CLIMATE CHANGE, EXCESSIVE HEAT EXPOSURE, AND RISK ASSESSMENT The Climate CHIP tool for new analysis and policy development Prof. Tord Kjellstrom Centre for Global Health Research University of Umea, Sweden and *National Centre for Epidemiology and Population Health The Australian National University, Canberra, Australia This presentation is in the morning of the last day (Friday) of the ICOH conference and 45 minutes has been assigned and it is the last keynote address followed by sub-plenaries and the closing ceremony. Before that, on the first day (Monday) of the conference the sub-committee on Thermal Hazards have a symposium on heat, work and health where I will present a paper on “Comparing different indexes to quantify occupational heat exposure”. The Thermal Hazards sub-committee has its business meeting in the evening of the first conference day. Dr Zayed from Canada has a symposium on Tuesday titled “Impact of climate change on occupational health and safety” (I don’t know the time yet) with a paper by Kjellstrom on “The ‘Hothaps’ program for climate change impact assessment and prevention”. I also have a poster accepted on “Occupational health and productivity loss due to climate change”. Poster session on Thursday. Hopefully this contributions will create justified interest in this part of climate change and health analysis. MoPH seminar, Nr 1, Bangkok, 15 November 2013

The climate change and health panorama Climate change has created new interest in climate conditions and health --- not just change is important, but the current conditions Mitigation reduces extent of ongoing climate change Adaptation reduces impacts on human society and health from climate change we can’t avoid Elderly and children are usually listed as vulnerable groups for climate change, but working age people are also vulnerable, and their health and well-being affects family health and community health ….. the links are important Health Risk Assessment is an essential component of effective prevention (gave a seminar on this at Thai MoPH on 17 September, 2012)

Key points, presented in Sept 2012: CLIMATE CHANGE, PUBLIC HEALTH, OCCUPATIONAL HEALTH, HEALTH IMPACT ASSESSMENT Climate conditions are well known to affect health via heat, cold, rain (floods), no rain (drought), cloud cover, and wind Local climate conditions and changes influence many public health risks, including occupational health risks Global and local climate change is ongoing, mostly human-induced, and will continue Workplace heat exposures are a threat to work productivity, as well as occupational health Preventive policies and actions needed Research gaps create occupational health threats The health sector in Thailand (in collaboration with other sectors) has an important role in reducing the major health and economic threats from climate change

Climate challenges to health Heat ….. A key health threat …. and behind other risks Cold ….. Lower than average temperatures linked to mortality increase (Tawatsupa et al) Rain (floods) …. Direct effects of water risks, lack of infrastructure services, lack of clean drinking water and food, displacement into camps, mental stress.. No rain, drought …. Lack of drinking water, food production stops, heat ….. Cloud cover …. Too much or too long … poor agricultural growth, “bad weather” mental stress, lack of tourist business … Wind …. Extreme wind causes injuries, damage to agriculture, lack of infrastructure services….. Sea level, storm surge, shape of bays ……

Heat and mortality …. the most studied climate and health problem. … Heat and mortality ….. the most studied climate and health problem. …. seeTawatsupa et al analysis of monthly temp and mortality in Central Thailand and Bangkok Cold season Hot season Wet season

Occupational heat exposure and effects, acute Acute health effects of excessive heat exposure at work - Sweating, dehydration, salt loss Loss of perceptual and motor performance Heat exhaustion - Increased accident risk - Increased body temperature (>37 oC) (>38 oC involves heat strain; >39 oC is dangerous except for short periods; >40 oC can lead to the serious effects listed below) Heat stroke, Unconsciousness, Death Mental effects, increased violence - Loss of ability to work intensively due to heat exhaustion Tawatsupa et al studies using data from “Thai Cohort Study”: general impacts on overall health and mental stress from heat

Chronic effects of Occupational heat exposure Chronic health effects of excessive heat exposure Worse clinical status for people with common chronic diseases (ageing working population) Heat sensitivity problems for specific disease victims: e.g. MS Kidney damage due to daily dehydration if lack of water access (reference for all effects: Book by Parsons, 2003) - Tawatsupa et al studies using data from “Thai Cohort Study”: decrease of general health, increased occupational accidents, increase of reported kidney disease among working people who stated high exposure to heat at work

