Climate change: the public health response

Building Resilience Against Climate Effects—a novel framework to facilitate climate readiness in public health agencies

Climate change is anticipated to have several adverse health impacts. Managing these risks to public health requires an iterative approach. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and regularly updating models and risk management plans with new information—hallmarks of adaptive management—are considered central tenets of effective public health adaptation. The Centers for Disease Control and Prevention has developed a framework, entitled Building Resilience Against Climate Effects, or BRACE, to facilitate this process for public health agencies. Its five steps are laid out here. Following the steps laid out in BRACE will enable an agency to use the best available science to project likely climate change health impacts in a given jurisdiction and prioritize interventions. Adopting BRACE will also reinforce public health’s established commitment to evidence-based practice and institutional learning, both of which will be central to successfully engaging the significant new challenges that climate change presents.

Becoming environmentally sustainable in healthcare: an overview

This paper provides an overview of environmental sustainability in healthcare and highlights the need for a policy framework for action. Examples from overseas demonstrate what has effectively enabled mitigation of and adaptation to the threat of climate change. The need to overcome perceived limits and barriers to health professionals’ engagement in sustainable practice is noted. The scientific evidence recommends immediate action. What is known about the topic? Climate change has negative impacts on human health. There are co-benefits in mitigating and adapting to climate change that will benefit both humans and health systems, increasing wellbeing, financial and health system efficiency. There is a need for health professionals to engage with sustainability. Australia’s health policy makers could learn useful lessons about how to be sustainable from the significant policy and legislation work occurring elsewhere. What does this paper add? This paper reports on the context of and need for becoming sustainable in healthcare. It provides brief examples of what has occurred in other countries and advocates for a policy framework to support further action in Australia. What are the implications for practitioners? The significance of this paper is that it notes the need for a consistent, whole-of-country approach to carbon reduction in many aspects of the healthcare system. From an increased preventative focus on population health, coupled with actions in patient care, and developing a whole-of-healthcare-system approach, benefits will be realised that serve to reduce carbon emission, thereby tackling the longer-term effects of climate change. This view is supported by the noted success of increasing sustainable health system actions in the United Kingdom National Health Service and elsewhere.

Immediate Impact of Hurricane Sandy on People Who Inject Drugs in New York City

Over the eight months following Hurricane Sandy, of October 2012, we interviewed 300 people who inject drugs in New York City. During the week after the storm, 28% rescued others or volunteered with aid groups; 60% experienced withdrawal; 27% shared drug injection or preparation equipment, or injected with people they normally would not inject with; 70% of those on opioid maintenance therapy could not obtain sufficient doses; and 43% of HIV-positive participants missed HIV medication doses. Although relatively brief, a hurricane can be viewed as a Big Event that can alter drug environments and behaviors, and may have lasting impact. The study's limitations are noted and future needed research is suggested.

Human health impacts of climate change: implications for the practice and law of public health

Reducing greenhouse gas emissions is an urgent priority. While few would argue that action to mitigate the causes of climate change should be led by public health practitioners, public health has a critical role in adaptation efforts. Adaptation seeks to lessen human vulnerability to extreme weather and to increased variability in temperature and precipitation. Climate change as an emerging health issue provides a test case for new approaches to public health: approaches that emphasize both collaboration with other government and private entities and application of innovative legal strategies.

Using a social justice and health framework to assess European climate change adaptation strategies

Climate change puts pressure on existing health vulnerabilities through higher frequency of extreme weather events, changes in disease vector distribution or exacerbated air pollution. Climate change adaptation policies may hold potential to reduce societal inequities. We assessed the role of public health and social justice in European climate change adaptation using a three-fold approach: a document analysis, a critical discourse analysis of a subgroup of strategies, and a ranking of strategies against our social justice framework. The ranking approach favored planning that includes various adaptation types, social issues and infrastructure changes. Themes on values identified in the five subgroup documents showed that risks are perceived as contradictory, technology is viewed as savior, responsibilities need to be negotiated, and social justice is advocated by only a few countries. Of 21 strategy documents assessed overall, those from Austria, England and Sweden received the highest scores in the ranking. Our qualitative assessment showed that in European adaptation planning, progress could still be made through community involvement into adaptation decisions, consistent consideration of social and demographic determinants, and a stronger link between infrastructural adaptation and the health sector. Overall, a social justice framework can serve as an evaluation guideline for adaptation policy documents.

Is planned adaptation to heat reducing heat-related mortality and illness? A systematic review

BACKGROUND

Extreme heat is an important public health risk. Climate change will likely increase the temperatures humans are exposed to through exacerbated heat wave intensity and frequency, possibly increasing health risks from heat. To prevent adverse effects on human health, heat prevention plans and climate change adaptation strategies are being implemented. But are these measures effectively reducing heat-related mortality and morbidity? This study assesses the evidence base in 2014.

METHODS

We conducted a systematic review of peer-reviewed published literature. We applied a combined search strategy of automated search and journal content search using the electronic databases PubMed, Web of Knowledge, Biological Abstracts, CAB Abstracts and ProQuest Dissertation & Theses A&I. Quality appraisal was conducted using CASP checklists, and we identified recurrent themes in studies with content analysis methodology. We conducted sub-group analyses for two types of studies: survey and interview research on behavioral change and perception, and observational studies with regression.

