## 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 surviva l. 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, surviva l. This makes the EPA's proposed carbon pollution rule for e l ectric 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. Long e r-te rm , the chance of limiting the rise in global temperatures to 2 degrees Celsius this century i s getting slimmer and slimmer, according to the International Energy Agency . Significantly, the lEA's chief economist recently attributed that pessimistic assessme nt to the continuing construction of power plants. ("What I see now with existing investments for plants und er constr u ction ... [is] we are see in g the door for a 2 degree Celsius target abo ut 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 fro m 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 Deadl y Effects

G lobal warming i s acknowledged b y scienti sts around the world to be a reality and to be caused primarily by human activity, especia ll y the burnin g of fo ss il fuel s. As th e eart h warm s, th e delicate balance of climate , weather events and life i s disrupted. Co n se quence s emerge that threaten human health and, ultimatel y, s urvival. This is o ne o f se,·e ral fact s heets produced b y P h ysicians for Social Re s p o n s ibility that e:'i:a.mine recent scie ntific ev idence of g lobal wanning 's impact o n health.



### G l o bal warming i s likely t o increase the frequenc y of "extrem e heat events " o r heat waves. • Fo r the twenty-first ce ont ry, the I P CC projects with " high confidence" that e..'i:treme heat events 

### will inte n s i fy in m ag nitud e an d durati o n over portio n s of the U. . where they alread y occ ur.• • W/e cannot attribute a specific h ea r wave to g lobal warming; h owever, the effect of g lobal warming on the probability of occurrence o f a hear wave can be determined . ln the case of the E ur o pean heat wave of 2003 , a group of s cienti s t s p u bli s hing in t h e jo urnal alure estimated wi th a grea ter than 90 % confidence l evel that human influenc e on climate more t h an doubled the probability of its occurre nce ." 

### He a t-related illne sses a re se ri o u s a nd can l ead to death. • Il u. · mo s t com m o n heat

-related illne ss is heat exh austion, w h ose symp tom s include intense thir s t , heavy sweating, arL'i:iery , dizzine ss, faintin g, nau s ea or vomitin g , and h eadach e . • Heat ex h austio n ma y p rogress to h ear s tr o ke , w hich i s a severe illne ss. I t s clinical d efinitio n includ es a core body temperature of 105°F or m ore, accompanied b y hot, dry s kin and central n ervous sys tem ab n or mali tie s s uch a s delirium , co nvul sions, o r coma. • Mortality from hear waves i s ofte n related to ca rdi ovascular, cere brovascul ar , a nd re s piratory cau ses, es p ecially preexi sting illn esses. 

### • Air pollution concentrations may rise durin g b eat waves , especially as people rum o n air conditioning, thu s increa sin g th eir u se o f electricity (w hic h if ge n erated b y burnin g coal i s a major so ur ce of polluti o n ) . Thi s polluti o n ma y exacerbate preexisting co n ditions s uch as angina and asthma and ma y lead to in crea se d death rates."' 

### Ext reme h ea t events a re alrea d y a s ignificant publi c health problem in 

### the U . S. • l n fact, C.'(tre me h e ar events are re spo n s ib l e for more d ea th s annually than h urricane s, li g htning, t o rnadoe s, fl oo d s, a nd eart hquak es combined." • T h e health impact o f extre m e heat events 

### will likel y b e exacerbated by t h e sy nerg i s tic ef f ects of a warming climate , urbanization, and an agin g populati o n .'

### H ea t w av e s a r e alr ea d y in c r eas in g. • A ro u g hl y 20 % overall in crease i n t h e numb er of h ea t wave s- a "s ignifi ca n t " upward trend

-- ha s bee n o b served for th e ea s tern and we s ter n U .. f o r th e p eriod 1 94 9 to 1 995. '"' • In the European b eat wave of 2003 , a n es tim a t e d 2 2,000 peo pl e di ed acros s B ritain, France, Ital y, the e th erland s, P o rtu g al an d S p ai n .'"'' Ot h er m o rtali ty estimates run as hi gh as 35 ,000. vrn • In P ari s, s ustained extr eme hi g h tem p er a tures ( includi ng h ig h nig h t-ti m e minimu m tem p er anu:es) , uni que in th e reco rd e d h.is tmy o f P ari s, toge th er wi th h o u si n g d esi gn e d fo r coo ler surruners, cause d a major p u b li c h e al th c ri si s. D eat h s in c r e a sed b y 1 40 % . " 

### T h e eld e rly a r e a t p a rticu l a rl y hi g h r is k . • A d va n ced ag e repre s e n ts one of the m os t signific a nt ri s k factor s f o r heat-rela ted death in the U.S. • r : ldcrh 

### pwpk h : \\ c dim ini s h ed abili ty to r egu la te b ody te m pera ture a n d tO ada p t p h ys iologicall y t o heat . In a ddi tion , th e y gene r a lly ex p erie n ce p oo r h eal th . T h e eld erly are al so more likel y to live al o n e a n d h ave re du ce d so cial co nt acts, w hi c h furth er in cre a s e s th e ir vu ln e r abili ty. ' • Thi s vu ln era ble p o pul a ti o n w ill grow as th e eld erly b eco m e an increasing l y large p ropo rti o n of the U. po pul atio n . 

### Oth e r p o pul a ti o n s a re a l so hi g h ly vuln e r a bl e t o e xtre m e h ea t exp os u re. • P eop le wi th o ut acce ss to air con di tio ning are a vulnera bl e popula ti o n . The urba n p oor are par ti cularly vu l n erab le , d u e to th e " urban h ear i s lan d" ph e n ome n o n . C i ty enviro n ments h o ld more h ear an d routinel y exp eri e n ce a mbie nt air tempera ture s f r om 2 °- 10°F war mer t h an th e s urro u n d ing r u ral a nd s ub urba n areas . " '· '" ' J h e urba n h eat is l an d a l s o abso r bs h e at during th e da yti me a nd r adi ates i t ou t a t n igh t, rai s in g nig h ttime minimum te m peratures , w hich ha s b ee n linke d epid e m iol ogica lly w id1 excess m orta li ty. xu• • P eop l e wi th certain p r e-existi n g me di cal co n ditio n s are vulner ab l e . T he s e con d itio n s incl ud e cardio v a sc ular di s ea s e , re s p iratory illn esses , obes i ty, neuro logic o r p syc hi atric di s ea e. • Al s o vuln era bl e are peo ple receiving medica tion s th at int er f ere wi th s alt a n d water balance ( e.g., d iureti cs, anticl 10 l ergic ag e n ts , and tranquilizer s th at im p air swe atin g)."' 

