New York City Panel on Climate Change 2015 ReportChapter 5: Public Health Impacts and Resiliency

5.1 Coastal storms and flooding 5.2 Extreme heat 5.3 Air pollution, aeroallergens, and vector-borne, water-borne, and food-borne diseases 5.4 Resiliency recommendations 5.5 Research recommendations 5.6 Looking ahead Recent experience from Hurricane Sandy and high-temperature episodes has clearly demonstrated that the health of New Yorkers can be compromised by extreme coastal storms and heat events. Health impacts that can result from exposure to extreme weather events include direct loss of life, increases in respiratory and cardiovascular diseases, and compromised mental health. Other related health stressors—such as air pollution, pollen, and vector-borne, water-borne, and food-borne diseases—can also be influenced by weather and climate. Figure 5.1 illustrates the complex pathways linking extreme weather events to adverse health outcomes in New York City. New York City and the surrounding metropolitan region face potential health risks related to two principal climate hazards: (1) increasing temperatures and heat waves, and (2) coastal storms and flooding. The health impacts of these hazards depend in turn on myriad pathways, the most important of which are illustrated in the figure. Although New York City is one of the best-prepared and most climate-resilient cities in the world, there remain significant potential vulnerabilities related to climate variability and change. As part of the NPCC2 process, a team of local climate and health specialists was mobilized to assess current vulnerabilities and to identify strategies that could enhance the resilience of New York City to adverse health impacts from climate events. The goal was to highlight some of the important climate-related health challenges that New York City is currently facing or may face in the future due to climate variability and change, based on emerging scientific understanding. As indicated in Figure 5.1, health vulnerabilities can be magnified when critical infrastructure is compromised. Critical infrastructure is a highly complex, heterogeneous, and interdependent mix of facilities, systems, and functions that are vulnerable to a wide variety of threats, including extreme weather events. For example, delivery of electricity to households depends on a multi-faceted electrical grid system that is susceptible to blackouts that can occur during heat waves. These, in turn, can expose people to greater risk of contact with exposed wires or to greater heat stress due to failure of air conditioning. Understanding and predicting the impacts that extreme weather events may have on health in New York City require careful analysis of these interactions. Two recent plans to enhance climate resiliency in New York City have been released. A Stronger, More Resilient New York (City of New York, 2013) was developed in the aftermath of Hurricane Sandy by a task force of representatives from City agencies and consultants. This plan was informed by a detailed analysis of the impacts of Hurricane Sandy on infrastructure and the built environment and by the NPCC's updated 2013 climate projections for the New York metropolitan region. It includes more than 250 initiatives and actionable recommendations addressing 14 domains of the built environment and infrastructure including the healthcare system and several other domains relevant to protecting public health. In addition, the 2014 New York City Hazard Mitigation Plan (HMP) (City of New York, 2014), developed by the NYC Office of Emergency Management in collaboration with the Department of City Planning, updated the 2009 HMP and assesses risks from multiple hazards that threaten New York City. These include but are not limited to several climate-related hazards such as coastal storms and heat waves, and it lays out comprehensive strategies and plans to address these hazards. Many of the measures recommended by A Stronger, More Resilient New York and the HMP have already been implemented, are in progress, or are planned (City of New York, 2013; 2014). This chapter does not include a detailed review of these plans, which would be beyond the expertise and charge of the contributors. Nonetheless, the recommendations in this chapter do broadly support the plans laid out in A Stronger, More Resilient New York and the 2014 HMP, and these are referenced at several points where they are especially relevant. Here we focus on summarizing and synthesizing the emerging scientific knowledge on climate-related health hazards, knowledge that can inform ongoing preparedness planning. Key terms related to climate variability and change as they are applied in the health sector are defined in Box 5.1. This is followed by sections describing health risks, vulnerabilities, and resilience strategies for coastal storms and extreme heat events. We then briefly discuss the interactions of climate change with air pollution, pollen, vector-borne diseases, and water- and food-borne diseases. We conclude with recommendations for research and resiliency planning. Initiatives and measures to reduce the vulnerability of natural and human systems against actual or expected climate change effects. Various types of adaptation exist, such as anticipatory and reactive, private and public, and autonomous and planned. For health, physiological adaptation is also relevant. The man-made built environment and supporting systems and facilities, including buildings, land use (e.g., parks and green space), transportation systems, and utilities (e.g., electricity, running water). Systems and assets, whether physical or virtual, so vital to the United States that the incapacity or destruction of such systems and assets would have a debilitating impact on security, national economic security, national public health or safety, or any combination of those matters. In the health sector, examples include the electrical grid, water supply, and access to functioning health care facilities. Source: §1016(e) of the U.S. Patriot Act of 2001 (42 U.S.C. §5195c(e)). Source: U.S. CDC (2014). The