Beating the Heat:

Public Health and

Climate Change
Jonathan E. Fielding, MD, MPH, MBA
Director and Health Officer
Los Angeles County Department of Public Health
APHA Annual Meeting and Exposition
San Diego, CA - October 27, 2008

Presenter Disclosures
Dr. Jonathan E. Fielding
(1)
The following personal financial relationships with
commercial interests relevant to this presentation existed
during the past 12 months:

No relationships to disclose

Climate Change is Happening Now

3
Source: IPCC 2007 (4th Assessment)

IPCC 2007: Human Impact is Evident

4
Source: IPCC 2007 (4th Assessment)

Global Contributors to
Greenhouse Gas Emissions
Leading sources of greenhouse gas emissions are combustion of fossil
fuels: coal, oil, and natural gas
More than 60% of the annual global industrial carbon dioxide
emissions come from industrialized countries, accounting for 20% of
the worlds population
U.S. per capita emissions of carbon are over 20 times higher than
India, 12 times higher than Brazil, and 7 times higher than China
These per capita rates expected to change significantly as China,
India, and other countries continue to develop economically
China is now the #1 carbon emitter, surpassing the U.S.

Global carbon dioxide emissions are projected to increase by at least

50% over the next 25 years under current conditions
5

Annual Carbon Dioxide Emissions - 2005

Others
Japan
India
EU

32.7%
4.6%
Total CO2 measured in
thousands of metric tons

4.9%
5.6%

Russia
China
U.S.

11.4%
18.4%
22.4%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

The most current estimates state that China is about to surpass the US in
emissions and its rate of emissions is accelerating.
6
Source: U.S. Greenhouse Gas Emissions Inventory

U.S. CO Emissions from Fossil Fuel

7
Source: U.S. Greenhouse Gas Emissions Inventory

Why Should Public Health Care?

It is our job to protect the publics health
WHO estimates that in the year 2000, there were 150,000 excess deaths
per year due to climate change
Climate change is already affecting health around the world, and its
impact on health will continue to grow

Fighting climate change is aligned with protecting and

promoting health
Many of the proposed solutions for climate change are healthy for
everyone

We have the appropriate skills

Public Health has the skills to effect behavior change, and those skills
can help people adopt greener behaviors too
Public Health has policy and advocacy skills that will help encourage
organizational and societal changes

We can be role models

8

Projected Impacts of Global

Temperature Change
0C
Food

Water

1C

2C

3C

4C

5C

Falling crop yields in many areas, particularly

developing regions
Falling yields in many
Possible rising yields in
developed regions
some high latitude regions450 ppm CO2 eq
Small mountain glaciers
disappear water
supplies threatened in
several areas

Significant decreases in water

availability in many areas, including
Mediterranean and Southern Africa

Sea level rise

threatens major cities

Ecosystems
Extensive Damage
to Coral Reefs

Rising number of species face extinction

650 ppm CO2 eq

Extreme
Rising intensity of storms, forest fires, droughts, flooding and heat waves
Weather
Events
Risk of Abrupt and
Increasing risk of dangerous feedbacks and
Major Irreversible
abrupt, large-scale shifts in the climate system
Changes
9

Source: L. Rudolph, 2008

Climate Changes Impacts on Health

10
Source: Haines, et al, JAMA 2004

Extreme Weather Events & Disease Clusters

11
Source: Epstein, Harvard Center for Health & Global Environment

Expected Environmental Impacts in So.

Cal. of Climate Change: Sea Level Rise
Effects of rising sea level
Coastal areas will become
vulnerable to storms and
flooding
Loss of coastal wetlands and
erosion of beaches
Saltwater contamination of
drinking water
Potential damage to roads,
highways, and other
infrastructures near coastal
areas
12

Expected Environmental Impacts in

CA of Climate Change: Floods & Droughts
Warmer temperatures can result in
premature and rapid snowmelt in the
Sierra snow pack, which alters the
timing of run-off water supplies for of
CAs surface water

Severe flooding may occur during

winter and spring, with slower water
flow during summer seasons
Drought risk may be acutely elevated during the summer months
June 2008 Governor Schwarzenegger declares state drought
13

Health Impacts of Heat Waves

Los Angeles projected to have an increase of 62% 88% in heat-related mortality by 2080
Health impacts likely to be seen 1 to 3 days after the
onset of the heat waves
Health effects of extreme and prolonged heat exposure
include: heat cramps, heat exhaustion, heat stroke, heat
syncope (fainting)

Devastating heat waves seen elsewhere recently

5-day heat wave in Chicago in 1995: 700 excess deaths,
most attributed to the heat
August 2003 European heat wave: 35,000 excess deaths
14

Heat Waves: Vulnerable Populations

Greater risk for people who do
not have access to air
conditioning
May not be able to afford air
conditioning
For populations unaccustomed to heat
waves, people may have air
conditioning but chose not to use it,
not realizing danger

Two vulnerable populations during heat waves:

Elderly: Population of senior citizens (> 60 years old) in Los Angeles
County is expected to increase by 83% by the year 2020
Low SES: Over 16% of LA County residents under 100% FPL
15

Potential Environmental Impacts in So.

