Adapting to the Changing Climate: An Assessment of Local Health Department Preparations for Climate Change-Related Health Threats, 2008-2012

Background

Climate change poses a major public health threat. A survey of U.S. local health department directors in 2008 found widespread recognition of the threat, but limited adaptive capacity, due to perceived lack of expertise and other resources.

Methods

We assessed changes between 2008 and 2012 in local public health departments'' preparedness for the public health threats of climate change, in light of increasing national polarization on the issue, and widespread funding cutbacks for public health. A geographically representative online survey of directors of local public health departments was conducted in 2011–2012 (N = 174; response rate = 50%), and compared to the 2008 telephone survey results (N = 133; response rate = 61%).

Results

Significant polarization had occurred: more respondents in 2012 were certain that the threat of local climate change impacts does/does not exist, and fewer were unsure. Roughly 10% said it is not a threat, compared to 1% in 2008. Adaptation capacity decreased in several areas: perceived departmental expertise in climate change risk assessment; departmental prioritization of adaptation; and the number of adaptation-related programs and services departments provided. In 2008, directors'' perceptions of local impacts predicted the number of adaptation-related programs and services their departments offered, but in 2012, funding predicted programming and directors'' impact perceptions did not. This suggests that budgets were constraining directors'' ability to respond to local climate change-related health threats. Results also suggest that departmental expertise may mitigate funding constraints. Strategies for overcoming these obstacles to local public health departments'' preparations for climate change are discussed.     

Suicide and public health

Suicide as a public health problem is generally underestimated. Deaths from suicide annually outnumber those from cancer of the respiratory system or of other common sites; more than twice as many die by suicide as from most communicable diseases combined. Most suicides are motivated by concern over ill health or domestic difficulties.A program tried in Yolo County to follow up persons who have attempted suicide indicates that a more systematic and widespread effort in this direction might be of value to the public health. It is recommended that attempts at suicide be considered a reportable disease for a one-year period and that a statewide program for following the patients be put into effect to provide rehabilitation as well as symptomatic treatment. Efforts by local health departments and private physicians are also worth while in reducing attempts at suicide.     

Disease intervention specialists as a resource in a public health emergency

With the current shortage of qualified staff at state and local public health departments, a flexible public health workforce could fill critical gaps in staffing. Disease intervention specialists (DISs) are public health outreach workers who are responsible for finding and counseling people with sexually transmitted diseases and their contacts. DIS skills and job duties parallel those that would be needed to respond quickly and efficiently to urgent public health problems, including bioterrorism. Including DISs in public health preparedness planning could be a practical way of providing surge capacity for departments of public health. In many states, DISs are already being used for functions that fall outside their traditional duties. However, planning and DIS training are essential for effective utilization of DIS skills in a public health emergency. North Carolina has included DISs in their bioterrorism response plans and currently deploys them on an as-needed basis for nonroutine activities.     

Violence in the emergency department: a survey of health care workers

BACKGROUND: Violence in the workplace is an ill-defined and underreported concern for health care workers. The objectives of this study were to examine perceived levels of violence in the emergency department, to obtain health care workers'' definitions of violence, to determine the effect of violence on health care workers and to determine coping mechanisms and potential preventive strategies. METHODS: A retrospective written survey of all 163 emergency department employees working in 1996 at an urban inner-city tertiary care centre in Vancouver. The survey elicited demographic information, personal definition of violence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 1996. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies. RESULTS: Of the 163 staff, 106 (65%) completed the survey. A total of 68% (70/103) reported an increased frequency of violence over time, and 60% (64/106) reported an increased severity. Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 1996. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. Seventy-seven respondents (73%) were afraid of patients as a result of violence, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in the emergency department, 12 (67%) reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies. INTERPRETATION: Violence in the emergency department is frequent and has a substantial effect on staff well-being and job satisfaction.     

