# Presentation: 515745

## BOSC Program Review
Sept. 26 – 28, 2005

Global Change Research Program

**Sept. 26 – 28, 2005**
**Global Change Research Program**

***Human Health Focus Area***

## Overview of Human Health Focus Area

**Why we do what we do**
**What we are doing**
**What environmental outcomes we are achieving**

**Heat-related**
**mortality & morbidity**

**Changes in**
**air quality**

**Infectious**
**diseases**

**Airborne**
**allergens**

**Accidents**
**And**
**injuries**

**Water-borne**
**diseases**

## Why a focus on human health?

## There is a link between climate change and human health

**Mediating Process**

**Health Outcomes**

- CLIMATE
- CHANGE:
- TEMPERATURE,
- PRECIPITATION,
- AND WEATHER

**There is a link between climate change and human health**

- Thermal extremes
- (*e.g*., heatwaves)

- Other extreme weather events
- (floods, storms, *etc.*)

- DISTURBANCES OF
- ECOLOGICAL SYSTEMS

- Geographic range and activity of
- vectors and infective parasites
- Altered local ecology of water-borne
- and food-borne infective agents
- Altered food productivity, and
- associated pests and diseases

- Sea level rise, population displace-
- ment, and damage to infrastructure

- Levels air pollution, including
- pollens and spores

**INDIRECT**

**DIRECT**

- Changes in heat- and cold-related
- illnesses and deaths

- Deaths, injuries, psychological
- disorders; damage to public health infrastructure

- Geographic ranges and incidence of
- vector-borne diseases

- Regional malnutrition and hunger,
- impaired child growth and development

- Changed incidence of diarrheal and
- certain other infectious diseases

- Injuries, risks of infectious disease (due
- to migration, crowding, contaminated
- drinking water), psychological disorders

- Asthma and allergic disorders; acute and
- chronic respiratory disorders and deaths

- Source: Adapted from IPCC, 1995.

## Why a focus on human health?

- Consistent with EPA mission to protect human health and the environment
- Clean Water Act
- Clean Air Act
- ORD expertise related to EPA’s regulatory role
- Health impacts from contaminated water
- Health impacts due to impaired air quality
- Linkages to other focus areas (air quality, water quality, ecosystems)
- Relationship to CCSP:
*Strategic Plan* (Chapter 9, Question 9.4):  “What are the potential health effects of global environmental change, and what climate, socioeconomic, and environmental information is needed to assess the cumulative risk to health from these effects?”
- Synthesis & Assessment Product 4.6:*  *State-of-the-science of socioeconomic, environmental, human health, and welfare impacts of climate variability

## Focus Area Goal

**Long-Term Goal:**   *Decision makers in the states and EPA *
*regional and program offices will use scientific information *
*and decision tools from EPA’s research and assessment *
*program to protect human health by adapting to global *
*change.*
- Four major categories of health impacts
- Weather-related morbidity
- Water- and vector-borne disease
- Airborne allergen health effects
- Ambient air pollution health effect

## What we are doing

## Three types of activities

**Needs assessment: ** Identification of research needs and knowledge gaps
**Health impacts research:   **Development of quantitative estimates of health risks associated with climate change
**Assessment and adaptation/decision support:**  Development of information and tools that help public health officials ameliorate global change health impacts

## Needs assessment

**2001 Health Sector Assessment (HSA)**
- Examined five health outcomes
-  temperature-related morbidity and mortality
-  extreme weather events such as storms and floods
-  air pollution
-  water- and food-borne diseases
-  vector- and rodent-borne diseases
- Overall conclusion:  “...multiple levels of uncertainty preclude any definitive statement on the direction of potential future change for each of the health outcomes assessed.”
- Also stressed the need to maintain and improve public health systems and their responsiveness to changing climate conditions
- Identified a list of **30** research needs and knowledge gaps

## Needs assessment  (cont.)

- 2005 EPA-commissioned report:
-     “Climate change and human health impacts in the United States: An update on the results of the U.S. National Assessment”   [Kristie Ebi, David Mills, Joel Smith]
- Literature published since 2001 supports HSA conclusion
- But some improvements in understanding of potential effects
- Refined understanding of mortality-heat stress relationship
- Quantified impact of urban heat islands on ambient air temperatures
- Continued development of morbidity and mortality data sets
- Advances in epidemiologic modeling techniques have refined quantitative exposure-response relationships in various health outcome areas

