Beating the Heat: Public Health and Climate Change

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Beating the Heat Public Health andClimate
Change

• Southern California Public Health Association
• Annual Conference, April 18, 2008

Jonathan E. Fielding, M.D., M.P.H.,
M.B.A Director of Public Health and Health
Officer L.A. County Department of Public
Health Professor of Health Services and
Pediatrics Schools of Public Health and Medicine,
UCLA
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Presentation Agenda

• Defining the problem of climate change
• Why should Public Health care?
• Discussing the impacts of climate change
• Global impacts
• Local impacts
• Health impacts
• Climate Change and Los Angeles
• Issuing the challenge

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I. Defining the Problem
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Defining Climate Change

• United Nations Framework Convention on Climate
  Change defines it as
• A change of climate which is attributed directly
  or indirectly to human activity that alters the
  composition of the global atmosphere and which is
  in addition to natural climate variability which
  is observed over comparable time periods
• Biggest impact of climate change Global warming
• An increase in average global temperatures
• Six gases are considered contributors to global
  warming
• Carbon dioxide
• Methane
• Nitrous oxides
• Three fluorinated industrial gases

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Basic Mechanism of Global Warming Greenhouse
Effect
Source U.S. Environmental Protection Agency
6
IPCC 2007 Warming is Unequivocal
Source IPCC 2007 (4th Assessment)
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IPCC 2007 Human Impact is Evident
Source IPCC 2007 (4th Assessment)
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Discrepancy Between Emitters and Where Impacts of
Climate Change Are Felt
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Global Contributors to Greenhouse Gas Emissions

• Leading sources of greenhouse gas emissions are
  combustion of fossil fuels coal, oil, and
  natural gas
• More than 60 of the annual global industrial
  carbon dioxide emissions come from industrialized
  countries, accounting for 20 of the worlds
  population
• U.S. per capita emissions of carbon are over 20
  times higher than India, 12 times higher than
  Brazil, and 7 times higher than China
• These per capita rates expected to change
  significantly as China, India, and other
  countries continue to develop economically
• China is now the 1 carbon emitter, surpassing
  the U.S.
• Global carbon dioxide emissions are projected to
  increase by at least 50 over the next 25 years
  under current conditions

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Annual Carbon Dioxide Emissions - 2005

• Total CO2 Contribution
• World 27,245,758 100
• U.S. 6,049,435 22.4
• China 5,010,170 18.4
• Russia 3,115,125 11.4
• EU 1,524,993 5.6
• India 1,342,962 4.9
• Japan 1,257,963 4.6
• (thousands of metric tons)

The most current estimates state that China is
about to surpass the US in emissions and its rate
of emissions is accelerating.
Source U.S. Greenhouse Gas Emissions Inventory
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Source U.S. Greenhouse Gas Emissions Inventory
U.S. CO² Emissions from Fossil Fuel
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Worldwide Effects of Global Warming

• Global climate has warmed by about 1 F over the
  last 100 years
• Worldwide effects are manifested by the
  destabilization of natural systems

• Rising sea levels
• Extreme weather patterns
• Coral reef disintegration

• Ice cap glacier melting
• Early arrival of Spring
• Oceans warming

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Why Should Public Health Care?

• It is our job to protect the publics health
• WHO estimates that in the year 2000, there were
  150,000 excess deaths per year due to climate
  change
• Climate change is already affecting health around
  the world, and its impact on health will continue
  to grow
• Fighting climate change is aligned with
  protecting and promoting health
• Many of the proposed solutions for climate change
  are healthy for everyone
• We have the appropriate skills
• Public Health has the skills to effect behavior
  change, and those skills can help people adopt
  greener behaviors too

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II. Impacts of Climate Change
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(No Transcript)
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Potential Health Effects of Climate Change
Source Dr. Howard Frumkin
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Source Epstein, Harvard Center for Health
Global Environment
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Extreme Weather Events Disease Clusters
Source Epstein, Harvard Center for Health
Global Environment
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Potential Environmental Impacts inSouthern
California of Changing Weather

