Hi, it's Mary Sheehan. We're going to talk now about climate and health governance for cities. So, what do I mean by governance? Well, in simplest terms, governance is the authority and resources applied in communities to get things done. So for example, when flooding hit Leizhou, China in 2017, shown in the first photo, or when flooding hit Houston, Texas in the same year, shown in the second photo, who is it that ensures the public's health is protected and how did they do that? So, both human catastrophes were caused by extreme weather. The frequency and intensity of which we know is increasing. The health effects from these kinds of events can involve death from drowning and accidents, and over the medium to longer term, mental stress from losses of homes and property, disease from polluted drinking water, allergies from mold and even forced relocation. What we're going to talk about here is, who is accountable for new or revised policies to protect population health and well-being from these kinds of risks? Well, here is a more formal definition of governance for public health. This comes from the World Health Organization. Public health governance is described as how governments and other non-government actors steer or orient communities to achieve public health goals. So, governance might involve one or often multiple government layers from local or city through up to regional, national, and international levels. In many countries, public health responsibilities have been decentralized, and they're implemented by a local public health authorities mandated and funded to carry out risk assessment, policy making, disease surveillance, and other priorities. One example is the United States where most states have such agencies, with over half further decentralized to the local level. Many European countries are similarly decentralized. Globally, many large cities, the main topic of our course here have their own local public health agencies. So, when we talk in the course about risk assessment approaches, and climate adaptation policies, and public health will often be talking about the work of local public health agencies in cities or at the local level. However, good governance means arrangements that are transparent, open, accountable to citizens, and with some participatory process also based on predictable legal rules and guidelines. Therefore, as we'll see, other actors have increasingly taken on important roles in health governance, including community groups, and other non-governmental actors, businesses, philanthropic organizations, and others. All of them can contribute to defining and implementing needed policy actions for climate related health adaptation and mitigation in cities as we'll see. Researchers have identified two pathways for likely human health impacts from changing climate parameters, and they've inferred different types of governance challenges from these two pathways. Now, I should say these are not either or both of these two pathways are occurring. The first pathway relates to expansion of existing health threats associated with climate. For example vector-borne diseases such as dengue fever, and I've shown here a world map indicating the presence of dengue fever. With the darker red zones, showing a high presence of dengue, whereas the lighter zones further from the tropics have lower presence. This is projected to evolve with heat and humidity over time. In terms of governance for vector-borne diseases, local public health agencies have tested tools and policies including vector management, education campaigns, and surveillance. So in this case, the main challenge maybe additional resources or mainstreaming preventive adaptation measures into ongoing programs. The second pathway, however, relates to new or at least not previously fully appreciated threats. An example of this is the impact of an extreme storm on physical infrastructure networks like electric power. The image here shows an aerial photo of Puerto Rico at night. In the top panel, the lights are all on and you can see San Juan there glowing in the northeast part of the island. The lower panel shows the same aerial shot just after Hurricane Maria passed in September of 2017. San Juan is almost invisible and there are virtually no lights elsewhere on the island in that lower panel. Many lights remains dark for months after the hurricane. So, the health impacts of loss of electric power in modern societies, both immediate and over an extended period, are now becoming better understood after numerous catastrophic storms worldwide. These kinds of impacts includes short-term risk of death from down power lines and longer-term risks such as carbon monoxide poisoning from fuel generators, food poisoning from lack of refrigeration, heat-related illness from lack of air conditioning, as well as more dire consequences for health care facilities, for example, that rely on electricity for urgent and intensive care. In this case, public health agencies, unlike the previous case, don't always have well-established tools and protocols, and they may need and are likely to need to work with other public and private actors. In this example, it would be the electric power providers to share knowledge, surveillance of health impacts, as well as preventive policies such as early warning and risk communication. So, improved ways of implementing such collaborative governance will be needed. We'll talk about some examples such as Chicago and New York where public