Water, Health, and Climate Change

Linda Rudolph, MD, MPHMay 27, 2015

Water is essential for life. Water is a human right.

* * *

2012 California Human Right to Water bill

“…every human being has the right to safe, clean, affordable, and accessible water adequate for human consumption, cooking, and sanitary purposes.”

What do we use water for?

• SUSTAIN LIFE• Stay hydrated• Grow food, fiber, trees

• Sanitation and hygiene• Sewer systems• Wash hands, bodies, food,

homes

• Hydropower

• Transportation

• Aquatic and riparian habitat

• Cultural and spiritual

• Recreation

• Aesthetics• Landscaping

Water for Life• Sufficient: Between 50 and 100 liters of water per person per

day are needed to ensure that most basic needs are met and few health concerns arise.

• Safe: free from micro-organisms, chemical substances and radiological hazards that constitute a threat to a person's health

• Acceptable in color, odor and taste for use

• Accessible: the water source has to be within 1,000 meters (0.6 mi) of the home and collection time should not exceed 30 minutes

• Affordable: water costs should not exceed 3 per cent of household income.

http://www.un.org/waterforlifedecade/human_right_to_water.shtml

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Sanitation and Safe Drinking Water

• Among the great public health achievements of the 20th century• Chlorination and other

drinking water treatment• Sewage disposal• Solid waste disposal • Food safety• Public hygiene education

But…..• 1.1 billion people (1/6) do not have access to a safe and adequate water

supply. • May increase to 2.3 billion by 2025

• 2 – 3.5 million people – mostly children < age 5 in developing nations – die each year from diseases due to unsafe drinking water, inadequate sanitation, or poor hygiene

• Water withdrawals tripled over the last 50 years• Demand for water for food production is projected to double by 2050 In 2010,

nearly all megacities were facing water scarcity • Almost half world population will be living in areas of high water stress by 2030

• Climate change increases high water stress

• Global water availability is sufficient to meet the personal and domestic needs of all human beings. But as demand for water from all sectors exceeds availability, prioritization of uses becomes all the more important.

http://www.zaragoza.es/contenidos/medioambiente/onu/1048-eng_report_of_special_rppPrteur_on_human_right_to_safe_drinking_water_and_sanitation.pdf

https://www.facingthefuture.org/IssuesSolutions/FastFactsQuickActions/WaterSecurity/tabid/185/Default.aspx#.VWUHNcbD7Sk

http://www.mercurynews.com/science/ci_25090363/california-drought-water-use-varies-widely-around-state

USA Average100-176 gpcd

Africa Average5 gpcd

Climate change impacts on water in California

Wetter Wets

Drier Dries

Higher Highs

Hotter Hots

Reduced Runoff

What are the health impacts of climate-change impacts on

water?

• Water availability and cost

• Water quality

• Water and food production

• Flooding

• Infectious diseases

• Water infrastructure

• Mental health

Drought & Climate Change

• Warming temperatures due to climate change• Larger fraction of precipitation falls in downpours• More storm water lost to storm runoff (vs absorbed in soil)

• Larger fraction of mountain precipitation fall as rain rather than snow

• Snowpack melts earlier due to warming• Reduced stream flows in late-spring, summer

• Higher evaporation rates• Losses of water from reservoirs• Drier soil

• Arctic ice loss may change the jet stream

How bad is this drought?

May 19, 2015

Drought Health Impacts

• Water Quality

• Water Availability and Affordability

• Food Costs and Insecurity

• Vector-borne disease• Stagnant pools

• Improper water storage

• Wildfire

• Air Quality• Increased dust and particulate

levels

• Increased pollen

• Wildfire smoke

• Airborne toxins from freshwater algal blooms (cyanobacteria)

• Recreational risks

• Unemployment & economic impacts• 1/3 CV jobs related to

farming

Water quantity• Most communities in

California not reliant on a single source of water, but some are• Some groundwater

reliant on annual rainfall

• Some small systems reliant on stream flow

• Some communities facing acute water shortages now

Water quality• Increase concentration of pollutants and contaminants in groundwater

and surface water• Toxics and metals• Bacteria, protozoa, amoeba (warming and concentration)

• Over 21 million Californians rely on contaminated groundwater as primary source of drinking water• Over 4 million people (especially in rural areas) highly vulnerable to

groundwater contamination

• Use of recycled water for food irrigation/processing may increase risks of E. coli and Salmonella

• Clean-up of contaminated water very costly

• Reduced stream and river flows can cause stagnation & low O2 levels

• US EPA estimates California will need to spend approximately $40 Billion on infrastructure improvements to ensure delivery of safe drinking water over next 20 years

Drought and Food

• Limits in growing season

• Reduced yields due to crop loss or fallowing

• Conditions that encourage insect and disease infestation in some crops

• Low crop yields can result in rising food prices and shortages, • Food insecurity associated with

diabetes, obesity.

