Using Data to Reduce Public Health Risk

By Jessica White, Public Health Scientist at Maricopa County DPH, and Vjollca Berisha, Senior Epidemiologist for Maricopa County DPH

Jessica White, DrPH, MS is the Public Health Scientist for the Maricopa County Department of Public Health. During her time at the county, her climate and health work has evolved from identifying heat-related illness within real-time hospital records to supporting community-generated plans for mitigating heat at neighborhood levels.

Vjollca Berisha, MD, MPH is the Senior Epidemiologist for the Maricopa County Department of Public Health. She leads a multidisciplinary team in the areas of communicable disease and heat-related illness. She also leads the Maricopa County Climate Change and Public Health Coalition. This partnership engages external community partners and academic institutions to co-lead the effort on climate and health moving forward.

Oct 31, 2019 | Environment, Society | 1 comment

Maricopa County (MC), Arizona experiences extreme weather, including heat waves, dust storms, drought, wildfires, flooding, and poor air quality events. These climate-sensitive hazards pose a threat to public health and can lead directly to illness, death, or worsening underlying health conditions. Maricopa County Department of Public Health (MCDPH), Office of Epidemiology has been conducting heat-associated morbidity/mortality surveillance since 2006, and extreme heat has become a public health priority as temperatures continue to rise. To combat the health risks associated with rising temperatures, the Maricopa Association of Governments (MAG) and the City of Phoenix formed the Heat Relief Network (HRN) in 2005. This collaborative created an innovative system of community cooling centers and water distribution stations throughout the county (Heat Relief Regional Network).

MC in Arizona is located in one of the hottest regions in the southwest. Over 4 million people (62% of the state’s population) reside in MC. The Phoenix metropolitan area is located at its center and includes more than 20 municipalities and three tribal communities. Each year, MC experiences extreme temperatures and continues to experience two to three weeks (cumulative) of excessive heat warnings issued by the National Weather Service. These temperatures result in an average of 100 heat-associated deaths each year. However, over the last three years, heat-associated deaths exceeded 150 each year (Graph 1) and the number of heat-associated injuries exceeded 2,000 each year.

Graph 1. Frequency of Heat-associated Deaths by Year, Maricopa County (2001-2018.

Nearly 40% of these deaths occur indoors. Despite more than 90% of MC homes having an indoor cooling system, people are still at risk for adverse health outcomes as a result of extreme heat in their homes. People at highest risk of dying indoors tend to be elderly individuals and those with chronic medical conditions partly. High temperatures also disproportionately affect other vulnerable populations including people of color and those experiencing poverty or homelessness, who may not have easy access to air conditioning and the cooler indoors. In MC, heat-related death rates were highest among people aged 75 years and older (8.1 per 100,000 residents), people aged 65 – 74 years (3.7), Native Americans (4.1), and African Americans (3.1). African Americans aged 75 years and older had the highest death rate of any age and race/ethnicity group within the county (37.4 per 100,000 residents). To view more statistics by year, trends over time and heat deaths by geography, check out this ESRI MAP developed by the Office of Epidemiology.

Measuring the Effects of Heat on Public Health

The Office of Epidemiology at MCDPH uses a data-driven approach to identify risk factors for heat-related deaths and injuries. A key component was a survey of the community to learn about community behavior, heat perception, and access to cooling systems.

Using data collected after death, we identified that older individuals who died from heat were more likely to be indoors than outdoors. The vast majority (87%) of those who died indoors of heat-related causes were not using an air conditioning (AC) unit at the time of death. For 61%, the AC unit was not functional; for 11% there was no electricity; and for 28%, either the AC unit was turned off or the reason was unknown.

To better understand the underlying cause for lack of functioning AC and to identify the unknown reasons for lack of AC in the death data, we conducted several heat-related surveys. In 2014, MCDPH conducted the Cooling Center Evaluation project in collaboration with community partners and educational stakeholders. For this evaluation, we interviewed individuals who visit cooling centers. From the visitor survey, we learned that 27% of respondents had an inoperable AC unit or could not afford to operate AC. 65% indicated they were aware of utility assistance programs, but had not applied. 10% were unaware of utility assistance programs (Maricopa County Cooling Center Evaluation Project” Visitor Survey Results).

