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TRAINING CURRICULUM OUTLINE

Tribal Climate HealthType of Training: Online, interactive, distance learning split into 5 self-paced modules. Will include various different learning methods of conveying information including talking head, voice-guided/animated slide, interview, video clip, etc.

Purpose and Audience of Training: To build the capacity of tribes and tribal-serving organizations to better understand, plan for, and address the health impacts of climate change by gathering and presenting the latest available information. Trainees are assumed to have little to no knowledge of climate change.

Learning Objectives: As a result of the training, trainees are expected to:

Gain a basic understanding of climate change science and projected impacts Be able to clearly communicate the linkages between human health and climate

change to tribal leaders and other community members Have working knowledge of the main climate change health impacts and the

strategies being used to address them Possess knowledge and skills needed to develop a climate change vulnerability

assessment in tribal communities with a specific focus on health Possess knowledge and skills needed to develop a climate change adaptation

plan in tribal communities with a specific focus on health Possess knowledge and skills needed to implement a climate change adaptation

plan in tribal communities with a specific focus on health

Module Overview:

Module LessonModule 0 Introduction & OverviewModule 1 Understanding Climate Change and Human HealthModule 2 Climate Change Health Impacts and StrategiesModule 3 Assessing Climate Change & Health Vulnerability Module 4 Preparing a Climate Change & Health Adaptation PlanModule 5 Implementing a Climate Change & Health Adaptation Plan

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Table of Contents

Module 0: Introduction and Overview...........................................................7Section 1: Introduction..................................................................................................7

Lesson 1: Welcome....................................................................................................7Lesson 2: Course Overview........................................................................................7Action Step:................................................................................................................7

Module 0 Pre-Assessment (Quiz)...................................................................................7Module 1: Understanding Climate Change and Human Health........................8

Section 1: What is Climate Change and What Does it Mean for Tribal Communities?. . .8Lesson 1: Climate Change Science.............................................................................8Lesson 2: Climate Change and Tribal Communities...................................................9Lesson 3: Traditional Knowledges and Climate Change.............................................9Action Step:..............................................................................................................10

Section 2: Climate Change is a Public Health Issue.....................................................10Lesson 1: Introduction to Climate Change Impacts on Human Health......................10Lesson 2: Climate Change Health Impacts and Tribal Communities.........................10Lesson 3: The Role of Public Health Professionals in Climate Change......................11Action Step:..............................................................................................................11

Module 1 Learning Assessment (Quiz).........................................................................12Module 2: Climate Change Health Impacts and Strategies............................13

Section 1: Temperature...............................................................................................13Lesson 1: Overview of Temperature-Related Health Impacts...................................13Lesson 2: Temperature-Related Health Impacts on Tribal Communities..................14Lesson 3: Temperature-Related Climate Health Indicators......................................14Lesson 4: Strategies to Address Temperature-Related Health Impacts....................15Lesson 5: Tribal Case Study.....................................................................................15Action Step:..............................................................................................................16

Section 2: Air Quality...................................................................................................16Lesson 1: Overview of Air Quality Health Impacts....................................................16Lesson 2: Air Quality Health Impacts on Tribal Communities...................................17

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Lesson 3: Air Quality Climate Health Indicators........................................................18Lesson 4: Strategies to Address Air Quality Health Impacts.....................................18Lesson 5: Tribal Case Study.....................................................................................19Action Step:..............................................................................................................19

Section 3: Extreme Events..........................................................................................19Lesson 1: Overview of Extreme Events Health Impacts............................................19Lesson 2: Extreme Events Health Impacts on Tribal Communities...........................20Lesson 3: Extreme Events Climate Health Indicators...............................................20Lesson 4: Strategies to Address Extreme Events Health Impacts.............................21Lesson 5: Tribal Case Study.....................................................................................22Action Step:..............................................................................................................22

Section 4: Vector-Borne Diseases................................................................................22Lesson 1: Overview of Vector-Borne Disease Health Impacts..................................22Lesson 2: Vector-Borne Disease Health Impacts on Tribal Communities..................23Lesson 3: Vector-Borne Disease Climate Health Indicators......................................23Lesson 4: Strategies to Address Vector-Borne Disease Health Impacts...................24Lesson 5: Tribal Case Study.....................................................................................24Action Step:..............................................................................................................25

Section 5: Water..........................................................................................................25Lesson 1: Overview of Water-Related Health Impacts..............................................25Lesson 2: Water-Related Health Impacts on Tribal Communities.............................26Lesson 3: Water-Related Climate Health Indicators.................................................27Lesson 4: Strategies to Address Water-Related Health Impacts...............................27Lesson 5: Tribal Case Study.....................................................................................27Action Step:..............................................................................................................28

Section 6: Food Safety.................................................................................................28Lesson 1: Overview of Food Safety-Related Health Impacts.....................................28Lesson 2: Food Safety-Related Health Impacts on Tribal Communities....................29Lesson 3: Food Safety-Related Climate Health Indicators........................................29Lesson 4: Strategies to Address Food Safety-Related Health Impacts......................30Lesson 5: Tribal Case Study.....................................................................................30Action Step:..............................................................................................................30

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Section 7: Mental Health.............................................................................................31Lesson 1: Overview of Mental Health Impacts..........................................................31Lesson 2: Mental Health Impacts on Tribal Communities.........................................32Lesson 3: Mental Health Climate Indicators.............................................................32Lesson 4: Strategies to Address Mental Health Impacts...........................................33Lesson 5: Tribal Case Study.....................................................................................33Action Step:..............................................................................................................33

Section 8: Populations of Concern...............................................................................34Lesson 1: Overview of Populations of Concern.........................................................34Action Step:..............................................................................................................34

Module 2 Learning Assessment (Quiz).........................................................................34Module 3: Assessing Climate Change and Health Vulnerability.....................35

Section 1: Addressing Tribal Climate Health Starts with a Vulnerability Assessment. .35Lesson 1: Overview of Vulnerability Assessments....................................................35Lesson 3: Preparing to Conduct a Vulnerability Assessment....................................36Lesson 2: Vulnerability Assessment Approaches......................................................37Action Step:..............................................................................................................39

Section 2: Conducting a Tribal Climate Health Vulnerability Assessment....................39Lesson 1: A Vulnerability Assessment Framework that Focuses on Tribal Climate Health.......................................................................................................................39Lesson 2: Steps in Assessing Tribal Health Vulnerability to Climate Change............41Lesson 3: Step 1: Determine Objectives and Scope.................................................41Lesson 4: Step 2: Gather Relevant Data and Expertise............................................41Lesson 5: Step 3: Assess Components of Vulnerability............................................42Lesson 6: Step 4: Identify and prioritize most significant vulnerabilities and strengths..................................................................................................................43Lesson 7: Step 5: Synthesize Results in an Assessment Report...............................43Lesson 8: Collaborative Approaches to Assessing Vulnerability...............................43Lesson 9: Tribal Case Study.....................................................................................44Action Step:..............................................................................................................44

Module 3 Learning Assessment (Quiz).........................................................................44Module 4: Preparing a Climate Change and Health Adaptation Plan..............45

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Section 1: Adaption Planning is a Critical Step in Addressing Tribal Climate Health....45Lesson 1: Overview of Adaptation Planning.............................................................45Lesson 2: Adaption Planning Approaches.................................................................46Lesson 3: Preparing to Conduct an Adaptation Plan.................................................47Action Step:..............................................................................................................47

