Heat Advisory: Protecting Health on a Warming Planet

Heat Advisory

Protecting Health on a Warming Planet

Alan H. Lockwood, M.D.

The MIT Press

Cambridge, Massachusetts

London, England

© 2016 Massachusetts Institute of Technology

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Library of Congress Cataloging-in-Publication Data

Names: Lockwood, Alan H., author.

Title: Heat advisory : protecting health on a warming planet / Alan H. Lockwood, M.D.

Description: Cambridge, MA : The MIT Press, [2016] | Includes bibliographical references and index.

Identifiers: LCCN 2016004065 | ISBN 9780262034876 (hardcover : alk. paper)

eISBN 9780262335720

Subjects: LCSH: Global warming—Health aspects. | Climatic changes—Health aspects. | Medical anthropology.

Classification: LCC RA793 .L66 2016 | DDC 613/.1—dc23 LC record available at https://lccn.loc.gov/2016004065

ePub Version 1.0

d_r0

To Anne—

and my family, present and future

Table of Contents

Title page

Copyright page

Dedication

Preface and Acknowledgments

1 Introduction

2 The Scientific Evidence for Climate Change

3 Heat and Severe Weather

4 Infectious Diseases

5 Climate Change, Agriculture, and Famine

6 Sea Level Rise and Environmental Refugees

7 Air Pollution, Air Quality, and Climate Change

8 Violence, Conflict, and Societal Disruption

9 Economic Considerations of Climate Change and Health

10 Protecting Health

Index

List of Tables

Table 1.1 Selected causes of death

Table 1.2 Risk factors for disease, worldwide

Table 2.1 Properties of long-lived atmospheric global warming gases (IPCC Fifth Assessment Report, Working Group I, Table 8.2)

Table 2.2 Global methane budget

Table 2.3 Predicted global mean sea level increases relative to 1986–2005 for four relative concentration pathway (RCP) scenarios

Table 3.1 Future climate change impacts on US mortality rates in the 2080 to 2099 time interval for the RCP2.6 and RCP8.5 scenarios

Table 3.2 Excess deaths due to heat for various World Health Organization regions

Table 3.3 Observed changes in heavy rainfall patterns in the United States, 1958–2012

Table 5.1 Agricultural commodity production, 2013, in millions of metric tons

Table 5.2 Crops vs. weeds

Table 6.1 Sea level rise and percent of expected flooding in major US cities

Table 7.1 Annual health benefits attributable to the Clean Air Act

Table 7.2 Annual health benefits expected after new ozone air quality standard, year 2025; includes ozone and particle-reduction effects

Table 9.1 Projected sea level increases

Table 9.2 Impacts of climate change on US agricultural yields with and without CO2 fertilization

List of Illustrations

Figure 1.1 Critical relationships between climate change ecosystem effects and human health. Adapted from figure SDM 1 in C. Corvalán, S. Hales, A. J. McMichael, Millennium Ecosystem Assessment (Program), and World Health Organization, Ecosystems and Human Well-Being, Health Synthesis: A Report of the Millennium Ecosystem Assessment (Geneva: World Health Organization, 2005).

Figure 2.1 A: Monthly average temperatures recorded in the Midlands region of England from 1659 to 1973 showing relative stability during this period. G. Manley, Central England Temperatures: Monthly Means 1659 to 1973, Quarterly Journal of the Royal Meteorological Society 100 (1974): 389–405. B: Global near-surface air temperatures from 1880 to 2010, compiled by the NASA Goddard Institute for Space Studies. The zero point is the average temperature from 1961–1990, as per the practice of the IPCC. The figure shows a general warming trend during this time. Similar data have been published by NOAA, the Hadley Unit of the UK Meteorological Office, and Berkeley Earth. Figure prepared by Robert A. Rhode for the Global Warming Art project, reproduced per terms of GNU free documentation license v 1.2.

