Addressing heat-related illness, wildfire smoke exposure, and environmental justice in Multnomah County, Oregon
The Climate and Health Program of Oregon’s Multnomah County Health Department aims to protect residents from illness and premature death associated with climate-related hazards. Building on their 2013 Climate Change and Public Health Preparation Plan, the health department is currently implementing several public health interventions to address extreme heat events and wildfire smoke exposure. Specific activities include implementing an early warning system during extreme heat events, operating cooling centers, planting trees to reduce urban heat islands, educating large sporting event operators on ways to mitigate and recognize heat-related illness, and collaborating with state agencies and the City of Portland on public messaging around ways to reduce wildfire smoke exposure. They are also collaborating extensively with local nongovernmental and community-based organizations to advance environmental justice in their adaptation work. The health department is also monitoring emergency room visits for heat-related illness and respiratory illness, tracking heat-related deaths, and recently completed an urban heat island mapping project in Portland; information from these efforts will inform future refinement of adaptation activities.
The Multnomah County Health Department has been formally working to address climate change risks to public health since 2010. With a Centers for Disease Control and Prevention (CDC) grant through the Oregon Health Authority (the state health department), Multnomah County was one of five Oregon counties selected to pilot the CDC’s Building Resilience Against Climate Effects (BRACE) framework. This formal focus on climate risk to public health was a natural progression of existing county adaptation efforts. For example, health department staff were already participating in the Climate Change Working Group of the National Association of County and City Health Officials (NACCHO). Additionally, the county and the City of Portland had jointly adopted a Climate Action Plan in 2009.
Multnomah County is located in northern Oregon. It encompasses several large metropolitan areas, including Portland and Gresham, and has a population of roughly 800,000 people. The health department operates county-wide, but much of its adaptation activity centers around the City of Portland, given that a majority of county residents reside there and because it is the geographical focus of the county and city’s joint Climate Action Plan.
The primary goal of the health department’s Climate and Health Program is to protect Multnomah County residents from illness and premature death associated with climate risks and climate-related hazards. Currently, the county is focused on two primary impacts: heat-related illness associated with rising temperatures and extreme heat events, and respiratory issues associated with wildfire smoke exposure. The county is also working on harmful algal bloom monitoring and public messaging for the Willamette River, and vector control and monitoring of mosquitos and ticks. While the department has received past grant funding to support climate and health initiatives, current activities are all state funded, either through the state general fund or fee supported measures.
With CDC BRACE funding, the health department developed their 2013 Climate Change and Public Health Preparation Plan. This plan identifies climate change risks to public health at the local level, identifies which populations and geographic areas may be impacted, discusses why equity and justice are important aspects to address, and outlines potential response activities. Findings and proposed activities from the Public Health Preparation Plan informed the 2015 Climate Action Plan update; the updated plan now features many health-related adaptation activities.
The health department is now working on implementing activities identified in the Public Health Preparation Plan and the 2015 Climate Action Plan with special focus on extreme heat and wildfire smoke exposure. For extreme heat, they are implementing an early warning system to alert and educate residents about extreme heat events. This system includes public communication and outreach efforts, such as press releases and hosting online information (e.g., briefings on symptoms of heat-related illness and safe behaviors during high heat periods). The department also hosts an interactive and seasonally updated online map that identifies cool places for people to take refuge from the heat (e.g., libraries, public buildings with air conditioning, water stations). During the most extreme events, the county also opens cooling shelters.
In addition to these short-term interventions, the health department is also working on some longer-term interventions to address extreme heat. They are increasing the number of air conditioned spaces in the county, installing air conditioning in structures utilized by the most vulnerable populations, and collaborating with the City of Portland on tree planting efforts in areas that consistently host heat islands and support vulnerable populations. The health department also provides guidance on recognizing and alleviating symptoms of heat-related illness for organizers of large sporting events that take place in the summer. During heat waves, the health department also conducts direct outreach to event planners to confirm readiness plans. This low-cost intervention was designed in direct response to early analyses of emergency room visits that showed that many heat-related incidents involved participants from such sporting events (e.g., healthy, fit adults competing in triathlons and marathons).
The health department is also working on several health interventions for wildfire smoke exposure, although response options for smoke are more limited than for heat. They are collaborating with state and city agencies on strong public messaging, such as online videos discussing actions people can take to limit smoke exposure (e.g., limiting outdoor activity, replacing indoor air filters, and creating lower-cost/do-it-yourself air filters). New challenges continue to arise; for example, wildfire season has begun to overlap with the start of the school year. In response, the health department has inventoried county schools, categorizing them by the degree of filtration and air conditioning they provide to identify potential needs for future upgrades. For smoke exposure, longer-term interventions identified by the department include ensuring that all public buildings (including schools) have high-quality air filtration and air conditioning, and helping public buildings establish clean air spaces (e.g., through the use of HEPA filters, which clean the air sufficiently even for highly sensitive groups).
The health department is also working on harmful algal blooms and vector control and monitoring. For example, they collaborate with the state and City of Portland on weekly monitoring for harmful algal blooms in the Willamette River during the summer. If blooms are detected, they implement an advisory protocol that includes public outreach and education efforts (e.g., where/when not to swim). For disease vectors, the health department monitors for mosquitoes and ticks, and conducts spraying to reduce mosquitoes.
