Climate Change: Managing the Shifting Environmental Health Risks

Climate Change: Managing the Shifting Environmental Health Risks

Changing hazards, changing risks, and the need for robust risk

management

Jeremy Hess, MD, MPH

Overview

• Climate change – What’s happening and why– What health impacts we’ll see

• Risks from environmental hazards– A conceptual framework for risk– How climate change is changing the risk landscape

• Risk management– Some approaches– Implications for public health

CLIMATE CHANGEA brief primer

Climate Change

Thanks to Daniel Rochberg for some slides

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpacts

http://www.pewclimate.org/facts-and-figures/international/historical

Increased Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpacts

2012 Peak Concentration: 396 ppm

CO2 Concentrations over the past 800,000 years(dark blue line)

Increased Temperature

http://ngm.nationalgeographic.com/big-idea/05/carbon-bath

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

The Copenhagen Diagnosis, available here.

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Historical and Projected Global Temperatures(degrees C; 2000 = 0)

IPCC

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate change

“Climate change refers to any distinct change in measures of climate lasting for a long period of time. In other words, ‘climate change’ means major changes in temperature, rainfall, snow, or wind patterns lasting for decades or longer.”

U.S. Environmental Protection Agency, Frequently Asked Questions about

Global Warming and Climate Change

http://www.epa.gov/climatechange/downloads/Climate_Basics.pdf

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

http://www.cbc.ca/gfx/images/news/photos/2009/07/06/drought-china-cp-w-6244601.jpg

“There is medium confidence that droughts will intensify in the 21st century in some seasons and areas, due to reduced precipitation and/or increased evapotranspiration.”

IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change AdaptationSummary for Policymakers, p. 11

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Maldives: 1,192 islands 330,000 peopleaverage elevation ~1 meter

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IPCC sea level rise projections by 2100: 18-59 cm

IPCC 4th Assessment Report, Synthesis Report

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

http://w

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“It is very likely that the length, frequency, and/or intensity of warm spells or heat waves will increase over most land areas.”

IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change AdaptationSummary for Policymakers, p. 11

“France's summer heatwave killed a total of 14,800 people, according to official figures released on Thursday.”

BBC News, September 25, 2003

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

photo by Paula Bronstein, Getty Images http://news.nationalgeographic.com/news/2010/08/photogalleries/100826-pakistan-flooding-millions-people-pictures/#/pakistan-flooding-man-water_25084_600x450.jpg

“It is likely that the frequency of heavy precipitation or the proportion of total rainfall from heavy falls will increase in the 21st century over many areas of the globe.”IPCC Special Report on Managing the Risks of Extreme Events and Disasters to

Advance Climate Change Adaptation, Summary for Policymakers, p. 11

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

Average tropical cyclone maximum wind speed is likely to increase, although increases may not occur in all ocean basins.

IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation, Summary for Policymakers, p. 11

It is likely that the global frequency of tropical cyclones will either decrease or remain essentially unchanged.

IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation, Summary for Policymakers, p. 11

http://ww

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ages/content/470571main_isabel_lg.jpg

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

ENVIRONMENTAL HAZARD RISKThe components of risk and how they are shifting

Event•Probability•Magnitude

Vulnerability•Exposure•Susceptibility

Loss•Damage •Valuation

Basic Risk Formula in CC Community

Probability x Consequence = Risk

Some Climate Change Risks

Lenton, T. M. (2011). Early warning of climate tipping points. Nature Climate Change. 1: 201-209.

Components of Risk

Equations• Risk = p(H) x impact or cost• Risk = p(H) x V/Res, where

– pH = Hazard probability– V = Vulnerability, where

• V = p(E) x (S)• pE = Exposure probability• S = Susceptibility

– Res = Resilience• Res ≡ Adaptive Capacity

Considerations• What is the hazard?• Who is most vulnerable?

– Little guidance– Based on exposure and susceptibility:

• Elderly • Children• Workers

• What drives adaptive capacity for vulnerable populations?

• How might early warnings facilitate protective responses and increase resilience?

How Risk is Changing: Hazards

How Risk is Changing: Hazards

IPCC. Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation. A Special Report of Working Groups I and II of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press; 2012.

