Integrating Health into Local Climate Response: Lessons from the U.S. CDC Climate-Ready States and Cities Initiative

Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review

PURPOSE OF REVIEW

Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change.

RECENT FINDINGS

This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.

Reimagining the Role of Health Departments and Their Partners in Addressing Climate Change: Revising the Building Resilience against Climate Effects (BRACE) Framework

Public health departments have important roles to play in addressing the local health impacts of climate change, yet are often not well prepared to do so. The Climate and Health Program (CHP) at the Centers for Disease Control and Prevention (CDC) created the Building Resilience Against Climate Effects (BRACE) framework in 2012 as a five-step planning framework to support public health departments and their partners to respond to the health impacts of climate change. CHP has initiated a process to revise the framework to address learnings from a decade of experience with BRACE and advances in the science and practice of addressing climate and health. The aim of this manuscript is to describe the methodology for revising the BRACE framework and the expected outputs of this process. Development of the revised framework and associated guidance and tools will be guided by a multi-sector expert panel, and finalization will be informed by usability testing. Planned revisions to BRACE will (1) be consistent with the vision of Public Health 3.0 and position health departments as "chief health strategists" in their communities, who are responsible for facilitating the establishment and maintenance of cross-sector collaborations with community organizations, other partners, and other government agencies to address local climate impacts and prevent further harm to historically underserved communities; (2) place health equity as a central, guiding tenet; (3) incorporate greenhouse gas mitigation strategies, in addition to its previous focus on climate adaptation; and (4) feature a new set of tools to support BRACE implementation among a diverse set of users. The revised BRACE framework and the associated tools will support public health departments and their partners as they strive to prevent and reduce the negative health impacts of climate change for everyone, while focusing on improving health equity.

Climate Change and Health: Challenges to the Local Government Environmental Health Workforce in South Australia

Climate change is the most urgent and significant public health risk facing the globe. In Australia, it has been identified that Environmental Health Officers/Practitioners (EHOs/EHPs, hereafter EHOs) are a currently underutilized source of knowledge and skills that can contribute to climate change adaptation planning at the local government level. The ability of local government EHOs to utilize their local knowledge and skills in human health risk assessment during a public health emergency was demonstrated through their role in the response to COVID-19. This study used a survey and follow up interviews to examine the roles and responsibilities of EHOs during the COVID-19 pandemic and used the results to examine the potential of the workforce to tackle climate change and health related issues. What worked well, what regulatory tools were helpful, how interagency collaboration worked and what barriers or hindering factors existed were also explored. A workforce review of EHOs in South Australia was also undertaken to identify current and future challenges facing EHOs and their capacity to assist in climate change preparedness. The findings demonstrated that the workforce was used in the response to COVID-19 for varying roles by councils, including in education and communication (both internally and externally) as well as monitoring and reporting compliance with directions. Notably, half the workforce believed they could have been better utilized, and the other half thought they were well utilized. The South Australian Local Government Functional Support Group (LGFSG) was praised by the workforce for a successful approach in coordinating multiagency responses and communicating directions in a timely fashion. These lessons learnt from the COVID-19 pandemic should be incorporated into climate change adaptation planning. To ensure consistent messaging and a consolidated information repository, a centralized group should be used to coordinate local government climate change adaptation plans in relation to environmental health and be included in all future emergency management response plans. The surveyed EHOs identified environmental health issues associated with climate change as the most significant future challenge; however, concerningly, participants believe that a lack of adequate resourcing, leading to workforce shortages, increasing workloads and a lack of support, is negatively impacting the workforce's preparedness to deal with these emerging issues. It was suggested that the misperception of environmental health and a failure to recognize its value has resulted in a unique dilemma where EHOs and their councils find themselves caught between managing current workload demands and issues, and endeavouring to prepare, as a priority, for emerging environmental health issues associated with climate change and insufficient resources.

Barriers and facilitators to state public health agency climate and health action: a qualitative assessment

BACKGROUND

As the health implications of climate change become more apparent, agencies and institutions across the United States are developing recommendations for state and territorial health agencies (S/THAs) to implement evidence-informed climate and health adaptation strategies. The CDC established the Building Resilience Against Climate Effects (BRACE) framework in 2010 to encourage local and state public health engagement in climate change adaptation. However, even after a decade of the BRACE initiative, the elements that affect the adoption and implementation of climate and health programming by S/THAs are not well understood.

