Climate Change and Human Health

it’s a pleasure to welcome you this afternoon and for some I know you’ve been hard at work in an important workshop related to very significant initiatives that we are launching here at Washington University it’s our climate change initiative and this began actually earlier this year and we’re very fortunate to have dr Peter Raven as our leader dr. Raven is the George Engelmann professor of botany emeritus in Arts and Sciences here at the University and he is president emeritus of the Missouri Botanical Garden an institution revered around the world thanks to his long and distinguished tenure as its leader our university climate change initiative is aimed at expanding scientific research education and public understanding of global climate change this initiative is going to provide forums to engage renowned speakers develop new courses and foster new teams who will address the important challenges we face as the inaugural event of the Washington University climate change initiative the university has been hosting this workshop today on climate change and human health the workshop is co-sponsored by the Institute for Public Health that’s led by dr. William Powderly we capitalize on our institutional strengths in global health and international networks to provide a forum for our faculty invited guests and community to transition the dialogue into action that move out of the individual laboratories of our distinguished faculty beyond individual campuses and across the globe to address the critical critical challenges facing individuals societies and the global world community we’re very fortunate to have very significant philanthropic support here at Washington University and this special lecture today is the first Alfred P and Blanche wide Greenes Felder lecture it will be delivered by dr. Howard Frumkin he would introduce more formally by professor Hamad repro cracy in just a few minutes but I’d like to tell you a little bit about the origin of the Greens Felder lectureship it was in 2009 that Sonya glasburgh made a major financial commitment to Washington University that established an endowed professorship for the directorship of our international center for advanced renewable energy and sustainability and this professorship was established on behalf of the glasburgh family and the gift provided funding for this what will become an annual Alfred P and Blanche white greens felder lecture the glass Berg’s family relationship with Washington University spans more than a century beginning in 1901 that’s even before the World’s Fair when Byron glass Berg’s uncle Alfred P grin spelter earned a bachelor’s degree in civil engineering in 1909 Green’s Felder married Blanche Jonker who earned a master’s degree in English from the University in 1927 he died in 1955 and she died in 1956 both had been known throughout their lives for their generous support of various organizations as a crusader for regional parks and recreation areas Greene’s Felder was instrumental in setting aside several thousand acres as recreation conservation and Wildlife Research and refuge areas in his honor the st. Louis regional planning and construction foundation designed designated 1,700 acres adjacent to Rockwoods reservation as the Alfred P greens Felder Memorial Park this facility was opened to the public in 1967 two of the glass Birds children are alumni of the University Sally glasburgh sans earned a PhD and earned an undergraduate and two master’s degree Tom Albert grant spurt received a law degree in 1987 their grandchild Adam is the most recent member of the glasburgh family Alumni graduating just a few years ago in 2009 through the generations the glass Berg’s have received undergraduate and graduate degrees from Arts and Sciences the School of Engineering and Applied Science the George Warren brown School of Social Work the School of Law and the John M Olin School of Business they are intellectually diverse as a family I’m pleased to say that all of

these schools plus our other important academic units in medicine art architecture have all played an instrumental role in this workshop today on climate change and human health and individuals from their faculties are represented in this important initiative the important gift that provided funding for the endowed professorship is deeply appreciated and I’m very pleased that Professor Hamad rate per Crossy receives this professorship and has led the International Centre for advanced renewable energy sustainability since its founding a madre is the Myron and Sonia glasburgh Albert and Blanche greens Felder distinguished University professor and he will now introduce our speaker dr. Frumkin please welcome him on trip across Thank You Chancellor writin let me first again acknowledge the fact that the Washington University climate change initiative we are very fortunate to have Professor Peter Haven to lead it Peter is here in audience and so are four of our distinguished visitors including this afternoon speaker but let me first acknowledge the presence of our other three very distinguished speakers all four of them have come from from places that are far away so we are very grateful that they made the time to come here Helene Margolis came from University of California Davis she made a presentation last night at our workshop professor shoe tau came from Peking University just to be at this workshop and then dr. Peter berry from Canada’s climate change in Health Office and Ontario also came here and made a presentation earlier today I like the for the three of them to stand up and be recognized because they have been in two important contributions this afternoon’s presentation will be made by professor Howard Frumkin professor Franken is the Dean and professor of environmental and occupational health sciences at the University of Washington’s School of Public Health the other in Washington related University dr. Frumkin is an internist environmental and occupational medicine medicine specialist and epidemiologist and he has worked in academia and public service from 2005 to 20,000 and 10 he held the leadership roles at the US Centers for Disease Control and Prevention first as the director of the national center for environmental health and agency for toxic substances and disease registry and later a special assistant to the CDC director for climate change and health during his tenure at CDC he created programs in climate change and healthy community design expanded its bio monitoring and environmental Public Health tracking programs and launched its national conversation on public health and chemical exposures dr Frumkin currently serves in the boards of the US Green Building Council the children in nature Network as the chair the Washington Global Health Alliance and the Yale climate and energy Institute external advisory board on Procter & Gamble sustainability expert advisory panel and on the advisory board for the national sustainable communities coalition as a member of the EPA’s Children health protection advisory committee he chaired the Smart Growth and climate change workgroups I can go on but I will take up most of his time he’s the co-author or author of over 200 scientific journal articles and chapters and books dr. Frumkin I welcome you to make this special presentation dr. Frumkin stock is on climate change and human health Chancellor Righton professor Park Rossi professor Raven thank you very much for the warm introduction for the invitation to be here and Chancellor especially for putting that in st. Louis peace after the name of the university to prevent confusion among guys like me visiting from University of Washington much appreciated do we have any students in the audience

