U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

73–578PDF 2013

S. HRG. 110–1212 

EXAMINING THE HUMAN HEALTH IMPACTS OF 

GLOBAL WARMING 

HEARING 

BEFORE THE

COMMITTEE ON 

ENVIRONMENT AND PUBLIC WORKS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

OCTOBER 23, 2007 

Printed for the use of the Committee on Environment and Public Works 

( 

Available via the World Wide Web: http://www.fdsys.gpo.gov 
(II) 

COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

BARBARA BOXER, California, Chairman 

MAX BAUCUS, Montana 

JOSEPH I. LIEBERMAN, Connecticut 

THOMAS R. CARPER, Delaware 

HILLARY RODHAM CLINTON, New York 

FRANK R. LAUTENBERG, New Jersey 

BENJAMIN L. CARDIN, Maryland 

BERNARD SANDERS, Vermont 

AMY KLOBUCHAR, Minnesota 

SHELDON WHITEHOUSE, Rhode Island 

JAMES M. INHOFE, Oklahoma 

JOHN W. WARNER, Virginia 

GEORGE V. VOINOVICH, Ohio 

JOHNNY ISAKSON, Georgia 

DAVID VITTER, Louisiana 

JOHN BARRASSO, Wyoming1

LARRY E. CRAIG, Idaho 

LAMAR ALEXANDER, Tennessee 

CHRISTOPHER S. BOND, Missouri 

BETTINA POIRIER, Majority Staff Director and Chief Counsel 

ANDREW WHEELER, Minority Staff Director 

1Note: During the 110th Congress, Senator Craig Thomas, of Wyoming, 

passed away on June 4, 2007. Senator John Barrasso, of Wyoming, joined 

the committee on July 10, 2007. 
(III) 

C O N T E N T S 

Page 

OCTOBER 23, 2007 

OPENING STATEMENTS 

Boxer, Hon. Barbara, U.S. Senator from the State of California ....................... 1 

Inhofe, Hon. James M., U.S. Senator from the State of Oklahoma ................... 2 

Barrasso, Hon. John, U.S. Senator from the State of Wyoming ........................ 4 

Bond, Hon. Christopher S., U.S. Senator from the State of Missouri ............... 5 

Craig, Hon. Larry E., U.S. Senator from the State of Idaho ............................... 8 

Cardin, Hon. Benjamin L., U.S. Senator from the State of Maryland .............. 17 

Whitehouse, Hon. Sheldon, U.S. Senator from the State of Rhode Island ........ 21 

WITNESSES 

Gerberding, Hon., Julie Louise, Director, Centers for Disease Control and 

Prevention Accompanied by: Howard Frumkin, Director, National Center 

for Environmental Health Agency for Toxic Substances and Disease Registry ....................................................................................................................... 9 

Prepared statement .......................................................................................... 11 

McCally, Michael, Executive Director, Physicians for Social Responsibility ...... 23 

Prepared statement .......................................................................................... 24 

Cooper, Susan R., Commissioner, Tennessee Department of Health .................. 39 

Prepared statement .......................................................................................... 40 

Responses to additional questions from: 

Senator Inhofe ........................................................................................... 43 

Senator Boxer ............................................................................................ 43 

Roberts, Donald R., Professor Emeritus, Uniformed Services University of 

the Health Sciences .............................................................................................. 45 

Prepared statement .......................................................................................... 46 

Responses to additional questions from: 

Senator Inhofe ........................................................................................... 49 

Senator Boxer ............................................................................................ 51 

ADDITIONAL MATERIAL 

Letters: 

Benjamin, Georges C., MD, FACP, FACEP (Emeritus), Executive Director, American Public Health Association .................................................... 57 

Libbey, Patrick M., Executive Director, National Association of County 

and City Health Officials (NACCHO) ......................................................... 59 

Heymann, David L., Assistant Director-General for Communicable Diseases, and Representative of the Director-General for Polio Eradication 61 

Position statement, Association of State and Territorial Health Officials 

(ASTHO), Climate Change and Public Health .................................................. 65 

(1) 

EXAMINING THE HUMAN HEALTH IMPACTS 

OF GLOBAL WARMING 

TUESDAY, OCTOBER 23, 2007 

U.S. SENATE, COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS, Washington, DC. 

The full committee met, pursuant to notice, at 10 a.m. in room 

406, Dirksen Senate Office Building, Hon. Barbara Boxer (chairman of the committee) presiding. 

Present: Senators Boxer, Inhofe, Bond, Craig, Cardin, 

Whitehouse, and Barrasso. 

STATEMENT OF HON. BARBARA BOXER, U.S. SENATOR FROM 

THE STATE OF CALIFORNIA 

Senator BOXER. The hearing will come to order. 

Because of our time constraints, I am going to reduce the time 

for Senators to 3 minutes for opening statements. If colleagues 

come in after we have begun the panel, they can work those opening statements into their questions. 

Good morning everyone. We all know the threat of global warming. There may be differences on what is causing it, but today we 

are going to deal with those threats. The World Health Organization has estimated that human-induced changes in the earth’s climate lead to at least three million cases of illness and more than 

150,000 deaths a year. 

We need to start at 4 minutes, so it should be 3:32 right now. 

Global warming can affect public health in many ways. Increased 

temperatures due to global warming can cause more frequent and 

more severe heat waves, which can cause illness and even death. 

For example, the European heat wave of 2003 caused countless 

numbers of illnesses and claimed 35,000 lives. Leading scientists 

are telling us that if we have more extreme weather events like 

this, and as the planet warms, it is very likely to affect our health. 

I think Dr. Gerberding’s written testimony certainly underscores 

that. 

The WHO predicts that in my home State of California, heat-related deaths could more than double by 2100. As I mentioned, California, I just want everyone to think as positively as they can for 

the people affected by these raging fires and for the emergency 

workers and particularly firefighters who are putting their lives on 

the line. 

Scientists from the World Health Organization, the EPA, and the 

IPCC are also concerned that global warming may contribute to the 

spread of certain mosquito-borne diseases like malaria. It could 
2 

help spread certain viruses and other disease-causing organisms to 

new areas. 

Global warming also might contribute to an increase in waterborne diseases including cholera, which causes severe diarrhea. 

Drought can cause the spread of water-borne diseases by wiping 

out supplies of safe drinking water and concentrating pollution. 

Floods can fuel water-borne illnesses as well. They wash sewage 

and other sources of pathogens into supplies of drinking water. 

We are beginning to see what happens when water warms. The 

Associated Press reported on September 28, and I ask unanimous 

consent to place that story in the record. Without objection. 

[The referenced document was not available at time of print.] 

Senator BOXER. They reported that a 14-year-old boy died from 

an infection caused by an amoeba after diving in Lake Havasu. According to a CDC official, and I am going to ask you about that Dr. 

Gerberding, these amoebas thrive in warm water, and as water 

temperatures continue to rise, we can expect to see more cases of 

these amoeba infections. 

The world is changing. Global warming is expected to cause an 

increase of ground-level ozone or smog because more ozone is 

formed at higher temperatures. Smog damages lungs and can cause 

asthma in children. It can cause premature death, especially in 

vulnerable people. 

Our public health systems are already overburdened. Global 

warming will place tremendous new demands on public health officials. That is why we are having this hearing today. As Sir Nicholas Stern, former chief economist at the World Bank tells us, 

every dollar we spend today to reduce our greenhouse gas emissions would save $5 later. Certainly, as we look at the array of diseases I have just mentioned, that is clear. 

We are beginning to take action here in Congress with a bipartisan breakthrough in this Committee, and we are going to deal 

with all of these issues. 

I would like to welcome all our witnesses today, including Dr. 

Gerberding, Director of the CDC; Dr. Frumkin of the National Center for Environmental Health; Dr. McCally for Physicians for Social 

Responsibility; Susan Cooper from the Tennessee Department of 

Health and Dr. Roberts from the Uniformed Services University of 

the Health Sciences. 

I thank you all for being here today. Your testimony will make 

an important contribution to this record as we proceed. 

So although I said 3 minutes, it turned out to be 4 minutes per 

colleague, so let’s get going. 

Senator Inhofe. 

STATEMENT OF HON. JAMES M. INHOFE, U.S. SENATOR FROM 

THE STATE OF OKLAHOMA 

Senator INHOFE. Thank you, Madam Chairman. 

First of all, let me say that I am glad tomorrow we are finally 

having a Subcommittee hearing on actually legislation. We have 

had so many hearings on global warming and all these things, but 

not on any particular piece of legislation. So I am looking forward 

to the Warner–Lieberman legislation. I really believe, Madam 
3 

Chairman, that we should really give this a long, deliberative hearing, several hearings, to get into all the details. 

In addressing today’s hearing, I will say that it appears the issue 

of health and global warming, like so many areas, has fallen prey 

to politics. Reducing issues such as malaria to a simple and naive 

view that higher temperatures equal higher malaria rates is not 

only simple, but simply wrong. Temperatures area factor, but it is 

also true that malaria can spread where it is relatively colder. 

According to Paul Reiter of the Pasteur Institute in testimony before the Senate Commerce Committee last year, he said, ‘‘The most 

catastrophic epidemic on record anywhere in the world occurred in 

the Soviet Union’’—he is talking about malaria—‘‘the 1920s with a 

peak incidence of 13 million cases per year and 600,000 deaths.’’ 

You don’t think of the Soviet Union as being a hotbed of malaria, 

but certainly it was. 

More important than temperatures are preventive measures and 

economic standards of living which, make no mistake, will be worsened by rash action to pass costly symbolic measures. 

As we will hear today, when you look beyond the rhetoric at the 

facts, malaria is very much a disease that we can greatly diminish 

or help flourish, depending on how we live and what policies we 

put into place. 

The facts are this: malaria was nearly wiped out a few decades 

ago by the use of DDT. This was not disputed. The disease now 

claims one million lives or more every year; again, not disputed. 

Regardless of the science of DDT, and it appears it did not support 

a ban, selective spraying can greatly diminish cases of malaria. 

It was only recently, after millions of deaths, that policies began 

to shift away from alarmism and toward the genuine concern for 

the people who were paying for the alarmism with their lives. Let’s 

not let history repeat again. 

Madam Chairman, we have our markup in the Senate Armed 

Services that is taking place up in the sterile room upstairs, S–407, 

so I will have to be up there. It is required attendance, but I am 

glad we are ably represented here with logic to my right. 

Thank you. 

[The prepared statement of Senator Inhofe follows:] 

STATEMENT OF HON. JAMES M. INHOFE, U.S. SENATOR FROM THE

STATE OF OKLAHOMA

Madame Chairman, I am concerned that this Committee is not focusing on what 

it should—to deliberate legislation. We have had hearing after hearing after hearing 

on what people think about global warming or what might happen if we have global 

warming. But little on what will happen if we legislate global warming. As of October 23rd, we have not had a single legislative hearing on any of the major bills. 

Tomorrow at the Subcommittee level, under the leadership of Chairman 

Lieberman, we will hold the first legislative hearing on a global warming bill. I commend Senators Warner and Lieberman for their hard work in crafting a bill and 

for holding tomorrow’s legislative hearing. But tomorrow’s hearing represents what 

should be the first step in the process, not the only step. 

A single hearing that receives testimony from a single witness expressing concerns about the bill—held a mere six days after introduction—falls far short of a 

considered and deliberative process. There has been no time to analyze the text of 

this bill, or for members of the Committee to obtain input from stakeholders concerned about how the bill will impact them, or for economists to model its impacts 

on the competitiveness of the American economy. 

Yet I understand there will be a markup next week of the bill. There is concern, 

Madame Chairman, that the full Committee examination will be even less sub-
4 

stantive, even less deliberative. It is my hope that you will commit to conducting 

a thoughtful process similar to that which has been conducted in the past on major 

bills, providing us with specifics. 

In addressing today’s hearing, I will say that it appears the issue of health and 

global warming, like so many areas, has fallen prey to politics. Reducing issues such 

as malaria to a simple and naive view that higher temperatures equal higher malaria rates is not only simple, but simply wrong. Temperatures are a factor, but it 

is also true that malaria can spread when and where it is relatively colder. According to Paul Reiter of the Pasteur Institute in testimony before the Senate Commerce 

Committee last year: 

‘‘The most catastrophic epidemic on record anywhere in the world occurred in the 

Soviet Union in the 1920s, with a peak incidence of 13 million cases per year, and 

600,000 deaths.’’ 

More important than temperatures are preventative measures and economic 

standards of living, which—make no mistake—will be worsened by rash action to 

pass costly symbolic measures. As we will hear today, when you look beyond the 

rhetoric at the facts, malaria is very much a disease that we can greatly diminish 

or help flourish, depending on how we live and what policies we put into place. 

The facts are this: malaria was nearly wiped out a few decades ago by the use 

of DDT. This is not disputed. The disease now claims one million lives or more every 

year—again, not disputed. Regardless of the science of DDT—and it appears it did 

not support a ban—selective spraying can greatly diminish cases of malaria. But it 

was only recently, after millions of deaths, that policies began to shift away from 

alarmism and toward a genuine concern for the people who were paying for that 

alarmism with their lives. Let us not repeat history here. 

Thank you. 

Senator BOXER. Logic always resides from your point of view on 

the right. 

[Laughter.] 

Senator BOXER. Senator Barrasso, welcome. 

Senator BARRASSO. Thank you very much. 

Senator INHOFE. [Remark made off microphone]. 

Senator BOXER. We agree that that is how you view it. Yes. 

STATEMENT OF HON. JOHN BARRASSO, U.S. SENATOR FROM 

THE STATE OF WYOMING 

Senator BARRASSO. Thank you very much, Madam Chairman. 

My thoughts and prayers are with the folks of your home State 

today, the rescue workers, the firefighters and the residents. 

I am looking forward to this hearing this morning because for 

the last 20 years I have been doing television reports in my home 

State of Wyoming on preventable causes of diseases, giving people 

information that they can use to stay healthy, to keep down the 

cost of their medical care, and things they can do in prevention. 

That is people washing their hands and staying active and exercising more and eating less, getting adequate sleep. There are so 

many current day health problems that we need to deal with, such 

as malnutrition, HIV, potential issues with bird flu. 

What I am always doing is trying to seek that balance on how 

we can focus our resources and attention today on current day preventable problems, and at the same time looking for ways to prevent problems and help protect people in the future. 

So I am looking forward to today’s hearings. Thank you very 

much, Madam Chair. 

Senator BOXER. Thank you so much. 

I believe, Senator Bond, you were next. 
5 

STATEMENT OF HON. CHRISTOPHER S. BOND, U.S. SENATOR 

FROM THE STATE OF MISSOURI 

Senator BOND. Thank you very much, Madam Chair. 

I did move up. Normally I sit in the cheap seats, and I thought 

maybe with smaller attendance today I would be able to see what 

everybody else looked like. I second what my colleague who does 

agree with what Dr. Barrasso said about present day health problems. Obesity is something we are very much concerned about as 

well. 

I join with him in seeing the horrendous fires. We have friends 

out in California who have been driven from their homes. We want 

to provide any support we can, perhaps even from the Midwest. I 

know you are very short. We have crews that are willing to travel. 

I appreciate your holding the hearing today on the health effects 

of climate change. We often focus on the size of ice caps, some of 

them increasing and some of them decreasing; the number of glaciers or the health of polar bears, and some of those are increasing 

in population. 

But I think we also have to focus on the health of our families. 

Witnesses in testimony today I understand will focus on the health 

impacts of climate change, but there is something vital that is very 

missing in these considerations. The problem is not a single witness is expected to speak a single word on the specific health impacts that could result from the implementation of the proposed 

Lieberman–Warner carbon bill. 

Now, I don’t believe there is any assurance that that is going to 

make any difference in global warming or climate change, at least 

not in the foreseeable future. But no one is asking will a solution 

we consider in Lieberman–Warner inflict more harm upon the 

American people than the things we are trying to avoid. It is hard 

to tell since the Committee will spend almost no time considering 

the details of the legislation it will mark up. 

As you know, several of us have shared with this Committee in 

a letter our severe misgivings about acting upon legislation which 

will receive almost no independent expert review or analysis. Given 

the chance, we might ask health experts about the health effects 

on fixed-income seniors, of going without prescription drugs because they must instead pay for higher power and gasoline bills 

under Lieberman–Warner. 