RESULTS

30 articles were included in the review. The majority of studies (n = 17) assessed mortality or morbidity reductions with regression analysis. Overall, the assessments report a reduction of adverse effects during extreme heat in places where preventive measures have been implemented. Population perception and behavior change were assessed in five studies, none of which had carried out a pre-test. Two themes emerged from the review: methodological challenges are a major hindrance to rigorous evaluation, and what counts as proof of an effective reduction in adverse health outcomes is disputed.

CONCLUSIONS

Attributing health outcomes to heat adaptation remains a challenge. Recent study designs are less rigorous due to difficulties assigning the counterfactual. While sensitivity to heat is decreasing, the examined studies provide inconclusive evidence on individual planned adaptation measures.

The role of social and intergenerational equity in making changes in human well-being sustainable

A sustainable world is one in which human needs are met equitably and without sacrificing the ability of future generations to meet their needs. Human well-being is described by four primary elements-basic human needs, economic needs, environmental needs, and subjective well-being. These elements can interact in a myriad of ways to influence overall well-being. What makes changes in human well-being sustainable for a population or a nation? Two major interactional concepts can push changes in human well-being toward a sustainable state in space and time-social equity and intergenerational equity. The concept of social equity distributes well-being over space, ensuring the fair treatment of all members of society promoting spatial sustainability of a well-being decision. The concept of intergenerational equity distributes well-being through time, ensuring the well-being of present and future generations of a population or nation, promoting temporal sustainability of a well-being decision. The roles of social and intergenerational equity in terms of their influence on human well-being are examined with a focus on more sustainable decision-making.

An approach to developing local climate change environmental public health indicators, vulnerability assessments, and projections of future impacts

Environmental public health indicators (EPHIs) are used by local, state, and federal health agencies to track the status of environmental hazards; exposure to those hazards; health effects of exposure; and public health interventions designed to reduce or prevent the hazard, exposure, or resulting health effect. Climate and health EPHIs have been developed at the state, federal, and international levels. However, they are also needed at the local level to track variations in community vulnerability and to evaluate the effectiveness of interventions designed to enhance community resilience. This review draws on a guidance document developed by the U.S. Council of State and Territorial Epidemiologists' State Environmental Health Indicators Collaborative climate change working group to present a three-tiered approach to develop local climate change EPHIs. Local climate change EPHIs can assist local health departments (LHDs) in implementing key steps of the 10 essential public health services and the U.S. Centers for Disease Control and Prevention's Building Resilience Against Climate Effects framework. They also allow LHDs to incorporate climate-related trends into the larger health department planning process and can be used to perform vulnerability assessments which can be leveraged to ensure that interventions designed to address climate change do not exacerbate existing health disparities.

Old health risks in new places? An ecological niche model for I. ricinus tick distribution in Europe under a changing climate

Climate change will likely have impacts on disease vector distribution. Posing a significant health threat in the 21st century, risk of tick-borne diseases may increase with higher annual mean temperatures and changes in precipitation. We modeled the current and future potential distribution of the Ixodes ricinus tick species in Europe. The Genetic Algorithm for Rule-set Prediction (GARP) was utilized to predict potential distributions of I. ricinus based on current (1990-2010 averages) and future (2040-2060 averages) environmental variables. A ten model best subset was created out of a possible 200 models based on omission and commission criteria. Our results show that under the A2 climate change scenario the potential habitat range for the I. ricinus tick in Europe will expand into higher elevations and latitudes (e.g., Scandinavia, the Baltics, and Belarus), while contracting in other areas (e.g., Alps, Pyrenees, interior Italy, and northwestern Poland). Overall, a potential habitat expansion of 3.8% in all of Europe is possible. Our results may be used to inform climate change adaptation efforts in Europe.

Association of climate variability and childhood diarrhoeal disease in rural Bangladesh, 2000-2006

This study examined the effects of meteorological factors, particularly, extreme weather events, on the prevalence of childhood diarrhoeal disease in Matlab, Bangladesh. Logistic regression models were used to examine impacts of temperature, rainfall and the extreme weather factors (the number of hot days and days with heavy rainfall) on childhood diarrhoea from 2000 to 2006 at the bari (cluster of dwellings) level. The results showed that the increases in the number of hot days and days with heavy rainfall were associated with an increase in daily diarrhoea cases by 0·8-3·8% and 1-6·2%, respectively. The results from multivariable stepwise models showed that the extreme weather factors were still positively associated with childhood diarrhoea, while the associations for average temperature and rainfall could be negative after other variables were controlled. The findings showed that not only the intensity, but also the frequency of extreme weather events had significant effects on childhood diarrhoea.

The public health impacts of climate change in the former Yugoslav Republic of Macedonia

Projected climatic changes for the former Yugoslav Republic of Macedonia for the period 2025-2100 will be most intense in the warmest period of the year with more frequent and more intense heat-waves, droughts and flood events compared with the period 1961-1990. The country has examined their vulnerabilities to climate change and many public health impacts have been projected. A variety of qualitative and quantitative methodologies were used in the assessment: literature reviews, interviews, focus groups, time series and regression analysis, damage and adaptation cost estimation, and scenario-based assessment. Policies and interventions to minimize the risks and development of long-term adaptation strategies have been explored. The generation of a robust evidence base and the development of stakeholder engagement have been used to support the development of an adaptation strategy and to promote adaptive capacity by improving the resilience of public health systems to climate change. Climate change adaptation has been established as a priority within existing national policy instruments. The lessons learnt from the process are applicable to countries considering how best to improve adaptive capacity and resilience of health systems to climate variability and its associated impacts.

