Getting Ready : Health, Planning and Climate Change Readiness

1. Contra Costa Health Services Getting Ready : Health, Planning and Climate Change Readiness

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

3. Current Disparities in Health: Income

4. Current Disparities in Health: Race

5. Current Disparities in Health: Education

6. Other Health Disparities • Heart Disease • Cancer • Stroke • Asthma

7. 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

8. Vulnerability

9. Vulnerability

10. Vulnerability

11. Vulnerability

12. Vulnerability

13. Climate Change Exacerbates Existing Health Disparities • Climate Impacts: • Extreme Heat • Increased Average Temperatures • Air Pollution • Wildfire • Severe Weather/Storms • Agricultural Disruptions • Drought • Sea Level Rise • 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

14. Climate Change Impacts: Geographically Uneven

15. Climate Change Exacerbates Existing Disparities • Climate Impacts: • Extreme Heat • Increased Average Temperatures • Air Pollution • Wildfire • Severe Weather/Storms/Sea Level Rise • Agricultural Disruptions • Drought • Health Impacts: • Displacement • Drowning • Injuries • Water and Food-Borne Disease from Failing Infrastructure • Groups Most Impacted: • Coastal Residents • Elderly • Children • Low-Income People

16. Climate Change Impacts: Geographically Uneven

17. Risk-Based InitiativeContra Costa County

18. 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

19. 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

20. Project Activities • 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

21. Public Health and Medical Hazard Risk Assessment • 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

22. Public Health and Medical Hazard Risk Assessment • Determine severityof 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

23. Severity is the magnitude of the hazard minussurge capacity and existing mitigation strategies. • Severity = hazard - mitigation

24. 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

25. Categories of Mitigation Strategies • Physical Infrastructure / Operational • Organizational Infrastructure • Social Infrastructure

30. 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

31. 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

32. “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%

33. 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

34. 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.

35. 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

36. Between 1960 – 1990 • Englewood: • 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

37. “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.”

38. Risk-Based Initiative Current Efforts • Earthquake Hazards • Vulnerable Population: Medically Dependent • Working with providers (services and equipment) to identify real-time emergency response efforts • Timeline • Planning underway – 2013 • Outcomes • Emergency response procedures • Mutual assistance agreements

39. Contra Costa County Climate Leaders Workshop CCC Operational Area Excessive Heat Emergency Plan February 28, 2013

40. 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

41. 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

42. 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

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

44. ResponsibilitiesLocal Government Role • Three Activation Levels • Monitor • Partial • Full • Gather and Analyze Information • Coordinate Services • Encourage Interagency Information Exchange

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

46. 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

47. Public Information • Websites Heat Tips Posted • Press Release Templates • Media Outreach • CCTV Videos

48. 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

49. Gaps • Heat Conference Call Updates with NWS and Cal EMA • Annual Readiness Campaign • Public Education and Outreach

50. 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