♪ [applause] MARA: Welcome.

This is the 2025 By Degrees Climate Summit.

I'm NHPR reporter Mara Hoplamazian.

We're talking about healthy connections, how our human health is reflective of our ecosystems.

With me are panelists Eric Orff, Marina Vaz, Kaitlynn Liset, and Semra Aytur.

So, I want to start with defining health and exploring how it shows up in all of your different lines of work.

The World Health Organization says health is not just the absence of illness or disease, but a state of complete physical, mental, and social well-being.

The WHO also says enjoying the highest attainable standard of health is a fundamental human right.

But I know that we each have our own ways of defining and assessing health.

So, Kaitlynn, I'm going to start with you.

How our bodies are doing is one of the first things we might think about when we think about health, and you have clinical experience as a nurse.

You also teach aspiring nurses.

As our climate has changed, how has your definition of what it means to be healthy developed along with, you know, hotter summers, warmer winters, and everything we’re seeing?

KAITLYNN: I think it's become a lot more holistic because, really, a lot of the human health effects that are negatively related to our climate are because it's all rooted in our climate warming and heat alone being the number one killer.

And then you think about all the things that are associated with heat, and you can actually see the data that will show that on these hotter days, or extreme heat days, you see a very big increase in the amount of emergency department visits alone because of anything from dehydration to exacerbation of cardiac disorders, renal disorders, anything like that.

And there are definitely populations that are more vulnerable to it.

And, they're really you did touch on it the health of humans is so closely linked to the health of our ecosystems.

MARA: Yeah.

Got it.

Eric, I'll turn to you.

You know, you've spent decades watching New Hampshire's natural world really closely.

You've written about how you've seen a change as the atmosphere warms up.

What are some of the biggest impacts you've seen from climate change on the health of our animals and our ecosystems in New Hampshire?

ERIC: Well, I might start out with some good news.

2024 was the hottest year on record in Concord.

But since I've been in the wildlife business for a half-century, I've watched some amazing things happen.

You know, yesterday was the opening day of the turkey season.

When I started at Fish and Game, there were fewer than 100 turkeys.

Now there are 50,000.

Bald eagles: there were none nesting 50 years ago when I started.

Now there are 100 pairs of bald eagles and almost 30 pairs of peregrine falcons.

Bear numbers: I was the the first bear biologist when, in the early 80s, I calculated there was about 1,000 bears and declining.

Now there's 6,000.

So, more moose, more deer, more bears, more turkeys, more common terns.

I helped New Hampshire Audubon because I worked the last 20 years of my career out of their Region Three office in Durham, and I would take Diane De Luca from Audubon once a year, I would commandeer one of the marine division's crafts, we’d cruised around Great Bay, and find a dozen common terns nesting.

Now there's 3,000 terns nesting at the Isles of Shoals.

We have an abundance of wildlife like we’ve never had before, but things are changing.

Our moose numbers have gone from upwards of 10,000 to 3,000.

And I've witnessed changes myself.

I grew up in Londonderry and discovered this marsh down back called Little Cohas Marsh and these birdhouses.

So, I joined the Londonderry Fish and Game Club at age 14 in 1964 a ways ago and they gave me some money to build some birdhouses some duck boxes.

I put them at Little Cohas Marsh and began checking them.

Well, my parents got me snowshoes for Christmas, and when the department regionalized in 1988, my assignment was Eric, would you check the duck boxes at Little Cohas Marsh?

Imagine that!

And, you know, at first I used a snow machine, and then an ATV, and then no ice.

So, the year I retired in 07, there was no safe ice at Little Cohas Marsh.

I watched winter disappear in my lifetime in New Hampshire; in Londonderry And other things: I was helping a friend shake his lobster traps for a number of years for like 40 years and after I retired, I did it more frequently.

Well, one day, we pull in his lobster trap and there's this weird fish.

In my last 20 years, I worked out of the marine division office, but I don't recognize that fish.

So, I went to move it over in the trap.

It took a piece of my finger.

It was a tropical gray triggerfish.

This finger was bitten by a gray triggerfish in Portsmouth, New Hampshire.

I had physical evidence of climate change on my finger.

So, yes, I have witnessed the climate changing and its impact on our fish and wildlife.

MARA: Yeah.

Got it.

Wow.

Those are great stories.

Thanks so much for for sharing those.

Marina, I'll turn to you now.

You know, you work with communities in Nashua as an environmental justice advocate.

Thinking of that WHO definition we heard earlier, you know, complete physical, mental, social well-being, what does health look like for the communities that you work with in Nashua?

MARINA: Yeah.

So I think, as you mentioned, we typically think of health as a personal thing and something we achieve through personal choices.

And, there's truth to that.

I grew up in Brazil.

So, if you're a Latino, you know what I'm talking about.

When it gets cold, your grandma is like, Go bundle up.

Otherwise, you're going to get sick.

Don't go out with wet hair.

You need to make those decisions to protect yourself.

But outside of that, what is the context?

Right?

Why am I getting cold when it's cold out?

Is the house drafty?

You know?

So, I think beyond personal decisions and personal choice, we have to look at the broader context in which we operate and how we can use collective action to achieve health for everyone.

MARA: And I want to follow up on that.

You know, what challenges do you see as the most pressing to address to get to a complete sense of well-being or that definition of health; a more comprehensive one?