A Statistical Modeling Framework for Projecting Future Ambient Ozone and its Health Impact due to Climate Change

The adverse health effects of ambient ozone are well established. Given the high sensitivity of ambient ozone concentrations to meteorological conditions, the impacts of future climate change on ozone concentrations and its associated health effects are of concern. We describe a statistical modeling framework for projecting future ozone levels and its health impacts under a changing climate. This is motivated by the continual effort to evaluate projection uncertainties to inform public health risk assessment. The proposed approach was applied to the 20-county Atlanta metropolitan area using regional climate model (RCM) simulations from the North American Regional Climate Change Assessment Program. Future ozone levels and ozone-related excesses in asthma emergency department (ED) visits were examined for the period 2041-2070. The computationally efficient approach allowed us to consider 8 sets of climate model outputs based on different combinations of 4 RCMs and 4 general circulation models. Compared to the historical period of 1999-2004, we found consistent projections across climate models of an average 11.5% higher ozone levels (range: 4.8%, 16.2%), and an average 8.3% (range: -7% to 24%) higher number of ozone exceedance days. Assuming no change in the at-risk population, this corresponds to excess ozone-related ED visits ranging from 267 to 466 visits per year. Health impact projection uncertainty was driven predominantly by uncertainty in the health effect association and climate model variability. Calibrating climate simulations with historical observations reduced differences in projections across climate models.

Ciguatera fish poisoning and climate change: analysis of National Poison Center Data in the United States, 2001-2011

BACKGROUND

Warm sea surface temperatures (SSTs) are positively related to incidence of ciguatera fish poisoning (CFP). Increased severe storm frequency may create more habitat for ciguatoxic organisms. Although climate change could expand the endemic range of CFP, the relationship between CFP incidence and specific environmental conditions is unknown.

OBJECTIVES

We estimated associations between monthly CFP incidence in the contiguous United States and SST and storm frequency in the Caribbean basin.

METHODS

We obtained information on 1,102 CFP-related calls to U.S. poison control centers during 2001-2011 from the National Poison Data System. We performed a time-series analysis using Poisson regression to relate monthly CFP call incidence to SST and tropical storms. We investigated associations across a range of plausible lag structures.

RESULTS

Results showed associations between monthly CFP calls and both warmer SSTs and increased tropical storm frequency. The SST variable with the strongest association linked current monthly CFP calls to the peak August SST of the previous year. The lag period with the strongest association for storms was 18 months. If climate change increases SST in the Caribbean 2.5-3.5 °C over the coming century as projected, this model implies that CFP incidence in the United States is likely to increase 200-400%.

CONCLUSIONS

Using CFP calls as a marker of CFP incidence, these results clarify associations between climate variability and CFP incidence and suggest that, all other things equal, climate change could increase the burden of CFP. These findings have implications for disease prediction, surveillance, and public health preparedness for climate change.

Building Resilience Against Climate Effects—a novel framework to facilitate climate readiness in public health agencies

Climate change is anticipated to have several adverse health impacts. Managing these risks to public health requires an iterative approach. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and regularly updating models and risk management plans with new information-hallmarks of adaptive management-are considered central tenets of effective public health adaptation. The Centers for Disease Control and Prevention has developed a framework, entitled Building Resilience Against Climate Effects, or BRACE, to facilitate this process for public health agencies. Its five steps are laid out here. Following the steps laid out in BRACE will enable an agency to use the best available science to project likely climate change health impacts in a given jurisdiction and prioritize interventions. Adopting BRACE will also reinforce public health's established commitment to evidence-based practice and institutional learning, both of which will be central to successfully engaging the significant new challenges that climate change presents.

Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave

INTRODUCTION

In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8 °C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality.

METHODS

We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1-31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations.

RESULTS

The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest "summer" months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19-25, 2010), mortality rate ratios were 1.76 [95% CI 1.67-1.83, p<0.001] and 2.12 [95% CI 2.03-2.21] applying reference periods (May 12-18, 2010) from various years.

CONCLUSION

The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June.

Sustainability in nursing: a concept analysis

AIM

The aim of this study was to describe, explore and explain the concept of sustainability in nursing.

BACKGROUND

Although researchers in nursing and medicine have emphasised the issue of sustainability and health, the concept of sustainability in nursing is undefined and poorly researched. A need exists for theoretical and empirical studies of sustainability in nursing.

DESIGN

Concept analysis as developed by Walker and Avant.

METHOD

Data were derived from dictionaries, international healthcare organisations and literature searches in the CINAHL and MEDLINE databases. Inclusive years for the search ranged from 1990 to 2012. A total of fourteen articles were found that referred to sustainability in nursing.

