Climate Change Solutions Series - Policy

The Intergovernmental Panel on Climate Change (IPCC) Working Group II report released in February is an urgent call for meaningful action to address climate change. It warns that failure to limit warming to 1.5C will multiply damage to natural systems, reduce the ability for humans, plants and animals to adapt and disproportionately threaten the lives and livelihoods of 3.3 – 3.6 billion people in developing countries.

Unfortunately, the current actions taken and/or pledged by nations has not been nearly sufficient. The independent, non-profit consortium that tracks global climate action, measures it against the goal of limiting warming to 1.5C and provides an ongoing assessment in their Climate Action Tracker, currently projects 2.7C warming by 2100 based on global policies/actions, 1.8C under the most optimistic (but unlikely) scenario with a 95% probability of exceeding 1.5C warming by 2100. Furthermore, their analysis found greenhouse gas emission reduction targets for 2030 submitted by Paris Climate Accord member countries will result in nearly double the emissions required to keep warming below 1.5C.

Clearly much more aggressive, comprehensive policy measures are necessary to close this emission reduction gap and avoid catastrophic climate change. In this post I explore actions taken to address climate change from a policy perspective, discuss major policy strategies adopted at the global, national, and local (U.S.) levels and how these tools may affect long-term emissions, climate change adaptation and associated impacts.

How are countries meeting Paris Climate Accord commitments?

The Paris Agreement has been adopted by 193 member countries (an unnecessary reminder – this dropped to 192 after the trump Administration removed the United States from the PCA one day after assuming office in 2017. A decision thankfully reversed by the Biden Administration.) with a guiding objective of limiting warming to 1.5C compared to pre-industrial levels. Members are required to submit their plans, called Nationally Determined Contributions (NDCs), to reduce greenhouse gas emissions and adapt to climate change impacts every 5 years. Developed countries such as the United States, European Union member states, Japan etc. are also strongly encouraged, but not required, to financially support developing countries via contributions to the Green Climate Fund.

A broad range of policy measures are being utilized to reduce greenhouse gas emissions. Common examples include restrictions on industrial emissions, implementation of carbon taxation or market-based emission cap-and-trade programs, removing subsidies for fossil fuels, incentivizing wind, and solar energy development, reducing deforestation, phasing out fossil fuel powered vehicles and coal-fired power plants.

The level of urgency regarding and commitment to addressing climate change varies widely between countries. Below are two examples of high commitment/urgency (Costa Rica) and low commitment/urgency (Russia). Referenced data and analysis comes via Climate Action Tracker.

Costa Rica

Climate Action Tracker (CAT) rates the policies and actions adopted by Costa Rica as ‘Almost Sufficient’ to limit warming to 1.5C. Only 7 of the 38 countries evaluated by CAT received this rating with no countries current policies/actions deemed completely compatible with meeting the 1.5C warming threshold. Costa Rica has moved aggressively in recent years to reduce greenhouse gas emissions through a moratorium on oil extraction, develop renewable energy sources and restore and protect previously degraded forests critical for carbon capture and adaptation. The robust availability of hydroelectric power and other renewable energy sources enabled Costa Rica to achieve 100% renewable energy generation for 300 consecutive days and has averaged 98% or more from renewables since 2014.

Russia

It comes as no surprise that Russian policies and actions to address climate change received a ‘Critically Insufficient’ rating from Climate Action Tracker. The Russian economy is heavily dependent on fossil fuels, which accounted for more than 60% of total exports in 2018 and its nationally determined contributions (NDCs) reflect intention to maintain or even expand fossil fuel extraction and export. Little or no effort has been made at the policy level to develop renewable energy sources or reduce domestic greenhouse gas emissions and Russia has not contributed to the Green Climate Fund. CAT estimates nearly 4C warming would result from global adoption of Russia’s climate change policies and actions.

Carbon taxation and cap-and-trade: examples from the United States and Canada

Two policy mechanisms to incentivize reduction of greenhouse gas emissions are a carbon tax and cap-and-trade program.

Carbon tax: the government establishes a price to be paid for each ton of greenhouse gas emitted, either based on quantity produced (for energy companies and other industrial emitters) or emission intensive goods/services such as gasoline (for consumers).

Example: British Columbia, Canada

The province of British Columbia in western Canada introduced an economy-wide tax on carbon in 2008 covering roughly 70% of total emissions. Starting at $10 per ton, the price has scaled up gradually in the years since implementation and is currently $50 per ton. At the consumer level the carbon tax added 9.96 cents per liter to the cost of gasoline. A key feature of the B.C. program is that by law it must be revenue-neutral, and all proceeds from the carbon tax are returned as a low-and-middle income tax cut. In 2020 a middle/low-income family of four received a $1,800 total carbon tax credit. The tax has been successful in slowing demand as fuel use decreased by 16 percent in the five years following implementation, and while emissions rose again in the past few years, analysis showed the increase reduced by 5-12% from what it would have been with no carbon tax.

Cap-and-trade: the government establishes a declining cap on carbon emissions for major sources and industries (i.e. energy producers/suppliers, electricity generators) and issues a set number of emission allowances, applicable facilities must either reduce emissions below the cap and/or purchase allowances to cover remaining emissions or in some cases a limited percentage of emissions can be covered through verified carbon offset projects (i.e. renewable energy development, forest conservation). This system is considered ‘market-based’ as the government generally does not control allowance pricing beyond establishing a minimum price, and facilities trade allowances with each other with pricing based on supply and demand.

Example: California, United States

The state of California passed Assembly Bill 32, the “California Global Warming Solutions Act” in 2006 that required reduction of statewide greenhouse gas emissions to 1990 levels by the year 2020 and a follow-up bill passed in 2018 established an annual declining cap on emissions to achieve reduction goal of 40 percent below 1990 levels by 2030. The California Cap-and-Trade program applies to sources responsible for 85 percent of emissions including electricity generators, industrial facilities and fossil fuel distributors. A key element of the program is that a small percentage of covered entities emission reduction obligation may be in the form of offset projects – 8% through 2020, 4% between 2021 and 2025 and 6% between 2026 and 2030 and 50% of supported projects must directly benefit the state of California (updated in 2021; prior to this change offset projects could be located anywhere in the United States). The program has been successful in several ways, including reducing greenhouse gas emissions as it achieved reduction to 1990 levels in 2016 (four years earlier than stated target of 2020), generating $5 billion in revenue from allowance auctions, of which 35% are required by law to fund projects benefiting disadvantaged and low-income communities and achieving significant public health benefits through reduced air pollution.

