Governance Lekgotla UMhlanga, Kwazulu-Natal Province, South … · 2019-05-26 · china’s huai...

Peter Orris, MD, MPH, FACP, FACOEM

Professor and Chief

Occupational and Environmental Medicine

9th Annual Air Quality

Governance Lekgotla

UMhlanga, Kwazulu-Natal Province,

South Africa

October 8, 2014

A WHO Collaborating Center

All opinions expressed in this presentation

are my own

And

do not necessarily represent the

University of Illinois

or

World Health Organization

“CLIMATE CHANGE IS THE BIGGEST GLOBAL HEALTH THREAT OF THE 21ST CENTURY… THE IMPACTS WILL BE FELT ALL AROUND THE WORLD – AND NOT JUST IN SOME DISTANT FUTURE BUT IN OUR LIFETIMES AND THOSE OF OUR CHILDREN.” THE LANCET 2009

3

USDA, Wikimedia Commons NOAA, Wikimedia Commons Suat Eman, freedigitalphotos.net

Jami Dwyer, Wikimedia Commons NOAA, Todd Heitkamp Wikimedia Commons USEPA, Wikimedia Commons National Parks Service, Wikimedia Commons

www.niehs.nih.gov/climatereport - April 2010

http://www.niehs.nih.gov/climatereport

BY THE 2080’S:

THE GREATEST ABSOLUTE LOSSES OF POPULATION BASED LABOR WORK

CAPACITY (IN THE RANGE 11% TO 27%)

ARE SEEN UNDER THE A2 SCENARIO IN SOUTHEAST ASIA, ANDEAN

& CENTRAL AMERICA, AND THE CARIBBEAN.

Source: IPCC, 2007

10

• Livestock:9- 18% anthropogenic emissions

• 80% agricultural emissions

Contributors to climate

change

Working Group III contribution to the IPCC Fifth Assessment Report

GHG emissions accelerate despite reduction efforts. Most emission

growth is CO2 from fossil fuel combustion and industrial processes.


Coal expansion plans New Power stations (2016~2021)

New (MW)

동부그린 #1 (‘16. 6) 550 #2 (‘16.12) 550 영 흥 #7 (‘18.12) 870 #8 (‘19. 6) 870 신 서 천 #1 (‘18.12) 500 #2 (‘19. 6) 500 NSP IPP #1 (‘18.10) 1000 #2 (‘19. 4) 1000 G프로젝트#1 (‘19. 4) 1000 #2 (‘19.10) 1000 동양파워 #1 (‘19.12) 1000 #2 (‘21. 7) 1000 동부하슬라#1 (‘19.12) 1000 #2 (‘20. 6) 1000

11,840 (14 plants)

18

COAL WORKERS

PNEUMOCONIOSIS

&

SILICOSIS

19 Coal accounted for 25% of global energy consumption in 2005, but generated 41% of the

CO2 emissions that year. (Epstein, P. Ann. N.Y. Acad. Sci. 1219 (2011) 73–98

COAL & ENERGY

Independent of other factors, access to electricity has a positive effect on population health

The Problem: 25% the world’s electricity is generated from the combustion of Coal 1,200 new power plants are currently under consideration

Wang, L POLICY RESEARCH WORKING PAP'ER 28 31, “Health Outcomes in Poor Countries & Policy Options” The World Bank, April 2002 Epstein, P et al “Full cost accounting for the life cycle of coal “ Ann. N.Y. Acad. Sci. 1219 (2011)

73–98 New York Academy of Sciences.

CHINA’S HUAI RIVER POLICY WHICH PROVIDED FREE WINTER HEATING VIA THE PROVISION OF COAL FOR BOILERS IN

CITIES NORTH OF THE HUAI RIVER BUT DENIED HEAT TO THE SOUTH.

LIFE EXPECTANCIES ARE ABOUT 5.5 Y (95% CI: 0.8, 10.2) LOWER IN THE NORTH OWING

TO AN INCREASED INCIDENCE OF CARDIORESPIRATORY MORTALITY.

LONG-TERM EXPOSURE TO AN ADDITIONAL 100 ΜG/M3 OF TSPS IS ASSOCIATED

WITH A REDUCTION IN LIFE EXPECTANCY AT BIRTH OF ABOUT 3.0 Y

(95% CI: 0.4, 5.6).

www.pnas.org/cgi/doi/10.1073/pnas.1300018110

CHEMICAL FORMS OF MERCURY

Elemental

Liquid metal

Inorganic salts

Mercuric chloride

Organic

Methyl, ethyl, dimethyl

Phenyl organic groups

http://en.wikipedia.org/wiki/File:Dimethylmercury2.png

http://en.wikipedia.org/wiki/File:Methylmercury.png

http://media-2.web.britannica.com/eb-media/38/123238-004-9B84B923.jpg

EXPOSURE PATHWAYS

Bio-magnification of Mercury

Source: South Florida Restoration Science Forum

HEALTH EFFECTS OF METHYL MERCURY

ON HUMANS

Inhalation

Oral

Dermal

Systemic

Existing Studies (ATSDR 1998)

