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Climate and Health: The Nutshell View
- 1. Climate and Health: The Nutshell View February 27, 2019 Robert Byron, MD, MPH
- 2. Climate Change is not about Temperature! 2 Charles Pierce 4/5/2016 Esquire
- 3. Boiling Frog Effect “Rapidly declining remarkability of temperature anomalies may obscure public perception of climate change” “We provide evidence for a “boiling frog” effect: The declining noteworthiness of historically extreme temperatures is not accompanied by a decline in the negative sentiment that they induce, indicating that social normalization of extreme conditions rather than adaptation is driving these results.” “ . . . reference point for normal conditions appears to be based on weather experienced between 2 and 8 y ago.” Rapidly declining remarkability of temperature anomalies may obscure public perception of climate change Frances C. Moore, Nick Obradovich, Flavio Lehner, Patrick Baylis Proceedings of the National Academy of Sciences Feb 2019, 201816541; DOI:10.1073/pnas.1816541116
- 4. 200,000 premature deaths 180,000 nonfatal heart attacks 150,000 hospitalizations 130,000 ER visits for asthma 18 million lost work days 11 million missed school days lung cancer, strokes, fetal harms, links to learning and behavior problems in children, diabetes and dementia Air Pollution Damages Our Health Shindell,D. Societal Benefits from Reductions in Emissions of Methane and Black Carbon. Drew Shindell. Written Testimony to the Senate Committee on the Environment and Public Works Hearing on the Super Pollutants Act of 2014 . Dec 2,2014 http://sites.nicholas.duke.edu/drewshindell/files/2015/01/Senate_EPW_testimony_Dec2014_Shindell_ v3.pdf Fabio Caiazzo, Aksshay Ashok, Ian Waitz, Steve H.L. Yim, Steven R.H. Barrett. Air pollution and early deaths in the united States. Part I: Quantifying the impact of major sectors in 2005. Environment volume 79, Nov 2013, 198-208. http://doi.org/10.1016/j.atmosenv.2013.05.081
- 5. Fetuses and Particulate Matter and Ozone http://www.nydailynews.com/life-style/health/cigarette-smoking- all-time-american-adults-article-1.2541307 http://www.publicdomainpictures.net/hledej .php?hleda=forest+fire http://www.publichealthnewswire.org/?attachment_id=396 7 https://www.travelblog.org/Photos/441840?7220299:4474644:16122 43:1516913:1516907:1516904:1516900:1348086:884819:769027:768 951:767283:749709:441840:386458:386331:386138:386085:355538:2 50424
- 6. Take home message: air quality worsens with climate change Particles: linger with stagnant air; smoke increases with forest fires. Ozone is worse when it is hot (summer afternoons especially) Allergens are increasing with warmer temperatures About 10% of the U.S. population has either Asthma or chronic lung disease Heat & air pollutants cause worsening symptoms, more ER visits and hospitalizations http://ephtracking.cdc.gov/showAsthma.action Franchini & Mannucci, 2015; GOLD, 2015; Halonen et al., 2009
- 7. Health Impacts Heat-related illnesses Cardiopulmonary illnesses Infectious diseases: Food-, Water- & Vector- borne diseases Mental health issues
- 8. Mental Health/Stress- Related Disorders Temp increase 0.5 degrees F results in more violent behavior Suicide rates increase with higher temperatures PTSD, anxiety common after hurricanes (Katrina), floods, heat waves, possibly wildfires Drought is slow, sustained, compared with most weather events Loss of community cohesion and sense of belonging, inc violence & crime Heat waves contribute to more alcohol and substance abuse. Prenatal air pollution exposure increases schizophrenia and autism risk to the unborn child
- 9. Heat Dehydration, heat stroke Respiratory, cardiac, circulatory and cerebrovascular (stroke) conditions Risk of death on a heat day was 10% greater than on a non-heat day.1 1. Isaksen, T., Fenske, R., Hom, E., Ren, Y., Lyons, H., & Yost, M. (2016). Increased mortality associated with extreme-heat exposure in King County, Washington, 1980–2010. International Journal of Biometeorology, 60(1), 85–98. doi:10.1007/s00484-015-1007-9
- 10. Infectious Diseases Spread of mosquito and tick vectors: Lyme Disease, West Nile; Aedes aegypti and Aedes albopictus mosquitos: Dengue, Yellow Fever Water-borne outbreaks due to flooding and resulting drinking water contamination. Increased risk of GI outbreaks with both flooding and drought.
