American Thoracic Society Comments on 

EPA Proposed Carbon Emissions Limits for Existing Power Plants 

Presented by 

Ivor Douglas, MD 

July 29 2015 

Denver, CO 

I am Dr. Ivor Douglas and I am the Chief, Pulmonary Sciences & Critical Care Medicine 

Director; Medical Intensive Care; Denver Health Associate Professor, University of 

Colorado. I am also the chair of the American Thoracic Society Health Policy 

Committee. Today, I am speaking on behalf of the American Thoracic Society, a 

medical professional organization of over 14,000 physicians, scientists nurses and allied 

health professional dedicated to the detection, prevention treatment and cure of 

respiratory, critical care and sleep related illness. The American Thoracic Society 

wishes to express our strong support for EPA's proposed carbon emissions standards 

for power plants. 

The research documenting the reality of climate change is comprehensive and 

compelling. The evidence supporting anthropogenic contribution to climate change is 

equally clear. As a practicing clinician, I am already seeing some of the health effects of 

global climate change right here in Denver. The earlier arrival of spring is impacting the 

health and well being of allergy suffers, the higher summer temperatures and the 

accompanying code orange and code red air pollution days is adversely effecting 

patients with asthma, COPD and other respiratory conditions. While my observations 

are anecdotal at best, they fit the pattern of predicted adverse health impacts 

associated with climate change. — A -5 A--v-t tv\P. €.7cPsp.". 1.6 . /k3A2-"lr--4"-P .--ap„ 

— (C.4--.1■1 L;2_ tv-N.ec---c; Aut,---41 

The ATS recently published in the Proceedings of the American Thoracic Society a A)LI-A `PN-RIcIsS 

workshop report: Respiratory Health Effects of Global Climate Change. I will leave a 

copy of that report with the panel. The workshop report explores the respiratory health 

effects of global climate change, which include: 

• changing pollen releases impacting asthma and allergic rhinitis, 

• heat waves causing critical care—related illnesses, 

• climate-driven air pollution increases exacerbating asthma and chronic 

obstructive pulmonary disease, 

• desertification increasing particulate matter (PM) exposures, 

• and climate-related changes in food and water security impacting infectious 

respiratory disease through malnutrition (pneumonia, upper respiratory 

infections). 

Because of the strength of the existing data from multiple scientific disciplines, trends in 

weather patterns, sea temperatures and ice measurements around the globe, and the 

breadth and severity of likely climate-forced human health issues, the ATS strongly 

urges EPA to move forward with the proposed carbon emissions limits from existing 

power plants. 
Source: Peng RD, Bobb JF, Tebaldi C, McDaniel L, Bell ML, Dominici F 2011. Toward 

a Quantitative Estimate of Future Heat Wave Mortality under Global Climate Change. 

Environ Health Perspect 119:701-706. http://dx.doi.org/10.1289/ehp.1002430 
American Thoracic Society Documents 

An Official American Thoracic Society Workshop Report: 

Climate Change and Human Health 

Kent E. Pinkerton, William N. Rom, Muge Akpinar-Elci, John R. Balmes, Hasan Bayram, 

Otto Brandli, John W. Hollingsworth, Patrick L. Kinney, Helene G. Margolis, William J. Martin, 

Erika N. Sasser, Kirk R. Smith, and Tim K. Takaro; on behalf of the American Thoracic Society 

Environmental Health Policy Committee 

THIS OFFICIAL WORKSHOP REPORT WAS APPROVED BY THE AMERICAN THORACIC SOCIETY BOARD OF DIRECTORS, JANUARY 2012 

CONTENTS 

Executive Summary 

Introduction 

Methods 

Respiratory Health Impacts of Climate Change 

Heat Research Needs 

Air Pollution Research Needs 

Natural (Seasonal) Research Needs 

Mitigation and Adaptation 

Recommendations for Clinicians and Researchers 

Recommendations for Mitigation and Adaptation 

Issues Affecting Low-Resource Countries 

Priority Research Infrastructure Needs 

Monitoring and Alert Systems 

Summary of Key Findings 

This document presents the proceedings from the American Thoracic Society Climate Change and Respiratory Health Workshop that 

was held on May 15, 2010, in New Orleans, Louisiana. The purpose of 

the one-day meeting was to address the threat to global respiratory 

health posed by climate change. Domestic and international experts 

as well as representatives of international respiratory societies and 

key U.S. federal agencies convened to identify necessary research 

questions concerning climate change and respiratory health and 

appropriate mechanisms and infrastructure needs for answering 

these questions. After much discussion, a breakout group compiled 

27 recommendations for physicians, researchers, and policy makers. 

