CLIMATE HEALTH Climate and Health Adaptation Plan for the Public Health Network of the Upper Valley - New Hampshire Department of Health and ...
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3/29/2016
CLIMATE
HEALTH
Climate and Health Adaptation Plan for the
Public Health Network of the Upper Valley
November 2015
1
3/29/2016
Acknowledgements
This report is the product of strong CLIMATEHEALTH Advisory Partner organizations assisting
regional and statewide Committee: throughout the process:
collaboration among partners on an
Alice Ely, Public Health Council Public Health Council of the
accelerated schedule. Particular
of the Upper Valley, Mascoma Upper Valley partner
thanks are owed to the following
Valley Health Initiative (MVHI); organizations and communities.
organizations and individuals:
Greg Norman and Wes Miller, Upper Valley Adaptation
Guidance and support provided by: Dartmouth-Hitchcock Workgroup (UVAW), with
Community Health; particular thanks to co-chairs
Matthew Cahillane, and Kathleen
Bush, NH Department of Health
Anne Duncan-Cooley, Upper Sherry Godlewski, NH
Valley Housing Coalition (UVHC) Department of Environmental
and Human Services (DHHS),
and Upper Valley Strong; Services (DES), and Alex Jaccaci,
Division of Public Health
Services (DPHS);
Nate Miller and Michael McCrory, Hypertherm, Inc.
Upper Valley Lake Sunapee
Roger Stevenson, Stacey Smith, This publication was supported by
Regional Planning Commission
and Robin Schell at Stevenson Centers for Disease Control and
(UVLSRPC).
Strategic Communications. Prevention (CDC) grant number
#5UE1EH001046-03 via the National
Center for Environmental Health in
Atlanta, Georgia. The contents of
the report are solely the
responsibility of the authors and do
not necessarily represent the
official views of the CDC.
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan
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Table of
Contents
Page Page Page Page
1 2 4 11
Executive Regional Climate Risks
Introduction
Summary Overview and Health
Page Page Page Page
12 16 18 21
Vulnerability Affected Interventions Action
Assessment Populations And Outcomes Plan
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan
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About the Public Health Council
The Public Health Council of the
Upper Valley (PHC) is hosted in
partnership with Dartmouth-
Hitchcock Community Health.
The PHC is a group of
organizations, municipalities,
schools, advocates, and businesses
working together to create a more
healthy, safe, supportive, and vital
Upper Valley. The PHC is one of
thirteen Regional Public Health
Networks in New Hampshire and is
distinct in that its partner
organizations serve communities in
New Hampshire and Vermont.
The New Hampshire communities in
the PHC’s region are Piermont,
Orford, Lyme, Hanover, Lebanon,
Plainfield, Dorchester, Canaan,
Enfield, Grantham, Orange, and
Grafton.
LINK TO PHC WEB PAGE
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Executive Summary
The CLIMATEHEALTH initiative Regional Assessment Interventions and Outcomes
seeks to increase community and
The regional assessment included: This Plan identifies three focus
individual resilience to the health
Analysis of regional geography areas for short-term interventions
impacts of climate change starting
and demographics; to increase community and
with this Upper Valley Region
Review of existing preparedness individual resilience to the health
Climate and Health Adaptation
and hazard mitigation plans and impacts of climate change within
Plan.
related reports (reference one year:
material on back page); Outreach, Education, Training
Identification of region-specific Develop a coordinated and
climate risks and vulnerable consistent education and outreach
populations; program among partners at
Determination of effective multiple operational levels from
short-term interventions. public education to specialized
Climate Risks training for partner organizations.
The increased likelihood of Partnerships
extreme heat and severe weather Strengthen existing healthcare and
events will have negative health preparedness partnerships. Identify
impacts. and engage new partners to
Health Vulnerabilities improve regional capacity and fill
Diminished access to health care or gaps in service.
decreased quality of life due to Health Data
weather events brought about by There is very limited health-care
climate change. data correlated to climate change
Affected Populations indicators and no effective data
Slayton Hill, Lebanon (2013) This plan focuses on the region’s specific to the region. Develop
Photo: UVLSRPC senior population; many of whom methodologies to collect and
live in rural areas and require analyze health data to create a
assistance to maintain a good baseline and track trends to
quality of life. evaluate the effectiveness of
recommended interventions.
