COPING WITH CLIMATE CHANGE MANIFESTATIONS ON WATER AND HEALTH

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COPING WITH CLIMATE CHANGE MANIFESTATIONS ON
WATER AND HEALTH
Konstantinos C. Makris and Syam S. Andra
CYPRUS UNIVERSITY OF TECHNOLOGY
Cyprus International Institute for Environmental
and Public Health
in association with the Harvard School of Public
Health
2
Disruption
What is the cost of avoiding climate change? If
we do everything we can now to reduce global
greenhouse gas emissions and ensure we adapt to
the future effects of climate change, the average
estimated cost is 2 of the world annual gross
domestic product (GDP). However, if we do
nothing, effects of climate change could cost
520 of the annual world GDP.

• Little work has been conducted on Sb endocrine
  disrupting effects.
• However, recent evidence suggests that Sb may be
  at least partially responsible for estrogenic
  effects. Choe et al. (2003) reported that
  antimony chloride has high estrogenicity in two
  bioassays. In an estrogen-receptor dependent
  transcriptional expression assay using human
  breast cancer cells, 1 µM antimony chloride had
  estrogenic activity that was 61 equivalent to 1
  nM 17ß-estradiol.

Stern N. The economics of climate change.
Cambridge Cambridge University Press, 2007.
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Perception of Cypriot Society on Climate Change

• In the EU, just over half (51) of respondents
  consider climate change one of the world's most
  serious problems (and 20 feel it is the single
  most serious problem).
• It is seen as the second most serious issue
  facing the world, after poverty, hunger and lack
  of drinking water, and a more serious problem
  than the economic situation.
• (Special Eurobarometer report, October 2011)

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Chemical Leaching

• Plasticizer molecules like antimony, BPA and
  phthalates from plastic wall skeleton, could move
  through the solid polymer matrix via the
  following mechanisms
• i. Diffusion
• ii. Photodegradation
• iii. Relaxation
• iv. hydrolysis

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Climate Change and HealthReduced Health Risk
compared with Tap Water?
A Human Health Perspective on Climate Change A
Report Outlining the Research Needs on the Human
Health Effects of Climate Change April 22, 2010,
NIEHS, USA.
6
How we STORE, TREAT and USE WATER will be key in
adapting to climate change challenges
Surface Water
Coastal Water
Recycled Water
(Bottled) Spring Water
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Hess et al., 2011,EHP
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How WE STORE, TREAT AND USE WATER will be key in
adapting to climate change challenges

• Supply Reduction
• Algal Blooms-Toxins-Treatment costs
• Pathogen maturation rates (Cholera)
• Runoff discharge
• Temperature-driven volatility, solubility,
  biodegradation effects on POP bioavailability
• Food supply contamination from irrigation

9
How WE STORE, TREAT AND USE WATER will be key in
adapting to climate change challenges

• Fish productivity-Species extinction/migration
• Algal blooms-Cladophora spp.
• Dissolved O2 reduction-Hypoxia-Fish kills
• Coral reef bleaching-zooplankton reduction
• Shell calcification reduction-Ocean acidification
• Coastal flooding by sea level rise(?)

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Desalinated Water
Seawater pollution with algae and petroleum
products might endanger the quality of
desalinated water, while treatment cost may be
exacerbated. Infrastructure risk due to sea level
for on-shore plants.
Hydrogeologic Cycle
Surface Water
Coastal Water
Recycled Water
Ground Water
(Bottled) Spring Water
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Potable Water in Urban Pipe Networks
Finished water under quality deterioration (DBP
formation, biofilm/scales release, Legionella
spp. outbreaks). Stagnation and intermittent flow
in drinking water distribution systems enhance
biofilm growth. Changes in hydrostatic pressure
within drinking water pipes may facilitate pipe
leakage and soil/contaminants intrusion. Wet/dry
alterations cause soil movement (swelling)
impacting pipe physical condition
failures/leakages. Backflow and wastewater
intrusion into pipes of drinking water systems
poses serious health risk.
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How WE STORE, TREAT AND USE WATER will be key in
adapting to climate change challenges
Desalinated Water

• Low aquifer and river flow (anoxic zones)
  deteriorate water quality and increase treatment
  costs.
• Seawater intrusion-Brackish waters
• Salting-out effect for increased bioavailability
  of POPs
• Deeper water table pumpinghigher costs

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How WE STORE, TREAT AND USE WATER will be key in
adapting to climate change challenges

• Increased demand
• Treated water quality reduction (xenobiotics)
• Urban storms may increase the contaminant load in
  treatment plants.