Section 1: Conducting a Tribal Climate Health Adaptation Plan..................................47Lesson 1: An Adaption Planning Framework that Focuses on Tribal Health..............48Lesson 2: Steps in Planning for Tribal Health Adaption to Climate Change..............48Lesson 3: Step 1: Determine Objectives and Scope................................................49Lesson 4: Step 2: Review Vulnerability Assessment Priorities and Establish Adaptation Goals......................................................................................................49Lesson 5: Step 3: Identify and Prioritize Potential Adaptation Strategies to Reduce Vulnerability and Risk...............................................................................................50Lesson 6: Step 4: Organize Selected Strategies into an Action Plan.........................50Lesson 7: Step 5: Synthesize Results in an Adaptation Plan.....................................50Lesson 8: Tribal Case Study.....................................................................................51Action Step:..............................................................................................................51

Module 4 Learning Assessment (Quiz).........................................................................51Module 5: Implementing a Climate Change and Health Adaptation Plan........52

Section 1: Moving from Planning to Implementation...................................................52Lesson 1: Take Action..............................................................................................52Lesson 2: Implementation Management and Resources..........................................53Lesson 3: Communications, Outreach, and Collaboration........................................53Action Step:..............................................................................................................54

Section 2: A Continuous Improvement Approach to Tribal Climate Health Adaptation54Lesson 1: Adaptation is Ongoing..............................................................................54Lesson 2: Evaluating Progress and Performance......................................................54Lesson 3: Staying Accountable to an Adaption Plan.................................................55Lesson 4: Updating an Adaption Plan.......................................................................55Lesson 5: Sharing Your Community’s Story..............................................................55Action Step:..............................................................................................................56

Module 5 Learning Assessment (Quiz).........................................................................56

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Module 0: Introduction and OverviewDescription of Module: This module will provide a brief explanation of the course, its key lesson areas, and its relevance for the professionals it is designed to train. The module includes a pre-assessment to allow evaluation of the effectiveness of the training.

Length: TBD

Section 1: IntroductionLesson 1: WelcomeType: Talking headLength: TBD

Welcome by Pala

Lesson 2: Course OverviewType: Voice-guided/animated slidesLength: TBD

Overview of Tribal Climate Health Project Intended audience/trainees and why course is relevant for them Learning objectives Course structure

Action Step: Confirm that this training is right for your needs and identify other members of

your team that should take the training

Module 0 Pre-Assessment (Quiz)

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Module 1: Understanding Climate Change and Human Health

Description of Module: This module will briefly cover climate change basics including causes, impacts (social, environmental, economic), vulnerability, mitigation, adaptation, current research, etc. The majority of this module will focus on describing the potential health impacts of climate change facing tribes throughout the U.S.

Learning Objectives:

Gain a basic understanding of climate change science and projected effects Be able to clearly communicate the linkages between human health and climate

change to tribal leaders and community members

Length: TBD

Section 1: What is Climate Change and What Does it Mean for Tribal Communities?

Lesson 1: Climate Change Science Type: Voice-guided/animated slidesLength: TBD

How greenhouse gases work Measurements of CO2 in atmosphere Scientific consensus on Earth warming 97% of scientists agree that climate-warming trends are very likely due to human

activities. Evidence includes:o Sea level riseo Temperature changeso Precipitation changeso Warming oceanso Shrinking ice sheetso Declining artic sea iceo Glacial retreato Extreme events (storms, droughts, floods, and wildfire)o Ocean acidificationo Decreased snow cover

The effects of climate change are expected to accelerate through this century The regional effects of climate change in the United States

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Citations and Suggested Resources: NASA, IPCC and USGCRP (NCA3, NCA4, Health)

Lesson 2: Climate Change and Tribal Communities Type: Voice-guided/animated slides, video, interview Length: TBD

Overview of tribal populations and locations in US General climate changes effects on tribes in different regions Indigenous groups are projected to be among the most vulnerable due to close

ties and reliance on ecosystem and natural resources (examples) Natural resources closely linked to religious beliefs and practices (examples) Climate change effects already felt by some tribal communities (examples of

dislocation, food shortages, coastal erosion, thawing permafrost, droughts, floods, wildfires, and snowstorms)

Video: “A Record of Change: Science and Elder Observations on the Navajo Nation”

High rates of poverty and unemployment limits tribe’s ability to help their populations adapt to weather and climate extremes

Because tribes are restricted by reservation boundaries, their attachment to the land, and off-reservation treaty rights, moving to new areas to accommodate climate shifts is not a viable option

Citations and Suggested Resources: USGCRP, U.S. Climate Resilience Toolkit, EPA, National Wildlife Federation

Lesson 3: Traditional Knowledges and Climate Change Type: Voice-guided/animated slides, interviewLength: TBD

Define traditional knowledges (vs Western science) Examples of traditional knowledges in land management practices Increasing recognition of the significance of traditional knowledges in relation to

climate change Benefits of collaborating to exchange information between scientists and

indigenous cultures Potential risks to indigenous peoples in sharing sensitive or sacred traditional

knowledges in federal and other non-indigenous settings (e.g. few protections, misappropriation)

Rising Voices Guidelines on sharing traditional knowledges in relation to climate change,

This training will incorporate traditional knowledges where publicly available or for which informed consent to share has been provided

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Citations and Suggested Resources:o NASA, USGCRP, Voices of the Confederated Tribes of Warm Springs

Action Step:

Section 2: Climate Change is a Public Health Issue

Lesson 1: Introduction to Climate Change Impacts on Human Health Type: Voice-guided/animated slidesLength: TBD

Climate change is projected to exacerbate existing health threats and create new public health challenges for American people (additional changes in coming decades will place more people at risk).

Activity: List potential health impacts of a warming climate, wetter climate, drier climate

Major changes to health projected by IPCC (e.g. illness/death due to heat waves, fire, undernutrition, food, water and vector borne disease)

Three basic pathways by which climate change affects healtho Direct impacts (e.g. heat, drought, and heavy rain) o Indirect effects (e.g. disease vectors, water-borne diseases, and air

pollution) o Macroeconomic effects (e.g. occupational impacts, undernutrition, and

mental stress) This training is organized by seven specific climate-related health impacts and

exposures (from the USGCRP), which are detailed in the following Lessons o Define cause-effect relationships between climate drivers, exposure

pathways, environmental conditions/hazards and health outcomes (explain with examples)

Citations and Resources:o IPCC, WHO, USGCRP, APHA. National Institute of Environmental Health

Sciences

Lesson 2: Climate Change Health Impacts and Tribal Communities Type: Voice-guided/animated slides, video Length: TBD

U.S. Climate Resilience Toolkit video clip: Indigenous Peoples, Lands and Resources

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Because of existing vulnerabilities, Indigenous people, especially those who are dependent on the environment for sustenance or who live in geographically isolated or impoverished communities, are likely to experience greater exposure and lower resilience to climate-related health effects.

