Read Dr. Caleb Dresser’s remarks given at a February 4, 2020 Massachusetts State Legislature briefing about the health impacts of fossil fuel use and climate change in Massachusetts. Dr. Dresser is the Center’s inaugural Climate and Human Health fellow. Learn more about the program here.
Good afternoon. Thank you for this opportunity to speak with you about the health implications of energy policy and climate change in the Commonwealth of Massachusetts.
I work in the emergency department, where my patients are often among the most vulnerable members of our society. In many cases, their diseases are affected by factors outside their control such as age, socioeconomic status, or membership in a minority group. I have cared for senior citizens who live alone and are unable to take active steps such as installing air conditioners during hot weather. I have cared for children of color who suffer from severe asthma, and who will leave the hospital to return to neighborhoods where they are exposed to automobile exhaust from highways on a daily basis. I have cared for people who do not speak English and have difficulty accessing resources or responding to health warnings. I have cared for outdoor workers who didn’t feel comfortable stopping work during the heat of the day. For each of these people, personal circumstances make them uniquely vulnerable to impacts from particulate air pollution and climate change.
Ongoing fossil fuel use in the Commonwealth of Massachusetts leads to air quality problems and substantial health impacts. Changes in our patterns of energy use could lead to improvements in air quality and the health of our families and neighbors.
In my clinical practice, I care for patients experiencing exacerbations of asthma and chronic obstructive pulmonary disease. These patients are often in respiratory distress when they arrive, requiring continuous breathing treatments and intravenous medications for stabilization. In some cases, I have to support their breathing with mechanical ventilation, leading to multi-day intensive care unit admissions that are expensive and stressful for patients and their families.
Particulate matter and other types of air pollution have been linked with respiratory diseases including asthma and chronic obstructive pulmonary disease.1 A 2018 study found that even low-level increases in particulate matter in the air of Massachusetts are associated with increased asthma attacks in children.2 Families living near major roads and highways appear to be at particular risk because of particulate matter and other chemical emissions from vehicles, which have been linked with increased asthma symptoms in children in multiple studies.3,4 In contrast, cleaner air has been linked with lower rates of chronic asthma in children.5
Particulate matter is produced by burning fossil fuels in vehicle engines, furnaces, and power stations. Fossil fuel storage, transport, and processing sites can also lead to chemical exposure. These sites are disproportionately located in poor or non-white communities and represent a substantial, ongoing environmental injustice.6
Reductions in particulate matter from fossil fuel combustion represent an opportunity to reduce rates of acute respiratory illness and substantial impact these diseases have on patients, families, and healthcare expenditures.7
In addition to the clinical impacts of continued use of fossil fuels due to short term air pollution, I would also like to discuss the health impacts associated with ongoing climate change in the Commonwealth of Massachusetts.
Climate change results from the continued production of carbon dioxide, methane and other greenhouse gases which enter the atmosphere and trap heat. The trapped heat leads to changes in local climate, rainfall patterns, and weather patterns.
Climate change in New England is expected to lead to substantial warming.8 While Boston has historically seen an average of 11 days above 90°F per year, Boston is expected to see 20 to 40 days per year as early as the 2030s, depending on emissions.9 Heat-related emergency department visits are expected to increase,10 and direct heat-related mortality in Boston may double by mid-century.11 The US Global Change Research Program reports that climate change in Massachusetts will also lead to more frequent and more intense heat waves, heavy rainfall events, severe storms, and coastal flooding made more hazardous by rising sea levels.8 All of these have substantial implications for human health; today I will speak briefly about heat waves and infectious disease.
High outdoor temperatures represent a serious health hazard for the people of Massachusetts. It is important to understand that people affected by heat-related illness are not simply too hot. I have cared for patients with severe dehydration causing kidney injury, or with core temperatures so high that even after aggressive cooling in the emergency department, they were admitted to the intensive care unit unconscious on a ventilator. Heat has also been linked to increased rates of irregular heartbeats,12,13 heart attacks,14,15 strokes,16,17 kidney stones,18,19 breathing problems,20 interpersonal violence, and suicide.21,22,23 According to the Federal Emergency Management Agency, heat waves are in fact the single deadliest natural hazard in the United States, with a death toll that exceeds all other natural disasters combined.24 In addition, according to a 2018 working paper from the National Bureau of Economic Research, heat waves cause more deaths at a lower temperature in historically cooler parts of the country such as Massachusetts.25
Infectious diseases are also a topic of increasing concern. As regional warming leads to milder winters and longer summer seasons, conditions are becoming increasingly favorable for the spread of Lyme disease.26 My colleagues and I now also test for and treat Babesiosis, a tick-borne disease microscopically similar to malaria that is increasing in frequency and prevalence.27 There is also concern that other diseases including West Nile virus may have transmission dynamics that are affected by climate change.8,28
I recently completed my clinical training and entered independent clinical practice. I look forward to treating patients in the Commonwealth over the next three decades. Over the course of my career, climate and public health analyses indicate I will care for an increasing number of patients who are experiencing the health impacts of climate change. These patients will in some cases experience devastating illnesses with long-term consequences that affect their ability to work, care for themselves, live independently, and participate in society, with substantial implications for their families and communities. It is of the utmost importance that we take steps now to mitigate these impacts.
