Bridging climate and health: New research agenda promoted by UMSN professor

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 As daffodils are springing up from the ground a month earlier than usual in Ann Arbor, Sue Anne Bell, Ph.D., clinical faculty member at University of Michigan School of Nursing (UMSN) and National Clinical Scholar at the Institute for Healthcare Policy and Innovation (IHPI), is leading the School of Nursing’s Climate Change and Health Seminar Series with the goal of establishing an interdisciplinary program of research addressing the health effects of a changing climate.
 
“My hope is that the seminar calls attention to climate and health across the university,” commented Bell. “The goal of this seminar is to educate students about climate and health, and use this platform as a call to action to advocate for our patients and ourselves.”
 
Established with School of Nursing Dean’s Centennial Scholars funding and in collaboration with the School of Public Health (SPH), the School of Natural Resources and Environment (SNRE), and the Graham Sustainability Institute, Bell and her colleagues have organized two seminars over the course of the semester to strengthen and coordinate research at the University of Michigan.
 
“Nurses have a valuable opportunity to effect policy and effect change,” said Bell, “Climate effects on health are not new - we have known about these changes for years - but global weather patterns in recent years have heightened the need for more attention to how these weather changes are affecting health.” 
 
Disaster within a disaster
“Climate change tends to produce a disaster within a disaster,” explained George Luber, Ph.D., Associate Director for Climate Change, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, and guest speaker at the first seminar on February 10, 2017.
 
Extreme weather events – a flood, hurricane, or heat wave – produce the immediate danger to health and loss of life as well as secondary effects. These are the compounding effects of climate change on health in ways that are not direct but nonetheless linked.
 
An example of this is the summer 2013, European heat wave. Thirty-thousand deaths were attributed to extreme heat during that time frame. In addition to those 30,000 deaths, 70,000 excess mortalities (additional deaths compared to average deaths in the time frame) were found, leading to a total mortality of the heat wave in the range of 100,000.
 
Cause of death for those mortalities are various, but they would seem to be linked to the extreme heat in one way or another according to Luber.
 
Surprising risk assessment
Weather events are considered geography-bound. In the upper Midwest, we don’t worry about tropical storms, and Floridians don’t worry about our thundersnow. Yet, Luber argued, that we need to understand that the risks of climate change spread beyond the weather itself.
 
Luber’s unit worked with the city of Austin, Texas on risk management and review of data to get a sense of the health risks of disaster there. They found that the major risk factor for public health in Austin is Gulf Coast storms. This is not because the city suffers from that weather, but because displaced people from the Gulf Coast evacuate to Austin, creating a significant burden on the public health system.
 
In addition to the demographic effects of climate change, changing temperatures allow for new pathogens and new pathways for pathogens to develop. Zika virus, West Nile virus, and Lyme disease are all examples of diseases that are beginning to spread far beyond where they have typically been found. Computer modeling will help to predict where we will see these diseases in the future, and public health departments in those areas will have to work to educate the population to be safe with the new threats. 
 
Coping with changes
To cope with these changes, Luber’s priority at the National Center for Environmental Health is to shift the coping range by applying climate change as a risk assessment tool and adapting to the newly predictable risks.
 
Success can be had. The State of Oregon, for example, had never experienced an extreme heat event, but data showed that it was likely. Luber’s group worked with the state to create a heat response plan using lessons from other areas – the east coast, Europe – that had experienced extreme heat. The state was prepared for the extreme heat of summer 2015 and minimized the health effects of it.
 
Steps that municipalities take to protect their communities will undoubtedly involve nurses. As discussed in the seminar, nurses are at forefront of health education efforts, and should also be at the forefront of educating people on responsible ways to live in a warming and storming world. At the same time, they will be important partners in looking for innovative solutions to new health challenges brought on by climate change.
 
Local problems, local solutions
Another key factor in shifting the coping range for health is understanding the differential effects of climate change in cities, suburbs, and rural areas. Data shows that the rates of asthma in urban areas has greatly increased due to both decreased air quality and the lengthened growing season of allergenic plants in urban areas while it has stayed relatively the same in suburban and rural areas. Jalonne White Newsome, Ph.D., Senior Program Officer, Environmental Program, Kresge Foundation and the second speaker of the seminar noted that any actions taken to address climate change and health must have in mind the needs of the most vulnerable communities.
 
In southeastern Michigan, the Kresge Foundation works to address climate, health, and equity by funding projects embedded in communities. White Newsome outlined how the Kresge Foundation sees community work: “the climate issue will take a little bit of everyone – policy advocates, engineers, planners, scientists, nurses,” she said. Cross-sector work that builds resilience in communities is needed. “Cities are incubators for solutions” she said, so we have to “work at the local level, with the folks who are experiencing the effects.”
 
For this reason, she and the Kresge Foundation encourage community engaged research, including such tactics as bringing the community in to develop questions, plan the research and think of solutions, while still understanding and respecting the scientific process. She encouraged current doctoral students to explore how they might use elements of community engaged research in their work.
 
Making a Michigan difference
Researchers at the University of Michigan have the chance to work on local problems in real time.
 
“As we speak, we are headed towards an early and intense pollen season, which is linked to various respiratory concerns,” said Bell. “The unusually high February temperatures, which were the highest ever recorded in the Traverse City area which is a major fruit producer for the state, caused fruit trees to bud. The buds will freeze and die with the freezing temperatures expected next week.”
 
The economic cost of climate change is also an important factor to take into consideration.
 
“The result of this is a loss of the fruit crop for the season, economic loss for fruit farmers, higher prices for fruit for consumers, and weakened fruit trees.  All of these events have indirect and direct impacts on health that are not always obvious,” she explains.
 
Bell has organized this seminar with U-M’s role in mind.
 
“I would like to see the University of Michigan take the lead in addressing the impact on climate and health, with a focus on vulnerable populations, who are the most disproportionately affected,” said Bell.
 
“Having close ties to urban communities, such as Flint and Detroit, represents an incredible opportunity to engage with these communities.”
 
Actionable science
Bell believes the health effects of climate change will only be mitigated when science, healthcare, and public policy work together to create usable, actionable science. This is the focus of the second seminar, on March 10, with speakers Linda McCauley, Ph.D., Dean, Nell Hodgson Woodruff School of Nursing at Emory University; Rosina Bierbaum, Ph.D., SNRE; Marie O’Neill, Ph.D., SNRE; and Lorraine Cameron, Ph.D., Michigan Climate and Health Adaptation Program, Michigan Department of Health and Human Services.