Mercury: Effects of Low Dose Prenatal Exposure

Grandjean, et. al., Neurotoxicology & Teratology, 19:6, 1997

Pe

r c

en

t o

f c

hil

dre

n w

ith

lo

w t

es

t

sc

ore

s a

t a

ge

7 y

ea

rs

40

30

20

10

0

MOTOR

ATTENTION

VISUOSPATIAL

LANGUAGE

MEMORY

> 50 g/l

Percen

t o

f C

hil

dren

wit

h L

ow

Sco

res

30-50 g/l15-300 g/l< 15 g/l

Children with low prenatal

mercury

exposure < 15 >50 30-50 15-30

Children with high prenatal

mercury

exposure

% F

aro

e I

sla

nd

Ch

ild

ren

wit

h

low

est

sco

res a

t ag

e 7

years

µg/l

THE SIGNIFICANCE OF SMALL EFFECTS: EFFECTS OF A SMALL SHIFT

IN IQ DISTRIBUTION IN A

POPULATION OF 300 MILLION

160 140 120 100 80 60 40

70 130 I.Q.

mean 100

7.0 million

"gifted" 7.0 million

"impaired"

5 POINT DECREASE IN MEAN IQ

160 140 120 100 80 60 40

Mean 95

70 130

4 million

"gifted" 11 million

“impaired"

57%

INCREASE

I.Q.

$1.3 billion

each year is attributable to

mercury emissions from

U.S. power plants.

Leonardo Trasande, Philip J. Landrigan, and Clyde Schechter Mount Sinai School of Medicine, New York, New York, USA

Environ Health Perspect 113:590–596 (2005).

Public Health and Economic Consequences of Methyl Mercury Toxicity

to the Developing Brain

Photo: Illinois State Geological Survey

Health Care Costs of Air Pollution

Source: World Health Organization (WHO)

URL: http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/

WHO estimates 7 Million Deaths Linked to Air Pollution in 2012

Outdoor Air Pollution Causes of Death

ischaemic heart disease

stroke

chronic obstructive pulmonary disease (COPD)

lung cancer

acute lower respiratory infections in children

“Excessive air pollution is often a by-

product of unsustainable policies in sectors

such as transport, energy, waste

management and industry.

In most cases, healthier strategies

will also be more economical in the

long term due to health-care cost savings

as well as climate gains”

Dr Carlos Dora

WHO Coordinator for Public Health, Environmental and

Social Determinants of Health

“Excessive air pollution is often a by-

product of unsustainable policies in sectors

such as transport, energy, waste

management and industry.

In most cases, healthier strategies

will also be more economical in the

long term due to health-care cost savings

as well as climate gains”

Dr Carlos Dora

WHO Coordinator for Public Health, Environmental and

Social Determinants of Health


Source: Multiple international sources

See slide notes for specific references

Air Pollution Health Care Costs by Country

$69 billion USD (£41 billion) in China in 2005(1)

$60.5 billion USD (£36 billion) in United States over 30 years(9)

$397 million USD (£236 million) in Canada in 2008(8)

$335 million USD (£199 million) in South Africa in 2002(5,6)

$191 million USD (£113 million) in Mexico from 2010 to 2013(2,3)

$150 - $693 million (£89 – 413 million) in Costa Rica in 2011. (14)

$12 million USD (£7 million) in Denmark annually (7)


Source: World Bank. India - Diagnostic assessment of select environmental challenges (Vol. 1 of 3) : An analysis of physical and monetary losses of

environmental health and natural resources (English). Disaster Risk Mgmt & Clim Change (SASDC) 2013 06/05;70004.

Geography and trends in air pollutants

The World Bank estimates outdoor air health costs are between

1% and 2.5% of GDP in 4 countries: China, India, Pakistan and Iran

Health Cost Attributed to Outdoor Air Pollution

Melillo, Jerry M., Terese (T.C.) Richmond, and Gary W. Yohe, Eds., 2014: Climate Change Impacts in the United States: The

Third National Climate Assessment. U.S. Global Change Research Program, 841 pp. doi:10.7930/J0Z31WJ2

Climate Change Impacts in the United

States



Climate Change Projected to Worsen Asthma


States



Ragweed Pollen Season Lengthens


States



Projected Changes in Tick Habitat


States



Projected Change in Heavy Precipitation Events


States



Heavy Downpours are Increasing Exposure to Disease


States

Harmful Bloom of Algae




States



ALTERNATIVE ENERGY GENERATION

Photos: HCWH, Practice Greenhealth Barriers to the plan are primarily social and political, not technological or economic.

