cc  >> Our second speaker is  Jonathan Patz, and Professor  Jonathan Patz has appointments  in the Nelson Institute, Center  for Sustainability in the Global  Environment or SAGE, and the  Department of Population Health  Sciences at the University of  Wisconsin Madison.  He co-chaired the Health Expert  Panel of the US National  Assessment on Climate Change,  and for the past 15 years,  Dr. Patz has been a lead author  for the United Nations  Intergovernmental Panel on  Climate Change, or IPCC, which  is the organization that shared  the 2007 Nobel Peace Prize with  Al Gore.  He has been invited to brief  both houses of Congress, served  on several scientific committees  of the National Academy of  Sciences and currently serves on  science advisory boards for both  CDC and EPA, as well as WICCI.  So now I'm going to hand it over  to Jonathan.  (applause)  >> Thanks very much.  So Steve has given you a look at  what climate change may bring as  far as physical change to  Wisconsin.  And what I'm going to do is talk  about more the biological  changes.  And what does climate change  mean for human health in  particular.  So I'm going to start off with a  couple slides just general  health effects, couple global  and regional issues and then  focus in on the Great Lakes  region.  And of course this is one that  caught the climatologists by  surprise and the oceanographers. 

 This is looking at the Arctic  ice melting.  And what you see here is this  line is the, well the top line  is the best-case scenario of how  the Arctic will be melting.  These are model changes into the  future.  This bottom line is worse-case  scenario for how fast the Arctic  will melt.  But the red line is what's  actually happening.  That's the observed trend.  So this is this shock of how  quickly the Arctic is melting.  Really woke people up, and of  course the polar bear became the  poster child for climate change  impact on species survivability,  but I'm here to tell you that  the polar bear may not be the  only species at risk.  Of course one of the sub-headers  here is how climate change  threatens your health.  Now John Magnuson showed how  warming in the northern  hemisphere is melting, is  leading to shorter ice periods,  shorter winters, and what you  see here in the top for various  lakes and rivers in the northern  hemisphere, the freeze dates are  trending later and the breakup  dates or the thawing dates are  trending warmer. 

 So that in Madison John Magnuson  determined that since 1953  there's been a 25% decrease in  the amount of time Lake Mendota  is frozen.  Now what does that have to do  with public health?  Well, of course, that's how many  of us get our exercise in  wintertime, and if we don't have  nice frozen lakes, we may get  less exercise.  Of course people would argue  they'd be on their bicycles  instead, but this is one where  at least some lifestyles may  change.  And, in fact, this photograph,  if you type in Google images ice  skating, I think I did ice  skating Great Lakes that's the  first image that came up, and  that is Lake Mendota so I got  very lucky on that one.  Now most of you have probably  seen this slide many times and I  just want to, for those of you  who haven't, quickly just go  over some of the general areas  of health impacts that we're  concerned about with climate  change.  And over here you see the three  physical attributes of climate  change: warmer temperatures, sea  level rise, primarily from  thermo expansion of saltwater,  but of course if the ice pack on  Greenland slips into the ocean,  well there's another story with  sea level rise.  And then, as Steve has been  focusing, on it's not just  temperature but extremes of the  water cycle.  Hydrological extremes is  concerning to many of us that  are studying the impacts of  changing climate.  So of course we do know that  people die in heat waves.  When you compound hot air  temperatures on top of a  sprawling city with black  asphalt roads and heat retaining  concrete buildings you get the  urban heat island effect. 

 So that the urban core can heat  up quite a bit.  Ground level photochemical smog.  This is a ground level ozone air  pollution is very temperature  sensitive.  And I'm going to show you a  slide from Dr. Tracey Holloway's  modeling work showing the  projections for ozone in  Chicago.  Aeroallergens, it's known that  ragweed plants produce much more  pollen in conditions where there  is both an increase in CO2 in  the air but also warmer  temperatures leading to more  ragweed pollen production.  So there's a concern of  aeroallergens increasing under  conditions of climate change.  I'll talk a little bit about  vector born diseases.  These are insect or rodent born  diseases, and many of these are  very climate sensitive.  Water born diseases, based on  what Steve has presented if  we're talking about extremely  heavy rainfall events and heavy  runoff, we are concerned about  the drinking water quality from  having contamination from these  flooding events and extreme  runoff events.  And of course our public health  depends on food and water  supplies. 

