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Normally, much of the solar energy gets reflected back into space

Climate Change

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Normally, much of the solar energy gets reflected back into space

Global warming caused by greenhouse gasses reflects more solar energy to earth

Greenhouse gasses

Greenhouse gasses:

CO2, methane, NOx, H20,

Climate Change

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Climate Change

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Greenhouse gasses

Greenhouse gasses:

CO2, methane, NOx, H20,

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Health Consequences of burning fossil fuels

Increasing CO2

Rising sea levels

More extreme weather

Rising temperature

CDC

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Image Source: CDC

Asthma, Cardiovascular & pulmonary dx, Lung cancer

Malaria, dengue, encephalitis, hantavirus, Lyme disease, West Nile virus

Malnutrition

Cholera, cryptosporidiosis, campylobacter, leptospirosis

Respiratory allergies, asthma

Injuries, fatalities, impact on infrastructure

Heat related illness and death, cardiovascular failure

Forced migration, civil conflict, mental health, access to care

Health Consequences

of burning

fossil

fuels

The health consequences of climate change include CLICK

Extreme heat: CLICK heat exhaustion, heat stroke, and death

Severe weather events CLICK which in addition to causing injuries and fatalities, also cause significant problems with accessing medical care

Air pollution CLICK exacerbating asthma, cardiovascular disease, and contributing to lung cancer

Changes in vector ecology CLICK resulting in the spread of disease such as malaria, dengue fever, and Lyme disease, among others

Increasing allergens CLICK resulting in an exacerbations of asthma and skin allergies

Impacts on our water quality CLICK leading to diarrheal disease

problems with adequate, nutritional foods CLICK will results in malnutrition

All of these are likely to cause forced migration, civil conflict, and access to care

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I am going to be coming back to this graph to use it as a table of contents

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Image Source: CDC

Heat related illness and death, cardiovascular failure

Health Consequences

of burning

fossil

fuels

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And if you look at the heat index -
incorporates relative humidity with air temperature,
Tells us What does it really feel like
it is predicted that we will have had 21 more days with the heat index above 105 by 2030, close to 50 by 2050

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The National Weather Service’s heat index incorporates relative humidity (a measure of temperature and dew point) with air temperature to measure what temperatures “feel like.” For example, if the air temperature is 88°F and there is 75% relative humidity, the heat index indicates it will “feel like” 103°F degrees.

Extreme heat isn’t just a scientific variable to be measured and cataloged. It has very real consequences for society. Hotter and more humid summers increase the risk from heat-related illnesses like heat exhaustion and heat stroke. Higher summer temperatures will increase electricity use from air conditioning, causing higher summer peak loads and potentially stressing the power grid. And when heat gets extreme, highways and railroads can buckle, snarling transportation. If greenhouse gas emissions continue on their current trends, these impacts will likely only get worse and become more frequent.

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Health Effects of Heat

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https://www.virginiaclinicians.org/2022-heat-illness-report

Health Effects of Heat

https://www.virginiaclinicians.org/2022-heat-illness-report

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Heat cramps, dehydration, heat exhaustion, heat stroke and death

Cardiac, respiratory, and kidney failure

Premature births, low birth weight, and congenital anomalies

Severe Burns

Health Effects of Heat

¹Goodman, et al 2018; ² Bulbena, Sperry, & Cunillera, 2006; Raj, 2014

But THERE ARE OTHER EFFECTS AS WELL that most people don’t think about CLICK

– Increase mortality from heart, lung and renal failure, again because our body is so stressed and working so hard to cool us down. CLICK

- Premature births CLICK

one I had never thought of before the extreme weather out west last summer CLICK–

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Background

She said that violence goes up by about 4 percent and suicide increases by about 1 percent per degree Celsius of warming. “The reasons for that probably have to do with neurotransmitters in the brain,” she said. “You know, our blood literally boils, in certain ways, when we are exposed to these high temperatures, and there are changes in [messenger chemicals in the brain like] epinephrine and serotonin and all sorts of other physiological things that make us less emotionally stable.”

Extreme heat in general raises levels of unease and depression, Haase said. It also “in a completely linear way, raises the incidence of violence and civic conflict, both interpersonal violence, as well as group-on-group violence of all kinds,” she added

Background:

Projected by centuries end US will annually lose 8 times 12,000 (deaths now) due to heat.

Scientist project that 27% of heat deaths due to climate change now.

Figuratively makes our blood boil – playing with neurotransmitter levels that bring out aggression and depression. https://insideclimatenews.org/news/01072021/heat-wave-deaths-pacific-northwest-climate-change/

12,000 deaths a year in US, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125937/. projected to be close to 100,000 by century end?

She said that violence goes up by about 4 percent and suicide increases by about 1 percent per degree Celsius of warming. “The reasons for that probably have to do with neurotransmitters in the brain,” she said. “You know, our blood literally boils, in certain ways, when we are exposed to these high temperatures, and there are changes in [messenger chemicals in the brain like] epinephrine and serotonin and all sorts of other physiological things that make us less emotionally stable.”

Extreme heat in general raises levels of unease and depression, Haase said. It also “in a completely linear way, raises the incidence of violence and civic conflict, both interpersonal violence, as well as group-on-group violence of all kinds,” she added.

Heat wave threats are widespread and pervasive.

THERE ARE OTHER EFFECTS AS WELL – Increase mortality from heart and lung failure, again because our body is so stressed and working so hard to cool us down. PREMATURE BIRTHS, MORE AGGRESSIVE BEHAVIOUrS LEADING TO MORE MURDERS AND SUICIDES (Blood figuratively boils – warm blood has different levels of neurotransmitters that lead to less emotional stability, AND EVEN COGNITIVE DECLINE., kidney disease – especially among workers in the heat who are chronically dehydrated, and one I had never thought of before the extreme weather out west this summer – physical burns from hot surfaces. The asphalt in Portland registered 165 degree F – even door nobs and metal handrails can cause second degree burns.

