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4 In 7 This is may be a 8 Temperatures above 4 The most severe form is heat and when the worker is sus- 9 11 Saberi, MD, MPH, Even weather events that are not ´ Rising temperatures and increased Heat-related illnesses result as a mal- 10 F have been shown to decrease produc- 8 Volume 60, Number 2, February 2018 quality, and allergen sensitization. Closely related atmosphericstratospheric changes ozoneresult affecting in concentration increased exposure(UV) also to ultraviolet effectsthat and accompanymore heat carbon severe ground-level and dioxidepollution. or emissions cause ambient air stroke, in which thedown, body is resulting unable in tocoma, confusion cool seizures, and or death. possible Otherillnesses heat-related include heat exhaustion, heatcope, syn- heat cramps, and rhabdomyolysis. ceptible due to age,medications, pre-existing condition, obesity, or lifestyle. Workers exposed to extreme heatprone are to more accidentslower and productivity injuries duefogged and to safety have sweaty goggles,tion, palms, discomfort, and agita- fatigue. Heat and Ultraviolet Effects extreme on a world scale canheat-related result in fatalities lethal inclimate places provides little opportunity where for accli- the matization, for those working in hot environments. air pollution directly impact workerIncreased health. ambient temperatureserbate can the exac- risks of injury, illness, and death takes. 95 tivity and increase work injuries and mis- considerable under-estimate of the total,many as casesbecause are heat not interactsconditions with recognized to other as which working more such the likely cause to be of apportioned,heat death and increases because is the riskmon of conditions death such from as cardiovascularease com- dis- and chronic lung disease. function of the centralthe nervous system body’s and adaptationintense mechanisms heat. during 2013, the USreported Bureau that ofheat-related Labor thousands illnesses Statistics of occurmore each occupational than year 350 and civilianpened worker in deaths hap- themental past heat decade exposure. due to environ- JOEM 3 TATEMENT 1 S imate include heat- Occupational health e experience of trau- 3–5 HEALTH UIDANCE Direct health effects likely to impact It is important to characterize cli- Many working groups are suscepti- and therefore OEM providers should CHANGE ON WORKER 6 that maychange. occur Rising as temperatures,quality, reduced a and air resultimpact the extreme of healthindirectly of climate weather (Table 1). workers directly patterns and DIRECT IMPACTS OF CLIMATE essential part of ACOEM’s corecies, competen- workers duechanging to weather rising patternsrespiratory temperatures include and heat, effects from reduced air mate-related health hazardstive so mitigation that effec- can and be developed adaptation to protect workers’and strategies health safety by minimizingity. their Therefore, vulnerabil- thisand paper identifies indirect direct lenges climate-related among health workersresponsibilities chal- and of describesenvironmental the the medicine occupational (OEM)in and responding provider toThe these issues health discussed challenges. in this paper are an possess thespecifically core qualified skills togate address that and the make miti- worker impacts them health and of productivity. climate change on ing a disaster response,illness secondary stress to and th mental matic natural event, andtibility increased to suscep- vector-borne disease. (ACOEM) are uniquely suitedprotection to of promote thepopulations facing health these challenges. of US working ble toimpacts both of direct climatetype because and (eg, of outdoor indirectletes, workers, their wildland laborers, health firefighters) job ath- oring, underlying their health risks exist- (eg, respiratory illness, heart disease,health pregnancy). effects Direct due to cl related illness, respiratoryreduced disease air due quality, to andinduction; increased indirect allergy effectssecondary include to illness exposures encountered dur- care providers and the American CollegeOccupational of and Environmental Medicine ACOEM G 2 , under the aus- This change has 1 2017 American College of Occupa- Tee Guidotti, MD, MPH, Ronda McCarthy, MD, MPH, Margaret Cook-Shimanek, MD, MPH, William B. Perkison, MD, MPH, Gregory D. Kearney, DrPH, MPH, Poune ß Treatment and Prevention of Climate Change-Related Health Problems Currently, the impact of climate on ver the lastchanges century, have global resulted climate in increased Mellisa A. Pensa, MD, MPH, and Ismail Nabeel, MD, MPH, ACOEM