 If we're talking about storms,  the bottom areas mental health  issue after storms and  environmental refugees, these  are going to be issues in other  parts of the world when you  think about Bangladesh which is  already at sea level and the  storm surge is forcing people to  be moving.  I threw in this slide at the  last minute because Steve made a  comment about future warmer  summers so this is just a global  look.  This was published two months  ago in Science showing that any  area that you see on the globe  that is shaded in orange or red,  these are areas with a greater  than 70% probability of  experiencing summers that are  warmer than the warmest summer  ever recorded thus far.  So this is looking in the middle  of this century by the period  2040s to 2060s.  These are areas with 70%  probability or more will get  hotter summers than they've ever  recorded, and here you're  looking at by the end of the  century 2080s to 2100 all these  red areas are regions with  greater than a 90% probability  of experiencing a summer hotter  than summers ever recorded.  Now this is a major problem when  you think about crops and food  supplies.  There are already 800 million  people that are food insecure at  a risk of hunger.  And according to some of the  model runs by this group, the  risk for hunger could double by  the middle of the century.  That is possibly one of the  biggest global public health  concerns that we have with  climate change.  Some regional observations, the  heat wave in Europe that I'm  sure you're all familiar with  that hit in 2003, killed more  than 50,000 people in 11 days. 

 That's a public health disaster.  Now this heat wave was an  atypical heat wave.  You can see if you look at  average summer temperatures for  Europe since 1909 this is the  normal distribution, and look  how far outside the norm 2003  was.  And as Steve was talking about  the frequency of extreme events  that is the story of climate  change that you can't pin the  blame of any single event like a  heat wave or a flood or some  sort of climate disaster, you  can't pin the blame on climate  change and say that event was  attributable to climate change.  But what you can do is talk  about probabilities as Steve  pointed out.  And -- et al in Nature  pointed out that the  greenhouse gases put into the  atmosphere over the last 30  years essentially changed the  frequency, the likelihood of  seeing extreme events such that  an event that extreme was  basically double the probability  of seeing an event that extreme  simply by greenhouse gas  emissions in the last 30 years.  So it's about probabilities.  Now I'm getting closer to  Wisconsin, don't worry.  This is Minneapolis, so I want  to talk about a few cities  nearby, Minneapolis and Chicago.  They're in Wisconsin, right?  (laughter)  I claim them anyway. 

 So in Minneapolis right now, if  you look at the blue bars which  are current climate right now  there's about a 17% or 18%  chance that Minneapolis  experiences two days of  extremely hot weather, over  100-degrees Fahrenheit.  So that's the current situation,  but 50 years from now, which  according to some of the climate  models, the probability of  having two days more than  100-degrees goes up to over  60%.  So the idea of these extremely  rare extreme temperatures could  become the norm.  So do you guys know what city  this is?  Can you see in the back?  Chicago.  And that is Chicago during the  heat wave in 1995.  Now the editors of Nature  thought the paper was about air  pollution and they misnamed the  sub-header here, they called it  the wheezy city.  But the authors corrected them  to say this is actually a paper  about heat waves.  And so this is what a heat wave  looks like in Chicago.  So what happens with extreme  heat is not only do people die  from temperatures but you can  also have increases in air  pollution especially ground  level ozone photochemical smog  that's very dangerous to  breathe.  And according to some research  looking at what would warmer  temperatures in the eastern US  mean for ozone pollution?  Just from temperature increases,  we see that an increase of 68%  more red ozone alert days is one  result. 

