Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.

Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.

Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.

But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.

The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.

Silicosis in modern industries

Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.

The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.

The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.

A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.

An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.

Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.

In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.

In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.

However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.

A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.

The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.

Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”

Silicosis symptoms and treatment

Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.

Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.

There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.

Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.

Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.

In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.

Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.

Research roundup

Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.

This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.

Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.

However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”

The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.

The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.

“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.

Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.

The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.

The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m³ to 0.1 mg/m³, although the risk of dust exposure to workers still remains high at those levels.

The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.

“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.

Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.

“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.

A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.

This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.

These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.

The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.

“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”

Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.

This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.

From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.

Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.

At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.

The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.

“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”

Additional research

Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.

Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.

Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.

Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.

From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.

Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.

Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.

Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.

Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.

The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.

Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.

Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.

Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.

Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.

Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.

The post Silicosis: An explainer and research roundup appeared first on The Journalist's Resource.

Trade winds usually push warm water across the Pacific westward toward Oceania and Asia, causing cold water to surface along the coastlines of the tropical Americas, including parts of Mexico, Central America and South America.

But every few years, trade winds weaken during the early spring, and warmer water settles around these coasts and into the mid-Pacific.

This phenomenon is part of a broader climate pattern called the El Niño-Southern Oscillation. The warm phase of ENSO is simply called El Niño. Stronger than usual trade winds, by contrast, push warm water westward, allowing more cool water to surface and bringing a La Niña pattern. El Niño and La Niña occur naturally, though recent research suggests climate change is affecting these patterns.

Fishermen in Peru first identified warmer than usual waters in the Pacific during the 1600s, and named the phenomenon “El Niño de Navidad,” since it often occurred near Christmas. Usually the rising, nutrient-rich cool waters brought a wealth of sea life to their nets. But once in a while, the bounty would shrink, coinciding with warmer waters the fishermen observed, typically during December.

Likewise, trade winds are naturally occurring and move east to west. For centuries, sailors used them to speed their cargo ships across oceans. Historical evidence suggests El Niño winds spurred the Spanish conquest of South America, allowing ships to reach northwestern parts of the continent that winds in years past had kept them from reaching. Climatologists are not entirely sure why trade winds weaken — sometimes they weaken seemingly randomly.

But Wenju Cai, director of southern hemisphere oceans research at the Commonwealth Scientific and Industrial Research Organisation in Australia, explained by email that “we know a bit.”

Cai pointed to the behavior of the Madden-Julien Oscillation, a moving mass of clouds, rain and wind over the Indian Ocean, discovered by climatologist Roland Madden and meteorologist Paul Julian in the 1970s, as one link to the intensity of trade winds over the Pacific.

El Niño patterns also mean shifting jet streams. Jet streams are currents of air that move roughly west to east and flow above trade winds. They are strongest around 6 to 8 miles above the earth’s surface, according to the National Oceanic and Atmospheric Administration.

Warmer Pacific waters cause the Pacific jet stream to dip south and extend across the southern U.S. and northern Mexico during strong El Niño years.

Jet streams form boundaries between warmer and cooler air, and high and low pressure. High pressure systems are more likely to bring fair weather and clearer skies, while low pressure systems are more likely to bring stormier weather.

During winter in the northern hemisphere, this dip in the jet stream typically results in warmer temperatures across much of Canada and the middle of the U.S., as well as more rain and flooding in southern California. Much of the Southeast, especially around the Florida panhandle, often gets cooler temperatures, as this area is just south of where the jet stream typically settles during El Niño.

This piece is a companion to our comprehensive explainer, “El Niño: What it is, how it devastates economies, and where it intersects with climate change.”

The post How El Niño and La Niña climate patterns form appeared first on The Journalist's Resource.

There is a band of water across the equatorial Pacific Ocean, stretching from the coast of South America through to the island nations of Southeast Asia, whose temperature climatologists closely monitor as a driver of global weather patterns.

Typically, warm water that settles around Indonesia during early spring works as an atmospheric engine, an energy source that affects weather patterns around the world for the coming year.

But every two to seven years, this atmospheric engine shifts. When unusually warm water settles instead off the western coasts of Mexico and South America during the spring, the moisture and energy released into the atmosphere can profoundly change regional weather, from North America and South America to Asia and Africa.

This phenomenon is part of a broader climate pattern called the El Niño-Southern Oscillation. The warm phase of ENSO is simply called El Niño. La Niña, its opposite, happens when those eastern Pacific waters are cooler than normal in the spring. A third, neutral phase, happens when Pacific waters are near average temperature.

As of mid-November, forecasters with the National Oceanic and Atmospheric Administration give a more than 55% chance of a strong El Niño this winter. Odds are 35% for a historically strong El Niño, like those that happened from 2015 to 2016, and 1997 to 1998. Odds are 62% that El Niño will persist into spring 2024.

The stronger an El Niño, the higher the likelihood of flood, drought and other regional weather consequences. This topic is relevant to environmental journalists and business journalists alike — and we’ve created this explainer to help reporters explain the consequences of this periodic weather pattern to their audiences.

Here is what this El Niño explainer will cover:  

• How weather that deviates from regular expectations can have devastating economic consequences, particularly for people working in industries like fishing and agriculture who rely on some measure of climactic predictability.
• The findings of recent research that puts average global economic losses during El Niño years in the trillions of dollars.
• The effects of climate change on El Niño, which are poised to substantially increase that tally in the decades to come, research finds.

El Niño: ‘The most predictable climate driver’

El Niño and La Niña patterns last several months to a year, though sometimes longer. A strong El Niño is often followed the next year by a La Niña pattern.

“ENSO is the most predictable climate driver at seasonal timescales,” write the authors of a June 2021 paper in the journal Environmental Hazards.

But specific weather observed during past El Niño patterns may not appear in the same way during subsequent ones. While climatologists can predict an El Niño pattern with a high level of probability, precise regional effects are less predictable.

“Every El Niño is different,” says Christopher Callahan, a postdoctoral scholar of earth system science at Stanford University. “They all have slightly different patterns, or slightly different effects.”

In order to understand how El Niño stunts global economic growth and how it hampers local and regional economies, it will help to first understand predictions for regional weather based on historical analyses of this climate pattern, especially for journalists covering and communicating its effects over the coming months.

How El Niño can affect regional weather

Past El Niño events have meant warm, dry air for Southeast Asia and northern Australia during the northern hemisphere’s winter months. Rain and cooler air appear in the southern U.S. during the winter months there.

In South America, countries situated in the northwest and along the mid-Atlantic coast have seen wetter, warmer weather. The Gulf of Alaska and western Canada have experienced warmer temperatures during past El Niño events. El Niño patterns can even alter shorelines, finds research published June 2023 in Nature Communications.

NOAA forecasters predict, as of mid-October, higher than usual temperatures in the U.S. Northwest and Northeast during the winter. Across much of the U.S. South, they predict equal odds of higher or lower temperatures. There’s a slightly greater chance of rain across the middle of the country and along the eastern seaboard, with higher chances of precipitation in the Southeast, the forecasters predict.

Climatologists and meteorologists deal in probabilities, and predictions are not certainties. Ten days is about as far as meteorologists can reliably predict when it comes to specific weather patterns. Climatologists study weather events and atmospheric patterns over the long term — anything greater than about two weeks.

“You look at these seasonal outlooks and such that are influenced by El Niño, and it might shift the odds to a 60% chance of heavy rains as opposed to the average, which might be a 33% chance,” says Emily Becker, associate director of the University of Miami Cooperative Institute for Marine and Atmospheric Studies. “That also still means there’s a 40% chance that you won’t have those heavy rains. That’s where El Niño’s information is provided — it’s in how the chances of certain events change. It never gives you a guarantee.”

How El Niño stunts global economic growth

Recent studies indicate El Niño patterns can significantly stunt economic growth. El Niño “drives considerable impacts that include El Niño-related droughts in western Pacific regions, floods in eastern Pacific regions and severe food shortage and cyclones to Pacific Island countries,” write the authors of a May 2023 paper published in Nature Reviews Earth & Environment.

Globally, Callahan and Mankin attribute $5.7 trillion in unrealized economic gains, measured by GDP, over the five years following the 1997-to-1998 El Niño, along with $4.1 trillion associated with the 1982-to-1983 El Niño. For some countries, like Peru, El Niño hasn’t just meant unrealized gains — overall economic growth shrunk in the following years.

Callahan and Mankin note that the 1997-to-1998 El Niño was stronger than the 1982-to-1983 El Niño, and the world economy was larger in the late 1990s than in the early 1980s.

“El Niño events can produce extreme climate conditions that range from extreme rainfall to drought, to heat, to wildfire, to landslides to disease outbreaks,” Callahan says. “All of these things appear to sort of combine and integrate, to produce economic stress that lasts for five, or even up to 10 years, making these events far more costly than we realized.”

Wenju Cai, director of southern hemisphere oceans research at the Commonwealth Scientific and Industrial Research Organisation in Australia, and coauthors find similar economic consequences in a September 2023 paper published in Nature Communications.

Using an analysis slightly different from Callahan and Mankin, they estimate the global economy would have been $2.1 trillion larger over the following three years if not for the 1997-to-1998 El Niño, and $3.9 trillion larger if not for the 2015-to-2016 El Niño.

La Niña can bring catastrophic rains to Southeast Asia and nearby regions, including some of the worst flooding in the history of Queensland, Australia during the 2010 La Niña. But fisheries off the Pacific coast of South America tend to do well, and some La Niña events have been shown to modestly boost global economic growth. Cai and coauthors associate the 1998-to-1999 strong La Niña with $60 billion in global economic gains.

Crucially, they also estimate that strong El Niño patterns linked to continued high emissions of greenhouse gasses could mean an additional $33 trillion in global economic losses through the end of the century.

“Greenhouse warming is likely to increase frequency and intensity of extreme El Niño events,” Cai explained by email. “An El Niño typically leads to a global economic loss in trillions of US dollars. Thus, an increase in El Niño frequency and amplitude will lead to more frequent extreme weather events that are more devastating in affected regions, and globally a greater loss in economic production, particularly in developing and emerging economies.”

Flood, drought and disease from El Niño patterns

While El Niño patterns tend to hamper the global economy, they can also be costly for local and regional economies. Take the southern U.S.: El Niño years often mean more rain than usual there, and flooding is the “most common and damaging natural disaster” in the U.S., write the authors of a July 2019 paper published in Weather, Climate and Society.

“The livelihood and socio-economic development of majority of the people in East African countries including Tanzania, Kenya, Uganda, Burundi and Rwanda largely depend on rain-fed agricultural activities,” write the authors. “The region is often affected by incidences of climate and weather extremes and is among the most flood-prone countries in Africa.”

For Zambia, a landlocked country in southern Africa, the strong 2015-to-2016 El Niño pattern brought severe drought, “which caused crops to fail shortly after planting and resulted in region-wide food deficit warnings,” write the authors of an April 2021 paper in Environment and Development Economics. 

The country particularly relies on maize for food and commerce. Since the 1990s, Zambian farmers have used sustainable land practices, such as crop rotation and soil and water conservation, according to the paper. Because El Niño patterns are generally predictable months in advance, farmers there were able to diversify production — but it wasn’t enough to make up the income from lost crops.

“We find that maize yields were substantially reduced and that household incomes were only partially protected from the shock thanks to diversification strategies,” the authors conclude. “Mechanical erosion control measures and livestock diversification emerge as the only strategies that provided yield and income benefits under weather shock.”

The results of a June 2020 paper in the journal Quaternary looks at drought data in Thailand over the past 2,000 years and finds mixed results as to whether El Niño patterns bring drought there. The authors conclude that “droughts are not a product of one climate pattern, but likely the result of numerous patterns interacting.”

Communities in the Costa Rican province of Guanacaste “suffer from recurrent droughts, often related to El Niño,” write the authors of a September 2021 paper published in Water Resources Research. El Niño-driven droughts are likely to severely reduce local water supplies, they find. The authors use hydrological modelling to estimate a 60% decline in streamflow and groundwater during an extreme El Niño pattern, with the nearby ocean temperature rising 2.5 degrees Celsius higher than usual.

La Niña, by contrast, brings intense storms to the province, which can help recharge groundwater aquifers, but are also “characterized by high sediment loads and often rush through the watersheds within hours,” the authors write.

“A key result is that with business-as-usual water use in combination with population growth and a change toward a drier climate … a decline in groundwater storage may be expected,” they conclude. “This would have substantial consequences for communities and agriculture that rely on groundwater especially during the long dry season.”

Flooding, extreme storms and fires related to El Niño patterns can make transportation difficult or impossible, with higher risks during El Niño years that roads, rail and other infrastructure could be wiped out in California, Hawaii and U.S. Pacific territories, finds research published December 2021 in Progress in Disaster Science.

Finally, El Niño patterns affect not just land and infrastructure, but have also been linked to disease outbreaks. Southeast Asia, Tanzania, the western U.S. and Brazil all saw disease outbreaks linked to the 2015-to-2016 El Niño, find the authors of a February 2019 paper in Scientific Reports. These outbreaks included plague in Colorado and New Mexico, cholera in Tanzania and dengue in Brazil.

“Extreme climate conditions, such as flooding associated with severe storms and natural disasters such as hurricanes, typhoons, or earthquakes, can disrupt water systems — exposing drinking water to waste water and other effluents — thus increasing the risk of cholera activity and other water-borne infections,” the authors write.

How climate change affects El Niño patterns

The science is settled that the world is warming at a historically fast rate due to humanity’s inventions, such as gasoline-powered vehicles and electric power.

“Human activities, principally through emissions of greenhouse gases, have unequivocally caused global warming, with global surface temperature reaching 1.1 [degrees Celsius] above 1850 to 1900 levels in 2011 to 2020,” write the authors of a 2023 summary report for policymakers from the United Nation’s Intergovernmental Panel on Climate Change.

While scientific consensus is not there when it comes to how climate change affects El Niño patterns, recent research explores specific links between global warming caused by humans, which is known as anthropogenic warming, and increasing variability in Pacific Ocean temperatures that fuel El Niño conditions.

The May 2023 paper in Nature Reviews Earth & Environment uses statistical modeling techniques to explore the effects of global warming on El Niño and La Niña patterns over the past 120 years — Cai is lead author.

This type of analysis is common in climate science research and is based on a complex series of computer models that simulate weather conditions. The authors acknowledge that when it comes to the intensity of El Niño and La Niña patterns, real-world data only goes back decades and is lower quality before the 1950s.

Still, they write that “determining the anthropogenic contributions to changing ENSO variability is vital to attribute causes of extreme events that are becoming more frequent and severe to understand ENSO projection and to gauge urgency of mitigation actions.” Cai also notes in an email to The Journalist’s Resource that the modeling approach used in the paper is the same as what the IPCC uses.

The authors find more than three-fourths of models show more frequent, stronger El Niño and La Niña patterns from 1961 to 2020 compared with 1901 to 1960. Taken together, the modelling results and other evidence in the paper “suggest that the increase in observed ENSO variability post-1960 is at least in part related to anthropogenic warming,” the authors write.

And it’s not just that models indicate El Niño patterns are likely becoming stronger. Global warming creates conditions that can exacerbate the effects of those patterns.

“For example, in areas where El Niño causes drought, higher air temperature due to greenhouse warming increases evaporation, so drought onset is earlier, drought is more severe, and drought is harder to get out,” Cai explained by e-mail. “In areas where El Niño causes flood, warmer air holds more water vapor, making the flood more extreme.”

The authors of another recent paper, published October 2023 in Geophysical Research Letters, examine the geologic record contained within stalagmites from southeastern Alaskan caves to analyze the core causes of El Niño patterns over millennia.

Climate in the Northeast Pacific is very influenced by water temperature in the equatorial Pacific — this is a teleconnection, a “pattern of influence,” as Callahan puts it, where a change in the atmosphere or water in one part of the world affects weather in another. The Aleutian Low, a low-pressure pattern that lingers over the Gulf of Alaska for much of the year, is stronger when the equatorial Pacific Ocean is warmer, bringing more rain than average to the southern Alaskan coast and northwestern Canada.

Stalagmites, which rise from a cave floor, and stalactites, which grow down from a cave roof, are part of the mineral deposit family known as speleothems. These deposits are “excellent at capturing atmospheric conditions over the past 3,500 years,” the authors write. Through the flow of water into and out of the cave and the natural dripping of water from cave roof to floor, the authors were able to look back in time at the existence of El Niño and La Niña patterns.

“It’s recording stable isotopes trapped in the rock, particularly Oxygen-18, which derives from precipitation,” says lead author Paul Wilcox, a postdoctoral researcher with the Innsbruck Quaternary Research Group in Austria. “Typically, we can only access that isotope by drilling small bits of powdered rock from the stalagmite, but this sample was unique in that it also contained trace amounts of water. It’s difficult to get that in a lot of records, and we were lucky enough to have samples that had enough water and grew fast enough to piece together a high-resolution record of ancient precipitation.”

Parts of the stalagmite sample with relatively high levels of Oxygen-18 indicate a weaker Aleutian Low — meaning that while that part of the stalagmite was forming, El Niño events were probably happening less frequently. Likewise, lower levels of the oxygen isotope indicate a stronger Aleutian Low, and the likely presence of more persistent El Niño patterns.

The other key part of this study has to do with solar irradiance, which is a measure of the naturally fluctuating energy from the sun that reaches the top of the earth’s atmosphere. Solar irradiance was the driving force behind El Niño and La Niña patterns for 2,000 years, until the 1970s, the authors find. They link La Niña patterns with more solar irradiance, and El Niño patterns with less solar irradiance.

Through satellite imagery and other measures, climatologists since the 1960s have known that the movement of air and water in different parts of the Pacific are not independent and random, but rather part of a larger system.

That system has changed, with connections between wind, water and atmosphere across the Pacific weakening since the 1970s. The authors point to data from the stalagmite as indicating that this change is linked to the remarkably high emission of carbon dioxide into the atmosphere, stemming from human activity since the Industrial Revolution.

“There is a noticeable change in El Niño and La Niña variability that’s been known for several decades,” Wilcox says. “The problem is, there was too short of a record to really pinpoint if humans were causing this change or not. And this is where geologic records like the one we produced helps — kind of really more convincingly shows that this was likely human caused.”

Of the five strong El Niño events since 1901, three have happened since the 1970s, according to a September 2019 paper in the Proceedings of the National Academy of Sciences. Similar to a December 2019 paper in Geophysical Research Letters, the authors of the PNAS paper identify a westward shift since the 1970s in the “warm center” that catalyzes El Niño patterns, coinciding with “a rapid warming in the Indo-Pacific warm pool,” which they note may or may not be due entirely to human activity.

Still, if temperatures in the western Pacific continue to warm, and if greenhouse gases continue to be emitted at current rates, “more frequent extreme El Niño events will induce profound socioeconomic consequences,” the authors write.

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The world will see a 4.7-fold increase in heat-related deaths between today and 2050 if governments and companies don’t curb the use of fossil fuels and mitigate climate change, according to the annual report of the Lancet Countdown on Health and Climate Change, published on November 14.

Now in its eighth year, the report adds to a growing body of research documenting the impact of human-caused climate change on human health.

For the first time, the report provides projections on the growing risks to human health if global temperatures continue to rise and calls for a global commitment to transition to clean energy and energy efficiency.

“This report diagnoses a stark reality,” Dr. Renee Salas, one of the report’s authors and an emergency physician at Massachusetts General Hospital and Harvard Medical School, said during an online briefing for the report, held after its release on Nov. 15. “It makes clear that the further expansion of fossil fuels is reckless as it threatens the health and wellbeing of every person in the United States and around the world.”

The Countdown report is the result of a collaboration between 114 experts in 52 institutions and was funded by the Wellcome Trust, a charitable foundation in London. It includes a global report and policy briefs for several countries, including the U.S.

The report was released ahead of the 28th UN Conference of the Parties of UNFCCC, commonly called COP28, which for the first time is featuring health as a key theme. COP28 will be held in oil-rich Dubai, United Arab Emirates, from Nov. 30 to Dec. 12.

Climate reports like the Lancet Countdown are large documents, laden with data, and can be difficult to summarize in one news story. But local journalists can look for specific issues that apply to their communities and speak with local experts, policymakers and residents to produce stories that resonate with their audiences.

Below are six tips to cover major climate reports like the Lancet Countdown.

1. Explain how fossil fuels threaten human health.

Current climate change is mainly driven by human-generated greenhouse gas emissions from burning fossil fuels such as coal and oil. When released into the atmosphere, the greenhouse gases carbon dioxide (CO₂) and nitrous oxide (N₂O) intensify the greenhouse effect and increase the planet’s average temperature. Covering Climate Now offers several explainers and guidelines to help journalists understand and relay this information to their audiences.

Under the 2015 Paris Agreement, world leaders pledged to limit the globe’s temperature increase to 1.5 degrees Celsius above pre-industrial levels by 2100. But, given the lack of action by governments and companies, the world is on track to heat by 2.7 degrees Celsius by 2100, according to the Lancet Countdown report.

Today, the global temperature has increased by 1.14 degrees Celsius above the pre-industrial era, which spanned from 1850 to 1900. So far, 2023 has been the hottest year in more than 100,000 years, with heat records broken on every continent.

Climate change and rising temperatures increase the frequency of heat waves and droughts, jeopardizing access to food and water, and putting millions of people at risk of malnutrition and food insecurity. The report finds that frequent heat waves and droughts were responsible for 127 million more people experiencing moderate to severe food insecurity worldwide in 2021 than the annual average between 1981 and 2010.

In addition, air pollution from the burning of fossil fuels causes and worsens many health conditions, including heart and lung disease, neurologic and kidney conditions, mental health disorders, allergies, infectious diseases, pregnancy complications and poor birth outcomes, injuries and death, the Lancet Countdown report’s authors write.

“We have decades, decades of rigorous epidemiology and medical research showing the effects of air pollution on health,” Dr. Rebecca Philipsborn, an associate professor of pediatrics at Emory University, said during a Nov. 16 online briefing by the New England Journal of Medicine. “I think it’s settled science.”

Weather conditions, including extreme heat, can also reduce the safe hours to work or exercise outdoors.

Moreover, climate change can accelerate the spread of life-threatening infectious diseases, such as the West Nile virus, dengue, Zika, chikungunya, malaria, and Vibrio bacteria.

Vibrio bacteria live in certain coastal waters and thrive in warmer water temperatures. With increasing temperatures, they could put a record 1.4 billion people at risk of diarrheal disease, severe wound infections and sepsis, according to the report.

