1. Climate Change, Environmental Health and Non-Communicable Diseases John M. Balbus, MD, MPH Senior Advisor for Public Health National Institute of Environmental Health Sciences PHI Side Event at UN High Level Meeting on Non- Communicable Diseases September 19, 2011

2. Overview Environmental factors cause a significant fraction of Non-Communicable Diseases Global epidemics of diabetes, obesity and cardiovascular disease are creating ever-growing populations with increased vulnerability to climate change stressors Policies and solutions put in place to address climate change can have significant benefits for NCD’s, and vice versa

3. Global burden of disease due to the modifiable environment http://www.who.int/quantifying_ehimpacts/en/

4. The environmental burden of disease Pru ̈ ss-Ustu ̈ n and Corvalán, 2006

5. Identifying synergies and opportunities for co-benefits

6. “Rest assured, in this day and age, ever more sophisticated and costly medicines, devices, and technologies will not be able to save the situation. They will not avert an impending disaster. Only smart, farsighted policies can do this.” Dr. Margaret Chan Director-General of the World Health Organization Opening remarks at the WHO Global Forum 27 April 2011

7. Meeting research needs Asthma, respiratory allergies and airway diseases Cancer Cardiovascular disease and stroke Foodborne diseases and nutrition Heat-related morbidity and mortality Human developmental effects Mental health and stress-related disorders Neurological diseases and disorders Vectorborne and zoonotic diseases Weather related morbidity and mortality

8. Asthma, Respiratory Allergies, and Airway Diseases May become more prevalent because of: increased human exposure to pollen (due to altered growing seasons) molds (from extreme or more frequent precipitation) air pollution and aerosolized marine toxins Mitigation/Adaptation measures: Reduced fossil fuel combustion lowers air pollutants Household insulation and ventilation could worsen IAQ

9. Cancer Climate change may result in: Altered fate and transport of carcinogens Changes in air pollution levels Prolonged ozone depletion and increased human exposure to UV Mitigation/Adaptation measures: Reduced fossil fuel combustion lowers carcinogenic air pollutant levels Increased active transportation raises physical activity levels and reduces cancer risk Alternative fuels and energy- related materials may introduce novel carcinogens

10. Cardiovascular Disease and Stroke Existing cardiovascular disease may be exacerbated by: increasing heat stress increasing exposure to particulate air pollution changing the distribution of zoonotic vectors that cause infectious diseases linked with cardiovascular disease. Mitigation/adaptation measures: Reduced fossil fuel use reduces exposure to air pollutants with cardiovascular toxicity Increased active transportation raises physical activity levels, reducing cardiovascular risks

11. Mental Health and Stress-Related Disorders Extreme weather events related to climate change may result in: geographic displacement of populations damage to property loss of loved ones chronic stress, all of which can negatively affect mental health. Adaptation/Mitigation measures: Effective adaptation should reduce psychological trauma and stress

12.  Chartered December 2009  Demonstration of “end to end” science in service of societal needs  Co-chaired by NIEHS, CDC and NOAA  11+ agencies involved

13. Synergistic solutions: improving cookstoves in the developing world Cookstove smoke kills nearly 2 million people each year More than half of those deaths are from COPD Black carbon from incomplete combustion contributes to atmospheric warming Improved cookstoves can improve health and equity and reduce short- lived climate forcing http://cleancookstoves.org/