05. CLIMATE HEALTH ACTIONS

Margaret Eggers, Alexandra Adams, and Susan Higgins, with contributing authors Robert Byron, Amy Cilimburg, Angelina Gonzalez-Aller, Paul Lachapelle, Miranda Margetts, Jennifer Robohm, and Nick Silverman,

 

Planning, preparation, and collaboration across all sectors, both at the state and community levels, are critical to reducing the broad impacts of climate change on public health. This section describes planning guides, action strategies, and information sources^[1] for 1) communities, 2) healthcare practitioners and institutions, and 3) individuals, organized for each sector by the key health issues described in Section 3. These tools will help communities and individuals access local climate and health data, assess the greatest threats to local well-being, prioritize goals and objectives, and prepare accordingly.

 

Planning, preparation, and collaboration across all sectors, both at the state and community levels, are critical to reducing the broad impacts of climate change on public health.

 

While the risks and outcomes of climate change may seem beyond anyone’s direct control, many manageable actions exist for protecting our communities, our families, and ourselves. The goal of this section is to provide information that helps Montanans maintain optimal health in the face of climate change.

Tackling problems of climate-induced environmental issues—e.g., warmer temperatures, increased forest disease and fire, or changing water quality and availability—often involves discussions of mitigation and adaptation. Mitigation is the work to reduce or stabilize the climate changes already taking place. Adaptation involves efforts to adjust to life in a changing climate. Mitigation and adaptation efforts also apply to tackling climate-induced human health issues. Citizen involvement in climate change adaptation and mitigation planning and action is already underway in some Montana counties, and several case studies are provided below.

 

Mitigation is the work to reduce or stabilize the climate changes already taking place. Adaptation involves efforts to adjust to life in a changing climate.

 

For some, tackling climate change may seem like too great a challenge, but even small efforts to improve health, well-being, and resilience make a difference for climate change mitigation and adaptation. It is time to work on building relationships, developing collaborations, and understanding who around you are most vulnerable to climate change, and who are best positioned to provide support.

 

Community Actions: Teaming Up for Success

A fall 2019 statewide survey of 222 Montana public-health and environmental-health professionals asked their concern regarding climate change. Almost three-fourths of respondents said that health departments should be preparing to deal with the public and environmental health effects of climate change, although less than 30% of the departments were currently doing so (Byron 2019; see sidebar Montanans and Climate Concerns in Section 2). Almost all respondents indicated that multiple entities should work together in this effort.

 

 

Top Actions for Communities

Join or create a broad community coalition, optimally including your local health department, and start working together across sectors to create and implement a community resilience plan that includes climate change mitigation and adaptation and.

• Identify human, organizational, financial, and other resources for conducting your work.

• Assess local climate change concerns such as extreme heat, poor air quality, drought/floods, food and water insecurity, vector borne diseases, and more.

• Gather the local/county epidemiological (health) and climate data needed for your work.

• Recognize that public health and economic well-being are inseparable—planning for climate change impacts will protect both.

• Assure that more vulnerable groups, including those with mental health concerns, are incorporated into all planning efforts.

 

 

Building resilience to climate change impacts on public health requires collaboration across all sectors: state, tribal, county, and municipal governments. It includes elected leadership; emergency management teams; public healthcare systems and practitioners; and local organizations, businesses, and community members (UNDRR and WHO 2020). A wealth of online materials is available to help build our resilience to climate change impacts. Developed by federal agencies and professional and non-profit organizations, these materials provide many examples from successful communities. In addition, many useful tools can be found in the Institute on Ecosystems’ Climate Smart Montana Program^[2] and in the subsections that follow. Our list of top actions for communities is presented  below.

 

Steps to create a community climate action plan

The Centers for Disease Control’s Climate and Health’s Building Resilience Against Climate Effects (BRACE) plan provides an excellent guide for creating a community climate action plan. This plan describes a five-step program to assist health officials and communities in preparing for health effects resulting from, or worsened by, climate change (Figure 5-1) (CDC 2019).

 

 

Initiating the BRACE (or other) planning framework requires broad community engagement and one or more government agencies, citizen groups, or organizations committed to leading the effort. Join with others in your community who are already addressing or are beginning to address the impacts of climate change on local health. As a team, carefully consider the support of your citizens and leaders. Assess your community’s capacity to develop a health and climate action plan. Is the CDC’s BRACE framework, or some other process, best suited to address your community’s capacity and needs?

It is possible, and perhaps likely, that a community’s first step will be to implement a well-thought-out engagement and education campaign or initiate some actions that will excite and galvanize a multi-sector coalition. As the National League of Cities advises in its multi-faceted  guide to local actions to address climate change, “Start with people, stay with people: build an inclusive, broad public engagement program with local partners to grow public support and political will for climate action” (NLCI undated). Including the public in initial planning leads to more public participation in plan implementation, and better understanding of community vulnerabilities (van Aalst et. al 2008; IPCC 2014; Di Matteo et al 2018).

