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PERUBAHAN IKLIMDAN KESEHATAN MASYARAKAT

PERUBAHAN IKLIMDAN KESEHATAN MASYARAKAT

Apakah Iklim?Iklim adalah pola gabungan cuaca, meliputirerata, nilai ekstrim, dinamika waktu, distribusispasial dari:

• panas dan dingin• berawan dan cerah• lembab dan kering• gerimis dan hujan lebat• snowfall, snowpack, & snowmelt• puting beliung, tornado dan badai salju

Perubahan iklim berarti perubahan pola

Iklim adalah pola gabungan cuaca, meliputirerata, nilai ekstrim, dinamika waktu, distribusispasial dari:

• panas dan dingin• berawan dan cerah• lembab dan kering• gerimis dan hujan lebat• snowfall, snowpack, & snowmelt• puting beliung, tornado dan badai salju

Perubahan iklim berarti perubahan pola

(after Holdren NCES, 2008)

Definitions

CUACA – kondisiatmosfer dalamjangka pendek

IKLIM – kondisiatmosfer dalamwaktu lama (rata-rata dalam 30tahun)

CUACA – kondisiatmosfer dalamjangka pendek

IKLIM – kondisiatmosfer dalamwaktu lama (rata-rata dalam 30tahun)

3

changes in extreme events

(CCSP SAP 3.3)

5

6

7

8

Temperature Projections for 21st Century

Projected Temperature Change, 1910 –2040 Effect of Projected Greenhouse Gas and Sulphate Combined Aerosol Increases.

Canadian Model

Siapa yang rentan?Geographical space: “people who live on arid or

semi-arid lands, in low-lying coastal areas, inwater limited or flood-prone areas, or on smallislands……”

Social space: “developing countries… have lessercapacity to adapt and are more vulnerable toclimate change damages, just as they are to otherstresses. This condition is more extreme amongthe poorest people” (double-exposure).

Geographical space: “people who live on arid orsemi-arid lands, in low-lying coastal areas, inwater limited or flood-prone areas, or on smallislands……”

Social space: “developing countries… have lessercapacity to adapt and are more vulnerable toclimate change damages, just as they are to otherstresses. This condition is more extreme amongthe poorest people” (double-exposure).

Source: Olmos, “Vulnerability and Adaptation to Climate Change: Concepts, Issues, Assessment Methods”, Foundation Paper, ClimateChange Knowledge network, 2001.

Dealing with Climate Change:Mitigation and Adaptation

Climate change

ImpactsImpacts

Responses

Mitigation Adaptation

Outline

• Dampak Iklim– Panas Ekstrim– Kualitas udara: polutan dan allergen– Banjir dan kekeringan– Dampak-dampak yang lain

• Bencana menimbulkan biaya tinggi• PERAN ILMU KESEHATAN MASYARAKAT?

DAMPAK IKLIM

• Dampak Iklim– Panas Ekstrim– Kualitas udara: polutan dan allergen– Banjir dan kekeringan– Dampak-dampak yang lain

• Bencana menimbulkan biaya tinggi• PERAN ILMU KESEHATAN MASYARAKAT?

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Definitions Adaptation – efforts

to anticipate andprepare for the effectsof climatechange, and therebyto reduce theassociated healthburden

Mitigation – efforts toslow, stabilize, orreverse climatechange by reducinggreenhouse gasemissions

Adaptation – effortsto anticipate andprepare for the effectsof climatechange, and therebyto reduce theassociated healthburden

Mitigation – efforts toslow, stabilize, orreverse climatechange by reducinggreenhouse gasemissions

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Extreme Heat

Extreme heat events can cause:

Heat tetany (hyperventilation) Heat rash Heat cramps Heat exhaustion Heat edema (swelling) Heat syncope (fainting) Heat stroke Death

Extreme heat events can cause:

Heat tetany (hyperventilation) Heat rash Heat cramps Heat exhaustion Heat edema (swelling) Heat syncope (fainting) Heat stroke Death

