Season 4, Episode 4: Meredith McInturff: Managing Public Health in Extreme Heat
Meredith McInturff, New Orleans Health Department
Listen
Meredith McInturff, manager of the Public Health Emergencies and Environmental Health Unit at the New Orleans Health Department, joins John to discuss how the New Orleans Health Department is evolving to meet the growing threats of extreme heat. She and John explore the public health challenges faced by vulnerable populations, from unsheltered individuals to transit riders and outdoor workers, and how these challenges are shaping new city policies and cross-sector partnerships aimed at heat resilience.
“We know that almost 70 percent of New Orleans experiences some form of urban heat island effect, which suggests that the combination of surfaces and the temperature, and maybe lack of wind, is causing it to be anywhere from 5 to 8 degrees hotter in certain areas.”
Key Topics
Extreme Heat Preparedness: Meredith and John address the health impacts of extreme heat, especially on specific populations like the unsheltered, transit riders, and outdoor workers.
Lessons from Hurricane Ida: Meredith discusses how Hurricane Ida highlighted the risks of power outages during heat waves and prompted a rethink in heat emergency responses.
Urban Heat Islands and Community Equity: Meredith discusses the urban heat island effect impacting 70% of New Orleans and the equity issues it raises.
Cross-Department Collaboration: Meredith talks about the efforts to bring together city departments in a unified strategy for heat mitigation, including tree planting and community outreach, that includes community input to improve preparedness across the city.
Reforestation and Green Infrastructure: Meredith and John discuss the role of reforestation and green infrastructure in long-term heat and flood management.
Links to Relevant Studies and Resources:
Learn more about Meredith McInturff
Meredith discusses the new Weather Wise NOLA, where residents can view neighborhood-level temperature and air quality data for New Orleans, provided by local WeatherStem stations.
Meredith mentions the Healthy Homes ordinance that has a renters complaint reporting software. Learn more about the Healthy Homes Program, which aims to improve housing quality and ensure safer indoor rental housing.
Meredith talks about a study that identified areas of New Orleans that identified areas in New Orleans that experience a heat island effect. Read about the recent findings for New Orleans here.
Meredith discusses NOLA Ready, the city’s emergency preparedness campaign.
Further Reading:
National Integrated Heat Health Information System (NIHHIS): Find national guidance and resources on heat and health.
Extreme Heat and Your Health: Insights from the Centers for Disease Control and Prevention (CDC) on the health risks associated with extreme heat and preventive actions.
“A few years ago, we had a real wakeup call in New Orleans … that was catalyzed by Hurricane Ida, and that response of a lack of power plus extreme heat that really made us reconsider: What are we doing around extreme heat when there is power available in the city?”
Transcript
AUDACIOUS WATER PODCAST
AUDACIOUS WATER S4 E4 110624
START (AUDACIOUS WATER EPISODE 4, SEASON 4)
[MUSIC]
JOHN: Welcome to Audacious Water, the podcast about how to create a world of water abundance for everyone. I'm John Sabo, director of the ByWater Institute at Tulane University. On today's show we continue to explore the second transformation with Meredith McInturff, manager of the Public Health Emergencies and Environmental Health Unit at the New Orleans Health Department. Meredith brings years of experience mobilizing responses to hurricanes, infectious diseases, and other environmental challenges. Coming up I talk with Meredith about the unique risks that extreme heat poses to public health, the innovative policies her team is implementing to address these issues, and the partnerships that make these responses possible.
JOHN: Meredith, welcome to the show.
MEREDITH: Thanks for having me.
JOHN: Yeah, this will be fun. We've known each other for a while. You're on the ByWater Community Advisory Board, and you're a Tulanian, a Newcomb Scholar with an advanced degree in epidemiology. I hang out with a bunch of epidemiologists at Tulane. I'm hoping that you can kick us off by telling us about what you do in a public health department in a major city, and especially what your job scope is in New Orleans. This is a podcast of mostly water listeners, so I think the background on public health and your role in that would be very helpful for them.
