Man, Health and Environment

Laurita R. Mendoza, SE, MPH

 Health is considered as an overall concept
reaching beyond the absence of illness and ailments

Health is only possible where:

Resources are available to meet human needs
"HEALTH is a Living and working environment is protected
state of complete from life-threatening and health threatening
pollutants, pathogens and physical hazards
physical, mental Health also includes a sense of well-being and
and social well- security
being and not Deficient living and working environment are
merely the associated with both physical and psychological
health problems
absence of Violence and alienation are associated with poor
disease or job prospects, overcrowded poor quality housing,
infirmity". (WHO) deficient services, and inadequate provision for
leisure, recreation, and childrens play and
development.
 Health and Environment
Disease is a result from complex interaction between man, an agent and the
environment. From ecological point of view, disease is defined as maladjustment of
the human organism to the environment.

Environment - (Physical, biological and psychosocial)

All of the external factors affecting an organism

May be other living organisms (biotic factors) or nonliving variables (abiotic factors), such as temperature,
rainfall, day length, wind, and ocean currents.

The environment is all external conditions, circumstances, and influences

surrounding and affecting the growth and development of an organism or
community of organisms.

Environmental health is the study and management of environmental conditions

that affect the health and well-being of the population
 Man and environment
agricultural, industrial, and
energy production, the use and
management of water and
Human wastes, urbanization, and
Activities distribution of income and assets
within and between countries,
the quality of health and other
public services, and the extent of
protection of the living, working
and natural environment

HEALTH type and

soil and their distribution of
chemical habitat and their
composition, air Biologica
Physical flora and fauna,
and water l including
resources, climate, Environm
Environm pathogens,
including ent reservoir s and
temperature, ent
vectors
humidity, radiation,
precipitation and
seasonal changes
 Environmental factors that impair
health
Pathogenic agents and their vectors and
reservoirs
Physical and chemical agents present in the
environment that are independent of human
activities
Can impair health either by their presence (ultraviolet
light) of by their relative deficiency (iodine)
Noxious physical and chemical agents added to
the environment by human activities
Nitrogen oxides, aromatic hydrocarbons solid wastes
produced by industries
 Disease Transmission
Disease Disease Disease transmitted
Herbicide /
transmitted in transmitted in by insects or other
insecticide
drinking water food arthropods

disease organisms Results from

protection against improper mismanagement
are shed into the environment
water in feces, and food-borne or misuse of
diseases, can be al chemicals
can produce illness managemen
in those who done through resulting in an
routine inspection of t can cause unacceptable
consume vector-borne
untreated, food service risk to human
establishments and disease health
contaminated outbreaks
water retail food outlets
(supermarkets) to
verify that food is
being stored and manufactured to
water treatment handled properly reduce
facilities are Vector populations of
usually able to include undesirable
purify water by animals, organisms
removing these insects, etc. (pests), the wise
agents or killing Food poisoning is use of pesticides
them by very rampant can protect
disinfecting the nowadays: milk tea human health
water poisoning, durian and agricultural
candy poisoning crops
Climate Effects on Health
Climate Effects on Health

http://www.cdc.gov/climateandhealth
Air Pollution

Climate change is projected to

harm human health by increasing
ground-level ozone and/or
particulate matter air pollution in
some locations. Ground-level
ozone (a key component of smog)
is associated with many health
problems, such as diminished lung
function, increased hospital
admissions and emergency room
visits for asthma, and increases in
premature deaths.
Allergens
Climate change, resulting in more
frost-free days and warmer
seasonal air temperatures, can
contribute to shifts in flowering time
and pollen initiation from allergenic
plant species. Increased CO2 by
itself can elevate production of
plant-based allergens. Higher pollen
concentrations and longer pollen
seasons can increase allergic
sensitizations and asthma episodes
and diminish productive work and
school days.
Wildfires

increasing the vulnerability of many forests to

wildfires
projected to increase the frequency of wildfires,
wildfire smoke contains particulate matter,
carbon monoxide, nitrogen oxides, and various
volatile organic compounds (which are ozone
precursors) and can significantly reduce air
quality, both locally and in areas downwind of
fires
Smoke exposure increases respiratory and
cardiovascular hospitalizations; emergency
department visits; medication dispensations for
asthma, bronchitis, chest pain, chronic
obstructive pulmonary disease, and respiratory
infections; and medical visits for lung illnesses
 Temperature Extremes