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan 1
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Introduction
New Hampshire State
Climate Action Plan
This climate and health
adaptation initiative is an
outgrowth of the 2009 NH
State Climate Action Plan
Historically, most New Hampshire vulnerable populations in the
(available online) through its
communities have had to recover region. This Plan presents an
recommendation that the
from floods, winter storms, approach to support a more
public health community
hurricanes, and other natural resilient region with improved
identify and protect the
disasters. These events are not new community health in the context of
vulnerable populations at risk
to New Hampshire residents and the region’s geography,
for climate impacts. The
some pride themselves in their demographics, and anticipated
2009 plan recommends:
resilience, or their ability to health concerns in the face of a
recover quickly and thrive. changing climate. Public health and
Changing climatic conditions will emergency response
This plan seeks to: agencies collaborate with
have significant long-term impacts
on quality of life factors including Identify climate-related health other agencies and
community health. risks and likely impacts to organizations to develop
vulnerable populations; effective public outreach;
CLIMATEHEALTH seeks to begin Evaluate baseline data that Partner organizations
helping communities, would help track climate and share relevant data and
organizations, and individuals health changes to identify health information;33
develop methods to adapt to the trends and quantify the Educate and empower
negative health impacts of climate effectiveness of interventions public health officials to
change. and outcomes; prepare for health-related
This Climate and Health Adaptation Initiate the process of a broader and social impacts
Plan identifies measurable, short- action plan for community and resulting from climate
term solutions to climate-related individual resilience and change.
health concerns for particularly improved health.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 2
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Introduction
Develop project work plan
CLIMATEHEALTH Partners Project Timeline Review background materials and support
JUNE 2015
The CLIMATEHEALTH initiative Plan development and engagement documents
Assemble Project Advisory Team and
begins with this Plan and will rely with partner organizations followed identify project partners
on regional partners to follow the an accelerated schedule from June Review background information and local
Action Plan and recommendations. to September 2015. planning documents
Engage Public Health Council and UVAW
This project work is the product of
close collaboration among PHC
Anticipated Next Steps Evaluate local climate risks to public
health
partners and new partner With this plan, CLIMATEHEALTH
organizations who share a common partners can begin short-term
interest in addressing climate interventions immediately. Certain
JULY 2015
Ongoing outreach and coordination with
change and its impacts upon interventions will be easy to partners and Project Advisory Team
community health and quality of complete and others may prove Identify vulnerable populations and health
life in the Upper Valley. outcomes of concern
more challenging. Measures of
Assess interventions and feasibility
Dartmouth-Hitchcock Medical community health resilience and
Center adaptation will be critically
Public Health Council of the important. Regional health
outcomes will take time to
AUGUST 2015
Upper Valley Review draft plan, target populations,
Regional Coordinating measure, and often take many outcomes, interventions with Project
Committee for Emergency years to change. Advisory Team
Preparedness Present draft to PHC and UVAW for
response and discussion surrounding
Upper Valley Adaptation interventions
Workgroup
Upper Valley Lake Sunapee
SEPTEMBER 2015
Regional Planning Commission
Upper Valley STRONG
Final Plan development
NH DHHS, Division of Public Final review of vulnerable populations,
Health Services health outcomes, and interventions with
NH Department of PHC and UVAW
Environmental Services
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HEALTH – Upper Valley Climate and Health Adaptation Plan 3
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Regional Overview - Geography
The PHC service area includes 12 Development patterns during the
municipalities in Grafton and post-industrial decades generally
Sullivan counties. Half of these reflect the established settlement
communities form part of New patterns. Lebanon and Hanover
N Hampshire’s western boarder along form a regional population and
the Connecticut River where there employment center and, with the
are relatively level swaths of highly exception of the Connecticut River
productive agricultural land. The Valley where agricultural uses are
landscape transitions eastward into still prominent, the remainder of
hills with steep slopes, and the Region is largely forested land,
generally more rocky soils and with scattered farms and low
ledge. density residential development.
As land development expanded Most residences are scattered along
since the 1700’s the region’s rural roads with limited utility
physical geography limited the type services at varying levels of repair.
of development: These lower density rural areas
Industrial communities, like tend to have a proportionately high
Lebanon and Enfield, formed elderly population (see the analysis
along rivers to harness the water maps in the Appendix). In a
power; geographic context these rural
Larger farms occupied the lands areas are more vulnerable to the
adjacent to the Connecticut negative impacts of flooding or
River; extreme weather events because
The remaining lands consisted of there is little or no redundancy in
low density, principally agrarian the infrastructure. A damaged
and residential uses around road, power line, or telephone line
HEALTH Project Area
CLIMATE small village centers. may isolate individuals from
essential health services.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 4
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Regional Overview - Demographics
At the time of the 2010 U.S. With few public transportation
Census, nearly 15% of New options outside of the Lebanon-
Hampshire citizens were over the Hanover employment center, those
age of 65. In the Upper Valley, 17% who do not drive or own a vehicle
of residents are over 65 years old. will be unable to access health
This population cohort will rise care, community services, and
steadily as “baby boomers” age other activities without outside
over the next 25 years. assistance. Growing demand for
services that support seniors aging
Demographic projections indicate
in place avoids the much higher
the proportion of senior citizens in
costs of providing institutional
the region will double by 2040.
care, but also exposes the aging
Senior populations are broadly population to isolation in rural
distributed in the service area with areas.
relatively higher senior populations
Percent 65 yrs +
in the rural communities. For
PHC Total Pop
Pop 65 yrs +
example, Grantham will likely have
a higher concentrations of seniors;
likely attributable to an attractive
retirement lifestyle communities,
access to health and community
services, proximity to essential 2010
44,020 7,568 17%
services. In its report, Senior Census
Housing Perspectives (2014), the 2015
44,015 9,098 21%
NH Center for Public Policy Studies Est.
