Fourth National Climate Assessment

USGCRP

TRACEABLE ACCOUNTS

Process Description

The chapter evaluated the scientific evidence of the health risks of climate change, focusing primarily on the literature published since the cut off date (approximately fall 2015) of the U.S. Climate and Health Assessment.¹ A comprehensive literature search was performed by federal contractors in December 2016 for studies published since January 1, 2014, using PubMed, Scopus, and Web of Science. An Excel file containing 2,477 peer-reviewed studies was provided to the author team for it to consider in this assessment. In addition to the literature review, the authors considered recommended studies submitted in comments by the public, the National Academies of Sciences, Engineering, and Medicine, and federal agencies. The focus of the literature was on health risks in the United States, with limited citations from other countries providing insights into risks Americans are or will likely face with climate change. A full description of the search strategy can be found at https://www.niehs.nih.gov/CCHH_Search_Strategy_NCA4_508.pdf. The chapter authors were chosen based on their expertise in the health risks of climate change. Teleconferences were held with interested researchers and practitioners in climate change and health and with authors in other chapters of this Fourth National Climate Assessment (NCA4).

The U.S. Climate and Health Assessment¹ did not consider adaptation or mitigation, including economic costs and benefits, so the literature cited includes research from earlier years where additional information was relevant to this assessment.

For NCA4, Air Quality was added as a report chapter. Therefore, while Key Messages in this Health chapter include consideration of threats to human health from worsened air quality, the assessment of these risks and impacts are covered in Chapter 13: Air Quality. Similarly, co-benefits of reducing greenhouse gas emissions are covered in the Air Quality chapter.

KEY MESSAGES

Key Message 1: Climate Change Affects the Health of All Americans

The health and well-being of Americans are already affected by climate change (very high confidence), with the adverse health consequences projected to worsen with additional climate change (likely, high confidence). Climate change affects human health by altering exposures to heat waves, floods, droughts, and other extreme events; vector-, food- and waterborne infectious diseases; changes in the quality and safety of air, food, and water; and stresses to mental health and well-being.

Description of evidence base

Multiple lines of evidence demonstrate statistically significant associations between temperature, precipitation, and other variables and adverse climate-sensitive health outcomes, indicating sensitivity to weather patterns.¹ These lines of evidence also demonstrate that vulnerability varies across sub-populations and geographic areas; populations with higher vulnerability include poor people in high-income regions, minority groups, women, children, the disabled, those living alone, those with poor health status, Indigenous people, older adults, outdoor workers, people displaced because of weather and climate, low-income residents that lack a social network, poorly planned communities, communities disproportionately burdened by poor environmental quality, the disenfranchised, those with less access to healthcare, and those with limited financial resources to rebound from disasters.¹⁰⁸^,¹⁰⁹^,¹¹⁰^,¹¹¹^,¹¹⁸^,¹⁷² Recent research confirms projections that the magnitude and pattern of risks are expected to increase as climate change continues across the century.¹⁷³

Major uncertainties

The role of non-climate factors, including socioeconomic conditions, population characteristics, and human behavior, as well as health sector policies and practices, will continue to make it challenging to attribute injuries, illnesses, and deaths to climate change. Inadequate consideration of these factors creates uncertainties in projections of the magnitude and pattern of health risks over coming decades. Certainty is higher in near-term projections where there is greater understanding of future trends.

Description of confidence and likelihood

There is very high confidence that climate change is affecting the health of Americans. There is high confidence that climate-related health risks, without additional adaptation and mitigation, will likely increase with additional climate change.

Key Message 2: Exposure and Resilience Vary Across Populations and Communities

People and communities are differentially exposed to hazards and disproportionately affected by climate-related health risks (high confidence). Populations experiencing greater health risks include children, older adults, low-income communities, and some communities of color (high confidence).

