Death By Degrees Washington PSR Free Report

PSR PHYSICIANS FOR SOCIAL RESPONSIBILITY BY DEGREES THE HEALTH THREATS OF CLIMATE CHANGE IN WASHINGTON W A S H I N G TO N R E P O R T PSR PHYSICIANS FOR SOCIAL RESPONSIBILITY BY DEGREES THE HEALTH THREATS OF CLIMATE CHANGE IN WASHINGTON Physicians for Social Responsibility Robert K. Musil, PhD, Executive Director Sharon Newsome, Director, Environment and Health Program Karen Hopfl-Harris, JD, Associate Director Lara Hensley, Grassroots Organizer Ann Hwang, Associate PSR Death by Degrees Medical Consultant Kent J. Bransford, MD Washington Advisory Board Robert L. Drury, PhD, President, The Hermes Group, Richland, WA Martin Fleck, Executive Director, Washington Physicians for Social Responsibility, Seattle, WA Richard Hoskins, PhD, MPH, Washington State Public Health Geographer and Senior Epidemiologist, Washington State Department of Health, Olympia, WA Jane Q. Koenig, PhD, Professor, Environmental Health, University of Washington, Seattle, WA Conway Leovy, Emeritus Professor, Atmospheric Sciences and Geophysics, University of Washington, Seattle, WA Peter M. McGough, MD, FAAFP, Family Physician, Associate Clinical Professor, University of Washington School of Medicine, Past-President, Washington State Medical Association and Washington Physicians for Social Responsibility Tim K. Takaro, MD, Clinical Assistant Professor, University of Washington Occupational and Environmental Medicine Program, Seattle, WA July 2000 This report was prepared by Physicians for Social Responsibility to alert Washington residents to the potential health effects of climate change and to encourage them to reverse global warming’s deadly course by reducing reliance on fossil fuels. 2 PHYSICIANS FOR SOCIAL RESPONSIBILITY 1101 Fourteenth St., NW, Suite 700 Washington, DC 20005 tel: (202) 898-0150 fax: (202) 898-0172 website: www.psr.org D E ATH BY D E GR E ES Executive Summary: Death by Degrees The rapid rate of warming since 1976, 0.35 degrees per decade, is consistent with the projected rate of warming based on human-induced effects. In fact, scientists now say that they cannot explain this unusual warmth without including the effects of both human-generated greenhouse gases and aerosols. —D. JAMES BAKER, ADMINISTRATOR, U.S. NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION The world is getting warmer at an unprecedented rate— and human activities may be the culprit. During the past one hundred years, average global surface temperatures have increased by approximately 1 degree Fahrenheit. In the next one hundred years, scientists estimate that the earth’s average surface temperature will increase another 1.6 to 6.3 degrees F.1 Each and every year from 1987 to 1999 has been one of the fifteen warmest years on record.2 Although uncertainties exist in measuring global warming, an overwhelming consensus has emerged over the past decade among scientists on several key points. First, the increase in temperature is real. Second, human activities—in particular our burning of fossil fuels—are affecting the climate system.3 Third, global warming could have significant impacts on our health and well-being.4 This report describes the impacts that climate change could have on human health. We focus on Washington, a state likely to face serious challenges due to climate changes. Washington typically experiences large seasonal variations in precipitation, with dry summers and wet winters. Nearly all climate models predict that global climate change will exacerbate these conditions, making summers drier and winters wetter,5 thereby increasing the intensity and frequency of floods in winter and the risk of drought in summers. Floods not only destroy property and threaten lives, but also increase the risk of infectious disease and cause psychological stresses, ranging from depression to post-traumatic stress disorder. Droughts may threaten the agricultural sector of Washington’s economy, impair hydroelectric power generation on which Washington is heavily dependent, increase the risk of certain kinds of infectious diseases, and increase the risk of forest fires. Future climatic conditions may increase the intensity and frequency of extreme weather events—snow, floods, storms, high winds, and The Health Threats of Climate Change in Washington 3 lightning—that incur high health and economic tolls. Washington is among the leaders in Presidentially-declared weather disasters, with four in 1997 alone.6 An outsider may think of Washington as having a relatively cool climate. However, since 1951 there have been 71 three-day heat waves in Seattle and 72 in Spokane.7 The predicted increase in Washington’s average summer temperature of approximately 4–5 degrees F (2–3 degrees C) could double the frequency of very hot How Global Warming Could Threaten days.8 Hot days increase the risk of Health in Washington: heat-related death and illness, • Global warming could increase the number of severe particularly among vulnerable weather events in Washington, already a leader in Presidenpopulations such as the elderly, the tially-declared weather disasters with four in 1997 alone.11 very young, people with pre-existing health conditions, and the poor. • Severe flooding in Washington in February 1996 killed 12 Warmer temperatures due to global three and caused an estimated $800 million in damages. climate change could exacerbate More frequent and severe floods could further destroy property, cause injuries, and spread illnesses through Washington’s air pollution problems. contaminated water. Increased levels of ground-level ozone and other irritants may in turn • Earlier snowmelts and higher temperatures could cause worsen respiratory illness among more summertime droughts, like the drought of 1999, Washington residents. The Washingthreatening agricultural production, compromising water ton State Department of Health quality, and impairing hydroelectric power generation. estimates that one in nine Washing• More extreme weather events could cause more landslides ton adults and one in ten of the like the January 1997 landslide in Snohomish County that state’s children have been diagnosed brought down 75,000–150,000 cubic meters of earth, with asthma,9 a condition that makes swept five cars of a passing freight train into Puget Sound, them more sensitive to worsening air and killed a family of four.13 quality. • Warmer temperatures could expand the habitat of ticks that Infectious diseases may also be on carry Lyme disease and lengthen the season during which the rise. Since the first case reported people are outdoors, increasing the state’s average of in the United States in 1993, there fourteen cases per year.14 have been 235 cases of hantavirus • Warmer ocean temperatures and changes in water stratificainfection in the United States, 21 of tion could increase shellfish contamination incidents by which were in Washington. Warmer bacteria, such as Vibrio parahaemolyticus which sickened weather may increase the range of 56 Washingtonians in July and August of 1997.15 the rodents that carry the virus and • Warmer summer temperatures could worsen air pollution by the window of time for transmission increasing concentrations of ground-level ozone and other to humans. This is true for other pollutants in the air that exacerbate asthma, a condition infectious illnesses, including illnesses suffered by one in nine adults and one in ten children in the transmitted by insects (ticks and state.16 mosquitoes) as well as by food and water contamination. Seafood contamination is a particularly serious threat to Washingtonians. Bacterial contamination of shellfish, such as the 1997 outbreak of Vibrio parahaemolyticus that caused 56 confirmed cases of illness in Washington,10 and the prevalence of deadly algal toxins could increase as the climate changes. Sea-level is predicted to rise due to global warming. The rising water level could increase flooding in low-lying coastal areas, cause salt water to intrude 4 D E ATH BY D E GR E ES into groundwater supplies, and contaminate groundwater with wastes. Natural subsidence of Puget Sound due to geological movements could further magnify the impacts of sea-level rise associated with global climate change. The state’s population and industry are both more heavily concentrated in the western half of the state, particularly around Puget Sound, which is precisely the region expected to face the most serious risks from rising sea levels. The aerospace and technology sectors have brought growing numbers of people to the state. The burgeoning population could further stretch Washington’s water resources, predicted to become more scarce with global climate change. Washington also has a wealth of natural resources—forests, waterways, coastline, and wildlife—and a thriving economy has grown up around these resources. Washington’s close economic and geographic ties to nature could make the state particularly vulnerable to the effects of global climate change. Residents of Washington need to be deeply concerned about global warming. In this report, we describe some of the effects global warming is anticipated to have on Washington state. The Complex Origins of Climate Change Since the end of the last Ice Age 10,000 years ago, temperatures worldwide have risen about 9 degrees F, mainly due to natural changes in the geographical distribution of the sun’s energy and in the amounts of dust, carbon dioxide, and other gases in the atmosphere. In recent years, the rate of increase in temperatures has been accelerating. On any given day, the average temperature is about 1 degree F higher than it was a century ago. Seven of the ten warmest years in recorded history occurred in just the last decade, with 1998 topping them all.17 Some greenhouse gases, such as carbon dioxide, methane, nitrous oxide, and water vapor, occur naturally, residing in the atmosphere and insulating the earth. These gases retain heat from the sun’s rays and keep the earth’s surface some 60 degrees F warmer than it otherwise would be.18 However, the amount of greenhouse gases in the atmosphere has been rapidly increasing. Since the beginning of the industrial revolution, atmospheric concentrations of carbon dioxide have increased nearly 30 percent, methane concentrations have more than doubled, and nitrous oxide concentrations have risen by about fifteen percent.19 These increases have enhanced the heat-trapping capacity of the earth’s atmosphere. Human activities are among the most important factors making the Earth warmer. Fuel burned to run cars and trucks, heat homes and businesses, and power factories generates approximately 80 percent of carbon dioxide emissions in the United States.20 Deforestation, livestock production, landfills, industrial production, and mining can also change the levels of greenhouse gases by increasing emissions or by decreasing the absorption of gases by plants. In 1994, the United States was responsible for releasing about one-fifth of global greenhouse gas emissions into the atmosphere.21 If current trends continue, carbon dioxide concentrations could increase by 30 to 150 percent by the year 2100.22 Scientists recently detected a new greenhouse gas 18,000 to 22,200 times more powerful than carbon dioxide, with an atmospheric life span of 3,500 years. 23 The gas trifluoromethylsulphur pentafluoride, or SF 5CF 3, has been found in the atmosphere five to twenty miles above the Earth’s surface, where it contributes to global warming by absorbing heat radiating from Earth’s surface. Researchers do not yet know where the gas comes from but levels have increased from near zero in the late 1960s to 0.12 parts per trillion in 1999. SF5CF 3’s long lifespan means that unless its production is prevented, its levels can be expected to increase as it accumulates in the atmosphere. It, along with other greenhouse gases, will remain there for centuries, trapping heat and threatening human health. The Health Threats of Climate Change in Washington 5 Are We Already Experiencing the Effects of Global Climate Change? Recent scientific studies suggest that global warming may already underway. Scientists at the National Climatic Data Center (NCDC) reported earlier this year that global warming rates appear to be accelerating.24 For sixteen consecutive months (May 1997 to September 1998) each month broke the previous monthly world average temperature record. According to Thomas R. Karl, lead author of the NCDC paper, there is only a one-in-twenty probability that this string of record high temperatures was simply a chance event.25 A recent National Academy of Sciences report states that there is no question that Earth’s warming has accelerated during the past two decades.26 In January, 2000, scientists at NASA’s Jet Propulsion Laboratory announced that the persistence of La Niña and El Niño events—which cause abnormal sea-surface temperatures thereby affecting worldwide weather patterns— might be part of a larger, long-lasting climate pattern.27 One criticism levied against many climate models that predict the impacts of greenhouse gases is that the earth’s atmosphere is not warming as rapidly as predicted. A report by researchers at the National Oceanographic Data Center and National Oceanic and Atmospheric Administration suggests that the world’s oceans, which can store and transport large amounts of heat, FIGURE 1 The Greenhouse Effect Some of the infared radiation passes through the atmosphere, and some is re-emitted in all directions by greenhouse gas molecules. The effect of this is to warm the Earth’s surface and the lower atmosphere. Some solar radiation is reflected by the Earth and the atmosphere. ATMOSPHERE Most radiation is absorbed by the Earth's surface and warms it. Infrared radiation is emitted by the Earth's surface. Energy from the sun drives Earth’s weather and climate, as shown in this illustration. Water vapor, carbon dioxide and other atmospheric greenhouse gases trap some of the sun’s energy, creating a natural “greenhouse effect.” However, problems arise when the greenhouse effect is enhanced by human-generated emissions of greenhouse gases, such as through the burning of fossil fuels. 6 D E ATH BY D E GR E ES could be storing this missing heat, thus helping to explain the inconsistencies in past climate forecasting.28 Researchers found that the earth’s oceans have warmed since the 1950s. This stored heat may be an early indicator of the further warming of air and sea temperatures in the next ten years.29 The similar warming patterns in the Pacific and Indian Oceans suggest that the same phenomenon is causing the changes in both oceans. Many Washingtonians are Vulnerable to the Health Effects of Climate Change Many Washington citizens, such as the young, the sick, and the elderly, are particularly vulnerable to the potential health effects of climate change.30 Socio-economic factors also put the poor and some minorities at higher risk. Children are at risk because their immune and other protective systems are not yet fully developed. They may also be more susceptible to air pollution because their lungs are still developing, they spend more times outdoors in the summer, and they take in more air on a per-weight basis.31 Children less than a year old are most sensitive to heat stress because their heat-regulatory systems have not fully matured.32 The simple fact that a child’s body surface area is proportionally greater than an adult’s makes that child more susceptible to heat and cold. A child dehydrates more easily due to external heat or fever compared to an adult with the same fever or in the same external temperatures. Individuals with existing illnesses are especially sensitive to heat stress, air pollution, and other possible effects of global warming. People with cardiovascular and respiratory illness or impairment are less able to adapt to additional physical stress caused by warmer and more humid environments. Air pollution has also been shown to have an especially severe impact on those suffering from heart and lung disease.33 Cardiovascular disease, including coronary heart disease and stroke, is the leading cause of death in the United States. Higher average temperatures could further elevate this statistic. It is also possible that warmer winters could reduce the number of deaths in winter months, however experts agree that the relationship between winter weather and mortality has been difficult to interpret. 