Climate Change and our Children s Health

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1 Climate Change and our Children s Health Robert J. Laumbach M.D., M.P.H., C.I.H. Department of Environmental and Occupational Medicine Rutgers Robert Wood Johnson Medical School March 1, 2014

2 Not just warmer weather Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increased food production in certain areas, the overall health effects of a changing climate are likely to be overwhelmingly negative. Climate change affects social determinants of health clean air, safe drinking water, sufficient food and secure shelter. - World Health Organization

3 A Thousand Cuts Projected Health Impacts of Climate Change Direct health effects of extreme heat Health impacts of flooding, droughts Increased air pollution (especially ground level ozone) Increased allergy and allergic asthma (most childrens asthma is allergic asthma) Changes in regional disease distribution Food insecurity: agricultural and fishery production Mental health and stress-related disorders Unequal distribution of health impacts: vulnerable communities and Environmental Justice

4 Children are among the most vulnerable More susceptible to heat More susceptible to toxic exposures More intake per body weight Less-developed defense systems Growing and developing bodies Less capable of communicating their needs Less capable of altering their environments Longer time of suffering persistent or permanent adverse effects

5 Children in developing countries are especially vulnerable

6 DALY = disability adjusted life years DALY = years of life lost + years of life lived with disability

7 And Climate Change is only one global factor

8 The climate in the Northeast Region has already changed Average temperature in Northeast has increased by almost 2 deg F since 1895 Average precipitation has increased by 5 inches since 1900 (about 10%) 74% increase in precipitation in very heavy events (highest 1% of all daily events) from 1958 to NCA Draft 2013

9 NCA Draft 2013

10 More extreme weather events: Heat Waves Projected increases in the number of days with a maximum temperature greater than 95 deg F between 2041 and 2070 compared to NCA Draft 2013

11 More Extreme Weather Events Small changes in the average lead to large changes in the frequency of extreme events of all kinds Hypothetical Example: Assuming a normal distribution with increase in average temp of 5 F from 45 to 50 F, extreme weather days > 105 or > 110 more than double in this example

12 Urban Heat Island Effects Populated areas greater than 10 deg hotter than forested areas of Central Park. These extremes will become even more extreme. NCA Draft 2013

13 Direct Health Effects of Extreme Heat

14 Direct heat affects young children as well as the elderly

15 Direct Health Effects of Extreme Heat Heat cramps, heat exhaustion, heat syncope, and heatstroke Exacerbation of heart disease, diabetes, sickle cell anemia, and other chronic diseases During the heat wave of summer of 2003 in Europe, more than 70,000 excess deaths was recorded. Young children, and athletic youth are vulnerable

16 Worse air pollution: Higher Ground-level (tropospheric) Ozone, Changes in Particulate Matter and Other Air Pollutants

17 Air Pollution and Climate Change

18 Ozone Sunlight + Heat Oxygen (O 2 ) + Nitrogen Oxides + Volatile Organic Compounds (VOCs) Ozone (O 3 )

19 NJ is already non-attainment for the 75 ppb 8-hr EPA ozone standard The EPA Clean Air Science Advisory Council already recommended lowering the standard to ppb to protect against health effects. Rising temperatures will make it more difficult to achieve health-based standards. Union of Concerned Scientists estimated a penalty factor of 1.2 ppb ozone for every 1 deg F rise in average temperature.

20 States that currently do not meet the 75 ppb EPA ozone standard Union of Concerned Scientists

21 Daily max. temperature is closely correlated with daily max. ozone UCS 2011

Health Effects Ozone Direct damage to the lungs: children more vulnerable Reduced lung growth in a study in Southern California Asthma exacerbation

22 Health Effects Ozone Direct damage to the lungs: children more vulnerable Reduced lung growth in a study in Southern California Asthma exacerbation Increased total, all-cause mortality Increased cardiovascular mortality? Recent NJ ozone data increase with recent warm weather? Union of Concerned Scientists

23 Projected increase in emergency room visits for asthma among children Percentage increases in emergency room visits for asthma related to ground level ozone among children in the NYC region by the 2020s NCA Draft 2013

24 Estimated episodes of acute respiratory symptoms with only 2ppb increased ozone by state Union of Concerned Scientists

