1. CLIMATE AND HEALTH – Greens
Why talk about climate and health? Because time is short and to get governments to act we need a mass
movement. Its time to stop debating the deniers and move on to mobilize the believers, who make up
65% of the population. The battlefront of public opinion has shifted, and we must confront 3
misconceptions. 1) climate change will only affect people in developing countries 2) we can deal with
it later and 3) if it happens, we can adapt. Researchers on climate communication in the US tested
various ways of talking about climate with focus groups and found that talking about health effects was
the most effective way to get listeners to care. Why?
People are more likely to respond if they think their own families are in danger.
It brings an abstract concept down to earth in terms that people understand.
It gently confronts the craziness in our culture which has us completely obsessed with what we take in
and in total denial about what we put out.
Our fascination with bizarre diseases and natural disasters holds peoples' attention long enough to get
the point across.
So what's the longterm forecast for New Zealand? As your TV weatherpeople like to say, its
changeable, but the changes are trending in a certain direction. warmer winters and hotter summers,
more frequent and longer heat waves. The wet areas will get wetter and the dry areas drier, with more
frequent drought, more heavy rains and more powerful storms.
GLOBE These changes are affecting the food we eat, the water we drink, the air we breathe, and the
place we live; all of which will affect our health.
CASE 1 HEAT STROKE
HEAT WAVE Extreme heat causes more deaths than any other type of extreme weather event. A heat
wave in Europe in the summer of 2003 caused 70,000 deaths. Another in Russia in 2010 killed
56,000 people.
Old, young, people with chronic diseases, outdoor workers and those taking certain medications are
more susceptible to heat related illness and death. Pregnant women and their unborn babies are also
affected with increased rates of birth defects and premature birth. City dwellers are at higher risk due to
the urban heat island effect: with absorption and radiation of heat from dark asphalt and cement, it
can be 9 deg hotter in cities than the surrounding suburbs. Overall the death rate goes up 1% for every
degree rise over 20 degrees. The definition of extreme heat depends on where you live. We adapt to
higher temperatures over time, so extreme heat causes more harm when it occurs earlier in the summer.
Aussies, for example, are less susceptible than Kiwis. The longer a heat wave goes on, the more severe
the effects. Heat waves fill hospitals with increased ED visits and admissions for heart, lung, and
kidney disease. A heat wave in Australia in 2009 bumped up hospital admissions 14-fold. Heat waves
don't just kill us, they make us kill each other. Extreme heat increases aggression and results in
increased rates of assault, murder, domestic violence, suicides and psychiatric holds for being a danger
to others. I could not find projections on future extreme heat for NZ, Tasmania was the closest. There
the number of hot summer days will double to triple by the end of the century. Heat waves will
quadruple in frequency and, in the northern third of the island last anywhere from a week to month
longer than they do now.
CASE 2 PSP
PARALYTIC SHELLFISH POISONING Warmer oceans promote harmful algae blooms which form
heat stable neurotoxins that accumulate in fish and shellfish. Paralytic shellfish poisoning can range

2. from tingling of the lips and hot/cold reversal to flaccid paralysis and respiratory failure. The mortality
rate ranges from 9-15%. There have been 29 hospitalizations for PSP in the Waikato district since mid
December from shellfish obtained in the Bay of Plenty, where warnings are still in place. A warning on
the West Coast began in October and was only recently lifted.
BLUE GREEN ALGAE Warmer water temperature combined with nutrient rich runoff from heavy
rain in agricultural areas causes cyanobacteria blooms in fresh water. These produce several toxins, the
most common being microcystin. Microcystin causes hepatitis with acute ingestion and liver cancer
with prolonged low level exposure. It cannot be destroyed by boiling. Children and pets are most
vulnerable to acute exposures because of their small size and tendency to play at the water's edge where
the algae is thickest. With a thick layer of algal scum at the shore, toxin concentration is increased 100
fold. With a strong wind blowing lake scum in to the shoreline concentrations can increase 1000 fold.
Fish and shellfish can concentrate microcystins. There is currently a public health warning for shellfish
with high microcystin levels in Hokianga Harbour due to an algae bloom in Lake Omapere
upstream. Three other lakes in northern north island are currently closed to recreational use due to high
levels of microcystin.
VIBRIO AND SEA SURFACE TEMPERATURE Warmer oceans also increase the multiplication
of Vibrio bacteria in shellfish. There are two common marine Vibrios, vulnificus and parahemolyticus.
