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Good morning, everyone, and welcome to the press conference for the release of the special report from the Montana Climate Assessment entitled “Climate Change and Human Health in Montana.” We are really glad you could join us in the lovely Zoom ecosystem this morning. My name is David Mark, and I will be moderating our time together today. I'm a primary care physician by training and the CEO of the Bighorn Valley Health Center, a community health center serving about ten thousand Montanans in the central and eastern parts of our state. As a physician who often cares for vulnerable patients with tenuous health that really does feel the impact of our changing climate, I am particularly excited about this report both because it's so thoroughly researched and it's super practical, offering really pragmatic resources that can be implemented at all levels of the healthcare system. This morning my primary task for the event is to shepherd us through a really value-packed schedule. We have assembled for you a really impressive group of panelists who will provide some important context for this work, and we will have ample time to address any and all questions you might have towards the end of the session. And to that end I'd like to point out that the Q&A feature on Zoom will be open throughout the session, so please feel free to enter your questions there and we will address them to our panelists during the back half of our hour together. So to begin our morning ,we are fortunate to have with us Dr. Alexandra Adams, who will be offering some opening remarks. Dr Adams is the lead author of the report and the director of the Center for American Indian and Rural Health Equity at Montana State University, so welcome, Dr. Adams. Thank you so much, David, and welcome everyone to the launch of the Montana Climate and Health report, or C2H2. here's what it looks like in person and on the live site has just gone live so you can check out that as well we're really grateful to have all of you here and as i prepared to open today's meeting i asked myself what would be most useful to you as the press what would you need to help your audiences understand this topic to have hope we all know that the effects of climate change are not just in our future they're here now in the form of wildfires and smoke flooding and vector-borne diseases and they're already affecting our loved ones and our communities today so with this report we want to open a conversation statewide about the effects of climate change on human health in Montana we want to help people understand the critical health effects of climate change especially for our most vulnerable populations will be hardest hit by wildfires and droughts and their economic effects and we want to send a message of hope by giving individuals communities and healthcare facilities small and large actionable ways to mitigate and adapt to these changes we also in the report highlight some of the fantastic work that several Montana communities are currently doing in climate and health that can serve as models for communities in the rest of the state the Montana climate and health report or c2h2 as we nicknamed it is a combination of two years of planning research and collaboration and writing by many people and it's a special report as David said from the Montana climate assessment it is the first document of this type by Montanans for Montanans the primary authors are all here today and you'll get to meet them in the q a including those on the institute on ecosystems the center for American Indian rural health equity and Montana health professionals for a healthy climate we also have six great panelists from around the state that agree to speak to you about what this work means to them i want to also send out a special shout out and thanks to the Montana healthcare foundation for funding this work so why do i care about this topic I’m a physician that's worked my entire life with rural and indigenous communities to improve the health and work in collaboration with them but I’m also a mother and i have a son his name is duncan and he lives in seattle and during the worst of the fires last summer i was on my phone a lot checking the site both for the seattle air quality and for our air quality here in Bozeman he was stuck inside working from home he had two hepa filters running in his house and because he's an engineer he also rigged up his own indoor air quality meter and i remember the heaviness in my chest when i went outside in Bozeman and tried to walk and breathe in that air and how much worse it was for him in seattle with much worse air quality but i also had a heaviness in my heart worrying about all the people who weren't able to be inside with hepa filters or weren't able to stay inside for work so my motivation for doing this work is not just for my own children but to protect our most vulnerable populations our children our elderly those with chronic disease and our rural and native populations so it is our hope that this report will help us come together as a state to address this major challenge of our time and enable our communities to not only adapt and mitigate to climate change but really to thrive so thank you all so much for being here today I’m going to turn it back over to David who will introduce our panelists thank you dr adams those are very inspiring words we'll now have some uh brief remarks by our panelists who are a group of esteemed individuals from across the state who really represent the broad diversity of stakeholders with important perspectives on this report to begin we have julia ryder who is a registered nurse working in the emergency department at Bozeman health and who is a board member for