34 In addition, many Washingtonians have behavioral factors that would put them at higher risk of developing these diseases. For example, 15 percent of adults are obese,35 23.8 percent smoke,36 and 19 percent lead a sedentary lifestyle.37 Several factors could make Washington’s elderly more susceptible to the potential health-related impacts of global climate change, particularly to heat-related illness. Elderly individuals may have less efficient heat-regulating systems. The temperature at which sweating begins is higher, affecting their ability to adjust to warmer temperatures. In addition, the elderly may have a harder time perceiving changes in temperature, preventing them from taking appropriate measures to prevent overheating. Pre-existing conditions such as cardiovascular or pulmonary diseases make a person more vulnerable to the effects of heat. Some commonly-taken medications, such as tranquilizers and anticholinergics, also increase susceptibility to heat-related illnesses.38 The Health Threats of Climate Change in Washington 7 Poverty can be an important risk factor for poor health status.39 Rates of children hospitalized for asthma, for example, increase as family income declines.40 If global warming Members of the 26 Native American tribes in Washington could increases levels of air pollution, be disproportionately affected by the potential health impacts poorer populations may be hit of global climate change. hardest. The poor in Washington’s Research by the Centers for Disease Control and Prevencities may also be at higher risk for tion found Native Americans in Washington to have several risk death from heat. Urban heat islands factors that could make them more susceptible to the adverse can have temperatures 9 degrees F health effects likely to occur with climate change.47 Higher rates of Native Americans report that in the last twelve months cost higher than surrounding areas.41 Heat was a barrier to obtaining health care. More Native American islands are created by heavily adults reported not having a physical examination in the past concrete, brick, stone, and asphalt two years compared to Washingtonians as a whole, and 20.8 laden urban architecture and a lack percent of Native Americans reported having fair or poor of shade, trees, and air flow in urban health status compared to 10.5 percent of the general environments.42 population. Individuals without medical Behavioral patterns could also put some Native Americans insurance may also be more suscepat higher risk for health problems associated with climate tible to the potential health effects of change. In 1997, 36.7 percent of Native American adults in climate change because they do not Washington were estimated to be smokers compared to 23.8 routinely see health care providers. percent for the population as a whole. 48 Poor respiratory health They may delay seeking treatment could make smokers more sensitive to air pollution problems aggravated by global climate change. More than twice the until a condition is severe or at a percentage of Washington Native Americans are obese more advanced, less-treatable stage.43 compared to the general population (32.3 percent compared Several research indicators show to 15.2 percent).49 Obesity can make individuals more African-Americans, Hispanics, and vulnerable to extreme heat.50 Native Americans in Washington to Diabetes, another risk factor that can increase vulnerability have poorer health status and less to heat,51 also disproportionately affects Native Americans: health insurance than the general nearly ten percent of Native Americans in Washington reported population. Rates of infant mortality, having had a diagnosis of diabetes, compared to 4.1 percent for example, are more than twice as for the population as a whole. high for African-Americans than for whites.44 African-American, Hispanic, and Native American Washingtonians are less likely to receive prenatal care.45 A University of Washington report found that the percentage of African-American, Hispanic, and Native American children without health insurance was twice the rate for whites.46 Indigenous Peoples May Disproportionately Suffer the Impacts of Global Warming Weather Extremes May Increase Illnesses and Deaths Related to Floods, Droughts, Storms, and Heat Global warming means not only higher temperatures, but also more unpredictability in weather patterns and more extreme weather conditions.52 Greenhouse gas concentrations increase heat and moisture in the atmosphere. Heat and water vapor create instability, leading to more frequent, and possibly more severe, weather activity.53 This could mean more floods, storms, 8 D E ATH BY D E GR E ES droughts, heat waves, and other natural disasters. Extreme weather can cause profound human suffering and huge economic losses. In 1998, extreme weather events caused 455 deaths and over $24.6 billion in economic losses nationwide.54 Washington is among the nation’s leaders in Presidentiallydeclared weather-related disasters, with four in 1997 alone.55 Weather extremes and temperature fluctuations can have wide-reaching health impacts, including illness, injury, and death. Water contaminated with chemicals or disease-causing micro-organisms can spread illness even after storms have ended. Power outages resulting from floods or storms could encourage the use of alternate heating and cooking sources, which, if used improperly, can increase the risk of carbon monoxide poisoning. Residents displaced from their homes by natural disasters can also experience psychological problems, ranging from depression to post-traumatic stress disorder.56 Washington typically experiences large seasonal variations in precipitation, with dry summers and wet winters. Nearly all climate models predict that global climate change will make summers drier and winters wetter.57 Climate change could also significantly impact the water supply for Washington state. Much of the state, particularly east of the Cascades, depends on snow cover for water.58 Warmer temperatures mean that the snow cover could melt earlier in the season, increasing early spring river flows and the likelihood of floods, and diminishing supplies available in the summer. Moreover, higher temperatures cause plants to draw water out of the soil at a faster rate. Therefore, the future could hold both an increased risk of flooding in the wet season and droughts in the summer. More Frequent and Severe Floods Could Cause Injuries and Illness We were flabbergasted, to be honest with you. Our best information is that global warming is having an impact on rainfall now.59 —THOMAS R. KARL, NATIONAL CLIMATIC DATA CENTER Precipitation in the Pacific Northwest has been increasing at an average rate of 2.9 inches per century, a rate consistent with models of global climate change.60 Some areas of the state, especially western Washington, saw a twenty percent increase in precipitation in the past century.61 In 1998–9, Olympia, Seattle, and Quillayute experienced record precipitation totals for the November to February period, with Quillayute exceeding by nearly 30 inches its previous record of 60.89 inches. Seattle tied its record of 87 days of precipitation in the same four-month period.62 By the year 2100, global climate change is predicted to increase winter precipitation by an additional ten percent.63 Several large floods have battered Washington in the past decade. Flooding along much of the west coast of the United States in December 1996 to January 1997 caused $3 billion in damages and caused 36 deaths. Severe flooding in February 1996 killed three and caused an estimated $800 million in damages in Washington state alone. Much of the flooding occurred on the rivers of western and southeastern Washington. Statewide flooding in November 1990 killed two and caused an estimated $250 million in damages.64 The Health Threats of Climate Change in Washington 9 Increased rainfall, added to Washington’s already wet winters, could have devastating consequences. As the ground becomes saturated, additional precipitation can not be absorbed and instead swells stream and river flows, increasing the likelihood and severity of floods. Floods can cause dramatic destruction, injury, and death. In the aftermath of floods, more insidious problems, such as contamination of water supplies by disease-causing micro-organisms or toxic chemicals, can continue to threaten health. Researchers estimate that twenty to 40 percent of drinking-water related disease outbreaks in the United States in the last twenty years occurred during extreme precipitation events.65 Flood waters can carry disease and other contaminants. The Washington State Department of Health, like others around the country, routinely advises residents to thoroughly disinfect or dispose of items contaminated with flood water.66 Many cities in the Pacific Northwest (including Portland and Seattle), have sewage systems connected to the storm drain system. This means that in times of heavy rain when the storm sewers are full, untreated sewage overflows into regional waterways. Sewage and other wastes could be washed into water supplies, spreading organisms that cause infectious diseases. Earlier this year, well water contaminated with the bacteria E. coli caused eleven deaths and over 2,000 cases of illness in Walkerton, Ontario. Officials suspect that heavy rains may have washed E. coli-contaminated run-off into a municipal well. In 1995, an outbreak of toxoplasmosis in British Columbia sickened over 110 individuals.67 Toxoplasmosis is an infection caused by a parasite found in cat feces. Although most people experience only mild symptoms, infants and people with weakened immune systems may suffer severe harm, particularly to the eyes and brain.68 Extreme precipitation generated large amounts of runoff, which contaminated the Humpback Reservoir, serving the Greater Victoria area, with the infective eggs of the parasite.69 Over 300,000 wells in Washington that serve an estimated 900,000 residents are at risk from flood waters.70 The Washington State Department of Health advises users of well-water, “If your well is flooded, assume the water in your home is contaminated.” An increase in heavy rains and run-off from agricultural land may increase contamination of water with pesticides.71 Chemicals stored in underground storage tanks could also leak into water supplies.72 Industrial sites are another possible source of contamination. In 1986, flooding of the Chehalis River 10 D E ATH BY D E GR E ES engulfed the American Crossarm and Conduit Company’s site. At this site Heavy Rains Could Bring More pentachlorophenol (penta), a toxic Landslides to Washington chemical and wood preservative, was used to treat wood for utility poles. Along with flooding, the heavy storms of the past few years The site was also contaminated with have caused dramatic and disruptive landslides in Washington. Coastal areas, Puget Sound, the Blue Mountains, and the area dioxins. During the flood, water around Mount St. Helens are particularly susceptible to flowed onto the site and washed landslides. Landslides often occur during and after heavy penta and dioxins into the commuwinter snows and rains,82 the types of weather predicted to nity. One observer recalled, “The stuff occur with climate change. came into their homes up to three Mudslides may disrupt electricity, the water supply, feet, maybe 40 inches, high. A lot of sewage systems, and gas lines. They wash out roads and their furniture had to be burned. contribute to the health problems that occur when sewage or Some of the worst contamination was flood water spills down hillsides, contaminating drinking water. in the playground area, and we have Torn down power lines and fallen tree limbs can be dangerous videos of children riding their bikes and can cause electric shock. During a power outage, alterthrough the floodwaters.”73 nate heat sources, used improperly, can lead to illness from fire Exposure to penta through the or carbon monoxide poisoning.83 A record month of precipitation in Washington during skin, by inhalation, or by ingestion December 1996, which brought almost twice the normal may cause spasms, convulsions, amount of precipitation at the National Weather Service coma, headaches, dizziness, and station in Seattle, was followed by a January landslide in 74 personality changes. Penta also Woodway, in Snohomish County. Estimated at 75,000– 75 causes skin lesions. According to the 150,000 cubic meters, the landslide swept five cars of a Environmental Protection Agency passing freight train into Puget Sound.84 A few days later a (EPA), long-term exposure to penta family of four was killed by a debris flow at Rolling Bay Walk may cause reproductive effects and on Bainbridge Island.85 This winter storm and its associated damage the liver and kidneys. Some landslides was hardly an isolated event. Heavy rains in evidence suggests that penta could February 1996 and December 1998 also triggered destructive cause cancer.76 Dioxins are extremely landslides.86 Many parts of the state can be affected by toxic substances. They have been landslides: the highest concentrations of landslides triggered by the February 5–9, 1996 storms occurred in the northwest edge linked to a wide range of adverse of the Blue Mountains, near Walla Walla.87 health effects, such as cancer,77 birth defects,78 harm to the reproductive system,79 and immune system suppression.80 Though the American Crossarms site has since been paved over, similar toxic contamination incidents may happen at other sites if floods become more common and more severe in Washington state. Finally, flooding may also have significant negative psychological consequences. Residents displaced from their homes often experience psychological problems ranging from depression to post-traumatic stress disorder.81 Most climate change scenarios predict an increase in extreme weather events. This means that despite heavier rainfall at times that may precipitate the events described above, drought conditions are also predicted at different times throughout the year. The Health Threats of Climate Change in Washington 11 More Droughts May Compromise Washington’s Water Supply and Agricultural Industry and Increase the Risk of Forest Fires In an age where small American farms are struggling to survive, a season like this summer could bring many Washington farms to their end. —SEATTLE POST-INTELLIGENCER, AUGUST 20, 1999 Droughts