Description of evidence base

Multiple lines of evidence demonstrate that low-income communities and some communities of color are experiencing higher rates of exposure to adverse environmental conditions and social conditions that can reduce their resilience to the impacts of climate change.¹⁰⁶^,¹⁰⁷^,¹⁰⁸^,¹⁰⁹^,¹¹⁰ Populations with increased health and social vulnerability typically have less access to information, resources, institutions, and other factors to prepare for and avoid the health risks of climate change.¹⁰⁷^,¹³²^,¹³³ Across all climate-related health risks, children, older adults, low-income communities, and some communities of color are disproportionately impacted. There is high agreement among experts but fewer analyses demonstrating that other populations with increased vulnerability include outdoor workers, communities disproportionately burdened by poor environmental quality, communities in the rural southeastern United States, women, pregnant women, those experiencing gender discrimination, persons with chronic physical and mental illness, persons with various disabilities (such as those affecting mobility, long-term health, sensory perception, cognition), the homeless, those living alone, Indigenous people, people displaced because of weather and climate, low-income residents who lack a social network, poorly planned communities, the disenfranchised, those with less access to healthcare, the uninsured and underinsured, those living in inadequate housing, and those with limited financial resources to rebound from disasters.¹⁰⁶^,¹⁰⁷^,¹⁰⁸^,¹¹⁰^,¹¹⁸

Adaptation can increase the climate resilience of populations when the process of developing and implementing policies and measures includes understanding the ethical and human rights dimensions of climate change, meeting human needs in a sustainable and equitable way, and engaging with representatives of the most impacted communities to assess the challenges they face and to define the climate solutions.¹²⁴^,¹²⁵

Major uncertainties

The role of non-climate factors, including socioeconomic conditions, discrimination (racial and ethnic, gender, persons with disabilities), psychosocial stressors, and the continued challenge to measure the cumulative effects of past, present, and future environmental exposures on certain people and communities will continue to make it challenging to attribute injuries, illnesses, and deaths to climate change. While there is no universal framework for building more resilient communities that can address the unique situations across the United States, factors integral to community resilience include the importance of social networks, the value of including community voice in the planning and execution of solutions, and the co-benefits of institutional readiness to address the physical, health, and social needs of impacted communities. These remain hard to quantify.¹²⁷^,¹²⁸

Description of confidence and likelihood

There is high confidence that climate change is disproportionately affecting the health of children, older adults, low-income communities, communities of color, tribal and Indigenous communities, and many other distinct populations. And there is high confidence that some of the most vulnerable populations experience greater barriers to accessing resources, information, and tools to build resilience.

Key Message 3: Adaptation Reduces Risks and Improves Health

Proactive adaptation policies and programs reduce the risks and impacts from climate-sensitive health outcomes and from disruptions in healthcare services (medium confidence). Additional benefits to health arise from explicitly accounting for climate change risks in infrastructure planning and urban design (low confidence).

Description of evidence base

Health adaptation is taking place from local to national scales.¹²⁹^,¹⁴⁸^,¹⁷⁴ Because most of the health risks of climate change are also current public health problems, strengthening standard health system policies and programs, such as monitoring and surveillance, are expected to be effective in the short term in addressing the additional health risks of climate change. Modifications to explicitly incorporate climate change are important to ensure effectiveness as the climate continues to change. Incorporating environmentally friendly practices into healthcare and infrastructure can promote resilience.¹⁵¹

Major uncertainties

Overall, while there is considerable evidence of the effectiveness of public health programs,¹¹⁰^,¹²⁹^,¹³⁰ the effectiveness of policies and programs to reduce future burdens of climate-sensitive health outcomes in a changing climate can only be determined over coming decades. The relatively short time period of implementing health adaptation programs means uncertainties remain about how to best incorporate climate change into existing policies and programs to manage climate-sensitive health outcomes and about which interventions will likely be most effective as the climate continues to change.¹⁷⁴^,¹⁷⁵ For example, heat wave early warning and response systems save lives, but it is not clear which components most effectively contribute to morbidity and mortality reduction.

Description of confidence and likelihood

There is medium confidence that with sufficient human and financial resources, adaptation policies and programs can reduce the current burden of climate-sensitive health outcomes.¹¹⁰^,¹⁵¹^,¹⁷⁶^,¹⁷⁷ There is low confidence that the incorporation of health risks into infrastructure and urban planning and design will likely decrease climate-sensitive health impacts.

