Climate change threatens human health and well-being in many ways, including impacts from increased extreme weather events, wildfire, decreased air quality, threats to mental health, and illnesses transmitted by food, water, and diseases-carriers such as mosquitoes and ticks. Some of these health impacts are already underway in the United States.

This finding is from chapter 9 of Climate Change Impacts in the United States: The Third National Climate Assessment.

Process for developing key messages: The key messages were developed during technical discussions and expert deliberation at a two-day meeting of the eight chapter Lead Authors, plus Susan Hassol and Daniel Glick, held in Boulder, Colorado May 8-9, 2012; through multiple technical discussions via six teleconferences from January through June 2012, and an author team call to finalize the Traceable Account draft language on Oct 12, 2012; and through other various communications on points of detail and issues of expert judgment in the interim. The author team also engaged in targeted consultations during multiple exchanges with Contributing Authors, who provided additional expertise on subsets of the key message. These discussions were held after a review of the technical inputs and associated literature pertaining to human health, including a literature review,5836b5e1-c6fa-4eaa-b453-93304c3021d5 workshop reports for the Northwest and Southeast United States, and additional technical inputs on a variety of topics.

Description of evidence base: The key message and supporting text summarizes extensive evidence documented in several foundational technical inputs prepared for this chapter, including a literature review5836b5e1-c6fa-4eaa-b453-93304c3021d5 and workshop reports for the Northwest and Southeast United States. Nearly 60 additional technical inputs related to human health were received and reviewed as part of the Federal Register Notice solicitation for public input. Air Pollution: The effects of decreased ozone air quality on human health have been well documented concerning projected increases in ozone,9d61dfcc-c3f3-4814-809a-22f08d31ab48 d6e399c7-1efe-4f91-927e-f957965e3aaa f5f232cf-d5d9-418f-9437-6b6b66cdcf86 9df9d372-1c41-4065-890e-9784acbd6005 14e6e3ee-86da-47b9-9a7d-a7fef9f1f758 85bd009d-5a5b-41c1-9195-26f57256413d 1a34e7a8-ddbc-4692-be94-44dd31bd5777 b8742545-e96a-4595-922d-b1262c7658d0 afbd60ab-ba9f-4547-88e3-968bc3a4b949 even with uncertainties in projections owing to the complex formation chemistry of ozone and climate change, precursor chemical inventories, wildfire emission, stagnation episodes, methane emissions, regulatory controls, and population characteristics.9221a18a-805b-4508-9e90-8caaa968a715 Ozone exposure leads to a number of health impacts.2a99259b-1d04-4d93-8ab5-2b02e5b75b2e 56b8fc2a-b9ea-4187-9038-e58d51b52c5b 2d58d3bb-62b3-45f2-b4c9-10d22b556f9c Allergens: The effects of increased temperatures and atmospheric CO2 concentration have been documented concerning shifts in flowering time and pollen initiation from allergenic plants, elevated production of plant-based allergens, and health effects of increased pollen concentrations and longer pollen seasons.56ba6aa9-7c56-4127-af29-64cb65e62319 cc3e5e5c-7e75-468e-b992-9806ac6f07bd 0b3b0345-837c-4be4-9e68-6dd8d6ea5e51 036ba27d-8341-4f6d-ad66-1288e53dee65 c681c3c2-48a8-4fe6-8e91-86db5bff7fa3 f3bb3bdd-bb8a-45d9-bb24-3d99824a5a0a 