threaten the health, well-being, and economy of the nation, causing economic and social losses comparable to that of major hurricanes.88 In addition to the loss of water available for drinking and agriculture, droughts can concentrate contaminants in water supplies, increase the risk of forest fires, and increase the levels of toxic substances in water used to irrigate agricultural crops. Climate change could bring more frequent and severe droughts to Washington as higher temperatures cause earlier snowmelts and increase water use, and as the number of months with rainfall decreases. East of the Cascades, Washington’s agricultural zone in the Columbia basin sometimes experiences low-water periods late in summer after water supplies from snowmelt are depleted. Soils and reservoirs retain only a fixed capacity of water; therefore, excess precipitation in the winter and spring, predicted to occur with climate change, would likely be lost as runoff rather than stored for summer use. Making matters worse, higher temperatures cause plants to increase their water uptake, further depleting the water supply. Droughts can concentrate micro-organisms in water supplies and cause water quality and supply problems in urban areas. In 1992, after earlier than usual spring snowmelts, the Seattle Public Utility released water from reservoirs to prevent flooding. A dry summer season followed leading to low water levels. During the drought, water quality problems arose. The water failed the state’s standards on fecal coliform count, indicating that the water could be contaminated with disease-causing micro-organisms, and had taste and odor problems.89 Water shortages in the Pacific Northwest may be more severe in the future because of the region’s rapid population expansion. Over the last thirty years, population growth in the Pacific Northwest has been twice the national rate, and the region can expect to add another 5 million people in the next 30 years. Droughts could also make Washington more vulnerable to forest fires. In October 1991, strong winds and very dry conditions fueled a fire started by downed power lines. The fire killed two and damaged or destroyed 100 homes.90 Forest fires can injure or kill firefighters and nearby residents. Smoke, which can cover a wide area, may increase respiratory illness, such as asthma and chronic obstructive pulmonary disease, particularly for people with pre-existing respiratory conditions.91 Washington’s large agricultural sector is vulnerable to droughts and other weather events. In 1995, Washington’s $4.4 billion worth of agricultural crops ranked it eighth in the nation in crop value.92 Agricultural production, processing, and marketing account for approximately $29 billion of the state’s total economy, or about twenty percent of the gross state product. Apples are now the state’s leading commodity, with Washington producing more than half of the nation’s apple crop.93 Thus, weather events that affect this sector 12 D E ATH BY D E GR E ES of the economy will also likely affect the personal income of many Washingtonians. The success of Washington’s agricultural sector is dependent upon its water supply. Currently, twenty-eight percent of all farm acres in Washington are irrigated.94 An inadequate water supply is likely the most important long-term impact climate change could bring to Washington’s agricultural sector, as too little water can result in social and economic devastation. The drought of 1999 scorched wheat fields and dashed hopes. Farmers in the southeastern pocket of the state who farm without irrigation were particularly hard-hit. The winter wheat crop yields were below average, and some farmers estimated they lost 30–40 percent of their crops.95 The U.S. Department of Agriculture declared parts of Washington drought disaster areas.96 Droughts may increase pests, weeds, and crop diseases. One study estimates that a roughly 4 degree F (2 degree C) rise in global mean temperature could cause a 30 percent decline in crop yields due to greater prevalence of plant disease in North America.97 Because weeds are better adapted to arid conditions than crops, intensified competition from weeds could cause an additional five to 50 percent loss of crops in the United States.98 Weather-stressed crops of corn, other cereal grains, and oil seeds can produce aflatoxin, a naturally occurring toxin that is potentially dangerous to animals and people.99 This toxic by-product of certain fungi is known to invade field crops under adverse environmental conditions, like those predicted to occur as the climate changes. For example, late-season moisture can promote fungus growth inside kernels that have been cracked open by The Health Threats of Climate Change in Washington 13 Extreme Weather May Affect Hanford’s Deadly Legacy The Hanford Nuclear Reservation in south central Washington produced plutonium and enriched uranium for use in the development of the atomic bomb. The site released radioactive materials directly into the air and into the Columbia River from 1944 to 1972.107 The soils at the site are extensively contaminated with radioactive and chemical wastes from direct discharges to the soil column of this desert steppe environment and from the thousands of unlined waste sites scattered around the site. Millions of gallons of highly radioactive wastes are still stored on the site in leaking waste tanks. According to the United States Department of Energy, over 60 million gallons of highly radioactive waste are stored in 177 underground tanks at Hanford. Over the years, at least one million gallons have leaked into the soil.108 Over 440 billion gallons of radioactive waste were discharged into the ground, contaminating the groundwater throughout much of the site.109 Weather could have particularly significant consequences in Washington due to Hanford’s deadly legacy. The increased precipitation and drought cycle is likely to increase the risk of range fires and affect the performance of waste site barriers designed for an arid environment. These impacts would increase the likelihood of unintentional release of radioactive and hazardous materials into the environment. Hanford began making plutonium in September 1944 and released radioactive materials into the environment for over 40 years.110 The first nuclear reactors at Hanford were first pass reactors, meaning that the water used to cool the reactor flowed directly over the radioactive fuel elements and was then discharged directly into the Columbia River. In the mid-1950s direct discharges into the river were replaced by discharges into trenches next to the river. These trenches and the soil column underneath remain highly contaminated. In some cases, such as at N-Springs, this contamination reaches groundwater and flows into the river.111 Radionuclides found in the groundwater include tritium, ruthenium-106, technetium-99, and iodine129.112 Iodine-129 has a half-life of 16 million years, meaning that any contaminated soil or water is likely to remain contaminated for many years to come. Uranium and strontium-90 are two other radionuclides of concern at Hanford. Chromium, a nonradioactive toxic chemical, was generated as a byproduct in the production processes at Hanford and is particularly toxic to young salmon. Radiation can cause cancer and other adverse health effects in humans. The children of parents exposed to radiation may have genetic defects or suffer from mental retardation.113 In addition to its impact on other species, chromium can damage the human kidney and liver, and may cause developmental defects.114 With the increased rainfall predicted to occur with global climate change, more frequent and severe floods would present more opportunities for contaminants to enter the groundwater and spill into streams, the Columbia River, and water supplies. Some radionuclides are bound to soil particles and are fairly immobile unless hydrostatic pressures or other conditions change (for example, more water moves through the soil). Even in non-flood conditions, higher rainfall, especially in winter, could increase the likelihood of these contaminants reaching groundwater. Water from rain and snow that does not evaporate or is not taken up by plants seeps through the contaminated soil. If it penetrates more than three meters deep, it can enter the groundwater supply. 115 Winter precipitation is particularly important because it is less likely to evaporate or be taken up by plants, and thus more likely to penetrate into groundwater. To help minimize this contamination, pilot barriers have been built. These barriers collect water and allow it to evaporate instead of entering the ground. However, these barriers were designed without taking into account the impact of increased rainfall. 116 As precipitation increases with global warming, these barriers may no longer be adequate.117 The summer droughts predicted to increase in Washington with global warming may bring their own health hazards. The Russian thistle, or sage brush, common in the area around Hanford, could contribute a particularly hazardous fuel for fires. The plants burn easily, like pine trees, because they contain highly combustible pherbol esters. Sage brush has a deep tap root, which brings buried waste up to the exposed part of the plant. These wastes could then burn in fires and be dispersed by the wind. Droughts, predicted to increase with global climate change, could dry plants, creating conditions that favor fires. A wildfire in August 1984 burned a third of the reservation,118 and CONTINUED ON NEXT PAGE 14 D E ATH BY D E GR E ES Hanford, continued smaller blazes are an annual occurrence. On June 29, 2000, a car crash sparked a fire which scorched 190,000 acres, destroying more than 70 buildings and injuring 15 people.119 Fires at sites with radioactive materials pose special threats to the health of the community and of emergency personnel combating the fire. A fire at Los Alamos National Laboratory in May 2000 burned nearly 300 contaminated sites.120 Air monitoring filters detected the release of radionuclides into the air.121 The destruction of vegetation, which normally helps to retain water and soil, increased the risk of flooding. Though laboratory officials insist there is no reason to worry, the attorney general of New Mexico has demanded proof that contaminated run-off from flood conditions will not threaten public health.122 Although the full range of problems caused by the recent fires at Los Alamos and Hanford are not yet fully known, residents living near these sites may have been relatively lucky. In the aftermath of the Los Alamos fire, a previously little-known study by the Department of Energy came to light. This study, conducted in 1997, postulated what might happen in the case of fire at Los Alamos.123 Burning plutonium and tritium-contaminated waste, both of which are likely to still be at Hanford, would send large doses of radiation into the air. Radioactive ash and dust could blow in the wind for weeks and months after a fire. drought.100 When ingested, aflatoxin may cause inflammation and cancer of the liver.101 Farmers may have a difficult time adapting to the variable weather conditions predicted to occur with climate change. While adaptation may be possible at a national or regional level, at the local level, communities dependent on specific crops or types of agriculture may suffer severely if global climate change causes changes in growing seasons or alters pest diversity.102 Washington’s shift in recent years away from annuals to perennials may also decrease the agricultural community’s ability to adapt and increase its vulnerability. Perennials require a greater initial investment and can take several years to provide a return on investment, compared to annuals which are replanted every year, require less water, and cost less. The loss of perennials could set farmers back on several years’ worth of investment.103 Finally, because Washington State is heavily dependent on hydroelectric power, droughts could create low-flow situations that compromise the energy supply. More than half of the state’s electricity in 1993 was generated by hydroelectric sources.104 The Columbia River is the greatest source of potential and actual hydroelectric power in the United States.105 Lower flows could reduce power generation capacities, especially if legally mandated minimum stream flows are needed to maintain fish and wildlife.106 More Illnesses, Injuries, and Fatalities Associated with Stormy Weather Washington has its share of severe storms, high winds, ice storms, and other extreme weather events. While scientists are less certain about how global climate change will affect these events, they do know that higher temperatures increase the frequency of air masses associated with inclement weather in winter.124 Thus, more frequent and intense storms may be on the way. Some climate models predict a deepening and southward shift of the The Health Threats of Climate Change in Washington 15 Aleutian Low, a low pressure system associated with El Niño weather patterns. The shifts in the low pressure system could bring more warm, wet storms to Washington toward the end of this century.125 One study estimates that a 3 degree F warming in Seattle would increase winter-related mortality from fifteen to about 40. Washington’s elderly—who may be less mobile and thus less able to evacuate quickly, less able to respond quickly to stressful events, and more prone to accidents—are particularly vulnerable.126 On May 31, 1997, six tornadoes touched down in Washington and thunderstorms produced large hail, heavy rain, flash flooding, and wind gusts up to nearly 80 miles per hour. The Spokane area ice storm of 1996 killed four and caused an estimated $22 million in damages. The increase in extreme weather conditions predicted to accompany global warming may greatly impact health, bringing more illness, injury, and death. Ice-covered walkways could increase the risk of falls. Downed electric power lines can cause fires, electrocutions, and explosions. If electrical power is disrupted, residents may not have access to public service broadcasts. Loss of effective refrigeration of foods could increase the risk of contamination. Depending on their severity, extreme weather events can tax, or even cripple, emergency care systems. The loss of power that often occurs during storms may result in an inability to run oxygen machines and other necessary medical equipment, thereby endangering the health of some Washingtonians. Carbon monoxide poisoning can be a major health consequence of severe storms. During power outages, people may be more likely to use alternative heat sources, often incorrectly. A wind storm that struck Washington in January 1993 interrupted power to an estimated 776,000 residents. Near freezing temperatures followed for four nights. Forty-four people who sought medical care were found to have carbon monoxide poisoning.127 Half of the victims did not speak English and may not have understood emergency broadcasts about how to prevent carbon monoxide poisoning. Carbon monoxide is an odorless, colorless, and tasteless gas produced from incomplete combustion of fuels containing carbon, such as kerosene and natural gas. It can bind to hemoglobin, preventing the hemoglobin from distributing oxygen to tissues.128 Carbon monoxide poisonings often occur during blizzards, when people sit in idling vehicles with