Dorette Quintana English, MA, Climate and Health Planning and Policy Specialist, Climate Change and Health Equity Section of the Office of Health Equity, shares experiences with JEDI in the California Department of Public Health’s CalBRACE program.
What resources do you use to conduct vulnerability assessments?
We engaged with a consortium of partners to select and develop the “Climate Change and Health Indicators for California (CCHVIs)”8 and for a template for vulnerability assessment reports for counties. The partners included staff from UC Davis, California Department of Public Health Environmental Health Investigations Branch in the Chronic Disease Center (now called the Center for Community Health and Wellness), subject matter experts from CalEPA and the Natural Resources Agency, a disability subject matter expert, CalBRACE staff, and staff from 12 local health departments and their invited community partners. We also held a webinar for all Office of Health Equity Staff to get their input on health equity and accessibility. The local health departments represented wide coverage of the state in terms of diversity in population composition and size, geographic location, types of exposures, incomes, and more. Through a series of online meetings, the local health departments reviewed and provided input to the template for the vulnerability assessment reports, including indicators and narratives, and for a template for climate and health profile reports (CHPRs) that were developed for every county in California.9
How does your health department define vulnerable populations; do you consider gender, race, ethnicity, income, education and/or existing environmental justice communities?
Our state and the Office of Health Equity has statutory language for vulnerable populations. According to the California Health and Safety Code Section 131019.5, “Vulnerable communities” include, but are not limited to, women, racial or ethnic groups, low-income individuals and families, individuals who are incarcerated and those who have been incarcerated, individuals with disabilities, individuals with mental health conditions, children, youth and young adults, seniors, immigrants and refugees, individuals who are limited-English proficient (LEP) and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQQ) communities, or combinations of these populations. “Vulnerable places'' means places or communities with inequities in the social, economic, educational, or physical environment or environmental health and that have insufficient resources or capacity to protect and promote the health and well-being of their residents.’10
Part of identifying vulnerability is identifying the status of the social determinants of health and how these influence vulnerability, adaptability and resilience. The “Climate Change and Health Vulnerability Indicators for California” characterize vulnerability in three domains:
- Environmental exposure — extreme heat days, air quality PM2.5, air quality ozone, drought, wildfires, sea-level rise in coastal areas
- Population sensitivity — children, older adults, poverty, education (25+ years without high school diploma), percent people of color, outdoor workers, vehicle ownership, linguistic isolation, disability (physical and mental), health insurance, and violent crime rate per 1000 residents.
- Adaptive capacity — percent household without air conditioning, percent area not covered by tree canopy, impervious surfaces, public transit access 0.5 miles with less than 15-minute wait time during peak hours.
CalBRACE also included a few indicators in the CCHVIs from the CDPH Office of Health Equity’s Healthy Community Indicators Project (HCI).11 The HCI contributes to assessing vulnerability with its standardized set of statistical measures, data and tools on the social determinants of health in California — including income security; food security and nutrition; child development,; housing; environmental quality; accessible built environments; prevention efforts; neighborhood and collective efficacy. Our Datasets include data for California, as well as its counties, regions, communities and census tracts when available.
Have you used qualitative methodology?
We used qualitative data and methodology in the introduction and afterword of the vulnerability assessment template and the indicator narratives. The template was reformatted into an interactive web-based platform for greater accessibility called the Climate Change and Health Vulnerability Indicators for California Visualized (CCHViz) with indicator data and maps for each county in the state.12 As stated above, we engaged several stakeholder groups and actively sought qualitative input in developing the Climate Change and Health Profile Report, the CCHVIs narrative templates for the indicators and the development of the online CCHVIz platform. We are updating the CCHVIs data and the narratives and intend to have robust engagement during this process also. We always recommend ground truthing quantitative data with community knowledge and input, as there are specific circumstances and conditions that aren’t visible or apparent in larger population and aggregated data sets. In a state as diverse as California, this is a critical assessment action especially in frontier and rural counties, Tribe locations, and where small populations with high vulnerabilities are sequestered within locations and populations generally characterized as more resilient based on social determinants of health data.
The most intensive qualitative assessment work we did at the community level is with a very small rural agriculture community, Tooleville in Tulare County, of 80 households. With the Counsel for Justice and Accountability and Tulare County Public Health Department, CivicSpark, and the Tooleville Water District we co-developed a vulnerability assessment using indicators most important to the community. The Counsel’s staff conducted interviews in both English and Spanish with community households to gather vulnerability assessment data. The local health department collaborated to develop the methodology for the assessment and engagement, which included a community meeting at the local water district board to discuss personal experiences with heat, air quality, water quality and availability, and health equity. The community meeting was attended by all partners and was conducted in Spanish. The Tooleville Water District and the Counsel for Accountability and Justice maintains ownership of the assessment and data. A summary of the report was presented at the February 4, 2019, meeting of California Climate Team’s Public Health Workgroup that focused on drought.13,14
We also used digital storytelling to ground truth data about exposures, and how communities are impacted by wildfires, wildfire smoke and heat as part of an assessment. Leaders and members from the Mixteco Indigenous Community Organizing Project and Lideres Campesinas organizations that represent agriculture workers, and wildfire survivors from northern California shared their experiences in 3-4 minutes videos. Some of the videos have captions in Spanish, Mixteco and English. Using personal narratives and storytelling to document impacts and health effects is another qualitative method of gathering data and also empowering communities to tell their stories and make recommendations.
What resources do you recommend?