Climate Change and Health Series – Profile: Washington State, USA

Washington State is bounded by the Pacific Ocean (west), Canadian border (north), Idaho border (east) and the Columbia River/Oregon border (south). Washington is unique for its diverse topography which includes two mountain ranges (Cascades and Olympics), five volcanoes (Mt. Baker, Rainier, St. Helens, Adams and Glacier Peak) the largest temperate rainforest (Hoh) in North America, islands, semiarid productive farmland to the east and thousands of rivers, streams and lakes.

Demographics, economics and other considerations

The total state population is over 7.6 million, adding nearly 1 million residents since 2010. Over 75% of the total population resides in western Washington with 2.2 million in Seattle and surrounding areas. Historically, Washington is relatively racially homogenous, nearly 70% of state residents identify as white, with Hispanic or Latino (13%), Asian (9.6%), Black or African American (4.4%), two or more races (4.9%) and Native American (1.9%) minority populations. Seattle and surrounding King County have diversified in last 20 years with over 50% of new residents born outside the United States.

The Cascade Mountains are a natural dividing line between western and eastern Washington, which vary significantly in terms of culture, politics and economics.

Western Washington and especially Seattle/King County is one of the most progressive areas in the country, this is reflected in political leadership which trends from ‘liberal’ to ‘ultra-liberal’, adoption of a $15 per hour minimum wage, ambitious greenhouse gas emission reduction goals including an 80 percent reduction compared to a 2007 baseline by 2050, plant, protect and prepare 3 million trees by 2025, tuition-free community college for public high school graduates. Aviation, technology, healthcare, academia are major industries including Boeing, Amazon, Microsoft, Harborview Medical Center and the University of Washington. Rapid economic growth has pushed the median household income in Seattle/King County to nearly $100,000 and average home value to almost $800,000. However, economic prosperity has not benefitted all groups, with the income gap between black ($55,152) and white ($100,298) households widening in the past 20 years and over 11,700 residents experiencing homelessness (2020 count; this figure likely rose due to the COVID-19 pandemic and associated economic impacts).

As with many other rural areas in the United States, Eastern Washington has grown increasingly conservative in recent years, with all but 1 district represented by Republicans in the state legislature. This was also reflected in the 2020 presidential election results with all but one eastside county going for Trump. Agriculture is the primary economic sector in eastern Washington, producing apples, cherries, wheat, potatoes and wine grapes. Academia is also a major employer with three large public universities and several private institutions. The economic growth experienced on the westside has not been felt east of the Cascades, as the median household income in the most populated eastside county, Spokane ($56,904), is far lower than King County ($94,974).

Climate Change and Health Concerns

 Extreme heat: A report from 2015 indicated that the Puget Sound region had warmed 1.3 degrees between 1895 and 2014 with significant warming in all seasons except spring. This warming trend is projected to continue through the 21st century with more frequent and extreme heat events. Washington experienced an historic heat wave in June 2021, as temperatures above 110 degrees smashed records in areas of the state. Mortality, hospitalizations and emergency medical service call rates increase significantly on days over 97 degrees. Vulnerable populations in Washington State include the nearly 12,000 western residents experiencing homelessness and 187,000 migrant/seasonal farmworkers on the eastside.

Poor air quality: risk of wildfire is projected to increase due to higher temperatures and drier conditions in the Pacific Northwest. The combination of heat, wildfires and unfavorable wind conditions can result in poor air quality, as illustrated when Washington State experienced the worst air quality in decades for several days in 2017. Populations adjacent to major roadways, ports and heavy industry in Seattle/King County (westside) and Spokane (eastside) with existing poor air quality and disproportionately impacted by socioeconomic determinants of health are more vulnerable during poor air quality events.

Precipitation: too much/too little precipitation may be an emerging issue in Washington State. A study by Seattle Public Utilities found that extreme precipitation events in western Washington had gotten 30 percent stronger since 2003 whereas eastern Washington is currently experiencing extreme drought. Flooding can contribute directly to water contamination/associated illness and reduced crop yields may worsen food insecurity which already impacts nearly a third of state residents.

Emission reduction strategies

Western: King County Metro Transit has committed to moving to a 100% zero-emission fleet no later than 2040, currently operates 185 zero-emission buses (of 1,600 total buses), purchased 120 more in 2020 and is developing the associated charging infrastructure.

Eastern: Puget Sound Energy operates the Wild Horse Wind and Solar facility, which includes 149 wind turbines and 2,408 solar panels (enough to power around 80,000 homes).

Climate Change and Health Series - Inequitable Impact Part I

The first installment of the sixth assessment report was released by the United Nations Intergovernmental Panel on Climate Change (IPCC) in September 2021. Key takeaways include: virtual certainty that observed increases in greenhouse gas emissions since 1750 are caused by human activities, human-induced climate change is the primary driver of more frequent and intense extreme heat and precipitation events since 1950 and global temperatures will continue to increase until at least 2050 under all emission scenarios and warming of 1.5-2C will be exceeded during the 21st century unless deep reductions in carbon dioxide, methane and other greenhouse gases occur in the next 1-2 decades.

The effects of climate change are not equitably distributed with those most impacted contributing the least greenhouse gas emissions. A study found that the 10 most food-insecure countries in the world, vulnerable to drought, flooding and reduced agricultural capacity due to climate change, account for less than 1 percent of total global emissions of carbon dioxide. Industrialized countries such as the United States continue to enjoy economic and lifestyle benefits fueled by high per capita greenhouse gas emissions while the consequences are exported to the global south. For example, the average American generates the same amount of carbon dioxide each year as 583 Burundians. Those especially vulnerable to climate change-related health impacts include the poor, children, elderly, BIPOC, immigrants and refugees, outdoor and factory/industrial workers and those residing in geographic areas with poor air quality, limited greenspace, high concentration of pavement and other features which increase susceptibility.

Climate change as threat multiplier for existing health disparities and inequities

COVID-19 has exposed how the ripple effects of societal inequities such as discriminatory housing policies, inequitable distribution of greenspace, grocery stores and healthcare systems contribute to health disparities based on race, citizenship status and/or geographic area. The pandemic in many ways has provided a glimpse of how climate change disproportionately impacts specific populations. A few features that intersect with equity and vulnerability to climate change:

Greenspace allocation

Redlining and other discriminatory housing policies in the United States restricted urban communities of color to neighborhoods with the least greenspace and most vulnerable to extreme heat. Per the National Climate Assessment (NCA), heat is a leading cause of weather-related mortality in the United States, contributing to over 600 annual deaths. The NCA further estimates that most areas of the U.S. will experience 20-30 more days over 90 degrees by 2050. This will almost certainly disproportionately impact specific populations, as studies found that formerly redlined areas were as much as 7C warmer than non-redlined areas, and that residents living in neighborhoods with higher racial diversity, extreme poverty and lower levels of education were more likely to be exposed to extreme heat.

