Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures.

California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.

Future fire emissions associated with projected land use change in Sumatra.

Indonesia has experienced rapid land use change over the last few decades as forests and peatswamps have been cleared for more intensively managed land uses, including oil palm and timber plantations. Fires are the predominant method of clearing and managing land for more intensive uses, and the related emissions affect public health by contributing to regional particulate matter and ozone concentrations and adding to global atmospheric carbon dioxide concentrations. Here, we examine emissions from fires associated with land use clearing and land management on the Indonesian island of Sumatra and the sensitivity of this fire activity to interannual meteorological variability. We find ~80% of 2005-2009 Sumatra emissions are associated with degradation or land use maintenance instead of immediate land use conversion, especially in dry years. We estimate Sumatra fire emissions from land use change and maintenance for the next two decades with five scenarios of land use change, the Global Fire Emissions Database Version 3, detailed 1-km2 land use change maps, and MODIS fire radiative power observations. Despite comprising only 16% of the original study area, we predict that 37-48% of future Sumatra emissions from land use change will occur in fuel-rich peatswamps unless this land cover type is protected effectively. This result means that the impact of fires on future air quality and climate in Equatorial Asia will be decided in part by the conservation status given to the remaining peatswamps on Sumatra. Results from this article will be implemented in an atmospheric transport model to quantify the public health impacts from the transport of fire emissions associated with future land use scenarios in Sumatra.

Exploring spatial heterogeneity in synergistic effects of compound climate hazards: Extreme heat and wildfire smoke on cardiorespiratory hospitalizations in California.

Extreme heat and wildfire smoke events are increasingly co-occurring in the context of climate change, especially in California. Extreme heat and wildfire smoke may have synergistic effects on population health that vary over space. We leveraged high-resolution satellite and monitoring data to quantify spatially varying compound exposures to extreme heat and wildfire smoke in California (2006-2019) at ZIP Code Tabulation Area (ZCTA) level. We found synergistic effects between extreme heat and wildfire smoke on daily cardiorespiratory hospitalizations at the state level. We also found spatial heterogeneity in such synergistic effects across ZCTAs. Communities with lower education attainment, lower health insurance coverage, lower income, lower proportion of automobile ownership, lower tree canopy coverage, higher population density, and higher proportions of racial/ethnic minorities experienced higher synergistic effects. This study highlights the need to incorporate compound hazards and environmental justice considerations into evidence-based policy development to protect populations from increasingly prevalent compound hazards.

Air Pollution and Blood Pressure: Evidence From Indonesia.

Indonesia faces significant air quality issues due to multiple emissions sources, including rapid urbanization and peatland fires associated with agricultural land management. Limited prior research has estimated the episodic shock of intense fires on morbidity and mortality in Indonesia but has largely ignored the impact of poor air quality throughout the year on biomarkers of cardiovascular disease risk. We conducted a cross-sectional study of the association between particulate matter less than 2.5 microns in diameter (PM2.5) and blood pressure. Blood pressure measurements were obtained from the fifth wave of the Indonesian Family Life Survey (IFLS5), an ongoing population-based socioeconomic and health survey. We used the GEOS-Chem chemical transport model to simulate daily PM2.5 concentrations at 0.5° × 0.625° resolution across the IFLS domain. We assessed the association between PM2.5 and diastolic and systolic blood pressure, using mixed effects models with random intercepts for regency/municipality and household and adjusted for individual covariates. An interquartile range increase in monthly PM2.5 exposure was associated with a 0.234 (95% CI: 0.003, 0.464) higher diastolic blood pressure, with a greater association seen in participants age 65 and over (1.16 [95% CI: 0.24, 2.08]). For the same exposure metric, there was a 1.90 (95% CI: 0.43, 3.37) higher systolic blood pressure in participants 65 and older. Our assessment of fire-specific PM2.5 yielded null results, potentially due to the timing and locations of health data collection. To our knowledge, this is the first study to provide evidence for an association between PM2.5 and blood pressure in Indonesia.

Mortality attributable to PM2.5 from wildland fires in California from 2008 to 2018.

In California, wildfire risk and severity have grown substantially in the last several decades. Research has characterized extensive adverse health impacts from exposure to wildfire-attributable fine particulate matter (PM2.5), but few studies have quantified long-term outcomes, and none have used a wildfire-specific chronic dose-response mortality coefficient. Here, we quantified the mortality burden for PM2.5 exposure from California fires from 2008 to 2018 using Community Multiscale Air Quality modeling system wildland fire PM2.5 estimates. We used a concentration-response function for PM2.5, applying ZIP code-level mortality data and an estimated wildfire-specific dose-response coefficient accounting for the likely toxicity of wildfire smoke. We estimate a total of 52,480 to 55,710 premature deaths are attributable to wildland fire PM2.5 over the 11-year period with respect to two exposure scenarios, equating to an economic impact of $432 to $456 billion. These findings extend evidence on climate-related health impacts, suggesting that wildfires account for a greater mortality and economic burden than indicated by earlier studies.

