Climate Change and Health Protection: from Global to Local Dr Sotiris Vardoulakis Air Pollution and Climate Change Group Centre for Radiation, Chemical and Environmental Hazards

IPCC 5th Assessment Report • Physical Science Basis • Impacts, adaptation and vulnerability • Mitigation of climate change

Climate Change and Health

Climate Change - Evidence • Atmospheric concentration of CO2 is increasing (pre-industrial approx. 280ppm, currently near 400ppm); • Other greenhouse gases (methane, nitrous oxide) have also increased. • Observed changes to the Earth’s climate system include:  increase in global surface temperatures  sea level rise  ocean acidification  shrinking ice sheets  more extreme events

IPCC 2013, 5th AR

Observed change in average surface temperature (1900-2012)

IPCC, 5th AR Climate Change and Health

oC

2060s

observations projections We are already committed to this from past emissions alone

°C

Temperature anomaly over Europe (wrt 1961-90)

Mitigation is vital, but we need to prepare for inevitable climate change

Hadley Centre

2040s

2003

Hughes et al (2011), modified from Capon and Hanna (2009) and Berry et al (2011)

Climate-sensitive Health Effects Relative changes in mortality associated with diarrhoea, malaria, inland and coastal flooding, and malnutrition from 2000 to 2030

(Patz et al., 2008)

Climate Change Risk Assessment (2012)

South West

Climate Change and Health

http://randd.defra.gov.uk/Default.aspx?Module=More&Location=None&ProjectID=15747

Population Trend Projections 16000000

14000000

UK population is currently 62M rising to 69-86M (2050s) & 72-113M (2080s)

120000000

NE NW 100000000

12000000

YH EM

80000000 10000000

WM EE

8000000

60000000

LN SE

6000000 40000000

SW

WA

4000000 20000000 2000000

SC NI

0

0

Climate Change and Health

UK

Age Distribution

(Source: ONS)

Health Effects of Climate Change in the UK •

• • • • • • • • •

Current evidence and climate projections Temperature Effects Air Pollution Aeroallergens (pollen and fungi) Indoor Environment Ultraviolet Radiation Floods Vector borne diseases Food and Water borne Diseases Health Co-benefits of Policies to Reduce Greenhouse Gas Emissions

http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/hecc2012

Temperature Effects • Increases in annual mean temperatures of around 2 to 5oC under a medium emissions scenario by 2080. • Preventable temperature mortality and morbidity, focusing on vulnerable population groups. • Improved understanding of the role of planned adaptation strategies and long-term physiological changes.

• Provision of input to public health plans, and evaluation of their effectiveness.

UK (2020s)

© UK Climate Projections 2009

Climate Change and Health

UK (2050s)

© UK Climate Projections 2009

Climate Change and Health

UK (2080s)

© UK Climate Projections 2009

Climate Change and Health

Days per year with Central England Temp < 0oC

Days per year with Central England Temp > 20oC

August 2003 heatwave 2003 mortality Baseline mortality

2003 mortality

Baseline mortality

(Johnson et al. 2005)

Temperature Effects England & Wales

10000

deaths

days 8000

4

Cold effects

Heat effects 6000

3 4000

2 2000

1

0

-10

-5

0

Climate Change and Health

5

10 15 Mean Temperature oC

20

25

30

Aggregate count of days

Mean daily deaths (per 100K population)

5

Relative Risks: Heat (all ages) per 1oC increase above temp threshold (93rd %ile) 1.12

UK heat

1.09

1.06

1.03

1.00

Climate Change and Health

Relative Risks: Cold (all ages) per 1oC decrease below temp threshold (60th %ile) 1.06

UK cold

1.04

1.02

1.00

Climate Change and Health

Heat and Cold related deaths in UK (per year for all ages) 80000

20000

B: Cold deaths

A: Heat deaths 60000

15000 12,538

41,408

42,842

40,397

40000

10000

36,506

7,040

20000

5000 3,281 1,974

0

0 2000s

2020s

2050s

2080s

2000s

2020s

2050s

2080s

(Hajat et al. 2014) Climate Change and Health

Temperature mortality (by age group) 600

400

2000

Heat deaths /100K (mean) 2000s 2020s 2050s 2080s

1600

327

1200

Cold deaths /100K (mean) 2000s 2020s 2050s 2080s

1573

1419 1153 933

206

800

200 113 77

0

0 1 1 2

4 6 11 17

0-64

65-74

18 26

79

468 421 341 274

400

48

0 75-84

85+

7 6 5 4

0-64

94 85 69 56

65-74

75-84

85+

Mean estimates of heat- and cold-related deaths in the UK per year per 100,000 population (Hajat et al. 2014)

Urban Heat Island Effect OC

Birmingham 11pm 5th August 2003

Modelled air temperature

Climate Change and Health

(Heaviside et al. 2015)

Air Pollution • Climate change interacts with air pollutants, such as ground level ozone and black carbon • Climate change may result in longer duration of exposure to aeroallergens • Health effects of air pollutants associated with short- and long-term exposure • Vulnerable people (e.g. those with preexisting respiratory illness) need to be protected

Ultraviolet Radiation • Climate change may affect ambient levels of UVR, but the critical factors affecting human exposure are lifestyle and behaviour. • Understanding the likely changes in ground level UV radiation and the balance between the risk of skin cancer versus a beneficial increase in outdoor activity.

