Preparing for the public health impacts of climate change through the Michigan Climate and Health Adaptation Program
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Projected climate impacts for Michigan, including extreme heat events, extreme precipitation events leading to flooding, and extreme weather events (e.g., freezing rain, heavy snow), pose a significant threat to public health. In particular, five priority climate-related health outcomes have been identified: heat-related illnesses, air quality and respiratory diseases, vector-borne diseases, water-borne diseases, and injuries related to extreme weather events (e.g., carbon monoxide poisoning, injury). With funding from the Centers for Disease Control and Prevention (CDC), the Michigan Climate and Health Adaptation Program (MICHAP) is helping build a climate-resilient public health system for the state, local health departments, and communities. Project activities have included efforts to raise awareness about the impacts of climate change on health and equity, funding community health impact assessments, developing a climate and health adaptation plan, outreach and training events, implementing pilot interventions (or adaptation actions), and evaluating the effectiveness of their programs and pilot interventions.
In 2009, the Michigan Department of Community Health (MDCH, now MDHHS) was awarded a one-year planning grant funded by the CDC to develop a climate change and public health strategic plan. In 2010, as part of the Climate-Ready States and Cities Initiative, MDCH received a three-year grant from the CDC to fund the Michigan Climate and Health Adaptation Program (MICHAP) to implement the strategic plan; subsequent funding was awarded by the CDC in 2013 and 2016 to continue implementing activities to help prepare for and respond to the health impacts of climate change in the state.
To date, the MICHAP has focused on heat-related illness, air quality, vector- and water-borne diseases, and extreme weather events. Project activities, which have primarily focused on working with local public health departments and communities, have been implemented over three phases: (1) 2010-2013, (2) 2013-2016, and (3) 2016-2021.
Phase 1 (2010-2013) focused on raising awareness within the state and local public health departments about the impacts of climate change on health and equity. Additionally, three community health impact assessments were funded: (1) expanding urban tree canopy in the City of Ann Arbor; (2) evaluating the Michigan Street Corridor Plan for the City of Grand Rapids; and (3) evaluating the benefits of non-motorized improvements in East Lansing. A key, non-local partner in this work was Human Impact Partners, an Oakland, California-based organization dedicated to increasing considerations of health and equity in decision-making.
The Health Impact Assessment (HIA) for Ann Arbor examined the health and psychological benefits associated with targeted tree planting in residential areas through the City of Ann Arbor Urban Community Forest Management Plan. Extreme heat, changes in precipitation, and extreme weather events are identified as the key drivers of health-related challenges, including asthma/allergies, air pollution, heat stress/heat-related illness, chronic disease, low birth weight, substance abuse, mental distress, obesity, and crime. The HIA uses the methodology developed by the North American HIA Practice Standards Working Group to identify several intermediate impacts of implementing a comprehensive urban forestry program (e.g., decreased urban and surface temperatures, infrastructure stress, and energy use) and projected health outcomes (e.g., decreased heat stress and heat-related illness, increased management of chronic illness, and decreased mental stress). The project mapped neighborhoods in the city that were most vulnerable to heat stress and associated with low tree canopy cover. The results of the assessment revealed six neighborhoods vulnerable to three or more adverse health outcomes associated with hot weather. Expanding tree canopy on public sites is recommended as a core priority along with strategies to incentivize planting on under-canopied private properties.
Phase 2 (2013-2016) focused on application of the CDC’s Building Resilience Against Climate Effects (BRACE) framework, including developing a state climate and health profile report and vulnerability assessment, assessing the burden of disease, identifying priority health impacts and possible interventions, developing a climate and health adaptation plan, and starting to evaluate impacts and activities. MICHAP partnered with the Great Lakes Integrated Sciences and Assessment Center (GLISA) to synthesize climate impacts information for the climate and health report, and also worked with researchers from the University of Michigan School of Public Health to develop the disease burden projections for heat-related illness and death in Michigan. Priority health impacts identified in this phase included heat-related illness, exacerbation of respiratory diseases associated with air pollution, vector-borne diseases (e.g., Lyme disease, West Nile virus), water-borne diseases (e.g., related to flooding), and extreme weather events resulting in carbon monoxide poisoning and/or other impacts (e.g., hypothermia and frostbite). Mental health was also identified as an emerging issue. MICHAP partnered with other BRACE grantees in a review of available literature to identify and assess available interventions (or adaptation actions) in response to health impacts; however, limited information on intervention efficacy was found. This review resulted in a CDC White Paper, Climate and Health Intervention Assessment: Evidence on Public Health Interventions to Prevent the Negative Health Effects of Climate Change.
During Phase 2, MICHAP also engaged in extensive outreach and training activities with communities, including providing input on the Michigan Green Communities Challenge, assisting with the public health portion of the Detroit Climate Action Plan, and working with the nonprofit Land Information Access Association (LIAA) on resilient master planning. Specifically, with MICHAP’s support, LIAA developed and led a climate and health training for community planners to help them incorporate climate and health concerns into Master Plan/Comprehensive Plan updates.