Deaths result from heat stroke,

cardiovascular disease, respiratory
disease, and cerebrovascular
disease
Heat waves are also associated
with increased hospital admissions
for cardiovascular, kidney, and
respiratory disorders
extreme heat events remain a
cause of preventable death
nationwide
Vulnerability to winter weather
depends on many non-climate
factors, including housing, age,
and baseline health.
 Precipitation Extremes: Heavy
Rainfall, Flooding, and Droughts
Increases in both extreme precipitation and
total precipitation have contributed to
increases in severe flooding events
Floods are the second deadliest of all
weather-related hazards in the US
Flash floods and flooding associated with
tropical storms result in the highest number
of deaths.
Elevated waterborne disease outbreaks
Drought conditions may increase the
environmental exposure to a broad set of
health hazards including wildfires, dust
storms, extreme heat events, flash
flooding, degraded water quality, and
reduced water quantity.
 Diseases Carried by Vectors

influences the distribution of diseases

borne by vectors
The geographic and seasonal distribution
of vector populations, and the diseases
they can carry, depends not only on
climate but also on land use,
socioeconomic and cultural factors, pest
control, access to health care, and human
responses to disease risk, among other
factors
Enhanced vector surveillance and human
disease tracking are needed
 Food and Waterborne Diarrheal
Disease
Diarrheal disease is a major public health
issue
Exposure to a variety of pathogens in water
and food causes diarrheal disease. Air and
water temperatures, precipitation patterns,
extreme rainfall events, and seasonal
variations are all known to affect disease
transmission
Diarrheal diseases have also been found to
occur more frequently in conjunction with
both unusually high and low precipitation.
Sporadic increases in stream flow rates,
often preceded by rapid snowmelt and
changes in water treatment, have also
been shown to precede outbreaks.
 Food Security
expected to threaten food production, food
quality and food prices and distribution
systems
food insecurity increases with rising food
prices
people cope by turning to nutrient-poor but
calorie-rich foods and/or they endure
hunger, with consequences ranging from
micronutrient malnutrition to obesity
nutritional value of some foods is projected
to decline
farmers are expected to need to use more
herbicides and pesticides because of
increased growth of pests and weeds
 Mental Health and Stress-Related
Disorders
extreme weather events can affect
mental health in several ways
high levels of anxiety and post-
traumatic stress disorder (Katrina)
Similar observations following
floods, heat waves, wild fires
Pre-term birth, low birth weight,
maternal complications
Suicidal rate rises with high
temperature
Disease Causation and
Immunity
 Epidemiology
Epidemiology is the study of the distribution
and determinants of health-related states or
events in specified populations, and the
application of this study to the control of
health problems.
Epidemiology is also used to search for
determinants, which are the causes and
other factors that influence the occurrence of
disease and other health-related events
 Uses of Epidemiology
Assessing the communitys health
Making individual decisions
Completing the clinical picture
Searching for Causes
 The epidemiological triad

Agent originally referred to an infectious microorganism or pathogen: a

virus, bacterium, parasite, or other microbe
Host refers to the human who can get the disease
Environment refers to extrinsic factors that affect the agent and the
opportunity for exposure
Component causes and causal pie
Component causes individual factors
Complete pie- sufficient cause
Necessary cause - component that appears in every pie
or pathway
 Natural History of Disease Timeline

Source: Centers for Disease Control and

Prevention. Principles of epidemiology,
2nd ed. Atlanta: U.S. Department of
Health and Human Services;1992.

Source: Centers for Disease Control and Prevention. Principles of epidemiology, 2nd
ed. Atlanta: U.S. Department of Health and Human Services;1992.
 Important terms to remember

