Three Portland-area counties launch regional climate health dashboard

Multnomah, Clackamas and Washington counties recently launched a regional dashboard that tracks the health impacts of climate change in the metro area. It includes data on heat and cold events, air quality, infectious diseases and the effects climate change can have on mental health. The dashboard is an evolution of the counties’ Regional Climate and Health Monitoring Report, which was previously released every two years as a lengthy PDF.

Sarah Present is the Clackamas County Health Officer, and Kathleen Johnson is a senior program coordinator at Washington County Public Health. They join us to talk about the new dashboard and how climate change is impacting public health in the metro area.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Clackamas, Washington and Multnomah counties recently launched a regional dashboard that tracks the health impacts of climate change in the metro area. It offers a searchable deep dive into extreme heat and cold events, air quality, infectious diseases and the effects that climate change can have on mental health.

Sarah Present is the Clackamas County Health Officer and a family physician. Kathleen Johnson is a senior program coordinator at Washington County Public Health. They both join me now. It’s great to have both of you on Think Out Loud.

Kathleen Johnson: Thanks, Dave. Good to be here.

Sarah Present: Thanks for having us.

Miller: So this dashboard is the most recent version and a sort of a new incarnation of data collection that these three counties have been making public for a while now. But in the past, it was a PDF; now, it’s this dashboard. We can talk about that change. But, first, just broadly, and Dr. Present, first, what’s the purpose of putting this data out here?

Present: Yeah, great question. So, we in public health have known for 30+ years that climate change is absolutely one of the greatest risks to the public’s health that we have in this generation. For many decades, we’ve been able to predict the type of health effects that changing climate would have on populations and people, including food insecurity, human migration, communicable infectious disease changes. But until our first report here in 2019, we started collecting data, we didn’t really know how it was affecting our region and our community.

In local public health, one of our main roles as public health is to collect data so that we can analyze it and see how our local populations are being affected. And therefore, we can use that to look at building resiliency or making policies that can affect people’s abilities to mitigate those changes.

Miller: What is the thinking, Kathleen, from having it go from this sort of static PDF that people could read – a lot of data was there – to this online database?

Johnson: A couple of reasons we moved to the database. One, there’s more user friendliness to an online dashboard, the ability to kind of click through rather than scroll through a long PDF report. And I think the other thing is the last couple iterations of this monitoring report and now dashboard. We have conversations as a regional group on like, how can we make this better? What is the evolution of this so that we can better share this data with community, with elected officials, with partners? And after the last report, the PDF version, we decided that we wanted to take it in more of a dashboard route.

It also allows us to update it more easily. We have really incredibly smart data analysts and epidemiologists that think about code and how we look at the data, how we upload the data. They figure out ways to do that in an easier way, rather than having to create this long PDF report – and a dashboard allows us to do that.

Miller: How often is it going to be updated?

Johnson: At this rate, I think we can promise at least every couple years. That’s been the trend since 2019. But part of the evolution is just figuring out how we can do that, how we can do that more frequently.

Miller: So let’s dig into the data itself. Sarah, let’s start with extreme heat, which is probably one of the health issues that people are most likely to think about in terms of the health effects of climate change. In the big picture, what stands out to you when you look at extreme heat and health in the metro region?

Present: What stands out to me in this data is looking at the longer summer, warm months that we have and the more days of elevated heat that we have. It has been really interesting to look at particularly the 2021 heat dome and really being able to see effects in heat related illness and death related to that, but also looking at the trends over time.

I think comparing our public health data to the actual weather data is really an interesting thing to do over a long period of time. The heat dome in particular led to policy changes. OSHA now has some rules around people working outside in the heat. Are we going to be able to see any changes in that over time, or are we not? And I think that there are some really sort of small factors that we see in these dashboards that will inform that sort of policymaking in the future.

Miller: Kathleen, one of the data points that stood out to me is that intoxication was the most frequently identified risk factor in emergency department visits for heat related illness throughout the entire region over a recent five-year period. What does that mean? What kinds of scenarios are actually making up that data?

Johnson: Sure, it could be a few different things. It’s hard to exactly pinpoint because it’s based on triage notes, so we’re just going off of what’s available in the records. But a few things – it could be people recreating, having a good time and maybe over-serving themselves on a really hot day. So that’s part of the messaging that we put out as local public health authorities, to really be mindful of that when it’s really hot outside, and staying hydrated is important.

Another thing that I think it’s connected to is our houselessness crisis. There are more people that live outside, that utilize different substances, and there’s a connection there as well.