Proximity to heavy industry and poor air quality

Race and income level are strong predictors of exposure to air pollution. The American Lung Association (ALA) found that nonwhite populations, especially African Americans, faced higher disease and mortality risk from air pollution and that African Americans were more likely to reside in areas with greater exposure to air pollution. Other factors such as low socioeconomic status, unemployment, Medicaid enrollment and higher use of public transportation were also associated with higher risk from air pollution. Climate change increases the likelihood of poor air quality events as warming is associated with higher levels of allergens and harmful air pollutants such as ground-level ozone (smog). 

Access to affordable, healthy food

Climate change is projected to significantly impact global availability of fruits and vegetables due to rising temperatures, drought and flooding. This may deepen existing food access disparities in the United States. Studies have consistently shown that residents of ethnic minority and low-income communities are more likely to be affected by poor access to healthy food products, chain grocery stores and supermarkets. Neighborhoods with predominantly black and/or Hispanic residents have fewer large chain supermarkets than those in majority white and non-Hispanic areas.

Profiles: climate change vulnerability in the U.S. and abroad

Location: western Washington State, United States

Western Washington is known for a cool, temperate climate overall with mild, dry summer days and temperatures that rarely exceed 80 degrees. However, the effects of climate change have increasingly been felt in record-breaking extreme heat events, poor air quality from wildfire smoke and more frequent and intense precipitation events.

A Climate Impacts Group Special Report from 2015 indicated that the Puget Sound region (containing Seattle) had warmed 1.3 degrees between 1895 and 2014 with significant warming in all seasons except spring. This warming trend is projected to continue through the 21st century with rate dependent on emission level, effecting all seasons with almost certainly more frequent and extreme heat events.

Additional extreme heat days will directly impact public health in western Washington. A separate CIG report on the health implications of climate change highlighted that mortality, hospitalizations and emergency medical service call rates increased significantly on days over 97 degrees. Areas of Puget Sound with the most paved surfaces, can be up to 20 degrees warmer than other and have the highest concentration of populations already impacted by health-related inequities and disparities.

Location: India

India is the second most populace country in the world with 1.3 billion people and the third largest emitter of greenhouse gas emissions after China and the United States. Although India has experienced rapid economic growth over the last few decades, a significant percentage of the population remain either poor (28% - 364 million) or in extreme poverty (13.5% - 176 million). According to the World Bank, nearly two-thirds of India’s population is either directly or indirectly dependent on agriculture for their living. Population density, social vulnerability and dependence on agriculture contributes to high climate change vulnerability.

Out of 191 countries, India ranks 29th in terms of vulnerability to climate change. Its primary exposures include extreme heat, flooding, cyclones and drought. The effects of climate change are already becoming evident as the frequency and intensity of droughts increased significantly between 1951 and 2016, water scarcity has become a primary issue and India/Bangladesh account for 86% of total global mortality from cyclones which have grown stronger and more frequent in recent years. Population displacement associated with natural disasters has become a nearly annual occurrence, with over 5 million forced from their homes in 2019 alone.

Climate Change and Health Series - Food Systems

Food cultivation accounts for over one-third of annual greenhouse gas emissions. Carbon dioxide, methane and other emissions directly contribute to human-caused climate change, with diverse impacts on food systems. These include reduced crop productivity and viability due to extreme weather events, increased temperatures and decreased water availability (drought). A brief overview of how these impacts may effect human health:

Drought

The effects of extreme drought are visible right now in the United States, where nearly 10% is in a state of ‘exceptional drought’ due to reduced snowpack, record-breaking extreme heat and population growth. California, which grows 25% of the national food supply, has been especially impacted with widespread water scarcity driving up production costs, with an associated increase of up to 40% in food prices for staples such as beef, pork and milk compared with 2020 levels.

Food-borne illness

Over 9 million cases of foodborne disease are diagnosed each year in the United States. Many of the pathogens that cause these illnesses are known to be influenced by climate change-related variables such as air temperature, water temperature and precipitation. Increased air and water temperatures and extended summer seasons are associated with more vibrio, E.Coli and Salmonella infections.

Food insecurity

Climate change impacts reducing crop yields worldwide and worsening malnutrition. Global yields of corn, wheat, soybeans have declined in recent years, with vital agricultural areas in Africa and Asia projected to lose 20-60% of viable acreage by 2098, based on an anticipated temperature increase of 2.6 to 4 degrees Celsius. This will likely increase food insecurity in developing countries where malnutrition is already a major cause of premature death and disease. This includes 45 percent of deaths in children under 5 and 35 percent of the overall disease burden. The United Nations estimates that over 700 million people worldwide suffer from severe food insecurity.

Workers

Climate change impacts such as extreme heat directly threatens the health of thousands of agricultural workers. This large, critical workforce is at increased risk for dehydration, heat stroke, exacerbation of existing chronic disease and even death. A report from the Centers for Disease Control and Prevention found that farmworkers die at 20 times of heat the national rate. Over 350,000 are employed in California’s Central Valley alone, which has experienced historic heat waves in recent years and climate models project over 40 extreme heat days per year by 2050.

Climate Change and Health Series - Air Quality and Public Health

Climate change impacts, including higher temperatures, longer/more extreme wildfire seasons and increasing ground-level ozone may worsen air quality. Poor air quality is associated with several health effects including diminished lung function, asthma attacks, coughing and long-term exposure can increase risk of lung cancer, cardiovascular disease and developmental issues in children. Poor air quality contributes to more than 4 million deaths per year worldwide.

Ground-level Ozone

Ground-level ozone is created when pollutants emitted by vehicles, refineries, power plants and other sources react in heat and sunlight. Higher temperatures and increasing stagnant air conditions associated with climate change are generally projected to worsen ground-level ozone concentration. Ozone is a primary component of smog and associated with chest pain, coughing, throat irritation, reduced lung function and worsened emphysema and asthma. The U.S. Climate and Health Assessment projects tens to thousands of excess deaths attributable to climate-driven increases in ozone by 2030, unless off-set by significant decreases in overall pollutant emissions.