2025
reported on the trend that this 45,463 13,354 29%
Est.
aging population will, “age in
2040
place.” 46,676 16,727 36%
Est.
Population estimates based on
projections prepared by NH OEP.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 5
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Regional Overview - Climate Change
There is a substantial body of Temperature
scientific and planning studies
Historic Trends: Likely Health Impacts:
addressing the impacts of climate
change on New Hampshire (see the Average annual maximum Longer growing seasons will
Reference Material at the end of temperatures have warmed 1.1 affect individuals with allergies,
this report). The region’s residents to 2.6oF (depending on the asthma, and cardiovascular
are witness to the impacts of station) with the greatest illnesses by increasing the
climate change trends with broad warming in winter (1.6 to 3.4oF). duration and severity of pollen
and complex impacts to the natural The number of days with events.
and cultural landscapes. minimum temperatures less than As the region’s landscape
32oF has decreased. changes with development
CLIMATEHEALTH focuses on the increased air pollution (e.g.
The length of the growing season
core impacts climate change will emissions from vehicles and
is two to four weeks longer.
likely have on public health. A commercial/industrial sources)
broader review of climate change Projected Trends: will affect individuals with
effects upon the region is available Mid-century annual average asthma and cardiovascular
in the reference documents listed temperatures may increase 3 to illnesses.
at the end of this report. 5oF, and end-of-century annual Increased number and severity
Overall, southern New Hampshire average temperatures may of hot days will result in
has been getting warmer and increase 4 to 8oF. increased incidents of heat
wetter over the last century, and Average summer temperatures mortality and morbidity.
the rate of change has increased may be up to 11oF warmer Northward expansion of insects
over the last four decades. Historic (compared to the historical due to regional warming
trends and climate model forecasts average from 1980 to 2009). increases exposure to vector
track a broad range of likely The frequency of extreme heat borne diseases (e.g. Lyme
outcomes for climate change. days is projected to increase disease, Eastern Equine
Public health impacts can be dramatically. Encephalitis) and other
associated with the following Extreme cold temperatures are pathogens.
climate change indicators: projected to occur less
frequently, and extreme cold
days will be warmer.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 6
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Regional Overview - Climate Change & Temperature
Climate Grid from Climate Change in Southern NH (2014) with historic and projected temperature trends.
Discussion of modeling a climate future on Page 9.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 7
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Regional Overview - Climate Change & Precipitation
Precipitation Likely Health Impacts:
Increased exposure to injury or Increased respiratory illnesses
Historic Trends: due to poor indoor air quality
death during or immediately
Annual precipitation has after an extreme weather event. because of post-flood mold or
increased 12 to 20 percent. Increased likelihood of individual dust.
Extreme precipitation events isolation in rural areas – lost Exposure to hazardous materials
have increased across the access to health care and in flood sediment.
region, which are evident from services. Mental health impacts from
Federally declared disasters Water and food-borne diseases stressors of forced relocation,
statewide over the last 20 years. after an event. personal loss of property, and/or
Projected Trends: post traumatic stress disorder.
Annual average precipitation is
projected to increase 17 to 20
percent by end-of-century.
Extreme weather events will
likely occur more frequently and
with more severity.
The frequency of extreme
precipitation events may
increase significantly. Under the
high emissions scenario, storm
events that drop more than four
inches of precipitation in forty-
eight hours are projected to
increase two- to three-fold by
the end of the century.
Direct and Indirect Impacts of Climate Change on Health and Wellbeing
Source: Health and Climate Change, 2015, The Lancet Commissions
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HEALTH – Upper Valley Climate and Health Adaptation Plan 8
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Regional Overview - Climate Change & Precipitation
possible scenarios:
Climate Grid from Climate Change in Southern NH (2014) with historic and projected precipitation trends.
Climate Change in Southern New
Hampshire modeled future climate Lower Emission Scenario: Higher Emissions Scenario:
projections for southern New Global improvements in energy Fossil fuels are assumed to remain a
Hampshire simulated temperature and efficiency and development of primary energy resource and emissions
precipitation from four Global Climate renewable energy results in reduced of heat-trapping greenhouse gases
Models and adjusted to New emissions of heat-trapping greenhouse grow to three times those of today by
Hampshire using regional historical gases below 1990 by the end of the the end of the century.
weather observations. These future twenty-first century.
climate projections followed two:
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HEALTH – Upper Valley Climate and Health Adaptation Plan 9
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Health Impacts of Tropical Storm Irene
In late August 2011, Tropical Storm Public health impacts of Tropical
Irene pummeled the slopes and Storm Irene
valleys of Vermont with heavy rain
Contamination of public water
and wind. Rainfall totals of 3-5”
systems infiltrated by waste water
were recorded throughout the state.
