Testimony of Barbara Gottlieb, Director of Environment and Health 

Physicians for Social Responsibility 

On the proposed "Standards of Performance for Greenhouse Gas Emissions for 

New Stationary Sources: Electric Utility Generating Units" 

Docket ID No. EPAHQ-OAR-2011-0660 

May 24,2012 

Washington, DC 

My name is Barbara Gottlieb. I am the Director of Environment and Health at Physicians 

for Social Responsibility, a national organization of health professionals that works to 

protect human life from the gravest threats to health and survival. I speak on behalf of 

PSR's.I(O,OOO members and activists. 

As you know, climate change is acknowledged by scientists around the world to be real, 

and to be caused primarily by human activity, especially the burning of fossil fuels. As the 

earth warms, the delicate balance of climate, weather, water and life is disrupted. The 

consequences threaten human health and, ultimately, survival. This makes the EPA's 

proposed carbon pollution rule for electric utility generating units one of the most 

important actions you can take to protect human health and well-being. 

The world is warming; 2011 was one of the warmest years on record, according to the 

World Meteorological Organization. Longer-term, the chance of limiting the rise in global 

temperatures to 2 degrees Celsius this century is getting slimmer and slimmer, according 

to the International Energy Agency. Significantly, the lEA's chief economist recently 

attributed that pessimistic assessment to the continuing construction of power plants. 

("What I see now with existing investments for plants under construction ... [is] we are 

seeing the door for a 2 degree Celsius target about to be closed and closed forever." Fatih 

Biro!, lEA chief economist, addressing a Reuters' Global Energy & Environment Summit.) 
This warming has grave consequences for human health. Global warming is predicted to 

increase the frequency of extreme heat events or heat waves, which can cause serious heatrelated illnesses and can lead to death. The most common is heat exhaustion, which in turn 

can progress to heat stroke. The clinical definition of heat stroke includes a core body 

temperature of 105°F or more and central nervous system abnormalities such as delirium, 

convulsions, or coma. With effects like these, heat waves can and do cause mortality, often 

related to cardiovascular, cerebrovascular, and respiratory causes, especially preexisting 

illnesses. 

Extreme heat events are already a significant public health problem in the U.S., responsible 

for more deaths annually than hurricanes, lightning, tornadoes, floods, and earthquakes 

combined. The health impact of extreme heat events will likely be exacerbated in the 

future by the synergistic effects of a warming climate, urbanization, and an aging 

population. Advanced age represents one of the most significant risk factors for heattemperature: Elderly peole have diminished ability to regulate body temperature; they 

generally experience poorer health; and they are more likely to live alone and have reduced 

social contacts, further increasing their vulnerability. This vulnerable group is growing as 

the elderly become an increasingly large proportion of the U.S. population. 

The urban poor are also highly vulnerable to extreme heat exposure. City environments 

hold more heat, creating the "urban heat island" phenomenon. After absorbing heat during 

the daytime, the urban heat island radiates it out at night, raising nighttime minimum 

temperatures - a phenomenon which has been linked epidemiologically with excess 

mortality. People with certain pre-existing medical conditions, including cardiovascular 

disease, respiratory illnesses, obesity, neurologic or psychiatric disease, are vulnerable. 

That encompasses a wide swath of the American public. 

Rising temperatures also worsen air quality and the risk of respiratory disease. Ozone 

formation increases with increasing temperature, and ozone contributes to asthma and 

other chronic lung diseases. In addition, a 2009 study indicates that ozone exposure is 

associated with a heightened risk of death from respiratory causes, and that long-term, 
low-level exposure can be lethal. This is very worrisome, given that other research 

suggests that ozone concentrations in the U.S. may increase between 5-10 percent over the 

next 50 years purely as a result of climate change. 

Because time is short, I have presented only a part of PSR's concerns about the health 

impacts of climate change. I will enter into the docket a full, footnoted version of this 

testimony, as well as information about climate change effects on human health related to 

extreme weather, floods and droughts; water-borne and insect-borne diseases; wildfires; 

impact on crop yields and the food supply; vulnerable populations; and the less-known but 

very real dangers of mental health effects due to climate change. 

I will also enter into the docket the names and addresses of 2,180 PSR members who have 

added their support for this very important proposed rule. These signatures are a small 

indication of the importance PSR places on this first federal action for nationwide reduction 

of greenhouse gases. We look forward to a strong rule and, in the future, more 

comprehensive steps to protect our health and our world from carbon pollution and 

climate change. Thank you. 
cm Physicians for 

Social Responsibility 

United States Affiliate of International Physicians for the Prevention of Nuclear War 

Health Implications of Global Warming: 

Heat's Deadly Effects 

Global warming 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. 

This is one o f se,·eral fact sheets produced by Physicians for Social Responsibility that e:'i:a.mine recent 

scientific evidence of global wanning's impact on health. 

Global warming is likely to increase the frequency of "extreme heat events" or heat waves. 

• For the twenty-first ceontry, the IPCC projects with "high confidence" that e..'i:treme heat events will 

intensify in magnitude and duration over portions of the U. . where they already occur.• 

• W/e cannot attribute a specific hear wave to global warming; however, the effect of global warming on the 

probability of occurrence of a hear wave can be determined. ln the case of the European heat wave of 2003, 

a group of scientists publishing in the journal alure estimated with a greater than 90% confidence level that 

human influence on climate more than doubled the probability of its occurrence." 

Heat-related illnesses are serious and can lead to death. 

• Ilu.· most common heat-related illness is heat exhaustion, whose symptoms include intense thirst, heavy 

sweating, arL'i:iery, dizziness, fainting, nausea or vomiting, and headache. 

• Heat exhaustion may progress to hear stroke, which is a severe illness. Its clinical definition includes a core 

body temperature of 1 05°F or more, accompanied by hot, dry skin and central nervous system abnormalities 

such as delirium, convulsions, o r coma. 