MARINA: I mean, I'm biased because this is my role, but I think it truly is collective action because there are things that you can only impact at a broader level when you bring people together and you're advocating for the same thing.

MARA: Got it.

Semra, I’ll go to you now.

You know, you look at health from a population level, specifically the relationships between policy and the environment and systems change.

Can you walk us through how these three things interact to affect our health?

SEMRA: Sure, sure.

So, I'm an epidemiologist by training.

So, that is sort of like, I used to say, being the doctor for a whole community and looking at the vital signs of a population rather than an individual patient.

And I think, really building on what Marina said, it's thinking about how people need to be able to take care of themselves, but also participate in the civic processes that shape the environments in which they live.

Because one thing we know from epidemiology and public health is that 70% to 80% of a population's health status is determined by non-medical factors: our social connections, the environment.

And, yes, good clinical care is very important, but these social and environmental determinants of health are really what we need in order to thrive and have a sense of well-being.

MARA: Yeah.

Got it.

I want to know, like, what's something you wish people understood more about how you view health and what it means to be healthy, like what your definition of health is.

SEMRA: So, yeah, I think one thing I'm thinking about a lot is actually from a book called Transformational Resilience by Bob Doppelt to give credit.

And this book talks about individual resilience, which is much about taking care of ourselves, taking care of our own bodies, but also the community resilience just like Marina said, collective action.

But bringing the two together, which I think is what I heard Professor Jola speak about; when we can take care of ourselves but then use the different skills that we have to work together and really build healthy communities, whether that's sharing our creativity, our knowledge, our lived experience, that's what generates what is called transformational resilience .

And we all have the power to do that together.

MARA: Yeah.

And Eric, I'll turn back to you.

One more on this question of, sort of, defining health.

Economic health and well-being in New Hampshire is really tied to our environment.

You know, there's a big industry in recreation and wildlife.

How have you seen climate change threaten that, maybe, or change how the economic health of our region is doing.

ERIC: And now for the bad news.

I have watched businesses go out of business.

Suds n’ Soda over in Greenland had a business that was there for a half-century.

And Great Bay, you know, in the late 80s, I began doing the mid-winter waterfowl survey for Fish and Game in which they would rent a plane from Concord and fly down and circle Great Bay the first week of January and count the ducks and geese in the rivers and now the ocean.

Well, in the time that I was doing it, the ice disappeared in Great Bay.

And that business went out of business because smelt fishing when I first flew in the early 90s, there would be communities of Bob Houses on Great Bay.

I mean, 20 here and 30 there.

There has been no ice the last decade to provide any of that ice fishing.

So, the businesses have, at the end of spring, they would have all their ice fishing gear still sitting there because there was no ice.

And it impacted places inland as well when there's no ice on Winnipesaukee.

So, it's impacted businesses significantly that I have grown to know my whole career.

And, other things that are impacted are moose viewing there’s a $12 million industry.

Back in the 80s when there were a lot of moose, there were 650 moose permits issued for hunting.

Last year: 33.

So, look at the economic impact on the North Country where you had guides, you had people renting rooms, you had a week of moose hunting.

That's gone.

So, we're losing the economic impacts of this changing New Hampshire with losing our moose.

MARA: Yeah.

Got it.

That must have been intense to watch all of that happen throughout your lifetime.

I just want to pause and remind our audience: If you have a question for one of our speakers, you can ask it by going to nhpr.org/climate .

and filling out the form there.

We'd love to hear from you guys during this conversation.

Now, I want to take some time to explore how people are responding to the health challenges that we've been talking about.

The last few summers, we've had several air quality alerts because of wildfires in Canada or in the Western U.S. Heat, as you were talking about earlier, Kaitlynn, poses a real risk to people, especially kids or older adults, folks who are isolated who might not be able to access alerts in their own language, just to name a few communities.

So, Kaitlynn, as a nurse, I want to know about moments you've been in clinic and thought, This person might be here because of climate change.

Can you tell us about some of those experiences?

KAITLYNN: Yeah, air quality is a perfect example of that because you have, you know, these air index ratings and they're out there, they're public.

And, if anybody looks at their weather app, there is the AQI air quality indicator You're smiling.

The AQI is right in there, and it wasn’t historically included in these apps.

But now, I've noticed my student generation, they're aware of unhealthy air days just because of their weather app.

Whereas my, you know, my grandpa who had COPD and emphysema, I would be trying to talk to him about like, Hey grandpa, the air quality’s not great today.

Maybe don't go out and exert yourself like you always do.

And we'd have to have a more in-depth conversation.

So, there is like a generational approach of who's more aware of it or not, but we'll see people come into the hospital with asthma, and you do really have to actually have a very clear conversation about why you might be having asthma exacerbations and start to kind of put these things together.

And then, even seeing people clinically, I think, sometimes, my mind goes to like hearts and hips and wintertime because you have snowstorms and we're getting these more extreme amounts of snow at once and people go out there and they're shoveling, maybe they're exacerbating their cardiac abnormalities, or maybe it's an arrhythmia, and then we see them for that.

Or black ice.

Everybody has heard of black ice, which is also clear ice.

It's a type of ice that actually has a way higher rating of people falling and slipping and breaking their hips.

And so, you're actually seeing that there really are these wetter weather patterns we have to start talking to people about like, Pay a little bit more attention to, not necessarily climate, but also like weather.

MARA: Yeah.

How is that informing preventative care.

