1、Ready or Not:ISSUE REPORTMARCH 2024PROTECTING THE PUBLICS HEALTH FROM DISEASES,DISASTERS,AND BIOTERRORISM2024SPECIAL FEATURE on the health impacts of extreme heat and its disproportionate risk for some populations2TFAH tfah.orgTRUST FOR AMERICAS HEALTH BOARD OF DIRECTORSStephanie Mayfield Gibson,M.D
2、.,FCAPChair of the TFAH Board of Directors Former Director,U.S.COVID-19 Response Initiative Resolve to Save LivesDavid Fleming,M.D.Vice Chair of the TFAH Board of DirectorsDistinguished Visiting FellowTrust for Americas HealthRobert T.Harris,M.D.,FACPTreasurer of the TFAH Board of DirectorsSenior Me
3、dical DirectorGeneral Dynamics Information Technology Theodore Spencer,M.J.Secretary of the TFAH Board of DirectorsCo-FounderTrust for Americas HealthCynthia M.Harris,Ph.D.,DABTDirector and ProfessorInstitute of Public HealthFlorida A&M UniversityDavid Lakey,M.D.Chief Medical Officer and Vice Chance
4、llor for Health Affairs The University of Texas SystemOctavio Martinez Jr.,M.D.,MPH,MBA,FAPAExecutive Director Hogg Foundation for Mental HealthThe University of Texas at Austin John A.Rich,M.D.,MPHDirectorRUSH BMO Institute for Health EquityRush University Systems for HealthEduardo Sanchez,M.D.,MPH
5、Chief Medical Officer for Prevention and Chief of the Center for Health Metrics&Evaluation American Heart Association Umair A.Shah,M.D.,MPHSecretary of HealthWashington State Department of HealthVince Ventimiglia,J.D.Chairman of Board of Managers Leavitt PartnersTRUST FOR AMERICAS HEALTH LEADERSHIP
6、STAFF J.Nadine Gracia,M.D.,MSCEPresident and CEOTekisha Dwan Everette,Ph.D.,MPA,MPH,CPHExecutive Vice PresidentStacy MolanderChief Operating OfficerAcknowledgementsTrust for Americas Health(TFAH)is a nonprofit,nonpartisan public health policy,research,and advocacy organization that promotes optimal
7、health for every person and community and makes the prevention of illness and injury a national priority.Review TFAHs 20232026 Strategic Plan at tfah.org.REPORT AUTHORSMatt McKillop,MPPSenior Health Policy Researcher and AnalystTFAHRhea K.Farberman,APRDirector of Strategic Communications and Policy
8、Research TFAHDara Alpert Lieberman,MPPDirector of Government Relations TFAHREPORT CONTRIBUTORSBreanca Merritt,Ph.D.Director of PolicyTFAHRyan FoxSenior Public Affairs OfficerTFAHMegan WolfeSenior Policy Development ManagerTFAHEXTERNAL REVIEWERSThis report benefited from the insights and expertise of
9、 the following external reviewers.Their review is not necessarily an endorsement of the findings or recommendations by the reviewer or their organization.TFAH thanks the reviewers for their time and assistance.Robert Dubrow,M.D.,PhDProfessor of Epidemiology,Department of Environmental Health Science
10、sFaculty Director,Yale Center on Climate Change and HealthYale School of Public HealthLisa Peterson,MPH,MPA,CPHSenior Director,PreparednessAssociation of State and Territorial Health OfficialsReady or Not2024TABLE OF CONTENTSMARCH 2024Table of ContentsEXECUTIVE SUMMARY.4SPECIAL FEATURE:The Health Im
11、pacts of Extreme Heat and its Disproportionate Risk for Some Populations .8 Interview with Marta Segura,MPH,Chief Heat Officer,City of Los Angeles .13 Interview with Gredia Huerta-Montaez,M.D.,FAAP,Pediatrician,San Juan,Puerto Rico.15 Sidebar:Public Healths Role in Protecting Older Adults During Ext
12、reme Weather Events.18SECTION 1:Assessing States Preparedness.20 Indicator 1:Nurse Licensure Compact.21 Indicators 2 and 3:Accreditation.23 Indicator 4:Public Health Funding.26 Indicator 5:Community Water System Safety.28 Indicator 6:Access to Paid Time Off.32 Indicator 7:Flu Vaccination Rate.34 Ind
13、icator 8:Patient Safety in Hospitals.38 Indicator 9:Public Health Laboratory Surge Capacity.41 Indicators Performance Matrix by State.44SECTION 2:Recommendations for Policy Action by Federal,State,Local,Territorial,and Tribal Policymakers and Health Officials,the Healthcare Sector,Community Leaders,
14、and Businesses.46 Priority Area 1:Provide Stable,Flexible,and Sufficient Funding for Domestic and Global Public Health Security.47 Priority Area 2:Ensure Effective Leadership and Coordination.50 Priority Area 3:Prevent and Respond to Outbreaks and Pandemics.52 Priority Area 4:Build Resilient Communi
15、ties and Promote Health Equity in Preparedness.54 Priority Area 5:Accelerate Development and Distribution of Medical Countermeasures.56 Priority Area 6:Ready the Healthcare System to Respond and Recover.58 Priority Area 7:Prepare for Environmental Threats and Extreme Weather.60APPENDIX A:Year in Rev
16、iew:An Overview of 2023s Major Public Health Emergencies,Threats,Reports,and Strategies.62APPENDIX B:Report Methodology.73ENDNOTES.75334EXECUTIVE SUMMARYMARCH 2024Executive SummaryIn 2023,the United States faced multiple public health emergencies.The COVID-19 pandemic,although no longer a declared e
17、mergency as of May,continued to pose significant concerns.In addition,the country experienced 28 weather-related disasters that each caused at least$1 billion in damage,a record number of such high-impact events.Severe storms in Mississippi caused extensive damage,underscoring the need for effective
18、 emergency responses.Wildfires in Maui,Hawaii,led to 100 known deaths and substantial destruction and economic losses.Additionally,smoke from Canadian wildfires severely affected air quality in the Midwest and Northeast,impacting vulnerable populations.Hurricane Idalia in the southeast U.S.and Typho
19、on Mawar in Guam further highlighted the growing threat of weather-related disasters,testing the resilience of public health infrastructures.These events emphasized the need for a comprehensive approach to public health preparedness,one that integrates immediate responses with long-term strategies f
20、or prevention,mitigation,and recovery.Ready or Not:Protecting the Publics Health from Diseases,Disasters,and Bioterrorism,now in its 21st edition,continues its crucial role tracking national public health emergency preparedness.This edition remains as vital as ever for policymakers,offering actionab
21、le data and recommendations to enhance emergency preparedness in their jurisdictions.The reports key indicators provide state officials with benchmarks to assess progress,identify gaps in all-hazards preparedness,and compare their states performance with others,serving as a vital tool for targeted p
22、olicy and fiscal decision-making.In addition,the reports special section discusses the increasing health impacts of extreme heat,particularly on population groups at disproportionate risk,and outlines action steps officials should take to protect health during heat waves.EFFECTIVE EMERGENCY PREPARED
23、NESS REQUIRES COMPREHENSIVE PUBLIC HEALTH INVESTMENT AND SYSTEMSCritical to public health preparedness and resilience is investment in the full range of public health activities across the Centers for Disease Control and Prevention(CDC),other federal agencies and at the state,local,tribal,and territ
24、orial levels.Public health emergencies,including extreme weather events and infectious disease outbreaks,repeatedly demonstrate the interconnectedness of the underlying health of the population and disaster resilience.People with chronic diseases or behavioral health conditions typically have the wo
25、rst outcomes during infectious disease outbreaks or natural disasters.Preventing chronic diseases and improving the underlying health of communities is therefore key to averting severe health impacts during emergencies.An effective public health response also requires experts from a range of discipl
26、ines,such as maternal health,child and adolescent health,older adult health,behavioral health,environmental health,and health equity.Investing only in one aspect of public health preparedness while neglecting chronic disease prevention is short-sighted and makes the nation more vulnerable in the lon
27、g run.Investing in programs that promote health in every community is an important first step in emergency preparedness.45 TFAH tfah.orgTABLE 1:Top-Priority Indicators of State Public Health PreparednessINDICATORS1Incident Management:adoption of the Nurse Licensure Compact.6Workforce Resiliency and
28、Infection Control:percentage of employed population that used paid time off in any given month.2Institutional Quality:accreditation by the Public Health Accreditation Board.7Countermeasure Utilization:percentage of people ages 6 months and older who received a seasonal flu vaccination.3Institutional
29、 Quality:accreditation by the Emergency Management Accreditation Program.8Patient Safety:percentage of hospitals with a top-quality ranking(“A”grade)on the Leapfrog Hospital Safety Grade.4Institutional Quality:size of the state public health budget compared with the past years budget.9Health Securit
30、y Surveillance:the public health laboratory has a plan for a six-to eight-week surge in testing capacity.5Water Security:percentage of the population that used a community water system that failed to meet all applicable health-based standards.Source:National Health Security Preparedness Index1Notes:
31、The National Council of State Boards of Nursing organizes the Nurse Licensure Compact.The U.S.Environmental Protection Agency assesses community water systems.Paid time off includes sick leave,vacation time,or holidays,among other types of leave.The Leapfrog Group is an independent nonprofit organiz
32、ation.TFAH drew every indicator and some categorical descriptions from the National Health Security Preparedness Index,with one exception:public health funding.See“Appendix B:Methodology”for a description of TFAHs funding data-collection process,including its definition.This years edition of Ready o
33、r Not does not include the Public Health System Comprehensiveness indicator.This indicator,which has been a valuable part of our report since 2022,assesses the percentage of state populations served by a comprehensive public health system.Unfortunately,we were unexpectedly unable to access updated d
34、ata from the latest National Longitudinal Survey of Public Health Systems(NALSYS)by Systems for Action,data that were needed to include the indicator in this years report.Instead,this years assessment of state public health emergency readiness is based on nine indicators rather than the usual 10.Sta
35、tes placement within the performance tiers may have been affected by this change,either negatively or positively.As we do every year,TFAH will evaluate the mix of performance indicators used in the report for the 2025 edition;we expect to return to 10 indicators at that time.This Years FindingsIn th
36、is 2024 report,as in past years,states were scored by Trust for Americas Health(TFAH)relative to one another for each indicator and overall.The Ready or Not report groups states and the District of Columbia into one of three tiers(high,middle,and low)based on their relative performances across the i
37、ndicators.This year,21 states and the District of Columbia scored in the high-performance tier,13 placed in the middle-performance tier,and 16 were in the low-performance tier(see Table 2).(See“Appendix B:Methodology”for more information on the scoring process.)TABLE 2:State Public Health Emergency
38、PreparednessState performance,by scoring tier,2023Performance TierStatesNumber of StatesHigh TierAL,AZ,CO,CT,DC,FL,GA,KS,MA,ME,MS,NC,NE,NJ,OH,PA,RI,SC,TN,VA,VT,WA21 states and DCMiddle Tier AR,DE,IA,ID,IL,MD,MO,MT,NH,NM,OK,UT,WI13 statesLow TierAK,CA,HI,IN,KY,LA,MI,MN,ND,NV,NY,OR,SD,TX,WV,WY16 state
39、sNote:See“Appendix B:Methodology”for scoring details.Complete data were not available for U.S.territories.6TFAH tfah.orgTFAHs analysis found:A significant number of states have proactively prepared to enhance healthcare and public health laboratory capacities in response to emergencies.As of this re
40、port,39 states have joined the Nurse Licensure Compact,a notable increase from 26 states in 2017.2 This compact permits registered nurses and licensed practical or vocational nurses to practice across multiple jurisdictions under a single license.Such an arrangement is particularly beneficial in eme
41、rgencies,as it allows for rapid augmentation of healthcare staffing.Nurses,for instance,can cross state boundaries to assist at evacuation centers or other medical facilities as needed.Furthermore,all states have developed written plans to significantly expand public health laboratory capacity for p
42、eriods ranging from six to eight weeks,with the exception of four:California,Missouri,Utah,and Virginia.This expansion is critical for managing simultaneous emergencies or handling large-scale outbreaks.These efforts reflect a growing commitment to emergency healthcare readiness and the ability to r
