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CLIMATE AND HEALTH NZ For General Audiences

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  • 1. CLIMATE AND HEALTH – GreensWhy talk about climate and health? Because time is short and to get governments to act we need a massmovement. Its time to stop debating the deniers and move on to mobilize the believers, who make up65% of the population. The battlefront of public opinion has shifted, and we must confront 3misconceptions. 1) climate change will only affect people in developing countries 2) we can deal withit later and 3) if it happens, we can adapt. Researchers on climate communication in the US testedvarious ways of talking about climate with focus groups and found that talking about health effects wasthe most effective way to get listeners to care. Why?People are more likely to respond if they think their own families are in danger.It brings an abstract concept down to earth in terms that people understand.It gently confronts the craziness in our culture which has us completely obsessed with what we take inand in total denial about what we put out.Our fascination with bizarre diseases and natural disasters holds peoples attention long enough to getthe point across.So whats the longterm forecast for New Zealand? As your TV weatherpeople like to say, itschangeable, but the changes are trending in a certain direction. warmer winters and hotter summers,more frequent and longer heat waves. The wet areas will get wetter and the dry areas drier, with morefrequent drought, more heavy rains and more powerful storms.GLOBE These changes are affecting the food we eat, the water we drink, the air we breathe, and theplace we live; all of which will affect our health.CASE 1 HEAT STROKEHEAT WAVE Extreme heat causes more deaths than any other type of extreme weather event. A heatwave in Europe in the summer of 2003 caused 70,000 deaths. Another in Russia in 2010 killed56,000 people. Old, young, people with chronic diseases, outdoor workers and those taking certain medications aremore susceptible to heat related illness and death. Pregnant women and their unborn babies are alsoaffected with increased rates of birth defects and premature birth. City dwellers are at higher risk due tothe urban heat island effect: with absorption and radiation of heat from dark asphalt and cement, itcan be 9 deg hotter in cities than the surrounding suburbs. Overall the death rate goes up 1% for everydegree rise over 20 degrees. The definition of extreme heat depends on where you live. We adapt tohigher temperatures over time, so extreme heat causes more harm when it occurs earlier in the summer.Aussies, for example, are less susceptible than Kiwis. The longer a heat wave goes on, the more severethe effects. Heat waves fill hospitals with increased ED visits and admissions for heart, lung, andkidney disease. A heat wave in Australia in 2009 bumped up hospital admissions 14-fold. Heat wavesdont just kill us, they make us kill each other. Extreme heat increases aggression and results inincreased rates of assault, murder, domestic violence, suicides and psychiatric holds for being a dangerto others. I could not find projections on future extreme heat for NZ, Tasmania was the closest. Therethe number of hot summer days will double to triple by the end of the century. Heat waves willquadruple in frequency and, in the northern third of the island last anywhere from a week to monthlonger than they do now.CASE 2 PSPPARALYTIC SHELLFISH POISONING Warmer oceans promote harmful algae blooms which formheat stable neurotoxins that accumulate in fish and shellfish. Paralytic shellfish poisoning can range
  • 2. from tingling of the lips and hot/cold reversal to flaccid paralysis and respiratory failure. The mortalityrate ranges from 9-15%. There have been 29 hospitalizations for PSP in the Waikato district since midDecember from shellfish obtained in the Bay of Plenty, where warnings are still in place. A warning onthe West Coast began in October and was only recently lifted.BLUE GREEN ALGAE Warmer water temperature combined with nutrient rich runoff from heavyrain in agricultural areas causes cyanobacteria blooms in fresh water. These produce several toxins, themost common being microcystin. Microcystin causes hepatitis with acute ingestion and liver cancerwith prolonged low level exposure. It cannot be destroyed by boiling. Children and pets are mostvulnerable to acute exposures because of their small size and tendency to play at the waters edge wherethe algae is thickest. With a thick layer of algal scum at the shore, toxin concentration is increased 100fold. With a strong wind blowing lake scum in to the shoreline concentrations can increase 1000 fold.Fish and shellfish can concentrate microcystins. There is currently a public health warning for shellfishwith high microcystin levels in Hokianga Harbour due to an algae bloom in Lake Omapereupstream. Three other lakes in northern north island are currently closed to recreational use due to highlevels of microcystin.VIBRIO AND SEA SURFACE TEMPERATURE Warmer oceans also increase the multiplicationof Vibrio bacteria in shellfish. There are two common marine Vibrios, vulnificus and parahemolyticus.Vibrio parahemolyticus generally causes gastroenteritis but Vulnificus causes bacteria in bloodstreamwhich is 50% fatal. The very young, very old, and people with liver disease and impaired immunefunction are more susceptible. In the US