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Climate change adaptation: Is there a role for Public Health?

PHO Rounds April 18, 2017

Ray Copes, MD Chief, Environmental and Occupational Health

Public Health Ontario Associate Professor

University of Toronto

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Disclosures and Disclaimer • No conflicts to declare

• Views are those of the presenter and not necessarily those of associated institutions

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Climate Change from Frumkin Environmental Health from Global to Local 3rd ed

• Global-scale changes resulting from higher concentrations of greenhouse gases, land-use changes such as deforestation and other drivers. Features Earth system changes such as changes in rainfall patterns, greater ocean acidification, and more frequent heat waves. These effects vary from place to place.

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Climate Change from Frumkin Environmental Health from Global to Local 3rd ed

• CC Mitigation – Actions that aim to stabilize or reduce the production of greenhouse gases (and perhaps sequester those greenhouse gases that are produced), corresponding to the public health concept of primary prevention.

• CC Adaptation – Adjustments in ecological, social, or economic systems in response to observed or expected climate impacts. More particularly, changes in processes, practices, and structures to reduce potential harm or to exploit beneficial opportunities associated with climate change.

• Mitigation is global; adaptation (more) local. 4

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Direct and Indirect Health Impacts

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Source: McMichael, NEJM, 2013 (p. 1339)

source: http://www.ipcc.ch/pdf/assessment-report/ar5/wg2/WGIIAR5-Chap11_FINAL.pdf

Great! So what do we look

for?

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Extreme Weather Events

• Observed since approximately 1950s

• Associated with overall: • Fewer cold temperature extremes • More warm temperature extremes • Higher high sea levels • More heavy precipitation events

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Direct Impacts – Heat and ColdIPCC 2014

• Mortality, hospitalization , not just heat stroke

• Contrast experience in France and Chicago with heat waves

• Fire risk – coupled with dry conditions US, Australia, Canada burns, respiratory mortality and morbidity

• Adaptive measures - increased access to a/c, heat alerts, cooling centres

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Non-accidental mortality Ontario

• Adjusted for: O3, NO2, influenza activity, statutory holidays, seasonal and long term time trends (including 19 CDs with >50% complete data)

Overall effect

Cause-specific death and temperature

• Adjusted for: O3, NO2, influenza activity, statutory holidays, seasonal and long term time trends (including 19 CDs with >50% complete data)

CVD All respiratory

Hospitalizations • Bai et al Nature Scientific Reports 2016

• Cold (1st %ile) was associated with 37% ( 95% CI ; 5%-78%) increase in hospitalizations for hypertension

• Cold and heat (99%ile) were associated with 12% (1-24% ) and 30% (6-58%) increase in diabetes related hospitalizations

• Arrhythmia no association

• Most of the ‘burden’ was associated with mild (vs severe) cold and heat

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Temperature and Non-accidental Death

LAG06

LAG03

LAG01

LAG6

LAG5

LAG4

LAG3

LAG2

LAG1

LAG0

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6% increase (95% CI)

model pdl.lag single.lag udl.lag

Non-accident - Warm

LAG06

LAG03

LAG01

LAG6

LAG5

LAG4

LAG3

LAG2

LAG1

LAG0

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6% increase (95% C

model pdl.lag single.lag udl.lag

Non-accident - C

* Per 5oC increase of daily mean temperature in warm season and 5oC decrease of temperature in cold season

Direct Impacts Floods and storms IPCC 2014

• Floods and storms – drowning, injuries, hypothermia, infectious disease, mental health

• Increased precipitation , sea level rise, storm surges

• Vulnerable infrastructure – water, waste treatment, health care, power gen, housing

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Direct Impacts -Floods and storms • Water and wind may result in more impact than heat

• Less predictable and more variable than temperature

• Sea level rise and subsiding coastal land in some areas are ‘certain’, may be coupled with increasing frequency and severity of storm surges

• Flood risks in inland areas with more frequent and severe precipitation, essential infrastructure may be compromised (water, waste treatment, power), fire, health care

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Direct Impacts -UV • Ambient UV and max summer temp related to cataracts and

non melanotic skin cancer

• Varies with location, US 5.5% increase in squamous and 2.9% increase in basal cell ca for every 1 degree C increase

• Stratospheric O3 is recovering but may diminish by 2100; projections are uncertain

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Indirect – Vector borne and other infectious disease • Malaria, Dengue, Tick-borne

• Reasonable certainty distribution of vectors will change

• Link to increases in human illness less clear

• Appearance of ‘new’ diseases may not follow predictable patterns (e.g. Cryptococcus gatii, V.Island and Pacific NW)

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Indirect- Food and Waterborne infections • Seasonality in many bacterial and viral infections

• May be compounded by extreme precipitation (established risk factor for water-borne outbreaks

• May affect terrestrial and aquatic foods

• Increase in algal blooms may also be temperature related

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Indirect- Air pollution • Many climate altering air pollutants or their reaction products

can damage health

• For a given mix of O3 precursors, increased temperature will lead to greater O3 formation

• Aeroallergens may also increase

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Indirect – Social and economic disruption

• Food supply –temperature, moisture and pests can affect the quantity and quality of food crops. Soil can be altered by wind and erosion

• Water supplies – quantity and quality may be compromised by reduced precipitation and in coastal areas salt water intrusion

• Displaced populations?