What are the long-term effects of going without heart medication, 

blood pressure medication, or pain medication? Fixed-income seniors under Lieberman–Warner will have to choose between paying 

their air conditioning bills to survive oppressive heat and rationing 

their medication. 

What are the health tradeoffs? How about low-income families? 

What are the long-term effects on nutrition? Higher heating and 

gasoline bills will force some families to choose whether to heat or 

eat? We saw that in Kansas City. Demand at food banks skyrocketed during our last recession and energy price run-up. Is not 

enough food good for health? Is not enough food good for childhood 

development? 

The amount of help for low-income families that will trickle down 

from Lieberman–Warner seems woefully inadequate. Initial estimates find us taking the allowances that bill provides times 18 per-
6 

cent for the number of allowances auctioned, times 20 percent for 

the number of auction allowances devoted to energy assistance, 

times 50 percent for the proceeds devoted to boost the LIHEAP program. Not surprisingly in a bill written by Northeasterners and 

East Coasters, supported primarily by Northeastern Coasters and 

West Coasters, they use a LIHEAP program formula which favors 

the Northeast in its heating problems. 

Unfortunately, Missouri’s share of the LIHEAP program is only 

2 percent, with no funds going to alleviate high summer air conditioning costs. That means that Missouri low-income families suffering with higher power bills will receive .02 percent of the auction proceeds. 

Madam Chair, I ask that the remainder of my statement be included in the record, and I appreciate the opportunity to raise the 

concerns of my constituents. 

[The prepared statement of Senator Bond follows:] 

STATEMENT OF CHRISTOPHER S. BOND, U.S. SENATOR FROM THE STATE MISSOURI

Madame Chairman, thank you for holding this hearing today on the health effects 

of climate change. While often the focus is on the size of ice caps, the number of 

glaciers or the health of polar bears, we also must focus on the health of our families. Witnesses and testimony today will focus on the health impacts of climate 

change, but something vital is still missing. 

The problem is, not a single witness is expected to speak a single word on the 

specific health effects resulting from implementation of the proposed LiebermanWarner carbon bill. No one is asking, will the solution we consider inflict more harm 

upon the American people then the thing we are trying to avoid? 

It is hard to tell since the Committee will spend almost no time considering the 

details of the legislation it will mark up. As you know, several of us shared with 

you in a letter our severe misgivings about acting upon legislation which will have 

received almost no independent expert review or analysis. 

Given the chance, we might ask a health expert about the health effects on fixedincome seniors of going without prescription medication because they must instead 

pay for higher power and gasoline bills under Lieberman-Warner. 

What are the long term effects of going without heart medication, blood pressure 

medication, or pain medication? Fixed-income seniors under Lieberman-Warner will 

have to choose between paying their air conditioning bills to survive oppressive heat 

and rationing their medication. What are the health tradeoffs of that? 

How about low-income families? What are the long term health effects of poor nutrition? Higher heating and gasoline bills will force some families to chose whether 

to heat or eat. We saw that in Kansas City—demand at food banks sky-rocketed 

during our last recession and energy price runup. Is not enough food good for 

health? Is not enough food good for childhood development? 

The amount of help for low-income families that will trickle down from the 

Lieberman-Warner carbon auction scheme seems woefully inadequate. Initial estimates find us taking the allowances Lieberman-Warner provides, times 18 percent 

for the number of allowances auctioned, times 20 percent for the number of auction 

allowances devoted to energy assistance, times 50 percent for the proceeds devoted 

to boost the LIHEAP program. 

Not surprisingly, in a bill written by Northeasterners and East Coasters supported primarily by Northeasterners and East Coasters, they use the LIHEAP program formula which favors the Northeast and its heating problems. Unfortunately, 

Missouri’s share of the LIHEAP program is only 2.2 percent, with no funds going 

to alleviate high summer air conditioning bills. 

That means, after all that figuring including a carbon price at $20 per ton, Missouri low-income families suffering with higher power bills will receive 2⁄10 of a percent of the auction proceeds, or approximately $329 for each person in the Missouri 

LIHEAP program. 

There are a couple of other pathways for helping low-income families, such as the 

set-aside for states, but there is no guarantee that states will use their share on 

low-income relief or instead for other authorized activities such as energy efficiency. 
7 

We also know that LIHEAP reaches only 1 in 6 families in need. Even if 

Lieberman-Warner proceeds double LIHEAP funding, 2 in 3 low-income families 

who cannot afford their energy bills now will be hit with even higher energy bills. 

A recent study found that low-income families such as those earning less than 

$16,000 per year under plans to reduce emissions by 15 percent would face $750 

to $1,000 in higher utilities bills. Of course, Lieberman-Warner wants to cut emissions by 70 percent. There are estimates out there saying this will cost several thousand dollars per family. How will a few hundred dollars in auction assistance funds 

make up for several thousand dollars in higher energy costs? 

And so I ask again, what will be the cost of hundreds or even thousands of dollars 

in lost medication? or lost meals? or lost winter nights with no heat? or lost summer 

days without air conditioning? These are some of the health effects questions I 

would like answered before we vote on this legislation. Thank you. 

Estimate of Lieberman-Warner Energy Assistance Funding for Missouri 

2012 

Total Allowances ............................................................................................................................................ 5,200,000,000 

Sec. 1201(d), p. 30.

Total Allowances Auctioned (18 percent in 2012) ........................................................................................ 936,000,000 

Sec. 3201, p. 86.

Energy Assistance Allowances from Auction (20 percent) ............................................................................ 187,200,000 

Sec. 4302(b)(2), p. 123.

Energy Assistance Proceeds (at $20/ton) ...................................................................................................... $3,744,000,000 

LIHEAP Portion of Energy Assistance Proceeds (50 percent) ........................................................................ $1,872,000,000 

Sec. 4501(1), p. 137.

MO Share of LIHEAP Proceeds (2.2 percent) ................................................................................................. $41,184,000 

‘‘The LIHEAP Investment’’, 2/07, p.8.

MO LIHEAP Recipients .................................................................................................................................... 125,000 

LIHEAP Energy Assistance Auction Proceeds ................................................................................................. $329 

per MO LIHEAP Recipient.

Senator BOXER. Senator, and you have done that every time, 

which is good. I mean, I hope you will vote for LIHEAP when it 

comes up because I have a couple of—— 

Senator BOND. [Remark made off microphone]. 

Senator BOXER. Well, I have a couple of votes where you did not, 

but we will talk about it, but you bring it up every time, and I 

think it is important for you to look at the record here because I 

will work with you, absolutely. 

I think what is important here is to straighten the record out on 

a couple of points. Number one, thank you so much for your offer 

of help. It is so important right now for California. So I know we 

have differences on climate change, but there is no difference in 

helping each other when our States are in trouble. 

Right now, we are down 50 percent in terms of our National 

Guard equipment because they are all in Iraq, the equipment, half 

of the equipment. So we really will need help. I think all of our 

States are down in terms of equipment. 

Senator BOND. Well, Senator Leahy and I on the National Guard 

Caucus will welcome your help because the Guard has traditionally 

been underfunded when Iraq started, Katrina hit. The Guard had 

only one third of the equipment it needs, and this is a battle we 

fight with the Pentagon, and our colleagues have been most helpful. 

Senator BOXER. That is another area where we can work together. It think it is good for people to see it. I have joined your 

caucus several months ago, and I am really ready to go because we 

have a letter that states from the Pentagon themselves that if 
8 

there is a real major catastrophe such as the one we are having 

now, we are really in some kind of trouble. So thank you very 

much for that. 

I also wanted to make sure everyone knows the schedule of hearings we are going to have before the bill Lieberman–Warner bill is 

marked up. We are going to have a hearing tomorrow on the Subcommittee level. Then we are going to have three hearings and two 

briefings before the Committee marks up the full bill. 

A lot of you have asked for that, and I agree with you 100 percent. I think what is important is that we do look at our vulnerable 

populations and what Lieberman–Warner has in store as far as 

helping them. So this we will do for sure. 

I thank you very much again, everyone, for their kind offers and 

remarks. 

Senator Craig. 

STATEMENT OF HON. LARRY E. CRAIG, U.S. SENATOR FROM 

THE STATE OF IDAHO 

Senator CRAIG. Madam Chairman, thank you, and thank you for 

what you have just said. A good number of us have approached you 

asking that we do a thorough examination of, with hearings on 

Lieberman–Warner, and it is important that we do so. 

Because I serve on the Forestry Committee and have chaired it 

over time and ranked there and spend a lot of time looking at fire, 

let me empathize with you and California for just a moment. Our 

Fire Center in Idaho has deployed all of its equipment to you, and 

just a moment ago I was handed a note that the evacuation number has gone up to 320,000. It is very real and very dramatic. 

I must tell you that we had one fire in Idaho this summer that 

was 600,000 acres. You are up to about 270,000 or 280,000 now. 

There is a very real difference, though. There weren’t any homes 

in the area. 

Senator BOXER. Right. 

Senator CRAIG. There weren’t any people structures. 

But let me for just a moment talk about that because it is a part 

of what we ought be understanding when we look at the holistic 

approach to climate change. We burned about two million acres in 

Idaho this summer, the worst fire season we have had in decades. 

Nationwide, it is, with the fires now burning in California both in 

human structure loss and life loss and acreage burned, it may be 

worse than last year. 

But Madam Chairman, here is an interesting statistic. When 

Senator Feinstein and I crafted Healthy Forests, you supported it, 

and I appreciate that a great deal. But because of the courts today, 

we are ineffective in doing the kind of urban wild-land interface 

cleaning that we should. In Southern California where the scrub 

oak grows rapidly and the thinning and the cleaning ought to 

occur, it hasn’t for a lot of reasons, mostly environmental concerns 

by some special interest groups. 

But here is an interesting statistic. If no public land fires had occurred in the United States this year, from a standpoint of carbon 

released into the atmosphere and greenhouse gases released into 

the atmosphere, it would have been equivalent to taking 12 million 

automobiles off the road. 
9 

Now, let’s get real with ourselves. While we charge into the unknown, with legitimate concern, there are some known things we 

ought to be doing, and one of those areas is forest health. What 

happened in San Francisco on October 20 when we talked about 

the need to produce clean energy? The light got turned off for an 

hour. Is that the way we are going to solve our problems in the future with energy needs is simply turn off the lights? 

I think Americans have spoken pretty clearly to that. In a communicative world which is extremely energy intensive today, I 

doubt we will be able to do that. 

So for just a few moments, let me talk about four important principles that we ought to be incorporating in climate change, and I 

will spend a lot more time with Lieberman–Warner in doing that. 

Senator BOXER. Senator, you have 40 seconds left. We are really 

going to try to get through. 

Senator CRAIG. I will not err on the side of 40 seconds. 

Let me suggest, though, that the New York Times recognized the 

goals of Lieberman and Warner, and said that they were impossible to achieve without nuclear power. I find it interesting that the 

1970s rock relics are headed to the Hill today to talk about their 

anti-nuclear musician position. I find it interesting that we can’t 

even get over the hurdles of the 1970s with the new technologies 

of today in our desire to create a cleaner world. 

There is a combination of a lot of things happening out there, 

Madam Chairman, but right now in a very tragic and real way, as 

Idaho during August and September contributed to huge volumes 

of carbon into the atmosphere, California is now contributing in an 

unprecedented way, and that is tragic. We ought to be spending a 

lot of time looking at the broad cross-section of issues. 

I ask unanimous consent that the balance of my statement be a 

part of the record. 

Senator BOXER. Of course it will be. 

Yes, the tragedy is the uncontrollable and unavoidable costs of 

these fires. Some of them actually could be stopped before they 

start because a lot of them are started by arsonists, as you know. 

They do contribute to the problem of global warming and that is 

why we have to be so careful, because even the steps we take may 

not be enough because of these other things. 

Well, I want to welcome Dr. Gerberding here because I just want 

to praise your agency and this Administration for understanding 

that we already do know some things about what is happening out 

there with Global Warming and you are getting ready for it, and 

you don’t view it as charging into the unknown, not after reading 

your statement. 

So could you please take 5 minutes and then we will ask you 

some questions. 

STATEMENT OF JULIE LOUISE GERBERDING, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION ACCOMPANIED BY: HOWARD FRUMKIN, DIRECTOR, NATIONAL CENTER FOR ENVIRONMENTAL HEALTH AGENCY FOR TOXIC 

SUBSTANCES AND DISEASE REGISTRY 

Dr. GERBERDING. Thank you. 
10 

It really is an honor to appear here. I must say I agree with what 

everyone has said this morning at the introductory level. I was in 

San Francisco at 8 o’clock on Saturday night and I found that hour 

of darkness to be very sobering and really a wonderful prelude to 

this hearing. 

I have a graphic here to just remind you that while we are dealing with an extreme weather event in California, and indeed it is 

tragic, there are extreme weather events going on elsewhere in the 

Country including the drought in the Southeast that is affecting 

Atlanta, and the flooding in New Orleans today. So we are in an 

environment where increasingly CDC and other public health agencies are being asked to respond and prepare for these kinds of extreme events. 

We need to do this in an environment of trying to change from 

really a climate of uncertainty to a climate of preparedness, preemption and planning. In order for that to happen, we do need to 

have some anticipatory understanding of what might be in store for 

us. 

These are potential consequences of climate change that have 

been proposed by many, including scientists. These are recapitulated by the World Health Organization and the other UN organizations. But I think what is important here is that there are things 

here that we can reliably say we know will happen. There are 

things that are here that might happen, that we have some uncertainties about. And then there are things here that we just simply 

can’t predict. 

The one thing that I think is irrefutable is the fact that weather 

is inextricably linked to health. We see that in the kinds of weather 

events that occur every day. We see it seasonally with the relationship to influenza. We see it over years in the consequence of things 

like El Nin ̃ o. I believe we will see this on a much longer time frame 

in the context of our changing climate. 

So if we accept the fact that there is an important relationship 

between health and climate, then we need to concentrate on how 

we go about identifying what we can understand, predict, preempt, 

and prepare for. 

One area where I think we have made the most progress is understanding how we would prepare for heat events. The catastrophe that occurred in Europe in 2003 should never happen again. 

Somewhere between 25,000 and 44,000 people were attributed to 

die from that terrible heat event. That, in this world in developed 

countries, should never be the case. 

I am proud to say that the Environmental Protection Agency, together with FEMA, NOAA and CDC, have worked together in an 

interdependent manner to produce this guidance on how to avoid 

the consequences of excessive heat events. I think this is the kind 

of model for what needs to happen in government. We need to come 

together, bring our best science, collaborate on finding sensible solutions that are science-based, and if we don’t have the science, to 

at least concentrate on using some common sense. 

There is an important role for public health and for CDC in all 

of this. On this graphic, which I think you have in hand, I have 

listed many of the things that CDC and its public health partners 

in State and local governments would be responsible for doing. I 
11 

would like to highlight those areas that I think are the most relevant for conversation today. 

One of those areas is the issue of health protection research. 

There is tragedy in not knowing what to do. We need to do the 

science to try to understand better the range of issues that may 

emerge with climate change. But an even greater tragedy is not 

doing what we know. I think we have plenty of examples there, 

where we need to apply the science and the knowledge that we do 

have in more creative ways. 

CDC has two centers that are especially involved in this issue. 

One is our National Center for Environmental Health, and Dr. 

Howard Frumkin is sitting behind me who directs that Center. The 

other is our new center, the National Center for Zoonotic and Vector–Borne Diseases. Dr. Ali Khan is the Deputy of that Center. 

That Center is based on the premise that ecological infectious diseases are in our future for a number of reasons, including climate 

change, and the kind of health protection research that CDC needs 

to do in collaboration with its other partners really needs to focus 

in on these areas. 

We have the infrastructure to make this happen. This is a graphic of some of our new laboratories, not just in Atlanta, but also in 

Puerto Rico and in Colorado, where this kind of science is being 

conducted today. I think we have a lot to contribute. We just need 

to bring everyone together, create an agenda, and forge ahead on 

solving some of these problems. 

So I look forward to your questions, and again really appreciate 

the opportunity to shine a light on the health consequences of climate change. 

Thank you. 

[The prepared statement of Dr. Gerberding follows:] 

STATEMENT OF JULIE L. GERBERDING, M.D., M.P.H., DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION, ADMINISTRATOR, AGENCY FOR TOXIC SUBSTANCES

AND DISEASE REGISTRY, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

INTRODUCTION

Good morning Madam Chairwoman, Senator Inhofe, and other distinguished 

members of the Committee. It is a pleasure to appear before you as Director of the 

Centers for Disease Control and Prevention (CDC), the Nation’s leading public 

health protection agency located within the Department of Health and Human Services. Thank you for the opportunity to present on climate change and human health 

and to highlight the role of CDC in preparing for and responding to the health effects of climate change. 

