Peter Orris, MD, MPH, FACP, FACOEM

Transcription

1 9th Annual Air Quality Governance Lekgotla UMhlanga, Kwazulu-Natal Province, South Africa October 8, 2014 Peter Orris, MD, MPH, FACP, FACOEM Professor and Chief Occupational and Environmental Medicine A WHO Collaborating Center

2 All opinions expressed in this presentation are my own And do not necessarily represent the University of Illinois or World Health Organization

3 NOAA, Todd Heitkamp Wikimedia Commons USEPA, Wikimedia Commons Jami Dwyer, Wikimedia Commons National Parks Service, Wikimedia Commons CLIMATE CHANGE IS THE BIGGEST GLOBAL HEALTH THREAT OF THE 21 ST CENTURY THE IMPACTS WILL BE FELT ALL AROUND THE WORLD AND NOT JUST IN SOME DISTANT FUTURE BUT IN OUR LIFETIMES AND THOSE OF OUR CHILDREN. THE LANCET USDA, Wikimedia Commons NOAA, Wikimedia Commons Suat Eman, freedigitalphotos.net

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8 BY THE 2080 S: THE GREATEST ABSOLUTE LOSSES OF POPULATION BASED LABOR WORK CAPACITY (IN THE RANGE 11% TO 27%) ARE SEEN UNDER THE A2 SCENARIO IN SOUTHEAST ASIA, ANDEAN & CENTRAL AMERICA, AND THE CARIBBEAN.

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10 Source: IPCC,

11 Livestock:9-18% anthropogenic emissions 80% agricultural emissions Contributors to climate change

12 GHG emissions accelerate despite reduction efforts. Most emission growth is CO 2 from fossil fuel combustion and industrial processes. Working Group III contribution to the IPCC Fifth Assessment Report

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16 Coal expansion plans New Power stations (2016~2021) New (MW) 동부그린 #1 ( 16. 6) 550 #2 ( 16.12) 550 영흥 #7 ( 18.12) 870 #8 ( 19. 6) 870 신서천 #1 ( 18.12) 500 #2 ( 19. 6) 500 NSP IPP #1 ( 18.10) 1000 #2 ( 19. 4) 1000 G 프로젝트 #1 ( 19. 4) 1000 #2 ( 19.10) 1000 동양파워 #1 ( 19.12) 1000 #2 ( 21. 7) 1000 동부하슬라 #1 ( 19.12) 1000 #2 ( 20. 6) ,840 (14 plants) Working Group III contribution to the IPCC Fifth Assessment Report

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18 COAL WORKERS PNEUMOCONIOSIS & SILICOSIS 18

19 19 Coal accounted for 25% of global energy consumption in 2005, but generated 41% of the CO2 emissions that year. (Epstein, P. Ann. N.Y. Acad. Sci (2011) 73 98

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25 COAL & ENERGY Independent of other factors, access to electricity has a positive effect on population health The Problem: 25% the world s electricity is generated from the combustion of Coal 1,200 new power plants are currently under consideration Wang, L POLICY RESEARCH WORKING PAP'ER 28 31, Health Outcomes in Poor Countries & Policy Options The World Bank, April 2002 Epstein, P et al Full cost accounting for the life cycle of coal Ann. N.Y. Acad. Sci (2011) New York Academy of Sciences.

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27 CHINA S HUAI RIVER POLICY WHICH PROVIDED FREE WINTER HEATING VIA THE PROVISION OF COAL FOR BOILERS IN CITIES NORTH OF THE HUAI RIVER BUT DENIED HEAT TO THE SOUTH. LIFE EXPECTANCIES ARE ABOUT 5.5 Y (95% CI: 0.8, 10.2) LOWER IN THE NORTH OWING TO AN INCREASED INCIDENCE OF CARDIORESPIRATORY MORTALITY. LONG-TERM EXPOSURE TO AN ADDITIONAL 100 ΜG/M3 OF TSPS IS ASSOCIATED WITH A REDUCTION IN LIFE EXPECTANCY AT BIRTH OF ABOUT 3.0 Y (95% CI: 0.4, 5.6).

