Climate Medicine

Over the past three years my extracurricular research has focused more on the COVID-19 pandemic news and related news from the public health field and less on emerging climate change adaptation policy. I've been a habitual follower of the UCSF Grand Rounds COVID-19 Update (initially in the beginning of the pandemic a weekly update, changing to every two weeks and then every month). This month I tuned in for the COVID-19 Update and found instead an interesting lecture by Dr. Kari Nadeau on "Climate Medicine" (a new term for me):

The 30th Annual Alice Hamilton Lecture: Climate Medicine and Occupational and Environmental Health (59:16) - May 11, 2023

Dr. Kari Nadeau is the Chair of the Dept. of Environmental Health at the Harvard School of Public Health (though until recently she was on the faculty at Stanford) and a specialist in adult and pediatric allergy and asthma. She presented a jam-packed lecture on the many impacts of climate change on public health and what a medical practitioner can do in response.

First, in his intro the curator of Grand Rounds Dr. Bob Wachter, Chair of the Department of Medicine at UCSF, noted that UCSF's Division of Occupational and Environmental Medicine was recently renamed the Division of Occupational, Environmental, and Climate Medicine.

Dr. Nadeau starts talking about climate change impacts on public health around 7:12 (after she gallops through the evidence that climate change is real).

I wish I could get a better version of this slide: 

"Global Climate Change: Pathways from greenhouse gas emissions to climate medicine"

Dr. Nadeau does a very thorough job reviewing all the major public health issues exacerbated by climate change including (in the order she mentions them):

•  Wildfires

She references an epidemiological paper on the connection between asthma and wildfire smoke in 2015 wildfire season, pointing to disproportionate impact on women, the elderly, and the low/middle income communities: Critical Review of Health Impacts of Wildfire Smoke Exposure (Reid, et al. Environ Health Persp, 2016).

I found a 45-slide PPT by Dr. Nadeau "Wildfires and Health" from 2019 from her time at Stanford that

focuses on the California case, landing with the summary line "There is no safe distance from a wildfire." (Download the PPT)

• Dust storms
• Pollens and molds (focusing on the Bay Area - the pollen season has increased by two weeks over the past 17 years and plants are producing more pollens)
• "Thunderstorm asthma" in Australia - something about how the electricity from the storms breaks the pollen into smaller parts, causing asthma in people who previously didn't have it
• Extreme heat
• Flooding, including toxins in water and fungal/bacterial overgrowth
• Waterborne and tickborne diseases  
• Air pollution (including wildfire smoke, dust)
• Drought, impacts on water and food supplies, plants becoming less nutritious 
• Infectious disease increase and biodiversity loss

Then she backs up and talks about secondary impacts a little.

• Displacement in climate change-related migration

She referenced a new online mapping tool - UNEP's Strata - that models potential displacement from climate change impacts. UNEP explains: "Strata is a geospatial data platform that supports practitioners and policymakers to identify and track environmental and climate stresses potentially driving threats to peace and security."

• Disproportionate impact on women/pregnant people and children

She referenced a new UNICEF report "The Climate Crisis is a Child Rights Crisis" (Aug. 2021).

This report introduces the Children’s Climate Risk Index (CCRI), "which uses data to generate new global evidence on how many children are currently exposed to climate and environmental hazards, shocks and stresses."

• Occupational health issues:
• Wildfire firefighters (10-yr shorter life span than average due to toxic exposure on the job, outside of risks from doing an emergency-related job)
• Farm workers (from heat stress- there are particular kinds of kidney disease associated with farm workers due to dehydration)
• Construction workers (with particular impacts in the U.S. on Hispanic people and people from Mexico, undoubtedly also true for farm workers)
• Workers doing flood clean-up

Then she took one more step back and looked at the "systems" view - concurrent stressors over a person's lifetime add up. I learned a new word here: "exposome" (the totality of internal and external exposures across the lifespan that affect human health). You have to think about climate change in the context of the exposome.

