How to protect people and planetary health: Lessons from the Peruvian Andes and New Orleans

In this final episode of Season 4 of Cities 1.5, David has conversations with two formidable and inspiring women who are fighting to protect the health of people and the planet from Lima, Peru and New Orleans, USA. As the impacts of the climate crisis hit harder and more frequently, the effects this has on human health also multiply. It is key that urban areas plan and adapt to meet the growing challenges of temperature rise, food insecurity, migration, and more. Of course, extreme weather events often have the most catastrophic consequences for humanity, leading to mass displacement, injury, disease and death. But if the worst happens, it is possible for cities and their residents to unite and rebuild to create a more resilient future…and other communities can learn lessons from their leadership.

Image Credit: Persnickety Prints @ Unsplash

Featured guests:
Professor Stella Hartinger Peña is the Regional Director of Lancet Countdown on Health and Climate Change for Latin America, and Associate Professor at Cayetano Heredia University in Peru.

Mayor LaToya Cantrell is the Mayor of New Orleans, a position which she has held since 2018.

Links:
Solved: How the World’s Great Cities Are Fixing the Climate Crisis - David Miller
The Lancet Countdown on Health and Climate Change Annual Report
The Impact of Hurricane Katrina on New Orleans - Big Easy Magazine
Addressing the Health Care Impact of Hurricane Katrina - The Kaiser Commission
What happened at the U20 Summit in Rio? - C40
COP29: Is the Loss and Damage Fund Becoming an Empty Promise? - Heinrich-Böll-Stiftung
Broadmoor Lives On: How a Community Saved Their New Orleans Neighborhood - The Clinton Foundation
New Orleans, Reinvented - The Atlantic
This is how New Orleans is rebuilding to be more resilient - Global Center on Adaptation
Solar and energy efficiency for all - NOLA

If you want to learn more about the Journal of City Climate Policy and Economy, please visit our website: https://jccpe.utpjournals.press/

Cities 1.5 is produced by the University of Toronto Press and Cities 1.5 is supported by C40 Cities and the C40 Centre for City Climate Policy and Economy. You can sign up to the Centre newsletter here. https://thecentre.substack.com/

Our executive producers are Calli Elipoulos and Peggy Whitfield.

Produced by Jess Schmidt: https://jessdoespodcasting.com/

Edited by Morgane Chambrin: https://www.morganechambrin.com/

Music is by Lorna Gilfedder: https://origamipodcastservices.com/

Transcript

David 00:00 

[Cities 1.5 main theme music] I'm David Miller and you're listening to Cities 1.5, a podcast exploring how cities are leading global change through local climate action. [music ends]  

[urgent music] As we close this season of Cities 1.5, we've seen how the challenges of tackling the climate crisis have continued to grow, and along with them, the impacts to our bodies, brains, and to the natural environment which surrounds us. But, there are enemies which must be vanquished if we are to protect the health of people and planet, such as disinformation, inequality, and the fossil fuel lobby machine, to name just a few of those which we've encountered over the course of this season. One of the most effective weapons in fighting back against these enemies is robust scientific evidence to inform effective health-protecting policies. [music fades out]  

[driving music] In response to this need, The Lancet Countdown: Tracking Progress on Health and Climate Change brings together over 300 leading researchers worldwide. Their work tracks the evolving links between health and the climate crisis and, in turn, helps to inform policies that enable a healthy, prosperous future, globally. 

The 2024 global report of The Lancet Countdown is the result of the expertise and dedication of 122 researchers, health professionals, and practitioners from 57 academic institutions and UN agencies. It provides a comprehensive assessment of the state of health and the climate crisis, building on eight years of experience of indicator development and monitoring. [music ends]  

[driving, pensive music] But, what exactly is the practical impact of this kind of research? Well, one thing that these metrics allow us to do is to design city policies that properly account for worst-case scenarios in resilience and adaptation planning, which is already vital and will become even more so in years to come. The increasing frequency and severity of extreme weather events shows how critical it is to study data and incorporate the learnings into policy so we can adequately prepare our cities.

One of the most deadly extreme weather events in recent memory, Hurricane Katrina, struck almost 20 years ago, but some of the most devastated areas are still working on recovery efforts today. In New Orleans, the largest American city impacted, 23% of city residents were living in poverty before the levees were breached, and this vulnerable population was disproportionately affected by the storm and its aftermath.

A report by The Kaiser Commission on Medicaid and the Uninsured found that Hurricane Katrina created immediate dangers to public health and dramatically increased the number of uninsured and impoverished Americans. Hurricane Katrina also destroyed and degraded the capacity to deliver emergency care, primary care, in-patient hospital services, long-term care, and mental health care throughout the affected region. This should serve as a warning to all cities to ensure their healthcare facilities and social service systems are fit to weather future tempests.

The City of New Orleans stands today as a sobering example of the reality that awaits many other cities around the world if they do not plan their mitigation and resilience policies to include the barrage of extreme weather events that science tells us are just beyond the horizon. But, it's also become a shining example of how it's possible to rebuild and revitalize one of the most unique and well-loved cities in the world through community engagement, inspired city leadership, and inclusive efforts to create a city that serves the needs of all residents. [music ends]

[light, rhythmic music] On this week's episode, we'll be hearing from both ends of the spectrum that need to be included in any conversation about health and resilience – science and policy. New Orleans is more than just a textbook example of extreme weather resilience. It's a city with over 350,000 inhabitants, many of whom lost everything in Hurricane Katrina, and who have spent the last 20 years rebuilding, sometimes from scratch. 

I spoke with Mayor LaToya Cantrell at the 2024 U20 Summit in Rio de Janeiro about how she's been supporting her city to make it the healthiest and most resilient it can be. 

