PuHealth PreventYunnan-23? I ?H112.th 719..E. ?v?If?! 5 -, . .J-r in?" g, Are We Ready? REPORT 2 PREPARING FOR THE PUBLIC HEALTH CHALLENGES OF CLIMATE CHANGE NACCHO National Association ofCounty City Health Officials Table of Contents Introduction .............................................................................................................. 3 Research Methods .................................................................................................... 7 Findings ................................................................................................................. 10 Part I: Beliefs of LHD Directors as Compared to Beliefs of the General Public ............................. 11 Part II: Public Health Readiness to Address Climate Change: Comparisons of 2012 and 2008 .......... 13 Part III: Breakdown by Belief in Climate Change, Geographic Region, and Department Budget ......... 20 Part IIIa: Perceptions—Tables 11–21 .............................................................................. 20 Part IIIb: Perceived Health Impacts of Climate Change—Tables 22–24 ............................................... 21 Part IIIc: Anticipated Health Impacts of Climate Change—Tables 25–36 .............................................. 22 Part IIId: Current Activity and Changes to Programs in Climate Change-Related Areas—Tables 37–49 .................. 23 Part IIIe: Mitigation-Related Programs—Tables 50–56 .............................................................. 24 Conclusion ............................................................................................................. 25 References .......................................................................................................... 27 Appendices ............................................................................................................ 28 Appendix A: Survey ................................................................................................ 29 Appendix B: Tables 11–56 ........................................................................................ 34 Acknowledgments This report was supported by the Centers for Disease Control and Prevention, cooperative agreement #5U38HM000449-05. NACCHO is grateful for this support. The contents do not necessarily represent the official views of the sponsor. NACCHO thanks the following people who contributed to this report: Lisa Brown, Jacques Colon, David Dyjack, Andrew Elligers, Jennifer Li, Edward Maibach, G. Erin Roberts, Connie Roser-Renouf, and Andrew Roszak. The mission of the National Association of County and City Health Officials (NACCHO) is to be a leader, partner, catalyst, and voice for local health departments. 1100 17th St, NW, 7th Floor Washington, DC 20036 P 202-783-5550 F 202-783-1583 © 2014. National Association of County and City Health Officials. Are We Ready? Report 2 2 anIlw- I . .li?.IlIfClimate change has serious health implications for present and future generations.1 The health effects of climate change are myriad and may include the following: heat-related health effects; extreme weather-related health effects; air pollution-related health effects; shifting distributions of disease vectors and diseases; health problems associated with food and water supply disruption and contamination; health problems associated with allergens; and health problems associated with social and economic disruption.2 Local health departments (LHDs) play a vital role in helping communities prepare for and address the health effects of climate change. To assess the readiness of LHDs to prepare for and address the health effects of climate change, the Environmental Defense Fund, the National Association of County and City Health Officials (NACCHO), and the George Mason University Center for Climate Change Communication (GMU CCCC) conducted a survey in 2008 of a nationally representative sample of LHD directors, Are We Ready? Preparing for the Public Health Challenges of Climate Change. The study found that most LHD directors recognized climate change as a serious threat to public health in their jurisdictions but were not confident in their agencies’ capacities to assess the potential health impacts of climate change on their communities, conduct adaptation planning, or conduct mitigation planning. This report summarizes survey results measuring the following perceptions of LHD directors: 1. The existence, causes, and dangers of climate change 2. Past and future impacts of climate change 3. Prioritization and capacity to assess and To assess LHD directors’ current perceptions of their agencies’ readiness to prepare for and address the health effects of climate change and to assess changes in such perceptions between 2008 and 2012, NACCHO and the GMU CCCC conducted a follow-up survey to the 2008 Are We Ready? survey in 2012. Survey questions assessed the following: respondents’ perceptions of the existence, causes, and dangers of climate change; respondents’ perceptions of the past and future impacts of climate change in their jurisdictions; respondents’ perceptions of their agencies’ prioritization of climate change and capacity to assess and address the impacts of climate change within their jurisdictions; and the activities, both current and planned, within agency climate change-related areas and mitigation-related programs. This report contains survey responses to a geographically representative online survey of 174 LHD directors out of 350 in the survey sample. This represents a response rate of 49.7 percent (LHD directors were randomly selected from NACCHO’s membership*). Survey responses were compared to the results of the 2008 Are We Ready? study and to a fall 2011 national survey of American adults, Climate Change in the American Mind: Americans’ Global Warming Beliefs and Attitudes.3,4 NACCHO further examined the survey responses based on three variables: (1) LHD director belief that climate change was or was not occurring; (2) geographic region of LHD; and (3) size of LHD budget. address the impacts of climate change. * NACCHO’s membership represents the nation’s 2,800 local health departments. For more information about NACCHO’s membership, visit nacchoprofilestudy.org Are We Ready? Report 2 Introduction 4 Nearly 8 out of 10 health directors think that climate change is occurring. Compared to 6 out of 10 Americans who believe that global warming is occurring. Survey respondents were more likely than the general population to believe that climate change was happening. Three-quarters of LHD directors thought climate change was occurring, compared to 63 percent of Americans nationally who believed that “global warming” (see Caveats under Research Methods) was occurring. The proportion of LHD directors who believed that climate change had impacted or would impact their jurisdictions—and who anticipated serious local health problems as a result—changed little from 2008 to 2012. In both 2008 and 2012, roughly two-thirds believed their jurisdictions had experienced climate change over the past two decades; roughly threequarters believed their jurisdictions would experience climate change during the next two decades; and roughly 60 percent believed their jurisdictions would likely experience one or more serious public health problems as a result of climate change during the next two decades. However, in 2012, LHD directors’ beliefs Are We Ready? Report 2 Introduction regarding the local health impacts of climate change were more polarized than they were in 2008, and the proportion of directors without opinions on the issue had decreased. Directors in 2012 were more likely than they had been four years prior either to strongly agree or to strongly disagree that climate change was or would be impacting their jurisdictions, and they were less likely to respond that they did not know whether local impacts had occurred or would occur. Despite the sustained high percentages of respondents who believed that climate change was occurring and likely to cause serious public health problems in their jurisdictions, the proportion of LHD directors who believed that preparing to deal with the public health effects of climate change was an important priority for their health departments decreased from 51 percent in 2008 to 41 percent in 2012. Further, the proportion of LHD directors who strongly believed that preparing to deal with the public health effects of climate change was not an important priority for their health 5 LHDs are already dealing with the health impacts of climate change in communities across the United States. However, nearly 9 out of 10 health directors believe that their LHD lacked sufficient resources needed to protect their communities from these health impacts. departments had significantly increased from four percent to 29 percent between the same years. Respondents again indicated a lack of perceived expertise to prepare for the public health impacts of climate change. In the earlier 2008 survey, the majority of surveyed LHD directors believed their LHDs lacked ample expertise to assess the potential public health impacts of climate change in their jurisdictions (77%) and to create effective climate change adaptation plans (83%). In the 2012 survey, 76 percent of directors believed their LHDs lacked the expertise to assess the potential impacts, and 80 percent believed their LHDs lacked the expertise to create effective plans to protect residents from the health impacts of climate change. Furthermore, in 2012, 87 percent of LHD directors believed that their health departments did not have sufficient resources to effectively protect local residents from the health impacts of climate change. Are We Ready? Report 2 Introduction Climate change is a severe threat to the public’s health. LHDs are already dealing with the health impacts of climate change in communities across the United States. A sizeable majority of LHD directors recognized the threat of climate change both in 2008 and again in 2012. Yet, LHDs continued to lack the expertise and resources necessary to prepare for and address the health effects. As the climate proceeds to change, this space between need and ability poses a significant and urgent threat that decision-makers at all government levels must recognize and address to protect the public. This report contains three parts. Part I compares LHD directors’ perceptions regarding climate change to the perceptions of American adults generally. Part II compares the perceptions of LHD directors in 2012 to those of LHD directors surveyed in 2008. Part III presents survey data in relation to three variables: respondent belief in climate change; geographic region; and LHD budget size. 6 >Research Methods With the completion of two “Are We Ready” surveys, the comparisons of survey results in this report provide longitudinal data about changes in attitudes and beliefs among LHD directors about climate change over time. In addition to the two national surveys of LHD directors conducted in 2008 and 2012 as part of the “Are We Ready” project, the report also uses data from a national survey of American adults conducted in fall 2011 for comparison.3,4 The report focuses primarily on the 2012 survey results and presents the other survey results for comparison. The 2011 survey of American adults, Climate Change in the American Mind: Americans’ Global Warming Beliefs and Attitudes, was a nationally representative online survey of 1,000 American adults, fielded Oct. 20, 2011, through Nov. 16, 2011.4 The 2008 survey, Are We Ready? Preparing for the Public Health Challenges of Climate Change, was a geographically representative telephone survey of 133 LHD directors, fielded between December 2007 and February 2008.3 The 2012 survey was a geographically representative online survey of 174 LHD directors, fielded Dec. 19, 2011, through Feb. 4, 2012. Research methods used in the 2012 survey are described below. A stratified random sample of 350 LHDs was selected to participate in the survey. The sampling plan included 12 strata based on (1) U.S. Census Region (Northeast, Midwest, South, West)24 and (2) population of LHD jurisdiction (<50,000, 50,000 to 499,999, 500,000+). The sample was designed to provide both national estimates and estimates for subgroups by geographic region and jurisdiction population size. An invitation to participate in the survey was sent initially by mail on Dec. 13, 2011, followed by an e-mail invitation on Dec. 16, 2011. A second e-mail invitation containing a link to the online survey was sent on Dec. 19, 2011. Two follow-up e-mail reminders were sent to nonrespondents during January 2012. Remaining nonrespondents were reminded by telephone on Jan. 20, 2012. The 2012 survey instrument largely replicated closedended items drawn from the 2008 survey, with several items also