What are the conversations you're having with doctors and nurses and even folks who are thinking about their own health?

KAITLYNN: There are definitely some health care providers that are routine and organically interested in this topic.

And I've noticed the younger generation tends to be a little more interested and eager to talk about it.

But then there are also health care providers that really do need direct messaging of how there is a link between humans and environment, what that link is, and what you have to do about it.

So, a lot of times, it's about creating awareness of the links and then creating tools, resources, frameworks for them to know what you do with it.

And like, New Hampshire Healthy Climate does a lot of work in that area.

They've developed the Checks Program, which is pediatric informed care.

And then you can also look at like Tick Free New Hampshire who they have a very public-facing platform, and they talk to the general public about ticks, but they've also started targeting health care providers and creating toolkits for health care providers to talk to the public about, This is how you respond to it, but this is also how you prevent tick bites.

MARA: Got it, got it.

I want to move out of the doctor's office again, or the nurse’s office.

Marina.

Community members in Nashua spent a lot of time in 2022 and 2023 pushing back on a proposed development of an asphalt plant.

A lot of the concerns are stemmed from impacts to residents’ health.

I want to hear you talk about that a little bit.

What did you learn from that experience about, you know, the importance of building relationships when it comes to fighting back against these kinds of environmental threats?

MARINA: Yeah.

Thank you for that question.

There was a proposal to build an asphalt plant very close to downtown Nashua in a low income neighborhood that is primarily Latino.

So, there are a lot of folks with a language barrier or limited English speaking.

So, community work was key there and going door to door and talking to people and letting them know this was happening.

And also equipping people with the tools to effectively voice their opinion on this.

So, that meant going to the planning board meetings.

We also, at CLF, advocated for language access, which was a big piece of this project because the city meetings are all in English.

And so, when this was affecting, a specific population in Nashua, we said, This is what you need to do so people can meaningfully engage with this process and really make their voices heard.

And I just want to say this was such a collective effort; not only of individuals, but organizations and coalitions.

And so, it truly comes down to relationships.

MARA: Yeah.

Got it.

And Kaitlynn, anything on language access in a medical setting?

What do you see there in terms of how people are responding to climate change and the ability to access information in different languages?

KAITLYNN: Someone might want to jump in, but there's definitely room for improvement about expanding the amount of languages in which this health information is delivered.

And, a lot of times, you have to think about what the appropriate reading level is as well, and how you can incorporate visual images.

And then, I think there's more and more effort where people are trying to also do in-person, hands-on training versus just expecting people to come into an office for a 15-minute visit and have the time to talk about all of this.

And so, there are a lot of modalities where the language needs to be adjusted, both for like, What is your primary language?

What is your preferred modality of teaching?

And... sorry, I feel like I squirreled on the topic, but... MARA: No, that was great!

SEMRA: You did great!

MARA: Semra, I'll turn to you now.

You know, you're working on a project to train ambassadors in nature-based solutions to climate change, which is something many of our audience members wrote in expressing their interest in these nature-based solutions.

Can you describe what a nature- based solution is and how that can help address health inequities?

SEMRA: Sure!

So, it's going to be hard to top Eric's lovely story, but it's sort of building on the power of nature what nature does in terms of ecosystem services like keeping our air and our water clean and supportive of health.

So, what nature- based solutions do is they often either mimic or conserve/preserve nature's normal way of functioning.

And some that we can think of are green spaces, parks, urban forestry, planting trees back in urban areas that may not have enough shade or trees, or preserving/ conserving old-growth forests.

Community gardens: so, our food systems, when you ask the question about prevention, there's so many opportunities there because eating locally, supporting local businesses, supporting local farms that produce some plant-forward diets or more sustainable seafood for us, these are things that benefit our economy, they're tremendously helpful for our health, and they often have carbon mitigation effects too.

So, these are things that we call multi- solving or co-benefits where you can do one thing and it has multiple benefits.

And it's kind of counter to the narrative of, Everything that we do environmentally is going to be going against an economic viewpoint, or something.

There's so many ways in which we share common goals, and a lot of that lands in the prevention space for public health.

The other one Marina talked about was when we prevented the asphalt plant.

So now, children are able to walk or bike to school in an area where... schools are close enough for people to still walk and bike.

That isn't true everywhere, but in places where active transportation is still possible for people, when people choose walking or biking, or in some places we have public transportation, then that both promotes human health physical activity is great and we need more of it in America and it also has a mitigation and adaptation effect for the climate.

MARA: Yeah.

And that makes me think.

I want to ask the two of you, you know, when we prevent things, I think sometimes it's hard to see the effects because the thing isn't there.

SEMRA: Yeah.

MARA: How do you measure success in that and how have you seen the benefit of preventing something in the work you two do?

Maybe, Marina, if you want to go first and then, Semra, you can chime in.

MARINA: Yeah.

Thank you for that question.

Well, I think in the case of the asphalt plant, the benefits are pretty immediate in terms of I know there isn’t additional pollution, there aren’t additional trucks, there is no odor from the asphalt plant that is impacting folks’ quality of life and health.

I think we can think about it in terms of, like we can think about the benefits of prevention in terms of positive things that we do want to see in that community.

So, for example, in the asphalt plant case, yeah, that looks like an active community.

Although that area was zoned General Industrial, it has developed to be quite residential; a lot of multifamily homes, schools, and educational buildings nearby.

So, I think we can think about prevention in terms of what we do want to see.

