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Thank you for attending today and for joining us for our fourth presentation of the 2020-2021 Health Equity Webinar Series. My name is Sue Higgins and I'm representing the three NIH-funded health research centers at Montana State University. These are the Center for American Indian and Rural Health Equity, Montana INBRE, and the American Indian/Alaska Native Clinical and Translational Research Program. Before we begin I'd like to acknowledge with great respect the Indigenous stewards on whose traditional territories MSU now stands, and whose historical relationship with the land continues to this day. MSU is located in the common hunting ground and major crossroads for Plains and Plateau Native nations including Shoshone, Nez Perce, Dakota, Salish, Crow and Blackfeet. Also, before we begin, there are a lot of health researchers, health providers, and public health professionals on this webinar listening in, and all of us here really want to acknowledge you and thank you for your great service during this crazy COVID pandemic – for all you've done to protect our communities, we really appreciate you. Today I'm really delighted to welcome four members of a team of authors who just published a major report titled Climate Change and Human Health in Montana: A Special Report of the Montana Climate Assessment. Here's what it looks like. In 2017 the Montana Institute on Ecosystems produced the Montana Climate Assessment, which reported the impacts of climate change on Montana's water resources, forests, and agriculture; but climate change is also greatly affecting human health around the world and here in Montana today. Our presenters will share the climate-related health impacts we can experience in Montana and what we can do about it through research collaboration and community preparedness. I wish we had lots more time for lengthy introductions of our highly accomplished and respected presenters, but for now I'm going to give you a quick one-liner on each of them, in order. These are our speakers: Dr. Alexandra Adams, MD, PhD, director and PI of the Center for American Indian and Rural Health Equity at Montana State University. Dr. Rob Byron, MD, MPH, a Montana internist and vice chair of the nonprofit organization Montana Health Professionals for a Healthy Climate. Dr. Lori Byron, MD, MS, pediatric hospitalist in Billings and chair of the Montana Health Professionals for a Healthy Climate. And Dr. Mari Eggers, PhD, MSU environmental health research scientist and member of the Gallatin County Board of Health and also a board member of the Montana Health Professionals for a Healthy Climate. We're also pleased to welcome Dr. Miranda Margetts, PhD, an environmental public health researcher and instructor in environmental risk assessment. She helped develop this report and will be co-moderating with me during the Q&A session after the presentations. On that note, please as people are presenting go ahead and post your questions in the Q&A function at the bottom and Miranda and I will go back and forth and make sure we try to field as many of your questions as possible. and as I mentioned before um this webinar is going to be recorded you'll receive a link to it after in a couple days and to share with your colleagues and we'll also post it on our website so without further ado thank you so much for being here and I'll ask Dr. Adams to begin thank you sue so um as sue knows and others know I've been talking to my 16 year old son recently and he's having a lot of problems with school and particularly geometry because he doesn't see the point of studying when the world is falling apart and I think we can all relate to that with COVID and everything else going on but this is a really hard thing to hear and to respond to as a mother so I'm going to spend the next few minutes that I have telling you my story as a physician as a researcher and as a mom and why I became involved in this climate and health work I'm a family physician and a public health researcher who've been working with indigenous communities on wellness promotion for over 20 years I've seen how the indigenous view of working with and being part of the environment is very different from the mainstream view and this understanding has really blessed me over the many years I've worked with indigenous communities here and in New Zealand but my Montana story began when I moved here from Wisconsin in the summer of 2016. beautiful summer if you can remember that with sunny clear skies and although I had to get used to the fact that it was really dry it was a beautiful lovely summer and then the summer of 2017 came one of our really tough summers right and that was a huge difference I learned that there was something called fire season and I never experienced that before growing up in the east and then living in the midwest we have so much water that this just isn't an issue and the fire season in 2017 was a really severe one with many thousands of acres burning both in the west and the eastern parts of Montana in fact NOAA data showed that for the U.S. 2017 was the costliest year on record for natural disasters mainly the result of climate change and this past summer sauce again with such severe smoke from fires all around the west and our own bridger fire here in Bozeman and in fact 2020 broke again the record in the us with the most climate disasters costing over one billion so as a physician I've been really concerned about the already underserved tribal and rural communities that we work with during smoke seasons many of them cannot access hepa filters or work outside in agriculture and face heavy smoke exposure in 2017 missoula had such bad smoke that one of our blackfeet elders in her 70s wasn't able to go out of her house and just like now she was worried about going to the grocery store because she had to wear a mask and she was concerned what the smoke would do to her breathing during the worst 10 days of fire and smoke this past summer I was checking my phone daily for air quality updates both here and in washington where my oldest son duncan lives he's 27 and he lives just outside seattle and he has asthma he was stuck inside working from home and he's an engineer so of course he was running two hepa filters in his house and even rigged up a home indoor air quality meter but I remember the heaviness in my chest walking outside here and Bozeman imagine how much worse it was for duncan and feeling really helpless as a mom but I also had a heaviness in my heart worrying about all the people