• Global warming and increase in variability of
  weather, leading to
• Change in rain fall patterns
• Less rain overall ? dry conditions ? higher risk
  of wildfires, loss of flora and fauna, loss of
  agriculture, increased stress on water supplies
• Heavier storms when it does rain ? increased risk
  of flooding
• Increase in temperature
• Elevated frequency and duration of heat waves ?
  immediate health risks, higher risk of wildfires,
  energy consumption spikes
• Increase in El Niño-type conditions
• Increased production of ozone and smog
• Increased temperature elsewhere ? sea level rise
  everywhere
• Change in habitat suitability for vectors ?
  shifts in vector-borne disease distribution

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Potential Environmental Impacts in So.Cal. of
Climate Change Rain Fall Patterns

• Effects of change in rain pattern
• Less rain/dry conditions lead to potential
• Loss of agriculture
• Greater risk of wildfires
• Adverse impact on fauna (disruption of food
  chains, stress placed on fisheries and endangered
  species)
• Stronger downpours lead to potential
• Mudslides/erosion
• Flash flooding

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Potential Environmental Impacts in So.Cal. of
Climate Change Sea Level Rise

• Effects of rising sea level
• Coastal areas will become vulnerable to storms
  and flooding
• Loss of coastal wetlands and erosion of beaches
• Saltwater contamination of drinking water
• Potential damage to roads, highways, and other
  infrastructures near coastal areas

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Potential Environmental Impacts in CA of Climate
Change Floods Droughts

• Warmer temperatures can result in premature and
  rapid snowmelt in the mountains, which alters the
  timing of run-off
• Severe flooding may occur during winter and
  spring, with slower water flow during summer
  seasons
• Drought risk may be acutely elevated during the
  summer months

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Potential Environmental Impacts in CA of Climate
Change Floods Droughts

• Sacramento-San Joaquin Delta levees are already
  vulnerable to storms, significant run-off, and
  earthquakes
• Rising sea level will stress these levees, which
  may result in unprecedented flooding in California

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Potential Environmental Impacts of Climate Change
in Los Angeles Heat Waves

• Experts predict that local heat waves will be
  more frequent and last longer in the future
• By 2020, there will be a twofold increase in the
  number of days over 90F in L.A.
• By the 2080s, the number of days above 90F in
  L.A. will increase from an average of 4 days a
  year to 14 to 37 days a year

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Potential Health Impacts of Heat Waves

• Los Angeles projected to have an increase of 62
  - 88 in heat-related mortality by 2080
• Health impacts likely to be seen 1 to 3 days
  after the onset of the heat waves
• Health effects of extreme and prolonged heat
  exposure include heat cramps, heat exhaustion,
  heat stroke, heat syncope (fainting)
• Devastating heat waves seen elsewhere recently
• 5-day heat wave in Chicago in 1995 700 excess
  deaths, most attributed to the heat
• August 2003 European heat wave 35,000 excess
  deaths

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Heat Waves Vulnerable Populations

• Greater risk for people who do not have access to
  air conditioning
• May not be able to afford air conditioning
• For populations unaccustomed to heat waves,
  people may have air conditioning but chose not to
  use it, not realizing danger

• Two vulnerable populations during heat waves
• Elderly Population of senior citizens (gt 60
  years old) in Los Angeles County is expected to
  increase by 83 by the year 2020
• Low SES Over 16 of LA County residents under
  100 FPL

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Potential Environmental Impacts in So.Cal. of
Climate Change Wildfires

• Wildfires are common in Southern California
• Characteristic of the area since prehistoric
  times
• Santa Ana winds may drive heat waves, prolong
  wildfires, and prevent wildfire control in this
  region
• Climate models predict the summer months will be
  longer, and hotter, due to global warming
• Result dry soil and vegetation become fuel for
  wildfires

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Potential Environmental Impacts in So.Cal. of
Climate Change Air Quality
CA ozone standard
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Potential Environmental Impacts in So.Cal. of
Climate Change Air Quality

• Increased temperature and increased carbon
  dioxide in atmosphere leads to
• Increase in formation of ground-level ozone (and
  smog)
• Increased allergen production (e.g. pollen)
• Longer seasons for allergen producing weeds
• Senior citizens, children, and people with
  respiratory and chronic diseases are most
  vulnerable to high levels of ozone and increased
  allergens
• Health effects of high levels of ozone exposure
  include
• Reduced lung function
• Respiratory discomfort
• Exacerbation of chronic respiratory illnesses
  (e.g. asthma)