7eaad122-f1a7-4062-bbfc-c4c9ad7d3078 0e8764f8-e7e0-44b4-89cc-218100c5049f d3eacb8b-2f2a-4ac5-9554-09fc1dbd706f 1c307875-852a-4593-8a27-8631d0b892b9 b9370347-fe7c-4b6f-9d49-af723ed931a4 49d46c73-b2da-4977-8c94-fc8d6954d0a0 Additional studies have shown extreme rainfall and higher temperatures can lead to increased indoor air quality issues such as fungi and mold health concerns.fe69d52e-ac37-4d64-9307-9076bb5270a7 c2e46e42-7cb9-4bb0-91df-c676943cd62a 9787187e-18a1-4e16-a244-f96aec28fbff dd4ad6ad-d135-4c25-9fe0-e462253fcf01 Wildfire: The effects of wildfire on human health have been well documented with increase in wildfire frequency036ba27d-8341-4f6d-ad66-1288e53dee65 391560e0-40c1-4f9d-b063-e87d18c87e02 29c056a0-9f13-4eb6-8783-42fbac1302e1 675223d5-b171-46be-9e57-632d71d10204 e1e1f3a0-9fea-4ad2-a3af-575716f9849e b95e9226-076c-4eb5-9367-472499624084 afbd60ab-ba9f-4547-88e3-968bc3a4b949 f0797ed7-cfce-4040-aebd-b5afc3393d55 leading to decreased air qualityc4dfc48f-0915-4916-8402-a68ee7f5471e 0d2f1e72-f7e5-4ab0-8dce-cd22cdd2617a ff976c12-df99-41bc-b0c7-464784c38941 10d9c653-28e6-45c4-92f7-cfc2f8218080 0e8fc18d-c727-48b5-ad4e-6eebd620f622 2784ddd2-c6dc-4f94-a943-3218b6623a7c and negative health impacts.0d2f1e72-f7e5-4ab0-8dce-cd22cdd2617a 1a72beb2-f4a0-4db9-bac8-eac55cbf676d ea4d54e3-419a-41ef-8ec9-38590dba75b9 72933923-2018-4811-8e01-6c9ffc8e0db4 Temperature Extremes: The effects of temperature extremes on human health have been well documented for increased heat waves,7de011b1-2d12-48e0-b3e1-0d81e4a8a7d6 315edcf2-107b-449d-b694-5d5a3c87ebbb 580f7af6-b0eb-4ebb-8da4-ab0a0b8ef68b 6168163c-2f61-4593-810e-fe389a8f7834 which cause more deaths,28b8aa29-bfe6-4d88-b73f-fe736f5042b6 f150b127-71ae-4dd2-b414-5590dcfbb80e hospital admissions7ed57375-4f4f-4157-9784-0d09fb2beae1 7f0eb22c-9da0-4cc2-a04f-3bcbbbef317d 22344c1d-cee2-4f9d-91c0-60ceb6e9ca57 and population vulnerability.d7337bde-d182-4ad9-bd11-b1b00c431ea7 24685210-b8ba-4951-b33c-bb43939d53ba Precipitation Extremes - Heavy Rainfall, Flooding, and Droughts: The effects of weather extremes on human health have been well documented, particularly for increased heavy precipitation, which has contributed to increases in severe flooding events in certain regions. Floods are the second deadliest of all weather-related hazards in the United States.5884b839-f80e-471d-82a9-c3bac6603227 a1b08f2f-e94c-4628-b82a-a646e71116ec Elevated waterborne disease outbreaks have been reported in the weeks following heavy rainfall,dba82efa-be61-4edd-af85-ee5e3ed07139 although other variables may affect these associations.91493d3b-4841-4022-860a-46f961ff4534 Populations living in damp indoor environments experience increased prevalence of asthma and other upper respiratory tract symptoms.dd2ae1f1-d28c-40b5-9a8f-ec46d6be86cb Disease Carried by Vectors: Climate is one of the factors that influence the range of disease vectors; 247e6da1-509e-46b7-956b-e39ff5bb87b9 d8639fa7-50e5-4103-808d-9ee8d11d3017 687c4ff2-5eea-4639-9949-abe1802e19be a shift in the current range may increase interactions with people and affect human health.4ae65d1d-6029-4cbc-bb94-a959b1248449 cebfc297-bf30-4501-ab0c-58fce0df35b8 f625d9e8-03ca-4529-b711-4337eab4fd1f d62b2dd6-ea37-41be-a6fb-5d45320fea28 North Americans are currently at risk from a number of vector-borne diseases.8af8019f-cb74-439e-9d95-f5febef01d2f 77f948ec-3f41-4367-a120-6096a78706f5 