Reservoir
Reservoir of an infectious agent is the habitat in which the agent
normally lives, grows, and multiplies.
include humans, animals, and the environment.
The reservoir may or may not be the source from which an agent
is transferred to a host
Human reservoirs.
Diseases that are transmitted from person to person without
intermediaries include the sexually transmitted diseases,
measles, mumps, streptococcal infection, and many respiratory
pathogens
Humans were the only reservoir for the smallpox virus, naturally
occurring smallpox was eradicated after the last human case
was identified and isolated
 Animal reservoirs
Humans are also subject to diseases that have animal
reservoirs. Many of these diseases are transmitted from animal
to animal, with humans as incidental hosts.
Zoonosis - infectious disease that is transmissible under natural
conditions from vertebrate animals to humans.
brucellosis (cows and pigs), anthrax (sheep), plague (rodents)
trichinellosis/trichinosis (swine), tularemia (rabbits)
rabies (bats, raccoons, dogs, and other mammals)
Zoonoses newly emergent in North America include West Nile
encephalitis (birds), and monkeypox (prairie dogs). Many newly
recognized infectious diseases in humans, including HIV/AIDS,
Ebola infection and SARS, are thought to have emerged from
animal hosts, although those hosts have not yet been identified.
 Environmental reservoirs.
Plants, soil, and water in the environment are also reservoirs for
some infectious agents
Many fungal agents, such as those that cause histoplasmosis,
live and multiply in the soil.
Outbreaks of Legionnaires disease are often traced to water
supplies in cooling towers and evaporative condensers,
reservoirs for the causative organism Legionella pneumophila
Portal of Exit path by which a pathogen leaves its host
 Modes of transmission
Direct
Direct contact
Droplet spread
Indirect
Airborne
Vehicle borne
Vectorborne (mechanical or biologic)
 Portal of entry - the manner in which a
pathogen enters a susceptible host.
Host - the final link in the chain of
infection is a susceptible host.
 Host defenses
Innate/natural immunity prevents entry of microorganisms into
tissues, or once they have gained entry, eliminates them to the
occurrence of disease
Present from birth
Non-specific acts on organisms and does not show specificity
Does not become more efficient on subsequent exposure
Specific Immunity refers to protective antibodies that are directed
against specific agent. It can be:
Active antigen
Passive antibodies
Natural acquired during normal biological defenses
Artificial - immunization
Causal Agent:
Dracunculiasis (guinea worm disease) is caused by the nematode
(roundworm) Dracunculus medinensis.

Life Cycle:

http://www.cdc.gov/parasites/guineaworm/biology.
html
 Implications for public health
Knowledge of the portals of exit and entry and modes of
transmission provides a basis for determining
appropriate control measures
Interventions is usually directed at:
- Controlling or eliminating agent at source of
transmission
- Protecting portals of entry
- Increasing hosts defenses
- Prevent a pathogen from encountering a susceptible
host
References:
1. WHO commission on Health and Environment, Our planet, our
health: report of the WHO Commission on Health and Environment
(1992)
2. US Department of Health and Human Services, Center for
Disease Prevention and Control, Principles of Epidemiology in
Public Health Practice 3rd ed. 2006
3. http://nca2014.globalchange.gov/report/sectors/human-health.
4. http://www.who.int/topics/environmental_health/en/
5. http://www.cdc.gov/parasites/guineaworm/biology.html
 Notes
Human health ultimately depends on societys capacity to manage the
interaction between human activities and the physical and biological
environment in ways that safeguard and promote health but do not threaten
the integrity of the natural systems on which the physical and biological
environment depends. This includes maintaining a stable climate and
continues availability of environmental resources (soil, fresh, water, clean air).
It also includes continued functioning of the natural systems that receive the
wastes produced by human societies domestic, industrial and agricultural
without exposing people to pathogens and toxic substances.

The physical environment has a major influence on human health not only
through temperature, precipitation and composition of air and water but also
through its interaction with the type and composition of air and water but also
through its interaction with the type and distribution of flora and fauna
(biological environment). The biological environment is a major influence on
the food supply and on the reservoirs and transmission mechanism of many
diseases.
(Slide 4)
 There are living organisms or their products that are harmful to humans
There are diseases that are transmitted in drinking water -these disease organisms
are shed into the water in feces, and can produce illness in those who consume
untreated, contaminated water. -Our municipal water treatment facilities are usually
able to purify water by removing these agents or killing them by disinfecting the
water.
There are diseases transmitted in or on food -to protect against food-borne diseases,
sanitarians from local health departments routinely inspect food service
establishments (restaurants) and retail food outlets (supermarkets) to verify that food
is being stored and handled properly.
- bacteria Salmonella serotype enteritidis Escherichia coli 0157:H7
There are those transmitted by insects or other arthropods -improper environmental
management can cause vector-borne disease outbreaks.
- St. Louis encephalitis La Crosse encephalitis, transmitted by mosquitoes and
plague and urine typhus transmitted by fleas.
Herbicides Insecticides
It is a result from mismanagement or misuse of chemicals resulting in an
unacceptable risk to human health.
These chemicals have been manufactured for the purpose of reducing populations of
undesirable organisms (pests) -most pesticides kill non-target organisms as well as
the target, or pest species. -the wise use of pesticides can protect human health and
agricultural crops.
(Slide 6)
Climate Effects on Health

The information on health effects has been excerpted from the Third
National Climate Assessments Health Chapter. Additional information
regarding the health effects of climate change and references to supporting
literature can be found in the Health Chapter
athttp://nca2014.globalchange.gov/report/sectors/human-health.

