The Yale-Lancet Countdown Regional Launch Event

January 11, 2022

Information

The 2021 Report of the Lancet Countdown on Health and Climate Change: Code Red for a Healthy Future tracks the relationship between health and climate change across five key domains over 40 indicators. Results indicate that key trends are getting worse and exacerbating already existing health and social inequities. Co-authors of this landmark report, an author of the accompanying Lancet Countdown Policy Brief for the United States of America, and the lead author of Climate Change and Health in Connecticut: 2020 Report joined to discuss issues and solutions on the global, national, and state levels.

Dr. Marina Romanello, Research Director – The Lancet Countdown: Tracking Progress on Health and Climate Change
Dr. Jodi Sherman, Director – Yale Program on Healthcare Environmental Sustainability, Yale Center on Climate Change and Health
Dr. Robert Dubrow, Faculty Director, Yale Center on Climate Change and Health
Dr. Jeremy Hess, Director – University of Washington Center for Health and the Global Environment
Dr. Laura Bozzi, Director of Programs - Yale Center on Climate Change and Health

November 18, 2021

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To CiteDCA Citation Guide

00:00<v ->Welcome everyone, I'm Robert Dubrow.</v>
00:03I'm a professor of Epidemiology
00:06and also the Faculty Director of the Yale Center
00:09on Climate Change and Health
00:11at the Yale School of Public Health.
00:13And welcome to this Yale Lancet Countdown launch event.
00:19So the Lancet Countdown on Health and Climate Change
00:22is an international collaboration
00:25that's been monitoring the health consequences
00:27of climate change through an annual report
00:30that's been published
00:31in the medical journal, The Lancet since 2015.
00:36The collaboration includes researchers
00:38from 43 academic institutions and UN agencies.
00:44And researchers from Yale
00:45have been part of the collaborations since 2019.
00:50The 2021 report was published
00:53in the Lancet this year on October 20th
00:57and that was followed
00:58by a Global Launch Event the following day,
01:01but subsequently there've also been
01:03regional launch events around the world.
01:05And this is one of those regional events.
01:09Given the COP26, that was just completed,
01:12the 2021 report which is organized around
01:16five domains and 44 indicators was particularly timely
01:21in framing the climate crisis as a public health crisis.
01:26So today we're gonna have five speakers
01:32and I'm gonna introduce them now
01:34and let you know what they'll talk about.
01:37So the first speaker is, Marina Romanello,
01:40who's the Research Director at the Lancet Countdown
01:43and the first author of the 2021 Report.
01:47And she's gonna give an overview and highlights
01:49of the Global Report.
01:52Then Dr. Jodi Sherman, who is a professor here at Yale,
01:56of both Anesthesiology and Environmental Health Sciences,
02:01and also the director of the Yale Program
02:03on Healthcare, Environmental Sustainability
02:06will talk about one of the indicators
02:09which is Healthcare Sector Emissions.
02:12Then I'm gonna talk about another indicator,
02:15which is air conditioning, benefits and harms.
02:19Yes sir, it's interesting Jeremy
02:21is a professor in the Department of Environmental
02:24and Occupational Health Sciences,
02:25Global Health and Emergency Medicine.
02:28And he's also the Director of the Center for Health
02:31and the Global Environment at the University of Washington.
02:34And he's gonna give an overview and highlights
02:37of the Lancet Countdown U.S. Policy Brief,
02:40which was a very important ancillary report
02:44that was done in conjunction with the Global Report.
02:47And then finally, Dr. Laura Bozzi,
02:50who's the Director of Programs
02:52at the Yale Center on Climate Change and Health
02:54will give an overview and highlights of
02:57a report that our center did
02:59on Climate Change and Health in Connecticut 2020 Report
03:02that was not associated with the Lancet Countdown,
03:05but nevertheless used it as a model in terms
03:09of organizing the report around the indicators.
03:12So without further ado, let me turn it over to Marina.
03:20Let's see (indistinct).
03:24<v ->Thank you Rob, thank you so much.</v>
03:27Let me see if I can share screen.
03:31Can you see my performance screen there?
03:36<v All>Yes.</v>
03:39<v ->Awesome, so I'm gonna try</v>
03:44to give you a very brief overview
03:46of the report and (mumbles)
03:49what the Lancet Countdown means
03:50but first of all,
03:51I really wanted to thank Yale for hosting this event.
03:55As Rob said, Yale is one of our key partners
04:00(mumbles) says it's really an honor to be here with you.
04:04So we are 43 partners around the world.
04:07The Lancet Countdown is patients
04:08and UN agencies around the world.
04:10And as Rob just said,
04:11we produce indicators tracking progress
04:13on health and climate change across impacts
04:15and what their response to climate change means for health
04:19and the data is published every year
04:20in a medical journal, The Lancet.
04:22The report that you see last year is the latest report
04:27that is labeled a code red for health.
04:28So I'm gonna tell you a bit about why that is,
04:30but this is just the latest of the series
04:33of the Lancet Countdowns Reports
04:36with our 5th year of iterations
04:38of this tracking and monitoring exercise.
04:43So I'll report to say that
04:45it's entitled a code red for a healthy future.
04:48And this is because across all of the indicators,
04:52we're tracking the impacts of climate change on health.
04:54We're seeing trends rapidly worsening
04:57and affecting particularly the most vulnerable
04:59in every society in every country exacerbating in this way,
05:03the inequities around the world.
