Degrees of Danger Texas PSR Free Report

PSR D PHYSICIANS FOR SOCIAL RESPONSIBILITY DEGREES OF HOW SMARTER ENERGY CHOICES CAN PROTECT THE HEALTH OF TEXANS GER T E X A S R E P O R T PSR PHYSICIANS FOR SOCIAL RESPONSIBILITY DEGREES OF HOW SMARTER ENERGY CHOICES CAN PROTECT THE HEALTH OF TEXANS GER Physicians for Social Responsibility Robert K. Musil, PhD, MPH, Executive Director and CEO Susan West Marmagas, MPH, Director, Environment and Health Program Brian Baenig, Legislative Director Laura Rasar King, MPH, CHES, Outreach Director Alicia Johnson, Program Coordinator Robin Clarke, Environment and Health Intern Author: Kathleen Barrows, Freelance Health Science and Education Writer Texas Advisory Board (Affiliations are listed for identification purposes only and do not imply organizational endorsement of this publication or its contents). Theresa Byrd, RN, DrPH., Associate Professor of Behavioral Sciences and Health Education, University of Texas-Houston School of Public Health at El Paso Janie D. Fields, Executive Director, Children’s Environmental Health Institute Michael Fischer, Senior Fellow, William and Flora Hewlett Foundation Fernando Guerra, MD, MPH., FAAP, Director of Health, San Antonio Metropolitan Health District; Chairman, Children’s Environmental Health Institute William Shelton, Jr., MD, Physicians for Social Responsibility Affiliate, Children’s Environmental Health Institute Board Member Randy Sowell, Land Manager, Cielo Wind Power, LLC June 2003 This report was prepared by Physicians for Social Responsibility to alert Texas residents to the potential health effects of air pollution, climate change, and reliance of fossil fuels. PHYSICIANS FOR SOCIAL RESPONSIBILITY 1875 Connecticut Ave., NW, Suite 1012 Washington, DC 20009 tel: (202) 667-4260 fax: (202) 667-4201 website: www.psr.org How Smarter Energy Choices Can Protect the Health of Texans Physicians for Social Responsibility Executive Summary ....................................................................................... 3 Texas’s Contribution to Air Pollution and Climate Change ................. 12 The Complex Origins of Climate Change................................................. 13 The State of the Science .............................................................................. 14 Climate Change on a Global Scale ............................................................ 14 Climate Change on a National Level......................................................... 16 Texas’s Energy Production, Air Pollution, and Climate Change ......... 16 Texas’s Energy Production ......................................................................... 16 Air Pollution and the Health of Texans .................................................... 17 Air Quality and Climate Change ............................................................... 22 Texas’s Water Resources and Climate Change ........................................ 23 Water Supply and Climate Change ......................................................... 23 Water Quality and Climate Change ........................................................ 25 Extreme Weather, Heat, Disease, and Climate Change ......................... 27 Extreme Weather Events ............................................................................ 27 Extreme Heat and the Health of Texans .................................................... 28 Diseases Carried by Insects ....................................................................... 30 Vulnerable Populations and Regions ........................................................ 32 Texas-Mexico Border Area ......................................................................... 32 Children, the Elderly, and the Poor .......................................................... 34 Texas Gulf Coast: An Eco-system Endangered ......................................... 35 Conclusions .................................................................................................... 37 Solutions and What You Can Do ............................................................... 38 Renewable Energy Sources ........................................................................ 38 Wind Energy ........................................................................................... 39 Solar Energy ........................................................................................... 41 Clean Biomass ........................................................................................ 42 Increased Energy Efficiency ....................................................................... 42 Modernization of Old Power Plants ...................................................... 42 New Micropower Technologies ............................................................. 43 Combined Heat and Power .................................................................... 43 Fuel Cells ................................................................................................ 44 What You Can Do ....................................................................................... 45 “The emerging trends of increased vulnerability to disease and increased exposureæ from warmer temperatures and the increased intensity of extreme weather events accompanying that warmingæ present an alarming picture; one that may serve as a ‘wake-up call’ regarding our patterns of development and the way we power that development.” —PAUL EPSTEIN, M.D., CENTER FOR HEALTH AND THE GLOBAL ENVIRONMENT (1) Executive Summary Texas, the largest state in area in the continental U.S., generates 99% of its electricity from coal, oil, natural gas, and nuclear power and nationwide ranks as the largest producer of carbon dioxide and unhealthy air emissions. If Texas were an independent nation, it would rank seventh in the world in carbon dioxide (CO2) production, the same as the United Kingdom, which has more than three times the population (15). Although Texas was once a leader in energy generation, and therefore exported a sizable percentage out of state, now over half of their coal and all of their nuclear fuel is imported (143). Texas is known for its weather diversity and extremes. Drought parches the plains of the Panhandle as well as West and Southwest Texas, hurricanes wreak devastation on the Gulf Coast, and Houston boils under summer heat waves. Texans, already accustomed to these extreme variations in weather, might ask: Can a climate characterized by extreme variation change even more? But the changes projected over the next 100 years could provide the greatest challenge yet to the quality of life and the health of Texans. But the challenge can be met. Texas has the natural, human, and economic resources to create a cleaner and more efficient energy system. It has the greatest potential in the nation for renewable energy (2). Combined with energy-saving measures, Texans have a chance to gain energy independence, boost the local economy, reduce emissions of greenhouse gases contributing to climate change, and protect human health. How Smarter Energy Choices Can Protect the Health of Texans 5 FIGURE 1 The Challenges Texas’ Energy Consumption and Production Some fear that climate change may increase the frequency and severity of extreme weather events, bringing Texas Energy History Quads (quadrillion BTUs) even greater losses of life and property damage to a state that over the last two decades has already 18 suffered over 16 weather disasters costing over a billion dollars each (3). Production Extreme heat is nothing new to Texans. In three of the last seven 12 years, Texas has ranked first among the states in the number of heatrelated fatalities (4). But the 6 Consumption environmental problems of Texas go beyond these unpredictable severe weather events and heat. Texans live on a daily basis with two major 1970 1980 1990 2000 climate-related problems: severe air Source: Railroad Commission, EIA pollution and scarce water resources. The air pollution clouding Texas skies, especially over major urbanindustrial centers like HoustonGalveston and Dallas-Fort Worth is taking its toll on Texans’ health. Chronic respiratory diseases like asthma are on the rise in both children and adults. In 1998, a year marked by record-breaking heat and ozone levels in Texas, asthma caused 343 deaths in the state (6) and resulted in an estimated $435 million in direct and $328 in indirect medical expenditures (14). The U.S. Environmental Protection Agency (EPA) estimated Texas, in 1999, as having the highest emissions nationwide of mercury, one of the most toxic substances known to exist. Mercury, a byproduct of coal combustion, is emitted from power plants and impacts the neurological development of children and causes seizures and even death. Due largely to its concentration of heavy industry, especially oil refineries, Texas usually ranks at or near the top among the 50 states in releases of unhealthy air emissions (13). In 2001, Texas was one of the three smoggiest states in the nation (11). Visitors to Big Bend National Park, far from the bustle of Texas urban life, complain of decreased visibility. Residents of El Paso breathe in the pollution from the brick-making factories in Juarez as well as the diesel fumes from the idling motors of cars and trucks waiting to cross over the U.S.-Mexico border. Environmental regulations are less stringent in Mexico than in the U.S. for both power plants as well as for vehicles, and oftentimes, regulations that do exist are less tightly enforced (104). Petrochemical facilities along the Gulf Coast, the cars, trucks, and sport utility vehicles (SUVs) in the traffic-congested urban areas, air-polluting school buses, and the coal-burning electricity-generating plants of Texas located throughout the state all add up to unhealthy air. 6 Degrees of Danger With warmer temperatures and sunlight, ground-level ozone, the Children: Hardest Hit by major component of smog, is formed Asthma and Ozone from nitrogen oxide and volatile In 1998, Texas ranked seventh in the nation in the number organic compounds ætwo pollutants of cases of pediatric asthma, the most prevalent chronic comprising emissions from power disease among children in the U.S., and over two and a plants, motor vehicles, and refineries. half million children (2,528,719) lived in counties that Eighty percent of Texas’ population exceeded the 8-hour ozone standard. This is second only to lives in urban areas, where groundCalifornia (47,48). level ozone pollution is an ongoing Ozone-related asthma attacks in children not only result problem. For the period of 1998 to in missed school days (48), but are also strongly linked to 2000, 16 of the state’s 22 reporting emergency room visits and hospital admissions of children counties, from a total of 254, received and other vulnerable populations. A recent research study an F from the American Lung in Southern California suggests that air pollution not only Association for the number of high triggers asthma attacks in children, but also may influence the development of new asthma cases. ozone days above the EPA limit (12). A study that controlled for socioeconomic status and Besides the air toxins that cause area of residence found that Hispanic children had a 2.5 disease and aggravate existing health times greater risk of developing asthma than whites (146). conditions, air pollution also includes greenhouse gases, such as CO2, which accumulate in the atmosphere and act as a blanket, trapping heat underneath and raising temperatures on the ground. Texas leads the nation in production of these gases, especially CO2. Close to ten and a half (10.4) tons of carbon dioxide per capita was emitted in Texas, almost twice the national average of approximately 5.4 tons per capita (2). Texas, with its 19 coal-burning plants, is highly dependent on coal for its energy supplies. Sixteen of the 19 power plants have been exempted or grandfathered from the Clean Air Act’s newer emission standards. These plants are some of the most polluting facilities in the world, releasing mercury, sulfur dioxide, nitrogen oxide, and CO2 into the air. Oil refineries are the nation’s major source of tons of toxic volatile organic compounds (VOCs), like cancer-causing benzene, and chemicals that cause asthma and developmental defects (144). Texas and Louisiana combined are home to 50% of the refinery “toxic hot spots.” The vitality of Texas rests on the continued availability of water, and the state is already depleting its water resources at an alarming rate. Climate change predictions are for a possible decrease in rain for Texas in winter and an increase of about 10% in other seasons. A projected increase in summer precipitation will likely come in the form of extremely wet days, which result in rapid runoff and a negligible increase of the state’s groundwater supply (5). The state’s primary sources of groundwater are already overdrawn, especially along the Rio Grande River. El Paso’s aquifer may be depleted as early as 2030 (6). As the second most populous state in the nation, with its population expected to double to about 40 million by 2050, municipal and industrial water use will inevitably increase. Only if state water plans and water conservation policies are implemented will the state have adequate water supplies over the next 50 years. How Smarter Energy Choices Can Protect the Health of Texans 7 But water is not only a question of quantity, but also quality. Both floods and droughts can result in water contaminated with microorganisms causing waterborne diseases. Gastrointestinal diseases caused by pathogens from contaminated water are a major problem in the border areas, and heavy metals like mercury and arsenic are infiltrating both ground and surface water in various regions of Texas (6). Shigellosis and Hepatitis A rates (in the border region are almost three times the national average (6). Certain populations and areas of Texas are expected to be more seriously impacted by climate change. Of special concern is the health status of Hispanics in Texas, which now number close to a third of the total population (36). Hispanic populations have disproportionately greater exposure to outdoor and indoor air pollutants, hazardous waste sites, pesticides, lead, and mercury, which may place them at greater risk for morbidity and even premature death from asthma, lead poisoning, behavioral and development problems, and cancer (145). Certain health measures indicate that the health of this population is actually deteriorating with longer residence in the U.S. This is mainly due to environmental exposures and stressors, which are exacerbated by climate change (100). Climate change will further increase the health risk to those already vulnerable—especially the young, the poor, the immunocompromised, and the elderly. Texas has a large population of children especially vulnerable to respiratory disease, the largest proportion of FIGURE 2 Renewable Energy Systems in Texas WIND SOLAR BIOMASS 8 Degrees of Danger people without health insurance in the nation, and a large border population already suffering from disease patterns that are more commonly associated with developing countries. Problems of water scarcity and quality, as well as polluted air, will affect these populations disproportionately. Texas is threatened by increasing air and water pollution and hazardous waste, yet in 2002 less than 2% of the current appropriated budget of the state was allocated for natural resources agencies (18). In 1996, Texas ranked 46th in spending per capita on environmental protection overall (19). The Solutions But there are solutions. Texas has the natural, human, and economic resources for a cleaner and more efficient energy system, which will reduce its emissions of greenhouse gases and other air pollutants. The state has the greatest potential in the nation for renewable energy. Renewable energy and efficiency programs have the potential to sustain Texas indefinitely, while providing economic benefits and enabling Texas to reclaim its position Carson County Health and Economy as a global energy leader. Further investments in renewable energy will Benefiting from Wind Power redirect money spent on energy to Carson County, Texas is home to Llano Estacado Wind Ranch local economies and create jobs in at White Deer. The wind farm is comprised of 80 wind numerous services. turbines capable of generating electricity for 28,000 The wind, solar, and biomass households each year. This farm, developed and maintained potential of Texas is estimated to be by Cielo Wind Power, LLC and owned by Shell Wind Energy, about 400 times the state’s present is helping displace air pollutants and boost the local energy consumption (2). According to economy by providing jobs for maintenance and operation, utilizing local services, and providing revenue to local an analysis by the Tellus Institute, landowners. Due to Cielo’s environmental standards, minimal investment in renewable energy and impact occurred during construction of the wind farm, and energy efficiency could create 71,500 native plant restoration occurred thereafter. The wind facility additional jobs in Texas by 2010 and does not interfere with pre-existing agricultural use. 123,400 jobs by 2040 (135). Texas has the second best wind potential in the nation, second only to Kansas (135). Wind energy is most cost-competitive renewable energy technology and has the potential to The Texas Electric Choice reduce state CO2 emissions by as much as 1.83 million Texans can easily support the tons per year, by reducing fossil fuel use (20). Wind development of renewable energy by energy in Texas in 2002 provided $2.5 million in royalty selecting a retail electric provider income to farmers and landowners hosting wind turbines offering energy from renewable on their land (138). sources. For more information on how Direct solar radiation in Texas is strongest in West and you can purchase renewable energy North Texas (125). Theoretically, if the entire state of to power your home or office, contact Texas were covered with solar cells, the state could the Texas Electric Choice Call Center generate 55 quadrillion BTUs of electrical energy every at 1-866-PWR-4-TEX, (1-866-797year. This would be enough to supply one and a half 4839) or visit http:// www.powertochoose.org/index.html times the world’s current energy consumption. Solar energy’s benefits are highlighted at the University of Texas How Smarter Energy Choices Can Protect the Health of Texans 9 How Climate Change Could Threaten Health In Texas According to physicians who have studied climate change and its effects, the most severe health risks in Texas could include the following: More frequent and severe attacks of asthma, an increased incidence of strokes, and worsening of other respiratory and cardiac problems resulting from • Increased ozone (smog) levels. • Greater emissions