The extreme weather events experienced in the US this year will likely be the new normal as global warming affects the earth’s climate. The result will be significant health impacts nationally and around the globe. Dr. Jeremy Hess, a national expert on the topic, describes the major human health consequences of a warming planet including infectious diseases, neurological disorders and heat-related morbidity.

1. Climate Change: Managing the
Shifting Environmental Health Risks
Changing hazards, changing risks, and
the need for robust risk management
Jeremy Hess, MD, MPH

2. Overview
• Climate change
– What’s happening and why
– What health impacts we’ll see
• Risks from environmental hazards
– A conceptual framework for risk
– How climate change is changing the risk landscape
• Risk management
– Some approaches
– Implications for public health

3. A brief primer
CLIMATE CHANGE

4. Climate Change
Thanks to Daniel Rochberg for some slides

5. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

6. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

7. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
http://www.pewclimate.org/facts-and-figures/international/historical

8. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
CO2 Concentrations over the past 800,000 years
(dark blue line)
2012 Peak Concentration: 396 ppm

9. http://ngm.nationalgeographic.com/big-
idea/05/carbon-bath

10. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

11. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
The Copenhagen Diagnosis, available here.

12. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

13. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
Historical and Projected Global Temperatures
(degrees C; 2000 = 0)
IPCC

14. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
“Climate change refers
to any distinct change in
measures of climate lasting for a
long period of time. In other
words, ‘climate change’ means
major changes in
temperature, rainfall, snow, or
Climate change
wind patterns lasting for
decades or longer.”
U.S. Environmental Protection Agency,
Frequently Asked Questions about
Global Warming and Climate Change
http://www.epa.gov/climatechange/downloads/Climate_Basics.pdf

15. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

16. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

17. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

18. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
“There is medium confidence that droughts will intensify in the 21st
century in some seasons and areas, due to reduced precipitation
and/or increased evapotranspiration.”
IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation
Summary for Policymakers, p. 11
http://www.cbc.ca/gfx/images/news/photos/2009/07/06/drought-china-cp-w-6244601.jpg

19. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
http://earthobservatory.nasa.gov/IOTD/view.php?id=5542
Maldives: 1,192 islands IPCC sea level rise projections
330,000 people by 2100: 18-59 cm
average elevation ~1 meter IPCC 4th Assessment Report, Synthesis Report

20. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
http://www.history.com/photos/heat-waves/photo2
“France's summer heatwave killed a total of 14,800
people, according to official figures released on Thursday.”
BBC News, September 25, 2003
“It is very likely that the length, frequency, and/or intensity of warm
spells or heat waves will increase over most land areas.”
IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation
Summary for Policymakers, p. 11

21. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
“It is likely that the frequency of heavy
precipitation or the proportion of total rainfall
from heavy falls will increase in the 21st
century over many areas of the globe.”
IPCC Special Report on Managing the Risks of Extreme Events and Disasters to
Advance Climate Change Adaptation, Summary for Policymakers, p. 11
photo by Paula Bronstein, Getty Images http://news.nationalgeographic.com/news/2010/08/photogalleries/100826-
pakistan-flooding-millions-people-pictures/#/pakistan-flooding-man-water_25084_600x450.jpg

22. Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
Average tropical cyclone maximum wind speed is likely to
increase, although increases may not occur in all ocean basins.
IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change
Adaptation, Summary for Policymakers, p. 11
http://www.nasa.gov/images/content/470571main_isabel_lg.jpg
It is likely that the global frequency of tropical cyclones will
either decrease or remain essentially unchanged.
IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change
Adaptation, Summary for Policymakers, p. 11

23. The components of risk and how they are shifting
ENVIRONMENTAL HAZARD RISK

24. Basic Risk Formula in CC Community
Event Vulnerability Loss
• Probability • Exposure • Damage
• Magnitude • Susceptibility • Valuation
Probability x Consequence = Risk

25. Some Climate Change Risks
Lenton, T. M. (2011). Early warning of
climate tipping points. Nature Climate
Change. 1: 201-209.

26. Components of Risk
Equations Considerations
• Risk = p(H) x impact or cost • What is the hazard?
• Who is most vulnerable?
• Risk = p(H) x V/Res, where – Little guidance
– pH = Hazard probability – Based on exposure and
– V = Vulnerability, where susceptibility:
• Elderly
• V = p(E) x (S) • Children
• pE = Exposure probability • Workers
• S = Susceptibility • What drives adaptive capacity
– Res = Resilience for vulnerable populations?
• How might early warnings
• Res ≡ Adaptive Capacity facilitate protective responses
and increase resilience?