Task Force on Climate Change Elk Grove Village, IL 60007 ([email protected]). ments to disclose any potentialests, competing inter- which areemphasizes carefully that the considered. judgments expressed ACOEM represent herein the best available evidenceof at publication the and time shalltion be of considered ACOEM the and posi- notof the contributing individual opinions authors. ACOEM, 25 Northwest Point Blvd, Suite 700, Illinois. Task Force on Climatepices Change ofUnderserved the Occupational Environmentaltions, Health reviewed Populations by andProcedures, sec- and the the Public Committee Positions,by and on approved the Policy, ACOEMrequires Board all substantive of contributors Directors. to its ACOEM docu- Environmental Medicine, Elk Grove Village, tional and Environmental Medicine Responsibilities of the Occupational and Environmental Medicine Provider in the Copyright e76 The authors declare noAddress conflicts correspondence to: of Marianne interest. Dreger, MA, This position paper was developed by the ACOEM From the American College of Occupational and focuses on North American workers health effects that may occur as adescribes the result responsibilities of of the climate OEM provider change and in responding to these health challenges. O Occupational and(OEM) providers are at the environmental forefronthealth of emerging issues medicine pertaining toincluding climate change, working and must populations be prepared to recognize, respondchange-related to, health and effectsguidance in mitigate document from workers. climate the This of American College Occupational and Environmental Medicine Workers are uniquely susceptiblehazards to imposed the health by environmental changes. DOI: 10.1097/JOM.0000000000001251 the health andthe productivity United of States workershigh has in concern. not This been paper primarilyon an focuses North area American of workers health effects events including heat waves, droughts, wildfires, and flooding. frequency and intensity of adverse weather impacted all regionsresulting of in loss the of life and United economic coststhe States, in billions of dollars. Furtherthe costs include loss of workerditures productivity associated and with expen- relocation. Copyright © 2017 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited Copyright © 2017 American College of Occupational and Environmental Medicine.

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TABLE 1. Impacts of Climate Change on Worker Health

Exposure Pathway/ Potential High-Risk ACOEM Core Climate Event Mechanism Health Effect Occupational Groups Competencies

Heat waves Increased temperatures, Heat stress related morbidity Outdoor trades workers, Environmental health, hazard hotter than usual and mortality athletes, firefighters, recognition, evaluation, and summers and milder military, migrant farm control, OEM-related law and winters workers. Older, isolated regulations, work fitness and or poorer workers more disability management, OEM at risk for heat stress- population management, health related illness; workers and productivity, OEM-related without access to air management and administration, conditioning. clinical OEM Solar ultraviolet radiation Increased solar UV Cataracts, cutaneous Outdoor workers, Environmental health, hazard (concomitant risk radiation from ozone- malignant melanoma, construction trades, recognition, evaluation, and affecting many of depleting gases in the immune system and agricultural workers, control, public health, same populations) atmosphere (overlap sunburn military, displaced surveillance, and disease with greenhouse workers, courier and prevention, OEM-related gases) delivery service workers management and administration, clinical OEM Ambient air pollution Increases in carbon Respiratory disease Older workers and/or those Environmental health, hazard emissions, particulate exacerbation including with pre-existing recognition, evaluation, and matter, airborne asthma, COPD, allergic respiratory illness control, toxicology, public aeroallergens and rhinitis, bronchitis; health, surveillance, and disease other respiratory premature death, acute prevention, health and exposures from and chronic productivity wildfires and ground- cardiovascular level ozone Flooding Increased variation, Drownings, injuries, skin Outdoor workers, first Environmental health, public health, geographic and infections, mosquito, tick responders surveillance, and disease seasonal distribution and other vector borne prevention, disaster preparedness of vectors diseases and emergency management, OEM-related management and