 Now if you compound that with  what's known about heat waves  which is stagnant air masses, if  you add the stagnant air masses  into the equation it could  actually worsen.  And of course the IPCC talks  about the Northeast and Midwest  United States by the middle of  this century would see a  decrease in climate change  induced, a climate change  induced decrease in the  frequency of surface cyclones.  Now Steve you're a  climatologist, I assume that  means more stagnant air masses,  correct?  Yeah.  If we look at hot temperature's  effects on atmospheric chemistry  and ozone, we're going to also  have to think about stagnant air  masses.  So this could actually be an  issue.  Tracey Holloway, the director of  SAGE, has been looking at  atmospheric chemical modeling  and climate for her entire  career and she has been doing  some modeling in this region.  This is showing that the number  of unhealthy ground level ozone  days in Chicago could increase  by three- to eight-fold by the  end of this century due to  climate change.  And of course, these are model  runs out to 2100.  And it varies, these are all the  different global climate models  and scenarios that you use.  But you can see there's a range  of effects but the idea that  they will be trending upwards as  far as ground level ozone  production. 

 The Clean Air Act in the United  States has done an outstanding  job as far as reducing air  pollution in this country.  Ground level smog ozone,  however, is the one pollutant  that remains problematic.  We've seen the least improvement  in ozone.  In general, ozone is best when  we have cold, wet summers, and  ozone levels are more dependent  on our annual climate than they  are our mitigation schemes.  But this is one where we may  have more difficulty meeting the  Clean Air Act levels for  attainment.  Well, there's been a lot of  concern about infectious  diseases and climate change.  And this is because many  infectious diseases are carried  by insects and difference  between us and insects is that  we are warm blooded and insects  are cold blooded.  So when people say look you know  what's the temperature  differential in Wisconsin  throughout the seasons.  It's minus 10 in the winter,  it's plus 90 in the summer.  We're talking about 100-degree  temperature differential. 

 So what's the dig deal if one or  two degrees of warming.  Well, this is where this issue  of small changes in physical  climate can have a dramatic  affect on biological systems  like malaria, West Nile virus, I  get choked up when I talk about  these diseases.  (laughter)  If I don't clear it  in one or two slides, I'll go to  the water fountain again.  So anyway, so a small change in  temperature could be very  important because whatever the  air temperature is around that  cold blooded insect, that's the  body temperature of the  mosquito.  If that mosquito is carrying  malaria parasites or West Nile  virus particles or Dengue or  yellow fever virus, whatever the  air temperature is has a very  dramatic affect on the  development time of these  pathogens inside the insect.  So this is where we observe, all  around the world, very important  geographic distributions between  tropical diseases and  nontropical diseases.  Malaria occurs in the tropics  because the parasite in the  mosquito does not develop below  18-degrees centigrade if it's  plasmodium falciparum, or  16-degrees centigrade if it's  vivax malaria.  If it gets too cold, you cannot  have malaria.  So this is where small changes  in temperature can affect  diseases especially if they're  carried by cold blooded insect  vectors.  Hang on I must have blocked  those slides out there. 

 Yeah, I did.  Okay, I just wanted to show you,  so I talk about malaria  but because we are talking  about Wisconsin let's talk  about a mosquito born disease  that does occur in Wisconsin  and that's West Nile virus.  Now West Nile virus came into  the country in the summer of  1999.  It entered New York, most likely  by international travel.  The genetic fingerprint on West  Nile virus that hit New York  looks like it came from the  Middle East, probably by an  infected bird or mosquito on the  plane and then it took hold in  New York.  With the birds it's a zoonotic  disease, in other words it  naturally cycles through animals  and people and horses are  infected and we can actually die  from this, but we're irrelevant  to the life cycle.  It's where the birds are that's  important as far as where this  disease is going.  And fairly predictably, once  there are enough built up in the  environment it started to  migrate with the birds south in  the subsequent years, and then  in 2002 we saw in the Midwestern  region, and this is looking at  the central flyway, the  Mississippi flyway, I'm sorry.  Thanks, I recovered but this is  good prevention here because I  really get choked up when I talk  about water born diseases.  (laughter)  So the bird flyways  sort of naturally took this  virus down south and then it  came up through the Mississippi  in 2002. 

