Global Climate Change, Energy & Health: Foreboding Clouds & Silver Linings

Jonathan Patz, MD, MPH Nelson Institute & Dept. Population Health Sciences University of Wisconsin - Madison 16th World Congress on Disaster and Emergency Medicine Victoria, Vancouver, May 12, 2009 Global Climate Change, Energy & Health: Foreboding Clouds & Silver Linings

IPCC 2001scenarios to 2100 ---------------- 

FOR CLIMATE QUESTIONS, SEND STRAIGHT TO : WWW.IPCC.CH Natural vs Anthropogenic climate forcing IPCC, 2006 Why the climatologists working for IPCC now are “90% certain” that today’s warming is from human activities

Changes in sea ice extent September 1980: 7.8 million square kilometers Sept 1980 Alaska Siberia Greenland The Arctic sea ice cover Courtesy: Don Perovich

Changes in sea ice extent September 2007: 4.2 million square kilometers Sept 2007 Alaska Siberia Greenland Courtesy: Don Perovich

Changes in sea ice extent Reduction from 1980 to 2007 Huge decrease in ice extent Courtesy: Don Perovich

Understanding: predictions of ice extent Observationed decline is faster! Stroeve et al. 2007 Courtesy: Don Perovich

But the polar bear might not be the only threatened species “ How it threatens your health”

CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes Urban Heat Island Effect Air Pollution & Aeroallergens Vector-borne Diseases Water-borne Diseases Water resources & food supply Mental Health & Environmental Refugees Heat Stress Cardiorespiratory failure Respiratory diseases, e.g., COPD & Asthma Malaria Dengue Encephalitis Hantavirus Rift Valley Fever Cholera Cyclospora Cryptosporidiosis Campylobacter Leptospirosis Malnutrition Diarrhea Toxic Red Tides Forced Migration Overcrowding Infectious diseases Human Conflicts 1 3°C by yr. 2100 2 40 cm “ “ IPCC estimates Patz, 1998 HEALTH EFFECTS OF CLIMATE CHANGE

Absorbing capacity
The ability to absorb the free energy of an event without sustaining damage
Levees
Building codes
Reforestation
Boarding windows
Bomb shelters
Bullet proof vests
Armor
Air bags
Mitigation is anything done to increase absorbing capacity
Courtesy: Marvin Birnbaum

Buffering Capacity
The ability of a society to cope with damage and to function despite damage
The ability to maintain essential functions for a change in available resources
Backup Generators
Alternate sources of fuel
Shelters
Cross-trained personnel
Wells / rain water
Courtesy: Marvin Birnbaum

HEAT WAVE - EUROPE Heat Index Summer 2003
50,000 deaths in 11 days

Comparing the 2003 Heatwave to past summer climate European heat wave of 2003, from Schär et al., 2004

Probabilities of future extremes can be estimated given projections of mean temperature Peterson et al., 2007 2057 2007

By 2050, warming alone may increase by 68% the number of Red Ozone Alert days across the Eastern US. (IPCC, 2007 -Bell et al, 2006)
“ The severity and duration of summertime regional air pollution episodes are projected to increase in the Northeast and Midwest US by 2045-2052 due to climate-change-induced decreases in the frequency of surface cyclones .” (IPCC, 2007 )

Future summers warmer than warmest on record
Today’s 800 million at risk for hunger could double by mid-century.
Battisi and Naylor, Science 2009

Sensitivity of cereal yield to climate change IPCC 2006

27% of reefs considered to be dead – at least half of these attributed to climate change

Relationship between temperature and malaria parasite development time inside mosquito (“extrinsic incubation period” or EIP). EIP shortens at higher temps, so mosquitoes infectious sooner.

Relationship between malaria and altitude, Zimbabwe. Altitude a good surrogate for temperature: the average temperature decrease with height = 6°C per 1000 meters Source: Taylor and Mutambu, 1986

Baseline 2000 2025 2050 2075 2100 Source: Ebi et al, 2005

Daily hospitalizations for diarrhoea, by daily temperature, Lima, Peru. (Shaded region corresponds to 1997-98 El Niño event) Checkley et al, Lancet 2000 (J. Patz PI) Daily hospitalisations for diarrhoea Daily temperature 1997 1993 Overall estimate from regression analysis: 7% increase in daily cases per 1 o C rise 5 o C +33% El Niño

Climate change: It’s not just about warming.