### Wildfir es a r e a n in c rea s ing threa t. • Hig h er te mp er atu r e s corn bin ed wi th extend e d perio d s of drough t a nd d ecrea se d so il m o i s ture rai ses th e ri s k of w ild ftres and t h e de ath a n d d am age d1 e y in fli c t. 1 n New Mexico, the w il dfire seaso n ha s grow n b y 7 8 d ays d uring ilie p a s t d1ree d eca d e s . ,., • Another hea ld1

- relared imp act fro m mo re f reque nt an d larger fire s: th e increa e in fine particulate air po ll utio n , bo d1 in the immediate vicinity of fire s and in are a s d own wind. "' • Fore s t fire s create m ore g l obal waru ung . Tree s norm all y S etTe a s a reserve o r "sink" of carbon, ab so r bing an d h o lding ca rb o n 

### in pl ace. Whe n d 1ey bum, in stea d of acting a s carbon s i nk s, tree s re lease t h eir carb o n t o th e atmo s p h e r e , increa s in g th e green h o u se e ff ec t . ., ." 

### Gl o b a l wa rmin g will w ors e n a ir qu ali ty and th e ri s k o f r es pira tory di sease . • T h e fo rm ation of o zo n e is know n to increa s e w id 1 increa s ing tem p erature . A po s itive a ss ociation ha s been f o un d be t wee n te m perature s a b ove 90 °F a nd gro un d

- level ozone pro d uctio n . Thi s is tru e even without inc rea ses in th e concentration o f vo latile orga nic co mp o un d s a n d nitrogen o xides (ozone's " precursor" poll u t ants). • In crea s in g evide n ce s u gge s ts d1a t ozo n e and h i g h tem p era tu r e af f ec t m ortali ty sy n ergistic all y. ..," • R esearc h s uggests tha t ozo n e co n ce n tratio n s in d 1e U.S. m a y in crease b etween 5-10 p er cent over d 1e n ext 50 y

ear s p urel y a s a re s ul t of climate c h an ge. This i s projecte d to be tru e ev e n if an d 1ropog enic precur sor emi ss io ns an d g lobal bac k gro un d concentra ti o n s are held co n s tant. , ; , • A new s tu d y (Ma rc h 2009) indicate s d1at ozo n e e..xpos ure i s a sso ciated with d1e ri sk of death from respiratory cau ses, and that l ong- term, low

- l e v e l exposure can be l e th al. "

### •

' l ntcrgmcmmcntal Panel on Climate Change. Clinme chan).,>c 21Xl7 : impac t s, adaptati on and \'Uinerability . In: Parr y l\ 11 ., Canz oam 0 1 ·. Paluukof JP . mn**d~r** I .Jndcn PJ. IIanson CE, e ds. Con tnbution of\Vork.ong Group II lO the l·ounh Assessment Repon of the l ntergo, · cmmcntal Panel on C hmal e Change. C Jmbrodgc : C an 1 bndgc UruYcrsiry**rc~s.** 2<Xl7:6 1 7-52. Accessed onlonc at http :/ / www.ipcc.ch / ipccrcpons / ar4-wg2.htm • Stoll P t \. Stone [) , \,and Allen l\ I R. !I uman Conrribuuon to the Huropcan II cat \Vme of 2003. No111rr ( 2()()4); 4 32: 6W-6 1-I .

w**ll aonc~**  A. cl al . "Climate cha n ge and human health: impacts, , · ulncrabiloty. and miti gation. Lancet, Vol. 367 June 2 4 , 2006 " Luber(; ct al. Climate Change and Extreme Il eal E,·enrs. " 1 \ m J Pre\ · t \l cd 2008;35(5 ) . Augus t 2008 . ' Luber G ct al. C l im a te Change and Ex rrc m c l lcat l>\ents." Am J Pre\' 1\ k- d 2008;35(5) . t \ ugu sr 2008. "G a f fc n DJ.**o~s** R .**ncrca~cd** su m merti m e hea t st ress on the U.S. arure 1998;396:529-30 . •• Kosatsky 'f' . The 2003 European II em Wa, ·es. L:.11ro .f11mil l. (

2005 ); I 0: 14 8

- 149 .**·~** Epstcon 1' . C l imate C h ange and ll uman ll ealth. N,..**b( ·).**  Mtd. (2005); 353 : 1433

- 1436. " I lame s \ . ct al. "Climate change and human healt h : ompacts, \'Ui neraboloty, and nulij,>ntion. l .ancct, Vol. 367 June 24, 2006 • Luber G ct al. C hmatc C han ge and Extreme !feat r.;, ·c nr s." \ on J Pre' l\lcd 2008;35 (5) . t\ugust 2 008 . "U.S. Ennronmcntal ProtL-ction , \gency . I t eat osland effect. U.S. l>nnronmental Protection \gency. 20115. •• Vosc R. Karl 'f' . Easterlin g D, Williams C, l\ l cnne l\ 1. C lima t e (

commumcauon ansong) : ornpact of land-usc change on domatc . arurc 2(M) -1 ; 42 7: 2 1 3- -1 .

.,. U.S. Em ironmenral Protection Agency . ExccSSI\ " C heat e\' Cnts !,•uodcbook. 2006 . "' Luber G ct al. C limate C hange and Extreme I l ear t ·:, ·ents." . \ m J Pre' Mcd 2008;35 (5) . August2008. " 1\ l cCall) 1\1. '"J'est.imony of Michael McC ally. MD, PhD, B efore the Se n at e r; n vi r onmcnr and Pub l ic Works Comnuncc." Octobe r 23 ,2007. "' Kinney P . "Cli m ate C hange, A i r Quality, and ! Iuman ll ca lth." Am 

### J l' rcv I\f ed 2008; 35(5 ). August 2008 .

"'' h eld C: American Association for the Ad\'anccme n t of&ocncc. "Ominous R eport on C l imate ( ; c nera tes Worldw i de C ove rage from AAA, Annual Mceung. " l 'c brua f) 15,2009. At --.L...'.!. ..'l"'- ""'**11~1** I 11 I• J 11 1! "'" Lube r G e t a l. C l imat e Change and Extreme I lent Events ." Am J Pre' !\t ed 2008;35 (5) . August 2008 . "' Kinne y P . " C I1matc C hange, Air Qualiry, and !I u m an ll ealth. " \ m J Pre' ' I\ t ed 2(108; 35 (5 ). August 2008. " Jcrret l\ 1. ct al . "l.ong-Tenn Ozone Exposure and 1\ l orrahty." C\\ England J ournal of 1\l edjcine , 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 warmin g i s acknowledged b y s cienti s t s around the world to be a reali ty and to be caused primarily b y htm1an ac ti vity, es peciall y th e burni n g o f fossil fuel s. As th e eart h warms, the d e li cate balan ce of climate, weather events a nd lif e i s cli s rupted . Co n seg u e n ce s e m erge t h at threaten human h e al th a nd , ultimately, s urvival This i s o ne o f s everal fact shee t s produced b y Ph ys icians f o r Social Re s p o n s i bility tha t**~'{amine** rec e nt s cientific evi d e n ce of g l o bal warming' s impact o n health . 