In summary, the continued use of fossil fuels in the Commonwealth of Massachusetts has substantial implications for the health of our families, friends and neighbors. In the short term, particulate matter released by burning fossil fuels continues to contribute to breathing problems such as asthma and chronic obstructive pulmonary disease. In the long term, fossil fuel use contributes to climate change, which is already leading to measurable changes in the incidence of some diseases and will lead too much more substantial changes in coming decades. Reductions in fossil fuel use can improve the health of the people of Massachusetts while simultaneously transitioning to a more sustainable future.
- Li M, Fa L, Bei Mao 1, Jia-Wei Yang 1, Choi A, Cao W, Xu J. Short-term Exposure to Ambient Fine Particulate Matter Increases Hospitalizations and Mortality in COPD: A Systematic Review and Meta-analysis. Chest, 149 (2), 447-458 Feb 2016
- Khalili R, Bartell S, Hu X, Liu Y, Chang H, Belanoff C, Strickland M, Vieira V. Early-life Exposure to PM 2.5 and Risk of Acute Asthma Clinical Encounters Among Children in Massachusetts: A Case-Crossover Analysis Environ Health, 17 (1), 20 2018 Feb 21
- Cakmak S, Mahmud M, Grgicak-Mannion A, Dales R. The Influence of Neighborhood Traffic Density on the Respiratory Health of Elementary Schoolchildren. Environ Int , 39 (1), 128-32 Feb 2012
- Bowatte G, Erbas B, Lodge C, Knibbs L, Gurrin L, Marks G, Thomas P, Johns D, Giles G, Hui J, Dennekamp M, Perret J, Abramson M, Walters E, Matheson M, Dharmage S. Traffic-related air pollution exposure over a 5-year period is associated with increased risk of asthma and poor lung function in middle age. Eur Respir J. 2017 Oct 26;50(4). pii: 1602357. doi: 10.1183/13993003.02357-2016. Print 2017 Oct.
- Khreis H, Kelly C, Tate J, Parslow R, Lucas K, Nieuwenhuijsen M. Exposure to Traffic- Related Air Pollution and Risk of Development of Childhood Asthma: A Systematic Review and Meta-Analysis. Environ Int, 100, 1-31 Mar 2017
- Mass.gov Website: “Mapping Toxics in Communities and Assessing Climate Vulnerability” and “Environmental Justice Communities in Massachusetts”. https://www.mass.gov/service-details/mapping-toxics-in-communities-and-assessing- climate-vulnerability and https://www.mass.gov/info-details/environmental-justice- communities-in-massachusetts. Accessed February 1, 2020.
- Buonocore J, Levy J, Guinto R, Bernstein A. Climate, air quality, and health benefits of a carbon fee-and-rebate bill in Massachusetts. Environmental Research Letters. 15 November 2018.
- Fourth National Climate Assessment: Chapter 18: Northeast. U.S. Global Change Research Program. https://nca2018.globalchange.gov/chapter/18/. Accessed January 18, 2020
- Climate Ready Boston Report: Climate Projection Consensus. https://www.boston.gov/sites/default/files/file/2019/12/03_climate_ready_boston_dig ital_climateprojectionconsensus.pdf. Accessed January 23, 2020.
- Kingsley S, Eliot M, Gold J, Vanderslice R, Wellenius G. Current and Projected Heat- Related Morbidity and Mortality in Rhode Island. Environ Health Perspect. 2016 Apr;124(4):460-7. doi: 10.1289/ehp.1408826. Epub 2015 Aug 7.
- Petkova E, Horton R, Bader D and Kinney P. Projected Heat-Related Mortality in the U.S. Urban Northeast. Int. J. Environ. Res. Public Health 2013, 10, 6734-6747; doi:10.3390/ijerph10126734
- Brunetti N, Amoruso D, De Gennaro L, Dellegrottaglie G, Di Giuseppe G, Antonelli G, Di Biase M. Hot spot: impact of July 2011 heat wave in southern Italy (Apulia) on cardiovascular disease assessed by emergency medical service and telemedicine support. Telemed J E Health. 2014 Mar;20(3):272-81. doi: 10.1089/tmj.2013.0086. Epub 2014 Jan 3. PubMed PMID: 24404817.