.

The World Health Organization has said heat stress linked to climate change is likely to cause 38,000 extra deaths a year worldwide Climate Reality

Heat stress can initially cause muscle cramps, profuse sweat, thirst, and fatigue

These factors converged to a devastating effect in the summer of 2003, when a heat wave baked the continent with temperatures 13 degrees above the average normal for the region. The heat killed at least 30,000 people caused 13 billion Euros in financial damages. Some estimates put the death toll as high as 70,000.

Doctors warn asphalt, sand and sidewalks can cause severe burns 120 degree cay – metal painted blackcan reach 150 degrees causing 2^nd degree burns scorching surfaces “pavement burn season 35 seconds barefoot – second degree burns seat belts buckles and door handles and even poolside concrete. Desert Sun: Doctors warn of burns from asphalt as heatwave hits Southwest 6/16/21 by Bob Christie

Climate change is increasing that statistic; on average, more than a third of heat-related deaths globally are due to climate change.

AND DUE TO RISING TEMPERATURES FROOM CLIMATE CHANGE, EXPERTS PROJECT A HUGE INCRESASE IN HEAT WAVE DEATHS – UP TO 2000 PERCENT IN COUNTRIES NEAR THE EQUATOR BY 2080, Scientists predict major increase in heatwave deaths as world warms

By Sebastien Malo, Thomson Reuters FoundaTION 7/2018

However, there are more effects people probably don’t think about. Increasing aggression,for example, and, believe it or not, a decline in cognitive functioning. And the people most at risk? Children, the elderly and pregnant women. People who have to work outside or people without air conditioning. CLICK

I really want to point out this one here, that is a major health effects of heat is and premature births low birth weight and congenital abnormalities

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Blacktop temperature in Portland, July 28, 2021:

155°F

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Indirect Health Effects of Heat

Decline in cognitive functioning

Increasing aggression, including assaults, murders, and suicides

Impact on health care delivery

Impact on infrastructure (energy, transportation, water)

Indirect effects of heat include

Decline in cognitive function, including slowed response time, diminished accuracy, and less sophisticated patterns of decision-making CLICK

- Change in behavior... More aggressive behaviors leading to more assaults, murders and suicides. when we are exposed to these high temperatures, and there are changes in [messenger chemicals in the brain like] epinephrine and serotonin and all sorts of other physiological things that make us less emotionally stable. CLICK

Big impact on health care delivery, with increased emergency room visits and hospitalizations CLICK

Impact on our infrastructure including more power needed for air conditioning, resulting in more power outages, as we saw in California in the summer of 2020.
----------------------

Decrease in outdoor sports

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Indirect Health Effects of Heat

Decline in cognitive functioning: slowed response time, diminished accuracy, and less sophisticated patterns of decision-making

Increasing aggression, including assaults, murders, and suicides

Impact on health care delivery

Impact on infrastructure (energy, transportation, water), including more power needed for air conditioning, resulting in power blackouts

Decrease in out-door sports

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WHO IS AT RISK?

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THE MOST VULNERABLE AMONG US

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c-change conversations

City Dwellers

Differences in temperatures:

Between urban and rural areas: 4^{0 -}11⁰

Between urban areas with green space and those that do not: as much as 8⁰

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Who else is vulnerable?

Those of us who live in cities.

The steel and concrete jungles of our cities absorb heat and since there is less grass and trees, there is less evaporation to cool the air. This means that cities will heat up more than the surrounding areas CLICK–

In fact the annual mean air temperature of a city can be 4° to 11°f warmer than surrounding rural areas during the day,

And even within cities, the temperatures can swing widely. And areas without a tree canopy and green spaces, like many poorer urban areas can be even hotter, by as much as 8 degrees hotter than neighborhoods with more green space.

Background:

(nat geo: https://www.Nationalgeographic.Com/climate-change/how-to-live-with-it/heat.Html) also, in cities we use more energy, including for air conditioning, which ironically makes the outside hotter.

1.5 to 2 times MORE LEADING TO AN INCREASE IN PREMATURE DEATHS.

Am journal of health.

So remember that 7 degree number on land that we are trending towards? Well, it will be more like 10 degrees hotter in cities – and even more in places in the city without urban canopy. In fact in LA , porrer neighborhood today are ofen 7.6 degrees hotter than neighborhoods with tree canapy. So the difference is stark.

Nat geo – poorer neighborhoods avg 7.6 fdgreed hotter in in LA - difference with urban canopy and not.”LA confronts its shady divide, 6/17/21

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“About 9,300 Avista Utilities customers in Spokane lost power on Monday with....... more planned blackouts ....in the city of about 220,000 people.”

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Health consequences

of climate change

Image Source: CDC

Health

Severe weather events:

Drought
Floods
Wildfires
Hurricanes

Heat related illness and death, cardiovascular failure

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Lake Powell

1999

2015

The USDM3 lassified >68% of the western US as under extreme or exceptional drought for nearly all of July–October 2021

The USDM3 classified >68% of the western US as under extreme or exceptional drought for nearly all of July–October 2021

1999

2015

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At the current rate of depletion, “35% of the southern High Plains will be unable to support irrigation within the next 30 years.”

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Drought: Health Impacts

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Reduced lake and wetland levels and stream flows
Potential concentration of pollutants
Decreased water supply for drinking and agriculture

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Climate change threatens the quantity and quality of our food supplies

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Drops in Crop Yield

Nutrient change in crops

Pollinator declines

Coral reefs collapse

Fisheries collapse

Decrease in milk and meat production

Samuel Myers,MD; Director, Planetary Health Alliance; Harvard School of Public Health

Climate changes effects the quantity and quality of our food – plants, animas and seafood

---------------

Droughts not only reduces the amount of food we grow, but the nutritional value of that food.

