United Nations reports warn of health impacts of climate change, thawing Arctic

geo6 final 2019The Fourth United Nations Environment Assembly (UNEA) convened from March 11 – 15 in Nairobi, Kenya, under the sombre cloud of the crash of Ethiopian Airlines which killed many, including Canadians, on their way to attend the meetings.

The flagship report, produced by 250 global scientists and experts, is the Sixth Global Environmental Outlook, which the UN press release calls “the most comprehensive and rigorous assessment on the state of the environment completed by the UN in the last five years .. warning that damage to the planet is so dire that people’s health will be increasingly threatened unless urgent action is taken.”  It warns that, without such urgent action,  cities and regions in Asia, the Middle East and Africa could see millions of premature deaths by 2050, with pollutants in freshwater systems leading to deaths through increased  anti-microbial resistance, as well as impacts on  male and female fertility and impaired neurodevelopment of children, from endocrine disruptors.  A 28-page  Summary for Policymakers   is available in multiple languages besides English, including French .  GEO6-NA_cover_large

The official documents from the UNEA meetings are compiled here , including the closing press release summary, “World pledges to protect polluted, degraded planet as it adopts blueprint for more sustainable future” .

Other reports relevant to Canada:

1.The Assessment and Data Report for North America is one of the regional reports, all of which are compiled here .

2.  Global Resources Outlook 2019: Natural Resources for the Future We Want    examines the economic benefits and environmental costs of resource use, and finds that all resource sectors combined (including agriculture, mining, forestry ) account for 53% of the world’s carbon emissions. Extraction and primary processing of metals and other minerals  is responsible for 20% of health impacts from air pollution and 26% of global carbon emissions. The report warns that without change,  resource demand would more than double to 190bn tonnes a year, greenhouse gases would rise by 40% and demand for land would increase by 20%.   A summary of the report appeared in The Guardian.

3.   With a forecast even more dire than the 2018  IPCC report, Global linkages: A graphic look at the changing Arctic  warns that even if global emissions were to halt overnight, winter temperatures in the Arctic would still increase 4 to 5°C by 2100 because  of  greenhouse gases already emitted and ocean heat storage. The UNEA report warns of the dangers of thawing permafrost, predicting that by  2050, four million people, and around 70% of today’s Arctic infrastructure, will be threatened.  However, a critique by  the Carbon Brief    disputes this particular conclusion within the UNEA report, and states that  if humanity can mobilize to hit a -2 degrees C target, “future Arctic winter warming will be around 0.5 to 5.0°C by the 2080s compared to 1986-2005 levels, much lower than the 5.0 to 9.0°C values stated in the report.” … “This means that much of the future warming in the Arctic will depend on our emissions over the 21st century, rather than being ‘locked in’, as the report claims.” The Carbon Brief analysis is summarized in The  Energy Mix .

 

Climate change and health: a new call to action for doctors

Two new articles appeared in the January issue of the New England Journal of Medicine, recognizing the health impacts of climate change and the gap in environmental justice. Most frequently cited, sometimes with alarmist headlines, is  “The Imperative for Climate Action to Protect Health” (Jan. 17)  (registration required). The authors state that the World Health Organization may have underestimated the health effects of climate cop24_health_climate_change_reportchange when it predicted in a 2018 report that climate change will kill 250,000 people per year between 2030 and 2050.  The NEJM authors Haines and Ebi state: “We think the impact is more difficult to quantify because there is also population displacement and a range of additional factors like food production and crop yields, and the increase in heat that will limit labour productivity from farmers in tropical regions that wasn’t taken into account, among other factors. ”  They point to the need for investment and policies to promote adaptation to reduce health risks.

