The Health Emergency of our Changing Climate

(air whooshing) (upbeat music) – Good evening, I’m very pleased to be part of this mini medical school presentation about climate change And I’m gonna be giving the first talk, an introductory talk, The Health Emergency of our Changing Climate As you can see at the bottom, I thank Physicians for Social Responsibility, and the Climate and Health Literacy Consortium, that’s a group that has actually studied climate change, and what messages work best, and what people retain and I’m taking advantage of that research to frame my messaging So these are mostly the messages from the Climate Health Literacy Consortium I’ve added a little but the first message is that global warming is real, that we are causing it and I have added unequally because I think that’s important, and that it’s bad for us And again, I’ve added on equally There are things that we can do and there are co benefits to doing them So that’s the main part of the talk And then there’s just a little epilogue where I give what I hope will be an example of something you can do to make a difference or something I did with a group I’m in So the Lancet has had issues about climate change since 2009 And already then they said it could be the biggest global health threat of the 21st century And they said the impacts will be felt all around the world, and not just in some distant future, but in our lifetimes and those of our children and that is absolutely turned out to be true and things have only gotten much, much more worrisome since that first climate change issue in 2009 So the first message is that global warming is real And I’ve cut this down to one slide, because I’m assuming that everybody now knows that the planet is getting warmer I picked this one because the source of it is interesting, the sources the Munich Reinsurance company, which is one of the biggest reinsurance companies in the world And reinsurance companies sell insurance to insurers So their job is to cover the cast of catastrophes that are so bad that otherwise insurers would go broke and they need to insure themselves against them And of course, as a reinsurance company, they are very interested in the effects of climate change and in publicizing those, and they have a whole lot of slides on their website and they come right out and say, “Please download these slides, use them “You don’t need any more permission.” Everybody give talks about Climate change So the next part is we’re causing it unequally And the first cause, of course, is global population This slide shows how population has increased in the last 12,000 years And of course, it starts getting very, very steep around the 20th century People typically say, “Oh, this is so bad, “it’s an exponential rise.” And actually, it hasn’t been exponential for the last 50 years or so So since 1970, I just use PowerPoint to draw a straight line, and it has been linear But linear is bad enough because the linear increase in population has been about 82 million people per year Or put another way, one billion people every 12.2 years And this slide also shows that most of the increase has been in Asia, and to a lesser extent, in Africa, the population of Europe has been pretty stable and North America has only increased a little So that was cause number one, increase in population Cause number two, is use of fossil fuels per person So, fossil fuels that we have had, the population has increased by a factor of five since 1850 But the energy use per person has increased by a factor of four So you put those two together and the total amount of energy this is in Exajoules, an exajoule is 10 to the 18th joules That’d be one followed by 18 zeros It’s a measure of energy Anyway, there’s been a 20 fold increase in the use of energy And from the color coding you can see that mostly that has been fossil fuels

Gas, oil and coal are the biggest contributors So, 20 fold increase in energy is mostly fossil fuels And what that leads to, when fossil fuels are burned that leads to carbon dioxide And concentrations of carbon dioxide have been closely correlated with temperatures for at least the last 800,000 years for which we have data And the source of these data is people drill into Antarctic ice, way down and the farther down they go, the older the ice is, and you can go down to ice that’s 800,000 years old, and look in the bubbles and measure how much co2 was around there, and by looking at the ratio of different isotopes, you can estimate what the average temperature was and this shows there’s a close correlation between carbon dioxide concentrations and global temperatures And the scary thing is, this is the last 800,000 years But this is where we are right now with a carbon dioxide concentration the air of over 400 parts per million And that hasn’t been seen in the last 800,000 years And so we’re very concerned that it will lead to, it already has led to higher temperatures and that that will continue to increase It’s important that it’s not just carbon dioxide There are other greenhouse gases, other gases that trap heat and contribute to global warming One of the important ones is methane And this slide shows that carbon dioxide, methane and nitrous oxide, the third most important one, have all been increasing dramatically in the last couple hundred years But they have different what’s called Global warming potential So the global warming potential compares how much one molecule of methane and nitrous oxide trap seed compared to carbon dioxide And the thing is, the global warming potential varies depending on what’s called the time horizon, because methane is very potent, but it doesn’t last as long as carbon dioxide So for a 20 year time horizon, each molecule of methane