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Climate Change, Health and Health Equity Subtitle or training audience/location Date Acknowledgments Kaiser Permanente The Kresge Foundation California Medical Association Foundation National Ethnic Physicians Organization National Medical Association & Golden State Medical Association page 2 |© 2016 Public Health Institute/Center for Climate Change and Health A Physician’s Guide to Climate Change, Health and Equity Climate change 101 Climate change and health equity Physician surveys on climate change Specific climate change impact on health Heat Drought Wildfires Rainfall and Storms Sea Level Rise Allergens Air Quality Infectious Disease Food Security Mental Health page 3 |© 2016 Public Health Institute/Center for Climate Change and Health Special focus areas Children Workers Pregnant women Co-benefits of climate action Transportation Solutions Energy solutions Food system solutions Urban greening solutions Climate Change 101 Climate vs. weather Warming of earth’s surface and oceans Emissions Carbon dioxide Methane Nitrous oxide Black carbon Potent climate pollutants page 4 |© 2016 Public Health Institute/Center for Climate Change and Health Why 1.5oC? In order to avoid catastrophic impacts of climate change, including the ability of human life to adapt and continue on the planet, the earth’s average global temperature cannot rise more than 1.5oC above preIndustrial levels. Currently, the planet is on track for a 4oC rise, making the earth uninhabitable. To stay below 1.5oC, we must remain within our carbon budget, or the total amount of carbon-equivalent emissions that would raise temperatures past 1.5oC. At current emissions rates we will blow through the budget in about 5 years. Climate Change and health: what physicians think • Climate change relevant to direct patient care: 86% • My patients are already being affected by climate change: 79% • Extreme weather events and wildfires 88% • Chronic disease due to air pollution 88% • Increase in allergy symptoms 80% • Heat related illness 75% • Vector borne illness 58% • Food and waterborne illness 56% Safarty, M., Mitchell, M., Bloodhart, B., Berg, C., & Maibach, E. (2014). Key findings National Medical Association Physician Survey. George Mason University Center for Climate Change Communication page 5 |© 2016 Public Health Institute/Center for Climate Change and Health “My patient experienced atrocities during Hurricane Katrina. As a result, she had PTSD and severe depression that prevented her from holding a stable job.” “…the area in which I work has been affected by increased flooding and increased snowfall which has increased episodes of back injury from snow and water removal.” Climate Change 101 Photo credit: US Global Change Research Project Climate and Health Assessment page 6 |© 2016 Public Health Institute/Center for Climate Change and Health Climate Change and Health Equity: The Climate Gap "Social injustice is killing people on a grand scale.” WHO Commission on the Social Determinants of Health, 2008 “…climate change is a ‘threat multiplier’… [that] will intensify the challenges of global instability, hunger, poverty and conflict.” U.S. Secretary of Defense Chuck Hagel page 7 |© 2016 Public Health Institute/Center for Climate Change and Health Extreme Heat Leading cause of weather related deaths Exacerbates cardiovascular, respiratory and renal disease Drug interactions and efficacy Crop and livestock loss Stronger longer pollen seasons Urban heat islands page 8 |© 2016 Public Health Institute/Center for Climate Change and Health By 2025, rising average temperatures will result in 2,1004,300 excess deaths in California. African Americans in Los Angeles are more than twice as likely to die in a heat wave than other residents. Drought Community showers, East Porterville, CA The total economic impact of the 2015 drought to California’s agriculture is estimated to be $2.7 billion— including losses in crop revenue, livestock and jobs. page 9 |© 2016 Public Health Institute/Center for Climate Change and Health Water quality and quantity Crop loss and food insecurity Wildfire risk Migration and conflict Infectious disease risk Valley Fever Dengue and West Nile Virus Air Quality Higher temperature ground level ozone smog Drought more dry, dusty conditions Wildfires more PM pollution Storms and flooding indoor mold Limits indoor and outdoor physical activity