This document summarizes the key points from a presentation on public health and climate change given by Dr. Jonathan E. Fielding. The summary includes: 1) Climate change is already occurring and human activities are contributing to increased greenhouse gas emissions and rising global temperatures. This will have widespread health impacts. 2) Public health professionals have an important role to play in both mitigating (reducing emissions) and adapting to the health impacts of climate change through emergency preparedness, advocacy, and promoting behaviors and policies that are good for both health and the environment. 3) Many strategies for mitigating climate change through reducing emissions from transportation, buildings, agriculture and other sectors also provide significant public health co-benefits

1. Beating the Heat:
Public Health and
Climate Change
Jonathan E. Fielding, MD, MPH, MBA
Director and Health Officer
Los Angeles County Department of Public Health
APHAAnnual Meeting and Exposition
San Diego, CA - October 27, 2008

2. 2
Presenter Disclosures
(1) The following personal financial relationships with
commercial interests relevant to this presentation existed
during the past 12 months:
Dr. Jonathan E. Fielding
No relationships to disclose

3. 3
Climate Change is Happening Now
Source: IPCC 2007 (4th Assessment)

4. 4
IPCC 2007: Human Impact is Evident
Source: IPCC 2007 (4th Assessment)

5. 5
Global Contributors to
Greenhouse Gas Emissions
 Leading sources of greenhouse gas emissions are combustion of fossil
fuels: coal, oil, and natural gas
 More than 60% of the annual global industrial carbon dioxide
emissions come from industrialized countries, accounting for 20% of
the world’s population
U.S. per capita emissions of carbon are over 20 times higher than
India, 12 times higher than Brazil, and 7 times higher than China
These per capita rates expected to change significantly as China,
India, and other countries continue to develop economically
China is now the #1 carbon emitter, surpassing the U.S.
 Global carbon dioxide emissions are projected to increase by at least
50% over the next 25 years under current conditions

6. 6
Annual Carbon Dioxide Emissions - 2005
Source: U.S. Greenhouse Gas Emissions Inventory
The most current estimates state that China is about to surpass the US in
emissions and its rate of emissions is accelerating.
22.4%
18.4%
11.4%
5.6%
4.9%
4.6%
32.7%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%
U.S.
China
Russia
EU
India
Japan
Others
Total CO2 – measured in
thousands of metric tons

7. 7
Source: U.S. Greenhouse Gas Emissions Inventory
U.S. CO² Emissions from Fossil Fuel

8. 8
Why Should Public Health Care?
• It is our job to protect the public’s health
– WHO estimates that in the year 2000, there were 150,000 excess deaths
per year due to climate change
– Climate change is already affecting health around the world, and its
impact on health will continue to grow
• Fighting climate change is aligned with protecting and
promoting health
– Many of the proposed solutions for climate change are healthy for
everyone
• We have the appropriate skills
– Public Health has the skills to effect behavior change, and those skills
can help people adopt greener behaviors too
– Public Health has policy and advocacy skills that will help encourage
organizational and societal changes
• We can be role models

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1°C 2°C 5°C
4°C
3°C
Sea level rise
threatens major cities
Falling crop yields in many areas, particularly
developing regions
Food
Water
Ecosystems
Risk of Abrupt and
Major Irreversible
Changes
0°C
Falling yields in many
developed regions
Rising number of species face extinction
Increasing risk of dangerous feedbacks and
abrupt, large-scale shifts in the climate system
Significant decreases in water
availability in many areas, including
Mediterranean and Southern Africa
Small mountain glaciers
disappear – water
supplies threatened in
several areas
Extensive Damage
to Coral Reefs
Extreme
Weather
Events
Rising intensity of storms, forest fires, droughts, flooding and heat waves
Possible rising yields in
some high latitude regions
450 ppm CO2 eq
650 ppm CO2 eq
Projected Impacts of Global
Temperature Change
Source: L. Rudolph, 2008

10. 10
Climate Change’s Impacts on Health
Source: Haines, et al, JAMA 2004

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Extreme Weather Events & Disease Clusters
Source: Epstein, Harvard Center for Health & Global Environment

