In the final regional perspective panel of the workshop, moderated by Lynn Goldman,1 Kathy Gerwig provided a perspective from Kaiser Permanente, a large integrated health system with facilities located primarily in California and other western states. Next, Renata Brillinger presented a perspective from the California Climate and Agriculture Network (CalCAN), a coalition of sustainable and organic agriculture organizations that works very closely with farmers and ranchers. The third and final panelist, Fletcher Wilkinson, presented a perspective from the Institute for Tribal Environmental Professionals (ITEP), a 25-year-old organization based in Arizona that works with tribes on a broad range of environmental issues, including climate change. This chapter summarizes these three panelists’ presentations. Key points made by the panelists are presented in Box 6-1.
In the open panel discussion with the workshop audience, topics covered included working with vulnerable communities, incentives for innovative approaches to agriculture, Kaiser Permanente and the political climate in California, the challenges of communicating about climate change with the agricultural sector and with legislature, learning from tribes, measuring greenhouse gas emissions in terms of health, and reasons for hope. The discussions around each of these topics are summarized at the end of this chapter.
1 John Bolduc was scheduled to moderate, but had to leave the workshop early due to the coming storm.
Gerwig began by remarking that she would be providing a perspective from Kaiser Permanente, a large integrated health system with medical centers, Permanente Medical Groups, and an insurance plan. Kaiser
2 This section summarizes information presented by Kathy Gerwig, vice president of employee safety, health, and wellness and environmental stewardship officer, Kaiser Permanente, Oakland, California.
Permanente’s climate action, she said, is a key pillar in the system’s environmental stewardship efforts, which are a component of its community benefit work.
Kaiser Permanente has eight regions, five of which are in the west. Of the health plan’s 11.7 million members, nearly 10 million live in western states. An even greater percentage of Kaiser Permanente’s greenhouse gas emissions come from the western part of the organization, because that is where all its hospitals are located, Gerwig explained. In the eastern regions, Kaiser Permanente has medical facilities, but not hospitals. Most of Kaiser Permanente’s 70 million square feet of real estate are in the western states, a large portion of it in California.
Gerwig commented on the fact that states where Kaiser Permanente facilities are located trend a little differently from the rest of the nation with respect to political context and, thus, opportunities for future work. In the 115th U.S. Congress, the House of Representatives has a Republican majority (238 Republicans, 198 Democrats). But among Kaiser Permanente states, Democrats outnumber Republicans two to one. In the 115th U.S. Senate, again, Republicans hold the majority, but Democrats outnumber Republicans by about four to one among states where Kaiser Permanente is located. Additionally, all of Kaiser Permanente’s western states have Democratic governors (California, Hawaii, Oregon, Washington)—an important consideration as Kaiser Permanente’s engagements in climate action are “a key pillar of its environmental stewardship.”
Health Care Organizations Are Powerful Community Forces
Health care organizations “wear a lot of different hats,” Gerwig continued. In addition to clinical care, health care organizations, particularly hospitals, are big emitters of greenhouse gas emissions, big water users, and big waste generators. “They leave,” Gerwig said, a “big environmental footprint.” Additionally, health care organizations provide many jobs, with hospitals often being the largest employer in their areas. Kaiser Permanente is the largest private employer in California. Thus, they are a “powerful force,” she said, for “community work.” Plus, they are big purchasers, and they have big supply chains. Whether their supply chains are global or local can have climate implications. Health care organizations are also big landowners, with, again, Kaiser Permanente owning 70 million square feet of real estate. Like most not-for-profit systems, Kaiser Permanente is also a large grant-maker. Finally, health care organizations are big investors. Kaiser Permanente has foundation funds to invest, Gerwig noted. The degree to which an organization’s investments are guided by social and climate criteria are important, she remarked.
Hospitals’ Community Health Needs Assessments
In addition to health care organizations impacting their communities in the many ways listed above, they also provide an important opportunity via Community Health Needs Assessments. These assessments, which are tied to the Patient Protection and Affordable Care Act, are required every 3 years from all not-for-profit hospitals. Gerwig noted that while the future of this requirement is uncertain, early signals indicate that they have not been targeted to be removed and that they will continue to be an opportunity. She explained that the opportunity provided by these assessments comes from the increased accountability and transparency for how not-for-profit hospitals spend their resources, and the fact that the assessments are not just about access. Gerwig described them as being about “working with communities to identify health needs, and then using the hospital as a place to have a conversation about how to meet those needs.”
In 2016, for the first time, climate and health showed up as one of Kaiser Permanente’s prioritized health care needs. Although it did not rank very highly on the list (see Table 6-1), 14 of Kaiser Permanente’s 39 hospitals prioritized it.
