Chris Buse , MA, PhD Candidate

1. What is public health adaptation to climate change? Exploring an emerging field of practice in Ontario, Canada Chris Buse, MA, PhD Candidate Lupina Research Associate, Comparative Program on Health and Society Doctoral Alumni, CIHR Strategic Training Program in Public Health Policy Dalla Lana School of Public Health Canadian Public Health Association Conference May 27, 2014 Toronto ON

2. Overview • Context: Climate change and health in Ontario • Study Overview • Discussion: Typologies of adaptation practice among Ontario health units

3. Climate Change is THE greatest threat to human health in the 21st CE Direct Indirect Exacerbation of health inequalities Food insecurity Mental health impacts Economic impacts of disasters ↑Poor air quality ↑respiratory disease, cancer Changes in distribution of infectious disease ↑incidence of vector-borne and zoonotic disease Contamination of food and water sources ↑foodborne and waterborne illness • ↑ Heat-related morbidity and mortality • ↑Extreme weather and accidental morbidity/mortality • ↑ Exposure to UV Radiation

4. Climate Change in Ontario • 1948-2006 temperatures have increased 1.3 degrees Celsius across southern Ontario (NRCan 2007) • Projected increase of 2-4 degrees C by 2050 (relative to 1971-2000 averages) (Feltmate and Thistlewaite 2011) • Source: Adapted from Casati and Yagouti (2010)

5. The Ontario Public Health Standards • Ontario Public Health Standards (2008) • Pursuant to Section 7of the Ontario Health Protection and Promotion Act, OPHS outlines mandatory service delivery guidelines for each of the 36 health units in Ontario, specifically: • “Conduct surveillance of the environmental health status of the community” • “Conduct epidemiological analysis of surveillance data” • “Increase public awareness of health risk factors associated with…climate change…by adapting and developing communciation strategies” • “Assist community partners to develop healthy policies to reduce exposure to health hazards”

6. Study Overview RQ: How is the OPHS mandate on CC being interpreted by practitioners and translated into action?

7. Methods: Webscan and Interviews • Web-based content analysis of 36 public health units in Ontario, Canada based on key word search • In-depth interviews with 20 public health practitioners from 20 health units • 36 contacted for an interview • 13 declined to participate on grounds they had nothing to contribute • 3 did not reply

8. Interview Sample (N=20) • Interview order (6 waves of sampling) was selected using a maximum variation sampling method that sampled cases based on geography (census division), size of health unit, and areas of programmatic focus on climate change * Includes Toronto

10. Number of Ontario Health Units (N=36) Reporting Climate Change-Related Programming from 2013 Webscan

11. Absence of Adaptation to CC: Policy and Innovation Gap

12. Discussion (1): OPHS Policy is constraining Inaction largely stems from: • Blame avoidance and problem denial • Waiting for more practical guidance from the province • Few enforcement mechanisms • A lack of resources, leadership • Limited acknowledgement of environmental determinants of health beyond proximal causes

13. Presence of Adaptation to CC: Policy and Innovation Success

14. Discussion (2): OPHS Policy is enabling Action stems from: • Strong federal support (and to a lesser extent the province vis-à-vis the MOE) • Champions within organizations who have a ‘different’ reading of the OPHS • Existing provincial ‘promising practices’ • Conducting vulnerability and adaptation assessments • Participating in regional climate change strategies • Built environment initiatives; ‘organizational greening’

15. Acknowledgements • My thanks to: • Participating Health Units and Staff • Blake Poland, Randy Haluza-Delay, Josephine Wong • Lupina Foundation, Comparative Program on Health and Society • CIHR Strategic Training Program in Public Health Policy • Health Canada’s Climate Change and Health Office chris.buse@mail.utoronto.ca