Over the last 100 years the average temperature on the Earth has risen approximately 1º Fahrenheit (F), growing at a rate twice as fast as has been noted for any period in the last 1,000 years (Pew Center on Climate Change (n.d. [a]); Walther et al., 2002). The Pew Center on Climate Change has noted that "globally, energy related CO₂ emissions have risen 130-fold since 1850 – from 200 million tons to 27 billion tons a year – and are projected to rise another 60 percent by 2030" (The Pew Center on Climate Change, n.d., [b], p. 1). The Arctic ice cap is shrinking;

A certain degree of the greenhouse effect is necessary for human life.

glaciers in Greenland, Tanzania, Spain, the European Alps, and Montana are melting; and the arctic permafrost is thawing (Lippsett, 2006; Overpeck et al., 2006; Vinnikov et al., 1999; Yoganathan & Rom, 2001). If there is scientific uncertainty about global climate change it is only about the speed and severity of consequences. Global warming is happening, climate change is occurring, and the health effects of climate change will necessitate an informed response by health professionals. This article provides a brief overview of global warming and climate changes, discusses effects of climate change on health, considers the factors which contribute to climate changes, and reviews individual and collective efforts related to reducing global warming.

Brief Overview of Global Warming and Climate Change

The greenhouse effect, explained in the Figure below, is influencing global warming. The greenhouse effect is a term used to describe the rise in temperature that the Earth experiences when certain gases in the atmosphere, such as water vapor, carbon dioxide, nitrous oxide, and methane, trap incoming solar radiation from the sun. A certain degree of the greenhouse effect is necessary for human life. The United States (U.S.) Environmental Protection Agency (EPA) (2007) has explained that without the greenhouse effect, heat would escape back into space, the Earth’s temperature would be 60º Fahrenheit colder, and life on the Earth, as we know it, could not be sustained. However, scientists and others are concerned that the Earth is experiencing an enhanced greenhouse effect related to human activities. An increase in the amount of greenhouse gases in the Earth’s atmosphere has led to a decrease in infra-red radiation back into space, causing an increase in the Earth's temperature, which in turn may contribute to changes in climate. A warmer Earth may lead to changes in rainfall patterns and a rise in sea level. It may also impact plants, wildlife, and humans in a variety of ways.

Figure 1: The Greenhouse Effect (U.S. EPA, Climate Change Science)

Global Climate Change and Human Health

The Australian Greenhouse Office of the Australian Department of Environment and Heritage (2005) reported "most climate models indicate that in many places global warming is likely to increase the frequency and duration of extreme events such as heavy rains, droughts, and floods" (p.1). The Intergovernmental Panel on Climate Change (IPCC) has noted that there has already been evidence of increases in the intensity or frequency of some of these extreme events throughout the 20th century (IPPC, 2001a). The United Nations University Institute for Environment and Health Security (UNU-EHS) has reported that the impact of extreme weather events around the globe has already created million’s of environmental refugees (UNU-EHS, 2007). These refugees have been displaced from their homes and countries due to sudden extreme weather events and slower environmental shifts such as an increase in desert area, diminishing water supplies, and rising sea levels.

There is mounting evidence that global climate change is already affecting human health through extreme weather events, changes in air and water quality, and changes in the ecology of infectious diseases (Patz, Epstein, Burke, & Balbus, 1996; Stott, Stone, & Allen, 2004). Extreme weather events, such as extremely hot weather, increase the death rates of the elderly and the very young. In 2003, Europe experienced its hottest summer in centuries, with temperatures averaging 3.5º Celsius above

Extreme weather events, such as extremely hot weather, increase the death rates of the elderly and the very young.

normal (Luterbachter, Dietrich, Xoplaki, Goosjean, & Wanner, 2004). Over 22,000 individuals throughout Europe died during or directly after the summer heat wave of 2003 (Kosatsky, 2005). In July of 1995, hundreds of Chicago residents died as a result of a heat wave that reached 106º F, with a heat index of over 120º F (Centers for Disease Control and Prevention, 1995). However, in the 1999 Chicago heat wave, there were fewer deaths. This decrease in deaths may be attributed to lessons learned in 1995 (Naughton et al., 2002). In the summer of 2005, the US experienced first-hand the impact of another extreme weather event when Hurricane Katrina made landfall near New Orleans, Louisiana. Katrina was one of the deadliest hurricanes in U.S. history. In Louisiana alone 1,464 people lost their lives and over 135 are still missing (Louisiana Department of Health and Hospitals, 2006).