The other article in January’s New England Journal of Medicine is an overview of the issue and a more direct call to action for doctors.  ” Climate Change: A health emergency ”   by Drs. Caren G. Solomon and Regina C. LaRocque states:    “Disruption of our climate system, once a theoretical concern, is now occurring in plain view — with a growing human toll brought by powerful storms, flooding, droughts, wildfires, and rising numbers of insect borne diseases. Psychological stress, political instability, forced migration, and conflict are other unsettling consequences. In addition, particulate air pollutants released by burning fossil fuels are shortening human life in many regions of the world. These effects of climate disruption are fundamentally health issues, and they pose existential risks to all of us. People who are sick or poor will suffer the most….As physicians, we have a special responsibility to safeguard health and alleviate suffering. Working to rapidly curtail greenhouse gas emissions is now essential to our healing mission….  The authors’ call to action includes: “working with medical students on climate action, supporting the undergraduate divestment movement, joining forces with like-minded health professionals, and speaking with our legislators. “

In Canada, the Canadian Association for Physicians and the Environment (CAPE)   is leading the way on such education and advocacy – a compilation of their press releases  reveals the broad range of their actions. Most recently, on January 15, CAPE announced  that the Ontario Court of Appeal has granted intervenor status to the Intergenerational Climate Coalition, of which  CAPE is a member, to defend the constitutionality of the federal pricing of climate emissions, challenged by the Ontario provincial government in a case to be heard in April 2019.  Other members of the Intergenerational Climate Coalition are Generation Squeeze,  Saskatchewan Public Health Association, the Public Health Association of BC, the Canadian Coalition for the Rights of Children , and the Youth Climate Lab.  The same group announced in December 2018  that it has intervenor status in the Saskatchewan government’s challenge to the federal carbon tax plan.

UPDATE: 

A February 5 press release states: “Together, representatives from the Canadian Association of Physicians for the Environment (CAPE) , the Canadian Medical Association (CMA)  , the Canadian Nurses Association (CNA), the Canadian Public Health Association (CPHA) and the Urban Public Health Network (UPHN) are calling for action: asking federal parties to recognize that climate change is the greatest public health challenge of the 21st century, and to make climate solutions a priority in the 2019 federal election.”

Dr. Gigi Osler, President of the Canadian Medical Association (CMA) is quoted  : “Climate change is no longer some abstract idea that may harm future generations or people on the other side of the globe; it’s a reality that’s already harming the physical and mental health of Canadians. We cannot afford to treat climate change as a wedge issue. We must treat it as the public health crisis that it is.”

Lancet Report details health impacts of climate change with new estimates re heat impacts on labour

The latest landmark Report of the Lancet Countdown  was released at the end of November 2018, updating the global research on the health impacts of climate change.    The title of the press release reveals the focus : Extreme heat damaging our health and livelihoods and threatening to overwhelm hospitals around the world  . Using new methodology, the report estimates work hours lost to extreme heat: “153 billion hours of work were lost in 2017 due to extreme heat as a result of climate change. China alone lost 21 billion hours, the equivalent of a year’s work for 1.4% of their working population. India lost 75 billion hours, equivalent to 7% of their total working population.” lancet 2018 map heat and labour

Although the 2018 report emphasizes the increasing threats related to heat, it  measures 41 indicators related to disease, air pollution, extreme weather, and addresses economic and social impacts – including food security and climate migration.  Regarding energy, it states “ In 2017, renewable energy provided 10.3 million jobs – a 5.7% increase from 2016. But fossil fuel extraction industries increased to 11 million – an 8% increase from 2016.” The report estimates  deaths from air pollution by source attribution, with coal estimated to account for 16%  of deaths globally.  It also includes a new indicator mapping extremes of precipitation, identifying South America and southeast Asia among the regions most exposed to flood and drought and, on food security, the report points to 30 countries experiencing downward trends in crop yields, reversing a decade-long trend.

In addition to the main global report, national Briefings for Policymakers are provided for the Brazil, China, the EU, India, the Netherlands, Spain, U.K. and the U.S., as well as Canada. An excellent summary of the main report and the Canadian sub-report appears from the Canadian Association of Physicians for the Environment.

The Briefing for Canadian Policymakers  is written in collaboration with the Canadian Medical Association and the Canadian Public Health Association. It provides a Canada-specific view of  health impacts, and makes recommendations: for example, “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 ;…  increase ambition in reducing greenhouse gas emissions and air pollution in Canada and twin this with an emphasis on Just Transition Policies to support an equitable transition for people who work in the fossil fuel industry as the energy economy transforms;…. Apply carbon pricing instruments as soon and as broadly as possible, enhancing ambition gradually in a predictable manner, and integrate study of resulting air pollution-related health and healthcare impacts into ongoing policy decisions.” The report provides Canadian context for  the under-appreciated topic of  “Climate Change, Mental Health and Ecological Grief”, with examples from the Arctic and sub-Arctice: Rigolet, Nunatsiavut, and a study of  the SOS Summer-of-Smoke , when the area around  Yellowknife experienced  prolonged smoke and fire exposure in 2014.