Montana healthcare professionals for a healthy climate welcome ms ryder thank you for having me today um can everyone hear me okay yep okay um not only am i a nurse but like dr adams mentioned i too am a mom I’m a mom of a little nine-month little girl so air quality is definitely something that's of interest to me and I’m also studying for my master's in public health so kind of tying together healthcare with public health issues and i would um i find this report very important and i value it because it pulls together how climate change affects not just individual patients but the public in general and it also gives very tangible solutions to what we can do to be part of the solution for how climate change is detrimental to human health um but i also come from working in a hospital for nine years and i have a special interest in how the carbon footprint of hospitals contributes to climate change and what i value about this report is that in the past healthcare has always had a green light to produce an enormous one amount of waste and consume copious amounts of energy this report it bridges the disconnect that healthcare has to its effect on climate change it helps bring awareness that by healthcare providers we have a great obligation and opportunity to protect our patients our communities better through changing our practices in healthcare um this report gives us solutions that now as healthcare providers and professionals that we can take care of our communities and our patients better so as a mom knowing that my little girl wants to grow up with healthy lungs and clean water as a nurse at the bedside knowing that my patients are coming in and maybe not understanding the correlation between their asthma attacks and air pollution and um as working in public health and knowing it's going to affect all our communities i really value the solutions in this report and the science that is based to explain this to people when you're trying to make change so that is what I’m grateful for with this report and how it ties into what i do thank you julia that's really great our next panelist is um is erica mckeon hanson who is the program director for the little river institute at msu northern in havre and who is also a member of the hill county board of health who will offer her valuable perspectives welcome ms mckeon hanson good morning everyone you hear me okay good so i speak with you this morning from the campus of Montana state university northern as David has mentioned which sits on the ancestral homelands of the blackfeet nation it's an honor to share my thoughts on the impact this report will have on my work as an educator a researcher public health professional a local board of health member and a Montanan as a member of the local hill county Montana board of health charged with supporting efforts to maintain the health of our county residents this report will serve as an important guide as we anticipate and plan for the future the evidence of climate change and its impact on human health presented in this report has done so in a way that it's easily accessible and understandable for all Montanans including local boards of health specifically my work as a researcher on the impact of harmful algal blooms in hill county Montana will be enhanced by this report guiding our efforts in this community-based participatory research project to educate the public on recognizing and reporting harmful algal blooms as well as the related dangers to both human and animal health personally i was born and raised in a small rural north central Montana agricultural community i continue to be concerned about the impact a changing climate has on my family and friends who rely on the agricultural economy for their livelihood and the rest of the world who rely on their production for food this report is an excellent resource for the family farm and ranch in Montana when planning for future production as a mother i owe a debt of gratitude to the hard work of everyone who played a role in producing such an impactful report i will sleep better at night knowing my children including one who already deals with two autoimmune diseases on a daily basis will have a healthier future as a result of informed decisions guided by this report thanks erica we appreciate it uh our next panelist is uh ms amy sillenberg who is the executive director of climate smart missoula thanks for joining us amy thank you for having me can you hear me okay great okay so um yeah so i work for um iran a local nonprofit and since our inception we have worked at the intersection of health and climate change preparedness and planning and I’m really excited for the release of this assessment for all of Montana so in the missoula area we've primarily been concerned with lengthening and worsening wildfire smoke seasons given climate change and given our geographic location we're in a valley we're downwind from wildfire smoke that can come from anywhere in the western u.s so via an effort we call summersmart because we're climate smart we've worked over the last few years and along alongside the missoula city county health department and others on a program to help people understand the health risks from wildfire smoke and then to act to reduce these we focused our work on those most vulnerable community members so our one feature is providing hepa portable air cleaners to those most at risk to allow for healthier indoor air quality so elderly those with asthma young kids and given some of those away for free to folks that can't afford those so these efforts were the seeds of an extensive planning effort over two years of planning um that we did with the missoula county in the city a process called climate ready missoula and our work first we first work