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The Public Health Institute (PHI) strongly urges the California Air
Resources Board (CARB) to prioritize the funding of climate
mitigation strategies with significant health co-benefits, in
communities that already suffer the greatest health inequities. We
ask that the revenue allocation process from the cap and trade
program explicitly incorporate health and health equity criteria,
and that CARB ensure the inclusion of public health experts in that
process.

Climate change is one of the biggest public health threats of this
century, undermining our air quality, the availability of clean
drinking water, our food supply, our homes, and our security.
Climate change disproportionately impacts vulnerable populations,
including low-income communities and people of color, those with
chronic illness, and the young and old; climate change thus
exacerbates existing health inequities.

Many – but not all – strategies to reduce greenhouse gas emissions
have significant health co-benefits, or positive impacts on health
that are not directly related to the impact on climate change
itself. Below we identify several examples of mitigation strategies
with health co-benefits, but note that this list is exemplary, not
exhaustive.

1.	EXPANDING AND ENHANCING INFRASTRUCTURE TO SUPPORT ACTIVE
TRANSPORTATION, INCLUDING WALKING, BICYCLING AND PUBLIC TRANSIT
USE:

Increasing active transportation is a critical strategy for
reducing greenhouse gas emissions (GHGE) from transportation, and
the mitigation strategy likely to yield by far the greatest health
co-benefits. A recent study, published in the American Journal of
Public Health and authored by Dr. Neil Maizlish of the California
Department of Public Health, forecast the health impacts of various
strategies to reduce transportation greenhouse gas emissions. The
study found that increasing median daily walking and bicycling from
4 to 22 minutes reduced the burden of cardiovascular disease and
diabetes by 14%, with significant decreases in breast and prostate
cancer, osteoporosis, and depression, and decreased GHGE by 14%;
low-carbon driving (fuel efficiency and low-carbon fuels) reduced
GHGE by 33.5% but had a far lesser health impact, reducing
cardiorespiratory disease burden by less than 1%. It should be
noted that the model also forecast a significant increase in
pedestrian and bicyclist injuries.

These results are comparable to those found in a number of other
similar studies conducted internationally. The health benefits of
increased physical activity associated with increased active
transportation could equal those of our greatest public health
achievements, particularly if careful attention is also paid to
ensuring that active transportation infrastructure is safe. A large
investment of cap and trade revenue in active transportation
infrastructure is highly recommended.

2.	EXPANDING AND ENHANCING URBAN GREENING:

Urban green space and tree canopy can act as a significant carbon
sink, absorbing carbon, and simultaneously provide multiple other
benefits including reduction in the urban heat island effect,
decreased storm water runoff, increased groundwater recharge, and
aesthetically pleasing places for people to exercise, play, and
congregate. Mitigation of the urban heat island can also have
significant impacts on reducing energy use, and thus GHGEs.  Urban
greenspace can also include school and community gardens that
increase access to affordable healthy food. As the earth warms and
extreme heat events become increasingly frequent and severe, the
health toll of extreme heat events is expected to grow
substantially; there were more than 70,000 excess deaths in the
European heat wave of 2003, and 650 in the California heat wave of
2006. Without substantial investment in urban green space and tree
canopy, as well as other cooling strategies such as cool roofs,
cool pavements and green roofs, it is likely that infill
development and increased residential density will add to the urban
heat island effect with its concomitant adverse health impacts.

3.	IMPROVING AIR QUALITY:

a.	Reductions in air pollution, particularly in communities with
existing high levels of pollution, can improve health and reduce
inequities. We recommend funding of strategies to reduce air
pollution associated with goods movement, such as trucks and
ships.

b.	Energy efficiency: We strongly support weatherization of homes
as a strategy for reducing greenhouse gas emissions through energy
efficiency, particularly if weatherization programs target renters
and multi-family housing in lower-income areas. However, we caution
that weatherization programs must be attentive to common health
hazards in poorly maintained homes, such as mold or lead; care must
be taken to ensure that these programs do not inadvertently
increase indoor air pollution.

PHI stands ready to assist CARB in any way we can to ensure that
cap and trade revenues are allocated in a manner that optimizes the
health co-benefits of strategies to reduce greenhouse gas
emissions, with an emphasis on reducing health inequities.

ABOUT THE PUBLIC HEALTH INSTITUTE:
The Public Health Institute, an independent nonprofit organization,
is dedicated to promoting health, well-being and quality of life
for people throughout the world. PHI's primary methods for
achieving these goals include: sharing evidence developed through
quality research and evaluation; conducting public policy and
advocacy; providing training and technical assistance; and
promoting successful prevention strategies to policymakers,
communities and individuals. For more information, visit
www.phi.org. 

Matthew Marsom, Vice-President for Public Health Policy & Advocacy
Linda Rudolph, MD, MPH, Center for Public Health and Climate Change
at PHI