Is Your State Prepared For The Health Impacts Of Climate Change?


This winter, a strange sickness has been spreading through the Caribbean. In St. Martin alone, where the disease was first detected in December, there have been over 500 confirmed cases and another 3,200 people are believed to have contracted the disease elsewhere in the Caribbean. The disease, Chikungunya fever, was once only seen in East Africa and while there were always a few cases of people with the fever reported in the Western hemisphere each year, they were all cases acquired abroad. But now it seems that the mosquito which spreads the disease is here to stay, and health officials in the U.S. are waiting to see when the first locally acquired case of the fever will spring up.

As climate change drives up temperatures and moisture levels, “there is plenty of habitat in the U.S. that is now suitable for the mosquito,” explained George Luber, an epidemiologist and the Associate Director of Climate Change at the Centers for Disease Control and Prevention (CDC).

In 2006, the CDC established its Climate-Ready State and Cities Initiative, which provides grant funding and other resources to help state health departments develop projections of how each state’s climate and weather patterns will change with increasing temperatures in order to prepare for the possible health impacts. Just 16 states and two cities are currently part of the program and money is tight, with each site receiving a couple hundred thousand dollars for a two or three year proposal. Outside of the CDC grants, however, most states don’t have any other source of funding to prepare for the wide range of public health impacts that are expected as the climate changes.

In most cases, what states need to prepare for isn’t a totally foreign disease like Chikungunya fever that suddenly shows up in town, it’s familiar problems, like flooding, extreme heat and compromised air quality. The challenge is to prepare for these once rare phenomenons occurring every year, or for the better part of an entire season.


In 2013, Colorado was besieged by destructive floods and epic wildfires, while Texas and California suffered through months of drought and cities from Hartford to Salt Lake City to Reno sweated through their hottest Julys on record.

It’s not in the future, it’s not somewhere else, it’s here and now and only about one third of states in the U.S. are doing anything to prepare for it.

According to George Benjamin, Executive Director of the American Public Health Association, climate change is “one of the most serious public health threats facing our nation.” Extreme heat alone kills more people each year than other natural disasters like hurricanes and tornadoes combined. Kim Knowlton, a climate and health senior scientist with the Natural Resources Defense Council, explained that the states furthest along the CDC’s track for preparing for the health effects of climate change — Michigan, Maine, Oregon and Minnesota — aren’t necessarily the states that face the greatest public health threats, they are just the states that have made preparations a priority and aggressively competed for CDC grants.

“We have so far to go in connecting the dots between climate change and public health,” said Knowlton. “It’s not in the future, it’s not somewhere else, it’s here and now and only about one third of states in the U.S. are doing anything to prepare for it.”

“This is just a wildly underfunded area,” Knowlton added. “And there is still no federal mandate that every state must have a climate change adaptation plan that includes public health preparedness. But what is honestly more important than our health?”


Fortunately, there are states that are leading the way, not because they have to, not because they have money to burn, but because they recognize that climate change is here and the work to protect the health of residents must be a priority.


In Maine, public health officials have prioritized studying how predicted increases in heat waves and the spread of certain diseases transmitted by insects.

“I know that preparing for extreme heat events may sound like old news to a lot of people” said Andy Smith, a toxicologist and Director of the Environmental and Occupational Health Programs at CDC Maine. “But in Maine, that’s something that we’ve never had to deal with before. So we’re really starting from scratch.”

The University of Maine Climate Change Institute has been working to downscale global and national climate models to generate Maine-specific climate projections for the public health department. That work indicates that Maine should expect anywhere from a two to five fold increase in extreme heat days by 2050.

About 50 percent of people in our state are automatically more vulnerable to extreme heat events.

Of course, one of the best ways to prevent heat-related illness is to stay indoors in air conditioning when the mercury sky-rockets. And while about 80 percent of households in the Northeast have air conditioning, when the Maine public health department surveyed thousands of people in Maine, they found that less than 50 percent of people had air conditioning in their homes.


“That means that about 50 percent of people in our state are automatically more vulnerable to extreme heat events,” said Smith.

That finding is leading officials in Maine to create a state-specific system of heat advisories and alerts. The National Weather Service issues heat advisories on a regional basis. For the Northeast region, residents aren’t warned of a heat advisory unless the heat index — a combination of humidity and temperature — is expected to range between 100° to 104°F for two or more hours. Given how few people have air conditioning, or potentially even access to air conditioning, in Maine’s many rural areas, the state is considering issuing it’s own alerts and advisories at a much lower heat index, maybe 90° or 95°F.

