Health Sector Contribution to the

National Assessment on the Potential Consequences of

Climate Variability and Change for the United States
The overall goal of the National Assessment is to analyze and evaluate what is known about the potential consequences of climate variability and change for the Nation in the context of other pressures on the public, the environment, and the Nations resources. The National Assessment process has been broadly inclusive, drawing on
inputs from academia, government, the public and private sectors, and interested citizens. Starting with broad public concerns about the environment, the Assessment is exploring the degree to which existing and future variations
and changes in climate might affect issues that people care about.
The National Assessment has three major components:
1. National synthesis: The National Assessment Synthesis Team has responsibility for summarizing and integrating
the findings of the regional and sectoral studies, with the broader literature, and then drawing conclusions about
the importance of climate change and variability for the United States.

CLIMATE CHANGE
AND HUMAN HEALTH
The Potential Consequences
of Climate Variability and Change

A Report of the
National Health
Assessment Group
For the
U.S. Global Change
Research Program

2. Sectoral analyses: Workshops and assessments are being carried out to characterize the potential consequences
of climate variability and change for major sectors that cut across environmental, economic, and societal interests.
The sectoral studies analyze how the consequences in each region affect the Nation, making these reports national
in scope and of interest to everyone. The sectors being focused on in this first phase of the ongoing National
Assessment include Agriculture, Forests, Human Health, Water, and Coastal Areas and Marine Resources.
3. Regional analyses: Workshops and assessments are characterizing the potential consequences of climate variability and change in selected regions spanning the US. The reports from these activities address the interests of those
in the particular regions by focusing on the regional patterns and texture of changes where people live. Many
workshop reports are already available (see http://www.nacc.usgcrp.gov) and regional assessment reports, of
which this is the first, will become available over the next several months.
Each of the regional, sectoral, and national synthesis activities is being led by a team comprised of experts from
both the public and private sectors, from universities and government, and from the spectrum of stakeholder communities.

Johns Hopkins University

Bloomberg School of Public Health
Department of Environmental Health Sciences
615 N. Wolfe Street
Baltimore, MD 21205-2179

May 2001

Introduction
Climate Change Has the Potential to Affect Human Health in the United States
This brochure summarizes a recent scientific
assessment of how current climate variability and
future global warming may affect people in the
United States.The assessment,sponsored by the
U.S.Environmental Protection Agencys Global
Change Research Program,makes clear that the
potential health impacts are diverse and demand
improved health infrastructure and enhanced,targeted research.
The study was conducted by a team of scientists
from academia, government,and the private sector as part of the congressionally mandated U.S.
National Assessment of the Potential
Consequences of Climate Variability and Change.
Leadership of the assessment was jointly shared
between the Johns Hopkins School of Public
Health and the Centers for Disease Control and
Prevention (CDC).
Five Critical Health Issues Identified
The study identifies and examines five
key health issues
Heat-related illness and death
Health effects related to extreme weather
events
Health effects related to air pollution
Water-borne and food-borne diseases
Vector-borne and rodent-borne diseases

The report also identifies groups at risk, key

research areas, and public health measures that,
if properly addressed, could improve the
nations resilience to risks associated with current climate variability and future climate
change.
Maintenance and Improvements in Health
Infrastructure are Essential

The future vulnerability of the U.S.

population to the health impacts of
climate change depends on our capacity
to adapt to potential adverse changes
through legislative, administrative,
institutional, technological, educational,
and research-related measures. Examples
include building codes and zoning to
prevent storm or flood damage, severe
weather warning systems, improved
disease surveillance and prevention
programs, improved sanitation systems,
education of health professionals and
the public, and research addressing key
knowledge gaps in climate/health
relationships.
From the Report to the President and Congress,
National Assessment Synthesis Team, 2001

The United States has a solid public health

infrastructure, but we are frequently reminded
that human health is inextricably bound to
weather and the many complex natural systems it affects. Weather-related deaths, such as
fatalities in heat waves and floods, and illnesses, such as water-borne diseases, continue to occur. By improving the nations public
health infrastructure, focusing on groups at
special risk, and addressing research gaps, we
can reduce the potential health impacts of climate change and variability.