Vibrio parahemolyticus generally causes gastroenteritis but Vulnificus causes bacteria in bloodstream
which is 50% fatal. The very young, very old, and people with liver disease and impaired immune
function are more susceptible. In the US Vibrio causes 95% of seafood related deaths. The prevalence
of Vibrio in NZ shellfish has increased since the 1980s. In the summer of 2009 V. vulnificus was
present in 17% of samples. There was a clear relationship between Vibrio levels and water
temperature.
AMOEBIC MENINGOENCEPHALITIS is another infection related to water temperature. It is still
Rare but tragic, it affects healthy children and is 100% fatal. Its caused by Naegleria, an amoeba that is
dormant in cold water and reproduces in warm water. In NZ you Naegleria infection by immersing the
head in thermal pools. In the US we've also seen cases from swimming in warm southern lakes, but the
child in this photo was the first one to die of amoebic meningitis after swimming in a lake in Minnesota
during a very hot summer, 500 miles north of any previously diagnosed infection. NZ doesn't have long
temp records for its lakes but measurements in Lake Taupo show it has warmed almost 1 degree since
1970 and NZ rivers have also warmed slightly over the last decade. Low water levels during droughts
will increase seasonal water temperatures and the risk of amoebic meningitis for young swimmers.
CASE 3 DENGUE
DENGUE Dengue is a viral infection transmitted by mosquitos. reemerging in the US and Australia.
Dengue sometimes called “breakbone fever” is a severe flu like illness with intense joint pain. There
are two kinds of dengue outbreaks: epidemic, in places like islands that have never experienced
dengue, 1 strain can rapidly infect up to 50% of the population. In places where dengue has been
around a long time, there are frequent cases with different strains but no big outbreak. Both are bad
because in the non epidemic scenario, if a child gets infected a second time with a different strain of
dengue virus, they get hemorrhagic fever, with uncontrollable bleeding and fluid buildup in the lungs
and belly that leads to shock and sometimes death. The US and Australia eradicated dengue by
mosquito control measures but it has returned. The US has had 11 outbreaks since 1980 and a tripling
of hospital admissions from 2000 to 2007, and Australia has had 40 outbreaks since 1995. According to
the WHO dengue is the most rapidly spreading mosquito borne infection in the world. Climate change
increases transmission of mosquito borne diseases. Warmer temperatures extend the mosquito breeding
season, decrease time to maturity, and speed multiplication of virus, so you get more mosquitos who
are more likely to bite, and each bite is more likely to transmit an infection. In addition, climate change

3. is expanding the geographic range of disease-carrying mosquitos.
Aedes aegypti, or Yellow Fever Mosquito, is the most efficient vector for dengue. It lives only in
tropical and subtropical climates because it can't survive cold winters. Aedes aegypti can't live in NZ
today. But by 2050, increased rainfall and warmer temperatures will provide conditions in which it
could thrive. Dengue is also transmitted by Aedes albopictus, the Asian Tiger Mosquito, an aggressive
daytime biter and invader of territory around the world which can survive winter freezes and in the US
is found as far north as Chicago. Both egypti and albopictus are daytime biters, so bed nets are
ineffective for prevention.Researchers at Wellington School of Medicine and the Univ of Waikato
developed a computer program to predict the effect of climate change on the expansion of these
mosquitos, in New Zealand including those that transmit dengue. This is not an abstract exercise.
Albopictus has been intercepted at least 11 times at NZ North Island ports. If it were to get past
Biosecurity, it could establish a foothold right now in Northland. With future climate change it could
expand along the entire coastline of the North Island and in very warm years even reach the South
Island. In addition to dengue, albopictus is a vector for Yellow Fever, West Nile Virus, and several
types of viral arthritis and encephalitis. Immuno-naive populations are extremely vulnerable to
epidemics of these diseases. In 1979 RRV entered Fiji via an infected Australian tourist causing an
outbreak of 50,000 cases and then spread to other islands ultimately infecting over 500,000 people.
MASS DISLOCATION Mosquitos are not the only ones on the move.
Worldwide, environmental events now create more refugees than war and genocide. Poorer countries
will bear the brunt of climate change and some of their refugees will come to NZ bringing diseases of
poverty with them. One of the most concerning is tuberculosis. TB takes a long time to treat and missed
doses result in resistance to medications. In rich countries we have nurses who give people their meds.
