1. Kent E. Pinkerton, PhD Source: NASA University of California, Davis Department of Pediatrics Climate Change, Agriculture and Global Public Health What Can We Learn from Our Own Backyard? Western Center for Agricultural Health and Safety (WCAHS) Seminar Series Davis, CA June 3, 2013

2. IPCC4th AR Global T increase 1.4 F

3. Our Climate is Changing Rapidly 3 UN World Meteorological Organization, March 2012 announcement of Global Temperature summary: The World is getting hotter……. The rate of increase since 1971 has been remarkable according to the preliminary assessment.

5. Climate Change and Africa Malawi BLANTYRE Stephen Gordon, MD, Liverpool School of Public Health

6. Village life is simple

7. Climate related problems in village life Seasonal hunger Every year Hospital impact Flooding Common and destructive Crop loss Drought Crops, also safety of water Stealing and violence Field guards Seasonal malaria Falling incidence Ethiopian micro-dams

8. Queen Elizabeth Central Hospital Limited space, staff, treatment and tests Limited staff, supplies, diagnostic tests and treatment

9. Climate-related health issues in hospital Malnutrition Anaemia Susceptibility to pneumonia Short life expectancy Cholera Water system in Blantyre Plague Migration from Mozambique But these overwhelmed by HIV and TB

10. Issues not seen in hospital Migration War Population stress Angola, Chad, Darfur, DRC, Eritrea, Mozambique, Sierra Leone, Somalia, Sudan, Uganda, Zimbabwe….

11. Climate data - Africa Despite covering a fifth of the world's total land area, Africa has the worst climate observation system of all continents, and one that is in a deteriorating state. About one in four weather stations in east and southern Africa that are part of the international data-sharing network called the Global Climate Observing System are not working, and most of the remaining stations are not functioning properly. Meanwhile, the density of the continent's weather stations is of one per 26,000 square kilometres, eight times lower than the WMO's minimum recommended level. Despite covering a fifth of the world's total land area, Africa has the worst climate observation system of all continents, and one that is in a deteriorating state. About one in four weather stations in east and southern Africa that are part of the international data-sharing network called the Global Climate Observing System are not working, and most of the remaining stations are not functioning properly. Meanwhile, the density of the continent's weather stations is of one per 26,000 square kilometres, eight times lower than the WMO's minimum recommended level.

12. Mechanisms that link climate change to health, morbidity and mortality Direct impacts of climate change, weather, and sea level rise on humans Impacts of climate change on physical and chemical agents Impacts of climate change on biological agents Impacts of climate change and sea level rise on fundamental life support

13. Climate-health linkages 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

14. Climate-health linkages Impacts of climate change on biological agents – Microbes (including algae) – Plants (pollens, poisons) – Zoonoses, including VBDs Impacts of climate change and sea level rise on fundamental life support – Water availability – Food/crop productivity – Shelter

15. Heat-Related Morbidity and Mortality Extreme heat causes more deaths in US than all other extreme events combined Risk factors: age, housing, urban residence, social isolation, underlying disease Impacts on co-morbidity a research priority Decline in cold-related death not expected to offset increase

16. Background: Motivation for Climate Change Concern in California In July 2006, California experienced a heat wave of unprecedented intensity and geographic extent – affecting the entire State. Coroners attributed 140 deaths to hyperthermia, and estimates from vital statistics data indicate > 650 heat-related deaths may have occurred over a 17-day period (July 14-30). Estimates of excess morbidity indicate there were ~1,200 hospitalizations and >16,000 Emergency Department Visits during the heat wave. Fewer cold- and heat-related deaths in past 30 years (in US). Attributed to higher % of homes with central heat & air conditioning. The public health burden of heat-related mortality and morbidity remains large, and unacceptable as heat-related illness is mostly (if not always) preventable.