Figure 2.2 Climate data from Vostok ice cores covering 420,000 years. From top to bottom: atmospheric CO2 concentration in parts per million by volume, which reached 400 ppmv in 2013; temperature change determined from hydrogen isotopes; CH4 concentration in parts per billion by volume; changes in global ice volume determined from oxygen isotopes; and solar energy deposits at 65 degrees N latitude, in joules. Figure rendered from color image in Wikimedia Commons file Vostok 420ky 4 curves insolation, in public domain.

Figure 2.3 The earth’s carbon cycle. This is a highly simplified version of the IPCC Working Group I, Fifth Assessment Report, Figure 6.1. It shows carbon movements between the atmosphere, land, and oceans, omitting many details. All values are in US tons of carbon (not tons of CO2). Fluxes, indicated by arrows, are tons per year at the present time. Bold face type indicates changes after the year of 1750. Regular type indicates fossil fuel and permafrost reserves.

Figure 2.4 The Keeling Curve. This is the record of the concentration of carbon dioxide in the atmosphere at the Mauna Loa Observatory from the late 1950s to the present. It shows a steady increase in the concentration of this important greenhouse gas and the annual fluctuations. The decreases in the concentration during the Northern Hemisphere spring are due to plant growth and carbon dioxide sequestration. In the fall, this process ends, and carbon dioxide levels rise during the winter months. Source: Wikimedia Commons, not copyrighted.

Figure 2.5 Atmospheric concentrations of important long-lived greenhouse gases over the last 2000 years. Increases since about 1750 are attributed to human activities in the industrial era. Concentration units are parts per million (ppm) or parts per billion (ppb), indicating the number of molecules of the greenhouse gas per million or billion air molecules, respectively, in an atmospheric sample. Modified from an original IPCC figure (FAQ 2.1, Figure 1, IPCC Fourth Assessment Report) and reproduced in accord with their copyright requirements.

Figure 2.6 Representative concentration pathways. Global mean annual surface temperature changes (in degrees Celsius) simulated by the Geophysical Fluid Dynamics Laboratory at the National Oceanographic and Atmospheric Administration. Historical conditions (1860–2005) and four projected future RCP scenarios are shown. Named for the approximate RF in year 2100, the RCP scenarios include a low-forcing scenario (RCP2.6), two moderate-forcing stabilization scenarios (RCP4.5 and RCP6), and a high-forcing scenario (RCP8.5). As a work product of the federal government, this figure is not copyrighted and is in the public domain. Adapted from a color figure in Wikimedia Commons from data of D. P. Van Vuuren, J. Edmonds, M. Kainuma, et al., The Representative Concentration Pathways: An Overview, Climatic Change 109 (2011): 5–31.

Figure 5.1 Percentage change in nutrients at elevated CO2 concentrations relative to the ambient CO2 concentration. Numbers in parentheses refer to the number of comparisons in which replicates of a particular cultivar grown under one set of growing conditions in one year at elevated [CO2] have been pooled and for which mean nutrient values for these replicates are compared with mean values for identical cultivars under identical growing conditions, except grown at ambient [CO2]. In most instances, data from four replicates were pooled for each value. Error bars represent 95 percent confidence intervals of the estimates, and [CO2] represents the atmospheric concentration of CO2. Reproduced with permission from S. S. Myers, A. Zanobetti, I. Kloog, et al., Increasing CO2 Threatens Human Nutrition, Nature 510, no. 7503 (2014): 139–142.

Figure 5.2 Undernourishment by region. The percentage of people in each region who are undernourished, adapted from FAO, IFAD, and WFP, The State of Food Insecurity in the World 2014: Strengthening the Enabling Environment for Food Security and Nutrition (Rome: FAO, 2014). Millennium Development Goals remain unmet in sub-Saharan Africa, the Caribbean, Southern Asia, and Oceania.