05:06When we think about climate change
05:07the first thing that comes to mind
05:09is increase of heat waves, increased temperatures.
05:11And we're seeing that the very vulnerable population,
05:13people over 65 years of age are increasingly being exposed
05:17to life-threatening heat waves.
05:21(mumbles) silent killers
05:22they're more than just uncomfortable
05:24and we're seeing very vulnerable groups
05:25increasingly affected.
05:26As you can see here mainly starting the year 2010,
05:30really rapid increase in exposure to heat waves.
05:34And heat waves not only affect our health directly
05:38in terms of morbidity or mortality,
05:41but they also affect our health indirectly
05:42by undermining our capacity to work.
05:45We also monitor the extent to which heat exposure
05:47is reducing our labor capacity
05:49particularly in the agricultural sector
05:51we're seeing big impacts in terms of hours of labor loss
05:54in countries that are very vulnerable,
05:56the low Human Development Index country group
05:58and the medium Human Developments in this country group
06:01seeing particularly big losses.
06:02Especially in the agricultural sectors
06:05we estimate that the losses
06:06in the low Human Developments Index country group
06:08amount to 4-8% of the total GDP of those countries
06:11being lost due to heat exposure.
06:13So social determinants of health also being put at risk
06:16and obviously increase heat-related mortality.
06:19We've seen the heat waves this year in Canada,
06:22in (mumbles) Kazakhstan.
06:28And here's for sure is increasing
06:30as is heat-related mortality as well.
06:33On increased heat and increased temperatures,
06:35our capacity to grow crops is also reducing.
06:37So we're seeing crop (indistinct)
06:41reducing across all major staple crops,
06:44anywhere from three to 6% of reduction
06:47of crop yield potential of the 1950s baseline,
06:50which is even getting exacerbated by the increased land area
06:54being affected by extreme drought.
06:57The percentage of land area
06:58affected by extreme drought exposure
07:00risk about 20% of record in 2019.
07:05And with dry weather, hot weather
07:06also coming in with incidents of wildfires in the U.S.
07:09who have been suffering a horrendous wildfire seasons
07:13as a result of climate change,
07:14much of which we have detection attribution study
07:16that bring down the cause to climate change.
07:19As temperatures change, precipitations patterns change
07:22and humidity changes.
07:24So to does the environmental suitability
07:26for the transmission of infectious diseases.
07:28And we're seeing particular increases
07:30in the suitability for transmission of dengue, of malaria,
07:33of vibrio pathogen and vibrio cholerae
07:35and other vibrio bacteria as well all around the world,
07:38particular vibrio bacteria
07:39in the Pacific, North Eastern Atlantic, Northeast as well.
07:45So all of our indicators are flashing red,
07:47really raising an alarm
07:48to the health risks of climate change,
07:52but perhaps the most concerning thing is that
07:55not only climate change is exacerbating health impacts,
07:58particularly on the most vulnerable,
08:00but our response to climate change
08:02is also increasing the inequities camp.
08:04Also we have failed to deliver
08:06adjust response to COVID-19,
08:08we're seeing an unjust response to climate change.
08:13The main thing that we need to do
08:14in order to reduce the impacts of climate changes
08:17obviously to quickly adapt and decarbonize.
08:20And when we talk about
08:21climate change mitigation, decarbonization,
08:23the energy system is the center (indistinct),
08:25it is the main contributor to greenhouse gas emissions.
08:28As you can see in this black line,
08:32the carbon intensity of the global energy system,
08:35that is the amount of carbon dioxide produced
08:40per unit of energy generated,
08:42has not changed practically since the '70s.
08:45And at the pace of slow reduction
08:46that we've seen from 2014 to 2018,
08:49it would take us roughly 150 years
08:51to fully decarbonize our energy systems.
08:54The other thing that is notable here is that
08:56it is the high Human Development Index countries,
08:58the ones that are adopting technologies to decarbonize
09:00and to benefit from the health permanently
09:02to perverse decarbonization
09:04whereas the high Human Development Index
09:06and the medium Human Development Index country groups
09:08are still growing at a carbon intensive way,
09:11not benefiting from a low carbon transition.
09:13And the low Human Development Index country groups
09:15still has to do that development
09:19and industrialization there.
09:22And what this mean for health
09:23is that exposure to air pollution is still incredibly high.
09:27We have not managed to reduce exposure
09:29to air pollution since 2015 significantly.
09:32In 2019, we saw roughly 3 million deaths
09:35attributed to ambient PM2.5 air pollution
09:38the most harmful form of air pollution
09:40and 1/3 that came from fossil fuels.
09:43And as we can see here,
09:45this is disproportionately affecting
09:47the high and medium Human Development Index country groups
09:52that are very carbon intensive,
09:55but the low Human Development country groups
09:57is being particularly affected
09:58by indoor exposure to air pollution,
10:00to the use of dirty fuels for cooking and for heating.
10:02So also big inequities in the transition
10:05to a cleaner source of fuels.
10:08However, there is still some hope
10:09that comes from our reports
10:10and that's really worthwhile noting.
10:12When we talk again about energy system,
10:14while we're still lagging behind,
10:16we are seeing a very fast adoption
10:17increase in the use of renewable,
10:19clean, new, renewable energies for energy production,
10:22particularly in the U.S. and in China,
10:24the biggest contributors to greenhouse gas emissions,
10:27which is really positive.
10:28Total energy produced from clean sources
10:31has reached 7.2% in 2018, and this is still growing.