to understand the science who in that who and what is most at risk from climate change and then to develop strategies to address these vulnerabilities so we sure wish that we would have had this assessment going into that planning effort the just released c2h2 is an incredibly valuable report very useful for communities across our state large or small as we all grapple with how to equitably address the health risks from climate change it's clear that communities and regions can use this information to chart their own unique course given local vulnerabilities whether it's heat smoke flooding drought or other climate surprises it's also true that with this assessment it provides guidance for all of Montana's to work across jurisdictions and learn from each other share resources so um you know it's our perspective that climate risks are difficult and expensive to address especially without preparation and the efficiencies that collaboration offers will matter a lot to all of us and there's just a lot of richness to this c2h2 that should benefit all of us thank you thanks amy sounds like some really exciting stuff happening in missoula our next panelist is is laura williamson who is the state epidemiologist for Montana's department of public health and human services thanks for being here laura thank you for having me um one moment all right so the climate change and human health and Montana report highlights that the health issues that public health organizations are working on today are not activities we will stop doing anytime soon these activities include the control of vector-borne diseases like west nile virus ensuring communities have safe drinking water during a flood event or advising schools on precautions to take during time support air quality due to wildfires three consequences of climate change that this report highlight mental health chronic disease and health equity are also priority issues identified by the state health improvement coalition which is a coalition of 24 public health and health care organizations across the state every five years the coalition identifies priority health issues to collectively work on to meaningfully move the needle to improve Montanan's health and you can find out more about these priority health issues in the state health improvement plan we know that many Montanans struggle to maintain good mental health in fact one in 10 Montana adults report frequent mental distress meaning they had 14 or more days of poor mental or emotional health in the past month and suicide a mental health crisis continues to affect every Montana community suicide related deaths in Montana are two times higher than the united states and and extreme weather events due to climate change adversely impact mental health after severe weather events people can experience anxiety post traumatic stress disorder substance abuse or suicidal thoughts we also know that climate change does not affect all groups of people equally those with existing physical and mental health conditions as well as the young and old those living in poverty and those with limited access to health services will be impacted more than others by severe heat or poor air quality caused by wildfires for example not all Montanans have the means or ability to simply stay indoors or turn on the air conditioning during those hot summer days that are filled with wildfire smoke we also know that mental and physical health conditions disproportionately affect American Indian residents and low-income residents the state health improvement coalition is working to improve the mental and physical health of vulnerable populations by increasing access to behavioral health and healthcare services this report emphasizes the work to improve the physical and mental health of all Montanans needs to continue and that practical and innovative solutions should be implemented and sustained so that residents throughout our state can achieve good health the work that dphs and the state health improvement coalition are doing now provides an opportunity to coordinate with additional partners to address the health needs of communities as they adapt and respond to climate change thank you to all the authors for inviting me to to make some comments about this report and congratulations on its publication and thank you laura we really appreciate the engagement and leadership that the state dphs continue to display on these really important topics so thanks for being here i realized i skipped over mr ray rasker who is the executive director of headwaters economics it's an independent nonpartisan nonprofit research and community support organization welcome ray um thank you for inviting me and uh good morning everybody um at headwaters economics we we work throughout Montana and throughout much of the country actually um to help communities adapt to the realities of uh climate change you know we're seeing um an increase in wildfires and an increase in flooding and as this report points out um it's getting hotter and drier and i think a lot of people realize that wildfires are worse than they ever have been in our lifetimes they're destroying more homes and killing more people than ever before we're seeing worse air quality especially during the fire season which is now lasting longer and if that wasn't bad enough on top of all of this we're also seeing uh increased threat from flooding um what we're also seeing at the community level it's fairly obvious that with um uh that some people are really disproportionately affected uh the poor the elderly people in substandard housing people with disabilities without healthcare and people with little mobility tend to suffer more during the flood or fire event they also have a harder time recovering from