October 8, 2014 Peter Orris, MD, MPH, FACP, FACOEM - 9th Annual Air Quality Governance Lekgotla - Saaqis
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9th Annual Air Quality
Governance Lekgotla
UMhlanga, Kwazulu-Natal Province,
South Africa
October 8, 2014
Peter Orris, MD, MPH, FACP, FACOEM
Professor and Chief
Occupational and Environmental Medicine
A WHO Collaborating Center
All opinions expressed in this presentation
are my own
And
do not necessarily represent the
University of Illinois
or
World Health Organization
NOAA, Todd Heitkamp Wikimedia Commons USEPA, Wikimedia Commons Jami Dwyer, Wikimedia Commons
National Parks Service, Wikimedia Commons
“CLIMATE CHANGE IS THE BIGGEST GLOBAL HEALTH
THREAT OF THE 21ST CENTURY… THE IMPACTS WILL
BE FELT ALL AROUND THE WORLD – AND NOT JUST IN
SOME DISTANT FUTURE BUT IN OUR LIFETIMES AND
THOSE OF OUR CHILDREN.”
THE LANCET 2009
3
USDA, Wikimedia Commons NOAA, Wikimedia Commons Suat Eman, freedigitalphotos.net
www.niehs.nih.gov/climatereport - April 2010
BY THE 2080’S: THE GREATEST ABSOLUTE LOSSES OF POPULATION BASED LABOR WORK CAPACITY (IN THE RANGE 11% TO 27%) ARE SEEN UNDER THE A2 SCENARIO IN SOUTHEAST ASIA, ANDEAN & CENTRAL AMERICA, AND THE CARIBBEAN.
Source: IPCC, 2007
10• Livestock:9- 18% anthropogenic
emissions
• 80% agricultural emissions
Contributors
to climate
changeGHG emissions accelerate despite reduction efforts. Most emission growth is CO2 from fossil fuel combustion and industrial processes. Working Group III contribution to the IPCC Fifth Assessment Report
Coal expansion plans
New Power stations (2016~2021)
New (MW)
동부그린 #1 (‘16. 6) 550
#2 (‘16.12) 550
영 흥 #7 (‘18.12) 870
#8 (‘19. 6) 870
신 서 천 #1 (‘18.12) 500
#2 (‘19. 6) 500
NSP IPP #1 (‘18.10) 1000
#2 (‘19. 4) 1000
G프로젝트#1 (‘19. 4) 1000
#2 (‘19.10) 1000
동양파워 #1 (‘19.12) 1000
#2 (‘21. 7) 1000
동부하슬라#1 (‘19.12) 1000
#2 (‘20. 6) 1000
11,840 (14 plants)
Working Group III contribution to the
IPCC Fifth Assessment ReportCOAL WORKERS
PNEUMOCONIOSIS
&
SILICOSIS
1819 Coal accounted for 25% of global energy consumption in 2005, but generated 41% of the CO2 emissions that year. (Epstein, P. Ann. N.Y. Acad. Sci. 1219 (2011) 73–98
24
COAL & ENERGY Independent of other factors, access to electricity has a positive effect on population health The Problem: 25% the world’s electricity is generated from the combustion of Coal 1,200 new power plants are currently under consideration Wang, L POLICY RESEARCH WORKING PAP'ER 28 31, “Health Outcomes in Poor Countries & Policy Options” The World Bank, April 2002 Epstein, P et al “Full cost accounting for the life cycle of coal “ Ann. N.Y. Acad. Sci. 1219 (2011) 73–98 New York Academy of Sciences.
www.pnas.org/cgi/doi/10.1073/pnas.1300018110
CHINA’S HUAI RIVER POLICY
WHICH PROVIDED FREE WINTER HEATING VIA THE PROVISION OF COAL FOR BOILERS IN
CITIES NORTH OF THE HUAI RIVER BUT DENIED HEAT TO THE SOUTH.
LIFE EXPECTANCIES ARE ABOUT 5.5 Y (95% CI: 0.8, 10.2) LOWER IN THE NORTH OWING
TO AN INCREASED INCIDENCE OF CARDIORESPIRATORY MORTALITY.
