TABLE.
Selected Indicators Proposed for Public Health Surveillance Related to Climate Change
| Indicator | Source of Proposed Indicator |
|---|---|
| A. Environmental domain | |
|
| |
| 1. Heat | |
| Maximum, minimum, and diurnal temperature | CSTE15 |
| Heating and cooling degree days | EPA22; USGCRP23 |
| Future projections of extreme heat | CDC24 |
| Historical extreme heat days and events | CDC24 |
| Frequency of extreme heat events | Upperman et al25 |
| Ambient air temperature | ASTHO26 |
|
| |
| 2. GHG | |
| CO2-equivalent GHG emissions per capita, by sector, eg, transportation and agriculture | CSTE15 |
|
| |
| 3. Air quality | |
| Air mass stagnation events | CSTE15; NRC27 |
| Pollen count | ASTHO26; CSTE15 |
| Change in length of ragweed pollen season | EPA22 |
| Number of wildfires and percentage of total acres impacted by state | CSTE15 |
| Frequency, severity, distribution, and duration of wildfires | NRC7 |
|
| |
| 4. Water safety | |
| Water temperature and turbidity | ASTHO26 |
| Rainfall from heavy precipitation events | ASTHO26 |
|
| |
| 5. Drought | |
| Drought events | ASTHO26 |
|
| |
| 6. Disease vectors | |
| Positive test results in mosquito sentinels and reservoirs | CSTE15 |
| Spatial distribution of vectors/sentinel species for emerging vector-borne diseases | ASTHO26 |
|
| |
| 7. Food supply | |
| Length of growing season | EPA22 |
|
| |
| 8. Land use | |
| Deforestation and other land use trends | NRC27 |
|
| |
| B. Vulnerability domain | |
|
| |
| 1. Demographic characteristics | |
| General community vulnerability to climate-related events | ASTHO26 |
| People older than 65 y and younger than 5 y, with chronic and mental diseases, incapacities, who live alone, have low incomes, live in urban heat islands, lack access to a public pool within 1 km, lack public transit access to a beach, or lack access to a park or green area within 500 m | Bernier et al28 |
| Percentage of population 5 y old and older with a disability | CDC24 |
| Percentage of population ever diagnosed with diabetes | Manangan et al29 |
| Age-adjusted estimates of percentage of adults 20 y of age or older with diagnosed diabetes | CDC24 |
| Rate of hospitalization for heart disease among Medicare beneficiaries over a 7-y period | CDC24 |
| Age-adjusted rate of hospitalization for heart attack among persons aged 35 y and older per 10 000 population | CDC24 |
| Access to cooling centers | CSTE15 |
| Population density | CDC24 |
| Percent population of a race other than white | CDC24 |
| Percent or number of population below the poverty line | Manangan et al29 |
| Median household income | CDC24 |
| Percent population 65 y of age or older and living alone | CDC24 |
| Location and vulnerability of populations at highest health risk following extreme weather events | ASTHO26; NRC27 |
| Location of, and number of children and others served by day care centers, schools, and health care centers; proportion of those facilities that are air conditioned | Bernier et al28 |
| Populations living at low elevations | Frumkin et al30 |
| Percentage of people without health insurance | CDC24 |
|
| |
| 2. Vulnerability of locations and resources | |
|
| |
| Per capita availability of health care facilities, professionals, supplies, equipment | NRC27 |
| Hospital counts | CDC24 |
| Hospitals per 100 000 people | CDC24 |
| Urban areas, school day care centers, and health centers sensitive to heat waves and extreme weather events | Bernier et al28 |
| Local/regional food production locations and volume | ASTHO26 |
| Capacity to store and deliver food during and after extreme weather events | ASTHO26 |
| Energy and water efficiency of facilities and equipment in food service establishments | ASTHO26 |
| Percentage of census tract area not covered in vegetation | Manangan et al29 |
| Percentage of forest cover | CDC24 |
| Percentage of cultivated crop land use | CDC24 |
| Percentage of developed land use | CDC24 |
|
| |
| 3. Exposure to risk factors | |
