BROWN-NICOLLET COMMUNITY HEALTH BOARD
EXAMPLE EXTREME HEAT VULNERABILITY
ASSESSMENT
Minnesota Climate and Health Program
Minnesota Department of Health
Environmental Impacts Analysis Unit
625 Robert Street North
PO Box 64975
St. Paul, MN 55164-0975
June 5, 2012
BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
This is a description of how demographic, social and health data compiled by MDH and provided at
http://www.health.state.mn.us/divs/climatechange/ can be used to start planning for extreme heat
events, using the Brown-Nicollet Community Health Board (CHB) as an example. The data used in this
assessment includes five characteristics from Census data 1 (children less than 5 years old, elderly 65
years old and older, elderly living alone, persons that live below the poverty level, and persons that live
below 200% of the poverty level), as well as additional vulnerability indicators, such as persons with preexisting conditions such as asthma, diabetes, or cardiovascular/heart disease, persons living in urban
areas, and persons at risk for prolonged exposure to the sun. Data for these vulnerabilities can be found
in the MDH Extreme Heat Toolkit, Appendix F: Data source for characteristics that affect negative health
outcomes from extreme heat, available online at http://www.health.state.mn.us/divs/climatechange/.
The data assessment is conducted for each county, Brown and Nicollet, separately. Summarizing the
data would mask locations of higher vulnerabilities, and many intervention strategies are conducted at
the county or local community level. Examples of strategies to prevent heat-related illnesses and
mortality from extreme heat are provided for each vulnerable or at-risk population. More information
on these strategies can be found in the MDH Extreme Heat Toolkit, available online at
http://www.health.state.mn.us/divs/climatechange/extremeheat.html. Often the first step for local
public health should be to connect with local emergency managers and local Red Cross chapters to
coordinate planning efforts, communications, and implementation strategies around extreme heat and
other extreme weather events.
CHARACTERISTICS FROM CENSUS DATA
Using the statewide maps and excel spreadsheet, an initial comparison of Nicollet County, Brown
County and the State of Minnesota can be made. Nicollet County has a total population of 32,271
persons, and 12,150 households; Brown County has a total population of 26,030, and 10,798
households. The following table shows the comparison of characteristics between Nicollet County,
Brown County and the State of Minnesota. Comparing local populations to the state shows whether
counties and local communities are above or below state averages as context, but does not necessarily
provide a significant health threshold comparison.
Vulnerable Populations
Percent of Population Less Than 5 Years Old
Percent of Population 65 Years Old or Older
Percent of Population Below Poverty Level
Percent of Population Below 200% of Poverty Level
Percent of Elderly Living Alone
1
Nicollet Co.
Brown Co.
Minnesota
6.2%
5.9%
6.7%
11.7%
19.0%
12.6%
25.9%
25.8%
25.5%
11.6%
10.0%
9.8%
14.8%
10.6%
9.4%
Data for this assessment was collected from the 2010 American Community Survey 5-Year Estimates
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
County summaries can often hide hidden disparities among communities within a county.
Initial observation of the table finds few differences between Nicollet County and the state’s rates for
the six characteristics, except for a higher percent of population 65 years old and older in Brown County.
However, this data presents averages for the county, and the percentages could vary between cities and
townships within the counties. There are 18 county subdivisions in Nicollet County: five cities and 13
townships. In Brown County, there are 23 county subdivisions: seven cities and 16 townships. Looking at
each county subdivision (e.g., city, township, unorganized territory) individually will expose each of the
five characteristics in more detail. To show the county subdivisions in Nicollet and Brown counties only,
filter the county subdivision tab of the excel spreadsheet using the filter arrow in the column for county
(column B) and selecting only the name of the county or counties that are of interest. (See graphic
below for clearer depiction of filtering.)
