CLIMATE CHANGE AND HUMAN HEALTH: A NURSES’ CALL TO ACTION

November 16, 2011 1:00 – 2:00pm eastern

Moderator: Brenda Afzal, MS, RN, U.S. Climate Policy Coordinator for Health Care Without Harm

Presenter: Kim Knowlton, DrPH, is a health scientist with Natural Resources Defense Council in New York. Her work focuses on issues related to the health impacts of global warming, including advocating for public health strategies to prepare for and prevent these impacts. Dr. Knowlton is exploring links between climate change and infectious diseases such as dengue fever, and partnering with city and state governments to make health preparedness a more central feature of climate adaptation plans. She has also researched heat- and ozone-related mortality and illnesses as well as possible connections between climate, pollen, allergies and asthma.

One (1) Contact hour will be awarded to Registered Nurses. Criteria for successful completion includes participation in the full webinar and submission of a completed evaluation form. Partial credit will not be awarded.

This continuing nursing education activity was approved by the PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

The planning committee members and speaker have declared no conflict of interest.

CE instructions and evaluation form at: http://www.noharm.org/us_canada/issues/climate/webinar_2011-11-16.php

Climate change interacts with existing

environmental challenges, such as:

• Urbanization • Energy Demand • Food Security • Water Supply • Biodiversity

IPCC WG1 2007 (http://ipcc.ch/)

The greenhouse effect is essential for making the earth inhabitable

IPCC WG1 2007 (http://ipcc.ch/)

(~54°F)

IPCC WG1 2007 (http://ipcc.ch/)

Climate Change is Happening National impacts observed in recent decades

US Global Change Research Program (2009)

2⁰F (1.1⁰ C) rise in US average temperature over the past 50 yrs Sea level rise >8” in past 50 yrs in parts of Atlantic & Gulf Coasts Oceans 30% more acidic than in pre-industrial times Increase in heavy downpours, as much as 67% in Northeast Current record warmth: Atlantic sea surface temperatures 4⁰F (2⁰C) above average Destructive potential of Atlantic tropical storms, hurricanes since 1970

Climate change threatens health

“Climate change is one of the most serious public health threats facing our nation. Yet few Americans are aware of the very real consequences of climate change on the health of our communities, our families and our children.”

– Dr. Georges Benjamin, Executive Director of the American Public Health Association

Climate-Health Impacts

Extreme Storm Events Heat Waves Air Pollution Pollens and Allergy Water-borne Diseases Food-borne Diseases Vector-Borne Diseases Ecosystem Impacts Food & Water Supply Insecurity Mental Health Impacts Environmental Refugees

Vulnerability to climate impacts

In the US & globally: economically disadvantaged people are among the most climate-vulnerable

Age vulnerability: children, people 65+

People with pre-existing illnesses, or limited mobility

Location affects climate-health vulnerability; for example: Coasts: Sea Level rise, storm surge Cities: heat waves, urban heat island

effect, air pollution

Current temperature trends - globally

2010 ties 2005 - Hottest year global surface temps since 1880 34th consecutive year with global temps >20th century average Jan 2000-Dec 2010: Warmest Decade on Record

Source: National Oceanic & Atmospheric Administration (NOAA)

2011: The Year in Extremes A record-breaking 14

“billion-$$” events so far in 2011: heat, drought, floods, snow, tornadoes

Thousands of extreme heat records broken

Total so far (early Nov.): $45 billion

Source: NOAA’s Climate Services

Source: NOAA Ofc of Climate, Water & Weather Services (2004)

Heat Waves

Major cause of death, hospitalizations & illness August 2003 European heat wave: 35,000+ died July 1995 Chicago heat wave: 700+ deaths Recent example: 2006 California Heat wave

– Daytime temperatures >100°F (38°C) for two weeks – Record night time highs – > 1 million people without electricity – 655 excess heat-related deaths – Morbidity excess: over 16,000 ER visits & nearly 1,200

hospitalizations – 25,000 cattle and 700,000 chickens died (farm economy impacts,

sanitation issues)

Heat Vulnerability factors

Individual susceptibilities Underlying medical conditions

Demographics Age, access to healthcare, social contacts

Housing Floor of building, building materials, air conditioning

Community or geography Latitude, greenery or park space, population density

Extreme heat & drought heighten wildfire risk; smoke emissions have harmful health effects

