LEARNING MODULE #17: ENVIRONMENTAL HEALTH: ISSUES AND IMPACT

Environmental Health: Environmental Health: Issues and ImpactIssues and ImpactIssues and ImpactIssues and Impact

Carol Ann Gross-Davis, PhD, MSAdjunct Assistant ProfessorDrexel University, School of Public HealthDepartment of Environmental and Occupational Health

Module #17: Environmental Health: Issues and Impact

Part 3: Global Part 3: Global Environmental Health Environmental Health and Climate and Climate ChangeChangeand Climate and Climate ChangeChangeEH-24 Reduce the global burden of disease due to poor water quality, sanitation, and insufficient hygiene

i i i l l h Emerging Issues in Environmental Health Climate Change: Air and Water pollution and Public Health Risks for specific PopulationsVulnerable Populations: To acquire an awareness of the increased risk of environmental pollution to certain increased risk of environmental pollution to certain populations.

2

WHAT IS CLIMATE?WHAT IS CLIMATE?WHAT IS CLIMATE?WHAT IS CLIMATE?“Climate encompasses the statistics of

h d htemperature, humidity, atmospheric pressure, wind, precipitation, atmospheric particle count and other meteorological elemental and other meteorological elemental measurements in a given region over long periods. Climate can be contrasted to weather, periods. Climate can be contrasted to weather, which is the present condition of these elements and their variations over shorter periods.”

3

Addressing Climate Change Addressing Climate Change Sk i Wi h S iSk i Wi h S iSkeptics With ScienceSkeptics With Science

• The term global warming is misleading; some areas will have warming, some cooling or other climate changes.

• Climate change more accurate description of what is happeningIntergovernmental Panel on Climate Change

C d b UN E i l P (UNEP) d W ld M l i l • Convened by UN Environmental Programme (UNEP) and World Meteorological Organization (WMO)

• The leading international body for the assessment of global climate change195 t i ti i t i l 195 countries participate in panel

• First report issued in 1990; 4th report in 2007; 5th:2013-2014

• Scientific consensus on climate change

• Peer review process - high level of scrutiny and credibility

4

• Represents a multitude of expert opinions

Melting of Snow and Ice: Change in Glaciers

5

5

Photo Credit: NASA, Tad Pfeiffer, Institute of Arctic and Alpine Research5

“Climate change is the biggest global health “Climate change is the biggest global health threat of the 21st century… The impacts threat of the 21st century… The impacts

will be felt all around the world will be felt all around the world –– and not and not just in some distant future but in our just in some distant future but in our lifetimes and those of our children.” lifetimes and those of our children.”

“The health sector can play a key role in “The health sector can play a key role in h l i i ti d t t th ff t f h l i i ti d t t th ff t f helping societies adapt to the effects of helping societies adapt to the effects of climate change and the risk it poses to climate change and the risk it poses to

human health ”human health ”“ human health.”human health.”The LancetThe Lancet

6

Source:

7

Source: http://www.global-greenhouse-warming.com/what-is-the-greenhouse-effect.html

Main Greenhouse Gases and their Anthropogenic SourcesAnthropogenic Sources

(Sources: EPA, NOAA, EIA/DOE)Water Vapor Power and industrial facilities, urban heat zones,

Carbon Dioxide (CO ) Burning of fossil fuels land use changes Carbon Dioxide (CO2) Burning of fossil fuels, land use changes (deforestation), cement manufacturing

Methane (CH4) Landfills, rice production, livestock, coal mining, oil and natural gas operations, wastewater treatment, melting permafrost, leakage from gas , g p , g gdrilling through fracking

Nitrous Oxide (N2O) Fertilizer, planted nitrogen-fixers, combustion

Ozone (Ground Level) Biomass and fossil fuel burning (from Nox and VOCs)VOCs)

Industrial Gases:Hydrofluorocarbons (HFCs)Perfluorocarbons

Human-made for industrial processes

(PFCs)Sulfur Hexafloride (SF6)

Aerosols These are not gases. Depending on their color and th h t i ti th h ti

8

other characteristics, they may cause heating or cooling effects

The Environmental Impacts of The Environmental Impacts of Climate Change will Affect Human Climate Change will Affect Human Climate Change will Affect Human Climate Change will Affect Human

HealthHealthAir PollutionAir PollutionIllness, injury, mortalityTemperature extremesA ti f i ti Aggravation of preexisting conditionsInfectious disease changesI i t d Increase in water- and food-borne diseasesMental health disordersPopulation displacementPopulation displacementFood insecurity, instability and conflict: malnutrition/starvation

