Climate Change and Public Health 6/16/2010

Transcription

1 Climate change and health: examples from heat epidemiology Marie O Neill Assistant Professor, Epidemiology & Environmental Health Sciences School of Public Health University of Michigan June 16, 2010 Overview Climate change, heat and health Public health prevention strategies Health research examples Local action on heat and health Translating health research into decision tools Marie S. O'Neill, PhD 1

2 The motivation Human combustion of fossil fuels produces greenhouse gases Consequences: global warming Increased variability of temperature, more heatwaves, extreme weather events Mean annual temperature has risen by ~ 0.6 C (1.2 F) since 1880 Marie S. O'Neill, PhD 2

3 Climate change, heat and health Frequency, intensity, duration of heat waves/ hot weather projected to increase Mortality during hot weather is well-studied Vulnerabilities by age, health status, SES, race, housing, air conditioning access, community social characteristics Relatively little known about morbidity Exposure to heat in epidemiology i frequently assigned on the basis of airport temperature monitoring stations for a whole region Epidemiologic study approaches Characterize shape of dose-response Quantify temperature effect on health compare death or hospitalization rates on hot versus comfortable day time series/poisson regression hot slope of U- or J-shaped curve Evaluate effect modification (who is at risk) Case-crossover, case-control, control, case-only Marie S. O'Neill, PhD 3

4 Who is at risk? Conceptual framework vulnerability considered at multiple levels Environmental exposures are not just physical, meteorological phenomena Occur in a societal context Research should lead to or guide action Preventive interventions can occur at multiple levels Levels of vulnerability to temperature Biomedical underlying disease (cardiovascular, diabetes), co-exposures, genetics, nutrition, medication use Socioeconomic oeconomic position individual traits (including race/ethnicity), neighborhood features Geography Topography and settlement patterns, housing, air conditioning access, acclimatization to prevailing temperature conditions Marie S. O'Neill, PhD 4

5 Temperature epidemiology Common approach Estimate exposure using outdoor temperature monitors Evaluate associations with population vital statistics Emerging g areas Examine intra-urban variability in temperature exposure; evaluate community-level vulnerability; estimate personal exposure Preventive Strategies Heat Health Warning Systems (HHWS) Interventions triggered when forecast meteorological conditions are oppressively hot Reverse 911 calls, text messages to mobile phones Opening cooling centers to assist low- income and elderly population Increase the prevalence and use of air conditioning Alter the built environment Plant trees, increase albedo of manmade structures, improve building ventilation, Reduce emissions of greenhouse gases Marie S. O'Neill, PhD 5

6 Heat health research at Michigan Focus on disproportionate impacts Low income, elders, communities of color Aim to package research results for effective communication Developing tools of relevance for public health action Involve policymakers and local communities in problem identification, research design, needs assessment, translation of findings into action Heat and hospital admissions among the elderly: Community, socio-economic and medical determinants of vulnerability and economic impacts U. S.Environmental Protection Agency Science to Achieve Results (STAR) grant R (January 2006-December 2010) Better understand health consequences of climate change and variability by studying heat and daily hospital admissions among elderly people in U.S. cities ( ) Evaluate individual/community determinants of vulnerability Estimate economic impacts Disseminate results to local governments to foster and inform preventive action Investigators: Marie O Neill, Ana Diez-Roux, Dan Brown (U of Michigan); Missy Stults, Michael Hughes (ICLEI: Local Governments for Sustainability); Joel Schwartz and Antonella Zanobetti (Harvard) Marie S. O'Neill, PhD 6

7 Reducing social disparities of heat wave impacts in a changing climate U.S. Centers for Disease Control and Prevention Grant R18 EH (Sept August 2011) Better translate evidence-based interventions intended to reduce social disparities iti in the health impacts of heat waves (e.g. heat wave health warning systems, tree planting and modifications to the built environment) to other settings. Encourage widespread adoption of effective local programs to prevent illness and save lives during heat waves. Qualitative and quantitative approaches Case studies: Detroit, MI; Phoenix, AZ, New York, NY, Philadelphia, PA Investigators: Marie O Neill, Edith Parker, Richard Rood (U of Michigan);Sabrina McCormick (George Washington U.); Missy Stults, Michael Hughes (ICLEI: Local Governments for Sustainability); Joel Schwartz and Antonella Zanobetti (Harvard); Kristie Ebi (ESS/LLC) Climate change, heat waves and health: Local tools for sustainability, equity and protection Funded by: Graham Environmental Sustainability Institute, University of Michigan (June 2008 May 2011) Conduct an interview-based needs assessment (among residents and government officials of Detroit, Michigan) Develop a heat vulnerability mapping decision support tool and demographic vulnerability indicators temperature data; satellite images of land-cover relevant to heat exposure (green space, built environment characteristics); demographic vulnerability indicators derived from the U.S. Census (percent poverty, race/ethnic composition, elderly residents, and single-person households) Design a prototype simple, inexpensive HHWS that could be implemented in Detroit and validate the system using historical health outcome data UM Faculty Investigators: : Marie O Neill, Richard Rood, Daniel Brown, Edith Parker Marie S. O'Neill, PhD 7