Even more important, in Gerwig’s opinion, is that so many of the other prioritized community health needs have climate co-benefits, thus providing hospitals with a tool to address climate-related health issues by engaging with communities in multiple ways. For example, most facilities listed obesity as the first, second, or third most important community health need (see Table 6-1). Addressing obesity by promoting physical activitiy affects climate action as well—walkable communities, bike-sharing programs, bicycle paths, active transportation, and mass transit all have obesity prevention and climate co-benefits. The same is true of community gardens and reduced meat consumption.
Gerwig next discussed economic security as another example where acting to address a community need could yield a co-benefit. Reiterating that hospitals are big purchasers, she explained that more purchasing from local sources has positive effects both on economic security of a community and the climate. Greater use of local sources increases local jobs, and local jobs mean shorter commutes, which, in turn, reduce fossil fuel use and greenhouse gas emissions. As a final example, she mentioned asthma and remarked that strategies to reduce traffic in order to reduce particulate matter, as a way of addressing asthma, also reduce fossil fuel emissions.
Gerwig used three specific community examples to further illustrate interactions between “climate and health” and the other community health needs. First, she described the rates of youth obesity (percentage obese), ozone (percentage of days exceeding standards), and asthma (percentage of adults with asthma) in Kern County, which is located in California’s
|Community Health Need||Number of Kaiser Permanente Hospitals Identifying the Need|
|Behavioral health (mental health and substance abuse/tobacco)||39|
|Access to care||39|
|HIV/AIDS/sexually transmitted infections||19|
|Maternal and infant health||15|
|Climate and health||14|
a Healthy Eating Active Living.
b Community health needs listed in bold are needs that can be addressed through co-benefit strategies (i.e., co-benefits for climate and health).
SOURCE: Gerwig presentation, March 13, 2017.
central valley, as “egregious” compared to either California or national benchmarks. The percentage of youth in Kern County who are obese is 22.41 percent, compared to 18.99 across California; and the percentage of days exceeding ozone standards is 13.54 percent in Kern County, compared to 2.65 percent across California and 1.24 percent nationally. She quoted a community member who participated in the Community Health Needs Assessment: “If you suffer from asthma then you may not go outside and be active and then you are gaining weight and you’re not eating healthy food.”
As a second example, Gerwig cited youth physical inactivity levels in Moreno Valley, located in southern California. The percentage of Moreno Valley youth who are physically inactive is 45.01 percent, compared to 35.92 percent across California. Again, Gerwig quoted a community member who participated in the assessment: “physical education programs have been scaled back in public schools, and outdoor sports and exercise programs can be challenging because of the hot climate.”
Finally, Gerwig cited road density in Riverside County, also in southern California, where the total road network density (road miles per acre) is 5.68, compared to 2.02 across California and 1.45 nationally. Again, she quoted an assessment respondent: “The lack of jobs available in Riverside County also increases commutes for residents, increasing the use of cars on the road and more pollution in the air.” For Gerwig, this example illustrates, again, the connection between a lack of local jobs, which means longer commutes, and climate impacts. If there were more local jobs, commutes would shorten, and not only would community economic security improve, but such efforts would have climate co-benefits as well.
Kaiser Permanente’s Greenhouse Gas Emissions
Gerwig noted that when discussing Kaiser Permanente’s efforts to address climate, she always starts by being transparent about what Kaiser Permanente is emitting. In 2015, the organization’s total greenhouse gas emissions amounted to nearly 800,000 metric tons of CO2e.3 The vast majority of these emissions (91 percent) were from the use of electricity and natural gas to power the buildings and equipment. Specifically, 65 percent of 2015 greenhouse gas emissions was from purchased electricity, 25.9 percent from stationary combustion (natural gas), 0.4 percent from stationary combustion (diesel), 4.3 percent from medical gases, 3.0 percent from refrigerants, and 1.4 percent from fleet vehicles.
Importantly, Gerwig pointed out, Kaiser Permanente’s greenhouse gas emissions were down 5 percent in 2015, compared to 2008, despite a 20 percent growth in membership and the construction of more hospitals over this time period.
Having much of their operations in California, Kaiser Permanente draws from a grid that, Gerwig said, “is getting cleaner.” Currently, about 25 percent of California’s electricity is from renewable power. By 2030, that figure is expected to rise to 50 percent. Because of the political climate in California and the way it allows companies to “green” their energy, Gerwig stated that there are other opportunities in terms of power purchase and other agreements that Kaiser Permanente is able to take advantage of as well.
