By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

Celebrating Earth Day provides an opportunity for local health department (LHD) leaders and staff to reflect on and plan for the health effects of climate change. Climate change is already having global impacts; LHDs are on the front lines of ensuring the health and safety of their communities and will face a plethora of local-level challenges brought on by climate change in the future.

Climate change will significantly impact the health of communities. The World Health Organization estimates that between 2030 and 2050, climate change will cause approximately 250,000 additional deaths per year.¹ Climate change is predicted to bring about an increase in heat-related illnesses; poorer air quality; an increase in droughts, forest fires, and brush fires; and more frequent and intense storms and floods. It will also affect issues such as food security and water-, food-, and insect-borne diseases.

One such insect-borne disease is the Zika virus, which has quickly become an urgent international public health concern. The rapidly spreading virus can cause birth defects such as microcephaly and Guillain-Barré syndrome. Scientists who study vectors such as the Aedes aegypti mosquito, which carries the Zika, dengue, and chikungunya viruses, have noted that a warming climate has allowed the mosquitos to proliferate faster and live longer. (NACCHO has compiled the latest guidance for health departments dealing with Zika on NACCHO’s Healthy People, Healthy Places blog; the Association of State and Territorial Health Officials has also compiled helpful resources on their Zika webpage.)

Earlier this month, the Obama Administration released an extensive report on the health effects of climate change. The report describes climate change and the major health problems associated with it as one of the gravest health threats to the nation.² It also emphasizes the importance of more aggressive global action to reduce the risks to human health.

The health risks associated with climate change will not be shared equally among individuals, communities, and populations. Climate change will disproportionately burden the very young, older adults, people living with mental and physical disabilities, low-income people, and marginalized communities.³ Climate change will also exacerbate problems of social and environmental justice.⁴

Local Health Department Leadership
Local health departments will be at the forefront of helping their communities cope with the health effects of a changing climate. Because geographic differences will result in varying climate-related health conditions, health departments will need to identify the effects specific to their community. For example, coastal communities are particularly sensitive to sea-level rise, which may lead to increased flooding, while arid communities must plan for the health impacts of drought.

Given their essential role in climate change adaptation, we must improve the capacity of local health departments to engage in climate change. The first step to increase capacity is to instill awareness in policymakers and the public that climate change is happening now and that the effects will be felt domestically, at the local level. NACCHO encourages health departments to promote the incorporation of adaptation planning into land use, housing, and transportation design; prepare their communities for extreme weather events; and coordinate with local, state, and federal partners on all-hazards disaster planning.

Innovations in Climate Change Adaptation
Several county and city health departments are already implementing innovative climate change adaptation and mitigation initiatives. For example, the Los Angeles County Department of Public Health developed a five-point plan to address the effects of climate change in its communities:

• Inform the general public about the climate change and health effects;
• Promote local planning, transportation, water, and energy policies that reduce carbon emissions;
• Provide guidance on heat, drought, and other climate-related emergency preparedness and response to government and community partners;
• Train and build the capacity of public health staff to monitor and integrate climate preparedness into their programs; and,
• Adopt best practices to reduce emissions within their own operations and facilities.

The five-point plan demonstrates how climate change work could be integrated into the daily functions of local agencies.

Another example is the El Paso Department of Public Health in Texas. It developed an Extreme Weather Task Force that has helped reduce the number of heat-related deaths by 50% since 2002. The task force educates the general public about the causes, health effects, and prevention of extreme hot and cold weather-related illness, encourages community participation and response, and conducts outreach to at-risk groups. For example, during a heat wave the task force reminded residents about the availability of electric fans for low-income residents who qualify for assistance. The task force has distributed more than 1,100 fans since 2012.

Other health departments are partnering with federal agencies to combat climate change. The Multnomah County Health Department in Portland, OR, used the Centers for Disease Control and Prevention’s Building Resilience Against Climate Effects (BRACE) Framework, a five-step process that allows health officials to develop strategies and programs to help communities prepare for the health effects of climate change. Since completing the assessment, the health department has collaborated with emergency management organizations to develop a communications toolkit for long-term care facilities, homeless shelters, and other service providers to use when communicating with residents about the risks of extreme heat, the signs and symptoms of heat-related illness, and personal prevention tips for staying safe.

Conclusion
Climate change has and will continue to impact the health of all communities across America. County and city health departments serve a critical role in helping their communities understand and prepare for the health effects of a changing climate. NACCHO encourages local health departments to operationalize climate change in their agencies. NACCHO will continue to raise awareness of the important role health departments play in climate change adaptation and advocate for additional resources to increase their capacity to address climate change.

Resources

• 12 Steps to Operationalize Climate Change in a Local Health Department
• Preparing for the Public Health Challenges of Climate Change
• Are We Ready?: Preparing for the Public Health Challenges of Climate Change
• Health Effects of Climate Change policy statement
• Strengthening and Expanding Local Health Department Surveillance and Research Capacity to Examine the Effects of Climate Change on Existing and Emerging Vectors and Vector-Borne Diseases policy statement
• Centers for Disease Control and Prevention’s BRACE Framework

References

1. World Health Organization. (September 2015). Climate Change and Health Fact Sheet. Retrieved April 5, 2016, from http://www.who.int/mediacentre/factsheets/fs266/en/
2. Dennis, B. (April 4, 2016). As the climate changes, risks to human health will accelerate, White House warns. The Washington Post. Retrieved April 5, 2016, from https://www.washingtonpost.com/news/energy-environment/wp/2016/04/04/as-the-climate-changes-risks-to-human-health-will-accelerate-obama-administration-says/
3. National Climate Assessment and Development Advisory Committee. (2014). Human Health.The Third National Climate Assessment. Washington, DC: U.S. Global Change Research Program. Retrieved April 5, 2016, from http://nca2014.globalchange.gov/highlights/report-findings/human-health
4. Ebi, K.L., Balbus, J. Kinney, P. L., Lipp, E., Mills, D., O’Neill, M. S., et al. Effects of Global Change on Human Health. In J. L. Gamble (Ed.), Synthesis and Assessment Product 4.6. Analyses of the Effects of Global Change on Human Health and Welfare and Human Systems. Washington, DC: Environmental Protection Agency.