How Risk is Changing: Exposure

Available: http://www.worldmapper.com

How Risk is Changing: Exposure

IPCC, SREX, 2012

How Risk is Changing: Susceptibility

Available: http://www.worldmapper.comGlobal Distribution of Preventable Deaths

Mortality Distribution

95% of disaster deaths occur in the developing worldIPCC, SREX, 2012

Combination, 1975-2010

People Killed

People Affected

Disasters

People Killed

People Affected

Disasters

Health Effects of Disasters

Pre-event – injuries, road traffic crashes

Event – debris injuries, drowning

Post-Event – displacement, chronic dz exacerbation

Recovery – depression, violence

Hurricanes Katrina and Rita

NOLA Health Care System Pre and Post

Rudowitz et al., 2006; slide courtesy John Balbus

Moving the Coping Range

THE ROLE OF RISK MANAGEMENTApproaches to risk and implications for public health

Aspects of Risk Management

• Multiple components– Risk recognition– Risk assessment– Risk engagement

• Multiple stances– Risk mitigation– Risk avoidance– Risk retention– Risk sharing

Minimize or AvoidRetention Sharing

Mitigation AvoidanceRetain or Share

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

okay, climate change is a problem.what do we do about it?

Climate Change

Increased GHG

Emissions

IncreasedGHG

ConcentrationsImpactsIncreased

Temperature

reduce emissions

(mitigation)

prepare for / respond to the

impacts(adaptation)

okay, climate change is a problem.what do we do about it?

mitigate against

this

adapt to this

Put another way:

Mitigation:“avoiding the unmanageable”

Adaptation:“managing the unavoidable”

http://www.ipcc.ch/graphics/graphics/ar4-wg1/ppt/figure02.ppt#278,22,Figure 2.21

Allaffect human

health

Potential Co-benefits of GHG Mitigation Policies

• Energy generation – decreased air pollution

• Transportation – increased physical activity, decreased air pollution, decreased injuries from collisions

• Agriculture – reduced red meat consumption

• Agriculture – improved nutrition

Identifying synergies and opportunities for co-benefits

Both Are Required

Yohe and Leichenko 2010

Risk Management Options

IPCC SREX Summary for Policy Makers, available here.

But Where to Start?

BRACE1. Forecasted

Climate Impact and Vulnerability

Assessment

2. Projected Disease Burden

3. Intervention Assessment

4. Health Adaptation

Planning and Implementation

5. Evaluation

“Place Specific and Path Dependent”

• At any point in time, health risks associated with environmental hazards depend markedly on interactions between components of risk

• Do we start with hazards or vulnerability?– If vulnerability relatively high, address that preferentially– If vulnerability relatively low, explore thresholds and

implications of shifting hazards• Be mindful of feedbacks over time:

– Exposure over time (or lack thereof) can feed back into vulnerability

– Implications for adaptive capacity, development, and resilience

Feedbacks Over Time

IPCC, SREX, 2012

Changing Risk Over Time

Tol R, Ebi K, Yohe G. Infectious disease, development, and climate change: a scenario analysis. Environment and Development Economics. 2007;12(05):687-706.

Awareness of Thresholds

Lenton, T. M. (2011). Early warning of climate tipping points. Nature Climate Change. 1: 201-209.

The Role of Learning

IPCC, SREX, 2012

Problem Types

Used with permission from Hovmand, P. S. Adapted rom Burrell, G., and Morgan,G. (1979). Sociological paradigms and Organizational analysis: Elements of sociology of corporate life. London, and Heinemann, and Lane, D. C. (1999). Social theory and System dynamics practice. Journal of Operational Research Society, 113, 501-527.

The Role of Transformation

IPCC, SREX, 2012

Simulations Can Help

Role of Adaptive Management

• Return to the risk equation– Reduce hazard probability– Reduce hazard exposure– Reduce susceptibility

• Requires modeling, learning, and adaptive management

• Integrated with sustain-able development

Assess

Plan

Implement

Monitor

Evaluate

Adjust

In Summary• Climate change is changing the risk landscape• Several risk management stances are available• Risk can be broken down into components and

the breakdowns can help guide risk management• Risk assessment, risk management, and risk

communication are increasingly linked• Adaptive management is an important short- to

medium-term tool