10:34So we do have the technology.
10:36And one other thing that is really worth noting
10:38is that the health sector that is crucial in protecting
10:42our health from climate change and we acknowledged that
10:45a climate change is a health crisis.
10:46They must be at the forefront
10:48of the fight against climate change.
10:51Health sector is now taking the lead
10:52and we've seen many commitments made during COVID
10:56of national health systems that have committed
10:59to reaching net zero by 2050,
11:01and over 50 health systems around the world
11:03committing to become more sustainable
11:05and more resilient to climate change.
11:10So just to finish off,
11:12I find a reflection that comes from our report,
11:14but also from what happened at COP26,
11:17we're currently exiting the COVID-19 pandemic.
11:21And as the world tries to recover
11:22around rolling trillions of funds
11:25towards economic reactivation and reframing.
11:28However, so far we see that only 18% of those trillion,
11:32almost $2 trillion allocated to COVID recovery
11:36would lead to reduction in greenhouse gas emissions.
11:40All the rest will have negative effects on climate change.
11:44So we're here at five or 10 points where we have to decide
11:47whether we're gonna go through a carbon intensive route
11:50that will lead us to a new crisis.
11:51A crisis of climate change impacts on health,
11:54and that will undermine our progress against the targets
11:56that we (mumbles) nationally
11:57determined contributions,
11:59or whether the world will act together
12:01to deliver adjust transition and make use of this moment
12:04to deliver a world of environmental sustainability,
12:09economic sustainability and growth,
12:12better health and reducing inequities.
12:15And with that, I will just close
12:16and invite you to visit lancetcountdown.org
12:18where you can explore a bit more of our indicators
12:21that I just gave you a very brief overview of.
12:26<v ->Thanks very much Marina.</v>
12:27<v ->(mumbles).</v>
12:29<v ->So next we'll have Dr. Jodi Sherman talking about</v>
12:34the indicator that she took the lead on.
12:39<v ->Thanks, can you hear me and see the screen okay?</v>
12:42<v All>Yes.</v>
12:43<v ->So my talk is going to focus</v>
12:46on the role of the healthcare sector,
12:48its contribution to climate change.
12:51Now, as Dr. Romanello was saying,
12:54we have increased demands for health services
12:57because of the problem,
12:58the myriad of health impacts of climate change,
13:01health care itself is ironically a significant contributor
13:06to global greenhouse gas emissions
13:08and non-greenhouse gas emissions.
13:10We've got a very high resource consumption industry,
13:14hospitals run 24/7,
13:16high-tech diagnostic therapeutic equipment,
13:19high energy intensive buildings.
13:21And health care is a unique risk for unique infection risks
13:26and prevention requirements
13:27that drive a lot of disposability
13:29and utilization of resource
13:31both in our energy as well as materials.
13:35We also live in a complex regulatory environment
13:39designed to protect our patients,
13:42patients and also occupational health,
13:45but we also have business models
13:46and that regulatory compliance and business models
13:48drive low volume consumption of resource.
13:52We also particularly in high-income nations
13:54and especially in the U.S. have the culture of excess
13:56and where disposability is normalized.
13:59And how can particularly, because we have a social mission
14:02to protect individual patients,
14:04we've really been neglecting about
14:05the impact of how care delivery affects public health
14:10and we can't really do that anymore.
14:12So the key results of the Lancet Countdown
14:16latest publication of 2021,
14:19globally health care emits 4.9%
14:22of total global greenhouse gas emissions.
14:24And this is rising at a rate of five to 6% annually.
14:29This is the most recent.
14:30There are several international studies.
14:31This is the most recent result.
14:34U.S. healthcare is an outlier and not in a good way.
14:37We spend twice as much
14:38on health care as any industrialized nation,
14:4118% of our GDP, health care globally is 10% of the economy.
14:45So if we can not want,
14:46should health care be leading as an industry
14:49and health care and all policies of protecting health,
14:53because we intersect with so many areas
14:56within the global economy,
14:58we have the opportunity to help drive change globally.
15:04Of that 4.9% emissions of health care in the U.S.
15:08is responsible for a 1/4 of those emissions globally,
15:12despite only having 4% of the global population.
15:17And we have the highest per capita
15:18health care greenhouse gas emissions.
15:21Now, if we have the best health outcomes for that impact,
15:25for those expenditures, there might be some justification,
15:30at least till we transition our energy sources
15:33and our embodied emissions but that's not really the case.
15:39So what we did is we associated
15:41per capita healthcare greenhouse gas emissions,
15:44along with the global burden of diseases,
15:46health care access, and quality index.
15:47This is from the 2020 paper of 2021.
15:50We did the same association with the Human Development Index
15:53and the results are the same.
15:55So we wanna have as low greenhouse gas emissions
16:00per health care capita as possible and as high performance
16:03in terms of health care, quality and access.
16:06And we can see the highest performers
16:07here in Europe particularly France is a notable outline
16:13performer in a good way versus the U.S.
16:15So not only do we have the highest
16:16per capita greenhouse gas emissions, we do not perform
16:19the best in terms of health care access and quality.
16:22And we're about 1700 kilograms of CO2
16:25equivalent emissions per capita for health care
16:29versus 450 in France.
16:30So 450 is around the break-even point.
16:33The good news is what that means
16:34is we can reduce our emissions
16:35without sacrificing quality of care.
16:38And in fact 11% of U.S. population is presently uninsured.
