Editing IPCC:AR6/WGII/Chapter-14 (section)

=== 14.5.6 Health and Well-being ===

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Research examining climate-change impacts on human health in North America has increased substantially since AR5 ( [[#Harper--2021a|Harper et al., 2021a]] ). Using a systematic approach ( [[#Harper--2021b|Harper et al., 2021b]] ), the assessment focused on advancements since AR5.

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==== 14.5.6.1 Heat-Related Mortality and Morbidity ====

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High temperatures currently increase mortality and morbidity in North America ( ''very high confidence'' ), with impacts that vary by age, gender, location and socioeconomic factors ( ''very high confidence'' ). Observed increases in heat-related mortality have been attributed to climate change in North America ( [[#Vicedo-Cabrera--2021|Vicedo-Cabrera et al., 2021]] ). Temperature effects on health vary based on how unusual the temperature is for that time and location ( ''medium evidence, high agreement'' ), highlighting the important role that temperature extremes and variability play in mortality and morbidity ( [[#Li--2013|Li et al., 2013]] ; [[#Lee--2014|Lee et al., 2014]] ; [[#Barreca--2016|Barreca et al., 2016]] ; [[#Allen--2018|Allen and Sheridan, 2018]] ). Adaptation has played an important role in reducing observed heat-related deaths ( [[#Vicedo-Cabrera--2018b|Vicedo-Cabrera et al., 2018b]] ).

Rising temperatures are projected to increase heat-related mortality across emission scenarios this century in North America ( ''very high confidence'' ), although the magnitude of increase varies geographically ( [[#Isaksen--2014|Isaksen et al., 2014]] ; [[#Petkova--2014|Petkova et al., 2014]] ; [[#Wu--2014|Wu et al., 2014]] ; [[#Weinberger--2017|Weinberger et al., 2017]] ; [[#Anderson--2018a|Anderson et al., 2018a]] ; [[#Limaye--2018|Limaye et al., 2018]] ; [[#Marsha--2018|Marsha et al., 2018]] ; [[#Morefield--2018|Morefield et al., 2018]] ). Elderly people ( [[#Isaksen--2014|Isaksen et al., 2014]] ; [[#Limaye--2018|Limaye et al., 2018]] ) and urban areas ( [[#Limaye--2018|Limaye et al., 2018]] ) are projected to experience the greatest increase in heat-related mortality this century. Warming temperatures are also projected to increase heat-related morbidity ( ''medium confidence'' ). For instance, the incidence and treatment costs of asthma attributed to warmer temperatures are projected to increase in Texas by 2040–2050 (A1B) ( [[#McDonald--2015|McDonald et al., 2015]] ).

While heat-related mortality is projected to increase across emissions scenarios and shared socioeconomic pathways, fewer deaths are projected under both lower-emissions scenarios and higher-adaptation scenarios in North America ( ''very high confidence'' ). Heat-related mortality was projected to be 50% less under RCP4.5 compared with RCP8.5 in the USA for SSP3 and SSP5 (Table 14.5; [[#Wu--2014|Wu et al., 2014]] ; [[#Marsha--2018|Marsha et al., 2018]] ).

'''Table 14.5 |''' A summary of adaptation options for different health outcomes in North America

{| class="wikitable"
|-
! Health outcome

! Adaptation options

|-
| Heat-related mortality and morbidity

| Future temperature-related health impacts can be reduced by adaptation measures ( [[#Petkova--2014|Petkova et al., 2014]] ; [[#Wu--2014|Wu et al., 2014]] ; [[#Mills--2015b|Mills et al., 2015b]] ; [[#Kingsley--2016|Kingsley et al., 2016]] ; [[#Anderson--2018b|Anderson et al., 2018b]] ; [[#Marsha--2018|Marsha et al., 2018]] ; [[#Morefield--2018|Morefield et al., 2018]] ), including more effective warning and response systems and building designs, enhanced pollution controls, urban planning strategies and resilient health infrastructure ( ''very high confidence'' ) (Figure Box 14.7.1).

