 We welcome you to the fourth workshop of the Activities on Communities, Climate Change, and Health Equity workshop series. I'd like to read the land acknowledgement. While we are gathered today, the National Academies is physically housed on the traditional land of the Noochuk Tank and Poo Scat away people's past and present. We honor with gratitude the land itself and her stewards whose relationship spans generations. We recognize that indigenous nations have distinct knowledge systems and ways of knowing and hold wisdom for how to live with the land. Respecting this knowledge as we gather to discuss living in extreme heat, it is our duty to listen, work with those who see with two eyes to create better, safer communities for all in the future. I want to thank the planning committee, the National Academy staff, and today's moderators and participants, all of whom have worked very hard to bring together these exciting events. Before we dive into today's goals and objectives, Audrey Thevenon from the National Academies will provide some context for this workshop. Audrey, the floor is yours. Thank you very much Venkat. I'm going to share my screen here. Okay, can you see my slides? Yes. Thank you. So first, I would like to acknowledge the excellent staff that has been working very hard with the committee to prepare for today's events. You will all see those individuals that work on the behind the scenes today and making up for your experience, participatory experience for all today, enjoyable. Some logistics here. We are in a Zoom meeting. This is not a webinar, so you will be muted and camera off and entrance, as you can see here on the screen. Please, for the fact that, you know, we have that Zoom and you can communicate with each other through the chat. We would like you to put your first name and your last name into your name. So rename yourself and you can see here how you can do this. Will you use the Slido platform, which is an outside platform to field questions at any given time, please enter questions into this, this experience and in the chat will be put the Slido information in order to access this. Do not use the chat to ask questions. We will not look at those questions. We will only look at the Slido platform. We will use the chat however, so to put comments, you can put comments there. You can also communicate with each other. You can send direct messages to each other. We really want it to be an experience that you can share with each other. If you need assistance, please find on the participant list, Leila Gehrig, our colleagues here, or any of the staff member. You will see that we have our names, followed by Nassim. This is the staff today. The workshop agenda, the speaker biographies, everything else, you can find that on our website. We will also put the link in the chat. You can also use the automated closed captioning as shown here where you can find it if you would like for accessibility, if you would like to follow the captions. Finally, this meeting is recorded. All the recording in addition to all the material, including the biographies and the agenda today and the presentations of our excellent speakers will be on our website. So a little bit of an overview of what the HMI, the Environmental Health Matters Initiative is. It is a cross-academy initiative. So here you can see HMI all the way on top that cut across our three academies, engineering, science, and medicine. But if you go on the bottom of this organ diagram, you can see also the seven divisions at the academies that we cover. We have the opportunity to really tap into the excellent work of all those divisions everywhere from behavioral science, all the way to transportation, policy, engineering, so on and so forth. The HMI mission aims to improve the health of all people equitably. We use system thinking but also provide evidence-based approaches to advance accessible, lasting solutions. We have three main objectives established and during partnerships, proposed actionable solutions, and all of these by implementing a comprehensive systems approach for environmental health solutions. This workshop is part of a series and we have the chance to have three sponsors for this workshop, the Center for Disease Control and Prevention, the National Institute of Environmental Health Sciences, and the Environmental Protection Agency. In addition to their continuing interest in tackling the most pressing issues in the environmental health, they recognize the National Academy's core values of operating independently from any sponsorship. This series recognized that communities that are the least able to respond often bear the largest health burden. And this series is aimed to explore the current state of knowledge about climate-related health disparities and the specific action co-produced with changemakers and leaders at all levels of decision to improve climate-related health outcomes for all. We have done three workshops. Today is the fourth one. The first one discusses the disproportionate impact of climate change with a range of different interest groups from health experts, reasoning practitioners, climate scientists, and other people with lived experience. The second workshop was focused on state-level implementations and we looked at identifying actions that could help improve climate-related health outcomes. The third workshop took a thematic focus and we looked at extreme eats and we explored real-world challenges related to extreme eat along with actions being pursued to prevent, adapt to, or mitigate the health consequences of these extreme events. And today's topic is looking at flood adaptation strategy to support health equity. And for this, I will ask our co-chairs, Van Katz, to take it away. Thank you. Thank you, Audrey. First, I'd like to acknowledge the work of our outstanding diverse committee of experts in preparing the workshop today. Today, day one of the workshop, the session will be focused on health risks, any inequalities stemming from storm, water, runoff, induced flooding events, and values for implementations for solutions to all. As we have four sessions, Monday, March 18, day two of the workshop will be centered on adaptation strategies to improve community resilience and reduce health inequities, which we will have four more sessions. So the two days build on each other. So please come and join us back on Monday. At the end of the workshop series, we'll produce a report in the format of a proceedings in brief or PIB. The link to the last PIB on extreme heat was posted in the chat earlier. These workshops are designed to be highly interactive and including stories reflecting people's lived experiences. So we expect these workshop will help pave the way for the future for understanding the interaction between science and society. So most of the times we in academia focus so much on the science, we forget that the real benefits of that translate to society. So I cannot think of a more interesting series of workshops than these organized by EHMI. So I know we are a few minutes earlier, nothing wrong because we can have more time for questions and answers. So let's get started with session one. The session one is the state of the knowledge and we have a few keynote speakers. The goals of this first session are to set the stage broadly for the current state of knowledge regarding flooding health communities and policies, focusing on existing barriers that we need to do now to promote and implement flood adaptation strategy that would support health equity. We have a fantastic lineup for the session with two speakers. In the interest of time, all biographies can be found on our website. Each speaker will have about 15 minutes or so to provide their thoughts and then we'll open the floor for questions and answers. Audience members, you are welcome to submit questions anytime using the Slido platform where everyone can upvote the questions they want to hear answered. We'll address as many of these as possible during our panel discussion after the two talks. Audience can use chat for comments and we use, we request you to use the chat function wisely. So now moving on to our first speaker. Our first speaker is Maureen Litchmond, who is the Dean of the School of Public Health at the University of Pittsburgh. Today Maureen will provide an overview of environmental health threats of flooding. Maureen, please take it away. Thank you very much and I'm so pleased to join this workshop. The evidence that we're going to present are so clear. And the focus that you just set up so nicely is that it's on people. It's about real people. And so if I can have my first slide please. We could go all the way to the beginning. Thank you. Thank you. So, when we talk about flooding and we connect that with environmental health threats, it's really important to think about the SWAT question. The SWAT from a perspective of who suffers, who do we need to, for whom do we need to focus our efforts on, who are most vulnerable and where do we elect the most resilient. So that's where the focus is for my keynote today to set the stage actually not only for today, but also for next weeks when we talk about more granular issues. Next please. And so my presentation objectives are to discuss flooding as an environmental phenomenon, as a phenomenon of disaster and as a climate driver. Second, to assess the compounded impact of flooding, not only on physical health, but also on psychosocial well-being. And then thirdly, to examine what we do next to address flooding from a public health perspective. Next slide please. Many of you are familiar with this figure that really looks at climate drivers, the changes from an environmental perspective, and then ultimately the impact on human health. When I teach, I actually call this the wheel of death with my students, but clearly what we're seeing is that whether you look at more extreme weather or rising temperatures or increased levels of CO2 or rising sea levels, the array, the slice of the pie, so to speak, goes directly from an environmental phenomenon to a health outcome. You know, when I was asked to, when the world's population became 8 billion strong, and I was asked what keeps you up at night as an environmental health scientist and a climate and health researcher, what keeps me up at night are four drivers. Heat, extreme heat, infectious disease, air and water pollution, and food insecurity, both food safety and food insecurity. So we did those four. Next slide please. And look what's happening on the ground. No one is safe anymore from flooding and no place is safe anymore from flooding. So if we look at Mississippi versus Planada in California or the rains, heavy rains that happened and flooding that happened in Texas and Louisiana, there is no place, in fact, no place in the world that is safe. Next please. Including in the state that I currently live now in Pennsylvania. Here you see a statewide heavy precipitation and the inland flooding consequences and I'd like you to look at particularly the consequence rating and the impact on human health. And so whether you look at human health narrowly from a physical perspective, environmental justice is right there. Agriculture, as remember I mentioned food security is also a critical of critical conference consequence rating. Recreation tourism, but I want you to particularly look at the built environment and the infrastructure that is so fragile in all of in all states in the United States, but all over the world. So if you combine human health, the narrow human health, environmental justice and equity, agriculture and the built infrastructure, you see the cumulative impact of the consequence of flooding on public health. Next please. So I'll take you to all the places that I've lived in the US when in 2005 I moved August one 2005 to join my academic institution then I too, after three weeks lost everything. I too, after three weeks had to send my kids away to another state to go to school. And I too was dedicated to protect the health of children with a number of us, particularly children with mother to severe asthma. And so we have all seen the pictures of disparities, we've all seen the pictures of the flooding of the city of New Orleans. What we've worked together is