Occupational health risks created by climate change: U.S. doctors get Guidelines, France releases expert report

tick_lyme_government of ontario

Warmer temperatures have brought the Black-legged tick  to Ontario, bringing an increase of Lyme’s Disease, especially for outdoor workers.

A  Guidance Document was released by the  American College of Occupational and Environmental Medicine in February 2018.  Responsibilities of the Occupational and Environmental Medicine Provider in the Treatment and Prevention of Climate Change-Related Health Problems  (also appearing  in the Journal of Occupational and Environmental Medicine ) is intended to set standards for physicians specializing in workplace health.  The Guidance Document  provides concise and very current information about  the direct physical impacts related to climate change (heat stress and ultraviolet exposure, air quality, and allergic sensitivities) as well as indirect impacts (disaster zone exposure, stress and mental health, and waterborne and vector-borne disease).  Most of this information is not new:  two previous major reports have covered the same ground: The Lancet Countdown Report for 2017,  (which links climate change and specific health conditions for the population at large, not just workers, and which included a report for Canada ), and the landmark U.S . Global Change Research Program report, The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment (2016)  .

What is important about this new Guidance Document?  It focuses on the workplace, and sets standards for the role of occupational health physicians which include a responsibility to protect workers.  For example:  “Provide guidance to the employers on how to protect working populations in the outdoors or in the field who are potentially exposed to the extreme temperatures…. Quickly identify employees with acute and chronic cardiovascular and respiratory illnesses within the organization who will be significantly affected by increasing temperature and worsening air quality, an increase in ozone, particulate matter, and high pollen count  ….Provide effective guidance to employers about seasonal activity and address the increasing risk of vector-borne disease among the working population…. Deliver support to the employees at risk for mental illness due to disasters, loss, and migration by providing more comprehensive programs through their employment….  The article concludes with: “ OEM providers are called to be on the forefront of emerging health issues pertaining to working populations including climate change. The competent OEM provider should address individual and organizational factors that impact the health and productivity of workers as well as create policies that ensure a healthy workforce.”

There is also a call to action in a new report from France’s Agency for Food, Environmental and Occupational Health & Safety.  The full expert analysis is available only in French ; an English abstract is here .  The report  predicts the occupational risks associated with climate change, from now till  2050, and identifies the main drivers of change: rising temperatures, changes in  the biological and chemical environment, and a change in the frequency and intensity of extreme events.  What’s new in this report?  It highlights the breadth of impact of climate change, stating that it will affect all occupational risks, except those associated with noise and artificial radiation.  The report also makes recommendations,  urging immediate workplace awareness campaigns and training about the health effects of climate change, with a preventive focus. From the English summary: “The Agency especially recommends encouraging all the parties concerned to immediately start integrating the climate change impacts that are already perceptible, or that can be anticipated, in their occupational risk assessment approaches, in order to deploy suitable preventive measures.”  The full report (in French only):  Évaluation des risques induits par le changement climatique sur la santé des travailleurs  (262 pages) is dated January 2018 but released in April. It was requested by France’s Directorate General for Health and the Directorate General for Labour, to support the country’s 2011 National Adaptation to Climate Change Action Plan (PNACC).

The Lancet measures the impact of climate change on public health, productivity and more

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The Lancet Countdown: Tracking Progress on Health and Climate Change is a global, interdisciplinary research collaboration which has published an annual review since 2016.   The Lancet Countdown’s 2017 Report  tracks 40 indicators across five areas, and concludes that the human symptoms of climate change are unequivocal and potentially irreversible. Of particular interest, Indicator 1.3 states that  “global physical labour capacity in populations exposed to temperature change has decreased by around 5.3% between 2000 and 2016.”  Other alarming statistics:  between 2000 and 2016, the number of vulnerable people exposed to heatwave events has increased by around 125 million; without further action against climate change, over 1 billion people may be at risk of become climate change migrants by the end of the century.  The full report is available here (registration required, free).

In addition to the global report,  the Lancet Countdown produces country-specific reports;  the Briefing for Canadian Policy-makers was  written in partnership with the Canadian Public Health Association.  It  makes several  recommendations for Canadian action, including • Phase out coal-powered electricity in Canada by 2030 or sooner, with a minimum of two thirds of the power replaced by non-emitting sources, and any gap made up by lowest-emitting natural gas technology. Track and cost the health benefits of the transition in Canada and globally; • Develop a National Active Transport Strategy for Canada to coordinate improvements to walking, cycling and transit environments. This should receive priority funding, with healthcare cost savings calculated in order to demonstrate the cost offset of the investments. • Enhance support for telecommuting and telehealth options. Within health systems, gather and analyze data on kilometers, greenhouse gas emissions, air pollution and costs saved by telehealth in order to help drive systems change. • Increase funding for research into the local health impacts of resource extraction, with a focus on impacts on Indigenous populations.• Integrate Health Impact Assessments as a core component of the federal Environmental Assessment process.Lancet_twitter_card_5

Pollution cost Canada $2 billion in Lost Labour Output alone

The June 2017 report, Costs of Pollution in Canada: Measuring the impacts on families, businesses and governments reviews and synthesizes existing studies to produce the most comprehensive assessment of pollution and its costs  in Canada to date. Some quick facts: the cost of climate change-related heat waves in Canada is estimated to have been $1.6 billion in 2015; Smog alone cost Canadians $36 billion in 2015. But the report also provides detailed estimates, organized in three categories: 1.  Direct Welfare Costs: (Harm to health and well-being such as  lower enjoyment of life, sickness and premature death); 2.  Direct Income Costs – (Direct out of pocket expenses for families (e.g. medications for asthma), businesses (e.g. increased maintenance costs for buildings) and governments (remediation of polluted sites); and 3. Wealth impacts.

