To: Environmental Protection Agency 

EPA Docket Center (EPA/DC) 

Mailcode 28221T 

1200 Pennsylvania Avenue, NW 

Washington, DC 20460 

From: Lynn Ringenberg, MD/PSR Florida Chapter 

POB 13901 

Tampa, Florida 33681 

ring46@me.com 

813-760-7017-personal cell 

RE: Docket ID No. OAR-2013-0602 

Good morning: I'm Dr. Lynn Ringenberg, professor emeritus of pediatrics at the University of 

South Florida and president of the Florida Chapter of Physicians for Social Responsibility, and 

president-elect of national PSR in Washington D.C., an organization of health care professionals 

dealing with issues that pose the gravest threats to human health and survival: Climate change 

and nuclear weapons. PSR shared the Nobel Peace Prize for our nuclear work in 1985. 

I want to thank the EPA for this opportunity to speak to you today. I know there are others here 

today speaking in opposition to this rule, but as a physician who has practiced medicine for over 

30 years and witnessed the decline in children's health over this period, I stand in strong support 

of the EPA Clean Power Plan. Everyday I practice, I see children struggling to breath due to 

asthma worsened by carbon pollution and young kids on 3 or 4 different medications to control 

their asthma symptoms. The quality of life for these children and their families is significantly 

impacted in a negative way by carbon pollution. It is time-overtime-as a nation- that we stand 

up to the polluters and say: no more damage to our health....clean it up! Just from soot and 

smog reductions alone, each dollar we invest in the Clean Power Plan could net American 

families $7 in health benefits. 
I wear this white coat as a symbol of a profession that I believe has an obligation to speak out 

against those who damage public health! We need to be the voice for those who can't speak for 

themselves: infants, children, the elderly, those with disabilities, chronic health problems and 

minority populations who receive the brunt of coal-fired power plant pollution. 

➢ There are a toxic slew of air pollutants in coal smoke, but the major one causing so many 

adverse health problems, like COPD, heart damage, asthma-to name a few- is carbon-the 

key driver of climate change. 40% of the carbon pollution in the United States comes from 

coal-fired power plants. There is no such thing as "clean coal". 

➢ Climate change affects health by increasing temperatures causing heat waves that can 

lead to dehydration, heat stroke and death, especially in young children, those with 

chronic health problems and the elderly. 

➢ As temperatures rise, more populations are exposed to disease-bearing insects, extreme 

weather events with water contamination, flooding, water-borne diseases and an increase 

in wildfires causing smoke and particle inhalation that will aggravate asthma and other 

pulmonary diseases, cause an increase in cardiac deaths and stroke. 

➢ Food production is vulnerable to climate change with increasing drought, floods and risk 

of famine, conflict and war. 

Everyone in this room is a parent, grandparent, aunt/uncle, or at least knows a kid- a friends, 

colleagues or neighbors and all of us are connected by our common humanity to care for our 

"collective" children. We can leave no greater legacy to our children/grandchildren and the 

generations that follow than to leave a healthy, carbon pollution-free planet. It is imperative that 

we set the stage for this life-saving journey through implementing a strong Clean Power Plan 

that will protect public health and drive innovation in clean energy sources, like solar, wind that 

will power the 21st century, grow our economy and create good jobs. 

Thank you EPA for taking this bold step-the most promising climate proposal in years. 
PHYSIC IANS FOR S O C IAL R ESPONS IBILITY 

WorkingToward a Healthy, Justand Peaceful W
PSR 

PHYSICIANS FOR 

SOCIAL RESPONSIBILITY 

www.psr.org 

Climate Change: 

The Health Impacts 

H

uman generated greenhouse gas emissions 

are warming the earth's climate. The threats 

to health posed by climate change are 

multiple, and increasingly severe. 

Warming generates more frequent and intense heat 

waves, extreme weather events, shoreline loss, 

flooding and drought, air and water pollution, and 

agricultural losses. These in turn have health 

consequences: heat-related illness and death; stormdriven mortality and injuries; allergies, asthma, and 

other conditions exacerbated by pollution; insect and 

water borne diseases; poorer nutrition and lessened 

food security, and greater mental and emotional 

stress. 

Researchers have found that clonat,' change may lead to more asthmarelated health problems in children, and more emergency room (ER) 

visits in the next decade. 

HEAT WAVES 

In most years, heat waves are the leading killer among 

extreme weather events in the U.S. Extreme heat 

events are rising in frequency, duration, and 

magnitude. 

► Effects of extreme heat range from cramps to 

exhaustion and stroke. Heat stroke can result 

in delirium, convulsions, coma, and even 

death. 

► In the 2003 European heat wave, an 

estimated 45,000 to 70,000 people died due 

to heat-related illness. In 2010 a Russian heat 

wave killed an estimated 56,000. 2013 

brought severe and record-breaking heat 

waves and drought to many U.S. regions and 

around the world. 

► Increasing heat levels and humidity are 

making outdoor work, play, and sports riskier 

to health. 

EXTREME WEATHER EVENTS AND RISING SEA 

LEVELS 

As the climate heats up, storms and floods are 

becoming more frequent, widespread, and intense. 

► Severe storm surges on coastal areas can be 

devastating. Hurricane Katrina displaced over 

1 million people and caused over 1,800 

deaths. Hurricane Sandy inundated parts of 

New York City, flooding subways and cutting 

off power. Over fifty health care facilities 

evacuated their patients during Sandy. 

► Thermal expansion and melting polar ice 

raise sea level, endangering people, animals, 

and crops in coastal areas worldwide. The 

city of Miami now has regular sewer backups 

with high tide and a full moon. 

► 2012 and 2013 together saw 21 U.S. weather 

and climate disaster events that cost more 

than $1 billion. The 2013 Moore, 

Oklahoma, tornado measured among the 

strongest tornadoes ever. 

► Extreme weather disasters not only cause 

event-related death and injury, but due to loss 

of homes, infrastructure and jobs, markedly 

worsen social determinants of health. For 

example, poverty levels rose significantly after 

Hurricane Katrina and have not returned to 

baseline eight years later. These effects are 

much worse on those who are poorer at the 

time of the event. 

A FACTSHEET FROM PHYSICIANS FOR SOCIAL RESPONSIBILITY 
AIR POLLUTION 

Higher temperatures increase ground-level ozone, a 

dangerous air pollutant. Almost half of Americans 

live in urban areas that already fail to meet the health 

standards for ozone. 

