Jan C. Semenza - The impact of climate change on public health

Transcript

The following transcript is AI generated and may contain errors.

Well, thanks again.

It's great to be here.

I have been given this impossible task to summarize the impact of climate change on population health.

Let me give you just one slide that summarizes my talk.

And so hey, OK, guys, time to choose heat wave, heavy rains, or West Nile virus.

So guess what?

This slide summarises my talks.

If you need to go back and deal with your patients, do it now, because this is all I'm going to cover today.

You have seen it all.

There's no more than this.

I always speak about heat waves, vector-borne diseases, and waterborne diseases in the context of population health.

And there's a lot of bad news, unfortunately, but I will also talk about adaptation and mitigation, how we can turn this around.

So anyway, this summarizes my talk.

And if you just look at one of these Nordic countries, I happen to live in Sweden, you can look the average summer temperature in Swedish, and if we compare it to a 30-year baseline, we can see that there's this dramatic deviation from that baseline in the 60s or 70s and 80s.

And you see it's getting warmer and warmer.

We are breaking records after records, so that's bad news.

ambient temperature obviously impacts the ice caps.

We can see a shrinking of the or icecaps in particularly people that live in Iceland have experienced that firsthand.

I was born in Zurich in Switzerland where all the alpine glaciers are retreating as well.

So it's obviously have an impact on our environment but also on public health.

And so at the very top layer here you can environmental climatic exposures that impact population health.

So for example, you can see here severe weather leads to injuries, fatalities and drowning, extreme heat leads heat related mortality, morbidity, air pollution, asthma, water contamination, changes in vector ecology, and so on.

So these are some of these key impacts.

And they only gave me 40 minutes to cover this, so I will give you a short version of this.

But the key message, the way do you want to think about this?

There are three components to this risk that you need to thing of.

This is the pillar of the talk today.

You need consider the hazard, which are these climate hazards that you saw before.

So this can be temperature, actually here, one second.

So temperature, heavy rain or heat waves, so these are the climate hazards.

But then we also talk about population vulnerability or individual vulnerabilities.

So comorbidities, population demographics and things like that.

These vulnerabilities are another aspect of the climatic risk that you need to take into account.

And then of course there is exposure.

Do you build a house in the floodplains where your house can get impacted by heavy rains and flooding?

Do get exposed to wild animals and Ebola is a good example of that.

hygiene and sanitation, wash systems, wild animals and things like that.

So that determines the risk at the heart of this Venn diagram.

If you think about climate risk, you always want to think of hazard, vulnerability and exposure that determine that risk.

For us in public health, the question is what do we do about this?

And so this is our strategy here.

We would like to reduce the hazard, reduce vulnerability and reduce exposure.

And what do we do?

In population, in public health, what we can do, we change that.

reduce that risk at the heart of the Venn diagram by driving climate change adaptation, preparedness and prevention.

That's the kind of strategy that we can take.

We can also reduce the exposure and then In a discipline that's not necessarily in public health, we can reduce greenhouse gas emissions.

And that is more like in the larger societal context of energy use and things like that.

But I'll show you a few examples where it could potentially impact mitigation strategies also.

So those are the strategies that we can take and this will be the basis of my talk and you will see at the end of the talk, I will talk about some of these uplifting adaptation and mitigation strategies, that can potentially use to counteract the impact of climate change.

So coming back to this slide here, let me focus on heat-related mortality.

And it turns out that the Swedish government assessed the risk for climate change on public health in a detailed report that I was part of.

So we basically went through all the different risks in Sweden.

This is the diagram that we came up with.

weighted risk analysis, where on one side, we look at the impact on the y-axis against the probability of that impact to happen.

And those who can read Swedish, or everybody can't read it, but understand Swedish.

You can see that heat waves is at that top of the weighted-risk assessment here.

It turns out that I was confronted with that issue when I worked at CDC, the Centers for Disease Control in the US.

And my boss called me at 9 o'clock at night and told me, hey, Jan, listen, pack your bag.

