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Jonathan A. Patz,^1,* Michael A. McGeehin,^2,* Susan M. Bernard,¹ Kristie L. Ebi,³ Paul R. Epstein,⁴ Anne Grambsch,⁵ Duane J. Gubler,⁶ Paul Reiter,⁷ Isabelle Romieu,² Joan B. Rose,⁸ Jonathan M. Samet,⁹ and Juli Trtanj¹⁰

¹Department of Environmental Health Sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA
²National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
³EPRI, Palo Alto, California, USA
⁴Center for Health and the Global Environment, Harvard Medical School, Boston, Massachusetts, USA
⁵Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
⁶Division of Vector-Borne Diseases, U.S. Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
⁷Division of Vector-Borne Diseases, U.S. Centers for Disease Control and Prevention, San Juan, Puerto Rico
⁸University of South Florida, St. Petersburg, Florida, USA
⁹Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA
¹⁰Office of Global Programs, National Oceanic and Atmospheric Administration, Silver Spring, Maryland, USA

Abstract
We examined the potential impacts of climate variability and change on human health as part of a congressionally mandated study of climate change in the United States. Our author team, comprising experts from academia, government, and the private sector, was selected by the federal interagency U.S. Global Change Research Program, and this report stems from our first 18 months of work. For this assessment we used a set of assumptions and/or projections of future climates developed for all participants in the National Assessment of the Potential Consequences of Climate Variability and Change. We identified five categories of health outcomes that are most likely to be affected by climate change because they are associated with weather and/or climate variables: temperature-related morbidity and mortality ; health effects of extreme weather events (storms, tornadoes, hurricanes, and precipitation extremes) ; air-pollution-related health effects ; water- and foodborne diseases ; and vector- and rodentborne diseases. We concluded that the levels of uncertainty preclude any definitive statement on the direction of potential future change for each of these health outcomes, although we developed some hypotheses. Although we mainly addressed adverse health outcomes, we identified some positive health outcomes, notably reduced cold-weather mortality, which has not been extensively examined. We found that at present most of the U.S. population is protected against adverse health outcomes associated with weather and/or climate, although certain demographic and geographic populations are at increased risk. We concluded that vigilance in the maintenance and improvement of public health systems and their responsiveness to changing climate conditions and to identified vulnerable subpopulations should help to protect the U.S. population from any adverse health outcomes of projected climate change. Key words: air pollution, climate change, flooding, global warming, heat waves, vectorborne diseases, waterborne diseases. Environ Health Perspect 108:367-376 (2000) . [Online 15 March 2000]

http://ehpnet1.niehs.nih.gov/docs/2000/108p367-376patz/ abstract.html

Address correspondence to J.A. Patz, Program on Health Effects of Global Environmental Change, Department of Environmental Health Sciences, Johns Hopkins University School of Hygiene and Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA. Telephone: (410) 955-4195. Fax: (410) 955-1811. E-mail: jpatz@jhsph.edu

*Co-chairs.

Special thanks to the U.S. EPA Global Change Research Program Director, J.D. Scheraga. We thank J.C. Beier, B. Boutin, R. Calderon, W.R. Daley, D. Dockery, D. Driscoll, D. Easterling, D. Engelberg, D.A. Focks, G. Greenough, M. Habib, W. Jakubowski, L. Kalkstein, T. Karl, E. Lipp, M. Lipsett, M. Mirabelli, R. Nasci, E. Noji, D. Paxman, W. Reisen, J. Riad, J. Schwartz, J. Selanikio, B.H. Sherman, R. Shope, A. Spielman, M. Wilson, and W. Yap. We also thank H. Curriero for report preparation and A. Redmon-Norwood for editing assistance.

This health sector assessment was sponsored by the U.S. Environmental Protection Agency Global Change Research Program as part of the overall U.S. National Assessment of the Potential Consequences of Climate Variability and Change (cooperative agreement CR 827040) .

Received 15 November 1999 ; accepted 31 January 2000.