of carbon dioxide, nitrogen oxide, sulfur dioxide, particulate matter, and other toxic pollutants. • Increased pollen levels. • Increased dust and particulates. Changes in the quality and supply of fresh water • Warmer temperatures leading to enhanced evaporation combined with changes in precipitation could further jeopardize already threatened water resources. • Increased risk of disease from bacterial, parasitic, and viral infections caused by consumption of water contaminated by animal and human waste. • Impaired water quality from droughts and floods. Greater health risk for vulnerable populations • Increased health risks for poor border populations, especially for mosquito-borne diseases, intestinal infections, and respiratory illnesses. • Increased incidence of respiratory problems such as asthma, especially among children. • Risk of heat-related illness, especially among the elderly and poor. Increased accidents and injuries from severe weather events • Increased severity and/or frequency of tropical storms, causing a rise in mortality and morbidity, especially along the Gulf Coast. • An increase in heavy precipitation events resulting in more flooding. More heat-related illness • Number of heat-related deaths could increase significantly. • Senior citizens, the very young, and the poor are at greatest risk of death from heat stress. Greater risk of infectious diseases • Increased risk of mosquito-carried diseases such as dengue, West Nile Virus, and malaria. Houston Health Science Center, which more than doubled its solar capacity in 2001, resulting in significant reductions in emissions of CO2, nitrogen oxides and sulfur dioxide. Due to the enormous savings in electricity costs, the University is now finalizing plans to install an even larger system on the School of Nursing Student Community Center building by the end of 2003. Texas ranks fourth for its landfill gas potential and sixth in its potential to utilize clean biomass (energy produced from fermenting any living plant matter)(135). Some Texas cities—San Antonio, Dallas, Garland, Waco, and Austin are developing projects to utilize combustible waste gases escaping from landfills for thermal production. (125,128). These gases can be collected and converted into clean energy, preventing methane, a greenhouse gas, from escaping into the atmosphere. Tax incentives like the federal production tax credit, which allows builders of renewable energy sources to receive a tax credit for the investment in renewable energy and the state’s renewable portfolio standard of 2.2% by 2009, which was enacted in 1999 to require that a percentage of electrical offerings be from renewable energy, have fueled a resurgence of wind energy in the state 10 Degrees of Danger (20). Wind power is becoming more SOLUTIONS: economically feasible and could realistically supply between 10 and Texas’ Energy Potential and Future 20% of Texas’ electrical needs by the Reducing air pollution and slowing the rate of climate change end of the decade (21). requires many approaches. They include: In addition, the state is applying its technological know-how to making • Increasing our use of renewable energy sources such as sources, fossil fuel- based energy more wind, solar, and biomass energy. Tax incentives, further research and development, and state and federal efficient. Texas is the nation’s leader Renewable Portfolio Standards are necessary to bring the in implementing Combined Heat and current technologies to the forefront of the energy debate. Power technologies, which can significantly reduce greenhouse gas • Decreasing our dependence on fossil fuels by improving the emissions. Hospital facilities in energy efficiency of power plants, micropower, and motor Houston and Austin, for example, vehicles. Installing modern pollution control technologies in grandfathered power plants and increasing the fuel have adopted new, clean micropower economy of automobiles will require less fossil fuels to be technologies (22). imported from other states. Cities throughout Texas are beginning to address climate change • Planning for smart growth and restricting sprawl. issues. Water conservation efforts in • Protecting water resources through more sustainable El Paso have significantly reduced agricultural practices, conservation, and ranchland water usage; citizens’ groups in management. Houston are working on reforesting • Protecting border and other vulnerable populations by a the city to help protect it from continuing commitment to social equity. summer heat. With budget shortfalls at both the federal and state levels, measures such as these, taken at local levels, must be a priority. The state’s energy potential, as well as the efforts of individual Texans, including health professionals, who assume a greater responsibility for the state of global climate change provide hope for cleaner air and water. How Smarter Energy Choices Can Protect the Health of Texans 11 How Smarter Energy Choices Can Protect the Health of Texans The report that follows will discuss the concept of air pollution, climate change and energy choices, the potential effects on global, national, and state levels during the next 50 to 100 years, followed by a detailed discussion of the potential health effects in Texas. It will examine challenges facing the two basic environmental media todayæair and wateræas well as the health threats stemming from extreme weather events, heat, and diseases transmitted by insects. The populations most vulnerable to these health threats are discussed, followed by a section on solutions. Texas’ Contribution to Air Pollution and Climate Change Emissions of greenhouse gases are particularly high in Texas. If Texas were an independent nation, it would rank seventh in the world in CO2 production, the same as the United Kingdom, which has more than three times the population (15). Since 1995, Texas has emitted close to twice as much CO2 as any other state in the U.S., accounting for FIGURE 3 more than 10% of the U.S. total. Close Carbon Dioxide Emissions for Selected States to ten and a half (10.4) tons of carbon dioxide per capita was emitted in 200 Texas, almost twice the national average of approximately 5.4 tons per capita (2). 166.56 In comparison to the rest of the 150 U.S., Texas has a far larger share of carbon emissions from industry than from transportation or residential and commercial buildings. This is because 100 94.83 a large portion of industrial carbon emissions in Texas arises from energy combustion of its 26 oil refineries (2). 64.05 60.83 50 Without national and state policies to curb emissions, it is expected that Texas carbon and pollutant emission will continue to rise steadily (2). 0 The EPA (5) estimates that Texas California Florida Pennsylvania Texas may experience the following climate Source: U.S. EPA Energy CO Inventories changes, based on one commonly used climate model from the United Kingdom (Hadley Centre): 2 Million Metric Tons of Carbon (MMTCE) • a temperature increase of 3˚F in spring (with a range of 1 to 6˚F) and approximately 4˚ in other seasons (with a range of 1 to 9˚F). 12 Degrees of Danger • a decrease in precipitation of 5 to 30% in winter, and an increase by approximately 10% in other seasons, especially summer, when rainfall could increase by as much as 30%. • an increase in extreme hot days in summer. Combined with the state’s history of extreme weather events and susceptibility to sea level rise, the predicted climate change may leave Texas particularly vulnerable. The Complex Origins of Climate Change Energy from the sun drives the earth’s weather and climate and heats the earth’s surface. The earth, in turn, radiates energy back into space. It is the existence of certain atmospheric “greenhouse gases,” such as water vapor, CO2, methane, and nitrous oxide, which trap some of the sun’s energy like the glass panels in a greenhouse. Without this effect, h own as the greenhouse effect, temperatures on the planet would be much lower than they are now, and life as it is known today would be impossible. Due to these greenhouse gases, the earth’s average temperature is about 60˚F (23). Since the end of the last Ice Age 10,000 years ago, average temperatures worldwide have risen 9˚F. This has mainly been due to natural changes in the geographical distribution of the sun’s energy and in the amounts of dust, CO2, and other natural gases in the atmosphere. In recent FIGURE 4 The Greenhouse Effect Earth radiates heat back into space atmospheric greenhouse gases from natural sources and human activity greenhouse gases trap heat Earth absorbs solar radiation (heat) deforestation reduces absorption of carbon dioxide burning of fossil fuels releases carbon dioxide industry releases carbon dioxide vehicles emit carbon dioxide and nitrogen dioxide agriculture produces methane and nitrogen dioxide emissions How Smarter Energy Choices Can Protect the Health of Texans 13 years, however, the rate of increase in temperatures has accelerated. Global mean surface temperatures have increased 0.6 to 1.2˚F between 1890 and 1996 and even more so in the last two decades. The 1990s was the warmest decade of the last century, with the years from 1998 to 2000 registering as three of the hottest years on record. Scientists attribute this intensification of this greenhouse effect to human activities, namely, human-generated emissions of greenhouse gases. Over the course of most of history, the balance has been maintained by the natural greenhouse gas emissions from plant respiration and the decomposition of organic matter. Since the beginnings of the industrial revolution, however, atmospheric concentrations of greenhouse gases have greatly increased. CO2 concentrations are up 31%; methane concentrations have more than doubled; and nitrous oxide concentrations have risen by about 15%. Fossil fuelsæused to run cars and trucks, heat homes and businesses, and power factoriesæare responsible for close to all of the CO2 emissions, 24% of methane, and 18% of the nitrous oxide emissions. But other human activities, including deforestation, agricultural, landfills, industrial production and mining, also contribute a significant share. All of these increases have enhanced the capability of the earth’s atmosphere to trap heat (23). The State of the Science “There is new and stronger evidence that most of the warming observed over the last 50 years is attributable to human activities.” —INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE, 2001(24) Climate Change on a Global Scale In 1988, the United Nations Environment Programme and the World Meteorological Organization established an international team of scientists to review the state of the science of global warming. Known as the International Panel on Climate Change (IPCC), it has since published what are recognized as the most comprehensive and credible three assessments of climate change in 1990, 1996, and 2001, based on reviews of published and peer-reviewed research on all aspects of global warming and climate change. In the latest report in 2001, the Third Assessment Report, the IPCC revised its original temperature projections of a rise of 1 to 3.5˚F in global average surface temperatures (24). It is now believed that the average could rise by another 2.5 to 10.4˚F (1.4˚ to 5.8˚C) by the end of this century, if the process is not slowed down. This rise in temperatures is far greater than recent natural fluctuations. The IPCC estimates that over the past 140 years, the global average temperature has risen by about 1˚F. Other effects of the warming phenomenon have been the rise of sea levels globally by 4 to 10 inches over the past century, a decrease in Northern Hemisphere snow cover and Arctic Sea ice, and a slight increase in precipitation over land. Predictions about climate change are based on a variety of evidence, including measuring greenhouse gases, using complex computer-generated meteorological models 14 Degrees of Danger to simulate climate, and studying past weather variables such as precipitation and heat records . Climate Change on a National Level In 1990, the U.S. Congress established the U.S. Global Change Research Program, mandating that it conduct a national assessment of the potential impacts of climate variability and change on the U.S. As a result, the U.S. National Assessment of the Potential Consequences of Climate Variability FIGURE 5 and Change (commonly referred to as Climate Change in the U.S. the National Assessment), with experts from academia, government, and the private sector, in 1997 began a study of the potential impacts of climate change over two time frames (to 2030 and to 2100) for geographic regions of the U.S. and for various national sectors, including health (27). Conclusions of the report were published in 2000. The working group of the National Assessment that was charged with studying the health effects of climate change identified five main categories of health outcomes that were most directly associated with climate variables. They are air pollutionrelated health effects; extreme weather events (storms, tornadoes, hurricanes, and precipitation); temperature-related illnesses and deaths; diseases transmitted by insects and rodents; and water and foodborne diseases (27). But health in relation to climate change is much more than looking at disease. The human health impacts of climate change will have both direct and indirect effects, as well as immediate and delayed effects (30). It involves addressing the issues of those populations that will be most severely affected by climate change, as well as relating disease to the larger ecosystems in which humans dwell. Waterborne diseases are directly related to issues of water quality and The U.S. is already feeling the effects of global climate change. Temperatures have increased by approximately 1˚F. over the past century in the contiguous U.S. (28). Precipitation has also been increasing, due particularly to an increase in heavy rainfall (more than 5 cm per day) and a decrease in light-precipitation events (29). The country’s contribution to climate change must be examined. Studies show that in 1997, the U.S., with 4% of the world’s population, was emitting close to one fifth of total global greenhouse gases (23). CO2 is the largest contributor to the greenhouse effect, accounting for 82% nationwide, followed by methane, accounting for 10% of U.S. emissions. And emissions are on the rise. Between 1990 and 1999, U.S. greenhouse gas emissions increased by 13%, and the Energy Information Administration projects that the average rate of increase will continue by 1.5% per year. If current trends continue, CO2 concentrations could increase anywhere from 30% to 150% by the year 2100 (23). CO 2 emissions (thousand metric tons of carbon) 1,500,000 1,200,000 900,000 600,000 300,000 0 Germany United Kingdom United States of America China (mainland) Russian Federation Source: Oak Ridge National Laboratory and University of North Dakota Canada Japan India How Smarter Energy Choices Can Protect the Health of Texans 15 quantity. Deaths from extreme weather events also are intricately linked to sea level rise along the Gulf Coast, which in turn, is linked to foodborne diseases like the contamination of shellfish. Texas’ Energy Production, Air Pollution, and Climate Change Most air pollution comes from the production of energy—primarily from the burning of fossil fuels such as coal and oil—to power modern life. Air pollution includes greenhouse gases, such as CO2, as well as other pollutants that endanger our health and diminish the quality of our lives. Texas’ Energy Production Texas relies heavily on coal, natural gas, and nuclear power for its electricity, with over half of all the coal and all of the nuclear power needed being imported (143). Over one-third of Texas’s electricity is derived from coal (143). The electric power industry is one of the most polluting industries in the world. Major power plant pollutants include mercury, CO2, sulfur dioxide, and FIGURE 6 The Cycle of Power Plant Pollutants Agricultural application Contamination of crops and soil Wind dispersion of particles Surface impoundment/ landfill Runoff into surface water Water table Contamination of groundwater Leaching into groundwater Contamination of fish 16 Degrees of Danger nitrogen oxide. Power plants built FIGURE 7 from 1940 to 1970 produce the vast Texas Electricity Generation by Energy Source majority of power plant air pollution. When Congress passed the Clean Air Petroleum Act in 1970, and amended it in 1977 0.6% and 1990, the electric power industry convinced members of Congress that older plants would soon be retired and therefore should be exempted Coal from strict new emission standards. 