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
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
“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
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
Children in developing countries are especially vulnerable
DALY = disability adjusted life years DALY = years of life lost + years of life lived with disability
And Climate Change is only one global factor…
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 2010. NCA Draft 2013
NCA Draft 2013
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 1971-2000 NCA Draft 2013
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
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
Direct Health Effects of Extreme Heat
Direct heat affects young children as well as the elderly
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
Worse air pollution: Higher Ground-level (tropospheric) Ozone, Changes in Particulate Matter and Other Air Pollutants
Air Pollution and Climate Change
Ozone Sunlight + Heat Oxygen (O 2 ) + Ozone (O 3 ) Nitrogen Oxides + Volatile Organic Compounds (VOCs)
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 60-70 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.
States that currently do not meet the 75 ppb EPA ozone standard Union of Concerned Scientists
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 • Increased total, all-cause mortality • Increased cardiovascular mortality? • Recent NJ ozone data – increase with recent warm weather? Union of Concerned Scientists
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
Estimated episodes of acute respiratory symptoms with only 2ppb increased ozone by state Union of Concerned Scientists
Estimated health care costs associated with only 2ppb increased ozone by state Union of Concerned Scientists
EPA’s Air Quality Index for Ozone Is limiting outdoor exertion good for kids?
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
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
Increased Allergy and Allergic Asthma
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!
Increased growth and increased pollen production per plant with increasing carbon dioxide NCA Draft 2013
Health Impacts of Flooding and Extreme Weather Events
NCA Draft 2013
1920s through 2008 NCA Draft 2013
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
Mold and Dampness • Exacerbation of pre-existing asthma • New-onset asthma • Respiratory symptoms • Hypersensitivity pneumonitis • Infection in immunocompromised individuals • Toxic effects of mold “ mycotoxins ”?
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
Malaria
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
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:10.1371/journal.pntd.0000338
Food Insecurity: Affects on Children’s Nutrition
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
Mental Health Impacts • Disasters – Storms, floods, droughts, fires • Displacement • Wars
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
Mental health: The need for a holistic approach
Mental Health Effects of Climate Disruption • Post-traumatic stress disorder (PTSD) • Anxiety • Depression • May not be recognized in children
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
Increasing vulnerability of US children to environmental stresses?
WHO
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