Are Therapeutic Gardens Safe?

Legacy Family Birth Center Garden fountain / Brian Bainnson

Among hospital administrators, there seems to be a growing concern that therapeutic gardens can harbor diseases and spread them to those who have compromised immune systems. There was a case of Legionnaire’s disease spread through a water fountain, and soils can also be a source of some illnesses, but the fears are essentially unfounded, argued a trio of landscape architects at the Environments for Aging conference in Las Vegas. Good design and maintenance can eliminate the risks.

Leah Diehl, director of therapeutic horticulture, the Greenhouse at Wilmot Gardens, college of medicine at the University of Florida, said landscape architects should use “evidence-based knowledge to counter fears.” The evidence points to the incredible health benefits of being in nature. As such, the proven health benefits of “seeing, hearing, touching water” found in a fountain — such as reduced stress, lower heart rates and blood pressures, and an increased sense of tranquility — outweigh the near-zero chance of catching something. In terms of soils, yes, there are toxic bacteria that naturally occur in the mix, but there’s also mycobacterium vaccae, which some scientists think can play a role in reducing the effects of depression and anxiety.

For landscape architect Brian Bainnson, ASLA, “proper design can disrupt the process of infection.” For an infection to occur, there needs to be a pathogen, a susceptible host, and a mode of transmission. He argued that the Legionella bacteria, which causes Legionnaire’s disease, is more often spread through HVAC systems, spas, and jacuzzis than fountains. He said a “lack of maintenance allows the pathogen to grow.” He also said “there is no documented evidence of an infection from a healthcare garden.”

For a healing garden at the Legacy Emanuel Medical Center in Portland, Oregon, he designed a water feature with an integrated design team of physicians, therapists, hospital administrators, and maintenance workers to ensure there was no standing water when the fountain is off, and that patients can’t easily touch the water (see image at top). “Removing standing water is also good for vector control,” meaning it reduces places where mosquitoes can breed.

For another garden in the oncology ward of a hospital, Bainnson recommended administrators install Ultraviolet (UV) or flouridation systems to ensure the water is clean. It’s important in these instances to work with the maintenance staff to make sure those filters are tested and cleaned regularly.

For him, “the benefits of the fountains are too high, and they should outweigh any perceived risks.”

Diehl offered other examples: the Evanston Hospital in Illinois, which has a three-story fountain wall that ends in a pool, use sand filtration and chlorination and tests regularly to ensure the highest levels of water quality. And at the Glenbrook Hospital, also in Illinois, there is an entire water management team charged with infection control that tests the water in their fountains each month.

Glenbrook Hospital fountain / AIA

Jack Carman, FASLA, a landscape architect who focuses on senior care facilities, talked about the potential dangers of flora in therapeutic gardens, arguing that “not all plants are safe.” He said when using a plant in a healthcare setting, it’s important to know if “it’s toxic and highly injurious.”

It can get complicated because some plants may be only mildly toxic, or both medicinal or toxic depending on the interaction. For example, juniper has a medicinal use but its berries are toxic in large amounts. And some other plants are questionable, like daffodils, which are safe, but have toxic bulbs.

But there are some straight-out dangerous plants, like Foxglove, that shouldn’t be in therapeutic gardens. “Also, azaleas and rhododendrons don’t belong in a garden for Alzheimer’s patients.” Plants with extremely sharp edges, like hollies, or thorns, like rose bushes, obviously shouldn’t be found near where anyone is walking.

American-style Senior Living Comes to China

Cypress Gardens / China Senior Care

In China, traditional Confucian values dictate that children take care of their parents in their old age. It’s taboo to put your parents in a home. But from 1979 to 2015, Chinese parents could only have one child, which means there’s a whole generation of Chinese with four grandparents and two parents to take care of. To get around the taboo, China Senior Care, a company based in Shanghai and Hangzhou, launched a Western-style senior residential care facility. The idea seems to be if a facility doesn’t seem typically Chinese, perhaps the stigma associated with placing an elder in a home will be avoided.

At the Environments for Aging conference in Las Vegas, Jane Rohde, principal with Baltimore-based architecture firm JSR Associates and Jerry Smith, FASLA, design principal at SMITH | GreenHealth Consulting, walked us through the brand-new Cypress Gardens, in Fuyang, a suburb of Hangzhou. The project, which took eight years, is a private, 5-star senior care center, with just 64 beds, some for assisted living and some for memory care for patients with neuro-cognitive disorders. Each room rents for about $5,000 per month. There are community spaces, restaurants, a library, a theater for both relaxation and entertainment. In fact, it replicates a traditional American senior care facility model: the car-dependent, self-contained suburban facility.

China, like the West is rapidly aging. According to the Brookings Institution, there will be nearly 250 million people 65 and older in China by 2030. Today, Chinese seniors are essentially cared for during “extended hospital stays,” said Rohde. “It’s OK if it’s called VIP care. But it’s really out of the 1950s,” with rows of beds packed into one room. It will be interesting to see how the culture and current senior care models evolves as the country ages.

Cypress Gardens sits on a steep suburban site in the side of a mountain, which meant major grading challenges for Smith, and his design-build partner, Yumin Li, ASLA, with POD Design, Shanghai. To deal with the slopes, Smith built in layers of stone retaining walls in the form of step terraces.

Retaining walls and terraces / China Senior Care

A winding drive leads visitors up to the upper level entry. Smith said working with multiple Chinese contractors (two for the building and interior and one for the landscape) was a new learning experience — “just getting the drive and entrance to meet each other was a challenge.”

Many of the rooms have their own terraces. And surrounding the base of the 6-story building are a series of “outdoor rooms,” both public and private, where residents can be alone or socialize, or engage in physical activities like Tai Chi.

Cypress Gardens terraces and outdoor spaces / China Senior Care

Smith said the owners “didn’t want the character of the space to be Chinese. They wanted all new, all Western.” A water fountain on the south wall cascades into a pool, in an effort to achieve the “Bellagio Wow!,” the owners said they wanted.

Still, Smith delivered a tasteful landscape that manages to be packed with a mix of Chinese and Western landscape elements, from pagodas, to a bosque of gingko trees, and a labyrinth.