filter arrow
county selection
POPULATION LESS THAN 5 YEARS OLD
N ICOLLET C OUNTY
Three communities, Courtland city, Lafayette city, and Nicollet city, have a higher percentage of children
less than 5 years old than the state (above 6.7%). However, these cities are not much higher than the
state; Lafayette city has the highest percentage of persons less than 5 years old at 8.1%. Additionally,
these cities’ total populations are fairly small; Nicollet city has the largest estimated population (1,066
persons), with an estimated 80 persons less than 5 years old. These may not be large vulnerable
populations, but that does not make them less vulnerable. North Mankato has exactly the same
percentage of persons less than 5 years old as the state at 6.7%, but the largest number among all the
communities in the county, with an estimated 881 children less than 5 years old.
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
B ROWN C OUNTY
Three communities have slightly higher percentages of children less than 5 years old than the state:
Comfrey city (14.5%), Evan city (10.0%), and Stately township (11.8%). Similar to they cities in Nicollet
County, these communities have small total populations: 441, 60, and 186, respectively. The community
with the largest total number of children less than 5 years old is New Ulm city, with 841 children less
than 5 years old (6.2%).
Children may be at increased risk due to dependency on other people for their care and/or physiological
differences, including smaller body mass to surface area ratio than adults, blunted thirst response,
production of more metabolic heat per pound of body weight and lower cardiac output. Strategies to
prevent heat-related illness and mortality for children include targeted education to day care centers
and social services organizations that work with families and/or young children. It is especially important
to message to parents that they should never leave children unattended in vehicles for any amount of
time. Even on days with relatively mild temperatures (~70°F), temperatures in parked cars can increase
rapidly. Leaving windows open does not significantly decrease the heating rate.
POPULATION 65 YEARS OLD AND OLDER
N ICOLLET C OUNTY
Three communities, Brighton township, Granby township and Ridgely township, have over 20% of their
population 65 years old and older, significantly more than the 12.6% for the state and 11.7% for Nicollet
County. These communities are small, with less than 50 persons 65 years old and older, however as
previously stated that does not make this population any less vulnerable. In fact, the small size of the
community may increase the social isolation of the elderly population, making them more vulnerable
than a larger elderly population in a bigger community. The community with the largest population of
persons 65 years old and older is North Mankato, with 1,491 (11.3%).
B ROWN C OUNTY
Five communities in Brown County have more than 20% of their population 65 years old or older:
Hanska city (21%), Mulligan township (27.5%), Sleepy Eye city (23.2%), Springfield city (29.6%), and Stark
township (25.2%). Two of these communities have fairly large populations, with large total numbers of
persons 65 years old or older: Sleepy Eye city (837 persons) and Springfield city (621 persons). The
community with the largest total number of persons 65 years old and older is New Ulm, with 2,410
persons 65 years old or older.
Certain physiological changes associated with aging, especially the body’s decreased ability to
thermoregulate, increase older adults’ risk of experiencing heat-related illnesses. Pre-existing disease
conditions and the use of certain medications also may increase older adults’ susceptibility to adverse
health outcomes from heat. Elderly persons, who live alone and/or at or below the poverty line, are
particularly vulnerable to negative health outcomes from extreme heat because of a combination of
factors associated with aging, social isolation, and economic constraints.
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
Strategies to prevent heat-related illness and mortality for the elderly include targeted education to
nursing homes and assisted living facilities, as well as social services organizations that work with elderly
or disabled populations. Many elderly who live alone may be unwilling to leave their homes, which can
be an increased health hazard if they do not have air conditioning. Working with mobile community
outreach organizations such as Meals-on-Wheels or nurses who conduct at-home care can be an
effective way to utilize existing services. On a smaller scale, implementing a community level buddy
system (i.e., neighbors check on neighbors, especially the elderly) during extreme heat events can also
be effective.