Vulnerable working groups Working people in tropical and sub-tropical countries during the hot season, particularly if working in in hot sunlight Workers who need to work continuously at high physical intensity Agricultural workers Construction workers Emergency workers Migrant workers Workers in factories or workshops without efficient cooling systems, a common situation in Low-Middle-Income countries Workers in slum workshops and other low income workers

Heat stress, a serious occupational hazard in heavy labor outdoors: lack of hydration leads to kidney damage; ongoing serious epidemic in Central America Sugar cane cutting, Nicaragua

Heat inside shoe factory, Vietnam: Fixed daily production targets …… Heat inside shoe factory, Vietnam: Fixed daily production targets ……. Takes 2 hours longer in hot summer days (35 oC)

Dangerous working conditions, including heat: Dar es Salaam slum, 2006

Exposure to chemicals that evaporate faster in hot work environments

Several potential OSH risks Extreme weather events; many after effects Occupational heat stress Kidney disease due to daily dehydration Vector-borne diseases Ecological change diseases Infectious diseases Nutritional security Social tensions – mental health Increased chemical exposures

International standard (ISO, 1989) for heat Stress in the Workplace: Recommended increase rest time per hour

Calculated hourly WBGT outdoors, in the sun and resulting hourly "work capacity" (based on ISO, 1989) for workers in heavy labour jobs (500W), Delhi, 1999

Heat impact on productivity of rice harvesters in West Bengal (Sahu et al., Industrial Health, 2013)

Comparison epidemiological study results and ISO standard (Kjellstrom et al, WHO report)

Hothaps Database Hothaps-Soft NOAA/GSOD Data Set import Breakdown of data availability Numerical data for further analysis List of weather stations find Statistics Graphs, trends, threshold analyses and quality control The new Hothaps-Soft software for describing local heat exposure conditions and trends It includes daily data from >18,000 weather stations around the world, and monthly CRU grid cell data for the same locations It will be integrated into new ClimateCHIP.org website Risk Assessment tool package

Hothaps-Soft: Monthly heat exposure diagrams; median and 25- and 40-% up and down.

Two time points, 1980s and recent 5 years

Different seasonal patterns; Bangkok and Hanoi

Annual averages of daily Tmax, Tmean and Tmin for weather station ( __ , slopes 0.27, 0.39 oC/decade) and grid cell ( ------, slope 0.29, 0.38 oC/dec ); comparison NOAA and CRU

Local heat trends is what matters: Time trends of extreme days using Hothaps-Soft: WBGT (Wet Bulb Globe Temperature) as an indicator of heat exposure  a function of Temperature, Humidity, Wind speed, Heat radiation Each decade, 13 more super-hot days

5 cities, WBGTmax, time trends 1980-2011

Mapping heat stress …… Projected WBGTmax , March In shade 1975 WBGT B A

Projected WBGT in South-East Asia, afternoon, March In shade 1975 WBGT B A In sun 1975

Projected WBGT in South-East Asia, afternoon, March In shade 1975 In shade 2050 WBGT B A In sun 1975

Projected WBGT in South-East Asia, afternoon, March In shade 1975 In shade 2050 WBGT B A In sun 1975 In sun 2050

Modeling time trend of loss of work capacity and productivity, South-East Asia

Local population density as a “risk factor” in Risk Assessment; Population per grid cell, 2000; 4 age groups