An outdoor room / China Senior Care

The pagodas mark the transition from the larger public spaces to the quiet memory care spaces, and can be “closed off for privacy and security as needed.”

Chinese children paying to have their parents stay at Cypress Gardens will see a “wonderful place with very high-end amenities,” Smith said. The facility opens in next month and it’s already mostly booked.

The Case for Humane Prisons

Construction of the amphitheater, Iowa Correctional Institution for Women / Iowa State University News Service

Long before anyone defined the field of environmental psychology, prisons were testing grounds for theories about how the design of the built environment could exert a physical and moral influence on people. In 19th-century England, the “Panopticon” prison design proposed a radial organization of brightly-lit and highly-visible cells around a dark central watch tower, to instill in prisoners the moral pressure and paranoia of constant social surveillance. In 21st-century Norway, prison buildings are separated by rolling hills and forests to promote frequent interaction with nature, and guards’ break rooms are cramped and uncomfortable to encourage them to spend their social time with inmates.

The distance between those approaches speaks to the struggle of societies to define the role of prisons as places for punishment or reform, for repentance or rehabilitation. It’s in this arena — fraught with moral undertones and with concerns about safety, accountability, justice, and injustice — that landscape architect Julie Stevens, ASLA, practices.

Stevens, an assistant professor at Iowa State University, has overseen three design-build projects at the Iowa Correctional Institution for Women, a medium-security prison in the small city of Mitchellville. Her approach to prison design is the same as for any community design: build relationships and recognize the humanity of the whole community, while honoring the voices of the most vulnerable — in this case the inmates, or “the women,” as Stevens referred to them most often during a lecture last week at North Carolina State University’s College of Design.

Stevens became involved at the women’s prison in 2011, when administrators were overseeing a $68 million expansion project that included no funding for design of the landscape. “The department of corrections wanted us to help them figure out where to put a few trees and shrubs,” Stevens said. “The prison was a lot of concrete, a lot of lawn, and essentially what happened is that a crew of about 12 women go out and start on one end of the prison with a cheap lawn mower and start mowing. And they push line after line after line, and when they get done, they start all over again.”

“We looked at this, and we thought, ‘We can do a lot better. We can make spaces more productive, more therapeutic.’”

The first design-build project was a limestone amphitheater flanked by two outdoor classrooms, a lawn mound, an aspen grove, and a constructed native prairie (see image above). Iowa State landscape architecture students designed the one-acre space with help from the women, and a team of students and inmates built the whole thing in one summer, using tons of donated gravel and limestone.

ASLA 2015 Student Community Service Award of Excellence, Landscapes of Justice. Students and inmates plant a tree, Iowa Correctional Institution for Women / Julie Stevens

During that first summer of construction, Stevens and her students noticed that prison staff tended to congregate at their cars after work, decompressing in the hot parking lot before driving home to their families. The next design-build project became a decompression deck for prison staff. When that was done, Stevens and her team created a healing garden to serve prisoners in the mental health unit. Now she’s building support for a design to serve the women and their children.

The projects are driven by the relationships Stevens has cultivated with prison administration, staff, and inmates. The designs accommodate administrators’ requests by promoting calm, creating functional spaces, and addressing security concerns — through open sight lines, for example, and the use of epoxy to keep limestone pieces fixed in place and unusable as weapons. The designs serve the women as daily spaces to gather and, during design and construction, as opportunities to build employable skills. But the effects are also more subtle.

“Some of these women have come from some pretty unthinkable situations, years of abuse. But when we’re in the garden and we’re working together, we have a single vision, we’re working toward a common goal, and we all get to be equal,” Stevens said. “Gardens are inclusive.”

The designs at the prison are informed by research on environmental preference and attention restoration theories, and Stevens has assembled a team of researchers to help capture the impact of the projects. They’re tracking protective factors, which are thought to reduce recidivism and which include demonstrations of teamwork and problem-solving. They’re also using surveys to keep track of the gardens’ effects on prisoners. Results so far suggest that being in the landscape makes the women feel calmer, more optimistic, and in greater control of their lives.

ASLA 2015 Student Community Service Award of Excellence, Landscapes of Justice. Prisoners experience the landscape, Iowa Correctional Institution for Women / Julie Stevens

For Stevens, who is a co-founder of the ASLA’s Environmental Justice professional practice network (PPN), those metrics are important. They start to illustrate the impact of the landscape in people’s lives, and they help make the case for corrections departments everywhere to invest in humane design.

But the root of her work at the prison, and in environmental justice generally, is deeper. It’s a belief — common to the history of thought on prison design — that the measure of a society lies in the treatment of its most vulnerable populations, that good design is important and should not be reserved for those with a voice. Stevens identified the solution at the end of her lecture: design and action driven by love.

“We have a lot of work to do. It’s really good work, and it’s really important work,” Stevens said. “We have to love and care for other people.”

This guest post is by Lindsey Naylor, Student ASLA, master’s of landscape architecture candidate, North Carolina State University.

New Senior Living Model Needed to Satisfy Aging Boomers

Crotona Senior Residences, Bronx, New York / Rendering by architectural firm of record: Magnusson Architecture and Planning PC, via Welcome to the Bronx

Senior living communities can either be car-dependent and isolated, or an urban or suburban “destination for experiences,” with proximity to transportation, services, arts and culture, restaurants, shopping, and personal development opportunities. Which community would you want to live in? The answer was clear in a session at Environments for Aging in Las Vegas.

According to Michael Hass, managing partner, Drive Development Partners, who is also a member of the Urban Land Institute’s senior housing council, from 1990-2009, senior living communities, mostly geared towards the World War I-era “silent” generation, were all about providing “a sense of security, peace of mind, ‘safety in numbers,’ and belonging.”

But in 2009, occupancy across the senior living industry dropped. This was a key year, the first year baby boomers (those born between 1946 and 1964) became consumers of these places themselves, not just shoppers of these facilities for their parents. Their views on the traditional places could be summed up with: “I’ll never live in a place like that.”