## Vector-borne diseases V ec tors c a rry a nd tr a nsmit di sease • Vec to r s ar e in sects ( m os gui toes, ticks , fl eas, black fli es and s andilie s) tha t ca rry infectious agent s uch a s pro tozoa, bacteria and viru es. • The y carry and tran s mit num erous cli seas e s to human s: para s itic vector-borne di seases s uch a s m alaria, l eis hmaniasis, a nd C ha gas cli s ea e; arboviral cli sea ses s uch a s d engue f ever, yellow fever, West il e Virus, Rift Vall ey fe ve r , and tic kb o rn e encep haliti s; and ba cterial and rickett s ial cli seases s u ch as L yme b o rr e li os i s, tularemia and pl ague. 

### Gl o b a l w a rming impact s vec t o r-h o me disease s • Vector organis m s and th e inf ectio u s a g en ts th ey c arry are col d

- b looded, so changes 

### in temperature 

### will affect th eir development, reproduction , beha v ior a nd s urvi v al rat es. • C han ging tem p erature and preci pitatio n may s hift the geog raphic ran ge 

### in which the y can live and th e sea so n al period o f cli sease risk . • Te mp erature a l so can affect p ath ogen developm e nt within vectors, precip itation ca n influence d1e availability of breeding s ite s, and clim atic variables ca n affect the clistribution and abundance of their vertebr ate h os t s peci es.•·" Glo b a l w a rmin g a nd mosquitoes : Mo s guitoe s are hig h l y se n s itive to temperarure. H ig h er temperature s: • b oost th eir reproductive rate, l e ngt h e n t h eir bree ding sea so n , and ma ke them bite m o r e freguentl y; • s h o rten d1e time it take s f or th e pathogen s they carry to mature to a n infectious state; • can expand the mo s guitoe s' ran ge to h igh er el evatio n s and more n o rth ern lati rud es, p otentia lly putting previo u s l y un exposed p o pulati o n s at ri s k. Sro rm s, h urricane s and flood s ca n contribute to th e s pread o f malar ia, a s they l eave b ehin d vector bree din g site s. Th e thr ea t t o he a lth : Mo s guit oes can carry malaria and dengue fe ver, amo n g other cli se ase s. • Malaria : o rne 3 50 to 500 millio n ca ses of ma laria occur annuall y, r es ultin g 

### in the deatl1 s of a n estimate d o n e to three million pe o ple , mos tl y yo un g children . \' o rldwide , malaria h a th e larges t disease burden (illne sse , death s, financial costs and o ther .inclicators) o f any ve c to r-borne cli sease . "'

# . .

• Dengue fever: It i s estimated that there are over 

### 100 million case s of dengue w o rldwide each y ear. The ca s e-fa talit y rate of its more s eriou s form , dengue h aemorrhagic fever (DHF) , i s ab o ut 5 % , mo s tl y among children and y oun g adults." The dis ease is now e nd em i c in man y countrie s o f tl1e A merica s; there i s a s mall risk for dengue outbreak s in tl1e continental Unite d State s., . 

### Global wa rming and ticks • Tick s maintain multipl e and divers e di s ea s e agent s (including b ac teria , v iru s e s, and para s i te s ) and s en 7 e a s bridgin g vector s between animal re s ervoir s of tl1 e disea s e and hu ma n s. • C h an ging weather patterns as socia ted wiili climate c hange h ave induced s h ift s in tl1e di s trib ution of vector ticks carrying Lym e di sease . Modeling indicate s iliat 

### in ilie future , ilie tick that carrie s L y me disea s e will expand into Ca n ada. n 

### Global warming and fleas • F l ea s are best known as vector s of tl1 e cau s ative agent of plague. Plague ha s ca u sed millions of human death s, e s peciall y dmi.og ilie Bl ack Deaili of t:l1e Middle Ages. • Pla gue i s s till with us, notably in New Me.xi co, where its preva l ence s eem s to c o rrelate wiili t:l1e tinling and amount of precipitation. n•.nu • Recentl y, s tudie s of plague tran s mi ss ion in ilie 

### U.S . fou nd iliat ilie pattern of human plague ca s e s ha s s hifted n o rthward a s temperature s have war m ed. It is predicted that s ome n or tl1 ward expan s ion of ilie di s ea s e coul d occur from ew Me.xico into'\ yoming and l daho. c< 

## Water-borne diseases Water-home inf ec tious di seases worsen with gl o bal warming • Infectiou s diarr h ea i s one of the m o s t preva l e n t of t:l1e world ' s water -b o rn e disea s es. It i s u s ually a sy mptom of gastro inte s tinal infection , w hic h can be cau s ed by a vari e ty of bacterial , viral and para s iti c organi s m s. I nfection i s s pread tluough cont.aminated food o r drinking

- water, or fr o m pers on to per s o n a s a re s ult of poor h y gie n e. • evere diarrhea lead s to fluid lo ss and m a y be life-tlueatening, particularl y in young children and peo ple wh o are malnou.rished or h ave impaired immunity . Globall y, it is t h e s econd

- l eading cau s e of mortality in y o un g children. x • Thi s i s o nly ex'Pected to wors en w iili climate change , driven b y factor s including increa s ed temperature s, fl o oding , and other c han ge s in rh e water c ycle ." • Cho lera i s a diarrhea l disease cau s ed b y bacteria tl1at o ccu.r naturall y in river s, e s tuarie s, and coa t al waters. cienrists have ob s erved a r e latio n s hip between ilie increa s e in s ea- s u.rface temperature a n d ilie on s et of c h olera epidemic s . S trong El Nino c y cle s and ot:l1er clin1.ate v ariable s provide a predictive capacity fo r c h o l era ep idemic s."' 