Global and Local Concerns: What Attitudes and Beliefs Motivate Farmers to Mitigate and Adapt to Climate Change?

In response to agriculture''s vulnerability and contribution to climate change, many governments are developing initiatives that promote the adoption of mitigation and adaptation practices among farmers. Since most climate policies affecting agriculture rely on voluntary efforts by individual farmers, success requires a sound understanding of the factors that motivate farmers to change practices. Recent evidence suggests that past experience with the effects of climate change and the psychological distance associated with people''s concern for global and local impacts can influence environmental behavior. Here we surveyed farmers in a representative rural county in California''s Central Valley to examine how their intention to adopt mitigation and adaptation practices is influenced by previous climate experiences and their global and local concerns about climate change. Perceived changes in water availability had significant effects on farmers'' intention to adopt mitigation and adaptation strategies, which were mediated through global and local concerns respectively. This suggests that mitigation is largely motivated by psychologically distant concerns and beliefs about climate change, while adaptation is driven by psychologically proximate concerns for local impacts. This match between attitudes and behaviors according to the psychological distance at which they are cognitively construed indicates that policy and outreach initiatives may benefit by framing climate impacts and behavioral goals concordantly; either in a global context for mitigation or a local context for adaptation.     

X-ray survey results and costs--A health officer's viewpoint. A preliminary report

The obvious results of a mass chest x-ray survey from a health officer's viewpoint are:1. The early discovery of unknown cases of pathologic conditions of the chest-tuberculosis, neoplasms, heart abnormalities.2. Increase in the community's awareness of its tuberculosis problem.3. Opportunity to work closely with the medical society and the individual private physicians.4. Stimulation of all agencies in a community, health and non-health, to work together on a health project for the good of all of the people.5. Increased cooperation between the local department of public health and other health agencies in a community.6. Opportunity to underline to a staff of a local department of public health the importance of thinking in terms of the department as a whole, rather than in terms of respective divisions or bureaus.7. Opportunity to focus the awareness of the community on its public health services. In relation to costs, there are three aspects from a health officer's viewpoint:1. The planning, together with other agencies, of an adequate budget with full recognition of community resources.2. The planning for estimated expansion of tuberculosis control services both in terms of increased expense for maintenance and operation, and of assignment of personnel to survey staff with resulting curtailment or postponement of other programs.3. The planning for completion of the follow-up program of the x-ray survey and of future continued extension of the total tuberculosis control program as the result of increased community awareness of the tuberculosis problem.     

Drivers of Public Attitudes towards Small Wind Turbines in the UK

Small Wind Turbines (SWTs) are a growing micro-generation industry with over 870,000 installed units worldwide. No research has focussed on public attitudes towards SWTs, despite evidence the perception of such attitudes are key to planning outcomes and can be a barrier to installations. Here we present the results of a UK wide mail survey investigating public attitudes towards SWTs. Just over half of our respondents, who were predominantly older, white males, felt that SWTs were acceptable across a range of settings, with those on road signs being most accepted and least accepted in hedgerows and gardens. Concern about climate change positively influenced how respondents felt about SWTs. Respondent comments highlight visual impacts and perceptions of the efficiency of this technology are particularly important to this sector of the UK public. Taking this into careful consideration, alongside avoiding locating SWTs in contentious settings such as hedgerows and gardens where possible, may help to minimise public opposition to proposed installations.     

Biosurveillance where it happens: state and local capabilities and needs

In recent years, improved biosurveillance has become a bipartisan national security priority. As has been pointed out by the National Biosurveillance Advisory Subcommittee and others, building a national biosurveillance enterprise requires having strong biosurveillance systems at the state and local levels, and additional policies are needed to strengthen their biosurveillance capabilities. Because of the foundational role that state and local health departments play in biosurveillance, we sought to determine to what extent state and local health departments have the right capabilities in place to provide the information needed to detect and manage an epidemic or public health emergency-both for state and local outbreak management and for reporting to federal agencies during national public health crises. We also sought to identify those policies or actions that would improve state and local biosurveillance and make recommendations to federal policymakers who are interested in improving national biosurveillance capabilities.     