Cal. of Climate Change: Wildfires
Wildfires are common in Southern
California
Characteristic of the area since
prehistoric times
Santa Ana winds may drive heat waves,
prolong wildfires, and prevent wildfire
control in this region

Climate models predict the summer

months will be longer, and hotter,
due to global warming
Result: dry soil and vegetation
become fuel for wildfires
16

Potential Environmental Impacts in So.

Cal. of Climate Change: Air Quality
Increased temperature and
increased carbon dioxide in
atmosphere leads to
Increase in formation of groundlevel ozone (and smog)
Increased allergen production (e.g.
pollen)
Longer seasons for allergen
producing weeds

Senior citizens, children, and people with respiratory and chronic diseases
are most vulnerable to high levels of ozone and increased allergens

Health effects of high levels of ozone exposure include:

Reduced lung function
Respiratory discomfort
Exacerbation of chronic respiratory illnesses (e.g. asthma)
17

Summary of Health Effects of Air Pollution

Amount of goods transported
through California projected to
nearly quadruple between 2000
and 20201
Will have significant impact on
air quality and health2
Diesel particulate matter (PM)
concentrated around ports,
railyards, and heavily trafficked
roads3
premature deaths
cancer
respiratory disease
lost workdays
global warming (2nd to CO2)
18 2005); 2 (Pacific Institute, 2006)
1 (Cal EPA,
3 (CA/EPA Air Resources Board); 4 (CA/EPA Air Resources Board, 2004)

Annual Health Impacts in CA

from PM and Ozone4

The Time for Inaction Has Past

Scale of threat is global: touches all, everywhere
Intensity of the threat: threatens all of our basic survival
mechanisms -- food, water, shelter, and health.
Scale of response: must engage every sector of society
Timeframe for response: we have at most 10 years -- not 10
years to decide upon action, but 10 years to alter fundamentally
the trajectory of global greenhouse emissions."
There is still time, but just barely. (Dr. James Hansen,
director of NASA Goddard Institute for Space Studies)

19

A Public Health Response

to Climate Change
Public health already utilizes a multi-level prevention
approach analogous approach can be taken to respond to
climate change
Primary prevention = climate change mitigation
Efforts to slow, stabilize, reverse climate change by reducing GHG
emissions
Efforts will occur in sectors other than PH, such as energy and transportation

Secondary/tertiary prevention = climate change adaptation

Efforts to prepare for, and minimize health burden of, climate change
Similar to public health preparedness for other uncertainties (e.g. pandemic
flu, bioterrorist attack), so likely that PH as sector will be involved in
adaptation efforts
20
Source: Frumkin, et al., AJPH 3/08

What Should We Do?

1. Mitigation = reduce GHG emissions
1.

Reduce energy usage and Reduce, Reuse, Recycle

1.
2.

As individuals, at home
As organizations, at work

2. Adaptation = prepare for impact of climate change

1.

Emergency preparedness
1.
2.

As individuals/families
As local health department

3. Mitigation and adaptation = advocate for healthy

policies
1. Support legislation that reduces GHG emissions
2. Support sustainable lifestyles & communities
21

22

Realizing the Co-benefits of

Reducing GHG Emissions
Primary benefits

reductions in the expected long-term consequences of global warming;

avoided damages of climate change

Co-benefits (or ancillary benefits)

economic, social, environmental, public health and other benefits
independent of any direct benefits from mitigating climate change

Health co-benefits
Benefits of climate change mitigation strategies that have a positive
effect on health
Example: promote cleaner energy production and cleaner fuels
Primary result = reduced GHG emissions from energy production
Co-benefit = less air pollution = less respiratory distress
23

Realizing the Co-benefits of

Reducing GHG Emissions
Important to realize the co-benefits of climate change
responses = certain efforts to address climate change often
yield other health benefits too
Strategy: reducing vehicle miles traveled
Primary result = lower motor vehicle GHG emissions
Co-benefit = higher physical activity rates

Strategy: promote cleaner energy production and cleaner fuels

Primary result = reduced GHG emissions from energy production
Co-benefit = less air pollution = less respiratory distress

24
Source: Frumkin, et. al., AJPH March 08

Key Mitigation Technologies

& Practices*
Transport

Fuel efficiency
Hybrids
Road to rail
Public transport
Non-motorized transport
Land-use planning

Agriculture
Crop & land management
Livestock & manure
management
Improved N fertilizer use

Industry
Energy efficiency
Heat & power recovery

Buildings

Daylighting
Energy efficiency
Improved cook stoves
Solar heating & cooling

Energy supply

* Items in green have health co-benefits!