If the 1.5-degree Celsius target is missed and the world becomes hotter by 2 degrees Celsius by 2100, the length of the coastline suitable for Vibrio bacteria could expand by 17% to 25% and lead to 23% to 39% more cases globally. Also, the potential for dengue transmission could increase between 36% and 37%, the Lancet report finds.

2. Explain how climate change exacerbates inequities.

The Lancet Countdown report highlights how climate change exacerbates inequities around the world and in the U.S.

People who live in poor countries are often least responsible for greenhouse gas emissions and yet bear the brunt of health impacts from climate change.

Wealthier countries have failed to reach the promised annual sum of $100 billion to support the countries that are most affected by climate change, according to the report. In 2009, during COP15, developed countries committed to mobilizing $100 billion a year for climate action in developing countries by 2020. In 2021, that sum was $90 billion, a 7.6% increase over the previous year, according to the Organization for Economic Co-operation and Development, an intergovernmental organization headquartered in Paris, France, with 38 member countries.

In the U.S., people with low income, people who live in historically redlined neighborhoods, and communities of color are more likely to live in areas where levels of air pollution are unhealthy, according to the U.S. brief portion of the Lancet Countdown report.

“Communities of color and low-income areas often face enormous and unjust burden of pollution because of fossil fuel industries,” Dr. Margot Brown, senior vice president of justice and equity at Environmental Defense Fund, said during the online Lancet briefing. “They are more likely to be located near them.”

While facing greater hazards from climate change, these communities have the fewest resources to recover from the harm, she said.

“Climate change is going to be a threat multiplier, meaning it will exacerbate the environmental injustice,” Brown said. “So, it is really imperative that we ensure that federal and state governments implement clean energy plant investments in an equitable and just way, opposing efforts that add to any additional pollution and overburden communities.”

3. Talk to emergency physicians, specialists, nurses and people at medical schools.

The medical community is increasingly aware of how climate change impacts patients, from older adults to outdoor workers to children and premature babies in neonatal intensive care units.

“We know that extreme heat and air pollution are associated with poor perinatal outcomes, including preterm birth and maternal hypertensive disorders,” said, Philipsborn of Emory University, who is a general pediatrician. “The subsequent burden of disease is immense.”

During the same briefing, Dr. Sumita Khatri, a pulmonologist, described how the burning of fossil fuels and climate change are the root of some of her patients’ breathing issues. For instance, one of her patients is a construction worker and his asthma has been worsened due to longer allergy seasons resulting from warmer temperatures, which in turn lead to higher pollen levels.

“People who work outdoors are at particular risk of heat-related respiratory symptoms and other heat-related illnesses,” Khatri said during the NEJM briefing. “The bottom line is this: Climate change is not a threat in some faraway land. It’s in our backyards.”

In 2022, heat exposure resulted in a loss of 490 billion potential labor hours globally, 42% more than the annual average from 1991 to 2000, according to the Lancet Countdown report. On average, each worker in the world lost 143 potential hours of work as a result of climate change.

There has also been a surge of interest in climate health education in medical schools during the past five years, Dr. Cecilia Sorensen, director of the Global Consortium on Climate and Health Education and associate professor of environmental health sciences at Columbia University, said during the NEJM briefing.

“I’d say a large amount of this is being led by our medical students,” Sorensen said.

4. Ask local hospitals how they’re incorporating climate change into their plans.

Climate change increases pressure on health systems, which care for affected people.

Extreme weather events can disrupt health systems and hospitals, according to a 2022 report by The Commonwealth Fund. Health workers may also experience the physical and mental health effects of climate change more than the general population, because climate change not only disrupts their lives but also makes their jobs more challenging, and raises the risk of burnout, according to the report.

The Lancet Countdown includes policy briefs for several countries with data on the health impacts of climate change specific to each country.

The U.S. brief finds:

• Adults over age 65 experienced a 138% increase in total exposure to heatwaves each year from 2013 to 2022 compared with 1986 to 2005, meaning each older adult, on average, was exposed to an additional 2.8 heatwave days per year as compared to the historical baseline.
• Infants under 1 year were exposed to 61% more heatwaves, meaning that each infant, on average, was exposed to an additional 3.2 heatwave days per year from 2013 to 2022 compared with 1986 to 2005.
• The transmission season for Plasmodium falciparum and Plasmodium vivax — two parasites that cause malaria — lengthened by 39% and 34%, respectively, in U.S. lowland areas from 2013 to 2022 compared with 1951 to 1960.
• The ability of Aedes aegypti — the mosquito that can carry the dengue virus — to transmit dengue had more than doubled from 2013 to 2022 compared with 1951 to 1960.

5. Highlight hopes and potential solutions.

Even though the Lancet Countdown report bears grim news, it provides morsels of hope.

Deaths from fossil fuel-derived air pollution have fallen by almost 16% since 2005. At the same time, global investment in clean energy grew 15% in 2022 to $1.6 trillion.

The report also outlines health benefits that could result from a transition to a zero-carbon future. Improved air quality could prevent many of the 1.9 million deaths each year that result from exposure to air pollution. Transition to low-carbon diets could prevent up to 12 million deaths annually from poor diets and reduce 57% of agricultural emissions from dairy and red meat production.

Covering this aspect of the Lancet report provides an opportunity to highlight climate solutions in your community. The Washington Post, for instance, has a dedicated section on climate solutions. NPR dedicated a week to covering climate solutions. And Covering Climate Now has a Climate Solutions Reporting Guide.

6. If national and local officials have introduced plans and legislation to combat climate change, ask advocates and residents if they’re seeing the impact.

During the Lancet Countdown online briefing, Admiral Rachel Levine, assistant secretary for health for the U.S. Department of Health and Human Services, listed the Biden Administration’s efforts to address climate change:

• In August 2021, the Biden Administration established the Office of Climate Change and Health Equity to address the impact of climate change on the health of Americans.
• In December 2021, President Biden issued an executive order setting requirements for federal agencies to reduce their carbon footprint and achieve net-zero emissions from buildings and campuses by 2045.
• In spring 2022, the administration launched the White House-HHS Health Sector Climate Pledge, a voluntary commitment by the health sector to reduce their greenhouse gas emissions by 50% by 2030 and achieve net-zero emissions by 2050. So far, 116 organizations have signed on.
• Also, the Inflation Reduction Act has several opportunities for the health sector, including tax credits, grants and technical assistance programs, “making billions available for transformative clean energy building efficiency and infrastructure resilience projects that could really remake the face of the section,” Levine said.

During the Lancet online briefing, one of the featured speakers, Roishetta Sibley Ozane, founder, director and CEO of Vessel Project of Louisiana, an environmental justice organization, urged policymakers to have conversations with communities that are bearing the brunt of air pollution and climate change.

“When you talk about what the Biden administration has done, it sounds good on paper. It looks good on paper,” said Ozane, who lives in Southwest Louisiana. “My community smells like rotten eggs, mixed with Clorox. You’re gonna get a headache, you’re gonna feel sick. You’re not gonna want to stay here, but this is where we live every day. We don’t need any false solutions. We need real conversations with real impacted people.”

Additional reading

The fifth National Climate Assessment
U.S. Global Change Research Program, November 2023.

Sacrifice Zones: Mapping Cancer-Causing Industrial Air Pollution
ProPublica, November 2021.

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American voters who have low or moderate levels of trust in university researchers are less likely to believe that climate change is an important problem and that it’s driven by human activities, according to a study published this month in PLOS Climate.

The study, which finds trust in university research centers was higher among voters under 30, non-Protestants, regular religious service attendees, Democrats, and ideologically moderate or liberal individuals, adds to an existing body of research examining the role of public trust in science, including climate change.

The study is based on a nationally representative survey of 2,096 registered U.S. voters who were asked questions about their belief in climate change, trust in university research centers, religion, ideology, political identity, race and gender. The online survey was conducted in May 2022.

The scientific community overwhelmingly agrees that climate change is real and the Earth’s climate is affected by human activities. Despite this scientific consensus, a portion of Americans don’t believe it.

Over the years, polls have shown a political and ideological divide in the U.S. in beliefs about climate change and its causes, and that divide may be widening.

An August 2022 survey by the Pew Research Center found 78% of Democrats describe climate change as a major threat, up from 58% a decade ago. Meanwhile, 23% of Republicans find climate change a major threat, almost identical to 10 years ago.

Meanwhile, Americans’ trust in scientists has been declining since the outbreak of the COVID-19 pandemic, according a February 2022 report by Pew.

Overall, 29% of Americans expressed a great deal of confidence in medical scientists to act in the best interests of the public, down from 40% in November 2020, according to the report.

Some responsibility for the trust decline lies with the scientists, according to Ramit Debnath, one of the authors of the PLOS Climate study, “Why Don’t Americans Trust University Researchers and Why it Matters for Climate Change.”

“A broken science communication paradigm restricts the flow of evidence-driven facts in [the] public domain,” Debnath wrote in an email.

The solution is for “universities and scientists to work to re-establish public trust and confidence in our research,” Debnath, an assistant professor at the University of Cambridge, and his co-authors R. Michael Alvarez, a professor of political and computational social science at the California Institute of Technology, and Daniel Ebanks, a Ph.D. candidate at Caltech, write in the paper.

The authors’ sentiment has been expressed by other researchers, including Dr. Adam Frank, an astrophysicist at University of Rochester and self-described “evangelist of science.”

Skeptics “need to understand how science works,” Frank said in a July 2022 story by the University of Rochester’s News Center. “We don’t gain their trust just by telling them about results. They need to understand how scientists know what they know.”

Debnath and colleagues add that trusted messengers, such as religious organizations and leaders, might play a pivotal role in helping garner this trust.

The consequences of distrust in university research

The study also highlights the ramifications of distrust in science.

“This lack of trust in climate science has critical environmental, social and political consequences,” write Debnath and colleagues in the study. “It weakens the science-society compact and enables the active resistance of powerful actors with vested interests to change the status quo from which they disproportionately profit.”

Also, “if the United States continues down this road of science denial, the best and brightest of the world won’t come here. It’s really about our nation’s capacity to be an economic powerhouse,” Frank says.

The role of the news media

Among the study’s other findings is an association between where people get their news and trust in researchers.

Those who follow the news on television and print were more likely to trust university research and believe that climate change is an important issue. Respondents whose primary news sources were online were least trusting of university research.

The study notes climate change denial in the U.S. has not only been fueled by a complex interplay of ideological forces and politics, but also by distorted media representations, including the practice of false balance, giving equal play to scientists and climate deniers. This has further muddied the waters, the authors write in the paper, presenting scientific consensus as just another opinion.

In his email, Debnath wrote that journalists play a central role in making science accessible to the public and in training university researchers in science communication.

“This is a life skill that scientists are often left to learn on their own or not care/not made aware about at all,” he wrote. “Journalists have a much greater role to play in both reinforcement and long-term strategy planning to prevent misinformation and polarization.”

The study’s findings

Responses to the question of climate change importance were simplified into two categories: important and not important. (You can read more about how climate change is the result of human activities on NASA’s website.)

Below are the study’s findings in more detail, grouped by the main survey question.

“On a scale from 0 to 10, how much do you trust university research centers, where 0 means you don’t trust the institution at all and 10 means you trust it completely.”

• Individuals aged 45-64 and those over 65 were less inclined to trust university research centers compared with those under 30.
• Respondents with postgraduate education showed a higher level of trust in university research centers compared with those with no post-high school education.
• Protestant registered voters displayed a lower trust in university research centers compared with individuals from other religious denominations (Catholic, Jewish and other) and those without any religious affiliation.
• Regular attendees of religious services exhibited higher trust in university research centers compared with those who never attend.
• Democrats and moderates showed a higher level of trust in university research centers than independents. The results for Republicans and conservatives were not statistically significant.
• Traditional information sources like print and television positively influenced trust in university research centers. Conversely, trust was lower among those who relied on online news sources, but this finding wasn’t statistically significant. The results for radio listeners were also not statistically significant.

“How much of a problem do you believe climate change may be in the next 10 years for the United States?”

• Trust in science played a pivotal role. Those with low trust in science were significantly less likely to see climate change as important compared with those with high trust. Even those with moderate trust in science were less likely to consider it an important issue, relative to high trust individuals.
• Respondents aged 45-64 and 65 and older were less likely to consider climate change an important problem compared with those under 30. The results for the 31-44 age group were not significant.
• Democrats and those identifying as moderates or liberals were more likely to view climate change as an important issue compared to Republicans and conservatives.
• Other demographics, like race/ethnicity, education, region, and religious affiliation, didn’t show statistically significant differences.
• People who followed news on television or print were more likely to believe climate change is a crucial issue. No significant findings were seen for radio or online news consumers.

“Do you think that climate change is caused by human activities or that it is a natural event?”

• Those with low trust in science were much less likely to attribute climate change to human activities compared with those with high trust. Even respondents with moderate trust were less likely to believe humans cause climate change when compared with those with high trust.
• 59% of respondents believed climate change is due to human activities, while 41% attributed it to natural events.
• Black respondents were more inclined to believe that climate change results from natural events compared with white respondents. Conversely, Hispanics/Latinos had a higher likelihood than other ethnicities and races to attribute climate change to human activities.
• Respondents over 45 were less likely to believe that climate change is caused by human actions.
• Jewish and non-Catholic respondents more often believed in human-caused climate change than other religious groups. Respondents with no religious affiliations were significantly more likely to attribute climate change to humans than nature.
• Democrats, moderates, and liberals were statistically more likely to attribute climate change to human activities than nature.

Next steps for scientists

The authors offer four recommendations for the scientific community to address this trust deficit:

1. Targeted research: More research is needed to understand who currently trusts university research on climate change and sustainability, who does not and who is on the fence, and how to develop tailored strategies for each group.
2. Message framing: The way scientific findings are presented can make a big difference. “These results suggest scientists cannot necessarily expect that these groups will automatically trust their work, even if their research is of high quality and well-evidenced. Instead, scientists need to be more sensitive to understanding how to translate and discuss their work in ways that are understandable, and which generate trust among the public,” the authors write.
3. Finding the right messengers: It’s not always the scientists themselves who make the best communicators. “While additional research is necessary, our survey results indicate that religious organizations and leaders might provide an important mechanism for the generation of higher levels of trust in university research,” they write.
4. Education: The long-term strategy should focus on primary and secondary education. “What is also needed is developing educational approaches and materials that help students better understand the scientific process and how they can best understand and interpret scientific materials. Only by educating the next generations can we minimize distrust of scientific research in the longer term,” the authors write.

Like all studies, this paper has limitations. The study is observational and it depends on survey designs, so it can only paint a partial picture of the issue. The authors note their future research aims to refine survey methods, introduce more nuanced questions, and delve deeper into causal relationships concerning trust in science and climate action.

The study was funded by the Quadrature Climate Foundation, Keynes Fund and Caltech’s Resnick Sustainability Institute. The funders had no role in the study. The authors declared no competing interests.

Sources

• What the data says about Americans’ views of climate change
  Alec Tyson, Cary Funk and Brian Kennedy. Pew Research Center, August 2023.
• Can the public’s trust in science—and scientists—be restored?
  University of Rochester News Center, July 2022.
• Americans’ Trust in Scientists, Other Groups Declines
  Brian Kennedy, Alec Tyson and Cary Funk. Pew Research Center, February 2022.
• The Role of Trust for Climate Change Mitigation and Adaptation Behaviour: A Meta-Analysis
  Viktoria Cologna and Michael Siegrist. Journal of Environmental Psychology, June 2020.
• Questioning Scientific Practice: Linking Beliefs About Scientists, Science Agencies, and Climate Change
  Thomas G. Safford, Emily H. Whitmore and Lawrence C. Hamilton. Environmental Sociology, December 2019.
• The Scientific Consensus on Climate Change
  Naomi Oreskes. Science, December 2004.
• Trust
  Esteban Ortiz-Ospina and Max Roser. Our World in Data.

Additional reading

• “How Trustworthy Is This Research?” Designing a Tool to Help Readers Understand Evidence and Uncertainty in Science Journalism
  Anders Sundnes Løvlie, Astrid Waagstein and Peter Hyldgård. Digital Journalism, April 2023.
• Public Trust and Mistrust of Climate Science: A Meta-Narrative Review
  Antoinette Fage-Butler, Loni Ledderer and Kristian Hvidtfelt Nielsen. Public Understanding of Science, August 2022.
• Meta-Analyses of Fifteen Determinants of Public Opinion About Climate Change Taxes and Laws
  Magnus Bergquist,  Andreas Nilsson,  Niklas Harring and  Sverker C. Jagers. Nature Climate Change, March 2022.
• Politicization of Science in the Public Sphere: A Study of Public Trust in the United States, 1974 to 2010
  Gordon Gauchat. American Sociological Review, March 2012.

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The farm bill is wide-ranging legislation that sets funding and directs priorities for a variety of federal food consumption and production programs in the U.S. — plus, voluntary programs aimed at promoting environmental conservation on privately owned land.

Congress usually debates and renews the farm bill every five years. The first farm bill was passed in 1933, with 18 farm bills having been passed in all. The most recent farm bill passed as the Agriculture Improvement Act of 2018 and it expires at the end September, the end of the federal fiscal year.

Over the coming weeks, legislators will make the case for the next farm bill to include funding that supports the interests of their constituents, as well as lobbying and advocacy groups. To help guide journalists in coverage of those debates, The Journalist’s Resource is taking a look at academic research on three pillars of farm bills: SNAP, environmental conservation and rural development.

The research featured in this miniseries can inform the questions that journalists at local, regional and national outlets ask of federal lawmakers.

This week, we’re focusing on environmental conservation.

Environmental conservation programs are among the largest components of recent farm bills, according to a January 2022 report from the Congressional Research Service.

Conservation efforts made up 7% of the 2018 bill — $60 billion out of an estimated $867 billion over 10 years, according to the Congressional Research Service. Every five years, Congress may reauthorize, amend or add to existing conservation programs. The Congressional Research Service estimates the yearly cost for these programs will top $6 billion as part of the next reauthorization.

“Objectives of the CRP include reducing soil erosion, enhancing biodiversity, improving air and water quality, decreasing surplus production of agricultural commodities, and providing income support for landowners,” according to an August 2021 paper published in Applied Economic Perspectives and Policy.

Federal legislation in 2022 directed an additional $18 billion toward farm bill and other conservation efforts. These funds were part of laws aimed at curbing inflation, slowing climate change and reducing prescription drug prices.

There are three main overarching farm bill conservation programs:

• The Conservation Reserve Program provides financial incentives for private landowners to remove large swaths of land from agricultural production. Since 2021, the program has particularly focused on encouraging the development of grasslands, which serve as habitats for a range of plant and animal life and can help prevent soil erosion.
• The Environmental Quality Incentives Program, where technical experts from the U.S. Department of Agriculture provide free help to farmers interested in incorporating conservation practices into their ranching and crop production.
• The Conservation Stewardship Program, which also provides one-on-one technical assistance, as well as annual payments to encourage agricultural producers to meet conservation goals over five year contracts.

Conservation Reserve Program components

There are three main parts to the CRP program, which is administered by the U.S. Farm Service Agency.

“General CRP” includes entire fields or farms — these lands cannot be used anymore for or food or animal production. They are often lands at risk of environmental degradation, such as from soil erosion.

“Continuous CRP” focuses on conserving parts of land used for production, such as wetland areas, but not entire fields.

“Grasslands CRP” allows animals to graze but prohibits farming or ranching.

As of July 2023, there were 8.4 million acres of whole fields or farms being conserved under the Conservation Reserve Program across the 50 states, along with 7.2 million acres of parts of productive land, and 6.4 million acres of grassland.

“Agricultural landowners with large land holdings, who value hunting, and have positive environmental values, attitudes, and behaviors, were more likely to participate” in at least one of the conservation programs, according to a survey of more than 2,500 landowners, including farmers and ranchers, in Minnesota, North Dakota and South Dakota, published in February 2019 in Land Use Policy.

Conservation benefits

Setting aside large parcels of land and allowing ecosystems to replenish can improve air and water quality, as well as increase biodiversity among animal species, research finds.

The authors of an October 2022 paper in Geohealth quantify the economic benefits of improved air quality from land set aside as part of the Conservation Reserve Program.

In examining 2,287 counties from 2001 to 2016, they find an inverse relationship between conservation enrollment and pollution: As the number of acres conserved goes up, fine particulate matter goes down.

They also estimate that across the counties studied, the farm bill’s conservation program avoided 1,353 deaths per year due to declining pollution. The authors estimate the dollar value of those deaths prevented at $9.5 billion.

“These findings provide evidence that CRP may generate economic gains in terms of avoided mortality, well above the cost of the program,” they write.

Likewise, the farm bill conservation program is associated with improved local water quality, according to an April 2021 study published in the International Journal of Applied Earth Observation and Geoinformation.

The authors studied conservation program enrollment and data on water nitrogen levels from 1999 to 2014 across nearly 18 million acres of the Illinois River Basin passing through Wisconsin, Indiana and Illinois. They link conservation program enrollment to lower nearby nitrogen levels along the Illinois River and offshoot streams.

“Most improvement can be associated with the CRP practices designed to improve water quality,” the authors write. “Nevertheless, it should be noted that the results indicate correlation but not necessarily causation, thus should be interpreted with caution.”

Numerous bird species, including the grasshopper sparrow, the thick billed longspur and short-eared owls, make grasslands their home. As grassland diminishes, populations of birds that prefer grasslands also decline, find the authors of a January 2022 study of the western Great Plains, published in Ecological Applications.

The authors of another study linking conservation efforts with maintaining biodiversity, published September 2021 in Rangeland Ecology & Management, note that after general conservation contracts expire, grassland contracts, which allow grazing, could be a viable way to preserve animal habitats while allowing land to be productive.

They write that “the vast majority of Great Plains grasslands are privately owned and managed by people who care deeply about conservation of the land but also need to make a living. Managers of private rangelands often acknowledge the importance of wildlife conservation but place this as a far lower priority than livestock production.”

Rental payments

The U.S. Department of Agriculture pays rent on conserved land for the contract term. Payments are made annually.

Rental rates vary by county. Rates are typically lower in states with less fertile land, such as Alaska, where the rate is $41 per acre on average for General CRP lands.

Rates are higher in midwestern states — known as America’s breadbasket, since historically that is where much of the country’s grain has been grown. Producers in Iowa, for example, can fetch $173 per acre, on average, for the general program.

The U.S. average is $78 per acre. Average rates vary by program component, in addition to by location — more information is available from the Farm Service Agency.

Rental rates can also change with each farm bill reauthorization. These rates are set as a percentage of the cash rental rate, which is the county average rent per acre a landowner could get if they rented to an agricultural producer. In the 2018 farm bill, the general conservation program rate was lowered from 110% of the cash rental rate to 85% — a reduction of 25 percentage points. The latest average cash rents by county are available from the National Agricultural Statistics Service.

