Climate Change and Health: �A Global Call to Action�

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The Basics

• Damage to the climate is real and it’s happening now.
• Human activity emits greenhouse gases (like CO2) into atmosphere, gases trap heat in atmosphere, altering the Earth’s climate.
• It could pose a catastrophic threat to the planet and human health…
• …BUT with a concerted action we create healthy and safe communities for our families and children.
• Addressing climate change could have major co-benefits – improved air quality, better physical and mental health.

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So, What is Climate Change?

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First, the Greenhouse Effect…

• Sunlight is either absorbed by Earth's surface (providing heat and energy) or reflected into space
• But some infrared radiation is absorbed by greenhouse gases (GHG) – carbon dioxide, methane, nitrous oxide, water vapor, etc.
• Too much GHG in the atmosphere leads to the “greenhouse effect,” the gases trap heat, warming the Earth and altering the climate balance.

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Global warming: brought to you in part by Greenhouse Gases�

• Greenhouse gases form a “blanket around the Earth.”
• The greenhouse effect is crucial to supporting life on the planet.
• As the atmospheric greenhouse gas concentration increases more heat is trapped and less escapes into space, and the average temperature of the lower atmosphere rises (i.e. global warming).

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Damage to the Climate – It’s Already Happening

• “Warming of our climate system is unequivocal, and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased.” (IPCC, 2013)

https://www.ipcc.ch/pdf/assessment-report/ar5/wg1/WG1AR5_SPM_FINAL.pdf

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Dear Earth: It’s not you, it’s us.

• Humans are primarily responsible for recent change in climate.
• GHG emissions have skyrocketed since the beginning of the Industrial Revolution, causing atmospheric concentrations of carbon dioxide, methane, and nitrous oxide to increase substantially.
• Carbon dioxide is the single largest GHG emitted by human activity.

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NOAA: Climate Model Indications and the Observed Climate

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Indicators of Climate Change

Panama’s San Blas Archipelago, submerged.

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NOAA: 10 Indicators of a Warming World

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Rising Global Surface Temperature

• The average surface air temperature of the Earth has increased by 1.1 degrees Celsius since the late 19^th century.
• In the Northern Hemisphere, the period from 1983 to 2012 was likely the warmest 30-year period of the last 1400 years.
• 2016 was the hottest year on record according to NASA, NOAA. 18 of 19 warmest years on record have occurred since 2001.

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Sea and Land Ice is Dwindling…

• NASA: “In 2012, Arctic summer sea ice shrank to the lowest extent on record.” In 2017 Arctic wintertime sea ice extent was at a record low.
• Antarctica and Greenland land ice sheets are losing mass. Greenland ice loss doubled between 1996 and 2005.

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…and Sea Level is Rising

• Global sea level has risen 7-8 inches since the beginning of the 20^th century.
• Sea level increase is the result of warmer oceans (ocean absorbs heat, water expands), and melting land ice.

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Image: Ground data sourced from coastal tide gauge records: 1870-2013

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Other Trends

• “Observed increases in the frequency and intensity of heavy precipitation events in most parts of the United States are projected to continue”
• Climate change is likely increasing the number and severity of some extreme weather events like heavy rainfall,
• An increase in tropical cyclone activity in the last 20 years, and
• Lower total snowfall and decreasing snowpack. (EPA)

Tuolumne River Basin, CA Image

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So, What Does This Have to Do With Health?

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Climate Change Poses Risks and Opportunities Related to Health

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• The 2015 Lancet Commission on Climate Change and Health report stated: “The effects of climate change are being felt today, and future projections represent an unacceptably high and potentially catastrophic risk to human health.”

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• BUT it also underscored that tackling climate change could be the greatest global health opportunity of the 21st century.

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Climate Change Impacts Human Health

Source: CDC

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Image (Lancet, 2015)

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Heat-related disorders, including heat stress

• As the climate continues to warm, more people could be susceptible to heat-related illness, incl. rashes, cramps, heat stress and heat stroke and premature death.
• Hot days associated with “increase in heat related illness,…renal failure, electrolyte imbalance, kidney stones, negative impacts on fetal health, and preterm birth.”
• “Emerging evidence demonstrates links between hotter temperatures and increased bacterial resistance to antibiotics, declines in cognitive function, worsening mental health conditions, and increased suicides” - Lancet
• Across Europe about 70,000 premature deaths were attributed to the 2003 heat wave.
• In 2017, an add’l 157 million heatwave exposure events occurred throughout the world, an 18 million increase from 2016.