You're shipping out to Chicago.

And why is that?

Well, it turns out that a heat wave killed 700 people, and you need to figure out what's going on.

A heat wave?

And what is that?

So it turns out that for my PhD, I isolated the heat shock receptor.

It's called the KDL receptor, and it turned out I knew everything about heat on a molecular level.

I had never heard of a heatwave.

that it would impact population health.

And guess what?

Nobody else did.

This was 30 years ago.

So nobody knew what that was, and I was supposed to figure out what was going on.

When I came to Chicago, we saw this.

I don't know if you can tell what this is.

It turns out that they brought a cooling truck to the morgue, where all these bodies were overflowing and didn't have the capacity to store them in their cooling space in the Morgue.

They brought these meat trucks.

Any meat eaters in here?

I'm just checking.

Anyway, so they brought the cooling truck to the morgue to take care of all these dead bodies, and they were going through these autopsies and tried to determine whether this was real or not, because there was a controversy between the mayor in Chicago, Richard Daly, a medical examiner, Dr.

Donahue.

He claims there is an epidemic.

The mayor said this is overinflated, they clashed and I was supposed to sort out who was right.

And so we went through the case definition that he had used for decades and we decided this was a real epidemic that was going on in Chicago.

I had a friend in town and had an enemy in time.

And you can see that the news were hitting the newspapers all over the U.S.

And we assessed the situation by looking at the heat index.

And nobody knows what that is.

It's a combination of heat and humidity.

We saw that it was going up really, really quickly in July.

Then after three days, we saw this dramatic increase in mortality as a result of that heat.

So we set up a case control study where we conducted 700 interviews in Chicago to figure out why did so many people die due to that heat.

And we went through all these different risk factors from social factors, environmental factors pre-existing medical conditions, you name it.

We went though the whole bit to differentiate why people died and why some other people didn't.

Again, this is a one-hour talk.

Let me give you one slide.

This is the one slide.

I don't know if you read odds ratios, but it turns out that people that have social contacts were less likely to die.

So if participate in church activities, if your part of a club, If you go bowling with your friends, you are less.

Likely to Die.

If we have friends in Chicago, You will are.

Less likely.

To die, even if we.

Have a pet at home, your less like it to.

Die, But if.

You live alone.

your increased risk.

And now let me give you the most dramatic slide that illustrates the dramatic impact of social isolation on population health in America.

What does that translate to?

I don't know if you can see what this is.

These are caskets that are brought to mass burial because nobody knew who that person was.

I remember I was trying to interview someone who knew that alcoholic who came with a brown bag with his whiskey bottle to his room and drank himself to death during the heat wake.

Nobody knew him.

So these were the people that were brought to Mass Burial.

This is the price of social isolation.

And we have spoken here in this conference about the importance of Social Contact because it can protect you from this type of climate change impact.

What I showed you earlier, the dome structure, it's all about social networks, social capital, ability to do things together, and this is what killed these individuals, a lack of contact.

So what we did with that information, now we have identified who is at increased risk for heat-related mortality.

We knew who the vulnerable people were.

And so we came up with heat health action plans where you can reach out to those vulnerable individuals that are at increase risk because it turns out that through methodological forecasts, you know that a heat wave is coming in five days.

Determine a heat threshold like, you know, it's going to be hot next week and then you can come up with a warning and alert and you Can reach out to those vulnerable individuals that sit in the nursing homes or live alone and?

Build a phone bank of these individuals here and Then you take action to make sure that you bring them to cooling shelters you reach Out to Make sure they stay cool that they drink and all that to protect the lives because nobody has to die from a Heatwave during that extreme weather It turns out that the Americans learned from that, and they reduced the heat wave mortality dramatically, but the Europeans didn't pay attention.

It turned out, that Europe was impacted by a massive heatwave a couple of decades later.

And I don't know if you can see this bar, this Gauss curve here.