Kaiser Permanente’s Environmental Stewardship Goals: Becoming Carbon Positive by 2025 and Other Climate-Related Goals
Climate action is Kaiser Permanente’s number one 2025 environmental stewardship goal. Specifically, the goal is to be net carbon positive by
3 CO2e, or carbon dioxide equivalent, is a standard unit for measuring carbon footprints.
2025. In other words, Gerwig explained, the goal is to become a little bit better than carbon neutral. Several of the other 2025 goals have climate co-benefits. For example, the second 2025 goal is the purchase of 100 percent of Kaiser Permanente’s food either locally or from farms and producers that use sustainable practices. Two additional 2025 goals with climate co-benefits are to have zero waste (recycle, reuse, or compost 100 percent of all non-hazardous waste) and to reduce water use (reduce the amount of water used by 25 percent per square foot of buildings).
According to Gerwig, even though Kaiser Permanente emitted nearly 800,000 metric tons of CO2e in 2015, the organization is well on its way to eliminating its greenhouse gas emissions. In 2016, Kaiser Permanente went live with two major off-site energy projects, one solar (110 megawatts [MW] solar power capacity to be purchased from Blythe solar plant in Riverside, California), and the other wind (43 MW wind power capacity to be purchased from turbines at Golden Hills wind farm in Altamont Pass, California). In California, both of these projects are online now and are drastically reducing greenhouse gas emissions. In addition, more than 100 Kaiser Permanente facilities across California are installing onsite solar for a total of 70 megawatts solar power. In sum, Gerwig said, currently half of the electricity that Kaiser Permanente uses to power its California facilities is renewable, consisting of mostly solar or wind sources.
Health Care’s Voice on Climate Change
Gerwig closed by adding her thoughts on health care’s voice for climate change and why health care institutions are so important in addressing community well-being as it relates to climate. First, she referred to what several other speakers had discussed about how communities are already suffering from the health impacts of climate change and added that, as a health care organization, Kaiser Permanente is seeing this happen. Next, Gerwig referred to earlier discussions on equity and added that Kaiser Permanente appreciates that those who will suffer the most are those who are least able to be resilient against what she described as “the onslaught of climate change.” Finally, as big greenhouse gas emitters, with 8 percent of greenhouse gas emissions in the United States coming from health care, Gerwig said, “[w]e have an obligation.”
In summary, Gerwig called for several community health actions around climate change. First, Community Health Needs Assessments provide an important opportunity for communities to engage not just with their health care partners, but with anyone who cares about health, and to address the
health impacts of climate change and community vulnerabilities. Second, she encouraged promoting renewable energy and energy efficiency. She recognized that having many of Kaiser Permanente’s operations located in California gives her what she described as a “bubble perspective,” but she stated there are opportunities in many other parts of the country as well. Third, she encouraged workshop participants to ask their health care partners to publicly report their greenhouse gas emissions. Fourth, she called for Leadership in Energy and Environmental Design (LEED) certification of all hospitals. Finally, she called for suppliers to use local employees.
The California Climate and Agriculture Network is a coalition of sustainable and organic agriculture organizations that works very closely with farmers and ranchers, scientists who study climate change and agriculture, nonprofit organizations, agricultural professionals, and policy makers, Renata Brillinger began. Brillinger went on to provide an overview of greenhouse gas emissions and other environmental challenges in California agriculture, discuss the impacts of climate change on agriculture, and outline what she described as California’s “very ambitious set of policies” related to climate change.
Challenges in California Agriculture: Greenhouse Gas Emissions, Water Contamination, and Other Environmental Problems
About 7 percent of California’s greenhouse gas emissions are attributed to on-farm emissions. Twenty-nine percent of these emissions come from enteric fermentation, 28 percent from manure management, 22 percent from soil and crop management, 19 percent from fuel use, and 2 percent from rice cultivation. Brillinger clarified that this 7 percent figure does not include the upstream and downstream impacts of food production, for example, the synthetic fertilizers and other inputs that come onto the farm.
In addition to greenhouse gas emissions, some parts of the state also have a significant groundwater contamination problem from the use of nitrogen as a fertilizer. Both synthetic and organic fertilizers contribute to this problem, Brillinger noted. Parts of the state have significant air quality challenges, notably in the Central Valley. Because of its geography, air polluted by industry, agriculture, and urban development gets trapped.
Without elaborating, Brillinger remarked that there is a “litany of other
4 This section summarizes information presented by Renata Brillinger, co-founder and executive director, California Climate and Agriculture Network, Sacramento, California.
challenges” related to agriculture, including soil salinization, water scarcity, and an alarmingly rapid loss of farmland.
