Multiple Impacts of Fossil Fuel Emissions on Children’s Health,

Development, and Future

Frederica Perera DrPH, PhD

Director, Columbia Center for Children’s Environmental Health Columbia University

Professor, Mailman School of Public Health

April 6, 2015

The Case for an Integrated Assessment and a Sharper Focus on Children as the

Moral Lever for Policy Change

Climate change and toxic air pollutants-- and their major human source, the burning of fossil fuels-- have already inflicted disproportionate suffering on children and are seriously endangering their future health and well-being. “A fuller accounting is needed that addresses the major issues of inequity: the disproportionate burden on the poor and the young; growing regional and socioeconomic disparities in impacts; and the escalating threat to future generations.”

Broad Scientific Consensus

• Earth’s climate is warming rapidly and at an accelerating rate; greenhouse gases from human activities, primarily CO2 from the burning of fossil fuels, are the main cause of this warming.

• People who are socially, economically, culturally, politically, institutionally, or otherwise marginalized are especially vulnerable to health impacts from climate change…especially in developing countries with low income.”

• Pollutants emitted by burning of coal, oil, diesel fuel and natural gas are linked to increased mortality, cardio-vascular disease, adverse birth outcomes, cognitive and behavioral disorders, respiratory disease, and cancer.

• Children, especially in low-income communities, are disproportionately affected.

(IPCC, 2014, Bunyavanich et al., 2003, IPCC 2007, Pediatrics 2007, Xu et al. 2012, Sheffield and Landrigan 2011, Perera 2014)

Burden of Environmental Disease and Poverty on Children

• One-third of the global burden of disease is caused by environmental

factors; children less than 5 years of age bear more than 40% of that burden, even though they represent only 10% of the world’s population (Prüss-Ustün and Corvalán 2006).

• More than 88% of the existing global burden of disease due to climate change occurs in children less than 5 years of age (Zhang et al. 2007).

• Globally: 1 billion, or half the world’s children, are poor (World Bank, 2012).

• U.S.: 16 million children, or 22% of U.S. children, are poor : African American (38%), Hispanic (35%), Non-Hispanic White (12%) (U.S. Census Bureau, 2010)

Fossil Fuel Burning Affects Children’s Health and Development Via Toxic

Pollutants and Climate Change

CO2

Climate change

Toxic Pollutants PAH, PM2.5 Black Carbon Mercury, SO2, NOx, VOCs etc.

...And the two interact to heighten risks

Sources of CO2 and Air Pollutants

• Greater absorption and retention of toxics via mother’s exposure during pregnancy or in childhood.

• Immature biological mechanisms of defense against both toxic exposures and stress.

• Chronic diseases “seeded” early in life have time to develop and impair health and wellbeing over the lifecourse.

• Damage from in utero and postnatal exposure to toxic pollutants and psychological stressors can be inherited trans-generationally via epigenetic changes.

Susceptibility of the Fetus and Child

(Sheffield and Landrigan, 2011; Perera and Herbstman 2011)

• Often living in areas vulnerable to climate related hazards

• Sources of ambient air pollutants disproportionately sited in lower income communities of color

• Lower income communities also experience more material hardship and psychosocial stress and worse nutrition and have limited capacity to adapt to climate change.

• The different types of “stressors” often interact to magnify adverse health effects

• Global climate change and pollution contribute to— and exacerbate— the striking socioeconomic inequalities that now exist in children’s health within and between countries.

Disproportionate Exposure in Low Income Populations

• Malnutrition

• Vector-borne disease (Malaria, Lyme Disease)

• Water-borne disease with higher rainfall

• Food-borne illness from higher temperatures

• Physical and psychological trauma from extreme weather-related events (Hurricanes Katrina, Sandy)

• Respiratory illness, asthma exacerbation from increased ozone, mold and pollen

• Heat-related illnesses

Observed Effects of Climate Change in Children

(Globally and in U.S.)