administration, hazard recognition, evaluation, and control, clinical OEM Vector- and waterborne Extreme weather events; Mosquito, tick, and other Sanitation workers, food- Hazard recognition, evaluation, and disease changing vector-borne diseases, animal production control, clinical OEM, temperatures affect waterborne disease workers, military- environmental health vector, pathogen, and deployed populations, host habitats; farmers, foresters, increased variation in landscapers, laborers, geographic and construction and forestry seasonal distribution workers, international aid of vectors workers, pregnant women, or those of childbearing age, emergency responders Mental health and well- Increased exposure to Mental, behavioral health Displaced workers, first Environmental health, OEM-related being traumatic events such and stress disorders responders, those with a law/regulations, disaster as natural disasters history of depression or preparedness and emergency anxiety management, health and productivity, OEM-related management and administration

COPD, chronic obstructive pulmonary disease; OEM, occupational and environmental medicine; SES, socioeconomic status; UV, ultra violet. Adapted and modified from Patz et al.5

It is generally assumed that heat example, environmental heat exposure in UV radiation protection remains an impor- stress is more of a threat in the general workers may be more hazardous than in tant occupational health measure for many population than in working populations other situations due to the inhibition of the of the same workers at highest risk for heat because the general population has a higher normal behavioral response to heat stress.8 stress. Outdoor workers are also at frequency of individuals with susceptibili- Vulnerable populations such as aging, preg- increased risk for a variety of eye diseases ties and some lack access to cool environ- nant, and migrant workers and workers with from UV radiation exposure, such as cata- ments. However, workers often have less chronic illnesses may be at more risk.12 racts and macular degeneration.13 control over their work environment and Atmospheric changes causing cli- OEM providers are uniquely posi- activities than the general community. In mate change and stratospheric ozone deple- tioned to monitor workers for climate- construction work, courier delivery, fire- tion share many of the same chemical related health hazards, educate employers fighting, and prolonged outdoor work, for drivers and present coupled risks. However, and workers on heat stress and UV radiation

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exposure prevention, and evaluate and treat OEM providers must be able to precipitation or water-related events.28,29 heat-related injury and illness. In most implement medical surveillance programs OEM providers must possess the core states, at-risk workers rely on the Occupa- that address the needs of specific job classes knowledge to identify environmental con- tional Safety and Health Administration and job vulnerabilities for those that may be ditions that lead to nasopharyngeal and (OSHA) General Duty Clause to provide affected by changes in air quality. The respiratory conditions such as allergy sen- regulatory protection from extreme heat as spectrum of organ systems impacted by sitization.6 required by the Occupational Safety and degraded air quality ranges from cardiovas- Health Act of 1970. With increasing ambient cular to reproductive. The OEM provider is INDIRECT IMPACTS OF temperatures and heat waves, the OEM pro- well prepared to attend to this range of CLIMATE ON WORKER vider should be prepared to recommend heat potential health impacts when designing HEALTH stress medical surveillance programs and or implementing a surveillance system in Indirect health impacts of climate are prevention/adaptation strategies for occupa- order to include at risk workers. The OEM those experienced due to natural disasters, tional heat stress, and to evaluate and treat provider also must be able to identify, 6 floods, and displacement. These effects heat-related illnesses. The National Insti- diagnose, and treat occupational or envi- include disaster zone exposures, stress tute for Occupational Safety and Health ronmental diseases that result from air pol- and mental health impacts, and waterborne (NIOSH) Criteria for a Recommended Stan- lution and manage work restrictions and and vector-borne diseases. dard: Occupational Exposure to Heat and accommodations. In addition, the OEM Hot Environments is an important resource provider must be able to identify and man- Disaster