Pollinators – bees and other insects pollinate 1/3 of the food we eat, and their levels are dropped at unprescedented levels. According to the Center for Biological Diversity, more than half of North America’s 4,000 native bee species are in decline, with 1 in 4 species at risk of extinction.

Coral reefs are collapsing all over the world – and they are home for 1 in four fish in the ocean. Over half a billion people depend on reefs for food, income, and protection.

As the rivers, lakes, and ocean heat up, fisheries will collapse, and many species of fish will move further north, and

as some regions become too hot for livestock to be raised outdoors, we are going to see a decrease in milk and meat production and cows become more susceptible to parasites and disease.

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Congressional budget office

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Hurricane Ida, August 2021

North Carolina

Louisiana deaths: 13

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Hurricane Ida, August 2021

North Carolina

Louisiana deaths: 13

Northeast Coast deaths: 43

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Health Impacts of hurricanes and other extreme weather events

Image: LA Times

Limited access to food and safe water

Contamination of water and food sources

Increased risk from infectious diseases

Disruption of services

Reduced ability to access health care,

Growing burden from unaddressed other medical issues

Mental health issues

Taken from KFF’s Issue Brief “Public Health in Puerto Rico after Hurricane Maria

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��

Hurricane Harvey’s Toxic Impact �� FRANK BAJAK of THE ASSOCIATED PRESS and LISE OLSEN of the HOUSTON CHRONICLE March 23, 2018

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More than 100 toxic releases

Over 365 tons of hazardous chemical released from 40 sites

A chemical plant northeast of Houston exploded and burned for days

13 Superfund sites damaged and flooded; a concrete cap meant to contain pollutants was damaged by the rushing floodwaters, releasing chemicals into the river

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Sea Level Rise

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The sea is rising... glaciers are melting and that the oceans are warming - and therefore thermally expanding.

Scientists say that sea level has risen about 8 inches in the last 150 years.

The BEST CASE SCENARIO is about 1 1/2 to 3 feet by the end of this century.

NOAA’s worst-case scenario is 8 feet, depending on how unstable the ice sheets become in Greenland and Antarctica.

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Let’s go back to water and talk quickly about sea level rise.

Scientists say that sea level has risen about 8 inches in the last 150 years.

And we know we will have additional sea level rise, simply because we know glaciers are melting and that the oceans are warming - and therefore thermally expanding.

The BEST CASE SCENARIO is about 1 1/2 to 3 feet by the end of this century.

NOAA’s worst-case scenario is 8 feet, depending on how unstable the ice sheets become in Greenland and Antarctica.

��

https://www.ucsusa.org/sites/default/files/legacy/assets/documents/global_warming/Causes-of-Sea-Level-Rise.pdf

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It’s Dangerous: �Sunny Day Nuisance Flooding

Fort Pulaski ,GA

Annapolis , MD

Charleston, SC

Miami, FL

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Take a look at what is happening along our coasts right now. Communities are battling chronic flooding regularly, even on sunny days, just due to sea level rise. They even have a name for it… “Sunny Day Nuisance Flooding”

-------------------------------

This may not look so drastic, but it has real impacts: Businesses are hurt, school buses can’t pick up children, cars must be regularly moved out of harm’s way. And it’s really hard to insure and sell your cars or your home.

Again, this isn’t a projection, it is happening today all up and down the coasts. AND IF ITS HAPPENING AT 8 INCHES, imagine at TWO FEET.

Don’t believe the predictions? Seems farfetched or far away in time? Take a look at what is happening along our coasts right now, as communities battle chronic flooding regularly on sunny days just due to sea level rise. This may not look so drastic, but it has real costs: Businesses are hurt, school buses can’t pick up children, cars must be regularly moved out of harm’s way. It’s really hard to insure and sell your cars or your home. Again, this isn’t a projection, it is happening today all up and down the coasts. And if it is happening at 8 inches, imagine at 2 feet.

https://www.elementascience.org/article/10.1525/elementa.234/ (Accessed10/16/17, 9/27/19) . And background on Sandy: https://www.washingtonpost.com/news/energy-environment/wp/2017/08/30/katrina-sandy-harvey-the-debate-over-climate-and-hurricanes-is-getting-louder-and-louder/?utm_term=.92072bbd9f27

https://www.nytimes.com/interactive/2016/09/04/science/global-warming-increases-nuisance-flooding.html

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Increase in heavy rain events (top 1%) since 1958
Big regional variations

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Health Impacts from Flooding

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Physical injuries (including drowning)
Food and water-borne illnesses
Food insecurity
Displacement
Mental health issues
interruption of emergency services
Allergies (mold)

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Health impacts from flooding can include

physical injuries (i drowning or injuries suffered from structural damage)
food and water-borne illnesses, including:

Salmonellosis
Cryptosporidiosis
Giardiasis

food insecurity – where are people going to get their next meal?
Displacement – where are they going to live –both in the acute setting during and after the storm, as well as long term– are they going to migrate
mental health issues: including dealing with the stress of repairs, loss, displacement, insurance issues;
interruption of emergency services

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There have been 18 flood-related deaths in Minnesota between 1995 and 2011. 10 of those deaths occurred in vehicles.