Both life‐history plasticity and local adaptation will shape range‐wide responses to climate warming in the tundra plant Silene acaulis

Many predictions of how climate change will impact biodiversity have focused on range shifts using species‐wide climate tolerances, an approach that ignores the demographic mechanisms that enable species to attain broad geographic distributions. But these mechanisms matter, as responses to climate change could fundamentally differ depending on the contributions of life‐history plasticity vs. local adaptation to species‐wide climate tolerances. In particular, if local adaptation to climate is strong, populations across a species’ range—not only those at the trailing range edge—could decline sharply with global climate change. Indeed, faster rates of climate change in many high latitude regions could combine with local adaptation to generate sharper declines well away from trailing edges. Combining 15 years of demographic data from field populations across North America with growth chamber warming experiments, we show that growth and survival in a widespread tundra plant show compensatory responses to warming throughout the species’ latitudinal range, buffering overall performance across a range of temperatures. However, populations also differ in their temperature responses, consistent with adaptation to local climate, especially growing season temperature. In particular, warming begins to negatively impact plant growth at cooler temperatures for plants from colder, northern populations than for those from warmer, southern populations, both in the field and in growth chambers. Furthermore, the individuals and maternal families with the fastest growth also have the lowest water use efficiency at all temperatures, suggesting that a trade‐off between growth and water use efficiency could further constrain responses to forecasted warming and drying. Taken together, these results suggest that populations throughout species’ ranges could be at risk of decline with continued climate change, and that the focus on trailing edge populations risks overlooking the largest potential impacts of climate change on species’ abundance and distribution.     

不同海拔高度农牧民对气候变化的感知与适应

气候变化已经对西藏地区产生了明显而深刻的影响。农牧民对气候变化的当地影响有较系统的认识。以西藏乃东区为研究对象。调查4个不同海拔梯度上农牧民对气候变化的感知与适应,然后利用气象数据对比农牧民对气候变化的感知,探究海拔高度与农牧民感知及其适应行为的关系,分析影响农牧民对气候变化感知与适应行为的因素。结果如下,研究区增温趋势明显,年降水量自2005年以来明显减少。不同梯度上的农牧民对当地气候变化的相对感知强度存在差异。农牧民对气温和雪覆盖变化的相对感知强度较高且基本随海拔升高而增强,而对雨季、农作物病虫害、新的病虫害变化的相对感知强度则随海拔升高而减弱。农牧民对年降水量的相对感知强度整体较低,但对近年年降水量持续减少记忆较深刻。在全球气候变化背景下,流域的上下两端会遭受较多的气候变化负面影响。农牧民对当地气候变化的感知与其采取的适应行为并不具有同步性。农牧民的受教育程度、经济状况、当地传统文化及其对气候变化的感知强度等因素均会影响农牧民对气候变化适应措施的选择。政府在制定及实施气候政策时应考虑流域内不同海拔高度区域气候变化特征及其影响的差异。     

Structural and Psycho-Social Limits to Climate Change Adaptation in the Great Barrier Reef Region

Adaptation, as a strategy to respond to climate change, has limits: there are conditions under which adaptation strategies fail to alleviate impacts from climate change. Research has primarily focused on identifying absolute bio-physical limits. This paper contributes empirical insight to an emerging literature on the social limits to adaptation. Such limits arise from the ways in which societies perceive, experience and respond to climate change. Using qualitative data from multi-stakeholder workshops and key-informant interviews with representatives of the fisheries and tourism sectors of the Great Barrier Reef region, we identify psycho-social and structural limits associated with key adaptation strategies, and examine how these are perceived as more or less absolute across levels of organisation. We find that actors experience social limits to adaptation when: i) the effort of pursuing a strategy exceeds the benefits of desired adaptation outcomes; ii) the particular strategy does not address the actual source of vulnerability, and; iii) the benefits derived from adaptation are undermined by external factors. We also find that social limits are not necessarily more absolute at higher levels of organisation: respondents perceived considerable opportunities to address some psycho-social limits at the national-international interface, while they considered some social limits at the local and regional levels to be effectively absolute.     

