Building Resilience Against Climate Effects in Arizona: Lessons Learned Implementing CDC's BRACE Framework

Arizona is a geographically diverse state in the Southwest United States. Canyons, mountains, deserts, and varying elevations influence the region's climate. Arizona experiences extended summer heat during the months of May through September. During this time, Arizona becomes one of the hottest places on Earth. Year after year, hundreds of people are admitted to hospitals because of heat- related illnesses. Almost 1,500 deaths from exposure to excessive natural heat have occurred in Arizona from 2000 to 2012.

The Third National Climate Assessment from the U.S. Global Change Research Program identified that climate change is increasing wildfires, declining water supplies, reducing agricultural harvests, and causing an increase in health impacts due to extreme heat. Projected temperature increases are expected to increase 2-3 degrees F by 2021-2050 and between 5-9 degrees F by 2070-2099 in Arizona. Increased temperatures are expected to cause ecological changes which in turn may affect disease vectors and air quality. Climate scientists also recognize that El Niņo and La Niņa may impact the Arizona monsoon, flooding hazards, and drought conditions.

As the field of public health gains more insight into the additional health burden of impacts related to the changing climate, the knowledge reconfirms the need for public health authorities to direct their efforts into addressing these impacts and combining atmospheric science with public health epidemiology. Arizona had a limited capacity to address current climate and health issues and strategies to adapt to future climate conditions. The Arizona Department of Health Services' (ADHS) developed a Climate & Health Program to build the agency's capacity to address and adapt to adverse effects from climate hazards on health. The Program was established through the Center for Disease Control & Prevention's (CDC) Building Resilience Against Climate Effects (BRACE) Cooperative Agreement in 2013 to anticipate health effects from changes in the climate by applying climate science, predicting health impacts, and preparing a flexible program. During this period, the Program defined its purpose, which is to address the following conditions: (1) a need for a sustained, capable, climate-aware public health workforce, (2) need for an improved planning, implementation, and evaluation of evidence-based, climate and health policies, laws, programs, and services, (3) limited public health resources on climate and health effects, (4) need for improved adaptation to climate effects for public health systems, (5) need for improved collaboration between atmospheric science and epidemiology, and (6) need to identify the additional public health burden of future climate effects.

ADHS is accomplishing short and long term outcomes by using existing and engaging new partners. Key partners include federal, state, local agencies, academia, and community members. The workgroups help ensure the use of best evidenced-based public health practices while considering lessons learned from previous activities, research, and other programs. The Program expects short term outcomes to include increases in the following; increases in the evidence base, collaborations, applications, and facilitated information exchange. Long term outcomes include decreasing the additional disease burden from climate effects, to maintain program sustainability, to increase community awareness of climate and health impacts, and to increase public health workforce capacity to respond to climate. By following CDC's BRACE Framework, the program's outputs for each step (climate & health profile, vulnerabilities assessment, assessment of public health interventions, a climate adaptation plan, and a program evaluation plan) will work towards the desired outcomes.

The presentation will highlight efforts under way to translate the latest findings from the atmospheric and climatic sciences, and to develop related tools that are tailored for use by the public health community in Arizona. The speaker will describe initiatives under way that include enhanced surveillance activities, strategies to model vulnerability to climate-sensitive health outcomes, and methods to identify and assess interventions used to reduce adverse health impacts on vulnerable populations. The speaker will also discuss initiatives that are building climate resilience capabilities within state and local health departments which will enable the agencies to forecast the most likely future health impacts from a changing climate within their area, identify communities and systems most at risk, and apply this information to enhance public health preparedness planning and response. The speaker will describe successes and challenges implementing CDC's process and share lessons learned for best practices in implementing the Framework at a state health department.