“Be aware of flood hazards no matter where you live, but especially if you live in a low-lying area, near water or downstream from a dam. Even very small streams, gullies, creeks, culverts, dry streambeds, or low-lying ground that appear harmless in dry weather can flood. Every state is at risk from this hazard.” – Federal Emergency Management Agency

Source:

(FEMA, 2012; SHELDUS, 2012; WHO, 2010; Ebi et al, 2008; CCSP, 2008)

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Mold growth is enhanced by heat and moisture

Heavy mold growth was identified in 70,000 water-damaged homes following Hurricanes Katrina and Rita in 2005,

Infants exposed to mold before the age of 1: 2.8 to 4 times more likely to develop asthma

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Allergens: Mold

Extensive mold contamination of ceiling and walls

(Source Terry Brennan, http://www.epa.gov/mold/moldcourse/imagegallery5.html)

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Mold is another problem seen with flooding
Mold growth is enhanced by heat and moisture
Mold can cause coughing, wheezing, nasal and throat conditions, and adversely affect persons with asthma or weakened immune systems
In the wake of Hurricanes Katrina and Rita in 2005, for example, heavy mold growth was identified in 70,000 water-damaged homes.
Another example of how mold can affect health: Infants who are exposed to mold before one year of age are 2.8 to 4 times more likely to develop asthma

-----------------------------

Increase in precipitation/floods
Increase in temperature and/or humidity
Increase in plant growth/plant biomass decay (leaf litter)
Improper installation or management of air conditioning systems can create conditions ripe for mold

Sources:

(Bernard et al, 2001; National Wildlife Federation, 2010)

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Health Impacts from Drought

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Reduced lake and wetland levels and stream flows
Decreased water supply for agriculture
Negative effects on soil moisture and crop progress will impact food security
Increased risk of wildfires

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Drought and lower water levels have the following public health issues:

Reduced soil moisture reserves, groundwater supplies, lake and wetland levels, and stream flows.
Decreased water supply for agriculture can adversely affect crop progress and soil moisture and therefore food supply
From 1996 to 2011, the U.S. lost $17.2 billion dollars in crop damage due to drought.
Wildfire dangers (e.g. Pagami Creek Fire, Boundary Waters Canoe Area Wilderness– started in August 18^th 2011, 92,682 acres): which can cause injuries, impair respiratory function with particles from smoke, property damage, and mental health impacts similar to those from flooding

Sources:

(DNR 2000, DNR 2011a; DNR 2011b; Kundzewicz et al, 2007; MPR, 2011a; State Climatology Office, Drought Information Resources; US EPA, 2011; US Forest Service Incident System, 2011; US National Hazard Statistics, 2012)

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Health consequences

of climate change

Image Source: CDC

Asthma, Cardiovascular dx, Lung cancer

Health

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�Air Pollution: �The presence of substances in the atmosphere that are harmful to the health of humans and other living beings or cause damage to the climate or environment

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'Invisible killer’: Fossil fuels caused 8.7m deaths globally in 2018�

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One in five of all deaths worldwide
Kills more people than other heat or severe weather events

https://www.theguardian.com/environment/2021/feb/

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Air Pollution

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https://www.who.int/health-topics/air-pollution#tab=tab_1

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Total deaths: 68, 553

Ambient: 19,811

Burning of fossil fuels: 48,742

Total Premature Deaths in the US from Air Pollution by Sector

The Lancet Countdown on Health and Climate Change; 2020

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Pollutants from burning fossil fuels

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Particulate matter

Gasses

Carbon dioxide
Methane
Ammonia
Carbon monoxide
Sulfur dioxide
Nitrous oxides

Secondary pollutants

Ozone: formed when hydrocarbons and nitrous oxides combine in the presence of heat and sunlight: SMOG
Acid rain: formed when water combines with nitrogen oxides and sulfur dioxide

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Particulate Matter

Particulate matter comes in different sizes (coarse and fine) from a number of sources including:

Small particles: Dust, etc. from construction, mining and agriculture; Pollen
Fine particles (PM 2.5): Burning fossil fuels in factories, power plants, and diesel- and gasoline-powered motor vehicles; fires

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PM 2.5 Mechanism of Injury

Impaired respiratory function�Chronic cough�Lung Disease

Bronchitis
Asthma�COPD�Pneumonitis

Cardiovascular disease�Lung cancer
Systemic effects

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Particulate Matter – Serious Health Impacts

Effects of acute exposure :

Short-term decrease in lung function
Exacerbation of respiratory and cardiovascular diseases
Hospitalizations and deaths

Effects of long term exposure:

Respiratory and cardiovascular diseases
Cardiopulmonary and lung cancer deaths

Potential health effects of PM exposure, increased risk of:
impaired respiratory function
chronic cough
bronchitis
chest illness
chronic obstructive pulmonary disease (COPD)
pneumonia
cardiovascular diseases
allergic disease and asthma
cardiopulmonary diseases
cancer

Particulate matter (PM) can have serious health impacts, including significant increases in mortality from cardiovascular and cardiopulmonary diseases as well as cancer.

Acute exposure to particulate air pollution not only exacerbates illness in people with respiratory disease but also increases the numbers of hospitalizations and deaths from cardiovascular and respiratory diseases
Long-term effects on health, particularly in the elderly and children, include impaired respiratory function, chronic cough, bronchitis, chest illness, and increased risk for respiratory causes such as COPD, pneumonia, and cardiovascular disease. PM has also been linked with increased allergic disease and asthma.
Long-term exposure to particulate air pollution is associated with cardiopulmonary and lung cancer mortality

Sources:

(Amann et al, 2004; Bernard et al, 2001; Pope et al, 1995; Pope, 2000; Shea et al, 2008; Clean Air Taskforce, 2010; Levy et al, 2010)

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Estimated contributions of all pollution risk factors to deaths caused by non-communicable diseases

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Landrigan; The Lancet Commission on pollution and health Lancet 2018; 391: 462–512

COPD

Lung Cancer

Ischemic heart disease

CNS Dx & Strokes

All other CV dx

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Air Pollution and Lung Cancer

Air pollution and PM2.5 are classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC)
Contributed to about 13-14% of lung cancer deaths worldwide in 2017
Second most common cause of lung cancer
Causes lung cancer even in never-smokers

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Estimated Hazard Ratios Associated with � mcg/^m3 increase of PM 2.5�Coleman N, et al Cancer Causes & Control (2020) 31:767–776

National Health Interview Survey and mortality follow-up

635,539 individuals surveyed from 1987 to 2014.
Included a sub-cohort of 341,665 never-smokers