But first, I speak to a world-leading expert about her research and work at The Lancet Countdown. Digesting and learning from these research findings is crucial if we're to understand the growing challenges we face at the intersection of climate and health. We must heed these warnings when creating policies to ensure cities and their residents are resilient, healthy, and safe as extreme weather events worsen and the climate crisis deepens. [music continues then ends] 

Stella Hartinger 05:56  

[rotary dial telephone rings] [clicks] My name is Stella Hartinger. I am from Lima, Peru, and I'm Associate Professor at the School of Public Health at Universidad Peruana Cayetano Heredia. [receiver chimes, replaced in cradle] 

David 06:10 

Professor, thanks so much for joining us on Cities 1.5 today.  

Stella Hartinger 06:16  

David, thank you very much for having me. I'm super excited to be here.  

David 06:20 

Can you just introduce yourself to the listeners and tell us a little bit about your background and your current roles?  

Stella Hartinger 06:28  

So, I'm a biologist. I did a Masters in Environmental Health and I then went ahead and did a doctorate in the Epidemiology, and then I came back to the university to actually start doing research. I've been working at Universidad Peruana Cayetano Heredia for the last 15 years. 

I started to do randomized controlled trials to improve household health through home-based interventions, so the idea of these interventions at household level. So, I work at Andean communities, about 3,000 metres above sea level – very poor communities, very rural communities. When we think about how to improve this health, David, we really need to start thinking about the basics. So, these home-based interventions are really to reduce indoor pollutants, to improve water quality and availability so that we could reduce childhood illnesses in these houses. 

So, I can say that that's maybe the beginning of my climate change experience, just working with rural Andean communities, households, to improve health, to improve wellbeing.  

David 07:33 

Can you talk a bit more about how that led to thinking about the nexus of climate change in health in that very granular way, in terms of indoor air quality, water health, you know, the things that are critically important to the healthy prospects of children growing up and living in those remote villages?

Stella Hartinger 07:54  

So, in 2008, you have to understand that only 30% of the population, for example, had electricity. So, it means that everybody has to cook with biomass fuels or with dung or with other type of fuels that are definitely dirty, and this is the reality still in many households around Latin America and in Africa and Southeast Asia. In Latin America, we have been moving towards cleaner cooking fuels in the last 15 years, but when we started, everything was biomass and dung for cooking. This means that the household was very polluted; that increased childhood illnesses like respiratory infections, pneumonia, in older adults, chronic obstructive pulmonary disease, for example. It increases the risk of cardiovascular diseases in the houses.

So, when you change really the homes, if you change the structure of the house, if you reduce pollutants at the house, you're actually improving their way of life. So, when we started, we started implementing improved cookstoves. In 2008, the Peruvian government had a program – we want to have a million improved cookstoves for a smokeless Peru. That was a campaign.

These improved cookstoves actually didn't work. They didn't reduce the pollutants to what the WHO was actually recommending. So then, we had to transition into other types of fuel and the other type of fuel that was transitioned in South America, Latin America, is gas – LPG stove. So now, we are in this very horrible crossroads in which we've reduced air pollution within our homes, our households, but we've changed it to a biomass fuel. 

[delicate, sombre music] So, when we're speaking now about having a just transition, we also need to now think that 75% of the population in Latin America cooks with biomass fuel, with LPGs. We actually need to reshuffle and change our way we work within these households so that they have cleaner electricity coming from cleaner sources. 

So, this is really where my intersection with climate change started.  

David 09:52 

LPG is liquid petroleum gas? 

Stella Hartinger 09:54  

Exactly. 

David 09:55 

There's a lot of scientific work being done at the nexus of climate change and health. Being responsible for the 2024 edition of The Lancet Countdown on Health and Climate, along with your colleagues, I think is an illustration of how important this nexus is. Can you talk a bit about why there is such interest in the intersection of climate change and health, and why we should be paying attention to this? [music ends] 

Stella Hartinger 10:25  

Yes. So, the global report for 2024, it has three key messages. What is interesting about the reports, David—and maybe I'm being a little bit too critical... I really love what we do. We have the latest research, we do the best indicators, we track them, and we've been doing it for the past eight years, but at some point, it's a little bit heartbreaking to actually see that everything's going in the wrong direction, especially the health indicators. 

So, when we write, for example, this is one of our key messages – people around the world face unprecedented threats to wellbeing, health, and survival due to the rapid increase of climate change, the rapid climate change that we see. This is not new, David. We already know this. We already know that health is getting worse, and we just report that health is getting worse. 

For example, we already know that we have reached the record high annual mean surface temperature, and we're already at 1.45°C above the preindustrial time. We already know that heat-related mortality has increased 167%, compared to the 1990s. 

We know that if we didn't have climate change, the increase in this heat-related mortality would only be 65%. We can calculate the attribution. We can attribute climate change to excess of mortality already. We publish this every year, and every year, we see that our indicators get worse. David. We see that 61% of the globe land area saw an increase in days with extreme precipitation. We see that 48% of the world has seen at least one month of extreme droughts. And, we see that when we combine both of these events, 151 million more people are experiencing moderate to severe food insecurity in 124 countries. 

So, we will continue to publish these heartbreaking numbers within the report to try to make evident that we need some change within the system, and we actually need to start thinking about not leaving people behind and make the changes that we actually need to do. 

So, yes, the report actually publishes about this. It's talking about annual economic losses, weather-related extreme events and its increases, the loss that we see in households that are not insured due to these extreme events, we also see that the changes in precipitation have increased or are favouring the transmission of infectious diseases such as dengue, malaria, West Nile virus, and so on and so on.  

David 13:05 

It's very uncomfortable reading the report. 

Stella Hartinger 13:09  

I know.  

David 13:10 

[chuckles wryly] You know, as you point out, The Lancet's been saying this for quite a while. Any comments you have on what the report tells us we should be doing, collectively? 

Stella Hartinger 13:20  

I think what we should be doing is thinking about adaptation strategies. We always try to finish on a positive note with the report, and the things that we can focus on as humans, as countries, as cities even, there are a couple of things that the report tells us to do. And, I think that one of those things is trying to reduce vulnerabilities, and I think that's why it's so important. And, I've never actually been invited to a podcast that is for cities, and maybe I'll take advantage a little bit of that.