today a few I my friends it’s 4 o’clock on a Friday afternoon during spring break all over America right now students are rolling kegs of beer down sidewalks and ironing their togas and otherwise getting ready for the weekend and there are some students here who chose to come to a lecture on climate change instead you are serious people you are righteous people you will be the ones who will get us out of the problems that we’re here to discuss and I think I can speak for all of the old-timers in the room to say thank you very much we appreciate your being here we’ll what I’d like to do is three things first I’ll give you a quick review of all of climate science including earth science atmospheric science and a few other pieces that’ll take about five minutes and the main purpose is to get us all on the same page to set the stage for talking about health impacts and also to impress you with my courage if not recklessness to be a simple country doctor talking about earth science in the presence of real earth scientists then I’ll talk about the health impacts of climate change as the lancet one of the leading medical journals in the world said you can see the picture of the cover here climate change is the biggest global health threat of the 21st century if not the biggest it’s right up there and I want to tell you why then the third piece will be what we want to do about it how we address the problem of the hill threats that come along with I’m a change well in broad outline this is a picture of what’s been called the Anthropocene this is a period of rapid growth over the last century to two centuries in almost every parameter you can think of measuring human footprint on the globe are you hearing me okay is it let this one down okay thanks so what you see here is a picture of energy use of travel of McDonald’s stores you name it and everything has been moving up so we are becoming a far more metabolically active species on the planet than we ever were part of that what enables a lot of that is energy consumption and you can see that pictured here following the same trajectory and you can see when you look closely that a large part of that energy that we’ve utilized in the last couple of centuries has been from fossil fuels coal oil and others which when combusted release large amounts of energy so that’s been a bonanza but when you burn those fuels you create carbon dioxide one of a number of greenhouse gases this is a picture of carbon dioxide levels rising as measured at the Mauna Loa Observatory and you can see that there is a steady increase from pre-industrial levels up to levels now that are in the 400 parts per million range that in turn leads to a greenhouse gas effect this is the same phenomenon that you experience in your car and a hot day or in a greenhouse where incoming thermal energy that ordinarily would be reflected and dissipated is kept close at hand and warms the interior surface so this is happening on a global scale and that in turn leads to Earth’s system changes several of which are pictured here the upper panel shows you the global average temperature up by about a degree centigrade over the last century the middle panel shows rising sea levels because water expands as it gets warmer and the bottom panel shows snow cover in the northern hemisphere decreasing and actually it doesn’t go to the last few years when the decrease has been especially drastic in rapid let me mention to you five features of those earth system changes that will set the stage for us discussing the health impacts of all of it the first is that there is a wide variation in the impacts on earth phenomena some places have droughts some places get wetter storms may become more severe as there’s more energy in the atmosphere when forests try out wildfires become more common in those areas some a wide range of effects a wide range of perturbations so to speak in natural systems and although it’s a global phenomenon it plays out very much on a local scale and that means that many of our responses will have to be local in conception and execution second as mean temperature shifts and that’s what you see pictured here there is a relatively small change in temperature just the one degree that I mentioned on a global average basis so far but at the extreme down at the bottom right you’ll see that there is quite a major change how you see a substantial increase in the number of extreme hot days or by analogy with other extreme events so this establishes new normals here are a couple of headlines from last summer in in where I live the the People’s Republic of Cascadia where cool used to mean something other than our lifestyle it used to mean a reliable summer weather forecast but not anymore so we are seeing a new normal next point is the

possibility of tipping points the changes that are occurring don’t necessarily happen in a steady unbroken way there is some nonzero probability that extreme changes will happen relatively suddenly and those have been very nicely described by a professor lenten in a series of papers you can see them pictured here one example that’s familiar to most of us is the Greenland ice sheet which if it melts a little faster than it has been melting at some point of migu to the point where rapid melting ensues and that may be true for the thermohaline circulation in the North Atlantic and for a number of other phenomena so as we anticipate earth changes and as we take steps to address them we need to keep in mind that the changes there is a certain nonzero risk of drastic and rapid changes and that would need to figure into our responses and the last point I’ll make I’ll make by showing you this picture of global temperature once again the one that showed you just a minute ago this red line shows the slope of temperature change over the last 150 years the blue line shows the global temperature change slope over the last hundred years this shows you the slope over the last 50 years and here’s the slope over the last 25 years so this is an accelerating set of changes one more point the ethics of all of this I want to move from science to ethics the pictures you see here are called cartograms they’re not really maps they scale various regions of the world according to particular parameters the upper map shows you a picture of the world rendered in proportion to cumulative co2 emissions from 1950 to 2000 and you see a very big bloviate at North America a big bloviate at Europe and a quite small almost appendicular South America Africa and much of Asia the bottom panel shows you the same kind of image but this one is scaled to the distribution of climate sensitive health effects according to quantification by the World Health Organization in the year 2000 malaria malnutrition diarrhea and flood related deaths and you can see that the impacts fall very heavily and disproportionately on poor parts of the world so those of us who have enjoyed the benefits of burning fossil fuels and utilizing the energy are not the same ones who are at risk of the impacts of all of this and that introduces very profound ethical considerations so here is a set of earth changes that are widespread and varied that redefine normal that are subject to sudden changes that are rapidly accelerating and that are ethically troubling well there it is all of Earth’s science in five minutes what does this mean for health well this slide is an inventory of the health impacts of climate change some of these occur in relatively direct ways some of them through indirect pathways some of them have very good evidence basis to support our understanding some are more speculative at this point I don’t have time to give you a full picture of the evidence for each of these so I’m going to give you top as if you will little tidbits of evidence to show you the way we’re developing our understanding for each of these health impacts and then we’ll pull it all together so the first will be heat we know a lot about the health impacts of heat in fact this is arguably one of the best studied of the impacts of climate change there’s a biomedical cascade of heat responses and if you’ve run a marathon during the summer you may even have experienced one or two of these hopefully not heat stroke which is a complete arrangement of thermo regulation and can actually be fatal we also know a lot about the epidemiology of heat waves so when a city gets very hot several days of super normal temperatures we know what happens this is a picture of the Chicago heat wave from 95 the bars represent deaths and they followed by a couple of days the line which represents the temperature so there’s generally a two-day lag or so this was one of the headlines from the Chicago newspaper at the time pointing out that we’re not all equally susceptible and this is what the epidemiologic research has shown us in fact age is a risk factor so our underlying medical conditions income and poverty status and as you move down the list from individual factors to community scale factors we’ve quite well enumerated what the risk factors are for succumbing to a heat wave heat waves don’t happen in a vacuum the world is becoming a more and more urban place in fact just in the past decade we reached the 50% point so more than half of the global population lives in cities that’s relevant because cities are hot places cities become hotter than the surrounding countryside a phenomenon known as the urban heat island because of the loss of evapotranspiration when trees are taken down because of the hot surfaces that retain heat and reradiating the evening hours and because of the local concentrated generation of heat so here’s a collision course we have a world that’s becoming