drawn from the 2011 national American adult survey. Questions assessed respondents’ Are We Ready? Report 2 Research Methods perceptions of the existence, causes, and danger of climate change; their perceptions of past and future health impacts of climate change within their jurisdictions; their perceptions of their agencies’ prioritization of and capacity to assess and address the impacts of climate change within their jurisdictions; and the current and planned adaptation and mitigation programs of their agencies. For the purposes of a brief follow-up study, a request for the names and e-mail addresses of survey sample LHD environmental health directors was also included. The survey took an average of 10 minutes to complete and was pre-tested for length and clarity by NACCHO’s Environmental Public Health Tracking Workgroup prior to fielding. The “Are We Ready?” project measures the climate change beliefs of LHD directors. With the release of the second report, the project offers a longitudinal look at how these beliefs are changing over time. A total of 174 LHD directors responded to the 2012 survey (49.7% response rate); three declined. The sample differed from the general NACCHO membership in two respects: (1) survey responses reflected a higher proportion of LHDs with large budgets and a smaller proportion of LHDs with midsized budgets; and (2) survey responses reflected a 8 higher proportion of LHDs from Western states and a lower proportion of LHDs from Midwestern states. For the purposes of survey results analysis, the 2012 survey data were downloaded and merged with the results of the 2008 survey and the 2011 national American adult survey in SPSS®. SPSS® was used for all data analyses. Indices were constructed for the number of types of current and anticipated local public health impacts of climate change and for the number of types of current and planned adaptation and mitigation programs. Cross-tabs, chi-square tests, and t-tests were used to compare the perceptions of the 2012 survey respondents to those of the 2008 survey respondents and to those of the 2011 national American adult survey respondents. Cross-tabs, chi-square tests, and t-tests were again used to compare the climate change programmatic information, as provided by respondents in the 2008 and 2012 surveys. The 2012 survey responses were further examined in relation to three variables: (1) LHD director belief that climate change was or was not occurring; (2) geographic region of LHD; and (3) size of LHD budget. Analysis-of-variance tests were used to assess differences on the indices of impacts and programs by these three variables. Geographic region was missing for some respondents because the respondents’ agency affiliations were not identifiable. The online questionnaire did not Are We Ready? Report 2 Research Methods require a login number to identify the respondent, but the initial question on the survey requested the name of the respondent’s agency. This resulted in several ambiguities (e.g., more than one LHD with the same name). Hence, the breakdowns in Part III by geographic region have fewer respondents. Caveats: The comparisons of the 2012 survey responses to the 2011 national American adult survey responses and the 2008 survey responses are qualified by two considerations: The 2011 national American adult survey asked respondents about the existence and causes of “global warming,” while the 2012 survey asked respondents about “climate change.” Recent research finds that Americans are six percent more likely to acknowledge the reality of climate change than global warming.25 This tendency may have resulted in a lower proportion of 2011 national American adult survey respondents reporting a belief in “global warming” than would have reported a belief in “climate change” and thus amplified the differences identified in this report between LHD directors and the general population. However, these differences are large enough that they would still be significant had both studies used the same term. The 2008 survey used a personal telephone interview, while the 2012 survey used an online questionnaire. Respondents may answer questions differently, depending on the survey method used. 9 >Findings Part I: Beliefs of LHD Directors as Compared to Beliefs of the General Public The beliefs of LHD directors surveyed in 2012 were compared to those of a national sample of American adults surveyed in fall 2011. The surveys used identical questions, with one exception: LHD directors were asked about climate change, while the national sample was asked about global warming. (For a discussion of the implications of this difference, please see the Research Methods section.) LHD directors were significantly more likely to believe that climate change was occurring than was the general population. As indicated by Table 1, three-quarters of directors thought climate change was occurring (76.5%), compared to 63 percent of Americans nationally who believed that global warming was occurring. LHD directors were more certain of their belief that climate change was occurring than was the general population. On a nine-point scale of belief certainty, in which nine represented “extremely sure climate change is happening,” five represented “don’t know,” and one represented “extremely sure climate change is not TABLE 1 LHD Directors Are More Likely to Believe that Climate Change Is Happening than the General Public Public Health Directors General Public Yes 76.5 63.4 No 11.2 16.6 Don’t know 12.4 19.9b 170 973 Extremely sure is happening 12.9 14.0 Very sure is happening 33.5 21.9 Somewhat sure is happening 27.1 24.5 Do you think that climate change/global warming is happening? a N [If yes]: How sure are you that climate change/global warming is happening? [If no]: How sure are you that climate change/global warminga is not happening? a Not at all sure is happening 2.9 2.9 Don’t know 12.4 20.1 Not at all sure is not happening 1.2 .9 Somewhat sure is not happening 6.5 6.1 Very sure is not happening 2.4 6.1 Extremely sure is not happening 1.2 3.5 N 170 973 mean 6.84 6.28c a The public health director survey said “climate change”; the national sample survey said “global warming.” National data have been weighted to match census benchmarks on demographic characteristics. b 2 X = 10.94, p<.01 c t=3.44, p<.001 Are We Ready? Report 2 Findings 11 happening,” LHD directors averaged 6.8, compared to 6.3 for the general population. Comparable proportions of LHD directors and the general public agreed that human activities were the primary cause of climate change (49% and 50%, respectively), but directors were more likely than the general population to believe that climate change was being caused by a combination of human activities and natural changes in the environment (17% and 6%, respectively). LHD directors were significantly more likely than the general population to believe that people in the United States were currently being harmed by climate change (43% and 30%, respectively). On a six-point scale, where six represented “they are being harmed now,” and one represented “never,” LHD directors averaged 4.3, compared to 3.8 for the general population, a significantly higher mean. However, LHD directors were almost as likely as the general population to believe that people in the United States would never be harmed by climate change (14% and 16%, respectively). (See Table 2.) TABLE 2 LHD Directors Are More Likely than the General Public to Believe that Climate Change Is Currently Causing Harm Public Health Directors General Public Caused mostly by human activities 48.8 50.3 Caused mostly by natural changes in the environment 28.0 33.2 A combination of human activities and natural changes (volunteered) 16.7 5.9 Other .0 1.6 None of the above because global warming isn’t happening 4.2 8.3 Don’t know (volunteered) 2.4 0.7b N 168 971 They are being harmed now 43.6 30.3 In 10 years 9.2 9.7 In 25 years 15.3 13.2 In 50 years 9.8 15.3 In 100 years 8.0 15.4 Never 14.1 16.1 Assuming climate change/global warming is happening, do you think it is... a When do you think climate change/global warminga will start to harm people in the U.S.? N 163 975 mean 4.28 3.76c Public health director survey said “climate change”; national sample survey said “global warming.” National data have been weighted to match census benchmarks on demographic characteristics. b 2 X = 33.71, p<.001 c t = 3.32, p<.001 a Are We Ready? Report 2 Findings 12 Part II: Public Health Readiness to Address Climate Change: Comparisons of 2012 and 2008 Part II of the report assesses the changes between 2008 and 2012 in LHD directors’ perceptions of their agencies’ readiness to prepare for and address the health effects of climate change. In 2012, LHD directors’ beliefs regarding the local health impacts of climate change were more polarized than they had been in 2008, and the proportion of directors without opinions on the issue had decreased. Directors in 2012 were more likely either to agree strongly or disagree strongly (as opposed to agreeing or disagreeing somewhat) that climate change was currently, or would be, impacting their jurisdictions than they were four years before. They were also less likely to respond that they did not know whether local impacts had occurred or would occur. (See Table 3.) The percentage of LHD directors who strongly agreed that their jurisdictions had experienced climate change over the past 20 years doubled, from nine percent to 18 percent, and the percentage who strongly disagreed jumped from one percent to 12 percent. The percentage of LHD directors who did not know whether their jurisdictions had experienced climate change decreased by six percent. When asked whether their jurisdiction would experience climate change over the next two decades, LHD directors demonstrated increased attitude formation and polarization; strong agreement increased from 23 percent to 39 percent; strong disagreement increased from one percent to 10 percent; and “don’t know” responses decreased from 19 percent to eight percent. Strong agreement that climate change would cause a serious local public health problem over the next 20 years increased from 11 percent to 29 percent; strong disagreement increased from two percent to 11 percent; and “don’t know” responses decreased from 31 percent to 15 percent. Are We Ready? Report 2 Findings TABLE 3 The Majority of LHD Directors Believe that Their Jurisdiction Has Experienced or Will Experience Climate Change Public Health Directors 2012 2008 My jurisdiction has experienced climate change in the past 20 years. Strongly agree 18.4 9.0 Somewhat agree 47.5 60.2 Somewhat disagree 8.9 10.5 Strongly disagree 12.0 0.8 Don’t know 13.3 19.5 Mean (excluding “don’t know”) 2.83 2.96 My jurisdiction will experience climate change in the next 20 years. Strongly agree 39.2 22.6 Somewhat agree 37.3 55.6 Somewhat disagree 6.3 2.3 Strongly disagree 9.5 .8 Don’t know 7.6 18.8 Mean (excluding “don’t know”) 3.15 3.23 In the next 20 years, it is likely that my jurisdiction will experience one or more serious public health problems as a result of climate change. Strongly agree 29.1 11.3 Somewhat agree 32.3 48.1 Somewhat disagree 13.3 8.3 Strongly disagree 10.8 1.5 Don’t know 14.6 30.8 Mean (excluding “don’t know”) 2.93 3.00 I am worried about the impact of climate change on the health and well-being of people in my jurisdiction. Strongly agree 31.8 Somewhat agree 35.7 Somewhat disagree 12.7 Strongly disagree 14.6 Don’t know 5.1 Mean (excluding “don’t know”) 2.89 N 158 not asked 133 13 Two-thirds of LHD directors (67.5%) in 2012 were worried about the impacts of climate change on the health and well-being of people in their jurisdictions. LHD directors were less likely in 2012 than they had been in 2008 to perceive that they or other relevant senior managers in their departments were knowledgeable about the potential public health impacts of climate change. In both 2012 and 2008, large majorities of LHD directors perceived that their LHDs did not possess ample expertise to assess the potential public health impacts of climate change on their communities or to create effective plans to protect local residents from those impacts. (See Table 4.) The percentage of LHD directors who believed that they were knowledgeable about the potential public health impacts of climate change decreased from 66 percent to 59 percent, while the percentage of directors who believed that they were not knowledgeable about the potential impacts increased from 31 percent to 39 percent. The percentage of LHD directors who believed that other relevant senior staff in their health departments were knowledgeable about the potential public health impacts of climate change decreased from 46 percent to 36 percent. In 2008 and 2012, large majorities of LHD directors believed that