► Ozone exposure can reduce lung function, 

permanently damage lung tissue, provoke 

new cases of asthma, and aggravate other 

chronic lung diseases. Ozone also affects the 

cardiovascular system and can increase the 

risk of dangerous heart arrhythmias. Further, 

ozone exposure increases the number of low 

birth-weight babies, currently the leading 

cause of infant mortality. Exposure to ozone 

in the first and third trimesters of pregnancy 

can cause 20% intrauterine growth 

retardation. 

1°. Climate change is increasing the 

extent,intensity, and frequency of wildfires. 

The smoke contains particulates and toxic 

gases which aggravate health problems, 

including heart and lung diseases, infections, 

and emergency department visits. 

► The allergy season will grow longer as 

ragweed and other pollens spread. Urban 

heat islands, pollutants, and allergens will 

combine to aggravate asthma. 

WATERBORNE DISEASES 

Increases in heavy rainfall, especially when 

interspersed with periods of drought, can contribute 

to flooding and contaminate water supplies. 

Dangerous waterborne diseases include hepatitis, 

giardiasis, cryptosporidiosis, and Naegleria fowleri —

the brain-eating amoeba. 

► Flooding can cause sewer overflows, with 

potential increases in infectious diseases. 

Flooding can also cause injuries and deaths, 

mold, psychological effects, and an increase 

in the populations of rats, mosquitoes and 

other disease-bearing hosts.In 2013, a 

thousand-year flood in Colorado caused $2 

billion in damage. 

► Infectious diarrhea is one of the most 

prevalent waterborne diseases globally. 

Severe diarrhea may be life-threatening, 

particularly in young children and the 

malnourished. Climate change is expected to 

worsen this. 

VECTOR-BORNE DISEASES 

Rising temperatures and changes in precipitation 

expand the habitable areas for disease-carrying 

animals, including birds, rodents, snails, and insects. 

This can increase the spread of such diseases as 

yellow fever, Schistosomiasis, Lyme disease, tickborne encephalitis, and hantavirus pulmonary 

Only forty-six percent of people in Africa have safe drinking water. 

syndrome. 

► Mosquitoes carry malaria, dengue fever, 

West Nile Virus, and other diseases. Higher 

temperatures boost their reproductive and 

biting rates, lengthen their breeding season, 

and accelerate the maturation rate of the 

malarial pathogen. Dengueor bone-break 

fever is now present in Texas and Florida, as 

mosquitoes capable of carrying the disease 

move north. 

► According to the World Health 

Organization, in 2010, 219 million people 

around the world were infected and 660,000 

died from malaria. As global warming 

continues, as many as 90 to 200 million 

additional people may be at risk of malaria 

by the latter half of this century. 

AGRICULTURAL LOSSES 

Climate change threatens food supply through severe 

storms, flooding, heat, drought, water evaporation, 

decreased pollination, and sea level rise. 

► Every 1.8°F increase in global average surface 

temperature yields an estimated 10% decline 
1 

in the world's major grain crops. If we 

continue burning fossil fuels at our current 

rate, global temperatures may rise as much as 

5.4° to 9°F by the end of the century, with 

30% to 50% declines in crop production. 

► Weather and rising temperatures can damage 

livestock and fisheries as well as crops. Rapid 

warming will force farmers to keep changing 

what they grow as agricultural zones migrate 

rapidly. 

Higher food prices resulting from diminished 

food security will reduce the capacity of 

people, especially the poor, to consume 

nutritious diets. 

► Nearly one-third of the world's land surface 

may be at risk of extreme drought by 2100. 

I nifty percent (,1 wheat crop 

was lost to fire in 2010. 

COMPLEX AND COMPOUND HEALTH EFFECTS 

Climate effects are likely to combine with a range of 

other factors to magnify health problems, possibly 

catastrophically. These include loss of infrastructure 

such as hospitals and housing, rising medical costs, 

shortages of food, clean water and productive 

farmland, greater levels of mental and emotional 

stress, regional conflicts and population migration, 

ocean acidification, and an inhospitable earth. The 

challenges of managing these costs while protecting 

human health will climb drastically. 

In the short term we can adapt to climate change, 

applying technologies like barriers on coastlines and 

pumps to avoid sewer backup. But as the climate 

heats up, the consequences will become catastrophic. 

The latest IPCC climate report warns that adaptation 

alone is not possible. 

To slow climate change, we must address the largest 

sources of greenhouse gases. Small steps can help, and 

some - such as bicycling and eating less meat and palm 

oil - also contribute to a healthier lifestyle. But to have 

an impact on a scale adequate to resolve the problem, 

we must slash fossil fuel combustion. This means 

transitioning quickly to clean, safe renewable energies. 

An energy system based on wind, sun and water power 

will allow us to reduce greenhouse gases and slow and 

eventually stop climate change. The use of renewable 

energies also reduces air and water pollution, 

contributing yet again to healthier conditions for human 

life. 

FOR FURTHER READING 

An overview McMichael Al. 2013. Globalization, 

Climate Change, and Human Health. NOM 

368:1335-1343. 

friejm.org/doi/full/10.1056/NUMrall093411 

For practicing physicians: Parker C. 2011. Slowing 

Global Warming: Benefits for Patient and Planet. 

Am Fam Phys 84:271-278. 

kafp.org/afp/2011/0801/p271.htmll 

Extensive U.S. resource: NCADAC ("National 

Climate Assessment and Development Advisory 

Committee"). 2013, Jan 11. Draft Climate Assessment 

Report. Chapter 9, Human Health. 

[ncadac.globalchange.gov/l 

Intergovernmental Panel on Climate. 2014. 

http:///www.scribd.com/doc/215381835/IPCCWorking-Group-II-Surrunary-for-Policymakers 

JOIN US! 

If you share the goal of reversing climate change, 

please join today. 

Visit us at www.psr.org 

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Climate Change and Health: 

Insect-borne Disease 

www.psr.org 

Climate change is acknowledged by scientists 

around the world to be a reality and to be caused 

primarily by human activity, especially the burning 

of fossil fuels. As the earth warms, the delicate 

balance of climate, weather events, and life is 

disrupted. Consequences emerge that threaten 

human health and, ultimately, survival. What is 

truly needed for health is restoration of a cool and 

stable climate. 