Munich RE estimates: 56,000 premature deaths in Russia 2010 (heat, fire, air pollution)

MODIS satellite, 6/8/2011 12:10 pm CDT

Wildfires

Source: US Global Change Research Program (2009)

Two-step process used to study climate-health impacts, and project them in the future:

2. The Epidemiologic Approach Study and quantify historical relationships between

climate-related “exposures” and human health outcomes

…The goal is to identify and quantify “exposure-response” relationships

2. The Risk Assessment Approach Predict future health impacts by modeling future

climate-related exposures and assuming historical exposure-response relationships will still operate

…Provides answers to “what if?” questions

Future climate-health effects (example: NY)

•Summer heat-related mortality could increase 70% by the 2050s, in the •tri-state NYC metropolitan region, with climate change •Adaptation matters: estimated 25% reduction in mortality Knowlton et al. (AJPH, 2007)

Ground-level ozone (smog) formation

Source: PL Kinney, ScD

• Power plants are the nation’s biggest carbon polluters. • Power plants dump more than two billion tons/yr of carbon pollution and other toxic pollutants into the air. • Moving forward with standards to clean up carbon pollution from new and existing sources like power plants is important to:

protect public health protect kids from dangerous air pollution

Bell et al. Climatic Change (2007)

Climate Change & Increasing Ozone: 2050s vs. 1990s

Ragweed and Climate Change

CO2 levels today – 131% more pollen

CO2 levels in 2050 – 320% more pollen

…compared with pre-industrial

levels.

Ziska & Caulfield, Aust J Plant Physiol 27:893-8, 2000

Climate Change, Allergies & Asthma Both ragweed pollen and

ozone air pollution are expected to worsen with higher CO2, temperatures.

Results: Could be more areas with

“double-whammy” Longer allergy season Worse symptoms in allergy &

asthma sufferers

Source: www.aklung.org/asthma

Katrina at landfall

Hurricane Katrina at landfall, August 29, 2005.

Source: PL Kinney, ScD

• Warmer temperatures increase atmospheric

moisture content • Earlier snowmelt

• National: 20% increase in heavy rainfall

• Record rainfall, flooding in much of US in 2011

Observed US climate changes, from extreme rain, snow, floods

Downtown Wilkes-Barre, PA, Sept 2011 (yfrog.com, twitter.com/CitizensVoice)

Waterborne Diseases

2/3 of US waterborne disease outbreaks followed precipitation above 80th percentile

Northeast: 67% increase in storms w/extreme ppt in last 60 years

Extreme rainfall events projected to increase in future with warming atmosphere

Environment America (2007)

Infectious Illnesses for ex., Dengue Fever

From: Confalonieri, U., B. Menne, R. Akhtar, K.L. Ebi, M. Hauengue, R.S. Kovats, B. Revich and A. Woodward, 2007: Human health. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the IPCC, M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E. Hanson, Eds., Cambridge University Press, Cambridge, UK, 391-431.

$14 billion in health-related costs from just six US climate change-related events, 2002-2009 (Knowlton et al., Health Affairs 2011)

Data from: WHO 2004 Map from: Jonathan Patz, University of Wisconsin

Health Impacts of Climate Change

•Heat •Floods •Malaria •Diarrhea •Malnutrition

Greenhouse Emissions by Country (Density-Equalizing Cartogram)

Mark Newman, University of Michigan │ www.worldmapper.org

What’s in the pipeline and what could come If carbon pollution were kept fixed at today’s levels, a committed

0.6°C of further warming would be expected by 2100. More warming would accompany more emission.