This is summer temperature over the centuries, And now you see that 2003 hit, maybe some of you remember, it was the hottest summer ever, And something like 70,000 people died during that heat wave in 2003. So the Europeans learned, we need to do something about this also.

And they started implementing these heat health action plans as well that have now been implemented in Europe, world, continent-wide.

They have had a great impact on heat layer mortality since.

The bad news is that at the same time, we have seen an increase in the vulnerable population.

So this graph here is from the Lancet Countdown Europe, where we published these indicators on a yearly basis to see where are we at when it comes to climate change and health.

And you can see here that if you look at people over 65 in Nordic countries, which is the blue line here, You can see an increase in the vulnerable population because our populations are aging.

We see more and more of these heat waves.

So these person days of risk are going up.

Again, that vulnerability that I mentioned earlier are growing up combined with the exposure to heat.

And so this puts it at risk.

And in fact, if you look at Sweden, which is a cold Nordic country like Finland, Norway, Denmark, and Iceland, but in 2018, we experienced a massive heatwave here in Sweden with something like 750 excess deaths due to that heat.

So even here, in Swedish, where we are right now, We are at-risk from these types of heatwaves.

And so this slide here looks at three different years because it turns out that after 2003, 2022 was the hottest year ever recorded here in Europe.

And work that was done by my colleagues at IS Global in Barcelona they calculated the mortality in Europe due to that extreme heat in 2022. And you can see that Western Europe, in particular Spain, but also Italy and Greece, were at impact, at increased risk from heat-related mortality, during that extremely hot year in 2020. Guess what?

2023 was the hottest year ever reported the year after that.

So we beat the record in 23. And again, a lot of people died in the southern part of Europe.

Then guess what, 2024 was that hottest day ever recorded.

We beat a record again.

Something like 60,000 people die mainly in eastern, southeastern Europe, and if you look at these numbers, it's staggering.

Check this out.

So here you see the summary.

In 2022, we had almost 70,000 people that died, in 23, 50,00 in 24, 60, 000 people.

I don't know if you know what these numbers mean.

If you think about 300 airplanes that crash with 200 people each, that's 60 000. Did you guys read about that in the newspapers?

Even airplane goes down with 60 people.

It's all over the news.

We are talking about 300 airplanes with 200 people each that crash.

And guess what?

Nobody's talking it.

What is wrong with us?

This is heat related mortality as we speak.

If this is not staggering, it's incredible.

So in summary, I would like to close out my first part of my talk with this depressing news.

And so basically, It turns out that 24 was another extreme year with 60,000 or so.

Altogether over the last three years, we had something like 180,00 people that died as a result of that extreme heat.

future projections don't look good and what we can do that work on the regional health we, can implement these regional heat health action plans.

We need to do better because these early warning systems do work but only work if we engage the population and get the message out to the most vulnerable and so something needs to be done to reach those individuals and we are in the process now publishing of the Lancet Countdown, where instead of using methodological forecast, we use exposed response curve to compute the actual mortality and whether there are women or men and what age group are at increased risk to target those individuals.

So there new innovations coming through the pipelines now where we develop better heat health action plans.

Coming back to baseline, so this slide again, I would like to talk about two vector-borne diseases that are relevant in this context.

I'd like talk to tick-born encephalitis specifically, but also mosquito- born diseases in the southern part of Europe.

And so here, this is infographics from the European Centers for Disease Prevention and Control, where I used to work, by the way.

core of this slide, if you can see this in the back.

But here, these are eggs from a tick.

And so these ticks, they're like spider-like animals.

They have a very complicated life cycle.

To go through different types of life cycles.

You can that these eggs, the hatch, and they hatch into larvae.

Once they are a larva, They need to feed on a small little animal, a bird or rodent, in order to mold into the next phase where there are nymphs.

And then they need to feed again on the squirrel or something like that in order to mold into an adult animal.

And that's where the female then bites a bigger animal like a human or a deer.

Then the females lay something, like 2,000 eggs or crazy like, and then she dies.