39.2% Unfortunately this has not happened, Gas and these old power plants continue 49.2% to emit, on average, 4 to 10 times more air pollution than a new plant. This loophole makes it profitable for utilities to keep operating old plants. Other 0.5% Sixteen of Texas’ 19 coal-fired power Hydroelectric plants are grandfathered under this 0.3% Nuclear 10.2% loophole. Source: EIA Oil refineries are the nation’s major source of tons of toxic VOCs, like cancer-causing benzene, and chemicals that cause asthma and childhood development problems (144). Texas and Louisiana are home to 50% of the refinery “toxic hot spots.” Nationwide in 36 states and 125 U.S. cities, more than 67 million people breathe air polluted by refineries (144). Refineries are also a source of large chemical releases during fires, explosions, and spills. During these accidents, many thousands of pounds of dangerous chemicals can be released in a short period. These dangerous spills often dump chemicals into the communities around refineries, causing health problems. Air Pollution and the Health of Texans National Ambient Air quality standards recognize six pollutants to be of public health concern: ground-level ozone, particulate matter, lead, nitrogen oxides (NOx), sulfur dioxide (SO2), and carbon monoxide. In addition, there are 188 hazardous air pollutants or air toxics, most of which are VOCs. See Table 1: Air Pollution: Its Sources and Health Impacts. Ozone: Ground-level ozone is the major component of what we commonly call smog, the most pervasive outdoor air pollutant in the U.S. Smog is at its worst on hot, sunny days, which are likely to become more numerous with global warming. Nearly one-half of the state’s population currently lives in metropolitan areas that do not meet federal standards for ozone (13). The two metropolitan areas of Houston-Galveston-Brazoria and Dallas-Fort Worth have the unhealthiest air in Texas, ranking among the 24 metropolitan areas in the U.S. with the worst ozone air pollution between 2000 and 2002 (12). In 2001, How Smarter Energy Choices Can Protect the Health of Texans 17 TABLE 1 Air Pollution: Its Sources and Health Effects Name of Pollutant Carbon Monoxide Abbreviation CO Source and Environmental Impacts CO is produced by burning organic matter such as fossil fuels, wood and charcoal. Motor vehicles produce 67% of the man-made CO that is released into the atmosphere. CO2 is produced by burning organic matter such as fossil fuels, wood and charcoal. CO2 is a greenhouse gas. Oxides of nitrogen are the chemicals responsible for giving smog its brown appearance. NOX contributes to the formation of ozone, production of particulate matter, and acid rain. Particulate mater consists of soot and dust particles that are smaller than the diameter of a human hair. Electricity generation, transportation and industry generate roughly equivalent proportions of PM. Oxides of sulfur are produced by the burning of fossil fuels. Large emitters of SOX include motor vehicles, refineries and power plants. SOX contributes significantly to acid rain. VOCs are a class of reactive organic gases that contribute to the formation of ozone and smog. Motor vehicles, refineries and power plants are the primary source of VOCs. Levels of VOCs are often determined by measuring unburned hydrocarbons (UHC) Air toxics like benzene, toluene, and formaldehyde are formed from fossil fuel processing and combustion. The U.S. EPA has identified 188 chemicals as hazardous air pollutants. Health Impacts Fatigue, angina, reduced visual perception and dexterity, death in closed space. Major contributor to global warming, which has been linked to an increase in the spread of disease. Irritates lung tissue, causes bronchitis and pneumonia, has been linked to a decrease in lung function growth. Penetrates deep into the lungs and is associated with numerous respiratory and cardiac problems and cancer. Reduces respiratory volume, increases breathing and nasal airway resistance. Carbon Dioxide Nitrogen Oxides CO2 NOX Particulate Matter PM Sulfur Oxides SOX Volatile VOC/ Organic UHC Compounds Coughing, fatigue and nausea; contributes to the inflammation of lung tissue and reduced lung capacity. Air Toxics Cancer, reproductive disorders, developmental disorders. Source: Micropower at the Crossroads: Public Health and the Future of Distributed Generation. Texas exceeded the EPA’s 8-hour standard over 300 times, joining California and Pennsylvania as the three smoggiest states in the country (11). Ozone is a toxic and irritating gas that, even in small amounts, can affect health. Exposure to elevated ozone levels can cause severe coughing, shortness of breath, pain when breathing, lung and eye irritation, and greater susceptibility to respiratory illnesses, such as bronchitis and pneumonia. Exposure to low levels of ozone over several hours can even reduce lung function in healthy adults who exercise moderately. Ozone is of special concern for residents of Texas with asthma, who number between 850,000 (12) and 1.25 million (13). Numerous studies have shown that 18 Degrees of Danger Children: Hardest Hit By Asthma Asthma is the most prevalent chronic disease among children in the U.S. (47). Ozone-related asthma attacks in children not only result in missed school days (48), but are also strongly linked to emergency room visits and hospital admissions of children and other vulnerable populations. A recent research study in Southern California suggests that air pollution not only triggers asthma attacks in children, but also contributes to the development of new asthma cases. Researchers found that children most likely to develop asthma were those exercising in active sports such as soccer, basketball, and tennis in the most polluted cities and concluded that in these conditions, air pollution and outdoor exercise could contribute to the development of asthma in children (49). Ozone has also been associated with adverse birth outcomes. A new California study suggests associations between ozone exposures during the second month of gestation and aortic valve defects, pulmonary artery and valve abnormalities, and other defects (50). Other research suggests that exposure to ozone may permanently affect the lung structure of children (51,52). Another study that controlled for socioeconomic status and area of residence found that Hispanic children had a 2.5 times greater risk of developing asthma than whites (146). In 1998, Texas ranked seventh in the nation in the number of cases of pediatric asthma, and over 2.5 million children (2,528,719) lived in counties that exceed the 8-hour ozone standard. This is second only to California (48). But for children living in the shadows of the dirty coal-fired power plants in Texas, the problem is even worse. In EPA stack tests, 67 different pollutants have been detected in the flue gas of coal-fired plants, including mercury and beryllium. Fifty-five of these are known to affect the brain and nervous system development of children (48). Power plants are responsible for 67% of sulfur dioxide emissions in the U.S. in the air. Texas, with its 19 coal-burning plants, is highly dependent on coal burning plants for its energy supplies. A recent study found that in 1998, over 1.5 million children in Texas lived within a 30-mile radius of coal-burning plants that were grandfathered under the federal Clean Air Act. Over 92,000 of these children had asthma, and close to one-third of them (453,088) lived in poverty. Over 1,000 schools were located in the same radius (48). higher ozone levels cause more asthma attacks, increase the need for medication and other medical treatment, and result in more hospital admissions and visits to emergency rooms (46). Even without asthma, young children, citizens over 65 years of age, anyone with underlying respiratory problems, and healthy adults who work or exercise outside are threatened by ozone (12). In 1998, a year marked by record-breaking heat and ozone levels in Texas, asthma caused 343 deaths in the state (13). If warmer temperatures are coupled with sunny days, keeping ozone levels low may become even more of a challenge. Volatile organic compounds (VOCs): VOCs in the atmosphere have two major health impacts: They are directly toxic and can combine with nitrogen oxides to form ozone. These hazardous air pollutants are associated with cancer as well as adverse neurological, reproductive, and developmental effects (53). As temperatures increase, more VOCs are emitted when people fuel and operate motor vehicles (54). Warmer temperatures lead to increased natural emissions of VOCs. With an increase of 10°C temperature, for example, natural emissions increase by two-fold (55). Thus, climate change is expected to increase levels of both How Smarter Energy Choices Can Protect the Health of Texans 19 human-made and natural sources of VOCs, increasing ozone levels. The petrochemical and industrial facilities of the Texas Gulf Coast account for close to three-fourths of the state’s toxic air emissions (13). Nitrogen oxides: Like VOCs, nitrogen oxides have multiple roles in adversely affecting health. Nitrogen dioxide combines with VOCs to form ozone. It can be directly toxic in the lungs, where it combines with water to form acids that damage the lung tissue (56). In the atmosphere, NOx oxidizes to become nitric acid, a major component of acid rain (54). They also combine with sulfur dioxide to form particulates. Since 1995, Texas has ranked second only to Ohio in the volume of NOx emissions released into the atmosphere (57). Sulfur dioxide and particulate matter: Like nitrogen oxides, sulfur dioxides are oxidized in the atmosphere to become acid rain. More importantly, however, they can combine with NOx to form fine particles, called particulate matter. Particulate matter produces a haze that can cause visibility problems, damages health, and also dirties and damages buildings and clothes. Particulate matter is perhaps the most pervasive and harmful pollutant from coal-burning electric power plants (58). Some of it is soot directly emitted by power plants. But it is the sulfur dioxide gas emitted from power plants that becomes transformed into tiny acidic sulfate particles that circulate in the atmosphere. Fine particulate matter, which is 1/100th the width of a human hair, is of great concern because it not only circulates in outdoor air, but also penetrates into indoor living spaces, thereby increasing our exposure. It tends to deposit deep in the lung, where it can affect both the respiratory and cardiovascular system (48). Numerous studies have pointed out the significant health effects of particulate matter. Scientists in the United Kingdom have concluded that long-term exposure to fine particle pollution is likely to be as dangerous as second-hand smoke (59). When concentrations of particulate matter increase, hospital admissions for respiratory and cardiac cases of elderly patients and children increase (60,61). The most comprehensive study yet of long-term exposure to fine particulate and sulfur oxide-related pollution, using American Cancer Society data from throughout the U.S., found that fine particulate matter is related to increased lung cancer, strokes, and heart attacks in adults (62). Especially for those who are obese, inactive, or have a history of heart problems, particulate matter can trigger a heart attack. The risk for heart attack peaked two hours and again 24 hours after exposure to increased levels of particulate matter, indicating that although an area meets the federal Clean Air Act requirements, particulate matter in the air may still pose a health hazard (63). Fine particles may be especially dangerous for babies and young children. One study found that infants living in cities with high levels of fine particles have a 26% increased risk for sudden infant death 20 Degrees of Danger syndrome, and infants living in high pollution areas were 40% more likely to die of respiratory causes (64). In Texas, the city of El Paso is currently designated as a nonattainment area for particulate matter (13). It has been estimated that particulate matter shortens the lives of 435 people per year in the Houston area. Complying with clean air standards would save $3 billion per year (65). Carbon monoxide: Odorless, invisible, and poisonous, carbon monoxide (CO) is formed when fuel does not burn completely. Though not a greenhouse gas itself, CO can increase the lifespan of other greenhouse gases and worsen climate change. It can also increase the production and concentration of ground-level ozone (24). Transportation accounted for about three-fourths of CO emissions nationwide in 1997, with the exhaust of cars and trucks contributing more than half of all CO emissions. In cities, car exhaust contributes as much as 95% of all CO emissions, thus accounting for high concentrations of CO in heavily trafficcongested areas. Nationally, average CO levels have shown a decrease since 1988. In 1994, Houston and Dallas were among the top most traffic-congested cities in the U.S. Following the national trend toward larger and more CO emitting vehicles, ownership of trucks and sports SUVs is high in Texas. In 1997, there was one pickup truck for every eight licensed drivers and about one SUV for every 30 licensed drivers (66). The cross-border truck traffic in Laredo, where long lines of trucks sit idling, is of special concern to Laredo residents (6). High exposures to CO now occur primarily with certain occupations such as firefighting. But even the low-level exposures that occur in urban settings may adversely affect the most oxygen-sensitive organs of the bodyæthe heart and the brain. Carbon monoxide retards the blood’s ability to deliver oxygen. Low concentrations can cause headache, confusion, shortness of breath, and fatigue. It can cause vision problems, reduce the ability to work or learn and reduce dexterity (6). Conditions such as cardiovascular disease, chronic respiratory disease, and pregnancy may put significant fractions of the population at elevated risk. Pregnant women, for example, who regularly breathe in air with 50 parts per million of CO tend to have low birth-weight babies (67). Generally, however, the health effects of CO cannot readily be separated from those of other pollutants (16). Lead: Lead, a heavy metal that persists in the environment for decades, has been significantly reduced in the air since 1970 due to federal regulations that mandate the use of unleaded gasoline. Leaded gasoline, however, is still used in off-road vehicles such as farm equipment and non-road transportation. Lead emissions are now primarily due to metal smelters, as well as the manufacture of lead-based paint, and lead-acid battery reclamation operations. Lead exposure, however, will continue to occur through past deposition of lead onto soil and other media from which it can become airborne or enter the human food chain. It continues to be a major public health concern because of its well-established neurological impact on children (54). How Smarter Energy Choices Can Protect the Health of Texans 21 Mercury: Mercury is an air pollutant byproduct of coal-fired power plants that settles on land and water and converts into methylmercury. One of the most toxic substances known to exist, methylmercury causes neurological defects, seizures, and even death. The primary sources of mercury are coal-burning electric utilities and commercial and industrial boilers. Mercury accumulates in water sources and settles in the body tissues of fish at 10,000 to 100,000 times the concentrations in the water. It is especially harmful for pregnant women because it crosses the placenta and can cause damage to the developing fetal nervous system. In 1999, Texas mercury emissions from electrical utilities, which deposit in the surrounding soils and waters, were estimated by the EPA to be the highest in the nation (43,13), and as of 2000, there were fish consumption advisories for mercury at eight reservoirs in the East Texas area (13) as well as for coastal waters (43). Valley Fever Coccidioidomycosis, known in the Southwest as valley fever, is a pulmonary infection found primarily in Arizona and California, but some cases have been reported in eastern and northern Texas, and the fungus causing valley fever is endemic in Texas. Symptoms include mild cold or flu-like ailments, and 60% of people who become infected with valley fever have no symptoms or only very mild symptoms. At its worst, however, the disease can spread beyond the lungs and infect the blood, other organs, and the brain, to cause a form of meningitis (70). Those at greatest risk for developing this severe form are persons 65 and older and patients whose immune systems do not function properly (such as those with AIDS). While researchers are still learning about the disease’s link to climate, it is believed that the fungus, which survives in extremely high temperatures, grows during wet periods and forms tiny spores that are released into the air. It is sensitive to temperature and moisture, so changes in the climate are likely to affect its growth and possibly the incidence of the disease. Pollens and natural allergens: Natural allergens such as pollens and fungal spores also contribute to air pollution and may increase with climate change. An increase in temperature and precipitation or a combination of drought with increasing temperatures could lead to increased fungal growth and particulate-carried fungal spores, which could exacerbate asthma and other respiratory conditions (68). Some pollen-producing plants, such as birch trees, have been found to increase their pollen production and the allergen content of the pollen with increasing temperatures (69). Warmer temperatures may also lengthen the seasons for allergies such as cedar fever. Air Quality and Climate Change “It has long been recognized that climate and weather exert a profound effect on air quality.” —GRAHAM BENTHAM, CENTER FOR ENVIR ONMENTAL RISK, UNIVERSITY OF EAST ANGLIA (45) The link between air quality and climate change is complex. Some of the gases that influence climate change are air pollutants with known negative health effects; others, like CO2, are not especially associated with negative 22 Degrees of Danger health effects but are major contributors to global climate change. Climate change is expected to affect air quality in at least five different ways: • As climate change causes temperatures to increase, ground-level ozoneæ the main component of smogæwill increase. Smog is formed from NOx and VOCs (both natural and human-made) in the presence of sunlight and heat. • Pollutant concentrations in the air of a specific location may be affected by local and regional weather conditions. Still air could allow pollutants to accumulate; wind could blow pollutants to other areas. Climate change could have significant effects on local weather conditions, which then have significant effects on local air quality. • Concentrations of human-made pollutants could increase as a result of escalating energy demand due to urban growth and development, if fossil fuels continue to provide the main energy source. Ground-level ozone, CO, particulate matter, NOx and SO2 are byproducts that come from burning fossil fuels. All have negative health effects. Climate change can increase concentrations of these pollutants as well as compound their effects. Global warming may also change some of the factors that influence their atmospheric concentrations, including wind speed and direction, precipitation, and other weather patterns. • Natural (nonhuman-made) sources of air pollutants also could increase. For example, higher temperatures cause forests and other sources of natural VOCs to emit greater amounts, which when they combine with NOx, form ground-level ozone. Texas’ Water Resources and Climate Change “It is the potential alterations in water supply due to a change in climate that are of greatest concern for Texas.” —GEORGE WARD AND JUAN B. VALDES, TASK FORCE ON THE IMPACT OF CLIMATE CHANGE, 1995 (31) Water Supply and Climate Change At least some portion of Texas has suffered a serious drought in every decade of the 20th century (32). During the first half of the 1950s, for example, a severe drought brought an estimated 65% reduction in runoff statewide and over 60% reduction in flows to the coast (33). Climate change projections indicate that with the increased evaporation caused by a predicted increase in temperature, stream flows in Texas could be reduced by as much as 35%. The city of El Paso is already facing depletion of its sole water source by 2030 and its sister city, Ciudad Juarez, is expected to run out in 2005 (6). Since Texas is already stretching its water resources to the limit, any further diminishment caused by climate change could have severe economic, social, and health impacts (31). Water sources in Texas are of two types, surface water and groundwater. With no winter snow mass that melts to feed lakes and rivers or sustained How Smarter Energy Choices Can Protect the Health of Texans 23 moderate-intensity