Present: In addition, many intoxicants do affect your body’s metabolism and your physical ability to tolerate heat. So intoxicants like alcohol really decrease your body’s availability to cool itself, similar to some other things that we can see in there like medications or other sort of health factors.

Miller: Let’s go from extreme heat to extreme cold, where there’s been a steady increase in emergency room and urgent care visits in the last five years. It’s a pretty clear upward trend from 2020 through 2024, which is the most recent data. What’s behind that increase?

Present: I’m not really sure. I think there are a number of factors that we can’t tell particularly from the data. If we’re able to look at the increase compared to the number of cold days, it doesn’t necessarily make sense in the same way that heat-related illnesses do, as far as the length of the warm season. But with climate changing, our cold events can be more severe. We can have more ice, more snow, which affects injury risk, fall risk, car accident risk, as well as people’s ability to warm themselves. And there are so many factors in that: where you live, whether you have access to heat, whether you have access to safe heat that doesn’t release carbon monoxide, and whether you can pay your utility bills to keep that heat on. So there’s so many factors that go into this that we really can dive more into our evaluation of this data.

Miller: Kathleen, I want to turn to air quality. What kind of data, broadly, did you and these teams from three different counties collect?

Johnson: Yeah, so the methods team for air quality, they look at the emergency department and urgent care visits, they look at hospitalizations and they also look at deaths. There’s a few different areas: an area called asthma-like symptoms, non-infectious respiratory illness, and then things like allergenic visits, so that might be a pollen allergy type of thing. And that’s the data we look at. Those are available through statewide databases. But we’re trying to, again, look at those trends over time. For a lot of those we do see, at least for the asthma-like and then the non-infectious respiratory, they tend to be higher just generally across the season, but we are seeing kind of an increase in that.

Miller: Well, let’s turn to some of these in particular. Dr. Present, what’s the connection between climate change and asthma?

Present: Many. With changing climates, not only heat but our weather patterns, we can have increased particulate matter that’s sort of being stagnant in the air. So, our air quality index and the air quality can be affected by both the temperature as well as the weather patterns. We do tend to have stagnant air during both our warm months and our cold months here. That poor air quality with air pollution increases your chance of having an allergic event at that time, but also over time, for small children, for other people, it increases your risk of getting asthma in the first place.

Miller: Maybe that helps to explain a little bit of a disconnect that I saw, because when I looked at one of the pages that showed air quality, when you look at 2020, it has by far the days with the worst air quality. Not surprisingly, that was when there was smoke from fires in so many parts of Western Oregon, including up into Clackamas County. The Portland metro area had fires, but we also had smoke from far away. So those were the days, in the entire five-year period, with by far the worst air quality.

But then, if you look at emergency department and urgent care visits for asthma and for non-infectious respiratory illness, they’ve all trended upward even since then. So, you’re saying that part of the explanation could be that it’s cumulative? That, say, asthma could have gotten worse from 2020, from some of those smoky days and from just the accumulation of breathing bad air?

Present: Yes and no. So, poor air quality for young children and infants increases your risk of getting asthma. Their poor air quality over time also increases risk of adults having asthma-like lung disease. I think when you look at 2020, we have to be careful to remember that was also sort of peak COVID time, so the infectious respiratory illnesses were higher in our emergency rooms. And a lot of people who did have underlying conditions or were at risk were staying away from the emergency rooms. I can’t make a direct connection to that, but we have to remember that’s part of it.

We do know that extreme particulate matter events, like wildland fires or urban fires, can cause lung damage that can then lead to new people having reactive airway disease. I don’t know that that’s necessarily what happened there. But I think over time, we are having more poor air quality days in general. And that’s the real takeaway from this, not that it’s causing more bad lung disease in adults, but it can in children and then we’re having more poor air quality days overall.

Miller: What about the severity of pollen seasons and allergies?

Present: Yeah, that’s really interesting, too. With the longer warm months, we have changes in our ecology of grasses, pollens and trees that people have allergies to. We know that the pollen count of even a particular type of tree can be higher with warmer weather or with climate changes. So, we’re having more pollen and changes in the type of pollen, and a lot of them are the ones that people are allergic to and they’re reacting to.

Miller: Kathleen, another area of the dashboard is focused on infectious disease. What infectious diseases are likely to become more common in the Portland area because of climate change?

Johnson: Well, I don’t know if I can speak to the likelihood of what will become more common, but what we track in the dashboard is illness related to Salmonella, which is a type of bacteria, and Campy, which is also a type of bacteria – they tend to be waterborne bacteria. So the reason why we take a look at those in the dashboard is because we know that with climate change, we can see, as we did this week, more intense periods of heavy rain, which can increase flooding. And we’ll also see, as Dr. Present was noting, longer warm seasons, which also bacteria like moisture and they like warmth, so they’re more likely to grow. And that’s why we track it over, over time and that’s one of the intentions of this dashboard is to look at that data and how it might be changing.