In April 2015, we conducted a Community Assessment for Public Health Emergency Response (CASPER). The results of the CASPER found:

  • An overwhelming majority of residents (94.5%) reported using central air conditioning to cool their house over the past summer.
  • Among AC users, 7.2% reported using it during nighttime only, while 4.8% reported using it during daytime only.
  • 10% of people felt too hot inside of their home “most of the time” or “always” during the previous summer.
  • The top three reasons that prevented people from using AC were the cost of electricity (20%), a non-functioning AC (5%), or the cost of repairs (2%).
  • Over 50% of respondents did not know that utility assistance services were available.

In 2016, we conducted a survey of homebound individuals focused on cooling systems in their homes to quantify their awareness and willingness to utilize community services. A majority of homebound individuals within our community (approximately 75% of respondents) felt too hot inside of their home “most of the time” or “always” during the previous summer. This is significantly higher than the response from the general population. The majority of homebound individuals reported having AC to cool their house (85%), however only (72%) reported that their AC is functioning. The top three reasons that prevented people from using AC were the cost of bills (81%), the cost of repairs (27%), or mobility limitations (17%).

These data gave us an opportunity to make a strong case to our partners and the community to highlight heat as a public health issue. Information from these surveys is shared with community members to assist in building prevention and intervention programs and actions.

Counter the public health effects of climate change by building partnerships.

The insight provided by the data has helped cultivate a series of long-standing partnerships focusing on heat and health between MCDPH and local governmental agencies, academia, and community organizations. Through surveillance information sharing, our partners have developed more targeted interventions. Examples of this include:

  • The cooling center evaluation study provided information on cooling center service gaps in the community, and we have worked with our partners to develop expansion plans to address these gaps (Cooling Center Evaluation), which has led to the existence of triple the number of cooling centers in the county since the evaluation.
  • The National Weather Service modified their heat advisories and heat-risk maps based on heat-related death data provided by public health (Heat Risk Map).
  • Our partners promote awareness in the community about heat safety and availability of services.

Beyond heat, climate-related hazards are a public health concern.

The data we collected for heat-related deaths and injuries, not only helped to create partnerships and solidify heat as a public health concern, but also allowed for expansion to other climate-sensitive hazards.

In 2015, MCDPH Office of Epidemiology was awarded a grant from the Public Health Institute (PHI) to expand the focus from heat to climate change more generally. This grant provided the opportunity to join the Climate Change and Public Health Learning Collaborative for Urban Health Departments and receive financial support to incorporate climate change mitigation, adaptation, and resilience work into local public health department program practice.

As a part of this project, MCDPH worked with community stakeholders to host a series of meetings designated, Bridging Climate Change and Public Health (BCCPH). BCCPH convenes representatives from a diverse array of local community organizations, private businesses, government agencies, and academic institutions to discuss public health issues associated with climate change. These meetings helped identify local activities in the fields of climate and health, as well as stakeholders’ perceived needs of the community and barriers to successful collaboration.

In 2017, the CDC funded the Building Resilience Against Climate Effects (BRACE) project. This grant allowed us to develop a strategic plan with five priority actions (Bridging Climate Change and Public Health strategic plan) for addressing environmental concerns affecting the health and well-being of the community.

We have been working in this area since 2005 and our experience has allowed us to join other efforts locally and nationally. Locally, we became core participants in The Nature Conservancy’s (TNC) Nature’s Cooling Systems project to design urban heat solutions in the Valley of the Sun. In addition, we closely collaborated with staff of the Institute for Sustainable Communities, which was instrumental in helping build our partnership capacity, and we recently we joined The Rio Reimagined project workgroup. Nationally, MCDPH, in collaboration with Columbia University and the American Council for an Energy Efficient Economy, will begin conducting research to understand the public health impact of energy insecurity.