contributes 86 times as much as a molecule of carbon dioxide But for 100 year time horizon that’s lower, it’s more like 34 And I think a lot of scientists are now saying we should be using these 20 year time horizons because we don’t have 100 years to make the kind of changes that we need to make Nitrous oxide has a less similar amount of time to carbon dioxide So those 20 and hundred year time horizon numbers are more similar and they’re close to 300 So what are these greenhouse gases do? Well, obviously they trap heat And this is very, very basic, non controversial physics that energy comes in from the sun And some of it is radiated back out by the earth Some of the bounces off clouds and stuff and goes out in the atmosphere But some of it is trapped by greenhouse gases, and is blocked from going out through the atmosphere out into space And the amount of warming of the earth that we get, depends on the balance of how much energy goes in, versus how much energy goes out And the greenhouse gases act like a blanket around the Earth in the atmosphere, keeping energy from going out, with the result that the earth heats up So, that was the second cause, which is, so first was increased population, second burning fossil fuels at a much higher rate And the third is market failure This is a quote from the Stern Review on Economics of Climate Change “Climate change is a result of the greatest market failure “the world has seen “The problem of climate change “involves a fundamental failure of markets, “those who damage others by emitting greenhouse gases “generally do not pay.” So there have been many calculations of you know, the actual cost of a gallon of gas in terms of the cost of the greenhouse gases that are released when you buy it When you burn it in your car, or even the cost of a hamburger and there are many times higher than the price you pay at the pump or at your Burger King, because those costs are externalized meaning other people have to pay ’em,

especially it’s gonna be people in low lying countries where sea level is going to inundate their countries, not the people who are actually driving their cars or eating the hamburgers So, it’s real We talked about the cause We know that greenhouse gases will trap heat But how do we know that the warming we’re seeing is due to that, and not some sort of natural variation as at least some global warming deniers have claimed? Well, we use models And the people who study climate have these complicated models that include all the things that might affect average temperatures Not only the gases in the atmosphere, but the sunspots and things like that And they compare what is observed for temperatures to what the models would predict And they fit the models based on data in the past And this actually, I have to say I’m delighted to see is a slide that has not been removed from the website of the National Oceanic and Atmospheric Administration, NOAA And this slide shows that the observed increase in temperature fits models that have human effects and doesn’t fit models, the blue ones, that don’t include human effects So that doesn’t absolutely prove that we are causing climate change, but it does say if we are not causing climate change, there is some other thing that’s not included in the models that makes the models not fit And, but they do fit when we include the human effects So, what I just showed you was models that sort of try to understand what has happened in the past But the other thing we use models for is to try to predict what’s going to happen in the future And the best science summary comes from the Intergovernmental Panel on Climate Change, the IPCC, you can Google that all of their reports are free to the public The latest is the 5th Assessment Report, latest complete report, which was released in 2013 It had 130 countries represented, 450 lead authors, 2500 expert reviewers, and it’s important, these are all volunteers They’re not people who are being paid by the IPCC And there’s a very transparent peer review process So these things go through multiple drafts and the scientists make comments on each other’s work in order to have it be transparent and have the highest quality science they can And this is an example of the sort of science that they do So you can think of the IPCC 5th Assessment Report, and the other reports, as what we call in medicine, a meta analysis, meaning you take all the studies that have been published on some topic, it could be, studies of the effect of statins on heart disease or blood pressure on stroke And you put together these studies to try to say, how similar are their results, and what can we be confident of? So, this is just one example of the kinds of models IPCC makes, and this is a study of different models, where depending on where the carbon dioxide concentrations stabilizes, remember, we’re at 400 now What is the process ability of exceeding a two degree centigrade change in temperature? Okay, there’s general agreement that a two degrees centigrade rise, in average global temperatures would be catastrophic So we’re trying to prevent that The higher the carbon dioxide level goes, the higher the probability that that will happen And we’re already at the uncomfortable, somewhere around 30, well, maybe 10 to 50% probability So each of these lines represents a different peer reviewed scientific study And, you’ll see some of them, there’s more than one by the same authors And sometimes, they’ll publish one and then they’ll refine their model and they’ll publish another one and then somebody else will say, “No, I don’t think you did that right “My model’s better.” And they’ll publish that This is what the IPCC does is it sort of says, “Okay, this is the range where these different models are.”

