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View examples of how CEHTP is supporting public health efforts in California.
- Providing evidence to support heat illness prevention policies
- Traffic tool improves regional planning
- Mapping disease hotspots improves how we track health
- Data to inform climate change policy
With heat waves endangering California, CEHTP provides evidence to support heat illness prevention policiesCEHTP confirms accuracy of local heat alerts, helping cities to make budget and policy decisions
Risk for heat waves increasing in California, costing lives and money
Heat waves have and will continue to impact all regions of California, including urban, rural, inland, and coastal areas. In California, heat waves are expected to become longer and more frequent over time. During the California 2006 heat wave, there were 140 confirmed deaths and an additional 515 suspected deaths due to extreme heat.1,2 An estimated $133 million in health-related costs was attributed to the heat wave, along with an estimated $500 million in agriculture-related costs from the loss of livestock.3,4 Heat illness and death are preventable if appropriate actions are taken by individuals, communities, and government agencies.
Heat alert systems are a first line of defense
The National Weather Service (NWS) monitors temperature and issues heat alerts. The heat alerts serve as triggers for cities and counties to take preventative action, such as opening cooling centers where the public can gather for life-saving relief from the heat.
Cities grappling with budget cuts need evidence
Due to budget cuts, the City of San Jose wanted scientific evidence from NWS to show there was a need for cooling centers during heat waves. Without this proof, decision-makers would not approve the opening of cooling centers as part of the city’s heat alert response plan for the upcoming summer.
CEHTP confirms emergency room visits increase during heat waves
The California Environmental Health Tracking Program (CEHTP) worked with the Bay Area NWS regional office to conduct a study to determine if heat alerts for the San Jose areas accurately predicted times when people suffered the most heat illness. CEHTP showed that heat-related emergency room visits peaked immediately following heat alerts for the San Jose area and subsided when the alerts were discontinued.
San Jose keeps cooling centers open
NWS presented the CEHTP study findings to City of San Jose decision-makers. Based on this evidence, the city decided to allow cooling centers to open as part of the city’s heat alert response.
Future studies planned
CEHTP is partnering with NWS to conduct a similar study in Los Angeles and hopes to expand this effort to other regions in the state. This information will help cities to make decisions about heat wave preparedness policies and help NWS refine its heat alert system for each region.
1 California Department of Public Health, 2007
2 Hoshiko S, English P, Smith D, Trent R. A simple method for estimating excess mortality due to heat waves, as applied to the 2006 California heat wave. Int J Public Health. 2010 Apr;55(2):133-7. Epub 2009 Aug 13.
3 Srinivasan, T. Aug 28, 2008. Cost of excess hospitalizations and emergency department visits for the 2006 California heat wave. Natural Resources Defense Council. Retrieved August 17, 2011, from http://docs.nrdc.org/health/files/hea_08082601A.pdf
4 Fujii, R. Sept 15, 2006. Heat wave summit assesses ag losses. The Record. Retrieved August 17, 2011, from http://www.recordnet.com/apps/pbcs.dll/article?AID=/20060915/MONEY/609150312/1003
SB 375: Reducing greenhouse gas emissions at a regional level
Passenger vehicles contribute significantly to greenhouse gas (GHG) emissions, which are likely contributors to climate change. As part of Senate Bill 375, California’s Metropolitan Planning Organizations must develop strategies through integrated land use, housing, and transportation planning to meet target GHG emissions reductions.
Planning processes must balance smart growth with good health
With the implementation of SB 375, California will fundamentally alter regional and local planning processes. These “smart growth” policies will result in health benefits by reducing vehicle use, which in turn will reduce air pollution regionally and create healthier, more active communities.
However, some communities within the region may end up with increased pollution exposure (for example, communities living near transportation hubs). Therefore, information is needed to predict and mitigate unintended health impacts of smart growth policies.
CEHTP provides traffic data at the local level
The integration of health into planning and development efforts requires local-level data on traffic. CEHTP has developed a traffic tool, currently in demonstration mode, to compute the amount of traffic that occurs near any address in the state. Traffic data can also be used as a proxy for vehicle emissions and can indicate potential health risks.
CEHTP Traffic Tool used to screen proposed development projects
Local agencies assess potential health risks when considering a development project. If risk estimates exceed established thresholds, the agency may perform additional analyses and implement risk reduction strategies. The CEHTP Traffic Tool has been used as part of this screening process.