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30 CHEMICAL FORMS OF MERCURY Elemental Liquid metal Inorganic salts Mercuric chloride Organic Methyl, ethyl, dimethyl Phenyl organic groups

31 EXPOSURE PATHWAYS

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33 Bio-magnification of Mercury Source: South Florida Restoration Science Forum

34 HEALTH EFFECTS OF METHYL MERCURY ON HUMANS Systemic Inhalation Oral Dermal Existing Studies (ATSDR 1998)

35 % Faroe Island Children with lowest scores at age 7 years Per cent of children with low test scores at age 7 years Mercury: Effects of Low Dose Prenatal Exposure Children with low prenatal mercury exposure 40 µg/l < < g/l g/l g/l > >50 g/l Children with high prenatal mercury exposure MOTOR ATTENTION VISUOSPATIAL LANGUAGE MEMORY Grandjean, et. al., Neurotoxicology & Teratology, 19:6, 1997

36 THE SIGNIFICANCE OF SMALL EFFECTS: EFFECTS OF A SMALL SHIFT IN IQ DISTRIBUTION IN A POPULATION OF 300 MILLION mean million "impaired" 7.0 million "gifted" I.Q

37 5 POINT DECREASE IN MEAN IQ Mean 95 57% INCREASE 11 million impaired" 4 million "gifted" I.Q

38 Public Health and Economic Consequences of Methyl Mercury Toxicity to the Developing Brain Leonardo Trasande, Philip J. Landrigan, and Clyde Schechter Mount Sinai School of Medicine, New York, New York, USA Environ Health Perspect 113: (2005). $1.3 billion each year is attributable to mercury emissions from U.S. power plants. Photo: Illinois State Geological Survey

39 Health Care Costs of Air Pollution WHO estimates 7 Million Deaths Linked to Air Pollution in 2012 Outdoor Air Pollution Causes of Death ischaemic heart disease stroke chronic obstructive pulmonary disease (COPD) lung cancer acute lower respiratory infections in children Excessive air pollution is often a byproduct of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to health-care cost savings as well as climate gains Dr Carlos Dora WHO Coordinator for Public Health, Environmental and Social Determinants of Health Source: World Health Organization (WHO) URL:

40 Health Care Costs of Air Pollution Air Pollution Health Care Costs by Country $69 billion USD ( 41 billion) in China in 2005 (1) $60.5 billion USD ( 36 billion) in United States over 30 years (9) $397 million USD ( 236 million) in Canada in 2008 (8) $335 million USD ( 199 million) in South Africa in 2002 (5,6) $191 million USD ( 113 million) in Mexico from 2010 to 2013 (2,3) $150 - $693 million ( million) in Costa Rica in (14) $12 million USD ( 7 million) in Denmark annually (7) Source: Multiple international sources See slide notes for specific references

41 Health Care Costs of Air Pollution Geography and trends in air pollutants The World Bank estimates outdoor air health costs are between 1% and 2.5% of GDP in 4 countries: China, India, Pakistan and Iran Health Cost Attributed to Outdoor Air Pollution Source: World Bank. India - Diagnostic assessment of select environmental challenges (Vol. 1 of 3) : An analysis of physical and monetary losses of environmental health and natural resources (English). Disaster Risk Mgmt & Clim Change (SASDC) /05;70004.

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43 Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

44 Climate Change Impacts in the United States Climate Change Projected to Worsen Asthma Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

45 Climate Change Impacts in the United States Ragweed Pollen Season Lengthens Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

46 Climate Change Impacts in the United States Projected Changes in Tick Habitat Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

47 Climate Change Impacts in the United States Projected Change in Heavy Precipitation Events Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

48 Climate Change Impacts in the United States Heavy Downpours are Increasing Exposure to Disease Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

49 Climate Change Impacts in the United States Harmful Bloom of Algae Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

50 Climate Change Impacts in the United States Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi: /j0z31wj2

51 ALTERNATIVE ENERGY GENERATION We estimate that 3,800,0005MW wind turbines, 49, MW concentrated solar plants, 40, MW solar PV power plants, 1.7 billion 3kW roof top PV systems, MW geothermal power plants, 270 new 300MW hydroelectric power plants, 720, MW wave devices 490,0001MW tidal Turbines Can power a 2030 world Barriers to the plan are primarily social and political, not technological or economic. Photos: HCWH, Practice Greenhealth The energy cost in a WWS world should be similar to that today.