To track illnesses caused by heat, the state of Maine has also created what is known as a syndromic surveillance system — an electronic reporting system of hospital admissions data.

“Now whenever someone seeks medical attention for a condition associated with extreme heat, we’ll know about it as it’s happening,” said Smith. “That kind of data is invaluable in terms of keeping tabs on what could be an unfolding health crisis.”

Maine’s other major climate-related public health threat is the increase of diseases transmitted by insects, primarily Lyme disease. Climate change is vastly increasing the range suitable for ticks. Once only present in the southernmost counties of Maine, Lyme disease has been spreading up the coast and westward and is now endemic to all sixteen counties in the state. There is also evidence that suggests that the feeding period of ticks in the Northeast is being prolonged as summer temperatures stretch into more of the year, allowing more time for uninfected larval ticks to become carriers of the bacteria that causes Lyme disease. In 2008, there were about 900 confirmed cases of Lyme disease; in 2011, there were well over 1,000.

“Our models show us that the ideal temperature range for ticks is spreading throughout the state,” said Smith. “We should expect to see more and more cases.”

Once Lyme disease becomes established in an area, it is almost impossible to eradicate, so the health department is using it’s limited funds on awareness campaigns in the areas where Lyme disease has never before been an issue people had to worry about.


Like Maine, Minnesota has focused a lot of its attention and funding on dealing with an unfamiliar threat, heat.

“The housing here in the upper Midwest is not designed to shed heat,” explained Dan Symonik, supervisor of the Environmental Impacts Analysis Unit at the Minnesota Department of Health. “It’s designed to hold heat and thank goodness given the last three months. But in the event of a heat wave, those structures are particularly maladapted.”

The state of Minnesota has created detailed maps on a county by county level showing where residents who are most vulnerable to heat-related illness live. At a glance, state public health officials can see which areas have a lot of elderly people living alone, or a lot of very small children or people with health conditions that may be aggravated by heat.  This kind of data allows counties to set up cooling shelters where they are most needed and even organize public transport to malls or other publicly air conditioned spaces if the heat becomes dangerous.

In addition to preparing for heat, Minnesota is bracing for floods. While researchers are still unsure if the total precipitation will change dramatically in the state in the years to come, they do expect to see an uptick in intense rainfall events which may lead to flash flooding. While flooding always results in a number of public health concerns, from the extreme (risk of drowning) to the more subtle (spread of mold) in Minnesota, officials are especially concerned about floodwaters contaminating groundwater supplies.

“There are about one million people in our state who depend on a private well on their property for their drinking water,” said Symonik. “That’s about 22 percent of the population. A flash flood has the potential to wash all manner of contaminates into that water supply — it’s just a witch’s brew of stuff you don’t want to drink — especially in rural areas where there are farms.”

The public health department has compiled a database of private wells in the state and is working on public awareness campaigns to educate people that their well water may remain unsafe for days after the floodwaters recede. Home testing kits that residents can use to test their water for bacteria are also being stored in convenient locations.

“When I was growing up, no one cared if you wore your seat belt,” said Symonik. “But now if I get in the car and don’t buckle up, I get yelled at by my kids. We’re hoping to start building the same kind of awareness around health and climate change in our middle schools, so the kids can help us do the work of getting the message out.”

Around Earth Day, a short documentary on climate-related health impacts in the state geared towards a middle school audience will air on Minnesota’s public broadcasting station. The documentary will then be sent throughout the school system to try and get the word out.

“It really shows kids what’s happening now and focuses on things they care about, like the state’s huge kids international soccer tournament we host each year,” said Symonik. That tournament at the end of July is getting hotter and hotter and more dangerous for kids to play in.”


In Michigan, the highest priority issue is heat-related illness. Like Minnesota, the state has compiled detailed maps of where vulnerable populations live and like Maine, tracks data from hospital admissions related to heat.

Some of Michigan’s very first round of grant money from the CDC has gone to the City of Ann Arbor where officials created a detailed plan of targeted tree plantings for residential areas of the city where mapping had shown that people were the most vulnerable to heat because of age or a preexisting condition or because they live in an area with lots of blacktop and little green space. Just a few trees can significantly reduce the urban heat island affect in a neighborhood and clean the air, giving some relief to asthma sufferers.

