Transcript of Briefing on Health, Climate Change and EPA Safeguards

AMERICAN PUBLIC HEALTH ASSOCIATION/
AMERICAN MEDICAL ASSOCIATION
NEWS MEDIA BRIEFING ON FEBRUARY 24, 2011

The news media briefing presenters were:   

• Georges Benjamin, MD, FACP, FACEP, executive director, American Public Health Association;

• Cecil Wilson, MD, president, American Medical Association;

• Perry Sheffield, MD, MPH, pediatrician, deputy director of the Pediatric Environmental Health Specialty Unit for EPA Region 2, and assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine; and 

• Kristie L. Ebi, PhD, MPH, MS, lead author for the human health chapter of the IPCC Fourth Assessment Report.

A full transcript follows:

Moderator: Good afternoon and welcome to this news conference sponsored by American Public Health Association.  You will be hearing today from four speakers. Before we introduce them as a group and then individually, I want to invite the operator back on the line to explain how the question and answer of today’s session will work. Operator?

Operator: During the question and answer session you may ask a question by pressing * then 1 on your touchtone phone. If you would like to remove yourself from the queue, you may press * then 2. Again, it’s * then 1 to ask a question.

Moderator: And we will have the operator back on the line at the start of the question and answer period to repeat those instructions about how members of the news media can pose their questions.

As I mentioned you will be hearing from four speakers today. They are: Dr. Georges Benjamin, executive director of American Public Health Association, Cecil Wilson, president of American Medical Association, Dr. Perry Sheffield, deputy director of the Pediatric Environmental Health Specialty Unit for EPA Region 2, and assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, and finally Kristie Ebi, lead author for the human health chapter of the IPCC Fourth Assessment Report.

Let’s begin with our first speaker today Dr. Georges Benjamin, executive director of American Public Health Association. Georges?

Dr. Georges Benjamin: Hello everyone and thank you very much for joining us. On behalf of the American Public Health Association, I’m pleased to have the opportunity to talk with you today about one of the greatest public health challenges we face and that of course is the challenge of climate change. I’m also honored to be joined by this very distinguished panel of public health and medical experts, who understand the science and its implication for human health. And I’m also very proud to point out the fact that several of them are members of the American Public Health Association. Now public health and medicine follow the science and the evidence has only grown stronger. Now back in 1995, my association adopted its first policy recognizing climate change as a public health threat. And as the body of evidence grew even clearer and more abundant, we adopted another resolution in 2007, recognizing that the science is unequivocal, that global warming is occurring, and that human activity is the cause of it. The same year, the U.S. Supreme Court ruled that six greenhouse gases, including carbon dioxide, met the Clean Air Act definition of air pollutants. And in response to the court’s ruling, in 2009 the U.S. EPA announced its endangerment finding, which recognized that greenhouse gases threaten public health. The endangerment finding allows the EPA to reduce greenhouse gas emissions from a range of sources, under the Clean Air Act. Now, I tell all of you this to give you context for today’s call. Because as you know, Congress is now looking at the question of the role of the EPA in updating U.S. safeguards against carbon dioxide and other pollutants. In fact, over the weekend, the House of Representatives adopted a fiscal year 2011 continuing resolution that would block the EPA from implementing its pending greenhouse gas emissions rule. Now, we believe that the EPA endangerment finding has the potential to significantly reduce the public health burden of climate change, and we are committed to protecting the agency’s authority over the full breath of its work. And we are not alone. The speakers on today’s call represent a much, much larger contingent of over 120 health organizations and experts who signed on to a letter that we organized last fall, which urged Congress to protect the public’s health, by letting the EPA move ahead on urgently needed new rules to curb global warming pollution. Among the signers were: of course APHA, the American Medical Association, the American Nurses Association, the American Academy of Pediatrics, the American Lung Association, among others. Now the public health and medical communities are very clear; greenhouse gases are the leading cause of climate change and human activity is to blame. It concerns us that climate change poses enormous health risks. Climate change can lead to extreme weather events, putting the health of elderly, sick and vulnerable populations at greater risk. It can lead to increased air pollution, which is linked to asthma and other respiratory illnesses. It can affect the drinking water supply and changes even in vector-borne diseases. Now, you’ll hear more about these linkages from our other colleagues on the phone today, but just to point out, these effects all come at a cost both in human and economic terms. Not only does an increase in asthma and other respiratory illnesses lead to greater health risks and reduced quality of life, but an increase in hospitalizations and utilization of medical care clearly contributes to rising health care costs. The endangerment finding allows the EPA to act on behalf of the public’s health to reduce greenhouse gas emissions from sources such as: automobiles, power plants and factories. And of course by recognizing greenhouse gas emissions as a direct and immediate threat to public health and welfare of the American people, we gain an additional important tool and take a big step forward in safeguarding the public’s health. And we believe we need to follow the science and uphold the EPA’s authority to reduce greenhouse gas emissions and protect public health. And I’ll turn it over to the moderator.

