Sometimes, the air quality is so unhealthy that even sheltering indoors doesn’t prevent smoke exposure. And even after fires stop burning, many residents in recent years have experienced more upper respiratory illnesses than usual, says Andrew Joseph Jr., chairman of the Confederated Tribes of the Colville Reservation. Even a decade ago, the area was blanketed by more small particulate matter from wildfire smoke than most other parts of the state.
Washington state health experts have recognized for years that climate change does and will continue to negatively impact our health. Public health agencies such as King County’s have created climate health planning documents, and in 2019 the Washington State Department of Health created a specific team related to climate health. But marrying climate and health data to figure out exactly how floods, fires and other phenomena spurred by climate change affect our bodies takes resources that have been scarce within local, state and federal health agencies.
However, the state now stands to gain more insight into these relationships, thanks to the state Health Department’s new hire: the state’s first official climate change epidemiologist. Department representatives declined to share the name of the new hire, who starts July 1.
Climate change epidemiologists try to determine how the climate affects health outcomes within a population. This information is practical and necessary for lots of parties, including hospital administrators, city planners, local health officers and utility managers, all of whom need the information to help their organizations adapt.
“Everybody needs to be ready to make these shifts … and we need data to help decision makers make good choices,” says Rad Cunningham, the Health Department’s climate health manager.
This hire underscores that. Cunningham says he hopes the new hire will work to make more and better data related to climate change and disease accessible and useful to health professionals and community leaders trying to equitably protect communities from harm. The climate epidemiologist will focus on projections, but will also work with current and historical data, as well as collaborate with academics and other researchers.
“Symbolically, if nothing else, it's huge. It's recognizing that climate is a legitimate and important thing for health,” says Dr. Jeffrey Duchin, health officer at Public Health — Seattle & King County.
Local and state leaders might leverage these projection data showing who is likely to suffer from climate effects when requesting and designating funding meant to curb disease and improve climate adaptation. There has historically been a disconnect between this evidence and policy, says Dr. Wael Al-Delaimy, a University of California, San Diego, epidemiologist who has written books and policy briefs advocating for more attention to climate and disease. But people like the Colville's Joseph, who is also co-chair of the state’s Indian Health Service Tribal Budget Workgroup, say evidence is instrumental for lobbying Congress, state legislators and others for funds.
Joseph worries about how wildfire and other changes will affect ecosystems, further exposing people and animals to disease. Some culturally important wild roots and berries are becoming harder to find, putting nutrition at risk. “When we lose those foods, it impacts our immune system. So, things like COVID and other illnesses are really impacting our people,” Joseph says.
If there are big financial commitments being made to protect people's health, they should be based on the best available evidence, says Dr. Jeremy Hess, director of the University of Washington’s Center for Health and the Global Environment.
Investing more in climate health data that people can use to plan their lives doesn’t come a moment too soon.
For instance, during last summer’s heat dome, Cunningham says, some hospital laboratories got too hot to operate and had to send samples elsewhere, slowing down test results. Restaurant freezers couldn’t keep food safely chilled to health code standards.
“It's great that people are starting to devote resources, [but] we need those resources to be proportional to the magnitude of the threat,” Duchin says. “Climate change is the single greatest threat to human health on the planet, and it will be for the foreseeable future. It's ironic and pathetic that we don't have resources devoted to addressing this problem in the public health system, and we don't have adequate resources anywhere really in the community.”
Understanding health impacts
It’s easy to understand the impacts of wildfire burning down a home. It’s harder to parse all of that fire’s effects on an entire population’s immediate and long-term health.
Teasing out how individual climate-fueled problems affect our health will only get harder as floods, heat waves and other disasters happen simultaneously. The UW’s Hess, a leading voice on developing methodologies to understand climate health impacts, points to California, where concurrent heat waves, drought and wildfire interrupt power supplies. Similar events could plausibly happen in Washington in the not-to-distant future, Hess says.
Washington’s Health Department staff includes researchers exploring aspects of climate change and health, including algal bloom and smoke experts, and has employed a climate health coordinator since 2015. There is some publicly accessible data about climate change already available through the state Health Department’s Washington Tracking Network. But the climate change epidemiologist will be the first with that explicit title and focus within the state health department.
While the epidemiologist will collaborate with Cunningham’s team, the person’s work will be funded through a Centers for Disease Control and Prevention grant and will report to epidemiologist Alli Ertl, who leads the environmental epidemiology and toxicology group, which runs the Washington Tracking Network.
The state has analyzed a few different ways that temperature and precipitation may change in Washington 30 years from now. That could help figure out which communities are going to face the brunt of future impacts. Cunningham wants the department to provide similar projections related to wildfire, sea level rise and other hazards.
