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CLIMATE AND HEALTH STRATEGIC PLAN FOR
MARICOPA COUNTY
2016-2021

Maricopa County Department of Public Health
Contact Us: climateandhealth@mail.maricopa.gov

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TABLE OF CONTENTS
ABOUT THE MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH ___________________________ 3
ABOUT BRIDGING CLIMATE CHANGE AND HEALTH WORKGROUP ____________________________ 3
ABOUT THIS DOCUMENT __________________________________________________________________ 3
BRIDGING CLIMATE CHANGE AND PUBLIC HEALTH STRATEGIC PLANNING WORKGROUP ______4
EXECUTIVE SUMMARY ____________________________________________________________________5
BACKGROUND __________________________________________________________________________7
CURRENT LANDSCAPE ____________________________________________________________________9
PRACTICAL VISION ____________________________________________________________________ 17
UNDERLYING CONTRADICTIONS ________________________________________________________ 19
STRATEGIC DIRECTIONS ________________________________________________________________ 23
CELEBRATING SUCCESS AND CHAMPIONS ________________________________________________ 24
BUILDING COMMUNITY AWARENESS THROUGH A STRATEGIC AND TARGETED COMMUNICATION
PLAN __________________________________________________________________________________ 26
FOSTERING ENVIRONMENTAL ACTION FOR A HEALTHIER COMMUNITY ______________________ 28
COORDINATING RESEARCH AND COLLABORATIVE EFFORTS TO CATALYZE CHANGE __________ 30
PROMOTING PUBLIC EDUCATION ABOUT CLIMATE AND HEALTH ____________________________ 32
REFERENCES ____________________________________________________________________________ 35

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ABOUT THE MARICOPA COUNTY DEPARTMENT OF
PUBLIC HEALTH
The Maricopa County Department of Public Health’s mission is “We make healthy lives
possible.” This mission is accomplished by providing residents and visitors with education and
tools to prevent health threats, such as infectious diseases, natural and human-caused
disasters, toxic exposures, and preventable injury. Public health also works to prevent chronic
diseases, such as heart disease, cancer, and diabetes.

ABOUT BRIDGING CLIMATE CHANGE AND HEALTH
WORKGROUP
In 2015, the Maricopa County Department of Public Health was selected by the Public Health
Institute to join The Climate Change and Public Health Learning Collaborative for Urban Health

Departments and receive financial support to incorporate climate change mitigation,
adaptation, and resilience work into local public health department program practice. As part
of this project, Maricopa County hosted two meetings named Bridging Climate Change and

Public Health on November 16, 2016 and May 18, 2017, which convened representatives from
a diverse array of local community organizations, private businesses, government agencies,
and academic institutions. Facilitated discussion helped identify local activities in the fields of
climate and health, as well as stakeholders’ perceived needs of the community and barriers to
successful collaboration. A subset of meeting participants formed the Bridging Climate Change

and Public Health Strategic Planning Workgroup, which developed a strategic plan with five
priority actions for addressing environmental concerns affecting the health and well-being of
the community over the months of August 2017 through January 2018.

ABOUT THIS DOCUMENT
This report was developed by the Bridging Climate Change and Public Health Strategic

Planning Workgroup in 2017, and published by the Maricopa County Department of Public
Health in 2018.

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BRIDGING CLIMATE CHANGE AND PUBLIC HEALTH STRATEGIC PLANNING WORKGROUP
Aimee Williamson - Trees Matter
Amber Hansen – Health Care Without Harm
Anna Bettis - Virginia G. Piper Charitable Trust
Barbara Burkholder – Arizona Asthma Coalition
Carrie Smith - Foundation for Senior Living
David Hondula - Arizona State University
Einav Henenson - Arizona Department of Water Resources
Emily Mead - Institute for Sustainable Communities
Erika Barrett - University of Arizona
Gretchen Reinhardt – Citizens’ Climate Lobby
Guillermo Velez - Chicanos Por La Causa
Hana Putnam – Arizona State University
Lucy Flaaten - Citizens’ Climate Lobby
Maggie Messerschmidt - The Nature Conservancy
Matthew Roach - Arizona Department of Health Services
Nancy Kiflemariam - City of Phoenix, Heat Relief Network
Sandy Bahr - Sierra Club
Tina Wesoloskie – Maricopa County Air Quality Department

Writing Team | Maricopa County Department of Public Health, Office of Epidemiology
Vjollca Berisha
Rishwa Patel
Kate Goodin
Jessica Bell
Jordan Arias
Aaron Gettel
Jessica White
Kaitlyn Sykes

Technical Support
Courtney Lonergan | Master Strategic Facilitator | Applied Cultural Anthropologist
www.partnersinparticipation.com | www.courtneylonergan.com | (907) 229-7773

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EXECUTIVE SUMMARY
Maricopa County experiences extreme heat, which has adverse effects on
community health and has been recognized as a serious public health issue. Therefore,
the Maricopa County Department of Public Health (MCDPH) has conducted
surveillance activities to assess morbidity and mortality due to extreme heat for the
past 10 years. In 2016, MCDPH was interested in expanding their scope to include other
climate-sensitive public health hazards. Subsequently, a network of stakeholders with
an interest in the health effects of climate-sensitive hazards was established as the
Bridging Climate Change and Public Health (BCCPH) stakeholder group. A smaller
Strategic Planning Workgroup of key stakeholders from the BCCPH group was then
convened over three sessions to work on a strategic plan for the group, which
culminated in this document.
Practical Vision
The driving discussion question to identify the Strategic Planning Workgroup’s practical
vision was, “What do we want to see in place in the next 3-5 years as a result of our
actions?” The goal of this question was to help the group develop concrete outcomes
that the BCCPH workgroup would like to achieve through activities included in the
strategic plan. The following goals were identified:


A healthy community infrastructure design



Reframed messaging for multiple stakeholder needs



A coordinated multi-scale education effort



Improved health strategies and outcomes



A diverse network of partnerships for climate change adaptation and mitigation
planning and development



New funding opportunities



Policy and research strategies, and private sector engagement.