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HR (95% CI)	Full cohort	Never-smoker cohort
All Cancers	1.15 (1.08- 1.22)	1.19 (1.06-1.33)
Lung cancer	1.13 (1.0-1.26)	1.73 (1.2-2.49)
Non-lung cancers	1.15 (1.07-1.26)	1.15 (1.02-1.30)

This survey studies over 600,000 people, and found even when adjusted for all other variable, including age, sex, ethnicity, income, education, race, marital status, BMI, smoking, urban versus rural, Census Regent’s, and survey year,CLICK

never-smokers were at a higher risk of getting lung cancer

National Health Interview Survey and mortality follow-up data were combined to create a study population of 635,539 individuals surveyed from 1987 to 2014. A sub-cohort of 341,665 never-smokers from the full cohort was also created. All hazard ratios are adjusted for age, sex, ethnicity, income, education, race, marital status, BMI, smoking, urban versus rural, Census Regent’s, and survey year

It is unknown whether or not the larger HR for never-smokers is due to different susceptibility, underlying biology, or simply due to differences in baseline risk. Given the large effect of smoking on lung cancer, the underlying or baseline mortality risk for lung cancer in never-smokers is much smaller than for smokers. As such the proportional hazard (an estimate of relative risk) associated with PM2.5 exposure would likely be larger in never-smokers than in smokers. The results from this study are comparable to a recent meta-analysis of cohorts examining PM 2.5 -lung cancer mortality (HR 1.13, 95% CI 1.07–1.20)

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Air Pollution Shortens Lung Cancer Survival�Eckel SP, et al. Thorax 2016;71:891–898.

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Risk of Dying with Localized Exposure

RISK of DYING

PM2.5 concentration

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CHEST 2019; 155(2):409-416

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Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review

Bekkar et al; JAMA Open Network, 2020

JAMA Network Open. 2020;3(6):e208243. doi:10.1001/jamanetworkopen.2020.8243

(

Systemic review
57 studies

48 of 58 [84%] on air pollutants;
9 of 10 [90%] on heat)

32,798,152 births
Subpopulations at highest risk:
persons with asthma
minority groups, especially black mothers.

Another effect of air pollution that is on preterm l and low birth rates, and still borns birth rates; This was a systemic review of over 32 million births and CLICK

found that the risk for pre-term, low birth weigh and still borns increased with air pollution CLICK

AnAbbreviations: IQR, interquartile range; NA, not applicable.

Other

For whole pregnancy PM 2.5 exposure.

a Risk presented as range from significant studies. The median is calculated from the range; a pooled analysis was not performed. For consistency, the whole pregnancy exposure was presented where possible.

b Single study unless specified.

c d e For whole pregnancy heat exposure. The only 2 studies on heat and stillbirth did not provide comparable outcomes that could be combined into a range with a median.

JAMA Network Open. 2020;3(6):e208243. doi:10.1001/jamanetworkopen.2020.8243

(

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Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review

Bekkar et al; JAMA Open Network, 2020

JAMA Network Open. 2020;3(6):e208243. doi:10.1001/jamanetworkopen.2020.8243

(

Systemic review
57 studies

48 of 58 [84%] on air pollutants;
9 of 10 [90%] on heat)

32,798,152 births
Subpopulations at highest risk:
persons with asthma
minority groups, especially black mothers.

Of note, they also found that these complication increased for mothers with underlying conditions, who lived near solid waste disposal plants, and with high third semester exposure

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Abbreviations: IQR, interquartile range; NA, not applicable.

Other

For whole pregnancy PM 2.5 exposure.

a Risk presented as range from significant studies. The median is calculated from the range; a pooled analysis was not performed. For consistency, the whole pregnancy exposure was presented where possible.

b Single study unless specified.

c d e For whole pregnancy heat exposure. The only 2 studies on heat and stillbirth did not provide comparable outcomes that could be combined into a range with a median.

JAMA Network Open. 2020;3(6):e208243. doi:10.1001/jamanetworkopen.2020.8243

(

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Air pollution linked to higher risk of autoimmune diseases

81,363
12% - 13% higher risk of developing an autoimmune disease
PM10: increased risk of rheumatoid arthritis
PM2.5: increased risk of:

rheumatoid arthritis,
connective tissue diseases,
and inflammatory bowel diseases.

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https://www.theguardian.com/environment/2022/mar/15/air-pollution-exposure-linked-higher-risk-autoimmune-diseases

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	Outdoor						Indoor
Burning of Fossil Fuels				Consequences of Climate Change	Farming	Ambien	Burning of Natural Gas Methane	Chemicals from Products
Gas	Diesel	Coal	Jet fuel	Wildfires	Dust ammonia	Sand, sea salt, etc

Common

Sources of Air Pollution

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Unprecedented Wildfires

@C-Change Conversations 2021

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https://www.unep.org/resources/report/spreading-wildfire-rising-threat-extraordinary-landscape-fires

North America was the only region in the world where air quality worsened between 2019 and 2020, due to wildfires that burnt a record 4.3 million acres of the US

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Mostly carbonaceous

5–20% elemental carbon
50% organic carbon

More oxidative potential due to presence of more polar compounds

Result:
More free radicals
More oxidative stress
More inflammation

PM2.5 from Wildfires is 10X More Harmful than from Other Sources�Aguilera, R ,Nature Communications,| https://doi.org/10.1038/s41467-021-21708-0

A recent study found that p.m. 2.5 from wildfires is 10 times more harmful than p.m. 2.5 from other sources.

Wildﬁre particulate matter contains more carbon

and has more oxidative potential due to the presence of more polar organic compounds than does ambient urban particulate

As a result, it generates more free radicals and thus have a greater potential to cause inﬂammation and oxidative stress in the lung than urban ambient particulate from the same region .

https://www.bloomberg.com/news/articles/2021-03-16/record-breaking-wildfires-made-north-american-air-worse-in-2020?sref=wINQCNXe�

From Grist

Aguilera, R ,Nature Communications,| https://doi.org/10.1038/s41467-021-21708-0

A recent study found that p.m. 2.5 from wildfires is 10 times more harmful than p.m. 2.5 from other sources.