| Location of chemical facilities at risk of extreme weather events | ASTHO26 |
| Rates of agricultural chemical application | ASTHO26 |
| Exposure to injury from transportation used during and after extreme weather events | ASTHO26 |
|
| |
| C. Health domain | |
|
| |
| 1. Heat-related | |
| Heat-related death rate | EPA22 |
| Rate of deaths, hospitalizations, and ED visits during summer months | CSTE15 |
| Number and rate of heat stress ED visits and hospitalizations | CDC24 |
| Excess daily all-cause mortality due to heat | Cheng and Berry20 |
|
| |
| 2. Utilization of health care services | |
| ED and ambulatory care visits, hospital admission, mortality, mental health outcomes | Frumkin et al30 |
|
| |
| 3. Morbidity and mortality | |
| Daily nonaccidental mortality | Cheng and Berry20 |
| Preventable deaths from climate change | Cheng and Berry20 |
| DALYs lost from climate change | Cheng and Berry20; NRC27 |
| Injuries and deaths due to extreme weather events | ASTHO26; CSTE15 |
| Cancer rates for respiratory disease | NRC27 |
| Food-borne, waterborne, and vector-borne diseases | Multiple |
| Annual incidence of confirmed Vibrio infections | USGCRP23 |
| Incidence of Lyme disease cases in humans | Cheng and Berry20; CSTE15; FPA22 |
| Incidence of West Nile virus cases in humans | Cheng and Berry20; CSTE15 |
| Human cases of valley and dengue fever and of hantavirus | CSTE15 |
| Allergic disease related to climate change | CSTE15 |
| Morbidity and mortality rates of populations exposed to toxic chemicals during extreme weather events | ASTHO26 |
| Premature deaths due to air pollution, eg, ozone and PM 2.5 | Cheng and Berry20 |
| Population movement and migration | Frumkin et al30; NRC27 |
|
| |
| D. Climate change mitigation domain | |
|
| |
| 1. Energy-related | |
| Total energy consumption per capita | CSTE15 |
| Renewable energy consumption per capita | CSTE15 |
| Vehicle miles traveled | CSTE15 |
|
| |
| 2. Extreme weather-related | |
|
| |
| Storm surge capacity in coastal areas | ASTHO26 |
|
| |
| E. Climate change adaptation domain | |
|
| |
| 1. Plans | |
|
| |
| Development of state climate change adaptation plans | CSTE15 |
|
| |
| Development of local climate change adaptation plans | City of San Francisco31 |
|
| |
| Adoption of urban planning and design policies to reduce heat exposure | Manangan et al29 |
|
| |
| Heat island mitigation plans | CSTE15 |
|
| |
| 2. Public health agency actions | |
|
| |
| Health surveillance systems related to climate change | CSTE15 |
|
| |
| Public health workforce trained in climate change research, surveillance, and adaptation | CSTE15; NRC27 |
|
| |
| 3. Population characteristics | |
|
| |
| Access to cooling centers | ASTHO26; CSTE15 |
|
| |
| Levels of exercise and fitness, eg, rates of bicycle, public transport, and car usage | NRC27 |
|
| |
| F. Policy | |
|
| |
| 1. State and local government actions | |
|
| |
| Formation of state climate change advisory board | CSTE15 |
|
| |
| Formation of local climate change advisory board | City of San Francisco31 |
|
| |
| Development of state climate change action plan | CSTE15; NRC27 |
|
| |
| Completion of state or local greenhouse gas inventory | CSTE15 |
|
| |
| Number and percentage of local governments participating in ICLEI-Local Governments for Sustainability (ICLEI) | CSTE15 |
|
| |
| Percentage of population living in cities participating in the U.S. Conference of Mayors Climate Protection Agreement | CSTE15 |
Abbreviations: ASTHO, Association of State and Territorial Health Officials; CDC, Centers for Disease Control and Prevention; CSTE, Council of State and Territorial Health Officials; DALYs, disability-adjusted life years lost; ED, emergency department; EPA, Environmental Protection Agency; GHG, greenhouse gasses; ICLEI, International Council for Local Environmental Initiatives; NRC, National Research Council; PM, particulate matter; USGCRP, U.S. Global Change Research Program.