Asthma, COPD and other respiratory disease Complications for cardiovascular disease California has 7 of the top 10 most polluted cities in the country for year-round particle pollution. Los Angeles has been ranked the No. 1 most ozone-polluted city for at least the past 16 years. page 10 |© 2016 Public Health Institute/Center for Climate Change and Health Allergens Longer and stronger pollen seasons Increased pollen production and potency More potent poison ivy, poison oak Higher temperatures more ozone increased sensitivity of respiratory tract page 11 |© 2016 Public Health Institute/Center for Climate Change and Health Wildfires Smoke from wildfires in Quebec traveled more than 1,000 miles downwind, causing a 30fold increase in Baltimore’s air pollution in 2002. Risk of injury, burns or death Homes and businesses destroyed LA Times Emergency response and public safety occupations at risk Trauma, stress, displacement Risks to water supply Air pollution: soot and fire fighting chemicals Exacerbates asthma, COPD and cardiovascular disease Premature death and acute illness page 12 |© 2016 Public Health Institute/Center for Climate Change and Health Rainfall, Storms and Floods Risk of injury and death from floods and severe storms Worsening indoor air quality: mold LA Times Increased waterborne pathogen exposure from sever runoff and overflow Increased winter precipitation increased pollen production in spring Recreational water risks Getty Images page 13 |© 2016 Public Health Institute/Center for Climate Change and Health NOAA Sea Level Rise Flooding and erosion: injury, death, property loss Freshwater contamination (salinization): threatens drinking water and irrigation stores, fish and wildlife Soil contamination (saltwater intrusion): threatens plants and wildlife page 14 |© 2016 Public Health Institute/Center for Climate Change and Health The U.S. government has allocated $48 million to relocate the entire community of Isle de Jean Charles, LA, where homes and property are being flooded by sea level rise. The island’s inhabitants, members of the Biloxi-ChitmachaChoctaw tribe, are the first American climate refugees. Infectious Disease Flooding & storm surge waterborne and foodborne illness, diarrheal disease Drought Valley Fever (Coccidiodes immitis spores) and West Nile Virus Expanded mosquito and tick habitat Dengue fever, West Nile Virus, Zika Virus Lyme Disease National Climate Assessment page 15 |© 2016 Public Health Institute/Center for Climate Change and Health Food Security and Nutrition Declining crop yields and nutrient content Increased herbicide and pesticide use Rising food prices and water shortages Algal blooms increased shellfish toxins Livestock death, decreased fish yields page 16 |© 2016 Public Health Institute/Center for Climate Change and Health The typical American meal includes ingredients from at least five foreign countries, contributing to transportation GHGE, especially if food is shipped by air. Climate Change and Mental Health Economic stress, anxiety Nutrition and physical activity Chronic disease management and co-morbid depression The Weather Channel Displacement, trauma and PTSD At risk groups First responders Pre-existing mental illness CDC Pregnant women and children page 17 |© 2016 Public Health Institute/Center for Climate Change and Health Co-benefit solutions: healthy people, healthy places, healthy planet Active transportation and transit Heart disease, diabetes, obesity and cancers Clean energy Respiratory disease, cardiovascular disease, adverse birth outcomes Sustainable agriculture Food security, heart disease, antibiotic resistance, pesticide exposure Urban greening Heat illness, flood risk, air pollution, physical activity, carbon capture page 18 | © 2016 Public Health Institute/Center for Climate Change and Health Health provider voice is critical Health frame elicits support for climate action Health co-benefits and community empowerment Health and equity opportunities are real and current Health workers are trusted, credible messengers in communities Health works in and with vulnerable communities Health voice has been critical – in partnership with community advocates page 19 |© 2016 Public Health Institute/Center for Climate Change and Health Health Provider Role in Climate Change, Health and Equity Eat less meat, especially red meat Walk, bike, use transit Clean energy, energy efficiency Green your clinic or hospital Grand