health, equity, and...
TRANSCRIPT
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“Climate change is the de0ining health challenge of our time.” Margaret Chan, World Health Organization
“Climate change threatens our fragile existence on this planet.” Jim Kim, World Bank
"Social injustice is killing people on a grand scale.” WHO Commission on the Social Determinants of Health, 2008
California’s Burden of Chronic Disease p 80% deaths due to chronic disease & injuries
n Heart disease leading cause of death
p 38% Californians live with chronic disease n 80% health care costs
p Costs of overweight/obesity and physical inactivity exceed $28 billion annually
p Key causes: physical inactivity, poor diet, tobacco
https://www.cdph.ca.gov/programs/Documents/BurdenReportOnline%2004-04-13.pdf
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Health Inequities Pathway
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Adapted from Bay Area Regional Health Inequities Initiative
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Living Conditions:
Physical, Social, Economic, Services Environments
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Living Conditions:
Physical, Social, Economic, Services Environments
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"Social injustice is killing people on a grand scale.” WHO Commission on the Social Determinants of Health, 2008
Climate-Health Pathway
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Adapted from Patz et.al. 2000 EnvHlthPersp
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Greenhouse
Gas Emissions
Climate Behaviors
Warming
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Global Climate Impacts
Hydrologic Variability
Ocean Acidification Sea Level Rise
Glacier & Snowpack Loss
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Local Climate Impacts
Wildfires Drought
Decreased Snowpack
http://c-change.la/temperature/ Extreme Heat
Coastal Flooding
Extreme Weather
Environmental & Socioeconomic Intermediate
Factors
Resources Conflict Economic Losses
Declines in Crop Yield Vector Habitat Microbial & Toxics Contamination
Water impacts
Drought & Climate Change
p Warming temperatures due to climate change n Larger fraction of precipitation falls in downpours
p More storm water lost to storm runoff (vs absorbed in soil)
p Larger fraction of mountain precipitation fall as rain rather than snow
p Snowpack melts earlier due to warming n Reduced stream flows in late-spring, summer
p Higher evaporation rates n Losses of water from reservoirs n Drier soil
p Arctic ice loss may change the jet stream
How bad is this drought?
May 19, 2015
n Extreme weather injuries, drownings, fatalities n Heat-related illnesses and deaths n Air pollution impacts – respiratory, cardiovascular n Allergic disease n Infectious disease
p Water and food-borne disease p Vector-borne disease
n Food insecurity and malnutrition n Water insecurity n Displacement, conflict, and migration n Stress and mental health impacts 15
Climate Health Impacts
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#! Leading weather-related cause of death #! Urban Heat Islands, chronic disease, work #! Worsens air pollution
Climate Health Impacts: Heat
Wildfire Smoke
Energy Use Costs & Pollution
Increased Ozone Levels
Dust
Deaths
Urban Heat Islands
Crop Yield Declines
Pollen
Drought Health Impacts
p Water Quality p Water Availability and
Affordability p Food Costs and Insecurity p Vector-borne disease
n Stagnant pools n Improper water storage
p Wildfire p Mental Health Impacts
p Air Quality n Increased dust and
particulate levels n Increased pollen n Wildfire smoke n Airborne toxins from
freshwater algal blooms (cyanobacteria)
p Recreational risks p Unemployment &
economic impacts n 1/3 CV jobs related to
farming
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http://www.sfclimatehealth.org/san-francisco-climate-projections/
San Francisco Climate Vulnerability p West Nile Virus increasing in SF Bay Area
n Santa Clara: 350 cases since 2012
p Increasing risk for mold-related allergies with fertile environment for mold n Old housing stock n Temperate climate
p Water supply at risk n SF gets 85% of water supply from Tuolomne River watershed n Reduced snowpack, early run-off n Wildfire threat to water infrastructure
p E.g. 2013 rim Fire
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Adapted from Bay Area Regional Health Inequities Initiative
Adapted from Patz et.al. 2000 EnvHlthPersp
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Other Environmental Impacts
Air Pollution
Deforestation
Topsoil Depletion
Water Contamination
Ocean Dead Zones
Ecosystems Collapse
Planetary Boundaries
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Climate Change Vulnerability & Resilience
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“Climate Gap”
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Climate Health
Inequities
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“San Francisco is particularly vulnerable to extreme heat because much of the infrastructure, housing, and residents lack the technologic, structural, or physiologic adaptations necessary to withstand severe heat waves.”