BACKGROUND

The health of all individuals is influenced by the health of people, animals, and 

the environment around us. Many trends within this larger, interdependent ecologic 

system influence public health on a global scale, including climate change. The public health response to such trends requires a holistic understanding of disease and 

the various external factors influencing public health. It is within this larger context 

where the greatest challenges and opportunities for protecting and promoting public 

health occur. 

PUBLIC HEALTH PREPAREDNESS FOR CLIMATE CHANGE

Climate change is anticipated to have a broad range of impacts on the health of 

Americans and the nation’s public health infrastructure. As the nation’s public 

health agency, CDC is uniquely poised to lead efforts to anticipate and respond to 

the health effects of climate change. Preparedness for the health consequences of climate change aligns with traditional public health contributions, and—like prepared-
12 

ness for terrorism and pandemic influenza—reinforces the importance of a strong 

public health infrastructure. CDC’s expertise and programs in the following areas 

provide the strong platform needed: • Environmental Public Health Tracking—.CDC has a long history of tracking occurrence and trends in diseases and health outcomes. CDC is pioneering new ways 

to understand the impacts of environmental hazards on people’s health. For example, CDC’s Environmental Public Health Tracking Program has funded several 

states to build a health surveillance system that integrates environmental exposures 

and human health outcomes. This system, the Tracking Network, will go live in 

2008, providing information on how health is affected by environmental hazards. 

The Tracking Network will contain critical data on the incidence, trends, and potential outbreaks of diseases, including those affected by climate change. • Surveillance of Water-borne, Food-borne, Vector-borne, and Zoonotic Diseases.— 

CDC also has a long history of surveillance of infectious, zoonotic, and vector-borne 

diseases. Preparing for climate change will involve working closely with state and 

local partners to document whether potential changes in climate have an impact on 

infectious and other diseases and to use this information to help protect Americans 

from the potential change in of a variety of dangerous water-borne, food-borne, vector-borne, and zoonotic diseases. CDC has developed ArboNet, the national arthropod-borne viral disease tracking system. Currently, this system supports the nationwide West Nile virus surveillance system that links all 50 states and four large metropolitan areas to a central database that records and maps cases in humans and 

animals and would detect changes in real-time in the distribution and prevalence 

of cases of arthropod-borne viral diseases. CDC also supports the major foodborne 

surveillance and investigative networks of FoodNet and PulseNet which rapidly 

identify and provide detailed data on cases of foodborne illnesses, on the organisms 

that cause them, and on the foods that are the sources of infection. Altered weather 

patterns resulting from climate change may affect the distribution and incidence of 

food- and water-borne diseases, and these changes can be identified and tracked 

through PulseNet. • Geographic Information System (GIS).—At the CDC, GIS technology has been 

applied in unique and powerful ways to a variety of public health issues. It has been 

used in data collection, mapping, and communication to respond to issues as wideranging and varied as the World Trade Center collapse, avian flu, SARS, and Rift 

Valley fever. In addition, GIS technology was used to map issues of importance during the CDC response to Hurricane Katrina. This technology represents an additional tool for the public health response to climate change. • Modeling.—Model projections of future climate change can be used as inputs 

into models that assess the impact of climate change on public health. CDC has conducted heat stroke modeling for the city of Philadelphia to predict the most vulnerable populations at risk for hyperthermia. In light of these projections, CDC has initiated efforts to model the impact of heat waves on urban populations to identify 

those people most vulnerable to hyperthermia. 

• Preparedness Planning.—Just as we prepare for terrorism and pandemic influenza, we should use these principles and prepare for health impacts from climate 

change. For example, to respond to the multiple threats posed by heat waves, the 

urban environment, and climate change, CDC scientists have focused prevention efforts on developing tools that local emergency planners and decision-makers can use 

to prepare for and respond to heat waves. In collaboration with other Federal partners, CDC participated in the development of an Excessive Heat Events Guidebook, 

which provides a comprehensive set of guiding principle and a menu of options for 

cities and localities to use in the development of Heat Response Plans. These plans 

clearly define specific roles and responsibilities of government and non-governmental organizations during heat waves. They identify local populations at increased high risk for heat-related illness and death and determine which strategies 

will be used to reach them during heat emergencies. 

• Training and Education of Public Health Professionals.—Preparing for the 

health consequences of climate change requires that professionals have the skills required to conceptualize the impending threats, integrate a wide variety of public 

health and other data in surveillance activities, work closely with other agencies 

and sectors, and provide effective health communication for vulnerable populations 

regarding the evolving threat of climate change. CDC is holding a series of five 

workshops to further explore key dimensions of climate change and public health, 

including drinking water, heat waves, health communication, vector-borne illness, 

and vulnerable populations. 

• Health Protection Research.—CDC can promote research to further elucidate the 

specific relationships between climate change and various health outcomes, including predictive models and evaluations of interventions. Research efforts can also 
13 

identify the magnitude of health effects and populations at greatest risk. For example, CDC has conducted research on the relationship between hantavirus pulmonary 

syndrome and rainfall, as well as research assessing the impact of climate variability and climate change on temperature-related morbidity and mortality. This information will help enable public health action to be targeted and will help determine the best methods of communicating risk. CDC can serve as a credible source 

of information on health risks and actions that individuals can take to reduce their 

risk. In addition, CDC has several state-of-the-art laboratories conducting research 

on such issues as chemicals and human exposure, radiological testing, and infectious 

diseases. This research capacity is an asset in working to more fully understand the 

health consequences of climate change. 

• Communication.—CDC has expertise in communicating to the general public 

health and risk information, and has deployed this expertise in areas as diverse as 

smoking, HIV infection, and cancer screening. Effective communication can alert the 

public to health risks associated with climate change, and encourage constructive 

protective behaviors. 

While CDC can offer technical support and expertise in these and other activities, 

much of this work needs to be carried out at the state and local level. For example, 

CDC can support climate change preparedness activities in public health agencies, 

and climate change and health research in universities, as is currently practiced for 

a variety of other health challenges. 

CONCLUSION

An effective public health response to climate change can prevent injuries, illnesses, and death and enhance overall public health preparedness. Protecting Americans from adverse health effects of climate change directly correlates to CDC’s four 

overarching Health Protection Goals of Healthy People in Every Stage of Life, 

Healthy People in Healthy Places, People Prepared for Emerging Health Threats, 

and Healthy People in a Healthy World. 

While we still need more focus and emphasis on public health preparedness for 

climate change, many of our existing programs and scientific expertise provide a 

solid foundation to move forward. Many of the activities needed to protect Americans from adverse health effects of climate change are mutually beneficial for overall public health. In addition, health and the environment are closely linked. Because of this linkage it is also important that potential health effects of environmental solutions be fully considered. 

Thank you again for the opportunity to provide this testimony on the potential 

health effects of global climate change and for your continued support of CDC’s essential public health work. 
14 
15 

Senator BOXER. Thank you very much, Doctor. 

You know, one of my colleagues, I think it was Senator Barrasso, 

said we have so many other issues—kids have to exercise, they 

have to watch their weight. I guess the implication is why look at 

this. 

First of all, my own answer to his rhetorical comment, I am sure 

he didn’t want me to answer it, is if we wait we could waste valuable time and people could be severely injured as a result. 

The other thing is, you know, we tell our kids it is really important to exercise, to eat properly. Well, here is a kid who went into 

Lake Havasu and he went swimming. Kids are supposed to do that 

to stay healthy. I would assume, Senator Barrasso, you would 

agree with that. Well, what happened was he wound up in the hospital. It seemed like a headache, nothing more, but when painkillers and a trip to the emergency room didn’t fix it, Aaron Evans, 

the 14-year-old, asked his dad if he was going to die. Oh, no, and 

then his father said, I come home and I am burying him. 

Well, what happened is Aaron was exposed to an amoeba, a microscopic organism, and I don’t pronounce it correctly, called 

naeglaria fowleri. Did I say that right? 

Dr. GERBERDING. Well, I usually say naeglaria. 

Senator BOXER. Naeglaria fowleri. 

Dr. GERBERDING. Fowleri. 

Senator BOXER. It attacks the body through the nasal cavity, 

quickly eating its way to the brain. The doctors said he probably 

picked it up a week before while swimming in Lake Havasu. They 

said such attacks are rare, though some health officials have put 

their communities on high alert, telling people to stay away from 

warm—warm—standing water. 

Now, Michael Beach, who works in your shop, he is a specialist 

in recreational water-borne illness for the Centers for Disease Control and Prevention, said, ‘‘This is definitely something we need to 

track. This is a heat-loving amoeba. As water temperatures go up, 

it does better. In future decades as temperatures rise, we better expect to see more cases.’’ 

Do you agree with those comments? 

Dr. GERBERDING. Well, I think what I agree with is that we need 

to find out the answer, and there are ways of monitoring for this 

organism and understanding how it does respond to the various 

changes in water temperature and other climatic effects, including 

salinity and the flocculants in the water. 

Right now, this is a rare disease, but it is exactly the kind of 

thing that we are here to talk about. What are the uncertainties 

and where can we apply our knowledge to decrease some of the uncertainty as we look forward to ecological changes? 

Senator BOXER. Now, Texas health officials are acting now. They 

are not waiting. They have issued a news release about the danger 

of amoeba attacks, telling people to be cautious around water. Are 

you doing anything at this stage at CDC? 

Dr. GERBERDING. There are a number of things that we are doing 

related to water per se. This particular organism is a tiny part of 

the overall issue of water and health and climate change. 

We anticipate many consequences of water. One of the exciting 

things that we are beginning to be able to do in 2008 is the track-
16 

ing project, where we can relate climate to health outcomes, both 

chronic diseases that I know were already mentioned as an important here and now problem, but also potential future diseases that 

will emerge or re-emerge in this context. 

Senator BOXER. Dr. Gerberding, I have a presentation by Michael 

McGeehan from the National Center for Environmental Health at 

CDC. Could we hold up that chart that says potential impacts? I 

just wonder if you agree with this. What he does is he shows heat, 

storms, coastal flooding, vector biology, air pollutants, food supply, 

civil conflict. Do you agree with this presentation, if global warming were to occur and we were not able to lessen its impact? Do 

you agree with that, that these are some of the problems that we 

could see on the orange? 

Dr. GERBERDING. Absolutely. This is a list of potential things 

that you could realistically expect, and these are the areas where 

we want to focus our attention in terms of the ecological science, 

as well as the ability to predict and model where the events may 

occur. 

I don’t think in some of these areas it is a question of if. It is 

a question of who, what, where, when, how and how bad it will be. 

Senator BOXER. Yes. Well, obviously, yes. A lot of us are trying 

to stop the worst effects by acting. A lot of others are putting their 

head in the sand and saying, oh, let’s concentrate on our other 

problems; we can’t even deal with those. I think we have to do both 

as Senators. You can’t close your eyes to the future, and you can’t 

close your eyes to the present. 

Senator Barrasso, 4 minutes please. 

Senator BARRASSO. Thank you very much, Madam Chairman. 

I think this is a tragic case that you reflected upon. I think my 

initial comments talked about trying to find a balance of how we 

do the best we can today, and also trying to protect into the future, 

which I was so glad to hear about the organization within the Centers for Disease Control and Prevention, this health protection research effort that is going on and what we can do there. 

I was just reading an article in Investors Business Daily, and 

this comes to try to find this balance. This was last week. It talks 

about Dr. William Gray, professor emeritus of the Atmospheric Department at Colorado State University. In the article, it says they 

found that $1 spent fighting HIV–AIDS produces $40 in social benefits; $1 spent in fighting malnutrition yields $30 in social benefits; 

but $1 fighting to lower CO2 emissions yielded between 2 cents to 

25 cents in benefits. It is trying to find that balance. 

I want to know if you have any comments on how we can best 

use our limited resources? 

Dr. GERBERDING. I am a scientist, not an economist. But I just 

read the Harvard Business Review this week from the October edition where they are presenting the issue of climate change to the 

corporate international communities, and really making a very 

strong business case that it is not just an issue of corporate social 

responsibility or philanthropy anymore. It is an issue of corporate 

survival and economic security for businesses. 

So I think the broad dimension of sustainability and climate 

change and their intersection are things that we need to look at. 
17 

I hope in the hearings and the debates that go on about various 

legislation this will be an area that will come up. 

As a public health official, I am always balancing the need to 

take care emerging or urgent reality today, and the need to do 

things like plan for pandemics or the health consequences of climate change. I think we have to be able to do both, but getting 

that responsible balance is part of what needs to be a very open 

debate. I agree that it should be a debate. 

Senator BARRASSO. And then the other question is, we hear 

about the tragedy of what happened in Europe in the heat wave 

and all of those who perished. And then one reads reports that 

with any change in temperature, a degree rise or two, there are reports of the number of lives that have been saved by not having 

the cold impact and the deaths that are caused by cold and the cardiovascular impacts of the extreme cold. Any comments on that? 

Dr. GERBERDING. There is better science now relating temperature and mortality rates, including a very large study done in the 

United States where this was looked at geographically and by various population subsets. 

I think one of the things to say to help put the European experience in perspective that in none of that climate tracking data that 

went on over a long period of time was there ever an event where 

25,000 people died from a winter storm. So what we are dealing 

with is not just the gradual increments in temperature that may 

be offset by less cold and more heat, but also these extreme events 

which are devastating, particularly to vulnerable people in our population. 

So you have to look at the total impact, not just the stable reflection of temperature and health status. I think there is a lot of uncertainty there, and we need to really be looking at the past climate and anticipating what it means in terms of the future, and 

what we are seeing happening right now today in the United 

States. 

Senator BARRASSO. Thank you very much. No further questions. 

Senator BOXER. Thank you, Senator. 

Senator Cardin, 4 minutes. We welcome you. 

STATEMENT OF HON. BENJAMIN L. CARDIN, U.S. SENATOR 

FROM THE STATE OF MARYLAND 

Senator CARDIN. Thank you, Chairman Boxer. I very much appreciate you holding this hearing. I think it is very important that 

this Committee explore the health impacts of global climate 

change. I would ask that my entire opening statement be made 

part of the record. 

Senator BOXER. Without objection. 

[The prepared statement of Senator Cardin follows:] 

STATEMENT OF HON. BENJAMIN L. CARDIN, U.S. SENATOR FROM THE

STATE OF MARYLAND

Madame Chairman: Thank you for holding this hearing today. 

As the National Academies of Science noted just last month, ‘‘Our understanding 

of the impact of climate changes on human well-being and vulnerabilities is much 

less developed than our understanding of the natural climate system.’’ Our current 

level of information gives us cause for grave concern. And common sense suggests 

that even greater health impacts are coming. 
18 

The extreme weather events that are expected to be among the first effects of 

global warming clearly present serious threats to human health and safety. And 

those events don’t have to be as immediate as a deadly hurricane or tornado. They 

can also be prolonged periods of extreme heat, leading to the premature deaths of 

our most vulnerable citizens including the elderly. 

Increases in global warming are also likely to result in increased levels of smog, 

which is a function of chemical pollution reacting in the presence of strong summer 

heat. Today more than 90 percent of all Marylanders live in ozone non-attainment 

areas. Global warming threatens progress being made on improving those numbers. 

The World Health Organization is predicting a 60 percent increase in ozone pollution in the eastern United States by 2050. 

Algal blooms could occur more frequently as temperatures warm—particularly in 

areas with polluted water. Diseases that tend to accompany algal blooms could become more frequent. These are adverse health effects that are already upon us. 

Global warming will simply make them worse. 

And that is just the beginning of the story. My greatest concerns are not about 

the health effects on Marylanders or even Americans. My greatest concerns have to 

do with the potential for widespread disease and dislocation that might accompany 

global warming in unstable parts of the world. Prolonged droughts can be expected 

to result in the spread of contagious diseases that will result from more people trying to use a declining water supply. The health impacts of global warming need to 

be more fully documented. We need better predictive models that can help us understand the likely health impacts of global warming in different parts of the world. 

We need better coordination among climate scientists, world health providers, and 

our national security and State Department officials. 