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Underlying Contradictions
The driving discussion question to identify underlying contradictions was, “What is
blocking us from moving towards our practical vision?” The following challenges were
identified:


People act out of self-interest vs. common good



Siloed effects lead to poor coordination



Political partisanship delays unified action



Conflicting information leads to biases



Culture and convenience impacts action



Vulnerable populations not represented, and normalization of climate change
related negative effects

Strategic Directions
During the BCCPH Strategic Planning Workgroup meetings, participants identified five
strategic directions for addressing environmental concerns affecting the health and
well-being of the community. These strategic directions are in agreement with the
climate and health adaptation strategies outlined in the Arizona Climate and Health
Adaptation Plan.1 The strategic directions for Maricopa County are:


Fostering Environmental Action for a Healthier Community



Coordinating Research and Collaborative Efforts to Catalyze Change



Developing a Strategic and Targeted Communication Plan



Promoting Community Awareness and Public Education about Climate and
Health



Celebrating Success and Champions

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BACKGROUND
Maricopa County, Arizona experiences extreme weather, including heat waves, dust
storms, drought, wildfires, flooding, and poor air quality events. These climate-sensitive
hazards pose a threat to public health and can lead directly to illness or death or
worsen underlying health conditions. MCDPH Office of Epidemiology has been
conducting heat-associated morbidity/mortality surveillance since 2006, and extreme
heat has become a public health priority as temperatures continue to rise. Addressing
heat-health impacts corresponds with MCDPH’s vision and mission to “make healthy
lives possible” by protecting and promoting the health and well-being of Maricopa
County residents and visitors. MCDPH has led several heat surveillance and planning
activities over the past decade that have resulted in long-standing partnerships
focusing on heat and health between MCDPH and local governmental agencies,
academia, and community organizations.
In 2015, MCDPH was awarded a grant from the Public Health Institute’s (PHI) Center for
Climate Change and Health to expand the focus from heat to other climate-sensitive
hazards. Community stakeholders were identified and convened in a series of
meetings to explore the current climate change and health landscape within
Maricopa County. This group was formalized as the Bridging Climate Change and
Public Health (BCCPH) stakeholder group and included a wide variety of community
partners across many different sectors. Initial conversations among the BCCPH partners
centered on defining what public health’s role should be in community efforts to
address climate-related health risks as well as what actions and resources participants
would like to see from a collaborative group moving forward. As a result of those
conversations, and other targeted outreach, it became clear that participants
wanted more structure to the collaborative and that sustaining the collaborative
would be a challenge if led entirely by MCDPH. Therefore, MCDPH convened a smaller

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group of key BCCPH participants to begin a strategic planning process. This effort was
aided by a grant from the Centers for Disease Control and Prevention’s (CDC) Building
Resilience Against Climate Effects (BRACE) program through the Arizona Department
of Health Services (ADHS), which allowed for a professional facilitator for the strategic
planning sessions. The strategic planning process focused on the human health effects
of climate change. Therefore, the scope of discussion did not include climate change
effects on animals, agriculture, oceans, or other ecosystems. This was purposeful in
order to limit the scope of the plan, represent the primary action areas of the
stakeholders, and allow it to be relevant for engagement with a public health
department.
The strategic planning process began with brainstorming ideas and evaluating the
current landscape of climate and health within Maricopa County. This included
identifying basic information, current challenges, and advantages of starting a
strategic plan at the time the workgroup was convened. Once the current landscape
was determined, the practical vision was defined. The practical vision is defined as a
set of positive changes resulting from implemented actions within the next three-to-five
years related to climate and health. The next step was to assess the challenges, known
as underlying contradictions, which may hinder the progress towards achieving the
practical vision. Using the underlying contradictions, corresponding priority actions
known as strategic directions were created. A strategic direction is a priority action
that will include innovative actions to address underlying contradictions and achieve
goals defined in the practical vision. Each strategic direction is simplified into the
current reality, first year accomplishments, and three-year goals. Next, a logic model
was developed for each strategic direction in order to define a plan, the short term
goals, and the long term goals. Furthermore, an implementation framework and tools
(meeting agenda, quarterly progress reports, and annual progress reports) were then
used to fulfill the strategic directions.

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CURRENT LANDSCAPE
Climate and Health Environmental Scan
The scan was a level-setting activity whereby all participants could approach the
planning process with the same level of information. The process identified basic
information surrounding climate and health within the Maricopa County community,
current challenges, and advantages of developing a Climate and Health Strategic
Plan now.
Basic Information
Comprehensive information about climate change in Maricopa County, and the
greater Southwestern region of the United States can be found in the National Climate
Assessment Regional Technical Input Report Series: Assessment of Climate Change in
the Southwest United States (subsequently referred to as the Climate Assessment)2 and
reports generated by the Arizona Department of Health Services. Included in the report
are notable findings of climate changes already seen in our region:






“The Southwest is warming. Average daily temperatures for the 2001–2010 decade were
the highest in the Southwest from 1901 through 2010. Fewer cold waves and more heat
waves occurred over the Southwest during 2001–2010 compared to average decadal
occurrences in the twentieth century. The period since 1950 has been warmer than any
period of comparable length in at least 600 years, as estimated on the basis of
paleoclimatic tree-ring reconstructions of past temperatures.” (p. 3)
o The Arizona Extreme Weather, Climate and Health Synthesis Report3 shows that
extreme heat is a health hazard in Arizona, and some Arizona counties may see
warming of up to 4.5 degrees Fahrenheit above current temperatures by 2060.
“Recent drought has been unusually severe relative to droughts of the last century, but
some droughts in the paleoclimate record were much more severe. The areal extent of
drought over the Southwest during 2001–2010 was the second largest observed for any
decade from 1901 to 2010. However, the most severe and sustained droughts during
1901–2010 were exceeded in severity and duration by multiple drought events in the
preceding 2,000 years.” (p. 3)
“Recent flows in the four major drainage basins of the Southwest have been lower than
their twentieth century averages. Streamflow totals in the Sacramento-San Joaquin
Rivers, Upper Colorado, Rio Grande, and Great Basin were 5% to 37% lower during 2001–

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2010 than their twentieth century average flows. Moreover, streamflow and snowmelt
in many snowmelt-fed streams of the Southwest tended to arrive earlier in the year
during the late twentieth century than earlier in the twentieth century, and up to 60% of
the change in arrival time has been attributed to increasing greenhouse-gas
concentrations in the atmosphere.” (p. 3)

