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@prefix dcterms: <http://purl.org/dc/terms/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
@prefix gcis: <http://data.globalchange.gov/gcis.owl#> .
@prefix cito: <http://purl.org/spar/cito/> .
@prefix biro: <http://purl.org/spar/biro/> .

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   dcterms:identifier "key-message-24-4";
   gcis:findingNumber "24.4"^^xsd:string;
   gcis:findingStatement " <p>Organizations and volunteers that make up the Northwest’s social safety net are already stretched thin with current demands (<em>very likely, high confidence</em>). Healthcare and social systems will likely be further challenged with the increasing frequency of acute events, or when cascading events occur (<em>very likely, high confidence</em>). In addition to an increased likelihood of hazards and epidemics, disruptions in local economies and food systems are projected to result in more chronic health risks (<em>very likely, medium confidence</em>). The potential health co-benefits of future climate mitigation investments could help to counterbalance these risks (<em>likely, medium confidence</em>).</p>"^^xsd:string;
   gcis:isFindingOf <https://data.globalchange.gov/report/nca4/chapter/northwest>;
   gcis:isFindingOf <https://data.globalchange.gov/report/nca4>;

## Properties of the finding:
   gcis:findingProcess "<p>This assessment focuses on different aspects of the interaction between humans, the natural environment, and climate change, including reliance on natural resources for livelihoods, the less tangible values of nature, the built environment, health, and frontline communities. Therefore, the author team required a depth and breadth of expertise that went beyond climate change science and included social science, economics, health, tribes and Indigenous people, frontline communities, and climate adaptation, as well as expertise in agriculture, forestry, hydrology, coastal and ocean dynamics, and ecology. Prospective authors were nominated by their respective agencies, universities, organizations, or peers. All prospective authors were interviewed with respect to the qualifications, and selected authors committed to remain part of the team for the duration of chapter development.</p> <p>The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at workshops, weekly teleconferences, and email exchanges. The author team, along with the U.S. Global Change Research Program (USGCRP), also held stakeholder meetings in Portland and Boise to solicit input and receive feedback on the outline and draft content under consideration. A series of breakout groups during the stakeholder meetings provided invaluable feedback that is directly reflected in how the Key Messages were shaped with respect to Northwest values and the intersection between humans, the natural environment, and climate change. The authors also considered inputs and comments submitted by the public, interested stakeholders, the National Academies of Sciences, Engineering, and Medicine, and federal agencies. For additional information on the overall report process, see Appendix 1: Process. The author team also engaged in targeted consultations during multiple exchanges with contributing authors for other chapters, who provided additional expertise on subsets of the Traceable Accounts associated with each Key Message.</p> <p>The climate change projections and scenarios used in this assessment have been widely examined and presented elsewhere{{< tbib '11' '07aed96a-e0e8-47dd-81d3-cdff5a6e261c' >}}<sup class='cm'>,</sup>{{<tbib '50' '0b30f1ab-e4c4-4837-aa8b-0e19faccdb94' >}}<sup class='cm'>,</sup>{{<tbib '263' '75cf1c0b-cc62-4ca4-96a7-082afdfe2ab1' >}}<sup class='cm'>,</sup>{{<tbib '264' 'f03117be-ccfe-4f88-b70a-ffd4351b8190' >}} and are not included in this chapter. Instead, this chapter focuses on the impact of those projections on the natural resources sector that supports livelihoods (agriculture, forestry, fisheries, and outdoor recreation industry), the intangible values provided by the natural environment (wildlife, habitat, tribal cultures and well-being, and outdoor recreation experiences), human support systems (built infrastructure and health), and frontline communities (farmworkers, tribes, and economically disadvantaged urban communities). The literature cited in this chapter is largely specific to the Northwest states: Washington, Oregon, and Idaho. In addition, the authors selected a series of case studies that highlight specific impacts, challenges, adaptation strategies and successes, and collaborations that are bringing communities together to build climate resilience. The most significant case study is the 2015 case study (Box 24.7), which cuts across all five Key Messages and highlights how extreme climate variability that is happening now may become more normal in the future, providing important insights that can help inform and prioritize adaptation efforts.</p>"^^xsd:string;
   