 The virus actually underwent  mutations and become more  dangerous.  So it made this incremental, not  incremental, major step up as  far as its lethality.  So in 2002 when it came up  through the Mississippi flyway  we went from about 60 cases to  about 4,000 cases.  So it made a big jump.  And then in 2003 it was in  Colorado and throughout the  Rockies, and then by 2004, not  surprisingly, it hit the west  coast.  Now what's interesting is each  place, each time, each year the  West Nile virus was in that  region as expected sort of  marching across the country with  the birds, there were places  that were much more, had many  more cases of disease than other  places.  And what was found was that the  strain of West Nile virus that  emerged for the first time in  North America during the record  hot July of 1999 actually  requires warmer temperatures  than other strains of that virus  around the world.  And the greatest West Nile virus  transmission during the epidemic  summers of 2002, 2003 and 2004  in the United States were linked  to above average temperatures.  1999, July of 1999, was the  hottest July ever recorded in  New York City.  This disease is interesting  because when you think about  mosquito born diseases you  cannot generalize your  mosquitoes. 

 A mosquito is not a mosquito is  not a mosquito.  It depends what species  mosquito.  And unlike malaria carrying  mosquitoes, these mosquitoes,  the genus is Culex mosquitoes,  these do well in drought  conditions and they're in the  urban environment, they love  dirty, concentrated, sludgy  water.  That's where they thrive.  Not surprisingly most big  epidemics around the world for  West Nile virus are linked  either to droughts or heat waves  or both.  So here is a story where  counterintuitive, you think  mosquitoes do need water to  breed in but this mosquito does  well in dirty concentrated water  and drought and heat waves can  actually worsen this situation.  So because there are so many  climatologists in the audience  tonight, I have to remind myself  not to just talk about  temperature.  And especially because Steve  Vavrus just talked about runoff  I really have to talk about what  are the implications of  extremely heavy rainfall in this  region.  And in fact globally since 1950  there's been an increase in  flood events.  So let's focus on the United  States. 

 Today we have already a problem  handling storm water runoff.  We have these combined sewer  overflow events all the time.  These CSO events.  We have over a trillion gallons  of sewage contaminated storm  water that overflow into surface  waters every year.  That would keep Niagara Falls  running for 18 days.  That's how much contaminated  water we have when we have these  flood events.  We studied water-borne disease  outbreaks across the United  States for a period from 1948 to  1994.  These were reported water-borne  disease outbreaks.  We excluded recreational  outbreaks, we excluded known  engineering failures and we did  not compare one place from  another which would be biased  because one state like Colorado  has pretty good reporting of  their water-borne outbreaks and  other states may not.  So we looked at one location,  one watershed and if there was  an outbreak we compared that  climate around the outbreak and  before the outbreak especially,  compared to that watershed's 50  year climate record. 

 So we're only comparing one  place for itself and then  running Monte Carlo analysis to  develop controls.  And what we found was that 67%  of reported water-borne disease  outbreaks were preceded by the  heaviest rainfall in the 80th  percentile for 50-year record  for that related watershed.  So it's fairly clear that heavy  rainfall is a risk regarding  water-borne disease exposure.  And in Milwaukee all of you are  familiar with the 1993  cryptosporidiosis epidemic.  It was estimated that more than  400,000 people were exposed to  this parasite.  Cryptosporidiosis is a parasite  that is very resistant to  chlorination, it's resistant to  ultraviolet radiation.  So when it's lying in the field  in a cow pie, this is actually  transmitted through human feces  and septic tanks but also in  livestock.  So it encapsulates, it's called  an oocyst.  So it gets this tough shell  around it and it can remain just  lying on the ground for a long  time and still be infectious.  So it's also five times smaller  than giardia so sometimes can  get through filtration. 