Addressing the impact of heat on health is well-aligned with MCDPH’s vision and mission “to make healthy lives possible” by protecting and promoting the health and well-being of MC residents and visitors. The climate has significant impacts on our community’s health. Through extensive surveillance and community surveys, we have demonstrated the importance of local public health data to increase buy-in from new and existing partners and obtain funding to address this significant public health issue. We encourage other health departments to consider the power of data and collaboration as they seek methods for protecting the public’s health from a changing climate.

Discussion

Leave your comment below, or reply to others.

Please note that this comment section is for thoughtful, on-topic discussions. Admin approval is required for all comments. Your comment may be edited if it contains grammatical errors. Low effort, self-promotional, or impolite comments will be deleted.

1 Comment

  1. What plans are being discussed to help those who are not in urban centers? I am
    concerned about urbanization as a solution especially for Native Americans in the region. The movement toward “sustainable communities” has me concerned on a larger scale as well. Funding and data often don’t look at protecting rural and indigenous communities — people who actually live with and on the land and are often more in tune with the earth than their urban counterparts. No offense — I have never live anywhere but modern suburbia myself. But I am becoming more aware at how blind our suburban and urban views can be. Data and funding can sometimes be misleading or at least narrow in scope and impact. Less urbanization may be an important potential answer to climate change — not more.

    Reply

Submit a Comment

Your email address will not be published. Required fields are marked *

Read more from MeetingoftheMinds.org

Spotlighting innovations in urban sustainability and connected technology

How Urban Industry Can Contribute Green Solutions for COVID-Related Health Disparities

How Urban Industry Can Contribute Green Solutions for COVID-Related Health Disparities

The best nature-based solutions on urban industrial lands are those that are part of a corporate citizenship or conservation strategy like DTE’s or Phillips66. By integrating efforts such as tree plantings, restorations, or pollinator gardens into a larger strategy, companies begin to mainstream biodiversity into their operations. When they crosswalk the effort to other CSR goals like employee engagement, community relations, and/or workforce development, like the CommuniTree initiative, the projects become more resilient.

Air quality in urban residential communities near industrial facilities will not be improved by nature alone. But nature can contribute to the solution, and while doing so, bring benefits including recreation, education, and an increased sense of community pride. As one tool to combat disparate societal outcomes, nature is accessible, affordable and has few, if any, downsides.

Crisis funding for public parks

Crisis funding for public parks

I spoke last week to Adrian Benepe, former commissioner for the NYC Parks Department and currently the Senior Vice President and Director of National Programs at The Trust for Public Land.

We discussed a lot of things – the increased use of parks in the era of COVID-19, the role parks have historically played – and currently play – in citizens’ first amendment right to free speech and protests, access & equity for underserved communities, the coming budget shortfalls and how they might play out in park systems.

I wanted to pull out the discussion we had about funding for parks and share Adrian’s thoughts with all of you, as I think it will be most timely and valuable as we move forward with new budgets and new realities.

3 Ways Communities Can Bond with Residents in the Age of Covid & Beyond

3 Ways Communities Can Bond with Residents in the Age of Covid & Beyond

There is a risk of further widening the gap between so-called ‘knowledge workers’ able to do their jobs remotely and afford to move, and those with place-based employment who cannot. Beyond that, retreating residents might take the very identity and uniqueness of the places they abandon with them.

Nurturing the community-resident bond could be an antidote to these dismaying departures, and new research sheds light on how. A recent report by the Urban Institute and commissioned by the Knight Foundation surveyed 11,000 residents of 26 U.S. metro areas to uncover what amenities created a “sense of attachment and connection to their city or community.” Three key recommendations emerged in Smart Cities Dive’s synopsis of the results.

Subscribe to Our Weekly Newsletter

Sign up for our email list to receive resources and invites related to sustainability, equity, and technology in cities!

You have Successfully Subscribed!

Share This