43、espond effectively to a variety of challenging scenarios.A large majority of U.S.residents who access their household water from a community water system had access to safe drinking water.In 2022,on average,only 5 percent of state residents were served by a community water system that failed to meet
44、 all relevant health-based standards.This represents a marginal improvement from 2018,where 7 percent of residents were in similar circumstances.Water systems that do not comply with these standards pose a heightened risk of water-based emergencies,potentially leading to contaminated water supplies
45、that endanger public health.To enhance safety,continuous monitoring and improvement of water system standards are essential to reduce these risks and ensure the provision of clean,safe water for all residents.A significant number of states have achieved accreditation in either public health,emergenc
46、y management,or both,demonstrating their commitment to maintaining high standards in these critical areas.As of January 2024,either the Public Health Accreditation Board or the Emergency Management Accreditation Program had accredited 43 states and the District of Columbia.Notably,29 of these states
47、,along with the District of Columbia,have received accreditation from both organizations.However,seven statesAlaska,Hawaii,New Hampshire,South Dakota,Texas,West Virginia,and Wyominghad not been accredited by either body.Accreditation from these programs is an important indicator of a states prepared
48、ness and capability in handling emergencies.It helps ensure that there are effective prevention and response systems in place,operated by adequately trained and qualified personnel.This dual accreditation is vital for enhancing state-level readiness and response to public health and emergency situat
49、ions,contributing to a higher standard of safety and preparedness for residents.However,the lack of accreditation does not necessarily mean that a state failed to earn accreditation.It could mean that the state chose not to apply for accreditation or its accreditation process is ongoing.Seasonal flu
50、 vaccination rates in the United States have experienced notable shifts over the past few years.While the country saw a significant rise in flu vaccination rates in earlier years,recent seasons have seen a decline.Specifically,the vaccination rate among Americans ages 6 months and older increased fr
51、om 42 percent in the 20172018 season to a peak of 52 percent in both the 20192020 and 20202021 seasons.However,this was followed by a slight decrease to 51 percent in the 20212022 season.More concerning is the 20222023 flu season,where CDC reported a vaccination rate of just 49 percent,the lowest si
52、nce the 20182019 season.3 The Healthy People 2030 initiative,a federal program establishing decade-long goals for national health improvement,has set a target of achieving a 70 percent annual seasonal influenza vaccination rate.4 This target underscores the importance of continued efforts to promote
53、 flu vaccination,which is key to reducing the incidence and severity of seasonal flu outbreaks.Enhancing public awareness and the accessibility of flu vaccines will be crucial in striving to exceed this target and thereby prevent flu hospitalizations and deaths.7 TFAH tfah.orgIn the United States,th
54、e utilization of paid time off(PTO)among workers varies across states,reflecting disparities in public health preparedness and workforce policies.During the period from March 2018 to March 2023,an average of 55 percent of workers reported using some form of paid time off,including sick leave,vacatio
55、n,and holidays.This measure,crucial for public health,allows workers to stay home during illnesses,reducing the spread of diseases and easing the burden on healthcare systems.The U.S.approach to PTO is unique,lacking comprehensive federal mandates and relying instead on individual employer policies
56、or state or local legislation.The significance of PTO was highlighted during the COVID-19 pandemic,when temporary federal mandates for sick leave helped reduce virus transmission rates.However,the absence of a uniform national policy underscores the need for more consistent and comprehensive approac
57、hes to ensure workforce health and resilience.This variability in PTO access and usage not only impacts individual health but also has broader implications for public health emergency preparedness and response.In a fall 2023 assessment,only 25 percent of U.S.hospitals on average earned an“A”grade fo
58、r patient safety.This rating measures a hospitals capability to ensure patient safety and manage public health emergencies.Historically,U.S.hospital safety has evolved dramatically,from improving medical education standards to integrating advanced technology and systematic safety protocols.However,d
59、espite these advancements,hospital errors still rank as a leading cause of death,necessitating continuous improvement in hospital practices.This indicator serves as a barometer of a hospitals performance in areas that are critical for preparedness,including intensive care capacity,prevention of hosp
60、ital-associated infections,error prevention,and readiness for emergencies.Report Purpose and MethodologyTFAH annually publishes the Ready or Not report series,which evaluates states preparedness for public health emergencies.This assessment is based on key indicators that collectively form a checkli
61、st of crucial issues and actions for states and localities to address continually.The report,encompassing all 50 states and the District of Columbia,enables states to compare their performance with that of prior years and of similar jurisdictions.This analysis was completed following consultations w
62、ith a diverse group of subject-matter experts and practitioners.The reports indicators,primarily sourced from the National Health Security Preparedness Index(NHSPI),5 include a unique measure:the trend in state public health funding levels,with data collected by TFAH.This indicator specifically gaug
63、es the resource adequacy of key agencies for emergency preparation and response.The NHSPI,historically an initiative of the Robert Wood Johnson Foundation,was produced with scientific and administrative direction from the University of Kentucky and the University of Colorado.For a comprehensive unde
64、rstanding of how TFAH selected and scored these indicators,see“Appendix B:Methodology.”Ready or Not and the NHSPI have somewhat different purposes and are meant to be complementary,rather than duplicative.With more than 100 indicators,the NHSPI paints a broad picture of national health security,allo
65、wing users to zoom out and holistically understand the extent of both individual states and the entire nations preparedness for large-scale public health threats.In slight contrast,Ready or Not,with its focus on fewer select indicators,focuses attention on state performances on a subset of the index
66、 and spotlights important areas in order for stakeholders to prioritize a smaller,more focused set of improvement goals.TFAH and the NHSPI both work to help federal,state,and local officials use data and findings from each project to make Americans safer and healthier.8TFAH tfah.orgThe Health Impact
67、s of Extreme Heat and its Disproportionate Risk for Some PopulationsEveryone living in the United States will experience the impacts of climate change,including unprecedented heatwaves,but some population groups are at heightened risk.Episodes of extreme heat,already the most frequent cause of clima
68、te related illness and mortality,are becoming more frequent,involve higher temperatures,are longer in duration,and are occurring in more regions of the country.These events have led to new and expanded threats to health,particularly among populations at greater risk for heat-related illness and in p
69、laces where extreme heat and/or sustained climate-related health risks are new occurrences,thus residents have not acclimated to them.In 2022,more people died in the United States due to extreme heat than due to any other type of weather-related event.6 Climate scientists predict that episodes of ex
70、treme and prolonged heat waves will be the new norm.Extreme heat deaths are known to disproportionately affect Black and Native Americans(due to socioeconomic factors)and people living in urban or rural communities.7 Protecting people from the health effects of heat is therefore an urgent public hea
71、lth need,as is understanding and responding to the ways in which some population groups are at increased risk.Record Heat:Who is at Heightened Risk?According to NASA,the summer of 2023 was the hottest ever recorded since record-keeping started in 1880.8 Many parts of the United States,including regi
72、ons normally associated with cooler summer temperatures,experienced days of record-breaking heat.In August,an estimated 57 million people living in the South and Southwest regions of the country spent days under an excessive heat warning,and an additional 54 million people were under a heat advisory
73、.9 Examples of extended extreme high temperatures occurred in the Phoenix,Arizona area,which experienced 54 consecutive days of temperatures reaching 110 degrees.10 In August,heat index measures reached 110 degrees in traditionally warm parts of the country but also reached record levels as far nort
74、h as Southern Illinois.11Most healthy adults are able to manage heat within typical ranges,but experts postulate that new levels of extreme heat has led to more heat-related illness nationwide particularly among disproportionately impacted groups,including under-resourced and low-income communities,
75、many communities of color,Tribes,immigrant populations,people with chronic diseases,people using medications that increase their heat-associated risks,people with a substance misuse disorder,pregnant people,infants,children,older adults,people who work outdoors,people who live in urban heat islands,
76、people living without air conditioning(or those who cannot afford to use it)and people who live alone.12 Furthermore,belonging to more than one of these groups,such as an older adult living in an under-resourced community,adds to the risk of heat-related illness.A further complication of protecting
77、people from the health impacts of extreme heat is that heat effects happen to different people at different levels of exposure.In other words,being outside or inside without air conditioning on a hot day might present little or no risk for some people but high risk for others,making general heat war
78、nings less effective.How Intersecting Risk Factors Increase Heat Impacts on Some GroupsMany population groups are at the highest risk of heat-related illness due to their age(including children and older adults),health,or economic status.Typically,groups at heightened risk include people with low in
79、comes,people with a disability,and some SPECIAL FEATURE:9 TFAH tfah.orgcommunities of color.In addition,the circumstances and built environment in which people livesuch as people who are unhoused,have limited access to transportation,work outdoors or in workplaces without air conditioning,people who
80、se homes are not air conditioned,and people who live in urban heat islands(areas with little or no green space that are without shade-producing tree canopies and that have a high proportion of asphalt)experience overlapping vulnerabilities that increase peoples risk for heat-related illness and mort
81、ality.Furthermore,redlining,which was the practice of systemically driving Black residents to certain neighborhoods,such as by denying home loans,created segregated and under resourced communities.Many of which continue to experience disproportionate levels of poor health outcomes and limited econom
82、ic opportunity.13Medical conditions such as heart disease,obesity,diabetes,kidney disease,and asthmaoften occurring at higher prevalence in communities that experience social,economic,and environmental disadvantages,including income disparities and lack of access to health promoting resources can wo
83、rsen the health impacts of extreme heat and other climate-related events.In addition,the conditions in which a person lives have a strong correlation to their ability to protect their health during heat waves.Research shows that many communities of color are disproportionately vulnerable to the effe