Zone Exposures for OEM clinicians wanting more informa- age health effects associated with air qual- 14 Disaster can be defined as the dis- tion on managing at risk workers. ity and understand when it is appropriate to ruption of a system in which the demand to obtain environmental monitoring to mea- respond exceeds the system’s resources. In Air Quality sure airborne toxins associated with climate 6 2005, the United States experienced its Climate change, UV radiation expo- change. second largest and most expensive natural sure due to ozone depletion, ambient air Allergic Sensitization disaster, Hurricane Katrina. This disaster pollution, and transport of air toxins are all and Hurricanes Sandy and Irene that fol- related by complex atmospheric physical Incidence and severity of occupa- lowed, provided responding local leader- and chemical phenomena. Although usu- tional respiratory and allergic disorders ship with the experience to give ally considered separately, each has com- are projected to increase secondary to cli- 23 recommendations for improved disaster plicated interactions, interdependencies, mate change. A survey of members of the management and emergency prepared- and common origins in the drivers of atmo- American Thoracic Society indicates a 30 4 ness. Experienced professionals recom- spheric change. Air quality for working strong majority opinion that increased mor- mend five categories on which to populations is degraded by many drivers of bidity from respiratory and allergic disease 24 concentrate resources for responding to atmospheric change: heat waves, increased is already evident clinically. future natural disasters: (1) planning and global temperatures, potential recurring Intensification of seasonal variations evaluation; (2) education and training; (3) increases in UV radiation, and extreme and extreme weather patterns contribute to 15 building relationships; (4) disaster and weather. In cities where there are large allergen exposure. Contributing factors behavior health; and (5) financial prepared- concentrations of workers, the combination include increased temperature, carbon ness.31 OEM core competency training par- of the urban heat island effect with urban air dioxide, and ozone. For example, ragweed allels these recommendations for improved pollution, compounds the effects of climate season length, production, and amount of 16 disaster management and are listed in change. major ragweed allergens have increased in Table 1 by event.6 The trained and experi- The main categories of air pollutants response to elevated ambient levels of car- 25,26 enced OEM physician is qualified to help that have occupational implications are bon dioxide. Furthermore, thunder- prepare employers and workers for disaster- ground-level ozone, polycyclic aromatic storms and floods are associated with zone exposures related to extreme weather hydrocarbons, pesticides, and allergens. increased pollen dispersion. Several aspects changes, flooding, heat waves, and wild- Ozone is temperature dependent—ambient of the pollen season are influenced by 17 fires by developing protocols for mitigation levels rise with increasing heat. Ground- climate: earlier and longer flowering sea- of a disaster incident at the worksite or in level ozone as well as particulate matter sons, increased pollen production, and the community in general. Also, the OEM have well established correlations with increased potency of pollen. Increased provider can be consulted to establish emer- increased incidence of cardiovascular and exposure to air pollutants damages natural gency procedures and protocols for the respiratory disease, and premature airway protective mechanisms. As a result, 18,19 clinical management of individuals death. Workers in proximity to com- the immune cells are more exposed to involved in disaster incidents and disaster bustion sources are at higher risk for expo- inhaled allergens and irritants, and so indi- zone exposures.15 Additional training in sure to polycyclic aromatic hydrocarbons viduals are at higher risk of sensitization.27 20 disaster management and emergency pre- (PAHs). While the most significant health Flooding as a result of hurricanes, paredness competencies can be found on end-point of PAHs is cancer, there may also storms, and other extreme precipitation the Federal Emergency Management be non-cancerous effects on the respiratory, events encourages allergen growth. This Agency web site.32 This training can be gastrointestinal, renal, and dermatological can result in new onset or worsening of adapted to all disasters and emergencies