Countermeasures Season 3 Episode 6 Transcript: Impact of Climate Change on Health

[00:00:02] Narrator Globalization, geopolitical conflicts, climate change and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses and more, we’ll explore what it means to protect public health, and how preparedness today can lead to a safer tomorrow. Throughout this season, we’ve spoken with experts from around the world about a wide range of public health threats, from vector-borne diseases and zoonotic spillover to biothreats and orthopoxviruses. Across all these challenges, a larger overarching threat looms, one that has the power to intensify nearly every threat we’ve discussed, global warming and its effects on our climate system. The effects of climate change touch communities around the world. In this episode, we look at how climate change is shaping public health today and how it will continue to test our health systems in years ahead and what we can do to be prepared. Kristie L. Ebi, PhD, MPH, is a professor of global health at the University of Washington. She has been conducting research and practice on the health risks of climate variability and change for more than 30 years. Kristie provides an overview of all the ways that climate change will affect the globe over the coming decades, such as rising temperatures and increased levels of CO2.

[00:01:44] Kristie L. Ebi Going to be characterized by some major challenges, because of climate change, because of biodiversity loss. One of them is food security. That comes from two major sets of changes. One is increasing temperature, changing precipitation patterns because of climate change. That is looking in vulnerable parts of the world, parts of sub-Saharan Africa, parts of Asia. Many crops are growing on the thermal edge of their tolerance. The second part of that is also worker productivity. That is as temperatures go up, there’s many places where it’s extremely hot, and particularly if there’s humidity. And it’s difficult for outdoor workers to be as productive. There’s estimates of how much worker productivity could be reduced under different amounts of climate change. And all of them are significant and will affect the places, of course, they have challenges today. The second major category is from carbon dioxide itself. Carbon dioxide affects our plants. And under those conditions, the protein content of wheat and rice goes down about 10 percent, B vitamins go down about 30 percent, and through another mechanism, the micronutrient content declines as well. I didn’t look at the latest numbers from the Food and Agriculture Organization, but I think it’s around 700 million people in the world are food insecure, about two billion have micronutrient deficiencies. So any decline in these micronutrients puts a lot more people at risk. When speaking of micronutrients, you can think, for example, of iron. About 1.5 billion women and girls are affected by iron deficiency anemia around the world, including in high-income countries. So large interactions with carbon dioxide and what that means for food security, and then on top of it, changes in crop yields. All projections indicate that as we go into the century, food security is going to be a major challenge, particularly around tropical regions, but it’s going to be affecting all regions.

[00:04:08] Narrator Eloise Todd is the executive director and founder of Resilience Action Network International, a network of over 400 organizations from all around the world dedicated to working on health and pandemics, climate finance, and biosecurity. Eloise also outlines some of the challenges we are facing, such as desertification and the process of land becoming unsuitable for agricultural uses.

[00:04:31] Eloise Todd  The impact of climate change on health is better understood now than it was before. And it’s good news that there is more recognition of the health impacts of climate change. What there needs to be is a much bigger focus on the impact of the climate change on health systems. We did some work a few years ago to show what the impact of climate on pandemic preparedness and pandemic response would be. And just very simple things that were not taken into account, such as 16 percent of hospitals are near to areas that would be overtaken by rising sea levels. So when we’re thinking about how to make health systems more resilient, there’s the perhaps obvious pieces such as, let’s make them carbon neutral, let’s think about the disease threats that are going to break out. But there are so many more challenges to think about with pandemics and climate and that intersection. And we know that there are different diseases that are going to come through. Zoonotic spillover is going to get, become more and more frequent. And with desertification and the proximity of humans to animals, that’s going to mean that there are more chances to get that crossover of diseases from animals to humans, which is where 75 percent of pandemics come from. So there really is this interconnection as the temperatures rise, disease is more likely, there’s more zoonotic spillover, there’s more destruction of natural habitats and the cycle goes on.

