Download Measuring the Public Health Impacts of Climate Change in the

Measuring the Public Health Impacts of Climate Change in the United
States
The Union of Concerned Scientists
September 24-25, 2011
Executive Summary
The Union of Concerned Scientists convened a workshop on “Measuring the Public Health
Impacts of Climate Change in the United States” from September 24-25, 2011 in Boston, Massachusetts.
The primary goal of the workshop was to initiate an ongoing interdisciplinary discussion about how to
more accurately estimate and project the economic costs of climate change-related health impacts in
the United States. A second objective was to develop a network of economists, public health experts,
and climate scientists committed to addressing this issue. Finally, the workshop sought to advance
participants’ understanding of the history and revision process of the Social Cost of Carbon (SCC), and
lay out strategies for improving SCC estimates in the U.S. The workshop was conducted under the
Chatham House Rule1.
“Measuring the Health Impacts of Climate Change in the United States” shed new light on the
necessity of and the momentum for a new area of thought, one that effectively synthesizes key insights
from climate economics and public health in order to create policy that accurately reflects climate
change risks and choices. There are key disconnects between what climate scientists say is happening to
our planet; what economists say is happening to our capacity to provide for ourselves; and what health
experts say is happening to our physiology in a warming climate. All of these concepts are connected,
and none is complete without the others.
For too many years, the three disciplines have focused on separate issues, used different
vocabularies, and operated in different fora. In the midst of invigorated opposition to national
mitigation, and in the wake of a year of widespread devastation from natural disasters, there is a
spreading realization that these fields must communicate and collaborate in order to shape a
comprehensive vision and plan of action. We anticipate that the next years of collaborative research and
policy development will be full of productive tensions and catalysis, with every difference between the
two fields’ approaches presenting an opportunity to paint a fuller picture of how climate change is
affecting our country and how we can shape a safe and productive future.
This workshop was a first step in that direction. Participants identified three broad categories of
follow-up action items that will be necessary to get this new effort off the ground; the first is “playing
within the sandbox”, or improving upon the techniques and models currently employed, in order to get
more accurate and just climate research and policy.
The second category was “playing outside the sandbox”, or thinking more broadly about the
context within which we operate: are today’s research questions the appropriate lines of inquiry? Are
our foundational assumptions legitimate? Is research executed in a sound, objective fashion, and is
evidence deployed in an efficient, equitable manner?
1
"When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the
information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant,
may be revealed.” See http://www.chathamhouse.org/about-us/chathamhouserule.
A final broad consideration concerned the communication of research and policy around climate
change, and ensuring that this increasingly urgent information is accessible and comprehensible to the
most powerful as well as the most vulnerable citizens.
This workshop and its proceedings are designed to address the first two categories of outcomes:
a near-term research and policy-setting agenda (chapters II and III), and a broader set of concepts and
questions to guide the evolution of these fields (chapters IV and V). The written proceedings are divided
into five chapters: the first chapter explains the design and logistics of the workshop. The second
chapter presents a brief overview of the state of the science on climate change and health, and offers a
suggested research agenda from the point of view of U.S. public health. In the third chapter, a basic
framework for climate economics is laid out alongside a hypothetical research agenda to improve
integrated assessment models (IAMs). The fourth chapter discusses near-term strategies for promoting
interdisciplinary collaboration and political engagement among practitioners, including a brief discussion
of the barriers to interdisciplinary research, ways to facilitate this type of collaboration and engage
peers, and a discussion of strategy specific to the Social Cost of Carbon. This collaboration is put into a
longer-term context in chapter five, which discusses some of the fundamental questions at the
intersection of climate economics and public health, identifies concrete next steps for workshop
participants, and describes elements of a long-term vision for this field.
I. Workshop Structure
Thirty-eight leading scientists in the fields of public health, economics and climate science were
convened in Boston from September 24-25 for “Measuring the Costs of Climate Change to U.S. Public
Health”, a workshop hosted by the Union of Concerned Scientists. The morning featured two
consecutive informational panels, on “Climate Change and Public Health: The State of the Science” and
“Economic Modeling and the Climate Crisis”. The subsequent moderated group discussion centered on a
future “Methodology and Research Agenda.” The workshop closed with three small group discussions:
“Advancing understanding through professional venues”; “Mobilizing peers for environmental health
advocacy”; and “The Social Cost of Carbon, EPA regulation, and the Interagency Working Group”. Finally,
the group engaged in a summary session that included planning next steps in communication, research,
and outreach.