RESULTS

Sustainability in nursing involves six defining attributes: ecology, environment, future, globalism, holism and maintenance. Antecedents of sustainability require climate change, environmental impact and awareness, confidence in the future, responsibility and a willingness to change. Consequences of sustainability in nursing include education in the areas of ecology, environment and sustainable development as well as sustainability as a part of nursing academic programs and in the description of the academic subject of nursing. Sustainability should also be part of national and international healthcare organisations. The concept was clarified herein by giving it a definition.

CONCLUSION

Sustainability in nursing was explored and found to contribute to sustainable development, with the ultimate goal of maintaining an environment that does not harm current and future generations' opportunities for good health. This concept analysis provides recommendations for the healthcare sector to incorporate sustainability and provides recommendations for future research.

Public health and climate change adaptation at the federal level: one agency's response to Executive Order 13514

Climate change will likely have adverse human health effects that require federal agency involvement in adaptation activities. In 2009, President Obama issued Executive Order 13514, Federal Leadership in Environmental, Energy, and Economic Performance. The order required federal agencies to develop and implement climate change adaptation plans. The Centers for Disease Control and Prevention (CDC), as part of a larger Department of Health and Human Services response to climate change, is developing such plans. We provide background on Executive Orders, outline tenets of climate change adaptation, discuss public health adaptation planning at both the Department of Health and Human Services and the CDC, and outline possible future CDC efforts. We also consider how these activities may be better integrated with other adaptation activities that manage emerging health threats posed by climate change.

Indicators for tracking European vulnerabilities to the risks of infectious disease transmission due to climate change

A wide range of infectious diseases may change their geographic range, seasonality and incidence due to climate change, but there is limited research exploring health vulnerabilities to climate change. In order to address this gap, pan-European vulnerability indices were developed for 2035 and 2055, based upon the definition vulnerability = impact/adaptive capacity. Future impacts were projected based upon changes in temperature and precipitation patterns, whilst adaptive capacity was developed from the results of a previous pan-European study. The results were plotted via ArcGISTM to EU regional (NUTS2) levels for 2035 and 2055 and ranked according to quintiles. The models demonstrate regional variations with respect to projected climate-related infectious disease challenges that they will face, and with respect to projected vulnerabilities after accounting for regional adaptive capacities. Regions with higher adaptive capacities, such as in Scandinavia and central Europe, will likely be better able to offset any climate change impacts and are thus generally less vulnerable than areas with lower adaptive capacities. The indices developed here provide public health planners with information to guide prioritisation of activities aimed at strengthening regional preparedness for the health impacts of climate change. There are, however, many limitations and uncertainties when modeling health vulnerabilities. To further advance the field, the importance of variables such as coping capacity and governance should be better accounted for, and there is the need to systematically collect and analyse the interlinkages between the numerous and ever-expanding environmental, socioeconomic, demographic and epidemiologic datasets so as to promote the public health capacity to detect, forecast, and prepare for the health threats due to climate change.

Public perception of climate change and its impact on health and environment in rural southwestern Nigeria

BACKGROUND

Climate change (CC) has received extensive media attention recently, and it is currently on the international public health agenda. A study of knowledge and attitudes to climate change, most especially from rural Nigerian communities, is important for developing adaptation strategies. This is a study of public perceptions of CC and its impact on health and environment in rural southwestern Nigeria.

METHODS

This was a community-based descriptive cross-sectional study of 1,019 rural respondents using a multistage sampling method. The research instrument used was a pretested, structured, interviewer-administered questionnaire. Data were analyzed using SPSS software. χ2, Cramér's V, and Kendall's τ-c statistics were employed in addition to fitting the data to a logistic regression model to explore associations found significant on bivariate analysis.

RESULTS

Mean age of respondents was 36.9 (±12.4) years. About 911 (89.4%) of respondents opined that there has been a change in climate in the last 10 years. Supernatural reasons were prominent among respondent-reported causes of CC. Identified risky behavior contributing to CC included smoking (10.7%), bush burning (33.4%), and tree felling (41.0%). Poor knowledge of causes but good knowledge of effects of CC were found in this study. About two-thirds of respondents had a positive attitude to causes of CC, while half had a positive attitude to the effects of CC. A significant association was found between educational status (P˂0.001, Kendall's τ-c=-0.042), occupational status (P˂0.01, Kendall's τ-c=0.088), and attitude to causes of CC. Further analysis using logistic regression showed that occupational status was significantly associated with likelihood of having a positive attitude, but educational status and marital status were not.

CONCLUSION

Rural areas of Nigeria are vulnerable to the adverse effects of CC. Respondents' poor knowledge but positive attitude to CC calls for dissemination of adequate information on CC in sustained health-promotion programs.

Extreme ambient temperatures and cardiorespiratory emergency room visits: assessing risk by comorbid health conditions in a time series study

BACKGROUND

Extreme ambient temperatures are an increasing public health concern. The aim of this study was to assess if persons with comorbid health conditions were at increased risk of adverse cardiorespiratory morbidity during temperature extremes.

METHODS

A time series study design was applied to 292,666 and 562,738 emergency room (ER) visits for cardiovascular and respiratory diseases, respectively, that occurred in Toronto area hospitals between April 1st 2002 and March 31st 2010. Subgroups of persons with comorbid health conditions were identified. Relative risks (RRs) and their corresponding 95% confidence intervals (CIs) were estimated using a Poisson regression model with distributed lag non-linear model, and were adjusted for the confounding influence of seasonality, relative humidity, day-of-the-week, outdoor air pollutants and daily influenza ER visits. Effect modification by comorbid health conditions was tested using the relative effect modification (REM) index.