their agencies lacked ample expertise to assess the potential public health impacts of climate change that could occur in their jurisdictions (77% and 76%, respectively) or to create effective climate change adaptation plans (83% and 80%, respectively). However, the responses were more polarized in 2012 than in 2008, and the percentage of LHD directors who strongly disagreed that their agencies had the expertise to assess the potential local health impacts of climate change or to create effective plans was much higher. The percentage of directors who Are We Ready? Report 2 Findings TABLE 4 The Majority of LHD Directors Believe that Their LHD Lacks the Expertise Necessary to Address Climate Change Public Health Directors 2012 2008 I am knowledgeable about the potential public health impacts of climate change. Strongly agree 14.7 4.5 Somewhat agree 44.2 61.4 Somewhat disagree 19.9 28.8 Strongly disagree 19.2 2.3 Don’t know 1.9 3.0 Mean (excluding “don’t know”) 2.56 2.70 The other relevant senior managers in my health department are knowledgeable about the potential public health impacts of climate change. Strongly agree 6.4 3.8 Somewhat agree 29.5 42.0 Somewhat disagree 30.8 36.6 Strongly disagree 28.2 5.3 Don’t know 5.1 12.2 Mean (excluding “don’t know”) 2.15 2.50 My health department currently has ample expertise to assess the potential public health impacts associated with climate change that could occur in my jurisdiction. Strongly agree 5.1 3.8 Somewhat agree 13.9 18.8 Somewhat disagree 29.1 49.6 Strongly disagree 46.8 27.8 Don’t know 5.1 0.0 Mean (excluding “don’t know”) 1.76 1.98 My health department currently has ample expertise to create an effective plan to protect local residents from the health impacts of climate change. Strongly agree 4.5 .8 Somewhat agree 12.3 15.9 Somewhat disagree 34.4 51.5 Strongly disagree 45.5 31.8 Don’t know 3.2 0 Mean (excluding “don’t know”) 1.69 1.86 My state health department currently has ample expertise to help us create an effective plan in this jurisdiction to protect residents from the health impacts of climate change. Strongly agree 5.2 3.0 Somewhat agree 16.1 22.6 Somewhat disagree 29.7 34.6 Strongly disagree 34.8 18.8 Don’t know 14.2 21.1 Mean (excluding “don’t know”) 1.63 1.68 N 158 133 14 strongly disagreed that their LHDs had the expertise to assess the potential local health impacts of climate change increased from 28 percent in 2008 to 47 percent in 2012. The percentage of directors who strongly disagreed that their LHDs had the expertise to develop effective adaptation plans increased from 32 percent in 2008 to 45 percent in 2012. Further, the percentage of LHD directors who strongly disagreed that their state health departments had the expertise to help them to create effective adaptation plans increased from 19 percent to 35 percent. The percentage of LHD directors who believed that preparing to deal with the public health effects of climate change was an important priority for their agencies was lower in 2012 than in 2008. The vast majority of LHD directors in 2012 believed that their agencies lacked sufficient resources to effectively protect local residents from the health impacts of climate change. (See Table 5.) The proportion of LHD directors who believed that preparing to deal with the public health effects of climate change was an important priority for their agencies was substantially lower in 2012 than in 2008. The proportion of directors who agreed that it was a priority decreased from 51 percent in 2008 to 41 percent in 2012. The proportion of directors who strongly disagreed that it was a priority increased from four percent in 2008 to 29 percent in 2012. In 2012, 87 percent of LHD directors believed that their agencies did not have sufficient resources to effectively protect local residents from the health impacts of climate change. In 2012, LHDs’ climate change-related programmatic activity was significantly reduced from 2008. This is consistent with the attitudinal data suggesting that LHDs were less prepared to assess and address the health impacts of climate change on their communities in 2012 than they were in 2008. (See Table 6.) In 2012, out of a possible 12 options for health issues that climate change may affect, respondents selected an average of 5.8 as areas of LHD programmatic Are We Ready? Report 2 Findings TABLE 5 The Majority of LHD Directors Believe that Their LHD Lacks the Resources Necessary to Protect Against Climate Change Public Health Directors 2012 2008 Preparing to deal with the public health effects of climate change is an important priority for my health department. Strongly agree 16.5 12.0 Somewhat agree 24.7 39.1 Somewhat disagree 24.7 40.6 Strongly disagree 28.5 3.8 Don’t know 5.7 4.5 Mean (excluding “don’t know”) 2.31 2.62 My health department currently has sufficient resources to effectively protect local residents from the health impacts of climate change. Strongly agree 1.3 Somewhat agree 7.1 Somewhat disagree 28.6 Strongly disagree 58.4 Don’t know 4.5 Mean (excluding “don’t know”) 1.49 N 158 not asked 133 activity. In 2008, an average of 7.7 of these issues were areas of LHD programmatic activity. The percentage of LHDs that had heat waves and heat-related illnesses as an area of programmatic activity remained largely unchanged in 2012 (56%) from 2008 (57%). For each of the remaining 11 types of health issues, a smaller percentage of LHDs addressed the issue through programmatic activity in 2012 than they had in 2008. Larger percentages of LHD directors in 2012 than in 2008 perceived six types of health issues, out of 12 options available, to have been affected by climate change in their jurisdictions. LHD directors in 2012 believed that climate change had affected an average of 3.32 types of health issues in their jurisdictions; LHD directors in 2008 believed that climate change had affected an average of 3.81 types of health issues. This difference was not statistically significant. (See Table 7.) 15 TABLE 6 LHDs Are Currently Working in Several Programmatic Areas that Will Be Impacted by Climate Change Public Health Directors 2012 2008 Below is a list of health issues that climate change may affect. For each of these health issues, please answer “Yes” if the health issue is currently an area of programmatic activity for your department. Heat waves and heat-related illnesses 56.2 57.1 Storms (including hurricanes) and floods 71.9 76.7 Droughts, forest fires, or brush fires 30.7 37.6 Vector-borne infectious diseases 88.9 94.7 Water- and food-borne diseases 92.1 97.0 Anxiety, depression, or other mental health conditions 21.1 30.8 Quality or quantity of fresh water available to your jurisdiction 46.4 66.9 Quality of the air, including air pollution, in your jurisdiction 34.9 50.4 Unsafe or ineffective sewage and septic system operation 70.6 78.9 Food safety and security 75.0 89.5 Lack of housing for residents displaced by extreme weather events 26.3 37.9 Lack of healthcare services for people with chronic conditions during service disruptions (such as 50.7 57.1 extreme weather events) Mean number of programs in climate-change related programmatic areas (out of a possible 12)* 5.83 7.74 N 158 133 *t = 5.92, p < .001 TABLE 7 The Majority of LHD Directors Believe that Climate Change has Affected Extreme Weather Such as Heat Waves and Floods in Their Jurisdiction Public Health Directors Do you think climate change has affected each of the following in your jurisdiction? Heat waves and heat-related illnesses Storms (including hurricanes) and floods Droughts, forest fires, or brush fires Vector-borne infectious diseases Water- and food-borne diseases Anxiety, depression, or other mental health conditions Quality or quantity of fresh water available to your jurisdiction Quality of the air, including air pollution, in your jurisdiction Unsafe or ineffective sewage and septic system operation Food safety and security Housing needs for residents displaced by extreme weather events Need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) Mean number of perceived local impacts of climate change (out of a possible 12)* N 2012 2008 53.6 56.3 42.4 32.0 25.8 25.8 23.2 40.4 11.3 17.9 24.5 56.9 45.9 47.7 40.6 18.2 22.2 43.8 42.5 13.1 14.7 19.5 30.2 26.6 3.32 158 3.81 133 *t = 1.26, n.s. Are We Ready? Report 2 Findings 16 TABLE 8 The Majority of LHD Directors Believe that Climate Change Will Make Extreme Weather Events, Vector-Borne Infectious Disease, and Poor Air Quality More Common in Their Jurisdiction Public Health Directors 2008 more common no change less common don’t know more common 2012 no less change common don’t know Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Heat waves and heat-related illnesses 73.5 18.5 7.9 0.0 75.2 15.5 0.8 8.5 Storms (including hurricanes) and floods 68.2 21.9 2.0 7.9 57.9 24.1 1.5 16.5 Droughts, forest fires, or brush fires 62.9 27.2 1.3 8.6 60.8 20.0 0.8 18.5 Vector-borne infectious diseases 53.0 33.1 1.3 12.6 56.4 21.1 3.0 19.5 Water- and food-borne diseases 44.4 41.7 0.7 13.2 36.4 34.8 1.5 27.3 Anxiety, depression, or other mental health conditions 49.0 25.2 0.0 25.8 41.9 20.2 0.8 37.2 Quality or quantity of fresh water available to your jurisdiction 49.7 34.4 0.7 15.2 64.6 18.5 3.1 13.8 Quality of the air, including air pollution, in your jurisdiction 54.3 29.8 1.3 14.6 67.4 14.0 2.3 16.3 Unsafe or ineffective sewage and septic system operation 26.5 53.6 3.3 16.6 19.1 48.1 6.1 26.7 Food safety and security 42.0 42.0 1.3 14.7 31.3 49.6 3.1 16.0 Housing needs for residents displaced by extreme weather events 54.3 31.8 0.0 13.9 43.1 38.5 0.0 18.5 Need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) 60.9 25.2 0.0 13.9 55.0 31.0 1.6 12.4 Mean number of anticipated increased impacts (out of a possible 12)* 5.54 5.97 N 158 133 *t = .95, n.s. In both 2012 and 2008, the majority of LHD directors believed that climate change would make the following types of health issues more common or severe over the next 20 years in their jurisdictions: heat waves and heat-related illnesses, storms and floods, droughts and fires, vector-borne infectious diseases, air quality and air pollution, and healthcare needs for people with chronic conditions during service disruptions (such as extreme weather events). Furthermore, a larger percentage of LHD directors in 2012 than in 2008 believed that climate change would make eight types of health issues more common or severe over the next 20 years.* (See Table 8.) In 2012, one-fifth of LHDs were increasing activities in the areas of heat waves and heat-related illnesses (21%) and storms and floods (21%) in response to changes in the climate. In 2012, the least common increased activity (one percent of LHDs) was in the area of anxiety, depression, or other mental health conditions in response to changes in the climate. In 2012, between five percent and 10 percent of LHDs *The response scales for anticipated impacts were different in the 2008 and 2012 surveys. The 2012 scale included more response options, which are not shown in Table 8. To see the full scale and all the responses, please see Tables 25–36. Are We Ready? Report 2 Findings 17 were increasing activities for each of the remaining nine (out of 12) programmatic areas, in response to changes in the climate. (See Table 9.) In 2008, 66 percent of LHDs had at least one type of program that may help to limit future impacts of climate change. In 2012, the percentage of LHDs that had at least one such type of program had decreased to 45 percent. This decrease was statistically significant. (See Table 10.) In 2008, 50 percent of LHDs had programs to encourage or help people to use active transportation, such as walking and cycling. In 2012, only 38 percent of LHDs had such a program. In 2008, eight percent of LHDs had programs to educate the public about climate change and its potential impact on health. In 2012, only four percent of LHDs had such a program. Out of six options available to respondents, only one was more prevalent in 2012 than in 2008: programs to encourage or help people to change the way they purchase foods such as buying locally grown foods, organic foods, or plant-based foods (36% and 34%, respectively). TABLE 9 The Majority of LHDs Are Not Changing Current Activities in Response to Climate Change Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities Is your health department changing its activities in any of the following areas, in response to changes in the climate? Heat waves and heat-related illnesses 21.2 10.6 68.2 Storms (including hurricanes) and floods 20.5 13.9 65.6 Droughts, forest fires, or brush fires 9.3 9.3 81.5 Vector-borne infectious diseases 7.9 17.9 74.2 Water- and food-borne diseases 6.0 18.5 75.5 Anxiety, depression, or other mental health conditions 1.3 14.0 84.7 Quality or quantity of fresh water available to your