1. Overview of US National Climate Assessments and Health
12/24/2018
Overview of US National Climate Assessments and Health
John Balbus, MD, MPH
Senior Advisor for Public Health, National Institute of Environmental Health Sciences
Director, NIEHS-WHO Collaborating Centre for Environmental Health Sciences
Medical Society Consortium Meeting
Arlington, VA April 9, 2018

2. A New World of CCHH…

3. Congressional mandate for NCA
From the Global Change Research Act of 1990:
Not less frequently than every 4 years … shall prepare and submit to the President and Congress an assessment which:
Integrates, evaluates, and interprets the findings ….and discusses the scientific uncertainties associated with such findings
Analyzes the effects of global change on the natural environment, agriculture, energy production and use, land and water resources, transportation, human health and welfare, human social systems, and biological diversity
Analyzes current trends in global change, both human- induced and natural, and projects major trends for the subsequent 25 to 100 years.
Think of CSSR and NCA4 as two volumes of the same report.
Volume 1, the Climate Science Special Report, responds to #1 & #3 of mandate
Volume 2, the Fourth National Climate Assessment, responds to #2 (and to some extent, #3)

4. HUMAN HEALTH THE IMPACTS OF CLIMATE CHANGE ON IN THE UNITED STATES:
A SCIENTIFIC ASSESSMENT
Health2016.globalchange.gov

5. Climate Change and Health1
Climate Change and Health
Conceptual diagram illustrating the exposure pathways by which climate change affects human health. Here, the center boxes list some selected examples of the kinds of changes in climate drivers, exposure, and health outcomes explored in this report. Exposure pathways exist within the context of other factors that positively or negatively influence health outcomes (gray side boxes). Some of the key factors that influence vulnerability for individuals are shown in the right box, and include social determinants of health and behavioral choices. Some key factors that influence vulnerability at larger scales, such as natural and built environments, governance and management, and institutions, are shown in the left box. All of these influencing factors can affect an individual’s or a community’s vulnerability through changes in exposure, sensitivity, and adaptive capacity and may also be affected by climate change.
Nuances from CHA
Climate change affetts the health of all Americans
Operates via exposure pathways that are influenced and moderated by other enviornmental and sociobehavioral factors
Vulnerabililty has three components:exposure, sensitivity, and lack of adaptive capacity at individual and communal levels.

6. Significant Findings
Quantifies future increases in temperature-related deaths
Confirms very high confidence in association between hotter- and colder-than-normal temperature and increased illness and death
Quantifies the increase of thousands to tens of thousands of premature heat-related deaths projected in the summer due to climate change
Assesses the impact of changes in tolerance to extreme heat on future deaths from heat
Confirms air quality impacts and provides likelihood for ozone, wildfire impacts
Provides new likelihood assessment (likely) and high confidence that climate change will make it harder for any given regulatory approach to reduce ground-level ozone pollution, and that increased wildfires increase risk of premature death, adverse cardiovascular/respiratory outcomes
Confirms high confidence that increases in airborne allergens will worsen allergy and asthma conditions and confirms indoor air health risks as significant emerging area
Connects changes in extreme events to increased exposure to health impacts
Describes health impacts to extreme events with high confidence, including death, injury, or illness; exacerbation of underlying medical conditions; and adverse effects on mental health
Identifies impacts to health from disruption of essential infrastructure
High confidence that coastal flooding will impact vulnerable communities

7. Significant Findings
Provides likelihood of changing vector distribution, expands discussion of WNV
Likely, high confidence in changing geographic and seasonal distribution of ticks carrying Lyme, and likely, medium confidence in increases in risk to human exposure
Assessment of impacts of West Nile virus show very likely, high confidence in climate change influence on distribution, abundance, and prevalence of infection in mosquitoes
Details sources and pathways (drinking, recreational) of waterborne illness risk
Disaggregates confidence and likelihood for changes in multiple water-related illnesses from Vibrio bacteria, marine harmful algae, freshwater harmful algae, and runoff sources
Describes health impacts of water infrastructure damage or failures
First assessment of rising CO2, climate on quality (nutritional value) of food
Describes impacts of pathogens, toxins, and chemical contaminants in US food chain
Assesses the large body of research establishing very likely, high confidence that nutritional value of food crops, such as wheat and rice, will decrease as rising levels of atmospheric CO2 reduce concentrations of protein and essential minerals in most species