in the west who didn't have access to air filters or the ability to work inside so when I started to understand climate change firsthand from watching the effects on the health and well-being of my friends and my family and our indigenous elders was really an epiphany for me how was I going to deal with this it was unsettling but it was also galvanizing I knew that I had two choices be frozen or lean in and get involved learn more and become part of the solution so my motivation for doing this work is not only to protect my own children but to protect our most vulnerable populations the elderly those with chronic diseases and rural and tribal populations and I'm going to turn it over now to the buyer and still really describe more of what we really know is happening okay Alex thank you and thank you everybody for being here the uh what we'd like to start with is perhaps a different version and that is uh c2h2 what does it mean for me or maybe a little more uh cynically what's in it for me um as sue showed us this is the report it's available uh as a pdf at but if you actually look at on the website there there are quite a few links to the citations and a variety of other interactive components not available if you download the report but we encourage everybody to have a look the main goal or one of the main goals of this report or assessment was to identify those aspects of changing climate in Montana that are likely to impact our health both our physical and our mental health a just as important and not stated here is to provide recommendations and potential solutions of actions that we can take to prepare mitigate and deal with these consequences ultimately climate change will be a will affect everybody it will be an equal opportunity disaster but some groups and populations are more vulnerable to the impacts the elderly the very young pregnant women and their fetuses indigenous populations the poor people with chronic medical conditions both physical and mental health issues are at higher risk outdoor workers and rural populations this slide is just a reminder it was first presented in 2018 by the lancet countdown u.s brief and it's also used in in the report it just reminds us of the many different ways that climate change can impact humans and the way we live everything from extreme heat waves to air pollution and yes air pollution is both the main cause of anthropogenic climate change and will worsen because of climate change itself to things like our food quality and food supply and population displacement and then along the bottom the individual impacts on people heat stress lung and cardiac disease and particularly concerning both mental health and the adverse birth outcomes due to the effects on pregnant women and their fetuses we won't have time to go in all into all these today but they are addressed in the report itself one of the main concerns in Montana that we've identified is heat and the Montana climate assessment identified that there will be about anywhere from five to 35 more days per year over 90 degrees now we'll talk a little bit more about in a minute but in addition to our health that also increases the chances of droughts but also makes their predictability much more difficult which will have impacts both on human health but also on our agriculture and other issues we should be concerned about the heat because it's the number one weather related killer in the united states direct impacts are things we could think of heat exhaustion or heat stroke and dehydration but perhaps just as importantly increases in temperatures and not even extreme temperatures result in more heart attacks strokes suicides lung disease our thinking is worse and there may be even an association with increased incidence of diabetes another issue that's really important and we talked a little bit about it is air quality and in this a couple things to consider first of all the air quality in the united states is better now than it was 20 years ago despite that yearly in the united states anywhere from 68 000 to as many as 250 000 people die related to air pollution itself now in Montana we think our air is pretty good and it is but every year the american lung association publishes an updated state of the air report and in Montana in 2020 10 counties got an f based on particulate matter two a d and one in a c uh ozone we did pretty well it's important to note that only 13 counties reported pm data and only seven ozone data now not big on missoula the the city because they are a model for addressing issues related to air quality and doing as much as possible both in the state and in the region but according to the 2020 state of the air report they were seventh worst in the country because of short-term critiques of matter pollution and 16th worst overall for annual and here's the kicker on that that's important is 93 of those bad days are due to forest fire smoke now forest fires are not exclusively due to climate change but climate change is certainly a major contributor to that and in Montana that's probably the number one source of air pollution and also the geography of uh where where cities and others are located with that I'm going to turn it over to dr Lori byron to talk about some more details thank you for being here I'm a pediatrician children fetuses and women are vulnerable populations for a number of reasons first the exposure to heat and particulate matter breathed in by pregnant moms affect the fetuses both hotter than normal temperatures and heat waves and breathing in particulate matter puts a pregnant mom at increased risk of delivering prematurely or delivering a baby that has entry you during growth retardation or delivering a baby that goes on to die of sudden unexplained infant death research indicates that three percent of all preterm births in the u.s are due to air pollution by mid-century ma Rob mentioned for eastern Montana it's actually 33 more days a year than what we have now with temperatures over 90 degrees so fetuses are really sensitive to the dirty air breathed in by their moms besides the problems around birth exposure to air pollution during pregnancy has also been linked to decreased lung function in infancy and childhood increased respiratory symptoms and the development of childhood asthma and it's also linked to neurodevelopmental problems like learning disabilities lowered iq adhd and autism note other problems cause those conditions too that it looks like climate change is one of them or air pollution is one of them nutrition is affected by climate change and