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Special Issue: Health Security and Climate Change


Philippine and U.S. service members learn to identify heat stroke (photo by Lance Cpl. Perria)

The Journal Health Security has a special issue out on climate change. The contents and abstracts are listed below. The special issue does a great job of exploring the emerging intersection between health and climate security, including a look at wildfires, the role of the US Department of Defense, and risks related to extreme heat. The issue is open access (free articles) for the next two months, so get reading!

Health Security: Special Issue on Health Security and Climate Change, Volume 14 Issue 2, Apr 2016


Promoting Resilience to Climate Disruption
Meghan D. McGinty, Eric Toner, Issue Editors
Health Security. Apr 2016, 14(2): 39-39.


A Conversation with Dr. John Holdren, Assistant to the President for Science and Technology, Director of the White House Office of Science and Technology Policy
Health Security. Apr 2016, 14(2): 40-42.

Reducing Risk by Acting on Climate
Janet G. McCabe, Thomas A. Burke
Health Security. Apr 2016, 14(2): 43-46.

Advocating for Health in a Warming World: A Health Advocate’s Perspective
Rebecca Ruggles
Health Security. Apr 2016, 14(2): 47-52.

Will Zika Virus and Microcephaly Epidemics Emerge After Ebola in West Africa? The Need for Prospective Studies Now
Daniel R. Lucey
Health Security. Apr 2016, 14(2): 53-54.

Preparing for Extreme Heat Events: Practices in Identifying Mortality
Sabrina McCormick, Jaime Madrigano, Emma Zinsmeister
Health Security. Apr 2016, 14(2): 55-63.

Climate change is increasing the frequency and severity of extreme heat events. These events affect cities in increasingly abrupt and catastrophic ways; yet, many of the deaths caused by exposure to heat have gone unnoticed or are inaccurately identified, resulting in a lack of urgency in addressing this issue. We aim to address this under-identification of deaths from heat waves in order to better assess heat risk. We investigated death records in New York City from 2010 to 2012 to identify characteristics that vary between deaths officially categorized as caused by heat wave exposure (oHDs) and those possibly caused by heat (pHDs). We found that oHDs were more often black and of a younger age than would typically be expected. We also found that there was a lack of evidence to substantiate that an oHD had occurred, using the NYC official criteria. We conclude that deaths from heat waves are not being accurately recorded, leading to a mis-estimation. Training regarding the collection and interpretation of evidence may improve preparedness for heat events.


Excess Mortality Attributable to Extreme Heat in New York City, 1997-2013
Thomas D. Matte, Kathryn Lane, Kazuhiko Ito
Health Security. Apr 2016, 14(2): 64-70.

Extreme heat event excess mortality has been estimated statistically to assess impacts, evaluate heat emergency response, and project climate change risks. We estimated annual excess non–external-cause deaths associated with extreme heat events in New York City (NYC). Extreme heat events were defined as days meeting current National Weather Service forecast criteria for issuing heat advisories in NYC based on observed maximum daily heat index values from LaGuardia Airport. Outcomes were daily non–external-cause death counts for NYC residents from May through September from 1997 to 2013 (n = 337,162). The cumulative relative risk (CRR) of death associated with extreme heat events was estimated in a Poisson time-series model for each year using an unconstrained distributed lag for days 0-3 accommodating over dispersion, and adjusting for within-season trends and day of week. Attributable death counts were computed by year based on individual year CRRs. The pooled CRR per extreme heat event day was 1.11 (95%CI 1.08-1.14). The estimated annual excess non–external-cause deaths attributable to heat waves ranged from –14 to 358, with a median of 121. Point estimates of heat wave–attributable deaths were greater than 0 in all years but one and were correlated with the number of heat wave days (r = 0.81). Average excess non–external-cause deaths associated with extreme heat events were nearly 11-fold greater than hyperthermia deaths. Estimated extreme heat event–associated excess deaths may be a useful indicator of the impact of extreme heat events, but single-year estimates are currently too imprecise to identify short-term changes in risk.


Responding to the Effects of Extreme Heat: Baltimore City’s Code Red Program
Jennifer L. Martin
Health Security. Apr 2016, 14(2): 71-77.