I want to see a community that has tree equity, one in which everyone has access to green space, one in which there aren't much higher levels of asthma based on where you live and facilities nearby that can exacerbate those respiratory illnesses.

MARA: Yeah.

Got it.

Anything quick to add, Semra?

SEMRA: Real quick.

A lot of the work in Europe is around what's called social prescribing, where doctors and nurses and other health professionals are now actually prescribing exposure to green space or blue space, which is water, ponds, lakes, oceans, etc., to keep us physically and mentally well.

But in order to do that, you know, it's premised on access and the ability for people to be able to have that experience, connect to nature, and then engage in healthy behavior, which has a whole range of chronic disease prevention outcomes.

But measuring that your question takes a long time.

So, what we often try to do is measure intermediate outcomes like social cohesion, social capital; sometimes things that have to do more with our sense of resilience.

There are different ways to measure that.

But in terms of measuring prevention, it is difficult because it takes a long time and the measures are difficult to implement.

MARA: Yeah.

Got it.

So, Eric, I want to turn to you.

We're talking about access to green space, and it makes me think of your work at Fish and Game.

I know you were there when a lot of restoration efforts were taking place in the mid 70s.

You talked about watching populations of all these very iconic New Hampshire species grow over your time.

I want to know: now that we’re seeing warmer, shorter winters, new threats, how is the current pace of climate change shaping how you think about future restoration efforts or preserving that pace of restoration?

ERIC: Well, a couple of things I think we should make note of are that, during the pandemic, what happened?

People found the public lands and the wild woods.

During the pandemic, woodlands were a wonderful medicine.

I think we need to double the amount of public lands that we have and prepare for the next pandemic.

But other things you can do: on our streams, we must remove dams where the waters back up and gets hot.

It’s fatal to some fish.

So, there are things that can be done.

Changing culverts and bridges so they’re not blocking the movement of fish.

I mean, Fish and Game did a study I think brook trout up on the Androscoggin River moved something like 20 miles!

Who knew that a brook trout moved 20 miles?

So, you got to give them room to roam, basically.

So, we need to improve the ability of wildlife to move.

Organizations like Bear-Paw Regional Greenways are connecting Pawtuckaway State Park to Bear Brook State Park and others so wildlife can travel if they need to move from one location to another.

And, of course, as our climate warms, one of the things that animals can do is go upslope.

So, they need to be able to have access to different habitats.

And, for moose, they need thermal refuges.

So, when it's really hot, they need some evergreens to get under.

So, we can do things to help our fish and wildlife.

We just need to get them done.

MARA: Yeah.

I want to ask you: one of our audience members from Manchester is asking, What nature-based solutions are particularly appropriate to implement in the New Hampshire context?

Do you have ideas about that, Eric?

ERIC: Well, certainly on the Merrimack River, they're building a second fishway, or fish passage facility, at the Hooksett Dam...

The fish ladder at the Amoskaeg Dam was finally built in he 80s.

And so, they’re again addressing the ability of animals to move to more appropriate habitats if they need to.

MARA: Yeah.

SEMRA: Can I jump in one thing there?

So, I think Eric brought up such an important thing that during the pandemic, yes, people found nature: Nature is medicine and that’s that’s my big thing!

But we have to also be aware that we can love something to death, right?

So, I think that's the thing that a lot of people, again, in the U.K. are talking about.

When we know that nature can take care of us, we have to be gentle with it.

We have to think about the ways in which the things we care for in terms of the earth allow the earth to take care of us.

And once we can, maybe, do that more and work together to care for the earth in a way that allows it to take care of us, that enables all kinds of nature- based solutions and collective action and other things.

MARA: Yeah.

Got it.

Well, I have so many more questions, but I think I want to move on to our next section.

Before the summit you know, all of us, we're talking about a challenge many of you have run into in your lines of work, which is resistance to talking about climate change and acknowledging its connection to daily life and our health.

We're also in a moment in our national political story where there's momentum toward dismantling efforts to mitigate and adapt to climate change.

So, I'm curious about the lessons you might have from the the resistance you met and the times when that resistance actually became like a light bulb moment, maybe.

So, Kaitlynn, let's start with you.

What's it been like to talk to other seasoned clinicians about climate change?

You know, are people open to thinking about this in a health context?

KAITLYNN: I think a lot of times they are if you make it valuable to them and personable.

Like, try to make it really reflective of something that is meaningful to them.

So, if you're going to talk to a critical care nurse, you can kind of talk about, Hey, what have you been noticing?

In 2017, when I was a brand new grad, I'll never forget how we had a hurricane, I think in Puerto Rico, and there was a morphine shortage.

And then, I thought that was like an isolated thing for me as a health care professional.

But then, in 2024, we had an IV fluid shortage because of another hurricane, that one hitting the U.S. And there's a a facility in Carolina that produces like 60% of our IV fluids.

And we, in health care, started to have to like prioritize who was going to get IV fluids.

And even, you know, months later, I was still giving people Gatorade because they weren't high acuity enough for us to give them the IV fluids.

And so, try to bring up that story like, Hey, do you remember when that was happening?

What did that look like for you?

Even talking about here, in New Hampshire alone, we had some cold snaps where pipes were freezing and we had to close ORs and ICUs and redirect clients to different places.

So, try to find an example that maybe somebody lived through or was affected by, or also find out honestly, as a nurse like, What’s your favorite body system?