• Mortality from hear waves is often related to cardiovascular, cerebrovascular, and respiratory causes, 

especially preexisting illnesses. 

• Air pollution concentrations may rise during beat waves, especially as people rum on air conditioning, thus 

increasing their use of electricity (which if generated by burning coal is a major source of pollution). This 

pollution may exacerbate preexisting conditions such as angina and asthma and may lead to increased death 

rates."' 

Extreme h eat events a re already a significant public health problem in the U.S. 

• ln fact, C.'(treme hear events are responsible for more deaths annually than hurricanes, lightning, tornadoes, 

floods, and earthquakes combined." 

• The health impact of extreme heat events will likely be exacerbated by the synergistic effects of a warming 

climate, urbanization, and an aging population.' 
H eat waves are already increasing. 

• A roughly 20% overall increase in the number of heat waves- a "significant" upward trend -- has been 

observed for the eastern and western U .. for the period 1949 to 1995.'"' 

• In the European beat wave of 2003, an estimated 22,000 people died across Britain, France, Italy, the 

etherlands, Portugal and Spain.'"'' Other mortality estimates run as high as 35,000. vrn 

• In Paris, sustained extreme high temperatures (including high night-time minimum temperanu:es), unique in 

the recorded h.istmy of Paris, together with housing designed for cooler surruners, caused a major public 

health crisis. D eaths increased by 140%." 

The elderly are at particularly high risk. 

• Advanced age represents one of the most significant risk factors for heat-related death in the U.S. 

• r:ldcrh pwpk h:\\ c diminished ability to regulate body temperature and tO adapt physiologically to heat. In 

addition, they generally experience poor health. The elderly are also more likely to live alone and have 

reduced social contacts, which further increases their vulnerability.' 

• This vulnerable population will grow as the elderly become an increasingly large proportion of the U. 

population. 

Other populations are also hig hly vulne rable to extreme heat exposure. 

• People without access to air conditioning are a vulnerable population. The urban poor are particularly 

vulnerable, due to the " urban hear island" phenomenon. City environments hold more hear and routinely 

experience ambient air temperatures from 2°- 10°F warmer than the surrounding rural and suburban areas."'· 

'" 'J he urban heat island also absorbs heat during the daytime and radiates it out at night, raising nighttime 

minimum temperatures, which has been linked epidemiologically wid1 excess mortality. xu• 

• People with certain pre-existing medical conditions are vulnerable. These conditions include cardiovascular 

disease, respiratory illnesses, obesity, neurologic or psychiatric disea e. 

• Also vulnerable are people receiving medications that interfere with salt and water balance (e.g., diuretics, 

anticl10lergic agents, and tranquilizers that impair sweating)."' 

Wildfires are an increasing threat. 

• Higher temperatures cornbined with extended periods of drought and decreased soil moisture raises the risk 

of wild ftres and the death and damage d1ey inflict. 1 n New Mexico, the wildfire season has grown by 78 days 

during ilie past d1ree decades.,., 

• Another heald1-relared impact from more frequent and larger fires: the increa e in fine particulate air 

pollution, bod1 in the immediate vicinity of fires and in areas downwind."' 

• Forest fires create more global waruung. Trees normally SetTe as a reserve or "sink" of carbon, absorbing 

and holding carbon in place. When d1ey bum, instead of acting as carbon sinks, trees release their carbon to 

the atmosphere, increasing the greenhouse effect . .,." 

Global warming will worsen air quality and the risk of respiratory disease. 

• The formation of ozone is known to increase wid1 increasing temperature. A positive association has been 

found between temperatures above 90°F and ground-level ozone production. This is true even without 

increases in the concentration of volatile organic compounds and nitrogen oxides (ozone's " precursor" 

pollutants). 

• Increasing evidence suggests d1at ozone and high temperature affect mortality synergistically . ..," 

• Research suggests that ozone concentrations in d1e U.S. may increase between 5-10 percent over d1e next 50 

years purely as a result of climate change. This is projected to be true even if an d1ropogenic precursor 

emissions and global background concentrations are held constant. ,;, 

• A new study (March 2009) indicates d1at ozone e..xposure is associated with d1e risk of death from respiratory 

causes, and that long-term, low-level exposure can be lethal. " 
• 

' lntcrgmcmmcntal Panel on Climate Change. Clinme chan).,>c 21Xl7: impacts, adaptation and \'Uinerability. In: Parry l\11 ., Canzoam 0 1·. Paluukof JP. mn 

d~r I.Jndcn PJ. II anson CE, eds. Contnbution of\Vork.ong Group II lO the l·ounh Assessment Repon of the lntergo,·cmmcntal Panel on Chmale Change. 

CJmbrodgc: Can1bndgc UruYcrsiry rc~s. 2<Xl7:6 17-52. Accessed onlonc at http:/ / www.ipcc.ch/ ipccrcpons/ ar4-wg2.htm 

• Stoll Pt\. Stone [),\,and Allen l\IR. !Iuman Conrribuuon to the Huropcan II cat \Vme of 2003. No111rr (2()()4); 432: 6W-61-I. 

w ll aonc~ A. cl al. "Climate change and human health: impacts, ,·ulncrabiloty. and mitigation. Lancet, Vol. 367 June 24, 2006 

" Luber(; ct al. Climate Change and Extreme Ileal E,·enrs." 1\ m J Pre\· t\lcd 2008;35(5). August 2008. 

' Luber G ct al. Climate Change and Exrrcmc l lcat l>\ents." Am J Pre\' 1\k-d 2008;35(5). t\ ugusr 2008. 

"Ga ffc n DJ. o~s R. ncrca~cd summertime heat stress on the U.S. arure 1998;396:529-30. 