Acreage caps

Farm bills cap the number of acres that can be included in conservation programs at any given time. Individual producers apply to have part or all of their land conserved.

While there is no limit to the number of acres an individual producer can apply for, no more than 27 million acres can be enrolled across the country, as of the most recent farm bill. For comparison, agricultural producers own about 900 million acres of land, according to the U.S. Department of Agriculture.

Federal legislators may raise or lower the cap during farm bill reauthorization. This was a point of debate in 2014, when that year’s farm bill reduced the cap from 32 million acres to 24 million acres, and in 2018, when the cap was raised to its current level.

Participation peaked in 2007 at nearly 37 million acres, according to research published in February 2020 in Applied Economic Perspectives and Policy.

“In no year has CRP met its farm bill acreage cap and acreage enrolled has fallen off significantly in recent years,” according to a March 2022 report from farmdocDaily, an online publication focusing on agricultural issues, published by the University of Illinois.

According to the January 2022 report from the Congressional Research Service, it is mostly a lack of federal dollars, not a lack of interest, that keeps producers from participating, particularly in the technical assistance programs.

Less than one-third of Environmental Quality Incentives Program applications were approved in 2021, compared with nine in ten general conservation program applications, the report finds.

“Arguments for expanding conservation programs in earlier farm bills were persuasive in light of evidence that large backlogs of interested and eligible producers were unable to enroll due to a lack of funds,” according to the report. “Debate on a new farm bill could see similar arguments.”

Conservation opportunity costs

Much of the research on the effectiveness of farm bill conservation programs focuses on outcomes and opportunity costs in specific states or groups of states in the especially fertile areas of the U.S. — primarily the Midwest.

Opportunity costs are what is given up when a choice is made. For agricultural producers, the cost of conservation is producing food for sale. The February 2020 paper in Applied Economic Perspectives and Policy explores opportunity costs in Kansas — specifically, whether conservation rental payments push land values up enough to counteract foregone crop sales, or whether the contracts hurt land values.

The authors analyze land parcel sales in the state spanning 1998 to 2014. They find sales of land with existing conservation contracts sell for 7% less on average than similar parcels without contracts. The buyer is discounted some money on the sale because they can’t farm it for a period of time.

The discount vanishes depending on years remaining on the contract and land quality.

“During years when it is likely a contract is up for renewal, parcels with CRP will sell with either no discount or a slight premium,” the authors write. “For land with relatively low productivity, as demonstrated by land sales in northwestern and north central Kansas, parcels with CRP sell with little to no discount.

Michigan State University agricultural economist Scott Swinton describes the conservation-versus-production decision making process in a November 2021 paper, also published in Applied Economic Perspectives and Policy:

“Farmers weigh two kinds of costs when deciding whether to participate in a conservation program. The first covers the direct costs of variable inputs and equipment. The second is the opportunity cost of giving up income from a current activity, such as crop production or live-stock grazing. Opportunity cost can be large, especially when shifting an entire field into a land retirement program.”

Because agricultural producers have more precise geospatial maps land than ever before, they may be able to fine-tune less productive parts of parcels set aside for conservation, Swinton suggests. There may also be opportunities for conservation within productive land, such as incorporating native plant life within crop fields, he adds.

“Looking ahead to the next Farm Bill in 2023, the public priorities, scientific evidence, and technological innovation point toward a role for precision conservation,” Swinton writes.

Source list

The Unintended Benefits of the Conservation Reserve Program for Air Quality
Douglas Becker, Alexander Maas, Jude Bayham and James Crooks. Geohealth, October 2022.

Mapping the Farm Bill: Reviewing the CRP; Law, Land & History
Jonathan Coppess and Christopher Laingen. farmdocDaily, March 2022.

Precision Conservation: Linking Set-Aside and Working Lands Policy
Scott Swinton. Applied Economic Perspectives and Policy, February 2022.

Farm Bill Primer: Conservation Title
Congressional Research Service, January 2022.

Increasing Durability of Voluntary Conservation through Strategic Implementation of the Conservation Reserve Program
Daniel Sullins, et al. Biological Conservation, July 2021.

Water Quality Related to Conservation Reserve Program and Cropland Areas: Evidence from Multi-Temporal Remote Sensing
Dameng Yin, et al. International Journal of Applied Earth Observation and Geoinformation, April 2021.

Thinking Like a Grassland: Challenges and Opportunities for Biodiversity Conservation in the Great Plains of North America
David Augustine, Ana Davidson, Kristin Dickinson and Bill Van Pelt. Rangeland Ecology & Management, September 2021.

The Opportunity Cost of the Conservation Reserve Program: A Kansas Land Example
Mykel Taylor, Nathan Hendricks, Gabriel Sampson and Dillon Garr. Applied Economic Perspectives and Policy, February 2020.

Further reading

Competing Farm Programs: Does the Introduction of a Risk Management Program Reduce the Enrollment in the Conservation Reserve Program?
Jisang Yu, Brittney Goodrich and Atticus Graven. Journal of the Agricultural and Applied Economics Association, September 2022.

Would Farmers Benefit from Removing More Land from Production in the Next Farm Bill?
Nathan Hendricks. Applied Economic Perspectives and Policy, March 2022.

Land Use Decisions after the Conservation Research Program: Re-enrollment, Reversion, and Persistence in the Southern Great Plains
Jessica Barnes. Conservation Science and Practice, July 2020.

Eastern Grasslands: Conservation Challenges and Opportunities on Private Lands
Patrick Keyser, et al. Wildlife Society Bulletin, September 2019.

Evaluating the Role of Farm Bill Conservation Program Participation in Conserving America’s Grasslands
Lily Sweikert and Larry Gigliotti. Land Use Policy, February 2019.

The post Environmental conservation in the farm bill: A research roundup appeared first on The Journalist's Resource.

In both cities and suburbs, affluent neighborhoods are more likely to enjoy the cool shade of trees than lower-income neighborhoods, some of which bear the scars of historic redlining and housing segregation.

The absence of trees is not just an aesthetic discrepancy — it can impact human health and well-being, a growing body of research shows. Neighborhoods devoid of trees often grapple with the urban heat island effect, where concrete and asphalt absorb and magnify summer’s heat and elevate the risk of heat-related illnesses. Heat islands are often linked to factors such as income and race.

Some studies have linked long-term exposure to green surroundings to health benefits such as living longer. In contrast, unsheltered sidewalks can deter residents from walking, exercising or socializing outdoors.

More than half of the world’s population now lives in urban areas. In the U.S. and Canada, nearly 80% of people live in urban areas, according to estimates from academic research. Meanwhile, in the U.S., urban tree canopy cover is declining at an estimated rate of four million trees per year due to urbanization and tree diseases.

In addition, climate change is making summer days hotter and heat waves more frequent and longer. Researchers warn this can further exacerbate the divide, calling on policymakers to invest in planting more trees and creating more green spaces in barren neighborhoods. Some cities are beginning to address these inequities by investing in new green spaces or testing creative solutions, such as green roofs.

American Forests, a nonprofit organization in Washington, D.C., has created Tree Equity Scores for nearly 200,000 urban neighborhoods in the U.S. to measures how well the benefits of urban tree canopy are reaching those who need them most, including low incomes, communities of color and those disproportionately affected by extreme heat, pollution and other environmental hazards.

Journalists can assess tree equity in their coverage area and find out whether local officials are implementing plans to reduce inequities in green space. To bolster journalists’ knowledge and reporting, we’ve gathered and summarized several recent studies that assess tree and green space inequities in cities and neighborhoods and examine their association with health. The studies are organized by publication date.

Research roundup

The Tree Cover and Temperature Disparity in US Urbanized Areas: Quantifying the Association with Income Across 5,723 Communities
Robert I. McDonald, et al. PLoS ONE, April 2021.

The study: Researchers use digital images from the U.S. Department of Agriculture’s National Agriculture Imagery Program to survey tree cover inequity in 100 large urban areas in the U.S., including 5,723 municipalities and home to 167 million people. They compare tree cover with summer land-surface temperature, using NASA’s Landsat imagery. The study focuses on one benefit of tree canopies: reducing temperature. Tree canopies primarily cool the air by shading surfaces such as concrete and asphalt, preventing heat storage and reducing the urban heat island effect. Tree cover can reduce land surface temperature by 10 to 20 degrees Celsius (18 to 36 degrees Fahrenheit) on a summer day, the authors write.

The findings: In 92% of the areas studied, low-income blocks had less tree cover than high-income blocks. More specifically, low-income blocks on average had 15.2% less tree cover and were 1.5 degrees Celsius (2.7 F) hotter than high-income blocks. In the Northeast U.S, low-income blocks had 30% less tree cover and were 4 C hotter (7.2 F) than high-income areas, showing some of the greatest differences in the U.S. At 54%, Connecticut had the greatest difference between high- and low-income neighborhoods. Researchers also find a positive association between more tree cover and populations that are white and have higher income. But, in 22% of the urban areas there was not a statistically significant relationship between income and tree cover.

Quote from the study: “A targeted investment in tree planting of $15.8 billion would close the urban tree cover disparity for 34 million people in low-income blocks of moderate or greater population density, although it would likely take at least 5–10 years for planted trees to be large enough to deliver significant ecosystem service benefits. Some of the needed tree planting would occur through public sector investment in tree planting and maintenance on the public right of way and publicly owned land… But some of the needed tree planting would have to occur on private land, which would require incentives or regulations that motivate the private sector to conduct this tree planting.”

More, from the lead author: “Tree inequality is worse in the suburbs,” published in thenatureofcities.com in May 2021.

Residential Housing Segregation and Urban Tree Canopy in 37 US Cities
Dexter H. Locke, et al. Urban Sustainability, March 2021.

The study: Researchers assess how the practice of redlining, a racially discriminatory housing policy established by the federal government’s Home Owners’ Loan Corporation during the 1930s, may relate to tree canopy coverage in city neighborhoods in 2020. “Tree canopy” typically refers to areas that are shaded by trees. The authors include 37 metropolitan areas, comparing predominantly white neighborhoods during the redlining era with areas where mostly racial and ethnic minorities lived.

The findings: Redlining influenced the location and allocation of trees and parks. The 37 metropolitan areas where mostly racial and ethnic minorities lived during the 1930s have, on average, 23% tree canopy cover today. Areas where U.S.-born white people lived in the 1930s have almost twice as much tree canopy, 43%.

Quote from the study: “Our investigation into 37 cities reveals a strong association between HOLC grades inscribed on maps roughly nine decades ago and present-day tree canopy. The study design cannot identify causal pathways, but the inequity invites careful scrutiny of the social, economic, and ecological processes that have created the demonstrably uneven and inequitable distribution of urban tree canopy in the United States.”

Green Spaces and Mortality: A Systematic Review and Meta-Analysis of Cohort Studies
David Rojas-Rueda, et al. The Lancet Planetary Health, November 2019.

The study: Researchers looked for English-language longitudinal studies that assessed the association between green spaces, or lack a thereof, and the risk of death from any cause. The meta-analysis of nine studies, published between 2012 and 2019, included more than 8 million adults from Australia, Canada, China, Italy, Spain, Switzerland and the U.S.

The findings: Increasing green spaces in neighborhoods is significantly associated with reducing risk of death. While researchers haven’t yet identified a causal relationship between green spaces and health, they have offered several theories. For instance, green spaces can foster physical activity, walking and cycling. They also lessen air pollution, noise and the heat island effect.

Quote from the study: “Although the benefits of green spaces and mortality that we found are robust, negative effects of increasing green spaces in the urban environment (such as gentrification) can occur, and these externalities should be considered when urban public policies are designed.”

Who Has Access to Urban Vegetation? A Spatial Analysis of Distributional Green Equity in 10 US Cities
Lorien Nesbitt, et al. Landscape and Urban Planning, January 2019.

The study: The study is an analysis of the relationship between urban vegetation and socioeconomic and demographic factors in 10 urban areas in the U.S.: Chicago, Houston, Indianapolis, Seattle, St. Louis, Los Angeles, New York, Phoenix, Portland, Ore. and Jacksonville, Fla. Researchers used high-resolution aerial imagery and Census data for their analysis. They define equitable access to urban vegetation as fair access, regardless of income, race or age.

The findings: Access to green spaces in urban areas is generally associated with higher income, higher education and higher percentage of white residents. Latino urban residents had the lowest level of access to urban greenery, followed by African American and Indigenous residents. Meanwhile, socioeconomic factors appear to be less often associated with access to park area, suggesting that parks are more equitably distributed.

Quote from the study: “The impact of urban vegetation exposure on the health and well-being of marginalized communities may become even more critical as climate change worsens. When health inequalities intersect with low access to urban vegetation, this intersection can create areas of high climate vulnerability.”

More on urban vegetation: The authors parse the effects of different types of green spaces. An area with a mix of vegetation, including shrubs, hedges, garden and crop plants and grassy areas, reduce stormwater runoff and offer green views that can reduce stress. Trees, or woody vegetation, can reduce the urban heat island effect by providing shade. Trees can also improve air quality, while parks offer space for physical activity and socialization.

More, from the lead author: “How cities can avoid ‘green gentrification’ and make urban forests accessible,” published in The Conversation in June 2021.

Additional reading

• Inequalities in Urban Greenness and Epigenetic Aging: Different Associations by Race and Neighborhood Socioeconomic Status
  Kyeezu Kim, et al. Science Advances, June 2023.
• Breathing Fresh Air in the City: Implementing Avenue Trees as a Sustainable Solution to Reduce Particulate Pollution in Urban Agglomerations
  Mamun Mandal, et al. Plants (Basel), April 2023.
• Leafier Communities, Healthier Hearts: An Australian Cohort Study of 104,725 Adults Tracking Cardiovascular Events and Mortality Across 10 Years of Linked Health Data
  Xiaoqi Feng, Michael A. Navakatikyan, Renin Toms and Thomas Astell-Burt. Heart, Lung and Circulation, January 2023.
• Exposure to Urban Greenspace and Pathways to Respiratory Health: An Exploratory Systematic Review
  William Mueller, et al. Science of the Total Environment, July 2022.
• The Disparity in Tree Cover and Ecosystem Service Values Among Redlining Classes in the United States
  David J. Nowak, Alexis Ellis and Eric J. Greenfield. Landscape and Urban Planning, May 2022.
• Urban Trees and Human Health: A Scoping Review
  Kathleen L. Wolf, et al. International Journal of Environmental Research and Public Health, June 2020.
• The Value of US Urban Tree Cover for Reducing Heat-Related Health Impacts and Electricity Consumption
  Robert I. McDonald, Timm Kroeger, Ping Zhang and Perrine Hamel. Ecosystems, May 2019.
• Redlining and Neighborhood Walking in Older Adults: The 2017 National Household Travel Survey
  Lilah M. Besser, Diana Mitsova, Christine L. Williams and Lisa Wiese. American Journal of Preventive Medicine, December 2022.
• The Relationship Between Urban Forests and Race: A Meta-Analysis
  Shannon Lea Watkins and Ed Gerrish. Journal of Environmental Management, March 2018.
• The Relationship Between Urban Forests and Income: A Meta-Analysis
  Ed Gerrish and Shannon Lea Watkins. Landscape and Urban Planning, February 2018.
• Exploring Pathways Linking Greenspace to Health: Theoretical and Methodological Guidance
  Iana Markevych, et al. Environmental Research, October 2017.
• Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women
  Peter James, Jaime E. Hart, Rachel F. Banay and Francine Laden. Environmental Health Perspective, September 2016.
• Trees Grow on Money: Urban Tree Canopy Cover and Environmental Justice
  Kirsten Schwarz, et al. PLoS ONE, April 2015.
• Urban Greening to Cool Towns and Cities: A Systematic Review of the Empirical Evidence
  Diana E. Bowler, et al. Landscape and Urban Planning, September 2010.

The post Tree equity and trees’ impact on surface temperatures, human health: A research roundup appeared first on The Journalist's Resource.

July was the Earth’s hottest month on record, according to the Copernicus Climate Change Service, a program of the European Union.

Extreme heat not only strains water, energy and transportation infrastructure, and affects crops and livestock, it also impacts human health. Many people don’t take heat warnings seriously, as highlighted in the findings of a 2007 telephone survey of 908 people in North America, published in the International Journal of Biometeorology. But studies show extreme heat can affect most people, particularly vulnerable populations like children, older adults and outdoors workers.

“It’s pretty clear that human-caused climate change is causing average temperatures to increase and it’s pretty clear that heat waves globally — but specifically in some regions of the world — are becoming longer, more frequent and more severe,” says Dr. Catharina Giudice, a practicing emergency physician and Climate and Human Health Fellow at Harvard University’s Center for Climate, Health, and the Global Environment. “And we’re certainly seeing the repercussions of that on the health of communities that, unfortunately, are not used to the heat, or not set up to deal with the heat.”

In the U.S., during the first seven months of 2023, there were 15 separate weather and climate disasters in which overall costs and damages reached or exceeded $1 billion, according to the National Oceanic and Atmospheric Administration. And the devastating August wildfire in Maui, Hawaii, which has been declared the deadliest U.S. wildfire in a century, has a current estimated cost of nearly $10 billion.

Heat is the leading cause of weather-related deaths in the U.S., outranking hurricanes, tornadoes and floods, according to the latest data available from the National Weather Service. Between 2004 and 2018, an average of 702 heat-related deaths occurred in the U.S. each year, according to a 2020 study in Morbidity and Mortality Weekly Report. About 70% of those deaths were between May and September.

“With continued warming, cold-related deaths are projected to decrease and heat-related deaths are projected to increase; in most regions, increases in heat-related deaths are expected to outpace reductions in cold-related deaths,” according to the U.S. Global Change Research Program’s Fourth National Climate Assessment, a detailed analysis of how climate change is affecting the United States and its people.

In July, President Biden asked the Department of Labor to issue the first-ever Hazard Alert for heat to protect workers, including farmworkers, farmers, firefighters and construction workers from the dangers of extreme heat. Since 2011, more than 400 workers have died due to heat exposure, according to the White House.

Who’s at risk?

Extreme heat can affect anyone, but certain populations are at a higher risk. They include children, older adults, outdoor workers, pregnant people, people with chronic diseases, people with disabilities, people experiencing homelessness, and incarcerated people. People of color, especially American Indian and Alaska Natives, and Black people have higher rates of heat-related deaths, according to data from the Centers for Disease Control and Prevention.

In addition, “communities that didn’t experience heat waves are now experiencing heat waves and extreme heat and some don’t have the societal infrastructure,” Giudice says. “There are apartments that don’t have air conditioning, because in the past that hasn’t been necessary. So when heat hits the community by surprise, it can be extremely dangerous because the infrastructure is not there.”

Also, certain medications put people at a higher risk. One example is diuretics, which stimulate the kidneys to remove water, and are commonly used to treat high blood pressure or for people who have too much fluid collecting in their bodies.

“So those people are more prone to dehydration and more prone to the effects of extreme heat,” Giudice says.

People who have substance use disorders are also at higher risk, since anything that alters consciousness is going to decrease the ability to respond to changing temperature, she says. “If you’re too intoxicated and you don’t realize that you’re in an extremely hot environment, obviously that’s going to affect your ability to remove yourself and seek shade and shelter.”

What are the solutions?

“I think the conversation several years ago was let’s prevent climate change from happening,” Giudice says. “And unfortunately, we are at a place where we’re already seeing climate change happening. So, we need to prevent future worsening and we need to cut our carbon emissions or usage of fossil fuels as fast as possible.”

The more immediate solutions are adapting to the changing climate at the individual, community and national levels, she says.

“At the individual level, it’s important for people to have a plan. If you don’t have air conditioning, where are going to go? Where’s the heat shelter? Some communities have specific cooling shelters,” Giudice says.

Also, “cities need to think about how to make sure that their electrical grids are able to withstand the surges in electrical usage during heat waves,” she adds.

Lastly, “it’s very important for people to have a community sense during heat waves and check on their neighbors, families and friends, especially if they have a loved one who is elderly and lives by themselves,” Giudice says.

Research roundup

To help journalists better explain the serious impact of extreme heat on physical and mental health, we’ve selected seven recent studies that explore the impact of extreme heat on human health. They address topics including heat strokes, heat waves, impacts on people with diabetes, outdoor workers, people who experience homelessness and the use of ambulance services. We’ve selected each study as a prompt for a news story or additional context for heat-related stories. They’re organized by publication date.

High Ambient Temperatures Associations with Children and Young Adult Injury Emergency Department Visits in NYC
Blean Girma, et al. Environmental Research, Health, September 2023.

The study:Researchers collected data on all daily emergency room visits in New York City from 2005 to 2011 from the New York Statewide Planning and Research Cooperative System, an administrative database of inpatient and emergency room visits in New York. They focused on emergency room visits in hotter months of May through September, and children and young adults from newborn to 25 years old. Heat-related injuries among kids include dehydration, heat-related illness, diarrhea and digestion disorders and infectious diseases. “When it is hot outside, exposed individuals may have impaired response abilities, which may in turn, result in unintentional injury,” the authors explain.

The findings: There was a 30% higher odds of emergency room visit for an injury during the warmest temperatures compared with coolest temperatures during the warm season. Young males between ages 5 and 9 were most likely to go emergency room with injuries during warmer weather, mostly due to increased activity or lack of adult supervision.

Quote from the study: “Our results underscore the importance of considering variation in the health effects of heat, and consequences for healthcare utilization, given the growing impact of climate change. This research raises awareness of the multifaceted ways by which climate change and the urban climate impact children’s health and well-being.”

Also from the study: “We suggest that local, city, and state government consider the vulnerability of children and young adults in their extreme heat mitigation strategies, which could also include highlighting activities, resources and tools community members can use to alleviate social and mental health stressors during warmer periods.”

Heat, Heatwaves, and Ambulance Service Use: A Systematic Review and Meta-Analysis of Epidemiological Evidence
Zhiwei Xu, et al. International Journal of Biometeorology, July 2023.

The study: In this systematic review and meta-analysis, researchers include 48 English-language papers published between 2011 and 2022 about the association between heat or heat waves and the risk of ambulance dispatches.

The findings: There’s an association between ambulance dispatches and heat or heat waves. Each 5 degrees Centigrade increase in average temperature was associated with 7% increased risk of ambulance dispatches for any cause and 2% increased risk of ambulance dispatches for heart disease.

More about ambulance activity: Ambulance data has been used as the bellwether of health service use, including hospitals and emergency rooms, during hot days. You can use this heat.gov tool to find emergency medical services responses to heat-related illnesses in each county across the country.