### Increased ri s k of water-borne di seases in the U.S. • l n countri e s witl1 reliable so urce s of potab l e water , conta minati on of recreati o na l water s fr o m extreme weather event s remain s a s i g nific ant mean s of di s ease transmissio n . E a r, n os e , and tluoat , re s piratory , and g a s trointe s tinal illne s se s are co mmonl y a sso ciated witl1 recreational s wimrning 

### in fre s h an d o cea ni c water s. • Oilier, p o tentiall y more s evere waterborne di s ea s e s are also transmirted in recreational wate rs , al tl1o ugh wiili le ss frequenc y, such as hepatitis , gia.rdia s i , and cryptosporidio s i s . " " • A s tud y of water contaminati o n of tl1e Great L ake s projected mat a s e.xtremel y h ea vy precipitation event s become stronger , tl1ere 

### will be a r e s ulting grea ter potencial for fl o odin g and ewer o verflow , with a corre s p o nding greater potential for waterborne di s ea s e s. I t s tated , " The Grear Lake s, which s erve a s a drinking water s ou.rce fo r more tl1an 

### 40 million peop l e , are particularly s u s ceptible to fecal pollution and can become re s ervoir s for waterborne di ease s." " '• (;age K. er al. "Climate and Vccrorbomc**Disca~c s"**  \m 

### J Prcv Mcd 200 8; 35 ( 5). • l'at'l. ct al.. lmpacr of regional clim\ ' ate chan ge on human h e alth . ' aturc. \'ol438. 17 1\:ovLmbe r 2005.

m S r .**I..oui ~** **~I.** and I l ess J . "Climate C hange: Impacts on and Implication s for Global! Jealtb ." . \m 

### J Prev**~led** 2008:35 ( 5 ) . 1 \ugusr 2008. " C D C. " Deng u e Fever Fact Sheet." C enters for Di s<.-ase C ontrol and Prev enti o n. htrp :l 

### I www .c dc .gov

### I ncid ocl l dvbid l dcngu e l #currcn t ' C D C. " Den g u e Fact Sheer." C cmers for**Di sc** **~c** C ontrol and Pr eve nti o n . 

## m l I• ,,, nud , , J .hbtd ltn II t tn J), 11 'I" I**p~** " Brown s tein JS , llolford TR , Fish D. Effec t of climat e cha n ge o n L y me di sease risk in North America.**~c ol**  . lcalth 2005:2:38-46. '" P ann e nt cr RR , Yadav EP, Pam1 c nrcr Ci\, E ttcsrad 1' , Gage Kl. . In c idenc e of plagu e associated with increased wint e r -s prin g precipitation in New**exico.** J \mj Trop Med Il yg 1 999:6 1:814 -2 1.

" "**scorc** RE , Bi gger s taff BJ , Brown TL , Fulgh am RE , R eynold s PJ ,**ngclthaler** Dl\1 , e r al. 1\lodcling relationships between climate and the frcc.1uenc y of hum an plagu e cases in rh c s ourhwe s r e m United Star es, 1960--1997. , \m 

### J Trop ]\ J ed lly g 2002;66: 18 6-96. akazawa Y, Williams R. Peterso n t\T, 1\ lead P , S raple s E, Gage KL . C lim at e change effects on plag u e and tularemia in the U nit ed Sta res . \'ector Borne Z oonotic Dis 2007;7:529-10. • S hea K and Cu mmirree on Environmcnrall lealrh. " Global C lim ate C han ge and Ch il dren's llcaltb. " P EDIA riU CS \ 'o lum c 120 . 1'\ umbcr 5, OVL'!nbcr 2007.

"' S r . I .<>t n s**~I.** and I les s 

### J. "C limate C hange: Imp acts on and Implication s for G loball lealth ." i \m J Prev i\ led 2008:35 ( 5 ) . , \ugusr 2008.

'"'Colwell R. "G lobal C lim ate and J Icalth : Predicting Inf ec ti ous Di sease Outbn.-a.ks ." Innova ti o n s. Summer 2006, Vol. I , No.3, Pages 1 9-23.**\cces~cd** o nlin e ar hHJ. "1\ 1 . u IIJ ·'"I' unql 1 1 .I •I 1 II 11 I ( Jl _**~** 1 .•**~** . 1

. < "'k" 1 I "" Patz 

### J c r al. "(] imare C hange and Warcrbom c Disea se Risk in th e Grea r I .akcs Region of the U . S." Am 

### J Prc v M c d 2008;35 ( 5 ) . i\ug u s r 2008.

' "' Par J: j cr al . "Cl im ate C hange and Wa terborn e Di sea se Risk in rhc G r e ar Lak es Region of th e U.S." t\mj Prev**d** 2008;35 ( 5) . i \u g ust 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 acknow l edged b y scienti s ts arou nd the world to be a reality and to be caused primarily b y human activity , e s peciall y the burning o f fo ss il fuel s. As the earth warms, the delicate balance of climate , weather events and lif e is di s rupted. Con s eq u ence s emerge that threaten human health and, ultimately, s mvival . This i s one of s everal fact s heet s produced by Ph ys ician s for Social Re s pon s ibility that examine recent scie ntifi c evidence of g l o bal war ming's impact o n h ea ld1 . This fact sheet draw s prim arily on d1e In tergovernmental Panel o n Climate C han ge (IP C C)'s 4th Asse s sment R e p o rt , Working G roup 22. • Facts an d citati o n s are from that s ource unles s od 1 erwi se indicated.



### W a rming will 

### affect food production. • G l obal warming 

### will affect crop y ield . Effects will be rni..xed , based on l o cation a nd degree of warming . • In l ow - latitude reg1on s and s ea s onall y dry area s , even "slight'' warming i s predicted to d ecrease y ield s . " • The reg1on s likel y to face the bigge t challe n ge s 

### in food s ecurity are Africa , particularly s u b

- Saharan Africa, and A sia, particularl y so uth Asia . • Crop y ield s could decrease sub s ta n tially acros s d1e 1\frican continent because of increa s ed frequenc y of drou g ht. Com production could e nd in so me area s. Live s tock production could suffer a s ran g eland deteriorated or turned into unproductive s h rub land and de s ert. • Rice production in As ia co uld d ecline . H owever , wheat prod u c ti o n in China and India 

### will increa s e 

### if the C02 ' fertili z atio n effect' take s effect. • In mid - to high-latitude reg1on s (s uch a s the United S tates ) , iri s predicted that "moderate " warming w ill benefit crop and pasture y iel

d s . w • H owever, once warming rise s more th an 3° C (5.4° F) , it \vill have increa s ing l y n egative i mp ac t s i n aU reg1on s, including North America . • More even than c h ange s in temperature and precipitation , food a nd fore s try production

-- and food insecuri ty-- are projected ro be affected by d1e increa s ed frequency and s everity of extreme c limate events. 