exhaust pipes blocked by snow.129 Poisonings may also occur when people use inadequately ventilated back-up stoves and heaters. In Washington in 1993, many victims, all of whom belonged to racial or ethnic minorities, were exposed to carbon monoxide through burning of charcoal. Storms can also bring heavy ice and snow to parts of Washington. Large snowfalls and unexpectedly cold temperatures can pose a variety of health risks, such as hypothermia, frostbite, and heart failure. • Hypothermia is an unintentional lowering of the core body temperature to below 95 degrees F. An average of approximately eleven people die each year in Washington from hypothermia.130 Symptoms of hypothermia include slurred speech, disorientation, uncontrollable shivering, stumbling, and drowsiness.131 Serious cases can result in coma, low blood pressure, and cardiac irregularities. Elderly persons living alone are especially at risk.132 16 D E ATH BY D E GR E ES • Frostbite occurs when the skin is exposed to temperatures below 23 degrees F. The ears, nose, toes, and fingers become frozen and lose blood flow.133 Frostbite can permanently damage tissues, and the most severe cases may require amputation of the affected area.134 • Congestive heart failure is the most frequent reason for hospitalization among older adults.135 People with heart problems are vulnerable to temperature extremes because their cardiovascular systems must work harder to maintain a constant body temperature. The Washington State Department of Health warns residents to avoid strenuous exertion in winter because it can lead to heart failure.136 Direct Effects of Heat on Health The thirteen years from 1987 to 1999 are each among the fifteen warmest years on record. Global land temperatures in 1999 made the year the second hottest year recorded, beaten only by temperatures in 1998. Over the last century, the average temperature in Ellensburg, Washington has increased from 46.2 degrees F to 47.2 degrees F.137 The rise in temperature is predicted to escalate with global warming: by the year 2100 temperatures in Washington are expected to increase by about 5 degrees F in winter and summer, and 4 degrees F in spring and fall.138 People living in places like the Columbia Basin, with its higher summer temperatures, could be at more risk for heat-related illnesses. Though Washington’s current high temperatures and humidity levels remain lower than those in some states, rising temperatures could in fact have the greatest impact in temperate zones. As temperatures increase around the globe, temperate regions are expected to warm disproportionately more than tropical and subtropical zones.139 A relatively small increase in average temperature could have dramatic effects on extremes. The frequency of very hot days in temperate climates is expected to approximately double for an increase of 4–5 degrees F (2–3 degrees C) in the average daily summer temperature.140 People in temperate zones who are unaccustomed to periods of excessive heat may be less prepared to cope with higher temperatures and thus more at risk.141 Heat waves can cause a number of heat-related illnesses as well as death. According to the Centers for Disease Control and Prevention, from 1979 to 1996, an average of 381 people died each year from exposure to extremely high temperatures.142 In particularly hot years that number can increase dramatically. For example, during the summer heat wave in Chicago from July 11–27, 1995, 465 deaths were classified by the Cook County Medical Examiner’s Office as heat-related.143 The true toll of Chicago’s heat wave is likely to have been even higher. The number of “excess” deaths—or deaths over what is normal for that time of the year—was close to 700.144 The Washington State Department of Health notes that even short periods of exposure to extreme heat can result in heat-related illnesses, and that all people are susceptible when temperatures rise above 90 degrees.145 An outsider may think of Washington, especially Seattle, as having a cool climate. The Health Threats of Climate Change in Washington 17 However, since 1951, there have been 71 three-day heat waves in Seattle and 72 in Spokane.146 In 1998, Spokane had 33 days where the temperature was 90 degrees or more.147 Heat taxes the cardiovascular system and can aggravate existing medical conditions, particularly in the elderly, young, and chronically ill, who are less well equipped physiologically to cope with heat.148 Due to the increased metabolic demands of pregnancy, pregnant women may be more sensitive to heat and humidity.149 The urban poor are also vulnerable, due to poor housing, lack of access to air-conditioning, and exposure to urban “heat island” effects.150 Farmworkers who are exposed to heat over extended periods of time are also at increased risk.151 Some elderly people may have conditions that put them at increased risk, including poor circulation, inefficient sweat glands, and changes in the skin caused by the normal aging process. Heart, lung, and kidney diseases, as well as any illness that causes general weakness or fever, may make individuals more susceptible to heat-related illness. Changes in diet, such as low-salt diets recommended for people with high blood pressure, and impaired perspiration due to medications could decrease the body’s ability to adapt to high temperatures.152 Other risk factors include being substantially overweight or underweight and drinking alcoholic beverages.153 Lack of access to fans, air conditioners, or cooled public spaces can also put people more at risk.154 Compounding the public burden of heat waves is the fact that as excessive heat increases so does the death rate for other medical conditions.155 Symptoms such as headache, nausea, and fatigue after exposure to heat may indicate a heat-related illness. Three common heat-related illnesses are heat cramps, heat exhaustion, and heat stroke. • Heat cramps are muscle spasms that primarily affect people who exert themselves through strenuous work or exercise. Mineral imbalances likely cause these cramps and salt and water replacement usually relieves them. A more severe condition is exertional heat injury that commonly occurs among runners who are not properly conditioned and hydrated. The body can reach 102 to 104 degrees, with symptoms that include goose bumps, chills, nausea, vomiting, and an unsteady gait. In severe cases, people may have incoherent speech, or even lose consciousness. Muscles, kidneys, and blood cells may be damaged. • Heat exhaustion is a warning that the body is getting too hot. It occurs when the cardiovascular system cannot keep up with heat demands. The affected individual may have clammy, flushed, or pale skin, sweat profusely, feel weak, faint, dizzy, or nauseated, and breathe rapidly and shallowly. When moved to a cool place, victims of heat exhaustion usually recover, though some may require hospitalization. • Heat stroke is a life-threatening disorder in which the body is no longer able to maintain a normal body temperature, and the body’s temperature rises to over 104 degrees F. Damage to the kidneys, muscles, heart, and blood cells may occur. Sweating stops altogether. Heat stroke can result in coma or death, and immediate medical attention is necessary. 18 D E ATH BY D E GR E ES Sea-level Rise May Threaten Water Supplies and Displace Coastal Residents We don’t yet know, and in the near term can’t know with absolute certainty, when sea level rise acceleration will begin, and precisely how much sea level will rise in the future. Research evidence tells us that sea level is rising, and solid scientific theory tells us that the rate of rise may increase substantially in the future. Logic, therefore, tells us that we must prepare for changes in our planning for coastal land uses and facilities while monitoring sea level rise.156 —DOUGLAS J. CANNING, SHORELANDS & WATER RESOURCES PROGRAM, WASHINGTON DEPARTMENT OF ECOLOGY On the Seattle coast, the sea has been rising at the rate of eight inches per century and it is likely to rise another nineteen inches by 2100 due to climate change.157 The rising waters may have dramatic impacts in Washington state: inundating low-lying areas; increasing residential, commercial and industrial property damage in coastal areas from storms and flooding; intruding into groundwater supplies; contaminating water with waste from disposal sites; and decreasing the effectiveness of on-site sewage disposal facilities. As the ocean warms, it expands. Warmer temperatures also melt glaciers and Antarctic ice shelves, which contribute to rising sea-levels. One of the largest icebergs ever observed broke off from Ross Ice Shelf in Antarctica in March 2000.158 At 183 miles by 22 miles, it was more than twice the size of Delaware. Two weeks later, a new iceberg, this one just larger than New York’s Manhattan Island, broke off of the same ice shelf.159 Glaciers in Washington’s Olympic National Park have also been melting and scientists predict that the glaciers in Glacier National Park could be gone by 2030.160 Natural subsidence of Puget Sound due to geological movements could further magnify the impacts of sea-level rise associated with global climate change. Washington’s geography renders it vulnerable to the impacts of sea-level rise. The heavily urbanized area around Seattle houses more than half of the state’s population and much of its industry, and the shoreline contains valuable beachfront property.161 These properties as well as coastal agriculture and aquaculture could be threatened by sea-level rise. Estuaries, where major rivers enter the ocean, are especially vulnerable to flooding.162 Some urban areas, including Olympia, located on the Deschutes River mouth on south Puget Sound, Aberdeen (on the Chehalis River mouth), and Raymond (on the Willapa River mouth), lack adequate flood control to prevent periodic flooding.163 In addition, the Puget Sound region contains tidal flats and river deltas with salt marshes and swamps. A one to three foot rise in sea level could eliminate half of the remaining tidal flats.164 Some regions, such as southern Willapa Bay, could be particularly hard hit: a forty-inch (one-meter) rise could eliminate over 80 percent of the area’s freshwater marsh and two-thirds of its beach.165 The rising sea-level could also erode coastal bluffs and make the land unstable. Landslide episodes, which already occur along many Puget Sound shoreline bluffs, could escalate.166 The Health Threats of Climate Change in Washington 19 FIGURE 2 Budd Inlet Potential Sea-level Rise in Olympia by 2100 Area presently submerged by the 100-year flood West Bay East Bay Expanded floodplain predicted for the year 2100 with sea-level rise due to global warming Thurston Avenue 5th Avenue Note: Elevations are based on 1983 aerial survey data and may not reflect recent measures to fill in low-lying areas. Source: City of Olympia, Public Works Department. Preliminary Assessment of Sea Level Rise in Olympia, Washington: Technical and Policy Implications. June 1993. Increases in extreme weather expected with global climate change could amplify the impact of sea-level rise. A higher average sea-level means that storm surges may threaten flooding over larger areas. Sea level also tends to be higher than normal during El Niño years—approximately two to four inches in south and central Puget Sound.167 The El Niño weather pattern has been occurring more frequently since the mid-1970s168 and it is possible that this increased frequency is linked to global climate change.169 If that is the case, more El Niño storms may create more problems in the future for Washington’s shoreline communities. Sea-level rise could also affect health by threatening the groundwater supply. Higher sea levels could aggravate existing problems with inland migration of sea water and intrusion into fresh water aquifers in Island and San Juan counties and along the shores of Hood Canal.170 Sea-level rise could also force a rise in coastal water tables, increasing the risk that contamination from underground storage tanks and coastal solid and hazardous waste sites, particularly the older sites, could migrate through groundwater and discharge into coastal bays.171 Soils saturated with sea water may speed corrosion of underground storage tanks.172 Prior to the 1970s, coastal communities often situated waste disposal sites in low-lying coastal areas. As these sites become enveloped by rising water tables, their contaminants could be released into the ground water stream and transported 20 D E ATH BY D E GR E ES into coastal bays.173 Further compounding the problem is the fact that the locations of some of these disposal sites are not precisely known. Thirty of 39 dioxin clean-up sites in Washington state are in coastal counties.174 Sea-level rise could inundate or threaten to flood these sites during storms. Contaminants could wash into the water supply or seep into the soil, creating long-lasting health problems. Many communities on Washington’s shoreline treat their sewage by passing the sewage onto a drainage field. As the sewage trickles through the ground, the soil acts as a natural filter, purifying the water before it returns to groundwater. As the water table rises, more and more of the soil layers become saturated. Once saturated, the ground is a less effective filter, increasing the risk of drinking water contamination.175 These on-site systems can also become flooded and leach into the ocean. Contamination from sewage disposal systems have forced the closing of shellfish beds throughout Puget Sound and in Willapa Bay.176 Rising water tables may bring more such contamination incidents.177 Strategies to combat the effects of sea-level rise in Washington could be costly. Adaptation strategies include retreating from the advancing sea and elevating houses and infrastructure. Air Pollution and Respiratory Illness May Increase Overall, one in nine Washington adults and one in ten of the state’s children have been diagnosed with asthma. It’s reaching epidemic proportions.178 —STEVE MACDONALD, WASHINGTON STATE DEPARTMENT OF HEALTH Heat can decrease air quality by increasing the levels of some pollutants, such as ozone and volatile organic compounds (VOCs). Both ozone and VOCs can harm human health. Climate change may also affect pollen levels, which exacerbate allergies. Warmer temperatures due to global climate change could increase Washington’s air pollution problems, especially in urban areas. Increased levels of ground-level ozone and other irritants would worsen respiratory illness among Washington residents. Smog Ground-level ozone is the major component of what we commonly call smog, the most pervasive outdoor air pollutant in the United States. Smog is at its worst on hot, sunny days, which are likely to become more numerous with global warming. With more hot weather on the way, Washington could experience increased ozone-related health problems. Ozone is a toxic and irritating gas that, even in small amounts, can harm the lungs. It is formed by the interaction of VOCs with nitrogen oxides in the presence of heat and light. VOCs are emitted from vehicles, industrial sources, and consumer and commercial products. Vehicles and power plants emit nitrogen oxides. Exposure to elevated ozone levels can cause severe coughing, shortness of breath, pain when breathing, lung and eye irritation, and greater susceptibility The Health Threats of Climate