Classic Heat Stroke in a Desert Climate: A Systematic Review of 2632 Cases
Saber Yezli, et al. Journal of Internal Medicine, March 2023.

The study: Researchers included 47 English language studies, including 2,632 patients, carried out between 1962 and 2019 and before April 2022 on heatstroke cases during the Muslim pilgrimage (Hajj) in the desert climate of Mecca, Saudi Arabia. About two million people perform the Hajj each year. The authors note that their systematic review includes one of the largest cohorts of heatstrokes reported to date, allowing them the review the natural course of heatstrokes from the earliest signs.

The findings: The early signs and symptoms of heatstroke can affect the nervous, digestive and cardiovascular systems, suggesting that it is a systemic illness. Heatstrokes induce widespread early tissue injury and multiple organ dysfunction and failure. Also, nearly 40% of people who had a heatstroke were overweight or obese, suggesting that this population is particularly vulnerable. Overweight and obese adults also have 3.5 times risk of death from heatstroke. People with high blood pressure and diabetes were also at a higher risk of heatstroke, which, the authors note, agree with previous reports that show an increase risk of heatstroke in people with most chronic conditions and medications used to manage them.

Quote from the study: “The findings of this review indicate that [heatstroke] is a severe medical condition with widespread early multi-organ injury. They suggest that early diagnosis and therapy reduce the progression to more organ damage resulting in lower mortality compared to previous studies in other settings. Importantly, they indicate that in the best possible setting, including early diagnosis and therapy, cooling and supportive therapy are not sufficient, and thus, novel interventions are urgently needed to further reduce morbidity and mortality.”

More about heatstrokes: Heatstroke, also written heat stroke, is the most serious heat-related illness, according to the CDC. It happens when the body can no longer control its temperature and can rise to 106 degrees Fahrenheit or higher within 10 to 15 minutes. Heatstroke can cause permanent disability or death if the person isn’t treated quickly. Early signs include confusion, slurred speech and profuse sweating.

The Impact of Heat Waves on the Mortality of Chinese Population: A Systematic Review and Meta-Analysis
Ranran Pan, et al. Medicine (Baltimore), March 2023.

The study: In this systematic review and meta-analysis, researchers analyzed the findings of 15 studies published before November 2022 on the impact of heat waves on the death of people in China. The authors note heat waves may pose a greater threat to China due to an aging population, which is more vulnerable to extreme heat.

The findings: Heat waves were associated with an increased risk of death in the Chinese population. There was a 19% increase in risk of death due to heat waves in China, which is higher than developed nations such as United States (11%) and Sweden (10%). However, the risk of heatwave-related deaths is lower in China than in developing countries such as India (43.1%) and Pakistan (166.8%). Also, the risk of death was higher among people who had less than six years of education compared with those who had more education, potentially due to more outdoor work and lack of health literacy.

Quote from the study: “In summary, the present meta-analysis provides strong evidence that heat waves are significantly associated with an increased risk of death in the Chinese population, especially among residents with low education levels. Therefore, high-risk populations should be the focus of public health policies, and prevention strategies should be developed and implemented to effectively reduce the public health harm caused by extreme temperature events.”

More about heat waves: There’s no set definition for heat wave. The National Weather Service defines it as “a period of abnormally hot weather generally lasting more than two days.” Heat waves can last weeks. In 2003, an estimated 70,000 people died in Europe due to a heat wave that spanned from June to August. And in 2010 in the Russian Federation, 56,000 more people died during a 44-day heat wave. From 1998 to 2017, more than 166,000 people died due to heat waves, including more than 70,000 who died during the 2003 heatwave in Europe, according to WHO.

Association Between Extreme Ambient Heat Exposure and Diabetes-Related Hospital Admissions and Emergency Department Visits: A Systematic Review
Donghong Gao, et al. Hygiene and Environmental Health Advances, December 2022.

The study: Researchers summarize the findings of 18 English-language papers, published between 2010 and 2022, which explored the link between extreme heat and diabetes emergency room visits or hospital admissions.

The findings: There’s a significant association between exposure to extreme heat and diabetes-related hospital admission or emergency room visits. Extreme heat was associated with 4.5% increased risk of hospital admission or emergency room visit among people with diabetes and 10% increased risk among older adults with diabetes.

Quote from the study: “The findings from this review will be useful for developing evidence-based interventions to reduce the impact of extreme heat exposure on diabetes, identifying the target population for the interventions (i.e., older adults), and supporting public health initiatives for public education to increase public awareness of the risk of extreme ambient heat exposure on diabetes.”

More about diabetes and extreme heat: Diabetes affects more than 10% of the U.S. population, and people with diabetes are among populations that are more vulnerable to extreme heat. Certain complications from diabetes — both type 1 and type 2 — such as damage to blood vessels and nerves, can affect sweat glands and the body can’t cool effectively, increasing the risk of heat exhaustion and heatstroke, according to the CDC. Also, people with diabetes get dehydrated more quickly.

Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012–2019
Lara Schwarz, et al. American Journal of Public Health, December 2021.

The study: Researchers obtained emergency department use data from two hospitals in San Diego between 2012 and 2019, analyzing data for 24,688 visits between May to September by patients who were identified as homeless.

The findings: In total, 94% of the patients were younger than 65; 14% said they needed a psychiatric consultation. The strongest risk of emergency room visits was during daytime heatwaves.

Quote from the study: “Homelessness is rapidly becoming a major social challenge in the United States. Structural inequalities, housing crises, high rental costs, and natural disasters have all contributed to the increasing number of persons experiencing homelessness in recent years. … As the threat of increasingly frequent and more intense heat waves continues to rise in the United States, particularly in California, understanding and prioritizing the needs of this rapidly growing vulnerable population will be a critical action in developing and deploying effective mitigation strategies.”

Extreme Heat and Occupational Injuries in Different Climate Zones: A Systematic Review and Meta-Analysis of Epidemiological Evidence
Syeda Hira Fatima, et al. Environment International, March 2021.

The study: Researchers included 24 English and non-English language studies, published between January 2005 and July 2020, which assessed the effects of extreme heat on work-related injuries among non-military workers. The systematic review represents work-related injuries in six countries — Australia, Canada, China, Italy, Spain and U.S. — and across nine climate zones. Work-related injuries during hot weather include heat stress, inability to work, heat-related illness, loss of productivity and even death.

The findings: All studies suggested that working in hot weather increased the odds of a work-related injury. Also, during heat waves, the risk of work-related injuries increased by 17.4%. Male workers and young workers were at highest risk of a work-related injury during hot weather. Outdoor work involving intensive work, including agriculture and construction were at high risk of injuries during high temperatures. Also, male, young and new workers were at a higher risk of injuries during heat weaves.

Quote from the study: “There is an urgent need to mitigate the impacts of occupational heat stress in the context of climate change and the anticipated rise in environmental heat stress. The risk of [occupational injuries] associated with extreme heat is not evenly distributed and is dependent on underlying climatic conditions, workers’ characteristics, nature of work, and workplace characteristics.”

Additional research

• Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity
  Anqi Jiao, et al. JAMA Network Open, September 2023.
• QuickStats: Age-Adjusted Rates of Death Involving Exposure to Excessive Heat* Among States with the Highest Numbers of Deaths — National Vital Statistics System, United States, 2021
  Morbidity and Mortality Weekly Report, September 2023.
• Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities
  Chunyu Guo, et al. Journal of Exposure Analysis and Environmental Epidemiology, August 2023.
• Heat waves and adaptation: A global systematic review
  Maryam Kiarsi, et al. Journal of Thermal Biology, August 2023.
• Predicting climate-change induced heat-related illness risk in Grand Canyon National Park visitors
  Danielle E. Buttke, Brinkley Raynor and Gregor W. Schuurman. PLoS One, August 2023.
• Extreme Temperature Events, Fine Particulate Matter, and Myocardial Infarction Mortality
  Ruijun Xo, et al. Circulation, July 2023.
• Association between ambient temperature and risk of stroke morbidity and mortality: A systematic review and meta-analysis
  Jing Wen, et al. Brain and Behavior, June 2023.
• Heat and health inequity: acting on determinants of health to promote heat justice
  Jeremy Hess. Nature Reviews Nephrology, January 2023.
• Urban extreme heat, climate change, and saving lives: Lessons from Washington state
  Zachary Kearl and Jason Vogel, Urban Climate, January 2023.
• Heat and air quality related cause-based elderly mortalities and emergency visits
  Mohamed Dardir, Jeffrey Wilson and Umberto Berardi. Environmental Research, January 2023.
• Association between ambient temperature and heat waves with mortality in South Asia: Systematic review and meta-analysis
  Asya Dimitrova, et al. Environment International, December 2020.
• Clinical Implications of Climate Change on US Emergency Medicine: Challenges and Opportunities
  Cecilia J. Sorensen, et al. Annals of Emergency Medicine, August 2020.
• Associations between high ambient temperatures and heat waves with mental health outcomes: a systematic review
  R. Thompson, et al. Public Health, August 2018.
• Differences in Heat-Related Mortality by Citizenship Status: United States, 2005-2014
  Ethel V. Taylor, et al. American Journal of Public Health, April 2018.
• Risk of death related to psychotropic drug use in older people during the European 2003 heatwave: a population-based case-control study
  Clementine Nordon, et al. American Journal of Geriatric Psychiatry, December 2009.

Resources

• The U.S. National Integrated Heat Health Information System (heat.gov) provides a wide range of heat-related information, including extreme health events and emergency medical services responses to heat-related illnesses across the country.
• Use CDC’s Heat & Health Tracker to find local information on extreme heat events.
• Check CDC’s Morbidity and Mortality Weekly Reports for data on national heat-related illnesses and deaths.
• GlobalChange.gov, or the U.S. Global Change Research Program, is a federal program mandated by Congress to coordinate research and investment toward understanding the forces that affect society. The site has several resources, including climate summaries for each state.
• Climate Central is an independent group of scientists and communicators who research and report on climate change and how it affects people’s lives.
• The OSHA-NIOSH Heat Safety Tool App can be used for planning outdoor work activities. It provides real-time heat index and hourly forecasts specific to a location.
• “Climate Changes Health: Extreme Heat” is an infographic by the nonprofit National Institute for Health Care Management (NIHCM) Foundation, illustrating various ways extreme heat affects health.
• Heat Policy Innovation Hub at Duke University brings together scientists and communities to develop and deploy solutions that reduce the impact of extreme heat on human health.
• Climate Resilience for Frontline Clinics Toolkit is a collaboration between The Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health and Americares, providing information of providers and patients to meet health care challenges from climate change.
• Center for Health and the Global Environment at the University of Washington focuses on the connections between climate change and human health.
• The Pediatric Environmental Health Specialty Units is a network of experts in reproductive and children’s environmental health, including a list of providers by state.

The post How extreme heat affects human health: A research roundup appeared first on The Journalist's Resource.

Researchers are learning more about the adverse impacts on the environment and human health of PFAS, shorthand for per- and polyfluoroalkyl substances. Nicknamed “forever chemicals” because they are difficult to destroy, they are widely used in everything from cosmetics to clothing to firefighting foam. Government agencies are picking up the pace to regulate their use.

Tap water is one of the main ways humans encounter PFAS. At least 45% of tap water in the United States is contaminated with one or more PFAS, researchers from the U.S. Geological Survey (USGS) estimate in a study published this summer.

The PFAS issue touches many journalistic beats, including business, consumer, environment, health, infrastructure, legal and local services. So chances are good that if you’re a journalist, you’ll encounter PFAS in your reporting.

To help inform news coverage of the topic, we enlisted advice from researchers and journalists including Kelly Smalling, a research chemist at the U.S. Geological Survey and lead author of the aforementioned study; Linda Birnbaum, the former director of the National Institute of Environmental Health Sciences and the National Toxicology Program; E.A. Crunden, a reporter for Politico’s E&E News who covers water issues; Barbara Moran, a climate and environment correspondent at WBUR in Boston who has reported extensively on PFAS; Rebecca Fuoco, the director of science communications at Green Science Policy Institute; and Jamie DeWitt, a professor of pharmacology and toxicology at East Carolina University who follows PFAS closely.

1. Start with the basics.

Journalists should be aware that PFAS are “a complicated class of over 12,000 man-made chemicals with distinct properties making them resistant to degradation and persistent in the environment,” Smalling said in an email interview. “They have been manufactured since the 1940’s but until recently, information on health implications were limited.” 

Journalists also should know and note why PFAS are nicknamed “forever chemicals.” It’s because they stick around for a long time due to their structure. They have a chain of linked carbon and fluorine atoms, with this combination being one of the strongest bonds in chemistry. By contrast, proteins and sugar compounds have relatively weak bonds, allowing the body to easily disassemble them. Manmade PFAS compounds don’t degrade under typical conditions in the environment or the body.

The compounds have likely wound their way into the environment in the decades since their invention, including into sources of water used for drinking worldwide. In recent decades, certain kinds of PFAS chemicals have been linked to serious health issues, including potentially higher risk for some cancers, autoimmune diseases, thyroid issues, liver disease, fetal complications, vaccine resistance and high cholesterol, among other concerns.

It’s worth “several hours of your time one day to bone up on the basics,” especially if you don’t have a science or health coverage background, says WBUR’s Moran.

This page from the Interstate Technology Regulatory Council, a state-led coalition with public and private members from all 50 states and Washington D.C. is a good place to start, she says.

“It contains a lot of straight-up, detailed PFAS info, and even an introductory video to get people started,” Moran notes. 

Many universities with scientists who research PFAS also have good resources for journalists, according to Dewitt, Moran and Crunden. Moran recommends Northeastern University’s PFAS Project Lab website. It includes news, background, a newsletter and information on upcoming conferences. DeWitt recommends the North Carolina State Center for Environmental Health Effects of PFAS or The University of Rhode Island’s STEEP (Sources, Transport, Exposure and Effects) website.

For health-specific information, start with the comprehensive 2022 National Academies report from the National Academies of Sciences, Engineering, and Medicine. The nonprofit Silent Spring Institute “can also be very helpful, and they are doing interesting research on the long-term health effects of drinking PFAS-contaminated drinking water,” Moran says.

The EPA and other agencies offer a plethora of information on government studies and upcoming rules. Those include the Food and Drug Administration,  the Centers for Disease Control and Prevention and the Defense Department.

2. Note what’s happening with PFAS regulation on a national and local level.

In March, the U.S. Environmental Protection Agency took a major step by proposing limits on six kinds of PFAS in drinking water under the national Safe Water Drinking Act. If enacted, the rule would cover the first new contaminant under the act since the 1990s. The EPA intends to issue the final rules by the end of the year. The new regulations, if finalized, won’t apply to private wells, notes Birnbaum.

The lower levels will likely require more than half of municipal water systems to install filtration devices, she explained in an e-mail interview.

Though the proposed rule would be the first to regulate PFAS in drinking water at a national level, half of all U.S. states already either regulate or are moving to regulate PFAS in drinking water, according to Safer States, a public advocacy group that tracks state legislation and policy.

3. Be specific and careful with your terminology.

It’s important to note that the umbrella term PFAS covers  more than 12,000 kinds of man-made chemicals,  an omission that pops up in some coverage, said Crunden.

The EPA proposed rule, for instance, applies to six kinds of those 12,000 PFAS chemicals, “and even within that there are thresholds” for the other PFAS that the EPA seeks to regulate as mixtures, Crunden said in an email interview.

Specificity also is important when reporting on the health risks of PFAS. “Any strong PFAS reporting lays out what we do know versus what we don’t re: the science and health implications,” Crunden explained. “Reporters should not buy into saying 12,000+ chemicals ‘cause cancer’; that simply has not been proven yet and research is limited. But good PFAS journalism should see you comfortably empowered to say at least two chemicals are strongly linked to cancer, and that there are concerns about the broader family, which also pose a number of other health issues.”

Another terminology clarification: Toxins is the correct term for naturally occurring poisonous substances, Crunden explained, so it’s not accurate to refer to PFAS as toxins. PFAS are man-made, which makes them toxicants, not toxins. “Toxic chemicals” would also be an accurate way to describe PFAS.

4. Keep your accuracy radar on high and double-check what sources say.

“A good way to get a feel for accuracy is to sense how much someone hedges their statements,” Crunden noted. “Advocates, while well-meaning, will tend to oversell something (remember, saying something ‘causes cancer’ is an enormous statement and VERY hard to prove scientifically). Industry members, by contrast, will downplay things significantly.”

You can find tips on how to characterize research findings accurately in this tip sheet from The Journalist’s Resource.

Even scientists can make mistakes, especially those not steeped in PFAS research, says Jamie DeWitt, a professor of pharmacology and toxicology at East Carolina University who follows PFAS closely.

“Listen very carefully, because in the world of PFAS and some worlds of science, some words sound very similar,”  DeWitt said. “Make sure to check what your scientists say. Because I’ve seen some scientists get interviewed on the topic, who aren’t really engaged in PFAS science. And they’ve made some really simple mistakes.”

5. Befriend a toxicologist.

Find a public health, public works or university toxicologist familiar with PFAS and ask to sit down with them, DeWitt, Crunden and Moran recommend – especially one who specializes in drinking water.

Many cities and towns have someone whose job it is to know the rules and the science. If you can’t find a local government toxicologist, find someone at a university who can be your  “check on things,” Moran says.

That helps with PFAS science, whether it be tied to the environment or health, Dewitt says.

“I don’t think that necessarily journalists get things wrong, but they might not talk to scientists to have all of the details correct because PFAS science is really complex,” DeWitt says.

Universities with research departments often have PFAS experts that can be good sounding boards, even if you’re not quoting them, Crunden notes.

“Fact-check everything someone tells you and normalize having some go-to scientist sources you trust,” Crunden said. “Researchers attached to universities are some of the most reliable, in my opinion.”

6. Monitor academic research, keeping in mind that much of it never makes it into the news media.

The pace of research is picking up in areas including human health, techniques to better destroy or degrade PFAS chemicals, and in gathering data for where they are most pervasive in the environment, water and other products.

Still, just a fraction of scientific and academic research makes it into the media, according to a study published in July 2023 in the journal Environmental Health led by researchers from the nonprofit Green Science Policy Institute who studied published papers on human health and PFAS.

Of 273 peer-reviewed epidemiological studies on PFAS and human health  published between 2018 and 2020, fewer than 8% issued a press release, the researchers found. Studies with press releases were 20 times more likely to wind up in news stories.

A good practice is to create alerts on services like PubMed and Eureka Alert! Many scientific studies are published behind a firewall. But journalists often can get access to scientific papers for free – if they know how to ask. This piece from The Journalist’s Resource outlines how to set up free accounts with several top academic journal publishers.

This research roundup and explainer, published as a companion to this tip sheet, summarizes several studies on where PFAS is found in drinking water geographically, health impacts, the efficacy of consumer water filters, new methods of destroying PFAS, and racial disparities in PFAS exposure.

“As papers are published, you can go through them to see if anything stands out to you,” says Fuoco, the lead author of the Green Science study whose full-time job is to publicize PFAS studies on human health. “And there’s always a corresponding author who has contact information.”

7. Go to a public water board or local government meeting where PFAS is being discussed, or attend state hearings.

As with any topic, some of the best story ideas come from meeting people you wouldn’t normally encounter just working the phones or doing online research, Moran says.

“If your state is considering legislation, try to attend the hearings or watch or listen to them, because that’s where you get good story ideas,” she says.

One way to communicate the situation clearly is to focus on a linear storyline, such as an area where water is provided through public wells, which are less studied and regulated than municipal water systems. A single water system, community or family’s story can be a good way to “wrap your head around it,” Moran says.

For journalists interested in covering PFAS legislation as a statewide issue, Moran recommends looking at Safer State’s 2023 website of current and anticipated actions across the country.

The National Conference of State Legislatures has state-by-state information on PFAS and drinking water. And the map and key issue page from the advocacy group Environmental Working Group are also good places to start.

Reporting resources

Information from the EPA and other U.S. government agencies:

Start with the main PFAS page, an explanation of PFAS chemicals, the agency’s “strategic roadmap” for PFAS chemicals and the page outlining materials tied to the draft regulation announced in March.

Also see this March report from the White House National Science and Technology Council across agencies.

This graphic from the Agency for Toxic Substances and Disease Registry shows the “PFAS family tree.”

The EPA also offers information on:

• Water filter use and steps consumers can take to cut their PFAS exposure
• Water testing
• Health advisories
• Long-term health effects and environmental risks
• Details of its fifth water•testing efforts under the agency’s unregulated contaminant monitoring rule which will provide information on 29 kinds of PFAS chemicals
• Comments on the proposed drinking water rule can be found on Regulations.gov. Sort through to find a local community, business, government or other entities. Often, the commentary has contact information for the author or authors.

Information on individual U.S. states:

• The nonprofit Safer States has information and maps on PFAS for the status of regulation in each state.
• The advocacy nonprofit Environmental Working Group offers a key issue page and interactive map.
• Bloomberg’s PFAS activity tracker keeps up on litigation, regulation and other changes.
• The Interstate Technology Regulatory Council has primers, videos and more.
• You’ll find links to drinking water agencies in each state from the Association of Drinking Water Administrators.

Other useful information:

• The American Water Works Association’s statement on PFAS and the EPA proposed regulation
• Bluefield Research, a Boston-based consulting firm

• The European Chemical Agency’s proposal to severely restrict PFAS use
• Canada’s draft state of PFAS report

• The American Chemistry Council’s webpage on PFAS chemicals

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If it feels like news coverage of the compounds colloquially named “forever chemicals” is everywhere, there’s a reason: The pace of research and likely government regulation for PFAS, short for perfluoroalkyl and polyfluoroalkyl substances, is accelerating.

In March, the U.S. The Environmental Protection Agency proposed limits on six PFAS in drinking water under the national Safe Water Drinking Act. If enacted, the rule would cover the first new contaminant under the act since the 1990s. The EPA intends to issue the final rules by the end of the year. The move is part of the Biden administration’s plans to fight PFAS pollution.

PFAS contamination in air, soil and water is a worldwide problem that many governments and agencies have begun addressing, including the European Union,  Canada and Japan.

Journalists would do well to educate themselves on PFAS because the issue now touches almost every beat: business, consumer, environment, health, infrastructure, legal and local municipalities that include water utilities. That’s why we created this explainer and research roundup. (For more on covering PFAS, see our related tip sheet, which includes a list of data resources.)

Let’s start with the basics. What are PFAS?