17. 2006 California Heat Wave: Coroners Case Reports Sex: Male 66% Race/Ethnicity (Classic Heat Stroke cases): White non-Hispanic: 63 referent Hispanic: 24 OR: 1.9 (1.2, 2.9) Black, non-Hispanic: 12 OR: 1.8 (1.0,23.2) Asian/Pacific Islander: 1 OR: 0.1 (0.01,0.8) Unknown Race: 19 Age Distribution: Male (n= 92) Mean = 61.7 (10 – 98) yrs Female (n=47) Mean = 73.3 (45 – 98) yrs Hispanics: trend to be in younger age-groups Lived alone (43%) And of those who lived alone and had a social contact, only 40% were checked on within 24 hours prior to death. AC: 1 reported to be using AC prior to death. No AC, or not reported74% Not functional13% Functional but not used13% Trent, R.B., et al., Review of July 2006 Heat Wave Related Fatalities in California, available at: http://www.cdph.ca.gov/HealthInfo/injviosaf/Documents/HeatPlanAssessment-EPIC.pdf. SES: 99% of cases lived in zip codes where > 50% of residents live below Poverty line

18. Historic California temperature data courtesy of: Richard Medina, University of Utah, Dept. of Geography, Salt Lake City, Steven LaDochy, California State University, Los Angeles, & William Patzert, Jet Propulsion Lab, NASA, Pasadena, CA. Source: IPCC Climate Change 2007: The Physical Science Basis Predicted change over 21 st Century: Average temperatures Average temperatures: > increase in summer vs. winter July-September in range of: 1.5°C–6°C (2.7°F–10.8°F) (Depends on the GCM and GHG emissions scenarios.) Relative to historical average temps… > warming inland as compared with coastal regions (within ~50 km of coast)…. …as much as 4°C (7.2°F) higher… Heat Waves: Heat Waves: in frequency: Individual events -- tendency for longer duration > spatial footprints (multiple population centers affected) Greatest magnitude events: more humid less nighttime cooling. Proportionately more extreme temperatures inland. California Climate Change Scenarios Project Dan Cayan et al., 2008, A. Gershunov et al., 2009 Climate Change: Past, Present, Future Heat Exposure Potential

19. Climate Change: Vulnerability: Scale is Critical Climate Change: Vulnerability: Scale is Critical Geographic Variation in Potential Risk Factors: Higher Spatial Resolution Critical for County, Local, & Subpopulation Perspectives Maps created by Zev Ross

20. Ozone Movie Courtesy of Sacramento Air Quality Management District and Sonoma Technology, Inc., Petaluma, CA. (www. sparetheair.com) Subpopulations, Individuals Climate Change: Simultaneous Hazards & Risks Climate Change: Simultaneous Hazards & Risks Geographic Variation in Potential Risk Factors: County, Local, & Subpopulation Perspectives

21. SHRINKING ARCTIC ICEPACK Arctic ice has lost 40% of its volume in three decades. Chance of this occurring secondary to natural cycles is <0.1%.

23. Breakup of Larsen B Ice Shelf on Antarctic Peninsula January - March 2002 Provided by the National Snow and Ice Data Center.

24. Increased Occurrence of Bleaching of Coral Reefs In 1997-8, 16% of the worlds reef building corals died due to El Nino increase in sea surface temperatures. Impact of thermal stress on reefs can be due to ocean acidification pH 8.16 to 8.05 from carbonic acid due to increasing CO 2.

25. Cause and effect: Climate change may have caused the pine-beetle catastrophe.

26. 26 Climate Change Will Increase Wildland Fires CA Climate Action Team, 2009 Report: An increase in the number, size and duration of fires will add to the air pollution that already burdens California. Risk of large wildfires: – up to 55% increase by 2050 – up to 128% increase by 2099 Wildland fires cause increased health care utilization for respiratory illness, especially asthma.

27. 27 March 2012: Hottest March ever recorded in US (NCDC) July 2012: Hottest July ever recorded in US (NCDC) o Hottest month out of last 1,400 months dating back to 1895 2012 Drought: most extensive US drought since 1950s o 80 percent of agricultural land in US affected (USDA) o Colorado and Wyoming had the hottest summer on record (NOAA) o Nebraska and Wyoming had the driest summer on record. (NOAA) Climate Change: The Evidence is Mounting

28. Source: American Lung Association in California Land Use, Climate Change and Public Health Issue Brief, 2009 28 Respiratory Health Effects of Climate Change