health agencies have begun working to plan for electric power needs of the most vulnerable during weather disasters. Cities with early learning of this sort will be able to share their experiences with others. Whether the health risks are traditional or newly identified, the first step in addressing them is often to bring together the players involved in climate change governance at the local level. This is often through a climate change risk assessment or strategic planning exercise to identify adaptation priorities. This bar chart shows the results of a survey of several 100 world cities regarding the governance structures and tools they used for climate change. As shown in the second bar from the top, nearly 40 percent of cities reported that adaptation actions were included within a broader plan, in fact, covering both mitigation and adaptation. A smaller share, less than 30 percent you see in the top bar, had plans that focused on adaptation only. So, whether such a plan covers adaptation only or both mitigation and adaptation, it's often convened and coordinated by a City Climate Change panel or the City Environmental Agency. So, the challenge for public health agencies is to make sure that they're fully integrated into such planning exercises. Much of the local adaptation effort as we've talked about aims to protect human well-being. So, it's very important that public health agencies are present. A number of large cities like Boston and Toronto for example, have succeeded in incorporating public health in a robust way into larger city climate planning exercises, and we can learn a lot from cases like this. So, the multi-sectoral nature of climate adaptation in the urban space brings us to the concept of complexity. Large cities have long been described as complex systems. That is, they're comprised of social networks of people and physical networks of infrastructure services, all of which interact in a large indents space. Cities further are managed by complex political and social organizations, and they develop over time in unpredictable ways. They can have feedback loops and unintended consequences. So in fact, one expert has actually called a city more a process than a thing, which is interesting. Meanwhile, the climate system itself and its human-driven changes have properties of complex systems also, making more challenging modelling as well as predicting the impacts of mitigation and adaptation policies. So, I wanted to give you an example of a complex system, a city that's complex. Mexico City was built on a lake, and that's shown in the Rivera mural image on the slide. This lake is all but disappeared through drainage and urbanization over the last five centuries representing how a city changes over time. Mexico has a metropolitan but also a megalopolitan planning level, spanning the city's 16 boroughs as well as 224 municipalities across five states. Transportation, water management, electricity, urban mobility, and virtually all of their services are integrally interrelated and must be addressed jointly. So, this gives you a sense of some of the reasons and some of the ways in which cities and climate change within cities are highly complex. So with these factors in mind, researchers have sought governance strategies that take account of complexity, and it's useful to apply some of these to the challenges of climate change impacts on health in cities. We'll talk about a few of them. So, several of those governance strategies are shown here. This list is taken from a report by the World Health Organization, which focused on public health governance and reflect the evolution to account for both good governance principles that we talked about at the beginning of this session, and the needs of complex systems that we've just went over. So, these five areas include collaborating and partnerships among different actors, direct engagement of citizens often through Internet and smart phone technology and social media, innovative regulatory arrangements including persuasion and self-regulation, the role of independent agencies and networks, and adaptive policies and resilient structures. So, we'll go through and talk about examples of each of these approaches before we wrap up this session. So, collaboration and partnerships, you recall in the example we spoke about of Puerto Rico and electric power. We saw the really essential nature of collaboration between public health and physical infrastructure, agencies, and authorities. So, a good example of how to do this is Barcelona's climate and health planning. The table on this side comes from a study of the different sectors, the Barcelona Public Health Agency partnered with on different particular climate health risks, and in each case, what was the role of the public health agency. These include for example, collaboration with the metropolitan transport agency on measurement of air pollution levels or with the regional water agency on water quality management. Another is the collaboration with the regional health authority on heatwave alert implementation. So, many of these other agencies were involved, in addition to the Barcelona public health agency, in developing the city's climate adaptation and resilience plan. So, this is an example, a number of other worlds cities, for example New York, have similarly designed their climate change adaptation strategies, so that a range of public agencies and private actors are engaged, and as always we'll be emphasizing the need for public