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Proceedings of a Worshop JANUARY 2022 IN BRIEF Communities, Climate Change, and Health Equity Proceedings of a Workshopâin Brief As the effects of climate change become more widespread and significant, communities least able to respond are bearing the largest burden. In the United States, communities disadvantaged by a legacy of racial segregation and environmental injustice struggle with disparate health outcomes, are vulnerable to the effects of climate change (e.g., severe flooding in low- lying areas and extreme heat in urban neighborhoods), and lack sufficient resources to recover from and rebuild for resilience against future events. On October 12 and 14, 2021, the 2-day virtual workshop âCommunities, Climate Change, and Health EquityâA New Visionâ brought together environmental health experts, resilience practitioners, climate scientists, and people with lived experience to discuss the disproportionate impact of climate change on communities experiencing health disparities and environmental injustice. During the workshop, the first in a four-part series, 41 speakers shared their perspectives on the topic and suggested specific actions that decision-makers can take to address the intersecting crises of climate change and health inequity (summarized in Table 1). The workshop was organized by an ad hoc planning committee of the Environmental Health Matters Initiative (EHMI), a program that spans all major units of the National Academies of Sciences, Engineering, and Medicine to facilitate multisector, multidisciplinary exchange around complex environmental health challenges. Jonathan Samet (Colorado School of Public Health) opened the event with an overview of the EHMI,1 which was established to address âwickedâ problemsâ problems that are complex, multidisciplinary, of global relevance, and impacted by multiple intersecting factors. Workshop planning committee chair Jeanne Herb (Rutgers University) summarized the background and aims of the workshop. Although the effects of climate change span the United States, certain communities and populations bear the largest burden. In these communities, climate change exacerbates the underlying inequities that drive existing health disparities. She noted that members of these communities not only contribute least to the causes of climate change but also have little influence on policy development and decision making; this imbalance further aggravates climate injustice. Moreover, the increasing frequency of extreme weather-related events underscores the urgent need to address the intersection of climate change and health inequity: âEvery day, every week, we see the devastating impact that climate change is having on the health and well-being of disproportionately affected populations,â Herb said. Therefore, one goal of this workshop was to inform action now, particularly with regard to upcoming federal and state policy opportunities, and with a focus on adaptation, preparedness, and resilience. Notwithstanding the need to âturbocharge our transition off of fossil fuels,â as expressed by Barb Gottlieb (Physicians for Social Responsibility), climate mitigation and pollution mitigation were not the primary focus of the workshop. This Proceedings of a Workshopâin Brief provides the rapporteursâ high-level summary of the workshop discussion. Additional details can be found in materials and videos available online.2 This proceedings highlights potential opportunities for action, but these should not be viewed as consensus conclusions or recommendations of the National Academies. CLIMATE CHANGE IS A PUBLIC HEALTH EMERGENCY Climate scientists, advocates, government officials, and representatives of disproportionately affected communities shared their firsthand knowledge to illustrate the human dimensions of the climate crisis in communities throughout the United States. 1 See https://www.nationalacademies.org/our-work/environmental-health-matters-initiative (accessed November 12, 2021). 2 See https://www.nationalacademies.org/event/10-12-2021/communities-climate-change-and-health-equity-a-new-vision (accessed November 12, 2021).
The Changing Conversation on Environmental Health, Climate, and Equity Published environmental health objectives for the United States still define environmental health largely in terms of exposures to harmful pollutants.3 However, as Martha Rudolph (Colorado Department of Public Health and Environment, Ret.) explained, there is growing recognition that pollutants are only one of the many facets within both the built and natural environments that influence human health. Climate change, Rudolph emphasized, âthe biggest change of allâ¦has a detrimental impact on environmental health and our health.â The way in which people connect climate change and human health has also evolved, said Allison Crimmins (U.S. Global Change Research Program [GCRP]). A 2016 GCRP report4 drew a direct link from upstream climate drivers, such as changes in temperature, precipitation, or sea level rise, to downstream health outcomes, such as increased mortality, respiratory illness, mosquito-borne disease, and mental health effects. Although the report recognized that certain characteristics, such as age, race, poverty, and preexisting health conditions, can influence an individualâs vulnerability to these upstream drivers, as seen in Figure 1, it did not consider the disparate impacts of climate change on entire populations within the United States. The GCRPâs fourth National Climate Assessment (NCA4)5 in 2018 advanced this conversation by identifying populations of concernâincluding communities of color, children, older adults, and low-income communitiesâthat are disproportionately affected by climate change. NCA4 noted where overlapping climate vulnerabilities and impacts combine within these populations to produce the greatest climate-induced health risks. This evolution in thinking is depicted in Figure 2. FIGURE 1 Conceptual diagram illustrating the exposure pathways by which climate change affects human health. SOURCE: Crimmins, A., J. Balbus, J.L. Gamble, C.B. Beard, J.E. Bell, D. Dodgen, R.J. Eisen, N. Fann, M.D. Hawkins, S.C. Herring, L. Jantarasami, D.M. Mills, S. Saha, M.C. Sarofim, J. Trtanj, and L. Ziska. 2016. Executive Summary. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, pp. 1â24. http://dx.doi.org/10.7930/J00P0WXS. Climate Change in the Context of Existing Environmental Health Inequities In a syndemic, two or more linked health problems affect a community at the same time and amplify each otherâs negative effects. Communities of color are experiencing ââ¦ there is no more the syndemic of climate change, environmental injustice, and structural racism, said fundamental a right we have Adrienne Hollis (Hollis Environmental Consulting). Any of these challenges on their neglected as a nation than the own may be deadly, but, together, they affect every aspect of life. Speakers from right to health.â â Dan Wildcat across the United States described the ways in which climate impacts amplify existing environmental health challenges in their communities. 3 See https://health.gov/healthypeople/objectives-and-data/browse-objectives/environmental-health (accessed November 12, 2021). 4 See https://nca2018.globalchange.gov/chapter/front-matter-about/ (accessed November 12, 2021). 5 See https://nca2018.globalchange.gov/chapter/front-matter-about/ (accessed November 12, 2021). 2