|-
| Wildfire-related mortality

| Air quality indices are correlated with many respiratory conditions ( [[#Yao--2013|Yao et al., 2013]] ; [[#Hutchinson--2018|Hutchinson et al., 2018]] ), suggesting that providing air quality information to the public could reduce smoke-related health impacts ( [[#Yao--2013|Yao et al., 2013]] ; [[#Rappold--2017|Rappold et al., 2017]] ). Enhanced coordination between the health sector and fire suppression agencies can also reduce the health impacts of wildfire smoke via improving communication, weather forecasting, mapping, fire shelters and coordinated decision making ( [[#Withen--2015|Withen, 2015]] ), including transnational and cross-jurisdictional actions.

|-
| Vector-borne disease

| Prevention of vector-borne disease currently involves surveillance, reducing environmental risks and promoting individual behaviours to reduce human–vector contact. Top-ranked Canadian West Nile interventions include individual protection (i.e., window screens, wearing lightly coloured clothing), and regional management and mosquito-targeting interventions (i.e., larvicides, vaccination of animal reservoirs, modification of human-made larval sites) ( [[#Hongoh--2016|Hongoh et al., 2016]] ).

|-
| Water-borne disease

| Climate change is projected to increase water-borne disease risks ( ''medium confidence'' ), particularly in areas with ageing water and wastewater infrastructure in North America ( ''high confidence'' ). In Wisconsin, USA, precipitation changes are projected to increase gastrointestinal illness in children this century (A1B, A2, B1) ( [[#Uejio--2017|Uejio et al., 2017]] ). Slight reductions in precipitation-associated gastrointestinal illness is projected if water treatment infrastructure is upgraded slowly over time; however, if water treatment infrastructure is installed more rapidly, large decreases in precipitation-associated gastrointestinal illness incidence are projected ( [[#Uejio--2017|Uejio et al., 2017]] ), highlighting the benefits of rapidly implementing adaptation actions.

|-
| Food-borne disease

| Food safety programmes play important roles in reducing the risk of climate-related food-borne disease ( ''high confidence'' ). Integrated health surveillance, more stringent refrigeration temperature controls to limit pathogen growth, targeted communication to the public and food sector, and enhanced coordination between the health and food sectors can reduce risk ( [[#Hueffer--2013|Hueffer et al., 2013]] ; [[#Jones--2013|Jones et al., 2013]] ; [[#Fillion--2014|Fillion et al., 2014]] ; [[#Doyle--2015|Doyle et al., 2015]] ). In Mexico, the projected risk of ''Vibrio parahaemolyticus'' in oysters was 11 times higher in a high-emissions scenario compared with a low-emissions scenario by the end of the century; however, this risk could be substantially lowered with adaptation measures, including improving temperature control ( [[#Ortiz-Jiménez--2018|Ortiz-Jiménez, 2018]] ).

|-
| Mental health

| Effectiveness of individual and/or group therapy, and place-specific mental health infrastructure, to treat mental health challenges is well proven; yet, there is limited evidence evaluating these interventions within the context of climate change (e.g., [[#Tschakert--2017|Tschakert et al., 2017]] ; [[#Young--2017b|Young et al., 2017b]] ; [[#Cunsolo--2018|Cunsolo and Ellis, 2018]] ).

|}

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==== 14.5.6.2 Cold-Related Mortality ====

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Winter season mortality rates are generally high in high-income regions such as North America, with most of that mortality due to cardiovascular diseases ( [[#Ebi--2013|Ebi and Mills, 2013]] ). It is important to differentiate between mortality related to cold temperatures and mortality due to other factors that vary with season ( [[#Ebi--2013|Ebi and Mills, 2013]] ; [[#Ebi--2015|Ebi, 2015]] ). Warmer temperatures do not always equate to lower winter mortality: many cold-related deaths do not occur during the coldest times of year or in the coldest places ( ''high confidence'' ) but occur during the beginning or end of the winter season ( [[#Barnett--2012|Barnett et al., 2012]] ; [[#Lee--2014|Lee et al., 2014]] ; [[#Schwartz--2015|Schwartz et al., 2015]] ; [[#Sarofim--2016b|Sarofim et al., 2016b]] ; [[#Smith--2019|Smith and Sheridan, 2019]] ). Warmer US cities generally experience more mortality from extreme cold events and cold temperatures than colder cities in the USA and Canada ( [[#Lee--2014|Lee et al., 2014]] ; [[#Gasparrini--2015|Gasparrini et al., 2015]] ; [[#Schwartz--2015|Schwartz et al., 2015]] ; [[#Wang--2016|Wang et al., 2016]] ; [[#Smith--2019|Smith and Sheridan, 2019]] ). While mortality rates linked to direct cold exposure (e.g., hypothermia, falls and fractures) is generally low, the relatively higher mortality during milder temperatures is thought to be largely due to respiratory infections and cardiovascular impacts ( [[#Lee--2014|Lee et al., 2014]] ; [[#Gasparrini--2015|Gasparrini et al., 2015]] ), which, although correlated with temperature, may not be caused by cold temperatures ( [[#Ebi--2013|Ebi and Mills, 2013]] ; [[#Ebi--2015|Ebi, 2015]] ; [[#Sarofim--2016a|Sarofim et al., 2016a]] ). When separating the effects of cold temperatures from the effects of the winter season, one study found that cold temperature did not drive mortality and suggested that winter season excess mortality was due to seasonal factors other than temperature (e.g., influenza, seasonal gatherings) ( [[#Kinney--2015|Kinney et al., 2015]] ).