Though the differential toxicity of wildﬁre PM 2.5 as compared to other ambient sources of PM 2.5 is not well understood 11–13 , recent animal toxicological studies suggest that particulate matter from wildﬁres is more toxic than equal doses from other sources such as ambient pollution 14,15 . In vitro and in vivo studies have shown that mechanisms that may explain wildﬁre-speciﬁc PM higher toxicity include inﬂammation, oxidative stress 15 , or increased respiratory infection by altering pulmonary macrophages activity 16 . Wildﬁre particulate matter is mostly carbonaceous (with 5–20% elemental carbon and at least 50% organic carbon 17,18 ) and has more oxidative potential than ambient urban particulate due to the presence of more polar organic compounds 19 . All the above compounds in wildﬁre smoke tend to generate more free radicals and thus have a greater potential to cause inﬂammation and oxidative stress in the lung than urban ambient particulate from the same region 20,21 .

https://www.bloomberg.com/news/articles/2021-03-16/record-breaking-wildfires-made-north-american-air-worse-in-2020?sref=wINQCNXe�

From Grist

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Source: https://www.economist.com/graphic-detail/2020/10/14/this-is-the-worst-fire-season-the-american-west-has-ever-seen

Excess Deaths in the elderly

per million people 2015 – 2020

After the fire

United States, west-coast wildfires

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Wildfires have a higher long-term impact on health in the east than the west

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https://www.washingtonpost.com/weather/2021/10/20/wildfire-smoke-deaths-eastern-us/

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Indoor air quality pollution

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What’s the problem with burning natural methane gas?

J Schiller

Methane

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METHANE

80 Times More Potent Than CO2

370 million tons release annually
For every ton of methane emitted:

1,430 people die prematurely
4,000 asthma-related emergencies
300 million work hours are lost

https://science.howstuffworks.com/environmental/conservation/issues/UN-report-methane-emissions-news.htm

leaking natural gas lines
agriculture (burping & pooping cows!)
thawing permafrost

Comes from

Formaldehyde (CH20)
Carbon monoxide (CO)
Nitrogen oxides
CO2

When it burns, results in:

Methane is a greenhouse gas, just like CO2.
It comprises about 80% of natural gas, and
And its very potent. 80 times more potent than CO2.,
It comes from leaking natural gas lines, agriculture, and thawing permafrost
And when it burns, it releases a number of toxic materials.
CLICK
370 million tons release annually
For every ton of methane emitted:

1,430 people die prematurely
4,000 asthma-related emergencies

And it has a lot of health effects....

For every million tons of methane emitted,

about 1,430 people die prematurely,
there are about 4,000 asthma-related emergencies

300 million work hours are lost to the health effects.

https://science.howstuffworks.com/environmental/conservation/issues/UN-report-methane-emissions-news.htm

that for every million tons of methane emitted, about 1,430 people die prematurely, there are about 4,000 asthma-related emergencies and 300 million work hours are lost to the health effects. To put that into context, around 370 million tons (335.6 million metric tons) of methane are released annually due to human activities.

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METHANE

76% of all methane emissions came from leaks when the stove was not in use.

Indoor Air Pollution From Leaky Gas Stoves

Lebel, Environ Sci Technol

https://doi.org/10.1021/acs.est.1c04707

“Families who don’t use their range hoods or who have poor ventilation can surpass the 1-hour national standard of NO 2 (100 ppb) within a few minutes of stove usage, particularly in smaller kitchens.”

This study looked at the methane emissions from 53 homes with gas burning stoves

and estimated that the methane emissions from all residential stoves nationwide would be equal to the annual greenhouse gas emissions of half a million cars

�And even when you’re not burning natural gas on the stove, there is still a problem.

76 percent—came from slow but steady leaks in stove piping and fittings when the stove was not in use.

Families who do not have good ventilation in their kitchens, particularly if they are small, Can pass the one hour national standard for nitrous dioxide within a few minutes of using the stove

https://science.howstuffworks.com/environmental/conservation/issues/UN-report-methane-emissions-news.htm

that for every million tons of methane emitted, about 1,430 people die prematurely, there are about 4,000 asthma-related emergencies and 300 million work hours are lost to the health effects. To put that into context, around 370 million tons (335.6 million metric tons) of methane are released annually due to human activities.

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What’s the problem with burning natural methane gas?

J Schiller

Methane

NO & NO₂= NO_x

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https://rmi.org/insight/outdoor-air-quality-brief/

2017 NO_x emissions from gas power plants and gas appliances

Gas appliances admit over twice as much NOX pollution and gas power plants nationwide, despite burning less gas

Once released outside, NO X from appliances reacts in the atmosphere to form harmful secondary pollutants like ground-level ozone and fine particulate matter (PM2.5 ).

And Gas appliances admit over twice as much NOX pollution and gas power plants nationwide, despite burning less gas

Appliance pollution is typically vented outdoors, just like fumes from a power plant smokestack. One important exception is unvented pollution from gas stoves, which can quickly build up to dangerous concentrations inside homes, increasing asthma risks. In addition to these indoor harms, gas stove pollution can exit homes through windows, and cracks, and (in some cases) vents, and ultimately contribute to outdoor pollution just like emissions from other vented appliances.

Once released outside, NO X from appliances reacts in the atmosphere to form harmful secondary pollutants like ground-level ozone and fine particulate matter (PM2.5 ). These appliance emissions contribute significantly to nonattainment of Environmental Protection Agency’s (EPA’s) National Ambient Air Quality Standards (NAAQS). RMI analysis of EPA’s National Emissions Inventory shows that counties in ozone nonattainment areas experience over 850 tons of appliance NO X pollution per year on average. That’s more than the average emissions in those counties from all power plants, including coal-fired plants. And in counties in ozone nonattainment areas classified as moderate or higher, which must apply Reasonably Available Control Measures to all emissions sources, appliances emit 1,150 tons per year of NO X on average—over twice as much as the average power plant emissions of 460 tons per year.

