Public Health

Introduction

"Pediatric nurse from NYC Health + Hospitals/Gotham Health, Belvis in the Bronx helps make checkups fun for her littlest patients." (Source: NYC Health + Hospitals)

Climate change is a complex and multisectoral issue. Generally seen primarily as an environmental problem with environmental impacts, climate change has serious effects on population and individual health as well. Climate change impacts will include acute events like disease outbreaks from increases in range and prevalence of disease vectors (e.g., mosquitos, among others), as well as slower-developing events like higher everyday temperatures, stressing frontline people like the elderly, young children, and residents of low-income communities and communities of color.^{See footnote 1} Multiple response strategies will therefore be necessary to respond to those events. Both traditional public health emergency response strategies and longer-term planning, built environment, and disease surveillance strategies across multiple jurisdictions will need to be put into place to be prepared for climate effects.

Compounding the breadth of climate effects on health is the fact that climate impacts both exacerbate existing problems and create novel problems that public health in the United States may not be well equipped to handle. Climate change impacts will intensify existing health conditions in frontline communities such as asthma (due to worsening air quality), but will also present new challenges such as unfamiliar (to the United States) new vector-borne diseases like dengue fever.^{See footnote 2} State and local public health agencies, governments at the state, local, and tribal levels, community-based organizations, and advocates will need to prepare for both higher incidences of existing diseases and for new problems they may currently lack information and training to address.^{See footnote 3} 

Public health effects of climate change do not affect all people or communities in the same ways or to the same degree. Pre-existing racial and income disparities are compounded by these effects: For example, lack of access to air-conditioning in many low-income communities compounds with higher temperatures in those communities due to lack of tree canopy and high concentrations of concrete to put residents at risk of heat stress and even death.^{See footnote 4} Frontline communities also often have disproportionate lack of access to resources to adapt, including not having regular preventive health visits and therefore poorer overall health in the first place.^{See footnote 5} 

Despite awareness of the disparities and inequities of climate impacts on frontline communities, public health and climate projects do not always follow principles of community engagement. Even in some of the substantively equitable examples cited in this chapter (i.e., outcomes are more equitable than a one-size-fits-all policy), community engagement is not always as deep or meaningful as it can be. Where possible, we have highlighted case studies with strong community engagement practices or made suggestions on how a case study could be replicated in a slightly different way, taking an innovative idea and deepening the strength of the community engagement. Centering the community being served should continue to be in the forefront while keeping the core public health principle of protecting the health of all people and communities.

Background

Children cool off at a city 'sprayground' splash park in Philadelphia. (Source: City of Philadelphia)

The impacts of climate change do not affect everyone equally. Heat, for example, is generally more severe in low-income urban neighborhoods and interacts with pre-existing health disparities such as asthma to produce worse health outcomes for residents.^{See footnote 6} Underlying disparities in access to healthcare compound those disparities in the social determinants of health such as housing or public safety to yield significantly worse health outcomes in frontline communities.^{See footnote 7} 

In addition, some individuals and communities are uniquely exposed to particular impacts. The elderly, young children, and those with chronic diseases can be more endangered by climate change impacts such as extreme heat on an individual basis. Children and the elderly do not regulate their body temperatures as easily as adults do, leaving them particularly at risk for heat-related illness.^{See footnote 8} Any public health approach to adapting to climate impacts must prioritize and engage frontline communities and pay particular attention to disadvantaged populations in order to achieve equitable outcomes.

Against the backdrop of these long-entrenched inequalities, solutions to the physical and public health problems should be targeted with an equity lens if they are not to exacerbate those existing disparities. Solutions identified in other chapters of this toolkit (cross-link to affordable housing, etc.), if pursued with the equity lens shown here, will improve health outcomes even though they are not health-specific policies. Further, efforts to incentivize beneficial private behavior such as tax incentives and rebates supporting investment in green and cool infrastructure can often benefit higher-income neighborhoods with greater familiarity with government systems and the ability to take advantage of government programs unless they are carefully crafted.

Because the ability to achieve good health is influenced by social determinants such as the built environment and land use, and because public health agencies only have authority over a fraction of the tools below, collaboration is critical to success in equitably protecting the public’s health from climate effects. Public health agencies will need to collaborate closely with a multitude of other agencies^{See footnote 9} (planning, transportation, public works, etc.) as well as nearby jurisdictions, federal and state agencies, and community-based organizations. While this level of collaboration by definition makes creating solutions more complex, it should create better health outcomes for all by ensuring that all partners are working towards the same goals.

Key Actors

Public health agencies and systems at the national, state, tribal, and local levels should be key partners in adapting to climate effects if the health of communities is to be protected. They will not, however, be able to protect the public’s health by themselves. As discussed above, public health agencies do not oversee all of the tools that are effective in adapting to the health effects of climate change, and therefore other key actors will be necessary as well. Coordinating efforts among disparate agencies at (in some cases) multiple levels of government can be extremely challenging, in addition to coordinating programs with the public health agency or others. Fully integrating the participation of community members and community-based organizations into public health efforts will help to ensure that solutions will actually work well in the communities they are intended to support.

Public Health Agencies have authority over traditional public health tools, such as disease surveillance and public health planning, and have the expertise necessary to bring a health equity lens to climate and other local government processes, ensuring that strategies are fully realizing the potential health equity gains.

Local Government Agencies (besides public health agencies) have authority over transportation, land use, the majority of streets, tree canopy, and other built environment tools, all of which have a significant impact on health outcomes.

Community-based Organizations including faith-based organizations, nonprofits, community development organizations, senior programs, and schools can be key partners in bringing their expertise of neighborhoods and the people who live and work there, increasing agencies’ effectiveness and reach. The involvement of community-based organizations throughout the planning processes, not just in the implementation phases, can also help to design programs that fully integrate both the community’s unique challenges and its strengths.

Policy Tools

This chapter describes equitable approaches to enhancing public health while centering equity, including those to prepare for and respond to both acute and longer-term public health effects. Excellent resources exist already creating a comprehensive set of equitable health responses to climate change; this chapter does not attempt to duplicate those efforts.^{See footnote 10} Instead, this particular chapter attempts to focus on the legal and policy tools available for creating equitable climate and health solutions, giving brief examples of several types. These tools can be used by public health agencies directly or in collaboration with partner agencies. Community-based organizations and advocates can use this chapter as a menu of actions to lobby local governments for, or in some cases, to manage themselves. A range of tools exists to achieve these goals, including (1) planning tools; (2) traditional public health tools; and (3) built environment tools. A discussion of the ways to pay for these efforts is also included.