 

As the National League of Cities advises…, “Start with people, stay with people: build an inclusive, broad public engagement program with local partners to grow public support and political will for climate action.”

Implementing a BRACE plan in Montana ideally requires access to county-level climate and air quality data, updated climate projections, and current and projected disease burden related to climate, as well as a better understanding of climate-vulnerable populations. With these data and the BRACE framework, state, tribal, and local leaders can collaborate across sectors more effectively to prepare for, manage, and reduce the health and economic impacts of climate changes (UNDDR 2020; UNDDR and WHO 2020). Data availability and access challenges—some of which are detailed below—exist in every community but should not impede planning and taking action. Data gaps and missing analyses that are consistently identified can become work mandates for state agencies and academic institutions.

The next step in creating a climate action plan is to assess sensitivity, exposure, and risk for your community. This assessment will form the basis for your community’s plan, and outline how it will address human health issues that result from climate change. Include local leaders, health professionals, a diverse stakeholder group representing your community, and people experienced in creating climate change plans. Explore the following questions:

• What are the major climate- and health-related risks facing your community now and expected in the coming decades? The impacts of climate change on health may also vary widely among community members (Islam and Winkel 2017; National Geographic 2019). Develop a climate action plan that is equitable, feasible, and tailored to community demographics (e.g., age and income distributions), exposures (e.g., climate components like increasing temperatures), and risks (e.g., the likelihood that exposure events like major wildfires or flooding will occur).
• Carefully consider the needs of each community’s unique vulnerable populations, as described in Section 4. Who are the most vulnerable? Why? What can be done to increase their resilience?
• Are any stakeholder groups underrepresented on your team? If so, how can you engage them?
• Beyond applying to the CDC’s Climate-Ready States and Cities Initiative^[4] for funding, what financial resources are available for this process and for outside facilitation to help guide discussions and actions?
• What kind of community outreach will your team need to implement before, during, and after development of your climate action plan?
• Could first-step targeted activities be initiated in your community before conducting a full climate and health assessment plan? If so, what steps? Getting started is one way to build support for further action, plus it can help develop climate and health literacy.

 

 

With persistence and patience, capable facilitation, and access to health- and climate-science expertise, your community can assess its health vulnerabilities to climate change, identify the most suitable and highest priority interventions, and then create and continuously improve your community climate action plan. That plan will describe mitigation or adaptation actions that fit your local conditions. For example, the Blackfeet Tribe, the Confederated Salish and Kootenai Tribes, and the community of Missoula have actively responded to climate-related changes faced by their people and landscapes (see sidebars).

 

 

Community Climate Action Planning for Health Resilience—Tips from Missoula
Amy Cilimburg, Executive Director of Climate Smart Missoula

More wildfire smoke combined with extreme heat is a challenge to physical and mental health—what can we possibly do? That was a question our newly formed non-profit, Climate Smart Missoula, asked a few years back as we recognized Missoulians were not prepared to “weather the changing weather.” Via our Summer Smart program, we started working on a handful of initiatives, from planting shade trees to donating indoor high-efficiency particulate air (HEPA) filters to homebound seniors. Because we were already working with our City-County Health Department, in 2017, when hazardous smoke filled our valley, we were able to rapidly grow this program, providing HEPA filters—and thus clean indoor air—to those most at risk, from babies to people with asthma to the elderly.

This early effort helped us learn that although it may be difficult to address the intersection of health and climate change, it can be done. And there’s more to do!

Our Summer Smart efforts gave us the confidence and motivation to broaden this work. We are now partnering with Missoula County and the City to craft and implement Missoula’s first-ever resiliency plan: Climate Ready Missoula^a. We first partnered with scientists to understand climate projections and then, given these, worked with hundreds of county residents to identify who and what is most at risk and what adaptation goals and strategies would best address these risks. We highly recommend the Climate Ready Communities guide^b or other similar (and free) planning resources available to help any Montana community get started.

By bringing people together to understand how we can best look ahead to the challenges coming our way and “bounce forward,” we can build social equity and strengthen a can-do attitude in the face of change. And community members will no doubt be healthier as a result of these efforts.

A few things we’ve learned along the way:

• Partner with community health professionals—they are trusted community members.
• Initiate conversations about who is most at risk in your area.
• Consider starting with a focused initiative, then expand as capacity and buy-in grows.
• Connect with neighboring communities when and where you can.
• Take care of your own personal health and go forth armed with compassion and hope.

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^a https://www.climatereadymissoula.org/
^b https://climatereadycommunities.org/learn-more/about-guidebook/

 

 

 

Stories of Climate Change, Health, and Indigenous Ways

Blackfeet Nation
Gerald Wagner and Termaine Edmo, Blackfeet Environmental Office

In 2018, Blackfeet Nation released a climate adaptation plan that works to protect our diverse ecosystems from the impacts of a rapidly changing climate. Underlying this plan is the Blackfeet understanding that people and nature are one, and that people can only be healthy if we ensure the health of the environment we depend on. Blackfeet Nation borders Glacier National Park to the east and Canada to the north. The Blackfeet Nation is not only our home, it's our place of origin. From the soil we walk on, to the water and land we protect, the Amskapii Pikunii people have worked hard to preserve our language, customs, traditions, and practices throughout the 10,000 years we have called this region home. We understand deeply that what happens to the Earth happens to us, and that we protect ourselves by honoring our traditional principles and values of stewardship.