that affects our children the increased carbon dioxide in the air causes our grain plants to produce more carbohydrates more easily and thus they now contain fewer micronutrients and less protein the verdict's still out on how this affects our children but in the u.s 20 of children are already low on iron and iron is one of the plant nutrients that decreases due to higher carbon dioxide food insecurity is an issue in the u.s and in Montana where 12 percent of our families are food insecure that was pre-coped it's much higher now as crop production is affected around the world with drought heat salt water intrusion into coastal lands extreme weather events and desertification food prices will continue to rise around the world and in Montana not affecting a lot of us on this call very much but certainly affecting the Montana children in food insecure homes and food insecurity as a child is associated with many significant health problems algae blooms which increase in warming waters and can lead to death affect the ability to play and exercise and erodes a child's confidence that the world is a safe place for indigenous youth in Montana and elsewhere the unpredictability of the seasons and the alteration to traditional food gathering is just one more issue that endangers the retention of their culture as Rob mentioned wildfire smoke leads to alterations in our lives for children there's less outdoor playtime and exercise and limitations on sporting events in poorly sealed homes a particulate matter is also breathed indoors so people in such homes sustain more exposure and more damage children are still developing their lungs for the first seven years and there's great concern of what this dirty year does to children research at sealy lake on adults showed that lung damage continued at least two years after an event both wildfire smoke and the increased pollen season leads to more children with asthma more asthmatic attacks and more medication use than children many of us are familiar with the air quality flag program on orange days sensitive groups should remain inside as much as possible and if they're outside they should limit vigorous activity sensitivity groups include all children and up to the age of 17. but these prolonged wildfire events affect mental health too like Rob mentioned and we don't have enough people in Montana to really be able to look at statistics for a lot of issues but in other parts of the country they've well documented the significant mental health effects from wildfires depression anxiety and post-traumatic stress disorder most of us know someone maybe even ourselves whose mental health suffered during a fire season not to mention the stresses after forced evacuation or loss of home or livelihood both the healthy gallatin and the climate smart missoula websites note a concern for mental health after wildfires also affecting mental health is heat increased heat increases all forms of violence including domestic abuse child abuse and suicides and we're number four in the nation for youth suicide but Montanans are seeing these things and they are concerned from a survey of the members of mpha and meha in the fall of 2019 two-thirds of them said their own health was already being affected by the climate and 86 percent said they were already seeing at least one climate change related event in their communities so with that I will hand over the mic to dr Mari eggers who will discuss resources for local health departments and boards of health so first thank you Lori and thank you to everyone who's is currently working on this pandemic as a member of our local board of health I I see just how overwhelming this is for county health departments for emergency management for health care professionals and while we may have no bandwidth right now to start addressing another public health crisis the reality is is that we're in the midst of two of them and to paraphrase bill gates there's a fast-moving one and a slow-moving one and of course the slow-moving one is the impacts of climate change on health so as we are seeing from the current pandemic public health crises not only affect physical health and mental health but also community economic well-being and key to both pandemics and climate change is advanced planning and preparedness this is really true for climate change adaptation if we don't plan and prepare for this it's going to really hurt us economically as well and rating agencies like moody's analytics are already looking at how climate change impacts are going to affect community credit ratings because you know events like severe storms and floods and live fires if that damages municipal infrastructure that's costly to municipal governments and therefore that threatens credit ratings a lowered credit rating from an agency like moody's increases the cost for towns and counties to borrow money for instance to finance a school or a new law and justice center so emergency management professionals are really key collaborators in this whole effort and Lori mentioned this survey and just to continue with that this was a survey she conducted she found that three-fourths of health departments said that we should be preparing to deal with the health effects of climate change that health departments should be involved in that work but less than 30 percent of them are doing so so you know beyond the current pandemic what are the challenges for health departments to do this clearly availability of funding to have the dedicated staff and resources to be able to do this expertise in adaptation planning for climate change access to data for this planning effort and just overall municipal and community support and I would just say from being involved on the board of health you know this this doesn't have to be seen as we're going to tackle and talk about climate change head on but we may just start with you know what are the impacts that are affecting our communities now is it wildfire smoke is it flooding is it a direct risk of wildfire and from that angle you know I find our local board of health is more willing to discuss these things so how do you learn more first you can invite doctors Rob and Lori byron to present to your staff and your board of health the center for disease control has a free guide called building resilience against climate effects for creating a community action plan that's a wonderful resource you can join climate smart Montana's network and listserv and get their announcements and also we have a wealth of resources posted on our website here both um federal state