Key Message 4: Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits

Reducing greenhouse gas emissions would benefit the health of Americans in the near and long term (high confidence). By the end of this century, thousands of American lives could be saved and hundreds of billions of dollars in health-related economic benefits gained each year under a pathway of lower greenhouse gas emissions (likely, medium confidence).

Description of evidence base

Benefits of mitigation associated with air quality, including co-benefits of reducing greenhouse gas emissions, can be found in Chapter 13: Air Quality. This Key Message is consistent with and inclusive of those findings.

Multiple individual lines of evidence across several health topic areas demonstrate significant benefits of greenhouse gas emission reductions, with health impacts and health-related costs reduced by approximately half under RCP4.5 compared to RCP8.5 by the end of the century, based on comprehensive multisector quantitative analyses of economic impacts projected under consistent scenarios (Ch. 13: Air Quality).³⁷^,¹⁵⁷^,¹⁵⁸^,¹⁵⁹^,¹⁶⁰^,¹⁶¹^,¹⁶²^,¹⁶³^,¹⁶⁴^,¹⁶⁵^,¹⁶⁶^,¹⁶⁷ The economic benefits of greenhouse gas emissions reductions to the health sector could be on the order of hundreds of billions of dollars annually by the end of the century.

Heat: Greenhouse gas emission reductions under RCP4.5 could substantially reduce the annual number of heat wave days (for example, by 21 in the Northwest and by 43 in the Southeast by the end of the century);¹⁶¹ the number of high-mortality heat waves;¹⁶²^,¹⁶⁸ and heat wave intensities.¹⁶¹^,¹⁶⁸ The EPA (2017)¹⁵⁷ estimated city-specific relationships between daily deaths (from all causes) and extreme temperatures based on historical observations that were combined with the projections of extremely hot and cold days (average of three years centered on 2050 and 2090) using city-specific extreme temperature thresholds to project future deaths from extreme heat and cold under RCP8.5 and RCP4.5 in five global climate models (GCMs). In 49 large U.S. cities, changes in extreme temperatures are projected to result in over 9,000 premature deaths per year under RCP8.5 by the end of the century without adaptation ($140 billion each year); under RCP4.5, more than half these deaths could be avoided annually ($60 billion each year).¹⁵⁷

Labor productivity: Hsiang et al. (2017)¹⁶⁷ and the EPA (2017)¹⁵⁷ estimated the number of labor hours from changes in extreme temperatures using dose–response functions for the relationship between temperature and labor from Graff Zivin and Neidell (2014).¹⁶⁹ Under RCP8.5, almost 2 billion labor hours are projected to be lost annually by 2090 from the impacts of extreme heat and cold, costing an estimated $160 billion in lost wages. The Southeast¹⁶⁴^,¹⁷⁰ and Southern Plains are projected to experience high impacts, with labor productivity in high-risk sectors projected to decline by 3%. Some counties in Texas and Florida are projected to experience more than 6% losses in annual labor hours by the end of the century.¹⁵⁷^,¹⁶⁰

Vector-borne disease: Belova et al. (2017)³⁷ and the EPA (2017)¹⁵⁷ define health impact functions from regional associations between temperatures and the probability of above-average West Nile neuroinvasive disease (WNND) incidence to estimate county-level expected WNND incidence rates for a 1995 reference period (1986–2005) and two future years (2050: 2040–2059 and 2090: 2080–2099) using temperature data from five GCMs. Annual national cases of WNND are projected to more than double by 2050 due to increasing temperatures, resulting in approximately $1 billion per year in hospitalization costs and premature deaths. In 2090, an additional 3,300 annual cases are projected under RCP8.5, with $3.3 billion per year in costs. Greenhouse gas emission reductions under RCP4.5 could avoid approximately half these cases and costs.