25

Coal to gas
Nuclear power
Renewable energy

GHG Mitigation Strategies,

Air Pollution, & Health
Globally ancillary benefits may be 30% 100% abatement costs
Public health improvement and knock-on effect to health services from
reductions in air pollutants account for approximately 80% total value
ancillary benefits in US
Canada proposed GHG emissions reductions would also reduce
SO2 by 9%, NOx by 7% of annual emissions
3,300 premature deaths per year avoided in Canada w/15% GHG reduction
(based on PM reduction only)

GHG reductions in 4 cities would avoid (through 2020)

64,000 premature deaths
65,000 chronic bronchitis cases
37 million person-days of restricted activity or work loss

26
Sources: IPCC (2001); Caton (2000); Blomqvist (2000); Cifuentes (2001)

Climate & Health Co-benefits

of Decreased Auto Use
Reductions
Greenhouse gas emissions
Air pollution
Noise
Infrastructure costs
Community Severance
Increases
Physical Activity
Social Capital
27
Borrowed from L. Rudolph

Reductions
Respiratory disease
Traffic injuries
Heart disease
Depression
Osteoporosis
Diabetes
Cancer
Stress

Climate & Health Benefits of Reduced

Meat Consumption
Average American diet requires the production of extra 1.5 CO2e
compared to a strictly vegetarian diet.
2.2 pounds beef = CO2e of 155 miles driving
Meat consumption reduction of 20% = switch from Camry sedan to Prius
Reductions
Greenhouse gas emissions
Antibiotic use
Water pollution (nitrates)
Air pollution
Soil erosion
Unsustainable H2O
consumption
Pesticide Use
28
Borrowed from L. Rudolph

Increases
Biodiversity
Global food security
Protein intake equity
Rural community
strength

Reductions
Ischemic heart disease
Obesity
Colorectal cancer
Breast & prostate cancers
Type II Diabetes
Antibiotic resistance
Respiratory disease
Pesticide health effects

Mitigation: What Can We Do In Our Homes

& Workplaces to Combat Global Warming?
Establish recycling programs in the workplace and
home
Recycling half of your household waste = hundreds of
lbs. of CO2 saved per year

Promote energy efficiency in the home and workplace

Changing regular light bulbs to compact fluorescent
bulb throughout your house = hundreds of lbs of CO2/yr

Make small energy use changes on a broad scale

E.g. replacing all light bulbs with energy efficient light
bulbs in all County buildings

Encourage renewable energy power sources (solar

energy and wind energy) and responsible use of
energy
Turning off your TV, computer, and other electronics =
thousands of lbs. of CO2 saved per year
29

Mitigation: What Can We Do In Our Homes

& Workplaces to Combat Global Warming?
Try to drive less and walk more!
You save gas money and keep our air
cleaner for every mile you dont drive
Most car trips taken in your neighborhood
are short enough to walk or bike

Encourage carpooling to
work/school
Encourage public transportation
use
Provide incentives for employees to purchase fuel-efficient vehicles
(e.g. electric, hybrid, CNG vehicles)
Every gallon of gas saved = tens of lbs. of CO2 saved

If you do take a car, maintain it

Properly inflated tires can improve gas mileage by 3%
30

Adaptation: Emergency Preparedness

We need to prepare now for the inevitable
effects of climate change, such as heat waves
and wildfires
Good news: preparing for one type of emergency
prepares us for all types of emergencies
Preparation minimizes impact of disasters and
fear/anxiety

We need to prepare ourselves as individuals

and as health agencies
31

Promote Healthy Policies

Support policies related to sustainable communities
Mixed use development, jobs near housing,
transit-oriented design, bike lanes and
sidewalks, parks and green
Development and utilization of useful public
transportation
Energy efficient "green" buildings and LEED
certification
Buildings consume 72% of the nations
electricity and more GHG than
transportation or industry*
Recycling, waste management and pollution
control
Securing safe water supplies

These policy decisions occur at all levels of government, so many opportunities for Public
Health to give input
Health Impact Assessments
Surveillance data tracking spread of vectors and diseases
32
Source: US Dept of Energy, 2007

What Should We Do?

Educate ourselves, public, and policy makers

Partnerships and collaboration
Lend PH credibility and experience in driving policy & behavior change
Advocate for aggressive government and business mitigation policies &
strategies that also promote health
PH leadership in advocating for personal, organizational, local government
carbon footprint reduction
Increase understanding and research re: health co-benefits
Ensure health co-benefits included in policy and cost assessments (e.g. HIAs)
Protect vulnerable populations
Advocate for equity in mitigation
Monitor health impacts of climate change
Preparedness and adaptation

33
Borrowed from L. Rudolph

We Cant Do It Alone
So why should we bother?
Efforts will yield long-term savings
Will make our economy more competitive
The co-benefits are great
Will improve the sustainability of our
communities
Moral obligation if we care about the health of
our communities, then we need to do our part
34

Jonathan E. Fielding, MD, MPH

Public Health Director
and
Health Officer
Los Angeles County
Department of Public Health
Special thanks to Linda Rudolph for use of some of her
slides