•• Kosatsky 'f'. The 2003 European II em Wa,·es. L:.11ro .f11mill. (2005); I 0: 148-149. 

·~ Epstcon 1'. Climate Change and lluman llealth. N,.. b( ·). Mtd. (2005); 353: 1433-1436. 

" I lames \ . ct al. "Climate change and human health: ompacts, \'Uineraboloty, and nulij,>ntion. l.ancct, Vol. 367 June 24, 2006 

• Luber G ct al. Chmatc Change and Extreme !feat r.;,·cnrs." \ on J Pre' l\lcd 2008;35(5). t\ugust 2008. 

"U.S. Ennronmcntal ProtL-ction ,\gency. I teat osland effect. U.S. l>nnronmental Protection \gency. 20115. 

•• Vosc R. Karl 'f'. Easterling D, Williams C, l\lcnne l\1. Climate (commumcauon ansong): ornpact of land-usc change on domatc. arurc 2(M)-1;427:2 13- -1 . 

.,. U.S. Em ironmenral Protection Agency. ExccSSI\"C heat e\'Cnts !,•uodcbook. 2006. 

"' Luber G ct al. Climate Change and Extreme I lear t·:,·ents." .\ m J Pre' Mcd 2008;35(5). August2008. 

" 1\lcCall) 1\1. '"J'est.imony of Michael McCally. MD, PhD, Before the Senate r;nvironmcnr and Public Works Comnuncc." October 23,2007. 

"' Kinney P. "Climate Change, Air Quality, and !Iuman llcalth." Am J l'rcv I\ fed 2008; 35(5). August 2008. 

"'' h eld C: American Association for the Ad\'anccment of&ocncc. "Ominous Report on Climate (; cnerates Worldwide Coverage from AAA, Annual 

Mceung." l'cbruaf) 15,2009. At --.L...'.!. ..'l"'- ""' 11~1 I 11 I• J 11 1! 

"'" Luber G et al. Climate Change and Extreme I lent Events." Am J Pre' !\ted 2008;35(5). August 2008. 

"' Kinney P. "CI1matc Change, Air Qualiry, and !Iuman llealth." \ m J Pre'' I\ ted 2(108; 35(5). August 2008. 

" Jcrret l\1. ct al. "l.ong-Tenn Ozone Exposure and 1\lorrahty." C\\ England Journal of 1\ledjcine, 360:1085-1095, 1\larch 12. 2009. 
• -. 

®Physicians for 

Social Responsibility 

United States Affiliate of International Physicians for the Prevention of Nuclear War 

Health Implications of Global Warming: 

Vector-borne and Water-borne Diseases 

Global warming is acknowledged by scientists around the world to be a reality and to be caused primarily by 

htm1an activity, especially the burning of fossil fuels. As the earth warms, the delicate balance of climate, 

weather events and life is clisrupted. Conseguences emerge that threaten human health and, ultimately, 

survival 

This is one o f several fact sheets produced by Physicians for Social Responsibility that ~'{amine recent 

scientific evidence of global warming's impact on health. 

Vector-borne diseases 

Vectors c a rry and transmit disease 

• Vectors are insects (mosguitoes, ticks, fleas, black flies and sandilies) that carry infectious agent such as 

protozoa, bacteria and viru es. 

• They carry and transmit numerous cliseases to humans: parasitic vector-borne diseases such as malaria, 

leishmaniasis, and Chagas clisea e; arboviral cliseases such as dengue fever, yellow fever, West ile Virus, 

Rift Valley fever, and tickborne encephalitis; and bacterial and rickettsial cliseases such as Lyme 

borreliosis, tularemia and plague. 

Glob al wa rming impacts vector-home diseases 

• Vector organisms and the infectious agents they carry are cold-blooded, so changes in temperature will 

affect their development, reproduction, behavior and survival rates. 

• Changing temperature and precipitation may shift the geographic range in which they can live and the 

seasonal period of clisease risk. 

• Temperature also can affect pathogen development within vectors, precipitation can influence d1e 

availability of breeding sites, and climatic variables can affect the clistribution and abundance of their 

vertebrate host species.•·" 

Globa l warming and mosquitoes: Mosguitoes are highly sensitive to temperarure. Higher temperatures: 

• boost their reproductive rate, lengthen their breeding season, and make them bite more freguently; 

• shorten d1e time it takes for the pathogens they carry to mature to an infectious state; 

• can expand the mosguitoes' range to higher elevations and more northern latirudes, potentially putting 

previously unexposed populations at risk. 

Srorms, hurricanes and floods can contribute to the spread of malaria, as they leave behind vector breeding sites. 

The threat to health: Mosguitoes can carry malaria and dengue fever, among other cliseases. 

• Malaria: orne 350 to 500 millio n cases of malaria occur annually, resulting in the deatl1s of an estimated 

one to three million people, mostly young children. \' orldwide, malaria ha the largest disease burden 

(illnesse , deaths, financial costs and other .inclicators) o f any vector-borne clisease."' 
. . 

• Dengue fever: It is estimated that there are over 100 million cases of dengue worldwide each year. The 

case-fatality rate of its more serious form, dengue haemorrhagic fever (DHF), is about 5%, mostly 

among children and young adults." The disease is now endemic in many countries of tl1e Americas; 

there is a small risk for dengue outbreaks in tl1e continental United States.,. 

Global warming and ticks 

• Ticks maintain multiple and diverse disease agents (including bacteria, viruses, and parasites) and sen7 e as 

bridging vectors between animal reservoirs of tl1e disease and humans. 

• Changing weather patterns associated wiili climate change have induced shifts in tl1e distribution of vector 

ticks carrying Lyme disease. Modeling indicates iliat in ilie future, ilie tick that carries Lyme disease will 

expand into Canada. n 

Global warming and fleas 

• Fleas are best known as vectors of tl1e causative agent of plague. Plague has caused millions of human 

deaths, especially dmi.og ilie Black Deaili of t:l1e Middle Ages. 