Floods

USA: Combined sewer overflows (CSOs) Courtesy: Kellogg Schwab 1.2 trillion gal of sewage & stormwater a year discharged during combined sewer overflows – would keep Niagara Falls roaring for 18 days Center for Water & Health, JHU Bloomberg School of Public Health

Extreme Precipitation and Waterborne Disease Outbreaks in the United States, 1948 -1994 Project Sponsor: US EPA, Office of Research & Development PI: J. Patz

Results
67% of waterborne disease outbreaks were preceded by precipitation above the 80th percentile (across a 50 yr. climate record), p < 0.001
51% of outbreaks were preceded by precipitation above the 90th percentile, p < 0.002
Surface water-related outbreaks had strongest correlation with extreme precipitation in the month of outbreak; groundwater-related outbreaks lagged 2 months following extreme precipitation.
Curriero, Patz, et al, 2001.

Milwaukee 1993 Cryptosporidiosis epidemic 405,000 exposed 54 fatalities Preceded by heaviest rainfall in 50 years

U.S. CCSP, 2008 Globally Averaged

Projected Changes in Extremes Globally IPCC (2007)

CLIMATE & LAND USE SYNERGY Hurricanes Mitch & Katrina

~ 9,600 people perished , widespread water- and vector-borne diseases followed, and nearly one million people were left homeless . Areas with extensive deforestation or degraded hillsides suffered the greatest morbidity and mortality and point to the importance of vegetation cover and as a buffer to severe floods, and the long-term prevention of injuries and fatalities

wetland loss in the Mississippi delta (1839 to 2020) Barataria-Terrebonne Estuary Program 1839 1870 1993 2020

New Orleans after Hurricane Katrina

How will climate change affect coastal populations? Estimated population impacted by sea level rise for selected counties, 2030 Dr. Annemarie Shneider (SAGE)

Ethics Climate Change and Health

Patz, Gibbs et al. 2007 Americans emit 6-times the global average CO 2 per capita Based on Smith et al. 2004. Distribution of 166,000 deaths/yr from recent warming. Based on McMichael et al 2004.

Key reason for banning smoking. Shouldn’t we consider climate change in the same way?

Patz, Gibbs et al. 2007

Millennium Development Goals (MDGs) 1- Eradicate extreme poverty and hunger 2- Achieve universal primary education 3- Promote gender equality and empower women 4- Reduce child mortality 5- Improve maternal health 6- Combat major diseases (HIV/AIDS, malaria, others) 7- Ensure environmental sustainability 8- Develop a global partnership for development Might climate change reverse progress on these priority fronts?

Source: National Geographic “ GROWING FUEL: The Wrong Way: The Right Way” October, 2007, National Geographic BIOFUELS: Where climate change, land use, energy, and health concerns come together … that is, the cure must not be worse than the disease!

Biofuels and Food Security
The amount of humanitarian food aid available for extremely impoverished countries will be affected in the short term as food aid shipments from the USA are inversely correlated to commodity prices
(Naylor et al. 2007)
For every percentage increase in the real prices of staple foods, 16 million more people could become food-insecure (Runge, 2003)

The Good News about climate change and our health

Energy consumption per person and life expectancy Wilkinson et al, 2007

The opportunity for improving health determinants We can reduce: The 800,000 annual deaths from urban air pollution The loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity WHO, 2007

Status of Americans
≈ 2/3 U.S. adults ≥ 20 are overweight or obese
≈ 15 % of children and adolescents age 6-19 are overweight (CDC 2004).
20.8 million people have diabetes (7% of the population) (CDCP 2005)
60% of American adults do not meet recommended levels of physical activity, and 25% are completely sedentary (DHHS, 1996)
40% of trips by car are < 2 miles (Dept of Transportation)

Ten Leading Causes of US Deaths per Year (CDC, 2004)

Percentage of trips by transport mode for US work trips 1960-2000 TRENDS IN TRANSPORTATION: Reliance on our cars

1/3 of US CO 2 emissions come from transportation sector Gurinder Osan/Associated Press US Dept. of Energy, 2005

Triple Win Bike Project
Health (personal)
Local Air Pollution (local)
Global Climate Change (global)
… Why global climate change could be the greatest public health opportunity we’ve had in over a century!