Climate change threatens all we hold sacred, and the impacts of a changing climate are visible everywhere. For example, more extreme weather events are starting to disrupt power and water supplies, communication systems, and transportation, making it difficult to maintain critical services. During winter storm emergencies, people have become stranded in their homes with insufficient food or medicine, jeopardizing their health and well-being. Similarly, more intense flooding can negatively impact services.

In 2019 alone, we experienced several winter storm emergencies and a flood disaster. During such events our communities demonstrate exceptional resilience, compassion, and creativity. Neighbors help each other free vehicles from mud or snow, we drive miles out of our way to check on Elders, and we continue to work on ways to be better prepared for the next emergency.

Our climate adaptation plan^a works to protect the health and well-being of our people. We want our people to understand the connection between climate change and health, so our adaptation plan is the foundation from which we iikakimaat (try hard) to care for the environment and thereby our people, and our ways of life.

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^a blackfeetclimatechange.com

 

 

Salish and Kootenai Tribes (CSKT) of the Flathead Indian Reservation
Mike Durglo, Jr., Environmental Director, CSKT Natural Resources

The Flathead Indian Reservation is home to approximately 28,000 people, of which about 9000 identify as Native American. CSKT has approximately 6800 enrolled tribal members, 4000 of whom live on the reservation. On the Flathead Indian Reservation, climate change threatens our treasured landscapes, our people, and the traditional customs and practices that sustain our way of life. Climate change is the result of the worldwide establishment of a way of life that is fundamentally at odds with the traditional ways of tribal people here. This establishment, and its disregard for the environment, pose serious risks to the S’elish, Qlispe, and Ktunaxa peoples^b that call the reservation home.

Climate change is already impacting the health and well-being of our people. Wildfires have caused hazardous air quality conditions, and extreme weather events create dangerous conditions and limit access to healthcare and other critical services. The climate crisis and the ecological changes that it brings threaten traditional customs, including our access to first foods through hunting, fishing, and gathering, and our ability to conduct ceremonies and spiritual practices. Many foods and medicinal plants grow on the reservation and aboriginal lands. As a result, climate change threatens our cultural survival, which directly affects both our physical and mental health. To address these risks, CSKT released our first Climate Change Strategic Plan^c in 2013 and is taking deliberate actions to address climate impacts wherever possible. Our tribal values affirm that everything is connected and that human beings have a responsibility to care for the things that were placed here, before the human beings.

As with all things, the CSKT follow the circle pathway worldview. Our Elders teach that all things are connected and that any impact or action on one resource will impact all. The diagram shown illustrates a tribal way of thinking as also expressed during our recent climate planning session. Climate-related disturbances including flood, drought, wind events, and wildfires impact our tribal resources, and will therefore impact our culture, traditions, and our foods and spirituality—without which our lifeways cannot survive. Impacts are also expected to be place-based. Impacts in the high-elevation region will be different from impacts to resources in the dry-grass and sage-steppe ecoregions of the reservation. The climate crisis requires immediate and sustained action to protect human health and well-being. For the people of CSKT, this requires protecting the ways of life that define us as a people.

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^b The Tribes which in English are called the Salish, Pend d'Oreille, and Kootenai.
^c http://csktclimate.org/

 

 

 

 

We understand deeply that what happens to the Earth happens to us, and that we protect ourselves by honoring our traditional principles and values of stewardship.

* * * *

Climate change is the result of the worldwide establishment of a way of life that is fundamentally at odds with the traditional ways of tribal people here. This establishment, and its disregard for the environment, poses serious risks….

 

Act on climate change not only for public health, but also economic well-being

As we are learning during the current COVID-19 pandemic, public health and economic well-being are inseparable. The same concept applies to climate-driven increases in wildfire, flood, and drought, which not only directly affect our health and our economy, but are also starting to influence state and local government credit ratings. Broad collaboration and planning will reduce the intertwined health and economic impacts of climate change.

Climate surprises—such as heat waves, drought, flooding, or other disasters—can trigger an exodus of residents, resulting in declining tax revenue, or bring a flood of new immigrants to the state from regions that are experiencing worse conditions. Damage to municipal infrastructure from severe storms, floods, wildfires, or other disasters can incur major expenses for communities. For instance, a major wildfire may result in runoff water of such poor quality that a community's current water plant can no longer adequately treat it. Such occurrences add to the risks that rating agencies assess. As a result, they might lower a government’s credit rating and ultimately increase its cost of borrowing money via bonds (Fitch Ratings 2018; Pew 2019; DeFries et al. 2019; Janney Investment Strategy Group 2019; New York Times 2019).