Air pollutants (ozone, particulate matter, black carbon, polycyclic aromatic hydrocarbons, mercury, nitrogen and sulfur dioxides): • Infant Mortality

• Low Birth Weight

• Allergy and asthma

• Respiratory infections

• Neurodevelopmental disorders

• Obesity

• Cancer Evidence of interactions with stressors related to poverty

Observed Health Effects of Combustion- Related Air Pollution in Children

(Globally and U.S.)

Costs of Climate Change and Air Pollution

• Climate change has increased the frequency and intensity of

weather-related disasters (floods, droughts, cyclones and

hurricanes) which directly affected an estimated 66.5 million

children worldwide, 600,000 of whom died, every year from 1990

to 2000 (Pronczuk and Surdu, 2008).

• The estimated health-related costs of just six climate-change-

related events in the US between 2002 and 2009 were about $14

billion and annual health-care costs were $740 million (Knowlton et

al., 2011).

• The avoided health costs (benefits) attributed to the US Clean Air

amendments are estimated to reach almost $2 trillion for the year

2020 (EPA, 2001).

International Cohort Studies

SES/Exposure Biomarkers

Outcomes

Effects of Air Pollutants due to Fossil Fuel Combustion in NYC Children

Neurodevelopment Birth Outcomes Obesity/metabolic disorders Asthma/Wheeze/Airway inflammation Cancer risk Polycyclic Aromatic

Hydrocarbons (PAH) Etc.

[Perera et al., 2003, 2004, 2006-2013, 2014; Rundle et al., 2012; Jung et al., 2012; Perzanowski et al., 2013, Peterson et al., 2015]

Effects of Prenatal PAH Observed in the NYC study

All significant (<0.05) after adjusting for potential confounders

• Reduced birth weight and head circumference

• Developmental delay age 3 (OR= ~3)

• IQ reduction age 5

• Behavioral problems (e.g., symptoms of anxiety/depression) ages 6-8

• Symptoms of ADHD age 9-11

• Obesity over childhood years

• Asthma and allergic sensitization ages 7-9

• MRI brain changes (age 7-9)

“High maternal adducts were significantly associated with the Conners Parent Rating Scale-Revised DSM-IV Inattentive (OR = 5.06, 95% CI 1.43, 17.93]) and DSM-IV Total (OR = 3.37, 95% CI [1.10, 10.34]) subscales.” “The results suggest that exposure to polycyclic aromatic hydrocarbons encountered in New York City air may play a role in childhood Attention Deficit Hyperactivity Disorder behavior problems.”

ADHD Findings

MRI Findings

“Findings suggest that prenatal exposure to PAH contributes to slower processing speed, attention-deficit/hyperactivity disorder symptoms, and externalizing problems in urban youth by disrupting the development of left hemisphere white matter.”

Prenatal PAH Exposure & Health Effects in

Three Different Cohort Studies

Krakow,

Poland

Birth Outcomes

IQ/ Cognition

Asthma/ Respiratory

Tongliang, China

TBD

NYC

Intervention Study in The City of Tongliang, Chongqing, China

Tongliang Children’s Cohorts

Chongqing

Tongliang

CCCEH Molecular Epidemiology Lab at Shanghai

Cohort I 3/02-6/02 150 pairs

Cohort II 3/05-6/05 150 pairs

5/2004

At Birth

Taking Gesell Test at age 2

Two Cohorts: Pre- and Post-Closure of a Coal Burning Power Plant

Benefits of Coal Plant Closure

2002 2005

Cohort

0.200

0.400

0.600

0.800

cord

add

ucts

Cord Adduct Levels in Tongliang

Comparing the post-closure cohort to the pre-closure cohort: • PAH-DNA adduct levels in newborns significantly lower • Ambient air levels of PAH significantly reduced

• No longer significant associations between exposure (adducts) and lower developmental scores • Levels of Brain Derived Neuropotrophin (BDNF) significantly higher

[Tang et al. 2008; Perera et al. 2008; Tang et al., 2014]

Intervention Study in the City of Taiyuan,Shanxi Province, China

Taiyuan-Changzhi Children’s Cohorts

CCCEH Molecular Epidemiology Lab at Shanghai

Shanxi Government Environmental Policies Were Implemented Prior

to 2010

[Tang et al., 2014]

Attributable Number of Cases Due to Particulate Matter (PM10)

Estimated benefits of 3.832->6 billion Yuan, 639 million->1 billion USD

[Tang et al., 2014]

Summary of the Evidence

• Evidence that climate change and fossil fuel pollution have affected children’s health globally and in NYC.

