The withdrawal by President Donald Trump from the Paris Agreement of the Conference of Parties on climate change poses a significant risk to the health of all Americans.
The agreement was carefully crafted, negotiated and signed by 200 countries that recognize the serious impact of climate change on the Earth and its inhabitants. It provides an essential framework for countries to develop technology, infrastructure and an economic model to transition from dependence on fossil fuels to renewable and environmentally clean energy.
The medical community is witness to the health effects of climate change now and not in some distant future. There are five categories of health effects that will affect not thousands but millions of people in America and around the world.
An increase in global temperature and frequency of heat waves will expose people to a risk of heat exhaustion (dehydration, headaches, weakness, nausea and vomiting) and/or heat stroke (high fever, stroke, confusion and coma). The most vulnerable will include the elderly, with multiple heart, lung and kidney conditions, multiple medications and a poorer ability to regulate their body temperature.
Children will be at risk due to their inability to thermo regulate, as will laborers who work outdoors and the homeless. History tells us that there have been 7,400 annual deaths between 1999-2010 in the United States, 15,000 deaths in France in 2009, 70,000 deaths in Europe in 2003 and 15,000 deaths in Russia in 2010 from heat waves. By 2081 Chicago will experience 2,000 deaths per year, and in 200 U.S cities there will be 11,000 deaths per year by 2030.
Respiratory effects from particulate matter and ozone result in exacerbation of asthma and other chronic lung conditions. The primary sources are automobiles, power plants and forest fires. At present, 43 million people in the United States and 92 percent of the world live in areas in excess of the World Health Organization limit and in 2015 there were 7 million deaths attributable to air pollution.
Fifty-five percent of the U.S. population tests positive for allergens and 34 million people have asthma. The increased length of the pollen season and growth of allergen- producing weeds, grasses, mold and fungus will lead to more exacerbations of asthma and chronic lung conditions at an annual cost of $56 billion per year with visits to the emergency room and hospital admissions.
Exposure to infectious disease from vectors such as mosquitoes and ticks has and will continue to escalate. There is a documented increase in cases of dengue, chikungunya, West Nile virus and Zika. With global warming, we will likely see a resurgence of malaria in certain areas of North America. The increased incidence of Lyme disease, anaplasma and babesia infection is already well-known to people in the Northeast and other areas of the United States.
An increase in heavy downpours and flooding in America and the world has and will lead to an increase in waterborne diseases such as E. Coli and other bacteria (salmonella, typhoid and cholera), parasites (Giardia) and viruses (Hepatitis A and Norwalk) with an impact on millions of people around the world.
Food security is at risk with rising carbon-dioxide levels from climate change affecting the quality (a decrease in nutritional value), distribution and safety of food. There will be a decrease in food production by 2 percent per year from drought and flooding in the face of a 14 percent-per-year increase in demand worldwide.
We know that extreme weather events lead to an increased incidence of stress, anxiety and depression. Hurricane Katrina led to 32 percent of affected people suffering from post-traumatic stress. In addition, 32 million people in the world migrated from their homes in 2015. Projections are that water, food and failure to mitigate against climate change will be the leading cause of mass migration in the United States and around the world.
We know that there will need to be a global effort to reduce anthropogenic greenhouse gas emissions and the developed countries need to take a leading role in developing/implementing and monitoring the success of mitigation measures. Further, the health benefits are substantial and risk of inaction will result in serious health consequences for Americans and people around the world.
We need to re-enter the Paris agreement and move forward at the local and state levels for the benefit or our patients.
Dr. Nitin S. Damle is a senior partner at South County Internal Medicine and a clinical assistant professor of medicine at the Warren Alpert Medical School of Brown University.
