Protecting Patients From Climate Change One Nurse At A Time

Created by two graduate students, the award-winning Nurses for Cool and Healthy Homes program trains nurses on how to work with vulnerable communities to address extreme heat and the health impacts of climate change.


“How can we help nurses address the impact of climate change on patients?”

That was the question Valerie Tran and Angela Wan, both graduate students at the University of Michigan School of Public Health, wanted to answer. Coalescing their mutual interests in public and environmental health, while pulling in Angela’s background as a nurse, the two submitted a proposal to Health Care Without Harm’s 2014 Climate and Health Contest for Nurses. Their winning project: Train public health nurses on how to work with vulnerable communities to address extreme heat and the health impacts of climate change.

Valerie Tran discusses Nurses for Cool and Healthy Homes during her TEDx talk at University of Michigan, March 2015.

Before graduate school, Angela was a nursing student who saw the power of community health workers, and Valerie worked as a CDC field assignee in the county Department of Public Health in Fresno, California. “We both have interests in public health, urban planning, climate change, and environmental health,” Valerie said. “We wanted to combine these interests to create a project that would address the very real health impacts of climate change that patients in Fresno are experiencing.”

Fresno County: Hot Climate, Heavy Health Burden

Crop field in Fresno. Source: Flickr Commons

Fresno County, part of Central Valley in California, has the highest farm revenues in the United States. But it is also one of the hottest and poorest parts of the county. Fresno is also the most polluted city in the country in terms of short-term particle pollution and year-round particle pollution. To make matters worse, the Obama Administration recently issued a report confirming that low-income communities are some of the hardest hit populations when it comes to climate change. Fresno is no exception. Its population comprises of 62.5% minorities and more than 22% of the population lives in poverty. The county’s extreme temperatures coupled with the burden of socioeconomic marginalization puts Fresno residents at a disproportionately higher health risk from climate change.

“We wanted to combine these interests to create a project that would address the very real health impacts of climate change that patients in Fresno are experiencing.” -Valerie Tran

While in Fresno, Valerie witnessed public health nurses managing overwhelming caseloads, which required them to go to homes and provide services to patients with a wide diversity of health needs. Seeing their patients struggle climate related health issues, Valerie and Angela came up with an elegant solution: incorporate a heat risk assessment into the public health nurses’ home visits.

Creating Healing Homes

Starting in earnest, they established the Nurses for Cool and Healthy Homes program, hoping to equip public health nurses with the knowledge and tools that empower home visit clients to stay cool and healthy in the face of extreme heat while minimizing their environmental impact.

Angela and Valerie worked with the local utility provider in Fresno, Pacific Gas and Electric Company (PG&E), a company that is known for its community outreach efforts. Then, using Michigan Department of Community Health’s home asthma assessments as an example, they developed a Home Heat Vulnerability Assessment, in the form of a short checklist that only takes three minutes to complete.

Rooms for rent in Fresno, California. Source: Flickr Commons.

Included in this checklist are items such as window condition, presence of working air conditioner, maintenance of comfortable temperature in the home, and barriers to paying utilities. The checklist also includes information that makes it easy for nurses to make appropriate energy assistance referrals and health referrals based on client responses.

“The advantage of performing this checklist in a home setting versus a clinical setting is that the nurses can see for themselves what sort of health risks are posed in the patient’s home environment.” -Angela Wan

Angela also noted that “if a nurse were to ask these same questions in a clinic setting, the nurse might get vague answers and might not feel as confident about the referrals [he or she] is making.”

“And when you are actually in the home setting, you notice things like how the windows are cracked and it is 90 degrees in the house,” said Angela. “Those are very clear pieces of evidence that you wouldn't be able to parse out as easily in the clinical setting.”

Empowering Nurses

Nurses for Cool and Healthy Homes opens the door for nurses — indeed, all health professionals — to think about how we can improve patient health by addressing climate change in the home. “A nurse or doctor doesn't need to be a utility or energy expert to recognize these issues in the home,” said Valerie. “They can use their public health expertise to recognize that their patients are at risk for some adverse health event.”

With global health leaders urging action to protect communities from the impacts of climate change, innovative ideas like Nurses for Cool and Healthy Home offer unique opportunities for nurses to leverage their skills and passion to lead the charge against climate change.


Valerie Tran, MPH, MUP is a graduate of the University of Michigan’s School of Public Health and Taubman College of Architecture + Urban Planning. Her work explores ways in which urban planning provides practical strategies for addressing the health and social impacts of climate change. She has worked with the Public Health Institute’s Center for Climate Change and Health, the Centers for Disease Control and Prevention, Fresno County Department of Public Health, HealthxDesign, and UC Berkeley’s Department of Environmental Science, Policy & Management.

Angela Wan, RN, is a graduate student at the University of Michigan pursuing a Master of Health Services Administration at the School of Public Health and a Master of Science at the School of Natural Resources and Environment. Her professional background includes internships with the Alliance of Nurses for Healthy Environments, Practice Greenhealth, and Intermountain Healthcare. Angela’s vision is to harness the power of health professionals to promote sustainability in healthcare and communities at large.


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