with communities and asked communities to be engaged in what we should focus on. And so while we design a multi year environmental epidemiological study, the message that I bring here that the environmental phenomenon had both physical and psychosocial impacts. When we evaluated what the main causes were of asthma exacerbations in children five to nine year old. Yes, there were 79 types of mold spores. And yes, mold in the homes was the major cost. But the number two reason statistically significant the number two reason why kids had asthma exacerbation after Hurricane Katrina, we're losing a pet and changing schools more than twice in one year. And so the integration and the cumulative impact of physical effects and psychosocial effects impact disproportionately people who are disparate disproportionate people who have suffered from environmental justice and environmental inequities. And so when you look at that total picture. It is an even worse impact that flooding can have on us in public health and population health in general, and on people who are most vulnerable specifically. Next please. So if you look at flooding from an environment as an environmental health phenomenon to the right, you see a picture of a home, a home fully molded. And in fact, this was a home that was used by many musicians in training. So jazz is a big deal in New Orleans currently and definitely in 2005 so loss of homes forced migration we don't often talk about forced migration as an impact of flooding. Chemical exposures I mentioned that and food insecurity if you can go to the grocery store to get milk and bread and all you and all you need. Then we're getting into a situation of food insecurity food insecurity. I mentioned specifically the psycho social impacts stress and anxiety. In fact, to this day and 2005 is almost 20 years ago. My youngest one still comes home when a hurricane happens to be safe in another state. And so that angst that trauma stays with children particularly a very, very long time. And so what we have seen are both risks to from a chemical stressors perspective and a non chemical stressors perspective. I talked with you a little bit about the study and I'll spend some more time talking about the United Home Nation as a specific for the population at the work, the phenomenal work that they're doing there, supported by the golf research program. And then underground storage tanks, who started to leak because of flooding, and they were no longer underground they were above ground. And so you see that cumulative impact, impacting firstly environment, and then people. Next, please. The United Home Nation. I have the privilege to work with for over a decade. And it is a tribe that not a lot of people know about. It's a tribe of about 19,000 members. But it's a tribe that stays together that is spread over many states that stays together because of the social networks and the sense of place, but is that very sense of place that has impacted repeatedly by flooding. So much so that you see the picture and the building this was about at the height of the of the pandemic around 2021 that very building that finally became their new home after multiple flooding situations was flooded again. And so the last time I visited part of that building was being reconstructed. And so how do you keep and I'll come back to that resilience piece. How do you keep going? How do you keep going particularly when flooding and rising sea level sticks over the very land that you live on? How do you keep going when your culture is being impacted because of forced migration? It is all about not looking at flooding as it's now here and it's gone. It is about flooding as a pervasive insult on people's life. Next please. And so we can look at the impact of flooding and other extreme weather events from an individual perspective. We've talked about all that makes an individual, all that comprises individual risk from a personal attribute but also to chemical stressors and how community links to those stressors, whether the community is supportive or whether the community is fragile. The link between individuals and the environment are always saying the health of the environment is inextricably linked to that of people. And so if the environment is sick, people will be sick. And so that link is critically important when we look at what's the impact over the lifespan, not the impact of a single event. And so the bottom line here is when we look at individual outcomes in the context of the exposo from a public health perspective, it is inextricably linked to what's happening at the population level and at the community level. Next please. And so how do we do this? We do this through precision public health. So just like precision medicine, where we can fingerprint the genetic makeup of an individual, we're fingerprinting the makeup of a community. And I'll explain what that fingerprinting is about so that we can tailor interventions specifically to not only the assets but the gaps of what's happening in the community. So it is the juxtapositioning of precision medicine and precision public health that will sustainably address issues like flooding. Next please. And so when we look at the cumulative impact of environmental phenomena on communities, we cannot escape the very historic burden that disparities and inequities bring. On top of that, the environmental health threats as we know them air pollution, salt pollution, water pollution. On top of that are particularly in the Gulf South, but all over our country and often all over the world as I started my presentation, the flooding, the disasters, the hurricanes that are exacerbated by climate change. And in other settings you could even think about what's ultimately happening to the planet. So how do we then on the raffle community for vulnerability and in the context, not only of public health research, but also public health practice. Next please. And so what is flood has to do that with, with how do we look at floods in that context. And so let's on the raffle. The community resilience component. How do we particularly in the inter disaster period so when things are quiet. How do we invest in the six areas that make up a community. How do we invest in the natural environment. How do we invest in infrastructure. Remember, I, I talked about the building infrastructure to the built environment and the built infrastructure. How do we make sure a community is financially stable, and that we value and support both the human side but the cultural side as we mentioned with the United home nation and other other cultures. How do we make sure there is strong social cohesion. And how do we make sure that the political system provides a governance that is supportive for sustaining healthy communities and so the national academies of sciences has spent and I was honored to be part of this process. A special report on this and I really encourage you to look at that report more deeply. Next please. But what's missing. If you look at how to undergird community resilience. He is and this is another study that that the national careers of science engineering medicine has done the key is to build the pillars support the pillars of this broken bridge. This bridge that is very fragile. It requires us to do things differently, whether we do it from population based research, or just simply more interventions. How do we transition how do we invest in making sure we can do precision public health and particularly in this context precision environmental public health. How do we do it if we have disparate databases we can do it is that if transportation data is disconnected from morbidity and mortality data. If access to food, the locations of grocery stores is miles away from where communities live. The integration of disparate databases is critical for us to make the decisions to increase community resilience. Similarly, how do we assure that the fragile infrastructure whether it's physical infrastructure or health infrastructure and access to care. How do we make sure that infrastructure can withstand yet another flood. How do we make sure that is sustainable funding and funding doesn't only come. This is one of my pet piece funding doesn't only come after the disaster happened but it's available in a sustainable way. How do we build that workforce that will do the work. So what's the human capital and ultimately as I mentioned before, are we assure sustained and protective governance next please. So what's the bottom line how do we move forward. We target individual and community vulnerability so put the resources where they needed the most in the most effective of times. Focus on both the physical and psycho social well being at the individual individual level at the community level and Lloyd precision public health strategies to strengthen on that social capital the six domains that I talked about. The best in strengthening the pillage as I mentioned particularly during the inter disaster period, and ultimately require not as an afterthought but to require community engaged scholarship to bolster resilience. So let me stop there and I look forward to questions afterwards thank you. Thank you Maureen thank you so very much for that very insightful talk. Now moving on to our next speaker, our next speaker, or this session is Margaret a walls from resources for the future. Today, Dr walls will be speaking about flood policy in the United States. Margaret, the floor is yours. Yes, thank you. Hi everyone. I'm going to attempt to share my screen. So give me a second here. And you'll see that let me put it on full screen mode. Okay, maybe if somebody can say yes you're seeing it because I can't see it. Okay, awesome. Perfect. Okay, so thanks very much. What I'm going to talk about today so I am at resources for the future where nonprofit non advocacy research organization. And I direct our program on climate risks and resilience. I'm an economist I do a lot of work on policy and do not do a lot of work on health. So what I'm going to talk about today is really give you the lay of the land on how we address flooding in the United States. We do a lot of different things so I'm going to touch on each of them and open to questions to get in deeper if we need to. There's way of background. This is some information on the number and costs of flooding since 1980 annual numbers through 2021 and this is, you know, data you may have seen before, it's the Noah billion dollar disasters. This is the site where they pull these numbers together so this is any official disaster that occurs in the United States that causes over a billion dollars and in costs or damages. And this just shows you if you can see from the bars that the number of events is going up we're having more and more disasters but also the costs of those events vary a lot that's the red line. We have really big hits in certain years so 2005 we had Hurricane Katrina, Hurricane Rita 2017 we had Harvey and Irma and Maria 2012 is Hurricane Sandy. So you know they're very spiky we have some really disastrous events that occur sometimes that cause hundreds of billions of dollars and damages. So on the whole things are going up, and I will point out that this is not only floods but also hurricanes shown here and they account for in the two of them together, three quarters of all disaster costs in the US come from those types of events. So what do we do about this problem, we do a number of things and I'm going to talk about each of these we invest in a lot of stuff. We have a large scale infrastructure. We also try to get people to do things on their individual properties and in local communities to mitigate hazards. We try to do to some extent to just reduce exposure to risk so we can mitigate on the one hand, try to make our home safer and so forth, or we can just get out of the way, and that's what reducing exposure is. We have a federally run flood insurance program that you all probably know about so I'll talk about that and the implications of it. As part of that program we do lots of mapping and communication about flood risks, and then of course we deal with recovery after disasters occur. So let's talk about each of these flood control infrastructure in the United States we have spent billions