Direct Welfare Costs of pollution, the most studied and understood,  are estimated as at least $39 billion in 2015, or about $4,300 for a family of four.  The Direct Income Costs   that could be measured amounted to $3.3 billion in 2015, but the study cautions that this many important costs could not be measured, and full impacts on income were likely in the tens of billions of dollars.  In this category, the study estimates  Lost Labour Outputs, using a metric derived from the 2016  OECD study,  The  Economic Consequences of Outdoor Air Pollution.  The OECD estimates outdoor air pollution to cost 0.1% of national GDP, which, when applied to Canada’s  2015 GDP of approximately  $1,986 billion, implies a costs of about $2 billion in lost labour output alone. And finally, Wealth impacts, or costs on value of assets , are said to be the least understood of pollution costs, about which, “We simply do not know how much pollution costs us in terms of lost wealth”.

Costs of Pollution in Canada: Measuring the impacts on families, businesses and governments was prepared by the International Institute for Sustainable Development (IISD), with funding from the Ivey Foundation; the full report is available in English- only. Summaries are in English  and French.Short  videos were derived in cooperation with the Conference Board of Canada to focus on key topics:  e.g. extreme weather, contaminated sites, and smog .

Climate change has consequences for mental health in the workplace

Mental Health and Our Changing Climate: Impacts, Implications, and Guidance  is a report released at the end of March by the American Psychological Association, Climate for Health, and ecoAmerica. The goal is to raise public awareness of the issue and to provide “climate communicators, planners, policymakers, public health professionals, and other leaders the tools and tips needed to respond to these impacts and bolster public engagement on climate solutions.”  Although it doesn’t directly address workplace issues, much of the discussion is relevant.  For example, the report catalogues the acute mental health impacts that result from the horror and disruption of natural disasters or extreme weather events such as Hurricane Katrina –  depression,  disrupted social relationships, domestic violence, and heightened intergroup aggression.  The report also highlights women as being at higher risk: “because, on average, women have fewer economic resources than men, women may also be more affected, in general, by the stress and trauma of natural disasters.” (p.39).

Extreme weather and disasters focus attention, but there are also chronic impacts resulting from longer- term climate changes – the key example given is a proven increase in violence and inter-personal aggression associated with higher temperatures.   Certain occupational groups are highlighted for their high risk to climate-related anxiety, including first responders to natural disasters, but also including health care-givers, and those directly employed in natural settings – conservation officers, park rangers.

The final section of the report deals with tips to build resilience at the individual and community level.  It urges that training be provided for first responders so that they can identify and deal with appropriate compassion for the victims of natural disasters.

New U.S. medical consortium forms to bring the message mainstream: climate change is harming our health

Eleven medical societies in the United States, representing over 400,000 medical practitioners, have joined together to form The Medical Society Consortium on Climate & Health .  Their launch document  on March 15  was  Medical Alert! Climate Change is harming our health , directed at the general public to sound the alarm that climate change health impacts are here and now.

The report gives only a nod to the threats in the workplace, given its goal to reach a general audience. It warns that “anyone can be harmed by extreme heat, but some people face greater risk. For example, outdoor workers, student athletes, city dwellers, and people who lack air conditioning (or who lose it during an extended power outage) face greater risk because they are more exposed to extreme heat. People with chronic conditions such as cardiovascular and respiratory diseases, and those who work or play outside, are especially vulnerable to extreme heat.. ..”  The report also touches on the other major health-related impacts, such as spread of infectious diseases borne by ticks and mosquitos, air pollution,  effects of forest fires, polluted air and food, mental health burden, etc.

The Consortium  states that “most physicians are aware of the adverse health effects of climate change and feel a responsibility to inform the public, patients and policymakers about them. A majority of survey respondents report they are already seeing health harms from climate change among their own patients – most commonly in the form of increased cardiorespiratory disease (related to air quality and heat), more severe and longer lasting allergy symptoms, and injuries attributed to extreme weather.”

The goal of the consortium is to educate,  and to advocate for reduced fossil fuel consumption and increased clean energy.  Their website offers a library of publications    related to the growing literature on climate change and health. The website  also compiles resources from their member societies, such as the American College of Physicians and the American Academy of Pediatrics,  about how to green medical workplaces.   In this, they join a number of existing associations such as Practice Greenhealth   and Healthcare without Harm, an international organization with Canadian membership.

In Canada, the Canadian Association of Physicians for the Environment , which was established in 1994,   shares a similar mission for policy advocacy, and maintains an active blog  and Facebook presence.  The Canadian Medical Association has a number of policy and position documents on environmental impacts on health; their most recent policy statement on Climate change and Health  was issued in 2010, yet still seems remarkably relevant.