Health Impacts of Climate Change: Psychological, Physical, and Community Dr. Susan Clayton The College of Wooster

Why look at the effects of climate change on health?

Describing the impacts can personalize the issue Health impacts transcend the partisan divide Understanding impacts is critical to preparing for them And make it less remote And make it politically palatable And make it more manageable

How can climate change affect human well-being?

Direct and indirect effects Acute and gradual changes Experience and perception Threat itself is a risk factor for psychological and emotional distress

Mental health and wellbeing Social relationships Physical health Mental health and wellbeing Social relationships Broader ways of thinking And emphasize human consequences to attract attention and emphasize self-interest Note interdependence among all of these aspects

Heat: higher average temperatures and more frequent heat waves Precipitation: changing patterns and more intense storms as well as droughts Rising sea levels: coastal flooding and storm surges Wildfires Air pollution: heat increases ground-level ozone and smog Source: EcoAmerica http://ecoamerica.org/research/#PsychImpacts

Source: EcoAmerica http://ecoamerica.org/research/#PsychImpacts

Source: EcoAmerica http://ecoamerica.org/research/#PsychImpacts

Acute impacts from natural disasters Death Injury Disease flooding increases water-borne disease Adverse birth outcomes preterm births low birth weight maternal complications

Indirect impacts Disruptions in food, water, shelter Disruptions in delivery of health services Impaired immune system functioning Increase in domestic abuse

Mental health effects PTSD Depression General anxiety Suicide and suicidal ideation Substance abuse -- all of which may last several years or longer

E.g., Hurricane Katrina 49% developed an anxiety or mood disorder 1 in 6 developed posttraumatic stress disorder Suicide and suicidal ideation more than doubled Similar rates of PTSD have been found after other disasters

Gradual changes Increased temperatures Changing patterns of precipitation Sea level rise Coffee, wine, chocolate Heavy precipitation events have increased by 71% in the Northeast

Health impacts Increased ozone levels and airborne particulates Asthma and respiratory effects Dust storms Associated with “valley fever,” a fungal pathogen Allergens Increased production of pollen Indoor mold more likely

Assuming no change in regulatory controls or population characteristics, estimates from combined ozone and particle health effects range from 1,000 to 4,300 additional premature deaths nationally per year by 2050

Spread of infectious diseases Ticks and Lyme disease Dengue, West Nile, Zika? Clinical depression has been observed in patients with West Nile virus Heat waves Kidney, cardiovascular and respiratory impacts In Australia, hospital admissions increased by 7% during heat waves Decreased access to clean water Algae blooms, Saltwater intrusion Including for dementia; mood disorders; neurotic, stress related, and somatoform disorders. And 1-2 billion at risk of inadequate water supply

Precipitation increases accidents Temperature increases fatalities Hunger Changes in agricultural potential of an area can lead to food insecurity. A 2° C temperature increase will place 100-400 million at risk of hunger, according to the World Bank Traffic accidents Precipitation increases accidents Temperature increases fatalities One study estimated an additional 603 deaths annually in the U.S. Foods at risk include coffee and wine

Higher temperatures have psychological effects Suicide rates go up Hospitalization for mental illness goes up Aggression goes up School performance goes down

Indirect effects Due to economic difficulties damage to physical and social infrastructure environmental degradation Desertification due to climate change could create 50 million migrants in the next 10 years.

Effects on perceptions Diminished sense of self loss of occupation loss of lifestyle and culture loss of autonomy Possibility of solastalgia loss of place and disruption of place bonds -- the loss of solace from valued places

“Our gardens have had to die because our house dam has been dry… “Our gardens have had to die because our house dam has been dry…. It’s very depressing because a garden is an oasis…that’s all gone, so you’ve got dust at your back door” (Australian farmer coping with drought) “You think your house is permanent… When you lose your house and everything you own, you learn everything is temporary” (Hurricane Sandy survivor)

Anxiety about the future Hopelessness Suicide Note learned helplessness

Uncertainty about climate change Individual responses lack of control, anxiety about unpredictability Intergroup tensions over meaning due to perceived inequity

Community impacts Increases in violence and crime Increases in interpersonal aggression Decreased social cohesion Associated with increased competition over resources, increased inequity, redirection of resources, breakdown of social infrastructure iated with stress, lack of social buffer, heat The loss of interpersonal and social networks can intensify responses to negative events

A threat to national security The Syrian refugee crisis is linked to unusual drought in the area, associated with climate change Jihadists are already blaming the U.S. for climate change Water conflicts

Threats to identity loss of occupation loss of place loss of lifestyle and culture loss of autonomy and control

Loss of occupational identity “Ranching families across the country are now facing an existential threat to a way of life that has sustained them” (New York Times on wildfires in the U.S.) http://www.public-health.uiowa.edu/gpcah/wp-content/uploads/2017/04/Safety-Watch_-Suicide-rate-among-farmers-at-historic-high.pdf https://www.nytimes.com/2017/03/20/us/burying-their-cattle-ranchers-call-wildfires-our-hurricane-katrina.html?smprod=nytcore-ipad&smid=nytcore-ipad-share Farmers in drought-afflicted areas in Australia and India have suffered increased levels of mental distress. Suicide rates are higher for agricultural workers in the U.S. than for any other occupational group.