Figure 6.1 Global average absolute sea level changes, 1880–2013. Cumulative sea level changes based on tide gauge measurements, and likely range of values based on number of measurements and methodological precision (grey) and satellite altimetry (black). Source: EPA, Climate Change Indicators in the United States, accessed October 24, 2014, www.epa.gov/climatechange/science/indicators/oceans/sea-level.html.

Figure 6.2 Average yearly and cumulative thickness of mountain glaciers. In most parts of the world, glaciers are shrinking in mass. Between 1961 and 2005, the thickness decreased by approximately twelve meters. Source: National Snow and Ice Data Center; image in public domain, modified from Wikimedia Commons (Wikipedia entry: Future Sea Level).

Figure 6.3 Future sea levels predicted by the four RCP scenarios. Data extracted from J. A. Church, P. U. Clark, A. Cazenave, et al., Sea Level Change, in Climate Change 2013: The Physical Science Basis; Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change, ed. T. F. Stocker, D. Qin, G-K. Plattner, et al., 1137–1216 (New York: Cambridge University Press, 2014).

Figure 7.1 Pathways linking cardiovascular disease to particulate exposure. Particulates cause acute, subacute, or chronic effects after they enter the blood; produce systemic oxidative stress and inflammation; and affect the autonomic nervous system. Abbreviations: MPO, meyloperoxidase; PAI-1, plasminogen activation inhibitor 1; WBC, white blood cell; ROS, reactive oxygen species; CRP, C-reactive protein; IL-1Β, interleukin 1-beta; IL-6, interleukin-6; TNF-α, tumor necrosis factor alpha; ET, endothelin; HDL, high density lipoprotein; all are molecules mediating or responding to oxidative stress and/or inflammation. Source: A. H. Lockwood, The Silent Epidemic: Coal and the Hidden Threat to Health (Cambridge, MA: MIT Press, 2012).

Figure 8.1 Marginal effects of rainfall deviations on total social conflict events. Increases and decreases in the expected amount of precipitation are associated with increases in violence. The solid line is the estimated percentage change; the dashed lines represent the 95 percent confidence interval. Reproduced with the permission from C. S. Hendrix and I. Salehyan, Climate Change, Rainfall, and Social Conflict in Africa, Journal of Peace Research 49, no. 1 (2012): 35–50.

Figure 8.2 Food riots and the Food Price Index. The Food Price Index was obtained from the Food and Agriculture Organization (http://www.fao.org, accessed January 14, 2015). In time interval A, food riots in Somalia, India, Mauritania, Mozambique, Yemen, Cameroon, Sudan, Ivory Coast, Haiti, Egypt, Somalia, and Tunisia caused approximately eighty-nine deaths. Many more died in time interval B, during riots in Mozambique, Tunisia, Libia, Egypt, Mauritania, Sudan, Yemen, Algeria, Saudi Arabia, Oman, Morocco, Iraq, Bahrain, Syria, and Uganda. These riots claimed more than twenty thousand lives, with more than half of those lost in Libya. Data from M. Lagi, K. Z. Bertrand, and Y. Bar-Yam, The Food Crises and Political Instability in North Africa and the Middle East, 2011, http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1910031.

Figure 9.1 Adaptation and social vulnerability for the contiguous United States. The total population living in areas that would be abandoned, nourished, or armored after a 66.9 cm sea level rise are shown with their Social Vulnerability Index scores. Moving from left to right along the bar chart demonstrates that as social vulnerability increases, the population protected from sea level rise risk (armored and nourished) decreases, while the population living in abandoned structures increases. As a work product of employees of the federal government, this is not known to be copyrighted.

Figure 9.2 State-level direct cost increases from changes in crime rates between 2080 and 2099 under conditions predicted by the RCP8.5 climate change scenario. Reproduced with permission from T. Houser, R. Kopp, S. M. Hsiang, et al., American Climate Prospectus: Economic Risks in the United States, 109 (New York: Rhodium Group, LLC, 2014).