FIGURE 2 Examples of populations at higher risk of exposure to adverse climate-related health threats along with adaptation measures that can help address disproportionate impacts. SOURCE: U.S. Global Change Research Program (USGCRP). 2018. Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II (D.R. Reidmiller, C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart, eds.). USGCRP, Washington, DC, 1515 pp. doi: 10.7930/NCA4.2018. Source: EPA. Reverend Leo Woodberry (Kingdom Living Temple and New Alpha Community Development Corporation) named a few of the challenges faced by the community of Florence, South Carolina. Many residents lack access to nutritious food and obtain healthy protein by fishing, but ocean warming and saltwater intrusion into estuaries have depleted local fish stocks, while torrential rain has destroyed local vegetable crops. Industrial development in wetlands has created impermeable surfaces that increase runoff and flooding, spreading herbicides, pesticides, and septic tank overflow, which in turn threaten drinking water and contaminate homes with black mold. The poor urban areas of Florence lack open space to plant trees, generating heat islands, and many renters cannot afford air conditioning. Florenceâs residents are disproportionately saddled with pre-existing conditions that cause premature death, including hypertension, diabetes, obesity, and respiratory problems, and they already have less access to healthcare, so the added impacts of climate change in their region cause them to be even sicker and die even earlier, said Woodberry. Allison Crimmins cited a case study of Calcasieu parish in Louisiana as an example of âcascading failuresâ from multiple climate threats.6 Calcasieu has high levels of racial segregation, poverty, and unemployment. Because of a proliferation of petrochemical facilities along the Louisiana coast, Calcasieu registers some of the highest levels of toxic emissions in the country, as well as disproportionately high rates of cancer, asthma, chronic obstructive pulmonary disease (COPD), premature death, low birthweight infants, and depression. In 2020, the COVID-19 pandemic brought job losses and food insecurity. In August 2020, Hurricane Laura hit the coast of Louisiana, destroying houses and infrastructure and disrupting the electric grid and water supply. A heatwave immediately followed. At the same time, an industrial facility near Lake Charles caught fire and released chlorine gas and other pollutants into the air, requiring residentsâmany of whom remained without powerâto stay inside and shut their windows. Residents with power and air conditioners were told to turn off their units, despite the heatwave. Indigenous communities already face multiple economic, political, and social crises, which climate change exacerbates. For example, of Alaskaâs 220-plus Indigenous communities, 144 are threatened by climate change as Alaska is warming faster than anywhere else on the planet, noted Jackie QataliÃ±a Schaeffer (Alaska Native Tribal Health Consortium). Entire communities of the Pointe-au-Chien âWe have to remember that the next storm tribe on the Gulf Coast have been destroyed by hurricanes, said Dan Wildcat is on the way, the next freeze is on the way, (Haskell Indian Nations University), noting that the resulting levels of stress, there are all kinds of things that people anxiety, and exhaustion are difficult to fathom. He said that no people on are actively dealing withâ¦we canât just be the planet experience the existential threat of climate change at the level talking about it.â â Carmen Llanes Pulido that Indigenous people do, because the identity of Indigenous people is the product of a longstanding symbiotic relationship between the environment, place, and people, in which the environment is not only a physical reality, but also an internalized reality of âwho we are.â Thus, climate change threatens the very existence of Indigenous people all over the globe, he said. 6 See http://www.lancetcountdownus.org/wp-content/uploads/2020/12/cs-compounding.pdf (accessed November 12, 2021). 3
The Role of Racism in the Disproportionate Impacts of Climate Change on Communities of Color In April 2021, the director of the Centers for Disease Control and Prevention (CDC) declared racism to be a serious public health threat.7 Speakers reflected on several ways in which historically entrenched racism drives health disparities as well as the disproportionate impacts of climate change. Because of redlining, that is, racial discrimination in housing, and the impact of racism on wealth and lending, people of color are more likely to reside in areas at greater risk for climate impacts, such as areas with more impervious surfaces,8 less tree canopy, a greater heat island effect, and greater flooding, said Rohan Radhakrishna (California Department of Public Health). Radhakrishna said that in Fresno, California, African Americans and Latinos are 8.5 and 4.5 times, respectively, more likely than whites to reside in such high-risk areas. Munerah Ahmed (New York City Department of Mental Health and Hygiene) noted that Black New Yorkers, who are concentrated in neighborhoods with less green space, are twice as likely to die from heatwaves as their white counterparts, and neighborhoods with the highest heat vulnerabilities also have the highest vulnerabilities to other health outcomes, such as asthma and diabetes.9 Structural racism affects housing, economic status, education, and community resources, and determines health outcomes on a regular basis, not only under conditions of extreme heat, said Ahmed. Hilton Kelley (Community In-Power and Development Association) observed that many African American communities were relegated to the deltas and marshes of Mississippi, Louisiana, and Texas, where they now endure chemical runoff and extreme flooding. âAfrican Americans were forced to live in those low-lying areas due to the Jim Crow laws and regulations [but] house after houseâ¦has been abandoned because FEMA [Federal Emergency Management Agency] would not assist them with elevating it nor would the cityâ¦therefore shouldnât we be given a fair shot and support we need with getting out of those areas now?â Stephanie Smith (Maryland House of Delegates and Baltimore City Department of Planning) cited the landmark 1987 study, âToxic Wastes and Race,â10 which demonstrated a direct correlation between the placement of toxic waste facilities and communities of poverty and/or color and led to coining of the term âenvironmental racism.â A follow-up report in 200711 found that an upper-income, upper-middle-class Black household is still more likely than a lower-income white household to live near a toxic polluting source. Surili Patel (Metropolitan Group) noted that environmental racism takes multiple forms, including racial discrimination in environmental policymaking and enforcement; deliberate targeting of communities of color for toxic waste disposal and the siting of polluting industries; and the official sanctioning of life-threatening levels of poisons and pollutants in communities of color. James Rattling Leaf (Great Plains Tribal Water Alliance, North Central Climate Adaptation Science Center) recalled Indigenous communitiesâ history of trauma and displacement when their land, languages, and customs were taken âand we were dispossessed of most things that really defined us as a people.â The Lakota live in some of the poorest counties in the United States and are still dealing with intergenerational trauma stemming from these losses as well as from the history of residential boarding schools, he said, adding that âwe can talk about climate change, but if we donât deal with these other things in conjunction, weâre not going to be where we need to be.