Ten of Vermont’s 17 major river Destruction of public water
basins experienced intense flooding. systems and broken pipes affected
Major floodwaters and debris poured public water supplies
through river ways and communities, Contamination of submerged wells
from the Mad River valley south to with chemicals or pathogens
the Deerfield River, affecting 225
municipalities. In many areas, flood Exposure to hazardous waste and
levels reached or exceeded those of fuel spills
Photo: Kerosene oil release in a the historic 1927 flood.
Waterbury mobile home park. Source: Injuries and drowning
Vermont ANR Spill Team As is the case throughout New Gastrointestinal diseases caused
England, climate data show that by viruses, bacteria and protozoa
Vermont is experiencing more in contaminated water
extreme rain events, which is
predicted to continue. The impacts Asthma attacks from greater
of Tropical Storm Irene provide some amounts of pollen, dust, and mold
insight surrounding such challenges spores in damaged housing
to communities. Beyond the damage Mental health impacts related to
to roads, bridges, state facilities, stress, anxiety, sleeplessness, and
and private residences, the flooding substance abuse
brings with it significant public
health impacts.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 10
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Climate Risks and Health
Projected climate change will have severe weather events, like winter
complex and significant impacts on storms, among the highest risk
the natural landscape, ecosystems, natural hazards. Climate models
communities, and social networks. project severe weather events will
CLIMATEHEALTH conducted an become more severe and frequent.
assessment of known plans and
This is consistent among climate
reports that address similar
change studies. A detailed analysis
challenges.
of federally declared disasters from
The community Hazard Mitigation 1986 to 2012 indicate a historic
Plans tend to identify flooding and trend corroborating this position.
Town NFIP Current Plan on Next Update
Participant File
Canaan Y 2011 2016
Dorchester Y 2014 2019
Enfield Y 2009 In Review
Grafton N Never Done -
Grantham Y 2008 In Process
Hanover Y 2015 2020
Lebanon Y 2010 2015
Lyme Y 2011 2016
Orange N 2010 2015
Orford Y 2010 2015
Piermont Y 2012 2017
Plainfield Y 2014 2019 Federal Expenditures on
Summary of Community Participation in the National Flood Insurance Program (NFIP) Presidentially Declared Disasters
and Hazard Mitigation Plans and Emergency Declarations in NH
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HEALTH – Upper Valley Climate and Health Adaptation Plan 11
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Health Vulnerability Assessment
The Upper Valley is becoming more
vulnerable to extreme heat events,
extreme precipitation events, as well
as, severe weather events.
The following tables provide a Prioritizing health vulnerabilities events.
detailed evaluation of eight unique was based on a qualitative
climate-related health burdens, or assessment process that considered
vulnerabilities. Project partners likely impacts to the region
participated in a vulnerability considering characteristics in the
assessment and provided input and regional overview.
guidance for most of the listed The three high priority health
priorities. Some of the vulnerabilities for the region are:
vulnerabilities were not identified
Increasing hospitalizations and
by partners, but were included in
deaths from extreme heat
reference documents and
events;
identified as low priority health
Increased incidents of injury and
vulnerabilities to the region, which
exposure to disease and
should be considered in long-term
contaminants after extreme
planning efforts.