Moderator: Again that was Dr. Georges Benjamin, executive director of American Public Health Association. That takes us to our second speaker today, Dr. Cecil Wilson, president of American Medical Association. Cecil?

Dr. Cecil Wilson: Thank you. I am Dr. Cecil Wilson, the president of the American Medical Association and an internist from Winter Park, Florida. I would like to add my thanks to you for joining this important discussion about the impact of climate change on public health. The scientific evidence, as you’ve already heard, clearly indicates that our climate is changing, air-pollution is increasing, weather is becoming more extreme, and with these changes come public health consequences. Our oceans are warming, which puts more moisture into the air and directly leads to the ever-increasing weather anomalies we’ve seen across the nation and the public health problems they present. While winters are shorter, they’ve become more perilous as evidenced by the record snowfalls we’ve seen in recent years. More winter precipitation has combined with extreme cold temperatures and the result is an increased rate of ice storms, snow-covered roads, creating treacherous travel conditions for both motorists and emergency vehicles. On the opposite end of the spectrum, extreme heat events, such as extended high-heat waves, have increased in the last two decades. An approximately 133 million Americans are living with a chronic condition, such as heart disease or diabetes, all of which are aggravated by heat waves, increasing the risk of serious complications and death. Increased heat events and rainfall have also increased insect migration and now many states are facing new and increased insect-borne illnesses. For example, dengue fever, a condition that has been rarely seen in this country, has now appeared in my home state of Florida. In addition, in the last 10 years, reports of tick-borne Lyme disease rose tenfold in both Maine and New Hampshire. Air quality is also suffering. The increase in air pollution from greenhouse gas emissions and the burning of fossil fuels brings its own set of health problems. Over the past three decades, poor air quality has extended the allergy and asthma season in this country by about 28 days, asthma rates have doubled, and the occurrence of other respiratory diseases is also on the rise. Burning fossil fuels are partly to blame for this rise in respiratory illness since fine particulate matter from that burning attaches to pollen allowing it to penetrate deeper into our lungs. The American Medical Association is working to ensure physicians and other health care professionals understand the basis for climate change and the rise in climate-related illness so they can prepare and respond to this challenge. Over the past several months, the AMA has hosted three state-based continuing medical education courses on human health and global climate change. The most recent was here last night in Jacksonville, Florida. In addition, The AMA’s Council on Science and Public Health recently examined the issue in depth. The conclusions of that report were added to the already existing number of AMA policies and support our efforts to combat climate change and to foster green initiatives. Medical and public health groups are taking leading roles in advocating for climate and energy policies that can improve public health, create jobs and combat climate change. On an individual basis, some physicians and other health care professionals are serving as role models for patients by adopting environmentally responsible practices to reduce waste and energy consumption. Climate instability threatens our health and life-supporting systems and the risk to our health and well-being will continue to mount unless we all do our part to help stabilize our climate and protect the nation’s health. Thank you.

Moderator: Again that was Dr. Cecil Wilson, president of the American Medical Association. Let’s proceed to our third speaker making brief opening comments today, Dr. Perry Sheffield, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, and deputy director of the Pediatric Environmental Health Specialty Unit for EPA Region 2.