Figure 10.1 Targeting health. Panel A is a key to understanding the remainder of the figure. The magnitude of the risk for each factor is shown by the width of the slice of the pie. The darkened portion of each slice depicts the potential for risk reduction in a hypothetical, highly adapted condition. Panel B shows the relative importance of the burden of poor health at present in a qualitative way. Panel C depicts the risks of and potential benefits to be gained from adaptation in the relative near term, 2030 to 2040. Panel D portrays the relative risks and adaptation potentials toward the end of the century, 2080 to 2100, with a temperature rise of 4°C relative to the preindustrial era. Source: Figure 11–6 (originally in color) from D. Campbell-Lendrum, D. Chadee, Y. Honda, et al., Human Health: Impacts, Adaptation, and Co-Benefits, in Climate Change 2014: Impacts, Adaptation, and Vulnerability; Part A: Global and Sectoral Aspects; Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change, ed. C. B. Field, V. R. Barros, D. J. Dokken, et al., 709–754 (New York: Cambridge University Press, 2014). Reproduced per IPCC guidelines.

Figure 10.2 Plea for blood donations to treat children with dengue hemorrhagic fever. This sign is in front of the Jayavarman VII Hospital in Siem Reap, Cambodia. It is in English and clearly aimed at the increasing number of tourists who visit Angkor Wat and other Khmer temples that surround the city.

Figure 10.3 Maeslant Barrier during a test closure. This storm surge barrier was built to protect the Rotterdam Harbor. It was completed in 1997. When monitoring systems predict a surge of more than three meters, computerized systems flood the dry docks that house each gate. The floating gates are moved to close the 360-meter-wide Rhine River waterway. Once in place, the gates are flooded and sink to prevent the surge from flooding the city and the port. Source: Koninklijk Nederlands Meteorologisch Instituut, http://bit.ly/19JEIiJ, accessed April 1, 2015. Not copyrighted; original in color.

Figure 10.4 The earthquake history of Oklahoma. The USGS estimates that there will be 941 earthquakes with a magnitude of 3.0 or greater for the year 2015 if the frequency continues to accelerate at the rate observed in the spring of that year. In the interval between 1978 and 1999, the state averaged 1.6 earthquakes of that magnitude annually. Modified from a color graph published by the United States Geological Survey. United States Geological Survey, Oklahoma Earthquake Information, last updated April 18, 2014, http://earthquake.usgs.gov/earthquakes/states/?region=Oklahoma, accessed December 29, 2015.

Preface and Acknowledgments

The impetus to write this book arose as I was finishing The Silent Epidemic: Coal and the Hidden Threat to Health. As I wrote, it became clear that there was another, more important story that was larger than one limited to the consequences of burning coal—namely, the effects of climate change on health. Coal continues to exert important ill effects on health during all phases of its life cycle, particularly in countries such as China and India, but the tide is turning. All over the world, ordinary citizens, their governments, and in some cases the power companies themselves all seem to realize that burning coal is not an option if we are to move toward a more sustainable energy future. The once-limiting costs of wind and solar power have fallen precipitously even as some utilities seek to impose restrictive net metering fees on rooftop solar installations.

Utilities that take advantage of the solar option face new challenges. What will they do at night when the sun does not shine? Will a mix of improved battery technology and heat storage technologies fill this void? Or will research and development transform laboratory curiosities—such as the use of light to split water into easily stored hydrogen and oxygen—mature into commercially viable technologies? Wind turbines continue to improve, and plans are emerging to harness the energy of tides, waves, and rivers without building dams.

Chai Jing, a courageous and outspoken Chinese journalist and mother, produced a documentary called Under the Dome that she shows to huge audiences. Its impact was great enough that access to the documentary on YouTube was blocked in China. Now, China has entered into an agreement with President Obama to limit carbon dioxide emissions and has taken steps to initiate a cap and trade policy to control these emissions. Meanwhile, the New York Times reported data from the US Energy Information Administration that shows that the BRIC countries (Brazil, the Russian Federation, India, and China) all generate a larger fraction of their electricity from renewable sources than we do in the United States. Of course, we Americans use much more electricity per capita even as we generate decreasing amounts from coal.