The energy cost in a WWS world should be similar to that today.

We estimate that

3,800,0005MW wind turbines,

49,000 300MW concentrated solar plants,

40,000 300MW solar PV power plants,

1.7 billion 3kW roof top PV systems,

5350 100MW geothermal power plants,

270 new 300MW hydroelectric power plants,

720,0000.75 MW wave devices

490,0001MW tidal Turbines

Can power a 2030 world


Substantial reductions in emissions would require large

changes in investment patterns.


Source: United States Environmental Protection Agency (EPA). The Benefits and Costs of

the Clean Air Act from 1990 to 2020; Final Report Rev. A. U S EPA Office of Air and

Radiation 2011 Apr 2011.

Health Care cost savings opportunities

Clean Air Act is estimated to save the United States $2 trillion (£1.2 trillion) from 1990 to 2020 in health and welfare benefits.

-250 000

-200 000

-150 000

-100 000

-50 000

0

Mortality Non-fatalmyocardialinfarction

Chronicbronchitis

Acutebronchitis

Hospitaladmissions

Emergencyroom visits

-5 000 000

-4 500 000

-4 000 000

-3 500 000

-3 000 000

-2 500 000

-2 000 000

-1 500 000

-1 000 000

-500 000

0

Respiratorysymptoms

Asthmaexacerbations

Instance Reductions Due to Clean Air Act (estimated for 2020)


Source: World Bank

See slide notes for specific references

Health Care cost savings opportunities

If India’s particulate matter pollution was reduced by 10%

via taxes on coal and oil production, it would save $34 billion (£20

billion) annually in health damages by 2030.

If India’s particulate matter pollution was reduced by 30%

via taxes on coal and oil production, it would save $67-105 billion (£40-62 billion) annually by 2030.(10,11)

Global Climate Change and

Human Health Resolutions

2001

The World Federation of Public Health Associations

Realizing that subsequent health effects from such perturbations in the climate system would likely include an increase in:

1) heat-related mortality and morbidity;(8-10, 3)

2) vector-borne infectious diseases, because temperature strongly determines pathogen

replication, as well as vector maturation, range, and infectivity period;(11-13; 4)

3) water-borne diseases due to increases in heavy precipitation (22; 4)

4) malnutrition from threatened agriculture, (14,15) especially in developing countries where

up to an estimated 300 million additional people may be at risk from hunger due to climate

change;(16,6) and 5) general public health infrastructure damage from weather disasters and

sea-level rise, aggravated by subsequent climate-related human migration;(18-20)

56

Francesco Marino, freedigitalphotos.net

the public health community needs to act

“The health sector must add its voice – loud and

clear…we must fight to place health issues at

the center of the climate agenda. We have

compelling reasons for doing so. Climate

change will affect, in profoundly adverse ways,

some of the most fundamental determinants of

health: food, air, water.”

Freedigitalphotos.net, Danilo Rizzuti, Jscreationzs, Carlos Porto

- Dr. Margaret Chan, Director General of the World Health

Organization, December 2007

57

Health Care Professionals are Influential Opinion Setters

Bending the Cost Curve

U.S. Hospital Energy Savings Annual savings could exceed

$5.4 billion (£3 billion)

over five years, and

$15 billion (£9 billion)

over 10 years

Annual Energy Savings:

$2 billion (£1 billion)

by year 5

$6 billion (£3.5 billion)

by year 10

Source: The Commonwealth Fund Issue Brief, November 2012, Can Sustainable Hospitals Help Bend the Health Care Cost Curve?

URL: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Nov/1641_Kaplan_can_sustainable_hosps_bend_cost_curve_ib.pdf

Kaiser Permanente

Sustainability Cost Savings (2009-2011)

Source: Kaiser Permanente – information not publically available/not for publication or public distribution

US $ 63.1 MILLION SAVED

(£37.7 MILLION)

US $ 63.1 MILLION SAVED

(£37.7 MILLION)

GLOBAL GREEN AND

HEALTHY HOSPITALS 1. Cost Savings: Health Care Environmental Footprint

Reduction

2. Health Care Costs of Air Pollution and Potential Savings

June 25, 2014

For more information about the Climate and Health Literacy Consortium

and to access more resources please visit:

http://www.noharm.org/us_canada/issues/climate/chlc/resources.php

Photo credit: Francesco Marino, freedigitalphotos.net

In Collaboration with

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4.c

om

February 11-15, 2015 Kolkata

Partnering Associations

Slides Developed From

Materials of

WHO, HCWH, UNEP, WHO, WWF

Maine Department of Environmental Protection

Colleagues at University of Illinois

Postings on the Internet

Thanks to all these colleagues for their slides and materials

to be edited by me for presentation

ACKNOWLEGEMENT

Governance Lekgotla UMhlanga, Kwazulu-Natal Province, South … · 2019-05-26 · china’s huai...

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