â The added impact of climate change has âWe also have to call a thing a thing when weâre discussing these issues created a âperfect stormâ of crises hitting Indigenous communities, said Wildcat. â¦environmental racism is fueled by racism.â â Stephanie Smith SOME CHALLENGES TO ADDRESSING THE CRISES IN DISPROPORTIONATELY AFFECTED COMMUNITIES Experts from affected communities, governments, and foundations described some of the challenges to finding and funding equitable solutions to the health inequity and climate crises. Impacts of Data and Funding Gaps on Disproportionately Affected Communities Government, foundation, and nonprofit speakers discussed the challenges that small communities and communities of color face in their efforts to be acknowledged in data and funded to address climate impacts and health inequities. The connections between pollution and health impacts have been well-established on a large scale. However, Mariella Puerto (Barr Foundation) explained, two aspects of data collection and analysis are lacking: data at the neighborhood or âmicroâ level to assist communities fighting local environmental threats, and rapid response data analysis to understand how proposed policies or regulations would impact communities. The need for micro-level data is particularly relevant for small 7 See https://www.cdc.gov/healthequity/racism-disparities/director-commentary.html (accessed November 12, 2021). 8 See https://www.usgs.gov/special-topic/water-science-school/science/impervious-surfaces-and-flooding?qt-science_center_ objects=0#qt-science_center_objects (accessed November 28, 2021). 9 See https://nyccas.cityofnewyork.us/nyccas2021v9/report/1 (accessed December 21, 2021). 10 See https://www.nrc.gov/docs/ML1310/ML13109A339.pdf (accessed November 15, 2021). 11 See https://www.nrdc.org/resources/toxic-wastes-and-race-twenty-1987-2007 (accessed November 15, 2021). 4
rural communities and Indigenous communities, noted Dorette Quintana English (California Department of Public Health). For example, many residents of Greenville, Californiaâthe home of many members of the Greenville Rancheria of Maidu Indiansâwere rendered homeless by the Dixie Fire, but Greenville hardly appears in existing climate data because of its small size. Research cited by Quintana English shows that year-round residents of small rural and frontier12 communities have been left behind by governments and organizations funding climate adaptation and recovery measures.13,14 Kristin Leahy Fontenot (FEMAâs Office of Environmental Planning and Historic Preservation) underscored the difficulty that small communities experience when competing for limited grant dollars to build resilience to climate change, noting that âa community like Miami and a small community also along the coastâ¦ are not equal players in a game like that.â Tribal nations are required to complete hundreds of pages of applications and policy reviews in order to gain access to programs, such as FEMAâs Building Resilient Infrastructure and Communities (BRIC)15 grants, said Jackie QataliÃ±a Schaeffer, because federal agencies are constrained by national policies governing the allocation of funds. But because Alaskan tribes are small, ranging from 50 to just over 2,000 members, staffing is insufficient to handle the paperwork, and small tribes have difficulty scaling down the programs. Climate philanthropies have also failed to invest in ââ¦when you have political polarization, racism, communities of color, said Mariella Puerto. A study by the New School sexism, and gender inequality, that always for Social Research found that only 1.3 percent of total climate funding creates gaps in knowledge and science and data, went to environmental justice organizations led by people of color.16 and it creates exclusion, which naturally creates ... gaps.â â Ayo Wilson Community Engagement in Decision-Making Processes Communities most affected by climate change are experts in identifying their problems and envisioning solutions, but they are often not consulted or compensated, producing results that may fail to address their needs. Speakers from such communities described some of the obstacles hindering their full participation in decisions that affect their health and resilience. Tribes lack the capacity to fully vet and develop effective policy responses to proposed federal regulations within allotted public comment periods, said Ann Marie Chischilly (Institute for Tribal Environmental Professionals [ITEP]). This leaves Indigenous communities out of the conversation, QataliÃ±a Schaeffer commented. In Puerto Rico, community and environmental lawyer Ruth Santiago has witnessed âso-called experts that are paid millions of dollars to do studies often make really egregious mistakes about what is on the ground and therefore what a project should look like,â because government officials failed to incorporate community input into their decision-making. On a local scale, Manal Aboelata (Prevention Institute) noted that municipal agencies are not required to demonstrate equitable decision-making by providing, for example, a map that shows how infrastructure dollars are spent in each area relative to need. She added that communities need access to this information, and public agencies need to be held accountable for achieving equity goals. Without this imperative, the ability to use public funds to achieve social, climate, and equity aims is severely limited, she added. Further, university-led research often does not benefit the communities being studied, noted Omega Wilson (West End Revitalization Association) and Bakeyah Nelson (Climate Imperative, Energy Innovation). Academics recruit local organizations to help with community engagement, but the community itself often cannot access the data it helped produce or the funds needed to advocate for policy change based on the findings. SOME CURRENT STRATEGIES AT WORK Advocates, government officials, funders, and representatives of disproportionately affected communities described the strategies they are implementing to advance health equity and to equitably respond to the climate crisis. 12 See http://frontierus.org/what-is-frontier/ (accessed November 29, 2021). 13 See https://www.energy.ca.gov/sites/default/files/2019-12/Governance_CCCA4-CNRA-2018-007_ada.pdf (accessed November 12, 2021). 14 Gupta, S. 2020. Climate Change, Health, and Equity Survey Findings: Gaps, Needs, and Opportunities. Health and Environmental Funders Network. https://www.gih.org/wp-content/uploads/2020/03/CHE-Survey-Findings-Report.pdf. 15 See https://www.fema.gov/grants/mitigation/building-resilient-infrastructure-communities (accessed November 15, 2021). 16 Baptista, A., and A. Perovich. 2020. Environmental Justice and Philanthropy: Challenges and Opportunities for Alignment. Tishman Environment and Design Center and Building Equity and Alignment for Impact. https://static1.squarespace.com/ static/5d14dab43967cc000179f3d2/t/5e5e7781cccebf576948d365/1583249295033/EJ+and+Philanthropy+Alignment+MW+and+ GS_3.3.20_final.pdf. 5
