Climate Change and Public Health: The Role of CDC February 17, 2008 Michael A. McGeehin, Ph.D., M.S.P.H. Director, Environmental Hazards and Health Effects, National Center for Environmental Health, CDC

Agenda Is climate change real? Is climate change a health issue? Is there a public health role? What is the role of CDC? A few parting thoughts.

IPCC 2007 Reports

VECTOR-BORNE DISEASES ENVIRONMENTAL REFUGEES Potential Health Effects of Climate Change HEAT  Heat stress, cardiovascular failure SEVERE WEATHER Injuries, fatalities AIR POLLUTION Asthma, cardiovascular disease ALLERGIES Resp allergies, poison ivy VECTOR-BORNE DISEASES Malaria, dengue, hantavirus, encephalitis, Rift Valley fever WATER-BORNE DISEASES Cholera, cryptosporidiosis, campylobacter, leptospirosis WATER AND FOOD SUPPLY Malnutrition, diarrhea, harmful algal blooms MENTAL HEALTH Anxiety, post-traumatic stress, depression, despair ENVIRONMENTAL REFUGEES Forced migration, civil conflict Climate change: Temperature rise Sea level rise Hydrologic extremes

The direct health effects of heat

European heat wave, 2003 UK 2,091 Italy 3,134 France 14,802 Portugal TIME LINE (FRANCE) CONFIRMED MORTALITY UK 2,091 Italy 3,134 France 14,802 Portugal 1,854 Spain 4,151 Switzerland 975 Netherlands 1,400-2,200 Germany 1,410 TOTAL 29,817-30,617 Vandentorren et al. Mortality in 13 French cities during the August 2003 heat wave. Am J Public Health 2004; 94(9):1518-20. Haines et al. Climate change and human health: Impacts, vulnerability and public health. Public Health 2006;120:585-96.

Severe weather events

Climate change and severe weather events, 1972-2004 Hurricane intensity (Saffir-Simpson scale categories 1 to 5), global, 1970-2004, including number of storms by category (A) and proportion of storms in each category (B). Bold curve in (A) is the maximum global hurricane wind speed (in m/sec). Dashed lines show the 1970–2004 average numbers in each category. Source: Webster et al., Science 2005;309:1844-46.

Increases in temperature or ultraviolet radiation (UVR) in the lower atmosphere enhance the chemical reactions that produce ozone. Ozone is a highly reactive gas which can oxidize molecules directly, and create high-energy free radicals that damage cell membranes. Optional Slide REFERENCE: Climate Change and Human Health, Chapter 3.

Ozone Season in Atlanta Unhealthful Source: M. Chang, Ph.D., Georgia Tech

Allergies

Ragweed Genus Ambrosia ↑ CO2 and temperature → ↑ pollen counts, longer growing season Source: Ziska et al., J Allerg Clin Immunol 2003;111:290-95; Graphic: Wall Street Journal, 3 May 2007.

Poison Ivy Toxicodendron radicans ↑ CO2 leads to ↑ photosynthesis ↑ water use efficiency ↑ growth ↑ biomass More allergenic urushiol Greater CO2 stimulation than most other woody species Source: Mohan et al. PNAS 2006;103:9086-89.

The predictable…

…and the surprising

VECTOR-BORNE DISEASES ENVIRONMENTAL REFUGEES Potential Health Effects of Climate Change HEAT  Heat stress, cardiovascular failure SEVERE WEATHER Injuries, fatalities AIR POLLUTION Asthma, cardiovascular disease ALLERGIES Resp allergies, poison ivy VECTOR-BORNE DISEASES Malaria, dengue, hantavirus, encephalitis, Rift Valley fever WATER-BORNE DISEASES Cholera, cryptosporidiosis, campylobacter, leptospirosis WATER AND FOOD SUPPLY Malnutrition, diarrhea, harmful algal blooms MENTAL HEALTH Anxiety, post-traumatic stress, depression, despair ENVIRONMENTAL REFUGEES Forced migration, civil conflict Climate change: Temperature rise Sea level rise Hydrologic extremes

Public Health Action on Climate Change Study and predict links between climate change and health Track diseases and trends related to climate change Investigate infectious water-, food-, and vector-borne disease outbreaks Public health workforce prepared to respond Communicate effectively on climate change Heat wave and severe storm response plans; focus on the most vulnerable Partnerships with private sector, civic groups, NGOs, faith community, etc.

The role of CDC Surveillance and data collection Outbreak investigations Technical assistance Forecasting and modeling Preparedness planning Research Education Training and capacity-building

A few parting thoughts: Four Cs Conceptualizing Communicating Complexity Co-benefits

“Mitigation and Adaptation” or “Preparedness and Prevention”

Care for future generations Care for the individual patient Care for the community Care for future generations THE CLINICAL APPROACH THE PUBLIC HEALTH APPROACH THE LEGACY APPROACH

Intergenerational responsibility Stewardship

Effective health communication

Edvard Munch does Climate Change Despair Anxiety Edvard Munch does Climate Change The Scream

“Think of the verbs associated with environmentalism and conservation: ‘stop,’ ‘restrict,’ ‘reverse,’ prevent,’ ‘regulate,’ and ‘constrain.’ All of them direct our thinking to stopping the bad, not creating the good.” The need for positive, aspirational messages.

“I have a nightmare…”

“I have a dream…”

The need for bold, cross-cutting thinking. “The challenge of climate change is so massive, so global, and so complex that it can only be overcome if we look beyond the issue categories of the past and embrace a grand new vision for the future.” The need for bold, cross-cutting thinking.

Complexity Reality (simplified)

Looking over the horizon

Source: IPCC

Population growth

“Hubbert’s peak” Source: Hubbert, 1956

Peak petroleum

Limits on land

Limits on water

Promoting co-benefits

Climate Change Synergies Heat wave plans including “buddy systems” ↑ social capital ↓ Vehicular travel ↓ car crashes; clean air; ↑ physical activity ↑ Fuel efficiency ↓ air pollution Locally grown food Fresh food; ↓ pesticide exposure; local business Energy-efficient buildings ↓ operating costs Alternative energy sources Business opportunities

Co-benefits: Trees Carbon sequestration Cooler temperatures Reduced energy demand Clean water Clean air Protection from sunlight Venues for physical activity Noise reduction Mental health Spiritual fulfillment

Co-benefits: Food and nutrition

Suddenly, Bob realizes that he’s “part of the problem.”

Co-benefits: Transportation  Depression  Air pollution  CO2 emissions  Physical activity  Osteoporosis  Injuries And by the way…  Infrastructure costs  Social capital

Summary Climate change is real. Climate change is a health issue. There a public health role. There is an important role for CDC.

Thank you!