It turns out that these animals have to feed three times, breakfast, lunch, and dinner.

In fact, I called it the last supper because after that, they die.

But we humans, we are the dead-end hosts.

So once the female dies, but we might get infected with a bite like that.

And if you look at tick-borne encephalitis, In Europe, these are the data that are submitted to the European Centers for Disease Prevention and Control.

You can see that there is a band here in the central part of Sweden.

Stockholm is particularly impacted, but also Gothenburg and the region where we are.

And then the southern part Norway is impacted by TBE.

They report data on a country level as opposed to a NUTS 3 or a regional level to ECDC.

So this is not correct.

There is no risk up here.

No risk in the country of Finland either, except around the Baltics.

That's how you can see that the baltic states, in fact central Europe here, Switzerland, where I was born, are at increased risk.

And so, central Europe and the northern part of Europe are increased for tick-borne encephalitis.

And we received data from Folke-Helsmut Jähten in Stockholm, and we plotted out the risk.

You can see that, particularly in Western Sweden and around Stockholm you see this dramatic increase in tick bone enzephylitis over the years.

So, there's something that's driving this increase.

So it turns out that TBE, you know this much better than I do, is a vaccine-preventable disease, and it's quite dramatic.

A friend of mine wanted to get the vaccine.

He dragged his feet, he was procrastinator, got infected, was hospitalized for weeks with paralysis.

You know how dramatic that is.

It's something that's entirely preventable, but a very dramatic disease that you can't really treat.

And so we looked at the variables that drive this disease.

It's a very complicated disease because you have the ticks, you the hosts, the rodents, and you've the humans, it's extremely complicated.

And what we did here, we used machine learning, artificial intelligence.

We have talked about that here too.

In this case, We can add all these variables into the system, and then the machine can sort out which are the most important variables.

And we can see whether this model works by predicting where the risk is going by holding some data out to see where it works.

So this is a model with a high predictive value.

We see that roe deer, for example, is the factor here at the bottom.

These are citizen science data where we looked at where people report roadkill or sick animals.

So this is the interaction between humans and animals, so this term here captures where are people getting close contact with wildlife.

We can see deer, what's called rodents, to be another factor.

But guess which one?

Which one is most important factor?

Temperature.

So temperature is the most strongest driving force for tick-borne encephalitis in Sweden.

And we see that that is a big risk factor.

We can now take this temperature forward in time under the moderate emission scenario.

You can see the band around Stockholm and Western Europe expands, so we can where the risk is going.

In fact, we project that forward in time.

You can see here the 30s, 50s 70s and 90s.

And you can See how those areas are getting more and more bigger and bigger.

Now this data can now be used for vaccine planning to make sure that we increase the vaccine coverage in those Areas that are at increased risk for TBE.

It turns out that Stockholm just enforced or facilitated subsidized vaccines for children and that's something that we need to consider in the future for those areas that are at increased risk.

We can project that forward in time under different exposure emission scenarios.

So we don't know what the future holds.

Either we get our act together and we reduce greenhouse gas emissions, or we drill baby drill, as our friend in the US tells us, to pump as much oil as we can and burn as many fossil fuels.

And you can see that if we do that, temperature will go up, and at the same time, the TBE trend will be a 60% increase per decade.

And so in summary, we can see that there is a strong climate link and climate change will then exacerbate that problem.

So we see the temperature over 12 degrees will increase the TBE risk.

That's temperature in the third quarter of the previous year that's associated with the risk And now we can project that forward in time, and you can see that under the climate change scenarios, if you see an 100% increase or so, but with vaccination strategies, we potentially contain that risk and fight back.

So my next chapter will be mosquito-borne diseases, because while we have been speaking about ticks, They are really focused on tick-borne diseases at the moment.

So this is our window of opportunities.

It turns out mosquitoes are on it and they take advantage of this.

And this our friend, the Asian tiger mosquito.

He was introduced twice into Sweden in 2023 in Lidingö and in Skåne, probably also in Åland.