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Extreme HeatRisk Factors

Lack of air conditioning in home Low socioeconomic status Living in urban areas Living in topmost floor of a

dwelling Living in nursing homes or being

bedridden Living alone or a lack of social or

family ties Prolonged sun exposure Drinking alcohol Exercising outside on warm days

Risk Factors

Lack of air conditioning in home Low socioeconomic status Living in urban areas Living in topmost floor of a

dwelling Living in nursing homes or being

bedridden Living alone or a lack of social or

family ties Prolonged sun exposure Drinking alcohol Exercising outside on warm days 16

Extreme HeatPOPULASI RENTAN

Everyone Elderly persons 65 years and

older Especially those who live

alone Children Persons with pre-existing

disease conditions Persons taking certain

medications Athletes Outdoor workers Homeless

POPULASI RENTAN

Everyone Elderly persons 65 years and

older Especially those who live

alone Children Persons with pre-existing

disease conditions Persons taking certain

medications Athletes Outdoor workers Homeless

17

• Higher temperatures in urbanareas relative to surroundingsuburban and rural areas can becaused by:

• Reduced vegetation and greenspace

• Heat-absorbing surfaces, suchas pavement

• Heat-reflecting surfaces,including many buildingmaterials

• Skyscrapers obstructing freeair flow

• Higher temperatures in urbanareas relative to surroundingsuburban and rural areas can becaused by:

• Reduced vegetation and greenspace

• Heat-absorbing surfaces, suchas pavement

• Heat-reflecting surfaces,including many buildingmaterials

• Skyscrapers obstructing freeair flow

18Images from the Metropolitan Design Center Image Bank.Used with permission.

Air Pollutants and Allergens

Climate change may affect exposures to airpollutants by:

Creating both more windiness and more airstagnation events

Increasing temperatures which . . .

Increase pollution from fossil fuelcombustion to meet electricity demandfor increased air conditioner use

Increase production of natural sourcesof air pollutant emissions

Increase formation of ozone

Lengthening the allergy season, creatingmore potent allergens

Climate change may affect exposures to airpollutants by:

Creating both more windiness and more airstagnation events

Increasing temperatures which . . .

Increase pollution from fossil fuelcombustion to meet electricity demandfor increased air conditioner use

Increase production of natural sourcesof air pollutant emissions

Increase formation of ozone

Lengthening the allergy season, creatingmore potent allergens

19Image from the Metropolitan Design Center Image Bank.Used with permission.


Ground-Level OzoneHealth ImpactsEffects of acute exposure:• Acute exposure to elevated

ozone can lead tohospitalization or death

Effect of long-term exposure:• Decreased lung function and

new-onset asthma• Elevated ozone can exacerbate

other conditions, such asasthma and allergies

Populations at RiskDue to increased exposure:• Healthy people, especially

athletes and outdoor workersin landscape and constructionwho may be exposed to higherlevels of ozone for longerperiods of time on highpollution days

Due to sensitivity:• Persons with respiratory and

cardiovascular diseases• Older adults and children

Effects of acute exposure:• Acute exposure to elevated

ozone can lead tohospitalization or death

Effect of long-term exposure:• Decreased lung function and

new-onset asthma• Elevated ozone can exacerbate

other conditions, such asasthma and allergies

Due to increased exposure:• Healthy people, especially

athletes and outdoor workersin landscape and constructionwho may be exposed to higherlevels of ozone for longerperiods of time on highpollution days


cardiovascular diseases• Older adults and children

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Particulate MatterHealth ImpactsEffects of acute exposure:• Short-term decrease in lung

function• Exacerbation of respiratory

and cardiovascular diseases• Hospitalization and death

Effect of long-term exposure:• Respiratory and cardiovascular

diseases• Cardiopulmonary and lung

cancer deaths

Populations at RiskDue to increased exposure:• Persons living or working in

urban areas, especially nearhigh-traffic corridors and/orstationary sources of PM (suchas factories or power plants)


cardiovascular diseases• Elderly and children• Persons with asthma and/or

allergies

Effects of acute exposure:• Short-term decrease in lung

function• Exacerbation of respiratory

and cardiovascular diseases• Hospitalization and death

Effect of long-term exposure:• Respiratory and cardiovascular

diseases• Cardiopulmonary and lung

cancer deaths

Due to increased exposure:• Persons living or working in

urban areas, especially nearhigh-traffic corridors and/orstationary sources of PM (suchas factories or power plants)


cardiovascular diseases• Elderly and children• Persons with asthma and/or

allergies21


Climate change impact onallergenic pollen:

• Increased pollen production• Longer pollen season• Increased potency of airborne

allergens• Proliferation of weedy plant

species that are knownproducers of allergenic pollen

• Introduction of new allergen-producing plant species

Climate change impact onallergenic pollen:

• Increased pollen production• Longer pollen season• Increased potency of airborne

allergens• Proliferation of weedy plant

species that are knownproducers of allergenic pollen

• Introduction of new allergen-producing plant species

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Mold growth is encouraged bymoisture:

• Increased precipitation and flooding• Increased humidity• Increase in plant growth/plant

biomass decay (leaf litter)• Improper installation or

management of air conditioningsystems can create conditions ripefor mold

Mold growth is encouraged bymoisture:

• Increased precipitation and flooding• Increased humidity• Increase in plant growth/plant

biomass decay (leaf litter)• Improper installation or

management of air conditioningsystems can create conditions ripefor mold

(Image Source: Terry Brennan, http://www.epa.gov/mold/moldcourse/imagegallery5.html)23

Flooding

Health Impacts of FLOODING

physical injuries(including drowning)allergies (mold)food and water-borneillnessesfood securitydisplacementmental health issuesinterruption ofemergency services

physical injuries(including drowning)allergies (mold)food and water-borneillnessesfood securitydisplacementmental health issuesinterruption ofemergency services

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Drought

Changing natural and social factors play a role in howdrought affects society, economy, and environment.Factors include:

• Timing of drought• Temperature• Population density and

growth• Development and

implementation of watersupply technology

• Land use patterns

• Timing of drought• Temperature• Population density and

growth• Development and

implementation of watersupply technology

• Land use patterns

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Drought

Health Impacts

• Reduced lake and wetland levelsand stream flows

• Potential concentration ofpollutants

• Decreased water supply fordrinking and agriculture

• Negative effects on soil moistureand crop progress will impactfood security

• Increased risk of wildfires

• Reduced lake and wetland levelsand stream flows

• Potential concentration ofpollutants

• Decreased water supply fordrinking and agriculture

• Negative effects on soil moistureand crop progress will impactfood security

• Increased risk of wildfires

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Other Impacts of Public Health Concern

Vectorborne Diseases

Climate changes such as warmer temperatures, increasedrainfall, longer warm season and less severe winters can impact therange and incidence of vectorborne disease. Risk is also impacted byland use, population density, and human behavior.

Black-legged ticks (“deer ticks”), which carry Lyme disease, are mostactive on warm, humid days. They are also most abundant in wooded orbrushy areas with abundant small animals and deer. If those areas areone where many people live, work, or visit for recreation, the incidenceof tick-borne disease can be high.

For more information on climate and vectorborne disease, visit:http://www.health.state.mn.us/divs/idepc/dtopics/vectorborne/climate.html

Climate changes such as warmer temperatures, increasedrainfall, longer warm season and less severe winters can impact therange and incidence of vectorborne disease. Risk is also impacted byland use, population density, and human behavior.

Black-legged ticks (“deer ticks”), which carry Lyme disease, are mostactive on warm, humid days. They are also most abundant in wooded orbrushy areas with abundant small animals and deer. If those areas areone where many people live, work, or visit for recreation, the incidenceof tick-borne disease can be high.

For more information on climate and vectorborne disease, visit:http://www.health.state.mn.us/divs/idepc/dtopics/vectorborne/climate.html

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Other Impacts of Public Health Concern

Power Outages• Demand for electricity increases in

warmer climates in order to air conditionhomes and businesses.

• Increased temperatures may reduce theefficiency of power production in facilitiesthat require water for cooling.