weather events;
Increased negative impacts to
mental health due to isolation
and stress from the above.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 12
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Health Vulnerability Assessment
CLIMATE EXPOSURE PATHWAYS – HEALTH EFFECTS & EVIDENCE FOR DATA SOURCE FOR PRIORITY FOR
OR VULNERABILITY DIRECT & INDIRECT IMPACTS RELEVANCE TO YOUR REGION YOUR REGION
YOUR REGION
Increasing Increase indoor & Heat stroke, heat Climate models Climate Change in High Priority –
occurrence of outdoor heat, cramps, heat forecast the number Southern New health impacts likely
extreme heat people without exhaustion, death, of days in excess of Hampshire, 2014; for the general
events from cooling and outdoor exasperation of 90°F may double by Vermont Climate population and
increasing workers suffer heat chronic illness (e.g. 2040 and triple by Change Health likely severe impacts
temperature stress respiratory, renal, the end of the Effects and on vulnerable
(increase in days and cardiovascular century Adaptation, 2011 populations
over 90°F) disease)
Increased extreme Increase in days Injury, drowning, Increased frequency Climate Change in High Priority –
precipitation and with heavy rain or death, water- and of extreme weather Southern New extreme and severe
occurrence of snowfall (likely to be food-borne events in New Hampshire, 2014; weather events can
extreme weather unpredictable), infectious diseases, Hampshire and Climate Change and have significant
events resulting in flooding, carbon monoxide Vermont; location Human Health in short-term and long-
power outages, poisoning, and scale of impacts New Hampshire, term health effects
disruption of respiratory illnesses unpredictable; 2014; Lessons
services, from mold in recent events within Learned from Irene:
contaminated water buildings, exposure region and adjacent Building resiliency as
supplies, release of to hazardous regions indicate we rebuild, 2012;
hazardous materials materials in likely future Vermont Climate
into floodwaters sediment, food and occurrences Change Health
water insecurity, Effects and
mental health Adaptation, 2011
impacts
Threats to Direct effects of Individuals with Anecdotal evidence Climate Change and High Priority –
mental health post-disaster existing mental shared by Human Health in project partner
impacts on mental illnesses and individuals involved New Hampshire, experience with past
health, indirect vulnerable in recovery efforts, 2014; Tropical events indicated
effects of climate- populations most no effective data Storm Irene: A climate change-
induced stress from impacted by addressing mental Retrospective on related events
post-disaster stresses from health impacts of Mental and negatively impact
economic and social property or personal extreme weather Emotional Impacts mental health,
stressors losses, events on Vermont particularly among
displacement, and Communities, Three vulnerable
financial burdens Years Later, 2014 populations
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HEALTH – Upper Valley Climate and Health Adaptation Plan 13
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Health Vulnerability Assessment (cont.)
CLIMATE EXPOSURE PATHWAYS – HEALTH EFFECTS & EVIDENCE FOR DATA SOURCE FOR PRIORITY FOR
OR VULNERABILITY DIRECT & INDIRECT IMPACTS RELEVANCE TO YOUR REGION YOUR REGION
YOUR REGION
Longer Growing Increase in the Aggravation of No air quality Climate Change in Moderate Priority –
Seasons number of days over respiratory diseases, and/or pollen- Southern New important to track
32°F, allergic plants increasing asthma related data being Hampshire, 2014; health indicators
bloom earlier and occurrence and collected in the Climate Change and and air quality to
later, people inhale severity, changing region; findings Human Health in correlate trends
greater amounts of timing and duration based on national New Hampshire,
pollen and/or more of hay-fever and international 2014; Vermont
days of exposure research Climate Change
Health Effects and
Adaptation, 2011
Longer Growing Increase in the Lyme and West Nile Incidence of Climate Change in Moderate Priority –
Seasons number of days over Virus diseases, diseases increasing Southern New health and climate
32°F, extended rodent urine, fecal, with climate change Hampshire, 2014; data tracking
season for disease and saliva-related trends; limited data Climate Change and necessary to
vectors like ticks or asthma and viral available on the Human Health in evaluate trends
mosquitoes, diseases, other regional level New Hampshire,
potential increase in possible diseases 2014; Vermont
rodent populations that occur in Climate Change
exposing people to warmer climates Health Effects and
more pathogens may occur in the Adaptation, 2011
region
Water and food Direct effects for Crop contamination, No effective data Climate Change and Moderate Priority –
security, food and loss of food sources increased food- available Human Health in severe weather
water-borne or quality of food, borne diseases, food New Hampshire, events and water
diseases flooding may and water 2014; Vermont supply outages have
contaminate wells insecurity, water Climate Change significant impacts
and other water supply Health Effects and on other facets of
supplies, power contamination, Adaptation, 2011; regional health
outages can cause pathogens may Lessons Learned
food spoilage and cause outbreaks from Irene: Building
introduce pathogens among population resiliency as we
rebuild, 2012
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HEALTH – Upper Valley Climate and Health Adaptation Plan 14
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Health Vulnerability Assessment (cont.)
CLIMATE EXPOSURE PATHWAYS – HEALTH EFFECTS & EVIDENCE FOR DATA SOURCE FOR PRIORITY FOR
OR VULNERABILITY DIRECT & INDIRECT IMPACTS RELEVANCE TO YOUR REGION YOUR REGION
YOUR REGION
Decreased air Increase in ozone Aggravation of other Limited Air quality, Climate Change and Low Priority – long-
quality pollution, people respiratory diseases, ozone, and other Human Health in term health burden
inhale pollutants increased asthma particulate pollutants New Hampshire, to track along with
occurrence are not actively 2014; Vermont likely changes in air
monitored in this Climate Change quality as regional
region; ozone and air Health Effects and development
pollution are not Adaptation, 2011 patterns change; two
immediate health days or fewer each
concerns year exceeding
NAAQS in Grafton
County (WISDOM,
2003-2008)
Increasing duration Increase in warm Skin cancer, Grafton County Vermont Climate Low Priority –
and intensity of UV days for sun bathing, cataracts identified as having Change Health important issue for
radiation from people expose skin highest incidence of Effects and community health,
ozone depletion. to sunlight more melanoma in NH; Adaptation, 2011; but connection
often incidence of NH Health WISDOM between rates of
melanoma online database incidence is complex
significantly and difficult to
increases with age, quantify; specific
but incidence rates issue not identified
for all ages not by project partners
increasing over time
Seasonal surface Increased exposure Microbiologic Increasing concern Vermont Climate Low Priority –
water quality due to to water-borne gastrointestinal for New England Change Health specific issue not
increasing water microbes or toxic diseases from viruses states Effects and identified by project
temperature conditions affecting or bacteria; blue- Adaptation, 2011 partners
swimmers and green algae bloom-
recreational water related poisoning
users
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan 15
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Affected Populations
CLIMATEHEALTH programs will, extreme weather emergency
over time, promote health response and recovery experience.