Indigenous Arctic communities have already experienced difficulty adapting to climate change effects such as reductions in sea ice thickness, thawing permafrost, increases in coastal erosion, and landslide frequency, alterations in the ranges of some fish, increased weather unpredictability, and northward advance of the tree line. These climate changes have disrupted traditional hunting and subsistence practices and may threaten infrastructure such as the condition of housing, transportation, and pipelines, which ultimately may force relocation of villages

Describe key climate health challenges for tribal communities: o Food securityo Water securityo Loss of cultural identifyo Degraded infrastructure and other impacts

Citations and Resources:- USGCRP

Lesson 3: The Role of Public Health Professionals in Climate ChangeType: Voice-guided/animated slides, interviewsLength: TBD

Public health professionals (including tribal community health workers) have an opportunity to prepare for the health risks of climate change already impacting community health and reduce health inequities

Short video interviews with public/tribal health professionals & APHA about their role

Typical role of health departments and potential health sector actions for climate change (examples of proactive public health engagement on climate change)

Survey results of local health official on climate change, including why engagement has been limited

Example: o Benton, OR Climate Change Health Adaptation Plan: 10 Essential Public

Health Services describe the public health activities that all communities should undertake and serve as the framework for the NPHPS instruments (CDC, 2013).

Citations and Resources: USGCRP, WHO, NACCHO, APHA, Climate Leadership Initiative

Action Step: Find out what your health department is already doing to engage on climate

change (e.g. policies, education, adaptation strategies)

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Module 1 Learning Assessment (Quiz)

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Module 2: Climate Change Health Impacts and Strategies

Description of Module: This module will explore all potential climate change health impacts that may affect tribal communities in a manner that is clear, actionable, and not overwhelming. The lessons focused on each impact will provide an overview of that impact, strategies for addressing the impact, and direct trainees to other resources for additional information.


Gain working knowledge of the main climate change health impacts and the strategies being used to address them

Length: TBD

Section 1: Temperature

Lesson 1: Overview of Temperature-Related Health ImpactsType: Voice-guided/animated slidesLength: TBD

Introductiono U.S. average temperatures have increased by 1.3°F to 1.9°F since record

keeping began in 1895, heat waves have become more frequent and intense, and cold waves have become less frequent across the nation

o Annual average U.S. temperatures are projected to increase by 3°F to 10°F by the end of this century, depending on future GHG emissions, etc

o Examples (Europe in 2003 – 30,000-70,000 heat related deaths, Vermont increase in days over 87 degrees, Chicago heat wave in 1995)

o CDC: 618 people in the United States are killed by extreme heat every year

o National Weather Service: Heat is the number one weather-related killer US

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Lesson 2: Temperature-Related Health Impacts on Tribal CommunitiesType: Voice-guided/animated slidesLength: TBD

Tribes are disproportionately located in climates with exposure to extreme heat events and are less likely to have access to air conditioning

Citations and Resources: CDC, USGCRP, APHA

Lesson 3: Temperature-Related Climate Health IndicatorsType: Voice-guided/animated slidesLength: TBD

Climate and Health Indicatorso Traditional knowledges and observationso Weather records including variances from average, minimum or maximum

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Ambient temperature (daytime and nighttime) Heat index (a combination of temperature and humidity) Wind chill (a combination of temperature and wind speed)

o Medical records including hospital admissions (coded for cardiovascular disease, respiratory disease, cerebrovascular disease, urinary, genital, kidney/renal and diabetes-related conditions, dehydration) and death certifications (coded for exposure to excessive heat/cold, but sometimes difficult to attribute)

Citations and Resources: CDC, USGCRP, APHA

Lesson 4: Strategies to Address Temperature-Related Health ImpactsType: Voice-guided/animated slides Length: TBD

List of Key Strategies o Develop an emergency heat plan to prepare city services for a heat event o Establish cooling centers to reduce heat stress and heat-related deaths

and illnesses o Provide emergency notification and well-being checks to protect the most

vulnerable (e.g. hydration tips, signs of heat related injuries, contact information for help, cooling center locations)

o Incorporate heat island reduction strategies - such as green or cool roofs, cool pavements, or increased vegetation and trees - into long-term planning efforts to help lower urban temperatures

Examples: o U.S. EPA, Excessive Heat Events Guidebooko Indian Country Today Extreme Heat Weeko U.S. EPA, Heat Island Effecto Alert Chicagoo Sustainable Chicago 2015

Citations and Resources: APHA, USGCRP, EPA

Lesson 5: Tribal Case StudyType: Voice-guided/animated slides, video or interviewLength: TBD

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https://www.epa.gov/arc-x/public-health-adaptation-strategies-climate-change

https://www.cityofchicago.org/city/en/progs/env/sustainable_chicago2015.html

https://www.cityofchicago.org/city/en/depts/oem/provdrs/alertchicago.html

https://www.epa.gov/heat-islands

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https://www.epa.gov/heat-islands/excessive-heat-events-guidebook

Citations and Resources:

Action Step: Identify which temperature-related climate and health indicators are being

tracked for your region in your health department

Section 2: Air Quality

Lesson 1: Overview of Air Quality Health ImpactsType: Voice-guided/animated slidesLength: TBD

Introductiono Changes in the climate affect the air we breathe both indoors and

outdoors including increased: Ground-level ozone (O3) (associated with motor vehicles,

wildfires, power generation) Fine particulate matter (associated with motor vehicles,

wildfires, dust) Allergens

o These pollutants contribute to respiratory and cardiovascular problems (e.g. asthma, allergic illnesses, heart attack, stroke)

o Increased health impacts from wildfires

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Citations and Resources: APHA, USGCRP, American Lung Association

Lesson 2: Air Quality Health Impacts on Tribal CommunitiesType: Voice-guided/animated slidesLength: TBD

USGCRP: Among minority children, the prevalence of asthma varies with the highest rates among Blacks and American Indians/Alaska Natives (17%)

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Citations and Resources: USGCRP

Lesson 3: Air Quality Climate Health IndicatorsType: Voice-guided/animated slidesLength: TBD

Climate and Health Indicatorso Traditional knowledges and observationso Particulate matter and ozone levels (number of days spike (high 8-hour

averages) and year-round averages) The American Lung Association State of the Air 2017 shows 125

million Americans (4 in 10 people) live in counties that earned an F for ozone or particulate pollution

o Allergen levelso Meteorological changeso Medical records including hospital admissions and death certificates (Air-

quality and allergy related illness, emergency room visits, premature deaths/mortality, acute and chronic cardiovascular and respiratory illnesses)


Lesson 4: Strategies to Address Air Quality Health ImpactsType: Voice-guided/animated slides, interviewLength: TBD

List of Key Strategieso Reduce vehicle emissions by encouraging smart growth development

where people can work, live, and play within a walkable area o Upgrade existing municipal fleets to reduce air pollutantso Incorporate travel efficiency strategies that reduce vehicle trips and miles

traveled into Regional Transportation Plans and Programs

Examples: Los Angeles and Ozone-Related Health Effects

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Citations and Resources: USGCRP, EPA

Lesson 5: Tribal Case StudyType: Voice-guided/animated slides, video or interviLength: TBD


Action Step: Identify which air quality-related climate and health indicators are being


Section 3: Extreme Events

Lesson 1: Overview of Extreme Events Health ImpactsType: Voice-guided/animated slidesLength: TBD

Introductiono Climate change projections indicate that there will be ongoing

increases in certain extreme events, which have significant health and economic impacts.