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Climate change and disasters: Is there a link?

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Disasters in Ontario

• Public Safety Canada: Canadian Disaster Databasehttps://www.publicsafety.gc.ca/cnt/rsrcs/cndn-dsstr-dtbs/index-en.aspx

•

• The CDD tracks "significant disaster events" which conform to the Emergency Management Framework for Canada definition of a "disaster" and meet one or more of the following criteria:

• 10 or more people killed

• 100 or more people affected/injured/infected/evacuated or homeless

• an appeal for national/international assistance

• historical significance

• significant damage/interruption of normal processes such that the community affected cannot recover on its own

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Searched: Ontario 2004-2013 - 10 years post SARS

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Type of Disaster Number

Flood 12

Wildfire 6

Tornado 6

Thunder storm 4

Winter storm 3

Res/chem fire 3

Epidemic 3

Explosion 2

Infestation 1

Rail accident 1

What can Public Health do?

Provincial Context Ontario’s Climate Change Strategy*

Vision

Areas of Transformation 1. A prosperous low-carbon economy with

world-leading innovation, science and technology

2. Government collaboration and leadership 3. A resource-efficient, high-productivity

society 4. Reducing greenhouse gas emissions

across sectors 5. Adapting and thriving in a changing

climate

*Provincial lead - Ministry of the Environment and Climate Change

Inter-agency and inter-ministry collaboration

Tools to increase local PHU adaptive capacity

Builds and facilitates partnerships and linkages at the local level

1. Ontario Air Quality Health Index (AQHI)

2. Ontario Heat Warning and Information System

3. Proposed Cold Warning and Information System

Ontario Climate Change and Health Toolkit:

1. Vulnerability & Adaptation Assessment Guidelines & Workbook

2. Climate Modelling Study

1. Interagency tools, data & resources

2. Public health input into the land-use planning process

Reduced Public Health Vulnerability

Healthy Resilient Adaptive

Communities

Ontario Framework for ActionFrom MOHLTC

Reduce incidence of

adverse health

outcomes from impacts

of climate change

Enhance capacity to

address risk factors

associated with climate

change

Reduce public

exposure to health

hazards related to a changing climate

Identify interventions that reduce exposure to

climate change impacts

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http://www.health.gov.on.ca/en/common/ministry/publications/reports/climate_change_toolkit/climate_change_toolkit.pdf

• Steps in a Health Vulnerability and Adaptation Assessment

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Figure Source: Ministry of Health and Long-Term Care (p. 19)

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Vulnerability Assessment for Adaptation Planning

• Adaptation activities occur at local to national levels

• Help prepare communities for impacts of climate change

• Health vulnerabilities due to climate change will differ according to location of community: • Urban – urban heat island effect • Rural – agriculture impacted by extreme weather • Coastal – flooding; sea levels • Northern – disruption of ecosystems in communities

dependent on country foods

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Ontario Climate Change and Health Toolkit

• Ontario Climate Change and

Health Vulnerability and Adaptation Assessment Guidelines

• Adaptation and Assessment Workbook

• Ontario Climate Change and Health Modelling Study

http://www.health.gov.on.ca/en/common/ministry/publications/reports/climate_change_toolkit/climate_change_toolkit.aspx

Vulnerability & Adaptation Assessment Guidelines

Key objectives

• Raise awareness about health impacts of climate change

• Enable public health units to identify local vulnerabilities within their communities

• Reduce public health vulnerability to climate change

• Assist public health units in developing

local adaptation plans

Vulnerability & Adaptation Assessment Workbook

Guidance and templates •Describe current risks including vulnerabilities and capacities

•Project future health risks

•Identify and prioritize policies and programs to manage the additional health risks associated with a changing climate

•Establish an iterative process for managing and monitoring health risks

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New Brunswick: Current Adaptation Strategies

• Raising homes and cottages

• Moving away from danger zones

• Installing barriers and using erosion-control methods

• Removing and trimming trees next to power lines

• Reducing time spent in sun and wearing sunscreen

• Obtaining generators and supplies in case of storms or power outages

• Storm water systems designed to handle increased precipitation

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Local Example: City of Toronto, Ontario

33 Ministry of Health and Long-Term Care (p. 49)

Local Climate Change Adaptation Case Studies http://www.nrcan.gc.ca/environment/resources/publications/impacts-adaptation/reports/municipalities/10079

• Clyde River – Community climate change adaptation plan

• Kamloops – Wildfire protection plan

• Metro Vancouver - Storm water management

• Edmonton - Urban forest management

• Regina - Water conservation program

• London – Climate change adaptation strategy

• Toronto – Heat alert system

• Quebec City – Environmental services adaptation plan

• Le Goulet – Climate change adaptation plan

• Halifax – Planning for sea level rise

• Annapolis Royal – Preparing for storm surges • http://www.nrcan.gc.ca/environment/resources/publications/impacts-adaptation/reports/assessments/2014/16309

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What can Public Health do?

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Public Health Adaptation • Enhanced disease and outcome surveillance

• Environmental monitoring

• Improving baseline health status of the population

• Improved disaster response

• Increase collaboration between health and other sectors (e.g. animal surveillance)

• Work to identify vulnerable populations and infrastructure and actions that will reduce these in the face of climate change

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Acknowledgements • Kara Dueck, MD - PHPM resident

• Tony Amalfa, MOHLTC

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