Wildfires and Particulate Matter (PM) 2.5

Particulate matter 2.5 refers to particles of dust, dirt, soot and chemical pollutants which are small enough to be inhaled and can lead to severe health impacts. These include cardiovascular disease, asthma, chronic obstructive pulmonary disease (COPD). Wildfires are a major annual source of PM2.5 in the United States, have grown more frequent and intense and are projected to worsen in the future due to climate change. Record breaking wildfires in recent years have contributed to hazardous air quality in the western United States. For example, in late summer 2020, smoke from fires in Oregon, California and Washington State caused the Pacific Northwest to experience the worst air quality in the world for several days. A health impact assessment conducted by researchers at the University of Washington found increased PM2.5 concentration during the 2020 poor air quality event was associated with increased all-cause mortality, cardiovascular disease and respiratory disease deaths.

Allergens

Outdoor allergies effect more than 25 million people in the United States and are one of the most common health issues for children. The production and distribution of airborne allergens such as pollen and mold spores may be influenced by climate change. For example, rising temperatures and delayed frost in the Midwest has contributed to lengthening of the ragweed pollen season.

Vulnerable groups

The elderly, children, immunocompromised and those with preexisting conditions are most at-risk from poor air quality. There also is a connection between socioeconomic status, air quality and associated disease risk in the United States. Low-income communities are more likely to live in neighborhoods with high concentrations(s) of ozone, PM2.5 and other pollutants relative to other areas. This disparity is reflected in prevalence of respiratory diseases such as asthma, rates are 11% higher among those with a family income below the Federal Poverty Level compared with those above.

Oversight

The Clean Air Act (1970) granted authority for air quality monitoring and regulation to the Environmental Protection Agency. State, local and tribal air agencies also complete these functions but are not permitted to establish weaker standards than those established by EPA. Addressing climate change has been restored as an EPA priority after removal during the trump Administration. This includes development of tools to identify those communities most at-risk from climate change impacts such as increased PM2.5 and ozone concentration.

Climate Change and Health Series – How Does Climate Change Impact Public Health?

The highlight of my career (thus far) has been to work at the intersection of climate change, public health and equity between 2017 and 2020.  This included serving on an interdepartmental Climate Health Action Team at a local health department and six-month practicum project supporting development of climate change and health messaging tailored to specific populations.

Key takeaways from those efforts included: 1: most people in the United States accept that climate change is real with immediate and long-term impacts. 2: the attitudes of many Americans regarding climate change tend to be interwoven with their political and religious beliefs and perceived connection to nature.  3: few people in the United States are aware of climate change-related health impacts. 4: national, state and local public health agencies have only recently begun integrating consideration of climate change into programs, services and messaging. 5: placing climate change messaging  within a health impact context can effectively build knowledge and motivate behavior change.

My goals for this post are to address key takeaway #3 in building awareness of connections between climate change and health impacts, how severe these impacts are projected to be in the future and how these impacts are/will disproportionately affect certain populations more than others.

Temperature and extreme heat

Arguably, the most direct connection between climate change and health is temperature. Annual temperatures in the United States have increased over the past few decades and 1.8 degrees relative to last century. Average temperatures are expected to increase by at least 2.5 degrees over the next several decades and between 3-12 degrees by 2100 depending on global emission levels. This may seem like a modest rise overall but will not be uniformly distributed and extreme heat events (temperatures dramatically above normal for a specific geographic area) are also projected to worsen significantly. Direct heat-related health impacts include heat stroke, exhaustion, and dehydration. Studies have also linked extremely hot days with increased demand for emergency medical services, hospitalizations and premature deaths. Equity consideration: Dense urban areas with limited green space and a high concentration of concrete and asphalt can be 5-10 degrees warmer than suburban and rural areas, placing populations who live there, including a disproportionate number of African Americans (52% more likely than whites), Asians (32%) and Latinos (32%) at highest risk during heat waves.

Extreme weather events

The historic winter storm that hit Texas in mid-February caused widespread power and water outages, significant crop loss and the premature deaths of over 75 people. It was also the latest example of an alarming rise in the number of global natural disasters. A United Nations report cited 7,348 major natural disasters occurred between 2000 and 2019, as compared to 4,212 natural disasters in the previous 20 years. Climate-related natural disasters have also risen 83 percent over the past two decades. Extreme weather events have several direct and down stream impacts on public health. There is the immediate loss-of-life and serious injuries, which often disproportionately impact the most overburdened populations, for example those experiencing homelessness, occupying substandard housing, limited-English proficient (less likely to receive emergency messaging). Major disruptions of agriculture, as resulted from the Texas winter storm, with the near or total loss of 37 major crops, also have broad impacts which most threaten at-risk communities. For example, food banks already facing unprecedented demand due COVID-19, are expecting to provide less food as a result of the storm.

Vector-borne diseases

Warming temperatures are expanding suitable habitat for insects such as mosquitos and ticks which can carry malaria, West Nile, Lyme disease and other serious illnesses. Lyme disease is transmitted to humans through tick bites – historically, ticks were only found in the Northeastern U.S. but have increasingly been identified in the Midwest. Unsurprisingly, expanded tick habitat has resulted in more cases of Lyme disease. The number of annual cases of Lyme disease in the United States has risen from around 10,000 in 1991 to 28,000 in 2018. A study by Carnegie Mellon University predicts that at the rate of current warming, the number of Lyme disease cases will increase by 21 percent by 2050. Agricultural workers are at especially high risk of contracting Lyme disease. This includes migrant, seasonal farmworkers who may have limited access to healthcare, are more likely to be uninsured with less financial resources to afford antibiotics critical for treatment and generally less likely to report potential cases.

Extreme precipitation

Rainstorms are increasing in strength due to climate change. This is especially relevant in the Pacific Northwest, where a study by Seattle Public Utilities found that extreme rainstorms have grown 30 percent stronger over the past 15 years. Heavy precipitation is a direct contributor to waterborne disease outbreaks, with a study published in the American Journal of Public Health reviewed finding over 50 percent of waterborne disease outbreaks in the United States were preceded by a precipitation event. According to the CDC, waterborne illnesses such as “swimmer’s ear,” Norovirus, Giardiasis and Cryptosporidiosis impact over 7 million people each year in the U.S.

These are only a few key examples of how climate change is impacting public health. Other less direct connections, which may be topics of future posts, include climate change and global/local food systems, workplace and population displacement. Overall, climate change will present added challenges for already overburdened populations, who have contributed the least to the problem but face the greatest impact(s).

Climate Change and Health Series - Introduction

The next (tentatively) five posts will focus on the intersection of climate change and public health. This is an area of great personal interest/concern, which I have had the opportunity to work in directly through professional roles and a grad school practicum project over the past few years. A brief overview, reason(s) for series and topics to be covered are below.