MEREDITH: Awesome. Well, my current role at the Health Department is as the Unit Manager of the Public Health Emergencies and Environmental Health Unit. And so within that we are a bit of a unique team within the Health Department locally. We're one of two local health departments in the State of Louisiana, along with Plaquemines Parish, which is directly south of us for those that aren't familiar. Our department celebrated our 125th anniversary last year, so we were actually founded in 1898 with the goal of maintaining cleanliness and health around sanitation, zoning, and inspections. And so in that way we maintain a lot of the same roles and responsibilities today. So today our mission is to promote, protect, and improve the health of all in our community through equitable policies, programs, and partnerships. So specifically when we're looking at public health emergencies and environmental health, we are looking at different causes of diseases, we're looking at potential sanitation issues and working across partners. We do a lot of emergency-preparedness work in partnership with different entities at the local, state, and federal levels. And we address other environmental issues as they come up in our city.
JOHN: That's great. That's perfect background. So let's pivot towards the topic. It's been - it was a hot summer here. Tell me about what you're seeing on the ground and what kinds of issues you and your group and your agency are facing with respect to heat.
MEREDITH: Sure. So within our team specifically we are divided into three sub teams. So I'll start by saying our field operations team are the ones that are boots on the ground, who are out, you know, in the community doing inspections, or following local ordinances to respond to public health complaints. And so this summer a lot of our work deals with folks experiencing homelessness and being responsive to needs and encampments, and identifying public health hazards. And so in that respect, for folks that are unsheltered, we have seen that there are pretty significant health impacts in that community. So working in partnership with our Office of Homeless Services and Strategies at the City, we are working to develop stronger procedures around not only water distribution, but encouraging folks to seek shelter, particularly during these extreme events. But if we take a step out a little bit and think about some of the requests we've received from other city departments, and thinking about their work, we know that recently New Orleans passed a Healthy Homes ordinance that has a renter-complaint reporting software. And so figuring out how to deal with questions of temperature thresholds, particularly during extreme heat events, and connecting residents to services when they need it most. So these are two areas that we are really passionate about the Health Department and figuring out better solutions going into next summer, and knowing how to connect people who are experiencing extreme heat the most and reporting it to protective services - or protective actions really.
JOHN: Right. So that's interesting. It's kind of - you've got one part that's for (the) unsheltered segment of the population, and another one that's sort of focused in the household, right?
MEREDITH: Right.
JOHN: What have you seen - in your experience as a public health official what have you seen over the last several years in terms of increases in exposure and responses to that by the community at large?
MEREDITH: Absolutely. I think a few years ago we had a real wake-up call in New Orleans, particularly that was catalyzed by Hurricane Ida, and that response of a lack of power plus extreme heat that really made us reconsider what are we doing around extreme heat when there is power available in the city? So unfortunately we learned that lesson the hard way and through a lot of heat-related deaths as a result of power outage from that disaster. But that also made us take a stronger look at our policies for extreme heat days when there is power. So in 2023 we actually declared our first local emergency over extreme heat in August of 2023, partially due to the actual temperatures we were seeing and number of hospitalizations and emergency departments admissions in general, or visits. And then secondly, due to the kind of coinciding risk of marsh fires and New Orleans east that were happening at the same time. So we're really starting to see the impact of heat in multiple ways, not just on human health but also on the environment as we're going forward. And I think that is really changing the way we think about heat-planning, and particularly both in response but also in adaptation and mitigation planning.
JOHN: Wow, that's amazing. I had just moved to New Orleans when Ida hit, and I stayed for it primarily to see... I mean, it was a dangerous storm. I was in a safe place and I had that advantage, but I wanted to see not the storm--I'm not, you know, a storm-chaser by any stretch of the imagination--but I wanted to see what happened afterwards. And to be honest with you, I stayed five days and on the fifth day without power, walking up to the 24, my apartment building, two times a day without air conditioning, and, you know, it took a long time to cool off after that walk up the stairs. I did eventually evacuate, go to Houston for a couple of days until the power came back on. So I remember that heat and it was pretty incredible. Let's shift gears. I'm really interested in the focus of your department on social determinants of health and the equity angle on this. And we talked a little bit about that in the context of the homeless segment of the population. Talk to me about what kinds of equity issues you see with respect to heat and heat exposure.
