Programs and Communities

Human exposure to excessively warm weather, especially in cities, is an increasingly important public health problem. This study examined heat-related health inequalities within one city in order to understand the relationships between the microclimates of urban neighborhoods, population characteristics, thermal environments that regulate microclimates, and the resources people possess to cope with climatic conditions. A simulation model was used to estimate an outdoor human thermal comfort index (HTCI) as a function of local climate variables collected in 8 diverse city neighborhoods during the summer of 2003 in Phoenix, USA. HTCI is an indicator of heat stress, a condition that can cause illness and death. There were statistically significant differences in temperatures and HTCI between the neighborhoods during the entire summer, which increased during a heat wave period. Lower socioeconomic and ethnic minority groups were more likely to live in warmer neighborhoods with greater exposure to heat stress. High settlement density, sparse vegetation, and having no open space in the neighborhood were significantly correlated with higher temperatures and HTCI. People in warmer neighborhoods were more vulnerable to heat exposure because they had fewer social and material resources to cope with extreme heat. Urban heat island reduction policies should specifically target vulnerable residential areas and take into account equitable distribution and preservation of environmental resources.

Maricopa County experiences extreme heat, which has adverse effects on community health and has been recognized as a serious public health issue. Therefore, the Maricopa County Department of Public Health (MCDPH) has conducted surveillance activities to assess morbidity and mortality due to extreme heat for the past 10 years. In 2016, MCDPH was interested in expanding their scope to include other climate-sensitive public health hazards. Subsequently, a network of stakeholders with an interest in the health effects of climate-sensitive hazards was established as the Bridging Climate Change and Public Health (BCCPH) stakeholder group. A smaller Strategic Planning Workgroup of key stakeholders from the BCCPH group was then convened over three sessions to work on a strategic plan for the group, which culminated in this document.

Practical Vision
The driving discussion question to identify the Strategic Planning Workgroup’s practical vision was, “What do we want to see in place in the next 3-5 years as a result of our actions?” The goal of this question was to help the group develop concrete outcomes that the BCCPH workgroup would like to achieve through activities included in the strategic plan. The following goals were identified:
 A healthy community infrastructure design
 Reframed messaging for multiple stakeholder needs
 A coordinated multi-scale education effort
 Improved health strategies and outcomes
 A diverse network of partnerships for climate change adaptation and mitigation planning and development
 New funding opportunities
 Policy and research strategies, and private sector engagement.

Underlying Contradictions
The driving discussion question to identify underlying contradictions was, “What is blocking us from moving towards our practical vision?” The following challenges were identified:
 People act out of self-interest vs. common good
 Siloed effects lead to poor coordination
 Political partisanship delays unified action
 Conflicting information leads to biases
 Culture and convenience impacts action
 Vulnerable populations not represented, and normalization of climate change related negative effects

Strategic Directions
During the BCCPH Strategic Planning Workgroup meetings, participants identified five strategic directions for addressing environmental concerns affecting the health and well-being of the community. These strategic directions are in agreement with the climate and health adaptation strategies outlined in the Arizona Climate and Health Adaptation Plan. The strategic directions for Maricopa County are:
 Fostering Environmental Action for a Healthier Community
 Coordinating Research and Collaborative Efforts to Catalyze Change
 Developing a Strategic and Targeted Communication Plan
 Promoting Community Awareness and Public Education about Climate and Health
 Celebrating Success and Champions

This established model is applied here to show the relative effects of four common mitigation strategies: increasing the overall (1) emissivity, (2) percentage of vegetated area, (3) thermal conductivity, and (4) albedo of the urban environment in a series of percentage increases by 5, 10, 15, and 20% from baseline values.

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events.

Objectives: This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season.

Methods: Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature–health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different “trigger points” at which heat-health intervention measures might be activated.

Results: We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22°C) across multiple health events and diagnoses.

Conclusion: Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.

