John M. Balbus, MD, MPH National Institute of Environmental Health Sciences Captain Edward A. Pfister, RS, MSPH HHS Environmental Program Manager HHS/OS/ASA/OFMP USPHS Scientific and Training Symposium June 20, 2012 Climate Health Risks and Community Resilience

The ‘00’s were our hottest decade

FROM: IPCC, 2007 WG1-C1-pg. 115

2011 had a record number of billion dollar disasters

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

How does climate change influence human health? Direct impacts of climate change, weather, and sea level rise on humans –Heat stress –Weather-disease curves –Storms, weather extremes Impacts of climate change on physical and chemical agents –Air pollution effects –Fate and transport of toxic chemicals –Ozone depletion interactions

How does climate change influence human health? Impacts of weather and climate change on biological agents –Microbes (including algae) –Plants (pollens, poisons) –Zoonoses, including VBD’s Impacts of climate change and sea level rise on fundamental life support –Water availability –Food/crop productivity –Shelter

Climate Change and Health

A Human Health Perspective on Climate Change Identifies research needed to better understand the health effects of climate change, and choose the healthiest mitigation and adaptation strategies : –11 Health Consequences Categories –Crosscutting issues 15

Eleven Human Health and Disease Categories Asthma, respiratory allergies, and airway diseases Cancer Cardiovascular disease and stroke Foodborne diseases and nutrition Heat-related morbidity and mortality Human developmental effects Mental health and stress-related disorders Neurological diseases and disorders Vectorborne and zoonotic diseases Waterborne diseases Weather-related morbidity and mortality

1 st set of NIH Population Vulnerability to Climate Change grantees

All affect human health

Climate Change: Adaptation and Mitigation Adaptation is a response, the actions necessitated by the actual or anticipated impacts of climate change. Mitigation is the effort to stop or slow climate change, usually by reducing the GHG emissions driving the problem. Two prongs used in concert: mitigation reduces impacts, making it adaptation easier.

Potential Co-benefits of GHG Mitigation Policies Energy generation – decreased air pollution Transportation – increased physical activity, decreased air pollution, decreased injuries from collisions Agriculture – reduced red meat consumption – Livestock has a huge GHG footprint (deforestation, water, transport, refrigeration…) Agriculture – improved nutrition

Potential Co-benefits of GHG Mitigation Policies For example, transportation policies that augment the use of public transportation or provide safer and more convenient means for individuals to walk or bicycle Co-benefits: reductions in toxic air pollution Increases in physical activity

Adaptation principles Climate change as stress multiplier Focus on vulnerability of people (and/or health systems) to climate change; assure continuity of services Impact is proportional to baseline prevalence of climate-sensitive diseases– prepare for future impacts of climate change on health Address existing health disparities in cardiovascular disease, diabetes, obesity, asthma Address upstream determinants of health Investigate health implications of major climate change policy decisions Importance of urban infrastructure options/strategies to respond to identified current and future health risks

President’s Climate Adaptation Task Force: Health Recommendation Protect human health by addressing climate change in public health activities –Enhance the ability of Federal decision makers to incorporate health considerations into adaptation planning –Build integrated public health surveillance and early warning systems to improve detection of climate change health risks –Promote resilience of individuals and communities to climate‐related health risks 23

Climate-Ready States and Cities Initiative Category 1: Assessment and Planning to Develop Climate Change Programs 4 States and 1 City HD $80k - $120k / yr / 3 yrs Activities Agency needs assessment Early strategic plan implementation Partnership building & engagement with other initiatives Strategic plan development

Climate-Ready States and Cities Initiative Climate-Ready States and Cities Initiative 4 States and 1 City HD $150k - $250k / yr / 3 yrs Activities Strategic Plan Implementation Identification and prediction of health impacts & population & system vulnerabilities Develop & tailor health programs Identify co-benefits and unintended consequences of policies, programs and projects in other sectors (HIA) Category 2: Building Capacity to Implement Climate Change Programs and Adaptations

Climate Change Adaptation: 2012 HHS Environmental Justice Strategy 26 HHS can improve the resiliency of vulnerable individuals and marginalized communities, through increased understanding of the human health impacts of climate change and preparedness planning at the state and local levels. Health outcomes that are sensitive to climate change include asthma, cardiovascular disease, stroke, heat-related illnesses and deaths, and mental and stress-related disorders.

Focus: Climate Change intersections with major HHS efforts HHS GoalsClimate Change Impacts Mitigation/Adaptation Cobenefits Reduce cardiovascular morbidity and mortality Impacts of heat stress and milder winters, air pollution Reduced fossil fuel combustion Increased active transportation Assure healthy home environments Moisture and moldHome retrofits; improved insulation, ventilation Preparedness and response capacity Increased frequency and severity of extreme weather events Community resilience to all hazards Reduce health disparities Climate impacts on heat stroke, flooding, air pollution Community engagement and preparedness

Highlights of High-Level Vulnerability Analysis for HHS Protecting the most vulnerable: health and human services in the face of weather extremes and climate threats –Office on Disability –Administration for Children and Families –Administration on Aging, Center for Medicare Services –Indian Health Service –Assistant Secretary for Preparedness and Response Incorporating Climate Change Considerations into Regulatory Decisions –FDA Incorporating Climate Change Considerations into Public Health Practice and Research –CDC, ATSDR, NIH

Summary Climate change is having significant impacts on the health and well- being of vulnerable populations in the United States and around the world While health adaptation is essential, it is equally important to highlight the health promotion benefits of climate change mitigation measures ‘ Necessary to integrate climate change, disparity awareness, and health and environmental impact considerations into internal management functions and policies The Commissioned Corps, as a cadre of public health professionals, has a critical role to play in improving community resilience

Thank you! Questions?