Climate change threatens human health in many ways. The impacts of climate change are already underway in the United States, including increasing temperatures, rising sea level, and more frequent and intense severe weather events. The recent scientific health assessment from the United States Global Change Research Program determined that these climate change impacts endanger our health by affecting our food and water sources, the air we breathe, the weather we experience, and our interactions with the built and natural environments. As the climate continues to change, the risks to human health continue to grow. The Climate and Health Program at the Centers for Disease Control and Prevention (CDC) developed the Building Resilience Against Climate Effects (BRACE) framework to help health departments prepare for these impacts. Sixteen state health departments and two city health departments are implementing the framework to assess vulnerabilities, project disease burden, determine potential interventions, and to develop and implement adaptation plans. This presentation will provide an overview of BRACE, describe how it is being implemented, and give examples of CDC technical guidance.

In the face of global climate change, public health agencies face several challenges: they must gather knowledge, predict future health impacts, and create new partnerships that cut across disciplinary boundaries. In New Hampshire (NH), a partnership between state and local public health agencies supported a climate and health adaptation planning process meant to build community resilience. The NH Department of Health and Human Services (DHHS) funded local agencies to implement the CDC BRACE Framework. Local agencies were encouraged to assess vulnerabilities and develop adaptation plans. To build capacity, NH DHHS created a guidebook, held trainings, and provided direct consultations. Four regional public health agencies were funded via a mini-grant process. The first cohort completed written Climate and Health Adaptation Plans in partnership with existing Regional Public Health Advisory Councils and Regional Planning Commissions, and is moving on to the implementation phase, while, the second cohort is undertaking the prioritization process. Throughout the process local agencies worked with partners to identify regional climate hazards, relevant health outcomes, possible interventions, and performance measures. Community-level interventions focused on heat illness in older adults and Lyme disease in youth. Interventions included development of training materials, delivery of information to target audiences, and evaluation of knowledge transfer or behavior change. A focused mini-grant process is sufficient to support a climate and health adaptation planning process. Project challenges include limited information on evidence-based interventions and a short timeframe to implement and evaluate adaptation strategies. The process has built several valuable partnerships across state and local agencies.

The California Building Resilience Against Climate Effects (CalBRACE) Project of the California Department of Public Health’s (CDPH) Office of Health Equity has elevated the need to address the human impacts of climate change in California’s climate change adaptation planning. CalBRACE views climate change and health inequities as sharing similar root causes, which are the inequitable distribution of social, political and economic power. These forces shape systems such as the economy, transportation, and housing, which in turn create the physical and social conditions and greenhouse gas emissions that drive both health outcomes and climate change. Fair and healthy climate resilience requires addressing the root causes of community vulnerabilities and improving living conditions for people facing health inequities. With support from the CDC’s Climate-Ready States & Cities Initiative, CalBRACE developed tools to identify populations and locations facing the greatest health threats from climate change. The 58 county-level Climate Change and Health Profile reports and 11 Climate Change and Health Vulnerability Assessment reports help jurisdictions prioritize resources to improve living conditions for vulnerable communities. CalBRACE presented strategies to improve health equity while adapting to climate change in California’s climate change adaptation plan, titled Safeguarding California: Implementation Action Plans. CDPH is collaborating with state agencies, health equity advocates and environmental justice organizations to develop guidance for state agencies to increase health equity as they address climate change adaptation in infrastructure and investment planning, as required by Governor Brown’s executive order. CDPH is institutionalizing health equity in climate change planning and implementation in California.

Identifying climate and health vulnerabilities in North Carolina is challenging due to breadth of potential impacts and the large geographical area of the jurisdiction. In North Carolina, vulnerability assessment using geographical information systems (GIS) for identified priorities (heat, wildfire smoke) allowed for focus of state government resources for climate and health adaptation. North Carolina Department of Health and Human Services utilized the CDC’s technical report series for vulnerability assessment. Using CDC subject matter expertise and the technical report, North Carolina inventoried existing data and maps. Data in 5 health impact areas was identified, and examined for geographical components. Twenty-three existing vulnerability maps were identified. Using North Carolina’s Climate and Health Profile priority health areas of heat and air quality and respiratory disease, maps of heat-related illness emergency department vulnerability and wildfire smoke health impacts were selected. Following map selection, North Carolina engaged the most vulnerable communities from the maps in ground truthing exercises. North Carolina reached out to local emergency response personnel, agriculture extension, local health departments, vulnerable populations, and forestry staff in the vulnerable communities. These community members provided local expertise, suggesting additional GIS layers for labor-intensive agriculture, older citizens living in poverty, and mobile homes. Local expertise was integrated into both the heat and wildfire smoke maps. Vulnerability assessment using GIS for climate and health impacts is a powerful tool for identifying and learning from vulnerable communities about local risks. In the future, North Carolina will use updated GIS maps to aid in adaptation planning and monitoring.