Although it may not be possible to correlate individual weather events to climate change, the catastrophic events described above illustrate the challenge of mounting an effective public health response to such destructive weather events. During the New Orleans storm, for example, thousands of individuals and families were displaced and crowded into shelters; floodwaters were contaminated with sewage; and there was a lack of food and potable water which created concerns about the possibility of a communicable disease outbreak. The National Environmental Trust (2006) warned of additional concerns about exposure to the toxic stew of 600 million pounds of toxic chemicals released to floodwaters when chemical plants, petroleum refineries, and petroleum bulk storage facilities were destroyed in the flood.

An additional health-related consequence of climate change is related to air quality. High temperatures, in the presence of sunlight and certain air pollutants such as volatile organic compounds and nitrogen oxides

An additional health-related consequence of climate change is related to air quality.

(emitted from motor vehicles, power plants, and other sources of combustion), result in the formation of ground level ozone. The higher the temperature and the more direct the sunlight, the more ozone is produced. Exposure to ozone is associated with increased risk of premature mortality; in fact there is an increase risk of premature mortality even at low levels of ozone (Bell, Peng, & Dominici, 2006).

There is also a concern that as temperatures rise we can expect to see a rise in vector-transmitted diseases, such as malaria, West Nile Virus, and Dengue Fever. There are concerns that insects that transmit these diseases will mature faster, lay more eggs, and bite more frequently (Epstein, 2000; Reiter, 2001). Linacre and Geerts (2002) expressed concern that as temperatures increase, insects will migrate geographically to areas where they previously had not been able to thrive. However, Reiter noted that in the history of malaria, yellow fever, and dengue, "climate has rarely been the principal determinant of their prevalence or range" (p.141).

Longstreth (2001) studied the special vulnerabilities of certain populations to the effects of climate change. Children are especially vulnerable since they may not have fully developed immune or heat-regulatory systems, because they breathe more air per pound than adults, and because they are more likely to play outside. The elderly are also at risk from extreme weather events which may result in falls, especially during evacuations; and they are more vulnerable to heat-related illness. Chronically ill people, such as persons with pre-existing heart or lung conditions, are at risk of illness or death from heat and air pollution.

The urban poor are also vulnerable because urban environments trap heat.

Immuno-compromised individuals are at higher risk of infectious diseases spread by contaminated food or water. The urban poor are also vulnerable because urban environments trap heat. Many of the urban poor may not have access to air conditioning or to cooled public spaces; nor may they have the resources to be able to seek early or preventative health care.

Contributors to Climate Change

The IPCC (2001b) has reported that most of the global warming changes are attributable to human activities; the Pew Center on Climate Change (2001) has noted that global warming is largely the result of emissions of carbon dioxide and other greenhouse gases from human activities, including industrial processes, fossil fuel combustion, and changes in land use, such as deforestation. Marland, Boden, and Andres (2005) have reported that North America is the highest fossil-fuel consuming, CO₂ emitting region of the world, with the US leading the way in the world’s total carbon emissions and a per capita rate well above any other country. The US is producing roughly 25% of the world’s carbon emissions, while having only 5% of the world’s population, (Schwartz, Parker, Glass, & Hu, 2006). Muir (2007) has reported that deforestation is driven by an increasing human population clearing forests for agriculture use and for forest products. When forests are burned they release stored carbon into the atmosphere contributing about one-sixth of global carbon emissions; whereas if forest are left standing, they have the potential to absorb about one-tenth of global carbon emissions projected for the first half of this century (Matthews 2006).

State, National, and International Efforts Toward a Solution

In the US, regional, state, and local governments are concerned with the economic and public health impacts of global warming. Recognizing that there is little action being taken nationally to address climate change, they are seeking their own solutions. Many states have joined regional initiatives that seek to reduce greenhouse gas emissions, create clean energy sources, and improve air quality. For example, several Northeastern and Mid-Atlantic states have joined forces to develop the Northeast Regional GreenHouse Gas Initiative (RGGI, n.d.), which seeks to reduce CO₂ emissions through a cap-and-trade system. A cap-and-trade system uses a market-based approach to reduce the total amount of carbon emissions that a particular industry can emit in a geographically defined area. For example, a regulatory agency will designate the amount of allowable carbon emissions for power plants at a level that is lower than current emissions. Permits are given to individual plants based on this new emission level. Those that are able to reduce their emissions below their permit level can "trade" or sell their excess permits to plants that are over their permitted emission level. This system allows for flexibility while still limiting carbon emissions (Union of Concerned Scientist, 2005).

In 2006, the Maryland General Assembly passed the "Healthy Air Act" to help reduce carbon emissions from coal-burning power plants. The 1977 Federal Clean Air Act had required power plants to use the best available pollution control technology when building new plants or when existing plants were modified (Sierra Club, n.d.). This 1977 Act exempted then-existing plants from immediately having to meet these requirements, because at the time Congress reasonably assumed these older plants eventually would be modernized or retired. Maryland closed this loophole with the passage of the 2006 Healthy Air Act which also requires power plants to reduce four major emissions – mercury (a neurotoxin), particulate-forming nitrogen oxides (NOx), particulate-forming sulfur dioxides (SO₂), and carbon dioxide (CO₂ ) which is a greenhouse gas.  