Mortality attributed to cold temperatures has increased in the USA and remained stable in Canada from 1985 to 2012 despite increasing winter temperatures ( [[#Vicedo-Cabrera--2018b|Vicedo-Cabrera et al., 2018b]] ). Some attenuation in cold-related mortality in Mexico and warmer US states is projected under climate change, but less so in colder climates in northeast USA and Canada, with statistically insignificant trends in some regions and increasing cold-related mortality in other regions ( [[#Li--2013|Li et al., 2013]] ; [[#Mills--2015b|Mills et al., 2015b]] ; [[#Schwartz--2015|Schwartz et al., 2015]] ; [[#Sarofim--2016a|Sarofim et al., 2016a]] ; [[#Wang--2016|Wang et al., 2016]] ; [[#Gasparrini--2017|Gasparrini et al., 2017]] ; [[#Vicedo-Cabrera--2018a|Vicedo-Cabrera et al., 2018a]] ; [[#Lee--2019|Lee et al., 2019]] ). These reductions in cold-related mortality are generally considered relatively small.

Observed and projected trends in winter mortality highlight that non-climate factors may have a greater role in driving winter mortality than cold temperature, and that these deaths are expected to occur with or without climate change ( [[#Ebi--2013|Ebi and Mills, 2013]] ; [[#Ebi--2015|Ebi, 2015]] ; [[#Sarofim--2016a|Sarofim et al., 2016a]] ). This challenges the assumption that warmer winters due to climate change would dramatically lower winter season mortality ( ''medium evidence, medium agreement'' ).

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==== 14.5.6.3 Wildfire-Related Morbidity ====

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Smoke from intensified wildfire activity in North America is associated with respiratory distress ( ''very high confidence'' ), and persists long distances from the wildfire and beyond the initial high-exposure time (see Box 14.2; [[#Hutchinson--2018|Hutchinson et al., 2018]] ). Exposure to wildfire smoke increases hospital admissions ( [[#McLean--2015|McLean et al., 2015]] ; [[#Alman--2016|Alman et al., 2016]] ; [[#Reid--2016|Reid et al., 2016]] ; [[#Yao--2016|Yao et al., 2016]] ; [[#Rojas-Downing--2017|Rojas-Downing et al., 2017]] ). Increased wildfire smoke from climate change is projected to result in more respiratory hospital admissions in the western USA by 2046–2051 (A1B) ( [[#Liu--2016|Liu et al., 2016]] ; [[#Rojas-Downing--2017|Rojas-Downing et al., 2017]] ).