These recommendations are listed under main issues that the workshop participants deemed of key importance to respiratory health. 

Issues include the following: (1) the health impacts of climate change, 

with specific focus on the effect of heat waves, air pollution, and natural 

cycles; (2) mitigation and adaptation measures to be taken, with special 

emphasis on recommendations for the clinical and research community; (3) recognition of challenges specific to low-resource countries 

when coping with respiratory health and climate change; and (4) priority research infrastructure needs, with special discussion of international needs for cooperating with present and future environmental 

monitoring and alert systems. 

Keywords: climate change; respiratory; pollen; greenhouse gases; 

cc:benefits 

Proc Am Thorac Soc Vol 9, !is. 1, pp 3-8, Mar 15, 2012 

Copyright © 2012 by the American Thoracic Society 

10.1513/pats.201201-015ST 

Internet address: www.atsjoumals.org 

EXECUTIVE SUMMARY 

Climate change is due to average global surface temperature increase over the past several decades from greenhouse gases in the 

troposphere reflecting infrared radiation back to the earth's surface. Greenhouse gases are dominated by CO2, but important 

contributions come from methane, nitrous oxide, carbon black, 

ozone, and small amounts of chemicals, including hydrofluorocarbons, hydrochlorofluorocarbons, and others. Importantly, the 

recent increased greenhouse gases chronicled by reports of the 

Intergovernmental Panel on Climate Change are anthropomorphic 

in origin. The year 2010 tied 2005 as the warmest year since records 

began in 1880 and was the 34th consecutive year with average 

temperatures above the twentieth-century average. The National 

Oceanic and Atmospheric Administration chronicled seven rising 

indicators of climate change: (1) air temperature over land, (2) seasurface temperature, (3) air temperature over oceans, (4) sea level, 

(5) ocean heat, (6) humidity, and (7) tropospheric temperature in 

the active weather layer of the atmosphere closest to the Earth's 

surface. Three indicators were declining: (1) Arctic sea ice, (2) 

glaciers, and (3) spring snow cover in the Northern hemisphere. 

How will a warming world affect pulmonary, critical care, and 

sleep physicians? Before the 2010 American Thoracic Society International Conference, the Workshop organizers invited national 

and international experts to consider these questions and make 

the following recommendations for research and investigation: 

• Epidemiology: Explore how climate changes in heat, humidity, precipitation, and extreme weather events impact the distribution of respiratory disease. 

• Heat Stress and Adaptation: Understand how extreme heat 

affects the individual and the community. 

• Vulnerable populations: Increase knowledge of how climateforced heat increases impact the young, impoverished, and 

those with chronic cardiorespiratory conditions. 

• Human Exposure Studies: Conduct chamber studies to understand how the human body responds to airborne exposures in 

conjunction with heat. 

• Climate-Forced Air Pollution: Examine how climate change 

influences the production, distribution, and interaction with 

air pollutants, especially heat and ozone. 

• Biomass Fuel Cooking: Charcoal, animal matter, and plant 

matter in indoor cooking and heating increase mortality from 

children's respiratory infections and chronic obstructive pulmonary disease; explore the impact and control on the release of black carbon into the atmosphere. 
4 PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY VOL 9 2012 

• Seasonal Disease Cycles: Understand how changing climate will impact the seasonal pattern of infectious diseases involving the respiratory system. 

• Human Migration: Study how climate change effects on water and food will potentially impact human migration patterns and conflict causing respiratory health challenges (e.g., 

tuberculosis). 

• Allergy: Explore how changing weather patterns, increased 

CO2, heat, and changing temperate zones will impact human exposures to pollen in terms of intensity, allergenicity, 

duration of growing seasons, and expanded pollen range. 

• Vector- and Zoonotic-Borne Disease: Investigate how respiratory health will be impacted by climate-induced vectorborne disease and their shifting ranges (e.g., dengue fever). 

