Developing and implementing a targeted health-focused climate communications campaign in Ontario—#MakeItBetter

SettingPublic health practitioners are called to effectively communicate with the public on climate change. The climate crisis requires swift action that starts with public awareness of climate-related health impacts and leads to public support for individual, community and systemic actions to mitigate and adapt to climate change.InterventionThis paper discusses learnings about public opinion research and communication strategies and how a health-focused climate communication campaign—#MakeItBetter—could help to increase awareness and engage new audiences, including public health partners, in conversations about climate change in order to reduce climate-related health impacts for current and future generations. The #MakeItBetter campaign was grounded in evidence-informed messaging, being sensitive to health inequities. Emerging research and pre-campaign testing suggest that framing climate change as a health issue is a promising practice.OutcomesThe #MakeItBetter campaign appeals to parents/caregivers to learn more about climate-related health impacts, take protective action for children and support multi-level climate action. The campaign launch secured 89 news stories, including multicultural media coverage. Longer-term evaluation is required to determine the campaign’s effectiveness in building public support for climate action.ImplicationsAn innovative approach to climate communication that draws on the intersections between behavioural and climate sciences and engages in multi-sectoral collaboration can spur both climate action and health protection, aiding public health practitioners and partners in effectively communicating the urgency for climate action. More work is needed to support communication on climate change as an inequity multiplier and promote climate action and community resilience for health equity co-benefits.     

Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience

Background: Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems.Objectives: We explored possible explanations for the lack of work on adaptive capacity, outline climate–health challenges that may lie outside public health’s coping range, and consider changes in practice that could increase public health’s adaptive capacity.Methods: We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity.Discussion: There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health’s adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting.Conclusions: Increasing public health capacity will be necessary for certain climate–health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.     

Preparing for Climate Change: A Perspective from Local Public Health Officers in California

Background

The most recent scientific findings show that even with significant emission reductions, some amount of climate change is likely inevitable. The magnitude of the climate changes will depend on future emissions and climate sensitivity. These changes will have local impacts, and a significant share of coping with these changes will fall on local governmental agencies. Public health is no exception, because local public health agencies are crucial providers of disease prevention, health care, and emergency preparedness services.

Methods

This article presents the results of a survey of California’s local pubic health officers conducted between August and October 2007. The survey gauged health officers’ concerns about the public health impacts of climate change, programs in place that could help to mitigate these health effects, and information and resource needs for better coping with a changing climate.

Results

The results of this survey show that most public health officers feel that climate change poses a serious threat to public health but that they do not feel well equipped in terms of either resources or information to cope with that threat. Nonetheless, public health agencies currently implement a number of programs that will help these agencies handle some of the challenges posed by a changing climate.

Conclusions

Overall, the results suggest that local public health agencies in California are likely in a better position than they perceive to address the threats associated with climate change but that there is a larger role for them to play in climate policy.     

Stop ringing the alarm; it is time to get out of the building!

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, “Moving on IPCC 1.5°C”, which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.     

The debate on climate change and health in the context of ecological public health: a necessary corrective to Costello et al.'s ‘biggest global health threat’, or co-opted apologists for the neoliberal hegemony?

The threat posed to global health by climate change has been widely discussed internationally. The United Kingdom public health community seem to have accepted this as fact and have called for urgent action on climate change, often through state interventionist mitigation strategies and the adoption of a risk discourse. Putting aside the climate change deniers' arguments, there are critics of this position who seem to accept climate change as a fact but argue that the market and/or economic development should address the issue. Their view is that carbon reduction (mitigation) is a distraction, may be costly and is ineffective. They argue that what is required is more economic development and progress even if that means a warmer world. Both positions however accept the fact of growth based capitalism and thus fail to critique neoliberal market driven capitalism or posit an alternative political economy that eschews growth. Ecological public health, however, appears to be a way forward in addressing not only social determinants of health but also the political and ecological determinants. This might allow us to consider not just public health but also planetary health and health threats that arise from growth based capitalism.     

'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing

Abstract This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906–1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.     

The public health emergency of climate change: how/are Canadian post-secondary public health sciences programs responding?