- 11. Mosquito Borne Disease Johnson TL et al. “Modeling the environmental suitability for Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus (Dipter: Culicidae) in the contiguous United States.” Jrl Med Entomol. Sept. 2017
- 12. Wildfires Increased intensity, frequency, duration and acres burned Increased exposure to PM Studies strongly associate wildfire smoke with increased respiratory symptoms and all-cause mortality, less clearly with cardiac events and pneumonia.
- 13. Rice Ridge/Seeley Lake Fire 2017 ED Visits: July 24-Sept 7 378 ED visits by Missoula and Powell County residents for respiratory symptoms, compared with 163 in 2016. 2.3 times higher Elderly (65 and over): 111 visits, compared with 39 in 2016. 5-17 year olds: 21 visits, compared with 14 in 2016.
- 15. Allergies Will Be Much Worse by 2040 2040 Grains of pollen per cubic meter: 21,735 2000 Grains of pollen per cubic meter: 8,455 Average pollen counts are specific to North America
- 16. CO2, Global Warming and Crops Increased CO2 decreases protein content in grains Zinc and iron content are also decreased. Increased temperature decreases productivity of grains
- 17. Questions?
- 18. References USGCRP, 2016: The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. Crimmins, A., J. Balbus, J.L. Gamble, C.B. Beard, J.E. Bell, D. Dodgen, R.J. Eisen, N. Fann, M.D. Hawkins, S.C. Herring, L. Jantarasami, D.M. Mills, S. Saha, M.C. Sarofim, J. Trtanj, and L. Ziska, Eds. U.S. Global Change Research Program, Washington, DC, 312 pp. http://dx.doi.org/10.7930/J0R49NQX NCA 4: USGCRP, 2018: Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II [Reidmiller, D.R., C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart (eds.)]. U.S. Global Change Research Program, Washington, DC, USA, 1515 pp. doi: 10.7930/NCA4.2018. Reid, C. E. et al. Critical Review of Health Impacts of Wildfire Smoke Exposure. Environ Health Persp 124, 1334–1343 (2016). Cascio, W. E. Wildland fire smoke and human health. Sci Total Environ 624, 586–595 (2018).
- 19. Links NCA 4: https://nca2018.globalchange.gov/downloads/NCA4_Ch14_Human- Health_Full.pdf Medical Society Consortium: Medical Alert! Climate Change is Harming our Health, https://medsocietiesforclimatehealth.org/wp- content/uploads/2017/03/gmu_medical_alert_updated_082417.pdf APHA: Adaptation in Action, Part II, https://www.apha.org/- /media/files/pdf/topics/climate/adaptation_in_action_part_2.ashx
- 20. Robert Byron, MD: rgbyron@gmail.com Contact Information
Editor's Notes
- Why do we care about climate change? For many, it is because it affects us as human beings. It affects our health. health impacts of climate change are most felt by the poor and vulnerable in countries that have done the least to cause it. Despite this, To get action in the US Congress we need to focus on effects here and now, so this talk will focus on US impacts. *So a talk on climate change is not a talk about science, though science and economy and politics are the basis. It is about human suffering - something that touches us all, especially those of us in the healthcare field who are pledged to alleviate suffering. My heart aches every time I see this photo and the caption - that Americans are dragging their feet. So although global impacts are extremely important, the focus of this talk will be on how health is impacted in America, so you can talk to others and Representatives to get action here. source: charles pierce 4/5/2016 esquire likens climate denial to the attempts to deal with the slavery crisis by not talking about it. -congressional gag rule of1836-politicians just won’t talk about it ‘will it take an epidemic of food poisoning or suicides before we “bestir”ourselves?