Additionally, the Climate Assessment and reports generated by the Arizona
Department of Health Services highlights projected future climate change effects in
our region. Projected effects are variable and depend on the models used as well as
any interventions or mitigation strategies which are employed during the interim time
period. Regardless, the Climate Assessment authors highlight a few predictions which
they are confident will occur in the future:










“Warming will continue, with longer and hotter heat waves in summer. Surface
temperatures in the Southwest will continue to increase substantially over the twentyfirst century (high confidence), with more warming in summer and fall than winter and
spring (medium-high confidence). Summer heat waves will become longer and hotter
(high confidence). Winter cold snaps will become less frequent but not necessarily less
severe (medium-high confidence).” (p. 5)
o The Arizona Extreme Weather, Climate and Health Synthesis Report3 supports this
assessment. The largest temperature changes are likely to occur in Arizona’s
more rural areas. The majority of heat related illness cases in Arizona occur in
Maricopa County. Between 2008-2012, Arizona saw a rise in the number of
emergency room visits for Heat related illness.
“Average precipitation will decrease in the southern Southwest. Precipitation will
decline in the southern portion of the Southwest region, and change little or increase in
the northern portion (medium-low confidence).” (p. 6)
o The southwestern desert and lower Colorado River valley, including Maricopa
County, receive less than 10 inches of annual precipitation with the driest areas
nearer to 3 inches of annual rainfall.3
“Precipitation extremes in winter will become more frequent and more intense (i.e.,
more precipitation per hour) (medium-high confidence). Precipitation extremes in
summer have not been adequately studied.” (p. 6)
“Late-season snowpack will continue to decrease. Late winter-spring mountain
snowpack in the Southwest will continue to decline over the twenty-first century, mostly
because temperature will increase (high confidence).” (p. 6)
“Declines in river flow and soil moisture will continue. Substantial portions of the
Southwest will experience reductions in runoff, streamflow, and soil moisture in the midto late-twenty-first century (medium-high confidence).” (p. 6)

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

“Droughts in parts of the Southwest will become hotter, more severe, and more frequent
(high confidence). Drought, as defined by Colorado River flow amount, is projected to
become more frequent, more intense, and more prolonged, resulting in water deficits
in excess of those during the last 110 years (high confidence).” (p. 6)

In addition to climate changes, there are additional factors that may exacerbate their
effects within Maricopa County specifically. First is population growth. As of 2017, the
US Census Bureau estimates that there are over 7,400,000 residents in Arizona, an
increase of 1.6% over the previous year, even lower-growth projections from the state
office of Economic Opportunity point to a significant increase in the number of people
living in Maricopa County in the coming decades (see figure 1).
Figure 1. Historical and Projected Maricopa
County Population

Reprinted with permission from ASU Water Simulation Project

Additional people means more demand for water and electricity; increased
development in the form of housing, roads, and other infrastructure; and increased
pollutants from water runoff, transportation, and others. Increased development and
other infrastructure also contribute to the Urban Heat Island Effect, which causes
significantly higher temperatures in urban areas compared to the temperatures in
surrounding rural areas. The differences in temperatures can be up to 10ºF (see figure

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2). The growth of the Phoenix metropolitan area since 1950 has led to a significant
increase in nighttime temperature due to the urban heat island effect.3

Figure 2. Urban Heat Island Effect

Reprinted with permission from Global Climate Change Impacts in the United States 2009 Report,
Crown Copyright and Licensing, Canada

With these changes identified, what human health effects do we currently see and
what do we expect to happen in the future? There are expected to be many effects
on human health, but many of them are multi-factoral and therefore influenced by
many different aspects of climate change and the urbanization and population
growth in Maricopa County. Impacts identified in the Climate Assessment and other
reports may include:


“Climate change will drive a wide range of changes in illness and mortality. In particular,
climate change will exacerbate heat-related human morbidity and mortality, and lead
to increased concentrations of airborne particulates and pollutants from wildfires and
dust storms. Climate change may affect the extent to which organisms such as
mosquitoes and rodents can carry pathogens (e.g., bacteria and viruses) and transmit
disease from one host to another (medium-high confidence).” (p.14)
o Fluctuations in climate will impact vector-borne diseases. Projections in Arizona
show an extension of mosquito activity season and location-specific changes in
mosquito abundance for West Nile Virus. Phoenix might see an extension of the

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











season with a break in summer as the summer temperatures reach and exceed
thresholds for survival. Changes in drought and high precipitation events will
impact the incidence of Valley Fever cases.4
“Allergies and asthma will increase in some areas. On the basis of data showing earlier
and longer spring flower bloom, allergies and asthma may worsen for individual sufferers
or become more widespread through the human population as temperature increases
(medium-low confidence).” (p. 14)
o Common allergic reactions and diseases are expected to increase. Poor air
quality affects a large portion of Arizona’s population living in regions that find it
difficult to meet federal air quality standards for particulate matter and ozone,
or that face challenges in maintaining compliance. Allergy season is likely to hit
earlier and remain longer in Arizona. However, air quality in Arizona has generally
improved over the past several decades due to technological advances and
pollution control.2
“Disadvantaged populations will probably suffer most. The health of individuals who are
elderly, infirm, or economically disadvantaged is expected to decrease
disproportionately to that of the general population (high confidence), due to their
increased exposure to extreme heat and other climate hazards.” (p.14)
o In Arizona, populations at increased risk due to exposure of extreme heat and
air quality include: low-income people, minorities, children, those engaged in outdoor
work or recreation, the elderly, those without access to air conditioning and those living
near heavily traveled roadways.2
“Changes in land cover will be substantial. Observed changes in climate are affecting
vegetation and ecosystem disturbance (Figure 1.8). Among those disturbances are
increases in wildfire and outbreak of forest pests and disease. Death of plants in some
areas of the Southwest also is associated with increases in temperature and decreases
in precipitation (high confidence).” (p.11)
“Climate change could further limit water availability in much of the Southwest. A large
portion of the Southwest, including most of the region’s major river systems (e.g., Rio
Grande, Colorado, and San Joaquin), is expected to experience reductions in
streamflows and other limitations on water availability in the twenty- first century
(medium-high confidence).” (p.12)
“Surface water quality will be affected by climate change. In some areas, surface water
quality will be affected by scarcity of water, higher rates of evaporation, higher runoff
due to increased precipitation intensity, flooding, and wildfire (high confidence).” (p.
14)
“Energy supplies will become less reliable as climate changes and climate change will
drive increasing energy demand in some areas. Delivery of electricity may become
more vulnerable to disruption due to extreme heat and drought events that increase
demand for home and commercial cooling, reduce thermal power plant efficiency or