Vibrio causes 95% of seafood related deaths. The prevalenceof Vibrio in NZ shellfish has increased since the 1980s. In the summer of 2009 V. vulnificus waspresent in 17% of samples. There was a clear relationship between Vibrio levels and watertemperature.AMOEBIC MENINGOENCEPHALITIS is another infection related to water temperature. It is stillRare but tragic, it affects healthy children and is 100% fatal. Its caused by Naegleria, an amoeba that isdormant in cold water and reproduces in warm water. In NZ you Naegleria infection by immersing thehead in thermal pools. In the US weve also seen cases from swimming in warm southern lakes, but thechild in this photo was the first one to die of amoebic meningitis after swimming in a lake in Minnesotaduring a very hot summer, 500 miles north of any previously diagnosed infection. NZ doesnt have longtemp records for its lakes but measurements in Lake Taupo show it has warmed almost 1 degree since1970 and NZ rivers have also warmed slightly over the last decade. Low water levels during droughtswill increase seasonal water temperatures and the risk of amoebic meningitis for young swimmers.CASE 3 DENGUEDENGUE Dengue is a viral infection transmitted by mosquitos. reemerging in the US and Australia.Dengue sometimes called “breakbone fever” is a severe flu like illness with intense joint pain. Thereare two kinds of dengue outbreaks: epidemic, in places like islands that have never experienceddengue, 1 strain can rapidly infect up to 50% of the population. In places where dengue has beenaround a long time, there are frequent cases with different strains but no big outbreak. Both are badbecause in the non epidemic scenario, if a child gets infected a second time with a different strain ofdengue virus, they get hemorrhagic fever, with uncontrollable bleeding and fluid buildup in the lungsand belly that leads to shock and sometimes death. The US and Australia eradicated dengue bymosquito control measures but it has returned. The US has had 11 outbreaks since 1980 and a triplingof hospital admissions from 2000 to 2007, and Australia has had 40 outbreaks since 1995. According tothe WHO dengue is the most rapidly spreading mosquito borne infection in the world. Climate changeincreases transmission of mosquito borne diseases. Warmer temperatures extend the mosquito breedingseason, decrease time to maturity, and speed multiplication of virus, so you get more mosquitos whoare more likely to bite, and each bite is more likely to transmit an infection. In addition, climate change
  • 3. is expanding the geographic range of disease-carrying mosquitos.Aedes aegypti, or Yellow Fever Mosquito, is the most efficient vector for dengue. It lives only intropical and subtropical climates because it cant survive cold winters. Aedes aegypti cant live in NZtoday. But by 2050, increased rainfall and warmer temperatures will provide conditions in which itcould thrive. Dengue is also transmitted by Aedes albopictus, the Asian Tiger Mosquito, an aggressivedaytime biter and invader of territory around the world which can survive winter freezes and in the USis found as far north as Chicago. Both egypti and albopictus are daytime biters, so bed nets areineffective for prevention.Researchers at Wellington School of Medicine and the Univ of Waikatodeveloped a computer program to predict the effect of climate change on the expansion of thesemosquitos, in New Zealand including those that transmit dengue. This is not an abstract exercise.Albopictus has been intercepted at least 11 times at NZ North Island ports. If it were to get pastBiosecurity, it could establish a foothold right now in Northland. With future climate change it couldexpand along the entire coastline of the North Island and in very warm years even reach the SouthIsland. In addition to dengue, albopictus is a vector for Yellow Fever, West Nile Virus, and severaltypes of viral arthritis and encephalitis. Immuno-naive populations are extremely vulnerable toepidemics of these diseases. In 1979 RRV entered Fiji via an infected Australian tourist causing anoutbreak of 50,000 cases and then spread to other islands ultimately infecting over 500,000 people.MASS DISLOCATION Mosquitos are not the only ones on the move.Worldwide, environmental events now create more refugees than war and genocide. Poorer countrieswill bear the brunt of climate change and some of their refugees will come to NZ bringing diseases ofpoverty with them. One of the most concerning is tuberculosis. TB takes a long time to treat and misseddoses result in resistance to medications. In rich countries we have nurses who give people their meds.In poor countries we end up with a lot of drug resistant TB. Asia and the Pacific Islands to be one of theareas most vulnerable to climate change. By 2050 over 100 million of their inhabitants will bedisplaced by rising seas, failed crops, and extreme weather. Asia and the Pacific Islands also have onethird of the worlds MDR TB and when the emigrate to the US theyre 20 times more likely thanEuropeans to develop active tuberculosis in their new home country.Extreme weather events in developed countries also cause internal displacement. In the US since 2005over 7 million people have been evacuated from their homes due to extreme weather events. One biglesson from Katrina was that the biggest health impact was not illness or injury from flood waters, butpeople with chronic diseases decompensating because they were disconnected from their