To better assess climate change risks, the rating agency Moody’s recently bought a controlling share of a company that specializes in climate change risk assessment. According to the New York Times, several major rating agencies, including S&P Global and Moody’s (Moody’s Investor Services 2017), have issued reports “…warning state and local governments that their exposure to climate risk could affect their credit rating. Moody’s has said that cities and counties with plans for reducing their exposure to climate risks, by updating their infrastructure for example, could see their ratings improve as a result, or at least not deteriorate” (New York Times 2019).

 

Moody’s Analytics: “Cities and counties with plans for reducing their exposure to climate risks, by updating their infrastructure for example, could see their credit ratings improve as a result, or at least not deteriorate.”

 

Communities need climate and health data for planning and action

One challenge facing Montana’s communities is that the climate and epidemiologic data necessary for planning are not currently collected for and shared with all counties in Montana. The coverage of NOAA/National Weather Service (NWS) meteorological stations is uneven in Montana, such that some parts of the state have limited direct information (NOAA-NCEIa undated). Additionally, only a small number of the meteorological stations have operated long enough to characterize long-term trends in climate variables (NOAA-NCEIb undated). Several programs seek to fill the gap. First, NOAA/NWS improves the coverage of recording sites by using participating cooperative observer information (NWSb undated) to provide a network of minimum/maximum temperatures, precipitation, snowfall, and snow depth. However, parts of Montana have relatively few of these sites and the time span of records is variable. Second, the Montana Climate Office is a partner in NOAA’s Mesonet program, set up to deploy automated weather and environmental monitoring stations at 74 sites across the state, and thus increase the spatial coverage of weather data and improve services (MCO 2020).

Further, the Montana Climate Office is working with US Army Corp of Engineers and NOAA to establish and maintain upwards of 220 additional monitoring stations across the state over the next 5-7 yr.^[5] The US Army Corp of Engineers and NOAA federal funding will support better soil moisture and snowpack monitoring for flood forecasts and drought assessment. However, little funding exists for updating and analyzing historical and recent climate trends, or local climate projections. Other funding will be necessary to add air-quality monitoring sensors to these stations, as presently there are only 20 air-quality monitoring stations managed by the Montana Department of Environmental Quality. Although the department posts current air quality conditions online, 20 stations provide only limited coverage and historical data are not provided.^[6]

MCA provides climate projections for Montana, focused on the seven NOAA climate divisions in the state (Whitlock et al. 2017; Section 2). However, projections at the climate division level are too coarse to assess climate trends for particular counties or communities. Each division covers a large area and their boundaries are not defined by physical geography. Local experience suggests this may be particularly true for changes in precipitation patterns (Doyle et al. 2013; Martin et al. 2020). The spatial resolution of climate projections will improve in future Montana climate assessments, with a scale that will be even more useful for community-level planning.

 

 

County-level epidemiologic data are also required for the CDC’s BRACE framework (CDC 2019), reviewed above. Statewide epidemiological data are collected by the Montana Department of Public Health and Human Services, but for a variety of reasons are not easily accessible at the county or community level. We need shared, statewide monitoring of health-facility visits related to climate change, especially county-level data about visits related to smoke, heat, or home-mold exposure; vector- or water-borne illnesses; and mental health concerns.^[7] In sum, data are a critical need for climate monitoring agencies and communities—particularly for state and county public health departments and their collaborators—to address the impacts of climate change on health. To meet that need the state of Montana, in collaboration with relevant federal agencies, should:

• increase the network of meteorological stations in the state to fill in geographic gaps;
• add to the network of air quality stations monitoring for particulate matter to fill in geographic gaps;
• increase funding to the Montana Climate Office for historical and current analysis of climate and human health trends and patterns at the state, county, and community scales;
• improve the spatial resolution of climate projections to provide county-level information; and
• create a shared, statewide monitoring process of health-facility visits related to climate change, with county-level data available to communities.

 

 

Strategies and actions for communities

The remainder of this section highlights some strategies your community will want to consider in planning and preparing for health-related impacts from climate change. How you prioritize these categories will depend on your review of the data and discussions across your multi-sector collaboration. Appendix B provides a tabularized list of resources for communities, including public and environmental health agencies and organizations, to develop climate change assessments and action plans.

