CHLH 594: Climate Change, Community Needs and Public Health
This course explores public health capacity building from the perspectives of a regulatory lawyer/economist and a medical educator/practitioner. The public health-law-medicine nexus is important for all three fields, but advances in one field often are not matched by changes in the other two fields. Students will work in two areas: (a) health impacts of greenhouse gases emissions and climate change; and (b) community health needs assessments.
The purpose of exploring disconnects in the public health-law-medicine nexus is to help public health students understand:
- Several emerging, challenging areas applying public health expertise, including strategies to identify and reduce the public health impacts from climate change as well as programs to assess and address community health needs
- How laws and health provider professional standards rely on public health analyses
- Structures for funding and managing public health capacity building
- Effects of developing (or failing to develop) new public health analyses and tools
This course will target several MPH program competencies:
- Identifying the major environmental and occupational hazards that pose a risk to individuals’ health through their interaction with the environment (Core)
- Performing and using statistical analyses of health data to inform community assessments and evaluations (Core)
- Using epidemiologic data and research to describe the pattern of diseases in communities and identify risk factors for diseases and for health disparities (Core)
- Applying systems thinking to identify policy approaches to improve health of populations (Core)
- Applying participatory strategic planning models to the development of public health plans for the prevention and control of disease (Core)
- Applying evidence-based frameworks to public health practice and problem solving (Concentration)
- Applying participatory strategic planning models to the development of public health plans for the prevention and control of disease (Concentration)
While advances in public health are integrated with changes in law and medicine, the capacity to deliver public health analyses often is out of sync with these other fields. Public health analyses may be forced to catch up to demands developed in law or medicine. In some other areas, public health experts work for years to have their findings and tools adopted in law or medicine. Frequently, lawmakers and health providers are unsure how to plan for, evaluate and respond to public health analyses.
Public health, law and medicine have been out of sync on greenhouse gas (GHG) emissions/climate change as well as on community health needs assessments. In these two fields, students will study, analyze and help develop solutions to these disconnects in the public health-law-medicine nexus.
Students will review and critique recent public health analyses, and then develop original analyses that could be used by lawmakers and health providers. The public health analyses studied include identifying the incidence of health problems; demonstrating environmental and community factors in causing health impacts; designing strategies to remediate health impacts and their underlying causes; assessing risks, costs and benefits; communicating strategies to policymakers and health providers; implementing remedial actions, including by training and reporting by health providers; evaluating and adjusting programs; and others. While the focus will be on the U.S., we will also review public health analyses related to climate change and community needs from the World Health Organization, United Kingdom and South Africa.
Consider the analogy to laws forcing technologies. In one case, California adopted laws with a phase-in of air pollution standards that could not be satisfied by existing cars or even vehicles in development at that time. When these laws were enacted, zero emission vehicle technologies, manufacturing, distribution, and customer demand did not exist. These laws created incentives for major engineering innovations and reshaping the marketplace. For zero emissions vehicles as well as a wide variety of technologies around the world, some technology forcing laws have been successful; in other instances, the incentives and time periods fell short of enabling the envisioned technological, manufacturing and marketplace breakthroughs.
Similarly, various laws and health provider professional standards force public health’s analytic capacity. The state of the art in public health analyses generally informs the process of adopting laws and health provider standards. However, laws and standards may find reasons to incorporate leaps in public health analyses. As in technology, forcing public health’s capacity to deliver analyses may or may not yield the developments sought by particular laws and professional standards.
Regarding the public health impacts of climate change, the Clean Air Act of 1970 established the U.S. context for researchers and regulators to identify air pollutants likely to endanger public health. The evolution of public health research and regulatory implementation took over forty years to begin to address GHG’s harms. Even with the adoption of regulatory measures, many hospitals and public health departments are slow in recognizing and adapting to these health dangers. Moreover, current graduate and post-graduate health provider education is spotty in training doctors and other professionals on this issue.
As another illustration, the Affordable Care Act ordered tax-exempt hospitals to assess community health needs. This demand is being pursued through an evolving set of public health research, community-specific data collections, stakeholder participation processes, recommended actions, and evaluations. Under this legal framework, hospital administrators, health care providers, and educators rely on public health expertise to find innovative ways to integrate these assessments into facilities, community outreach and other programs, health care delivery practices, training, and communications. In guiding actions by hospitals, health care providers, educators, and others, are community health needs assessments actually improving health outcomes?