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III. Climate Change and Los Angeles
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A Public Health Responseto Climate Change

• Public health already utilizes a multi-level
  prevention approach analogous approach can be
  taken to respond to climate change
• Primary prevention climate change mitigation
• Efforts to slow, stabilize, reverse climate
  change by reducing GHG emissions
• Efforts will occur in sectors other than PH, such
  as energy and transportation
• Secondary/tertiary prevention climate change
  adaptation
• Efforts to prepare for, and minimize health
  burden of, climate change
• Similar to public health preparedness for other
  uncertainties (e.g. pandemic flu, bioterrorist
  attack), so likely that PH as sector will be
  involved in adaptation efforts

Source Frumkin, et al., AJPH 3/08
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What Should We Do?

• Mitigation reduce GHG emissions
• Reduce energy usage and Reduce, Reuse, Recycle
• As individuals, at home
• As organizations, at work
• Adaptation prepare for impact of climate change
• Emergency preparedness
• As individuals/families
• As local health department
• Mitigation and adaptation advocate for healthy
  policies
• Support legislation that reduces GHG emissions
• Support sustainable lifestyles communities

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Mitigation What Can We Do In Our Homes
Workplaces to Combat Global Warming?

• Establish recycling programs in the workplace and
  home
• Recycling half of your household waste hundreds
  of lbs. of CO2 saved per year
• Promote energy efficiency in the home and
  workplace
• Changing regular light bulbs to compact
  fluorescent bulb throughout your house hundreds
  of lbs of CO2/yr
• Make small energy use changes on a broad scale
• E.g. replacing all light bulbs with energy
  efficient light bulbs in all County buildings
• Encourage renewable energy power sources (solar
  energy and wind energy) and responsible use of
  energy
• Turning off your TV, computer, and other
  electronics thousands of lbs. of CO2 saved per
  year

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Mitigation What Can We Do In Our Homes
Workplaces to Combat Global Warming?

• Try to drive less and walk more!
• You save gas money and keep our air cleaner for
  every mile you dont drive
• Most car trips taken in your neighborhood are
  short enough to walk or bike
• Encourage carpooling to work/school
• Encourage public transportation use

• Provide incentives for employees to purchase
  fuel-efficient vehicles (e.g. electric, hybrid,
  CNG vehicles)
• Every gallon of gas saved tens of lbs. of CO2
  saved
• If you do take a car, maintain it
• Properly inflated tires can improve gas mileage
  by 3

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Adaptation Emergency Preparedness

• We need to prepare now for the inevitable effects
  of climate change, such as heat waves and
  wildfires
• Good news preparing for one type of emergency
  prepares us for all types of emergencies
• Preparation minimizes impact of disasters and
  fear/anxiety
• We need to prepare ourselves as individuals and
  as health agencies

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Adaptation Emergency Preparedness

• For individuals and families Just Be Ready,
  Prepare Together.
• Create a family emergency preparedness plan
• Practice your and update your plan regularly
• Create an emergency supplies kit
• Know what to do in specific types of emergencies
• Check out www.labt.org for preparedness resources

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Adaptation Emergency Preparedness

• For local health departments
• Create and practice emergency preparedness and
  response plans
• Ensure that all staff are trained in emergency
  preparedness and response

• Consider how your operations may be impacted by
  potential emergencies
• Heat waves can lead to blackouts
• Wildfires may impact some sites
• Are you prepared to have employees shelter in
  place at work?
• Make sure your residents are prepared

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Promoting Healthy Policies CAs Global Warming
Legislation

• AB 1493 Californias Vehicle Global Warming Law
  Directs the Air Resources Board to require car
  makers to reduce greenhouse gas emissions from
  new passenger vehicles light trucks starting in
  2009
• Would reduce GHG emissions from cars in CA by 18
  (30 m. tons) by 2020, and by 27 (50 m. tons) by
  2030
• Impact would be much greater, as over a dozen
  other states have adopted CAs proposed standards
• But running into roadblocks with Federal EPA and
  current administration
• EPA blocked implementation of CAs proposed
  standards, now states are suing the EPA