Climate change, together with other natural and human-made health

stressors, influences human health and disease in numerous ways. Some
existing health threats will intensify and new health threats will emerge. Not
everyone is equally at risk. Important considerations include age, economic
resources, and location.

In the U.S., public health can be affected by disruptions of physical,

biological, and ecological systems, including disturbances originating here
and elsewhere. The health effects of these disruptions include increased
respiratory and cardiovascular disease, injuries and premature deaths
related to extreme weather events, changes in the prevalence and
geographical distribution of food- and water-borne illnesses and other
infectious diseases, and threats to mental health.
(Slide 7)
 Air Pollution

Climate change is projected to harm human health by increasing ground-level ozone

and/or particulate matter air pollution in some locations. Ground-level ozone (a key
component of smog) is associated with many health problems, such as diminished
lung function, increased hospital admissions and emergency room visits for asthma,
and increases in premature deaths.

Factors that affect ozone formation include heat, concentrations of precursor

chemicals, and methane emissions. Particulate matter concentrations are affected by
wildfire emissions and air stagnation episodes, among other factors. By increasing
these different factors, climate change is projected to lead to increased
concentrations of ozone and particulate matter in some regions. Increases in global
temperatures could cause associated increases in premature deaths related to
worsened ozone and particle pollution.

Estimates that assume no change in regulatory controls or population characteristics

have ranged from 1,000 to 4,300 additional premature deaths nationally per year by
2050 from combined ozone and particle health effects. Less certainty exists about the
responses of airborne particles to climate change than the response of ozone.
Health-related costs of the current effects of ozone air pollution exceeding national
standards have been estimated at $6.5 billion (in 2008 U.S. dollars) nationwide,
based on a U.S. assessment of health impacts from ozone levels during 20002002.
(Slide 8)
 Climate change, resulting in more frost-free days and warmer seasonal air
temperatures, can contribute to shifts in flowering time and pollen initiation
from allergenic plant species. Increased CO2 by itself can elevate
production of plant-based allergens. Higher pollen concentrations and
longer pollen seasons can increase allergic sensitizations and asthma
episodes and diminish productive work and school days. Simultaneous
exposure to toxic air pollutants can worsen allergic responses. Extreme
rainfall and rising temperatures can also contribute to indoor air quality
problems, including the growth of indoor fungi and molds, with increases in
respiratory and asthma-related conditions.

Asthma prevalence (the percentage of people who have ever been

diagnosed with asthma and still have asthma) increased in the U.S. from
7.3% in 2001 to 8.4% in 2010. Asthma visits in primary care settings,
emergency room visits, and hospitalizations were all stable from 2001
through 2009. Asthma death rates per 1,000 persons with asthma declined
from 2001 through 2009. As pollen exposures increase, patients and their
physicians will face increased challenges in maintaining adequate asthma
control.
(Slide 9)
 Climate change is increasing the vulnerability of many forests to
wildfires. Climate change is also projected to increase the frequency
of wildfires in certain regions of the United States. Long periods of
record high temperatures are associated with droughts that
contribute to dry conditions and drive wildfires in some areas.
Wildfire smoke contains particulate matter, carbon monoxide,
nitrogen oxides, and various volatile organic compounds (which are
ozone precursors) and can significantly reduce air quality, both
locally and in areas downwind of fires.