84、cts of extreme heat and air pollution due to long standing impacts of structural racism.For example,the effects of discriminatory banking practices greatly limited property values and buying power within communities of color.14 Redlined communities typically were core urban neighborhoods and Black n
85、eighborhoods.15 The effects of redlining continue to impact health in many communities of color today as more Black people live in under resourced communities,in urban heat islands or near contaminated land or waterways,putting them at greater risk of heat or other environmental health threats.16 Pe
86、ople who are unhoused are likely to have no or limited access to air conditioning and may also have limited or no access to shade and cooling centers.Furthermore,a 2014 study in New York City found a strong association between older adults who lived in deteriorating and dilapidated housing and their
87、 vulnerability to the impacts of extreme heat.17 Rural populations can also be at heightened risk of heat-related illness due to lack of air conditioning,lack of access to healthcare or social services,and geographic isolation.18Heat and PregnancyPregnant people exposed to high levels of environment
88、al heat are at higher risk of developing labor and delivery complications than expectant people not experiencing chronic heat exposure,according to a study published in The Journal of the American Medical Association.19 The study results linked exposure to environmental heat to severe maternal morbi
89、dity,including increased risk of cardiac arrest,eclampsia,heart failure,and sepsis.20 The studys authors noted that the heat many parts of the country experienced during the summer of 2023 would qualify as chronic exposure to extreme heat,21 which can lead to pre-term births.In 2019,one out of every
90、 10 infants was a pre-term birth,and health professionals are concerned that the number of such births will continue to rise due to the increasing amount of extreme heat.22 Short and long term exposure to heat is also a risk factor for stillbirth.23Impacts of Extreme Heat on Infants and Young Childr
91、enChildren are often at higher risk for the health impacts of climate change,including extreme heat,than other age groups for a number of reasons:their bodies are still developing,they breathe at a faster rate,and they often spend more time outdoors.24 Heat stroke is particularly dangerous for child
92、ren and can lead to damage to their brains,hearts,kidneys,and muscles.25Exposure to extreme heat is also dangerous for infants.Such exposure puts babies at increased risk for preterm birth and low birth weight.Babies can overheat quickly;one reason is that their sweat glands are not fully developed.
93、Therefore,one of the bodys primary methods of remaining cool,sweating,is not as effective in infants as it is in older groups.26 Poor air quality,often related to wildfire smoke(wildfires are often fueled by the dry conditions created by extreme heat)or ground-level ozone,can cause health problems f
94、or everyone but is especially dangerous for the developing lungs of a child and can lead to increased risk for adverse birth outcomes,developmental disorders,and asthma.27The impact of extreme heat and other climate change on children is a strong example of the ways social,economic,and environmental
95、 inequities can exacerbate health risks.For example,more children of color live in communities where the impact of extreme heat is a more significant health risk than it is in affluent communities.A community with few trees and more industry,traffic,and TFAH tfah.org10asphalt becomes a heat island w
96、ith few places for kids to play or cool off.As longer and more intense heat waves and wildfire smoke events increase,preventing and monitoring these events and their impact on children will become more critical.School districts need to be alert to the health risks associated with excessive heat and/
97、or poor air quality in school buildings.A 2020 Government Accountability Office report found that an estimated 41 percent of U.S.public school districts needed to update or replace their heating/ventilation and air conditioning systems in at least half of their school buildings.28 The environmental
98、safety of school buildings is another place where certain populations groups,often people of color,are disproportionately impacted,with schools in Black and Hispanic neighborhoods more likely to lack air conditioning or have poor indoor air quality.29Impact of Extreme Heat on Older AdultsOlder adult
99、s,people ages 65 and older,are more prone to heat-related illness,due to medications or chronic conditions that impact their ability to regulate body temperature or when their condition is exacerbated by the heat.They are also more susceptible to the negative health effects of air pollution.30 Peopl
100、e 65 and older accounted for more heat-related hospitalizations in the United States than did any other age group.31 Increases in overall average temperatures and increasing numbers of heat waves in communities across the country are expected to lead to more heat-related illnesses and deaths among p
101、opulations at higher risk of poor outcomes,including older adults.32Because more people of color live in urban heat islands,their life conditions increases their heat vulnerability.33 National data show that nearly 90 percent of U.S.households use air conditioning,but about 12 percent of households
102、living below the poverty line lack home air conditioning.34 When looked at through the lens of the number of older adults living at or near the poverty line,the lack of in-home air conditioning creates health risks for many older Americans.According to the Congressional Research Service,in 2021 abou
103、t 5.8 million people above the age of 65 lived in poverty.35 An additional consideration is older adults who have air conditioning but cannot afford to use it.Reliance on public transportation to get to a store,a medical appointment,or a cooling center during a heat wave is another example of an inc
104、reased vulnerability for some older adults.According to a University of Maryland School of Medicine study,20 percent of senior adults report that they rely on public transportation to get to their medical appointments.36Heat and Indigenous PopulationsNative Americans,Native Alaskans,and Native Hawai
105、ians are often at higher risk for health impacts during periods of extreme heat.According to CDC data and reporting,between 2004 and 2018,indigenous groups experienced the highest rate of heat-related deaths in the United States.37 One primary reason is the higher levels of chronic disease within In
106、digenous populations due to long-standing inequities in the social determinants of health such as access to education,employment,and healthcare.38 Other factors include threats to natural resources and ecosystems produced by climate change as well as a lack of health promoting infrastructure in some
107、 Indigenous communities.39Heat Impacts on People Who Live in Public HousingPeople who live in public housing often have higher rates of chronic disease often associated with income levels,access to transportation and healthcare,and environmental hazards.They are also typically older.These factors pu
108、t them at higher risk for heat-related illness.Adding to the risk factors are poor indoor air quality and a lack of air conditioning and green space within many communities with public housing.40Heat and People with Existing Medical or Behavioral Health Conditions or DisabilitiesExtreme heat multipl
109、ies the health risks for people with mental and cognitive health conditions,as well as for people with chronic health conditions and disabilities.41 People with behavioral health conditions are often at higher risk of harm during heat waves as the use of alcohol,drugs,and psychotropic medications in
110、crease the risk of heat-related illness and death.42 Periods of extreme heat have also been found to be associated with increases in insomnia,depressive feelings,suicidal ideation,and suicide.43What Action Steps are Needed?Protecting health from the impacts of extreme heat requires attention and act
111、ion steps at many levels and by many sectors,including federal,state,and local government;employers;the public health system;the healthcare sector;and schools,among others.An issue in many communities is what agency has lead or coordinating responsibility for protecting residents from the health imp
112、acts of extreme heat.Clarity is needed about who is in charge and that office or agency needs the resources to do the job.Emergency response and public health systems need to be involved and working together as does the healthcare delivery system.Community partners are also needed.Programs to protec
113、t residents from the health impacts of extreme heat will need to focus on increasing the community,family,and individual ability to adapt to the environmental impacts of climate change and on advancing environmental justice.Heat response plans describe and organize activities to prevent heat-related
114、 illness and deaths.44 CDC advises that in creating heat response plans,local health departments,working with other partnerssuch as emergency response agencies,fire,police,emergency services,and social service providersshould consider local conditions,capacities,resources,and populations.45In additi
115、on to community-level conditions,an individuals or households ability to adapt to the impacts of heat and/or air quality is a consequential factor in how they fare during heat or other climate-related emergencies,and that ability is often related to income,health status,age,English proficiency,and w
116、here people live.Therefore,heat adaptation programs should be designed and implemented in ways that prioritize equity and address the needs of communities most at risk first.The needs of pregnant people,young children,older adults,and people with chronic illness or disabilities must be recognized in
117、 all planning.A variety of programs are recommended,being piloted,or are in place in states and localities to create more heat-resilient communities.The following is a sampling of such programs:l A 2022 examination of 21 local government heat action plans found that all the plans included surveillan
118、ce systems and activation triggers,heat health messaging and risk communication,the use of cooling centers,and interagency coordination.48 l California has identified six areas for state action to protect residents from the effects of extreme heat:1.Implement a state-wide monitoring system to identi
119、fy extreme heat and heat illness events before they are impacting people,to monitor trends,and to intervene early.2.Accelerate readiness to protect communities most impacted by extreme heat,including through cooling more schools and homes,supporting community resilience centers,and expanding nature-
120、based solutions.11 TFAH tfah.orgCDC recommends that municipal heat response plans include:l An overview of the anticipated impacts of extreme heatl A description of thresholds for activationl Identification of at-risk populations and geographiesl Relevant community considerationsl Identification of
121、preparedness,response,and recovery actions and partnershipsl Delineated roles and responsibilities,including how efforts will be coordinatedl An evaluation and revision processHeat response actions can include:l Surveillancel Heat-health messaging and communications,including in the workplacel Front
122、line healthcare and social services interventionsl Neighbor outreachl Cooling centersl Water distributionl Fan distributionl Changes to the built environmentl Energy assistance46Also at the federal level,in July 2023,the U.S.Department of Labors Occupational Safety and Health Administration released
123、 a heat hazard alert to share information with employers about their responsibility to protect workers against heat-related illness and how to go about doing so.4712TFAH tfah.org3.Reaches communities that are disproportionately impacted.4.Expand economic opportunities that will address extreme heat
124、impacts.5.Increase public awareness about the health risks of extreme heat.6.Protect natural and working lands,ecosystems,and biodiversity from the impacts of extreme heat.49l Some cities are working to reduce urban heat islands through green infrastructure investments,including planting trees and e
125、ncouraging the creation of green and cool roofs through grant and tax-credit programs.50 Shade is particularly important near public transportation stops and walking routes to shops and schools.l Many municipalities have heat early warning systems,including planning with healthcare and social servic
