From radical roots in community politics, Howard Frumkin has risen to high office. In 1982, as a newly minted doctor specializing in occupational health, he trolled the union halls of Philadelphia, instructing listeners on ways to protect themselves from workplace hazards. His mission these days is no less bold: to protect the health of Americans from the ravages of climate change. On leave from his position as chairman of the department of environmental and occupational health at Emory University's Rollins School of Public Health, he now directs the National Center for Environmental Health's Agency for Toxic Substances and Disease Registry at the Centers for Disease Control. At his office in traffic-choked Atlanta, he spoke to Josie Glausiusz of his plans for an overhaul of government action on climate crises.
Tell us a bit about your early career.
I went to Philadelphia for med school and got involved in some community-based occupational health work at the time. It was clear then that the communities around factories could be affected by conditions in the factories, that pollutants don't respect factory walls. Plumes of smoke move from factories or power plants to nearby communities, and when chemicals are dumped on factory grounds, they can trickle down and get into the groundwater.
In 1990 I came down here to Atlanta. I worked in small towns where factories or hazardous waste sites threatened people's health, and I found it a great joy to try to help people respond. I had a bit of an epiphany almost a decade ago. As I drove around Atlanta interminably, on roads that no kid could ever walk or bike on, and as I looked at these obese people, I realized that as important as chemical threats are to people's health, the built environment poses different kinds of hazards that are probably as important, if not more so.
You've described climate change as "perhaps the largest looming public health challenge that we face." Why do you say that?
Climate change is global in scale. It is vast in its potential impact and it cuts across almost every field in public health, from infectious disease to chronic disease to injuries. And in many senses it's unpredictable, which means we have that much more to prepare for. This is really a problem that is unprecedented in its scope.
What are the impending crises for which we have to prepare?
The potential of climate change to increase severe weather events is alarming. There are heat waves, flooding. We expect air pollutants -- in particular, ozone -- to increase with warming temperatures, and ozone is a trigger of asthma attacks. Airborne allergens will be a potentially greater problem because certain plants that produce spores and allergens do very well with rising temperatures. We have recent evidence that poison ivy, for example, grows more exuberantly and secretes a more dangerous toxin, urushiol, under high carbon dioxide scenarios.
Which diseases are you most concerned about?
We've seen rapidly accumulating evidence of the spread of infectious diseases. Climate conditions in much of the United States are already sufficient to support the mosquitoes that transmit dengue and malaria. Other infections are surprising, like Cryptococcus gatti, an organism that has shown up in the Pacific Northwest, having leaped from Central America. It's a fungal infection that affects the nervous system, and it can be fatal. It occupies a rainforest niche, and there is some evidence that the slight warming of the Pacific Northwest is what created the expanded habitat for that organism.
With heavier rainfalls, you end up having heavily contaminated water coming into municipal treatment plants from raw sewage. We have good evidence, from doing surveillance over several years, of outbreaks of diarrheal disease that are associated with prior severe weather events.
What else keeps you up at night?
The occurrence of severe heat days is increasing, and heat waves are bad for health. We also have populations becoming increasingly concentrated in coastal areas. These are vulnerable populations because of the potential for sea-level rise. We now know that after disasters such as Katrina, one of the most serious, long-lasting impacts is on mental health. The displacement that people suffered, the destruction of their property, the uprooting of their families and friends -- these are all very traumatic. So is living in the shadow of a severe threat.
You've called Hurricane Katrina "the major environmental health disaster of our time." How did it change your thinking?
The devastation in New Orleans was like nothing I had ever seen. It was impossible not to think that the combination of a lot of people living and working in a low-lying coastal area, in a region where major hurricanes are expected to become more common, could presage further such disasters. It was also clear that we as a nation weren't prepared to respond. Government agencies weren't coordinated enough in their responses. We didn't have the material, equipment, and people where they were needed. So it underlined the importance of diligent efforts in public health preparedness.
We hear a lot these days about preventing climate change. But what about adapting to it -- since it seems to be inevitable?
To start off, collecting good data is absolutely essential to public health. We do a lot of that already. The Centers for Disease Control, for example, tracks the occurrence of infectious diseases across the country. But we also need to get different kinds of databases to talk with each other. We have environmental data collected mostly by the Environmental Protection Agency, we have health data collected by the CDC and by HMOs, we have demographic data collected mostly by the Bureau of the Census. Getting them to integrate with each other -- so that we can determine if there is an association between, say, changes in rainfall and changes in ecosystem conditions and health -- is the big challenge.
Is the problem just coordinating the data we have, or do we also need more scientific research?
We need to develop methods to model and forecast disease and mortality risks. Then there's a research agenda that has to do with protecting the public. One other thing: Climate change, although it's a global phenomenon, plays out on a local and regional scale. That means the research is going to be carried out simultaneously at many places across the country, and we need a much larger cadre of people to do that. One of our most important jobs is training the next generation of public health officials so they can tackle all of these climate change challenges.
How about education? What do you tell the public to do?
Survey data show that climate change is becoming a higher and higher priority for Americans. Part of what we have to do is provide good information. We need messages that are informative but not frightening. We need to create constructive engagement, hopefulness, and helpful behaviors, and not create despair and hopelessness and disengagement. One of the key messages is that this is a problem we can tackle.
Can you explain what you mean by creating helpful behaviors?
We can show people that some of the things we need to do to address climate change, we also need to do for other reasons. We're a sedentary and overweight society, so here at the CDC we encourage more walking and bicycling. That happens to be a perfect response to climate change as well, because it helps to reduce greenhouse gas emissions from the transportation sector. And by the way, if people walk and bike more, then they reduce the risk of being in a car crash. Car crashes are the major killer of young people in this country. And by the way, if they travel in cars less, then we also reduce air pollution.
So do you bike to work?
Not anymore. I did for 15 years when I worked at Emory, but now that I'm here I can't. I live seven miles away, which is a bikeable distance, but it's on suicidal roads. Now I drive my Prius instead.
-- Josie Glausiusz