• Severe storms and flooding can interruptpower service through damaged anddestroyed infrastructure

• Brownouts: intentionally reduced voltagein a power supply system used for loadreduction in an emergency; may preventblack outs but can have other impacts

• Demand for electricity increases inwarmer climates in order to air conditionhomes and businesses.

• Increased temperatures may reduce theefficiency of power production in facilitiesthat require water for cooling.

• Severe storms and flooding can interruptpower service through damaged anddestroyed infrastructure

• Brownouts: intentionally reduced voltagein a power supply system used for loadreduction in an emergency; may preventblack outs but can have other impacts

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Climate Change and Public Health

ExtremePrecipitation

Extreme Heat

Air Pollutants &Allergens

Drought

Changes inEnvironment &

Habitat

Severe Storms& Flooding

Wildfire

Heat-related illness anddeath

Cardiovascular disease,stroke

Respiratory Illness

Injuries and Drowning

Vector-borne illness

Displacement

Waterborne andfoodborne illness

Stress, Mental Illness

Adaptation Measures

Climate Changes Events Health Outcomes

Mitigation Public HealthRole

Risk

Fac

tors

(pos

itive

and

neg

ativ

e)29

ExtremePrecipitation

IncreasedTemperature

IncreasedHumidity

Extreme Heat

Air Pollutants &Allergens

Drought

Changes inEnvironment &

Habitat

Severe Storms& Flooding

Wildfire

Heat-related illness anddeath

Cardiovascular disease,stroke

Respiratory Illness

Injuries and Drowning

Vector-borne illness

Displacement

Waterborne andfoodborne illness

Stress, Mental IllnessRi

sk F

acto

rs(p

ositi

ve a

nd n

egat

ive)

Public Health Strategies

Mitigation• Promote activities that reduce harmful

emissions• Active communities that make

biking, walking, and/or publictransportation safe and convenient

• Telecommuting or other workschedule alternatives that do notrequire employees to drive daily

• Reduce the production of harmful airpollutants by:

• Improving energy efficiency• Reduce energy consumption• Use alternatives to fossil fuels• Reduce combustion of fossil fuels

• Promote activities that reduce harmfulemissions

• Active communities that makebiking, walking, and/or publictransportation safe and convenient

• Telecommuting or other workschedule alternatives that do notrequire employees to drive daily

• Reduce the production of harmful airpollutants by:

• Improving energy efficiency• Reduce energy consumption• Use alternatives to fossil fuels• Reduce combustion of fossil fuels

30Images from the Metropolitan Design Center Image Bank.Used with permission.

Public Health Strategies

Adaptation• Monitoring conditions and providing useful information to the public

• Extreme heat events• Air Quality Index• Disasters

• Community and infrastructure planning• Retention ponds and wetlands increase water storage• Pervious surfaces and rain gardens increase infiltration, reducing run-

off• Increasing capacity of stormwater systems• Reduce the urban heat island effect by maintaining green space in

urban areas• Emergency Preparedness

• Robust all-hazards plans that include annexes for severestorms, extreme heat, power loss

• Identification and understanding of high-risk and vulnerablepopulations

• Monitoring conditions and providing useful information to the public• Extreme heat events• Air Quality Index• Disasters

• Community and infrastructure planning• Retention ponds and wetlands increase water storage• Pervious surfaces and rain gardens increase infiltration, reducing run-

off• Increasing capacity of stormwater systems• Reduce the urban heat island effect by maintaining green space in

urban areas• Emergency Preparedness

• Robust all-hazards plans that include annexes for severestorms, extreme heat, power loss

• Identification and understanding of high-risk and vulnerablepopulations 31

Communicating Climate Change

The Yale Project on Climate Change Communication identified six distinctAmerican audiences, each of which responds to the issue of climate change inmarkedly different ways.