of dollars on hard infrastructure across the country to try to protect ourselves. So most of this has been through federal dollars in the mid 20th century, the US Army Corps of Engineers believe it or not accounted for a lot of federal spending that we were spending on everything. And we built miles and miles of levies and blood balls we now have 23,000 miles of levies in the US. Also in your local communities, you're spending on stormwater infrastructure, there's dams and reservoirs tide gates lots of different things. And each on each of these slides I just want to have a little bit of a takeaway about this, the point here. And one thing I'll say about infrastructure is that the average just talking about levies for a minute. The average age of levies in the United States is 60 years old, they're getting old. A lot of our infrastructure, you probably know this is an old and in need of repair. It's also not built for a changing climate. So we have a lot of stuff that isn't ready for the extreme events we have now the rising sea levels and so forth. So, all this costs a lot of money, it costs money to build it costs money to maintain. And we're probably not doing enough. We also do things, you know, at the individual property level or we try to get people to do it and in communities so in FEMA designated floodplains which we're going to talk about in a moment with respect to flood insurance. FEMA requires some things they require local communities to have a floodplain ordinance and that ordinance has to do something with building codes. And those building codes generally they're fairly minimal really but they require first floor elevation in the floodplain. They also have a few other things in them but to participate in the national flood insurance program you have to have these things. Beyond that, there's some things that other things that get done, there's little bits of financial incentives here and there, lots of communication outreach education to try to get people to do the very few number of things that can be done to reduce your risk on your individual property. You can elevate your heating and air conditioning equipment there's a photo of that there. You can elevate your home that's quite expensive. We also can do small things like install flood bins. One takeaway here is first of all there isn't a lot. And it's hard to get people to do this stuff. I also do work on wildfires and there's a lot of stuff we can do in the wildfire space it's still very hard to get people to do things, either for financial reasons for people not paying attention for have another it's more important for them to deal with. So as I said above, another thing we can do is just get out of the way. So, this is called reducing exposure to risk. So there's a risk at an event occurs, but there's also the costs that happen when an event occurs, and that has to do with how many people and how many, how much property the value of that property that's sitting there getting flooded. So how do we deal with that problem, we can deal with it through a variety of things. A lot of them are left to local governments so local governments do most of our land use planning and zoning and the United States. They're not they're in charge but not the federal government in general not even the state governments it's really falls to your local communities. So what those local communities can do is a number of things that they want to they can rearrange their zoning to try to encourage less development in risky areas. They can try to protect those areas by turning them into parks greenways various kinds of buffers. They can increasingly there's a few cities that are doing what are called resilience overlay zones where you again that's a way of working in your zoning code to try to just redirect development. So those are all things you do ahead of time what if you already have a bunch of properties in the way then we have property buyouts and I'm sure you all know about these. This is where an already developed property often that's been in hurt in a storm has been damaged will end up being will pay to buy that property out. So, and the map on the right is a picture just an example of that this is the hurricane sandy buyout program after in New York, and the red area shows what areas were inundated and those blue and yellow dots are where people actually sold their homes and bought out and a lot of cases those properties are bought out and destroyed and the land is turned into open space. In some cases, they're bought out and the properties are elevated and made more flood resilient. This kind of approach is very effective at reducing disaster costs, but we don't do very much of it and it's very challenging. It's challenging to make buyouts work because, as you can imagine, it's difficult to get people to move there are a whole host of issues with it. It's also difficult to get at this ahead of time with planning and zoning because communities rely on property tax revenues to pay for local services. There's a lot of resistance in communities. But this is an effective approach if we can figure out how to do it. So let's talk for a minute about the very important national flood insurance program and risk mapping. So insurance is critical. We all have homeowners insurance if we own a home. Insurance protects us when we have a big loss. And it's critical in the flood space. It really serves sort of two purposes flood insurance. First of all, it provides a signal of the risk and the prices that you pay should provide a signal. So it should incentivize you to kind of do the right thing, live in the right places, pay for mitigation and so forth. But of course also it's a very big aid in recovery after a flood. If you have a national flood insurance policy, you get up to $250,000 for damage to your property after an event and up to 100,000 for building contents. That money comes in pretty quickly compared to other things. And if you don't have a flood insurance policy, what are you going to do? You have to rely on your savings. Some sort of loan if you can get it charity and federal assistance. So insurance is critical. And floods are not covered in a standard homeowners policy. You must have a separate flood only policy and most of those come from the national flood insurance program. A key part of the flood insurance world is these maps that FEMA generates. So these are called flood insurance rate maps or firms. And that's the FEMA designated 100 year floodplain, which I'm sure you've all heard about. I put an example here. This is a Washington DC since we're, I'm in Washington DC, the National Academy is in Washington DC. I thought I would look up the flood map for Washington DC and put it here. And it just illustrates the pinkish areas are the 100 year floodplain and those bright red is the 500 year so still at risk but less risk. Within the floodplain if you have a federally backed mortgage you are required to have a flood insurance policy. Outside of the maps floodplain you are not required to have insurance policy. This has created some problems. We have a very large what's called a flood insurance gap in the US, not a lot of people by flood insurance in low income communities that gap is bigger. And part of the challenge is that the flood maps have been somewhat misinterpreted. They've been misinterpreted that if you are outside the line, you are not at risk. And in fact that is not the case. After many floods, people are find their homes inundated and we hear these stories all the time, even though they are outside the floodplain. So, we have a challenge in communicating risks to people, the flood maps were not actually intended to do that but they are the main thing people look at to know if they're at risk. So this is an issue. And the lastly let's talk about disaster aid so when we have this is another part of our federal policy toward flooding. After disaster strike, we step in and provide assistance. There are two types of assistance from FEMA individual assistance which goes to homeowners and renters and public assistance which goes to state and local governments, mainly local governments. It also provides money and through its community development block grant program, and that has grown in recent years actually so we think of FEMA only but actually housing and urban development also provides funding and USDA to a certain extent. The graph on this slide just shows you the size of the of this, and I just pulled this out of a congressional budget office report and it shows you disaster aid that comes through regular annual appropriations from Congress, and then the supplemental is which the point of this report was just to show you how big the supplemental is in times where we have really big disasters like 2005. Again, in 2017, and even the coven 19 was was considered a disaster and we have supplemental appropriations for that. This is, you know, we spend a lot of money on recovering after storms hit. So that's the point of this figure. And I think a kind of a takeaway that I would like to give you is that while things are somewhat changing our policies in the US have mostly been post disaster focused at the expense of pre disaster. So I mentioned things like, you know, mitigation in communities. You know how we try to get homeowners to elevate their homes and we do all those kinds of things. Those are peanuts, compared to the amount of money we spend after a disaster strikes in just recovering from that disaster. And I think it's fairly well known that FEMA has been a post disaster oriented agency. And I do think that's changing. And in order to really build resilience pre disaster. We need to have our policies more focused on pre disaster. So this is a whole other conversation we can have and maybe we can talk about it afterwards. But this is just sort of the lay of the land on how our policy currently works. And I want to have one last slide that talks about some justice and equity challenges in the flood policy space. There's several findings in the literature, certain things that we know. First of all, we know that low income populations and people of color are disproportionately exposed to blood risks. There's several studies I can point you to that have shown that for a variety of reasons. We just find that maybe because property values are lower or a number of things. We find more socially vulnerable people living in those high risk areas. But even beyond that, and you know our first talk gal that this a little bit even beyond that exposure question, when a flood hits, many populations are more vulnerable. And we're more vulnerable because of underlying health risks, English language challenges, lower incomes make it just harder to recover. And then lastly, we have justice and equity challenges bound up in the way a lot of our policies and institutions work. And the one thing, a few things I will point to the first one being in FEMA benefit costs. So if you are applying for some grant programs that FEMA runs, you have to do a benefit cost analysis as a requirement of your grant application, and you have to show that the benefits of what you're going to be doing. In FEMA benefit cost analysis, loom large. So if you are applying for some grant programs that FEMA runs. You have to do a benefit cost analysis as a requirement of your grant application and you have to show that the benefits of what you're going to spend that money on outweigh the costs. If you are getting disaster aid from FEMA that is partly based on your property values. There are a lot of things that in the way we spend money are based on avoided flood damages or property value losses things that are going to be more money to hire property value households. And we are trying to work, FEMA has made a number of changes to some grant programs trying to get around this problem is increasingly recognized problem, but it is a problem. Beyond that, there are a lot of issues in grants with local cost share requirements so low income communities again FEMA is addressing some of this, but there are cost share requirements it's not just federal money you've got you got to pony up and put some skin in the game and that can be very difficult for under resource communities. And then lastly and this is another thing