health agencies and authorities to be fully, to have a full seat at that table. So, engaging citizens and climate health practice. So, here's another governance strategy with promise, and that's engaging citizens in data collection, reporting and monitoring. A good example is a group called ISeeChange, which is a non-governmental organization that provides a community weather and climate online journal platform where people can use their smart phone app and other technologies to report changes they observe in weather parameters at the local level. It also provides support to community investigations on specific climate hazards. So, I'll give an example of two investigations, and you can find these and others on their website. The first is the Harlem Heat Project in New York City, where residents, perhaps, the family of the boy in this photo, measured heat and humidity in their homes, and shared this information through this portal, which then became available to media and public health agencies, and as a result provided improved information on actual conditions in Harlem during heat waves. A second example is flood tracking in New Orleans where residents could monitor water levels and this during storms, and this data improved flood mapping and monitoring. So, public health agencies can gain from such citizen science efforts because they provide data that may not perhaps normally would be collected or available, particularly for the most vulnerable groups. Mixed regulation and persuasion. So, employing regulation and persuasion is another interesting governance strategy. The example here is the Fossil-Fuel-Free Streets declaration, which was announced by 12 large world cities in 2017, to create emissions free zones in each of their cities, and the goal is reducing greenhouse gas emissions, but also at the same time enhancing health through greener more livable cities. The cities intend to implement this through both government regulation, but also partnerships with business. In this case, the zero emissions bus manufacturers such as shown in the photo, as well as bike share promoters and other citizen and private groups that support enhanced use of renewable energy for transport and walkability in cities. You'll find the reference for this Fossil-Fuel-Free Streets declaration and the 12 cities online, and it's an interesting example to look at. In this case, the role of public health agencies would be to monitor the progress on reducing respiratory disease, reducing traffic accidents, et cetera, through surveillance, and even evaluating the effectiveness of such programs on their impact on health. Independent organizations. Relying on an independent organization or a network of organizations to foster and support policy change is also a governance strategy with promise. The example here is the Global Cool Cities Alliance, which is an independent organization that works to promote more efficient, comfortable buildings, promote healthier, more resilient cities, and to cancel some of the warming effects of climate change through global cooling. Its main tools are putting reflective roofs on public and private buildings. The Global Cool Cities Alliance also partners with the umbrella organization, C40 Cities, which is a group of nearly 100 now for the largest world cities, working to address climate change and resilience. In fact, you'll find a number of other interesting climate mitigation and adaptation city networks on the C40 website, which I'd encourage you to look at. Public health agencies can help and there's a role for public health agencies here, which is to help track the actual reduction in heat-related illness and other health impacts of the kinds of interventions that are supported by organizations like this. Then adaptive policies and resilience strategies. So, we'll focus quite a lot on adaptive policies and resilient strategies as a key tool for local public health agencies. We'll talk specifically about the assessment framework used by the United States Centers for Disease Control and Prevention called Building Resilience Against Climate Effects or BRACE, and we'll also talk about the European Union's similar Climate ADAPT framework. I hope you'll recognize that both of these assessment frameworks, BRACE and Climate ADAPT, reflect some of the ideas of good governance and complex systems that we've been talking about. For example, both rely on iterative adaptive learning, engaging stakeholders and regularly updating models and planning with new information and knowledge. So, we'll go over these frameworks in greater detail in other sessions. So, wrapping up then, governance is simply the authority and resources for getting things done in the community. Local public health agencies are often the main climate health governance actors in cities, and climate adaptation planning is often their main tool, although it's often coordinated by another agency and it's very important for public health agencies to make sure they have a seat at the table. Whoever is we've learned complexity of cities and climate system suggests that other governance structures are also really important, and among those with most promise, are some of the ones we have discussed, cross-sectoral collaboration, citizen participation, persuasion and self-regulation, knowledge networks run by independent organizations, and these adaptive assessment frameworks. So, public health agencies have a key role to play in the success of each and all of these strategies.