METHODS

Using an implementation science framework, this study sought to further understand and define the barriers and facilitators that determine the breadth and success of climate change and health activities undertaken by state health agencies (SHAs). We conducted focus groups with representatives from SHAs with and without climate and health programs, and analyzed data using the framework method for qualitative research.

RESULTS

This study identified funding, state and agency-level prioritization, staff capability and capacity, and political will and polarization as factors that influence the readiness for implementation and implementation climate for climate and health activities.

CONCLUSIONS

As the impacts of climate change intensify, S/THAs will need to expand resources and capacity, and seek advocacy and assistance from external organizations in order to support the level of engagement required to strengthen climate resilience. Findings from this study have implications for public health policy and highlight potential pathways to expand support for climate and health activities in S/THAs in the U.S.

Climate Change and Health: Local Government Capacity for Health Protection in Australia

Climate change is the greatest global health threat of the 21st century, with numerous direct and indirect human health consequences. Local governments play a critical role in communities' response to climate change, both through strategies to reduce emissions and adaption plans to respond to changing climate and extreme weather events. Australian local government environmental health officers (EHOs) have the relevant skills and expertise to inform and develop adaptation plans for health protection in the context of climate change. This study used an online survey followed by phone interviews of local government management to determine the extent to which EHOs are involved in adaptation planning in health protection climate change plans. Questions were also asked to determine whether local councils are aware of EHOs' capability to contribute and to gauge the willingness of management to provide EHOs with the workload capacity to do so. The findings demonstrated that although climate adaptation and mitigation planning is occurring in local government, it is not including or considering the public health impacts on the community. Primarily, it was found that this oversight was due to a lack of awareness of the health impacts of climate change outside of a disaster or emergency scenario. Currently, EHOs are an untapped source of knowledge and skills that can contribute to climate change adaption planning. To support this, a framework of local environmental health practice was developed to assist the reconceptualization of the scope of practice required for the planning and response to climate change.

Perception of extreme hot weather and the corresponding adaptations among older adults and service providers-A qualitative study in Hong Kong

Background

Extreme hot weather events are happening with increasing frequency, intensity and duration in Hong Kong. Heat stress is related to higher risk of mortality and morbidity, with older adults being particularly vulnerable. It is not clear whether and how the older adults perceive the increasingly hot weather as a health threat, and whether community service providers are aware and prepared for such future climate scenario.

Methods

We conducted semi-structure interviews with 46 older adults, 18 staff members of community service providers and two district councilors of Tai Po, a north-eastern residential district of Hong Kong. Transcribed data were analyzed using thematic analysis until data saturation was reached.

Results

It was agreed upon among the older adult participants that the weather in recent years has become increasingly hot and this led to some health and social problems for them, although some participants perceived that hot weather did not have any impact in their daily lives and they were not vulnerable. The community service providers and district councilors reported that there is a lack of relevant services in the community to support the older adults in hot weather; and there is generally a lack of public education regarding the heat-health issue.

Conclusions

Heatwaves are affecting older adults' health in Hong Kong. Yet, discussions and education effort regarding the heat-health issue in the public domain remain scarce. Multilateral efforts are urgently needed to co-create a heat action plan to improve community awareness and resilience.

Environmental Health: A Position Paper From the American College of Physicians

Environmental health refers to the health effects associated with environmental factors, such as air pollution, water contamination, and climate change. Environmental hazards are associated with poor outcomes in common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians (ACP) seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of climate change, improve air and water quality, reduce exposure to toxic substances, and address environmental injustice. ACP affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live in a healthy environment.

Specific aeroallergen sensitization associated with current rhinitis among adults in southwestern Saudi Arabia

Data about allergic sensitization to rhinitis among adults are limited. The objectives were to explore the prevalence of current rhinitis (CR) and associated specific allergen sensitizations in southwestern Saudi Arabia. A cross-sectional study was conducted on 969 adults in southwestern regions of Saudi Arabia, namely Aseer, Jazan, and Al Baha. From each region, 5 primary health care centers were chosen. The validated Arabic Version of the International Study of Asthma and Allergies in Childhood questionnaire was used. Total immunoglobulin E (IgE) enzyme-linked immunosorbent assay, cytokine enzyme-linked immunosorbent assay (interleukin [IL]-4, IL-10, IL-13, and interferon-γ), aeroallergen-specific IgE immunoassay (a panel of 30 common aeroallergens; 9 indoor and 21 outdoors), and eosinophilic count were assessed. A prevalence of CR of 35.8% (95% confidence interval: 32.8%-38.9%) was found. Regarding outdoor aeroallergens, Mesquite-positive IgE antibodies were higher among CR adults (odds ratio = 1.52, 95% confidence interval: 1.02-2.21) compared to those without CR. The same significant pattern was found with Chenopodium, Ragweed, Pigweed, Russian thistle, Bermuda grass, Timothy grass, and Rye. All indoor aeroallergens were not significantly associated with CR. Total IgE and eosinophil count were significantly higher among adults with CR. In conclusion, CR in southwestern regions of Saudi Arabia is common and of significant public health importance. Aeroallergens that associate with adult sensitization to CR tend to be of the outdoor variety particularly the herbaceous grass and their pollens. The magnitude of CR and its association with exposure to outdoor aeroallergens should be taken into account by health policy decision makers, clinicians, and medical practitioners when diagnosing and treating related conditions.