Because every nurse has their thing and you try to tie it into like, Oh, that's your favorite organ?

Let's go with that.

[laughing] MARA: What's your favorite [laughing] body system?

KAITLYNN: It's the GI system [laughing] the gastrointestinal system!

I don't know why but it is.

MARA: Awesome.

Well, I have many questions about that, but we got a question from Joan in the audience.

How is the education of nurses and I know you work with accrediting bodies for nursing, so, How is the education for nurses changing to address the health impacts of climate change?

KAITLYNN: All right, I’ll try to keep it as basically, nursing has accreditation bodies, and they make sure that we are preparing nurses the next generation to be effective nurses; safe, competent leaders.

There’s this group called AACN, for instance.

Historically, every time I wanted to talk about like climate and health, it was always like, No, no, Kaitlynn, it’s too political.

And, in recent years, a body like AACN has started to actually put out position statements that say [they’re] going to talk about climate and health [and show] it is linked.

And they actually have like specific language now that calls out these topics.

And then, that ties into the code of ethics.

So, the American Nurses Association Code of Ethics I'm sorry.

ANA was the position statement.

They have a code of ethics which is really a driver of nursing practice and our responsibilities.

And then you have that AACN, which is like a nursing school accreditation body now actually saying that our competency-based education and evaluation of nurses is going to start specifically looking at this as it relates to population health, for instance.

So, you start to have this trickle-down effect.

MARA: Yeah.

Got it.

So, there's some momentum you're seeing?

KAITLYNN: Yeah.

MARA: Eric, let's turn to you.

I know you've worked with lots of hunters and fishers in your time.

Can you talk about where some of the points of resistance were when you were talking about climate change with those folks and how you have approached people so things started to click for them?

ERIC: Well, they talk about the brick wall.

I was an outdoor writer my whole career at New Hampshire Fish and Game and beyond.

And because I had written monthly columns in some sportsmen’s papers, when I retired in 07, I’d already been writing about the observations I'd seen in changing winters in New Hampshire and was recruited by the National Wildlife Federation the Ranger Rick folks.

They said, Oh, you know, go back to New Hampshire and talk about global warming and do that...

It was like impossible.

The hunters and fishers slightly lean right and would say, Oh, that's Al Gore's BS.

That really isn't happening here.

I used to go to the Colebrook Moose Festival in 08-’09, and up there, Oh, no.

That's not happening to our moose.

That's not happening here.

I have learned if you hit them in the head with a moose, they changed their mind.

As moose numbers went down, the belief went up.

That's a reciprocal fraction, and it has worked.

Even some of these very right-leaning folks that were not believers, it took the loss of our moose for them to see the light.

But it has worked.

We don't nearly get the resistance as I had when I first started some 17 years ago.

MARA: Yeah.

So, you're saying seeing the loss really hits home for people.

How have you seen things, you know, change?

What are you seeing now compared to when you were doing this work initially?

How have the conversations around climate change shifted in those communities?

ERIC: Well, certainly more people are way more accepting of us.

They don't push back the way they did.

I'm certainly worried in the current political climate that we're going to we're going to step back a little bit.

Not every step is forward.

Sometimes, you get back on your heel, but then you have to push harder.

You have to make a difference.

We have to all drill down and do twice what we were doing before.

Right now, that's what we have to do.

We have to do more right now.

MARA: Got it.

Semra, you think a lot about how policy affects our health.

What are the kinds of resistance you've seen to policies that address health and climate change?

SEMRA: So, right now, I think we've heard a lot from the keynote speaker about the threats to a lot of institutions, public health being one, the EPA being another.

So, I won't rehash all of that.

But I think I'm going to contrast with the strides we made in 2024.

So, we made a lot of really, I think, positive political strides in 2024.

There was a lot of momentum for green infrastructure, for the kinds of nature- based solutions that I was speaking about, going all the way from federal to state and even public-private partnerships.

And then, one of the things that we did in the CDC shout out to my colleagues at the CDC who fought really to do a lot of work on climate justice and many of whom now are tremendously under threat.

But we did a new revision of what's called the BRACE Framework: Building Resilience Against Climate Effects.

And that had first been published in 2014.

But we did a whole rewrite of BRACE over the past two- two and a half years to talk more about mitigation and equity.

And that work is now published on the University of Massachusetts Lowell’s website.

I can provide the link to anyone because it is not able to be published where it should be.

I'll leave it at that.

But it's available.

It's part of the data- saving movement that our keynote speaker talked about.

So, there have been ways that we harness the tremendous strides that we made, and we are trying to just keep moving forward, just like Eric said, doubling down.

Towns have done a lot.

So, the towns of Hampton, Seabrook, Rye, Portsmouth, have done amazing coastal resilience work, which I think one of the breakouts is going to touch on.

They did projects like Tides to Storms and a High Water Mark Initiative where they showed how flooding and sea level rise would be increasing and threatening public buildings, historic landmarks, really kind of highlighting the fact that so many tourists go to these places that you can show through public art, through signage, how much higher the water is going to be.

Right here at Strawberry Banke, for example.

What does that mean to our culture?

To our New England way of life?

It's about showing, through moose, through historical buildings, through our culture, through the things we love to do, that it's real, it’s now, and we’re all in it together.

MARA: Got it.

Marina, we’ve seen environmental justice take a lot of the criticism from this administration, and those programs have received the swiftest funding cuts.

