Community-based sentinel surveillance and preference elicitation inform climate change adaptation in rural and frontier communities in Alaska

Background: Residents of the circumpolar north must adapt to the environmental effects of climate change, in part by enhancing local capabilities and capacities to reduce adverse health impacts. Effective adaptations require measurement and discussion of environmental effects and associated health outcomes at the local level.

Methods: A cohort of more than 60 study participants representing eight communities across Alaska provided monthly surveillance surveys from April or May of 2011 to March or April of 2012. The survey's structured thematic sections included community observations on local weather, hunting and harvesting, food and water safety, and general health and air quality. Open-ended text fields for each theme and for general observations were included. Surveillance results were presented in each community, and climate change vulnerabilities and adaptation strategies were assessed in a participatory manner using a qualitative value-jury approach.

Results: Community participants selected two or more of three primary environmental hazards with priority health sequelae. These were extreme or unusual weather events associated with unintentional injuries, threats to food security associated with a host of adverse health outcomes including paralytic shellfish poisoning, and reduced indoor/outdoor air quality associated with respiratory complaints. Participants requested time-sensitive communications warning of extreme weather events, zoonotic diseases, and adverse air quality forecasts in their communities. Residents may use these communications to modify traditional travel times or routes, practice safe subsistence consumption of shellfish or game, and avoid areas affected by air quality warnings. The second round of surveillance data will assess the utility of these risk communications and associated adaptive practices.

Conclusion: This study demonstrates the effectiveness of sentinel surveillance systems and preference elicitation exercises, such as the value-jury approach, for informing climate change related vulnerability assessments. Such assessments can inform strategic planning by community stakeholders in those communities seeking to reduce morbidity and mortality from climate change.