POPULATION BELOW POVERTY LEVEL AND 200% OF POVERTY LEVEL
N ICOLLET C OUNTY
Three communities fair significantly worse than the state and county for both poverty and below 200%
of poverty: Lafayette city (17.4% below poverty; 28.1% below 200% of poverty), New Sweden township
(20.4% below poverty; 31.9% below 200% of poverty), and St. Peter city (23.9% below poverty; 40.1%
below 200% of poverty).
B ROWN C OUNTY
Two communities in Brown County have notably higher poverty rates than the state: Cobden city and
Evan city. In Cobden city, 52.9% of the population lives below the poverty level and 70.6% of the
population lives below 200% of the poverty level. In Evan city, 16.7% of the population lives below the
poverty level and 70.0% of the population lives below 200% of the poverty level.
Persons living at or below poverty line are less likely to have air conditioners in their homes, live in
deteriorating and substandard homes, and may have difficulty paying for higher electricity bills from
increased electricity usage during an extreme heat event. Strategies to prevent heat-related illness and
mortality for persons who are economically constrained include the following: opening public cooling
centers (this can often be coordinated with the local Red Cross Chapter), suspending utility (electricity
and water) shutoffs or providing financial assistance for persons having difficulties paying their bills, and
providing water at public places.
ELDERLY LIVING ALONE
N ICOLLET C OUNTY
Two communities, Lafayette city and Ridgely township, have high percentages of households that are
elderly living alone: 22.4% and 17.6%, respectively.
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
B ROWN C OUNTY
Three communities in Brown County have high percentages of households that are elderly living alone:
Comfrey city (20.8%), Eden Township (20.7%), and Sleepy Eye city (20.9%). New Ulm’s percentage of
households that are elderly living alone is also higher than the state percentage (15.6% versus 9.4%),
with a total of 889 households that are elderly living alone.
See discussion and strategies for Elderly Living Alone under the previous section, “Population 65 Years
Old and Older.”
CHARACTERISTICS FROM HEALTH AND OTHER VULNERABILITY DATA
Heat can exacerbate existing conditions, putting certain people at increased risk for heat-related
illnesses and possible death. Any condition that affects the body’s ability to cool itself or puts additional
stress on already compromised systems will make a person more susceptible to negative health effects
from heat. In this section, the assessment compares health data and other characteristics provided in
the MDH Extreme Heat Toolkit, Appendix F: Data source for characteristics that affect negative health
outcomes from extreme heat.
ASTHMA
Minnesota Public Health Data Access provides asthma data as three-year summaries of asthma
hospitalizations by county. The following table is provided using the data query:
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
The age-adjusted asthma hospitalization rate for the whole state is higher than the rates for both
Nicollet and Brown Counties, but has been decreasing in recent years (from 9.0 per ten-thousand
persons to 8.2 per ten-thousand persons). The three-year averaged asthma hospitalization rates for
both Nicollet and Brown Counties appear to be increasing in recent years (from 3.4 per ten-thousand
persons to 5.0 per ten-thousand persons in Nicollet County, and from 6.4 per ten-thousand persons to
6.7 per ten-thousand persons in Brown County), although the differences may not be statistically
significant. 2
Heat can exacerbate respiratory conditions, such as asthma, chronic obstructive pulmonary disease, and
bronchitis. Strategies to prevent heat-related illness and mortality for persons who have respiratory
conditions include the following: ensuring that educational messages are targeted to these populations,
health care providers and social service organizations. These populations should find air conditioned
locations, and be cautioned to not undertake unnecessary activities that may affect their ability to
breathe.
DIABETES
CDC Diabetes Data & Trends provides diabetes data for adults (20 years old and older) diagnosed with
diabetes in Minnesota by county. The following map is provided using the data query:
FIGURE 1: 2008 AGE-ADJUSTED ESTIMATES OF THE PERCENTAGE OF
ADULTS WITH DIAGNOSED DIABETES IN MINNESOTA
2
Statistical significance means that a result is unlikely to have occurred by chance. Significance levels show you
how likely a result is due to chance. In this table, the column “95% Confidence Interval” is interpreted as: if the
95% confidence interval is used over and over sampling a population, 95% of the time the confidence interval will
contain the true rate for the particular location (county or state). Because the rates overlap in this table, the
observed increase in rates for the counties may not be significant, or put another way, may be a result of chance.