Heat response plans are becoming increasingly more common as US cities prepare for heat waves and other effects of climate change. Standard elements of heat response plans exist, but plans vary depending on geographic location and distribution of vulnerable populations. Because heat events vary over time and affect populations differently based on vulnerability, it is difficult to compare heat response plans and evaluate responses to heat events. This article provides an overview of the Baltimore City heat response plan, the Code Red program, and discusses the city’s response to the 2012 Ohio Valley/Mid Atlantic Derecho, a complex heat event. Challenges with and strategies for evaluating the program are reviewed and shared.


Legal Preparedness for Hurricane Sandy: Authority to Order Hospital Evacuation or Shelter-in-Place in the Mid-Atlantic Region
Meghan D. McGinty, Thomas A. Burke, Beth A. Resnick, Katherine C. Smith, Daniel J. Barnett, Lainie Rutkow
Health Security. Apr 2016, 14(2): 78-85.

Hospitals were once thought to be places of refuge during catastrophic hurricanes, but recent disasters such as Hurricanes Katrina and Sandy have demonstrated that some hospitals are unable to ensure the safety of patients and staff and the continuity of medical care at key times. The government has a duty to safeguard public health and a responsibility to ensure that appropriate protective action is taken when disasters threaten or impair the ability of hospitals to sustain essential services. The law can enable the government to fulfill this duty by providing necessary authority to order preventive or reactive responses—such as ordering evacuation of or sheltering-in-place in hospitals—when safety is imperiled. We systematically identified and analyzed state emergency preparedness laws that could have affected evacuation of and sheltering-in-place in hospitals in order to characterize the public health legal preparedness of 4 states (Delaware, Maryland, New Jersey, and New York) in the mid-Atlantic region during Hurricane Sandy in 2012. At that time, none of these 4 states had enacted statutes or regulations explicitly granting the government the authority to order hospitals to shelter-in-place. Whereas all 4 states had enacted laws explicitly enabling the government to order evacuation, the nature of this authority and the individuals empowered to execute it varied. We present empirical analyses intended to enhance public health legal preparedness and ensure these states and others are better able to respond to future natural disasters, which are predicted to be more severe and frequent as a result of climate change, as well as other hazards. States can further improve their readiness for catastrophic disasters by ensuring explicit statutory authority to order evacuation and to order sheltering-in-place, particularly of hospitals, where it does not currently exist.


Adapting to Health Impacts of Climate Change in the Department of Defense
Jean-Paul Chrétien
Health Security. Apr 2016, 14(2): 86-92.

The Department of Defense (DoD) recognizes climate change as a threat to its mission and recently issued policy to implement climate change adaptation measures. However, the DoD has not conducted a comprehensive assessment of health-related climate change effects. To catalyze the needed assessment—a first step toward a comprehensive DoD climate change adaptation plan for health—this article discusses the DoD relevance of 3 selected climate change impacts: heat injuries, vector-borne diseases, and extreme weather that could lead to natural disasters. The author uses these examples to propose a comprehensive approach to planning for health-related climate change impacts in the DoD.


Longitudinal Community Assessment for Public Health Emergency Response to Wildfire, Bastrop County, Texas
Katie R. Kirsch, Bonnie A. Feldt, David F. Zane, Tracy Haywood, Russell W. Jones, Jennifer A. Horney
Health Security. Apr 2016, 14(2): 93-104.

On September 4, 2011, a wildfire ignited in Bastrop County, Texas, resulting in losses of 34,068 acres of land and 1,645 homes and 2 deaths. At the request of the Texas Department of State Health Services Health Service Region 7 and the Bastrop County Office of Emergency Management, Community Assessments for Public Health Emergency Response (CASPER) were conducted in the weeks following the wildfire and again 3.5 years later to assess both the immediate and long-term public health and preparedness impacts of the wildfire. The objective of these assessments was to learn more about the trajectory of disaster recovery, including rebuilding, evacuation, household emergency planning, and mental and physical health outcomes among both adults and children. In 2015, households exposed to the 2011 wildfires were significantly more likely to have established a family meeting place and evacuation route, to have confidence in the local government’s ability to respond to disaster, and to report symptoms of depression and higher stress. Longitudinal assessments using the CASPER method can provide actionable information for improved planning, preparedness, and recovery to public health and emergency management agencies and community residents.


From the Field

Knowing Your Partners: 2015 Wildfire Season Tested Washington State Regional Healthcare Coalitions’ Emergency Response Plans
Mary Small
Health Security. Apr 2016, 14(2): 105-106.

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