that's getting well recognized is that it is daunting to try to apply for money and get that money and get that help. It's daunting for individuals to apply for individual assistance or FEMA it's daunting for communities to apply for grants because of the paperwork requirements the technical requirements and all of those things. And again, agencies are working on this with a lot of develop technical assistance, but it's where have a long way to go. And that's in my box here problems are recognized changes are being made you all are probably familiar with the justice for the initiative, which says that 40% of the benefits of certain federal investments have to go to disadvantaged communities and that's, that's been a help, but these are challenging problems and will not be solved overnight. So that's it. Thank you very much. I'll just point you to some of the things I talked about are in some reports on our website and I would direct you to those so thanks a lot. Thank you very much. Maureen and Margaret so very inspiring and so very complete and thoughtful. So now I want to invite questions from the audience and please type them in Slido as I brought it to you before. You know before we start off I'll take the chair's prerogative. And I'm going to ask the first question. And the first question is what kind of and this is for both of you, you know, what kind of strategies have researchers used to incorporate community engaged scholarship without further marginalizing the perspectives and needs of communities. Hopefully prior than post disaster prevention is better than cure. Let me start and then Margaret probably will add. You cannot thank you so much for asking that very pointed question. You cannot, as we say in disaster management, particularly in disaster preparedness, you can exchange you know the old fashioned business cards in the middle of a disaster, which means that you have to be infested for decades in your community you have to be with you have to be from that community, you know, be in that community to be able to then partner and engaged, and that doesn't mean that absolutely is not asking for that support letter at the 11th hour before you submit your brand. It means that when nothing is happening when you invest in the community when you're part of the celebrations when you're part of addressing the concerns I could tell you that after, for example, particularly after the all spell we did three things one we went to the community and said, what's what's what's worrying you. And their worries were three four was the safe seafood was the fish safe to eat given what would happen. What will happen to the babies and the babies and moms of the babies were babies of the moms were pregnant. And it's the air shape to breathe we took those to create an entire consortium driven by community so it's that community and each scholarship. The other thing we did. And I'm very proud of that is that we integrated high school students within the School of Public Health to learn about environmental issues to learn about lots to learn about a pollution, and I'm better than I connected them with a faculty member. And that door open not only opportunities for college, but there are now physicians and engineers walking around because of those two months with us. And I'm doing the same program here in Pittsburgh and it's no different. And so engaging early engaging sustainably, even without funding and that's the key that's the key challenge right but that's the test. And investing in the community on the front line making sure that, for example, the Bachelor's of Science of Public Health students are required to do 120 hours of surface learning in frontline communities there where I was then in the Gulf, and here I am now in Pittsburgh. That's the difference you make in a sustainable way. Yeah, I agree with that. Yeah, yeah, I agree with what Maureen said I will say there are really challenge big challenges so I just want to. You know, and I'm not the best person probably nobody wants really the economists coming in and talking to them but I think there are challenges in sort of meeting and communicating around the difficult issues. So some of those that I mentioned are things like, you know, possible relocation everybody hates that term but, you know, thinking about where you're going to live what a thriving community looks like. I think it's really important to kind of have those discussions upfront at the beginning of projects I have a project right now we're trying to do that and not about relocation but I mean just about what you want your community to look like where are the problems in the community what are the potential solutions and talk to the solutions from the technical side, where you might have the flood modeler you might have the people who can kind of tell you, you know, the people to know about climate forecast and kind of convey that, but also get the on the ground because people know a lot about their communities they know where places flood you know there there's information to be gathered, and then in talking through solutions just to try to get that early on in the in the in the process as we mentioned to sort of get everybody working towards a goal that you can kind of bring both the technical, you know, and data and all those things that you can bring as researchers to the table in conjunction with the community. So, I want to say it's challenging early on is important and figuring out what you're both, what is the objective. But we've advanced so progress has been made since Katrina that's my kind of my mark there. We are now investing in part of preparedness we are now recognizing that recovery doesn't take a year it could take 10 years it could take 20 years and so investment in that phase is really critical. But communication is so key. And I'm hoping that we, we have a task as scientists to inform evidence based policy, so that FEMA policies can change and other supporting agencies policies can change to help communities when nothing is happening to prepare when something will be happening. I'll give you an example if you know when in the middle of hurricane Katrina there was a volunteer organization who sent tons of blankets to the community. It's August, it's 100 degrees in New Orleans, what we needed was safe water to drink. And so it's that communication and understanding what the needs are is what makes makes a difference. And again, one of the things which I take away because I lived through it, not in New Orleans, but you know in United States and as a faculty member in South Carolina, I think 20 years have passed since Rita Katrina. One of the things which has improved vastly and this is what I feel as an academic is that you know there is much greater communication you know I don't think that those days the Internet and Wi-Fi was all very, very, very in its infancy now, you know, messages and news and information flows through the speed of light and you know we don't have to worry about getting information almost everybody has a smart phone, you know 20 years ago, you had to get a boarding pass to board a plane and now nobody, nobody stops anywhere to go to that. So let me jump to the second question. This is all from Slido through your comments. I've heard from several municipal, local flooding managers and planners who are concerned of how outdated the FEMA flood plain maps are. How might national academies or the broader research community support in more frequent updating of these boundaries. What do you guys think and let's flip the order now Margaret you go first you know what do you think about this flood plain maps and what can we do I mean we are you know here to assist the communities. Well, FEMA is working on this and they're for their future flood risk data initiative, they're trying to get around this problem I mentioned with the hard boundary, suggesting an in out kind of thing, and creating more graduated flood risk information so property level information. This is also in their risk rating 2.0 which is their initiative to change the way you pay for your flood insurance. Not all of this is popular because some people's rates are going up, but there's a lot of work at FEMA on, you know, fixing the flood map problem. They've been working on this for a while, it's taking a while. Rescrating 2.0 is they're doing that now since 2021. But there's a good amount of work you know they're also private information now I'm sure people are familiar with flood factor which is, you know, the first street foundation of the independent organization has developed property level flood risk information and if they've partnered with redfinned and realtor.com so you can go right on there and input your address if you're looking to buy home and figure out what the flood risk is so things are starting to change and sort of conveying risks better, I would say. Let me add that this is a good example of science and evidence based policy, because one size does not fit all, although there could be general guidelines, it is so important to tailor the investments and the responses and the decisions based on the community's needs. What I'm telling you is what will make sure that the investment actually goes further. And so while it might look like initially a larger investment in some communities than others, that investment might go longer because imagine if there is a, well, we don't have to imagine there are more frequent and more severe hurricanes. If we think fast, early and sustainably will be better, we'll have a shorter time to recover physically, not necessarily from a human human health perspective, but if we focus if we tailor that precision environmental health to those communities that are most vulnerable that are in that as Michael said the repeated flooding area. How do we help? How do we tailor our policies to those who are most in need? How do we do that? And we do that by integrating the physical data with the human health data. That's what needs to happen more often. It's happening, but it needs to happen more often. Okay, so since I'm a civil engineer, I'll ask this question which appeared in Slido. If addressing flooding is controlled by public health, will there be a role for civil engineers, urban planning, landscape architecture, disciplines which have been working on both the physical and the social infrastructure, and how? Let's start with Maureen. You know, I'm so glad you brought it up because I'm married to an engineer and we have intense discussions at home where the medicine and public health are a science because engineering is a science and the rest is all art. Not so true, right? And so we, I live next to the school here, the School of Public Health is next to the School of Engineering and we invest together and I require that an engineer and a public health professional work together on an issue of environmental health and climate. And we've had fantastic seed programs that ultimately resulted in the fences that make sense. And so it's that transdisciplinary approach to environmental health that we're broadening, whether it's focused on flood or focused on climate that is required. It's not a luxury anymore for a public health professional or an engineer to work in isolation. Absolutely. We not only want to work together, we must, it is a requirement, it's a pretty requisite to be meaningful in terms of what it is we are doing in our communities. Margaret? I don't think we have to worry about engineers being shut out. I think they're going to play really important roles. I'll just leave it at that. I think I wasn't sure I quite understood the question. It sounded like the person was asking about environmental health and public health, playing a bigger role, what that meant for the engineers who played traditionally large roles in this area. And I think engineers are central. So we're going to see plenty of that. Yeah, so the next question is something which I'm engaged in right now. So as most of the people in the audience may know that is national science foundation funded sets of project called coastlines and people. And one of the things we do in that is surveys and working with the communities, not just research but social science based community outreach and engagement. So one of these