jurisdiction 7.3 9.9 82.8 Quality of the air, including air pollution, in your jurisdiction 5.3 13.9 80.8 Unsafe or ineffective sewage and septic system operation 4.6 14.6 80.8 Food safety and security 6.0 17.9 76.2 Lack of housing for residents displaced by extreme weather events 6.6 12.6 80.8 Lack of healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) 7.3 16.7 76.0 Are We Ready? Report 2 Findings 18 TABLE 10 Few LHDs Are Engaged in Mitigation Programs for Climate Change Public Health Directors 2012 Current program 2008 Planned program Current program Planned program Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… Encourage or help people to use active transportation, such as walking and cycling 37.5 19.7 50.4 11.3 Encourage or help people to use mass transportation 15.1 7.9 15.0 6.0 Encourage or help people to change the way they purchase foods such as buying locally grown foods, organic foods, or plant-based foods 36.2 20.4 33.8 9.0 Educate the public about climate change and its potential impact on health 3.9 15.8 8.3 18.0 Reduce fossil fuel use or conserve energy in the operation of the health department 18.5 13.9 21.1 18.8 Help residents of your jurisdiction reduce their fossil fuel use or conserve energy 5.3 7.9 6.0 8.3 N 158 133 Number of current and planned mitigation programs 2012 2008 0 55.2 33.8 1 16.7 25.6 2 11.5 23.3 3 8.0 11.3 4 5.7 2.3 5 2.3 3.0 6 0.6 0.8 Mean number of current programs 1.02 1.35 t = 2.06, p<.05 Are We Ready? Report 2 Findings 19 Part III: Breakdown by Belief in Climate Change, Geographic Region, and Department Budget Part III of the report examines differences in perceptions and programming among the 2012 survey respondents based on three potentially important factors: belief in climate change; geographic location; and LHD budget. The findings reveal that these factors were strongly associated with perceptions about climate change and the health impacts of climate change, as well as current and planned mitigation activities.* Part IIIa: Perceptions—Tables 11–21 Belief in Climate Change Geographic Region LHD directors’ belief that climate change was occurring was strongly associated with their perceptions of current and future climate change impacts in their jurisdictions. Seventy-seven percent of directors who believed that climate change was happening also believed that their jurisdictions had experienced climate change in the past 20 years and 88 percent believed that their jurisdictions would experience climate change over the next 20 years. In contrast, 88 percent of directors who did not believe climate change was real did not believe that their jurisdictions had experienced climate change in the past 20 years, and 82 percent did not expect local impacts. Northeastern LHD directors were more likely than Western, Midwestern, or Southern LHD directors to believe that their jurisdictions would experience climate change and its related public health impacts over the next two decades. Northeastern LHD directors were also more worried about the impact of climate change on the health and well-being of people in their jurisdictions. However, the percentage of Northeastern LHD directors who believed that their jurisdictions had already experienced climate change in the past two decades (63%) was slightly lower than that of Western LHD directors (69%), Midwestern LHD Directors (67%), or Southern LHD directors (65%). Directors who believed that climate change was occurring were more likely to report that climate change was an important priority for their departments. They were less likely to believe that their departments had the necessary expertise to conduct risk assessments, to develop adaptation plans, or to believe that their departments had sufficient resources to protect local residents from the health impacts of climate change. Directors who did not believe that climate change was occurring were about as likely to believe they were knowledgeable about the potential public health impacts of climate change (59%) as directors who believed climate change was occurring (62%). See Appendix B for tables 11–56 *Note that the number of respondents for some of these analyses is small and should be interpreted cautiously. Are We Ready? Report 2 Findings Climate change adaptation was a priority for a larger percentage of Western and Northeastern LHDs (48% and 44%, respectively) than Southern or Midwestern LHDs (38% and 36%, respectively). Southern LHD directors were most likely to believe that they (72%) and other senior managers (39%) were knowledgeable about potential health impacts of climate change. Midwestern LHD directors had the lowest selfassessed knowledge: 51percent perceived themselves to be knowledgeable, and 33 percent believed that other senior managers were knowledgeable. Department Budget Directors of LHDs with large budgets ($5M+) were more likely than directors of LHDs with mid-sized budgets ($1–4.99M) and small budgets (<$1M) to believe that their jurisdictions had experienced climate 20 change in the past 20 years and to believe that their jurisdictions would experience climate change in the next 20 years. Three-quarters (76%) of directors of LHDs with large budgets believed that their jurisdictions had experienced climate change in the past 20 years, compared to 62 percent of directors of LHDs with small budgets and 58 percent of directors of LHDs with mid-sized budgets. Over four-fifths (86%) of directors of LHDs with large budgets believed that their jurisdictions would experience climate change in the next 20 years, compared to 76 percent of directors of LHDs with small budgets and 65 percent of directors of LHDs with mid-sized budgets. Eighty percent of directors of LHDs with large budgets were worried about the impact of climate change on the health and well-being of people in their jurisdictions, compared to 60 percent of directors of LHDs with small budgets and 63 percent of directors of LHDs with mid-sized budgets. Directors of LHDs with large budgets were much more likely than directors of LHDs with mid-sized budgets or small budgets to believe themselves knowledgeable about the potential public health impacts of climate change (73%, 56%, and 48%, respectively). Directors of LHDs with large budgets were also more likely to believe that the other relevant senior managers in their departments were knowledgeable about the impacts. They were somewhat more likely to believe that their departments had the expertise needed to conduct climate change risk assessments and develop effective climate change adaptation plans. Directors of LHDs with large budgets were more likely to believe that preparing to deal with climate change health impacts was an important priority for their departments. However, they were no more likely to believe that their departments had sufficient resources to effectively protect local residents from the health impacts of climate change: only nine percent of directors of LHDs with large budgets, five percent of directors of LHDs with mid-sized budgets, and 10 percent of directors of LHDs with small budgets believed that their departments had sufficient resources. Part IIIb: Perceived Health Impacts of Climate Change—Tables 22–24 Belief in Climate Change The number of types of health issues that LHD directors perceived in their jurisdictions as having been affected by climate change was strongly statistically related to their beliefs that climate change was occurring. Directors who believed that climate change was happening perceived an average of 4.3 types of health issues as having been affected locally by climate change, while directors who were uncertain whether climate change was happening perceived 0.6 types of health issues as having been affected by climate change; those who believed climate change was not happening perceived 0.1 types of issues (see column of means in Table 24). Among LHD directors who believed that climate change was happening, the most frequently cited types of local health issues that were believed to have been affected by climate change were storms and floods (68%), heat waves and heat-related illness (63%), and droughts, forest fires, or brush fires (52%). Are We Ready? Report 2 Findings Few LHD directors who were uncertain whether climate change was occurring or who believed that it was not occurring recognized that climate change had affected any types of local health issues. A quarter of directors who were uncertain believed that climate change had affected storms and floods (27%). Twenty percent believed that climate change had affected mental health conditions, including anxiety and depression. Geographic Region The number of types of health issues that LHD directors perceived in their jurisdictions as having been affected by climate change was not significantly different between Northeastern LHD directors (3.08), Midwestern LHD directors (3.63), Southern LHD directors (3.83), and Western LHD directors (2.85). Regional differences in the types of health issues that LHD directors perceived as having been affected in their jurisdictions were apparent. A larger percentage of Southern LHD directors (62%) than Midwestern 21 (61%), Northeastern (57%), or Western (39%) LHD directors perceived heat waves and heat-related illness as having been affected by climate change. Larger percentages of Northeastern and Midwestern LHD directors than Southern and Western LHD directors perceived storms (including hurricanes), floods, and vector-borne infectious diseases as having been affected by climate change. Conversely, larger percentages of Western (57%) and Southern (57%) LHD directors than Midwestern (42%) and Northeastern (20%) LHD directors perceived droughts, forest fires, or brush fires as having been affected by climate change. Larger percentages of Southern (35%) and Midwestern (34%) LHD directors than Western (18%) and Northeastern (17%) LHD directors perceived anxiety, depression, or other mental health conditions as having been affected by climate change. Larger percentages of Western (54%) and Southern (43%) LHD directors than Northeastern (37%) and Midwestern (34%) LHD directors perceived air quality as having been affected by climate change. Department Budget The number of types of health issues that directors of LHDs with large budgets perceived in their jurisdictions as having been affected by climate change (4.0) was higher than the number perceived by directors of LHDs with small budgets (3.38) and mid-sized budgets (2.64). Also, a larger percentage of directors of LHDs with large budgets perceived heat waves and heatrelated illness; droughts, forest fires, or brush fires; vector-borne infectious diseases; water-borne and food-borne diseases; quality or quantity of fresh water available to their jurisdictions; quality of the air in their jurisdictions; housing needs for residents displaced by extreme weather events; and need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) as having been affected by climate change. Part IIIc: Anticipated Health Impacts of Climate Change—Tables 25–36 Belief in Climate Change Geographic Region The number of types of health issues that LHD directors anticipated becoming more, or much more, common or severe over the next 20 years because of climate change in their jurisdictions was strongly statistically related to their belief that climate change was occurring. LHD directors who believed that climate change was occurring anticipated, on average, that seven types of health issues would become more common or severe, or much more common or severe, in their jurisdictions, compared to 2.4 types of health issues anticipated by directors who were uncertain whether climate change was occurring and compared to 0.4 types of issues anticipated by directors who did not believe that climate change was occurring (see Table 36). The average number of types of health issues that LHD directors anticipated becoming more or much more common or severe in their jurisdictions over the next 20 years because of climate change was very similar for Northeastern, Midwestern, Southern, and Western LHD directors. Among LHD directors who believed that climate change was occurring, the health issues anticipated to become more or much more common or severe over the next 20 years because of climate change were heat waves and heat-related illnesses; storms and floods; and droughts, forest fires, or brush fires. Are We Ready? Report 2 Findings Regional similarities and differences in the types of health issues anticipated to become more or much more common or severe were apparent. The issues that the greatest percentages of Midwestern and Southern LHD directors anticipated becoming more or much more common were severe heat waves and heat-related illness (78% and 71%, respectively); storms and floods (76% and 63%, respectively); and droughts, forest fires, or