9

malnutrition/starvation

Direction and Magnitude of Change Direction and Magnitude of Change of Selected Health Impacts of of Selected Health Impacts of of Selected Health Impacts of of Selected Health Impacts of

Climate ChangeClimate Change

http://www.ipcc-wg2.org/. Chapter 8. Pg 418

10

Extreme Temperatures: Extreme Temperatures: H WH WHeat WavesHeat Waves

Most vulnerable populations: Increase in heat related - Elderly, young children

- People living alone, socially isolated, mentally ill

S i i ll

illnesses and mortality:- Heat stroke

- Heat exhaustion - Socio-economically

disadvantaged

- People lacking access to air conditioning or cooling spaces

- Heat cramps

- People with chronic diseases or bedridden

- People who work outside

- People taking certain medications

- Urban poor due to heat island effects

11

Urban Heat IslandsUrban Heat Islands

Little vegetation, limited evaporation, heat absorbing and retaining materials – can raise local temperature 2 – 10 F

12

Health Impacts of HeatHealth Impacts of HeatHealth Impacts of HeatHealth Impacts of Heat

Normal adaptation to heat stress:- Increased cardiac output 

Relaxation of the blood vessels in the skin to increase blood flow- Relaxation of the blood vessels in the skin to increase blood flow from the core to the surface of the body. 

- Sweat cools the body through evaporation

Excess deaths occur:on days with higher‐than‐average temperatures

i l h t tin places where summer temperatures vary more

where extreme heat is rare 

13

Séguin J 2008. Human Health in a Changing Climate. Health Canada

Heat Wave Examples Heat Wave Examples Heat Wave Examples Heat Wave Examples

2006 California heat wave2006 California heat waveDaytime temperatures > 100 degrees for 2 weeksRecord nighttime highsRecord nighttime highs> 1 million people lost electricityDeath toll: 150‐450Excess ER visits: 16,000

Excess hospitalizations: 1000

2003 European heat waveDeath toll > 45,000

1995 Chicago heat waveDeath toll  900

14

Death toll: 900

HeatHeat--Related Deaths in the USRelated Deaths in the US

15

Other Climate Change EffectsOther Climate Change EffectsOther Climate Change EffectsOther Climate Change Effects• Sea Level Rise

• Changes in Food Supply

• Climate change alters agricultural area and productivity

• Increase in Wildfires

16

Increased Ozone and Poor Air Increased Ozone and Poor Air Q liQ liQualityQuality

More warm days →more smog →more power fgeneration without decreased emission of GHGs →

more severe problem

Increased risk of ER visits and hospital admissions for respiratory illnessrespiratory illness

I d  i k  f  th   t  d  b ti  Increased risk of asthma onset and exacerbations, cardiac arrhythmias, myocardial infarction and total mortality

17

mortality

Pollen and Natural Air Pollen and Natural Air PollutantsPollutants

• Increased temperatures and ground‐level CO2 will increase plant metabolisms and pollen production

Arvind Balaraman, freedigitalphotos.net Wikimedia CommonsCDCWikimedia Commons, Sue Sweeney Freedigitalphotos.net, Yaron Jeroen van Oostrom

increase plant metabolisms and pollen production

• Longer and earlier pollen seasons

• Increase in allergic rhinitis and respiratory diseases such as asthma and chronic obstructive pulmonary disease

18

disease

WW d F dd F d BBWaterWater‐‐ and Foodand Food‐‐Borne Borne DiseasesDiseases

Increased air and water temperatures increase the replication, persistence, survival, transmission and range of some survival, transmission and range of some pathogens and vectors

Heavy rainfall and flooding facilitates rapid i f h transportation of pathogens to water

supplies, better habitat for mosquitoes

Malaria and dengue fever being reported at Malaria and dengue fever, being reported at higher elevations is Africa, Asia and Latin America

MMWR. 2002. 51(41):921-3. Ambulatory

19

Locally transmitted malaria in Canada in 1990s, and some US states

Pediatrics. 2003, 3(1):44-52.

