Researchers' Working Meeting on Climate Change Impacts
in the Mid-Atlantic Region
Penn State--June 8-9, 1998

(Summarized by Andrea Denny and Grant Yang)

Panel:

Chair - Patricia Kocagil, Penn State
Jonathan Patz, Johns Hopkins University
Anne Grambsch, U.S. EPA/OPPE
Hugh McKinnon, U.S. EPA/National Risk Management Research Lab

Patricia Kocagil outlined the basic concerns and intended directions for the health component of MARA, based on IPCC guidelines and limited to those issues believed to be the most relevant to the Mid-Atlantic Region. Direct health impacts could include thermal impacts from higher temperatures or extreme events such as floods. Indirect impacts could include health effects from increased pollen and spores, air pollution, vector-borne diseases and other infectious diseases.

The health group plans to establish a baseline of current health status and its determinants. This will serve as a benchmark for assessment of climate impacts on health. Establishing this baseline requires collecting a great deal more data. The health group plans to divide the area into sub-regions and collect information about the demographics, lifestyle choices, access to medical care, and current causes of mortality and morbidity. Hopefully, this will allow the group to assess potential changes in the relative risks of certain health endpoints.

Kocagil raised two basic questions: Are the chosen health impacts the appropriate ones for investigation? How can the impacts of climate change on health be projected? The panelists’ presentations may provide insights for these questions.

Under a separate grant to study health impacts, Jonathan Patz’s team has shown links between climate and urban heat islands, air pollution (respiratory problems), vector-borne diseases (malaria), water-borne diseases (cholera), and water resources and food supply (malnutrition). For the Mid-Atlantic region, health issues related to climate change also include cryptosporidiosis (water-borne) and lyme disease (vector-borne). We need to identify priority health issues for both local (or regional) and national assessments. For example, urban heat may be a regional concern but the linkages among climate change, ozone depletion, and stratospheric cooling will be of national concern. Two kinds of studies could relate health effects to climate change: 1) Predict runoff from precipitation and the differences by regions to examine water-related diseases. 2) Select diseases most relevant to the region, and examine the potential link to climate change.

Several other topics are relevant to MARA. One is runoff modeling and links with an agricultural GIS of streams to predict water quality and the spread of diseases such as encephalitis with mild/wet winters and hot summers. Heat mortality is more common in cities that are normally cool (i.e., Northern cities) than in cities with a warmer climate (i.e., Southern cities). It is unknown which path cities will follow under climate change. More people die in winter than in summer and it is difficult to predict how climate change will affect this observed relationship. Finally, heat mortality is affected by sensitivity and vulnerability to heat. Areas where there are high percentages of elderly citizens or high degrees of poverty are more vulnerable to heat mortality. We need to examine vulnerability for other diseases as well as understanding what population groups are vulnerable to climate change.

Discussion:

· Need to consider adaptation and mal-adaptation issues. For example, in the case of mosquito problems, spraying can harm endangered dragonflies, and better wetlands management might be a better option. Another example is the potential for people to become lax in watching for ticks, now that there is a vaccine for lyme disease. But the vaccine is only 70% effective.

· Need to determine whether the seasonal difference in mortality is causal or coincidental. For example, could state of mind, holidays, parties, family gatherings and short days have as much of an impact as cold temperatures?

· Most of the research on insect adaptability has looked at mice, ticks, and mosquitoes, which are the main carriers for this area. It is possible that other animals may also adapt, especially insect predators.

· Vulnerable populations may be at risk because of lifestyle factors.

· Hanta virus has been found in every state and could become a problem in the region, especially in PA with its many hunting cabins.

Grambsch identified the major types of studies relevant to MARA: temperature thresholds (linear), synoptic categorization (linear) and temperature (nonlinear). The studies show significant relationships between temperature and mortality for many areas. The studies also show that temperature thresholds vary by location, responsiveness depends on "what you are used to", and different classifications (e.g., age, cause) are needed in mortality studies. One problem is in identifying heat-related mortalities because they are often classified as a different cause of death.

Applying this knowledge to climate change studies can be difficult. For example, acclimatization and adaptation occur via infrastructure as well as via physiological and behavioral changes. Net changes (summer and winter) need to be considered. Is mortality displacement (elderly dying a few days or months earlier than otherwise) happening, and if so how much of a concern is it? And finally, vulnerability issues related to demographic changes need to be considered.

The next major research needs are: 1) a system of valuing health impacts, 2) characterizing indicators of health (such as specific symptoms or hospital admissions), and 3) examining different response options (e.g., CDC report on city responses, Philadelphia’s experimental emergency heat system, and Washington Weather Warning Systems). Health may be related to air quality because of cogeneration of emissions, meteorological effects on pollution concentrations, and synergistic health effects (e.g., open mouth breathing in hot weather). Many of the existing health studies, air quality modeling and emissions inventories can be used to study health impacts from climate change. Several research gaps still need to be addressed, such as heat-related morbidity, how other weather extremes affect morbidity and mortality, and heat-air quality synergistic effects.

Discussion:

· Insurance premiums do not account for these issues yet, because the premiums are modified annually and insurance companies can afford to wait until impacts are clearer. Changes in premiums could be used as an indicator of health.

· The smoking population is more vulnerable to climate impacts because of other health problems.

· Climate related accidents (e.g., snow and auto accidents) have not been considered because they are not really considered public health. Crime rates also have the potential to be impacted by climate change.

· The research has focused on cities, and results can be used as indicators for non-urban areas. However, research is also needed for decentralized populations.

· More studies are needed on the effectiveness of adaptation, especially among the most vulnerable.

· Risk communication: Most cities have emergency plans. The issue is to use these programs effectively, incorporate community involvement, and tear down language barriers.

EPA has a lot of information about air and water quality, but correlation with health endpoints does not imply causation. His office is using a risk management research approach so that, ultimately, decision makers can choose an optimal action. He suggested studying the links between ecosystems and human health because pooling resources provides numerous environmental and health indicators.

He then outlined different EPA research programs that might be useful to MARA:

Drinking Water/ Ground Water

• microbial/ DBP control
• small systems/ non-public water supplies
• distribution systems corrosion
• distribution systems water quality
• source water protection
• subsurface pathogens
• aquifer vulnerability
• water re-use/ wastewater

Wet Weather Pollution Control

• urban watershed management
• stormwater-groundwater interaction
• toxics characterization
• storm inlet treatment devices
• rapid sedimentation, disinfection, corrective action
• control sewer overflow disinfection
• wet weather flows

Air Pollution

• source identification and characterization
• tropospheric ozone
• fine particle source characterization and control
• greenhouse gas mitigation
• global climate change adaptation

Pollution Prevention

• pollution prevention tool development/ application
• life cycle analysis
• product / process substitution (especially manufacturing and chemical processes)
• separation technology (membrane, etc.)

Discussion:

· Air and water quality information can be organized in relation to climate by the policy office of EPA and CDC, but questions need to be framed correctly.

· Wastewater is treated for pathogens, but it is still costly to remove nutrients such as nitrogen and phosphorous. The growth of the phisteria problem may make this more of a priority.

· Some types of adaptation strategies are necessary to mitigate the impacts. For example, examine where additional air quality improvement might be appropriate because climate change might exacerbate air quality problems or health impacts. Another example is redesigning infrastructure for water supply systems or waste-water treatment systems when they need to be replaced.