Starting in 2009, senior living developers saw new demand among some of the oldest baby boomers for communities with “flexibility, choice, a unique variety of experiences, and spending opportunities.” They don’t want the self-contained campus, “35 acres in a cornfield.” Hass said: “They want an individualized experience, not the same formal dining room every day.”

Sean Thomson, senior living director, CR Architects, said a new model is needed to reach the 75-million-strong boomers, and walkable urban communities could be it. Walkable urbanism is in demand among all age groups, but is particularly appropriate for seniors.

A report from the George Washington University school of business found that “walkable urbanism is gaining market share.” Furthermore, there is a 90 percent premium for walkable office space, 71 percent premium for retail, and 66 percent premium for multi-family housing.

A 2013 report from Fannie Mae found senior communities with a WalkScore above 80, which means they are walkable, had a “relative risk of default that is 60 percent lower.” Those communities with a WalkScore below 8, which deemed them totally car-dependent, had a “risk 121 percent higher.” As Thomson explained, “walkable communities have a real human impact, but they also have real financial results.” Places with WalkScores in the 60 and 70s have some services in walking distance, but those with scores of 90-plus are ideal.

The ideal walkable senior community is basically found in dense European and Asian cities, or New York City. Imagine an apartment complex in a highly walkable environment, open to the surrounding neighborhood, with ground floor shops, cafes, and restaurants, and close to multi-modal transit opportunities, parks, plazas, self-storage facilities, and co-working spaces. Instead of all these services provided within an isolated campus, they are distributed through the surrounding neighborhood.

Thomson said an urban environment can provide better quality and a higher range of restaurants than any isolated senior community can. Embedding a senior community in a neighborhood also enables that inter-generational contact, social integration, and intellectual engagement so critical to “successful aging.”

Thomson summed up the benefits of walkable urbanism for seniors: “you don’t have to build the amenities; they are already there.”

To make these kinds of communities happen will take some creative housing development strategies. Senior housing developers can partner with medical groups, physicians networks, hospital districts, religious institutions, fitness or wellness companies, or become parts of existing mixed-use developments. “Senior living developers are almost never the top bidders so they need to be part of mixed-use projects, attach themselves to bigger projects.”

In revitalizing second-tier cities, senior housing developers have a real chance, particularly if they piggy-back on mixed-use developments where it’s advantageous to have a set of new fixed-income resident buyers all in one place. “Senior living communities can become an asset to a community.”

Senior housing developers can remake under-performing hotels or extended-stay hotels, or B and C class multi-family housing. “They can partner instead of acquire.”

Also, Thomson can even see universities and colleges building nearby housing for retired alumni who want to return to the area.

They created a vision of a 2.5-acre urban senior development with medical facilities, spa, club, street-facing “fast, fresh” restaurants, shops, a playground, grocery store, and housing for 100-200 residents. “It wouldn’t be adult daycare, but a place where people enjoy themselves.” Perhaps this model could be deemed senior or grey urbanism?

When asked where this comprehensive vision is actually happening in the U.S., both Thomson and Haas said “some elements are happening incrementally, but not all together.”

Empathize and Then Design

Virtual dementia tour / The Davis Enterprise

“Dementia used to be viewed as a psychological problem, a mental illness. There was a stigma associated. Now, we know it’s an organic problem related to cell death in the brain. It’s a medical condition,” said P.K. Beville, founder of Second Wind Dreams, at the Environments for Aging conference in Las Vegas. Dementia, which includes diseases like Alzheimer’s, some forms of Parkinson’s, Lewy body disorders, and others, is now called a neuro-cognitive disorder. It affects more than 5 million Americans and their families.

Throughout the conference, perhaps the major focus was how to orchestrate a shift to more empathetic or patient-centric care for those with neuro-cognitive disorders. Just like with autism, it’s now understood there is a spectrum of neuro-cognitive disorders. One person with the disorder is really one person with the disorder. Designers, physicians, and researchers are partnering to better understand what it’s like to have a neuro-cognitive disorder and then create more sensitive processes and empathetic spaces that can help alleviate the pain these patients experience while institutionalized in memory-care facilities.

With these disorders, there is a loss of cognitive abilities. Our ability to hear, speak, read, and understand come from different parts of our brain. If there is cell death in these areas, then forging understanding connections with others becomes much more challenging. For many of these patients, long-term memory may be intact, but not short-term episodic memory. Also, semantic memory, which deals with abstract concepts, and procedural memory, which helps people remember how to get from point A to B, may be damaged. With the loss of abstract memory, “the goals or intentions of life is lost,” explained Terry Zborowsky, a researcher with HGA architects and engineers in one session, which is why they need “so many cues from the environment.” The loss of procedural memory means those care environments become incredibly confusing, so designers must be really thoughtful to make them more legible.

In her keynote, P.K. Beville said she wants caregivers to better understand why patients with neuro-cognitive disorders behave the way they do. When this is achieved, we can create spaces to better meet their needs. For example, Alzheimers patients in advanced stages “don’t get warning signals when they have to go to the bathroom.” All of the sudden it just comes on and they have to go. If the bathroom is far away, they may miss it and then be labeled incontinent and placed in briefs. “That’s a horrible threat to their dignity. How can we get them to their bathroom faster?” Some ideas: make the bathrooms more easily accessible via hallways, instead of hiding them, and put them in direct line of sight from beds.

Patients with neuro-cognitive disorders often have macular degeneration, which will put a large black spot in the middle of their vision. Their peripheral vision will also be significantly degraded. Their field of view is then limited to just a few feet, which is why they often look down to see where they are going. Beville said, knowing this, “it’s really silly that caregivers are still sitting to the sides of patients when they feed them. Imagine this fork flying out of space into your mouth.” When a patient balks or refuse to eat, they are then labeled difficult and that behavior gets “charted.” It makes much more sense to sit directly in front of the patient and create dining spaces that enable this.

