In 2007, Denver unveiled its Climate Action Plan and set a greenhouse gas reduction goal to reduce emissions by 10 percent per capita below 1990 levels. Denver is on track to meet this goal and continues to be proactive in reducing city-wide per capita emissions. However, the planet is warming and the resulting effects have the potential to harm Denver’s social, economic, and environmental sectors. Along with mitigation practices aimed to reduce greenhouse gas emissions, Denver must address and prepare for the impacts of climate change already occurring and those projected to occur, in order to prosper in the future. Supplementing Denver’s Climate Action Plan, the Climate Adaptation Plan offers collaborative strategies to adapt to a future climate with higher temperatures, more extreme weather events, and changes to annual snowpack. Denver recognizes climate change as a defining issue of the 21st century and remains committed to facing the challenges of a changing climate through preparedness, forward thinking, and cost-effective strategies. Denver strives to not only be one of the greenest cities in the nation, but also one of the most innovative and climate resilient cities in the face of rapid climate change. The objectives of the Climate Adaptation Plan are to prepare, mitigate, and plan for risks associated with the following potential climate impacts to Denver: 1. An increase in temperature and urban heat island effect; 2. An increase in frequency of extreme weather events; 3. Reduced snowpack and earlier snowmelt.Denver’s Climate Adaptation Plan visions to provide a collaborative path forward to prepare for a hotter climate, protecting what we cherish. Denver’s Climate Adaptation Plan was prepared with the following values understood: The City and County of Denver is preparing for a hotter and more variable climate. The Plan provides a collaborative path forward to prepare for these climate changes, protecting what we cherish so future generations will enjoy a quality of life characterized by economic opportunity, parks and open spaces, recreational activities, and an environment conducive to support residents’ health and well-being. The focus of this Plan is to identify adaptation strategies within Denver City agencies and community organizations that will lead to future adaptation efforts Denver can implement. Successful implementation of the Plan supports a vibrant Denver that is resilient to climate challenges and continues to prosper as a world-class city where everyone matters. Long-term planning and coordinated implementation are needed to address the social, economic and environmental consequences of climate change impacts on Denver. In response, Denver convened a working group made up of A resilient community will be able to enjoy economic opportunity, parks, open spaces, recreational activities, and an environment conducive to support resident’s health and well being. department representatives in spring, 2012 to begin assessing the impacts Denver may face as a result of a changing climate. In coordination with City agencies, the working group identified Denver’s top vulnerabilities to climate change. These were used as a framework to establish short, medium, and long-term climate adaptation activities. These activities will allow Denver to reach its long-term vision to be one of the most innovative and resilient cities in the face of climate change. The short, medium, and long-term activities are categorized by sectors throughout the Climate Adaptation Plan. The sectors refer to broad planning areas that will be affected by climate change impacts. The sectors used in the Climate Adaptation Plan are: buildings and energy, health and human services, land use and transportation, urban natural resources, water consumption, and food and agriculture. Each sector is facing different impacts from climate change and can adapt in different ways. Systematically examining which climate impacts affects each sector helps identify where climate adaptation action is most needed, allowing Denver to create forward-thinking and cost-effective adaptation strategies.

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After going through this manual, the learner should be able to: – Define key terms and concepts of climate change and human health – Describe the effects of climate change on human health – Identify the health impacts of climate extremes -Explain the link between climate change and infectious disease – Determine the approximate magnitude of the health impacts of climate change – Explain the interaction between ozone depletion and greenhouse gas-induced warming – Describe the effects of climate change on the learner’s city – Analyse the current health situation -Identify the main climate-related health threats – Identify vulnerable populations – Plan public health interventions to address climate change and its health impacts – Discuss issues related to monitoring health impacts of climate change – Discuss key areas that can be addressed by public health research – Describe possible policies and measures to respond to climate change How this Manual is Organized This manual is divided into eleven Sessions. Session 1: An overview of climate change and human health – risks and responses Session 2: Health situation in cities Session 3: Weather, climate, and climate change Session 4: Health impacts of climate extremes Session 5: Climate change and infectious diseases Session 6: How much disease could climate change cause? Session 7: Stratospheric ozone depletion Session 8: Monitoring health impacts of climate change Session 9: Public health research focus in studying climate change Session 10: Assessing community vulnerability and adaptive capacity Session 11: Planning public health interventions to address climate change and its health impacts