PFAS are a group of more than 12,000 man-made chemicals and compounds used in all kinds of products since the 1940s, according to the EPA’s master list. 3M, which created the first PFAS, began selling it to DuPont in the 1950s for use in nonstick cookware. PFAS compounds stave off heat, grease, oil and water. Manufacturers use or have used versions of them in products, including firefighting foam, construction materials, non-stick cookware, cosmetics, clothing, and food containers, to name a few. 

PFAS are made up of a chain of linked carbon and fluorine atoms. Because the man-made compounds don’t degrade easily in the environment — or the human body — they have earned the “forever chemicals” nickname.    

The most studied types of PFAS, are perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS). Both were mostly phased out in the mid-2000s by the manufacturers, according to the EPA. Yet they remain in the environment and find their way into drinking water from contaminated sources including surface areas. The EPA is targeting four other chemicals that when used in combination are designed to replace PFOA and PFOS in some consumer and industrial products. These mixtures can pose a health risk ”greater than each chemical on its own,” according to the EPA.

Those chemicals, made up of fewer carbon atoms, “are more quickly eliminated from the human body than PFOA and PFOS,” according to an EPA fact sheet. “They are still persistent in the environment.”

In recent decades, certain PFAS  have been linked to numerous health issues, including potentially higher risk for some cancers, autoimmune diseases, thyroid issues, liver disease, fetal complications, vaccine resistance and high cholesterol, among other concerns. Even very small amounts of certain kinds of PFAS may pose health risks over a lifetime.

“We are all contaminated with PFAS, and nearly all of our drinking water is also contaminated,” said Linda Birnbaum, the former director of the National Institute of Environmental Health Sciences and the National Toxicology Program in an email to The Journalist’s Resource.

Researchers from the U.S. Geological Survey in August 2023 published a paper estimating that at least 45% of tap water in the U.S. contains at least one or more types of PFAS. Their study covers both tap water for municipal systems as well as private wells and rural drinking water systems. That’s important to note, as the EPA’s proposed rules do not include private wells.

“If the average American is worried about the quality of their drinking water, they can use this and other studies to get informed, evaluate their own personal risk and reach out to their local health officials about testing or treatment,” Kelly Smalling, lead author of the study and a research chemist at the U.S. Geological Survey, said in an email interview.

A 2020 study from the watchdog nonprofit Environmental Working Group (summarized below) estimates more than 200 million people — nearly two-thirds of Americans — have tap water contaminated with a mixture of the PFAS compounds at concentrations exceeding 1 parts per trillion, or ppt. That’s the equivalent of about one drop of PFAS in 20 Olympic sized swimming pools.

Research is “still ongoing to determine how different levels of exposure to certain PFAS may lead to adverse health outcomes,” according to the EPA.    

PFAS chemicals can last in the human body for a long time. Some have a half-life, or the time it takes the body to cut the presence of a substance to about half, of about eight years. They are mainly removed from the body by excretion, mostly through urine.      

What is the state of PFAS regulation in the United States?

There are currently no federal regulations for PFAS in drinking water.

But half of all U.S. states already either regulate or are moving to put limits on certain kinds of PFAS, according to Safer States, a public advocacy group that tracks state legislation and policy. The National Association of State Legislatures has state-by-state information on PFAS and drinking water.

And EWG tracks PFAS in drinking water across the country. It has data and an interactive map highlighting its findings. As of June 2022, EWG estimates some 2,858 locations in all 50 states, Puerto Rico and Guam have contaminated drinking water.

In 2016, the EPA issued an advisory to keep the combined levels of PFOA and PFOS in drinking water at 70 parts per trillion, or ppt, either separately or combined.

The March 2023 proposed national rule was released under  a 2019 formal PFAS action plan that also includes potentially establishing drinking water standards., and an update to that plan in 2020 that includes calls for establishing what’s called a maximum contaminant level (MCL) for PFOA and PFOS in drinking water. And as of July 1, 2023, 180 kinds of PFAS must be reported to the EPA’s Toxic Release Inventory program, which tracks the release of chemicals from industry and government.

The levels in the proposed drinking water rule announced in March call for levels far below that, at 4 ppt, for PFOA and PFOS, the lowest level most labs can detect for these two most studied kinds of PFAS. A “hazard index” is proposed to regulate the remaining four compounds commonly blended together and used as replacement chemicals for PFOA and PFOS.  They are: Perfluorononanoic acid (PFNA), hexafluoropropylene oxide dimer acid (HFPO-DA, commonly known as GenX Chemicals),  Perfluorohexane sulfonic acid (PFHxS) and Perfluorobutane sulfonic acid (PFBS).

If finalized, the proposed regulation would mandate public water systems monitor, notify the public and bring down the level of the PFAS chemicals to the new standards. 

In June 2023, 3M announced a preliminary $10.3 billion settlement with thousands of public water suppliers that had sued over PFAS contamination and announced it planned to stop making PFAS chemicals by 2025. (It had already agreed to “phase out” some forms of PFAS in 2000.) The 3M settlement announcement followed a similar $1.2 billion announcement from DuPont, Chemours and Corteva.

But 22 attorneys general asked a judge in late July to block the 3M settlement saying it doesn’t do enough to resolve claims and is too restrictive on how cities and towns can use the funds, Politico reported.

In a regulatory filing with the U.S. Securities and Exchange Commission, 3M listed details of the proposed settlement including what systems are eligible. It’s worth a look at the public information for journalists searching for story ideas or information about specific communities and the settlement.   

How much does it cost to remove PFAS?

Many water utilities will have to improve filtration and systems to reduce the levels of PFAS in drinking water, especially in states that haven’t broached their own regulations already. The proposed EPA drinking water rule does not apply to private wells.

Because the chemicals are difficult to eradicate, upgrading water systems will be expensive.

The 2021 Infrastructure Investment and Jobs Act provides about $9 billion in funds over five years tied to PFAS, according to the White House. According to an EPA fact sheet, that breaks down to:
• $4 billion through the Drinking Water State Revolving Funds, including a requirement states earmark 25% for “disadvantaged communities or public water systems serving fewer than 25,000 people.”
 • $5 billion as grants via the Emerging Contaminants in Small or Disadvantaged Communities (EC-SDC) Grant Program, which promotes “access to safe and clean water in small, rural, and disadvantaged communities while supporting local economies” In February 2023, the EPA announced the first $2 billion of this funding was available.

Still, some communities worry that the federal funding is insufficient. The EPA estimates it will cost utilities $772 million to $1.2 billion to comply if the proposed rule is finalized. Utilities might have to increase water bills to pay for the costs, not a popular move for any municipal budget.

The American Water Works Association, whose members include public utilities, said in March it expects the cost to reach $3.8 billion annually for utilities to install recommended treatment systems for PFOA and PFOS removal, citing an analysis undertaken for the group by the firm Black & Veatch.

The EPA also estimated economic benefits of $908 million to be $1.2 billion, according to a report from Bloomberg Law.

“One of the important things that the EPA does when it puts out a draft rule like this, is to consider the economic costs and benefits,” says Jamie DeWitt, a professor of pharmacology and toxicology at East Carolina University who follows PFAS closely. “While the cost might translate to individual homeowners in terms of an increase in their water bill, it also means that there will be fewer economic costs imposed on individuals and societies due to the chronic diseases that have been linked to PFAS exposures.”

What have journalists been missing?

PFAS chemicals weren’t widely studied in the environment until the early 2000s, notes a fact sheet from the nonprofit Interstate Technology and Regulatory Council, a state-led coalition with public and private members from all 50 states, and Washington D.C. Since then, it’s been a “very active area of research,” according to the group. 

Yet many studies on PFAS don’t make it into media coverage unless researchers issue a press release, according to a study published in July 2023 in the journal Environmental Health, led by researchers from the nonprofit Green Science Policy Institute.

Of 273 peer-reviewed epidemiological studies on PFAS and human health  published between 2018 and 2020, fewer than 8% issued a press release, the researchers found. Those that issued a release were 20 times more likely to draw attention from journalists.

The number of important studies that appear to be overlooked was surprising, says lead author Rebecca Fuoco, whose full-time job is to publicize PFAS studies. 

“When studies are unpublicized, that is, not covered in the media, they’re also reaching fewer scientists,” Fuoco says. “We found a correlation between media coverage and scholarly citation. There were studies that my scientist colleagues had not seen or didn’t know about, which was even more shocking to see.”

It’s important to pay attention to the research when covering PFAS issues. To get you started, here are summaries of six recent studies along with suggestions of related studies for you to read. The studies cover where PFAS is found in drinking water geographically, health impacts, the efficacy of consumer water filters, new methods of destroying PFAS, and racial disparities in PFAS exposure.

Research Roundup

Population-Wide Exposure to Per- and Polyfluoroalkyl Substances from Drinking Water in the United States
David Q. Andrews and Olga V. Naidenko. Environmental Science & Technology Letters, October 2020.

The study: This research from the Environmental Working Group analyzes PFAS and PFOS found in drinking water in the United States using publicly available data from the EPA, the U.S. Geological Survey, Colorado, Kentucky, Michigan, New Hampshire, New Jersey, North Carolina and Rhode Island. The researchers estimate the number of people in the United States who may be exposed to combined PFAS in drinking water at concentrations above 1 part per trillion, or ppt (equivalent to 1 nanogram per liter) and above 10 ppt.

The findings: The EWG scientists estimate more than 200 million people — nearly two-thirds of Americans — have tap water contaminated with a mixture of the PFAS compounds at concentrations exceeding 1 ppt, in part because PFAS chemicals are “nearly ubiquitous” in surface water, the predominant source of drinking water in the U.S. They based their estimates on a total U.S. population of approximately 330 million, with 297 million served by community water systems and 241 million people served by systems tested in 2013-2015 through the EPA’s Unregulated Contaminant Monitoring Program. The researchers also estimate between 18 million and 80 million people may be exposed to combined PFOA and PFOS concentration in drinking water at concentrations above 10 ppt.

The authors write: “The overall prevalence of PFAS in drinking water, revealed by testing with sensitive analytical limits, suggests that the majority of large metropolitan surface water systems in the U.S. may contain detectable PFAS. Conventional drinking water treatment is typically ineffective for PFAS.”     

Why we’re highlighting this study: This study uses publicly available data from both federal and state sources. It details sample locations and the method used to extrapolate the figure showing broad contamination is likely. It also provides a preliminary estimate of contamination from private wells, often difficult to survey.

Related study:

•  Detection of Poly- and Perfluoroalkyl Substances (PFASs) in U.S. Drinking Water Linked to Industrial Sites, Military Fire Training Areas, and Wastewater Treatment Plants
  Xindi C. Hu, et al.Environmental Technology & Science Letters. Aug. 9, 2016.

Low-temperature mineralization of perfluorocarboxylic acids: Forever chemicals’ Achilles’ heel
Brittany Trang, et al. Science, August 2022. 

The study: All PFAS have at least one carbon atom that is fluorinated — a near indestructible structure. In this study, researchers use a new process to “deflourinate” a kind of PFAS, called PFCA      : they mix water and a solvent called dimethyl sulfoxide at relatively low temperatures (80 to 120 degrees centigrade) compared with other methods. That leaves carbon and inorganic fluoride, two far less harmful substances. Under laboratory conditions, the combination then breaks down within 24 hours after adding  sodium hydroxide, also known as caustic soda or lye.

The findings: Scientists found a weakness in the PFAS structure by targeting one end of the molecule in a process that heats PFAS in dimethyl sulfoxide with sodium hydroxide. Sodium hydroxide is what’s known as a reagent — a compound used to start a chemical reaction. The process broke down PFAS molecules quickly into relatively benign substances. The scientists successfully tested the method on 10 kinds of PFAS, including perfluoroalkyl carboxylic acids (PFCAs), perfluoroalkyl ether carboxylic acid (PFECAs), PFOAs and GenX (the trade name of a compound developed by DuPont). 

In the authors’ words: “In contrast to other proposed PFAS degradation strategies, the conditions described here are specific to fluorocarbons, destroy concentrated PFCAs, give high fluoride ion recovery and low fluorinated by-product formation, and operate under relatively mild conditions with inexpensive reagents. The proposed mechanism is consistent with both computational and experimental results, provides insight into the complexity of PFAS mineralization processes, and may be operative but unrecognized in other PFAS degradation approaches.”

Why we’re highlighting this study: This study shows a simple process for breaking down one kind of  PFAS atomic structure. Scientists are now investigating how to use it for large amounts of PFAS chemicals outside the lab. While most methods use filters to remove PFAS, this method, if it can be used widely, breaks them down. The study drew widespread attention and hope that “forever” might not be forever after all.

Related studies: 

• Recent advances in electrochemical decontamination of perfluorinated compounds from water: a review
  Fuqiang Liu, et al Frontiers of Environmental Science & Engineering, February 2023.
• Electrochemical degradation of PFOA and its common alternatives: Assessment of key parameters, roles of active species, and transformation pathway
  Fatemeh Asadi Zeidabad, et al. Chemosphere, February 2023.

Per- and polyfluoroalkyl substances (PFAS) in United States tapwater: Comparison of underserved private-well and public-supply exposures and associated health implications
Kelly Smalling, et al. Environment International, August 2023.

The study: Scientists from the U.S. Geological survey set out to compare human PFAS exposure in tap water from publicly regulated supply and unregulated private well systems, the most comprehensive survey  to date. The researchers note that there’s limited information on PFAS in residential tap water , especially for consumers who get their water from private wells. Many studies look at water sources, like lakes and groundwater, rather than the residential tap. Roughly one in eight U.S. residents get water from private wells. Researchers aggregated sampled tap water results from 716 locations (269 private wells and 447 public supply systems) across the U.S. during 2016 to 2021. They tested for 32 types of PFAS. The samples were assessed by three labs and compared with possible contamination sources, like industrial sites that may contaminate sources of drinking water.

The findings: The researchers estimate at least 45% of tap water in the U.S. contains at least one or more types of PFAS, with figures ranging from one to nine types, with a median of two different PFAS types in. The research also confirms previous studies that found urban areas are more likely to have PFAS in tap water. The authors estimate the probability of not finding PFAS in tap water is about 75% in rural areas versus 25% in urban areas. Drinking water exposure, the scientists note, may be more common in the Great Plains, Great Lakes, Eastern Seaboard and central and southern California.

The authors say next steps may be to:

• Integrate more geospatial datasets and PFAS data to better identify vulnerable regions and populations.
• Expand monitoring to include rural small-and private-well dependent communities.
• Expand analysis methods used by drinking water monitoring programs in the U.S. and globally.

In the author’s words:  The findings support “the continued need for point-of-use tap water monitoring, with an emphasis on unmonitored private-wells and underserved communities on small community water supplies.”

Why we’re highlighting this study: There is limited information on PFAS in tap water on a national level, particularly from private well sources, from which about 45 million people get their water, many in rural areas. The authors note how prevalent PFAS chemicals are likely to be in urban water systems.

Related study:

• Comparative case study of legislative attempts to require private well testing in New Jersey and Maine
  Sara V. Flanagan and Yan Zheng. Environmental Science & Policy, July 2018.

Sociodemographic Factors Are Associated with the Abundance of PFAS Sources and Detection in U.S. Community Water Systems 
Jahred M. Liddie, Laurel A. Schaider and Elsie M. Sunderland.Environmental Science & Technology, May 15, 2023.

The study: In the first study of its kind, researchers from the Harvard T.H. Chan School of Public Health, the Harvard Paulson School of Engineering and Applied Science, and the Silent Spring Institute, a non-profit organization that investigates environmental chemicals, evaluate communities with a higher population of Black and Hispanic/Latino residents and their exposure to PFAS chemicals in their drinking water supplies versus other communities. They examine PFAS concentrations from more than 44,000 water samples from 7,873 community water systems across 18 states collected between January 2016 and August 2022.

The findings: People living in communities with higher proportions of Black and Hispanic/Latino residents are more likely to have tap water contaminated with certain PFAS chemicals than people living in other communities. Roughly one in four people in the states studied were served by water systems with at least one kind of PFAS chemical detected above 5 nanograms per liter..

The authors also find that each possible source of PFAS chemicals inside a watershed  — an airport or a fire training area — could be associated with much higher levels of PFAS in drinking water systems. Water from watersheds with a higher concentration of those sites were also more likely to ultimately wind up in water systems that served Hispanic and Black communities versus those without the potential PFAS sources, the researchers find.

In the author’s words: Community Water Systems’ (CWS) “watersheds with PFAS sources served higher proportions of Hispanic/Latino and non-Hispanic Black residents compared to those without PFAS sources. CWS serving higher proportions of Hispanic/Latino and non-Hispanic Black residents had significantly increased odds of detecting several PFAS. This likely reflects disparities in the siting of PFAS contamination sources. Results of this work suggest that addressing environmental justice concerns should be a component of risk mitigation planning for areas affected by drinking water PFAS contamination.”

Why we’re highlighting this study:  This is the first study directly examining socioeconomic factors, PFAS levels in drinking water and potential sources of the contamination. As a new federal-level rule is rolled out by the EPA, more data may become available to researchers to parse broader and more detailed findings around the social justice aspects of PFAS and drinking water.

Assessing the Effectiveness of Point-of-Use Residential Drinking Water Filters for Perfluoroalkyl Substances (PFASs)
Nicholas J. Herkert, et al. Environmental Science & Technology Letters, March  2020.

The study: Researchers led by scientists at Duke University tested residential water filters used both inside home plumbing systems and in consumer products like water pitchers in two North Carolina regions. Because PFAS chemicals can be difficult to remove from full scale municipal and well water systems, the authors set out to look at how at-home filters performed. They collected 89 samples from 73 homes and screened for 16 different kinds of PFAS.

The findings: Under-the-sink “dual stage” and reverse osmosis filters showed “near complete removal” for the PFAS chemicals the researchers evaluated. In all, researchers looked at 89 water samples; 76 of those samples went through “point of use” or POU filters, on in-home devices, while 13 filtered water via “point of entry” or POE filters, where water enters the home. Other (and less expensive) types of filters didn’t work as well for PFAS chemicals overall. Of the PFAS chemicals tested, those with “long chain” molecules were easier to remove than “short chain” molecules, with up to 70 percent removal and 40 percent removal respectively.

In the authors’ words: “We demonstrated that residential activated carbon POU/POE systems have variable performance. While under-sink reverse osmosis systems appear to be an ideal option for removing PFAS, they have a high capital cost. Ultimately, an activated carbon filter should provide some removal of PFAS from drinking water… and have a lower capital cost.”

Why we included this study: With an increasing number of PFAS related stories in the news, we wanted to provide research on what consumers can do to lessen their exposure, particularly from drinking water.

Related reading:

• The Environmental Working Group tested filters for PFAS chemical removal in July 2023 and published its recommendations. Consumer Reports also offers a guide, compiled in conjunction with a 2021 report with The Guardian. And finally, this Q&A from the EPA answers a plethora of consumer-oriented questions, including those about drinking water filters.

Per‐and Polyfluoroalkyl Substance Toxicity and Human Health Review: Current State of Knowledge and Strategies for Informing Future Research
Suzanne E. Fenton, et al. Environmental Toxicology and Chemistry, March 2021. 

The study review: This overview published in 2021 surveys and assesses current research and what scientists know about PFAS chemicals and their toxicological effects, or what the chemicals and poisons do to a person’s body. The authors want to figure out a way to study more of the thousands of kinds of PFAS together rather than individually. The authors include and examine studies on PFAS chemical exposure that suggest a link to or higher risk of autoimmune disorders including thyroid disease, increased cholesterol levels, diminished vaccine response, low sperm count, liver damage, inflammatory bowel disease, increased risk of miscarriage, obesity and some cancers, among other impacts on human health.

The recommendations: The authors call for a way to better define relationships between a PFAS chemical’s structure and biomarkers, or indications that show a specific change or response in how the human body is supposed to operate. If a method can be found, scientists will learn more about a far larger number of PFAS chemicals than the limited number studied now, common effects and a way to respond to more versions of them in specific parts or areas of the body.

In the authors’ words: “There are only a handful of PFAS with enough health effects data for use in decision‐making, as evidenced by state‐led standard setting,” the authors write. “There are numerous health effects reported for those PFAS tested, which sets this family of chemicals apart from many others and elevates the need for precautionary action. With hundreds of PFAS lacking health effects data, translational research teams using innovative methodologies and carefully designed studies will be critical to our state of knowledge on human health toxicity of per‐and polyfluoroalkyl substances.”

Additional reading:  Scientific Basis for Managing PFAS as a Chemical Class,      
Carol F. Kwiatkowski, et al. Environmental Science & Technology Letters, August, 2020.

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From the U.S. to Canada to Greece, wildfires have been wreaking havoc across the globe in recent months, burning land, forests and homes, and killing or displacing wildlife and humans. The smoke can affect people near and far from the fires.

Wildfire smoke is a mix of gases and fine particles from burning trees, plants, buildings, and other material, according to the Centers for Disease Control and Prevention. The smoke contains small pollutants known as particle matter, or PM 2.5, which are 30 times smaller than the diameter of a human hair. These particles can go deep into the lungs and reach the bloodstream.

Exposure to wildfire smoke can irritate the lungs, cause inflammation, alter immune function, and increase susceptibility to respiratory infections, including COVID-19, according to the CDC. In June, the agency issued an advisory to health professionals about the acute signs and symptoms of smoke exposure, as smoke from wildfires in Canada affected air quality in parts of U.S.

Moreover, wildfires can upend people’s lives, leading to mental stress.

Several studies have established the short-term health effects of wildfire exposure, finding an association with higher risk of death and respiratory and cardiovascular complications. A 2022 study, published in Science of the Total Environment, finds the Australian bushfires in 2019 and 2020 were associated with a 6% increase in emergency department visits for respiratory diseases and 10% increase for cardiovascular diseases.

But there’s still a dearth of population-based high-quality evidence on the long-term health effects of wildfires, according to the authors of “Long-term impacts of non-occupational wildfire exposure on human health: A systematic review,” published in Environmental Pollution in March 2023.

The authors review 36 academic studies, mostly from Australia, Canada and the U.S., which were published between 1987 and 2022. The majority focus on health impacts one to two years after exposure to a wildfire. More than half of the studies focus on mental health. The authors note that most of the included studies were from developed countries with limited data.

Study findings

The analysis finds in the long term, wildfires and wildfire smoke are associated with mental health disorders, including post-traumatic stress disorder, respiratory diseases and COVID-19 complications, death from heart disease and poorer general health.

Among the findings:

There was no significant long-term association between wildfire exposure and child mortality and hospitalization due to respiratory diseases.

Several studies showed an association between wildfire exposure and increased risk of flu rates, asthma in children and different types of cancer.