In poor countries we end up with a lot of drug resistant TB. Asia and the Pacific Islands to be one of the
areas most vulnerable to climate change. By 2050 over 100 million of their inhabitants will be
displaced by rising seas, failed crops, and extreme weather. Asia and the Pacific Islands also have one
third of the world's MDR TB and when the emigrate to the US they're 20 times more likely than
Europeans to develop active tuberculosis in their new home country.
Extreme weather events in developed countries also cause internal displacement. In the US since 2005
over 7 million people have been evacuated from their homes due to extreme weather events. One big
lesson from Katrina was that the biggest health impact was not illness or injury from flood waters, but
people with chronic diseases decompensating because they were disconnected from their usual source
of care. Outbreaks of communicable disease are also common in shelters where large numbers of
people live in close quarters. Aside from the physical consequences, these experiences leave emotional
scars : 30% of people affected by major fires and hurricanes develop symptoms of Post Traumatic
Stress Disorder.
CASE 4 ASTHMA
POLLEN CO2 acts as fertilizer, especially for weeds and increases pollen production. The graph
shows ragweed pollen production with preindustrial, current and future CO2 levels. High pollen levels
cause flare ups of allergies and increased ER visits for asthma. New Zealand has one of the highest
prevalances of asthma and allergic disease in the world and rising rates of hospitalization for asthma
exacerbations.Climate change is also increasing the length of ragweed's flowering season and its
allergenicity and increasing the geographic range of common allergenic plants.
OZONE Ground level ozone, commonly called smog, is a potent respiratory irritant. It is formed
when nitrogen oxides and VOCs combine in the presence of sunlight. The warmer and sunnier the
weather, the more ozone is produced. New Zealand generally has good air quality and even Auckland,
which has the worst air quality in the country, has levels of ozone below the safety standards set by the

4. Ministry for the Environment. That may be fine for your avarge healthy person, but increases in ground
level ozone, even when they remain below environmental standards, make asthma worse. Increases in
ozone even at low levels also cause increased deaths from heart and lung disease. Warmer temperatures
would increase ozone levels in Auckland and adversely affect people with asthma. Since 1 in 6 adults
and 1 in 4 children in New Zealand are asthmatic, even a small effect could have large consequences.
DROUGHT Drought is becoming more frequent in NZ. In the US, farmers in drought affected areas
have increased rates of suicide. Climate change is expected to increase the frequency and severity of
drought, especially in Canterbury, Otago, and Northland.
HUNGER Crop failures raise food prices. At the moment, the round of extreme weather events in
Australia has increased the price of fruit and veg in NZ. The drought here has cut milk production in
half in the past month with a resulting 15% increase in the price of dairy. In the last national nutrition
survey, 40% of New Zealand households were moderately to severely food insecure. Price increases
worsen food insecurity and health: Kids from food insecure families are more likely to be hospitalized
and in poor health. Iron deficiency anemia, which is associated with poor school performance and
irreversible developmental deficits, is 11x more common in preschool children from food insecure
households, and 8x more common in primary grades. Food prices determine not only how much but
what kind of food people eat. Food insecure adults fill up on cheap empty calories and have increased
rates of obesity and diabetes. In addition to its general impact on the poor, droughts disproportionately
affect the nutritional, spiritual, and mental health of aboriginal people who depend on hunting, fishing
and gathering as part of their traditional diet and low income rural residents who depend on fishing and
hunting to feed their families.
AUSTRALIAN DUST/AUCKLAND Loss of surface vegetation during droughts leads to desert
expansion and dust storms. Dust emissions in Australia have doubled since the 1990s. Big Australian
dust storms like the ones in 2009 increased particulate levels in the northern half of the North Island
and the West Coast of the South Island. Elevated particulate levels are associated with worsening of
asthma and COPD. In Asia, increased admissions for heart and lung disease are seen for up to month
after dust storms and studies show transiently decreased pulmonary function in children.
Dust storms carry bacteria, fungi, toxins and heavy metals. In Africa dust storms are followed by huge
outbreaks (like 250,000 people) of meningococcal meningitis. In California and Arizona we are seeing
epidemic level increases of coccidiodomycosis or Valley Fever, a fungal pneumonia caused by inhaling
dust containing fungal spores.
CASE 5 NITRATE TOXICITY 28 year old woman who lives on a dairy farm is in the 6th month of
her second pregnancy. Her midwife gets concerned because stomach isn't growing as fast as it should
and while waiting in the queue for an ultrasound she goes into labor and delivers a stillborn baby with
multiple birth defects. CLUE Its a drought year. Their water comes from a bore.
