Global Health Impacts of Climate Change: Addressing Local Consequences

1. Climate Change:Global health impacts and local consequences Muge Akpinar-Elci, MD, MPH Director and Associate Professor Center for Global Health Old Dominion University, VA Workshop on Mitigation and Adaptation Research in Virginia, August 2015

3. Why should we care? http://www.mindmapart.com/climate-impacts-mind-map-jane-genovese/

4. Perhaps… http://www.newrepublic.com/article/117799/climate-change-will-force-us-abandon-cities-if-we-dont-prepare-now

5. Global Injustice • Climate change effects people around the world • things are a bit hotter, or a bit colder and a bit more uncertain, • too little or too much water, not enough food, • not safety and security • It is a survival…

6. Climate Change and Health • Climate change directly impacts health • Climate change impacts the weather, air, food supply, water, and economic longevity of humans • Temperature increases regionally due to climate change has been shown to impact the biological and physical systems of humans worldwide • Respiratory Health has shown to be a concern! • Increases amount of pollen and allergen • Increases mold • Increases the concentrations of outdoor ozone and particulate matter D’Amato, Cecchi, D’Amato, & Annesi-Maesano, 2014

7. Effects of Sea Level Rise on Health • Injury • Infrastructure damage • Food and water insecurity and contamination • Release of chemicals, sewage, and pollutants • Allergic and respiratory diseases • Vector born diseases • Impacts on chronic diseases and mental health • Population displacement

8. Population displacement

9. Flooding and Health • Indirect Health effects of flooding: • Damage to water and sanitation infrastructure • Damage to crops and or disruption of food supplies • Damage/destruction of property • Disruption of livelihood and income • Population displacement • Damage to health care infrastructure Few & Matthies, 2013

10. Flooding and Health • Direct health effects of flooding: • Drowning • Injuries • Vector and rodent borne diseases • Chemical contamination • Skin/eye infections • Mental health • Diarrhoel diseases • Respiratory Diseases Few & Matthies, 2013

11. Flooding and Respiratory Health • Lower respiratory symptoms were reported more frequently in homes with dampness or mold in children and adults • Allergen levels higher in flooded homes • Flooding leads to loss of electrical power which can be substituted by petroleum-fuelled equipment • Increases risk of carbon monoxide poisoning • Increases risk of exposure to harmful fumes or particulate matter Few & Matthies, 2013, Miller, 2013; Fewtrell et al, 2006

12. Flooding in U.S. • “Health effect of exposure to water-damaged New Orleans homes six months after Hurricanes Katrina and Rita” • Respiratory symptoms were positively associated with exposure to water-damaged homes and respirator use had a protective effect. • “Schools serving populations already at elevated risk of respiratory illness were disproportionately affected by the flooding of Hurricane Floyd. “ Cummings, 2008 Guirdy et al, 2005

13. Flooding in Guyana Flood dateAffected (#people) 1988 No data 1996 38,000 2005 274,000 2006 35,000 2008 100,000 EM-DAT: The OFDA/CRED International Disaster Database, http://www.emdat.be/ http://www.wondermondo.com/Best/SA/GuyanaFallsList.htm http://globalvoicesonline.org/2007/08/23/guyana-georgetown-is-flooded/

14. The case of COVE & JOHN, GUYANA • The town was flooded in December 2008 • To evaluate the prevalence of respiratory symptoms among occupants of water-damaged houses after the 2008 floods in Guyana • Out of 185 households, a total of 130 households completed the questionnaire (70%).

15. The Respiratory health problems and Flooding • Flooded houses 76.1% • Mould inside the home 37.3% (questionnaire) • Dampness and mould 32.8% (direct observation) • A statistically significant association was found between flooded houses and “Fever and Chills” (p<0.05) • A statistically significant association was also found between the presence of mould and runny nose, bronchitis (p<0.05) S. Rose, M. Akpinar-Elci. ISCOM, 2010

16. November 2014, Guyana

17. Sick PopulationAsthma and Saharan Dust • 200 million tones of dust • Sahara to the Caribbean • Arrives in the Caribbean within one week • PM 2.5 • Reasons to increase • Climate change (?!) • A wetter or a drier North Africa • Land use in western Africa

18. Saharan Dust and the Emergency Room Visits Due to Asthma in Grenada Mean Monthly Asthma Visits & Dust R2 = 0.036 p< 0.001 Akpinar-Elci et al, 2015

19. Health care workers’ perspective on Climate Change in the Caribbean • We conducted focus groups with Caribbean healthcare providers including physicians, veterinarians, nurses, health administrators and technicians who discussed the public health and healthcare impacts of the climate change. • Participants were recruited from providers lacking any obvious environmental health interest or expertise in Trinidad and Grenada. • Two countries with markedly • different geographies, cultures, population sizes, industrialization level, economies, and carbon emissions (in 2009 there were 37.4 metric tons per capita for Trinidad and 2.4 metric tons per capita for Grenada, compared with 17.3 in the USA) Macpherson and Akpinar-Elci, 2015

20. Their perspective • When asked about the local impacts of climate change, participants in both nations agreed that it has already contributed to • the increase of heat stress, • respiratory diseases, • vector borne disease, • mental health problems within their respective communities • availability of drinking water, • climate variability related to floods and droughts, • disaster preparedness, • threats to food security. Macpherson and Akpinar-Elci, 2015

21. Women and Single MotherNutmeg and Hurricane Ivan http://blahblohblog.wordpress.com/2009/09/07/hurricane-ivan-grenada-5-years-ago/ September 2004, Grenada http://www.flickr.com/photos/httpwwwsergiocomphotos/542390375/

22. Nutmeg Industry in Grenada

23. Nutmeg Workers • 93 workers • 77% female (single mother) • Mean age 47.2±11.4 years Akpinar-Elci et al, ATS 2011

24. Respiratory Symptoms Akpinar-Elci et al, ATS 2011

25. Adaptation in the developing world Nutmeg industry in Grenada • Prevent land degradation in Grenada • Implement renewable energy in nutmeg industry • Build a capacity for nutmeg workers • Reduce the poverty among the nutmeg industry workers, farmers, and the community

26. Prevention of Land Degradation • Activity: • Planting nutmeg trees in land degradation areas • Outcomes: • Promote and support sustainable land management • Increase nutmeg production • Positive impacts the nutmeg industry, environment, and Grenada economy

27. Implementing Renewable Energy in Nutmeg industry • Activity • Introduction of Solar dryer into nutmeg plant • Outcomes • Create a more efficient approach to processing the nutmeg products (shorter time, higher quality) • Improve economic and environmental benefits, • Prevent adverse health effects

28. Solar Dryer • End-product quality increased • Drying time reduced from 8 wk to 4 wk • No exposures • No dust • No mold • No pesticide • No ergonomic problems

29. UNDP Success Story

30. Nutmeg Production 500% increase

31. Virginia and Asthma

32. Hampton Roads, Sea Level Rise, Flooding http://www.nasa.gov/centers/langley/news/researchernews/rn_climatechange.html http://www.portsmouthva.gov/dna/Flood_Insurance_Rate_Maps.aspx

33. Hampton Roads and Asthma Behr, Diaz, Akpinar-Elci, 2015

34. Act Now…

35. Community-based Adaptation CARE, 2011, http://www.careclimatechange.org/files/adaptation/CARE_Understanding_Vulnerability.pdf

36. Thank you http://archive.itvs.org/risingwaters/ Email: makpinar@odu.edu