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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Public Health Impacts of Climate Change in California:Community Vulnerability Assessments and Adaptation Strategies
Report No. 1:
Heat-Related Illness and MortalityInformation for the Public Health Network in California
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
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Table of Contents
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Executive Summary
I. Introduction
II. Spectrum of Heat-Related Illness
III. Community Vulnerability for Heat-Related Morbidity and Mortality
IV. Prevention, Adaptation, and Mitigation
V. Short-term and Long-term Recommendations
ReferencesSources of Additional InformationAppendices
888
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
List of Figures and Tables
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Executive Summary
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
C
•
•
The primary objective of
this community vulnerability
assessment, the
is to identify locationsand/or
populationswith high risk for
heat-relatedillness.
7
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
•
•
•
•
Virtually all heat-related
illness and death is
preventableif the
appropriateprevention
strategies are adopted and implemented
bycommunities
and individuals.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
A. Our Changing Climate and Impacts on Public Health in California
T
4
I. Introduction
B. California’s Actions to Address Climate Change
C
ordinations
As the number and duration of extreme heat events
increase,there will be a concomitantincrease in
heat-relatedillnesses and
deaths.
9
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
The purpose of the Climate Change Public Health Impacts
Assessmentand Response Collaborative
was to develop
the requisite knowledge to prepare for, prevent, and reduce the
health impacts of climate change in California.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
A. Heat Stress
A
II. Spectrum of Heat-RelatedIllness
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
B. Heat Cramps, Heat Syncope, Heat Edema
H
C. Heat Exhaustion
H
Becauseuntreated
heatexhaustion
can progress to heat stroke,
the most serious form of heat-related
illness,treatment
should begin
signs of heat exhaustion.
12
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
D. Heat Stroke
H
Heat stroke is an extreme
medicalemergency
that if untreated can result in death or permanent neurologicalimpairment.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
III. Community Vulnerability to Heat-RelatedMorbidity and Mortality
A
Indicators of Risk
I
1. Historic Heat Waves, Heat Islands, and Air Conditioner Ownership in California
Historic Heat Waves and Temperature Trends in California
A community’s overall
vulnerability
its constituent populations,
as well as the capacity of its public health and emergency
responseinfrastructure.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 1:
Source: Smooth surface generated using data from Steve LaDochy, Richard Medina and William Patzert
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Heat Islands
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Impervious Surfaces in California
Impervious Surface (%)
Figure 2:
Source: U.S. Geological Survey
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
The 2006 Heat Wave
Impervioussurfaces are
anthropogenicfeatures that
limit the ability of water to
soil.
isto
ckph
oto.
com
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Average Daily Maximum Temperature
July 2006
Temperature (ºF)
Figure 3:
Source: Oregon State University, PRISM Group
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CountyMaximum
Temperature
Minimum
Temperature
1 Imperial 107.9 81.6
2 Riverside 102.2 73.3
3 Kings 100.6 68.5
4 Tulare 100.2 67.2
5 Fresno 99.0 65.7
6 Kern 98.2 66.6
7 Inyo 97.2 60.9
8 Colusa 97.0 62.9
9 Yolo 96.8 61.1
10 Merced 96.7 60.9
11 Glenn 96.3 63.0
12 Butte 95.8 62.2
13 Sacramento 95.8 62.2
14 Calaveras 94.9 61.6
15 San Bernardino 94.9 65.5
16 Mendocino 94.7 55.2
17 Solano 92.7 59.9
18 San Joaquin 92.7 59.0
19 Lake 92.5 54.7
20 Los Angeles 92.4 65.4
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Air Conditioner Ownership in California
Top 20 Counties by Average Daily Maximum and Minimum Temperatures (ºF) , July 2006Table 1:
Source: University of California, IPM California Weather Database
The capacity to adapt to
elevatedtemperatures,
through the use of cooling mechanismssuch as air
conditioning,is a
component of vulnerability to heat morbidity and mortality.
20
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
.