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







ability to operate, reduce hydropower production, or reduce or disrupt transmission of
energy (medium-high confidence).” (p.15)
“Climate change will affect urban areas in differing ways depending on their locations
and on their response or adaptive capacities. Climate change will affect cities in the
Southwest in different ways depending on their geographic locations. Local capacity
to address effects of climate change will also vary depending on governmental,
institutional, and fiscal factors. Incidences of air pollution related to increased heat are
likely to increase, and water supplies will become less reliable (medium-high
confidence).” (p.15)
o The Arizona Department of Health Services released their first version of the
Arizona Climate and Health Adaptation Plan in 2018. This plan intends to support
the development of interventions and enhancement of public health
preparedness activities for climate change.1
“Reliability of transportation systems will decrease. Climate change will affect
transportation systems in different ways depending on their geographic location (e.g.,
changing sea level and storm surge affect coastal roads and airports), potentially
impeding the movement of passengers and goods (medium-high confidence).” (p.15)
“Climate change may disproportionately affect human populations along the U.S.Mexico border. Climate changes will stress on already severely limited water systems,
reducing the reliability of energy infrastructure, agricultural production, food security,
and ability to maintain traditional ways of life in the border region (medium-high
confidence).” (p.15)
“Native American lands, people, and culture are likely to be disproportionately affected
by climate change. Effects of climate change on the lands and people of Southwestern
Native nations are likely to be greater than elsewhere because of endangered cultural
practices, limited water rights, and social, economic, and political marginalization, all
of which are relatively common among indigenous people (high confidence).” (p.15)

Residents and visitors of Maricopa County already experience a wide range of
adverse health effects from climate-sensitive hazards. However, we do not need to
wait for the future to see these human health effects. Previous work by the Maricopa
County Department of Public Health identified that the number of heat related deaths
is continuing to increase.5 While heat related deaths occur to a wide range of
individuals, those individuals who die from heat exposure indoors often have
complications with air conditioning including not having their air conditioning
functioning or turned on. Further research identified costs as a significant barrier to
running air conditioning for many Maricopa County residents.6

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Current Challenges
The strategic planning workgroup identified a number of possible barriers to
accomplishing the work identified during the strategic planning process. These barriers
were initial level-setting challenges identified at the outset of planning, and additional
barriers or challenges were identified late in the process of developing strategic
directions. Those challenges are included within the logic models for each Strategic
Direction and should be discussed as additional activities or objectives are added to
this plan in the future.












There is a lack of funding for public health agencies in general, and very little funding
to support public health agencies working within the context of climate change.
Without resources to support this work it is common for public health and other health
organizations to be left out of climate change planning initiatives. This is not to say that
human health is left out of these discussions, but rather that the agencies most
equipped to distribute messaging around health outcomes, engage with health
providers, and rally support for improving health, may not be part of the conversation.
Many people are not aware of how their individual actions can have an effect on a
global issue like climate change. This may lead individuals, or even organizations, to
feel that they have no role in affecting climate change when the opposite is often true.
Some aspects of the research community are not always engaged with non-profits or
other key organizations to provide the necessary data for them to aid in the progression
of climate-related efforts. There are often silos separating the research, policy, and
action communities which can lead to disjointed progress and lack of mutual
understanding of community-wide issues.
Due to the sprawling nature of Maricopa County’s urban environment, drastically
changing transportation modalities may not be possible. Many people have cars and
prefer to drive over taking public transportation. Although there is room to make
significant progress in this area, human behavior change is difficult and this barrier
should not be underestimated.
Maricopa County has a growing population, including groups more vulnerable to
climate change effects such as the elderly and homeless. This implies that focusing on
disadvantaged or vulnerable populations will be critical in the success of any objectives
or activities identified in this plan. These groups may need different implementation
strategies and/or communication methods.
Climate change is a political issue with varying degrees of interest across the political
spectrum. This implies that an array of strategies will be needed in order to make the
most impact for the most people.

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Advantages
Advantages of completing a strategic plan for climate change and health were
identified in order to solicit factors which might support the success of the strategic
plan once implemented. The advantages identified were:


A network of local community stakeholders and other connections that are interested
in collaborating on climate change and health.



Changes in federal funding and outlook on climate change will empower us as a local
community to take the lead in this arena.

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PRACTICAL VISION
The driving discussion question to identify our practical vision was, “What do we want
to see in place in the next 3-5 years as a result of our actions?” The goal of this exercise
was to help the group develop concrete outcomes that we would like to achieve
through activities included in the strategic plan. We revisited this practical vision
throughout the planning process to keep our activities and objectives grounded within
our original goals and purpose. Each piece of the practical vision is described below.
Healthy Community Infrastructure Design is Employed
People in our community spend ~90% of their time indoors in places such as homes,
schools, and workplaces.7 In addition, we use roadways and highways to reach these
places. Growing research has shown that the built environment, including parks,
sidewalks, and other features can significantly affect our physical activity, asthma,
obesity, cardiovascular disease, lung cancer mortality, and mental health.8-13 Many of
these health outcomes will also be affected by the increasing human risks from climate
change. One solution to both issues, poor health outcomes and climate change
effects, is reexamining how our community infrastructure is designed and built.14-16
Some examples of built environment interventions could be:


Changing the color of urban surfaces, including asphalt and roofs to decrease
urban heat island effect



Improving drainage and reducing sources of standing water to decrease mosquito
growth



Increasing tree canopy, planting, and care

Climate Change Messaging Has Been Reframed
As will be discussed in the next section Underlying Contradictions, the current public
understanding of climate change and its effects is mixed. We envision a community
where there is a universal understanding of climate change risks, its effects, and actions
that can be taken to mitigate or adapt to the effects of climate change. This is