questions actually hits at the heart of that. It says, how do we not burden overburden community residents by expecting them to show up for every community engaged effort initiative was studied because these people have their own lives they have their own professions. So let's start with Margaret first here. Well, how do we how do you manage that how do we manage our expectations, because you know we are scientists, we want everybody to show up for everything but that's not the real one. No, it's a really great question and I don't know the answer. You try lots of things and you're trying to not overburden the same people over and over, but I hear this a lot. It is a big issue. You know, I'll just tell one story which is I also host our podcast part time at RFF and I had the director of the Los Angeles County Parks department on and they've done some really interesting equity related investments in LA County around their park system which is huge. The Los Angeles County is the largest county in the US population wise, and she talked about the process for doing this and engaging communities and what they wanted to see. And it's really interesting you can read their reports on their website but she talked a lot about what they did you know they got they had meetings at the times that people could come working people. They provided food they provided childcare they provide you make it easy for people to do these things. And that's just the one, you know, we know this from others as well I just thought when she was on the podcast she really had it engaging an interesting way to talk about it and I think those are things that are important but it's an acknowledged hurdle. It's actually very simple. We, the community communities are leaders communities are scientists to we learn from them, rather than the opposite way. And so we also value them the same way we value other faculty and co-investigators so communities are community leaders are always part of anything that I do, and we value them not only by providing food we value them by paying them. We value because their time is equally often more important than what we bring. Also, there are several and I think the sponsors for this of this workshop of more and more whether it's NIH NSF or CDC are infesting in implementation science and implementation science requires that there is co creation co implementation and co benefits. And so without being able to show that you're not we are not going to get an implementation science and I'm so pleased that all of the major funders are now recognizing the importance of implementation science, but particularly the translation of science into what makes sense in the community scientists. In fact, one of the grants I actually had our community leaders develop a curriculum for faculty of how to do community engage science and that was fantastic. It was a was a true learning experience and so it's the reciprocal enrichment of both of this both species of knowledge and species of implementation that we not only have to respect with that we have to value in all ways, including failure their time. So the next question is, again, you know, given the vast experience between both of you. Do you have any examples of local areas local communities, which are doing a good job with zoning and land use local land use planning because, you know, in the end of the course, I always argue land use is probably the most important thing when it comes to flooding because being a civil engineer and knowing the meaning of the word infiltration land use becomes a big issue so more in starting with you. I mean, any good examples. I mean, we had that very question actually when we did the study on looking at we are how to what progress we've made with community resilience and yes, communities in California keep coming up, but there are communities also in the Midwest also in the Southeast there are everywhere there are communities who did a few things well. One, they invested in that social capital those domains that I talked about to they had leaders they had government and policymakers that were embedded and committed to making that decision. And three, they had community leaders they were not on the sidelines, but that we're in those communities and so there are whether it's the United Nations or other communities in the Midwest, our communities here in Pittsburgh, it is that investment in social capital those six domains that sets one community apart from each other or creates more resilient structures that are in place. We tell those stories we, we, we publicize those stories. And, you know, a while ago and some, there's some still that there are community resilience officers at the city level, and those people did a phenomenal job in integrating those disparate agencies that come together when a disaster happens, but integrating them in one place, we need to have more of those resilience officers. Well, this is a good question to just being a little more specific about the planning and zoning aspect of that question and are their communities I think they're asking that can be held up as exemplars, you know, and sort of doing some creative approaches to really manage their land uses. I don't know, there's everybody's doing something different, as Maureen said, I would point partly to Norfolk, Virginia Norfolk has one of the worst sea level rise problems on the East Coast Sarah face with a problem. There's there were I think one of the first to have a resilience overlay zone and what that does is creates an incentive for, you know, no, not relocating a certain areas and relocating in other areas that are for upland zones they call them I think, and they're trying to use that overlay zone and we have overlay zones are a common thing in planning and zoning, they're used for historical areas they're used for other things so we do these overlays of that by themselves they don't do a lot, but they don't do anything. And then if you marry them with some other kinds of incentive based options or, you know, carrots and sticks, you can make it work and in Norfolk they're trying to do this with like, trying to encourage the use of transfer of development rights programs and things like that that will allow some shifting around so I would point to Norfolk Boston has a relative a newer overlay resilience overlay zone that they're using I think time will tell whether these really do it make a change. But my two cents in that it isn't all about the planning part but it is also about the regulations and incentives. So plans are great, but they're just plans on paper and so we need sort of implementation of those plans. So actually you mentioned a word in there which leads to the next question, which you can be the first one to respond to Margaret. How can resilience hubs be used to support communities at risk of flooding, especially considering resilience hubs should be located in a floodplain. You know, you know when we look at the long history of human civilizations, all human civilization started on floodplains, but you know now we want to move a little bit away so so what's the role of this resilience hubs and how can they be optimized in that usage. Well, it's not something I'm a big expert on resilience hubs, I will say that, you know, they're, they're supposed to be supporting, you know, obviously, relatively safer areas for people to, you know, live, work and play and find a way to, you know, not be as at risk. It's not easy in all communities to find a place for that. So, you know, know a bit about the Kentucky floods and in Appalachia you have really serious issues trying to figure out where you're going to have resilient locations. So, you know, that's one thing I'll say is like it's a little bit of planning and thinking about these things is good but I'm not sure how on a long run day to day basis how you get them to the level at which they're going to accomplish what you think what you want them to accomplish maybe Maureen has knows more about them and can say more about the concepts. So, the, the concept of the resilience hub was in the past and often been seen very narrow in the physical resilience so make sure the base and the bridges and you know, but it is when you resilient has become more beneficial when they deliberately integrate the public into the human health piece and so you'd have the physical infrastructure please the built environment the sustainability. I wanted to mention that resilience hops now also expand into addressing sustainability, which is easier in a way to and it's easier to implement because you can measure it, you know, in my world what and all of our worlds and what get measures get done. And so, integrating the different pieces that comprise the resilience that or that are vulnerable. I think it's a better more integrated and systems approach. That's what often missing the silo approach is still it's the easier way to go because you don't have to work with each other and talk to each other and actually bring the resources together, but it's the systems approach that most sustainable. And so that's why the world of resilience hops are increasingly more connected to the sustainability efforts in a specific area. Okay, and the last question goes back to you Maureen, because you've been answering everything so well both of you. Can you expand on what you meant by community engaged scholarship. Thank you for asking that question. So, there is a old paradigm from it's called the International Association of Public Participation, and it goes from consultation to enforcement to collaboration to this to power. And when people say community, oh, I'm working with community X or community Y, all they mean is they'll show up and they'll listen and they'll leave and they could do whatever they want with that information. That's consultation or information dissemination. That's not working together. Now, when you get to collaboration, you actually commit that you'll make joint decision making. You get to all the way to empowering and people, a lot of people like to use the word and particularly, you know, in academia, well, I can power the community know you haven't because when you empower community you give away all the decisions and that's not the way we work together. It's getting to collaboration where you invest in a community really co create that research proposal. Co create the implementation roadmap. Share the dollar share the budget share the accountability to co create the evaluation that's particularly important because often we seen as promising a lot and doing very little that's useful. So it's that co creation and co manage co implementation co management and co evaluation that's at the core of implementation science. That's community engaged scholarship and nothing less. Thank you so much Maureen thank you so much Margaret I mean this has, you know, set us off on a great trajectory for the remainder of today and for Monday. So now we're going to transition to session numbers to, which is moderated by one of our wonderful planning committee members. Anilu and Joko, who is an associate professor in the Department of Public Health at Southern Connecticut State University and only the floor is yours. Thank you very much. So welcome to all we appreciate you taking your time today to join this workshop and hope you have found it so far to be insightful and informative. And so we're going to now transition to the next part of the workshop today. And so the goal of this session, which is shared stories on the ground lived experiences is to highlight shared experiences to a set of stories and different geographic locations where participants worked directly with affected populations, local communities, state governments, researchers, implementers, associations and others. So our four excellent storytellers will discuss their experience aligning communities needs while navigating external expectations policies limiting resources and tools with varying levels of proven efficacies. All storytellers bios can be found on our website. And I believe the link will be or should be in the chat. So today each speaker will have seven minutes maximum to tell their story with three minutes of burning questions, if any, which will allow for about 20 minutes of Q&A with