Heat

Two strategies communities can use to address heat-related impacts to health are to: 1) inform citizens about the dangers of overheating in extreme temperatures; and 2) provide cool or cooler spaces both inside and outside. Examples include:

• Encourage employers to improve the workplace environment and policies to reduce heat exposure. During extremely hot weather employers should, for example, provide outdoor workers ready access to shade, drinking water, and restroom facilities, plus allow break time for workers to cool off.
• Inform those working, playing, or otherwise spending extended time outdoors about the importance of resting, hydrating, and seeking shade to avoid potentially life threatening, heat-related health issues.
• Designate (or create) a cooling facility for your community or workplace where people can go during a heat emergency. Such a facility might be an air-conditioned school or community center, or a deeply shaded park, perhaps near a community swimming pool, lake, or river.
• Ensure vulnerable populations (see Section 4) understand heat-related health issues and have a plan for staying cool. For example, develop programs to ensure access to cool community spaces. Likewise, ensure that those most vulnerable to extreme heat have window fans or air conditioners.
• Create incentives and programs to address the rising urban heat-island effect (USEPAd undated). Examples include substituting lighter colored materials in place of black asphalt and tar on roads and driveways, and encouraging more environmentally friendly building practices, including cool roofs, constructed with light colors and heat-reflecting materials.
• Create incentives, programs, and/or campaigns to plant and care for trees and other vegetation to create shade (USEPAe undated).

Air quality

While it might be possible to mitigate some of the health effects of wildfire and smoke through forest management practices, local communities do not generally carry out such efforts. However, every Montana community can focus on adaptation strategies for dealing with wildfire by increasing their community’s fire resilience and, during wildfire season, improving air quality indoors and outside.

Actions your community can take include:

• Implement sustainable construction and encourage new housing in more sustainable and fire-safe areas (Zakaria 2020). Learn more about building fire resilience in your community through an excellent online resource titled “The science of firescapes: achieving fire-resilient communities.”^[8] The Federal Emergency Management Administration provides relevant checklists for homeowners (FEMAb undated) and communities (FEMAc undated).
• Educate homeowners about assessing fire risks to their homes, checking with their insurance company on the terms of their homeowner’s wildfire coverage, and, if needed, reducing fuels around their home.
• Develop or enhance emergency response plans for forest and grassland wildfires. Create a community database of people who would need physical assistance to evacuate if required, and determine who will help those people in such emergencies.
• Inform homeowners about options to create safe indoor air using HEPA portable air cleaners, MERV 13 air filters, or HVAC (heating, ventilation, and air conditioning) systems. See the Personal/Air Quality/Indoor Air subsection below and the Climate Smart Missoula guide to filtration systems.^[9]
• Consider funding air filtration in public spaces, for example in schools, daycare centers, senior centers, municipal buildings, evacuation shelters, houses of worship, and gyms and recreational facilities. Such work is underway in Montana: the team at Climate Smart Missoula donated portable HEPA air cleaners to those who were most vulnerable.
• Encourage employers to reduce workers’ exposure to smoke and particulate matter. For example, employers could halt or limit outdoor work during periods of poor air quality, schedule (if possible) employees to work at alternative sites having less hazardous air quality, or provide protective breathing masks appropriate to the conditions.
• Encourage schools, organizations and employers to implement the federal Air Quality Flag Program.^[10]
• Work with the Montana Climate Office and Department of Environmental Quality to ensure a) your community has a weather station with added sensors for particulate matter (PM_2.5 and PM₁₀); and b) that the public has online access to both real-time and historical data.

 

 

Flooding and water-related illness

Flooding can impact human health in a number of ways, including by increasing exposure to vector-borne diseases.

Actions to counteract or minimize exposure include:

• Protect wetlands and restrict new development in flood-prone areas in and adjacent to your community. Wetlands retain water, slowly filtering and releasing it to surface waters, thereby improving surface water quality. Wetlands also serve as recharge areas for groundwater. Hence, wetlands protection and open space planning not only conserve habitat and local amenities, they also help protect water quality and quantity. For these reasons, identify and protect wetlands and other such groundwater recharge areas from development. If impermeable parking lots are built, design adjacent landscaping to capture and filter runoff. Note that if wetlands are destroyed by development, Montana law requires that alternate wetlands be created nearby.^[11]
• One major way floods can impact health is by contaminating lakes and ponds with nutrient and sediment runoff. Excessive nutrient enrichment, termed eutrophication, can result in deaths of fish and other aquatic organisms from depleted oxygen levels (National Ocean Service, NOAA undated), and trigger hazardous algal blooms (MTDPHHS 2019). During hazardous algal blooms, algae release toxins—poisonous to humans and other animals—into the water (see Section 3, Water-Related Illnesses subsection). Best management practices such as creating vegetative buffers for water bodies and limiting excessive use of fertilizers are effective mitigation measures (USEPA 2020).
• Assess water and wastewater infrastructure needs and vulnerabilities to flooding, drought, and sediment runoff following wildfire. Does your infrastructure need upgrading to handle such events? Assure that an emergency response plan is in place in the event of an extreme weather event. The Montana Department of Environmental Quality provides a useful two-page flier^[12] that includes guidelines on training, development of local emergency planning committees, core elements of an Emergency Response Plan, and compliance with the National Incident Management System.
• Ensure that emergency service providers have appropriate training, adequate supplies, and tested plans and systems ready to help those in need during flooding (and other emergency) events. Three critical items to prepare in advance are methods and logistics a) for emergency communications and outreach; b) for evacuation, including strategies, routes, and safety zones; and c) for accessing medical care. The Montana Primary Care Association^[13] and two Montana Department of Public Health and Human Services programs—Ready and Safe^[14] and EMS and Trauma Systems^[15]—are good resources to consult.