Smoke exposure increases respiratory and cardiovascular

hospitalizations; emergency department visits; medication
dispensations for asthma, bronchitis, chest pain, chronic obstructive
pulmonary disease (commonly known by its acronym, COPD), and
respiratory infections; and medical visits for lung illnesses. It has
been associated with hundreds of thousands of deaths annually,
based on an assessment of the global health risks from landscape
fire smoke. Future climate change is projected to increase wildfire
risks and associated emissions, with harmful impacts on health.
(Slide 10)
 Extreme heat events have long threatened public health in the United States. Many
cities, including St. Louis, Philadelphia, Chicago, and Cincinnati, have suffered
dramatic increases in death rates during heat waves. and related conditions, but also
from cardiovascular disease, respiratory disease, and cerebrovascular disease. Heat
waves are also associated with increased hospital admissions for cardiovascular,
kidney, and respiratory disorders. Extreme summer heat is increasing in the United
States, and climate projections indicate that extreme heat events will be more
frequent and intense in coming decades.
Some heat-related sickness and death risks have diminished in recent decades,
possibly due to better forecasting, heat-health early warning systems, and/or
increased access to air conditioning for the U.S. population. However, extreme heat
events remain a cause of preventable death nationwide. Urban heat islands,
combined with an aging population and increased urbanization, are projected to
increase the vulnerability of urban populations to heat-related health impacts in the
future.
Milder winters resulting from a warming climate can reduce illness, injuries, and
deaths associated with cold and snow. Vulnerability to winter weather depends on
many non-climate factors, including housing, age, and baseline health. While deaths
and injuries related to extreme cold events are projected to decline due to climate
change, these reductions are not expected to compensate for the increase in heat-
related deaths.
(Slide 11)
 The frequency of heavy precipitation events has already increased for the nation as a
whole, and is projected to increase in all U.S. regions. Increases in both extreme
precipitation and total precipitation have contributed to increases in severe flooding
events in certain regions. Floods are the second deadliest of all weather-related
hazards in the United States, accounting for approximately 98 deaths per year, most
due to drowning. Flash floods and flooding associated with tropical storms result in
the highest number of deaths.
In addition to the immediate health hazards associated with extreme precipitation
events when flooding occurs, other hazards can often appear once a storm has
passed. Elevated waterborne disease outbreaks have been reported in the weeks
following heavy rainfall, although other variables may affect these associations. Water
intrusion into buildings can result in mold contamination that manifests later, leading
to indoor air quality problems. Buildings damaged during hurricanes are especially
susceptible to water intrusion. Populations living in damp indoor environments
experience increased prevalence of asthma and other upper respiratory tract
symptoms, such as coughing and wheezing, as well as lower respiratory tract
infections such as pneumonia, respiratory syncytial virus (RSV), and RSV
pneumonia.
At the opposite end of precipitation extremes, drought also poses risks to public
health and safety. Drought conditions may increase the environmental exposure to a
broad set of health hazards including wildfires, dust storms, extreme heat events,
flash flooding, degraded water quality, and reduced water quantity. Dust storms
associated with drought conditions contribute to degraded air quality due to
particulates and have been associated with increased incidence of
coccidioidomycosis (valley fever), a fungal pathogen, in Arizona and California.
(Slide 12)
 Climate is one of the factors that influence the distribution of
diseases borne by vectors (such as fleas, ticks, and
mosquitoes, which spread pathogens that cause illness). The
geographic and seasonal distribution of vector populations, and
the diseases they can carry, depends not only on climate but
also on land use, socioeconomic and cultural factors, pest
control, access to health care, and human responses to
disease risk, among other factors. Daily, seasonal, or year-to-
year climate variability can sometimes result in vector/pathogen
adaptation and shifts or expansions in their geographic ranges.
Such shifts can alter disease incidence depending on vector-
host interaction, host immunity, and pathogen evolution. North
Americans are currently at risk from numerous vector-borne
diseases, including Lyme, dengue fever, West Nile virus
disease, Rocky Mountain spotted fever, plague, and tularemia.
Vector-borne pathogens not currently found in the United
States, such as chikungunya, Chagas disease, and Rift Valley
fever viruses, are also threats.
 Climate change effects on the geographical distribution and
incidence of vector-borne diseases in other countries where these
diseases are already found can also impact North Americans,
especially as a result of increasing trade with, and travel to, tropical
and subtropical areas. Whether climate change in the U.S. will
increase the chances of domestically acquiring diseases such as
dengue fever is uncertain due to vector-control efforts and lifestyle
factors, such as time spent indoors, that reduce human-insect
contact.
Infectious disease transmission is sensitive to local, small-scale