Progress of Local Health Department Planning Actions for Climate Change: Perspectives from California, USA

Public health departments are on the frontlines of protecting vulnerable groups and working to eliminate health disparities through prevention interventions, disease surveillance and community education. Exploration of the roles national, state and local health departments (LHDs) play in advancing climate change planning and actions to protect public health is a developing arena of research. This paper presents insights from local public health departments in California, USA on how they addressed the barriers to climate adaptation planning with support from the California Department of Public Health’s Office of Health Equity Climate Change and Health Equity Section (OHE), which administers the California Building Resilience Against Climate Effects Project (CalBRACE). With support from the U.S. Centers for Disease Control and Prevention (CDC) Climate-Ready States and Cities Initiative (CRSCI), CalBRACE initiated an adaptation project to seed climate planning and actions in county health departments. In this study, we compared the barriers and strategies of twenty-two urban and rural LHDs and explored potential options for climate change adaptation in the public health framework. Using key informant interviews and document reviews, the results showed how engagement with CalBRACE’s Local Health Department Partnership on Climate Change influenced the county departments’ ability to overcome barriers to adaptation through the diversification of funding sources, the leveraging strategic collaborations, extensive public education and communication campaigns, and the development of political capital and champions. The lessons learned and recommendations from this research may provide pathways and practices for national, state and local level health departments to collaborate in developing protocols and integrating systems to respond to health-related climate change impacts, adaptation and implementation.

Health effects from heat waves in France: an economic evaluation

BACKGROUND

Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019.

METHODS

Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs.

RESULTS

Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion).

CONCLUSION

The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.

Understanding Emerging Environmental Health Concerns and Environmental Public Health-Tracking Priorities Among State and Local Professionals in Colorado

CONTEXT

Colorado is experiencing dramatic changes related to population growth, climate change, and expanded industrial activity. Local and state public health professionals are trying to address a growing array of unique public health issues with stagnant or limited resources.

OBJECTIVES

To understand, through perspectives from local and state public health professionals, the alignment of contemporary environmental and community health issues with state and local capacity and state environmental public health-tracking priorities.

DESIGN

During 2014-2015, we conducted semistructured interviews which informed the development of a statewide survey of Colorado's professionals from public health, emergency management, forestry, and transportation.

SETTING

This work took place in Colorado.

PARTICIPANTS

Fifteen professionals from public (n = 9), academic (n = 4), and private (n = 2) sectors were interviewed. Forty-seven professionals, representing 34 counties and 40 public agencies, completed the 25-minute online survey.

MAIN OUTCOME MEASURES

Environmental and community health concerns; contributing factors to environmental concerns; strengths and limitations of capacity to respond to issues; and frequency of community engagement activities.

RESULTS

Top environmental health concerns were indoor air pollution (eg, radon), outdoor air pollution, and waste management. Transportation, extreme weather (eg, wildfires), and oil and gas development were most frequently reported as major contributing factors to concerns. Obesity, physical inactivity, and mental illness were the top community health concerns. To remain prepared for emerging challenges, professionals cited a need for more spatiotemporal-refined data related to their top concerns in the environmental public health-tracking database, and support from local, state, and federal agencies, in addition to personnel and funding. To address concerns, participants reported frequently working with government officials, advisory committees, and media outlets.

CONCLUSIONS

This project illuminates opportunities to strengthen connections between the state's environmental public health-tracking priorities and local-level capacity related to professionals' top concerns. It also suggests reinforcing and broadening partnerships to improve data infrastructure and inform environmental public health priorities.

Flexibility and partnerships perceived as supportive of dual hazard response: COVID-19 and heat related illness, Summer 2020

OBJECTIVES

To understand how health departments implemented the response to the dual hazards of Heat Related Illness (HRI) and COVID-19 in Summer 2020.