What lessons can you share from experiencing this, you know, current resistance to your work?

MARINA: Yeah.

Thank you for that.

I think it's important to acknowledge that what's happening at the federal level and attacks on environmental justice, they have real impacts, especially for organizations that rely on that funding to do the work.

What I will say, though, something that's really powerful about environmental justice is that it's a bottom-up movement.

And I think, similar to what the other panelists have shared, it's really about like people's connection to place and community and things that matter to them.

And so, I think as much as we can relate what we're advocating for to quality of life and that everyone is entitled to the highest quality of life we can provide them, that, I think, is something that resonates across party lines.

MARA: And where do you see the biggest disconnect between people who are, you know, experiencing environmental or climate or health challenges and people in power making policy?

Where do you feel like the biggest miscommunication is happening?

MARINA: Well, I think in my work, what I see is that, often, the people who are in power making decisions, they don't have that first-hand experience.

They don't understand the barriers.

And so, that's why it's so important for us to create avenues to always be giving that feedback to decision makers.

Because people don’t know what they don't know.

But, you have to serve everyone.

And when there are barriers, we need to address those so everyone can participate fully.

MARA: Do you have examples of those avenues that have worked well for you?

MARINA: Yeah.

So, well, going back to the example of the asphalt plant, that was something that not only was a matter of environmental injustice in terms of the impacts that the asphalt plant would have had on folks’ health and well-being, but also a matter of process, right?

So, when we talk about language access, sometimes when I'm talking with folks and they're like, Oh, what do you work on?

and I mention language access as an area of work.

They may think, What does language access have to do with environmental justice?

But it really is important in terms of process as well as substance that we're making things equitable.

So, not only were we able to provide language access at those public meetings, allowing full participation, but also now there is a conversation in the city of Nashua of, What do we need to be doing to make sure that we're reaching all of our communities?

MARA: Yeah.

So, starting that process, getting that ball rolling.

Got it.

We got an audience question from Cynthia in Grantham who's wondering how to talk and communicate with folks who have alternative facts.

Any suggestions there from your collective experiences?

Maybe we can go down the line from Eric on down, and then we could do a little lightning round of advice.

ERIC: A round of alternative facts!

[chuckling] SEMRA: A natural at it!

ERIC: That’s what I'm going to say.

There are, you know, you have to bring out the science.

It's really the only it's on your phone!

So, the facts are so easily accessible to all of us, and we just need to fight back when there's misinformation and set them straight.

The information is available at your fingertips.

There's no reason you can't provide the correct information when someone is giving you some alternate facts which are not facts at all.

We should even say those words, in my opinion.

MARA: Got it.

KAITLYNN: Oh gosh!

There's so many things going through my mind.

So, I think a lot of times, we, as nurses, try to take advantage of the fact that for 23 years in a row we’ve been voted the most trusted profession.

Wooh!

And, there's also like 4.7 million of us in the U.S. alone.

So, try to use that as, a lot of times I say, we're very good at looking at evidence and reading the evidence and let's talk about, like, what reputable sources means and like, Oh, okay, so show me what you have and let's talk through that.

Sometimes, you can actually just point out the holes and they kind of go, Oh.

Or, other times, they're going to just die on that hill.

And you try to look at this as like, Are they responding with fight, flight, or freeze?

Because a lot of times we've all heard of fight or flight, but there's also this freeze component where sometimes it might just be easier to status quo; keep going as usual.

And so, you try to gauge whether there is an irrational fear going on where actually accepting that what I'm saying might be right is actually more distressing to them.

And so, it’s a lot of motivational interviewing, which is something we do a lot in health care.

MARA: Yeah.

Got it.

Yeah.

Thinking about fight, flight, and freeze in that context, I've never thought about that before.

Semra, what about you?

SEMRA: So, I’ve thought a lot about this because it so much in teaching.

So, I think all of us are short of a perfect answer, but I felt like I had to educate myself and I'm just starting to do that.

One of the things we’re learning, I should say, in public health is that, like Kaitlynn said with motivational interviewing, there's sort of a starting point of just hearing a person.

So, at least what the communication science tells us is that before we immediately jump to the facts, which would be my scientist hat, would be to really listen.

And I want to start, misinformation is often when people are unintentionally spreading inaccurate information.

Disinformation is the intent to spread inaccurate information for financial or political gain.

So, there's a difference there.

And most often, misinformation is people maybe not fully understanding something or coming from a place where their own belief system has, you know, enabled them to tune into a certain narrative.

So, at least what we're kind of rethinking in public health is, Well, let's hear why someone feels the way they do.

I'm thinking back again to our keynote about not reinforcing, kind of, exclusion.

So, taking a little time to just understand where somebody is coming from, even if it might be a very different perspective from the one we believe is right or we want to hear, and then thinking about engaging in a conversation about, Well, did you know that there is this source from a nurse or a trusted messenger that actually suggests that the following is true?

So then providing something that is hopefully from a trusted source appears even better.

Another hunter, another person who comes from their community.

That's an even better way to draw a bridge.

But then it's just that building trust and being able to reinforce those accurate messages and drown out the false misinformation, which is difficult because a lot of it is funded.

It's politically funded.

MARA: Yeah.

Got it.

Marina, what's your advice?

MARINA: Yeah, I think, along the lines of what Semra shared, I think listening to people and understanding where they're coming from because especially when it's a case of misinformation, there are real reasons why there's distrust or they've come to believe something that is not true.

