San Francisco 2017
Climate and Health Adaptation Framework

Climate change is happening now.

Climate change is any major change in climate that lasts a long time. Right now, we’re experiencing global warming – the average surface temperatures on earth are rising. The burning of fossil fuels —coal, oil, gas—releases carbon dioxide and other greenhouses gases into the atmosphere. The gases trap heat. The temperature goes up. This will cause more variable weather, heat waves, heavy precipitation, flooding, droughts, more intense storms, sea level rise, and air pollution.  This creates significant and cascading impacts on public health. 

Climate change affects the San Francisco Department of Public Health (SFDPH)’s ability to protect and promote health. Since 2010, SFDPH’s Climate and Health Program has worked to address the public health impacts of climate change by developing assessments, outreach materials, plans, indices, and indicators for adaption and resilience efforts. 

This Climate and Health Adaptation Framework is a compendium of the Climate and Health Program’s work over the last several years, and represents a starting point to engage San Francisco’s diverse City and community stakeholders on designing solutions that reduce health disparities and climate health impacts. The Climate and Health Adaptation Framework does not represent a final plan, but rather a tool to begin conversations about how best to adapt to the health impacts of climate change.

Climate and Health Adaptation Framework Objectives

The goals of the Climate and Health Adaptation Framework are to:

•    Increase awareness of climate impacts.

•    Identify and assess how climate change will impact both public health in San Francisco and the Public Health Department’s ability to protect and promote health.

•     Propose a draft framework of strategies and activities to reduce the health burden of climate change, improve health equity, and develop a culture of climate preparedness.

•    Propose draft indicators to measure the severity of the climate risks and associated health risks.

•    Collaborate with internal and external stakeholders on climate change challenges. 

Climate and Health Adaptation Framework Next Steps

Over the next year, the Climate and Health Program plans to have open discussions with San Francisco City departments and communities, especially in San Francisco’s most vulnerable neighborhoods, to further refine the proposed framework and strategies. This discussion will serve as a roadmap for the Department, the City and local communities on how best to prepare the health impacts of climate change. Next steps in this process include:

  •    The development and implementation of a culturally competent outreach strategy to work with both internal and external stakeholders to cultivate partnerships, further develop adaptation strategies and increase awareness of climate change impacts.

 •    The development of an Implementation and Monitoring Strategy to document how adaptation strategies and activities are selection, implemented, communicated, and evaluated.

 •    Preparing the Health Department to become informed about the health implications of climate change in order to educate clients and communities and to incorporate sustainable principles to assist with the adaptation of SFDPH infrastructure and operations. 

The Climate and Health Adaptation Framework

Climate Risks

Adaptations and interventions were chosen to correspond to climate risks identified in the Obama Administration’s 2016 report, The Impacts of Climate Change on Human Health: A Scientific Assessment. These climate risks are:

1. Climate change will have the largest health impact on vulnerable populations.

2. Extreme heat can be expected to cause an increase in the number of premature deaths.

3. Extreme storms, sea level rise, and flood inundation will have cascading direct and indirect impacts on public health, housing, and city services.

4. Air pollution will likely increase, worsening allergy and respiratory conditions.

5. Higher temperatures, sea level rise, extreme storms and flooding increase the risks of waterborne illnesses.

6. Climate change, including rising temperatures and changes in weather extremes, is expected to increase the exposure of food to certain pathogens and toxins.

7. Warmer winter and spring temperatures are projected to lead to changes in vectors and vector-borne disease.

8. Rising temperatures, extreme heat events, and changing precipitation patterns are projected to exacerbate drought conditions in California. 

Strategies for Consideration:

Adaptations and Interventions

Climate Risk 1

Climate change will have the largest health impact on vulnerable populations.

Overview

Although climate change will impact all San Franciscans, not all San Franciscans will suffer these impacts evenly. This is the climate gap. 

Factors that can influence the climate gap are often rooted in current and historic systemic inequality and include socio-economics and demographics (age, race, income, educational attainment), environmental factors (tree cover, air pollution), exposure to hazards (sea level rise, temperature), infrastructure factors (housing quality, overcrowding, air conditioning), access to neighborhood goods and services (healthy food, pharmacies), transportation (access to public transportation, bicycle/pedestrian amenities), and pre-existing health conditions.

In 2015, SFDPH established the Community Resiliency Indicator System. The Community Resiliency Indicator System measures climate change vulnerability and resiliency among San Francisco neighborhoods to identify vulnerable neighborhoods to collectively plan climate interventions that will increase the City’s adaptive capacity. The San Francisco neighborhoods projected to be most affected by the health impacts of climate change are Bayview Hunters Point, Chinatown, Downtown/Civic Center, Mission Bay, and SOMA.

Adaptations and Interventions

Climate Risk 2

Extreme heat can be expected to cause an increase in the number of premature deaths.

Overview

Climate scientists project higher temperatures, more extreme-heat days, and longer heat waves.  