So this mosquito has been introduced into Sweden, but it was initially introduced in Albania in 79, then in the 90s into Genova, and I'll show you a slide of that in a minute.

But this one here is the mosquito that transmits chikungunya, dengue, zika, all these tropical viral diseases that are transmitted by mosquitoes.

This next slide is from the Lancet Countdown Global, where we looked at the climatic suitability for these mosquitoes.

There are two mosquitoes, one is Aedes aegypti and one Aedas albopictus.

and these are the ones, and you can see that if we look at the estimated R0, so this is not a true R 0, this climatic suitability for transmission, we can that the climactic suitablity has a dramatic increase, particularly for albopictus, by 50% or so, over a baseline from the 50s.

So we take a base line from 50 and see how that changes over time.

And you can see there has been an incredible increase in that suitability, climatic suit ability for transmission for all the pictures.

But guess what?

It's not just temperature, right?

You cannot have a one track mind.

It is a multifactorial issue.

it turns out that the other factor that drives dengue transmission is what.

population mobility.

So these are flight passenger volume that's coming into Europe from all over the world.

Population mobility is the problem because it turns out if someone goes to Thailand, as a lot of Swedes do, and gets infected by a mosquito, that gets bitten by a mosquito that's infected with dengue or chikungunya, they will bring that virus back because they fly within the viremic period, and they land in Barcelona and Rome or Milan.

And that where they get bitten another local mosquito.

Then that local mosquitoes causes a local outbreak.

We call this octoctonous transmission, local outbreaks.

Human population mobility is one problem.

What is the other problem?

As I mentioned earlier, these mosquitoes, they move, too.

So where do you want to go?

Mountains, forest, beach, or city?

I don't care, as long as it's warm.

It turns out mosquitoes don' t fly that far, maybe 100 meters, but they hitchhike along.

They get into the car, get under the cars, and they expand along the transportation corridor.

There are great at expanding, so we move but so do they.

And this map here shows how Albopictus was first introduced in the 90s into Genova and then it expanded on the Italian peninsula after a decade or so.

It moved into France and Spain and it's been moving north ever since.

So here you have, I don't know if you can see this in back, this is five years, so this 92, 1990 to 1994, 1999, and so on.

And you can see that it's moving up into France and Germany.

So this is massive expansion of this mosquito.

We have shown that this not on here, that the mosquito moves 60 kilometers a year.

It turns out that these outbreaks that they bring, they move at 120 kilometers a year, even faster.

And we can see that per year we have something like 50 million people more that get exposed to this potential mosquito.

Because these are the districts and you can that it's getting more and more districts here.

Italy, 100% of districts are infected and so on.

But if you look at these local outbreaks, so we're not talking about imported cases, we are talking local dengue or chingunya outbreaks in Europe, you can see that this is a rapid increase.

Have you ever heard of an exponential curve, anyone?

Well, if haven't, this one.

So this is an incredible increase.

This is unbelievable.

It's just skyrocketing.

We see this incredible increases in local dengue outbreaks in Europe.

And in fact, if you translate that into the district, you can not see, this administrative region.

You see again an exponential increase, a dramatic increase in those districts.

And so we asked the question, how long does it take for the mosquito to arrive in one district until we have the next dengue outbreak?

And that's illustrated on this slide here.

So here you can see that in the 90s, the mosquitoes arrived in a district, and it took 25 years for their first dengu or chingunya outbreak.

It arrived at 90 in district and then it takes 25 Today it takes five years until we have the next outbreak.

So now the mosquito arrives today in a district, it only takes 5 years, until you will see the first dengue outbreak So what is driving this?

Why do we see this acceleration in this survival time?

Survival time in, this case, is arrival of the mosquito in a district until we have the next outbreak of dengue.

And it turns out we set up this multivariate regression model to compute the hazard ratio.

It turns up urban areas are more at risk compared to rural areas.

We see that imported cases are a problem, an area that has more imported case from Thailand or somewhere, they are at 8% increased risk.