1ba3decc-52e5-4aa8-84e5-d706838bc0e4 dd8f9880-294f-45b5-9090-426a0b146e08 bb2ac3a7-743b-40fd-9888-fbc4209f2782 1565a1be-5aa3-4a4c-b1e8-d434a348b3ce d64171cf-ca5d-4fe7-94df-739b33cc8cb0 4feaa87e-fd56-4e7f-b059-787bb01e11fc 6cf210b3-abcd-474a-b270-b4e346898e75 10973e71-74e8-4308-864b-a90aadfba382 db741c59-3276-430e-b3ff-2cea74073263 6d74c91c-b4e6-4d19-9a20-589c8e519148 accbf1b4-1ef4-460c-b77f-5a4ea4c15532 There are some ambiguities on the relative role and contribution of climate change among the range of factors that affect disease transmission dynamics.4ae65d1d-6029-4cbc-bb94-a959b1248449 cc7c424e-b684-414f-8896-af2d2fee05b6 247e6da1-509e-46b7-956b-e39ff5bb87b9 d8639fa7-50e5-4103-808d-9ee8d11d3017 8af8019f-cb74-439e-9d95-f5febef01d2f cebfc297-bf30-4501-ab0c-58fce0df35b8 f625d9e8-03ca-4529-b711-4337eab4fd1f d62b2dd6-ea37-41be-a6fb-5d45320fea28 687c4ff2-5eea-4639-9949-abe1802e19be However, observational studies are already underway and confidence is high based on scientific literature that climate change has contributed to the expanded range of certain disease vectors, including Ixodes ticks which are vectors for Lyme disease in the United States.42a70c4d-4b63-4a1c-bf87-785383d013dc 001ff09f-665d-4872-acdc-11e8af22e83e 2970d11e-802d-4df1-b0b4-e1f0684e7425 Food- and Waterborne Diarrheal Disease: There has been extensive research concerning the effects of climate change on water- and food-borne disease transmission.12b8de4f-5527-4afb-88fd-056fafdd9b12 01c49cdf-06bb-41ef-95be-37a8553295b7 dbc4911d-950a-434b-b067-7dd438e2d45b 986057a7-7c6a-4d52-abbe-480652e4131f 2e14106d-235f-4140-920c-0d6c64e3b72a 6dc3924f-8cb4-4183-9a2c-78457dd00846 bb57c512-c1d5-472c-88e2-5760610c93fd b3528935-e211-45c8-872f-2a9d6c7e0093 a5d4557b-2340-45c2-89cd-4c2bc5e9d720 03009fa3-0b53-44b8-a890-6e3ac5850680 64b2c0fc-7c3c-4b6e-acd6-fd384be7d7f6 The current evidence base strongly supports waterborne diarrheal disease being both seasonal and sensitive to climate variability. There are also multiple studies associating extreme precipitation events with waterborne disease outbreaks.dba82efa-be61-4edd-af85-ee5e3ed07139 This evidence of responsiveness of waterborne disease to weather and climate, combined with evidence strongly suggesting that temperatures will increase and extreme precipitation events will increase in frequency and severity (Ch. 2: Our Changing Climate), provides a strong argument for climate change impacts on waterborne disease by analogy. There are multiple studies associating extreme precipitation events with waterborne disease outbreaks and strong climatological evidence for increasing frequency and intensity of extreme precipitation events in the future. The scientific literature modeling the projected impacts of climate change on waterborne disease is somewhat limited, however. Combined, we therefore have overall medium confidence in the impact of climate change on waterborne and food-borne disease. Harmful Algal Blooms: Because algal blooms are closely related to climate factors, projected changes in climate could affect algal blooms and lead to increases in food- and waterborne exposures and subsequent cases of illness.03009fa3-0b53-44b8-a890-6e3ac5850680 64b2c0fc-7c3c-4b6e-acd6-fd384be7d7f6 918354f7-f16e-4cad-9289-20d41305abb8 da0435d7-46ed-4cc5-bb32-921edfc711a0 81a84ac5-4314-41ff-8ee8-1620db18cd00 030e3539-a620-441c-adb6-042db1a3fa6e 3325ef64-347b-4c33-9289-9e05e905dcbe Harmful algal