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Respiratory disorders, including asthma and allergies

• Higher temperatures and increased pollen load may exacerbate respiratory problems. Elevated ground-level ozone concentrations could affect lung function. Wildfires increase risk of exposure to particulate matter and other pollutants.
• In 2016, over 7 million deaths were connected to the joint effects of outdoor ambient air pollution and household indoor air pollution, according to the WHO. Globally, climate change could be responsible for 60K air pollution-linked premature deaths in 2030 and 260K by 2100 under current emission trends.
• Pollen season has lengthened in central North America as temperatures have risen and the frost-free period has extended.
• Elevated carbon dioxide concentration may facilitate the increased growth of allergen-producing weeds, grasses, trees and fungi.
• Heavy rainfall and flooding may cause dampness in homes, potentially leading to indoor mold and fungal growth, associated with nasal and throat symptoms, coughing, wheezing, asthma exacerbation, and other problems.

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Vector- and water-borne diseases

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• A warmer climate and changing weather patterns may create hospitable environments for climate-sensitive vectors like mosquitos and ticks that spread diseases like Lyme disease, West Nile virus, dengue, chikungunya, and Zika.
• In 2015-2016, warmer conditions spurred by El Nino may have broadened the range and capacity of mosquitos to transmit the Zika virus, which causes fever, rash, headaches, and birth defects.

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• Some models predict that climate change could be a factor in extending Lyme disease into Canada.
• “in 2016, global vectorial capacity for the transmission of dengue virus was the highest on record, rising to 9.1% above the 1950s baseline for A aegypti and 11.1% above the baseline for A albopictus.” - Lancet, 2018 Countdown
• Water-borne diseases may also thrive in flooded regions as well as those where water is scarce.
• For example, cholera may develop and spread in drought-stricken areas where lack of water leads to poor sanitation.
• Warmer sea surface temperature assoc. w/ increased prevalence of pathogenic Vibrio.

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Vector-borne disease cases on the rise…

Image: CDC, 2018

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Food security problems and water scarcity

• According to the Lancet, “30 countries are experiencing downward trends in crop yields, reversing a decade-long trend that had previously seen global improvement. Yield potential is estimated to be declining in every region, as measured by accumulated thermal time.”
• As the population grows and food demand rises, "climate change could result in an increase of 20% of people at risk of chronic hunger.”
• Rising CO₂ concentrations affect food quality by decreasing iron, zinc, and protein and other nutrients in crops.
• Water scarcity may be accelerated as the climate changes and more regions experience drought. Risk is especially pronounced in presently dry regions.
• One study estimates that about 100 million additional urban dwellers will experience perennial water shortages under climate change conditions than under current climate.(1)

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Mental health disorders, including post-traumatic stress disorder and depression connected to natural disasters.

• Disasters caused by climate change may have a negative effect on mental health. Examples incl. extreme heat may increase mood and behavioral disorders among certain populations and extreme weather events linked to depression, anxiety, post-traumatic stress disorder.
• Mental health problems can occur due to displacement, relocation and loss of property and personal finances in the aftermath of a disaster.
• Nearly half of surveyed New Orleans residents affected by Hurricane Katrina reported anxiety mood disorder and a substantial number reported post-traumatic stress disorder.
• The U.S. military considers climate change to be a national security issue and “threat multiplier,” that exacerbates existing problems, such as food insecurity, pandemic disease, and conflict over resources.

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High-risk populations

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IPCC: Understanding Global Warming of 1.5°C

• Intergovernmental Panel on Climate Change’s 2018 report found:
• Human activities have caused about 1°C of global warming, expected to reach 1.5°C between 2030 and 2050.
• “Any increase in global warming is projected to affect human health, with primarily negative consequences (high confidence). Lower risks are projected at 1.5°C than at 2°C for heat-related morbidity and mortality (very high confidence) and for ozone-related mortality if emissions needed for ozone formation remain high (high confidence). Urban heat islands often amplify the impacts of heatwaves in cities (high confidence). Risks from some vector-borne diseases, such as malaria and dengue fever, are projected to increase with warming from 1.5°C to 2°C, including potential shifts in their geographic range.”
• “Every bit of warming matters.”