Today’s hearing is an especially timely one. We are starting to see the truly global 

health impacts associated with global climate change. Today’s hearing should help 

us understand the current state of our knowledge. Today’s hearing should also provide constructive ways in which we can better monitor, plan and protect our citizens 

and those around the world in future years. 

I look forward to hearing from today’s witnesses. 

Thank you, Madame Chairman. 

Senator CARDIN. Let me say, I could concentrate on the impact 

on my State of Maryland, the sea level changes and the impact 

that are going to have on health; the change of water temperature, 

which has an incredible impact on the environment in the State of 

Maryland. 

I want to follow up on Senator Boxer’s question on the global effects of climate change, whether it is heat or whether it is dealing 

with some of the changes of population, or whether it deals with 

the potential food supply or extreme weather conditions, and ask 

you whether there are efforts internationally which CDC is part of 

to try to get a common understanding of what is happening, so that 

we can develop an international strategy to deal with the potential 

changes of food supply, of population, of all those other issues that 

could have a major impact on the entire world, and whether CDC 

is playing a role in trying to get that type of collaboration internationally. 

Dr. GERBERDING. We are playing a role. One specific example 

would relate to the President’s Malaria Initiative where we are out 

trying to implement a program to reduce the deaths due to malaria 

by 50 percent. As part of that, of course, we are tracking malaria 

and will learn a lot about the effectiveness of our programs, as well 

as hopefully the influence of climate. 

But I would say right now today, other than some collaborative 

work we are doing in conjunction with the World Health Organization, we are not really exhibiting leadership and doing as much as 

we should be doing. I think it is time for us to step forward and 

do some convening around these issues, and really contribute to an 

international agenda. 
19 

The World Health Organization has created a platform for the 

global health consequences of climate change, and there are some 

very specific goals and objectives in there that CDC really should 

and could contribute a great deal to. 

One of the areas where we excel is in the area of surveillance, 

and our ability to relate human health issues with data that is 

being collected by other climate scientists and other agencies in 

other parts of the world is really a unique contribution that I think 

we can leverage things we are already doing quite well. 

Another very important asset that we have is our ability to communicate. We have a Web site that was just voted the number one 

health Web site in the Nation. We are trying to globalize it so that 

it is more relevant and more reachable in other places that might 

want to be able to use our shared information. 

So there are some specific things that we could do better right 

now, and then there are some things we would like to be able to 

do in the future. 

Senator CARDIN. Well, I applaud you for your Web site. I expect 

that it is not only one of the top in our Country, but probably top 

in the world. CDC is looked upon internationally. I must tell you, 

at international meetings frequently CDC is mentioned as a standard that is important for the entire world. 

Moving on malaria is important and I appreciate the leadership 

that you are applying there, and as you acknowledge, I think there 

is more that an organization such as CDC can do to sensitize the 

international community that we are all in this together. Malaria 

is important to attack internationally, as are other issues including 

perhaps change in food supply as a result of what is happening 

with global climate change, or dealing with sea level increases and 

what impact that is going to have internationally on concerns that 

we all share. 

So I just would urge you to be as aggressive as you can on individual issues, individual health issues that are affected by climate 

change. But to start to develop the protocols that we are working 

in a more aggressive way so we have a common set of models that 

we can use so that we all can work together, rather than just one 

country dealing with it. 

Thank you, Madam Chair. 

Senator BOXER. Thank you, Senator. 

The reason I am moving it along is we may have a vote as early 

as 11-ish. 

So Senator Craig, go ahead. 

Senator CRAIG. Madam Chairman, thank you very much. 

I am not one of those who would suggest we ought to wait, because I think information and knowledge is power. And let me say, 

Dr. Gerberding, I will join with Senator Cardin in recognizing your 

Web site and the work you do. 

Knowledge is power, and a lot of people don’t have the knowledge 

to make the decisions they could make that are relatively practical 

that improve health situations. For example, we all know about 

this new superbug, MRSA. And yet on your Web site, you are very 

practical. It probably saves lives. It is wash your hands, shower 

after exercise, cover skin traumas with a bandage, don’t share razors, and keep surfaces clean. 
20 

We are all creatures of habit, and habits are what we respond 

to daily. We don’t want to change our habits unless we are forced 

to, or unless knowledge tells us we ought to. One of the things that 

you can do and you are doing is to be able to spread that practical 

knowledge that will change habits and normal everyday actions. So 

I don’t think we ought to wait at all, Madam Chairman, on information and flow and understanding and sharing. 

At a climate change conference in The Hague a good number of 

years ago, I got into an interesting debate with a professor from 

Bangladesh about sea rise. To him, it was a very practical problem. 

If the sea rises at all, his country is eliminated. It doesn’t exist 

anymore. His people would simply have to pack up and leave, an 

entire nation, albeit small, but we know tremendously populated. 

A little different in the State of Maryland, with impacts, you bet. 

Real? You bet. But Maryland probably, with a few feet, doesn’t disappear. Some of it might, but Bangladesh would. So it is a matter 

of perspective, and it is also a matter of reality. 

One of the things I find out, Madam Chairman, when we talk 

about energy conservation, most people don’t understand how to 

conserve, but if they are given a practical list of things they can 

do as a family, as a small economic unit in a large economic unit, 

it is amazing the kinds of savings that can occur if there are simply 

one or two less trips to the supermarket every week, because they 

organized a shopping list and went once instead of three times. 

Practical? Yes. Do they need to be instructed in it? In most instances, yes. 

So while we are wrestling with the bigger issues and your work 

sometimes can be very practical, it becomes phenomenally important and it does save lives, and I want to thank you for the work 

you do. 

Let me also react, and I think that Senator Barrasso touched on 

it, I think all of us were shocked by the number of deaths in Europe when that heat wave occurred. For those of us who have traveled in Europe, we find it interesting that there aren’t any air conditioners. We have grown to know that they are just in every home 

in America today almost, but it is a cool area of the world and they 

never felt they needed it. 

But I have seen studies that would suggest cold or a substantially colder temperature would produce a good deal more deaths 

and is more difficult to adjust to than heat. Are there any studies, 

or have you looked at that at the CDC to draw any conclusions 

about it? 

Dr. GERBERDING. I think there have been some very excellent initial work that EPA has funded through some academic environments that are trying to understand this more clearly. One of the 

interesting observations is that the effect of temperature depends 

on what you are used to. So if you are used to living in a cold temperature, you are more tolerant of more cold, but less tolerant of 

more heat. If you are used to living in a warmer temperature, you 

have a harder time with cold, but you do a little bit better with the 

extremes of heat. So our biology and our ecology really intersect in 

some very interesting ways there. 

What we don’t know yet, other than the fact that these are particular problems for the elderly primarily because of the cardio-
21 

vascular stress, we don’t really know what the sub-population 

issues are. So there is a great deal more that will be learned 

through this kind of research. 

Senator CRAIG. Thank you. 

Senator BOXER. Thank you, Senator. 

Senator CRAIG. Thank you, Madam Chairman. 

Senator BOXER. Senator Whitehouse, 4 minutes please. 

STATEMENT OF HON. SHELDON WHITEHOUSE, U.S. SENATOR 

FROM THE STATE OF RHODE ISLAND 

Senator WHITEHOUSE. Thank you, Madam Chair. 

May I ask unanimous consent that my opening statement be put 

at the appropriate place in the record? 

Thank you. 

[The prepared statement of Senator Whitehouse follows:] 

STATEMENT OF HON. SHELDON WHITEHOUSE, U.S. SENATOR FROM THE

STATE OF RHODE ISLAND

Madam Chairman, thank you for holding this important hearing today on the 

growing impact of global climate change on human health. I’m proud that our chairman has worked hard to move us past a debate over whether global warming in 

fact exists—as all scientists and the American people do not doubt that it does— 

and onto the critical question of what we do next. 

As our chairman and many of my colleagues know, the solution to climate change 

cannot be limited to reducing the pollutants that caused it. That will help—but it’s 

too late to ignore the need for a more comprehensive approach that considers global 

warming’s impact on our environment, our wildlife, on every aspect of our society— 

and particularly on ourselves. 

The threats to public health from global warming affect us all, and will continue 

to worsen the longer we delay speedy action to limit global warming pollution in 

the United States and around the world. Unfortunately, those who will bear the 

greatest burden are those least able to protect themselves, including our children, 

the elderly, and those without access to adequate medical care. I applaud the chairman for highlighting this important topic and look forward to working with her and 

my colleagues on the committee to pass strong legislation to significantly reduce our 

nation’s contribution to global climate change. 

We have already begun to see the effects of climate change on our health. Unfortunately, the degree of warming we have already experienced today is only a fraction of what we can expect in the future without decisive action to improve the quality of our air and water. Warmer temperatures stemming from rising levels of global 

warming pollution in the air have already been linked to increased ‘‘red alert’’ days 

in our cities from unhealthy levels of smog, and a resulting increase in asthma and 

other respiratory illnesses, especially in our youth and elderly. A recent report by 

researchers at Yale University concluded that many U.S. cities could see a doubling 

of unhealthy ozone days if global warming pollution is left unchecked. Such a 

change would have a far-reaching ripple effect on our quality of life, as fewer children and seniors could take part in outdoor recreation and other activities, and on 

our economy as well. 

I am particularly troubled by the impact on our children, because they are not 

only one of the most vulnerable segments of our population, but because it is they 

who will have to live with the myriad of consequences from a warming world in the 

future. The environmental ministers from the G–8 nations emphasized this point in 

a unanimously approved declaration on children’s environmental health, stating 

that ‘‘Children will be among the most susceptible to more severe heat waves, more 

intense air pollution, and the spread of infectious diseases. Future generations will 

face many potential impacts of climate change with serious health, environmental 

and economic consequences.’’ 

Before joining the Senate I was proud to serve on the board of Creating Healthy 

Environments for Children, now known as Healthy Child Healthy World, a group 

dedicated to protecting our children from harmful environmental threats. Their 

work is so important, but the federal government should be at the forefront of these 

efforts. Wherever possible, as we conduct further research on the effects of green-
22 

house gas emissions and set policy regarding pollutant cuts, we should take special 

care to consider the impact on children. 

Increases in unhealthy ozone and smog, however, are not the only dangers we 

face. Rising temperatures are also beginning to change disease patterns. Diseases 

carried by ticks and mosquitoes are spreading into new areas and scientists have 

warned that epidemics such as dengue fever and malaria may reemerge in the 

United States. If we allow this to continue the strain on our already overburdened 

public health system could be devastating. 

Instances of extreme weather are also increasing and leading to more severe 

floods, storms, and extended heat and cold waves. We have seen the havoc wreaked 

by hurricanes Rita and Katrina on the homes, lives, and mental and physical health 

of the residents of the Gulf Coast—devastation they continue to fight and overcome 

today. Left unchecked, climate change will result in future storms of this magnitude 

for which we continue to be unprepared. 

Madam Chairwoman, I am dedicating to working with you to address these challenges now, before they become worse. We have an obligation to respond to the overwhelming facts and scientific evidence pointing toward the need to take aggressive 

action now to limit the impact of global warming on our environment, our economy, 

and the health of our people. 

Senator WHITEHOUSE. Doctor, I serve also on the Intelligence 

Committee. We spend a great deal of time looking at national security issues. I was wondering if you would mind talking a little bit 

about global warming and climate change in the context of United 

States national security, both in terms of direct impacts occurring 

within the geographic United States, and also indirect impacts 

from consequences that physically occur in other nations, but have 

ramifications for U.S. national security. 

Dr. GERBERDING. I think I can address this generically and perhaps in more detail in another environment. 

Senator WHITEHOUSE. Since we have 3 minutes and 10 seconds, 

I think we have to do it pretty generically here. 

Dr. GERBERDING. I would say that, first of all, the two large 

areas where this would be most relevant are in the areas of food 

security and water security, because obviously the kinds of social 

disruption and the economic harms that can come about if those 

problems emerge in a particular location add to other factors that 

initiate ideologic conflict and/or other kinds of strife. 

So we are mindful of the intersection between health, security 

and economics, and all we have to do is look at SARS to understand what a tremendous problem that one infectious disease outbreak really created. So it is a very interdependent process, and 

there absolutely are important security concerns that we can certainly speculate about and talk offline. 

Senator WHITEHOUSE. Good. I appreciate it. 

Senator BOXER. Thank you, sir. Thank you. 

Well, you know, we are going to move on to our next panel, but 

I just have to say, Dr. Gerberding, that I found your presentation 

extremely important. I found your testimony very powerful. You 

are not into the politics of this. You are into helping people, and 

I think what you said today is very important. It is devoid of politics. What you are telling us is we better get ready for this and we 

better get ready for this now. I appreciate it very, very much. 

Thank you. 

Dr. GERBERDING. Thank you. I appreciate the opportunity to be 

here and also to make a case for getting the science. I think that 

is exactly where we need to go. Thank you. 

Senator BOXER. Absolutely. Thank you very much. 
23 

And now we are pleased to invite our next panel up. We have 

Dr. Michael McCally, M.D., Ph.D., Executive Director, Physicians 

for Social Responsibility; Susan Cooper, MSN, RN, Commissioner, 

Tennessee Department of Health; and Dr. Don Roberts, Professor 

Emeritus, Uniformed Services University of the Health Sciences. 

We welcome you. It is my intent to move you along. We will give 

you 5 minutes. If you can go 4, that gives us more time for questions because we are going to have to stop this whole hearing because we think we have four votes in a row. 

So let’s get started. Dr. McCally, Physicians for Social Responsibility, welcome, sir. 

STATEMENT OF MICHAEL MCCALLY, EXECUTIVE DIRECTOR, 

PHYSICIANS FOR SOCIAL RESPONSIBILITY 

Dr. MCCALLY. Good morning and thank you. 

I am Dr. Michael McCally. I am executive director of Physicians 

for Social Responsibility. I am pleased to join Dr. Gerberding and 

my other witnesses beside me on the subject of health and global 

warming. I will cut my remarks. 

PSR and its 32,000 members believe that climate change is a 

global health crisis. In support of this position, I am pleased to provide the Committee today a growing list of very distinguished 

American physicians, including clinicians, professors from wellknown medical schools, a former Governor, Nobel laureates, a 

former Surgeon General, all physicians, all have joined PSR in calling on this Committee and the Congress and the President to act 

on global warming and quickly put in place appropriate controls on 

greenhouse gas emissions. 

I have also provided members of the Committee with a brief 

analysis that highlights human health impacts of global warming 

in the U.S., much in the fashion that Dr. Gerberding has just given 

us. I would very quickly cite just a few examples we have heard, 

and many of them, Madam Chairman, you covered them in your 

opening remarks. 

We have already talked about here this morning the summer of 

2003 record-breaking temperatures in Europe and the 35,000 lives 

that were lost. I would mention air quality, more than 100 million 

Americans live in areas where ozone levels exceed the U.S. EPA air 

quality standard. Rates of asthma, respiratory and related cardiovascular disease continues to rise. Global warming undermines efforts to improve air quality as rising temperatures accelerate ozone 

formation during summer months. 

Finally, West Nile virus, not seen in this Country before 1999, 

and I was in New York and worked on the issue as the first manifestation of that issue appeared in that city. To date, more than 

25,000 cases of West Nile virus have been reported across this 

Country and Canada, with more than 1,000 deaths. 

I would just want to mention briefly the problems of the Western 

United States. In my home State of New Mexico, the wildfire season has grown by 78 days in the last three decades. The West has 

seen greater temperature rises than other parts of the United 

States. In some areas, temperatures have already risen on average 

by 2 °C over the past century, more than the global average of one 

half degee. 
24 

In coming decades, further rise in temperature will bring snows 

that melt sooner, shrinking snow pack, and threat to the stored 

water supply. It is predicted that water resources in the Colorado 

Basin will decline by 40 percent in this century. 

So it seems to me that the science debate is over. There is scientific and increasingly a social consensus that we must act definitely to stabilize greenhouse emissions and to limit further temperature rise. To date, there has been no significant Federal action 

on global warming. As a scientist and a physician, as a citizen and 

as a grandparent, I find this inaction disturbing. 

I have one more page. 

We are passing responsibility for global warming to our children 

and our grandchildren. We need action now. Not all government is 

ineffective. In the absence of a Federal response, cities and States 

have taken action. There are now more than 290 American cities 

and 27 States working on climate action plans. These actions include efforts to improve the efficiency of vehicles, buildings, expand 

our use of renewable energy, and many of these projects tend carefully to the cost implications that have been raised this morning 

appropriately, and include green industrial development. 