16:44About 1/3 of U.S. healthcare resources
16:46are deemed low value and inappropriate,
16:48it's about 1/4 globally.
16:50What that means is that we have room
16:52to improve our environmental performance
16:55without sacrificing quality of care
16:57and preserving resources to improve our access to care.
17:02I'm gonna shift gears
17:03in terms of where this information comes from.
17:06In order for us to understand
17:08where the levels of influence are,
17:10I'm gonna turn to the greenhouse gas protocol.
17:12This is from the U.K.
17:13National Health Service Net Zero report.
17:16The National Health Service in England
17:17is leading the world in its commitment
17:19to net zero emissions in health care.
17:21The virtue of the greenhouse gas protocol
17:24is it allows us to group emissions
17:26in terms of our influence
17:28so we understand the levels for change.
17:30So scope one, direct emissions are coming from a facility
17:33from burning fuel to heat the building for example,
17:37or release of inhaled anesthetic gases,
17:39so direct emissions on our scope one.
17:42Scope two is indirect coming from the supply chain.
17:45So whether or not, excuse me, is coming from electricity.
17:48So whether or not that is renewable or not
17:51affects our calculations.
17:53And scope three is everything else,
17:55most notably the supply chain and also travel.
17:58So applying that to the U.S. healthcare system,
18:02we see the most recent results
18:05are absolute emissions from health care in the U.S.,
18:08554 million metric tons
18:10or 8.5% of our nation's greenhouse gases
18:13coming just from U.S. healthcare.
18:16And emissions are on the rise.
18:19We see a slight difference in 2012
18:20with improvements of renewable energy in our system,
18:25but overall we're rising at a faster rate
18:29than other nations globally this far.
18:32And as you can see the breakdown by scopes,
18:34the vast majority of emissions are coming from scope three,
18:36which we'll come back to in a moment.
18:38The other thing that we did in the U.S.
18:39is we associated greenhouse gas
18:41and non-greenhouse gas emissions with disease burden
18:44and found that harm from health care pollution
18:46from U.S. healthcare pollution
18:48is equivalent to 388,000
18:50disability adjusted life years annually.
18:53Most of that is due to particulate matter or air pollution
18:57and both air pollution and greenhouse gas emissions
18:59come from combustion of fossil fuels.
19:01So cleaning up our energy system
19:04is one of the most important things we can do
19:06to reduce health care's impacts.
19:08And then this is similar in magnitude
19:10to deaths due to medical errors,
19:13which were first reported by this (mumbles) in 2000,
19:17the 44-98,000 deaths annually
19:20were lost due to medical errors,
19:22about 10 years of life loss for age
19:24so if you multiply by 10,
19:25you see we're in the same order of magnitude.
19:27And why that matters is that
19:29this harmful medical errors sparked
19:30the patient safety movement
19:31that everything we do in healthcare
19:33is through the lens of patient safety.
19:35And what we're trying to say is that this problem
19:36is just as big and just as serious,
19:39and that pollution prevention
19:40is a new patient safety movement
19:41that needs to be taken seriously.
19:43And so where those emissions come from
19:45in terms of levels of impact?
19:47About 4/5ths in the U.S.
19:49and this is similar in other health,
19:51this National Health (mumbles) Forfeits
19:53is coming from the supply chain.
19:55So notably, pharmaceuticals, chemicals,
19:57medical devices, and food.
19:59And these are things we have direct influence over
20:01as health care administrators and clinicians and regulators,
20:04because we determine how resources are consumed,
20:07manufacturers and regulators control what's embedded,
20:10what the emissions are that are embedded,
20:12what goes to marketplace.
20:14So this helps us to understand
20:15the different levels of influence.
20:17And ultimately the question is what is best practice
20:20both for patients and public health?
20:22And really there are three direct approaches
20:25to try and influence.
20:29One is reducing emissions embodied in healthcare service,
20:32so electrification of our buildings
20:34and our capital equipment,
20:35but they must be paired with cleaning up our energy sources.
20:39Moving to a circular economy we're using materials,
20:42reducing waste resource stewardship,
20:44which could not be more clearly needed
20:47as evidenced by the pandemic.
20:51Matching supply with the demand
20:52meaning we have to address inappropriate or low value care,
20:57care that is unwanted, unneeded, ineffective.
21:00All those things need to be addressed, and we can do it.
21:03And then reducing,
21:04moving all the way upstream to reducing
21:06the need for health care to begin with
21:08health promotion, disease prevention,
21:10addressing the social determinants of health,
21:12and certainly mitigating all those causes of climate change
21:16and ultimately value in health care, high values,
21:19maximizing the best benefits for patients and populations,
21:22minimizing costs as well as environmental and social harms.
21:25Thank you very much.
21:27<v ->Thanks, Jodi.</v>
21:40<v ->I think just share the screen.</v>
21:51<v ->Yes, everyone see?</v>
21:54Okay, great.
21:55So I'm gonna talk about indicator 2.3.2,
21:59which is air conditioning benefits and harms.
22:02I'd like to acknowledge my collaborator
22:04on this Lingzhi Chu and also the International Energy Agency
22:09for providing essential
22:11and published data for this indicator.
22:15And so let me get right to the headline finding.
22:19Use of air conditioning averted an estimated
22:22195,000 heat-related deaths
22:25among people 65 years or older in 2019, that's globally.
22:31AC however, AC also contributed to greenhouse gas emissions,
22:36air pollution, peak electricity demand,
22:39and urban heat islands.