o Extreme events include 1) flooding related to extreme precipitation, hurricanes, and coastal storms, 2) droughts, 3) wildfires, and 4) winter storms and severe thunderstorms.

o Health impacts can occur during an extreme event (death or injury), during disaster preparation or post-event clean up, or as a result of property damage, destruction of assets economic impacts, environmental degradation, etc.

o Extreme events also disrupt public services and infrastructure such as power, water, transportation, and communication systems, that are critical to maintaining access to health care and emergency response services (lowers adaptive capacity)

o Populations of concern and coastal communities are particularly vulnerable to adverse health outcomes resulting from extreme events

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Lesson 2: Extreme Events Health Impacts on Tribal CommunitiesType: Voice-guided/animated slidesLength: TBD

o Possibility of displacement/relocation


Lesson 3: Extreme Events Climate Health IndicatorsType: Voice-guided/animated slidesLength: TBD

Climate and Health Indicatorso Traditional knowledges and observations

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o Medical records including hospital admissions and death certificates (drowning, displacement, burns, injuries, mental health consequences, gastrointestinal and other illness)


Lesson 4: Strategies to Address Extreme Events Health ImpactsType: Voice-guided/animated slidesLength: TBD

List of Key Strategieso Account for future flood risk (e.g., using the new federal flood

standard) to protect drinking water and wastewater treatment facilities o Use green infrastructure to reduce stormwater runoff o Preserve wetlands and establish vegetated buffers along rivers and

streams to reduce flooding, runoff, and erosiono Develop crisis management plans to anticipate and prepare for future

extreme climatic events o Account for climate risks in Brownfields cleanup and redevelopment

activities • Integrate future flood risk projections into remedy selection for hazardous waste cleanups

o Consider opportunities for toxic use reduction and safer chemical storage strategies (e.g., not storing chemicals in flood-prone locations such as basements) to reduce the potential for chemical release during flood events

o Develop notifications for the public (e.g. drinking water, fire danger, evacuation and other safety tips, contact information for help)

Examples: South/Northeastern hurricanes and storms CA wildfires in 2017


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https://www.epa.gov/sites/production/files/2016-09/documents/community-based-adaptation_handout.pdf

Lesson 5: Tribal Case StudyType: Voice-guided/animated slides, video or interviewsLength: TBD


Action Step: Identify which climate and health indicators are being tracked for your region

in your health department

Section 4: Vector-Borne Diseases

Lesson 1: Overview of Vector-Borne Disease Health ImpactsType: Voice-guided/animated slidesLength: TBD

Introductiono Climate change can result in modified weather patterns (particularly

high and low temperature extremes) and extreme events that alter the seasonality, distribution and prevalence of vector-borne disease, and may result in emergence of new vector-borne diseases

o Vector-borne diseases are illnesses that are carried and transmitted by vectors, which include mosquitoes, ticks, and fleas, which can carry and transfer viruses, bacteria and protozoa.

o Detail vectorso Detail vector-borne diseases, rates and projectionso Health impacts include increased incidents of Lyme disease (due to

northward range expansion, earlier tick activity, over 36,000 cases in 2013) and West-Nile virus, Malaria, etc (due to changing mosquito dynamics)

o Predictions are difficult because there are complex interactions between climate changes, pathogen adaptation, changing ecosystems, human behavior and adaptive capacity.

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Lesson 2: Vector-Borne Disease Health Impacts on Tribal CommunitiesType: Voice-guided/animated slides

Length: TBD

Native land management techniques


Lesson 3: Vector-Borne Disease Climate Health IndicatorsType: Voice-guided/animated slidesLength: TBD

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Climate and Health Indicatorso Traditional knowledges and observationso Vector and pathogen data o Medical records including hospital admissions and death certificates

(e.g. Lyme disease)


Lesson 4: Strategies to Address Vector-Borne Disease Health ImpactsType: Voice-guided/animated slidesLength: TBD

List of Key Strategieso Reevaluate Lyme disease season onset dateo Encourage personal protective behaviors: applying repellents before

spending time in tick habitat, performing tick checks, and bathing after being outdoors

Examples: o USGCRP: Changes in Lyme Disease in Northeasto USGCRP: Changes in West-Nile in Southeast




Action Step: Identify which vector-borne disease-related climate and health indicators are

being tracked for your region in your health department

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Section 5: Water

Lesson 1: Overview of Water-Related Health ImpactsType: Voice-guided/animated slidesLength: TBD

Introductiono Climate changes (temperature, water temperature,

precipitation/runoff, hurricanes and storm surge) are expected affect fresh and marine water resources and water infrastructure

o Water-related illnesses are caused by: existing and new water related contaminants/pathogens, such

as bacteria, viruses and protozoa, and toxins produced by certain harmful algae, cyanobacteria and

chemicals (introduced into the environment by human activities)

o Health impacts may result from ingestion, inhalation, or direct contact with contaminated drinking/recreational water or fish/shellfish, but depend on human behavior, adaptive capacity and other factors.

o There are many public health and environmental safeguards already in place to reduce health risks

Water infrastructure failures resulting from extreme events pose health risks

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Lesson 2: Water-Related Health Impacts on Tribal CommunitiesType: Voice-guided/animated slides

Length: TBD

USGCRP: Lack of consistent access to potable drinking water and inequities in exposure to contaminated water disproportionately affects tribes and Alaska Natives, especially those in remote reservations or villages (due to unequal access to adequate water and sewer infrastructure, and various environmental, political, economic, and social factors jointly create these disparities).

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USGCPR: With increases in contamination, reliance of tribal communities on traditional diets including fish and shellfish consumption may result in health risks and cultural implications


Lesson 3: Water-Related Climate Health IndicatorsType: Voice-guided/animated slidesLength: TBD

Climate and Health Indicatorso Traditional knowledges and observationso Water quality data o Medical records including hospital admissions and death certificates

(many water-borne illnesses go undiagnosed)


Lesson 4: Strategies to Address Water-Related Health ImpactsType: Voice-guided/animated slidesLength: TBD

List of Key Strategies o Water monitoringo Boiling water

Examples



USGCRP: Changes in Suitable Coastal Vibrio Habitat in Alaska

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Action Step: Identify which water-related climate and health indicators are being tracked

for your region in your health department

Section 6: Food Safety

Lesson 1: Overview of Food Safety-Related Health ImpactsType: Voice-guided/animated slidesLength: TBD

Introductiono Climate change is very likely to affect global, regional, and local food

security by disrupting food availability, decreasing access to food, and making utilization more difficult (USGCRP “Climate Change, Global Food Security, and the U.S. Food System”)

o Increasing carbon dioxide (CO2) and climate change alter safety, nutrition, and distribution of food by through multiple pathways which fall under 2 areas:

Rising global temperatures and subsequent changes in weather patterns and extreme events (can increase pathogen and chemical exposure, disrupt access to food supply)

Increased CO2 will effect on plant photosynthesis (can stimulate growth, but lower protein/minerals in crops)

o Centers for Disease Control and Prevention (CDC) estimate that there are 48 million cases of foodborne illnesses per year, with approximately 3,000 deaths

o Most acute illnesses are caused by foodborne viruses (noroviruses), followed by bacterial pathogens (such as Salmonella)

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Lesson 2: Food Safety-Related Health Impacts on Tribal CommunitiesType: Voice-guided/animated slidesLength: TBD