“This position is really going to strengthen our team's ability to think about what is the long-term impact,” he says. “We're going to be learning ourselves and also helping others learn from the data we've created.”
But for the average person, the Health Department’s visualizations of these projections aren’t terribly easy to parse these days — and those charts aren’t clear about how they relate to our health.
Right now, a strong example of collecting policy-minded health data in a useful way is a map of environmental health disparities co-developed by the Health Department, UW researchers and community coalitions such as Front & Centered. Based on listening sessions with impacted communities, researchers created the map to identify who suffers most from environmental harm and why that happens. Their research can also help leaders create policy and fund programs that prioritize people impacted by pollution — people who often identify as Black, Indigenous and people of color. Cunnigham says he hopes something similar can happen specifically to address climate health disparities.
A lot can happen in a few years for a discipline this young. “We're working on the systems to use that data at the same time that we're trying to develop it,” Cunningham says.
Washington state first attempted to address the health impacts of climate change a little over a decade ago, says UW Professor Emeritus Dr. Richard Fenske. In 2007, Fenske participated in the state’s Climate Change and Human Health Impacts Team, which explored the most likely types of health problems that could come out of climate change in Washington state, who would suffer most and how to avoid these impacts.
It felt as though public health and climate science experts spoke different languages, Fenske says.
But there’s been “a sea change” in terms of the number of public health employees not only interested in getting more data related to climate change, but concerned about finding resources to build programs related to it, Cunningham says.
Epidemiologists understand on a macro level how our health changes as the climate does, says Hess of the UW, but forecasting is “a moving target.” Epidemiologists know that climate change is likely going to put us in the paths of more diseases spread by wildlife. Although experts can’t tell us exactly when something like an outbreak, for instance, will happen, they are continually understanding more about the kinds of conditions that would kick outbreaks into gear.
Health departments can’t understand disease at the population level without good data or the methods and people to interpret it. Health experts say the information Washington’s new climate epidemiologist could provide, then, would be useful in many ways.
Hess says what Washington needs to do is very similar to the suggested responsibilities of their new climate change epidemiologist. “We need to systematically assess these impacts … put that all in one place, and then assess how climate change is likely to impact the underlying burden of disease, and where and what to do about it,” he says.
It’s not unlike how we’ve been trying to get a handle on COVID-19. Disease models tell epidemiologists how the pandemic will affect Washington, from incidence of disease to hospital impacts, and leaders use that information to make management decisions.
Ultimately, public health needs access to both real-time and long-term projections.
And meeting everyone’s expectations will require developing and validating a lot of new method. A lot of hospital health data, for instance, was never collected with climate assessments in mind. Hess worked with the Centers for Disease Control and Prevention to create a methodology that health departments can use to do those projections, which Cunningham says the state Health Department is working on understanding.
Plus, making climate-related disease projections 30 years into the future is tough. “It’s not going to be a really exact science, but it can help us get a sense of the risk … but ideally our projections will be wrong,” Cunningham says, if people work to prevent these health problems.
Even with someone in this position, Washington’s climate epidemiologist’s work is only as good as the data the person has access to. Cunningham says that for some climate impacts, like heat and precipitation changes, data just hasn’t been paired with local health data like hospital admissions, emergency service responses, and more — yet.
Similar to how state researchers struggled to gather timely data on COVID testing and case reporting, Fenske says, good data-collection systems are key to quickly understanding climate threats to our health, like heat or air pollution from wildfires.
University of California, San Diego’s Al-Delaimy says the health data itself is often limited, too — in quality, in availability by location and in accessibility to scientists. “So having somebody internally [at a state health agency], and collaborating with academics to pursue this will make this much easier,” he says.
The sheer magnitude of climate change will itself be a hurdle for Washington’s first official climate change epidemiologist. Becoming an expert on climate change is challenging, Cunningham says, and one person can’t have deep knowledge of every aspect of its intersections with health.
The state Health Department and counties like King County say they have submitted grants to bring in more help to work on climate change epidemiology. Cunningham also notes a desire for more real-time data that is useful to people during emergencies, like its syndromic surveillance pages set up for wildfire smoke.
But with community input and support, more data will come.
“We're not going to own climate change as a subject matter," Cunningham says. "But we're going to work with Ecology and Commerce and the University of Washington and community groups. And … it's going to take a lot of partnerships to make it into something that's really gonna impact health.”
Update: This article was updated at 3:46 p.m. on Friday, June 3 to correct the spelling of Dr. Richard Fenske's name.