Two young men wade near the base of the fast-falling Minnehaha Falls, Thursday, July 18, 2013 in Minneapolis amid a continuing heat wave. CREDIT: Associated Press
Two young men wade near the base of the fast-falling Minnehaha Falls, Thursday, July 18, 2013 in Minneapolis amid a continuing heat wave. CREDIT: Associated Press

Air pollution is a less obvious, but no less deadly, public health impact of climate change. Ozone smog forms when pollution from vehicles, factories, and other sources reacts with sunlight and heat. Increasing temperatures speed this process and result in more smog. Ragweed and other allergens in the air are also expected to worsen as rising carbon dioxide levels cause plants to produce more pollen. Michigan is anticipating an increased production of ozone and particulate matter from heat and drought and consequently an uptick in asthma and respiratory illness.

In East Lansing Michigan, which like Ann Arbor got a portion of an early state CDC grant, local officials are working to reduce air pollution by making the area more walkable and bikeable by adding sidewalks, bike lanes and slowing traffic. Simply getting cars off the streets, especially in hot stagnant weather reduces the formation of ozone, which the EPA has likened to a sunburn on your lungs.  The spread of waterborne diseases is also on Michigan’s public health radar. Modeling shows that extreme rain events and flooding predicted to become more common with climate change may increase the prevalence of Great Lakes pathogens like toxic algal blooms, giardiasis, Legionnaire’s and Naegleria fowleri (“brain-eating bacteria”).

This fall, the public health department will publish a Climate and Health Profile report describing the state’s current and future climate, anticipated health effects related to climate, and describing the regions and sub-populations at particular risk of adverse health effects. This report will be followed by a climate-related Burden of Disease in Michigan analysis which will try to quantify the additional illness caused in the state by climate change.


While Oregon faces many of the same climate-related health risks as Maine, Michigan and Minnesota, public health officials also have to battle with the dangers of air pollution caused by wildfires.

Regionally scaled down climate models for the Northwest predict warmer, drier summers for Oregon, which has already witnessed a dramatic decline in snowpack.

The number of western wildfires has increased relentlessly over recent decades. A 2012 report compiled by Climate Central calculated that today there are more than twice as many large wildfires — 1,000 acres or more — burning each year than there were in the 1970s. Blazes burning as many as 10,000 acres are seven times as common as four decades ago.

A 2011 report from the National Research Council predicted that for every 1.8°F temperature increase, the area burned in the West will quadruple. By the end of the century, temperatures across the U.S. may rise as much as 8°F.

Wildfire smoke is made up of tiny organic and black carbon particles that can travel deep into the lungs and even cross over into the bloodstream. The smoke can irritate the eyes and airways, leading to coughing, headaches, scratchy throats and runny noses. And for some people, wildfire smoke can trigger asthma attacks, heart attacks and even strokes.

We only got started in 2009 and we’re a small group within the CDC and we are the only investment in climate change and public health in this country.

Last summer, more than 50,000 acres of forest burned in August in Southern Oregon. Particle pollution reached unhealthy levels for more than a week in some communities and the Red Cross handed out more than 20,000 respirator masks to help people avoid breathing smoke.

Hospitals in the area reported up to a 20 percent increase of patients complaining of breathing problems. People stayed home from work and kids stayed inside.

In Jackson County, one of the areas in the south of the state most affected by wildfires, public health officials are rethinking how they monitor air quality.

“In the past, Jackson County has been mostly concerned with car emissions and winter wood smoke,” said Julie Early-Alberts, a manager at the Oregon Department of Public Health. “So monitors have been designed and placed to capture these emissions, not summer and fall wildfire smoke.”

Air Quality Indexes also usually only report a 24 hour average, which doesn’t capture how quickly conditions can change in a wildfire situation where winds are shifting and smoke can suddenly change direction. Jackson County is working to develop new air monitoring stations especially for capturing wildfire smoke data and is planning to offer air quality index averages that more accurately reflect current conditions.


While George Lubuer of the CDC commends the work that states have been doing over the past few years, he has no illusions about how much more work still needs to be done

“We are a new program,” Luber explained. “We only got started in 2009 and we’re a small group within the CDC and we are the only investment in climate change and public health in this country.”

Because of the extremely limited funding that the CDC has to disperse, there are entire areas of public health impacts that are being almost entirely neglected. While mental health issues have been getting a lot of attention recently in relation to gun violence, the mental health effects of climate change are just beginning to be studied.

“We’ve witnessed the devastating affects that losing your home to a flood or your way of life to a drought can have on people,” said Knowlton of NRDC. “But we barely have any data on how depression, anxiety or suicide rates are related. It just hasn’t been made a priority amidst all the other extremely urgent areas in this field.”

This April, the latest National Climate Assessment Report is scheduled to be released. For the first time, it will contain an entire chapter dedicated to public health and climate change.