Extreme heat is the number one cause of weather-related deaths. Direct impacts of extreme heat includes increases in heat-related illnesses such as heat-stroke, dehydration, and heat-related mortality such as heart disease. High temperatures can also exacerbate the impact of pre-existing health conditions such as diabetes and renal disease. Higher temperatures and stagnant air worsen San Francisco’s air quality and lead to higher rates of respiratory illness, asthma, and allergies. Extreme heat is a stressor for those with mental and behavioral health disorders. Increases in heat-related hospitalizations and emergency room visits strain the city’s healthcare infrastructure and affects care for all San Franciscans. Heavy air conditioning usage taxes the city's electrical grid, threatens power outages, and increases energy costs for San Franciscans. 

In 2012, the SFDPH developed a Heat Vulnerability Index to identify the community determinants of extreme heat vulnerability and the most vulnerable neighborhoods to assist in the development and evaluation of programs and policies to better prepare for, respond to, and recover from heat-related hazard events. The neighborhoods identified as highly vulnerable to the health effects of extreme heat include Bayview/Hunters Point, Downtown/Civic Center, Chinatown, Mission,  and SOMA.

Adaptations and Interventions

Climate Risk 3

Extreme storms, sea level rise, and flood inundation will impact public health.

Overview

San Francisco is vulnerable to coastal flood inundation, caused by the combined impact of sea level rise and extreme storms.

Direct impacts of sea level rise and extreme storms include an increase in fatal and nonfatal injuries. Water intrusion and dampness can cause mold and increase rates of respiratory illness and allergies. Flooding can affect the transportation network, which impedes access to home, work, medical care, and pharmacies. Extreme storms can cause power outages which impact those dependent on elevators or electronic medical devices. A prolonged power outage can increase exposure to food-borne illness through failures in refrigeration. Indirect effects of sea level rise and extreme storms also include individual and municipal economic losses and housing shortages due to dislocation, reduced supply, and unaffordability. Income loss exacerbates mental and behavioral stress, food insecurity, and social isolation. 

In 2016, the SFDPH conducted an assessment of San Francisco’s vulnerability to the health effects of flooding and extreme storms. Especially vulnerable neighborhoods include Bayview/Hunter’s Point, Chinatown, Downtown/Civic Center, Mission Bay, North Beach, and SOMA.

Adaptations and Interventions

Climate Risk 4

Air pollution will likely increase, worsening allergy and respiratory conditions.

Overview

Climate change is anticipated to affect local air quality.

Higher concentrations of ground-level ozone will increase rates of asthma attacks, shortness of breath, coughing, chest-tightness, irritated mucus membranes, pulmonary inflammation, and respiratory illnesses and diseases. PM2.5 concentration can exacerbate asthma, bronchitis, and acute and chronic respiratory disease. These ailments will especially affect children because their lungs are still developing, and because their faster breathing rates increase their exposure to pollutants. In adults, worsened air quality from ground-level ozone or other pollutants could increase rates of chronic lung disease such as emphysema and premature death.

Air pollution-related health impacts in San Francisco are largely influenced by proximity to high-traffic corridors and industrial areas, where people of color and low-income residents are disproportionately located. In addition, the largest increases in ozone levels from climate change will occur in areas where ozone is already high, so the communities that are currently most exposed will suffer the worst of the changes.

The areas with the highest rate of preventable hospitalizations related to air quality include Bayview/Hunter’s Point, Chinatown, Western Addition and SOMA.

Adaptations and Interventions

Climate Risk 5

Higher temperatures, sea level rise, extreme storms, and flooding increase the risks of water-related illnesses.

Overview

Waterborne illnesses are caused by contact with water contaminated by disease-causing microbes or pathogens. Contact with contaminated water can occur by either ingesting contaminated drinking water or by touching, swimming, or wading in contaminated recreational water or flood waters. As extreme storms become more frequent and more severe, heavy precipitation events may cause municipal storm drains to overflow or residential stormwater management systems to malfunction. Contact with stormwater or wastewater has been associated with increased rates of gastrointestinal illness. Standing water or failure of the sewage, wastewater, or drinking-water infrastructure may cause waterborne illnesses, such as bacteria, viruses, and parasites to flourish.

Populations that are particularly vulnerable to illnesses associated with contact of contaminated water include children, elderly residents, populations with pre-existing health conditions, populations in high-risk sewer overflow zones, and those without adequate housing or in homes with poor plumbing. Heavy rainfall during December of 2014 may have contributed to a spike in Shigella cases among San Francisco’s homeless population.

Adaptations and Interventions

Climate Risk 6

Climate change, including rising temperatures and changes in weather extremes, is expected to increase the exposure of food to certain pathogens and toxins.

Overview

Foodborne disease and illnesses refer to bacteria, viruses, and parasites spread through the food we eat. Climate change is expected to affect ambient air and water temperatures, precipitation levels, and the frequency of extreme weather events, all of which are key factors in the introduction of pathogens into the food chain, food contamination, and foodborne disease.