Short-Term total and wildfire fine particulate matter exposure and work loss in California.

BACKGROUND: Few studies investigated the impact of particulate matter (PM2.5) on some symptom exacerbations that are not perceived as severe enough to search for medical assistance. We aimed to study the association of short-term daily total PM2.5 exposure with work loss due to sickness among adults living in California. METHODS: We included 44,544 adult respondents in the workforce from 2015 to 2018 California Health Interview Survey data. Daily total PM2.5 concentrations were linked to respondents' home addresses from continuous spatial surfaces of PM2.5 generated by a geostatistical surfacing algorithm. We estimated the effect of a 2-week average of daily total PM2.5 exposure on work loss using logistic regression models. RESULTS: About 1.69% (weighted percentage) of adult respondents reported work loss in the week before the survey interview. The odds ratio of work loss was 1.45 (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.03, 2.03) when a 2-week average of daily total PM2.5 exposure was higher than 12 µg/m3. The OR for work loss was 1.05 (95% CI: 0.98, 1.13) for each 2.56ug/m3 increase in the 2-week average of daily total PM2.5 exposure, and became stronger among those who were highly exposed to wildfire smoke (OR = 1.06, 95% CI: 1.00, 1.13), compared to those with lower wildfire smoke exposure (OR = 1.04, 95% CI: 0.79, 1.39). CONCLUSIONS: Our findings suggest that short-term ambient PM2.5 exposure is positively associated with work loss due to sickness and the association was stronger among those with higher wildfire smoke exposure. It also indicated that the current federal and state PM2.5 standards (annual average of 12 µg/m3) could be further strengthened to protect the health of the citizens of California.

Up in smoke: California's greenhouse gas reductions could be wiped out by 2020 wildfires.

In this short communication, we estimate that California's wildfire carbon dioxide equivalent (CO2e) emissions from 2020 are approximately two times higher than California's total greenhouse gas (GHG) emission reductions since 2003. Without considering future vegetation regrowth, CO2e emissions from the 2020 wildfires could be the second most important source in the state above either industry or electrical power generation. Regrowth may partly of fully occur over a long period, but due to exigencies of the climate crisis most of the regrowth will not occur quickly enough to avert greater than 1.5 degrees of warming. Global monetized damages caused by CO2e from in 2020 wildfire emissions amount to some $7.1 billion USD. Our analysis suggests that significant societal benefits could accrue from larger investments in improved forest management and stricter controls on new development in fire-prone areas at the wildland-urban interface.

Wildfire, Smoke Exposure, Human Health, and Environmental Justice Need to be Integrated into Forest Restoration and Management.

PURPOSE OF REVIEW: Increasing wildfire size and severity across the western United States has created an environmental and social crisis that must be approached from a transdisciplinary perspective. Climate change and more than a century of fire exclusion and wildfire suppression have led to contemporary wildfires with more severe environmental impacts and human smoke exposure. Wildfires increase smoke exposure for broad swaths of the US population, though outdoor workers and socially disadvantaged groups with limited adaptive capacity can be disproportionally exposed. Exposure to wildfire smoke is associated with a range of health impacts in children and adults, including exacerbation of existing respiratory diseases such as asthma and chronic obstructive pulmonary disease, worse birth outcomes, and cardiovascular events. Seasonally dry forests in Washington, Oregon, and California can benefit from ecological restoration as a way to adapt forests to climate change and reduce smoke impacts on affected communities. RECENT FINDINGS: Each wildfire season, large smoke events, and their adverse impacts on human health receive considerable attention from both the public and policymakers. The severity of recent wildfire seasons has state and federal governments outlining budgets and prioritizing policies to combat the worsening crisis. This surging attention provides an opportunity to outline the actions needed now to advance research and practice on conservation, economic, environmental justice, and public health interests, as well as the trade-offs that must be considered. Scientists, planners, foresters and fire managers, fire safety, air quality, and public health practitioners must collaboratively work together. This article is the result of a series of transdisciplinary conversations to find common ground and subsequently provide a holistic view of how forest and fire management intersect with human health through the impacts of smoke and articulate the need for an integrated approach to both planning and practice.

