1. Climate Change and Public Health: The Role of CDC
February 17, 2008
Michael A. McGeehin, Ph.D., M.S.P.H.
Director, Environmental Hazards and Health Effects,
National Center for Environmental Health, CDC

2. Agenda Is climate change real? Is climate change a health issue?
Is there a public health role?
What is the role of CDC?
A few parting thoughts.

3. IPCC 2007 Reports

6. VECTOR-BORNE DISEASES ENVIRONMENTAL REFUGEES
Potential Health Effects of Climate Change
HEAT 
Heat stress, cardiovascular failure
SEVERE WEATHER
Injuries, fatalities
AIR POLLUTION
Asthma, cardiovascular disease
ALLERGIES
Resp allergies, poison ivy
VECTOR-BORNE DISEASES
Malaria, dengue, hantavirus, encephalitis, Rift Valley fever
WATER-BORNE DISEASES
Cholera, cryptosporidiosis, campylobacter, leptospirosis
WATER AND FOOD SUPPLY
Malnutrition, diarrhea, harmful algal blooms
MENTAL HEALTH
Anxiety, post-traumatic stress, depression, despair
ENVIRONMENTAL REFUGEES
Forced migration, civil conflict
Climate change:
Temperature rise
Sea level rise
Hydrologic extremes

7. The direct health effects of heat

9. European heat wave, 2003 UK 2,091 Italy 3,134 France 14,802 Portugal
TIME LINE (FRANCE)
CONFIRMED MORTALITY UK
2,091
Italy
3,134
France
14,802
Portugal
1,854
Spain
4,151
Switzerland
975
Netherlands
1,400-2,200
Germany
1,410
TOTAL
29,817-30,617
Vandentorren et al. Mortality in 13 French cities during the August 2003 heat wave. Am J Public Health 2004; 94(9):
Haines et al. Climate change and human health: Impacts, vulnerability and public health. Public Health 2006;120:

11. Severe weather events

12. Climate change and severe weather events, 1972-2004
Hurricane intensity (Saffir-Simpson scale categories 1 to 5), global, , including number of storms by category (A) and proportion of storms in each category (B). Bold curve in (A) is the maximum global hurricane wind speed (in m/sec). Dashed lines show the 1970–2004 average numbers in each category. Source: Webster et al., Science 2005;309:

13. Increases in temperature or ultraviolet radiation (UVR) in the lower atmosphere enhance the chemical reactions that produce ozone.
Ozone is a highly reactive gas which can oxidize molecules directly, and create high-energy free radicals that damage cell membranes.
Optional Slide
REFERENCE: Climate Change and Human Health, Chapter 3.

14. Ozone Season in Atlanta
Unhealthful
Source: M. Chang, Ph.D., Georgia Tech

15. Allergies

16. Ragweed Genus Ambrosia
↑ CO2 and temperature → ↑ pollen counts, longer growing season
Source: Ziska et al., J Allerg Clin Immunol 2003;111:290-95;
Graphic: Wall Street Journal, 3 May 2007.

17. Poison Ivy Toxicodendron radicans ↑ CO2 leads to
↑ photosynthesis
↑ water use efficiency
↑ growth
↑ biomass
More allergenic urushiol
Greater CO2 stimulation than most other woody species
Source: Mohan et al. PNAS 2006;103:

19. The predictable…

21. …and the surprising

23. VECTOR-BORNE DISEASES ENVIRONMENTAL REFUGEES
Potential Health Effects of Climate Change
HEAT 
Heat stress, cardiovascular failure
SEVERE WEATHER
Injuries, fatalities
AIR POLLUTION
Asthma, cardiovascular disease
ALLERGIES
Resp allergies, poison ivy
VECTOR-BORNE DISEASES
Malaria, dengue, hantavirus, encephalitis, Rift Valley fever
WATER-BORNE DISEASES
Cholera, cryptosporidiosis, campylobacter, leptospirosis
WATER AND FOOD SUPPLY
Malnutrition, diarrhea, harmful algal blooms
MENTAL HEALTH
Anxiety, post-traumatic stress, depression, despair
ENVIRONMENTAL REFUGEES
Forced migration, civil conflict
Climate change:
Temperature rise
Sea level rise
Hydrologic extremes

24. Public Health Action on Climate Change
Study and predict links between climate change and health
Track diseases and trends related to climate change
Investigate infectious water-, food-, and vector-borne disease outbreaks
Public health workforce prepared to respond
Communicate effectively on climate change
Heat wave and severe storm response plans; focus on the most vulnerable
Partnerships with private sector, civic groups, NGOs, faith community, etc.

25. The role of CDC Surveillance and data collection
Outbreak investigations
Technical assistance
Forecasting and modeling
Preparedness planning
Research
Education
Training and capacity-building

26. A few parting thoughts: Four Cs
Conceptualizing
Communicating
Complexity
Co-benefits

27. “Mitigation and Adaptation”or
“Preparedness and Prevention”

28. Care for future generations
Care for the individual patient
Care for the community
Care for future generations
THE CLINICAL APPROACH
THE PUBLIC HEALTH APPROACH
THE LEGACY APPROACH

30. Intergenerational responsibility
Stewardship

31. Effective health communication

38. Edvard Munch does Climate Change
Despair
Anxiety
Edvard Munch does Climate Change
The Scream

40. “Think of the verbs associated with environmentalism and conservation: ‘stop,’ ‘restrict,’ ‘reverse,’ prevent,’ ‘regulate,’ and ‘constrain.’ All of them direct our thinking to stopping the bad, not creating the good.”
The need for positive, aspirational messages.

41. “I have a nightmare…”

42. “I have a dream…”

43. The need for bold, cross-cutting thinking.
“The challenge of climate change is so massive, so global, and so complex that it can only be overcome if we look beyond the issue categories of the past and embrace a grand new vision for the future.”
The need for bold, cross-cutting thinking.

44. Complexity
Reality (simplified)

45. Looking over the horizon

46. Source: IPCC

47. Population growth

48. “Hubbert’s peak”
Source: Hubbert, 1956

49. Peak petroleum

50. Limits on land

51. Limits on water

52. Promoting co-benefits

53. Climate Change Synergies
Heat wave plans including “buddy systems”
↑ social capital
↓ Vehicular travel
↓ car crashes; clean air; ↑ physical activity
↑ Fuel efficiency
↓ air pollution
Locally grown food
Fresh food; ↓ pesticide exposure; local business
Energy-efficient buildings
↓ operating costs
Alternative energy sources
Business opportunities

54. Co-benefits: Trees Carbon sequestration Cooler temperatures
Reduced energy demand
Clean water
Clean air
Protection from sunlight
Venues for physical activity
Noise reduction
Mental health
Spiritual fulfillment

55. Co-benefits: Food and nutrition

56. Suddenly, Bob realizes that he’s “part of the problem.”

57. Co-benefits: Transportation
 Depression
 Air pollution
 CO2 emissions
 Physical activity
 Osteoporosis
 Injuries
And by the way…
 Infrastructure costs
 Social capital

58. Summary Climate change is real. Climate change is a health issue.
There a public health role.
There is an important role for CDC.

59. Thank you!