Background/Objectives
Laws and policies drive many systemic public health outcomes across the social determinants of health, from access to health care, to emergency preparedness, to laws establishing procedures for public participation in government decision making. But laws and policies can bake in inequitable health outcomes if health equity and community needs are not central to their drafting. As lawmakers craft laws to mitigate the health impacts of climate change, a public health law lens can help ensure equitable policies and outcomes.
Our laws have not equally assured health for all individuals – and climate change will intensify those inequities. Climate change and health equity laws are multi-purpose tools that, if structured properly, can begin to reverse the health inequities built into our systems; mitigate climate change; and increase community resilience. For example, laws and policies can prioritize community involvement in emergency preparedness and recovery efforts, or expand green infrastructure while also limiting climate displacement and gentrification.
Communities will experience the health impacts of climate change differently both throughout the nation and within a region, making community-designed climate adaptation strategies essential for climate resilience. At the same time, federal efforts, such as Justice40 and the Federal Plan for Equitable Long-Term Recovery and Resilience (ELTRR) are aligning to support inclusive policies addressing equity and climate change resilience.
The COVID-19 pandemic required urgent implementation of mitigation policies that had the best likelihood of success locally and regionally. The COVID-19 response provides lessons about the management of a global threat to public health that can be used to help mitigate and adapt to another global public health challenge: climate change.
The pandemic experience revealed a fundamental flaw in the U.S. public health system – the very communities at the highest risk faced barriers to participation in developing and implementing policies to reduce harm within the community. Health equity could not be achieved until the most at-risk communities were included in deliberate pathways to provide culturally appropriate mechanisms of communication, data collection, and implementation and evaluation of policies and interventions. Essential to achieving health equity, community health workers (CHWs) were able to break barriers and foster pathways to participation.
The lessons learned have informed the ELTRR – a “multi-sector approach…pairing coordinated federal action with non-government actions…[to address] the deep disparities in health, well-being, and economic opportunity that were laid bare during the COVID-19 pandemic.” The ELTRR recognizes the essential role of communities “to engage in equitable, self-driven discussions of needs and solutions;'' and via “community-centered collaboration within and outside of government to ensure an equitable and thriving future.” The ELTRR also recognizes CHWs’ role in climate change and health equity as an illustrative example of such effort.
The inclusion of key stakeholders from the grassroots level is an overarching objective in any standardized framework, such as ELTRR, that is used to mitigate and adapt to climate change. CHWs can help achieve this objective when they are active participants in this process. Recognized as “multi-solvers” in the ELTRR, CHWs can play a key role as promoters and enablers of a process that ensures local buy-in and integration of local solutions on a systems level. However, this requires adequate training of CHWs using a curriculum design informed by ELTRR principles which allow for integration and coordination of local efforts.
Development and utilization of an adaptable education model for CHWs, using a standardized, evidence-based approach to curriculum design, is necessary for shared action and coordinated efforts in climate change risk mitigation. The curriculum should provide training in essential climate-related skills and competencies to prepare the various components of the healthcare workforce to function in unison and follow best practices for climate change risk mitigation while adapting to the specific needs of local communities. Jagals et al. propose six curriculum domains to guide climate change risk mitigation training of the various sectors of the healthcare workforce.
These domains align with the ELTRR principles for coordination of mitigation efforts, and address the entire spectrum from the provision of foundational knowledge about climate and environmental change and associated health sciences, to methods of engaging in risk management, to collective strategies on a large scale. This standardized curriculum framework also enables CHWs to help address local policy needs by equipping them to be effective advocates in policy discussions, focusing on their communities' specific needs for targeted policy solutions and collecting vital grassroots data on the health effects of climate change, thereby supplying policymakers with precise, current information for shaping local laws and policies. Collectively, these curriculum domains serve as a guide for a curriculum that highlights and utilizes CHWs’ unique set of functional and educational characteristics.
CHWs are in a unique position to facilitate the processes outlined above. Due to their close ties to the communities they serve, CHWs are instrumental in identifying and relaying information about the community’s health and social concerns, including those relating to local climate and environmental effects and relevant risk factors. CHWs can also play a significant role in asset mapping of resources already available to utilize in risk mitigation. Moreover, they can be trained to participate in, coordinate, or spearhead climate-related community interventions, such as education and policy advocacy, through direct, meaningful community engagement. By gathering and sharing information, engaging with the community, and relaying the community’s voice, CHWs can aid efforts in coordination and partnership building between stakeholders from local to global levels. Their roles in information gathering and quantitative and qualitative community data collection also position them to effectively contribute to climate-related program evaluation processes.
Given their relevant lived experience as members of the communities they serve, CHWs are well-positioned to improve the effectiveness of public health policies and interventions. Local Public Health Departments can also incorporate CHWs in their climate change mitigation efforts to tailor climate-related interventions to specific local needs – e.g., as community data collectors for heat and air quality vulnerability maps; supporting efforts to address spatial inequality and environmental justice; and community engagement and education efforts.
Massoud Agahi and Cameron Salehi’s work on the Greener Grassroots Initiative – a pilot program to address climate change in local communities – utilizes the standardized curriculum domains proposed by Jagals et al. Hosted by the non-profit community-based organization United American Indian Involvement, this program aims to train CHWs in addressing the disproportionate health effects of climate change in urban American Indian/Alaska Native (AI/AN) communities in southern California to build resilience and help integrate local efforts within a unified national framework.
Approach/Activities
The Greener Grassroots Initiative focuses on leveraging CHWs’ trusted status in the community, firsthand insights into local needs, and adept communication skills with residents to implement strategies for climate resilience that are both culturally sensitive and community-centric, aligning with ELTRR principles. It utilizes a standardized set of curriculum domains that can be replicated and scaled at the national, state, local, or tribal level. Hosted by a community-based organization, the pilot program trains CHWs according to a customized curriculum designed to address the disproportionate health effects of climate change in the urban AI/AN population of southern California. The program has equipped CHWs to assist in conducting risk assessments in the community, identify key local resources, offer education and referrals to community members, aid in the reform and execution of public health policies, and coordinate with local organizations and care teams to address the health needs of AI/AN communities in response to climate and environmental change. CHWs participating in the program will also support the subsequent Greener Grassroots evaluation process by aiding in qualitative and quantitative community data collection and analysis, as well as disseminating lessons learned and best practices through local and wider channels.
Climate change is a global public health risk; therefore, mitigation and adaptation efforts are most effective when coordinated across a wide range of communities with different local challenges and resources. The Greener Grassroots model is designed to facilitate the inclusive, community-centered approach to public health challenges of such magnitude that is critical in such comprehensive frameworks as ELTRR. We aim to replicate and scale this model on a national and, potentially, global scale. To that end, we are developing partnerships with key stakeholders in public health law, policy, and authorities at all levels of government.
Results/Lessons Learned
Early results indicate a strong desire by CHWs to engage with the community to build climate resilience. We will present our preliminary findings in the conference regarding the process and outcomes of the Greener Grassroots Initiative, including results of surveys of various stakeholders in addition to the CHWs which appear to indicate that a structured curriculum and a clear understanding of the unique roles of CHWs can help ensure equitable engagement among and across communities.
Soon after the formal training phase of the program was started, additional CHWs were interested to join the initial cohort. We will aim to present the most updated results that include this extended cohort in the analysis by the time of the presentation. Furthermore, since the program was formally announced, we have received requests to collaborate on similar climate resilience initiatives in other regions in and outside of the state. We will also provide a status report on any such additional collaborative efforts to the extent feasible.