Waterborne InfectionsWaterborne Infections8 l b k b 8 d548 gastrointestinal outbreaks between 1948 and 1994 

in US. 68% of cases were preceded by precipitation above the 80th percentilep

Daily hospital admissions for pediatric diarrhea in Peru i d  %   b li   ft  th  fl di   d increased 200% over baseline after the flooding and high temperatures triggered by the 1997–98 El Niño

Similar findings with cholera, Giardia, Cryptosporidium and E. coli

20

Am J Public Health. 2001; 91: 1194–1199. Lancet. 2000; 355: 442–450

Zoonotic and VectorZoonotic and Vector--borne borne Zoonotic and VectorZoonotic and Vector--borne borne DiseasesDiseases

Introduction and spread of new diseases

Increased geographical range and risk of current diseases diseases

Re-emergence of formerly prevalent diseasesCDC/ Wikimedia Commons

Prolonged transmission cycles

Examples: Lyme disease; Dengue Fever, Malaria; Chikungunya; Tularemia; Rabies; Encephalitis: Chikungunya; Tularemia; Rabies; Encephalitis: (West Nile Virus, St. Louis Encephalitis, Western Equine Encephalitis); Schistosomiasis; Hantavirus Pulmonary Syndrome

USDA

21

Climate Change Will Worsen Climate Change Will Worsen Health Disparities between Rich Health Disparities between Rich 

and Poorand Poorand Poorand Poor

• Poor housing to begin with, more difficulty replacing housing after severe weather events

• Lack of Air Conditioning (AC)→↑risk of heat related death• Lack of Air Conditioning (AC) → ↑risk of heat‐related death

• Low income – decreased use of AC because of fear of cost

• Increase food insecurity by decreasing crop yield

22

Key PointsKey Pointsyy

Environmental Health is the study of those factors in the Environmental Health is the study of those factors in the environment that affect human health

These factors represent chemical, biological, or physical These factors represent chemical, biological, or physical agents contained in air, water, soil, or food, and are transported to humans via inhalation, ingestion, or skin absorption

Adverse health effects may be acute or delayed in onset, clinical or subclinical, and reversible or irreversibleI l diIncluding

- Air pollution- Toxics and Waste

Global Climate Change

23

- Global Climate Change

Addressing Environmental Health is Addressing Environmental Health is i li lcrucial…crucial…

Nearly 25 percent of all deaths and the total disease burden Globally can be attributed to disease burden Globally can be attributed to environmental exposures

Poor environmental quality has its greatest impact on people whose health status is already at risk

Th f i t l h lth t dd Therefore, environmental health must address the societal and environmental factors that increase the likelihood of exposure and disease

24

increase the likelihood of exposure and disease

RReferenceseferencesRReferenceseferencesWorld Health Organization (WHO). Preventing disease through healthy environments. Geneva, Switzerland: WHO; 2006. environments. Geneva, Switzerland: WHO; 2006. Intergovernmental Panel on Climate Change. Website at: http://www.ipcc.ch/publications_and_data/publications_and_data_reports.shtmlEstablished by the UN Environmental Programme  (UNEP) and World y g ( )Meteorological Organization (WMO)

WHO: www.who.int

Patz Jonathan A. “Climate Change”. In Environmental Health: From Global to Patz Jonathan A.  Climate Change . In Environmental Health: From Global to Local, 2nd Edition Frumkin H, Ed. Jossey‐Bass Publications.2010:279‐328

HUD. Healthy Homes Issues: Asthma. Version 3, 2006.Am J Public Health 2001; 91: 1194–1199 Lancet 2000; 355: 442–450Am J Public Health. 2001; 91: 1194 1199. Lancet. 2000; 355: 442 450

25

ReferencesReferencesReferencesReferencesLevin et al, Environ Health Perspect 2008;116:1285-1293

ATSDR. Case Studies in Environmental Medicine: Environmental Triggers of Asthma. 2007; http://www.atsdr.cdc.gov/csem/asthma/

MMWR May 2011. Vital Signs: Asthma Prevalence, Disease Characteristics and Self-Management Education CDCManagement Education. CDC

Jacobs et al. Env Health Perspect 2002;110:A599-A606.

Sé i J 2008 H H l h i Ch i Cli H l h C dSéguin J 2008. Human Health in a Changing Climate. Health CanadaAm J Public Health. 2001; 91: 1194–1199. Lancet. 2000; 355: 442–450

MMWR. 2002. 51(41):921-3. Ambulatory Pediatrics. 2003, 3(1):44-52.( ) y ( )REF: NCEH/CDC, 2008 (www.cdc.gov/asthma)

EPA (U.S. Environmental Protection Agency). (1997). Mercury Study Report to Congress. Volume VI: An Ecological Assessment for Anthropogenic Mercury Emissions in the United States

26