LONG-TERM EXPOSURE TO AN ADDITIONAL 100 ΜG/M3 OF TSPS IS ASSOCIATED
WITH A REDUCTION IN LIFE EXPECTANCY AT BIRTH OF ABOUT 3.0 Y
(95% CI: 0.4, 5.6).CHEMICAL FORMS OF MERCURY
Elemental
Liquid metal
Inorganic salts
Mercuric chloride
Organic
Methyl, ethyl, dimethyl
Phenyl organic groupsEXPOSURE PATHWAYS
Bio-magnification of Mercury
Source: South Florida Restoration Science ForumHEALTH EFFECTS OF METHYL MERCURY
ON HUMANS
Systemic
Inhalation
Oral
Dermal
Existing Studies (ATSDR 1998)Mercury: Effects of Low Dose Prenatal Exposure
Children with low prenatal µg/l Children with high prenatal
mercury mercury
exposure >50
50 g/l exposure
40
test
with
7 years
30
with low
Percent of Children with Low Scores
Children
7 years
ageage
of children
20
at at
Island
scores
lowest scores
Per cent
10
% Faroe
0
ATTENTION LANGUAGE
MOTOR MEMORY
VISUOSPATIAL
Grandjean, et. al., Neurotoxicology & Teratology, 19:6, 1997THE SIGNIFICANCE OF SMALL EFFECTS:
EFFECTS OF A SMALL SHIFT
IN IQ DISTRIBUTION IN A
POPULATION OF 300 MILLION
mean 100
7.0 million 7.0 million
"impaired"
"gifted"
40 60 80 100 120 140 160
I.Q.
70 1305 POINT DECREASE IN MEAN IQ
Mean 95
57%
INCREASE
11 million 4 million
“impaired" "gifted"
40 60 80 100 120 140 160
70 I.Q. 130Public Health and Economic
Consequences of Methyl Mercury Toxicity
to the Developing Brain
Leonardo Trasande, Philip J. Landrigan, and Clyde Schechter
Mount Sinai School of Medicine, New York, New York, USA
Environ Health Perspect 113:590–596 (2005).
$1.3 billion
each year is attributable to
mercury emissions from
U.S. power plants.
Photo: Illinois State Geological SurveyHealth Care Costs of Air Pollution
WHO estimates 7 Million Deaths Linked to Air Pollution in 2012
Outdoor Air Pollution Causes of Death
“Excessive air pollution is often a by-
product of unsustainable policies in sectors
such as transport, energy, waste
ischaemic heart disease
management and industry.
stroke
In most cases, healthier
strategies
chronic obstructive pulmonary
disease (COPD)
lung cancer
acute lower respiratory
will also be more economical in the
infections in children
long term due to health-care cost savings
as well as climate gains”
Dr Carlos Dora
WHO Coordinator for Public Health, Environmental and
Social Determinants of Health
Source: World Health Organization (WHO)
URL: http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/Health Care Costs of Air Pollution
Air Pollution Health Care Costs by Country
$69 billion USD (£41 billion) in China in 2005(1)
$60.5 billion USD (£36 billion) in United States over 30 years(9)
$397 million USD (£236 million) in Canada in 2008(8)
$335 million USD (£199 million) in South Africa in 2002(5,6)
$191 million USD (£113 million) in Mexico from 2010 to 2013(2,3)
$150 - $693 million (£89 – 413 million) in Costa Rica in 2011. (14)
$12 million USD (£7 million) in Denmark annually (7)
Source: Multiple international sources
See slide notes for specific referencesHealth Care Costs of Air Pollution
Geography and trends in air pollutants
The World Bank estimates outdoor air health costs are between
1% and 2.5% of GDP in 4 countries: China, India, Pakistan and Iran
Health Cost Attributed to Outdoor Air Pollution
Source: World Bank. India - Diagnostic assessment of select environmental challenges (Vol. 1 of 3) : An analysis of physical and monetary losses of
environmental health and natural resources (English). Disaster Risk Mgmt & Clim Change (SASDC) 2013 06/05;70004.Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2
Climate Change Impacts in the United
States
Climate Change Projected to Worsen Asthma
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2Climate Change Impacts in the United
States
Ragweed Pollen Season Lengthens
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2Climate Change Impacts in the United
States
Projected Changes in Tick Habitat
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2Climate Change Impacts in the United
States
Projected Change in Heavy Precipitation Events
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2Climate Change Impacts in the United
States
Heavy Downpours are Increasing Exposure to Disease
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2Climate Change Impacts in the United
States
Harmful Bloom of Algae
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2Climate Change Impacts in the United
States
Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The
Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2ALTERNATIVE ENERGY GENERATION
We estimate that
3,800,0005MW wind turbines,
49,000 300MW concentrated solar plants,
40,000 300MW solar PV power plants,
1.7 billion 3kW roof top PV systems,
5350 100MW geothermal power plants,
270 new 300MW hydroelectric power plants,
720,0000.75 MW wave devices
490,0001MW tidal Turbines
Can power a 2030 world
Barriers to the plan are primarily social and political, not technological or economic.