RESULTS

Stronger associations of cardiovascular disease ER visits were observed for persons with diabetes compared to persons without diabetes (REM = 1.12; 95% CI: 1.01 - 1.27) with exposure to the cumulative short term effect of extreme hot temperatures (i.e. 99th percentile of temperature distribution vs. 75th percentile). Effect modification was also found for comorbid respiratory disease (REM = 1.17; 95% CI: 1.02 - 1.44) and cancer (REM = 1.20; 95% CI: 1.02 - 1.49) on respiratory disease ER visits during short term hot temperature episodes. The effect of extreme cold temperatures (i.e. 1st percentile of temperature distribution vs. 25th percentile) on cardiovascular disease ER visits were stronger for individuals with comorbid cardiac diseases (REM = 1.47; 95% CI: 1.06 - 2.23) and kidney diseases (REM = 2.43; 95% CI: 1.59 - 8.83) compared to those without these conditions when cumulated over a two-week period.

CONCLUSIONS

The identification of those most susceptible to temperature extremes is important for public health officials to implement adaptation measures to manage the impact of extreme temperatures on population health.

A review of national-level adaptation planning with regards to the risks posed by climate change on infectious diseases in 14 OECD nations

Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate change impacts and increase health system resilience (i.e., adaptation). In this paper, we review and evaluate national-level adaptation planning in relation to infectious disease risks in 14 OECD countries with respect to "best practices" for adaptation identified in peer-reviewed literature. We find a number of limitations to current planning, including negligible consideration of the needs of vulnerable population groups, limited emphasis on local risks, and inadequate attention to implementation logistics, such as available funding and timelines for evaluation. The nature of planning documents varies widely between nations, four of which currently lack adaptation plans. In those countries where planning documents were available, adaptations were mainstreamed into existing public health programs, and prioritized a sectoral, rather than multidisciplinary, approach. The findings are consistent with other scholarship examining adaptation planning indicating an ad hoc and fragmented process, and support the need for enhanced attention to adaptation to infectious disease risks in public health policy at a national level.

Lessons from Hurricane Sandy: a community response in Brooklyn, New York

The frequency and intensity of extreme weather events have increased in recent decades; one example is Hurricane Sandy. If the frequency and severity continue or increase, adaptation and mitigation efforts are needed to protect vulnerable populations and improve daily life under changed weather conditions. This field report examines the devastation due to Hurricane Sandy experienced in Red Hook, Brooklyn, New York, a neighborhood consisting of geographically isolated low-lying commercial and residential units, with a concentration of low-income housing, and disproportionate rates of poverty and poor health outcomes largely experienced by Black and Latino residents. Multiple sources of data were reviewed, including street canvasses, governmental reports, community flyers, and meeting transcripts, as well as firsthand observations by a local nonprofit Red Hook Initiative (RHI) and community members, and social media accounts of the effects of Sandy and the response to daily needs. These data are considered within existing theory, evidence, and practice on protecting public health during extreme weather events. Firsthand observations show that a community-based organization in Red Hook, RHI, was at the center of the response to disaster relief, despite the lack of staff training in response to events such as Hurricane Sandy. Review of these data underscores that adaptation and response to climate change and likely resultant extreme weather is a dynamic process requiring an official coordinated governmental response along with on-the-ground volunteer community responders.

Regional and seasonal response of a West Nile virus vector to climate change

Climate change will affect the abundance and seasonality of West Nile virus (WNV) vectors, altering the risk of virus transmission to humans. Using downscaled general circulation model output, we calculate a WNV vector's response to climate change across the southern United States using process-based modeling. In the eastern United States, Culex quinquefasciatus response to projected climate change displays a latitudinal and elevational gradient. Projected summer population depressions as a result of increased immature mortality and habitat drying are most severe in the south and almost absent further north; extended spring and fall survival is ubiquitous. Much of California also exhibits a bimodal pattern. Projected onset of mosquito season is delayed in the southwestern United States because of extremely dry and hot spring and summers; however, increased temperature and late summer and fall rains extend the mosquito season. These results are unique in being a broad-scale calculation of the projected impacts of climate change on a WNV vector. The results show that, despite projected widespread future warming, the future seasonal response of C. quinquefasciatus populations across the southern United States will not be homogeneous, and will depend on specific combinations of local and regional conditions.

Extreme Weather Events and Mental Health: Tackling the Psychosocial Challenge

Climate change is an emerging challenge to the mental health of entire humanity. Several studies, in recent times, have brought to light the adverse public mental health outcomes of extreme weather events for the suffering communities. The general public and the policy making bodies need to gain awareness about these impacts. Through such awareness, communities and their governments can institutionalize mechanisms to provide psychological support to the populations affected by climate change, before it becomes a massive public health challenge and starts affecting the social and vocational lives of people. There is an urgent need for addressing these impacts. The aim of this paper is to provide an overview of the deleterious effects of climate change related extreme weather events on mental health, the worldwide response of several communities to such events, and preparedness of the public and government to deal with these adverse mental health impacts. Policy imperatives to prevent and mitigate these impacts have been suggested. It is hoped that the psychologists, governments, and communities will act earnestly to prevent the impending harm to human mental health due to climate change.