brush fires (62% and 63%, respectively). The issues that the greatest percentages of Northeastern LHD directors anticipated were storms and floods (80%); heat waves and heat-related illness (77%); and the need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) (70%). The issues that the greatest 22 percentages of Western LHD directors anticipated were droughts, forest fires, or brush fires (79%); the need for health services for people with chronic conditions during service disruptions (75%); heat and heat-related illness (71%); and air quality (71%). Department Budget The average number of types of health issues that LHD directors anticipated becoming more or much more common or severe in their jurisdictions over the next 20 years because of climate change was significantly larger for directors of LHDs with large budgets (6.8) than for directors of LHDs with small budgets (5.5) or mid-sized budgets (4.4). Of the available health issues, LHD directors with large budgets most anticipated heat waves and heatrelated illness (87%), storms and floods (78%), and air quality (78%) becoming more or much more common or severe. Large percentages of directors of LHDs with large budgets also anticipated a need for health services for people with chronic conditions during service disruptions (72%); droughts, forest fires, or brush fires (69%); and housing needs for residents displaced by extreme weather events (69%). The issues that the greatest percentages of directors of LHDs with mid-sized budgets anticipated were heat waves and heat-related illness (61%); need for health services for people with chronic conditions during service disruptions (58%); storms and floods (55%); and droughts, forest fires, and fires (55%). The issues that the greatest percentages of directors of LHDs with small budgets anticipated were also heat waves and heat-related illness (70%), storms and floods (68%), and droughts and fires (63%). Part IIId: Current Activity and Changes to Programs in Climate Change-Related Areas— Tables 37–49 Belief in Climate Change Geographic Region LHDs with directors who believed that climate change was happening had programmatic activity in an average of 6.13 climate change-related areas. LHDs with directors who were uncertain whether climate change was happening, or who believed that climate change was not happening, had lower average numbers of programmatic activity (5.52 and 5.32, respectively), but the differences were not statistically significant (see Table 49). Southern LHDs had programmatic activity in an average of 6.61 climate change-related areas. This was a slightly higher number than that of Midwestern, Western, or Northeastern LHDs (5.86, 5.82, and 5.03, respectively). Southern LHDs were also increasing a slightly higher number of activities in response to changes in the climate than were Midwestern, Western, or Northeastern LHDs. However, these differences were not statistically significant (see Table 49). LHDs with directors who believed that climate change was happening were increasing an average of 1.15 activities in response; LHDs with directors who were uncertain whether climate change was happening were increasing an average of 0.29 activities; and LHDs with directors who believed that climate change was not happening were not changing activities in response to climate change. Department Budget Are We Ready? Report 2 Findings LHDs with large budgets had programmatic activity in an average of 7.05 climate change-related areas. This was significantly higher than the average number of types of climate change-related areas of programmatic activity for LHDs with mid-sized or small budgets (5.47 and 5.33, respectively). LHDs with large budgets were also changing a slightly higher number of activities in response to changes in the climate than were LHDs with mid-sized or small budgets. 23 Part IIIe: Mitigation-Related Programs—Tables 50–56 Belief in Climate Change LHDs with directors who believed that climate change was happening had a significantly higher average number of current programs that may help to limit future climate change than LHDs with directors who were uncertain whether climate change was happening or believed that climate change was not happening (see Table 56). LHDs with directors who believed climate change was happening had an average of 1.2 current programs; LHDs with directors who were uncertain if climate change was happening had an average of 0.7 programs; and LHDs with directors who believed that climate change was not happening had an average of 0.4 programs. LHDs with directors who believed that climate change was happening, who were uncertain whether climate change was happening, or who believed that climate change was not happening did not differ significantly in their average number of planned programs that may help to limit future climate change. Geographic Region Western LHDs had a higher average number of current programs that may help to limit future climate change Are We Ready? Report 2 Findings (1.35) than did Southern (1.10), Midwestern (0.86), or Northeastern LHDs (0.73), although the differences were not statistically significant. Midwestern LHDs had the highest average number of planned programs that may help to limit future climate change, although the differences between the regions were again not significant. The percentage of Western LHDs that had current programs to encourage or help people to use active transportation, such as walking and cycling, was second to the percentage of Southern LHDs that had such programs (39.3% and 44.7%, respectively). Department Budget LHDs with large budgets had a significantly higher average number of current programs that may help to limit future climate change than did LHDs with mid-sized or small budgets. LHDs with large budgets had an average of 1.8 current programs, while LHDs with mid-sized and small budgets had an average of 0.6 programs. LHDs with large budgets had a higher average number of planned programs that may help to limit future climate change than did LHDs with mid-sized or small budgets, although the differences were not statistically significant. 24 Overall, history has shown that climate variability is an important determinant of health. The health effects of climate change are part of a broader context, and the existence of local physical and social conditions preceding extreme weather events can either moderate or exacerbate the overall impact. Climate change will affect human health and the geographic range, incidence, and severity of health outcomes that are sensitive to weather and climate. Climate change affects public health at many dimensions. A substantial amount of literature focuses on climate change at the global scale, and this report examines public health preparedness for climate change at the local level. This report identifies critical gaps in resources, programs, and expertise in the U.S. public health system’s capacity to respond to the health impacts of climate change. Specifically, this survey found that in 2012, 80 percent of LHD directors believed their LHDs lacked the expertise to create effective climate change adaptation plans, and 87 percent of LHD directors believed their LHDs lacked sufficient resources to effectively protect the local population from the impacts of climate change. Only four percent of LHDs have programs to educate the public about climate change and its potential impact on health. A sizeable majority of LHD directors recognized the threat of climate change both in 2008 and 2012. Yet, LHDs continued to lack the expertise and resources necessary to prepare for and address the health effects. As climates proceed to change, this space between need and ability poses a significant and urgent threat that decision-makers at all government levels must recognize and address to protect the public. From a public health perspective, scientific research must facilitate advocacy work. Involving local communities in monitoring, discussing, advocating, and assisting with climate change adaptation is crucial. Are We Ready? Report 2 Conclusion NACCHO supports local public health activities to address climate change, including the following: > Instituting strong, continuous, science-based, and culturally competent education programs to inform policymakers, communities, and LHD staff on the health impacts of climate change and on issues and opportunities regarding mitigation of climate change and adaptation to climate change. > Developing local climate change mitigation plans and adaptation plans that address the health impacts of climate change. > Participating in scientifically based research programs related to climate change that readily translate to the practice of public health. > Supporting research on emerging health impacts related to climate change and public health best practice standards. > Conducting ongoing health monitoring of climate change impacts on local communities, including conducting vulnerability assessments and environmental studies and using the best available tools (e.g., geographic information system mapping) and sciences (e.g., ecology, climatology, geography) to better understand the impacts of climate change on public health. Particular attention must be given to the most vulnerable populations. > Advocating for policies, plans, programs, and resources to support climate change mitigation and adaptation. Mitigation and adaptation activities should be healthbased, science-based, equitable, and sustainable. > Building partnerships with key local stakeholders to engage and enlist them in the response to climate change. > Providing opportunities to educate and train public health leadership and the public health workforce to ensure the capacity of LHDs to respond to the health effects of climate change. > Using environmental health regulatory activities and authorities to protect the public’s health from climate change. 26 References 1. Confalonieri, U., Menne, B., Akhtar, R., Ebi, K.L., Hauengue, M. et al. (2007). Human Health. In: Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden, and C.E. Hanson, Eds., Cambridge University Press: Cambridge, UK, 391–431. 2. U.S. Global Change Research Program. (2009). Global Climate Change Impacts in the United States. T.R. Karl, J.M. Melillo, and T.C. Peterson, Eds., Cambridge University Press: Cambridge, UK. 3. 4. 5. Environmental Defense Fund, National Association of County and City Health Officials, and George Mason University. (2008). Are We Ready: Preparing for the Public Health Challenges of Climate Change. Retrieved Jan. 28, 2014, from www.naccho.org/topics/ environmental/climatechange/upload/are-we-ready_14_ view.pdf. Intergovernmental Panel on Climate Change. (2013). Summary for Policymakers. In: Climate Change 2013: The Physical Science Basis Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. T.F. Stocker, D. Qin, G.K. Plattner, M. Tignor, S.K. Allen, J. Boschung, A. Nauels, Y. Xia, V. Bex, and P.M. Midgley, Eds., Cambridge University Press: Cambridge, UK, and New York, 3. 10. National Oceanic and Atmospheric Administration, National Climatic Data Center. (2013). State of the Climate: Global Analysis for Annual 2013. Retrieved Jan. 27, 2014, from http://www.ncdc.noaa.gov/sotc/ global/2013/13. 11. U.S. Global Change Research Program. (2009). 28. 12. Intergovernmental Panel on Climate Change. (2013). 18. 13. U.S. Global Change Research Program. (2009). 28. 14. U.S. Global Change Research Program. (2009). 41. Leiserowitz, A., Maibach, E., Roser-Renouf, C., Smith, N., & Hmielowski, J. (2011). Climate Change in the American Mind: Americans’ Global Warming Beliefs and Attitudes in November 2011. Yale University and George Mason University: New Haven, CT. Retrieved Jan. 28, 2014, from http://environment.yale.edu/climate/files/ climatebeliefsnovember2011.pdf. 15. U.S. Global Change Research Program. (2009). 30. Intergovernmental Panel on Climate Change. (2007). Climate Change 2007: The Physical Science Basis. Contribution of Working Group I to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. S. Solomon, D. Qin, M. Manning, Z. Chen, M. Marquis, K.B. Averyt, M. Tignor, and H.L. Miller, Eds., Cambridge University Press: Cambridge, UK, and New York. 20. Intergovernmental Panel on Climate Change. (2013). 9. 6. Confalonieri et al. (2007). 391–431. 7. Intergovernmental Panel on Climate Change. (2007). Summary for Policymakers. In: Climate Change 2007: The Physical Science Basis. Contribution of Working Group I to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. S. Solomon, D. Qin, M. Manning, Z. Chen, M. Marquis, K.B. Averyt, M. Tignor, and H.L. Miller, Eds., Cambridge University Press: Cambridge, UK, and New York, 5. 8. 9. U.S. Global Change Research Program. (2009). 9. Are We Ready? Report 2 Conclusion 16. U.S. Global Change Research Program. (2009). 32. 