Departures from Average Maximum and Minimum Temperatures, California, July 2006Figure 4:
Average Maximum TemperatureDeparture from Average (ºF)
Average Minimum TemperatureDeparture from Average (ºF)
Source: Generated 8/1/2006 at the Western Regional Climate Center using provisional data. NOAA Regional Climate Centers.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Source: California Energy Commission
Figure 5:
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
2. Heat-related Deaths in California from the Summer 2006 Heat Wave
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 6:
Source: California Department of Public Health
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Death rate
(per 100,000 population)
1 Stanislaus 23 4.6
2 San Joaquin 21 4.6
3 Fresno 20 2.3
4 Kern 15 2.0
5 Sacramento 13 0.9
6 San Bernardino 10 0.5
7 Imperial 10 6.4
CountyNumber of
Deaths
Source: California Department of Public Health
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 7: Deaths due to Extreme Heat in California and Typical Central Valley Temperature*, July 15- August 1, 2006
Table 2: Top Counties for Heat-Related Deaths, July 2006 Heat Wave
Source: California Department of Public Health
Temperature
Deaths
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
3. Demographic Determinants of Vulnerability
A) Vulnerable Populations
Elderly
T
Children Participants in Athletic EventsSocial
isolation and medication use are also factors
that are not uncommon
amongthe elderly that makes them more
susceptible to the effects of
heat.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Medically Compromised and Socially Isolated
•
•
•
•
Outdoor Workers
Californiaworkers in
agriculture and construction
industries have experienced
severeheat-related
illness and death in recent
years.
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
B) Demographic Analysis of California Counties
Our review of the published
literature
three main categories of host factors related to elevated
risk for these outcomes:
(1) social and behavioralfactors ; (2)
demographics;and (3) health
status.
28
Source: U.S. Census 2000
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 8:
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Source: U.S. Census 2000
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 9:
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Source: U.S. Census 2000
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 10:
31
Source: U.S. Census 2000
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 11:
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 12:
Source: U.S. Census 2000
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Capacity
A. Air Conditioner Ownership and Demographic Determinants of Vulnerability by County
Analysis of vulnerability to heat morbidity and mortality must account for adaptation
to elevated temperature,
and air conditioner
ownership is a key aspect of this capacity.
34
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Poverty and Social Isolation in California Counties Categorized by Air Conditioner OwnershipFigure 13:
Source: California Energy Commission, U.S. Census 2000
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Figure 14:
Source: California Energy Commission
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
B. Geographic Analysis of Increased Temperatures, Elevation, and Ozone Levels Poor air quality
can affect the health of a
large portion of Californians,
with a disproportionate
effect on children, the elderly, those
withpre-existing
chronicdiseases, and those in lower
socioeconomicstrata.N
atio
nal P
ark
Ser
vice
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Ozone (ppm)*
Intersection of Elevation, Increased Temperatures,
and Ozone Levels
Figure 15:
Source: California Air Resources Board and Steve LaDochy, Richard Medina, and William Patzert
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
IV. Prevention, Adaptation, and Mitigation
A. Prevention Strategies
1. Cooling Centers
A2. Public Education and Outreach
Mobilization of Social Contacts of Vulnerable Individuals
Education Regarding Personal Cooling Strategies
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
B. Strategies for Mitigation of Effects of Heat Islands
T
C. Strategic Implementation Plans and Emergency Response/Heat Warning Plans
•
•
•
S
The single strongest
message that has come from evaluation of prior deadly
heat waves is the need for all
communitiesto have
emergencyresponse plans
in place.
40
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
V. Recommendations for Short-term and Long-term Strategies
Short-term strategies
C
•
•
California will be confronted
with heat emergencies for the foreseeable
future and they will be
increasing in frequency.Weather
changes related to climate
change will only compound the risks to human health due to
heat.
41
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Long-term strategies
•
...in the long-term
household air conditioning
will only exacerbatethe global warming
problem by increasing
energydemand,
unless more of California’s energy can come from renewable
sources.
42
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
•
•
•
43
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
References
44
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
45
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
Sources of Additional Information
Report design by Rosanne Hoyem,ZevRoss Spatial Analysis
Inset images provided by istockphoto.com
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
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Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
48
Preventing Summer Heat Illness
California Department of Public Health – July 2007
Summer heat waves can be dangerous. A
very high body temperature can damage the
brain and other vital organs. Some health
conditions can make it harder for the body to
stay cool in hot weather. These include old
age, obesity, fever, dehydration, heart
disease, poor circulation, sunburn and drug
and alcohol use. To protect your health when
temperatures are very high:
Get Plenty to Drink
Sweating removes needed salt
and minerals from the body.
When it is hot, drink more
water, juice and sports drinks.
