From Air Pollution to the Climate Crisis: - IA de Investigación especializada en el MIT

De la contaminación del aire a la crisis climática:
Leaving the Comfort Zone

Patrick L. Kinney

While climate change poses existential risks to human health and welfare, el público
health research community has been slow to embrace the topic. This isn’t so much
about a lack of interest as it is about the lack of dedicated funding to support re-
buscar. An interesting contrast can be drawn with the field of air pollution and
salud, which has been an active and well-supported research area for almost fifty
años. My own career journey started squarely in the latter setting in the 1980s, pero
transitioned to a major focus on climate and health starting around 2000. El
journey has been punctuated with opportunities and obstacles, most of which still
existir. In the meantime, a large body of evidence has grown on the health impacts of
climate change, adding more urgency to the imperative for action. Institutionaliza-
tion of climate and health within the federal regulatory and funding apparatus is
now needed if we are to make the transition to zero carbon in ways that maximize
health and equity benefits.

A s a public health scientist with an interest in environmental factors affect-

ing human health, there seem to be so many interesting problems to work
on that one rarely finds the time to step back and ask, how did I get here?
More personally, how did I make the transition from being a mainstream air pol-
lution health scientist to one of the few public health researchers looking at cli-
mate change? También, what opportunities and barriers molded my journey toward
that outcome? These are questions I hadn’t given much thought to before agree-
ing to participate in the May 2018 Witnessing Professionals and Climate Change
Workshop at Princeton University.1 I approach the questions that the conference
posed from the perspective of my development as a public health scientist over
a period in which the evidence for, and societal awareness of, climate change as
an existential challenge grew exponentially from a very quiet beginning. Engage-
ment by the public health field in the climate change discussion has grown pro-
portionately, but remains surprisingly limited.

In many ways, the story of my career started in a small city in Pennsylvania.
Donora is a steel town sitting low in the valley of the Monongahela River near
pittsburgh. Octubre 27, 1948, was a foggy, smoggy Wednesday in Donora. De hecho,

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the air was unusually thick even for Donora. The local steel mills and zinc smelter
were spewing out noxious fumes as they always did. But on that Wednesday, el
weather had changed in a way that made the pollution worse. A temperature in-
version had formed over the valley. An inversion acts like a lid, preventing upward
movement of pollutants emitted near the ground. Mientras tanto, the hills ensured
that nothing could move sideways either. Como resultado, pollution levels started to
build up. By the next day, residents began to report severe respiratory problems.
They were coughing and wheezing, and calling their doctors or trying to get to
the hospital. There was no relief on Thursday, nor Friday. Pollution continued to
build up. The air was so thick that driving became hazardous. Finalmente, on Sunday
night, the rain came and cleared the air. Sin embargo, during those few days when the
air was unusually polluted, twenty of the town’s fourteen thousand residents had
died. In the weeks following, another fifty people died of respiratory causes. Y
about half the town, around seven thousand people, complained of respiratory
problems as a result of the smog.

The Donora experience caught the public and many health professionals by sur-
prise. Until then, most people thought of pollution as a sign of economic develop-
ment and progress. Sure, it was annoying and could make your eyes burn, but no-
body really thought pollution could kill you. A few years later in London, en 1952,
there was an even more severe air pollution disaster, brought on under similar me-
teorological conditions as in Donora, a temperature inversion. Sin embargo, the pollu-
tion was different. In London, the culprit was coal combustion: residents and busi-
nesses in London burned coal to warm their homes and buildings. But because of
the inversion, all that coal pollution got trapped over the city. And London had a
much larger population than Donora, Pensilvania. Based on an analysis of death
records in London before, durante, and after the episode, epidemiologists have esti-
mated that over ten thousand people may have died from exposure to air pollution.2
Like Donora, el 1952 London smog event drew a great deal of new attention
to the health risks of air pollution from both the general public and policy-makers.
This led in the following decade to the first regulations to limit air pollution levels in
both the United Kingdom and the United States. En los Estados Unidos, the Clean Air
Act of 1963 called for setting National Ambient Air Quality Standards to protect hu-
man health, including for groups most sensitive to ill effects. The Clean Air Act also
created new demands for knowledge generation, information systems, air quality
planning and guidance, and air monitoring data. This soon evolved into a symbiotic
regulatory-science ecosystem combining regulatory agencies, affected businesses,
funding agencies, and academic researchers working together to clean the air. Este
would have profound and long-lasting impacts on the scientific and technical com-
munities. And it was remarkably successful. Just since 1990, hourly sulfur dioxide
concentrations decreased by nearly 90 por ciento; desde 2000, average annual PM2.5
(particulate matter) concentrations have dropped by nearly 40 percent.3