II. Climate Change and Public Health: The State of the Science
The unfolding impact of climate change on human health in the United States
There is incontrovertible evidence that climate change poses a growing threat to human health
in the United States. From the incremental health impacts of rising temperatures to the less predictable
devastation of high-impact low-probability weather events, the literature on climate and health suggests
that the costs of inaction on climate change are unacceptably high in human terms as well as economic
terms. The most salient incremental risks to U.S. public health include more frequent and severe heat
waves associated with heat exhaustion, heat stroke, and exacerbated cardio-respiratory conditions;
increasing rates of formation of ground-level ozone and exacerbated respiratory problems; a longer and
more severe allergy season due to an extension of the warmer seasons; and changing patterns of
vector-borne diseases, such as Lyme disease. Beyond these incremental effects, the projected increases
in extreme weather such as hurricanes, floods, and droughts present a less predictable but potentially
serious threat of injury, disease, and death.
The science also tells us that health risks loom larger for some Americans than for others. In
addition to geographic vulnerability, the most severely affected communities will be those without the
economic and political resources to effectively plan for or recover from climate events. The health risks
will also become increasingly severe in the next decades in the face of unabated climate change. These
realities present urgent distributional and intergenerational justice considerations, which must be
included in comprehensive scientific analyses of the costs and benefits of action on climate change.
The health risks posed by climate change in tropical and developing countries will threaten
sustainable development in the U.S. and abroad, and make it more difficult to attain the Millennium
Development Goals. Famine and malnutrition, mass displacement and “refugeeism,” outbreaks of
malaria and dengue fever, desertification, and increasing resource-related violence are some of the
patterns that are already spreading globally and are likely to be exacerbated by climate change. As we
have seen in the political developments of the past decade, instability and suffering abroad can directly
or indirectly create domestic problems in the United States. Thus, an international lens must be
employed alongside domestic considerations in order to paint a complete picture of the costs of inaction
to the economic and physical wellbeing of Americans.
Challenges in public health research on climate change
While the public health literature on climate change has advanced rapidly over the past decade,
panelists identified a number of challenges still facing the research community. An overarching
challenge is effectively mainstreaming environmental health into all areas of climate policy. In spite of
the growing awareness of health issues in climate politics and economics, there persists a dangerous
tendency to overlook the public health dimensions of environmental threats and focus on the more
familiar, less personal threats to physical infrastructure. This oversight leads to public underestimation
of the severity of the climate threat, as well as squandered opportunities to implement primary
prevention measures and save lives and livelihoods.
Suggested Research Agenda:
 Prioritizing decentralized, localized case studies to achieve a more granular view of how
climate change is affecting the country. When regional or national impacts are aggregated,
local impacts are obscured, which undermines local capacity for adaptation and the public’s
sense of what is at stake in the climate change debate. Focusing on case studies also enables
more sensitivity to relationships across drivers.
 Retrospectively characterizing costs and benefits of public health interventions on climatesensitive health outcomes and publicizing analyses.
 Strengthening the public health literature on the health impacts of extreme weather; while
disasters are more difficult to study within a traditional scientific framework (in terms of
using counterfactuals and case controls), they are essential to study both for their
potentially devastating impacts and the fact that they could ultimately provide a more
compelling societal incentive for mitigation and adaptation projects than the more
incremental health impacts.
 Identifying and calculating morbidity from climate change-related events in addition to the
more common focus on mortality.
 Understanding how to anticipate, quantify, and address the mental health impacts of
climate change. There is an emerging body of evidence that indicates that climatic
uncertainty and extreme weather can increase the prevalence of depression, stress, and
anxiety, but there is still a strong need to educate mental health professionals on
environmental issues and strengthen the evidence.
 Drawing from a diversity of social science perspectives, such as systems dynamics and other
theories of change or resistance, to inform our strategy about what kinds of evidence to
seek and how to communicate outcomes.
 Building on research about the distributional risks and opportunities for adaptation in urban
communities, low-income areas, and communities of color.
 Remaining sensitive to the possibility that urgent questions related to climate change lie
beyond the scope of traditional scientific “puzzles”; for example, phenomena that don’t
work according to well-understood rules (such as positive feedbacks in the carbon cycle) or
environmental or political problems so grave they are considered insoluble.