126、e providers.Planning should ensure that heat related public messaging reaches vulnerable populations.51l Municipalities are partnering with community-based organizations to plan and execute programs to protect residents during periods of extreme heat.l When building or resurfacing roads,some jurisdi
127、ctions are using surfaces that produce less heat.A number of cool pavement systems and materials are currently in use or being studied.52ADDITIONAL RESOURCES:The National Integrated Heat Health Information System was created by the National Oceanic and Atmospheric Administration and CDC to develop a
128、nd provide actionable,science-based information to help protect people from the effects of heat.heat.gov CDCs Climate and Health Program Heat&Health Tracker provides heat and health information at the local level to allow community officials to better prepare for and respond to extreme heat events,i
129、ncluding heat exposure and heat-related illness data.Ephtracking.cdc.gov/Applications/heatTracker/The health threats created by extreme heat are serious and increasing,which makes continued research,funding,piloting,and scaling programs that can mitigate the impact of heat on health critically impor
130、tant.Public health must play a key role in helping to implement these programs,and policymakers must provide the public health system with the resources to do so.13 TFAH tfah.orgInterview with Marta Segura,MPH Chief Heat Officer,City of Los AngelesMarta Segura was appointed the city of Los Angeles f
131、irst-ever Chief Heat Officer in June 2022 while also serving as the Director of the Climate Emergency Mobilization Office in a dual role.She is one of only ten chief heat officers worldwide and the first Latina and person of color to hold this position within the United States.TFAH:What does your da
132、y-to-day work as a heat officer look like?Which types of partners do you engage with most frequently?Ms.Segura:As the founding Chief Heat Officer and the Director of the Climate Emergency Mobilization Office for the city of Los Angeles,and with heat as our most dangerous climate hazard,I hit the gro
133、und running.I had to start executing,planning,and growing our team while simultaneously putting out fires,creating policy,and planning for the long term.Youre planning,hiring staff,and developing the data and the policy reports so that your office is positioned to create long-term impacts,and in our
134、 case,with public health and equity as a throughline.We have a staff of six now but started as an office of one.My team and I combine the work of resilience officers,emergency response officers and climate officers while also addressing public outreach,media,and communications so that we keep the pu
135、blic informed about what to do and how to protect themselves from the risks of extreme heat.A key day-to-day role is influencing equitable climate policy within the city,state,and federal governments,and meeting with colleagues across the globe through various climate cohorts,such as C-40 Cities,Ten
136、 Across,and others.So,you have at least five key pillars in doing this work extreme heat and climate planning,climate policy reporting,emergency response,public awareness/stakeholder engagement,and coordination and collaboration with various departments who have a key role in heat mitigation and ada
137、ptation.Every day,I ask myself how does this improve the health and livability of our most vulnerable communities,because if we improve conditions for them,we improve climate and extreme heat solutions for all.If you ask some leaders in other cities they often say,oh,cities exist to spur economic de
138、velopment or were here to create economic vitality.But I would say those are means and metrics,not the ultimate results we seek.Our city charter plainly states that protecting the health and safety of our residents is our reason to exist as a city.Strategies and climate investments to reduce the eff
139、ects of extreme heat and other climate hazards should be leveraged to create healthy communities.We can do much of that through equitable investments and green job creation.But only by measuring a reduction in health disparities and by evaluating livability metrics will we know if we are succeeding
140、in our role as a city.TFAH:How does your office coordinate with emergency services during extreme heat events,and what protocols are in place to ensure rapid response to heat-related emergencies?Ms.Segura:Fortunately,the city of Los Angeles has a terrific emergency management department,led by our g
141、eneral manager,Carol Parks.Theyre a phenomenal department and partner that consistently seeks to be innovative and collaborative.Theyve embraced my role from day one and we have worked most closely on our cooling center strategies and on our forthcoming local hazard mitigation plan,which will includ
142、e heat and equity for the first time.They have protocols for all climate and natural disaster emergencies and an adverse weather task force that works with the National Weather Service,which I am a part of.When the National Weather Service predicts that we will have a heat alert,the emergency manage
143、ment team calls the task force together.That includes our office,the police and fire departments,and Los Angeles countys public works and public health departments.We all strategize and ensure that we have the resources necessary to address whatever the National Weather Service tells us the potentia
144、l challenges will be.And thats where we identify how many cooling centers we need,how much outreach to the unhoused to get them sheltered we need,and deployment of emergency responders,etc.I am very grateful for their support.Our next local hazard mitigation plan(LHMP),which the Federal Emergency Ma
145、nagement Agency requires,will include heat mitigation as a central section,and that then informs FEMA and the state of California on the most vulnerable areas of L.A.and the resources we need for preventing harm,preparing our infrastructure and our emergency response to extreme heat.Only a few citie
146、s in the nation have addressed extreme heat in their LHMPs.TFAH:Do you have specific outreach strategies to communicate with populations at higher risk due to extreme heat?Do you tailor your 14TFAH tfah.orgefforts culturally or linguistically for specific populations that might not have immediate ac
147、cess to traditional media channels?Ms.Segura:First,our office has an annual heat awareness campaign that addresses many vulnerable populations,and we publish materials in several languages.And we channel these to various multi-ethnic media outlets.Im proficient in Spanish,so Latino media sources in
148、Los Angeles also interview us.We also have Korean,Chinese,Armenian,and Tagalog materials.We plan to add more languages for the next heat season.We collaborate with many departments and nonprofits to execute our social media campaign and our PSA campaigns as well.With regard to the unhoused,fortunate
149、ly,this is a priority for our mayor.The mayors office has an extensive network of staff and offices that directly address outreach for the unhoused.The mayors office and the Los Angeles Homeless Services Authority created and invested in what they call climate stations,like cooling centers.And these
150、 climate stations have water,showers,shade,and triage.The University of Southern Californias street medicine team responds to the unsheltered no matter where they are.The public works department and the L.A.Sanitation Department also have outreach teams to address the unhoused.The heat action plan t
151、hat were developing will assess our existing resources.Not only so we dont duplicate efforts but also so that we are more synergistic.The other strategy we will expand involves working directly with nonprofit organizations in those hard-to-reach communities and promoting the community health educato
152、r model.Some of those organizations already have community health educators.Its a natural partnership to connect with the local organizations that are already experts in reaching these communities.Additionally,the media has been beneficial.The press has been interested in conveying to these communit
153、ies how to protect themselves.Im also part of a regional climate collaborative,and last year,we put this information on all of our buses.We had 2,400 buses and all had information on how people should protect themselves during heat events.TFAH:What kind of data does your office collect or monitor?Ho
154、w does it inform your longer-term strategies or your day-to-day work?Ms.Segura:One of our primary roles in our charter is protecting public health and safety.Thus,health must be a key factor in our data and metrics to effectively measure our success as a city.One of the fortunate things about Los An
155、geles is that we have a city-wide equity index and the UCLA Heat Maps.The data from the UCLA heat maps show the excess emergency room visits and deaths during heat waves for the past ten years.We must also look for any correlation between preexisting health conditions and vulnerable communities with
156、 high pollution burdens.Cities should also identify data for infant mortality rates or injuries to mothers during heat waves.We know there are excessive infant mortality rates in our Black and Brown communities,for example.We need to see the degree to which heat plays a role in these disparities.If
157、we could correlate these higher rates with heat waves,we could do more to protect pregnancies.More tools and data allow us to accelerate solutions.My role is to ensure that equitable climate metrics are grounded in local data and accelerate climate solutions to reflect the climate disparities in hom
158、es and communities and how city-wide investments impact communities.TFAH:Do you have advice for other municipalities that want to install their heat officer,even if they dont have the same resources that Los Angeles has?Ms.Segura:You should prioritize your goals based on the resources in your city.I
159、n my case,we collaborate with public safety,public health,and emergency management departments and engage in emergency operations with them to fill gaps they have not addressed for heat response and mitigation.Cooling centers are more than Band-Aids for our communities that lack thermal comfort or A
160、C at home,they are life saving measures.But cities need to ensure people know about them and that they are comfortable and accessible.We are promoting the use of our libraries more than ever because we have 73 of them and they are very local to most communities and are well equipped to serve familie
161、s and children and even our unhoused.To prevent the greatest harm,you must acknowledge your emergency response role,not just a climate policy role.It elevates the position to a new level.So,if a city is looking to address the effects and disparities caused by extreme heat,that officer needs a high l
162、evel of influence,collaboration,and resources to coordinate with various agencies across the city.Also,make sure that these priorities are legislated and in your job description.Maintain open communication with the city council,mayors office,and the various departments through the creation of a heat
163、 action plan-also a critical part of coordination and execution.We will launch our first heat action plan this June.Fundamentally,you have to be very good at collaboration and leveraging existing resources and doing so through plan integration and alignment,with an eye towards reducing the health di
164、sparities and harm caused by extreme heat.15 TFAH tfah.orgInterview with Gredia Huerta-Montaez,M.D.,FAAPSan Juan,Puerto RicoDr.Huerta-Montaez is a pediatrician and the past president of the Puerto Rico Chapter of the American Academy of Pediatrics(AAP).She is a current member of the Executive Commit
165、tee of AAPs Council of Environmental Health and Climate Change.TFAH:What do you consider to be the most pressing challenge related to extreme heat exposure in children?Dr.Huerta-Montaez:The first thing we need to recognize is that children are more vulnerable to extreme heat.The most pressing challe
166、nge to protecting childrens health,safety,and security amid climate change challenges,including extreme heat,is that society is not placing children as a priority.If we placed a premium on childrens health and well-being,we would address their needs and protect them now,while having the will to take
167、 steps necessary to bequeath them a healing planet,invest in climate resilient and healthier infrastructures,including safer green spaces that support community living.With 2023 being the hottest year on record,it is imperative that we strengthen our efforts,be intentional in the work,and invest the