• Mold: Study how changes in humidity, precipitation, and 

extreme weather events will impact respiratory exposures 

to mold, especially those brought on by flooding. 

• Desertification: Understand how climate-forced desertification and the long-term transport of mineral dusts will impact 

respiratory health. 

• Forest Fires: Recognize how climate change will impact the 

frequency and intensity of forest fires and their likely impact 

on human exposures to respiratory irritants. 

In addition, the Workshop participants suggested opportunities to mitigate the adverse effects of Climate Change through 

a variety of approaches: 

• Educational Outreach to Clinicians and Public Health Practitioners: Provide information about climate change and its 

potential impacts on respiratory health. Clinicians and public health providers can influence public opinion and policy 

makers on how climate change affects human health. 

• Climate Change Research Centers: Develop and fund climate change and Human Health Research Centers. These 

Centers should adopt a multidisciplinary approach and include cross-disciplinary training based in public health and 

medical schools to foster scientific skills sets for the study of 

climate change and human health. 

• International Research Collaboratives: Incorporate into the 

mission of existing international research collaboratives the 

study of how climate change affects human health. 

• Build Healthy Buildings and Community: Construct energyefficient healthy buildings located in communities designed to 

foster exercise and minimize exposure to vehicular emissions. 

• Alternative Energy: Identify and protect against any respiratory health risks that new alternative energy processes 

possess (e.g., acetaldehyde, acrolein). 

• Monitoring and Alert Systems: Develop national air quality, pollen, and weather-alert systems; develop potential of 

personal technologies to alert individuals and communities 

of climate-related health threats. 

We, as pulmonary physicians and scientists, currently have minimal capacity to respond to climate change and its impacts on 

health. The extent to which climate change influences the prevalence and incidence of respiratory morbidity remains largely undefined. However, evidence is increasing that climate change does 

drive respiratory disease onset and exacerbation as a result of increased ambient and indoor air pollution, desertification, heat stress, 

wildfires, and the geographic and temporal spread of pollens, molds, 

and infectious agents associated with increased allergenicity, temperatures, and atmospheric concentrations of carbon dioxide (1-6). 

The American Thoracic Society (ATS) Climate Change and 

Respiratory Health Workshop was held in New Orleans, Louisiana, 

on May 15, 2010. The purpose of the 1-day meeting was to address 

the threat to respiratory health posed by climate change (7-9). 

Domestic and international experts convened to identify necessary 

research questions as well as appropriate research mechanisms and 

infrastructure needs. The ultimate goal was to present recommendations for the health sector to implement efficient approaches to 

limit the respiratory health impact of climate change. The proceedings from the workshop are presented below. 

METHODS 

The workshop cochairs, in consultation with members of the American Thoracic Society's Environmental Health Policy Committee, 

invited U.S. and international experts on respiratory health and 

climate change to participate in the workshop. International respiratory societies and key U.S. federal agencies were also represented. 

All members of the writing committee submitted Conflict of Interest statements prior to the workshop. No important conflicts of 

interest were identified or became apparent during the workshop. 

After viewing a series of expert presentations on the respiratory 

health effects of climate change, participants were assigned to 

breakout groups to discuss key research questions and needs. A 

facilitator and reporter were assigned to each breakout group. 

All participants were encouraged to express opinions and recommendations. The discussions of the breakout groups were presented to the entire workshop for additional input and then 

transcribed, collated, and summarized in this manuscript. Additional recommendations were formulated during teleconferences 

among writing committee members after the workshop. Any disagreement was resolved by discussion and consensus. All workshop 

attendees had the opportunity to review and revise the manuscript 

prior to submission. 

A summary of the methodology is presented in Table 1. 

RESPIRATORY HEALTH IMPACTS OF CLIMATE CHANGE 

Preliminary research has shown climate change has potentially direct and indirect adverse impacts on respiratory health. Published 

studies have linked climate change to increases in respiratory disease, including the following: changing pollen releases impacting 

asthma and allergic rhinitis, heat waves causing critical care—related 

diseases, climate-driven air pollution increases exacerbating asthma 

and chronic obstructive pulmonary disease, desertification increasing particulate matter (PM) exposures, and climate-related changes 

in food and water security impacting infectious respiratory disease 

through malnutrition (pneumonia, upper respiratory infections). 

