Enhancing Public Health Response to Health Impacts of Climate Change: Needs, Gaps, and Opportunities

Abstract

Climate change is the greatest global public health challenge of the 21st century. The nature and extent of health impacts of climate change will vary widely from region to region and will be felt unequally among communities around the country. The local public health workforce is at the forefront in understanding, anticipating, and addressing the health effects of climate change for their jurisdiction. Global and national calls for action define the public health role and encourage action by all public health partners. However, climate adaptation continues to be a challenge for this sector and is not perceived as a key public health priority. This dissertation seeks to understand the level of engagement and activities undertaken by an engaged public health workforce that includes not just public health departments at the municipal, county, state, tribal, and territorial levels but also non-profit and private agencies that are a part of this sector (Appendix A). By focusing on those members of the workforce that are already acting on climate change, this study hopes to evaluate the use, accessibility, and relevance of available climate science. This dissertation also aims to understand the individual level behaviors, interactions, and collaborations which influence climate work at the local level and identify strategies to build the public health capacity for climate change adaptation (Appendix B). Finally, this study attempts to illustrate the role of academia in enhancing public health capacity for climate adaptation through both education and research (Appendix C). Ultimately, this dissertation fills a gap in public health adaptation to climate change and provides practical solutions to enhance public health capacity to prepare, manage, and respond to the health impacts of a changing climate. Methods: Three different methodologies are adopted to address these questions: online survey, key informant interviews, and review of graduate course curriculum. An online survey was implemented to assess the current level of engagement with the health impacts of climate change among public health entities agencies across the United States. The online survey tool consisted of 46 multiple choice and open-ended questions to elicit information on existing climate change associated projects and initiatives; sources of information; and usability of existing tools. The survey was emailed to public health and climate change networks nationally and a total of 140 professionals participated in this online survey component of this study. Participants who completed this survey were asked to participate in a 1-hour interview that was designed to gain an in-depth understanding on individual facets (e.g., educational background and training, motivation) of engagement, access and use of climate science; networks and partnerships in-place to inform activities; and recommendations for building public health capacity. A total of 25 interviews were conducted with public health professionals for this component of the study. Finally, course listings and syllabi reviews were assessed in order to determine the degree to which accredited schools and programs of public health integrate climate change into existing graduate curriculum, Websites of ASPPH institutions were examined to identify graduate public health courses. Inclusion terms included “climate”, “climate change”, “global warming”, “environment”, or “environmental change”. Courses were classified as focused or integrated climate change and subsequent content analysis was conducted on available syllabi to further assess the approach to climate change and health education utilized. Results: This dissertation contributes several key findings and strategies relevant to the research and scientific community, academia, and government including the following: The public health sector engages in a wide range of activities to address the health impacts of climate change. Public health action is hampered by a lack of funding, public health-relevant research, and a significant mismatch in information needed and available for decision-making. These facets accompanied by lack of institutional support, limited expertise and the culture and politics of climate change and public health limit the public health system’s ability to engage with climate change. There is also a dearth of climate change courses in graduate public health education and a need for incentivizing both climate change action and education through alignment with existing grant deliverables and accreditation standards and forming a culture of climate change preparedness. Key recommendations for building public health capacity include increased funding for local level climate action, building knowledge and expertise of current future workforce members, an increased focus on public health relevant research, and adoption of existing knowledge co-production frameworks to create climate services for public health application. Climate change is a threat-multiplier, a persistent and underlying driver of health that needs to be a fundamental component of all public health action. This study reaffirms the need for mainstreaming climate change into public health operations in order to build climate health resilience in communities around the world.