Change in Washington 21 to respiratory illnesses such as bronchitis and pneumonia.179 Higher ozone levels have been shown to cause more asthma attacks, increase the need for medication and medical treatment, and result in more hospital admissions and emergency rooms visits.180 High ozone levels pose especially serious risks for those with chronic heart and lung disease, the very young and very old, and pregnant women.181 Ozone could also cause cardiovascular problems in people with high blood pressure or other risk factors.182 Even moderately exercising healthy adults can experience from a fifteen, to an over twenty, percent reduction in lung function from exposure to low levels of ozone over several hours.183 And, some healthy people simply are more sensitive to ozone than others, experiencing more health effects from ozone exposure than the average person.184 A recent Harvard Medical School study has found a link between air pollution and heart problems.185 An individual’s heart rate varies somewhat throughout the day, depending on the person’s physical activities and emotions. The heart of a healthy person is generally able to respond quickly to activity changes, such as going from a state of rest to exercising. On days with high ozone levels, however, the test subjects had reduced heart rate variability.186 Everyday air pollution may therefore impair the heart’s ability to change the speed at which it beats, which could lead to heart-related problems and death.187 Increases in ozone pollution due to higher temperatures brought about by climate change could have particularly profound impacts in Washington given the high number of residents who already suffer from respiratory illness. The Washington State Department of Health found that one in nine Washington adults and one in ten of the state’s children report being diagnosed with asthma, a condition in which the airways of the lungs become either narrowed or completely blocked, making breathing difficult.188 The number of children with asthma has grown dramatically in recent years, and it is now the most common chronic childhood disease, affecting an estimated 4.8 million children in the United States.189 In Washington the disease is estimated to affect over 600,000 individuals including over 150,000 children.190 Scientists estimate that a warming of 4 degrees F could increase ozone concentrations by five percent.191 Washington already has days when ozone levels climb dangerously high. In July 1998, high ozone levels exceeding the federal standards caused the director of the Puget Sound Air Pollution Control Agency (now the Puget Sound Clean Air Agency) to warn people with respiratory problems to stay inside.192 In September 1999, the Puget Sound Clean Air Agency issued a smog watch, after hot weather and a temperature inversion—when temperatures increase, instead of decrease, with altitude— made the area especially prone to high ozone levels.193 Seven times in 1998, Washington exceeded the EPA standard for ozone of 120 parts per billion (ppb) average over a one-hour period.194 The EPA found that ozone caused adverse effects even at levels below this standard.195 The agency is phasing in a new standard of 80 ppb over an eight-hour period. The new standard is designed to take into account the harmful impacts of longterm exposure to ozone, including increased hospital admissions, aggravation of respiratory illnesses, and impaired lung function.196 Washington may find it even more difficult to meet this new federal standard.197 22 D E ATH BY D E GR E ES Washington’s booming population and increasing vehicle pollution could augment Washington’s ozone problems. In King, Pierce, and Snohomish counties, people are driving 74 million miles, or three-quarters the distance to the sun (93 million miles), each typical workday, according to the Washington State Department of Ecology.198 In addition, motor vehicles themselves are a significant source of carbon dioxide, a greenhouse gas that causes global warming. Volatile Organic Compounds (VOCs) VOCs are released into the air by power plants, municipal waste incinerators, motor vehicles, solvent use, and the chemical and food industries. VOCs consist of a variety of hazardous substances, such as benzene, butanes, and toluene. VOCs in the air have two major health impacts: they are precursors to the photochemical production of ozone, and some VOCs are directly toxic. These hazardous air pollutants are associated with cancer and adverse neurological, reproductive, and developmental effects.199 Higher temperatures cause VOCs to evaporate and disperse more rapidly into the atmosphere, causing ozone formation and health problems near and far from the pollutant’s source.200 Pollen As the mercury in a thermometer starts to rise on warm days, pollen counts tend to rise as well. Many scientists believe that rising temperatures will create favorable conditions for an even wider variety of pollen-producing plants, leading to an increase in levels of airborne pollen and spores that can aggravate respiratory disease, asthma, and allergic disorders.201 The severity of allergies could be intensified by projected changes in heat and humidity.202 Hay fever sufferers in Washington could experience more attacks during more months of the year. Climate Change Could Create Conditions that Foster the Spread of Infectious Diseases Global trends such as increased population density, human habitation of previously wild areas, and frequent global travel already tip the balance in favor of an increase in infectious disease. Changes in Washington’s weather due to global warming could compound the risk of diseases caused by infectious agents, such as bacteria, viruses, and other micro-organisms. The Health Threats of Climate Change in Washington 23 A Plague of Ticks and Mosquitoes Some disease-causing organisms are transmitted to humans by insects and other animals, referred to as vectors. Global warming could increase the habitats of these vectors and sustain conditions that facilitate disease transmission. Lyme disease is the most common vectorborne disease in the United States. Since official reporting began in 1987, there have been an average of fourteen cases of Lyme disease reported in Washington State each year.203 Lyme disease is transmitted to humans by ticks. Ixodes pacificus, the western black-legged tick, is believed to be the main vector in Pacific states. One to two percent of I. pacificus ticks tested in California and Oregon have been shown to be infected with the micro-organism that causes Lyme disease. Similar studies have not been performed in Washington.204 Symptoms of Lyme disease can vary from person to person. Commonly, early symptoms are localized but can progress to involve the entire body. Victims develop a rash, along with headaches, muscle pain, and flu-like symptoms. In some cases, the central nervous system and the heart can be affected. Some patients may also suffer chronic symptoms. At the early stage of disease, treatment with antibiotics can prevent the disease from worsening. Most cases occur between May and August, the most active feeding period of the ticks and the months during which most people are outdoors.205 Warmer temperatures may extend the length of the season during which people are outdoors, thereby increasing their exposure to ticks and disease. Temperature and humidity also affect the reproduction and activity of ticks. For example, the minimum temperature at which ticks are active is FIGURE 3 Lyme Disease Increases in Warmer Months In Washington, reports of Lyme disease cases have tended to peak in late spring and summer, when warmer temperatures make ticks more active and encourage people to go outdoors. As global climate change increases temperatures, the number of cases may increase in Washington. 8 Source: Adapted from Northwest Center for Public Health Practice and Washington State Department of Health, Lyme Disease: A Monograph and Guide for Washington Physicians. 30 Cases reported in Washington by month of onset (1987–1996) 30 25 24 20 19 15 17 15 10 5 7 4 5 0 Jan Feb Mar Apr May June July Aug Sep 7 0 1 Oct Nov Dec 24 D E ATH BY D E GR E ES 39 degrees F (4 degrees C).206 An increase in average temperature brought about by global warming may increase the amount of time per year that ticks are active. Warming temperatures could also shift the ticks’ geographic range northward. Currently, Lyme disease is more common in California and Oregon than in Washington, but a northward shift of the tick’s geographic distribution could put Washington squarely in the tick’s territory. Scientists in Sweden have noticed a similar northward shift already occurring for a disease-causing European tick.207 Hantavirus causes hantavirus pulmonary syndrome (HPS), a deadly respiratory disease. Symptoms can start several weeks after exposure, and include fever, chills, and severe muscle aches, followed by the abrupt onset of respiratory distress and shortness of breath. Other symptoms include nausea, vomiting, and abdominal pain. Almost half of all cases reported (42 percent) have resulted in death.208 Currently, only supportive treatment is available for HPS. Since 1993, when HPS first emerged in the United States, 21 cases have been reported in Washington. Lewis County has had three cases; Lincoln, Stevens, Adams, Franklin, Yakima, Lickitat, King, and Snohomish counties have each had two cases; and Grant and San Juan counties have each had one case.209 In the western United States, the deer mouse is the main carrier of hantavirus. The disease spreads to humans when they come into contact with rodent urine, saliva, or droppings. People may be exposed to hantavirus by breathing dust after cleaning rodent droppings or disturbing nests, or by living or working in rodent-infested settings. Researchers have connected the emergence of HPS in the United States to a variety of environmental factors. In the southwestern United States, where the majority of hantavirus cases has occurred since 1993, rodent populations multiplied after a period of increased precipitation followed by a dryer period. The rains produced an abundance of rodent food resources, such as vegetation and insects, leading to an increase in rodent populations. The following drought reduced food sources and rodents were forced to compete for food, water, and territory, increasing rodent-to-rodent contact and spreading the disease among the rodent populations. As the increased populations of mice exceeded the carrying capacity of their environments, rodents moved into less stressful environments such as homes and buildings, thereby increasing the likelihood of rodent-to-human contact.210 It has been suggested that the drought conditions before periods of heavy precipitation may have also played a role in increasing rodent populations by decreasing the populations of the rodent’s natural predators. The United States’ deer mouse population increased ten-fold in a single year, from 1992 to 1993, the year when the first HPS case was reported in the United States.211 Global warming could bring both increased precipitation and more severe droughts to Washington, exactly the types of climate patterns that encourage expansion of the deer mice population, and may increase the number of HPS cases. Malaria in Washington? Until the mid-19th century, malaria extended as far north as 50 degrees north latitude, beyond the Canadian border.212 Every The Health Threats of Climate Change in Washington 25 year, travelers contract malaria abroad and bring the disease back to Washington.213 As temperature and precipitation patterns change, they may affect the viability and geographical distribution of the anopheline mosquitoes that transmit the disease. A 5 degree F (3 degree C) increase in global mean temperature could increase the mosquito population in temperate areas ten-fold,214 creating conditions that could facilitate the transmission of malaria. As drug resistant strains increase, malaria may become even more of a health threat. Other diseases brought from overseas may be even more difficult to manage. The outbreak of West Nile virus that killed seven people and sickened scores in New York last summer shows just how quickly an infectious disease can spread and how deadly it can be, given the right local conditions. A large local mosquito population and warmer temperatures that favor viral transmission could increase the risk of the spread of deadly infectious diseases.215 Warmer Weather Could Increase Contamination of Water, Food, and Shellfish In the century to come, global changes could modify the climate of Washington State. Warmer temperatures and more precipitation extremes (increased frequency and severity of both floods and droughts) could contribute toward conditions that are ripe for increased contamination of food and water. Increased flooding of lakes, streams, and marshes may increase opportunities for contamination by bacteria or other pathogens. An estimated twenty to 40 percent of drinking water-related disease outbreaks in the United States in the last twenty years occurred during extreme precipitation events.216 In addition to microbial contaminants, increased precipitation may accelerate the leaching of chemicals from hazardous waste sites into water sources.217 Flooding could also cause more runoff, which would bring in more chemical contaminants, such as nitrates and pesticides, and more human and animal wastes.218 Droughts, also predicted to occur more frequently with global warming, can concentrate contaminants and prevent rivers from flushing themselves clean. Making matters worse, flooding or water shortages can disrupt or impair local sewage systems.219 When a river floods, it carries more sediments. Those sediments can make it difficult for a water treatment plant to operate correctly. Filters may become clogged and, in situations with very high levels of sediment, a plant may not be able to operate at all.220 Thus water sources could be more contaminated and less effectively treated. Cryptosporidium poses an emerging threat in the United States. Difficult to filter and resistant to chlorine disinfection, cryptosporidium can infect humans through the drinking water supply as well as through recreational water, such as lakes and swimming pools. Symptoms of cryptosporidiosis include diarrhea, loose or watery stool, stomach cramps, upset stomach, and a slight fever. Cryptosporidiosis poses serious health threats to vulnerable populations, such as people with HIV/AIDS, immuno-compromised individu- 26 D E ATH BY D E GR E ES als, some elderly, and children. An outbreak in Milwaukee in 1993 resulted in 403,000 cases.221 The outbreak coincided with unusually heavy spring rains and runoff from melting snow.222 Cryptosporidiosis is not a reportable disease in Washington. However, state health officials believe that Cryptosporidium has been causing human illness for a long time, but it has been overlooked due to difficulties in testing and diagnosis.223 Giardia lambia has become recognized as one of the most common causes of waterborne human disease in the United States in the past fifteen years.224 In 1997, 738 cases of giardiasis were reported in Washington.225 Giardia can cause gastrointestinal symptoms, such as diarrhea, stomach cramps, bloating, gas, fatigue, and weight loss. These symptoms usually appear one to two weeks after infection and last four to six weeks in otherwise healthy people.226 