Intersections between Climate-related Events and Public Health Preparedness and Response: ASTHO Technical Assistance Support Opportunities 60th PIHOA Executive Board Meeting August 30, 2016 Honolulu, HI James Blumenstock Chief Program Officer, Health Security ASTHO

Objective and Presentation Overview Objective: Discuss ways in which ASTHO can support identified approaches and interventions to strengthening USAPI resiliency to the negative health impacts of climate effects and natural disasters. Agenda: ASTHO Organization-wide Support to its Members and Partners Examples of ASTHO’s Contributions on the “National Stage” Specific Climate/Severe Weather Event Projects, Activities, and Resources

ASTHO Organization-wide Support to its Members and Partners

ASTHO ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. Territories, and the District of Columbia, and over 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions. Vision Healthy people thriving in a nation free of preventable illness and injury. Mission To transform public health within states and territories to help members dramatically improve health and wellness.

The Beginning: Cholera (vibrio cholerae) May 7, 1884—formed the National Conference of State Boards of Health At the 1883 AMA meeting in Detroit the health officers met informally again and decided to form their own national organization—the National Conference of State Boards of Health. JN McCormack (KY) chair, CW Chamberlain (CT) secretary. First Annual Meeting of NCSBH held that fall in St Louis, MO

About the Association of State & Territorial Health Officials (ASTHO) Cholera Outbreak of 1873 ASTHO's origin dates back to 1873, related to cholera outbreaks. Health officials at that time realized that outbreaks and pathogens do not recognize geographic boundaries and in order to protect the health of their citizens, the states were going to have to work together to ensure public health. Red denotes states with Cholera cases Yellow denotes those areas not yet states

About the Association of State & Territorial Health Officials (ASTHO) ASTHO officially formed in 1942 to… Provide a network for State and Territorial Health Officials and agencies Advocate the interests of state/territory-based public health at the national level. Provide a forum to share best practices in health policy and programs With the passing of the Social Security Act of 1935, state/territorial health officials recognized the need for an organization that would help them navigate rapidly expanding state/territorial public health policies and programs and represent them on matters concerning federal health grants. ASTHO as we know it today formally incorporated March 23, 1942--four years before the CDC was started. ASTHO is a non-profit organization representing public health agencies in U.S. states, territories, and DC. State health officials are the “primary members” – 59 members in total, but ASTHO also represents over 100,000 state and territorial public health agency staff. Our Mission: To transform public health within states and territories to help members dramatically improve health and wellness. 

ASTHO Today – 59 Members, 10 Time Zones 59 members working to improve health in their jurisdictions, most of whom are actively engaged in the organization 50 States District of Columbia 5 Territories (Puerto Rico, Virgin Islands, Guam, Northern Marianas Islands, and American Samoa) 3 Freely Associated States (Micronesia, Marshall Islands, and Palau) Membership spans 10 time zones In addition to the state health officials, senior deputies and several peer networks from the agencies receive support from and participate in ASTHO. These peer networks include Preparedness directors Environmental health directors Primary Care Officers State Legislative Liaisons Chief Fiscal Officers Performance Improvement Officers Human Resource Directors

ASTHO Policy Committees Access Chair: Susan Moran (MI) Environmental Health Chair: Larry Wolk (CO) Infectious Disease Chair: Nate Smith (AR) Informatics Chair: Susan Mosier (SK) Performance Chair: Wendy Braund (WY) Preparedness Chair: John Dreyzehner (TN) Prevention Chair: Harry Chen (VT) Eight committees provide oversight to ASTHO’s policy and programmatic work. Policy committees meet annually at a summit, usually in conjunction with the ASTHO Annual Meeting and a few times throughout the year via phone. Encourage SHOs to join a policy committee.

Peer Networks Senior Deputies Primary Care Office Directors Directors of Public Health Preparedness State Legislative Liaisons State Environmental Health Directors Accreditation Coordinators Human Resource Directors\Workforce Development Directors Strategic National Stockpile (SNS) Coordinators Chief Financial Officers Informatics Directors All state and territorial health agency staff members are eligible to participate in open ASTHO meetings. ASTHO also provides networking and leadership development, policy and programmatic services, and technical assistance to other groups of agency staff including: Senior Deputies ("senior deputy" is ASTHO's terminology for those staff considered second in command to the health official) Directors of Public Health Preparedness State Environmental Health Directors Human Resource Directors\Workforce Development Directors Chief Financial Officers Primary Care Office Directors State Legislative Liaisons Accreditation Coordinators Strategic National Stockpile (SNS) Coordinators Informatics Directors