27. How Risk is Changing: Hazards

28. How Risk is Changing: Hazards
IPCC. Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation. A
Special Report of Working Groups I and II of the Intergovernmental Panel on Climate Change.
Cambridge, UK: Cambridge University Press; 2012.

29. How Risk is Changing: Exposure
Available: http://www.worldmapper.com

30. How Risk is Changing: Exposure
IPCC, SREX, 2012

31. How Risk is Changing: Susceptibility
Global Distribution of Preventable Deaths Available: http://www.worldmapper.com

32. Mortality Distribution
95% of disaster deaths occur in the developing world
IPCC, SREX, 2012

33. Combination, 1975-2010
Disasters

34. Health Effects of Disasters
Pre-event – injuries, road traffic crashes
Event – debris injuries, drowning
Post-Event – displacement, chronic dz exacerbation
Recovery – depression, violence

35. Hurricanes Katrina and Rita

37. NOLA Health Care System Pre and Post
Rudowitz et
al., 2006; slide
courtesy John
Balbus

38. Moving the Coping Range

39. Approaches to risk and implications for public health
THE ROLE OF RISK MANAGEMENT

40. Aspects of Risk Management
Minimize or Avoid
• Multiple components
– Risk recognition
Mitigation Avoidance
– Risk assessment
– Risk engagement
• Multiple stances
– Risk mitigation Retain or Share
– Risk avoidance
– Risk retention
Retention Sharing
– Risk sharing

41. okay, climate change is a problem.
what do we do about it?
Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations

42. okay, climate change is a problem.
what do we do about it?
Increased Increased
Increased Climate
GHG GHG Impacts
Temperature Change
Emissions Concentrations
reduce prepare for /
emissions respond to the
impacts
(mitigation) (adaptation)

43. Put another way:
adapt mitigate
to against
this this

44. Mitigation:
“avoiding the unmanageable”
Adaptation:
“managing the unavoidable”

46. All
affect human
health
http://www.ipcc.ch/graphics/graphics/ar4-wg1/ppt/figure02.ppt#278,22,Figure 2.21

47. Potential Co-benefits of GHG
Mitigation Policies
• Energy generation –
decreased air pollution
• Transportation –
increased physical
activity, decreased air
pollution, decreased
injuries from collisions
• Agriculture – reduced red
meat consumption
• Agriculture – improved
nutrition

48. Identifying synergies and opportunities
for co-benefits

49. Both Are Required
Yohe and Leichenko 2010

50. Risk Management Options
IPCC SREX Summary for Policy Makers, available here.

51. But Where to Start?

52. BRACE
1. Forecasted
Climate Impact
and Vulnerability
Assessment
2. Projected
5. Evaluation
Disease Burden
4. Health
Adaptation 3. Intervention
Planning and Assessment
Implementation

53. “Place Specific and Path Dependent”
• At any point in time, health risks associated with
environmental hazards depend markedly on
interactions between components of risk
• Do we start with hazards or vulnerability?
– If vulnerability relatively high, address that preferentially
– If vulnerability relatively low, explore thresholds and
implications of shifting hazards
• Be mindful of feedbacks over time:
– Exposure over time (or lack thereof) can feed back into
vulnerability
– Implications for adaptive capacity, development, and
resilience

54. Feedbacks Over Time
IPCC, SREX, 2012

55. Changing Risk Over Time
Tol R, Ebi K, Yohe G. Infectious disease, development, and climate change: a scenario analysis.
Environment and Development Economics. 2007;12(05):687-706.

56. Awareness of Thresholds
Lenton, T. M.
(2011). Early
warning of climate
tipping points.
Nature Climate
Change. 1: 201-
209.

57. The Role of Learning
IPCC, SREX, 2012

58. Problem Types
Used with permission from Hovmand, P. S. Adapted rom Burrell, G., and Morgan,G. (1979). Sociological paradigms
and Organizational analysis: Elements of sociology of corporate life. London, and Heinemann, and Lane, D. C.
(1999). Social theory and System dynamics practice. Journal of Operational Research Society, 113, 501-527.

59. The Role of Transformation
IPCC, SREX, 2012

60. Simulations Can Help

61. Role of Adaptive Management
• Return to the risk
equation Assess
– Reduce hazard probability
– Reduce hazard exposure Adjust Plan
– Reduce susceptibility
• Requires
modeling, learning, and
adaptive management Evaluate Implement
• Integrated with sustain-
able development Monitor

62. In Summary
• Climate change is changing the risk landscape
• Several risk management stances are available
• Risk can be broken down into components
and the breakdowns can help guide risk
management
• Risk assessment, risk management, and risk
communication are increasingly linked
• Adaptive management is an important short-
to medium-term tool