• Plague is still with us, notably in New Me.xico, where its prevalence seems to correlate wiili t:l1e tinling and 

amount of precipitation. n•.nu 

• Recently, studies of plague transmission in ilie U.S. found iliat ilie pattern of human plague cases has shifted 

no rthward as temperatures have warmed. It is predicted that some nortl1ward expansion of ilie disease could 

occur from ew Me.xico into'\ yoming and ldaho. c< 

Water-borne diseases 

Water-home infectious diseases worsen with global warming 

• Infectious diarrhea is one of the most prevalent of t:l1e world's water-borne diseases. It is usually a 

symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic 

organisms. Infection is spread tluough cont.aminated food or drinking-water, or from person to person 

as a result of poor hygiene. 

• evere diarrhea leads to fluid loss and may be life-tlueatening, particularly in young children and people 

who are malnou.rished or have impaired immunity. Globally, it is the second-leading cause of mortality 

in young children. x 

• This is only ex'Pected to worsen wiili climate change, driven by factors including increased temperatures, 

flooding, and other changes in rhe water cycle." 

• Cholera is a diarrheal disease caused by bacteria tl1at occu.r naturally in rivers, estuaries, and coa tal 

waters. cienrists have observed a relationship between ilie increase in sea-su.rface temperature and ilie 

onset of cholera epidemics. Strong El Nino cycles and ot:l1er clin1.ate variables provide a predictive 

capacity for cholera epidemics."' 

Increased risk of water-borne diseases in the U.S. 

• l n countries witl1 reliable sources of potable water, contamination of recreational waters from extreme 

weather events remains a significant means of disease transmission. Ear, nose, and tluoat, respiratory, 

and gastrointestinal illnesses are commonly associated witl1 recreational swimrning in fresh and oceanic 

waters. 

• Oilier, po tentially more severe waterborne diseases are also transmirted in recreational waters, altl1ough 

wiili less frequency, such as hepatitis, gia.rdiasi , and cryptosporidiosis. "" 

• A study of water contamination of tl1e Great Lakes projected mat as e.xtremely heavy precipitation 

events become stronger, tl1ere will be a resulting greater potencial for flooding and ewer overflow, with 

a corresponding greater potential for waterborne diseases. It stated, "The Grear Lakes, which serve as a 

drinking water sou.rce for more tl1an 40 million people, are particularly susceptible to fecal pollution and 

can become reservoirs for waterborne di eases." "' 
• (;age K. er al. "Climate and Vccrorbomc Disca~cs" \m J Prcv Mcd 2008; 35(5). 

• l'at'l. ct al.. lmpacr of regional clim\'ate change on human health. 'aturc. \'ol438. 17 1\:ovLmber 2005. 

m Sr. I..oui~ ~I. and I less J. "Climate Change: Impacts on and Implications for Global! Jealtb." .\m J Prev ~led 2008:35(5). 1\ugusr 2008. 

" C DC. " Dengue Fever Fact Sheet." Centers for Dis<.-ase Control and Prevention. 

htrp:l I www.cdc.gov I ncidocll dvbidl dcnguel #currcn t 

' CDC. " Dengue Fact Sheer." Ccmers for Di sc ~c Control and Prevention. 

m l I• ,,, nud ,,J .hbtd ltn II t tn J), 11 'I" I p~ 

" Brownstein JS, llolford TR, Fish D. Effect of climate change on Lyme disease risk in North America. ~col .lcalth 2005:2:38-46. 

'" Pannentcr RR, Yadav EP, Pam1cnrcr Ci\, Ettcsrad 1', Gage Kl.. Incidence of plague associated with increased winter-spring 

precipitation in New exico. J\mj Trop Med Ilyg 1999:6 1:814 -21. 

"" scorc RE, Biggerstaff BJ, Brown TL, Fulgham RE, Reynolds PJ, ngclthaler Dl\1, er al. 1\lodcling relationships between climate and 

the frcc.1uency of human plague cases in rhc sourhwesrem United Stares, 1960--1997. ,\m J Trop ]\Jed llyg 2002;66: 186-96. 

akazawa Y, Williams R. Peterson t\T, 1\lead P, Sraples E, Gage KL. Climate change effects on plague and tularemia in the United 

Stares. \'ector Borne Zoonotic Dis 2007;7:529-10. 

• Shea K and Cummirree on Environmcnrall lealrh. "Global Climate Change and Children's llcaltb." PEDIAriUCS \ 'olumc 120. 

1'\umbcr 5, OVL'!nbcr 2007. 

"' Sr. I .<>tns ~I. and I less J. "Climate Change: Impacts on and Implications for G loball lealth." i\m J Prev i\led 2008:35(5). ,\ugusr 2008. 

'"'Colwell R. "Global Climate and J Icalth: Predicting Infectious Disease Outbn.-a.ks." Innovations. Summer 2006, Vol. I, No.3, Pages 

19-23. \cces~cd online ar hHJ. "1\ 1 . u IIJ ·'"I' unql 1 1 .I •I 1 II 11 I ( Jl _ ~ 1 .• ~ .

1 . < "'k" 1 I 

"" Patz J cr al. "(]imare Change and Warcrbomc Disease Risk in the Grear I .akcs Region of the U.S." Am J Prcv Mcd 2008;35(5). 

i\ugusr 2008. 

' "' ParJ: j cr al. "Climate Change and Waterborne Disease Risk in rhc G rear Lakes Region of the U.S." t\mj Prev d 2008;35(5). i\ugust 

2008. 
. . 