### Secon d ary impact s and multiple va ri a bles can increas e risk and unpredictable o ut co m es. • Climat e c h ange increa s e s the ri s k s of s econdary impacts s uch a s fires a nd outbreak s of pe s ts and pailiogen s, wid1 negative co n s equen ce s for food , fiber and forestry. • Multip le s tre ss or s (s uch a s secon d ary impact s) increa s e overa ll se n siti vity to climate c han g e and reduce d1e re s ilienc y of d1e agricul tural sector. • Climate chan g e s cenario s that incorp o rate s everal varia bl e s ( for example , increased frequenc y o f heat srre s , plu s droughts , p lu s flooding events) pro ject greater reduction s in crop y ields and li ve s tock productivity. They a ls o indicate "d1e pos s ibilit y for surpri s e s,"" · that i s, outcomes d1at ma y be unfore s ee n o r bard to predict .

# . "

Sm a ll a nd s ub s i s te n c e pr o du c ers -mu c h o f th e d ev elo pin g w o rld 's popul a ti o n - a re vu ln era bl e. • ubsistence farmer s and sma ll-s cale agriculrural pr o ducers , pa s torali sts and fi s herf o lk will be particularl y vuh1erable to climate c hange's effects. l11e IP CC predic t s that they will s uffer "co mp l ex , localise d impacts of c limate c h an ge." • On a lon g er time frame , s mall p rod u cer s w ill have to contend wit h d.i.mini s h e d ri ve r fl ows, as hig h

- m o un tain s n ow- pack s hrink s; s ea lev el ri se, w hic h ma y increa se so il s alini ty and ev entuall y fl oo d l ow- l yin g coas tal land; an d a loss o f agriculrurallab o r a s climar.e

-respon s ive di seases s u c h a s ma laria bec o m e m ore pre va l ent. • S mall producers t y

p icall y p rod uc e relatively littl e s urp l u s and live near th e e d ge of s urvival . The narrow m argin in their food production m eans the y are con s trained i.n their ability to ex periment with new crops and te c hnique s, and thu s le ss ab l e to adapt to climate cha n ge. Wea lth y co un trie s a r e vuln e r a bl e too. • The 2003 heat wave in E urope wa s implicat e d in the death s o f ten s o f d1 ous and s of people . Tt al so co rrelate d with n o table dr ops in crop y ield s:' • l n F rance, cora crop and fora ge productio n fell b y 30% compared to 2002. Fruit harve s t s fell b y 25 % . • ] n I tal y, a rec o rd drop o f 36 % occurre d f o r co ra grow n in the Po v alley. • Co rn, the mo s t imp ortant cr o p in th e U . S., is vulnerable to g l obal w armin g. n • Temperamre s above 7 2 ° F s h o rten corn 's repro du c tive lifecycl e, givin g th e grain le ss tim e to grow and d ecreas ing yield . A s tud y b y t h e L aw re n ce Berke ley Na ti o n al L ab ora tory and the Car ne gie In sti tution estima te s that climate ch an ges sinc e 1981 ha ve cost corn producers world-wid e about

1 .2 billi o n per y ear. • Weed s , p es t s an d so me l ea f a nd r oo t pad10ge n s ma y p roliferate m ore s ucce ss full y and expand d1eir range s in re s pon se to increa ses in temperature and humidi ty. For exampl e , c o rn farmer s in the warmer so uthern parts of the U.S. appl y pe s ticid es m o re fr e qu e ndy d1an d o farmer s in n o r th ern s tate s. Tf g l o bal warming r es ult s 

### i.n the northward e.xpan si o n o f p est range s , farmer s in n ort h ern s tare s m ay have to s pra y m o re , re sulting in grea ter financial and e nvi.r o runental c osts. • Gro und -level ozo ne h as "s ignificant advers e ef fect s" o n crop y ield s, pa s ture and f o re s t growth. Ozone , whicb f orms fr o m certain p o lluta nts in the presenc e of h ea t, i s anticipated to ri se due to g lo bal war min g. • S ntdie s s h ow that ozo n e is toxic to soy bean s, wheat, p ean uts a nd cotton .'"'' • Rural area s in the Midwe s t an d ea s tern U.S. alread y h ave hig h ozo ne l evel s . Incr eases in rural o zo n e levels co uld af fect the profitabilit y and co mp e titi vene ss o f imp o rtant ca s h crop s.'"' • E l evated C02 l ev

el s may ameliorate the negative impa cts from oz one , but not s ufficientl y. T h e TP CC pro j ects tl1at incre as in g ozo n e conce n trati o n s will have a n ega tive impact on plant pro ducti on, " with or wid10ut C02 incre a ses , with o r with ou t clim ate c h a nge."L '

• Ea ste rlmg , W . E . . P . K A gga rwal , P. Bauma. K . M . Brande r, L. Erda , S.J\ 1. I l owd e n . A. Kinle nko, J . Mono n . J .- F . So u ss ana, J . Schm1dhuber a nd F . . Tubidlo , 2007: Food , librc and f o r

e s t pmduct s. Oi m

alr (b an

fj 2007 : lmpatt.f, Adapt a tio

n and I u lnr m b

i fltJ' C11 n t ri

bution**o( ll'** **"o rk.in** **,~** Grou p II to 1 /x 1-ou r tb Assur m

tn l Rrpo rt of t /If! lni UllfJ

i f nlm tll

tal Pa m/o n Oima le 0k ll (f!!, i\ I. L . Parry , O. F . Ca nzi : mi,J.P . l'alutikof , I' .

