PUBLIC HEALTH

Introduction

If the global temperature continues to increase; elderly folks, young children, pregnant women, homeless individuals and outdoor workers will be significantly impacted. These people groups and others are projected to experience complications such as heat stroke, respiratory and cardiovascular diseases. According to the CDC, an increase in temperature will cause air quality to decrease and an increase in air pollutants which is expected to exacerbate asthma in those who already have it and an increase in asthma and respiratory patients. The most concerning consequence from an increase in global temperature is an escalation of danger days. The Scientific American Journal defines danger days as “days where the heat index is over 105℉”. Without intervention, we can expect about ⅓ of the U.S population to experience at least 20 danger days annually by 2030. Scientists

expect that the southern states will be impacted by the largest increase in danger days. For example, Charleston, West Virginia is expected to have over 168 danger days annually by 2050. But, we can expect to see northeastern states such as New York, Maine, and Michigan, who rarely report danger days, experience over 60 danger days annually by 2050.

As hot danger days increase, the amount of time and number of regions where species of mosquitoes can reproduce lengthens. African highlands usually have low temperatures which restricts mosquitoes, many of which carry vector-borne diseases. These vector-borne diseases include malaria, lymphatic filariasis and O’nyong’nyong fever, with the most dangerous being malaria. Malaria is caused by the Plasmodium falciparum parasite and carried by Anopheles species mosquitoes. Malaria mainly affects subtropical areas since the weather conditions of those areas allow for disease transmission to humans year-round. However, in an article by Afrane, et al., they state that “Global climate warming may render suitable the high-altitude areas previously unsuitable for proliferation of the mosquito vector population,” The greater the mosquito population, the greater the chance that those mosquitoes will carry vector-borne diseases like malaria.

Malaria can present in different ways ranging from mild to fatal symptoms. Uncomplicated malaria presents in a variety of symptoms including fever, chills, nausea, vomiting and body aches. While uncomplicated malaria has more flu-like symptoms, severe malaria can be deadly and is treated like a medical emergency. Severe malaria symptoms include seizures, coma, severe anemia, metabolic acidosis, hypoglycemia and organ failure. Depending on the specific type of Plasmodium parasite an individual is infected with, they can experience recurrent bouts of symptoms months to years after the initial infection.

Currently, the United States does not have many malaria cases and the cases that do come up are usually imported from other countries. Economic development has contributed to the elimination of malaria from the United State but the temperate climate of the United States also plays a big role. However, our climate may not be as much of a protector as it has been in the past. The United States has Anopheles mosquitoes, the species that can transmit malaria, so the possibility of malaria being reintroduced into America is always a possibility. The more Anopheles mosquitoes present in the United States, the greater the probability that some of them will transmit malaria. In a University of Michigan press release, they stated that by using a mathematical model, they “showed that an increase in temperature can lead to a much larger increase in the abundance of mosquitoes. And because mosquito abundance is generally quite low in these highland regions, any increase in abundance can be an important factor in transmission of the disease,”. As temperate climates are getting warmer, mosquitoes are staying in highland regions for a longer time, leading to an increase in mosquitoes, some of which can transmit malaria to humans.

Policy Innovations: EuroHEAT

With an increase of Danger Days expected in the United States by 2050, it is essential that there is a proper response system enacted by the federal government to eliminate the health hazards and potential increased mortality rates associated with these Danger Days.

EuroHEAT is an example of a responsive European Union action plan which implements Heat Health Warning Systems to mitigate the effects of heat on the population. Action plans such as EuroHEAT outline the specific roles of medical staff, government employees, caregivers, etc. in properly responding to Danger Day heat levels. France has a widespread distribution mechanism to alert the public on days of high heat, designated public shelters that are cooled, and has backup generators for hospitals and care facilities to protect at risk individuals. This tiered response system makes it possible to prevent the catastrophe and high mortality rates that resulted in the 2003 and 2011 heat waves across Europe. The United States currently has the EPA Heat Preparedness Guide that lays the groundwork for additional readiness measures for high heat days in the United States, however would greatly benefit from a similar tiered system.
PETA, the Pan-European Thermal Atlas: renewable energy index is an interactive map that indicates areas of high heat demand, and illustrates the development of heat islands associated with large cities. Cities of high heat potential are also at higher risk for an increased number of Danger Days, and heat induced health hazards.
To eliminate high heat outputs from cities, federal and local governments have incentivized renewable energy solutions that decrease the overall heat potential of a given area. To promote transfer to renewables, PETA, the Pan-European Thermal Atlas also layers areas with the highest renewable energy potential. The establishment of a similar tool for the United States could provide energy suppliers and interested parties with a vital resource to move away from coal and other energy sources resulting in high localized heat, that causes adverse health effects on populations.