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For several years now, those working in public health have been building the case that climate change is a major public health issue. National Public Health Week 2008, themed “Climate Change: Our Health in the Balance,” was the official start to APHA’s work to illuminate the connection between climate change and public health. Working with our diverse partners across the country, APHA is educating national policymakers and practitioners about the vital role of public health agencies in addressing climate change and in preparing communities for related health impacts. Since then, much has been accomplished, but much remains to be done. At the federal level, the Centers for Disease Control and Prevention (CDC) has been instrumental in the public health response to climate change. CDC published a series of articles on climate change and public health in the November 2008 issue of the American Journal of Preventive Medicine and has established a climate change program to administer grants to help state and local health departments assess and build their capacity to address climate change.State and local health officials should participate in climate planning processes, conduct local needs assessments, monitor and prepare for current and future climate-related health risks and educate the public about health risks associated with climate change. To assist in this work, APHA, with funding from and in collaboration with CDC, hosted a year-long, six-part webinar series titled “Climate Change: Mastering the Public Health Role” in 2009–2010. More than 2,600 public health practitioners from across the country tuned in. APHA and CDC are pleased to present this guidebook as a “translation” of that webinar series. APHA and CDC will continue to collaborate with our partner organizations to supply additional guidance and information as it develops in the future. This is only the beginning — there is much more work to do. We hope you find this guidebook useful in shaping your public health response to the challenges of climate change program to administer grants to help state and local health departments assess and build their capacity to address climate change.

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BACKGROUND: According to a wide variety of analyses and projections, the potential effects of global climate change on human health are large and diverse. The U.S. National Institutes of Health (NIH), through its basic, clinical, and population research portfolio of grants, has been increasing efforts to understand how the complex interrelationships among humans, ecosystems, climate, climate variability, and climate change affect domestic and global health. OBJECTIVES: In this commentary we present a systematic review and categorization of the fiscal year (FY) 2008 NIH climate and health research portfolio. METHODS: A list of candidate climate and health projects funded from FY 2008 budget appropriations were identified and characterized based on their relevance to climate change and health and based on climate pathway, health impact, study type, and objective. RESULTS: This analysis identified seven FY 2008 projects focused on climate change, 85 climate-related projects, and 706 projects that focused on disease areas associated with climate change but did not study those associations. Of the nearly 53,000 awards that NIH made in 2008, approximately 0.17% focused on or were related to climate. CONCLUSIONS: Given the nature and scale of the potential effects of climate change on human health and the degree of uncertainty that we have about these effects, we think that it is helpful for the NIH to engage in open discussions with science and policy communities about government-wide needs and opportunities in climate and health, and about how NIH’s strengths in human health research can contribute to understanding the health implications of global climate change. This internal review has been used to inform more recent initiatives by the NIH in climate and health.

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BACKGROUND: Because of complex interactions of climate variables at the levels of the pathogen, vector, and host, the potential influence of climate change on vector-borne and zoonotic diseases (VBZDs) is poorly understood and difficult to predict. Climate effects on the nonvector-borne zoonotic diseases are especially obscure and have received scant treatment. OBJECTIVE: We described known and potential effects of climate change on VBZDs and proposed specific studies to increase our understanding of these effects. The nonvector-borne zoonotic diseases have received scant treatment and are emphasized in this paper. DATA SOURCES AND SYNTHESIS: We used a review of the existing literature and extrapolations from observations of short-term climate variation to suggest potential impacts of climate change on VBZDs. Using public health priorities on climate change, published by the Centers for Disease Control and Prevention, we developed six specific goals for increasing understanding of the interaction between climate and VBZDs and for improving capacity for predicting climate change effects on incidence and distribution of VBZDs. CONCLUSIONS: Climate change may affect the incidence of VBZDs through its effect on four principal characteristics of host and vector populations that relate to pathogen transmission to humans: geographic distribution, population density, prevalence of infection by zoonotic pathogens, and the pathogen load in individual hosts and vectors. These mechanisms may interact with each other and with other factors such as anthropogenic disturbance to produce varying effects on pathogen transmission within host and vector populations and to humans. Because climate change effects on most VBZDs act through wildlife hosts and vectors, understanding these effects will require multidisciplinary teams to conduct and interpret ecosystem-based studies of VBZD pathogens in host and vector populations and to identify the hosts, vectors, and pathogens with the greatest potential to affect human populations under climate change scenarios.