extreme events so the climate change and human health assessment makes these issues very clear and does it i think in a very accessible very easy to read format we're grateful thanks for the hard work appreciate all the work that all the authors put into this this is definitely a resource that we're going to be using thank you thank you ray uh our final panelist this morning is mr john doyle who is the director of the crow uh water quality project at little bighorn college um john is a crow tribal member who uh was also a county commissioner in bighorn county for 24 years and a member of the health board there um he's his long and illustrious career also includes his being a founding member of both the crow environmental health steering committee uh the plenty doors community development corporation um and uh so we're really grateful that you've joined us john thanks for being here yeah thank you for inviting me it's kind of last minute i know and uh this stuff what i would want to share with uh all those listening is that um your stories are a little bit different than what we're experiencing here on a reservation uh that we've been living with a different part of climate change issues and that is the loss of our income from coal development coal was a major source of revenue for us for 45 years and it was our main source of revenue and jobs for a majority of our crow people when the production started going away a thousand jobs went away from the tribal government and uh and at the mines there's continual loss of jobs so our community is dealing with um the effects of climate change in a different way and while we're focused on solutions and identify and some of the other issues the social part that we're dealing with it's not really visible and in the county itself like like dr mark had mentioned i was in the county for 24 years in the local government i knew and know how the coal mines supported the local government there not only the local government but the school system as well to a huge amount and we're right on the verge of those coal mines that support the local county government as being greatly reduced last week one of them started the process of bankruptcy and 70 miners are laid off 70 miners miners that may live in sheridan but their jobs are here in Montana so that community even though it's not in any of these discussions that will be affected too and then while we're trying to deal with the economic uh impacts from that part of climate change we deal with the covet and so when you're in a community that is already completely stressed from no money no jobs very very deep poverty then you throw this into the mix and you can see what climate change will mean to many many people in a different time and in the future that if we're having a hard time now and we know climate change is going to be much worse as time goes then it's going to be much more difficult for more than more than just us and so while our focus has been water and looking at well water and how it affects our community and the health of number of our people are suffering from finding the resources to solve those solution pRoblems is is a bigger challenge and while we went out and tested maybe over the course of 10 years 300 or more wells and we find that 40 percent of those walls are contaminated by various contaminants and trying to make that correlation between climate change the water levels that surrounds us whether it's lack of water or too much water you know our wells and our homeowners are affected and then how do we go and address that when you have no resources and then how do you share that that 10 years of research with somebody don't want to believe it that is the biggest challenge is that if people don't want to believe that then it makes it very much very difficult two weeks ago i was on a zoom conference and um I’ll share this brief story with you and I’ll stop is that for 10 years we've been looking at wells and yet when we went to a funder that was on the zoom with us he said i can't take john's uh concern because he read it out of some ins uh what do you call it uh uh it was kind of like a found book how can you how can i believe that that message it's coming from some obscure book that he picked up in a flea market in the east and so what kind of a message is that to somebody that is trying to make our community better but they don't want to let go of money and so then our community members suffer and uh to a great deal so it's more than um the obvious we have to deal with that undertow of a lot of different things that are going on so anyway thank you for inviting me and uh have any questions I’ll try to answer them but our issues are different and bigger and harder thanks john we really appreciate your your valuable perspective on this really complicated and multifaceted issue we're now going to transition into a period of question and answer and a note on sort of the mechanics of this we have a couple of options available for folks who want to pose questions you can certainly uh type your question into the q a feature uh and our we will get those uh questions read and directed to the appropriate panelists i also want to point out that the the authors of this report are also available uh for questions as well our authors include uh dr adams uh Rob and Lori byron uh mari eggers bruce maxwell susan higgins and kathy whitlock and importantly kathy and bruce are provide an important connection to the to the 2017 report from the Montana climate assessment another option if you uh so choose is if you want to just verbalize your question you can make a request in also in the q a and we can unmute your mic and then you can actually uh just ask your question out loud um so with that we will dive in to the