audience and all storytellers at the end. And if the planning committee or other storytellers have burning questions, you will have the opportunity to pose it at the end of each presentation. So our first storyteller is Kemp Burdak, who is the Cape Fear River Keeper at Cape Fear River Watch. Kemp, if you can please turn on your camera and mute yourself and also share your screen. I would like to remind all that they have seven minutes at max for their presentations with three minutes of burning questions right after. So Kemp can take it away. Okay, thank you. We just make sure the, okay, does that look good to you all? Yes, I can see it. Okay. Great. So I live in southeastern North Carolina on the east coast right around where that red circle is. And I was born and raised in this area. So I've seen over the last 50 years or so firsthand the impacts of climate change. And one of the most impactful changes to the climate is the way climate change relates to hurricanes. And so, you know, in the Atlantic climate change is actually changing hurricanes. The storms are getting bigger and stronger. They are carrying more moisture and they're moving more slowly. And so as these storms make landfall and they move inland, communities experience extreme flooding events. And since 1996, the Cape Fear region and southeastern North Carolina has experienced a 500 year storm event to 1000 year storm events and too many 100 year storm events to list here. Which I think maybe speaks to some of the discussion we had in earlier presentations about the need to update how we evaluate floodplains. The six most destructive of these storms, five of which occurred in the last 40 years and two of which occurred in the last eight years, killed 137 people in North Carolina and caused close to $50 billion in damages in North Carolina alone in today's dollars. So storm surge and high winds get a lot of attention when hurricanes come but I'm going to focus more on inland impacts from hurricanes focusing on Hurricane Florence, which made landfall in September of 2018. Florence made landfall here near Cape Fear and move northwest kind of in this direction where the where the circle area is directly at the Cape Fear watershed and dropped as much as 36 inches of rain in some places. River flooding was extensive. And the relatively flat landscape here in North Carolina was completely covered in flood waters. So it's an illustration of that this is a bridge in Fayetteville, North Carolina during normal conditions. You can see the boats down here. This is that bridge during flooding from Hurricane Florence. Entire communities in Eastern North Carolina were isolated by flooded roadways and washed out ridges. So people couldn't leave their communities and assistance couldn't get to those communities. So the Cape Fear basin that I showed you an earlier map is North Carolina's largest watershed is larger than the state of New Jersey. And it's also the state's most industrialized watershed and so virtually every industry in the basin experienced significant negative storm impacts. The leading industry in the Cape Fear basin is agriculture specifically animal factory farms where hogs and chickens are housed indoors for the entirety of their lives and tightly packed buildings, which of course concentrates the waste from those thousands hundreds of thousands even millions of animals. North Carolina is the nation's leading producer of poultry and the nation's second leading producer of hogs. Hog waste is collected in these giant open cesspools like you see in this image here. Chicken waste is collected in giant piles which are frequently left out on fields. Other industrial sites impacted by Hurricane Florence and the Cape Fear basin include two separate coal ash storage areas, one near the top of the basin and one near the bottom. Wastewater treatment plants, chemical manufacturing plants, slaughterhouses, paper mills, junkyards and landfills. So flood water inundated, hog waste cesspools overwashed these giant piles of poultry waste, it overwhelmed municipal wastewater treatment infrastructure, it ruptured coal ash ponds and washed that coal ash into waterways. It washed through junkyards and landfills, it covered wastewater settling ponds and it covered remediation sites at industry. And all of that waste flooded through communities, it flooded through homes and schools, through churches, daycare centers, nursing homes. You can see here an image of a poultry facility with the water flowing out down through this community. That flood water carried pathogens from untreated human waste and animal waste, heavy metals from coal ash, PFAS chemicals from chemical manufacturing plants, petroleum and other chemicals from junkyards and landfills. And that animal waste combined with human waste and natural sources of organic materials and quickly decomposed and that process reduced dissolved oxygen in the Cape Fear River to zero, resulting in enormous fish kills. And the stench in these communities from this combination of pollution was unbearable, I can tell you from personal experience. When flood waters began to recede, you know, you had soggy homes and schools and buildings with no power. In September, it's hot here in September and those structures cooked in the September heat and black mold started to set in. People who returned to their property faced a myriad of health concerns, bacteria and other pathogens from millions of drowned livestock and their waste combined with human waste, respiratory impacts and high levels of toxic pollutants. Attempts to access and remediate damaged property led to cuts and scrapes with high risk of infection and of course the mental health challenges of dealing with a disaster of this scale. Private wells were covered with polluted floodwaters for days or weeks leading to contaminated water supplies, entire neighborhoods, mucked out homes and these enormous piles of garbage grew on roadside and stayed in place for months. Many families lost everything, flooding from Florence, covered homes that had never been flooded before and many of those folks didn't have flood insurance. And in my area, there are still hundreds of properties that sit deserted and rotting and rebuilding efforts in North Carolina have been largely criticized as failures. And of course, tragically, the people who had suffered the most in Florence were the people who were least able to bounce back from the disasters. So last slide the lessons learned, I say maybe because we seem to have a very short memory around, around flooding events there's there's frequently a lot of energy here after a big flood to do what needs to be done to make our community more resilient and to prevent these disasters from happening again. And that energy seems to fade fairly quickly. I hope that we learn that climate change is is making hurricane impacts worse and that we need to plan now before the next storm. I hope that we have learned that floodplain assessment in North Carolina is inaccurate and needs to be updated. And that a lot of that inaccuracy, I will just say is intentional in North Carolina and is driven by interest that that want to develop in floodplains and push back very hard against changing the way we evaluate the risk in those floodplains. I hope that we learn that building or keeping or rebuilding hazardous industry and floodplains threatens public health. I hope we learn that allowing or encouraging residential development, new residential development. In floodplains floodplains that are designated accurately only sets people up for eventual disaster it's not a it's not an if situation it's a wind situation here. Impacts are flooding or felt long after water receipts so health impacts are felt long, you know months and even years after the storms have passed. Impacts from large floods should be looked at cumulatively and not separately. So it's a combination of, of, you know, the loss of housing and the in the contamination of water and the mental health challenges. And then finally our response to disasters so far in North Carolina has been inadequate and people suffered needlessly because of that. And that's especially true in communities, low wealth communities and communities of color. Thank you. Thank you camp for sharing your story a very compelling story. Are there any burning questions from the committee members or other storytellers? If not, I can pose a question. In the interest of time, so I will just kind of pose a question to you on camp. So, like I mentioned, very compelling so many things. Kind of, I was thinking about as you were presenting just even the terms 1000 year storm event or 100 year storm event, which shows how you know, pressing the issue is the other thing I thought about that could probably relate to the previous speakers in this workshop was you mentioned that North Carolina being the leading producer of poultry and also second leading producer of hogs and I thought about possible food insecurity issues as a result. I was wondering if you want to comment on any of those effects as it related to these events. Yeah, you know, I think the concern is is less with these large industrial size farms, you know, which which export a lot of what they produce I think the concern is less about food insecurity because of flooded farms although, you know, tens of thousands hundreds of thousands of animals died and the flood inside those barns, but it's more about the impacts of that kind of activity in the floodplain on people downstream that really is concerning less about the food insecurity there in my opinion anyway. I see just after that the environmental justice issue you mentioned the community surrounding were least likely to bounce back. And, you know, they were probably also more likely to be more adversely affected by these. So, you know, in terms of maybe their food supply and things of that nature. And, you know, you mentioned things such as the, the black mold you mentioned. I think that the types of toxins that were spilling into the communities were pretty striking. So things like path pathogens. You mentioned PFAS. You mentioned petroleum from landfills and animal waste. So I think that's also something that's very telling that the fact that the area, the communities that are at least likely to be able to respond. We're also inequitably exposed to these toxins that were spilling from the events. Exactly. Yeah, I mean, you know, North Carolina has Eastern North Carolina is is covered by wide floodplains and these large rivers that train East towards the Atlantic. And, you know, that's where the worst damage happens. And that also happens to be where a lot of environmental justice communities are located. And so, you know, they deal with these things on a daily basis. Those effects are, you know, multiplied exponentially. So exposure to the, to the pollution from industrial facilities in the floodplain is, is expanded. I mean, to the point where that pollution washes through your home and soaks into, you know, your, your carpet. And, you know, it, it's a, it is always a tough situation for environmental justice communities in North Carolina and hurricanes make it, you know, impossible. Indeed. Thank you very much for your insightful presentation. We're going to go now to the second storyteller. And the second storyteller is Ramona Taylor Williams, who is the executive director of the Mississippi communities United for prosperity. Ramona, please turn on your camera and mute yourself and share your screen. Good morning. Good morning everyone. Thank you so much for having us here to tell our story. About MCAP, Mississippi communities united for prosperity, and the work that we have done in a small community in Mississippi, in Central Mississippi, Duck Hill, Mississippi that is sits 100 miles north of Jackson and 100 miles south of Memphis. And the Duck Hill community had been flooding for more for, for decades. And we were fortunate to receive $300,000 in funding from the southeastern sustainability directors network to develop an initiative that we coined achieving sustainability through education and economic solutions to seeds. And we developed a water diversion system to help to mitigate the flooding, using both green and gray infrastructure technology. We