USGCRP: Climate change will affect U.S. Indigenous peoples’ access to both wild and cultivated traditional foods associated with their nutrition, cultural practices, local economies, and community health


Lesson 3: Food Safety-Related Climate Health IndicatorsType: Voice-guided/animated slidesLength: TBD

Climate and Health Indicators

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o Traditional knowledges and observationso Medical records including hospital admissions and death certificates


Lesson 4: Strategies to Address Food Safety-Related Health ImpactsType: Voice-guided/animated slidesLength: TBD

List of Key Strategies

Exampleso USGCRP: Crops Susceptible to Mycotoxin Infections



USGCRP: Changes in Suitable Coastal Vibrio Habitat in Alaska


Action Step: Identify which food safety-related climate and health indicators are being


Section 7: Mental Health

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Lesson 1: Overview of Mental Health ImpactsType Voice-guided/animated slidesLength: TBD

Introductiono Mental health consequences of climate change range from minimal

stress and distress symptoms to clinical disorders, such as anxiety, depression, post-traumatic stress, and suicidality

o Mental health impacts can result from these climate factors: Disasters associated with extreme climate/weather events/fires,

especially for children, the elderly, women (especially pregnant and post-partum women), people with preexisting mental illness, the economically disadvantaged, the homeless, and first responder

High-risk coping behaviors, such as alcohol abuse, can also increase following extreme weather events.

Extreme heat (especially people with mental illness) Drought Threat of climate change (via media messages/public

communication)


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Lesson 2: Mental Health Impacts on Tribal CommunitiesType: Voice-guided/animated slidesLength: TBD

USGCRP: Indigenous communities or tribes are expected to experience higher risk of poor mental health outcomes

o Threat of relocation


Lesson 3: Mental Health Climate IndicatorsType: Voice-guided/animated slidesLength: TBD

Climate and Health Indicatorso Traditional knowledges and observationso Medical records including hospital admissions o The U.S does not currently have sustained psychological and social

impact assessments or monitoring programs and measures necessary to identify important changes in mental health and well-being associated with climate change


Lesson 4: Strategies to Address Mental Health ImpactsType Voice-guided/animated slidesLength: TBD

List of Key Strategies Examples

o USGCRP: Hurricane Katrina (2005)


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Action Step: Identify which mental health-related climate and health indicators are being


Section 8: Populations of Concern

Lesson 1: Overview of Populations of ConcernType: Voice-guided/animated slides, videoLength: TBD

Introductiono While all Americans are subject to the public health threats associated

with climate change, the following populations are especially vulnerable:

Children and pregnant women Older adults/elderly Communities of Color, Low Income, Immigrants, Limited English

Proficiency Groups Indigenous peoples Occupational groups People with disabilities People with pre-existing medical conditions

o Vulnerability is the tendency or predisposition to be adversely affected by climate-related health effects and encompasses three elements: Exposure, sensitivity and ability to adapt

o Vulnerability varies over time and is place-specifico Social determinants of health, such as those related

to socioeconomic factors and health disparities, may amplify, moderate, or otherwise influence climate-related health effects

o Mapping tools and vulnerability indices identify climate health risks

33

Citations and Resources: USGCRP, U.S. Climate Resilience Toolkit

Action Step: Identify what aspects of your community’s location present food, water,

infrastructural and other security concerns


34

Module 3: Assessing Climate Change and Health Vulnerability

Description of Module: This module will cover how to assess climate change vulnerability and risk for each tribal community, focused on the potential health impacts. This part will offer an adaptable step-by-step approach for conducting an individualized vulnerability/risk assessment. Building upon the content of Module 2, it will show tribes how to identify, study, and document the climate and health impacts most likely to affect these tribal lands within a given community and which populations have increased vulnerability and risk. This module will leverage and guide trainees on how to optimally utilize valuable, existing information and resources that have been made available by agencies, nonprofits, and other organizations.

This blueprint for conducting a climate change vulnerability assessment will be accompanied by templates, tools, and assignments so that trainees can accomplish their assessment while taking or referring back to the course. As trainees develop an even greater understanding of the potential risks facing their community while conducting their assessment, they will be directed to revisit the relevant climate health impacts covered under Module 2 for more information. As a result, the module will serve as a dynamic reference resource rather than just a one-time training.


Possess knowledge and skills needed to develop a climate change vulnerability assessment in tribal communities with a specific focus on health

Length: TBD

Section 1: Addressing Tribal Climate Health Starts with a Vulnerability Assessment

Lesson 1: Overview of Vulnerability AssessmentsType: Voice-guided/animated slidesLength: TBD

35

Developing and implementing effective adaptation strategies first requires an understanding of the potential impacts of climate change on our natural world and health.

o Difference between mitigation and adaptation Vulnerability definition: is the process of identifying, quantifying, and prioritizing

(or ranking) the vulnerabilities in a system, often in the context of disaster management.

Vulnerability assessments catalogue existing resources and use the latest scientific and traditional knowledge to determine potential threats to those resources

The value of a vulnerability assessment is that it allows health departments to understand the people and places in their jurisdiction that are more susceptible to adverse health impacts associated with the climate-related exposures modified by climate change. This assessment of people and place vulnerability can then be used to implement more targeted public health action to reduce harm to people.

Vulnerability to climate change has three principal components: sensitivity, exposure, and adaptive capacity.

IPCC: “The most effective measures to reduce vulnerability in the near term are programs that implement and improve basic public health measures such as provision of clean water and sanitation, secure essential health care including vaccination and child health services, increase capacity for disaster preparedness and response, and alleviate poverty (very high confidence). In addition, there has been progress since AR4 in targeted and climate-specific measures to protect health, including enhanced surveillance and early warning systems”

The results of vulnerability assessment is used to advance development of adaptation strategies, plans and implementation efforts.

Lesson 3: Preparing to Conduct a Vulnerability AssessmentType: Voice-guided/animated slidesLength: TBD

Pre-assessment o What is the staff’s knowledge, training or education on projected climate

change health impacts and appropriate adaptation and preparedness measures?

o What has been the tribe’s historical response and ability to manage emergencies in the past?

o Do current tribal goals and operational plans include climate change preparedness?

o Is climate change adaptation and preparedness reflected in the budget and long-range financial plans?

o What are the funding opportunities and challenges of integrating climate adaptation into daily operations

36

o Does the tribe build and maintain collaborative relationships with other government agencies, nonprofits or businesses that can aid in climate adaptation


Lesson 2: Vulnerability Assessment ApproachesType: Voice-guided/animated slides, interviewLength: TBD

Many communities have found assessing vulnerability comprehensively across a broad range of systems and services is in effective approach to anticipating climate changes (rather than one-by-one)

There are several approaches to conducting climate change vulnerability assessments:

o Traditional climate change vulnerability assessments provide two essential contributions to adaptation planning:

Identify species or systems that are likely to be most strongly affected by projected changes; and

Understanding why these resources are likely to be vulnerable, including the interaction between climate shifts and existing stressors.

o Topics typically include stormwater, wastewater, water supply, solid waste, emergency response, air quality, public health

There is no single right approach to vulnerability assessment. Must be based user needs, the decision processes into which it will feed, and the availability of resources such as time, money, data, and expertise

ITEP approach <Interview> ICLEI approach The State of California currently provides national leadership in addressing

climate change. The California Adaptation Planning Guide suggests that vulnerability assessments and adaptation plans are part of a cyclical continuum.

