Getting Ready : Health, Planning and Climate Change Readiness

Contra CostaHealth Services

Overview

• Climate Change, Vulnerabilities and Health • Public Health and Medical Risk Assessment • County Excessive Heat Plan • Concluding Thoughts

Current Disparities in Health: Income

Current Disparities in Health: Race

Current Disparities in Health: Education

Other Health Disparities

• Heart Disease• Cancer• Stroke• Asthma

Vulnerable Populations Experience Health Disparities

• Income • Race • Education • Gender/Sex• Linguistic Isolation• Age• Chronic Conditions• Disability • Geography

– Access to Resources– Access to Health Promoting Destinations (Health Care,

Healthy Food, School, Family, Etc.) – Neighborhood Cohesion – Proximity to Toxins

Vulnerability

Vulnerability

Vulnerability

Vulnerability

Vulnerability

Climate Change Exacerbates Existing Health Disparities

Health Impacts: • Death • Cardiovascular Stress

and Failure • Illnesses such as Heat

Stroke, Heat Exhaustion and Kidney Stones

Groups Most Impacted: • Elderly • Children • Farm/Outdoor Workers • Diabetics • Low-Income Urban Residents • People with Respiratory Diseases

Climate Impacts: • Extreme Heat • Increased Average Temperatures • Air Pollution • Wildfire • Severe Weather/Storms • Agricultural Disruptions • Drought • Sea Level Rise

Climate Change Impacts: Geographically Uneven

Climate Change Exacerbates Existing Disparities

Health Impacts: • Displacement • Drowning• Injuries• Water and Food-Borne

Disease from Failing Infrastructure

Groups Most Impacted: • Coastal Residents • Elderly • Children• Low-Income People

Climate Impacts: • Extreme Heat • Increased Average Temperatures • Air Pollution • Wildfire • Severe Weather/Storms/Sea Level Rise • Agricultural Disruptions • Drought

Climate Change Impacts: Geographically Uneven

Risk-Based InitiativeContra Costa County

Bay Area Risk-Based Pilot Project

• CDC selected 10 Metropolitan Statistical Areas in the U.S. to participate in a Risk-Based Pilot Project

• San Francisco/Oakland Metropolitan Statistical Area (Bay Area MSA) was one of the 10

• Bay Area MSA has over 4 million residents

Bay Area Risk-Based Pilot Project Cont’d • Six Bay Area Health Departments participating

in the Project:

• Alameda• Contra Costa• Marin• San Francisco• San Mateo• City of Berkeley

• UCLA contracted to conduct PH & Medical Hazard Risk Assessment

• Establish a coordinated planning effort

• Conduct a Public Health and Medical Hazard Risk Assessment

• Rank and prioritize threats (hazards)

• Propose mitigation strategies

• Develop an MSA risk mitigation plan

• Evaluate and measure plan

Project Activities

Identification of potential hazards and risks related to public health, medical, and mental/behavioral health systems

Assessment of the potential loss or disruption of essential services such as clean water, sanitation, or the interruption of healthcare and public health services

Public Health and Medical Hazard Risk Assessment

Determine severity of hazards to human health, and public health, medical, and mental/behavioral health services and infrastructure

Map at-risk populations

Engage stakeholders in determining hazard mitigation

Public Health and Medical Hazard Risk Assessment

Severity is the magnitude of the hazard minus surge capacity and existing

mitigation strategies.

Severity = hazard - mitigation

In hazard mitigation planning, as with most other planning efforts, the actual process of planning is as important as the plan itself.

October 1, 2011

Categories of Mitigation Strategies

• Physical Infrastructure / Operational

• Organizational Infrastructure

• Social Infrastructure

Emergency Preparednessin Contra Costa County

• Percent of residents who report they are NOT prepared for a disaster

- 20 % in all residents - 40 % in people living below 200% of the federal

poverty level

• Among those that take medication, 11 % report they are NOT prepared with enough medication for an emergency

Source: 2009 California Health Interview Survey

Emergency Preparednessin Contra Costa County

• Percent of residents who report they are very or somewhat confident that the public health system responds to major disasters

- 68 % in all residents - 63 % in people living below 200% of the federal

poverty level• Percent of residents who report they are very or somewhat

confident that the public health system responds fairly- 85 % in all residents - 68 % in people living below 200% of the

federal poverty level

Source: 2009 California Health Interview Survey

“Adaption”, Eric Klinenberg, New Yorker Magazine, January 7, 2013

• July 1995 – Chicago Heat Wave• 739 deaths – 7 times as many as died in Hurricane Sandy• Working air conditioner reduced death by 80%

Eight of the 10 community areas with highest heat wave death rates:

• Predominately African-American

• Pockets of concentrated poverty and violent crime

• Older people were at risk of staying home and dying alone during the heat wave

Three of the 10 neighborhoods with the lowest heat wave related deaths were also poor, violent, and predominately African American.

Men who identified themselves as Papa B, left, and Cadillac Bob, find refuge from the heat in a shaded lot between their homes Thursday, July 5, 2012 on Chicago's south side.

Englewood and Auburn Gresham, two adjacent neighborhoods on the South Side of Chicago were both ninety-nine percent African American, with similar proportions of elderly residents.