Climate change and health in Israel: adaptation policies for extreme weather events

Climatic changes have increased the world-wide frequency of extreme weather events such as heat waves, cold spells, floods, storms and droughts. These extreme events potentially affect the health status of millions of people, increasing disease and death. Since mitigation of climate change is a long and complex process, emphasis has recently been placed on the measures required for adaptation. Although the principles underlying these measures are universal, preparedness plans and policies need to be tailored to local conditions. In this paper, we conducted a review of the literature on the possible health consequences of extreme weather events in Israel, where the conditions are characteristic of the Mediterranean region. Strong evidence indicates that the frequency and duration of several types of extreme weather events are increasing in the Mediterranean Basin, including Israel. We examined the public health policy implications for adaptation to climate change in the region, and proposed public health adaptation policy options. Preparedness for the public health impact of increased extreme weather events is still relatively limited and clear public health policies are urgently needed. These include improved early warning and monitoring systems, preparedness of the health system, educational programs and the living environment. Regional collaboration should be a priority.

Occupation and environmental heat-associated deaths in Maricopa county, Arizona: a case-control study

BACKGROUND

Prior research shows that work in agriculture and construction/extraction occupations increases the risk of environmental heat-associated death.

PURPOSE

To assess the risk of environmental heat-associated death by occupation.

METHODS

This was a case-control study. Cases were heat-caused and heat-related deaths occurring from May-October during the period 2002-2009 in Maricopa County, Arizona. Controls were selected at random from non-heat-associated deaths during the same period in Maricopa County. Information on occupation, age, sex, and race-ethnicity was obtained from death certificates. Logistic regression analysis was used to estimate odds ratios for heat-associated death.

RESULTS

There were 444 cases of heat-associated deaths in adults (18+ years) and 925 adult controls. Of heat-associated deaths, 332 (75%) occurred in men; a construction/extraction or agriculture occupation was described on the death certificate in 115 (35%) of these men. In men, the age-adjusted odds ratios for heat-associated death were 2.32 (95% confidence interval 1.55, 3.48) in association with construction/extraction and 3.50 (95% confidence interval 1.94, 6.32) in association with agriculture occupations. The odds ratio for heat-associated death was 10.17 (95% confidence interval 5.38, 19.23) in men with unknown occupation. In women, the age-adjusted odds ratio for heat-associated death was 6.32 (95% confidence interval 1.48, 27.08) in association with unknown occupation. Men age 65 years and older in agriculture occupations were at especially high risk of heat-associated death.

CONCLUSION

The occurrence of environmental heat-associated death in men in agriculture and construction/extraction occupations in a setting with predictable periods of high summer temperatures presents opportunities for prevention.

Managing the health effects of temperature in response to climate change: challenges ahead

BACKGROUND

Although many studies have shown that high temperatures are associated with an increased risk of mortality and morbidity, there has been little research on managing the process of planned adaptation to alleviate the health effects of heat events and climate change. In particular, economic evaluation of public health adaptation strategies has been largely absent from both the scientific literature and public policy discussion.

OBJECTIVES

We examined how public health organizations should implement adaptation strategies and, second, how to improve the evidence base required to make an economic case for policies that will protect the public's health from heat events and climate change.

DISCUSSION

Public health adaptation strategies to cope with heat events and climate change fall into two categories: reducing the heat exposure and managing the health risks. Strategies require a range of actions, including timely public health and medical advice, improvements to housing and urban planning, early warning systems, and assurance that health care and social systems are ready to act. Some of these actions are costly, and given scarce financial resources the implementation should be based on the cost-effectiveness analysis. Therefore, research is required not only on the temperature-related health costs, but also on the costs and benefits of adaptation options. The scientific community must ensure that the health co-benefits of climate change policies are recognized, understood, and quantified.

CONCLUSIONS

The integration of climate change adaptation into current public health practice is needed to ensure the adaptation strategies increase future resilience. The economic evaluation of temperature-related health costs and public health adaptation strategies are particularly important for policy decisions.

The impact of heat on morbidity and mortality

With forecast trends predicting climate changes that will result in warmer weather globally, the potential for heat-related morbidities and mortality increases. Critical care nurses are uniquely poised to have an impact on the health care consequences of persons exposed to excessive ambient heat. The first step is a clearer understanding of ambient heat, heat conditions, and heat factors. This understanding combined with knowledge of persons at highest risk for heat-related mortality and morbidity can lead to interventions to ameliorate the prevalence and incidence of these incidents.

Climate change and mosquito-borne diseases in China: a review

China has experienced noticeable changes in climate over the past 100 years and the potential impact climate change has on transmission of mosquito-borne infectious diseases poses a risk to Chinese populations. The aims of this paper are to summarize what is known about the impact of climate change on the incidence and prevalence of malaria, dengue fever and Japanese encephalitis in China and to provide important information and direction for adaptation policy making. Fifty-five papers met the inclusion criteria for this study. Examination of these studies indicates that variability in temperature, precipitation, wind, and extreme weather events is linked to transmission of mosquito-borne diseases in some regions of China. However, study findings are inconsistent across geographical locations and this requires strengthening current evidence for timely development of adaptive options. After synthesis of available information we make several key adaptation recommendations including: improving current surveillance and monitoring systems; concentrating adaptation strategies and policies on vulnerable communities; strengthening adaptive capacity of public health systems; developing multidisciplinary approaches sustained by an new mechanism of inter-sectional coordination; and increasing awareness and mobilization of the general public.