Impacts of Climate Change on Agriculture
Being dependent as it is on natural resources and water, the agriculture sector is arguably on the front lines of the impacts of climate change, Brillinger asserted. Its major impacts on crop production and yields include
- Erratic and extreme weather events, such as the drought that California recently emerged from, followed by possibly the wettest year on record and the anticipation of significant flooding and faster snowpack melting;
- Drought and water scarcity (e.g., 524,000 acres of farmland were fallowed in 2015, causing an estimated $1.84 billion loss);
- New pests and diseases;
- Decreased chill hours (i.e., the number of days below a certain temperature that some fruit and nut trees need in order to properly bear flowers and, subsequently, fruit), which, Brillinger said, is beginning to hit some California crops in a very significant way;
- Subsidence (i.e., the overdrawing of the groundwater table), which led to land sinking up to 2 inches per month in some parts of the Central Valley in 2015, with what Brillinger described as having “astounding” impacts on infrastructure;
- Heat stress for both livestock and farm workers; and
- Economic impacts of all of these factors (e.g., more than 21,000 agriculture jobs were lost in 2015).
California’s Climate Strategy
“The good news,” Brillinger continued, is that California’s governor and legislature have adopted a highly ambitious set of climate policies. The current state mandate is to reduce greenhouse gas emissions to 40 percent below 1990 levels by 2030, a new target that just passed in August 2016 as part of SB (Senate Bill) 32. Among the several specific goals laid out as part of reaching this target, two involve agriculture: carbon sequestration in the land base and reduction of short-lived climate pollutants.
SB 32 was preceded by AB 32, which was passed in 2006 and set an initial target to reduce emissions to 1990 levels by 2020. AB 32 also included a cap-and-trade program, which Brillinger remarked provides economic incentives for many voluntary practices to achieve additional emissions reductions in addition to regulating the largest greenhouse gas-emitting industries. The California program is designed somewhat uniquely,
she explained, in that it includes an auction of permits to continue emitting greenhouse gas emissions. The permits are issued at the discretion of the governor and legislature, with money collected from the auction deposited into the Greenhouse Gas Reduction Fund. To date, Brillinger said, approximately $3 billion of the fund has been spent, mostly on activities related to the built environment (i.e., transportation and housing) or forest restoration and protection. Another $2.2 billion has been proposed for the coming fiscal year, 2017–2018. “This is a significant amount of money in a state that was, not so long ago, in debt,” Brillinger said.
Using some of the Greenhouse Gas Reduction Fund monies, California has recently established four “climate smart” agricultural programs to give grants to farmers for various activities and projects that reduce greenhouse gases: (1) the Sustainable Agricultural Lands Conservation (SALC) program; (2) the State Water Efficiency and Enhancement Program (SWEEP); (3) the Dairy Methane Reduction Program; and (4) the Healthy Soils Initiative. The funding for these programs has totaled approximately $27 million in 2014–2015, $70 million in 2015–2016, and $85 million (plus an amount for the SALC program, which has yet to be budgeted) in 2016–2017. Brillinger predicted that the total for 2016–2017, when the SALC program is included, will probably be around $110 million.5 She then went on to describe each of these four programs in detail.
Sustainable Agricultural Lands Conservation
SALC allocates grants for the permanent protection of farmland at risk of development. Brillinger described it as a “sister program” to an affordable housing and smart growth development program and the pairing of the two programs as a “very unique” approach to land planning. Thus far, $42.5 million has been allocated for farmland easements to keep them in production and minimize sprawl development and therefore avoid development-related greenhouse gas emissions. While the budget for the coming year is unclear, again, Brillinger predicts that it will be around $30 million. The “scientific underpinnings” of the program, she said, include evidence showing that one acre of urban land emits 70 times more greenhouse gas than one acre of irrigated cropland.
Brillinger commented that in addition to its impact on climate, the protection of greenbelts around cities also impacts health, for example, by improving air and water quality (i.e., open space and agricultural lands can absorb water and replenish groundwater tables). Additionally, greenbelt protection impacts food security and recreational access to open space.
5 The figure in the budget enacted is $95 million for 2016–2017 (figure provided by Brillinger after the workshop).
State Water Efficiency and Enhancement Program
SWEEP gives direct payments to farmers in the form of competitive grants to reduce water and energy use. This program requires that farmers reduce water use, and because water requires energy to pump, also reduces energy use. Thus far, about $67–$68 million has been allocated to these grants, benefiting more than 500 different farms and projects across the state.
Dairy Methane Reduction
The dairy methane reduction program is complicated and “still taking form,” Brillinger said. She described methane as a “very potent greenhouse gas.” Thus far, $12 million has been spent on anaerobic digesters on a few of the largest concentrated animal feeding operations in the Central Valley to capture methane and convert it into a bio-gas, and another $50 million has been allocated for this current budget year to be split between anaerobic digesters and alternative manure management practices. CalCAN has been focusing a tremendous amount of energy on the latter, she said, and has been a leading advocate because they would like to see some of the state funding be allocated toward practices that have other benefits in addition to reduced greenhouse gas emissions. They are hoping the funds will be used not only to increase use of alternative manure management practices, specifically composting, but also to move cows onto grass for longer parts of the year.