With this information in mind, I approached Clay Morgan, my editor at the MIT Press, about a follow-up to The Silent Epidemic. He and his associates were enthusiastic, and we agreed on a timeline that would see the book in the hands of readers before the 2016 presidential elections. Clay, like me, is now enjoying his retirement, and I am in the capable hands of Miranda Martin, Beth Clevenger, Kathleen Caruso, and their colleagues at the MIT Press. I am particularly indebted to the anonymous peer reviewers whose trenchant comments helped make this a better book. I owe a special debt of gratitude to Melinda Rankin whose invisible copyediting skills improved the style and accuracy of the final text.

The task of writing this book was daunting. Unlike those who made climate science their life’s work, I became a clinical neuroscientist. In many ways, the research challenges I faced prepared me for the task I have undertaken. Success depended on reading trusted sources as widely as possible, making evidence-based decisions, resorting to clinical and scientific judgment when necessary, and moving ahead. I envy writers like Elisabeth Kolbert and others whose well-deserved stature enabled them to obtain support for their work, some of which has influenced mine. Kolbert was able to travel extensively and visit scientists as they worked. I traveled with my computer to the amazing library at the University at Buffalo where helpful librarians were usually able to provide me with papers from other repositories. It was rare to wait more than a day for a loan request to be fulfilled.

I am indebted to a great many individuals whose work I have relied on extensively during the course of writing this book. First and foremost are the authors of the peer-reviewed scientific publications that have provided what I hope is a solid, data- and evidence-based approach to my topic. Many of these authors have been extraordinarily helpful by giving permission to reproduce their work and sending me copies of papers not readily available at the University at Buffalo along with other relevant publications. The numerous scientists who contributed to the Intergovernmental Panel on Climate Change Fifth Assessment Reports have been a constant inspiration and unlocked the doors to important lines of inquiry that are not a usual part of a neurologist’s training and experience. I am indebted to the often-nameless scientists who performed herculean work as they wrote, fact-checked, and reviewed reports published by governmental agencies such as the Environmental Protection Agency, the US Department of Agriculture, the US Energy Information Administration, and others. Although I have tried to rely on the peer-reviewed literature whenever possible, many outstanding organizations, including Physicians for Social Responsibility (PSR), the Sierra Club, and the Natural Resources Defense Council, have made important contributions. Earthjustice receives special thanks for its work and support.

Who can’t help but be inspired by the following sources? In no particular order: James Balog, the genius behind the documentary Chasing Ice; Elizabeth Kolbert, author of The Sixth Extinction, a book that everyone should read; Al Gore, whose An Inconvenient Truth reminds us how to use the bully pulpit; and Bill McKibben and all the good people at 350.org. If James Hansen’s voice had been heeded, this book would not have been necessary. There are scores of others that served as a source of ideas and inspiration.

During my rewarding and varied career as a physician–scientist, I learned to cherish the value of evidence-based decision-making. I try as hard as possible to be aware of sources of bias that affect thinking and behavior. I ask the same of others as we undertake the formidable task of planning for the future we want for our children, grandchildren, and the others who will follow us and who must live with the choices we make today. This generation may be the last one that has any hope of mitigating what some refer to as an impending climate change public health disaster or, from a decidedly more optimistic perspective, the opportunity to deal triumphantly with this public health opportunity. There are many win-win, no-regrets choices to make if we have sufficient wisdom to do so.

As I began final revisions of the book, Pope Francis visited the United States, where he addressed Congress and the United Nations. In his May 24, 2015, encyclical Laudato si’, he wrote: Our sister [Mother Earth] now cries out to us because of the harm we have inflicted on her by our irresponsible use and abuse of the goods with which God has endowed her.¹ Five days later, a multinational group of health professionals wrote this about climate change in the preeminent journal The Lancet: A healthy patient cannot continue with indefinitely rising levels of a toxin in the blood.² Religious leaders, climate scientists, and healthcare professionals all speak with a common voice.