37

http://resources.ca.gov/docs/climate/01APG_Planning_for_Adaptive_Communities.pdf

o Similarly, CDC’s Building Resilience Against Climate Effects (BRACE) 5-step cyclical framework helps health departments prepare for and respond to climate change. First step focuses on anticipating climate impacts, assessing associated health outcomes, and populations and locations vulnerable to these health impacts. <Interview>

Adapted approach for tribes (See Lesson 3) Tribes like Swinomish Indian Tribal Community “indigenize” the BRACE

framework when incorporating health into their climate adaptation efforts. <Interview>

38

Oregon State Health Department recommends assessing capacity and strengths, not just hazards and risks <Interview>

Citations and Resources: USGCRP, CDC, National Wildlife Federation, APHA, International Panel on

Climate Change, Climate-Ready Tribes/Swinomish/NIHB, Oregon State Health Department, State of California, Climate Leadership Initiative

Action Step: Complete pre-assessment to determine your internal capacity for conducting

a vulnerability assessment Secure direction and resources to begin a vulnerability assessment if needed

Section 2: Conducting a Tribal Climate Health Vulnerability Assessment

Lesson 1: A Vulnerability Assessment Framework that Focuses on Tribal Climate HealthType: Voice-guided/animated slidesLength: TBD

Tribal vulnerability assessments have unique characteristicso Traditional knowledges and practiceso Cultural resources and practiceso Focus on additional data collection and systemso Focus on sustenance, important species, and land management

Proposed framework: I. Executive Summary

II. Introduction and Backgrounda. Purpose b. Background/policy goalsc. Method/process (including community involvement)d. Description of community/reservation, ecosystems, culture, history,

and climate of area assessedII. Vulnerability Findings: Observed and reported changes and impacts

(models, studies, literature), both positive and negativea. Baseline and historic conditionsi. Direct quotes of community members and local experts

1. E.g. "In low snow years, there is not enough spring flood to bring the salmon carcasses back into the system. "

2. E.g. “Our dogs used to bark for month straight, from sun up to sun set, because there were so many caribou. Now it is quiet. There are no caribou.”

39

b. Current and projected impacts: i. Climate changes for environment, habitats and speciesii. Associated human health impacts/disease burden See

applicable health impact areas and indicators Lessons in Module 2. Use key climate and health indicators.

iii. Population sensitivity (e.g. children, outdoor workers, race and ethnicity, etc)

iv. Adaptive Capacity (e.g. air conditioning, tree canopy, public transit, etc)

c. Identify and rank most significant vulnerabilities/needsIII. Assessment of Public Health Department Climate PreparednessIV. Next Steps Activity: Download and review Template and examples Examples: <Interviews, video clips>

o “Climate Change in Kiana, Alaska: Strategies for Community Health”o “Community Observations on Climate Change” Nashagak River Trip

Report o “Climate Change and Health Effects in the Bristol Bay Region of Alaska:

Project Synthesis Report”o Swinomish/Climate-Ready Tribeso Upper Snake River Watershed Climate Change Vulnerability Assessmento Puyallup Tribe of Indianso Nondalton AK

Citations and Resources: U.S. Climate Resiliency Toolkit, examples (see links above), CDC

Lesson 2: Steps in Assessing Tribal Health Vulnerability to Climate ChangeType: Voice-guided/animated slidesLength: TBD

1. Determine objectives and scope 2. Gather relevant data and expertise3. Assess components of vulnerability4. Identify and prioritize most significant vulnerabilities5. Synthesize results in an assessment report

Note: Using images helps illustrate risks Throughout the process, communicate progress and results with key

stakeholders and decision makers, and revise as needed.

Citations and Resources: Climate Leadership Initiative, US Climate Resiliency Toolkit, CDC

40

https://www.cdc.gov/climateandhealth/pubs/assessinghealthvulnerabilitytoclimatechange.pdf


https://westernalaskalcc.org/projects/Lists/Project%20Products/Attachments/22/Climate%20Change%20in%20Nondalton%20FINAL%20Report%20Feb%202014_smaller.pdf

http://www.uppersnakerivertribes.org/app/uploads/2016/10/USRT.CCVA_.pdf

http://anthc.org/wp-content/uploads/2016/01/CCH_AR_042014_Climate-Change-Bristol-Bay-Region.pdf

http://anthc.org/wp-content/uploads/2016/01/CCH_AR_042014_Climate-Change-Bristol-Bay-Region.pdf

http://anthc.org/wp-content/uploads/2016/01/CCH_AR_092014_Climate-Change-and-Upper-Nushagak-River.pdf

http://anthc.org/wp-content/uploads/2016/01/CCH_AR_092014_Climate-Change-and-Upper-Nushagak-River.pdf

http://anthc.org/wp-content/uploads/2016/01/CCH_AR_102011_Climate-Change-in-Kiana.pdf

Lesson 3: Step 1: Determine Objectives and Scope Type: Voice-guided/animated slidesLength: TBD

a. Identify audience and user requirements and constraintsb. Engage key internal and external stakeholders, including tribal health and

environmental professionalsa. Provide detailed guidance and examplesb. Activity: Make a list of potential stakeholders

c. Establish and agree on goals and objectivesd. Decide on timeframe and region of focuse. Identify suitable assessment scopef. Determine appropriate spatial and temporal scales g. Identify available and needed resources and limitationsh. Select assessment approach based on user needs, and available resources


Lesson 4: Step 2: Gather Relevant Data and Expertise Type: Voice-guided/animated slidesLength: TBD

a. Review existing literature and traditional knowledges on assessment scope and climate impacts specific to community, including health

b. Reach out to subject experts on target population segments, systems, species, etc.

c. Determine which climate and health indicators data will need to be gathered a. Activity: Compile your responses from Action Steps in Module 2 and

download the Inventory of Climate Health Indicatorsd. Obtain or develop climatic projections, focusing on ecologically relevant variables

and suitable spatial and temporal scalese. Obtain or develop ecological response projections f. Identify the health outcomes and implications associated with climate exposures

and known risk factors

The challenge of obtaining data It is not uncommon to develop vulnerability assessments with limited access

to datao Example: Atquasuk, Alaska - “This report includes observations,

experience and knowledge shared by a wide range of local experts. Predictions and projections on future conditions such as climate, flooding, and erosion are based on available information and limited by the quality of current scientific data and the uncertainties inherent in models. Research and model development is ongoing in Alaska and new information will be available in the near future.”