- Each year in the US. Shindell,D. Societal Benefits from Reductions in Emissions of Methane and Black Carbon. Drew Shindell. Written Testimony to the Senate Committee on the Environment and Public Works Hearing on the Super Pollutants Act of 2014 . Dec 2,2014 http://sites.nicholas.duke.edu/drewshindell/files/2015/01/Senate_EPW_testimony_Dec2014_Shindell_ v3.pdf Fabio Caiazzo, Aksshay Ashok, Ian Waitz, Steve H.L. Yim, Steven R.H. Barrett. Air pollution and early deaths in the united States. Part I: Quantifying the impact of major sectors in 2005. Atmospheric Environment volume 79, Nov 2013, 198-208. http://doi.org/10.1016/j.atmosenv.2013.05.081 Women at the heart of their families health care and well being; these issues affect them
- Fetuses are profoundly sensitive to the PMs breathed in by their mothers. They have found that any PM breathed by the mother puts the fetus and young infant at risk. The PM can be from any source. In the US, they estimate that 3% of premature births - or 16,000 preemies a year and 4B $ for the newborn hospitalizations are due to the burning of fosil fuels. https://ehp.niehs.nih.gov/15-10810/ - 3% of US preemies
- --Heat waves contribute to more alcohol and substance abuse2 --People with mental illness may be more susceptible to heat,9 --Some medications used to treat schizophrenia can interfere with temperature regulation14 Medications with anticholinergic properties include antihistamines, parkinsonism medication, atropine/scopolamine and the other belladonna alkaloids, neuroleptics, antispasmodics, Photo: http://www.nationalreview.com/corner/426463/murphy-mental-health-bill-set-markup-ian-tuttle Mental Health: Temp and violent behavior: Doherty T.J., Clayton, S. “The Psychological Impact of Global Climate Change.” American Psychologist 2011; 66(4): 265–276. Suicide Rates Increase with temp Doherty T.J., Clayton, S. “The Psychological Impact of Global Climate Change.” American Psychologist 2011; 66(4): 265–276. Increased alcohol and substance abuse: Bulbena A, Sperry L, Cunillera J. “Psychiatric effects of heat waves.” Psychiatric Services 2006; 57(10): 1519- 1519. Extreme Weather Events and Mental Health: http://www.ptsd.va.gov/professional/trauma/disaster-terrorism/traumatic-effects-disasters.asp Drought and Mental Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682759/ Loss of Community Cohesion: http://ecoamerica.org/wp-content/uploads/2014/06/eA_Beyond_Storms_and_Droughts_Psych_Impacts_of_Climate_Change.pdf Autism: http://ehp.niehs.nih.gov/1307984/#r43
- For most of the period, comparable to breathing second hand smoke, and for the worst periods, comparable to smoking an unfiltered cigarette continuously due to particulate matter ingestion.
- ID #3472 - May not be modified or used in presentations that are recorded, streamed, or broadcast.