Overview

Climate change presents diverse threats to human health. The World Health Organization estimates that increased extreme heat, precipitation, weather events and other symptoms of climate change contribute to more than 150,000 annual deaths worldwide, a number which is projected to rise above 250,000 by 2030. Populations in areas of greatest risk, such as rural sub-Saharan Africa and Asia have contributed the least to climate change.

Motivation

I want to explore climate change and health for several reasons:

·       A new policy era: The Biden Administration has committed to addressing climate change after a near total retreat from action over the past four years. This includes rolling back Obama-era environmental and emission regulations, installing energy industry lobbyists at EPA/Interior and exiting the Paris Climate Accord.

·       Resources: There is a growing body of research on the effects of climate change on global public health. For example, last week The Lancet released a comprehensive report on climate change and health impacts across 43 indicators, summarizing the findings of leading academic institutions and UN agencies. Additionally, significant resources are available through the UN, National Institutes of Health, CDC, academic institutions including the Climate Impacts Group (University of Washington) here Washington State.

·       Excuse/opportunity to review latest climate change/health research: :)

Topics*

·       Impacts

·       Vulnerabilities

·       Mitigation/adaptation strategies

·       Management and policy

·       Communication

*topics may be updated

For next post: Climate Change and Health Impacts

COVID-19 and Food Insecurity

The United States has the largest economy in the world with a total gross domestic product ($18.71 trillion) which far outpaces China ($11.14 trillion). Abundant natural resources and highly mechanized agriculture has enabled the United States to become one of the top producers of food in the world, including corn (#1), beef (#1), chicken (#1), wheat (#3), potatoes (#5) and a significant percentage of many fruits and vegetables. However, despite great wealth and bounty, food insecurity impacts millions of Americans and has significantly worsened during the COVID-19 pandemic.

Chronic food insecurity in the United States

Hunger is a chronic issue in the United States and worse here than in many other industrialized nations. 21% of U.S. respondents to a 2011/2012 Gallup poll reported difficulty affording basic food, in comparison with participants from the United Kingdom (8%), Sweden (6%) and Germany (5%). The percentage of U.S. households experiencing food insecurity has hovered at or above 10% for the last decade, with 10.7% or 13.7 million households reporting food insecurity in 2019. Food insecurity is not equitably distributed in the U.S. population, as households with children are 1.5 times as likely as those without children to experience food insecurity, and Black, Latinx, single parents and low-income households are disproportionately impacted.

COVID-19

The COVID-19 pandemic has directly contributed to rising food insecurity in several ways. Over 14 million Americans became unemployed between February and May 2020, and although the economy has shown signs of recovery, the unemployment rate is still nearly double pre-pandemic levels (3.5% (February 2020) vs. 6.9% (October 2020)). Many unemployed who were buoyed by early stimulus payments/unemployment benefits have exhausted their savings in recent months and are unable to afford food. Feeding America, the largest food bank non-profit in the United States, reported 4 in 10 of those visiting food banks since March were receiving assistance for the first time. Food banks and other social service non-profits are heavily reliant on private donations and volunteers, many of whom are elderly and most at-risk from COVID-19, have experienced significant declines in volunteerism, donations and fund-raising activities. School closures have reduced or eliminated access to free breakfast, lunch and take-home meals for many children from low-income families. A survey by the School Nutrition Association found 80% of respondents representing nearly 2,000 districts were providing less meals than before the pandemic.

Ways to give

Food insecurity is an issue which will almost certainly worsen in the short-term as the United States continues to report over 150,000 cases and 1,000 deaths per day, anticipated surges from Thanksgiving/Christmas travel and gatherings and with widespread vaccination not likely before spring 2021. If you are able – below are two very well-regarded non-profit organizations offering direct food assistance and other services and accept donations/volunteers:

·       Feeding America (Nationwide)

·       Northwest Harvest (Washington State)

Affordable Care Act

Constitutionality of the Affordable Care Act (ACA) is currently being debated before the Supreme Court. Passed during the Obama Administration, this health reform package has provided coverage for those with pre-existing conditions, enabled states to dramatically expand Medicaid access and individuals to purchase subsidized private health insurance policies through state and federally administered health insurance marketplaces. For this post I wanted to take a closer look at the ACA, associated impact on insurance coverage access, efforts by the Trump Administration and (primarily) Republican-led states to weaken and/or overturn the law and how it might be expanded in a Biden presidency.

How did we get here?

The United States is unique among industrialized nations in not ensuring healthcare coverage to every citizen. Our reliance on a patchwork of public/private health insurance programs resulted in spiraling numbers of uninsured through the mid-2000s. Over 46 million (14% of total U.S. population) were uninsured when the Affordable Care Act was signed into law in 2010. This included many with serious underlying health conditions and financially vulnerable but with incomes just over the threshold to qualify for Medicaid. The burden of paying for medical treatment out-of-pocket fueled a steep rise in bankruptcy filings throughout the 2000s, with medical bankruptcies accounting for over 60% of all filings starting in 2007.

The Affordable Care Act contains several components intended to dramatically increase access to health insurance coverage and lower out-of-pocket expenses. These include:

• Medicaid expansion: the federal government covers 90% of total costs incurred by individual states that choose to expand Medicaid eligibility to those making up to 138 percent of the federal poverty level. 39 states have opted for Medicaid expansion.

• Health insurance exchanges: individuals who do not receive health insurance coverage through their employer or do not qualify for Medicaid can purchase private insurance plans on a state or federally administered marketplace, and based on their income, receive a subsidy for a portion or all of the monthly premium. 15 states currently operate their own health exchange with the federal government handling administration for the other 35.

Others:

• Small Business Health Options Program (SHOP): enables small businesses with up to 50 employees to build a customized insurance offering for their employees, purchase in a competitive marketplace and potentially receive significant federal tax credits.

• Ability for young adults to stay on parent’s insurance until age 26: prior to the ACA most health plans would remove young adults from their parent’s insurance plan upon turning 18. Young adults were the most likely to be uninsured due to being in school, working part-time jobs and/or changing jobs frequently.

What has been the impact of the ACA?

Access

Overall, the ACA has significantly reduced the number of uninsured in the United States – falling from 46.7 million (2010) to 27 million (2019). Medicaid expansion has extended insurance coverage to an additional 14.2 million with large increases in expansion states and more modest gains elsewhere. An average of 11.5 million have purchased subsidized health insurance through a state marketplace since 2015.