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facilitated by consistent and unified climate and health messaging across agencies
and organizations.
Coordinated Multi-Scale Education Effort
Promoting climate change and health education in the community in general would
be facilitated by inclusion of coordinated curriculum within formal education sectors
from grade schools through university levels. This would include the science behind
climate change and its impact on human health as well as how adaptation and
mitigation strategies can be implemented. A particular effort would also highlight
vulnerable populations.
Improved Health Strategies and Outcomes
Overall we would like to see decreased health effects from climate sensitive hazards.
Whether this is from extreme heat, flash floods, dust storms, or any other locally relevant
hazard. Additionally, for those strategies already in place in our community, such as
hydration stations, cooling centers, utility assistance programs, etc., we would like to
see these services strengthened and improved.
A Diverse Network of Partnerships for Climate Change Adaptation and Mitigation
In order for most climate change adaptation or mitigation strategies to be successful
in any community, they require multi-sector collaboration and support. To facilitate
the work included in this strategic plan to its best possible conclusion it will be necessary
to increase public/private partnerships, engage non-traditional health partners, and
promote institutional level change. We see this manifested as a diverse network of
partnerships focused on climate and health topics.
Activities Include New Financing Models and Strategies
Funding will be required to effectively promote and support adoption of activities
included in this strategic plan. As a result, we will need to be creative in implementing
funding models and include that creativity within planning for each activity.
Additionally, some interventions may be linked directly to financing in innovative ways
such as reducing food waste within an organization, providing incentives to adopt
policies or programs, or providing community grants for capital improvement projects.

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UNDERLYING CONTRADICTIONS
The driving discussion question to identify underlying contradictions was: “What is
blocking us from moving towards our practical vision?” This significantly differed from
the very first conversation during the Current Landscape activity where challenges
were identified, because now the group had identified specific changes it would like
to see in the community and were discussing barriers to motivating change or
implementing interventions directed at those specific changes.

These underlying

contradictions were then either addressed directly by one of the Strategic Directions
or were factors in refining the strategies proposed within a Strategic Direction. These
should also be kept in mind as future activities or objectives are added to this strategic
plan. Below is a brief summary of each of the concepts identified as underlying
contradictions.
Acting out of Self-Interest vs. Common Good
On a business, organizational, and individual level there are well documented17-21
conflicts between factors that can be termed self-interest and the common good. This
could include things that we see manifested across daily life such as the medical
system’s focus on treating disease rather than preventing, 22 Americans’ lack of savings
for retirement,

23

or in businesses view of social responsibility.24 In environmental

sociology this is sometimes termed cosmopolitanism. More specifically as this conflict
relates to climate change and health, this conflict manifests itself as:


Businesses typically value revenue and profits as a primary arbiter of success. It
is often secondary to think of a businesses’ social responsibility- particularly as it
relates to sustainability or other interventions which might cost the business
money in the short term.



Climate change needs short and long term goals to be realized in order to affect
change but it is often difficult to balance the focus on disparate types of
implementations in the same plan.

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

Climate change itself is a very complex and overwhelming topic for many
individuals and they can feel paralyzed to take action as a result.



It is often difficult to fund prevention activities as it is typically difficult to show
their effectiveness in a short timeframe- if at all. There is a common problem with
accounting for the success of an intervention when the intervention’s goal is to
avoid something happening.

How does an organization show that the

intervention is what dispelled certain outcomes rather than random chance or
issues with an original model or assumptions? Even if the workgroup is able to
account for the intervention’s direct outcomes, many climate change
mitigation and adaptation activities may take decades to manifest measurable
change.


There will always be other local and national issues competing for money, time,
or other resources.



The general public, who would have to implement many activities included in
this plan, may lack interest in this topic.

Silo Effects Lead to Poor Coordination
When individuals or organizations working within the areas of climate change research,
mitigation, or adaptation are not mutually aware of each other’s’ efforts, do not
communicate regularly, and are not complimentary, there can be inefficiencies and
limitations to the results they can achieve alone. These can be manifested as:


An unclear call to action for the public or decision makers



Non-uniform messaging, or conflicting messages



Inefficient programs, actions, or projects



Unaddressed problems or sectors- “That’s someone else’s problem!”



Duplicative efforts because organizations are unaware of what others are doing

Conflicting Information Leads to Biases
On a national and local scale, conflicting information in mass media messaging for
climate change can affect the way the messages are received in the validity of
climate science, the scale of ecological risk, the scale of climate politics, and support

21

for mitigation policy. These issues can lead to vastly different understandings of climate
change by the consumers which can then bias their views of and support for actions
contained here in this plan.25-28
Culture and Convenience Impacts Action
Research has shown that climate change mitigation and adaptation activities within
a given community are influenced by our history, our social and cultural norms,
economic factors, and political relations. These cultural values can promote or limit
the effectiveness of climate change strategies, especially when the strategy focuses
on an individual’s need to change behavior or practices. Some examples of locally
relevant cultural values which might limit the effectiveness of activities proposed in this
plan include:


The reliance on personal vehicles for routine transportation and attitudes
towards mass transit options29



The perception that climate change solutions are too hard or inconvenient30



The historical focus on independence and self-determination31



The historical preference for reduced rules, laws, and regulations31



The cost of implementing strategies to the individual 32

Lack of Engagement with Vulnerable Populations
The effects of climate change on individuals are not equally distributed around the
world nor in our local community.33-37 Risks to people can be unequal based on
geography, politics, biology, economics, and other social factors. For example, seniors
may be more vulnerable during a flooding event because they are not as capable of
evacuating. Lower income individuals may not be able to repair their air conditioner
or pay high electricity bills during the summer, leaving them more vulnerable to rising
temperatures. Many times, those most likely to experience climate change effects
now and into the future are not engaged as part of the climate change planning and
implementation efforts.

22

Normalization of Climate Change Negative Effects
Many changes in our regional climate have been happening over decades and even
lifetimes. As a result, it is often normal for people to no longer perceive the risks
associated with those exposures. For instance, according to “Assessing Adaptation
Strategies for Extreme Heat: A Public Health Evaluation of Cooling Centers in Maricopa
County, Arizona,” 50% of people in our community believe that their health is not at risk
due to heat during the summer.38 In addition, 36% of individuals surveyed in Maricopa
County’s Community Assessment for Public Health Emergency Response (CASPER)
survey for Heat Vulnerability and Emergency Preparedness39 stated that heat was not
considered a perceived risk in their household despite the fact that 60% of heatassociated deaths in Maricopa County occur in individuals who have lived in Arizona
for more than 20 years.5 This lack of perception of personal risk to climate effects could
pose problems in motivating individuals to take action around strategies included in
this plan.