Photos: HCWH, Practice Greenhealth
The energy cost in a WWS world should be similar to that today.Substantial reductions in emissions would require large changes in investment patterns. Working Group III contribution to the IPCC Fifth Assessment Report
Health Care Costs of Air Pollution
Health Care cost savings opportunities
Clean Air Act is estimated to save the United States $2 trillion
(£1.2 trillion) from 1990 to 2020 in health and welfare benefits.
Instance Reductions Due to Clean Air Act (estimated for 2020)
0 0
Mortality Non-fatal Chronic Acute Hospital Emergency -500 000 Respiratory Asthma
myocardial bronchitis bronchitis admissions room visits symptoms exacerbations
-50 000 infarction -1 000 000
-1 500 000
-100 000 -2 000 000
-2 500 000
-150 000 -3 000 000
-3 500 000
-200 000 -4 000 000
-4 500 000
-250 000 -5 000 000
Source: United States Environmental Protection Agency (EPA). The Benefits and Costs of
the Clean Air Act from 1990 to 2020; Final Report Rev. A. U S EPA Office of Air and
Radiation 2011 Apr 2011.Health Care Costs of Air Pollution Health Care cost savings opportunities If India’s particulate matter pollution was reduced by 10% via taxes on coal and oil production, it would save $34 billion (£20 billion) annually in health damages by 2030. If India’s particulate matter pollution was reduced by 30% via taxes on coal and oil production, it would save $67-105 billion (£40-62 billion) annually by 2030.(10,11) Source: World Bank See slide notes for specific references
Global Climate Change and
Human Health Resolutions Francesco Marino, freedigitalphotos.net
2001
The World Federation of Public Health Associations
Realizing that subsequent health effects from such perturbations in the climate system would
likely include an increase in:
1) heat-related mortality and morbidity;(8-10, 3)
2) vector-borne infectious diseases, because temperature strongly determines pathogen
replication, as well as vector maturation, range, and infectivity period;(11-13; 4)
3) water-borne diseases due to increases in heavy precipitation (22; 4)
4) malnutrition from threatened agriculture, (14,15) especially in developing countries where
up to an estimated 300 million additional people may be at risk from hunger due to climate
change;(16,6) and 5) general public health infrastructure damage from weather disasters and
sea-level rise, aggravated by subsequent climate-related human migration;(18-20)
the public health community needs to act
56“The health sector must add its voice – loud and
clear…we must fight to place health issues at
the center of the climate agenda. We have
compelling reasons for doing so. Climate
change will affect, in profoundly adverse ways,
some of the most fundamental determinants of
health: food, air, water.”
- Dr. Margaret Chan, Director General of the World Health
Organization, December 2007
Freedigitalphotos.net, Danilo Rizzuti, Jscreationzs, Carlos Porto
57Health Care Professionals are Influential Opinion Setters
Bending the Cost Curve
U.S. Hospital Energy Savings
Annual savings could exceed
$5.4 billion (£3 billion)
over five years, and
$15 billion (£9 billion)
over 10 years
Annual Energy Savings:
$2 billion (£1 billion)
by year 5
$6 billion (£3.5 billion)
by year 10
Source: The Commonwealth Fund Issue Brief, November 2012, Can Sustainable Hospitals Help Bend the Health Care Cost Curve?
URL: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Nov/1641_Kaplan_can_sustainable_hosps_bend_cost_curve_ib.pdfKaiser Permanente
Sustainability Cost Savings (2009-2011)
US $ 63.1 MILLION SAVED
Source: Kaiser Permanente – information not publically available/not for publication or public distribution (£37.7 MILLION)GLOBAL GREEN AND
HEALTHY HOSPITALS
1. Cost Savings: Health Care Environmental Footprint
Reduction
2. Health Care Costs of Air Pollution and Potential SavingsJune 25, 2014
For more information about the
Climate and Health Literacy Consortium
and to access more resources please visit:
http://www.noharm.org/us_canada/issues/
climate/chlc/resources.php
Photo credit: Francesco Marino, freedigitalphotos.netPartnering Associations
www.rcog2014.com
February 11-15, 2015 Kolkata
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In Collaboration withACKNOWLEGEMENT Slides Developed From Materials of WHO, HCWH, UNEP, WHO, WWF Maine Department of Environmental Protection Colleagues at University of Illinois Postings on the Internet Thanks to all these colleagues for their slides and materials to be edited by me for presentation
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