Climate Change Impacts On Public Health.

Warmer average temperatures will lead to hotter days and more frequent and longer heatwaves.

April 21, 2021, 9:47 a.m.

The impacts of climate change include warming temperatures, changes in precipitation, and increases in the frequency or intensity of some extreme weather events, and rising sea levels. These impacts threaten our health by affecting the food we eat, the water we drink, the air we breathe, and the weather we experience.

The severity of these health risks will depend on the ability of public health and safety systems to address or prepare for these changing threats, as well as factors such as an individual's behavior, age, gender, and economic status. Impacts will vary based on where a person lives, how sensitive they are to health threats, how much they are exposed to climate change impacts, and how well they and their community are able to adapt to change.

People in developing countries may be the most vulnerable to health risks globally, but climate change poses significant threats to health even in wealthy nations such as the United States. Certain populations, such as children, pregnant women, older adults, and people with low incomes, face increased risks;

Warmer average temperatures will lead to hotter days and more frequent and longer heatwaves. These changes will lead to an increase in heat-related deaths reaching as much as thousands to tens of thousands of additional deaths each year by the end of the century during summer months.

These deaths will not be offset by the smaller reduction in cold-related deaths projected in the winter months. However, adaptive responses, such as wider use of air conditioning, are expected to reduce the projected increases in death from extreme heat. Exposure to extreme heat can lead to heatstroke and dehydration, as well as cardiovascular, respiratory, and cerebrovascular disease. Excessive heat is more likely to affect populations in northern latitudes where people are less prepared to cope with excessive temperatures. Certain types of populations are more vulnerable than others: for example, outdoor workers, student-athletes, and homeless people tend to be more exposed to extreme heat because they spend more time outdoors. Low-income households and older adults may lack access to air conditioning which also increases exposure to extreme heat. Additionally, young children, pregnant women, older adults, and people with certain medical conditions are less able to regulate their body temperature and can therefore be more vulnerable to extreme heat. Urban areas are typically warmer than their rural surroundings. Climate change is projected to increase the vulnerability of urban populations to heat-related health impacts in the future. Heatwaves are also often accompanied by periods of stagnant air, leading to increases in air pollution and associated health effects.

Changes in the climate affect the air we breathe both indoors and outdoors. Warmer temperatures and shifting weather patterns can worsen air quality, which can lead to asthma attacks and other respiratory and cardiovascular health effects. Wildfires, which are expected to continue to increase in number and severity as the climate changes, create smoke and other unhealthy air pollutants. Rising carbon dioxide levels and warmer temperatures also affect airborne allergens, such as ragweed pollen. People exposed to higher levels of ground-level ozone are at greater risk of dying prematurely or being admitted to the hospital for respiratory problems. Ground-level ozone can damage lung tissue, reduce lung function, and inflame airways. This can aggravate asthma or other lung diseases. Children, older adults, outdoor workers, and those with asthma and other chronic lung diseases are, particularly at risk. The higher concentrations of ozone due to climate change may result in tens to thousands of additional ozone-related illnesses and premature deaths per year Particulate matter is the term for a category of extremely small particles and liquid droplets suspended in the atmosphere. Fine particles include those smaller than 2.5 micrometers (about one ten-thousandth of an inch). Some particulate matter such as dust, wildfire smoke, and sea spray occur naturally, while some are created by human activities such as the burning of fossil fuels to produce energy. These particles may be emitted directly or may be formed in the atmosphere from chemical reactions of gases such as sulfur dioxide, nitrogen dioxide, and volatile organic compounds. Inhaling fine particles can lead to a broad range of adverse health effects, including lung cancer, chronic obstructive pulmonary disease (COPD), and cardiovascular disease. Climate change is expected to increase the number and severity of wildfires. Particulate matter from wildfire smoke can often be carried very long distances by the wind, affecting people who live far from the source of this air pollutant. Older adults are particularly sensitive to short-term particle exposure, with a higher risk of hospitalization and death. Outdoor workers like firefighters can also have high exposure.