Climate Change Increases the 

Threat of Disease from Insects 

Insects can carry and transmit numerous diseases to 

humans. One concern about climate change is that it 

increases the spread of these insects and the 

diseases they carry. 

• Changing temperature and precipitation 

shifts the geographic range in which insects 

live, resulting in expansion pole-ward and 

into higher elevations. 

• Individual diseases that are sensitive to heat 

and precipitation will have a larger range 

and longer lifespan. The insects that carry 

them may experience an increase in their 

reproduction rate. 

Climate Change Aids Mosquitoes 

As the climate changes, new temperature and rain 

patterns will affect where mosquitoes live as well as 

their breeding and feeding patterns. 

Higher temperatures: 

• Expand the range of mosquitoes pole-ward 

and to higher elevations, putting previously 

unexposed populations at risk. 

• Boost reproduction rate, lengthen breeding 

season, make mosquitoes bite more, and 

speed the development of the diseasecausing agents they carry (bacteria, viruses, 

etc.) to an infectious state. 

Rainfall: 

• Standing water left by more intense and 

frequent rainfall, storms and hurricanes in 

many regions creates sites for mosquitoes 

to breed. 

Mosquitoes and Their Threat to Health 

Mosquitoes are transmitters of several viruses that 

can cause severe illness or death in humans, 

including West Nile Virus, dengue fever, 

encephalitis, and malaria. 

West Nile Virus 

• Between 1999 and 2012, about 37,000 cases 

of West Nile Virus were reported in the 

U.S., causing approximately 1,500 deaths 

annually. 

• There are no medications to treat or vaccines 

to prevent WNV infections 

• Approximately 80% of people who contract 

West Nile Virus do not show any symptoms. 

PHYSICIANS FOR SOCIAL RESPONSIBILITY 
Signs like the one above can alert you to tick-prone 

areas and caution you about the diseases they can 

carry. 

How to Protect Yourself 

• Wear protective clothing and insect repellent 

to prevent insect bites. 

• Check yourself and pets for ticks after being in 

wooded or grassy areas 

• Take extra precautions from dusk to dawn, 

when mosquitoes are most likely to bite. 

• Capture and remove or store water runoff that 

provides a breeding ground for mosquitoes. 

• Repair damaged screens to prevent insects 

from coming inside your home. 

• Listen to warning systems and signs to be 

aware of hazardous areas and outbreaks. 

Take action to reduce climate change! 

To protect our world from the health effects of climate 

change, we must take steps that restore the 

climate. This includes switching from fossil fuels to 

safe clean renewable energy sources like sun, water 

and wind. Planting trees and protecting forests. 

Planning growth to assure efficient, convenient mass 

transit. Where conditions permit, walking and 

bicycling more. We'll all live better on a cool, green, 

healthy planet! 

To learn more about what you can do, visit PSR's 

website: 

www.psr.org/environment-and-health/climate-change/ 

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...gfitiare qf krernationai swims .,6)! the Prewation of Nuclear Mir. +wpm of the 1985 Sobel Prue fior Peace 

1111 14 St. NW. Su te 700 • Washngbor. DC 2005 

Telephone: ,;202) 667-4280 • Fax: (20216674201 • WWW.D5r.Ong 

Mosquito-borne Diseases, continued... 

Dengue Fever 

• Dengue fever can be transmitted by the 

Asian tiger mosquito, which is found in 36 

countries. 

• The disease is now established in many 

countries of the Americas, including popular 

tourist areas. Cases have been found in 

Florida. 

• The most serious form of dengue, known as 

dengue hemorrhagic fever (DHF), can be 

fatal. It kills about 5% of its victims, mostly 

children and young adults. 

Malaria 

• In 2012 there were 207 million cases of 

malaria worldwide, causing some 627,000 

deaths, mainly in sub-Saharan Africa. 

• Each year in the U.S. there is an average of 

1,500 reported cases of malaria, usually 

brought in by people who contracted the 

disease in a foreign country. 

Climate Change and Ticks 

Ticks serve as "bridges," carrying diseases between 

affected animals and humans. 

Lyme Disease 

• Typical symptoms of this tick-borne disease 

include fever, headache, fatigue, and a 

characteristic skin rash. If left untreated, 

infection can spread to joints, the heart, and 

the nervous system. 

• Modeling indicates the tick that carries 

Lyme disease will reach north into Canada, 

affecting previously unexposed populations. 

Rocky Mountain Spotted Fever 

• Rocky Mountain Spotted Fever (RMSF) is a 

tick-borne disease that is potentially fatal. 

Typical symptoms include fever, headache, 

abdominal pain, vomiting, and muscle pain. 

• Untreated, RMSF can cause serious damage 

to internal organs, particularly the kidneys. 

• Despite its name, over half of U.S. cases 

occur in the South Atlantic states (Delaware 

through Florida). 

• Research suggests that, with warming 

trends, incidence of RMSF will increase in 

northern latitudes. 
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NOPFI 

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no/1 J Climate Change and Health: 

The Effects of Heat 

www.psr.org 

Climate change is real and is caused primarily by 

human activity, especially burning fossil fuels. As 

ocean and air temperatures rise, the delicate 

balance of climate, weather events and life is 

disrupted. Human health suffers as a result. What 

is truly needed for health is a cool, stable climate. 

Climate Change and Heat Waves 

A heat wave is an extreme 

weather event when the 

temperature for a given region 

is unusually warmer than 

average, for a period lasting 

from a few day to months. 

It is difficult to directly 

attribute a specific heat wave to 

climate change. However, 

scientists see a strong 

correlation. 

• For the 21stcentury, the 

Intergovernmental Panel on 

Climate Change (IPCC) projects with 80% 

confidence that extreme heat events will 

intensify in magnitude and duration over 

portions of the U.S. where they already occur. 

• The IPCC is also "virtually certain" there will 

be a decrease in the frequency and magnitude 

of cold days/night and increase in frequency 

and magnitude of unusually warm days/nights 

on a global scale. 

• Scientists estimate that human influence on 

climate change more than doubled the 

probability of the European heat wave of 2003. 

Heat and Health 

Extreme heat can cause a range of ailments: 

• Milder effects: rashes, cramps, heat exhaustion. 

• Severe effects: Heat stroke. This is a severe 

illness. Body temperature rises to 105°F or 

more and can be accompanied by delirium, 

convulsions, coma and even 

death. 

The risk of death from heat 

waves is higher for people with 

pre-existing heart conditions 

and respiratory illnesses. 