III.Economic Modeling and the Climate Crisis
Integrated Assessment Models: What they are, and what they’re not
Integrated Assessment Models (IAMs) combine macroeconomic models and simplified physical
climate models to estimate the costs of a subset of quantifiable climate impacts. Depending on the type
of model, they can be used to measure how marginal changes in climate variables influence the
monetary value of downstream impacts and to estimate costs of “optimal” levels of emissions
reductions. A central feature of IAMs is a damage function, which estimates the marginal economic
losses that arise with increasing atmospheric carbon. The projected price of the damages caused by
each additional ton of carbon dioxide emitted is called the “Social Cost of Carbon” (SCC). 2 Effectively,
mitigation efforts that cost less than the social cost of carbon are considered economically viable, while
any mitigation effort that costs more than the SCC is considered economically inefficient.
There are three principal categories of IAMs used in climate economics: scenario-driven models
such as PAGE (C. Hope, Cambridge University); welfare maximization models such as DICE and FUND (W.
Nordhaus, Yale); and cost effectiveness/standard –based models (MERGE, REMIND, POLES,
IMAGE/TIMER, E3MG). The current U.S. government value for the SCC of $21/ton (established by an
interagency process) is a central estimate of the output from model runs performed with the DICE,
PAGE, and FUND models using certain assumptions; cost effectiveness or standard-based models are
thus far only employed in policy-making in Europe. A critical distinction between welfare-maximization
models and cost-effectiveness models is that the latter assume an upper limit on carbon emissions and
seek an effective price on carbon to reach that limit, while welfare-maximization models prescribe a
slow policy ramp (or, if the discount rate is high enough, no action on mitigation).
The popularity of IAMs among some practitioners, particularly economists, is based on their
ability to capture the interrelated drivers between economic activity that produces (or alternatively
mitigates) the emissions that drive climate change and the consequent human and environmental
impacts. However, there was a consensus among workshop participants that the welfare-maximization
models used to estimate the current SCC employ outdated, oversimplified and sometimes completely
2
U. S. Government, Interagency Working Group on Social Cost of Carbon (2010, February). Technical
Support Document: Social Cost of Carbon for Regulatory Analysis Under Executive Order 12866.
Retrieved 2012, from HYPERLINK "http://www.epa.gov/otaq/climate/regulations/scc-tsd.pdf"
www.epa.gov/otaq/climate/regulations/scc-tsd.pdf
unrealistic assumptions related to climate science and impacts. In particular, the public health impacts
are underestimated (if they are present at all), and interdisciplinary collaboration is necessary to amend
the most serious flaws in the models. The current research paradigm does not incorporate enough of a
rigorous interdisciplinary screen on the assumptions or the output of these models. Without the
collaboration of health experts, climate scientists and economists, significant public health relationships
and impacts will be overlooked.
Suggested Research Agenda:
 Revising the IAMs with interdisciplinary teams of professionals with diverse expertise,
including health experts. The health sector must come forward with models to integrate
into existing IAMs in order to capture the full magnitude of future impacts.
 Continuing to update the climate science used in IAMs; the data inputs and mechanistic
considerations within the models are often out of date , which leads to vastly different
outputs from the model
 Improving damage functions with more spatially disaggregated research on climaterelated health impacts.
 Improving estimates of damages that are calculated indirectly, including non-market
damages (such as pain and suffering).
 Emphasizing the importance of high-risk, low-probability events in economic models
and incorporating better assumptions about risk aversion
 Achieving a more comprehensive and refined understanding of how climatic changes
translate to impacts (including instances where there are non-marginal changes,
discontinuities, and thresholds).
 Employing higher discount rates (or discount rates that vary with time) so as to more
accurately reflect the threats that climate change poses to future generations (or that
places higher value on climate impacts faced by future generations).
 Looking beyond IAMs and the cost-benefit frame for other ways to elucidate the public
health impacts of climate change and the need to act to address them.
IV. In the near-term: Strategies for Promoting Interdisciplinary
Collaboration and Political Engagement
Barriers to interdisciplinary research
Many participants expressed frustration at the lack of opportunities and incentives in academia
for research that integrates economics and public health. There are scant funding sources that
accommodate the interdisciplinary focus, and journals are often less inclined to publish such work.
Academics reported that this interdisciplinary work was often viewed less favorably by tenure
committees. They also observed that it was difficult for graduate students and post-doctoral candidates
to find funded positions with an interdisciplinary orientation. Finally, they acknowledged that the two
disciplines have very different vocabularies and norms, and it was often difficult to communicate
successfully when crossing the boundary between the two fields in order to get funding or present a
proposal.
Short-term opportunities to promote understanding between economists and health
professionals
Workshop participants suggested that the first steps towards creating a durable professional
niche at the intersection of climate economics and public health include:
 Setting up an infrastructure for steady communication, such as a listserv or a wiki, among
workshop participants and other colleagues in economics, public health, and climate science.