8 Public Health PhD Student and Postdoctoral Researchers Carina Gronlund Jalonne White-Newsome Robert Kononowech Natalie Sampson Kathleen Bush Kathryn Conlon Postdoc: Dr. Kai Zhang Variability in heat exposure Marie S. O'Neill, PhD 8

9 But: the gradient is not just urban to rural! Within urban areas, there is strong gp patterning of both heat exposure and social vulnerability to heat* Vulnerability mapping has been proposed as a tool to help target Heat wave Health Warning System interventions, which are now triggered based on one temperature monitor for a large area * e.g., Harlan SL, Brazel AJ, Prashad L, Stefanov WL, Larsen L Neighborhood microclimates and vulnerability to heat stress. Social Science & Medicine 63(11): Marie S. O'Neill, PhD 9

10 Census tract level data from Detroit showing green space and population characteristics relevant to heat vulnerability White-Newsome, JL, O Neill MS, Gronlund, CJ, Sunbury, TM, Rood, RB, Parker, EA, Brown, DG, Brines, SJ, Rivera, Z. (2009) Climate change, heat waves and environmental justice: Advancing knowledge and action. Environmental Justice, Vol 2, Number 4, DOI: =env High resolution heat profile: London London slides used with permission of Glenn MacGregor Marie S. O'Neill, PhD 10

11 Spatial variation of heat sensitivity: London Index based on: Pop > 85 Long-term limiting illness Living in a flat Living in medical/care institutions Deprivation High heat sensitivity mapped over surface temperature Marie S. O'Neill, PhD 11

12 Convergence of surface temperature hotspots and areas of high sensitivity Is this pattern of joint occurrence a good predictor of the spatial variation of mortality? Are these maps a useful tool for action? Local action on heat and health Few U.S. cities currently have programs Bernard SM, McGeehin MA. Municipal heat wave response plans. American Journal of Public Health 2004;94(9): Balbus J, Ebi KL, Finzer L, Malina C, Chadwick A, McBride D, Chuk M, Maibach E. Are We Ready? Preparing for the public health challenges of climate change National Association of City and County Health Officials (NACCHO)/Environmental Defense O Neill MS, Jackman D, Wyman M, Manarolla X, Gronlund CJ, Brown D, et al U.S. local action on heat and health: are we prepared for climate change? International Journal of Public Health. DOI /s Marie S. O'Neill, PhD 12

13 Connecting to local governments ICLEI: Local governments for sustainability international membership association of local governments working on climate protection and sustainable development; >1200 members Climate Resilient Communities Program Preparing for Climate Change: A Guidebook for Local, Regional and State Governments with King County, WA ;Climate Impacts Group Five Milestone Process for Adaptation Advisory committee of local governments City preventive programs survey Administered by ICLEI under our EPA-funded study Survey Design Questions based in part on EPA Excessive Heat Events Guidebook Covered heat health warning systems, urban heat island mitigation (tree planting, reflective paving) Key results: Local leadership, resources and political support was most important in whether programs existed Local government staff most wanted to learn from case studies in other communities Marie S. O'Neill, PhD 13

14 Future heat-research plans Analyze heat; hospital admissions; & mortality Estimate t costs of heat-related t dh health lthi impacts Consider projections of future temperature range and variability, future demographic profiles, and potential preventive/mitigative programs to forecast range of impacts Incorporate results into decision tool, interactively with end users, and hold workshops with participation from researchers, local leaders and other stakeholders Marie S. O'Neill, PhD 14

15 Heat health decision tool (Robert Kononowech leading effort) Decision tool that will allow users to evaluate and compare the benefits of various green infrastructure improvement strategies aimed at mitigating local urban heat island effects and reducing carbon dioxide emissions Allow users to input various heat island mitigation strategies such as tree planting or increasing the reflectivity (albedo) of manmade structures Quantify the human health benefits gained from reducing temperature Similar to some pre-existing existing decision tools like BenMAP and CAPPA Heat health decision tool (2) Collaborating with ICLEI-Local Local Governments for Sustainability, EPA, researchers at Harvard Use mortality/morbidity effect estimates developed in our studies as analytical basis for decision tool Culminate in the creation of a free, easy- to-use web-based based decision tool intended for use by a wide variety of users: politicians, public health professionals, governmental agencies at the local, state or federal level, policy groups, non-profit organizations, community outreach groups, researchers and scientists, etc Marie S. O'Neill, PhD 15

16 Prototype Decision Tool Table O'Neill MS, Carter R, Kish JK, et al. Preventing heat related morbidity and mortality: new approaches in a changing climate. Maturitas 2009;64(2): Concluding remarks Regardless of the nature of future climate change, or our research results, mitigation and adaptation activities pursued by local governments are good ideas Energy efficiency measures save money Better stewards for future generations Climate sensitive health impacts are an environmental and social justice issue Affect poor, elderly, young, and communities of color disproportionately Marie S. O'Neill, PhD 16

17 Thank you! Marie S. O'Neill, PhD 17