Local Organizing to Build Resilience and Community Ownership The climate crisis takes diverse forms that reflect the complexity of U.S. geography, history, and culture. Even within the same city, neighborhoods have different needs. Advocates and government officials described varied approaches to addressing the particular needs of their communities and preventing future climate disruptions. In southeast Austin, Texas, development and inadequate regulation âhave allowed certain risk factors to just layer on each otherâ and disproportionately expose a community with many immigrants, military personnel, and people of color to catastrophic flooding, said Carmen Llanes Pulido (Go Austin/Vamos Austin [GAVA]). GAVA works on climate resilience by applying existing, local community organizing methods to improve disaster preparedness and drainage infrastructure. Simultaneously, GAVA strives to obtain more equitable investment from government agencies and to establish âcommunity- drivenâ frameworks for capturing that investment, Llanes Pulido said. Puerto Rico is home to some of the most contaminating fossil fuel plants in the nation, said Santiago. Its electricity is supplied by a public utility that Santiago described as âvery carbonized, centralized, undemocratic, and colonial.â After Hurricane Maria knocked out the islandâs power supply and roughly 4,000 people died, citizens sought to become active participants in the planning and implementation of electricity supply and provision. They have put forth a proposal17 that promotes a radical transformation of the grid to include community-based rooftop solar and other systems that can provide resilience in the face of increasingly frequent and intense hurricanes and storms. Social resilience is the goal of New York Cityâs âBe A Buddyâ program,18 said Munerah Ahmed. In the recent past, city policies dismantled neighborhoods, breaking the social connections that promote community resilience. To rectify this problem, New York City created a program aimed at fostering the social connections needed to develop greater resilience to climate change and other emergencies. Each community partner designed the program to suit its residents. âItâs not enough to bounce back from One uses a peer-to-peer senior model to recruit older adults; another uses an one crisis after another; we also need intergenerational approach, including youth workforce development; and a third to address the root causes and bounce uses arts and environmental justice to build connections within the community forward.â â Rohan Radhakrishna and to identify people in need of assistance and people able to volunteer during an extreme weather emergency. Coalitions and Networks to Help Communities Engage Regionally and Nationally For small, geographically isolated communities, the expertise and coordination required to advance climate equity can be difficult to attain. Coalitions serve these populations by sharing resources to aid with data analysis, funding, and policymaking; training community members to advocate for their particular adaptation needs; and pursuing long-term goals. Bishop Marcia Dinkins leads the Black Appalachian Coalition (BLAC),19 a four-state campaign to confront historic inequities in climate, environment, and health along the Ohio River Valley. Dinkins said that race, class, and economy play a large role in climate funding and climate equity, and even the public health narrative perpetuates inequities that disadvantage the Black community. BLAC was launched to challenge such narratives, including that of nostalgic whiteness âthat is rooted richly and romanticizedâ¦within the Appalachian and rural areas,â and to bring the lived experiences of Black people into focus to understand their health, infrastructure, and economic needs and to address historic racism, Dinkins explained. The goal is to âbreak the needle for degenerative policymakingâ and to create a more inclusive process by changing the narrative to one that sees all people as deserving, said Dinkins. The Chisholm Legacy Project (CLP)20 was also founded with a goal of correcting longstanding injustices, said Jacqui Patterson (CLP). It assists communities in four areas: community building, movement building, bending the arc of mainstream environmentalism toward equity and justice, and supporting Black women leaders in climate. Because of the diversity and small size of many tribal nations, coalitions are a powerful approach to more effectively address common tribal needs. ITEP has served greater than 95 percent of the 574 tribal nations throughout the United States, said Ann Marie Chischilly. ITEP helps tribes develop climate adaptation plans that are culturally sensitive and appropriate to their nations, and that consider the next seven generations. These plans are the basis for funding from the U.S. government and foundations. ITEP partners such as the National Tribal Air Association also help tribes develop policy response kits to 17 See https://www.queremossolpr.com (accessed November 12, 2021). 18 Charles-Guzman, K., A. Colarusso, D. Henry, H. Kim, and E. Lindsey. Cool Neighborhoods NYC: A Comprehensive Approach to Keep Communities Safe in Extreme Heat. Office of the Mayor. https://www1.nyc.gov/assets/orr/pdf/Cool_Neighborhoods_NYC_ Report.pdf. 19 See https://www.blackappalachiancoalition.com/ (accessed December 8, 2021). 20 See https://thechisholmlegacyproject.org/ (accessed December 8, 2021). 6
proposed regulations on environmental issues.21 Through ITEP mentorships, members of small tribes obtain expert advice from others in their region. The Alaska Native Tribal Health Consortium provides health services to 229 tribes across Alaska and helps tribes with climate adaptation, while intertwining Indigenous knowledge and science with traditional western processes, said Jackie QataliÃ±a Schaeffer. Collecting Actionable Data to Support Climate Equity Initiatives Collecting useful data that can inform policy and action is central to all of these efforts. Officials from state, local, and federal governments and one advocacy organization described the types of data that have been most useful for identifying interventions to promote climate and health equity. Prior to 2008, most weather-related health advisories were based purely on meteorological data, said Munerah Ahmed. To better predict the health impacts of changing temperatures, the New York City Department of Mental Health and Hygiene combined health data with meteorological data to inform health advisories. The department also mapped heat extremes throughout New York City, producing a heat vulnerability index that city policymakers use to inform equitable investment. In partnership with the National Oceanic and Atmospheric Administration (NOAA), the CDC recently developed a heat and health tracker,22 which helps emergency responders and communities prepare for and respond to heat events, said Patrick Breysse (National Center for Environmental Health, Agency for Toxic Substances and Disease Registry, CDC). However, Krystal Laymon (White House Council on Environmental Quality) noted that the U.S. Environmental Protection Agency (EPA), FEMA, CDC, and others all have separate tools, which introduce a variety of risks. Laymon opined that the data should be coalesced into an instrument that is straightforward for communities to use so that they can understand their climate risks and work toward a solution. Breysse also described the CDCâs Climate-Ready States and Cities Initiative (CRSCI), which allocates resources to states and communities across the country to implement the CDCâs BRACE program (Building Resilience Against Climate Effects), a bottom-up effort that helps communities identify and address their climate and health vulnerabilities. Using CDC funding through the BRACE framework, the Massachusetts Department of Public Health (MDPH) developed tools to identify climate hazards in 351 communities in Massachusetts,23 scaling down to sub-census-block groups and even further to identify individuals potentially at risk of climate and environmental hazards, said