Dr. Perry Sheffield: Thank you for this opportunity.  As the moderator said, I’m Perry Sheffield, a pediatrician and environmental health specialist from the Mt. Sinai School of Medicine in New York City. I’d like to discuss three key points related to climate change vulnerability. The first is that children are more vulnerable than adults to many environmental exposures associated with climate change. Second, children are just one of several important vulnerable groups in the United States. And lastly, as a country we can address major public health challenges while also reducing our impacts on climate. So to begin with: children. Early in training, pediatricians are taught that children are not, quote “little adults.” In comparison to adults, their metabolic rates are higher relative to size, they breathe faster (at a faster rate), and they consume more food and water per pound of body weight. Asthma, as mentioned, affects millions of people and is on the rise especially in children. We currently have a manuscript in review showing an increase in future pediatric asthma emergency department visits in the New York City metropolitan region, since we know rising temperatures associated with climate change increase smog concentrations in cities like New York. Higher temperatures can mean more smog; more smog makes children with asthma sicker, and increases the number of children with asthma. Since children are still growing and developing, environmental factors such as air pollution can affect them differently than adults. For example, exposure to pollen either during pregnancy or early childhood, may affect the development of allergic diseases such as asthma. And as Dr. Wilson mentioned, there is now evidence that the pollen season is getting longer in certain parts of the United States. So while the symptoms from allergies and asthma may be also affected by climate change, I want to emphasize now that the number of children with asthma may increase as well. Also as a result of global warming, extreme storms, including hurricanes, heavy rainfall and even snowstorms, are expected to increase and these events pose risk of injury and disruption of regular medical services, which are particularly important to children with special medical needs. Other effects of climate change are: heat waves and droughts, which are responsible for more deaths in this country per year than any other kind of extreme weather. And children’s bodies are at greater risk of effects from heat waves such as dehydration. Children come to the hospital more frequently during heat waves. The consequence of all these factors according to estimates from the World Health Organization: Death and illness among children globally, already accounts for 88 percent of the burden of climate change related health impacts. And now to my second point: Children are not the only vulnerable group. Other groups include: the elderly, the poor and those who are already sick with other illnesses, also as Dr. Wilson mentioned. The increased risk on persons who are very young or elderly is shown in a study of the 2006 California heat wave, where children under 4 or adults over 65 had the most increase in emergency department visits. And these vulnerabilities in the United States are increasing at enormous rates. The rate of people over 65 is increasing at the fastest rate in 100 years, and we currently have the largest number of people living in poverty since the 1960s. Lastly, I want to emphasize some overall public health vulnerabilities that we, as a country, have. Two examples include: asthma and obesity. These are massive public health problems that can be simultaneously improved with solutions to climate change. By continuing to reduce air pollution from power plants, we can get rapid air quality improvements and decrease not only asthma symptoms but also the number of people who have asthma. The Clean Air Act standards are not a bright line below which there are no health effects. The reductions even below the current standards have been shown to have immediate health benefits. When air pollution was reduced during the Atlanta Olympics in 1996, asthma attacks among children dropped by 44 percent and that was with all the pollutant levels before and after the games already within the air pollution limits. Secondly, by encouraging transportation that increases physical activity, we can have a positive impact on the problem of obesity. Meanwhile, we will be addressing climate change by reducing emissions of heat-trapping gases. The bottom line is that the healthier we can make ourselves as a country, the less vulnerable we will be. Additional information on these comments is available through the American Public Health Association. Thank you.

Moderator: That was the opening statement of Dr. Perry Sheffield, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, and deputy director of the Pediatric Environmental Health Specialty Unit for EPA Region 2. Closing the opening remarks period today is Kristie Ebi, lead author for the human health chapter of the IPCC Fourth Assessment Report.

Kristie Ebi: Good afternoon, I really appreciate the opportunity to talk with you and to be part of this most distinguished panel. Climate change can alter the geographic range and number of cases of injuries, illnesses and deaths associated with temperature, precipitation and other weather variables. Climate change has already increased temperatures and heavy precipitation events. These changes are affecting human health. I would like to highlight three of the health risks. As others have mentioned, heat waves have increased in frequency, intensity and length. Extreme heat is the leading weather-related cause of death in the United States. No one should die in a heat wave. To protect their citizens, communities are implementing heat wave early warning systems to warn vulnerable populations of the risks and of appropriate actions to take. U.S. Centers for Disease Control and Prevention and the U.S. Environmental Protection Agency have issued guidance documents and are working with communities in designing systems that best reflect local needs. These systems have been shown to save lives. The second issue is ozone. Ozone is an air pollutant that’s formed on clear, cloudless days. The rate at which it’s formed is temperature dependent. Ozone is a lung irritant that can affect asthmatics and those with chronic obstructive pulmonary disease and can put stress on people who have heart disease. Increased concentrations of ozone, attributable to climate change, could increase the number of ozone-related cases of all of these diseases. The projections for the numbers of increases are fairly large in some regions. Finally, changing temperature and precipitation patterns can alter the geographic range of a wide variety of diseases carried by mosquitoes, ticks and other vectors. As mentioned by Dr. Wilson, Lyme disease is increasing in some areas. Canada is tracking the move north of Lyme disease and improving their surveillance and monitoring programs to ensure that their citizens are prepared and are protected. Other infectious diseases are appearing in new areas. For example, there was an outbreak in 2004 of the leading seafood-related cause of gastroenteritis in the U.S.: Vibrio parahaemolyticus. This outbreak occurred in Alaska. The outbreak was attributed to increased ocean temperatures, which would have resulted from climate change. This increased the northern range of Vibrio parahaemolyticus by about 600 miles. Although climate change is a current and future health risk, increased attention to avoiding, preparing for and responding to climate change can prevent most of these additional risks. Thank you.