Due to the complex factors that influence atmospheric levels of fine particulate matter, scientists do not yet know whether climate change will increase or decrease particulate matter concentrations across the United States. Particulate matter can be removed from the air by rainfall, and precipitation is expected to increase in quantity though not necessarily frequency. Climate-related changes in stagnant air episodes, wind patterns, emissions from vegetation and the chemistry of atmospheric pollutants will also affect particulate matter levels.

Climate change may affect allergies and respiratory health. In addition to lengthening the ragweed pollen season, rising carbon dioxide concentrations and temperatures may also lead to earlier flowering, more flowers, and increased pollen levels in ragweed.

Increases in the frequency or severity of some extreme weather events, such as extreme precipitation, flooding, droughts, and storms, threaten the health of people during and after the event. The people most at risk include young children, older adults, people with disabilities or medical conditions, and the poor. Extreme events can affect human health in a number of ways by Reducing the availability of safe food and drinking water. Damaging roads and bridges, disrupting access to hospitals and pharmacies. Interrupting communication, utility, and health care services. Contributing to carbon monoxide poisoning from improper use of portable electric generators during and after storms. Creating or worsening mental health impacts such as depression and post-traumatic stress disorder

Vectorborne diseases are illnesses that are transmitted by disease vectors, which include mosquitoes, ticks, and fleas. These vectors can carry infectious pathogens, such as viruses, bacteria, and protozoa, from animals to humans. Changes in temperature, precipitation, and extreme events increase the geographic range of diseases spread by vectors and can lead to illnesses occurring earlier in the year.

The geographic range of ticks that carry Lyme disease is limited by temperature. As air temperatures rise, ticks are likely to become active earlier in the season, and their range is likely to continue to expand northward. Typical symptoms of Lyme disease include fever, headache, fatigue, and a characteristic skin rash.

Mosquitoes thrive in certain climate conditions and can spread diseases like the West Nile virus. Extreme temperatures—too cold, hot, wet, or dry—influence the location and number of mosquitoes that transmit the West Nile virus. More than three million people were estimated to be infected with the West Nile virus in the United States from 1999 to 2010.

The spread of climate-sensitive diseases will depend on both climate and non-climate factors such as land use, socioeconomic and cultural conditions, pest control, access to health care, and human responses to disease risk. The risks for climate-sensitive diseases can be much higher in poorer countries that have less capacity to prevent and treat illness.

People can become ill if exposed to contaminated drinking or recreational water. Climate change increases the risk of illness through increasing temperature, more frequent heavy rains and runoff, and the effects of storms. Health impacts may include gastrointestinal illness like diarrhea, effects on the body's nervous and respiratory systems, or liver and kidney damage. Climate impacts can affect exposure to waterborne pathogens (bacteria, viruses, and parasites such as Cryptosporidium and Giardia); toxins produced by harmful algal and cyanobacterial blooms in the water; and chemicals that end up in water from human activities. Changing water temperatures mean that waterborne Vibrio bacteria and harmful algal toxins will be present in the water or in seafood at different times of the year, or in places where they were not previously threats. Runoff and flooding resulting from increases in extreme precipitation, hurricane rainfall, and storm surge will increasingly contaminate water bodies used for recreation shellfish harvesting waters and sources of drinking water. Extreme weather events and storm surges can damage or exceed the capacity of water infrastructure (such as drinking water or wastewater treatment plants), increasing the risk that people will be exposed to contaminants.

Water resource, public health, and environmental agencies in the country provide many public health safeguards to reduce the risk of exposure and illness even if water becomes contaminated. These include water quality monitoring, drinking water treatment standards and practices, beach closures, and issuing advisories for boiling drinking water and harvesting shellfish.