Marc Nascarella (MDPH). Local municipalities in Massachusetts now use these tools to advocate for state funding and training to address their climate-related needs. In Los Angeles County, data were crucial to the success of a 2016 ballot measure that authorized a parcel tax to pay for parks and open spaces,24 said Manal Aboelata. With community participation, the Los Angeles Department of Parks and Recreation conducted a needs assessment that used spatial mapping to produce a map illustrating park acreage per thousand residents throughout the county. This work revealed dramatic disparities in the distribution of parks and open space, with areas receiving the most park investment having the least park need. The map proved invaluable when the ballot measure was put before voters and also serves as a baseline for directing infrastructure dollars to the highest need areas, said Aboelata. Aboelata emphasized the crucial role played by a community advisory board in defining the metrics of the study and in connecting the research to advocacy goals.25 Within the California Department of Public Health, the Climate Change and Health Equity section of the Office of Health Equity collaborates with other agencies to address social determinants of living conditions and employs extensive data analysis tools, said Rohan Radhakrishna. One tool is CCHVIz, the Climate Change and Health Vulnerability Indicators, which groups indicators into three types: exposures, adaptive capacity, and population sensitivity.26 These indicators can be overlaid at a granular level to determine where people will be hit first and worst and to prioritize investments by state and local governments. A second tool, CalEnviroScreen, maps disproportionate vulnerability to multiple sources of pollution at the census tract level.27 A third tool, the California Healthy Places Index (HPI), explores 25 local indicators to determine life expectancy at birth.28 HPI is linked to a policy guide for both local- and state-level action, and it has been used to direct billions of dollars in state grants and funding, said Radhakrishna. These powerful tools have their limitations, he added, noting that significant variation occurs by block and not by census tract and that meaningful community engagement is necessary to ground the data. 21 See https://www.ntaatribalair.org/policy-resource-kits/#CurrentNTAAPolicyResourceKits (accessed November 19, 2021). 22 See https://ephtracking.cdc.gov/Applications/heatTracker/ (accessed December 8, 2021). 23 See https://www.mass.gov/climate-and-health (accessed November 29, 2021). 24 See https://www.preventioninstitute.org/blog/putting-land-use-policy-work-health-equity (accessed November 12, 2021). 25 See https://www.gih.org/philanthropy-work/featured/changing-the-landscape-people-parks-and-power/ (accessed November 19, 2021). 26 See https://www.cdph.ca.gov/Programs/OHE/Pages/CC-Health-Vulnerability-Indicators.aspx (accessed November 12, 2021). 27 See https://oehha.ca.gov/calenviroscreen (accessed November 12, 2021). 28 See https://healthyplacesindex.org (accessed November 12, 2021). 7
ADDRESSING THE CLIMATE CRISIS AND ADVANCING HEALTH EQUITY Speakers proposed strategies for addressing the climate crisis and advancing health equity. Federal agency speakers described their plans to realize the vision of Executive Order 14008,29 âTackling the Climate Crisis at Home and Abroad,â issued on January 27, 2021. EO 14008 directs federal agencies âto develop programs, policies, and activities to address the disproportionate health, environmental, economic, and climate impacts on disadvantaged communitiesâ and created the Justice40 Initiative, which aims to deliver 40 percent of relevant federal investment to disadvantaged communities. Operationalizing Equity âThe first [challenge] is to remember the humans,â said Radhakrishna. âSo often when people think about climate change, they think of infrastructure, trees, wildfires. The human health and equity reasons for climate action are so important, and they could be mandated to be addressed by all infrastructure investments and policies.â Carmen Llanes Pulido noted that equity depends on process as well as outcome, and Aboelata added that the Prevention Institute uses a framework30 that identifies three types of equity: structural, distributional, and procedural. This framework enables people to break down the components of equity to consider the historic and contemporary sources of inequity and to evaluate the success of efforts to close gaps. Stephanie Smith referenced a fourth consideration, transgenerational equity, noting that younger generations are often excluded from policymaking. Policy and systemic changes focused on improving climate, health, and equity are a form of primary prevention, said Radhakrishna, who proposed three types of changes that state, local, and tribal governments can make to address the root causes of health disparities. First, following the example of a 2015 California executive order,31 governments can require that specific health, climate, and emergency preparedness considerations are factored into all decisions. Second, health departments can create offices of climate change and health equity, similar to the one recently established at the U.S. Department of Health and Human Services.32 Third, states can require the involvement of disproportionately affected populations in climate change decision-making. To guide this last effort, the California Office of Health Equity created a checklist of questions to elicit a detailed picture of the impact of policies on vulnerable populations.33 Closing Gaps in Data and Funding Although equity in funding is crucial for achieving racial equity, communities must have the capacity to apply, receive, and use the dollars, noted Sacoby Wilson (University of Maryland). The invisibility of small communities further exacerbates existing funding gaps, with funders more commonly supporting projects in larger population areas. Quintana English suggested that this inequity could be offset through set-asides for small rural communities, as well as support to help these communities navigate the application process. Aboelata mentioned research from the University of California, Los Angeles, which found that when state-wide policy included a definition of equity, resources were directed to the communities with the highest need. Noting that âthe climate philanthropy field has a long way to go,â Mariella Puerto encouraged workshop participants to pay attention to the Climate Funderâs Justice Pledge, a campaign by the Donors of Color Network to persuade the top climate philanthropies to commit at least 30 percent of their annual U.S. climate funding to environmental justice groups led by Black, Indigenous, and people of color.34 Regarding the national level, Patrick Breysse mentioned several current CDC efforts to center communities in its climate work by addressing gaps in data and funding. The CDC recently created an environmental justice dashboard and is developing an environmental justice index. The agency plans to use these tools to identify communities at increased risk of environmental exposures and to allocate resources, in an âeffort to achieve environmental justice across the board,â added Breysse. He anticipates increased funding for CRSCI grants and expansion of the BRACE framework, with the goal of establishing a fully national program that includes strengthening workforce capacity at the local level. It is not easy to get federal money to communities on the ground who need it, said Heidi Stiller (NOAAâs Office of Coastal Management); âThere are a lot of rulesâ¦you have to sign in to seven different online systems to apply for, receive, and then administer your grantâ¦itâs a problem.â In line with the Justice40 Initiative, FEMA is working to make BRIC grants 29 See https://www.federalregister.gov/documents/2021/02/01/2021-02177/tackling-the-climate-crisis-at-home-and-abroad (accessed November 12, 2021). 30 See https://www.changelabsolutions.org/product/planners-playbook (accessed November 29. 2021). 31 See https://www.library.ca.gov/wp-content/uploads/GovernmentPublications/executive-order-proclamation/39-B-30-15.pdf (accessed November 15, 2021). 32 See https://www.hhs.gov/ocche/index.html (accessed November 15, 2021). 33 See https://opr.ca.gov/docs/20180312-Equity_Checklist.pdf (accessed November 29, 2021). 34 See https://climate.donorsofcolor.org (accessed November 15, 2021). 8