differences in weather, human modification of the landscape, the
diversity of animal hosts, and human behavior that affects vector-
human contact, among other factors. Finer-scale, long-term studies
are needed to help quantify the relationships among weather
variables, vector range, and vector-borne pathogen occurrence; the
consequences of shifting distributions of vectors and pathogens; and
the impacts on human behavior. Enhanced vector surveillance and
human disease tracking are needed to address these concerns.
(Slide 13)
 Diarrheal disease is a major public health issue in developing countries
and, while not generally increasing in the United States, remains a
persistent concern. Exposure to a variety of pathogens in water and
food causes diarrheal disease. Air and water temperatures, precipitation
patterns, extreme rainfall events, and seasonal variations are all known
to affect disease transmission. In the United States, children and the
elderly are most vulnerable to serious outcomes, and those exposed to
inadequately or untreated groundwater will be among those most
affected.
In general, diarrheal diseases, including salmonellosis and
campylobacteriosis, are more common when temperatures are higher,
though patterns differ by place and pathogen. Diarrheal diseases have
also been found to occur more frequently in conjunction with both
unusually high and low precipitation. Sporadic increases in stream flow
rates, often preceded by rapid snowmelt and changes in water
treatment, have also been shown to precede outbreaks. Risks of
waterborne illness and beach closures resulting from changes in the
magnitude of recent precipitation (within the previous 24 hours) and in
lake temperature are expected to increase in the Great Lakes region as
a result of projected climate change.
(Slide 14)
 Globally, climate change is expected to threaten food production and certain aspects of
food quality, as well as food prices and distribution systems. Many crop yields are
predicted to decline because of the combined effects of changes in rainfall, severe
weather events, and increasing competition from weeds and pests on crop plants.
Livestock and fish production are also projected to decline. Prices are expected to rise in
response to declining food production and associated trends such as increasingly
expensive petroleum (used for agricultural inputs such as pesticides and fertilizers).
While the U.S. will be less affected than some countries, the nation will not be immune.
Health can be affected in several ways. First, Americans with particular dietary patterns,
such as Alaska Natives, will confront shortages of key foods. Second, food insecurity
increases with rising food prices. In such situations, people cope by turning to nutrient-
poor but calorie-rich foods and/or they endure hunger, with consequences ranging from
micronutrient malnutrition to obesity. Third, the nutritional value of some foods is
projected to decline. Elevated atmospheric CO2 is associated with decreased plant
nitrogen concentration, and therefore decreased protein, in many crops, such as barley,
sorghum, and soy. The nutrient content of crops is also projected to decline if soil nitrogen
levels are suboptimal, with reduced levels of nutrients such as calcium, iron, zinc,
vitamins, and sugars; this this effect can be alleviated if sufficient nitrogen is supplied.
Fourth, farmers are expected to need to use more herbicides and pesticides because of
increased growth of pests and weeds, as well as decreased effectiveness and duration of
some chemicals. Farmers, farmworkers, and consumers will be increasingly exposed to
these substances and their residues, which can be toxic. These climate change impacts
on the nutritional value of food exist within a larger context. Other factors, such as
agricultural practices, food distribution systems, and consumer food choices, also play
key roles. Adaptation activities can reduce the health-related impacts of some of the
anticipated food security challenges. (Slide 15)
 Mental illness is one of the major causes of suffering in the United States, and
extreme weather events can affect mental health in several ways. Following
disasters, mental health problems increase, both among people with no history
of mental illness, and those at risk a phenomenon known as common
reactions to abnormal events. These reactions may be short-lived or, in some
cases, long-lasting. For example, research demonstrated high levels of anxiety
and post-traumatic stress disorder among people affected by Hurricane Katrina,
and similar observations have followed floods and heat waves. Some evidence
suggests wildfires have similar effects. All of these events are increasingly
fueled by climate change. Other health consequences of intensely stressful
exposures are also a concern, including pre-term birth, low birth weight, and
maternal complications.
In addition, some patients with mental illness are especially susceptible to heat.
Suicide rates vary with weather, rising with high temperatures, suggesting
potential climate change impacts on depression and other mental illnesses.
Dementia is a risk factor for hospitalization and death during heat waves.
Patients with severe mental illness, such as schizophrenia, are at risk during
hot weather because their medications may interfere with temperature
regulation or even directly cause hyperthermia. Additional potential mental
health impacts, less well understood, include the possible distress associated
with environmental degradation and displacement and the anxiety and despair
that knowledge of climate change might elicit in some people.
(Slide 16)