The medical community supports the assertions of our colleagues 

who serve on the Intergovernmental Panel on Climate Change. In 

order to reduce U.S. emissions to an acceptable level, we support 

mandatory controls on greenhouse gases that will reduce emission 

levels to a 1990 baseline by the end of the next decade, and an 80 

percent reduction by the middle of the century. 

Finally, to conclude, I do want to point out that physicians are 

beginning to consider the implications of global warming for clinical practice and for public health preparedness. They will need 

support and leadership from the CDC in particular in these new 

efforts. I would urge the Committee to understand that the Centers 

for Disease Control, and through it, State and local health departments, must be appropriately funded to respond adequately to global warming. 

I thank you. 

[The prepared statement of Dr. McCally follows:] 

STATEMENT OF MICHAEL MCCALLY, M.D., PH.D., EXECUTIVE DIRECTOR OF

PHYSICIANS FOR SOCIAL RESPONSIBILITY

Good morning, Madame Chair and members of the committee. I am Dr. Michael 

McCally, Executive Director of Physicians for Social Responsibility (PSR), and a 

medical school Professor of Community and Preventive Medicine. My field is environmental health. I am pleased to join Dr. Gerberding and Commissioner Cooper 

in testifying before the committee about the human health dimensions of global 

warming. 

Managing global warming will be a long and protracted task. The U.S. must engage now and with the same level of effort we mounted to deal with previous global 

crises: two world wars and a cold war. As a leading emitter of greenhouse gases the 

United States must accept its share of the burden in solving this problem. 

PSR and its 32,000 members believe climate change is a global health crisis. In 

support of this position I am pleased to provide to the committee today a list of 115 

distinguished physicians that includes professors from 15 medical schools, a former 

governor, two Nobel Laureates and former Surgeon General David Satcher. 

We continue to collect endorsers for these principles, which also are supported by 

the American Nurses Association, the American Public Health Association and the 

National Association of Pediatric Nurse Practitioners. Together, these groups represent more than 200,000 physicians, nurses and public health professionals. All 

have joined PSR in calling on this committee, the Congress and the president to act 
25 

on global warming and quickly put in place appropriate controls on greenhouse gas 

emissions. 

Already, the World Health Organization estimates that 150,000 people die every 

year from effects of global warming. While those deaths may not be as apparent in 

the U.S. the impacts of global warming are pervasive and will shortly affect every 

citizen in this country in some manner. 

I have provided all members of the committee with a brief analysis prepared by 

PSR that highlights the human health impacts of global warming in the U.S. 

Weather related events that cause death are not uncommon in the U.S.—it is the 

extremes and frequency of these events that will cause a mounting public health 

toll. Likewise, poor air quality is presently a problem in many areas of the country 

and will be exacerbated by rising temperatures. 

Already we are seeing the symptoms of global warming in the form of heat waves, 

fires, flooding, hurricanes, drought and increases in pest and water borne diseases: 

• The most recent report from the Intergovernmental Panel on Climate Change 

confirms that across the globe, including here in the United States, the frequency 

and duration of heat waves has increased over the last 50 years. In the summer 

of 2003, record breaking heat waves across Europe claimed an estimated 35,000 

lives, tragically demonstrating the potentially disastrous public health consequences 

of a continued trend of increasingly frequent extreme heat events. Looking into the 

future, researchers estimate that Chicago will experience 25 percent more frequent 

heat waves with a business-as-usual scenario, while the number of annual heat 

wave days in Los Angeles will rise from 12 to between 44 and 95—the upper end 

of this range marking a 692 percent increase. Extreme heat, already the number 

one cause of weather-related deaths in the U.S., will become an increasing public 

health burden if global warming is left unmitigated. 

• Although ambient air pollutant concentrations have generally fallen since passage of the 1970 Clean Air Act, more than 100 million Americans live in areas 

where ozone levels exceed the U.S. Environmental Protection Agency’s 8-hour air 

quality standard and rates of asthma and other respiratory diseases continue to 

rise. Global warming will undermine efforts to improve air quality as rising temperatures accelerate ozone formation during summer months. A recent study published in the journal Climatic Change projects that across 50 U.S. cities, the number 

of unsafe air days—days when ozone levels exceed the U.S. Environmental Protection Agency’s 8-hour air quality standard—will increase by 68 percent. The study 

also estimates that the number of unhealthy ‘‘red alert’’ days—days when everyone, 

young and old, healthy and infirm are advised to avoid prolonged outdoor exertion— 

is expected to more than double across these 50 cities. Here in the nation’s capitol, 

the number of healthy air days during the summer months is expected to drop by 

24 percent. Left unaddressed, rising ozone concentrations will cause serious respiratory and cardiovascular health problems in America’s cities. 

• West Nile Virus, virtually unseen in the U.S. as recently as 1999, has spread 

to 47 states as warmer winters and changing precipitation patterns allow conditions 

for an expansion of the mosquito population. To date, more than 25,000 cases of 

West Nile Virus have been reported across the country and more than 1,000 deaths 

have been recorded. 

And, extreme weather events are increasing with results that are difficult to predict and prepare for. As an example, those of us in the medical community were 

frustrated and finally ashamed of the response to Hurricane Katrina. Hundreds of 

people received inadequate or no health care at all. As a result, many unnecessary 

deaths occurred and hundreds of others were left sick without sanitation or clean 

water supplies. And, as the public health fallout of Katrina demonstrated, it is the 

poor and disadvantaged who are likely to suffer the most. They have more difficulty 

escaping the heat, are more frequently exposed to the elements and have less access 

to health care. 

As scientists and physicians we must examine the evidence and look for solutions, 

treatments if you will. Medicine is based on notions of prevention. We devise treatment plans or solutions with an aim of cure. But, those things that we cannot cure 

we must work to prevent—certainly that is the case with global warming. The medical community supports the assertions of our colleagues who serve on the Intergovernmental Panel on Climate Change. In order to reduce U.S. emissions to an acceptable level, we support mandatory controls on greenhouse gases that will reduce 

emission levels to the 1990 baseline by the end of the next decade and then lead 

to an 80 percent reduction by the middle of the century. 

In my home state of New Mexico scientists believe that global warming is leading 

to more heat, less snow and more wildfires. The West has seen larger temperature 

increases than any other part of the United States. In some areas temperatures 
26 

have already risen by 2 degrees C over the past century, much more than the average change globally of +0.5 degrees C. 

Warming clearly is present in the Southwest. In New Mexico the wildfire season 

has grown by 78 days during the past three decades. Fire is a significant and costly 

public health and economic problem. In coming decades further rise in temperature 

will bring later snows that melt sooner, shrinking the snow pack and stored water. 

One study predicts that water resources in the Colorado basin will decline by 40 

percent in the century. 

There is scientific and increasingly social consensus that we must act quickly and 

definitively to stabilize greenhouse gas pollution and to limit further temperature 

rise. To date there has been no significant federal action on global warming. As a 

scientist and physician, as a citizen and as a grandparent I find this inaction unconscionable. We are passing responsibility for global warming to our children and 

grandchildren. The administration has failed to address global warming, and the 

Congress should feel an extra sense of responsibility. 

Not all government is ineffective. In the absence of a federal response cities and 

states have taken action. There are now 290 American cities and 27 states working 

on climate action plans. These actions include efforts to improve the efficiency of our 

vehicles and our buildings and to expand our use of renewable energy from the wind 

and the sun. 

Finally, the U.S. medical and public health community as you have heard this 

morning is not prepared for multiple, large scale disasters that will manifest themselves as a result of climate change. Preparedness is a new medical and public 

health mission for which we are not adequately funded. I would urge the committee 

to understand that the Centers for Disease Control—and through it state and local 

health departments—must receive the funds necessary to respond appropriately to 

the challenges we will face as a result of global warming. 

That concludes my testimony, and I will be glad to answer any questions from 

the committee. 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 

Senator BOXER. Thank you, sir. 

Susan R. Cooper, Commissioner, Tennessee Department of 

Health. We welcome you. 

STATEMENT OF SUSAN R. COOPER, COMMISSIONER, 

TENNESSEE DEPARTMENT OF HEALTH 

Ms. COOPER. Thank you, Madam Chairman and members of the 

Committee. I am here today as the Commissioner of the Tennessee 

Department of Health, and also as a member of the Association of 

State and Territorial Health Officials, or ASTHO. This organization 

represents all of the State and territorial public health agencies of 

the United States, the U.S. territories, and the District of Columbia. Our members are the chief health officials of these agencies. 

As Commissioner of Health, one would ask what our job is, and it 

is pretty simple. Our job is really to protect, promote and improve 

the health of the citizens of our States. 

It is really a pleasure to be here today to discuss the human 

health impacts of climate change. I would like to begin by thanking 

you for recognizing the need to include the public health system in 

preparing for and responding to the consequences of climate 

change. ASTHO does support the scientific consensus put forward 

with the IPCC Fourth Assessment Report that the weight of evidence demonstrates that human factors have and will continue to 

contribute significantly to changing the world’s climate. 

We have validated this through a unanimous passage of our position statement about three weeks ago. Our statement complements 

the policy and position statements of the Centers for Disease Control and Prevention and the National Governors Association. 

We know that the anticipated health effects related to weather 

and climate change include death and illness from heat waves, injuries from catastrophic events such as hurricanes, tornadoes and 

floods, increased air pollution with concurrent rises in respiratory 

and cardiovascular disease, detrimental impacts on water quality 

and quantity, and an increase in the incidence of vector-, food- and 

water-borne diseases. 

Recent climate-related challenges from extreme weather events 

and the changing patterns of communicable disease, have already 

demonstrated the critical need to improve public health capacity to 

identify, prevent and respond to these threats. 

We recognize that climate change has serious far-reaching implications for the health of this and future generations. So today, I 

would like to focus on the assertion that climate change has the potential to place unprecedented demands upon the public health infrastructure of the United States, the need for action to bolster 

State, Federal and local health systems to cope with these challenges, and urging our State, local and Federal government bodies, 

including legislatures, to provide leadership in the development 

and coordination of sound public health policy. 

We acknowledge that there are great uncertainties regarding the 

project impacts of climate change on health. The actual impacts 

may be influenced by many confounding factors, such as socioeconomic status, demographic structures, geographical location, access to medical care, and adaptation measures. We as States continually and effectively respond to weather- and climate-related 
40 

events, but our systems are being taxed by these events as they are 

appearing with increased frequency and greater severity. 

I would just like to give you a few State examples. In August of 

this year, Tennessee faced a significant and very deadly heat wave. 

It resulted in temperatures exceeding 100 °C for a number of days, 

accompanied by significant drought. Water systems were taxed. 

Power demands led to rolling electrical outages. Human effects 

were substantial, resulting in 15 deaths, 14 in one county. 

We were very successful in proactively addressing the heat by 

working with the Governor’s office and other State agencies to 

reach out to vulnerable populations to provide air conditioners to 

low-income elders and families with children; to coordinate water 

and cooling stations; and opening community health shelters for 

those at risk. 

We have seen an algal bloom on the Chesapeake Bay, which has 

resulted in major fish kills, threatening oyster farms and certainly 

impacting human health through shellfish poisoning. In Montana, 

we know that this State is faced with significant wildfire threats 

and increasing temperatures will see a continued rise in those, contributing to increased respiratory distress and failure, death in 

many cases. 

In Georgia, again they are facing significant droughts. Unfortunately, they have seen a rise in the occurrence of West Nile virus, 

where in Tennessee our drought has produced a decrease in West 

Nile virus. 

There are many, many examples of this, but we are her today to 

ask for strong coordination and collaboration across all tiers of government to really improve our understanding of climate change so 

that we can optimally prepare and respond to these health impacts. 

We urge you to look toward research investment to better understand the potential health impacts of climate change and to develop 

and enhance our surveillance capabilities to mitigate impacts. 

These efforts should include, but not be limited to initiating and 

promoting scientifically based health programs, developing practice 

standards, identifying promising practices and success stories, developing decision support systems that enable our agencies to predict, anticipate and model events, and develop early warning systems that will help us enable rapid response. 

I see that my time is over. I have many more things I would love 

to share with you, but I will stop, and I would be happy to take 

any questions at the end. 

[The prepared statement of Ms. Cooper follows:] 

STATEMENT OF SUSAN R. COOPER, MSN, RN, COMMISSIONER, TENNESSEE DEPARTMENT OF HEALTH, REPRESENTING THE ASSOCIATION OF STATE AND TERRITORIAL

HEALTH OFFICIALS

OPENING

Chairman Boxer, Senator Inhofe, Senator Alexander and Members of the Committee, I am Susan R. Cooper, MSN, RN, Commissioner of the Tennessee Department of Health and member of the Association of State and Territorial Health Officials (ASTHO). ASTHO represents the state and territorial public health agencies 

of the United States, the U.S. Territories, and the District of Columbia. Our members are the chief health officials of these agencies. My job is to protect, promote 

and improve the health of the citizens of my state. It is a pleasure to appear before 

you today to discuss the human health impacts of climate change. 
41 

BACKGROUND AND CHALLENGES

First, let me begin by thanking you for recognizing the need to include the public 

health system in preparing for and responding to the consequences of climatic 

change. ASTHO supports the scientific consensus put forward within the Intergovernmental Panel on Climate Change Fourth Assessment Report that the weight of 

evidence demonstrates that human factors have and will continue to contribute significantly to changing the world’s climate. This recognition is clearly illustrated 

through the unanimous passage of a Position Statement on Public Health and Climate Change during the ASTHO Annual Meeting, held just three weeks ago. 

ASTHO’s position statement compliments the policy and position statements of the 

Centers for Disease Control and Prevention and the National Governors Association. 

The anticipated health effects related to weather and climate change include 

death and illness from heat waves, injuries from catastrophic events such as hurricanes, tornadoes, and floods, increased air pollution with concurrent rises in respiratory and cardiovascular diseases, detrimental impacts on water quality and 

quantity, and an increased incidence of vector-, food- and water-borne diseases. Recent climate-related challenges, from extreme weather events to changing patterns 

of communicable disease, have already demonstrated the critical need to improve 

public health capacity to identify, prevent, and respond to these threats. 

ASTHO recognizes that climate change has serious far-reaching implications for 

the health of this and future generations. My remarks will focus on (1) the assertion 

that climate change has the potential to place unprecedented demands upon public 

health infrastructure in the United States, (2) a need for action to adequately bolster federal, state and local health systems to cope with the present and future challenges of climate change, and (3) urging federal, state and local government bodies, 

including legislatures, to provide leadership in the development and coordination of 

sound public health policy to address health impacts related to climate change. 

ASTHO acknowledges that there are uncertainties regarding the projected impacts of climate change on health. The actual effects of climate change on population 

health are influenced by many confounding factors, including socioeconomic status 

of individuals and communities, demographic structure of the population, geographical location, access to medical care, and adaptation measures implemented to 

reduce negative impacts. Recognizing these uncertainties, ASTHO supports decisive 

action to adequately bolster public health infrastructure to prepare for future challenges. 

KEY ISSUES AND STATE EXAMPLES IN THE HEALTH SECTOR

States continually and effectively respond to weather and climate related events 

but the systems are being taxed as these types of events appear to occur with increased frequency and with greater severity. I would like to give a few recent state 

specific examples. 

In August of this year, Tennessee experienced a prolonged, severe heat wave 

which lasted eleven days where temperatures exceeded 100 degrees. This was accompanied by a severe drought. Water systems were severely taxed, resulting in numerous water restriction orders. Power demands led to rolling electrical outages in 

some areas. Human effects were substantial. Fifteen deaths were reported to be 

heat-related, fourteen of which occurred in one Tennessee county. An increase in 

heat related illnesses and injury was also reported. Through surveillance activities 

and proactive monitoring, the Tennessee Department of Health reached out to communities at risk to provide statewide information on preventing heat-related illness 

and injury. In addition, the TDOH worked with the Governor’s office and other state 

agencies to identify vulnerable populations and to activate our public health preparedness system to implement mitigation strategies such as providing window air 

conditioning units to low income elders and families with children, coordinating 

water/cooling stations, and opening community shelters for those at risk. 

With increased surface water temperatures, states all along U.S. coasts are seeing 

increases in harmful algal blooms. In 2007, a bloom along the Chesapeake resulted 

in a major fish kill and threatened oyster farms along the Bay. Blooms not only impact the aquatic life, but can also directly impact human health through shellfish 

poisoning, skin irritation from direct contact, respiratory distress by inhalation of 

toxins, and decreased availability of recreational waters. Algal bloom events also attract significant public and media attention. The Virginia Department of Health 

works collaboratively with other state agencies and academic institutions on a 

Harmful Algal Bloom Task force to monitor, respond to and communicate with the 

public about algal blooms. 