Water quality: Chapra et al. (2017)¹⁶⁵ and the EPA (2017)¹⁵⁷ evaluate the biophysical impacts of climate change on the occurrence of cyanobacterial harmful algal blooms in the contiguous United States using models that project rainfall runoff, water demand, water resources systems, water quality, and algal growth. In 2090, warming under RCP8.5 is projected to increase the length of time that recreational waters have concentrations of harmful algal blooms (cyanobacteria) above the recommended public health threshold by one month annually; greenhouse gas emissions under RCP4.5 could reduce this by two weeks.

Food safety and nutrition: There is limited evidence quantifying specific health outcomes or economic impacts of reduced food safety and nutrition.

Major uncertainties

While projections consistently indicate that changes in climate are expected to have negative health consequences, quantifying specific health outcomes (for example, number of cases, number of premature deaths) remains challenging, as noted in Key Message 1. Economic estimates only partially capture and monetize impacts across each health topic area, which means that damage costs are likely to be an undervaluation of the actual health impacts that would occur under any given scenario. Economic estimates in this chapter do not include costs to the healthcare system.

Description of confidence and likelihood

There is a high confidence that a reduction in greenhouse gas emissions would benefit the health of Americans. There is medium confidence that reduced greenhouse gas emissions under RCP4.5 compared to RCP8.5 will likely reduce lost labor hours by almost half and avoid thousands of premature deaths and illnesses projected each year from climate impacts on extreme heat, ozone and aeroallergen levels (Ch. 13: Air Quality), and West Nile neuroinvasive disease. There is medium confidence that the economic benefits of greenhouse gas emissions reductions in the health sector could likely be on the order of hundreds of billions of dollars each year by the end of the century. Including avoided or reduced benefits of risks that are difficult to quantify, such as mental health or long-term health consequences, would increase these estimates.

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Hurricane Flooding	1	2	3	4	5
Hospital Flooding by Hurricane Category	1	2	3	4	5	None

Front Matter

National Topics

National Topics (cont.)

Regions

Responses

Appendices

Key Message 1Climate Change Affects the Health of All Americans

Key Message 2Exposure and Resilience Vary Across Populations and Communities

Key Message 3Adaptation Reduces Risks and Improves Health

Key Message 4Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits

Key Message 1

Key Message 2

Key Message 3

Key Message 4

Likelihood

Confidence Level

EXECUTIVE SUMMARY: Chapter 14: Human Health

Vulnerable Populations

CHAPTER 14 Human Health

Introduction

Authors

Contributors

Recommended Citation

Related Links

Climate Change Affects the Health of All Americans

Figure 14.1: Climate Change and Health

Extreme Events

Temperature Extremes

Vector-Borne Diseases

Water-Related Illnesses and Death

Food Safety and Nutrition

Mental Health

Exposure and Resilience Vary Across Populations and Communities

Figure 14.2: Vulnerable Populations

Building Resilient Communities

Adaptation Reduces Risks and Improves Health

Adapting to the Health Risks of Climate Change

Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits

Temperature-Related Mortality

Figure 14.4: Projected Change in Annual Extreme Temperature Mortality

Labor Productivity

Infectious Diseases

Water Quality

TRACEABLE ACCOUNTS

Process Description

KEY MESSAGES

Key Message 1: Climate Change Affects the Health of All Americans

Description of evidence base

Major uncertainties

Description of confidence and likelihood

Key Message 2: Exposure and Resilience Vary Across Populations and Communities

Description of evidence base

Major uncertainties

Description of confidence and likelihood

Key Message 3: Adaptation Reduces Risks and Improves Health

Description of evidence base

Major uncertainties

Description of confidence and likelihood

Key Message 4: Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits

Description of evidence base

Major uncertainties

Description of confidence and likelihood

REFERENCES

Key Message 1
Climate Change Affects the Health of All Americans

Key Message 2
Exposure and Resilience Vary Across Populations and Communities

Key Message 3
Adaptation Reduces Risks and Improves Health

Key Message 4
Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits

EXECUTIVE SUMMARY:
Chapter 14: Human Health

CHAPTER 14
Human Health