The gap in capacity building on climate, health, and equity in built environment postsecondary education: a mixed-methods study.

Institutions of higher education are feeling increasing pressure from both students and the international climate community to offer more courses and joint degrees on the role of the built environment in advancing climate action, population health, and social equity. The built environment plays a leading role in this new, transdisciplinary approach. Thoughtfully designed buildings, neighborhoods, and communities can simultaneously lower per capita greenhouse gas emissions, reduce population exposure to dangerous climate-sensitive extreme weather events, reduce disparities in climate-related health outcomes, and advance social equity goals. This mixed-methods study explored the extent to which post-secondary courses and joint degree programs teach students the research methods and technical skills they will need to design and implement built environment interventions addressing the effects of climate change on population health and social equity. The study found that the number of universities offering courses addressing climate, health, and equity in the built environment grew from 2018 to 2022. The number of joint planning/public health degree programs rose from four in 2005 to 15 in 2022. No joint architecture/public health degree programs were identified. A detailed review of 99 course descriptions from three universities found that 17 courses (roughly 1/5 of the total) covered population health, built environment, and climate change; and, 2/3 of the set (n = 60) covered two out of the three topics. Schools of public health were more likely to offer courses covering all three topics, whereas schools of architecture were more likely to include the building scale in relevant courses. Exposure pathways and social equity/vulnerable populations were the most common methods included in relevant courses. Professors and administrators at institutions identified by the study as "transdisciplinary-ready" reported that accreditation requirements and university rules governing the allocation of student tuition had slowed efforts to offer cross-listed courses. However, faculty in these institutions regularly collaborate informally with their peers - both on transdisciplinary research and by offering guest lectures in each other's courses. The results of this study show that, while universities have made great strides over the past 18 years in beginning to support transdisciplinary research and pedagogy, institutional barriers and gaps in key content areas remain.

Associations between Green Building Design Strategies and Community Health Resilience to Extreme Heat Events: A Systematic Review of the Evidence.

This project examined evidence linking green building design strategies with the potential to enhance community resilience to extreme heat events. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method for a systematic review, it assessed the strength of the evidence supporting the potential for Leadership in Energy and Environmental Design (LEED®) credit requirements to reduce the adverse effects of extreme heat events and/or enhance a building's passive survivability (i.e., the ability to continue to function during utility outages) during those events. The PRISMA Flow Diagram resulted in the selection of 12 LEED for New Construction (LEED NC) credits for inclusion in the review. Following a preliminary scan of evidence supporting public health co-benefits of the LEED for Neighborhood Development rating system, queries were submitted in PubMed using National Library of Medicine Medical Subject Headings Terms. Queries identified links between LEED credit requirements and risk of exposure to extreme heat, environmental determinants of health, co-benefits to public health outcomes, and co-benefits to built environment outcomes. Public health co-benefits included reducing the risk of vulnerability to heat stress and reducing heat-related morbidity and mortality. The results lay the groundwork for collaboration across the public health, civil society, climate change, and green building sectors.

Health Co-Benefits of Green Building Design Strategies and Community Resilience to Urban Flooding: A Systematic Review of the Evidence.

Climate change is increasingly exacerbating existing population health hazards, as well as resulting in new negative health effects. Flooding is one particularly deadly example of its amplifying and expanding effect on public health. This systematic review considered evidence linking green building strategies in the Leadership in Energy and Environmental Design® (LEED) Rating System with the potential to reduce negative health outcomes following exposure to urban flooding events. Queries evaluated links between LEED credit requirements and risk of exposure to urban flooding, environmental determinants of health, co-benefits to public health outcomes, and co-benefits to built environment outcomes. Public health co-benefits to leveraging green building design to enhance flooding resilience included: improving the interface between humans and wildlife and reducing the risk of waterborne disease, flood-related morbidity and mortality, and psychological harm. We conclude that collaborations among the public health, climate change, civil society, and green building sectors to enhance community resilience to urban flooding could benefit population health.

An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District.

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.

Assessing climate change and health vulnerability at the local level: Travis County, Texas.

We created a measure to help comprehend population vulnerability to potential flooding and excessive heat events using health, built environment and social factors. Through principal component analysis (PCA), we created non-weighted sum index scores of literature-reviewed social and built environment characteristics. We created baseline poor health measures using 1999-2005 age-adjusted cardiovascular and combined diabetes and hypertension mortality rates to correspond with social-built environment indices. We mapped US Census block groups by linked age-adjusted mortality and a PCA-created social-built environment index. The goal was to measure flooding and excessive heat event vulnerability as proxies for population vulnerability to climate change for Travis County, Texas. This assessment identified communities where baseline poor health, social marginalisation and built environmental impediments intersected. Such assessments may assist targeted interventions and improve emergency preparedness in identified vulnerable communities, while fostering resilience through the focus of climate change adaptation policies at the local level.

An approach to developing local climate change environmental public health indicators, vulnerability assessments, and projections of future impacts.

Environmental public health indicators (EPHIs) are used by local, state, and federal health agencies to track the status of environmental hazards; exposure to those hazards; health effects of exposure; and public health interventions designed to reduce or prevent the hazard, exposure, or resulting health effect. Climate and health EPHIs have been developed at the state, federal, and international levels. However, they are also needed at the local level to track variations in community vulnerability and to evaluate the effectiveness of interventions designed to enhance community resilience. This review draws on a guidance document developed by the U.S. Council of State and Territorial Epidemiologists' State Environmental Health Indicators Collaborative climate change working group to present a three-tiered approach to develop local climate change EPHIs. Local climate change EPHIs can assist local health departments (LHDs) in implementing key steps of the 10 essential public health services and the U.S. Centers for Disease Control and Prevention's Building Resilience Against Climate Effects framework. They also allow LHDs to incorporate climate-related trends into the larger health department planning process and can be used to perform vulnerability assessments which can be leveraged to ensure that interventions designed to address climate change do not exacerbate existing health disparities.

Demystifying first-cost green building premiums in healthcare.

This study assesses the extent of "first-cost green building construction premiums" in the healthcare sector based on data submitted by and interviews with 13 current LEED-certified and LEED-registered healthcare project teams, coupled with a literature survey of articles on the topics of actual and perceived first-cost premiums associated with green building strategies. This analysis covers both perceived and realized costs across a range of projects in this sector, leading to the following conclusions: Construction first-cost premiums may be lower than is generally perceived, and they appear to be independent of both building size and level of "green" achievement; projects are using financial incentives and philanthropy to drive higher levels of achievement; premiums are decreasing over time; and projects are benefiting from improvements in health and productivity which, although difficult to monetize, are universally valued.

Higher performance healing environments.

Over the past five years, a remarkable confluence of unprecedented healthcare construction and green building tools and programs tailored for the healthcare sector have created a bold vision of what a 21st Century hospital can be. Informed by the fundamental precept of "first, do no harm", this quiet revolution is shaping the way hospitals and other healthcare facilities are planned, designed, constructed and operated.