more global and we have a world that’s becoming hotter where the hottest places are liable to be the cities and so this is an epidemiologic forecast in the making but it’s also the case that given our epidemiologic and biomedical insight we can plan ahead if we know where the hot parts of cities are and we know where the vulnerable individuals are in cities we can do heatwave preparedness planning we can set up refugee centers with air can we can set up buddy systems we can train health professionals to deal with hyperthermia so this is not only an example of a well understood problem but an example of a problem that we know enough to be able to address our biomechanical and epidemiologic understanding matters a lot we know that social circumstances matter a theme to which I’ll return again and again concurrent trends matters so we need to be systems thinkers location matters different parts of cities are hotter summer cooler and preparedness matters these will be recurring themes as we move through the health impacts of climate change severe weather events I mentioned before the increasing severity of storms there’s debate about whether storms are increasingly frequent the Intergovernmental Panel on Climate Change issued a comprehensive report on severe weather events just last year and you can see them listed here along with what was felt at the time to be a level of certainty about the increase in risk of each of these events and you can see that there’s a broad range of severe weather events that are liable to happen as climate change advances cyclone frequency cyclone is the generic term for tornadoes hurricanes the storms what they’re called varies according to region of the world but cyclone is the generic term shown here and this emphasizes that there are many parts of the world where cyclone risk is high and is likely to get higher sea level rise is also occurring and the combination of higher sea levels and severe storm activity over oceans means heavy wave activity in coastal cities very large numbers of the world’s people live in coastal areas you can see that depicted on this map which means that there are large and growing at-risk populations as these trends move ahead as sea levels continue to rise land will be inundated this is a picture of the river delta region of Bangladesh where millions of people live and will be displaced at some point before too long but that’s not just a faraway problem this is a picture of Manhattan modeled to show a 3.5 meter sea-level rise this is on the high end of the range that is forecast but it’s in the plausible range and you can see that large parts of Manhattan may go away this is also true of Seattle large parts of my city that will be inundated in as well on the other hand drought is a common problem it’s plagued Australia for some years now and drought has a series of health impacts as well malnutrition when local food production fails compromised sanitation the generation of dust causing respiratory toxicity for the people who breathe it in mental health impacts interesting data showing rising suicide rates in Australia tracking right along with the droughts in rural areas these are very very destabilizing events and it’s important to note that when these severe weather events happen they don’t affect everybody equally these are images that you may remember from Katrina just eight years ago now when it was a national shame but an unavoidable reality that the poor people and people of color in New Orleans were far less able to escape and reform more likely to suffer losses both in safety and health and in property than those who had more resources so the lessons we learned from the severe weather events story location matter is once again these are problems that unfold differentially in different places social circumstances matter we need to do vulnerability assessment in advance so that we can plan to protect people and after disasters happen resources for resiliency and recovery matter greatly we have been better at dealing with the adrenaline charged acute phase of disasters than we have been at dealing with the long term recovery and that’s a lesson that we’re learning from these disasters air quality a few points on air quality this operates in interesting and diverse ways first ozone formation ozone is one of the key air pollutants in many parts of the country in the world ozone formation is driven by heat ozone is the so called secondary pollutant that isn’t emitted directly from tailpipes and smokestacks but forms in the air from precursors and that reaction is driven by heat so here you see data from New York and from Atlanta illustrating that as temperatures get higher ozone levels rise all things being equal a second air quality issue has to do with forest fires the combination of bark beetles and other dangerous to forests drying out forests in creating a lot of tinder droughts and warming lead to an increased risk of wildfires we’ve seen many of these in my