rainfalls over large parts of the state, thunderstorms are the main source of surface water. Precipitation tends to be locally intense but of brief duration. Reservoirs, therefore, supply virtually all surface water used for consumption and form the cornerstone of Texas’ water resources (31). The other major water sources for Texas are the nine major and 20 minor aquifers. Aquifers, permeable natural rock formations, serve as underground reservoirs. When it rains, water slowly percolates down through the soil to replenish these underground reservoirs in a process called recharge. With the heavy and intermittent rainfall typical of Texas, however, the soil is often not able to absorb the water fast enough, and it becomes runoff. Much of the runoff in all regions of the state ends up flowing uncaptured to the coast or to other states, and thus does not help to recharge the aquifer. In addition, water is now being pumped out from the aquifers faster than it is being replenished (31). Texas’ water supply varies substantially from one region to the next, from the water-rich, low usage East to the arid South and West, with its high water demands based largely on agricultural demand for irrigation. Hydrologically, the state can be divided into four regions: • The High Plains region (commonly known as the Texas Panhandle), with only 7% of the state’s population, accounts for 70% of groundwater withdrawal in the entire state, predominantly for agriculture. The Ogallala aquifer, upon which the area greatly depends, is expected to be drawn down at an even faster pace with the increased demand for irrigation under climate change. • East Texas, with relatively the same population as the High Plains, is the most water rich area of the state, with virtually no groundwater usage and with the greatest runoff rate. The Trinity River, which receives an abundance of rainfall, serves most of the largest metropolitan areas of the state, including Dallas and Houston. Still, one study has predicted that six years of drought worsened by global climate conditions would cause reservoir levels in Dallas to fall to less than 22% of conservation capacity (34). • The Central Texas region (including San Antonio) contains the principal population centers and industrial capacity of the state. Groundwater withdrawal for both agricultural and municipal use comes almost totally from the Edwards aquifer in south-central Texas, which is the main municipal water supply for San Antonio. • South Texas is the most arid region of the state. Semiarid and already prone to drought, it is economically dependent on its agricultural base, which accounts for more than 85% of water demand in the area. Even as of 1995, the demand for water was much greater than the supply. With high birthrates and continuing immigration to the area, municipal demand for water is expected to double or triple by the year 2040.Economists estimate that the water deficit in the Lower Rio Grande Valley alone has an annual impact of $400 million on agriculture (6). Low flows in the Rio Grande, resulting from drought conditions, the water deficit, and aquatic weeds, actually culminated in complete closure at the mouth of the river in February 2001 (6). 24 Degrees of Danger Water Scarcity: Solutions In a state like Texas, and over much of the arid western U.S., range improvement can be the least expensive and the most effective way of buffering the effects of climate change and water scarcity (21). Ranchland watersheds have the largest available source of fresh water, with native plant cover acting as the collection system for this underground storage. It also serves as a filtration system, with an ability to provide better quality than runoff in reservoirs. There is 10 times as much water in the landscape as there is in rivers and lakes. Seventy percent of the Texas watershed is ranchland, with another 20% devoted to annual agriculture and woodlands. According to the National Resources Conservation Service, 80% of it exhibits less than half of its biological potential, which impacts both the quantity and quality of water in Texas. Innovative approaches such as Holistic Resource Management, which suggests to ranchers simple and inexpensive strategies for livestock grazing, are necessary to more successfully use rangeland for cleaning air and collecting water. {37). By employing water conservation measures for everyone in the state, more can be done with less water. In the area of residential water use, the city of El Paso has successfully implemented an aggressive conservation program, reducing daily per person water usage to 152 gallons, as compared to 202 gallons per person in Dallas (6). In agriculture, water needs can be reduced by employing improved conservation technologies, such as drip and low-energy sprinkler water systems and increased attention to irrigation timing. Texas currently has thousands of miles of unlined irrigation canals, 550 of which are in the Lower Rio Grande Valley alone. Lining these canals as well as reducing seepage loss in lined canals through the use of better construction methods and more flexible piping could significantly reduce Texas’s agricultural demand (6). Between 1930 and 1980, when the state’s population more than doubled, water use increased more than five-fold (35). Though water use for irrigation is declining, municipal and industrial use is expected to increase, especially with the rate of population growth registered between 1990 and 2000æ22.8% (36). Population growth alone may make it extremely difficult to cope with Texas’ threatened water supply (31). Water Quality and Climate Change Changes in precipitation, temperature, humidity, salinity, and wind have a measurable effect on water quality (15). As floodwaters wash across farmland, rangeland, industrial sites, and shallow sewage systems, pollutants such as pesticides, chemicals, and animal and human wastes can enter surface and groundwaters (38) The resulting bacteria, viruses, and protozoa, bring gastrointestinal illnesses (7,38,39). A large number of drinking water epidemics in the U.S., for example, have been related to protozoan parasites. The largest outbreak in U.S. history occurred in Milwaukee, Wisconsin in 1993, where contamination of the drinking water supply with Cryptosporidium resulted in 400,000 estimated cases of cryptosporidiosis and 54 deaths. A contributing factor to the contamination was heavy rainfall and runoff that affected the raw surface water arriving at the drinking water plants (40,41). Outbreaks of Escherichia coli, which is a common foodborne pathogen, have also been linked to rainfall events, How Smarter Energy Choices Can Protect the Health of Texans 25 especially heavy rainfall preceded by a drought (27). Most healthy individuals recover, but if not treated appropriately, the illness can become The 114,500 acres of water in Sam Rayburn Reservoir serious, and even deadly, especially provide a local example of the effect of drought on water in vulnerable populations, such as quality. As the largest reservoir completely within the state of young children. Texas, it provides power, drinking water, and recreational Contamination of water for opportunities for Beaumont, Port Arthur, and several other drinking, fishing, and recreational cities in Texas. But for Texans, it is known best for being one activities continues to be of concern of the bass fishing capitals of the nation. in some parts of Texas. The 1999 But the drought of 2000 dropped the reservoir more than 11 feet below its normal level, reducing its surface area by incidence in Texas of two bacterial 25%, and killing thousands of fish. Two massive bass kills also illnesses, salmonellosis and occurred in the lake during 1998 and 1999. It is believed that shigellosis, was 11 per 100,000 when the water level is low and the water temperature rises, population. Among children, the bass population becomes stressed, making it susceptible however, the rate was much higher. to a common aquatic disease. For humans, health warnings Children under the age of one had for mercury contamination in the fish have been issued since an incidence of salmonellosis of 145 1995, and people swimming in the lake run the risk of coming per 100,000, and among those in contact with pathogenic bacteria (44). under five, the rate of shigellosis was 53 per 100,000 population (42). One to three cases of primary amebic meningoencephalitis, almost all of which result in death, are also reported statewide each year. Three deaths reported in 2001 were all of children exposed to Naegleria fowleri in recreational water (42). The low stream flows and the resulting decreased water supply that come with drought conditions, too, can help create conditions that are amenable for ameba to thrive. Substances in water, like salt and toxic agents, tend to concentrate, leading to more polluted waters. In Texas, increasing salinity levels are a major concern in areas like the Lower Rio Grande Valley, where salt in the Falcon Reservoir, the area’s main water supply, is more than double that found in the drinking water supply throughout the country. One of the most dangerous substances that tends to concentrate with low stream flows is neurotoxic mercury. Water for agricultural use is also compromised. Seventy five percent of water used for irrigation is from groundwater, and elevated levels of nitrates, the most common groundwater contaminant, are widespread throughout Texas. Nitrate contamination results from agricultural fertilizer application and excess concentrations of animal waste compounded by the increase in confined animal feeding operations. There were over 7,500 documented cases of groundwater contamination statewide in 2000, largely due to leaking petroleum storage tanks (13). In addition, close to 10% of Texans depend on water from private groundwater wells, a significant number of which exceed drinking water standards for both nitrates and arsenic (13). Arsenic has been shown to increase the risk of various types of cancers. Water Quality: the Local Example of Lake Rayburn 26 Degrees of Danger Extreme Weather, Heat, Disease, and Climate Change “Texas’s climate has always been variable and sometimes extremeæand climate change may intensify this historical pattern.” —ROBERT TWILLEY, CONFRONTING CLIMATE CHANGE IN THE GULF COAST REGION (17) Extreme Weather Events It is believed that with climate change, extreme weather events will become more common during the 21st century; climate change will influence not only their frequency of such events, but their timing, intensity, and duration (71). Extreme weather events include severe storms, hurricanes and tornadoes, and unusual amounts of precipitation. An additional complicating factor is the expected sea level rise associated with such events. The significant wave heights (between three and six feet) that accompany severe hurricanes (categories 3 through 5) could reach further inland along the coasts if barrier islands and wetlands are lost as buffers (17). Drowning is the most common cause of death from extreme weather, especially in flash floods. But the public health impacts of flooding go beyond drowning. They include the following: damage to homes and displacement of occupants, infectious diseases worsened by crowded living conditions, contamination of water sources, disruption of sewage service, increased insect populations that may cause disease, injuries sustained in clean-up, and even stress-related mental health problems (72). The expanding population in higher risk coastal and floodplain areas, such as Houston-Galveston, subjects people and property to greater exposure (73). Floods also may create areas of standing water and other conditions ideal for breeding disease-bearing mosquitoes. In addition, the molds and fungi that grow on interior surfaces following floods provide an added risk to those with allergies (74). Stachybotrys chartarum or black mold, commonly found in waterdamaged buildings, has been of particular concern, especially for the insurance industry. The Centers for Disease Control and Prevention (CDC), however, has concluded that a possible association between the mold and pulmonary hemorrhaging in infants has not been proven (75). In the U.S., extreme weather events cause hundreds of death and injuries annually (74). From 1945 to 1989, natural disasters in the U.S., the majority How Smarter Energy Choices Can Protect the Health of Texans 27 attributed to storms, tornadoes, and hurricanes, caused 14,536 deaths or an average of 323 deaths per year. In more recent years, between 1986 and 1995, the number of average annual deaths from such events has actually increased to 485 (74). Extreme weather events are not new to Texas. Historically, hurricanes have struck the Texas coast about once every five years. On September 8, 1900, for example, a hurricane struck Galveston, killing more than 6,000 people (74). Storm surges of 15 to 18 feet accompanied that storm (76). The high-density development along the coast adds to the potential for devastating damage. Extreme weather events causing damages of over $1 billion have occurred more than 16 times in the state between 1980 and 2001, making Texas one of two states in the nation with this distinction (3). In 1998, record downpours of 10 to 20 inches in southeast Texas resulted in 31 deaths and $1 billion in damages. With Tropical Storm Allison in 2001, some areas of Harris County and the Houston metropolitan area received up to 37 inches of rain in 24 hours. A rapid needs assessment conducted by the city’s Department of Health and Human Services one week after the storm found that the incidence of illnesses was significantly greater in flooded homes than non-flooded homes. Twenty five percent of people in flooded homes reported some sort of illness, ranging from diarrhea and respiratory symptoms to sleep disturbances and nightmares (72). Extreme Heat and the Health of Texans “There is now a body of evidence showing how daily death rates vary with temperature and other weather conditions in a large number of American cities.” —GRAHAM BENTHAM, CENTER FOR ENVIRONMENTAL RISK, UNIVERSITY OF EAST ANGLIA (45) TABLE 2 Heat-related Fatalities In Texas, 1995-2001(* Indicates #1 ranking) Year 2001 2000* 1999 1998* 1997 1996* 1995 Texas HeatRelated Deaths 20 71 22 66 2 10 8 Total U.s. HeatRelated Deaths 166 158 502 173 81 36 1,021 Source: Compiled from National Weather Service data, “Heat-Related Fatalities,” http://www.nws.noaa.gov/om/ severe_weather/heat01.pdf and www.nws.noaa/gov/ om/hazstates.shtml Under extreme or chronic heat stress, the body loses its ability to maintain temperature balance. The heart tries to pump harder and faster to dissipate the heat. The reduction or collapse of the body’s ability to shed heat by circulatory changes and sweat results in a variety of heat-related disorders, including heat cramps, exertional heat injury, heat exhaustion, heat stroke, heart attacks, and stroke. In general, hospital admissions and emergency room visits from all causes increase during hotter weather. Studies have shown that during oppressive heat waves, there is a significant increase in the number of deaths per day for the general population (73). Following a record-breaking, five-day heat wave in 1995 in Chicago, the number of deaths increased by 85%, accompanied by an increase in hospital admissions (77). Some of the deaths were from heatstroke, but most were from common conditions 28 Degrees of Danger such as heart attacks, stroke, and respiratory diseases, exacerbated by the heat (45). Heat stress may also cause the blood to form clots more easily (78). There is some evidence that heatrelated deaths in the U.S. tend to occur The Heat Index early in the summer in regions not accustomed to extreme heat (45). Still, Another way to compare environmental conditions that could Texans will be susceptible to the heat lead to heat stress is the heat index. The index combines the waves and increased temperatures that effects of heat and humidity, thus giving a better sense of what the may come with global warming. Heat human body feels. A 90˚ day with high humidity, for example, waves, like other weather variables, feels more uncomfortable than one with low humidity (80). Much uncertainty exists around how much of an increase to have varied substantially over the past expect in the heat index in Texas. Some climate models project century, but there has been a warming a summertime heat index increase of between 10 and 25°F. trend in Texas since the late 1960s. That means, for example, that summertime conditions for Between September 1-5, 2000, Texas Houston could become like those in Panama (115˚) (81). experienced the hottest days in the history of the state, with over 15 local record highs broken (79). In three of the last seven years, Texas has ranked first among the Extreme Heat: Solutions states in the number of heat-related Installing early warning systems, which advise the public and fatalities (4). See Table 2: Heatpublic health officials that dangerously hot weather is coming, Related Fatalities in Texas. And of can allow communities to prepare for heat waves. Such systems the 26 U.S. cities having more than are already in place in Chicago, St. Louis, and several other U.S. 25 four-day heat waves in the 1990s, cities. With such a system, steps including media advisories in eight (Houston, Brownsville, Midland, multiple languages, telephone hotlines, air-conditioned shelters, El Paso, Corpus Christi, Austin, Fort and expanded outreach to the homeless can be taken (77). Worth, and San Antonio) were in Many potential negative effects of heat could be averted if housing were better designed for extreme temperatures (73). Texas (80). One study projects that by Public housing, where many of the most vulnerable live, needs 2050, heat-related deaths during a to be fitted with adequate ventilation systems, proper typical summer could triple, from insulation, and efficient up-to-date air-cooling systems that are about 35 heat-related deaths per easily used by the elderly. Cooler building materials, summer to over 100 (5). reflective roofing, and paving with cooler surfaces can be Residents of urban areas are at used with little or no additional construction costs, assuring greater risk of heatstroke and other greater air quality and protection from heat. In 2001, the heat-related causes of mortality because Texas State Legislature passed legislation requiring new buildings and roads absorb heat during residential and commercial buildings use energy-efficient the day and release the heat during the building materials (84). night. This phenomenon, known as the As cities spread outward, the heat island effect expands in “heat island effect,” keeps nighttime area and intensity (85). In Houston, The Houston Advanced Research Center, with funds for a “Cooler Houston” Plan, is temperatures high and prevents