And all of them, of course show that the higher the carbon dioxide, the higher the chances of exceeding this two degrees centigrade, which is a 3.6 degree Fahrenheit increase in average temperatures It’s a little bit of a problem because the climate change denier say, “Oh, but you mean you’re giving me this white range? “You can’t say exactly what’s gonna happen.” And this is a problem we scientists have, which is that we tend to be honest and upfront about our uncertainty But there’s no uncertainty that higher carbon dioxide concentrations will cause global warming and that we’re causing it And then I pointed out, we’re causing it unequally so this is a map that shows carbon emissions It’s old, but it hasn’t changed much It’s the United States with 4% of the world’s population has been responsible for about 25% of greenhouse gas emissions So that’s why this United States looks so bloated on this map And if it were compared to population, it would be even more bloated So the next message is, it’s bad for us And once again, it’s bad for us unequally And a lot of the rest of this course is gonna be about how it’s bad for us For the second part of this presentation, Kristy is gonna talk about heat waves But this is just a from last June, a French meteorologist looked at the heat map of France And it reminded him of the painting, the Scream by Edvard Munch because it looks like that, and the higher temperatures and especially the heat waves, big problem, especially for vulnerable populations that Kristy will talk about next Another problem increased in wildfires and anyone in the Bay Area certainly is very, very familiar with that They besides leading into horrible destruction of the stuff that’s burned, they increase particulate pollutants and ozone And you may remember for a while, in 2008, we had the worst air quality anywhere in the world, in the San Francisco area Elderly children and people with respiratory illnesses are the most vulnerable And the 2018 wildfires in California were the worst ever recorded in California And Dr. John Balmes and Katherine Gundling will be talking about fires and other air quality issues related to climate change on May 26 Another big problem is infectious diseases So with warming many vector borne diseases, that’s diseases that are transmitted by mosquitoes or other arthropods, or insects or animals that can transmit a disease to a person The kind of mosquito called Aedes, Aedes aegyti, is a not a native mosquito for California It’s an invasive species and we’re now seeing Aedes mosquitoes This is a mnemonic for our med students to help them remember what diseases are caused by these mosquitoes Chikungunya, dengue, yellow fever and Zika These are all bad diseases that you don’t wanna get, the Zika particularly for pregnant women because it causes horrible microcephaly in the fetuses And then there’s waterborne diseases So along with global warming comes a lot more flooding from storms, and that leads to societal disruption and when you have things like that, where the water supplies ain’t safe then you get diseases like cholera, other infectious diseases transmitted by the fecal oral route Another huge problem is droughts that lead to the melting, You can sort of think of the Arctic ice as sort of acting like ice in an icebox that helps keep things cool As that melts, things warm up And we get lower crop yields, food insecurity, malnutrition, population displacement and armed conflict And maybe you, I don’t know if you know that the civil war in Syria really was partly caused by a horrible drought there, said an article from Thomas Friedman in the New York Times between 2006 and 2011 Some 60% of Syria’s landmass was ravaged by drought With the water table already too low and river irrigation shrunken, it wiped out the livelihoods of 800,000 Syrian farmers and herders,

and they ended up going to the cities And it was the inability of the Assad government to take care of them that was partly responsible for the civil war in Syria, which is then of course affecting people all around the world Increased storms and flooding, where I’ll see plenty of that which cause direct injuries and deaths But then as I mentioned, contaminated water supplies and increased risk of infectious diseases, long term psychological effects, post traumatic stress and grieving and so on, and huge financial losses The 2017 hurricane season, you probably remember, three horrible hurricanes with those amounts of damages And then, respiratory disease, asthma and allergy, so even when there aren’t wildfires, pollen seasons have gotten longer people with allergic illnesses are suffering more from that There’s all kinds of mold and mildew that happens in houses after flooding The smoke from the fires and higher temperatures are closely correlated with higher ozone levels which have been shown to increase respiratory and actually also cardiovascular mortality And psychological effects, as I mentioned before PTSD, depression and eco-anxiety Many of us are suffering from this fear that the future is gonna be horrible, and the future for our children and grandchildren And I’ll say a little bit more about that But Dr. Robin Cooper from our Department of Psychiatry will be talking more about that on June 2 And maybe the scariest thing of all, is sea level rise As with climate change two things happened that raise sea level One is ice melts But the other thing is just thermal expansion, as things get warmer, they expand and those two things have led to sea level rise, which will lead to more coastal flooding during storms Saltwater intrusion into freshwater supplies, and eventually population displacement, refugees and armed conflict So I showed you before from ice cores the last 100,000 years, but co2 levels have been higher if you go back millions of years And when they were, the temperatures were two to three