Giardia is found in the feces of infected animals or humans. Humans become infected by consuming contaminated food or water or by accidentally swallowing the parasite picked up from surfaces contaminated with infected feces (e.g. toys, bathroom fixtures, diaper changing tables). Children are also at risk when they put contaminated objects in their mouths. Water from mountain streams and rivers may be infected, and ingesting this water, whether intentionally or accidentally, could cause illness. Well water can be contaminated by runoff from rain or flood water, or by seepage of animal wastes in animal grazing areas. Warmer, moister weather predicted to occur with global warming could increase cases of diseases caused by food contaminated with E. coli, salmonella, and the hepatitis A virus, and the number of shellfish contaminated with bacteria and toxins. A study in the United Kingdom found that the number of food poisoning cases increased with temperature, above a threshold of 45.5 degrees F (7.5 degrees C).227 There were nearly 700 cases of food poisoning in Washington state in 1998.228 People can also ingest disease-causing micro-organisms such as E. coli, salmonella, and the hepatitis A virus by drinking contaminated water, eating seafood from contaminated water, or eating fresh produce irrigated or processed with contaminated water. Hepatitis A is a liver disease with symptoms that include jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, and diarrhea. An estimated 125,000 to 200,000 infections of hepatitis A occur each year in the United States, of which two-thirds cause clinical disease and approximately 100 are fatal.229 Washington has averaged nearly 1,000 cases each year from 1990 to 1998.230 Children and young adults are most at risk. E. coli and salmonella also jeopardize health in Washington. E. coli bacteria normally live in the intestines of humans and animals. Although most strains are harmless, several produce toxins that can cause diarrhea. One particular strain, E. coli O157:H7, can cause severe diarrhea and kidney damage. It has particularly serious consequences in the young and the elderly.231 One single large outbreak in Washington in 1993 sickened 477 people. Since then, Washington has averaged about 160 cases per year.232 Salmonella is even more common: an average of over 700 cases of salmonella infection are reported in Washington each year.233 Warmer temperatures and extreme weather events could bring these numbers up even higher in the months and years to come. The Health Threats of Climate Change in Washington 27 Seafood contamination is a particularly serious threat to Washingtonians. Higher sea surface temperatures, occurring with global warming, reduce the amount of oxygen dissolved in the water and stimulate photosynthesis and metabolism. These factors favor the growth of Vibrio pathogens as well as toxin-laden algal blooms.234 Vibrio bacteria can contaminate shellfish and cause human illness. Anyone who eats raw or partially cooked shellfish or fish is at risk for vibriosis. Individuals with liver disease, with suppressed immune systems, or who take antacids are more likely to get sick. Symptoms include diarrhea, abdominal cramps, nausea, vomiting, headache, fever, and chills, and usually last two to three days. More severe cases may require hospitalization. Vibrio parahaemolyticus, a common species in the waters off Washington’s coast, caused a large outbreak in Washington in July and August of 1997.235 Fifty-six confirmed cases of infection were associated with consumption of shellfish harvested from the western United States and British Columbia marine waters. Nationwide, seafood consumption causes approximately one-fifth of all foodborne disease outbreaks.236 Vibrio bacteria are more common in warmer months, and shellfish and fish are more likely to be contaminated during the summer.237 As the average temperature of the world’s oceans rises, 238 increased water temperatures may lengthen the time span for contamination. Algal toxins present another threat to the health of Washingtonians. Shellfish consume toxins produced by algae in the ocean. The toxins can accumulate to dangerous levels in the shellfish. When consumed by humans, the toxin-laden shellfish cause symptoms ranging from diarrhea and nausea to amnesia, coma, and death. Cooking does not destroy the toxins, and may in fact further concentrate them.239 Over the past thirty years, the frequency and global distribution of toxic algal poisonings appear to have increased.240 Warm weather favors algal growth, and could thus contribute to this increase. Human activities also affect the growth of harmful algal blooms by altering the balance of nutrients in the water. Nitrogen, which can come from agricultural, industrial, and urban sources, may accelerate the growth of algal blooms.241 Outbreaks have been linked to unusual climatic events,242 and some have suggested that climate change could play a role in the increasing frequency and distribution of toxic algal blooms.243 Saxitoxin, the neurotoxic chemical that causes paralytic shellfish poisoning, is a seasonal problem on the west coast of the United States, from Alaska to California. In October 1998, five people became ill after eating mussels commercially harvested from Carr Inlet in Pierce County.244 Domoic acid, a deadly toxin produced by algal blooms, has contaminated razor clams in Washington. The toxin was first detected on the West Coast in 1991 and is now routinely found in razor clams along Washington’s coast.245 It can cause amnesic shellfish poisoning (ASP). Symptoms of ASP include gastrointestinal disorders (vomiting, diarrhea, abdominal pain) as well as neurological problems (confusion, memory loss, disorientation, seizure and coma).246 Domoic acid first came to the attention of public health authorities in 1987, when it caused a disease outbreak on Canada’s Prince Edward Island. 28 D E ATH BY D E GR E ES That year was an El Niño year with warmer than usual temperatures and wet conditions that washed nutrients into the ocean.247 The links between climate patterns and domoic acid are still unclear, and more research is needed. Two populations in Washington could be particularly hard hit by contamination of fish and shellfish. Many Native American tribes rely on natural resources for their livelihood. Shellfish contamination, along with loss of shellfish habitats due to development and sea-level rise, could harm communities reliant on commercial harvesting.248 Asian and Pacific Islander communities in Washington consume higher levels of seafood than the average population.249 Members of certain minority groups, such as the Mien community, tend to rely heavily on locally harvested seafood.250 A Bleak Outlook for Salmon In March 1999 eight Pacific Northwest evolutionarilysignificant units (ESUs)—subgroups of salmon species that are isolated enough to be considered important for genetic or ecological diversity—were listed as threatened and one as endangered, bringing the total number of ESUs listed up to 24.251 A report by the National Research Council in 1996 concluded that Pacific salmon have disappeared from about 40 percent of their historical breeding ranges in Washington, Oregon, Idaho, and California over the last century, and many remaining populations are severely depressed in areas where they were formerly abundant.252 The life cycle of salmon is complex: living in both freshwater and seawater, their life patterns make them sensitive to environmental changes. The changes brought by global climate change could further threaten their existence. Salmon hatch from eggs deposited in freshwater streams and remain in these streams for a few weeks to several years, depending on the species and geographic location. As juveniles, they undergo a physiological transformation into “smolts” and begin their journey to the ocean. Many species of salmon migrate to the ocean in the spring and early summer months, the typical time of high flows in streams and rivers swollen by snowmelt and of food abundance in coastal oceans. Mature salmon eventually return to their rivers of origin to spawn. Most die after spawning, bringing to those streams valuable marinederived nutrients. The general pattern of climate change effects predicted for Washington state paint a bleak outlook for salmon. Higher winter precipitation with earlier snowmelt and lower summer flows may threaten the critical smolt migrations. In addition, higher stream temperatures (above 70 degrees F, or 21 degrees C) are known to cause severe problems for salmon of all species in the Pacific Northwest and could impede the salmon’s return journey to their natal streams for spawning.253 Climate also influences the ocean environment that greets young salmon as they arrive. In especially warm years, large schools of predatory fish have been observed in the coastal waters of the Pacific Northwest earlier in the year and closer to shore. These predators pose a particularly serious threat to young salmon. During exceptionally warm years Pacific mackerel can virtually eliminate entire batches of hatchery chinook smolts as they enter estuarine waters off the west coast of Vancouver Island.254 In recent years, salmon and steelhead populations have fallen to less than ten percent of their historical levels. These losses cannot be wholly attributed to climate change, but the changes to come could wipe out the remaining habitats for some salmon species.255 The loss of salmon could further threaten the cultural and spiritual well-being of Native American tribes. For these tribes, salmon are an integral part of a connection with past generations and the future.256 The Health Threats of Climate Change in Washington 29 Economic Hardships Could Lead to Impaired Health Status The production and processing of agricultural goods and timber-related products form a crucial part of Washington’s thriving economy. Fishing, especially for salmon, is also important. Washington each year ranks in the top three or four commercial fishing states in the nation.257 The Washington Department of Fish and Wildlife estimates that in 1991 commercial fishing had a $531 million impact on the state’s economy and supported 16,400 jobs. Sport fishing also contributes impressively to Washington’s economy, bringing in more than $704 million to Washington’s economy in 1996.258 Global climate change could threaten these lynchpins of Washington’s economy, as increased climate variability, particularly wetter winters and drier summers, changes the natural environment that supports Washington’s wildlife, forests, and the human population. If these industries suffer, so will the income of many Washingtonians. Socio-economic status can influence health status.259 Thus, threats to the economic well-being of Washingtonians due to climate change also threaten their health. Job losses may lead to loss of health insurance. Lack of insurance may be associated with poorer health status and with behaviors that can result in poorer health, such as delay in seeking proper health care.260 The Precautionary Principle Legislators and environmentalists often refer to a legal term called “the precautionary principle” when dealing with global warming issues. The term’s definition states, “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context, the proponent of an activity, rather than the public, should bear the burden of proof.”261 This theory comes down to common sense and in practice is nothing new. An early example of the precautionary principle in action occurred in 1854, when London had a cholera epidemic. A doctor by the name of John Snow mapped the locations of local cholera deaths and discovered that most of them occurred within 250 yards of a public water pump. Suspecting that the water pump was the source of the contagion, Dr. Snow had the handle removed, making the pump inoperable. Miracle of miracles, the plague ended. This was years before the biological cause of cholera was known.262 The precautionary principle has four main components. First, communities have a duty and a right to take anticipatory action to prevent harm. Second, the proponents of a new technology, process, activity, or chemical bear the burden of proving that it is harmless. Third, communities have an obligation to discuss and explore a full range of alternatives to the hazards posed. Lastly, decisions must be open, informed, and democratic. The precautionary principle is no different than practicing preventive medicine. Most of us go to the doctor when we feel that we may be at risk for a certain ailment. In other words, we take action to prevent something bad from happening to us. Global warming requires that same sense of precaution and willingness to take action. 30 D E ATH BY D E GR E ES What You Can Do We’re on the threshold of an energy-use revolution. And if we’re smart, we’ll stay a step ahead of the market and provide the clean energy decade with the tools it needs— the solar panels, biomass, wind power, fuel cells. Let’s invest our energy in working towards clean energy.263 —WASHINGTON GOVERNOR GARY LOCKE, MARCH 16, 2000 This paper has reviewed in depth the threats to human health that could result from global climate change. The United States has a greater ability to adapt to, and prepare for, these changes than other countries, due to our health care infrastructure and strong economy. Nonetheless, the potential health effects of climate change are real and demand attention. Increased levels of heat, extreme weather events, vector-borne and waterborne diseases, and air and water pollution can affect all Americans. The poor, elderly, young, and immuno-compromised will be the hardest hit. We have the power to mitigate the impacts of climate change by decreasing greenhouse gas emissions and investing in strategies that will help us to prepare for what is to come. But we must act now. Residents of Washington can help to reverse global warming before it creates a full-blown health crisis. The number one priority is to decrease the use of fossil fuels. As an added benefit, the energy conservation techniques recommended here to combat global warming are very similar to those desperately needed to cut air pollution. In addition, they can increase our standard of living while reducing economic costs and creating economic opportunities for Washington. As Governor Gary Locke noted, “What some call environmental cutting edge today, they’ll be calling economic genius tomorrow.” He predicted, “We could be the clean energy empire. It’s that simple.”264 There is a lot you can do in Washington, starting now, to combat global warming and bring down the consumption of fossil fuels. 