Hi, this is Mary Fox. Glad to be with you to take a look at climate and health assessment methods used in the US. Before we begin, I'd like you to think about what aspects of the changing climate affect you the most? Maybe it's heat, maybe it's extreme storms, too much water, too little water. No matter where you are, there are climate changes. Here in the US, there are various climate trends happening simultaneously, and the trends differ based on region. Here on the East Coast, we have floods and precipitation. On the West Coast, you've seen news about the wildfires and the drought. We have a lot of things going on, and they're different in different places. Since 2009, our Centers for Disease Control and Prevention has had a Climate and Health Program working to support the public health response to these varied climate trends, by developing resources to adapt to the change in climate. They're focuses on communities. To help the communities, they provide support to city and state health officials, developing guidance, trainings, publications, information to support health departments in community decision-making. The main framework that the Climate and Health Program has developed to help climate change adaptation is called BRACE, Building Resilience Against Climate Effects. This is a classic example of a continuous improvement management system. There's a five-step process, beginning with an assessment and understanding of disease burden, all the way through developing interventions, implementing the plan, and evaluating the quality of the activities. And then if necessary, you can repeat the cycle. The BRACE framework has been deployed in numerous states around the country, and this map shows you in green the states that have been applying the BRACE framework. There are also two cities, New York city and San Francisco that have been using this system. We're going to focus in on Maryland and specifically some results for Baltimore City. So, here's a picture of the climate drivers and their potential health consequences in Maryland. Even though Maryland is such a small state, we have a varied geography from oceanfront to mountains. So, the climate drivers of extreme heat and precipitation contribute to a number of different health issues in these different areas, and the Maryland profile was designed to begin to take a look at these climate changes and related health impacts. So, where do we begin any assessment? We start by scoping it out. So, what exactly are we going to do and where are we going to apply it? So, the where included Baltimore City and several counties around the state representing the different geographic areas. The what included exposures to extreme heat and extreme precipitation, and several health outcomes, hospital admissions for heart attacks and asthma, and cases of Salmonella food poisoning. Here, we can walk through the approach. So, this figure shows how the various datasets came together to develop the analysis and produce the results that we'll see in a few minutes. Using historical data on health and weather, analysts began to understand how heat and precipitation were related to heart attacks, asthma, and food poisoning in the recent past. These relationships were then applied considering current and future population and climate changes. The resulting vulnerability assessment tells us where we're going in terms of projected rates of the hospitalizations for heart attack, asthma, and food poisoning. So, I want you to know about where these data came from, and some of the models that were used. The historical data on hospitalizations came from the state health department. The extreme heat and precipitation data came from the National Climatic Data Center. Local health profiles were gathered for the various counties and Baltimore City, and these were sourced from the county and City Health Departments and the Maryland Environmental Health Tracking Program. The projections going forward came from a couple of different places. The climate modeling was derived from the models that are used internationally by the Intergovernmental Panel on Climate Change. Then, the population projections that get us to what's happening in Maryland communities came from the Maryland Department of Planning. So, in any type of large assessment like this, there're going to be data issues. There are some gaps due to limited data. So, you remember one of the issues in Maryland is changes in vector-borne diseases particularly Lyme disease. Mental health is a big problem that we anticipate with many of the climate changes. Sea level rise, obviously Maryland has a lot of coastline. But we have limited data on these right now, and so they weren't included in the profile. We have to acknowledge that these are things we just can't tackle with the quantitative datasets at this time. Another aspect of this assessment is that we know that food poisoning is always under-reported. So, whatever impacts we project, we know that we're underestimating that. The climate model used is based on economic growth, which is good I think and appropriate for where we're going. With all of these considerations, interpreting the results and thinking about the results, we need to keep it at a big picture. We're looking at the trend rather than saying there's going to be X number more heart attacks, right? So, we want to keep it big picture. But even so, even including all of the different strengths and limitations that this assessment put together, there's a lot we're going to learn, and a lot we can take forward to inform our public health approaches. So, let's take a look first at the climate findings, both for extreme heat and extreme precipitation. So, we look first at extreme heat. These bar charts show each bar what has happened over a 10-year period since the 1960s. If we look at extreme heat, particularly if we look at summer extreme heat first, we'll see that there has been a lot of great increase in extreme heat over the past three years. Also useful to note that we have seen extreme heat events increased in spring and also in winter. The thing to remember though in terms of public health impact is that, particularly winter extreme heat still will not be very high temperature. So, there may be extreme heat within the normal for winter, but it's not going to be so hot that it influences heat stress and that sort of thing. Looking at extreme precipitation, we don't see a strong trend there. Extreme precipitation has remained relatively stable in Maryland over this time period. Here's a look at the Baltimore City population and demographic data on age, on race, ethnicity, health outcomes, and risk factors. The one thing I wanted to point out here and I know that you can look more closely at these data, heart disease, and asthma, and other respiratory conditions are among the leading causes of morbidity and mortality within the city, which is why the scoping exercise focused in on those, and I think we can anticipate that we're going to see some strong results related to those really important health outcomes. Here we are. So, the projections for Baltimore City going forward to 2040 on food poisoning relatively small change. But for the hospitalizations for these major causes of morbidity and mortality, so heart attack and asthma, there were really large changes greater than a 100 percent change expected. Again, thinking about the big picture and trend, these types of increased outcomes is going to be important for the health system to be thinking ahead and be prepared for those, and that's the whole purpose for talking through this assessment framework. So, that helps us figure out what we're going to do next. So, takeaways from today, BRACE is a practical tool guiding assessment and management. It's flexible. Climate drivers change, what's happening where you are is different from what's happening where I am. So, we need a framework that can be applied in many different situations. It's also scalable. This is a framework that can be used in cities and towns, can be used in provinces and states or nations. It's flexible in that you can put together the data that you have and you move forward with it even though acknowledging that there are may be limitations. Another great thing about the BRACE framework is that there are a lot of resources available, and these have been developed by the CDC Climate and Health Program. There's guidance, there's examples, there's lots that you can look into to support an effort under BRACE. Bottom line, it's action-oriented. So, this type of assessment tells us what we need to be doing, and it informs our plans and thinking about next steps. Thanks.