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
2004 – 2008 Age-adjusted Estimates of the Percentage
of Adults with Diagnosed Diabetes in Minnesota
2004 2005 2006 2007 2008
Minnesota
5.4
5.5
5.6
5.6
5.8
Nicollet County 5.4
5.7
5.9
6.2
6.5
Brown County
5.9
6.0
5.9
6.3
6.6
The age-adjusted estimates for the percentage of adults with diagnosed diabetes are higher in both
Nicollet and Brown Counties than the state, and have been increasing faster than the state in recent
years (increase of 0.4 percentage points in five years for the state, 1.1 for Nicollet County, and 0.7 for
Brown County).
Persons with diabetes (or other endocrine disorders) may be more at risk during extreme heat events.
Additionally, persons with diabetes may have other health conditions, such as obesity, or take certain
medications that could affect their ability to stay cool. These populations should be encouraged to stay
cool, hydrate sufficiently and find air conditioned locations, and they should be cautioned to not
undertake unnecessary activities.
CARDIOVASCULAR/HEART DISEASE
CDC Heart Disease and Stroke
maps provide heart disease
rates for elderly adults (65
years old and older)
hospitalized for heart disease
between 2000 and 2006 in
Minnesota by county. The
map on the right is provided
using the data query.
Nicollet and Brown Counties
are Category 1 counties,
which mean they had a lower
heart disease hospitalization
rate for the population 65+
from 2000 to 2006. The
hospitalization rate was 57
per 1,000 in Nicollet County
and 52 per 1,000 in Brown
County, age-adjusted and
spatially smoothed.
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
Persons with cardiovascular disease conditions (e.g., congestive heart failure, myocardial infarction) may
be more at risk during extreme heat events. Additionally, persons with heart disease conditions may
take certain medications that could affect their ability to stay cool. These populations should be
encouraged to stay cool, hydrate sufficiently and find air conditioned locations, and they should be
cautioned to not undertake unnecessary activities.
PROLONGED EXPOSURE TO SUN
The Minnesota Department of Employment and Economic Development (DEED) Local Employment
Dynamics for April 2010 through March 2011 (Quarter 2 2010 - Quarter 1 2011), shows an annual
employment average of 212 for Agriculture, Forestry, Fishing and Hunting industry in Nicollet County,
and an annual employment average of 501 for the same industry in Brown County. For the same time
period, there was an annual average of 243 jobs in Construction in Nicollet County, and an annual
average of 510 jobs in Construction in Brown County.
People who are involved in sporting activities or work in outdoor occupations, like farming, landscaping,
roofing, and construction, are at an increased risk for heat-related illnesses. These people may be
exposed to the sun and extreme heat for longer periods of time and need to take extra precautions to
stay cool and hydrated. The Centers for Disease Control and Prevention’s National Institute for
Occupational Safety and Health (NIOSH) provides useful safety and health tips for workers exposed to
heat stress. This critical information, found online at http://www.cdc.gov/niosh/topics/heatstress/ ,
should be messaged to employers and employees of outdoor work environments. For a quick fact sheet,
see http://www.cdc.gov/niosh/docs/2010-114/pdfs/2010-114.pdf.
LIVING IN URBAN AREAS
The University of Minnesota land cover analysis from 2000 shows than 9% (26,878 acres) of Nicollet
County is urban land cover, and 2.8% is impervious surfaces (8,131 acres). Brown County is 8.72%
(34,486 acres) urban land cover, and 2.53% (9,903 acres) is impervious surfaces. The county maps
generated by the University of Minnesota show the location of these urban areas/impervious surfaces
(see attachments “2000 Nicollet County Land Cover and Impervious Surface Area” and “2000 Brown
County Land Cover and Impervious Surface Area”).
