Friday, April 19, 2013

Health Impacts of Climate Change

Excerpts from HUMAN HEALTH AND WELL-BEING IN AN ERA OF ENERGY SCARCITY AND CLIMATE CHANGE.  By Cindy L. Parker, MD, MPH and Brian S. Schwartz, MD, MS.   2010, Post Carbon Institute.
In the past hundred years, we have created lifestyles, communities, food systems, water systems, transportation systems, and health systems that are entirely reliant on cheap and plentiful oil and that assume a favorable and stable climate. Our health and well-being have been shaped by these lifestyles and systems, but they have not necessarily been well served: Climate change and the threat of energy scarcity now pose serious challenges to our “health system,” specifically health care services and public health services.

The consequences of climate change and energy scarcity will be wide ranging and complex, will affect all aspects of our lives, and will touch all people—some more so than others.

We have spent the last sixty years building a physical infrastructure— including highways, office buildings, housing subdivisions, and shopping malls—that was entirely shaped by the availability of cheap and plentiful oil. Homes are far removed from jobs, services (including health services), and even places for recreation and social gathering— all things we need for our well-being. Thus our built environment becomes an important health risk regulator as energy scarcity makes distance more of an obstacle.

Another unexpected determinant of health risk is what might be termed our “provisioning system”—that is, the ways in which we provide our communities with the goods they need. The manufacture and transport of most goods will be impacted in obvious ways by the challenges ahead, but the health risk of the food system is probably the most worrisome. Our food generally comes to us from industrial models of food production, thousands of miles away and completely dependent on fuel, pesticides, herbicides, fertilizers, and plastics made from petroleum and natural gas—a very vulnerable situation in a future of oil prices double or even triple what they are today. In addition, climate change threatens to bring not just more crop-damaging extreme weather (especially droughts/floods) but major shifts in agricultural zones and pest ranges.

Climate change and energy scarcity will create direct challenges for our health system, but they will also create myriad indirect problems for health simply because of how we have built and provisioned our communities and economies up until now.

Recent U.S. national-security reports state that climate change will pose serious threats to national security because it will likely increase poverty, lead to serious environmental degradation, and weaken national governments […].  A growing number of analysts are viewing climate change and energy scarcity through these lenses and the conclusion is unmistakable: Climate change and energy scarcity pose unprecedented challenges to human health and well-being.

Global warming is tracked by following the average global temperature, but averages can be misleading. For example, relatively small average temperature increases mask one of the hallmarks of climate change: more frequent and longer-lasting severe heat waves. In 1995, a heat wave hit Chicago resulting in more than 700 deaths; more than 45,000 people died in heat waves during the summer of 2003 in Western Europe; and the summer of 2006 brought scorching heat to much of the United States and Canada, killing 300 in California alone and sending tens of thousands to emergency rooms and hospitals.

Some people are more vulnerable to heat than others, including babies, children, the elderly, the poor, those who live in inner-city neighborhoods, and the socially isolated (again highlighting the importance of social well-being). More Americans die every year from heat stress than from any other weather-related event, with the exception of Hurricane Katrina. Computer models suggest that if climate change occurs unabated (“climate chaos”), by 2040 heat waves as severe as the 2003 event that killed so many people in Europe could occur every other year.

Heat waves are especially deadly because warmer temperatures worsen air quality. For example, higher temperatures increase concentrations of ground-level ozone (the primary component of smog and an important contributor to global warming), which damages the lungs, blood vessels, and heart. People who have asthma and other breathing disorders are especially vulnerable to the effects of ozone, requiring more medications and leading to more emergency-room visits and hospitalizations.  The combination of high temperatures and high ozone concentrations is especially deadly and plays an important role in the numbers of people who die during heat waves. Other kinds of air pollution are expected to get worse with climate change as well. 

Warmer temperatures, milder winters, precipitation changes, and other effects of climate change can influence the distribution and risk of many infectious diseases.  Debilitating and deadly insect-borne diseases such as malaria, dengue fever, and Lyme disease are especially sensitive to changes in temperature, humidity, and rainfall patterns and will likely increase their ranges and possibly their transmissibility.  Waterborne infectious diseases will also be influenced by warmer temperatures, changes in precipitation patterns, and the compromised ability of degrading ecosystems and suboptimal built environments to deal with heavy precipitation events.

Climate change also promises to bring more severe and potentially more frequent extreme weather events such as hurricanes, tornadoes, and heavy rainfall, all of which increase the risk of injury and death and cause social disruption […].

Competition for shrinking environmental resources, especially the necessities of water, food, and housing, could potentially result in greater conflict within and between geopolitical entities. There is ample evidence that the scarcity of environmental resources has played an important role in many areas of conflict, such as the genocides that devastated Rwanda and continue to occur in Darfur, the ongoing clashes between Zapatista rebels and the federal government in Mexico, and the decades-long modern Israeli-Palestinian conflict.  That is, what have been termed “ethnic conflicts” have actually been exacerbated by, if not directly caused by, environmental scarcity. Such conflicts will increase in the era of energy scarcity and climate change. In addition, the number of environmental refugees created by rising sea levels and failure of the local ecosystems to meet basic needs could increase by many hundreds of millions.  These refugees will face a greater risk of attack and conflict if they must cross political or cultural borders and will face the same hardships in many countries as those who flee war zones. As climate change worsens the gap between those with resources and those without, social unrest may worsen and spread into previously stable areas. This is another example of a risk regulator. If left unchecked, environmental degradation and the challenges it creates can ultimately threaten the basis of society itself.

The risks to mental well-being in a future of energy scarcity and climate change are quite significant.
Examples include persons forced from their homes due to extreme weather events; the inability of the environment to provide sufficient food and water; individuals faced with job loss, separation from family and friends, and concern about the future; and persons coping with the various disruptions to life caused by an unstable climate. Such mental health outcomes as depression, anxiety, and post-traumatic stress disorder are expected to increase as a result.

The effects of climate change will create new demands on our health care system and for public health services. We must prepare for this reality, while also doing everything we can to reduce our contributions to global warming. All the health system adaptations we can envision and all the ways to enhance community resilience that we can call for—much less implement—will not be enough if the climate is not ultimately stabilized.

All forms of energy, other than passive warming from the sun, have an environmental and a societal cost. Therefore, using less energy or using it more efficiently should be a primary societal goal, regardless of where that energy comes from. To accomplish this goal, housing patterns, transportation options, food and water provisioning, and many other aspects of our lives will all have to be redesigned to require substantially less energy from any source. Energy scarcity will force these decisions upon us, but hasty decisions to replace petroleum with other liquid fuels, such as ethanol, biodiesel, or oil from oil sands, will only forestall the inevitable for a short time and will greatly aggravate other problems, such as climate change and food and water insecurity.

Some options, however, for addressing the dual challenges of climate change and energy scarcity could make our communities better places to live. A stronger sense of community, greater emphasis on family and friends, less time spent in cars and commuting, and localization of economic activity and food production will all benefit health and well-being.

Transforming our health care and public health systems will require significant policy changes. It’s essential that citizens educate their elected officials about the issues and demand prompt, well-informed, forward-looking solutions. This will not be easy, because the necessary changes will likely be seen as politically unpopular and volatile energy prices will encourage actions that do not necessarily serve society well in the long run. But if we make the right choices now, we can maximize the benefits and lessen the risks. The transition to the energy-scarce, climate-constrained future will create significant hardship if tough decisions about how to proceed are not made soon. However, the end result of a more self-sufficient, cohesive, resilient, and healthy society is worth the effort.

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