There are a number of ways in which changes in climate are expected to increase the risk of foodborne illness. Higher ambient temperatures can increase the number of pathogens already present on produce, meats, and seafood. Rising ocean temperatures can lead to an increase in the frequency of naturally occurring pathogens such as Vibrio parahaemolyticus, which causes illness linked to shellfish consumption. Likewise, increased temperatures combined with decreased salinity from greater rainfall, could result in increases of Vibrio vulnificus, which is also linked to illness from shellfish consumption. Water temperatures are expected to rise with climate change. Warmer water increases fish and mammal metabolic rates, accelerating the uptake of contaminants like methylmercury. Once introduced into the food chain, these contaminants can cause serious health effects.

Adaptations and Interventions

Climate Risk 7

Warmer winter and spring temperatures are projected to lead to changes in vectors and vector-borne disease.

Overview

It is difficult to predict with certainty how changes in temperatures, precipitation, and extreme storms will impact host populations because other factors unrelated to climate change, such as infrastructure, global travel, and vector control programs can simultaneously impact host populations. 

Changes in precipitation, especially towards wet and dry extremes, and warm winter temperatures will impact both the growth and dispersal of mosquito populations. Native to Africa, the Aedes aegypti mosquito has expanded into the Southern United States and was recently discovered for the first time in the San Francisco Bay Area. The Aedes aegypti mosquito is a vector for such diseases as Chikaungungya, Zika, and Dengue Fever.

Particularly rainy seasons after dry seasons have been linked to increases in host populations such as rats and mice. The largest health impact associated with these species is allergies and asthma, but House mice can also spread Lympocytic Chorio-menigitis and bites may lead to bacterial infections.

Lyme disease is the most common vector-borne disease in the United States. The primary vector for Lyme disease, the Ixodes scapularis tick, is concentrated in the Eastern half of the United States. 95% of United States cases of Lyme disease occur in just 14 states, concentrated primarily in the mid-Atlantic seaboard and Upper Midwest. Lyme can also be spread by nymphal Ixodes pacificus, which lives along the West Coast including the San Francisco Bay Area. The populations of these tick nymphs tend to grow during particularly wet or hot seasons.

Adaptations and Interventions

Climate Risk 8

Rising temperatures, extreme heat events, and changing precipitation patterns are projected to exacerbate drought conditions in California. 

Overview

California could be subject to frequent and severe droughts like the 2011 -2016 drought that reduced state reservoirs to less than 30% of capacity. Drought strains the state’s water supply, disrupts California’s agricultural output, contributes to wildfires that worsen air quality, and could result in an increase in the price of produce, causing income loss and food insecurity. Less rain could allow respiratory irritants (e.g. particulate matter) to stay in the air longer. Drought conditions and high temperatures could also expand the blooming season for ragweed and other allergens, increasing resident exposure to respiratory irritants that cause allergies, asthma, and respiratory illness. 

The combined effects of the drought, higher temperatures, historic forest management practices that prematurely extinguish small fires that clear underbrush and decay, human development that encroaches into wildland, and invasive species have all conspired to make wildfires greater in both frequency and intensity. The most direct impact of wildfires on San Francisco is the health impacts associated with smoke that may drift into San Francisco. Wildfire smoke is particularly harmful to human health. The gases and particulate matter that constitute wildfire smoke can cause respiratory ailments and can exacerbate pre-existing health conditions by triggering asthma attacks or worsening chronic heart and lung diseases. Wildfire smoke can also cause allergic reactions and irritate the eyes, nose, and throat. Young children and elderly are particularly vulnerable to the health impacts associated with poor air quality and there is correlation between wildfire smoke inhalation during pregnancy and low birthweight.  

Adaptations and Interventions

Assessment of Public Health Preparedness

The Assessment of Public Health Preparedness pivots to assess to what degree are SFDPH staff, structure, and infrastructure prepared for the increased health burden associated with climate change.

This section begins with results and analysis from a 2016 survey to SFDPH leadership to better understand: 1) SFDPH leadership’s current perception of climate change in relation to San Francisco, SFDPH programs and activities and the populations served by these programs and activities; 2) Current SFDPH activities that either incorporate climate adaptation or produce climate health co-benefits and; 3) The capacity of SFDPH programs to develop or incorporate new interventions to assess and address the health impacts of climate change.

The Assessment of Public Health Preparedness then include an assessment of SFDPH’s guiding documents for the purpose of identifying opportunities to more formally integrate climate preparedness and community resiliency into the Department’s strategic planning.

This sections ends with a quick vulnerability assessment of SFDPH-owned infrastructure to climate change-related extreme weather events and health stressors. This assessment demonstrates that many SFDPH-owned properties are in neighborhoods projected to be affected by the health impacts of extreme heat, flooding, and air pollutants.

For More Information...

For more information, please consult these resources:

San Francisco Department of Public Health: www.sfdph.org

SFDPH Climate and Health Program: www.sfclimatehealth.org

Click here for the full San Francisco Climate and Health Adaptation Framework report

Or email us at

Cyndy.Comerford@sfdph.org, Manager of Policy and Planning
Director of Climate and Health Program

Matt.Wolff@sfdph.org, Health Systems and Geospatial Analyst