Climate change is transforming the landscape of public health by altering the severity, frequency, and types of challenges faced by local public health professionals and their partners. The health considerations associated with changing temperatures, changing precipitation patterns, extreme weather events, and other aspects of climate change are myriad and complex.1 The shifting distribution and prevalence of infectious disease, increased exposure to pollutants, and a range of impacts to mental health are just a few of the public health challenges caused by a changing climate. Moreover, the health risks associated with climate change will not be shared equally among individuals, communities, and populations. Climate change will disproportionately burden the very young, older adults, people living with mental and physical disabilities, low-income people, and marginalized communities.

Because the health impacts of climate change are experienced locally, the involvement of local communities in monitoring, discussing, advocating, and assisting with climate change adaptation is crucial. The nation's 2800 local health departments work closely with other government agencies, local businesses, and community partners to address the health impacts of a changing climate and develop and implement solutions that keep people healthy and safe. Because the public health sector is on the front lines addressing health impacts, it has a critical role to play: giving voice to the health implications of failure to act on climate change; fostering climate-resilient communities; and ensuring that strategies protect health, reduce health inequities, and maximize health co-benefits.

Climate change will amplify known public health needs and will likely create new public health needs that may exceed the capacity of local health departments to respond, thereby increasing the demands placed on traditional local health department programs and services.2 Local health departments will have to expand current programs and be open to innovative, nontraditional ideas and strategies to work on climate change-focused initiatives. Many solutions can be found at the local level, and investing in neighborhood-scale projects that create healthy, sustainable, and resilient communities is one of the best places to begin tackling the health effects of climate change.

In August 2014, San Luis Obispo County Public Health Department initiated the first climate change and health communications campaign in the state of California, the OutsideIn SLO: We Take Health and Climate Change Personally campaign.3 The campaign was codeveloped with the California Department of Public Health and is managed by an advisory committee consisting of public health and governmental bodies such as the obesity prevention coalition (HEAL-SLO), the Air Pollution Control District, the regional transportation planning agency, and the local planning department. The OutsideIn SLO: We Take Health and Climate Change Personally campaign developed fact sheets, brochures, and stickers and partnered with a wide array of community partners, including a bike coalition, a homeless assistance nonprofit, and the food bank. As a component of the campaign, OutsideIn SLO added a climate change class to the WIC (Women, Infants, and Children) program. Because WIC clients are likely to be disproportionately affected by climate change-for instance, the California drought will likely lead to increased food prices, a particular financial burden for clients-it is important these individuals understand the ins and outs of the issue. In addition, the campaign provided climate change information in elementary school classrooms. This campaign also represents an important partnership between the state and local health departments, as the California Department of Public Health hopes the lessons learned through this local campaign can be used at the state level as well.

Columbus Public Health and The Ohio State University collaborated on a community climate change project to provide city leaders with information on the community's perception about climate change and adaptation and mitigation efforts.4 Through surveys and more than a dozen community meetings, this project provided the community with information on the best available science around climate change and gathered information on how community members perceived climate change and the individual and community action they are willing to support. The project indicated there is an opportunity-and a need-for local officials to pursue the health effects of climate change in their programming and education. Perhaps, most importantly, the project demonstrated ways local officials can engage the community around this issue, specifically from the perspective of a local health department's target audience.

Furthermore, local health departments need federal efforts to support local actions that address the challenge posed by climate change. For example, the Clean Power Plan has set flexible and achievable standards to reduce carbon dioxide emissions by 32% from 2005 levels by 2030.5 Existing power plants are the largest source of carbon pollution in the nation. The Clean Power Plan provides the greatest protection for communities from the impacts of climate change and from the harmful emissions of these plants. Cutting carbon pollution will also cut direct emissions of dangerous pollutants, including sulfur dioxide, nitrogen oxides, fine particulate matter, and mercury, and will reduce ozone and particulate matter pollution. Reducing these pollutants will prevent thousands of premature deaths, asthma attacks, heart attacks, hospital admissions, and emergency department visits.

The Centers for Disease Control and Prevention has developed a framework known as BRACE (Building Resilience Against Climate Effects).6 By following the BRACE framework, health departments can incorporate climate change into their planning and response activities. The Centers for Disease Control and Prevention's Climate-Ready States and Cities Initiative (CRSCI), in which 16 states and 2 cities are currently pioneering the use of the BRACE framework, demonstrates how federal, state, and local agencies can work together to address the health impacts of climate change.7 Through the CRSCI, the San Francisco Climate and Health Program developed a Heat Vulnerability Index to identify neighborhoods most susceptible to the health effects of extreme heat. The program analyzed surface temperature data alongside 21 social and environmental vulnerabilities.8 The index is currently being used in a number of adaptation efforts such as guiding where to designate cooling centers and where to conduct education and outreach efforts. San Francisco also developed a Heat Wave Disaster Response Plan, which is an official annex to the city's Emergency Operations Plan. This plan includes issuing public advisories, notifying hospitals and health care facilities, and reaching out to vulnerable communities. Similar to San Francisco, the City of Milwaukee Health Department has responded to extreme heat events by working with the state's CRSCI staff to develop the Excessive Heat Event Coordination Plan.9 The local health department also developed an Heat Vulnerability Index to direct prevention and intervention strategies, including risk messaging targeted to high-risk populations, siting of cooling centers, and deployment of other resources. In addition, as public health heat-related illness surveillance is critical, the City of Milwaukee Health Department can request and analyze heat-related illness public health surveillance from area hospital emergency departments.

With the necessary resources, local public health departments are uniquely positioned to respond to these health impacts and protect the public's health. The National Association of County and City Health Officials (NACCHO) provides technical assistance, training, and education on climate change to local public health department officials.10 NACCHO's Climate Change Workgroup consists of local health department officials from around the country who meet monthly to explore ways in which local communities can address these concerns and develop programs and policies to mitigate the health impacts. In addition, many public health preparedness professionals and partners across the country are currently looking to better incorporate adaptation planning and may find valuable resources from peers and trusted resources. The NACCHO Climate Change Toolkit includes many climate change impact planning resources that can help local health departments that are working to integrate climate adaptation into preparedness planning.

Tackling climate change now is the greatest global health opportunity of the 21st century. NACCHO believes it has a responsibility to help public health leaders step up to the challenge, talk about the fact that climate change is a big health threat, and support and encourage climate actions that also promote and improve community health. Find out more about NACCHO's Climate Change Program at http://naccho.org/topics/environmental/climatechange.

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