blooms have multiple exposure routes.45c78ce3-56d1-4ed8-864b-bca300114602 735320eb-92d5-401c-957d-993e06668fa8 c41878da-d01e-4bfc-a839-484d89334c7a Food Security: Climate change is expected to have global impacts on both food production and certain aspects of food quality. The impact of temperature extremes, changes in precipitation and elevated atmospheric CO2, and increasing competition from weeds and pests on crop plants are areas of active research (Ch. 6: Agriculture, Key Message 6).2334a252-10b7-4f9a-8312-409147a7333a 5b19a296-8813-4bbf-a292-2b555607a74b 0da20a61-8e46-4547-ae2d-18e927ea9224 af9250bc-28b0-4ad7-a9b7-021ff769d8fe 242761d1-1e32-4bd8-92a1-24f527121099 3818382e-ae71-4de7-9b23-0a5d9195ae5f b4dfdd6a-ffce-44a3-b6b7-5770f5c70fbb d4e4b28f-2018-42c7-9131-dd60ab9946c3 49d46c73-b2da-4977-8c94-fc8d6954d0a0 The U.S. as a whole will be less affected than some other countries. However, the most vulnerable, including those dependent on subsistence lifestyles, especially Alaska Natives and low-income populations, will confront shortages of key foods. Mental Health and Stress-Related Disorders: The effects of extreme weather on mental health have been extensively studied.88cd6f85-8f7f-4946-9e7b-4b1ad1590858 34647534-8863-4fde-b8d0-f24bcdc4fcc6 9845a991-d58b-409b-91b9-670cc383d030 8eccc146-c874-49ff-ba79-160c0e12c158 Studies have shown the impacts of mental health problems after disasters,6fc9a84e-1ac3-4301-80f5-cb4bf0806428 465e189f-798c-4db7-a381-6c2cb6f9c565 c4f4b08b-a7a1-4c34-8220-a7f881f5be47 with extreme events like Hurricane Katrina,0e71e17a-442f-46d8-b62f-cc3213f85208 8702da89-76d0-44e1-9eda-b04dc6a26385 floods,de8e1aa9-dc37-4056-90f7-d11b9fa20f2c 63de15ee-1f68-4899-a9f2-067f3ec89bda heat waves,922bcd50-dd07-4e05-afc7-fe3bcb1a953a and wildfiresceafce9f-08b6-4a6f-accb-95678efa13c9 having led to mental health problems. Further work has shown that some people with mental illnesses are especially vulnerable to heat. Suicide rates vary with weather,f3f74a8a-8d03-4770-8765-66c57dd40da3 83c98464-a66f-4c93-8698-a45966ccc96b bf16e763-fb16-45db-bdb9-e533ccb2bdac dementia is a risk factor for hospitalization and death during heat waves,922bcd50-dd07-4e05-afc7-fe3bcb1a953a 8bf8d41a-8b94-4ec2-95f0-cfd77b48685e and medications for schizophrenia may interfere with temperature regulation or even directly cause hyperthermia.1e9a7907-02f2-4da8-9e93-131f92515dbc 114cd0b9-5577-4c58-b5b1-24c822dd4ad7 Additional potential mental health impacts include distress associated with environmental degradation, displacement, and the knowledge of climate change.34647534-8863-4fde-b8d0-f24bcdc4fcc6 9845a991-d58b-409b-91b9-670cc383d030 ac2a32ac-2dce-4cf0-943a-f788c508b72a 06f5500e-fab9-4da4-b90d-aed04d543f83

New information and remaining uncertainties: Important new evidence on heat-health effectse2f39823-225f-43ea-ae65-dfc3d73bf9a6 1f4ec538-27f4-4a34-9d75-2d4cf9d2e960 71cceabc-45d8-4b40-bb94-30755e6db7d3 confirmed many of the findings from a prior literature review. Uncertainties in the magnitude of projections of future climate-related morbidity and mortality can result from differences in climate model projections of the frequency and intensity of extreme weather events such as heat waves and other climate parameters such as precipitation. Efforts to improve the information base should address the coordinated monitoring of climate and improved surveillance of health effects.

