Protecting the Health and Well-Being of Communities in a Changing Climate Proceedings of a Workshop (2018) / Chapter Skim
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5 Regional Perspectives from the Northeast
5 Regional Perspectives from the Northeast
Pages 61-88
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From page 61... ...
In the open panel discussion with the workshop audience, a range of issues were addressed: collaboration across the different sectors of the NYC health care system; mortality and other outcomes of the Hurricane Sandy evaluation; alert, disaster, and fatigue; an elaboration of Baltimore's incorporation of climate planning into its All-Hazards Mitigation Plan; funding for all of the various programs discussed by the panelists; and whether and how the different planning approaches discussed by the panelists had been scaled from approaches others had taken and whether and how the approaches could be scaled up even further, for example, to a national level. The discussions around each of these issues are summarized at the end of this chapter.
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From page 62... ...
(Cahillane) • altimore's approach to climate planning is unique because it uses the federal B government's required All Hazard Mitigation Plan, but incorporates climate change into this plan.
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From page 63... ...
residential providers, which include NYC's 173 licensed nursing homes, 77 licensed adult care facilities, and more than 1,000 other resident programs that provide housing support for people with substance abuse disorders, developmental disabilities, and other behavioral and mental health problems; (3) community-based providers, which Quinn described as any provider in the community that offers ambulatory care services, including nearly 500 federally qualified health centers, more than 100 dialysis centers, 67 methadone maintenance treatment programs, and "countless" other providers located in more than 10,000 buildings across the 5 boroughs; and (4)
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From page 64... ...
Quinn asserted that before discussing the NYC health care system experience with Hurricane Sandy, it would be helpful to discuss the city's experience with Hurricane Irene, which preceded Sandy by about 14 months. Irene ended up causing less damage than originally predicted.
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From page 65... ...
to coordinate the evacuation and repatriation of health care facilities. HEC is led by the state health department, Quinn noted, but is supported by key NYC stakeholders, including the city's local health department and emergency management agency, the Greater New York Hospital Association, and others.
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From page 66... ...
Because the risk of evacuating fragile patients may outweigh the risk of sheltering in place, she said, "the consequences of a decision to evacuate can truly be life or death." She went on to say, "Of course, hindsight is 20/20, so leaders will be criticized for bad outcomes, regardless of whether their decision in the moment was the right one." A third key concept driven home by the Sandy experience, Quinn continued, is the need for surge spaces of different types. Special medical needs shelters and even hospitals are not designed to accommodate the needs of residents of nursing homes and adult care facilities.
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From page 67... ...
Many of these programs, Quinn noted, focus directly on the long-term care sector. For example, the department has provided nearly all NYC long-term care facilities with radios for redundant communications, and also offers a free technical assistance program for nursing homes and adult care facilities.
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From page 68... ...
As another example, the potential for worsening heat waves makes clear the need to consider adequate housing and access to city services as a public health problem and to ensure that health care facilities can manage a brief heatrelated patient surge as easily as they can manage a peak seasonal flu surge. In conclusion, to ensure the best possible outcomes for all community members, Quinn called for more resilient and adaptable systems and for stronger relationships and better collaboration before, during, and after emergencies.
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From page 69... ...
One is a weather and injury study at Plymouth State University; the other is a study on heat stress and emergency department visits. The Building Resilience Against Climate Effects Framework CDC's BRACE framework has been very helpful for New Hampshire's state-level work, Cahillane continued (see Figure 5-1)
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From page 70... ...
Third is the assessment of public health interventions and identification of evidence-based public health practices with known impacts on current problems and perhaps future problems as well. For example, Cahillane asked, is there a good intervention for asthma?
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From page 71... ...
Projecting Local Health Burdens Cahillane reiterated the challenge of this step of the BRACE framework. One of the existing tools that the state public health department uses to assess health trends is its dynamic web portal, NH WISDOM.3 By plugging in health outcomes or behavioral issues that they want to examine, users can view county- and city-level trends.
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From page 72... ...
compared with average rates across the state. State-wide priority health issues that have risen to the top as a result of this work, Cahillane continued, include heat stress; habitat change (with an impact on ticks and Lyme disease)
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From page 73... ...
. Assessing Public Health Interventions Based on these priority health issues, the state health department has been working with local communities to define exposure pathways.
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From page 74... ...