23

STRATEGIC DIRECTIONS
The current landscape, underlying contradictions, and practical vision were then
discussed jointly to group potential activities into overall strategies which were
termed Strategic Directions. The five Strategic Directions were identified as:


Celebrating Success and Champions



Building Community Awareness through a Strategic and Targeted Communication
Plan



Fostering Environmental Action for a Healthier Community



Coordinating Research and Collaborative Efforts to Catalyze Change



Promoting Community Awareness and Public Education about Climate and Health

Each Strategic Direction includes first year accomplishments, three year goals, and a
logic model.

24

CELEBRATING SUCCESS AND CHAMPIONS
First Year Accomplishments
o

o

Distribute 4 Climate and Health Champion awards
- Youth
- Citizen
- Business
- Organization
Provide “experience prizes” to school age children

Three Year Success Indicators
o
o

Increase number of businesses that implement sustainability measures
Recognize businesses that contribute to common good via the Better Business Bureau
(BBB) website

Logic Model
The logic model illustrates some of the activities, outputs, and outcomes to fulfill this
strategic direction. (See next page)

25

CELEBRATING SUCCESS AND CHAMPIONS

26
BUILDING COMMUNITY AWARENESS THROUGH A STRATEGIC AND
TARGETED COMMUNICATION PLAN
First Year Accomplishments
Short Term:
o
o
o
o
o

Identify communication experts
Identify a list of key stakeholders
Develop and deploy a pre-satisfaction
survey of practitioners in field
Evaluate existing list serves and other
communication tools
Hold regular meetings

Long Term:
o Complete a communication guidance
document (messaging)
o Create internal and external
communication evaluation plan
o Sustainability and public health data
resources assessment
o Shared social media activities
o Media training
o Regular meetings

Three Year Success Indicators
Short Term:
o Media is at the table (news, print, radio)
o Identify the influential champions for this
work within different organizations
(leaders who prioritize the campaign)
o Increased number and diversity of
agencies
using
communication
guidance (messaging document)
o Coordinating
with
other
seasonal
campaigns (flu season/summer season)
and
compile
the
communication
updates in advance and in a timeless
manner

Long Term:
o Unified communications plan completed
o Increased number of opportunities for
media, public health, and sustainability
professionals to collaborate and continue
the dialogue
o Post Satisfaction Survey of practitioners in
field
o Ongoing
implementation
of
the
communication evaluation plan

Logic Model
The logic model illustrates some of the activities, outputs, and outcomes to fulfill this
strategic direction. (See next page)

27

BUILDING COMMUNITY AWARENESS THROUGH A STRATEGIC AND TARGETED COMMUNICATION PLAN

28

FOSTERING ENVIRONMENTAL ACTION FOR A HEALTHIER COMMUNITY
First Year Accomplishments
o
o
o
o
o
o

Create a climate adaptation toolkit for municipalities – Star Cities Program
Identifying political will and funding across municipalities and private companies
Evaluating current cooling center data and identify locations
Identify partners interested in high density
Identify current solar and water programs
Identifying partners and success stories of market strategies (partner with Arizona State
University [ASU] and Citizen’s Climate Lobby [CCL]) with Maricopa Association of
Government (MAG) and Valley Metro

Three Year Success Indicators
o
o
o
o
o
o

Increase ridership Valley wide
3% increase in tree canopy county-wide
Collaboration between cities on planning documents that address long term projects for
climate impacts
Expanded coverage of cooling centers into nights/weekend and other locations
Broad public understanding of how market strategies address climate pollution
At least one city to adapt a temperature reduction goal and funding to support it

Logic Model
The logic model illustrates some of the activities, outputs, and outcomes to fulfill this strategic
direction. (See next page)

29

FOSTERING ENVIRONMENTAL ACTION FOR A HEALTHIER COMMUNITY

30

COORDINATING RESEARCH AND COLLABORATIVE EFFORTS TO CATALYZE
CHANGE
First Year Accomplishments
o
o
o
o

Environmental scan of complete list of stakeholders, frameworks, and toolkits
Convene a meeting with current platform people for opportunities for expansion
Identify nontraditional funding sources and collaborators
Identify and engage in current community collaboration efforts

Three Year Success Indicators
o
o
o
o
o

Create a comprehensive list of stakeholders
Produce a platform to share knowledge and expertise
Earn funding from nontraditional sources to mitigate climate health hazards
Increase participation in community collaboration efforts
Develop a formal process or framework or toolkit for engaging with population and
stakeholders

Logic Model
The logic model illustrates some of the activities, outputs, and outcomes to fulfill this
strategic direction. (See next page)

31

COORDINATING RESEARCH AND COLLABORATIVE TO CATALYZE CHANGE

32

PROMOTING PUBLIC EDUCATION ABOUT CLIMATE AND HEALTH
First Year Accomplishments
o
o
o
o
o

Assess and document how climate change and health is included for 50% of K – 12
districts in MC
Identify organization who is willing to develop and host a CME/CEU course
Connect with program curriculum developers (faculty, prof. Orgs, schools) to begin
discussing teacher’s academy future directions of health affected by climate
Scope out technology requirements for hosting online library/repository
Develop qualified speaker Distribution List and mechanism for receiving requests.

Three Year Success Indicators
o
o
o
o
o

Knowledge of inclusion of climate change and health curriculum in each K-12 district
Online CME/CEU programs available for health professionals
Climate linked health effects are integrated into health professional programs/courses
Library or repository of quality educational materials/curriculum/activities is centrally
available (target teachers and students but broadly available
Knowledgeable and qualified speakers available for lectures/training, professional
conferences, community events and accompanying materials (handouts, PowerPoint
presentation, etc.)

Logic Model
The logic model illustrates some of the activities, outputs, and outcomes to fulfill this
strategic direction. (See next page)

33

PROMOTING PUBLIC EDUCATION ABOUT CLIMATE AND HEALTH

34

Mission
Adaptation and mitigation of climate-sensitive hazards to improve community health.