IPCC Report

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U.S. Regional Effects of Climate Change

Northeast U.S.

• Observed and projected effects include warmer temperatures (esp. in urban areas), increased rainfall intensity, and sea level rise.
• In NE, an estimated 650 add’l excess deaths per year caused by extreme heat by 2050.
• Excess deaths from ground-level ozone predicted to increase in NE.
• Vector-borne disease threat, esp. Lyme and West Nile virus, expected to grow in NE

Citation for Regional Effects slides.

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U.S. Regional Effects of Climate Change

Northwest U.S.

• Climate-connected extreme events have increased number of ER visits and hospital admissions over last few decades.
• Drier conditions and higher temperatures may enhance the risk of wildfires, leading to respiratory problems, stress from displacement, and other issues.
• “Airborne particulate levels from wildfires are projected to increase 160% by mid-century under a lower [emissions] scenario creating a greater risk of smoke exposure through increasing frequency, length, and intensity of smoke events.”

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Image. Source: NCA4

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U.S. Regional Effects of Climate Change

Southeast

• Observed impacts include rising sea levels and increases in number and intensity of extreme weather events (e.g. hurricanes, heavy precipitation).
• “Sixty-one percent of major Southeast cities are exhibiting some aspects of worsening heat waves, which is a higher percentage than any other region of the country.”
• Projected outcomes include continued sea level rise and coastal flooding, increasing urban temperatures, and reduced water availability.

Image. Source: NCA4

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U.S. Regional Effects of Climate Change

Midwest

• Observed effects of climate change include increased extreme precipitation and flooding.
• Projected health effects in the region include more frequent and extreme heat waves, poorer water and air quality, and extreme rainfall events and flooding.
• Vector habitat changes include northern expansion of West Nile virus-transmitting mosquitos.

Image. Source: NCA4

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U.S. Regional Effects of Climate Change

Southwest

• Increased heat, drought and insect outbreaks have increased wildfire risk.
• Extreme heat, poor air quality, and pathogen growth-promoting conditions may result in heat-related illness and death, chronic disease vulnerabilities, and other health risks.
• 2006 heat wave in CA and NV led to add’l 600 deaths, 16k ER visits, 1,100 hospitalizations compared to non heat wave summer days.

Image. Source: NCA4

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U.S. Regional Effects of Climate Change

• Southern Great Plains
• Climate change expected to increase avg temperature and frequency, duration, and intensity of extreme heat and decrease in extreme cold events. Above projected global avg sea level rise may occur along Gulf coast during 21^st century. CC likely to exacerbate aridity in region.
• “changes in extreme temperatures are projected to result in an additional 1,300 deaths per year under a higher [emissions] scenario by the end of the 21^st century.” Half of these deaths could be avoided under a lower emissions scenario.
• Drought could affect water availability and quality in the region.
• Northern Great Plains
• Precipitation pattern changes and extreme events will increase water management challenges.
• More very hot days could impact agriculture, energy production, human health, streamflows, snowmelt, and fires.
• Indigenous peoples in the region are experiencing “increased fire frequency and intensity, and climate projections that show increased fire risks for the region are causing concern for the health of forests, wildlife, freshwater systems and fisheries, and human health.”

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Source: NCD4 SGP and NGP

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U.S. Regional Effects of Climate Change

Coastal US

Sea-level rise, storm surges, erosion, inland and coastal flooding are among the climate-related concerns.

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Potential Global Impact

• Polar Regions (Arctic and Antarctica): Risks for ecosystems, human health and well-being, unprecedented challenges especially from rate of change.
• Europe: Increased damage from river and coastal floods, increased water restrictions, increased damages from extreme heat events and wildfires.
• Asia: Increased flood damage to infrastructure, livelihoods, and settlements; heat-related human mortality; increased drought-related water and food shortage.
• Australasia: Increased flood damage to infrastructure and settlements, increased risks to coastal infrastructure and low-lying ecosystems.
• Small Islands: Loss of livelihoods, settlements, infrastructure, ecosystems, services, and economic instability; risks for low-lying coastal areas.
• Africa: Compounded stress on water resources, reduced crop productivity, vector- and water-borne diseases.
• Central and South America: Reduced water availability and increased flooding and landslides; reduced food production and quality, spread of vector-borne diseases.”