tribal non-profit from faith organizations and I encourage you to consult those resources kind of the next question is well how do you get the data you need well ideally you need both climate and health data and the climate data is somewhat more available there are currently data from resonant weather stations all across the state and the current data is available online the Montana climate office is in the process of adding more than 200 weather stations across our state you can contact them and find out if there's one going up in your area we were able to add them as a net station for co-agency to this network by coming up with about five thousand dollars for the station and annual maintenance fees really the Montana climate office has done the rest and maintains the station and connected it to the internet it's been great to have that data including for farmers and ranchers local soil moisture data which hadn't previously been available there are also state and federal online air quality maps there are a couple links listed there you can check today's air quality and you can also request historical air quality data at least from the epa I am not sure from the state so what about local health data this is this is harder to come by electronic health records are simply not going to provide data linking climate events um such as heat waves or floods to you know to health events it's hard to get data from the state epidemiologist down to the county level but you can consult the Montana climate assessment for climate projections from your region you can prioritize based on these projections based on doing a community health assessment and also based on local knowledge um you know what is happening in your area is your community most concerned with you know a direct wildfire threat is it that a drought could eliminate your surface water supply for your public water supply that's the case in places in eastern Montana is it extreme heat the whole number of impacts and a good summary of them in chapter five of our report which is available just a little bit more about local knowledge you know I find working with a tribe in eastern Montana that there's a wealth of community knowledge because people live there for you know 50 or 60 generations about what's what's changing and how far back those changes have been occurring they've been losing snowpack for the last you know 80 years as long as people can remember the snowpack has been declining farmers maybe third or fourth generation or just lived a lifetime farming the same land they they see this they know this and nearly three quarters of Montana farmers and ranchers surveyed believe that climate change is having an adverse effect on their operation and they are anxious about how this is going to affect their business in the future a couple examples of community action here's a great one from missoula so they they followed this playbook they consulted with scientists on what their projections were for their area worked with hundreds of county residents to determine who and what is most at risk and what are the best ways to address those and they decided to start by tackling on poor air quality distributing hepa air filtration systems and more in their community and you can learn more about what they're doing on their website um tribes are also in the forefront of this for our state of Montana both blackfeet and salish gutenai have climate change adaptation plans so there's a whole tribal section of resources and this online guide for resources that I've linked here and other other sources besides tribal there are all kinds of resources on this link I would also urge you to go to our website Montana health professionals for healthy climate consider signing up to get our newsletter contact us for our public presentations from the byrons or consider consulting with us if you'd like to find an academic researcher who might be in a position to apply for federal funding that you can apply for as a health department and could work with you on research on these issues university of Montana has a great virtual seminar series on climate change and health organized by john robin contact her to listen in and also we have graduates of both msu and um in the state and masters students in climate and health from university of washington seattle if you're looking to hire someone to work on this with your health department and finally just some sources of funding the cdc does have competitively available funding for the through their brace program again if you partner with university researchers they have access to all you know very diverse funding including things for intervention research where you aren't just getting data you are making a difference in your community you know collaborate with non-profits in your community whose members are really committed to doing this work and would love to work with a local health department in many cases and finally I just heard this from the Montana disaster and emergency services division uh and they see their job as protecting assets at risk protecting community safety and and human life and audrey while lester said you know for every dollar that's invested in disaster mitigation that saves us six dollars in recovery and that there are millions of dollars in federal and state mitigation money that go you unused every year so contact them and find out what this funding consists of and how you can get involved with that I'm going to turn it over to Alex thank you mary thanks for all those great resources if you can stop screen sharing that will be good then okay awesome thank you guys um for sticking with us and I saw some other people joined us so that's wonderful so um we've gotten lots of data and good suggestions and what do we need to do that we can start to make a difference and I think for you watching this presentation what is the difference that is yours to make my feeling is we have to start to really face us and not deny it and not blame individuals but begin to address the systemic things we can do together to adapt and mitigate the effects of climate change and that means really working together across sectors to make changes in our healthcare systems and in our communities and statewide so how can we be better citizens how can you and I bring all the people into the conversations that are really important and this includes business owners farmers ranchers climate change scientists healthcare providers public health officials and others together and how can you and I really think and plan for the things we can do