8. 12/24/2018
Significant Findings
Presents an important emerging area: increased mental health consequences
Confirms Very High Confidence in extreme weather and climate related impacts including post-traumatic stress disorder (PTSD), depression, and anxiety, often at the same time
Introduces issue of mental health impacts from the real and perceived threats of climate change and risks of heat exposure to people with pre- existing mental health illnesses or prescription medications
Details the ways in which climate change affects the health of us all
People experience different inherent sensitivities to the impacts of climate change at different ages and life stages. For example, the findings confirm with very high confidence the very young and old are particularly sensitive to climate-related health impacts.

9. NCA4: A two-volume effort
Congressional Mandate
4th National Climate Assessment
Vol. I: Climate Science Special Report
Vol. II: Climate Change Impacts, Risks, and Adaptation in the U.S.
integrates, evaluates, and interprets the findings of the Program (USGCRP) and discusses the scientific uncertainties associated with such findings ✔️
analyzes the effects of global change on the natural environment, agriculture, energy production and use, land and water resources, transportation, human health and welfare, human social systems, and biological diversity
analyzes current trends in global change, both human- induced and natural, and projects major trends for the subsequent 25 to 100 years.

10. Processes and guidance developed by the Steering Committee
Chapter leadership recruited
Full Chapter Author teams named
Author teams scoped chapters and developed chapter outlines
Feb-Mar: Engagement activities and author team teleconferences
Apr: Author meeting
Jan-Jun: Drafting and public engagement
Jun-Aug: NOAA TSU review of First Order Draft and author response
Aug-Oct: Interagency review of Second Order Draft and author response
Nov-Mar 2018: Public comment period and National Academies review of Third Order Draft and author response
Mar: Author meeting
Apr-May: Interagency review of Fourth Order Draft and author response
Jun-Aug: Final interagency reviews of Fifth Order Draft
Sep-Dec: Layout and production of Final Report
Dec+ : Release and public engagement
2016
2017
2018
Schedule is subject to change

11. Key Messages from Health Public Comment Draft
Key Message 1: Although every American is vulnerable to the health impacts associated with climate change, risks are not experienced equally, with older adults, children, low- income communities, and communities of color among the population groups that are particularly vulnerable. Health risks arise from exposure to heatwaves, floods, droughts, and other extreme events; from vector-, food- and water- borne infectious diseases; from changes in the quality and safety of food and water; and from stresses to mental health and well-being. The risks are projected to increase with additional climate change.

12. Key Messages from Health Public Comment Draft
Key Message 2: Adaptation policies and programs that help individuals, communities, and states prepare for and manage a changing climate reduce the number of injuries, illnesses, and deaths from climate-sensitive health outcomes. Further, explicitly incorporating climate change risks into infrastructure planning and urban design can have beneficial health consequences.

13. Key Messages from Health Public Comment Draft
Key Message 3: By the end of this century, reducing the severity of climate change by reducing greenhouse gas emissions could save thousands of lives each year and produce hundreds of billions of dollars in health-related economic benefits each year, compared with following a pathway of higher greenhouse gas emissions.

14. What is new about NCA4’s third order draft coverage of health?
Regional focus with strong health content
Proposed incorporation of newly published quantitative economic analyses
Stronger health care sector content
Several draft sectoral chapters have significant health content
Air Quality
International
Sectoral Interdependencies
Built environment

15. Activities in Federal CCHH Science
Goal: Comprehensive Science Plan
Partners: National Security, Infectious Disease/Pandemic Threats Communities, Climate and Earth Sciences, Disaster Response
Components
Predicting Climate-Sensitive Infectious Diseases
Building the Evidence Base for Disaster Risk Reduction for Health Care Systems
Integrated Assessment of Air Quality Impacts from Climate- sensitive Pollutants

17. https://tools.niehs.nih.gov/cchhl/
12/24/2018

18. Conclusions
Field of climate and health is advancing in US and around the world
US GCRP Climate and Health Assessment helps establish a benchmark of scientific knowledge
US GCRP is sustaining assessment of health impacts of climate change and advancing scientific inquiry

19. Thank you for your attention!
John Balbus, MD, MPH