In neuro-cognitive patients, degeneration of the reticular activating system is “what’s causing all the mess. It removes what’s important, causing a loss of focus. When this area of the brain is damaged, the brain picks up all sensory input, relevant or irrelevant.” These patients will hear everything — a door being slammed, a vacuum cleaner, a TV, and even the HVAC system. A dog barking or baby crying will be incredibly painful. When these patients are overwhelmed, they will begin to rock or become agitated. It’s important that memory care facilities then eliminate all sounds that can cause an annoyance. “The dining room can become a cacophony of sound. No wonder the residents don’t want to eat.”

Beville has created an amazing virtual reality tour that demonstrates what it’s like to have a neuro-cognitive disorder like Alzheimer’s. Working with leading medical professionals, researchers at Georgia Tech, and patients, she modeled the effects using goggles, which layers the effects of macular degeneration on whatever you are looking at; gloves that reduce fine motor skills; and headphones that mimic the aural sensory overload these patients can experience. Some two million caregivers in senior facilities have taken the tour.

At the conference, she modeled the newest iteration of the tour using Samsung Gear virtual reality (VR) headsets, instead of goggles, which augment a user’s field of view. The woman who tested it said it was a “terrifying experience.” She said she had “no perception of depth or peripheral vision; it was very hard to hear. I was very, very anxious.”

Studying the responses of the caregivers who have taken the tour, Beville found they exhibit the same behavior as those with Alzheimer’s and other neuro-cognitive disorders. They mumbled or hummed in an attempt to focus and block out the extraneous noises. They were agitated, wandered, rummaged, made negative statements that indicated they felt overwhelmed or depressed. Just 8-10 minutes in the headset caused some to have “strange or bizarre behavior.” Now imagine someone struggling with this condition for years.

Through the tours, Beville found older patients with this condition need “three times the light to see than younger people.” So facilities and their landscapes need to be well lit. The reaction time of the pupil is also delayed, so any changes in lighting causes major issues and should be avoided. Noise needs to be reduced to eliminate distractions. And patients want clear guidance — “something to do” — to help them focus.

After taking the tour, more caregivers agreed with the statement that neuro-cognitive disorder patients “don’t get the care they need.” The tours then help facilities begin to institute performance-based systems to improve quality of care. After taking the VR tour, caregivers say they will be “more patient and understanding with patients, will take more time and provide more attention, and communicate better.” Beville and her group are measuring the changes before and after sensitivity training to demonstrate improvements, which can be measured in adaptive behaviors among patients (engagement, communication, wayfinding, and social integration) and maladaptive behaviors (aggression, confusion, disorientation).

In another session, we heard how to take empathetic design to the next level. Architect Alana Carter, with HGA architects and engineers, explained how she checked herself into a healthcare facility she was redesigning, pretending to be a stroke victim with degraded capabilities on her entire left side. She was fed, washed, and helped in the bathroom. She called the experience “extremely humbling,” but it gave her insights into what needed to be done better from a patient point of view.

Carter and her colleague Zborowsky called for “walking in the footsteps” of patients first, using a comprehensive design methodology to uncover design solutions that will improve environments for aging. Their teams put GPS tracking devices on staff and patients and apply sensors that generate heat maps to understand the flow and popularity of areas in a facility. This kind of analysis can reduce inefficiencies in layout and help discover what features patients feel most comfortable around. Using VR headsets, HGA then prototypes Revit designs of new spaces in real-time, working with caregivers to optimize layouts and features. Finally, they test implemented designs through comprehensive pre- and post-occupancy reviews.

Carter concluded: “We need to move design for seniors out of the care facilities and into museums, galleries, movie theaters, and the home. We need to bring empathetic design to all places. We need to design for the outliers.”

We Must Better Communicate the Health Risks of Climate Change

Climate change march / Safety Messenger
Climate change march / Safety Messenger

“Climate change is a complicated topic, which makes it anathema to clear communication,” explained Dr. Ed Maibach, who runs the center for climate change communication at George Mason University. At the climate and health summit at the Carter Center, Maibach said most Americans associate climate change with “plants, penguins, and polar bears,” and view it as a “22nd century problem.” Climate change is seen as a “scientific, environmental, and political problem, but not a public health one.” Given only about one-third of Americans are environmentalists, framing climate change as a health problem first and foremost could help spur more action. Everyone is concerned with the health of their communities and children.

Maibach is seen as a leading expert on climate change communications. His advice for how we can better reach the public is practical: “the less you say, the more you’re heard; say the things that have the most value; and use audience research to determine which messages have the most value.”

When crafting communications messages, it’s important to “repeat things over and over again,” adapt key messages, reinforce them, but also find a variety of trusted voices, like doctors and nurses, to convey them. “Aim simple, clear messages at target audiences. They will then share with their family members and friends.”

Maibach has been studying what messages will work with various segments of the public. He found there are a number of different Americas. “About 18 percent are alarmed by climate change, 34 percent are concerned, 23 percent are cautious, 5 percent are disengaged, 11 percent are doubtful, and 7 percent are dismissive.”

The messages that will resound with more of these groups include: “(1) 97 percent of climate scientists are convinced human-caused climate change is happening; (2) climate change is already harming our health now. All of us can he harmed, but some are more likely to be harmed, like children, the elderly, pregnant women, student athletes, the sick and poor; and (3) reduce energy waste and embrace clean energy, so we can clean up our air and water.” Maibach said even “the dismissive segment gets that last point, as many of them are enthusiastic about renewable energy.”

Dr. Susan Pachecho, University of Texas Health Science Center, said instead of focusing on tailored messages, communicators must create narratives with personal stories that really connect. “Stories of patients work. Less is better.” She also called for using the humanities — fiction, poetry, art, and music — to better reach students on the health risks of climate change.

And one of the most intriguing speeches came from Jerry Taylor, head of the Niskanen Center, and a Republican who was a climate denier at the Cato Institute for decades before he saw the light and started to believe the science. Taylor explained how to reach Republicans, who really are the ones who need to shift their views if we are going to have more support for climate action. “Democratic opinion on the left and center has been there [supportive of efforts on climate change] for 25 years. Republican opinion: What will move them?”