GROUNDWATER TOXICITY Droughts increase the concentration of contaminants in ground
water, affecting those who get their drinking water from private bores or bore sourced public water
systems like Hahei, Onemana, and Whangamata in Coromandel. Nitrate is the most common
contaminant in NZ. As you can see from the map, elevated nitrate levels are widespread. Areas at high
risk are those with shallow aquifers and high levels of agricultural nitrogen input. Elevated nitrate
intake in pregnant women results in increased rates of miscarriage and congenital defects. In babies
under 6 months, gut bacteria convert the nitrate to nitrite that binds to red blood cells and prevents
them from carrying oxygen, causing blue baby syndrome. Long term exposure has been associated
with bladder and gastric cancers.
WAIKATO WATER CONTAMINANTS Here are the most recent groundwater test results for
Waikato. The community source water samples were all taken from schools.

5. BUSH FIRE Climate change has increased the frequency and size of wildfires. Wildfire smoke
contains potent respiratory irritants, carcinogens, nitrogen oxides, VOCs, and fine particulates.
The biggest health impacts from fires are from fine particulates. An active wildfire can release as much
as a ton per minute raising the concentration of fine particles in air even many miles away to 7 times
above safety limits. Fine particles cause upper and lower airway inflammation and can pass from the
alveoli into the bloodstream. Studies examining hospital records during and after fires show a rise in
ER visits, admissions, and deaths for asthma, bronchitis, pneumonia, heart attack and stroke,
particularly in the elderly. Studies following the 2003 SoCal fires showed a 34% increase in hospital
admissions for respiratory conditions, primarily among the very young (under 5) and very old, and
decreased birth weights for babies exposed in utero in any trimester. Fine particulates from fire are
more toxic to the lungs than those from other air pollution. Researchers exposed mice to particulates
collected during the 2008 California fires and found increased protein and leukocytes and decreased
macrophages on pulmonary lavage compared with equal doses collected from urban sources. Fire
ecologists in New Zealand predict that fire risk will rise substantially and the fire season will be longer,
especially in the Bay of Plenty, the east of both islands and the central Wellington and Nelson
regions. By 2080 the fire risk will more than double for Gisborne, Napier and Christchurch.
CASE DIARRHEA A small town GP office is overwhelmed by calls from patients with fever,
vomiting, diarrhea and abdominal pain. By the time the cause was found, 125 people had become ill.
(Darfield)
COMBINED SEWER OVERFLOW Combined sewer overflow is a common type of sewer system
where the same pipes that carry away our raw sewage do double duty for storm runoff. When there is
heavy rain, these systems are overwhelmed and the water, mixed with sewage, overflows: into streets,
rivers and lakes. Auckland and Whangarei dump raw or partially treated sewage in their harbors
with heavy rainfall. The health consequences can be severe in locations where surface water is used for
drinking water, like in Thames and most of the Coromandel.
GASTROENTERITIS This is why the majority of drinking water contamination cases in urban
watersheds and nearly 70% of all gastroenteritis outbreaks occur after heavy rainstorms. In 2011, NZ
had 45 such outbreaks of gastroenteritis from contaminated drinking water.
Children are the ones most likely to get severely ill. This slide shows how children's visits to the
emergency room for gastroenteritis (black line) match up with a model based on heavy rainfall (blue
line).Hospital admissions of kids with diarrhea triple after heavy rain.
FLOODS due to heavy rain are the most frequent natural disaster in NZ and these will become more
frequent. Coastal flooding and storm surges will increase in the future due to sea level rise and more
powerful storms fueled by warmer ocean temperatures. By 2030 sea level is predicted to rise about 18
cm, doubling to tripling the risk of 100 year floods. Sea levels will rise up to a meter by the end of
the century and flooding is predicted to increase 5 to 20 fold.
MOLD Mold is a major health hazard in the aftermath of flooding but it doesn't always take floods to
grow mold. New Zealand's 89,000 leaky houses, are vulnerable to mold from heavy rainfall. The
University of Otago's Housing and Health Program estimates these homes result in an additional
$26 million in health costs every year. Mold exposure triggers exacerbations of allergies and asthma. It
may be a cause of asthma as well. A researcher at University of Cincinnati has been following a group
of children at risk of asthma due to their family history. He found that children exposed to mold in the
home as infants had 3x higher rate of asthma by age 7.