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How WE STORE, TREAT AND USE WATER will be key in
adapting to climate change challenges

• Increased withdrawal-Spring capacity issues-Shift
  to bottled water
• Water quality reduction-Brackish waters
• Plasticizer leaching

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Neglected Water CompartmentURBAN STORMWATER
Desalinated Water
Hydrologic Cycle
Coastal Water
Surface Water
STORM Water
Recycled Water
Ground Water
(Bottled) Spring Water
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Extreme Rainfall-Induced Health Hazards
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EXTREME WEATHER EVENTS URBAN STORMAWATER
MANAGEMENT
More than 50 of waterborne disease outbreaks
were preceded by intense rainfall events in the
USA above the 90th percentile (Curriero et al.,
2001, AJPH). In need of stormwater urban
collection ponds and deployable portable filters
for contaminants 1. Erosion-Sedimentation 2.
Increase downstream pollution from Brownfields
contaminant release 3. Unwanted mixing of
freshwater with sewage during floods and
downstream runoff 4. Pump station failure, power
outage, possible loss of water supply
Venice, IT, summer 2006
Kris Snibbe/Harvard Staff Photographer, Harvard
Gazette, October 27, 2011
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?ccess to improved water source, GDP and infant
mortality

Hunter et al., 2010. Water Supply and Health.
PLoS Med 7(11) e1000361
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Sea Rise and SaltWater Intrusion

• Average estimated sodium intakes from drinking
  water ranged from 5 to 16 g day-1 in the dry
  season, compared with 0.61.2 g day-1 in the
  rainy season. The annual hospital prevalence of
  hypertension in pregnancy was higher in the dry
  season (OR 12.2 95 CI, 9.514.8) than in the
  rainy season (OR 5.1 95 CI, 2.917.26) (Khan
  et al., 2011, EHP).
• Increases in water salinity may increase
  POP/pesticide bioavailability due to salting out
  effect.

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Water and Health -- Adaptation Measures
1. Climate change effects on water sectors before
hitting hard our economy need to be classified
and hierarchically addressed by pertinent
agencies 2. Interdisciplinary efforts need to be
initiated by engaging plethora of expertises,
ranging from engineers, economists, health
scientists, biologists, environmental scientists,
and others as needed 3. Coastal infrastructure
sustainability and maintenance, Sea level
rise? 4. Disaster management and preparedness
plans 5. Climate change and public health
education and learning
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Acknowledgement

• We would like to thank the Harvard-Cyprus program
  of the Harvard School of Public Health for
  partially funding and supporting of this study.

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Extended Heat Periods and Heat Waves
1. Heat Stress may be overwhelming for patients
suffering with cardiovascular or respiratory
disease, diabetes, and other chronic
diseases. 2. Need to estimate heat related
mortality and compare it with the increased air
pollution mortality due to the use of air
conditioning in Peak demand seasons (summer).
Example of the impact of the average air
temperature on daily mortality in humans. These
data represent the mortality (324.7 deaths per
day) in The Netherlands from 1979 to 1987. The
size of each block is proportional to the sample
size. Data and graph modified from Kunst et al.
(1993).
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Shortened Gestational Age with Heat Stress Periods

• Gestational age at delivery determines fetal
  maturity at birth.
• Shorter gestational age at delivery was
  documented to be the primary cause of perinatal
  mortality, both in Europe and US.
• Risk increases with decrease in gestational age.
• A 5-day reduction in gestational age was observed
  when subjects were exposed to 32 C (Heat Index)
  on the day before delivery (p 0.03)

Dadvand et al., 2011. Climate Extremes and the
Length of Gestation. Environmental Health
Perspectives.
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Stress-Pollution Interactions

• Temperature effects may be acting as an effect
  modifier towards the toxicity of a pesticide
  during an animal study (Gordon C.J., 2003,
  Environ. Res.). For example, toxicological
  experiments with rodents for a pesticide showed
  no-effect level at 5 mg/kg at relatively warm
  ambient temperatures when literature showed 75
  mg/kg as a no-effect level.