17. U.S. Global Change Research Program. (2009). 33–34. 18. U.S. Global Change Research Program. (2009). 33. 19. U.S. Global Change Research Program. (2009). 35. 21. Intergovernmental Panel on Climate Change. (2013). 6. 22. U.S. Global Change Research Program. (2009). 37. 23. U.S. Global Change Research Program. (2009). 24. Geographic region is defined by the U.S. Census Bureau as follows: The Northeastern states are CT, MA, ME, NH, NY, PA, RI, and VT. The Midwestern states are IA, IL, IN, KS, MI, MN, MO, OH, NE, ND, SD, and WI. The Southern states are AL, AR, DC, DE, FL, GA, LA, MD, MS, NC, OK, SC, TN, TX, VA, and WV. The Western states are AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, and WY. 25. Schuldt, J., Konrath, S., & Schwarz, N. (2011). “Global warming” or “climate change”?: Whether the planet is warming depends on question wording. Public Opinion Quarterly, 75(1). Retrieved Jan. 28, 2014, from http:// poq.oxfordjournals.org/content/75/1/115.full.pdf+html. 27 Appendix A: Survey Public Health and Climate Change: Are We Ready? Thank you for taking the time to complete this survey. It should take about 10 minutes to complete. We are interested in learning how public health departments are responding to the health impacts climate change may be causing in the U.S. Your responses will help NACCHO and CDC to develop materials that support your efforts. To begin, we’d like to ask you some background questions. What is the name of your health department? __________________________________________________________ 1. What is the approximate annual budget for your health department? Less than $1,000,000 $1,000,000 to $4,999,999 $5 million or more 2. “Climate change” refer to the idea that the world’s average temperature has been increasing over the past 150 years, may be increasing more in the future, and that the world’s climate may change as a result. What do you think? Do you think that climate change is happening? Yes No Don’t Know [ Ask if q2 = yes] 3. How sure are you that climate change is happening? Not at all sure Somewhat sure Very sure Extremely sure [ Ask if q2 = no] 4. How sure are you that climate change is not happening? Not at all sure Somewhat sure Very sure Extremely sure 5. Assuming climate change is happening, do you think it is ... Caused mostly by human activities Caused mostly by natural changes in the environment Other None of the above because climate change isn’t happening Are We Ready? Report 2 Appendices 29 6. When do you think climate change will begin to harm people in the U.S.? They are being harmed now In 10 years In 25 years In 50 years In 100 years Never 7. How much do you agree or disagree with the following statements? Strongly Disagree Somewhat Disagree Somewhat Agree Strongly Agree Don’t Know a) My jurisdiction has experienced climate change in the past 20 years. b) My jurisdiction will experience climate change in the next 20 years. c) In the next 20 years, it is likely that my jurisdiction will experience one or more serious public health problems as a result of climate change. d) I am worried about the impact of climate change on the health and well-being of people in my jurisdiction. e) My health department currently has ample expertise to assess the potential public health impacts associated with climate change that could occur in my jurisdiction. f) Preparing to deal with the public health effects of climate change is an important priority for my health department. 8. How much do you agree or disagree with the following statements? Strongly Disagree Somewhat Disagree Somewhat Agree Strongly Agree Don’t Know a) I am knowledgeable about the potential public health impacts of climate change. b) The other relevant senior managers in my health department are knowledgeable about the potential public health impacts of climate change. c) My health department currently has ample expertise to create an effective plan to protect local residents from the health impacts of climate change. d) My state health department currently has ample expertise to help us create an effective plan in this jurisdiction to protect residents from the health impacts of climate change. e) My health department currently has sufficient resources to effectively protect local residents from the health impacts of climate change. Are We Ready? Report 2 Appendices 30 9. Below is a list of health issues that climate change may affect. For each of these health issues, please answer “Yes” if the health issue is currently an area of programmatic activity for your department. (Please answer “No” if a department other than the health department performs this activity OR if no department in your jurisdiction performs this activity. Yes No Don’t know a) Heat waves and heat-related illnesses b) Storms (including hurricanes) and floods c) Droughts, forest fires, or brush fires d) Vector-borne infectious diseases e) Water- and food-borne diseases f) Anxiety, depression, or other mental health conditions g) Quality or quantity of fresh water available to your jurisdiction h) Quality of the air, including air pollution, in your jurisdiction i) Unsafe or ineffective sewage and septic system operation j) Food safety and security k) Housing for residents displaced by extreme weather events l) Need for healthcare services for people with chronic conditions during service disruptions, such as extreme weather events 10. Do you think climate change has affected each of the following in your jurisdiction? Increased No change Decreased a) Heat waves and heat-related illnesses b) Storms (including hurricanes) and floods c) Droughts, forest fires, or brush fires d) Vector-borne infectious diseases e) Water- and food-borne diseases f) Anxiety, depression, or other mental health conditions g) Quality or quantity of fresh water available to your jurisdiction h) Quality of the air, including air pollution, in your jurisdiction i) Unsafe or ineffective sewage and septic system operation j) Food safety and security k) Housing needs for residents displaced by extreme weather events l) Need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) Are We Ready? Report 2 Appendices 31 11. Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common or severe Somewhat more common or severe No change Somewhat less common or severe Much less common or severe Don’t know a) Heat waves and heat-related illnesses b) Storms (including hurricanes) and floods c) Droughts, forest fires, or brush fires d) Vector-borne infectious diseases e) Water- and food-borne diseases f) Anxiety, depression, or other mental health conditions g) Quality or quantity of fresh water available to your jurisdiction h) Quality of the air, including air pollution, in your jurisdiction i) Unsafe or ineffective sewage and septic system operation j) Food safety and security k) Housing needs for residents displaced by extreme weather events l) Need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) 12. Is your health department changing its activities in any of the following areas, in response to changes in the climate ? Increasing activities Changing activities for reasons unrelated to climate change No changes to activities in response to climate change a) Heat waves and heat-related illnesses b) Storms (including hurricanes) and floods c) Droughts, forest fires, or brush fires d) Vector-borne infectious diseases e) Water- and food-borne diseases f) Anxiety, depression, or other mental health conditions g) Quality or quantity of fresh water available to your jurisdiction h) Quality of the air, including air pollution, in your jurisdiction i) Unsafe or ineffective sewage and septic system operation j) Food safety and security a) Housing for residents displaced by extreme weather events b) Need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) Are We Ready? Report 2 Appendices 32 13. Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to.... Current Program Planned Program No Current or Planned Program a) Encourage or help people to use active transportation, such as walking and cycling b) Encourage or help people to use mass transportation c) Encourage or help people to change the way they purchase foods such as buying locally-grown foods, organic foods, or plant-based foods d) Educate the public about climate change and its potential impact on health e) Reduce fossil fuel use or conserve energy in the operation of the health department f) Help residents of your jurisdiction reduce their fossil fuel use or conserve energy 14. We would like to contact the Director of Environmental Health Services at your public health department to ask a few additional questions about resources your department may be using to protect people in your jurisdiction from the impacts of climate change (such as vulnerability assessments). Please write the name and email address of the individual at your department who is responsible for environmental health: Name: ________________________________________________________________________________________ Email: _________________________________________________________________________________________ Thank you for taking the time to complete this survey! 15. Would you like to receive a summary report of the results? No Yes 16. When we release this report we would like to have some survey participants who are willing to provide quotations for our report or to speak to the press. These people would be identified as having participated in the survey and would be contacted later with a more specific request. Would you be willing to provide quotations for the report? Yes—quotations for report Yes—speak to the press No thanks Are We Ready? Report 2 Appendices 33 Appendix B: Tables 11–56 Table 11 My jurisdiction has experienced climate change in the past 20 years. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 18.4 47.5 8.9 12.0 13.3 158 Yes 23.4 54.0 5.6 3.2 13.7 124 No 0.0 5.9 23.5 64.7 5.9 17 Don’t Know 0.0 41.2 17.6 23.5 17.6 17 Northeast 25.0 37.5 6.3 6.3 25.0 32 Midwest 15.4 51.3 10.3 12.8 10.3 39 South 17.5 47.5 7.5 17.5 10.0 40 West 17.2 51.7 13.8 6.9 10.3 29 $1M< 19.0 42.9 9.5 12.7 15.9 63 $1–4.99M 15.0 42.5 7.5 20.0 15.0 40 $5M+ 20.0 56.4 9.1 5.5 9.1 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Table 12 My jurisdiction will experience climate change in the next 20 years. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 39.2 37.3 6.3 9.5 7.6 158 Yes 50.0 38.7 3.2 1.6 6.5 124 No 0 5.9 17.6 64.7 11.8 17 Don’t Know 0 58.8 17.6 11.8 11.8 17 Northeast 59.4 25.0 3.1 6.3 6.3 32 Midwest 35.9 41.0 2.6 10.3 10.3 39 South 35.0 35.0 5.0 15.0 10.0 40 West 34.5 44.8 13.8 3.4 3.4 29 $1M< 39.7 36.5 6.3 11.1 6.3 63 $1–4.99M 30.0 35.0 10.0 15.0 10.0 40 $5M+ 45.5 40.0 3.6 3.6 7.3 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 34 Table 13 In the next 20 years, it is likely that my jurisdiction will experience one or more serious public health problems as a result of climate change. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 29.1 32.3 13.3 10.8 14.6 158 Yes 36.3 37.1 8.9 3.2 14.5 124 No 0.0 0.0 23.5 64.7 11.8 17 Don’t Know 5.9 29.4 35.3 11.8 17.6 17 Northeast 40.6 34.4 6.3 6.3 12.5 32 Midwest 25.6 33.3 12.8 12.8 15.4 39 South 27.5 32.5 17.5 12.5 10.0 40 West 34.5 31.0 13.8 10.3 10.3 29 $1M< 28.6 36.5 12.7 12.7 9.5 63 $1–4.99M 22.5 27.5 17.5 15.0 17.5 40 $5M+ 34.5 30.9 10.9 5.5 18.2 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Table 14 I am worried about the impact of climate change on the health and well-being of people in my jurisdiction. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 31.8 35.7 12.7 14.6 5.1 157 Yes 40.7 39.0 8.1 6.5 5.7 123 No 0.0 17.6 11.8 70.6 0.0 17 Don’t Know 0.0 29.4 47.1 17.6 5.9 17 Northeast 41.9 32.3 6.5 9.7 9.7 31 Midwest 28.2 33.3 15.4 15.4 7.7 39 South 30.0 32.5 20.0 17.5 0.0 40 West 31.0 41.4 6.9 17.2 3.4 29 $1M< 27.4 32.3 16.1 17.7 6.5 62 $1–4.99M 22.5 40.0 12.5 20.0 5.0 40 $5M+ 43.6 36.4 9.1 7.3 3.6 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 35 Table 15 My health department currently has ample expertise to assess the potential public health impacts associated with climate change that could occur in my jurisdiction. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 5.1 13.9 29.1 46.8 5.1 158 Yes 3.2 14.5 30.6 47.6 4.0 124 No 23.5 5.9 23.5 47.1 0.0 17 Don’t Know 0.0 17.6 23.5 41.2 17.6 17 Northeast 6.3 9.4 31.3 46.9 6.3 32 Midwest 2.6 15.4 20.5 53.8 7.7 39 South 7.5 12.5 40.0 37.5 2.5 40 West 6.9 13.8 37.9 37.9 3.4 29 $1M< 4.8 4.8 31.7 55.6 3.2 63 $1–4.99M 5.0 15.0 27.5 42.5 10.0 40 $5M+ 5.5 23.6 27.3 40.0 3.6 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Table 16 Preparing to deal with the public health effects of climate change is an important priority for my health department. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 16.5 24.7 24.7 28.5 5.7 158 Yes 21.0 28.2 25.0 21.0 4.8 124 No 0.0 11.8 23.5 64.7 0.0 17 Don’t Know 0.0 11.8 23.5 47.1 17.6 17 Northeast 18.8 25.0 18.8 31.3 6.3 32 Midwest 20.5 15.4 20.5 35.9 7.7 39 South 12.5 25.0 35.0 25.0 2.5 40 West 13.8 34.5 27.6 24.1 0.0 29 $1M< 17.5 25.4 19.0 28.6 9.5 63 $1–4.99M 5.0 22.5 27.5 42.5 2.5 40 $5M+ 23.6 25.5 29.1 18.2 3.6 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 36 Table 17 I am knowledgeable about the potential public health impacts of climate change. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 14.7 44.2 19.9 19.2 1.9 156 Yes 16.3 45.5 21.1 15.4 1.6 123 No 17.6 41.2 5.9 29.4 5.9 17 Don’t Know 0.0 37.5 25.0 37.5 0.0 16 Northeast 15.6 40.6 25.0 15.6 3.1 32 Midwest 12.8 38.5 17.9 25.6 5.1 39 South 20.5 51.3 17.9 10.3 0.0 39 West 17.2 48.3 24.1 10.3 0.0 29 $1M< 8.1 40.3 22.6 29.0 0.0 62 $1–4.99M 7.7 48.7 25.6 12.8 5.1 39 $5M+ 27.3 45.5 12.7 12.7 1.8 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Table 18 The other relevant senior managers in my health department are knowledgeable about the potential public health impacts of climate change. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 6.4 29.5 30.8 28.2 5.1 156 Yes 5.7 31.7 32.5 25.2 4.9 123 No 17.6 11.8 29.4 35.3 5.9 17 Don’t Know 0.0 31.3 18.8 43.8 6.3 16 Northeast 3.1 34.4 31.3 28.1 3.1 32 Midwest 5.1 28.2 17.9 41.0 7.7 39 South 15.4 23.1 41.0 12.8 7.7 39 West 3.4 37.9 34.5 24.1 0.0 29 $1M< 6.5 19.4 24.2 46.8 3.2 62 $1–4.99M 5.1 25.6 43.6 17.9 7.7 39 $5M+ 7.3 43.6 29.1 14.5 5.5 55 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 37 Table 19 My health department currently has ample expertise to create an effective plan to protect local residents from the health impacts of climate change. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 4.5 12.3 34.4 45.5 3.2 154 Yes 3.3 11.5 35.2 47.5 2.5 122 No 18.8 6.3 31.3 37.5 6.3 16 Don’t Know 0.0 25.0 31.3 37.5 6.3 16 Northeast 3.1 12.5 40.6 40.6 3.1 32 Midwest 5.1 10.3 17.9 61.5 5.1 39 South 10.5 10.5 42.1 34.2 2.6 38 West 0.0 14.3 50.0 35.7 0.0 28 $1M< 3.2 8.1 32.3 54.8 1.6 62 $1–4.99M 5.1 10.3 35.9 43.6 5.1 39 $5M+ 5.7 18.9 35.8 35.8 3.8 53 2012 Totals 2012 results by… Belief in Climate Change Region Budget Table 20 My state health department currently has ample expertise to help us create an effective plan in this jurisdiction to protect residents from the health impacts of climate change. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 5.2 16.1 29.7 34.8 14.2 155 Yes 4.9 17.9 26.8 34.1 16.3 123 No 12.5 6.3 25.0 50.0 6.3 16 Don’t Know 0.0 12.5 56.3 25.0 6.3 16 Northeast 3.1 15.6 31.3 37.5 12.5 32 Midwest 5.1 7.7 25.6 41.0 20.5 39 South 7.9 18.4 34.2 26.3 13.2 38 West 6.9 24.1 34.5 27.6 6.9 29 $1M< 4.8 8.1 25.8 45.2 16.1 62 $1–4.99M 2.6 12.8 38.5 33.3 12.8 39 $5M+ 7.4 27.8 27.8 24.1 13.0 53 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 38 Table 21 My health department currently has sufficient resources to effectively protect local residents from the health impacts of climate change. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know N 1.3 7.1 28.6 58.4 4.5 154 Yes 0.0 5.7 30.1 60.2 4.1 123 No 13.3 6.7 20.0 53.3 6.7 15 Don’t Know 0.0 18.8 25.0 50.0 6.3 16 Northeast 0.0 3.1 28.1 59.4 9.4 32 Midwest 0.0 12.8 15.4 66.7 5.1 39 South 5.4 5.4 43.2 43.2 2.7 37 West 0.0 6.9 37.9 55.2 0.0 29 $1M< 1.6 8.2 18.0 70.5 1.6 62 $1–4.99M 2.6 2.6 33.3 53.8 7.7 39 $5M+ 0.0 9.3 37.0 48.1 5.6 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 22 Perceived Local Impacts of Climate Change: Heat Waves, Storms, Droughts, and Vector-Borne Diseases Do you think climate change has affected each of the following in your jurisdiction? Heat waves and heat-related illness Storms (including hurricanes) and floods Droughts, forest fires, or brush fires Vector-borne infectious diseases N 53.6 56.3 42.4 32 151 Yes 65.8 67.5 51.7 40.3 120 No 0.0 0.0 0.0 0.0 16 Don’t Know 13.3 26.7 13.3 0.0 15 Northeast 56.7 70.0 20.0 43.3 30 Midwest 60.5 65.8 42.1 40.5 38 South 62.2 56.8 56.8 24.3 37 West 39.3 42.9 57.1 17.9 28 $1M< 47.5 59.0 44.3 31.7 61 $1–4.99M 50.0 47.4 31.6 18.4 38 $5M+ 63.5 59.6 48.1 42.3 52 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 39 TABLE 23 Perceived Local Impacts of Climate Change: Water- and Food-Borne Diseases, Mental Health Conditions, Fresh Water Availability, and Air Quality Do you think climate change has affected each of the following in your jurisdiction? Water- and food-borne diseases Anxiety, depression, or other mental health conditions Quality or quantity of fresh water available to your jurisdiction Quality of the air, including air pollution, in your jurisdiction N 25.8 25.8 23.2 40.4 151 Yes 32.5 29.2 29.2 49.2 120 No 0.0 6.3 0.0 6.3 16 Don’t Know 0.0 20.0 0.0 6.7 15 Northeast 23.3 16.7 20.0 36.7 30 Midwest 36.8 34.2 15.8 34.2 38 South 24.3 35.1 37.8 43.2 37 West 21.4 17.9 25.0 53.6 28 $1M< 26.2 21.3 21.3 34.4 61 $1–4.99M 21.1 31.6 21.1 26.3 38 $5M+ 28.8 26.9 26.9 57.7 52 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 40 TABLE 24 Perceived Local Impacts of Climate Change: Sewage and Septic System Operation, Food Safety, Housing during Extreme Weather and Healthcare during Service Disruptions Do you think climate change has affected each of the following in your jurisdiction? Need for healthcare services for people with chronic conditions during service disruptions (such as extreme weather events) Mean number of perceived impacts (12 possible) N Unsafe or ineffective sewage and septic system operation Food safety and security Housing needs for residents displaced by extreme weather events 11.3 17.9 24.5 30.2 3.32 151 Yes 13.3 22.5 30.8 37.3 4.32 120 No 6.3 0.0 0.0 0.0 0.16 16 Don’t Know 0.0 0.0 0.0 6.7 a 0.62 15 Northeast 13.3 20.0 26.7 33.3 3.08 30 Midwest 13.2 18.4 23.7 27.8 3.63 38 South 10.8 16.2 29.7 37.8 3.83 37 West 7.1 14.3 17.9 32.1 b 2.85 28 $1M< 14.8 21.3 19.7 25.0 3.38 61 $1–4.99M 5.3 7.9 23.7 29.7 2.64 38 $5M+ 11.5 21.2 30.8 36.5 4.00c 52 2012 Totals 2012 results by… Belief in Climate Change Region Budget F = 23.99, p<.001 F = .54, n.s. c F = 1.89, n.s. a b Are We Ready? Report 2 Appendices 41 TABLE 25 Anticipated Local Impacts of Climate Change: Heat Waves and Heat-Related Illness Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 26.5 47.0 18.5 7.9 0.0 0.0 151 33.1 53.7 8.3 5.0 0.0 0.0 121 0.0 0.0 86.7 13.3 0.0 0.0 15 0.0 40.0 33.3 26.7 0.0 0.0 15 Northeast 36.7 40.0 13.3 10.0 0.0 0.0 30 Midwest 29.7 48.6 13.5 8.1 0.0 0.0 37 South 26.3 44.7 23.7 5.3 0.0 0.0 38 West 21.4 50.0 25.0 3.6 0.0 0.0 28 $1M< 27.1 42.4 22.0 8.5 0.0 0.0 59 $1–4.99M 15.8 44.7 28.9 10.5 0.0 0.0 38 $5M+ 33.3 53.7 7.4 5.6 0.0 0.0 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget TABLE 26 Anticipated Local Impacts of Climate Change: Storms (Including Hurricanes) and Floods Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 28.5 39.7 21.9 1.3 0.7 7.9 151 34.7 45.5 12.4 1.7 0.8 5.0 121 0.0 6.7 80.0 0.0 0.0 13.3 15 6.7 26.7 40.0 0.0 0.0 26.7 15 Northeast 46.7 33.3 10.0 3.3 0.0 6.7 30 Midwest 29.7 45.9 16.2 0.0 0.0 8.1 37 South 31.6 31.6 28.9 0.0 2.6 5.3 38 West 14.3 50.0 32.1 0.0 0.0 3.6 28 $1M< 35.6 32.2 22.0 3.4 0.0 6.8 59 $1–4.99M 18.4 36.8 31.6 0.0 2.6 10.5 38 $5M+ 27.8 50.0 14.8 0.0 0.0 7.4 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget Are We Ready? Report 2 Appendices 42 TABLE 27 Anticipated Local Impacts of Climate Change: Droughts, Forest Fires, or Brush Fires Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 24.5 38.4 27.2 1.3 0.0 8.6 151.0 29.8 44.6 18.2 1.7 0.0 5.8 121 0.0 0.0 86.7 0.0 0.0 13.3 15 6.7 26.7 40.0 0.0 0.0 26.7 15 Northeast 26.7 33.3 30.0 3.3 0.0 6.7 30 Midwest 24.3 37.8 29.7 0.0 0.0 8.1 37 South 23.7 39.5 28.9 0.0 0.0 7.9 38 West 28.6 50.0 17.9 0.0 0.0 3.6 28 $1M< 25.4 37.3 27.1 1.7 0.0 8.5 59 $1–4.99M 18.4 36.8 31.6 2.6 0.0 10.5 38 $5M+ 27.8 40.7 24.1 0.0 0.0 7.4 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget TABLE 28 Anticipated Local Impacts of Climate Change: Vector-Borne Infectious Diseases Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 13.2 39.7 33.1 0.7 0.7 12.6 151 16.5 47.9 24.0 0.0 0.8 10.7 121 0.0 6.7 86.7 0.0 0.0 6.7 15 0.0 6.7 53.3 6.7 0.0 33.3 15 Northeast 23.3 43.3 26.7 0.0 0.0 6.7 30 Midwest 16.2 37.8 35.1 0.0 0.0 10.8 37 South 10.5 34.2 42.1 0.0 2.6 10.5 38 West 3.6 46.4 32.1 3.6 0.0 14.3 28 $1M< 16.9 40.7 30.5 1.7 0.0 10.2 59 $1–4.99M 10.5 23.7 50.0 0.0 2.6 13.2 38 $5M+ 11.1 50.0 24.1 0.0 0.0 14.8 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget Are We Ready? Report 2 Appendices 43 TABLE 29 Anticipated Local Impacts of Climate Change: Water- and Food-Borne Diseases Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know 11.3 33.1 41.7 0.0 0.7 13.2 14.0 39.7 33.9 0.0 0.8 11.6 121 0.0 6.7 86.7 0.0 0.0 6.7 15 0.0 6.7 60.0 0.0 0.0 33.3 15 Northeast 20.0 36.7 36.7 0.0 0.0 6.7 30 Midwest 13.5 27.0 48.6 0.0 0.0 10.8 37 South 10.5 28.9 44.7 0.0 2.6 13.2 38 West 3.6 35.7 46.4 0.0 0.0 14.3 28 $1M< 13.6 39.0 37.3 0.0 0.0 10.2 59 $1–4.99M 10.5 15.8 55.3 0.0 2.6 15.8 38 $5M+ 9.3 38.9 37.0 0.0 0.0 14.8 54 2012 Totals N 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget TABLE 30 Anticipated Local Impacts of Climate Change: Anxiety, Depression, or Other Mental Health Conditions Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? 2012 Totals Much more common More common No change Less common Much less common Don’t know N 8.6 40.4 25.2 0.0 0.0 25.8 151 9.9 44.6 19.8 0.0 0.0 25.6 121 0.0 13.3 66.7 0.0 0.0 20.0 15 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget 6.7 33.3 26.7 0.0 0.0 33.3 15 Northeast 6.7 46.7 26.7 0.0 0.0 20.0 30 Midwest 10.8 43.2 24.3 0.0 0.0 21.6 37 South 13.2 44.7 21.1 0.0 0.0 21.1 38 West 7.1 35.7 28.6 0.0 0.0 28.6 28 $1M< 6.8 35.6 28.8 0.0 0.0 28.8 59 $1–4.99M 13.2 36.8 28.9 0.0 0.0 21.1 38 $5M+ 7.4 48.1 18.5 0.0 0.0 25.9 54 Are We Ready? Report 2 Appendices 44 TABLE 31 Anticipated Local Impacts of Climate Change: Quality or Quantity of Fresh Water Available to Your Jurisdiction Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 13.9 35.8 34.4 0.7 0.0 15.2 151 17.4 40.5 28.1 0.8 0.0 13.2 121 0.0 0.0 86.7 0.0 0.0 13.3 15 0.0 33.3 33.3 0.0 0.0 33.3 15 Northeast 20.0 30.0 36.7 0.0 0.0 13.3 30 Midwest 13.5 29.7 40.5 2.7 0.0 13.5 37 South 15.8 36.8 31.6 0.0 0.0 15.8 38 West 10.7 57.1 25.0 0.0 0.0 7.1 28 $1M< 15.3 32.2 39.0 0.0 0.0 13.6 59 $1–4.99M 7.9 39.5 31.6 2.6 0.0 18.4 38 $5M+ 16.7 37.0 31.5 0.0 0.0 14.8 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget TABLE 32 Anticipated Local Impacts of Climate Change: Quality of the Air, Including Air Pollution, in Your Jurisdiction Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem will remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 15.2 39.1 29.8 1.3 0.0 14.6 151 19.0 45.5 21.5 1.7 0.0 12.4 121 0.0 0.0 86.7 0.0 0.0 13.3 15 0.0 26.7 40.0 0.0 0.0 33.3 15 Northeast 23.3 26.7 33.3 0.0 0.0 16.7 30 Midwest 13.5 40.5 29.7 2.7 0.0 13.5 37 South 13.2 36.8 36.8 0.0 0.0 13.2 38 West 10.7 60.7 21.4 3.6 0.0 3.6 28 $1M< 15.3 30.5 39.0 0.0 0.0 15.3 59 $1–4.99M 2.6 31.6 42.1 2.6 0.0 21.1 38 $5M+ 24.1 53.7 11.1 1.9 0.0 9.3 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget Are We Ready? Report 2 Appendices 45 TABLE 33 Anticipated Local Impacts of Climate Change: Unsafe or Ineffective Sewage and Septic System Operation Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem will remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 4.6 21.9 53.6 2.6 0.7 16.6 151 5.8 25.6 48.8 2.5 0.8 16.5 121 0.0 0.0 86.7 6.7 0.0 6.7 15 0.0 13.3 60.0 0.0 0.0 26.7 15 Northeast 6.7 23.3 60.0 0.0 0.0 10.0 30 Midwest 8.1 18.9 54.1 2.7 0.0 16.2 37 South 2.6 26.3 50.0 7.9 2.6 10.5 38 West 0.0 25.0 57.1 0.0 0.0 17.9 28 $1M< 5.1 25.4 52.5 1.7 0.0 15.3 59 $1–4.99M 2.6 15.8 57.9 5.3 2.6 15.8 38 $5M+ 5.6 22.2 51.9 1.9 0.0 18.5 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget TABLE 34 Anticipated Local Impacts of Climate Change: Food Safety and Security Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem will remain the same in your jurisdiction? 2012 Totals Much more common More common No change Less common Much less common Don’t know N 9.3 32.7 42.0 1.3 0.0 14.7 150 11.7 35.8 37.5 1.7 0.0 13.3 121 0.0 13.3 80.0 0.0 0.0 6.7 15 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget 0.0 26.7 40.0 0.0 0.0 33.3 15 Northeast 13.3 33.3 43.3 0.0 0.0 10.0 30 Midwest 8.1 32.4 40.5 2.7 0.0 16.2 37 South 8.1 37.8 40.5 2.7 0.0 10.8 37 West 7.1 28.6 53.6 0.0 0.0 10.7 28 $1M< 10.3 34.5 41.4 0.0 0.0 13.8 58 $1–4.99M 7.9 26.3 47.4 2.6 0.0 15.8 38 $5M+ 9.3 35.2 38.9 1.9 0.0 14.8 54 Are We Ready? Report 2 Appendices 46 TABLE 35 Anticipated Local Impacts of Climate Change: Housing Needs for Residents Displaced by Extreme Weather Events Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem will remain the same in your jurisdiction? Much more common More common No change Less common Much less common Don’t know N 13.9 40.4 31.8 0.0 0.0 13.9 151 17.4 46.3 23.1 0.0 0.0 13.2 121 0.0 0.0 93.3 0.0 0.0 6.7 15 0.0 33.3 40.0 0.0 0.0 26.7 15 Northeast 16.7 46.7 26.7 0.0 0.0 10.0 30 Midwest 10.8 43.2 35.1 0.0 0.0 10.8 37 South 21.1 34.2 31.6 0.0 0.0 13.2 38 West 7.1 42.9 35.7 0.0 0.0 14.3 28 $1M< 10.2 35.6 39.0 0.0 0.0 15.3 59 $1–4.99M 13.2 34.2 42.1 0.0 0.0 10.5 38 $5M+ 18.5 50.0 16.7 0.0 0.0 14.8 54 2012 Totals 2012 results by… Yes Belief in Climate No Change Don’t Know Region Budget TABLE 36 Anticipated Local Impacts of Climate Change: Need for Healthcare Services for People with Chronic Conditions during Service Disruptions (such as Extreme Weather Events) Over the next 20 years, do you think climate change will make these problems more common or severe, less common or severe, or will the problem remain the same in your jurisdiction? 