MEREDITH: Absolutely. There are so many different intersections of heat and health that we're still exploring all the different relationships that could be out there. But some that have really come to our attention through partners and through just outreach events in general are transit writers locally. I'm thinking about the impact that extreme heat has on a population that is outdoors waiting on a bus to get to work, to school, to events around the city, and really think about, you know, protective actions that you can be taking not only during your ride but before and after your ride as well. We know a lot of heat-related illness and injury does not happen immediately, it's more of the chronic stress factor. And so, you know, potentially drinking water and thinking about getting a good night of sleep before being on a bus, and then similarly on the back end, is going to be almost as protective as, you know, the actual action of taking a different vehicle and not having that heat stress. So that is one population. We've worked really closely with Ride New Orleans to do some heat-safety trainings for transit riders, and particularly focusing in on older adult populations with Providence Community Housing and other groups to get that message out there in the community. The second group I would really highlight is our outdoor workers citywide. We don't have very strong outdoor worker policies for extreme heat events as of right now. There have been a few changes over the summer that help with protections for sanitation workers by encouraging earlier start times in the morning so that they can be out of the heat by, you know, the middle of the day or late in the day. But we are taking a pretty strong look internally at a lot of our policies at the City around heat, injury, and illness prevention, offering trainings to city departments that are particularly focused on outdoor work, and where possible, trying to change policies to make sure that they are as protected as possible from potential risks.
JOHN: That's great. Are there places in New Orleans that are more exposed than others?
MEREDITH: Absolutely. So we know that - there was a study that came out in 2021 that suggested that almost 70% of New Orleans experiences some form of Urban Heat Island effect, which basically suggests that the combination of surfaces and the temperature, and maybe lack of wind, is causing it to be, you know, anywhere from five to eight degrees hotter in certain areas. And so knowing that a lot of our city experiences that is one factor we consider in planning interventions. But the other, you know, reality of it is looking at our tree canopy and where we have shade and where we don't have shade in the city. And so if you look at, you know, the reforestation plan that was put together by SOUL New Orleans and approved by City Council, and you overlay that with a temperature map, they look pretty similar as to which areas have shade and which do not. So reforestation is a really big part of the work that we need to do in heat, but it certainly can't fix all of the issues that we have.
JOHN: So interesting. I want to come back to that in a little bit when we talk about interventions for other aspects of climate change and how they might help or hurt with addressing heat as a specific goal. Before we go there I'm really interested in kind of what you're seeing in terms of, you know, heat being a driver for different types of illnesses. Could be cardiovascular, could be pulmonary, could be things related to neonatal health. Give me some examples of the types of outcomes that heat is driving.
MEREDITH: Yeah, I think you hit the nail on the head with those different populations and kind of conditions. Unfortunately, at the moment that is one of our major challenges in heat is understanding the exact illness or driver behind somebody, you know, presenting to an emergency department. The New Orleans Health Department does work really closely with the Louisiana Department of Health and other partners who are taking a really deep-dive look at our emergency department utilization rates, and also our mortality data at the state level. And then we are separately also looking at our available information from New Orleans EMS, and the Orleans Parish Coroner's Office to really dig into more determinants. But there have not been the pieces of information that we'd like to see. It's not perfectly coded, for example, in an electronic health record to say, "This person clearly had this disease and therefore that's why they're here." So that is why we have been more broad in our messaging strategy as a city, just, you know, saying that heat impacts everyone. But one of the methods we've been using is using NOLA Ready, which is our city's emergency preparedness campaign, to get the word out that particularly folks that are taking any sort of medication, whether that may be for hypertension or for blood pressure, it could be psych medications or anything in that realm, it can have an impact on how you function day to day, if there are changes to your body temperature. So that's one of the strategies we've been using. But we don't have great data on how each type of disease is manifesting locally. But generally if you look at national trends, yes, those are some of the key populations that we are concerned about.
JOHN: Interesting. I mean, as a statistician, or with some training in statistician, I'm thinking about cause and effect. And more importantly the link between recency versus - you know, a pulse-vs-a-stress type of stressor, right, and how you would measure that. It seems to me like understanding correlates of prolonged exposure to heat events might be an easier set of data to collect than the actual event, and may be more connected to the outcome itself, right?
MEREDITH: Absolutely. And so that is part of the role that we're looking at in the future is considering how we can plug into longer-term research projects that are collecting, you know, similar health indicators. We know that our small team may not be the right answer for collecting all of that, but working in collaboration with other, you know, major studies--and we know there are many across the region--to look at the potential impacts that these particularly hot summers, this summer, last summer, potentially even 2021, looking at that, have had on our population, our residents.