corner of the country and the smoke that’s generated can be quite intense relatively short-lived we’re talking about generally weeks of exposure not years of exposure but high enough that mortality from cardiovascular and respiratory disease increases measurably in affected populations third allergies it would be great if God had ordained that climate change is going to be good for crop plants and bad for weeds that would be really nice but it doesn’t work out that way in fact two of the plants that are climate change winners are ragweed and poison ivy which all photosynthesize more efficiently grow more exuberantly and faster and in the case of poison ivy the Urushi all which is the allergenic toxin actually becomes more allergenic so here’s another way in which air quality writ large may affect us through climate change lessons well we know a lot about air quality already we’ve done a lot of air pollution research over recent decades this is not a new problem this is an aggravation of an existing problem so it’s a nice example of the fact that our existing tools in this case models mathematical models that help us understand air pollution are very applicable to tackling the climate change problem medical vulnerability matters a lot so people with asthma people with underlying chronic lung disease are of special concern in anticipating and dealing with these problems in excess to healthcare matters so actually the Affordable Care Act may turn out to be one of the important climate adaptation strategies we adopt or moving to Canada would work well too next topic infectious diseases this is a table that shows a range of infectious diseases around the world with kind of simple icons in the right-hand column as to how likely an expansion of range and an increase in risk is with each disease the take-home message here is inherent in the term tropical diseases you’ve all heard this term and that name connotes the fact that many diseases exist within particular ecological niches and as those ecological niches expand so made the range of those diseases the vector borne diseases ones that are transmitted by mosquitoes or ticks or other vectors is one category of infectious diseases but another category that I’ll mention in passing is the waterborne diseases such as cholera so what do we know about all of these dengue fever is one example the mosquitoes that carry dengue become more metabolically active reproduce faster and feed more frequently feeding as the means of transmitting the disease with warmer temperatures and we have actually seen an increase in dengue fever activity in this country over recent years as predicted by papers in the early climate literature of 15-20 years ago it’s expected that at current rates of change in climate we will see substantial increases in the global population at risk of dengue now one needs to be careful not to be too simplistic about this there are many factors that impact infectious disease risk in fact studies of twin cities on the us-mexico border where the ecosystem is relatively constant across the border so far higher rates of infection on the Mexican side than on the US side reminding us that interventions like screens on windows and air conditioning help a lot so there will be many strategies available to reduce baseline risk of infectious diseases as the probability of disease transmission increases in certain regions there’s been a lot of scholarship on malaria and the results in Africa where malaria is most troublesome are interesting and mixed areas in Africa that will become drier should see a decrease in malaria activity areas that will become wetter should see an increase malaria has been documented to be rising and altitude so mountainous zones where malaria stopped above a certain altitude are now seeing the disease at above that altitude as the warmer weather climbs up the mountain sides and there is a very extensive activity in malaria modeling now one of the better understood infectious diseases in the climate world West Nile virus not something we ever thought of as a climate related disease but it turns out that studies of the dynamics of West Nile in this country show correlations both with temperature and with rainfall such that we expect that as those factors change over time West Nile dynamics will be affected and likely the probability of spread will increase what are born diseases are interesting this was a kind of a it’s a classic paper now showing the association between extreme precipitation and waterborne disease outbreaks we don’t have the best surveillance data on diarrheal disease outbreaks but we have fairly good data we probably under count drastically but the pattern of those disease outbreaks is fairly well characterized and it turns out that if you tabulate all of the diarrheal disease outbreaks in this country over a 50-year period or so and if you look at the association with

antecedent severe rainfall events there’s quite a strong association something about heavy rain predisposes populations to diarrheal disease outbreaks it may be that contaminants are washed into wells it may be that water treatment systems are overwhelmed by the heavy flow of water probably a range of factors that does this but as severe storms and precipitation events become more frequent we can expect that the risk of this kind of phenomenon will rise as well in fact we now have a fairly good data this comes from Canada showing that a number of the waterborne diseases shown here salmonella Campylobacter in e.coli our temperature related so as temperature rises we expect increasing trouble with these conditions as well and while much of what I just said is predictable was predicted before we began to see the trends sometimes surprises happen Cryptococcus kdi is an organism that has been well known in tropical areas for some time but it showed up on Vancouver Island British Columbia about a decade ago everybody’s surprised it exists in marine mammals that exists in bark of trees and in soil and it jumps and it affects people it turns out that this was probably due to the transportation of the organism from tropical areas up to BC but also to the fact that there were micro climates on the shores of Vancouver Island that are temperate rainforests that incrementally changed enough to become hospitable habitats for this organism and so the organism took hold it’s now come down to Washington and Oregon we need a good public health surveillance to be able to pick it up when it happened and then we need to be able to treat it so surprises do happen we need good ecosystem research to be linked with health research and that’s why multidisciplinary efforts exemplified by this forum are so important a climate is only one of many important determinants of infectious disease so we need systems thinking in reducing the risk of infectious disease we need good Public Health surveillance again we need modeling and we need to be alert for surprises coming down the homestretch of health impacts now I want to turn to the topic of food this one interestingly may be one of the biggest impacts globally but it’s not nearly as well studied in the climate and health literature as some of the others like heat but here you can see some examples of papers that have been published in the last few years crop production is affected by climate change now carbon dioxide is an input to photosynthesizing plants and so you might think that more co2 would be a good thing and for some plants at least in theory it is especially the c3 crops rice wheat and soy the c4 crop seemed to benefit less from carbon dioxide fertilization but carbon dioxide fertilization doesn’t occur in a vacuum it occurs in the context of climate change so other things are happening simultaneously such as more severe weather events such as more heat waves more storms and those things have to be figured into predictions about the impacts on agriculture of climate change well it turns out that empirical data are anything but reassuring here you see data for four crops maize wheat rice and soy and in every case that 10 the trend is toward decreased productivity of those crops over recent years with higher co2 levels crop yields are projected globally to decrease and to decrease most strikingly in areas that are already food insecure you can see South Asia North Africa parts of Latin America there there will be increases in some places across Canada Siberia and so we may see shifts of agricultural production to those places but the adjustment may well be very difficult to do it’s not only a crop output that is threatened but some very interesting wrinkles that you might not anticipate one wrinkle is that with co2 fertilization nitrogen incorporation by some plants is diminished and so you see decreased protein content of a number of plants that are now protein bearing plant foods for populations that depend on these sources of protein that can be a serious dietary threat pathogens also are affected by climate change and many plant pests and pathogens are moving poleward that is away from the equator farther north and so that creates challenges in maintaining crop productivity as well many weeds actually thrive better under conditions of climate change with higher co2 then do the crop plants that we’re trying to grow so the competition between weeds and crops becomes more vicious than ever and many weeds become more resistant to herbicides under conditions of co2 fertilization so this may mean among other things decreased crop outputs thanks to weeds and increasing herbicide contents and some of our foods well all of that will conspire as you know to