usual sourceof care. Outbreaks of communicable disease are also common in shelters where large numbers ofpeople live in close quarters. Aside from the physical consequences, these experiences leave emotionalscars : 30% of people affected by major fires and hurricanes develop symptoms of Post TraumaticStress Disorder.CASE 4 ASTHMAPOLLEN CO2 acts as fertilizer, especially for weeds and increases pollen production. The graphshows ragweed pollen production with preindustrial, current and future CO2 levels. High pollen levelscause flare ups of allergies and increased ER visits for asthma. New Zealand has one of the highestprevalances of asthma and allergic disease in the world and rising rates of hospitalization for asthmaexacerbations.Climate change is also increasing the length of ragweeds flowering season and itsallergenicity and increasing the geographic range of common allergenic plants.OZONE Ground level ozone, commonly called smog, is a potent respiratory irritant. It is formedwhen nitrogen oxides and VOCs combine in the presence of sunlight. The warmer and sunnier theweather, the more ozone is produced. New Zealand generally has good air quality and even Auckland,which has the worst air quality in the country, has levels of ozone below the safety standards set by the
  • 4. Ministry for the Environment. That may be fine for your avarge healthy person, but increases in groundlevel ozone, even when they remain below environmental standards, make asthma worse. Increases inozone even at low levels also cause increased deaths from heart and lung disease. Warmer temperatureswould increase ozone levels in Auckland and adversely affect people with asthma. Since 1 in 6 adultsand 1 in 4 children in New Zealand are asthmatic, even a small effect could have large consequences.DROUGHT Drought is becoming more frequent in NZ. In the US, farmers in drought affected areashave increased rates of suicide. Climate change is expected to increase the frequency and severity ofdrought, especially in Canterbury, Otago, and Northland.HUNGER Crop failures raise food prices. At the moment, the round of extreme weather events inAustralia has increased the price of fruit and veg in NZ. The drought here has cut milk production inhalf in the past month with a resulting 15% increase in the price of dairy. In the last national nutritionsurvey, 40% of New Zealand households were moderately to severely food insecure. Price increasesworsen food insecurity and health: Kids from food insecure families are more likely to be hospitalizedand in poor health. Iron deficiency anemia, which is associated with poor school performance andirreversible developmental deficits, is 11x more common in preschool children from food insecurehouseholds, and 8x more common in primary grades. Food prices determine not only how much butwhat kind of food people eat. Food insecure adults fill up on cheap empty calories and have increasedrates of obesity and diabetes. In addition to its general impact on the poor, droughts disproportionatelyaffect the nutritional, spiritual, and mental health of aboriginal people who depend on hunting, fishingand gathering as part of their traditional diet and low income rural residents who depend on fishing andhunting to feed their families.AUSTRALIAN DUST/AUCKLAND Loss of surface vegetation during droughts leads to desertexpansion and dust storms. Dust emissions in Australia have doubled since the 1990s. Big Australiandust storms like the ones in 2009 increased particulate levels in the northern half of the North Islandand the West Coast of the South Island. Elevated particulate levels are associated with worsening ofasthma and COPD. In Asia, increased admissions for heart and lung disease are seen for up to monthafter dust storms and studies show transiently decreased pulmonary function in children.Dust storms carry bacteria, fungi, toxins and heavy metals. In Africa dust storms are followed by hugeoutbreaks (like 250,000 people) of meningococcal meningitis. In California and Arizona we are seeingepidemic level increases of coccidiodomycosis or Valley Fever, a fungal pneumonia caused by inhalingdust containing fungal spores.CASE 5 NITRATE TOXICITY 28 year old woman who lives on a dairy farm is in the 6th month ofher second pregnancy. Her midwife gets concerned because stomach isnt growing as fast as it shouldand while waiting in the queue for an ultrasound she goes into labor and delivers a stillborn baby withmultiple birth defects. CLUE Its a drought year. Their water comes from a bore.GROUNDWATER TOXICITY Droughts increase the concentration of contaminants in groundwater, affecting those who get their drinking water from private bores or bore sourced public watersystems like Hahei, Onemana, and Whangamata in Coromandel. Nitrate is the most commoncontaminant in NZ. As you can see from the map, elevated nitrate levels are widespread. Areas at highrisk are those with shallow aquifers and high levels of agricultural nitrogen input. Elevated nitrateintake in pregnant women results in increased rates of miscarriage and congenital defects. In babiesunder 6 months, gut bacteria convert the nitrate to nitrite that binds to red blood cells and preventsthem from carrying oxygen, causing blue baby syndrome. Long term exposure has been associatedwith bladder and gastric cancers.WAIKATO WATER CONTAMINANTS Here are the most recent groundwater test results forWaikato. The community source water samples were all taken from schools.