168、 time and resources needed to protect children from the risks related to extreme heat.These risks can be easily overlooked by our recognition of the need for children to spend time outside connecting with nature,playing sports,rather than being plugged to screens,sedentary and socially isolated.We h
169、ave a long way to go regarding public awareness and achieving positive impact in communities,and more so with climate change,a crisis that can be perceived as abstract.I remember after the 2017 hurricanes in Puerto Rico,I thought,this is a wakeup call,but today we still see the consequences of a pai
170、nfully slow response.Its been over five years and there are families that still have blue tarps on their roofs.How can a family with a broken roof be prepared for extreme heat?This leads me to a higher order,root problem:children living in poverty.They are the most vulnerable.Anything that we do to
171、protect childrens health and our environment is going to improve everybodys health and readiness for all these challenges.In 2007,the American Academy of Pediatrics was the first major medical society to publish an evidence-based policy statement about climate change and childrens health.Recommendat
172、ions are written,we just need to put them into practice.TFAH:Given the accelerating impact of climate change on heat,what shorter-term actions should be taken to protect children from its effects?Dr.Huerta-Montaez:One component of the solution to the climate crisis is in the hands of the government
173、and businesses.But parents,caretakers,and families can also become advocates for childrens health and help to increase awareness in their community.For example,talking to their childrens sports coaches to make sure that practice and game planning consider the weather forecast and avoid hours of extr
174、eme heat.Even on days when temperatures are below 90 degrees,children must take appropriate and frequent water and cooling breaks.Tragedies happen on the sports field due to heat related illnesses and the risks are increasing with climate change.Protecting the skin and the eyes from the sun and lear
175、ning the signs and symptoms of heat related illness and what to do are other examples of important actions.Parents must also be aware that people are more irritable in extreme heat,including children,especially if they cant play outdoors,which can make them more restless and demanding.For extremely
176、hot days,families can plan for indoor activities,so kids dont end up spending several hours with electronic devices in their hands.This can be an opportunity to create family time.If the home does not have air conditioning or they live in places with frequent power outages like in Puerto Rico,it is
177、important to identify a safe place to go on those extreme daysa shopping mall,church,a library,or as in the case of communities that are ahead on preparedness,a place designated as a cooling center that provide protection from heat.TFAH:How can public health and healthcare providers better communica
178、te heat-related challenges to parents and caregivers?Dr.Huerta-Montaez:First,we need to support climate change and health curricula,including mental health,in medical and nursing schools 16TFAH tfah.organd other healthcare professional training programs,and in continued education for those already i
179、n practice.It is essential that clinicians be well prepared to prevent,recognize,and treat heat-related illnesses.Secondly,there is an urgent need to revise the role of medical insurance.Payers of healthcare have a huge responsibility in the adaptation of our healthcare system to climate change.Phys
180、icians need support to allocate more time to patients to discuss climate and health-related topics.In pediatrics,the well-child care visit should be an opportunity to discuss primary prevention and health promotion topics with the families including anticipatory guidance on heat-related illness.But
181、preventive services are paid at a lower rate for children than for adults,which affects the time physicians can dedicate to one-on-one education and counseling.Thirdly,the medical home is the ideal place to educate parents and caregivers about these challenges and how to protect their children.The m
182、edical home model has been well defined by the American Academy of Pediatrics as an approach centered on the family to provide comprehensive care based on the patient needs from infancy to adulthood.Unfortunately,the payer system does not support the medical home model,so there are many inconsistenc
183、ies and inequities in access to comprehensive care,leaving many families vulnerable to a range of health risks,including heat.Collaborations are fundamental to communicate and raise awareness among families,clinicians,and healthcare providers about the climate change effects on childrens health.For
184、example,the Puerto Rico chapter of the American Academy of Pediatrics has built a strong coalition with the Supplemental Nutrition Program for Women,Infants,and Children(WIC)program as more than 50 percent of children younger than 5 years of age in Puerto Rico receive nutritional services through WI
185、C.Weve already trained almost all nutritionists in the WIC program about climate change and health,food and water security in Puerto Rico,and the role of nutrition in protecting children from the health impacts of environmental exposures.In particular,we are emphasizing the importance of the growth
186、and development in the first 1,000 days of life for healthier kids,to ensure they have the resilience needed for climate change.TFAH:We are seeing the closure of childrens hospitals and shortages of pediatric hospital beds,often in areas facing risks of extreme heat.What should policymakers at state
187、 and national levels be thinking about to alleviate these challenges?Dr.Huerta-Montaez:Its not a new problem.Its been happening for at least a decade and the causes are multifactorial.In 2018,almost a quarter of children in the U.S.had to travel farther for pediatric beds compared to 2009.Imagine a
188、situation of increased childhood illness and trauma in the context of climate change.It magnifies what is already happening.We learned some lessons about pediatric care from COVID-19,but there are so many lessons we didnt learn and unfortunately,climate change is the next lesson.Some factors respons
189、ible for closures are shortages in the pediatric workforce and lack of optimal training for other healthcare professionals in pediatric care.Children are not little adults and theres a specific level of inpatient and acute care that they need.For hospitals struggling financially,there is,unfortunate
190、ly,a tendency to assign pediatric beds to adult patients,which makes children even more vulnerable.We need to increase consistent,sustainable funding for pediatric-ready emergency departments,licensed beds,and increase the workforce to provide trauma-informed,evidence-based care,including for mental
191、 health.Support should also include loan repayment and the recruitment of underrepresented populations in the pediatric workforce.Given the burnout of the pediatric healthcare workforce during the pandemic,we also need to support the well-being of healthcare providers in an intentional way.We should
192、 also address regulatory challenges,including telemedicine models that are financially sustainable,and invest in increasing the capacity to support continuity of care during disasters.TFAH:How does extreme heat and its related disasters impact childrens mental and emotional well-being?Dr.Huerta-Mont
193、aez:Prenatal exposures during climate-related events,including high heat,can increase a babys risk for psychiatric and developmental health outcomes later in life.These outcomes are magnified by social determinants such as living in poverty,living in highly contaminated areas,or poor access to medic
194、al care,etc.Heat and other climate events create interruptions in our normal routines and can lead to stress and disruption of family life.Children are at 17 TFAH tfah.orggreater risk of developing anxiety and depression in association to extreme heat and can also respond to heat with behavioral pro
195、blems.Psychiatric medications can also interfere with their bodys ability to respond to heat.Heat has been linked to violent behavior and crime which can impact children directly and indirectly.Suicidality has also been linked to climate change.Sleep is fundamental to brain growth and development,bu
196、t heat waves bring extremely hot nights,which leads to poor quantity and quality of sleep.Poor sleep leads to poor cognitive function associated with depression,stress,anxiety,and decision making.These risks are exacerbated in children with no air conditioning at home or attending schools with no AC
197、 or living in a heat island or very urbanized areas that experience higher temperatures.Another area that needs focus to be better prepared for the impact of climate change on mental health is school health.The school setting could be part of an effective model to screen for these problems and refer
198、 for care based on guidelines in climate preparedness and mental health.TFAH:How should states and territories better prepare for pediatric needs during times of heat extremes,and how can the federal government support that preparedness?Dr.Huerta-Montaez:States and territories are key for translatin
199、g federal policy into action,and all state and territory actions should be community-based.Community leaders know about the day-to-day struggles and understand those social determinants that lead to injustices and inequities in their communities.We need to listen and empower communities to act if we
200、 really want to make a difference.That also means better collaboration with local governments and NGOs,medical organizations,the education sectorall the key componentsand be clear about their specific role and goals,especially for individuals who have leadership or elected roles at state and territo
201、ry levels.We also need to listen to the best existing evidence,translate that science and share it with the communities because we are not going to protect children with opinions.For example,there is evidence that cities with highly urbanized areas are at higher risk,so those local governments need
202、to take steps to invest in infrastructure to protect people from extreme heat;invest in early warning systems,urban cooling centers,and educate the communities about risk factors.This communication isnt a one-time thing.The message has to be repetitive,creative,and intentional;it must consider peopl
203、es beliefs and cultures;and be accessible to people with neurodiversity and physical challenges.Cities must be supported to implement energy-efficient measures to make sure we use more resilient materials in our infrastructure while protecting nature.It is important to invest in vegetation and trees
204、,as part of long-term planning to lower urban temperatures by increasing canopies and green spaces,which has been shown to improve mental health and well-being for everybody.States and territories are key for translating federal policy into action,and all state and territory actions should be commun
205、ity-based.18TFAH tfah.orgPUBLIC HEALTHS ROLE IN PROTECTING OLDER ADULTS DURING EXTREME WEATHER EVENTSThe growth in the older adult population in the United States is a public health success story.As such,it is crucial that the public health sector attends to the complex health and social needs that
206、older people and their families and caregivers face.The COVID-19 pandemic underscored public healths role in addressing the vulnerability of older adults to infectious disease.The potentially fatal impact of extreme heat is a second area in which the public health sector needs to be prepared to safe
207、guard older adult health.Older adults are at higher risk for serious health impacts during weather events including extreme heat due to their often-complex health conditions and because more older people are socially isolated or live in understaffed senior-living facilities.Knowing and planning for
208、the needs of older adults during extreme weather events is key to protecting their health.The following are examples of how local health departments are working to protect the health of older adults during heat waves.Public HealthSeattle&King County,Washington The Pacific Northwest experienced a lon