interventions to make individuals
The principal findings of this
and communities more resilient to
assessment found the most
the impacts of climate change.
affected populations from a
This plan focuses on those
climate change-related event
populations likely to be most
would be the elderly and lower
affected by climate change-related
income populations. Photo: Jennifer Hauck, Valley News
health threats.
Elderly Population Flash Floods Hammer Lebanon
The Health Vulnerabilities
Assessment identified increasing Regionally there is a significant A severe rainstorm on July 2, 2013
exposure to extreme heat and proportion of 65+ yr. old residents caused flash flooding throughout
severe weather events as priority who are aging in place. Given the Lebanon and other communities in
issues in the region. An assessment rural character of the region the region. The sudden high volume
of the most affected populations climate-related risks include: run-off from the rain caused
considered those most impacted by Isolation if a severe weather significant wash-out damage to the
these high priority vulnerabilities. event damages roads or utilities Slayton Hill Road and a recently
The assessment relied heavily on completed affordable housing
Loss of medical services for the
geographic information and complex.
chronically ill
analyses using readily available Exposure to water and food- While there were no injuries during
demographic information from the borne illnesses. the event, it took weeks to restore
US Census and the NH Social the housing complex and re-
Vulnerability Index. Primary health Lower Income Population
establish the displaced residents
data sources, including the NH Tropical Storm Irene revealed an and years to reconstruct Slayton
DHHS Health WISDOM online important fact: residents with Hill Road.
database, have limited data at the limited financial resources cannot
PHC or community level. Such events can cause significant
recover quickly from losses
stress and could exacerbate existing
Additional input from project sustained from a severe weather
mental illness among displaced
partners was based on specific event. This makes lower income
residents.
populations particularly vulnerable.
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HEALTH – Upper Valley Climate and Health Adaptation Plan 16
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Affected Populations – Elderly, Lower Income
CLIMATE EXPOSURE PATHWAYS – DIRECT HEALTH EFFECTS & VULNERABLE EVIDENCE OF RISK LOCATIONS OF
OR VULNERABILITY & INDIRECT IMPACTS POPULATIONS AND FOR FOCUS POPULATIONS AT
PLACES POPULATIONS RISK
Increasing Increase indoor & Heat stroke, heat People with lower SOCIAL Rural areas where
occurrence of outdoor heat, people cramps, heat income, elderly, those VULNERABILITY there is greater
extreme heat events without cooling and exhaustion, death, living alone or INDEX (SVI): likelihood of isolation
from increasing outdoor workers exasperation of isolated or without • Population 65 yrs + and loss of services if
temperature suffer heat stress chronic illness (e.g. AC. People with • Population living there is a power
(increase in days respiratory, renal, asthma, or COPD below poverty level outage; housing age
over 90°F) and cardiovascular FOCUS OTHER DATA: and quality may
disease) POPULATIONS: • Housing units more affect personal or
Elderly and lower than 30 years old household resilience
income population
Increased extreme Increase in days with Injury, drowning, People with lower SVI: Rural areas where
precipitation and heavy rain or snowfall death, water- and income and elderly, • Population 65 yrs + there is greater
occurrence of (likely to be food-borne infectious unprotected water • Population living likelihood of isolation
extreme weather unpredictable), diseases, carbon supply systems for below poverty level and loss of services if
events resulting in flooding, monoxide poisoning, individual households OTHER DATA: extreme weather
power outages, respiratory illnesses or communities, • Floodplains (FEMA event causes road
disruption of services, from mold in residents on isolated Mapping) closures (e.g. wash-
contaminated water buildings, exposure to rural roadways • Location of outs or blizzard
supplies, release of hazardous materials FOCUS households in conditions), power
hazardous materials in sediment, food and POPULATIONS: floodplains (no data outages and/or loss
into floodwaters water insecurity, Elderly and lower available) of communications
mental health income population • Non-redundant due to downed
impacts road network overhead utilities
Threats to Direct effects of post- Individuals with People living in SVI: Rural areas have
mental health disaster impacts on existing mental disaster affected • Population under relatively higher
mental health, illnesses and areas or otherwise 65 without health populations
indirect effects of vulnerable directly impacted by insurance vulnerable to threats
climate-induced populations most an event, individuals • Population living to mental health
stress from post- impacted by stresses with existing mental below poverty level including likely
disaster economic from property or illness • Population with a existing mental illness
and social stressors personal losses, FOCUS disability and personal or
displacement, POPULATIONS: OTHER DATA: household resilience
financial burdens Elderly and lower • Reports (lower income
income population summarizing households have
mental health lesser capacity for
impacts of extreme resilience)
weather events
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HEALTH – Upper Valley Climate and Health Adaptation Plan 17
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Interventions and Outcomes
CLIMATEHEALTH focuses on Principal Interventions organizations and engage new
increasing regional resilience to the partners to avoid unnecessary
This Climate and Health Adaptation
health impacts of climate change. organizational overlap and
Plan identifies three focus areas
This assessment focuses on short- redundancy. Identifying key
for short-term interventions to
term interventions and outcomes stakeholders (both existing PHC
increase community and individual
for the target vulnerable partners and others) with a gap
resilience to the health impacts of
population. analysis would be an important
climate change.