One study from Israel found higher hospitalization rates two years after wildfire exposure compared with the year before the wildfire occurred. In addition, people with underlying health conditions, such as overweight or obesity, diabetes and heart disease, and lower income had higher rates of hospitalizations than those without underlying health conditions and higher income.

Two studies found that wildfire exposure is associated with shorter height in children, especially when moms were exposed to the smoke during the pregnancy. One study suggests that may be due to the impact of wildfire smoke on pregnant moms’ respiratory health. 

The authors of the systematic review add that current evidence, although limited, suggests people with certain vulnerabilities — including smoking, lower levels of education, obesity, older age, underlying diseases and lower income — might be at higher risk of negative long-term effects of wildfire exposure.

All 21 studies that assessed the association between wildfire exposure and mental health found negative impacts in adults. Those associations include anger problems, possible post-traumatic stress disorder, depression and heavy drinking. Most studies found a higher rate of PTSD symptoms after exposure to wildfires.

There are several reasons why wildfires have long-term impacts on health, the authors of the systematic review explain.

• Direct impact, including long-term injuries, and even death, resulting from burns and inhalation of smoke during the fires.
• Indirect impact via air pollution and mental stress resulting from economic loss, casualties and forced evacuations.
• Damage at the cellular and molecular level. Air pollution, including smoke, might cause DNA damage, decrease the viability of cells and result in cell death. The smoke can also lead to inflammation in the body and the brain.

“The population-based high-quality evidence with quantitative analysis on this topic is still limited,” they write. “Given the long-term projections of increasing frequency of wildfires and length of the wildfire season due to climate change, the anticipated increase in the frequency and acreage burned by prescribed fires, and the increasing aging population that is more vulnerable to suffer from long-term impacts of wildfire exposure, more scientific evidence is urgently needed to determine long-term impacts of wildfire exposure on human health.”

Wildfires and climate change

Compared with 2001 to 2004, nearly 60% of countries experienced an increased number of days that people were exposed to very or extremely high fire risk and 72% of countries had increased human wildfire exposure during 2017 to 2020, the study authors note.

The intensity and frequency of wildfires is increasing in the U.S. and worldwide. According to the National Oceanic and Atmospheric Administration, there were 20 wildfires that caused more than $1 billion in damage between 1980 and 2021 in the U.S. Sixteen of those have occurred since 2000, according to data from the National Interagency Fire Center.

Wildfires are among the Environmental Protection Agency’s climate change indictors, which show the causes and effects of climate change. Wildfires occur naturally and play a role in maintaining the ecosystems in forests and grasslands, but too many wildfires can throw off the nature’s balance.

Wildfire season has gotten longer and there are more wildfires affecting more areas. This increase is due to several factors, including warmer springs, longer dry summers and drier soil and vegetation, according to the EPA.

Funding

The study was funded by the Australian Research Council and the Australian National Health and Medical Research Council. The authors declared no competing financial interests.

How to access this study

Environmental Pollution is published by Elsevier, a Dutch publishing company specializing in scientific research. This study is behind Elsevier’s paywall, but there are several ways you can access it, including emailing the senior author, Shanshan Li. We also have a list of academic journals and publishing companies that offer journalists access to their content upon request.

Additional research

• Preterm birth and term low birth weight associated with wildfire-specific PM2.5: A cohort study in New South Wales, Australia during 2016–2019 Yiwen Zhang, et al. Environment International, April 2023.
• Wildfire smoke and symptoms affecting mental health among adults in the U.S. state of Oregon Maria C. Mirabelli, et al. Preventive Medicine, November 2022.
• Exposure to wildfire-related PM2.5 and site-specific cancer mortality in Brazil from 2010 to 2016: A retrospective study Pei Yu, et al. September 2022, PLOS Medicine.
• Long-term health effects of wildfire exposure: A scoping review Emily Grant and Jennifer D. Runkle. The Journal of Climate Change and Health, May 2022.
• Long-term exposure to wildfires and cancer incidence in Canada: a population-based observational cohort study Jill Korsiak, et al. The Lancet Planetary Health, May 2022.
• Wildfire exposure during pregnancy and the risk of adverse birth outcomes: A systematic review Sana Amjad, et al. Environment International, November 2021.
• Mortality risk attributable to wildfire-related PM2·5 pollution: a global time series study in 749 locations
  Gongbo Chen, et al. The Lancet Planetary Health, September 2021.
• Risk and burden of hospital admissions associated with wildfire-related PM2·5 in Brazil, 2000–15: a nationwide time-series study Tingting Ye, et al. The Lancet Planetary Health, September 2021.
• Psychological effects of the 2017 California wildfires on children and youth with disabilities Elizabeth McAdams Ducy and Laura M. Stough. Research in Developmental Disabilities, July 2021.
• Wildfires, Global Climate Change, and Human Health Rongbin Xu, et al. The New England Journal of Medicine, November 2020.
• The health impacts and economic value of wildland fire episodes in the U.S.: 2008–2012 Neal Fann, et al. Science of The Total Environment, January 2018.

Resources to track wildfires and air quality

• The Fire Information for Resource Management System (FIRMS) U.S./Canada shows all active fires in the two countries. FIRMS also provides a map of wildfires around the world.
• The U.S. Environmental Protection Agency’s AirNow shows the level of air quality based in ZIP code, city or state. AirNow also has a fire and smoke map.
• The National Interagency Fire Center provides current data on wildfires in the U.S., including the number of firefighters fighting the fires and the acres burned.
• The CDC has a guide on how people can protect themselves from wildfire smoke.
• The wildfires layer on Google Maps shows active wildfires.
• Several news outlets track wildfires or air quality and smoke from wildfires, including The New York Times and CNN.

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This collection of research on indoor air quality in U.S. schools, originally published in December 2022, was updated April 12 with a new report that raises concerns about the number of school districts that have not followed the federal government’s guidance on strategies to increase indoor airflow and ventilation to prevent the spread of COVID-19.

The COVID-19 pandemic has forced a spotlight on indoor air quality in schools and the importance of proper ventilation.

It also has brought renewed attention to a longstanding problem in many U.S. classrooms: air pollution, ranging from pet dander and paint fumes to mold, trace metals and formaldehyde.

For many years, schools facing funding shortfalls put off costly projects that would improve indoor air quality and ventilation — replacing roofs, for example, and updating their heating and air conditioning systems. When the federal government announced in 2021 that it would distribute $123 billion in emergency relief funds to help schools prevent the spread of COVID-19 and recover from its impact, school districts had backlogs of deferred renovation and maintenance.

Education officials have a lot of flexibility in how they use that money, the bulk of which remained unspent in late 2022, according to a Washington Post analysis. School districts have until September 2024 to spend the money.

Public health leaders, researchers and advocacy organizations have urged them to put some of it toward improving indoor air quality. Meanwhile, the CDC has stressed that improved air flow and ventilation are crucial in helping stop COVID-19 from spreading indoors.

On April 7, the CDC released a report indicating many school districts have not adopted any of the four key strategies it recommended for increasing air flow and ventilation, including inexpensive changes such as opening windows and using fans to circulate air.

To better understand schools’ efforts to improve indoor air quality amid the pandemic, the private firm MCH Strategic Data surveyed a total of 8,410 school districts nationwide late last year.

Epidemiologist Miguella Mark-Carew, the lead author of the report, said journalists should ask school district leaders about barriers that might be preventing them from improving indoor air quality. She also recommended asking officials about their experiences implementing changes.

“For school districts that have implemented ventilation improvements, understanding lessons learned from their ventilation improvements may help others school districts at the beginning stages of making such improvements,” Mark-Carew wrote in an email interview. “Learning about how improving indoor air quality has impacted students, teachers, and staff (i.e., reduced staff and student absenteeism) would also provide information about the benefits of proper ventilation.”

As news outlets scrutinize schools’ use of emergency relief funds and cover the progress of these projects, it is important journalists know what the research says about how indoor air quality can affect student health and learning.

Children are especially susceptible to health problems linked to poor air quality.

“Exposure to various air pollutants in school buildings risks severe damage to pupils’ health since they inhale a larger volume of air corresponding to their body weights than do adults,” a group of 19 researchers write in an October 2022 paper, “Indoor Air Quality and Health in Schools: A Critical Review for Developing the Roadmap for the Future School Environment.”

Below, we’ve gathered and summarized several academic studies and government reports that examine this issue in the U.S. and abroad. Together, they suggest:

• Tens of thousands of U.S. schools have been operating with faulty or outdated HVAC systems, and many schools lack air conditioning.
• Poor indoor air quality and ventilation are common in schools across the planet.
• Certain pollutants often are found in higher levels inside school buildings than in homes and commercial buildings.
• Poor indoor air quality is linked to a variety of health problems, ranging from coughing and wheezing to more serious conditions such as asthma and cancer.
• Breathing polluted air harms students’ academic performance. If students get sick, they miss school. Studies also show that poor classroom air quality reduces cognitive ability.
• Remediation efforts are hampered by the fact there are “no generally accepted criteria for distinguishing a problematic level of dampness and mold, which adversely affects health, from a non-problematic level of dampness and mold,” one researcher writes.
• Improvements in outdoor air quality over the years has helped boost student test scores, raising the possibility that cleaner air could help reduce historic differences in test scores between Black and white children.
• Climate change has created new challenges for schools, considering some airborne pollutants are more prevalent in warmer climates. As temperatures rise, some schools in cooler regions of the country have installed air conditioning.

Read more about these findings below. Toward the bottom of the page, we’ve included links to other useful resources, including investigative journalism projects focusing on indoor air quality in schools.

The condition of school facilities

Ventilation Improvements Among K-12 Public School Districts — United States, August-December 2022
Miguella Mark-Carew; et al. Morbidity and Mortality Weekly Report, April 2023.

When 8,410 U.S. school districts were asked about indoor air quality since the COVID-19 pandemic began, many reported using at least one of these strategies the CDC had recommended for improving airflow and ventilation inside classrooms and other buildings:

• Replacing or upgrading HVAC systems.
• Maintaining continuous airflow in school buildings during active hours.
• Installing or using in-room air cleaners with high-efficiency particulate air (HEPA) filters.
• Installing ultraviolet germicidal irradiation (UVGI) devices.

The majority of districts, however, reported they did not use any of the four strategies — or did not know whether any had been implemented in 50% or more of their public schools, according to this report from the U.S. Centers for Disease Control and Prevention. For example, 27.9% of schools surveyed in the Midwest indicated they had not replaced or upgraded their HVAC systems. Another 39.8% reported it was “unknown” whether most schools had done that.

“That none of the four ventilation strategies was reported by more than approximately one half of school districts underscores the ongoing opportunity to improve indoor air quality among K-12 school buildings in the United States,” the authors write.

Between Aug. 8 and Dec. 29, MCH Strategic Data surveyed school district office staff members. It conducted weekly telephone surveys of districts serving 2,500 students or more, and biweekly surveys of smaller districts. 

The resulting report provides a broad look at some of the ways education officials have tried to prevent the spread of COVID-19 among students, school employees and the many people who visit or do business with local schools. It also indicates some schools could not or would not make inexpensive changes such as opening windows and using fans to keep indoor air moving.

Among the districts that did make changes, 50.7% reported maintaining continuous airflow through school buildings during active hours at most of their schools and 33.9% reported replacing or upgrading HVAC systems at most schools. Meanwhile, 28% reported installing or using in-room air cleaners equipped with HEPA filters and 8.2% reported installing UVGI devices.

The authors of the report point out that rural districts reported replacing or upgrading HVAC systems and using in-room air cleaners less frequently than districts in other areas.

“This difference might be due to limitations in resource availability and difficulty finding contractors available and willing to complete capital improvements,” they write. “In addition, rural schools might be more likely to use natural ventilation, such as opening windows, than are suburban and city schools because of less exposure to noise and air pollution in rural areas or simply having windows that can be opened.”

School Districts Frequently Identified Multiple Building Systems Needing Updates or Replacement
U.S. Government Accountability Office report, June 2020.

An estimated 41% of U.S. school districts need to update or replace HVAC systems in at least half their schools, which means at least 36,000 public schools are operating with faulty or outdated HVAC systems, according to this report the U.S. Government Accountability Office prepared for Congress.

The report spotlights a range of problems common in public school buildings nationwide that can affect student learning, health and safety. The findings are based on a nationally representative survey of school districts conducted in late 2019 as well as in-person visits to 55 schools in six states — California, Florida, Maryland, Michigan, New Mexico and Rhode Island — from June to September 2019.

Some of the other big takeaways:

• 27.7% of districts reported needing to repair or replace roofs in at least half their schools. Moisture from leaky roofs “can lead to the growth of mold, fungi, and bacteria; the release of volatile organic compounds; and the breakdown of building materials,” according to the National Institute for Occupational Safety and Health. “Moisture also provides a favorable environment for cockroaches, rodents, and dust mites.”
• 8.9% need to address “environmental conditions” such as mold, lead or asbestos in at least half their schools.
• 20.6% of districts need to update or replace systems for monitoring indoor air quality in at least half their schools.

Site visits revealed that schools in cooler areas of the country have had to alter class schedules or install air conditioning systems as climates have warmed.

“Officials in a Michigan [school] district said about 60 percent of their schools do not have air conditioning, and in 2019, some temporarily adjusted schedules due to extreme heat,” according to the report. “Officials in a Maryland district said the district retrofitted some schools with air conditioning, but did not update pipes and insulation serving the HVAC systems, which has caused moisture and condensation problems in these buildings. Officials were concerned the moisture and condensation could lead to air quality and mold problems, but said that to remedy these issues could cost over $1 million for each building.”

The Ventilation Problem in Schools: Literature Review
William J. Fisk. Indoor Air, November 2017.

Ventilation rates in classrooms across the globe often do not meet minimum standards, concludes this paper from the Berkeley Lab , a U.S. Department of Energy laboratory managed by the University of California.

Ventilation rates refer to the amount of outdoor air allowed into a building. In the U.S., a commonly used ventilation standard for classrooms calls for a minimum ventilation rate of approximately 7 liters per second or 15 cubic feet per minute per occupant, explains senior scientist William J. Fisk.

In this paper, Fisk reviews the scholarly literature published from 1995 to 2016 on school ventilation and carbon dioxide levels in classrooms across various countries, including the U.S., China, Greece and Sweden. He asserts that the cost of boosting classroom ventilation rates is small compared to the benefits in terms of student health and academic performance.

“The evidence of an association of increased student performance with increased ventilation rates is compelling,” he  writes. “There is evidence of associations of reduced respiratory health effects and reduced student absence with increased ventilation rates.”

Fisk points out that schools’ energy costs would rise if they improved the ventilation in their classrooms. Many schools also would need to upgrade or repair their HVAC systems.

“The economic value of increases in student performance and health and of reductions in absence are not easily quantified,” Fisk writes. “However, the annual incremental energy and capital costs of increasing ventilation rates as needed to meet or exceed current standards, range from a few dollars to about ten dollars per person.”

How common is mold and other types of indoor air pollution?

Ventilation Improvements Among K–12 Public School Districts — United States, August–December 2022
Miguella Mark-Carew; et al. Morbidity and Mortality Weekly Report, April 2023.

When 8,410 U.S. school districts were asked about indoor air quality since the COVID-19 pandemic began, many reported using at least one of these strategies the CDC had recommended for improving airflow and ventilation inside classrooms and other buildings:

• Replacing or upgrading HVAC systems.
• Maintaining continuous airflow in school buildings during active hours.
• Installing or using in-room air cleaners with high-efficiency particulate air (HEPA) filters.
• Installing ultraviolet germicidal irradiation (UVGI) devices.

The majority of districts, however, reported they did not use any of the four strategies — or did not know whether any had been implemented in 50% or more of their public schools, according to this report from the U.S. Centers for Disease Control and Prevention. For example, 27.9% of schools surveyed in the Midwest indicated they had not replaced or upgraded their HVAC systems. Another 39.8% reported it was “unknown” whether most schools had done that.

“That none of the four ventilation strategies was reported by more than approximately one half of school districts underscores the ongoing opportunity to improve indoor air quality among K–12 school buildings in the United States,” the authors write.

Between Aug. 8 and Dec. 29, MCH Strategic Data surveyed school district office staff members. It conducted weekly telephone surveys of districts serving 2,500 students or more, and biweekly surveys of smaller districts. 

The resulting report provides a broad look at some of the ways education officials have tried to limit the spread of COVID-19 among students, school employes and the many people who visit or do business with local schools. It also confirms that some school districts could not or would not make inexpensive changes such as opening windows and turning on fans to keep indoor air moving.

Among the districts that did make changes, 50.7% reported maintaining continuous airflow through school buildings during active hours at most of their schools and 33.9% reported replacing or upgrading HVAC systems at most schools. Meanwhile, 28% reported installing or using in-room air cleaners equipped with HEPA filters and 8.2% reported installing UVGI devices.

The authors of the report point out that rural districts reported replacing or upgrading HVAC systems and using in-room air cleaners less frequently than districts in other areas.

“This difference might be due to limitations in resource availability and difficulty finding contractors available and willing to complete capital improvements,” they write. “In addition, rural schools might be more likely to use natural ventilation, such as opening windows, than are suburban and city schools because of less exposure to noise and air pollution in rural areas or simply having windows that can be opened.”

Asthma Prevalence and Mold Levels in US Northeastern Schools
Evin J. Howard, et al. Journal of Allergy and Clinical Immunology: In Practice, March 2021.

Researchers analyzed dust samples collected from 32 schools in densely populated areas in the northeastern U.S. and found they contained several types of mold. They also discovered mold levels in classroom dust often exceeded levels of mold found in dust collected from local homes.

Researchers tested samples taken from a total of 114 classrooms and the bedrooms and living rooms of 33 homes from 2014 through 2018. They tested for 30 types of mold, 26 of which are associated with water damage and 10 of which are associated with outdoor sources.

Classrooms had higher levels of these molds, associated with water damage: aureobasidium pullulans, eurotium amstelodami and penicillium crustosum.

Classrooms also had higher levels of these molds, associated with outdoor sources: alternaria alternata, cladosporium cladosporioides 1, cladosporium cladosporioides 2, cladosporium herbarum, epicoccum nigrum and penicillium chrysogenum.

For most remaining mold types, differences were not statistically significant.

When the researchers looked for links between mold levels and rates of asthma among schoolchildren living in the area, they found asthma was most common in schools with higher levels of outdoor mold — the kind found in soil and on leaf surfaces, for example.

“Therefore, the differences in the prevalence of asthma was not indicative of any significant differences in mold growth resulting from water-damage indoors but rather factors associated with the increased levels of molds from outside entering and accumulating in the schools,” the researchers write, adding that 30 of the 32 schools studied did not have air conditioning.

“In addition to AC, the frequency of window and door opening could also affect the levels of [outdoor] molds,” they write. “Cleaning frequency and thoroughness could also affect the build-up of [outdoor] molds inside schools.”

Association Between Allergen Exposure in Inner-City Schools and Asthma Morbidity Among Students
William J. Sheehan, et al. JAMA Pediatrics, January 2017.

This study, which also focuses on the northeastern U.S., found high levels of mouse allergen in 37 elementary schools. It concludes that children with asthma exposed to high levels of mouse allergen, which is present in the urine, hair and dander of mice, were more likely to experience increased asthma symptoms and poorer lung function.

Researchers analyzed samples of dust taken from the classrooms and bedrooms of 284 students, aged 4 to 13 years, who had been diagnosed with asthma and attended one of the 37 elementary schools from March 1, 2008, to Aug. 31, 2013. Researchers tested for allergens associated with mice, rats, dogs, cats, cockroaches and dust mites.

Mouse allergen was most prevalent. It was detected in 99.5% of school samples and 96% of home samples. However, mouse allergen levels were higher in schools than in homes.

Cat, dog and dust mite allergens also were common in schools and homes, although at much lower levels. For example, researchers found cat allergen in 94.8% of school samples and 79.4% of home samples. Allergens from cockroaches and rats “were mostly undetectable” in both locations, the researchers write.

They note that allergen levels and the types of allergens present in schools differ according to the climate of the area.

“In the inner-city schools in our study, mouse allergen was the predominant exposure, whereas levels of cockroach, pet, and dust mite allergens were undetectable or low,” they write. “In contrast, other cities with warmer climates and different building conditions have demonstrated high levels of school cockroach allergen. The low levels of dust mites and cockroach in our study are likely owing to the long, dry, and very cold winters in the studied region, as these pests require humidity and warmth to survive.”

Classroom Indoor PM2.5 Sources and Exposures in Inner-City Schools
Aleshka Carrion-Mattaa, et al.Environment International, October 2019.

For this study, researchers went into 32 schools in densely populated areas in the Northeast to measure airborne levels of fine particulate matter with diameters of 2.5 micrometers or smaller (PM2.5). Prior research has found this type of air pollution is associated with cognitive impairment and exacerbated asthma.

Researchers analyzed PM2.5 levels inside schools each fall, winter and spring from 2009 to 2013 and compared them to outdoor levels. They learned that indoor and outdoor concentrations of PM2.5 were comparable, “demonstrating penetration of outdoor pollution to indoors.” They also learned PM2.5 levels inside schools varied by season and contained a range of pollutants from automobiles, roads, soil, burning vegetation and other sources.

Pollution from motor vehicles was greatest during the fall and winter, the researchers write.

“Activities in the school environment during winter such as using motor equipment/vehicles to clean the snow and spreading salt, and during the fall such as cleaning the leaves may have driven these differences to the other sources,” they explain. “In addition, higher contribution of biomass burning in winter is more likely associated with wood burning at the neighborhood of schools.”

Of the 32 schools studied, four had air conditioning systems, 15 had radiant heat “natural ventilation” and the rest had either classroom-based vents or a combination of ventilation types.

Indoor air quality and child health, student performance

Indoor Air Quality and Health in Schools: A Critical Review For Developing the Roadmap for the Future School Environment
Sasan Sadrizadeh, et al. Journal of Building Engineering, October 2022.

This paper summarizes 50 years of classroom air quality research conducted in 40 countries across six continents, concluding that various pollutants pose severe risks to student health.

Indoor air quality in schools “is characterized by a complex of contaminants,” including molds, bacteria, volatile organic compounds, particulate matter, and trace metals from road traffic, the researchers write. They note that several studies have found that levels of certain airborne pollutants were higher inside schools than in homes and commercial buildings.

“Inhalation exposure to air pollution has increased children’s mortality rate, acute respiratory disease, and asthma,” they write. “Due to different responses of the children’s immune systems to indoor air exposures, various chronic diseases and symptoms have been reported and characterized as ‘sick building syndrome.’”