J . , -an dc r Linden and C. E . II an son , J ,:d s., Cambndge Uni, ·crsi t y Pre ss , C ambcid !,>C, UK, 27 3

- 3 1 3 . \cc cssed o nune at http :/ / www . ipcc . ch / pd f/assess mcnt- r eron / ar4 / " g 2/ ar4-wg2 -c haptc r5 . pdf • I

bid . m I

b id . " lb1d . • T c llc e n - L awmn , T . I Io tt er Fie ld s, L owe r Yield s: I l ow Glo b al Wannin g Could ll un . \meric a 's Faon s.(2009) Em · ironment A me r i ca R esea rch & Po licy Ce nte r . \c cesscd o nhne a t http :/ / v. · ww .e m .r o nme m amt.'ri ca.org/u plo ad s/ 1 IG/U I. / II G U L G p l l8lqB8pW07M41 xn , \fh o tfie l d s_ l owy i e ld s. pdf . n fbid .**bid .**  •w Ib i d . u Ea s r c rlong . W . E ., P . K. A gga rw al. P . [13 tim a, K.J\1. Brand e r , L E rd a,**1.** l lo\\dc n , . \ . Kinlc nko ,J. M o n o n.J .- F . So u ss ana , J. Schmidhuber an d F . '. T u bic llo. 2007: Food, librc and fo re s t p ro du c t s. Oi malt (.A m § 200

- : Impar t s. A t kif> l

a lio n (}J/d I**m~bilif).** Ctlntri lmtion ofll''o r k.ing Gro up /I to Ilit I Dll rf

iJ AsstS.fllltnl R rJW rf of 1/it ln lt'l!,Oir mm Mial Pan rl on Cli ma

tt CIJ< II {f!! · M .l .. Parry , 0 . 1 •. C a nziani , J . P . l'alu ti k of

, P.J. \ 'a n d c r L ind e n a nd C . l ,. I I an son , E ds.,**ambrid~: c**  Uni, ·e r si ty Press, C ambri d g

e , UK , 273

- 313 . Ac ces sed o nl i ne at h up :/ / www.ipc c .c h / pdf /ass e ss mc nt - r c pon /ar4 / wg2 / ar 4-w g 2 · c ha ptcr 5.pd fI 

# ® Physicians for Social Responsibility United States Affil i ate of International Physicians for the Prevention of Nuclear War 

# Health Implications of Global Warming: Impacts on Vulnerable Populations

G l obal warming i s acknowledged by sc i e nti s ts around th e wor ld to be a reality and to be caused primarily b y human activity , especially the b urning of fo s sil fue l s . As th e earth warms, the d elica t e balance of c limate, weather events a nd life i s disrupted . Consequences emerge that threaten hum an h eal d1 and , ultimatel y, s urvivaL Tlus i s one of s everal fact sheets produced b y Ph ys ician s for ocia l Re sponsibility d1at e.xamine recent s cientific evidence of global wanning' s impact on heald1 .
G l obal warming t hreat e n s to harm our h eald1 an d well

-being- but it wo n 't affect all of us e gu a ll y. ome gro up s of people are more likel y to be harmed d1an others . The mo s t vulnera ble tend to b e d1e younge s t and the o l dest among u s, th e poor , and d1o s e who are already sic k . The cli s proportionate and di s criminatol)' impacts d1at climate c h ange will have o n vulnerab l e p o pulati on s m ake climate change one of the most s ig nificant enviro nm ental ju s tice iss ue s of our time. 

### Children a r e more vulnerab le to g lobal warming-induced dangers

• C hildren and infants have greater s en s itivi ty to certain e.'l:po s ure s . Children are e s pecially vulnerable tO air p o llution . Their lungs are developing and growin g; the y breathe at a higher rate than adults , and d1ey s p e nd more time outdoor s engagin g in vig orous ph ys ical activity. Children who participate in outdoor s ports in communitie s with hig h ozone arc at increa s ed ri s k of de, ·eloping a s d1ma. • C hildren are at 1 -llgher ri k fro m extrem e wead1er events s uch a s hurri canes and flood s. A s ociated h ealm con s eguence s include injur y, death, increase s in infectious cli s eases , an d posttraumatic mental he ald1 and behavior pr o blem s. ' Mental and e m otional distress for children and ado lescent s after weather cli s a s ters include p os ttraumatic stres s clisordcr, aggre s s i ve behavior, s ad n e ss , and s ub s tance abu s e ." • C IUl dren must depend on caregivers for th eir ow n preparedn ess and r es p o n se . Ex p erien ce s wid1 Hurricane Katrina demon s trated d1 e difficul ty of tracking cl1 il dren's w h erea b outs , keeping ciUldren and caregivers together , an d meeting the s p ecia l n eed s of hospitalized infants and children ." ' • T h e s e factor s can al s o interact \vith poverty, race, and cla s s to further increase ri s k. " · • The probability that global warming will co n tinue for decade s ( an d po ss ib l y for ce nturies) raise s is s ues of intergc n erational e quit y. If we fail to s ufficiendy reduce gree nh o u s e gase s, we will impair d1 e wo rld our clllidren and grand children 

### ,vill inherit . 111e more we po s tpone action, the m o re we increase t h e cost s that future g eneration s will ha v e tO pa y to cope with d1 e co n seq uenc e s of global warming. ' 

### Global warming threatens the elderl y. The elder l y are at particular ly high ri s k of adver s e h eal d1 effect s from C. C\"treme heat exposure. • Advanced age represent s one of d1e most s ignificant ri s k factors for heat

-related death in d1e • I , kk rh p e o p l e ha'c dimini s hed ability to regulate bod y temperature and to adapt p h y s iologicall y to h ear. ] n additio n , d1e y g enerall y experience p oor hea lt h . Th e elderl y are al s o m ore likel y to li ve alone and have reduced s ocial contacts , which further increa s e s their vulnerability. " • Thi s vuL1erable population will grow a s the elderl y become an increa s ingly large pr o portion o f d1e U.S . population .

