North Carolina (NC) will see substantial changes in temperature and other weather in coming decades based on past emission-producing activities. These climate changes will have large impacts on public health, and thus public health adaptations at the local level are needed. In order to develop appropriate and adequate responses, indicators are being piloted that monitor climate-related health in NC.

Highlighted findings from environmental indicators: • From 2000 to 2007, total greenhouse gas emissions showed a small increase, due to increases in the transportation and electric power sectors. From 1973-2008, no overall increase in air mass stagnation events was observed. • From 2002-2010, the frequency and severity of wildfires did not increase. Generally, the frequency of fires had a parallel relationship to the total acres affected by wildfire. • From 1999-2008, positive test results for West Nile Virus (WNV) in mosquitoes was parallel to the results in chicken sentinel flocks. Positive test results reached a peak in 2003, and declined to zero positives in 2008. Sentinels tested positive for WNV from 2001 through 2007, while mosquitoes tested positive for WNV from 2002 through 2004.

Highlighted findings from health indicators: • From 1995-2009, heat-related morbidity and mortality showed no overall increase, with peaks in 1999 and 2005, as well as a peak in mortality in 2008. Most hospitalizations were due to unspecified exhaustion, heatstroke/sunstroke, water exhaustion, and syncope, respectively. Seventy-five percent of heat-related hospitalizations from 1995-2009 were males. Heat-related morbidity and mortality among emergency department (ED) visits in 2008 and 2009 showed a larger number of deaths (21 v. 2), hospitalizations (108 v. 80), and ED visits (2294 v. 1647) in 2008 versus 2009. • From 1995-2009, no overall increase was seen among cases of allergic disease. The majority of hospitalizations for allergic disease were females.

Highlighted findings from mitigation indicators: • From 2000 to 2006, energy consumption per capita showed a small increase in the industrial sector, while staying the same in the residential, commercial, and transportation sectors. • From 1992 to 2007, vehicle miles traveled per capita increased by about 2,000 miles. • In 2006, NC's renewable energy profile consisted of a majority hydroelectric (68%), with renewable energy also coming from wood and other derivative fuels (31%) and landfill gas/Municipal Solid Waste biogenic (1%).

Highlighted findings from adaptation indicators: • The NC climate change advisory board has recommended the development of a state adaptation plan, which may address human health adaptation. • The State Hazard Mitigation Plan has identified extreme heat and climate change as hazards, although it has not included cooling centers as a mitigation measure. • One heat island mitigation plan exists in the state. • Four health surveillance systems exist related to climate change.

Highlighted findings from policy indicators: • Forty-three local NC governments participate in the US Conference of Mayors Climate Protection Agreement, which govern 30% of NC's population. • A state climate change advisory board has been developed in recent years, and a state greenhouse gas inventory has been completed. Two cities/localities have completed greenhouse gas inventories. • Ten local governments, representing 20% of NC's population, participate in ICLEI, a national climate change group comprising of local government leaders. • A state climate change action plan has been completed, and two local climate change action plans have been completed.