Cost

The impact of the ACA on cost varies based on coverage source (i.e. state exchange or employer-sponsored). Individuals and families with employer-sponsored coverage on average are contributing two percent more of their annual income than in 2008 and premiums, deductibles and out-of-pocket costs have generally increased every year since 1999. Premiums for small businesses participating in the SHOP marketplace have grown around 5% per year, although this increase is significantly less than in the years prior the ACA. The gross cost (before subsidy) of ACA marketplace plans decreased between 2019 and 2020 after generally increasing since 2014 - the first year of ACA implementation. Of course, most marketplace enrollees qualify for a subsidy, and the net (after subsidy) premium cost also decreased between 2019 and 2020. The major takeaway on cost, is those most in need of premium assistance (i.e. low-income individuals and families), are paying much less out-of-pocket for health insurance coverage than before health reform.

How has the Trump Administration (and GOP allies) attempted to undermine and overturn the ACA?

The ACA has been under constant attack since 2016. The administration and its Republican allies in Congress have sought to weaken (if not fully repeal) the law through policy, legislative and legal means:

• Policy: eliminated subsidies for insurers who offered plans in state exchanges, significantly reduced navigator assistance and outreach/marketing funding for health insurance exchanges and allowed short-term health insurance plans that did not provide ‘essential benefits’ to reenter marketplace.

• Legislative: eliminated individual mandate/penalty for no insurance. This removed financial incentive for many healthy, young adults to be insured and supported legal challenges to the ACA.

• Legal: there have been over 2,000 legal challenges to the ACA since 2010. These have resulted in Medicaid expansion remaining optional for individual states (leaving an estimated 2 million without access to health insurance), allowed employers with a religious objection to not cover contraception and directly challenged the constitutionality of the law. The Supreme Court has twice ruled the law is constitutional and in response to a current challenge by 18 states and the Trump Administration which argues that removal of the individual mandate/penalty invalidates the entire law, seems poised to decide again in its favor.

These actions have contributed to an increase of 2 million in the total number of uninsured since 2016. 20 million more would be added if the current legal challenge is successful and ACA is overturned by the Supreme Court.

How would a Biden Administration expand on the ACA?

President-elect Biden has proposed two broad strategies for building on the Affordable Care Act:

• Lowering the Medicare eligibility age from 65 to 60: this could potentially increase enrollment by 23.

• Public option: creates an affordable federally administered health plan offered on state health exchanges and allows those with employer-sponsored insurance who may be eligible for a subsidy to opt out and select a lower-cost, potentially more comprehensive insurance plan on a state health exchange.

The likelihood of either strategy being adopted is heavily dependent on whether the Democrats take control of the Senate. Two run-off Senate races in Georgia will likely chart the near term direction of healthcare reform in the United States.

Environmental Policy under the trump Administration

Election day. The potential for change in presidential (and congressional) leadership prompted a look into what might be the most damaging outcome from the last four years. Environmental policy under the trump administration has aggressively prioritized deregulation of fossil fuel industries, opening public lands to energy exploration, reducing protections for threatened/endangered species, weakening industrial/automobile emission standards and abandoning international commitments to address climate change.

Regulatory agency leadership recruited directly from industry

Despite pledging to “drain the swamp” during the 2016 presidential campaign, the trump administration has installed former fossil fuel executives and lobbyists in senior regulatory leadership positions. This includes Andrew Wheeler, EPA administrator and David Bernhardt, Secretary – Department of Interior, who both lobbied on behalf of the oil and gas industry. Nearly 50% of total political appointees to the EPA and Interior have close ties to the industry. Advisory committees, which are responsible for informing policy development and under prior administrations were staffed with scientists and academics, have been filled with industry representatives that have not been vetted through the federal ethics review process.

Public lands opened for economic activity

The administration has overseen the largest reduction of protected lands in U.S. history. This includes a 51% reduction to Grand Staircase-Escalante and 85% reduction to Bears Ears National Monuments in Utah. Additionally, the Department of Agriculture recommended a significant portion of the 9.37 million acre Tongass National Forest in Alaska be opened for logging operations. If not permanently blocked through legal action or reversed by a new administration, these actions would endanger plant/animal species and increase vulnerability to climate change as forests prevent a significant amount of greenhouse gas gases from entering the atmosphere.

Removing protections for threatened and endangered species

Another strategy designed to ease fossil fuel development is weakening protections for threatened and endangered species. The Department of Interior has proposed broad revisions to the Endangered Species Act that reduces protections for species classified as ‘threatened’ and allows for consideration of economic factors in determining if a species is listed as ‘endangered.’ This could result in species left without critical protections at a time when a U.N. report has warned as many as 1 million plant and animal species are in danger of extinction worldwide.

A retreat from climate action

The United States accounts for the second most annual carbon dioxide emissions in the world. Carbon dioxide is the primary driver of human caused climate change that disproportionately impacts low-emitting countries in the developing world. Recognition of the need for global action to address climate change prompted 195 countries, including the United States (under the Obama Administration) to adopt the Paris Climate Accord in 2016. This agreement established targets of 20% reduction of carbon dioxide, 20% increase of renewable energy market share and 20% increase in energy efficiency for member countries and $100 billion in annual contributions from industrialized countries, to support mitigation and adaptation strategies in developing nations.

Despite mounting evidence of climate change impacts such as record-breaking heat waves, wildfires, hurricanes, the trump Administration announced the U.S. would become the first (and still only) country to withdraw from the Paris Climate Accord in 2017. This dramatic signal of climate change apathy has been followed by a dismantling of Obama-era regulations designed to reduce carbon emissions. This includes removing greenhouse gas emissions targets from the Clean Power Plan for industrial polluters and reducing automobile fuel efficiency standard increases from 5% to 1.5% per year. These changes are projected to result in over 1 billion additional metric tons of carbon dioxide emitted annually in the United States.

Health Disparities in the U.S. - Part 3

Why are there chronic health disparities in the United States? This is the third post in a series exploring this question through review of a specific contributing factor. The first two entries looked at the influence of health insurance access and socioeconomic status on health outcomes. The topic of this post is geographic area. Rapid industrialization, transition from family to large-scale commercial farming and associated population migration from rural to urban areas has contributed to inadequate healthcare facilities/services, limited insurance coverage options and health disparities in the rural United States.

Demographics and context

According to the Census Bureau, rural areas contain 19.3 percent of the total U.S. population, totaling 60 million people. A significant majority (80%) of U.S. residents live in urban areas. This reflects a long-term population shift from rural to urban areas that started in the early 20th century. Rural residents are generally older (median age: 51), with more than 20 percent of the population in many counties being 65 or older, less likely to have a college degree (19 percent) and are much less ethnically diverse (79% white) than those in urban areas (44% white).