So, by promoting adaptation measures at city levels, because there's only so much you can do at the governmental level—the governmental level, we already produce the national adaptation plans, we produce the NDCs for the country—but what I see, at least for Latin America, is that this is not being really translated into the cities, or even implemented anyway. So, there's a gap with what's happening nationally, with what's happened locally or regionally.

So, the first thing and the importance of adaptation is that we should be reducing vulnerabilities to reduce the exposures and the sensitivities of the communities to those climate-related hazards. That is absolutely important.

The second is that we need to start thinking about, if we invest now in these adaptation strategies that are really outlined in many of the national adaptation plans, we could minimize economic costs, we can reduce damage to infrastructure and reduce healthcare expenses.

So, COVID has showed us that our health system is not prepared to receive any more shocks than we have now, and if we don't change, if we don't make this healthcare climate resilient, we will only face more inequities and more damage. And again, the majority of the people that it's going to affect are those that are most vulnerable.

David 15:13 

[gentle music] There's an urgency in acting now for city governments, as well. Can you talk a bit about what you see where you are? So, you've been so clear about the general trends in the urgency in acting to reduce vulnerabilities led by our governments—our local governments, as well. In Peru, maybe in Latin America in general, what are you seeing as the biggest public health threats and where do we need to invest? Where do we need the right policies? Where do we need the right actions if we are going to mitigate against them and adapt to them? [music fades out]

Stella Hartinger 15:57  

As for the global, what we're seeing about impacts, just to make a little bit of a summary, in the Latin America report, we saw exactly what we're globally seeing. We see an increase in temperatures, we see an increase in exposures, we see an increase in premature mortality linked to these heat-related deaths. We see an increase in infectious diseases, especially in our region for dengue. 

So, this said, we see basically the same things that we're seeing globally. We have a couple of differences between the global reports, especially in infectious diseases where we've seen the biggest increase. 

But, what are we lacking? With respect to policy gaps, we're lacking, in that public health considerations are not integrated into climate policies, right now. The climate agenda is being led by the Ministry of Environment in many of our countries here in Latin America and they still can't see the integration of health within their policies and the need to have health within their policies. 

This could be for many reasons, first of all, because climate change has always been seen as something independent from health, and just the last COP, not the one we just had, but the one the year before, we had our first health day in that COP. So, it's something absolutely recent, and I was talking to one of the delegates from the Ministry of Health that were in the COP, and it was like, "Ah, now health has a permanent role," and she told me, "Whoa, whoa, whoa, Stella. This will take time to integrate health within our climate policies now. It will take at least five years so that we can understand the nexus." 

So really, when we say there are policy gaps, it's that the policy is not at the speed of what we're actually publishing, of what we're actually seeing, and they don't think that the loss and damage also includes human lives, and this lack of integration, inadequate funding, I talk here to the ministry, the people responsible in the Ministry of Health in Peru, and they say, "We haven't received $1 to do anything related to health and climate change in the last year," so what can I say? 

[delicate, sombre music] Unfortunately, there is no multisectoral collaboration, and as you know David, there is no way to improve health if the other sectors like agriculture, housing, energy are not part of the response. And, health is not the pillar for what they're responding to. [music fades out]

We actually have some scoping reviews that we carried out just to figure out what are these knowledge gaps. For example, related to impacts or related to research, Latin America only produces 4% of all the research, globally. So, there is no way that actually we can have a voice in a response because we really don't know what's happening in a region with regards to the impact of climate change and health. Everybody's talking, "Ah, but we have so much information. We have a very good pathway, a very good idea of where we should be going," But, how that is impacting other regions that are not the Global North, we don't have that information. 

It's 4% for Latin America. For Africa, we don't even know what that number is. So, what are the problems that are needing to be resolved there? So, respecting to health impact data for Latin America, the majority of the research has been done in infectious diseases – nothing on mitigation or adaptation, so we're talking about adapting a lot in our meetings and we have to do adaptation and we have to do this and we have to do that. We haven't found a single publication that is talking about adaptation for Latin America at the moment that we did that scoping review. 

For mitigation, it's very little. It's only linked to reforestation. But, the concept of introducing mitigation to have healthcare benefits, it's still not there. So, regarding knowledge gaps, we have a lot, and of course, we're not talking about what is going to happen with Indigenous communities, what's happened with the tropical glaciers disappearing.

We don't know what's going to happen with migrant populations, very, very little mental health—almost nothing—and when you actually try to look at the information on the region, we are not even collecting the information on mental health at the regional level or the country level, the sub-national level. And the reason for that, David, is because we don't have the hell their system in place to actually have a good service provision for mental health for people, as we have it now.

Don't even talk about the moment that we have an extreme climate event that pushes us to the other level. So yeah, many things.

David 20:48 

[gentle music] Given those challenges at the national level, it actually sounds like there is a real importance to leadership from local and city governments in partnership with their communities, and of course, with the scientists who can try to help steer their way through. 

Stella Hartinger 21:09  

Yeah. 

David 21:09 

I need to ask you about trying to solve these problems with people because we've heard from a number of guests on various issues on the podcast how it's becoming harder to talk to people about issues around climate change because of the disinformation that spreads on the Internet.  

Stella Hartinger 21:33  

Hmm.  

David 21:34 

You've spoken so articulately about the challenges of a lack of foresight in national governance in Latin America to link health challenges, adaptation, funding and research to their climate plans. Is there an impact in Peru or elsewhere in Latin America, as well, of disinformation making it harder to talk to people about these issues and build consensus around what needs to be done, or are you not there yet? [music fades out]  

Stella Hartinger 22:06  

It's an interesting question because we hear the misinformation because we are linked, we are in social media, so we try to bring the information about climate change and health to at least this digital community. We are also now trying to understand what local communities think about climate change. We've been operating like on a macro level, again, this top-down approach, not really bottom up. 