Finally, the global Countdown report warns  that “A lack of progress in reducing emissions and building adaptive capacity threatens both human lives and the viability of the national health systems they depend on, with the potential to disrupt core public health infrastructure and overwhelm health services.”  It points to the growth of health-related advocacy groups , the divestment from fossil fuels, (including by the Canadian Medical Association), and the need for climate change-related training for health professionals.    The Canadian report also addresses this need for training for health professionals, stating:  “A well-trained workforce is required to respond to these challenges. The Canadian Public Health Association’s Ecological Determinants Group on Education has been working to integrate an ecosocial approach into public health education, including facilitating the participation of the Canadian Federation of Medical Students in an International Federation of Medical Students’ Associations initiative which seeks to see climate change and health gain a foothold in curricula by 2020 with fuller integration by 2025.”

The Lancet Countdown: Tracking Progress on Health and Climate Change is a global, interdisciplinary report funded by the Wellcome Trust, and researched through the collaboration of  27 academic institutions and inter-governmental organizations. The full report is here  (registration required).

U.K. Committee issues recommendations for heatwaves – including workplace changes

sweating office workerOn July 26, the U.K.’s Environmental Audit Committee published Heatwaves: adapting to climate change,  which examines the developing trend of heatwaves, the responsibility for heatwave protection, how to protect human health and well-being, and effects on  productivity and the economy.  The final statement on conclusions/recommendations states:  “Heatwaves can result in overheating workplaces and lower employee productivity. In 2010, approximately five million staff days were lost due to overheating above 26°C resulting in economic losses of £770 million. Given that extreme temperature events in Europe are now 10 times more likely than they were in the early 2000s, similar losses will occur more frequently. However, some businesses, particularly smaller businesses, do not have business continuity plans in place. The Government should make businesses aware of the developing threat of heatwaves and the economic consequences. Public Health England should also issue formal guidance to employers to relax dress codes and allow flexible working when heatwave alerts are issued. The Government should consult on introducing maximum workplace temperatures, especially for work that involves significant physical effort. Procurement rules should be updated so that schools and the NHS do not spend public money on infrastructure which is not resilient to heatwaves. The Department for Education should issue guidance for head teachers about safe temperatures in schools and relaxing the school uniform policy as appropriate during hot weather. ” At present, there is no set temperature limit for indoor work, (only that buildings be kept at a “reasonable” temperature)  and the government’s 2018 Heatwave Plan makes no mention of employer responsibilities or the dangers of heat stress for workers.

tuc logoSome of the Committee recommendations echo those contained in the  Trades Union Congress publication, Cool it! Reps guide on dealing with high temperatures in the workplace .  It documents examples of heat stress in workplaces, and provides checklists for union representatives in both indoor and outdoor workplaces. The Cool it! guide  recommends that a maximum indoor  temperature be set at  30°C (27°C for those doing strenuous work), and  “ a new legal duty on employers to protect outside workers by providing sun protection, water, and to organise work so that employees are not outside during the hottest part of the day.”  The guide also takes note of the  special circumstances of drivers.

Current heat-related guides and information from the government’s Health and Safety Executive are here.

Heat waves: How well are workers protected ?

construction drinking waterThe heat waves that have gripped much of the world in June and July have also been manifest in Canada, where as many as 70 people died in Quebec (mostly in Montreal), as temperatures stayed at over 40 degrees Celsius with the humidex. Many more are likely to have died, but Health Canada does not keep statistics on heat related deaths. In their July 7  press release  on the topic, the Canadian Association of Physicians for the Environment  quote figures from the Climate Atlas of Canada  which  state:  “Before 2005, Montreal had, on average, 8 days per year with temperatures over 30 degrees C.  With climate change, it is predicted that Montreal will experience more than 50 days per year with extreme temperatures by 2050.” For Toronto, the prediction is for 55 days per year with temperatures over 30 degrees after 2050.