Populations Most Vulnerable to Climate Change Health Threats

in the United States

At present, much of the U.S. population

is protected against adverse health
outcomes associated with weather and/or
climate, although certain demographic
and geographic populations are at
increased risk.
From the Report to the President and Congress,
National Assessment Synthesis Team, 2001

Within the United States, the elderly, children,

and low-income and immunocompromised individuals already are at higher risk from a variety
of environmental hazards, including air pollution, water pollution, heat stroke, and infectious
diseases. These same individuals may be more
vulnerable to health risks that can be intensified
by climate change.
July Heat Index Change - 21 st Century
Canadian Model
+25F

Low-Income Individuals
Poverty is a risk factor for heat-related illnesses and deaths because low-income individuals
are more likely to live in urban areas (where
summer temperatures are often highest), are
less likely to be able to afford air-conditioning
systems, and may have less access to health
care. Because poverty is higher among
African-Americans and Hispanics, these groups
may be more susceptible to health risks related to extreme weather conditions.

The Elderly
The proportion of elderly residents in the
United States is expected to rise in the coming
decades. Aging is often accompanied by
chronic illnesses that may increase susceptibility to infectious disease or to extreme heat and
other environmental conditions. Poverty,
which increases with age among the elderly,
may add to this groups risk from severe
weather.

+20F

+15F

+10

+5F

Hadley Model
+25F

Children
The factors that may affect childrens special
vulnerability to possible future climate change
include poverty, access to medical care, and
childrens susceptibility to environmental hazards because of their size, behavior, and the
fact that they are growing and developing.

+20F

+15F

+10

+5F

Heat and heat waves are projected to increase in severity and frequency with increasing global mean temperatures. Both of the above models project substantial increases in the July heat index over the 21st
century. The largest increases are in the southeastern states, where
the Canadian model projects increases of more than 25 F. (Map by
Benjamin Felzer, UCAR, based on data from Canadian and Hadley
modeling centers.)

Immunocompromised
Individuals
Many illnesses, such as cancer, AIDS, and diabetes, compromise human immune systems.
Individuals affected in this manner may be
more susceptible to water-borne and vectorborne infectious diseases and to physical
stresses, such as those experienced during
heat waves or floods. Adequate protection
from those stresses is important and includes
access to air conditioning, sanitation, and safe
drinking water.

Critical Health Issues

Related to Climate Change in the United States

Heat-Related Illnesses and Death
More frequent heat waves are projected to
accompany climate change in the United States.
Because the elderly are the most susceptible to
dying from extreme heat, these heat waves pose
particular risks to an aging U.S. population.
Populations in northeastern and Midwestern
U.S. cities, where high temperatures currently
appear infrequently or irregularly, are likely to
experience the greatest number of heat-related deaths and illnesses, which include heat
cramps, fainting, heat exhaustion, and stroke.
Within heat-sensitive regions, urban areas are
the most vulnerable and the threat is intensified by the absence of nighttime heat relief. For
example, the 1995 Chicago heat wave caused
more than 600 fatalities.
Milder winters could potentially reduce the current level of winter deaths. In general, however,
more research is needed to understand the relationship between temperature and winter
deaths.
Heat Related Deaths in Chicago in July 1995
180

HI

160
140

120
115

Tmax

110

120

105

100

100

80

95

60

90

40

85

20

80

75

Strategies That Could Reduce Risk

Individual behavioral changes, including
increased fluid intake and increased use of air
conditioning
Development of community-wide heat emergency plans
Health Effects Related
to Extreme Weather
Events
Changes in the frequency, timing, intensity, and duration of
extreme weather events, such
as floods and storms, could
have negative health impacts in the United States.
Potential effects from weather disasters range
from acute trauma and drowning to conditions of
unsafe water and post-traumatic stress disorder.
The health impacts of floods, storms, and other
extreme weather events hinge on the vulnerabilities of the natural environment and the local population, as well as on their capacity to recover.
The location of development in high-risk areas,
such as coasts and floodplains, increases a communitys vulnerability to extreme weather effects.
Adverse health outcomes in the United States are
low compared with global figures, partly because
of the many federal, state, and local government
agencies and non-governmental organizations
engaged in disaster planning, early warning, and
response. Nonetheless, climate change and vulnerability will likely require increased vigilance.
Strategies That Could Reduce Risk
Continued refinements to public early warning
systems
Improved engineering for flood control
Enhanced zoning and building codes
Air Pollution-Related Health Effects