Population per grid cell, 2000, 2030, 2050; all ages

Loss of work capacity as percent of available daylight working hours Loss of work capacity as percent of available daylight working hours. Differences between % in 2050 and 1975 depending on climate estimates for 2050 (3 models and average); Heavy labour in the Sun, outdoors. Year A, 1975 2050 B, 2050 B - A Model  Region: BCM EGMAM IPCM Average Difference 3 Asia, East 3.65 6.26 7.21 8.45 7.31 4 Asia, South 15.37 22.50 24.80 27.10 9.43 5 Asia, South East 17.41 27.17 28.54 31.19 28.97 11.56 12 Lat-America, Central 4.88 8.54 9.08 10.39 9.34 4.46 15 North America 1.80 3.56 3.90 4.23 2.10 21 Africa, West 15.67 25.91 27.20 29.64 27.59 11.91 North America, A1975 / B 2050: moderate labour in sun: 0.8 / 1.88 heavy labour in shade or indoors: 0.29 / 0.95

New economic estimates Dell, Jones and Olken, 2012: 1 oC temp increase leads to 1.3% reduction of annual GDP growth Martin, Muuls, Ward, 2011: sensitivity of UK manufacturing firms to extreme weather events; heat wave years reduce economic performance DARA report Climate Vulnerability Monitor: 2 – 3% reduction of annual GDP (in 2010) in low and middle income tropical countries due to heat impacts on labor productivity … release 26 Sept, 2012 Check: www.daraint.org

The economic impact of work time loss on income trends: No loss = 4% growth/year, A = 1% loss, B = 2% loss

Estimated cost of climate change, million US$ (DARA, 2012), Thailand in 2010 and 2030 Hazard 2010 2030 Drought 40 200 Floods and landslides 100 1,000 Storms -5 -35 Biodiversity 350 2,500 Desertification -80 -650 Heating and cooling 3,000 Labor Productivity 15,000 150,000 Sea-level rise 1,500 6,750 Water access -300 -2,250 TOTAL 16.670 159,350

ClimateCHIP = Climate Change Health Impact & Prevention profiles http://www.climatechip.org/ -- still under development --

Climate CHIP content Climate CHIP Introduction Overview of climate conditions causing heat stress in a country – graphics, maps Potential health effects Risk factors Preventive policies and actions Health impact assessments Conclusions and recommendations References  links to conditions in specific grid cells (0.5 x 0.5 degrees, or 50 x 50 km)

ClimateCHIP “Your Area” analysis When the name of a place is entered, the map immediately goes to that grid cell and highlights it in pink. Then the available climate data and health risks for different years or months can be displayed:

Trend and seasonal analysis; Delhi Tmax

Mapping of grid data: average Tmax in 1995; 4 months

Modeled Tmax in 2050; 4 months

Average WBGTmax in 1995; 4 months

Modeled WBGTmax in 2050; 4 months

Lost work capacity; Work in shade, 1995

Lost work capacity; Work in sun, 1995

Research needs and ongoing efforts in Hothaps Quantify the impacts of climate conditions on workplace heat exposures and related health, productivity and economic effects Identify and test heat prevention methods; Develop health impact assessment methods linked to climate modeling to estimates future health, productivity and economic impacts. Current field study sites: Nicaragua, Costa Rica, South Africa, Ghana, India, Nepal, Bangladesh, Thailand, Laos, Vietnam, China, Australia, New Zealand New research initiatives will be welcomed

FOCUS ON EVIDENCE FOR PREVENTION Main aims of ongoing global program, Hothaps: (High Occupational Temperature Health and Productivity Suppression) 1. Accumulate and publish new evidence leading to mitigation of climate change …. Applications of Health Impact Assessment 2. Increase awareness of occupational health and safety program needs …… promote common aspects of OSH 3. Influence architects and planners so that future work places are designed to reduce heat stress 4. Make link to “green economy”, sustainability policies, etc. …… and find new partners for OSH 5. Encourage mitigation of climate change, based on health and economic loss estimates

Email to HOTHAPS: kjellstromt @ yahoo.com Google: “kjellstrom climate” or “ClimateCHIP.org” for all reports on Hothaps Now let’s think of some discussion points: 49

Discussion topics: Climate condition data: how to get most accurate estimates of current and future situations ….. ??? Health and productivity loss estimates for Risk Assessment: how to develop calculation methods that fit the situation in Thailand …… ??? Engaging with other sectors: how to create true cooperative analysis with all economic sectors …. ???