If you see health expenditures, it turns out that those districts that have more health expenditure, 100 euro per capita per district, we see a 20% increase in dengue outbreaks.

So that means we need to reduce health spenders.

Good.

That doesn't make sense, right?

So it turns out that those districts that spend more on health, they're more likely to detect a dengue outbreak because they think that if you don't have the resources, you're not going to check for dengo or chikungunya or something like that.

If you invest in health you've got to pick those up, so that's a good thing.

And then, of course, climate.

It turns our climate, one degree increase in mean summertime situation increases the risk by 55%. And so, again, temperature is one of the strongest drivers of this acceleration of these outbreaks.

And why is that?

It turns out that mosquitoes are cold-blooded.

They don't like it cold.

OK, let me know when it's 18 degrees or higher.

It doesn't work when its cold, right?

So they hang out.

So what did we do?

We separated the colder districts compared to the warmer districts.

We stratified them into two different groups, and we looked at how fast does a cold district transition to an outbreak compared to a warm district that transitions to outbreak.

And you can see this Kaplan-Meier survival curve where these curves separate.

So the warmer districts are more likely to experience an outbreaks.

A mosquito arrives in a worm district and then it's much faster until we have the first dengue or chingunya outbreak, does that make sense?

So in summary, I'm done with the second part of my talk here.

1% increase risk in mean summer temperature is associated with a 55% percent increase in arbovirus or chinguna dengue outbreaks, and then warmer regions are more likely to experience these type of outbreaks.

And when you project that forward in time, you see that increase going up.

I didn't show you that.

But it looks like we're going from sporadic occasional cases into an endemic state.

Italy is a part-time tropical country.

If you'll see a patient that came from Italy, for vacation and has weird viral symptoms that mimic dengue, consider dengui.

Because we might have to consider vaccinations in the future if you want to go to Italy, because that's the trajectory then we are on.

It's not a good trajectory to be on, and so the endemic state, that what we're concerned about.

Coming back to baseline, let me talk about waterborne diseases to close out this issue.

And a lot of people, of course, don't really think that this is an issue.

We have looked at a study in Sweden where we looked extreme precipitation in all Nordic countries and we see an increase in waterborne diseases.

I don´t have time to go into that because they only gave me half an hour or 45 minutes.

But let me show you this.

This one here is again one of these weighted risk analysis.

So what we did here, we took all infectious diseases that are of concern in Europe and we ranked them according to how strongly are they associated with climate change.

And so we saw that some infectious diseases are strongly linked to climate and others are not.

So then we asked our questions, well, now if a disease is strongly associated to the climate, do we need to take public health action?

We decided, no, not necessarily.

I mean, just because it's associated, who cares?

That's not the point.

The point is, is there high mortality, high morbidity, higher health expenditures, then we need to take public health actions.

So we weighted it against the impact on societies.

On this diagram or table here, you can see the association with climate change, highly associated with the climate or not so much, and then the on society and only if the impact is high, we need to take public health action.

And one of the diseases that I would like to focus on today is a waterborne disease, which is this one here, these Vibro infections.

It turns out these are marine environments that live in brackish water, like the Baltic Sea, so low salt content.

They don't like the Mediterranean necessarily, unless it's an estuary.

So brackish water, and particularly when it gets warm.

And the problem with Vibrio infections is the fact that there's no surveillance for them on the European scale.

We decided, what can we do about these infections, because this is a problem.

tackle these vibrio infections.

This is what they look like.

Here you can see vibro bacteria, vibrovulnificus paramiliticus.

And these are non cholera vibria infections, and you see that they like temperatures over 15 degrees at low salt.

You can also see they can cause very serious wound infections like gastroenteritis and septicemia with a case fatality rate of 50%. These are serious infections And so we asked the question, how can we set a system that can monitor these waterborne diseases?

And we ask this question.

If you think that climate change has an impact on the environment, like increased temperature, heat waves, that leads to direct exposures like heat stroke and drowning and so on, but also indirect exposure like vector borne diseases that we talked about earlier, and then socioeconomic impact, displacement and what do we do in public health?

