Developing Resilience to Public Health Risks of Extreme Heat in the U.S.−Mexico Border Region

Key Messages.

• A U.S.-Mexico border region heat-health partnership has developed new capacities to address public health risks of extreme heat in the Paso del Norte region (Ciudad Juarez, El Paso, Las Cruces).
• The partners have identified important research and outreach challenges, including: translating climate research into evidence-driven public health interventions and actionable strategies; increasing the effectiveness of risk communication to the general public; and improving coordination and communication between researchers and practitioners.
• The partnership conducted extreme heat awareness month activities in May, 2017, in each of the Paso del Norte cities.
• The partnership has successfully garnered further funding, to address specific needs for bilingual outreach, awareness raising, and capacity building in the most vulnerable communities, through a 2-year project, entitled Hot Spots for Heat Resilience in Border Cities: A Pilot Study in El Paso, TX.

Rationale. Extreme heat is the deadliest natural disaster in the United States, killing an average of 130 people per year. Climate models project annual average temperature increases of more than 7 F (4 C), for the Paso del Norte border region (Ciudad Juarez, Chihuahua, El Paso, Texas, Las Cruces, New Mexico), by the end of the 21^st Century, under assumptions of continued high rates of greenhouse gas emissions (RCP 8.5), with an increase of at least 10 F (5.5 C) on the hottest days. A warming climate will exacerbate the public health impacts of extreme heat, as heat waves become longer, more frequent, and more severe. To address these concerns, we have developed a partnership, through a pilot project, in conjunction with the National Integrated Heat Health Information System (NIHHIS). Activities of the partnership aim to build understanding of climate extremes, such as heat waves, and enhance the capacity of communities to prepare for and respond to climate impacts.

Context. In the Paso del Norte region, daily maximum temperatures can exceed 110 F (43 C), and minimum temperatures, can sometimes exceed 85 F (29 C). When minimum temperatures are high, people cannot recover from the prolonged exposure of high daytime temperatures, which increases health-related risks. The region shares an international border, with a high proportion of people living below the median income of the U.S. national average. The Paso del Norte region is home to an estimated 2.4 million people, most of whom live in or near the principal cities of El Paso (TX), Las Cruces (NM), and Ciudad Juarez.

Progress. A July, 2016 NIHHIS workshop brought together individuals in government, academia, and practitioners from Mexico and the U.S., that work in the areas of public health, emergency management, weather and climate, sustainability, and urban planning. Participants identified five key challenges: (1) translation of climate and health research into evidence-driven interventions and actionable strategies; (2) co-production of discipline-specific environmental and health information to support decisions on all timescales; (3) develop improved risk communication strategies to inform populations of the public health risks of extreme heat, and to inspire behavior changes that reduce risks; (4) enhanced coordination and communication among emergency management entities; and (5) improved public health surveillance and monitoring, coupled with improved heat wave prediction skill. These, and other challenges and needs, are discussed in a recent report.

Since fall 2017, working groups have embarked upon a variety of activities, including: (a) improved documentation of historical episodes of extreme heat within the region; (b) development of a climate, weather, and public health metadatabase; (c) development of a directory of local expertise relevant to heat-health studies, practice, and communication; (d) improved long-lead heat wave prediction; and (e) enhanced heat season early warning communication and capacity building. The Ciudad Juarez Office of Resilience, in cooperation with the Environmental Education Taskforce of the Binational Border 2020 Program and the Texas Commission on Environmental Quality, convened a May 2017 conference aimed at practitioners in public health, and community leaders. The Las Cruces, NM Office of Resilience has implemented a neighborhood-level public health survey, to improve understanding of public risk perceptions. The El Paso, TX Office of Resilience has developed a working group on green infrastructure, building, transportation and planning practices to reduce local urban heat island hot spots. In May, 2017 the partnership coordinated a Heat Awareness Month, in which each city made concerted bilingual pre-heat season awareness announcements and convened public awareness events—including coordinated heat awareness proclamations by the mayors of each city.

Hot Spots for Heat Resilience in Border Cities. The Hot Spots project addresses the environmental and social justice issues associated with public health risks of extreme heat in low-income, marginalized communities along the US-Mexico border, called colonias. Colonias, are unregulated, and often unincorporated, areas along the US-Mexico border, whose residents often lack basic public services, such as sewer systems, electricity, and potable water. Communities of low socioeconomic status are at increased risk of heat-related health issues for multiple reasons, including: lack of access to bilingual information, inability to afford air conditioning, and poor building insulation. Only senior citizens and the disabled are eligible to receive state assistance for installing and updating AC units, leaving other vulnerable residents (e.g., pregnant women and children) without help.

Goals of the Hot Spots project are to improve understanding and awareness, and reduce risks, related to the symptoms of heat stress and exhaustion, and increase capacity through education and social learning. The project, funded by the Agnese Nelms Haury Program in Environmental and Social Justice, kicked off with summer 2017 team teleconferences and in-person meetings. The project team aims to develop a certified heat-health risk training program and neighborhood network-building strategy; develop and evaluate low-cost interventions to reduce negative heat-health impacts to residents and pregnant women; and organize a prototype border-wide learning network, to improve heat-health preparedness. Key partners include non-governmental organizations that focus on the social and environmental health needs of vulnerable border communities, a network of community health workers, called promotoras, a network of maternal health providers (doulas, and midwives), and researchers from multiple border-centric universities (University of Arizona, University of California at San Diego, University of Texas at El Paso).