1. Preparing for Climate Change: Protecting our Drinking Water Gina M. Solomon, M.D., M.P.H. Senior Scientist, NRDC Associate Clinical Professor, UCSF gsolomon@nrdc.org

2. Red Tides Infectious Disease Asthma Allergies Heat Stress Extreme Weather

3. Global Warming is Happening

5. Myth: Global Warming Will Be Gradual

6. Key Elements of Adaptation Identifying Vulnerabilities Identifying Vulnerabilities –Physical Environment –Demographic Tracking Tracking –Disease –Zoonotic –Environmental Conditions Climate-Smart Design Climate-Smart Design –Communities –Buildings Public Education Public Education –Preparedness

7. Rainfall Patterns will Change

8. The Lessons from Katrina

9. ‘Next New Orleans’ may be in California: Sacramento-San Joaquin Delta cited as ‘scariest spot’ for flooding

10. The Sacramento-San Joaquin Delta 2,600 miles of levees (7x the length of the New Orleans system); 2,600 miles of levees (7x the length of the New Orleans system); Areas >20 feet below sea level; Areas >20 feet below sea level; >300,000 people in direct path of a flood; >300,000 people in direct path of a flood; Drinking water for 24 million people. Drinking water for 24 million people.

11. A Flood is Likely… Cover Sacramento with 17 feet of water; Cover Sacramento with 17 feet of water; Salt water intrusion into delta, contaminating irrigation and drinking water supplies. Salt water intrusion into delta, contaminating irrigation and drinking water supplies. Chance of a “catastrophic flood” in next 50 years is ~66%.

12. Actions Needed – Delta Levees Identifying Vulnerabilities Identifying Vulnerabilities –Where are the weak points? –Where do the most people live? Tracking Tracking –Flood risk warnings, evacuation decisions. Climate-Smart Design Climate-Smart Design –Don’t build in flood-prone areas –Let some areas flood –Spend money to repair and protect critical areas Public Education Public Education –Flood danger –Evacuation plans

13. March-April 1993: Milwaukee Cryptosporidium outbreak Largest waterborne disease outbreak in documented U.S. history; Largest waterborne disease outbreak in documented U.S. history; Water from one water treatment plant; Water from one water treatment plant; 403,000 of 1.6 million residents in the Milwaukee area (of which 880,000 were served by the malfunctioning treatment plant) became sick; 403,000 of 1.6 million residents in the Milwaukee area (of which 880,000 were served by the malfunctioning treatment plant) became sick; Symptoms included stomach cramps, fever, diarrhea and dehydration; Symptoms included stomach cramps, fever, diarrhea and dehydration; Over 100 deaths were attributed to this outbreak, mostly among the elderly and immunocompromised people; Over 100 deaths were attributed to this outbreak, mostly among the elderly and immunocompromised people; Cause of epidemic never officially identified. Cause of epidemic never officially identified.

14. Drinking Water Vulnerability Recipe for a Cryptosporidium Outbreak Recipe for a Cryptosporidium Outbreak –Impaired watershed (fecal, sediment) –Water treatment deficiencies –Extreme precipitation events

15. Precipitation and Drinking Water Contaminants Giardia Cryptosporidium Two-thirds Two-thirds of waterborne disease outbreaks followed precipitation above the 80th percentile More than half of outbreaks followed precipitation above the 90th percentile

16. Impaired Waters in California Watersheds listed as impaired under the Clean Water Act Watersheds listed as impaired under the Clean Water Act

17. California Surface Water Quality Assessment Rivers and Streams Rivers and Streams –12,430 miles designated for drinking assessed –Good22.6 % –Threatened11.6 % –Impaired65.9 % Lakes, Ponds, and Reservoirs Lakes, Ponds, and Reservoirs –652,896 miles designated for drinking assessed –Good22.1 % –Threatened19.3 % –Impaired58.6 %

18. In 1997 & 1998 USEPA required source water testing at large drinking water systems (> 10,000 people) for microbial contaminants. In 1997 & 1998 USEPA required source water testing at large drinking water systems (> 10,000 people) for microbial contaminants. –43 water systems were tested in CA; –20 had at least one detection of crypto, giardia or virus; –Represents water systems serving approx 18.5 million people in CA. Source Water Vulnerability

19. DPH has completed source water assessments for 95% of the ~15,000 CA water systems; DPH has completed source water assessments for 95% of the ~15,000 CA water systems; Assessments include a vulnerability score for each Possible Contamination Activity (PCA) identified for that source; Assessments include a vulnerability score for each Possible Contamination Activity (PCA) identified for that source; PCAs include sources of microbial contamination such as animal operations, septic systems, liquid waste disposal, AFO/CAFO, wastewater treatment plants. PCAs include sources of microbial contamination such as animal operations, septic systems, liquid waste disposal, AFO/CAFO, wastewater treatment plants.

20. Water Treatment Vulnerability –Filtration –Disinfection –Turbidity

21. Actions Needed – Drinking Water Safety Identifying Vulnerabilities Identifying Vulnerabilities –Map water distribution systems; –Develop a predictive model for water quality disease risk at the community level; –Identify and map high-risk areas (age of septic systems, topography, agricultural regions). Tracking Tracking –WBDSS should be improved; –Water quality testing for biologic and non-biologic is inadequate; –Consider new surveillance strategies such as pharmacy records and syndromic surveillance reporting for GI illnesses. Climate-Smart Design Climate-Smart Design –Improve infrastructure – water disinfection and distribution systems; –Protect watersheds from runoff and fecal contamination. Public Education Public Education –Public outreach and education around water quality advisories.

22. Global Warming and Health Project 1. Research links between global warming and health; 2. Educate the public, the media, and policymakers; 3. Advocate for preparedness to predict, prevent, and respond to health crises; 4. Reduce pollution both from toxic chemicals and greenhouse gases.