22:42So we could see that on the one hand indoor cooling,
22:46you're represented by air conditioning
22:48provides great benefits.
22:50On the other hand there is significant harms.
22:53So I'll elaborate, but first let's look at this graph
22:58on the right-hand side.
23:01The blue is proportion of households with air conditioning.
23:05This is global.
23:06So you can see a steady rise and in 2019, it was about 33%.
23:13So a 1/3 of the households in the world
23:14have air conditioning.
23:17The green up here is carbon dioxide emissions
23:20and you can see a steady increase
23:22in carbon dioxide emissions
23:25as a result of air conditioning
23:27using more and more electricity
23:28because they're being more and more air conditioning.
23:31And in 2019, it was up to about one gigaton
23:36or a billion tons of carbon,
23:37which represents carbon dioxide,
23:39which represents about 3%
23:42of total anthropogenic CO2 emissions.
23:47Okay, so now let's take a deeper dive into some of this.
23:52Let's take a look at the bottom row first, which is world.
23:57So heat-related deaths were about 345,000.
24:01This was estimated in one of the other
24:05Lancet Countdown Indicators
24:07and note that it's just for people greater
24:10or equal to age 65 years.
24:13Heat-related deaths averted by air conditioning
24:16again was about 195,000.
24:18So what that means is that
24:20if there had been no air conditioning in the world,
24:23there would have been roughly 540,000 heat-related deaths
24:27in people over age 65,
24:29instead of the 345,000 that actually occurred
24:33and of course these are estimates.
24:37And that's with a proportion of house,
24:39overall proportion as I said is 33% with air conditioning.
24:43Let's look at a few of the countries.
24:45So first China was estimated
24:47to have 72,000 heat-related deaths
24:51and roughly the same number of heat-related deaths
24:54averted due to the presence of air conditioning.
24:57So without air conditioning,
24:59the number of heat-related deaths
25:01would have been about double.
25:03And you can see that proportion of households
25:05with air conditioning in China is fairly substantial.
25:09It's about two thirds.
25:11On the other hand, India is estimated to have
25:1646,500 heat-related deaths,
25:19but only 2,400 averted by air conditioning.
25:24And that of course is due to the small proportion
25:27of households with air conditioning in India
25:29which is about 6%.
25:32And then one more example,
25:34the United States which has a very high proportion
25:38of households with air conditioning,
25:4092% is estimated to have had about
25:4520,500 heat-related deaths,
25:49but almost 48,000 heat-related deaths averted by
25:53the presence of air conditioning meaning that
25:56if there had been no air conditioning in the United States,
25:59there would have been almost 70,000 heat-related deaths.
26:02This is all among people of age 65.
26:08So you could see that
26:09one of the points to take out of this is number one,
26:12indoor cooling is very effective,
26:14but number two, there're a lot of inequities right now.
26:17There are some countries
26:18with very low prevalence of air conditioning,
26:20others with very high prevalence
26:23and you could see how that's manifested in these numbers.
26:30So now let's go through the harms and a little more detail.
26:35Air conditioning represents 8%
26:38of global electricity consumption in 2019.
26:43I mentioned the greenhouse gas emissions, the CO2 emissions,
26:46but we also have the problem that the main refrigerants
26:51that use an air conditioning is hydrofluorocarbons
26:55and those are powerful greenhouse gases
26:57it turns out in themselves,
26:59and they often leak into the atmosphere
27:02and that's an issue.
27:04We were able to estimate 21,000 premature deaths
27:08due to PM2.5 and that's the fine particulate matter
27:12of emissions from fossil fuel powered electricity
27:16used for air conditioning in 2019, that's global.
27:22Air conditioning is a major contributor
27:24to peak electricity demand on hot days,
27:27often contributing to more than half of the demands
27:31and that contributes to power outages.
27:35And finally, it turns out that there's so much waste heat
27:39that goes from the inside to the outside
27:43as a result from using air conditioning,
27:46that it could actually contribute
27:48to the urban heat island effect
27:50as much as one degree centigrade at nighttime.
27:58So sustainable indoor cooling is urgently needed.
28:07The IEA projects that according
28:10to a business-as-usual scenario in 2050,
28:13air conditioning use will soar understandably
28:18because people in India deserve
28:20to have indoor cooling for example
28:22and there are a lot of people in India.
28:2516% of air conditioning will represent
28:2716% of global electricity consumption.
28:32It will be 2 gigatons of CO2 emissions
28:34instead of the current 1 gigaton.
28:38And in addition,
28:39we have the hydrofluoro carbon emission problem
28:42and that would represent 1-2 gigaton CO2 equivalent.
28:47So the goal we have before us
28:49is to make sustainable indoor cooling accessible
28:52to everyone in the world who needs it.
28:55So it needs to be accessible and also sustainable.
28:59And so this is an outline of a possible way forward.
29:03First, we need energy efficient building design
29:07through strong, enforced building codes.
29:10And a key element of that is to utilize lessons
29:15from traditional building designs
29:17and tropical and subtropical regions
29:19that over the period of centuries
29:21people lived in very hot climates,
29:24developed a lot of wisdom about how to build buildings
29:29that would remain cool, including by ways to provide shade,
29:34thermal mass, insulation and ventilation.
29:37And that wisdom has largely been ignored
29:41for the past few decades.
29:43So we need to return to that wisdom.
29:46We need strong weatherization programs
29:51and that's actually a justice issue too.
29:54We need low-tech solutions.
29:56Fans are often useful, also cool roofs.