Climate change and the direct impacts of higher concentrations of carbon dioxide in the atmosphere are expected to affect food safety and nutrition. Extreme weather events can also disrupt or slow the distribution of food. Higher air temperatures can increase cases of Salmonella and other bacteria-related food poisonings because bacteria grow more rapidly in warm environments. These diseases can cause gastrointestinal distress and, in severe cases, death. Practices to safeguard food can help avoid these illnesses even as the climate changes. Climate change will have a variety of impacts that may increase the risk of exposure to chemical contaminants in food. For example, higher sea surface temperatures will lead to higher mercury concentrations in seafood, and increases in extreme weather events will introduce contaminants into the food chain through stormwater runoff. Higher concentrations of carbon dioxide in the air can act as a "fertilizer" for some plants, but lowers the levels of protein and essential minerals in crops such as wheat, rice, and potatoes, making these foods less nutritious. Extreme events, such as flooding and drought, create challenges for food distribution if roads and waterways are damaged or made inaccessible.

Any changes in a person's physical health or surrounding environment can also have serious impacts on their mental health. In particular, experiencing an extreme weather event can cause stress and other mental health consequences, particularly when a person loses loved ones or their home. Individuals with mental illness are especially vulnerable to extreme heat; studies have found that having a pre-existing mental illness tripled the risk of death during heat waves. People taking medication for mental illness that makes it difficult to regulate their body temperature are particularly at risk. Even the perceived threat of climate change (for example from reading or watching news reports about climate change) can influence stress responses and mental health. Some groups of people are at higher risk for mental health impacts, such as children and older adults, pregnant and postpartum women, people with pre-existing mental illness, people with low incomes, and emergency workers.

Some groups of people are more vulnerable than others to health risks from climate change. Three factors contribute to vulnerability: sensitivity, which refers to the degree to which people or groups are affected by a stressor such as higher temperatures; exposure, which refers to physical contact between a person and a stressor; and adaptive capacity, which refers to an ability to adjust to or avoid potential hazards. For example, while older adults are sensitive to extreme heat, an older person living in an air-conditioned apartment won't be exposed as long as she stays indoors, and as long as she can afford to pay for the electricity to run the air conditioner. Her ability to take these actions is a measure of her adaptive capacity. Children are vulnerable to many health risks due to biological sensitivities and more opportunities for exposure (due to activities such as playing outdoors). Pregnant women are vulnerable to heatwaves and other extreme events, like flooding. Older adults are vulnerable to many of the impacts of climate change. They may have greater sensitivity to heat and contaminants, a higher prevalence of disability or preexisting medical conditions, or limited financial resources that make it difficult to adapt to impacts. Occupational groups, such as outdoor workers, paramedics, firefighters, and transportation workers, as well as workers in hot indoor work environments, will be especially vulnerable to extreme heat and exposure to vector-borne diseases. People with disabilities can be very vulnerable during extreme weather events, unless communities ensure that their emergency response plans specifically to accommodate them. People with chronic medical conditions are typically vulnerable to extreme heat, especially if they are taking medications that make it difficult to regulate body temperature. Power outages can be particularly threatening for people reliant on certain medical equipment.

Other linkages exist between climate change and human health. For example, changes in temperature and precipitation, as well as droughts and floods, will affect agricultural yields and production. In some regions of the world, these impacts may compromise food security and threaten human health through malnutrition, the spread of infectious diseases, and food poisoning. The worst of these effects are projected to occur in developing countries, among vulnerable populations. Declines in human health in other countries can affect the United States through trade, migration, and immigration and has implications for national security.

Although the impacts of climate change have the potential to affect human health around the world, there is a lot we can do to prepare for and adapt to these changes—such as establishing early warning systems for heatwaves and other extreme events, taking steps to reduce vulnerabilities among populations of concern, raising awareness among healthcare professionals, and ensuring that infrastructure is built to accommodate anticipated future changes in climate. Understanding the threats that climate change poses to human health is the first step in working together to lower risks and be prepared.

Dr.Karki. is a retired Senior Veterinary Officer at Veterinary Public Health Office.

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