Studies of heat waves in urban areas show a link between increases in

death and increases in heat. The above graph tracks the maximum
temperature (Tmax), heat index (HI), and heat-related deaths during a
1995 Chicago heat wave that caused at least 600 deaths over five
days. (Source: NOAA/NCDC).

Climate change and variability may affect exposure to air pollutants in the United States by influencing local weather, changing the distribution

Maximum Daily Ozone Concentrations versus

Maximum Daily Temperature in Atlanta and New York.

Plains

Wastewater systems that combine storm water

drainage and sewage are still in use in about 950 communities. Increased storm events could lead to more
combined sewage overflow (CSO) events, posing a risk
to water safety. Source: USEPA,
http://www.epa.gov/owmitnet.cso.htm

Little is known how climate change might alter

tornado frequency

Upper Midwest

Northwest
Heavy runoff and flooding can
lead to outbreaks of water-borne
infectious diseases

Locations of Combined Wastewater Systems

The 1995 heatwave in Chicago

resulted in over 600
fatalities

Northeast
Weather conditions affect
the formation of smog(groundlevel ozone) along the eastern
seaboard

Higher surface temperatures are conducive to the formation of

ground-level ozone, particularly in urban areas such as Atlanta and
New York City. Ground-level ozone can intensify respiratory diseases
and cause short-term reduction in lung function. (Maximum daily
ozone chart provided by U.S. EPA).

and types of airborne allergens, and increasing

both human-driven and natural emissions.
Warmer and more variable weather may cause
increases in ground-level ozone. These increases
could intensify respiratory diseases by damaging
lung tissue, reducing lung function, and sensitizing the respiratory tract to other irritants. More air
conditioning use due to warmer temperatures
could cause an increase in potentially harmful
power plant emissions. Exposure to particulate
matter from these and other combustion-related
sources can aggravate chronic respiratory and cardiovascular diseases, alter host defenses, damage
lung tissue, lead to premature death, and possibly
contribute to cancer.
In addition, changes in green plant distribution or
pollen production could affect the timing and/or
duration of hay fever and other seasonal allergies.
Strategies That Could Reduce Risk
Improved early warning systems
for air quality
Increased use of mass transit
Better urban planning
Improved pollution control policies

Southeast
Climate variability influences
the frequency of forest fires and
subsequent respiratory illness

Southwest
El Nio-related
extreme rainfall can increase the
risk of rodent-borne diseases,
such as hantavirus and plague
Water-Borne and
Food-Borne Diseases
Climate change and weather variability in the
United States pose threats for water-borne diseases, some food-borne diseases, and marine
and coastal issues, including harmful algal
blooms and ecological disruption. Changes in
precipitation, temperature, humidity, salinity,
and wind have a measurable effect on the quality of water used for drinking, recreation, and
commerce. Heavy rainfall has been associated
with water-borne disease outbreaks throughout
the United States.
Temperature also influences the occurrence of
bacterial agents, toxic algal blooms (red tides),
and survival of viral pathogens that cause shellfish poisoning. Although federal and state water
regulations protect much of the U.S. population,
current deficiencies in watershed protection and
storm drainage systems can increase the risk of
contamination events if rainfall increases as pro-

Seasonality of Shellfish Poisoning in Florida

1981-1994

jected with climate

change. For example,
more than 950 communities in the United
States have combined
sewer overflow systems,
which service both
public wastewater and
drinking water. During
periods of heavy rainfall, these systems discharge excess wastewater directly into surface water bodies that may
be used to provide public drinking water.