Moderator: And again that was Kristie Ebi, lead author for human health chapter of the IPCC Fourth Assessment Report. That takes us to the Q and A portion of the call today. I want to invite the operator back on the line to explain again how the Q and A period will go today. Operator?

Operator: At this time, if you would like to ask a question, please press * then 1 on your touch-tone phone. If you decide to withdraw your question, please press * then 2 to remove yourself from the list. Please limit yourself to one question and a single follow-up. If you need to ask an additional question, please know that you may press * then 1 to rejoin the queue.

Moderator: And while we’re waiting for our first question, I want to emphasize that the question and answer period is for reporters only and that you will be able to find a transcript of today’s call as well as a streaming audio of today’s call at
www.apha.org as soon as later on this afternoon at 4 pm EST. Operator, do we have any questions in the queue at this time?

Operator: Yes we do. The first question comes from Amy Harder of National Journal. Please go ahead.

Amy Harder (Media): Hi, thanks so much for holding this conference call. I would like to get your take on how you can compare the health effects to the carbon to greenhouse gas emissions to those of traditional air pollutants? As you all know, EPA’s running out a slew of other regulations as well, including the Boiler MACT, which came out yesterday. And the next month, they’re going to be doing the air toxic pollutions of power plants. So can you talk about the severity of those air pollutants as compared to the carbon emissions? Thank you.

Wilson: This is Cecil Wilson; let me take a stab at that. First, it’s not just carbon pollution. To a great extent when we talk about greenhouse gases, we’re talking about things like water vapor and in particular carbon dioxide, which is the result of adequate combustion of fossil fuels and that’s the sort of thing we get from our automobiles. And that carbon dioxide remains in the atmosphere for some 100 years so it hangs around a long time and that has continued to increase. And those are the kinds of things that add to the greenhouse effect, which adds to climate change, the increasing temperature both of air and our oceans that contributes to these variations in weather, which means our summers are hotter, our winters may be shorter but they may be colder and more severe.

Sheffield: This is Perry Sheffield. I would just add to that, that on the one hand it’s difficult to compare the severity of the health effects because the temporal scale is so different. Many of the other pollutants — the fine particulate matter that Dr. Wilson had mentioned, ozone that Dr. Ebi had mentioned — have immediate health effects. Whereas carbon dioxide or many of these other greenhouse gases, by affecting climate change, have long-term health effects that we’re starting to see effects of now but will continue to see the effects of for many, many years. So it’s difficult to make a direct comparison but I would just emphasize again that many of the solutions can have both short- and long-term health benefits.

Moderator: Was there a follow-up question there?

Harder (Media): No, that’s all I had. Thanks.
Moderator: Okay, great. Operator, let’s move to our next question.

Operator: The next question comes from Emily Walker of MedPage Today. Please go ahead.

Emily Walker (Media): Hi, thanks for taking my question. I just kind of wanted to get a sense of what the message is for doctors on this. What can physicians do with this information?

Wilson: Well, let me take that in two approaches. The first is that the AMA sees its role in this as preparing physicians to deal with climate-related illnesses and I referenced in my remarks the educational part of that. We’re working to ensure that physicians and other health care professionals are aware of the projected rise in climate-related illnesses and we’re doing that through medical education courses. The second part of that question is: What can the medical community do to combat climate change? And we see at least two roles there and that is that medical and public health groups can take leading roles in advocating for climate and energy policies that would improve public health, the EPA and those kinds of things. In addition, we would encourage physicians to serve as role models for patients by adopting environmentally responsible energy and waste-reducing medical practices. And just simple kinds of things like: using energy efficient lights, turning the thermostat down, using low-flow faucets, water cooler instead of bottled water, recycling, those kinds of things; serving as a role model.