1.8oC = 3.2oF

2.8oC = 5.0oF

3.4oC = 6.1oF

CO2 Eq

850

600

400 0.6oC = 1.0oF

Two Strategies for Solutions

Mitigation Adaptation

Climate Solutions: Strategies

interventions to reduce emissions (or enhance sinks)

of greenhouse gases

initiatives & measures to reduce the vulnerability of natural & human systems

against actual or expected climate change effects

Two Strategies for Solutions

Mitigation Adaptation

Climate Solutions: Strategies

interventions to reduce emissions (or enhance sinks)

of greenhouse gases

initiatives & measures to reduce the vulnerability of natural & human systems

against actual or expected climate change effects

• Carbon pollution regulations (mainly on CO2) – like the Clean Air Act

• Energy efficiency measures • Rely more on clean, renewable energy sources • Biological carbon sequestration (forests, etc.) • Reducing other greenhouse gases from industry,

agriculture, waste management • Decarbonization technology

– CO2 removed directly from the air & stored

Mitigation options

The Rising Tide for Global Warming Solutions November 2008

Design and construction practices that significantly reduce or eliminate the negative impact of buildings on the environment and occupants in five broad areas: Energy efficiency and renewable energy Sustainable site planning Safeguarding water and water efficiency Conservation of materials and resources Indoor environmental quality

What is “green design”?

Renewable energy sources: Solar Power for an old urban apt bldg

NYSERDA's web site is: www.powernaturally.org

Photos: Ken Schles

Two Strategies for Solutions

Mitigation Adaptation

Climate Solutions: Adaptation (or Preparedness)

interventions to reduce emissions (or enhance sinks)

of greenhouse gases

initiatives & measures to reduce the harm to natural & human systems from climate

change effects

NRDC’s Climate Change Threatens Health website: local climate-health threats, and adaptation actions www.nrdc.org/climatemaps

4 Key Elements: Climate-Health Preparedness Strategies

Identify Local Vulnerabilities

Track Environmental Changes & Health Threats

Build Resilient Communities

Promote Education & Public Dialogue

Philadelphia Heat-Health Warning System

Identifying Vulnerabilities - City worked w/agencies to identify where elders live; Neighbors check on elderly via “buddy system” in heatwaves Tracking - National Weather Service, Dept of Public Health, Corporation for Aging, News Media are in contact when heat wave is predicted, and public is alerted frequently; free “Heatline” info Climate-Smart Design Cool Homes Program encourages energy-efficient design; free energy audits Public Education Cooling centers opened; no utility service suspensions; more Fire, EMS, Homeless svc staff; Public education about protecting health, getting info during heat wave

Ebi et al. (BAMS 2004)

Rep. Capps’ (D-CA) “Climate Change Health Protection & Promotion Act” proposed Nov. 2011

Need more state & regional climate-health adaptation plans that target the most vulnerable communities

Challenges $$ Resources to support national & local preparedness efforts Need consensus: climate adaptation in planning priorities Support needed for national surveillance database on climate-

sensitive events and associated health outcomes Building knowledge & experience now on adaptation Few practitioners, teachers, or students are trained… so far

Promoting adaptation

A Clean Energy Future To limit & reduce health

effects, move toward cleaner, non-polluting energy sources that won’t run out Adapt to unavoidable climate

change impacts with public health preparedness Limit carbon pollution from

current sources

Conclusions

Effects of climate change have a human face Action needed to reduce carbon emissions &

limit the most severe health effects Energy/environmental policies must protect

children's health & society’s most vulnerable Health professionals can be powerful leaders We can improve our lives & create healthier

communities

“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 US ANTHROPOLOGIST (1901 - 1978 )

“We know enough now to act”

Thank you!

Brenda Afzal, MS, RN U.S. Climate Policy Coordinator,

Health Care Without Harm brendaafzal@gmail.com

Kim Knowlton, DrPH Senior Scientist, Natural Resources Defense Council (NRDC),

Ass’t Clinical Prof., Mailman SPH, Columbia University kknowlton@nrdc.org

Additional resources: • Climate and Health Literacy Consortium: www.noharm.org/us_canada/issues/climate/chlc/resources.php • The Clean Air Promise: http://cleanairpromise.noharm.org • Join the HCWH Nurses Workgroup: http://www.noharm.org/us_canada/nurses/join.php • Climate health threats by state: www.nrdc.org/climatemaps

This webinar has been recorded and will be available for viewing online later in November. For more information about climate and health, please visit the Health Care Without Harm website at www.noharm.org.

CE instructions and evaluation form at: http://www.noharm.org/us_canada/issues/climate/webinar_2011-11-16.php

November 16, 2011 1:00 – 2:00pm eastern

CLIMATE CHANGE AND HUMAN HEALTH: A NURSES’ CALL TO ACTION