Taylor said “for the most part, tribal political leaders guide public policy. What drives Republican opinions on climate change are Republican political leaders.” In 2008, Senator John McCain promoted a cap and trade program to reduce carbon emissions. Positions have shifted farther to the right in just under a decade, as neither presidential candidate Mitt Romney or Donald Trump put forth any climate plan. (But, still, 49 percent of Trump supporters agree climate change is happening, and 62 percent want to see emissions regulated).

What’s needed are a few more McCains, Republican tribal leaders who will show some leadership on the issue, just like former Secretaries of State James Baker III and George Schultz, along with former Secretary of the Treasury Henry Paulson did with their call for a revenue-neutral carbon tax.

To reach more Republican and grow more of these leaders, Taylor advised against using phrases like “massive socio-economic transformation.” He said “that’s not going to happen, and Republicans like capitalism and the 21st century as it is.” Also, “unleashing the government,” like the environmentalist Bill McKibben has proposed, with a sort of New Deal for a new green economy, also isn’t going to fly, as that would be viewed as a “war on the economy.” He said for Republicans, “it’s not about the debate on the climate science,” but fear of government control of the economy.

Taylor also urged Democrats “not to overplay certainties. There is less knowledge of future scenarios” than many would like. “Will we reach a new climate stability in 60 years or 3-4 centuries? Will temperatures level out at a 1.5-3 Celsius or 8-10 Celsius increase? There is a lot we don’t know about how bad it will be.”

Instead, “risk management works well on Capitol Hill. There is a big distribution of possible outcomes, with one option being ‘no impact,’ and another being ‘big impact.'” Advocates can present the “most likely outcomes,” which will encourage Republicans to hedge their bets. Also, discussing the co-benefits of fighting climate change, like improved health, works. For example, we can have a cleaner and healthier planet.

But “de-industrialization, raising energy costs, massively increasing government spending — we don’t need to do this. Harnessing the market is a near-universal remedy that Republicans can put into play.”

The Climate + Health Challenge: “We Have the Solutions” (Part 1)

Wind and solar installation / Stanford University News
Wind and solar installation / Stanford University News

If we don’t reduce the billions of tons of carbon dioxide pouring into the atmosphere each year, there will be significant health impacts, argued former Vice President Al Gore and some of the world’s leading scientists, at a summit organized at the Carter Center in Atlanta. The first half of the conference explained the challenges facing the world if we surpass an increase of 2 degree Celsius (3.6 degree Fahrenheit), which is seen as a key thresh hold: the accelerated spread of infectious diseases, less nutritious food, more challenging mental health problems, and more dangerous air pollution. In the second half of the day, Gore and others offered some solutions — to mitigate climate change, and thereby reduce expected health impacts, and better anticipate and manage the coming public health challenges.

After hearing so much doom and gloom, Gore said “we have the solutions at hand. Hope is justified.” Just a few decades ago, environmentalists hoped we would achieve 30 gigawatts of wind power by 2010. In 2017, we have achieved 17 times that amount. The estimates were for 18 gigawatts of solar power by 2010. In 2017, we achieved 77 times that number.

Gore explained that three-fourths of new energy plants being created around the world are either wind or solar. And coal has fallen out of favor in many countries. India has issued a new policy that will stop all coal plants moving forward. China is retiring old coal plants and put a moratorium on new ones.

In addition to the climate benefits, there are real health benefits to shutting down coal plants. As has been described, coal energy generates more air pollution than other sources of energy, shortening lives. In his talk, Sir Dr. Andy Haines, London school of hygiene and tropical medicine, explained how a “7 percent increase in clean energy investments can save 3 million lives by 2040.” He said President Obama’s clean energy plan would avoid 175,000 deaths, while the tougher vehicle emissions standards finalized in the final days of the Obama administration would save another 125,000 lives. “The health benefits of this offset 25-1050 percent of the costs,” depending on how you calculate them.

Haines called for fixing CO2 prices worldwide, around $20-100 per ton, in order to create a consistent and transparent tax on pollution. “A tax wouldn’t have to be an overall increase. It could be non-regressive.” In Sweden, a ton of carbon now costs $160, but the country has still seen growth and is now shifting to a low-carbon economy. Unfortunately, only 12 percent of the world’s emissions are now covered by a pricing scheme. Furthermore, most of the world currently rewards fossil fuel production, as governments give oil, coal, and gas companies some $5 trillion in subsidies per year.

The world’s cities account for 85 percent of the world’s economy, and some 71-16 percent of global carbon dioxide emissions. If cities can reduce their emissions, as many are working on doing so, we can make a great deal of progress, regardless of the politics of any country. Comparing Atlanta and Barcelona, which each have about 2.5 million people, Haines demonstrated the potential emission reductions that could happen with better urban planning and design. In Atlanta, which is some 7,000 square miles, each car-owning resident spews out 7 tons of carbon each year. In comparison, Barcelona, which is just 648 square miles, each person release less than 1 ton of emissions a year. Barcelona is far more walkable and bikeable with more public transit, and cities like Atlanta need to become like Barcelona much faster. Not only is walking and biking better for the environment, but there are also major health benefits. And for those who don’t have the strength to bike, Haines made the case for e-bikes. (In another talk, Laura Turner Sydell, board member of the Turner Foundation, said “Atlanta has come light years in the past 20 years,” but still has much further to go).

Trends of urbanization in Atlanta and Barcelona / Morphocode
Trends of urbanization in Atlanta and Barcelona / Morphocode

Carbon dioxide stays up in the atmosphere for 1,000 years. But we can target short-lived pollutants now to reduce some of the worst climate and health impacts. Haines called for targeting black carbon, methane, tropospheric ozone, and HFCs. “Regulating these gases can keep us well below a 2 degree Celsius increase.” Black carbon can be reduced with the distribution of clean cook stoves, which also cut back dangerous indoor air pollution. Cows are a major source of methane. In 1961, there were 2.4 billion of these ruminants; today, there are more than 3.8 billion of them. Encouraging a more vegetarian or vegan diet can reduce methane emissions without changing overall dietary profiles much. And methane from natural gas production and landfills can be easily captured and reused as fuel.

Forests are another important part of the solution. “Forests reduces air pollution, clean water, decrease malaria transmission and other disease risks,” while serving as important carbon sinks and sources of biodiversity. “We need to have stable forests to stay below a 2 degree increase.”