Many states already implement Renewable Electricity Standards (RES) which encourage sustainable long term renewable energy solutions. Twenty nine states implement these standards in full and eight have voluntary goals that are typically greater than 20%. Several countries are leading renewable energy initiatives and incentives through research and development, expansion and implementation of renewable technologies.
Despite being one of the world’s largest polluters, the People’s Republic of China has made great investments into renewable energies evident by: enacting Renewable Energy Laws, developing the Renewable Energy Industry Development Guidance Catalogue, and creating long term plans and initiatives for their Environmental Protection Industry. These policies and guidelines have aided in the reduction of significant air quality related health diseases among the Chinese population. Similar investments by the United States in renewables would aid in increasing the health and well being of individuals, specifically in cities, where there is an increased development of long term diseases among youth.

Policy Innovation: Ahmedabad Study

The Ahmedabad Heat and Climate Study

The Ahmedabad Heat and Climate Study is important for the U.S.
Heat is a major problem because it kills ten times more people in the U.S. than tornados or other extreme weather events
There are seven overlapping phases of the project, which could easily be adapted to take place in a metropolitan U.S. city
- 1st phase: a planning and conceptual model was developed in which goals and objectives were clarified
  - This led to the development of a conceptual logic model for the activity and its implementation and evaluation
  - Occurred because of facilitated face-to-face meetings with team members and local partners, constituent representatives, and international experts
  - The goal was to integrate the best evidence regarding public health preparedness for extreme heat with local needs and programming preferences
  - Included a two-day kick-off workshop involving over 401 public health experts, scientists, policy makers, government officials and local stakeholders from India and the US
  - The findings from this meeting were summarized in a meeting report
- 2nd phase: focused on needs assessment with key constituencies, communities, and organizations
  - Characterization of population vulnerability to heat in Ahmedabad
  - Evaluation of the impact of the 2010 heat wave on morbidity and mortality generally among specific populations
  - Assessment of the health sector’s capacity to respond to extreme heat
  - Characterization of the appropriate thresholds for early-warning and other interventions designed to reduce health impacts from extreme heat exposure
  - All assessments were done at the same time
  - Supplemented with other qualitative work
- 3rd phase: baseline data collection
  - Mortality records from the registrar of births and deaths at the Ahmedabad Municipal Corporation
  - Outpatient and inpatient attendance from city hospitals
  - Temperature data for several decades
  - Emergency ambulance calls for the past six years
  - Heat vulnerability surveys with slum communities and outdoor workers
- 4th phase: focused on coalition building and outreach in anticipation of intervention and evaluation activities
  - The group drafted a list of key community and other contacts and initiated a systematic outreach effort
  - Outreach took place in person, via electronic communications and social media, and through workshops
- 5th phase: focused on intervention development across a range of settings
  - Medical officer training
  - Enhanced interagency cooperation
  - Two interventions are central to the early warning system effort
    - The 2013 Heat Action Plan (HAP)
      - Developed as an administrative tool that would define different levels of heat emergency for the city and clarify activities among the plan participants for each level
      - Developed to incorporate the best practices from other plans and to incorporate a robust community outreach campaign
    - Extreme Heat Early Warning System based on probabilistic weather forecasting
      - Issues forecasts of extreme heat a little over a day in advance
      - The pilot forecasts were generated through an innovative hybrid dynamical-statistical temperature forecast system developed by the Georgia Institute of Technology and the Climate Forecast Applications Network
        
        The hybrid model uses the European Center for Medium-Range Weather Forecast Variable Ensemble Prediction System that is calibrated to adjust for model bias
- 6th phase: focused on intervention implementation
  - Interventions were first implemented in a pilot fashion in 2013
  - Several preparatory actions occurred
    - Circulation of the draft HAP
    - Solicitation of feedback from government officials, medical officers, and community groups
    - “Table-top exercise”: implements the HAP with government officials during different simulated heat emergencies
    - Based on the findings from this exercise, modifications to agency actions were made
- 7th phase: project evaluation
  - Includes assessment of its effects on two main target populations
    - Organizations involved in the public health response to extreme heat
    - The general population (particularly people most vulnerable to extreme heat)
  - Currently ongoing
Results of the study
Republicans view human health as the most important issue having to do with environmental concerns, so Republicans would encourage Ahmedabad’s study to occur in a similar US city
Democrats focus more on sustainable energy than they do on climate change, so they would not be as receptive as Republicans