METHODS

We interviewed five health jurisdictions with a Building Resilience Against Climate Effects (BRACE) Framework HRI project to understand impacts to organizational roles and preparedness activities, capacity to respond to the heat season, challenges experienced with resources and personnel, and how partners influenced their capacity to respond to dual hazards.

RESULTS

Health jurisdictions working in both heat preparedness and on the COVID-19 response highlighted three components as integral to maintaining public health capacity throughout the pandemic: 1) adapting to changing roles and responsibilities, 2) building and strengthening inter-organizational partnerships, and 3) maintaining flexibility through cross-training as themes to maintain the public health capacity throughout the pandemic.

CONCLUSIONS

With impacts of the changing climate, including resultant extreme events with subsequent public health impacts, simultaneous responses are likely to arise again in the future. Developing cross-training programs, fostering flexibility and adaptability within the workforce, and building and sustaining external partnerships can support health departments anticipating the need to respond to simultaneous public health hazards in the future.

Private groundwater contamination and extreme weather events: The role of demographics, experience and cognitive factors on risk perceptions of Irish private well users

Extreme weather events (EWEs) may significantly increase pathogenic contamination of private (unregulated) groundwater supplies. However, due to the paucity of protective guidance, private well users may be ill-equipped to undertake adaptive actions. With rising instances of waterborne illness documented in groundwater-dependent, developed regions such as the Republic of Ireland, a better understanding of well user risk perceptions pertaining to EWEs is required to establish appropriate educational interventions. To this end, the current study employed an online and physical questionnaire to identify current risk perceptions and correspondent predictors among Irish private well users concerning extreme weather. Respondents were elicited via purposive sampling, with 515 private well users elucidating perceived supply contamination risk in the wake of five EWEs between the years 2013-2018 including drought and pluvial flooding. A novel scoring protocol was devised to quantify overall risk perception (i.e. perceived likelihood, severity and consequences) of extreme weather impacts. Overall risk perception of EWEs was found to demonstrate a significant relationship with gender (p = 0.017) and event experience (p < 0.001), with female respondents and those reporting prior event experience exhibiting higher median risk perception scores. Risk perception was additionally mediated by perceived self-efficacy in undertaking supply maintenance (p = 0.001), as well users citing confidence in ability scored significantly lower than those citing no confidence. Two-step cluster analysis identified three distinct respondent subsets based on risk perception of EWEs (high, moderate and low perception), with female respondents and those with a third-level education significantly more likely to fall within the high perception cluster. Study findings affirm that certain demographic, experiential and cognitive factors exert a significant influence on private well user risk perceptions of EWE impacts and highlight potential focal points for future educational interventions seeking to reduce the risk of human infection associated with groundwater and extreme weather.

Framing climate change as a human health issue: enough to tip the scale in climate policy?

Almost four decades of climate science have not yet led to transformative policy change at the pace and scale required to confront the climate crisis. Colleagues in the planetary health community attribute much potential to framing climate change as human health issue in order to create greater impact on policy makers. In this Personal View, we discuss the promise and limitations of this approach by drawing on insights from political science and public policy with regards to the complexity of these contentious policy issues. We argue that we, as academics, have a moral obligation to embrace an active role in the knowledge-to-action (KTA) sphere and that we would be well advised to expand our KTA approach to include evidence-based strategies, such as lobbying or civil resistance. As scientists, we can no longer wait to embrace the realpolitik insights of political science to move our evidence into policy action.

Science Policy to Advance a Climate Change and Health Research Agenda in the United States

Climate change is thought to be one of the greatest public health threats of the 21st century and there has been a tremendous growth in the published literature describing the health implications of climate change over the last decade. Yet, there remain several critical knowledge gaps in this field. Closing these gaps is crucial to developing effective interventions to minimize the health risks from climate change. In this commentary, we discuss policy trends that have influenced the advancement of climate change and health research in the United States context. We then enumerate specific knowledge gaps that could be addressed by policies to advance scientific research. Finally, we describe tools and methods that have not yet been fully integrated into the field, but hold promise for advancing the science. Prioritizing this advancement offers the potential to improve public health-related policies on climate change.