ObjectiveThe Intergovernmental Panel on Climate Change recently issued a statement that the fate of human society and human health is at serious risk of catastrophic impacts unless we take bold action to keep global warming under 1.5 °C. In 2015, the Canadian Public Health Association noted emerging efforts to embrace intersectoral approaches to global change in public health research and practice. In this study, we question the extent to which Canadian Graduate Public Health Sciences Programs have kept pace with these efforts to see climate change surface as a new frontier for training the next generation of researchers and practitioners.MethodsSemi-structured interviews (19) were conducted with Department Heads (or equivalents) of graduate-level Public Health Sciences Programs at 15 Canadian universities concerning the place of climate change in their respective curricula. Interviews were designed to elicit participants’ institutional perspectives on the importance of climate change in the Public Health Sciences and identify perceived challenges and opportunities.ResultsDespite wide recognition among participants that climate change is a public health “crisis”, very few reported having substantive curricular engagement on the topic. Key challenges identified were lack of resources, organizational issues, and political barriers. Key opportunities to adapt curricula to address this new frontier in Public Health were faculty interest and expertise, cross-disciplinary collaboration, and pressure from the institution.ConclusionOur findings provide evidence for post-secondary Public Health Sciences Programs to understand the need to address their own sluggishness when what is needed are bold, even radical, shifts to existing curricula.     

MUNICIPAL ADMINISTRATION OF HEALTH AND WELFARE DEPARTMENTS

This author suggests separate departments of public service, safety and welfare. Fire, police and health would be divisions of public safety. Public welfare should include social welfare, public schools, public library and recreation. Social welfare should dispense all relief funds, and teach mental orderliness in homes with highest grade of trained nurses for teachers.     

MUNICIPAL ADMINISTRATION OF HEALTH AND WELFARE DEPARTMENTS

This author suggests separate departments of public service, safety and welfare. Fire, police and health would be divisions of public safety. Public welfare should include social welfare, public schools, public library and recreation. Social welfare should dispense all relief funds, and teach mental orderliness in homes with highest grade of trained nurses for teachers.     

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.     

Constraints and barriers to public health adaptation to climate change: a review of the literature

Public health adaptation to climate change is an important issue and inevitably is needed to address the adverse health impacts of climate change over the next few decades. This paper provides an overview of the constraints and barriers to public health adaptation and explores future research directions in this emerging field. An extensive literature review was conducted in 2010 and published literature from 2000 to 2010 was retrieved. This review shows that public health adaptation essentially can operate at two levels, namely, adaptive-capacity building and implementation of adaptation actions. However, there are constraints and barriers to public health adaptation arising from uncertainties of future climate and socioeconomic conditions, as well as financial, technologic, institutional, social capital, and individual cognitive limits. The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome these constraints and barriers. It is proposed here that high research priority should be given to multidisciplinary research on the assessment of potential health impacts of climate change, projections of health impacts under different climate and socioeconomic scenarios, identification of health co-benefits of mitigation strategies, and evaluation of cost-effective public health adaptation options.     

Climate change,women's workload in smallholder agriculture,and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.     

Disease Surveillance and Achieving Synergy In Public Health Quality Improvement

Objective

To examine disease surveillance in the context of a new national framework for public health quality and to solicit input from practitioners, researchers, and other stakeholders to identify potential metrics, pivotal research questions, and actions for achieving synergy between surveillance practice and public health quality.

Introduction

National efforts to improve quality in public health are closely tied to advancing capabilities in disease surveillance. Measures of public health quality provide data to demonstrate how public health programs, services, policies, and research achieve desired health outcomes and impact population health. They also reveal opportunities for innovations and improvements. Similar quality improvement efforts in the health care system are beginning to bear fruit. There has been a need, however, for a framework for assessing public health quality that provides a standard, yet is flexible and relevant to agencies at all levels.The U.S. Health and Human Services (HHS) Office of the Assistant Secretary for Health, working with stakeholders, recently developed and released a Consensus Statement on Quality in the Public Health System that introduces a novel evaluation framework. They identified nine aims that are fundamental to public health quality improvement efforts and six cross-cutting priority areas for improvement, including population health metrics and information technology; workforce development; and evidence-based practices (1).Applying the HHS framework to surveillance expands measures for surveillance quality beyond typical variables (e.g., data quality and analytic capabilities) to desired characteristics of a quality public health system. The question becomes: How can disease surveillance help public health services to be more population centered, equitable, proactive, health-promoting, risk-reducing, vigilant, transparent, effective, and efficient—the desired features of a quality public health system?Any agency with a public health mission, or even a partial public health mission (e.g., tax-exempt hospitals), can use these measures to develop strategies that improve both the quality of the surveillance enterprise and public health systems, overall. At this time, input from stakeholders is needed to identify valid and feasible ways to measure how surveillance systems and practices advance public health quality. What exists now and where are the gaps?

Methods

Improving public health by applying quality measures to disease surveillance will require innovation and collaboration among stakeholders. This roundtable will begin a community dialogue to spark this process. The first goal will be to achieve a common focus by defining the nine quality aims identified in the HHS Consensus Statement. Attendees will draw from their experience to discuss how surveillance practice advances the public health aims and improves public health. We will also identify key research questions needed to provide evidence to inform decision-making.

