“When the Levee Breaks” and Other Tales of Public Health in a Changing Climate

Why Public Health and Climate Change

• Many fundamental concerns for Public Health – Food Security and Food Access (Lauri Andress)– Clean water (Michael McCawley)– Zoonotic diseases (Diane Gross)– Direct medical consequences of heat(OccMed & Occ

Health faculty)– Extreme precipitation events– Migration due to coastal inundation (political

consequences - me)– Emergency preparedness (formerly Warren Eller)

“Climate Change in 7 slides”Slide 1

• My perspective in this presentation is more as a teacher.

• I taught WVU’s first course on climate change in 1991 and 1992.

• There are certain fundamental concepts about global climate change that crystalize our understanding of the topic.

• The next slide is Slide 1 of “Climate Change in 7 slides”– I added some extra’s for clarity

• The Greenhouse Effect

The Keeling CO2 Data

It Looks Like This

Or this…

One More Look at CO2The historical record on CO2 from NOAA

https://www.esrl.noaa.gov/gmd/ccgg/trends/history.html

Carbon Sources and Sinks (circa 1976!)

Carbon Sinks - 2001

#s in red are anthropogenic

Global Mean Temperature

The consensus(The Berkeley Earth version)

Current Sea Level Rise

Wikipedia: http://en.wikipedia.org/wiki/Current_sea_level_rise

Global Climate Change and Health

Anomalies

• Decision making models typically want data.• In the public health aspects of climate change,

we want for data.• For years, we have been observing things that

have best been described as anomalies• Many of these earlier anomalies are now clear

data driven trends– Temperature, arctic Ice loss, and sea level rise the

three most prominent

Trends in Anomalies

• Coral reef bleaching – food chains and fisheries

• Glacier recession– Glacier National Park

– Ask India and China about loosing the Himalayan glaciers

• Direct health impacts of heat and heat waves– Not yet an empirically confirmed trend.

– We scientists are like this. We live (and die) by our ! = .05 threshold of probability – our level of confidence.

– Corporations express certainty.

More anomalies and trends• Zoonotic diseases

– Changing habitats mean changing diseases– Is Ebola an anomaly?– How about HIV, Zika, Lyme, West Nile, Dengue, Chikungunya,

H1N1, H5N8, Malaria…• Tropical Storms

– Trend in rapid strengthening of storms – Storms in general still too variable (some confidence, but not

high)• Extreme precipitation events (low and high)

– Harvey & Florence & Ellicot City, MD– This year’s flooding in Nebraska and Iowa– NOAA flood gauges

So it is happening

• Climate change is not like other pollution problems– It is not a point source impact.

• And it costs too much to fix…??• This is how a health policy analyst looks at this– At least this health policy analyst

• What are the costs of doing nothing?• How does one assess policy decisions?

Discount rate• Economists argue about what discount rate to use. – How to determine what future impacts are in today’s

dollars helps to decide what to spend now.– The heart of cost-benefit and cost-effective analysis– Economists argue about this

• There is some merit to the idea that climate change may well have a negative discount rate– As we defer action, the future costs rise at a faster rate

than any reasonable comparable return-on-investment• And we argue about the very real measurable costs of

reducing fossil fuel consumption.– The very real costs of the consequences are not are readily

measured

So who do we want to pay?Because we will be paying!

• We can pay at the gas pump and the electricity and gas meters…

• Or we can pay at– The grocery store,

• Lost fisheries, floods, droughts, increased costs due to global competition for food resources

• We import about 15% of our food - competition• We spend at least twice as much on food as we do on

energy.– Our homeowner’s insurance policy

• Flooding, storms– Even our homes

• Coastal zone restrictions, changing construction standards, and inundation will cause population movement, which will raise housing prices

More places to pay• Our water meter as clean water gets scarcer.

– It will - salt water intrusion in coastal aquifers• Our doctor’s office/insurance/Medicare/Medicaid

– Increased costs due to increased infectious disease rates,– Increased burden due to reduced nutritional standards because

of contracting food security– Diabetes and cardiovascular disease will increase

• And of course our taxes. – Who pays for all the damage to infrastructure when it floods, or

a hurricane hits– Migration will become a tremendous problem.

• Including wars– We will not be immune to this.

India believes in Walls

• Bangladesh was delivered by Typhoon Bhola in 1970 – 500,000 fatalities

• There will be more….– and there will be 20,000,000+ refugees next time

The Sixth Major Extinction Event• The Holocene Extinction– Last 11,700 years and due largely due to humans– Extinction rate is 100 to 1,000 times natural rate– The result of an unregulated commons– Megafauna seem particularly vulnerable

• Martha Done in by the railroad

Lest you think this can’t happen

Changing Habitat

Parasites

• Among the parasites that are likely to be of concern:

• Protozoans– Amoebas, Giardia, Cryptosporidium

• Helminths– Flatworms, flukes, roundworms, nematodes

• Louses (Arthropods)– Fleas, ticks, lice, mites, bloodsucking arthropods

like mosquitos

Parasites

• Among the parasites that are likely to be of concern:

• Protozoans– Amoebas, Giardia, Cryptosporidium

• Helminths– Flatworms, flukes, roundworms, nematodes

• Louses (Arthropods)– Fleas, ticks, lice, mites, bloodsucking arthropods

like mosquitos

Climate change is a lottery

• Parasites are valuable.• They hold some species in check.• They play an important part in ecosystem

balance.

Lyme Disease

1996 20121 dot placed randomly within county of residence for each confirmed case

Disease Vectors and Zoonotic Diseases

Dengue

• Breakbone fever• Yellow fever mosquito

– aedes aegypti• Climate factors play a

huge role in distribution

• Wildfires - A sweeping and destructive conflagration especially in a wilderness or a rural area– Public Health Impact

• Burn Injuries • Exacerbations of chronic obstructive pulmonary disease

and asthma• Population displacement that results in a need for basic

necessities such as shelter, water, food, security & sanitation

Low Precipitation Events

Camp Fire: Paradise, CA

High Precipitation Events• Floods - Significant rise of water level in a stream, lake,

reservoir or a coastal region (UNDHA)

• Public health Impact1. Damage to homes and consequent displacement of occupants2. Infectious disease exacerbated by crowded living conditions3. Compromised personal hygiene4. Contamination of water sources 5. Disruption of sewage service and solid-waste collection, 6. Increased vector populations 7. Injuries sustained during clean-up,8. Stress-related mental health and substance-abuse problems 9. Death

Pakistan - 2014

This is why you evacuateStorm Surge - Hurricane Ike, 2008

A hypothetical worst-case study

• Flood control on the Mississippi river had a long history.– Read LousiannaRiverControl.html

• The concerns for the river and the fate of New Orleans are frequently revisited.

• The modern era begins with the changes brought about by the Mississippi River Flood of 1927

Old River Control Structure

When the Levee Breaks

Is there Hope?

Global Climate Change and Public Health