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149 (4) Fall 2020Patrick L. Kinney

W hen I entered graduate school in 1981, this regulatory-science ecosys-

tem for air pollution and health was well established. I quickly learned
that scientists did the research to quantify health effects of air pollu-
ción, and then the Environmental Protection Agency (EPA) used those findings to
periodically update air quality standards. States would clamp down on responsible
local emission sources, and would also put out air sensors as part of a nationwide
air monitoring network that tracked compliance with the standards. Interesting-
ly, that same monitoring network became the key source of exposure data for the
research community doing epidemiologic studies, such as a seminal study linking
mortality rates to long-term particulate matter concentrations in U.S. cities.4

There was a lot to do. There were many questions to ask, and as a graduate stu-
mella, I was eager to design studies to answer them. During my graduate training and
for several years afterward in the department of environmental medicine at New
York University (NYU), and later at Columbia, I helped design epidemiologic stud-
ies to answer questions like: Is ozone acutely associated with mortality? Do long-
term ozone exposures lead to chronic respiratory diseases, as suggested in some an-
imal studies? Do transportation sources such as diesel vehicles create hot spots of
unhealthy air near roadways? (The answers turned out to be yes in all cases.)

After five years as a junior faculty member in an NYU department complete-
ly devoted to air pollution and health research, en 1994, I was presented with an
opportunity to move to Columbia University. At NYU, I had been part of a very
productive but narrowly focused air pollution research laboratory set in Sterling
Forest, forty-five miles north of the George Washington Bridge, an easy fifteen-
minute commute on country roads from my upstate home. As I think back on it,
the idea of moving away from my comfortable niche at NYU was daunting. De hecho,
it took almost a year for me to finally decide to accept Columbia’s offer. Uno de
the key factors that finally pushed me over the edge was that Columbia University
was in the process of forming the Earth Institute (EI), a novel effort to coordinate
environmental sustainability scholarship across Columbia University. The EI’s
launch in 1995 was spearheaded by then Executive Vice-Provost Michael Crow,
who sought to create “a community of environmental and social scientists, law-
yers, policy and management analysts, health experts and engineers to collabo-
rate across schools and disciplines.”5 This holistic view of environmental science
was inspirational, holding the promise to open new research doors.

M oving to Columbia at that time turned out to have a profoundly positive

effect on my future scholarship. Joseph Graziano, my new chair and
the person who recruited me, was among the senior faculty launching
the EI. As soon as I moved to Columbia, I was immediately connected to a remark-
ably rich network of potential new colleagues. I kept working on my air pollution
and health studies, but I also kept one ear open for interesting new opportunities.

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Dédalo, la Revista de la Academia Estadounidense de las Artes & SciencesFrom Air Pollution to the Climate Crisis: Leaving the Comfort Zone

A door opened early in 1999 when I was invited to a meeting at the EI to discuss
joining a team to assess potential climate change impacts in the New York City
(NYC) metropolitan region. This was to be one of eighteen regional components
of the U.S. National Assessment of the Potential Consequences of Climate Vari-
ability and Change. Led by Cynthia Rosenzweig, senior staff at the NASA Goddard
Institute for Space Studies (GISS) in NYC and the Columbia Center for Climate
Systems Research, the EI team was seeking a faculty member who knew some-
thing about public health to complement a team of climate science and impact
modelers. At the first meeting at the EI, I met several new colleagues, incluido
Drew Shindell, a climate modeler at GISS. He told me about the model he used to
project future climate and air pollution under a range of greenhouse gas scenarios.
Drew was particularly interested in how climate change could affect ground-level
ozone concentrations. Ozone was something I knew a lot about. I had been do-
ing epidemiology studies to understand ozone health effects ever since graduate
escuela. It seemed like it would be fairly straightforward to project future ozone-
related health impacts if Drew’s model could estimate what the ozone concentra-
tions might be under future climate scenarios. I enthusiastically agreed to be part
of the team. Working with two master of public health students at the Mailman
School of Public Health, we developed a report on potential health impacts of cli-
mate change in the region, which was published in 2000 as part of the Metro East
Coast report.6