This paper is based on a review of 304 reports and research papers published between 1970 and 2022. It offers a broad overview of research examining types of pollutants. It finds, for example, that volatile organic compounds — a group of chemicals used in finishing and furnishing — are one of the most dangerous pollutants found in classroom air.

“Construction materials, furnishings such as desks and shelves, resins of wood products, adhesives, glues, paints, cleaning chemicals, and carpets are primary [volatile organic compounds] emission sources in schools,” the researchers write. “The VOC concentrations in newly built or recently renovated school buildings may be significantly higher than ordinary ambient levels.”

The paper also discusses factors that influence levels of pollution inside schools such as ventilation, temperature, outdoor wind speeds and classroom cleaning protocols.

The researchers point out that research demonstrates a link between indoor air quality and student achievement. Studies “confirm that poor air quality affects both typical schoolwork of pupils, i.e. performance in simple learning tasks such as math and language exercises and pupils’ examination grades and end-of-the-year results,” they write.

Does Dampness and Mold in Schools Affect Health? Results of a Meta-Analysis
William J. Fisk, Wanyu R. Chan and Alexandra L. Johnson. Indoor Air, November 2019.

While research suggests students are at an increased risk of developing respiratory issues when dampness and mold are present in schools, renovations aimed at eliminating dampness and mold do not always alleviate such health problems, according to this Berkley Lab analysis.

To better understand the health conditions associated with mold and dampness in schools, researchers combined and analyzed data they collected from 11 studies of the issue published between 1995 and 2016. What they learned: The evidence most strongly suggests that coughing, wheezing and nasal symptoms are associated with mold and dampness in schools.

When the Berkley Lab researchers reviewed four other studies on renovations to correct dampness and mold in schools, they found mixed results. One of those studies reported improvements in some — but not all — student health symptoms after a thorough renovation was completed. For example, there was not a statistically significant change in the number of student complaints about headaches. That study, which focuses on four schools in Finland, also found that “a partial renovation did not significantly improve health.”

Berkley Lab researchers note that efforts to reduce dampness and mold might be more successful is there were generally accepted criteria for distinguishing problematic levels of dampness and mold.

“Ideally, school districts seeking to reduce dampness and mold in their buildings would have clear criteria defining the dampness and mold conditions that trigger remedial actions,” the researchers write. “However, the various studies cited have employed a variety of definitions for dampness and mold and there are no generally accepted criteria for distinguishing a problematic level of dampness and mold, which adversely affects health, from a non-problematic level of dampness and mold.”

Association between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School Children: A Prospective Cohort Study
Jordi Sunyer, et al. PLOS Medicine, March 2015.

Children who attended schools in parts of Barcelona, Spain where there were high levels of automobile traffic pollution showed less progress on cognitive exams than did children attending schools where traffic pollution was low, this study finds.

For example, students in more polluted areas demonstrated a 7.4% increase in working memory over the course of a year, on average. Meanwhile, students in less polluted areas showed an average increase of 11.5%.

Researchers note there also were gender-based differences.

“Boys appeared more susceptible to air pollution, although both boys and girls showed an adverse association of school air pollution with cognitive development,” they write. “Although results could be due to chance, in animals, males were more susceptible to airborne metals than females, which may be because of sex-specific altered dopamine function.”

Thirty-nine schools participated in the study. A combined 2,715 students aged 7 to 10 years took computerized tests every three months for a year so researchers could measure their inattentiveness and development of working memory.

The researchers also collected data on levels of three types of pollutants — carbon, nitrogen dioxide and ultrafine particles — present inside classrooms and outside in school courtyards.

The researchers point out that air pollution was highest in a wealthy area of Barcelona and that most of the schools in high-traffic areas that participated in the study are located there. Children attending schools where traffic pollution was lowest tended to have better-educated mothers, more siblings and fewer behavior problems than children attending schools in more polluted regions. 

The researchers suggest the harms of air pollution could stay with children years into the future.

“Impairment of high cognitive functions has severe consequences for school achievement,” they write. “Thus, reduced cognitive development in children attending the most polluted schools might result in a disadvantage in mental capital, which may have a long-lasting life course effect.”

Outdoor air pollution

Air Pollution and Student Performance in the U.S.
Michael Gilraine and Angela Zheng. National Bureau of Economic Research working paper, May 2022.

Improvements in outdoor air quality over the past two decades have raised student test scores, according to this analysis, which also concludes cleaner air would help reduce longstanding differences in test scores between Black and white children.

To investigate the relationship between air quality and student achievement, the authors analyzed satellite-based measurements of fine particulate matter, or PM2.5, and other pollution-related data from 2002-03 to 2018-19. They then linked air quality data to math and reading test scores for more than 11,000 U.S. school districts for the academic years 2008-09 through 2017-18.

The authors also factored in schools’ proximity to power plants and year-to-year variations in production at individual plants. 

They determined that concentrations of fine particulate matter dropped nationwide over the period studied, driven largely by reductions in coal use. For students, on average, PM2.5 concentrations dropped by 3 micrograms per cubic meter.

The authors point out that test scores, measured in standard deviations, rose, although not as much as they could have.

“Substantial improvements to student performance and equity through cleaner air are still possible, however,” they write.

Other resources for journalists

• The U.S. Environment Protection Agency provides reports and resources on indoor air quality in schools, including national air-quality standards for particulate matter.
• The Indoor Air Quality Scientific Findings Resource Bank, located at the Berkeley Lab, gathers research on how indoor air quality affects people’s health or work performance.
• ASHRAE, formerly known as the American Society of Heating, Refrigerating, and Air-Conditioning Engineers, is a professional organization with a mission of “serv[ing] humanity by advancing the arts and sciences of heating, ventilation, air conditioning, refrigeration and their allied fields.”
• The Indoor Air Program at the University of Tulsa conducts research on indoor air quality in schools, homes and workplaces.

News investigations of indoor air quality in schools

• Toxic PCBs Festered at This Public School for Eight Years as Students and Teachers Grew Sicker, The Seattle Times and ProPublica, 2022.

• Mold Notebook: Which SC Colleges Had the Most Mold Reports, The Daily Gamecock and The Post and Courier, 2022.
• Toxic City: Sick Schools, The Philadelphia Inquirer, 2018.
• Toxic Schools: Mold, Air Quality Spark Thousands of Complaints in Central Florida, Orlando Sentinel, 2010.

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Each year, there are an estimated 16 million cases of acute gastrointestinal illness in the U.S. stemming from contaminants in community water systems.

New research in The Review of Economics and Statistics finds quick notification of water problems can help keep households healthy, avoiding millions of dollars in lost job earnings and direct health care costs.

The research shows that timing matters: Households noticeably change their behavior by purchasing bottled water, but only when notified immediately of potential problems with their tap water.

“People tend to think that the water coming out of their tap is treated and clean and safe to drink,” says author Michelle Marcus, a health and environmental economist at Vanderbilt University. “But it’s actually fairly surprising how often these health-based drinking water violations occur even in the U.S., where we have pretty good water quality.”

In November, for example, residents of Millwood, Washington, faced a boil water order for nearly a week after samples showed elevated levels of coliform bacteria.

In October, water at an elementary school in Honolulu tested positive for coliforms following several nearby water main breaks.

In September, residents in west Baltimore were told to boil water after officials there found coliform contamination, including E. coli, in samples.

While coliform bacteria are generally not harmful to humans, according to the U.S. Environmental Protection Agency, federal regulators long maintained that coliforms are a bellwether for disease-causing viruses, parasites and bacteria.

The Environmental Protection Agency requires that community water systems, which can be public or privately owned, conduct regular tests for coliforms.

The public must be notified within 24 hours of acute violations. Acute violations happen when public health is immediately at risk — for example, if a water system detects thermotolerant coliforms such as E. coli, which can grow at relatively high temperatures and often indicate water contaminated with human or animal feces.

E. coli live naturally in the intestines, but certain strains can cause gastrointestinal illness, ranging from mild diarrhea to nausea and vomiting, with the risk of kidney failure in rare cases in very young and older people.

Federal regulations allow local water officials to use a variety of methods to issue public violations, including the news media or postal mail.

Until 2016, federal rules also required that most community water systems notify residents within 30 days when 5% of their monthly samples tested positive for total coliforms.

“Total coliforms are a group of closely related bacteria that are natural and common inhabitants of soil and surface waters,” according to a 2015 Environmental Protection Agency guidance document for community water systems serving under 1,000 people.

As of 2016, the federal government no longer requires that water systems of any size notify residents of coliform violations stemming from regular sampling — so long as any indications of fecal contaminants fall below prescribed levels and the water system identifies and fixes the problem.

In its final rule, which was published in 2013 but did not go into effect until 2016, Environmental Protection Agency officials maintain that the mere presence of coliforms “by themselves do not indicate a health threat.”

But the recent research shows that when the public is not notified of coliform violations in a timely way, there can still be costly consequences related to purchases of over-the-counter remedies, hospital stays and lost time at work.

Immediate notification, less sickness

Waterborne pathogens that cause gastrointestinal illness account for $160 million in direct healthcare costs each year in the U.S., according to research published in January 2021 in the journal Emerging Infectious Diseases. The authors estimate an additional $2.39 billion in direct healthcare costs when people get sick from breathing contaminated water droplets — at a hot tub or spa, for example.

The new paper in The Review of Economics and Statistics explores how the timing of public notifications related to water quality issues affects household behavior.

Marcus focuses on coliform violations from 2004 to 2015 in North Carolina, because of the quality and detail of data available for the state. This period covers roughly the decade before the federal rule went into effect that made it so community water systems no longer had to tell the public about certain types of contamination identified during routine testing.

Acute violations — those arising from testing indicating an immediate health risk and requiring 24-hour public notice — led households in affected areas to increase bottled water purchases by roughly 78%, on average, during the month the violation occurred, Marcus finds.

Less severe violations related to routine testing — those requiring public notice within 30 days rather than 24 hours — did not, on the whole, affect bottled water purchases.

Marcus finds 60% of community water systems in North Carolina notified households of those less severe violations within one week. Yet for water systems that notified households within one day of less severe violations, bottled water sales increased 40% on average. Notifications sent beyond the first day did not affect bottled water purchases.

While the notification timing was available for North Carolina, the method of communication was “not systematically recorded,” Marcus says. But the research shows early notification of water problems can meaningfully change household behavior.

“The timing of information to the public really matters,” Marcus says. “That’s something that can broadly apply to many different violations for drinking water, and even violations for different types of pollution.”

Although most coliforms do not affect human health, Marcus notably links less severe violations — those that water systems typically took longer to communicate to the public — with more purchases of over-the-counter medicines for stomach distress.

That relationship was not evident for acute violations, indicating the uptick in purchases of clean bottled water following quick notifications helped people avoid sickness.

Hospital admissions were also linked to monthly violations, especially for school-aged children. Likewise, monthly violations were linked to school absences, especially for elementary school students.

Costs of delayed notification

Marcus figures the dollar costs related to immediate warnings about potentially harmful water compared with warnings that come later. If the public had been notified within 24 hours of all testing violations — even those that only required notification within 30 days — Marcus estimates bottled water purchases would have been $365,000 higher in North Carolina during the decade studied.

Marcus also estimates how much the violations that water systems were slower to communicate to the public cost residents in terms of medication purchases, hospital visits and time lost at work.

• Some $441,000 worth of over-the-counter gastrointestinal medicines were purchased due to coliform violations in North Carolina.
• Emergency department visits cost another $422,000.
• Assuming an average wage of $25 per hour and assuming one parent missed one work day for each day a student was absent from school, there were nearly $7 million in lost earnings over the decade.

These are, to be sure, “back-of-the-envelope” calculations, as Marcus writes in the paper. Considering the wages-lost estimate, for example, some parents will have paid time off and won’t have foregone earnings because their child missed school. Others might have nearby relatives to help.

Still, the rough total estimate of costs related to monthly coliform violations that were not immediately communicated to the public comes out to $7.7 million — well above the several hundred thousand dollars’ worth of bottled water that would have been purchased if the public had been immediately notified about every violation.

“The jury’s still out,” Marcus says, referring to the long-term effects of the Environmental Protection Agency’s decision to no longer require public notifications for less severe coliform violations. But, she adds, her research “does indicate that previous to that revision, we were observing health effects for even that monthly coliform violation, which was thought not to matter very much in terms of health.”

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On April 25, 2014, the city of Flint, Michigan, changed its municipal water supply source from the Detroit-supplied water coming from Lake Huron to the Flint River as a cost-saving measure. The new water source, however, was not treated and tested adequately, so it corroded the old water pipes, resulting in lead and other contaminants to enter drinking water.

By September 2015, a Virginia Tech research team found “serious levels of lead in the city water.” On Oct. 16, 2015, the city switched back to the Detroit water supply.

But the crisis didn’t end there.

By 2020, the rates of mental health disorders such as depression and post-traumatic stress disorder remained higher than average, according to a recent study in JAMA Network Open.

One in 5 Flint residents met the criteria for depression, 1 in 4 for PTSD and 1 in 10 for both depression and PTSD, estimates that exceed regional, national and global averages, according to “Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis.” The study is based on in-depth online and mail surveys of 1,970 adult Flint residents between 2019 and 2020.

“We can’t know what percent is directly attributable to the crisis versus preexisting issues that have been around in Flint for a number of years, including disinvestment and concentration of poverty, which can influence mental health problems,” says Aaron Reuben, the study’s lead author and a postdoctoral scholar at Duke University and the Medical University of South Carolina. “But we find that when you compare Flint to the wider country or to Michigan, depression and PTSD are significantly elevated and we were able to connect this elevation to experiences people had during the crisis.”

Although the statistical findings of the study may not be generalizable to other regions, they add to the existing body of literature documenting the mental health effects of human-caused disasters on communities.

“Environmental disasters have significant mental health consequences, particularly when they involve toxic chemicals, misinformation being distributed, possibly criminal negligence by public officials, and they last a long time,” Reuben says.

For public official and decision makers, the message is to make mental health response part of the crisis response, Reuben says. “And it should start at day one with the assessment of need.”

The study finds several factors associated with persistent mental health conditions following the Flint water crisis, including being female, an annual income below $25,000 and previous traumatic experiences. Those who felt the water crisis had affected their health or their family’s health were also significantly more likely to meet the criteria for depression or PTSD.

Low confidence in public officials and lack of trust in the accuracy of information given by them was also linked to whether people had mental health problems later, as they continued to worry about potential health complications from exposure to contaminated water or didn’t understand what they’ve been exposed to.

“Those things are psychologically stressful and can be limited by good communication campaigns” by public officials, Reuben says.

Also significant among the findings is access and use of mental health services.

Among the respondents, 34.8% said they were offered mental health services. Among those who were offered the service, 79.3% accepted it.

“We found that when you offer services, people do want them,” Reuben says.

Despite the study’s findings, Reuben emphasized that the Flint community is remarkably resilient.

“When you look at all of the crises, the stressors, the disinvestment that the community has gone through over not just the last few years, but decades, in a way, they’re doing remarkably well,” he says. “What we want to do is just highlight that there are a number of folks who are not doing as well as they could and that we want this to be bringing attention to the lingering needs in the community.”

More on the study and its findings

The survey was conducted between Aug. 13, 2019 and April 10, 2020. Most of the data were collected before COVID-19 was declared a pandemic in March 2020, the authors write. Respondents were compensated with $35.

Slightly more than half of respondents were women. In total, 53.5% were Black, 42.5% white, 0.1% Asian, 0.3% Native American and 1.6% checked “other.” About 2% said they were more than one race.

Of the responding households, 56.8% had an annual income below $25,000 and 6.3% had an income above $75,000.

The authors say the final sample was demographically representative of Flint’s adult population. The city’s population was 80,628 in July 2021, according to the U.S. Census Bureau.

Most of the respondents — 86.8% — lived in homes directly affected by the water crisis.

In total, 97.7% said they changed their behavior to avoid or reduce exposure to contaminated water by avoiding drinking, cooking or cleaning with it. Of the respondents, 76.9% reported spending money to lower their risk by taking measures such as buying bottled water for cooking and cleaning or replacing all pipes and fixtures in their homes.

At the time of survey, 80.1% said they were concerned that exposure to the contaminated water would have long-term effects on their health.

Based on survey results, the study estimates prevalence of depression in the city was 22.1% during 2019-2020, more than double that in Michigan (9.4%), the U.S. (7.8%) and globally (7.2%), according to the study.

Prevalence of PTSD was two-to-five times greater than rates among U.S. veterans after deployment (12.1%), the general U.S. population (4.7%) and estimated global averages (2.8%), the study estimates.

Aside from factors such as gender, income and lack of trust in public officials, previous traumatic experiences were also associated with higher risk of depression and PTSD after the water crisis.

Respondents who had past exposure to any potentially traumatic events were twice as likely to experience depression, 4.5 times as likely to meet the criteria for PTSD and 5 times as likely to report both depression and PTSD compared with the general populations.

Rates were even higher for individuals who reported past physical or sexual trauma. They were 3 times as likely to report depression, 6 times as likely to have PTSD and 7 times as likely to report both compared with the general populations.

“There’s plenty of reasons the mental health problems we’re seeing today will continue unless additional services [are provided in Flint],” says Reuben. “The crisis isn’t done necessarily.”

The study has several limitations. Researchers’ estimates of depression and PTSD are presumptive because the conditions were not diagnosed by a clinician. Also, the estimates could be low if those who responded to the survey were less impaired than those who did not participate, or, high if those with unmet mental health needs were more motivated to participate.

In addition, the study doesn’t establish causal relationships between the water crisis and mental health condition, the authors note. The study also didn’t measure actual lead exposure, but the perception of it.

More research on the mental health effects of environmental disasters

Researchers have long known that natural and human-caused disasters are stressful events, and that a certain portion of the affected population will develop mental health conditions. Most studies recommend including mental health outreach early in the crisis response.

Here are a few studies on the mental health effects of environmental disasters in the U.S.:

Jackson County, Mississippi: In November 1996, one of the largest human-caused disasters in U.S. history at the time was confirmed by officials in Jackson County, Mississippi: 1,800 homes and businesses had been contaminated with the pesticide methyl parathion during a 10-year period.

The chemical, approved by the Environmental Protection Agency for spraying over fields to control insects, was being used indoors, mainly by exterminators, to kill insects, especially cockroaches. The chemical affects the nervous system and high doses can cause death. By 1997, the EPA had spent $69 million to decontaminate homes and businesses. No deaths or serious injuries were linked to the pesticide, according to Stephen Braun’s 1997 narrative piece in the Los Angeles Times.

A 2000 study, published in the journal Health & Social Work, finds 55% of those affected by the contamination, regardless of contamination levels, had symptoms of depression. The study was based on phone or in-person surveys of 115 households, between October and December 1997.

“Mental health services and support groups should be made available immediately after the disaster and remain accessible for a couple of years after the cleanup begins,” the authors write. “Because victims are unlikely to actively pursue formal providers, public awareness campaigns should begin soon after the disaster and attempt to legitimize formal mental health services and make them more readily available and accessible for low-income people.”

Graniteville, South Carolina: In January 2005, a large chlorine spill in Graniteville, South Carolina, led to death of nine people and hospitalization of 72. At least 840 people received medical treatment at area hospitals and doctors’ offices.

A survey of 225 survivors about 10 months after the spill showed that 36.9% had symptoms of post-traumatic stress, according to a study published in Social Psychiatry and Psychiatric Epidemiology in November 2011. Also, 27% of respondents reported panic attacks.

“Our findings suggest that personnel providing mental health services should be especially considerate of those with serious physical injuries,” the authors write. “Perhaps even more important than exposure, the physical morbidity resulting from a disaster is a strong risk factor for psychological distress.”

Flint, Michigan: Researchers have also studied mental health outcomes of the Flint water crisis shortly after it happened.

A 2017 study, published in the Journal of Community Psychology, used online and mail surveys of 786 Flint residents, conducted between September 2015 and September 2016, to examine the relationship between perceptions of household tap water quality and post-traumatic stress disorder symptoms.

Researchers find those who experienced poorer tap water quality during the water crisis experienced greater PTSD symptoms.

“The findings of our study underscore the negative effects of the Flint water crisis on adults and demonstrate the need for psychological interventions addressing the psychosocial effects of the crisis,” the authors write.

Jackson, Mississippi: The water crisis in Jackson, Mississippi, resulting from the failure of the city’s water treatment plants in August 2022, is a more recent example of a water disaster.

A December 2022 study, published in the journal Sustainability, uses health data from the Centers for Disease Control and Prevention to statistically compare the city of Jackson with eight nearby cities. It finds worse health status and health outcomes in Jackson compared with nearby cities, pointing to issues with the city’s hygiene and environmental health system.

“The urban water crisis in Jackson may already result in immense public health inequities, and the black communities experience significantly higher public health diseases than the majority-white cities,” writes the study’s author, Qingmin Meng. “The significantly worse mental and physical health status and the nine types of health outcomes in Jackson and Canton, which are majority-black cities in the Jackson region, than other seven non-majority black cities have showed Jackson may have started a critical degradation in public health that is still significantly threatening the black communities in Jackson, and likewise, the city of Canton.”

Meng compares the Jackson water crisis to Flint’s.

“Currently, the Jackson water crisis is significant yet overlooked for many years that may end up causing public health consequences even worse than Flint,” he writes.

Take-home message

Reuben says just providing more mental health services isn’t enough. Rather, there needs to be a holistic look at factors driving depression and PTSD in the community beyond a water crisis.

“We can’t go back and undo the crisis, but we can create a situation in which people feel that their needs are being looked after, that the information being provided by public officials are accurate,” he says.

He encouraged journalists to hold officials accountable, especially after published research points out the existing problems.

“We’ve got this study. Now what? Who’s going to do something with it?” he asks. “Get the response of folks in positions to make those decisions. What do they think of these findings? Go into the community and find people willing to be the representative, the voice and face of some of these problems.”

Additional reading

• “Experiences of the Flint Water Crisis Among Reproductive-Age Michigan Women in Communities Outside of Flint: Differences by Race and Ethnicity,” Sidonie K. Kilpatrick, et al. Journal of Racial and Ethnic Health Disparities, March 2022.
• “Lead-Laced Water In Flint: A Step-By-Step Look At The Makings Of A Crisis,” Merrit Kennedy, published on NPR in April 2016, details the timeline of the Flint water crisis.
• “‘Roach Men’ Left Toxic Trail,” Stephen Braun, published in October 1997 in the Los Angeles Times, explains the methyl parathion crisis in Jackson County, Mississippi.
• “Water, but not everywhere: Research sheds light on race and water access in metro areas,” Clark Merrefield of The Journalist’s Resource, published in November 2020, details a study that finds householders of color in the 50 largest metropolitan areas were 34% more likely to lack what the U.S. Census Bureau calls “complete plumbing” compared with white, non-Hispanic householders.
• “Racial disparities in access to running water: 5 studies to know,” Clark Merrefield of The Journalist’s Resource, published in November 2020, highlights five academic on the link between race and access to indoor running water.
• “Investigating stories on water access, affordability and safety: 5 tips to get started,” Clark Merrefield of The Journalist’s Resource, published in December 2020, lists five reporting tips for journalists.