   gcis:descriptionOfEvidenceBase "<p>Cascading hazards could occur in any season; however, the summer months pose the biggest health challenges. For example, wildfire could occur at the same time as extreme heat and could damage electrical distribution systems, thereby simultaneously exposing people to smoke and high temperatures without the ability to pump water, filter air, or control indoor temperatures. Although some work is being done to prepare, responses to emergency incidents continue to show that there are considerable gaps in our medical and public health systems.{{< tbib '315' '4774f70f-d9c5-43a7-9561-ef771165e5b9' >}} Public health departments are in place to track, monitor, predict, and develop response tactics to disease outbreaks or other health threats. In the case of cascading hazards, the public health system has a role in communicating risks to the public as well as strategies for self-care and sheltering-in-place during a crisis. Unfortunately, local health departments report inadequate capacity to respond to local climate change-related health threats, mainly due to budget constraints.{{< tbib '316' 'f82a2e76-95bb-4a33-8877-8c16ca217397' >}} Hospitals in the United States routinely operate at or above capacity. Large numbers of emergency rooms are crowded with admitted patients awaiting placement in inpatient beds, and hospitals are diverting more than half a million ambulances per year due to emergency room overcrowding.{{< tbib '317' '3c69fb3a-7bcd-4acb-93a2-5dbf687d8491' >}}</p> <p>Existing environmental health risks are expected to be exacerbated by future climate conditions,{{< tbib '187' 'b1577125-f789-49e6-9656-c40ed932184a' >}} yet over 95% of local health departments in Oregon reported having only partial-to-minimal ability to identify and address environmental health hazards.{{< tbib '194' '796714bc-3fbc-471a-9c93-fbee657006a9' >}} The capacity of our public health systems is largely inadequate and unable to meet basic responsibilities to protect the health and safety of people in the Northwest.{{< tbib '162' 'f1ca2352-7158-4312-9c4b-3d1189c1ad10' >}}<sup class='cm'>,</sup>{{<tbib '194' '796714bc-3fbc-471a-9c93-fbee657006a9' >}} Public health leaders from state and local health authorities, state advisory boards, and public health associations have been working together for over five years to develop a plan for rebuilding, modernizing, and funding the region’s public health systems.</p> <p>Socioeconomic income levels can be a predictor of environmental health outcomes in the future.{{< tbib '187' 'b1577125-f789-49e6-9656-c40ed932184a' >}}<sup class='cm'>,</sup>{{<tbib '195' 'c6bc7876-ad40-4d51-83e5-49816363385c' >}} Food systems face continued increases in environmental pressures, with climate change influencing both the quality of food and the ability to distribute it equitably. The capacity to ensure food security in the face of rapidly changing climate conditions will likely be a major determinant of disease burden.{{< tbib '318' '646126e1-2c39-4498-891f-a7d36d902899' >}}</p> <p>Climate mitigation strategies can in some cases have substantial health co-benefits, with evidence pointing toward active transportation{{< tbib '319' '50e17b29-8313-4a48-95e9-cdca2241f4ea' >}} and green infrastructure improvements.{{< tbib '320' 'd1845478-f491-4533-8ef3-bad72ef5282d' >}} This evidence of health co-benefits provides an additional and immediate rationale for reductions in greenhouse gas emissions beyond that of climate change mitigation alone. Recognition that mitigation strategies can have substantial benefits for both health and climate protection offers the possibility of strategies that are potentially both more cost effective and socially attractive than are those that address these priorities independently.{{< tbib '321' '25181456-7f49-4348-8ce8-55e4def0e02b' >}} The Oregon Health Authority’s Climate Smart Strategy Health Impact Assessment found that almost all climate mitigation policies under consideration by the Metro Regional Government could improve health, and that certain policy combinations were more beneficial, namely those that reduced vehicle miles traveled.{{< tbib '322' '62f522a8-bb4a-44a3-89a4-2862e6cd2981' >}} For example, according to 2009 data available on the National Environmental Public Health Tracking Network, a 10% reduction in PM<sub>2.5</sub> could prevent more than 400 deaths per year in a highly populated county and about 1,500 deaths every year in the state of California alone. Working across sectors to incorporate a health promotion approach in the design and development of built environment components could mitigate climate change, promote adaptation, and improve public health.{{< tbib '323' 'd01a3234-774c-4ea8-bbc3-f7fd726699bb' >}}</p> "^^xsd:string;
   