This was my first research on the health effects of climate change. A key pre-
cursor for such a transition was the existence of the interdisciplinary framework
of the EI that made possible the random connections that could lead to creative
collaborations, like mine with Cynthia and Drew. Cynthia was key in organizing
the Metro East Coast project, which was an intentionally interdisciplinary team.
Climate change is so complex a challenge that it naturally called for multidisci-
plinary teams. In the early stages, there weren’t too many people in any one disci-
pline working on it, so the teams would have one health person, one modeler, uno
impact assessor, a government stakeholder, etcétera. There was not yet a critical
mass of people in any one discipline at the table (especially true for public health)
to make it easy to stay in one’s comfort zone. You were likely to be the only person
from your field on the team. De este modo, one was forced to reach across and learn how to
talk and collaborate with the others. To take on this sort of challenging collabora-
tion I think calls for a certain openness to taking risks, a personality that is attract-
ed to new things. Why was I receptive to this? For one thing, there’s something
deeply invigorating about meeting new scientists in other fields and trying to un-
derstand what they do and how that might intersect with what you do. It’s like a
puzzle to solve. My doctoral training in environmental health was similarly multi-
disciplinary, so I was used to this. Environmental health was and is a very broad
domain, unlike biology or chemistry or economics, tal vez.

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149 (4) Fall 2020Patrick L. Kinney

A s I began to research the implications that climate change could have for

human health, I soon realized how little was yet known about this im-
portant topic. To be sure, there were pioneers, including Anthony Mc-
Miguel, Andy Haines, Paul Epstein, Jonathan Patz, and Kristie Ebi, who had
raised the alarm about potential public health risks of climate change.7 However,
the mainstream environmental health research community had not yet engaged
with the topic. The lack of research on climate and health was shocking, and a lit-
tle awe-inspiring. I hadn’t before had the opportunity to catch an early glimpse of
a whole new discipline that was as-yet unstudied, like an unexplored wilderness.
It surprised me, but also motivated me to start working in this field. For one thing,
it’s interesting to learn new stuff, and to be a pioneer in an uncrowded field. Pero
more important, it was clear that climate change was going to be a huge problem
for both Earth and society, and one that everybody would soon start to care about.
I began to build on that initial collaboration to expand my research on like-
ly health impacts of climate change. The connections I had made through the EI
formed an excellent foundation for an expanding network of collaborators. Uno de
the first questions we asked was: to what extent will climate change affect future
air pollution, holding everything else constant? And given those changes, qué
would be the health impacts? I had a special interest in ground-level ozone, cual
gets worse when temperatures increase. Ozone of course is desirable to have in
the upper layers of our atmosphere because it’s effective at blocking health-dam-
aging UV radiation. But you don’t want to breathe ozone, a strong oxidant gas that
has been associated with a wide range of adverse health effects, including prema-
ture deaths. Ground-level ozone is formed through reactions between nitrogen
dioxide gas and volatile organic compounds in the atmosphere, in the presence
of sunlight. Ozone formation is greater at higher temperatures, and ozone is the
main component of summer smog episodes.

By early 2000, when the EPA issued a request for applications for research proj-
ects to quantify health impacts of climate change, I was ready to jump in. We pro-
posed and were soon funded to model climate in the 2020s, 2050s, and 2080s, y
analyze what that might mean for ozone and fine particle pollution.8 We were
able to show that increasing health risks might occur in the NYC metro region
and throughout the Eastern United States.9 And that knowledge–early knowl-
edge that we began to generate–had some impact; Por ejemplo, in supporting the
EPA’s endangerment finding of 2009. In order to regulate carbon dioxide as an
air pollutant, the EPA needed to make the case that carbon dioxide and related
greenhouse pollutants have adverse health effects. But unlike ozone or fine par-
ticles, most greenhouse gases (GHGs) don’t directly harm health at ambient con-
centrations. What the EPA was able to show, sin embargo, was that GHGs, by driving
climate change, could result in adverse health effects from heat waves, worsening
air pollution, and other pathways. Our findings on climate-induced increases in

