Public Health Officials Respond to Climate-Change Impacts

Adapting to Health Risks is the 'Mission of the Day'

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Kim Knowlton is a senior scientist in the public health program with the Natural Resources Defense Council.

Linda Bruemmer directs the Division of Environmental Health for the Minnesota Department of Health.

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Posted: Wednesday, December 5, 2012 4:03 pm

While United Nations member states meet this week in Qatar on their elusive quest for a global response to climate change, state and local public health departments in the U.S. have been quietly preparing their response to climate change impacts at the ground level.

Whether in a coastal region faced with rising seas, an interior state suffering from increasing heat waves and wild fires, or the Farm Belt bracing for more intense and destructive droughts, vulnerable populations bear the worst hardships of climate change.

That’s why the Centers for Disease Control and Prevention, the American Public Health Association, the Natural Resources Defense Council, the National Association of City and County Health Officials, and other organizations are building a framework for protecting community health and the environment in a warmer world.

The Centers for Disease Control and Prevention (CDC) has detailed likely health effects of extreme temperatures and extreme weather events. For example, increased temperatures raise the risk of heat exposure. Images of children playing in the cooling stream of a fire hydrant on a scorching summer afternoon in cities like Chicago and St. Louis have long been common news fare. But the CDC says these sorts of heat waves will become more typical due to climate change. That means public health officials need to look out for conditions ranging from heat rash to heat stroke presented in their clinics and emergency rooms.

Prolonged heat exposure can worsen cardiovascular and respiratory conditions. Further, heat worsens ground-level ozone, aggravating asthma and chronic obstructive pulmonary disease, the CDC says. And finally, heat waves send people to the thermostat to cool the air, thereby using more electricity, often generated by fossil fuels. For people without access to air conditioning or electric fans, exposure to heat can be life threatening, the CDC says.

Even in places where hot weather is not a typical health threat, extreme weather events can be dangerous. For example, intense rainstorms that cause flooding in turn lead to injuries while people try to move about in flood-damaged areas. Further, extreme weather events can cause disruptions in health care services, including mental health care. Getting to work and getting back home again, seemingly mundane tasks, can be severely disrupted after a major flood.

The CDC anticipates a variety of other health effects from what it calls the “complex phenomenon” of climate change. Higher temperatures may result in longer growing seasons and high pollen production, meaning more people seeking treatment for allergies and asthma. These conditions are also more favorable for disease-spreading insects such as mosquitoes, midge flies and ticks. Higher concentrations of carbon dioxide in the oceans may lead to greater acidity, and create “adverse ecosystems in the world’s tropical oceans,” according to the CDC.

“Fortunately, early action by city managers, health officials, and the federal government can reduce the impact of these problems on our health by preparing and responding to the effects of global warming. But we must start now," said Kim Knowlton, a senior scientist in the public health program with the Natural Resources Defense Council (NRDC). She said a recent meeting of the American Public Health Association (APHA) offered more than 100 sessions on the connection between climate change and health.

“There are more conversations every year among people who are on the front lines of the issues of extreme weather disasters. They are turning out to hear about the work that’s being done,” Knowlton said. Ironically, during this year’s meeting, Hurricane Sandy hit the East Coast. “We were watching television at the conference, and people were saying ‘That’s my hospital, those are my people, I have to leave.’”

Knowlton explained what it means to see climate change through a public health lens. “First, look at your community, ask who is most vulnerable and where they live,” she said. “Vulnerable” often means the elderly, who can have limited mobility.

“Do some mapping and outreach and learn where to reach out when the next extreme weather event comes,” Knowlton suggested.

Next, conduct surveillance of health events. “Get a handle on heat and air pollution illnesses, increase in mosquito activity, changing numbers of extreme heat days, and big shifts in big storm events that send flood waters into water ways,” she said.

Next, think of the big picture issues such as infrastructure, health, communications, transportation, and energy. “Bring people around the table to get them to talk through these scenarios. Talk about designing or redesigning communities and parks with climate changes in mind. Every place has limited budgets, but you can do quite a bit with even limited budgets.”

