Disclaimer I have nothing to disclose OUTLINE Immediate and - PDF document

Climate and Health in 2019 Paul English, PhD MPH Tracking California Public Health Institute 2019 Photos credit: Jon Tyson; Adrien Taylor on Unsplash Disclaimer I have nothing to disclose OUTLINE ‐ Immediate and Medium‐Term Threats ‐ Case studies: Transportation and Industrial Agriculture ‐ Moving Forward: Positive and Negative Social Pressures

Continuing Climate‐Related Health Threats • Wildfires/Air Quality • Heat Waves • Heat‐Related Neuropathy • Increased probability of rare catastrophic weather events • Population Displacement • Infectious Disease Spread Medium‐Term Health Threats • Limits of Human Tolerance to Heat • Food supply • Mental Health Air Quality from Woolsey/Camp Fires CA November 2018 11/9/18 Location Air Quality Index San Francisco 177 Fremont 179 Beijing 34 Source: NASA Nov 14 2 PM image Hong Kong 63 New Delhi 237 Ukiah 336 Ongoing Issues on Wildfire Smoke Exposures ‐ Childhood exposures ‐ Acute smoke exposures ‐ Long term consequences on lung function? ‐ Exposure to 24 hr avg PM2.5 during 2008 CA wildfires related to asthma ER and hosp (Reid, et al 2016) ‐ Wildfires could double the number of premature deaths from fine PM by 2100 (Ford et al 2018) ‐ Rescue meds to reduce airway inflammation among asthmatics during wildfire events ‐ Use of masks during wildfire events ‐ Prenatal exposures (UC Davis work) ‐ Firefighter exposures (biomonitoring)

Solution Source: Atlantic Magazine Heat Stress Neuropathy • Up to 20,000 deaths among sugarcane workers in El Salvador and Costa Rica • Moyce et al 2016 (UC Davis): 12% of approx. 300 workers had acute kidney disease after a summer work shift (heat stress and dehydration) • Not associated with traditional risk factors (diabetes, hypertension, etc.) • “one of the first epidemics due to global warming?” What is the limit of human survivability for heat? “Human exposure to approx 35°C (95°F) wet bulb temperature for even a few hours will result in death even for the fittest of humans under shaded, well‐ventilated conditions” (Im, et al 2017) (ambient air wet bulb temperature (combined measure of temp and humidity) Threshold likely to be reached in South Asia by end of this century (Im, et al 2017)

Fig. 1 Spatial distribution of highest daily maximum wet-bulb temperature, TWmax (°C), in modern record (1979–2015). Eun-Soon Im et al. Sci Adv 2017;3:e1603322 Published by AAAS Fig. 3 Vulnerability due to population density, poverty, and outdoor working conditions. Eun-Soon Im et al. Sci Adv 2017;3:e1603322 Published by AAAS Solution Dubai Mall of the World “The world’s first temperature‐controlled city” Dubai summer average high around 106 °F and overnight lows around 88 °F Totally enclosed 13 million square feet 250‐room inn, 22 movie theatres, 120 restaurants, 14,000 parking spaces Street car system To be built using state of the art green technology?

Ongoing extreme events 2017: Houston Flooding CA: 5 of its 20 worst wildfires ever India: Epic monsoon flooding Insurance payout that year: $135 b Uninsured losses: $195 b (Source: The Economist 2.23.19) Photo credits: CDC Increased probability of rare catastrophic weather events e.g. Hurricane Harvey August 2017 Source: ‐ 1 year of rain in 1 week (Third “500 year” CDC flood in less than 40 years) ‐ Massive evacuations, massive damage ‐ Largest flood event in Houston history Atmospheric river rare mega storm in CA scenario • Could last for weeks and cause more than 1.5 million people to evacuate • Floodwaters would inundate cities and form lakes in the Central Valley and Mojave Desert • Damage estimated at more than $725 billion statewide. Source: US Army Corps Engineers and USGS. Whittier Narrows Dam Source: Army Corp Engineers Post‐storm infectious disease spread Mosquito‐borne: Dengue Chikungunya Malaria Zika West Nile • Migration of vectors due to changes in precipitation, humidity, temperature Source: Dominican Republic after Tropical Storm Isaac, 2012, CDC • Rise in drug and pesticide resistance

Climate Change Migration (photo courtesy of CDC) • Role of climate change (drought, flooding, extreme weather) in causing famine, conflict, and population displacement/migration ‐ Occurring in poorest areas with high vulnerability/few resources • “Climate Gentrification” (residents moving to areas without climate change hazards resulting in higher property values) • Example: Phoenix to Flagstaff • Mobility responses should be related to rate of onset of climate hazard (UNEP) Climate Change Migration Public Health Capacity to Address Climate‐Related Health Threats • Lack of capacity at national, state and local levels: 75% of local health dept respondents reported that their agencies “lacked the expertise to assess the potential impacts” of climate change (NACCHO 2008; 2012 and Roser‐Renouf, et al 2016) • Over 19% of total state and local health dept workforce were lost from 2008 to 2014 (51,000 jobs). (ASTHO) • Only 14 percent of the workforce has formal training in public health, despite a 300 percent increase in public health graduates since 1992. (ASTHO: PH WINS study 2017)

The Web of Climate‐Related Impacts on Human Health, Transportation Example Drought Transportation Wildfires Human (Anthropogenic Limit on climate forcing ) Heat Air Respiratory Tolerance pollution and other Non‐ disease active outcomes Loss of Public Transport Public Health Health Action Capacity Lack of Diabetes Trust in /Obesity Science Adaptation and Increase in other Vaccine preventative Preventable activities Illness Industrial Agriculture, Ecological Impacts, and Climate Change ‐ Livestock (confined agricultural feeding) and Rice cultivation: Methane emissions ‐ Fossil Fuel use/fertilizers/pesticides ‐ Deforestation/Land Use ‐ Monoculture practice leading to loss of biodiversity/pesticide resistance: potential threats to food supply Nearly half of all insect species are In rapid decline Causes: deforestation Pollution Pesticides Climate change Source: International Union for the Conservation of Nature and Sanchez‐Bayo and Wyckhuys, 2019

The Web of Climate‐Related Impacts on Human Health, Industrial Agriculture Example Industrial Ag/CAFO Meat (Anthropogenic Catastrophic Consumption Climate Forcing) Insect Collapse Methane Increased Food Antibiotic Cancer Availability Resistance Risk / Quality Ocean warming CO2 /Acidification Deforestation Social Trends: PROS of respondents think global warming is 73% happening, which is a 10% increase from 2015. 62% think climate change is mostly caused by Humans (source: Leiserowitz et al 2018.) Nearly half of Americans support a carbon tax. That share is higher when told that the tax would go toward environmental restoration or renewable energy R&D. (Source: Univ Chicago and AP, 2018) Green New Deal: focus on public spending on green energy Social Trends: CONS Rise of Scientific Populism “America was founded on liberty and independence, and not on government coercion, domination, and control. We are born free, and we will stay free.” ‐ 45 th President of the United States “Global warming is not about science, but about politics ‐‐ that is, about expanding the power of elites using the coercive instruments of government to control the lives of people everywhere. ” Charles Kadlec, “The Goal Is Power: The Global Warming Conspiracy,” Forbes Magazine, 7/25/11 “Why, then, are we allowing an elite aristocracy of doctors and professors to bully people who disagree with them about laws that disempower parents and place an unequal vaccine risk burden on vulnerable children in the name of the public health ?” (“ Zero Tolerance Vaccine Laws in America: Will You Defend Vaccine Freedom?, National Vaccine Information Center, 2.19.19) Riots in France