30:02We need continuous strengthening
30:03of air conditioning performance standards
30:05and mandatory labeling.
30:07So for example if through technology,
30:10we could make air conditioning,
30:12several orders of magnitude more efficient,
30:15then it's not really onerous.
30:17We solve a lot of the problems.
30:19So air conditioning just because
30:21it's cold air conditioning isn't there,
30:23in its current form that has these major issues.
30:29The electricity that powers air conditioning
30:31needs to be zero-carbon electricity.
30:34We need to regulate the use
30:36and disposal of the refrigerants.
30:40There's progressing along those lines,
30:42the Montreal Protocol Kigali Amendment
30:45aims to phase out hydrofluorocarbons
30:48and so that needs to be actually implemented.
30:51We need to prevent leakage of refrigerants
30:55during air conditioning operation and maintenance.
30:58And finally, not finally, but we need to recycle
31:01or destroy refrigerants at the end of life
31:04often when air conditioners are disposed of improperly
31:09and then the refrigerants leak out into the atmosphere.
31:13And then we need to expand urban green
31:16and blue space to cool down cities
31:18so that we need less air conditioning in the first place.
31:22So with that I'll conclude and turn it over to Jeremy.
31:34<v ->Great, thanks Robert.</v>
31:36I'm gonna go ahead and try and share my screen.
31:41I think that's gonna kick yours off.
31:50<v ->Okay, good so you have yours on?</v>
31:52<v ->Yes.</v>
31:53<v ->Okay, great.</v>
31:56<v ->Excellent.</v>
32:01So I'm gonna give you a very brief overview
32:04of the U.S. policy brief for the Lancet Countdown
32:09on health and climate change.
32:14And I'm gonna start out by highlighting the goals.
32:17The goals of the global countdown are to influence
32:22global processes including the COP and so
32:25the report is released every year in advance of the COP.
32:29And the goal there
32:30is to introduce health into the conversation
32:32and it's been very successful at that over the years.
32:35The goals of the U.S. brief are related to that,
32:38but also different.
32:40And so one of our goals is to highlight trends in data
32:46from the global report that are relevant
32:48and specific to the U.S.
32:51We're also interested in promoting awareness
32:54and understanding of the intersections
32:55between climate change and health for a U.S. audience,
32:58which sometimes refracts these questions
33:02through a different set of considerations and experiences.
33:08We also are a very large country with a diverse population,
33:12and a diverse set of
33:15environmental climate sensitive hazards.
33:18And so the goal of the U.S. brief is to present findings
33:24through the lens of experience of populations in the U.S.
33:29and to highlight the very important,
33:31really fundamental considerations related to equity
33:37in these impacts for U.S. populations.
33:41Next, we are very keen on advancing collaboration
33:45within the health sector around this issue in the U.S.
33:48and that's a major goal of our effort
33:50is to organize that community.
33:52And then lastly, we wanna promote action by policy makers
33:55that is informed by the findings from the global report
33:59and the U.S. brief.
34:01So this year we produced our fifth report.
34:04It presented a suite of indicators
34:07from the global report specific to the United States,
34:10and also brought in some other scientific work
34:12that was relevant to the U.S. context.
34:15This brief represents the consensus
34:17of over 70 institutions domestically.
34:21And as I said, it brings in data from the global report.
34:26The brief this year brings in emphasis
34:31on three climate sensitive hazards
34:33that have plagued the United States in recent years;
34:38extreme heat, drought, and wildfires,
34:41and it calls for policy makers to make three commitments.
34:45One is an urgent investment in research and interventions
34:48to protect health and prioritize equity in the process.
34:51The second is to account for the health costs
34:54of fossil fuel combustion in their decision-making.
34:58And the third is to rapidly cut greenhouse gas emissions.
35:02I'm gonna go into each of those briefly,
35:04and then tell you a little bit about
35:06the report and the launch.
35:08So as Marina emphasized, we know from global data
35:15that health risks from extreme heat are growing
35:17and the trend is the same in the United States.
35:20And particularly we wanted to emphasize the impact on groups
35:24at different points in the life cycle.
35:27And this is the theme we've developed
35:28at different points in different ways over the years.
35:32The data for the U.S. shows that we continue to see
35:36a pretty dramatic rise in exposure among people over 65
35:42and among infants to extreme heat
35:46relative to this baseline here from 1986-2005.
35:52The second point is the droughts harm health.
35:58And this is something that
35:59a lot of people may not be as well aware of.
36:01And so we put some energy this year
36:05into clarifying the ways in which drought harms health
36:10and those are elaborated here in this infographic.
36:14Of course, some of the impacts
36:16are mediated through extreme heat exposure,
36:19but a number of others go through pathways
36:21that are a little more indirect,
36:22including changes in water quality,
36:24changes in infectious disease exposure
36:27and changes in infectious disease ecology
36:29associated with drought, impacts on mental health
36:32particularly in rural communities
36:33and then also respiratory disease impacts.
36:36And we also brought out the equity dimension highlighting
36:42the wide range in intensity of exposure
36:46to drought across the United States
36:48and then how drought affects different communities
36:52quite differently in its various impacts
36:57and particularly highlighting
36:58the impact on rural and farming communities.
37:02And then lastly, we focus this year on wildfires.
37:05And of course, as you all know,
37:06wildfire seasons have been very intense of late.