 

 

Food security

Drought and extreme weather events impact local food security (see related sidebar in Section 3), for example, when hail damages crops. But while some Montanans source their food close to home, most rely heavily on food produced long distances away and trucked to grocery stores. Climate change in other parts of the world can impact our food security. Crop destruction or failure and transportation interruption—potential outcomes from climate “surprises” (see Section 2) or pandemics—may result in pricing increases or interruptions to Montana’s food supply. A vibrant local food system can build resilience in the face of such challenges, as well as support local economies (State of Montana 2020).

 

Climate change in other parts of the world can impact our food security. …. [Thus] encourage personal, small-scale agriculture, local farmers’ markets, and farm-share programs to support and diversify local food supply and empower individuals with the knowledge and skills to grow their own food.

 

A few examples of community actions that can help protect food security in the face of climate change are:

• Incorporate the complexities of food security into community climate action plans. Identify those who most rely on food from outside sources, with particular attention to vulnerable people.
• Develop forums to discuss how much and what kinds of foods can be stored for emergencies. Information on types and amounts of foods, as well as sanitation, cooking without power, and more can be found in the Federal Emergency Management Act^[16] and Ready.gov^[17].
• Encourage personal, small-scale agriculture, local farmers’ markets, and farm-share programs to support and diversify local food supply and empower individuals with the knowledge and skills to grow their own food.
• Tap resources offered by County Extension and Natural Resources Conservation Service offices to understand sustainable practices, irrigation efficiencies, and integrated pest management.
• Enhance and incentivize more effective, multi-stakeholder approaches to drought response planning through local watershed groups and public works departments.

Vector-borne and zoonotic diseases

Paying attention to outbreaks of vector-borne, zoonotic, and other infectious diseases belongs on a community’s planning radar. Climate change is a key contributor to the emergence of these diseases (see Section 3), and warming temperatures promote mosquito, tick, and other arthropod reproduction and range extension. Having good drainage near homes and mosquito control programs (e.g., municipalities that spray for mosquitos) are two ways to reduce vectors at the community level. Community education on vector-borne diseases is essential (see Actions for Individuals subsection below). Medical practitioners and those involved in public health should stay current on issues of vector-borne disease epidemiology and symptoms, as provided by the Centers for Disease Control^[18], the US Department of Agriculture Animal and Plant Health Inspection Service^[19], and Montana’s Department of Public Health and Human Services^[20].

Mental health

Extreme weather events, prolonged heat and smoke, and environmental and societal change all affect mental health, including increasing feelings of disconnectedness and despair. Build a plan for community well-being. Actions include:

• Plan for increased mental health impacts of climate change by working with local hospitals, clinics, health departments, schools, and faith and service organizations to build mental health services that connect across jurisdictions in your county and community.
• Inform healthcare providers and the public about the mental health impacts related to climate-induced extreme weather events, poor air quality, rising heat, flooding, drought, and more. Discuss and plan for the potential community disruption (e.g., to healthcare access and food and water availability) that can be caused by extreme events, and how that disruption can impact the mental health of individuals and communities.
• Build in-school capacity to address mental health issues in youth related to climate change. Acknowledge the anxiety some students feel around mounting climate change impacts (Burke et al. 2018), by opening discussion among teachers, students, parents, and friends. Consider also setting up mentoring programs with community members like the Child Advancement Project established by Thrive.^[21]

 

Extreme weather events, prolonged heat and smoke, and environmental and societal change all affect mental health, including increasing feelings of disconnectedness and despair.

 

Strategies and Actions for Healthcare Practitioners and Institutions

Medical practitioners, clinics, and hospitals have critical roles to play in preparing for and coping with health issues resulting from climate change. All in the medical field must become fluent in the language of climate change and its health impacts, and knowledgeable of the treatment methods they will be required to apply—be those currently used methods, or new skills they can obtain.

This subsection describes strategies and actions applicable to individual practitioners and healthcare facilities. We also recognize the many online resources on the intersection of human health and climate change available for both groups. Table 5-1 provides a number of these resources, with an emphasis on information for Montana providers.