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Ground-Level Ozone (O₃)

Distinct from ozone which forms naturally in the upper atmosphere and protects us from the sun's harmful ultraviolet rays

Ground-level (or Tropospheric) ozone is a main pollutant for which concentrations are anticipated to be affected by climate

Ground-level ozone formed by the reaction of the primary pollutants, volatile organic compounds (VOCs) and nitrogen oxide (NO_x), in the presence of sunlight and heat.

Source: American Lung Association

Ozone is a gas that occurs both at ground level and in the Earth’s upper atmosphere. Atmospheric ozone protects life on Earth from the sun’s harmful ultraviolet (UV) rays.

Ground-level ozone is is considered a secondary pollutant formed by the reaction of volatile organic compounds (VOCs) and nitrogen oxide (NO_x) in the presence of sunlight and heat.

This graphic from the American Lung Association demonstrates the complex chemical reaction that combines precursor pollutants (volatile organic compounds and nitrogen oxides) that react in the presence of heat and sunlight to create ground-level ozone. Emissions from industrial facilities and electric utilities, motor vehicle exhaust, gasoline vapors, and chemical solvents are some of the major sources of NOx and VOC.

Sources:

(Bernard et al, 2001; Jacob & Winner, 2009; Union of Concerned Scientists, 2011; US EPA, 2003)

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https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

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These emissions now account for more annual deaths than pollution from coal power plants

https://www.washingtonpost.com/climate-environment/2021/05/10/farm-pollution-deaths/

and disease (Part 1)Another source of PM2.5 is – surprisingly – agriculture.

PM2.5 articles are directly produced when farmers till fields or burn crops before harvest., or by dust kicked up by livestock in large animal feeding operations. This “primary” PM 2.5 is associated with about 4,800 premature deaths per year

A bigger problem, however, is ammonia, a highly reactive molecule released by manure and fertilizer.

Ammonia can interact with other gases in the atmosphere, which can combine with other pollutants such as nitrogen and sulfur compounds to create small, hazardous particles. CLICK

More people die year from air pollution caused by agriculture than from goal power plants

https://www.washingtonpost.com/climate-environment/2021/05/10/farm-pollution-deaths/

But “secondary” particulate matter, which is generated when emissions from farms interact with other gases in the atmosphere, is even more problematic. This is especially true for ammonia, a highly reactive molecule released by manure and fertilizer, which can combine with other pollutants such as nitrogen and sulfur compounds to create small, hazardous particles.

�

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Castillo, GeoHealth, 2021: 5, e2021GH000431. https://

All-cause Mortality

% of African Americans by Ward

Intra-Urban Inequities in PM2.5-Attributable Health Impacts:

A Case Study for Washington, DC

Castillo, GeoHealth, https:// doi.org/10.1029/2021GH000431

And, of course, we cannot ignore the fact that air pollution disproportanlly effects people in the underserved, poor, or minority communities.

This is a study looking at excess deaths due to PM2.5 in the DC area, where I live. The blue areas indicate neighborhoods that have a low percentage of blacks while the orange and red areas indicate neighborhoods with a high percentage.. CLICK

Blue is PM2.5 -attributable all-cause mortality rates The highest PM2.5 -attributable all-cause mortality rates are more than four times higher in the most impacted neighborhoods, versus the least

Castillo, M. D., Kinney, P. L., Southerland, V., Arno, C. A., Crawford, K., van Donkelaar, A., et al. (2021). Estimating intra-urban inequities in PM 2.5 -attributable health impacts:

A case study for Washington, DC. GeoHealth, 5, e2021GH000431. https:// doi.org/10.1029/2021GH000431

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Castillo, GeoHealth, 2021: 5, e2021GH000431. https://

All-cause Mortality

% of African Americans by Ward

Intra-Urban Inequities in PM2.5-Attributable Health Impacts:

A Case Study for Washington, DC

Castillo, GeoHealth, https:// doi.org/10.1029/2021GH000431

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PM2.5 polluters disproportionately and systematically affect people of color in the United States

Tessum et al., Sci. Adv. 2021; 7 : eabf4491 28 April 2021

Within individual states
Within individual urban and rural areas�Across incomes�Across exposure levels�Largest sources of disparities varies widely by source type and locations

Industry�Light duty gasoline vehicles�Construction�Heavy duty diesel vehicles

People of color

White

This graph show the Percent of PM 2.5 exposure caused by emission source types that disproportionately expose people of color in purple and Whites in green. The x axis shows increasing PM2.5 exposure. The dashed line represents of 50% equity, meaning that if the dot falls above that line, that group is disproportionately more exposed, and If one falls below that line, that group is less exposed disproportionately expose them and the other half is from source types that expose them less than average. For all of these – across states,urban areas, rural areas, and income levels, one can see that most emission sources consistently result in higher exposures for people of color and lower exposures for Whites.

Fig. 2. Percent of PM 2.5 exposure caused by emission source types that disproportionately expose people of color (POC) and Whites. Data shown for (A) U.S. states (n = 48 states), (B) urbanized areas (n = 481 areas), (C) rural areas in each state (n = 48 states), and (D) income bins (n = 16 bins; last bin is >$200,000). Icon area is proportional to population; shaded areas are kernel density estimates. A y axis value of 50% would represent equity for that group (i.e., for the population-average exposure), meaning that half of their exposure comes from source types that disproportionately expose them and the other half is from source types that expose them less than average. Across geographies and levels of exposure (A to C), as well as incomes (D), most emission sources consistently result in higher exposures for POC and lower exposures for Whites. Source: data

Fig. 2. Percent of PM 2.5 exposure caused by emission source types that disproportionately expose people of color (POC) and Whites. Data shown for (A) U.S. states (n = 48 states), (B) urbanized areas (n = 481 areas), (C) rural areas in each state (n = 48 states), and (D) income bins (n = 16 bins; last bin is >$200,000). Icon area is proportional to population; shaded areas are kernel density estimates. A y axis value of 50% would represent equity for that group (i.e., for the population-average exposure), meaning that half of their exposure comes from source types that disproportionately expose them and the other half is from source types that expose them less than average. Across geographies and levels of exposure (A to C), as well as incomes (D), most emission sources consistently result in higher exposures for POC and lower exposures for Whites. Source: data file S2.