So, I think understanding where people are coming from and not dismissing that is really important.

MARA: Yeah.

Got it.

So, as the federal government makes deep cuts across departments and seeks to roll back climate funding, I want to ask all of you about how you're sort of thinking about ways to potentially fill in gaps that are left or maybe reimagine what to do locally without the federal government.

Eric, let's start with you.

Wildlife conservation work across the country gets a lot of federal support.

What's it going to look like to continue that work if that funding is, you know, under threat or stops.

ERIC: Well, hopefully there won't be a big impact.

For instance, the New Hampshire Fish and Game Department is not only funded from licensed sales of hunters, fishermen, and trappers, but also the federal dollars are from taxes on guns and fishing equipment, which is through the U.S.

Fish and Wildlife Service.

And that is a dedicated fund that would be very, very difficult for any politician to stop.

So, I'm not worried about that.

Certainly, there are others.

You know, over my career, I worked with members from the U.S.

Fish and Wildlife Service, from the U.S. Forest Service.

I heard several thousand of the U.S. Forest Service people are gone and over 300 Fish and Wildlife Service people.

So, the people that I worked with for decades are gone because they just were taken out of the system.

And they were doing important work in New Hampshire.

I mentioned the river herring that run up.

Well, they are a partner to doing that.

So, they always were a partner to the things that the New Hampshire Fish and Game Department was doing, as well as folks from the U.S. Forest Service.

The [White Mountain] National Forest worked with them very closely, deciding, you know, Well, we shouldn’t cut these trees because the bear claw marks.

You know, that’s good bear food.

You know, cut these trees so that won’t impact the bear population in the National Forest.

So, we I've been retired 18 years, but I'm still a we.

Anyways, so, you know, we've worked very closely with our federal cohorts, which is concerning now that some of them are no longer there.

MARA: Yeah.

Got it.

Kaitlynn, I think I'll direct this to you.

What in your line of work, or with other people in your field, is under threat?

And, you know, with accrediting bodies maybe in particular, what's playing out in the national landscape there?

KAITLYNN: I think we're fortunate that, you know, a lot of ways, health care is definitely looked at as this kind of necessity.

I mean, we are underfunded and do have threats, but, I think a lot of times we have this advantage where people are going to usually seek us out.

No matter what the climate is, we will lose some population that says, I'm not going to go because it's inaccessible or it's more expensive.

But, there are a lot of forced opportunities to just keep engaging with people.

But I think health care, in general, it doesn't take funding to go volunteer in your community or create some sort of community engagement event where you get stakeholders together.

And we've done it before where it was health care providers, folks who were experts in ticks, Fish and Game... We got everybody together.

We went into the community and created an open, free event and we had multi-generational attendance and we distributed resources, we talked a lot about mitigating tickborne illness, and it didn't really actually take any funding to do that.

It was just everybody saying, Let's get together and do this event.

And it was successful.

But it's hard.

Not everybody has the bandwidth to do that.

MARA: Yeah.

Got it.

Well, I have many more questions on funding, but let's move on to the future.

So, you know, as we think about the next three years or the next ten years, the next few decades, I want to know what you each envision as a healthy future for New England.

So, what's what's in your mind's eye when you think about that?

And then, also, what's available to us right now to make that a reality?

One of our audience members from Greenville asked, How do we make changes together and not in isolation?

That's another thing I'm thinking about.

So, Marina, I'll go to you first.

You know, what do you envision for neighborhoods in Nashua?

What are some of the levers you want to pull there to create a healthy future?

MARINA: Yeah, absolutely.

So, I think clean air and water are a must.

But beyond that I want to see tree equity; I want to see public infrastructure that encourages connectivity active transportation.

And I think the key to that really is, well, collective action, but connection.

I think in the health field, you talk about connection like literal physical connection, but also like that we're creating spaces in the physical world or otherwise where community can come together, share information, and advocate for the changes they want to see.

MARA: Yeah.

Got it.

Semra, let's go to you.

What's your vision for a healthy future and what big picture or little picture policy changes would you want to see?

SEMRA: It’s really fairly similar to Marina.

So, we are so fortunate to live in a state and a region where we have beautiful mountains, we have forests, we have oceans, we have lakes, we have moose some anyway.

We have all these natural resources and the ability for people to access those, I think, is what is still inequitable.

And so, I would love to see greater access, equitable access to the state's resources, but also, in doing that, when people are exposed to nature, social science shows that people are more likely to engage in pro-social behavior, pro-environmental behavior, and try to work to protect those resources, as well as work together for other social justice issues.

So, I think it's that reciprocity piece that I would love to say.

And the last thing I'll quote one of my friends in Maine who has an art institute that they are working on a coastal Maine art institute and their quote is, Make America Create Again.

And I just love that because I think it is really, you know, again, the power of co-creation, knowledge development, and honoring each other's strengths and using nature or not using partnering with nature, I think, to bring health to everybody.

MARA: Yeah.

I want to ask you: are there any pressing research questions that are on your mind right now?

What are your things?

SEMRA: Yeah!

So, there's research around, Well, how does nature do that?

So, there's a whole lot of research around, Well, what are the mechanisms?

Are they neurological?

There's brain science research about how nature actually improves brain health.

There's all the cardiovascular research.

So, there are mechanistic questions about how nature gets into our bodies and creates health.