<m Physicians for 

Social Responsibility 

United States Affiliate of International Physicians for the Prevention of Nuclear War 

Health Implications of Global Warming: 

Shrinking the Food Supply 

Global warming 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, 

smvival. 

This is one of several fact sheets produced by Physicians for Social Responsibility that examine recent 

scientific evidence of global warming's impact on heald1. This fact sheet draws primarily on d1e 

Intergovernmental Panel on Climate Change (IPCC)'s 4th Assessment Report, Working Group 22.• Facts 

and citations are from that source unless od1erwise indicated. 

Warming will affect food production. 

• G lobal warming will affect crop yield . Effects will be rni..xed, based on location and degree of warming. 

• In low-latitude reg1ons and seasonally dry areas, even "slight'' warming is predicted to decrease yields." 

• The reg1ons likely to face the bigge t challenges in food security are Africa, particularly sub-Saharan 

Africa, and Asia, particularly south Asia. 

• Crop yields could decrease substantially across d1e 1\frican continent because of increased frequency 

of drought. Com production could end in some areas. Livestock production could suffer as 

rangeland deteriorated or turned into unproductive shrub land and desert. 

• Rice production in Asia could decline. However, wheat production in China and India will increase 

if the C02 'fertilization effect' takes effect. 

• In mid- to high-latitude reg1ons (such as the United States), iris predicted that "moderate" warming will 

benefit crop and pasture yields.w 

• However, once warming rises more than 3°C (5.4°F), it \vill have increasingly negative impacts in aU reg1ons, 

including North America. 

• More even than changes in temperature and precipitation, food and forestry production -- and food 

insecurity-- are projected ro be affected by d1e increased frequency and severity of extreme climate events. 

Secondary impacts and multiple variables can increase risk and unpredictable outcomes. 

• Climate change increases the risks of secondary impacts such as fires and outbreaks of pests and pailiogens, 

wid1 negative consequences for food , fiber and forestry. 

• Multiple stressors (such as secondary impacts) increase overall sensitivity to climate change and reduce d1e 

resiliency of d1e agricultural sector. 

• Climate change scenarios that incorporate several variables (for example, increased frequency o f heat srre s, 

plus droughts, plus flooding events) pro ject greater reductions in crop yields and livestock productivity. 

They also indicate "d1e possibility for surprises,""· that is, outcomes d1at may be unforeseen or bard to 

predict. 
. 

" 

Small and subsistence producers -much of the developing world's population - are vulnerable. 

• ubsistence farmers and small-scale agriculrural producers, pastoralists and fisherfolk will be particularly 

vuh1erable to climate change's effects. l11e IPCC predicts that they will suffer "complex, localised impacts 

of climate change." 

• On a longer time frame, small producers will have to contend with d.i.minished river flows, as high-mountain 

snow-pack shrinks; sea level rise, which may increase soil salinity and eventually flood low-lying coastal land; 

and a loss of agriculrurallabor as climar.e-responsive diseases such as malaria become more prevalent. 

• Small producers typically produce relatively little surplus and live near the edge of survival. The narrow 

margin in their food production means they are constrained i.n their ability to experiment with new crops and 

techniques, and thus less able to adapt to climate change. 

Wealthy countries are vulnerable too. 

• The 2003 heat wave in Europe was implicated in the deaths of tens o f d1ousands of people. Tt also 

correlated with notable drops in crop yields:' 

• l n France, cora crop and forage production fell by 30% compared to 2002. Fruit harvests fell by 

25%. 

• ] n Italy, a record drop o f 36% occurred for cora grown in the Po valley. 

• Corn, the most important crop in the U.S., is vulnerable to global warming. n 

• Temperamres above 72°F shorten corn's reproductive lifecycle, giving the grain less time to grow 

and decreasing yield. A study by the Lawrence Berkeley National Laboratory and the Carnegie 

Institution estimates that climate changes since 1981 have cost corn producers world-wide about 

1.2 billion per year. 

• Weeds, pests and some leaf and root pad10gens may proliferate more successfully and expand d1eir 

ranges in response to increases in temperature and humidity. For example, corn farmers in the 

warmer southern parts of the U.S. apply pesticides more frequendy d1an do farmers in northern 

states. Tf global warming results i.n the northward e.xpansion of pest ranges, farmers in northern 

stares may have to spray more, resulting in greater financial and envi.rorunental costs. 

• Ground-level ozone has "significant adverse effects" on crop yields, pasture and forest growth. Ozone, 

whicb forms from certain pollutants in the presence of heat, is anticipated to rise due to global warming. 

• Sntdies show that ozone is toxic to soybeans, wheat, peanuts and cotton.'"'' 

• Rural areas in the Midwest and eastern U.S. already have high ozone levels. Increases in rural ozone 

levels could affect the profitability and competitiveness of important cash crops.'"' 

• Elevated C02 levels may ameliorate the negative impacts from ozone, but not sufficiently. The 

TPCC projects tl1at increasing ozone concentratio ns will have a negative impact on plant production, 

"with or wid10ut C02 increases, with or without climate change."L' 

• Easterlmg, W.E .. P.K Aggarwal, P. Bauma. K.M. Brander, L. Erda, S.J\1. I lowden. A. Kinlenko, J. Monon. J.-F. Soussana, J. Schm1dhuber and F. . 

Tubidlo, 2007: Food, librc and forest pmducts. Oimalr (banfj 2007: lmpatt.f, Adaptation and I ulnrmbifltJ' C11ntribution o( ll' "ork.in,~ Group II to 1/x 1-ourtb 

Assurmtnl Rrport oft/If! lniUllfJif nlmtlltal Pam/ on Oimale 0kll(f!!, i\I.L. Parry, O.F. Canzi:mi,J.P. l'alutikof, I'.J. ,-an dcr Linden and C. E. II anson, J,:ds., 

Cambndge Uni,·crsity Press, Cambcid!,>C, UK, 273-313. \cccssed onune at http:/ / www.ipcc.ch/ pdf/assessmcnt-reron/ ar4/ " g2/ ar4-wg2-chaptcr5.pdf 

• Ibid. 

m Ibid. 