JOHN: Interesting, yeah. And that's why we have you on our CAB--we want to grow that kind of effort so that the city, and more broadly the Gulf can be braced for these impacts of climate change, you know, that go beyond heat. And we've talked about many of them in our own conversations
[MUSIC]
JOHN: Up next Meredith shares how cross-city partnerships and community networks are essential to protecting vulnerable residents from extreme heat.
JOHN: Let's turn to solutions a little bit. You know, you talked about policy and your role in kind of preparedness. What's New Orleans doing to address the impacts of heat, and maybe as a second question, what can other cities learn from these activities?
MEREDITH: Sure. That's a really great question. And I think we are still learning from other cities as well. I'm really thankful for our partnership, too, with C-40 cities. We're still in a learning process and figuring out who structures programs differently. But I can definitely speak to some of the pieces that we're currently working on. One important step forward that we needed at the City of New Orleans that has already happened is instillation of weatherSTEM stations. So these are localized weather stations that provide temperature, wind, and air quality measurements at the neighborhood level. So one of our observations is from National Weather Service data. We only have a point at the airport, which for those that are familiar is in Kenner, which is far away from downtown New Orleans and doesn't necessarily adequately show the heat that we're experiencing locally. So having these localized weatherSTEM stations has been helpful for reconsidering the thresholds for action at the city level. So being able to look at if any neighborhood hits that level do we activate something for the whole city or just for that neighborhood? And we're still working through that, and it's still a newer product, but that has been very helpful. All of that data can also be accessed online at Weaterwise.NOLA.gov. So also educating the public that if they have concerns about weather and temperature, that they can be looking at it themselves. It's not something that's just used by government to make decisions, but it's actually a tool that's available to them as well. The other piece I would highlight is really incorporating heat into our all-hazards preparedness messaging. And, you know, we do a lot of hurricane work obviously in the City of New Orleans, but reminding people that that is not the only hazard that we experience here, and preparedness for a hurricane is just as important as preparedness for heat, or for a tornado, or for extreme cold, or for any of the other hazards. So really thinking about preparedness in a more all-hazards inclusive way has been really helpful, particularly when working with populations that may have limited income, and they are thinking about their preparedness steps, but then thinking, you know, how am I going to cover all of these different scenarios, trying to find those common items. That'll be helpful no matter what. I'll also highlight that working in partnership with some of our different organizations, both at the state level and at the local level, Louisiana Public Health Association and Healthy Community Services have been doing a lot of work on a Smart Surfaces grant project to gain community feedback on the burden of extreme heat in their neighborhood or on their personal health. And that has been really informative to us, because they've been looking at some of our hardest-hit neighborhoods and getting that feedback in a way that feels more organic. It's not coming from the City asking you about your experience. It's from another, you know, organization. But using that information to information to inform some of the work we're doing maybe at the local or neighborhood level more than at the city-wide level has been helpful. And then lastly I would say just continuing to look at opportunities for collaboration across city departments. I think this is one area where for a long time we have been in silos. And I think that's not specific to New Orleans; I think a lot of cities experience this issue. But trying to find opportunities for collaboration, whether that is between the Health Department and Safety and Permits, or between Code Enforcement, or Sanitation, Parks and Parkways, all these different groups are working on heat in different ways. But really connecting those dots and making sure that our workers have the same knowledge of the bigger picture in the goal behind what they're doing. And also having the safety materials there while they're doing it. So a lot of times, you know, whether that be inspections in the field, or planting trees, or picking up garbage, there's all heat risk there in those actions. But trying to figure out the reasons why we're doing these different things and why we need to continue putting worker safety at the forefront of our priorities.
JOHN: Interesting. Two follow up questions, one on getting the hazard message out. What's the best platform for doing that? Is it Facebook, or is it the website, or how do you do that?