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Dédalo, la Revista de la Academia Estadounidense de las Artes & SciencesFrom Air Pollution to the Climate Crisis: Leaving the Comfort Zone

ozone-related mortality were part of the rather sparse set of evidence available for
the EPA to bolster its arguments in support of the endangerment finding. Witness-
ing this direct use of our research for policy development reinforced my commit-
ment to continue working in this field. Even though the U.S. climate and health
research enterprise remained quite limited at that point, it was gratifying to see
that the findings that had emerged to date were directly useful for policy-making.
Making the link to adverse health impacts was a critical piece of evidence that the
EPA needed. In addition to the EPA regulatory developments, findings on public
health impacts were used in periodic climate impact assessment reports, incluir-
ing those of the U.S. Global Change Research Program.10

T he transition I made from air pollution epidemiology to climate health

impacts research was relatively easy on the technical front. It turned out
that the research tools needed to quantify impacts of climate on health are
the same as those used to study the effects of air pollution on health. These include
epidemiology and biostatistics (used to estimate exposure-response relationships
using empirical data) and risk assessment (used to explore potential health im-
pacts or benefits of hypothetical scenarios of change). To be sure, climate change
does present unique methodological challenges to epidemiology, especially relat-
ed to its long-term gradual nature (something that epidemiology is not well suited
a). Sin embargo, en la mayor parte, there aren’t significant technical barriers to pub-
lic health scientists entering the field.

The challenge had more to do with the lack of a research “ecosystem” of the
sort we had for air pollution. Missing was a cadre of like-minded colleagues, sup-
portive departments, reliable federal funding agencies, receptive government reg-
ulators, etcétera. Most prominent among these as a barrier for public health re-
searchers has been the lack of federal research funding.11 Research on the health
effects of climate change doesn’t fit easily within the National Institutes of Health
(NIH), where molecular and mechanistic biological questions are of paramount
funding interest. Nor does it fit well at the National Science Foundation, dónde
health effects are of limited interest. Two key federal agencies, the Centers for Dis-
ease Control and Prevention and the EPA, historically played a central role in fill-
ing this gap by supporting work at the intersection of climate change and health.
Sin embargo, both agencies have seen their climate and health research operations
eviscerated under twelve years of oil-industry-infused presidential leadership
desde 2000, assisted by powerful climate deniers in Congress. The result is a lost
generation of critical scientific knowledge and expertise, which is now urgently
needed to develop cost-effective policies that both build health resilience to wors-
ening climate extremes and also maximize health and social equity co benefits of
rapid decarbonization strategies. To catch up will require a massive, ongoing fed-
eral effort to generate the needed knowledge.

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149 (4) Fall 2020Patrick L. Kinney

The gap in federal research funding has hobbled progress in this field and pre-
sented a substantial entry barrier to public health researchers who might other-
wise be highly motivated to generate urgently needed new knowledge. Most pub-
lic health schools reside in medical centers and operate on a soft-money model,
where the bulk of one’s salary must be funded from outside grants, ideally from
the federal government with full overhead. If the federal government isn’t funding
research on the health effects of climate change, too few public health researchers
can enter the field, in spite of the growing evidence of increasingly severe storms
and heat waves.

On the positive side, I’ve witnessed over the past decade a slow but steady
transition toward climate research among a small number of open-minded, Bueno-
established senior investigators who have reached points in their careers where
they have the freedom to shift away from what they’ve been doing to focus on the
crisis of climate change. At the other end of the career ladder, there has been an
influx of young predoctoral and postdoctoral climate investigators. What is miss-
ing so far are the midlevel, highly productive academic researchers whose career
advancement depends on a track record of NIH grants.

After my initial EPA STAR grant in 2000, much of my scholarly work on cli-
mate and health has been carried out without dedicated funding. While that has
made things a little challenging, the work has continued apace due largely to a
steady influx of highly motivated and extremely productive graduate students and
postdocs. For many years running, many of the very best students who applied to
our departmental Ph.D. program at Columbia wanted to study climate and health.
And we had funding to support both grad students and postdocs. Our trainees
made important discoveries about climate change and ozone, calor, pollen, y
other factors.12 Along the way, we created at Columbia the first dedicated program
on climate and health in the country, including a master of public health certifi-
cate. Por supuesto, the kinds of research studies that can be done with student labor
are limited to those where readily available data sets could be analyzed, or where
small-scale field studies could be carried out with small supply budgets and lots of
student footwork. That has limited the scope of work that I have been able to do.
También, given the bleak funding landscape, it remains uncertain whether students
who graduate with training in climate and health can expect to find jobs where
they will be able to apply their unique knowledge. The gap in institutionalization
and political defunding conspire to create dangerous currents against which cli-
mate and health practitioners will need to swim.

