, e.g., COPD
Asthma Malaria Dengue Encephalitis Hantavirus Rif
t Valley Fever Cholera Cyclospora Cryptosporidios
is Campylobacter Leptospirosis Malnutrition Diarr
hea Toxic Red Tides Forced Migration Overcrowdin
g Infectious diseases Human Conflicts
Urban Heat Island Effect Air Pollution Vector-bo
rne Diseases Water-borne Diseases Water
resources food supply Environmental Refugees
CLIMATE CHANGE
Temperature Rise 1 Sea level Rise 2 Hydrologic
Extremes
1 3C by yr. 2100 2 40 cm IPCC
estimates
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HEAT WAVE - EUROPE

• 40,000 Deaths in just 11 days

• Heat Index Summer 2003

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Relationship between temperature and malaria
parasite development time inside mosquito
(extrinsic incubation period or EIP). EIP
shortens at higher temps, so mosquitoes
infectious sooner.
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USA Combined sewer overflows (CSOs)
Courtesy K. Schwab
1.2 trillion gal. of sewage stormwater a year
discharged during combined sewer overflows
would keep Niagara Falls roaring for 18 days
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Results

• 67 of waterborne disease outbreaks were
  preceded by precipitation above the 80th
  percentile (across a 50 yr. climate record), p lt
  0.001
• 51 of outbreaks were preceded by precipitation
  above the 90th percentile, p lt 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, Rose, Lele, 2001.
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Relative vs Attributable Risk
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Source EPA, Global Change Research Program
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USGCRP National Assessment of the Potential
Consequences of Climate Variability and Change

• QUESTIONS
• 1) What is current status of sector or region?
• 2) What are climate sensitivities or projections
  of climate change for sectors or regions?
• 3) What is our capacity to adapt to
  climate-induced change?
• 4) What are the key knowledge gaps?

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National Assessment (cont.)

• Sectors
• Agriculture
• Coastal Zones
• Forestry
• Human Health
• Water
• Regions
• 19 geographic regions Native Americans

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Five National Climate Research Sectors
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U.S. Global Change Research Program National
Climate Change Assessment Regions
Native Peoples Covered Nationally
Southwest
California
Rocky Mountains and Great Basin
Pacific Northwest
Central Great Plains
Appalachians
Eastern Midwest
Northern Great Plains
Great Lakes
New England
South Atlantic Coast
Gulf Coast
Southeast
Metropolitan East Coast
Southern Great Plains
Mid Atlantic
Source USGCRP
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Extreme Weather Events
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IPCC Third Assessment Report Conclusions

• An increasing body of observations gives a
  collective picture of a warming world and other
  changes in the climate system.
• Global average surface temperature has increased
  about 0.6oC
• Temperatures have risen during the last 40 years
  in the lowest 8 km of the
  atmosphere
• Snow cover and ice extent have decreased
• Global average sea level has risen 10-20 cm
  during the 20th century and ocean heat content
  has increased since the late 1950s
• Some aspects of climate have changed (e.g.,
  precipitation, cloud cover, temperature
  extremes), others appear not to have changed
  (e.g., Antarctic sea-ice, tropical storms,
  tornadoes)

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Criticism of Risk Assessment

• Risk assessments base on multiple inputs
• Empirical evidence
• Hypotheses
• Science OR Judgement
• Numerous default assumptions

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Socioeconomic root causes Proximate causes
Social change and development
Demographic change
Climate change
Overharvesting
Biodiversity loss
Public policies
Poverty / inequity
Habitat loss alteration
Pollution
Macroeconomic policies
Markets
Source Wood et al.2000. The Root Causes of
Biodiversity Loss
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and what about synergistic effects that can
determine local vulnerability of populations
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Johns Hopkins University School of Public
Health Course Global Environment and Health
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The Heat Island
Dark surfaces such as asphalt roads or rooftops
can reach temperatures 30-40C higher than
surrounding air
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New Orleans after Hurricane Katrina
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wetland loss in the Mississippi delta (1839 to
2020)
Barataria-Terrebonne Estuary Program
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9,600 people perished, widespread water- and
vector-borne diseases followed, and nearly one
million people were left homeless. Areas with
extensive deforestation or degraded hillsides
suffered the greatest morbidity and mortality and
point to the importance of vegetation cover and
as a buffer to severe floods, and the long-term
prevention of injuries and fatalities
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DPSEEA framework of WHO

• Driving force ACTION
• Population growth lt-------------- Economic and
  social policy
• Economic activity Clean technologies
• Pressure
• Resource depletion lt-------------- Hazard
  management
• Waste release
• State lt------------- Environmental improvement
• Natural hazards pollution
• Depleted resources
• Exposure lt------------- Education awareness
• External exposure absorbed dose
• Effect lt------------- Surveillance treatment
• Well-being
• Morbidity Mortality

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Health and the Rio Conventions
Biological Diversity

• Land degradation, deforestation
• Desertification hastened by landcover change

• Nutritional changes
• Disease Regulation
• Medicinal products
• Water purification