MEREDITH: It's a lot of ways. I think we have learned that emergency alerts themselves can be tiring, so we are trying to be sparse with those and really reserving those for the extreme days when it is as its peak worst. But a lot of people have indicated to us that, you know, community conversations, hearing it from somebody who is not the City, is equally as helpful. So those interpersonal relationships, whether that is within somebody's family, or within a church, or another social, you know, group, organization in the city, finding those ways to share the message that then can be reshared is really important to us. There are certainly also opportunities for just static signage. You know, one thing we've looked at or considered are yard signs or ways to kind of message within bars and restaurants, which is another area where we see a lot of people take refuge from heat. And so reminding them to rehydrate in those situations. You know, there are a million ways, but really those conversations and having concern for somebody's personal health I think have been most effective in changing some of the mindset on heat.
JOHN: That's interesting. So to your point on interventions--and I think sort of understanding, you know, the surface - the effect of surface of the city on heat--let's go back to - like, you made that point about reforestation being really important. And at ByWater we work on water so we don't often work in the heat realm for heat itself, although I think it's, you know, a universally important topic when you think about climate change. One of the things that is interesting to me is, you know, another risk is flooding during non-hurricane events, non-tropical-storm events, right? We have standing water in the city way too often, and it has a whole bunch of effects on people's health and just their ability to go to work and things like that. One of the interventions for that, that many community-based organizations who are on our CAB are working on, is green infrastructure as a means for absorbing some of that rainwater so that it doesn't end up in the streets and prevent you from getting to work, or getting to your car, or whatever. Is there coordination between those efforts and some of the reforestation efforts you had, and do you see some win-wins in that department?
MEREDITH: Absolutely. It's definitely the area that I appreciate our partnership with the Office of Resilience and Sustainability the most. So they are kind of the lead organization on our citywide heat mitigation and adaptation plan, but they're also the lead on our stormwater management program. And so we work really closely with their team to make sure that as we're looking at opportunities for maybe it's grants or maybe it's, you know, other outreach opportunities or work, that we're including each other in that conversation, whether that is, you know, stormwater looking to figure out, like, health impacts that could be related or vice versa, if I'm coming to them with more questions about, you know, heat and the infrastructure mechanisms behind some of the things we're seeing. So I think the communication and collaboration is definitely there. It may be too early at this point to see the true wins. I will say reforestation is kind of a long game, particularly when it comes to heat. And I'm sure it's probably very similar with water, as well, in terms of how much the tree and soil can absorb, you know, after an event once it's planted. But definitely it's something that we are continuing to collaborate on and looking for ways to find progress opportunities or check-ins in figuring out how we can prioritize both and use them for multiple projects, whether that is reforestation or canopy photos for both projects, or if it is community events that are already targeting green infrastructure projects. We could also add in heat messaging, you know, as an additional layer to that. So there are a lot of opportunities I think we're just getting to explore, and I think we'll continue to explore with the development of the new plan.
JOHN: That's fantastic. And it's so important because you've got a limited budget for climate adaptation, right?
MEREDITH: Right.
JOHN: You know, next to zero in some cases in some cities. And so the more that you can bundle these preparedness activities into one intervention I think the better. And just for the listeners, you know, green infrastructure has two potential outcomes I think for heat in this case. One is, it's not pavement. And the second is, eventually there'll be tree-cover and shade, which is an additional benefit for that. I think on the flipside sometimes it's really hard to convey how much of it we need in order to make a difference, right? But I think the silver lining of that is that we don't need a national park in the middle of New Orleans to make that happen. (They) can be creative and in designs that are aesthetically pleasing and in places that we're not using every day, so that it's not as onerous as creating a National Park, right?
MEREDITH: Right.
JOHN: Very cool. Okay, pivot a little bit here. What are some strategies that your department is taking on to mitigate heat in disadvantaged communities? We've kind of touched on this a little bit, but just wanted to see where that piece sits in New Orleans.
MEREDITH: It's a good question. I would say that that's a little bit of the next level of prioritization as well, and that's where the plan comes in. I think at present we have a lot of ideas, but based on the data alone there haven't been clear areas or interventions that seem to be cohesive to have an impact on kind of - from a public health perspective. There are certainly individual-level interventions that could be taken. And so I think we're still figuring out that question directly and thinking about disadvantaged areas. We do know that central city does get hotter than most places, and so one of the interventions that we are considering in that process is looking at public building availability in that area and their hours of operations, and doing more focus groups and surveys around would people use that space if it were available to them during an extreme heat event? And so there are kind of several layers to that, and we know where those areas are, but as of right now those definitive actions haven't been teased out.