Benjamin: And this is Georges Benjamin. You know the other thing we can certainly do functionally for our patients is, and I certainly agree with everything Dr. Wilson said, is also to point something out that there is something called the air quality index and they need to pay attention to that. And that’s the index which helps us decide how healthy or unhealthy the air is every day. So when we see a Code Red day, which tells us that the air is not as healthy as we would like it to be, that they should pay attention and there are some behaviors that they will need to adjust when they see that. So that’s not the day to go out and fill up the gas tank if you can avoid it. That’s not the day to mow the grass, particularly if you have a cardiac or respiratory condition and you should get some clinical advice from your doctor on what to do on those days.

Walker (Media): Sorry. I’m just wondering, is that something that doctors even know? I mean if you work in a hospital, is there somebody who announces, “Hey, it’s a Code Red day, be aware when you see these patients.” Or, are doctors just kind of supposed to know this on their own?

Benjamin: Yes, they do. Public health doctors, you know, talk about this all the time and they put out those notices usually with the departments of the environment. And ER docs — I used to be an emergency physician — ER docs are quite aware of Code Red days because we know that when that occurs, we’re going to see lots of patients in the emergency department.

Wilson: I would just add that, I’d say that the lay press is helping with that in a slightly different way and that is that I know our local paper, particularly during the summer will provide some space to say what the pollen count is for that day, which is also help for the public in thinking about challenges of being outside.

Moderator: Operator, let’s move to our next questioner.

Operator: The next question comes from Darryl Fears of the Washington Post. Please go ahead.

Darryl Fears (Media): Uh… thanks. I wanted you to talk about the benefits of the Clean Air Act, as you know them. How many Americans does it impact? And two, is this really a message you are sending to House Republicans who are challenging the EPA’s authority to regulate or enforce the Clean Air Act?

Benjamin: Hi, this is Georges Benjamin. Let me…let me remind everyone why we have the Clean Air Act. I would encourage those, all of you in the media, to go back into your archives. You don’t have to go back that far. I was born in ’52. Go back to the ‘40s, go back to the ‘50s, go back to the ‘60s and pull all the pictures that we have of the air. When we had people who were wearing masks and communities where they were burning lots of coal and people actually had to pull bits of stuff out of their nose or mouth. People were coughing. People were choking. And look at how bad the air was back then. That would explain to you why 40 years ago we did this. This is not because somebody decided to have a regulatory epiphany. This is because air quality was a significant public health problem. And over the years, we have progressively improved the air quality and it’s not just a bunch of numbers. You know if you go back and pull those pictures; you can actually see pictures of it. Now, we also know that even today, we have days in which the air quality is not optimal. We have days, and again those you know, particularly the Code Red days we talk about. Or the warning days, when we tell people that, “well it’s hot, it’s smoggy, the pollution count is high, or the pollen count is high.” These are real days that really impact real people on a daily basis. And I think the message is to…to any member of Congress, to go back and let’s not reinvent history, let’s go back and look at the history and understand why we actually did this.

Wilson: And this is Cecil Wilson. Let me just also add that we do recognize the tremendous challenges that are confronting Congress in dealing with the nation’s deficit problem. That being said, we believe that preventing the EPA for example from protecting the Clean Air Act has the potential for harming the public’s health. And as Dr. Benjamin said, these are real people, they’re not just numbers. But let me give you some numbers that the EPA just provided, and that was that in one year alone, the Clean Air Act was estimated to have prevented 18 million child respiratory illnesses, 850,000 asthma attacks, 674,000 cases of chronic bronchitis, and 205,000 pre-mature deaths. And that’s not…and just the monetary value, aside from the lives that are helped, is actually estimated by the EPA to exceed the cost of that protection by a factor of more than 30:1. These are real people who can be helped and need to continue to be.

Moderator: Is there a follow-up question there?

Fears (Media): Yes, there is. I know I can go and get this from the EPA but what year…..you cited a year, “in one year,” what year did the EPA say that this was?

Wilson: And I would let you go and look that up because I do not have it.

Fears (Media): Okay.

Moderator: Operator, do we have additional questions in the queue at this time?

Operator: Not at this time.

Moderator: Well we want to make sure that reporters on the line have a chance to pose their questions to this group while we have them together on the line, so we will invite the operator back on the line to go through the instructions one more time. Operator?

Operator: As a reminder, if you would like to ask a question you may press * then 1 on your touch-tone phone. To remove yourself from the queue, you can press * then 2. Again, it is * then 1 to ask a question.

Moderator: And while we’re waiting to see if there are additional original questions, we want to stress one more time that you can find the transcript of this call along with an audio recording of this call later today at
www.apha.org. Operator do we have additional questions at this time?

Operator: Yes, we do.

Moderator: Let’s go ahead and proceed.