more accessible to disproportionately affected communities by offering technical assistance in the application process and considering economic disadvantage and other vulnerabilities in scoring, said Kristin Leahy Fontenot, adding that existing programs will need to be scrutinized to determine where they may inadvertently perpetuate disparities. Following the Lead of Affected Communities We must move beyond any model of public health that means treating communities as objects in scientific studies, said Dan Wildcat. Speakers discussed examples of the types of change needed to move toward an authentically inclusive process, in which disproportionately affected communities can actively engage in addressing the climate crisis in ways that benefit them directly. Suzi Ruhl (Yale School of Medicine) used the metaphor of communities setting the table rather than simply sitting at the table. Omega Wilson added, âIf Iâm coming to the table and all you have is spaghetti and I donât eat spaghettiâ¦I want to write the menu.â Local knowledge and data must drive the questions that guide research, and results must be used to inform policy and action, said Tisha Holmes (Florida State University). James Rattling Leaf and Jackie QataliÃ±a Schaeffer emphasized not only the deep historical knowledge embedded in Indigenous cultures, but also the wisdom these cultures offer humanity regarding how best to relate to nature and one another. Noting the difficulty of adapting large federal programs to meet the needs âPublic health professionals have of Alaskan tribes, QataliÃ±a Schaeffer called for a wholescale change of mindset and a to cultivate relationships with reimagining âfrom the foundation of that policy,â because greater success has been communities, and this means achieved by tackling problems on a small scale, incorporating Indigenous knowledge, doing public health differently.â and then scaling up. â Dan Wildcat To overcome the limitations of university-led research, the West End Revitalization Association pioneered community-owned and -managed research (COMR),35 said Omega Wilson. COMR prioritizes the research needs of the affected community, which receives funding and retains ownership of the data. The results of COMR must be applied so as to benefit the community: âscience for complianceâ¦[not] researching people of color and Indigenous people like guinea pigs, but actually correcting the problem that you find,â said Wilson. Carmen Llanes Pulido expressed concern that resilience and sustainability are becoming buzzwords, and stressed the importance of maintaining a community voice in shaping indicators of success and redefining values. She commented, âfrontline communitiesâ¦can very concretely and tangibly tell you 10 things they need to have in place before the next storm.â Stephanie Smith noted that engaging communities as partners in data collection builds valuable connections while increasing individualsâ investment in their communities, providing an on-ramp to advocacy. Using the Power of Stories âWhat many people undervalue, what I find most important, is story,â said Smith. Elected officials may be influenced more by their constituentsâ stories of how they are impacted than by the data. These stories have the greatest impact when they are delivered directly to the decision-maker by the affected parties rather than by advocacy groups, she added. Manal Aboelata outlined how the Prevention Institute collected the personal stories of residents from East and South Central Los Angeles. When presented in combination with data showing that inequities in the distribution of parks, open space, and tree canopy were tied to substantial gaps in life expectancy, these stories became a powerful advocacy tool. The absence of Black peopleâs stories was the catalyst for the formation of the Black Appalachian Coalition, said Bishop Marcia Dinkins, explaining, âWhen the stories and the people are absent, then you really canât have a full conversation around solutions.â Dan Wildcat underscored the importance of engaging Indigenous peoplesânot only to better understand the nature of the problem and find solutions, but also to leverage the powerful Indigenous voice about the existential threats that humanity faces. Enhancing Public Education, Engagement, and Collaboration Finding effective solutions to the climate and health inequity crises will depend on the ability to marshal diverse resources and span the silos that isolate scientific disciplines, government agencies, and geographical regions. It will also depend on better communication and education that enable the full participation of affected communities. âInequity thrives in ambiguity and opaque policies,â said Smith, noting that to build public trust, the decision-makers in government must be transparent about the process that led to a particular decision. Baltimore offers simulations of decision-making for citizens and has trained nearly 200 residents on human health and the environment. The simulations ââ¦enabled people to feel that the system can be influenced by them [by erecting] an on-ramp [that] didnât exist before,â said Smith. Universities have been great allies, but needed even more than education, said Ruth Santiago, is for government 35 See https://pubmed.ncbi.nlm.nih.gov/20208213/ (accessed November 15, 2021). 9
officials to be more accessible, share their knowledge, and listen to the lived experiences and the local knowledge of residents. Small communities, such as Greenville, California, need participatory planning and engagement to prepare them in advance of disaster, said Dorette Quintana English. Alaska has some of the most extreme environments on the planet, ranging from rainforest to Arctic tundra, and tools and adaptation processes developed in Alaska could help communities in the Gulf of Mexico, said Jackie QataliÃ±a Schaeffer. Dan Wildcat and colleagues have proposed a research hub to focus on the impacts of climate change on coastal native communities. The proposed Coastlines and People hub will serve as a model of convergent science, bringing together experts in climate modeling and remote sensing with residents on the ground. At the National Institutes of Health (NIH), a working group is developing an NIH-wide strategy for climate change and health, with input from across the United States and around the globe, said Richard Woychik (National Institute of Environmental Health Sciences, National Toxicology Program, NIH). Among the priorities that have emerged is the need for âsustained research partnerships, especially those with disadvantaged communities,â he added. One Justice40 pilot program at the NIH, the Environmental Career Worker Training Program (ECWTP), has trained more than 13,000 workers since 1995. This program, which has been targeted for expansion, delivers 100 percent of training activities to disadvantaged communities, said Woychik. The Office of Domestic Climate Policy (ODCP) is designing a clean energy accelerator to leverage private capital to invest in low-income and disadvantaged communities, said Sonia Aggarwal (ODCP). At NOAA, Heidi Stiller wants to deploy more advisors into communities to help them understand and apply climate predictions: âwe need an adaptation army.