In general, public attention and interventions are normally directed to  the most vulnerable in the population: the aged, chronically ill, homeless and those living alone, as in “Doctors urge population to stay cool after dozens die during heat wave in Central Canada”  in the National Observer   (July 10). But what about workers, who may not have the option to “cool off”?

On July 17, the U.S. advocacy group Public Citizen published  Extreme Heat and Unprotected Workers  , describing the state of regulation in the U.S., current and historical statistics on heat-related illness and death, particularly for construction and farm workers, the likely exacerbation of the situation due to climate change, and making the case for a federal heat stress standard. One example: The report states that from 1992 to 2016, heat killed 783 workers in the U.S. and seriously injured nearly 70,000.  Based on this hard-hitting analysis, Public Citizen, along with United Farm Workers Foundation and Farmworker Justice, joined more than 130 public health and environmental groups in submitting a petition to the U.S.  Occupational Safety and Health Administration, calling for the agency to require employers to protect their workers from heat by imposing mandatory rest breaks, hydration and access to shade or cooled spaces, among other measures.  The report is summarized by  Inside Climate News in “Heat Wave Safety: 130 Groups Call for Protections for Farm, Construction Workers ” .

In a July article  in  Morbidity and Mortality Weekly Report, published by the U.S. Centres for Disease Control (CDC) , researchers recommend using a heat index of 85 degrees F as a threshold for potentially hazardous worker heat stress, rather than the current U.S. standard of 91 degrees F (32.8C).  They base this recommendation on a review of 25 incidents of outdoor occupational heat-related illnesses, including 14 deaths, that were investigated by the U.S. Occupational Safety and Health Administration (OSHA) between 2011 and 2016.  They found a risk of illness at a heat index of just 29.4 C (85 F) –  and 6 deaths happened below 90 degrees F. The authors also noted: “Employers often obtain heat index information from publicly broadcasted weather reports or forecasts that do not necessarily reflect conditions at their work sites.”  Other  recommendations from the article:   “ a comprehensive heat-related illness prevention program should include an acclimatization schedule for newly hired workers and unacclimatized long-term workers (e.g., during early-season heat waves), training for workers and supervisors about symptom recognition and first aid (e.g., aggressive cooling of presumed heat stroke victims before medical professionals arrive), engineering and administrative controls to reduce heat stress, medical surveillance, and provision of fluids and shady areas for rest breaks.”

In Canada, Professor Glenn Kenny of the University of Ottawa is an expert on the effects of heat stress  on older people, and on workers.  Some of the studies on which he has collaborated: “Heat Exposure in the Canadian Workplace” (2010) in the American Journal of Industrial Medicine , in which he points out the strengths and weaknesses of the Threshold Limit Values (TLVs) based upon Wet Bulb Globe Temperature (WBGT), the standard used in most Canadian jurisdictions;  “Do the Threshold Limit Values for work in hot conditions adequately protect workers?”  (2016) ; and   “An evaluation of the physiological strain experienced by electrical utility workers in North America” (2015) in the Journal of Occupational and Environmental Hygiene .

What are the existing heat standards for workers? A fact sheet from The Canadian Centre for Occupational Health and Safety (CCOHS), Temperature conditions: Legislation , provides  a summary chart of Canadian legislation, ranging from Alberta, (which has guidelines only), to Ontario, which  has the most specific standards, set out in clause 25(2)(h) of the Occupational Health and Safety Act   .  Also useful: CCOHS Fact Sheet: Humidex and work  and Thermal Comfort for Office work.  From the Occupational Health Clinics for Ontario Workers (OHCOW) – Humidex Based Heat Response Plan (2014).

In the U.S.,  Occupational Safety and Health Administration (OSHA) maintains a web portal for working in indoor and outdoor heat  and the National Institute for Occupational Safety and Health portal on heat stress   is here.  NIOSH also publishes information on Hazards to Outdoor Workers   which includes heat, sun exposure, vector- borne diseases by ticks, mosquitos, and a separate fact sheet for Lyme disease(none of which have been updated since 2010) .  In February 2016, the NIOSH published  Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments,   which updated the  previous version from 1986.