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What is public health adaptation to climate change? Exploring an emerging field of practice in

Ontario, Canada

Chris Buse, MA, PhD CandidateLupina Research Associate, Comparative Program on Health and Society

Doctoral Alumni, CIHR Strategic Training Program in Public Health PolicyDalla Lana School of Public Health

Canadian Public Health Association ConferenceMay 27, 2014 Toronto ON

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Overview

• Context: Climate change and health in Ontario

• Study Overview

• Discussion: Typologies of adaptation practice among Ontario health units

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Climate Change is THE greatest threat to human health in the 21st CE

Direct• ↑ Heat-related morbidity

and mortality

• ↑Extreme weather and accidental morbidity/mortality

• ↑ Exposure to UV Radiation

Indirect• Exacerbation of health

inequalities• Food insecurity• Mental health impacts• Economic impacts of disasters• ↑ Poor air quality

– ↑ respiratory disease, cancer

• Changes in distribution of infectious disease– ↑ incidence of vector-borne and

zoonotic disease

• Contamination of food and water sources– ↑ foodborne and waterborne illness

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Climate Change in Ontario• 1948-2006 temperatures have increased 1.3 degrees Celsius

across southern Ontario (NRCan 2007)• Projected increase of 2-4 degrees C by 2050 (relative to 1971-

2000 averages) (Feltmate and Thistlewaite 2011)

Source: Adapted from Casati and Yagouti (2010)

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The Ontario Public Health Standards• Ontario Public Health Standards (2008)– Pursuant to Section 7of the Ontario Health Protection

and Promotion Act, OPHS outlines mandatory service delivery guidelines for each of the 36 health units in Ontario, specifically:• “Conduct surveillance of the environmental health status of

the community”• “Conduct epidemiological analysis of surveillance data”• “Increase public awareness of health risk factors associated

with…climate change…by adapting and developing communciation strategies”

• “Assist community partners to develop healthy policies to reduce exposure to health hazards”

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Study Overview

RQ: How is the OPHS mandate on CC being interpreted by practitioners and translated into action?

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Methods: Webscan and Interviews

• Web-based content analysis of 36 public health units in Ontario, Canada based on key word search

• In-depth interviews with 20 public health practitioners from 20 health units– 36 contacted for an interview– 13 declined to participate on grounds they had

nothing to contribute– 3 did not reply

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Interview Sample (N=20)• Interview order (6 waves of sampling) was selected

using a maximum variation sampling method that sampled cases based on geography (census division), size of health unit, and areas of programmatic focus on climate change

Health Units by Census Division (N) Interviews Conducted

Central East (4) 3

Central West (5)* 3

Central South (4) 2

East (6) 2

Southwest (9) 6

North (7) 4

TOTAL (36) 20

* Includes Toronto

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Extreme Temperature

Vectorborne Disease

Zoonotic Disease

Air quality

Economic Disruptions

Water-borne contamination

Food-borne contamination

UV Radiation

Food Insecurity

Worsening Health Inequalities

Mental Health

Extreme Weather

0%10%20%30%40%50%60%70%80%

Percentage of Climate Change Impact Areas Reported by Ontario Health Units Grouped by Census Division (Data from 2013)

Central East (N=5) Central South (N=4) Central West (N=5) East (N=6)North (N=7) Southwest (N=9)

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Number of Ontario Health Units (N=36) Reporting Climate Change-Related Programming from 2013 Webscan

Staff hosted or a

ttended CC worksh

ops/lectu

res

Food secu

rity pro

gramming

Loca

l Food In

itiatives

Sun Safety Campaigns

Anti-idlin

g behaviour change ca

mpaigns

Active/A

ltern

ative Transporta

tion Campaigns

Community Recy

cling In

formation

Vector S

urveillance

Air Quality

Monito

ring

Natural Conservation In

itiatives

Emergency preparedness

information fo

r individuals

Contributed to

intergovern

mental publica

tions

Built enviro

nment initiatives

Provides w

eb links t

o other agencie

s or o

rganizations

Urban fo

restry in

itiatives

Health Equity

Worksh

ops02468

10121416

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Absence of Adaptation to CC: Policy and Innovation Gap

Barrier Supporting QuoteProblem Denial • “[CC] is hardly ever addressed as far as I hear.

I’m not sure why and I think some of it might be personal… People aren’t going to change, so maybe a bit of it is denial?”

Prioritization of Other Areas

• “I don’t think it’s really seen as something that is important here.”

Blame Avoidance • “It's just too much, it's just too far in the future, it's uncertain, it's scary, and is it really our business?”

Lack of Resources • “We don't really have the resources to start any kind of planning and anything in depth as the project goes to climate change”

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Discussion (1): OPHS Policy is constraining

Inaction largely stems from:– Blame avoidance and problem denial–Waiting for more practical guidance from the

province– Few enforcement mechanisms– A lack of resources, leadership– Limited acknowledgement of environmental

determinants of health beyond proximal causes

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Presence of Adaptation to CC: Policy and Innovation Success

Adaptation Strategy ExamplesCapacity Building and Knowledge Exchange

• Training workshops; • Provincial meetings; • Roundtable exercises

(Intersectoral) Management and Planning

• Reviews of official plans; • Organizational ‘greening’; • Participation in regional climate change

strategies• Sourcing funding

Surveillance and analysis • Warning or observation systems; • Epidemiological surveillance; • Vulnerability assessments

Communication and Outreach • Dissemination of behaviour change messages (e.g. sun safety campaigns)

Green infrastructure • Built environment initiatives; • Urban forestry strategies

Localized Food Production • Development of local food charters

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Discussion (2): OPHS Policy is enabling

Action stems from:– Strong federal support (and to a lesser extent the

province vis-à-vis the MOE)– Champions within organizations who have a ‘different’

reading of the OPHS

• Existing provincial ‘promising practices’– Conducting vulnerability and adaptation assessments– Participating in regional climate change strategies– Built environment initiatives; ‘organizational greening’

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Acknowledgements

• My thanks to: – Participating Health Units and Staff– Blake Poland, Randy Haluza-Delay, Josephine Wong– Lupina Foundation, Comparative Program on Health and

Society– CIHR Strategic Training Program in Public Health Policy– Health Canada’s Climate Change and Health Office

chris.buse@mail.utoronto.ca