questions um and um thankfully we have uh madison boone with us who will help organize this effort our first go ahead madison no go ahead sorry well i was just gonna pulling up the q and a function right now I’m gonna see a few coming in so dave our first question and i apologize um for folks on the press if i mispronounce your name please feel free to correct me um but from tom kuglin who asks how is the report quantifying the level to which climate change is impacting public health versus other factors and i think perhaps we can uh address that one to dr adams um if you want to take a stab at that question i was going to turf that to kathy so well maybe jointly that's good for that answer but um in terms of quantifying i think that's a that's difficult we we do understand as as john has pointed out that there are significant economic effects of climate change but that is not something that is particularly addressed in this report we really more look at all of the different effects of the different types of climate change are happening across the state and in different regions and then in different vulnerable populations and we do look at quantifying some of that but i think it's not maybe as detailed as what you're asking I’m not sure if it's an economic question and buried in that we might need some clarification Cathy do you have some thoughts on that too yeah we don't we don't quantify and that we make a direct relationship as to how much climate change is going to affect how much human health but there are some things that are really clear um in in that in setting up those relationships for example we are worried about the the projections for higher temperatures extreme heat we know that it's going to get four to six degrees warmer by mid-century and in all pRobability as much as 10 degrees fahrenheit warmer by the end of the century and what concerns us most is the extremely warm days days over 90 degrees which we think by the end of the century will will get more than a month of those compared to what we get today um and so those are the sorts of things that we see and then we look at who's going to be impacted by those and particularly these extremely warm days are affecting eastern Montana where a large sector of the population is working outdoors in agriculture and if i my way in this is Rob byron um there are no distinct lines between uh impacts as Cathy alluded to heat and as john alluded to the various impacts that climate change will have on the crow population and others climate change is often thought of as a threat multiplier in many cases it makes things that already exist much worse like we already see conditions related to heat those will get worse we already see conditions related to wildfires those will get worse there are other implications as well and particularly in populations we talk about things like hepa filters well being able to get funding for people to have hepa filters is a huge issue particularly in small communities in a big public health issue as laura williams alluded to uh spread of vector-borne diseases is monitoring those uh monitoring air quality so there are very many overlaps here lots of solutions but no single solution will answer all the questions thank you great thank you our next question is actually going to be uh a verbal question uh kayla derose uh has a question for the panel can you hear me okay we can okay great um yeah this is kayla derose with yellowstone public radio hello thank you for your time um this is a question for the authors um who's the intended audience for the recommendations in this report and how do those people or groups or agencies use it and it's its recommendations to implement change statewide if that's the goal and what would that look like David do you want me to start answering that and then we um we can move around that would be great i was thinking we should go in alphabetical order of authors last names yeah well that's always me so thank you that's a really great question and i think we thought long and hard about this report as being both a scientific document that would be really useful for people that were in the field but really also a very practical document so people who are from anything from an individual that might have an interest in how to do things in their own home to somebody in the healthcare field who might wonder about how to treat their patients or who's running a organization and trying to reduce waste in that situation to the public health community and um industry and institutions that want to make changes so it really has a broad appeal i think a broad audience and um the chapters are set up such that chapters four and five deal with vulnerable populations and then sort of uh key things that um we can do for those um different populations and community and individual and healthcare actions so it's i think it sort of spans the spectrum if you will does anybody else want to chime in on that one just I’ll go ahead Rob yeah i was going to say just to emphasize that it also two of the points that go across all of those kayla is one it encourages working together um both at all levels um both in organizations across sectors with public health officials with elected officials um and that's one of the the most important things the other thing that is noted in several areas in it is the need for the ability to do both collect more information or data and to share that more readily so that people at all levels can have access to it to make practical use of it sue did you want to expand as well yeah and and just to add to what uh Rob and alex just said um really in the fifth chapter especially um breaks it down to very key recommendations for individuals so whatever you want to do in your home to address