- Zanobetti A, O’Neill M, Gronlund C, Schwartz J. Susceptibility to mortality in weather extremes: effect modification by personal and small-area characteristics. Epidemiology. 2013 Nov;24(6):809-19. doi: 10.1097/01.ede.0000434432.06765.91. PubMed PMID: 24045717; PubMed Central PMCID: PMC4304207.
- Sun Z, Chen C, Xu D, Li T. Effects of ambient temperature on myocardial Infarction: A systematic review and meta-analysis. Environ Pollut. 2018 Oct;241:1106-1114. doi: 10.1016/j.envpol.2018.06.045. Epub 2018 Jun 19. Review. PubMed PMID: 30029319.
- Claeys M, Rajagopalan S, Nawrot T, Brook R. Climate and environmental triggers of acute myocardial infarction. Eur Heart J. 2017 Apr 1;38(13):955-960. doi: 10.1093/eurheartj/ehw151. Review. PubMed PMID: 27106953.
- Li T, Horton R, Bader D, Liu F, Sun Q, Kinney P. Long-term projections of temperature- related mortality risks for ischemic stroke, hemorrhagic stroke, and acute ischemic heart disease under changing climate in Beijing, China. Environ Int. 2018 Mar;112:1-9. doi: 10.1016/j.envint.2017.12.006. Epub 2017 Dec 11. PubMed PMID: 29241068.
- Lavados P, Olavarría V, Hoffmeister L. Ambient Temperature and Stroke Risk: Evidence Supporting a Short-Term Effect at a Population Level From Acute Environmental Exposures. Stroke. 2018 Jan;49(1):255-261. doi: 10.1161/STROKEAHA.117.017838. Epub 2017 Dec 11. Review. PubMed PMID: 29229725.
- Ordon M, Welk B, Li Q, Wang J, Lavigne E, Yagouti A, Copes R, Cakmak S, Chen H. Ambient Temperature and the Risk of Renal Colic: A Population-Based Study of the Impact of Demographics and Comorbidity. J Endourol. 2016 Oct;30(10):1138-1143. Epub 2016 Sep 15. PubMed [citation] PMID: 27538756
- Fakheri R, Goldfarb D. Ambient temperature as a contributor to kidney stone formation: implications of global warming. Kidney Int. 2011 Jun;79(11):1178-85. doi: 10.1038/ki.2011.76. Epub 2011 Mar 30. Review. PubMed [citation] PMID: 21451456
- Ma Y, Zhou J, Yang S, Yu Z, Wang F, Zhou J. Effects of extreme temperatures on hospital emergency room visits for respiratory diseases in Beijing, China. Environ Sci Pollut Res Int. 2018 Dec 1. doi: 10.1007/s11356-018-3855-4. [Epub ahead of print] PubMed PMID: 30506386.
- Schinasi L and Hamra G. A Time Series Analysis of Associations between Daily Temperature and Crime Events in Philadelphia, Pennsylvania. J Urban Health. 2017 Dec; 94(6): 892–900. Published online 2017 Jul 7. doi: 10.1007/s11524-017-0181-y. PMID: 28687898
- Michel S, Wang H, Selvarajah S, Canner J, Murrill M, Chi A, Efron D, Schneider E. Investigating the relationship between weather and violence in Baltimore, Maryland, USA. Injury. 2016 Jan;47(1):272-6. doi: 10.1016/j.injury.2015.07.006. Epub 2015 Jul 13.
- Basagaña X, Sartini C, Barrera-Gómez J, Dadvand P, Cunillera J, Ostro B, Sunyer J, Medina-Ramón M. Heat waves and cause-specific mortality at all ages. Epidemiology. 2011 Nov;22(6):765-72. doi: 10.1097/EDE.0b013e31823031c5.
- FEMA Extreme Heat Fact Sheet. Federal Emergency Management Agency. https://www.fema.gov/media-library- data/91582c34fe107c04aaee531b1d9a870e/FEMA_FS_extremeheat_508.pdf Accessed January 17, 2020.
- Heutel G, Miller N, Molito D. Adaptation and the mortality effects of temperature across US climate regions. Working Paper 23271. National Bureau of Economic Research. March 2017.
- Monaghan A, Moore S, Sampson K, Beard C, Eisen R. Climate Change Influences on the Annual Onset of Lyme Disease in the United States. Ticks Tick Borne Dis 6 (5), 615-22 Jul 2015.
- Peter J Krause. Human Babesiosis. Int J Parasitol, 49 (2), 165-174 Feb 2019
- Epstein P. West Nile Virus and the Climate. J Urban Health, 78 (2), 367-71 Jun 2001