IPCC, 2014: Climate Change 2014: Synthesis Report

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How to Take Action for your Patients and the Planet

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Climate Change May Already Be Hurting Your Patients

• As physicians, we are on the front lines of this problem – and our patients may already be experiencing the effects.
• A survey of American Thoracic Society members found that 77% of respondents believed increases in the severity of chronic illness resulting from increased air pollution as a consequence of climate change.
• A survey of American Academy of Allergy, Asthma, and Immunology members found that 63% indicated their own patients had increased allergic symptoms associated with climate change.
• 61% of members of the National Medical Association survey respondents indicated that their own patients were already being harmed by climate change “a great deal” or “moderately.”

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Physician and public health organizations have spoken up about climate change and health

“The changing climate is causing physical, chemical, and ecological changes that are fundamentally altering the planet. These changes pose significant threats to human health, with children representing a uniquely vulnerable group.” (American Academy of Pediatrics)

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“Our AMA supports the findings of the Intergovernmental Panel on Climate Change’s fourth assessment report and concurs with the scientific consensus that the Earth is undergoing adverse global climate change and that anthropogenic contributions are significant. These climate changes will create conditions that affect public health, with disproportionate impacts on vulnerable populations, including children, the elderly, and the poor.” (American Medical Association)

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“Climate change can harm the water supply, increase vector-borne disease and increase extreme weather events. Vulnerable populations such as communities of color, the elderly, young children, the poor and those with chronic illnesses bear the greatest burden of injury, disease and death related to climate change. As an APHA priority, we believe in the need for strong climate change strategies and interventions that protect people's health. The public health community plays a critical role.” (American Public Health Association)

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ACP Recommendations

• A global effort is required to reduce anthropogenic greenhouse gas emissions and address the health impact of climate change. The United States must commit to taking both a leadership and collaborative role in developing, implementing and ensuring the success of such a global effort and in reducing its own contributions to greenhouse gas emissions. Climate change adaptation strategies must be established and mitigation measures must be adopted.

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Adaptation: Limiting the Damage Done by a Changing World

Adaptation is “adjustment in natural or human systems to a new or changing environment that exploits beneficial opportunities or moderates negative effects.”

Problem

• Drought in Africa

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• Extreme Heat Events in Europe

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• Urban flooding in North America

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Adaptation Strategy

• Reducing non-climate stressors on water rec., sustainable urban devel., strengthen institutional capacities for demand mgmt.
• Warning systems, reduced emissions to improve air qual., residence, workplace modifications
• Use of pervious surfaces, rooftop gardens; wetland conservation, planting of mangroves, coast-protecting vegetation

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Climate Change Mitigation: The Key to Stopping Further Climate Change

• Climate change mitigation is a “human intervention to reduce emissions or enhance sinks of greenhouse gases” including
• more efficient use of energy
• expanded use of carbon neutral or low-carbon energy
• reductions in deforestation and increases in reforestation
• lifestyle and behavioral changes (such as energy conservation and reduced energy demand).

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Mitigation could have major health benefits

Action

• Increasing safe active transport and use of lower-emission vehicles
• Increase use of clean-burning stoves
• Reduction in use of coal-generated electricity

Outcome

• Reduce heart disease, cerebrovascular disease, dementia, depression
• Reduce indoor air pollution exposure, respiratory illness
• Lower air pollution, better respiratory health

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Addressing Climate Change is a Win-Win Situation

• Fossil fuel combustion is a major source of air pollution, endangering respiratory health
• Switching to clean energy or reducing consumption can improve the air breathed by children, elderly, people with chronic illness, who are especially vulnerable
• Agriculture industry emits massive amounts of methane and other greenhouse gases
• Reducing meat consumption in favor of more fruits and vegetables may contribute to a more healthy, balanced diet
• Healthy buildings – recycled construction materials, encourage use of stairs over elevators, use of natural lighting
• Less construction-related pollution, improved physical activity from stair use, better mental health from day-lighting.