Results

The roundtable will discuss how the current state of surveillance practice addresses each of the aims described in the Consensus Statement to create a snapshot of how surveillance contributes to public health quality and begin to articulate practical measures for assessing quality improvements. Sample questions to catalyze discussion include:

• —How is surveillance used to identify and address health disparities and, thereby, make public health more equitable? What are the data sources? Are there targets? How can research and evaluation help to enhance this surveillance capability and direct action?
• —How do we identify and address factors that inhibit quality improvement in surveillance? What are the gaps in knowledge, skills, systems, and resources?
• —Where can standardization play a positive role in the evaluation of quality in public health surveillance?
• —How can we leverage resources by aligning national, state, and local goals? —What are the key research questions and the quality improvement projects that can be implemented using recognized models for improvement?
• —How can syndromic surveillance, specifically, advance the priority aims?

The roundtable will conclude with a list of next steps to develop metrics that resonate with the business practices of public health at all levels.     

U.S. Funding Is Insufficient to Address the Human Health Impacts of and Public Health Responses to Climate Variability and Change

Background

The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States.

Objective

In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change.

Discussion

Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year.

Conclusions

Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.     

Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS

As the use of certified electronic health record technology (CEHRT) has continued to gain prominence in hospitals and physician practices, public health agencies and health professionals have the ability to access health data through health information exchanges (HIE). With such knowledge health providers are well positioned to positively affect population health, and enhance health status or quality-of-life outcomes in at-risk populations. Through big data analytics, predictive analytics and cloud computing, public health agencies have the opportunity to observe emerging public health threats in real-time and provide more effective interventions addressing health disparities in our communities. The Smarter Public Health Prevention System (SPHPS) provides real-time reporting of potential public health threats to public health leaders through the use of a simple and efficient dashboard and links people with needed personal health services through mobile platforms for smartphones and tablets to promote and encourage healthy behaviors in our communities. The purpose of this working paper is to evaluate how a secure virtual private cloud (VPC) solution could facilitate the implementation of the SPHPS in order to address public health disparities.     

Best of ARM: Evaluating engagement in multisector community health networks: The case of tribal organizations

ObjectiveTo quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.Data SourcesWe used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems.Study DesignSocial network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two‐part regression models estimated predictors of tribal engagement.Data CollectionA stratified random sample of local public health agencies was surveyed, yielding 574 respondents. An additional cohort of oversampled respondents was also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n = 154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems.Principal FindingsWhen an AI/AN serving health facility was present in the region, tribal organizations participated in 28% of public health networks and 9% of implemented public health activities. Networks with tribal engagement were more comprehensive in terms of the breadth of sectors and social services participating in the network and the scope of public health activities implemented relative to networks without tribal engagement. The likelihood of tribal engagement increased significantly with the size of the AI/AN population, the presence of a tribal facility with Indian Health Service funding in the region, and geographic proximity to reservation land (p < 0.10).ConclusionsThe vast majority of public health networks do not report engagement with tribal organizations. Even when AI/AN serving health facilities are present, reported engagement of tribal organizations remains low.     

Challenges to Protecting the Right to Health under the Climate Change Regime

Researchers and global policy makers are increasingly documenting negative health impacts from climate change, raising concerns for realizing the right to health. Importantly, courts have held that anthropogenic activities affecting climate may threaten a population’s standard of health and compromise its inviolable right to health. However, legal hurdles—such as the fragmentation of climate change and human rights laws and the difficulties in proving causal links—hamper efforts to litigate right to health claims in the context of climate change. To address these challenges, this article assesses the detrimental effects of climate change from an international human rights perspective and analyzes climate change litigation to explore potential avenues to press for the right to health in the face of climate change.     

What Could Be Future Scenarios?—Lessons from the History of Public Health Surveillance for the Future: ––A keynote address presented at the 8th World Alliance for Risk Factor Surveillance (WARFS) Global Conference on October 30, 2013, Beijing,China

This article provides insights into the future based on a review of the past and present of public health surveillance—the ongoing systematic collection, analysis, interpretation, and dissemination of health data for the planning, implementation, and evaluation of public health action. Public health surveillance dates back to the first recorded epidemic in 3180 BC in Egypt. A number of lessons and items of interest are summarised from a review of historical perspectives in the past 5,000 years and the current practice of surveillance. Some future scenarios are presented: exploring new frontiers; enhancing computer technology; improving epidemic investigations; improving data collection, analysis, dissemination and use; building on lessons from the past; building capacity; and enhancing global surveillance. It is concluded that learning from the past, reflecting on the present, and planning for the future can further enhance public health surveillance.