• Climate induced Biodiversity loss
• Deforestation effects on climate

• Extreme weather events
• Heat waves air pollution
• Malnutrition
• Water- Food-borne disease
• Vector-borne diseases

• Water scarcity and safety
• Agro-ecosystem productivity
• Food scarcity
• Droughts

Climate Change
Desertification
Source WHO, 2006

• Precipitation changes leading to drought

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The Sustainability Triangle
Courtesy F. Westley Nelson Inst., UW - Madison

• Social justice

Modified pressure
Equitable distribution
Sustained services for all
Distributed consumption
Investment in sustainable technologies
Vibrant economy
Healthy environment
Provides services
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Problems of Underdevelopment
Problems of Overdevelopment
overpopulation
global warming
poor maternal health, infant mortality,
infectious diseases
Co2 emissions
compromised educational and medical infrastructure
industrial growth
environmental degradation
global market for food and resources
poverty
hunger
subsidies
overharvesting of resources
food and resource export
international loans
international debt repayment
Courtesy F. Westley
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Millennium Ecosystem Assessment

• Largest assessment of the health of Earths
  ecosystems
• Prepared by 1360 experts from 95 countries
  extensive peer review
• Similar to IPCC consensus of the worlds
  scientists
• Called for by UN Secretary General in 2000
  authorized by governments through 4 conventions

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Examined the consequences of ecosystem change for
human well-being

• Assessed changes in 24 ecosystem services
• Ecosystem services are the benefits people obtain
  from ecosystems
• Provisioning services
• Regulating services
• Cultural services
• Supporting services

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Ecosystem Services
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Unprecedented scale and pace of change over past
40 years

• Population has doubled
• Economic activity increased 6-fold
• Humans have changed ecosystems more rapidly and
  extensively than in any comparable period of time
  in human history

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Precautionary principle

• As governments agreed in 1992 In order to
  protect the environment, the precautionary
  approach shall be widely applied by States
  according to their capabilities. Where there are
  threats of serious or irreversible damage, lack
  of full scientific certainty shall not be used as
  a reason for postponing cost-effective measures
  to prevent environmental degradation.
• FIRST DO NO HARM

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Levels of Prevention

• Primary - remove hazard or its effect
• Secondary - surveillance and early
  response
• Tertiary - treatment to avert adverse outcome

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• GREEN ROOFS
• responds to
• stormwater runoff
• urban heat island effect
• regional warming due to global climate change

US Mayors Climate Protection Agreement across
160 US cities to reduce greenhouse gas emissions
SOURCE Colin Cheney Director Earth Pledge
Green Roofs Initiative
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Can Madison become the most modern city in the
World? (modern.as in more bikes and biketrails
than cars and roads.)
Madison already ranks among top 5 biking cities
in US
1 third of US bike retail is based just in
Madison!
Win-win solutions ideal.. But win-win-win even
better!
1 - Personal Fitness 2 - Reduced Local Air
Pollution 3 - Reduced Greenhouse Gas
Emissions The Triple-Win Biking Project
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THERE ARE ALWAYS TRADEOFFS TO CONSIDER
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Unprecedented change in structure and function of
ecosystems

• More land was converted to cropland in the 30
  years after 1950 than in the 150 years between
  1700 and 1850.

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Degradation and unsustainable use of ecosystem
services

• Approximately 60 (15 out of 24) of the ecosystem
  services evaluated in this assessment are being
  degraded or used unsustainably

Degraded Capture fisheries Wild foods Wood
fuel Genetic resources Biochemicals Fresh
Water Air quality regulation Regional and local
climate regulation Erosion regulation Water
purification Pest regulation Pollination Natural
Hazard regulation Spiritual and religious
values Aesthetic values
Enhanced Crops Livestock Aquaculture Carbon
sequestration (in last 50 yrs)
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When assessment results meet the intended policy
decision makers
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Electronic Databases

• ?Toxicology Data Network (TOXNET -
  www.toxnet.nlm.nih.gov).
• ?CHEMTREC (Chemical Transportation Emergency
  Center - www.chemtrec.org)
• ?Material Safety Data Sheets (MSDS) are available
  on the Occupational Safety and Health
  Administration website www.osha.gov.
• ?Hazardous Substances and Health Effects Database
  (HazDat), available on ATSDR's website at
  www.atsdr.cdc.gov.

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Communicating Risk

• Essential to seriously consider best methods
• Example
• Fact less than 2 tenths of a percent of known
  chemicals have been tested for causing cancer.

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Of over 5 million known chemical
substances only 30 are definitely linked to
cancer in humans (white dot) And only 7,000
have been tested for carcinogenicity The rest
is darkness
Source J. Adams Risk, 1995
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EcoHealth ONE Oct. 7-10, 2006 Madison,
Wisconsin THEME Promoting Global
Health-Sustaining Natural Resources
THANK YOU Visit the website

• http//www.ecohealth.net