 

Table 5-1. Information sources useful for healthcare providers, be they individuals or facilities.a
Source	Resource description	Website
American College of Physicians (ACP)	Climate change toolkit for physicians, including ACP position paper, educational materials, greening the healthcare sector documents and other resources	https://www.acponline.org/advocacy/ advocacy-in-action/climate-change-toolkit
American Academy of Pediatrics (AAP)	AAP policy statement on Global Climate Change and Children’s Health	https://pediatrics.aappublications.org/ content/136/5/992
Climate Psychiatry Alliance	What psychiatrists can do about impacts of climate change on mental health, in terms of patient care, systems of care and public health advocacy.	https://www.climatepsychiatry.org/what-to-do
American Psychological Association (APA)	APA 2017 Publication (69 p) titled, “Mental health and our changing climate: Impacts, implications and guidance.”	http://ecoamerica.org/wp-content/uploads/2017 /03/ea-apa-psych-report-web.pdf
American Public Health Association (APHA)	APHA’s declared mission is to “Improve the health of the public and achieve equity in health status,” including improving mental healthcare. This brief publication referenced describes immediate, gradual and indirect impacts of climate change on mental health.	https://www.apha.org/~/media/files/pdf/ topics/climate/ climate_changes_mental_health.ashx
Medical Society Consortium for Climate and Health	Group that, among many functions, advocates for climate change action based on health impacts.	https://medsocietiesforclimatehealth.org/
Montana Health Professionals for a Healthy Climate (MTHPHC)	Group that, among many functions, advocates for climate change action based on health impacts. MTHPHC welcomes all health professionals and health profession students to join as members.	https://www.montanahphc.org
American Lung Association (ALA)	The ALA advocates for climate action and preparedness by elected officials as well as professional and public organizations. Resources on climate change impacts on air pollution and lung health, as well as ways to fight climate change.	https://www.lung.org/clean-air/climate-change
MyGreenDoctor	An evidence-based practice management tool for individual practitioners, clinics, and hospitals to save money by becoming environmentally sustainable.	https://www.mygreendoctor.org
Health Care Without Harm	Works to transform healthcare worldwide. Their Climate and Health program supports the healthcare sector in reducing its carbon footprint, building climate-smart and resilient hospitals and communities, and mobilizing healthcare's ethical, economic, and political influence to advance the transition to a low-carbon future that supports healthy people living on a healthy planet.	https://noharm-uscanada.org/climateandhealth
Alliance of Nurses for Healthy Environments (ANHE)	The Mission of ANHE: Promoting healthy people and healthy environments by educating and leading the nursing profession, advancing research, incorporating evidence-based practice, and influencing policy.	https://envirn.org/
------- a Websites shown were active as of December 2020. For the latest resources and web links, go online to the Climate Change and Human Health link at the Montana Climate Assessment website (montanaclimate.org).

 

Practitioners

Clinicians—primary care, subspecialty, or mental health professionals—are generally trusted by their patients. Thus, healthcare practitioners trained to detect potential health impacts of climate change can not only assess and treat those health impacts, they can also inform their patients. Groups like the American College of Physicians, American Academy of Pediatrics, and Climate Psychiatry Alliance provide tools and guidelines for integrating climate- and health-related questions and discussions into routine patient visits (Table 5-1). Providers have many opportunities for productive, climate-related actions when interacting with patients, the medical community, or the community-at-large, as enumerated here.

 

 

Top Actions for Practitioners

• Get informed about the effects of climate change on health, including mental health, so you can recognize concerns and treat your patients accordingly. Be especially vigilant during climate-related extreme-events, including droughts, floods, wildfires, and other disasters.

• Educate your patients about the effects of climate change on health.

• Provide educational materials about the effects of climate change on physical and mental health in your clinic and on your organizations websites.

• Become involved with professional or public organizations advocating for climate action based on health impacts (Table 5-1).

• Provide primary care, behavioral health, and crisis treatments that ameliorate the physical and mental health impacts of climate change (Anderson et al. 2017). The resources provided in Community Actions subsection above include checklists for health-related impacts, such as those from mold, overheating, wildfire smoke, vector-borne disease, lack of nourishing foods, and the mental health distresses from major storm and other climate-induced weather events.

• Consider providing patient-specific information related to climate change and ways to protect yourself, both in your clinic and on your organization’s websites.

• Be an advocate in your community providing trusted guidance and information. Become involved with professional or public organizations advocating for climate action based on health impacts (Table 5-1).

 

 

 

Healthcare institutions

In addition to the actions of individual practitioners, hospitals, clinics, and other healthcare facilities can make a substantial difference to their patients and communities dealing with climate-related health issues, as enumerated below.

 

 

Top Actions for Healthcare Institutions

• Work on mitigation efforts, for example instituting energy savings programs, upgrades to HVAC systems, development or improvement of recycling programs, and more. Choose one and start!

• Work within your organization and with community public health, community, academic leaders, and other groups to create a community plan for management of climate surprises, disasters, and pandemics.

• Add climate health effects to electronic records for both physical and mental health.

• Contribute to climate and health trainings for health professionals, including psychological first aid.

 

 

Here are additional actions for healthcare institutions:

 

 

Greener Healthcare Ideas
Julia Ryder BSN, RN, CEN (Founding Board Member of Montana Health Professionals for a Healthy Climate^a)

 

According to the World Health Organization, the US healthcare system contributes 8% of our greenhouse gas emissions (WHO undated). Climate change is a threat to human health, and hospitals especially must do all they can to model best-available environmental practices.