37:10So we collaborated with some colleagues at Emory
37:15who developed this figure showing that
37:20we're seeing earlier onset of the wildfire season,
37:23the wildfire season is becoming more intense,
37:25and that there's a clear correlation
37:27with temperature anomalies over this 20 year time series.
37:31We also emphasize in the report
37:33the fact that smoke exposure,
37:37it seems like it's a local issue
37:38and of course it is very intense locally
37:40when these fires occur mostly in the West,
37:42but that the smoke extends all the way over to you all
37:46in the Northeast and impacts
37:50your air quality quite adversely.
37:55And these impacts again
37:57are really not equitably distributed.
38:00And these communities here, Black, Latino,
38:02Latino communities, American Indian communities,
38:05and low income groups are all much more highly exposed
38:09and more adversely affected the groups.
38:13The report also developed some case studies
38:16and I don't have a chance
38:18to go into all of the specifics here,
38:20but we explored the role of climate change
38:24in increasing risk for dengue in the United States,
38:27particularly through increasing
38:29vectorial capacity and/or not.
38:33And then also throwing some analogies
38:37between the COVID pandemic energy issues
38:44and infrastructure challenges that we've seen,
38:48and then interactions with climate sensitive hazards,
38:52including extreme heat and wildfires
38:55that exacerbated the impacts
38:57of those hazards at multiple points.
39:00We experienced that definitely here
39:01in the Pacific Northwest
39:02with our extreme heat event this past summer,
39:06which was catastrophic
39:07and would have been really difficult on its own,
39:10but was that much more difficult to handle
39:13because of all of the capacity issues
39:15that we're focusing, we've experienced with COVID,
39:17and this is likely a glimpse of
39:20what we'll see in the future in terms of strain
39:22on the healthcare system driven
39:25certainly by climate sensitive hazards,
39:27but also interacting with a number of other
39:31elements of social destabilization
39:34that we're seeing in the U.S.
39:37So our policy recommendations are to focus on adaptation
39:40through research that really gets down to local levels
39:47and thinks through how to reduce exposure,
39:49how to implement effective interventions
39:51quickly and at scale, focusing on economics and finance,
39:55and do a more comprehensive accounting
39:58of the health-related costs of fossil fuels.
40:01So taking those externalities
40:02and incorporating them into decision-making, policy-making.
40:05And then lastly of course,
40:07an urgent focus on mitigation
40:09and an emphasis there on policies
40:12that will advance health equity
40:15rather than undermine it.
40:19We have a suite of additional resources
40:21in addition to our policy brief,
40:23we have executive summaries,
40:24we have briefs that are aimed at the general public
40:29both of those are in English and Spanish.
40:32We have a brief that
40:34is written specifically for health professionals,
40:36and we have a brief that focuses on the novel science
40:39that is in this year's report.
40:42We also have regional briefs that emphasize impacts
40:47for different areas of the United States.
40:50And we have a big launch event every year
40:53and it coincides with the launch of the global report
40:56and we really work hard with our partner Climate Nexus
41:01to bring in a diverse range of voices and perspectives,
41:07and to reach a large range
41:11of communities with this launch.
41:13And so you can see here we had
41:15a really nice diverse collection of speakers
41:20at this last year's event which was recorded,
41:24and you can access the recording
41:26and all of those other resources at this link here,
41:29lancetcountdownus.org.
41:32Thanks and I look forward to ongoing conversation
41:35and answering your questions later in the session.
41:39<v ->Thanks, Jeremy.</v>
41:41Okay, so last but not least is Laura Bozzi
41:45who's gonna talk about the Connecticut Report.
41:48<v ->Thank you, and I also wanna acknowledge</v>
41:54my (mumbles) about (indistinct)
41:58on the appointment I wanna talk about today.
42:02So last September the Yale Center
42:04on Climate Change and Health released
42:05the Climate Change and Health 2020 Report.
42:08I mentioned it during initial inspiration
42:10from the global Lancet Countdown (mumbles).
42:13It's one of those with the recognition
42:14that there was a gap and clear information
42:16specific to Connecticut on how climate change (mumbles).
42:21The report is based on 19 Indicators,
42:23you can see on the right,
42:24tracking changes to the environment
42:26and health outcomes.
42:27It's purpose is to inform policy makers,
42:30health professionals, advocates, and residents,
42:32about the impacts of climate change
42:34now in the future on human health in Connecticut.
42:37Wherever possible,
42:38we were printed indicator results for each county.
42:41There are eight counties in Connecticut.
42:42We talked as far back as the dataset would allow
42:45and some cases to the late 1800s.
42:48Some of our indicators
42:50do already demonstrate a trend consistent
42:52with what's expected under climate change,
42:55such as increasing the average temperature
42:57or rising number of heavy rainfall events.
43:00Other indicators don't yet show a trend,
43:02but scientific studies project such changes
43:06(indistinct).
43:10We also produced an issue for each series,
43:12three of what you see here.
43:14The issue briefs (mumbles) the 2020 reports for domains,
43:18summarizing key indicator findings,
43:20and extending the report
43:21to include specific policy requisitions.
43:27An important theme of the 2020 report
43:29and the issue briefs is recognition of climate change
43:31as an environmental justice issue.
43:34A climate change affects everyone we know
43:36but some people are hit much harder.
43:38It's often called a risk amplifier or a threat multiplier.
43:42Some people are more vulnerable than others
43:44because of where they live or work, their age or race,
43:48their health condition, their socioeconomic status.
43:51These underlying drivers of vulnerability
43:53are often tied to deep among standing inequities
43:56which are now made worse by climate change.
