Authors: Resham Patel, MPH, Senior Program Analyst and Stacy Hosler, MSPH, Program Analyst; Public Health Preparedness, NACCHO
In 2011 and 2012, the United States experienced 25 extreme weather events—storms, floods, droughts, heat waves, and wildfires—that each caused at least $1 billion in damages. These events resulted in a total price tag of over $174 billion and collectively resulted in 1,141 fatalities nationwide.  With 43 states and 67 percent of U.S. counties affected by “billion-dollar damage” extreme weather events in 2011 and 2012,  public health preparedness professionals and partners that plan for typical storms, droughts, or fires now need to frame their plans around “superstorms,” “100-year droughts,” and “the largest fire in the state’s history.” Research suggests that the increase in extreme weather events is due to changes in weather patterns that are unlikely to subside in the near future, increasing the likelihood that these once rare events will become common occurrences. 
The map of Significant Weather in the United States in 2012 notes a variety of significant extreme weather events that impacted multiple states, many of which took the country by surprise and required federal assistance. Several events, such as Superstorm Sandy, revealed deficiencies across multiple agencies’ plans ranging from transportation and natural resource management to disaster relief that may have been mitigated if such a disaster was anticipated. Even the annual expectations for heat related illness can surprise cities and regions without proper plans. At the top of the list for weather-related deaths in the United States for years, heat is a major threat. Since record keeping began in 1895, average temperatures have increased 1.5 degrees Fahrenheit.  Without significant reductions in emissions, the world’s average temperature could climb as much as 7 to 10 degrees Fahrenheit by 2100.  Although 2012 was the hottest year on record for the lower 48 states, many will remember the 1995 heat wave in Chicago where 465 heat-related deaths occurred. An unexpected and unprecedented weather event intersected with an ill-prepared Chicago for its worst weather-related disaster.  Hazard risk assessments are generally based on historical data, but focusing the lens on historical data proved detrimental in both Superstorm Sandy and the Chicago heat wave and continues to plague many regions that are not adequately preparing for what changes in climate will bring. The Environmental Defense Fund, in partnership with the National Association of County and City Health Officials (NACCHO) and George Mason University, released Are We Ready, which advocates for increased resources and training for local and state health departments to support climate change related work.
The impact of increased frequency and magnitude of extreme weather events on populations in the wake of these events must be considered. People who live in poverty, older adults, and children are especially at risk for changes in climate. Geographic distribution near coasts and urban areas, chronic medical conditions, and a physiological increased sensitivity to heat make older adults disproportionately affected by hurricanes, droughts, floods, infectious disease, and rising summer temperatures. Climate changes affect pollen counts and exacerbate summer heat by the urban heat island effect. Young children are particularly sensitive to increased pollen counts and urban smog, leading to increased asthma attacks and other respiratory ailments. These issues are also high on President Obama’s priority list, as highlighted in the 2013 President’s Climate Action Plan, which outlines how federal agencies will support communities as they prepare for climate impacts through the establishment of a task force addressing local preparedness and resilience building efforts. 
The vulnerability of our communities to these events requires pre-disaster planning based on climate adaptation plans. According to the Center for Climate and Energy Solutions, 15 states currently have complete climate adaptation plans that all include public health concerns, and four additional states have plans in progress. These adaptation plans are specific to regional needs and can focus on a variety of issues, including sea-level rise and associated flooding, drought mitigation and water insecurity, hurricanes and other severe weather, and extreme heat events.  Part of local and regional discussions around climate change adaptation should include evaluating and planning for changing health considerations from new weather patterns and threats. Consider the following climate-risk management questions:
- What new hazards should be considered as possible scenarios in your jurisdictional risk assessment?
- What assets and liabilities does your jurisdiction need to consider when addressing these new hazards?
- What unique populations are in need of special health considerations?
- How will your unique populations change over the next five years, ten years?
Many public health preparedness professionals and partners across the country are currently looking to better incorporate adaptation planning and may find valuable resources from peers and trusted resources. The NACCHO toolkit includes many climate change impact planning resources that could help LHDs that are working to integrate climate adaptation into preparedness planning. The following plans and resources may also provide guidance:
- NACCHO’s Climate Change Demonstration Sites
- CDC’s Climate-Ready States & Cities Initiative
- Georgetown Climate Center’s State and Local Adaptation Plans
- CDC’s Building Resilience Against Climate Effects (BRACE) Framework
- NACCHO’s Climate Change Webcasts