Phase 3 (2016-2021) has thus far focused primarily on implementing pilot interventions – one focused in an urban area (Detroit) and another focused on a rural area (Marquette County) – and assessing their effectiveness. In Detroit, MICHAP is working with the city’s public health department to build their internal capacity to address health effects from climate and environmental exposures, particularly to impacts such as extreme heat and cold events. For example, the health department has begun working with Detroit’s emergency response agencies to develop plans for extreme heat and cold events to include interventions (e.g., opening cooling centers, issuing heat alerts). MICHAP, in partnership with Michigan State University (MSU) Extension, the School of Planning, Design, and Construction (SPDC), and the Sustainable Built Environment Initiative (SBEI), has been working with the local government, community partners, and the health department in Marquette County to integrate climate and health into existing plans. Activities have included one-on-one conversations with vulnerable populations (e.g., homeless, veterans, aging) and utilizing the MSU SBEI process to convene charrette-style events with the community to increase awareness about climate, health, and equity issues. As part of the charrettes, MSU Extension and SPDC used “before” and “after” images of sites from around the community to communicate climate impacts and interventions. For example, one photo showed a washed-out culvert, which they used to show downstream health issues, possible interventions, and how green infrastructure interventions could address the health issues. Charrettes focused on four health themes: (1) vector awareness; (2) air quality issues (e.g., particulates from fire, drought, increased pollen production from shifting seasons); (3) emergency response and extreme events (e.g., damage to transportation infrastructure and the energy grid and loss of access to services); and (4) water-related issues (e.g., drought and flooding).
MICHAP has also been working to develop resources for communities to help them address climate-related water issues. For example, some Michigan communities are more vulnerable to flooding impacts while in other areas, communities are more vulnerable to water shortages. They have partnered with a community planning group to develop resources on climate, water, and health including a compilation of existing local ordinances related to source water protection and an interactive story map. These resources are designed to help local communities better understand where their water comes from, the climate-related issues that could impact those resources, and examples of how they can be more protective, especially given potential climatic changes.
Throughout these activities, MICHAP has utilized the following information and resources: (1) National Climate Assessment, particularly sections on climate and health and climate projections; (2) resources from GLISA; (3) spatial data and monitoring data from the National Oceanic and Atmospheric Administration, U.S. Environmental Protection Agency (air quality), Michigan Department of Environmental Quality (water quality), and National Weather Service (air temperature); (4) CDC Climate and Health Program; (5) CDC National Environmental Public Health Tracking Program; and (6) materials from the American Public Health Association and American Planning Association, among others.
Outcomes and Conclusions
As a result of this work, MICHAP has produced numerous products to help Michigan prepare for the public health impacts of climate change. Example products include:
- Michigan Climate and Health Profile Report;
- Michigan Climate and Health Adaptation Program Strategic Plan Update: 2016-2021;
- City and County Health Impact Assessments;
- Compilation of Michigan Emergency Preparedness Information;
- Marquette Area Climate and Health Adaptation Guidebooks (Vol I and Vol II), which discuss how health is impacted and lists over 140 policy options for implementing interventions;
- Climate Health Adaptation Planning in Michigan: Training for Local Planners and Decision Makers; and
- Many others that can be found on the MICHAP website.
As part of Phase 1, MICHAP underwent a process evaluation to assess program implementation and effectiveness of achievement of early outcomes of their work. As part of Phase 3, MICHAP is now in the process of evaluating the effectiveness of their pilot interventions. Specifically, MICHAP identified three intervention tiers and corresponding evaluation metrics as part of the Marquette County project:
- Build a network of partners and establish a common language (example metric: number of times met);
- Conduct community education and outreach, including identifying vulnerable populations and gathering their input (example metric: change in stakeholder knowledge of local climate and health issues from before to after engagement process); and
- Create a health adaptation guidebook (example metric: guidebook created).
MICHAP is continuing to work with Marquette County to prioritize policy recommendations, implement a demonstration of one of the recommendations, and then evaluate the demonstration. Because it is challenging to measure a change in health outcomes, the evaluation will likely focus on indicators that show a reduced risk of exposure to climate events (e.g., reduced number of flood events).
Numerous factors have helped facilitate adaptation action throughout this project, including:
- Bringing local information to local communities (e.g., historic storm data for the community);
- A focus on things the community has already been experiencing (e.g., extreme events) and how they are likely to get worse in the future;
- Working through the community planning process rather than as a standalone process;
- Identifying co-benefits of adaptation recommendations;
- Finding and working with core community members, leaders, and/or committees (e.g., trusted local voices and sources), who then serve as the messenger to the rest of the community; and
- Linking mitigation and adaptation where possible.
Some barriers that have arisen include a general lack of understanding about how decision-makers can affect health outcomes as well as how their work contributes to climate adaptation (e.g., stormwater management); disconnect between public health and other decision makers (e.g., community planners, elected officials); politicization of the climate change issue; and a perceived conflict between climate action and economic prosperity. Funding was also identified as a barrier to continued work in health and adaptation; however, climate health and equity is gaining momentum and new funding opportunities are emerging (e.g., Kresge Foundation and Robert Wood Johnson Foundation).
Kershner J. 2019. Preparing for the public health impacts of climate change through the Michigan Climate and Health Adaptation Program [Case study on a project of the Michigan Department of Health and Human Services]. Product of EcoAdapt's State of Adaptation Program. Retrieved from CAKE: https://www.cakex.org/case-studies/preparing-public-health-impacts-climate-change-through-michigan-climate-and-health-adaptation-program (Last updated June 2019)