" lb1d. 

• Tcllcen-Lawmn, T. I Iotter Fields, Lower Yields: I low Global Wanning Could ll un .\merica's Faons.(2009) Em·ironment America Research & Policy 

Center. \ccesscd onhne at http:/ / v.·ww.em .ronmemamt.'rica.org/uploads/1 IG/UI./ IIG ULGpl l8lqB8pW07M41 xn,\fhotfields_lowyields.pdf. 

n fbid. 

bid . 

•w Ibid. 

u Easrcrlong. W.E., P.K. Aggarwal. P. [13tima, K.J\1. Brander, L Erda, 1. l lo\\dcn, .\ . Kinlcnko,J. Mon on.J.-F. Soussana,J. Schmidhuber and F. '. 

Tubicllo. 2007: Food, librc and forest products. Oimalt (.Am§ 200-: Imparts. A tkif>lalion (}J/d I m~bilif). Ctlntrilmtion of ll''ork.ing Group /I to I lit I DllrfiJ 

AsstS.fllltnl RrJWrf of 1/it lnlt'l!,OirmmMial Panrl on Climatt CIJ<II{f!!· M.l .. Parry, 0 .1•. Canziani,J.P. l'alutikof, P.J. \'an dcr Linden and C.l,. II anson, Eds., 

ambrid~:c Uni,·ersity Press, Cambridge, UK, 273-313. Accessed online at hup:/ / www.ipcc.ch/ pdf/assessmcnt-rcpon/ar4/ wg2/ ar4-wg2·chaptcr5.pdf 
I 

®Physicians for 

Social Responsibility 

United States Affiliate of International Physicians for the Prevention of Nuclear War 

Health Implications of Global Warming: 

Impacts on Vulnerable Populations 

Global warming 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 heald1 and, ultimately, 

survivaL 

Tlus is one of several fact sheets produced by Physicians for ocial Responsibility d1at e.xamine recent 

scientific evidence of global wanning's impact on heald1. 

G lobal warming threatens to harm our heald1 and well-being- but it won't affect all of us egually. ome groups 

of people are more likely to be harmed d1an others. The most vulnerable tend to be d1e youngest and the oldest 

among us, the poor, and d1ose who are already sick. The clisproportionate and discriminatol)' impacts d1at 

climate change will have on vulnerable populations make climate change one of the most significant 

environmental justice issues of our time. 

Children are more vulnerable to global warming-induced dangers 

• Children and infants have greater sensitivity to certain e.'l:posures. Children are especially vulnerable tO 

air pollution. Their lungs are developing and growing; they breathe at a higher rate than adults, and d1ey 

spend more time outdoors engaging in vigorous physical activity. Children who participate in outdoor 

sports in communities with high ozone arc at increased risk of de,·eloping asd1ma. 

• Children are at 1-llgher ri k from extreme wead1er events such as hurricanes and floods. A sociated 

healm conseguences include injury, death, increases in infectious cliseases, and posttraumatic mental 

heald1 and behavior problems. ' Mental and emotional distress for children and adolescents after weather 

clisasters include posttraumatic stress clisordcr, aggressive behavior, sadness, and substance abuse." 

• CIUldren must depend on caregivers for their own preparedness and response. Experiences wid1 

Hurricane Katrina demonstrated d1e difficulty of tracking cl1ildren's whereabouts, keeping ciUldren and 

caregivers together, and meeting the special needs of hospitalized infants and children."' 

• These factors can also interact \vith poverty, race, and class to further increase risk."· 

• The probability that global warming will continue for decades (and possibly for centuries) raises issues of 

intergcnerational equity. If we fail to sufficiendy reduce greenhouse gases, we will impair d1e world our 

clllidren and grandchildren ,vill inherit. 111e more we postpone action, the more we increase the costs 

that future generations will have tO pay to cope with d1e consequences of global warming. ' 

Global warming threatens the elderly. The elderly are at particularly high risk of adverse heald1 effects 

from C.C\"treme heat exposure. 

• Advanced age represents one of d1e most significant risk factors for heat-related death in d1e 

• I, kk rh people ha'c diminished ability to regulate body temperature and to adapt physiologically to hear. 

] n addition, d1ey generally experience poor health. The elderly are also more likely to live alone and have 

reduced social contacts, which further increases their vulnerability." 

• This vuL1erable population will grow as the elderly become an increasingly large proportion of d1e U.S. 

population. 
Globa l warming impacts the poor disproportionately 

People in poor countries - and poor people in wealthy countries like our own - already suffer disproportionately 

from poor health and inadeguate health infrastructure. They are likely to be heavily impacted by global warming. 

• People without access to air conditioning are vulnerable ro excessive heat events, or heat waves. The 

urban poor are particularly vulnerable, due to the "urban heat island" phenomenon. City environments 

increase thermal-storage capacity and routinely experience ambient air temperatures from 2° - 10°F 

wanner than d1e surrounding rural and suburban areas.'""· ' "' ·n 1e urban heat island also absorbs heat 

during the daytime and radiates it out at night, raising nighttime minimum temperatures, which have 

been linked epidemiologically wiili ~"cess mortality.'"' 

• Excessive heat e..xposure affects people \vid1 certain pre-existing medical conditions, including 

cardiovascular disease, respiratory illnesses, and obesity. These conditions are already more prevalent 

among the poor, and the poor are less likely to be able to access and afford treatment. 