12. 12
Expected Environmental Impacts in So.
Cal. of Climate Change: Sea Level Rise
Effects of rising sea level
• Coastal areas will become
vulnerable to storms and
flooding
• Loss of coastal wetlands and
erosion of beaches
• Saltwater contamination of
drinking water
• Potential damage to roads,
highways, and other
infrastructures near coastal
areas

13. 13
Expected Environmental Impacts in
CA of Climate Change: Floods & Droughts
 Warmer temperatures can result in
premature and rapid snowmelt in the
Sierra snow pack, which alters the
timing of run-off water supplies for ½ of
CA’s surface water
Severe flooding may occur during
winter and spring, with slower water
flow during summer seasons
 Drought risk may be acutely elevated during the summer months
 June 2008 – Governor Schwarzenegger declares state drought

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Health Impacts of Heat Waves
Los Angeles projected to have an increase of 62% -
88% in heat-related mortality by 2080
Health impacts likely to be seen 1 to 3 days after the
onset of the heat waves
Health effects of extreme and prolonged heat exposure
include: heat cramps, heat exhaustion, heat stroke, heat
syncope (fainting)
Devastating heat waves seen elsewhere recently
5-day heat wave in Chicago in 1995: 700 excess deaths,
most attributed to the heat
August 2003 European heat wave: 35,000 excess deaths

15. 15
Heat Waves: Vulnerable Populations
Greater risk for people who do
not have access to air
conditioning
May not be able to afford air
conditioning
For populations unaccustomed to heat
waves, people may have air
conditioning but chose not to use it,
not realizing danger
Two vulnerable populations during heat waves:
Elderly: Population of senior citizens (> 60 years old) in Los Angeles
County is expected to increase by 83% by the year 2020
Low SES: Over 16% of LA County residents under 100% FPL

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Potential Environmental Impacts in So.
Cal. of Climate Change: Wildfires
 Wildfires are common in Southern
California
 Characteristic of the area since
prehistoric times
 Santa Ana winds may drive heat waves,
prolong wildfires, and prevent wildfire
control in this region
 Climate models predict the summer
months will be longer, and hotter,
due to global warming
 Result: dry soil and vegetation
become fuel for wildfires

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Potential Environmental Impacts in So.
Cal. of Climate Change: Air Quality
 Increased temperature and
increased carbon dioxide in
atmosphere leads to
 Increase in formation of ground-
level ozone (and smog)
 Increased allergen production (e.g.
pollen)
 Longer seasons for allergen
producing weeds
 Senior citizens, children, and people with respiratory and chronic diseases
are most vulnerable to high levels of ozone and increased allergens
 Health effects of high levels of ozone exposure include:
 Reduced lung function
 Respiratory discomfort
 Exacerbation of chronic respiratory illnesses (e.g. asthma)

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Summary of Health Effects of Air Pollution
• Amount of goods transported
through California projected to
nearly quadruple between 2000
and 20201
• Will have significant impact on
air quality and health2
• Diesel particulate matter (PM)
– concentrated around ports,
railyards, and heavily trafficked
roads3
 premature deaths
 cancer
 respiratory disease
 lost workdays
 global warming (2nd to CO2)
Annual Health Impacts in CA
from PM and Ozone4
1 (Cal EPA, 2005); 2 (Pacific Institute, 2006)
3 (CA/EPAAir Resources Board); 4 (CA/EPAAir Resources Board, 2004)

19. 19
The Time for Inaction Has Past
• Scale of threat is global: touches all, everywhere
• Intensity of the threat: threatens all of our basic survival
mechanisms -- food, water, shelter, and health.
• Scale of response: must engage every sector of society
• Timeframe for response: “…we have at most 10 years -- not 10
years to decide upon action, but 10 years to alter fundamentally
the trajectory of global greenhouse emissions."
• “There is still time, but just barely.” (Dr. James Hansen, director
of NASA Goddard Institute for Space Studies)

