Climate change in the Great Lakes Region: Key Vulnerabilities to Public Health Jonathan Patz, MD, MPH Jonathan Patz, MD, MPH Nelson Institute & Dept. Population.

Climate changeClimate change in the in the Great Lakes Region: Great Lakes Region: Key Vulnerabilities to Key Vulnerabilities to

Public HealthPublic Health

Jonathan Patz, MD, MPHJonathan Patz, MD, MPH Nelson Institute & Dept. Population Health Sciences Nelson Institute & Dept. Population Health Sciences

University of Wisconsin - MadisonUniversity of Wisconsin - Madison

Climate Change Webinar Series Climate Change Webinar Series

Ohio State UniversityOhio State University

Sept. 28, 2010Sept. 28, 2010

CLIMATE

CHANGE

Temperature Rise 1

Sea level Rise 2

Hydrologic Extremes

Urban Heat Island Effect

Air Pollution & Aeroallergens

Vector-borne Diseases

Water-borne Diseases

Water resources & food supply

Mental Health &

Environmental Refugees

Heat StressCardiorespiratory failure

Respiratory diseases, e.g., COPD & Asthma

MalariaDengueEncephalitisHantavirusRift Valley Fever

CholeraCyclosporaCryptosporidiosisCampylobacterLeptospirosis

MalnutritionDiarrheaToxic Red Tides

Forced MigrationOvercrowdingInfectious diseasesHuman Conflicts

1 3°C by yr. 21002 40 cm “ “IPCC estimates

Patz, 1998

HEALTH EFFECTS OF CLIMATE CHANGE

Probabilities of future extremes can be Probabilities of future extremes can be estimated given projections of mean temperatureestimated given projections of mean temperature

Peterson et al., 2007

2057

2007

Heatwave morbidity -Milwaukee

Li, et al. , unpublished (EPA STAR grantEPA STAR grant, J. Patz, PI)

•By 2050, warming alone By 2050, warming alone maymay increase by 68% the increase by 68% the number of Red Ozone Alert number of Red Ozone Alert daysdays across the Eastern US. across the Eastern US. (IPCC, 2007 -Bell et al, (IPCC, 2007 -Bell et al, 2006)2006)

• ““The severity and The severity and duration of summertime duration of summertime regional air pollution regional air pollution episodes are projected to episodes are projected to increase in the Northeast increase in the Northeast and Midwest US by 2045-and Midwest US by 2045-2052 due to2052 due to climate-climate-change-induced decreases change-induced decreases in the frequency of surface in the frequency of surface cyclonescyclones.” .” (IPCC, 2007(IPCC, 2007))

Days per summer (June, July, August) with O3 above the NAAQS limit of 84 ppb. Colored, solid lines reflect the 10-year running mean of exceedances for each model (mean across SDSM ensembles, and across the study sites). Colored dotted lines reflect year-to-year exeedance values (mean across SDSM ensembles, and across the study sites).

Holloway et al. 2009

USA: Combined sewer overflows (CSOs)

Courtesy: Kellogg Schwab

1.2 trillion gal of sewage & stormwater a year discharged during combined sewer overflows

– would keep Niagara Falls roaring for 18 days

Center for Water & Health, JHU Bloomberg School of Public Health

Combined Sewer Systems & Past Combined Sewer Systems & Past Precipitation Trends Precipitation Trends

Source: National Climatic Data Center/NESDIS/NOAA

Past Precipitation Trends

Source: EPA

CSS Communities

770 systems serve around 40 million people

Source: EPA (Courtesy– J. Scheraga)

Sewage overflows in the Great LakesSewage overflows in the Great Lakes

• Intense storm events result in combined sewer Intense storm events result in combined sewer overflows (CSO’s) overflows (CSO’s)

• Great Lakes provides drinking water to 40M people Great Lakes provides drinking water to 40M people and has >500 beachesand has >500 beaches

• Sewage contains human pathogens including viruses, Sewage contains human pathogens including viruses, protozoan, and pathogenic bacteriaprotozoan, and pathogenic bacteria

• The EPA has estimated 140 communities release The EPA has estimated 140 communities release 150 150 billionbillion liters of combined sewage each year liters of combined sewage each year

Bradford Beach

South Shore Beach

Bradford and South Shore Beach on Lake Michigan

E. coli CFU/100 ml

235-999

0-100

100-235

1000-9999

10,000-20,000

RainfallRainfallUrban stormwaterUrban stormwaterSewage overflowSewage overflow

Courtesy: Sandra McLellan

UW-Milwaukee

Reported waterborne diseases, US, from 1948-1994

• 67%67% of waterborne disease outbreaks were preceded by precipitation above the 80th percentile (across a 50 yr. climate record), p < 0.001

• 51%51% of outbreaks were preceded by precipitation above the 90th percentile, p < 0.002

• Surface water-related outbreaks had strongest correlation with extreme precipitation in the month of outbreak; groundwater-related outbreaks lagged 2 months following extreme precipitation.

Curriero, Patz, et al, 2001.

U.S. CCSP, 2008 Globally AveragedGlobally Averaged

Projected Change in the Frequency of 2" Precipitation Events (days/decade) from 1980 to 2055 based on

downscaled climate models (http://www.wicci.wisc.edu)

Courtesy: Steve Vavrus (UW-Madison

Courtesy: Steve Vavrus (UW-Madison)

The Good News about climate change and our health

The opportunity for improving health determinants

We can reduce:

The 1,000,000 annual deaths from urban air pollution

The loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity

WHO, 2007

Ten Leading Causes of US Deaths per Year (CDC, 2004)

Friedman et al. JAMA 2001;285:897

Asthma and Air Pollution

• Asthma-related emergency room visits by children decreased 42%decreased 42%

• Children’s emergency visits for non-asthma causes did not change during same period

• Natural experiment during 1996 Summer Olympic games in Atlanta

• Peak morning traffictraffic decreased 23% and peak ozoneozone levels decreased 28%

Comparative Scenario

The Natl. Personal Transportation Survey reports median trip length in urban and suburban areas of the region to be 4-8 km, representing ~20% of VMT for the region. Our alternative scenario thus assumes that all round trips of 8 km or less could be accomplished through alternative modes of (non ICE) transportation.

Grabow et al (in review)

20% fewer car trips:Change in O3 & PM 2.5

Grabow et al (in review)

• hundreds of lives savedhundreds of lives saved

• Thousands of Hospital admissions avoidedThousands of Hospital admissions avoided

• Billions reduction in health care costs Billions reduction in health care costs

Value of co-benefits is large

22

Fig 1 and fig 2

Compare to cost of climate policy: almost always <$30/tCO2

Nemet G F, Holloway T and Meier P 2010 “Implications of incorporating air-quality co-benefits into climate change policymaking” Environmental Research Letters 014007

$2 – 196 /tCO2 with a mean of $49/tCO2

Nemet et al. 2010

Decision Support

• In adapting to climate change, we need to include health co-benefits stemming from mitigation policies; thus far, one-sided discussions of costs

Thank you!Thank you!

[email protected]

www. sage.wisc.eduwww. sage.wisc.edu

Educational website:www.ecohealth101.org