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There’s a growing realization in the health care community about the toll that the practice of medicine takes on the Earth.

The health care industry “is among the most carbon-intensive service sectors in the industrialized world,” accounting for between 4.4% and 4.6% of greenhouse gas emissions, according to a key paper on this topic, published in 2020 in Health Affairs.

In the United States, the toll is particularly heavy. It’s estimated that the health care sector produced about 8.5% of domestic greenhouse gas emissions in 2018, according to that paper. It also notes the U.S. medical system may be responsible for about a quarter of all global health care greenhouse gas emissions, which is more than the health care system of any other nation.

The Biden administration highlighted its efforts to reduce these kinds of emissions during the United Nations Climate Conference (COP27) in November. U.S. delegates announced that more than 100 health care organizations have signed the voluntary Health Sector Climate Pledge initiative that the Department of Health and Human Services created with the White House. In kicking off this initiative in June, Adm. Rachel Levine, a pediatrician who serves as assistant secretary of the Department of Health and Human Services, stressed the link between climate change and illness.

“We’re already seeing the damage done by extreme heat, wildfires, severe storms, and increasing chronic disease burdens, all associated with climate change,” said Levine in a June 30 statement.

Levine described the Health Sector Climate Pledge initiative as “the beginning of a longer ongoing effort with partners from across the industry, which is exactly the kind of big response we need as a country.”

Organizations that sign the pledge have agreed to try to reduce emissions linked to climate change by 50% by 2030, from a baseline level set no earlier than 2008.

While certainly a positive step, this White House initiative depends on the goodwill of hospital administrators and leaders of companies that make medical products. Put bluntly, it is a strictly voluntary pledge and has no guarantee of lasting beyond the Biden administration.

The organizations that signed this pledge “are not obligated to report data on their progress to the federal government in association with this pledge,” according to an FAQ on the HHS website.

Weaving environmental efforts into the practice of medicine

Some leaders in medicine have recommendations for ways to secure more lasting incentives to reduce the carbon footprint of healthcare. They want to leverage the clout of the federal government as the nation’s biggest purchaser of health care and drive changes through regulation, such as a mandate to report on efforts to address climate change.

Among those advocating for regulation is Jodi Sherman, an associate professor of anesthesiology and epidemiology at Yale School of Medicine University, who spearheaded development of the Yale Gassing Greener app. This allows her fellow anesthesiologists to easily see how much pollution they can avoid through different choices of inhalation gases during surgeries.  She also is an author of professional guidance intended to help anesthesiologists better understand how their choices of gases affect emissions, and one of many authors of the previously cited 2020 Health Affairs paper.

Sherman maintains that efforts to reduce health care’s contribution to climate change should be woven into the practice of medicine. “This is the new frontier for patient safety where we are looking beyond the patient in front of us,” she says.

In covering this topic, journalists need to dig beyond press releases and statements from health care organizations about their support for the broad goal of reducing the carbon footprint. They should press hospital leaders and executives of medical supply companies for concrete examples of their plans to reduce their organizations’ carbon footprints. And they should look at what the research says.

The United Kingdom’s Sustainable Development Unit

Researchers who have studied the health care sector’s effect on climate change suggest the United States look to a United Kingdom program as a model. 

The U.K.’s  National Health Service has been a leader for many years in keeping tabs on emissions, a key step toward reducing them. It created a Sustainable Development Unit in 2008, and began that year conducting assessments of the NHS’s carbon footprint, write Imogen Tennison and her co-authors in a 2021 article published in The Lancet.

“Regularly updated and improved upon, these assessments now constitute the longest-running effort to quantify health-care-related greenhouse gas emissions in the world,” they write of the work of the Sustainable Development Unit.

The U.S. differs from the U.K., which has a centralized government-run health system as its dominant provider of medical care. But to truly make a difference in the U.S., the federal government should require health care organizations to report on their emissions, Sherman and her coauthors argue in their 2020 Health Affairs article, Health Care Pollution And Public Health Damage In The United States: An Update.

“Mandated emissions reporting would inform science-based interventions and facilitate rapid adoption of sustainable health care practices that could dramatically reduce health care pollution and improve public health,” they write.

The United States has a complex medical system, involving a mix of public and private initiatives and laws in 50 states plus the District of Columbia, as well as regulations enforced by federal agencies. But many U.S. hospitals and medical offices depend on payments from the Medicare and Medicaid programs, which are the nation’s largest purchasers of health care.

There are at least two promising ideas for attaching emission reporting rules to Medicare payments:

1. The Centers for Medicare and Medicaid Services could require reporting emissions data as one of its conditions for paying for health care services.
2. There could be a mandate from The Joint Commission,  a nonprofit organization on which CMS heavily relies to check on how well hospitals are run. Loss of accreditation from The Joint Commission puts at risk hospitals’ Medicare payments, which are the financial lifeblood of many of these organizations. If the Joint Commission showed more interest in reporting on emissions, it could inspire hospital leaders to track them, even if this didn’t rise to the level of a threat to payment.

Scope 1, 2 and 3

Before we delve into these suggestions, let’s go over the widely used Scope 1, 2 and 3 framework for discussing greenhouse gases. These classifications are part of the comprehensive standardized framework created by the Greenhouse Gas Protocol, which resulted from a partnership between the World Resources Institute and the World Business Council for Sustainable Development (WBCSD).

The authors of the 2020 Health Affairs update describe these classifications in their paper as follows:

• Scope 1 refers to greenhouse gas emissions emitted directly from health care facilities, such as from on-site boilers and certain medical gases.
• Scope 2 covers those emitted indirectly through purchased electricity.
• Scope 3 refers to those emitted in the supply chain through the production of goods and services procured by health systems.

For more on this, see this World Resources Institute primer.

CMS raises the question

The Centers for Medicare & Medicaid Services this year asked the public for feedback about how health organizations can track greenhouse gases, a move that signals the agency may eventually take steps in this direction.

The agency included a request for information on ways to address climate change in its draft update of the Medicare payment rule for inpatient services for fiscal 2023. CMS uses its annual payment rules as vehicles to make myriad changes in the conditions it attaches to its payments.

CMS released the proposed Medicare rule for 2023 payments for hospital inpatient services in April. (You can find all of the comments on this wide-ranging proposed rule posted here. There’s a search box that lets you home in on comments that addressed CMS’ questions on climate change. Tip for journalists who work for a regional news outlet: Try searching on the name of a state and the term “climate change”.)

Among the questions CMS posed was whether hospitals or health systems are setting “time-bound, public aims” for addressing greenhouse gas (GHG) emissions. The reactions were mixed.

Already noted as a leader in this area, the staff of the Cleveland Clinic, for example, told CMS that it has a goal to be carbon neutral by 2027, in terms of both Scope 1 and 2 emissions. The comment also said the clinic “would support the establishment of time-bound goals for GHG emissions reduction in the health care industry sector-wide.”

These statements were parts of the Cleveland Clinic’s comment to CMS on the draft Medicare payment rule. (Comments on federal rules are posted on the Regulations.gov website, which can be a great source for journalists.)

In contrast, the American Hospital Association (AHA) urged CMS to consider the burden of potential new rules on its members, while also stating broad support for the goal of reducing greenhouse gas emissions. Older physical structures, for example, may not be able to undergo the same type of retrofitting of heating or cooling systems compared with newer ones, AHA said in a June comment to CMS.

The hospital lobbying group also questioned whether HHS “has the legal authority to impose requirements on hospitals to address threats created by climate change.”

In their Health Affairs article, Sherman and her coauthors argue for using Medicare’s existing frameworks intended to judge the quality of medical care to create a system for tracking the carbon footprints of hospital systems. (See Exhibit 4 of their paper for a more detailed discussion of ways that existing CMS metrics could be expanded to address climate change.)

The Joint Commission and a proposed SEC rule

Jonathan Perlin, who became the  president and chief executive of The Joint Commission in March, discussed his plans to address climate change in an October interview with New England Journal of Medicine’s NEJM Catalyst. Perlin said decarbonization efforts are critical because “climate change is having a direct and inequitable effect on the health and well-being of people globally.”

Perlin also spoke about convening a technical advisory panel to consider this issue, in part to consider ways to encourage health systems to address reducing their own carbon footprints.

It would be wise for journalists to keep tabs on Perlin’s plans to address the carbon footprint, says Brian Chesebro, an anesthesiologist and the medical director for environmental stewardship at Providence Health Oregon. There are important stories to be written about any action The Joint Commission takes in this area, he says.

“The Joint Commission has tremendous influence over the operations of health care and tremendous influence over the leadership,” Chesebro says.

In addition, the Securities and Exchange Commission in March proposed a rule that would require many companies to disclose their greenhouse gas emissions, as well as their potential financial losses from climate change.

The proposed SEC rule applies broadly to publicly traded companies. This would include companies such as HCA Healthcare, a for-profit hospital system, which as of September owned and operated 182 hospitals. It would also apply to companies that make drugs, medical devices and health supplies.

As of December, though, the SEC had yet to finalize the proposal. And the commission faced pushback from industry groups — as well as from one of its own members.

The climate change proposal would not produce the kind of “comparable, consistent, and reliable disclosures” that the commission wanted, said SEC Commissioner Hester Pierce, in a March statement to SEC Chairman Gary Gensler. Pierce was appointed as an SEC commissioner in 2018 following a nomination by then President Donald Trump.

The SEC proposal asks some large companies to provide information about the carbon footprint of their suppliers, customers, employees and other factors such as changing weather patterns. 

In a public statement issued for a March 2022 SEC meeting, Pierce said she understands the drive to “bring clarity in an area where there has been a lot of confusion and greenwashing,” using a term for efforts to make companies and organizations seem more environmentally responsible than they are.

But Pierce questioned whether the SEC would get the results it sought from its proposal, arguing about challenges ahead in gathering reliable data and analyses.

Research roundup

In the research roundup below, we’ve gathered and summarized analyses on emissions, as well as papers outlining the challenges of gathering data on the carbon footprint of the U.S. healthcare sector.

The first two studies could be considered required reading for journalists delving into this topic, as they contain solid estimates of changes in the contribution of health care organizations to climate change in the U.K. and U.S.

The other five papers present analyses and thoughtful plans and suggestions on topics including:

• How reducing use of over-testing and low-value treatments could help shrink the carbon footprint of U.S. health care.
• A detailed list of actions the federal government could take to leverage its financial clout as a purchaser of health care and a supporter of medical research and training.
• How to reduce greenhouse gas emissions due to manufacturing of medical devices
• Reconsidering travel to medical conferences.

Health Care’s Response to Climate Change: A Carbon Footprint Assessment of the NHS in England
Imogen Tennison; et al. The Lancet Planetary Health, February 2021.

The carbon footprint of the U.K.’s NHS fell by 26% from 1990 to 2019, mostly due to reduced use of certain kinds of inhalers and in forms of energy used for heat and power, the authors write.

This was the key conclusion of what the authors describe as “the longest and most comprehensive accounting of national health-care emissions globally.” In addition to highlighting the major wins in reducing the carbon footprint, the study illustrates areas where growth in emissions was at least held in check amid rising demand for medical services.

The total tally for the NHS in England dropped from 33.8 megatons of carbon dioxide equivalent (Mt CO2e) in 1990 to 25.0 Mt CO2e in 2019, the study finds.

Among the biggest contributors to that decline was a change in production of metered dose inhalers, stemming from the 1987 Montreal Protocol, an international treaty designed to reduce production of products that deplete the Earth’s protective layer of ozone. It set in motion efforts to phase-out of chlorofluorocarbon propellants in metered dose inhalers, which are used for asthma and other lung conditions. (There are still concerns, though, about emissions from inhalers.

The carbon footprint for metered dose inhalers dropped from 4.64 Mt CO2e in 1990 to 0.80 in 2019.

The carbon footprint attributed to oil dropped from 1.74 Mt CO2e to 0.02 Mt CO2e. This analysis weighed both the reduction in the NHS’ direct consumption of oil for its energy needs, a Scope 1 use, and oil consumed in the supply chain of the NHS, the Scope 3 uses.

It’s important to note that during the study period, the population of England increased by 17% and the NHS England’s provision of care doubled, in terms of a measure as hospital stays.

The carbon footprint for travel related to the NHS did tick up during the 1990-2019 period, rising from 1.9 Mt CO2e to 2.4 Mt CO2e. This figure includes commutes by NHS staff as well as trips by patients and visitors.

In the paper, the authors highlight the 2008 creation of the NHS’ Sustainable Development Unit, which has closely tracked carbon footprint, as a contributor to their analysis.

“Regularly updated and improved upon, these assessments now constitute the longest-running effort to quantify health-care-related greenhouse gas emissions in the world, and are notably the only national-level analyses carried out by a public agency with institutional support, rather than by independent researchers,” the authors write.

To hear Tenninson and co-author Matthew J. Eckelman discuss this paper, check out this episode of the Lancet’s Planetary Health podcast.

Health Care Pollution And Public Health Damage In The United States: An Update
Matthew J. Eckelman; et al. Health Affairs, December 2020.

U.S. health care greenhouse gas emissions rose 6% from 2010 to 2018, reaching 1,692 kg per capita in 2018 — the highest rate among industrialized nations, the authors write. In other terms, they reached about 553 Mt CO2e in 2018, or approximately 8.5% of domestic U.S. greenhouse gas emissions, the authors write.

This figure — 8.5% — has been widely cited, including by the White House in its June statement on the Health Sector Climate Pledge.

In making these estimates, the authors used data from the Environmentally-Extended Input-Output model (USEEIO), developed by the EPA. This model melds data on economic transactions between 389 industry sectors, with emissions data that the EPA describes as “a wealth of environmental information, including data on land, water, energy and mineral use, air pollution, nutrients, and toxics.”

The paper also includes estimates of state-level emissions. Midwestern and Northeastern states generally have higher per capita emissions than Western or Southern states, the authors report.

Their calculations also suggest that in 2018 greenhouse gas and toxic air pollutant emissions resulted in the loss of 388,000 disability-adjusted life-years (DALYs). DALY is a tool researchers use to show a broader picture of the effects of a harmful substance or practice on people. (The World Health Organization explains that a DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality and the years lived with a disability due to prevalent cases of the disease or health condition in a population, the WHO explains.)

This disease burden is “within the same order of magnitude as years of life lost as a result of deaths from preventable medical errors and it remains a concerning issue for health care safety, quality, and cost containment efforts,” the authors write.

Why Climate Activists Should Care About Healthcare Waste and Overuse
Daisy Valdivieso and Thomas B. Newman. The Journal of Climate Change and Health, October 2022.

The authors call for greater efforts to reduce use of medical tests and procedures that are considered unlikely to deliver significant benefit as an easy way to shrink the carbon footprint of medical care.

They cite the work of the The American Board of Internal Medicine’s Choosing Wisely program as a resource in weighing what tests and procedures patients and clinicians should consider skipping. Choosing Wisely collects recommendations from specialists who have reviewed studies about treatments and tests commonly used in their fields.

This approach also plays more to the strength of people practicing medicine than do strategies more focused on reducing energy consumption in a broad sense.

“Emissions from buildings, ventilation, and lighting are not healthcare workers’ area of expertise, but we do have expertise in identifying low-value care,” the authors write. “Drawing connections between the high cost of healthcare and healthcare waste can help draw urgency to the matter.”

Prescriptions for Mitigating Climate Change–Related Externalities in Cancer Care: A Surgeon’s Perspective
Victor Agbafe; et al. Journal of Clinical Oncology, March 2022.

This paper provides an overview of efforts underway in medicine to reduce emissions of greenhouse gases, with an emphasis on cancer surgeries. Its suggestions include ways to reduce emissions from operating rooms such as scheduled preventive maintenance.

It also touches on efforts to avoid unnecessary waste in the surgical supply chain. Trays of instruments prepared for operations sometimes have unnecessary or rarely used sterile instruments, which could be weeded out by more selective preparation, the authors write.

Confronting Health Care’s Climate Crisis Conundrum : The Federal Government as Catalyst for Change
Kenneth W. Kizer and Kari Christine Nadeau, JAMA, January 2022.

In the Viewpoint article, Kizer and Nadeau urge a broad application of what’s been learned about quality metrics to efforts to reduce the carbon footprint of the U.S. health care sector.

More public reporting is needed to understand the scope of the problem and identify solutions, the authors write.

“First, the president could direct all federal agencies that provide health care to begin reporting on the environmental and societal consequences of their operations in accordance with the Global Reporting Initiative framework and standards for environment, social, and governance (ESG) reporting,” they write.

“Government health systems do not disclose these data (and very rarely do private health care organizations), unlike more than 90% of the Standard & Poor’s top 500 companies and many nongovernment entities,” they add.

Other suggestions include:

• Direct CMS to require all recipients of Medicare, Medicaid, and the Children’s Health Insurance Program funds to begin ESG reporting.

• Have the VA and the Defense Department require ESG reporting from the private health care providers with whom they contract.

• The Food and Drug Administration could include ESG reporting as a requirement in applications for approval of new medicines and medical devices. Kizer and Nadeau write that the U.K.’s National Health Service and its equivalent of the FDA — the Medicines and Healthcare Products Regulatory Agency — already do this.

• The federal government could require that institutions receiving research funds from the National Institutes of Health, Department of Defense, or other federal government agencies report on ESG performance and develop sustainability plans. The government could also leverage its role as the biggest funder of physician training, graduate medical education and other health professional training, to demand climate change education be included in the curriculum of programs.

“This could constitute a substantial step toward better equipping health professionals to confront climate change and other planetary health problems,” they write. Educational institutions receiving such funds also could be required to report on ESG performance.

Estimation of the Carbon Footprint Associated With Attendees of the American Psychiatric Association Annual Meeting
Joshua R. Wortzel; et al. JAMA Network Open, January 2021.

The American Psychiatric Association (APA) saved the estimated equivalent of burning 500 acres of dense forest, or 22 million pounds of coal, when it opted for a virtual annual conference in 2020 due to the pandemic, the authors write.

There’s tension between the APA’s having made a priority of addressing the effects of climate change on mental health, while holding one of the world’s largest annual psychiatric conferences, according to the paper.

With that in mind, the authors created a study that included data from the APA about the cities and countries of origin of about 16,620 attendees at the 2018 annual meeting and about 13,335 at the 2019 annual meeting.

The authors then identified likely transportation modes and departure airports for each attendee based on their distance from the meetings. Estimates for emissions for attendees considered to be within driving distance were based on Environmental Protection Agency’s guidelines. For flying emissions estimates, the authors used the Flight Emissions API (GoClimate) web tool. They concluded that the 2018 New York City and 2019 San Francisco APA annual meetings produced an estimated 19,819 and 21,456 metric tons of CO2e emissions, respectively.

This analysis was not meant to discourage in-person conferences, but to spark consideration of ways to reduce their carbon footprint, the authors write. “Creative workarounds” such as greater use of virtual meetings should be considered, they conclude.

Transforming The Medical Device Industry: Road Map To A Circular Economy
Andrea J. MacNeill; et al. Health Affairs, December 2020.

The authors of this analysis argue for a shift toward more reusable products, which might be less profitable for some manufacturers but better for the planet. “Single-use blood pressure cuffs, for example, have been introduced to obviate the need for cleaning, despite little evidence that reusable cuffs are significant vectors of pathogens when properly reprocessed,” the authors write.

They write that despite broad adoption of single-use disposable products, there is no compelling evidence that they reduce infections acquired during surgery or other health care.

“Most of the decrease in surgical site infection rates from 4–6 percent in 1987–90 to 2 percent in 2009 can be attributed to the use of evidence-based protocols to standardize care and enhance host defense mechanisms (for example, glycemic control and normothermia),” they write.

They argue for an “expanded notion of patient safety that considers population health,” and which “would take into account the social and environmental damages of the current single-use disposable–dominant health care supply chain.”

The authors argue that regulators should take responsibility for the safe sale and reuse of medical devices. They could, for example, restrict single-use disposable labeling to products for which safe reuse cannot be reasonably demonstrated, instead of allowing single-use disposable labeling by default.

Additional resources

Commonwealth Fund’s Climate Change and Health Care initiative website:                      

This respected nonprofit organization is seeking to help health systems with tools, and resources to reduce their carbon emissions. It also is supporting new academic research to measure, compare, and reduce the health system’s carbon footprint. Among its recent publications of interest to journalists are:

• How the Inflation Reduction Act Can Help the Health Care Sector Reduce Greenhouse Gas Emissions, Sept. 22, 2022. This blog post looks at how a major 2022 law on environmental and health policy may help medical systems and organizations try to reduce their emissions.     
• Action to Decarbonize the U.S. Health Care System: Lessons from the U.K.’s National Health Service, July 26, 2022. This blog post looks in more detail at NHS England efforts at decarbonization, which were described earlier in this article.

National Academy of Medicine’s Action Collaborative on Decarbonizing the U.S. Health Sector: A leading U.S. coordinator of health care initiatives is seeking to help medical organizations share ideas for reducing their carbon footprints. Its plans include holding meetings and seeking other ways to share suggestions.

American Medical Association (AMA) Climate Change website: The largest organization of doctors in the United States has been speaking in support of efforts to reduce emissions. It has called on doctors to assist in educating patients and the public on the physical and mental health effects of climate change and on environmentally sustainable practices, and to serve as role models for promoting environmental sustainability.

Agency for Healthcare Research and Quality is a federal agency that tries to have medical practices supported by research used more widely in health care. AHRQ contracted with the nonprofit Institute for Healthcare Improvement (IHI) to develop a primer with suggestions for reducing emissions.

Health Care Without Harm: A global group with a U.S. operation that seeks to help reduce the environmental footprint of the health care sector.

The Journalist’s Resource:

• The 2022 Lancet climate change and health report: Dire warnings and glimmers of hope (November 21, 2022)

• 7 tips for finding local stories in The Lancet’s health and climate change report (October 27, 2022)

• Want to reach skeptics? Researchers suggest leaving the term ‘climate change’ out of some news coverage (May 28, 2022)

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