• Low-income populations are particularly vulnerable to floods and storm surges. They may live in highrisk areas such as flood plains and coastal zones, and they may have access to a limited public health 

infrastructure. Additionally, low-income populations are less likely to be covered by health insurance. ' 

• Poor and subsistence farmers, pastoralists and fisherfolk are vulnerable to storms and sea surges, the 

reduction in river flow due to melting icepacks, increased soil salinity, the impact of heat on crop yields 

and livestock, and drought. 

Climate change is likely to have severe effects on the poorest countries of the world. 

• The Intergovernmental Panel on Climate Change projects that global warming is likely to increase 

malnutrition, increase death, disease, and injmy from heat waves, floods, storms, fire, and drought, and 

expand the geographic range of malaria in the poor countries of the world."' 

• The leading heald1 risks in d1e poorest countries - malnutrition, inadeguate and unsafe water, poorgual.ity nutrients, and the burning o f low-guality fuels for housel1old use- are aU significandy sensitive 

to cl.ima te. "' 

• l n low latitudes and areas with marginal rainfall, local warming of even a degree or less may reduce 

substantially the yield of principal grain crops.xiu 

• The most severe health burdens from global warming are projected to have the greatest effect on 

countries that are least responsible for d1e emission of green house gases. Those emissions originate 

prinurily in weald1y, industrialized countries in temperate climates, whereas their negative health effects 

are predicted to concentrate in poor countries d1at typically already suffer the worst health ... ,. 

Environmental refugees 

• In addition to the poor, a new class of vulnerable population has emerged, spurred in part by global 

warming: environmental refugees. They are d1e people who are displaced from d1eir homes by such 

phenomena as rising sea levels, ~"pandiog deserts, and catastrophic weather events, flooding, etc. 

• It has been estimated that 25 million people have already been displaced for environmental reasons -

more than the approximately 21 million refugees that have fled war and persecution. 

• Like the poor, they too are at high risk for health: highly vulnerable to disease, at risk of spreading 

communicable diseases to new areas, vulnerable to shortages of often limited local resources, and subject 

to interruptions in supply chains and access to therapies for chronic medical condition. ''. 

• They are also subject to physical attack and emotional stress. 

' Greenough G, McGeehin M, Bernard SM, Tnanj J, Riad J, Engelberg D. The potential impacts of climate variability and change on health impacts of 

extTeme weather events in the United tates. Environ Health Perspect. 2001 ;109(suppl2): 191 - 198 

" Ahern M, Kovats RS, Wilkinson P, Few R, Matthies F. Global health impacts o f floods: epidemiologic evidence. Ep idemiol Rev. 2005;27:36--46 
'" Shea K, Conunittee on Environmental Health . "Global Climate Change and Children's Health.'' I' EDIATRICS Volume 120, Number 5, November 

2007. 

" Ebi, K. and Paulson J. "Climate Change and Children." Pediatr Clin N Am 54 (2007), 213-226. 

' Ebi, K. and Paulson J. ·'Climate Change and Children: · Pediatr Clin N Am 54 (2007), 213-226. 

" Luber G ct al. Climate Change and Extreme I lear Events." Am J Prcv Mcd 2008;35(5). August 2008. 

"' U.S. Environmental Protection Agency. Heat island effect. U.S. Enviroumeutal Protection Agency. 2005. \\ w w !>.~ en' h~<~tJ,Jand nllk' hun I. 

"" Vase R, Karl T, Easterling D, Williams C, Menne M. Climate (communication arising): impact of land-use change on climate. Nature 

2004;427:213- 4. 

'' U.S. Environmental Protection Agency. Excessive heat events guidebook. 2006. w" w x)M.cnv h~au,J.md ahmu ln~atguJddx>ok.hunl . 

• Haines A. ct aL "Climate change and human health: impacts, vulnerability, and mitigation. Lancet, Vol. 367 June 24, 2006. 

" lntergovemmental Panel on Climate Change. Climate change 2007: impacts, adaptation and vuln<-'fability. Contribution of Working Group II to the 

Fourth Assessment Report of the lntcrgovemmental Panel on Climate Change. Parry ML, Canziani OF, l'alutikof JP, van der Linden PJ, Hanson CE, 

eds. Cambridge UK: Cambridge University Press, 2007. 

'" St. Louis M. and Hess J. "Climate Change: Impacts on and Implications for Global Health." Am J Prev Med 2008;35(5). August 2008. 

'"' Intergovernmental Panel on Climate Change. Africa. ln: Parry ML, Canziani OF, PaJutikof JP, Vander Linden PJ, Hanson CE, eds. Climate 

Change 2007: Impacts, Adaptation and Vulncrnbility. Contribution of Working Group II to the Fourth Assessment Report of the lntergovcmmental 

Panel on Climate Change. Cambridge: Cambridge University Press, 2007:433-67. 

'"' St. Louis M. and Hess J. "CI.imate Change: Impacts on and Implications tor Global Health.'' Am J Prev Med 2008;35(5). August 2008. 

" t. Louis M. and Hess J. "Climate Change: Impacts on and Implications for Global Health.'' Am J Prev Med 2008;35(5). August 2008. 
.,Physicians for 

Social Responsibility 

United States Affiliate of International Physicians for the Prevention of Nuclear War 

Health Implications of Global Warming: 

Be Mindful of Mental Health 

Global warming is acknowledged by scientists around the world to be a reality and to be caused primarily by 

human activity, especially the burning o f fossil fuels. As the earth warms, the delicate balance of climate, 

weather events and life is disrupted. Consequences emerge that dueaten human health and, ultimately, survival. 

This is one of several fact sheets produced by Physicians for Social Responsibility that examine recent scientific 

evidence of global warming's impact on health. 

All of the specific health risks of global warming h ave associated mental health risks.' 

