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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24846.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Protecting the Health and Well-Being of Communities in a Changing Climate PROCEEDINGS OF A WORKSHOP Leslie Pray, Rapporteur Roundtable on Population Health Improvement Roundtable on Environmental Health Sciences, Research, and Medicine Board on Population Health and Public Health Practice Health and Medicine Division PREPUBLICATION COPY: UNCORRECTED PROOFS

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and AAMC, Aetna Foundation (#1002892), The California Endowment (#10003309), Dartmouth Hitchcock Medical Center, Exxon Mobil, General Electric Company (#10003080), Fannie Rippel Foundation, HealthPartners, Health Resources and Services Administration (DHHS-10003351), Kaiser Permanente (#10002957), Kresge Foundation (#10002910), Low Income Invest Fund, National Association of County & City Health Officials (#10003582), Nemours, New York State Health Foundation (#10002907), NIEHS (DHHS-10003294), NYU Langone School of Medicine, Office of the Assistant Secretary for Health (DHHS-10003388), Robert Wood Johnson Foundation (#10002897), Samueli Institute, and Wake Forest Baptist Medical Center. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/24846 Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2017 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Protecting the health and well-being of communities in a changing climate: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24846. PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

PLANNING COMMITTEE ON PROTECTING THE HEALTH AND WELL-BEING OF COMMUNITIES IN A CHANGING CLIMATE1 HENRY ANDERSON, Adjunct Professor, Occupational and Environmental Health, University of Wisconsin Department of Population Health Sciences; former Chief Medical Officer, Wisconsin Division of Public Health PAUL A. BIEDRZYCKI, Director, Disease Control and Environmental Health, City of Milwaukee Health Department JOHN BOLDUC, Environmental Planner, Cambridge Community Development Department KATHY GERWIG, Vice President, Employee Safety, Health and Wellness, and Environmental Stewardship Officer, Kaiser Permanente SURILI PATEL, Senior Program Manager, Environmental Health, American Public Health Association LINDA RUDOLPH, Director, Climate Change and Public Health Project, Public Health Institute Health and Medicine Division Activity Staff ALINA BACIU, Activity Co-Director KATHLEEN STRATTON, Activity Co-Director HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice Consultants LESLIE PRAY, Rapporteur 1 The National Academies of Sciences, Engineering, and Medicine's planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. v PREPUBLICATION COPY: UNCORRECTED PROOFS

ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 GEORGE J. ISHAM (Co-Chair), Senior Advisor, HealthPartners; Senior Fellow, HealthPartners Institute for Education and Research SANNE MAGNAN (Co-Chair), Adjunct Assistant Professor, University of Minnesota PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health JOHN AUERBACH, Executive Director, Trust for America’s Health CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance, Consultant for Health Strategy, The Dow Chemical Company RAPHAEL BOSTIC, Judith and John Bedrosian Chair in Governance and the Public Enterprise; Director, Bedrosian Center on Governance, University of Southern California DEBBIE I. CHANG, Senior Vice President, Nemours CHARLES J. FAZIO, Senior Vice President and Medical Director, HealthPartners, Inc. GEORGE R. FLORES, Senior Program Officer, The California Endowment KATHY GERWIG, Vice President, Employee Safety, Health and Wellness and Environmental Stewardship Officer, Kaiser Permanente ALAN GILBERT, Director of Global Government and NGO Strategies, GE Healthymagination MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County MARTHE GOLD, Senior Scholar in Residence, The New York Academy of Medicine MARC N. GOUREVITCH, Muriel G. and George W. Singer Professor of Population Health, Department of Population Health; Professor, Department of Medicine; Professor, Department of Psychiatry; Chair of the Department of Population Health, New York University School of Medicine GARTH GRAHAM, President, Aetna Foundation GARY R. GUNDERSON, Vice President, Faith Health, Wake Forest University WAYNE JONAS, Executive Director, H & S Ventures ROBERT M. KAPLAN, Professor, Stanford University DAVID A. KINDIG, Professor Emeritus of Population Health Sciences; Emeritus Vice Chancellor for Health Sciences, University of Wisconsin–Madison PAULA M. LANTZ, Associate Dean for Academic Affairs and Professor of Public Policy, University of Michigan MICHELLE LARKIN, Associate Vice President, Associate Chief of Staff, Robert Wood Johnson Foundation THOMAS A. LAVEIST, Professor and Chair, Department of Health Policy, Milken Institute School of Public Health, The George Washington University JEFFREY LEVI, Professor, The Milken Institute School of Public Health, The George Washington University SARAH R. LINDE, Chief Public Health Officer, Health Resources and Services Administration SHARRIE MCINTOSH, Vice President for Programs, New York State Health Foundation PHYLLIS D. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation BOBBY MILSTEIN, Director, ReThink Health 1 The National Academies of Sciences, Engineering, and Medicine's forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. vii PREPUBLICATION COPY: UNCORRECTED PROOFS