So now, we're trying to go and talk to the communities to see what they think. What we came across is that, first of all, climate change is not a concept that everybody understands. When we talk about climate change, we have to talk about, "Have you perceived changes in rain? Have you had more droughts? Have you seen changes in the moment that the rain appears when you're starting to sow, like the plants in agriculture? Is this changing?" 

So, I think that we have to do two things. First, we have to educate our public. When we started working with The Lancet Countdown, globally, before we had the Latin America chapter, when I told people, "We're working on a report for The Lancet," "What's The Lancet? What is climate change? What are you talking about?" 

So, it's been seven or eight years just to actually get the message across. We've done it, as I say, at a national level, not at a subnational level, so working with cities, working with communities is something that we still haven't managed to do and I am not sure that many countries have. 

We have one of the indicators in Latin America in which one of the indicators is a city-level indicator that says if they've had done any type of risk assessment. Less than 2% of the municipalities—we're calling them cities—municipalities had done this risk assessment. Or, they don't know that they have to do them. They don't see the importance of actually doing them or they don't have the resources or the technical possibilities to do them. So, we really need to start working at other levels and that level is a city level. 

But, with regard to misinformation that you were telling me, we have another indicator because we had the same curiosity of what you're saying. I think there is a lot of misinformation in the Internet. I am not quite sure if it has reached Latin America at the levels that you can see in the US or you can see in Europe, but what I can tell you is that, from the posts that we have in the media, the people that are more respected are journalists, newspapers and radio stations. Then, we have that it's the politicians that they follow. But, there's very little interaction with posts that are coming from science and from education. 

So, people simply do not trust us or do not know us, or they're really not interested because it's too sciency and maybe I don't understand. So yes, there will be a huge portion of misinformation, but I think that we need to work more with media, with journalists, with newspapers, so that they are the source of the good information, because they're the ones that are being listened to.  

David 25:14 

It's quite interesting because, in North America and Europe, it's starting to become the other way around. People are looking to listen to individuals they respect, as opposed to the media. Can you give a couple of examples of what communities are actually seeing in Peru at the moment, in terms of climate-related events, whether it's droughts, whether it's the melting glaciers threatening water supplies, and maybe speak a little bit about the impacts of the events you actually are seeing, related to climate change, on people's physical and mental health?  

Stella Hartinger 25:53  

We are about to publish this study. It's about perceptions in rural Andean farmers, so we have farmers that are between 2,000 metres above sea level and above, to around 4,000 meters also, so quite a big range, and we thought that we were going to find the differences in these different altitudes or different altitude levels about what the perception is about climate patterns and weather. But, impressively— well, shockingly enough, they all feel that the precipitation patterns have changed. 

What they perceive, and I think that the people know the best, even if we... Yeah. What they perceived is that their rainfalls, that their wet season, as they call it, has become very, very short and very, very intense. The same amount of water is actually falling from the sky, is raining. Instead of a four-month period, it's in a two-month period, and this makes it very, very difficult for agriculture. And remember that, according to the altitudinal plane, the agriculture is for self subsistence, or the agriculture is for selling or for buying other goods. 

So, even this small change in precipitation at different altitudes will have a massive impact on the livelihoods of these communities. We actually did some in-depth interviews with them and one that breaks my heart is—and I get a little bit throaty when I say it because—they are saying, "We just sit here and wait. We have nothing else to do but sit and wait." So, this means that the adaptation strategies that we were discussing just a few minutes ago, it's not reaching them. 

So, the adaptation strategies, that's the other thing that we need to think about, our cities, that they need to be cities specific. That's why it's so important that each city, each community, each mayor, each authority in the area starts to think what they need, what the community needs because, David, if we don't do this, then we will have a massive migration and displacement to other areas. And then, I think we haven't even tackled what that would mean for the economies of our countries. Where will people go if they don't have anything to eat? That is the big question. 

That's why so important—so important—to have these multisectoral approaches towards climate change and that's why health needs to be in the middle. The agricultural people say, "Ah, but agriculture is the most important thing." Yes, it is, but it's because, if it doesn't work, people will starve and people will migrate and move because nobody's going to sit there. As they say, "I'm just sitting and waiting." At some point you have to stop waiting. You will actually get out and move. 

So, you asked for me to give you an extreme weather event example. I actually can do that [chuckles]. So, in Peru, we have the El Nino phenomenon. I know it's not climate related yet. We have some hypotheses that it's going to become more extreme and more frequent because of climate change. So, we know this event will come. The problem with us is, for example, we had our last massive event in 2017, which came very abruptly to tell you the truth—we were not prepared—and what we saw—and I'm just going to read you the numbers—what we saw is 169 deaths, we have 194,000 people displaced, we had 300,000 homes damaged, and 65,000 homes that people couldn't come back. We have around 4,000 schools that were damaged, collapsed roads, bridges, reduced, I don't know, 1% of our GDP. 

And we know, David, that this event comes, but still this happens, and I think this is the portion that I don't get about the cities, and this is something that we complain as researchers because we tell them that we know that this is coming. Why are you not prepared? It seems so, like, we are not ready to confront something that we already know that we're going to happen. 

David 30:01 

It's fascinating to hear your anger come out and your emotions and, you know, it made you very emotional to talk about the farmers sitting there and waiting for action. Why did it touch you so much? 

Stella Hartinger 30:15  

[gentle music] I've been working in these communities for 15 years and I don't see change. We see small change. We do our research, we propose things, but things don't change at the speed that they should be changing. That's why I get emotional. I don't know how else to explain it. Yeah, it’s frustrating. [music fades out]

David 30:36 

It's just wrong and, you know, one of the things we're trying to do on Cities 1.5 is make sure we can spread the knowledge so that change happens. You know, if the El Ninos are getting worse, you worry, yeah. 

Stella Hartinger 30:47  

Of course. You worry. 