## Needs assessment  (cont.)

- Status of science not surprising
- Health outcomes have long been focus of epidemiologic research in US
- But data gaps still exist that limit ability to provide definitive conclusions
- Continued lack of reliable local and regional projections on climate change limits ability to quantify attributable burden of disease due to climate change
- Uncertainties about adaptive capacities
***Until reliable quantitative estimates of both impacts and ***
***adaptive capacity are developed, the net impacts of climate***
***change on human health will inevitably be described as***
***uncertain.***

## Health impacts research

**2000-2003:  Interagency joint solicitation (EPA, NOAA, NSF, NASA, EPRI)**
- 12 grants awarded, covering a range of health outcomes
- 3 grants dealt with water-borne diseases, including cholera, salmonella, campylobacter, and diarrhea
- Several grants dealt with vector-borne diseases, including Bartonellosis, Rift Valley Fever, encephalitis, dengue, and malaria.
**2005: Two STAR RFAs**
- First focused on two priority research areas identified by HSA
- Heat- and cold-related illnesses
- Waterborne diseases
- Second solicited proposals addressing issue of how climate change and health impact assessments can be transformed into useful information for public health decision makers

## Bartonellosis and climate variability  (place-based)

- The study site is in the Peruvian Andes, where the disease has been known since the 1600s.  The first dramatic epidemic of the disease was documented in the 1870' s during construction of a railroad in the area, when nearly 7000 workers died from the acute form of the disease.
- Studies currently underway are investigating the relationship between bartonellosis epidemics and el Niño-induced regional climate variation.  Preliminary results suggest that even slight changes in rainfall and temperature influence disease outbreaks during the warm season.

**Bartonellosis and climate variability  (place-based)**

**Sandfly**

## Assessment and adaptation/decision support

- Limited intramural assessment activity focused on HSA issues of concern
- Inclement weather and accidental injuries
- Violent crime and weather variability
- Effects of extreme heat on emergency department and hospital admissions
- Effects of global change on the quality of life (or nuisance) of vector-borne diseases
- Development of health scenarios for use in climate impacts assessments

## Outcomes we are achieving

## Informing Public Health Interventions to Prevent Hantavirus Pulmonary Syndrome in the Southwestern United States

- 1993: HPS outbreak in SW with high death rate (>50%)
- Hypothesis:  outbreak due to environmental conditions and increased rodent populations caused by unusual weather associated with 1991-92 ENSO
- EPA-sponsored study at The Johns Hopkins School of Hygiene and Public Health explored this hypothesis
- Found that high-risk areas for HPS can be predicted over 6 months in advance based on satellite generated risk maps of climate-dependent land cover.
**Risk maps**, developed in partnership with CDC and the Indian Health Service, are already being implemented for disease prevention in the southwest by the U.S. Department of Health and Human Services.

**Informing Public Health Interventions to Prevent Hantavirus Pulmonary Syndrome in the Southwestern United States**

## The international dimension: building capacity

*Climate change and human health: risks and responses*
- (WHO, 2003)

*Methods of assessing human health vulnerability and public health adaptation to climate change  *(WHO, 2003)

## The international dimension: building capacity

*Lessons learned and insights for adaptation policy*
- (Co-sponsored with EPRI, 2005)

-   WHO partnership:  Workshops to build in-country capacity
-   2000:  Pacific Islands focus (Samoa)
-   2002:  Caribbean Islands focus (Barbados)
-   2003:  Global Islands focus (Maldives)
-   2005:  Central Asian Republics (Uzbekistan)
-   2005:  China (as part of US-China Bilateral Initiative

-   2005:  Millennium Ecosystem Assessment:  Health Synthesis Report

## Outreach and communication

- Partnership with EPA Office of Air and Radiation
- Development of city heat plans
- Communication of health impacts information to public health officials and other stakeholders

## Future directions

- Continued support for health impacts research through STAR RFAs
- Decision Assessment to identify future stakeholders and to prioritize research and assessment activities
- Challenge:  Work with CCSP to engage HHS

## Human Health Focus Area Posters

- Climate change and human health
- The Health Sector Assessment of the First U.S. National Assessment
- Future directions in the human health focus area