â Philanthropic foundations can play a significant role in strengthening the publicâs capacity to participate in decision- making. Noting that âthe climate field is not very diverse,â the Barr Foundation is exploring ways to build the leadership and capacity of equity-centered climate organizations and career pathways for people of color to enter the climate field, said Mariella Puerto. Institutional funders should stop bifurcating climate adaptation from disaster recovery, said Jeanne Herb, adding that the communities most affected by the pollution that drives climate change are also disproportionately affected by climate disasters, and funders must find solutions that address both. Addressing the Root Causes of Inequity The only way to achieve lasting equity is by correcting injustice, said Surili Patel, adding that to do so requires a reimagining of all sectors so that equitable access to tools and opportunities becomes embedded in the structure. Speakers described examples of what this work would entail. We must look farther upstream for solutions, starting with building political will and wealth in communities, said Patel. Affected communities could derive benefit from libraries, pools, and schools where they can ride out heat events, take refuge from wildfires, and access nutritious food that is not undercut by a changing climate. Communities of color, disadvantaged communities, and people struggling with health issues must define equity on their own terms, said Bishop Marcia Dinkins. Economic inequality is causally linked with health problems and lower life expectancy, said Rohan Radhakrishna, and explicitly naming and addressing inequities based on racism will improve resilience to the health impacts of climate change among people of color. Stephanie Smith added that âa lot of policy areasâ¦might not jump out at you as having disproportionate benefits for communities that have been excluded and sometimes just overlooked altogether, but [supporting] policy measures that will enable people to live more fully in this American experienceâ¦is the first step.â Several speakers also noted that local communities do not control the drivers of climate change, and that the sweeping changes necessary to prevent the worst climate scenarios cannot be accomplished without policy change on the national level. Aggarwal agreed, saying that federal efforts to reduce carbon emissions and advance environmental justice must make âmeaningful progress on the time scale that we need.â FINAL REFLECTIONS Making these changes will require a cooperative effort, said Ana Diez Roux (Drexel University), with local groups, national coalitions, foundations, scientists, and policymakers working together âto challenge the idea that there is no other way to organize our world, and to create urgency about the need to address these bigger factors. If we donâtâ¦ then all the other work that weâre going to do is only going to be tinkering around the edges.â Speakers shared many ideas for actions that can be undertaken now to address climate change and health inequity, which are summarized in Table 1. 10
TABLE 1 Potential Actions Suggested by Individual Workshop Participants to Address Climate Change and Health Inequity in the United States Area of Focus Potential Actions Possible Actors a Include disaster preparedness as a form of primary prevention against adverse health outcomes Governments, Funders Restructure allocation and management of climate resilience dollars, including noncompetitive disaster preparedness Federal Government grants for under-resourced communities Apply Justice40 and equity tools to direct investments to the most affected communities Governments, Funders Investing in disaster preparedness and recovery Build human capacity for successful grant application and management in disadvantaged communities Governments, Funders for vulnerable communities Establish disaster preparedness and recovery set-asides for renters and populations with low critical mass Federal Government Streamline grant applications and reduce onerous reporting requirements for small rural communities and Indigenous Federal Government communities Restructure programs to scale for small Indigenous populations and enable incorporation of local knowledge Federal Government Legislate equal justice requirements for all infrastructure spending Governments Employ health equity assessment tools to identify communities with disproportionate vulnerability to climate impacts and Governments, Researchers, prioritize investment Funders Gather data to track adherence to equity and justice requirements by government agencies and share these data with the Governments, Researchers, Operationalizing climate- public to promote accountability Media related health equity and justice at local, state, and Create an office of climate change and health equity in every health department Governments tribal levels Systematically consider the climate, health, and equity impacts of policies at all levels Governments Require involvement of disproportionately affected communities in climate change decision-making Governments Employ a policy, systems, and environmental change approach to address complex challenges by simultaneously Governments changing multiple stressors Governments, Universities, Support multidisciplinary, collaborative research that includes affected communities as research partners Funders Obtain micro-level data to inform local action Governments, Researchers Perform rapid response analyses to evaluate the impact of proposed legislation and regulation on communities Governments, Researchers Collecting actionable Support interdisciplinary and interagency training and research to investigate the multiple, interacting factors that Governments, Universities, data to inform investment contribute to climate and health Funders and legislation aimed at Develop incentives, rewards, and funding structures for researchers to engage in solution-focused science addressing Universities, Governments, achieving climate-related climate-related health inequities Funders health equity goals Identify unintended adverse equity consequences of the measures taken to address climate change Researchers, Governments Amend public comment process to enable small rural communities and Indigenous communities to respond effectively to Federal Government proposed legislation and regulation Act with urgency: undertake pilot projects now; draw on existing data, modeling, and the bright spots where interventions Governments, Researchers, are succeeding to inform this work Funders, Coalitions Listen to members of affected communities, share expert knowledge, and include communities in decision-making Governments Incorporate local and Indigenous knowledge into the decision-making process Governments Provide on-ramps for community engagement through citizen research, simulations of legislative decision-making, and Governments, Universities, Engaging communities in other activities Coalitions identifying their climate- related health challenges Universities, Governments, Form