20. 20
A Public Health Response
to Climate Change
Public health already utilizes a multi-level prevention
approach – analogous approach can be taken to respond to
climate change
Primary prevention = climate change mitigation
Efforts to slow, stabilize, reverse climate change by reducing GHG
emissions
Efforts will occur in sectors other than PH, such as energy and transportation
Secondary/tertiary prevention = climate change adaptation
Efforts to prepare for, and minimize health burden of, climate change
Similar to public health preparedness for other uncertainties (e.g. pandemic
flu, bioterrorist attack), so likely that PH as sector will be involved in
adaptation efforts
Source: Frumkin, et al., AJPH 3/08

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What Should We Do?
1. Mitigation = reduce GHG emissions
1. Reduce energy usage and Reduce, Reuse, Recycle
1. As individuals, at home
2. As organizations, at work
2. Adaptation = prepare for impact of climate change
1. Emergency preparedness
1. As individuals/families
2. As local health department
3. Mitigation and adaptation = advocate for healthy
policies
1. Support legislation that reduces GHG emissions
2. Support sustainable lifestyles & communities

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23. 23
Realizing the Co-benefits of
Reducing GHG Emissions
• Primary benefits
– reductions in the expected long-term consequences of global warming;
avoided damages of climate change
• Co-benefits (or ancillary benefits)
– economic, social, environmental, public health and other benefits
independent of any direct benefits from mitigating climate change
• Health co-benefits
– Benefits of climate change mitigation strategies that have a positive
effect on health
– Example: promote cleaner energy production and cleaner fuels
Primary result = reduced GHG emissions from energy production
Co-benefit = less air pollution = less respiratory distress

24. 24
Realizing the Co-benefits of
Reducing GHG Emissions
Important to realize the co-benefits of climate change
responses = certain efforts to address climate change often
yield other health benefits too
Strategy: reducing vehicle miles traveled
Primary result = lower motor vehicle GHG emissions
Co-benefit = higher physical activity rates
Strategy: promote cleaner energy production and cleaner fuels
Primary result = reduced GHG emissions from energy production
Co-benefit = less air pollution = less respiratory distress
Source: Frumkin, et. al., AJPH March ‘08

25. 25
Key Mitigation Technologies
& Practices*
• Transport
– Fuel efficiency
– Hybrids
– Road to rail
– Public transport
– Non-motorized transport
– Land-use planning
• Buildings
– Daylighting
– Energy efficiency
– Improved cook stoves
– Solar heating & cooling
• Agriculture
– Crop & land management
– Livestock & manure
management
– Improved N fertilizer use
• Industry
– Energy efficiency
– Heat & power recovery
• Energy supply
– Coal to gas
– Nuclear power
– Renewable energy
* Items in green have health co-benefits!

26. 26
GHG Mitigation Strategies,
Air Pollution, & Health
• Globally ancillary benefits may be 30% – 100% abatement costs
• Public health improvement and “knock-on” effect to health services from
reductions in air pollutants account for approximately 80% total value
ancillary benefits in US
• Canada proposed GHG emissions reductions would also reduce
– SO2 by 9%, NOx by 7% of annual emissions
– 3,300 premature deaths per year avoided in Canada w/15% GHG reduction
(based on PM reduction only)
• GHG reductions in 4 cities would avoid (through 2020)
– 64,000 premature deaths
– 65,000 chronic bronchitis cases
– 37 million person-days of restricted activity or work loss
Sources: IPCC (2001); Caton (2000); Blomqvist (2000); Cifuentes (2001)

27. 27
Climate & Health Co-benefits
of Decreased Auto Use
Reductions
• Greenhouse gas emissions
• Air pollution
• Noise
• Infrastructure costs
• Community Severance
Increases
• Physical Activity
• Social Capital
Reductions
• Respiratory disease
• Traffic injuries
• Heart disease
• Depression
• Osteoporosis
• Diabetes
• Cancer
• Stress
Borrowed from L. Rudolph

