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).

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.

Increasing frequency and intensity of heat stress bring dangers to outside workers and will trigger migration

The 40-plus temperatures and melting asphalt of Australia’s latest heat wave  seem hard to understand for North Americans shivering under a polar vortex, but both temperature extremes relate to climate change, and both can be deadly for vulnerable groups, including outdoor workers.  On December 22, a new scientific paper was published in Environmental Research Letters and summarized in layman’s terms by Climate News Network as  “Humidity is the  real heat wave threat”  (December 24).   In “Temperature and humidity based projections of a rapid rise in global heat stress exposure during the 21st century”  in Environmental Research Letters,   scientists at Columbia University’s  Lamont-Doherty Earth Observatory used numerous models to project  frequency of high wet-bulb readings, (a scale which combines heat and humidity). The authors project that in the south-east U.S., where current wet-bulb temperatures now reach 29 or 30°C only occasionally, such highs could occur 25 to 40 days per year by the 2070’s or 2080’s,  and wet-bulb temperatures of 35°C  could occur on one or two days a year.  (35°C on a wet-bulb scale is considered the limit of human survivability.)

The situation would be worse in parts of South America,  China, and especially in Northeast India and coastal West Africa, where there is little cooling infrastructure, relatively low adaptive capacity, and rapidly growing populations. The authors conclude that “ heat stress may prove to be one of the most widely experienced and directly dangerous aspects of climate change, posing a severe threat to human health, energy infrastructure, and outdoor activities ranging from agricultural production to military training.” One might add, to any outdoor worker, including those in agriculture, construction , delivery, and emergency responders.

Similar warnings were published for farmers in Asia in “Deadly heat waves projected in the densely populated agricultural regions of South Asia” in Science Advances (August 2, 2017),  summarized by Inside Climate News.    Researchers at Massachusetts Institute of Technology and Loyola Marymount University in Los Angeles concluded  “The most intense hazard from extreme future heat waves is concentrated around densely populated agricultural regions of the Ganges and Indus river basins.”

But a recent article from Climate News Network  shows that we’re all in this together.  ” Warming drives climate refugees to Europe”  (Dec. 22) summarizes a study which combined EU asylum-application data with projections of future warming, and concludes that even under optimistic scenarios, asylum applications to the EU would increase by 28% by 2100 . The article concludes “Though poorer countries in hotter regions are most vulnerable to climate change, our findings highlight the extent to which countries are interlinked, and Europe will see increasing numbers of desperate people fleeing their home countries.”

 

 

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.