209、g-duration,unprecedented heat wave in the summer of 2021,resulting in 157 heat-related deaths,67 percent of which occurred in adults 65 and older.53 In response,Public HealthSeattle&King County(PHSKC)developed an Extreme Heat Response Plan to outline strategies the public health sector can take to p
210、rotect the community and limit poor health outcomes from extreme heat events.54 Strategies include a new notification and warning system,collaboration with local emergency management for incident action planning,and the development of heat health and safety guidance that identifies lead and enforcem
211、ent agencies.The plan also includes communication strategies,such as disseminating information about cooling center availability and locations and promoting heat safety messaging specifically for vulnerable populations such as people in homeless shelters and assisted-living facilities.These messages
212、 are also provided in multiple languages.PHSKC has been participating in TFAHs Age-Friendly Public Health Systems(AFPHS)movement since 2020,raising awareness of the public health roles in healthy aging and identifying healthy aging strategies within the AFPHS 6Cs Framework.55 As a result,PHSKC condu
213、cted a survey of the countys senior centers to determine readiness for heat-related emergencies,provided training for public health practitioners to respond to heat-related emergencies,and created emergency kits for older adults determined to have the highest need for support.PHSKC is working to sha
214、re these resources with other local health jurisdictions in the state to enhance the public health role in preventing harm to older adults during heat-related emergencies.56In other states:l The New York State Department of Health,in partnership with the New York State Office for the Aging,offers ti
215、ps and resources for older adults and their families and caregivers to stay safe during excessive heat events,57 including recognizing symptoms of heat-related illness and information about cooling centers.5819 TFAH tfah.orgl The city of Chicago developed a system in which city workers call older ad
216、ults and are authorized to turn city buildings into cooling centers when temperatures rise.l The Department of Human Services in Oregon created tip sheets for caregivers with information about heat-related illnesses and contact information for cooling centers.59 l Some county health departments in F
217、lorida have conducted walk-throughs of their jurisdictions emergency-needs shelters to identify and eliminate fall risks and to ensure adequate space for caregivers and needed medical equipment.In addition to the public health sectors activities to protect older people from extreme heat,there is a g
218、rowing movement of older adults who are engaged in the climate change issue.As noted by the National Council on Aging,“older adults have enormous resources and represent an engaged and energized group of climate activists who are rolling up their sleeves to impact the climate crisis.”60 Climate expe
219、rts,retired physicians,and others are pooling their experience to raise awareness and develop tools to educate older people and equip communities to prevent harm from heat-related climate events.Promoting services like checking in on older adults who are socially isolated and disseminating fact shee
220、ts for families and health providers are key strategies.Through the AFPHS movement,61 many state and local health departments are implementing healthy aging policies and programs.TFAHs AFPHS“6Cs Framework”offers guidance for health departments to enhance efforts to protect older adults from the effe
221、cts of extreme heat events:1.Create and lead efforts to prioritize older adults health and well-being during emergencies by including older adults in emergency preparedness policies and plans.2.Connect and convene key partners across aging services,emergency services,and healthcare to build a high-l
222、evel coalition committed to optimizing emergency preparedness systems and support for older adults.3.Coordinate existing emergency preparedness supports and tools to produce a centralized hub of emergency protocols,evidence-based toolkits,and accessible resources for both older adults and their care
223、givers to use before and during an emergency.4.Collect,analyze,and translate data on shortcomings of existing emergency systems to identify needs and disparities among older adults as well as pathways for strengthening their emergency resiliency.5.Communicate the heightened risks older adults face d
224、uring emergencies and ensure that this population and their caregivers are well informed on available resources for maintaining health and well-being during an emergency.6.Complement general support systems for older adults by distinguishing and addressing the additional needs of certain groups amon
225、g older adults,such as those with Alzheimers disease and related dementias,those with impaired mobility,or those who live in disaster-prone areas,or in homes without air-conditioning.20Ready or Not2024SECTION 1:ASSESSING STATES PREPAREDNESSSECTION 1:MARCH 2024Assessing States PreparednessIn the wake
226、 of numerous and diverse public health challengesincluding the COVID-19 pandemic,the overdose epidemic,climate changeinduced health crises,infectious disease outbreaks like measles and Mpox,and the simultaneous health threats of flu,COVID,and respiratory syncytial virus(RSV)it is clear that states m
227、ust be equipped to handle a range of potential crises.This necessitates an understanding of each states strengths,risks,and vulnerabilities in terms of emergency preparedness.To assist states in evaluating their readiness and to underscore key areas of concerns and necessary actions,this report pres
228、ents an analysis of nine critical indicators.These indicators,largely consistent from year to year,are informed significantly by the National Health Security Preparedness Index(NHSPI).The NHSPI,historically spearheaded by the Robert Wood Johnson Foundation,has been produced under the scientific and
229、administrative direction of the University of Kentucky and the University of Colorado.These indicators are designed to encapsulate and inform fundamental aspects of states emergency preparedness.Each states performance in these indicators,detailed in“Appendix B:Methodology,”has been analyzed.Based o
230、n this analysis,states have been categorized into three distinct performance tiers:high,middle,and low(see Table 3).This categorization aims to provide a clear framework for states to identify areas needing improvement and to strategize effectively for future emergencies.TABLE 3:State Public Health
231、Emergency PreparednessState performance,by scoring tier,2023Performance TierStatesNumber of StatesHigh TierAL,AZ,CO,CT,DC,FL,GA,KS,MA,ME,MS,NC,NE,NJ,OH,PA,RI,SC,TN,VA,VT,WA21 states and DCMiddle Tier AR,DE,IA,ID,IL,MD,MO,MT,NH,NM,OK,UT,WI13 statesLow TierAK,CA,HI,IN,KY,LA,MI,MN,ND,NV,NY,OR,SD,TX,WV,
232、WY16 statesNote:For the criteria and scoring methodology,refer to“Appendix B:Methodology.”Data for U.S.territories were not fully available.Note:The significance of this evaluation transcends individual state or local entities and mandates ongoing enhancement efforts from a variety of stakeholders.E
233、ffective progress usually necessitates consistent involvement and collaboration among diverse policymakers and administrators.While certain indicators fall within the direct control of state lawmakers,others demand comprehensive,multisectoral efforts,including community participation.2021 TFAH tfah.
234、orgWorkforce shortages,vividly evidenced during the most acute phases of the COVID-19 pandemic,have strained healthcare systems,at times pushing them to and even beyond capacity.Notably,during critical periodsDecember 2020,September 2021,and January 2022at least 20 percent of U.S.hospitals anticipat
235、ed imminent staff shortages.62 The ability to rapidly mobilize medical personnel across state lines is crucial for healthcare responsiveness during such crises.However,newly graduated or relocating nurses often experience a bottleneck in the licensure process,which can extend for months according to
236、 an NPR analysis of 32 states licensing records,particularly in larger states.63This indicator assesses the adoption of the NLC,established in 2000 by the National Council of State Boards of Nursing,which enables registered and practical nurses to practice in any member state with a single multistat
237、e license,eliminating the need for emergency declarations.This agreement streamlines cross-state healthcare responses by reducing administrative complexities.Before the implementation of the NLC,nurses were required to obtain individual licenses for each state in which they wished to practice,naviga
238、ting a complex web of applications,fees,and state-specific requirements that often included differing continuing education standards.This arduous and time-intensive process hindered their employment mobility,making it difficult for nurses to swiftly address workforce shortages,respond to emergencies
239、,or explore cross-border career opportunities.Consequently,the restrictive licensing regime contributed to delays in healthcare delivery,particularly in regions lacking sufficient medical personnel or during times of critical need,such as natural disasters or widespread health crises.The introductio
240、n of the NLC has significantly improved the mobility of nurses,allowing them to practice across multiple states with a single license and thus enhancing the flexibility of the nursing workforce.This increased mobility has proved to be especially valuable during public health emergencies,enabling a s
241、wift and effective response as nurses are promptly deployed to areas in need without the hindrance of obtaining individual state licenses.Additionally,as nurses can now provide care to patients across state lines,the NLC has been instrumental in the expansion of telehealth services,which broadens ac
242、cess to healthcare and makes it more efficient.Membership in the NLC is a significant indicator of a states public health emergency preparedness for several reasons.First,it allows for rapid mobilization of nursing staff across state lines during emergencies,enhancing the states capacity to respond
243、quickly to health crises.This is particularly crucial during unexpected surges in healthcare demand,such as pandemics or natural disasters.Secondly,the NLC facilitates telehealth services,essential for providing care in remote or underserved areas during emergencies.Lastly,by standardizing licensure
244、 requirements,the NLC helps ensure a consistent level of nursing care across states,maintaining quality healthcare standards even in emergency situations.In addition to enabling nurses to provide surge capacity across state lines,the compact has also been pivotal to the expansion of telehealth servi
245、ces,allowing INDICATOR 1:ADOPTION OF THE NURSE LICENSURE COMPACT(NLC)KEY FINDING:Participation in the NLC has expanded to 39 states,enhancing interstate nursing workforce mobility.22TFAH tfah.orgnurses to remotely manage chronic conditions and offer behavioral health care to patients during natural
246、disasters or for patients for whom travel is difficult.Additionally,the NLC has addressed chronic nursing shortages by allowing for the seamless recruitment of nurses into areas with persistent staffing gaps,notably improving healthcare delivery in rural and underserved communities.During the COVID-
247、19 pandemic,hospitals across the country faced extraordinary pressure as surging infections dramatically increased admissions.States that were members of the NLC had an advantage:they could more readily bring in nurses from other member states,avoiding harmful delays,or send nurses to assist when ot
248、her states experienced acute shortages.Reflecting on this,NLC Director Jim Puente said in June 2020:“I think the COVID-19 pandemic is going to cause the states that are not in the compact now to really take a second look at it.If the NLC was expanded to all 50 states,none of the guesswork with emerg
249、ency orders would be necessary because nurses could travel to other states where they are needed.No applications,fees,or background checks would be necessary.”64As of October 2023,the NLC had been adopted by 39 states,with Rhode Island and Washington being the latest to join.65 This marked a net inc
250、rease of 13 states since 2017.In June 2023,Rhode Island Governor Daniel J.McKee signed the NLC into state law.66 Rhode Island initially joined the NLC in 2008 but opted out in 2018 before reinstating it.67 Senator Joshua Miller,supporting the bill,highlighted its role in addressing the states nursin