Multnomah County has also been working with community-based nonprofit organizations and local cultural organizations to better incorporate environmental and social justice principles in its response to climate change. The Kresge Foundation provided initial funding for the county to engage with local organizations with expertise in these realms, and the county has worked extensively with the Coalition of Communities of Color. The county is now working to inform state-level policy by ensuring that legislative decisions advance environmental justice initiatives. For example, Oregon is currently developing greenhouse gas pricing legislation, and revenues from this bill could be invested in protecting vulnerable populations from climate-related health hazards.
These health adaptation activities are part of larger adaptation planning and implementation efforts occurring under the updated 2015 Climate Action Plan. This plan is led by the Multnomah County Office of Sustainability and the Portland Bureau of Planning and Sustainability, and has been supported by the Institute for Sustainable Solutions at Portland State University. Given that many other local and county government departments are actively working on climate change, the health department focuses on bringing the public health perspective to bear in adaptation work that is already happening.
The health department and other partners have used a variety of tools and resources to inform their adaptation efforts. Climate science from the Oregon Climate Assessment Reports and the National Climate Assessment, as well from the Northwest Climate Toolbox and modeled and gridded climate data, have been used to inform the county’s efforts. For monitoring health outcomes of climate-related events, the health department has used their syndromic surveillance system, which monitors emergency room visits, as well as the National Environmental Health Public Health Tracking Portal. The department has also used different tools to communicate with the public and decision-makers, including different Yale Program on Climate Change Communication products. More generally, the health department conducts public outreach and stakeholder involvement via web communication, press releases, and targeted outreach to other agency departments, counties, and health practitioners.
Outcomes and Conclusions
The health department has several assessment activities underway. These activities are designed to create a better situational awareness of climate-created health problems, which can then be used to inform and refine response activities such as the heat early warning system. Specifically, the health department is trying to better understand public exposure to climate risks (e.g., number of days/nights with extreme heat, air particulate matter). They recently completed a study that measured temperature differentials and mapped urban heat islands in Portland, which has allowed more nuanced analyses and visualization of heat risk. For example, the study identified neighborhoods that are more likely to experience higher temperatures based on their physical form. The health department recognizes the need to continue to improve tools for monitoring climate events that impact health. For example, they have a monitoring network that measures smoke exposure, but no existing monitoring for allergenic pollen.
The health department is also tracking health outcomes of climate-related events. For example, they are tracking emergency room and urgent care visits for heat-related illnesses and deaths and respiratory illnesses from smoke exposure and allergenic pollens. The health department is also leveraging existing monitoring systems to gain additional insights. For example, physicians are required to report certain diseases, and some of these are vector-borne (e.g., West Nile Virus, Lyme disease), creating climate-informed tracking opportunities.
One primary challenge the health department has faced is the current lack of evidence-supported interventions or off-the-shelf toolkits for climate change like there are for other public health issues (e.g., tobacco use, flu vaccines). As a discipline, public health relies heavily on data-driven and evidence-supported approaches. However, for climate issues, identifying what kind of data to collect and how to collect it has been difficult, and the evidence base for different interventions has been slow to build. In the interim, the health department has relied on creativity to generate low-cost, easily implementable, and no-regret interventions (e.g., providing guidance on heat-related illness prevention and management to operators of large sporting events). Health adaptation activities have also been facilitated by supportive leadership at the agency, county, and state level, which has fostered bold action as well as frank and honest discussion and reflection. Additionally, the health department has benefitted greatly from collaborating with many Northwest academic scientists, resulting in abundant, relevant, and high-quality research.
The health department and the county as a whole continue to be challenged by funding availability, particularly restrictions that limit the ways or places in which money can be spent. These limitations result in a piece-meal approach to funding adaptation activities (e.g., tree planting and building retrofits to address extreme heat impacts are funded separately). However, existing and previous funding (e.g., through the CDC) has connected the health department to a network of health and climate change practitioners, fostering knowledge exchange. For example, the health department has benefitted from interacting with large metropolitan areas in other states.
Looking to the future, the health department is concerned about human migration to the Pacific Northwest as a result of climate change. This phenomenon is hard to credibly forecast or track, and poses many risks to the health sector and human communities. Human migration may increase communicable disease risk and disease vectors, heighten demand for existing health care and social services, and further impact disadvantaged communities by increasing competition for scarce resources (e.g., housing). However, migration may also present opportunities; population growth will likely reinforce the demand for healthy, supportive neighborhoods, and create opportunities to make or remake built environments to better house resources that support public health.
Moving forward, the health department has several overarching goals for its Climate and Health Program. First, the department is pursuing funding to partner with neighboring counties subject to similar climate risks to establish key climate-related health indicators and outcomes. In doing so, they aim to create a broader, integrated network of health practitioners responding to climate change threats. Secondly, in partnership with the City of Portland, the department hopes to continue their work with a strong focus on environmental justice, so that in the course of responding to climate change they can correct historic injustices and improve upon unacceptable disparities. The department is in the final stages of evaluating how equity goals outlined in the 2015 Climate Action Plan are being met, and updated health and environmental justice goals and activities will be integrated into the next update of the Climate Action Plan, scheduled for 2020. Ultimately, they hope their environmental justice efforts will become a standard for other counties and cities to follow as they begin to address climate change.
Reynier W. 2019. Addressing heat-related illness, wildfire smoke exposure, and environmental justice in Multnomah County, Oregon [Case study on a project of the Multnomah County Health Department]. Product of EcoAdapt's State of Adaptation Program. Retrieved from CAKE: https://www.cakex.org/case-studies/addressing-heat-related-illness-wildfire-smoke-exposure-and-environmental-justice-multnomah-county-oregon (Last updated June 2019)