Finally, focus on education, which Knowlton said is really just communication. It means “talking to each other about the connections between environmental change that is fueled by climate change and the ways we chose to get our energy. We have heat trapping gases, rising temperatures. We want to avoid these effects and there is a lot we can do to prevent and avoid these effects.”

These health risks come with costs, of course. NRDC scientists partnered with economists to investigate the health costs of six climate change-related events. These events were ozone smog pollution, heat waves, hurricanes, mosquito-borne infectious diseases, river flooding, and wildfires. According to the study, these events will worsen with climate change in ways likely to harm human health. Associated health costs: more than $14 billion, in 2008 dollars.

For example, in California, a 2006 heat wave lasting two weeks caused 655 deaths, 1,620 hospitalizations, and more than 16,000 excess emergency room visits. Its cost was estimated at nearly $5.4 billion. In 2009, flooding in North Dakota caused two deaths, 263 emergency room visits, and an estimated 3,000 outpatient visits. Estimated cost: nearly $20.4 million, according to the NRDC. Healthcare costs resulting from Hurricane Sandy are still being tallied.

The CDC is helping with grant funding for what they call “climate ready states,” but Knowlton says only about a third of the states have a health element in their climate adaptation plans. In fact, some states have no climate adaptation plans at all, she said.

“There is still a lot of under-preparedness.” However, she sees many locations working at a grassroots level to develop their own mitigations and adaption plans. In some cases, there might be apathy among the public or the public officials. “The local political climate does have an impact, but as our experience with weather and nature grows, politics will be put aside,” she said.

One state entity aggressively developing a climate change plan that includes a health component is the Minnesota Department of Health. MDH has received funding from the Association of State and Territorial Health Officials (ASTHO) and the CDC. Linda Bruemmer directs the Division of Environmental Health for MDH.

In a recent American Public Health Association (APHA) webinar, Bruemmer said the department began its planning by starting with its workforce. It conducted a survey regarding its staff’s “knowledge of climate change and its relationship to public health.” MDH wanted to know what staff knew about these issues and where they felt they needed additional education and training. Then MDH developed a plan to act upon what it learned from its staff.

From there, it developed six goals including identifying the public health impacts of climate change; identifying how it is already dealing with these impacts; determining which populations are at greatest risk; enhancing its preparedness; increasing its capacity to respond and adapt to the public health impacts of climate change; and finally, communicating and educating public health professionals, healthcare providers, state agency personnel, policymakers, vulnerable populations and the general public on the human health impacts of climate change.

Minnesota is not a place one commonly associates with rising sea levels or scorching summer heat. However, Bruemmer said state officials are concerned about other climate-related issues including increases in tick-borne disease, especially in forested areas. With increased temperatures, ticks enjoy a longer growing and feeding season, coupled with lower mortality rates in winter. These conditions have encouraged new tick species and new disease agents to develop, she said. With increased precipitation, researchers have noticed an increase in blacklegged tick survival in warm seasons. The third leg of the stool, increased humidity, has meant more time available for tick feeding each day.

With this scenario, Bruemmer said, she and the MDH staff learned that even people not living in coastal areas, or in especially warm climates, need to think about climate adaptation. She uses that word intentionally.

“Mitigation” is a politically charged word in Minnesota, she said, meaning that not everyone yet accepts that climate change is human caused or can be resolved through human action. That’s why the term adaptation is a more appropriate word for them to use. Using language people are comfortable with has resulted in willing collaborators from across the public-service spectrum.

Knowlton of NRDC applauds the efforts of state and local health planners. “Being prepared for what happens now is fantastic, and then they can cope with longer and more frequent events. Maybe people’s bodies will adapt better to these changes over time, but for now there are more and more vulnerable people. Aging, obesity, and diabetes contribute to making people more vulnerable,” Knowlton said.

“Economic disadvantage and poverty is another issue,” she added. “People in poor households have less access to health care, to housing if they are displaced, to transportation, to disparity in resumption of services. This problem is a big one, it affects lots of sectors. It is the mission of the day.”

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