degrees centigrade higher, and sea levels were six meters higher So if our temperature rises by two or three degrees, the six meter sea level rise that we’ll see, this shows what would happen in Bangladesh and Florida what percentages would be underwater And one of the problems in Florida is that the soil is porous So it’s not like you can like build sea walls around it to keep the water out, because it will just bubble up from the ground So this was a demonstration, the Stand Up For Science Demonstration at the meeting of the American Geophysical Union I love this sign “Ice has no agenda, it just melts.” By the way, that’s me over there with other members of physicians for Social Responsibility And that, I think, also was a example one of the messages that we’re getting from the COVID epidemic, which is that science is real We’ll come back to that So who was affected? So this was the graph I showed you before of who’s causing it These are world maps showing who is affected and you can see the huge discrepancy between the greenhouse gas emitters and the places that are suffering from drought, floods, storms and so on So, the effects of climate change are very unequal So that’s the bad news The good news is there are things that we can do And one thing you can do is estimate your own carbon footprint There’s many online calculators, the best ones include your food, we’ll come back to that And they show the effects of changes you can make and are state specific So you can Google carbon footprint calculator, my favorite is on the Nature Conservancy site And the other place to Google is the Footprint Network where you can see your environmental footprint So the US per capita carbon footprint is about 21 tons So after you’ve done that, if you’re like, I and many of us in academic medicine used to be,

one of your biggest contributions to climate change, and to your carbon footprint is airplane travel And one trip to the East Coast from California, your share of that, riding Economy Class is one to two ton of co2, it’s higher in the Economy Class and first class, one or two tons And that’s in relation that your typical per capita, household electricity consumption in California, where we actually have a lot of hydroelectric power is only three tons of co2 So for years, I was bugging my wife and my kids, oh, turn off the lights, you’re wasting energy And then I would hop on a plane and go to NIH for a meeting or something like that And that would completely, totally swamp all the possible little conservation we could do So one good thing about COVID is people are learning to get stuff done remotely So reduce your travel by combining trips and then considering offsetting your travel If we have time afterwards, if there is questions, I can talk about carbon offsets So another thing you can do is look at the food you eat And it turns out not all foods are equal And there’s one particularly type of food that causes more climate change, more global warming, and that’s ruminant meat or meat from ruminant animals So that’s mostly beef, and lamb But animals that have a rumen digest the cellulose in grass or whatever they’re munching on, probably by having bacteria that help them with that digestion and a byproduct of that is the production of methane And so when these animals are burping out methane that goes up into that sphere, and that’s why they cost so much more climate change and global warming than either pork, which is not a ruminant, or poultry For fish, it depends how the fish was caught, if it’s from trawling, where you have to have the boats running and burning diesel fuel, then it’ll have a higher greenhouse gas footprint But not only there are good things that we can do, but there are co benefits of doing them And this is the first slide about that, this is a meta analysis I mentioned meta analysis before when we grouped together studies, different studies to try to find the best answer by combining the studies, and this is a meta analysis of all cause mortality, finding higher risk of all cause mortality for people who eat more meat And there are studies suggesting that actually red meat is worse for you than white meat So this led UCSF Medical Students to call on UCSF departments to go beef and lamb free because the carbon footprint and several departments including my departments, epidemiology, and biostatistics and pediatrics, ob gyn, ophthalmology, urology, anthropology, history and social medicine have all pledged not to serve beef or lamb at their departmental events and there’s a lot more we can do to cut down on our red meat consumption And the other thing, especially people in health care can do is looking at our own carbon footprint So the healthcare sector contributes about 4.4% of the world’s greenhouse gas emissions If we were a country, we’d be the fifth largest producer of greenhouse gases And I think what all of us need to do is look in the place where we work, or the circles in which we operate And look at is there waste there? I work in healthcare And so I look, and notice and try and do something about health care waste, which is about 30% of our spending, it amounts to more than $3,000 per year And discretionary funding for anything, including infrastructure conservation, renewable energy is constrained by the huge amount we spend and the huge amount we waste on health care And this is a quote from the Academic Senate Sustainability Committee, “Trying to reduce the environmental footprint “from health care, without examining what we do, “is like trying to reduce our carbon footprint from travel “without considering what trips we take.” So this is actually my focus and my research and my main, my day job, and there’s another mini med school course going on, starts pretty soon and I’m giving a talk in that one on June 3rd, called Safely Doing Less Part of the mini medical course, what’s next?