251、g shortage and improving staffing in hospitals and health facilities.“Our state is grappling with a severe shortage of nurses,”Miller said.“Returning to the compact is a way we can make it easier and more appealing for nurses to come here for a job,making it easier for our hospitals and health facil
252、ities to fill their staffing needs.Rejoining the compact is good for our public health and safety.”68TABLE 4:39 States Participate in the Nurse Licensure CompactParticipants and nonparticipants,2023ParticipantsNonparticipantsAlabama MainePennsylvania AlaskaMassachusetts ArizonaMarylandRhode Island C
253、aliforniaMichiganArkansasMississippiSouth CarolinaConnecticutMinnesota ColoradoMissouriSouth DakotaDistrict of ColumbiaNevadaDelawareMontanaTennesseeHawaiiNew YorkFloridaNebraskaTexasIllinoisOregon GeorgiaNew HampshireUtahIdahoNew JerseyVermont IndianaNew MexicoVirginiaIowaNorth CarolinaWashington K
254、ansasNorth DakotaWest VirginiaKentuckyOhio WisconsinLouisianaOklahomaWyomingNote:As of January 2024,in Pennsylvania,nurses holding active compact licenses from other states were permitted to practice,but resident nurses in these states were not yet able to apply for a compact license.Source:National
255、 Council of State Boards of Nursing6923 TFAH tfah.orgThe Public Health Accreditation Board(PHAB)is dedicated to advancing the quality and performance of public health departments across the United States.As an independent entity,PHAB administers a national public health accreditation program that se
256、ts rigorous standards for public health services and operational efficiency.This accreditation process involves a comprehensive evaluation against a set of nationally recognized,evidence-based standards designed to improve the effectiveness of public health departments.These standards cover various
257、aspects of public health practices,including community health assessment,policy development,environmental health,health education,and emergency response.The goal of PHAB accreditation is to ensure that participating health departments meet a high level of performance and provide optimal health servi
258、ces to their communities.Accreditation by PHAB signifies a health departments commitment to continual quality improvement,transparency in operations,and accountability to the communities they serve.It is a mark of excellence that indicates a departments dedication to meeting the health needs of the
259、population effectively and efficiently.PHAB accreditation includes several standards and measures that are relevant to assessing and improving state public health departments emergency preparedness capabilities.For example,Standard 2.2 focuses specifically on health departments roles in preparing fo
260、r and responding to various types of public health emergencies.70,71 This standard requires health departments to have emergency operations plans,continuity of operations plans,risk communication plans,and processes for coordinating response efforts with partners.Health departments must also conduct
261、 exercises to test emergency plans and use after-action reports to drive improvements.Additionally,while focused more broadly on public health law and regulation,Standard 6.1 includes measures related to monitoring and enforcing orders that could be relevant during emergency situations.72The standar
262、ds also contain a number of measures that,while not emergency-specific,relate to capabilities like surveillance,data analysis,communication,workforce development,and information technology management that provide an underlying foundation to facilitate an effective emergency response.For example,stro
263、ng routine surveillance and analysis capacity improves situational awareness when threats emerge.In all,conforming to the range of applicable standards provides a mechanism for health departments to demonstrate and improve their level of emergency preparedness and response capability.The standards h
264、elp drive health departments to collaborate with partners,maintain up-to-date plans,develop supportive systems and infrastructure,and employ continuous quality improvement practices that enable an agile and effective response when public health threats or emergencies occur.In 2022,PHAB introduced Ve
265、rsion 2022,updating its standards to incorporate recent public health challenges,including the COVID-19 pandemic,racism as a public health crisis,climate change impacts,and effective communication strategies.This revision underscores the need for INDICATORS 2 AND 3:ACCREDITATION STATUS OF STATE PUBL
266、IC HEALTH AND EMERGENCY MANAGEMENT SYSTEMSKEY FINDING:Most states are accredited by the Public Health Accreditation Board and/or the Emergency Management Accreditation Program,but seven states lack accreditation from either body.24TFAH tfah.orghealth departments to be perpetually ready for emergenci
267、es and to consider social determinants of health and equity in their threat mitigation strategies.73PHAB accreditation serves as a valid and meaningful indicator of state public health emergency preparedness due to its comprehensive evaluation of key capabilities necessary for effective crisis respo
268、nse.The accreditation process requires public health departments to meet stringent standards that encompass essential aspects of emergency preparedness,such as surveillance,epidemiology,laboratory capacity,and emergency response planning.By adhering to these rigorous criteria,accredited departments
269、demonstrate their readiness to handle public health emergencies,including disease outbreaks,natural disasters,and bioterrorism events.The process also helps ensure that departments maintain a robust infrastructure,trained workforce,and effective communication strategies,all crucial for quick and eff
270、ective action during crises.Furthermore,PHAB accreditation emphasizes continual quality improvement and community engagement,which are vital for adapting to evolving public health challenges and maintaining trust and collaboration with the public.Hence,PHAB accreditation not only reflects a departme
271、nts current preparedness but also its commitment to evolving and enhancing its emergency response capabilities over time.The Emergency Management Accreditation Program(EMAP)is a voluntary assessment and accreditation process for government agencies responsible for disaster preparedness and emergency
272、 response functions.Established by a consortium of key emergency management organizations,EMAP promotes standardization and excellence in public emergency programs by evaluating them against a comprehensive set of standards and best practices.To become EMAP accredited,an emergency management program
273、 must undergo a lengthy evaluation involving careful self-assessment across dozens of standards,peer review by independent practitioners,and meticulous site visits by EMAP assessors.These standards encompass a wide range of critical emergency preparedness areas including program administration,legal
274、 authorities,fiscal management,communications systems,training programs,operational planning,exercise evaluation,and crisis response procedures.The EMAP accreditation process assists emergency agencies in identifying capability and procedural gapsdriving continuous improvement and building framework
275、s for robust crisis coordination with other accredited entities.PHAB and EMAP accreditations stand as valid and meaningful indicators of public health emergency preparedness due to their comprehensive evaluation criteria and adherence to national best practices.PHAB accreditation,with its focus on p
276、ublic health departments,ensures that accredited entities meet rigorous standards in key areas such as epidemiology,emergency response planning,and community health assessment.This accreditation demonstrates a health departments capability to effectively manage public health emergencies,from prepare
277、dness and response to recovery.Similarly,EMAP accreditation evaluates 25 TFAH tfah.orgemergency management programs across a wide range of preparedness and response capabilities,including crisis communication,resource management,and operational coordination.By meeting EMAPs standards,agencies valida
278、te their proficiency in handling various emergency situations.Together,these accreditations provide some assurance that a state or locality not only has robust public health systems in place but also has the operational capacity to respond to emergencies effectively.The combination of PHAB and EMAP
279、accreditations serves as a comprehensive benchmark,indicating a well-rounded and tested readiness for public health emergencies,making them reliable indicators for evaluating public health emergency preparedness.As of January 2024,29 states plus the District of Columbia held accreditation from both
280、PHAB and EMAP.Fourteen states had single-entity accreditation.Louisiana and Virginia were previously accredited by both but only held PHAB accreditation as of October 2023.(See Table 5.)Notably,seven statesAlaska,Hawaii,New Hampshire,South Dakota,Texas,West Virginia,and Wyominghave not attained accr
281、editation from either PHAB or EMAP.Lack of accreditation does not necessarily indicate denial but may reflect a states barriers to the accreditation process,such as workforce or financial limitations,or a states accreditation could be in-process.This analysis focuses on state-level accreditation and
282、 does not account for local,tribal,or territorial health departments that may hold accreditation independently.TABLE 5:43 States and the District of Columbia Accredited by the PHAB and/or the EMAPAccreditation status by state,January 2024PHAB and EMAPPHAB ONLYEMAP ONLYNo AccreditationAlabama Illinoi
283、sOklahomaIndiana Michigan AlaskaArizonaKansasPennsylvania Iowa NevadaHawaiiArkansasMaryland Rhode Island Kentucky TennesseeNew HampshireCaliforniaMassachusetts South CarolinaLouisiana South DakotaColoradoMississippiUtahMaineTexasConnecticutMissouri VermontMinnesota West Virginia DelawareNew Jersey W
284、ashington MontanaWyomingDistrict of Columbia New YorkWisconsinNebraskaFloridaNorth Carolina New Mexico Georgia North DakotaOregon IdahoOhio Virginia29 states+DC11 states3 states7 statesNote:This table tracks state accreditations by PHAB and EMAP.States with conditional or pending accreditation statu
285、ses at the time of data collection are listed as not accredited.Some states may comply with applicable standards without seeking formal accreditation.This analysis is limited to state-level accreditations and excludes local or tribal health departments,which may hold their own accreditations separat
286、e from state health departments.Sources:PHAB74 and EMAP7526TFAH tfah.orgINDICATOR 4:STATE PUBLIC HEALTH FUNDING TRENDS KEY FINDING:A majority of states held their public health funding steady or increased it in fiscal year(FY)2023,but at least 11 states reduced funding.(Data were not available for t
287、wo states.)Recent public health emergencies have highlighted the critical need for sufficient,flexible,and sustained funding for public health systems.This funding is essential for preparedness and response capacity,including the detection,prevention,and control of disease outbreaks,and for mitigati
288、ng the health consequences of disasters.An additional challenge to public health budgets is the fact that the infusion of funding(both federal and state)to respond to COVID-19 was one-time funding that has been spent,is set to expire,or in some cases has been rescinded by Congress,creating budgeting
289、 cliffs in many departments.Core public health capabilities,such as epidemiology,environmental hazard detection and control,infectious disease prevention and control,and risk communications,along with targeted emergency response resources,are vital.These competencies help officials maintain routine
290、functions and have surge capacity readily available for emergencies.A trained,ready,and community-aware public health workforce is essential for this surge capacity and requires sustained,predictable funding.The Public Health Activities and Services Tracking project at the University of Washington i
291、dentifies six core areas of state public health programming and services:761.Communicable disease control.Public health services related to communicable disease epidemiology,hepatitis,HIV/AIDS,immunization,sexually transmitted diseases,tuberculosis,etc.2.Chronic disease prevention.Public health serv
