Chapter 11 Public Health Authors: Patrick Kinney,1,2 Perry Sheffield,3 Richard S. Ostfeld,4 Jessie Carr,2 Robin Leichenko,5 and Peter Vancura5 1 Sector Lead 2 Columbia University 3 Mount Sinai School of Medicine 4 Cary Institute of Ecosystem Studies 5 Rutgers University Contents Introduction....................................................................398 11.5 Equity and Environmental Justice Considerations ...412 11.1 Sector Description ................................................398 11.5.1 Vulnerability .................................................412 11.1.1 New York State Public Health System.........398 11.5.2 Adaptation ...................................................413 11.1.2 New York City Public Health System...........399 11.6 Conclusions ...........................................................413 11.1.3 Public Health Funding: Sources and Targets ...399 11.6.1 Main Findings on Vulnerability and 11.1.4 Emergency Preparedness............................399 Opportunities ..............................................413 11.1.5 Current Health Status for Climate-sensitive 11.6.2 Adaptation Options......................................414 Diseases......................................................400 11.6.3 Knowledge Gaps .........................................414 11.1.6 Economic Value ...........................................402 Case Study A. Heat-related Mortality among People 11.2 Climate Hazards ....................................................402 Age 65 and Older...................................................414 11.2.1 Temperature.................................................402 Case Study B. Ozone and Health in New York City 11.2.2 Precipitation.................................................403 Metropolitan Area ..................................................420 11.2.3 Changing Patterns of Monthly Case Study C. Extreme Storm and Precipitation Temperatures and Precipitation ..................403 Events ...................................................................421 11.3 Vulnerabilities and Opportunities ...........................403 Case Study D. West Nile Virus.......................................423 11.3.1 Temperature-Related Mortality ....................404 References.....................................................................424 11.3.2 Air Pollution and Aeroallergens....................405 Appendix A. Stakeholder Interactions ...........................429 11.3.3 Infectious Diseases......................................409 Appendix B. Technical Information on Heat Wave Cost ...435 11.4 Adaptation Strategies ............................................409 Appendix C. Annotated Heat-Mortality, Wildfires, 11.4.1 Key Adaptation Strategies ..........................410 and Air Pollution Methods References ..................436 11.4.2 Larger-scale Adaptations ............................411 11.4.3 Co-benefits and Opportunities ....................411 398 ClimAID Introduction 11.1.1 New York State Public Health System Greenhouse gas emissions have already altered Earth’s climate, and substantial global and regional climate The New York State public health infrastructure changes over at least the next 100 years are virtually adheres to the Centers for Disease Control and guaranteed. This will include continued warming, along Prevention’s (CDC’s) 10 essential public health services with changing patterns of floods, droughts, and other and core functions of assessment, policy development, extreme events. The consequences of these climate and assurance of services (Figure 11.1). A diverse state, changes for public health in New York State are likely to with populations spread unevenly over urban and rural be dramatic, particularly for people who are more service areas, New York is one of 26 states that rely vulnerable because of age, pre-existing illness, or primarily on a county-based system for public health economic disadvantage. service delivery (NYSPHC, 2003). A range of potential health vulnerabilities related to Local health departments operate under the authority climate change (Confalonieri et al., 2007; CCSP, 2008) of either the county legislature or local board of health. are relevant to New York State, including the following: The result is a highly decentralized system with a non­ uniform provision of core services. For example, local • more heat-related deaths health departments provide environmental health • diverse consequences as a result of more intense services in 37 out of New York’s 62 counties, while the rainfall and flooding events State Department of Health (NYSDOH) provides • worsening air quality (due to increasing smog, service to the other areas (PHANYC, 2001). The New wildfires, pollens, and molds) and related York State Public Health Council has identified this respiratory health impacts decentralization of public health service delivery as a • changing patterns of vector-borne and other key obstacle to efficient coordination of programming infectious diseases and data resources for climate-health preparedness. The • risks to water supply, recreational water quality, and Council has recommended regional, multi-county food production due to shifting precipitation initiatives, which are proven models for more efficient patterns and equitable distribution of expertise and services (NYSPHC, 2003). The first four of these issues are the focus of this chapter, which presents both public health vulnerabilities and adaptation options available for reducing future climate-related risks. The ClimAID health assessment has been carried out through a combination of research, analysis, and interactions with relevant New York State stakeholders. The broader interdisciplinary, multi-sector ClimAID team also contributed to this sector’s work. Case studies highlight the interplay of risks and responses for key health outcomes. 11.1 Sector Description An overview of the public health system of New York State is essential for understanding potential climate change vulnerabilities as well as opportunities for increased resilience. Source: CDC Figure 11.1 Core functions and 10 essential services of public health Chapter 11 • Public Health 399 In an effort to improve healthcare provision, in 1996 11.1.3 Public Health Funding: Sources and New York State initiated a data and knowledge Targets communication program linking a wide range of partners, including hospitals, local health departments, Local health departments are funded by a combination nursing homes, diagnostic centers, laboratories, of federal and state income streams and grants, insurance provider networks, and federal agencies. complemented by fees levied through the local tax base Current communication networks—the Health Alert and distributed by the State in proportion to county Network (state and city levels), the Health Provider population. According to the Public Health Association Network, and the Health Information Network—are of New York City (PHANYC), in 2001, New York City viewed as “both very helpful and very underutilized” accounted for 46 percent of State aid, with the next six by the Public Health Association of New York City largest counties (Suffolk, Nassau, Erie, Westchester, (PHANYC, 2001). However, as a result of non- Monroe, and Onondaga) receiving an additional 22 standardized data systems, the value of these networks percent. Together these most-populous counties, which across user groups is often compromised (PHANYC, contain 72 percent of the state’s population, accounted 2001). These would be appropriate organizations to for 70 percent of the State aid to local health target for climate-health educational outreach and to departments (PHANYC, 2001). In the 2001 fiscal year, evaluate climate-health interventions. the New York City Department of Health and Mental Hygiene budget drew 62 percent of funding from city tax revenues (PHANYC, 2001). 11.1.2 New York City Public Health System There is growing concern among public health New York City has been at the forefront of public practitioners that the confluence of State budget health programming and policy since the founding tightening with increasing needs of emerging chronic of the Board of Health in 1866, the first such agency illnesses and emergency programming may threaten in the United States. More recently, New York City provision of basic healthcare services—both climate conducted the nation’s first regional Health and and non-climate related (NYS ACHO, 2008). While Nutrition Examination Survey (NYC HANES), post-September 11 federal funding for emergency modeled after the CDC’s National Health and preparedness programming has benefitted the entire Nutrition Examination Survey, providing state and many aspects of surveillance and policymakers and public health professionals with programming, the sufficiency and security of these funds invaluable population-based health information into the future is a matter of serious concern (NYSPHC, (NYC DOHMH, 2007). 2003). It is also important to note that the federal health care landscape is evolving in significant ways as In 1995, the New York City Department of Health and a result of the recent passage of health care reform Mental Hygiene (DOHMH) instituted a system of legislation. syndrome-based surveillance to locate potential disease outbreaks through ongoing monitoring of public health service use patterns and analysis for 11.1.4 Emergency Preparedness time- and location-related deviations. What started primarily as a means to detect waterborne illnesses Projected changes