43:59Our issue briefs in particular elevate policy solutions
44:02that apply a justice or an equity lens in response.
44:08I'll now turn to some examples of our indicators
44:11following that they're ports for domains
44:13beginning with temperature.
44:17Annual average temperature
44:18has increased over three degrees Fahrenheit
44:20across Connecticut and in each county
44:22in the last 125 years.
44:25Over that time, six of the hottest years in Connecticut
44:28have been since 2005
44:30versus has very broad implications for health
44:33among other impacts, high heat days causing stress,
44:36heat stroke and even death.
44:38High heat days often coincide with close and alert days
44:41because high temperatures magnify those official levels.
44:45Annual winter temperatures
44:46that we're seeing now in here in Connecticut this year
44:50can create conditions for larger tick
44:52and mosquito populations that are active
44:54over a greater proportion of the year.
44:56A longer season for ragweed pollen,
44:58which causes hay fever and exacerbates asthma.
45:03And particular in heat-related illness,
45:07we tracked reported cases of heat stress in Connecticut
45:10and found that from 2007-2016 there were on average
45:14422 emergency department visits
45:16and 45 hospitalizations per year for heat stress
45:20but this is certainly an underestimate.
45:23Young adults were more likely to be admitted to the ED
45:26for heat-related illness than other age groups,
45:29but the risk of inpatient admission increases with age
45:33and is highest for those 75 and older.
45:37Heat risks can be confounded
45:38to do the urban heat island effect.
45:40As you can see on the right
45:42that cities are hotter than the surrounding area
45:45because of more manmade infrastructure that absorbs heat
45:48as well as air conditioning accepted by (mumbles).
45:52This health risk is magnified for those low financial
45:55or social resources to adapt.
45:57And importantly vulnerability factors are cumulative.
46:00Some people are associated
46:01with a number of the categories that are on the left,
46:04which puts them at people greater risk.
46:07As we look to the future,
46:10the Governor's Council on Climate Change reported five
46:14projected five degree very high increase
46:16in average temperature by 2015 in Connecticut
46:21compared to a 1978 and 1999 reference period.
46:26So we can expect more extreme heat events
46:29for them to become more common
46:30and more severe and to last longer.
46:32Importantly temperature increases after 2050
46:35depends on how quickly we stop emitting greenhouse gases.
46:38And thus the Governor's Council on Climate Change said,
46:39"Coordinated mitigation now means it is more likely
46:42"the temperatures will stabilize after 2050.
46:45"If not, warming is likely to accelerate."
46:49Moving to extreme events.
46:53We tracked national or really declared weather disasters
46:58that were issued for Connecticut
46:59and found that from 2010-2019,
47:02there were nine such disaster declarations
47:04compared to only 13 in the previous 56 years.
47:09In addition to direct health apart from weather disasters,
47:11there're important indirect effects,
47:15including disruptions that can occur
47:17to critical infrastructure, assessment of electricity,
47:20drinking water, food refrigeration, internet service,
47:24transportation is one implication of health,
47:27losing our electricity can be life-threatening
47:29for someone who uses home dialysis.
47:32There are mental health impacts from the trauma of disasters
47:36and their long-term community impacts.
47:39And the building staff and lower income communities,
47:41the doctrine that increased risk
47:42for damage by natural disasters,
47:45partly because of historic patterns
47:47of development in vulnerable areas,
47:50plus a chronic under investment in public infrastructure
47:52(indistinct).
48:00We tracked Lyme disease cases in Connecticut
48:04and found that the number of cases in the last decade or so
48:07have decreased statewide, which is good news.
48:10However, there are emerging concerns
48:13when issues we highlighted at the report
48:15is expansion of the lone star tick in Connecticut.
48:18Once a tick transmit a number of diseases
48:20and medical conditions that you can see on the slide,
48:24it's the most common human biting tick
48:25in the Southeastern U.S.
48:28It's expanding into Connecticut likely due to factors,
48:31including warming temperatures
48:33and especially warmer winters.
48:36Importantly established breeding populations
48:38were discovered in Fairfield County in 2018
48:41and New Haven County where we are today in 2019,
48:44meaning that ticks aren't transient but established here.
48:49Finally air quality.
48:52You may be aware that Connecticut has issues
48:54with ground-level ozone solutions
48:57which is a strong long year attempt.
48:59And back to the American Lung Association gave each county
49:02thinking that getting an upgrade for ozone solution
49:04in its 2019 report.
49:07And as you can see from this figure,
49:11we found that while the number
49:12of air quality alert days for ozone decreased over time,
49:17the more still needs to be done.
49:19Ground-level ozone is largely
49:21the result of burning fossil fuels,
49:23whether in our vehicles or power plants or our homes.
49:26So this is where we can see the strong health benefit
49:28of climate mitigation as other speakers have mentioned.
49:32Switching into clean energy sources also drives,
49:35also reduces fuse drivers of global air pollution.
49:40And on that note I'll conclude
49:42with our systems level recommendations
49:44that we have in our report.
49:46I invite you to read the report to learn more about those,
49:49but I'll conclude with our overarching recommendation
49:54for swift action to reduce
49:56and eliminate greenhouse gas emissions in Connecticut
49:59for our health today and for the future.
50:07<v ->Thanks Laura.</v>
50:08Think we could end it here.
50:10Thanks to all the speakers
50:12and thanks to everyone who attended and have a good day.
50:20<v ->Thank you everyone.</v>