(Gordon C.J., 2003, Environ. Res.)
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Heat-Related Interventions-Dilemmas

• Identification of elderly and children while
  provisioning them with access to air
  conditioning. Could increased use of air
  conditioning serve as a cost-effective
  intervention measure when their use leads to air
  pollution and risk for power outage in the
  summer?
• Both health (exposure and toxicologic) and
  economic-based risk assessment plans.
• Socioeconomic status and the built environment
  may be extremely important factors of
  susceptibility to heat waves and heat stress on
  morbidity/mortality in Cyprus.

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Microplastics in the marine environment and
Climate Change

• Physiological effects on marine biota induced by
  bioavailable compounds desorbed from ingested
  plastics are being investigated, since mass of
  ingested plastic in Great Shearwaters (G?????)
  was positively correlated with PCBs in their fat
  and eggs.
• There is also potential danger to marine
  ecosystems from the accumulation of plastic
  debris on the sea floor. The accumulation of such
  debris can inhibit gas exchange between the
  overlying waters and the pore waters of the
  sediments, and disrupt inhabitants of the benthos
  
• (Moore, C.J., 2008, Environ. Res.).

Laysan albatross chick, Kure Atoll, 2002, photo
Cynthia Vanderlip, AMRF.
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High Air and Water Temperatures

• Solvent Switching is defined as contaminant
  partitioning into different phases towards
  thermodynamic equilibrium. Temperature-driven
  effects on Henry constant for various organics.
  Concentrations of contaminants may not exceed
  thermodynamic constraints.
• Solvent Depletion is an energy-intensive process
  that increases fugacity since solvent
  concentrations decrease. Food web alterations,
  organic carbon changes, biomagnification).
  Concentrations of contaminants may exceed
  thermodynamic constraints.

(McDonald et al., 2002, EST)
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Greenhouse gases sunlight
O3
T
Secondary PM and photodegradation
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Harmful and Nuisance Algal Blooms
Cyanobacteria (blue-green algae) produce toxins
(microcystins, nodularins, saxitoxins,
anatoxin-a, anatoxin-a(s) , cylindrospermopsin)
whose health effects range from liver damage,
including liver cancer, to neurotoxicity. Nuisanc
e algal blooms like those of Cladophora spp. are
expected to grow in frequence in Cyprus coasts.
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CLIMATE CHANGE IN A NUTSHELL
Manifestations
Melting Ice Cap
Factors

• Ocean Circulation
• Water Temperature
• Salinity

• Transportation
• Industry
• Agriculture
• Heating

Processes
Rainfall Variations
Temperature Rise
Greenhouse Effect
CO2 CH4 N2O
Land Use Changes
Consequences

• Disasters
• Floods
• Cyclones
• Heat Waves
• Droughts

Sea Level Rise
Fossil Fuel Burning

• Urbanization
• Deforestation

• Outcome
• Casualties
• Famines
• Diseases Spread
• Biodiversity Losses
• Economic Losses

Reference Modified from UNFCCC 2007.
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CLIMATE CHANGE BROADER IMPACTS

• WATER, AIR, WEATHER, ECOSYSTEMS, OCEANS

Reference 1) USEPA , 2) UNEP/GRID-Arendal,
Potential climate change impacts ,
UNEP/GRID-Arendal Maps and Graphics Library,
http//maps.grida.no/go/graphic/potential-climate
-change-impacts (Accessed 13 October 2011)
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Cyprus-Specific Synoptic Plan