   gcis:assessmentOfConfidenceBasedOnEvidence "<p>There is <em>high confidence</em> that there will be increased hazards and epidemics, which will <em>very likely</em> disrupt local economies, food systems, and exacerbate chronic health risks, especially among populations most at risk. There is <em>high confidence</em> that these acute hazards will increase due to future climate conditions and will <em>very likely</em> increase the demand on organizations and volunteers that respond and form the region’s social safety net. There is <em>medium confidence</em> that mitigation investments can help counterbalance these risks and <em>likely</em> result in health co-benefits for the region.</p> "^^xsd:string;
   
   gcis:newInformationAndRemainingUncertainties "<p>Preparing and responding to cascading hazards is complex and involves many organizations outside of the medical and public health systems. There is not a common set of metrics or standards for measuring surge capacity and emergency preparedness across the region.</p> <p>There is uncertainty in whether domestic migration will place further stress on social safety net systems.</p> "^^xsd:string;

   a gcis:Finding .

## This finding cites the following entities:


<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/article/10.1007/s00382-016-3418-7>;
   biro:references <https://data.globalchange.gov/reference/07aed96a-e0e8-47dd-81d3-cdff5a6e261c>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/epa-multi-model-framework-for-quantitative-sectoral-impacts-analysis-2017>;
   biro:references <https://data.globalchange.gov/reference/0b30f1ab-e4c4-4837-aa8b-0e19faccdb94>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/article/10.1016/s0140-6736(09)61759-1>;
   biro:references <https://data.globalchange.gov/reference/25181456-7f49-4348-8ce8-55e4def0e02b>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/book/hospital-based-emergency-care-at-breaking-point>;
   biro:references <https://data.globalchange.gov/reference/3c69fb3a-7bcd-4acb-93a2-5dbf687d8491>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/book/medical-surge-capacity-workshop-summary>;
   biro:references <https://data.globalchange.gov/reference/4774f70f-d9c5-43a7-9561-ef771165e5b9>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/article/10.2105/ajph.2012.300939>;
   biro:references <https://data.globalchange.gov/reference/50e17b29-8313-4a48-95e9-cdca2241f4ea>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/climate-smart-communities-scenarios-health-impact-assessment>;
   biro:references <https://data.globalchange.gov/reference/62f522a8-bb4a-44a3-89a4-2862e6cd2981>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/article/10.1146/annurev-publhealth-031816-044356>;
   biro:references <https://data.globalchange.gov/reference/646126e1-2c39-4498-891f-a7d36d902899>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/climate-science-special-report>;
   biro:references <https://data.globalchange.gov/reference/75cf1c0b-cc62-4ca4-96a7-082afdfe2ab1>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/state-oregon-public-health-modernization-assessment-report>;
   biro:references <https://data.globalchange.gov/reference/796714bc-3fbc-471a-9c93-fbee657006a9>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/oregon-climate-health-profile-report>;
   biro:references <https://data.globalchange.gov/reference/b1577125-f789-49e6-9656-c40ed932184a>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/climate-health-vulnerability-assessment>;
   biro:references <https://data.globalchange.gov/reference/c6bc7876-ad40-4d51-83e5-49816363385c>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/health-all-policies-guide-state-local-government>;
   biro:references <https://data.globalchange.gov/reference/d01a3234-774c-4ea8-bbc3-f7fd726699bb>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/article/10.3390/ijerph120809768>;
   biro:references <https://data.globalchange.gov/reference/d1845478-f491-4533-8ef3-bad72ef5282d>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/report/ipcc-ar5-wg1>;
   biro:references <https://data.globalchange.gov/reference/f03117be-ccfe-4f88-b70a-ffd4351b8190>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/webpage/98ff68b5-0574-43cf-a2b0-b46beda7c683>;
   biro:references <https://data.globalchange.gov/reference/f1ca2352-7158-4312-9c4b-3d1189c1ad10>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   cito:cites <https://data.globalchange.gov/article/10.1371/journal.pone.0151558>;
   biro:references <https://data.globalchange.gov/reference/f82a2e76-95bb-4a33-8877-8c16ca217397>.



<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   prov:wasDerivedFrom <https://data.globalchange.gov/scenario/rcp_4_5>.

<https://data.globalchange.gov/report/nca4/chapter/northwest/finding/key-message-24-4>
   prov:wasDerivedFrom <https://data.globalchange.gov/scenario/rcp_8_5>.