The confined animal feeding operations in California’s Central Valley are “quite harmful” for both the environment and human health, Brillinger said, with big impacts on both air and water quality.
Healthy Soils Initiative
The Healthy Soils Initiative is an even newer program than the dairy methane reduction program. At the time of this workshop, it was still being designed; Brillinger expected it to be rolled out in the next few months. It represents another unique approach to greenhouse gas emissions, in her opinion, because it addresses a powerful benefit of agriculture: that agriculture can be a sink for carbon. She explained that the only places where carbon can go are into the atmosphere or oceans, where, she said, “we don’t want it to go,” or into forests and agricultural lands, where, she said, “we do want it because it is a building block of life” and “a key component of crop fertility.” The goal of the program is to provide grants to farmers to implement practices on their farms that will improve soil health and store more carbon in the soil and in woody plants in the hedgerows
around farm boundaries, driveways, and buildings. Brillinger remarked that in addition to storing carbon, these plants also create greater diversity, pollinator habitat, and wildlife corridors for creatures that need to move across farm landscapes. Other activities that this program will likely fund include cover cropping and the use of compost, soil, and mulch, all of which build more carbon into the soil. Building soil carbon, Brillinger said, will reduce dependence on synthetic nitrogen fertilizer, thereby improving both air and water quality, and will result in farm systems that are more resilient to the impact of climate change.
Although the federal Farm Bill touches on some aspects of these four programs, for example, by providing conservation payments to farmers for improved environmental stewardship, these California programs are unique, Brillinger observed. She added that she is aware of farmers who are receiving payments to provide climate benefits by transitioning to climate-smart practices.
In addition to California’s climate-smart vision and these four programs in particular, another key piece of the California story, Brillinger said, is the state’s attempt to address environmental justice and equity issues. She noted two bills in particular, SB (California Senate Bill) 535 and AB (California Assembly Bill) 197.
SB 535, which passed several years ago, requires that 25 percent of monies spent from the Greenhouse Gas Reduction Fund must be allocated to disadvantaged communities. (Brillinger did not define it, but noted that the state of California defines “disadvantaged” in a specific way.) Brillinger explained that this bill, in part, addresses the disproportionate economic burden that poorer communities face as the state makes its transition to a clean energy economy. It also attempts to address the fact that communities are located in the places where the biggest pollutants are being produced.
AB 197, which passed in August 2016, takes SB 535 one step further, requiring that the state do a better job linking its greenhouse gas reduction efforts with the actual air quality problems created by the same greenhouse gas-emitting industries. “How that actually plays out is an experiment in progress,” Brillinger said. “We have quite a bit more work to do.”
Even the future of cap-and-trade is in question, according to Brillinger. The program sunsets in 2020. A court case is pending between the state and the oil industry around whether the program is legal, but there are also one or more new bills expected this legislative year that will attempt to expand the program past 2020.
Fletcher Wilkinson prefaced his talk by stating that tribal climate change issues are just as diverse as the tribes’ locations and cultures around the United States. While he was going to attempt to provide a tribal perspective on climate change, he emphasized that he would not be, by any means, addressing all of the tribes’ problems. He then went on to describe ITEP’s work in climate change.
ITEP’s Climate Change Program
ITEP recently celebrated its 25-year anniversary. The Institute works with tribes on a broad range of environmental issues, from air quality to solid waste. It conducts trainings, provides technical assistance, provides air monitoring equipment, lobbies Congress, and works with partner organizations on projects. Its Climate Change Program was founded in 2009 with an Environmental Protection Agency grant. The intention was to become what Wilkinson called a “one-stop shop” for tribes for anything needed to address climate change. The overarching goal of the program is to help tribes build their capacity to deal with climate change. Wilkinson explained that part of tribal sovereignty is not relying on the federal government, yet addressing climate change issues can be difficult for small tribal communities to do on their own.
One way that ITEP helps build tribal capacity to respond to climate change is through training workshops. ITEP partners with either a host tribe or organization in the region to host the training and then invites 25–35 tribal participants. The workshops are held over the course of a few days, during which workshop participants discuss issues they are facing and how they are addressing those issues. Wilkinson stressed that ITEP works with the tribes through the entire process—from building buy-in and trust from a tribe, to developing a vulnerability assessment, to eventually the tribe writing its own adaptation plan. ITEP has held 30 of these trainings thus far, including one just completed in Anchorage, Alaska; one was scheduled for Spokane later that week, and another four to five were planned for later in the year.