She then  (28:10) pivoted to talk about solutions, how doctors can support their patients and give them tools to protect themselves, like, what masks and filters can help against wildfire smoke.

She then (34:38)  introduced the topic of climate change x mental health.

She pointed to the article that shows positive returns to cognition from greenery from a study done in Melbourne: Associations of traffic-related air pollution and greenery with academic outcomes among primary schoolchildren (Claesen, et al. Environmental Research, 2021).

She also pointed to a pilot study on biodiversity, the immune system, and microbiota done with children in Finland: Biodiversity intervention enhances immune regulation and health-associated commensal microbiota among daycare children (Roslund, et al. Science Advances, 2020). That study found that immunity was better in children exposed to more green space.

Continuing on with her focus on solutions, she mentioned the new trend of electrifying school buses.

She ended with the potential advocacy role of health care providers - they are seen as a trusted source of information by patients and should feel empowered to talk about the connection between health stressors and climate change when counseling patients.

Dr. Wachter and Dr. Nadeau ended with a little Q&A. She noted the importance of the work of the Governor's Office in California to electrify vehicles in the state and other bright spots on the horizon.

Brief thoughts on the Safe and Affordable Drinking Water Fund (RIP)

I've been AWOL from my blog for the past few months due to being hired by the California Energy Commission (CEC) to work on energy efficiency compliance issues as an Energy Analyst.

This is going to be a quickie dip into blogging and then back to analyzing energy.

A Safe and Affordable Drinking Water Fund was under discussion as part of the California budget, but was scrapped on June 8, 2018, per the Sacramento Bee (by D. Kasler and A. Ashton). The compromise that resulted involves new General Fund contributions to safe drinking water projects. The Maven's Notebook, a water policy blog founded by Chris Austin, noted that same day that the legislature is evidently (per Cal-EPA) showing "a commitment to continue discussions this summer."

I have deep respect for the Visalia-based Community Water Center, which supported the creation of this new public goods charge for water. I have to believe they aren't going to give up on this idea, which has been kicking around for a long time. There's lots of support for it, with two-thirds of Californians supporting the fund according to their background about the fund.

Their press release issued on June 8, 2018, doesn't mention that the fund was scuttled, but frames it as a victory because there is now a new commitment of resources dedicated to safe drinking water projects, and the aforementioned commitment to continue discussions this summer. Hopefully those discussions go somewhere where there is a lot more safe drinking water for California's poor and rural communities.

Meanwhile, let's talk about this idea of a public goods charge for water.

Here's an old CPUC-issued paper written in 2010 by some fellow alums from the Goldman School of Public Policy (at UC Berkeley), supporting the introduction of a public goods charge for water. My fellow water policy nerds proposed these reasons for the introduction of a public goods charge for water:

• A public goods charge for water creates a price signal for water conservation. 
• A public goods charge for water would provide a stable, sustainable funding mechanism to support the full list of conservation and efficiency activities specified in Assembly Bill 32. 
• The dual energy and water conservation programs specified in AB 32, which could not be fully funded through the other mechanisms we considered, will be effective to both mitigate and adapt to climate change. 
• Our proposed implementation strategy will help institutionalize regional water agencies, which are necessary for the state’s long‐term water‐planning effectiveness. 

(Note: AB 32, for anyone not immersed in California climate change work, is the landmark California Global Warming Solutions Act of 2006, which primarily addressed greenhouse gas reduction goals.)

This paper proposes that the public goods charge be assessed via "volumetric surcharges on each water bill where metered, or by alternate means in the short‐term for areas not metered."

The Safe and Affordable Drinking Water Fund took another approach to raising funds. This was clarified in a blog post by attorney S. Holzer:

The bill would levy a 95 cent per month tax on water meters “up to one inch or customers without water meters” (see Article 5 of SB 623).  The tax would increase, depending on the size of the water meter at issue, to as much as $10 per month for customers with water meters greater than four inches.There would be exemptions from the tax for low-income customers, e.g. if the customer’s household income equals or is less than 200 percent of the federal poverty level, or if the water meter exclusively measures flow of non-potable/recycled water.