The number small family farms have declined significantly over the past century with the rise of large-scale, factory farming. A report from the United States Department of Agriculture cited a decrease of 2 million farms between 1935 and 2012, with the same total acres of farmland being held in far fewer, much larger farming operations. The total rural labor force has declined significantly in recent years with a net 277,000 reduction between 2013 and 2017. Declining economic opportunity is also reflected in overall poverty rate (16.4 percent vs. 12.9 percent in urban areas) with the percentage of children growing up poor (25 percent vs. 20 percent in urban areas).

Limited healthcare facilities, personnel and resources

Residents of rural areas are more likely to be uninsured (12.3%) than those in urban areas (10.1%) and states with substantial rural populations have been less likely to pursue Medicaid expansion as outlined in the Affordable Care Act. For those able to afford subsidized private insurance, the number of available insurance carriers has declined in many rural areas with large portions of Alaska, Mississippi, Alabama, North Carolina and the entire state of Wyoming having only 1 participating carrier in the state Affordable Care Act Marketplace.

A review by Forbes found rural areas had around 20 less total physicians per 10,000 people than in urban areas. The disparity is even worse for specialty care with only 30 specialists per 100,000 people in rural areas contrasted with 263 specialists per 100,000 urban residents. 60 percent of rural residents live in an area without sufficient mental health providers to meet the needs of community and over 50 percent lack a provider licensed to provide treatment for opioid addiction. Access to emergent care has also declined with 112 hospital closures in rural counties over the past decade.

Health disparities between rural and urban residents

Rural communities are in general, less healthy and have worse health outcomes than residents in suburban and urban areas. For example, rural areas have higher rates of serious chronic diseases including heart disease, cancer, respiratory illnesses and stroke and significantly more unintentional injuries. Rural residents are also more likely to use tobacco and have been disproportionately impacted by the opioid epidemic, with a rate of overdose deaths 45% higher than in urban areas. These disparities are also reflected in mental health illnesses and outcomes, with a higher incidence of depression, reported economic, mental and family-related distress and suicide.

Health Disparities in the U.S. - Part 2

What factors contribute to chronic health disparities in the United States? This is the second post in a series exploring that question through discussion of a specific factor. Post 1 addressed the influence of health insurance structure, coverage disparities and associated impact on health status/outcomes (post 1 link here).

This post focuses on a closely related factor – socioeconomic status. Income level is one of the strongest predictors of access to necessary medical care, chronic disease risk/management, risk of premature death and life expectancy.

The poor have less options for basic care

Over 74 million low-income adults and children are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The cost of their medical and dental care is covered through reimbursement payments to each healthcare provider. A major issue disincentivizing many providers from accepting Medicaid patients is a reimbursement rate (amount of payment received for service) that is much less on average than private insurance and only 72% of Medicare. Medical providers are far less likely to accept Medicaid patients (71%) than Medicare (85.3%) and privately insured (90%). Access to dental care is even more restricted as not all state Medicaid programs provide dental benefits and only 38 percent of dental practices accept Medicaid. Scheduling and attending appointments are more burdensome for Medicaid enrollees, who wait 24 days to schedule an appointment and are 20% more likely than privately insured patients to wait more than 20 minutes at the appointment.

High prescription drug costs

Prescription drugs cost 80-150% more in the United States than in other industrialized countries. In a poll conducted by the Kaiser Family Foundation, nearly 25% of respondents reported difficulties affording their prescriptions including a significant percentage of those with incomes less than $40,000 (35%). The Harvard School of Public Health similarly reported that one out of every four patients unable to fill a prescription for themselves or a family member due to cost. This could have severe health consequences for those with chronic diseases requiring daily medication management such as diabetes. The cost of insulin in the U.S. has risen by more than 1000% since 1999 and diabetics who are unable to afford their regular scheduled dose risk blindness, stroke, kidney failure, limp amputation and even death.

Life expectancy, chronic disease and mortality risk

Poor individuals in the United States are more likely to be impacted by serious chronic illnesses including heart disease, diabetes and several types of cancer. For example, a study conducted by the National Cancer Institute (NCI) found those with family incomes less than $12,500 were 1.7 times more likely to develop lung cancer than those with incomes $50,000 or higher. This could be attributable to significantly higher smoking prevalence among below the poverty line (41.1% (men)/32.5% (women)) compared with those at or above (18.3%).

Unsurprisingly, given the disparities in healthcare access, prescription drug costs, disease risk, and other factors highlighted above, life expectancy also varies widely by socioeconomic status in the United States. Top income earners live over 12 years longer on average than the very poor, and have gained six years of longevity since 2000 as compared to no change for those at the lowest income levels. Overall U.S. life expectancy decreased for the first time since the World War I/Spanish Flu era of 1915-1918 between 2015 and 2018. This four-year decline was driven primarily by the opioid epidemic which claimed over 200,000 lives and disproportionately impacted low-income communities.

Inequitable impact of COVID-19

The COVID-19 pandemic has infected over 8 million and killed more than 220,000 U.S. residents. It has also underscored the risk to groups already experiencing chronic inequities. Black, Latinx and American Indian/Alaska Native populations have higher rates of poverty, are more likely to uninsured with less access to healthcare services and are far more likely to be infected, require hospitalization and die from COVID-19 than whites.

Health Disparities in the U.S. - Part 1

Bellevue and Auburn are two cities in Western Washington State separated by less than 25 miles. Residents of Bellevue live 10 years longer on average than their counterparts in Auburn. What factors and underlying context(s) account for this disparity? This question is far too broad/complex for a single brief post (innumerable academic articles, books and textbooks on this topic run to thousands of pages), so I decided to spend each of the next few posts discussing a specific element contributing to health disparities in the United States. The focus of this post is likely for many the most relevant/obvious contributor to health status – health insurance coverage.

Structure and coverage

The United States is one of the only industrialized nations which does not provide universal healthcare coverage to all residents. Instead coverage is obtained through a patchwork system of privately purchased, employer-sponsored or government subsidized private insurance plans and state/federal government administered insurance for low-income, disabled, military and elderly via programs including Medicaid, Medicare and Tricare. Historically this system has left many in the U.S. without access to insurance coverage. Prior to passage of the Affordable Care Act (ACA) in 2010 that introduced government subsidized private insurance and provided an opportunity for states to dramatically increase access to Medicaid, there were 46.5 million uninsured. The ACA enabled almost 20 million additional individuals to gain insurance coverage between 2014 and 2016, but the number of uninsured has risen by over 1 million since 2016 and stands at 27.9 million. This includes over 2 million people stuck in a ‘coverage gap’, who are unable to afford private insurance, and reside in states including Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming that have declined to expand Medicaid. As we can see there is a strong regional trend in that nearly all are southern states and (perhaps unsurprisingly) have high rates of uninsured (over 10%) compared with the national average (8.9%) and most other states.