first step.
The regional assessment and
1) Outreach, Education, and
analysis of interventions and 3) Health Data
Training
outcomes revealed:
Guidance documents for this plan
Develop a broad, coordinated
There are significant stressed the need to quantify likely
education and outreach program
opportunities for multi-sector health outcomes due to the
among health care, preparedness,
partnerships to increase regional recommended interventions.
and resilience partners at multiple
resilience. Unfortunately, there is very limited
operational levels. This includes
Regional emergency response health-related data correlated to
multi-media outreach for the
and affiliated agencies address weather events or other climate
public (e.g. public health
the primary impacts of a severe change indicators; particularly for
announcements, severe weather
weather event (e.g. – injury, the high priority vulnerabilities
alerts, recommended actions to
evacuation, short-term housing identified in this assessment. It is
mitigate impacts), resilience
and health care). necessary to establish a baseline of
trainings for regional partners,
Recent experience with Tropical health and climate data, and then
specialized trainings for
Storm Irene and other localized to track that data over time to
organizations serving target
events reveals there is a need to evaluate the effectiveness of
populations.
broaden community and future interventions. ReThink
organizational preparedness for 2) Partnerships Health of the Upper Connecticut
long-term recovery efforts. River Valley is assessing a regional
This resilience effort spans beyond
health measurement system and
this initiative or any other
may be able to inform statewide
individual organization. It is
data development programs by
important to strengthen
DHHS.
relationships with existing partner
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan 18
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Interventions and Outcomes
GOAL FOR INTERVENTION TYPE
ENVIRONMENTAL HEALTH BASELINE REDUCTION IN Primary, INTERVENTION INTERVENTION
EXPOSURE EFFECTS & PUBLIC PUBLIC Secondary, STRATEGY ACTIVITY
IMPACTS HEALTH DATA HEALTH Tertiary
IMPACTS
Increased Increased heat Average count Reduce rate of Primary, Increase awareness • Public outreach and
exposure and stress leads to of 125 heat- heat-related Secondary of heat-related education through
excess heat heat-related related hospital hospital visits illness and ways to training and media
(increase in days hospital visits per year by 50% in the prevent it • Training for regional
over 90°F) from admissions, (1998-2009) region before partner
200% to 400% injury, and NH WISDOM 2020 organizations
death online
database
Primary, Improve personal • Sponsored home
Secondary resilience to extreme weatherization for
weather events vulnerable
populations
• Develop local
partnerships for
community-based
relief centers
Secondary Increase tracking of • Continued home
at risk populations check-ups by
during extreme organizations
weather events conducting home
visits
• Train regional
communities in local
practices to identify
and track local
vulnerable
populations
Secondary Improve tracking of • State and regional
heat-related illnesses partners develop
data collection and
tracking standards
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HEALTH – Upper Valley Climate and Health Adaptation Plan 19
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Interventions and Outcomes (cont.)