raise food prices and interesting modelling work has been done in the agricultural world on what will happen to food prices under conditions of climate change and here you see some predictive projections you can see that most of the major food crops are expected to become more expensive over time now the agricultural research generally stops at this point but we can ask the question what will that do to human health and well-being well we have food insecurity not only in other parts of the world but right in this country here’s a graph showing the trends in food insecurity in this country over the last few years and with rising income inequality actually a higher proportion of our population up to about 14 percent now is food insecure but using the Department of Agriculture definition I pulled a very interesting book called the Missouri hunger atlas for 2013 it turns out we have data for this state and Missouri is a little ahead of the nation in its food insecurity there are up to about I guess 1516 percent of the state’s population that is food insecure well what do people do when they’re low on cash and they need to eat they tend to buy the most energy dense low cost food and those are the foods that are on the left side of this graph and the upper part of the graph so you can see lard is up there and lobster is at the other end people move toward the more obesogenic foods and it may be that this is the pathway by which climate change will aggravate one of our most vexing problems now and that is the problem of obesity and overweight and the diseases that flow from that so this is a complex systems problem ranging from agriculture to dietary behavior to plant physiology climate change aggravates existing problems a recurring theme very large potential impacts globally but we have this problem domestically as well mental health how might climate change threaten mental health well we’re beginning only now to see some literature on this topic and it’s actually as much speculation as it is data so far one piece that we understand very well is that after disasters mental health is enormous Lee affected in the post Katrina diaspora even with the deaths that occurred acutely probably the biggest collective burden was on mental health of the people whose lives were upended and who had to move there’s another pathway for mental health impact and I’m going to introduce it by showing this surprising picture this is the atom bomb going off in Hiroshima in 1945 I grew up in the aftermath of that event how many of you remember this drill confessing our age now this was an air raid drill this is where we had to prepare for the possibility that the Russians were about to drop an atom bomb so we were told to Duck and Cover drop under our desk hug our knees look at a part of our Anatomy that you ordinarily weren’t supposed to look at or talk about during school hours and that would protect you from the atom bomb this little girl is disobeying instructions and looking up so she will not be protected and these children did not fully get under their desks and so they’ll be protected only from the waist up and their bottom ends will not be protected well I’m making light of this but it was not a cheerful vision under which to grow up it raises the question is the kind of narrative that I’ve just been inflicting on you likely to cause in children or in adults or in all of us some of the same kinds of anxieties that arose under the Cold War threats of nuclear war as suggested by this New Yorker cartoon we actually have very interesting journalistic accounts now journalists have gone into classrooms and elementary schools ask children to draw pictures of climate change and they get pictures of the earth melting down so there may well be a reservoir of anxiety or depression out there in anticipation of climate change a different pathway related to that is a concept that’s been dubbed solastalgia by Australian philosopher Glenn Albrecht this is the nostalgia the sadness the grief that stemmed from the loss of familiar and beloved places especially familiar in beloved ecosystems so if you see the forests around you the boreal forests of Canada that you’ve grown up with and that your parents and grandparents knew suddenly dying off due to beetle infestations there is a mental health impact to that phenomenon and finally a mental health impact in regard to people with severe mental illness many of these individuals have impaired thermoregulation as a part of the mental illness sometimes the medications that are used to treat them aggravate that problem and people who are psychotic may not even recognize that the temperature is very high in that they need to take steps to protect themselves so this is an at-risk population during heat waves we also have data showing that violence rises when temperature rises so probably a number of paths ways by which mental illness can be aggravated by climate change we have a

large existing baseline of mental illness so again an existing problem that is aggravated or amplified in a number of ways and the last phenomena I’ll talk about is the large civil disruption the possibility of environmental refugees as areas become uninhabitable due either to the loss of crops and or to Saline infiltration of fresh water tables in coastal areas and/or to scarcity of other resources so that the term climate refugee has come to characterize this possibility and climate warfare is held to be a possibility as well there’s some very interesting Defense Department analyses projecting where trouble spots in the world may occur and many of these have been identified as being potentially climate related in fact there’s a coherent argument that the Darfur crisis was the first climate war when the pastoral and the migratory populations that have been able to coexist there for many generations no longer could because of the drying of the area war is very bad for public health and we now have some quantitative modeling looking at just what the relationship may be with climate change you can see here I don’t even really know whether to show you this with a straight face but somebody actually has calculated a regression coefficient linking warming temperatures worldwide with increasing probabilities of conflict so this is a large under-recognized potential for suffering and we need preparedness and service delivery for displaced populations in prevention for armed conflict so there is the inventory that I wanted to take you through this is kind of like the horsemen of the apocalypse and I bet I know how you feel right now probably about like this it’s a gloomy story but I’m not going to leave you feeling gloomy because there is a lot of good news ironically and surprisingly behind all of this I’m not going to summarize all the lessons that we learned go directly I’m going to touch on the health sector the health sector has been dealing with this for the last 10 or 20 years we have a literature arising in health world those of you who are in medicine or nursing or public health may be familiar with this and we are developing strategies for anticipating and preparing for climate change when we frame this in health terms we borrow existing line language and adjust it to the health world so you’ve heard the terms mitigation and adaptation mitigation being the steps that we take primarily to reduce greenhouse gas emissions and to reduce or control climate change that’s called prevention that’s actually a much better word isn’t it adaptation are the steps that we take to protect people from the effects of climate change that are already inevitable and already occurring that’s oops that’s called preparedness Public Health preparedness so this is very much in the tradition of public health we have a range of actions that are this is the Bible for any Public Health Department in the country these are called the ten essential functions of public health and it turns out that they map very nicely to the steps we have to take to address climate change so I don’t want to take time to go through this now but I want to leave you with the message that the public health toolbox is actually in pretty good shape to address the impacts of climate change but we can’t stop there any more than public health Crusader is a century and a half ago could stop at treating infectious diseases and not go on to advocate water treatment systems in cities we need to go upstream and think about how health improvements can be assured by upstream actions so I’m going to talk about four strategies and that’ll close out this talk and then we’ll open for discussion and I’m going to do this in a very optimistic frame because I think I feel quite optimistic about this and I hope that you will too innovation we are seeing a fair amount of innovation we’re seeing transportation innovations that are reducing the carbon footprint of travel both more fuel-efficient cars as you see here and back to the future actually taking mass transit walking that picture on the right is a mother walking her children to school the year is 1957 the last known time this happened in the United but it’s coming back and that’s a 1963 picture of a little boy riding his bike to school that was me that was my bike my first bike so um these things are becoming more popular innovation and energy where we are harnessing photosynthesis we are harnessing solar energy we are figuring out better and better ways to get the energy that we need to live well but to do that in ways that don’t aggravate climate change innovations and buildings are fantastic this I’m proud of this building this is the Bullitt center which is the headquarters of the Bullitt foundation in Seattle this is the greenest