climate change and how it impacts your personal health and then communities what community leaders and decision makers and emergency departments need to think about and then again the third section is really about for medical practitioners what ideas and suggestions they want to bring into their their clinics for their patients to understand and know so there's some really clear those are the key audiences i would say and we're also going to be delivering hard copies um here's here's the book that alex held up uh to all public libraries and county health departments and so it should be available in to lots of groups and also all the tribal community tribal councils and clinics great thanks wonderful well dave we have a question that came in from bella butler um and bella asks would an author please expand on the utility of this report and grounding the concept of climate change in a tangible way in Montana as opposed to viewing it as a cognitively and geographically distant issue great now which author would like to take that one bruce would you like to take that question sure i can do that um i think that that our the connection with fire is is the obvious one i mean it's something that that a big portion of the state certainly western Montana and central Montana um are noticeably dealing with so it's very tangible to Montana in that way but i also think that that the heat the increasing heat that we're seeing and the exposure to that heat by individuals in eastern Montana is is quite important and with the with the increasing potential for significant drought and the effect that will have on on agricultural producers will affect not just just physical health due to the heat and exposure to that heat but also the the fact that um uh there's so much stress goes with the fact that if you can't produce crops or or the economics of uh of reducing reduced yields and things like that uh really have a significant impact on on people's mental health in in those areas and i think we're seeing some of the telltale signs of that so i think those those are a couple of ways that really relate directly to to what's going on in Montana and um although you know we note throughout the report ways that other parts of the country are seeing things that are sort of uh maybe predictors of what might happen in the future in Montana but those are the things that that pRobably directly relate i would say uh erica you uh are on the banks of the lovely milk river in an agricultural community I’m wondering if you want to expand at all on some of the agricultural themes that bruce mentioned um you know i i think that um this report really is going to give like bruce had said something tangible for um our producers and i mentioned the family farm and the family ranch um to actually be able to digest and it is such an accessible way that i also mentioned um that it will be something that they can then take and i've got one family member that uses um uses a drone and collects data and this i think is just another piece that they can then fold into what they do and and help to make decisions that then are going to um be better for the climate but also better for their family farm and ranch operations and ultimately for food production worldwide can i comment on that one too um i i think tangible in Montana looking at a less tangible topic is with mental health and one of the studies that is um in the report is a study that was done at farmers and ranchers in Montana a couple years ago looking at their anxiety and their concern because of climate's effect on agriculture and almost three-fourths of the respondents actually felt more anxiety because of what they anticipate climate doing um to their livelihood and another really important one i think is that as we look at more extreme precipitation events and more of the early spring runoff that leads to flooding and i think Rob and i have always worked in native communities our whole life and what we saw a few years back when there was a flood is that after a couple weeks you know it made the national news over these cool pictures of the interstate being covered with water but after a couple weeks everything looked normal from the outside but here on the ground as john doyle can attest to it was not on normal and there were families that had lost everything they had and these were families that were already living on the edge so if your drywall gets ruined or you lose all your clothes or your furniture and you're just barely making ends meet you can't recover and so what we saw was that years later people were still living in fema trailers or living in a family's another family member's bedroom or some of them were even homeless and that has a huge effect on your on your health and your ability to care for your family maybe john would like to contribute to that too i i think you touched on it pretty good there i think that there's so much more that could be said but i think it would pRobably take all of our time doing that there's so much more than that one of the things i was going to add to that David is i think that the reason that we feel like this is very useful in many ways is because we have so many local examples both data driven as well as um just important examples of how things are already happening on the ground in Montana and what that will look like in the future and and how can that be either mitigated or how how's that going to get worse so it's really very example driven and and that's a really nice piece of the report so there's some kind of pull outs that way that's great uh one uh one thing i'd love for the authors to expand on a little bit would be you know what are the um what are the key recommendations that are included in this report that that we can