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@prefix dcterms: <http://purl.org/dc/terms/> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . @prefix gcis: <http://data.globalchange.gov/gcis.owl#> . @prefix cito: <http://purl.org/spar/cito/> . @prefix biro: <http://purl.org/spar/biro/> . <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> dcterms:identifier "climate-change-increase-health-risks"; gcis:findingNumber "18.3"^^xsd:string; gcis:findingStatement "Increased heat wave intensity and frequency, increased humidity, degraded air quality, and reduced water quality will increase public health risks."^^xsd:string; gcis:isFindingOf <https://data.globalchange.gov/report/nca3/chapter/midwest>; gcis:isFindingOf <https://data.globalchange.gov/report/nca3>; ## Properties of the finding: gcis:findingProcess "The assessment process for the Midwest Region began with a workshop was that was held July 25, 2011, in Ann Arbor, Michigan. Ten participants discussed the scope and authors for a foundational Technical Input Report (TIR) report entitled “Midwest Technical Input Report.” The report, which consisted of nearly 240 pages of text organized into 13 chapters, was assembled by 23 authors representing governmental agencies, non-governmental organizations (NGOs), tribes, and other entities. \r\nThe Chapter Author Team engaged in multiple technical discussions via teleconferences that permitted a careful review of the foundational TIR and of approximately 45 additional technical inputs provided by the public, as well as the other published literature, and professional judgment. The Chapter Author Team convened teleconferences and exchanged extensive emails to define the scope of the chapter for their expert deliberation of input materials and to generate the chapter text and figures. Each expert drafted key messages, initial text and figure drafts and traceable accounts that pertained to their individual fields of expertise. These materials were then extensively discussed by the Author Team and were approved by the Chapter Team members. "^^xsd:string; gcis:descriptionOfEvidenceBase "The key message and supporting text summarize extensive evidence documented in the Technical Input Report. Technical inputs on a wide range of topics were also received and reviewed as part of the Federal Register Notice solicitation for public input. Evidence for extreme weather such as heat waves across the U.S. are discussed in Chapter 2 (Our Changing Climate, Key Message 7) and its Traceable Accounts. Specific details for the Midwest are in “Climate Trends and Scenarios for the U.S. National Climate Assessment” with its references. A recent book also contains chapters detailing the most current evidence for the region. Heat waves: The occurrence of heat waves in the recent past has been well-documented, as have health outcomes (particularly with regards to mortality). Projections of thermal regimes indicate increased frequency of periods with high air temperatures (and high apparent temperatures, which are a function of both air temperature and humidity). These projections are relatively robust and consistent between studies. Humidity: Evidence on observed and projected increased humidity can be found in a recent study. Air quality: In 2008, in the region containing North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa, Missouri, Wisconsin, Illinois, Michigan, Indiana, and Ohio, over 26 million people lived in counties that failed the National Ambient Air Quality Standards (NAAQS) for PM2.5 (particles with diameter below 2.5 microns), and over 24 million lived in counties that failed the NAAQS for ozone (O3). Because not all counties have air quality measurement stations in place, these data must be considered a lower bound on the actual number of counties that violate the NAAQS. Given that the NAAQS were designed principally with the goal of protecting human health, failure to meet these standards implies a significant fraction of the population live in counties characterized by air quality that is harmful to human health. While only relatively few studies have sought to make detailed air quality projections for the future, those that have generally indicate declining air quality (see uncertainties below). Water quality: The EPA estimates there are more than 800 billion gallons of untreated combined sewage released into the nation’s waters annually. Combined sewers are designed to capture both sanitary sewage and stormwater. Combined sewer overflows lead to discharge of untreated sewage as a result of precipitation events, and can threaten human health. While not all urban areas within the Midwest have combined sewers for delivery to wastewater treatment plants, many do (for example, Chicago and Milwaukee), and such systems are vulnerable to combined sewer overflows during extreme precipitation events. Given projected increases in the frequency and intensity of extreme precipitation events in the Midwest (Chapter 2: Our Changing Climate, Key Message 6), it appears that sewer overflow will continue to constitute a significant current health threat and a critical source of climate change vulnerability for major urban areas within the Midwest."