1. Societal Risks and Responses: climate and health in a Risk Assessment Framework Jonathan Patz, MD, MPH University of Wisconsin - Madison Summer Colloquium on Climate and Health July 17-21, NCAR, Boulder

2. Risk is defined as the probability that an event will occur. It can also be defined as the probability that a health effect will occur after an individual has been exposed to a specified amount of a hazard. Risk assessment is the process of gathering all available information on the toxic or adverse effects of a physical, chemical or biological agent and evaluating it to determine the possible risks associated with exposure.

3. Elements of Risk Assessment and Risk Management ResearchRisk AssessmentRisk Management Lab & field observations Extrapolation from Models Exposure estimates and population susceptibility Hazard identification Dose-response assessment Exposure assessment Risk characterization Development of regulatory options Evaluation of interventions Reformulation or improvements of policies

4. 4 Steps of Risk Assessment Hazard identification –Does the agent cause adverse effects? Dose-response assessment –What is the relationship btw dose and adverse outcomes Exposure assessment –What are the types of and pathways and levels of exposure Risk characterization – What is the estimated probability or incidence of adverse effects? How robust is evidence? How certain is the evaluation?

5. Assess the Risks Here!

6. Dose-response Dose Response Linear Threshold

7. Exposure Internal Dose Biologically Effective Dose Early Biologic Effect Altered Structure/ Function Clinical Disease Exposure and Effect Biomarkers Susceptibility Markers Exposure-dose-effect continuum

8. CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes Urban Heat Island Effect Air Pollution Vector-borne Diseases Water-borne Diseases Water resources & food supply 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 HEALTH EFFECTS OF CLIMATE CHANGE

9. HEAT WAVE - EUROPE Heat Index Summer 2003  40,000 Deaths in just 11 days

11. Relationship between temperature and malaria parasite development time inside mosquito (“extrinsic incubation period” or EIP). EIP shortens at higher temps, so mosquitoes infectious sooner.

12. USA: Combined sewer overflows (CSOs) 1.2 trillion gal. of sewage & stormwater a year discharged during combined sewer overflows – would keep Niagara Falls roaring for 18 days Courtesy: K. Schwab

13. Results 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*, Rose, Lele, 2001.

14. Relative vs Attributable Risk

15. Source: EPA, Global Change Research Program

17. USGCRP National Assessment of the Potential Consequences of Climate Variability and Change QUESTIONS: –1) What is current status of sector or region? –2) What are climate sensitivities or projections of climate change for sectors or regions? –3) What is our capacity to adapt to climate- induced change? –4) What are the key knowledge gaps?

18. National Assessment (cont.) –Sectors: Agriculture Coastal Zones Forestry Human Health Water –Regions: 19 geographic regions & Native Americans

19. Five National Climate Research Sectors Human Health Agriculture Coastal Areas Forestry Water Resources

20. Mid Atlantic Southern Great Plains Metropolitan East Coast Southeast Gulf Coast South Atlantic Coast New England Great Lakes Northern Great Plains Eastern Midwest Appalachians Central Great Plains Pacific Northwest Rocky Mountains and Great Basin California U.S. Global Change Research Program: National Climate Change Assessment Regions Southwest Native Peoples: Covered Nationally Source: USGCRP

23. Extreme Weather Events Floods Droughts BlizzardsBlizzards NOAANOAA HurricanesHurricanes Tornadoe s Tornadoe s

24. “An increasing body of observations gives a collective picture of a warming world and other changes in the climate system.” – Global average surface temperature has increased about 0.6 o C – Temperatures have risen during the last 40 years in the lowest 8 km of the atmosphere – Snow cover and ice extent have decreased – Global average sea level has risen 10-20 cm during the 20 th century and ocean heat content has increased since the late 1950s – Some aspects of climate have changed (e.g., precipitation, cloud cover, temperature extremes), others appear not to have changed (e.g., Antarctic sea-ice, tropical storms, tornadoes) IPCC Third Assessment Report Conclusions

25. Criticism of Risk Assessment Risk assessments base on multiple inputs –Empirical evidence –Hypotheses –Science OR Judgement –Numerous default assumptions

26. Social change and development Demographic change Poverty / inequity Macroeconomic policies Markets Public policies Overharvesting Habitat loss & alteration Pollution Climate change Biodiversity loss Socioeconomic root causes Proximate causes Source: Wood et al.2000. The Root Causes of Biodiversity Loss

27. synergistic effects …and what about synergistic effects that can determine local vulnerability of populations

28. Johns Hopkins University School of Public Health Course: Global Environment and Health

29. The Heat Island Dark surfaces such as asphalt roads or rooftops can reach temperatures 30-40°C higher than surrounding air

30. New Orleans after Hurricane Katrina

31. 1839 1870 1993 2020 wetland loss in the Mississippi delta (1839 to 2020) Barataria-Terrebonne Estuary Program

33. ~ 9,600 people perished, widespread water- and vector- borne diseases followed, and nearly one million people were left homeless. Areas with extensive deforestation or degraded hillsides suffered the greatest morbidity and mortality and point to the importance of vegetation cover and as a buffer to severe floods, and the long- term prevention of injuries and fatalities