Still, we’re seeing more and more students wanting to work in climate and
health now, as the reality of climate change becomes ever more apparent. We’ve
seen so much evidence of change around us, and the lack of global or federal ac-
tion in the face of those changes has been deeply alarming to young people who
will inherit our world.

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Dédalo, la Revista de la Academia Estadounidense de las Artes & SciencesFrom Air Pollution to the Climate Crisis: Leaving the Comfort Zone

P ublishing scientific papers and working to inform policy developments are

important aspects of being an effective witness to the climate change cri-
hermana. Another way we can witness is by being better at communicating our
knowledge outside the academy. Most public health scientists publish research
results in papers in scientific journals. We go to conferences among our peers, y
we talk about our research with peers. Journals and scientific conferences have
seen a steady rise in climate and health research related studies. Those findings are
sometimes picked up and used by regulators and policy-makers. But for an issue
of the magnitude of climate change, the audience we need to reach is much larger.
Health concerns can be a big motivator of public support for environmental regu-
laciones. Though we haven’t been trained to do it, there is an urgent need for health
scientists to communicate more directly with the public about the health effects
of climate change. Climate change remains a politically divisive topic, partly due
to the lack of knowledge among the general public about the many direct connec-
tions with human health. Survey research has shown that attitudes toward alter-
native energy sources among Americans are informed by environmental health
risks as well as cost considerations.13

While climate change itself remains a politically divisive topic, improved pub-
lic knowledge about the health implications of our energy choices could help lead
us toward strategies that are good for both health and the planet. Filling the knowl-
edge gap calls for different kinds of communication tools than most researchers
have been trained for. Researchers will increasingly need to make the effort to tell
the story of climate and health in words that convey greater feeling and meaning
to more people.

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Sobre el Autor

Patrick L. Kinney is the Beverly Brown Professor of Urban Health at the Boston
University School of Public Health. He has recently published in such journals as
New England Journal of Medicine, Nature Climate Change, The Lancet Planetary Health, Sci-
ence of the Total Environment, and BMC Pregnancy & Childbirth.

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149 (4) Fall 2020Patrick L. Kinney

notas finales

1 Witnessing Professionals and Climate Change Workshop at Princeton University,
Puede 12, 2018, https://uchv.princeton.edu/events/witnessing-professionals-and-climate
-change-workshop.

2 Ver, Por ejemplo, Michelle L. Campana, Devra L. davis, and Tony Fletcher, “A Retrospective
Assessment of Mortality from the London Smog Episode of 1952: The Role of Influenza
and Pollution,” Environmental Health Perspectives 112 (1) (2004): 6–8.

3 Estados Unidos. EPA trends reports are a good source. Ver, Por ejemplo, Environmental Protec-
tion Agency, Our Nation’s Air (Washington, CORRIENTE CONTINUA.: Environmental Protection Agency,
2018), https://gispub.epa.gov/air/trendsreport/2019/#introduction.

4 A good example of a study that took advantage of air pollution data that had been collect-
ed for other purposes is C. Arden Pope III, Richard T. Burnett, miguel j.. Thun, et al.,
“Lung Cancer, Cardiopulmonary Mortality, and Long-Term Exposure to Fine Particle
Air Pollution,” Journal of the American Medical Association 287 (9) (2002): 1132–1141.

5 See the Earth Institute at Columbia University, “About Us,” https://www.earth.columbia

.edu/articles/view/3341 (accessed November 14, 2019).