propensity for the health of individuals or groups to be adversely affected as a result of exposure to a climate hazard. Vulnerability is an internal characteristic of the affected system and includes the characteristics of persons or groups and their situation that influence their capacity to anticipate, cope with, resist, and recover from an adverse climate event. Different levels of vulnerability will lead to different levels of health damage and loss under similar conditions of exposure to physical events of a given magnitude. Source: IPCC (2012). Resilience is the ability of a system and its component parts to anticipate, absorb, accommodate, or recover from the effects of a potentially hazardous event in a timely and efficient manner, including through ensuring the preservation, restoration, or improvement of its essential basic structures. Source: Lavell et al. (2012). Storm surge-related health risks will be compounded in the future as sea level continues to rise and with the potential for more intense storms in a changing climate (Lane et al., 2013a; Chapter 2). Large and growing numbers of people live near coa-sts and within areas likely to be impacted by coastal storms (Walsh et al., 2014). The health risks related to coastal storms can vary widely and in ways that are hard to predict due to differences in the severity, timing, and location of landfall, the topographic and infrastructure characteristics of affected areas, and the capacity for preparedness and These pathways and their interactions are in Figure 5.1. can impact health not through direct exposure to climate hazards such as and but also a of hazards, of which through in critical These hazards, for which exist, can result in a of and health health effects due to direct exposure to hazards include and from or physical of these health effects in the aftermath of Hurricane Sandy Box due to a risk for during extreme events in et al., et al., is not a to in New York City and was not for or a event can result in health including those due to to in of a due to or of economic or an to in to increases vulnerability to direct hazards and from health care and complex challenges of the of and individuals and can occur from events due to flooding and damage to of electricity can it or to water to of buildings, within buildings, and support et al., These infrastructure can lead to a wide of adverse health effects on the health, and economic of in the affected For example, exposure to heat or in the of climate may lead to or or from or is potential in have been and Hurricane Sandy in terms the to which the health of New Yorkers can be at risk by coastal In its on Sandy in New York of which by due to the The by and other of or Although these the most and impact of they do not for the impact on from and natural as as other health in impacted Hurricane Sandy impacts due to its and a and the that its with Box impacts within the due to local in the and the to which transportation infrastructure was and health and in New York City due to of which of the due to flooding and damage to infrastructure in and Other health affected by Sandy a facilities, and care facilities, and Hurricane Sandy landfall, of New York City at some during the the grid been in areas or running of damage to electrical and Many people not in of the in in conditions that one or more of these essential a of the health impacts of Sandy careful analysis of health some of which have so been For example, in the health the impact of people or heat in some to or heat in the impact and related to exposure for the of of exposure including and for as as to the due to also outcomes the other there was in diseases A more for and Sandy health including those related to facilities, stress and mental health and damage to and access to that not such as and ongoing to these impacts with by the for and and can water of in areas when to can also et al., et al., of is a risk for and may result in respiratory such as or and be a risk for et al., et al., Research by the New York City has hazardous or in may be in the event of For example, Figure 5.2 the of facilities, and to in the of the 2014). As demonstrated by Hurricane critical healthcare infrastructure can be and for by coastal flooding events A Stronger, More Resilient New City of New York, that care that can be impacted by coastal storms include facilities, facilities, and mental facilities, and In addition, for people for in is with risk of diseases and with in care that could from health conditions et al., of and and access to care can health to direct and hazards and their including can have adverse for mental health, or to et al., et al., stress is a natural important of impacts include physical or physical and health impacts can or events as support this is an for which more is can include risks related to and including and exposure to and to from can potentially expose as as to levels of are not Vulnerability to be greater where multiple are the of experience with Hurricane Sandy as as from other coastal we can highlight several ways in which health resiliency can be in the face of coastal events. Health resilience can be in and are to vulnerability ways to for storms and other climate systems to vulnerable and on of and other types of care Health impacts can be by capacity for of and other and to or in with a focus on the most it is important to enhance and agencies in and For those is to the of physical and mental health care and New York Hazard Mitigation Plan (City of New York, includes the Plan within the Coastal Storm Plan and to more and in that essential utilities and running face health measures to critical infrastructure against flooding and risks will health as as critical and infrastructure systems are also critical for public health. that can reduce of delivery of for the health system include areas or and and other essential systems from preparedness for and safety, systems to systems, and plans to of care and in at facilities. Many resiliency measures are in the Hazard Mitigation Plan (City of New York, and A Stronger, More Resilient New York (City of New York, including for facilities, are already in and and More and more coastal flooding events are not the climate-related health hazards by New York City due to climate change in the temperatures will result in and more intense heat waves. was the of of in the United States in as it has been on for heat in 2014). events such as or and are the most and impacts of climate change on human health et al., In of the of these New York City is in resiliency to heat to the public and healthcare of heat access to and other Various exposure such as or or of other have been to the effects of heat on and In a recent exposure as of in New York City et al., are broadly defined as of weather an of to local In New York, a heat is defined as a of at with temperatures Chapter it is that health impacts can occur when one or two of temperatures are In New York a heat is when an extreme heat event is defined as any one a heat of or any two or more These are based on of the and in NYC et al., heat to the of temperatures at within an than in surrounding A recent in New York City that the heat can et al., The heat may enhance the health risks of climate-related As are other cities in the and of the United States and cities the in New York City is susceptible to the impacts of heat and will face challenges in the to that to vulnerability in such cities include the heat that can the impacts of temperatures et al., and a of that may be to weather and air to U.S. In to expected in the to New York is and the of in has been are risk for and and A of have health during and heat such as the heat of et al., and the heat in et al., in New York City on episodes and More recent have health in to but more These more recent an that can be to the that when temperatures rise levels of a for from et al. is in Figure This that and temperatures can risk of The in the at the the of temperatures in in which there is the impacts of heat have on et al., et al., and has a direct impact on with most on the or exposure to due to also have been with For example, in New York from cardiovascular with temperatures in a recent et al., occur at but have also an in and for diseases during heat episodes et al., et al., to a recent based on and and in New York City to temperatures may also have an impact on For example, a recent an and et al., on the of in a especially for the of that occur at during extreme heat events et al., Box a heat in New York City in for example, there as heat on there that in with the heat as by NYC The of the on that this is and these can be and to risk including the of air levels of and other that are to this the of The of the on that it potentially a for the of the require multiple of as and the In addition, there is for the of heat to and effects of heat may be especially a during an extreme heat event. are more likely during heat due to the for for air an that stress on the systems that and the other air important from exposure to health blackouts exposure to heat with a in health can also risk of from use of and the in U.S. in the Although this not with a heat it during weather and in and an in respiratory et al., and As a result of temperatures a in electricity and an electricity grid, climate change may Other health impacts of heat may be with and et al., potential future health impacts from temperatures linking projections future the health of the the and of the and the A recent by and projections from an of climate and two and to in the current in the face of climate change et al., are in Figure which in an on the and in future of recent heat impacts with during heat in the that in New York City vulnerability to heat may be as has been in other et al., A recent by a in heat impacts the et al., 2014). use of air and air during heat may have a in Vulnerability climate and more people will to and more people will be exposed to extreme future in these or the growing of and individuals in New York City will a or in health outcomes is have that and those with more susceptible to the health impacts of and et al., A recent in New York City that during heat to other more likely to occur in individuals than other more likely to occur at than in and and more likely those in where more households public during heat more likely in areas of the with and likely in areas with more green Air also New York City Understanding vulnerability can to including measures that and exposure to heat public during heat waves, and of air and (Lane et al., could be a of of or In heat in and and of to be risk for et al., et al., on the by extreme heat events could New Yorkers to in on and may be The of by is likely the result of a complex of but one is the of access to air conditioning. A recent indicated that of New Yorkers do not have a functioning air and an do not use their air (Lane et al., The most for of air was followed by the that it was not and a of air conditioning. In to air and also to be on New York City on heat health risks and they can be health are characteristics that potentially to or of more complex climate of the health for New York City and the New York metropolitan region that from NPCC2 are in 5.1 with a in A of measures is to reduce risks and during extreme heat are to enhance of air for people are most vulnerable to also to use of air in heat and reduce during heat waves. A of air at increases the risk of et al., air also to electrical during heat waves, which increases the risk of or blackouts and increases of The numbers of during heat a of vulnerable New Yorkers use (Lane et al., It is especially important to identify and enhance to vulnerable are and to a or at This can through and so health heat will in this green reduce local temperatures et al., can be an important for especially when to vulnerable and are strategies with potential for local ongoing New York City are to impacts of the heat Chapter In the can be to reduce heat related to and other and and especially during Health resiliency during extreme heat events depends on a electrical electrical especially in vulnerable and public is New York City face a variety of climate-related