 So cryptosporidiosis is a  significant diarrheal disease  and when we looked at this  situation we found that that  epidemic was preceded by the  heaviest rainfall month in the  50-year record, it was in the  99th percentile.  So the scenario is that the  three rivers that are coming in  with all the agricultural runoff  and human septic runoff.  In fact the fingerprint, the  farmers were happy to find out  that the genetic fingerprint of  this crypto turned out to be  human septic, but it is carried  also by livestock.  So all this runoff into Lake  Michigan, the intake for  Milwaukee's water is a pipe out  in Lake Michigan and apparently  with all that runoff the  parasites reached the intake.  This is a photograph by one of  our collaborators, sent by her,  I don't think she took the  picture, Sandra McLellan who  works with Steve and I on an EPA  grant, and we're also working  with the Wisconsin State Health  Department to look at climate  change impacts for Wisconsin.  This is a photograph of the  turbid runoff.  You see this is a flood, heavy  rainfall event in 1980, I  believe, and this is what the  outflow looks like.  This floodwater streaming into  the lake.  The good news is that since 1993  Milwaukee, they relocated their  water intake much further out  into Lake Michigan.  So even though you see this in  the harbor of Milwaukee  following a heavy rainfall, I'm  not sure that they're going to  have that same situation again  unless they've got some pretty  unlucky wind combination and a  heavy flood like this. 

 It might not happen again  because they did something about  it.  But I want to talk about what  water managers should be  thinking about as far as  adaptation to climate change  when you think that this type of  event already happens, we  already have over a trillion  gallons of contaminated sewage  water that is overflowing every  year in this country.  What about when you look at  pictures that Steve Vavrus just  showed that the intensity of  rainfall and runoff is going to  be increasing and it's going to  increase in this region.  Well this is some interesting  current analysis where this is  from Dr. Mark Borchert up at  Marshfield Clinic here in  Wisconsin.  And what we're seeing is the  seasonal variability of  gastrointestinal illness versus  rainfall precipitation and snow  melt, so combining snow melt and  rainfall.  And what you see, the black line  are cases of illness.  So intestinal illness.  And the blue is snow melt, snow  depth.  So every time you see the blue  dipping down, the snow is  melting.  So you get this snow melt and  look what happens with cases. 

 And you have here rainfall are  the bar graphs.  Here's again another big snow  melt and look at the cases going  up.  Snow melt, cases.  So when I look at Steve's  scenario I'm not assured because  he's telling me that springtime  is where we're going to have  heavier rainfall especially and  we're already seeing a response  in diarrheal disease,  gastrointestinal illness related  to snow melt and rainfall, this  makes me worried that we may be  seeing a higher risk of these  events.  So this is current day.  This is looking at the last few  years of data.  So now the future is that things  are going to get a little bit  hairier when it comes to heavy  rainfall.  This is from the IPCC, North  America is going to get wetter.  I'm not going to focus on this  because you've got a better  analysis from Steve that's  regional.  This is an early graph. 

 Steve is that still valid, that  one, or you've refined that?  This is showing the increase  frequency of very heavy rainfall  events, and according to Steve's  analysis we may see a 50% to  120% increase in the frequency  of these combined sewage  overflow events for a place like  Chicago.  So this is where extremes in  climate intersect with public  health risk.  And if you think about the  country and then the Great Lakes  region we have, according to  EPA, about 770 communities that  still combine stormwater runoff  and sewage.  It's a known problem.  The communities know it's a risk  but it's billions and billions,  maybe trillions of dollars as  far as fixing, redoing these  water systems.  So we know it's a problem.  Again, you know that there are  trillions of gallons that  overflow already.  I was wrong, sorry about the  trillions, $45 billion in future  investments are needed.  And this is showing average  trends in rainfall.  You see the Great Lakes region,  we have been trending to be up  to 40% wetter in the last 100  years. 