1 2 Get your own house in order. Use energy-efficient light bulbs. Install a solar thermal system to help provide your hot water (carbon dioxide reduction: 720 pounds per year). Recycle all of your home’s waste newsprint, cardboard, glass, and metal (carbon dioxide reduction: 2,480 pounds per year). Lower your thermostat in winter and raise it in summer, reducing your energy use. When purchasing a home or remodeling, request efficient insulation and energy efficient appliances, refrigerators, and water heaters. Carpool more and drive less. Sixty-two percent of Washington State’s greenhouse gas emissions in 1990 came from transportation.265 If current patterns do not change, automobile emissions are likely to increase as Washington’s population continues to grow. Leave your car at home for one or two days a week and you will save tons of carbon dioxide emissions. Carpool and use public transportation whenever possible. The Health Threats of Climate Change in Washington 31 3 4 5 6 If you are buying a new car, look for a more energy-efficient one. Encourage automakers to develop and sell cars, trucks, and sport utility vehicles (SUVs) with higher fuel efficiency. The EPA and Department of Energy web site (http://www.fueleconomy.gov), allows you to do a side-byside comparison of vehicles so that you can select the most energy-efficient vehicle that meets your needs. Demand that electric utilities use low-carbon technologies and renewable energy, such as wind and solar power. Support efforts that require all power plants to meet federal air pollution standards. Encourage the businesses you patronize to become energy-efficient. American businesses spend about $100 billion on energy each year to operate commercial and industrial buildings. By using energy-efficient products and procedures, organizations could reduce their energy use by 35 percent, or $35 billion nationally. Numerous programs can help businesses change their energy usage and save money at the same time. Put your favorite businesses in touch with EPA’s Energy Star Buildings program (1-888-STAR-YES, http://www.epa.gov/greenlights), and Climate Wise program (1-800-459-WISE, http://www.epa.gov/climatewise). Support policies that can help to slow global warming. You can do this by supporting candidates who are serious about reducing emissions of carbon dioxide and other greenhouse gases. Encourage your Members of Congress to increase appropriations for renewable energy research and development, to incorporate carbon dioxide emission reduction requirements into electricity restructuring legislation, and to commit to ratifying the Kyoto Protocol to the Framework Convention on Climate Change, an international agreement that would require countries to lower their emissions of greenhouse gases. In addition, request support for increases in the minimum milesper-gallon standards for cars, SUVs, and light trucks. More fuel efficient vehicles generate fewer of the harmful emissions that contribute to global warming and air pollution. Tell your Members of Congress to support action under the Corporate Average Fuel Economy (CAFE) law to raise fuel efficiency standards. 7 Work with local groups and chapters of national organizations to promote awareness of global warming and related issues in Washington state. These include: • Washington chapter of Physicians for Social Responsibility (4554 12th Ave. NE, Seattle, WA 98105, 206-547-2630, wpsr@wpsr.org); • Climate Solutions (610 4th Ave. East, Olympia, WA 98501, 360-352-1763, www.climatesolutions.org, contact: Rhys Roth); • League of Women Voters of Washington (1411 Fourth Ave., Ste. 803, Seattle, WA 98101-2216, 206-622-8961, contact: Donna Ewing, 360-456-4635 or Sue Minahan, SueDonOly@aol.com); 32 D E ATH BY D E GR E ES • Sierra Club Cascade Chapter (8511 15th Ave. NE, Ste. 201, Seattle, WA 98115, 206-523-2147); • Washington Association of Churches (419 Occidental S, Ste. 201, Seattle, WA 98104, 206-625-9790, contact: Shelly Means); and • Washington Public Interest Research Group (PIRG) (3240 Eastlake Ave. E, Ste. 100, Seattle, WA 98102, 206-568-2850, fax: 206-568-2858, washpirg@mindspring.com, contact: Parker Blackman, Executive Director). Where Physicians for Social Responsibility (PSR) Stands Physicians for Social Responsibility (PSR), the active conscience of American medicine, uses its members’ expertise and professional leadership, influence within the medical and other communities, and strong links to policy makers to address this century’s greatest threats to human welfare and survival. While we recognize that uncertainties exist in the measurement of global warming— just as all scientific measurement is uncertain—we are moved to action for several compelling reasons. First, the overwhelming consensus among scientists is that the Earth’s temperature is increasing and weather patterns are changing in ways potentially harmful to human health. This fact is overlooked in statements funded by the energy industry that attempt to minimize the severity of global warming. Second, just like businesses, governments, and responsible individuals, PSR feels the need to act decisively in the face of uncertainty to protect those whose welfare has been entrusted to us. We cannot say exactly when to expect a noticeable increase in floods, or in deaths from asthma among people living in smog-congested cities. No one can. But as Surgeon General Luther Terry stated in his 1962 report on motor vehicles and air pollution, the need for further research should not stop us from taking “all practicable steps to minimize” the hazard. We are certain that fossil fuels play a role in global warming, one step that we can control. For the sake of our own well-being, and that of future generations, we need to act now. PSR is working to create a world free of global environmental pollution, nuclear weapons, and gun violence. In 1985, PSR shared the Nobel Peace Prize with the International Physicians for the Prevention of Nuclear War. PSR is a non-governmental organization in official relations with the World Health Organization. The Health Threats of Climate Change in Washington 33 NOTES: 1. U.S. Environmental Protection Agency (USEPA), Global Warming Site: Climate, http://www.epa.gov/globalwarming/climate/ index.html. National Oceanic and Atmospheric Administration (NOAA), Climate of 1999—Annual Review, http://www.ncdc.noaa.gov/ol/ climate/research/1999/ann/ann99.html. Intergovernmental Panel on Climate Change (IPCC), The Regional Impacts of Climate Change: An Assessment of Vulnerability (Cambridge, UK: Cambridge UP, 1998) [hereinafter Regional Assessment]. IPCC, Climate Change 1995, Second Assessment Report, Working Group I Summary for Policy Makers (1996). JISAO/SMA Climate Impacts Group, Univ. of Washington (CIG), Impacts of Climate Variability and Change: Pacific Northwest, November 1999. National Weather Service (NWS), Top Ten 20th Century Weather Events in Washington State, http://www.seawfo.noaa.gov/ WATOP10.htm; Federal Emergency Management Agency (FEMA), 1997 Disaster Activity, http://www.fema.gov/library/ diz97.htm. NOAA Air Resources Laboratory, http:// gus.arlhq.noaa.gov. A three-day heat wave occurs when three consecutive days reach extreme temperatures, defined as the 85th percentile of the apparent temperatures in July and August. Apparent temperature is a combination of air temperature and humidity. IPCC Regional Assessment 309. Washington State Department of Health (DOH), Asthma in Washington reaches epidemic proportions, News release, http://www.doh.wa.gov/Publicat/99_News/ 99-85.html. 16. Washington State DOH, Asthma in Washington reaches epidemic proportions, News release, http://www.doh.wa.gov/ Publicat/99_News/99-85.html. 17. NOAA, Climate of 1999—Annual Review. 18. USEPA, Global Warming Site: Climate; USEPA, Global Warming Site: Atmospheric Change—Past, http://www.epa.gov/ globalwarming/climate/atmospheric/ past.html. 19. USEPA, Global Warming Site: Climate. 20. USEPA, Global Warming Site: National Emissions – Recent Trends, http:// www.epa.gov/globalwarming/emissions/ national/trends.html. 21. USEPA, Global Warming Site: Climate. 22. USEPA, Global Warming Site: Climate. 23. M de Laine, “New, Mean Greenhouse Gas Appears,” Discovery.com News, Apr 10, 2000. 24. TR Karl et al, The record breaking global temperatures of 1997 and 1998: evidence for an increase in the rate of global warming?, Geophys Res Letters 2000; 27(5):719. 25. Study: Record temps=global warming, Associated Press, Feb 24, 2000. 26. J Hebert, Scientists report warmer earth, Associated Press, Jan 13, 2000. 27. La Niña’s persistence may be part of larger climate pattern, Jet Propulsion Laboratory Media Relations Office, Jan 19, 2000. 28. S Levitus et al, Warming of the world ocean, Science 2000; 287:2225–9. 29. J Hebert, Oceans getting warmer, Associated Press, Mar 27, 2000. 30. J Longstreth, Public health consequences of global climate change in the United States— some regions may suffer disproportionately, Environ Health Perspect 2000; 107(Suppl 1):169–79. 31. American Lung Association, Danger zones: ozone air pollution and our children (New York: American Lung Association, 1995) 2–7; Committee on Environmental Health, American Academy of Pediatrics, Handbook of Pediatric Environmental Health, ed. RA Etzel (Elk Grove Village, IL: American Academy of Pediatrics, 1999) 11. 32. Longstreth. 33. Longstreth. 34. J Patz et al, The Potential Health Impacts of Climate Variability and Change for the United States: Executive Summary of the Report of the Health Sector of the U.S. National Assessment, Workshop Summary, Environ Health Perspect 2000; 108(4):367–376; http://ehis.niehs.nih.gov/topic/global/ patz-full.html. 2. 3. 4. 5. 6. 7. 8. 9. 10. Washington State DOH, Public Health Fact Sheet—Vibriosis, http://www.doh.wa.gov/ Topics/vibriosis.htm. 11. NWS, Top Ten; FEMA, 1997 Disaster Activity. 12. NWS, Top Ten. 13. RL Baum et al, Landslides triggered by the winter 1996–7 storms in the Puget lowland, Washington, USGS Open-File Report 98– 239, 1998, http://geohazards.cr.usgs.gov/ pubs/ofr/ofr98-239/ofr98-239.html. 14. Washington State DOH, Annual Communicable Disease Tables for 1998, http:// www.doh.wa.gov/EHSPHL/Com_Dis/1998/ 1998tabcon.htm. 15. Washington State DOH, Public Health Fact Sheet—Vibriosis, http://www.doh.wa.gov/ Topics/vibriosis.htm. 34 D E ATH BY D E GR E ES 35. Centers for Disease Control and Prevention (CDC), State-specific prevalence of selected health behaviors, by race and ethnicity— Behavioral Risk Factor Surveillance System, 1997, MMWR 2000; 49(SS02):1–60, 20. 36. Washington State DOH, Tobacco and Health in Washington State, http://www.doh.wa.gov/ tobacco/report. 37. CDC, State-specific prevalence of selected health behaviors, by race and ethnicity, 29. 38. World Health Organization (WHO), Climate Change and Human Health, eds. AJ McMichael, A Haines, R Slooff, and S Kovats (Geneva: WHO, 1996); EM Kilbourne, Illness due to thermal extremes, Public Health and Preventive Medicine, 13th ed., eds. JM Last and RB Wallace (Norwalk, CT: Appleton Lange, 1992) 491–501; National Institute on Aging (NIA), Hyperthermia: A hot weather hazard for older people, http://www.nih.gov/nia/ health/agepages/hyperthe.htm. 39. National Center for Health Statistics, Health, United States, 1998, with Socioeconomic Status and Health Chartbook, Hyattsville, MD, 1998, 84–7. 40. National Center for Health Statistics 83. 41. USEPA, “In the News: NASA presents satellite information on weather, land use,” Feb 23, 2000. 42. Longstreth. 43. Longstreth. 44. CDC, Washington State Health Profile, 1999 (Atlanta, GA: CDC, 1999) 13. 45. CDC, Washington State Health Profile, 1999 (Atlanta, GA: CDC, 1999) 14. 46. H Foster, “Racism lives, study of state children shows,” Seattle Post-Intelligencer, Apr 26, 2000. 47. CDC, State-specific prevalence of selected health behaviors, by race and ethnicity— Behavioral Risk Factor Surveillance System, 1997, MMWR 2000; 49(SS02):1–60. 48. Washington State DOH, Tobacco and Health in Washington State. 49. CDC, State-specific prevalence of selected health behaviors, by race and ethnicity— Behavioral Risk Factor Surveillance System, 20. 50. Washington State DOH, Extreme Heat. 51. W Zhao and AL Kersting, Preventing heat stress in agriculture, Rutgers Cooperative Extension. Fact Sheet FS747, http:// www.cdc.gov/niosh/nasd/docs2/pdfs/ nj00800.pdf. 52. IPCC Regional Assessment. 53. Longstreth. 54. U.S. Public Interest Research Group, Flirting With Disaster: Global Warming and the Rising Costs of Extreme Weather, Oct 27 1999. 55. NWS, Top Ten; FEMA. 56. ET Gerrity and BW Flynn, Mental Health Consequences of Disasters, in The Public Health Consequences of Disasters (Noji E, ed), 101-21 (New York: Oxford University Press, 1997). 57. CIG 20. 58. CIG 27. 59. Newsweek, Jan 22, 1996, 28. 60. CIG Report Summary, 5. 61. USEPA, Climate Change and Washington, EPA 230-F-97-008uu, September 1997, http://www.epa.gov/globalwarming/ publications/impacts/state/wa_impct.pdf. 62. National Climatic Data Center, February 1999, http://www.ncdc.noaa.gov/ol/climate/ extremes/1999/february/febext1999.html. 63. USEPA, Climate Change and Washington. 64. NWS, Top Ten. 65. Joan Rose, in John Tibbetts, “Water World 2000,” Environ Health Perspect 2000; 108:A69–72, A72. 66. Washington State DOH, Public Health Fact Sheet: Floods, http://www.doh.wa.gov/ Topics/floods.htm. 67. “Outbreak of Toxoplasmosis associated with municipal drinking water—British Columbia,” Canada Communicable Disease Report 1995; 21–28:F1-3. 68. CDC Division of Parasitic Diseases, Fact Sheet: Toxoplasmosis, http://www.cdc.gov/ ncidod/dpd/parasites/toxoplasmosis/ factsht_toxoplasmosis.htm. 69. IPCC Regional Assessment 313. 70. Washington State DOH, Division of Drinking Water Programs, Overview, http:// www.doh.wa.gov/ehp/dwover.htm. 71. WHO 131. 72. WHO 131. 73. Doris Cellarius, personal communication, May 31, 2000. 74. PG Jorens and PJC Schepens, Human pentachlorophenol poisoning, Human and Experimental Toxicology 1993; 12:479–95. 75. Agency for Toxic Substances and Disease Registry (ATSDR), Toxicological Profile for Pentachlorophenol, 1993. 76. USEPA, National Primary Drinking Water Regulations, Technical Factsheet on Pentachlorophenol, http://www.epa.gov/ ogwdw000/dwh/t-soc/pentachl.html, revised Jan 27, 1998. 77. McGregor et al, An IARC evaluation of PCDDs and PCDFs as risk factors in human carcinogenesis, Environ Health Perspect 1998; 106(Suppl 2):755. The Health Threats of Climate Change in Washington 35 78. Mably et al, In utero and lactational exposure of male rats to 2,3,7,8 TCDD, Toxicology and Applied Pharmacology 1992; 114:118–36. 79. Rier et al, Endometriosis in Rhesus monkeys following chronic exposure to 2,3,7,8 TCDD, Fundamental and Applied Toxicology 1993; 21: 433–41. 80. DeVito et al, Comparisons of estimated human body burdens of dioxinlike chemicals and TCDD body burdens in experimentally exposed animals, Environ Health Perspect 1995; 103(9):820–31. 81. Gerrity and Flynn. 82. EL Harp et al, Landslides and Landslide Hazards in Washington State Due to February 5–9, 1996 Storm, USGS. 83. Washington State DOH, Public Health Fact Sheet: Mudslides, http://www.doh.wwa.gov/ Topics/mudslides.htm. 84. RL Baum et al, Landslides Triggered by the Winter 1996–7 Storms in the Puget Lowland, Washington, USGS Open-File Report 98-239, 1998, http:// geohazards.cr.usgs.gov/pubs/ofr/ ofr98-239/ofr98-239.html. 85. Baum. 86. Harp; Baum. 87. Harp. 88. NOAA, Drought Grips Nearly Half of U.S., http://www.publicaffairs.noaa.gov/ releases2000/mar00/noaa00016.html. 89. CIG 50. 90. NWS, Top Ten. 91. P Duclos et al, The 1987 forest fire disaster in California: Assessment of emergency room visits, Arch Environ Health 1990; 45:53–8. 92. Washington Agricultural Statistics Service (WASS), Welcome to the Washington Agricultural Statistics Service, http:// www.nass.usda.gov/wa/ssoinfo.htm. 93. WASS, 1998 Annual Bulletin: Agriculture in Washington, http://www.nass.usda.gov/ wa/; “Washington State,” http:// www.encyclopedia.com. 94. USEPA, Climate Change and Washington, EPA 230-F-97-008uu, September 1997, http://www.epa.gov/globalwarming/ publications/impacts/state/wa_impct.pdf. 95. “Farmers face critical losses,” Seattle PostIntelligencer, Aug 20, 1999. 