Highest levels CO2 in at least 800,000 years
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IPCC AR5 Synthesis Report
The window for action is rapidly closing 65% of our carbon budget compatible with a 2°C goal already used
Amount Used 1870-2011:
515 GtC
Amount Remaining:
275 GtC
Total Carbon Budget:
790 GtC
AR5 WGI SPM
Rockefeller Foundation/Lancet Commission on Planetary Health
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“We have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature’s resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature’s life support systems in the future. Health effects from changes to the environment including climatic change, ocean acidification, land degradation, water scarcity, over- exploitation of fisheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth.” http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)60901-1.pdf
IPCC AR5 Synthesis Report
The Choices We Make Will Create Different Outcomes
With substantial mitigation
Without additional mitigation
Change in average surface temperature (1986–2005 to 2081–2100) AR5 WGI SPM
Root Causes
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#! Energy
#! Transportation
#! Land Use #! Agriculture
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Health Co-Benefits or Co-Harms of Climate Interventions
p Reduce n Greenhouse gases n Air pollution n Fuel poverty
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• Reduce • Asthma • Respiratory
disease • CVD • Adverse birth
outcomes
Clean Energy/Energy Efficiency Co-Benefits
EPA Clean Power Plan p Power plants: largest U.S. source of
carbon pollution n roughly one-third of all domestic GHGE
p Clean power plan proposal: n cut carbon pollution from the power sector by
30 percent from 2005 levels n cut pollution that leads to soot and smog by
over 25 percent in 2030 p State-specific goals p State flexibility
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Clean Power Plan Building Blocks p Make fossil fuel power plants more efficient p Use low-emitting power sources more p Use more zero- and low-emitting power sources p Use electricity more efficiently p State implementation is key
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SB 350 (DeLeon): Renewable Portfolio Standard !! Increases the RPS to 50% by the year
2030 "! Current RPS 33% by 2030
http://www.energy.ca.gov/commission/fact_sheets/documents/Fact_Sheet_-_50_Percent_Renewables.pdf
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Current RPS 33% by 2030
SB350: Energy Efficiency !! Increase energy efficiency by 50% by
2030
http://www.arb.ca.gov/html/fact_sheets/2030_energyefficiency.pdf
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SB350: Reduce Petroleum Use !! Reduce petroleum
use by 50% by 2030 !! Production,
refining, and the use of petroleum "! Nearly half of
greenhouse gas (GHG) emissions
"! 80% of smog-forming pollution
"! Over 95% of cancer-causing diesel PM
http://www.arb.ca.gov/newsrel/petroleum_reductions.pdf
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Reducing Transportation GHGE p Low Carbon Fuels p Zero Emission Vehicles p Fuel Efficient Vehicles p Reduce Vehicle Miles Traveled
n Walk n Bike n Public Transit n Car Share
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ITHIM Preliminary Projections of Health Impacts of Increased Bicycling and Walking: 4 to 19 minutes of daily physical activity, SCAG Region
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Change in disease burden
Change in premature deaths/yr
Cardiovascular Dis.* 12% 3,134
Diabetes 12% 374
Depression 3% <2
DemenBa 6% 465
Breast cancer 3% 60
Colon Cancer 3% 75
Road traffic crashes 22% 315 * Ischemic heart disease, stroke, hypertensive heart disease
Active Transportation Co-Benefits
California Clean Vehicle Rebates
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Bicycle Safety
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http://cal.streetsblog.org/wp-content/uploads/sites/13/2015/04/Caltrans_Strategic_Mgmt_Plan_0330151.pdf
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Promote community health through active transportation and reduced pollution in communities .