Urban dwellers are more at risk for heat-related illnesses than rural dwellers. Due to the “urban heat
island effect,” urban areas are usually hotter and cool off less at night than rural areas. This effect can be
experienced even in small urban areas. Urban heat islands can increase health risks from extreme heat
by increasing the potential maximum temperatures residents are exposed to and the length of time that
they are exposed to elevated temperatures. Strategies for targeting urban dwellers can include
connecting with media outlets to broadcast messages on how to stay cool and hydrated, activating an
extreme heat information line at the city or county for persons calling for heat-related information,
opening cooling centers and coordinating with the local Red Cross chapter, and providing water in public
places.
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
LIVING IN NURSING HOMES/BEDRIDDEN
The Minnesota Department of Health has three licensed providers of nursing homes in Nicollet County,
all located in St. Peter: Benedictine Living Community (79 nursing home beds), Good Samaritan Society
of St. Peter (38 nursing home beds) and the So Psychiatric Nursing Facility of St Peter (48 nursing home
beds). There are four licensed providers of nursing homes in Brown County: Divine Providence
Community Home (58 nursing home beds) and Sleepy Eye Care Center (65 nursing home beds) in Sleepy
Eye, Oak Hills Living Center (94 nursing home beds) in New Ulm, and St. John Lutheran Home (105
nursing home beds) in Springfield.
Persons living in nursing homes and/or are bedridden are at increased risk of suffering from heat-related
illnesses. These persons may be at increased risk due to dependency on others for care, and they
frequently have underlying medical conditions and take medications that affect their ability to regulate
their body temperature. Developing a database/list of high-risk facilities (e.g., those with mobility/health
impaired residents) and organizations that serve vulnerable populations and their locations aids
prioritization of prevention efforts to populations vulnerable to extreme heat and facilitates
dissemination of extreme heat information to the organizations that serve these populations through
faxes, emails, and/or telephone contact trees. Nursing homes and other elderly centers, for example,
should be contacted and provided information to ensure that their populations are staying cool and are
being assessed for symptoms of overexposure to heat. Additional staff may need to be on call to provide
extra care during an extreme heat event.
NEXT STEPS
Examples of intervention strategies for specific vulnerable or at-risk populations have been provided in
the assessment above. The MDH Extreme Heat Toolkit provides a thorough but not necessarily complete
list of strategies for preventing heat-related illnesses and mortality for specific vulnerable populations.
The complete toolkit can be found online at:
http://www.health.state.mn.us/divs/climatechange/extremeheat.html.
MDH does not expect a community or CHB to conduct all the outreach efforts itself. One of the best
strategies is to partner with local partners, especially emergency management, social services, and
health care services. Local partners may already have strategies in place and/or already work directly
with the communities that will be most impacted by extreme heat events.
As local public health departments undertake the Local Public Health Assessment and Planning Process
and/or the Jurisdictional Risk Assessment, they should consider if and where these data resources and
strategies might be included. MDH’s tools and staff should be used as a resource. In addition to the
Extreme Heat Toolkit, MDH is developing training modules around different issues related to climate
change and health, including water quantity and quality; air quality; agricultural issues and food security;
and mental health impacts. All tools and resources may be obtained from the MDH Climate Change
website as they are released at http://www.health.state.mn.us/divs/climatechange/ or by emailing staff
at [email protected].
MINNESOTA DEPARTMENT OF HEALTH
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BROWN-NICOLLET COMMUNITY HEALTH BOARD - - EXAMPLE EXTREME HEAT VULNERABILITY ASSESSMENT
Minnesota Department of Health
625 Robert Street North
PO Box 64975
St. Paul, MN 55164-0975
651-201-4893
[email protected]
http://www.health.state.mn.us/divs/climatechange/
June 2012
MINNESOTA DEPARTMENT OF HEALTH
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