96. U.S. Department of Agriculture, Secretarial Disaster Designations, 1999, http:// drought.fsa.usda.gov/designations.htm. 97. WHO 113. 98. WHO 113. 99. Ohio Department of Agriculture, ODA offers free aflatoxin testing on drought-stressed corn, Sep 16 1999. 100. Ohio Department of Agriculture. 101. Center for Food Safety and Applied Nutrition, Food and Drug Administration, Chapter 41: Aflatoxins, The Bad Bug Book, http://vm.cfsan.fda.gov/~mow/intro.html. 102. USEPA, Climate change and Washington. 103. CIG 33. 104. Energy Policy Group, Washington State Community, Trade and Economic Development, Washington State energy use profile 1970–1993, http://www.energy.cted.wa.gov/ FILES/PRFL/BASE02.HTM. 105. “Washington,” Microsoft Encarta. 106. CIG 38. 107. Hanford Health Information Network (HHIN), Health Bulletin, http:// www.doh.wa.gov/Hanford/publications/ overview/bulletin.html. 108. HHIN, The release of radioactive materials from Hanford: 1944–1972, http:// www.doh.wa.gov/hanford/publications/ history/release.html. 109. HHIN, Release. 110. HHIN, Release. 111. Tim Takaro, personal communication, May 29, 2000. 112. HHIN, Release. 113. USEPA, Radiation: Risks and Realities; “What is Radiation?” http://www.epa.gov/ radiation/rrpage/rrpage2.html. 114. ATSDR, Toxicological Profile for Chromium, 1990. 115. D Yamaguchi, Rising winter precipitation at the Hanford nuclear reservation, Washington: possible implications for surface barrier performance, Department of Environmental Health and Consortium for Risk Evaluation with Stakeholder Participation (CRESP), University of Washington, Seattle, unpublished manuscript, Sep 11, 1998. 116. Yamaguchi. 117. Yamaguchi. 118. Yamaguchi. 119. “Fire Rages across Hanford,” Tri-City Herald, Jun 20, 2000, http:www.tri-cityherald.com. 120. K Davenport, Contamination concerns, The Santa Fe New Mexican, Jun 12, 2000. 121. K Davenport, Contamination concerns. 122. K Davenport, Madrid wants proof that runoff is no threat, The Santa Fe New Mexican, Jun 21, 2000. 123. K Easthouse, DOE’s safety claims under scrutiny, The Santa Fe New Mexican, May 13, 2000. 124. USEPA, Climate change and Washington. 125. CIG 50. 126. USEPA, Climate change and Washington; Longstreth. 36 D E ATH BY D E GR E ES 127. CDC, Unintentional carbon monoxide poisoning following a winter storm— Washington, January 1993, MMWR 1993; 42(06):109–11. 128. Mayo Clinic, Carbon monoxide: How to protect your family, http:// www.mayohealth.org/mayo/9812/htm/ co.htm. 129. CDC, Carbon monoxide poisonings associated with snow-obstructed vehicle exhaust systems—Philadelphia and New York City, January 1996, MMWR 1996; 45(01):1–3. 130. CDC, Hypothermia related deaths—Georgia, January 1996–December 1997, and United States, 1979-1995, MMWR 1998; 47(48):1037–40. Average number of deaths per annum calculated from Figure 1, assuming population equals 5,689,263 (U.S. Census Bureau estimates for July 1, 1998, http://www.census.gov/population/ estimates/state/st-98-1.txt.) 131. Washington State DOH, Public Health Fact Sheet—Winter Storms, http:// www.doh.wa.gov/Topics/storm.htm. 132. CDC, Hypothermia related deaths—Georgia, January 1996-December 1997, and United States, 1979-1995, MMWR 1998; 47(48):1037–40. 133. Washington State DOH, Winter Storms. 134. CDC and U.S. Department of Health and Human Services (DHHS), Extreme Cold: A Prevention Guide to Promote Your Personal Safety, http://www.cdc.gov/nceh/ emergency/cold.pdf. 135. CDC, Changes in mortality from heart failure—United States, 1980–1995, MMWR 1998, 47(30):633–7. 136. Washington State DOH, Winter Storms. 137. USEPA, Climate change and Washington. 138. USEPA, Climate change and Washington. 139. IPCC, Climate Change 1995: The Science of Climate Change. Contribution of Working Group I to the Second Assessment Report of the Intergovernmental Panel on Climate Change (Cambridge U.P.: Cambridge, 1996). 140. IPCC Regional Assessment 309. 141. IPCC Regional Assessment 309. 142. CDC, Heat-related illnesses and deaths— Missouri, 1998, and United States, 1979– 1996, MMWR 1999; 48(2):469–72. 143. CDC, Heat-related mortality—Chicago, July 1995, MMWR 1995; 44(31):577–9. 144. JC Semenza et al, Heat-related deaths during the July 1995 heat wave in Chicago, NEJM 1996; 335:84-90; S Whitman et al, Mortality in Chicago attributed to the July 1995 heat wave, Am J Public Health 1997; 87(9): 1515–8. 145. Washington State DOH, Public Health Fact Sheet—Extreme Heat. 146. NOAA Air Resources Laboratory. http:// gus.arlhq.noaa.gov. A three-day heat wave occurs when three consecutive days reach extreme temperatures, defined as the 85th percentile of the apparent temperatures in July and August. Apparent temperature is a combination of air temperatures and humidity. 147. NWS Spokane, http://www.wrh.noaa.gov/ spokane/lcd/otx/gegbtl.htm. 148. NIA Hyperthermia; Washington State DOH, Public Health Fact Sheet: Extreme Heat, http://www.doh.wa.gov/Topics/Heat.htm. 149. Zhao and Kersting. 150. WHO. 151. Zhao and Kersting. 152. NIA Hyperthermia. 153. Washington State DOH, Public Health Fact Sheet—Extreme Heat. 154. NIA Hyperthermia. 155. CDC, Heat Related Deaths—United States, 1993, MMWR 1993: 42(28):558–560. 156. DJ Canning, Sea level rise in Washington State: State-of-the-knowledge, impacts, and potential policy issues, Document 93–537, Washington Department of Ecology: December 1991, vi. 157. USEPA, Climate change and Washington. 158. “Huge chunk of ice breaks off from Antarctica ice sheet,” www.cnn.com, Mar 23, 2000. 159. “New iceberg adrift off Antarctica,” www.cnn.com, Apr 7, 2000. 160. Andrea Woodward, Biological Resources Division, USGS, personal communication, May 3, 2000. 161. USEPA, Climate change and Washington; “Washington,” Microsoft Encarta. 162. CIG. 163. CIG 76. 164. USEPA, Climate change and Washington. 165. Canning 37. 166. Canning 19–27. 167. CIG 78. 168. Van Dolah. 169. CIG 24. 170. Canning 30. 171. Canning 30. 172. Canning 29. 173. Canning 31. 174. Washingon State Department of Ecology, Washington State Dioxin Source Assessment, July 1998, Publication 98-230. 175. Douglas Canning, Washington Department of Ecology, personal communication, May 24, 2000. The Health Threats of Climate Change in Washington 37 176. Canning 30. 177. Canning 31. 178. Washington State DOH, Asthma in Washington reaches epidemic proportions, News release, http://www.doh.wa.gov/Publicat/ 99_News/99-85.html. 179. USEPA, Health and environmental effects of ground-level ozone—Fact Sheet, Jul 17, 1997, htpp://ttnwww.rtpnc.epa.gov/ naaqsfin/o3health.htm; JH Dickey, No room to breathe, http://www.psrus.org/ breathe.htm. 180. CP Weisel et al, Relationship between summertime ambient ozone levels and emergency department visits for asthma in central New Jersey, Environ Health Perspect 1995; 103(Suppl 2):97–102. 181. Washington State Department of Ecology, 1998 Air Quality Annual Report, http:// www.wa.gov/ecology/air/98rptbea.pdf 182. H Gong Jr et al, Cardiovascular effects of ozone exposure in human volunteers, Am J Respir Crit Care Med 1998; 158(2):538–46. 183. USEPA, Health and environmental effects of ground-level ozone. 184. USEPA, Office of Air Quality Planning and Standards, Smog—Who Does It Hurt? What You Need To Know About Ozone and Your Health, http://www.epa.gov/airnow/health/ smog1.html#5. 185. DR Gold et al, Ambient pollution and heart rate variability, Circulation 2000; 101(11):1267–73; E Zablocki, Air pollution linked to health problems, deaths, WebMD Medical News, Mar 20, 2000, http:// webmd.lycos.com/content/article/ 1728.55867. 186. Zablocki. 187. Zablocki. 188. CDC, Self-reported asthma in adults and proxy-reported asthma in children— Washington, 1997–1998, MMWR 1999; 48(40):918–20. 189. Washington State DOH, Asthma. 190. CDC, Self-reported asthma in adults and proxy-reported asthma in children— Washington, 1997–1998. 191. USEPA, Global Warming: Impacts—Health, http://www.epa.gov/globalwarming/impacts/ health/index.html. 192. J Peterson, “Cool, marine air to turn down the sizzle,” Seattle Times Jul 29, 1998. 193. F Davila, “As summer warmth finally arrives, so does a smog alert,” Seattle Times Sep 14, 1999. 194. USEPA Office of Air Quality Planning and Standards, AIRSDATA Monitor Values Report for ozone, query from http:// www.epa.gov/airsweb/monvals.htm. 195. Spokane County Air Pollution Control Authority (SCAPCA), “New air quality standards for particulate and ozone pollution,” On the Air, Fall 1997, http:// www.scapca.org. 196. SCAPCA. 197. L Altose, Washington State Department of Ecology, quoted in “Area’s smog nearly airquality violation,” Seattle Times, Apr 22 1999. 198. Washington State Department of Ecology, Trouble in Paradise for air quality at Mount Rainier, News release, http:// www.wa.gov:80/ecology/pie/1999news/ 99-148.html. 199. L Rushton and K Cameron, Organic Chemcals, Air Pollution and Health, eds. ST Holgate et al (Academic Press, 1999), 813–38. 200. New Hampshire Department of Environmental Services, Reducing toxic air pollutants in New Hampshire, http:// www.des.state.nh.us/ard/toxpage.htm. 201. Executive Office of the President, Office of Science and Technology Policy, Climate Change: State of Knowledge, Oct 1997, 12. 202. IPCC Regional Assessment 310. 203. Washington State DOH, Annual Communicable Disease Tables for 1998, http:// www.doh.wa.gov/EHSPHL/Com_Dis/1998/ 98tabcon.htm. 204. Northwest Center for Public Health Practice and Washington State Department of Health, Lyme disease—a monograph and guide for Washington physicians, http:// healthlinks.washington.edu/nwcphp/lyme/. 205. Northwest Center for Public Health Practice and Washington State Department of Health, Lyme disease—a monograph. 206. IPCC Regional Assessment 313. 207. E Lindgren et al, Impact of climatic change on the northern latitude limit and population density of the disease-transmitting European tick Ixodes ricinus, Environ Health Perspect 2000; 108:119–23. 208. Washington State DOH, Public Health Fact Sheet—Hantavirus, http://www.doh.wa.gov/ topics/hanta.htm. 209. Washington State DOH, Hantavirus. 210. D Engelthaler et al, Climatic and Environmental Patterns Associated with Hantavirus Pulmonary Syndrome, Four Corners Region, United States, Emerging Infectious Diseases 1999; 5(1):87–94. 211. WHO 95. 212. IPCC Regional Assessment 312. 213. Washington State DOH, Annual Communicable Disease Tables for 1998. 214. AE Platt, Infecting ourselves: how environmental and social disruptions trigger disease, Worldwatch Paper 129 (Washington, DC: Worldwatch Institute, 1996) 40. 38 D E ATH BY D E GR E ES 215. IPCC Regional Assessment 312–3. 216. Joan Rose, in John Tibbetts, “Water World 2000,” Environ Health Perspect 2000; 108:A69–72, A72; IPCC Regional Assessment 313. 217. IPCC Regional Assessment 312. 218. IPCC Regional Assessment 312. 219. IPCC Regional Assessment 313. 220. Brad Blegen, director, City of Spokane Department of Water and Hydroelectric Services, personal communication, May 24, 2000. 221. WR MacKenzie et al, A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply, New Engl J Med 1994; 331(3):161–7. 222. IPCC Regional Assessment 314. 223. Washington State DOH, Public Health Fact Sheet—Cryptosporidium, http:// www.doh.wa.gov/Topics/crypto.html 224. CDC, Fact Sheet: Giardiasis, www.cdc.gov/ ncidod/parasites/giardiasis/ factsht_giardia.htm 225. Washington State DOH, Public Health Fact Sheet—Giardia, http://www.doh.wa.gov/ Topics/giardia.html 226. CDC, Fact Sheet: Giardiasis. 227. G Bentham and IH Langford, Climate change and the incidence of food poisoning in England and Wales, Intl J Biometeorology 1995; 39:81–6, in WHO 263. 228. Washington State DOH, Annual Communicable Disease Tables for 1998. 229. CDC, Viral Hepatitis A Fact Sheet, http:// www.cdc.gov/ncidod/diseases/hepatitis/a/ fact.htm. 230. Washington State DOH, Public Health Fact Sheet—Hepatitis A, http://www.doh.wa.gov/ Topics/hepafact.html. 231. Washington State DOH, Public Health Fact Sheet—E. coli, http://www.doh.wa.gov/ Topics/ecoli.htm. 232. Washington State DOH, E. coli. 233. Washington State DOH, Annual Communicable Disease Tables for 1998. Average number of cases of salmonellosis statewide from 1989 to 1999. 234. CDC, Outbreak of Vibrio parahaemolyticus associated with eating raw oysters—Pacific Northwest, 1997, MMWR 1998; 47(22): 457–62; IPCC 1995. 235. Washington State DOH, Public Health Fact Sheet—Vibriosis, http://www.doh.wa.gov/ Topics/vibriosis.htm. 236. FM Van Dolah, Marine algal toxins: origins, health effects, and their increased occurrence, Environ Health Perspect 2000; 108 (Suppl 1):133–41. 237. Washington State DOH, Vibriosis. 238. Levitus. 239. CDC, Epidemiologic notes and reports: paralytic shellfish poisoning—Massachusetts and Alaska, 1990, MMWR 1991; 40(10): 157–61. 240. Van Dolah. 241. Van Dolah. 242. Van Dolah. 243. Van Dolah. 244. Northwest Fisheries Science Center (NWFSC), “State health officials issue shellfish harvest warning—cite unusually high biotoxin levels,” West Coast Marine Biotoxins and Harmful Algal Blooms Newsletter, Oct 23, 1998, http:// www.nwfsc.noaa.gov/hab/newsletter/ washington.htm. 245. NWFSC, Impacts of harmful algal blooms, http://www.nwfsc.noaa.gov/issues/EC-6503. 246. Center for Food Safety and Applied Nutrition, Food and Drug Administration, The Bad Bug Book, http://vm.cfsan.fda.gov/ ~mow/intro.html. 247. IPCC Regional Assessment 315. 248. USEPA, Climate change and Washington; CIG 79. 249. R Sechena et al, Asian and Pacific Islander Seafood Consumption Study, EPA 910/ R-99-003, May 27, 1999. 250. Sechena. 251. CIG 52. 252. National Research Council, Upstream: Salmon and Society in the Pacific Northwest (Washington, DC: National Academy Press, 1996). 253. CIG 57. 254. CIG 54. 255. USEPA, Climate change and Washington. 256. Shelley Means, Racial and Environmental Justice Associate, Washington Association of Churches, personal communication, May 22, 2000. 257. Washington Department of Fish and Wildlife, Fact Sheet: Economic impacts of commercial and recreational fishing in Washington state, http://www.wa.gov/ wdfw/factshts/economic.htm. 258. Washington Department of Fish and Wildlife, Economic impacts. 259. NE Adler and JM Ostrove, Socioeconomic status and health: what we know and what we don’t, Ann N Y Acad Sci 1999; 896:3–15; NE Adler et al, Socioeconomic inequalities in health. No easy solution, JAMA 1993; 269(24):3140–5. The Health Threats of Climate Change in Washington 39 260. P Franks et al, Health insurance and mortality. Evidence from a national cohort, JAMA 1993; 270(6):737–41; HE Freemen et al, Uninsured working-age adults: characteristics and consequences, Health Serv Res 1990; 24:811–23; JS Weissman et al, Delayed access to health care: risk factors, reasons, and consequences, Ann Int Med 1991; 114:325–31. 261. J Tickner, Precautionary Principle, the networker, The Newsletter of the Environment and Health Net, May 1997, 2:34. 262. Tickner. 263. Press conference at the Siemens Solar plant in Vancouver, WA, Mar 16, 2000, transcribed by Ryhs Roth, Climate Solutions. 264. Press conference at the Siemens Solar plant in Vancouver, WA, Mar 16, 2000, transcribed by Ryhs Roth, Climate Solutions. 265. Washington State Energy Office, Greenhouse Gas Emissions Inventory for Washington State, 1990, WSEO #93-260, January 1994, revised March 1994. Printed on recycled paper. 40 D E ATH BY D E GR E ES PHYSICIANS FOR SOCIAL RESPONSIBILITY 1101 Fourteenth St., NW, Suite 700 Washington, DC 20005 tel: (202) 898-0150 fax: (202) 898-0172 website: www.psr.org