creating a workable strategy for addressing the heat island nighttime relief from the heat (78). The effect and lowering temperatures. Planting trees and phenomenon not only contributes to vegetation also alleviates some heat problems, as trees create discomfort, but also to ozone formation shade and absorb some of the heat trapped by the urban and higher energy bills. Urban areas landscape. Groups such as the Quality of Life Coalition and like Houston, for example, are the Houston Green Coalition are already conducting treenormally 5 to 9˚F hotter than planting projects to expand Houston’s tree canopy (82). surrounding areas (82). How Smarter Energy Choices Can Protect the Health of Texans 29 Diseases Carried By Insects “….the public is increasingly vulnerable to exotic diseases and to new strains of old diseases that we can expect to come cascading across America in an era of global warming. West Nile is only a wake-up call.” —WILLIAM H. SCHLESINGER, NICHOLAS SCHOOL OF THE ENVIRONMENT AND EARTH SCIENCES, DUKE UNIVERSITY (86) Climate change throughout the world is helping to expand breeding grounds and livable areas for mosquitoes and other insects that carry diseases. Warmer temperatures can speed maturation of some insects, as well as development of the disease within the insect (7). Outbreaks of some vectorborne diseases, such as encephalitis and West Nile virus, may follow period of extended droughts (87). The general consensus is that warming of the earth may bring conditions that will increase the range of the insects, thus causing the spread of vector-borne diseases farther north. Diseases that are caused when an infected insect bites a human or other animal were once common in the U.S. Until the mid-1900s, malaria was endemic in the U.S., and epidemics of mosquito-borne diseases such as dengue and yellow fever occurred regularly during the summer. By the middle of the 20th century, however, they had largely disappeared, thanks to changing agricultural practices, improved housing and sanitation, and mosquito control (9). Still, such diseases continue to circulate in the U.S. Most exhibit distinct seasonal patterns and are sensitive to rainfall, temperature, and other weather variables. Unhealthy environmental practices, such as illegal tire dumping on both sides of the Mexico-U.S. border, also create perfect breeding grounds for disease-carrying mosquitoes. Three insect-borne diseases that have re-emerged in Texas recently will be discussed here. In addition, various forms of encephalitis have been endemic to Texas for decades and are actually on the decline. West Nile Virus: According to some experts, West Nile virus is the harbinger of other diseases previously thought of as exotic in the U.S., which may become more widespread with global warming (86,88). The first cases of West Nile virus ever to appear in the U.S. were reported in New York City in the summer of 1999, when over 60 people became ill and seven died (89). In 2002, the number of nationwide cases had increased to 4,156, with 284 fatalities (90) It is still unknown how the disease, which is normally found in the warmer climates of Africa, West Asia, and the Middle East has spread, especially to New York City, with its cold Eastern winters. The primary carrier of the disease is a mosquito (Culex pipiens), which typically breeds in the foul water of city drains and catch basins. Though most of these cases were concentrated in Illinois, Ohio, and Michigan, West Nile’s rapid expansion across the U.S., including Texas, indicates that it is now permanently established in the Western hemisphere 30 Degrees of Danger (90). West Nile virus first arrived in Texas in 2002. By the end of the year, 202 cases had been reported in Texas, with 13 deaths (90). Dengue: Dengue is considered to be the most important viral vector-borne disease in the world (91). Predominant in areas where household water storage and inadequate solid waste disposal services prevail, dengue is second only to malaria in the number of people infected worldwide. Since 1994, epidemics of dengue have increased substantially in the Caribbean, Mexico, and South and Central America. Nearly all of the 2,700 suspected cases reported in the U.S. between 1977 and 1995 were of U.S. residents who had traveled abroad (9). There is concern that dengue may be introduced to the U.S. from neighboring countries, especially along the border. Better living standards, housing conditions, and public health infrastructure, however, have tended to protect the U.S. against large outbreaks (9,92). Between 1980 and 1999, over 62,514 cases of dengue were reported in the three Mexican states adjoining Texas (93), while Texas reported only 64 locally acquired cases during almost the same period. There is, however, evidence that medical personnel are not identifying the disease (10). Dengue is considered a major threat to public health, especially in South Texas (94). Dengue fever season in Texas typically runs from August through December. Cooler weather either kills the mosquitoes that carry the virus or causes them to become less active. But it is highly dependent on local environmental factors. A predicted fall in humidity in Brownsville as a result of climate change, for example, might actually decrease the potential for dengue fever in that city (95). In 1999, the largest outbreak of dengue fever to hit south Texas in almost 20 years sickened more than a 51 people, 16 of which contracted it in southern Texas. The outbreak resulted in one death, the first caused by dengue fever in Texas in decades (96). Malaria: Over the past 10 years, locally acquired malaria has again been documented on a small scale. Initially, most of the documented cases were among farm workers in southern California, with large number of immigrants from malaria-endemic areas. In Texas, at least 20 new cases of malaria have been diagnosed annually in Houston Vector-borne Diseases: Solutions during the 1990s, most of which The standard of living and health care infrastructure in the involved travelers. In 1994, three U.S. reduce the risk of epidemics from insect-borne disease. cases of locally acquired malaria were Less time spent outdoors in the daytime, window and door reported in Houston (97). A screens, air conditioning, and better mosquito control and significant number of mosquitoes that health services should keep these problems from becoming transmit the disease present the unmanageable in most parts of the U.S. (78). It is important, potential for malaria’s re-emergence, however, to strengthen and maintain surveillance systems, so the public can be alerted and take action, and physicians especially given the warm humid can diagnose and properly treat vector-borne diseases. climate of the Houston area (98). How Smarter Energy Choices Can Protect the Health of Texans 31 Vulnerable People And Regions “Climate change impacts will vary significantly by social and economic status.” —NATIONAL ASSESSMENT (16) A 1999 study examining the possible public health consequences of climate change by region in the U.S. found that some regions may suffer disproportionately from climate change. Texas had the highest number of sensitive subpopulations in the nation. They included children, elderly over the age of 75, immigrant populations, and those with heart disease, below the poverty line, without health insurance, and receiving Medicare and Medicaid funds (99). Of special concern is the health status of Hispanics in Texas, which now number close to a third of the total population (36). Certain health measures indicate that the health of this population is actually deteriorating with longer residence in the U.S. Due to lower income levels, type of occupations, and places of residence, Hispanics in comparison to other Texans are disproportionately exposed environmental toxins. These include outdoor and indoor air pollutants, hazardous waste sites, pesticides, lead, and mercury, which may place Hispanics at a greater risk for morbidity and even premature death from asthma, lead poisoning, behavioral and development problems, and cancer (145). Texas-Mexico Border Area The impoverished areas of the world will be the most vulnerable to climate change (16,102). And there are impoverished areas of Texas, the colonias, which are comparable to the squatter settlements of the developing world. Colonia, a Spanish term for neighborhood or community, refers to an unincorporated settlement that may lack basic water and sewer systems, paved roads, and safe and sanitary housing (103). There are approximately 1,500 such settlements in Texas (6), which account for the largest colonia population of any American state along the border. Estimates range from 1.5 million (104) on the entire U.S. border to over 2 million on the Texas side alone (105). During the last few decades, industrial growth along the border has grown tremendously. The Border Industrial Program (1965) and the North American Free Trade Agreement (1992) have facilitated trade between the U.S. and Mexico, encouraging urbanization and explosive population growth. The number of new factories (called maquiladoras) has grown by about 50% since 1993, causing increased congestion and a higher population density that have strained the area’s ability to provide clean water, sanitation, and other basic 32 Degrees of Danger services. Currently, 12% of the border population does not have access to potable water, and 30% does not receive wastewater treatment (104). In Texas, colonias in the El Paso-Ciudad Juarez area face severe water supply challenges. Ninety percent of the region’s water comes from the already seriously overdrawn aquifers, Hueco Bolson and Mesilla (13). In addition, bacteria levels from the untreated wastewater of Ciudad Juarez and the Rio Conchos in Mexico pollute the Rio Grande, the shared river between Mexico and the U.S. Severe health risks, which respect no geographic boundaries, result. Shigellosis and Hepatitis A in the border region are almost three times the national average (6). Children are especially at risk. In children of the colonias near El Paso, the prevalence of hepatitis A is 50% higher than in the rest of the U.S., and in a sample of children aged four to seven in a Texas border town, 21% were infected with Helicobactor pylori, an infectious agent that causes the majority of gastric ulcers (106). The 14 counties bordering Mexico have exceptionally high rates of neural tube defects, with anencephaly rates in some individual counties reaching as high as 26 per 10,000 (107). High pesticide use in the region poses a threat to human health, especially of farm workers and their children. In 1996 the Department of Agriculture estimated the ranch work force in Texas to be 264,000 with an additional 500,138 seasonal farm workers and their dependents (108). Two of the most migrant farm worker-dense counties in the U.S. are located in Texas, Hidalgo County and Cameron County. Migrant farm workers are especially vulnerable to the intensive use of organophosphate and carbamate insecticides used in the cultivation of the area’s food crops, which include green chiles, wheat, peanuts, pecans, avocados, lettuce, and onions. One study found that the concentrations of certain types of pesticides in the dust in farm workers’ homes near commercial orchards were between 17 and 100 times that in the soil of outdoor play areas (109). Use of banned pesticides along the border is frequent, including for the treatment of lice (110). Air quality is another major concern. The higher volume of traffic and industrial emissions from the maquiladoras pose a serious air pollution problem. In the city of Laredo, the busiest overland port in the world, long lines of idling trucks at the border crossing emit dangerous diesel fumes, which may be carcinogenic. The situation in El Paso, which is not compliant with federal standards for either particulate matter or carbon monoxide, is especially serious (13). Because of the winter inversions typical of the El PasoCiudad Juarez airshed, pollutants are trapped at ground level beneath warm air masses, leading to high ground-level concentrations of ozone, particulate matter, and carbon monoxide (104). In addition, environmental regulations are less stringent in Mexico than in the U.S. for both power plants as well as for vehicles, and oftentimes, regulations that do exist are less tightly enforced (104). With stricter enforcement difficult in the Mexican communities, health hazards threaten people on both sides of the border. Warmer temperatures and climate change will only exacerbate the multitude of health risks that already exist in this border region. How Smarter Energy Choices Can Protect the Health of Texans 33 Children, the Elderly, the Sick, and the Poor From a public health perspective, populations especially vulnerable to the effects of climate change are 1) the elderly, 2) children, and 3) the poor, and 4) those with preexisting disease (16,99). Children under the age of five represent 7.8% of the population of Texas, above the national average of 6.8% (36). They will be especially vulnerable to climate change, largely because they are still developing. Children are not just little adults. • Their defense mechanisms are not yet fully developed, increasing their susceptibility to the harmful effects of pollution. • Children breathe more rapidly. They take in more air per minute (440 to 500 ml/kg) and inhale more air for their size than do adults (who breathe 100 to150 ml/kg.) Pound for pound, children breathe 50% more air than do adults, thus inhaling a greater percentage of pollution (48). • Infants and children drink more water, juice, milk, and other liquids. Infants consume 3 to 5 oz/kg/day. For adults, this translates to 30 12 oz. cans of soda or beer per day. • Infants have larger surface are for absorption relative to weight, and the skin of the newborn is more absorptive. • Children spend more time outdoors, swimming in lakes, ponds, and streams, exposed to harmful UV rays, polluted air, and contaminated water. Because exercise increases the penetration of pollutants into the lungs, children’s outdoor activities make adverse health effects more likely. • They are close to the ground by nature of their smaller stature and crawling; dust and chemicals settle on the ground and may be more intense. • Today’s children will have a have a heavier lifetime exposure to air pollution, UV rays, and a longer time to develop diseases with a long latency, than do those born in 1960 (101). The elderly, defined by the U.S. Census as those 65 years of age or older, presently represent 9.9% of the Texan population, as compared to 12.4% nationally (36). As the middle-aged population of Texas ages, the proportion of elderly will increase. The elderly, especially those 65 years of age and older, are in may ways like the young. With the elderly, however, it is the loss of functions that children have not even yet acquired that causes their vulnerability. • Their ability to disperse heat through the body’s physiological mechanism is impaired, making them more vulnerable to heat waves. • They are more likely to have underlying illnesses, especially cerebrovascular, cardiovascular, and respiratory, which are worsened by impaired respiration. 34 Degrees of Danger • They are less able to perceive changes in temperature. • The decline in their immune systems makes them more susceptible to infectious diseases. • They are at greater risk of taking medications, which may contribute to heatstroke. • Their ability to respond to emergencies is diminished because of mobility problems. Those with pre-existing disease: Conditions that suppress the immune system, such as AIDS and organ transplantation, lead to greater susceptibility to infections. As mentioned above, those with cerebrovascular, cardiovascular, and respiratory diseases can lead to dehydration, and people with those diseases are especially susceptible to heat stress and air pollution. The poor: Persons living below the poverty line represent 15.4% of the Texas population, above the national figure of 12.4%. There were 4,478,000 Texans under the age of 65 without health care coverage in 2000, representing 23.6% of the total population. Since 1998, Texas has had the highest percentage of people under 65 without health care coverage in the nation (36). Death during heat waves in the U.S. is primarily an urban phenomenon that disproportionately affects areas with low- income populations (99). The poor may be more vulnerable to climate change due to • less access to air-conditioned places because of the high cost of utilities. • reduced awareness of the potential dangers of heat awareness due to lack of access to media, such as newspapers and television. • residence in urban areas, where the heat island effect actually increases warming and the consequent effects of heat. • poor nutrition and crowding that may increase their susceptibility to infectious diseases because of compromised immune systems (99). • lack of medical insurance, resulting in fewer visits to health care providers (100). Approximately one-third of the residents of the Texas-Mexico border area are uninsured, for example, compared to one-quarter of the population statewide (6). The Texas Gulf Coast: An Eco-system and Economy Endangered The Texas Gulf shoreline stretches approximately 370 miles from the Sabine River at the Louisiana state line to the Rio Grande River at the Mexican border (119). It is composed largely of wind tidal flats, sandy marshes, salt marshes, and beach (5), but it is also the site of Texas’ major urban and industrial centers. More than half the nation’s chemical and petroleum production is located along the Texas coast and the four counties How Smarter Energy Choices Can Protect the Health of Texans 35 surrounding Galveston Bay are home to 20% of Texans (120). These facilities and their contribution to the state’s economy are threatened by sea-level rise and gulf storms and face the costs of protection against these dangers. The Gulf Coast , therefore, of all regions in Texas, is one of the most vulnerable to climate change. Climate models project sea-level rises along the Gulf Coast to range between 8 to as much as 20 inches by the end of this century. When subsidence, or the settling of land that results from erosion and the removal of groundwater from aquifers is considered, the situation is magnified. The relative sea-level rise could range from 15 inches along most of the Gulf Coast to 44 inches along the Louisiana Mississippi Delta. (17). Natural coastal erosion also increases the area’s vulnerability. The Houston-Galveston area is particularly vulnerable. Subsidence caused by ground-water withdrawal and worsened by the opening of the Houston ship channel in the 1950s, had exceeded 1.5 feet as of 1995 (76). The city of Galveston, which sits at 17 feet above sea level, is already witnessing a sea-level