David 30:49 

In the context of your anger and frustration and people just sitting there waiting, they must face mental health challenges too, not just physical health challenges. How much do we know about the impacts on the mental health of survivors of these events?  

Stella Hartinger 31:08  

Yeah, so El Ninos, there are actually a couple of publications. So, what I first found in the Group of mothers is, as that they do develop PTSD, so post-traumatic stress, as soon as the event hits. What this study is saying, that it's around 40% of moms that are reporting this. But, as the time goes by, this number continues to decline in time. 

But, I think that the most important portion here, David, is that yes, they do develop this type of stress, but the problem is that our Peruvian health system does not have the necessary doctors or the number of doctors, or the number of psychiatrists, psychologists to actually even respond to these mental health challenges. We don't have enough people to respond, so that's why mental health is so important because it's true – after the first shocks, things go down, but we have so many other structural problems in Peru regarding mental health that, again, only these extreme health events, it pushes the system to its limit. 

But, to my approach, to my understanding now, we don't have the sufficient information regarding research on mental health disorders in Peru, and we don't have the services to respond. Unfortunately, I don't have more information regarding this, but I think it's such a priority. 

However, I must say that globally I've been seeing that there are some calls for funding to start looking into research on mental health and extreme events. So, I do hope that some of the research will start coming or appearing in the next couple of years.  

David 32:42 

Well, it's not just the residents, but the first responders and healthcare workers as well when there's a big event. What do we need to do to actually mitigate against the growing public health threat caused by the climate crisis and posed by the climate crisis, and maybe, you know, some suggestions for mayors and the city governments they lead? How can they better protect their residents and help them in the face of these varieties of public health challenges that you've identified so clearly?  

Stella Hartinger 33:16  

I think that one of the biggest challenges that we need to tackle in a way forward is really political will. These climate health policies must become urgent priorities. We must allocate sufficient resources to actually carry out these tasks. We are, at the moment, every time we go to one of these COP events, we're waiting for the money that was promised. We're waiting now for the loss and damage fund. 

I agree it's super important to get the international funding coming to the communities, coming to the countries, but there also needs to be some commitment at national level and we really need to put the resources in to start working. We simply can't wait. There is really a level of urgency. There is a rapid, accelerating pace of climate change that will not wait for international cooperation if we actually don't do it ourselves. 

I think another big barrier-- it's a cultural barrier that we also have. We have diverse cultures in Latin America. We have very high inequalities and, if we don't start listening to each other, there will be very little that we can actually do. What I want to say is that, for example, there are voices that are unheard. I'm just talking about the farmers that I work with, but really the Amazonian Indigenous communities are not heard. They are imposed, and many of their adaptation strategies have not been developed with them. 

They work and they think, based on nature, and this is something that we are not tackling at all and not working together with them to have a path in which we can actually have a plan or national adaptation plans that consider other cultural beliefs. 

So definitely, I think funding for health adaptation, building climate-resilient health systems is extremely important because, as you mentioned, in many of the El Nino extreme weather events that we've been facing in Peru, the first responders become part of the emergency of some point. Many of the primary healthcare first responders, they break down. The nurses and technicians that are working there are now becoming victims and they can't actually help respond. 

So, when we say building a climate-resilient health system, have a risk assessment of your community, and this is something that the cities need to do. You can't let people live next to a place where you know that the water or the mudslide is going to come down. We have places in Peru that are called huaico. Huaico is the translation in Spanish for mudslide. We have people that say, "Ah, I live in a huaico." How can this be possible? And we know this. There is really zero territorial management in the countries.  

David 36:21 

You're being very clear. But, you know, there's a parallel. Where you started with this particular answer, speaking about listening to Indigenous people as a start rather than imposing, we've spoken with Mayor Cantrell of New Orleans about Hurricane Katrina, and there's a parallel there because Hurricane Katrina, maybe, the scientists say it was climate related, maybe not, but there will be more. Just like the El Ninos, there'll be more because of climate. She got into politics because she was in a local community that people weren't listening to about the rebuilding after Hurricane Katrina.  

Stella Hartinger37:00  

I don't know how to explain it. Really, it's so frustrating, and I am so happy that this person, she's into politics and maybe she can shift people and say, "Do it correctly." 

David 37:09 

One of the things we're asking our guests, in the context of the conversations we have, is what a good life would look like to them and, you know, we've had a conversation about some difficult and uncomfortable issues. If you saw a light, you know, at the end of this tunnel, what could a good life in the context of your work and today's conversation, what could that mean to you?  

Stella Hartinger 37:38  

Yeah, that's a tough question. I was actually thinking about this. So, what would this look like? I think that the easiest answer, it would be a way to reduce the inequalities that we see now. Everybody should have access to health, everybody should have access to education, for starters. And, I know this sounds so basic, but in many of our communities in Latin America, we don't have this. We don't even have this. 

So, what does a good life mean? I think that we, at least, have the basic needs covered for everybody in our communities, in our countries. And again, this is education, this is health... the possibility of having food and not be food insecure, or at least not being 20% of the population not knowing where their next meal is going to come from, reducing poverty and have some basic form of being part of the system because that's another big problem. The people that are going to be most affected by climate change—and everybody says this—have the least to do with the problem and this is happening all over the Global South. We had nothing or very little to do with the problem, but we're going to bear the consequences.  

So, maybe the question is for the Global North. What is the least that you would be comfortable of not having? So, what would you give up to make the others reach your standard of living? Because we're not there. I don't know how to explain it, David, and I don't know how to articulate it better. Maybe in Spanish, I would have a better chance of saying it more articulately.  

David 39:14 

Say it in Spanish.  

Stella Hartinger through Spanish to English translator 39:18 

We need to have the minimum and the fair essentials to ensure a prosperous population that can excel in education, health, access to decent housing, water, electricity, and the ability to live in an environment where their children can play, enjoy wellbeing, and not feel afraid to think beyond their daily situation.  

