Beating the Heat: Public Health andClimate Change

Southern California Public Health AssociationAnnual 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

Presentation AgendaI. Defining the problem of climate change

I. Why should Public Health care?

II. Discussing the impacts of climate change

I. Global impactsII. Local impactsIII. Health impacts

III. Climate Change and Los AngelesIV. Issuing the challenge

I. Defining the Problem

Defining Climate ChangeUnited 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 warmingAn increase in average global temperatures

Six gases are considered contributors to global warming

Carbon dioxide Methane Nitrous oxides Three fluorinated industrial gases

Basic Mechanism of Global Warming = Greenhouse Effect

Source: U.S. Environmental Protection Agency

IPCC 2007: Warming is Unequivocal

Source: IPCC 2007 (4th Assessment)

IPCC 2007: Human Impact is Evident

Source: IPCC 2007 (4th Assessment)

Discrepancy Between Emitters and Where Impacts of Climate Change Are Felt

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 world’s 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

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)

Source: U.S. Greenhouse Gas Emissions Inventory

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

U.S. CO² Emissions from Fossil Fuel

Worldwide Effects of Global WarmingGlobal climate has warmed by about 1° F over the

last 100 yearsWorldwide effects are manifested by the

destabilization of natural systems

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

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

Why Should Public Health Care?• It is our job to protect the public’s 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

II. Impacts of Climate Change

Potential Health Effects of Climate Change

Source: Dr. Howard Frumkin

Source: Epstein, Harvard Center for Health & Global Environment

Extreme Weather Events & Disease Clusters

Source: Epstein, Harvard Center for Health & Global Environment

Potential Environmental Impacts inSouthern California of Changing WeatherGlobal 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 floodingIncrease 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 smogIncreased temperature elsewhere → sea level rise everywhereChange in habitat suitability for vectors → shifts in vector-borne

disease distribution

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 agricultureGreater risk of wildfiresAdverse impact on fauna

(disruption of food chains, stress placed on fisheries and endangered species)

Stronger downpours lead to potential:Mudslides/erosionFlash flooding

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

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

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

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 futureBy 2020, there will be a twofold increase in the

number of days over 90°F in L.A.By the 2080s, the number of days above 90°F in

L.A. will increase from an average of 4 days a year to 14 to 37 days a year

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 recently5-day heat wave in Chicago in 1995: 700 excess deaths,

most attributed to the heatAugust 2003 European heat wave: 35,000 excess deaths

Heat Waves: Vulnerable Populations

Greater risk for people who do not have access to air conditioningMay not be able to afford air

conditioningFor 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 (> 60 years old) in Los Angeles

County is expected to increase by 83% by the year 2020Low SES: Over 16% of LA County residents under 100% FPL

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

Potential Environmental Impacts in So.Cal. of Climate Change: Air Quality

CA ozone standard

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)

III. Climate Change and Los Angeles

A Public Health Responseto Climate Change

Public health already utilizes a multi-level prevention approach – analogous approach can be taken to respond to climate changePrimary prevention = climate change mitigation

Efforts to slow, stabilize, reverse climate change by reducing GHG emissionsEfforts will occur in sectors other than PH, such as energy and transportation

Secondary/tertiary prevention = climate change adaptationEfforts to prepare for, and minimize health burden of, climate changeSimilar 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

What Should We Do?1. Mitigation = reduce GHG emissions

1. Reduce energy usage and Reduce, Reuse, Recycle1. As individuals, at home2. As organizations, at work

2. Adaptation = prepare for impact of climate change

1. Emergency preparedness1. As individuals/families2. As local health department

3. Mitigation and adaptation = advocate for healthy policies

1. Support legislation that reduces GHG emissions2. Support sustainable lifestyles & communities

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

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 don’t 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%

Adaptation: Emergency PreparednessWe need to prepare now for the inevitable

effects of climate change, such as heat waves and wildfiresGood 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

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 kitKnow what to do in specific types of emergencies

Check out www.labt.org for preparedness resources

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

Promoting Healthy Policies –CA’s Global Warming Legislation

AB 1493: California’s 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 2009Would reduce GHG emissions from cars in CA by 18% (30 m.

tons) by 2020, and by 27% (50 m. tons) by 2030Impact would be much greater, as over a dozen other states have

adopted CA’s proposed standardsBut running into roadblocks with Federal EPA and

current administrationEPA blocked implementation of CA’s proposed standards, now

states are suing the EPA

Promoting Healthy Policies –CA’s 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.

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 nation’s 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

diseasesSource: US Dept of Energy, 2007

Los Angeles County’s 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 County’s 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 County’s 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

We Can’t Do It AloneSo why should we bother?

Efforts will yield long-term savingsWill make our economy more competitiveThe co-benefits are greatWill improve the sustainability of our

communitiesMoral obligation – if we care about the health

of our communities, then we need to do our part

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 tooStrategy: reducing vehicle miles traveled

Primary result = lower motor vehicle GHG emissionsCo-benefit = higher physical activity rates

Strategy: promote cleaner energy production and cleaner fuelsPrimary result = reduced GHG emissions from energy productionCo-benefit = less air pollution = less respiratory distress

Source: Frumkin, et. al., AJPH March ‘08

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

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)

Lungs of a non-smoker as affected by air pollution (source: AQMD)

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

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

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

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)

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)

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 California’s air quality standards would exceed costs by a 3:1 ratio ***

*Source: California Air Resources Board, 2005; **Source: California Resource Board;

*** Source: US Environmental Protection Agency; ****Source: South Coast AQMD

IV. Issuing the Challenge

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!

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

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

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 Districthttp://www.aqmd.gov/

California Air Resource Boardhttp://www.arb.ca.gov/homepage.htm

LA County Public Health – Healthy People Build Healthy Communities