Practical
Vision

Healthy
Community
Infrastructure
Design

Reframing
Message for
Multiple
Stakeholder
Needs

Strategic Directions
Celebrating Success and
Champions
An opportunity to raise
awareness of current climate
and health-related activities
and successes across our
community.

Coordinated
Multi-Scale
Education Effort

Improved Health
Strategies and
Outcomes

Building a
Diverse Network
of Partnerships
for Climate
Change
Adaptation and
Mitigation

Enhance and
Build New
Financing, and
Policy and
Research
Strategies

Private Sector
Engagements

As a diverse and informed stakeholder group, what are the key strategies and innovative solutions
we can implement to address climate and health hazards in Maricopa County over the next 5 years?

Building Community
Awareness through a
Strategic and Targeted
Communication Plan
Supporting reasonable and
unified climate change and
health messages

Fostering Environmental
Action for a Healthier
Community

Coordinating Research and
Collaborative Efforts to
Catalyze Change

Promotes individual and
organizational movement
towards implementing
mitigation and adaptation
efforts.

Providing the opportunity to
link research and practice to
ensure that results are
applicable and meaningful.

Promoting Community
Awareness and Public
Education about Climate
and Health
Providing resources for
education in the private and
public sector which are
supported by current science

35
References
1) Roach M, Barrett E, Brown HE, Dufour B, Hondula DM, Putnam H, Sosa B. 2017.
Arizona’s Climate and Health Adaptation Plan. A report prepared for the United States
Centers for Disease Control and Prevention Climate-Ready States and Cities Initiative.
2) Garfin, G., Jardine, A., Merideth, R., Black, M., & LeRoy, S. (2013). Assessment of
Climate Change in the Southwest United States. Retrieved March 8, 2018, from
http://www.swcarr.arizona.edu/sites/all/themes/files/SW-NCA-color-FINALweb.pdf
3) Chuang, W-C., A. Karner, N. Selover, D. Hondula, N.Chhetri, A. Middel, M. Roach and
B.Dufour. 2015. Arizona Extreme Weather, Climate and Health Synthesis Report. A
report prepared for Arizona Department of Health Services and the United States
Centers for Disease Control and Prevention Climate-Ready States and Cities Initiative.
4) M. Roach, H. E. Brown, R. Clark, D. Hondula, J. Lega, Q. Rabby, N. Schweers, J. Tabor.
(2017) Projections of Climate Impacts on Vector-Borne Diseases and Valley Fever in
Arizona. A report prepared for the Arizona Department of Health Services and the United
States Centers for Disease Control and Prevention Climate-Ready States and Cities
Initiative.
5) Maricopa County Department of Public Health publishes weekly and annual heat related
death reports. Reports and more information on heat related deaths can be found at
https://www.maricopa.gov/1858/Heat-Surveillance
6) Maricopa County Department of Public Health completed a Community Assessment for
Public Health Emergency Response (CASPER) in 2015. More information on the
CASPER can be found at https://www.maricopa.gov/1858/Heat-Surveillance
7) Hancock, T. (2002). Indicators of environmental health in the urban setting. Can J Public
Health, Suppl 1(93), 45-51. Retrieved March 8, 2018, from
https://www.ncbi.nlm.nih.gov/pubmed/?term=Indicators of environmental health in the
urban setting . Hancock T.
8) Handy, S., Boarnet, M., Ewing, R., & Killingsworth, R. (2002). How the built environment
affects physical activity: views from urban planning. Am J Prev Med, Suppl 2(23), 64-73.
Retrieved March 08, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/12133739.
9) Rauh, V., Chew, G., & Garfinkel, R. (2002). Detreriorated housing contributes to high
cockroach allergen levels in inner-city households. Environ Health Perspect, Suppl
3(110), 489. Retrieved March 8, 2018, from
https://www.ncbi.nlm.nih.gov/pubmed/?term=Deteriorated housing contributes to high
cockroach.
10) Morland, K., Wing, S., Diez Roux, A., & Poole, C. (2002). Neighborhood characteristics
associated with the location of food stores and food service places. Am J Prev Med, (1),
23-29. Retrieved March 8, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/11777675.
11) Pope, C., Burnett, R., Thun, M., Calle, E., Krewski, D., Ito, K., & Thurston, G. (2002).
Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air
pollution. JAMA, 9(287), 1132-1141. Retrieved March 8, 2018, from
https://www.ncbi.nlm.nih.gov/pubmed/11879110.
12) Halpern, D. S. (1995). Mental health and the built environment more than bricks and
mortar? (4th ed., Vol. 50). London: Taylor & Francis. Retrieved March 8, 2018, from
http://journals.sagepub.com/doi/abs/10.1177/001872679705000407?journalCode=huma