To reduce energy usage, a healthcare facility must first know how much natural gas and fuel it uses, energy and water it consumes, and waste it produces. Once familiar with these measures, a facility can set goals to reduce them. Programs such as Practice Green Health and Health Care Without Harm help hospitals set goals and lead the way in sustainability. For example, healthcare facilities can:

• improve local air quality by creating no idling zones on their campuses;

• reduce toxic emissions from incinerators with clear guidelines and education for all employees regarding materials that can and cannot be processed in biohazard waste dispensers;

• reduce laundry energy requirements by reducing the use of hot water and electricity;

• switch to LED light bulbs (which also saves a hospital thousands of dollars); and

• update and improve maintenance of HVAC systems that consume an enormous amount of energy.

Proper waste distribution and management must be demonstrated on every level in the hospital. The average hospital creates 29 lb (13.2 kg) of waste per patient bed per day (Eckelman and Sherman 2016). Accessibility to well-placed recycling, compost, and trash bins is important; they should be placed anywhere food is offered. To assist patients and staff, clear signage and instructions should be placed near every bin to ensure people properly segregate their waste.

Above all, if a healthcare facility wants to reduce its carbon footprint, it must build a culture of awareness by encouraging employees to turn off lights, shut down computers, utilize natural lighting, and not open materials until needed. It can reward employees who walk, bike, or carpool to work, and offer online meeting options rather than having employees drive to work for short time frames.

A hospital can also help patients become healthier by offering more vegetable-based, locally sourced meals in the cafeteria, and cooking classes on how to prepare these foods at home. Last of all, hospitals can invest in growing trees and other plants around campus. Such efforts not only improve air quality, but also provide shade and emotional support for patients and families.

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^a More information at https://www.montanahphc.org/index.php

 

 

 

 

• Improve and model sustainable practices and processes, including capturing anesthesia gases, decreasing use of disposables, shifting to renewable energy, and sourcing food locally. Tell your community that you are taking such steps, and hence helping mitigate climate change. Table 5-1 provides links to two programs—Health Care Without Harm and MyGreenDoctor.org—scoped to meet such goals (also see sidebar).
• Conduct climate adaptation and resilience planning with communities and local and state public health systems.
  
  • Consider addressing HVAC/HEPA retrofits to maintain facility indoor air quality, particularly for hospital inpatients.
  • Develop defined steps for meeting the needs of distressed communities, including not only physical ailments and distress, but also the needs of those who are mentally traumatized or have severe mental illness (Rao 2006). The Centers for Disease Control and Prevention has created a five-step plan titled Building Resilience Against Climate Effects that health officials can follow to help your community prepare for the health effects from or exacerbated by climate change (see the Community Actions subsection above for more information).
  • Assess impacts on the public health, medical, and mental healthcare systems due to shifting priorities, budget cuts, and budget diversion (e.g., to fire suppression) related to climate change.
• Work with universities, insurance providers, other healthcare systems, and local and state public health agencies to acquire critical data on the mental health consequences of climate-related extreme weather events and disasters. Those data should include prevalence and severity of climate-related health conditions, hospital admissions, suicide attempts, and episodes of violence.
  • Recognize that overarching psychosocial consequences of global climate change, termed climate anxiety, stem from awareness of the looming threats and current risks of climate change.
  • Prepare for disruptions to mental healthcare (including availability of psychotropic medications) due to climate-related weather events and unexpected disasters that may interrupt supplies.
  • Educate decision makers—be they in public health, healthcare systems, emergency response, the medical insurance industry, or local or state government—to increase understanding of where and how to invest in medical and public health infrastructure and resources.
• Implement, support, or participate in training programs for clinicians, as well as healthcare, public health, and environmental health students and professionals on the health effects of climate change. (Healthcare training is a component of healthcare systems.)
  • Curriculum development.—Address the physical and mental health impacts of climate change in educational curricula for graduate and professional students in clinical health and social work training programs in Montana. Review availability of pre-professional courses and course components on a) the physical and mental health impacts of climate change; and b) community-level climate change adaptation planning. Such courses are scoped for undergraduates in healthcare, public health, and environmental health degree programs at institutions of higher education across Montana.
  • Continuing education.—Provide climate health certification/training programs, continuing medical education credits, continuing education workshops, and online medical training modules for primary care, nursing, pharmacy, mental health, and public health professionals that highlight potential health and mental health impacts of climate change, and interventions to address those impacts. Examples of such efforts include the Climate Change and Health Certificate offered at the Yale School of Public Health^[22], and the Climate Change and Health Training Module Series offered by the Minnesota Department of Health^[23].
  • Psychological First Aid.—Ensure that first responders in Montana have training to respond to the psychological impacts of climate-related weather events and disasters. Psychological First Aid is an evidence-informed modular approach to help children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism.^[24]
• Join local, regional and national networks of health professionals working on climate change and health.
  • Encourage members to become involved in climate change mitigation and adaptation efforts through Montana Health Professionals for a Healthy Climate (Table 5-1).

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