JOHN: I know that neighborhood well, on my way - yeah. And I can almost envision some of those spaces, right, and parks, shade structures and things like that, right?
MEREDITH: Yeah.
JOHN: And it's interesting--the question actually came from my experience in Phoenix, and in my experience in Phoenix if you look at a map of - you know, or a satellite view of Phoenix, the wealthy neighborhoods have the most trees, right? And so that, you know, speaks volumes to exposure I think. On the flipside, we can grow trees very fast in Arizona. And I think, you know, that gets to your point about reforestation as a long-game. It is a long-game because it takes a while for there to be a canopy. So great. Well, two more questions kind of to wrap up. The first is--maybe a couple more--one set of questions is, from your perspective what's going well when we are thinking about heat? And on the flipside what are you worried about?
MEREDITH: That's a good question. I think what I'm excited about with heat response at the moment is that it does have a lot of traction, and it's got a lot of attention. Locally with our city council we have champions there who are looking for solutions and want to be supportive of that. I think, you know, within the City there's a lot of willingness to do that, but also at the national level having a national heat strategy being released this year really gives us a framework to work from, and saying that we're not the only city that's trying to prioritize this work. And so when we're looking for potential funding opportunities or partnerships I think a lot of it is there. The pieces are there, it's just about making them work together. And I think what makes me the most nervous about heat is that there's still so much we don't fully know from a public health perspective, from an attitudes and behavioral-change perspective of our community. One response we get a lot is that, "It's always hot. It's New Orleans; it's always that. I can just go, you know, get a snowball and I'll be fine." And I think what we really need to prioritize is a changing perspective of how heat has an impact on your body over time, and as you get older you're not the same as you were, you know, perhaps ten, twenty years ago. So being able to communicate that message of protection--even if you were able to survive it ten years ago conditions are different both environmentally and on a personal level. That would suggest that, you know, perhaps this event could be different. And so that's something that we have to work on as a community and figuring out how we can really instill that value in folks.
JOHN: It's almost like it's 90, so what does it matter if it's 92?
MEREDITH: Right.
JOHN: But over the long haul those two degrees make a difference.
MEREDITH: Exactly. That is the challenge.
JOHN: Right. So maybe to close, tell me what's on the horizon? What's a project that you're working on right now that you love and, you know, that's related heat, and you think is going to make a difference?
MEREDITH: There are several, but I would say the one I'm most excited about at the moment is probably the opportunity to work collaboratively on a heat strategy. I think having clear priorities and a shared definition across departments will just make our work a lot easier. And I think we're getting close with what we have currently, but I think having both community buy-in into that project, and saying, "Here are our priorities at a neighborhood level, at a resident level, at a sub-population"--let's say it could be folks with cardiovascular disease or, you know, folks that have kids--having some shared priorities in a conversation around the same plan is going to be really helpful for us in knowing all the priorities. I think right now we're very segmented in our approach. We know when somebody has an issue and they want it addressed. But to have clear parameters and buy-in is going to be really important going forward. And just to see the number of people from all different disciplines--again, whether it be public-health people, people in the medical community, people who are in restaurants and bars, you know, that's bene a great area of outreach for us, from an engineering perspective architecture, you know, kind of biology and natural sciences--I think there's a lot of different intersections here that I'm just really excited to see what solutions folks bring to the table and priorities for future work.
JOHN: That's great. Well, thanks for joining me. This has been - I've learned a lot, but I'm sure the listeners have also learned a lot. And I really appreciate you taking the time.
MEREDITH: Thanks for having me.
[MUSIC]
JOHN: So heat is a big deal in cities, but not one that they are not preparing for. Public health agencies like New Orleans Department of Health are keenly aware of the challenges and laying the groundwork for adaptive capacity to these challenges. One of the key challenges is that the task of adapting is often distributed across many different agencies, operating under different mandates, and at different levels of governmental organization. Harmonizing effort is key to developing a preparedness plan for heat and many of the other climate-related hazards that we are already experiencing.
JOHN: That's it for this episode of Audacious Water. If you liked the show please rate and review us and tell your colleagues and friends. For more information about Audacious Water, and to find in-depth show notes from this episode, visit our website at AudaciousWater.org. Until next time I'm John Sabo.
[0:31:09]
END (AUDACIOUS WATER EPISODE 4, SEASON 4)