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ACP Recommendation

• The health care sector, within the United States and globally, must implement environmentally sustainable and energy-efficient practices and prepare for the impacts of climate change to ensure continued operations during periods of elevated patient demand.

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The Health Care Industry is One of the Largest Consumers of Energy

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• “If the health sector were a country, it would be the fifth-largest emitter on the planet.”
• U.S. health sector spends over $9 billion annually on energy costs
• Power plant emissions are connected to premature deaths, chronic bronchitis, asthma attacks, emergency room visits and more.
• “30% cut in healthcare electricity’s carbon pollution by 2030 would reduce greenhouse gas emissions, preventing an estimated 4,130 premature deaths, 85,000 asthma attacks, 4 million respiratory symptom events and 3,750 hospital visit incidents and save about $1.2 billion in medical costs.” – Health Care Climate Council

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How Can You Help “Green” Your Facility?

• Transportation
• Energy operations
• Energy in the built environment
• Waste
• Food Service

(Source: Health Care without Harm)

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Green Transportation Strategies�

• Transportation accounts for 29% of Total U.S. Greenhouse Gas Emissions
• Reduce fleet emissions – Hospital fleets to include high-fuel efficiency, hybrid, alternative fuel vehicles
• Help commuters reduce emissions – Encourage use of mass transit, carpooling, telecommuting for employees; shuttles to public transit; active transportation like walking and cycling
• choose suppliers with efficiency or alternate-fuel standards
• prefer local suppliers – reduce transportation and shipping distance, fuel consumption
• purchase energy-efficient shipping – choose lighter products with less packaging, encourage environmentally sustainable packaging (1)

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Case Study: Seattle Children’s Hospital

• Hospital proposed Comprehensive Transportation Plan
• Reduce vehicle traffic by shuttle links to transit hubs, parking changes, encourage carpooling, free transit for employees, vanpool service
• Make area more walk-, cycling-friendly through capital investments that link hospital and surrounding community to larger walking/biking networks, free bikes to employees who pledge to bike to work, cash for those who don’t drive to work, on-site bike maintenance, discounts on gear from in-house bike shop.
• “Seattle Children’s Hospital is already more than halfway to its goal of getting from 50 percent car commuting to 30 percent.”
• Drive-alone commuting trips by employees down from 73% in 1995 to 38% in 2015

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Reduce Your Facility’s Energy Use

• Make buildings more energy efficient – switch to energy efficient light bulbs (CFLs, LED bulbs), turn down thermostat, upgrade major equipment to most energy-efficient model; optimize building envelope with insulation and energy-efficient windows
• Install On-Site Renewable Energy Capability - Solar panels can generate a portion of facility’s energy, solar hot-water heating system
• Purchase Energy-Efficient Products – Buy Energy Star or Federal Energy Management Program-designated products.
• Reduce Standby Energy Use – Plug computers/electronic equipment into power strip and turn off when not in use.
• Purchase Green Power – Use power generated from renewable sources like wind, solar.

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Case Study: Boston Green Ribbon Commission Health Care Working Group

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• Nearly all major Boston-area hospitals participate. Commission’s goal is 25% drop in GHG emissions by 2020, 100% by 2050
• Member hospitals achieved cuts in electricity, natural gas use, GHG reductions for all fuels.
• Sector energy use dropped by 9.4% from 2011-2015, “avoiding greenhouse gas (GHG) emissions equivalent to 126 million miles traveled by an average passenger vehicle.”
• 100% of Partners HealthCare energy is from zero emission sources. Boston Medical Center expects to be 92-100% carbon neutral by 2018. (1)
• Cost savings conservatively estimated at $15 million, enough to pay for healthcare for 1,357 Massachusetts Medicare enrollees.

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The Built Environment

• incorporate green building principles – Use day lighting, natural ventilation, green roofs; maximize energy efficiency with better insulation and energy-efficient windows, other ways to optimize building envelope.
• consider overall transportation impacts of facility siting – Site facility near public transportation hub, build in developed areas.
• use native vegetation and plant trees on site, use local and regional building materials – Trees, vegetation can reduce heat island effect, act as carbon sinks, native plants need less water.
• offset emissions from building construction – less energy required to transport local products to building site.
• purchase only lumber products certified by the Forest Stewardship Council – support sustainable forestry practices.