### Glob a l warming impa cts th e poor disproportionate ly People in poor countries - and poor peop l e in wealth y co untrie s like our ow n - already s uffer di s proportionatel y from poor health and inadeguate h ealth infra s tructure. They are likely to be h eavily impacted b y global warmin g . • Peopl e wi th o u t acce ss to air conditioning are vulnerable ro exce ss ive heat eve n t s, or heat wave s . The urban po o r are particularl y vulnerabl e , due to t h e "ur ban heat is land " phenomenon . City envir o n ment s increa s e th ermal -s torage capacity and ro u tinel y experience ambient air temperature s from 2 °

- 10 ° F wanner than d1e s urrounding rural and s uburban area s . '""· ' " ' ·n 1e u rban heat i s land al s o a b sor b s h eat durin g the daytime and radiate s i t out at night, rai sing nighttime minimum temperature s, wh ich h ave been linked e pid emio logica ll y wiili**~"ce ss**  mortality. '"' • Exce ss ive h eat e..xpo s ure affects peop l e \vid1 certain pre- existing m edical co ndi tion s, including cardiov a s cular di s ea s e , r e s piratory illn e ss e s, and obe sity. The s e co nditi on s are alread y more p revalent among the poor, a nd the poor are le ss likely to be able to acce ss a n d a ff ord tr e atment. • Low

- income populations are particularly vulnerabl e to fl ood s a n d s torm s urge s . T h e y may li v e 

### in hi gh

ri s k area s s uch a s flood plain s and coa s tal zone s, and they may have acces s to a limited publi c h e alth infra s tructure . Additionally, low

-income populatio n s are l e ss likel y to b e covered b y h ealth in s urance. ' • P oor an d s ub s i s tence farmer s , pa s torali s t s and fi s herfolk are vulne rabl e to storm s and sea surge s, t h e reduction in river flow due to melting icepack s, in crea s ed s oil s alinity, t h e impact of h eat on crop y ield s and liv e s tock, and drought. 

### Climate change is likely to have severe e ffect s on the po o rest coun t ri es of the world.

• T h e Intergovernmental P ane l on Climate C h ange projects th at g l obal war min g i s like l y to increa s e malnutrition , incre a s e d e ath , di s ea s e , and injmy from h eat wav e s, fl ood s, s torm s, fire , and drou g ht, and expand the g eographic ran ge o f mal aria in the po or cou n trie s o f the wor l d. "' • T h e leadin g h e ald1 ri s k s in d1 e poore st co untrie s - m alnutritio n, inadeguate an d u n s afe w ater , po o r gual.i ty nutrient s, and th e burning o f l o w - guality fue l s f or h o u s el1 o ld u s e- are 

### aU s ignificand y sen sitiv e to cl.ima te. "' • l n l ow latitude s and area s with marginal rainfall, local warmin g of eve n a d eg re e or l e ss ma y reduce s ub s tantiall y the y ield of principal grain crop s.xiu • Th e m o st s evere h ealth burden s from g l o b al warming are pr oj e cted to h av e th e greatest effect on countrie s tha t are lea s t re s po n sible for d1e emi s s i on of gr een h o u s e ga s es . Tho s e em i ss io n s originate prinurily in weal d1 y, indu s trialized c ountri es in temp erate clima te s , w h ereas th eir neg ative health effect s are predict e d to concentrate in poor co untri e s d1at typi ca lly alr e ad y s uffer the wors t health..., . 

### Environmental refugees

• I n addition to t h e poor , a new cla ss of vulnerable p o pulation ha s emer ged , s p urred 

### in part b y glo bal warming : envir o nmental refugee s . T h e y are d1 e p eo p l e w h o are di s placed from d1eir h o m e s b y s uch p h e n o m ena a s ri s ing s ea leve l s,**~"pa ndio** **g** de s erts , and ca ta s trop hic weather ev e nt s, fl o o ding , etc. • I t h a s been es timated th at 2 5 million p eop le h ave alread y been di s placed for e n viro nm e ntal rea s on s - m o re than t h e approximately 21 millio n ref ugee s th at have fl e d war and per s ecutio n . • Like th e p oor , t h e y too are at hi g h ri s k for health: highl y vuln er ab le to di s ea s e, at ri s k of s preading co mmunicab l e di s ea s e s to new area s, vuln erab l e to s h o r ta ges of ofte n limited local r e s ource s, and s ubject to interruption s in sup ply chain s and acce ss to therapie s for c hronic medical conditio n. '' . • They are al so s u b j ect to ph ys ical attack an d emotional s tre ss .

' Green oug h G, M c Geehin M , Bernard S M , T nanj J , Riad J , E n ge lberg D. Th e potent ial im pa cts o f c lima te variabi lit y and c han g e on hea lt h im pac ts o f extTe me weath er e v ents in th e United t a te s. En vi ro n H e alth P ers p ec t . 2001 ; 109 (s u ppl2 ): 1 91

- 1 9 8

" A he rn M , Kovats RS, W ilk in s o n P , Few R , Ma tthi e s F . G lobal hea lth impa c t s o f fl oods: ep idemio l ogi c evid e nc e . E p id e mi o l Rev . 2005; 27 :3 6--46'" S hea K, C onuni ttee on E nvironmenta l H ea l th . " G lobal Climat e C hange and C h ildren 's H eal th .'' I ' E D I AT R IC S Vo l ume 120 , Number 5 , N ov ember 2 0 07 . " Eb i , K. and Paul s on J . "C lim ate C h a nge and C hi ldre n ." Pediatr C lin N Am 54 (2007 ), 213-226 . ' E

bi , K . and Paul s on J . · 'C limat e C han ge and C h i ldren : · P ediat r C lin N A m 5 4 (2007) , 213-226. " Lub er G c t a l. C l im ate C hange a nd Ex tr e me I l e a r Eve nts." A m 

### J Pr c v M c d 2008;3 5 ( 5) . Augu s t 2008 . " ' U. S . E n vironm e ntal Protecti o n Age nc y . H eat is land eff ec t. U . S . En v iroumeutal Protection Agenc y . 2005 . \\ w w**!>.~ en'** **h~<~tJ,Jand** nllk' hun I.

"" V a se R , Karl T , Eas terling D , W ill iam s C, Men ne M . C lim a te ( c om munic ation ari s ing ): impa c t of land

- u s e c hange o n c limate. Nature 200 4 ;4 27 : 213

- 4 .

'' U .S . E nvironmental Protec tio n A gen cy. Exces s ive hea t events guidebook . 2006 . w" w x)M.cnv**h~au,J.md** ahmu**ln~atguJddx>ok.hunl .**  • Hain es A . c t aL "C l imate c han ge and human h ea lth : impac ts, vuln erabili ty , and mitigation . Lancet , Vol. 367 June 2 4 , 200 6. " lnt e rgovemmenta l Pan e l on C l ima te Change . C limat e c hang e 2 007 : impacts , adaptati o n and vuln<-'fab ilit y . C o n tribution of Working Gro u p II to th e Fourth A ss e ss ment Repo rt of th e lntcrgovemmental Pan el o n C li mate C han ge . Parry ML , C an z i a ni O F, l 'a lutik ofJP , van d e r Linden PJ , Han s o n CE , ed s. C am brid ge UK : C ambridge U nive rs ity Pres s, 2007 .