systems.21 Outdoor air pollution is a Group respiratory disorders such as allergic dis- from the worksite to the national level. I carcinogen for lung and other types of orders and asthma.28 Ambient ozone levels cancer according to the International also play an important role in triggering Agency for Research on Cancer.22 Workers asthmatic events. Stress and Mental Health subjected to pesticides and other dermal The OEM provider can identify Related Impacts pollutants may experience increased expo- those who have compromised health and/ Studies have shown that the mental sure because of amplified dermal uptake or work performance due to allergy sensiti- health of workers in susceptible occupa- during hyperthermic conditions due to zation. Some contaminated air settings, tions can be significantly affected by sweating and increased blood flow.20 such as indoor air, may be a result of increasing weather fluctuations associated

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Copyright © 2017 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited JOEM Volume 60, Number 2, February 2018 Climate Change-Related Health Problems

with changes in climate. A positive associ- specific to the recognition and management the outdoors or in the field who are potentially exposed to the extreme tem- ation has been found between suicide rates of vector-borne and waterborne disease are 37,50 among farmers and the severity of drought listed in Table 1. peratures. conditions.33,34 First responders are also In the face of extreme weather 2. Quickly identify employees with acute susceptible to the effects of natural disas- events, the OEM provider must anticipate and chronic cardiovascular and respira- ters. In August 2005, Hurricane Katrina and address the health impacts of vector- tory illnesses within the organization devastated the New Orleans area resulting borne and waterborne pathogens on who will be significantly affected by in hundreds of deaths and the evacuation of affected workers. Given the potential for increasing temperature and worsening entire communities. A significant number climate-related changes in exposure risk to air quality, an increase in ozone, particulate matter, and high pollen of first responders who worked in the after- workers, providers must regularly access 16,37,51 math of this storm reported new onset of current resources for up-to-date vector count. depression and posttraumatic stress disor- and disease information.14,40–46 When the 3. Help in devising a plan of action with der.16,35,36 The number of first responders risk cannot be completely eliminated, OEM the employer to mitigate potential reporting mental health disorders was even providers need to recommend worksite pre- adverse effects before, during and after flooding events and disruption of essen- more significant among those who devel- cautions which may include the use of 37,52 oped respiratory symptoms, had their own personal protection equipment, application tial infrastructure. family members affected by the storm, or of mosquito or tick repellant, and/or alter- 4. Provide effective guidance to employers were working in isolated duty stations.16,36 ing work hours to minimize exposure. about seasonal activity and address the increasing risk of vector-borne disease It will be important to guide employ- These actions are also relevant in a 37,53 ers to have additional mental health resour- disaster setting. among the working population. ces available for their workforce during OEM providers are clinically 5. Expedite clinical management and iso- increasingly frequent severe weather trained to take thorough occupational lation of employees affected by food- events, and that the OEM provider will and environmental histories, allowing borne illnesses and work with the employer in protecting the population be able to rapidly deploy these services them to screen and characterize risk for 37,54 for the employees. The ACOEM core com- climate related health exposures. In a set- served by these individuals. petencies in the section on Psychiatry, pro- ting of increased exposure risk, the OEM 6. Deliver support to the employees at risk vide a comprehensive description of the provider is prepared to identify, manage, for mental illness due to disasters, loss, fundamental skill set that will enable the treat, or appropriately refer for treatment and migration by providing more comprehensive programs through their OEM provider to effectively deal with these those with exposures resulting in disease. 