About Climate Change and Health

Published literature on the possible health consequences of climate change in the United States identifies a number of potential outcomes, mostly adverse, that are of interest to public health practitioners. For example, if the summer heat waves become more frequent or last longer, heat-related morbidity and mortality, particularly among the urban, elderly poor, could increase. Because higher temperatures have been shown to exacerbate air pollution, longer, hotter summers may lead to increased respiratory illness in our cities, where more than 75% of the American population now lives. On the other hand, there may be health benefits to climate change; for example, reduced winter mortality. The habitats of disease-carrying insects or rodents may change as regional climates become more or less hospitable to them. As we have seen during the recent series of El Niño events, extreme weather events result in injury, illness, emotional distress, and even death; changes in the hydrological cycle may result in increased severity and frequency of storm events like those driven by El Niño and a resulting increase in such morbidity and mortality. Additionally, storm events can result in exposure of people to water and food-borne diseases as a result of contaminated storm water runoff and flooding.

About the National Assessment

The U.S. Global Change Research Program (USGCRP) was created in 1989 by Presidential Initiative, and formalized in 1990 by act of Congress. Its mission is to coordinate the global change resources and research activities of several federal agencies. USGCRP's budget supports scientific research on key global change environmental issues. In the authorizing legislation, Congress required the USGCRP to conduct a national assessment of the impacts of climate change and climate variability. That effort was begun in 1997, and a report to Congress is due in January 2000.

More specifically, the "Global Change Research Act of 1990" (P.L. 101-606) states that the federal interagency committee for global change research of the National Science and Technology Council "shall prepare and submit to the President and the Congress an assessment which -

1. integrates, evaluates, and interprets the findings of the Program and discusses the scientific uncertainties associated with such findings;
2. analyzes the effects of global change on the natural environment, agriculture, energy production and use, land and water resources, transportation, human health and welfare, human social systems, and biological diversity; and
3. analyzes current trends in global change, both human-inducted and natural, and projects major trends for the subsequent 25 to 100 years."

The assessment process emphasizes the participation of government, industry, non-profit organizations, academic and research institutions, and the public. Three levels of assessment are underway.

First, twenty different "regional" groups-19 defined geographically, and the 20th involving tribal nations-are involved in identifying specific regional issues surrounding climate change. Almost all of these groups have held regional workshops and have issued workshops reports.

At the same time, analyses focused on various key national sectors are underway. Among these sectors is the human health sector described below. Other sector groups are addressing agriculture, forestry, water resources, and coastal areas.

Finally, there is a National Assessment Synthesis Team (NAST) whose job is to integrate the efforts of the regional and sector teams into a synthesis report to be submitted to Congress.

About the Health Sector Assessment

The health sector is preparing an assessment that is intended to address four key questions:

1. What is the current status of the nation's health, and what are current stresses on our health?
2. How might climate change affect the country's health and existing or predicted stresses on health?
3. What is the country's capacity to adapt to climate change, for example, through modifications to the health infrastructure or by adopting specific coping mechanisms? What are the negative health impacts, if any, of adapting? What are the co-benefits, if any? What are the economic and social costs/benefits?
4. What essential knowledge gaps must be filled?

These questions can be answered, to the extent an answer is currently possible, through comprehensive research in a range of sources, including scientific literature; government reports and information; ongoing and unpublished research; and some computer modeling, using climate change and socioeconomic scenarios developed by the NAST.

Our assessment will look at what is known about the relationship between climate and health, and at the effects warmer temperatures, sea level rise, and changes in the hydrological cycle might have on human health in the United States. We must factor in expected changes in the American population and way of life as a result of aging, urbanization, immigration patterns, population growth, economic development, and other changes. We must also evaluate the extent to which the nation can adapt to or mitigate the health effects of climate change, and identify other current and possible future health priorities for the country that might compete for the nation's attention and resources.

About the Health Sector Assessment Team

The Health Sector Assessment is co-chaired by Dr. Jonathan A. Patz, Director of the Program on the Health Effects of Global Environmental Change at Johns Hopkins University School of Public Health, and Dr. Michael A. McGeehin, Chief of the Centers for Disease Control (CDC) Health Studies Branch, and is directed by Ms. Susan M. Bernard, also of Johns Hopkins. A group of eight lead authors has been assembled from a range of government, academic, and private institutions: Dr. Kristie L. Ebi of the Electric Power Research Institute; Dr. Paul R. Epstein, Associate Director of the Center for Health and the Global Environment at the Harvard Medical School; Ms. Anne Grambsch of the Environmental Protection Agency; Dr. Duane J. Gubler, Director of CDC's National Center for Infectious Diseases, Division of Vector-Borne Disease; Dr. Isabelle Romieu of CDC's National Center for Environmental Health; Dr. Joan B. Rose of the Department of Marine Sciences at the University of South Florida; Dr. Jonathan Samet, Chief of the Epidemiology Department of the Johns Hopkins University School of Public Health; and Ms. Juli Trtanj, Office of Global Programs at the National Oceanic and Atmospheric Administration.

About the Involvement of Public Health Practitioners

Although responsibility for conducting the assessment rests with the Assessment Team, comments and suggestions by other interested people in the public health field is critical to the success of our assessment. We are particularly interested in ascertaining the answers to the following questions:

1. What does the public health community know about global climate change?
2. What are the current health problems and stresses facing the American public?
3. What health priorities are anticipated by the public health community over the next 20 to 100 years?
4. How significant a problem (or how significant a benefit) does the public health community expect the health effects of global climate change to be? What information is that judgement based on?
5. Can (and should) the public health community take steps now or in the near future to mitigate or adapt to the possible health effects of climate change?
6. What research is needed to fill in the gaps in the public health community's knowledge of potential connections between human health and climate change?

Public health practitioners interested in helping to defining the scope of our investigation and in defining the concerns and priorities of the public health community with respect to health and climate change are invited to attend a special session at the American Public Health Association's upcoming convention (November 16 through 19, 1998, in Washington, D.C). If you are planning to attend the convention, please come to the session on the National Assessment, scheduled for Tuesday, November 17, 1998, at 4:15 to 5:45 in the Renaissance Hotel, Room No. 8 (note the APHA schedule is subject to change; please check the final schedule at the conference).

Beyond that meeting, we are inviting members of the public health community to participate by (1) reviewing and commenting on our proposed work plan; (2) attending a workshop to be held in early 1999; and (3) reviewing and commenting on the draft report. If you are interested in receiving more information or in participating in the assessment, please send an email to healthfx@jhsph.edu or call 410-955-4195 or 410-955-4074.