Also, "the bill would allow farmers to enroll in a waiver program by paying an applicable fee..."

More on the Safe and Affordable Drinking Water Fund as it was originally conceived:

A News Deeply/ Water Deeply article by Tess Townsend (May 8, 2018) California Considers Charge on Utility Bills to Create Safe Water Fund summarizes the scope of the proposed-and-now-scuttled fund thus:

A piece of legislation, introduced last year as Senate Bill 623 and later included as a trailer bill in the governor’s proposed budget, seeks to solve this structural problem by raising a $140 million annual Safe and Affordable Drinking Water Fund, from a combination of charges on agriculture and residential water users. Money would go toward ongoing operation and maintenance costs for treatment in under-resourced districts. The charge on residential users would amount to about $1 a month for most households served by the 1,000 or so agencies collecting fund revenue.

You can read the original bill here.

From the above, I deduce that the amount collected wouldn't have been tied (or not tied tightly) to the rate of consumption of water. This means the funding stream wouldn't be choked by water conservation.

I just want to flag this point for people working on the development of future public goods charges. It's important.

You see, I have learned that the funding stream for the work I'm doing at the California Energy Commission in the Efficiency Division is tied to energy consumption. The upshot is that the more successful the CEC Efficiency Division is at its job, the less money it has.

The funding for my division comes from ERPA, the Energy Resources Program Account. The law dictating the creation of the ERPA was passed in 1974. You can read it here. It is a fee applied to a utility bill to fund public-interest programs related to that utility service. The 1974 law directs the state's electricity utilities to gather a surcharge per kilowatt hour of electricity consumed.

It wasn't thought through to its inevitable conclusion, apparently, as it now dwindles and the governor is demanding a doubling of energy efficiency in the state.

Batten Down the Hatches: Double El Niño is Trouble for Public Health

Since January I've been seeing articles about a second El Niño forming in the Pacific, expected to bring buckets of rain to the U.S. west coast this winter. The historic drought we're having here in California makes this sound like a godsend. I only hear the coming deluge discussed in positive terms. Or a marketing opportunity: a friend moving out of the area just posted her rain boots for sale with the tag "El Niño is coming!"

Obviously natural disasters like immense storms and floods pose a direct physical threat to people and their homes. For a risk-minded person, an image like this might come to mind at the mention of the upcoming intense El Niño:

Source: U.S. Navy. Hurricane Katrina rescue.

But there are less obvious dangers from the oncoming Double El Niño that should be included in risk calculations. First, let's remind ourselves the defining characteristics of this phenomenon.

El Niño is just a rainy winter, right?

El Niño is when the central and eastern equatorial Pacific Ocean water gets warmer and air pressure gets lower, part of the El Niño Southern Oscillation (ENSO), which alternates with La Niña (when the eastern equatorial Pacific waters cool and air pressure gets higher). Usually, as the water warms more moisture goes into the atmosphere and creates more storms. So, the primary impact associated with El Niño in the U.S. is more storms on the west coast.

An El Niño was declared in 2014, but the warm water/more storms connection turned out to be weak. The energy from the warm water is just "sitting there," according to Kevin Trenberth of the National Oceanic and Atmospheric Administration (NOAA), in a March 2015 "Living on Earth" piece from PRI.

The NOAA Climate Prediction Center declared in July:

There is a greater than 90% chance that El Niño will continue through Northern Hemisphere winter 2015-16, and around an 80% chance it will last into early spring 2016.

Trenberth said in the PRI piece of the pending Double El Niño: "this could mean more than a few months of odd weather, but instead usher in a new phase of climate change."

Perhaps as a result of the congestion from not releasing the energy from the 2014 warming cycle, current sea surface temperatures indicate an El Niño as strong as the record-breaking one in 1997-1998. However, NOAA meteorologist, Michelle L’Heureux, points out that the two El Niño's early indicators don't line up exactly ("Keep calm and stop obsessing over weekly changes in ENSO" - July 7, 2015), and in a July 23 Scientific American article she is quoted as saying "we cannot find a single El Niño event that tracked like another El Niño event."

