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Climate Change and Public Heath: The Truth and the Myth

In the APHA Seminar #4: “Climate Change in Public Health”, real solutions were proposed by a panel of five environmental change experts for the impact of the changing environment.  Jonathon Patz, director of the School of Public Health at University of Wisconsin-Madison, started the discussion, dictating the known issues of climate changes. His outline consisted of a logical flow of steps from increasing temperature, leading to a rise of sea level, and therefor resulting in hydrologic extremes, increase vector and pathogen levels (thereby leading to higher levels of disease), increased heat and storms, and finally a decrease in mental and psychological health. He closed his opening presentation with cryptic remarks on how these impacts could be offset by true changes to the healthcare system, and specifically how cofactor analysis of these figures could result in true change to the entire system. His brief overview set the stage for the rest of the presenters to speak of the various impacts prevalent to the climate change community today.

Dr. Alistair Woodward, from the Auckland School of Public Health in New Zealand, then expressed how immediate changes to the realm of Climate change will make direct, acute impacts to the changes in public health data. In this presentation, Woodward expressed how over 55,000 excess deaths in Russia, and how 40,000 excess deaths in the US occurred in 2011, and how with global warming, this will increase by a factor between 5-10 or greater. The reason for this factor uncertainty was directly linked to the changing of the weather; the behavior of weather is actively morphing to adapt to the global weather change.  This behavior deviation is fundamentally based on the changing of dry /wet season cycles. With increased excessive drought can change the natural fire season in to an extremely precarious hazard for agroscience, industry, and personal safety. In conjunction, disease mechanics are changing. Incubation time for a disease is up, greater crop failure, and increasing fuel cost (also causing increasing food cost). This being said, successful adaptations are possible. For instances, after a huge heat wave in France in 2003, the French government adapted in 2006 by installing preventative measures. This allowed for a mitigation of the 6,452 expected deaths to decrease to 2,065 actual deaths; proof of preventative public health measures adapted to climate change can and do exist.

Dr. Ann Lion and Dr. Patz followed this presentation with further explanation of how sustainable practice can result in mitigation of both death and increase of economic stability. In Dr. Campbell’s presentation (given by Dr. Patz), it was expressed how without a change to the system, twice as much water stress, half the food, and 10 times the natural disasters would occur by 2080. This being said, he offered an excellent triangular graph, showing how 3 areas (energy security, climate change resistance, and air pollution reduction) all when increased, show more benefits to the other categories, as opposed to when a singular change is made in one category. Therefore, the argument was made that sustainable practices should be the best measure for solving the issue of global warming.

The final presentation, explained by Andy Haines, showed how increased benefits from cofactors in the areas of Housing, Transport, Food Production, and electricity generation result from increased cost in global warming reduction. In India, replacement of stovetops and increasing bicycling, in a public health prevention method, resulted in reduction of 0.5-1 Billion Metric tons of carbon in 10 years, reduction of deaths by ~5400/year, 20-30 percent reductions in other forms of death (reductions in CV and heart disease, car crashes, diabetes and depression), as well as $15 Billion saved because of increases in active travel public health measures, in comparison to a $150 million premium. This ended with a defense of cofactor analysis as a radical success to the population changes seen.

I can say with complete certainty that sustainable practice needs to be incorporated in a greater fashion into the United States. This being said, I feel that more Americans need to be skeptical of the figures and reasons for incorporation. A reason for more practice (which seems logical and fundamentally  correct) would be the decrease of production cost for a company. From a microeconomic standpoint, if a person were to buy a water filtration device, the production of plastic waste mitigated would allow for a reduction in cost necessary for bottled water. In conjunction, this results in less production of plastic water bottles, sending a macroeconomic signal to bottled water companies of reduced production of water bottles, resulting in an aggregate mitigated production of Green House Gas (GHG) due to plastic processing. This is how the free market operates. Therefore, the benefit of a production of more sustainable practice, which mitigates waste production in the short term, also yields added benefits of substantially less GHG emission while still providing clean water.  In this analysis, the mitigation of disease are not taken in to account, and nor are the changes in life expectancy due to change from decreased potential BPA exposure from plastic water bottle usage, as these are nearly statistically insignificant rates. Therefore, my question is this: why are these taken in to account in climate change policy analysis? When Patz opened the presentation, he made an excellent point in stating that there is a direct reduction of heat resulting from reduction of emissions, and that this reduction of heat results in reduction of disease. This makes sense. Therefore, an excess death measurement here should assume that with x number increased cases, and since this disease has a y attack/death rate, these deaths should be avoided makes sense. In conjunction, excess dehydration/death rates of a population (generally neonatal and geriatric subpopulations) make sense as well, and should be included as well. This being said, I’m curious where the radical numbers of excess death come in to play in the United States. To ascertain these rates, would have to assume an entire population is either belong to the neonatal or oldest subpopulation, and then assume that these excess degrees warmer/colder result in the numbers presented. This “precautionary principle” certainly allows for good public health outcomes, as the worst-case-scenarios are always presented, but really, this increases hysteria around an inflated issue. Yes, these issues are real, but how real is the question? Climate change scientists would obviously search for the greatest possible estimate, as to ensure funding for further projects, yet many of these estimates are assuming the most susceptible areas and most susceptible populations are nearly universal. In the mid-June to mid-July heat wave of 2011, 24 deaths were recorded. 1 How, therefore, can we attribute 40,000 excess deaths to global warming? Dehydration may be a contributing factor to the cause of death in many populations, yet one cannot state that without Global warming, someone won’t die of pneumonia, simply because less pneumonia should be prevalent in a population.

In conjunction with excess death benefits, the problems of other correlations seem problematic. For instance, with the decrease of unsustainable stoves in India as well as an exercise program (biking), one cannot directly correlated either of these rates to the full reduction of disease. Yes, more sustainable food production as well as better green transportation mechanisms are both cobeneficial to the reduction of GHG, which could impact health greater when placed in conjunction. This being said, one cannot attribute all mitigations to have a similar impact. PAHs and other toxins from “dirty” coal used in India account for the major reduction of both GHG and health impact; this sort of coal is different in the United States as all coal is not created the same (different coals exist in different areas, based on different geological terrains). This being said, the same mitigation practices seen there in two different programs may not necessarily yield the same problems here. In DC, a public health biking program would probably not impact as many people, as many who live in the district already bike everywhere, or use the capital bikeshare system. In order to full assess the impact of climate change, one needs to not only look at the science and health impact, but also view the current sociological and behavioral trends of a culture. Cultural anthropologists would state that this relative nature of how people interact differently in different areas would lead to great reductions of problems based on what issues are occurring in different areas.

Therefore, my overarching theme is this: climate change needs to be placed relative to an area. A city with clean coal, relatively low smoking rates, and large biking areas will not be as proportionally protected, as a city with the opposite characteristics. Therefore, to assume a population undergoes equal rates of change per a public health impact for the most susceptible population makes no sense. These inflationary rates (in Presentation 4, it was suggested that more than 2 Billion people by 2080 would be impacted directly by Global Warming – where did this figure come from?)  need to be scaled in to modern day cost of implementation versus direct benefit of measure, compared to a figure of noncompliance. All cofactors should directly tie back in to the direct actions, and these figures should also be shown in yearly reduction rates.

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