In addition to the trainings, ITEP helps tribes build the capacity to address climate change impacts by maintaining a website with a host of information that tribes can use, such as profiles of other tribes that are working with climate change and examples of tribal adaptation plans that already have been implemented.
ITEP also provides a toolkit that is specific to tribes. Wilkinson described the toolkit as, essentially, a set of documents that tribes can use to
walk through the planning process. In addition to other documents, the toolkit includes a template that tribes can use to start an adaptation plan.6 Along with the toolkit, ITEP provides direct technical assistance to tribes. A few of Wilkinson’s colleagues have worked directly with tribes to help them write their adaptation plans.
Tribal Planning Is Different
Wilkinson emphasized that tribal planning is different than a city or state’s planning efforts. Many tribal communities, he explained, have been located in one area, even one village, for not hundreds, but thousands of years. The people who live there now grew up there, their grandparents grew up there, their great grandparents grew up there, and so on through many generations. Their entire identity, from their culture to their history, from their spirituality to their food pathways is, Wilkinson said, “all connected to that place where they live.” Thus, their sense of place is very strong and, he said, “needs to be integrated throughout the entire planning process.”
For example, when a tribe is working on a vulnerability assessment, traditional foods are a big issue that comes up often, Wilkinson observed. Many tribes, especially in the west and in Alaska, do not purchase their foods from supermarkets. Rather, they practice subsistence hunting, gathering, and agriculture. Thus, he said, “traditional foods are really important to them.”
In addition to traditional foods, culturally important resources also need to be considered during vulnerability assessments. For example, sagebrush is very important to the Navajo, who use it for ceremonies and a whole host of other purposes. The potential loss of that resource, Wilkinson said, “could be devastating to the culture.”
At the adaptation plan stage, again, Wilkinson said, tribal planning is different, with the main difference being tribal reliance on traditional ecological knowledge, or TEK. This knowledge, which comes from having lived in an area for thousands of years, is a powerful tool for tribes that needs to be integrated into their adaptation plans. Wilkinson described TEK as a unique knowledge, or understanding of place, that tribes have accumulated after having observed environmental changes over many generations (e.g., changes in sea ice or wildlife). An example of how this knowledge can be integrated into adaptation plans is predicting how thick sea ice will be in 50–100 years based on knowledge of how thick it was 100 years ago.
Geographic relocation is another factor that is very different for tribes
6 The template is available at http://www7.nau.edu/itep/main/tcc/Resources/adaptation (accessed August 22, 2017).
and something that cities do not face. Wilkinson mentioned a tribe in Louisiana that recently received a grant to move and some tribes in Alaska and Washington that are considering moving. For native people who have lived in an area for so long, with all of their culture based on that location, relocation is, Wilkinson said, “a really emotional thing.”
Finally, he noted that coastal erosion is another big climate-related problem that is affecting tribes.
Climate Change and Health
The same connection between climate and health that other speakers have addressed is true of tribes as well, Wilkinson continued. A good example is the food calendar by which many tribes live. That is, tribes collect, harvest, or hunt different types of foods at different times of the year. Plus, some cultural resources have to be collected at specific times. But with climate change, some plant species are moving higher in elevation or disappearing altogether, and the ranges of some animal species are shifting. Wilkinson remarked that he had been in Alaska a few weeks prior to this meeting and was speaking with a man who told Wilkinson that when the man was a child, his tribe would hunt for caribou often. Caribou was still an important food to the man’s tribe. But the caribou, the man told Wilkinson, no longer come near the tribe’s village. The last time the man went on a caribou hunt, he had to travel 160 miles by snowmobile. “These are some really massive changes that are impacting tribal people,” Wilkinson said.
The changes are not just impacting their food. Traveling 160 miles is stressful and taxing on the body. Moreover, not being able to collect this food for one’s family and one’s community also impacts one’s spiritual and cultural connections with the community. Food sharing is an important cultural value. There have been some suicides linked to not being able to provide, according to Wilkinson.
Tribes Are Resilient
Wilkinson concluded with a positive note: tribes are resilient. Because of their long history of adaptation, tribes have several strengths with respect to finding solutions that work for them. Traditional ecological knowledge is one of those strengths, as are tribes’ strong cultural and community bonds. He mentioned a program in the Hopi Tribe to teach Hopi farmers new ways to farm their corn, which is becoming a serious challenge on the reservation because of drought. Additionally, he mentioned some communities in Alaska that are holding culture camps for a few weeks in summer to bring elders and youth together to teach language, history, and traditional
methods of collecting food. Programs like this, Wilkinson said, strengthen the bonds that small villages rely on for resilience.
