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CDC's Climate-Ready States & Cities Initiative

World globe on deserted plainAs the nation's public health agency, CDC is using its prevention expertise to help state and city health departments investigate, prepare for, and respond to the health effects that climate change may have on people. The world’s climate is showing signs of a shift. The world is becoming warmer, with more precipitation and weather extremes. Potential effects of this climate change are likely to include more variable weather. Stronger and longer heat waves, more frequent extreme weather events such as flooding and tropical cyclones, rises in sea level, and increased air pollution will become more the rule than the exception. CDC is helping state and city health departments address and prepare for the health effects related to climate change. CDC approaches this challenge in the same way it prepares for the possibilities of bioterrorism and pandemic influenza.

CDC’s Climate-Ready States and Cities Initiative is helping 16 states and 2 cities develop ways to anticipate these health effects by applying climate science, predicting health impacts, and preparing flexible programs. CDC will help states and cities partner with local and national climate scientists to understand the potential climate changes in their areas. CDC will assist states and cities in developing and using models to predict health impacts, to monitor health effects, and to identify the area’s most vulnerable to these effects.

CDC’s BRACE framework provides guidance to states and cities to develop strategies and programs to confront the health implications of climate change. In approaching the health implications of climate change it is of paramount importance to find ways to understand and incorporate complex atmospheric data and both short and long range climate projections into public health planning and response activities. Coupling atmospheric data and projections with epidemiologic analysis enables a jurisdiction to more effectively anticipate, prepare for and respond to a range of climate sensitive health impacts.

There are five sequential steps in the BRACE Framework:

Step 1: Forecasting Climate Impacts and Assessing Vulnerabilities where a health department identifies the scope of the most likely climate impacts, the potential health outcomes associated with those climatic changes, & the populations and locations vulnerable to these health impacts within a jurisdiction.

Step 2: Projecting the Disease Burden where a health department, as best as possible estimates or quantifies the additional burden of health outcomes due to Climate Change – to support prioritization and decision making.

Step 3: Assessing Public Health Interventions where a health department seeks to identify the most suitable health interventions for the health impacts of greatest concern. The health impacts will have been quantified or better defined in the previous health risk assessment step.

Step 4: Developing and Implementing a Climate and Health Adaptation Plan where a health department develops and implements a health adaptation plan for climate change that addresses health impacts, gaps in critical public health functions/services, and a plan for enhancing adaptive capacity in the jurisdiction.

Step 5: Evaluating Impact and Improving Quality of Activities step for the Framework – whereby a health department can evaluate the processes it has used, determine the value of utilizing the framework and the value of climate and health activities undertaken. This step is also important for quality improvement and to incorporate refined inputs such as updated data or new information.

Technical Assistance

Map of Category 1 and 2 locations


Arizona Department of Health Services
Health Impacts: Health effects due to extreme heat

California Department of Health

Florida Department of Health

Illinois Department of Public Health (The Board of Trustees of the University of Illinois) “Under Development”

Maryland Department of Health and Mental Hygiene

Massachusetts Department of Health
Health Impacts: Water, food, and vector borne diseases, heat stress, hazardous weather events, respiratory diseases

Michigan Department of Community Health
Health Impacts: Heat related disease, respiratory disease

Minnesota Department of Health
Health Impacts: Extreme heat events, vector borne disease

New Hampshire Department of Health and Human Services

New York State Department of Health
Health Impacts: Extreme weather, waterborne, food-borne, and vector disease

New York City Department of Health and Mental Hygiene “Under Development”
Health Impacts: Heat-related morbidity and mortality, respiratory illness, water-borne and vector-borne disease

North Carolina Department of Public Health
Health Impacts: Temperature related morbidity and mortality; extreme weather; air pollution; water, food, and vector borne diseases

Oregon Department of Health
Health Impacts: Water and food borne diseases, extreme weather, ecosystems

Rhode Island Department of Health

San Francisco Department of Public Health
Health Impacts: Heat stress morbidity and mortality associated with air quality impacts

State of Maine Department of Health and Human Services
Health Impacts: Heat related outcomes, vector-borne disease

Vermont Department of Health

Wisconsin Department of Health Services

For more information on CDC's Climate-Ready States & Cities Initiative please feel free to send an e-mail to: climateandhealth@cdc.gov

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