all take to lessen the impact of climate change on health perhaps um alex if you could lead off and then we'd love to hear your thoughts mari too as one of the authors yeah so i think one of the key recommendations and i think Rob alluded to this was really we have to all come together as different communities around Montana there's lots of things happening in different places as amy sillenberg talked about with the wonderful work in missoula a lot of tribes have already done a lot of work on this but we really need an adequately funded and coordinated statewide public health network that really engages all of these different groups and stakeholders to think about planning implementing and training around climate mitigation and adaptation and that's one of our big recommendations the other one is around data and i might let bruce or kathy or mari speak to the need for data as well because i think that's a really critical piece what we know is we've got some climate data and some health data but not very connected yet and we need to work on getting those data sets more connected so I’ll turn bar would you like to comment on data connectivity sure and maybe just a little broader one of the things that i really learned from working on this report as well as from serving on the local board of health is how completely inseparable public health and community economies are and one of the things i learned was that rating agencies like moody's that assess municipal credit ratings are starting to look at how prepared communities are for flooding for wildfire smoke for you know all of these climate change related emergencies and they are getting to they are warning communities that are getting to the point that if communities don't have a plan in place to be able to you know to be prepared for these emergencies that that's going to affect municipal credit ratings and that will directly affect our economy and to be able to do this kind of plan planning we absolutely need health data and climate data at least on the county level which is not widely available at this point for Montana so both the health and the climate data down to a more local level are going to be essential to be able to plan and prepare for these coming events and to protect both public health and our economy at the same time bruce or kathy do you want to add to that well i think that the coverage of instrumented climate climate uh stations is very uneven across the state um when you look at things like air quality my co-authors have pointed out that there really isn't good coverage for a lot of eastern Montana for example and so that that makes a disconnect between trying to warn people about things like wildfire smoke or or imminent air quality issues but not really having the data in hand that's really very accurate to that particular place so hopefully this report will help highlight some of those areas where there's gaps in instrumentation but also just gaps in knowledge that that we need to fill it's been interesting doing this report because we're really two communities that don't work very much together uh we we have our own our own things going on we're a climate science community and then we're healthcare professionals and so this report was a a really important and i think personally enriching experience for all of us to come together and look at our greatest resource in Montana and that's our people and talk about what climate change means for that for for us uh in Montana and our health that's great another follow-up question from bella butler is about another important resource in Montana aside from people which is uh snowpack and uh she notes that um the resort town of big sky is one example where economic livelihood really heavily depends on snowpack and so the question is does the report consider the potential mental health implications that may occur due to changes in precipitation and snowpack I’m wondering uh Rob maybe you could comment on that um we did not address that specifically relative to to snowpack itself but certainly the mental health applications of both earlier snowmelt with spring flooding longer drought and both of those which go along with lesser snowpack are huge as our as bruce alluded to it does talk a lot about the mental health aspects both of uh sudden events be it floods or fires as well as the much more long-term mental uh impacts of slower events whether it's drought or implications that bell asked about of of towns that depend on snowpack for a large part of their livelihood which is something that will happen over a longer period with severe implications um not just to pocket books but to mental health as well i i think what uh john doyle mentioned in relationship to the crow the the loss of income we all in the healthcare community are aware that having a job and having job security is one of the most important social determinants of health and some of those issues have been addressed in the past by headwaters economics when they looked at huge predicted job losses across Montana both in agriculture and in tourism between the trout fishing issues and the snow issues so we know it's a big issue is that something ray that headwaters economics has quantified is it quantifiable it's a it's a good question uh we we've got a tool online called um neighborhoods at risk and it's now a national national tool um shows you the climate change and um shows you who uh lives in particular areas who's most vulnerable um and then it's it's a tool that allows you to if you have limited resources and you want to focus your resources on the most vulnerable people you can go there the need to quantify this economically depends a lot on your audience and who you're trying to convince right and oftentimes you don't