now into the future so we're prepared and I believe one of the things we can really begin to do is to start having these conversations just being here is a great start but having conversations with our families what we need to do in our lives like driving less and getting outside and biking and walking more but we cannot and must not blame ourselves or guilt each other as this is not an individual problem we've got to start to move away from this as an individual responsibility issue and into collective action in the c2h2 report we share a number of exciting examples more than Mari just shared across Montana small and large that are doing just this and they're already making a difference in creating these climate adaptation plans and making real difference in our communities and these can serve as models for your community and other Montana communities uh one example martin mentioned is Bozeman's climate accident plan which has actually reduced some emissions despite our large increase in population and the brace tool is described further either on the cdc site or in our in our report that can really help your community create and implement your own climate action plan so we have chapters with sets of actions you can take as individuals as healthcare settings and healthcare providers and in communities and this will really help you begin expand or continue your current work I think bringing all of these different resources together across the state needs to be our next step in creating a network of Montana climate action groups that can work together and share ideas and prepare our state and our community for climate change now and into the future so statewide groups that we've suggested such as climate smart Montana monday Montana health professionals for a healthy climate are a really great start toward the type of networking that we need to build this collective action and for all the healthcare providers out there I think it's really critical that we engage the healthcare community that really help people understand that climate change is going to affect every aspect of our lives from our economic well-being to our daily health and well-being and my co-authors and I really want to send a message of hope by giving individuals communities and healthcare organizations these small and large actionable ways to mitigate and adapt to these changes and to really critically understand how this is going to affect the future so we can be part of the solution and while that's exciting it's also scary but the only way we're going to get through this and the only way we're going to make a difference for our children and our grandchildren and our grandchildren's children and the next seven generations as our indigenous friends today is if we work together we need to start to pull together all of those data sources with all the different kinds of people and different voices that we need to pull everyone together and start collectively and move into a collective action mindset about how we make these small medium and large changes to the way we do things in order to survive and to thrive in the future so we really hope that you're going to use this report as a toolbox for action in your community as this is everyone's issue and everyone has a role to play you can do this we can do this thank you and we're going to turn over to questions now I think yeah thank you so much Mari Rob Lori and Alex lots of good information there I'm going to share a screen now um my screen which hopefully you can see um just this very first link we want you all to know that you can go to this link and download the report uh the full report it's a long one and there's especially after five has a ton of great information on climate health actions but also all of the impacts of climate change and some background material on um on the climate um assessment of 2007 of 2017. um so I'm going to turn things over to Miranda to appreciate the q a I think see hi everyone my name is Miranda margats I just wanted to let you know if you have questions feel free to put them in the q a but we have had a few come through so I'll get started thanks to a question from libby camalo and my apologies if I've mispronounced your last name but libby has a great question that I think might be best put toward Mari and perhaps if the byrons would like to jump in as well libby asks what role do you see for people who do not have medical or public health training to play in the public's preparedness for climate impacts to public health Mari would you like to have a shot at answering that one for libby um well yes thank you that's a great question and I think you know on on two levels first there is a lot you can do just for your own family and you know what you know around your own house around your own land um you know think about how how well your house is prepared for a if a fire comes through you know do you have shrubs and trees around your house that should be pruned that are an issue um do you have a hepa filtration for smoke season do you have flood insurance there are a whole list of individual actions including starting your own garden buying more produce locally I would encourage you to look through chapter five for a lot of things you can do just you know in your own home and with your own family and secondly there are lots of community organizations out there like climate smart Montana that you can get involved with and be part of your community action on these issues and and learn from other people and Rob and Lori yeah the the other thing I would say that's particularly important is we just need to talk about it um we need to normalize the discussion that this is a problem and we all need to address it together it's it's not up to any individual but in order to do that we need to to be able to discuss it and and go across get rid of the partisanship get rid of the sectors and just have the discussions because that's where the the solutions are really going to come another thing is if you're not a healthcare professional allying with with healthcare professionals so I've seen in the last few years that a number of the environmental groups are now incorporating the issues involved with human health and climate change into into their concerns and into their actions um also if you are within a municipality whether you're a board of health or someone else within cities and counties a lot of these groups have already worked with health care providers when they do climate plans and we have a number of most of the major cities but a couple of the smaller