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The press coverage was immediate and sensational, "Queen Letizia of Spain showcases Parisian chic in the French capital." Unbelievable. The queen was elegant, however, her presence was intended to draw attention not to her attire, but rather to the World Health Organization's (WHO's) Second Global Conference on Health and Climate that took place July 7-8, 2016, in Paris. Paris is where I happen to be at this moment, extracting energy from tiny cups of espresso before the long, tedious flight home to Denver. It's a little after 9 a.m. on Saturday, and I'm obsessed with the press's attention to the queen's attire, especially when life as we know it hangs in the balance.

The original Paris Agreement, of which the U.S. is a signatory, was completed on December 12, 2015. The agreement aims to curb greenhouse gas emissions to limit global warming to below 2 [degrees]C. The agreement also commits countries to implement adaptation plans to protect human health from the worst climate change impacts. In the absence of a successful implementation, rising global temperature will exacerbate heat waves, droughts, floods, and fires. These outcomes, regretfully, will lead to disruption in food and water supplies, and likely give rise to vectorborne, waterborne, and foodborne infections.

I've listened intently over the last two days to small Pacific Island nations like Tuvalu, which convey exasperation over the impending submergence of their way of life under rising seas. Closer to home, healthcare systems in Saint Vincent and the Grenadines have innovated to adopt a Smart Hospital Initiative, in part to adapt to increasingly common extreme storms that ravage the Caribbean. Regretfully, these tiny nations are on the leading edge of the battle while larger countries, such as the U.S. and Australia, struggle to achieve national consensus on a way forward.

First, let's be clear. The climate has always changed; it is the acceleration of those changes that threaten life as we know it. While much about the climate conversation has been muddled by conjecture and half-truths, there are three undebatable extremes being observed in the U.S. and abroad: 1) extreme precipitation and drought cycles, 2) extreme high sea levels, and 3) extreme warm spells. On any given day, some part of the U.S. suffers from these extremes--simply read your local paper for examples. The deputy mayor of Paris attended the Conference and reported that in 2003, five consecutive days of temperatures above 95 [degrees]F led to 13,000 excess deaths. Paris is not unique.

You may recall my column last year ("Go Big or Go Home," September 2015), which highlighted the Earth's human population mass migration to cities. This migration drives annual increases in the population of big cities by 60 million new residents per year. By 2050, some 70% of Americans will live in cities where air quality is notoriously poor and asphalt-induced heat sinks exist. The air quality in these urban areas will continue to decline unless major carbon-based emission interventions are implemented. Globally, some seven million people die each year from air pollution. We also believe that 36% of lung cancers and 34% of strokes are related to poor air quality, which are exacerbated by climate change.

While I could impress you with additional statistics, that's not my aim here. Americans cherish the health, safety, and security of their families. It is time to toggle toward solutions, and society will benefit from our profession's participation in the dialogue.

What is our profession's immediate role and responsibility in climate and health? I share four ideas with you.

1. Raise awareness. Normalize the climate conversation at home and in your community about the effects of a rapidly changing climate. We know that evidence and data alone do not necessarily sway public opinion. Think about gun violence, immunizations, and lead paint if you need immediate examples of where data and evidence have failed to impact public opinion. Recognize and start with the values and beliefs of your community. Tell stories and appeal to our human emotions centered on safety and security. The British in attendance at the Conference openly described the "Brexit" referendum as an emotional decision, not an evidence-based one. Let's identify and harness the emotive power of our arguments.

2. Lead by example. Do the right thing. Where possible, move away from carbon-based energy and promote clean and renewable energy sources. What does that look like in practice? Personally, for our part, Angela and I walk to work and hop on public transportation whenever we can. We deliberately purchase locally sourced food and have reduced our meat consumption.

We are also sensitive to our association's visible leadership role. The NEHA 2016 Annual Educational Conference (AEC) & Exhibition was largely a paperless event. We are also slowly migrating toward a paperless NEHA office environment, and an ever-increasing number of our members elect to receive the Journal electronically. Each of us can be leaders in sustainability and reduced energy consumption within our individual means and social context.

3. Spend more of your time being interested and less time being interesting. Learn about sustainable food systems. Educate yourself on the opportunity costs and benefits of renewable energy sources. Reflect on your professional role in a rapidly urbanizing planet. Read an article on evolving vector ecology. Become versed in One Health. Make plans to attend the 2017 AEC in Grand Rapids next July, where sustainability and climate change will receive the attention they deserve.

4. Insert yourself into the conversation. I was deeply troubled throughout much of the Conference by repeated references to the role of the health sector, which almost exclusively was linked to the contributions of doctors and hospitals. Cut me a break. For the record, our profession is part of the health sector and we need to self-invite ourselves to the party. I was also disappointed by the composition of the American speakers in Paris. The U.S. National Institute of Environmental Health Sciences, an American economist, and a New York-based nongovernmental organization, Health Care Without Harm, gave presentations. Where were our government's premier environmental health practice agencies such as the Centers for Disease Control and Prevention/National Center for Environmental Health and the U.S. Environmental Protection Agency? During the closing session I spoke publicly in front of the 500 or so delegates about the potential contributions of the sizeable global environmental health workforce, which had been largely overlooked throughout the Conference. This omission represented an inexplicable oversight by WHO.

Queen Letizia left a lasting impression on me. She was gracious, she was accessible, and most importantly, she remained in the Conference auditorium listening intently for hours after her speaking opportunity had passed. She also said something during her prepared remarks that cling to me, "Each of us must embrace a fundamental change in attitude toward nature and each other." That would be a magical development if realized--one I aspire to for my career in environmental health and one we might reflect upon as a professional community.

You can view the Conference's conclusions and action agenda at climate-change-0.

The Hotel Edgar staff inform me that it's time to move on ... got a plane to catch.

Twitter: @DTDyjack

David Dyjack, DrPH, CIH
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Title Annotation:DirecTalk MUSINGS FROM THE 10TH FLOOR
Author:Dyjack, David
Publication:Journal of Environmental Health
Article Type:Column
Geographic Code:1USA
Date:Sep 1, 2016
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