Transcript presentation - Canadian Public Health Association

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Case #1

You are part of an Environmental Health Team at a local public
health unit.

The combination of weather and air pollution is resulting in a
high Air Quality Health Index reading for your community.
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What information do you need to successfully inform your
community of the health risks of air quality, and to address
policy issues related to air quality?
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Questions
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Who is at highest risk for health impacts from air pollution?
What are the main contributors to air pollution?
How is AQHI measured?
How is air quality impacted by climate change?
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AQHI
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Health effects at low pollutant concentrations
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Mix of multiple pollutants
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NO2
ozone
PM2.5/10
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Health
Risk
Low Risk
Moderate
Risk
High Risk
Very High
Risk
Air Quality
Health
Index
1-3
4-6
7 - 10
Above
10
Health Messages
At Risk Population*
General Population
Enjoy your usual outdoor activities. Ideal air quality for outdoor activities.
Consider reducing or rescheduling
strenuous activities outdoors if you
are experiencing symptoms.
No need to modify your usual outdoor
activities unless you experience symptoms
such as coughing and throat irritation.
Reduce or reschedule strenuous
Consider reducing or rescheduling
activities outdoors. Children and the strenuous activities outdoors if you
elderly should also take it easy.
experience symptoms such as coughing and
throat irritation.
Avoid strenuous activities
outdoors. Children and the elderly
should also avoid outdoor physical
exertion.
Reduce or reschedule strenuous activities
outdoors, especially if you experience
symptoms such as coughing and throat
irritation.
Health Canada:
+Health effects of longterm air pollution
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increased risk of stroke
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increased risk of heart disease
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increased risk of chronic and acute respiratory
infections, including asthma
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increased incidence of lung cancer
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WHO - outdoor air pollution is a Group I
carcinogen (2013)
delayed development of the lungs
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Case #2
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You are a Medical Officer of Health for a medium-sized city. Average
summer temperatures have been increasing, with several heat-related
deaths the previous year. The following week is predicted to meet
criteria for declaring a heat alert.
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What steps should be taken to develop a Heat Alert and Response
System?
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Questions
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Why is increasing heat a health issue?
What are the key components of a Heat Alert and Response System?
What public health interventions are important?
Heat Alert and Response Systems to Protect health: Best Practices
Guidebook
French Heat Wave 2003 Daily Mortality,
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Source: INVS, 2003
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Relationship between daily maximum temperatures in June, July and
August, and all non-traumatic deaths for selected Canadian cities, 1986–
2005
Heat Alert & Response Systems to Protect Health: Best Practices Handbook
Health Canada, 2012
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Heat Alert & Response System
Heat Alert & Response Systems to Protect Health: Best Practices Handbook
Health Canada, 2012
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+ Case #3
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You are a public health consultant working with the health
department in the Northwest Territories on climate change
issues. Through a community consultation process you have
noted that a key priority is the impact of climate change on food
security.
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Questions
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What aspects of food security will be impacted by climate change?
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What are the health impacts of climate change on food security in
Canada’s north?
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What are the real and potential health impacts of climate change on
food security globally?
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UN Special Rapporteur on the right to
food: Canada already has problems
“ In 2007/2008: 7.7% of households in Canada reported
experiencing moderate or severe food insecurity
“a staggering 1 in 10 families, 10.8%, with at least one child
under the age of six were food insecure during the same
period.”
“deep and severe food insecurity faced by aboriginal peoples
across Canada…17.8% of First Nations adults (age 25–39)
reported being hungry but did not eat due to lack of money for
food in 2007/2008.”
Olivier De Schutter, Special Rapporteur on the right to food:
Visit to Canada from 6 to 16 May 2012
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Health Effects of Climate Change in Canada’s
North
- Food Insecurity
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More difficult access to country food
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Rising store-bought food prices secondary to poor crop yields.
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Decreased safety of travel on the land/ice
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Cultural dislocation/stress
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Damage to infrastructure
Health Canada-Séguin, J. Human Health in a Changing Climate:
A Canadian Assessment of Vulnerabilities and Adaptive Capacity
Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2
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Country Food: Adapting to
Climate change to protect food security
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Move hunting camps & fishing sites in response to environmental changes to
migration patterns
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Increase flexibility in hunting schedule & species
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Refer to Traditional Knowledge to understand cycles in nature & stewardship
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Increase representation in institutions that influence the environment(GNWT,
EconDev)
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Increase in Advocacy at national & international levels
(Slide from Nelida Duran’s presentation to the Yellowknives Den
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Climate change: increasing food
insecurity - case study - Djibouti.
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MSF Balbala Slum Malnutrition Project
High World Food
prices in 2008 led to a
malnutrition
emergency in Djibouti,