Operator: The next question comes from Leora Falk of BNA Daily Environment Report. Please go ahead.

Leora Falk (Media): Hi there, thanks for taking my question. I was just wondering, you mentioned that the health effects of climate change are arise over…I’m sorry the health effects of greenhouse gas emissions arise over a longer time period, what, in reducing greenhouse gases, how long would it take for us to see a switch…I’m sorry, a benefit for human health? What’s the timeline there?

Sheffield: This is Perry Sheffield. When I said that they, the effects arise over a long period, we know that there’s, what we refer to as sort of some built-in climate change already pre-programmed. So, as I think you were alluding to, there are already effects being seen. And we know that if we continue to release greenhouse gases, create the emissions that we are currently producing both within the United States and throughout the world, that we will worsen the situation. But if we’re, hypothetically, to stop today releasing all greenhouse gases, it would still take decades, as Dr. Wilson mentioned the half-life of carbon dioxide is very long, and so it would take a long time to un-program what we’ve already programmed into the environment. The advantage that we can see in the short-term, meaning within days or months depending on how quickly we change our emissions, are in terms of the short-term health effects. So that’s cardiovascular, respiratory … the list goes on and on. So there’s both immediate effects from changing emissions but in terms of changing the atmospheric concentration and then having benefits from that, that’s a longer time period.

Falk (Media): But the short-term benefits, those are from reducing things like black carbon, particulate matter, not from carbon dioxide? Or is it from carbon dioxide and methane?

Sheffield: Most of those are from… particulate matter…or nitrogen oxides, or sulfur oxides, the other criteria pollutants that are already being regulated by EPA. But, there is some evidence of some even… so for example, with carbon dioxide, we know that plants, there’s some nice studies looking at ragweed pollen and the current increase in carbon dioxide that we’ve seen is potentially increasing the pollen counts from some of the ragweed or other plants. And so there’s potentially other direct effects like that but that’s not through carbon dioxide acting on the atmospheric gases, way up high, but more directly here locally. But we don’t think that breathing carbon dioxide at the current levels that it is has direct human health effects.

Ebi: This is Kristie Ebi. I’d like to just to add a reminder to that, that not only do societies need to reduce their greenhouse gas emissions but also need to prepare for climate change. In the climate change community it’s called adaptation and there are significant efforts around the world to help societies prepare for a whole range of impacts. The extent of impacts observed in the future will depend not only on reductions in greenhouse gas emissions but the ability of society to prepare, avoid and respond to the kinds of impacts that are projected.

Moderator: Was there a follow-up question there?

Benjamin: Hi, this is Georges Benjamin. But I think the other point to be made is: While from a regulatory perspective we focus on each of the individual pollutants because that’s what regulators do, from a functional perspective, when you’re burning fossil fuels, it kind of all comes out the tail pipe. So, it’s not like you can say, ”Well, let’s breathe a little carbon dioxide today, and let’s breathe a little sulfur dioxide tomorrow, and let’s breathe a little pollutant….particulate matter the next day.” It’s all mixed together. And so and it all has, not only its individual toxic effects, but it also has toxic effects together on the human body that we really don’t completely understand.  So it’s just important to remember that functionally, what happens and what people are exposed to is quite different then what we regulate things in.

Moderator: Operator, I understand that we have an additional original question in the queue and a couple of follow-up questions so let’s move to our next question.

Operator: Yes, the next question comes from Barbara Kessler of greenrightnow.com. Please go ahead.

Barbara Kessler (Media): Hi, thanks for holding the conference. You touched on this; I would like to hear a little bit more though. The greenhouse gas emissions are changing the atmosphere, up high, and that’s causing the greenhouse effect, and yet we must, there are these reports that are coming out that, for example poison ivy is worse, that you know, ragweed is possibly pollinating more heavily, not just for a longer period. Do have any, perhaps any of you could take this, do you have any evidence or have you come across anything that suggests that the asthma and allergies are worsening in intensity…. not just in their… in numbers?

Sheffield: There’s definitely evidence that asthma and allergies are worsening in intensity. In terms of measured by symptoms, linking that specifically to one cause is difficult.  So it’s sort of we can simultaneously say that as you mention there’s some really nice studies coming out looking at the direct effects of carbon dioxide on plants so either the potency of the ursodiol released by the poison ivy or the….the makeup of pollen in/from ragweed. But…linking that specifically to allergies is another, is a tough step because allergies and asthma tend to be multi-factorial.

Kessler (Media): Linking that to climate change, in other words, is difficult to say?