Evaluating Impact The evaluations of the Upper Valley Heat Project and New Hampshire Lakes Region Tick Project, Cahillane continued, have revealed a limited ability in the early stages to show quantitative change in knowledge or behaviors via pre- and post-testing. However, both projects have successfully shown some qualitative change in the amount of community collaboration among the local planning commission, recreation department, and elder care services.
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From page 75... ...
. CITY OF BALTIMORE: COMMUNITY RESILIENCE IN A CHANGING CLIMATE4 Kristin Baja began by emphasizing that some populations are more vulnerable to the impacts of climate change than others, and thus, it is important to consider equity in climate planning work.
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From page 76... ...
She defined resiliency as: "The ability of our community to anticipate, accommodate, and positively adapt to or thrive amidst changing climate conditions or hazard events and enhance quality of life, reliable systems, economic vitality, and conservation of resources for present and future generations." Baja highlighted "positively adapt to or thrive" as a key component of what Baltimore is trying to do with all of its climate planning. In addition to its acknowledgment of climate change and focus on resiliency, the city also does something a little different, Baja added, by considering not just climate-related "shocks," but also "stresses" (see Figure 5-3)
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From page 77... ...
Baja described what is known as Baltimore's "Black butterfly" and "white L," with the Black butterfly representing where African Americans
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From page 78... ...
78 PROTECTING COMMUNITIES IN A CHANGING CLIMATE have been "told" they can live since the 1910 ordinance segregating Blacks and whites by block. The white L is where most of the city's transportation, as well as the Inner Harbor, are located.
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From page 79... ...
. An initial, immediate focus of the work that Baja has been involved with in Baltimore, and a focus that Baja perceived as being key to initiating many other city programs, was enhancing community preparedness.
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From page 80... ...
The hubs are also being used by other city programs, including health department programs. In addition to the help and safe signs and resiliency hubs, another specific community-level tool being implemented as part of Baltimore's disaster preparedness efforts is its ambassador program, a peer-to-peer engagement network of more than 150 ambassadors who help with outreach.
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From page 81... ...
Another key piece of the city's disaster preparedness efforts, Baja continued, is that instead of just thanking community members for telling their stories and providing information, she and her colleagues in the city office show how they are actually using the information. One way they do this is through Baltimore's Every Story Counts campaign, which Baja described as a communications campaign "about the amazing people that live in Baltimore that are doing things on their own without support." She showed an image of a group of women who help immigrants and nonnative English speakers to find resources, health care, and other opportunities within the system.
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From page 82... ...
Additionally, she mentioned increasing efforts to conduct planning exercises and trainings across sectors and the success they have had over the past couple of years bringing health care partners into health department exercises. For example, in 2016, the NYC health department solicited help from a couple of representatives from large health care systems in the planning of a cyber-attack exercise to ensure that the exercise was as realistic as possible.
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From page 83... ...
"We want to see our preparedness program more focused on those day-to-day improvements," she said. Hurricane Sandy Evacuation Quinn was asked by an unidentified audience member whether any data were collected on the impact of the Hurricane Sandy evacuation, with such a sharp disruption in the lives of the estimated 6,000 persons evacuated from health care facilities.
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From page 84... ...
But it is different with residents, which is why she and her office are placing such an emphasis on making the resiliency hubs fun locations, with games, where people already congregate and spend time. Baltimore: Incorporating Climate Planning into the All-Hazard Mitigation Plan Terry Allan of Cuyahoga County Board of Health, Ohio, asked Baja to elaborate on the City of Baltimore's approach to community-level emergency management.
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From page 85... ...
"Without a doubt," he said, "it is all the supporters in Congress and the administration who believe in this work and want to get it done." Additionally, he underscored the importance of the support of people in the community who want to engage and who give in-kind and work extra hours. Scaling Raymond Baxter, a health adviser, observed that all of the programs described by the panelists embody comprehensive planning approaches.
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From page 86... ...
The NYC health department has been working with the NYC health care system since the beginning of the CDC-funded Hospital Preparedness Program in the early 2000s, Quinn commented. Much of that work, she said, has focused on the acute care sector.
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From page 87... ...
REGIONAL PERSPECTIVES FROM THE NORTHEAST 87 for preparedness (i.e., resiliency to either a hurricane or earthquake or to daily economic or violent stressors)
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