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Promoting Healthy Policies CAs Global Warming
Legislation

• AB 32 Global Warming Solutions Act Requires
  California to reduce global warming emissions to
  1990 levels by 2020.
• First comprehensive program of regulatory and
  market mechanisms to achieve real, quantifiable,
  cost-effective reductions of GHG emissions
• Directs Air Resources Board to develop
  regulations and to establish a reporting system
  to track and monitor levels of global warming
  emissions.
• Gov. Schwarzenegger signed AB 32 in Sept. 2007.

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Promote Healthy Policies

• Support policies related to sustainable
  communities
• Mixed use development, jobs near housing,
  transit-oriented design, bike lanes and
  sidewalks, parks and green
• Development and utilization of useful public
  transportation
• Energy efficient "green" buildings and LEED
  certification
• Buildings consume 72 of the nations electricity
  and more GHG than transportation or industry
• Recycling, waste management and pollution control
• Securing safe water supplies
• These policy decisions occur at all levels of
  government, so many opportunities for Public
  Health to give input
• Health Impact Assessments
• Surveillance data tracking spread of vectors and
  diseases

Source US Dept of Energy, 2007
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Los Angeles Countys Responseto Climate Change

• Board of Supervisors approved the Countywide
  Energy and Environmental Policy in Jan. 2007
• Joined the Cool Counties initiative, pledging
  to reduce GHG emissions and develop a plan to
  carry out the pledge
• Created the Energy and Environmental Policy Team
  includes ISD, Public Works, Public Health,
  Regional Planning, local utility agencies, and
  others
• Energy and Water Efficiency Committee goal to
  reduce Countys energy and water consumption 20
  by 2015
• Green Building Operations Committee goal to
  develop a sustainable design program for new and
  existing buildings
• Environmental Stewardship Committee goal to
  reduce Countys environmental footprint,
  including quantifying CO2 emissions from County
  operations and improving recycling efforts
• Los Angeles County operations in 2006 700,000
  tons of CO2
• Passed policy to get discounts on hybrid vehicles
  for County employees, contractors, and family of
  employees

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We Cant Do It Alone

• So why should we bother?
• Efforts will yield long-term savings
• Will make our economy more competitive
• The co-benefits are great
• Will improve the sustainability of our
  communities
• Moral obligation if we care about the health of
  our communities, then we need to do our part

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Realizing the Co-benefits ofReducing GHG
Emissions

• Important to realize the co-benefits of climate
  change responses certain efforts to address
  climate change often yield other health benefits
  too
• Strategy reducing vehicle miles traveled
• Primary result lower motor vehicle GHG
  emissions
• Co-benefit higher physical activity rates
• Strategy promote cleaner energy production and
  cleaner fuels
• Primary result reduced GHG emissions from
  energy production
• Co-benefit less air pollution less
  respiratory distress

Source Frumkin, et. al., AJPH March 08
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Summary of Health Effects of Air Pollution

• More pre-term babies and birth defects
• Increases in
• abnormal lung development in children1
• asthma symptoms and other respiratory diseases in
  children and adults2
• deaths from heart disease and lung cancer3

Lungs of a non-smoker as affected by air
pollution (source AQMD)
1 (Gauderman et al. 2007, Lancet) 2 (McConnel et
al. 2006, Env Health Perspectives Meng et al.
2006, UCLA CHPR Research Brief) 3 (Pope et al.
2002, JAMA)
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Largest Local Contributor to Air Pollution Los
Angeles Ports

• More than 40 of all United States imports come
  through the Ports of Los Angeles and Long Beach
• These ports contribute more than 20 of diesel
  particulate pollution in Southern California, and
  represent the single largest source of air
  pollution in the region

Source South Coast Air Quality Management
District U.S. Department of Transportation
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Largest Local Contributor to Air Pollution Los
Angeles Ports

• Cargo trucks and rail systems also contribute to
  diesel emissions originating from the ports

• Trade and goods movement are expected to
  increase, as the ports continue to accommodate
  the growth of imported goods entering the U.S.
• LA Ports are currently examining ways to reduce
  GHG emissions, such as requiring use of
  low-sulfur fuels near shore