rise of 25 inches per century, which may increase to 38 inches by 2100 (5). Global warming may have a significant impact on the coastal region’s water resources. Excess precipitation could result in an increase in fresh water discharged by rivers from floods, expanding oxygen-poor waters. Drought could result in the following effects: • a reduction of runoff and lower groundwater levels for parts of the year, causing a shortage of water for humans and the surrounding ecosystem; • a reduction of freshwater flows and resulting increases in extreme salt concentrations in Texas lagoons; • an increase in local subsidence and sinkhole formation from such human activities as dredging, pumping groundwater, and constructing reservoirs; • changes in soil moisture and a shifting of forest dynamics and composition; Any changes that affect the sea, whether they are water temperatures at the surface, nutrient levels, winds, currents, or precipitation patterns, can change the marine ecosystem (121). One of the most direct public health effects of this change is the possible increase in foodborne diseases transmitted from fish and shellfish from contaminated waters (38). The consumption of fish and shellfish contaminated with biologic toxins causes a number of gastrointestinal and paralytic human diseases (16). Between 1978 and 1987, 90% of outbreaks and 75% of individual cases of seafood-borne illnesses 36 Degrees of Danger reported to the CDC were from consumption of contaminated tuna, mackerel, bluefish, some reef fish species, and raw mollusks (38). Warmer seas, brought on by extended drought and extreme summertime heat, can contribute to the increased intensity, duration, and extent of harmful algal blooms. One of the most common of the harmful algal blooms in Texas is Gymnodinium breve. When microscopic toxic algae increase in number and bloom, discolored red patches appear in ocean waters. The red tide, which is caused by the organism, produces a toxic effect on the central nervous system of shellfish, which when consumed by humans can lead to neurotoxic shellfish poisoning (122). The bloom itself can also cause respiratory irritation from aerosolized inhalation of toxic sea spray (38). In 1996 and 1997, the Texas Health Department issued aquatic closures for oyster, clam, and mussels in Corpus Christi and Aransas Bays due to the red tide (122). Again, in the fall of 2000, the deadly red tide algae returned to span 300 miles of Texas coastline and close oyster beds for weeks to prevent human shellfish poisoning (122). A second form of microscopic algae common in Texas produces the brown tide. Though not toxic to fish, it blocks out sunlight, killing underwater plants, which are the food source for fish. Brown tide has plagued the Corpus Christi area for several years, killing Coastal Regions: Solutions the eelgrass and vegetation in the Climate change is too often not being considered in coastal area, and ultimately destroying the management. It is urgent for coastal management agencies to fish habitat. (122). begin adaptation now regarding development of land in the All of these changes have an coastal zone. Some regulatory programs continue to permit economic cost. The EPA estimates the structures that block the inland shift of beaches and wetlands. cumulative cost to replenish sand to But in Maine, Rhode Island, South Carolina, and protect the coast of Texas from a 20Massachusetts various forms of “rolling easement” have been inch sea level rise by 2100 at between implemented, which allow for wetlands and beaches to $4.2 and $12.8 billion (5). With only a migrate inland as the sea level rises and encourage 10-inch rise in sea level, the brown landowners and conservation agencies to purchase the shrimp catch in the U.S. Gulf Coast required easement. Implementing such procedures, however, could fall 25% (5). is feasible only in coastlines with a low degree of development (17). Conclusions This report has reviewed the threats to human health, particularly in Texas, that could result from increased air pollution and climate change. A long history of weather extremesæfrom hurricanes to heat and drought æhas given Texans experience in adapting to and preparing for such climate change. But new health problems, such as the emergence of vector-borne diseases, present new cause for concern. More importantly, as this report has shown, the environmental stresses of water and air pollution and increasing population will only compound the public health effects of climate change. The poor, elderly, and young, and certain regions of the state will be the hardest hit. Texas plays an important role in climate change, due to its high emissions of greenhouse gases and air pollutants. The important role of Texas in How Smarter Energy Choices Can Protect the Health of Texans 37 supplying energy for the nation cannot be ignored. But, as evident from the experience of California, economic development does not have to be at the expense of the environment and global climate. We must act now to protect the health of Texans, by slowing and eventually reversing climate change by decreasing discharges of pollutants into the soil, air, and water, and significantly reducing fossil fuel consumption and greenhouse gas emissions. In addition, we need to invest in strategies that will help us to prepare for what may come. It is essential that we formulate a healthy energy policy, consisting of renewable use and energy efficiency, and implement plans to improve our public health infrastructure, including disease surveillance and emergency response capabilities. The concluding section of this report discusses how Texas as a state, Texans as individuals, and Texas health professionals can be part of the solution. Solutions And What You Can Do “Texas is the nation’s biggest greenhouse gas emitter, is one of the most vulnerable to global warming impacts, and has more potential to develop solutions than other states.” —PETER ALTMAN, DIRECTOR, SUSTAINABLE ENERGY AND ECONOMIC DEVELOPMENT COALITION (SEED) (123) Texas ranks very low in a number of key environmental indicators and lags behind in spending on environmental protection. Only 1.7% of the current appropriated budget of the state is allocated for natural resources agencies (18). And a recent study ranks the state 46th in per capita The Precautionary Principle spending on environmental The public health community, legislators, ethicists, and protection overall (19). But there is environmentalists often refer to “the precautionary hope in the rich renewable energy principle” when dealing with climate change issues. The potential of the state, new term’s definition states, “When an activity raises threats of micropower technologies, and in the harm to human health or the environment, precautionary potential of individuals and health measures should be taken even if some cause and effect professionals to advocate for change relationships are not fully established scientifically. In this in environmental legislation and context, the proponent of an activity, rather than the public, make choices that help save air and should bear the burden of proof” (140). water. The precautionary principle has four main components: • Communities have a duty and a right to take anticipatory action to prevent harm. • The burden of proof of the harmlessness of a new technology, process, activity, or chemical is the responsibility of the proponents, not the public. • Communities have an obligation to discuss and to explore a full range of alternatives to the hazards posed. • Decisions must be open, informed, and democratic. Renewable Energy Sources A report issued in 2002 for the Texas Sustainable Energy Development Council puts Texas at an “energy crossroads” (124). For many years, it has been the excess energy production of Texas that has helped fuel the rest of the country. In the early 1990s, however, Texas began 38 Degrees of Danger importing energy from out of state. FIGURE 8 Economists estimate that 80% of State Comparison of Renewable Power every dollar spent on energy bills leaves the state economy (137). By This figure, based on data from a study conducted for the United Nations, 1998, Texas consumed greater than indicates that Texas has more potential to develop clean renewable energy resources than any other State. 10% more energy than it produced. At that time, Texas ranked last in the Texas nation in its percentage of energy Montana derived from renewable energy sources (124). Coupled with efficiency Kansas measures, however, renewables can North Dakota be the answer. Renewable energy can South Dakota protect Texans’ health, boost the local Wyoming economy, and create jobs. Nebraska Texas has more renewable energy BIOMASS resources than any other state in the New Mexico nation, resources that can help boost WIND Colorado economic growth by redirecting dollars SOLAR Oklahoma spent on energy into local economies. 0 1 2 3 4 5 6 7 8 9 The wind, solar, and biomass potential of Texas is estimated to be 4,330 Renewable Energy Protential (quads) quadrillion BTUs per year. This is about Source: InfinitePower.org 400 times the state’s present energy consumption. According to an analysis by the Tellus Institute, investment in renewable energy and energy efficiency could create 71,500 new jobs in Texas by 2010 and 123,400 jobs by 2040 (135). Ranchers, farmers, and landowners are in a position to especially benefit from renewable energy use. Landowners can receive more than $2,000 per turbine per year for installing wind turbines (135). Farmers can grow energy crops, in order to convert these crops and crop wastes to energy or sell crops to energy companies. Solar energy can also prove to be a more economical choice than traditional means for farmers to power remote water pumps, lights, and electric fences. 10 Wind Energy Texas has the second best wind potential in the country, second only to Kansas (135). If all the land with wind potential was developed (excluding urban areas or environmentally sensitive land) in Texas with utility-scale wind turbines, the power produced each year would still equal 316,455,000 megawatt-hours, or 114% of the entire state’s electricity consumption (136). Texas’ first 1,100 megawatts of wind power created 2,500 jobs, and in 2002 alone, farmers and landowners hosting wind turbines on their property received $2.5 million in royalty income (138). Wind technology is versatile and adaptable. A small stand-alone wind turbine can provide enough power for a typical U.S. household, while groups of larger turbines combine to generate utility-scale electricity. The technology of wind power has improved tremendously since the early experiments with this renewable energy source in California. Noise from the rotors have been reduced How Smarter Energy Choices Can Protect the Health of Texans 39 Carson County’s Health and Economy Benefiting from Wind Power Carson County, Texas is home to Llano Estacado Wind Ranch at White Deer. The wind farm is comprised of 80 wind turbines capable of generating electricity for 28,000 households each year. This farm, developed and maintained by Cielo Wind Power, LLC and owned by Shell Wind Energy, is helping displace air pollutants and boost the local economy by providing jobs for maintenance and operation, utilizing local services, and providing revenue to local landowners. Due to Cielo’s environmental standards, minimal impact occurred during construction of the wind farm, and native plant restoration occurred thereafter. The wind facility Llano Estacado Wind Ranch, Carson County, TX does not interfere with preexisting agricultural use. through low rotation speed, bird kills avoided by redesign, and the towers redesigned so as to allow traditional land uses such as agriculture or livestock to continue (21). In addition, wind power, unlike solar energy, is well suited for high voltage usage, such as washing machines and refrigerators. In addition, this new class of wind turbines can generate power that is cost-competitive with dirty coal-fired power plants (125). According to the Electric Power Research Institute, the cost of producing wind energy has decreased nearly four-fold since 1980. According to the U.S. Department of Energy, the cost of electricity from wind has dropped from $0.35 per kilowatt-hour in 1980 to less than $0.05 per kilowatt-hour today at good wind sites (139). Texas’s Commitment To Renewables: Renewable Portfolio Standard (RPS) Texas is one of 16 states to have enacted legislation that requires utilities to provide a certain percentage of renewable power as part of their total offering of electricity (129). A concept that originated abroad, this mechanism, known as renewable portfolio standards (RPS), represents an innovative state-level climate change policy. It is especially noteworthy given Texas’ vast potential for renewables and its historical production and consumption of fossil fuels (19). Signed into law in 1999, the program orders a “cumulative installed renewable capacity” of 2880 megawatts by January 2009, which experts estimate will represent 3 to 4% of total electricity production. In an effort to offer utilities flexibility in meeting the standard requirement, the state also established a Renewable Energy Credits Trading Program. Any utility unable to meet the RPS can use renewable energy credits to purchase energy from certified renewable energy projects in Texas. Though the goals of the Texas RPS are modest in comparison to other states (2.2% by 2009 as compared to New York’s 15% by 2020), the Texas RPS has launched what a report of the PEW Center on Global Change has called “unprecedented attention to renewables” (20). A study by the Lawrence Berkeley National Laboratory considers the state’s RPS to be the “major driver in the resurgence of wind energy development in the state” (130). A national RPS of 10% and 20% are being encouraged by numerous health and environment organizations. A 10% RPS alone would directly employ 8,500 Texans with a payroll of $255 million from the wind industry (142). An additional 9,775 jobs would be created in supporting businesses, and wind companies would pay nearly $250 million a year in taxes and royalties by 2020 (142). Texas has taken the first step in formally investing in renewable technologies. Texas and the other states that have already acted serve as models for a nationwide RPS. State and national renewable portfolio standards are necessary to diversify the mix of the country’s energy supplies. 40 Courtesy: Cielo Wind Power, LLC Degrees of Danger Use of wind power in Texas to reduce fossil fuel use could reduce state CO2 emissions by as much as 1.83 million tons per year (20). Since the 1999 requirement that 2.2% of the state’s electricity come from renewable sources by 2009 (see sidebar for further information on the Renewable Portfolio Standard) and the federal energy tax credit of 1995, Texas has experienced a dramatic increase in wind power capacity. With this so-called “Texas Wind Rush” Texas wind power has grown from 187 megawatts of wind power in 1999 to 1,101 operational megawatts of wind power (enough to run about 300,000 homes for a year) in January of 2002 (127). One expert sees as realistic a national goal of 10 to 20% of energy needs being met by renewable energy, as long as production tax credits continue, with Texas wind power supplying between 10 and 20% of Texas’ electrical needs (21). The windiest locations in the state are in north and west Texas and along the Gulf Coast (127). Utility companies have invested $1 billion in ranches in West Texas, where McCamey, the state’s “wind energy capital” is located (127). In addition to being perhaps the most affordable means of renewable energy source, it also provides a good Texas Businesses Embracing Solar Power source of jobs and income, relying on Solar power use is expanding throughout the state, though it local labor and land. still represents only a fraction of total power production in the state. The most significant programs to promote the use of Solar Energy solar power use are in Austin and San Antonio. In Austin, large arrays of photovoltaic cells have been installed on the Solar energy can be directly converted convention center. And in San Antonio, Austin Electric Utility into usable energy through such operates two photovoltaic-generating stations that generate processes as solar water heating and enough electricity for 50 to 100 homes and has installed cells photovoltaic technology. Theoretically, on the rooftop of its customer service center (22,125). In if the entire state of Texas were 2001, the University of Texas-Houston Health Science Center covered with solar cells, the state more than doubled its photovoltaic capacity, resulting in significant reductions in emissions of CO2, NOX and SO2. Due could generate 55 quadrillion BTUs of to the enormous savings in electricity costs, the University is electrical energy every year. This now finalizing plans to install an even larger system on the would be enough to supply one and a School of Nursing Student Community Center building by the half times the world’s current energy end of 2003. Solar cells are also used on the control units at consumption. Direct solar radiation in the state’s oil and gas facilities. Texas is strongest in west and north Texas (125). Photovoltaic technology was developed over 40 years ago for use in satellites. Solar power can provide energy reserves when they are most needed—during heat wavesæand its cost has been reduced considerably since the 1980s (131). With technical improvements, connecting photovoltaic panels to the state’s power gird makes it possible to depend on this form of renewable energy. When electricity consumption How Smarter Energy Choices Can Protect the Health of Texans Courtesy of University of Texas Health Science Ceneter at Houston 41 Kinko’s Sets Example as Good Corporate Neighbor Kinko’s, Inc. announced in April 2003 that over 70% of its Texas branches will purchase green power through Strategic Energy to meet a portion of the company’s electricity needs. Fifty-seven branches in Dallas/Fort Worth, Houston, Midland/Odessa, and Tyler Falls will in sum be purchasing 1.6 million kilowatt hours of renewable energy each year. A purchase of this size offsets CO2 emissions as much as removing 204 passenger vehicles from the road; this is also the equivalent to the CO2 absorbed by 760 acres of U.S. forestland (141). from air conditioning is at its peak, the panels feed excess electricity into the grid (22). Photovoltaic technologies are • Simple, because they use few or no moving parts, making maintenance costs minimal. • Versatile, since they can serve as an alternative power source during peak power demands, operate remotely, and are easily transported. • Reliable, with very high online availability. • Scalable, meaning that since they are modular, they are easily scaled according to the amount