Mortality from environmental heat is a significant public health problem in Maricopa County, especially because it is largely preventable. Maricopa County has conducted heat surveillance since 2006. Each year, the enhanced heat surveillance season usually begins in May and ends in October. The main goals of heat surveillance are to identify the demographic characteristics of heat-associated deaths (e.g., age and gender) and the risk factors for mortality (e.g., homelessness). Sharing this information helps community stakeholders to design interventions in an effort to prevent heat-associated deaths among vulnerable populations.

The two main sources of data for heat surveillance are: preliminary reports of death (PRODs) from the Office of the Medical Examiner (OME) and death certificates from the MCDPH Office of Vital Registration.

Heat-associated deaths are classified as heat-caused or heat related. Heat-caused deaths are those in which environmental heat was directly involved in the sequence of conditions causing deaths. Heat-related deaths are those in which environmental heat contributed to the deaths but was not in the sequence of conditions causing these deaths. For more information on how heat-associated deaths are classified, see the definitions in Appendix. For more information on MCDPH’s surveillance system, see Background and Methodology.

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

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.

En la zona metropolitana de Phoenix, el calor urbano está afectando la salud, la seguridad y la economía y se espera que estos impactos empeoren con el tiempo. Se prevé que el número de días por encima de 110˚F aumentará más del doble para el 2060. En mayo de 2017, The Nature Conservancy, el Departamento de Salud Pública del condado de Maricopa, Central Arizona Conservation Alliance, la Red de Investigación en Sostenibilidad sobre la Resiliencia Urbana a Eventos Extremos, el Centro de Investigación del Clima Urbano de Arizona State University y el Center for Whole Communities lanzaron un proceso participativo de planificación de acciones contra el calor para identificar tanto estrategias de mitigación como de adaptación a fin de reducir directamente el calor y mejorar la capacidad de los residentes para lidiar con el calor. Las organizaciones comunitarias con relaciones existentes en tres vecindarios seleccionados para la planificación de acciones contra el calor se unieron más tarde al equipo del proyecto: Phoenix Revitalization Corporation, RAILMesa y Puente Movement. Más allá de construir un plan de acción comunitario contra el calor y completar proyectos de demostración, este proceso participativo fue diseñado para desarrollar conciencia, iniciativa y cohesión social en las comunidades subrepresentadas. Asimismo el proceso de planificación de acciones contra el calor fue diseñado para servir como modelo para esfuerzos futuros de resiliencia al calor y crear una visión local, contextual y culturalmente apropiada de un futuro más seguro y saludable. El método iterativo de planificación y participación utilizado por el equipo del proyecto fortaleció las relaciones dentro y entre los vecindarios, las organizaciones comunitarias, los responsables de la toma de decisiones y el equipo núcleo, y combinó la sabiduría de la narración de historias y la evidencia científica para comprender mejor los desafíos actuales y futuros que enfrentan los residentes durante eventos de calor extremo. Como resultado de tres talleres en cada comunidad, los residentes presentaron ideas que quieren ver implementadas para aumentar su comodidad y seguridad térmica durante los días de calor extremo.

Como se muestra a continuación, las ideas de los residentes se interceptaron en torno a conceptos similares, pero las soluciones específicas variaron entre los vecindarios. Por ejemplo, a todos los vecindarios les gustaría agregar sombra a sus corredores peatonales, pero variaron las preferencias para la ubicación de las mejoras para dar sombra. Algunos vecindarios priorizaron las rutas de transporte público, otros priorizaron las rutas utilizadas por los niños en su camino a la escuela y otros quieren paradas de descanso con sombra en lugares clave. Surgieron cuatro temas estratégicos generales en los tres vecindarios: promover y educar; mejorar la comodidad/capacidad de afrontamiento; mejorar la seguridad; fortalecer la capacidad. Estos temas señalan que existen serios desafíos de seguridad contra el calor en la vida diaria de los residentes y que la comunidad, los negocios y los sectores responsables de la toma de decisión deben abordar esos desafíos.

Los elementos del plan de acción contra el calor están diseñados para incorporarse a otros esfuerzos para aliviar el calor, crear ciudades resilientes al clima y brindar salud y seguridad pública. Los socios de implementación del plan de acción contra el calor provienen de la región de la zona metropolitana de Phoenix, y se brindan recomendaciones para apoyar la transformación a una ciudad más fresca.

Para ampliar la escala de este enfoque, los miembros del equipo del proyecto recomiendan a) compromiso continuo e inversiones en estos vecindarios para implementar el cambio señalado como vital por los residentes, b) repetir el proceso de planificación de acción contra el calor con líderes comunitarios en otros vecindarios, y c) trabajar con las ciudades, los planificadores urbanos y otras partes interesadas para institucionalizar este proceso, apoyando las políticas y el uso de las métricas propuestas para crear comunidades más frescas.

The Maricopa County Heat Relief Network (HRN) is an ad-hoc partially self-organized network with some attributes of hierarchical coordination that forms each year to provide heat relief and hydration to residents in need by operating as cooling centers. These HRN organizations are a collection of non-profit, governmental and religious organizations. This dissertation looks at the HRN from a complexity governance perspective and engaged different parts of the network in interviews to learn more about their perspective in delivering heat relief. Further, participatory modeling with a prototype agent based model was done with the HRN coordinating agencies to look for emergent outcomes in the HRN system and learn from their perspective. Chapter one evaluates organizational theory and complexity with climate adaptation, hazard preparedness and resilience in the HRN. Chapter two presents results from interviews with HRN facility managers and evaluates their perspective on how they function to offer heat relief. Chapter three finds that the HRN is a good example of complexity governance when engaged through a participatory agent based modeling approach. Chapter four engages the HRN coordinators in participatory agent based modeling interviews to increase their systems level awareness, learn about their perspective on heat relief delivery, and how the system can be improved. Chapter five looks across the different levels of the HRN investigated, the facility managers and coordinators, for differences and similarities in perspectives. The research conducted in this dissertation shows different levels of systems awareness of the different parts of the HRN and how participatory modeling can be used to increase systems awareness. Results indicate that there was very little horizontal network connection between HRN facility managers and most of the interaction was vertically coordinated indicating opportunities for increased network communication in the future both horizontally and vertically if communication interventions were put in place.