For the first time, carbon dioxide emissions have been flat the past two years, despite the fact that world economy grew, Gore said. “Carbon dioxide emissions are going to start to go down. But we aren’t solving the crisis fast enough.”

For that to happen, Gore is pushing for more solar and wind capacity. He thinks renewable energy sources are good for the U.S. economy. “Solar jobs have grown 12 times, more than any other energy sector.” He also called for retrofitting buildings to make them more energy efficient. “Those jobs can’t be outsourced.” And as Haines explained, “cutting building-related CO2 emissions could prevent some 5,000 deaths” by reducing air pollution.

The UN Paris agreement to limit carbon emissions requires states to provide an update on their progress every five years. The idea is to use these five-year marks to ratchet up expectations and actions. Countries are already preparing for the first five-year mark in 2021, Gore said. Unfortunately, it’s unclear whether the Trump administration will continue to meet the obligations of the agreement.

Read part 2.

The Climate + Health Challenge: “We Have the Solutions” (Part 2)

pollution
US Embassy in Beijing air pollution monitor app / Digital Journal

If we don’t reduce the billions of tons of carbon dioxide pouring into the atmosphere each year, there will be significant health impacts, argued former Vice President Al Gore and some of the world’s leading scientists, at a summit organized at the Carter Center in Atlanta. The first half of the conference explained the challenges facing the world if we surpass an increase of 2 degree Celsius (3.6 degree Fahrenheit), which is seen as a key thresh hold: the accelerated spread of infectious diseases, less nutritious food, more challenging mental health problems, and more dangerous air pollution. In the second half of the day, Gore and others offered some solutions — to mitigate climate change, and thereby reduce expected health impacts, and better anticipate and manage the coming public health challenges.

A number of scientists called for boosting the amount of climate change adaptation funds that go to health. Of the $1.2 billion collected for adaptation by the United Nations, only 2 percent of that goes to health measures, said Dr. Kristie Ebi, University of Washington. And, unfortunately, there is almost no serious research being conducted on the health impacts of climate change.

Dr. Rainer Sauerborn, Heidelberg Institute of Public Health, made the important point that there is no one-sized-fits-all solution for climate adaptation. Every community’s challenges will be unique, which means support for local research and action is vital. He wondered why there were no researchers from the Middle East or Africa at the conference.

Public health officials made the case for increased spending on public health surveillance and early warning systems. In Beijing, for a period of time, the U.S. embassy provided the one reliable indicator of air pollution levels in the city. Its feed has spurred activism and Chinese government action to better monitor and reduce air pollution. If more developing world cities had more reliable air pollution monitoring and alert systems, those particularly vulnerable to poor air could be instructed to stay inside on really bad days. These systems also generate demand for air quality improvements.

With more funding, public health organizations can better monitor disease threats as well. For example, the European Center for Disease Control and Prevention (ECDC) is monitoring the precursors of vibrio, an aquatic pathogen, explained Dr. Jan Semenza, and sending alerts to communities before a vibrio outbreak strikes. Testing the system against Swedish data, they’ve found “there is an epidemic signal we can predict.”

Dr. Howard Frumkin, University of Washington, a leading environmental health specialist, and co-editor of Making Healthy Places, called for doctors and scientists in the public health field to seek partners “outside their comfort zones” and reach out to those working on the built environment, like planners, landscape architects, and architects.

The Centers for Disease Control and Prevention (CDC) was represented by Dr. George Luber, who explained the tools the CDC has available for communities planning for health impacts, such as the Building Resilience Against Climate Effects (BRACE) framework, which also includes technical assistance. Luber said the role of the CDC is to provide accessible scientific guidance and decision-making support tools.

But it’s important that all communities get support for dealing with their climate and health challenges in the future. Catherine Flowers, with the Alabama Center for Rural Enterprise, said parts of Alabama were like a “third world country,” with sewage bubbling up and contaminating front lawns. “This is where environmental justice and climate intersect.”

And Gary Cohen, Health Care Without Harm, thinks the healthcare sector can come together as a single force for good. Given the sector accounts for 17 percent of the U.S. economy, it’s poised to play a lead role. Gundersen Health in Wisconsin, which was almost entirely fueled by coal a few years ago, now runs on power generated from wind and bio-waste. Cohen said in more than 200 cities, the healthcare sector is the biggest employer. Associations of these firms are moving to renewable energy and divesting from any fossil fuel stocks.

These companies can help shift the U.S. to a more sustainable, less polluting form of energy production, and speak out about the health risks with climate change. “If we mobilize the health community, we have a massive army at hand. Doctors and nurses are among the most trusted people in America. We will be unstoppable,” argued Cohen.

However, despite all the positive talk about how we can manage the coming challenges, many scientists at the conference agreed that there are many “unknown unknowns” looming out there. For example, there are new worries about the micro-organisms now dormant under the vast permafrost. Just ten years ago, no one knew the nutritional value of many important crops would be reduced in a higher carbon atmosphere. What other impacts are lurking out there? There is much that still can’t be predicted. 

The most important investment now may be to dramatically boost funding on scientific research, and monitoring and early warning systems.

We Can’t Ignore the Health Impacts of Climate Change (Part 1)

Aedes aegypti mosquito, a carrier of the Zika virus / James Gathany / CDC
Aedes aegypti mosquito, a carrier of the Zika virus / James Gathany / CDC

The Centers for Disease Control and Prevention (CDC) organized a three-day conference on climate and health. As the Trump administration took power, the conference was abruptly cancelled. So former Vice President Al Gore and his Climate Reality Project, former President Jimmy Carter, the American Public Health Association (APHA), public health expert Dr. Howard Frumkin, and others stepped in to fill the gap, putting on a one-day summit at the Carter Center in Atlanta last week. ASLA signed on as a member of the summit’s partnership circle, along with the American Institute of Architects (AIA) and the U.S. Green Building Council. In Atlanta, Gore kicked off the conference by arguing that “too little attention is being paid to the health consequences of climate change.” And focusing on coming health impacts could be a more compelling way to persuade the public that more action is needed now. We couldn’t agree more.