^^xsd:string; gcis:assessmentOfConfidenceBasedOnEvidence "In the absence of concerted efforts to reduce the threats posed by heat waves, increased humidity, degraded air quality and degraded water quality, climate change will increase the health risks associated with these phenomena. However, these projections are contingent on underlying assumptions regarding socioeconomic conditions and demographic trends in the region. Confidence is therefore high regarding this key message. "^^xsd:string; gcis:newInformationAndRemainingUncertainties "Key issues (uncertainties) are: \r\nHuman health outcomes are contingent on a large number of non-climate variables. For example, morbidity and mortality outcomes of extreme heat are strongly determined by a) housing stock and access to air-conditioning in residences; b) existence and efficacy of heat wave warning and response plans (for example, foreign-language-appropriate communications and transit plans to public cooling centers, especially for the elderly); and c) co-stressors (for example, air pollution). Further, heat stress is dictated by apparent temperature, which is a function of both air temperature and humidity. Urban heat islands tend to exacerbate elevated temperatures and are largely determined by urban land use and human-caused heat emissions. Urban heat island reduction plans (for example, planted green roofs) represent one ongoing intervention. Nevertheless, the occurrence of extreme heat indices will increase under all climate scenarios. Thus, in the absence of policies to reduce heat-related illness/death, these impacts will increase in the future.\r\nAir quality is a complex function not only of physical meteorology but emissions of air pollutants and precursor species. However, since most chemical reactions are enhanced by warmer temperatures, as are many air pollutant emissions, warmer temperatures may lead to worsening of air quality, particularly with respect to tropospheric ozone (see Ch. 9: Human Health). Changes in humidity are more difficult to project but may amplify the increase in heat stress due to rising temperatures alone.\r\nCombined sewer overflow is a major threat to water quality in some midwestern cities now. The tendency towards increased magnitude of extreme rain events (documented in the historical record and projected to continue in downscaling analyses) will cause an increased risk of waterborne disease outbreaks in the absence of infrastructure overhaul. However, mitigation actions are available, and the changing structure of cities (for example, reducing impervious surfaces) may offset the impact of the changing climate.\r\n"^^xsd:string; a gcis:Finding . ## This finding cites the following entities: <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/article/10.1016/j.amepre.2008.08.026>; biro:references <https://data.globalchange.gov/reference/030e3539-a620-441c-adb6-042db1a3fa6e>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/book/434135ed-eb50-4c46-9484-77563769e657>; biro:references <https://data.globalchange.gov/reference/1e5da375-51dd-4e29-8fe3-0d9e164b7856>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> biro:references <https://data.globalchange.gov/reference/2626b5ca-ec04-4e41-8405-9f582c779a7a>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/article/10.3394/0380-1330(2007)33%5B566:DAFOEC%5D2.0.CO;2>; biro:references <https://data.globalchange.gov/reference/5a66bdda-d5f3-4eb0-83d1-64cb86216182>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/report/noaa-techreport-nesdis-142-3>; biro:references <https://data.globalchange.gov/reference/95f2ea7d-12e3-4ed5-9247-7cf139db91a9>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/book/434135ed-eb50-4c46-9484-77563769e657>; biro:references <https://data.globalchange.gov/reference/9a70a3f4-3c60-4a8a-8cc9-bf5d7e112c12>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/book/434135ed-eb50-4c46-9484-77563769e657>; biro:references <https://data.globalchange.gov/reference/b228ac0d-7bf9-4391-99e7-5c598b9ce55e>. <https://data.globalchange.gov/report/nca3/chapter/midwest/finding/climate-change-increase-health-risks> cito:cites <https://data.globalchange.gov/book/434135ed-eb50-4c46-9484-77563769e657>; biro:references <https://data.globalchange.gov/reference/cd02cc8f-9ba1-4ce5-8283-b479b0374d33>.