Alarmed Concerned Cautious Disengaged Doubtful Dismissive

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12% 27% 25% 10% 15% 10%

Highest belief in climate changeMost concernedMost motivated

Lowest belief in climate changeLeast concernedLeast motivated


12% 27% 25% 10% 15% 10%


34

• Completely convincedthat climate change isreal

• Believe that people arealready being harmed byclimate change

• Supportive of personaland policy action

• Believe that climatechange is real

• Feel that dangerousimpacts of climate changewill be seen in 10 years

• Supportive of personaland policy action

• Unsure whether climatechange is occurring

• Believe the impacts ofclimate change will beseen in 25 years

• Do not believe personalactions or the actions ofa single nation will makeany difference


12% 27% 10% 15% 10%


25%

35

• Less convinced thatclimate change ishappening

• Believe that impacts ofclimate change will be feltin 50 years

• Do not feel thatimmediate action isneeded

• Unconcerned aboutwhether or not climatechange is occurring

• Believe the impacts ofclimate change will befelt in 100 years

• Do not feel thatimmediate action isneeded

• The only segment that iscompletely unconcernedabout climate changebecause they do notbelieve it is happening


• Frame climate change as ahuman health issue

• Localize climate change

• Emphasize the health co-benefits associated withclimate change action

Communications Strategies

• Frame climate change as ahuman health issue

• Localize climate change

• Emphasize the health co-benefits associated withclimate change action

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1997,” Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention. Available online:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4921a3.htm.

Amann, Swart, Raes, Tuinstra. 2004. A good climate for clean air: linkages between climate change and air pollution. Climatic Change 66: 263–269.Anderson GB and Bell ML (2011), “Heat waves in the United States: Mortality risk during heat waves and effect modification by heat wave characteristics

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http://www.cdph.ca.gov/programs/CCDPHP/Documents/CA_Public_Health_Adaptation_Strategies_final.pdfCenters for Disease Control and Prevention (CDC) (2009), “Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety,” Available

online: http://www.bt.cdc.gov/disasters/extremeheat/heat_guide.aspCenters for Disease Control and Prevention (CDC). 2012. Climate and Health, Aero-allergens (website). Accessed May 8, 2012:

http://www.cdc.gov/climatechange/effects/allergens.htmCenters for Disease Control and Prevention, US Environmental Protection Agency, National Oceanic and Atmospheric Agency, and America Water Works

Association. 2010. "When Every Drop Counts: Protecting Public Health During Drought Conditions-- A Guide for Public HealthProfessionals." Atlanta, US Department of Health and Human Services.

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http://files.dnr.state.mn.us/publications/waters/mn_water_supply.pdf___________. 2011a. Drought. Available online: http://www.dnr.state.mn.us/climate/drought/index.html___________. 2011b. Lake Level Minnesota. Available online: http://www.dnr.state.mn.us/climate/waterlevels/lakes/ index.htmlEbi KL, Balbus J, Kinney PL, Lipp E, Mills D, O’Neill MS, and Wilson M. 2008. Effects of global change on human health. In: Analyses of the Effects of Global

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Galatowitsch S, Frelich L, and Phillips-Mao L (2009), “Regional Climate Change Adaptation Strategies for Biodiversity Conservation in a MidcontinentalRegion of North America,” Biological Conservation 142: 2012–2022.

Adcock MP, Bines WH, Smith FW (2000), “Heat-Related Illnesses, Deaths, and Risk Factors – Cincinnati and Dayton, Ohio, 1999, and United States, 1979-1997,” Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention. Available online:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4921a3.htm.

Amann, Swart, Raes, Tuinstra. 2004. A good climate for clean air: linkages between climate change and air pollution. Climatic Change 66: 263–269.Anderson GB and Bell ML (2011), “Heat waves in the United States: Mortality risk during heat waves and effect modification by heat wave characteristics

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effects in the United States. Environmental Health Perspectives Vol 109, Supplement 2, pp 199-209.California Department of Public Health. 2008. Public Health Climate Change Adaptation Strategy for California. Available online:

http://www.cdph.ca.gov/programs/CCDPHP/Documents/CA_Public_Health_Adaptation_Strategies_final.pdfCenters for Disease Control and Prevention (CDC) (2009), “Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety,” Available

online: http://www.bt.cdc.gov/disasters/extremeheat/heat_guide.aspCenters for Disease Control and Prevention (CDC). 2012. Climate and Health, Aero-allergens (website). Accessed May 8, 2012:

http://www.cdc.gov/climatechange/effects/allergens.htmCenters for Disease Control and Prevention, US Environmental Protection Agency, National Oceanic and Atmospheric Agency, and America Water Works

Association. 2010. "When Every Drop Counts: Protecting Public Health During Drought Conditions-- A Guide for Public HealthProfessionals." Atlanta, US Department of Health and Human Services.