a very hot country
where sig agriculture
is not possible.
A pediatric
malnutrition project
was set up in the large
slum, Balbala,
adjacent to Djibouti
city.
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Severe Acute Malnutrition:
-Immunocompromise
-Delayed and stunted growth
-High acute mortality from
opportunistic infections (diarrhea,
pneumonia) (Median <5 fatality rate
=30-50%)
-Poor long-term
neurodevelopmental outcomes.
Mortality much-decreased with inpt
treatment: MSF Target = <5%
(MSF-Djibouti=1-2%)
FOOD INSECURITY SECONDARY TO CLIMATE CHANGE
“rising incomes and growth in the global population, expected to
create 2 billion more mouths to feed by 2050, will drive food prices
higher by 40-50%. Climate change may add a further 50% to maize
prices and slightly less to wheat, rice and oil seeds.”
http://www.wfp.org/content/climate-change-how-warming-world-threat-our-food-suppliesClimate
20% more people will be at risk of hunger by 2050 due to the
changing climate.”
(World Food Program: http://www.wfp.org/climate-change)
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• Spikes in food prices in 2008 and 2011 led to food riots around
the world: potential for further health problems secondary to
conflict
• Improving food security needs to be a national and international
priority.
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Case #4
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What may be the single most cost-effective way to reduce GHG
in a way that also improves health outcomes?
+Meeting unmet contraception needs
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May be more effective in controlling climate change than most low-carbon
technologies1,2
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-each $7 spent on meeting unmet contraception needs reduces CO2 by >1 tonne 1
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-meanwhile, it costs up to $32 to reduce CO2 by 1 tonne using low-carbon technologies 1
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Health co-benefits
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decreased maternal mortality, prematurity, infant mortality, increased education, female
empowerment 2
1-(Master’s Dissertation, Thomas Wire, London School of Economics)
http://www.populationmatters.org/documents/reducing_emissions.pdphpMyAdmin=e11b8b687c20198d9ad050fbb1aa7f2f
2-WHO: Family planning: a health and development issue, a key intervention for the survival of women and children.
http://apps.who.int/iris/bitstream/10665/75165/1/WHO_RHR_HRP_12.23_eng.pdf
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+Case #5 – Small group discussion –
Shale Gas Development
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Sources of energy
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Coal
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Hydroelectric
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Nuclear
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Natural Gas
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Renewables - i.e. solar, wind, biomass
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Each source needs to be considered for health impacts
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Current issue: Shale gas development (Fracking)
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What is Hydraulic Fracturing?
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A technology that has allowed access to large volumes of shale
gas that were previously inaccessible/uneconomical to produce
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Injection of large volumes of water, sand and chemicals /
additives at high pressure down and acres into horizontally
drilled wells thousands of meters below the surface, causes rock
layer to fissure
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What are
community
concerns about
shale gas
development?
From: Council of Canadian Academies, 2014. Environmental
Impacts of Shale Gas Extraction in Canada. Ottawa (ON): The
Expert Panel on Harnessing Science and Technology to
Understand the Environmental Impacts of Shale Gas
Extraction, Council of Canadian Academies
http://www.scienceadvice.ca/uploads/eng/assessments%20a
nd%20publications%20and%20news%20releases/shale%20gas/s
halegas_fullreporten.pdf
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Unknowns
“Several important uncertainties concerning the
environmental implications…”
absence of…baseline information about
geological & environmental conditions
performance of key components
of…technology
pathways, fate, and behaviour of industryrelated contaminants in ground water
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Unknowns - Human Health
“…gaps in knowledge of the effects of large-scale shale gas
development on human health:”
Mixtures of chemicals…generally unknown and
untested
Additives will change due to reactions
Pathways of fracturing chemicals in the
environment…including [exposure] routes…unclear
Typical exposure…not fully established…health impacts
difficult to predict or quantify
Calculations of additive risk for specific
compounds/cumulative risks from several compounds
not available
Public health surveillance…or rigourous health impact
assessments…have not been conducted
Lack of baseline monitoring
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Role of Public Health
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Toxicology
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Cluster analyses
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Research
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Policy analysis
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GIS
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Evidence from similar industries
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Risk assessment and risk management
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Health Impact Assessment
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Health Impact
Assessment
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Means of assessing the
health impact of
policies, plans and
projects in diverse
economic sectors,
using quantitative,
qualitative and
participatory techniques
(WHO 2011.
http://www.who.int/hia/e
n/)
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+Case #5 – Small group discussion –
Shale Gas Development
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You are living in a medium-sized province where shale gas development
is being considered. The community has many individuals and several
groups who would like a ban or a moratorium. There are also many who
would like to proceed with development. Others are uncertain about the
best course of action for the province.
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A community meeting has been organized to help inform the provincial
government review process.
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You are playing the role of the individual described on your card.
Instructions
- Take two minutes to outline your thoughts
- Each person takes one to two minutes to present to the group
- Debate / discuss these questions for five minutes:
- What course of action would you recommend to the province? Can you
come to a group consensus?
- What further information do you need to inform your recommendation?
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