Hi, this is Tom Burke. Today, I want to talk to you about weather. Yeah, the weather like the climate. But, first, I want to start with a couple of questions. Has climate change had an impact on you? How? Health? Maybe behavior? Your local environment? Your water supply intake? How about the food you eat? Or has it had a financial impact on you? What kind of other impacts might climate change have had on you? Think about that. Well, climate impacts everything. Everyone is vulnerable to climate impacts on their health and well being at some point in their lives. It even impacts the clothes you wear. Think about it. First thing in the morning, I check the temperature, and also as a public health official, I was also very aware of the weather because the weather changes everything. Climate change can have a range of impacts on physical, mental effects, community health. Some groups of people, particularly the very young and the very old are especially vulnerable to climate change. So, today I want to talk about a public health perspective, a public health lens on climate impacts. Now, I know there's been lots of controversy and political argument about climate change and its causes and things like that, but really in this course, we want to focus on the public health perspective. So, in this slide, you see a very lengthy progression, but if you really look at it it's a pretty cool looking diagram from a paper that I worked on, on the interrelationship from the global level of the ecology, right down to the community level, the population level, and right down to our organs and tissues and cells and even below the cellular level. There are aspects of the weather or the climate that really affect us, temperature, air quality, water resource impacts, extreme events, illness, mental health often forgotten about. Think of Katrina and the impacts after the hurricanes. But, also think about how rough it is to weather many many hot days on end or extremely cold weather. So, mental health too. Food safety is an issue, and really in public health something that affects all of the practitioners, populations of concern. The key to public health is protecting the most vulnerable. So, I want to go through some examples of the public health impacts of climate change. So, I think we're all familiar with heat waves. I used to play summer basketball in Jersey City, New Jersey and there's nothing like summer basketball leagues, but sometimes when the temperature is still in the 90's in the evening and you're playing on those hard concrete courts, it's really tough. You have to be worried about even with athletes, extreme heat causing dehydration, and cardiovascular, and respiratory effects. So, imagine the vulnerable population during the same times of heat waves, the vulnerability of some outdoor workers, low-income households with no air conditioning, pregnant women. I remember searching all over upstate New York for a fan at our little summer rental cottage there when my wife was very pregnant and we just couldn't seem to cool the place. So, there are stages in the life of all people where things related to whether really make a difference. Of course, they're the really dramatic effects and so in this slide, you see a catastrophic day and actually series of days for Chicago and Cook County, where there was a spike in temperature and as you see that back in 1995, excess deaths, heat-related deaths, soared. So, you see this trend analysis of daily mortality, and there in July, between the 11th and 27th. You see this incredible spike where the daily death rate more than doubled. That's an effect, that's an enormous effect. Now, that's an extreme event. It doesn't take extreme events to really affect our health. So, going on with the health effects, the next big one is cardiovascular and respiratory effects. Changes in climate affect the air we breathe, not just outdoors, but indoors. Warmer temperatures and shifting weather patterns, can worsen air quality both in the summer and winter, and exacerbate or lead to asthma attacks and other respiratory and cardiovascular health effects. Ozone. Now, here in Baltimore, we have challenges with ozone. In fact, we're in violation of standards in certain days, particularly hot days, because of the regional impacts of pollution in our area. People exposed to higher levels of ground-level ozone are at greater risk to dying prematurely, being admitted to the hospital for respiratory problems. I know knowing so many clinicians here at Hopkins, that you can see the effects of temperature in our emergency rooms, not just here in Baltimore, but throughout the world. Ground-level ozone can damage lung tissue, reduce lung function, and inflame airways. It aggravates asthma and other lung diseases in children and older adults, outdoor workers who are forced to be out there in poor air quality have a real challenge with ozone related to changes in temperature. One of the dramatic effects in 2017 has been the amazing, lengthy wildfire season in California, unprecedented amounts of wildfires. From this slide and this picture of the tremendous plume of smoke, which really is particulate air pollution outside the city of Los Angeles, you see that millions of people around the world are subject to the health challenges related to wildfires, not just the acute effects of burning up and losing everything and the emotional impacts of that, but the effects of particulate matter. Now, scientists don't know yet whether climate change will increase or decrease particulates in the air, but certainly wildfires and climate-related events, wind patterns, and emissions have an effect on our health. Talking a little bit more about asthma and allergies, allergic illnesses including hay fever. "I have allergies and I have to take