The Ciclovia and Cicloruta programs: promising interventions to promote physical activity and social capital in Bogotá, Colombia

OBJECTIVES

We compared participants from the Ciclovia (streets temporarily closed to motorized vehicles and open for pedestrians) and Cicloruta (bicycle paths) programs in Bogotá, Colombia, to assess associations of program participation with physical activity, safety, social capital, and equity.

METHODS

We conducted 2 cross-sectional studies in October 2009 with intercept surveys: one among 1000 Ciclovia participants and the other among 1000 Cicloruta participants.

RESULTS

Most Ciclovia participants met the physical activity recommendation in leisure time (59.5%), and most Cicloruta participants met it by cycling for transportation (70.5%). Ciclovia participants reported a higher perception of safety (51.2% regarding traffic and 42.4% about crime) and social capital (odds ratio = 2.0; 95% confidence interval = 1.4, 2.8) than did Cicloruta users. Most Cicloruta users reported living in low socioeconomic status categories (53.1%), had lower educational attainment (27%), and did not own cars (82.9%). Most Ciclovia participants reported living in middle socioeconomic status categories (64%), had low-to-middle educational attainment (51.1%), and did not own cars (66.1%).

CONCLUSIONS

The Ciclovia and Cicloruta programs have the potential to equitably promote physical activity and provide a mobility alternative in complex urban settings such as Bogotá.

Health co-benefits and risks of public health adaptation strategies to climate change: a review of current literature

Objectives

Many public health adaptation strategies have been identified in response to climate change. This report reviews current literature on health co-benefits and risks of these strategies to gain a better understanding of how they may affect health.

Methods

A literature review was conducted electronically using English language literature from January 2000 to March 2012. Of 812 articles identified, 22 peer-reviewed articles that directly addressed health co-benefits or risks of adaptation were included in the review.

Results

The co-benefits and risks identified in the literature most commonly relate to improvements in health associated with adaptation actions that affect social capital and urban design. Health co-benefits of improvements in social capital have positive influences on mental health, independently of other determinants. Risks included reinforcing existing misconceptions regarding health. Health co-benefits of urban design strategies included reduced obesity, cardiovascular disease and improved mental health through increased physical activity, cooling spaces (e.g., shaded areas), and social connectivity. Risks included pollen allergies with increased urban green space, and adverse health effects from heat events through the use of air conditioning.

Conclusions

Due to the current limited understanding of the full impacts of the wide range of existing climate change adaptation strategies, further research should focus on both unintended positive and negative consequences of public health adaptation.

Mapping Heat Health Risks in Urban Areas

Periods of extreme heat pose a risk to the health of individuals, especially the elderly, the very young, and the chronically ill. Risk factors include housing characteristics, and socioeconomic factors, or environmental risk factors such as urban heat islands. This study developed an index of population vulnerability in an urban setting using known environmental, demographic, and health-related risk factors for heat stress. The spatial variations in risk factors were correlated with spatial variation in heat-related health outcomes in urban Melbourne. The index was weighted using measured health outcomes during heatwave periods. The index was then mapped to produce a spatial representation of risk. The key risk factors were identified as areas with aged care facilities, higher proportions of older people living alone, living in suburban rather than inner city areas, and areas with larger proportions of people who spoke a language other than English at home. The maps of spatial vulnerability provide information to target heat-related health risks by aiding policy advisors, urban planners, healthcare professionals, and ancillary services to develop heatwave preparedness plans at a local scale.

Climate change: could it help develop 'adaptive expertise'?

Preparing health practitioners to respond to the rising burden of disease from climate change is emerging as a priority in health workforce policy and planning. However, this issue is hardly represented in the medical education research. The rapidly evolving wide range of direct and indirect consequences of climate change will require health professionals to have not only broad content knowledge but also flexibility and responsiveness to diverse regional conditions as part of complex health problem-solving and adaptation. It is known that adaptive experts may not necessarily be quick at solving familiar problems, but they do creatively seek to better solve novel problems. This may be the result of an acquired approach to practice or a pathway that can be fostered by learning environments. It is also known that building adaptive expertise in medical education involves putting students on a learning pathway that requires them to have, first, the motivation to innovatively problem-solve and, second, exposure to diverse content material, meaningfully presented. Including curriculum content on the health effects of climate change could help meet these two conditions for some students at least. A working definition and illustrative competencies for adaptive expertise for climate change, as well as examples of teaching and assessment approaches extrapolated from rural curricula, are provided.