also work closely with the communities to look at their communities from through the lands of community and economic development. However, before we could move into the economic development community and economic development basis, we had to address the issue of flooding. And we were very successful, the town of Duck Hill no longer floods, and the model seeds model gain national attention from the EP from the Environmental Protection Agency, EPA. So that's what we're featuring here on this particular slide. That was in 2018. We started the work in 2018 and that went through 2020 just before COVID hit. But I want to talk a little bit about where our current work is because we centered our work in the rural areas. Not thinking that we were going to look at the urban, the urban centers, I live in the city of Jackson. And however, when we ran into the water crisis back in 2022, I had to take a different approach towards our work. And we looked at the city of Jackson once we learned that what actually caused the system, the water treatment system to collapse was flooding. We knew that we would not be able to have the impact or the resources to look at the city as a whole. So what we did was we selected three communities that we would focus on using the seeds model from Duck Hill, using that model to look at how we would be able to create a sustainability plan. I'd like to talk a little bit, Charles, if you could put up our next slides. I want to talk a little bit about how our work as frontline community organizations, we realized our limited capacity to address major issues such as flooding. And so we rely very heavily on developing strategic partnerships where we will be able to do as the previous speaker said in the last session, Marine, how we will be able to tackle major issues such as flooding in particular in the city of Jackson. So anchor institutions like universities play a significant role in helping us to build our capacity to challenge these kinds of issues. So we were fortunate to partner with Columbia University, the school of sustain climate and sustainability. And one of the things that we looked at was these three communities, there were three different communities that had three different neighborhood associations and those neighborhood associations were not talking to one another. So the first thing that we wanted to do was bring the communities together, so that they would begin to talk about a common issue, develop a common agenda. Of course, the common agenda was flooding because these three communities significantly flood when the Pearl River spills over into the Ross Barnett reservoir. When the reservoir reaches its capacity, they open the floodgates, and then those they discharge those waters downstream, and it floods out these three communities. One of the things that I kind of see this as being is that they create many Katrina's and to save the homes along the reservoir. So we looked at a sustainability plan initially, but we realized that the communities weren't quite ready for the sustainability plan because we needed to bring them together. So we work with the students at Columbia, sustain a fourth year sustainability students and we develop the comprehensive community communications plan. So we are in our fourth cohort of students. So we've gone through many reiterations or community organizing engaging community. We formed a community advisory board, and that community advisory board is focusing on the Army Corps of Engine engineers, what's called labeled as the one lake plan. And so communities have been excluded. These are communities of color and they have been excluded during a 15 year planning process around this whole one lake plan. So we said, well, okay, community needs to have a plan of its own. So we work with the students this semester, and we have developed a sustainability plan what you see on the right was a product that was developed by last semester students, and they developed a problem tree and this is the problem tree. And that work from the other three cohorts has influenced our ultimate sustainability plan that we are working on now. Why is sustainability plan, it reduces flood, the flood reduction plan, which we all know that it is not enough plan management governance as a systemic issues with multiple competing glows and no clear definition of what success looks like. We want things, we want success out of this. So if you could go to the next slide please. We want to think and rethink how planning for sustainability, how it works. The old way was that, you know, you've got the city planning department and all of the players to the exclusion of our communities. So we want to change that trajectory and make it more community centered and more community driven. The next slide please Charles. Now we're in the process of moving towards developing our sustainability plan, the other cohorts of students, we developed a comprehensive communications plan survey because we wanted to get a better understanding of what residents were facing and also from a public health perspective, and we also did the problem mapping. What we are doing now is reviewing the literature around nature based solutions for planning and developing a work plan. And these are the different phases. Our next step is now we are focusing on formulating the sustainability plan, implementing the survey that has been developed identifying funding resources. And also those strategic partnerships and then just keep continuing to address the main issues that have come out of the many community engagement and forms that we have held. Next slide please. We looked at what kind of tools do community need in order to develop a nature based sustainability plan and we looked at various nature based solutions leveraging the natural environment, such as the wetlands and native vegetation to manage flooding and enhance resiliency against extreme weather events. We also wanted to address the economic interventions. And so, and we wanted to look at, we really wanted this model to be not only centered on the heavy flood mitigation part that also okay we're past our time. But the main thing that we want to highlight here is the importance of having strategic partners and our number one partners being the universities and the anchor institutions because they bring so much resources. Intelligence to the work that we are doing in order to make our community safer, healthier and more sustainable. Thank you. Thank you Ramona for that very insightful presentation. And so our mind viewers, we will be collecting questions for Q and A after in the slide. Oh, so please add your questions there. So, thank you again Ramona. I think a salient part of your presentation was when you mentioned rethinking the plan for sustainability and the fact that there is that resident academic and government partnerships. So, we appreciate that. And so we're going to go on to the next storyteller. And so our next storyteller is Abigail Matoz Pagan, who is a disaster nurse at the University of Puerto Rico, my ideas. Abigail, if you can please turn on your camera and mute yourself and share your screen. And so the floor is yours. Thank you. Thank you to all. It took me out. It took me out of the room. We can see your presentation and hear you. Okay, your, your volume's a little low. Can you see the presentation? Yes, we can see it. You can just put it in presentation mode and you'll be good to go. Okay, great. Thank you. And you will want to swap the display settings to swap. Perfect. Thank you. All right. Thank you. Thank you so much. Well, happy to be here with you all great presentations. I was relating to everything that you said and camp I just wanted to let you know that I was in Florence, responding to to. I was in North Carolina, responding to Florence when, when it happened. And one of the things that I, that I saw that was very, very similar to what I'm going to share with you today is the elderly population that we saw there was increasingly high and almost the same thing that we saw here. I would like to present to you what, what is our experience and how we did it and and what we did our interventions, the outcomes and the conclusions and what do we learned about all of this. And one of you said, I am in Puerto Rico, Puerto Rico is a very small island here in the Caribbean, and we are at risk of hurricanes and storms and flooding. All year rounds basically, but we've had five, in fact, by the last five years we've had five storms and hurricanes that that really took a lot of us. Everybody knows about Hurricane Maria in 2017, which caused catastrophic flooding across the whole island. And it caused extensive damage to the infrastructure to homes to businesses. We saw it in a lot of loss of life and long term power outages that lasted six and six months and one year. And we still are suffering from that power outage. The floods of 2019, which was a very heavy rainfall causing a lot of flooding also in some parts of the island. It caused a lot of evacuations and road closures and damage also to the infrastructure. The tropical storm in 2020 also caused significant flooding and a lot of floods slides in the mountains. And it resulted in a lot of damage to all the roads and bridges. Many of the communities were uncommunicated. And it was hard to get to them and to assist them. In September 2022, just five years after Hurricane Maria, it all happened again with 30 inches of rain, heavy rainfall in the southern and central region of Puerto Rico, causing a significant flooding that caused a lot of damage to our class of roads and bridges and homes. And again, problems with the power grid. That is something that we here in Puerto Rico are very, very, with the trauma to lose our power. So that this is the island of Puerto Rico and all the coastal areas that you see here in blue are the main risk of flooding because in the center of the island, there's a big range of mountains that the rivers all drain to that to that area. Unfortunately, those are the areas that are most populated. So they receive a lot of those waters and rivers flooding their homes and their communities. So those consequences that we see in the coastal areas are infrastructure damage and property destruction and a lot of financial losses with a lot of health risks. Health risks that are acute problems and that are chronic problems and long term problems, increasing morbidity and mortality. And, and we saw that in, in, in Maria. A lot of this place, this placement of people, but the only problem that we have at maybe maybe different than the, that's that the United States is that we don't have anywhere to go. We were just a little island. So we can just move to another state. I mean, we, we can, but we can't, we can't move it immediately. Right. So the displacement, those two shelters or two family home or to another community, but basically everything is flooded. So it is, it is very difficult. And there's a lot of disruption of essential services. Services that are so important to the community services like hospital in Maria. We did not have for, for maybe two weeks. We didn't have, we didn't have hospitals available for. So, when we look at the hurricanes and the promise that they bring with, with flooding. We see that there's also problems with storm surge and tidal waves that also flood all the coastal areas with six to nine feet above ground level. Also the rainfall and the flooding that we get or we got in those two storms were more than 25 to 30 inches of rain. Those caused a lot of flooding and mudslides and those were basically the most problems to our people and to get to where they had to go. They could not get out of their homes and they could not get any assistance either. We have a problem. It's a cultural problem. People don't want to leave their homes. People want to stay. So, how do you, how do you convince them when they're when they're living in a flooded area? They know it. And they've had flooding before the year before the year before, but they don't want to move because that's the only thing they have or because that's a sentimental value for them. So, in, in health care, we had a lot of infrastructure problems. Almost all hospitals in Maria were damaged by by the hurricane itself