Strategies That Could Reduce Risk

Improved surveillance for infectious diseases
Enhanced water systems and improved water
systems engineering
Watershed protection policies
Vector-Borne and
Rodent-Borne Diseases
Vector-borne diseases result from
infections transmitted to humans and other animals by blood-feeding insects, such as mosquitoes, ticks, and fleas. Most vector-borne diseases
exhibit a distinct seasonal pattern, which clearly
suggests that they are weather sensitive. For
example, past St. Louis encephalitis outbreaks
have been associated with a pattern of warm, wet
winters, cool springs, and hot, dry summers.
Rodent-borne diseases are less directly affected
by temperature. However, the impact of weather
on disease-carrying rodent populations (for example, increased food supply or exposure during
flooding) can affect transmission of diseases such
as hantavirus and flea-borne plague.

16
14
12
10
8
6
4
2
0
Jan Feb
Mar Apr
May Jun
Infections

Deaths

Jul Aug
Sep Oct

Nov Dec

Water-borne disease agentssuch as Vibrio bacteria, which cause

shellfish poisoningare affected by weather. Over a 14-year period in
Florida, a higher number of Vibrio-related illnesses and deaths
occurred during summer, when water temperature is higher. (Adapted
from Lipp and Rose, 1997).

In general, disease transmission by insects and

rodents is a complex process and unique for each
disease. Population characteristics, human behavior, and ecological factors play a critical role in
determining when and where disease occurs,
which makes it unlikely that increasing temperatures alone will have a major impact on tropical
diseases spreading into the United States. There is
even greater uncertainty regarding diseases that
cycle through animals and can also infect
humans, such as Lyme disease and mosquito-carried encephalitis viruses.

Strategies That Could Reduce Risk

Improved disease surveillance
Enhanced insect-control programs
Vaccine development and improved
protections for U.S. travelers to diseaseendemic areas
Need for Research About
Climate and Health
Projections of the extent and direction of the
potential health impacts of climate variability
and change are extremely difficult to make
because of the many confounding and poorly
understood factors associated with potential
health outcomes, population vulnerability, and
adaptation. In fact, the relationship between
weather and specific health outcomes is understood for a relatively small number of diseases,
with few quantitative models available for analy sis. The costs, benefits and availability of
resources to address adaptation measures also
require evaluation. Research aimed at filling the
priority knowledge gaps identified in this assessment would allow for more quantitative assessments in the future.
From the Report to the President and Congress,
National Assessment Synthesis Team, 2001

The following research areas were among those

identified as priorities by the expert health
assessment team:
Research areas on heat-related illness and death
Improved prediction, warning, and response
systems
Relationship of weather to influenza and
other causes of winter mortality
Techniques to enhance urban design and
energy systems
Research areas on health impacts from
extreme weather events
Improved surveillance for long-term health
effects from storms
Techniques to enhance prediction, warning,
and response
Investigation of past impacts and effectiveness of warnings

Research areas on air pollution-related

health effects
Relationship between weather and air pollution concentrations
Relationships between exposure patterns and
health effects
Effect of weather on vegetative emissions and
allergens (such as pollen)
Research areas on water-borne and
food-borne diseases
Improved monitoring of weather/ecological
effects on marine-related disease
Impacts of land use and agriculture on water
quality
Enhanced monitoring and mapping of the
movement of contaminants in surface water
and groundwater, combined with improved
monitoring for human disease
Research areas on vector-borne and
rodent-borne diseases
Improved rapid diagnostic tests, especially in
the field
Enhanced disease surveillance strategies
Linkages between climate, altered ecology,
and infectious disease transmission
Expertise from many disciplines is required to
solve these important questions.
For More Information
The full assessment document was published
in the May 2001 special supplement issue
of the journal Environmental Health Perspectives.
Also, visit the health assessment Web site at
http://jhsph.edu/nationalassessment-health
or call 410/614-6976.
To view the official report to Congress, or for
information on the other sector and regional
assessment reports of the U.S. National
Assessment on the Potential Consequences of
Climate Variability and Change, visit the U.S.
Global Change Research Program Web site at
http://www.usgcrp.gov/usgcrp/library/
nationalassessment
This health assessment is sponsored by the U.S.
Environmental Protection Agency, Global Change
Research Program
(http://www.epa.gov/globalresearch).