The magnitude of health risks varies by age ( [[#Le--2014|Le et al., 2014]] ; [[#Reid--2016|Reid et al., 2016]] ; [[#Liu--2017a|Liu et al., 2017a]] ; [[#Liu--2017b|Liu et al., 2017b]] ), gender ( [[#Delfino--2009|Delfino et al., 2009]] ; [[#Rojas-Downing--2017|Rojas-Downing et al., 2017]] ), socioeconomic conditions ( [[#Henderson--2011|Henderson et al., 2011]] ; [[#Rappold--2012|Rappold et al., 2012]] ; [[#Reid--2016|Reid et al., 2016]] ) and underlying medical conditions ( [[#Liu--2015|Liu et al., 2015]] ). The intersectionality of these subgroups plays an important role in health-related vulnerability to wildfire smoke. Among the elderly in the western USA, risks of respiratory admissions from wildfire smoke was significantly higher for African American women in lower-education counties ( [[#Liu--2017b|Liu et al., 2017b]] ). For Indigenous Peoples, medical visits for respiratory distress, heart disease and headaches increased during a wildfire in California ( [[#Lee--2009|Lee et al., 2009]] ). In northern Canada, Indigenous livelihoods were disrupted during a wildfire, which negatively impacted mental, emotional and physical health ( [[#Dodd--2018a|Dodd et al., 2018a]] ; [[#Howard--2021|Howard et al., 2021]] ).

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==== 14.5.6.4 Vector-Borne Disease ====

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Climate change creates conditions that enable earlier seasonal activity and general northern expansion of ticks ( [[#Ogden--2014|Ogden et al., 2014]] ), increasing human exposure to tick-borne diseases in North America ( ''very high confidence'' ). Lyme disease incidence and geographic extent has already increased in Canada and the USA ( [[#Eisen--2016|Eisen et al., 2016]] ), which has been associated with climate change ( [[#Ogden--2014|Ogden et al., 2014]] ), including warmer temperatures ( [[#Cheng--2017|Cheng et al., 2017]] ; [[#Lin--2019|Lin et al., 2019]] ). Climate change is projected to increase disease spread into new geographic regions, lengthen the season of disease transmission and increase tick-borne disease risk in North America across emissions scenarios throughout this century ( ''very high confidence'' ), with regional variability ( [[#Roy-Dufresne--2013|Roy-Dufresne et al., 2013]] ; [[#Feria-Arroyo--2014|Feria-Arroyo et al., 2014]] ; [[#Monaghan--2015|Monaghan et al., 2015]] ; [[#Robinson--2015|Robinson et al., 2015]] ; [[#McPherson--2017|McPherson et al., 2017]] ). Chagas disease is transmitted by triatomines, and most of the Mexican population (88.9%) already reside in areas with at least one infected vector species in both rural and urban populations ( [[#Carmona-Castro--2018|Carmona-Castro et al., 2018]] ). Chagas has already extended its range into the southern USA, and the triatomines’ niche is projected to expand northward this century ( [[#Garza--2014|Garza et al., 2014]] ; [[#Carmona-Castro--2018|Carmona-Castro et al., 2018]] ) in both rural and urban areas ( [[#Carmona-Castro--2018|Carmona-Castro et al., 2018]] ).

Climate change is projected to impact the distribution, abundance and infection rates of mosquitoes in North America ( ''high confidence'' ), which will increase risk of mosquito-borne diseases including West Nile virus, chikungunya and dengue ( ''medium confidence'' ). The geographic distribution of West Nile virus is projected to expand in North America this century (A1B) ( [[#Harrigan--2014|Harrigan et al., 2014]] ). In the USA and Canada, mosquitoes are projected to emerge earlier in the year and remain active longer into the fall; however, mosquito population dynamics vary by location with northern locations projected to have an increased vector abundance, and currently hot areas may become ''too'' hot, thus negatively affecting mosquito survival (A2, A1B, B1) ( [[#Chen--2013|Chen et al., 2013]] ; [[#Morin--2013|Morin and Comrie, 2013]] ; [[#Brown--2015a|Brown et al., 2015a]] ).

Local transmission of chikungunya virus has emerged in Mexico and the USA since AR5, and areas suitable for transmission are projected to expand (RCP4.5 and RCP8.5) ( [[#Tjaden--2017|Tjaden et al., 2017]] ). Although chikungunya virus is not currently in Canada, climate change is projected to make southern British Columbia suitable for virus transmission this century, particularly under RCP8.5 ( [[#Ng--2017|Ng et al., 2017]] ).