State and Territorial Environmental Health Directors (SEHD) SEHD group is comprised of State and Territorial Environmental Health Directors or their appropriate counterparts. ASTHO convenes monthly SEHD Steering Committee calls and full membership calls. ASTHO will continue to foster and encourage SEHD participation from the insular areas. Guam, CNMI came to recent SEHD annual meetings. The State Environmental Health Directors are an organized peer group within ASTHO whose membership includes environmental health leadership from the U.S. state and territorial health agencies, and the District of Columbia. SEHD Facilitates increased awareness of environmental health activities in differing states. Guam came to SEHD meeting in 2010 and CNMI in 2015. 2016 SEHD Annual Meeting (Denver, CO)

ASTHO Today – 20 Affiliates…The Power of Collaboration NAVCO ASTHO is supported by a network of 20 Affiliated Organizations representing an array of state public health agency leaders. Top leaders from ASTHO and the 20 Affiliates serve on ASTHO’s Affiliate Council. The Council meets at least quarterly to share information on major initiatives and identify ways the organizations can align to better support states and territories in their efforts to improve public health outcomes. While each Affiliate represents a different program director or leader within the state and territorial health agencies, all share a common mission to promote and protect the public’s health and prevent illness and injury. In addition, legislative staff from several organizations meet 2-3 times per month to align and maximize federal advocacy efforts. Org Names (not necessary to go through. Just fyi in case someone asks) Health Facilities Survey Agencies Immunization Managers MCH Programs Public Health Labs Dental Directors Directors of Nursing Local Health Liaison Officials Nutrition Directors Social Workers Epidemiologists Directors of Health Promotion and Education AIDS Directors Chronic Disease Directors Statistics and Information Systems EMS Officers Minority Health Vector Control STD Directors Information Officers Injury Directors

Examples of ASTHO’s Contributions on the “National Stage”

Issues Addressed in 2016 NHSC Brief Cybersecurity Critical Infrastructure Fragility Natural Threats Countering Terrorism Immigration Reform Sustainable and Flexible Grant Funding Effective Information Sharing Mutual Aid to Build Capabilities and Reduce Costs

Natural Threats “Climate Adaptation – Communities from coast to coast are vulnerable to the effects of changing climate conditions and extreme weather. Rising sea levels affect coastal communities and increase their vulnerability to hurricanes and coastal flooding while extreme weather can impact the severity of traditional natural hazards throughout the country. More severe and costly disasters are becoming the norm. While determining the cause of this global phenomenon may be an important factor in slowing, halting, or reversing the impacts, the Consortium is primarily concerned with the actions, policies, and strategies that are necessary to mitigate, respond to, and recover from its consequences.”

Development of Public Health and Medical Mission Ready Packages

Development of Public Health and Medical Mission Ready Packages Mission Ready Packages (MRPs) are specially created asset bundles used in disaster recovery and response. Mission Ready Packages are defined as “specific response and recovery capabilities that are organized, developed, trained and exercised prior to an emergency or disaster” (Emergency Management Assistance Compact, 2014). The use of MRPs is a major component of the Emergency Management Assistance Compact (EMAC). Using the EMAC system, states can request or deploy equipment, personnel (including volunteers) and other resources through MRPs to assist in disaster recovery efforts.

Phase I MRPs Bariatric Ambulance Team Four-Wheel Drive Ambulance Team The Bariatric Ambulance Team provides life support care and response to bariatric patients through the use of specialized bariatric vehicles. The team may augment existing emergency medical services; provide patient and medical facility evacuation support; provide patient triage, treatment, and transport; and provide on-scene medical care. Four-Wheel Drive Ambulance Team The four-wheel Drive Ambulance Team provides life support, care, and response to patients through the use of specialized four-wheel drive ambulances. The team may augment existing emergency medical services, patient and medical facility evacuation support, and patient triage, treatment, and transport and provide on-scene medical care when transportation is hindered by air or by road during emergencies.