In Montana, a state that routinely faces wildfire threats, increasing temperatures 

will result in more frequent occurrences of large, uncontrolled fires. Wildfires not 
42 

only pose a direct threat to the health and safety of nearby residents, but also create 

dangerous levels of particulates in the air, contributing to respiratory distress and 

failure, and death in many cases. In 2007, the Montana Department of Public 

Health and Human Services worked closely with the Department of Environmental 

Quality to issue alerts about air quality and health impacts, aimed particularly at 

vulnerable populations. The state health agency also utilized the Health Alert Network to communicate with local health professionals throughout the fire season. 

CHALLENGES

In Georgia this year, an extreme drought situation has impacted both the availability of water and paradoxically resulted in an increase in mosquito populations 

throughout the state. Because of the lack of precipitation, residents are being forced 

to irrigate and water their lawns and gardens to make up for the drought, creating 

fertile opportunities for mosquito growth. Subsequently, human West Nile Virus 

cases have risen to more than twice the number as were reported in 2006. The public health outcomes and impacts of shifts in weather patterns on individual states 

and localities is unpredictable and complex. While Georgia saw an increase in West 

Nile Virus cases with an extended drought, Tennessee saw a 68 percent decrease 

in cases as a result of the severe drought and significant water use restrictions. In 

order to ensure adequate response to protect the public’s health with such variations, it is essential that we maintain critical public health surveillance systems 

and that they be equipped to monitor real-time changes in disease trends. 

Climate change may increase the number of known disease vectors, such as mosquitoes and ticks, or expand the geographic range of these disease vectors and their 

natural reservoirs. Climate conditions that increase water temperatures, water salinity or nutrient levels would change marine ecosystems along the Texas gulf coast 

and possibly increase diseases associated with fish and shellfish consumption and 

swimming. The impact of climatic change on disease occurrence is uncertain. However, to identify any change in disease occurrence, local and state health departments need to maintain disease surveillance activities to detect any changes in disease occurrence and to identify vulnerable subpopulations that would be adversely 

impacted by changing climatic changes. In 2005, the first cases of domestically acquired Dengue Fever were identified in Cameron County along the Texas-Mexico 

border. The Texas Department of State Health Services conducted an epidemiologic 

investigation and continues to conduct surveillance for Dengue Fever. In addition 

to changes in infectious disease patterns, health departments may need to develop 

new surveillance systems to measure non-infectious diseases such as heat-related 

deaths and asthma related to decreasing air quality. Maintaining and enhancing 

disease surveillance systems and having staff to analyze and evaluate information 

collected by these systems will ensure the detection of disease changes and ensure 

that appropriate disease intervention and control measures are initiated. 

PLANNING AND PREPARING FOR CLIMATE CHANGE

ASTHO advocates strong coordination and collaboration across all tiers of governmental public health to improve understanding of climate change and enable optimal preparation and response to related health impacts. We urge federal, state and 

local government bodies, including legislatures, to provide leadership in the development and coordination of sound public health policy to address health impacts related to climate change. 

ASTHO supports enhancing the ability of federal, state and local health agencies 

to understand and prepare for the health impacts linked to climate change in their 

jurisdictions. ASTHO urges the federal government to provide leadership, resources 

and programs to support state health agencies in developing educational initiatives 

to raise awareness of the link between climate change and human health among 

public health professionals and prepare for the potential health impacts with enhanced planning, surveillance initiatives, and event response. Sustaining funding 

for public health preparedness will be critical in helping state and local health departments maintain the capacity to respond to climatic and other public health 

emergencies. 

ASTHO supports investment in research to better understand the potential health 

impacts of climate change and to develop and enhance surveillance and response 

systems to mitigate health impacts. These efforts should include, but not be limited 

to, initiating and promoting scientifically based health programs; developing practice standards; identifying promising practices and success stories; developing decision support systems that enable agencies to predict, anticipate and model events; 

and developing early warning systems that enable rapid response. 
43 

ASTHO emphasizes the importance of public health agencies and professionals to 

inform communities, policy makers, other government departments and industry of 

the public health impacts of climate change. Public health leaders must be at the 

forefront of all mitigation and adaptation actions related to climate change. ASTHO 

encourages public health agencies and professionals to actively engage with all 

stakeholders to insure consideration of the potential health impacts in all aspects 

of behavior, consumption and decision making that may contribute to climate 

change. ASTHO urges public health agencies and professionals to actively promulgate policies towards preventing and mitigating the public health impacts of climatic change. 

In closing, I want to again thank the members of this Committee for your past 

commitment to improving the health, safety and wellbeing of our nation. We know 

that so much more can be and must be done to protect our nation’s health as we 

continually anticipate and prepare for a myriad of public health threats. We welcome the opportunity to continue to work with you in pursuit of that goal. 

Thank you for your attention. I will be pleased to answer any questions you may 

have. 

RESPONSE BY SUSAN R. COOPER TO AN ADDITIONAL QUESTION

FROM SENATOR INHOFE

Question. A recent article in ‘‘Geotimes’’ magazine shows that global population 

killed by natural disasters has decreased 10-fold since 1964, while the number of 

natural disasters has risen 5-fold. Would you say that humans are more prepared 

than ever for natural disasters? 

Response. I can say, without reservation, that as a Nation, we are much better 

prepared today than ever before to effectively respond to all hazards, including natural disasters. It is important to emphasize that in addition to advancing critically 

important interventions to prevent the occurrence or at least mitigate the magnitude of such events, the public health community is also responsible for managing 

the health and medical consequences when emergencies and disasters do occur. This 

is paramount given the ever increasing threats our society faces and must deal with, 

and the fact that we will never be in a risk-free environment and public health must 

remain at the ready to prevent, control and reduce illness, injury, and mortality. 

The example you have shared clearly illustrates success in this regard. Through 

effective pre-event planning, training and exercising response personnel, use of 

rapid detection and surveillance systems, early warning and communications strategies including public education and awareness, and building surge capacity in our 

health care system to handle mass casualties, we have and will continue to strive 

to further reduce the impacts of man-made and natural disasters and acts of terrorism. 

We are clearly seeing the return on our investment in rebuilding and strengthening our public health system since 2001. We must, however, sustain these capacities and capabilities and further expand them in order for all jurisdictions to be 

equally well prepared at all times. We cannot become complacent and let our guard 

down. The threats and challenges from all sources, including those such as extreme 

weather events and the emergence of infectious diseases which may be attributed 

to climate change, warrant priority consideration as it pertains to federal funding, 

technical assistance provided to states and localities, and sound national policies 

and strategies. 

RESPONSES BY SUSAN R. COOPER TO ADDITIONAL QUESTIONS

FROM SENATOR BOXER

Question 1. Please describe the importance of preventing conditions that create 

health threats, rather than acting to reduce the adverse impacts of such threats. 

Response. Primary prevention involves taking action to prevent problems from occurring before the onset of symptoms. It focuses on environmental or systemic 

changes that are aimed at entire populations, such as an entire community, rather 

than treating one individual at a time. 

About twenty years ago, a metaphor about ‘‘going upstream’’ was created to help 

explain the value of prevention. Today, that metaphor still works well for creating 

new converts. This example taken from the Prevention Institute 

(www.preventioninstitute.org) helps explain the value of prevention. Suppose you are 

standing next to a river, and you see someone drowning as he floats downstream. 

You jump into the river and pull him ashore. As soon as you’ve done that, you see 
44 

another person in trouble, again floating downstream, and you rescue her as well. 

Every time you’ve saved one person, you see another, and another. After you’ve 

dragged another drowning body out of the river, you’re thoroughly exhausted and 

you know you don’t have the energy to save one more victim so instead you decide 

you must go upstream to find out what is causing these people to drown. If you can 

prevent whatever is causing these people to drown at the source, you won’t have 

to continue saving the victims, one by one. Eventually, you find that people are falling into the river because they are stepping through a hole in a bridge. You fix the 

bridge, and people stop falling in. Primary prevention means ‘‘going upstream’’ and 

fixing the bridge before more people fall into the river. This takes fewer resources, 

and results in less pain and suffering than pulling each drowning person out of the 

river. 

While ‘‘downstream’’ efforts are important and represent one of the primary roles 

of public health, focusing attention and effort ‘‘upstream’’ will more effectively reduce human suffering, medical costs, productivity losses, injury and death. 

ASTHO encourages policy makers to make prevention a cornerstone of America’s 

health system. Ensuring that a reformed health system incorporates prevention policy principles would have an enormous impact on the health of the American people. 

Delivering preventive services that have been proven effective is essential if we are 

to optimize the health of our citizens. 

Investing in prevention means supporting the two approaches that health professionals use to promote health and prevent disease, namely, (1) improving the quality and quantity of clinical preventive services delivered to individual patients and 

(2) implementing community preventive services, programs, and policies aimed at 

broad populations or sub-populations. 

Considerable and compelling evidence makes clear that community preventive 

services aimed at populations have an enormous impact on health and are extremely cost-effective. The nation will get a much greater return on investment by 

focusing on health improvements in communities, schools, and worksites rather 

than focusing solely on what occurs in traditional healthcare settings, such as doctors’ offices and hospitals. 

A health system continuum must be developed that goes from community-based 

health promotion and disease prevention, to primary care-based health promotion 

and disease prevention, to primary-based early detection and treatment of disease, 

to specialty care diagnostic testing, hospital care, emergency care, and end-of-life 

care. 

Question 2. What types of coordinating activities by the federal government can 

best assist states to prepare to address the human health impacts from global 

warming? 

Response. ASTHO advocates strong coordination and collaboration across all tiers 

of governmental public health to improve understanding of climate change and enable optimal preparation and response to related health impacts. ASTHO urges the 

federal government to strongly consider the health impacts related to climate 

change as a key consideration in reforming existing policy and law, and in future 

decision making and resource allocation that may contribute to negative health outcomes from climate change. Policies and decisions that further contribute or exacerbate changes in climate, should strongly consider adverse effects to the health of the 

community in all deliberations. Further, policies and practices from federal agencies 

that can help to mitigate the emerging threats to public health from climate change 

and that can support health agencies to better prepare for the health impacts are 

urged. 

Coordination of a comprehensive research agenda to establish a more complete 

picture of evidence as to the health impacts associated with climate change is of 

paramount importance. Establishing a core center to coordinate and pursue this research agenda with participation from all arms of the federal government is urgently needed. In addition to fundamental research on health impacts, the establishment of a research agenda to develop improved systems to undertake surveillance 

to monitor and model changes and their likely effects on public health is also in 

great need. The coordination of leading federal agencies to develop early warning 

systems tied to changing weather patterns, natural ecology and human factors will 

add to the capabilities of state and local health agencies to manage changes to public health threats. 

ASTHO urges the first tier involvement of the Department of Health and Human 

Services (DHHS) in all federal initiatives related to addressing climate change. 

ASTHO believes that it is imperative that public health is fully and equally engaged 

with all other considerations when working towards the challenges that climate 
45 

change presents, and urges the federal government to include representation from 

DHHS in all federal discussions related to climate change. 

As Climate Change and the health effects that may be experienced will be very 

different from region to region, the federal government must play a greater role to 

coordinate activities, provide sage technical assistance and guidance and foster adequate and necessary allocation of funding for specific initiatives. Increased coordination should enable more flexibility to improve resource allocation and can ensure 

commonality in the goals of the different arms of the federal government. 

Senator BOXER. Thank you very much. 

Dr. Roberts, we welcome you. Dr. Roberts is Professor Emeritus, 

Uniformed Services University of the Health Sciences. 

STATEMENT OF DONALD R. ROBERTS, PROFESSOR EMERITUS, 

UNIFORMED SERVICES UNIVERSITY OF THE HEALTH 

SCIENCES 

Mr. ROBERTS. Thank you, Chairman Boxer. 

I will address the specific issues of climate change and vectorborne diseases. 

Opinions and perspective of individuals who have long and credible histories of insect-borne disease research and operational experience have often been excluded from the debate on the role warming temperatures might have on future trends of malaria and other 

insect-borne infections. For this reason alone, I appreciate the opportunity to be here today to describe the work and evidence compiled by some of those experts. 

The human health impact of global warming is being used as an 

argument for political actions to forestall theoretical harm. I am 

concerned about the scientific validity of this argument. I am also 

concerned about the consequences political actions will have for 

poor people in the United States and elsewhere. 

The acquisition of human disease is under great regulatory control of human behavior, disease-preventive measures, the economy, 

and standards of living. I will briefly summarize two reports. 

One was on dengue along the border of Texas and Mexico. This 

was conducted by CDC. There was low risk of dengue on the Texas 

side because of air conditioning that prevented mosquitos from entering houses or places of businesses and transmitting disease. 

This was not true for most businesses and households in Mexico, 

illustrating the importance of a vigorous economy and high standards of living to prevent dengue. 

The same is true of our protections against malaria. Malaria-infected people continually enter the United States, yet we maintain 

almost no response capability to an imported case or exercise any 

specific preventive measures. Our freedom from malaria is not because of cold U.S. temperatures, use of insecticides, antimalarial 

drugs, or any other specific malaria-preventive measure. 

No, our 60-year record of freedom from endemic malaria is a result of wealth and high standards of living. Indeed, a high standard of living is far and away the best malaria preventive measure 

yet discovered. 

However, absent a strong economy and high living standards, 

malaria preventives will still eliminate or reduce malaria transmission. This point is illustrated with results of malaria control operations in Southern Africa. Joint malaria control operations in 
46 

Swaziland and Mozambique have been underway since 1999. 

Again, I will summarize the results. 

In pre-spray surveys, infection rates in children in Mozambique 

were 64 percent. In Swaziland, they were 2 percent to 8 percent. 

The only explanation for low malaria infections in Swaziland and 

high infection rates just across the border in Mozambique was 

Swaziland sprayed houses. Mozambique did not. After spray operations were implemented in Mozambique, malaria rates on the Mozambique side of the border dropped from a pre-spray rate of 62 

percent to 38 percent in 2001, and 22 percent in 2002, and 8 percent in 2003. Rates also dropped in Swaziland to 0.25 percent. 

In summary, we can control malaria regardless of warm temperature or other natural ambient conditions. Our malaria problems stem from failure to do so. 

I would like to end my testimony with comments about who 

might be harmed by political action on climate changed based on 

the idea that insect-borne diseases will spread. Luckily, we can 

learn from history. In previous history before this Committee, I detailed the unfortunate political process that led to restrictions on 

the use of DDT and other insecticides in malaria control. These restrictions were not based on scientific evidence, and we can trace 

the re-emergence of malaria to the rise in political pressure to ban 

the use of DDT and to dismantle spraying programs. 

The people who paid for this unscientific political action were 

poor people in poor countries, and over many years millions paid 

with their lives. It has taken many hard, difficult years to fight 

against this anti-insecticides agenda, but now the U.S. Government 

is once again supporting malaria control that uses insecticides, including DDT. As a result, lives are being saved and malaria control 

is improving in many countries. 

We have a responsibility not to repeat past mistakes. I would 

urge this Committee to pay close attention, close and careful attention to the science and to disease control experts before taking political action on climate change on the basis of the spread of insectborne diseases. 

Thank you. 

[The prepared statement of Mr. Roberts follows:] 

STATEMENT OF DONALD R. ROBERTS, PROFESSOR EMERITUS, UNIFORMED SERVICES

UNIVERSITY OF THE HEALTH SCIENCES

Thank you Chairman Boxer, ranking member Inhofe and members of the Senate 

Committee on Environment and Public Works for the opportunity to present my 

views on human health impacts of global warming. 

Opinions and perspectives of individuals who have long and credible histories of 

insect-borne disease research and operational experience have often been excluded 

from the debate on the role warming temperatures might have on future trends of 

malaria and other insect borne infections. For this reason alone, I appreciate the 

opportunity to be here today to describe the work and evidence compiled by people 

with hands-on-experience in the field of vector-borne disease control. 

The topic of your hearing is important. The human health impact of global warming is being used as an argument for political actions to forestall theoretical harm. 