Both had high rates of poverty, unemployment, and violent crime.

Heat Wave Deaths:

• Englewood = 33 /100,000

• Auburn Gresham = 3 /100,000

Between 1960 – 1990Englewood:• Lost 50% of its residents• Lost most commercial outlets and social cohesion• Older people fearful of leaving their homes

Auburn Gresham:• No population loss• People walked to diners and grocery stores• Neighbors participated in block clubs and church

groups• Neighbors did door knocking wellness checks

“The key difference between neighborhoods like Auburn Gresham and others that are demographically similar turned out to be the sidewalks, stores,

restaurants, and community organizations that bring people into contact with friends

and neighbors.During the severe heat waves…, living in a neighborhood like Auburn Gresham is the rough equivalent of having a working air conditioner in each room.”

Risk-Based Initiative Current Efforts• Earthquake Hazards

• Vulnerable Population: Medically Dependent

• Working with providers (services and equipment) to identify real-time emergency response efforts

TimelinePlanning underway – 2013

OutcomesEmergency response proceduresMutual assistance agreements

Contra Costa County Climate Leaders Workshop

CCC Operational Area Excessive Heat Emergency Plan

February 28, 2013

Emergency Support Functions

• 1. Transportation• 2. Communications• 3. Public Works and Engineering• 4. Firefighting• 5. Emergency Management• 6. Mass Care and Shelter• 7. Resource Support

Emergency Support Functions Continued

• 8. Public Health and Medical Services• 9. Urban Search and Rescue• 10.Hazardous Material Response• 11. Agriculture & Natural Resources• 12. Utilities• 13. Public Safety and Security• 14. Recovery and Mitigation• 15. External Affairs

Heat Plan Overview

• Identifies Partners• Describes Responsibilities• Criteria for Implementing• Public Information Material• Identifies those most vulnerable• EHSD Cooling Centers

• *Note: This plan is an Annex to the EOP

Partners

• Employment and Human Services• American Red Cross / CBOs• Cal EMA• Health Services• CAO – Communications and Media• National Weather Service• City / Local Government

ResponsibilitiesLocal Government Role

• Three Activation Levels– Monitor– Partial– Full

• Gather and Analyze Information• Coordinate Services• Encourage Interagency Information Exchange

Responsibilities Continued

• Alert Partners to Implement their plans• Monitor locations with power outages• Ensure heat tips are posted on websites

Implementation Criteria

• 105 Degrees• In Excess of 3 Days (Local and NWS)• Night temperatures are 75 Degrees +

• Increase in Heat medical emergencies as identified by the County Health Officer

• 105 Degrees accompanied by extended power outages

Public Information

• Websites Heat Tips Posted

• Press Release Templates

• Media Outreach

• CCTV Videos

Cooling Centers• Public

– Libraries• Private

– Shopping Malls– Book Stores– Movie Theaters

• Community Based Organizations– Community Centers– Senior Centers

• City Buildings

• Request extended hours and lower admission rate to expand access

Gaps

• Heat Conference Call Updates with NWS and Cal EMA

• Annual Readiness Campaign– Public Education and Outreach

Special Considerations

• People with Disabilities and Access and Functional Needs– Have County Agencies serving at risk populations to do

phone check ups• Immediate Outreach• County Weatherization Programs• Animals– Pets– Livestock– Wildlife

Community Preparedness

• Build Cohesion• Community Emergency Response Team (CERT)– Encourage Neighbors, Families and Friends to check up on

one another• Senior Outreach Friendly Visitor Program• Survival Attitude and Effort• Consider Rescheduling outdoor public events

Summary

• Clearly defined process

• Community Preparedness is key

• Public Education and Outreach

Contact Information

• Marcelle Indelicato• Senior Emergency Planner• Office of the Sheriff• Emergency Services Division• minde@so.cccounty.us• 925-313-9609

What Can We Do Prepare for Climate Change and Reduce Health Disparities

• Physical Infrastructure / Operational

• Social Infrastructure—Social Cohesion

• Organizational Infrastructure

Physical Infrastructure: Weatherization

Social Infrastructure: Plan for Vibrant, Cohesive Communities

• Neighborhood Councils

• Community Organizing• Street Lighting • Vibrant, Mixed Use

Neighborhoods • Parks • Empowering People

Organizational Infrastructure:

• Do you have organizational systems that are designed to be resilient?

• Know and understand agency response plans? • Who is responsible for emergency planning in

your city? Do you know? Do you work with them? Work across disciplines!

• Outreach? Are you incorporating emergency response into your public outreach?

• Other Ideas?

Planning Opportunities to Mitigate Impacts:

• Addressing Heat Islands • Tree Planting • Open Space Preservation • Strengthening Food Systems • Improving Indoor/Outdoor Air Quality • Working Towards Economic Security • Fostering Social Cohesion

What’s Next?

• We’re not totally sure. Trying to figure it our ourselves. But we’ve started to assemble some data (on vulnerability) and identify impacts.

• Trying to figure out how to implement. Need your help in thinking this through.

• Ask you to build a focus on people and their health into your work.

Resources

http://cal-adapt.org

http://cchealth.org/built/http://cchealth.org/health-data/hospital-council/