[00:06:13] Narrator As Kristie and Eloise have outlined, the intersection of climate change with other health challenges is both broad and complex, and as our understanding deepens, one issue is emerging as an especially urgent concern, heat.

[00:06:27] Kristie L. Ebi Almost everywhere in the world has been affected by heat waves recently, and they affect us strongly. It depends on our underlying physiology. It depends on our activities, but ultimately what we’re concerned about is our core body temperature. Our core body needs to stay within a pretty narrow range to protect our cells and our organs. When we go throughout our day, our core body temperature goes up and down. We’re more physically active, our core body temperature goes up. We relax, we find a shady place, our core temperature comes down. But over hours, if we have a higher core body temperature and that heat continues to build up, it does then start affecting our organs. We know from studies of heat waves that about half of the excess deaths in a heat wave are from cardiovascular causes. This indicates our heart is pretty sensitive to those higher temperatures. We also know from the extensive studies of heat waves that almost all heat-related deaths are preventable. And there’s a big focus on trying to prevent all of these adverse deaths, all of the hospitalizations that result from heat waves. There are well-known, particularly vulnerable groups, children, adults over the age of 65, outdoor workers, of course, people who engage in sports during periods that are quite warm. There are other vulnerable groups. We can think of, for example, pregnant women. There’s lots of research showing that pregnant women exposed to high temperatures during pregnancy more often have low birth weight babies. And that can have lifelong consequences for the baby. People who have chronic diseases, that would make them more susceptible to higher temperature, people who take certain prescription drugs that reduce the ability of the body to sweat. As you can see, it’s a very long list of people. And those are just the physiological characteristics.

[00:08:47] Narrator Melissa Furlong, Ph.D., is an environmental epidemiologist who studies the chronic health effects of environmental contaminants that result from extreme heat.

[00:08:58] Melissa Furlong There are different risks associated with heat waves and with wildfires, but if we’re thinking about populations that are uniquely at risk for heat waves, we have to consider the unhoused people who might live in their homes but either don’t have access to regular air conditioning or are unwilling to use their air conditioning for cost purposes. And again, populations that spend a lot of time outside. So either people who have to spend a lot of time walking to work or working outdoors, or just walking outside. So those people are at highest risk from heat waves. And then when we’re thinking about wildfires, so anybody who lives in an area where that isn’t generally affected by wildfires, those people are going to be at higher risk and in populations that have some health susceptibilities, right? Like obviously if you have asthma or respiratory problems, then you’ll be at increased risk from wildfire smoke, but also pregnant women and the elderly are at uniquely high risks from wild fire smoke exposure. And so there’s been some evidence that has been produced over the last 10 years that shows that women who have exposure to more heat waves during pregnancy that they are more likely to have babies who are born pre-term. So that means before 37 weeks of gestation, which could submit risk for lots of other health conditions. And also, they’re more likely to be born with low birth weight, which again is associated with several different health conditions in childhood and throughout life. And heat waves probably are also associated with several different other health outcomes for the baby, for the infant, and for the child.

[00:10:46] Narrator  Cities and communities are beginning to develop heat action plans in order to address this growing threat. Kristie details some strategies she has seen implemented.

[00:10:58] Kristie L. Ebi There is something called the urban heat island, which basically says that urban areas are hotter than the surrounding rural areas because of what our cities are built from. The materials, the asphalt, the cement absorb heat during the day, they release it slowly at night. And so urban areas can be many, many degrees warmer than the surrounding rural areas. On top of that, if people have window air conditioners, for example, those dump heat into the environment. And so looking at all of the ways that our urban environment can be modified to make it more comfortable in a warmer climate. Tree planting programs, having access to blue spaces, of thinking about the different kinds of structures, the different kinds of building materials, the different kinds of orientation of buildings. They’re not directly facing the sun, for example. There’s a long list of urban design elements that can be put in place. And the sooner that communities start thinking about this, the more they can put it into their regular planning, that this is not an extra expense that has to be paid today, but this is, oh, we’re going to be doing X. And so let’s build these actions into that, into our planning. I personally live in Seattle. Seattle is a sea of cranes. There’s constantly building. And so there’s lots of opportunity to think about how to structure our urban environment, which then of course will reduce the overall risks combined with a heat wave early warning and response system can really make a difference.