Hospitalizations for stroke and 

cardiovascular disease also 

increase as temperature rises. 

How serious is the threat? 

Serious! 750 people died as a 

result of heat-related illnesses in the 1995 

Chicago heat wave. 

During the European heat wave in 2003, an 

estimated 70,000 people died from stroke, 

heart attack, lung disease, and other causes 

exacerbated by heat. 

Heat and Mental Health 

• Long-lasting bouts of heat exacerbate stress 

and symptoms of mental illness. 

• Heat waves have been shown to increase 

violent behavior, suicide, and homicide. 

PHYSICIANS FOR SOCIAL RESPONSIBILITY 
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How to Protect Yourself Take action to reduce climate change 

• Stay inside air conditioned homes or 

shelters during heat waves 

• Avoid physical exertion outdoors on hot 

days, especially if you have asthma 

• Stay hydrated 

• Know the symptoms of heat exhaustion and 

heat stroke and seek medical attention: 

Heat Exhaustion: 

o Headache 

o Dizziness 

o Dark colored urine 

o Rapid heartbeat 

o Profuse sweating 

o Confusion 

o Muscle cramps 

o Nausea 

o Fainting 

Heat Stroke (most of the above plus): 

o Lack of sweat 

o Red, hot, dry skin 

o Fainting and unconsciousness 

Who is most vulnerable? 

• The elderly, who have diminished ability to 

regulate body temperature and are more 

likely to suffer from poor health 

• Babies and young children 

• Pregnant and nursing mothers 

• Those chronically ill with pre-existing 

cardiovascular, respiratory, neurologic, and 

psychiatric conditions, or obesity. 

• Outdoor workers 

• Athletes, and children who are active 

outdoors. 

• People who abuse drugs and alcohol 

• People without access to air conditioning 

including the poor and those in areas 

previously not warm enough to warrant air 

conditioning. 

• Urban populations. City environments 

hold more heat and routinely experience 

temperatures 2-10 degrees Fahrenheit 

warmer than surrounding areas. 

To protect our world from the health effects of 

climate change, we must take steps that restore the 

climate. This includes switching from fossil fuels 

to safe clean renewable energy sources like sun, 

water and wind. Planning future growth to ensure 

efficient, convenient mass transit. Where 

conditions permit, walking and bicycling 

more. We'll all live better on a cool, green, healthy 

planet! 

To learn more about what you can do, see PSR's 

website: www.psr.org/environment-and-health 

Get involved! 

Anyone can become a member of 

Physicians for Social Responsibility. If you 

share our goal of protecting our health 

from the threat of toxic chemicals, please 

join today! Visit us at www.PSR.org 
Climate Change and Health: 

Wildfires 

PSR 

PHYSICIANS FOR 

SOCIAL RESPONSIBILITY 

1111- I 

!It!, 

www.psr.org 

Climate change is real and is caused primarily by 

human activity, especially burning fossil fuels. As 

ocean and air temperatures rise, the delicate balance 

of climate, weather events and life is disrupted. 

Human health suffers as a result. What is truly 

needed for health is a cool, stable climate. 

Wildfires and Your Health 

Widespread fires have a major impact on human 

health and life. 

• Air pollution particles in smoke and ash can 

cause coughing, irritated throat and sinuses, 

shortness of breath, chest pain, headaches, and 

stinging eyes. 

• Smoke worsens respiratory conditions such as 

allergies, asthma, or chronic obstructive 

pulmonary disease. 

• Inhalation of carbon monoxide can aggravate 

angina. 

• Chronic health effects include increases in 

cardiovascular disease and mortality in 

populations living in areas with higher fine 

particulate air pollution. 

• Burns and death. Those who do not evacuate 

safely and firefighters are at risk of being burned 

or killed by wildfires. The 2013 wildfire in 

Arizona killed 19 firefighters. 

• Damage to homes affects people's physical and 

mental health. It also impacts access to medical 

care. 

How to Protect Yourself & Others 

• If a wildfire occurs in your area, avoid outdoor 

activities. People with respiratory problems and 

chronic heart problems should consult with their 

doctor about taking extra precautions. 

• If you must go outdoors in a smoky area, breathe 

through a damp cloth. While driving in smoky 

areas, keep windows and vents closed. 

• Know evacuation routes. Listen to evacuation 

and safety advice if a wildfire occurs. 

• Be responsible with fire: 

o Be cautious disposing cigarettes. 

o Only build fires in designated areas and 

during permitted times. Do not leave 

campfires unattended. Extinguish them 

thoroughly. 

o Use spark arrestors on off-road vehicles. 

• Make sure trees and woody vegetation are a safe 

distance from your home. Stick to droughtresistant plants in your yard. 

PHYSICIANS FOR SOCIAL RESPONSBILITY 
Climate Change Spurs Wildfires 

Wildfires are uncontrollable and unpredictable fires in 

natural landscapes. The frequency of large wildfires 

and the area they burn has been increasing, especially 

in the western United States. Climate change is major 

contributor to this increase, for a number of reasons. 

Warmer Temperatures 

Average global temperatures have increased by 1.2°C 

over the past century, primarily because of increasing 

heat-trapping greenhouse gases, including carbon 

dioxide. 

As global temperatures rise, fire seasons become 

longer as warmer temperatures begin earlier and 

extend into the fall. 

Insects 

Higher temperatures allow for a longer lifecycle for 

beetles and other insects that eat trees. Dry conditions 

also weaken trees and make it easier for theses insects 

to damage them further, resulting in dead and highly 

combustible plants. 

Drier Conditions 

Snow packs are now melting up to four weeks 

earlier than they did 50 years ago, due to warmer 

temperatures. The water these snow packs supply 

soaks into the soil and then evaporates earlier than it 

would have years ago. As the season progresses, 

forests and grasses have less summer water source, 

making them more prone to drought, and ultimately, 

wildfires. 

In addition, areas in the Western United States that 

already naturally experience fires, are experiencing 

decreased precipitation. In recent years, this region 

has been experiencing drought conditions, drying out 

vegetation -- and dry plant matter burns at higher 

temperatures. Combined with large quantities of fuel, 

this can lead to catastrophic fires. 

Take action to reduce climate change 

To protect our world from the health effects of 

climate change, we must take steps that restore the 

climate. This includes switching from fossil fuels to 

safe clean renewable energy sources like sun, water 

and wind. Planning future growth to ensure efficient, 

convenient mass transit. Where conditions permit, 

walking and bicycling more. We'll all live better on a 

cool, green, healthy planet! 