37,55 challenges.6 Travel medicine OEM providers follow employment. shifting patterns of vector-borne disease 7. Help with communication strategies Waterborne and Vector-Borne when making decisions about required during climate change related scenarios. Diseases workforce prophylaxis. Exposure pathways included extreme Climate associated shifts in seasonal Beyond the individual clinical inter- heat, poor air quality, reduce food and and geographic patterns are expected to action OEM providers are additionally water quantity, concomitant UV exposure, changes in infectious agents and increase the frequency of certain tick-, skilled at interpreting and communicating 37 mosquito-, and flea-borne diseases. Cli- risk on a population level, which is critical population displacement. mate change influences the abundance for certain weather related health events. and distribution of vectors and animal res- Local public health OEM professionals are SUMMARY AND ervoirs, the percentage of infected vectors, also trained to develop and implement vec- CONCLUSIONS presence of vector habitats, and human tor-borne disease surveillance, prevention, Workers are uniquely susceptible to behaviors that increase frequency of con- and control programs.47,48 These activities the health hazards imposed by environ- tact.37 Outdoor workers are particularly may entail collaboration with other clinical mental changes. Direct hazards include vulnerable to these climate-related health specialties and public health professionals. heat waves, reduced air quality, and aller- 16,38 effects. Contact with contaminated OPERATIONAL SUPPORT- gen sensitization. Indirect health hazards soil, water, animals, and infrastructure also include disaster zone exposures, stress makes certain working populations more RELATED RESPONSIBILITIES and mental health impacts, and water- susceptible to pathogenic bacteria expo- OF AN OEM PROVIDER borne and vector-borne disease. The sure, including those in fisheries, agricul- OEM providers must understand the OEM provider possesses the core compe- ture, sanitation, and animal husbandry.20 direct and indirect impacts of climate tencies needed to recognize risks and Vector-borne and non-vector-borne dis- change on working individuals and act mitigate hazards, as well as recognize eases create an unhealthy and less physi- within an organization to mitigate health and respond to health effects in the occu- cally capable workforce, contribute to risks as well as respond to health crises.20 pational environment. OEM providers are decreased local work productivity with The OEM provider’s skills encompass clin- called to be on the forefront of emerging associated economic consequences, and ical case management, comprehensive health issues pertaining to working pop- have the potential for lingering health knowledge of the workplace setting, and ulations including climate change. The effects after resolution of acute illness.39 providing effective guidance to employers competent OEM provider should address OEM providers should, where appli- in matters involving environmental health- individual and organizational factors that cable, anticipate and recognize how shifting related issues.6,15,49 The following list sum- impact the health and productivity of patterns of vector and waterborne disease marizes the responsibility of the OEM pro- workersaswellascreatepoliciesthat might affect worker populations, and are vider in climate-related organizational ensure a healthy workforce.6 Therefore, familiar with prevention, evaluation, treat- worker health issues: OEM providers must be prepared to rec- ment, and referral for such conditions, ognize, respond to, and mitigate cli- including notification of appropriate public 1. Provide guidance to the employers on mate change-related health effects health agencies. Core competencies how to protect working populations in in workers.

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REFERENCES 19. Jerrett M, Burnett RT, Pope 3rd CA, et al. Long- Health in the United States: A Scientific Assess- term ozone exposure and mortality. N Engl J ment. Washington DC: US Global Change 1. Intergovernmental Panel on Climate Change Med. 2009;360:1085–1095. Research Program; 2016. Available at: http:// (IPCC) Core Writing team. In: Pachauri RK, 20. Applebaum KM, Graham J, Gray GM, et al. An dx.doi.org/10.7930/J0BZ63ZV. Accessed Decem- Meyer LA, editors. Climate Change 2014: Syn- ber 6, 2017. thesis Report. Geneva, Switzerland: IPCC; overview of occupational risks from climate 2013. change. Curr Environ Health Rep. 38. Schulte PA, Bhattacharya A, Butler CR, et al. 2016;3:13–22. Advancing the framework for considering the 2. Ruth M, Weston RF, Coelho D, Karetnikov D. effects of climate change on worker safety and The US Economic Impacts of Climate Change 21. World Health Organization (WHO). Review of Evidence on Health Aspects of Air Pollution: health. J Occup Environ Hyg. 2016;13:847– and Costs of Inaction. College Park, MD: Uni- 865. versity of Maryland; 2007. REVIHAAP Project: Technical Report. Copen- hagen, Denmark: WHO Regional Office for 39. Bennett CM, McMichael AJ. Non-heat related 3. Guidotti TL. Occupational medicine in time of Europe; 2013. impacts of climate change on working popula- crisis. In: Ciottone GR, editor. Ciottone’s tions. Glob Health Action. 