1. Climate change in the Great Lakes Region: Key Vulnerabilities to Public Health Jonathan Patz, MD, MPH Jonathan Patz, MD, MPH Nelson Institute & Dept. Population Health Sciences Nelson Institute & Dept. Population Health Sciences University of Wisconsin - Madison University of Wisconsin - Madison Climate Change Webinar Series Ohio State University Sept. 28, 2010

2. CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes Urban Heat Island Effect Air Pollution & Aeroallergens Vector-borne Diseases Water-borne Diseases Water resources & food supply Mental Health & Environmental Refugees Heat Stress Cardiorespiratory failure Respiratory diseases, e.g., COPD & Asthma Malaria Dengue Encephalitis Hantavirus Rift Valley Fever Cholera Cyclospora Cryptosporidiosis Campylobacter Leptospirosis Malnutrition Diarrhea Toxic Red Tides Forced Migration Overcrowding Infectious diseases Human Conflicts 1 3°C by yr. 2100 2 40 cm “ “ IPCC estimates Patz, 1998 HEALTH EFFECTS OF CLIMATE CHANGE

3. Probabilities of future extremes can be estimated given projections of mean temperature Peterson et al., 2007 2057 2007

4. Heatwave morbidity -Milwaukee EPA STAR grant Li, et al., unpublished (EPA STAR grant, J. Patz, PI)

5. By 2050, warming alone may increase by 68% the number of Red Ozone Alert days across the Eastern US. (IPCC, 2007 -Bell et al, 2006)By 2050, warming alone may increase by 68% the number of Red Ozone Alert days across the Eastern US. (IPCC, 2007 -Bell et al, 2006) “The severity and duration of summertime regional air pollution episodes are projected to increase in the Northeast and Midwest US by 2045- 2052 due to climate- change-induced decreases in the frequency of surface cyclones.” (IPCC, 2007) “The severity and duration of summertime regional air pollution episodes are projected to increase in the Northeast and Midwest US by 2045- 2052 due to climate- change-induced decreases in the frequency of surface cyclones.” (IPCC, 2007)

6. Days per summer (June, July, August) with O3 above the NAAQS limit of 84 ppb. Colored, solid lines reflect the 10-year running mean of exceedances for each model (mean across SDSM ensembles, and across the study sites). Colored dotted lines reflect year-to-year exeedance values (mean across SDSM ensembles, and across the study sites). Holloway et al. 2009

7. USA: Combined sewer overflows (CSOs) Courtesy: Kellogg Schwab 1.2 trillion gal of sewage & stormwater a year discharged during combined sewer overflows – would keep Niagara Falls roaring for 18 days Center for Water & Health, JHU Bloomberg School of Public Health

8. Combined Sewer Systems & Past Precipitation Trends Source: National Climatic Data Center/NESDIS/NOAA Past Precipitation Trends Source: EPA CSS Communities 770 systems serve around 40 million people Source: EPA (Courtesy– J. Scheraga)

9. Sewage overflows in the Great Lakes Intense storm events result in combined sewer overflows (CSO’s)Intense storm events result in combined sewer overflows (CSO’s) Great Lakes provides drinking water to 40M people and has >500 beachesGreat Lakes provides drinking water to 40M people and has >500 beaches Sewage contains human pathogens including viruses, protozoan, and pathogenic bacteriaSewage contains human pathogens including viruses, protozoan, and pathogenic bacteria The EPA has estimated 140 communities release 150 billion liters of combined sewage each yearThe EPA has estimated 140 communities release 150 billion liters of combined sewage each year

10. Bradford Beach South Shore Beach Bradford and South Shore Beach on Lake Michigan E. coli CFU/100 ml 235-999 0-100 100-235 1000-9999 10,000-20,000 Rainfall Urban stormwater Sewage overflow Courtesy: Sandra McLellan UW-Milwaukee

11. Reported waterborne diseases, US, from 1948- 1994 67% 67% of waterborne disease outbreaks were preceded by precipitation above the 80th percentile (across a 50 yr. climate record), p < 0.001 51% 51% of outbreaks were preceded by precipitation above the 90th percentile, p < 0.002 Surface water-related outbreaks had strongest correlation with extreme precipitation in the month of outbreak; groundwater-related outbreaks lagged 2 months following extreme precipitation. Curriero, Patz, et al, 2001.

12. U.S. CCSP, 2008 Globally Averaged

13. Projected Change in the Frequency of 2" Precipitation Events (days/decade) from 1980 to 2055 based on downscaled climate models (http://www.wicci.wisc.edu)

14. Courtesy: Steve Vavrus (UW-Madison

15. Courtesy: Steve Vavrus (UW-Madison)

16. The Good News about climate change and our health

17. The opportunity for improving health determinants We can reduce: The 1,000,000 annual deaths from urban air pollution The loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity WHO, 2007

18. Ten Leading Causes of US Deaths per Year (CDC, 2004)

19. Friedman et al. JAMA 2001;285:897 Asthma and Air Pollution decreased 42%Asthma-related emergency room visits by children decreased 42% Children’s emergency visits for non-asthma causes did not change during same period Natural experiment during 1996 Summer Olympic games in Atlanta traffic ozonePeak morning traffic decreased 23% and peak ozone levels decreased 28%

20. Comparative Scenario The Natl. Personal Transportation Survey reports median trip length in urban and suburban areas of the region to be 4-8 km, representing ~20% of VMT for the region. Our alternative scenario thus assumes that all round trips of 8 km or less could be accomplished through alternative modes of (non ICE) transportation. Grabow et al (in review)

21. 20% fewer car trips: Change in O 3 & PM 2.5 Grabow et al (in review) hundreds of lives saved hundreds of lives saved Thousands of Hospital admissions avoided Thousands of Hospital admissions avoided Billions reduction in health care costs Billions reduction in health care costs

22. Value of co-benefits is large 22 Fig 1 and fig 2 Compare to cost of climate policy: almost always <$30/tCO 2 Nemet G F, Holloway T and Meier P 2010 “Implications of incorporating air-quality co-benefits into climate change policymaking” Environmental Research Letters 014007 $2 – 196 /tCO 2 with a mean of $49/tCO 2 Nemet et al. 2010

23. Decision Support In adapting to climate change, we need to include health co- benefits stemming from mitigation policies; thus far, one-sided discussions of costs

24. Thank you! patz@wisc.edu www. sage.wisc.edu Educational website: www.ecohealth101.org