There has been concern about increased aeroallergens and mold 

exposure associated with allergy and respiratory health after the 

flooding that occurred from Hurricane Katrina, which deluged the 

southern United States in 2005 (10-15). The impact of climate 

change on pollen and mold spores and allergic respiratory diseases 

is of growing concern (16, 17). Workshop participants suggested 

links between climate-forced migration, crowding, and tuberculosis, 

as evidenced in large areas of Africa as deserts spread in this 

continent. Climate change may also cause seasonal shifts impacting 

seasonal flu patterns (7, 18, 19). 

Although all of these factors were discussed at the workshop, the 

most serious and direct health risk of climate change was believed to 

be heat-related disease resulting from increased frequency and severity of heat waves, which have been demonstrated to increase morbidity and mortality (20). Higher surface temperatures, especially in 

developed urban areas, promote the formation of ground-level 
5 

American Thoracic Society Documents 

TABLE 1. METHODOLOGY 

Methods Checklist Yes No 

Panel assembly 

Included experts from relevant clinical and nonclinical fields 

Included individuals who represented patients and society at large 

Included methodologist with appropriate expertise (documented expertise in development of conducting 

systematic reviews to identify the evidence base and development of evidence-based recommendations) 

Literature review 

Performed in collaboration with a librarian 

Searched multiple electronic databases 

Reviewed reference list of retrieved article 

Evidence synthesis 

Applied preselected inclusion and exclusion criteria 

Evaluated included articles for sources bias 

Explicitly summarized benefits and harms 

Used PRISMA1 to report systematic review 

Used GRADE to describe quality of evidence 

Generation of recommendations 

Used GRADE to rate the strength of recommendations 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

Definition of abbreviations: GRADE = Grades of Recommendation Assessment, Development and Evaluation; PRISMA1 = 

Preferred Reporting Items for Systematic Reviews and Meta-Analyses 1. 

ozone (4,21), and ozone exposure has been linked to exacerbations 

of chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis, lung cancer, and acute lower respiratory infection. 

During heat waves, health effects can be due to combined exposures to excessive heat and air pollution. A recent analysis of 

European heat waves (1990-2004) measured higher respiratory 

than cardiovascular mortality, although specific causes could not 

be determined (22). The impacts of climate change on surface 

ozone, 502, and NO„ concentrations in the United States and 

elsewhere have been examined in numerous recent studies (23-

28), with potentially important morbidity and mortality implications for human health (29-32). In addition, as the demand for air 

conditioning increases during heat waves, power consumption 

and the production of fine PM increases, which is a contributor 

to cardiopulmonary disease. 

Workshop participants identified key climate change factors—

heat, air pollution, and airborne allergens—that they believed 

present significant challenges to respiratory health worldwide. Corresponding research needs and questions for each climate change 

factor were discussed. The results of the discussion are presented 

below. 

Heat Research Needs 

• Epidemiology: Explore how climate changes in heat, humidity, precipitation, and extreme weather events impact 

the distribution of respiratory disease. 

• Heat Stress and Adaptation: Understand how increased 

heat, particularly extreme heat, affects a community's ability to adapt. 

• Vulnerable Populations: Increase knowledge of how climateforced heat increases impact vulnerable populations (e.g., 

old, young, impoverished, those with chronic cardiorespiratory conditions, or chronic disease overall). 

Air Pollution Research Needs 

• Human Exposure Studies: Conduct chamber studies to 

understand how the human body responds to airborne 

exposures in conjunction with heat. 

• Climate-Forced Air Pollution: Examine how climate 

change influences the production and distribution of air 

pollutants (e.g., how increased ambient temperatures will 

amplify known hazardous exposures or modify the effect 

of known exposure-outcome relationships). 

• Co-benefits and Trade-offs: Elucidate the interactions between air quality control measures, sustainable development, and climate change mitigation and adaptation 

measures. Topics include cobenefits research (biomass fuel 

cooking/heating alternatives), PM reduction and its impact 

on the atmospheric energy balance, air pollution and cloud 

formation, urban planning, renewable energy, and energy 

consumption. 

