A New and Needed Role for Public Health: Acting on Climate Change

At the Center for Climate Change and Health, we look to support and highlight local public health departments as they take on the challenge of integrating climate change into their daily work. Climate change impacts all aspects of public health, from disaster recovery to disease control to social networks to issues of equity and access. San Francisco’s Climate and Health Program, started in 2010, is one of the most comprehensive models of what health departments can do to start planning for action on climate change.

Painted ladies. San Francisco.

San Francisco’s Public Health Department (SFPDH) recently released a comprehensive Climate and Health Adaptation Framework, which describes the outcomes from a series of vulnerability assessments conducted in several neighborhoods throughout San Francisco. The report describes the health risks associated with climate change and proposed adaptation and mitigation strategies, as well as review of the capacity of the public health department to address the anticipated rising needs. The general response has been very positive, reports Cyndy Comerford, Manager of Policy and Planning at the San Francisco Public Health Department and Director of the Climate and Health Program. She describes the report’s distribution as “really just the tip of the iceberg” in acting on climate change. “We have a duty to get it out there and get more targeted and in depth feedback,” regarding what can feasibly be implemented. She says SFDPH plans to get feedback over the next 6 months to find out peoples’ top priority health issues. Then, says Comerford, “we’ll make the connection between the empirically-based adaptation interventions and the community’s priorities.”

To learn more about the city’s framework, we asked Comerford about challenges faced, lessons learned, advice for other departments, and more.

What was the goal in creating the Climate and Health Adaptation Framework?

“This report and framework is the transition point from assessment and education to action. The goal of the report is really to establish a starting point to take to the community, other agencies, and the city for input.”

For the last 5 years, SFDPH has focused on assessments of health impacts and environmental/ climate change exposures, using the data from these assessments to make plans for emergencies and educate the city. The report outlines over 70 interventions, around which SFDPH will integrate feedback from diverse stakeholders before moving forward.

Where does the report fit into your overall climate planning as a local health department?

“We’re trying to figure this piece out— through this report, we know what we want to do, but how do we actually…select adaptions and interventions?” Within the Climate and Health Framework there are now over 70 suggested city-led strategies, which include the deployment of a sensor network to provide real-time monitoring of air quality to enhanced weather related warnings for vulnerable populations. There is a need to prioritize these adaptations and interventions. “One strategy is connecting health care, which in San Francisco is connected to SFDPH and using health care providers and staff as key messengers.”

Such messengers include those with education expertise, like the health educators who are part of SFDPH and work largely with communities. Health professionals can serve as a strong voice for taking action on climate change for health, and are uniquely positioned to educate patients and communities, and advocate for local, state, and federal policies that support climate action for health. Comerford added that as the city’s largest department, SFDPH also has a lot to do to work on their own footprint and their own adaptation and mitigation strategies as a department. Building internal capacity to understand and address climate change is a necessary step in moving forward, Comerford describes, and one that will take priority as the work continues.

Were people surprised that equity was a guiding principle in a report focused on climate change? Did you receive any pushback?

“The concept of equity and disparities is obvious to health. The public health department is respected by others in the city for leading on health disparities and equity. We didn’t receive pushback from other departments.”

Describing a recent meeting of city directors, Comerford highlighted that equity was on the forefront of people’s minds. One of the strengths of public health, she describes, is that people see the health department as leading on this issue, so addressing climate change as a health equity issue was an easy and direct link to make.

What were some of the challenges in creating this report, particularly within the context of a highly-gentrified city?

“One of the biggest issues is limited staff time. We have 1.5 people working on climate change in the public health department. We’re limited in what can happen in going out into the community—we really need to rely on other city groups and tag onto their events…The most successful partnerships have been with organizations and city departments that are really plugged into the fact that climate change is a systems issue that is connected to transportation, food systems, health care, and beyond. It’s more challenging when partners are highly focused on one specific problem or methodology that doesn’t allow them to expand their view.”

“Many people didn’t initially think about climate change and health, but now it’s something they can really connect to when the health piece is incorporated. Place-based assessments that allow people to connect health to climate and simplifying the science” have allowed for greater understanding.

While it took some time to figure out the partnerships piece, the Climate and Health Program has now connected with groups including the Interfaith Council, SF Planning Department, and locally-based environmental justice groups. Another significant challenge has been that twelve different city departments in San Francisco all work on climate change in some way—meaning twelve departments have twelve different messages and twelve different strategies. Coordinating a unified message and set of goals from the twelve departments throughout the city is a major effort, particularly as such “collaboration defies the structure of government” in some ways, says Comerford.

What lessons were learned, and what would you recommend to others who want to conduct similar work in their communities, especially those in less liberal contexts than San Francisco? 

“It’s important to build on your strengths—including who you have in your health department. Draw on epidemiologists, data analysis, community educators, emergency planners. These folks are ‘natural’ at climate change work. You need to find champions within the departments to move climate change forward.” Comerford described the need to work internally within the health department, not just with other outside partners. Within the department, it is necessary to “get leadership involved, get people to understand the health impacts of climate change.”

Building internal capacity, says Comerford, facilitates the process of drawing on established partnerships when carrying out the suggested actions including adaptations that need support of many, including executive teams. Additionally, Comerford notes that understanding perceptions of climate change among staff within SFDPH can help the Climate and Health team have a better idea of what the communities’ perceptions might be.

What do you think are some of the potential roadblocks in carrying out the adaptions and interventions for the various climate risks listed in the framework? Are there any ‘low-hanging fruit,’ which you see as more easily achieved/successful?

“The big elephant in the room is funding—especially in the current political climate. The Centers for Disease Control and Prevention is funding basically the whole program. After getting the report out and finishing a few other things, we then need to look at how the funding will continue. Also, the communication and coordination within city departments is trying at times; making sure we are still moving forward. Don’t let perfect be the enemy of moving forward—this happens a lot in government. We have to find a balance between having all the answers, which we don’t, and giving info to the public and getting people engaged, so that they are prepared when we ask them to help take part in the solution.”

Pressing issues like the fate of the health care policy, environmental policy, social welfare resources, and much more makes keeping climate change at the forefront a challenge, says Comerford. The barrage of political and economic assaults on issues vital to health and survival make it hard to keep people engaged in climate change, even though the connections may be evident. Public health and other departments are facing other pressing priorities, describes Comerford, so engagement is a challenge as departments are faced with hard decisions around other priority areas.

What do you see as the role of local health departments in mobilizing support for policies that have co-benefits for health?

“Equity is a core principal that public health brings to the table. Public health workers tend to be good collaborators—we’re used to different types of challenges and wins that come along with collaboration. We also have the capacity and bandwidth to monitor health impacts as well, and public health has access to the data that allows us to make the climate change, health, and equity connections.”

What’s more, describes Comerford, is that when public health workers are in the community, they have experience really engaging people and emphasizing co-benefits of taking action.

As seen in San Francisco, tackling climate change and health issues is a massive undertaking, but a vital one. Many city departments have a stake in addressing the issue, yet the questions of equity and health in the context of climate threats and risks are inseparable. We look forward to seeing more from local public health departments as we share experiences such as this one.

Explore the Climate Change and Health Adaption Framework for more details on the adaptations and interventions mentioned. Download the full report here. For questions, contact Comerford at Cyndy.Comerford@sfdph.org.

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