The Maryland Nurses Association had actively lobbied for implementation of this 2006 Healthy Air Act, introduced as a four-pollutant bill. They understood that Marylanders and residents of surrounding states were facing early death and disease as a result of exposure to the pollution emitted from coal burning power plants across Maryland. Nurses who visited the state capital to communicate with legislators about the bill were assured that the legislature would pass a three-pollutant bill (Mercury, NOx, SO₂). However, they were warned that the fourth pollutant, CO₂ , a greenhouse gas that significantly contributes to global warming and climate change, probably would not make it through the bill amendment process.

Nurses recognized that part of the problem in having CO₂ addressed in this bill was that legislators were having difficulty understanding how carbon pollution impacted public health. So Maryland nurses, in collaboration with environmental organizations, worked to educate legislators

Nurses recognized that part of the problem in having CO2 addressed in this bill was that legislators were having difficulty understanding how carbon pollution impacted public health.

on the causes, public health impacts, and solutions to the problems caused by greenhouse gas pollution. They shared with the legislators that there is little disagreement among climate scientists that global warming is occurring (Adejuwon et al., 2001; National Research Council, 2001) and explained how climate change was already impacting public health (Epstein, 2005; Patz, Cambell-Lendrum, Holloway, & Foley, 2005; Weinhold, 2004). As noted above, this 2006 bill was successfully passed as a four-pollutant bill. Although regional and state initiatives are helpful and can serve as models for national and international action (Pew Center on Climate Change, n.d. [c]), they are not enough to reduce global warming at the national and international levels.

In 1992 the US signed onto the United Nations Framework Convention on Climate Change. The goal of this non-binding agreement was to stabilize greenhouse gas concentrations. However, by 1995 it was apparent that a stronger agreement would be needed. Hence governments around the world entered into further negotiations that eventually led to the development of the Kyoto Protocol in 1997. This Protocol was stronger in that it set individual emission targets for different countries. It has been ratified by 166 nations. Although the US was a key negotiator in developing this Protocol in 1997, it renounced the Protocol in 2001 (Pew Center on Climate Change, 2001, n.d. [d]).

Individual and Collective Solutions

Global warming may be one of the greatest threats to our planet. The impact of global warming, which is already being felt, is expected to intensify in the years ahead. Fortunately nurses can take personal action to address the challenge of global warming by making choices in their homes, workplaces, communities, and legislatures. In homes nurses can make smart choices by buying energy-efficient appliances and cars and opting for public transportation when available. In the workplace nurses can strive to reduce, reuse, and recycle in order to decrease the health care impact on the environment. Nurses can also promote the safest, most advanced methods of waste disposal, never opting for incineration, which is a polluting and outdated method of waste disposal. Nurses can also join local communities, faith communities, and organizations that are already working to reduce global warming. The experiences of the Maryland nurses, described above, illustrates how nurses can work with legislators at any level to create and implement policies that will lead to fewer carbon emissions from cars, good public transportation, sustainable communities, and renewable energy.

Messages from nurses are accepted as credible and compelling since nursing is a very trusted profession.

Messages from nurses are accepted as credible and compelling since nursing is a very trusted profession. As nurses begin to understand and see the effects of global warming, their advocacy roles as well as their roles in health planning and care delivery will evolve.

Conclusion

It is important that nurses grasp the effects of global warming and advocate for policies and practices which will decrease the global warming process. This article has provided a brief overview of global warming and climate changes, discussed effects of climate change on health, considered the factors which contribute to climate changes, and reviewed individual and collective efforts related to reducing global warming. It is hoped that this article will assist nurses and other health care providers decrease the negative effects of global warming and thus improve the health of all people who live on the planet called Earth.

Author

Brenda M. Afzal, MS, RN
E-mail: bafzal@son.umaryland.edu

Brenda Afzal is a Director of Health Programs in the Environmental Health Education Center at the University of Maryland School of Nursing where she is responsible for several critical initiatives including environmental health education and advocacy and leadership development. Ms. Afzal works at the local, state, and federal level in developing nurses’ capacity to effectively engage in the emerging area of environmental health. Her leadership is evident in the Maryland State Nurses’ Association where, as an elected officer, she helped developed an Environmental Health Task Force, creating a model for other states to follow. She has helped to develop an effective network of state and national environmental and nursing organizations that have been successfully engaging on common-ground issues related to health and the environment. Her advocacy work has been recognized nationally and is currently supported by the Beldon Fund.

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