Breath of Fresh…Smog?

With Air Quality on the decline due to climate change, what does this mean for the agency assigned to protect our health?


The Centers for Disease Control and Prevention (CDC) works 24/7 to protect America from health threats, fight disease, and support communities and citizens to do the same [1]. Climate Change is expected to increase both the severity and frequency of health problems and create unprecedented and unanticipated health challenges over the next few decades:

Figure 1: Impact of Climate Change on Human Health [2]
Figure 1: Impact of Climate Change on Human Health [2]
Climate change increases ground-level ozone (key component of smog) and/or particulate matter air pollution. This is associated with respiratory and cardiovascular health problems, such as diminished lung capacity, increased hospital admissions and emergency room visits, and increases in premature deaths. Heat, precursor chemicals, and methane emissions affect ozone levels. Particulate matter concentrations are affected by wildfires and air stagnation [3]. Estimates of health-related costs associated with air pollution assuming no change in regulatory controls or population characteristics range from 1,000 to 4,300 additional premature deaths nationally per year by 2050 and costs of $6.5 billion (in 2008 US dollars) [4]. Additionally, deaths from chronic lung diseases increased by 50% from 1980 to 2010, and chronic respiratory diseases are expected to become the third leading cause of death and possibly the costliest illness in the coming years [5]. Current US air quality policies are projected to reduce ozone generating emissions, but climate change is increasing the frequency of regional weather patterns conducive to increasing ground-level ozone, and unless the reductions can offset the influence of climate change, tens to thousands of additional ozone-related illnesses and deaths are expected per year [6]. Figures 2 & 3 show projected changes in ozone mortality rates in 2030 [7].

Figure 2: Projected ozone-related deaths in 2030 [7]
Figure 2: Projected increase in ozone-related deaths in 2030 [7]
Figure 3: Additional Ozone Deaths by Climate Region [7]
Figure 3: Additional Ozone Deaths by Climate Region [7]
As it is CDC’s mission to protect America from health threats, the threat of climate change due to air pollution is a real challenge that will affect its operating model in years to come.


In 2006, the CDC Climate and Public Health Framework was created to address and prepare for the impact of climate change on public, and in 2009, the CDC formally established the Climate and Health Program within the CDC’s National Center for Environmental Health (NCEH) [8]. The program is using the CDC’s prevention expertise to help state and city health departments prepare for climate change health effects. The mission of the program is to:

  1. Lead efforts to identify populations vulnerable to climate change.
  2. Prevent and adapt to current and anticipated health impacts.
  3. Ensure that systems are in place to detect and respond to current and emerging health threats.

The program is currently helping 16 states and 2 cities (Figure 4) utilizing the BRACE framework (Figure 5) to drive projections and analyses for use in public health planning and response activities [9].

Figure 4: CDC Currently Funded State and City Climate Change Programs [9]
Figure 4: CDC Currently Funded State and City Climate Change Programs [10]

Figure 5: BRACE Framework [10]
Figure 5: BRACE Framework [11]
The CDC is also encouraging communities to address the health threats associated with air quality per the following recommendations [12]:

  • Share forecasts of air quality index (AQI) from [13] through local TV stations, radio programs and newspapers. See Figure 6 for the AQI from Thursday, November 3rd, 2016 and Figure 7 for the AQI Levels.
  • People with pollen allergies should limit outdoor activities during days with high pollen counts.
  • Incorporate active modes of transportation through urban planning to reduce vehicle miles and traffic-related pollution.

Figure 6: November 3rd, 2016 AQI Forecast [12]
Figure 6: November 3rd, 2016 AQI Forecast [12]
Figure 7: AQI Levels Explanation [12]
Figure 7: AQI Levels Explanation [13]
It should be noted that the CDC is only one government agency tackling climate – many others are also addressing this problem.