cities in Montana have already started doing climate assessments and um if there's not if you're not aware of health professionals that care about this in your area we can help you find them or we've committed to be willing to help communities that don't have a health care provider that really has this concern and I'm going to add something to that because these are great suggestions and I think people often think if they don't have the right kind of degrees or expertise but really in any kind of collective action we need people with all sorts of different talents so maybe your talent is art and doing an art installation about this is really going to really make a huge difference or maybe your talent is I'm really good at social media well people like us or maybe aren't so good at social media could really use your expertise so there's always a place for all different kinds of people and these kinds of of um collective action pieces I you know we've we've seen this in all kinds of other movements that make a difference in terms of helping your community it needs to be everybody thanks Alex and thanks to all panelists for answering those questions we have another quite specific one but I think it's a great question since we have been hearing about it more in relation to covert and especially in relation to air quality klein jones asks what is required to install a hepa air filtration system is it a filter installed in the standard spot in the heating system or something more and I think that's a great question and if any of the panelists have a response please jump in with that this is Rob and well certainly not an expert on that most hepa filters I think in at least in residential situations are installed or are portable filters they can be installed within some ventilation systems but because they require a fair amount of maintenance and because they are I guess so filter out so much that it puts quite a load on the entire ventilation system so in talking about homes it's usually portable filters uh stand-alone filters that almost plugs in like a fan as as an example right and I don't know laura if you've told your patients this but I used to tell my patients like you're going to be breathing the air that you sleep with for many many hours so if you can only afford a smaller filtration unit that can only fit in one room put it in the bedroom so it's running all night so that you're breathing you know clean air all night and a lot of our little asthmatic kiddos do a lot better when they have that kind of unit in their bedrooms and for people that can't afford it there's actually some sites on the internet where you can figure out how to attach filters to your box fans and it actually does help significantly and hats off and thanks to groups like climate smart uh missoula that have worked on getting help healthcare filters to people that can't afford them yep and I think Mari you've got a great section in chapter five that piece that you wrote about like how to choose a hepa filter and things like that so check that out too and I would just add in terms of your home home furnace um you need to find out from whoever installed your furnace or whoever does your maintenance whether you can substitute your current filter with a hepa filter and whether the furnace can take that load so for instance for our home our home furnace we were able to put in a hepa 13 filter and turned out that we had to order the filters online they weren't available at any local hardware store but we we are able to do that with our home furnace and it has a setting that just runs fan and not heating or cooling so we can do that during smoke season great another fairly specific question from peggy brownlee why is there an increase in diabetes attributed between climate change is it due to an increase in obesity or is it due to the increased carbohydrate content in the grains we use I'd like to grab that one okay the most specific answer to that is we don't know for sure um and there has been at least a couple of studies that have sown excuse me shown in association one with uh exposure to particulate matter and the the hypothesis is that because particulate matter is so physiologically active it's not just inert little particles but they're very biologically active particles that that may in some way be inducing inflammation or some other aspect that could lead to increased diabetes there are separate studies which have shown a potential increase in diabetes related to heat as well uh however I I don't know the mechanism I I don't either and your what your one hypothesis on the carbohydrates has been a concern on top of the two that Rob just mentioned that just adding more carbohydrates to our to the normal diet that you ate 10 or 20 years ago could put you more at risk for metabolic syndrome thank you we have a comment that came through that I just wanted to mention and that was from kathleen mcmahon thanks kathleen kathleen mentions that climate smart glacier county has partnered with the flathead county health department to get a grant to purchase portable hepa filters and distribute to at-risk low-income households last year we purchased 50 units kathleen said she also mentioned that most counties have prepared community health needs assessments that are funded by federal grants the ones that kathleen has has reviewed do not discuss climate health related impacts and she understands that the grant guidelines do not require this topic to be addressed so her question is how can we get this to be a topic in these assessments so in a nutshell that is how can we have federal grants for community health needs assessments to ensure that climate health impacts are being required as a criteria within them that's a great question I'm not sure if anyone would like to jump in to respond to that first Alex yeah I'll jump in I guess I think having worked on other issues that we put into you know these kinds of assessments I think it's a matter of raising awareness about the issue we had to do the same thing with pediatric obesity a number of years ago when I was in wisconsin that wasn't a required piece in any of those assessments but it was clearly impacting downstream health in many big ways so it was really a matter of educating the local um health care community and the local public health departments so that when they did write those because you have a fair amount of flexibility in writing those as well um that they put in something about climate and health into that so I think that's an important consideration um I guess that's