Health Behaviors and Chronic Disease

In New Hampshire, the projected increase in temperature and precipitation may be directly

associated with warmer, wetter seasons that influence the ability of people with chronic disease to perform daily functions, engage in healthy behaviors such as physical activity, and respond to emergencies.

The effects of climate change on chronic disease are challenging to track as chronic disease usually has multiple causes and triggers. On the other hand, surveillance systems such as the Behavioral Risk Factor Surveillance System (BRFSS) provide a standardized way to collect self-reported behavioral health

information in each state.

4.8.1. Summary of Existing Knowledge

Although the relationship between chronic disease and climate change has received less attention in the literature compared to injuries and acute illnesses, climate change is likely to affect major chronic diseases in complex ways. Long-term conditions such as asthma and allergies have been covered in previous sections, and mental health will be covered in the following section. In this section, the issue of concern is chronic diseases that disproportionately affect the elderly and vulnerable populations, including: cardiovascular disease, chronic respiratory diseases, obesity, and diabetes.

Not only can air pollution and increased heat directly affect those with chronic conditions, but it can alter behaviors and lifestyle choices (e.g., physical activity) that are major modifiable risk factors for multiple chronic diseases.

International research has investigated the potential health benefits of adopting greenhouse gas (GHG) mitigation policies.276 _{Scenarios of GHG mitigation} were developed for México City, México; Santiago, Chile; São Paulo, Brazil; and New York, New York. The authors estimated that the adoption of readily available technologies to reduce fossil fuel emissions over the next two decades in these cities would reduce particulate matter and ozone, thus avoiding approximately 64,000 premature deaths (95% confidence interval [CI] 18,000-116,000) (including infant deaths), 65,000 (95% CI 22,000-108,000) chronic bronchitis cases, and 46 million (95% CI 35-58 million) person-days of work loss or other restricted

activity.

Climate change and severe weather can restrict the ability of chronic disease populations to remain physically active, access medical care, participate in the workforce, or obtain healthy food. Physical activity and nutrition have direct impacts on obesity, diabetes, cardiovascular disease, some cancers, and certain mental health conditions.277 _{One of the most} exciting new research directions in climate change/ public health collaborations is in the area of “co- benefits” related to many adaptation strategies. For example, many of the same evidence-based policy, environmental, and systems change strategies that have been promoted by the “healthy eating/active living” (HEAL) movement within chronic disease prevention (e.g., promoting access to parks and green space, encouraging multi-modal transportation systems and “smart growth” land use patterns,

improving access to affordable healthy food (including local agriculture and farmer’s and farmer’s markets, and promoting “joint use” of school facilities) are also important climate change adaptation strategies. We are just not used to thinking of them as such. Thinking in terms of co-benefits moves beyond single-disease thinking and illustrates how decisions can potentially benefit public health more holistically, along with the environment and economic system.278 _{Collaborative} processes such as Health Impact Assessment (HIA) and adaptive management can be useful to help multi- sectoral stakeholders envision co-benefits and trade- offs of pending policy and planning decisions. 4.8.2 Potential Public Health Impact in New Hamp- shire: Health Behaviors and Chronic Disease

Importantly, climate change may affect key health behaviors (e.g., physical activity, diet), which are among the major modifiable risk factors associated with cardiovascular disease. For example, rising temperatures may mean that people spend more time outside exercising in fall/winter/spring than

they normally would in the Northeast, and less time in the summer. Changes in exercise habits may also change exposure to particulate matter, pollen, and disease vectors, especially for vulnerable populations. Extreme weather events, such as flooding, can make public parks and recreational facilities inaccessible, potentially causing people to abstain from physical activity. Consumption of fruits and vegetables may change as access to locally grown produce changes in response to climate conditions, in terms of both availability and costs. While several relevant studies have been published on sustainable environments, health behaviors and social capital, there have been few in New Hampshire linking climate change to these outcomes.279

Both extreme cold and extreme heat have been associated with increased incidence of hospital admissions for chest pain, acute coronary syndrome, stroke, and variations in cardiac dysrhythmias, though the reported magnitude of the exposure-outcome associations is inconsistent280 _{Weather conditions such} as extreme heat serve as stressors in individuals with pre-existing cardiovascular disease, and can directly precipitate exacerbations.281

In summary, vulnerabilities pertaining to behavioral and chronic disease impacts are likely to follow similar socio-demographic patterns as those described previously for other impacts, particularly for the elderly, socially or linguistically isolated individuals, immigrants/refugees, low income individuals, those working in strenuous occupations, and those suffering from disabilities or multiple chronic

illnesses. The importance of the way we plan our built environment, including land use, transportation, and water management plans, as well as how we interact with our natural environment and preserve its life- supporting functions, must be emphasized as pivotal points of intersection in the “Geography of Resilience” framework described at the beginning of this report.

in terms of linking the co-benefits of multi-sectoral, multi-level planning initiatives currently being implemented in NH. These include: the work of the NH Regional Planning Commissions on the Granite State Future initiative, hazard-mitigation planning efforts, and local health department initiatives such as neighborhood health improvement strategies. They also include institutional policies on environmental sustainability such as those initiated by NH DES, the work of the UNH Institute on Disability (IOD) on emergency preparedness, Integrated Watershed Resource Management and related partnerships in NH.282 _{A common thread running through these diverse} initiatives is the potential for multiple public health co- benefits in terms of both mitigation and adaptation.