commercial building in the world it’s a living building all of its water is the water that it captures on-site no waste goes out of the building it generates all of its electricity with that solar panel up on the roof all of the materials that went into the building were sourced from within a couple of hundred miles 300 toxins were excluded from the building when it was built so on the first day that it opened which was just this past spring and you walked into it there was no new building smell there were no dangerous organic chemical exposures in the building so this combination of energy efficiency and healthy joyous feeling buildings is a set of innovations that’s very encouraging the return of walkable neighborhoods young people more and more are moving into cities now they are passing up the the impulse for a driver’s license they don’t drive they walk they like the vibrant mixed-use urban fabric and that is itself one of the strategies for reducing travel demand and reducing per capita carbon footprint and it’s happening food we are exploring alternative food production systems will probably never supply the food that the world needs or even that our country needs through small-scale local agriculture but we’re certainly seeing a lot more of it and that’s an encouraging strategy as well in finally communication we now have the capacity for a guy like me when I’m invited to speak to a crowd like you to do it by Skype and that would obviate the need for the carbon footprint of a jet plane so more and more meetings are happening that way more and more communications are happening that way obviating the need for some travel so across the spectrum of the ways in which we use energy and the ways in which we contribute to climate change we’re seeing a lot of progress in each of these I would argue is a public health strategy now we want to linger on communication for just a minute very important because the public has to go for this if we are to achieve these interventions and I’m gonna claim that I know a little something about communication because I come from the healthcare world and we do a lot of health communication we are the ones routinely who tell you to have your colonoscopy to eat smaller portions to quit smoking to wear a condom sometimes all at the same time and that’s not easy news to deliver but we’re pretty good at delivering tough news so what have we learned that would help us become good communicators about climate change not only health professionals but all of us how should we deal with this communication well one thing we’ve learned is know your audience when you try to communicate so where does the American public stand now on the question of climate change well we’ve got a challenge this is a Pew Research Center data what is the top priority for the president in the Congress this year and you can see across three years twenty two thousand nine twelve and thirteen down there at the very bottom is dealing with global warming people care much more about employment the economy immigration you name it it’s not a high priority issue when people are asked about what environmental problems they think are most important contamination of soil and water by toxic waste is at the top and way down there at the bottom is global warming this is completely out of sync with what most health professionals would think are threats to public health but there it is that’s the state of public opinion now the majority of Americans believe that global warming is happening but it’s not a robust majority you can see there that it has wavered over time in the 50 to 60 percent range many fewer believed that it’s caused by humans we’re now at about 40 percent who thinks that it’s human cause and we know that not everybody belongs to the same belief group we in fact can be subdivided the climate communications group at George Mason and Yale universities have identified what they call the six Americas ranging from the alarmed all the way to the dismissive and the messaging to each of those subpopulations needs to be different exactly as it needs to be different for selling cars or anything else so social marketing is a very important part of the task ahead of us it’s difficult to get people to believe in climate change because of a number of identifiable barriers to addressing and engaging the issue one is that it’s unprecedented it’s complicated people discount risks people aren’t good at thinking probabilistically your daily experience doesn’t confirm climate change although recently that’s changed a little bit and probably that’s had an impact on the public’s belief in climate change climate change is frightening and people want to turn off something that’s frightening people mistrust information sources and authorities people don’t like needed behavioral changes that are implied if you take on the climate change problem and climate change has been hitched or derailed I might say by ideology there’s been a concerted effort to obfuscate the facts about climate