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There is now widespread agreement among climate scientists that the earth is warming as a result of human activity, primarily due to rising levels of carbon dioxide and other heat trapping atmospheric gases created by burning fossil fuels. It is also clear that current trends in energy use, development, and population growth will lead to continuing — and more severe — climate change over the course of this century and beyond. Climate change is expected to adversely affect the health of all Americans as well. In fact, many communities across the United States are already experiencing the negative health effects associated with climate change. Fortunately, public health professionals have many opportunities to help the public and other decision-makers better understand the human implications of climate change, and to correct the misperception that climate change primarily harms the non-human world. Americans value good health and the well-being of their community members. We are positioned to explain how the rapidly emerging threats associated with climate change are connected with individual and community health. By communicating the potential of global climate change to harm human health in communities across America, and by conveying the potential to improve human health through actions that limit climate change, we can enhance public understanding of the full scope of the problem, and help enable appropriate responses by individuals and communities.

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The American Medical Student Association:1. BELIEVES that global warming is one of the major threats to public health and health equity in our time and that all sectors of society, especially the health professional community, must be engaged in solutions to the climate crisis. (2009)2. BELIEVES that stabilization of climate change in time to minimize harm to the global community will require a reduction of global warming emissions to at least 80 percent below current levels by the year 2050 and may require movement toward zero emissions. (2009)3. JOINS the global community in pursuit of the 2050 climate stabilization goal by organizing staff, national leaders, and other interested members charged with creating an inventory of our organizational greenhouse gas (“GHG”) emissions and implementation of a comprehensive plan to achieve significant, measurable and sustainable reduction of those GHG emissions to at least 80 percent below current levels by 2050, with the ultimate goal of a policy of climate neutrality: net-zero global warming emissions. The committee will develop a plan that establishes short-, mid-, and long-term GHG reduction targets, make the inventory and plan available to AMSA members and will regularly review institutional progress and new scientific data related to climate stabilization. (2009)4. COMMITS to reduction of GHG emissions by a variety of means, including budget-neutral and budget-saving measures, at all AMSA properties and functions. (2009)5. URGES medical schools, hospitals, and health institutions to make equivalent commitments. (2009)6. URGES medical students and health professionals, especially AMSA leaders, members and staff, to adopt environmentally healthy lifestyle changes wherever possible. (2009)7. URGES inclusion in medical school curricula of the causes of global warming, of the public health impacts, and healthy equity implications of climate change, and of strategies to mitigate and adapt to climate change. (2009)8. SUPPORTS enactment of a multi-sector national program of requirements, market-based limits, and incentives for reducing GHG emissions to at least 80 percent below current levels by 2050, including provisions for scientific review of evidence related to health-protecting climate stabilization targets. (2009)9. BELIEVES that emission allowances represent public goods and should be managed to the benefit of the public. Polluters should be forced to pay for these emission allowances through an auction system. Funds generated such auctions should be used to advance clean, renewable energy technologies, reduce the impact on low-income workers and communities and assist those most impacted by the effects of global warming. (2009)10. BELIEVES that climate stabilization should not come at the expense of economic development in poor countries that are not responsible for this crisis. Instead, corporations, developed countries and the wealthy of all countries should bear the primary financial responsibility for reducing global GHG emissions. (2009)11. SUPPORTS international agreements on climate stabilization that promote economic justice, encourage sustainable development and the growth of the global renewable energy infrastructure, especially in developing countries, and that require reductions in GHG emissions commensurate with available resources, current share of emissions, and historic responsibility for emissions. (2009)12. SUPPORTS efforts to identify, analyze, and mitigate public health impacts of climate change and prepare for and build resilience to those impacts. Special consideration, commensurate to impact, should be given to the needs of vulnerable populations, including in developing countries, people of color, the poor, women, the elderly, children, and people with disabilities. (2009)13. BELIEVES that national and international efforts to end poverty, support women’s rights, and provide universal education and healthcare, including access to reproductive services are critical to climate stabilization. (2009)14. SUPPORTS investment in Green Jobs programs to provide employment, promote economic justice, and provide the needed training, education, and workforce to help build the renewable energy infrastructure. (2009)15. BELIEVES medical students should take a leadership role in promoting public awareness and health professional action on climate change. (2009)