• Children, especially poor children, bear the brunt. • Implications for children’s academic performance,

lifetime earnings, and health over the lifecourse and for the health and well-being of future generations

• Evidence that policy interventions work.

Need for a New Paradigm and Action to Protect Children Now and in the Future

A CHILD-CENTERED MODEL OF SUSTAINABILITY THAT PLACES THE NEEDS OF CHILDREN AND FUTURE GENERATIONS AT THE CENTER OF

ENVIRONMENTAL AND SOCIAL, ENERGY AND CLIMATE POLICY

•Mandated by the greater vulnerability of children to toxic physical and social stressors, the potential long-term (even transgenerational) effects of these exposures, and the need to address striking socio- economic disparities in exposure and therefore health •A science-based paradigm, with the broadly shared value of children’s well-being providing the ultimate driver for policy change

Need for a New Paradigm and Action to Protect Children Now and in the Future

• The joint effects of climate change and fossil fuel emissions and the socioeconomic and racial disparities in those effects have not been adequately considered.

• This has resulted in a piecemeal and fractured accounting of the risks to children and therefore an underestimation of both the urgency and the benefits of taking action.

• To be effective, prevention and adaptation strategies to climate

change and energy policy must be centered on the needs of children--present and future.

"We are hurtling towards a future where the gains being made for the world's children are threatened and their health, wellbeing, livelihoods and survival are compromised … despite being the least responsible for the causes. We need to listen to them.“ (David Bull, UNICEF's UK executive director)

Need for a New Paradigm and Action to Protect Children Now and in the Future

A CHILD-CENTERED MODEL OF SUSTAINABILITY

• “If we do not succeed in putting our message of urgency through to today's parents and decision makers, we risk undermining our children's fundamental right to a healthy, life-enhancing environment “(Report of the Brundtland Commission: Our Common Future, 1987).

• Require leaders to make decisions with the “Seventh Generation to come” in mind (Constitution of the Confederation of the Six Nations of the Iroquois).

Acknowledgements

Center Investigators: H. Andrews, F. Champagne, S. Chillrud, K. Donohue, D. Evans, G. Freyer, J. Genkinger, J. Herbstman, L. Hoepner, M. Horton, K. Jung, A. Just, P. Kinney, S. Lederman, G. Lovasi, A. Margolis, R. Miller, S. Oberfield, M. Orjuela, M. Perzanowski, V. Rauh, A. Rundle, D. Tang, S. Wang, R. Whyatt WE ACT: P. Shepard, O. Dotson-Newman NYSPI: B. Peterson and MRI study staff; UNIVERSITY OF CINCINNATI: S. M. Ho, W. Tang; Xiang Zhang; CDC: A. Calafat, A. Sjodin

Polish Study collaborators: W. Jedrychowski & colleagues, Jagiellonian Univ. of Krakow

China Study collaborators: Children’s Hospital of Chongqing Medical University; University of Nevada, Desert Research Institute (DRI); Chongqing Institute of Environmental Sciences (CQIES); Fudan University School of Public Health; Jiaotong University; Shanxi School of Public Health, Shanxi Medical University; Shanxi Hospital; Taiyuan Municipality CDC; Shanghai Key Laboratory of Children’s Environmental Health

Funding: The National Institute of Environmental Health Sciences (NIEHS) U.S. Environmental Protection Agency (EPA) John and Wendy Neu Family Foundation; New York Community Trust; Blanchette Hooker Rockefeller Foundation; Schmidt Family Foundation/11th Hour Project; Energy Foundation; Rockefeller Brothers Fund Other Private Foundations & Individuals I have no conflicts of interest to report .