  • 5. BUSH FIRE Climate change has increased the frequency and size of wildfires. Wildfire smokecontains potent respiratory irritants, carcinogens, nitrogen oxides, VOCs, and fine particulates.The biggest health impacts from fires are from fine particulates. An active wildfire can release as muchas a ton per minute raising the concentration of fine particles in air even many miles away to 7 timesabove safety limits. Fine particles cause upper and lower airway inflammation and can pass from thealveoli into the bloodstream. Studies examining hospital records during and after fires show a rise inER visits, admissions, and deaths for asthma, bronchitis, pneumonia, heart attack and stroke,particularly in the elderly. Studies following the 2003 SoCal fires showed a 34% increase in hospitaladmissions for respiratory conditions, primarily among the very young (under 5) and very old, anddecreased birth weights for babies exposed in utero in any trimester. Fine particulates from fire aremore toxic to the lungs than those from other air pollution. Researchers exposed mice to particulatescollected during the 2008 California fires and found increased protein and leukocytes and decreasedmacrophages on pulmonary lavage compared with equal doses collected from urban sources. Fireecologists in New Zealand predict that fire risk will rise substantially and the fire season will be longer,especially in the Bay of Plenty, the east of both islands and the central Wellington and Nelsonregions. By 2080 the fire risk will more than double for Gisborne, Napier and Christchurch.CASE DIARRHEA A small town GP office is overwhelmed by calls from patients with fever,vomiting, diarrhea and abdominal pain. By the time the cause was found, 125 people had become ill.(Darfield)COMBINED SEWER OVERFLOW Combined sewer overflow is a common type of sewer systemwhere the same pipes that carry away our raw sewage do double duty for storm runoff. When there isheavy rain, these systems are overwhelmed and the water, mixed with sewage, overflows: into streets,rivers and lakes. Auckland and Whangarei dump raw or partially treated sewage in their harborswith heavy rainfall. The health consequences can be severe in locations where surface water is used fordrinking water, like in Thames and most of the Coromandel.GASTROENTERITIS This is why the majority of drinking water contamination cases in urbanwatersheds and nearly 70% of all gastroenteritis outbreaks occur after heavy rainstorms. In 2011, NZhad 45 such outbreaks of gastroenteritis from contaminated drinking water.Children are the ones most likely to get severely ill. This slide shows how childrens visits to theemergency room for gastroenteritis (black line) match up with a model based on heavy rainfall (blueline).Hospital admissions of kids with diarrhea triple after heavy rain.FLOODS due to heavy rain are the most frequent natural disaster in NZ and these will become morefrequent. Coastal flooding and storm surges will increase in the future due to sea level rise and morepowerful storms fueled by warmer ocean temperatures. By 2030 sea level is predicted to rise about 18cm, doubling to tripling the risk of 100 year floods. Sea levels will rise up to a meter by the end ofthe century and flooding is predicted to increase 5 to 20 fold.MOLD Mold is a major health hazard in the aftermath of flooding but it doesnt always take floods togrow mold. New Zealands 89,000 leaky houses, are vulnerable to mold from heavy rainfall. TheUniversity of Otagos Housing and Health Program estimates these homes result in an additional$26 million in health costs every year. Mold exposure triggers exacerbations of allergies and asthma. Itmay be a cause of asthma as well. A researcher at University of Cincinnati has been following a groupof children at risk of asthma due to their family history. He found that children exposed to mold in thehome as infants had 3x higher rate of asthma by age 7.LEPTOSPIROSIS Leptospirosis is a severe infection which causes hepatitis and acute kidney failurethat is transmitted to humans when the urine of infected animals comes into contact with the eyes, nose,