It must be a situation where I can dream and think about the future. I believe that it what will enable a person to have a good life. 

David 40:00 

Muchas gracias, profesora, for both being on the show today, for your ongoing work, but most importantly for your incredible passion for those who are facing significant challenges because of the actions of others. Keep up the great work.  

Stella Hartinger 40:18  

Thank you, David. [music continues then ends] 

David 40:28 

[light, driving music] This episode of Cities 1.5 is produced by University of Toronto Press with generous support from C40 Cities. Want more access to current research on how city leaders are approaching climate action? We also publish the Journal of City Climate Policy and Economy. Our mission is to publish timely, evidence-based research that contributes to the urban climate agenda and supports governmental policy towards an equitable and resilient world. The Journal serves as a platform for dynamic content that highlights ambitious, near-term climate action, with a particular focus on human-centred solutions to today's most pressing climate challenges. To read the latest issue, visit JCCPE.utpjournals.press or click on our link in the show notes. [music ends] 

Mayor Cantrell, thanks so much for joining us on Cities 1.5.  

LaToya Cantrell 41:31  

Oh, thank you for having me.  

David 41:34 

You're a legend.  

LaToya Cantrell 41:34  

Oh, no, the city of New Orleans, I tell you, we're on the front lines. That makes us legendary as a city, but how we respond is so important, so thank you.  

David 41:43 

I think you're right. You know, people understand that New Orleans has a very recent history of having to show resilience and demonstrate resilience in the face of massive storms, and we're seeing this in so many more cities today because of climate. 

People want to know New Orleans' story, but maybe let's start with yours a little bit. How did you get motivated to care about climate, to care so much about your city, to put yourself forward and very successfully run and be a great mayor of a great city? 

LaToya Cantrell 42:16  

Thank you for that, but I have to say, it kind of piggybacks off of your initial comment. Like what's happening in cities in terms of climate, they're thrust into caring about it, and that's what happened in the city of New Orleans during Hurricane Katrina. I was a neighborhood leader, and my community of Broadmoor had 9-12 feet of water, sitting in our community for three weeks, but 80% of the city was underwater. And, then we woke up—well, really, we were displaced—to find that our local newspaper had green dots over 7 neighbourhoods—one of them was mine—where they were recommending that the neighbourhood not return, that it become a drainage part. 

And so, all hell broke loose, I'm quoted as saying, but the community rallied and said, "Hey, we're going to come back and we're going to come back better and stronger and we're going to plan for ourselves at bottom up." And so, it was from that grassroots organizing, of being forced to plan for ourselves because, again, we were told, or it was recommended to the mayor at the time that we not even be rebuilt as a community. And so, we took it on and we were the only community, not only that planned for ourselves, but our plan was embedded in every single planning process initiated by government at the local level, as well as the state level. 

David 43:44 

From the grassroots up.  

LaToya Cantrell 43:44  

Bottom up. That's it. 

David 43:46 

Can you just talk a bit about what it was like to have 9 to 12 feet of water? I mean, it's almost inconceivable. I'm over 6 feet tall, so you're talking about water twice the height of me being there for three weeks. It's very hard for people to imagine what that must have been like. 

LaToya Cantrell 44:05  

In our city, or in our neighbourhood and city, 80% of the city was underwater. Our levees failed at the time, and we got this water and so we were considered the bottom of the bowl, if you will. But, we knew that we had to do something different. And so, it was really in the planning phases to where we wanted to come up with plans to hold water in our community. And so, we had those plans initiated and real projects initiated and embedded in our plan, and it was only through building public-private partnerships, community at the centre of it all, but our universities, of course, our NGOs, government—you can't pass up government with the largest pockets—and as well as our faith-based community. 

But, it was the people who demonstrated to government at the time that we could do it and we forced government to pay attention because we were on the ground, gutting homes, finding money to rebuild homes, creating a space for rebuilding our library, which made it back, came back as a library and a community centre, a place that was neutral, a place that you share information, get information, get tools and resources to improve your quality of life. 

We were the first as our plans initiated the state to come up with how they were going to rebuild schools in New Orleans, and my neighbourhood was one of the first to rebuild a school because it was based on how we planned and how we did not let up about being better than we were.  

[delicate, sombre music] We have a public school in our neighbourhood, and we had it then, that wasn't a place where everyone saw themselves, because not everyone in the community was sending their children there.  

David 45:51 

Right.  

LaToya Cantrell 45:51  

And so, with the library, that was a neutral space. Everyone could see themselves in that library, a free place but it was a neutral place, again, where you can get information, share information, and it was about building up community. And, everyone mattered when it came to the neighborhood of Broadmoor. That was a microcosm of the city of New Orleans, demographically and socioeconomically. And so, while it wasn't the richest neighbourhood and the more affluent neighbourhood, actually took a page out of our book, we led them. [music fades out] 

David 46:22 

Oh, isn't that interesting?  

LaToya Cantrell 46:24  

Yes, because we didn't have a choice, meaning we needed one another and that was really my example that demonstrated to me that the strong need the weak, and the weak need the strong. If everyone in the community had resources to rebuild, who's going to help you? But, when you have a large population of people that had need, them that brought resources, and then it benefited everyone. 

So, you needed to demonstrate that you could come back, so therefore you needed the resources. But then, you also needed to demonstrate you needed help. So, it was that balance, I believe, that really led us to strengthening our public-private partnerships that led us to recovery. 

David 47:06 

People remember at the time the federal government was quite criticized about having a slow response to Katrina. It's a pretty extraordinary story that the community led the recovery, and I guess it does spark a question. How did being involved in that community rebuilding as a real leader in your community, how did that spark interest in you to go into government and stand for office?  

LaToya Cantrell 47:33  

So, well, I was encouraged by the residents. I was encouraged by my community and a seat became open on the city council. They needed to fill the seat and my community rallied and said, "You need to run," and I decided to do that. I was outraised in terms of money, four times the amount of my opponents. I was not the political candidate, but the people demonstrated that they had hope and they saw something. They saw results in leadership and it was really for mayor that I ran, and I pulled it off. I won.  