rounds presentation Policy statement or resolution Patient education Care plans and protocols Home assessments Write an Op-ed or Letter to the Editor Tv and radio interviews Community presentations Local zoning and development Legislative visits Policy testimony page 20 |© 2016 Public Health Institute/Center for Climate Change and Health Climate and Health Champions Take Action Fresno Madera Medical Society Climate and Health Resolution Legislative Testimony for California Senate Bill 1383: Climate Super Pollutants page 21 |© 2016 Public Health Institute/Center for Climate Change and Health References 1. United States Environmental Protection Agency (2016). Inventory of US greenhouse gas emissions and sinks: 1990-2014 (DRAFT). Retrieved from: https://www3.epa.gov/climatechange/ghgemissions/gases.html 2. Morello-Frosh, R., Pastor, M., Sadd, J., Shonkoff, S. (n.d.) The climate gap: Inequalities in how climate change hurts Americans & how to close the gap. Available at: University of California Program for Environmental and Regional Equity website: https://dornsife.usc.edu/pere/climategap/ Wendland, T. (2016, May 14). Native Americans’ relocation from Louisiana home: ‘first climate change refugees.’ National Public Radio. Available at http://www.npr.org/2016/05/14/478040492/nativeamericans-relocation-from-louisiana-home-first-climate-change-refugees Associated Press. (2015, October 3). Alaska seeks federal money to move a village threatened by climate change. The New York Times. Available at http://www.nytimes.com/2015/10/04/us/alaska-seeksfederal-money-to-move-a-village-threatened-by-climate-change.html?_r=0 Howitt, R., MacEwan, D., Medellín-Azuara, J., Lund, J., Sumner, D. (2015). Economic analysis of the 2015 drought for California agriculture. UC Davis Center for Watershed Sciences. http://www.pbs.org/wgbh/americanexperience/features/general-article/dustbowl-mass-exodus-plains/ California Department of Public Health. (March 2016). Community assessment for public health emergency response (CASPER) addressing the California drought-Tulare County, California, October 2015. Available at http://hhsawebdocs.tchhsa.org/Questys.CMx.HHSAWebdocs/File.ashx?id=3813&v=1&x=pdf&r=HHSA_Webdocs Zelezny, L., Fu, X., Harootunian, G., Drexler, D., Avalos, A., Chowdhury, N., …Edmonson, C. (2015). Impact of the Drought in the San Joaquin Valley of California. Available at: http://www.fresnostate.edu/academics/drought/ California Department of Public Health. (March 2016). Community assessment for public health emergency response (CASPER) addressing the California drought-Tulare County, California, October 2015. Available at http://hhsawebdocs.tchhsa.org/Questys.CMx.HHSAWebdocs/File.ashx?id=3813&v=1&x=pdf&r=HHSA_Webdocs American Lung Association. (2016). State of the Air 2016. Available at http://www.lung.org/our-initiatives/healthy-air/sota/ Rowangould, G.M. (2013). A census of the US near-roadway population: Public health and environmental justice considerations. Transportation Research Part D: Transport and Environment, 25, 59-67. Beitler, J. (October 2006). Tracking Nature’s Contribution to Pollution. NASA Earth Observatory. Available at http://earthobservatory.nasa.gov/Features/ContributionPollution/ Center for Disease Control and Prevention. (May 23, 2013). Deaths associated with Hurricane Sandy October-November 2012. MMWR, 62(20). 393-397. Available at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6220a1.htm Gilbert N. 2012. One-third of our greenhouse gas emissions come from agriculture. Available at http://www.nature.com/news/one-third-of-our-greenhouse-gas-emissions-come-from-agriculture-1.11708. Natural Resources Defense Fund. 2007. Food miles: How far your food travels has serious consequences for your health and the climate. Available at https://food-hub.org/files/resources/Food%20Miles.pdf. Uejio, C.K., Tamerius, J.D., Wertz, K. & Konchar, K.M. (2015). Primer on climate science. In G Luber & J Lemery (Eds.), Global Climate Change and Human Health (p. 5), San Francisco, CA: Jossey-Bass. Wendland, T. (2016, May 14). Native Americans’ relocation from Louisiana home: ‘first climate change refugees.’ National Public Radio. Available at http://www.npr.org/2016/05/14/478040492/nativeamericans-relocation-from-louisiana-home-first-climate-change-refugees 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. page 22 |© 2016 Public Health Institute/Center for Climate Change and Health