2010;3. Disaster Medicine. 2nd ed., New York, NY: 22. International Agency for Research on Cancer Elsevier; 2015. p. 23. (IARC). Air Pollution and Cancer: IARC Sci- 40. Center for Disease Control and Prevention entific Publication No. 161. Geneva, (CDC). Climate Effects on Health; 2016. Avail- 4. National Institute for Occupational Safety and Switzerland: World Health Organization Press. able at: http://www.cdc.gov/climateandhealth/ Health. Impact of Climate on Workers [web effects/. Accessed December 6, 2017. site]. Available at: http://www.cdc.gov/niosh/ 23. US EPA. National Air Quality: Status and topics/climate/how.html. Accessed October 2, Trends of Key Air Pollutants [web site]; 41. Center for Disease Control and Prevention (CDC). 2017. 2016. Available at: https://www.epa.gov/air- Dengue; 2016. Available at: http://www.cdc.gov/ trends. Accessed October 2, 2017. dengue/index.html. Accessed December 6, 2017. 5. Patz JA, McGeehin MA, Bernard SM, et al. The potential health impacts of climate variability 24. Sarfaty M, Bloodhart B, Ewart G, et al. Ameri- 42. Center for Disease Control and Prevention (CDC). and change for the United States: executive can Thoracic Society member survey on climate Malaria; 2016. Available at: http://www.cdc.gov/ summary of the report of the health sector of change and health. Ann Am Thorac Soc. malaria/index.html. Accessed December 6, the US National Assessment. Environ Health 2015;12:274–278. 2017. Perspect. 2000;108:367–376. 25. Ariano R, Canonica GW, Passalacqua G. Pos- 43. Center for Disease Control and Prevention (CDC). 6. Cloeren M, Gean C, Kesler D, et al. American sible role of climate changes in variations in West Nile Virus; 2016. Available at: http:// College of Occupational and Environmental pollen seasons and allergic sensitizations during www.cdc.gov/westnile/. Accessed December 6, Medicine’s Occupational and Environmental 27 years. Ann Allergy Asthma Immunol. 2017. Medicine Competencies-2014: ACOEM OEM 2010;104:215–222. 44. Center for Disease Control and Prevention Competencies Task Force. J Occup Environ 26. Ziska L, Knowlton K, Rogers C, et al. Recent (CDC). Zika Virus; 2016. Available at: http:// Med. 2014;56:e21–e40. warming by latitude associated with increased www.cdc.gov/zika/. Accessed December 6, 7. Smith KR, Woodward A, Lemke B, et al. The length of ragweed pollen season in central 2017. last Summer Olympics? Climate change, North America. Proc Natl Acad Sci USA. 45. US Environmental Protection Agency (EPA). Cli- health, and work outdoors. Lancet. 2016;388: 2011;108:4248–4251. mate Change Indicators: Lyme Disease. Climate 642–644. 27. Royal Society. Ground-Level Ozone in the 21st Change Indicators; 2016. Available at: http:// 8. Gubernot DM, Anderson GB, Hunting KL. The Century: Future Trends, Impacts and Policy www.epa.gov/climate-indicators/climate-change- epidemiology of occupational heat exposure in Implications. London, England: The Royal indicators-lyme-disease. Accessed December 6, the United States: a review of the literature and Society; 2008, 132. 2017. assessment of research needs in a changing 28. Barbeau DN, Grimsley LF, White LE, El-Dahr 46. US Environmental Protection Agency (EPA). Cli- climate. Int J Biometeorol. 2014;58:1779– JM, Lichtveld M. Mold exposure and health mate Change Indicators: West Nile Virus. Climate 1788. effects following hurricanes Katrina and Rita. Change Indicators; 2016. Available at: http:// 9. Platt M, Vicario S. Heat illness. In: Marx JA, Annu Rev Public Health. 2010;31:165–178. www.epa.gov/climate-indicators/climate-change- editor. Rosen’s Emergency Medicine. 7th ed., 29. WHO. WHO Guidelines for Indoor Air Quality: indicators-west-nile-virus. Accessed December 6, Philadelphia, PA: Elsevier; 2009 . pp. 1882– Dampness and Mould. Copenhagen, Denmark: 2017. 1889. WHO Regional Office for Europe; 2009. 