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Case Study: Group Health Puyallup Medical Center

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• Washington State facility first in nation to receive LEED for Healthcare Gold certification.
• Facility includes ground-level vegetation and green roof
• Designed for water use reduction – Special sensors activate cold water for cooling sanitized medical equipment only when necessary
• Uses a more efficient steam generator boiler
• Used local and/or recycled construction materials
• Car charging stations and bike racks on site.

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Reducing Health Care Waste for a Healthier Future

• recycle and buy recycled products – Recycle all recyclable products, including electronics
• collect and recycle nitrous oxide anesthetic gases – limit the amount that escapes into atmosphere during use
• dispose of waste locally – Local disposal reduces travel-related emissions
• prevent waste – through recycled material use, reduced use of virgin material, reducing amount of wasted material
• divert at least 90% of constructed waste – produced during construction and demolition

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Case Study: Virginia Mason Single-Use Device Reprocessing Project

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• Single-use devices, including arthroscopic/orthopedic, laparoscopic devices, end up in landfills and use energy during manufacturing, disposal and transport.
• VM worked with a reprocessing vendor to help them reduce costs and waste.
• Reprocessed devices must meet FDA safety standards
• Physicians on leadership team were consulted and visited reprocessing facility to observe quality control and inspection process.
• As a result purchasing costs dropped by $3 million since 2012, in 2014 VM reported it had reprocessed or recycled nearly 19,000 pounds of devices.

• Education about benefits of reprocessing and sharing clinical data and research on the quality and safety comparability of reprocessed devices is key to achieving support.

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Food Service: Healthy Food, Healthy Planet

• Reduce the amount of meat protein on menus – Agriculture/meat protein production is a major source of greenhouse gas emissions. If Americans ate beans instead of beef, U.S. would meet up to 75% of GHG reduction goals in 2020.
• buy local and seasonal food – reduce long-distance food transport leads to lower emissions
• compost food waste - creates a recycled product (compost) that can replace fertilizer.
• eliminate bottled water – encouraging tap water use will reduce waste.

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Case Study: University of Washington Healthy Food Initiative

• Increased purchasing of sustainable, local, organic (SLO) food: 20% produce, 67% dairy, 47% is locally sourced
• Meatless Mondays, more vegetarian/non-meat protein options, decreasing meat portion sizes has reduced amount of meat served
• UW estimates that efforts have cut overall GHG emissions by 11.8%, the emissions equivalent of 211 cars!

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Green Tips for Small Practices

• Energy Efficiency – Turn off electronics when not in use; install energy-efficient lighting; lower thermostat 74F in summer, 68F in winter
• Renewable Energy – Purchase renewable energy from your utility company (or credits)
• Water Efficiency – Use tap instead of bottled water, promptly fix water leaks, install efficient fixtures.

(Source: My Green Doctor)

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Advocacy: How to Communicate about Climate Change

When discussing the issue with your colleagues, grand rounds audience, or your community, mention the following key points:

• Climate change is real and human-caused.
• Climate change is bad for us and our community in a number of ways.
• Localize the issue (if you live in S. Florida, talk about how climate change could worsen flooding, leading to displacement, dampness-related respiratory illness, etc.)
• We need to start taking action now to protect the health of our community’s most vulnerable members—including our children, our seniors, people with chronic illnesses, and the poor—because our climate is already changing and people are already being harmed.
• Taking action creates a “win-win” situation for us because, in addition to dealing with climate change, most of these actions will benefit our health too.
• For example, walking or biking instead of driving short distances could reduce the risk of cardiovascular disease as well as reduce greenhouse gas emissions.

(Source: Conveying the Human Implications of Climate Change report (1))

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More Resources

• Intergovernmental Panel on Climate Change (IPCC) - http://www.ipcc.ch/
• U.S. Global Change Research Program - http://www.globalchange.gov/
• Health Care without Harm (U.S./Canada) - https://climatecouncil.noharm.org/
• My Green Doctor - http://www.mygreendoctor.org/
• Medical Society Consortium on Climate and Health – https://medsocietiesforclimatehealth.org/
• U.S. Green Building Council - http://www.usgbc.org/
• Energy Star - https://www.energystar.gov/

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Protect People and the Planet

We Can Do This

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