Sheffield: Right.
Kessler (Media): Okay. I didn’t know if I was muted there or not.
Moderator: No, everyone gets a follow-up.

Kessler (Media): Okay. Well, I guess that was mine. Yes, there’s a worsening but it’s difficult to say the causality.

Sheffield: That’s an area of a lot of research and there’s certainly people talking about that as a theoretical mechanism as contributing to the current worsening that we’re seeing of asthma and allergies on a global scale.

Kessler (Media): Thank you.

Moderator: Operator, let’s move to our next questioner.

Operator:  The next question comes from Doyle Rice of USA Today. Please go ahead.

Doyle Rice (Media): Oh hi, thanks for doing this conference. Just a, a kind of…. overall broad question here about umm…. Can you kind of tease out how much of what’s going on now with, you know, the various human health problems, tease out what is directly related to climate change as opposed to what might be going on independent of the excess carbon in the atmosphere? Is there a way to say, “Well, this much more is happening because of climate change than it would have been just anyway”?

Wilson: This is Cecil Wilson. Let me just give you the physicians’ perspective. This is such a complicated, interactive system that we live in, that that’s a challenge. And what we do know is that we are seeing increases in diseases, which are impacted by differences in climate. Whether it’s too cold or too hot….or whether there are pollutants in the air. And so, but to assign a fraction of that to one cause or another is, is challenging. And I think Dr. Sheffield was alluding to that in her earlier remarks, which maybe she’d like to add.

Sheffield: Well, the work that’s being done that best teases that out is sort of the natural experiments that are happening. So Kim Knowlton and colleagues and me looked at the 2006 California heat wave. We were able to say, specifically during this event, there was this much change in emergency department visits in that case. And so when there’s specific events that occur that are representative of the changes that we think, are what change is bringing, then we’re able to best tease out the specific effects. But… it is a tricky thing to research.

Wilson: Maybe I might add, since you mentioned the California experience, just some of the numbers. During that two-week period and that was in 2006 as Dr. Sheffield alludes to, in which temperatures were over 100, there were 450 deaths, 16,000 ER visits and 1,000 hospitalizations which were attributed to that event. And then the other one, which I think many people still remember, is the Chicago heat wave in 1995. During which time there were 900 deaths which were attributed to that heat wave. So, I mean, clearly these were cause and effect based upon what was happening in the climate.

Ebi: This is Kristie Ebi. That’s an excellent question. It gets to the heart of much of the work that’s being done looking at the impacts of climate change, which is trying to detect whether there has been a change in disease patterns in this case and then attributing that change to climate change. Doing so requires a large number of long-term data sets. In the second…. in the fourth assessment report there was a chapter that looked at this for ecosystems. We were able to locate 28,000 data sets for ecosystems and looked at whether the changes that had been reported are consistent with climate change. And we’re able to show that in more that 90 percent of the cases, the changes are consistent with what you would expect with changing temperature and precipitation patterns. There isn’t that body of literature yet for health. It doesn’t mean that there won’t be in the future. So there are very active research programs to try and understand. And to be able to answer your question, one of the challenges then: that the funding levels has been very, very low looking at any of the health consequences of climate change, which makes it harder then to have the data to answer those questions.

Rice (Media): Thanks, that helps. Thanks.

Moderator: Operator, do we have additional questions in the queue at this time?

Operator: Yes, we do.

Moderator: Let’s go ahead and proceed.

Operator: The next question comes from Amy Harder of National Journal. Please go ahead.

Harder (Media): Hi, thanks for taking another question of mine. So, from what I’ve been hearing, it sounds like and obviously correct me if I’m wrong, but that the extreme weather events are…would be the biggest contributor of how greenhouse gases are causing health problems.  Would that be accurate? And then if that is accurate, then… to get around this politically of course, you know environmental groups and the administration, others are saying we need to act on these, we need to implement these carbon regulations because of the public health effects, public health effects of greenhouse gas emissions. But if you are saying that it gets back, it’s actually the extreme weather events that the CO2 causes, then you get back to the same argument that we have over and over again and that’s whether or not climate change is actually happening. And then that is, is itself a separate debate I would say, albeit related debate to whether or not, through this, through the public health concerns of greenhouse gases. So that was kind of a couple of questions but hopefully you can talk to that.