- ID #792.B - Can be used in noncommercial online and TV broadcasts of your presentation, but not modified. Average grains of pollen per cubic meter, by 2040, triples. DESCRIPTION: Text slide about how allergies are projected to be much worse in 2040 due to higher pollen counts in the air ADDITIONAL TALKING POINTS: To put it simply, climate change is stacking the deck against a healthy human population. Vector-borne diseases, heat stress, air pollution, and waterborne diseases are all influenced by a changing climate – and not in our favor. Two major impacts that are driving changes in the global health system are increased average temperatures and changing rainfall patterns. Both factors affect the food we eat, the water we drink, the air we breathe, and the weather we experience.[1*] Climate change has increased the number of extreme heat days in many parts of the world. [2*] The Intergovernmental Panel on Climate Change has stated that it is “virtually certain” that by the end of the twenty-first century the Earth will experience an increase in the frequency and magnitude of unusually warm days and nights. Extreme heat can have many impacts on human health including: increased muscle pains or spasms, heat exhaustion, heat stroke, and exacerbated respiratory and cardiovascular issues. The poor, the elderly, the young, those with pre-existing medical conditions (especially cardiac and respiratory conditions), as well as the mentally ill, are the most vulnerable to extreme heat. In 2003, for example, Europe was hit by a major heatwave that caused an estimated 70,000 deaths. [3*] These events have occurred all over the world; another example occurred in southern Pakistan in June 2015, when more than 800 people died during an extreme heatwave.[4*] In the US, extreme heat events cause more deaths annually than hurricanes, lightning, tornadoes, floods, and earthquakes combined.[5*] Rising global average temperatures also have widespread health consequences beyond the direct impacts of events like heatwaves. For instance, this warming can allow for vectors – small organisms such as mosquitos or ticks that can carry diseases – to expand their habitat ranges.[6*] We see this happening now as several diseases have spread to new areas in recent years. From malaria reaching the highlands of eastern Africa to the rising incidence of Lyme disease in North America, studies are increasingly naming the changing climate as a contributing factor. Additionally, warmer temperatures can increase the number of days that are conducive for many vectors to reproduce, while in some cases allowing them to reproduce faster. This is because some vectors — like mosquitoes — mature faster in warmer temperatures. Compounding the problem, some viruses incubate faster inside mosquitos and other vectors when temperatures are hotter, again expanding the amount of time a vector is dangerous to human health. Mosquitos are one of the most prominent vectors for tropical diseases. Recent research suggests that under a worst-case scenario involving continued high global emissions coupled with fast population growth, the number of people exposed to the principal Zika-carrying mosquito—known as the Aedes aegypti mosquito— could rise to as many as 8-9 billion by late this century, compared to the current 4 billion people today. Zika is a worldwide epidemic that has recently spread to Puerto Rico, Brazil, Indonesia, Venezuela, Mexico, the United States, and many other nations. Pregnant women, or those trying to become pregnant, are one of the most at-risk groups to the Zika virus because it can cause birth defects like microcephaly and other severe fetal brain problems.[7*],[8*],[9*],[10*] The Aedes aegypti mosquito can also spread other diseases like dengue fever and yellow fever. While Zika has gotten a lot of the attention in recent years, dengue fever is estimated to kill 20,000 people per year. In 2015, it killed 839 people in Brazil alone, a 40 percent increase from the previous year.[7*] Burning fossil fuels contributes to global warming as well as local and regional air pollution.[1*] Worldwide, air pollution kills approximately an average of 6.5 million people annually.[11*] In 2016, Zabol, Iran was named the most polluted city in the world by the World Health Organization when measuring fine particulate matter, or particulate matter in the air that measures about 2.5 micrometers (PM 2.5), and Onitsha, Nigeria was named the most polluted city in terms of slightly larger particulate matter that measures about 10 micrometers (PM 10).[12*] Air pollutants from dirty energy are not the only particulate matter in the air that we need to worry about, either. In fact, by 2040, pollen levels are projected to increase, which will cause some people’s allergies to become more severe. In 2000 on average, there were slightly less than 8,500 grains of pollen per cubic meter of the air, but studies suggest that in 2040 there could be almost 22,000 grains of pollen per cubic meter on average, nearly three times more than we see today.