Redesigning biodiversity conservation projects for climate change: examples from the field

Few conservation projects consider climate impacts or have a process for developing adaptation strategies. To advance climate adaptation for biodiversity conservation, we tested a step-by-step approach to developing adaptation strategies with 20 projects from diverse geographies. Project teams assessed likely climate impacts using historical climate data, future climate predictions, expert input, and scientific literature. They then developed adaptation strategies that considered ecosystems and species of concern, project goals, climate impacts, and indicators of progress. Project teams identified 176 likely climate impacts and developed adaptation strategies to address 42 of these impacts. The most common impacts were to habitat quantity or quality, and to hydrologic regimes. Nearly half of expected impacts were temperature-mediated. Twelve projects indicated that the project focus, either focal ecosystems and species or project boundaries, need to change as a result of considering climate impacts. More than half of the adaptation strategies were resistance strategies aimed at preserving the status quo. The rest aimed to make ecosystems and species more resilient in the face of expected changes. All projects altered strategies in some way, either by adding new actions, or by adjusting existing actions. Habitat restoration and enactment of policies and regulations were the most frequently prescribed, though every adaptation strategy required a unique combination of actions. While the effectiveness of these adaptation strategies remains to be evaluated, the application of consistent guidance has yielded important early lessons about how, when, and how often conservation projects may need to be modified to adapt to climate change.     

Climate Change and Health Research in the Eastern Mediterranean Region

Anthropologically induced climate change, caused by an increased concentration of greenhouse gases in the atmosphere, is an emerging threat to human health. Consequences of climate change may affect the prevalence of various diseases and environmental and social maladies that affect population health. In this article, we reviewed the literature on climate change and health in the Eastern Mediterranean Region. This region already faces numerous humanitarian crises, from conflicts to natural hazards and a high burden of disease. Climate change is likely to aggravate these emergencies, necessitating a strengthening of health systems and capacities in the region. However, the existing literature on climate change from the region is sparse and informational gaps stand in the way of regional preparedness and adaptation. Further research is needed to assess climatic changes and related health impacts in the Eastern Mediterranean Region. Such knowledge will allow countries to identify preparedness vulnerabilities, evaluate capacity to adapt to climate change, and develop adaptation strategies to allay the health impacts of climate change.     

Daily scheduling of home health care services using time-dependent public transport

This paper presents a real-world optimization problem in home health care that is solved on a daily basis. It can be described as follows: care staff members with different qualification levels have to visit certain clients at least once per day. Assignment constraints and hard time windows at the clients have to be observed. The staff members have a maximum working time and their workday can be separated into two shifts. A mandatory break that can also be partitioned needs to be scheduled if the consecutive working time exceeds a certain threshold. The objective is to minimize the total travel- and waiting times of the care staff. Additionally, factors influencing the satisfaction of the clients or the care staff are considered. Most of the care staff members from the Austrian Red Cross (ARC) in Vienna use a combination of public transport modes (bus, tram, train, and metro) and walking. We present a novel model formulation for this problem, followed by an efficient exact solution approach to compute the time-dependent travel times out of the timetables from public transport service providers on a minute-basis. These travel time matrices are then used as input for three Tabu Search based solution methods for the scheduling problem. Extensive numerical studies with real-world data from the ARC show that the current planning can be improved significantly when these methods are applied.     

Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies

Background

The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers’ infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies.

Methods

Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes.

Results

The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother’s accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers.

Conclusions

Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.