Natural (Seasonal) Research Needs 

• Disease Cycles: Understand how changing climate will impact the pattern of infectious disease (i.e., flu, colds). 

• Human Migration: Study how climate-forced changes in 

water/food security, risk of extreme weather events, and 

heat will potentially impact established and novel human 

migration patterns as well as how communities and regions 

will likely adjust to these migration patterns in terms of 

health care and respiratory disease, such as tuberculosis. 

• Allergy: Explore how climate change (increased atmospheric 

CO2 concentrations and temperatures) will impact human 

exposures to pollen and mold spores in terms of intensity, 

allergenicity, duration, and timing of growing and pollenproduction seasons and changed flora and pollen range. 

• Vector- and Zoonotic-Borne Disease: Investigate how respiratory health will be impacted by climate change-induced 

vector-borne diseases and their shifting ranges. 

• Humidity, Precipitation, and Mold: Study how climate changes 

in humidity, precipitation, and extreme weather events 

will impact respiratory exposures to mold, especially those 

brought on by flooding of dwellings or high humidity. 

• Desertification: Understand how climate-forced desertification and the long-term transport of mineral dusts will impact respiratory health. 

• Forest Fires: Recognize how climate change will impact the 

frequency and intensity of forest fires and its likely impact 

on human exposures to respiratory irritants along with effective adaptations to lessen or avoid such effects. 
6 PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY VOL 9 2012 

MITIGATION AND ADAPTATION 

Efforts to prevent and prepare for climate change include mitigation strategies, defined as actions to limit further climate change by 

reducing the production of greenhouse gases, and adaptation strategies, defined as actions to lessen adverse impacts by preparing for 

inevitable changes in climate and climate variability (3, 33). Generally, mitigation and adaptation strategies are being developed independently of each other, and to date, the public health and clinical 

perspective has not been well represented (34). In this context, 

the following broad-based and specific recommendations relevant 

to respiratory health were proposed. Each recommendation has 

elements that can be implemented in the short term as well as a 

planning component for making changes that occur over the medium to longer term (5-10 and 10-100 year time frames). 

Recommendations for Clinicians and Researchers 

• Educational Outreach to Clinicians and Public Health Practitioners: Provide information about climate change and its 

potential impacts on respiratory health (11, 18). Medical 

societies should develop guidelines for medical alerts. Public 

health measures need to be in place to reach vulnerable 

populations during specific climate change—related events, 

such as heat waves or severe air pollution episodes and other 

extreme weather events (e.g., extreme rainfall and floods) or 

rising sea levels and storm surges that challenge or threaten 

community infrastructure. This might include but not be 

limited to information on how to get to cooling centers, 

optimal dosing for medications that affect thermoregulation, 

and access to care (e.g., planning surge capacity). 

• Cross-Disciplinary Training Programs: Develop and fund 

cross-disciplinary training programs based in public health 

and medical schools to foster the scientific skills sets needed 

to understand the interactions between climate change and 

human health. Encourage clinicians and researchers to participate in the development of mitigation and adaptation 

strategies and share their expertise with policy makers at 

the local, state, federal, and international levels. 

• Climate Change Research Centers: Develop and fund climate change/human health research centers. These centers 

should adopt a multidisciplinary approach to studying interactions between human health links and climate change. 

• International Research Collaboratives: Incorporate into the 

mission of existing international research collaboratives the 

study of how climate change affects human health. 

Recommendations for Mitigation and Adaption 

• Behavior: Understand the factors that impact the capacity 

and willingness to adopt effective greenhouse gas—mitigation 

strategies by individuals and communities and design educational programs to increase communities' awareness of the 

health benefits (35). 

• Power of Clinical Community: Clinicians and health care providers influence the public and policy makers. They should be 

proactive in identifying and contributing to solutions and 

capitalize on that power by creating venues and pathways 

by which their voices can be heard. 

• Build Healthy Buildings and Community: Construct energyefficient, healthy buildings (e.g., include adequate ventilation 

to prevent/reduce indoor mold-fostering moisture and exposure to air pollution, natural light, air conditioned spaces) 

located in communities designed/modified to foster exercise 

and minimize exposure to vehicular emissions (36). 