David 48:10 

Very interesting that you won when you didn't have the money, but you had the people.  

LaToya Cantrell 48:15  

That's exactly right. I didn't have the money, nor the political machine behind me, but it wasn't necessary, and the people demonstrated that. And, my same base encouraged me to run for mayor and it was almost the same situation. 18 people that were in the race. I was not the political favourite. I was not a native of New Orleans and I didn't have the money, but the people saw results, based on our plans and implementing those plans, and they elected me, the first woman to serve in the city's 300-year history. And, I'm not even supposed to be there, but I've been there, next year, 35 years and I've built trust in that. I do what I say and I say what I mean.  

David 49:01 

A powerful combination for an elected official, particularly a mayor, to do what you say and say what you mean. I've always thought I was lucky in my own political career because nobody tried to talk me out of being me because they didn't think I could win. So, you know, being you is a really powerful thing and I'd just like to explore that a bit more. How is your experience of community building in response to this terrible natural disaster, the community leading the conversation about how to fix the community and, you know, maybe bringing government into it, how's that informed your approach as city councillor, now mayor, on challenges like climate change, on challenges like income security?  

LaToya Cantrell 49:49  

Well, one, it was a clear understanding that the world's greatest experts on where they live are the people who live in those communities in their neighbourhood, so you have to listen to them. You have to hear them out. And, I remember, almost 20 years ago when we were with our plan, saying, "Hey, we want to not only rebuild our library better, but we want to hold, you know, a million gallons of water to free it from running into the drains that will keep our community dry – again, better than we were before, being safer, and, at the time, being told, "Oh, no," you know, "Oh no. Kids are gonna drown," you know, at the school when you want a bioswale. They're gonna drown." 

Well, like, "No. It's not a pool. It's a bioswale. It will absorb the water and it will free it up from going into the drain, so when you think back then and up until now, well, now, the city of New Orleans, we're leading in these spaces. We have resilience, districts that we've created in over 12 areas of the city that's holding millions of gallons of water throughout the city and 80% of the area that was flooded during Katrina, and the residents are able to see firsthand now, while they were kicking and screaming on the front end, but now they see that it's reduced the levels of water in their homes and in businesses, and so that also helps you bring people along. 

But then, you build community as you move along, as well. You also have to, and bringing people along is making sure that you provide more of an equitable approach in understanding that New Orleans was driven, our economy, highly on hospitality. And so, in the rebuilding approach, it was making sure that we diversify our economy and COVID even taught us that, as well.  

David 51:34 

Yes, very much. Yeah. 

LaToya Cantrell 51:34  

It really did, but it also indicated that we were on the right path in terms of bioscience and technology, I would even say relative to renewable energy platforms and educating our citizens to understand that those jobs are the future of jobs right now and creating workforce training and development opportunities so that your people can take advantage of those jobs. 

So, just people have to see themselves in the innovation and the projects that you're wanting to invest in and, when they do that, I think that it becomes real and you begin to shift the mindset. But again, bring people along.  

David 52:14 

I think that point is sometimes underappreciated, particularly by advocates who are justly trying to get to a conclusion. But, people need to see their own, "Where am I? Where's my part in this?" 

LaToya Cantrell 52:28  

That's exactly right. And, one of the initiatives—I'm just thinking about workforce with technology and tech sales—and when we had an issue with the hospitality industry kind of going down, particularly even during COVID, we taught our hospitality industry workers that, hey, the same way you pitched that dessert, the same way you pitched that cocktail, that entree, you can do tech sales and you can be trained up in 12 weeks and go from, you know, making a few dollars to over $150,000 a year. Well, initially, they didn't see themselves in that, but once you train them up, they then become the example of what's possible. 

And so, we're building off of those initiatives, and just think about year to year, we're seeing growth in these industries, but mostly growth in our people. 

David 53:22 

[gentle music] Katrina was a forerunner of what other cities are going to be experiencing. What do you think are some lessons for other cities from New Orleans on the resilience side? And, I don't want to ask the same question about this economic side because it's such a powerful vision you're articulating. Are organizations like C40 or we're here at the U20 in Rio de Janeiro, yeah, how helpful is it when you're somewhere like this with your peers, globally and internationally?  

LaToya Cantrell 53:54  

Well, I think being a part of C40 has been a real collaborative opportunity to share information and also learn from your sister and brother mayors because it's happening in cities and it's happening on the ground, and mayors are the closest to the people that we all collectively serve. And also, to be inspired, to be reassured that, one, the work, we know it's not easy work. We know that, where we come from. But, when you are in a collective, it helps you stay focused and, when you stay focused, it allows you really the ability to drown out the noise and to get the work done. 

And then, when you see the work being done, again, across the globe because it's happening in cities, it just gives you the courage to continue to stand and to bring people along. And sometimes, you have to bring them along kicking and screaming, but once they see the change, then their overall quality of life, it makes it easier to continue to bring people along. So, it's not easy work, but it's necessary.  

David 55:02 

Both in the example of the rebuilding after Katrina and, you know, bringing people along to get them to understand that a bioswale was necessary if the neighbourhood was going to exist because the water had to go somewhere-- 

LaToya Cantrell 55:15  

Absolutely.  

David 55:15 

--and in the issue of jobs and trying to transition from a primarily tourist-based economy to one that looked to high-tech and, you know, future-oriented jobs, those are both difficult conversations to have with people. And, you know, if we look at the current political environment, sometimes the climate deniers are winning elections. Are there some lessons you've learned, as mayor, about how to bring people along that worked that maybe others could learn from your experience in New Orleans? You overcame these tough issues and have charted a path forwards.  