 So if you think about the things  that Steve showed and also  consider this problem of  combined sewage overflow events  in our region, the EPA has  already put out some numbers.  And if combined sewage systems  are designed to meet the EPA's  control policy, which is to just  get down to four events per  year, however they do not plan  for climate change, incremental  increases in heavy runoff,  everything that Steve has just  been talking about, then there  could be an average of 237  events per year above what  they're shooting for across the  182 communities in the Great  Lakes region.  Now this is an EPA report, don't  ask me about the specific  numbers.  But again this is looking at  adaptation.  We already know we have a  problem of combined sewage  overflow, we need to strengthen  our water treatment and  management systems.  But if we just do it for today  we're going to be missing the  boat and we're going to be, it's  something that really for this  region we have to plan for as  far as stresses on our water  quality and safety.  So finally I want to just shift  gears and talk a little bit  about climate mitigation policy  and how it relates to public  health.  What we're seeing here are the  10 leading causes of death in  the United States.  And everything encircled there,  which I mean sure you can't read  this, but this is heart disease,  cancer, strokes, chronic lung  disease and unintentional  injuries and diabetes.  So all of those, that's most of  our leading causes of death in  this country. 

 Those are all very much linked  to either sedentary lifestyle,  air pollution or motor vehicle  crashes.  So let's take a case scenario of  something that we've  experienced, a natural  experiment in the United States.  When we had the Olympics in 1996  in Atlanta, the local  authorities wanted to reduce air  pollution for the athletes so  they had all sorts of rules to  reduce traffic.  Traffic decreased by 23% which  led to a reduction in air  pollution.  The ground level photochemical  smog ozone pollution decreased  by 28%.  So what happened to asthma,  admissions to the emergency  room?  Asthma decreased by 42%.  So you reduce traffic by 23% you  get a 42% reduction in asthma  visits to the emergency room.  And of course these are smart  epidemiologists and you guys  would ask the question well,  people couldn't drive, they  couldn't drive to the emergency  room so you see a reduction,  right?  No, these guys were smart.  They looked at children's  emergency room visits for  non-asthma cases and they didn't  change at all.  So they had a nice control to  show that people were going to  the emergency room but for  respiratory related issues and,  in this case asthma, a marked  reduction. 

 So this is obvious if you reduce  pollution you reduce air  pollution related illness.  Well, transportation, hang on, I  have those blocked out too,  sorry.  Okay, transportation is about a  third of our greenhouse gas  emissions.  So if we're trying to reduce  greenhouse gas emissions to  mitigate climate change,   globally 800 million, I'm sorry,  800,000 people, globally, almost  a million people globally, died  prematurely every year from air  pollution.  So here's something, a third of  our US emissions are from  transportation.  And I showed you this scenario,  reduce automobile traffic and we  reduce asthma.  But what about in Madison?  We're actually running this  experiment.  I have a graduate student,  Maggie Grabow, who's looking at  what if one out of five car  commute trips in Madison was  replaced by a bicycle trip.  So 20% reduction in traffic in  Madison.  What would it mean for air  quality and human health?  Well for air quality it would  mean a 12% reduction in ground  level ozone, and a 2% reduction  in particulate matter, which is  also hazardous to breathe. 

 And we're running the EPA air  quality public health model  called BenMAPs and what he find  we'd have almost 2,000 fewer  cases of asthma per year, fewer  missed work and school days,  14,000 less respiratory symptoms  a year and we'd save $40 million  in health costs.  So here's a story where I see  adaptation to climate change and  mitigation blending together and  I sort of don't like to separate  them.  I'm a health guy; all I think  about is prevention.  And it's a matter of at what  level you want to intervene.  Do we want to be treating  illness or do we want to be  preventing illness and do we  want to do things in between.  And this is where mitigation  policy to reduce greenhouse  gases and have greener cities  and greener transportation,  multimodal transportation, to  reduce greenhouse gases and  climate change will have this  automatic co-benefit, this  immediate benefit of reducing  air pollution which we know is  hazardous anyway.  So this is where I think  adaptation and mitigation sort  of blend together in a continuum  of simply risk management.  So with that I will stop and  remind you that I come both from  the School of Medicine and  Public Health but my primary  appointment is in the Nelson  Institute Center for  Sustainability and the Global  Environment where we try to put  all of these things and  integrate them together to  answer these issues.  Thank you.  (applause)