Fires, Smoke Exposure, and Public Health: An Integrative Framework to Maximize Health Benefits From Peatland Restoration.

Emissions of particulate matter from fires associated with land management practices in Indonesia contribute to regional air pollution and mortality. We assess the public health benefits in Indonesia, Malaysia, and Singapore from policies to reduce fires by integrating information on fire emissions, atmospheric transport patterns, and population exposure to fine particulate matter (PM2.5). We use adjoint sensitivities to relate fire emissions to PM2.5 for a range of meteorological conditions and find that a Business-As-Usual scenario of land use change leads, on average, to 36,000 excess deaths per year into the foreseeable future (the next several decades) across the region. These deaths are largely preventable with fire reduction strategies, such as blocking fires in peatlands, industrial concessions, or protected areas, which reduce the health burden by 66, 45, and 14%, respectively. The effectiveness of these different strategies in mitigating human health impacts depends on the location of fires relative to the population distribution. For example, protecting peatlands through eliminating all fires on such lands would prevent on average 24,000 excess deaths per year into the foreseeable future across the region because, in addition to storing large amounts of fuel, many peatlands are located directly upwind of densely populated areas. We also demonstrate how this framework can be used to prioritize restoration locations for the Indonesian Peatland Restoration Agency based on their ability to reduce pollution exposure and health burden. This scientific framework is publicly available through an online decision support tool that allows stakeholders to readily determine the public health benefits of different land management strategies.

Major atmospheric emissions from peat fires in Southeast Asia during non-drought years: evidence from the 2013 Sumatran fires.

Trans-boundary haze events in Southeast Asia are associated with large forest and peatland fires in Indonesia. These episodes of extreme air pollution usually occur during drought years induced by climate anomalies from the Pacific (El Niño Southern Oscillation) and Indian Oceans (Indian Ocean Dipole). However, in June 2013--a non-drought year--Singapore's 24-hr Pollutants Standards Index reached an all-time record 246 (rated "very unhealthy"). Here, we show using remote sensing, rainfall records and other data, that the Indonesian fires behind the 2013 haze followed a two-month dry spell in a wetter-than-average year. These fires were short-lived (one week) and limited to a localized area in Central Sumatra (1.6% of Indonesia): burning an estimated 163,336 ha, including 137,044 ha (84%) on peat. Most burning was confined to deforested lands (82%; 133,216 ha). The greenhouse gas (GHG) emissions during this brief, localized event were considerable: 172 ± 59 Tg CO2-eq (or 31 ± 12 Tg C), representing 5-10% of Indonesia's mean annual GHG emissions for 2000-2005. Our observations show that extreme air pollution episodes in Southeast Asia are no longer restricted to drought years. We expect major haze events to be increasingly frequent because of ongoing deforestation of Indonesian peatlands.

El Niño and health risks from landscape fire emissions in Southeast Asia.

Emissions from landscape fires affect both climate and air quality1. In this study, we combine satellite-derived fire estimates and atmospheric modeling to quantify health effects from fire emissions in Southeast Asia from 1997 to 2006. This region has large interannual variability in fire activity due to coupling between El Niño-induced droughts and anthropogenic land use change2,3. We show that during strong El Niño years, fires contribute up to 200 µg/m3 and 50 ppb in annual average fine particulate matter (PM2.5) and ozone (O3) surface concentrations near fire sources, respectively. This corresponds to a fire contribution of 200 additional days per year that exceed the World Health Organization (WHO) 50 µg/m3 24-hour PM2.5 interim target (IT-2)4 and an estimated 10,800 (6,800-14,300) person (~2%) annual increase in regional adult cardiovascular mortality. Our results indicate that reducing regional deforestation and degradation fires would improve public health along with widely established benefits from reducing carbon emissions, preserving biodiversity, and maintaining ecosystem services.

Forecasting fire season severity in South America using sea surface temperature anomalies.

Fires in South America cause forest degradation and contribute to carbon emissions associated with land use change. We investigated the relationship between year-to-year changes in fire activity in South America and sea surface temperatures. We found that the Oceanic Niño Index was correlated with interannual fire activity in the eastern Amazon, whereas the Atlantic Multidecadal Oscillation index was more closely linked with fires in the southern and southwestern Amazon. Combining these two climate indices, we developed an empirical model to forecast regional fire season severity with lead times of 3 to 5 months. Our approach may contribute to the development of an early warning system for anticipating the vulnerability of Amazon forests to fires, thus enabling more effective management with benefits for climate and air quality.