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Conceptualizing climate as a distinct variable limits our understanding of the synergies and interactions between climate change and the range of abiotic and biotic factors, which influence animal health. Frameworks such as eco-epidemiology and the epi-systems approach, while more holistic, view climate and climate change as one of many discreet drivers of disease. Here, I argue for a new paradigmatic framework: climate-change syndemics. Climate-change syndemics begins from the assumption that climate change is one of many potential influences on infectious disease processes, but crucially is unlikely to act independently or in isolation; and as such, it is the inter-relationship between factors that take primacy in explorations of infectious disease and climate change. Equally importantly, as climate change will impact a wide range of diseases, the frame of analysis is at the collective rather than individual level (for both human and animal infectious disease) across populations.

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Focused on 15 major U.S. cities representing a range of geographic, population, and climate-related dynamics, this study coalesced leading research and local policies, programs, and perspectives on integrating communities of color in climate change planning and adaptation especially to build community resilience. As such, the goal of this report is to offer content and perspective that contributes to climate change planning and adaptation in at least four concrete ways: Provide a snapshot of progress that a subset of major U.S. cities have made to build resilience to climate change in vulnerable communities of color, describing the nature and extent of progress they have made in related programs and policies; • Offer experiences, lessons, replicable models, and best practices with respect to engaging communities of color to build resilience to climate change; • Share common barriers and challenges that cities face to engaging diverse communities in climate change; and • Present specific opportunities and practical recomm endations for cities as they work to create, renew, or enhance efforts to build community resilience among vulnerable communities of color. Findings from this research are intended to provide new information and analysis on how major cities across the country are working to educate, engage, and empower vulnerable communities of color to build resilience to climate change. To our knowledge, this is the first report of its kind to document urban level experiences and innovations in cities across the United States around building climate change resilience for diverse communities. As such, these “ground level” portraits offer a unique opportunity to inform local, state and national advocacy and policy efforts to more fully engage and integrate vulnerable populations—and in particular, communities of color—into climate change planning. This report is intended for a broad audience, including public health practitioners, local emergency preparedness and sustainability officials, policymakers, community-based organizations, advocates, and others explicitly working to advance the ability of vulnerable communities of color to prepare for, prevent, and cope with the effects of a changing climate.

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BACKGROUND: Climate change affects human health, and health departments are urged to act to reduce the severity of these impacts. Yet little is known about the perspective of public health nurses—the largest component of the public health workforce—regarding their roles in addressing health impacts of climate change. OBJECTIVES: We determined the knowledge and attitudes of public health nurses concerning climate change and the role of public health nursing in divisions of health departments in addressing health-related impacts of climate change. Differences by demographic subgroups were explored. METHODS: An online survey was distributed to nursing directors of U.S. health departments (n = 786) with Internet staff directories. RESULTS: Respondents (n = 176) were primarily female, white public health nursing administrators with ≥ 5 years of experience. Approximately equal percentages of respondents self-identified as having moderate, conservative, and liberal political views. Most agreed that the earth has experienced climate change and that climate change is somewhat controllable. Respondents identified an average of 5 of the 12 listed health-related impacts of climate change, but the modal response was zero impact. Public health nursing was perceived as having responsibility to address health-related impacts of climate change but lacking the ability to address these impacts. CONCLUSIONS: Public health nurses view the environment as under threat and see a role for nursing divisions in addressing health effects of climate change. However, they recognize the limited resources and personnel available to devote to this endeavor.

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