• Current and foreseeable climate change (CC)
  environmental manifestations
• Water-Related, but not visually observed CC
  Environmental Manifestations
• CC-Impacted Health Categories and Water
• Hydrologic Cycle Alterations due to CC
• Water-Related CC Health Impacts
• Water-Mediated CC Heath Impacts
• Synthesis and Adaptation Plans
• What is Next for Cyprus

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Climate Change and Health Effects
2 9 2 N AT U R E VO L 4 7 2 2 1 A P R I L 2
0 1 1
Heat Periods and Waves, Storms/Hurricanes,
Floods, Drought, Nutrition, Food Safety, Air
Pollution, Aerosolized Allergens, Infectious
Diseases, Occupational Health, UV Radiation.
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Key Population Health Terms
Susceptibility Intrinsic biological factors that
can increase health risk of individual such as
medical history genetic variants and stage in
life. Vulnerability Human populations at
higher risk due to environmental or
personal-socioeconomic factors. Both susceptible
and vulnerable populations are called sensitive.
J. Estrin, NY Times, March, 2010
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Sea Level Rise Between 1870-2006
http//maps.grida.no/go/graphic/trends-in-sea-leve
l-1870-2006
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Climate Change and Aflatoxins

Reference 1Patterson and Lima, 2010. How will
climate change affect mycotoxins in food? Food
Research International 43 (2010) 19021914
2CAST. (2003). Mycotoxins Risks in plant,
animal, and human systems. Ames IA, Council for
Agricultural Science and Technology.
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Climate change affects fisheries industry
http//maps.grida.no/go/graphic/vulnerability-of-n
ational-economies-to-potential-climate-induced-cha
nges-in-fisheries
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Ocean Acidification and Climate Change
http//maps.grida.no/go/graphic/acidification-due-
to-climate-change-impacts-for-oceans-and-coral-ree
fs
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High Air and Water Temperatures

• Decrease dissolved oxygen levels
• Increase contaminant load to water bodies (both
  chemical and microbial)
• Reduce stream and river flows
• Foster algal blooms
• Increase the likelihood of saltwater intrusion
  near coastal regions
• Increase disinfection by product formation in
  potable water supplies
• Ozone formation
• Enhance ice/snow melt and possible release of
  POPs, e.g., PAH, PCB, Dioxins, EDC
• Volatility, Solubility, Biodegradation
• Increase incidence cases of Legionella spp.
  outbreaks due to prevailing of thermophila
  bacteria in higher ambient temperature
  environments
• Reference by Noyes et al., 2009, Environ.
  International

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Concentrations of target compounds (ng L-1) and
minimum reporting levels (MRL) in wastewater
samples from Larnaca, CY (Makris and Snyder,
2011).
Recycled Water
Influent Effluent Influent Effluent
Concentration Concentration MRL MRL
       
Atenolol 3900 lt MRL 200 1.1
Atorvastatin 100 lt MRL 100 0.53
Atrazine lt MRL lt MRL 50 0.26
Benzophenone lt MRL 410 10000 53
Caffeine 82000 26 1000 5.3
Carbamazepine 580 390 100 10
DEET 1500 400 200 20
Diazepam lt MRL 3.4 50 0.26
Dilantin lt MRL 61 200 20
Fluoxetine lt MRL lt MRL 100 0.53
Iopromide lt MRL 120 2000 11
Meprobamate 310 14 50 0.26
Primidone lt MRL 20 100 0.53
Sulfamethoxazole 240 7.7 50 0.26
TCEP lt MRL 420 2000 11
TCPP lt MRL 3000 20000 2000
Trimethoprim 110 lt MRL 50 0.26
BHA lt MRL lt MRL 200 1.1
Bisphenol A lt MRL lt MRL 1000 5.3
Diclofenac 1400 lt MRL 100 0.53
Gemfibrozil 3800 88 50 0.26
Ibuprofen 4300 33 200 1.1
Musk Ketone lt MRL lt MRL 5000 26
Naproxen 1400 lt MRL 100 0.53
Octylphenol lt MRL lt MRL 5000 26
Triclosan 480 5.7 200 1.1
Tremendous pressure on increased recycled water
production in light of climate change
effects. Xenobiotics in recycled water need to be
treated prior land application.