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Public Health Adaptation to Climate Change in the Federalist States of Canada and Germany

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Public Health Adaptation to Climate Change in the Federalist States of Canada and Germany Public Health Adaptation to Climate Change in the Federalist States of Canada and Germany By Stephanie E. Austin A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Master of Arts in Geography Department of Geography McGill University Montréal, Québec, Canada August 2017 © 2017 Stephanie E. Austin ACKNOWLEDGEMENTS This thesis is the product of countless collaborations, pieces of advice and words of encouragements. First of all, this work would not be possible without the cooperation and interest from all of the interviewees. Thank you for taking the time to speak with me, and I hope you will find this research interesting and potentially useful. I would like to thank my supervisor, Dr. James Ford, for his guidance, trust and the many opportunities. To my committee members, Dr. Lea Berrang Ford, Dr. Robbert Biesbroek and Dr. Nancy Ross: Lea, thank you for your mentoring, enthusiasm, and for looking outside the box (“what if we…”); Robbert, thank you for your patient teaching, answering endless questions, and guidance through the world of public administration and policy; and Nancy, thank you for sparking my interest in public health and health geography as an undergraduate student, training me in health geography, and for pushing me to bring my work to its fullest potential. I am grateful for funding from the Canadian Institutes for Health Research (CIHR) Fredrick Banting and Charles Best Canada Graduate Scholarship and Michael Smith Foreign Study Supplement, the Fonds de Recherche du Québec en Santé (FRQS) Master’s Training award, and the McGill University Department of Geography. This project additionally received funding through Drs. James Ford and Lea Berrang Ford’s CIHR Applied Public Health Chairs and Social Sciences and Humanities Research Council (SSHRC) funding. This research benefitted enormously from a research abroad period at the Institute of Political Science, Heidelberg University. Thank you to my host supervisor, Dr. Jale Tosun, for welcoming me and providing your insight and new directions to this research. Thank you as well to my colleagues and friends in Heidelberg, including Eva Thomann, Andreas Fleig, Melina Moik and Christian Ott, for their encouragements and introduction to Germany. In particular, I would like to thank Nicole Schmidt for being my ‘adaptation buddy,’ my sounding board, and for translating my abstract into German. Thank you to my research assistants at McGill University, Dorothy Heinrich, and at Heidelberg University, Jannes Rupf and Florian Dorner, for their dedication, suggestions, and contributions to this project. What better place for such a journey than the McGill University Department of Geography, which has been my second home and community since I entered Burnside Hall as an undergraduate student in 2009. I have been fortunate during my time in the Department to be surrounded by and supported by inspiring individuals in the Health Geography Lab, the Climate Change Adaptation Research Group, and the 2015 graduate student cohort, including Alexandra Lesnikowski, Michelle Maillet, Laurence Côté-Roy, Lauren Wustenberg, Margot Charette, Malcolm Araos, Sarah MacVicar and Sarah Mah. More broadly in the Department of Geography, thank you to the rotating Graduate Program Directors, Sebastien Breau, Oliver Coomes and Ben Forest, and to the amazing staff including Catherine Klempa and Filomena Fata, for guiding me through McGill’s bureaucracy all the way to completion. In addition, thank i you to my undergraduate honours thesis supervisors, Dr. Sarah Turner and Dr. Navin Ramankutty for their early research training. Thank you to my friends outside of academia, Jill Wood and Rebecca Jones, for the reality checks and laughter, and to my writing buddy Sophie Schoenberg, for companionship and encouragement during many hours of thesis writing. Thank you to my family for being there for me with your support, cheerfulness, and reassurances: Alice Austin, Jason Austin, Karina Austin, Jeff Austin, Brian Hague, Dani Brown, Gilles Gingras and Nicole Carbonneau. I would also like to welcome my niece Lucia Austin Hague to the world, whose arrival provided a spark of life to the long thesis writing months. Lastly, thank you to Lauren Gingras, for your endless support and encouragement from Day 1 (and the snacks!), and for translating my abstract into French. ii ABSTRACT Climate change is projected to have considerable impacts on human health, and public health institutions at all levels of government will need to adapt to protect the health of populations. The impacts of climate change are highly localized, thus federal systems are expected to have