292、ices related to asthma,cancer,cardiovascular disease,diabetes,obesity,tobacco use,etc.3.Injury prevention.Public health services related to firearms,motor vehicles,occupational injuries,senior fall prevention,substance-use disorder,other intentional and unintentional injuries,etc.4.Environmental pub
293、lic health.Public health services related to air and water quality,fish and shellfish,food safety,hazardous substances and sites,lead,onsite wastewater,solid and hazardous waste,zoonotic diseases,etc.5.Maternal,child,and family health.Public health services related to the coordination of services;di
294、rect service;family planning;newborn screening;population-based maternal,child,and family health;supplemental nutrition;etc.6.Access to and linkage with clinical care.Public health services related to beneficiary eligibility determination,provider,or facility licensing,etc.Public healths infrastruct
295、ure enables states to promote health equity and build resilience in populations in addition to carrying out emergency response activities.However,public health funding,often discretionary,is prone to neglect or reduction,especially in tight fiscal periods.Decades of underfunding have weakened emerge
296、ncy preparedness and response capabilities.State investments play a crucial role in health agencies operations:about 28 percent of state and territorial health department revenues77 and 21 percent of local health department revenues come from state sources,on average.78Fortunately,at least 37 states
297、 and the District of Columbia either maintained or increased their public health 27 TFAH tfah.orgfunding in FY 2023,as indicated in Table 6.Nonetheless,at least 11 states reduced their funding,potentially compromising their preparedness and responsiveness in critical situations.(This indicator does
298、not assess the adequacy of states public health funding.Notably,due to inflation and population growth,stable funding may effectively represent a reduction.)From FY 2019 to FY 2022,state-supported funding for public health services experienced significant fluctuations due to pandemic-related actions
299、.In some instances,a temporary infusion of state-supported funds was allocated for just one year.In other cases,state-supported funding was temporarily cut and supplanted by federal pandemic aid.This reliance on federal aid highlights the need for states to develop robust,adaptable funding models th
300、at can effectively integrate federal funds,ensuring a cohesive financial strategy for long-term public health goals.Moreover,the distribution and adequacy of public health funding are pivotal for advancing health equity.Funding disparities can lead to inequitable access to health services,particular
301、ly among communities that are under resourced or marginalized.A funding strategy that prioritizes health equity ensures that all communities,regardless of socioeconomic status,have access to essential health resources.This approach is crucial for building a resilient,equitable,and inclusive public h
302、ealth system that meets the diverse needs of its entire population.TFAH requests that states report only their state-supported funding,which forms a significant part of the public health funding landscape.The trend in a states public health funding serves as a valid and meaningful indicator of its p
303、reparedness for public health emergencies.Adequate and consistent funding is the cornerstone of building and maintaining a robust public health infrastructure,which includes developing a well-trained workforce,advanced surveillance systems,effective use of technology,and robust communication channel
304、s.These are essential for rapid and efficient responses to health crises.When funding is stable or increasing,it indicates a states commitment to strengthening its public health systems,enhancing its capacity to respond to emergencies such as disease outbreaks,natural disasters,or bioterrorism event
305、s.Conversely,declining or fluctuating funding can create vulnerabilities in the public health system,potentially leading to gaps in emergency preparedness and response capabilities.Therefore,monitoring funding trends provides critical insights into a states readiness to protect its populations healt
306、h in the face of unforeseen challenges,making it a key metric for evaluating overall public health emergency preparedness.TABLE 6:State Public Health Funding Held Stable or Increased in at least 37 States and DCFunding by state FY 2022 to 2023Alabama Alaska Arizona Arkansas California Colorado Conne
307、cticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska NevadaNot reportedNew Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Okla
308、homa Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiaNot reportedWisconsin Wyoming Note:Caution should be exercised when comparing across states due to variations in organizational responsibilities,budgeting practices,and fis
309、cal structures that can affect public health funding data.For fiscal year 2023,Nevada and West Virginia did not submit their public health funding data to TFAH.To understand the nuances and methodology behind the data collection,including TFAHs specific criteria for defining public health funding,pl
310、ease refer to“Appendix B:Methodology.”Source:TFAH analysis of states publicly available funding data.28TFAH tfah.orgAccess to safe water is crucial for consumption,sanitation,hygiene,healthcare,and the operation of other critical infrastructure.In the United States,the vast majority of the populatio
311、n relies on public water systems.79 The U.S.Environmental Protection Agency(EPA)establishes legal limits on contaminants in drinking water,including microorganisms(bacteria and viruses),disinfectants(e.g.,chlorine)and their byproducts,various chemicals(e.g.,industrial pollutants and lead),and radion
312、uclides(radioactive materials).80 The EPA also requiresstatesto regularly report on the quality of drinking water from public water systems within their jurisdictions.81These water systems are obligated to report any violations,such as non-compliance with established monitoring and reporting schedul
313、es,treatment techniques,maximum contaminant levels,and customer-notification requirements.82The development of drinking water safety and regulation in the United States dates back to the late 19th and early 20th centuries,coinciding with rapid urbanization and industrialization that underscored the
314、need for improved water-quality standards.The U.S.Public Health Service established initial guidelines in 1914,concentrating on the bacteriological quality of drinking water.83 Significant progress occurred with the Federal Water Pollution Control Act of 1948.However,the cornerstone was the Safe Dri
315、nking Water Act(SDWA)of 1974,which laid the groundwork for current water safety and regulation.84 This act authorized the EPA to set national health-based standards,regulate contaminants in public water systems,and supervise water providers.Amendments to the Safe Drinking Water Act in 1986 and 1996
316、further broadened these regulations,including safeguards for drinking water sources.The ongoing battle against contaminants such as lead and per-and polyfluoroalkyl substances continues to influence the evolution of water safety policies.The United States is home to one of the worlds safest public d
317、rinking water supplies.However,some communities,particularly those with a high proportion of low-income residents,lack consistent access to safe water.When water safety issues arise,a multisector emergency and long-term public health response is necessary.The most prominent water-contamination crisi
318、s in recent years occurred in Flint,Michigan,in 2014 and 2015,when a change in the water source caused distribution pipes to corrode,leading to the leaching of lead and other contaminants into the drinking water.This incident exposed tens of thousands of residents,including young children,to high le
319、vels of contaminants.85 In 2019,Newark,New Jersey,residents had to resort to bottled water due to high lead levels in their tap water.Subsequently,nearly all of the citys 23,000 lead service lines were replaced with copper pipes.In July 2021,the state enacted laws requiring public water systems to i
320、nventory and replace lead service lines within 10 years.86,87 Newark made such progress that Vice President Kamala Harris commended it for removing thousands of lead pipes in under three years,suggesting it could serve as a model for other U.S.communities.88 She highlighted this achievement as addre
321、ssing not only a public health crisis but also INDICATOR 5:COMMUNITY WATER SYSTEM SAFETYKEY FINDING:Although most Americans receive water from community systems that comply with the health-based standards mandated by the Safe Drinking Water Act,there is still potential for further improvement.29 TFA
322、H tfah.orgcorrecting racial disparities.In children,even low levels of lead exposure can harm the nervous system and lead to developmental delays,learning disabilities,and issues with weight and hearing.89 These incidents have the potential for long-term impacts on childrens health and brain develop
323、ment,as well as on the mental health and trust of the community.Climate change has increased the frequency of wildfires,creating a residual risk of toxic chemicals contaminating community water systems.For instance,following the Hermits Peak and Calf Canyon fire in northeastern New Mexico in 2022a r
324、esult of Forest Service officials losing control of two prescribed burnsofficials in Las Vegas,Nevada,faced challenges in maintaining safe and accessible drinking water.The citys main reservoir was overwhelmed by ashy sludge,leading to a limit of 44 gallons per person per day(about two showers worth
325、90).91 Pollution from major wildfires can include natural debris,silt,asbestos,heavy metals,radioactive isotopes,and carcinogens from decomposing wells.92 Climate change also intensifies major storms and flooding,93 which can damage water infrastructure,contaminate waterways,and cause power outages,
326、leading to issues with potable water access and safety.For example,when Hurricane Ian struck coastal Florida in September 2022,it disrupted the water infrastructure in Lee County,including Fort Myers,and severed water lines.94 This situation left three of the countys hospitals without water,necessit
327、ating the evacuation of some patients.In Polk County,dozens of lift stations pumping wastewater to treatment plants went offline,and officials warned residents against overwhelming the local system to the extent that it could cause untreated water to backflow into homes.At one point,the Florida Depa
328、rtment of Health issued nearly 50 boil-water advisories.95In Jackson,Mississippi,a heavy downpour in August 2022 overwhelmed the citys water system,cutting off water access for 150,000 residents for several days.This event followed a prolonged boil-water notice due to flooding.96 In December 2022,su
329、bfreezing temperatures caused further damage to the water system.As a result,the community faced another boil-water order,and some residents had no water at all.97 According to an analysis by The Washington Post,this crisis disproportionately affected less affluent communities in Jackson.Between 201
330、7 and 2022,areas with median household incomes under$50,000 experienced twice as many boil-water notices than higher income areas.98 Fortunately,federal officials have taken significant steps to resolve the crisis.In late 2022,a third-party administrator was brought in to lead repair efforts,99 and
331、Congress allocated$600 million to fund the work,with at least$115 million already invested.100In 2023,communities along the Mississippi River,particularly in New Orleans and surrounding areas in Louisiana,faced a crisis due to saltwater intrusion from the Gulf of Mexico.101 Exacerbated by drought co
332、nditions,this environmental challenge threatened the regions drinking water supply.Salty water poses health risks,especially for pregnant people,and can corrode old pipes,potentially releasing harmful materials.The situation led to emergency actions from local and state authorities,including New Orl
333、eans Mayor LaToya Cantrell and then-Louisiana Governor John Bel Edwards,as well as a federal emergency declaration approved by President Biden.Efforts to address the issue included constructing an underwater sill in the Mississippi River102though this is a temporary solution.This crisis underscores the growing challenges posed by climate change and environmental degradation,emphasizing the need fo
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