2012 Totals Much more common More common No change Less common Much less common Don’t know Mean number of anticipated impacts N 15.9 45.0 25.2 0.0 0.0 13.9 5.54 151 2012 results by… Belief in Climate Change Region Budget Yes 19.8 50.4 16.5 0.0 0.0 13.2 6.97 121 No 0.0 0.0 93.3 0.0 0.0 6.7 0.37 15 Don’t Know 0.0 46.7 26.7 0.0 0.0 26.7 2.43a 15 Northeast 20.0 50.0 23.3 0.0 0.0 6.7 5.70 30 Midwest 10.8 48.6 29.7 0.0 0.0 10.8 5.53 37 South 23.7 31.6 28.9 0.0 0.0 15.8 5.80 38 West 14.3 60.7 17.9 0.0 0.0 7.1 5.52b 28 $1M< 13.6 39.0 32.2 0.0 0.0 15.3 5.53 59 $1–4.99M 15.8 42.1 28.9 0.0 0.0 13.2 4.40 38 $5M+ 18.5 53.7 14.8 0.0 0.0 13.0 6.80c 54 F = 33.90, p<.001 F = .03, n.s. c F = 3.85, p<.05 a b Are We Ready? Report 2 Appendices 47 TABLE 37 Current Activity and Changes to Programs in Climate Change-Related Areas: Heat Waves and Heat-Related Illness Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 56.2 21.2 10.6 68.2 153 Yes 55.7 24.8 9.1 66.1 122 No 43.8 0.0 20.0 80.0 16 Don’t Know 73.3 13.3 13.3 73.3 15 Northeast 50.0 23.3 13.3 63.3 30 Midwest 63.2 18.9 5.4 75.7 38 South 63.2 31.6 7.9 60.5 38 West 51.7 17.9 14.3 67.9 29 $1M< 42.6 13.6 5.1 81.4 61 $1–4.99M 50.0 15.8 7.9 76.3 38 $5M+ 75.9 33.3 18.5 48.1 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 38 Current Activity and Changes to Programs in Climate Change-Related Areas: Storms (Including Hurricanes) and Floods Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 71.9 20.5 13.9 65.6 153 Yes 68.9 24.8 10.7 64.5 122 No 75.0 0.0 33.3 66.7 16 Don’t Know 93.3 6.7 20.0 73.3 15 Northeast 73.3 30.0 23.3 46.7 30 Midwest 63.2 18.9 2.7 78.4 38 South 86.8 26.3 7.9 65.8 38 West 62.1 14.3 14.3 71.4 29 $1M< 68.9 18.6 10.2 71.2 61 $1–4.99M 76.3 15.8 15.8 68.4 38 $5M+ 72.2 25.9 16.7 57.4 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 48 TABLE 39 Current Activity and Changes to Programs in Climate Change-Related Areas: Droughts, Forest Fires, or Brush Fires Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 30.7 9.3 9.3 81.5 153 Yes 32.0 11.6 7.4 81.0 122 No 6.3 0.0 13.3 86.7 16 Don’t Know 46.7 0.0 20.0 80.0 15 Northeast 10.0 3.3 6.7 90.0 30 Midwest 21.1 5.4 8.1 86.5 38 South 42.1 18.4 7.9 73.7 38 West 58.6 7.1 14.3 78.6 29 $1M< 23.0 8.5 6.8 84.7 61 $1–4.99M 26.3 7.9 7.9 84.2 38 $5M+ 42.6 11.1 13.0 75.9 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 40 Current Activity and Changes to Programs in Climate Change-Related Areas: Vector-Borne Infectious Disease Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 88.9 7.9 17.9 94.7 153 Yes 88.5 9.9 14.0 76.0 122 No 93.8 0.0 40.0 60.0 16 Don’t Know 86.7 0.0 26.7 73.3 15 Northeast 90.0 10.0 26.7 63.3 30 Midwest 92.1 8.1 10.8 81.1 38 South 89.5 10.5 13.2 76.3 38 West 79.3 3.6 25.0 71.4 29 $1M< 91.8 8.5 13.6 78.0 61 $1–4.99M 84.2 5.3 21.1 73.7 38 $5M+ 88.9 9.3 20.4 70.4 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 49 TABLE 41 Current Activity and Changes to Programs in Climate Change-Related Areas: Water- and Food-Borne Diseases Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 92.1 6.0 18.5 75.5 152 Yes 91.7 7.4 15.7 76.9 121 No 93.8 0.0 33.3 66.7 16 Don’t Know 93.3 0.0 26.7 73.3 15 Northeast 93.3 6.7 26.7 66.7 30 Midwest 89.5 5.4 13.5 81.1 37 South 94.6 7.9 13.2 78.9 38 West 89.7 0.0 25.0 75.0 29 $1M< 90.0 6.8 13.6 79.7 60 $1–4.99M 89.5 2.6 21.1 76.3 38 $5M+ 96.3 7.4 22.2 70.4 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 42 Current Activity and Changes to Programs in Climate Change-Related Areas: Anxiety, Depression, or Other Mental Health Conditions Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 21.1 1.3 14 84.7 153 Yes 19.0 1.7 13.3 85.0 121 No 25.0 0.0 20.0 80.0 16 Don’t Know 33.3 0.0 13.3 86.7 15 Northeast 23.3 0.0 13.3 86.7 30 Midwest 23.7 2.7 16.2 81.1 38 South 21.1 2.6 10.5 86.8 38 West 20.7 0.0 10.7 89.3 29 $1M< 11.5 1.7 8.6 89.7 61 $1–4.99M 18.4 2.6 15.8 81.6 38 $5M+ 34.0 0.0 18.5 81.5 53 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 50 TABLE 43 Current Activity and Changes to Programs in Climate Change-Related Areas: Quality or Quantity of Fresh Water Available to Your Jurisdiction Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 46.4 7.3 9.9 82.8 153 Yes 45.9 9.1 8.3 82.6 122 No 37.5 0.0 13.3 86.7 16 Don’t Know 60.0 0.0 20.0 80.0 15 Northeast 50.0 6.7 13.3 80.0 30 Midwest 50.0 2.7 10.8 86.5 38 South 47.4 13.2 7.9 78.9 38 West 51.7 3.6 10.7 85.7 29 $1M< 37.7 8.5 5.1 86.4 61 $1–4.99M 44.7 7.9 13.2 78.9 38 $5M+ 57.4 5.6 13.0 81.5 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 44 Current Activity and Changes to Programs in Climate Change-Related Areas: Quality of the Air, Including Air Pollution, in Your Jurisdiction Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 34.9 5.3 13.9 80.8 153 Yes 36.4 6.6 13.2 80.2 121 No 31.3 0.0 20.0 80.0 16 Don’t Know 26.7 0.0 13.3 86.7 15 Northeast 41.4 3.3 23.3 73.3 29 Midwest 18.4 2.7 13.5 83.8 38 South 34.2 10.5 5.3 84.2 38 West 55.2 3.6 17.9 78.6 29 $1M< 30.0 3.4 13.6 83.1 60 $1–4.99M 23.7 0.0 13.2 86.8 38 $5M+ 48.1 11.1 14.8 74.1 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 51 TABLE 45 Current Activity and Changes to Programs in Climate Change-Related Areas: Unsafe or Ineffective Sewage and Septic System Operation Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 70.6 4.6 14.6 80.8 153 Yes 68.9 5.0 12.4 82.6 122 No 87.5 0.0 33.3 66.7 16 Don’t Know 66.7 6.7 13.3 80.0 15 Northeast 73.3 6.7 10.0 83.3 30 Midwest 76.3 5.4 10.8 83.8 38 South 78.9 7.9 15.8 76.3 38 West 58.6 0.0 14.3 85.7 29 $1M< 63.9 5.1 8.5 86.4 61 $1–4.99M 76.3 2.6 21.1 76.3 38 $5M+ 74.1 5.6 16.7 77.8 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 46 Current Activity and Changes to Programs in Climate Change-Related Areas: Food Safety and Security Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 75.0 6.0 17.9 76.2 153 Yes 74.4 6.6 16.5 76.9 121 No 87.5 0.0 26.7 73.3 16 Don’t Know 66.7 6.7 20.0 73.3 15 Northeast 73.3 10.0 10.0 80.0 30 Midwest 89.2 5.4 13.5 81.1 37 South 81.6 7.9 15.8 76.3 38 West 62.1 3.6 32.1 64.3 29 $1M< 66.7 6.8 10.2 83.1 60 $1–4.99M 81.6 2.6 26.3 71.1 38 $5M+ 79.6 7.4 20.4 72.2 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 52 TABLE 47 Current Activity and Changes to Programs in Climate Change-Related Areas: Housing for Residents Displaced by Extreme Weather Events Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 26.3 6.6 12.6 80.8 153 Yes 24.8 7.4 10.7 81.8 122 No 12.5 0.0 20.0 80.0 16 Don’t Know 53.3 6.7 20.0 73.3 15 Northeast 20.0 10.0 13.3 76.7 30 Midwest 24.3 5.4 8.1 86.5 37 South 28.9 10.5 5.3 84.2 38 West 27.6 3.6 17.9 78.6 29 $1M< 18.0 8.5 8.5 83.1 61 $1–4.99M 29.7 2.6 15.8 81.6 37 $5M+ 33.3 7.4 14.8 77.8 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 48 Current Activity and Changes to Programs in Climate Change-Related Areas: Lack of Healthcare Services for People with Chronic Conditions during Service Disruptions (such as Extreme Weather Events) Current area of activity Increasing activities in response to climate change Changing activities for reasons unrelated to climate change No changes to activities N 50.7 7.3 16.7 76.0 153 Yes 49.2 9.2 15.0 75.8 121 No 37.5 0.0 20.0 80.0 16 Don’t Know 78.6 0.0 26.7 73.3 15 Northeast 23.3 13.3 16.7 70.0 30 Midwest 55.3 2.7 16.2 81.1 38 South 47.4 13.2 5.3 81.6 38 West 65.5 3.7 25.9 70.4 29 $1M< 36.7 8.6 12.1 79.3 60 $1–4.99M 47.4 0.0 18.4 81.6 38 $5M+ 68.5 11.1 20.4 68.5 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget Are We Ready? Report 2 Appendices 53 TABLE 49 Current Activity and Changes to Programs in Climate Change-Related Areas: Mean Number of Current and Changing Adaptation Programs Mean number of current activities Mean number of activities increased due to climate change Mean number of activities changing for other reasons N 5.83 0.9 1.47 153 Yes 6.13 1.15 1.36 122 No 5.32 0.00 2.32 16 Don’t Know 5.52 a b 0.29 c 1.67 15 Northeast 5.03 1.00 1.59 30 Midwest 5.86 0.72 1.12 38 South 6.61 1.49 1.07 38 West 5.82 d e 0.50 f 1.82 29 $1M< 5.33 0.88 1.03 61 $1–4.99M 5.47 0.56 1.67 38 $5M+ 7.05g 1.24h 1.92i 54 2012 Totals 2012 results by… Belief in Climate Change Region Budget TABLE 50 Mitigation Programs: Encourage or Help People to Use Active Transportation, such as Walking and Cycling Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… Current program Planned program No current or planned program N 37.5 19.7 42.8 151 Yes 40.5 20.7 38.8 121 No 13.3 20.0 66.7 15 Don’t Know 33.3 13.3 53.3 15 2012 Totals 2012 results by… Belief in Climate Change Region Budget Northeast 35.5 16.1 48.4 31 Midwest 29.7 35.1 35.1 37 South 44.7 7.9 47.4 38 West 39.3 25.0 35.7 28 $1M< 25.4 25.4 49.2 59 $1–4.99M 21.1 18.4 60.5 38 $5M+ 61.1 14.8 24.1 34 Are We Ready? Report 2 Appendices 54 TABLE 51 Mitigation Programs by Group: Encourage or Help People to Use Mass Transportation Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… Current program Planned program No current or planned program N 15.1 7.9 77.0 151 Yes 16.5 8.3 75.2 121 No 6.7 0.0 93.3 15 Don’t Know 13.3 13.3 73.3 15 2012 Totals 2012 results by… Belief in Climate Change Region Budget Northeast 9.7 16.1 74.2 31 Midwest 8.1 8.1 83.8 37 South 13.2 7.9 78.9 38 West 28.6 3.6 67.9 28 $1M< 5.1 6.8 88.1 59 $1–4.99M 7.9 5.3 86.8 38 $5M+ 31.5 11.1 57.4 34 TABLE 52 Mitigation Programs: Encourage or Help People to Change the Way They Purchase Foods such as Buying Locally Grown Foods, Organic Foods, or Plant-Based Foods Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… Current program Planned program No current or planned program N 36.2 3.9 43.4 151 Yes 37.2 19.8 43.0 121 No 26.7 13.3 60.0 15 2012 Totals 2012 results by… Belief in Climate Change Region Budget Don’t Know 33.3 33.3 33.3 15 Northeast 29.0 12.9 58.1 31 Midwest 35.1 27.0 37.8 37 South 42.1 21.1 36.8 38 West 42.9 17.9 39.3 28 $1M< 23.7 22.0 54.2 59 $1–4.99M 34.2 21.1 44.7 38 $5M+ 50.0 18.5 31.5 34 Are We Ready? Report 2 Appendices 55 TABLE 53 Mitigation Programs: Educate the Public about Climate Change and Its Potential Impact on Health Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… 2012 Totals Current program Planned program No current or planned program N 3.9 15.8 80.3 151 5.0 19.0 76.0 121 2012 results by… Belief in Climate Change Region Budget Yes No 0.0 0.0 100.0 15 Don’t Know 0.0 6.7 93.3 15 Northeast 3.2 16.1 80.6 31 Midwest 2.7 18.9 78.4 37 South 2.6 13.2 84.2 38 West 10.7 17.9 71.4 28 $1M< 3.4 10.2 86.4 59 $1–4.99M 0.0 2.6 97.4 38 $5M+ 7.4 31.5 61.1 34 TABLE 54 Mitigation Programs: Reduce Fossil Fuel Use or Conserve Energy in the Operation of the Health Department Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… 2012 Totals Current program Planned program No current or planned program N 18.5 13.9 67.5 151 2012 results by… Belief in Climate Change Region Budget Yes 21.7 13.3 65.0 120 No 0.0 20.0 80.0 15 Don’t Know 13.3 13.3 73.3 15 Northeast 9.7 6.5 83.9 31 Midwest 22.2 19.4 58.3 36 South 13.2 13.2 73.7 38 West 28.6 17.9 53.6 28 $1M< 5.2 12.1 82.8 58 $1–4.99M 10.5 13.2 76.3 38 $5M+ 38.9 16.7 44.4 34 Are We Ready? Report 2 Appendices 56 TABLE 55 Mitigation Programs: Help Residents of Your Jurisdiction Reduce Their Fossil Fuel Use or Conserve Energy Some public health programs may help to reduce future climate change. Please indicate whether your department has a current or planned program to… 2012 Totals Current program Planned program No current or planned program N 5.3 7.9 86.8 151 5.8 9.1 85.1 121 2012 results by… Belief in Climate Change Region Budget Yes No 0.0 0.0 100.0 15 Don’t Know 6.7 6.7 86.7 15 Northeast 0.0 6.5 93.5 31 Midwest 2.7 10.8 86.5 37 South 2.6 5.3 92.1 38 West 14.3 10.7 75.0 28 $1M< 3.4 6.8 89.8 59 $1–4.99M 0.0 2.6 97.4 38 $5M+ 11.1 13.0 75.9 34 TABLE 56 Mitigation Programs: Number of Current and Planned Mitigation Programs Mean number of… Current programs Planned programs N 1.02 0.75 151 Yes 1.18 0.84 121 No 0.37 0.42 15 Don’t Know 0.71a 0.62b 15 Northeast 0.73 0.62 31 Midwest 0.86 1.02 37 South 1.10 0.63 38 West c 1.35 d 0.76 28 $1M< 0.59 0.74 59 $1–4.99M 0.62 0.53 38 $5M+ 1.83 0.97 34 2012 Totals 2012 results by… Belief in Climate Change Region Budget e f F = 3.45, p < .05; bF = 1.22, n.s. F = 1.38, n.s.; dF = 1.01, n.s. e F = 16.77, p<.001; fF = 1.74, n.s. a c Are We Ready? Report 2 Appendices 57