what I'd say I don't think you can legislate that you know these are grants and people have to write what they need that's really particular to their own community but knowing that you know and knowing that these are very particular impacts on health we should be thinking towards those things and Alex this is Rob would also say that those raising that awareness also can come from the community itself of talking to community leaders whether it's public health or elected officials or local hospital of saying yes we want this addressed or why hasn't it been addressed or can we address it that will have a significant impact uh even if it's not an absolute requirement in the grant funding and I think that the the survey results that um you know 86 percent of health care providers were already seeing these climate change impacts in the community might be a way to convince people that it's an issue um also we we work with a number of people nationally that might have connections with how community health needs assessments uh questions are are created so we will try and um and find out something about get back to you it is a great question I think the other thing that often I've seen and I don't know if you guys have seen inspired is that um people people are often working in these silos in a community so there's the healthcare community working here and they may be doing their own assessment and then there's the public health department doing a separate sort of assessment and then there's the environmental folks and really have to get everybody together on that same page and I think that's where some of these examples um and some of that brace framework is really helpful for getting people on the same room this report came out of that we all got in the same room from people around the state and said this is what we need so um Rob and Lori byron and Mari edgars could you tell us more about the work of Montana health professionals for healthy climate um I know that you are offering to share this information with lots of groups and organizations and can you tell us more about about your organization so um Montana hphc was formed uh pretty much to give voice to the healthcare professionals from throughout our state a lot of people were were trying to be active but were also very isolated and this is happening not just in Montana but nationally of trying to bring voice from the healthcare sector of how important climate change is and to make these connections that yes this is already impacting our health and it's going to impact it more as many of you all know health professionals especially nurses are the some of the most trusted people in our society so having us talking out at a time when sometimes scientists aren't listened to as much is a is a good thing we are working with legislature to testify we're working with some of the state departments you know within the department of health and others and also working with some of the cities and counties I think it really helps us to have numbers behind our name we have about 150 people that have signed on there's absolutely no commitment and it's free but you know if we can tell whoever that we're talking to you know 500 healthcare professionals have signed on and we have a very wide definition of what we consider healthcare professional that includes veterinarians uh nursing assistants Mari's an environmental health scientist uh yeah we have a climate scientist on board so if you touch health in any way we'd like to have you uh sign up for our newsletter Mari I just said another thing that we've been talking about is if you know you're with a community health department or you know a local nonprofit and you'd really like to collaborate with someone from a university that's got research background to tackle something that you want to tackle you'll contact us and we will see if we can help you make those connections and I just want to repeat that that Rob and laurie give presentations all over the state you know virtually these days but um on climate change impacts on health and if you'd like them to come talk to your class your church group your local nonprofit your county health department please contact them thanks Mari and thanks Rob and laura we have another good question that I think the byrons might be best place to answer at least to start with it's from caroline patterson caroline's interested to know what possibilities do you see in the future for partnerships between those focused on climate change and those in public health focused on suicide prevention and Lori this obviously refers to the content in your presentation regarding the mental health impacts from climate change right and there are uh there's been a slew of research and a slew of work by both the american psychological association and the american psychiatric association in the last couple years there's a lot of really active members in those groups uh you know so they're definitely on this issue as far as collaborations I guess I don't know of any specifically but I think even within the Montana health professionals we have a number of healthcare mental health experts and I think people are interested one of our board members is a psychologist so I think we're willing to to do work with the suicide people that's great and caroline perhaps I'm sure Lori would welcome you to stay in touch with her and connect through that if you're interested in furthering those potential collaborations um mario Alex or Rob did you on any uh any ha have anything else to add to that no I noticed another couple questions coming in though so we may want to get to those before we run out of time okay thanks Alex yeah we had a good question from joshua brown joshua says that he's interested in learning more about local food system climate change mitigation efforts does he have any do we have any suggestions for where he might be able to find more information about these um [Music] Rob would you like to have a go at that question um I actually will have a go at it and and um that's uh one there's a lot of work with with both regenerative agriculture separately sustainable agriculture local markets and things along those lines and one good reference for that or one good uh organization is arrow so if you look at that's a e r o um they are doing a whole lot of work uh in these areas and trying to bring more people together so I I encourage you to look there thanks Rob we have another question from paul buck paul asks do you foresee a general increase in the severity of infectious diseases such as cold flu strep