health impacts in to the direct effects of storms and extreme important risks are air pollution, aeroallergens, vector-borne diseases, and water and food-borne change has the potential to and from respiratory and cardiovascular through its effects on air diseases such as are a public health in New York and cardiovascular is the most of in New York U.S. In in New York was to in the United States as a New York with the of under the of in New York City from to important air in the of climate change is which is on from a combination of and is on and the of with temperatures and to have the potential to in some in to climate change and et al., et al., et al., et al., to is with and and and et al., In New York for under the of have been to rise by by the the as the result of climate increases in et al., The New York and Health a of climate change and human health in the New York metropolitan potential increases in in New York City from to the by et al., is important air in New York City from a human health The most is by the of and are to and of such as or also the climate by and increasing temperatures through greater of may rise with in to can a in terms of health and climate. climate adaptation measures to such as air and measures to reduce such as and can have impacts on air and human health. the air to of and reduce air and and can to such as from and to types of is with multiple including to et al., et al., et al., of et al., et al., et al., and of et al., et al., Recent has that several that are in and important of in the New York City and are to climate change and are to and in the to the and U.S. et al., The of the has already been demonstrated to be for et al., et al., is also by due to and et al., et al., in have in the of the by as as the two to of recent et al., In the of the has by as as and 2009 in more in with temperatures and et al., areas such as New York City may experience on the and of the from the heat and et al., In addition, exposure to air in areas such as can enhance to et al., and et al., As a future in and could lead to in the of the and potentially the of diseases such as important and and can support climate change and adaptation Research is ongoing and and human health. can also be an important of which are to knowledge from this inform future and including such as that are also to changing climate Other such as also to the of respiratory and and have been to air and climate change coastal and events can conditions for the of and other in the environment et al., and et al., 5.1, diseases are by such as and of several types of vector-borne diseases have been in New York including and et al., for and is influenced by climate such as and on multiple For example, there is that the the has its the several in part due to temperatures et al., climate change may lead to in the and of some vector-borne diseases or their it is important to that climate is one of of vector-borne can be exposed to water- and food-borne through a variety of including through the of water and of et al., A of that water and food-borne in are to climate including changing more extreme and in in the Although vary by temperatures to the of diseases such as and et al., for and et al., from to in in the extreme events and are to in the region as climate change continues et al., is especially to strategies to of including from and other and from and will be more important than in a changing climate. New York City and surrounding are exposed to levels of and other air of the of in a with and New York City also systems for air in the potential of heat and In the health impacts from or more can be potentially by systems that inform and at the of the so they have of and access to care to be through other New York City include as a for in future of is an part of health systems to enhance resilience to risks, including to and such as and of not in areas where they are to but also in areas where they may to in a climate in to assess as as the of Health and the public to be the and of diseases that may occur more with climate change, such as can be the of water and the of and of New York in the face of changing and will be essential to ensuring an of water the is critical infrastructure system in New York City. Extreme events can the capacity of the to direct of surrounding by to and the of water green infrastructure can address this to some et al., of the water and heat of these initiatives are knowledge will be essential for New York City to and future health impacts from extreme weather events in a changing climate. research that has the potential for resiliency it is recommended that a local and be and that will the NPCC2 Health a of areas in which research knowledge is In the current knowledge on climate impacts and vulnerability in New York we identify several for resiliency planning. These within the of with preparedness of and and of resilience with a health New York City has a of and initiatives under to resilience to more intense coastal flooding in to climate change effects on sea level rise and addressing preparedness and infrastructure measures are in the Hurricane Sandy the NYC Hazard Mitigation and A Stronger, More Resilient New The NPCC2 Health and recommendations to coastal resilience in New York City. Although some are already in to to more and heat in New York several preparedness have been New York City is in the of a of research capacity for climate change will flooding and extreme heat conditions These NPCC2 projections the a from on for these it is important for agencies to a national of relevant on the effects of climate change 2014). The of sea level rise in risk is one for of climate is and In the for in the is a of climate for in the the recommendations in this New York City its ability to and the ongoing local effects of climate change on the health Chapter of This to such as and for heat or and due to extreme weather and supporting their and in New York City and the surrounding metropolitan region. Other important to of levels and and in New York City. on these health part of the This will and a of and for analysis of