We monitoring that.

at the end of the causal chain.

And you can see that here, this is what we do in surveillance.

We like to monitor upstream determinants, environmental climatic precursors of disease, monitor climactic conditions before we have the health outcome.

The idea is that we see this epidemiologic curve where we monitor sea surface temperature and salinity, where then take public health action to reduce that epidemiological curve as we've seen it under COVID.

And this is the diagram.

Here we have global climate change increase in ambient temperature that causes marine heat waves, and these marine heatswaves cause heat surface temperature increase.

with brackish water where we can see these type of infections.

And so we set up a system where monitor sea surface temperature and salinity worldwide in the Chesapeake Bay, in U.S., in Bay of Bengal, or also here in Baltic Sea.

This is what it looks like.

We monitor the sea temperature, and now we come up with this forecast where the Bay is at increased risk.

due to these vibrio infections.

And in fact, we can see that this environmental signal that we picked up corresponds to an epidemiologic signal.

So this is an epidemiologic precursor of disease.

We can that relationship between sea surface temperature and vibro infections in Sweden is, in effect, an exposure-response curve here, so there is a strict relationship.

to Sweden or all Baltic states that there is a risk.

And however, that early warning system works, but not as well as we want it.

Do you remember 2018? There was a peak in Vibro infections in Sweden in relationship to increase the surface temperature and salinity.

So it works but it doesn't work aswell.

We can project that forward in time.

You can't really see this.

But you can see that the risk is going further and further north.

So in summary, we need to pay attention as clinicians to see where that risk is going, even in districts where we haven't seen these Vibrio infections in the past, and it's moving up.

And so now the last part of my talk.

I know that my time is up, so I'm hurrying up I can speak faster if you want.

So this here is from the Lancet Countdown Europe, where we looked at litigation.

So, this was just published last month.

And so, here we look at climate litigation, and you can see at these blue graphs here, these two bars, that have health documented in the litigation so we can that there has been a dramatic increase in litigation where they use health as an indicator.

I told you I'm Swiss, I am very proud of the Swiss seniors.

And these are the people that started the climate in Jordan.

And they decided to take the Swiss government to court and they used the science that we had developed in the past to claim that all the women are at increased risk, they're more vulnerable because they have problems with thermoregulation, the isolated, pre-existing medical conditions, sequelae, sleep depression, and so on.

So they basically claim, based on the evidence we know at, increased risks.

And so, on August 23, they basically decided to get together and decided, to sue the Swiss government for not taking action against climate change.

And, so they took the, like 2,000 women or so 64 and older, and they submitted the legal case.

What did the swiss do best?

They dismiss cases like that.

They don't like it, So they just dismiss it.

Guess what, these women, they didn't take no for an answer.

They appeal.

Guess who is dismissed?

They appealed.

He's dismissed.

And what do you do?

So you take it to the Court of Human Rights, and the court of human rights in The Hague, the fast-tracked it and put it in the great chamber.

So they received the ruling on April 9th.

My time is up.

I have to go now, sorry.

Do you want me to continue?

Anyway, so it turns out they won.

So it turned out that Switzerland had violated or failed to comply with its duties.

The judges ruled that climate protection is a human right.

Switzerland violated their rights.

It's a crisis and it's illegal duty to take action.

And this set a precedent for all the members of the human court.

We believe that you can monitor environmental or epidemic precursors of disease and then you anticipate potential risk with these early warning systems that I mentioned, the heat health action plans or the Vibro early-warning system.

However, they don't work well enough.

And so we need to come up with better strategies.

And I would encourage all of you to engage in evidence-based litigation.

I do that.

Also at the Supreme Court in Stockholm a few months ago to testify against fossil fuel industries and advocate for our rights as humans to be healthy and not to subject to their whims.

So I'd like you do the same.

This is my email.

If you have any questions, let me know.

Sorry, I'm over.