throat etc from the impacts of climate change such as heat allergens smoke um paul thanks for that question I know that the report covers this and uh I'll probably throw to Rob and laurie again I know that they as physicians have concentrated on this within the report so you might like to talk more to that so um yes in for several overlapping reasons one as we've seen during covid areas uh that have higher rates of air pollution have increased rates of covid and have more serious covert um the so air pollution by itself increases the risk of those also in terms of allergens there's been dramatic increases as a result of probably both the co2 and temperatures in the amount of pollen produced particularly by certain plants like ragweed and others so yes we expect to see increases there as well and then also increases in particulate matter from more drying resulting in more dust more wildfires from the whole combination so yeah it's it's kind of a perfect storm for badness when it comes to infectious disease yeah and I would add that I think that the stress and inflammation caused by all of that cascading you know makes people more vulnerable to to being sick and other illness you know chronic diseases worsen as well so there was also new research that's come out that considers wildfire smoke as a an infectious agent and there are certain infectious diseases that say firefighters are more susceptible to because of fungal spores for instance carried by wildfire smoke um that you know that that applies to all of us who are exposed to wildfire smoke thanks murray uh we also have a comment and a question from peg brownlee peg notes that since cars are a big contributor to pollution and climate change are you aware of any groups working toward pressuring u.s automakers to make available cars like they have in europe they shut off automatically when otherwise they would be idling at stoplights and have saved millions of gallons of gas peg also thanks for the information so thank you peg and I wonder if any of our panelists are aware of efforts regarding that issue with u.s automakers um there's a number of groups that are that are putting pressure on both automakers and on the federal government and local government so for example nevada did a clean air related to car petition I guess with the governor's office and I know the pediatrician signed on to that the virginia clinicians for climate action group just um petition just had a study uh done by a by a non-partisan group on the transportation risks to human health and you know looking at the deaths that are caused by the transportation in the state of virginia and their big emphasis is because they want to go to legislature and start working on the transportation sector because they've already kind of made some huge efforts in the electricity sector there so there's a number of groups that are working on that thanks laurie can I just jump into we're about to we need to close in a few minutes but um one of the big emphases in this report is about the collaboration and the connection of climate data and health data and as medical providers public health professionals what kinds of information do health professionals need to start to collect to create trends that will really link with the climate data and how can that be done and if there's a few questions about that um and is there a little parting information on that topic we had a lot of discussion about this during writing as you know um because there wasn't great data that we could pull from um the electronic health record data does not currently contain you know easy ways to do that and so I think that thinking with some of those bigger ehrs and some of the bigger health systems about how we could start to put those into the ehr would be really important particularly for emergency room visits um where people are kind of interfacing right away from you know whatever climate um change may have been occurring that you know is more current like a you know wildfire that may bring a lot of people into the er what do you guys think we had a it's a tricky topic because there's lots of places we need data right and to I mean we all agree that would be very helpful in terms of of uh bringing that about there's lots of barriers right I can also use the word excuses for not doing that but uh it's the kind of connections we need to make at the same time realizing that yes we want to protect people's privacy for their their healthcare records and others um and the but making those connections of oh that the person who came in and had a heart attack it happened to be 100 degrees outside is that important yes is that data collected nowadays no how do we do that in a way that also doesn't compromise their care because now the the providers and nurses are having to enter a bunch of extra information that's not going to help them right then and there so lots of questions we understand the needs figuring out how to get beyond those is and this is not unique to Montana at all this is national and global figuring out how to get beyond those is a challenge that a lot of people are working on because we know it will help in the long run and dr eggers do you have something to add I know you've written a lot especially in chapter five about this need for uh connecting databases you know I just add it it's even more challenging in Montana because apparently we have a Montana law that prevents the state from sharing health data down to the county level um for some small counties clearly there is a privacy protection issue but for counties like yellowstone you know there's no reason that I can see not to do this for common you know for more common conditions so there are legal issues as well as health system issues that make that tough in Montana and I just wanted to add one thing um someone asked about food systems there are farm share programs all over Montana like towns harvest for Bozeman and and many more that I'm not aware of but one thing you can do is just participate in a farm share program and buy a share of a local producers produce each summer well thank you all so much I think we've come to the close and uh so appreciate your time and and thank you all for your very thoughtful questions. I'm sorry we didn't get to all of them, but there will be a survey that comes to all of you who participated and attended this webinar. We'd love to gather more information from you on information you need and thoughts you have on this whole topic, so watch for that. And, again, thank you so much for attending and have a great day.