The dengue mosquito vector is well established in Mexico and the southeast USA. In northwest Mexico, incidence of dengue cases is associated with minimum monthly temperature ( [[#Diaz-Castro--2017|Diaz-Castro et al., 2017]] ), and the geographic range of the vector in the USA is restricted, in part, by low temperatures. Thus, a northward range expansion is projected; however, future dengue risk also depends on built environments and competition with other mosquito species ( [[#Colón-González--2013a|Colón-González et al., 2013a]] ; [[#Eisen--2013|Eisen and Moore, 2013]] ). Climate change is projected to increase the geographic range and extend the seasonal activity of the dengue vector in the southern USA by 2045–2065 (A1B); however, transmission is projected to be limited by low winter temperatures in the mainland USA, potentially preventing its permanent establishment ( [[#Butterworth--2017|Butterworth et al., 2017]] ). In Mexico, increased dengue cases are projected this century (A1B, A2, B1) ( [[#Colón-González--2013b|Colón-González et al., 2013b]] ).

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==== 14.5.6.5 Water-Borne Disease ====

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Heavy precipitation events are associated with contaminated drinking water and water-borne disease in North America ( ''high confidence'' ). Acute gastrointestinal illnesses increase with many hydro-climatological variables, including precipitation, streamflow and snowmelt ( [[#Harper--2011|Harper et al., 2011]] ; [[#Wade--2014|Wade et al., 2014]] ; [[#Galway--2015|Galway et al., 2015]] ). Extreme precipitation is associated with ''Campylobacter'' and ''Salmonella'' infections in the USA, particularly in counties characterised by farms and private well water ( [[#Soneja--2016|Soneja et al., 2016]] ). In Canada, human ''Giardia'' infections are associated with increased temperature, precipitation, pathogen presence in livestock manure, and river water level and flow ( [[#Brunn--2019|Brunn et al., 2019]] ). Land-use patterns and aquifer-types are associated with water-borne disease, and ecological zones with higher water-borne rates are projected to expand in range in Canada by 2080 ( [[#Brubacher--2020|Brubacher et al., 2020]] ).

In North America, stormwater and water treatment infrastructure play important roles in reducing water-borne disease risk during precipitation events ( ''high confidence'' ). In the USA, heavy precipitation events are associated with higher rates of childhood gastrointestinal illness in municipalities with untreated drinking water, but not in municipalities with treated drinking water ( [[#Uejio--2014|Uejio et al., 2014]] ). In Mexico, disparities in access to treated water are a key determinant of morbidity in children under age 5 years ( [[#Jiménez-Moleón--2011|Jiménez-Moleón and Gómez-Albores, 2011]] ; [[#Romero-Lankao--2014|Romero-Lankao et al., 2014]] a). In remote communities in Alaska and Northern Canada, challenges in water service provision and maintenance can increase risk of water-borne disease during high-impact weather events ( [[#Harper--2011|Harper et al., 2011]] ; [[#Bressler--2018|Bressler and Hennessy, 2018]] ; [[#Harper--2020|Harper et al., 2020]] ). In older sections of many North American cities, sewage treatment plant capacity is exceeded by overflow of combined sanitary and storm sewer systems during heavy precipitation events, resulting in bypass of untreated and microbiologically contaminated wastewater discharge into drinking water sources ( [[#Jagai--2017|Jagai et al., 2017]] ; [[#Olds--2018|Olds et al., 2018]] ; [[#Staley--2018|Staley et al., 2018]] ). These sewer overflow events are associated with increased gastrointestinal illness across age groups ( [[#Jagai--2017|Jagai et al., 2017]] ).

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==== 14.5.6.6 Food-Borne Disease ====

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Warmer air temperature, changes in precipitation, extreme weather events and ocean warming can increase microbial pathogen loads in food ( ''very high confidence'' ). Indeed, temperature and extreme weather are top factors influencing food safety in Canada ( [[#Charlebois--2015|Charlebois and Summan, 2015]] ). Outbreaks of ''Vibrio parahaemolyticus'' have been associated with the consumption of raw oysters harvested from higher-than-usual ocean temperatures in Canada and Alaska ( [[#McLaughlin--2005|McLaughlin et al., 2005]] ; [[#Taylor--2018|Taylor et al., 2018]] ). Warmer air temperature increases ''Campylobacter'' , ''Salmonella'' and ''E. coli'' prevalence in Canadian meat products ( [[#Smith--2019|Smith et al., 2019]] ), higher microbial load in American produce ( [[#Ward--2015|Ward et al., 2015]] ) and increased ''Campylobacter'' spp., pathogenic ''E. coli'' and ''Salmonella'' spp. infections in humans ( [[#Akil--2014|Akil et al., 2014]] ; [[#Valcour--2016|Valcour et al., 2016]] ; [[#Uejio--2017|Uejio, 2017]] ).

