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Beating the Heat: Public Health and Climate Change


Why Should Public Health Care? It is our job to protect the public's health ... Greater risk for people who do not have access to air conditioning ... – PowerPoint PPT presentation

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Title: Beating the Heat: Public Health and Climate Change

Beating the Heat Public Health andClimate
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
Presenter Disclosures
Dr. Jonathan E. Fielding
  • (1) The following personal financial
    relationships with commercial interests relevant
    to this presentation existed during the past 12

No relationships to disclose
Climate Change is Happening Now
Source IPCC 2007 (4th Assessment)
IPCC 2007 Human Impact is Evident
Source IPCC 2007 (4th Assessment)
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 worlds
  • 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

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
Source U.S. Greenhouse Gas Emissions Inventory
U.S. CO² Emissions from Fossil Fuel
Why Should Public Health Care?
  • It is our job to protect the publics health
  • WHO estimates that in the year 2000, there were
    150,000 excess deaths per year due to climate
  • 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
  • We can be role models

Projected Impacts of GlobalTemperature Change
Falling crop yields in many areas, particularly
developing regions
Falling yields in many developed regions
Possible rising yields in some high latitude
450 ppm CO2 eq
Significant decreases in water availability in
many areas, including Mediterranean and Southern
Small mountain glaciers disappear water
supplies threatened in several areas
Sea level rise threatens major cities
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
Climate Changes Impacts on Health
Source Haines, et al, JAMA 2004
Extreme Weather Events Disease Clusters
Source Epstein, Harvard Center for Health
Global Environment
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

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 CAs surface water
  • Severe flooding may occur during winter and
    spring, with slower water flow during summer
  • Drought risk may be acutely elevated during the
    summer months
  • June 2008 Governor Schwarzenegger declares
    state drought

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

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 (gt 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

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

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
  • 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
  • Health effects of high levels of ozone exposure
  • Reduced lung function
  • Respiratory discomfort
  • Exacerbation of chronic respiratory illnesses
    (e.g. asthma)

Summary of Health Effects of Air Pollution
  • Amount of goods transported through California
    projected to nearly quadruple between 2000 and
  • Will have significant impact on air quality and
  • Diesel particulate matter (PM)
  • concentrated around ports, railyards, and heavily
    trafficked roads3
  • premature deaths
  • cancer
  • respiratory disease
  • lost workdays
  • global warming (2nd to CO2)

Annual Health Impacts in CA from PM and Ozone4
1 (Cal EPA, 2005) 2 (Pacific Institute, 2006) 3
(CA/EPA Air Resources Board) 4 (CA/EPA Air
Resources Board, 2004)
The Time for Inaction Has Past
  • Scale of threat is global touches all,
  • Intensity of the threat threatens all of our
    basic survival mechanisms -- food, water,
    shelter, and health.
  • Scale of response must engage every sector of
  • 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)

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
  • 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
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
  • Support legislation that reduces GHG emissions
  • Support sustainable lifestyles communities

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Realizing the Co-benefits ofReducing GHG
  • Primary benefits
  • reductions in the expected long-term consequences
    of global warming avoided damages of climate
  • 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

Realizing the Co-benefits ofReducing GHG
  • Important to realize the co-benefits of climate
    change responses certain efforts to address
    climate change often yield other health benefits
  • Strategy reducing vehicle miles traveled
  • Primary result lower motor vehicle GHG
  • 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
Key Mitigation Technologies Practices
  • 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

Items in green have health co-benefits!
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
  • 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)
Climate Health Co-benefits of Decreased Auto
  • 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

Borrowed from L. Rudolph
Climate Health Benefits of Reduced Meat
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
  • 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
  • Increases
  • Biodiversity
  • Global food security
  • Protein intake equity
  • Rural community strength

Borrowed from L. Rudolph
Mitigation What Can We Do In Our Homes
Workplaces to Combat Global Warming?
  • Establish recycling programs in the workplace and
  • Recycling half of your household waste hundreds
    of lbs. of CO2 saved per year
  • Promote energy efficiency in the home and
  • 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
  • Turning off your TV, computer, and other
    electronics thousands of lbs. of CO2 saved per

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 dont 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
  • If you do take a car, maintain it
  • Properly inflated tires can improve gas mileage
    by 3

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

Promote Healthy Policies
  • Support policies related to sustainable
  • Mixed use development, jobs near housing,
    transit-oriented design, bike lanes and
    sidewalks, parks and green
  • Development and utilization of useful public
  • Energy efficient "green" buildings and LEED
  • Buildings consume 72 of the nations 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

Source US Dept of Energy, 2007
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
  • Increase understanding and research re health
  • 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
We Cant 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
  • Moral obligation if we care about the health of
    our communities, then we need to do our part

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