GOAL FOR INTERVENTION TYPE
ENVIRONMENTAL HEALTH BASELINE REDUCTION IN Primary, INTERVENTION INTERVENTION
EXPOSURE EFFECTS & PUBLIC PUBLIC Secondary, STRATEGY ACTIVITY
IMPACTS HEALTH DATA HEALTH Tertiary
IMPACTS
Increased health Increased risk Reported cases Reduce Primary, Increase tracking of • Develop methods to
impacts from loss of degraded of isolation and incidents Secondary, Tertiary at risk populations aggregate locations
of basic services health due to health needs where during weather of vulnerable
and/or isolation untreated not being met vulnerable events populations for use
due to extreme chronic illness (no data populations are by emergency
weather events or personal available at this isolated from responders without
causing degraded disability where time) necessary violating privacy
quality of life utility services health care (no
(e.g. electric & metric at this Primary, Secondary Increase community- • Train community
telephone) time) based resilience volunteer groups in
and/or home practices during long- practices to assist
care visits are term recovery efforts local populations in
necessary, need
mental and • Train residents in
emotional personal resilience
stress for practices
affected
populations
Threats to mental Individuals with Mental health Reduce Primary Increase community- • Train community
health existing mental impacts from incidents of based resilience volunteer groups in
illnesses and extreme post traumatic practices during long- practices to assist
vulnerable weather events stress, or term recovery efforts local populations in
populations including post depression due need
most impacted traumatic to extreme • Train residents in
by stresses stress, weather events personal resilience
from property incidents of (no metric at practices
or personal depression, this time) Secondary, Increase access to • Develop mental
losses, worsened Tertiary mental health health counseling
displacement, mental illness counseling during intervention plans
financial (no data and after severe with partner
burdens available at this weather events organizations
time) • Increase crisis
intervention training
for community first
responders
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan 20
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Action Plan
The CLIMATEHEALTH initiative Goal: Target Population:
will commence with the following Increase community and individual Seniors (65+ years old)
action plan based on the regional resilience to the health impacts of Target Timeline:
assessment findings in this report. climate change.
Within one year.
Strategy Level of Potential Partners Performance Measure
Action
Objective: Provide effective outreach and education to increase personal and community resilience.
Strategy: Develop severe weather event media ● Region Municipalities; PHC; Number of media packets prepared (each
packets and coordinated plans among partners ○ State Regional Coordinating tailored to a specific event); Coordinated
to release information prior to a forecast event. Council (RCC); UVAW outreach plan among partner organizations
Strategy: Team with partner organizations to ● Region PHC; RCC; FEMA; Individuals attending, commitments to
host public forums about health and climate ○ State UVAW furthering personal resilience, volunteer
change issues and community resilience. commitments for community resilience groups
Objective: Strengthen regional partnerships and capacity for partner organizations.
Strategy: Train partner organizations who work ● Region Municipalities; PHC; Number of trainings, individuals /organizations
directly with the target population regarding ○ State DHHS (as advisor) represented at trainings, organization
outreach and health impacts of climate change. commitments to resilience partnerships
Strategy: Conduct assessment of regional Assessment results, existing partners
organizations to identify gaps in services and ● Region Municipalities; PHC; participating in process, new organizations
possible new partner organizations to fill gaps. ○ State DHHS (as advisor) identified, new organization commitments to
partnership
Objective: Expand health impacts of climate change tracking data.
Strategy: Participate with state to develop data ● State Partner organization commitments to assist
sources and tracking strategies. ● Region PHC; DHHS with overall data effort, action plan for next
steps
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Appendix – Analysis Maps
CLIMATE
HEALTH – Upper Valley Climate and Health Adaptation Plan 22
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Appendix – Logic Model for Health Outcomes
INPUTS ACTIVITIES OUTPUTS OUTCOMES
Funding/Grants Public Outreach & Target Groups Short-Term Outcomes
• CDC/DHHS Education Populations Increased public education
• FEMA/HSEM • Severe weather media • Elderly and messaging
• EPA/NHDES packets • Disabled • Utilize existing partner
community ties with
• HUD/CDFA • Community and personal • Mentally Ill target populations
• Private Foundations resilience training Partnerships • Work with partners to
• Resilience Foundations • Guidelines for local • PHC Partners develop media packets
resilience practices • New Partners • Strengthen capacity for
• Fact sheets identifying Regional Communities CLIMATEHEALTH
available resources partner organizations
Partners • Partner trainings
• State Agencies • Engage new partner
Ongoing Partner Outputs organizations
• Federal Agencies
Coordination Enhance personal and
• Regional Public Health
• Understand partner roles community resilience
• Regional Public Safety Long-Term Outcomes
in climate health •Outreach for target
• Regional Municipalities Increased public personal
adaptation populations & community resilience
• Non-Profits & Agencies
• Identify and address gaps •Identify and track health • Increase number of
with Shared Goals
in service outcome indicators regional resilience
• Expand partnerships Strengthen Regional programs with direct
Partnerships community ties
•Coordinate climate + • Develop long-term
Specialists/Materials Health +Climate Projects strategies
• Community Health Data health interventions and
• CLIMATEHEALTH • Evaluate strategies for
• Climate Change Data projects among partners
tracking data low/moderate priority
• Resilience Experts •Develop new partnerships health outcomes
• Tracking intervention
• Local, State, Federal to expand regional • Re-evaluate
health outcomes
Resilience Plans capacity effectiveness of short-
• Promote partner projects
term interventions
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CLIMATE
HEALTH Reference Material
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