Data resources are available to tribes (SNAP, MATCH, Regional Tribal Resilience Liaisons, Data.gov etc)

Community-scale data may still be a challenge

41

https://www.data.gov/climate/

Activity: Identify and list applicable data sources for your community Understanding, identifying and incorporating Traditional Knowledges


Lesson 5: Step 3: Assess Components of Vulnerability Type: Voice-guided/animated slidesLength: TBD

a. Evaluate climate sensitivity of assessment targetsb. Determine likely exposure of targets to climatic/ecological changec. Describe current and projected climate and health impactsd. Consider adaptive capacity of targets that can moderate potential impacte. Estimate overall vulnerability of targets (including past strategies/measures

used)f. Document level of confidence or uncertainty in assessments g. Determine why specific targets are vulnerable to inform possible adaptation

responses


Lesson 6: Step 4: Identify and prioritize most significant vulnerabilities and strengthsType: Voice-guided/animated slidesLength: TBD

a. Determine criteria for evaluating which vulnerabilities are most significant (cost, health, safety, etc.)

b. Rank vulnerabilities using selected criteriac. Identify the specific strengths the community has that can be built upond. Communicate initial findings with key stakeholders and decision makers, and

revise as needed

Lesson 7: Step 5: Synthesize Results in an Assessment ReportType: Voice-guided/animated slidesLength: TBD

a. Draft and present final assessment to stakeholders and decision-makers

Citations and Resources:o Climate Leadership Initiative, US Climate Resiliency Toolkit, CDC

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Lesson 8: Collaborative Approaches to Assessing VulnerabilityType: Voice-guided/animated slidesLength: TBD

Why collaborateo Coordination amongst multiple partners makes data collection and

analysis more cost effectiveo Can help overcome limited resource and technical capacity o Leverages resources and expertiseo Results in coordinated plans and policy solutions to foster regional

resilience How to collaborate Challenges to collaborating

o Relationships/politics/trusto Goals aren’t alignedo Too many partners can make process cumbersomeo Governance/decision-making

Examples: o Climate Change Vulnerability of Native Americans in the Southwesto ARRCA CA

Citations and Resources: U.S. Climate Resiliency Toolkit, Georgetown Climate Center

Lesson 9: Tribal Case Study Type: Voice-guided/animated slides, interviewLength: TBD

Upper Snake River Tribes Foundation: Four tribes assessed vulnerability collaboratively

Citations and Resources: U.S. Climate Resilience Toolkit, Tribal Climate Change Guide

Action Step:o Use the steps in this Section to prepare your vulnerability assessment

43

https://tribalclimateguide.uoregon.edu/adaptation-plans

https://toolkit.climate.gov/case-studies/moving-forward-together-building-tribal-resiliency-and-partnerships

https://toolkit.climate.gov/case-studies/moving-forward-together-building-tribal-resiliency-and-partnerships

http://www.georgetownclimate.org/reports/lessons-in-regional-resilience.html

http://nativeadaptation.arizona.edu/


44

Module 4: Preparing a Climate Change and Health Adaptation Plan

Description of Module: This module will cover the process for developing a living and actionable tribal climate change adaptation plan that focuses on health impacts. This will involve teaching a step-by-step approach that includes activities, assignments, and templates that are all customizable. This plan will incorporate the findings of a tribe’s vulnerability/risk assessment and the actions to address these vulnerabilities and risks, which focus on the specific and unique climate change health impacts faced by the tribe developing the plan. Trainees will be guided in how to lay out the actions and strategies in a living adaptation plan that the sets forth the major activities to be accomplished each year for at least the subsequent 4-5 years, and the personnel and parties responsible for each activity.The lessons, tools, and other resources under this part will address managing the planning process, community and stakeholder engagement, leveraging existing information, and more.


Possess knowledge and skills needed to develop a climate change adaptation plan in tribal communities with a specific focus on health

Length: TBD

Section 1: Adaption Planning is a Critical Step in Addressing Tribal Climate Health

Lesson 1: Overview of Adaptation PlanningType: Type: Voice-guided/animated slidesLength: TBD

Communities that begin planning now will have the best options for adapting to climate change

Adaptation definition: a change or the process of change by which an organism or species becomes better suited to its environment

o In this case, we are the organism

45

Adaptation plans typically help a community identify priority actions to respond to their urgent and immediate climate change vulnerabilities and risks

It ensures that the community has considered ways to be prepared for the impacts of climate change-driven events, including health impacts

An adaptation plan builds upon a vulnerability assessmento Vulnerability assessment identifies problemso Adaptation plan identifies viable solutions to mitigate or eliminate those

problems (especially the most serious) Adaptation plans are typically iterative and include short, medium and long term

strategies based on feasibility and prioritization

Citations and Resources: World Health Organization, EPA

Lesson 2: Adaption Planning ApproachesType: Type: Voice-guided/animated slidesLength: TBD

Generally, community-based adaptation planning incorporates a diverse portfolio of strategies which may include:

Infrastructure and asset development Technological process optimization Institutional and behavioral change or reinforcement Integrated natural resources management (such as for watersheds

and coastal zones) Financial services, including risk transfer Information systems to support early warning and proactive

planning Awareness-raising Governmental policies, plans and procedures (e.g. capital plan,

zoning code, general plan) Capacity building

Ecosystem-based adaptation planning: focuses on the integrated management of land, water and living resources that promotes conservation and sustainable use in an equitable way

Health-based adaptation planning: focuses only on health-related aspects of climate change

o Example: BRACE - Benton, OR Climate Change Health Adaptation Plan Climate Action Plans: a community may incorporate adaptation strategies within

its Climate Action Plan, which is typically focused on emission reduction measures

46

https://www.ecologic.eu/3931

https://www.epa.gov/arc-x/planning-climate-change-adaptation

This training suggests an approach that aligns health adaptation strategies within a comprehensive framework of adaptation planning


Lesson 3: Preparing to Conduct an Adaptation PlanType: Voice-guided/animated slides, interviewLength: TBD

Pre-planning assessmento What specific direction was received after the Vulnerability Assessment

and how does that inform the approach that will be used to conduct the adaptation plan? (e.g. emphasis on health, economics, emergency preparedness, mitigation, etc)

o Who is tasked with creating this plan? If Health Department, may decide to use a health-based adaptation planning approach or may collaborate with others to do a more comprehensive adaptation plan

o Are resources dedicated to both the development AND implementation of the plan? Will they cover estimated costs or do other resources need to be identified?

<Interview tribe willing to discuss resources/costs>


Action Step: Complete pre-planning assessment to determine your internal capacity for

conducting an adaptation plan Secure direction and resources to begin an adaptation plan, if needed

Section 1: Conducting a Tribal Climate Health Adaptation Plan

Lesson 1: An Adaption Planning Framework that Focuses on Tribal HealthType: Voice-guided/animated slides

47

Length: TBD

Tribal adaptation plans have unique characteristics

Proposed framework: I. Tribal Leader Statement

II. Executive SummaryIII. Introduction and Background

a. Purpose b. Background/policy goalsc. Method/process (including community involvement)d. Description of community/reservation, ecosystems, culture, history, and

climate of area assessedV. Summary of Vulnerability Findings: including projected impacts and

prioritized needs for each of the applicable climate/health impact areasVI. Adaptation Goals

VII. Adaption Strategies: including existing and needed activities, resources and capacities and whether a strategy is short term, medium or long term

a. Organize strategies by applicable climate/health impact areas b. Code strategies/objectives/activities for sector and type of action

VIII. Action Plan: sets forth: a. Major activities to be accomplished each year for at least the subsequent 4-5

years, and the personnel and parties responsible for each activityb. Process to implement the plan, monitor and document progress and

reevaluate the plan

Activity: Download and review template Examples:

Citations and Resources: CA Natural Resources Agency, Yakama Nation, Georgetown Climate Center

Lesson 2: Steps in Planning for Tribal Health Adaption to Climate ChangeType: Voice-guided/animated slidesLength: TBD

1. Determine objectives and scope 2. Review vulnerability assessment priorities and establish adaptation goals 3. Identify and prioritize potential adaptation strategies to reduce vulnerability and

risk4. Organize selected strategies into an action plan5. Synthesize results in an adaptation plan

Throughout the process, communicate progress and results with key stakeholders and decision makers, and revise as needed.