So my research really is focused on trying to find and reduce waste in healthcare So another thing we can do, is divest from fossil fuels This is a quote from Bill McKibben “If it’s to wreck the climate, “then it’s wrong to profit from that wreckage.” And Fossil Free UC was started by students in 2012 In 2018, the UCSF Academic Senate Sustainability Committee, on which I serve proposed a system wide divestment memorial that’s like a resolution to the regions The UCSF faculty passed this overwhelmingly, 79% in favor in 2019 And then it passed the system wide academic center faculty all over the UC system with 77% support And Victory, this is the Fossil Free UC site After a year’s long campaign culminating in a full UC system wide vote for fossil fuel divestment The university of California financial officers announced they would divest 13 billion of endowment and 70 billion of pensions of fossil fuels Yay! Although they did say they were doing it to save money (laughing) Because of their fiduciary responsibility, they got the message So I wanna just mention COVID, this horrible epidemic has a little bit of a silver lining one there has been a huge drop in greenhouse gas emissions and if you live in the Bay Area, you may have noticed how clear the air is It has introduced many, to video conferencing and telehealth visits UCSF telehealth visits have gone from 2% to I think it’s like 60, 70% now of visits And it’s an opportunity to learn from our mistakes So if the argument we can’t do what the scientists tell us because it would be too expensive, so let’s do nothing for now, I think has lost some credibility And so I think COVID-19 presents a teachable moment And this is actually comes from a conference call that Bill McKibben was on from our Climate Health Now! group So a teachable, one thing to learn is science is real Ignoring threats does not make them go away Timing is key when responding to threats It is just so important, even the couple of weeks that the Bay Area got as a head start on COVID compared to other places like New York City has made a huge difference, and if we’d respond to the threats of global warming threats 50 years ago when the issue was first raised, it would have been easier, but it’s still gonna be easier now than later And that this also, COVID-19 and South Korea versus the USA And I think he sent another message that health professionals are a trusted voice So doctors need to speak out about climate change like they are about COVID because we’re the ones who take care of the victims of bad policy decisions and it doesn’t feel good So he said time to get angry and speak out So we know enough to act, given the high risks and the disproportionate effects even a low probability would warrant action And the good news is the interventions have co benefits, reduced air pollution, environmental degradation, and decreased international conflict from the extraction of burning of fossil fuels, better health from eating less meat from walking and cycling rather than driving and so on So what you can do is set an example, your coworkers will notice how you get to work If you go into work Your friends and family will notice what you eat and where do you go on vacation Your colleagues will notice your business travel And just to give a little preview of treatment for eco-anxiety and this, I have a picture of Robin there I think that’s from when she was speaking at Stanford Come together in community, find allies who understand what you are feeling Take care of yourself with mindfulness meditation, time in nature, and then identify what specific problems speak to you and get to work So I have a closing story, it’s a true story Pictured here is the San Mateo Hayward bridge It’s the longest bridge in the Bay Area and the 25th longest bridge in the world And back in 2001, this was the view if you exited The Foster City Costco

And if you were on either of those two lanes, you were going to Hayward But the only sign to tell you that is not really visible as you exit the Costco parking lot So I made more than one accidental trip to Hayward as a result of this poor signage So I used The Caltrans website to make a suggestion, I wrote on behalf of the Social Action Committee of the Unitarian Universalists of San Mateo, which thinks globally and acts locally I’m writing to call attention to a problem that wastes time and energy The problem is that it’s too easy, accidentally to get on highway 92 eastbound at Foster City Boulevard and be forced to drive all the way to Hayward So, that’s September 2001 More than a year later, we’re up to the seventh email and this is Robert Haus from the Department of Transportation responding, again He says, “I forwarded your remarks once again “to the person in charge of signing for San Mateo County “As we said previously, signing is a matter of balance “Too few signs lead to confusion, “too many signs can lead to the same result.” Blah, blah, blah “You can’t have your bridge signs.” Fast forward, (laughs) up to 2004, email number 28 By now I have much more friendly with Mr. Haus Greetings, Mr. Haus, I was over at the Foster City Costco this afternoon So naturally, my thoughts turned to you How are you doing? I hope you have a happy holiday season And don’t forget that the wish of the Unitarian Universalists of San Mateo this year, as in 2001, two and three is that someday, every trip to Hayward will be a wanted trip to Hayward Will our wish some day come true? You could make it happen Well, it finally did This is the before picture with some members of the Social Action Committee and people from the Department of Transportation And there’s the after picture, we got two signs there And in fact, we got these new signs, the yellow part is new If you’re actually on the Highway 92, not just on the entrance to it, and that maybe kind of hard to see but also says last exit So we were victorious So in summary, climate change poses grave threats to the health of people on the planet Healthcare contributes because of its own large carbon footprint and its costs So we want people to improve healthcare value You can reduce your own environmental footprint by conserving energy, reducing travel, eating less meat and offsetting carbon, but this will not be enough We all need become change agents So I highly recommend you join a group that’s working on that, because there are co benefits as shown in this slide “What if it’s a big hoax “and we create a better world for nothing?” This is me and my wife at some demonstrations And thanks very much for your attention (soft music)