To learn more about what you can do, see PSR's 

website: www.psr.org/environment-and-health 

Get involved! 

Anyone can become a member of Physicians 

for Social Responsibility. If you share our 

goal of protecting our health from climate 

change, please join today! Visit us at 

www.PSR.org 

PSR® 

PHYSICIANS FOR SOCIAL REPONSIBILITY 

U.S affiliate of Inteniational Pkyslcians far the Prewntion of Nuclear War, recipient of the 1445 \'abel Pere tar Peace 

1111 14' St. NW, Su to 700 • Washmgtor, DC 20305 

Telephone: (202) 667-4260 • Fax: (202)607-4201 • www.psnorg 

1985 

NOBF:1, 

PEACE 

PRIZE 

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\ed., Pre: • lor Ave. 

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Climate Change and Health: 

Climate Change 

Contaminates Your Water 

Climate change is real and is caused primarily by 

human activity, especially burning fossil fuels. As 

ocean and air temperatures rise, the delicate balance 

of climate, weather events and life is disrupted. 

Human health suffers as a result. What is truly 

needed for health is a cool, stable climate. 

Climate Change and Waterborne 

Diseases 

Climate change is making 

heavy intense downpours, 

droughts and rising water 

temperatures more common 

This can alter the quality of our 

drinking and recreational 

water. Bacteria and viruses 

thrive in these new conditions 

and when they come into 

contact with humans, can cause 

numerous illnesses. Lack of 

water can also impact human health, especially in 

drought conditions. 

Flooding and Runoff Contaminate Water 

Contamination of drinking water by bacteria, viruses, 

and protozoa can trigger outbreaks of illnesses such 

as the diarrheal diseases legionella, campylobacter, 

and cholera. 

• From 2009-2010, 33 water-associated disease 

outbreaks were reported in the U.S. They 

caused 1,040 cases of illness, 85 hospitalizations, and nine deaths. 

Many regions of the world, including the Northeast 

and Southern Great Plains of the United States, have 

experienced an increase in precipitation. This is 

expected to continue as climate change persists. 

Some regions, like the Midwest, have experienced 

alternating patterns of flooding and drought. Drought 

reduces the earth's ability to absorb the water. When 

precipitation falls as more intense storms or as 

hurricanes that can cause flooding and jeopardize 

water quality. 

• In rural areas, water runoff picks up animal 

wastes, pesticides, and fertilizers. 

• In cities, runoff both 

carries pollutants and 

overwhelms sewage 

systems, causing 

untreated sewage to 

flow into drinking and 

recreational water 

sources. 

Drought Disrupts 

Water, Food, and 

Health 

Some regions, such as the Southwest U.S. and at 

times the Midwest, will experience decreased 

precipitation and longer, more frequent droughts. 

These conditions can also impact waterborne disease. 

• As water sources decline, the concentration of 

contaminants increases, making them more 

likely to affect human health. 

• Lack of clean water prevents adequate 

hydration and disrupts good hygiene. 

• Periods of drought impact crops and livestock 

production and increase the price of food. 

• Severe drought can also create dust-storm 

conditions, which can increase the risk of 

respiratory infections and exacerbate asthma. 

PHYSICIANS FOR SOCIAL RESPONSIBILITY 
The Dying Oceans 

The vast oceans are not immune to climate change. 

Rising carbon dioxide emissions increase ocean 

temperatures and acidity. 

• The combination of higher surface water and 

increased nutrient loading from agricultural 

runoff contribute to harmful algae blooms 

that produce biotoxins. 

• Consumption of fish or shellfish 

contaminated with toxins can cause 

neurological damage, respiratory harm, skin 

irritations and diarrhea. 

• Increases in ocean acidity threaten coral reefs 

and the future of shellfish like oysters, clams, 

and mussels. Where people depend heavily 

on seafood for food and income, incomes and 

nutrition are both likely to suffer. 

How to protect yourself and your planet 

• Decrease your household water use, 

especially during periods of drought. 

• Listen to federal, state, and local fish 

consumption advisories for fish that are 

unsafe to eat. 

o Limit consumption of fish that 

typically have higher levels of 

mercury. These include tuna, 

swordfish, mackerel, sea bass, and 

grouper. 

o If pregnant, avoid completely fish 

with the highest amount of mercury. 

• Listen to warnings about pollution and 

outbreaks of illnesses related to water. 

o Avoid pollution-prone beaches and 

lakes when notified, especially after 

rainfall. 

• Take government or medically advised 

precautions when contamination is detected in 

drinking water, such as boiling the water 

before use. 

Take action to reduce climate change 

To protect our world from the health effects of 

climate change, we must take steps that restore the 

climate. This includes switching from fossil fuels to 

safe clean renewable energy sources like sun, water 

and wind. Planning future growth to ensure efficient, 

convenient mass transit. Where conditions permit, 

walking and bicycling more. We'll all live better on a 

cool, green, healthy planet! 

To learn more about what you can do, see PSR's 

website: www.psr.org/environment-and-health 

Get involved! 

Anyone can become a member of 

Physicians for Social Responsibility. If you 

share our goal of protecting our health from 

climate change, please join today! Visit us at 

www.PSR.org 

PHYSICIANS FOR SOCIAL REPONSIBILITY 

C.S.affiliate of International Ph..x.anx ji:r the Present., ,(Nuclear War, recipient of the 19A5 .Vofiel Prue for Peace 

1111 14 SI NW, Su le 70C • Wash ngtor. DC 20005 

'elephona ;202)607-4260 • Fax :212`,667-4201 • venw ■org 
PSR 

PHYSICIANS FOR 

SOCIAL RESPONSIBILITY 

„ IroV , ,,, I Pr Pr Pea, 

www.psr.org 

Climate Change and Health: 

Storms and Sea Level 

PEACF 

MILL / 

MUM 

Climate change is real and is caused primarily by 

human activity, especially burning fossil fuels. As 

ocean and air temperatures rise, the delicate balance of 

climate, weather events and life is disrupted. Human 

health suffers as a result. What is truly needed for 

health is a cool, stable climate. 

One of the most visible ways in which humans 

experience climate change is though extreme weather 

events. Large storms, hurricanes, and flooding create 

situations that are hazardous to human health. 

