finding 26.3 : key-message-26-3

A warming climate brings a wide range of human health threats to Alaskans, including increased injuries, smoke inhalation, damage to vital water and sanitation systems, decreased food and water security, and new infectious diseases (very likely, high confidence). The threats are greatest for rural residents, especially those who face increased risk of storm damage and flooding, loss of vital food sources, disrupted traditional practices, or relocation. Implementing adaptation strategies would reduce the physical, social, and psychological harm likely to occur under a warming climate (very likely, high confidence).

This finding is from chapter 26 of Impacts, Risks, and Adaptation in the United States: The Fourth National Climate Assessment, Volume II.

Process for developing key messages:

The Alaska regional chapter was developed through public input via workshops and teleconferences and review of relevant literature, primarily post 2012. Formal and informal technical discussions and narrative development were conducted by the chapter lead and contributing authors via email exchanges, teleconferences, webinars, in-person meetings, and public meetings. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, Engineering, and Medicine, and federal agencies. The author team also engaged in targeted consultations during multiple exchanges with contributing authors, who provided additional expertise on subsets of the Traceable Account associated with each Key Message.

Description of evidence base:

The evidence base for climate-related health threats can be divided into three main categories. First are those threats that have strong documentation of both the climate or environmental driver and the health effect. An example is the emergence of gastrointestinal illness due to the northward expansion of the bacteria Vibrio parahaemolyticus among Alaska shellfish. Other threats with a similar level of evidence include increased venomous insect stings.

Second, some health threats are based on a combination of well-documented climate-driven environmental changes and records of anecdotal community observations of health impacts. Examples include the increased risk of injury or death from exposure among winter subsistence-related travelers or respiratory problems from smoke inhalation during wildfires. The community observations of these threats point to a real trend.cc3776b7-7ea8-42e9-802d-2ef5e6ac2f40,935f5a26-c05d-4889-8afe-80fea0f7a831 However, there is no historical or current means to document and track such injuries or exposures. Therefore, objective evidence, such as increased rates of occurrence or peer-reviewed reports, is not currently available. Other threats that fit this category include respiratory symptoms from dust and pollen, decreased food security, and loss of cultural and traditional lifestyles and practices along with the accompanying mental health or social disruption effects.

The third category is those threats that are logical inferences of potential health risks based on documented environmental changes and community-vulnerability assessments. Examples include the well-documented threats from coastal storms to community infrastructure and shorelines and the damage to community water and sanitation systems from permafrost thawing or erosion. The risk of physical harm from major storm or flooding events is obvious, and the loss of a water/sewer system would likewise pose a clear threat to health through waterborne or water-washed infections. However, these threats are based on likely outcomes from existing trends in environmental change. The human health effects are either undocumented or are anticipated in the future. Many of the infectious disease risks and harmful algal blooms (HABs) fall into this category; where range expansion of pathogens or vectors is occurring, health effects are likely to follow.

New information and remaining uncertainties:

The greatest uncertainties in the health threats of climate change lie in the geographic distribution, magnitude, duration, and capacity to detect the effects. Many of the impacts of climate changes are most evident in rural Alaska, which is an enormous area and sparsely populated. Thus, sporadic events with geographic variability such as storms or HABs may have a range of human health effects from none to severe, depending on the timing and location of exposure. Likewise, the magnitude and duration of the effects on health are difficult to predict based on variability in the source of risk and human adaptation. The lack of repeated outbreaks of V. parahaemolyticus illnesses from raw shellfish consumption is a good example of how adaptations in aquaculture practices and commercial regulations, along with likely changes in consumer practices, appear to have reduced the magnitude of the health threats, compared with initial outbreak. Finally, we have limited capacity to detect many of the health outcomes associated with climate change. The organized reporting and monitoring of climate-linked health effects by public health are limited to the toxin-mediated illnesses, some of the infectious diseases, mortality events, and unusual clusters of illnesses or injuries. Even among those conditions, underreporting of illnesses is common due to healthcare-seeking behavior, lack of recognition by medical providers due to unfamiliarity or limited diagnostic capacities, or incomplete compliance. For many of the anticipated health effects, such as nonoccupational injuries, mental health issues, and respiratory conditions, there may be documentation in a person’s individual health records, but no systems are in place to collect such information and link these illnesses to climate or environmental events or conditions. Large administrative healthcare databases, such as the Alaska Hospital Discharge Data System or the Alaska Health Information Exchange, could be used for focused investigations or ongoing monitoring. However, these would only be useful for severe illnesses with large geographic or multiyear distributions. These datasets would likely miss health events that do not result in emergency room visits or hospitalizations, that are rare, or that occur in irregular episodes. Data from ambulatory clinic visits, community surveys, or syndrome-based surveillance efforts would be needed to detect and characterize uncommon or less severe health occurrences.

Assessment of confidence based on evidence:

There is high confidence that there will be a continuation of trends causing higher winter temperatures, increased storm events, increased frequency and extent of wildfires, and increased permafrost thawing with associated erosion. Given these trends, there is very likely to be subsequent human health effects, but the distribution and magnitude of these effects remain uncertain.

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