[13*] If increasing heatwaves, vector-borne diseases, and air pollution were not enough, climate change is also creating more favorable conditions for the spread of waterborne diseases.[1*] As discussed earlier, warmer air holds more water, which is increasing the number of heavy downpours in many places around the world. Combine this increase in downpours with rising temperatures, and it can create more favorable environmental conditions for the growth, survival, and spread of waterborne diseases. In the US, waterborne pathogens are estimated to cause 8.5 to 12 percent of acute gastrointestinal illness cases, affecting between 12 and 19 million people annually.[14*] Globally, the World Health Organization asserts that contaminated drinking water is estimated to cause 502,000 diarrheal deaths each year. [15*] REFERENCES: [1*] The US Global Change Research Program, “Climate and Health Assessment: Climate Change and Human Health,” last accessed July, 2017. https://health2016.globalchange.gov/climate-change-and-human-health [2*] US Environmental Protection Agency, “Climate Change Indicators: High and Low Temperatures,” last updated December 17, 2016. https://www.epa.gov/climate-indicators/climate-change-indicators-high-and-low-temperatures [3*] Physicians for Social Responsibility, “Heat’s Deadly Effects,” last accessed July, 2017. http://www.psr.org/resources/heats-deadly-effects.html [4*] Adil Jawad, “Heat wave subsides in Pakistan as death toll reaches 860,” Phys.org (blog), June 25, 2015. http://phys.org/news/2015-06-subsides-pakistan-death-toll.html [5*] Climate Communication, “Heat Waves: The Details,” last accessed July, 2017. https://www.climatecommunication.org/new/features/heat-waves-and-climate-change/heat-waves-the-details/ [6*] Climate Nexus, “Climate Change and Vector-Borne Diseases,” last accessed July, 2017. http://climatenexus.org/learn/public-health-impacts/climate-change-and-vector-borne-diseases [7*] Justin Gillis, “In Zika Epidemic, a Warning on Climate Change,” The New York Times, February 20, 2016. http://www.nytimes.com/2016/02/21/world/americas/in-zika-epidemic-a-warning-on-climate-change.html?_r=1 [8*] Seth Borenstein, “Zika Mosquito Likes Higher Temperatures,” US News, February 3, 2016. http://www.usnews.com/news/world/articles/2016-02-03/higher-temperatures-makes-zika-mosquito-spread-disease-more [9*] European Centre for Disease Prevention and Control, “Current Zika transmission,” last updated accessed July, 2017. http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/zika-outbreak/pages/zika-countries-with-transmission.aspx [10*] Centers for Disease Control and Prevention, “Zika Virus—Women and Their Partners Trying to Become Pregnant,” last updated May 25, 2017. https://www.cdc.gov/zika/pregnancy/women-and-their-partners.html [11*] World Energy Outlook, “Energy and Air Pollution” International Energy Agency (2006). http://www.iea.org/publications/freepublications/publication/WorldEnergyOutlookSpecialReport2016EnergyandAirPollution.pdf [12*] Adam Taylor, “The Most Polluted City in the World isn’t Beijing or Delhi,” The Washington Post, May 13, 2016. https://www.washingtonpost.com/news/worldviews/wp/2016/05/13/the-most-polluted-city-in-the-world-isnt-beijing-or-delhi/ [13*] John Platt, “Pollen counts — and allergies — expected to double by 2040,” Mother Nature Network (blog), March 25, 2013. http://www.mnn.com/health/allergies/stories/pollen-counts-and-allergies-expected-to-double-by-2040 [14*] J. M. Trtanj, et al., “Ch.6: The Impacts of Climate Change on Human health in the United States: A Scientific Assessment” (US Global Change Research Program, 2016). https://health2016.globalchange.gov/water-related-illness [15*] World Health Organization, “Drinking Water,” last updated November 2016. http://www.who.int/mediacentre/factsheets/fs391/en/
- Studies with wheat, rice, maize, and soybeans show that protein levels are lowered 6-8 % when they are grown in higher CO2 levels. The resulting increase in carbohydrate in the crops could increase the rate of metabolic syndrome, diabetes, heart disease and stroke that currently afflicts many in minority countries due to high levels of obesity. The decreases in nutrition will obviously affect the majority countries, leading to more malnutrition, especially protein-energy malnutrition, or kwashiorcor. 4 Zinc and iron levels fall also, and 2 billion people in the world (primarily in Africa and SouthEast Asia) already suffer from deficiencies of both of these (mostly in majority nations). For wheat, a 1° Celsius increase (1.8° Fahrenheit) in projected mean temperature was found to decrease wheat yields by nearly 21 percent.6 We initially thought that higher CO2 levels would be beneficial to crops but research is refuting this. Picture: http://www.dreamstime.com/stock-photography-few-ears-wheat-image14920922 Myers SS, Zanobetti A, Kloog I, et al. Increasing CO2 threatens human nutrition. Nature 2014; 510: 139–42.