How to Protect 

Yourself and 

Others 

Regardless of the type of 

storm, it is important to 

take precautions to stay 

safe. 

Before the storm: 

• Make an 

emergency plan with your household. 

• Have a small stockpile of bottled water, nonperishable food, manual can opener, flashlight 

and batteries. 

• Pay attention to important warning and safety 

announcements. 

• Monitor the weather and safety warnings with 

a television or battery-powered radio. 

• Be prepared to evacuate. 

During a storm: 

• In case of a tornado, seek shelter in a basement 

or most interior room, preferably without 

windows. Get out of mobile homes. If 

outdoors, lie flat in the lowest-lying ditch. 

• In case of hurricane, listen to evacuation 

advice. In a building, seek shelter in an 

interior room on the lowest floor. If in a 

mobile home, seek shelter elsewhere. Avoid 

windows. 

• Shut off water and gas if instructed to do so. 

• If the power goes out, use flashlights. Do NOT 

use candles. 

• Stay away from floodwaters. Do NOT attempt 

to cross flowing water on foot or in a vehicle. 

After the storm: 

• Continue to avoid floodwaters. 

• Stay away from downed power lines. 

• Be careful near debris. 

Climate and Intense 

Storms 

Heavy and extreme 

precipitation events are 

increasing in many regions 

and their frequency has 

increased as temperatures 

have risen. 

Health impacts of heavy 

precipitation include crop 

damage and soil erosion, potentially affecting food 

supply; injuries due to flooding; standing water that 

provides a breeding ground for mold and disease 

carrying insects, and water contamination. 

EPA data shows that a significant portion of total 

annual rainfall in the United States comes from 

extreme single-day precipitation events. 

Extreme storm events are often associated with 

conditions that can develop tornadoes. A 2013 study 

from Stanford University found that sustained 

warming would boost by 40% the number of intense 

storms. Thanks to improved forecasting and early 

warning systems, injury and death tolls from tornadoes 

have dropped significantly. 

PHYSICIANS FOR SOCIAL RESPONSIBILITY 
Climate and Hurricanes 

As with storms, hurricane winds and high water levels 

harm human health by posing the risk of personal 

injury and death. They can also damage health care 

infrastructure including buildings, power lines, and 

roads that are important in accessing health care. 

The combination of flooding and damage creates a risk 

of water contamination leading to spread of 

waterborne diseases like cholera, legionella, and 

campylobacter. 

Standing water also provides a breeding ground for 

mold as well as disease-carrying insects like 

mosquitoes. This poses the risk of outbreaks of West 

Nile Virus and other insect-borne disease. 

After storms, mental health is also a major concern. If 

people have experienced separation from family, 

displacement, or loss of home, they are likely to need 

help. Research shows 30-40% of disaster victims are 

at risk of a new mental disorder, especially depression 

and post-traumatic stress disorder. 

The National Oceanic and Atmospheric Administration (NOAA) reports that by the end of the 21St 

century, atmospheric warming will cause hurricanes to 

be more intense and have 20% higher rainfall rates. 

NOAA also projects a greater chance of increased 

numbers of very intense hurricanes in some ocean 

basins. 

Sea Level Rise 

Climate change also causes sea levels to rise due to 

melting ice caps and expansion of water as it warms. 

The combination of rising sea level and increased 

hurricane intensity is making coastal areas more 

vulnerable to flooding from storm surges. 

Storm surge is sea level rise that occurs when water is 

pushed toward the shore by the winds associated with 

storms and hurricanes. Along the coast, storm surge is 

often the greatest threat to life and property from a 

hurricane. 

At least 1,500 persons lost their lives during Hurricane 

Katrina. Many of those deaths occurred directly or 

indirectly as a result of the 27.8-foot storm surge. 

The Intergovernmental Panel on Climate Change 

reports sea level has risen up to 8 inches during the 

past century. Assuming trends continue, global sea 

level is projected to rise another two feet by 2100. 

Take action to reduce climate change 

To protect our world from the health effects of 

climate change, we must take steps that restore the 

climate. This includes: Switching from fossil fuels 

to safe clean renewable energy sources like sun, 

water and wind. Planning future growth to ensure 

efficient, convenient mass transit. Where 

conditions permit, walking and bicycling 

more. We'll all live better on a cool, green, healthy 

planet! 

To learn more about what you can do, see PSR's 

website: www.psr.org/environment-and-health 

Get involved! 

Anyone can become a member of Physicians 

for Social Responsibility. If you share our goal 

of protecting our health from the threat of toxic 

chemicals, please join today! Visit us at 

www.PSR.org 

PSRe 

PHYSICIANS FOR SOCIAL REPONSIBILITY 

LYS affiliate allmernationai Pk.....nrianqiw M. Prow:Tan of Nuclear War, recipient of the 1485 Vahei' Prce,tiw Puke 

1111 14' Sl, NW, Su to 70C • Wash nglor, DC 20005 

Telephone: ;202)667-4260 • Fa. l2C21667-4201 • wnw.psr.orp 
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Vnirrnn[t.a1 Phpiciatas for dm Praies e/NVWr Wag 

www.psr.org 

Climate Change 

and Famine 

C

limate change is already threatening the 

Earth's ability to produce food. These effects 

are expected to worsen as climate change 

worsens. Estimates vary, but for every 1.8°F increase 

in global average surface temperature, we can expect 

about a 10% decline in yields of the world's major 

grain crops— corn, soybean, rice and wheat1'2Climate 

experts predict that global temperature may rise as 

much as 5.4°F to 9°F if we continue burning fossil 

fuels at our current rate.' This could lead to 30% to 

50% declines in crop production.' Already, one in 

seven people, including many living in the U.S., is 

hungry every day.' 