• Affects health of livestock and cost of feed• Herd culling can increase meat and

dairy prices

• Impacts on fisheries

http://www.motherjones.com/environment/2014/02/wheres-californias-water-going

http://www.motherjones.com/environment/2014/02/wheres-californias-water-going

Nutritional recommendations

Drought and Mental Health

• Drought stress may be different than stress in other disasters• extended event with no single moment of impact• anxiety builds over time and becomes chronic• less noticeable to self and others• may not be viewed as seriously because damage not as visible

• Impact is worst for already stressed farm families and communities • May be greater for young farmers, farmers with second off-farm

job, women in farm families

• Drought and suicide• Australia• U.S. Mid-west

http://www.health.vic.gov.au/pcps/downloads/planning_practice_guide.pdf

Warmer Water TemperaturesCoastal and Inland Water Bodies

• Naturally occurring pathogens andtoxin-producing harmful algae

• Expand seasonal windows of growth• Expand geographic range

• Expansion northward of invasive species

• Changes in fish populations• Increase mercury contamination in

fish• Reduce dissolved oxygen, incomplete

mixing• Increase vectors

Extreme Precipitation & Flooding

• Warmer air holds more moisture

• Rain falling in more concentrated episodes

• Risk: overwhelm capacity of• Combined sewer systems• Water treatment facilities

Anaheim, 1938

Orange County Hospital, 1938

Public Health Issues - Precipitation

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Extreme Precipitation

Increased runoff:

sediment, contaminants,

nitrate, etc.

Sewage overflo

ws

Contamination of surface and groundwater

Waterborne disease outbreaks from drinking water or recreational contact (beachgoers): Giardiasis, E coli, Cryptosporidium

Physical injuries and destruction of property

Flooding Health Effects• Acute injuries & fatalities

• Drowning, trauma

• Contamination• Increase pathogen loads  from urban, agricultural, and wildlife sources

• Impacts drinking water/waste water/sewage treatment and storm water• Increased risk failure/damage• Water infrastructure breakdown exacerbates risk (especially aging

infrastructure)

• Mental Health• PTSD, depression, anxiety, access to mental health services

• Disruption social networks & support

• Respiratory illness • Asthma, respiratory infection, mold

• Chronic disease, dermatitis, arthritis

• Disruption in medications

• Soil erosion/loss• Agriculture and aquatic habitat impacts

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Waterborne Disease Outbreaks in U.S.

• Inadequate, interrupted, or intermittent water treatment associated with waterborne disease outbreaks• Number of pathogens in the source water

• Age of the distribution system

• Quality of the delivered water

• Climatic events that tax treatment plant operations

• ½ of waterborne disease outbreaks from 1948 – 1994 associated with extreme precipitation• 1993 Milwaukee Cryptosporidium Outbreak

• 1.61 M people were affected; over 400,000 w/ significant symptoms; 100 people died

• 1971 to 2002: 764 documented waterborne outbreaks associated with drinking water • 575,457 cases of illness, 79 deaths

• Estimated number of waterborne illnesses/year: 19.5 M/yr. all health outcomes• GI illness only: estimates 12M – 16M/year

http://www.ncbi.nlm.nih.gov/pubmed/18020305

Transportation Impacts

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Sea Level Rise & Storm Surge

• LA region sea level rise projected:• 5 – 24 inches) from 2000 to

2050 • 17 – 66 inches from 2000 to

2100.

• Roads, water systems, health facilities at risk

• Saline intrusion • Sacramento-San Joaquin

Delta

http://c-change.la/sealevelrise/

Displacement and Migration

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Public Health Role

• Educate the public about water, climate change, and health

• Advocate for health, equity, and sustainability in water policies and programs

• Protect our precious water resources from further contamination

• Support actions to enhance water supply sustainably, mindful of health concerns

• Increase monitoring for water-related health risks and outcomes

Public Health Role• Ensure access to adequate supplies of safe and clean drinking water, water

for sanitation and hygiene, and water for healthy food production

• Educate the public about water, climate change, and health

• Advocate for health, equity, and sustainability in water policies and programs

• Protect our precious water resources • Source protection, pollution protection, replenishment

• Support policies, programs, funding, and infrastructure to enhance water supply sustainability• Water conservation and efficiency• Water recycling and reuse (e.g. gray water)• Repaired and expanded infrastructure (green and gray)• Water and soil management • Safety net systems (e.g. lifeline water rates)

• Increase monitoring for water-related health risks and outcomes

• Enhance public health preparedness for water impacts of climate change

Public Health has an important role.Join the webinar series to learn more!

http://phasocal.org/water-initiative/

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http://climatehealthconnect.org/climate-and-health-alliance/

http://www.phi.org/uploads/application/files/h7fjouo1i38v3tu427p9s9kcmhs3oxsi7tsg1fovh3yesd5hxu.pdf

Linda Rudolph, MD MPHlinda.rudolph@phi.org