Following Wilkinson’s presentation, he, Gerwig, and Brillinger participated in an open discussion with the audience.
Working with Vulnerable Communities
Moderator Goldman opened the discussion by commenting on the unique relationship with the community that each of the panelists described and how, in each case, particular segments of the community were most impacted by climate change. Specifically, she mentioned Gerwig’s observation that people with the least economic opportunity not only drive the furthest to work, but also to purchase things they need because of the lack of supply chains in their communities. Then, in agriculture, as Brillinger discussed, the challenge to change farming practices impacts people inequitably. Finally, with tribes, as Wilkinson discussed, climate change has profound impacts on the traditional gathering of food and on other cultural patterns. Goldman asked the panelists to elaborate on how their respective organizations are working with these more impacted communities and the insights that they have gained from having worked with them.
Gerwig reiterated what she described as the “incredibly useful” platform that Community Health Needs Assessments provide because they draw on listening to the community. Health care providers may think they know what their community’s health needs are, but, she said, “we all have our lenses.” It is only when they invite conversation and transparency that they see what these needs really are. Additionally, she emphasized the importance of data. For example, the website communitycommons.org/chna (accessed May 9, 2017) has a mapping tool that allows users to enter a zip code and obtain a great deal of information about what is going on in the environment in that area. Having a conversation with a community, coupled with having these data, “will guide the thinking,” she said, and ensure a collaborative partnership and holistic consensus.
The core of CalCAN’s work, Brillinger said, is guided by their farmer advisors and partners. This is the case for a few reasons. First, farmers are the ones who know what will work. “If it won’t work on the ground, if it doesn’t keep them in business,” she said, no policy, incentive, or amount of funding will “move the needle.” Thus, Brillinger and colleagues filter everything they theorize about through their farmer advisors and partners. In her opinion, more needs to be done to ensure that the scientific research being conducted in this area is similarly farmer-led and farmer-participatory. Her
guess is that this is true in the public health space as well—that the communities most impacted or most vulnerable are the best people to guide research and planning needs.
Wilkinson concurred that the same is true of tribal programs. He emphasized the importance of “listening to what each tribe needs, because the needs are so different. We let them guide us in how we can help.”
When asked how ITEP makes a connection between a tribe and the scientific expertise they might need, for example, to find alternative ways of growing corn, Wilkinson responded that a key part of their training is building partnerships. They like to have a partnership going into each training, and they talk a lot about partnerships during the trainings. For example, for a recent training in Alaska, ITEP partnered with the Alaskan Native Tribal Health Consortium, which Wilkinson described as “true experts” on health issues in Alaska. Having them present at the 3-day training so that everyone could develop rapport with each other was, he said, “really valuable.”
Incentives for Innovative Approaches in Agriculture
Jonathan Patz asked Brillinger about incentives for innovative approaches in sustainable agriculture and whether there are special programs for “out-of-the-box” practices. He mentioned entomophagy, the eating of insects (e.g., cricket flour), as a growing area in the field of alternative protein sources that are being studied not just for humans, but also for animal feed (e.g., the feeding of mealworms to chickens). Programs in this area, in Patz’s opinion, “could turn into big ticket changes.”
Brillinger replied that the programs she discussed are state-run programs and that innovation is constrained by the requirement that every dollar spent be allocated to actually demonstrating reduced greenhouse gas emissions. Even practices less innovative than entomophagy are constrained by this requirement, she noted. This creates a challenge as these innovative programs are designed and rolled out, because there are constraints in what the state is willing and able to fund. Unless it can be shown that a new approach is going to reduce greenhouse gas emissions, she said, “there is nothing” that will fund that approach. The quantitative models being used to project future emissions reductions per practice are based on available science. But given that this is an “emergent” field, she said, the science is limited. Thus, to date, what has been funded is very conservative.
When Patz stressed that an entomophagy approach would, in fact, result in “huge” greenhouse gas reductions, Brillinger suggested that funding such a project would likely have to begin with an animal feed source, then transition to a consumer product.
Kaiser Permanente and the Political Climate in California
George Isham commended Kaiser Permanente’s work in the area of climate adaptation as “an inspiration,” but described what he called a “conundrum” related to the politicization of the subject of climate change and the overlap between electoral patterns and socioeconomic disparities in states such as California. He wondered what the larger implications of these complex issues are for an organization like Kaiser Permanente when it thinks about how it can contribute to improving community health across California.