  • 6. mouth or broken skin. Reservoirs include wild mammals, livestock, domestic pets and rats. NZ hasexperience with this as an occupational disease of farmers and meat handlers, but most casesworldwide are caused by contact with flood waters or runoff contaminated with animal urine. InCalifornia lepto is considered an emerging disease with a small but increasing number of human casesin the past decade resulting from recreational contact with contaminated water. Even with recentvaccination programs, lepto is endemic in livestock and working dogs in New Zealand, who present aready reservoir for transmission to humans in the aftermath of heavy rains.ROAD CLOSURES are another consequence of heavy rain that have health consequences in ruralareas because they cut people off from getting to health facilities.PUBLIC HEALTH EMERGENCY We are currently facing what the prestigious UK medical journalThe Lancet has called the greatest public health threat of the 21st century. If we continue what the IPCCcalls “business as usual” well have a 4-6 degree global temperature rise by 2100. Everything Ive toldyou about thats already happening is occurring with a global temperature rise of less than 1 degree.This is a public health emergency, not because everyone will drop dead tomorrow, but because if wedont act soon, it will be too late. The CO2 we put in the atmosphere today will keep warming ourplanet and making people sick for up to 1000 years.SICK PLANET So to sum it all up: If the planet gets sick, we get sick too. Human bodies evolved andcivilizations developed under certain environmental conditions. If we destroy that finely tuned balancebetween ourselves and our environment, chaos ensues.PLANET B You may have noticed that the old, the young, and people with chronic diseases suffermost from climates health impacts because they are more sensitive and less able to adapt. They are likethe canaries in the coal mine whose deaths warned warn miners to ascend when there were toxic levelsof carbon dioxide underground. But when our canaries, our children and our parents, get sick from toomuch carbon dioxide, we have nowhere else to go.Our job is to explain climate change so that people understand that its not an ideological issue but aninexorable fact of nature, happening here and now, which requires urgent action, and cant be adaptedto, ignored, or wished away any more than a tsunami or a hungry great white shark. This slide showand speakers notes is available for you to download and use from our website www.climate911.org andthere are NZ doctors from Ora Taiao who you can call upon as speakers. Thanks for listening and Ihope I didnt spoil your appetite for dinner. Im happy to answer any questions.
  • 7. mouth or broken skin. Reservoirs include wild mammals, livestock, domestic pets and rats. NZ hasexperience with this as an occupational disease of farmers and meat handlers, but most casesworldwide are caused by contact with flood waters or runoff contaminated with animal urine. InCalifornia lepto is considered an emerging disease with a small but increasing number of human casesin the past decade resulting from recreational contact with contaminated water. Even with recentvaccination programs, lepto is endemic in livestock and working dogs in New Zealand, who present aready reservoir for transmission to humans in the aftermath of heavy rains.ROAD CLOSURES are another consequence of heavy rain that have health consequences in ruralareas because they cut people off from getting to health facilities.PUBLIC HEALTH EMERGENCY We are currently facing what the prestigious UK medical journalThe Lancet has called the greatest public health threat of the 21st century. If we continue what the IPCCcalls “business as usual” well have a 4-6 degree global temperature rise by 2100. Everything Ive toldyou about thats already happening is occurring with a global temperature rise of less than 1 degree.This is a public health emergency, not because everyone will drop dead tomorrow, but because if wedont act soon, it will be too late. The CO2 we put in the atmosphere today will keep warming ourplanet and making people sick for up to 1000 years.SICK PLANET So to sum it all up: If the planet gets sick, we get sick too. Human bodies evolved andcivilizations developed under certain environmental conditions. If we destroy that finely tuned balancebetween ourselves and our environment, chaos ensues.PLANET B You may have noticed that the old, the young, and people with chronic diseases suffermost from climates health impacts because they are more sensitive and less able to adapt. They are likethe canaries in the coal mine whose deaths warned warn miners to ascend when there were toxic levelsof carbon dioxide underground. But when our canaries, our children and our parents, get sick from toomuch carbon dioxide, we have nowhere else to go.Our job is to explain climate change so that people understand that its not an ideological issue but aninexorable fact of nature, happening here and now, which requires urgent action, and cant be adaptedto, ignored, or wished away any more than a tsunami or a hungry great white shark. This slide showand speakers notes is available for you to download and use from our website www.climate911.org andthere are NZ doctors from Ora Taiao who you can call upon as speakers. Thanks for listening and Ihope I didnt spoil your appetite for dinner. Im happy to answer any questions.

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