Maricopa County, Arizona, anchor to the fastest growing megapolitan area in the United States, is located in a hot desert climate where extreme temperatures are associated with elevated risk of mortality. Continued urbanization in the region will impact atmospheric temperatures and, as a result, potentially affect human health. We aimed to quantify the number of excess deaths attributable to heat in Maricopa County based on three future urbanization and adaptation scenarios and multiple exposure variables.

Two scenarios (low and high growth projections) represent the maximum possible uncertainty range associated with urbanization in central Arizona, and a third represents the adaptation of high-albedo cool roof technology. Using a Poisson regression model, we related temperature to mortality using data spanning 1983–2007. Regional climate model simulations based on 2050-projected urbanization scenarios for Maricopa County generated distributions of temperature change, and from these predicted changes future excess heat-related mortality was estimated. Subject to urbanization scenario and exposure variable utilized, projections of heat-related mortality ranged from a decrease of 46 deaths per year (− 95%) to an increase of 339 deaths per year (+ 359%).

Projections based on minimum temperature showed the greatest increase for all expansion and adaptation scenarios and were substantially higher than those for daily mean temperature. Projections based on maximum temperature were largely associated with declining mortality. Low-growth and adaptation scenarios led to the smallest increase in predicted heat-related mortality based on mean temperature projections. Use of only one exposure variable to project future heat-related deaths may therefore be misrepresentative in terms of direction of change and magnitude of effects. Because urbanization-induced impacts can vary across the diurnal cycle, projections of heat-related health outcomes that do not consider place-based, time-varying urban heat island effects are neglecting essential elements for policy relevant decision-making.

Background: Vulnerability mapping based on vulnerability indices is a pragmatic approach for highlighting the areas in a city where people are at the greatest risk of harm from heat, but the manner in which vulnerability is conceptualized influences the results.

Objectives: We tested a generic national heat-vulnerability index, based on a 10-variable indicator framework, using data on heat-related hospitalizations in Phoenix, Arizona. We also identified potential local risk factors not included in the generic indicators.

Methods: To evaluate the accuracy of the generic index in a city-specific context, we used factor scores, derived from a factor analysis using census tract–level characteristics, as independent variables, and heat hospitalizations (with census tracts categorized as zero-, moderate-, or highincidence) as dependent variables in a multinomial logistic regression model. We also compared the geographical differences between a vulnerability map derived from the generic index and one derived from actual heat-related hospitalizations at the census-tract scale.

Results: We found that the national-indicator framework correctly classified just over half (54%) of census tracts in Phoenix. Compared with all census tracts, high-vulnerability tracts that were misclassified by the index as zero-vulnerability tracts had higher average income and higher proportions of residents with a duration of residency < 5 years.

Conclusion: The generic indicators of vulnerability are useful, but they are sensitive to scale, measurement, and context. Decision makers need to consider the characteristics of their cities to determine how closely vulnerability maps based on generic indicators reflect actual risk of harm.

Preventing heat-associated morbidity and mortality is a public health priority in Maricopa County, Arizona (United States). The objective of this project was to evaluate Maricopa County cooling centers and gain insight into their capacity to provide relief for the public during extreme heat events. During the summer of 2014, 53 cooling centers were evaluated to assess facility and visitor characteristics. Maricopa County staff collected data by directly observing daily operations and by surveying managers and visitors. The cooling centers in Maricopa County were often housed within community, senior, or religious centers, which offered various services for at least 1500 individuals daily. Many visitors were unemployed and/or homeless. Many learned about a cooling center by word of mouth or by having seen the cooling center’s location. The cooling centers provide a valuable service and reach some of the region’s most vulnerable populations. This project is among the first to systematically evaluate cooling centers from a public health perspective and provides helpful insight to community leaders who are implementing or improving their own network of cooling centers.

The City of Phoenix Street Transportation Department partnered with the Rob and Melani Walton Sustainability Solutions Service at Arizona State University (ASU) and researchers from various ASU schools to evaluate the effectiveness, performance, and community perception of the new pavement coating. The data collection and analysis occurred across multiple neighborhoods and at varying times across days and/or months over the course of one year (July 15, 2020–July 14, 2021), allowing the team to study the impacts of the surface treatment under various weather conditions.