• Increase Respiratory Resilience to Environmental Stressors: 

Improve overall population health (e.g., address the global 

obesity epidemic in developed countries and nutritional deficiency in developing countries) and reduce exposure to 

ambient and indoor air pollution. 

• Alternative Energy: Identify and protect against any respiratory health risks that new, alternative energy processes 

possess. 

ISSUES AFFECTING LOW-RESOURCE COUNTRIES 

Although all countries will be affected by climate change, workshop 

participants acknowledged that low-resource countries are uniquely 

vulnerable to the respiratory health risks brought on by climate 

change. This is due to low-resource countries often lacking economic 

resources, having a close dependence on natural systems for basic 

food and water provision, and suffering from inadequate housing, 

energy, and waste management (1) (Table 1). These challenges 

limit societal adaptation to climate-related shocks (37) or the ability 

to even consider implementing mitigation strategies. 

In addition, these countries are often plagued by several respiratory health challenges that defy analysis by simple, linear exposure 

models, including high rates of childhood pneumonia (38, 39), high 

levels of air pollution (40), increasing prevalence of chronic diseases (41), and a range of conditions related to inadequate nutrition 

and safe water. On a positive note, although climate change makes 

some health goals more difficult to achieve, it also offers an opportunity to accelerate achievement of health goals through actions 

that both reduce the risk of climate change and protect health, a 

"cobenefit." 

PRIORITY RESEARCH INFRASTRUCTURE NEEDS 

Workshop participants believed that for both low- and highresource countries to benefit from climate change and respiratory 

health research, improved research infrastructure and concerted 

international cooperation among governments, agencies, scientists, and communities are paramount. Myriad research needs exist in low- and high-resource countries that should be remedied 

to effectively develop research partnerships that can address major climate-related risks to global respiratory health. A crucial 

step toward building research infrastructure is to understand 

the existing national surveillance systems, augmenting their efficiency and scope, and reinforcing the completeness and reliability in data collection. Considering the variability in currently 

existing surveillance systems worldwide, implementation of accurate and reliable surveillance systems is necessary to identify, 

capture, and monitor climate changes that can affect respiratory 

health and should include the following: 

Monitoring and Alert Systems 

• Pollen Tracking: Develop national and international pollenmonitoring networks. 

• International Air Quality—Monitoring Network: Develop 

and fund improved national and international air quality—

monitoring networks, particularly in rapidly growing cities 

of the developing world. 

• Weather Forecasting: Improve weather forecasting to understand climate-forced change in weather and its impact 

on human health (heat, humidity, extreme weather events, 

precipitation, food and water security). 

• Weather Alert Systems: Expand or develop effective alert systems to inform communities about pending extreme weather 

events that can link to air pollution—monitoring systems. 
American Thoracic Society Documents 

7 

• Personal Technology Alert and Reporting Systems: Explore the potential of personal technologies as a way to 

both alert individuals and communities of climate-forced 

health threats as well as using such personal technologies 

to collect human health data. 

SUMMARY OF KEY FINDINGS 

The purpose of the ATS Climate Change and Respiratory Health 

Workshop was to identify necessary research questions as well appropriate mechanisms and infrastructure needs for limiting the respiratory health impact of climate change. A crucial step to be 

taken is improving public health and clinical educational programs 

to raise awareness of climate change and the potential health consequences and attract more of the work force to this area of study. 

There needs to be an emphasis on public recognition and early 

warning response to severe climate-related events with the awareness that these effects are likely to have the most impact on susceptible populations: the elderly, infants and children, those with 

existing respiratory/cardiovascular disease or autonomic dysfunction 

in temperature control, and those living in low-resource countries. In 

addition, multidisciplinary research efforts involving research scientists, clinicians, public health specialists, sociologists, local—state 

partners, climatologists, toxicologists, epidemiologists, and population scientists are required to address unanswered health-related 

consequences of climate change. Funding agencies should encourage multidisciplinary approaches and introduce newer funding 

mechanisms, collaborative program project grants, new investigator 

awards, and training awards to enhance research interest of newer 

investigators in this field. For example, research on climate and respiratory health can be enhanced by greater access to and coordination among existing Earth system science, technology, and data 