LEPTOSPIROSIS Leptospirosis is a severe infection which causes hepatitis and acute kidney failure
that is transmitted to humans when the urine of infected animals comes into contact with the eyes, nose,

6. mouth or broken skin. Reservoirs include wild mammals, livestock, domestic pets and rats. NZ has
experience with this as an occupational disease of farmers and meat handlers, but most cases
worldwide are caused by contact with flood waters or runoff contaminated with animal urine. In
California lepto is considered an emerging disease with a small but increasing number of human cases
in the past decade resulting from recreational contact with contaminated water. Even with recent
vaccination programs, lepto is endemic in livestock and working dogs in New Zealand, who present a
ready reservoir for transmission to humans in the aftermath of heavy rains.
ROAD CLOSURES are another consequence of heavy rain that have health consequences in rural
areas because they cut people off from getting to health facilities.
PUBLIC HEALTH EMERGENCY We are currently facing what the prestigious UK medical journal
The Lancet has called the greatest public health threat of the 21st century. If we continue what the IPCC
calls “business as usual” we'll have a 4-6 degree global temperature rise by 2100. Everything I've told
you about that's already happening is occurring with a global temperature rise of less than 1 degree.
This is a public health emergency, not because everyone will drop dead tomorrow, but because if we
don't act soon, it will be too late. The CO2 we put in the atmosphere today will keep warming our
planet and making people sick for up to 1000 years.
SICK PLANET So to sum it all up: If the planet gets sick, we get sick too. Human bodies evolved and
civilizations developed under certain environmental conditions. If we destroy that finely tuned balance
between ourselves and our environment, chaos ensues.
PLANET B You may have noticed that the old, the young, and people with chronic diseases suffer
most from climate's health impacts because they are more sensitive and less able to adapt. They are like
the canaries in the coal mine whose deaths warned warn miners to ascend when there were toxic levels
of carbon dioxide underground. But when our canaries, our children and our parents, get sick from too
much carbon dioxide, we have nowhere else to go.
Our job is to explain climate change so that people understand that its not an ideological issue but an
inexorable fact of nature, happening here and now, which requires urgent action, and can't be adapted
to, ignored, or wished away any more than a tsunami or a hungry great white shark. This slide show
and speakers notes is available for you to download and use from our website www.climate911.org and
there are NZ doctors from Ora Taiao who you can call upon as speakers. Thanks for listening and I
hope I didn't spoil your appetite for dinner. I'm happy to answer any questions.

7. mouth or broken skin. Reservoirs include wild mammals, livestock, domestic pets and rats. NZ has
experience with this as an occupational disease of farmers and meat handlers, but most cases
worldwide are caused by contact with flood waters or runoff contaminated with animal urine. In
California lepto is considered an emerging disease with a small but increasing number of human cases
in the past decade resulting from recreational contact with contaminated water. Even with recent
vaccination programs, lepto is endemic in livestock and working dogs in New Zealand, who present a
ready reservoir for transmission to humans in the aftermath of heavy rains.
ROAD CLOSURES are another consequence of heavy rain that have health consequences in rural
areas because they cut people off from getting to health facilities.
PUBLIC HEALTH EMERGENCY We are currently facing what the prestigious UK medical journal
The Lancet has called the greatest public health threat of the 21st century. If we continue what the IPCC
calls “business as usual” we'll have a 4-6 degree global temperature rise by 2100. Everything I've told
you about that's already happening is occurring with a global temperature rise of less than 1 degree.
This is a public health emergency, not because everyone will drop dead tomorrow, but because if we
don't act soon, it will be too late. The CO2 we put in the atmosphere today will keep warming our
planet and making people sick for up to 1000 years.
SICK PLANET So to sum it all up: If the planet gets sick, we get sick too. Human bodies evolved and
civilizations developed under certain environmental conditions. If we destroy that finely tuned balance
between ourselves and our environment, chaos ensues.
PLANET B You may have noticed that the old, the young, and people with chronic diseases suffer
most from climate's health impacts because they are more sensitive and less able to adapt. They are like
the canaries in the coal mine whose deaths warned warn miners to ascend when there were toxic levels
of carbon dioxide underground. But when our canaries, our children and our parents, get sick from too
much carbon dioxide, we have nowhere else to go.
Our job is to explain climate change so that people understand that its not an ideological issue but an
inexorable fact of nature, happening here and now, which requires urgent action, and can't be adapted
to, ignored, or wished away any more than a tsunami or a hungry great white shark. This slide show
and speakers notes is available for you to download and use from our website www.climate911.org and
there are NZ doctors from Ora Taiao who you can call upon as speakers. Thanks for listening and I
hope I didn't spoil your appetite for dinner. I'm happy to answer any questions.