But even if this El Niño doesn't live up to the hype, meteorologist Eric Holthaus wrote last October "a longer-term climate signal is beginning to point in the direction of more frequent bursts of warming over the next several years."

On top of that, a parallel system, the Pacific Decadal Oscillation (PDO), is warming the northeastern Pacific. (Look at the bottom of this University of Washington chart of sea surface temperature anomalies in the North Pacific and it looks like the PDO is in full swing.)

Will California be Singing in the Rain?

Who knows? No two El Niños are the same, as pointed out by meteorologist Michelle L’Heureux above. 

We might have yet another dry winter because of "the Blob": a warm water/high pressure ridge combination lingering off the coast of California blocking incoming storms. (For more info read El Niño vs. the Blob: which will win out this winter? - from the KPCC science desk, Aug. 10, 2015, including a 1:22 animation explaining their different effects.)

Then there is the salient point that "El Niño rains can come like a wrecking ball," brought up in a July 30, 2015, opinion piece by one climate change adaptation planner, AECOM's Josh Sawislak. He questions the readiness of the state's infrastructure if the predicted floods do come.

While California hopes for and dreads a winter of floods, other places will have to brace for drought and fire. In the southwest Pacific, they await dry conditions. East Australia is expecting dangerous bushfire conditions (check out this Sydney Morning Herald article from May 2015 describing expected El Niño impacts in Australia this winter, with a bonus 2-minute cartoon explaining the phenomenon).

Beyond the direct public safety risks from wildfire and flood, why should people worry about El Niño's impact on public health?

El Niño and Disease

Drought and Meningitis

Historically, a strong El Niño has brought drought and famine to the Sahel region of Africa, and researchers are now drawing connections between the weather pattern and specific diseases. In July 2015, a Nigerian doctor O. Oluwole published findings correlating the increase of meningococcal meningitis epidemics in the Sahel with strong El Niños. This supports previous findings that high dust and wind (which accompany drought) correlate with meningitis outbreaks in the so-called "meningitis belt" (stretching across the Sahel from Senegal to Ethiopia) where "major epidemics of lethal meningitis are routine" (The Guardian, March 25, 2014). With these findings, vaccination campaigns can be stepped up in preparation.

Floods and Stunted Growth

In November 2014, researchers at Johns Hopkins published findings showing that children born during and shortly after the 1997-1998 El Niño event in Northern Peru, which brought heavy coastal flooding, were "on average shorter and had less lean mass for their age and sex than expected had El Niño not occurred."

The study's lead researcher, William Checkley told Mother Jones magazine that the findings align with previous findings about El Niño's public health consequences: increased risk of infection, social and emotional stress, and increased risk of contracting infectious diarrheal and respiratory diseases from flooding and heat. All of this combined could easily harm a child's development.

El Niño and War

Solomon Hsiang, an economist who studies the impact of climate change on conflict, together with  K. Meng and M. Cane, found "the probability of new civil conflicts arising throughout the tropics doubles during El Niño years relative to La Niña years" according to data from 1950 to 2004 (Nature, 2011). Another researcher who looks at the connection of weather and conflict, Marshall Burke, suggested that the findings could lead to governments of countries with high risk of extreme heat or drought during El Niño "putt[ing] in place measures and safety nets to try to reduce the risk of conflict in that year." Or, the approach of El Niño could at least put international rescue and refugee organizations on notice to step up their fundraising efforts in advance.

All I can say is batten down the hatches.

More information:

• Is my country at risk from El Niño?

This October 2012 Daily Mail UK piece shows historical global distribution of flood damage from El Niño, using maps from the Global Change Institute in Amsterdam.

• NOAA's real-time sea surface temperature maps

El Niño and "the Blob" are both visible in the Pacific if you look at the anomalies map-- the second map down. 

• NOAA's El Niño Portal

With a link to the ENSO Blog.