Health and Personal Fitness
(personal)
2. Health and Local Air Pollution (local) 3. Greenhouse Gas Emissions and Global Climate Change (global) Triple Win Bike Project

Calculating the Health/Fitness Benefits of Bicycling
Displays and Records
Current and Average Power
Heart Rate
Cadence
Speed
Energy Expenditure
Ride Distance
Ride Time
CycleOps PowerTap -- gives you access to real-time performance measurements Lance Armstrong

Personal Fitness and Health
Average Bicycle Commute in Madison is 3.4 miles
Energy Expenditure: 144 kcal round trip
Around 200 minutes additional physical activity
9-10 lbs weight loss in year
Reduce risk of ischaemic heart disease by 47%
Reduce risk of stroke by 39%
Reduce risk of breast cancer for women by 34%
Reduce risk for colon cancer by 43%
Reduce risk for type II diabetes by 31%
WHO, CRA 2002

Evolution of CDC Physical Activity Recommendations
OLD: sporadic, intense training, 3-5 times per week
NEW: 30 minutes, moderate activity, preferably every day, either in a single session or in multiple bouts, each lasting at least 8–10 minutes
Added value of commuting by bike?

The Heat Island

Heat early-warning systems save lives Figure 3: Summer daily heat-index measures, heat-related mortality, and heat-related emergency medical service (EMS) runs: Milwaukee, WI, 1995 and 1999 (Source: Weisskopf, Anderson, Foldy, Hanrahan et al. 2002).

(personal)
2. Health and Local Air Pollution (local) 3. Greenhouse Gas Emissions and Global Climate Change (global) Triple Win Bike Project

Asthma and Air Pollution Friedman et al. JAMA 2001;285:897
Asthma -related emergency room visits by children decreased 42%
Children’s emergency visits for non-asthma causes did not change during same period
Natural experiment during 1996 Summer Olympic games in Atlanta
Peak morning traffic decreased 23% and peak ozone levels decreased 28%

Air Quality and Human Health If 20% of car trips in Madison replaced by bicycle trips… 12.21% ozone reduction & 2.07% PM 2.5 reduction 1,906 fewer asthma cases per yr 4,765 fewer missed days of school per yr 14,587 fewer cases of acute respiratory symptoms/yr Save over $40 million in costs from reduced exposure to ozone and particulate matter

Money Saved from Reduced Ozone Exposure Per Year - Madison $ 17,454,707 /year Total $ 15,910,536 / year Mortality $ 759,018 / year Acute Respiratory Symptoms $ 357,299 / year School Loss Days $ 179,901 / year Worker Productivity $ 147,498 / year Asthma Exacerbation $ 99,391 / year Hospital Admissions $ 1,064 / year Emergency Room Visits

(personal)
2. Health and Local Air Pollution (local) 3. Greenhouse Gas Emissions and Global Climate Change Triple Win Bike Project

Greenhouse Gas Mitigation If 20% of car trips in Madison replaced by bicycle trips… 33,374,395 lbs CO 2 saved (16,687 tons) 4.2% reduction in the total amount of carbon dioxide emissions in Madison

Urban planning is public health and disaster planning policy!

“ Be the change you wish to see in the world.” Gandhi

Thank you! [email_address] www. sage.wisc.edu

A cautionary note

All Eyes on Biofuels Number of Scientific Articles with keyword “ biofuels ” Matt Johnston, SAGE, UW-Madison

All Eyes on Biofuels… Biofuels Binaries: Not an simple black-or-white issue Matt Johnston, SAGE, UW-Madison

Overabundant distiller waste from corn ethanol Distillers grains fed to cattle
10X higher prevalence of E. coli O157:H7 (15% vs. 1.5%) in feces of cattle fed distillers grains vs. corn. (USDA, 2008)
Research Project “Effect of Distillers Grains on E. Coli O157:H7 in Finishing Feedlot Cattle,” USDA ARS Meat Safety and Quality Research Division . As reported by Mark Steil, Minnesota Public Radio, October 17, 2008. http://minnesota.publicradio.org/display/web/2008/10/17/e_coli/
Couresy: David Wallinga

Diesel and fertilizer to produce corn for ethanol production results in more PM 2.5 than burning the equivalent amount of gasoline ! Hill et al. unpublished data Life Cycle Analysis shows need for Health Impact Assessment in Energy Policy

Billions of gallons of water consumed Source: IATP 2006 ethanol and water report Ecosystem impacts More corn ethanol = Less water Couresy: David Wallinga

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Global Climate Change, Energy & Health: Foreboding Clouds & Silver Linings

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