collection efforts underway at organizations such as the World 

Health Organization (WHO), National Aeronautics and Space 

Administration (NASA), U.S. Centers for Disease Control and 

Prevention (CDC), U.S. Environmental Protection Agency 

(USEPA), U.S. National Institute of Environmental Health Sciences (NIEHS), World Meteorological Organization (WMO), 

the United Nations (UN), and many others. Critical use of existing 

resources is likely to enhance cobenefits to several agencies partnering. Last, defined public health cohorts, disease surveillance 

programs, review of existing climate surveillance systems, and environmental tracking and registry systems need to be improved or 

developed globally. Domestic and international participants in the 

ATS workshop came together to collectively discuss the respiratory health challenges brought about by climate change. These 

proceedings present their concerns and recommendations to other 

members of the health, research, and policy sectors, so that they 

can be informed and act on a challenge that faces us all. 

This official ATS Workshop Report was prepared by a writing 

committee of the American Thoracic Society Environmental 

Health Policy Committee. 

Members of the Writing Committee: 

KENT E. PINKERTON, PH.D. (Co-chair) 

WILLIAM N. Rom, M.D., M.P.H. (Co-chair) 

MUGE AKPINAR-ELCI, M.D., M.P.H. 

JOHN R. BALMES, M.D. 

HASAN BAYRAM, M.D., PH.D. 

OTTO BRANDLI, M.D. 

JOHN W. HOLLINGSWORTH, M.D. 

PATRICK KINNEY, SC.D. 

HELENE G. MARGOLIS, PH.D. 

WILLIAM MARTIN, M.D. 

ERIKA N. SASSER, PH.D. 

KIRK R. SMITH, M.P.H., PH.D. 

TIM K. TAKARO, M.D., M.P.H. 

Author Disclosure: I.R.B. served as a member of the California Air Resources 

Board (appointed physician member of state agency; $10,001-50,000) and as 

a member of panels of the U.S. Environmental Protection Agency's Clean Air 

Science Advisory Committee ($1,001-5,000). K.E.P., W.N.R., M.A.-E., H.B., 

0.B., J.W.H., P.L.K., H.G.M., W.J.M., E.N.S., K.R.S., and T.K.T. reported they 

had no commercial interests or noncommercial, nongovernmental support relevant to subject matter. 

Workshop Attendees: 

JOHN BALBUS, M.D. 

JOHN R. BALMES, M.D. 

RUPA BASU, PH.D., M.P.H. 

HASAN BAYRAM, M.D., PH.D. 

Otto BRANDLI, M.D. 

PATRICIA CONRAD, D.V.M., PH.D. 

DORR DEARBORN, M.D., PH.D. 

RICHARD DEY, PH.D. 

KRISTIE EBI, PH.D., M.P.H. 

STEPHEN B. GORDON, M.D. 

ANNE GRAMBSCH 

SHU HASHIMOTO, M.D., M.P.H. 

JEREMY HESS, M.D., M.P.H. 

JOHN W. HOLLINGSWORTH, M.D. 

KAZUHIKO ITO, PH.D. 

S. K. KATIYAR, M.D. 

PATRICK L. KINNEY, SC.D. 

DAVID LEVINSON, PH.D. 

HELENE G. MARGOLIS, PH.D. 

WILLIAM J. MARTIN, M.D. 

YVONNE NJAGE, M.D. 

KENT E. PINKERTON, PH.D. 

RAIENDRA PRASAD, M.D. 

WILLIAM N. ROM, M.D., M.P.H. 

ERIKA SASSER, PH.D. 

TORBEN SIGSAARD, M.D. 

KIRK R. SMITH, M.P.H., PH.D. 

J. K. SUMARIA, M.D. 

TONY SZEMA, M.D. 

TIM K. TAKARO, M.D., M.P.H. 

KATHERINE WALKER, SC.D. 

LYDIA WEGMAN, J.D. 

MARK WINDT, M.D. 

Ho-IL YooN, M.D., PH.D. 

DAYA UPADHYAY, M.D. 

Acknowledgments: The American Thoracic Society and the workshop co-chairs 

gratefully acknowledge the support organizations whose support made the workshop possible: The Swiss Lung Foundation, the U.S. Environmental Protection 

Agency, and the National Institutes of Environmental Health Sciences. 

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