Clean Air Taskforce. 2010. The Toll from Coal: An Updated Assessment of Death and Disease from America’s Dirtiest Energy Source.Available online: http://www.catf.us/resources/publications/files/The_Toll_from_Coal.pdf

Climate Change Science Program (CCSP). 2008. Analyses of the effects of global change on human health and welfare and human systems. A Report bythe U.S. Climate Change Science Program and the Subcommittee on Global Change Research. [Gamble JL (ed.), Ebi KL, Sussman FG,Wilbanks TJ, (Authors)]. U.S. Environmental Protection Agency, Washington, DC, USA.

Governor Dayton, M. 2012. Individual Assistance request to President Barak Obama. July 19, 2012.Department of Natural Resources (DNR). 2000. Minnesota’s Water Supply: Natural Conditions and Human Impacts. Available online:

http://files.dnr.state.mn.us/publications/waters/mn_water_supply.pdf___________. 2011a. Drought. Available online: http://www.dnr.state.mn.us/climate/drought/index.html___________. 2011b. Lake Level Minnesota. Available online: http://www.dnr.state.mn.us/climate/waterlevels/lakes/ index.htmlEbi KL, Balbus J, Kinney PL, Lipp E, Mills D, O’Neill MS, and Wilson M. 2008. Effects of global change on human health. In: Analyses of the Effects of Global

Change on Human Health and Welfare and Human Systems [Gamble JL (ed.), Ebi KL, Sussman FG, and Wilbanks TJ (authors)]. Synthesisand Assessment Product 4.6. U.S. Environmental Protection Agency, Washington, DC, pp. 39-87.

Federal Emergency Management Agency (FEMA). 2012). Floods. Available online: http://www.ready.gov/floodsFrumkin et. al, 2008. Framing Public Health Matters, Climate Change: the Public Health Response, Howard Frumkin, MD, DRPH, Jeremy Hess, MD, MPH,

George Luber, PhD, Josephine Malilay, PhD, MPH, and Michael McGeehin, PhD, MSPH, American Journal of Public Health, March 2008,Vol. 98, No. 3, pp 435-445.

Galatowitsch S, Frelich L, and Phillips-Mao L (2009), “Regional Climate Change Adaptation Strategies for Biodiversity Conservation in a MidcontinentalRegion of North America,” Biological Conservation 142: 2012–2022.

37

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http://www.drought.unl.edu/portals/0/docs/DRC_Guide.pdf

Horstmeyer, SL. 2008. Relative humidity . . . Relative to what? The dew point temperature . . . a better approach. Available online:http://www.shorstmeyer.com/wxfaqs/humidity/humidity.html

Jacob DJ, Winner DA. 2009. Effect of climate change on air quality. Atmospheric Environment ,Vol 34, pp. 51-63.Kessler R. 2011. Stormwater Strategies: Cities prepare aging infrastructure for climate change. Environmental Health Perspectives. Vol 119, Num 12.Knowlton K, Rotkin-Ellman M, Geballe L, Max W, Solomon GM. 2011. “Six Climate Change-Related Events in The United States Accounted for About $14

Billion in Lost Lives and Health Costs.” Health Affairs, Vol 30, No. 11, pp. 2167-76.Kovats RS and Hajat S (2008), “Heat stress and public health: a critical review,” Annu Rev Public Health; 29:41-55.Kundzewicz ZW, Mata LJ, Arnell NW, Döll P, Kabat P, Jiménez B, Miller KA, Oki T, Sen Z and Shiklomanov IA. 2007. Freshwater resources and their

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