Patient Transport Team The Patient Transport Team provides life support response and supplements ground ambulances and EMS personnel in support of the requesting jurisdiction. The team may augment existing emergency medical services, patient and medical facility evacuation support, and patient triage, treatment, and transport and provide on-scene medical care. Pre-Hospital Acute Care Team The Pre-Hospital Acute Care Team provides advanced life support care and response to the requesting entity and stabilizes acute medical emergency and trauma patients in a pre-hospital care setting. The team may augment existing emergency medical services, provide triage and treatment for acute patients, and provide pre-hospital stabilizing medical care. The location of operations may vary depending on the needs of the requesting jurisdiction. Patient transport vehicles are not part of this package but the team will integrate with and support the actions of the local EMT/paramedic responders and medical response system.

Clinical Care Team The Clinical Care Team provides medical supervision/services; this includes providing/coordinating medical services for individuals requiring Functional Needs Support Services. This may include such services as ensuring prescriptions are filled, administering medication, treating minor wounds, monitoring glucose, etc. This team can also support O2 oversight and monitoring. Furthermore, the team will evaluate/assess individuals with acute onset of signs and symptoms and help determine if 911 transportation is necessary. Disaster Portable Morgue Unit The Disaster Portable Morgue Unit provides equipment and commodities to support mass fatality operations. The unit has fully-equipped mobile morgue equipment and a supply cache that supports specially trained teams and provides storage of deceased.

Medical Facility Emergency Water Supply Team The Medical Facility Emergency Water Supply Team provides emergency water or provides the resources needed by a facility to access and utilize alternate water sources. The Medical Facility Emergency Water Supply Team includes a combination of equipment that could be used to: (1) haul, store, or provide water; (2) disinfect or purify water; (3) re- route water to a facility; and/or (4) conserve water. Behavioral Health Team The Behavioral Health Team delivers mental health services to those impacted by the incident. This may include survivors or first responders or others as requested by the requesting jurisdiction. The Behavioral Health Team primarily provides community supportive services, including psychological first-aid, assessment of psychological state, referral of survivors to local resources for ongoing psychiatric or psychological treatment, mediation in the event of disruptive behavior, crisis counseling, Critical Incident Stress Management (CISM), emotional and spiritual care, or other early psychological interventions.

Phase II MRPs Epidemiology Surveillance Team The Epidemiology Surveillance Team coordinates with public health officials and healthcare providers to monitor the health status of individuals potentially exposed to an infectious disease. The team conducts community assessments following a disaster to help determine the need for public health and healthcare interventions and to aid in the development of strategies to mitigate the public health impact of future disasters, conducts contact tracing and track case numbers during a disease outbreak and/or pandemic in affected areas, and assists in the development and dissemination of public health messages and guidance to stakeholders in the affected community.

Radiological Monitoring and Decontamination Teams The Radiological Monitoring Team focuses on providing radiation dosage monitoring of persons who have been exposed to a potential or known radiological release. They will work with hazardous materials teams to monitor persons before and after decontamination processes. The Radiological Pet Decontamination Team focuses on providing radiation dosage monitoring and conducting decontamination of household pets and service animals who were exposed or potentially exposed to a radiological release, especially those who will be entering a shelter facility.

Medical Support for Sheltering Team The Medical Support for Sheltering Team provides clinical and functional needs support for shelter operations, ensuring that those with special medical and functional needs, chronic health disorders, and disabilities are cared for during and after an emergency. The team does not include a behavioral health component because this was covered by the Behavioral Health Team developed in Phase I. If behavioral health support is needed, the request to EMAC would be for both teams.

Learn More About MRPs http://www.emacweb.org/

Specific Climate/Severe Weather Event Projects, Activities, and Resources

Climate & Health The Climate Change Collaborative (CCC) Multi-disciplinary team of 22 experts from 18 different organizations Extreme Weather and Climate Readiness: Toolkit for State and Territorial Health Departments Palau pilot tested the toolkit in 2015 CCC reviewed Palau’s Climate Change Policy document New funding opportunity for the insular areas Funding of up to $50,000 will be available for four territorial health agencies to conduct a climate and health project. CCC- Supports and builds the capacity of state and territorial health agencies to tackle the public health challenges presented by climate change The toolkit offers practical steps for integrating climate readiness into seven public health topic areas: air quality, water safety, vector-borne and zoonotic disease, food safety, chemical safety, healthy sustainable communities and injury prevention, and natural disaster emergency preparedness. Worksheets have been provided throughout the toolkit to assist readers in performing Climate Readiness Assessments in each topic area. Palau’s Climate Change Policy document does take into consideration part of ASTHO’s toolkit RFP release scheduled for September 15 2016