* 10% reduction in number of fatalities in a calendar year in each of the following mode types: car, transit, pedestrian, and bicyclist .
* By 2020, achieve 15% reduction (3% per year) of statewide per capita VMT relative to 2010 levels reported by District .
* By 2020, increase non-auto modes: • Triple bicycle; • Double pedestrian; and • Double transit .
Active Transportation !!California 2010-2012 2000
Total 22.5%
!! Vancouver "! 2008 40% bike,walk,transit
!! Netherlands 27% bike
!! Beijing 32% bike
http://www.cityclock.org/urban-cycling-mode-share/#.VbB-AcbD7SI
http://www.dot.ca.gov/hq/tsip/FinalReport.pdf
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p Reductions n Meat consumption n GHG emissions n Pesticide use n Synthetic fertilizer use n Antibiotic use n Water pollution n Soil erosion n Biodiversity loss n Unsustainable H2O consumption n Food miles
p Increases n Access affordable healthy food n Agricultural land preservation n Rural community strength
p Reductions n Obesity n Cardiovascular disease n Cancer (breast, prostate,
colorectal) n Type II Diabetes n Antibiotic resistance n Pesticide illness
Sustainable Food Systems/Consumption Co-Benefits
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p Urban greening n Reduce heat illness risk n Healthy food access n Reduce storm water
run-off & flooding risk n Replenish groundwater n Places to be active n Decrease energy
consumption n Lower energy costs n Reduce air pollution n Reduce crime
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Heat Resilience Co-Benefits
Co-Harms
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LCFS: Food Prices & Insecurity
Market Mechanisms: Pollution in EJ Communities
Groundwater Use: Subsidence
TOD: Gentrification
Green Jobs: Occupational Risks Job Loss
The Choice is Ours
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Climate Change is a Health Emergency.
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Root Causes
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Health sector has a vital role p Health frame elicits support for climate action p Health co-benefits and community empowerment
provide antidote to despair and helplessness p Health and equity opportunities are real and
current p Health workers are trusted, credible messengers in
community p Health works in and with vulnerable communities p Health institutions are “anchor institutions”
n Direct impacts, procurement, power and credibility p Health voice has been critical – in partnership with
community advocates
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Why aren’t we doing more?
§ Competing priorities § Tyranny of the urgent
§ Lack capacity § Funding, resources, knowledge, expertise
§ Lack leadership § Politicized issue
§ What can we do that will be effective?
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Integrate Climate, Health, & Equity in All Policies
n Integrate climate change reduction and resilience explicitly into health programs, policies, and practice
n Integrate health & equity explicitly into climate change policies and programs
p TALK ABOUT IT! p GET ENGAGED!
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What we can do?
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p Be a leader - talk to colleagues, communities, decision makers
p Support local, state, and federal climate action strategies with health and equity co-benefits
p Oppose expansion of fossil fuel extraction/production p Support clean, safe, renewable, energy p Support rapid acceleration/ funding for active transportation p Support funding and policies for sustainable ag/peri-urban ag p Advocate for green zones and just transition p Support building standards for climate resilience p Divest endowments and pension funds from fossil fuels p Advocate to end fossil fuel subsidies p Develop and implement urban heat island mitigation
strategies p Support regulations of carbon, methane, ozone pollution p Make polluters pay e.g. carbon tax, nitrogen fertilizer tax
Support Movement Building
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http://climatehealthconnect.org/climate-and-health-alliance/
http://www.phi.org/uploads/application/files/h7fjouo1i38v3tu427p9s9kcmhs3oxsi7tsg1fovh3yesd5hxu.pdf
Linda Rudolph, MD MPH [email protected]