[00:12:47] Narrator Wildfires present another concern.

[00:12:49] Kristie L. Ebi There is robust evidence that wildfire smoke is much more toxic than what comes out of tailpipes. And so don’t use the same scales that people use for whether air quality is acceptable or not. If it’s wildfire smoke, it’s three to 10 times more toxic. And so to take that into account for trying to protect people who’ve got any kind of lung condition, anybody who’s vulnerable to those high concentrations of wildfire smoke. One of the many increasing challenges for health systems is, of course, that hazards are not appearing one at a time and to prepare for what we call compounding and cascading risks. Pacific Northwest, lots of heat waves, lots of wildfires, they of course happen basically around the same time that the wildfires start when it’s particularly hot. And how to approach then addressing these multiple simultaneous challenges.

[00:13:57] Melissa Furlong So firefighters are obviously at increased health risk from wildfires just because they are the frontline responders. Most of what I do about with firefighters is on municipal fire exposures, so structural rates of, like, in town, but, and then a little bit on wildland. So we know that firefighters are at increased risk for several different types of cancers. The International Agency for Research on Cancer actually, designated the occupation of firefighting as a class 1 carcinogen in 2022, but we don’t know the specific exposures that are contributing and we don’t know the biological mechanisms and we also don’t know, like, what we have an idea of what firefighters can do to protect themselves, but they don’t have a comprehensive picture of how firefighters can protect themselves. But part of the issue with wildland firefighting is that it’s really difficult. Very hard. It’s also very different from municipal firefighting, structural firefighting. And PPE is not routinely used in wildland firefighting so the firefighters are exposed to very high levels of heat and really high levels of air pollution and wildfire smoke during the wildland fire. And the other thing about wildland fires is that they often go on for weeks at a time. So, like, for a municipal fire, a structural fire, right, you know, the firefighter goes and it’s out maybe in a couple of hours. But for the wildland fires, the firefighters are out basically camping out for weeks fighting these wildfires. And so we have really high levels of exposure.

[00:15:32] Narrator While immediate threats like heat and wildfires are near-term concerns, it’s important that potential long-term effects of climate change are also considered and planned for.

[00:15:42] Eloise Todd  How should we be planning our health systems? What do truly resilient supply chains look like? Where should we even be building primary health care facilities, factories? Where will the workers be living in 10, 20 years because of climate change and some of the inevitable migratory effects that happen? What will happen with food systems and what does that mean for populations’ urbanization? The subject is fascinating. It’s also a glimpse into the future that people sometimes feel uncomfortable looking at. But if we really want to plan and understand how we’re going to deliver the kind of countermeasures we need and the kind of preventive measures we need in order to tackle the threats that are coming down the line, we need to have an honest look at where the science is taking us and plan around that. When it comes to climate and health and climate resilient health systems, there has been a decent amount of talk around the issue, but it has tended to land on very specific, tangible outcomes. Everybody likes to have a manageable goal as something that they feel is achievable, to say, oh, well, there’s one slice of the problem and here’s how we can tackle it. And that’s also quite something that governments want to do. It’s something that businesses want to do and also philanthropy. But because of where we are with climate change, it’s really important that we do look at the whole picture systemically. And I think there’s a changing appetite and a changing readiness to want to look at that and be ready to look at that, but it’s taken quite a lot of hard work to get people there.

[00:17:29] Narrator Eloise notes just how important it is that this is a global effort.