Piloting a city health adaptation typology with data from climate-engaged cities: Toward identification of an urban health adaptation gap

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publicly-available adaptation database. We found two-thirds of actions of these 'active adapter' cities were health-associated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly one-third addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptation-engaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

Making the climate crisis personal through a focus on human health

Climate change-driven health impacts are serious, widespread, and costly. Importantly, such damages are largely absent from policy debates around the costs of delay and inaction on this crisis. While climate change is a global problem, its impacts are localized and personal, and there is growing demand for specific information on how climate change affects human health in different places. Existing research indicates that climate-fueled health problems are growing, and that investments in reducing carbon pollution and improving community resilience could help to avoid tens to hundreds of billions of dollars in climate-sensitive health impacts across the USA each year, including those stemming from extreme heat, air pollution, hurricanes, and wildfires. Science that explores the underappreciated local health impacts and health-related costs of climate change can enhance advocacy by demonstrating the need to both address the root causes of climate change and enhance climate resilience in vulnerable communities. The climate crisis has historically been predominantly conceived as a global environmental challenge; examination of climate impacts on public health enables researchers to localize this urgent problem for members of the public and policymakers. In turn, approaches to climate science that focus on health can make dangerous climate impacts and the need for cost-effective solutions more salient and tangible.

Climate Change and Health: Local Solutions to Local Challenges

Purpose of Review

Climate change has direct impacts on human health, but those impacts vary widely by location. Local health impacts depend on a large number of factors including specific regional climate impacts, demographics and human vulnerabilities, and existing local adaptation capacity. There is a need to incorporate local data and concerns into climate adaptation plans and evaluate different approaches.

Recent Findings

The Centers for Disease Control and Prevention (CDC) has provided funding, technical assistance, and an adaptation framework to assist localities with climate planning and activities. The differing processes with which states, cities, and tribes develop and implement adaptation plans have been observed. We outline examples of the implementation of CDC’s framework and activities for local adaptation, with a focus on case studies at differing jurisdictional levels (a state, a city, and a sovereign tribe).

Summary

The use of local considerations and data are important to inform climate adaptation. The adaptable implementation of CDC’s framework is helping communities protect health.

Local actions to health risks of heatwaves and dengue fever under climate change: Strategies and barriers among primary healthcare professionals in southern China

BACKGROUND

Climate change and extreme weather poses significant threats to community health, which need to be addressed by local health workforce. This study investigated the perceptions of primary healthcare professionals in Southern China on individual and institutional strategies for actions on health impacts of climate change and the related barriers.

METHODS

A mixed methodological approach was adopted, involving a cross-sectional questionnaire survey of 733 primary healthcare professionals (including medical doctors, nurses, public health practitioners, allied health workers and managers) selected through a multistage cluster randomized sampling strategy, and in-depth interviews of 25 key informants in Guangdong Province, China. The questionnaire survey investigated the perceptions of respondents on the health impacts of climate change and the individual and institutional actions that need to be taken in response to climate change. Multivariate logistic regression models were established to determine sociodemographic factors associated with the perceptions. The interviews tapped into coping strategies and perceived barriers in primary health care to adapt to tackle challenges of climate change. Contents analyses were performed to extract important themes.

RESULTS AND CONCLUSION

The majority (64%) of respondents agreed that climate change is happening, but only 53.6% believed in its human causes. Heat waves and infectious diseases were highly recognized as health problems associated with climate change. There was a strong consensus on the need to strengthen individual and institutional capacities in response to health impacts of climate change. The respondents believed that it is important to educate the public, take active efforts to control infectious vectors, and pay increased attention to the health care of vulnerable populations. The lack of funding and limited local workforce capacity is a major barrier for taking actions. Climate change should be integrated into primary health care development through sustainable governmental funding and resource support.

Early Warnings: The Lessons of COVID-19 for Public Health Climate Preparedness

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems - governance, information, services, determinants, and capacity - to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

PreciPatch: A Dictionary-based Precipitation Downscaling Method

Climate and weather data such as precipitation derived from Global Climate Models (GCMs) and satellite observations are essential for the global and local hydrological assessment. However, most climatic popular precipitation products (with spatial resolutions coarser than 10km) are too coarse for local impact studies and require “downscaling” to obtain higher resolutions. Traditional precipitation downscaling methods such as statistical and dynamic downscaling require an input of additional meteorological variables, and very few are applicable for downscaling hourly precipitation for higher spatial resolution. Based on dynamic dictionary learning, we propose a new downscaling method, PreciPatch, to address this challenge by producing spatially distributed higher resolution precipitation fields with only precipitation input from GCMs at hourly temporal resolution and a large geographical extent. Using aggregated Integrated Multi-satellitE Retrievals for GPM (IMERG) data, an experiment was conducted to evaluate the performance of PreciPatch, in comparison with bicubic interpolation using RainFARM—a stochastic downscaling method, and DeepSD—a Super-Resolution Convolutional Neural Network (SRCNN) based downscaling method. PreciPatch demonstrates better performance than other methods for downscaling short-duration precipitation events (used historical data from 2014 to 2017 as the training set to estimate high-resolution hourly events in 2018).