I am concerned about the scientific validity of this argument. I am also concerned 

about the consequences political actions will have for poor people in the United 

States and elsewhere. I will address these concerns in the course of my testimony. 
47 

1 BBC News. Global warming disease warning. Friday, June 18, 1999. Website: http:// 

news.bbc.co.uk/1/hi/sci/tech/372219.stm ‘‘The World Health Organisation (WHO) says global 

warming could lead to a major increase in insect-borne diseases in Britain and Europe.’’ 

‘‘This in turn could lead to an increase in disease-carrying pests such as ticks, mosquitoes and 

rats, which live in warmer climates and whose breeding-grounds are often in damp areas.’’ 

‘‘ ‘There is an urgent need to consider how to improve research and monitoring and how to 

minimise adverse health impacts,’ they write in a report in the British Medical Journal.’’ 2Warming trend may contribute to malaria’s rise. Science Daily, March 22, 2006. Website: 

http://www.sciencedaily.com/releases/2006/03/060322142101.htm 3 Reiter P, Lathrop S, et al. Texas lifestyle limits transmission of dengue virus. Emerg Infect 

Dis [serial online] 2003 Jan. Available from: URL:http://www.cdc.gov/ncidod/EID/vol9no1/o2– 

0220.htm 4Folha Online [20.10.2007] http://www1.folha.uol.com.br/folha/mundo/ult94u338268.shtml 5http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list— 

uids=12875252&dopt=AbstractPlus 

A BBC report detailed a claim by WHO and researchers1 that global warming 

would cause major increases in insect borne diseases. This claim is often repeated 

and similar claims have even suggested that global warming will worsen the problems of malaria in Africa and other endemic regions.2

No knowledgeable biologist would argue temperatures do not influence developmental rates of mosquitoes or developmental rates of malaria parasites in mosquitoes. Temperature does, in fact, have strong regulatory control over these developmental events. Likewise, combinations of factors, such as warming temperatures 

and increasing rainfall can produce favorable conditions for mosquito production. 

However, acquisition of insect-borne pathogens is complex and should never be reduced to considerations of warming temperatures alone. The one thing we have 

learned through the course of time and experience in control of insect-borne diseases 

is that presence of disease is largely a product of a few, very important, factors. One 

is human behavior as it relates to disease acquisition. Another factor is preventive 

measures to stop disease transmission. Another two factors are economic conditions 

and standards of living that work to prevent acquisition of disease. I want to illustrate the importance of the latter two factors with a study conducted by a large 

team of investigators led by Dr. Paul Reiter in the border area with Mexico.3

Each year Mexico reports outbreaks of dengue fever. For example, on Sunday, October 20, 2007, the Secretary of Health announced a dengue epidemic underway in 

Mexico, with almost 23,000 cases so far this year and 6 deaths.4 Dengue outbreaks 

even occur along the border of Mexico with the United States. However such outbreaks generally do not extend into the United States. 

The study I refer to was conducted in 1999 and encompassed two border towns, 

one in Mexico (Nuevo Laredo) and one in Texas (Laredo). The two towns are located 

close together and combined could be viewed as a single city with a river running 

through it. Temperature and climatic conditions in Laredo and Nuevo Laredo are 

practically the same. The population of Laredo was 200,000 and Nuevo Laredo was 

289,000. The study involved collecting data on mosquito abundance and sero-prevalence of dengue infections (analyses of anti-bodies as evidence of previous dengue 

infection) in sample households in the two towns. Investigators found that Aedes 

aegypti, the urban vector of dengue virus, was more abundant in Laredo. Yet, seroprevalence of dengue was greater in Nuevo Laredo. So, while the mosquito vector 

was ‘‘remarkably’’ abundant in the Texas town, risk of dengue infection was much 

less. The investigators used various sets of data to show that the major factor accounting for lower risk of dengue infections in Laredo was extensive use of air conditioners and evaporative coolers. In Laredo, houses and business were enclosed and 

people remained indoors where it was cool. As a result, mosquitoes could not enter 

houses or places of business and transmit disease. This was not true for most businesses and households in the Mexican city of Nuevo Laredo. 

Essentially, the 1999 study illustrates the importance of a vigorous economy and 

high standards of living to prevent dengue and other important insect-borne diseases. The same is true of our protections against malaria. Many malaria-infected 

people are reported in the United States each year. For example, over 1,300 imported cases were documented in 20025 and this does not accurately account for 

many unreported cases that occur in illegal workers. In spite a continuous flow of 

malaria infections into the U.S., our country does not have endemic malaria. We 

have sustained this relative freedom from malaria for almost 60 years. Yet, we 

maintain almost no response capability to an imported case or exercise any specific 

preventive measures. Our freedom of malaria is not because of cold U.S. temperatures, use of insecticides or anti-malaria drugs, or any other specific malaria preventive measure. No, our freedom from malaria is a direct result of wealth and high 

standards of living. Indeed, a high standard of living is far and away the best ma-
48 

6Sharp BI, Kleinschmidt I, et al. Seven years of regional malaria control collaboration—Mozambique, South Africa, and Swaziland. Am J Trop Med Hyg 76(1), 2007:42–47. 7Lubombo. Malaria control in the Lubombo spatial development area. A regional collaboration. Report produced on behalf of the Regional Malaria Control Commission by the MRC and 

UCT. August 2004:34 pp. 8Tren R. Africa Fighting Malaria. Washington D.C. personal communication October 18, 2007. 

laria preventive measure yet discovered. However, absent a strong economy and 

high standards of living, malaria preventives will still eliminate or reduce malaria 

transmission, regardless of amount of rainfall or regardless of warming temperatures. To illustrate this point I will describe results of malaria control in southern 

Africa. 

I take this example from the Lubombo Spatial Development Initiative (LSDI).6,

7 This is a joint program between the governments of Mozambique, Swaziland, and 

South Africa to develop the general region into a competitive economic zone. The 

communities in this zone (Lubombo region) of high malaria risk are some of the 

poorest in the region. Malaria control was a priority undertaking of the LSDI because malaria control was recognized as a precursor to development. The tri-national program agreement was signed in 1999 and various stages of the program 

got underway in October 1999. Of the three countries, I will compare conditions in 

Swaziland with Mozambique. 

Environmental conditions and native peoples of the adjoining strips of Mozambique and Swaziland are very similar. Patterns of temperature and rainfall are 

similar. There is considerable poverty in both and the only truly significant difference, in regard to malaria, is that Swaziland has maintained an indoor spray program for many years.8 For this reason, when pre-spray (as far as the startup of the 

Lubombo initiative) surveys were conducted in 1999, malaria prevalence at the 4 

sentinel sites in Swaziland was 2–8 percent. There were no significant differences 

in infection rates in children versus older age groups. In striking contrast, Mozambique had no routine spray program leading up to the pre-spray survey. Child and 

adult prevalence surveys were conducted at all sites in the first survey round in December 1999 in Mozambique. Average infection rate in children was 64 percent and 

30 percent in adults. Infection rate differences in children and adults are attributed 

to protective immunity from frequent malaria infections. In other words, children 

in Mozambique were more susceptible to infection than were adults. 

Data from these two countries show how preventive measures can truly provide 

high levels of malaria prevention in areas of high malaria risk. The level of protection is revealed in low infection rates in Swaziland (2–8 percent) versus 30 to 64 

percent infection rates in adults versus children in Mozambique. The only explanation for low malaria infections in Swaziland and high infection rates just across 

the border in Mozambique was Swaziland sprayed houses. Mozambique did not. Additionally, once malaria infections were reduced in border areas of Mozambique, 

Swaziland infection rates dropped even lower. This drop was attributed to fewer imported malaria cases from across the border with Mozambique. By 2006, infection 

rates in Swaziland were only 0.25 percent. After spray operations were implemented 

in Mozambique, malaria rates on the Mozambique side of the border dropped from 

a pre-spray rate of 62 percent to 38 percent in 2001, 22 percent in 2002, and 8 percent in 2003. This example provides stark testimony to the fact that we can exert 

effective control over malaria regardless of warm temperatures or other natural ambient conditions. The bottom line is, we can control malaria. Our malaria problems 

stem from failure to do so. 

I would like to end my testimony with a few comments about who might be 

harmed by political action on climate change based on the idea that insect borne 

diseases will spread. Luckily we can learn from history. In previous testimony before this committee I detailed the unfortunate political process that led to restrictions on the use of DDT and other insecticides in malaria control. These restrictions 

were not based on scientific evidence and we can trace the re-emergence of malaria 

and other insect borne diseases such as dengue to the rise in political pressure to 

ban the use of DDT and to dismantle the spraying programs. The people who paid 

for this unscientific political action were poor people in poor countries and, over 

many years, millions paid with their lives. It has taken many hard and difficult 

years to fight against this anti-insecticides agenda, but now the U.S. government 

is once again supporting malaria control that uses insecticides including DDT. As 

a result, lives are being saved and malaria control is improving in many countries. 

But many lives were lost thanks to the unscientific and largely political anti-insecticides campaign. We have a responsibility not to repeat past mistakes. I would urge 

this committee to pay close and careful attention to the science and to disease con-
49 

1Steere AC, Coburn J, Glickstein L. The emergence of Lyme disease. J Clin Invest. 2004 April 

15; 113(8): 1093–1101. 2MacLean JD, Ward BJ. The return of swamp fever: malaria in Canadians. CMAJ. JAN. 26, 

1999; 160 (2): http://www.cmaj.ca/cgi/reprint/160/2/211.pdf 

trol experts before taking political action on climate change on the basis of the 

spread of insect borne diseases. 

RESPONSES BY DONALD R. ROBERTS TO ADDITIONAL QUESTIONS

FROM SENATOR INHOFE

Question 1. You testified about the program instituted by several poor African nations to reduce malaria. I was startled to hear about the enormous difference that 

Swaziland’s, and later, Mozambique spraying program made in decimating malaria 

rates. Can you discuss further your views on the argument that increasing temperatures mean that malaria deaths will skyrocket? 

Response. Those who argue that warming will increase malaria deaths base their 

opinions on certain fundamental, but irrelevant, relationships. One irrelevant relationship is warming temperature can speed development of insects and pathogens 

inside insects. Another irrelevant relationship is that warming may change area 

ecology and allow a competent malaria vector to move in and transmit disease to 

people who live there. I will explain why these relationships are irrelevant; but first 

I want to focus attention on how climate change can actually reduce risks of disease 

and death. 

It is important to understand that too much warming can accelerate death of malaria-carrying mosquitoes. In fact, even modest warming, in absence of adequate humidity, can reduce survival of the malaria mosquito. As mentioned above, some 

argue that warming temperatures will change local ecology in ways that favor increased survival or improve reproductive success of malaria mosquitoes. In fact, 

changes in local ecology can have no affect at all on malaria mosquitoes or work 

against both survival and reproductive success of malaria mosquitoes. Likewise, 

warming and ecological changes may be entirely neutral or even work against invasion of competent vectors into areas where they have not been before. The reason 

for focusing attention on these interactions is to advise that belief in warming temperature as a cause of increasing malaria deaths is wrong. 

Temperature is just one of many factors that influence the transmission and 

spread of arthropod-borne diseases (such as malaria). We can consider the appearance and spread of Lyme disease in the United States to get a better understanding 

of the complexities and regulatory controls of these diseases. Lyme disease, as with 

other arthropod-borne pathogens, can benefit from warming temperatures. 

Lyme disease was first recognized as a disease entity in the northeastern U.S. in 

the 1960s1. It has grown as a public health problem since those years and has 

spread into many new areas. I recall when it was not present in Maryland. Then 

in the 1980s the disease made its appearance in Maryland and is now strongly entrenched there. It has spread to other states as well. Unlike malaria, which is transmitted by mosquitoes, ticks transmit Lyme disease and rodents are important in 

Lyme disease epidemiology. Yet, deer are the preferred host of the adult tick and 

increases in deer populations have facilitated spread of this disease. As numbers of 

deer continually increased, especially in urban areas, tick densities increased, the 

disease spread to new areas, and human infection became more common. Thus, 

Lyme disease is an example of a disease agent that benefits from warming temperatures but is most prevalent in colder regions. The reason for this distribution is that 

temperature is only one factor in a vast array of factors that influence Lyme disease 

distribution and proliferation. The same is true for malaria. 

Basically there is no scientific basis for fear that increasing temperatures will 

produce more and more cases of malaria and more and more malaria deaths. Scare 

stories about warming temperatures and increasing disease often utilize stories 

about malaria moving to highland areas as proof that warming temperatures will 

cause increases in disease and death. Such stories often fail to state that highland 

malaria is not new and malaria has occurred in the highland areas before. Indeed, 

malaria has occurred in highland areas around the globe. In decades past, malaria 

was even common in very cold northern regions of North America and Russia. In 

the big picture, these popular stories about highland malaria are just not that important. Highland malaria represents a relatively minor component of the global 

burden of human malaria. 

Malaria was once endemic in the United States and Canada.2 Malaria was eliminated from this large geographical area through systematic use of malaria control 
50 

3 Nash D, Mostashari F, et al. The outbreak of West Nile virus infection in the New York City 

area in 1999. N Engl J Med. 2001 Jun 14;344(24):1807–14. 

methods, growing wealth, better housing, and improved standards of living. It did 

not disappear as a result of lower temperatures and it will not return to the U.S. 

and Canada as a result of warming temperatures. Mankind has the ability to control, and in some locations, even eliminate malaria. Mankind also has ability to 

treat cases and, by and large, prevent deaths. In the world today, the fundamental 

cause of increasing malaria is our failure to use tools like DDT and other insecticides to prevent transmission and proliferation of disease. Likewise, the basic cause 

of huge numbers of malaria deaths is our failure to build proper public health infrastructure and to promptly diagnose and treat infections. 

In written testimony I presented evidence to confirm the relationships described 

above. 

Question 2. If malaria is controllable, what would you say is the primary reason 

for the ineffective response to this threat? 

Response. Even though malaria is a controllable disease, it is an extremely complex disease to control and requires detailed knowledge of mosquitoes, parasites and 

human behavior. Resistance to malaria treatments has been particularly challenging and has required enormous investments in new malaria drugs. The somewhat fickle nature of international aid has meant that donor support for malaria 

control is dependent on political will and interest both in donor nations and malarial 

countries alike. 

Yet the primary reason for the ineffective response to re-emerging malaria has 

been environmental activist campaigns against public health programs for spraying 

insecticides inside homes, and DDT in particular. 

There is no disputing the fact that environmental activists have worked for decades to stop use of insecticides in malaria control programs. This activism was on 

display in the 1970s suite environmental groups to stop USAID from exporting DDT 

for use in national malaria control programs. But this was just one small step in 

a much larger and globally orchestrated campaign to eliminate house spray programs and public health uses of insecticides. This campaign was behind the 1997 

World Health Assembly resolution for countries to reduce reliance on use of insecticides for disease control. The fact that the 1997 resolution was adopted attests to 

the success of the global campaign to shut down national spray programs. And, of 

course, the natural outcome of their success has been ongoing re-emergence of devastating diseases as typified by malaria and the global dengue pandemic. 

Shamefully, the same organizations that campaigned tirelessly to eliminate use 

of public health insecticides and allow diseases to re-emerge are now claiming global 

warming is the cause of increasing malaria. The public record of many activist organizations is on public display in opposing public health use of insecticides and in 

claiming global warming is facilitating the re-emergence of devastating diseases. 

Environmentalists should be broadly condemned for their role in unleashing those 

diseases on poor people of the world. They should also be broadly condemned for 

dishonestly using growth of those diseases as a cause celebre for fundraising in 

modern campaigns against global warming. 

Question 3. Is there anything else you would like to comment on in regards to 

the hearing? 

Response. Yes, there are two issues I would like to comment on in regards to the 

hearing. 

The first issue is an inference that the spread of West Nile Virus was caused by 

warming temperatures. In the discussion part of the hearing I stated that warming 

temperatures were not responsible for WNV spreading across the lower 48 states. 

I would like to add to that statement. 

It is true that warming temperatures can speed development of mosquito larvae 

in water. It is also true that warming temperatures can speed development of viral 

infection in mosquitoes. Yet, warming was not responsible for the appearance of 

WNV in 19993 or spread of WNV in the U.S. If warming temperatures were the 

cause of the spread of WNV across the contiguous 48 states, then human infections 

would have been more common in the south, where temperatures were warmer, 

than in the north, where temperatures are cooler. In fact, the opposite is true. With 

few exceptions, the greatest concentrations of human infections occurred in more 

northern areas of the country. These observations can be verified by a quick examination of the maps prepared by the CDC (see: http://diseasemaps.usgs.gov/wnv— 

us—human.html). Revealed in those maps are suggestions of far more important 
51 

factors in the distribution and transmission of WNV than just warming temperatures. 