the inherent advantage of allowing for regional diversity and policy experimentation in adaptation, but are also prone to conflict and stalemates. In addition, local public health authorities often lack the capacity to adapt to climate change, despite being on the ‘front lines’ of climate impacts. Assistance is needed from upper-level governments for local-level public health adaptation to climate change. It is unclear, however, how different levels of government are interacting for public health adaptation or what form that support should take beyond vague calls to build capacity. This thesis examines the relationship between different levels of government in Canada and Germany for public health adaptation, framed in federalism, intergovernmental relations, and adaptive capacity concepts. This thesis aims to i) characterize how intergovernmental dynamics are patterned across national, regional, and local levels of government in federal systems for public health adaptation to climate change; and ii) examine how federal and regional governments could contribute to enabling and supporting local public health authorities’ adaptive capacity in federal systems. This research is based on 28 semi-structured interviews in comparative nested case studies of Quebec, Canada and Baden-Württemberg, Germany. I find that coordination between levels of government specifically for climate change and health is rare, but climate change issues are occasionally discussed through existing methods of public health coordination. Interactions for public health adaptation between the federal and regional governments follow expected patterns of intergovernmental relations (i.e., loosely coupled in Canada, tightly coupled in Germany), but I find the inverse occurring in the relationship between regional governments and local public health authorities in each country. Additionally, adaptive capacity varies widely between local public health authorities, but all report having insufficient funding, and consequently staff, for adaptation activities. Based on interviewees’ perspectives and needs, and complemented by adaptation literature, I identify specific measures upper-level governments can take to build local public health authorities’ capacity for adaptation, grouped under the action-oriented and interrelated themes of: building financial capacity; fostering knowledge, knowledge translation and skills; collaborating and coordinating for shared knowledge; and claiming leadership. These findings contribute to adaptation literature by iii demonstrating how adaptation is occurring across multiple levels of government in the public health sector and characterizing approaches to in coordination and interactions in the two case studies. Moreover, this research supports decision-makers seeking to enable sub-national public health adaptation to climate change. iv RÉSUMÉ Les changements climatiques sont prévus d’avoir un impact considérable sur la santé humaine; les institutions de santé publique sur tous les niveaux gouvernementaux auront besoin de s’adapter afin de protéger la santé des populations. L’impact des changements climatiques est hautement localisé, pour ce les systèmes fédéraux qui sont prédits d’avoir l’avantage inné de permettre une diversité régionale et une expérimentation à l’adaptation, mais qui sont vulnérables aux conflits et aux impasses. De plus, les autorités de santé publique locales manquent souvent de capacités d’adaptation aux changements climatiques, bien qu’ils soient aux premières lignes face aux impacts de ceux-ci. L’assistance à l’adaptation de la santé publique au niveau local est requise des niveaux gouvernementaux supérieurs. Il est toutefois incertain comment les différents niveaux gouvernementaux interagissent pour l’adaptation aux changements climatiques en santé au-delà des références vagues au renforcement des capacités. Cette thèse examine les relations entre les différents niveaux gouvernementaux du Canada et de l’Allemagne pour l’adaptation aux changements climatiques, encadré dans les concepts de fédéralisme, de dynamiques intergouvernementales et de capacité à l’adaptation. Cette thèse vise à i) caractériser les patrons de dynamiques intergouvernementales entre les niveaux nationaux, régionaux et locaux dans les systèmes fédéraux pour l’adaptation aux changements climatiques dans le domaine de la santé; et ii) examiner comment les systèmes gouvernementaux fédéraux et régionaux peuvent contribuer à permettre et à renforcer la capacité d’adaptation des autorités de santé publique locales dans les systèmes fédéraux. Cette recherche est basée sur une étude par cas comparative de 28 entrevues semi-structurées du Québec, au Canada et de Baden- Württemberg, en Allemagne. J’y trouve que la coordination entre les niveaux gouvernementaux spécifique à l’adaptation aux changements climatiques est rare, bien
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