     

Similarities in butterfly emergence dates among populations suggest local adaptation to climate

Phenology shifts are the most widely cited examples of the biological impact of climate change, yet there are few assessments of potential effects on the fitness of individual organisms or the persistence of populations. Despite extensive evidence of climate‐driven advances in phenological events over recent decades, comparable patterns across species' geographic ranges have seldom been described. Even fewer studies have quantified concurrent spatial gradients and temporal trends between phenology and climate. Here we analyse a large data set (~129 000 phenology measures) over 37 years across the UK to provide the first phylogenetic comparative analysis of the relative roles of plasticity and local adaptation in generating spatial and temporal patterns in butterfly mean flight dates. Although populations of all species exhibit a plastic response to temperature, with adult emergence dates earlier in warmer years by an average of 6.4 days per °C, among‐population differences are significantly lower on average, at 4.3 days per °C. Emergence dates of most species are more synchronised over their geographic range than is predicted by their relationship between mean flight date and temperature over time, suggesting local adaptation. Biological traits of species only weakly explained the variation in differences between space‐temperature and time‐temperature phenological responses, suggesting that multiple mechanisms may operate to maintain local adaptation. As niche models assume constant relationships between occurrence and environmental conditions across a species' entire range, an important implication of the temperature‐mediated local adaptation detected here is that populations of insects are much more sensitive to future climate changes than current projections suggest.     

甘南高原农户对极端天气的适应障碍及适应意向

基于入户调查数据,探讨了甘南高原农户对极端天气的适应障碍,并采用二元Logistic回归模型分析了适应障碍对农户适应意向的影响。结果发现:(1)甘南高原农户面临的规范性障碍最严重,信息技术障碍次之,再次为制度障碍和认知障碍。不同生计农户面临的适应障碍存在差异,其中,纯农户主要面临信息技术障碍,兼业户和非农户则主要面临规范性障碍。(2)纯农户对极端天气的适应意向主要受认知障碍、信息准确性障碍、适应策略选择时机障碍、政策激励障碍和牲畜拥有量的影响,兼业户主要受认知障碍、技术服务障碍、政策激励障碍影响,非农户主要受认知障碍、资源获取性障碍影响。除适应策略选择时机障碍外,其余适应障碍越小,不同生计农户的积极适应意向均越强。最后,提出了解决农户适应障碍的对策建议。     

MENTAL HEALTH PROGRAMS—The Role of the Health Officer

Traditionally the treatment of mental illness has been a responsibility of state governments, but they have been unable to solve the problem with any degree of success.In spite of rationalizations as to why a health department should not become involved in this field, more and more local health departments in California and across the nation are initiating various services in mental health.With the widespread interest in mental health at national and state levels and in local citizens'' groups, local health officers must involve themselves in this most difficult effort.While the treatment of the emotionally disturbed and the psychotic is demanded most aggressively by the public which seeks outpatient, inpatient, and rehabilitation services on the local level, two services—consultation and education-information services—offer more hope in the promotion of mental health as contrasted with the treatment of mental illness.     

Climate change disrupts local adaptation and favours upslope migration

Contemporary climate change is proceeding at an unprecedented rate. The question remains whether populations adapted to historical conditions can persist under rapid environmental change. We tested whether climate change will disrupt local adaptation and reduce population growth rates using the perennial plant Boechera stricta (Brassicaceae). In a large‐scale field experiment conducted over five years, we exposed > 106 000 transplants to historical, current, or future climates and quantified fitness components. Low‐elevation populations outperformed local populations under simulated climate change (snow removal) across all five experimental gardens. Local maladaptation also emerged in control treatments, but it was less pronounced than under snow removal. We recovered local adaptation under snow addition treatments, which reflect historical conditions. Our results revealed that low elevation populations risk rapid decline, whereas upslope migration could enable population persistence and expansion at higher elevation locales. Local adaptation to historical conditions could increase vulnerability to climate change, even for geographically widespread species.