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Ports Goods Movement Health Effects

• Communities residing near the ports, rail
  systems, and trucking routes are affected due to
  the diesel emissions
• California has an estimated 2,400 premature
  heart-related deaths annually due to pollution
  from the L.A. ports and goods movement
• There are approximately 62,000 cases of asthma
  symptoms in California
• More than 1 million respiratory-related school
  absences in California annually

Source Environmental Health Perspectives
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Summary of Health Effects of Air Pollution

• Amount of goods transported through California
  projected to nearly quadruple between 2000 and
  20201
• Will have significant impact on air quality and
  health2
• Diesel particulate matter (PM)
• concentrated around ports, railyards, and heavily
  trafficked roads3
• premature deaths
• cancer
• respiratory disease
• lost workdays
• global warming (2nd to CO2)

Annual Health Impacts in CA from PM and Ozone4
1 (Cal EPA, 2005) 2 (Pacific Institute, 2006) 3
(CA/EPA Air Resources Board) 4 (CA/EPA Air
Resources Board, 2004)
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Health Impacts of PoorAir Quality in Southern CA

• 6,500 annual premature deaths linked to small
  particulate matter (PM) are now higher than
  deaths from second-hand smoke (5,000/yr)
  traffic accidents (3,200/yr) and homicide
  (2,000/yr)
• Fine particles (PM 2.5) significantly reduce lung
  function and growth in Los Angeles children (Avol
  et al., 2001 Gauderman et al., 2002 Peters et
  al., 1999)
• Asthma and air pollution in So Cal
• Onset of asthma is linked to exposure to outdoor
  ozone (McConnell et al., 2001)
• Almost 9 of kids up to 17 and 6.5 of adults in
  LA County currently have asthma (2005 LAHS)

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The Debate Regarding How to Combat Global Warming

• What can we safely conclude?
• Percentage of days that LA County did not meet
  state standard for ozone 20
• Attaining the current California standards for
  ozone and particulate matter (PM) would help
  reduce current health problems related to air
  pollution
• 9,000 annual premature deaths
• 7,000 annual hospitalizations
• 1,258,000 annual respiratory illnesses
• Yearly impact of poor air quality in California
  from premature deaths and healthcare costs 48
  billion
• Benefits of implementing Californias air quality
  standards would exceed costs by a 31 ratio

Source California Air Resources Board, 2005
Source California Resource Board Source
US Environmental Protection Agency Source
South Coast AQMD
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IV. Issuing the Challenge
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National PH Week Pledge

• Be prepared
• Learn more about climate change and health
• Spread the word
• Travel differently
• Use your car less, walk and bike more
• Use public transportation
• Eat differently
• Go meatless one day a week
• Green your work
• Use less paper
• Telecommute and conference call more often
• Green your home
• Reduce, reuse, recycle
• Heat and cool smartly
• Use water efficiently
• Use green power

Reduce your ecological footprint!
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Summary

• Increase of greenhouse gas emissions likely
  results in global warming, and the U.S. is the
  main contributor to greenhouse gas emissions
  (although developing countries are increasing
  emissions at alarming rate)
• California industry, transportation, and seaports
  contribute significantly
• Global warming has devastating potential effects
  on human health, the environment, and the economy
  in Southern California and worldwide

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Summary

• Utilizing an approach of supporting mitigation
  efforts and promoting adaptation to the changing
  climate, Public Health can have a positive
  impact. The co-benefits of many mitigation
  efforts will yield benefits for the health of our
  environment and the public
• Two California Assembly Bills have been passed to
  address global warming in the state of California
• Several methods to help combat global warming in
  the community, workplace, and home

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Resources

• U.S. Environmental Protection Agency
• http//www.epa.gov/
• Intergovernmental Panel of Climate Change
• http//www.ipcc.ch/
• Energy Information Administration
• http//www.eia.doe.gov/
• South Coast Air Quality Management District
• http//www.aqmd.gov/
• California Air Resource Board
• http//www.arb.ca.gov/homepage.htm

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LA County Public Health Healthy People Build
Healthy Communities