Most models only consider the effect of rising 

temperatures and carbon dioxide (CO2) levels on 

crop growth, and thus represent relatively conservative 

scenarios. Climate change will disrupt food production 

and distribution in other ways that are hard to quantify 

and include in prediction models, such as: 

► More droughts causing large-scale crop loss 

► 

Increasing frequent, severe, and longer-lasting heat 

waves killing crops 

I Thriving plant pests and diseases destroying crops 

► Heavy rains and storms flooding fields, eroding soils 

and washing away crops 

► Melting glaciers and changing river flows reducing 

water availability for irrigation 

► Rising sea levels and storm surges flooding crops 

and salting soils 

Higher ozone levels damaging plants and reducing 

crop yields 

Specific climate change impacts 

RISING TEMPERATURES: The effects of warmer 

temperatures on crop production will vary by region 

and crop, but almost all estimates indicate eventual 

reduced overall crop yields.''' Higher temperatures 

decrease rates of photosynthesis, reduce soil moisture, 

increase water demand and lead to increased survival 

of plant pests, diseases and weeds—all of which 

combine to reduce final yields.1,5A7 

INCREASING CO2: In certain plants, like wheat, 

soybeans and rice, higher CO2levels actually increase 

Thirty percent of Russia's wheat crop was lost to fire 2010. Climate change will disrupt food production and distribution. 

A FACTSHEET FROM PHYSICIANS FOR SOCIAL RESPONSIBILITY 
U.S. Drought Monitor 

http://droughtmonit....tedu/orchive.hhA 

Intensity: 

DO Abnormally Dry 

ED 01 Drought-Moderate 

In D2 Drought - Severe 

• D3 Drought - Extreme 

▪ D4 Drought - Exceptional 

Drought Impact Types: 

r. Delineates dominant impacts 

S = Shod-Term, typically <6 months 

(e.g. agriculture, grasslands) 

L = Long-Tenn, typically >6 months 

(e.g. hydrology, ecology) 

The Drought Monitor focuses on broad-scale conditions. 

Local conditions may vary. See accompanying text summary 

for forecast statements. 

Released Thursday, August 30, 2012 

Author: Brian Fuchs, National Drought Mitigation Center 

USDA 

growth by the "CO, fertilization effect".i," Higher 

CO, levels increase photosynthesis and reduce plant 

water loss.''" However most experts agree that the 

CO2-related benefits on some crops will be outweighed 

by other negative effects of climate change as global 

temperatures continue to rise 2,8,9 

INCREASING TEMPERATURE EXTREMES: An 

increase in the number of days of extreme heat leads 

to large declines in crop yields, especially when they 

occur during key stages of plant development such as 

flowering and grain-filling.L5" Extreme heat damages 

photosynthetic and reproductive cells, causing 

decreased growth and sterility, and can decrease 

grain quality.5,6,10,11 

INCREASING DROUGHT: Climate change will cause 

more frequent, severe and long-lasting droughts. Many 

of the largest crop losses in history can be attributed 

to drought and it is the main cause of year-to-year 

variations in yields.' 10Eighty percent of agriculture 

is rain-fed and especially susceptible to drought,' but 

even irrigated agriculture is threatened by drought 

as stored water supplies are depleted." The area of 

land producing major crops (corn, rice, soy, wheat, 

sorghum and barley) affected by drought has risen 

from 5-10% in the 1960s to 15-25% today." 

HEAVY RAINS, FLOODS AND TROPICAL STORMS: 

Extreme rainfall events and intensity of tropical 

storms is increasing.' Rainfall intensity could increase 

by 25% in many agricultural areas.' Heavy rainfalls 

reduce crop productivity by a number of mechanisms. 

Flooding wipes out vast areas of crops and damages 

others. In Bangladesh in 2007, cyclone Sidr damaged 

1.6 million acres of cropland and over 25% of the rice 

crop." Heavy rains also cause significant soil erosion 

reducing long-term productivity. Waterlogged soils 

reduce plant growth and increase fungal diseases." 

Farming operations are often delayed when soils 

Fifty percent of cropland had significant drought in 2012. 
are too wet for heavy machinery and flooding can 

destroy farming supplies, machinery and other 

infrastructure.5Finally, coastal storm surges contribute 

to soil salinization making widespread areas unfit 

for planting.5 

MELTING GLACIERS AND CHANGING RIVER 

FLOWS: Glaciers are a critical water supply for 

drinking and irrigation but the majority of the world's 

glaciers are shrinking.° Glacier runoff provides water 

through the year where rainfall is limited, allowing 

irrigation during dry seasons.5Receding glaciers 

threaten large rivers, such as the Ganges, Indus and 

Brahmaputra in India, on which over 500 million 

people depend, to become seasonal— devastating 

regional agriculture if adaptations are not made 5.15 

SEA LEVEL RISE: As sea levels rise, low-lying coastal 

agriculture in major river deltas and small island 

nations is especially vulnerable.5Rising seas and 

storm surges will inundate agricultural lands, and 

salinization of soils and aquifers will threaten 

agriculture.5 

PESTS AND DISEASES: Many crop pests, such 

as aphids and weevils, grow better and live in a 

wider range of areas in warmer temperatures 

and higher CO2levels.5Changes in climate also 

shift the geographic range and frequency of crop 

diseases, altering the predictability of outbreaks 2'5,17 

Environmental stresses may cause mutations in crop 

diseases that increase their destructiveness. Heat 

and water stress reduce crop resistance to pests and 

diseases.5 

WEEDS: Certain invasive weeds, such as privet and 

kudzu in the United States, benefit from increasing 

temperatures and CO2levels more than crops.'" There 

is evidence that herbicides may lose effectiveness 

at elevated CO2levels.'7As increasing amounts of 

herbicide are required to maintain productivity, 

significant economic, environmental and health costs 

will result.'" 

INCREASING OZONE: Ground-level ozone is a 

major air pollutant that results from burning fossil 

fuels.9Ozone inhibits photosynthesis and stunts 

plant growth.",9Current ozone levels are already 

suppressing yields of many crops (alfalfa, beans, 

peanut, potato, rice, soy and wheat) and these effects 

will worsen as ozone levels continue to rise.9 

Corn crop under water 

Conclusion 

Farmers are resilient and frequently adapt to changes 

in weather. However, climate change will create 

conditions outside of human experience, challenging 

farmers' ability to adapt.5While farmers with more 

wealth and resources are more likely to be able to 

adapt to a changing climate through investments 

in new technologies, seed varieties and cropping 

patterns, poorer subsistence farmers will be less likely 

to adapt and are thus more vulnerable.1'2'6Regardless 

of wealth, complete adaptation is not possible. 

Increasing extreme weather events has the potential 

to devastate infrastructure of the entire food system.° 

Storms and flooding can destroy food processing, 

packaging and storage facilities and disrupt 

transportation infrastructure such as roads, bridges, 

railways, airports and shipping routes preventing 

available food from getting to where it is needed.1037 

Though this fact sheet focuses on agricultural 

crops, they are only one part of the food supply. The 

changing climate also affects animal production. 