47. California Department of Public Health. Vector- 10. Zivin JG, Neidell M. Temperature and the 30. Rogers B, Lawhorn E. Disaster preparedness: Borne Disease Section; 2016. Available at: allocation of time: implications for climate occupational and environmental health profes- http://www.cdph.ca.gov/programs/vbds/Pages/ change. J Labor Econ. 2014;32:1–26. sionals’ response to Hurricanes Katrina and default.aspx. Accessed December 6, 2017. 11. Sherman R, Copes R, Stewart RK, Dowling G, Rita. AAOHN J. 2007;55:197–207. 48. Virginia Department of Health. Vector-borne Guidotti TL. Occupational death due to heat 31. Craddock HA, Walsh L, Strauss-Riggs K, Schor Disease Control; 2015. Available at: http:// stroke: report of two cases. CMAJ. K. From leaders, for leaders: advice from the www.vdh.virginia.gov/epidemiology/DEE/ 1989;140:1057–1058. lived experience of leaders in community health Vectorborne/. Accessed October 2, 2017. 12. Woodward A, Smith KR, Campbell-Lendrum sector disaster recovery after Hurricanes Irene 49. American College of Occupational and Envi- D, et al. Climate change and health: on the latest and Sandy. Disaster Med Public Health Prep. ronmental Medicine. Role of Occupational and IPCC report. Lancet. 2014;383:1185–1189. 2016;10:623–630. Environmental Medicine Physicians in Emer- gency Preparedness and Response (Policy and 13. World Health Organization (WHO). Climate 32. Federal Emergency Management Agency (FEMA). National Incident Management Sys- Practice Statement); 2010. Available at: http:// change and human health-risks and responses; www.acoem.org/OEMPhysicians_Emergen- 2003. Available at: http://www.who.int/global- tem (NIMS); 2015. Available at: https://training.fema.gov/nims/. Accessed October 2, 2017. cyPreparedness.aspx. Accessed October 2, change/climate/summary/en/index7.html. 2017. Accessed October 2, 2017. 33. Hanigan IC, Butler CD, Kokic PN, Hutchinson MF. Suicide and drought in New South Wales, 50. Balbus J, Crimmins A, Gamble JL, et al. Intro- 14. NIOSH. Criteria for a Recommended Standard: duction: climate change and human health. The Occupational Exposure to Heat and Hot Envi- Australia, 1970–2007. Proc Natl Acad Sci USA. 2012;109:13950–13955. Impacts of Climate Change on Human Health in ronments; 2016. Available at: http:// the United States: A Scientific Assessment. www.cdc.gov/niosh/docs/2016-106/. Accessed 34. Smith DI, Hutchinson MF, McArthur RJ. Cli- Washington, DC: US Global Change Research October 2, 2017. matic and Agricultural Drought: Payments and Program; 2016: 26–42. Policy. Australia: Canberra; 1992. 15. Guidotti TL. Health and Sustainability: An 51. Fann N, Brennan T, Dolwick P, et al. Air quality Introduction. New York: Oxford University 35. Tak S, Driscoll R, Bernard B, West C. Depres- impacts. The Impacts of Climate Change on Press; 2015. sive symptoms among firefighters and related Human Health in the United States: A Scientific 16. Schulte PA, Chun H. Climate change and occu- factors after the response to Hurricane Katrina. Assessment. Washington, DC: U.S. Global pational safety and health: establishing a pre- J Urban Health. 2007;84:153–161. Change Research Program; 2016:69–98. liminary framework. J Occup Environ Hyg. 36. West C, Bernard B, Muelle C, Kitt M, Driscoll 52. Bell JE, Herring SC, Jantarasami L, et al. 2009;6:542–554. R, Tak S. Mental health outcomes in police Impacts of extreme events on human health. 17. Jacob DJ, Winner DA. Effect of climate change personnel after Hurricane Katrina. J Occup The Impacts of Climate Change on Human on air quality. Atmos Environ. 2009;43:51–63. Environ Med. 2008;50:689–695. Health in the United States: A Scientific Assess- 18. Brook RD. Cardiovascular effects of air pollu- 37. Crimmins A, Balbus JL, Gamble CB, et al., Eds. ment. Washington, DC: US Global Change tion. Clin Sci (Lond). 2008;115:175–187. The Impacts of Climate Change on Human Research Program; 2016:99–128.

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53. Beard CB, Eisen RJ, Barker CM, et al. Vector- 54. Ziska L, Crimmins A, Auclair A, et al. Food 55. Dodgen D, Donato D, Kelly N, et al. Mental borne diseases. The Impacts of Climate Change safety, nutrition, and distribution. The Impacts health and well-being. The Impacts of Climate on Human Health in the United States: A of Climate Change on Human Health in the Change on Human Health in the United States: Scientific Assessment. Washington, DC: US United States: A Scientific Assessment. Wash- A Scientific Assessment. Washington, DC: US Global Change Research Program; 2016: ington, DC: US Global Change Research Pro- Global Change Research Program; 2016: 129–155. gram; 2016:189–216. 217–245.

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