That's really cool.

But I think there are practical questions about how people engage in communities and build successful models.

Like, one that I'm working with out of Barcelona, Spain, there's a group coming, actually, to New Hampshire to do a training in forest spaces around mental health benefits.

So, there are practices now that social workers learn and psychologists learn.

They have funny names like forest therapy, forest bathing, which is a practice out of Japan, blue health, a blue prescription.

These are things that are being researched, and they're showing effectiveness on a variety of physical and health outcomes.

How they work?

Well, there's basic science to be done.

But it's also how do we implement them and how do we build models in local, place-based contexts that, They’re working in other places.

Can they work here?

How will they work and how will we build reciprocity around the relationships we're studying?

MARA: Yeah.

Kaitlynn, how does this look in a clinical context?

You know, what's your vision for a healthy future when you think about the doctor's office or the hospital setting?

KAITLYNN: Yeah.

I think regardless of the setting or the acuity level or it’s the whole health care spectrum...

So, there's this concept called Planetary Health .

There’s an absolute expert right here on that topic.

But this idea of Planetary Health is really saying that and it piggybacks off of what of what you said everything is intertwined.

The health of the human depends on the health of the natural systems.

And, if health care could get to a point where that is just a common knowledge health care theme, then I think we're going to be a lot better positioned not only to address the mitigation and resilience aspects of human health and climate-sensitive health risks, but also take a more preventative approach to all of this because health care, a lot of times, is very reactionary, like, Oh, you have a problem?

Health care's here to help you.

But we have to start getting more prepared and preventative about, like, Can we prevent that disease from ever happening?

And then like, How did we prepare you to do that?

How were health care providers prepared to do that?

And I really think if we can get Planetary Health as a foundational knowledge or concept within health care it would just have a ripple effect.

MARA: And could you give us maybe a one or two-sentence definition of Planetary Health ?

KAITLYNN: I honestly, I'm going to defer to the expert because she really taught me about it.

SEMRA: But Kaitlynn co-wrote a book about this.

So, she's an expert too.

We have a book coming out!

But, anyway, it is defined as the health of human civilizations and the earth systems on which life depends.

That's from a Lancet Commission report.

But it's also a transdisciplinary social movement.

So, when we talk about environmental justice, One Health which is plants, animals, and the ways in which those support health a lot of these other social movements are now being folded under the Planetary Health umbrella in terms of how we think about interconnections, what you started us off with, Mara.

KAITLYNN: And, sometimes, people if they ever say like, Sounds political again.

You can always say, Do you have a happy place or do you ever spend time outdoors to refresh yourself, renew yourself?

Or, like, you know, the hunter-fisherman: Where's your favorite spot?

Probably out in the woods.

And you bring them into this idea that, like, if nature can have this benefit, then how could it not also have a harm.

And so, it's again the message, the messenger, and making it personal.

MARA: Got it.

Eric, let's go to you for for your sort of vision for a healthy future in New Hampshire.

What do you picture when you think about that?

You know, I think what these two have said about connecting more people to the environment, I mean, you've got a better chance of seeing a bald eagle, a peregrine falcon, a moose, a common tern than your great great grandmother.

These are the golden years of wildlife.

We need to get people out there to appreciate it.

You know, I read an article in New Hampshire Business Review that struck me this winter; an article about access to the environment.

And apparently, there’s a bus from Manchester that takes someone to Bear Brook over the summertime, once a week.

There was a person that had not left the city in ten years.

And, you know, there again: my lack of realizing how there are people that are not able to connect to the environment.

We need to we need to shore up those connections and get more people into the environment because we have so much to offer, why not give it to them, make it available to them?

It's good for their health.

It's good for all of us.

MARA: Yeah.

So, more people connected to natural spaces is your vision for the future.

[chuckling] SEMRA: Sign me up, Eric.

MARA: We have a question from the audience that we may end on.

They're wondering, What's one thing you'd each suggest that individuals could do to address climate change?

Marina, can I go to you first?

MARINA: Yes.

So, I'm big on collective action.

I feel there's so much pressure in terms of climate change.

It's so easy to get overwhelmed and feel like you have to do everything, and if you don't measure up, you’re worthless you're not doing anything.

And then, also, the instinct to shut down and just say, Well, it's too big.

I can't do anything anyways.

Don't get stuck in that.

Odds are there's something that you care about that connects to the environment.

Is it access to nature and, like, green space and blue space?

Is it public transportation?

Is it access to healthy and affordable foods?

So, I would say however you relate to it, whatever issue is close to your heart, invest in that and then find other people who are invested in that.

And yeah.

MARA: Yeah.

Got it.

We've got about 30 seconds left.

Eric, can I go to you?

What's your one thing?

Well, I tell people, When you leave the room, turn the light off.

[laughter] We all have a we all have a responsibility to start with ourselves.

You know, we don't need that light on when you're not in the room.

Turn it off!

Your outside lights, you know, have them on motion sensors.

You know, our birds are migrating now.

They're bothered by these lights.

We all can make steps at our home that every one of us can do.

You just have to think about the choices that you're going to make.

MARA: Got it.

Well, thank you all so much!

I feel like we could keep talking for another few hours, but unfortunately, we've got to wrap this up.

Thank you to all the panelists for joining us today.

Give it up for them.

[applause] And thanks so much to our audience for joining us for the By Degrees Climate Summit.

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