6 “U.S. National Assessment of the Potential Consequences of Climate Variability and
Change–Region: Metro East Coast,” Climate Impacts, http://www.climateimpacts.org/us
-climate-assess-2000/regions/metro-east/default.htm (accessed November 14, 2019).
7 Examples of early reviews on climate and health include: Jonathan A. Patz, Michael A.
McGeehin, Susan M. Bernard, et al., “The Potential Health Impacts of Climate Vari-
ability and Change for the United States–Executive Summary of the Report of the
Health Sector of the U.S. National Assessment,” Journal of Environmental Health 64 (2)
(2001): 20–28; Paul R. Epstein, “Is Global Warming Harmful to Health?” Scientific
Americano 283 (2) (2000): 50–57; and Andrew Haines, Antonio J.. McMichael, and Paul
R. Epstein, “Environment and Health: 2. Global Climate Change and Health,” Canadian
Medical Association Journal 163 (6) (2000): 729–734.

8 Christian Hogrefe, Barry Lynn, Kevin Civerolo, et al. “Simulating Changes in Regional Air
Pollution over the Eastern United States Due to Changes in Global and Regional Cli-
mate and Emissions,” Revista de Investigación Geofísica: Atmósferas 109 (D22) (2004).

9 Two papers that emerged from that work that specifically focus climate impacts on the
health effects of ozone were Michelle L. Campana, Richard Goldberg, Christian Hogrefe, et
Alabama., “Climate Change, Ambient Ozone, and Health in 50 A NOSOTROS. Cities,“Cambio Climático 82
(1–2) (2007): 61–76; and Kim Knowlton, Joyce E. Rosenthal, Christian Hogrefe, et al.,
“Assessing Ozone-Related Health Impacts under a Changing Climate,” Environmental
Health Perspectives 112 (15) (2004): 1557–1563.

10 A NOSOTROS. Global Change Research Program, The Impacts of Climate Change on Human Health in the
United States: A Scientific Assessment (Washington, CORRIENTE CONTINUA.: A NOSOTROS. Global Change Research Pro-
gram, 2016).

11 Kristie L. Ebi, John Balbus, Patrick L. Kinney, et al., “U.S. Funding Is Insufficient to Ad-
dress the Human Health Impacts of and Public Health Responses to Climate Variability
and Change,” Environmental Health Perspectives 117 (6) (2009): 857–862.

12 Examples include Katrin Burkart and Patrick Kinney, “Is Precipitation a Predictor of Mor-
tality in Bangladesh? A Multi-Stratified Analysis in a South Asian Monsoon Climate,"
Science of the Total Environment 553 (2016): 458–465, https://doi.org/10.1016/j.scitotenv

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Dédalo, la Revista de la Academia Estadounidense de las Artes & SciencesFrom Air Pollution to the Climate Crisis: Leaving the Comfort Zone

.2016.01.206; Kai Chen, Arlene M. Fiore, Renjie Chen, et al., “Future Ozone-Related
Acute Excess Mortality under Climate and Population Change Scenarios in China: A
Modeling Study,” PLOS Medicine 15 (7) (2018); Kim Knowlton, Barry Lynn, Richard A..
Goldberg, et al., “Projecting Heat-Related Mortality Impacts under a Changing Climate
in the New York City Region,” American Journal of Public Health 97 (11) (2007): 2028–
2034; Tiantian Li, Radley M. Horton, and Patrick L. Kinney, “Projections of Season-
al Patterns in Temperature-Related Deaths for Manhattan, Nueva York,” Nature Climate
Cambiar 3 (2013): 717–721; Jaime Madrigano, Kazuhiko Ito, Sarah Johnson, Patrick L.
Kinney, and Thomas Matte, “A Case-Only Study of Vulnerability to Heat Wave-Related
Mortality in New York City (2000–2011),” Environmental Health Perspectives 123 (7) (2015):
672–678; Elisaveta P. Petkova, Antonio Gasparrini, and Patrick L. Kinney, “Heat and
Mortality in New York City since the Beginning of the 20th Century,” Epidemiology
25 (4) (2014): 554–560; and Perry E. Sheffield, Kim Knowlton, Jessie L. Carr, and Pat-
rick L. Kinney, “Modeling of Regional Climate Change Effects on Ground-Level Ozone
and Childhood Asthma,” American Journal of Preventive Medicine 41 (3) (2011): 251–257.
13 Stephen Ansolabehere and David M. Konisky, Cheap and Clean: How Americans Think about

Energy in the Age of Global Warming (Cambridge, Masa.: La prensa del MIT, 2014).

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149 (4) Fall 2020Patrick L. Kinney
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