36
13) Weich, S., Blanchard, M., Prince, M., Burton, E., Erens, B., & Sproston, K. (2002).
Mental health and the built environment: cross sectional survey of individual and
contextual risk factors for depression. Br J Psychiatry, (180), 428-433. Retrieved March
08, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/11983640.
14) United States Environmental Protection Agency. (n.d.). Retrieved March 08, 2018, from
https://www.epa.gov/smartgrowth/smart-growth-and-climate-changehttps://neha.org/ehtopics/climate-change-0/built-environment-and-climate-change
15) Galvin, G. (2017, November 01). Designing Healthy Communities Requires
Collaboration. Retrieved March 08, 2018, from https://www.usnews.com/news/healthiestcommunities/articles/2017-11-01/how-urban-design-affects-community-health
16) Srinivasan, S., O'Fallon, L., & Dearry, A. (2003). Creating Healthy Communities, Healthy
Homes, Healthy People: Initiating a Research Agenda on the Built Environment and
Public Health. Am J Public Health, 9(93), 1446-1450. Retrieved March 08, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447991/.
17) Martens, W., Linden, B. V., & Wörsdörfer, M. (2017). How to Assess the Democratic
Qualities of a Multi-stakeholder Initiative from a Habermasian Perspective? Deliberative
Democracy and the Equator Principles Framework. Journal of Business Ethics, (141), 119. doi:10.1007/s10551-017-3532-4
18) Ordnung, Wirtschaft, & Gesellschaft. (2015). Paternalistic Economic Policies:
Foundation, Implications and Critical Evaluations. ORDO, 66(1), 27-60. Retrieved March
8, 2018, from
https://econpapers.repec.org/article/bpjordojb/v_3a66_3ay_3a2015_3ai_3a1_3ap_3a2760_3an_3a4.htm.
19) Wwrsddrfer, M. (2015). Equator Principles: Bridging the Gap between Economics and
Ethics? SSRN Electronic Journal, 250(2), 205-243. doi:10.2139/ssrn.2557417
20) Wörsdörfer, M. (2014). Inside the “Homo Oeconomicus Brain”: Towards a Reform of the
Economics Curriculum? Journal of Business Ethics Education, 11, 5-40.
doi:10.5840/jbee2014112
21) Wörsdörfer, M. (2014). ‘Free, Prior, and Informed Consent’ and Inclusion: Nussbaum,
Ostrom, Sen and the Equator Principles Framework. Transnational Legal Theory, 5(3),
464-488. doi:10.5235/20414005.5.3.464
22) Lavizzo-Mourey, R. (2012, May 30). We must focus on preventing disease if we want our
nation to thrive. Retrieved March 8, 2018, from
https://www.theatlantic.com/health/archive/2012/05/we-must-focus-on-preventingdisease-if-we-want-our-nation-to-thrive/257759/
23) Marte, J. (2017, September 15). Why it's so hard for Americans to save for retirement.
Retrieved March 8, 2018, from https://www.washingtonpost.com/business/why-its-sohard-for-americans-to-save-for-retirement/2017/09/15/7558a978-934d-11e7-89fabb822a46da5b_story.html?utm_term=.aa9cca5de756
24) Velasquez, M., Andre, C., Shanks, T., Meyer, S., & Meyer, M. (2014, August 02). The
Common Good. Retrieved March 8, 2018, from https://www.scu.edu/ethics/ethicsresources/ethical-decision-making/the-common-good/
25) Graffeo, M. (2017, April 28). Environmental psychology: Conflicting climate attitudes.
Retrieved March 8, 2018, from
https://www.nature.com/articles/nclimate3293?WT.feed_name=subjects_climatechange-policy

37
26) Cameron, T. A. (2003). Updating Subjective Risks in the Presence of Conflicting
Information: An Application to Climate Change. SSRN Electronic Journal, 30(1), 63-97.
doi:10.2139/ssrn.436530
27) Broadbent, J., Sonnett, J., & Botetzagias, L. (2016). Conflicting Climate Change Frames
in a Global Field of Media Disclosure. American Sociological Association, 2. Retrieved
March 8, 2018, from
http://journals.sagepub.com/doi/10.1177/2378023116670660#articleCitationDownloadC
ontainer
28) Lahsen, M. (n.d.). Culture, Science and Uncertainty: Conflicting Positions on Climate
Change. Retrieved March 8, 2018, from
https://cfpub.epa.gov/ncer_abstracts/index.cfm/fuseaction/display.highlight/abstract/214
4
29) Leonard, S. and Parsons, M. (2013) Cultural dimensions of climate change adaptation, in
Climate Adaptation Futures (eds J. Palutikof, S. L. Boulter, A. J. Ash, M. S. Smith, M.
Parry, M. Waschka and D. Guitart), John Wiley & Sons, Oxford. doi:
10.1002/9781118529577.ch18
30) Persson, J., Sahlin, N., & Wallin, A. (2015). Climate change, values, and the cultural
cognition thesis. Environmental Science & Policy, 52, 1-5. Retrieved March 8, 2018, from
https://www.sciencedirect.com/science/article/pii/S1462901115000982.
31) Martinez, G. (2014). Social dimensions of climate change adaption in coastal regions:
findings from transdisciplinary research. München: Oekom verlag. isbn:978-3-86581682-5
32) Adger, W., Barnett, J., Brown, K., Marshall, N., & O'Brien, K. (2013). Cultural dimensions
of climate change impacts and adaptation. Nature Climate Change, 3, 112-117.
Retrieved March 8, 2018, from https://www.nature.com/articles/nclimate1666
33) U.S. Global Change Research Program. (n.d.). Populations of Concern. Retrieved March
8, 2018, from https://health2016.globalchange.gov/populations-concern
34) McGill, N. (2016). Vulnerable populations at risk from effects of climate change: Public
health working to find solutions. The Nation's Health, 46(9), 1-14. Retrieved March 8,
2018, from http://thenationshealth.aphapublications.org/content/46/9/1.1
35) Intergovernmental Panel on Climate Change. (n.d.). Conceptual framework for the
identification and assessment of key vulnerabilities. Retrieved March 8, 2018, from
https://www.ipcc.ch/publications_and_data/ar4/wg2/en/ch19s19-1-2.html
36) Center for Health, Environment and Justice. (n.d.). Climate Change: Universal Threat,
Unequal Impacts. Retrieved March 8, 2018, from http://chej.org/2016/05/04/climatechange-universal-threat-unequal-impacts/
37) Acevedo, S., Mrkaic, M., Pugacheva, E., & Topalova, P. (2017, September 27). The
Unequal Burden of Rising Temperatures: How Can Low-Income Countries Cope?
Retrieved March 8, 2018, from https://blogs.imf.org/2017/09/27/the-unequal-burden-ofrising-temperatures-how-can-low-income-countries-cope
38) Berisha, V., Hondula, D., Roach, M., White, J., McKinney, B., Bentz, D., Mohmed, A.,
Uebelherr, J., Goodin, K. (2017 January). Assessing Adaptation Strategies for Extreme
Heat: A Public Health Evaluation of Cooling Centers in Maricopa County, Arizona.
Retrieved April 27, 2018, from
https://www.maricopa.gov/DocumentCenter/View/22115/Cooling-Centers-EvaluationJanuary-2017

38
39) Maricopa County Department of Public Health. (2015 March). Community Assessment
for Public Health Emergency Response (CASPER) Heat Vulnerability and Emergency
Preparedness Needs Assessment. Retrieved April 27, 2018, from
https://www.maricopa.gov/DocumentCenter/View/5366/Community-Assessment-forPublic-Health-Emergency-Response-CASPER-PDF