29. Heat Waves August 2003 heat wave in France. Mean maximum temperature exceeded the seasonal norm by 11-12ºC on 9 consecutive days. 15,000 excess deaths were observed in France (60% increase of expected mortality) and 32,000 throughout Europe. Mortality was age-related. It was 45% higher in women than in men >45 years. Increased mortality in widowed, single, and divorced people. Excess mortality at hospitals (42%), home (32%) and in nursing homes (19%). Lack of air conditioning important cause. Significant increase in deaths related to heatstroke, hyperthermia, and dehydration; heart failure, chronic respiratory, and stroke also markedly contributed to the mortality. Psychiatric disorders, especially depression, had increases. Dhainaut J-F, et al Critical Care 2004; 8:1-2. Stafoggia M et al Epidemiology 2006; 17: 315-23.

30. 30

31. Ozone Increases with Higher Temperatures 31

32. Black Carbon and Climate Change 32 Black carbon (BC) is emitted directly as a result of incomplete combustion of fossil fuels and biomass. Leads to climate warming by: Absorbing incoming and reflected sunlight in the atmosphere; Darkening clouds, snow, and ice thereby reducing albedo; and Changing precipitation and cloud patterns.

33. BIOMASS AND HUT LUNG Asia, Africa, Latin America, indoor air pollution caused by burning biomass (branches, wood, dung, charcoal) and coal over primitive stones occurs in millions of homes. WHO estimates 1.9M premature deaths/year from indoor air pollution (twice that from outdoor pollution). 9.8M by 2030. Nearly half the people in the world use polluting inefficient stoves to cook their food each day: 3B people use biomass – 10% of global energy consumed. 80% of domestic energy consumption in India. 4 th in developing countries burden of disease. Hut Lung in women and pneumonia in children. High incidence of lung cancer in Chinese women. 6.7B tons of carbon by 2050 in Africa (cumulative); 6% of Africas total. Global Alliance for Clean Cookstoves is a new public-private partnership with a goal of 100M homes to adopt clean and efficient stoves and fuels by 2020. Medicine 2000; 79: 310-7.

35. Bronchoalveolar lavage cells with anthracotic pigment within the alveolar macrophages (X400).

36. A Human Health Perspective on Climate Change: A Report Outlining the Research Needs on the Human Health Effects of Climate Change

37. American Thoracic Society Workgroup Paper, March 2012: Climate Change and Human Health 37 …evidence is increasing that climate change does drive respiratory disease onset and exacerbations… "Our greatest concern is infants, children, the elderly and other sensitive populations," he said. "They will be the first to experience serious climate change-related health problems. Dr. Kent Pinkerton, UC Davis, Workgroup Co-Chair Thank You!

38. Acknowledgements John Balmes, MD; UCSF/UC Berkeley Stephen Gordon, MD; Liverpool School of Tropical Medicine, UK Helene Margolis, PhD; UC Davis Medical Center William Rom, MD; New York University Marc Schenker, MD; UC Davis, Western Center for Agricultural Health and Safety

40. Health Effects of Climate Change Heat-related illness and death Exacerbation of respiratory disease (e.g., asthma) Increased cardiopulmonary mortality Increased pollen season so increased respiratory allergic reactions (e.g., asthma) 40

41. Global Warmings Terrifying New Math Bill McKibben (350.org) has endorsed three critical numbers: 2°C as the acceptable amount of global warming agreed to as the Copenhagen Accord signed by 167 countries responsible for more than 87% of the worlds carbon emissions. Scientists estimate we can emit 565 gigatons of CO 2 into the atmosphere by 2050 and still stay below 2°C. In 2011 we emitted 31.6 gigatons and emissions are increasing 3%/year reaching the limit in 16 yr. Carbon Tracker Initiative states that all of the oil, gas and coal companies have 2,795 gigatons C in their combined reserve proprietary databases. This is valued at $27 trillion (if we stayed at 565 gigatons, approx. $20 trillion would have to be written off). ATS Workshop Report: Climate Change and Human Health. PATS 2012; 9: 3-8. Bill McKibben. Global Warmings Terrifying New Math. Rolling Stone Aug 2, 2012.

42. Temperature increase is due to Greenhouse Gases