[00:17:33] Eloise Todd  The challenge with that is that it mainly focused on high income countries around the world. And so we need that kind of effort when we look at low-middle-income countries as well, and to see if they can implement technologies that leapfrog some of the things that were put into place in high income countries and sort of get to where we need to be more quickly. Low-middle-income countries are certainly much more at risk from climate change. Many of them are in a much hotter zone, not all of them, but many, which means they will have very harsh conditions to deal with as the temperatures rise. Many countries are starting from health systems that are quite rudimentary and need to have a lot more investment. However, that also means there’s a big opportunity, an opportunity to work with communities to deliver the kind of services in a community way that will have more buy-in from local populations. So there’s a mutual learning curve between people trying to deliver services and also those on the ground. There’s also the opportunity to leapfrog technologies and really get to where we need to be a lot more quickly.

[00:18:55] Narrator While there are many issues requiring a unified approach, Kristie, who has worked in the field for decades, highlights where things are moving in the right direction.

[00:19:04] Kristie L. Ebi I’m in the privileged situation of having worked on climate change and health for several decades. I started at a time when there was very, very few people in the field. A good colleague likes to say that in the beginning we all could have met in a phone booth. It is an exaggeration, but it’s not as much of one as it should be. And what really gives me hope is how many people are now paying attention. The young people are really interested in climate change in general more are coming into climate change and health. They understand the risks. They really want to make a difference. That increased awareness, that increased engagement means that there is a momentum to move forward and ensuring we do increase resilience to a changing climate because we have people who are energetic, enthusiastic. And as young people always are, and they hate being called young people, but as they engage in their careers, they are committed to moving the situation from where we are today to a future that is more resilient and more sustainable. And that gives me a lot of hope.

[00:20:26] Eloise Todd  When we talk about sustainable and resilient health systems, we just have to think back to the COVID pandemic to understand how important community relationships and information and the right information and trusted sources are. This was a challenge that faced people everywhere from the UK, where I grew up, to different countries across Africa, all around the world, every single corner of the world. We know certain things for sure. We know that people trust their peers, their trusted community figures, their leaders. You trust your good friends. This is universal. These rules are universal. And so in order to tap into those networks, it’s so important that the local authorities, the governments, the civil society organizations, the people that want to make change happen, everybody’s on the same page. There’s a networked approach to getting the right information, to understanding what the right information is, that it’s verified, and then everybody can walk forward together, spreading the right information and also doing enough in advance to kind of form an inoculation, if you pardon the pun. The disinformation if and when it comes. At Resilience Action Network International we believe there is a lot of work to do still to define what it will take to build truly resilient climate resilient health systems across low- and middle-income countries and also frankly across the whole world. While we salute the initiatives that exist already and are ongoing, we truly believe that there needs to be a much more wholesale, holistic approach to this issue, where we’re willing to say, what is it going to take to design a system that is flexible and agile enough, that responds to where people will be living, that will respond to where people will able to inhabit, and what kinds of diseases and challenges that they will face in the future. So we’re not just designing for now, for the mid-20s, but we’re designing for 2030, 2040, 2050. And we need to take that leap, and that’s the piece that we think is vital.

[00:23:03] Narrator As we’ve heard throughout this episode, climate change touches every corner of public health, from the immediate dangers of health and wildfire smoke to long-term pressures on food security, health systems, and communities around the world. But we’ve also heard something else, a growing sense of momentum towards solutions that could help turn the tide on the climate crisis. As Kristie reminds us, only a few decades ago, the field of climate and health was so small it could fit in a phone booth. Today is filled with researchers, practitioners, young professionals and community leaders who understand the risks and are determined to build a more resilient future. That energy and commitment is a powerful source of hope. And as Eloise emphasizes, building climate-resistant health systems will require a holistic global effort, one that looks decades ahead, strengthens community trust, and treats resilience not as a cost, but as an investment in our collective future. Climate change is reshaping the world we live in, but with attention, innovation, flexibility, and collaboration, we can shape how our health systems respond. Thank you for joining us for this episode and for this season, as we’ve explored the threats and opportunities shaping global health today. The views and opinions expressed by the guests are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates. Guests are not representatives or spokespersons for Emergent BioSolutions, and their appearance on this podcast is not an endorsement.