partnerships to educate communities about the science underlying their environmental health and health equity and shaping solutions Coalitions Governments, Coalitions, Form partnerships to build social resilience Funders Establish programs to develop the leadership skills of youth from affected communities and provide them with Governments, Funders, opportunities to engage Coalitions, Universities Media, Governments, Center the climate discussion around human health; emphasize that climate change is a major global health issue Funders Raising public awareness of Rigorously document the unequal impacts of climate change, as well as the inequities inherent in the fact that people Researchers, Funders, the human health impacts suffering the most are not driving the changes Governments, Media and inequities caused by Communities, Coalitions, climate change Share firsthand stories of climate-related health impacts with the public and with government decision-makers Media Coalitions, Media, Discuss the co-benefits, where addressing climate change also benefits health, and vice versa Governments Partner with affected communities in shaping research priorities and solutions Researchers Employ a participatory research framework, such as community-owned and -managed research Researchers Centering frontline communities in climate- Share research results with communities and support advocacy needs informed by the research Researchers related health research Measure impacts of climate change on small and low-density communities and tribes Researchers Coalitions, Governments, Develop a repository of effective strategies for centering community participation to inform climate policy and practice Researchers Employ an expansive definition of environment that recognizes the contribution of economic and social inequities, past Governments, Researchers, and present, to current environmental inequities Funders Addressing the deep Work collectively to address the major drivers of climate change and to correct unsustainable and highly inequitable Governments, Researchers, structural and systemic patterns of consumption Funders, Coalitions factors impacting health equity and vulnerability to Look upstream of the immediate disasters to name and correct unjust structures and strengthen communities that have Governments, Coalitions, climate change been historically disadvantaged Funders, Media Federal Government, Support climate and health equity for citizens residing in U.S. territories that are disenfranchised at the national level Coalitions, Funders a Actors have been inferred where attendees did not explicitly identify actors. NOTES: This table lists potential actions attributed to individual workshop participants in the text above, grouped by similarity, because topics were discussed from different angles at different points during the workshop. This table does not include all actions mentioned by participants. These actions are not consensus conclusions or recommendations of the National Academies. 11
DISCLAIMER: This Proceedings of a Workshopâin Brief was prepared by Carol Berkower, Abigail Ulman, and Alex Reich as a factual summary of what occurred at the workshop. The statements recorded here are those of the individual workshop participants and do not necessarily represent the views of all participants, the workshop planning committee, the Environmental Health Matters Initiative committee, or the National Academies of Sciences, Engineering, and Medicine. REVIEWERS: To ensure that this Proceedings of a Workshopâin Brief meets institutional standards of quality and objectivity, it was reviewed in draft form by Tracey Holloway, University of Wisconsin-Madison; Maureen Lichtveld, University of Pittsburgh; Mark A. Mitchell, George Mason University; and Linda Rudolph, Public Health Institute. The review comments and draft manuscript remain confidential to protect the integrity of the process. Workshop planning committee members: Jeanne Herb (Chair), Rutgers University Bloustein School of Planning and Public Policy; Ana V. Diez Roux, Drexel University Dornsife School of Public Health; Jamie Donatuto, Swinomish Indian Tribal Community; Adrienne L. Hollis, Hollis Environmental Consulting; Tisha T.J. Holmes, Florida State University Department of Urban and Regional Planning; Philip R.S. Johnson, The Heinz Endowments; Rebecca E. Morss, National Center for Atmospheric Research; Bakeyah S. Nelson, Climate Imperative, Energy Innovation; Linda Rudolph, Public Health Institute; Peggy M. Shepard, WE ACT for Environmental Justice; and Sacoby M. Wilson, University of Maryland, College Park. Members of the Environmental Health Matters Initiative committee: Martha E. Rudolph (Co-Chair), Colorado Department of Public Health & Environment (retired); Jonathan M. Samet (NAM) (Co-Chair), Colorado School of Public Health; Darrell Boverhof, The Dow Chemical Company; Thomas A. Burke, Johns Hopkins Bloomberg School of Public Health; George P. Daston, Procter & Gamble Company; Ana V. Diez Roux (NAM), Drexel University Dornsife School of Public Health; Estella M. Geraghty, Esri; Lynn R. Goldman (NAM), The George Washington University Milken Institute School of Public Health; Daniel S. Greenbaum, Health Effects Institute; Gavin Huntley-Fenner, Huntley-Fenner Advisors, Inc.; Philip R. Johnson, The Heinz Endowments; Beth Karlin, See Change Institute; Jennifer McPartland, Environmental Defense Fund; Devon C. Payne-Sturges, Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health; and Amy Pruden, Virginia Tech. Liaisons of the Environmental Health Matters Initiative committee: Francie Abramson, Target; John Balbus, National Institutes of Health (NIH)/National Institute of Environmental Health Sciences (NIEHS); Linda Birnbaum, NIH/NIEHS; Patrick Breysse, Centers for Disease Control and Prevention; Wayne Cascio, U.S. Environmental Protection Agency; Elizabeth Cisar, U.S. Environmental Protection Agency; David Dyjack, National Environmental Health Association; Zach Freeze, Walmart; Richard Fuller, Pure Earth; Carlos Gonzalez, National Institute of Standards and Technology; Al McGartland, U.S. Environmental Protection Agency; Ansje Miller, Health & Environmental Funders Network; Gary Minsavage, ExxonMobil Corporation; Surili Patel, Metropolitan Group; Geoffrey S. Plumlee, U.S. Geological Survey; Katherine Robb, American Public Health Association; John Seibert, U.S. Department of Defense; Robert Skoglund, Covestro; Joel Tickner, Green Chemistry & Commerce Council (GC3); Juli Trtanj, National Oceanic and Atmospheric Administration; and Jalonne White-Newsome, Empowering a Green Environment and Economy, LLC. The Environmental Health Matters Initiative, under which this workshop was organized, has been supported by the Gordon and Betty Moore Foundation through Grant GBMR8014, the National Institute of Environmental Health Sciences, National Institutes of Health, U.S. Department of Health and Human Services, under Contract No. HHSN263201800029I, the Centers for Disease Control and Prevention, ExxonMobil, Target Corporation, U.S. Environmental Protection Agency, and Walmart Foundation, as well as the National Academy of Sciencesâ George and Cynthia Mitchell Endowment for Sustainability Science and the National Academy of Sciencesâ Cecil and Ida Green Fund. 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. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity: Proceedings of a Workshopâin Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/26435. Division on Earth and Life Studies Copyright 2022 by the National Academy of Sciences. All rights reserved.