Loss of cultural identity: Indigenous communities Weakened social networks Increased level of conflict Increased drug and alcohol abuse

Indigenous cultures face a threat to their way of life

Loss of place identity identity “The lake was our mother and father. Without the lake, where do we go?” “Can the people of the lake exist without the lake?” The Uru-Murato of Bolivia http://www.nytimes.com/interactive/2016/07/07/world/americas/bolivia-climate-change-lake-poopo.html Also evidence among Inuit and in Louisiana coastal community

Natural disasters in 2018 displaced 19 million people worldwide This does not include the gradual changes, whose economic and social impact is probably greater.

Migration presents a health risk Immigrants are more likely to develop psychosis This is true even among second-generation immigrants, showing that it is the social context post-migration and not the pre-migration factors that matter. Unlike survivors of discrete traumas, refugees experience stressors that accumulate over the pre- flight, flight, exile, and repatriation periods.

Who will be affected?

Not everyone will be affected equally The poorest countries will suffer the greatest health impacts Within the U.S., poor communities are likely to bear the greatest burden Those with multiple stressors and/or fewer resources

Sources of vulnerability Geographically vulnerable Economically vulnerable members of low-income communities and nations Socially vulnerable women, members of marginalized communities Physiologically vulnerable The elderly are particularly vulnerable to heat Those already suffering from mental illness Multiple stressors increase vulnerability Thermoregulation is affected by some medications for schizophrenia, e.g.

Children are particularly vulnerable Physical vulnerability: Immaturity can enhance the risk of disease, impact of persistent stress, vulnerability to pollutants, and effects of malnutrition. Stress itself, along with malnutrition and lack of clean water, makes the body more vulnerable.

Children are particularly vulnerable Social vulnerability: Disruption to education Psychological vulnerability: Dependence on others Need for security Mental health of the caregiver can impact the child’s mental health Effects will depend on the child’s developmental stage as well as sources of resilience. Some studies suggest higher rates of PTSD

Inequality itself is a threat to mental health through risk factors such as Reduced personal autonomy Negative self-perception Stress Social isolation Insecurity

What can be done? Promoting resilience More quotes from Sandy survivors

Most people do recover from trauma Post-traumatic growth is possible Becoming actively involved in addressing climate change can help people to cope with the stress of worrying about it “We learned first-hand that the best way for us to heal from our devastation and loss was to help others recover.” (Hurricane Sandy survivor)

Factors associated with resilience Practical support Community ties Sense of optimism Active coping strategies Practical support includes informational resources and mental health support Coming together as a community can actually strengthen social ties and provide an occasion for personal growth. Active coping was associated with cognitive performance among elementary school children after a disaster

Plan ahead Educate people about what to expect and how to adapt Focus on local impacts Conduct a vulnerability assessment Establish the infrastructure to encourage adaptation E.g., assess flooding potential and re-zone districts, plant wetlands, erect barriers, establish effective early warning systems for extreme weather, have backup plans for clean water. After Milwaukee implemented a plan for extreme heat conditions, a subsequent heat wave resulted in only half the anticipated number of deaths. Enhanced tree canopies and fewer heat-absorbing surfaces could reduce heat-related mortality by a substantial amount. Psychosocial support is a key component of an effective response to a natural disaster

Consider the social context Strengthen social networks, work across multiple groups Consider the most vulnerable; plan for mental health resources Encourage optimism and sense of efficacy Emphasize co-benefits Events in a community can affect levels of engagement, trust, and reciprocity by supporting pro-social norms (or not)

Acting on climate change can protect health Burning fossil fuels emits pollution that is associated with 4 of the 5 leading causes of death in the U.S. Coal-burning plants are also the leading cause of mercury pollution, which affects the brain 3.2 million people a year die from factors related to physical inactivity. Choosing to walk or cycle instead of driving can have strong positive health impacts. Eating less meat, especially red meat, would reduce risk of heart disease and death while reducing carbon emissions.

The environment can be a source of resilience A view of nature through a window has been experimentally associated with more rapid recovery from surgery, reduced requests for painkillers Time in the natural world has been associated with greater sense of purpose in life, reduced stress, positive emotions, vitality, awe,… … and these positive emotions have in turn been associated with lower levels of pro-inflammatory cytokines, which are associated with a variety of health problems including heart disease and depression Greatergood.berkeley

Health is not just the absence of disease Climate change presents an opportunity to examine the social and physical infrastructure of our communities to consider opportunities of enhancing well-being

What you can do Inform yourself Communicate about the health effects of climate change (especially to policymakers) Get involved in disaster preparedness efforts Coordinate and support with others involved in addressing climate change Communication overcomes collective ignorance (Darley and Latane studies)

Change the social context Lead by example Overcome collective ignorance

Acting on climate is acting on health! “Countries will have to undergo a shift from understanding climate change solely as a threat, to embracing the response to climate change as an opportunity for human health and well-being” The Lancet Countdown: Tracking progress on health and climate change. (2016)