'" S t. L o ui s M . and H ess J . "C limate Change : Imp ac ts on and Imp li cat ion s for G l obal H ea lth . " Am J Prev Med 200 8; 35( 5). A ugus t 200 8.

' "' Intergo vernmen tal Pan e l o n C limate C h a n ge . Afri ca . ln : P arry ML, C anzia ni OF , PaJutik ofJ P , V ander L inde n PJ, Ha ns on C E , eds. C li m a te C hang e 2007 : Impact s , Adapt ation and V ulncrnbility . C o ntributi o n o f Wo rkin g Gro up II to the Fourth As s e ss ment Report of the l ntergovcmmental Pan e l on C limate C ha ng e . C ambrid ge : C ambridg e U niversity Pr e ss, 2007 :43 3-67 .

'"' S t. Lou i s M . and H e ss J . "CI.imate C ha nge: Impa c ts o n and Impli cation s tor G lo b a l H eal th .' ' Am J Prev Med 200 8; 35 ( 5 ) . Augu s t 200 8. " t . L o u is M . and He ss J . "C li m ate C hange : Impa c ts o n and Impli cation s for G l obal Health .'' A m J Prev Med 200 8; 35(5 ). A ugu s t 200 8.

# ., 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 i s acknowledged b y s cienti s t s arou nd the world to b e a reality and to b e cau s ed primaril y b y hum an activ ity, especially the burning o f f oss il fuel s. As t h e earth warms, the delicate balance o f climate , we ather eve nt s and life i s di s rupted. Co n sequence s emerge that dueaten human h ealth and , ultimatel y, s urvi val. This i s o ne of s everal fact s h eets pr o duced b y Ph ys icians f o r So cia l R e s p o n sibili ty that ex a mine recent s c i entific evidence o f glo b al warming 's impact o n h ealth .


### All of the specific h ealth ri sks of global w a rming h ave associated mental health risks .'
• E-J eat wave s co ntribute to more alcoh o l and s ub s tance abu se.• • Ju s t an increase o f 1 degree F (0.5 

### C) see m s to increa s e th e ri s k of vio l enr behavior, e s peciall y in warm climat es and the inner ci ty. w • Food a nd water s hortages threaten our ba sic s ense of s ecuri ty and theref o re are as so ciat e d with increa s es in P osrtra um atic Stress Disorder and od1er mental heal th problem s." · • T h e du o nic droug ht in the o utback of Au s tralia is ca u s ing a new an d danger o u s v ariatio n o f grief, so l astalgia , whic h i s a kind of dis tress about envir o nm e ntal l osses in one 's h o m eland. ' • P erce pti o n s o f p oo r air quali ty re s ult s in increased anxiety , es p eciall y in children , a l o ng with increa se d famil y vio l ence ." • Indi vidua l panic and grou p h ys teria are ris ks of vector-borne o r waterborne di seases. Recent harbingers of tlu s p ossibility were s een in th e SARS epidenu c.'· " • P eo pl e 'vith s cluzo phrenia are of particular ri s k hea lth

- wi se a s iliey tend to igno r e h ealt h ri s k s and ten d n ot to take nec ess a r y precautio n s. One s tud y link s in c rea sed air po lluti o n , s p ecific ally from motor ve hicles , with a n in crea sed ri s k for s cl lizop l uenia . 

### If duplicated , thi s w o uld be an important findin g with implication s in r egar d to climate c han ge.'"' • When v ie wed in th e totality o f irs impacts, g l o b al warming creates the p o tential for large-sc ale hum an conflict , a s a re ult o f di s p lacement fr o m climate-s carred land s a nd / o r di s pute s over increa s in g ly s carce re so urc es. 

### The dir ec t mental health risks of g l obal warming have some unusual variations.
• The menral health implicatio n s w ill vary wi th the t y

p e, s uddenne ss , and s cale o f climate change dama ge, as well a s the social , hi s to rical , and cultural c o ntext . .All o f thi s w ill be filtered thro ugh the re s ilienc e o f each indiv idual. L' • 1 n certain is olated l oc ale s, the c limate c h ange of g l o bal warming can b e d e s irou s and b e neficial to human lif e, at lea s t temp or aril y. Tn the s e environme nts, m e ntal wellbeing can improve.• Und er-recognize d b ackground anxiety e.:cists in communities prone to und esired c lima te c h an ge and th e associated na rural disa s ter s.• • Chil dre n who feel they are grow in g u p in a threatened f uture ten d to b e m o r e troub l ed tha n rhe.ir parent s or gra ndpare nts. A survey of Austra lian c hildre n indicated th at a quarte r of th e c hildren fear th e world will come to an end b efo re d1e y grow u p ." • l f the p erce pti o n i s that peo ple are caus ing climate c han ge, rather than it being mainl y a natur a l phen o men a, the ri s k o f P o ttraumatic S tress Di sorder will increase fo llowing climat e- related di s a s ters. \Vh enever there i s a p er ceptio n t h at m ore cou ld ha ve b ee n don e to ave rt, mitigate o r res p o nd to di s asters , d 1e m en tal h e alth toll will b e hig h er . S u c h was t h e ca se wid1 Hurri c an e Katrina .'" • Pe o p l e w h o h ave to mo ve from climate -ravaged e n viro nment s, s uch a s fl oo d e d Ban g lade s h , ha ve co m e to b e kn ow n a s " climate refugee s." S tre ss Di sord e r s are co mmon in s uch s ituation s and compli ca ted b y "cu l nua l b ereaveme n t."'"' 

### R eso ur ces f or providing mental he aJth care related to g l o b a l warming a re in adequ ate ly developed

• More pe o p l e are likel y to be vu ln era bl e to the mental health implication s of clim ate chan g e tha n ph ys ical h ealth impairm e nts. Yet f or general mental heald1care in m os t cou n tries, insurance a nd re so urc es are inad e qu ate co mp ared with ge n eral h eal th care . • Di sas ter R es p o n se Teams are pre pared for r e ponding to acme di sas ters, but not to d1 e m o r e cluonic and s lowl y d evelopin g mental health pro ble m s related to g lobal warmin g. • Even wi th adeq u ate r esources, peo pl e wi t h m enta l illne ss often receive inadequa te care."" '

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