1. How Health Professionals Can Contribute to a Healthy Environment in a Changing Climate Mona Sarfaty, MD MPH Director, Program on Climate and Health Center for Climate Change Communication George Mason University 2014

2. DECLARATIONS I Have No Commercial Interests to Declare Related to this Presentation Presentation is partially supported by the George Mason University Foundation

3. Outline How Americans think about climate change Attribute of communication The concept of frames Benefit of the health frame for addressing climate change Effective communication approaches Examples of public health projects that are trying to protect people from climate change by focusing on the local environment

4. Introduction Current/future health threats of climate change (CC) are well documented but not understood by the general public. Americans consistently underestimate the current or future impact of climate change: see it as remote, polar bears, glaciers The concept of vulnerable communities is also not understood; this needs attention from public health professionals.

5. Climate Change in the American Mind The U.S. public's understanding of climate change has been studied extensively. Climate Change in the American Mind Project (2008)--bi-annual representative national survey of American adults. Center for Climate Change Communication at George Mason University (Mason 4C) Yale Project on Climate Change Communication Identified six distinct segments of the U.S. population –- or audiences -– defined by their perception of "global warming.“ People in each segment have a distinct pattern of beliefs, behaviors, policy preferences, levels of issue engagement.

6. Global Warming’s Six Americas, Fall 2013

7. People Rely on Frames to Communicate Frames are attributes of communication. Any given issue has many different facets & can be viewed from different perspectives (or through different frames). Any given frame is likely to engage specific types of people, have little impact on others, and may even antagonize some Climate Change is framed as environment, scientific, political, economic, moral, security…… Few see it as a health issue. When asked what concerns them about climate change, few identify health as a major concern

8. Health Is a Message that Engages People Note, when voters were asked about the importance of potential consequences of climate change, 75 percent of voters responded that people’s health is an "extremely" or "very important" concern. And most people endorse the following statement: "Taking actions to limit global warming –- by making our energy sources cleaner and our cars and appliances more efficient, by making our cities and towns friendly to trains, buses, and bikers and walkers, and by improving the quality and safety of our food –- will improve the health of almost every American.“ This health “co-benefits” gets a positive reaction from people in all six Americas.

9. The Messenger is Also Important People are more likely to accept information if they perceive its source as trustworthy. The most effective messengers are trusted authorities on the frame presented. Information about climate change framed around health elicits a more productive set of responses when it comes from health professionals. * Health professionals have a special role to play in communicating about climate change. * *Maibach EW, Nisbet M, Baldwin P, et al. Reframing climate change as a public health issue: An exploratory study of public reactions. BMC Public Health 2010; 10: 299.BMC Public Health

10. Communicating About Climate Change Health professionals can credibly communicate three simple messages: 1.There is a scientific consensus about human-caused climate change 2.Climate change is harming people's health everywhere 3.But people and communities can take actions that will limit climate change, protect their health from the consequences of climate change, and make their communities healthier places to live. These Messages are Persuasive Because: A focus on solutions can bring people together, even when the underlying thinking is quite different. Including a value can help: “Protection” is a value with wide appeal. N.B: Gloom and doom is a barrier to action; it is associated with a sense of helplessness, denial, and avoidance.

11. Getting the Messages Out: Contact, Convene, Collaborate Strengths of Public Health More examples of co-benefits messages: Encouraging people to walk or bike, rather than drive, improves their health AND reduces use of fossil fuels. Buying locally-grown, fresh produce reduces fat intake AND long-distance food transportation using less fossil fuels. Awareness of air quality can encourage people outside when air quality is healthy AND stay in and protect themselves from pollen/pollutants when it’s not.

12. Ann Arbor Addresses heat, air pollution, & environmental justice Public Health Professionals Contribute Healthy Environments

13. A Tree Planting Intervention The purpose of this Health Impact Assessment (HIA) is to examine the health/psychosocial benefits of targeted tree planting in residential areas of Ann Arbor, MI with low tree canopy & vulnerable pops. If a residential area had 2 risk factors including low SES and poorer health status, it was identified as highly vulnerable to heat AND poor health outcomes. Six neighborhoods identified as vulnerable. This health impact assessment is in progress. Health Professionals Contribute to Healthy Environments

14. Assessment of Heat Vulnerability in San Francisco* * CDC Grant to SFDPH to study vulnerability to heat and poor air quality, 2012. Public Health Contribute Healthy Environments

15. The Assessment Risk factors Lack of air conditioning Chronic diseases (heart, pulmonary) Development of new hotter conditions with little preparation Lack of adjustment, technologic and physiologic Identify the locations Heat vulnerability index Public Health Professionals Contribute to Healthy Environments

16. Risk Factors * *SES factors, older age and social isolation, air quality, density, lack of vegetation

17. Locate Areas with Highest Air + Surface Temps South of Market, Mission, Potrero Hill, Bernal Heights, Bayview, Visitation Valley, Crocker Amazon, Nob Hill

18. After high risk areas identified, approaches are needed Risk factors + hotter areas = high risk neighborhoods Chinatown Civic Center Bayview Mission Addressing the risks of heat may be approached through strategies: From Public Health From Clinical Settings From Area wide community policies Public Health Professionals Contribute to Healthy Environments

19. Public health Strategies 1995 - Instituted Heat Watch/Warning Alert systems/preventative measures/outreach (Phila)* *1993 Philadelphia Heat Waved caused 118 deaths.

20. Philadelphia reduced heat-related mortality From 118 in ‘93 to <40 per year in ‘04.

21. Clinical Care - Protect & Prepare Patients Clinical strategies Informational Posters, Handouts Verbal reminders Calls to high risk patients from case managers Hydration, Avoiding exertion Finding cool locations

22. Community strategies to reduce heat risks Cooler areas have vegetation and/or water

23. Conclusion Americans don’t generally associate climate change with health But health is an effective frame in which to address climate change and improve the environment Health professionals can play a credible and influential role when health is part of the message. Get the messages right. Contact, convene, collaborate Avoid doom and gloom Protect the vulnerable--more projects are needed

24. Thank You!