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Climate & Health Benefits of Reduced
Meat Consumption
Reductions
• Greenhouse gas emissions
• Antibiotic use
• Water pollution (nitrates)
• Air pollution
• Soil erosion
• Unsustainable H2O
consumption
• Pesticide Use
Reductions
• Ischemic heart disease
• Obesity
• Colorectal cancer
• Breast & prostate cancers
• Type II Diabetes
• Antibiotic resistance
• Respiratory disease
• Pesticide health effects
Average American diet requires the production of extra 1.5 CO2e
compared to a strictly vegetarian diet.
2.2 pounds beef = CO2e of 155 miles driving
Meat consumption reduction of 20% = switch from Camry sedan to Prius
Increases
• Biodiversity
• Global food security
• Protein intake equity
• Rural community
strength
Borrowed from L. Rudolph

29. 29
Mitigation: What Can We Do In Our Homes
& Workplaces to Combat Global Warming?
 Establish recycling programs in the workplace and
home
 Recycling half of your household waste = hundreds of
lbs. of CO2 saved per year
 Promote energy efficiency in the home and workplace
 Changing regular light bulbs to compact fluorescent
bulb throughout your house = hundreds of lbs of CO2/yr
 Make “small energy” use changes on a broad scale
 E.g. replacing all light bulbs with energy efficient light
bulbs in all County buildings
 Encourage renewable energy power sources (solar
energy and wind energy) and responsible use of
energy
 Turning off your TV, computer, and other electronics =
thousands of lbs. of CO2 saved per year

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Mitigation: What Can We Do In Our Homes
& Workplaces to Combat Global Warming?
 Try to drive less and walk more!
 You save gas money and keep our air
cleaner for every mile you don’t drive
 Most car trips taken in your neighborhood
are short enough to walk or bike
 Encourage carpooling to
work/school
 Encourage public transportation
use
 Provide incentives for employees to purchase fuel-efficient vehicles
(e.g. electric, hybrid, CNG vehicles)
 Every gallon of gas saved = tens of lbs. of CO2 saved
 If you do take a car, maintain it
 Properly inflated tires can improve gas mileage by 3%

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Adaptation: Emergency Preparedness
We need to prepare now for the inevitable
effects of climate change, such as heat waves
and wildfires
Good news: preparing for one type of emergency
prepares us for all types of emergencies
Preparation minimizes impact of disasters and
fear/anxiety
We need to prepare ourselves as individuals
and as health agencies

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Promote Healthy Policies
 Support policies related to sustainable communities
 Mixed use development, jobs near housing,
transit-oriented design, bike lanes and
sidewalks, parks and green
 Development and utilization of useful public
transportation
 Energy efficient "green" buildings and LEED
certification
Buildings consume 72% of the nation’s
electricity and more GHG than
transportation or industry*
 Recycling, waste management and pollution
control
 Securing safe water supplies
Source: US Dept of Energy, 2007
 These policy decisions occur at all levels of government, so many opportunities for Public
Health to give input
 Health Impact Assessments
 Surveillance data tracking spread of vectors and diseases

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What Should We Do?
• Educate – ourselves, public, and policy makers
• Partnerships and collaboration
• Lend PH credibility and experience in driving policy & behavior change
• Advocate for aggressive government and business mitigation policies &
strategies that also promote health
• PH leadership in advocating for personal, organizational, local government
carbon footprint reduction
• Increase understanding and research re: health co-benefits
• Ensure health co-benefits included in policy and cost assessments (e.g. HIAs)
• Protect vulnerable populations
– Advocate for equity in mitigation
• Monitor health impacts of climate change
• Preparedness and adaptation
Borrowed from L. Rudolph

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We Can’t Do It Alone
So why should we bother?
Efforts will yield long-term savings
Will make our economy more competitive
The co-benefits are great
Will improve the sustainability of our communities
Moral obligation – if we care about the health of
our communities, then we need to do our part

35. Jonathan E. Fielding, MD, MPH
Public Health Director
and
Health Officer
Los Angeles County
Department of Public Health
Special thanks to Linda Rudolph for use of some of her
slides