Health departments are on the frontlines of climate change
The impacts on human health include extreme heat to mosquito-borne diseases. How can health care providers keep up?
When the rains of Hurricane Harvey finally dissipated in late summer 2017, the potential for health hazards lingered on. At least 25 million gallons (PDF) of sewage floated through the streets of Houston and surrounding areas. Chemical and other industrial plants pulsed out millions of pounds of dangerous air pollution. Soggy homes grew mold and harbored bacteria and fine particles that snaked into residents’ lungs.
A full year after the storm, a survey found that one in every six Gulf Coast residents affected by Harvey said someone in their household had a new or worsened health condition. We can blame the hurricane for the health hazards, but that hurricane, according to experts, was made substantially worse because of climate change. And when it comes to the health hazards relating to climate change, hurricanes are far from the only culprit. Extreme heat events, increasingly frequent and severe wildfires, the spread of tick- and mosquito-borne diseases — these and more are affecting human health. And sitting on the front lines in the effort to prepare for, and respond to, all those climate-related health effects are U.S. public health departments — state and local agencies around the country charged with assessing and protecting communities’ health and coordinating services.
"They’re where the rubber hits the road," says Aaron Bernstein, a pediatrician at Boston Children’s Hospital and co-director of the Harvard T.H. Chan School of Public Health’s Center for Climate, Health, and the Global Environment (C-CHANGE). Public health departments large and small have begun climate change programs of various sorts. Some aim simply to educate the public about climate-related risks, while others are taking more active approaches to managing and responding to those risks, including monitoring for certain diseases and improving emergency response when disaster strikes. But a persistent problem of resources and funding, especially in smaller city and county departments, makes these efforts difficult.
Some data and predictions related to climate and health are more than a little alarming. According to a large report from the U.S. Global Change Research Program, by the end of the century U.S. cities could see an increase of as many as 10,000 heat-related deaths per year. Increasing temperatures also will exacerbate ground-level ozone concentrations, resulting in up to "thousands of additional ozone-related illnesses and premature deaths" by 2030, according to the report. Increasing extreme events will stress water systems, food supplies and mental health. These effects can pop up at a moment’s notice. Just to take one example, the devastating wildfires that hit California in November led to at least one day when some cities in the northern part of the state had the worst air quality in the world.Particularly with climate change, the ‘hasn’t happened’ part is really tricky because, the whole problem with climate change is that it is changing the rules of the game.
Health departments are starting to both react to and prepare for such problems. In Houston, where the memory of Harvey is still fresh, the city’s health department launched a registry in April of residents and people who may have been visiting the city to monitor the health effects of the storm and to better understand how climate-related weather disasters might be handled differently in the future. In other large cities, health departments have developed entire programs around climate change. Los Angeles created a five-point plan (PDF) aimed at reducing climate change health effects, and its health department offers speakers for community groups hoping to learn about those effects. Boston, while furthering specific plans such as making emergency cooling available for elderly people during increasingly common heat waves, is also trying to incorporate (PDF) climate-related health planning into a wide range of city policies.
Leaving the big cities
When you leave the big cities, though, things get a bit more complicated. In San Luis Obispo County, home to only 280,000 people, health promotion division manager Kathleen Karle was involved in a small climate campaign several years ago. "We did outreach in farmers’ markets," she says. "We had no money to do it." The health department there was contacted by the state, which was offering some funding from the Centers for Disease Control and Prevention (CDC) to pay for fliers, handouts and other communications materials.
They zeroed in on issues such as extreme drought and wildfire, but within the year, the funding dried up, and the department’s activities stopped. "You need a dedicated funding stream. You can’t be applying for grants every time you turn around," Karle says.
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