Decreasing supply and increasing prices of feed 

grains will increase the price of meat.° Temperature 

extremes will increase animal deaths and the cost of 

cooling animal facilities.° Rising temperatures and 

changing rainfall patterns will alter the distribution 

of animal diseases such as anthrax and blackleg, 

potentially reducing production.9The overall impact 

on fisheries is uncertain, however a 40% catch decline 

is expected in the tropics as commercial species move 

north out of warming waters.' 

Food prices will rise as climate change reduces 

the amount of food available. And people get angry, 

even violent, when food becomes more expensive. 
PSR 

PHYSICIANS FOR SOCIAL RESPONSIBILITY' 

U.S. sifilisto sf havmaiional Physicians for the Prevention of Nuclear War, recipient of the 1985 Nobel Prize for Peace 

1111 14th St, NW, Suite 700 • Washington, DC 20005 

Telephone: (202) 667-4260 • fax: (202) 667-4201 • Web: www.psr.org 

In 2008, world wheat, rice, corn and soybean prices 

tripled.18 Food riots erupted across Egypt, Yemen, 

Morocco, Cameroon, Senegal, Ethiopia, Haiti, 

Indonesia, Mexico, and the Philippines.18Social order 

unraveled as armed Thai villagers guarded their rice 

fields against rice rustlers; grain trucks were hijacked 

in Sudanese refugee camps; Pakistani troops had to 

guard grain elevators and wheat trucks.18There is 

concern about increased conflict and violence as food 

supplies constrict. 

Already one billion people in the world go hungry 

every day-that's one in every seven people.18Every 

year one third of child deaths are caused in part by 

under-nutrition.19World population continues to 

grow and is expected to reach 9 billion by 2050." To 

feed this many people and their rising demand for 

animal products, overall food production must rise 

by 70% from 2005-07 levels." But a 5°F to 9°F rise in 

global average temperature could reduce grain yields 

by 30% to 50%, and global food supplies even more. 

The combination of decreasing food production 

in the face of increasing food demand would likely 

lead to widespread social unrest and hunger-even 

catastrophic global famine. 

This is the future that awaits us if we fail to act. But 

we can rewrite the future from this grim view IF we 

work to create many solutions, from efficiencies to new 

renewable energy, to reduce greenhouse gas emissions 

by 80% by 2050. To find out how you can get involved 

in making a better future, visit WWW.PSR.ORG to 

discover actions going on in your area. 

Endnotes 

1. Committee on Stabilization Targets for Atmospheric Greenhouse Gas 

Concentrations, Board of Atmospheric Sciences and Climate, Division of 

Earth and Life Studies, National Research Council. Climate stabilization 

targets: Emissions, concentrations, and impacts over decades to millennia. 

National Academies of Sciences. 2011. 

2. Henson R. Warming world: Impacts by a degree. National Academies of 

Sciences. 2011. 

3. National Research Council (NRC). Advancing the science of climate 

change. National Academies of Sciences. 2010. 

4. Food and Agriculture Organization of the United Nations. The State of 

Food Insecurity in the World. 2012. 

5. Gornall J, Betts R, Burke E, et al. Implications of climate change for 

agricultural productivity in the early twenty-first century. Philos Trans R Soc 

Lond B Biol Sci. 2010;365(1554):2973-2989. 

6. Lobel! DB, Gourdji SM. The influence of climate change on global crop 

productivity. Plant Physiol. 2012;160(4):1686-1697. 

7. Ziska LH, Blumenthal DM, Runion GB, Hunt ER, Diaz-Soltero H. Invasive 

species and climate change: An agronomic perspective. Clim Change. 

2011;105:13-42. 

8. Long SP, Ainsworth EA, Leakey AD, Morgan PB. Global food insecurity. 

treatment of major food crops with elevated carbon dioxide or ozone 

under large-scale fully open-air conditions suggests recent models may 

have overestimated future yields. Philos Trans R Soc Lond B Biol Sci. 

2005;360(1463):2011-2020. 

9. United States Department of Agriculture (USDA). Climate change and 

agriculture in the United States: Effects and adaptation. 2013;USDA 

Technical Bulletin 1935:1-186. 

10. Handmer J, Honda Y, Kundzewicz ZW, et al. Changes in impacts of climate 

extremes: Human systems and ecosystems. In: Managing the risks of 

extreme events and disasters to advance climate change adaptation. A 

special report of working groups I and II of the intergovernmental panel on 

climate change (IPCC). 2012: 

231-290. 

11. Teixeira El, Fischer G, van Velthuizen H, Walter C, Ewert F. Global hotspots of heat stress on agricultural crops due to climate change. Agric For 

Meteorol. 2013;170(15):206-215. 

12. Li YP, Ye W, Wang M, Yon XD. Climate change and drought: A risk 

assessment of crop yield impacts. Clim Res. 2009;39:31-46. 

13. United Nations. Cyclone Sidr United Nations rapid initial assessment report. 

2007. http://ochaonline.un.org/News/NaturalDisasters/Bangladesh/ 

tabid/2707/Default.aspx 

14. Zemp M, et.al. Global glacier changes: Facts and figures. UNEP world 

glacier monitoring service. 2008. 

15. Kehrwald NM, Thompson LG, Yao TD, et al. Mass loss on Himalayan glacier 

endangers water resources. Geophys Res Lett. 2008;35(122503). 

16. Gregory PJ, Johnson SN, Newton AC, Ingram JS. Integrating pests and 

pathogens into the climate change/food security debate. 1 Exp Bat. 2009; 

60:2827-2838. 

17. Hatfield 1, Tokle G, Grotjahn R, et al. Chapter 6: Agriculture. 

In Draft of National climate assessment development. 2013;11 Jan:227- 

261. http://ncadac.globalchange.gov/downlood/NCAlan11-2013- 

publicreviewdraft-chap6-agriculture.pdf 

18. Brown L. World on the edge: How to prevent environmental and economic 

collapse. First ed. New York, NY: W.W. Norton & Company, Inc.; 

2011:240. 

19. United Nations Inter-Agency Group for Child Mortality Estimation. Levels 

and trends in child mortality. Report 2011. 2011:1-19. 

20. Food and Agricultural Organization (FAO), Office of the Director, 

Agricultural Development Economics Division Economic and Social 

Development Department. High level expert forum-How to feed the world 

2050. 2009.