Avoid drinks with caffeine (tea, coffee, and
cola) and alcohol. Be sure to eat regularly.
Wear Light Clothing and Sunscreen
Wear as little clothing as possible when you
are at home. Choose lightweight, light-
colored, loose-fitting clothing.
In the hot sun, a wide-
brimmed hat will keep the
head cool.
If you will be in direct sun, use a
sunscreen with a sun
protection factor (SPF) of 15 or
higher and follow package
directions. Reapply every 2
hours while in the sun.
Warning: If your doctor limits the amount of fluid you drink or if you take water pills, ask him or her how much you should drink when the weather is hot. If you are on a low-salt diet, talk with your doctor before drinking a sports beverage.
Stay Cool Indoors
The best way to beat the heat is to stay in an
air conditioned area. If you don’t have an air
conditioner, go to a shopping mall or public
building for a few hours. A cool shower or
bath is also a good way to cool off.
Schedule Outdoor Activities Carefully
Try to be less active during the hottest part of
the day, late afternoon. If you must be out in
the heat, plan your activities so that you are
outdoors either before noon or in the evening.
While outdoors, rest often in a shady area.
Never leave kids or pets in a parked car.
Pace Yourself
If you are not used to working or exercising in
hot weather, start slowly and pick up the pace
gradually. Take frequent, regularly scheduled
breaks. If activity in the heat makes your heart
pound or leaves you gasping for breath, stop
activity, get into a cool or shady area, and
rest. Especially if you become lightheaded,
confused, weak or feel faint.
Use a Buddy System
During a heat wave, check on your friends
and family and have someone do the same
for you. If you know someone who is elderly
or has a health condition, check on them
twice a day during a heat wave. Watch for
signs of heat exhaustion or heat stroke.
High temperatures can cause serious health
problems. Know the symptoms of heat-related
illness and be ready to help.
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute
49
Treating Summer Heat Illness
California Department of Public Health – July 2007
Heat stroke happens when the body can no
longer control its temperature. The body’s
temperature rises fast. The body cannot
sweat and is unable to cool itself. Warning
signs include red, hot, dry skin; very high
body temperature, dizziness, nausea,
confusion, strange behavior or
unconsciousness, rapid pulse or throbbing
headache. Heat stroke can cause death or
disability if treatment is not given. What to do:
Get medical help quickly.
Get the victim to a shady area.
Cool the person off with a cool shower,
garden hose, etc.
Do not give the victim fluids to drink.
If emergency medical personnel are
delayed, call the hospital for further
instructions.
Heat exhaustion is a milder illness that
happens when the body has lost too much
water and salt in sweat. Warning
signs include heavy sweating, cramps,
headache, nausea or vomiting, tiredness,
weakness, dizziness and fainting. If heat
exhaustion is not treated, it can turn into heat
stroke. Get medical help if the symptoms are
severe or if the victim has heart problems or
high blood pressure. Help the victim cool off
with:
Cool, nonalcoholic beverages,
Rest, lying down,
Cool shower, bath or sponge bath,
Air-conditioning,
Lightweight clothing.
Heat cramps are muscle
pains and spasms due to heavy activity.
They usually involve the stomach muscles or
the legs. It is generally thought that the loss
of water and salt from heavy sweating causes
the cramps. If you have heart problems or
are on a low-sodium diet, get medical
attention for heat cramps. What to do:
Stop. Sit quietly in a cool place.
Drink clear juice or a sports beverage.
Rest for a few hours to avoid heat
exhaustion or heat stroke.
Get medical help if heat cramps do not
stop after one hour.
Sunburn is when skin becomes red, painful
and unusually warm after being in the sun.
Sunburn should be avoided because it
damages the skin and could lead to more
serious illness. What to do:
See a doctor if the sunburn affects an
infant younger than one year old or if
the victim has fever, blisters or severe
pain.
Stay out of the sun.
Bathe the sunburned area with cool
water.
Use moisturizing lotion on sunburn, do
not use salve, butter or ointment.
Do not break blisters.
For more information… Call CDC for info in English or Spanish:800-CDC-INFO (800-232-4636) 888-232-6348 (TTY) Or visit: www.cdc.govwww.bepreparedcalifornia.ca.gov
Climate Change Public Health Impacts Assessment and Response CollaborativeCalifornia Department of Public Health and the Public Health Institute