LaToya Cantrell 55:56  

Well, I would say, on the front end of that, Mother Nature is the leader in this, showing us that climate has changed and we must adapt, and so one of the things that is when the tornadoes come, when the hurricanes come, when the extreme heat comes, you know, these are real-life conditions that impact people's lives, and so it's not about, oh, me trying to change your mind about it. You're forced to because it's a reality that you're now living through. 

So, for example, we experienced Hurricane Ida a couple years ago, where our grid, our utility grid went down. We lost electricity for almost 2 weeks' time. Well, hey, people learn firsthand. When I lost 11 of my senior citizens because of extreme heat, that was overlapped with a hurricane where our grid went down, it demonstrated what could happen, and so using that as, unfortunately, a horrible opportunity to bring people along because we have to figure out how we're going to do grid replacement and because of that, we were able to get over $50 million to do grid replacement with our utility in New Orleans. That's a game changer. 

But also, in addition to that, looking at renewable energy platforms like solar, solar for all programs where residents in the city can have their homes built out with solar, making it easier to live in more efficient living environments, and also being able to operate off the grid. These things are important.  

David 57:34 

That's more resilient if there's a storm, right?  

LaToya Cantrell 57:34  

Absolutely. And so, they're force multipliers as well – one, on the workforce side of it, because you need to train people to do these jobs in solar and green infrastructure and the like, and then also, you're teaching people that we have to invest here because our quality of life really depends upon it. 

So, it's these force multipliers that become real opportunities, unfortunately, due to disasters, but you know what? You got to bring folks along, even as it relates to lessons learned, you know, during Katrina, one of the issues was a lack of communication. Communications failed pretty much at every level, but today we have a trusted communications tool and an environment where the public has told us that our NOLA Ready system, it's our alert system, the public has said it is their number-one trusted resource to get information that they rely on, and they respond to. 

When they get the information coming from government straight to the people, they see it as serious. They do not question it and they respond to what we're telling them they need to do, and that lets me know that you've brought people along and you save lives also because of it. And, what I can see, even here recently in communities, the communication tool wasn't there. People didn't trust what they were hearing, and not only that, but just being prepared, and so I know that this is a lesson learned that we can continue to share with other cities because it's not a matter of if... It is when. And, we have to be prepared and we have to be able to trust those voices that tell us what to do when the disaster comes our way.  

David 59:20 

[pensive music] Mayor Cantrell, your humanity shines through because in every single comment, you start with people and seeing each other. You're not just a gifted mayor and leader, but you're someone with massive empathy and we've heard it all day.  

LaToya Cantrell 59:36  

I really appreciate it, but one thing you do learn when disaster strikes, that your first responders are your neighbours, and so that means that you have to have a plan, and you cannot expect government to come in immediately because those first responders have to be safe too. 

David 59:53 

Right. 

LaToya Cantrell 59:53  

And so, sometimes in those environments, they can't come immediately, but your neighbours are right there. So, you need to know your neighbours. You need to know who's living in homes, even where your pets are, so that we can respond in a real way because we have to see ourselves in one another.  

David 1:00:10 

Fantastically clear and much appreciated for you taking the time to speak with us today. You've got a massively busy schedule here at U20. Thank you for being on Cities 1.5 and thank you, more importantly, for the work you've been doing for years, if not decades. Thank you.  

LaToya Cantrell 1:00:28  

Listen, we can get through this, but we can't get through it without one another, so you need to have plans in place. You have to know how you're going to communicate in real time because it's not a matter of if, it's when. And, when it comes, we want lives to be saved so we can go on and continue to save our planet. There is no planet B. This is the only one we have. [music ends] 

David 1:00:56 

[energetic, upbeat music] As the 20th anniversary of Hurricane Katrina approaches, it's key that cities around the world heed its lessons. They must adapt their infrastructure, health facilities, and economic safeguards to help their residents be resilient in the face of the climate crisis. But, we should also be inspired by cities like New Orleans, who've managed to rebuild after apocalyptic events. It's a salutary reminder that there is always hope, even in the darkest of times. By taking on board the findings and recommendations of scientists and experts, such as Professor Hartinger Peña, who we heard from today, we can mitigate and adapt to ensure that we avert and protect against the worst ravages of the climate crisis. [music continues then fades out] 

[Cities 1.5 main theme music]  That's it from season four of Cities 1.5. Hopefully, you'll feel a little bit more positive, or at least a little more informed about the state of the health of our planet and the people who live on it, and have a better understanding as to why global climate health has a direct impact on our individual wellbeing, and also on the well-being of the ecosystems around us. 

We'll be back for the next season of Cities 1.5 this spring. But before that, we also have a bonus miniseries launching early 2025, but I don't want to give too much away, but let's just say both of these seasons make a lot of cents... dollars and cents, that is. They're both about the economic impacts of the climate crisis on our world and what kind of alternatives there are to our current and failing global economic systems. So, be sure to subscribe to Cities 1.5 if you haven't already done so, to ensure that you can be the first to listen to these new episodes and, until then, keep yourself and your own backyard healthy because world-saving climate action is closer than you think. See you next time. 

[Cities 1.5 main theme music continues] This has been Cities 1.5, leading global change through local climate action. I'm David Miller. I was the Mayor of Toronto, Canada, and I know, firsthand, the role cities can play in solving the climate crisis. Currently, I'm the Editor in Chief of the Journal of City Climate Policy and Economy, published by the University of Toronto Press in collaboration with the C40 Centre for City Climate Policy and Economy, where I'm also the Managing Director. C40's mission is to use the voices and the actions of its member mayors to help the world avoid climate breakdown. 

[music continues] Cities 1.5 is produced by University of Toronto Press in association with the Journal of City Climate Policy and Economy and C40 Cities. This podcast is produced by Jessica Schmidt, and edited by Morgane Chambrin. Our executive producers are Peggy Whitfield and Calli Eliopoulos. Our music is by Lorna Gilfedder. 

The fight for a healthier world is closer than you think. To learn more, visit the show's website, linked in the episode notes. See you next time. [main theme music continues then ends]