JOSÉ T. MONTERO, Director, Office for State, Tribal, Local and Territorial Support; Deputy Director, Centers for Disease Control and Prevention MARY PITTMAN, President and CEO, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation JAMES N. WEINSTEIN, CEO and President, Dartmouth-Hitchcock, Peggy Y. Thomson Professor, Evaluative Clinical Sciences, Dartmouth-Hitchcock Medical Center Roundtable on Population Health Improvement Staff KIMANI HAMILTON-WRAY, Senior Program Assistant (from April 2017 DARLA THOMPSON, Program Officer viii PREPUBLICATION COPY: UNCORRECTED PROOFS

ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE1 FRANK LOY (Chair), U.S. Representative to the 66th Session of the General Assembly of the United Nations LYNN R. GOLDMAN (Vice Chair), Professor, Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University HENRY A. ANDERSON, Adjunct Professor, Occupational and Environmental Health, University of Wisconsin Department of Population Health Sciences; former Chief Medical Officer, Wisconsin Division of Public Health JOHN M. BALBUS, Senior Advisor for Public Health, National Institute of Environmental Health Sciences, National Institutes of Health FAIYAZ BHOJANI, Chief Medical Officer, Global Manufacturing and Chemicals, Royal Dutch Shell LINDA S. BIRNBAUM, National Institute of Environmental Health Sciences, National Institutes of Health WAYNE E. CASCIO, Director, Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, Environmental Protection Agency Initiative Office of Public Engagement LUZ CLAUDIO, Associate Professor, Community Outreach & Education, Mount Sinai School of Medicine DENNIS J. DEVLIN, Senior Environmental Health Advisor, ExxonMobil Corporation RICHARD A. FENSKE, Professor and Associate Chair, School of Public Health and Community Medicine, University of Washington DAVID D. FUKUZAWA, Managing Director, Health, The Kresge Foundation BERNARD D. GOLDSTEIN, Consultant, Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh RICHARD J. JACKSON, Professor and Chair, Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles SUZETTE M. KIMBALL, Senior Advisor, Office of the Director, U.S. Geological Survey, U.S. Department of the Interior JAY LEMERY, Assistant Professor of Emergency Medicine; President, Wilderness Medical Society, School of Medicine, University of Colorado Denver MAUREEN Y. LICHTVELD, Professor and Chair; Freeport McMoRan Chair of Epidemiology; Associate Director Population Sciences, Louisiana, Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine AL MCGARTLAND, Office Director, National Center for Environmental Economics, Environmental Protection Agency DAVID M. MICHAELS, Professor, Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University SUSAN L. SANTOS, Assistant Professor, School of Public Health, Rutgers University KIRK P. SMITH, Professor of Global Environmental Health, School of Public Health, University of California, Berkeley AGNES SOARES DA SILVA, Regional Advisor, Sustainable Development and Health Equity, Pan American Health Organization/World Health Organization 1 The National Academies of Sciences, Engineering, and Medicine's forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. ix PREPUBLICATION COPY: UNCORRECTED PROOFS

JOHN D. SPENGLER, Professor, Environmental Health and Human Habitation, Harvard T.H. Chan School of Public Health G. DAVID TILMAN, Director, Cedar Creek Ecosystem Science Reserve; Regents Professor, Department of Ecology, Evolution and Behavior, University of Minnesota JULI TRTANJ, One Health and Integrated Climate and Weather Extremes Research Lead, Climate Program Office, National Oceanic and Atmospheric Administration PATRICIA VERDUIN, Chief Technology Officer, Global Research & Development, Colgate- Palmolive Company DICK ZIMMER, former Congressman, Zimmer Strategies, Inc. x PREPUBLICATION COPY: UNCORRECTED PROOFS