“We are now using the open sky as a sewer,” Gore said. The billions of tons of carbon emissions spewed into the atmosphere have a warming effect equal to exploding 400,000 Hiroshima atomic bombs every day. If unabated, the warming effect of all of this pollution will not only lead to ecological catastrophe, but a “medical emergency.” If we continue on a “business as usual” scenario, which could eventually warm the planet by 8-12 degrees Fahrenheit by the end of the century, there will be dire implications for human health.

Gore and leading scientists discussed key areas where climate change is expected to cause major human health impacts (due to time constraints, they left out discussing animal and plant health). Here below are the first four impacts; part 2 will have the rest:

Infectious Diseases: “Tropical diseases are on the move. With air travel, they can spread more easily, but with climate change, there are new areas where diseases can become endemic.” As regions warm, diseases like Zika, Chikungunya, West Nile, Dengue Fever, malaria, and others spread by mosquitoes, can take root. Many regions not currently affected by these diseases — places thought to be north of the “mosquito line” — should worry and become better prepared. Also, average global humidity is 4-5 percent higher than 30 years ago, and those numbers are only expected to increase. With higher humidity and heat, mosquitoes speed up their reproductive and metabolic rates, which means there are more mosquitoes biting more.

In India, “there were 39 million cases of Dengue fever per year.” Last year, a park in Tokyo was closed due a Dengue Fever outbreak. And in central China, “malaria has re-emerged” for the first time in ages.

The spread of the Zika virus in the U.S,, which the CDC considers a health emergency, has already affected Puerto Rico, Miami-Dade county, and the U.S. Virgin Islands. And many scientists, Gore said, “suspect it’s now spreading up and down the Gulf Coast.” For most people, Zika causes relatively mild symptoms, such as a rash, fever, joint pain, and eye aches, for about a week and then clears up. For pregnant women, there are serious implications — the virus can cause miscarriages or fetal microcephaly and other birth defects.

Ticks, which are already vectors for disease transmission, are also moving north. “Virtually 100 percent of Canada will be within tick range in a few decades.” And we’ll also see new species — like snails — become vectors for transmissions.

Moving onto to other worrying scenarios, Gore said “runoff from increased flooding or extreme precipitation events will damage our water supplies.” With higher temperatures and more frequent storms, we will see the spread of cholera and other water-borne diseases. According to Dr. Glenn Morris, University of Florida, who conducts research on emerging infectious diseases, in the aftermath of Hurricane Sandy, some 50 percent of the water supply in Haiti was contaminated by cholera.

Vibrio aquatic pathogens, which infect shorelines and also make oysters and other shellfish very dangerous to eat, are also spreading. Morris, said “vibrios are extremely temperature sensitive and every one degree temperature increase can encourage their spread.” Already, the number of cases in the north Atlantic is increasing.

Morris said even slight temperature gains can increase disease transmission. “Climate change opens up new ecological niches for pathogens. These are the unexpected consequences when people play with the environment.”

Heat Stress: While flooding from storms and heavy rains is the extreme weather event that kills the most number of people worldwide, heat stress is the biggest killer in the United States, according to Gore. Mortality rates increase by 4 percent during heat waves, which are more dangerous for the elderly, children, athletes, outdoor workers, socially-isolated people, urban dwellers, the homeless, the poor, and communities of color.

For the past 17 years, the planet has just been getting warmer and warmer. Dr. Kim Knowlton, Natural Resources Defense Council (NRDC) and Mailman School of Public Health, Columbia University, said 2016 was the hottest year on record, beating 2015, which at that time was the hottest year on record. Currently, New York City has about 670-1,300 heat deaths per year, with 65,000 heat emergencies. Dr. Jonathan Patz, University of Wisconsin, said New York City can expect triple the number of extreme heat days (up to 39 days) by 2045. Correspondingly, Dr. Knowlton anticipates heat deaths to also triple.

Heatwave in New York City / NY Daily News
Heatwave in New York City / NY Daily News

More broadly, higher temperatures mean reduced productivity. Outdoor workers experiencing heat stress can’t work. Knowlton said with higher temperatures, the “U.S. could see a reduction in economic output of $2 trillion; by 2100, a 20 percent drop in GDP from extreme heat.”

Many places are reaching all time highs, too, Gore explained. India hit an all-time high of 123 Fahrenheit last summer, and Sydney recently reached 117 Fahrenheit. In Iran, a city hit 165 Fahrenheit, with the heat index, in 2015. What makes this all worse: “night-time temperatures are also increasing, so there is no relief.”

Gore said in these conditions “no human can be outside for more than a few hours.” The projections show that vast swathes of the Middle East and North Africa are on track to reach some of these temperatures on a regular basis. “Areas of the planet could no longer be habitable. They could become beyond the limit of human survival. Mecca and Medina are in this zone.”

Dr. Knowlton said it’s time to take into consideration the health impacts of the world’s energy choices. Moving to renewable energies now may still result in a 3-4 degree planetary temperature increase, which will be “manageable,” while a 10-15 degree increase, under current fossil fuel-driven scenarios, would be “catastrophic.”

Air Pollution: Some 6.5 million people die each year prematurely from air pollution, reports the International Energy Agency. Carbon dioxide and related co-pollutants, otherwise grouped together as small particulate matter, found in vehicle exhaust and power plant emissions are behind these deaths.

Because of air pollution, the life expectancy of those living in northern China has been cut by 5.5 years. In Henan province, it’s estimated that air pollution takes the lives of 4,000 people a day. Pollution in Beijing, China’s capital city, has reached near “unlivable levels.” It’s not just China experiencing deadly air pollution though. New studies show that 99.5 percent of Indians breathe unhealthy air, as do 94 percent of Nigerians. According to one analysis, Tehran, the capital of Iran, was rated as having the world’s worst air.

Tehran air pollution / Green Prophet
Tehran air pollution / Green Prophet

Some sources of energy are dirtier than others. For example, deaths from coal-related pollution are higher than pollution from other sources. Gore said “coal creates $216 billion in health costs per year.” (Furthermore, coal burning is heavily damaging in other ways. Mercury, which is a co-pollutant that comes out of coal, has tripled in the world’s oceans. Some 16 percent of China’s cropland is also contaminated with it).