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PM2.5 polluters disproportionately and systematically affect people of color in the United States

Tessum et al., Sci. Adv. 2021; 7 : eabf4491 28 April 2021

Within individual states
Within individual urban and rural areas�Across incomes�Across exposure levels�Largest sources of disparities varies widely by source type and locations

Industry�Light duty gasoline vehicles�Construction�Heavy duty diesel vehicles

People of color

White

These four graphs show the Percent of PM 2.5 exposure caused by emission source types that disproportionately expose people of color in purple and Whites in green. The x axis shows increasing PM2.5 exposure. The dashed line represents of 50% equity for that group, meaning that if the dot falls above that line, that group is disproportionately more exposed, and If one falls below that line, that group is less exposed disproportionately expose them and the other half is from source types that expose them less than average. For all of these – across states,urban areas, rural areas, and income levels, one can see that most emission sources consistently result in higher exposures for people of color and lower exposures for Whites.

Fig. 2. Percent of PM 2.5 exposure caused by emission source types that disproportionately expose people of color (POC) and Whites. Data shown for (A) U.S. states (n = 48 states), (B) urbanized areas (n = 481 areas), (C) rural areas in each state (n = 48 states), and (D) income bins (n = 16 bins; last bin is >$200,000). Icon area is proportional to population; shaded areas are kernel density estimates. A y axis value of 50% would represent equity for that group (i.e., for the population-average exposure), meaning that half of their exposure comes from source types that disproportionately expose them and the other half is from source types that expose them less than average. Across geographies and levels of exposure (A to C), as well as incomes (D), most emission sources consistently result in higher exposures for POC and lower exposures for Whites. Source: data

Fig. 2. Percent of PM 2.5 exposure caused by emission source types that disproportionately expose people of color (POC) and Whites. Data shown for (A) U.S. states (n = 48 states), (B) urbanized areas (n = 481 areas), (C) rural areas in each state (n = 48 states), and (D) income bins (n = 16 bins; last bin is >$200,000). Icon area is proportional to population; shaded areas are kernel density estimates. A y axis value of 50% would represent equity for that group (i.e., for the population-average exposure), meaning that half of their exposure comes from source types that disproportionately expose them and the other half is from source types that expose them less than average. Across geographies and levels of exposure (A to C), as well as incomes (D), most emission sources consistently result in higher exposures for POC and lower exposures for Whites. Source: data file S2.

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Disparities in

nitrogen dioxide pollution

Kerr et al, PNAS 2021

This is another study in which the authors looked at the NO2 levels in various cities across the country. The orange dots represent areas in the cities which have the least white populations, and the blue dots areas which have the highest white population.

You can see the disparities in N02 between most white and least white for all of these cities,

PNAS2021 Vol. 118 No. 30 e2022409118

https://doi.org/10.1073/pnas.2022409118|1 of 8

�

ig. 2.Disparities in baseline and lockdown NO2columns for different (A) racial, (B) median household income, and (C) educational attainment populationsubgroups. Disparities are shown for three conglomerations (all, urban, and rural census tracts), and urban tracts are further separated into the 15 largestMSAs in the United States. For each conglomeration or MSA, demographic subgroups are determined using the 10th and 90th percentiles as thresholds. NO2levels are thereafter averaged over tracts within these subgroups. If the difference in subgroup NO2distributions for a particular demographic variable andtime period is not statistically significant, mean NO2levels are denoted with an “X” and no connector lines. Conglomerations or MSAs with no significantchange in NO2disparities between the baseline and lockdown periods are shaded in gray.Kerr et al.COVID-19 pandemic reveals persistent disparities in nitrogen dioxide pollutionPNAS|3 of 8https://doi.org/10.1073/pnas.2022409118

�

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What Can We Do?

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What Can We Do?

Ride less

Walk/bike more
Telecommute
Carpool
Public Transportation
Decrease air travel

Food

Solar power

Electrify everything

Stoves
Cars

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Advocate!

Your community, your hospital, state and nationally

Support policy makers

Support climate change non-profits

CCL- Citizens Climate Lobby
LCV- League of Conservation Voters
National Resource Council

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Renewables are now the cheapest form of new energy generation in many parts of the world and are projected to be the cheapest everywhere by 2030.

International Energy Agency; Bloomberg New Energy Finance; Deutsche Bank; Lazards

Lazard

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New Clean Energy Technologies

Existing

Electric cars
Zero transmission transit
Zero energy buildings
Biofuels

Emerging

Clean hydrogen as fuel
Carbon removal technologies
Small scale nuclear

J Schiller

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Modern water treatment and indoor plumbing�The Transcontinental Railroad�The Interstate highway system
Electrification of America
The Apollo moon mission�The World Wide Web and modern Internet

AND

Combat big tobacco companies to decrease smoking rates 68% from 1965 in the US

J Schiller

Old

“New” technologies�

Previous generations have worked together to achieve transformational technologies and transform society

The World’s Littlest Book on Climate Change, Nelson et al

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Advocate!

Your community, your hospital, state and nationally

Medical societies

Support climate change health care non-profits

Virginia Clinicians for Climate Action
Health Care Without Harm

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“Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it is the only thing that ever has”

Margaret Mead

J Schiller