change in recent years and this has been a very concentrated effort in this country but not only in this country and a very very troublesome challenge the climate denial universe well polling data showed that one of the most trusted sources of information is scientists climate scientists are at the top their television weather reporters are actually quite well trusted the mainstream news media below that I’m not showing you the rest of the diagrams that came with this data display but as you move down the list you get to use car salesmen and members of Congress and sexual offenders so way at the top is climate scientists this is advantageous but what’s interesting is this four and ten Americans believe that most scientists think global climate change is real six and ten Americans think there is a lot of disagreement about this and don’t believe there’s scientific consensus so Americans trust scientists but they’ve been given the impression that scientists are at odds about this subject here this is in graphic form the pink bars show you the public perception of scientific consensus and it’s all over the map the Green Line shows you the reality that something like 97 98 percent of climate scientists have achieved a consensus about the basics of climate change and this is a very interesting encounter intuitive observation but we have pretty good data now if people believe that there is scientific consensus about something then their beliefs move toward that something so the climate denial strategy of implying that there’s a lot of doubt has been quite effective many Americans have a lot of doubt about the existence of scientific consensus and that is leading to efforts now to broadcast much more compellingly the fact that there is great scientific consensus about this issue a second whole approach is to frame climate change in various different ways three possible frames would be national security we need to attack climate change and become energy independent and reduce the risk of conflict health what I’ve been talking with you about now and we need to protect and steward the environment these are various frames that could be used in communicating about climate change the health frame in a series of comparative studies elicited more hope and less anger than the others in the most skeptical respondents so another tip here we may want to use this health communication frame a lot what should we not do we should probably not be apocalyptic as the people here are we should probably not exaggerate as my favorite scientific journal did in the pictures shown here here’s an example of climate communication this was an article in a scientific journal population adiposity that’s fatness and climate change you can like the article are not like at what they said was that as people get heavier and heavier number one they use more fuel to transport themselves around and number two they have a big carbon footprint to make all the food that they eat and I was a little gimmicky but the reason I show it to you is I want to show you how the intrepid British press covered this story the day that it was released probably not a very effective way to communicate climate science disproportionate messaging is not a good idea can you all read the bottom line there and gloomy messaging is probably not a good idea but gloom is liable to result if we get it wrong so this was Edouard monks famous painting the scream you may not know that this was part of a series of paintings that he did and interestingly anybody know what triggered these paintings these were done in the year after Krakatoa erupted and the world was a darker cooler place for a couple of years and apparently it’d be the Scandinavians who ordinarily are very resilient to dark depressing days got more depressed and that Bart did the series of paintings it’s actually his paintings on thinking about climate well the theme that I’ll commend to our attention comes out of this interesting book breakthrough this was an analysis a self-criticism of the environmental movement the author’s pointed out that many of the verbs associated with environmentalism are negatives stop restrict reverse prevent they pointed out that this is not very sticky with the public they called for positive aspirational messages and the example they used was the de famous classic American speech which did not go this way went that way positive aspirational messages stick secondly these authors pointed out that climate change is extremely complex and if it is seen as

yet one more niche interest one more vested interest if climate change advocates are competing in the marketplace of idea that the cacophony of ideas with educational reform and immigration reform and everything else will never win but if we create bold cross-cutting messages green prosperous thriving communities resilient communities bringing in many of the features that include climate adaptation and mitigation we may win and the last my favorite piece of communication strategy from Republican strategist Frank Luntz who who is extremely skilled at what he does I won’t read this to you you can read it yourself but whatever the correct message is turned out to be and they will vary from audience to audience they need to be repeated so those of us who care about bringing the public along in its understanding of climate change and in crafting good policy need to be need to stick with it well I’m gonna close by talking about co-benefits co-benefits are the really good news story at the heart of dealing with climate change my symbol for co-benefits is this label of menorahs electromagnetic bathing fluid this was a medication that my mother raised me on in the years after the Civil War and as you can see it cured neuralgia cholera rheumatism paralysis hip disease measles female complaints and other things and it worked beautifully I never had any of those problems I had female complaints to junior high school but you know we all did well we actually don’t have a medication that does all that but we do have strategies that offer such a wide range of benefits both in health and in other sectors that we should recognize them celebrate them and implement them give you one example cycling there’s been a quantitative analysis of this particular source of co-benefits so I want to mention it if more people get on bicycles that means they’re out of cars we’re burning less petroleum putting less carbon into the air and what’s the major cause of death and young people in this country car crashes epidemiology one on one says take people out of a dangerous micro environment and you reduce the risk of bad things happening now we probably take on some risk of bicycle accidents and that needs to be figured in but there’s also the issue of air pollution air quality gets better as people get out of their cars so investigators at university of wisconsin calculated the economic and health benefits of theoretical shifts from cars to bicycles and found that it was enormous ly beneficial across those range climate change mitigation air pollution improvement and reduction of traffic accidents food offers a CO benefit creating meat is extremely carbon intensive because cropland has to be devoted to growing the grain that are fed to the cattle and then as some of you are Midwesterners and you know more about cattle than I do but you do know that if you stand at the southern end of the cow or the northern end of the county knows out both ends that’s what ruminants do and methane is at weight a very effective greenhouse gas as well the carbon footprint for a portion of beef a six ounce portion of beef is almost 10 pounds and an energy equivalent amount of vegetables is 0.4 pounds so a climate mitigation strategy is eat lower on the food chain shift not not go all the way if you don’t want to but shift from meat to vegetables well turns out there’s a co benefit there very strong evidence showing that higher meat consumption is a strong predictor of higher mortality in fact as the editorial that accompany this particular epidemiologic article said reducing meat consumption as multiple benefits what we would call Co benefits climate and cardiovascular health in the last example of co-benefits is street trees planting lots of trees in cities has a number of benefits it mitigates urban heat island effect cools the cities down it offers stormwater management it promotes physical activity because a strong predictor of people getting out and walking and running is greenery on the street it cleans air it offers beauty and inspiration it improves mental health nature contact turns out to be good for mental health so again here’s a simple climate intervention in cities that offers a range of co benefits so these are sweet spots these are steps that we can and need to take to address climate change that offer a wide range of benefits and that’s a good news story but a close with five reasons for hope that were posted by a climate blogger just a few months ago climate impacts are changing public perception one would hope that as these earth system changes progress people will wake up to what’s happening and that indeed seems to be exactly what’s occurring a public opinion is shifting along with these severe weather events climate change is