25 Estimated health care costs associated with only 2ppb increased ozone by state Union of Concerned Scientists

26 EPA s Air Quality Index for Ozone Is limiting outdoor exertion good for kids?

27 Combined Effects of Heat and Ozone High heat days tend to be high ozone days as well Little is known about the combined effects of heat and ozone Vulnerable populations: children, the elderly, people with respiratory disease such as asthma, and heart disease Vulnerability is also increased because infrastructure, eg. power generation, is more likely to fail on high heat days

28 Increased Wildfires due to Drought Smoke from wildfires has widespread health effects: July 2002 fires in Quebec increased fine particle concentrations up to 30-fold across NJ into Baltimore NCA Draft 2013

29 Increased Allergy and Allergic Asthma

30 The majority of children s asthma is allergic asthma Ragweed pollen season length has increased by as much as 13 to 27 days in central North America just since 1995!

31 Increased growth and increased pollen production per plant with increasing carbon dioxide NCA Draft 2013

32 Health Impacts of Flooding and Extreme Weather Events

33 NCA Draft 2013

34 1920s through 2008 NCA Draft 2013

35 Extreme events: floods and injuries, illnesses Floods approximately 98 deaths per yr in US, most due to drowning Waterborne diseases due to overflow of sewage Dampness and mold Chemical contamination Redistribution of contaminated sediments Lead poisoning due to remediation of older homes

38 Mold and Dampness Exacerbation of pre-existing asthma New-onset asthma Respiratory symptoms Hypersensitivity pneumonitis Infection in immunocompromised individuals Toxic effects of mold mycotoxins?

39 Diseases carried by insects and rodents Effects on distribution of diseases borne by insects and rodents remains uncertain Flooding may provide increased habitat for breeding of mosquitos and other vectors Regions may shift as habitat changes

40 Malaria

42 Highest rates of Lyme disease occur in children: Projected Changes in Tick Habit Areas in orange are projected to be newly suitable for the tick that transmits Lyme disease NCA Draft 2013

43 Affects on Infectious diseases: Complex, much to learn Parola P, Socolovschi C, Jeanjean L, Bitam I, Fournier P-E, et al. (2008) Warmer weather linked to tick attack and emergence of severe rickettsioses. PLoS Negl Trop Dis 2(11): e338. doi: /journal.pntd

46 Food Insecurity: Affects on Children s Nutrition

47 Food Security Issues Many crop yields, livestock and fish production are projected to decline Rising prices lead to increased consumption of nutrient poor but calorie-rich foods The nutritional value of some foods is projected to decline eg. less protein and other nutrients in grains Greater use of herbicides and pesticides

48 Mental Health Impacts Disasters Storms, floods, droughts, fires Displacement Wars

49 Mental Health and Stress-Related Disorders Mental health problems more common after disasters such as floods, heat waves, and wildfires Some patients with mental illness are especially susceptible to heat Suicide rates are higher in hot weather Patients with schizophrenia and other severe mental illness are at risk due to their illness and medications Stress is transmitted to children, who are less able to express the effects of trauma and to get help

50 Mental health: The need for a holistic approach

52 Mental Health Effects of Climate Disruption Post-traumatic stress disorder (PTSD) Anxiety Depression May not be recognized in children

53 Environmental Justice Distribution of environmental conditions by race/ethnicity/socioeconomic status Outdoor temperatures (urban heat islands) Outdoor work Indoor temperatures (lack of access to adequate, reliable air conditioning) Poorer baseline health Eg. Increased prevalence of asthma, chronic obstructive pulmonary disease, diabetes, heart disease

54 Increasing vulnerability of US children to environmental stresses?

55 WHO

56 More Information on Health Effects of Climate Change US Global Change Research Project: 2013 Draft National Climate Assessment CDC WHO

57 Questions?

Moderator and Presenter. George Luber, PhD Chief Climate and Health Program US Centers for Disease Control and Prevention

Moderator and Presenter. George Luber, PhD Chief Climate and Health Program US Centers for Disease Control and Prevention Moderator and Presenter George Luber, PhD Chief Climate and Health Program US Centers for Disease Control and Prevention Climate Changes Health Tools to Communicate the Problem George Luber, PhD Chief,