The other thing that we take a look at or the other things we take a look at in the dashboard are vector-borne diseases, which include Lyme disease, which is often transmitted through ticks, and then West Nile virus, which is transmitted through mosquitoes. And then the new one that we added is Valley Fever, which is an illness due to a fungus that lives in the soil that also can increase with environmental changes like warmer conditions, drought, and then moisture.

Miller: Dr. Present, at this point, is the public health guidance for people in the Portland metro area that, say, after they walk around some grassy area in the summer, they should do a tick check. That’s been pretty common practice in the East Coast for Lyme disease for decades now and we’ve heard over the years that it’s been moving westward. Has it gotten to the point where you recommend that we do that here?

Present: Locally-transmitted Lyme disease is still very rare. And that really is one of the reasons that we have Lyme on our dashboard is because it is something that we can anticipate to see more of in the future, but it is still incredibly rare. Most of the Lyme disease cases that we still have are people who have traveled to places where it’s more common, like the East Coast. I think it’s always important to do tick checks, make sure you don’t have any bites, but I don’t think we need to be as worried about Lyme disease right now. But that’s part of why we monitor this over years and years.

Miller: I want to turn to mental health. The sense I get is that it’s a little bit harder for public health officials like you to know exactly how to track this, to put that into data form. So, what are the challenges, first, just in terms of getting, creating good data about the mental health effects of climate change?

Johnson: Yeah, I can start us. Well, I think one of the challenges is that we don’t have a statewide database like the others, where we can track mental health changes connected to climate change over time. We don’t have historical data to understand what mental health experiences or emotional experiences were. So we’re trying to, as a part of this dashboard, to figure out how we can take a look at that and understand that better.

That’s one of the things that we’ve been doing in the last couple of iterations is really trying to get better about how we collect data around mental health impacts. And you’ll see in this most recent iteration, that we did a survey and we partnered with behavioral health providers. I think it also went out on social media, but that’s kind of our in-between working solution due to the lack of a good historical data record.

Miller: Sarah, what stands out to you in the data that is now being put out by these three counties about climate change and mental health?

Present: I, unfortunately, was not very surprised at the data. I think three-quarters of people have poor mental health effects of their concern around climate change, whether it’s fear, anxiety, worry, depression. But many people also have ways that they are finding resilience. And I think that is one of the big things that we can take from this is we all know that it is scary. I have a child who I see her having nervousness about the climate changing. But to be able to talk about this data and talk about the challenges, as well as how to be resilient, how to find joy and how to find hope – we did collect that in the survey – and I think that 25% of people were able to share ways that they’re managing that anxiety.

Johnson: In Washington County, we did some recent community engagement, and that was one thing that came out of engaging with communities is a real desire for spaces to connect with other people and build that resilience through those social connections. I think people are really longing for that and that was also clear in the data from the dashboard as well.

Miller: How are you hoping – Sarah, first – that people will use this dashboard? And when I say people, I guess also, who do you want to go to this dashboard?

Present: So, I think in general, in public health, we’re really wanting to just make sure that our public health data is available to the communities who are seen in that data. So, I think we have a lot of community partners, community-based organizations that work with different populations, many on emergency response or climate resiliency. So to be able to see their work in this data, but also be able to focus their work and focus resources is important.

Miller: What’s an example, a concrete example of how you think policies, approaches or programs could change in a way that is directly attributable to this report? I guess I’m just wondering … so, it’s not just data for the sake of data, but that someone looks at the data and says, “OK, now we’re going to do this because of it.” What’s an example of what you hope to happen or what has already happened?

Present: Well, something that is already happening … We all have limited resources. We need to make sure that we appropriate them appropriately. But like with the heat-related illnesses in Multnomah County, the demographics showed higher illness rates in houseless people, as well as people living alone inside. Whereas, in Clackamas County, there were more sorts of outdoor farmworkers. So we can use our resources to work with our partners, working with farmworkers to help build education and resiliency there, and know that our resources may be more effective.

Miller: Kathleen Johnson and Sarah Present, thank you so much.

Present: Thank you.

Johnson: Thanks, Dave.

Miller: Sarah Present is a family physician for Clackamas County Health Centers. She joined us, though, in her role as the Clackamas County Health Officer. Kathleen Johnson is senior program coordinator at Washington County Public Health. There is a link to these new dashboards on our website.

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