 Sharing regular research and policy updates through such a network.
 Sharing vocabulary, tips on funding sources, and other discipline-specific information to
facilitate cross-over between fields.
 Establishing a norm of “sanity checks” among climate scientists, public health professionals and
economists; when designing or editing interdisciplinary research, researchers should seek
informal consultations from experts in complementary fields in order to minimize published
information that is out-of-date, repetitive, or framed inappropriately.
 Using contemporary research and policy news to build the argument for funding
interdisciplinary research, to be advanced by third parties (perhaps from the nonprofit sector) to
government agencies, foundations and academic centers.
 Coordinating briefings on climate change and climate economics for doctors, nurses, hospital
administrators, and other trusted messengers. Create online PowerPoint presentations and
informational posters for offices to be distributed more widely.
 Continuing to actively build the network of professionals working at this intersection,
particularly among post-doctoral candidates, graduate students, and healthcare economists not
yet familiar with the health impacts of climate change.
Engaging peers in environmental health advocacy
In order to draw more public health experts, climate scientists, and economists into the
advocacy arena on climate economics issues, the working group charged with that cause submitted the
following recommendations:
 Create virtual and social networks to keep professionals updated on the political landscape of
environmental health, particularly in relation to upcoming decisions on EPA regulations and the
presidential elections. This could operate through email updates within institutions, through
scheduled briefings from professional colleagues or lobbyists, and through strategic use of social
media sites such as Facebook and Twitter. Particular attention should be paid to the proposed
upcoming revision of the Social Cost of Carbon.
 Coordinate political advocacy among professionals in the form of letters to the editor, op-eds,
direct sign-on letters, and media interviews. Attempt to “put a human face” on the political
stories in the media by allowing clinicians to share stories from their medical practice.
 Publicly recognize the potential links between climate change and newsworthy extreme
weather events in order to harness these “teachable moments” that could help spread public
awareness of the costs of inaction on climate change. Do not neglect to follow up on the
aftereffects of these events weeks or months later.
 Encourage colleagues to ask politicians probing questions in public forums and to publicize their
answers, in order to hold them accountable for their stated intentions.
 Encourage health professionals and economists to attend each of the U.S. Global Change
Research Program’s National Climate Assessment (NCA) stakeholder meetings to ensure that
the NCA is comprehensive geographically and sufficiently rigorous, and that its findings enter
the policy debate. Any gaps in the NCA could indicate an area for future research.
The Social Cost of Carbon, EPA regulation, and the Interagency Working Group
The working group focused on the Social Cost of Carbon proposed three general routes to
achieve an urgently needed increase in the calculated social cost of carbon:
 The government process: Work to ensure that health expertise and state-of-the-art science
are adequately incorporated in the next revision of the SCC. Public health and economics
professionals should watchdog the process and publicize analyses for each new step. Ensure
that the health and climate science is up-to-date, granular, and not aggregated in a
misleading way.
 Working from the outside: recruit high-profile researchers from outside the governmental
and NGO communities to further the argument that Integrated Assessment Models must be
thoroughly revised, for example through a letter or research paper in a peer-reviewed
journal. Calculations on ozone, malaria, or heat-related morbidity and mortality could be
isolated to prove the imperfections in these models.
 Public-facing strategy: strive for greater frequency and depth of media coverage of climate
economics, so that grassroots environmental and health groups can better educate and
mobilize the public around upcoming political events.
V. Redefining the Paradigm
A key contribution of this conference was to build the case for a new hybrid field at the
intersection of climate economics and public health. Many questions emerged regarding the precise
definition of this area of study; will it be housed primarily within economics or public health, or will it be
its own entity? How should it be referred to; health-related climate economics, climate-related health
economics, or something catchier? What is its long-term, transformative vision?
This chapter begins with a list of concrete follow-up items suggested by workshop participants,
continues with their ideas for a longer-term vision for this field. It closes with a list of preliminary
questions that will help establish the scope of this collaboration.
Proposed foundational questions
1. Should we focus on improving the welfare-maximization IAM’s, advocate for a shift to costeffectiveness IAM’s, or find a different policy tool? Who should decide this? What evidence is
necessary to strengthen this argument, and what is the time frame?
2.
Is it worthwhile to improve the accuracy of the damage function, or should we argue that the
damage function inexorably fails to capture the magnitude of the threat of climate change, and
shift to a model based on climate science-based thresholds? What are other alternatives to the
damage function? What sort of research teams are needed to address this problem?