REVIEWERS This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: PHILIP M. ALBERTI, Association of American Medical Colleges WAYNE CASCIO, National Health and Environmental Effects Research Laboratory ALLISON GOST, Maryland Institute for Applied Environmental Health MAUREEN LICHTVELD, Tulane University Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DEREK YACK of The Vitality Group. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. xi PREPUBLICATION COPY: UNCORRECTED PROOFS

CONTENTS 1 INTRODUCTION 1 About the Roundtables, 2 Organization of the Workshop and This Proceedings, 3 2 SETTING THE STAGE 5 The Fierce Urgency of Now, 2 The Global Climate Crisis: Large Health Risks and Opportunities, 8 Discussion, 16 3 Regional Perspectives from the South 21 Louisville Metro Government Office of Sustainability, 22 Faith in Landscape Stewardship, 25 Empower Kentucky, 28 Discussion, 32 4 REGIONAL PERSPECTIVES FROM THE MIDWEST 37 Local Public Health Perspectives: Climate Health Preparedness and Response, 38 Protecting the Health and Well-Being of Communities in a Changing World, 42 Discussion, 46 5 REGIONAL PERSPECTIVES FROM THE NORTHEAST 51 Health Care Emergency Preparedness in New York City, 52 Planning for Climate Change in New Hampshire, 57 City of Baltimore: Community Resilience in a Changing Climate, 63 Discussion, 68 6 REGIONAL PERSPECTIVES FROM THE WEST 73 Climate + Community Health + Health Care in the West, 74 California’s Innovative Climate and Agriculture Policies, 79 A Perspective from The Institute for Tribal Environmental Professionals, 83 Discussion, 85 7 REFLECTIONS ON THE DAY 91 Reflections of Ray Baxter, 91 Reflections of Frank Loy, 94 Discussion, 95 APPENDIXES A REFERENCES 99 Additional References and Resources, 102 xiii PREPUBLICATION COPY: UNCORRECTED PROOFS

B WORKSHOP AGENDA 105 C BIOSKETCHES OF PRESENTERS AND MODERATORS 109 xiv PREPUBLICATION COPY: UNCORRECTED PROOFS

Boxes, Figures, and Tables BOXES 1-1 Statement of Task 2 2-1 Key Points Made by Individual Speakers 5 3-1 Key Points Made by Individual Speakers 21 4-1 Key Points Made by Individual Speakers 37 5-1 Key Points Made by Individual Speakers 51 6-1 Key Points Made by Individual Speakers 73 FIGURES 2-1 Change in average earth surface temperatures: The projected difference in increases in average earth surface temperatures between 1986–2005 and 2081–2100. 9 2-2 Three scenarios for the Earth’s temperature show the importance of applying a health frame. 12 2-3 Effects of physical activity on relative risk for several health outcomes. 15 3-1 Three maps of Louisville showing: (a) tree canopy coverage, (b) mortality from heart disease, and (c) average daily high temperature (May–September 2012). 23 3-2 Cumulative pollution overlay. 30 4-1 GHS energy efficiency: Change in Gundersen Health System (GHS) energy efficiency since 2008, as measured by the difference between aggregated facilities’ energy use intensity (EUI) and utility-purchased energy. 44 4-2 First U.S. health system heated, powered, and cooled by local renewable energy. 45 5-1 BRACE (Building Resilience Against Climate Effects) framework. 58 5-2 New Hampshire Social Vulnerability Index (SVI). 60 5-3 Shocks and stresses affecting the City of Baltimore. 64 5-4 Maps illustrating Baltimore’s socioeconomic differences: the Black butterfly and the white “L,” Baltimore’s “Black butterfly,” with the African-American population, income, and unemployment overlaid 65 TABLES 6-1 2016 Kaiser Permanente Prioritized Community Health Needs 76 xvi PREPUBLICATION COPY: UNCORRECTED PROOFS

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On March 13, 2017, the Roundtable on Environmental Health Sciences, Research, and Medicine and the Roundtable on Population Health Improvement jointly convened a 1-day public workshop in Washington, DC, to explore potential strategies for public health, environmental health, health care, and related stakeholders to help communities and regions to address and mitigate the health effects of climate change. Participants discussed the perspectives of civic, government, business, and health-sector leaders, and existing research, best practices, and examples that inform stakeholders and practitioners on approaches to support mitigation of and adaptation to climate change and its effects on population health. This publication summarizes the presentations and discussions from the workshop.

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