Assessment of confidence based on evidence: Overall: Very High confidence. There is considerable consensus and a high quality of evidence in the published peer-reviewed literature that a wide range of health effects will be exacerbated by climate change in the United States. There is less agreement on the magnitude of these effects because of the exposures in question and the multi-factorial nature of climate-health vulnerability, with regional and local differences in underlying health susceptibilities and adaptive capacity. Other uncertainties include how much effort and resources will be put into improving the adaptive capacity of public health systems to prepare in advance for the health effects of climate change, prevent harm to individual and community health, and limit associated health burdens and societal costs. Increased Ozone Exposure: Very High confidence. Allergens: High confidence. Wildfires: Very High confidence. Thermal Extremes: Very High confidence. Extreme Weather Events: Very High confidence. Vector-borne Infectious Diseases: High or Very High confidence for shift in range of disease-carrying vectors. Medium confidence for whether human disease transmission will follow. Food- and Waterborne disease: Medium confidence. Harmful Algal Blooms: Medium confidence. Food Security: Medium confidence for food quality; High confidence for food security. Threats to Mental Health: Very High confidence for post-disaster impacts; Medium confidence for climate-induced stress.

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• Human biometeorology (d8639fa7)
• National Climate Assessment Health Sector Literature Review and Bibliography. Technical Input for the Interagency Climate Change and Human Health Group (5836b5e1)
• Emerging Vibrio risk at high latitudes in response to ocean warming (918354f7)
• Outbreak of Vibrio parahaemolyticus Infections Associated with Eating Raw Oysters -- Pacific Northwest, 1997 (da0435d7)
• Health Impact Assessment of Global Climate Change: Expanding on Comparative Risk Assessment Approaches for Policy Making (81a84ac5)
• Climate Change and Waterborne Disease Risk in the Great Lakes Region of the U.S. (030e3539)
• Heat wave impact on morbidity and mortality in the elderly population: A review of recent studies (e2f39823)
• Ambient Temperature and Morbidity: A Review of Epidemiological Evidence (1f4ec538)
• Summer temperature variability and long-term survival among elderly people with chronic disease (71cceabc)
• The impact of temperature variability on wheat yields (2334a252)
• Historical Warnings of Future Food Insecurity with Unprecedented Seasonal Heat (5b19a296)
• Impact of climate change and bioenergy on nutrition (0da20a61)
• Implications of climate change for agricultural productivity in the early twenty-first century (af9250bc)
• Prioritizing Climate Change Adaptation Needs for Food Security in 2030 (242761d1)
• Nonlinear temperature effects indicate severe damages to U.S. crop yields under climate change (3818382e)
• Global food security under climate change (b4dfdd6a)
• Crop and pasture response to climate change (d4e4b28f)
• Rural Mental Health Impacts of Climate Change (88cd6f85)
• The psychological impacts of global climate change. (34647534)
• Hope, despair and transformation: climate change and the promotion of mental health and wellbeing (9845a991)
• Adapting to and coping with the threat and impacts of climate change. (8eccc146)
• The extent and impact of mental health problems after disaster (6fc9a84e)
• Disaster Mental Health: Theory and Practice (465e189f)
• Trauma and Stress Response Among Hurricane Katrina Evacuees (c4f4b08b)
• Exposure to Hurricane-Related Stressors and Mental Illness After Hurricane Katrina (0e71e17a)
• Trends in mental illness and suicidality after Hurricane Katrina (8702da89)
• Global Health Impacts of Floods: Epidemiologic Evidence (de8e1aa9)
• An attempt to quantify the health impacts of flooding in the UK using an urban case study (63de15ee)
• The Effect of Heat Waves on Mental Health in a Temperate Australian City (922bcd50)
• Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study (ceafce9f)
• Weather and suicide: the present state of knowledge on the association of meteorological factors with suicidal behaviour (f3f74a8a)
• Synchronized annual rhythms in violent suicide rate, ambient temperature and the light-dark span (83c98464)
• Relationship between daily suicide counts and temperature in England and Wales (bf16e763)
• Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence (8bf8d41a)
• Psychotropic drugs use and risk of heat-related hospitalisation (1e9a7907)
• Heat-related side-effects of neurological and non-neurological medication may increase heatwave fatalities (114cd0b9)
• Climate Change and Displacement: Multidisciplinary Perspectives (ac2a32ac)
• Climate Change and Displacement: Multidisciplinary Perspectives (06f5500e)