Demographics

Insurance enrollment varies widely based on race and ethnicity. White (8% uninsured) and Asian/Native Pacific Islander (7%) are significantly less likely to be uninsured than Black (11%), Hispanic (19%) and American Indian/Alaska Native (22%) residents. Unsurprisingly, there is also an inverse correlation between income level and uninsured rate –  over 36% those below the federal poverty line (FPL) (<$26,200 annual earnings for a family of 4) in states without Medicaid expansion are uninsured, as compared to only 7% of residents at or above 400% of FPL ($104,800 – family of 4). This disparity is much less significant in Medicaid expansion states with 16% at FPL uninsured as to 4% at or above 400% of FPL.

Health status and outcomes

Insurance coverage is a key predictor of health status and outcomes. Studies have consistently found those without health insurance are far less likely to access preventative care and medical screenings, have worse outcomes from chronic diseases such as diabetes, heart disease, renal disease, HIV and mental illness, receive fewer hospital services and are at higher overall risk of premature death. Insurance also reduces existing disparities between population groups driven by a lack of access to preventive services such as screenings. For example, African Americans are 20% more likely to get colorectal cancer than other population groups and often lack access to preventive screenings due to no or limited insurance coverage - a study estimated that gaining comprehensive health insurance would result in a 5% increase in colorectal screenings.

For next post: socioeconomic status and health

COVID-19, Climate Change and Public Health

The COVID-19 pandemic and an historic wildfire season have exposed a chronically under-resourced public health sector and vulnerability to the growing impacts of climate change.

Over 7.5 million people have contracted COVID-19 with 211,000 deaths. The pandemic has dramatically impacted the U.S. economy with nearly 8% unemployment and 14 million residents applying for unemployment insurance coverage since April. As a result, food banks are experiencing record demand, millions are unable to pay their rent/mortgage and at-risk of eviction and hundreds of thousands of small businesses may be forced to permanently close.

An historic wildfire season has presented a second major crisis for millions of residents in several western states including California. Many in the immediate path of fires have been forced to evacuate and traditional places of refuge such as schools, community centers and churches are less available and/or safe due to concerns of COVID-19 transmission. Extreme poor air quality from wildfire smoke impacted communities from southern California to the Canadian border, and is especially hazardous to those with preexisting respiratory illnesses, who are already at greatest risk if infected by COVID-19.  

The scale of wildfires in California is unprecedented with over 4 million acres burned in 2020 (thus far), a single year record and more than the last three years combined. The effects of climate change such as warmer temperatures, more extreme heat events, shifting precipitation patterns and drier forests, when combined with high winds, create ideal conditions for catastrophic wildfires. Climate scientists project overall warming, the frequency of extreme heat events and severe wildfire seasons to accelerate in the future. This presents enormous challenges for government agencies stretched thin by declining resources.

Public health has been especially hard hit in recent years. State and local health departments have lost over 55,000 positions due to funding cuts since 2010. The United States spends $3.6 trillion on healthcare each year, but only 3% is allocated for public health and prevention. COVID-19 response has suffered from inadequate trained staff to implement testing sites, conduct contact tracing, develop multi-lingual information and resources, complete outreach in especially vulnerable communities etc.

Strengthening our public agencies is a critical step towards building the capacity necessary to better address future climate change and public health challenges.

Litter.

I frequently travel Highway 104 between the Kitsap Peninsula and Olympic National Park and have always been disturbed by the volume of litter next to the roadway. This road serves as the primary conduit for over 3 million annual visitors to the national park - an incredibly unique and ecological diverse area that includes the Hoh rainforest, old growth forests, snowcapped mountains, glaciers, rocky coastline, natural lakes and thousands of plant and animal species. The decision by so many to visit a place of stunning natural beauty and leave piles of trash is baffling and prompted a look into the amount, applicable laws, clean-up costs and environmental impact of litter in the United States.

Litter volume, demographics and cost

A multi-year study completed by Keep America Beautiful estimates there are over 50 billion pieces of litter on roadways in the United States. The majority of litter is intentionally discarded by motorists, who are generally younger and male. Cigarette butts are by far the most commonly littered item, followed by paper items (i.e. fast-food wrappers, bags, cups), plastic bottles and beverage cans. The high frequency and volume of littering comes despite laws in all 50 states that mandate fines, imprisonment, or both. However, with over 47,000 miles of interstate highway and 4 million navigable roadways in the United States, meaningful enforcement seems completely unrealistic. State and local municipalities and volunteers are left with the burden of clean-up, which costs an estimated $11.5 billion annually.  

Impact

Litter can harm the environment, wildlife, and human health in several ways. Trash, especially plastic debris can contribute to habitat degradation, be consumed by animals, toxic chemicals such as PCBs are transported in stormwater, have been shown to damage marine organisms and may also contaminate drinking water. Litter also releases methane, a greenhouse gas many times stronger than carbon dioxide, and primary contributor to climate change.  

What can we do?

Making a meaningful dent in the litter accumulating on roadways in the United States seems like an insurmountable challenge. However, an additional finding from the Keep America Beautiful study is instructive - “People are much more likely to litter into littered environments.” This highlights the dual impact of litter clean-up activities, in both removing existing litter and discouraging future littering. I would add a third assumption/impact – people are much less likely to litter along a road if they see others actively picking it up.

I’m in the process of testing this assumption through weekly litter clean-up sessions along Highway 104 and will dedicate a future post to these experiences (it’s very fulfilling).

A beginning

Hey, my name is Colin, a (very) amateur landscape photographer and public health professional, raised and based in Washington State.

I started the ‘2050 blog’ to discuss areas of passion such as public health, climate change, environmental conservation, the Seattle Mariners etc. My goals for this site are to highlight specific topics/issues, provide useful information, links and resources and prompt discussion/reflection.

 A bit of housekeeping:

Post frequency: 1-2 per week dependent on schedule

Sources: hyperlinked in text

Photos: all images published on the blog were taken by me unless otherwise credited

Communication: please feel free to connect via the ‘Contact’ page or write to twentyfiftyblog@gmail.com

Thanks for reading!