Climate change is projected to increase food safety risks ( ''medium confidence'' ); however, the actual burden of food-borne disease will depend on the efficacy of public health interventions ( ''high confidence'' ). Increased ciguatera fish poisoning is associated with increased sea surface temperatures (SSTs) and tropical storm frequency, and this risk is projected to increase this century ( [[#Gingold--2014|Gingold et al., 2014]] ). ''Campylobacter'' infection in humans due to food contamination from flies is projected to increase this century in Canada ( [[#Cousins--2019|Cousins et al., 2019]] ), and increased housefly populations are projected this century in Mexico ( [[#Meraz%20Jimenez--2019|Meraz Jimenez et al., 2019]] ). Climate change may also lead to new emerging food-borne disease risks. For instance, ''V. cholerae'' is a pathogen previously restricted to tropical regions; however, due to warming ocean temperatures, its detection has significantly increased along Canadian coasts ( [[#Banerjee--2018|Banerjee et al., 2018]] ).

Climate change is projected to increase human food-borne exposure to chemical contaminants ( ''medium confidence'' ). Increases in SST have been associated with greater accumulation of mercury in seafood, marine mammals and fish ( [[#Ziska--2016|Ziska et al., 2016]] ). This particularly increases food safety risks in the Arctic, with methylmercury and polychlorinated biphenyl concentrations in high trophic animals projected to increase under high-emission scenarios by 2100 ( [[#Alava--2017|Alava et al., 2017]] ; [[#Alava--2018|Alava et al., 2018]] ).

Climate-related food-borne disease risks vary temporally, and are influenced, in part, by food availability, accessibility, preparation and preferences ( ''medium confidence'' ). For example, seafood risks are more pronounced in coastal regions due to high seafood consumption ( [[#Radke--2015|Radke et al., 2015]] ). In Alaska and northern Canada, where locally harvested foods are critical to diet, climate change may introduce new pathogens to local food sources through wildlife range changes, warming temperatures affecting safe fermentation and drying preparation methods, and food temperature control in below-ground cold storage in or near permafrost ( [[#King--2014|King and Furgal, 2014]] ; [[#Harper--2015|Harper et al., 2015]] ; [[#Rapinski--2018|Rapinski et al., 2018]] ).

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==== 14.5.6.7 Nutrition ====

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Agricultural productivity declines due to climate change ( [[#14.5.4|Section 14.5.4]] ) are projected to lower caloric availability and increase the prevalence of underweight people and climate-related deaths in North America by 2050 (IMPAACT) ( [[#Springmann--2016a|Springmann et al., 2016a]] ; [[#Springmann--2016b|Springmann et al., 2016b]] ; [[#Springmann--2018|Springmann et al., 2018]] ); however, this lower caloric availability could also reduce obesity, which could result in deaths avoided ( [[#Springmann--2016a|Springmann et al., 2016a]] ; [[#Springmann--2016b|Springmann et al., 2016b]] ). The climate-related deaths per capita due to reduced fruit and vegetable consumption is projected to exceed the mortality due to reduced caloric intake in North America by 2050, particularly in Canada and the USA ( [[#Springmann--2016a|Springmann et al., 2016a]] ; [[#Springmann--2016b|Springmann et al., 2016b]] ). These climate-change projections underscore the importance of focusing on nutritional security in North America, instead of only considering caloric intake.

Shifting to a more sustainable diet can have adaptation and mitigation co-benefits while simultaneously improving health outcomes for North Americans. Transitioning to more plant-based diets is projected to reduce climate-related deaths in Canada, the USA and Mexico by 2050 ( [[#Springmann--2016a|Springmann et al., 2016a]] ; [[#Springmann--2016b|Springmann et al., 2016b]] ), while simultaneously reducing food-related GHG emissions per capita in North America by 2050 ( [[#Springmann--2018|Springmann et al., 2018]] ).