no longer just an environmental problem it has been adopted by those who advocate energy security by those who advocate Green Prosperity and so on so it’s taking on broad frames that make it more appealing to the public we are seeing an efficient and effective low carbon society emerging in China where there’s global leadership and that has been a growing source of carbon emissions but we’re seeing real progress there renewable energy is growing exponentially it’s the fastest growing sector of the energy economy and finally carbon pricing is here it’s not everywhere but we’re seeing at many parts of the world now in in parts of this country and that is the policy intervention that we need ultimately to drive down the use of carbon so there is a lot of reason for hope and there are some good news stories and even if most of what I said was wrong we won’t be sorry we won’t be sorry if we do these things what if it’s all a hoax we create a better world for nothing that may be the direction in which we aim and that’s a good frame to think about our climate change work so climate change is a public health priority climate mitigation and adaptation are public health strategies because of all the things that climate change uncontrolled will do to health and well-being there is a lot we can do and as we do those things we need to be innovative and we’re seeing that emerge we need to communicate effectively we need to celebrate co-benefits and we need to encourage hope thank you very much for your attention and thank you for Chancellor excellent presentation when the best I’ve ever seen on climate change and I’ve been communicating about myself for several years right now though I have to kind of address the elephant in the room because colleges and universities are doing an outstanding job of educating the public for this but unfortunately so much funding for universities also comes from the fossil fuel industry and so right now there’s a movement nationwide for colleges and universities that divest from fossil fuels and then oh it’s a very uncomfortable subject but I was wondering we could still address divestment from colleges and universities from fossil fuels yeah I’m aware of the movement we have students that you dub like I say everybody know what you dub means that’s University of Washington you dub and we have some students at U dub who were pushing for divestment I don’t understand it well enough to have an opinion I the the reasons to advocate divestment are very clear and the model of apartheid in South Africa is a very compelling model most investment counselors apparently say it’s probably not enough to make a difference and you’ll have a bigger impact empirically if you don’t divest and use the greater returns to do things that directly help fight climate change so I you know I’m aware of two sides to the argument I think it’s an empirical question everything we do we should hold our feet to the fire and say is it having the maximum impact and so I think I would address it that way and I don’t know what the answer is so that there can be very rapid and large-scale changes I mean rapid on the timescale of tens of years would you comment on your views regarding probability and especially related to human health I don’t know how to think about those probabilities I would almost I would defer to an earth scientist on that the my reading of the literature tells me that these are nonzero probabilities but I think there are wide confidence intervals about how likely each of those tipping point events is and and how soon it might happen so it’s really almost a mental exercise it’s it’s akin to the question of do you buy fire insurance for your house you know most of us do most of us understand that a fire in the house is a low probability high consequence event and we act accordingly so I for me in in the most general sense I think that since there are low probability high consequence events that are possible that probably ought to inform our thinking as a society about responding but I can’t come and I just don’t know enough to comment on the specific probabilities or

Consequences of any of those actions I guess I think there’s some examples and I’m wondering if any of them are being modeled at the moment for instance the entire Arctic region including Alaska and Barrow Alaska North Slope as well as all the Canadian provinces up at the Arctic Circle are experiencing extreme changes in their social composition their livelihoods from global changing and the recession of the sea ice and can examples like that be modeled in order to predict some of this probability yeah Peter do you want to speak to that we have somebody here who is with Health Canada and actually follows those modeling exercises closely we certainly are seeing that changes in some of the aboriginal and Inuit populations in the North in terms of dangerous travel conditions and and such and and the changes I think you’re right are much more severe than we’re seeing in southern parts of Canada and their exhaust for baited by a lot of the conditions that people are living in up there in terms of some of these these other much more dramatic changes I’m not I’m not sure if if they if they say much about some of the much more dramatic changes other or the probability of those much more dramatic changes other than showing us you know what can really happen to cultures and and communities that are severely impacted by climate change and and I think in Canada and Southern Canada we sort of have this sense of or this perception that’s up there and that’s very different and we’re down here and we’re it’s not going to happen to us kind of thing but IIIi think we can really learn from some of the food security issues that are happening up there in terms of the caribou disappearing or the cultural issues in terms of not being able to access you know water bodies that they’ve access for hundreds of years I don’t think we’re that far apart and and we can learn a lot actually from that I thought your your presentation was excellent and your your data on the lack of the public’s perception of scientific consensus on this issue is really disturbing and I guess you know people have asked me about this before when I teach politics and my answer is pretty simple and it’s Fox News The Wall Street Journal their editorial page anyway so I guess I’m wondering what you think how you break through to that audience if you’re going to get a change of public perception we’re gonna have to get some kind of changes in the way they cover these issues and I guess I’m I’d like to hear more about how you think we’d do that well it’s a great question I you know I think all of us as Americans have been fretting these last couple of weeks over the dysfunctionality of the country in general the government shutdown the coming right up to the edge of defaulting and we’ve all been analyzing as a mature political scientists why that’s happening so I think my personal belief is that a big part of that reason is the segmentation of media so that people consume self-reinforcing news now rather than balanced objective ABC NBC CBS like in the good old days and then add to that all the money that’s in politics and add to that the redistricting that enables extremist members of Congress to be elected and re-elected safely and you have a political discourse to which science and reasonableness often seem irrelevant I’m a big believer in education I think we’re sitting here at a great university there we’ve got a country full of great universities and I think that if students learn how to think rationally how to turn to evidence at a forum opinions how to respect science I think that’s all for the good so I think when small part of the answer and it’s the answers got to be very big and very multifaceted but for those of us who are in the business of higher education boy do we have a pressing need to to teach an appreciation of science and to model that and to model evidence-based thinking but I think you know Franklin says advice is probably good advice to express the truth and express it again and again and again because this is that there’s a competition of voices out there and and the truth needs to prevail and it will prevail but it’s not going to prevail if those of us who have something to say

keep quiet so teach the young and be an activist