There is a range of ambient temperatures that permit mosquito and virus development and those temperatures are normally present throughout the U.S. during 

much of the Spring, during Summer months, and much of the Fall. In other words, 

conditions are favorable for spread of WNV with or without any unusual warming 

of ambient temperatures. Besides, as described in response to the first question, too 

much warming can actually begin to work against mosquito survival and disease 

transmission. 

The second issue I would like to comment on in regard to the hearing is how we 

should use public funds to prepare for theoretical harm from warming temperatures. 

Our first line of defense against insect-borne diseases has been use of chemicals to 

repel, irritate, or kill insects. This statement is as true today as it was in the mid1940s when mankind started using DDT for disease control. Yet, since the late 

1960s, agencies within the United States have been working to systematically get 

rid of those chemical tools. Not only have vast millions, if not billions, of dollars 

been spent in one way or another to oppose public health insecticides, the U.S. government has invested almost nothing in research to find better chemical tools. The 

anti-insecticide campaign has ruined disease control programs, eliminated valuable 

chemical tools, and gutted national research expertise. As a consequence, today we 

have far fewer cost-effective chemicals to combat arthropod-borne diseases like malaria than in the 1960s. 

There would be no better use of public funds to combat re-emerging diseases than 

to reinvest in research. I have presented previous testimony that DDT functions 

mostly as a spatial repellent. When it is sprayed on house walls it stops malaria 

mosquitoes from entering houses and transmitting malaria to residents while they 

sleep. It should be viewed as a humanitarian disaster that there is no fully funded 

research program in the world focused on finding a spatial repellent as substitute 

for DDT in malaria control programs. The public health community needs a new 

and heavily funded program to find new chemicals and new methods for using spatial repellents, contact irritants, and insecticides. I am describing an old problem 

that needs to be addressed and resolved. It is time to address this national tragedy 

by appropriating new research and development money specifically for finding new 

chemical tools and new methods of using public health insecticides. 

RESPONSE BY DONALD R. ROBERTS TO AN ADDITIONAL QUESTION

FROM SENATOR BOXER

Question. Do you agree that the Intergovernmental Panel on Climate Change in 

2007 described a range of potential health effects from global warming, including 

respiratory problems and diseases, water-borne diseases, impacts from extreme 

weather events, among others, in addition to vector-borne diseases? 

Response. Yes, I agree that the Intergovernmental Panel on Climate Change in 

2007 described a range of potential health effects from global warming, including 

respiratory problems and diseases, water-borne diseases, impacts from extreme 

weather events, among others, in addition to vector borne diseases. Yet, I also know 

they claimed global warming would increase malaria deaths and problems of other 

insect-borne diseases. I am not well-versed in the other potential health harms they 

describe. However, their claims about climate change, malaria, and other arthropodborne diseases are wrong. In my opinion, they are indulging in scare tactics to scare 

the public as a means of changing policies. The IPCC loses credibility through these 

tactics and it gives me pause to wonder to what extent they are indulging in the 

same scare tactics with their other claims. 

There is an important decision making process for dealing with each potential 

health effect from global warming. In each case, there should be balanced consideration of whether it is best, both in cost to the economy and long-term outcome, to 

research methods and solutions to the problem opposed to enacting policies and programs that might amount to endangering economies of the world, to include that 

of the United States, to stop global warming. This is particularly important given 

the unequivocal and direct link between poverty and mosquito borne diseases such 

as malaria. Policies designed to deal with global warming on the basis that it will 

increase the spread of mosquito borne diseases may well exacerbate these diseases 

and worsen the misery that they cause for millions of people in poor countries. 

Senator BOXER. Thank you, sir. 

Well, Dr. Roberts, your answer to global warming is more pesticide use. My answer is reduce the impacts of global warming so 
52 

you don’t have to get into that battle of DDT and who is right and 

who is wrong. I think that is a very big difference between us. 

Are you familiar with West Nile virus? 

Mr. ROBERTS. Yes, ma’am. 

Senator BOXER. Do you know when health officials first recorded 

its introduction here in America? 

Mr. ROBERTS. It was in 1999. 

Senator BOXER. Correct. Can mosquitos and other animals carry 

this disease? 

Mr. ROBERTS. Mosquitos do carry the disease. They transmit the 

disease. 

Senator BOXER. So the answer is yes. 

Now, 8 years later, rather than being in one State, because you 

said we already can deal with it, how many States have recorded 

finding West Nile virus? 

Mr. ROBERTS. West Nile virus has spread across the whole of the 

United States. It is a zoonotic infection. 

Senator BOXER. Yes, 48 States have it. So do you agree that preventing the conditions that allow the spread of disease-carrying 

mosquitos is more health protective than taking actions once the 

disease spreads? 

Mr. ROBERTS. With all due respect, Senator, I do not see a link 

between warming temperatures and the spread of West Nile virus. 

West Nile virus would have spread across the United States regardless. 

Senator BOXER. Okay. Do you see the connection between warm 

standing water and mosquitos? 

Mr. ROBERTS. Of course. Yes, ma’am. 

Senator BOXER. Thank you. That answers my question. 

Dr. McCally, how do you feel about this whole notion of just saying, well, let’s not worry about it; we will just spray? 

Dr. MCCALLY. It has been correctly pointed out that the control 

of endemic infectious disease requires a number of modalities. I 

think that to slow down our response to climate change and the 

scope of the health effects that it is already demonstrating and 

causing because of disagreements about the specifics of the public 

health response to malaria or to West Nile virus is terribly misleading. 

Senator BOXER. I would ask you this, your testimony, Dr. 

McCally, refers to one study that estimates that global warming 

could cause the number of unsafe air days to increase by 68 percent. What would this mean for emergency room visits by the most 

vulnerable in society, our children, the elderly and people with 

asthma? 

Dr. MCCALLY. We know from studies in Southern California and 

Atlanta and elsewhere that emergency room visits for chronic lung 

disease, including asthma in children, tracks those changes very 

closely. 

Senator BOXER. Dr. Cooper, Commissioner Cooper, I am sorry, 

the IPCC predicts an increase in wildfires from global warming. 

What are the projected public health impacts from increased 

wildfires? This is very meaningful to me as I see my people in California just suffering to even find enough air to breathe right now. 

Here is just a picture you can just see. It is just extraordinary. 
53 

There is a connection between global warming and these wildfires. 

So what does it mean to the vulnerable citizens? 

Ms. COOPER. Certainly, we know that wildfires post a direct 

threat to the health and safety of nearby residents, but it also creates dangerous levels of particulates in the air. These particles certainly contribute to increasing respiratory complications, things 

like increasing the incidence of asthma, the severity of the asthma 

cases as children or vulnerable adults present to their health care 

providers. They certainly can contribute to respiratory distress and 

failure, which would lead to death in very many cases. 

So we certainly would encourage actions that would allow us to 

put public health systems in place that would allow us to respond 

earlier to potential threats. 

Senator BOXER. Thank you very much. 

Senator Barrasso. 

Senator BARRASSO. Thank you very much, Madam Chairman. 

Dr. Roberts, if I could, I was looking at your background with the 

Tropical Health Department of Preventive Medicine at the Uniformed Services Health Science Center. I remember fully when 

that program was begun. I want to focus on your comments. It is 

politics versus science. I know you are concerned we are overreacting and where we ought to be going from here. 

Mr. ROBERTS. My specific concern, Senator, is that we not enact 

policies precipitously, specifically on the basis of the reported increase in diseases like malaria and dengue, which is another 

anthroponosis, increasing beyond our ability to control it, specifically as a result of global warming. In my opinion, that will not 

happen. 

Senator BARRASSO. When I look at West Nile virus, which we 

certainly had in my State, certainly it is something we see in the 

summer, but my understanding from the study of it was that it 

didn’t have to do with global warming. It just had to do with the 

disease and how it is transmitted and how it exists. Do you want 

to comment a little bit more on that? 

Mr. ROBERTS. This was with West Nile? 

Senator BARRASSO. Yes, sir. 

Mr. ROBERTS. Right. West Nile virus is a zoonotic infection. As 

a consequence, we acquire that infection mostly outside, outdoors. 

Our ability to control it, therefore, is extremely limited because of 

the very broad environment in which that disease cycles. 

And so, basically the disease will run its course. There is not a 

lot that we can do about it. Except in urban area of concentrated 

populations, some spraying could be beneficial. It is very different 

than what we see with malaria or, say, dengue fever. These are 

anthroponotic infections. They cycle entirely within mosquito populations and humans, and therefore our ability to control those, 

what I call the great diseases, is entirely different. We can control 

those through appropriate use of preventive measures. 

Senator BARRASSO. Thank you. No further questions. 

Senator BOXER. Thank you. 

At this time, I am going to put in the record this call to action, 

Medical Leadership on Global Warming. I am going to share it 

with you, Dr. Roberts and with you, Senator Barrasso, because this 

is well over 100 leading physicians from the leading universities all 
54 

over our great Nation, just telling us that this is a looming crisis 

and we have an obligation to act. I think it is very different than 

Dr. Roberts’ point of view, which is a minority point of view, but 

I certainly respect it, sir. But I think we ought to place this in the 

record at this time. 

Senator Cardin, you are next. 

Senator CARDIN. Commissioner Cooper, I want to talk a little bit 

about the importance of the information we get from State health 

departments and from county health departments. It is our warning system in our community. There is an infectious disease problem. The information is reliable. It helps us to deal with it, not only 

in the specific county or State in which the reports come in, but 

to deal with it in our Country and beyond the borders of our Country. 

It has also been modified since September 11th to deal with 

threats to our Country by either chemical or biological agents. The 

information is very valuable to all of us in trying to plan the appropriate policies to make sure the people of our Country remain 

healthy. 

So my question is, I am not confident that we have the right system in place for statistical information for non-infectious diseases 

and to try to evaluate the impacts of global climate change. I would 

just like to get your assessment as to whether we should be more 

attentive to try to be more sophisticated in the information we get 

from our State and county health departments. 

Ms. COOPER. I think it is a great question. Certainly, surveillance is a very important part of the work that State public health 

departments do. These increases in the extreme events, whether it 

is heat-related, cold, and when we see hurricanes, floods and what 

not, we have pretty good warning systems that things are about to 

happen. But we don’t necessarily have all of the systems in place 

to look at in detail the downstream effects of the climate event. 

We can look at them individually, but it would be nice if we 

could really bolster this surveillance system and bolster the research needed to put policies in place that are scientifically based. 

This is a new world for us. As you said, the world certainly 

changed on 9/11. This, for me, is a part of our emergency preparedness planing infrastructure. It is just one more column, if you will, 

of threats to the citizens of our State. 

Certainly, we would encourage that we find ways to fund systems that really help us with our planning, with our surveillance 

initiatives, and also with event responses. It is nice to be able to 

share success stories across States. 

Senator CARDIN. Thank you for that response. We want sciencebased information. I think that listening to the testimony of all 

three of the witnesses on this panel, I would welcome suggestions 

as to how the Congress can encourage that type of information 

coming out of our States and counties so that we can make the 

right type of science-based decisions. That is what we want to do. 

So I just think we haven’t really given this as much thought as 

we need to give, and I would appreciate you being on the front line, 

perhaps making some suggestions where we could be helpful as a 

partner to encourage that type of collection and warning system 

throughout our Country. 
55 

Thank you very much, Madam Chair. 

Senator BOXER. Thank you. 

Senator Whitehouse. 

Senator WHITEHOUSE. Thank you, Madam Chair. 

Commissioner Cooper, I am interested in the position statement 

on public health and climate change that has recently been adopted 

by the Association of State and Territorial Health Officials. I have 

not seen that yet. Is it generally consistent with what we have 

been reading about from the International Panel on Climate 

Change? 

Ms. COOPER. Yes, sir. It is consistent with that, and it is also 

consistent with the policy and position statements of the Centers 

for Disease Control and the National Governors Association, because the report really stresses that the weight of the evidence 

demonstrates that human factors have and will continue to contribute significantly to changing the world’s climate. We support 

that. We believe that. 

Senator WHITEHOUSE. And you were able to get that? Was there 

a minority report? 

Ms. COOPER. This position statement passed unanimously by the 

State and territorial health officers. 

Senator WHITEHOUSE. Unanimously, including the State health 

officers from Wyoming and Oklahoma? 

Ms. COOPER. It passed unanimously. 

Senator WHITEHOUSE. Well, I would like to find out how you 

managed to do that because there is a marked contrast between, 

Madam Chair, the unanimity of the trained health professionals in 

every single State in the Country, who can get together and just 

weeks ago come out with a unanimous statement, and the dialogue 

that still persists in the Senate chamber on this subject. I don’t 

know if, Commissioner Cooper, you would care to offer an explanation as to how it is that your group manages to find unanimity 

on this issue, and we find even consensus difficult to achieve. 

Ms. COOPER. I believe we try to focus on what our roles are as 

State health officers. We truly, again, will stand to protect the 

health of the public, promote health, and improve health. If you 

can agree that those three things are important, and you look for 

policies that support moving in that direction. I think that grounding in that, instead of looking at our differences, we looked at our 

similarities. We looked at what was good for the citizens of our 

State, and I believe that was one of the driving factors. 

Senator WHITEHOUSE. Well, I am impressed that it was unanimous, and I appreciate your efforts. I thank you for your testimony. 

Madam Chair. 

Senator BOXER. Thank you very much. 

Of course, Senator Whitehouse, we are so behind, not only the 

public health community, and there are exceptions, one noted at 

the table. But we are so far behind. Remember, there are still people who said HIV doesn’t cause AIDS and tobacco doesn’t cause 

cancer. You are never going to have unanimity, but basically there 

is as close to unanimity as we can get among the scientists, and 

among the doctors. And yet it is so elusive here in the United 

States Senate, but we are going to of course try to challenge that 

in this Committee. 
56 

I would ask unanimous consent to place into the record a letter 

we received, dated October 22, from the American Public Health 

Association. It says, ‘‘We want to make it clear that climate change 

is a public health issue, from changes in vector-borne diseases to 

impacts on drinking water supply, to extreme weather events. We 

are already seeing the effects of climate change on health across 

the globe.’’ So we are going to put that letter in the record. 

[The referenced document follows on page 57.] 

Senator BOXER. And then we have the National Association of 

County and City Health Officials. A lot of my colleagues on the 

other side of the aisle say let the States and local people take the 

lead. Well, here is what they say: ‘‘The National Association of 

County and City Health Officials believes that climate change has 

serious far-reaching health implications for this and future generations.’’ And they say that the health departments have to address 

these impacts. 

[The referenced document follows on page 59.] 

Senator BOXER. And then the World Health Organization, they 

say they have carried out both qualitative reviews and quantitative 

assessments of the health risks posed by climate change. The organization concluded that the health hazards posed by climate change 

are significant, wide-ranging, distributed throughout the globe, and 

difficult to reverse. 

[The referenced document follows on page 61.] 

Senator BOXER. So I would just call on my colleagues to heed the 

people who are the healers in this world and in this Country, and 

get off your duff and support good legislation and let’s get it going 

now. 

Senator WHITEHOUSE. Madam Chair? 

Senator BOXER. Yes, I would yield to you. 

Senator WHITEHOUSE. I just wanted to ask if the Association of 

State and Territorial Health Officials’ position statement on climate change and public health is in the record of this hearing? 

Senator BOXER. I would like you to add that to what we just put 

in the record. 

Senator WHITEHOUSE. Okay. May I ask unanimous consent to 

make it part of the record? 

Senator BOXER. Yes. 

[The referenced document follows on page 65.] 

Senator BOXER. Absolutely. Would you like to quote from a couple of sentences from it? 

Senator WHITEHOUSE. It is all good. I would start reading it and 

I would go all the way through. 

[Laughter.] 

Senator BOXER. All right, Senator. 

I just want to thank our panel very, very much. Again, we are 

making a record here in this Committee, a record that we think 

must not be ignored by colleagues from both sides of the aisle and 

by the American people. 

Thank you. 

We stand adjourned. 

[Whereupon, at 11:20 a.m. the committee was adjourned.] 

[Additional material submitted for the record follows.] 
57 
58 
59 
60 
61 
62 
63 
64 
65 
66 

Æ