Nutrition impacts will not be experienced uniformly within countries ( [[#Shannon--2015|Shannon et al., 2015]] ; [[#Zeuli--2018|Zeuli et al., 2018]] ). In Alaska and Canada, IK has documented how climate change has already impacted locally harvested foods and challenged nutrition security (CCP6; [[#Lynn--2013|Lynn et al., 2013]] ; [[#Petrasek%20MacDonald--2013|Petrasek MacDonald et al., 2013]] ; [[#Harper--2015|Harper et al., 2015]] ; [[#Hupp--2015|Hupp et al., 2015]] ; [[#Bunce--2016|Bunce et al., 2016]] ). For First Nations coastal communities in western Canada, decreased access to traditionally harvested seafood is projected to reduce nutritional status by 2050 (RCP2.5, RCP8.5), with higher nutritional impacts for men and older adults ( [[#Marushka--2019|Marushka et al., 2019]] ). Substitution of seafood with non-traditional foods (e.g., chicken, canned tuna) would not replace the projected nutrients lost ( [[#Marushka--2019|Marushka et al., 2019]] ), challenging assumptions that market food substitutions could be effective adaptation strategies for Indigenous Peoples

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==== 14.5.6.8 Mental Health and Wellness ====

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Climate change has had, and will continue to have, negative impacts on mental health in North America ( ''high confidence'' ) (Figure 14.8). Climate change impacts mental health through multiple direct and indirect pathways stemming from extreme weather events, slower, cumulative events, and vicarious or anticipatory events ( [[#Cunsolo%20Willox--2013|Cunsolo Willox et al., 2013]] ; [[#Cunsolo%20Willox--2014|Cunsolo Willox et al., 2014]] ; [[#Durkalec--2015|Durkalec et al., 2015]] ; [[#Yusa--2015|Yusa et al., 2015]] ; [[#Schwartz--2017|Schwartz et al., 2017]] ; [[#Trombley--2017|Trombley et al., 2017]] ; [[#Burke--2018b|Burke et al., 2018b]] ; [[#Cunsolo--2018|Cunsolo and Ellis, 2018]] ; [[#Dodd--2018b|Dodd et al., 2018b]] ; [[#Hayes--2018|Hayes et al., 2018]] ; [[#Middleton--2020b|Middleton et al., 2020b]] ). Climate-change disruptions to infrastructure, underlying determinants of health and changing-place attachment are also stressors on mental health ( [[#Vida--2012|Vida et al., 2012]] ; [[#Cunsolo%20Willox--2013|Cunsolo Willox et al., 2013]] ; [[#Burke--2018b|Burke et al., 2018b]] ; [[#Obradovich--2018|Obradovich et al., 2018]] ).

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[[File:1e3c41ae4ee5a818864da379d328dde5 IPCC_AR6_WGII_Figure_14_008.png]]

'''Figure 14.8 |''' '''Pathways through which climate change impacts mental health risk in North America'''

In North America, climate change has been linked to strong emotional reactions; depression and generalised anxiety; ecological grief and loss; increased drug and alcohol usage, family stress and domestic violence; increased suicide and suicide ideation; and loss of cultural knowledge and place-based identities and connections ( [[#Cunsolo%20Willox--2013|Cunsolo Willox et al., 2013]] ; [[#Durkalec--2015|Durkalec et al., 2015]] ; [[#Harper--2015|Harper et al., 2015]] ; [[#Fernández-Arteaga--2016|Fernández-Arteaga et al., 2016]] ; [[#Schwartz--2017|Schwartz et al., 2017]] ; [[#Trombley--2017|Trombley et al., 2017]] ; [[#Burke--2018b|Burke et al., 2018b]] ; [[#Cunsolo--2018|Cunsolo and Ellis, 2018]] ; [[#Clayton--2020|Clayton, 2020]] ; [[#Dumont--2020|Dumont et al., 2020]] ).

Suicide is projected to increase in Mexico and the USA by 2050 due to rising temperatures (RCP8.5) ( ''limited evidence'' ) ( [[#Burke--2018b|Burke et al., 2018b]] ). Literature on climate change and mental health in North America is increasing; however, few population-level quantitative studies exist, although they are increasing (e.g., [[#Burke--2018b|Burke et al., 2018b]] ; [[#Kim--2019|Kim et al., 2019]] ; [[#Dumont--2020|Dumont et al., 2020]] ; [[#Middleton--2021|Middleton et al., 2021]] ).

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