3. Are conventional quantifications of damages such as Values of a Statistical Life (VSLs), DisabilityAdjusted Life Years (DALYS), and harm to economic measures such as the Gross Domestic
Product (GDP) valuable tools for the calculation communication of danger, or dangerous tools
that obscure the human suffering they are meant to represent? What are potential alternative
measures to develop and substitute? Which individuals, institutions, and fields stand to take the
lead on this issue, and how should it be communicated to the public?
4. What are the key issues at the nexus of public health and climate economics that should be
tackled in the next two years? In the next ten years? (Some examples: the discount rate, the
Social Cost of Carbon, damage functions, choosing among various types of IAMs, attribution,
valuation in general),
5. What are the advantages and disadvantages of researching and communicating the health
impacts of climate change on a global scale vs. a national scale vs. a local scale? How does this
vary with different audiences and in different forums?
6. To what extent should those working on improving the technicalities of the IAM’s focus on
communication this work to the public? Should this be a public-facing campaign that integrates
communications expertise, or an “inside game” among technical experts and policy-makers? If
the campaign should be public-facing, who are the best messengers, and which means of
communication would be the most effective?
7. What research is needed to support a revision of the Social Cost of Carbon? What are effective
advocacy strategies and time frames for this shift? Should this be an imminent priority for the
economics or public health community? If not now, when?
8. How can these models take into account questions of distributional justice within the United
States? International distributional justice? Intergenerational justice? Who should help answer
these questions, and how can we expand the conversation to include them?
9. What research is needed to support a revision of the discount rate? Should the discount rate be
eliminated altogether? What are effective advocacy strategies and time frames for this shift?
Should this be an imminent priority for the economics or public health community? If not now,
when?
10. Should these issues be promoted in policy-making forums beyond the governmental agencies
(such as in the private sector, among insurance companies or “green businesses”)? If so, how
should the messengers and the messages themselves change?
11. How should various adaptation scenarios figure into these economic models? Who are the
professionals and lay experts who should contribute to those calculations?
Elements of a long-term vision
 Health considerations, including mental health effects, will be mainstreamed into climate policy
on a local, national, and international level.
 Climate policy-making will consistently take into account “black swans”, or high-impact lowprobability events that may constitute some of the most significant impacts of climate change
but which are often left out of economic models and adaptation planning.
 The initial step of bidirectional training between economists and health professionals will
eventually lead to the education of “bilingual” academics from graduate programs that integrate
the two disciplines (perhaps based at policy schools or schools of public health; workshop
participants could help define potential projects for graduate students to take on). The Robert
Wood Johnson Foundation constitutes a helpful model.
 Funding sources will recognize the necessity of interdisciplinary work, with special opportunities
for collaborations or scientists trained in multiple areas.
 We will see the evolution of a vocabulary and set of research practices that inherently hybridize
economics and public health; for example, the establishment of alternatives to Value of a
Statistical Life (VSLs) or Gross Domestic Product (GDP) would necessarily integrate ideas from
both disciplines.
Next Steps
 Create a listserv or wiki to be housed within UCS that will enable consistent communication
among conference participants and interested colleagues.
 Generate between five and ten defining questions that outline the scope of this new field,
including its research framework and its immediate agenda.
 Reconvene this group for 2-4 days, with pre-defined goals, working groups, bidirectional
training, and a glossary for shared understanding. This conference would be an opportunity for
participants to focus on tackling the “foundational questions” and to plan an application for a
Gordon Conference or similar venue the following year.
 This longer conference would bring together 50-70 people for 3-4 days in order to generate
scientific papers on key features of the damage function, attribution and valuation, and other
areas instrumental to the field.
 These papers could be pulled together for a special issue of a journal focused on climate
economics and health (for example, Nature or the Journal for Political Economy).
VI. Conclusion
“Measuring the Public Health Impacts of Climate Change in the United States” built upon an
essential conversation about the tools that we are using to plan for and communicate the
challenges and opportunities of climate change. Effective syntheses of models from public
health, economics and climate science are urgently needed to construct a more comprehensive
picture of how global warming will affect human health and organization, and enable us to
construct more effectual solutions.
This hybridization would also help develop a precedent for weighing human physiological
and social needs more heavily in policy decisions, which could ultimately influence a wider
variety of issues. The high stakes of climate change policy make this debate a unique
opportunity to conduct a broader examination of the assumptions and values that drive our
policies and institutions. Many relevant insights are emerging within each of these disciplines;
the next step is to coordinate the sharing of ideas and envision a new paradigm that promotes
health and well-being from an economic, physiological, social and environmental perspective.