Dr. Patrick Kinney, Boston University, said “air pollution should be at the center of the discussion on health and climate.” Warmer temperatures make smog worse, as it increases the negative impacts of ozone and strong oxidant gases. Kinney also said areas impacted by wildfire, which are expected to double with climate change, will also increase harmful smoke inhalation.

Allergens: Another form of natural air pollution that will get worse: pollen, which is expected to triple in many areas by 2040. In areas with Ragweed, there will be an increase in pollen load by 320 percent by 2100.

Ragweed / Identify That Plant
Ragweed / Identify That Plant

Kinney said that in New York City, “pollen season is now coming earlier. That’s bad news for people with asthma and allergies.”

Read part 2 on mental health and food impacts.

We Can’t Ignore the Health Impacts of Climate Change (Part 2)

A farm that has been destocked for two years in Queensland, Australia / ABC
A farm that has been destocked for two years in Queensland, Australia / ABC

The Centers for Disease Control and Prevention (CDC) organized a three-day conference on climate and health. As the Trump administration took power, the conference was abruptly cancelled. So former Vice President Al Gore and his Climate Reality Project, former President Jimmy Carter, the American Public Health Association (APHA), public health expert Dr. Howard Frumkin, and others stepped in to fill the gap, putting on a one-day summit at the Carter Center in Atlanta last week.

Gore and leading scientists discussed key areas where climate change is expected to cause major human health impacts (due to time constraints, they left out discussing animal and plant health). In the first part, we covered the first four — infectious diseases, heat stress, air pollution, and allergens; here, below, are the rest:

Mental Health: Gore said except for Dr. Lise Van Susteren, with the Center for Health and the Global Environment, Harvard T.H. Chan School of Public Health, few seem to be studying the mental health impacts of climate change.

Dr. Van Susteren gave perhaps the most powerful speech of the conference, as so much of what she said hasn’t been in the spotlight before. She said the most negative weather impacts of climate change — flooding, storms — result not only in injuries and property loss, but a sense of displacement, which leaves an incredible “emotional toll.”

Shifts in temperatures also have a mental health impact. In higher temperatures, studies have found, there is a “40 percent increase in conflict, and 14 percent jump in conflict between groups.” There is increased unrest among all ethnic groups. She imagined a future with higher temperatures and more refugees resulting in increased conflict worldwide.

Somali refugees displaced by flooding / How Stuff Works / Brendan Bannon /AFP, Getty Images
Somali refugees displaced by flooding / How Stuff Works / Brendan Bannon /AFP, Getty Images

And in societies facing an influx of refugees, there has been a “sharp turn to the far right.” In a time of peril, “people regress and give up on their values.” In a state of anger and aggression, “systems can be easily overwhelmed. Faith in government can fail.”

More deeply, she wondered what happens to people’s unconscious psychological states when “the place they call home goes away,” when they can’t return to a place that has been irreversibly changed. She argued that the “fear, anger, sorrow, and trauma” of that experience can “push people to the breaking point” and result in “abuse, drugs, and violence.” She said more and more communities are experiencing this type of nostalgia for lost, damaged lands.

Furthermore, we will feel the loss of the natural world. With some scientists estimating that 30-50 percent of species could go extinct in the coming decades, “we will lose that the awe and wonder we get from biodiversity. The cost is our souls.”

Many people not currently directly impacted by climate change yet may still have “climate anxieties.” A group of climate Cassandras see “future disasters coming,” which takes a psychological toll. She point to children in Australia who are having a hard time focusing due to fears associated with drought and climate change. It has become so common it’s considered a new condition. In a startling statement, she then equated climate change with child abuse, and burning fossil fuels with aggression that puts people in harm’s way.

Food: Important food crops are heat sensitive. Each day corn is above 84 degrees Fahrenheit, there is a 0.7 percent loss in yield, Gore explained. With wheat, there is a 20 percent drop with a 1 degree increase. All those crops also need water, which is becoming increasingly scarce in many places. And another little known effect of rising carbon dioxide in the atmosphere is the reduction of nutrient levels in important grains. Zinc, copper, magnesium levels drop by 10 percent of more in common grains as CO2 levels rise, Gore said. This bodes ill for the world’s poor who rely on these grains for these nutrients and can’t afford supplements.

Dr. Samuel Myers, an expert on climate and food at Harvard University, took a step back to look at the big picture. He said “food demand is the highest in history, but climate change is affecting all food systems, threatening the quality, quantity of food and where it’s produced.” Some scientists have posited climate change could have a helpful fertilizing effect by raising temperatures and humidity, but the positive impact will be “smaller than thought,” and be likely far outweighed by the negative impacts.

With rising temperatures, the tropics can expect a 15-25 percent drop in yields. On top of that, more heat is “incompatible with long outdoor labor.” Fisheries peaked about a decade ago and their capacity is falling about 1 percent a year. Fisheries will also now move further towards the north and south poles. Water scarcity threatens livestock. With all these changes, Myers predicts the world will become increasingly dependent on food trade. This hits the poor the hardest, as they are “most susceptible to food price shocks.”

Crops will have less nutritional value. A group of scientists around the world have been growing 41 cultivars over 10 years in open-field conditions, but have been circling them in a ring of carbon dioxide at the levels of 550 parts per million (ppm), which is the level expected in 50 years. The scientists found that with all C3 crops, which include beans, rice, wheat, potatoes, there has been a drop in iron and zinc values along with protein levels. “These deficiencies are already a huge problem today in the world’s population. The effect of climate change may be that 200 million more people will have a new onset of zinc deficiency, and 1 billion people will have an existing deficiency exacerbated. There will be a similar effect with iron and protein, particularly in Africa and South Asia.”

Carbon crop study / Phys.org
Carbon crop study / Phys.org

Myers argued said just a decade ago, “scientists didn’t know that food would have less nutritional value. These complex unknown effects are worrying.”

Read part 1.