I am proud to have been a member and supporter of Physicians for Social Responsibility for over three decades. I will donate all of the royalties from the sale of this book to PSR to help it in its mission to protect all of us from the greatest threats to survival.

Without the loving support of my wife, Anne, I could not have contemplated taking on the task of writing this book. She was always there, ready to provide the criticisms that improved my effort, find the mistakes that I failed to see, correct the spelling and usage errors that inevitably crept onto my pages (in spite of spell check), and bring me the odd cups of tea or coffee that helped sustain the effort needed to move ahead. It is almost inevitable that errors remain, in spite of Anne’s able efforts and those of my editors at the MIT Press. Those mistakes are mine alone.

Alan H. Lockwood

Oberlin, Ohio

Notes

1. http://w2.vatican.va/content/francesco/en/encyclicals.index.html#encyclicals.

2. N. Watts, W. N. Adger, P. Agnolucci, et al., Health and Climate Change: Policy Responses to Protect Public Health, The Lancet 386, no. 10006 (November 7–13): 1861–1914, http://dx.doi.org/10.1016/S0140-6736(15)60854-6.

1

Introduction

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

—Preamble to the constitution of the World Health Organization, April 1948

When we saw the first pictures of the earth as viewed from space, it became evident that we are a small part of a system that is vast, complex, and interconnected. As scientists have learned more about the intricacy of these systems, we have discovered that life depends on their integrity. We barely understand some of the elements of even the simplest systems and are completely ignorant about altogether too many others. One of the fundamental goals of scientific, economic, geographical, and psychosocial research—as well as formal examinations of numerous other areas of study—is to better understand our world so that we may profit from this knowledge.

The law of unintended consequences tells us that intentional or unplanned incursions that involve these life-sustaining systems may produce an unforeseen result. To restate a point made by Donald Rumsfeld when he discussed the possibility of weapons of mass destruction in Iraq: We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend[s] to be the difficult ones.¹ Rumsfeld’s admonition certainly applies to climate change, for which the consequences of complexity are dismissed by those who believe that it is a hoax and embraced by those who believe that it is real and happening right now.

To begin to understand the law of unintended consequences, extrapolate this simple example to the billions of interconnected systems that depend on the earth’s climate. Three-toed sloths make a weekly, energy-consuming trip to the ground. Sloths have few enemies in the trees where they live. On the ground, predators are everywhere. What evolutionary advantage does this perilous trip confer on the sloths, and why do they make the trip? They make it to defecate. Research has shown that this act is a critical step in the sloth’s life cycle.²

A unique species of moths that lives in the sloth’s fur lays its eggs in the newly deposited dung: this is the only dung that will do. Newly hatched juvenile moths fly up to the forest canopy to find and live in the fur of the needed sloth. They then live out their entire lives in the sloth’s fur, but the story does not end there. After the moths die, their bodies sustain algae that also live in the sloth’s fur. These algae are the primary source of the sloth’s nutrients; without the algae, the sloths would starve. An unintended disruption of this cycle could lead to the extinction of both the moths and the sloths.

The next example is perhaps more relevant to considerations of climate change. On September 4, 1882, Thomas Edison threw a switch that started the flow of electricity from the newly completed Pearl Street Station to John Pierpont Morgan’s nearby office. Although the coal ash from the power plant quickly became a problem, there was no way that Edison could have known that the carbon dioxide produced by the coal that was burned in the power plant would start to change the climate. Now, more than a century and a quarter later, we know that burning coal and other fossil fuels injects billions of tons of carbon dioxide into the atmosphere each year. Scientific research has shown conclusively that this greenhouse gas is the most important factor driving climate