Integrating Public Health into Climate Change Policy and Planning: State of Practice Update

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012

Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate-sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate-sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick-borne Lyme disease in Michigan and mosquito-borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health-related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7-24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate-sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate-sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate-sensitive health-related costs. The high health-related costs associated with climate-sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.

Health professionals in a changing climate: protocol for a scoping review

INTRODUCTION

Climate change will impose significant health impacts. Although we know health professionals should play a critical role in protecting human health from climate change, their preparedness to engage with these issues worldwide is unclear. This study aims to map the range and nature of existing evidence regarding health professionals' knowledge, attitudes, perceptions and practices regarding climate change and health impacts and the challenges they face, and identify knowledge gaps to guide future development of research, policy and practices.

METHODS AND ANALYSIS

We will perform a scoping review based on the six-stage framework proposed by Arksey and O'Malley. Our study includes peer-reviewed literature focusing on any aspect of health professionals' work regarding climate change and health since 2002 and indexed in MEDLINE/Pubmed, Web of Science, Scopus or Embase. Identified papers will be described and assessed. Thematic analysis will be applied to evaluate and categorise the study findings.

IMPLICATIONS AND DISSEMINATION

This is the first scoping review of health professionals' activities to anticipate and prepare for health impacts attributable to climate change. It will provide evidence regarding the current situations worldwide and gaps in preparedness. The findings can be used to highlight accomplishments to date, identify gaps and further develop good practices for health professionals' engagement. The results will be published in the peer-reviewed literature and shared at health professional society meetings.

Assessing Health Vulnerabilities and Adaptation to Climate Change: A Review of International Progress

Climate change is increasing risks to human health and to the health systems that seek to protect the safety and well-being of populations. Health authorities require information about current associations between health outcomes and weather or climate, vulnerable populations, projections of future risks and adaptation opportunities in order to reduce exposures, empower individuals to take needed protective actions and build climate-resilient health systems. An increasing number of health authorities from local to national levels seek this information by conducting climate change and health vulnerability and adaptation assessments. While assessments can provide valuable information to plan for climate change impacts, the results of many studies are not helping to build the global evidence-base of knowledge in this area. They are also often not integrated into adaptation decision making, sometimes because the health sector is not involved in climate change policy making processes at the national level. Significant barriers related to data accessibility, a limited number of climate and health models, uncertainty in climate projections, and a lack of funding and expertise, particularly in developing countries, challenge health authority efforts to conduct rigorous assessments and apply the findings. This paper examines the evolution of climate change and health vulnerability and adaptation assessments, including guidance developed for such projects, the number of assessments that have been conducted globally and implementation of the findings to support health adaptation action. Greater capacity building that facilitates assessments from local to national scales will support collaborative efforts to protect health from current climate hazards and future climate change. Health sector officials will benefit from additional resources and partnership opportunities to ensure that evidence about climate change impacts on health is effectively translated into needed actions to build health resilience.

Development of a Climate Change Vulnerability Assessment Using a Public Health Lens to Determine Local Health Vulnerabilities: An Ontario Health Unit Experience

Climate change is negatively impacting the health of Canadians and is accordingly expected to have a significant impact on public health agencies and their response to these health impacts throughout the twenty-first century. While national and international research and assessments have explored the potential human health impacts of climate change, few assessments have explored the implications of climate change from a local public health perspective. An applied research approach to expand local knowledge and action of health vulnerabilities through a climate change action plan and vulnerability assessment was utilized by a local public health agency. Adoption and adaptation of the approach used may be valuable for public health organizations to assist their communities. Through completing a vulnerability assessment, an evidentiary base was generated for public health to inform adaptation actions to reduce negative health impacts and increase resiliency. Challenges in completing vulnerability assessments at the local level include the framing and scoping of health impacts and associated indicators, as well as access to internal expertise surrounding the analysis of data. While access to quantitative data may be limiting at the local level, qualitative data can enhance knowledge of local impacts, while also supporting the creation of key partnerships with community stakeholders which can ensure climate action continues beyond the scope of the vulnerability assessment.