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.

Assessment of an evacuation shelter program for people with access and functional needs in Monroe County, Florida during Hurricane Irma.

This case study presents an evaluation framework to assess the facilitating and constraining factors that influenced the emergency response, operation, and management of a Special Needs Shelter Program in Monroe County, Florida during Hurricane Irma in 2017. A qualitative analysis of key documents and discussions with agencies directly involved in the Monroe County Special Needs Shelter Program was used to assess four major emergency response processes: notifications and communications, evacuation and transportation, sheltering, and interagency coordination. A critical cross-cutting theme emerged, which was a lack of a common definition for populations with "special needs" across different agencies resulting in uncertainties about who should be admitted to the Special Needs Shelter and have access to their services. We generate public health and emergency management lessons to inform future adaptation, preparedness, and response plans to extreme weather events for populations with access and functional needs in Monroe County and Florida's coastal communities more broadly.

Florida neighborhood analysis of social determinants and their relationship to life expectancy.

BACKGROUND: Social determinants of health (SDOH) contribute to unequal life expectancy (LE). Only a handful of papers have analyzed these relationships at the neighborhood level as opposed to the county level. This study draws on both the SDOH and social vulnerability literature to identify relevant factors affecting LE. METHODS: LE was calculated from mortality records for Florida from 2009 to 2013 for 3640 census tracts with reliable estimates. A spatial Durbin error model (SDEM) quantified the direction and magnitude of the factors to LE. The SDEM contains a spatial error term and jointly estimates both local and neighborhood associations. This methodology controls for non-independence between census tracts to provide unbiased statistical estimates. RESULTS: Factors significantly related to an increase in LE, include percentage (%) of the population who identify as Hispanic (beta coefficient [ß]: 0.06, p-value [P] < 0.001) and % of age dependent populations (% population < 5 years old and % population > 65) (ß: 0.13, P < 0.001). Conversely, the following factors exhibited significant negative LE associations, % of households with no automobile (ß: -0.05, P < 0.001), % of mobile homes (ß: -0.02, P < 0.001), and % of female headed households (ß: -0.11, P < 0.001). CONCLUSIONS: Results from the SDEM demonstrate social vulnerability indicators account for additional geographic LE variability beyond commonly studied SDOH. Empirical findings from this analysis can help local health departments identify drivers of spatial health disparities at the local level.

Minigrants to Local Health Departments: An Opportunity to Promote Climate Change Preparedness.

CONTEXT: Human health is threatened by climate change. While the public health workforce is concerned about climate change, local health department (LHD) administrators have reported insufficient knowledge and resources to address climate change. Minigrants from state to LHDs have been used to promote a variety of local public health initiatives. OBJECTIVE: To describe the minigrant approach used by state health departments implementing the Centers for Disease Control and Prevention's (CDC's) Building Resilience Against Climate Effects (BRACE) framework, to highlight successes of this approach in promoting climate change preparedness at LHDs, and to describe challenges encountered. DESIGN: Cross-sectional survey and discussion. INTERVENTION: State-level recipients of CDC funding issued minigrants to local public health entities to promote climate change preparedness, adaptation, and resilience. MAIN OUTCOME MEASURES: The amount of funding, number of LHDs funded per state, goals, selection process, evaluation process, outcomes, successes, and challenges of the minigrant programs. RESULTS: Six state-level recipients of CDC funding for BRACE framework implementation awarded minigrants ranging from $7700 to $28 500 per year to 44 unique local jurisdictions. Common goals of the minigrants included capacity building, forging partnerships with entities outside of health departments, incorporating climate change information into existing programs, and developing adaptation plans. Recipients of minigrants reported increases in knowledge, engagement with diverse stakeholders, and the incorporation of climate change content into existing programs. Challenges included addressing climate change in regions where the topic is politically sensitive, as well as the uncertainty about the long-term sustainability of local projects beyond the term of minigrant support. CONCLUSIONS: Minigrants can increase local public health capacity to address climate change. Jurisdictions that wish to utilize minigrant mechanisms to promote climate change adaptation and preparedness at the local level may benefit from the experience of the 6 states and 44 local health programs described.

Occupational heat exposure among municipal workers.

PURPOSE: Outdoor workers face elevated and prolonged heat exposures and have limited access to air-conditioned spaces. This study's overarching research aim is to increase knowledge of municipal worker heat exposure and adaptation practices. The study's sub-objectives are: (1) quantifying exposure misclassification from estimating personal heat exposure from the official weather station; (2) surveying worker's knowledge and practices to adapt to extreme heat; and (3) relating heat exposure and adaptation practices to self-reported thermal comfort. METHODS: Participants wore a personal heat exposure sensor over 7 days from June 1st to July 3rd, 2015 in Tallahassee, Florida US. Next, participants confirmed the days that they wore the sensor and reported their daily thermal comfort and heat adaptations. Finally, participants completed an extreme heat knowledge, attitudes, and practices survey. RESULTS: Some participants (37%) experienced hotter and more humid conditions (heat index > 2) than the weather station. The most common heat adaptations were staying hydrated (85%), wearing a hat (46%), and seeking shade (40%). During work hours, higher temperatures increased the odds (odds ratio: 1.21, 95% confidence interval: 1.03-1.41, p = 0.016) of a participant feeling too hot. Shifting work duty indoors made workers to feel more comfortable (odds ratio: 0.28, 95% confidence interval: 0.11-0.70, p = 0.005). CONCLUSION: In hot and humid climates, everyday, heat exposures continuously challenge the health of outdoor workers.