a decongestion," pretty much every day. But, you think about allergic illnesses and the extension of the allergy season that many areas of the globe are seeing. You think about asthma affecting millions of Americans. It's estimated, there are 34 million Americans that have been diagnosed with asthma. These are things that are really exacerbated by changes we see in our weather, in our climate. From the length of the growing season for certain allergy potential or exacerbating pollens on to ragweed, which we certainly see in our area of the school here in Maryland. But worldwide, those who are vulnerable are subject to this health effect. Then of course, there are the extreme weather events. I think, most people, it's still debated just whether the extreme events like hurricanes are actually caused by man-made global warming. Clearly, there's always been extreme weather events. But I think the scientific consensus is growing, the climate change increases the probability and the frequency of extreme weather events. Certainly, that seems to be the data that we're seeing. So, if you look at 2017 in recent years, we have had tremendous extreme weather events. Think of those many health affects, the traumatic injury and death, traffic-related crashes, drownings, or failed water rescues, isolation of health care and nursing facilities, the tragedies in Hurricane Katrina of folks in nursing homes, who couldn't be reached, who couldn't have access to the appropriate care and even more recently, we see that in Puerto Rico with a great power outages. My own mother was in a nursing facility, very near death, and Superstorm Sandy in New Jersey, and we were frantic because for three days, because of down trees and power failures, we couldn't get to my mother. So, these are real, they affect everyone. There's food and drinking water related illnesses, that are of a much higher probability during weather event. It's hard to get clean water to folks after extensive rains and flooding. Then, you have the related vector-borne or bug-borne illnesses. Let's face it. After heavy rains, we know there's lots of good nesting grounds for bugs and after a major storms, we have to be very concerned particularly about mosquito-borne illnesses, but other things as well. I also know having been a health officer, irritants like rodents and rats, and water bugs seem to get routed from the sewers, and from construction sites, and vector-borne illnesses is a reality during extreme weather events. Sometimes, we don't realize that people who have been evacuated have lost their medication. How do you get your blood pressure medication? How do you get your heart medicine? These are the kind of things that perhaps don't make headlines, but are really important to all our health. Most of us need daily medication. Medication access is very important. Then finally, mental health. I think this is something we unfortunately underestimate, but extreme climate events put tremendous stress on the mental health of even the strongest. Imagine losing everything in the wildfires, or imagine being evacuated for a long time, or being unable to be with your family members. This exacerbates pre-existing mental health and stresses the mental health of all of us. So, I mentioned 2017 being a tremendously active year from a climate perspective, in this slide, you see there's something unseen before, three active hurricanes in the Gulf and the South Atlantic. So, this slide shows the actual data from Superstorm Sandy. It's close to my heart, and some of the biggest impacts we're in my home state of New Jersey. Storm related deaths and how did they shake out here? Well, we're all aware of the tragic drownings from floods. But think about these other things. Perhaps, preventable causes of death and injury, automobile accidents, falls, illness related to vectors or contaminated food or water, in some instances fire, falling trees is a big one. So, these are things that we as a public health community can take a look at, be informed by the data and take measures to keep people out of harms way during these catastrophic events. Evacuations are reality in this changing world. Evacuations, I can tell you as a former health commissioner, some of the toughest calls. They also have risk with them. So, I talked about the bugs, and the fleas, and the ticks, obviously, an enormous part of kind of post-storm or high precipitation. But even more than that, there's not a farmer in the world who doesn't realize changes in weather and who isn't aware of them. Our food is dependent upon a certain constant condition for optimal preparation of food and so, it's important that we understand that climate has an effect on our food supply. I want to close with talking a little bit more about the most vulnerable. As I mentioned at the start, public health is driven by protecting those of us who are most vulnerable. When it comes to climate change, I think one of the lessons of this session is, we're all vulnerable. But particularly, populations of color, immigrants, and low income, children, the very young and the very old. Those with pre-existing conditions and disability and chronic diseases, might suffer the most from a changing climate where we are not adapting to that change. The lesson is, climate change is a public health issue. It's not just about polar bears or losing the glaciers. It's not a war about cold. It's not a war about carbon. The real war is the war to protect public health. The impacts are real, they're occurring now in every community around the globe. We in the public health community, have a real responsibility to understand the range of impacts, to use our unique public health lens to understand who's vulnerable, and work together to adapt to change and protect public health.