Gerwig replied that Kaiser Permanente has adopted a “philosophy of inclusion.” That is, as it develops policies, plans, and strategies, it keeps its focus at the level of the community. Their operations in Kern County, California, for example, serve that particular community. The process used to identify that community’s health needs is the same that has been used to identify health needs in other communities. “You base it on data,” she said. “You base it on what the community members want.” The assessments identify specific community issues, such as violence, food scarcity, or something else. In addition to that community-level work, Kaiser Permanente also pursues priorities for the environmental program overall. Gerwig cited renewable energy as an example. The recently built solar plant in Riverside County in southern California, which she had mentioned during her presentation, is not producing electricity only for that community’s own use. That electricity, she explained, is going to the grid, thereby supporting reduced fossil fuel use throughout the state.
The Challenges of Communicating About Climate Change with the Agricultural Sector and with Legislature
An unidentified workshop audience member asked Brillinger how CalCAN has communicated with the farming and ranching communities that they work with, which are located primarily in the “red part” of California, and how that communication has changed over time as the agricultural impacts of climate change have become more salient to people in these communities.
Brillinger replied that two changes in particular have advanced CalCAN’s work enormously in the past 3 to 4 years. One was the drought, which changed the conversation “quite a bit,” she said. “We started talking about drought as much as we talked about climate change.” Members of the agricultural community were highly impacted by that and were alarmed, she said. The second was the flow of money from the Greenhouse Gas Reduction Fund into agriculture, beginning in 2014, with the first online program being the State Water Efficiency and Enhancement Program.
Brillinger recalled that when CalCAN was founded in 2009, there was no constructive voice of agriculture at the climate policy table in the state of California. At that time, most of the voices were lobbyists opposing AB 32 and trying to limit regulation. Since then, now that nearly $200 million has been allocated, she said, “the tune has changed.” She described farmers as “pragmatic.” They are not necessarily motivated by greenhouse gas reduction emissions or carbon sequestration, rather by staying in business and making sure they have enough water and other resources. If dollars are available that will get them those benefits, then they will take those dollars. “The demand for these programs is huge,” she said, and that demand has helped CalCAN’s communication efforts.
Brillinger was also asked by the same audience member how CalCAN has communicated about the connections between climate change and agriculture with people in legislature, who are primarily not from the agricultural sector. Brillinger agreed that the vast majority of legislators in California are urban and that there is a lot of literacy building to do among legislators who do not have a relationship with agriculture. She expressed a desire to work more with the public health sector and others to find multiple mutual benefits related to health, food access, and food security. “We really need to develop some narratives around how this can solve a lot of problems,” she said.
Learning from Tribes
Referring to tribes who have lived on their land for thousands of years, passing stories from one generation to the next about how they have adapted to environmental changes in the past, Sanne Magnan asked Wilkinson what could be learned from this oral tradition. Wilkinson replied that while tribes are passing these stories down through oral history, tribes are also protective of these stories. In his opinion, asking what can be learned from these stories about how tribes have adapted in the past is a difficult question. Yet, he said, there are ways that traditional knowledge and science can be brought together for mutual benefit. For example, he mentioned that much of what is known about pre-1950 sea conditions in the Arctic is based on traditional tribal knowledge of sea ice.
An unidentified audience member recalled visiting a Shoalwater Bay Tribe site on the southern peninsula of Washington state, where the tribe has been measuring climate impact for many years. The audience member commented on the impressiveness of the tribe’s extensive planning for rising sea water and relocation inland and referred other workshop participants to the Robert Wood Johnson Foundation (RWJF) website, where its story and stories from other communities facing similar experiences are being shared. The tribe was a winner of the RWJF Culture of Health Prize.
Measuring Greenhouse Gas Emissions in Terms of Health
An audience member suggested that given the tremendous harm from carbon offset, particularly in the area of cardiology, perhaps greenhouse gas per unit of delivery should be measured in terms of Healthcare Effectiveness Data and Information Set (HEDIS). Gerwig was unaware of any efforts in that arena, but thought the idea “striking.” More broadly, she said, the question explores how more mainstream health care measures can be used in ways that will attract the attention of people working in health care. Goldman added that there is nothing to stop anyone from doing this voluntarily and suggested that a number of organizations could get together and work on it instead of waiting for a regulation.
Reasons for Hope
Goldman closed the discussion by articulating that what she said were two “reasons for hope.” First is that when there are situations where people are able to obtain resources, whether through grants or other means, much can be accomplished through community work, even communities not traditionally first in line to address these issues, such as the farming community. Second, in circumstances where it is okay to talk about the reality of climate change and the human role in climate change, again, much can be accomplished. Cricket farming, for example, which Patz had mentioned, may be out-of-the-box today, but, Goldman said, “everything I heard today a decade ago would have been considered to be completely out of the box . . . there was a time when none of this would have been possible to fund with grants or any other way.”