Ebi: This is Kristie Ebi. As part of the U.S. climate change science program, there were I believe 21 synthesis and assessment products, which were produced instead of doing a national assessment. One of the synthesis and assessment products was on human health and human well-being. The conclusions from the authors of the human health chapter essentially said: that the major concerns for U.S. citizens from climate change are around heat waves, as you mentioned the extreme events, but also potentially around diarrheal diseases and respiratory diseases. There’s a number of studies around the world showing that the number of cases of is related to ambient temperature; as temperatures goes up, there’s more cases of salmonella. In the U.S. right now there’s approximately 350 million self-reported cases of diarrheal disease every year. Five maybe 10 percent of those cases are probably salmonella. And so, even a small increase in the number of cases of salmonella because of rising temperatures would increase the number of people experiencing diarrheal disease. This puts particularly the elderly but also children at increased risk. I mentioned ozone. Ozone is a lung irritant; it does cause quite significant respiratory problems. With rising temperatures, all else being equal, there will be more ozone, which will cause more lung problems. Those have significant morbidity and mortality in the U.S. So both salmonella and ozone are associated with increasing temperatures, not with the extremes of the distribution. So the answer is, for both aspects, human health is being affected in the U.S. and with additional climate change those numbers are expected to increase unless actions are taken.

Wilson: And this is Cecil Wilson. Let me just add, the challenges that are presented by increases in insect vectors, like mosquitoes and ticks, relate to the general warming trends and that is: warmer day times, night times which are not as cool, which…and warming trends, which in the case of places like Maine and New Hampshire, have expanded further north so that they contribute to that problem.

Harder (Media): Everybody’s still on indirect. The carbon dioxide’s effect on the atmosphere then affects public health, rather than, as you guys have mentioned before, it’s not a direct. It’s not something like mercury for instance…obviously that’s an extreme. 

Wilson: Well, let me just add. Maybe I, and I was going to say this a little earlier. The greenhouse effect is what actually keeps this, our globe from being so cold that we basically would have trouble surviving. So those effects are effects that help to warm, the challenge is: if it warms too much and that’s what we’re describing, that’s what we are seeing. That it’s not that carbon dioxide in and of itself is toxic, although as a human if you breathe too much carbon dioxide, that’s, that’s deadly. But, it’s the effect of it on the temperature.

Moderator: My understanding now is that there are no remaining questions in the queue. So what I’d like to do…some reporters on the line will want to take their questions off-line. At this point in the call, I’d like to go back through our list of speakers and provide an opportunity for them to give some closing thoughts for today. And we will start with start with Dr. Benjamin. Dr. Benjamin?

Benjamin: Hi, let me just first thank you for spending some time with us today.  And again, as kind of my closing salvo is just to remind us again why we put in place the Clean Air Act in the first place. It has made significant improvements in the health and well-being of the American public and we would absolutely like to keep it that way.

Moderator: And those were closing thoughts from Dr. Georges Benjamin, executive director of American Public Health Association. Dr. Wilson, do you have any closing thoughts for today?

Wilson: I would just re-emphasize that we do know that climate change has a variety of effects. A lot of them are economic but a lot of them do have to do with health and the impacts related to air pollution and global warming and that’s something we need to be aware of and pay attention to.

Moderator: And those were closing thoughts from Dr. Cecil Wilson, president of American Medical Association. And Dr. Sheffield, do you have anything to close the call with today?

Sheffield: I’ll just say that climate change will not only have different effects in different areas of the country, but will have, as I mentioned, different effects on different vulnerable groups; children and elderly being some of the most important.

Moderator: Dr. Perry Sheffield, environmental…. I’m sorry, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine and deputy director Environmental Health Specialty Unit for EPA Region 2. And Kristie Ebi, Kristie do you have any closing thoughts for today?

Ebi: I want to thank everyone who participated. The press plays a vital role in helping Americans understand the potential health risks of climate change. I really appreciate the questions that people asked and try to understand better what this issue means for U.S. citizens and how to best communicate that in the articles that you write. If there’s any information, additional information that you would like, I’m sure all of us on the panel would be more than happy to provide you with more information to make sure that, that you understand and clearly communicate what these risks are. Thank you.

Moderator: And those were closing thoughts from Kristie L. Ebi, PhD and lead author for the human health chapter of the IPCC Fourth Assessment Report. Again, just one last time, you can find a transcript of today’s call along with a streaming audio replay of this news event today at
www.apha.org at 4 p.m. Eastern Time today. Again, you’ve been listening to a news conference sponsored by American Public Health Association. On behalf of APHA, AMA, and the other speakers participating in this call today, thank you for joining us. That concludes today’s tele-news event. Thank you.