of power needed (22). Clean Biomass Biomass energy is produced from fermenting any living plant matter (plants, grass, and agricultural crops and waste) to produce ethanol or methane to generate The Texas Electric Choice electricity (125,128). It is important to emphasize that Texans can easily support the utilities only use the cleanest and most efficient forms of development of renewable energy by biomass. Municipal solid waste (garbage) incinerators are selecting a retail electric provider offering not considered clean biomass, since waste incinerators are energy from renewable sources. For more the second largest source of dioxin in the country. The information on how you can purchase ideal growing locations for biomass resources in Texas are renewable energy to power your home or in east and parts of north and central Texas. There is office, contact the Texas Electric Choice great potential for using the large amounts of plant and Call Center at 1-866-PWR-4-TEX, (1-866animal waste for thermal power generation. Some Texas 797-4839) or visit http:// cities, San Antonio, Dallas, Garland, Waco and Austin, www.powertochoose.org/index.html are developing projects to utilize combustible waste gases escaping from landfills for thermal production (125,128). Municipalities and utilities can make use of often wasted landfill gas, which they typically have to burn in the open air to prevent explosions that could occur with uncontrolled releases. This gas can be collected and converted into clean energy, preventing methane, a greenhouse gas, from escaping into the atmosphere. Texas ranks sixth in the nation for its clean biomass potential and fourth for its potential to utilize landfill gas (135). Increased Energy Efficiency Modernization of Old Power Plants Aging power plants, mostly coal burners, exempted from the Clean Air Act are the worst polluters in the U.S. Texas has 19 coal-burning plants, 17 of which are grandfathered from current regulation under the Clean Air Act. Through the New Source Review program in the Clean Air Act, regulations 42 Degrees of Danger require that any upgrades or expansion of these plants also must include upgraded pollution controls. If this country is to significantly decrease air pollution and greenhouse gases, old power plants will need to be cleaned up to modern standards. Senator James Jeffords (I-VT) introduced a bill passed in 2002 by the Senate Environment and Public Works committee that would achieve reduction in NOx, sulfur dioxide, CO2, and mercury, the four main pollutants from power plants. This bill did not reach the Senate floor; therefore, Senators Jeffords, Collins (R-ME), and Lieberman (D-CT) reintroduced the bill in the 108th Congress. Similar legislation has been introduced in the Senate and House of Representatives; however, this legislation ignores the climate change-causing CO2 and rolls back current Clean Air Act health protections. Clean air legislation is needed nationally to reduce the four major power plant pollutants to prevent unnecessary deaths. New Micropower Technologies Micropower, also known as distributed generation, is energy production that occurs near the place where it is used. Dirty diesel engines have been the most prevalent form of micropower in operation, and in 2001 the Texas Commission on Environmental Quality set air pollution standards for new micropower units. Strict standards for existing units need to be set, but thanks to new technologies such as combined heat and power and fuel cells, clean micropower for the future is possible. It promises to be a growing sector of the energy market of Texas (22). Combined Heat and Power (CHP) Combined heat and power (CHP) is an application of technologies to meet needs for heating and cooling as well as mechanical and electrical power. Properly designed fossil fuel-based generators can dramatically increase their efficiency through modification to CHP systems. Since CHP is fossil-fuel based, it is not a sustainable energy resource like wind or solar power. Still, it represents improvement over less efficient technologies. With increased efficiency comes fuel savings and reduced emission of greenhouse gases (22). CHP systems • ncrease efficiency by capturing waste heat. • Produce lower emissions than conventional separate systems. • Enhance service delivery due to advanced technology and local control. • Provide flexibility since they can deliver multiple energy services (22). Texas is the nation’s leader in implementing CHP, with 9,829 megawatts installed as of 2002. This represents 10% of the state’s power (22). There is an estimated additional 20,000 megawatts of capacity of untapped CHP potential at 110 best sites (132). How Smarter Energy Choices Can Protect the Health of Texans 43 In the late 1990s, Baylor University, upon recommendation of Sempra Energy Solutions, expanded its university generators into a full CHP system. The award-winning system combined with other efficiency upgrades is expected to reduce the university utility bills by a third (22). Fuel Cells Fuel cell technology provides a good local power generation operation where solar and wind energy is not feasible. Like CHP, it currently uses fossil fuels to create hydrogen but emits far less pollutants. With further technical development, fuel cells may use renewable energy. Fuel cells, unlike batteries, are fed a continuous supply of fuel. They are currently being developed for use in vehicles and stationary applications like power for individual facilities such as hospitals, office buildings, and schools. The first commercial fuel cell in Texas began operating in June 2002 at the Rebekah Baines Johnson Health Center in Austin. Using natural gas as its source of hydrogen, it meets all the electricity needs of the health center and helps satisfy the center’s water heating needs (22). A fuel cell commercialization plan currently being developed for the state by the Public Utility Commission of Texas estimates that, with moderate incentives, 200 megawatts of new fuel cell capacity could be achieved each year from 2006 to 2010 (133). Tougher Fuel Economy Standards Cars and light trucks consume 40% of the oil used in the U.S. and create 20% of the nation’s CO2 pollution. Increasing the fuel efficiency of these vehicles is the biggest single step we can take to reduce the consumption of fossil fuels, decrease CO2 emissions, and slow the rate of climate change. Corporate Average Fuel Economy (CAFE) standards set the minimum mile per gallon (mpg) requirements that fleets of cars and light trucks must achieve. CAFE standards have remained stagnant since 1975, despite the improvement in technology in the last quarter century. In fact, the overall fuel economy of new cars and trucks sold in the U.S. in 2001 dropped to its lowest level since 1980 due to dramatic increases in sales of SUVs and minivans with poor fuel economy. Lower fuel economy means more gasoline consumed and more emissions released. Current CAFE standards are 27.5 mpg for cars and 20.5 mpg for light trucks (including pick-ups, SUVs, and minivans). Toughening CAFE standards would dramatically reduce pollution levels. New fuel efficiency standards of 40 mpg for cars and light trucks could cut CO2 pollution by 345 million tons per year. (134) Improving vehicle efficiency will not compromise automobile safety. Good design and technology since the mid-1970s have nearly doubled fuel economy, while cutting fatality rates by more than half. Contrary to popular belief, SUVs are not generally safer than passenger cars. The Insurance Institute for Highway Safety has reported that in many accidents, SUVs lead to higher fatality rates than smaller cars. Technology available today makes it possible to increase fuel economy and save lives. In fact, the National Academy of Sciences concluded that fuel economy could be increased to 37 mpg without any reduction in vehicle size or weight. The Academy found that CAFE standards can be improved through the use of aluminum or highstrength, lighter-weight steel bodies, better tires and tire maintenance, and innovations in aerodynamic design. 44 Degrees of Danger WHAT YOU CAN DO Health professionals should take specific actions to help prevent the health effects of air and water pollution and climate change from harming local communities and patients. Refer to the report insert titled, Responsible Actions, for individual actions to take to reduce climate change and air pollution. In addition to these individual actions, health professional can talk about these issues with colleagues, and catalyze action on the local, state, and national level. Medical resolutions assert a powerful voice in the community and provide language and reasoning to elected officials looking for ways to help protect public health locally. The California Medical Association has adopted two important resolutions on air pollution that can serve as a model for Texas resolutions. Developing patient brochures or distributing those made by others may help your patients prevent an asthma attack on a high ozone day or avoid mercury poisoning in their newborns. While the big picture of how air pollution and energy choices affect climate change and your patients’ health may not fit in a handy, easy-to-read brochure, tips on how to prevent these effects individually may help reduce hospital visits and medical treatment in the long run. PSR has created Code Red Alert: Ozone and your Health to provide patients information about the effects of ozone on human health. Code Red Alert, along with all of PSR’s educational materials can be downloaded or ordered for free from www.psr.org. Work with local groups and chapters of national organizations to promote awareness of global climate change and related issues in Texas. You can find a list of such organizations at www.tnrcc-watch.org/contacts.html. Some of them include American Lung Association of Texas (512) 467-6753, www.lungusa.org Clean Air Task Force, www.catf.us The CoolTexas Network, (512) 477-1155, www.cooltexas.net Environmental Defense Fund (Austin), (512) 478-5161, jmarston@environmentaldefense.org Nature Conservancy, www.nature.org Public Citizen Texas Office, (512) 477-1155, www.citizen.org/texas Sierra Club, Lone Star Chapter (Austin) (512) 477-1729, www.sierraclub.org/ chapter/tx Smart Growth America, www.smartgrowthamerica.com Sustainable Energy and Economic Development Coalition (SEED), (512) 479-7744, www.seedcoalition.org Texas Campaign for the Environment, (512) 326-5655, www.texasenvironment.org Texas Center for Policy Studies, (512) 474-0811, www.edf.org Texas Clean Water Action, (512) 474-0605, (713) 529-9426, www.cleanwateraction.org/tx/ Texans Care for Children, www.texanscareforchildren.org Texans for Public Justice, (512) 472-9770, www.tpj.org How Smarter Energy Choices Can Protect the Health of Texans 45 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 climate change—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 climate change. Second, just like businesses, governments, and responsible individuals, PSR feels the need to act decisively to protect the public health and welfare. 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 climate change, one step that we can control. For the sake of our own well being, and that of future generations, we need to act now. 46 Degrees of Danger Reference List 1. Epstein P. Global Warming and Climate Change: Human Health Implications, Reviews by Paul Epstein, M.D., M.P.H. Harvard Medical School, Center for Health and the Global Environment, Quarterly Review: Global Climate Change 4:1, 2002. Available: http://www.med.harvard.edu/chge/qrsummer02/eps.htm. Accessed: 10/20/02. Tellus Institute: Bernow S, Dougherty W, and Dunbar J. Texas’ Global Warming Solutions. Study for the World Wildlife Fund. 2000. National Oceanic and Atmospheric Administration (NOAA). Billion Dollar Weather Disasters by State 1980-2001. National Climatic Data Center . 1/01/02. Available: http://www.ncdc.noaa.gov/reports/billionz.html. Accessed: 10-20-02. National Oceanic and Atmospheric Administration (NOAA). Heat-Related Fatalities. National Weather Service. 2002. Available: http://www.nws.noaa.gov/om/severe_weather/heat01.pdf. Accessed: 11-17-02. U.S. Environmental Protection Agency. Climate Change and Texas. EPA 230-F-97-008qq. Washington D.C. 1997. Available: http://www.epa.gov/globalwarming/impacts/stateimp/texas. Accessed: 10-10-02. Texas Natural Resource Conservation Commission (TNRCC). State of the Rio Grande and the Environment of the Border Region: Strategic Plan, Fiscal Years 2003-2007, Volume 3. SFR-035C/02. 2002. Austin, Texas. World Health Organization. Climate Change and Human Health. McMichael AJ, Haines A, Slooff R, Kovats S. eds. Geneva, World Health Organization. 1996. Texas Department of Health. West Nile Virus in Texas. Zoonosis Control Division 10/18/02. Available: http:// www.tdh.state.tx.us/zoonosis/diseases/Arboviral/westNile/default.asp. Accessed: 10-22-2002. Gubler DJ, Reiter P, Ebi KL, Yap W, Nasci R, Patz JA. Climate Variability and Change in the United States: Potential Impacts on Vector-and Rodent-Borne Diseases. Environmental Health Perspectives 109: 223-233 (2001). 2. 3. 4. 5. 6. 7. 8. 9. 10. Center for Disease Control and Prevention. Underdiagnosis of DengueæLaredo, Texas, 1999. MMWR Weekly 50: 57-59 (2001). Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5004a2.htm. Accessed: 11-10-02. 11. U.S. Public Interest Research Group Education Fund and Clean Air Network. Danger in the Air: The 2001 Ozone Season Summary. U.S. Public Interest Research Group Education Fund. 2002. Available: http://uspirg.org/ uspirg.asp?id2=7727&id3=USPIRG. Accessed: 4-14-03 12. American Lung Association. ALA State of the Air, 2002: Texas. 2002. Available: http://www.lungusa.org/air2001/states/ s_texas02)two.html. Accessed: 10-22-02. 13. Texas Natural Resource Conservation Commission (TNRCC). State of the Texas Environment: Strategic Plan, Fiscal Years 2003-2007, Volume 2. SFR-035B/02. 2002. 14. Asthma and Allergy Foundation of America. The Costs of Asthma in Texas. AAFA . 2003. Available: http://www.aafa.org/ states/display.cfm?State=tx. Accessed: 3-3-2003. 15. Clarkson J. Greenhouse Gas Emissions. In North G, Schmandt J, Clarkson J, eds. The Impact of Global Warming on Texas: A Report of the Task Force on Climate Change in Texas. Austin: University of Texas Press. 1995. 50-67. 16. National Assessment Synthesis Team. U. S. National Assessment of Climate Change: Overview. 2000. Available: http:// usgcrp.gov/usgcrp/Library/nationalassessment/overview/htm. Accessed 10-28-02. 17. Twilley R et.al. Confronting Global Climate Change in the Gulf Coast Region: Prospects for Sustaining Our Ecological Heritage. Union of Concerned Scientists. Cambridge, 2001. 18. Texas Center for Policy Studies. The Real Budget Project: Funding Levels and Needs at Natural Resource Agencies in Texas. October 2002. Available: http://www.texascenter.org/publications/envirobudget.pdf. Accessed 11-01-02. 19. Council of State Governments. Resource Guide to State Environmental Management (Fifth Edition). 1999. 20. Rabe, BG. Greenhouse and Statehouse: The Evolving State Government Role in Climate Change. PEW Center on Global Climate Change. 2002. Available: www.pewclimate.org. 21. Sowell, R. 2003. Personal Communication. 11-4-02. 2-5-03. 22. Heavner B, Metzger L, Smith T, MacLeod M. Micropower at the Crossroads: Public Health and the Future of Distributed Generation. TexPIRG, Public Citizen Environmental. 2003. Available: www.citizen.org/pressroom/release.cfm?ID-1290. Accessed 3-10-2003 23. U.S. Environmental Protection Agency. Global Warming - Climate. Available: http://yosemite.epa.gov/oar/ globalwarming.nsf/content/climate.html, Accessed: 11-17-2002. 24. Intergovernmental Panel on Climate Change. Third Assessment Report, Summary for Policymakers: A Report of Working Group I of the Intergovernmental Panel on Climate Change. 2001. Available: http://www.ipcc.ch. Accessed: 6-12-01. 25. Hoerling M, Hurrell J, and Xu T. Tropical Origins for Recent North Atlantic Climate Change. Science 292: 290-292 (2001). 26. Barnett TP, Pierce D W, and Schnur R. Detection of Anthropogenic Climate Change in the World’s Oceans. Science 292: 270 (2001). 27. Patz JA, McGeehin MA, Bernard SM, Ebi KL, Epstein PR, Grambsch A, Gubler D, Reiter P, Romieu E, Rose JB, Samet JM, Trtanj J. 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. Environmental Health Perspectives 108: 367-376 (2000). How Smarter Energy Choices Can Protect the Health of Texans 47 28. Karl TR, Knight RW, Easterling DR, Quayle RG. Indices of Climate Change for the United States. Bulletin of the American Meteorological Society 77: 279-303 (1996). 29. Karl, TR et.al. Trends in High-Frequency Climate Variability in the Twentieth Century. Nature 377: 217-220 (1995). 30. McMichael A J. Global climate change and human health: An overview. In Haines A, McMichael A J, eds. Climate Change and Human Health: A Discussion Meeting Held at the Royal Society on Tuesday 20 October 1998. London, The Royal Society. 1999, 27-34. 31. Ward G, Valdes JB. Water Resources. In North G, Schmandt J, Clarkson, J eds. The Impact of Global Warming on Texas: A Report on the Task Force on Climate Change in Texas. Austin, University of Texas Press. 1995, 68-87. 32. North G, Bomar G, Griffiths J, Norwine J, Valdes JB. The Changing Climate of Texas. In North G, Schmandt J, Clarkson J eds. The Impact of Global Warming on Texas: A Report on the Task Force on Climate Change in Texas. Austin, University of Texas Press. 1995, 24-49. 33. Ward G. A Water Budget for the State of Texas with Climatological Forcing. CRWR, 92-93. University of Texas at Austin (1992). 34. Schmandt J, Ward G. Texas and Global Warming: Water Supply and Demand in Four Hydrological Regions. University of Texas at Austin. 1991. 35. Texas Center for Policy Studies and Environmental Defense. Texas Environmental Profiles. Trends in Water Use. 2000. Available: http://www.texasep.org/html/wqn/wqn_1trn.html. Accessed: 1114-2002. 36. U.S. Census Bureau. Census 2000. State and County Quick Facts: Texas. Available: http:// quickfacts.census.gov/qfd/states/48000.html. Accessed: 11-7-02. 37. Allan Savory Center for Holistic Management. Getting Animals to the Right Place at the Right Time and for the Right Reasons. The Allan Savory Center for Holistic Management . 2002. Available: http://www.holisticmanagement.org/ahm_graze.cfm? Accessed: 11-19-02 38. Rose JB, Epstein PR, Lipp RK, Sherman BH, Bernard SM, Patz JA Climate Variability and Change in the United States: Potential Impacts on Water- and Foodborne Diseases Caused by Microbiologic Agents. Environmental Health Perspectives 109: Supplement 2, 211-220 (2001). 39. Curriero FC, Patz J, Rose JB, Lele S. The Association Between Extreme Precipitation and Waterborne Disease Outbreaks in the United States, 1948-1994. American Journal of Public Health 91: 1194-1199 (2001). 40. Mackenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, Kazmierczak JJ, Addiss DG, Fox KR, Rose JB et al. A Massive Outbreak in Milwaukee of Cryptosporidium Infection Transmitted Through the Public Water Supply. New England Journal of Medicine 331: 161-167 (1994). 41. Hoxie NJ, Davis JP, Vergeront JM, Nashold RD, Blair KA. Cryptosporidiosis-associated Mortality Following a Massive Waterborne Outbreak in Milwaukee, Wisconsin. American Journal of Public Health 87: 2032-2035 (1997). 42. Texas Department of Health. The Health of Texans: Texas State Strategic Health Plan, Part 1. Austin, Texas Department of Health, Office of Health Information and Analysis. 90-11514. 2002. 43. U.S. Environmental Protection Agency. Update: National Listing of Fish and Wildlife Advisories. EPA-823-F-02-007. 2002. 44. Burtman, B. Reeling. Houston Press 12 (14):20-29, April 6-12, 2000. 45. Bentham, G. Direct Effects of Climate Change on Health. In Haines A, McMichael AJ, eds. Climate Change and Human Health: A Discussion Meeting Held at the Royal Society on Tuesday 20 October 1998. London, The Royal Society. 1999, 35-44. 46. Weisel, C. P. Relationship between Summertime Ambient Ozone Levels and Emergency Department Visits for Asthma in Central New Jersey. Environmental Health Perspectives 103: 97102, (1995). 47. National Center for Environmental Health. CDC’s Asthma Prevention Program. Available: http:// www.cdc.gov/nceh/asthma_old/factsheets/asthma.htm. 48. Hill LB, Keating M. Children at Risk: How Air Pollution from Power Plants Threatens the Health of America’s Children. Clean Air Task Force. 2002. Available: www.cleartheair.org. Accessed: 1119-02 49. McConnell R, Berhane K, Gilliland F, London SJ, Islam T, Gauderman WJ, Avol E, Margolis HG, and Peters, JM. Asthma in Exercising Children Exposed to Ozone: A Cohort Study. The Lancet 359: 386-391, (2002). 50. Ritz B, Yu F, Fruin S, Chapa G, Shaw G, Harris J. Ambient Air Pollution and Risk of Birth Defects in Southern California. American Journal of Epidemiology 155: (2002). 48 Degrees of Danger 51. Lau E, Study Suggests Asthma Culprit: Young Lungs exposed to Ozone Seem More Prone to Problems with Development. Sacramento Bee . 4-15-2001. 52. Mortimer KM, Tager IB, Dockery DW, Neas, LM. The Effect of Ozone on Inner City Children with Asthma. Identification of Susceptible Subgroups. American Journal of Respiratory and Critical Care Medicine 162: 1838-1845 (2000). 53. Rushton L, Cameron K. Selected Organic Chemicals. Air Pollution and Health. Academic Press. 1999, 813-838. 54. Bernard SM, Samet JM, Grambsch A, Ebi KL, Romieu I. The Potential Impacts of Climate Variability and Change on Air Pollution-Related Health Effects in the United States. Environmental Health Perspectives 109, Supplement 2: 199-209, (2001). 55. U.S. Environmental Protection Agency. National Air Pollutant Emission Trends Update: 19701996. Washington, D.C., U.S. Environmental Protection Agency, 1997. 56. Mustafa M, Tierney D. Biochemical and Metabolic Changes in the Lung with Oxygen, Ozone, and Nitrogen Dioxide Toxicity. American Review of Respiratory Diseases 118: 1061-1090 (1978). 57. U.S. Environmental Protection Agency. EPA Scorecard. U.S. Environmental Protection Agency. 2002. Available: www.epa.gov/airmarkt/emissions/score01/score01.a2.pdf, Accessed: 11-18-02. 58. Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. Health Effects of Outdoor Air Pollution, Part 2. American Journal of Respiratory and Critical Care Medicine 153: 477-498, (1996). 59. Public Citizen. Dirty, Dangerous, and Deadly Diesels. 2001. Available: http://www.citizen.org/ documents/ACFC91.doc. Accessed: 11-05-02 60. Dockery D W, Pope CA, Xu X, Spengler J, Ware J, Fay M, Ferris B, Speizer F. An Association between Air Pollution and Mortality in Six U.S. Cities. New England Journal of Medicine 329: 1753-1759, (1993). 61. Seaton A, MacNee W, Donaldson K, Godden, D. Particulate Air Pollution and Acute Health Effects. The Lancet 345: 176-178, (1995). 62. Pope CA, Burnett RT, Thun M, Calle EE, Krewski D, Ito K, Thurston GD. Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution. JAMA 287: 1132-1141 (2002). 63. Peters A, Dockery DW, Muller J, Mittleman, M. Increased Particulate Air Pollution and the Triggering of Myocardial Infarction. Circulation 103: 2810 (2001). 64. Woodruff, TJ, Grillo J, Schoendorf, KC. The Relationship between Selected Causes of Postneonatal Infant Mortality and Particulate Air Pollution in the United States. Environmental Health Perspectives 105: 608-612 (1997). 65. Press Release: Mayor Lee P. Brown Releases Results of Sonoma Air Quality, 5-4-1999. 66. U.S.Census Bureau. 1997 Vehicle Inventory and Use Survey. U.S.Census Bureau . 1998. Available http://www.census.gov/prod/ec97/viuspr/97tvprtx.pdf. Accessed: 11-13-0002. 67. Davis, D. When Smoke Ran Like Water: Tales of Environmental Deception and the Battle Against Pollution. New York, Basic Books (Perseus). 2002. 68. Beggs PJ, Curson PH. An Integrated Environmental Asthma Model. Archives of Environmental Health 50: 87-94 (1995). 69. Ahlholm J U, Helander ML, Savolainen J. Genetic and Environmental Factors Affecting the Allergenicity of Birch (Betula pubescens ssp, czerepanovii [Orl.] Hamet-Ahti) Pollen. Clinical and Experimental Allergy 28: 1384-1388 (1998). 70. CLIMAS - Climate Assessment for the Southwest. Predicting Valley Fever Incidence. Available: http://www.ispe.arizona.edu/climas/research/vf/background.html. Accessed: 10-24-02 71. Intergovernmental Panel on Climate Change. The Regional Impacts of Climate Change: An Assessment of Vulnerability. 1998. Available: http://www.epa.gov/globalwarming/reports/pubs/ ipcc/chp8/america15.html. Accessed: 6-18-01. 72. Center for Disease Control and Prevention. Tropical Storm Allison Rapid Needs Assessment Houston, Texas, June 2001. MMWR Weekly 51: 365-369 (2002). Available: http://www.cdc.gov/ mmwrhtml/mm5117a1.htm. Accessed 11-10-02. 73. Kalkstein LS, Greene JS. An Evaluation of Climate/Mortality Relationships in Large U.S. Cities and the Possible Impacts of a Climate Change. Environmental Health Perspectives 105: 84-93 (1997). 74. Greenough G, McGeehin M, Bernard SM, Trtanj J, Riad J, Engelberg D. The Potential Impacts of Climate Variability and Change on Health Impacts of Extreme Weather Events in the United States. Environmental Health Perspectives 109, Supplement 2: 191-198 (2001). How Smarter Energy Choices Can Protect the Health of Texans 49 75. Texas Medical Association, Council on Scientific Affairs. Black Mold and Human Illness. CSA 1-102. 2002. Available: http://www.tcais.org/insurance/mold_study.php. Accessed: 2-19-03. 76. Clarkson J, Wilson JD, Roeseler W. Urban Areas. In North G, Schmandt Clarkson J. eds. The Impact of Global Warming on Texas: A Report of the Task Force on Climate Change in Texas. Austin, University of Texas Press. 1995, 168-186. 77. McGeehin MA, Mirabelli M. The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States. Environmental Health Perspectives 109, Supplement 2: 185-189 (2001). 78. Kilbourne EM. Illness Due to Thermal Extremes. In Wallace RB, ed. Public Health and Preventive Medicine. Stamford CT: Appleton & Lange. 1998. 607-617. 79. National Oceanic and Atmospheric Administration (NOAA) Selected U.S. City and State Extremes, September 2000. National Climatic Data Center. Available: http://www.ncdc.noaa.gov/ oa/climate/extremes/2000/september/septemberext20000.html. Accessed: 11-24-02. 80. Ozone Action and Physicians for Social Responsibility. Heat Waves and Hot Nights. 7-26-2000. Available: http://216.51.38.3/heatstress/report.html. Accessed 11-5-02. 81. Cool Texas Network. Cool Texas Special Report. Cool Texas . 1-1-2002. Available: http:// www.cooltexas.net. Accessed: 10-10-02. 82. Houston Advanced Research Center (HARC). Press Release: HARC Receives Funding to Draft “Cooler Houston” Plan. 4-12-2002. 83. Kalkstein, L. S. and K. E. Smoyer. The Impact of Climate Change on Human Health: Some International Implications. Experientia 49: 969-979, 1993. 84. Tom “Smitty” Smith. Personal Communication. 11-11-2002. 85. Frumkin H. Urban Sprawl and Public Health. Public Health Reports 117: 201-217 (2002). 86. Schlesinger WH. Warming Up to Disaster: West Nile Virus Is Only a Wake-up Call. Chicago Tribune. 9-22-2002. Available: http://www.chicagotribune.com/news/opinion/oped/chi0209220069sep22.story. Accessed: 10-20-02. 87. Epstein P. Is Global Warming Harmful to Health? Scientific American . 8-20-00. Available: http:// www.sciam.com/print_version.crfm?articleID=0008C7B2—E060-1C73-9B8109EC58. Accessed: 916-02. 88. Epstein P. West Nile Virus and the Climate. Journal of Urban Health: Bulletin of the New York Academy of Medicine 78: 367-371 (2001). 89. Texas Department of Health. Disease Prevention News. West Nile Virus: A Risk in Texas? 62 (9) 422-02. Available: www.tdh.state.tx.us/phpep/. Accessed: 10-22-02. 90. Center for Disease Control and Prevention. West Nile Virus Update Current Case Count. Available: http://www.cdc.gov/od/media/wncount.htm. Accessed: 4-17-03. 91. Hales, S, de Wet N, Maindonald J, Woodward A. Potential Effect of Population and Climate Changes on Global Distribution of Dengue Fever: An Empirical Model. Lancet 359: 830-834 (2000). 92. Rieter, P. Global Climate Change and Mosquito-borne Disease. Environmental Health Perspectives 109: 141-162 (2001). 93. Center for Disease Control and Prevention. Dengue Fever. Division of Vector-borne Infectious Diseases. Available: http://www.cdc.gov/ncidoc/dvbid/dengueindex.htm. Accessed: 11-10-02. 94. Gubler D. Dengue and Dengue Hemorrhagic Fever. Clinical Microbiology Reviews. 11: 480-496 (1998). 95. Githeko AK, Lindsay SW, Confalonieri UE, Patz JA. Climate change and vector-borne diseases: A regional analysis. Bulletin of the World Health Organization 78: 1136-1147, 2000. 96. Texas Department of Health. TDH News Release: Texas Records Dengue Fever Death. Texas Department of Health. 12-22-1999. Available: http://www.tdh.state.tx.us/news/b_new300.htm. Accessed: 11-11-02. 97. Center for Disease Control and Prevention. Local Transmission of Plasmodium vivas Malaria, Houston, Texas 1994. MMWR Weekly 44: 301-303 (1995). 98. Mundy SB, White C, Hines JS, Marino BJ, Young EJ. Mosquito-Transmitted Malaria Acquired in Texas. Southern Medical Journal 1996. 99. Longstreth J. Public Health Consequences of Global Climate Change in the United States — Some Regions May Suffer Disproportionately. Environmental Health Perspectives 107, Supplement 1: 169-181 (1999). 100. Guerra F. Personal communication. 4-1-02. 50 Degrees of Danger 101. Lorin M. Overview of Environmental Threats to Children’s Health. Biennial Scientific Symposium on Children’s Health as Impacted by Environmental Contaminants, Children’s Environmental Health Institute. San Antonio. 11-1-02. 102. Clarkson J, Schmandt J. Policy Options for Addressing the Impacts of Global Warming in Texas. In North G, Schmandt J, Clarkson J eds. The Impact of Global Warming on Texas: A Report of the Task Force on Climate Change in Texas. Austin, University of Texas Press. 1995. 103. Dallas Federal Bank. Texas Colonias: A Thumbnail Sketch of the Conditions, Issues, Challenges and Opportunities. 1999. Available: http://www.dallasfed.org/htm/pubs/ca/colonias.html. Accessed: 10-23-0002. 104. Schmidt, CW. Bordering on Environmental Disaster. Environmental Health Perspectives 108: A308-A315 (2000). 105. Texas Department of Health. Bureau of State Health Data and Policy Analysis. Selected Facts for 1997, the Border Area. 1999. Available: http://www.tdh.state.tx.us/dpa/. Accessed: 11-20-03. 106. Redlinger T, O’Rourke K, Goodman K. Age Distribution of Helicobactor pylori Seroprevalence among Young Children in a United States/Mexico Border Community: Evidence for Transitory Infection. American Journal of Epidemiology 150: 225-230 (1999). 107. Texas Department of Health. Recent High Rates of Anencephaly in Laredo. Texas Birth Defects Monitor 7: 1-2 (2001). 108. Texas Department of Health. 1999 Epidemiology Annual Report - Pesticide Poisoning – Acute Occupational Pesticide Exposure Surveillance. Available: http://www.tdh.state.tx.us/epidemiology/ 99annual/reports/pesticide.htm. Accessed: 2-19-03. 109. Simcox NJ, Fenske R, Wolz S, Lee I, Kalman D. Pesticides in Household Dust and Soil Exposure Pathways for Children of Agricultural Families. Environmental Health Perspectives 103: 11261134 (1995). 110. Donnelly, K. C. Sources and Pathways of Childhood Exposure to Pesticides. Biennial Scientific Symposium on Children’s Health as Impacted by Environmental Contaminants, Children’s Environmental Health Institute. San Antonio. 11/1/02. 111. Texas Center for Policy Studies and Environmental Defense. Texas Environmental Profiles. Pesticides. Available: 2000. Available: http://www.texasep.org/html/wqn/wqn_1trn.html. Accessed: 2-18-03. 112. The 1999 Toxic Exposure Surveillance System Annual Report. American Journal of Emergency Medicine 18: 517-574 (2000). 113. Moses M. Health and Preventive Medicine. In Wallace, R., ed. Stamford, CT, Appleton & Lange. 1998. 114. Le Couteur D, Mclean A, Taylor M, Woodham B, Board P. Pesticides and Parkinson’s Disease. Biomedical Pharmacotherapy 53: 122-130 (1999). 115. Thiruchelvam M, Richfield E, Baggs R, Tank A, Cory-Slechta D. The Nigrostriatal Dopaminergic System as a Preferential Target of Repeated Exposures to Combined Paraquat and Maneb: Implications for Parkinson’s Disease. Journal of Neuroscience. 20: 9207-9214 (2000). 116. Texas Pesticide Information Network and Consumers Union Southwest Reginal Office. Pesticide Report Card: Texas Schools Score from A to F in the Integrated Pest Management Program. 1999. Austin. 117. Bell E, Hertz-Picciotto I, Beaumont J. A Case-Control Study of Pesticides and Fetal Death Due to Congenital Anomalies. Epidemiology 12: 148-156 (2001). 118. Spix, C., Anderson HR, Schwartz JA, Vigotti MA, LeTertre A, Vonk JM, Touloumi G, Balducci F, Piekarski T, Bacharova L, Tobias A, Ponka A, Katsouyanni K. Short-Term Effects of Air Pollution on Hospital Admissions of Respiratory Diseases in Europe: A Quantitative Summary of APHEA Study Results. Archives of Environmental Health 53: 54-64, (1998). 119. Longley, W. Estuaries. In North, G., J. Schmandt, and Clarkson J, eds. The Impact of Global Warming on Texas: A Report of the Task Force on Climate Change in Texas. Austin, University of Texas Press. 1995. 120. Texas Center for Policy Studies and Environmental Defense. Texas Environmental Profiles. Coastal Resources and Water Quality. Available: http://www.texasep.org/hml/wql/wql_5cst.html. Accessed: 11-20-02. 121. U.S. Environmental Protection Agency. Climate Change and Public Health. EPA 236-F-97-005. Washington D.C. 1997. 122. Texas Center for Policy Studies and Environmental Defense. Texas Environmental Profiles. Red and Brown Tides. Available: www.texasep.org/html/wql/wql_5cst_redtide.html. Accessed: 11-2002. How Smarter Energy Choices Can Protect the Health of Texans 51 123. The Cool Texas Network. Press Release. 11-1-02. Available: http://www.cooltexas.net/news/ pr_100012002.html. Accessed: 10-20-02. 124. Virtus Energy Research Associates. Texas’ Renewable Energy Resources. Available: http:// www.infinitepower.org/resintro.htm. Accessed: 11-15-02. 125. Texas Center for Policy Studies and Environmental Defense. Texas Environmental Profiles: Renewable Energy. Available http://www.texasep.org/html/nrg/nrg_3rnw.html. Accessed: 11-1402. 126. California Energy Commission. Wind Energy in California. Available: www.energy.ca.gov/wind/ overview.html. Accessed: 4-1-03. 127. Herrick T. Oil Patch Turns to Turbines as Ranchers Sell Wind Rights. Texas Wind Rush. Wall Street Journal. 9-23-02. 128. State Energy Conservation Office. Renewable Energy Resources for Texas. SECO Fact Sheet, No. 8. 2002. Available:http://www.infinitepower.org. 129. Fialka JJ. Florida Utility Finds It’s Not Easy Even Trying to Be Green. Wall Street Journal. 4-22002. 130. Wiser R, Langniss O. The Renewables Portfolio Standard in Texas: An Early Assessment. 2001. Berkeley, Ernest Orlando Lawrence Berkeley National Laboratory. 131. Herig C. Using Photovoltaics to Preserve California Electricity Capacity Reserves. NREL/BR 52031179. 2001. National Renewable Energy Laboratory. 132. American Council for an Energy-Efficient Economy, The Role of CHO in Addressing Texas’s Need for Pollution Reduction and Growth in Energy Demand. July 2001. 133. Public Utilities Commission of Texas. Staff White Paper on Stationary Fuel Cells for Power Generation. 4-2002. 134. Sierra Club. Sierra Club Global Warming and Energy Program. 2000. Available: http:// www.sierraclub.org/globalwarming/. Accessed 4-12-03. 135. U.S. PIRG Education Fund. Generating Solutions: How Clean, Renewable Energy is Boosting Local Economies and Saving Consumers Money. 4-2003. Available: http://uspirg.org/ uspirg.asp?id2=9634&id3=USPIRG& Accessed: 5-08-03. 136. U.S. Department of Energy. Energy Efficiency and Renewable Energy: Texas Wind Resources. Available: http://www.eere.energy.gov/state_energy/tech_wind.cfm?state=TX Accessed: 5-08-03. 137. U.S. Department of Energy. Energy Efficiency Strengthens Local Economies. Available: http:// www.eere.energy.gov/cities_counties/enrgyeff.html Accessed: 5-06-03. 138. Sustainable Energy and Economic Development and Public Citizen. Renewable Resources: the New Texas Energy Power House. 9-2002. 139. U.S. Department of Energy. Wind Technology Overview. Available: http://www.eere.energy.gov/ state_energy/technology_overview.cfm?techid=2 Accessed: 5-07-03. 140. Tickner J. 1997. Precautionary Principle. The Networker, The Newsletter of the Science and Environmental Health Net 2;34. Available: http://www.pmac.net/precaut.htm Accessed: 3/11/03. 141. Strategic Energy. Kinko’s Expands Texas Green Power Purchases With Strategic Energy. 4-28-03. Available: http://www.sel.com/Supply/Electricity/news/greenpower.php Accessed: 5-8-03. 142. Sustainable Energy and Economic Development. Press Release. 8-20-02. Available: http:// www.seedcoalition.org/pc020820.htm Accessed: 5-8-03. 143. Union of Concerned Scientists. Renewing Texas. 8-02. Available: http://www.ucsusa.org/ publication.cfm?publicationID=474 Accessed: 5-08-02 144. Refinery Reform Campaign. Refinery Basics. Available: http://www.refineryreform.org/ refinery_basics.htm Accessed: 5-20-03. 145. Flores G, Fuentes-Afflick E, Barbot O, Carter-Pokras O, Claudio L, Lara M, McLaurin JA, Pachter L, Gomez FR, Mendoza F, Valdez RB, Villarruel AM, Zambrana RE, Greenberg R, Weitzman M. The health of Latino children: urgent priorities, unanswered questions, and a research agenda. Journal of the American Medical Association Jul 3;288(1):82-90, (2002). 146. Litonjua AA, Carey VJ, Weiss ST, Gold DR. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatric Pulmonology Dec;28(6):394-401,(1999). 52 Degrees of Danger PHYSICIANS FOR SOCIAL RESPONSIBILITY 1875 Connecticut Ave., NW, Suite 1012 Washington, DC 20009 tel: (202) 667-4260 fax: (202) 667-4201 website: www.psr.org