48

http://www.georgetownclimate.org/adaptation/state-information/overview-of-californias-climate-change-preparations/overview.html


Lesson 3: Step 1: Determine Objectives and ScopeType: Voice-guided/animated slidesLength: TBD

a. Identify audience, user requirements, and needed productsb. Engage key internal and external stakeholders, including tribal health and

environmental professionalsa. Secure support and participation from community partners

i. Government agencies and decision-makersii. Community groupsiii. Emergency preparedness plannersiv. Healthcare providers

b. Provide detailed guidance and examplesc. Activity: Make a list of potential stakeholders

c. Establish and agree on goals and objectives of the planning processd. Decide on timeframe and region of focuse. Determine appropriate spatial and temporal scales f. Select adaptation approach based on targets, user needs, and available

resources


Lesson 4: Step 2: Review Vulnerability Assessment Priorities and Establish Adaptation GoalsType: Voice-guided/animated slidesLength: TBD

a. Review the findings of the vulnerability assessment, including prioritiesb. Work with stakeholders to establish adaptation goals to mitigate or eliminate

priority vulnerabilities


Lesson 5: Step 3: Identify and Prioritize Potential Adaptation Strategies to Reduce Vulnerability and RiskType: Voice-guided/animated slidesLength: TBD

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a. Gather and review existing adaptation actions and identify areas where gaps exist

b. Compile a table of potential strategies a. Activity: Compile a list of applicable strategies from Module 2 or from the

Inventory of Climate Health Adaptation Strategiesb. Consider strategies that can address both mitigation and adaptation

i. Sometimes complement, sometimes conflict (e.g. cooling center)c. Explore case studies and adaptation planning resourcesd. Evaluate costs, benefits and capacity to accomplish each action e. Assess each option and categorize them as feasible, potentially feasible or not

feasiblef. Develop criteria for determining value of adaptation strategies, which may

include economic benefits, health benefits, ability to both adapt to and mitigate climate change

g. Rank the actions using selected criteriah. Select which ranked strategies will be pursued within the next 4-5 years


Lesson 6: Step 4: Organize Selected Strategies into an Action PlanType: Voice-guided/animated slidesLength: TBD

a. Integrate selected strategies into a high-level stepwise plan, including objectives and phasing (e.g. activities to be completed each year for 4-5 years)

b. Incorporate milestones, timelines and accountability measuresc. Include activities for regular review of plan, tracking progress and making

updates


Lesson 7: Step 5: Synthesize Results in an Adaptation PlanType: Voice-guided/animated slidesLength: TBD

a. Draft and present final assessment to stakeholders and decision-makers


Lesson 8: Tribal Case Study Type: Voice-guided/animated slides, interview

50

Length: TBD

Yakama Nation (2016)

Citations and Resources:o Tribal Climate Change Guide

Action Step:o Use the steps in this Section to prepare your adaptation plan


51

https://tribalclimateguide.uoregon.edu/adaptation-plans

http://www.critfc.org/wp-content/uploads/2016/05/Yakama-Nation-Climate-Adaptation-Plan-.pdf

Module 5: Implementing a Climate Change and Health Adaptation Plan

Description of Module: This module will cover how to implement a health focused climate change adaptation plan, how to continuously monitor and evaluate progress in fulfilling plan objectives, and how to make needed adjustments by regularly updating the plan. Lessons, activities, and resources will focus on project and program management, communication and meetings, public outreach, stakeholder involvement, agency and intergovernmental interactions, performance measurement, accountability, available and needed resources, plan revisions, and more. This part will also address the potential roles and responsibilities of public health and environmental staff, including how to effectively work together.


Possess knowledge and skills needed to implement a climate change adaptation plan in tribal communities with a specific focus on health

Length: TBD

Section 1: Moving from Planning to Implementation

Lesson 1: Take Action Type: Voice-guided/animated slidesLength: TBD

Now that the planning is done, move forward with the stakeholders who accept responsibility and bring resources to take action

Decision makers should assign responsibility for overall implementation management to a specific division/group/individual that is expected to facilitate collaboration amongst partners

o Working together amongst health/environmental professionals

Citations and Resources: National Association of County and City Health Officials

52

type:%20Talking%20Head/Screen

Lesson 2: Implementation Management and ResourcesType: Voice-guided/animated slidesLength: TBD

Successful adaption implementation entails work, proper management and resources

Develop and use an implementation plan: this can be an internal work plan that organizes all scope of activities <provide template>:

o Responsible division/group/individualo Cost estimateso Schedule of completion – may consider starting with the most urgent or

most feasible actions firsto Processes for monitoring and evaluating progress

Identify and pursue available and needed resourceso Funding opportunities (provide examples)o Personnelo Training/capacity buildingo Subject matter experts

Citations and Resources:Tribal Climate Change Guide

Lesson 3: Communications, Outreach, and CollaborationType: Voice-guided/animated slides, interviewLength: TBD

Successful adaption implementation entails keeping the following key stakeholder groups engaged:

o Tribal Communityo Tribal Leadershipo Other Internal Stakeholderso External Stakeholders and Partners – including other health professionals

Develop a public outreach/education plan/campaign to increase awareness amongst stakeholders about the plan and its progress

o Provide list of outreach practices Examples

o Interview tribe

53

https://tribalclimateguide.uoregon.edu/funding

o Others


Action Step: Use the information in this Section to develop an implementation plan and

outreach campaign

Section 2: A Continuous Improvement Approach to Tribal Climate Health Adaptation

Lesson 1: Adaptation is Ongoing Type: Voice-guided/animated slideLength: TBD

o Congratulations, you’ve begun implementing an adaptation plano The plan was designed to be used and reevaluated over a long timeframe and will

need continuous attentiono BRACE framework: preparing for climate change is a cyclical and continuous processo Climate change projections change, adaptation strategies are completed or

impeded, etc o Continuous improvement concept


Lesson 2: Evaluating Progress and Performance Type: Voice-guided/animated slides Length: TBD

o Measuring progress and performance is essential and should be done two ways: o Develop monitoring strategies to regularly gather data on climate and health

indicators and metrics used in vulnerability assessment (examples of metrics)o Develop a tracking system to gather information on the completion of actions

selected in the adaptation plan

54


Lesson 3: Staying Accountable to an Adaption PlanType: Voice-guided/animated slidesLength: TBD

Regular progress reports to decision makers are key to keeping on tracko Pick appropriate interval (e.g. annual)o Seek input and feedbacko Showcase early wins to the public and other stakeholderso Identify poor performanceo Determine whether the implementation of the plan is actually increasing

resilience Examples of progress reports


Lesson 4: Updating an Adaption PlanType: Voice-guided/animated slidesLength: TBD

o Review and update action plan (recommend annually)o Review and update adaptation plan (recommend every 4-5 years)


Lesson 5: Sharing Your Community’s StoryType: Voice-guided/animated slides, videoLength: TBD

Others can benefit from your experience Document the process and results Share it broadly Leverage successes to gain funding and support for larger initiatives


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Action Step:o Continually measure and report progress on regular intervals


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