• Warmer summers may encourage more healthy outdoor activities and increased vitamin D production. • UVR related public health messages for specific target groups such as young people and the elderly.

Climate Change and Health

Floods • Climate change is likely to affect river and coastal flood risk. • Some areas are particularly vulnerable to coastal floods: South Wales, NW Scotland, Yorkshire and Lincolnshire, East Anglia and Thames Estuary. • Floods affect both the physical and mental health of populations. • Development and evaluation of public health action plans, advice and guidance.

Changes in Precipitation – Winter

Changes in Precipitation – Summer

28

Indoor Environment • Climate change may exacerbate health risks and inequalities associated with building overheating, indoor air pollution, effects from flooding, dampness and biological contamination • Characterise the health risks and benefits associated with current and future building infrastructure under climate change scenarios • Climate change mitigation and adaptation measures may affect the indoor environment (e.g. air quality in buildings)

Health Co-benefits of Mitigation • Mitigation policies may achieve health, GHG and economic benefits simultaneously (‘the triple bottom line’). • Health co-benefits of policies to reduce GHG emissions in transport, energy generation and food production. • Evaluation of the health effects (both positive and negative) of emerging ‘low carbon’ technologies and biofuel policies.

http://www.healthy-polis.org/

Sustainable, Resilient, Healthy People & Places Vision of sustainable health and care: Working to reduce carbon emissions, minimising waste & pollution, making the best use of scarce resources, building resilience to a changing climate and nurturing community strengths and assets

(SDU 2014)

Health Protection Research Unit Environmental Change and Health Dr Sari Kovats, LSHTM, Director

• Theme 1: Climate resilience – Dr Shakoor Hajat, LSHTM

• Theme 2: Healthy sustainable cities – Dr Sotiris Vardoulakis, PHE

• Theme 3: Health and the natural environment – Prof Lora Fleming, UoE

HEALTHY-POLIS: International Consortium for Urban Environmental Health & Sustainability Health

Urban Environment

www.healthy-polis.org Climate

Sustainability

Conclusions • Climate change is likely to pose challenges to health protection in the UK and globally by aggravating existing public health problems. • Air pollution, heat and cold, and floods have significant impacts on public health (particularly on vulnerable populations). Some of these impacts (e.g. heatwaves) are projected to increase in the future. • Further research is needed on current and future interactions between climate, and environmental and behavioural drivers that affect public health. • The environmental public health sector needs to respond to these challenges by:  strengthening modelling, monitoring and surveillance systems  improving the resilience of public health infrastructure

 improving the assessment & communication of environmental risks  developing & communicating the evidence on health benefits of climate change adaptation and mitigation  undertaking research to further understand and quantify the risks

Acknowledgements Climate change & associated work in PHE: Clare Heaviside, Gordon Nichols, Jolyon Medlock, John Thornes, Bernd Eggen, Alison Gowers, Sani Dimitroulopoulou, Stephen Morton, Giovanni Leonardi, John O’Hagan, Naima Bradley, Alec Dobney, Adrienne Dunne, Angie Bone, Virginia Murray, Carla Stanke, Katie Carmichael, Owen Landeg, Kevyn Austyn, Tim Gant, Jill Meara, Anna Cichowska, Anthony Kessel HPRU Environmental Change & Health: Sari Kovats, Lora Fleming, Shakoor Hajat, Zaid Chalabi, Mike Davies, Paul Wilkinson, Andy Haines, Kat Arbuthnott, Debbie Hemming, Yolanda Clewlow, Pete Faloon, Nick Osborne, Mat White, Anna Mavrogianni, Ian Hamilton, Jonathon Taylor, Ai Milojevic, Gianni Lo Iacono, Helen Macintyre, Rachel McInnes, and others Healthy-Polis: Keith Dear, Tony Capon, Mike Depledge, Otto Hänninen, Jenny Salmond, Jan Semenza, Stefan Reis, Paula Santana, Paul Clift DH, Defra, EA, ASC, NHS SDU: Louise Newport, Jonathon Graves, Paul Holley, Sonia Roschnik, David Pencheon, Kathryn Humphrey, Rob Hitchen, Jim Hodgson In memory of Professor Tony McMichael

Climate Change and Health