The Bay Area Air Quality Management District has integrated the CEHTP Traffic Tool into its California Environmental Quality Act (CEQA) Guidelines Risk and Hazard Screening Analysis Process. The tool is used to screen proposed projects for potential hazards and determine whether additional environmental review is needed. The San Francisco Planning Department has also used the CEHTP Traffic Tool in a similar fashion.
Preterm birth is a growing and costly public health problem in California
Preterm birth- also known as premature birth- is birth prior to 37 complete weeks of gestation. Preterm birth disproportionately impacts low-income communities and communities of color. Preterm birth is related to individual and community-level risk factors, such as access to medical care, proper nutrition, and environmental hazards.
Infants that are born preterm are at higher risk of dying in the first year of life and of having developmental problems throughout life. In 2005, the estimated cost for a single infant born prematurely in the U.S. was $51,600.1
Public health practitioners and health care providers need data
Public health practitioners and health care providers need to know who is at risk for preterm birth. This information helps them to target resources more effectively to the communities in greatest need. However, preterm birth data at the local (sub-county) level are not readily available.
We provide data in a web-based query system
CEHTP fulfills the need for data by providing preterm birth data by race and ethnicity, at local levels, and for multiple years. We also use advanced statistical methods to map preterm birth by census tract. These data are available publicly via our web-based query system.
Our data can be used to target efforts and track diseases over time
In Fresno County, a public health nurse used CEHTP’s preterm birth census tract data to identify locations for targeting activities. The CEHTP data were also used in developing a 5-year plan for maternal and child health in Fresno County.
Our unique maps show neighborhood rates
Health data that are readily available for public health practice are typically displayed at the state and county level. This data is of limited use for program planning and resource allocation. Using geocoding tools and advanced statistical methods, CEHTP maps data at a more local level: the census tract. This demonstrates a clear picture of where risk for preterm birth is the highest.
Below are maps of preterm birth: (1) at the county level, and (2) at the census tract level from the CEHTP web portal. Comparison of the maps demonstrates the increased utility of the census tract level maps. The darker areas have higher preterm birth rates. The lighter areas have lower preterm birth rates. In 2006, the preterm birth rate for the state was 10.1%.
A typical, commonly-available map: Preterm birth by county, 2006
CEHTP map: Preterm birth by census-tract, Los Angeles area, 2006
1 Cost estimates [from the IOM (2006) Preterm Birth: Causes, Consequences, and Prevention], include medical care, maternal delivery, early intervention, special education, and lost household and labor market productivity
Impacting Climate Change Policy: CEHTP participated in a Health Impact Assessment of AB 32 and California’s landmark cap-and-trade programCEHTP provides data and expertise to inform climate change policy in California
AB 32: Legislation to reduce greenhouse gas emissions
Greenhouse gas (GHG) emissions are widely accepted as likely contributors to climate change. Assembly Bill 32, the Global Warming Solutions Act, mandated a reduction of GHG emissions to 1990 levels by the year 2020. The bill directs the California Air Resources Board (ARB) to develop early actions to reduce GHG and to create a scoping plan to determine actions to best meet the 2020 limit. The bill also stated that low-income communities should not be disproportionately impacted.
Health Impact Assessment (HIA): Using science to inform policy
HIA is a cutting-edge field that bridges scientific data and public input to assess potential health impacts of proposed policies. HIAs offer practical recommendations to policymakers to reduce risks and capitalize on opportunities to improve health.
The HIA of cap-and-trade, conducted by the California Department of Public Health and the California Environmental Health Tracking Program (CEHTP), was the first HIA performed by a State agency in California. The HIA aimed to describe the distribution of potential health effects of cap-and-trade and to suggest mitigation efforts to minimize health risks while improving health benefits. The HIA results were presented to the California Air Resources Board (ARB), the agency implementing AB 32.
CEHTP contributes environmental data
The HIA used air pollution data provided by CEHTP. The data were used to highlight the distribution of potential health benefits and health risks resulting from the implementation of AB 32 in three vulnerable California communities (the City of Richmond, Wilmington, and the San Joaquin Valley).
Protecting vulnerable communities
In the HIA, emphasis was placed on promoting health opportunities and reducing health risks in disadvantaged communities. Following recommendations from the HIA, ARB’s final draft regulations included a resolution to devote 10% of program revenue to reduce GHG emissions and mitigate health impacts in the most disadvantaged and vulnerable communities.
The HIA process included stakeholders from industrial, environmental, and public health organizations. The HIA received high praise from ARB and participating stakeholders.
Model for the future
The results from this HIA can inform climate policy in other states and at the Federal level. Similar methods can be used in California to meet health and equity objectives of future emission reduction strategies, such as those required by Senate Bill 375 and smart-growth efforts.