ASTHO Climate & Health Grant Program Goals: Reduce climate‐related morbidity and mortality in Insular Areas Build capacity to identify and assess climate‐related health threats to the Insular Areas Build climate and health adaptation capacity within Territorial governments Expectations/Deliverables: Work on one or more steps of CDC’s Building Resilience Against Climate Effects (BRACE) framework. Timeline: RFP release date- September 15 Applications due- October 21 Notify Awardees- October 31 Project duration-November 1, 2016 to June 30, 2017 Sample activities: Create a climate adaptation plan or strategy. Provide training to health agency personnel on relevant climate change topics. Collaborate and hold meetings/workshops with community members and key stakeholders. Plan or implement a specific intervention Develop and implement an educational campaign on climate and health. ASTHO is available to provide technical assistance to the grantee at no additional cost. CDC staff is also available via phone or email for technical assistance.  

Building Resilience Against Climate Effects Step 1: Anticipate Climate Impacts and Assessing Vulnerabilities Step 2: Project the Disease Burden Step 3: Assess Public Health Interventions Step 4: Develop and Implement a Climate and Health Adaptation Plan Step 5: Evaluate Impact and Improve Quality of Activities Step1: Identify the scope of climate impacts, associated potential health outcomes, and populations and locations vulnerable to these health impacts. Step 2: Estimate or quantify the additional burden of health outcomes associated with climate change. Step 3: Identify the most suitable health interventions for the identified health impacts of greatest concern. Step 4: Develop a written adaptation plan that is regularly updated. Disseminate and oversee implementation of the plan. Step 5: Evaluate the process. Determine the value of information attained and activities undertaken.

CDC's Climate-Ready States & Cities Initiative CDC’s Climate-Ready States and Cities Initiative is helping 16 states and 2 cities develop ways to anticipate these health effects by applying climate science, predicting health impacts, and preparing flexible programs. CDC will help states and cities partner with local and national climate scientists to understand the potential climate changes in their areas. CDC will assist states and cities in developing and using models to predict health impacts, to monitor health effects, and to identify the area’s most vulnerable to these effects. CDC’s BRACE framework provides guidance to states and cities to develop strategies and programs to confront the health implications of climate change. In approaching the health implications of climate change it is of paramount importance to find ways to understand and incorporate complex atmospheric data and both short and long range climate projections into public health planning and response activities.

Vector Control Activities Products of ASTHO’s vector control work groups over the years. Communicating about Effective Mosquito Control:  This toolkit provides model fact sheets, communication strategies, and useful templates for collaborating with policymakers and members of the public to develop and support scalable mosquito control programs.   Before the Swarm: Guidelines for the Emergency Management of Vector-Borne Disease Outbreaks: Offers practical recommendations for integrating mosquito control activities into overall preparedness and emergency management efforts.  (also include the impact of the changing weather on the spread of vectors) Public Health Confronts the Mosquito: Developing Sustainable State and Local Mosquito Control Programs: Provides final recommendations for creating sustainable mosquito control programs. The report focuses on four areas: planning ahead, involving others, using the best science and data, and informing the public. Before the Swarm Public Health Confronts the Mosquito Communicating about Effective Mosquito Control

Environmental Public Health Tracking: Peer-to-Peer Fellowship Program ASTHO is accepting applications for the 2016-2017 Fellowship Program. Funding is available for up to four state and/or territorial health agencies to conduct a pilot project on an environmental health issue of their choice. Unique opportunity for health agencies to strengthen their environmental health surveillance capacity through in-depth mentorship from a current CDC Tracking grantee, learn key tracking techniques, and build networks and data partnerships. The Tracking Network is the first national online database to provide users with access to exposure information, hazard monitoring, and health effects data in one location. Participating states (25 states and 1 city) feed data into the network, which is utilized to respond to regional exposure concerns and protect communities’ health. The tracking network is a good starting point to explore how climate affects health. For example analyzing emergency department visits and reported deaths during a heat wave can help identify vulnerable communities so they can better prepare for future events. ASTHO has supported expansion of the Tracking Network through its State-to– State Peer Fellowship program, developed in 2009 in partnership with CDC.

Moving Forward: ASTHO’s Next Steps Increase the level of coordination and communication between the disparate programs involved in addressing the public health consequences of climate change. Foster strategic research to improve climate science. Create tools and disseminate resources to strengthen state and territorial climate and health programs.

ASTHO is a resource and stands ready to assist and support you! Jim Blumenstock jblumenstock@astho.org Office: 571-527-3134 Cell: 732-614-1360