While there is progress and change being made at the CDC from an organizational and action standpoint, additional steps are still needed. The currently funded states and cities in the CDC’s program are very limited when compared to the overall United States, and based on the data projections for health-costs (dollars and deaths), a more active and urgent approach is required. CDC should be using their position to implement changes at the national level rather than just working with other groups at the state and city level. The same BRACE framework and recommendations should be applied. Some possible solutions/actions include:

  1. Approaching national newspapers and publications to include the Air Quality Index (AQI) in their weather sections – For example, USAToday does not currently include AQI; however, this would increase awareness among populations vulnerable to pollutants in the air.
  2. Increasing the amount of protected bike lanes to encourage people to use alternative forms of transportation – Between 1874 and 2011, there were only 78 protected bike lanes, but there are currently 292 protected lanes as of the end of summer 2016 [14]
  3. Improving the distribution of Air Quality and Climate Change information to providers and at risk patients, which could be done through partnership with academic centers or patient foundations such as the Cystic Fibrosis Foundation, American Lung Association, or COPD Foundation.

Sixteen (16) states and two (2) cities against a world of climate change is not enough. (776 words)

















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5 thoughts on “Breath of Fresh…Smog?

  1. Air pollution is a very serious and pressing problem in greater China region. Currently many people still choose to work in Beijing for better job opportunities while we don’t really know the real risk of air pollution. There’s still not enough data to conclude how exactly is air pollution going to affect human health over 10, 20, 30 year period of time. It’s interesting to see how US is trying to address the issue and how we can collectly make a change.

  2. This is a disturbing problem arising from climate change that I have never thought about before. The role of the CDC in addressing this problem is very interesting since it will require multi-disciplinary solutions which require collaboration between different government agencies (State Departments of Transportation, Environmental Protection Agency, etc.) as well as private sector players and NGOs. On the bright side, it may be easier to get the general public to change their behavior and support climate change policies by focusing on the noxious air pollutants (not just CO2 – which doesn’t have any health effects) that they will have to deal with as climate change increases.

  3. I found it very interesting and impressive that the CDC identified this as a priority as early as 2006. Although large cities like NYC and LA were already experiencing discernible effects from air pollution, to roll this initiative out in other areas of the country demonstrates a longer-term perspective on the air pollution challenge. I am thinking of this in contrast to the Indian government, which has only just started enacting policies and pollution tracking now that Delhi has become the most polluted city in the world and that individuals are experiencing noticeable decreases in health quality on a daily basis. It makes me feel thankful to live in the US.

    On the other hand, I do wonder how closely the US government is working with companies to hold them accountable for contribution to air quality deterioration. Given how much industrial and transportation activities contribute to air pollution, it seems critical to me that the government is enacting thoughtful legislation on these sectors. Given that so much of this requires slow-moving regulation, I also wonder about the role that industry bodies may play in creating multi-company agreements and incentives.

  4. This is a great post and draws attention to the fact that we *don’t* pay enough attention to the impacts of climate change on our health. It is a problem that is easier to procrastinate dealing with if it is going to affect future generation, rather than us – but your post is a stark reminder that climate change is already affecting us and that the faster we can resolve some of its issues, the better off we will be in our lifetimes. I liked your point about engaging government at the national level instead of just the state and local levels, but I wonder if federal action will be as impactful. Is it more effective to get buy in from many state and local governments that are very connected to their communities or to engage the federal government to employ a sweeping mandate that may be a little out of touch with its citizens’ tactical needs?

  5. I am very surprised that climate change-related health issues is such a major issue in the US – I guess I’ve never really heard the same level of urgency in talking about lung disease attributed to smog and related issues in the US as I do in China. I am also surprised by the number of states in which the CDC is focusing their BRACE efforts – I have only heard of smog being an issue in the US in the state of California so was surprised to see how many other states were included on the map. I would love to better understand the magnitude of the health problem in the US today, and what people’s attitudes towards climate change-related health issues are. Are people very concerned or do they not see it as a threat? If the population doesn’t perceive this as an immediate threat to their health, I wonder how effective the CDC will be in getting people at a large scale to pay attention to things like the AQI index – I know at least for me, it’s not something that I pay much attention to currently. But I agree with you that to people with sensitive lung problems, it would be very important.

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