"From this place and of this place:" climate change, sense of place, and health in Nunatsiavut, Canada

As climate change impacts are felt around the globe, people are increasingly exposed to changes in weather patterns, wildlife and vegetation, and water and food quality, access and availability in their local regions. These changes can impact human health and well-being in a variety of ways: increased risk of foodborne and waterborne diseases; increased frequency and distribution of vector-borne disease; increased mortality and injury due to extreme weather events and heat waves; increased respiratory and cardiovascular disease due to changes in air quality and increased allergens in the air; and increased susceptibility to mental and emotional health challenges. While climate change is a global phenomenon, the impacts are experienced most acutely in place; as such, a sense of place, place-attachment, and place-based identities are important indicators for climate-related health and adaptation. Representing one of the first qualitative case studies to examine the connections among climate change, a changing sense of place, and health in an Inuit context, this research draws data from a multi-year community-driven case study situated in the Inuit community of Rigolet, Nunatsiavut, Canada. Data informing this paper were drawn from the narrative analysis of 72 in-depth interviews conducted from November 2009 to October 2010, as well as from the descriptive analysis of 112 questionnaires from a survey in October 2010 (95% response rate). The findings illustrated that climate change is negatively affecting feelings of place attachment by disrupting hunting, fishing, foraging, trapping, and traveling, and changing local landscapes-changes which subsequently impact physical, mental, and emotional health and well-being. These results also highlight the need to develop context-specific climate-health planning and adaptation programs, and call for an understanding of place-attachment as a vital indicator of health and well-being and for climate change to be framed as an important determinant of health.

Securing 'supportive environments' for health in the face of ecosystem collapse: meeting the triple threat with a sociology of creative transformation

In this paper, we reflect on and explore what remains to be done to make the concept of supportive environments--one of the Ottawa Charter's five core action areas--a reality in the context of growing uncertainty about the future and accelerated pace of change. We pay particular attention to the physical environment, while underscoring the inextricable links between physical and social environments, and particularly the need to link social and environmental justice. The paper begins with a brief orientation to three emerging threats to health equity, namely ecological degradation, climate change, and peak oil, and their connection to economic instability, food security, energy security and other key determinants of health. We then present three contrasting perspectives on the nature of social change and how change is catalyzed, arguing for an examination of the conditions under which cultural change on the scale required to realize the vision of 'supportive environments for all' might be catalyzed, and the contribution that health promotion as a field could play in this process. Drawing on sociological theory, and specifically practice theory and the work of Pierre Bourdieu, we advocate rethinking education for social change by attending more adequately to the social conditions of transformative learning and cultural change. We conclude with an explication of three key implications for health promotion practice: a more explicit alignment with those seeking to curtail environmental destruction and promote environmental justice, strengthening engagement with local or settings-focused 'communities of practice' (such as the Transition Town movement), and finding new ways to creatively 'engage emergence', a significant departure from the current dominant focus on 'risk management'.

Public health nurses' knowledge and attitudes regarding climate change

BACKGROUND

Climate change affects human health, and health departments are urged to act to reduce the severity of these impacts. Yet little is known about the perspective of public health nurses--the largest component of the public health workforce--regarding their roles in addressing health impacts of climate change.

OBJECTIVES

We determined the knowledge and attitudes of public health nurses concerning climate change and the role of public health nursing in divisions of health departments in addressing health-related impacts of climate change. Differences by demographic subgroups were explored.

METHODS

An online survey was distributed to nursing directors of U.S. health departments (n = 786) with Internet staff directories.

RESULTS

Respondents (n = 176) were primarily female, white public health nursing administrators with ≥ 5 years of experience. Approximately equal percentages of respondents self-identified as having moderate, conservative, and liberal political views. Most agreed that the earth has experienced climate change and that climate change is somewhat controllable. Respondents identified an average of 5 of the 12 listed health-related impacts of climate change, but the modal response was zero impact. Public health nursing was perceived as having responsibility to address health-related impacts of climate change but lacking the ability to address these impacts.

CONCLUSIONS

Public health nurses view the environment as under threat and see a role for nursing divisions in addressing health effects of climate change. However, they recognize the limited resources and personnel available to devote to this endeavor.

Fuel use in a large, dynamically deployed emergency medical services system

INTRODUCTION

Emergency medical services (EMS) systems are a central component of the healthcare system, particularly for older patients. As currently configured, EMS transport is fundamentally petroleum dependent. Petroleum scarcity is an emerging public health concern, particularly for patient transport. Little is known regarding EMS fuel use, potential impacts of scarcity on operations, or strategies to minimize these impacts.

OBJECTIVE

The objective of this study was to characterize the fuel use of a large, urban, hospital-based, dynamically-deployed EMS system, and to identify broad optimization categories to minimize EMS's petroleum dependence.

METHODS

Fuel use was reviewed retrospectively using fuel purchasing and maintenance data from January 2007 through September 2008. Data on unit-hours, call volume, and patient transports also were collected. Data were processed using descriptive statistics.

RESULTS

During the study period, a fleet of 35 diesel ambulances operated for 277,849 unit-hours and traveled 1,902,710 miles. Detailed mileage data were available for 66,527 unit-hours, 23.9% of the sample. Overall, vehicles averaged 6.6.89 (6.71, 7.08) miles per gallon (mpg), 11.5 (10.4, 12.6) miles were travelled per call, and 16.2 (14.8, 17.6) miles per transport; 2.7 (2.4, 2.9) gallons of fuel were used per transport.

CONCLUSIONS

In this EMS system, operations are fundamentally dependent on petroleum. Mileage estimates can serve as a baseline to evaluate interventions for reducing petroleum dependence and in contingency planning. As cost pressures increase and these interventions become more common, systematic evaluations will be important.