52 Substantial reductions in emissions would require large changes in investment patterns. Working Group III contribution to the IPCC Fifth Assessment Report

53 Health Care Costs of Air Pollution Health Care cost savings opportunities Clean Air Act is estimated to save the United States $2 trillion ( 1.2 trillion) from 1990 to 2020 in health and welfare benefits. Instance Reductions Due to Clean Air Act (estimated for 2020) Mortality Non-fatal myocardial infarction Chronic bronchitis Acute bronchitis Hospital admissions Emergency room visits Respiratory symptoms Asthma exacerbations Source: United States Environmental Protection Agency (EPA). The Benefits and Costs of the Clean Air Act from 1990 to 2020; Final Report Rev. A. U S EPA Office of Air and Radiation 2011 Apr 2011.

54 Health Care Costs of Air Pollution Health Care cost savings opportunities If India s particulate matter pollution was reduced by 10% via taxes on coal and oil production, it would save $34 billion ( 20 billion) annually in health damages by If India s particulate matter pollution was reduced by 30% via taxes on coal and oil production, it would save $ billion ( billion) annually by (10,11) Source: World Bank See slide notes for specific references

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56 Global Climate Change and Human Health Resolutions 2001 Francesco Marino, freedigitalphotos.net The World Federation of Public Health Associations Realizing that subsequent health effects from such perturbations in the climate system would likely include an increase in: 1) heat-related mortality and morbidity;(8-10, 3) 2) vector-borne infectious diseases, because temperature strongly determines pathogen replication, as well as vector maturation, range, and infectivity period;(11-13; 4) 3) water-borne diseases due to increases in heavy precipitation (22; 4) 4) malnutrition from threatened agriculture, (14,15) especially in developing countries where up to an estimated 300 million additional people may be at risk from hunger due to climate change;(16,6) and 5) general public health infrastructure damage from weather disasters and sea-level rise, aggravated by subsequent climate-related human migration;(18-20) the public health community needs to act 56

57 The health sector must add its voice loud and clear we must fight to place health issues at the center of the climate agenda. We have compelling reasons for doing so. Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air, water. - Dr. Margaret Chan, Director General of the World Health Organization, December 2007 Freedigitalphotos.net, Danilo Rizzuti, Jscreationzs, Carlos Porto 57

58 Health Care Professionals are Influential Opinion Setters

59 Bending the Cost Curve U.S. Hospital Energy Savings Annual savings could exceed $5.4 billion ( 3 billion) over five years, and $15 billion ( 9 billion) over 10 years Annual Energy Savings: $2 billion ( 1 billion) by year 5 $6 billion ( 3.5 billion) by year 10 Source: The Commonwealth Fund Issue Brief, November 2012, Can Sustainable Hospitals Help Bend the Health Care Cost Curve? URL:

60 Kaiser Permanente Sustainability Cost Savings ( ) Source: Kaiser Permanente information not publically available/not for publication or public distribution US $ 63.1 MILLION SAVED ( 37.7 MILLION)

61 GLOBAL GREEN AND HEALTHY HOSPITALS 1. Cost Savings: Health Care Environmental Footprint Reduction 2. Health Care Costs of Air Pollution and Potential Savings

62 June 25, 2014

63 For more information about the Climate and Health Literacy Consortium and to access more resources please visit: climate/chlc/resources.php Photo credit: Francesco Marino, freedigitalphotos.net

64 Partnering Associations Heading February 11-15, 2015 Kolkata In Collaboration with

65 Slides Developed From ACKNOWLEGEMENT Materials of WHO, HCWH, UNEP, WHO, WWF Maine Department of Environmental Protection Colleagues at University of Illinois Postings on the Internet Thanks to all these colleagues for their slides and materials to be edited by me for presentation