actually have to put a dollar value on it you just have to point out who's at risk from climate change um there are instances where it helps to quantify um you know some we're working with a community right now where the cost of doing nothing far exceeds the cost of doing something this has to do with flood in the town of three forks and if you can quantify that it really helps elected officials make a decision better great thanks we have uh a a pretty um practical question from madison atkinson um and uh perhaps sue you could take this question it's where and how can the public access the c2h2 report well right during this press conference it is being launched online at the institute on ecosystems website and also if people are really interested in getting a hard copy they should just email me um and i will send it to you but um we will have it readily available online shortly and uh we'll send a post message to everybody attending this conference about exactly where to get it i think it's in your press release but we'll confirm all that very shortly thanks so I’m just putting into the chat it's correct sue that's where we're headed yep scott's saying yes so it's going into the chat for everybody right now so if i can explain that the mon the first Montana climate assessment is on that page as well and so you'll see the 2017 report that deals with water agriculture and forests but next to it is this big beautiful report this special report that's coming out today and you can click on either one but the place to go for all of the climate information is great our next question is from kiana gardner who writes a few of you have already highlighted the importance of teamwork when it comes to addressing these issues so are there recommendations that require our neighbors namely idaho the dakotas etc to come to the table and have we spoken with any of the leaders in those states to sort of begin this process I’m wondering maybe bruce or alex if you want to take a stab at that bruce i think you should pRobably go first on that one well yeah or maybe the byron's yeah yeah i have not or i to my knowledge we really haven't communicated that much with the other surrounding states we certainly looked at the kinds of information that they're that they're assembling related to climate change and human health but in terms of trying to team with them on a regional basis to my knowledge we haven't done much of that now Rob and laurie might be doing some of that that I’m not aware of do you want to could i could i just step in and say actually we are doing a report now with wyoming and idaho and Montana uh focused on the greater yellowstone region and so this is the first time we've gone from the state level which has you know very sharp political boundaries that are artificial in terms of the pRoblems we face to looking at a grand ecosystem and involving three states as well as the um you know the tribal reservations around greater yellowstone in this discussion of climate change so it hasn't been released yet but it's it's underway and it's it's when you go talking when you talk to people in other states there's a whole set of new challenges but also opportunities and laura perhaps do you know of any uh formal work at the state level to to sort of begin these uh multi-state uh dialogues i am not aware of any perhaps my colleagues at deq might be aware of some but I’m sorry i don't have much not in the dphhs world great thanks Rob you might want to speak to this kind of national or international effort in this area around climate and health i think that would be super helpful well i was also going to point out is the i mean particularly in the the current environment it's hard to require anybody to do anything but particularly at the governmental level versus what we need to do is start the conversations one thing about climate change is it does not recognize any borders whatsoever and it is an equal opportunity uh uh disaster um unfortunately uh the now uh certainly at the national level there both organizations within uh the environmental community and the health community are working uh at the to bring about climate action in terms of policy legislation and others and certainly the international level and actually to that end uh just last week there were two major reports released the lancet countdown 2020 which addresses global issues related to climate change and the 2020 lancet countdown u.s brief which is specific to the united states um so with those with these three reports lansing countdown the u.s brief and now c2h2 we go from the global to the national to the to the state level and it's up to all of us to start the conversations we can't this is one thing we can't say it's not my job um because it's all of our jobs and we've got to start doing that though it's difficult uh because of both political and cultural differences especially in the united states right now great thank you well it appears as though we have um arrived at the end of the list of questions and uh we are close to the end of our hour so I’ll I’ll make one last appeal anybody have any additional questions for authors or panelists at this time all right well hearing and seeing none uh we are close to the end of our hour so again for um for additional questions uh or follow-up i would direct your attention to the press release that does have contact information for sue higgins and she will field your questions and direct them to where they need to go. And with that I would like to thank all of our panelists. We appreciate your insights and your time. Thank you to all of the authors, and thank you to all in the press for joining us, and we will give you all four minutes of your day back. So thank you all for joining us. Have a good day.