• E-J eat waves contribute to more alcohol and substance abuse.• 

• Just an increase of 1 degree F (0.5 C) seems to increase the risk of violenr behavior, especially in warm climates 

and the inner city. w 

• Food and water shortages threaten our basic sense of security and therefore are associated with increases in 

Posrtraumatic Stress Disorder and od1er mental health problems."· 

• The duonic drought in the outback of Australia is causing a new and dangerous variation of grief, solastalgia, 

which is a kind of distress about environmental losses in one's homeland.' 

• Perceptions o f poor air quality results in increased anxiety, especially in children, along with increased family 

violence." 

• Individual panic and group hysteria are risks of vector-borne or waterborne diseases. Recent harbingers of tlus 

possibility were seen in the SARS epidenuc.'·" 

• People 'vith scluzophrenia are of particular risk health-wise as iliey tend to ignore health risks and tend not to take 

necessary precautions. One study links increased air pollution, specifically from motor vehicles, with an increased 

risk for scllizopluenia. If duplicated, this would be an important finding with implications in regard to climate 

change.'"' 

• When viewed in the totality o f irs impacts, global warming creates the potential for large-scale human conflict, as a 

re ult o f displacement from climate-scarred lands and/ or disputes over increasingly scarce resources. 

The direct mental health risks of global warming have some unusual variations. 

• The menral health implications will vary with the type, suddenness, and scale o f climate change damage, as well as 

the social, historical, and cultural context . .All o f this will be filtered through the resilience of each individual.L' 

• 1 n certain isolated locales, the climate change of global warming can be desirous and beneficial to human life, at 

least temporarily. Tn these environments, mental wellbeing can improve. 
• Under-recognized background anxiety e.:cists in communities prone to undesired climate change and the associated 

na rural disasters.• 

• Children who feel they are growing up in a threatened future tend to be more troubled than rhe.ir parents or 

grandparents. A survey of Australian children indicated that a quarter of the children fear the world will come to 

an end before d1ey grow up." 

• lf the perception is that people are causing climate change, rather than it being mainly a natural phenomena, the 

risk of Po ttraumatic Stress Disorder will increase following climate-related disasters. \Vhenever there is a 

perception that more could have been done to avert, mitigate or respond to disasters, d1e mental health toll will be 

higher. Such was the case wid1 Hurricane Katrina.'" 

• People who have to move from climate-ravaged environments, such as flooded Bangladesh, have come to be 

known as "climate refugees." Stress Disorders are common in such situations and complicated by "culnual 

bereavement."'"' 

Resources for providing mental heaJthcare related to g lobal warming are inadequate ly developed 

• More people are likely to be vulnerable to the mental health implications of climate change than physical health 

impairments. Yet for general mental heald1care in most countries, insurance and resources are inadequate 

compared with general healthcare. 

• Disaster Response Teams are prepared for re ponding to acme disasters, but not to d1e more cluonic and slowly 

developing mental health problems related to global warming. 

• Even with adequate resources, people with mental illness often receive inadequate care.""' 

i Parker CL, hapiro SM. Climate Change: Your l-Ieald1 at Risk. Westport, Connecticut: Praeger, 2008. 

u Bulbena A, perry L, Cunillera]. "'Psychiatric effects of heat waves." Psychiatric Services 2006; 57 (1 0): 1519-1519. 

ill Rotton J, Cohen EG. "Global warming and U .. crime rates: r\n application of routine activity theory." Envir Beh 2003; 

25: 802-825. 

iv Lee Y, Lee MK, Chun KH, Lee HK, Yoon SJ. "Trauma experience of North Korean refugees in Chirla." AmJ 

Preventive Med 2001; 20(3): 225-229. 

,. Albrecht G, antore G-M, Connor L, Higginbotham , Freeman S, Kelly B, rain H, Tonoa A, Pollard G." olastalgia: 

d1e distress caused by environmental change." Australian Psychiatry 2007; 15(1): 595-598. 

,-i Ro tton J, Frey J. "Air pollution, weather, and violent crimes. Concomitant time-series analysi of archival data." J Pers & 

oc Psychology 1985; 49(5): 1207-1 220. 

vii Lee AM, '\' ong] G\ ' S, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. "Stress and psychological distress among 

AR survivors 1 year after the outbreak." Canadian J Psychiatry 2007; 52(4): 233-240. 

viii Pedersen, C. B., Raaschou-Nielsen, 0., Herre~ 0 ., & Mortensen, P. B. (2004). Air pollution from traffic and 

schizophrenia risk. Schi;:_ophrenia ReseardJ. 66, 83-85 

ix Fritze JG, Blashki GA, BurkeS, Wiseman J. " fl ope, despair and transformation: Climate change and the promotion of 

mental health and well-being." Intern J Ment Health ystems 2008; www.ijmhs.com/ content/2/1 / 13 

x Reser J. "The e-xperience of namraluncertainly. In International Perspectives on Natural Disasters: Occurrence, 

migration, and consequences. Edited by: toltman JP, Lidstone J, DeChano LM. D ordecht: Kluwer Academic; 2004; 369-

384. 

xi Tucci J, 1itchc11 J, Goddard C. Children's Fears, Hopes and Heroes: Modern Childhood in Australia. Melbourne: 

Australian Childhood Foundation; 2007. 

xii Ozer E, Besr , Lipsey T, '\ eiss D . "Predictors o f post-trawn atic stress disorder and symptoms in adults: a metaanalysis." Psycho) Bulletin 2003; 129: 52-73. 

xiii Porter M, l laslam . "Predisplacemenr and posrdisplacemenr factors associated with mental health of refugees and 

internally di placed person : a meta-analysis. JAlvlA 2005; 294(5): 602-612. 

xiv Jlv1itchell AJ, Malone D , Doebbeling CC. "Quality of medical care for people with and without comorbid mental illness 

and ubstance misuse: systematic re,·iew of comparative smdies." British J Psychiatry 2009; 194: 49'1-499.