34. DPSEEA framework of WHO Driving forceACTION –Population growth<--------------Economic and social policy –Economic activityClean technologies Pressure –Resource depletion <--------------Hazard management –Waste release State<-------------Environmental improvement –Natural hazards & pollution –Depleted resources Exposure<-------------Education & awareness –External exposure & absorbed dose Effect<-------------Surveillance & treatment –Well-being –Morbidity & Mortality

35. Biological Diversity Climate Change Desertification Nutritional changes Disease Regulation Medicinal products Water purification Extreme weather events Heat waves &air pollution Malnutrition Water- & Food-borne disease Vector-borne diseases Water scarcity and safety Agro-ecosystem productivity Food scarcity Droughts Health and the Rio Conventions Human health Human health Climate induced Biodiversity loss Deforestation effects on climate Land degradation, deforestation Desertification hastened by landcover change Precipitation changes leading to drought Source: WHO, 2006

36. The Sustainability Triangle Social justice Equitable distribution Vibrant economy Provides services Healthy environment Modified pressure Sustained services for all Distributed consumption Investment in sustainable technologies Courtesy: F. Westley Nelson Inst., UW - Madison

37. Problems of Underdevelopment Problems of Overdevelopment povertyhunger environmental degradation compromised educational and medical infrastructure poor maternal health, infant mortality, infectious diseases overpopulation global warming Co2 emissions industrial growth global market for food and resources subsidies international loans food and resource export international debt repayment overharvesting of resources Courtesy: F. Westley Desertification & CBD UN FCCC

38. Millennium Ecosystem Assessment –Largest assessment of the health of Earth’s ecosystems –Prepared by 1360 experts from 95 countries; extensive peer review –Similar to IPCC – consensus of the world’s scientists –Called for by UN Secretary General in 2000; authorized by governments through 4 conventions

39. Examined the consequences of ecosystem change for human well-being Assessed changes in 24 ecosystem services Ecosystem services are the benefits people obtain from ecosystems –Provisioning services –Regulating services –Cultural services –Supporting services

40. Ecosystem Services

41. Unprecedented scale and pace of change over past 40 years –Population has doubled –Economic activity increased 6-fold –Humans have changed ecosystems more rapidly and extensively than in any comparable period of time in human history

42. Precautionary principle As governments agreed in 1992: “In order to protect the environment, the precautionary approach shall be widely applied by States according to their capabilities. Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation.” FIRST DO NO HARM

43. Levels of Prevention Primary - remove hazard or its effect Secondary - surveillance and early response Tertiary - treatment to avert adverse outcome

44. SOURCE: Colin Cheney Director | Earth Pledge Green Roofs Initiative GREEN ROOFS responds to: stormwater runoffstormwater runoff urban heat island effecturban heat island effect regional warming due to global climate changeregional warming due to global climate change “US Mayors’ Climate Protection Agreement” across 160 US cities to reduce greenhouse gas emissions

45. Can Madison become the most “modern” city in the World? (modern….as in more bikes and biketrails than cars and roads.) Madison already ranks among top 5 biking cities in US 1 third of US bike retail is based just in Madison! Win-win solutions ideal….. But win-win-win even better! 1 - Personal Fitness 2 - Reduced Local Air Pollution 3 - Reduced Greenhouse Gas Emissions The “Triple-Win Biking Project”

46. THERE ARE ALWAYS TRADEOFFS TO CONSIDER

47. Unprecedented change in structure and function of ecosystems More land was converted to cropland in the 30 years after 1950 than in the 150 years between 1700 and 1850. Cultivated Systems in 2000 cover 25% of Earth’s terrestrial surface (Defined as areas where at least 30% of the landscape is in croplands, shifting cultivation, confined livestock production, or freshwater aquaculture)

48. Degradation and unsustainable use of ecosystem services Approximately 60% (15 out of 24) of the ecosystem services evaluated in this assessment are being degraded or used unsustainably Degraded Capture fisheries Wild foods Wood fuel Genetic resources Biochemicals Fresh Water Air quality regulation Regional and local climate regulation Erosion regulation Water purification Pest regulation Pollination Natural Hazard regulation Spiritual and religious values Aesthetic values Enhanced Crops Livestock Aquaculture Carbon sequestration (in last 50 yrs)

49. When assessment results meet the intended policy decision makers…

50. ◦Toxicology Data Network (TOXNET - www.toxnet.nlm.nih.gov ). www.toxnet.nlm.nih.gov ◦CHEMTREC (Chemical Transportation Emergency Center - www.chemtrec.org ) www.chemtrec.org ◦Material Safety Data Sheets (MSDS) are available on the Occupational Safety and Health Administration website: www.osha.gov. www.osha.gov ◦Hazardous Substances and Health Effects Database (HazDat), available on ATSDR's website at www.atsdr.cdc.gov. www.atsdr.cdc.gov Electronic Databases

51. Communicating Risk Essential to seriously consider best methods Example: –Fact: less than 2 tenths of a percent of known chemicals have been tested for causing cancer.

52. Source: J. Adams “Risk”, 1995 Of over 5 million known chemical substances only 30 are definitely linked to cancer in humans (white dot)… And only 7,000 have been tested for carcinogenicity… The rest is darkness

54. http://www.ecohealth.net EcoHealth ONE Oct. 7-10, 2006 Madison, Wisconsin THEME: “Promoting Global Health- Sustaining Natural Resources” THANK YOU & Visit the website