and then by the outage of the college grid. Then we could not find diesel for all those 79 hospitals that were out. And a lot of competition for that diesel companies and organizations that needed that too. So, the hospitals were closed and shut down because of the shortage of diesel. As a consequence also, we have some pharmaceutical companies that do IV fluids. And there was a really shortage of IV fluids in the states also in the nation because the company had a lot of damage. So we could not find IV fluids for, for, for some time. And of course, the worst probably it was a communication system that failed. We did not have communication at all. And, and, and it was like maybe five or six days before we could get any communication with someone out of the island. But inside the island, not even the satellites worked. I was working with the national disaster medical system. I, and I stayed here for the week. And we could not communicate with the satellite. It was very difficult. I mean, it had a lot of inconveniences. We had that tall that that were very high and very different with everybody that made the the analysis, but we had drownings and injuries and medical emergency that could not be attended. And of course, the indirect causes of death, lack of prescription medicine, all the pharmacies were closed. We cannot find any pharmacy open. And when they open, they could not read, we repack their, their, their medication or their prescriptions for the public. Insulin was a problem. We cannot find insulin. And there was a lot of cardiovascular events where people died of my partner in part at their home. And the ambulance could not get there. And of course, the hospital generator, like I said, finger was, was a big, big problem right here on the bottom. You can see the death toll. And Harvard University made a study and they, they decided that it was 4,000 people who died. And then George Washington said, probably 3,000, but I would go more with Harvard University because I saw a lot of death, direct death and indirect death. We have, we have, and we still have a lot of vulnerable population. Our elderly population in Puerto Rico is growing and it's right now, approximately 20, 24% of the population and the younger people are moving out. So there's, there's a lot of problems with our elderly who takes care of them. And they are at home by themselves alone. So when things happen, they are right there, they don't have anybody to help sometimes. So, and they die and they died by themselves. The children, when, when I was deployed to, to help out in the, in the mountains, and in the countryside. They were, they appeared to be unbothered. They, they, they looked like they were happy. Of course, we had a lot of them of health and assistance and resources from from the United States government. So they were amazed of all the helicopters and all the soldiers and all the people that we're trying to help. But many of our elderlies in those areas were, were unable to approve for food for water for medication. And like they said, they were there unattended and, and it was hard for them. The renal patients that we have, we have a lot of renal patients that get hemodialysis and they were unable to get the treatment. And, and they were, it was very scarce for them to go and have an hour or two hours of hemodialysis. And also because they could not get to the center. So diabetes hypertension, heart failure. They did not have their medication and they could not get their regular diet low sodium. What they were getting was the MREs. Those are military foods that are specially packed in a little pouch with a lot of preservatives and sodium and a lot of calories. Sometimes one of those little pouches can have 3000 calories and that's what they were eating. And of course it was, it was new to a lot of the population and they were like eating that maybe three times a day. So we had a lot of problems with hypertension and heart failure patients. The people that would bed that was bedridden and suffered from extreme heat, because we did not have no fans, no air conditioning, no power. So they were in a lot of heat and there was no clean water. And they couldn't get any electrical support for oxygen or, or maybe, and maybe it sounds a little exaggerated, but it was, it was very, very hard for, for these patients to get the equipment that they needed maybe two, three, four, five, six days. It's eternity for them. So this picture I took, I took myself. And it's very interesting that you can see those two persons there. Hugging in and we saw a lot of despair and distress, a lot of isolation, a lot of anxiety. But at the same time, we could see a lot of signs of resiliency of neighbors helping each other of phone and food sharing. Abigail, sorry to interrupt. We are over time. But so more speaker bits. So if you can just try to just maybe wrap up in 60 seconds and then we'll jump on. Okay. The people's experience. As you can see by the pictures, they were suffering and they had a lot to do with, with what they, with the response and what we did. There was a lot of local help, community leaders that helped with with the response municipal and federal, the federal government sent a lot of 10,000 federal workers came to the island to work and the defense brought 9,000 military personnel. And there was a coalition of health care professionals that provided at home services to all those people that could not come. We have, we had a lot of health impact. We still have them. And every time there is a storm and a flood. We see those health and contamination of water sewage chemical and other pollutants outbreak of hepatitis a increase of leptospirosis mosquitoes and other vectors then get specially the mold that you all mentioned also. That that mold that brings a lot of respiratory problems allergy than asthma. We see physical injuries like cuts and bruises and fractures and drowning and indirect death. We also see mental health effects, like anxiety stress depression and post-traumatic stress disorder. And of course, the increase of morbidity and mortality from those chronic diseases. So, what do we take away from this and from these experiences? Flooding flooding events in Puerto Rico. There's every day we have to look at them as something that we live and that we should learn from each experience. We need to improve in our infrastructure, our communication system and power grid and of course the response teams. People resources, right? Education in the sessions, probably from elementary to high higher education. I think we should include that topic in every school because that's important. The more you learn from it every single day, that's that's a habit and you learn how to how to do things that are different. So, also communication, which is crucial. We didn't have that system. Now we do and we're getting better at that. And also prepare for the worst for water supply, food medication. And have a registry of those people that I've been written and disabled so that we can at least help them and get to get out and prepare for the extended periods of power outage. You have to consider also the burnout factor and be attentive to the signs and symptoms of heat, fatigue and anxiety, depression or worsen in mental status. That's it. Thank you so much. And I'll take the questions maybe later. Yes, I think we'll hold that to the end. So thank you Abigail for your poignant conversation. I believe we are going to possibly about 215. So we'll have 1 more speaker and then hopefully we'll have a few minutes after for Q and a. So I'd like to introduce our next storyteller. And that is me with Appalachian Media Institute project and she's a project director at Apple shop. So maybe I see you on camera. So the floor is yours. Okay, great. Yes, I'm with Apple shop. We are a 50 year old media arts and education center located in the East Kentucky cold fields and Central Appalachia. And as a film I'm a filmmaker and I have done documentaries about the Buffalo Creek disaster in 1972, in which 125 people were killed. We've worked on documentaries in rural Louisiana and Mississippi after Katrina and Rita. And then of course, most recently, we had this horrendous flood in my hometown of whites. Well, not just Whitesburg Eastern Kentucky and this behind me is downtown Whitesburg. And I wanted to show some clips from a film that I worked on with the Center for rural strategies trying to kind of immediately after the flood share stories of what people had gone through. So here are some some of the stories from some of the volunteers and survivors of the flood. We're just going to show a short clip. So go for it. Hopefully it'll work. The water in here came all the way up to this. So this whole house was basically filled with water. There's a woman that lived here. She needs a walker to get around. And she held on to the top of her porch floating in the water for five hours until someone was able to come and rescue her. And she's all she's in her late 70s. I thought that after a flood like this that there would be like boots on the ground and the government comes and I'm from the government. I'm here to help you or whatever. But it was a learning process where eventually it said in that that that there was really no help coming, at least not in that form. People coming and doing this business of mucking houses out and getting all of the things out and then gutting the walls and then applying, you know, mold killer. That was just us learning and watching YouTube videos on how to do it. And that is kind of a shocking thing to realize that it's a sort of ragtag group of volunteers doing it. Just seeing the need, the need was just so grand and still is. It's just overwhelming and you know, it's just hard to could be hard to make decisions like, OK, which house do we go to? One of the things people say is how they're just so grateful and thankful that they didn't lose their life or lose a loved one. Most of us agree that human lives are more important than tangible objects. I think it should still be reminded that tangible objects do connect us to people and memories. While we were doing the cleanup crews, folks were also still coming into our mutual aid headquarters to get different supplies that we had on hand. And we were also giving cash out the door to folks who needed it. It was really obvious a lot of people had difficulty in asking for that help and receiving that help. You know, one thing that I learned real quick was to make it very clear that it was not my money that I was giving to people. You know, I think that made people more willing to accept the cash. You know, one thing that was really difficult was just people saying how ashamed they were. And that was really hard because it's like it's not their fault. There's nothing about this that's their fault. That was really hard and trying to just try and alleviate that feeling of shame that people felt. I guess you could say that there is a part of that that is good in the sense that, you know, it's neighbors helping neighbors in a community helping out. But at the same time, like we only have so many resources and volunteers. And we eventually hit a point where we were very exhausted and we ran out of volunteers. And it just speaks to the need of, you know, institutions with greater resources and money and manpower to be available to help during times like this. It makes you sad. I mean, you know, I'm going to go back there and I'm going to get up every morning and look out the door. And you will see family that's gone, friends that, you know, the house is level. It kind of reminds you of a ghost town. But you know, you got to do what you got to do. And whether people move stuff back, a lot of them says they may, a lot of them says they may not. So it's just one of them things that you have to wait and see what you're going to do. I just don't want people to move away. The people who stayed have been so brave to try and stay, you know, and to find and we can do a lot with a little here. We always have been able to. And for those who are moving away, I get it, you know, I understand. But I just hope that we can find a way to build housing up off of the creeks, flood proof our bridges and use this disaster as instead of the end of us as a catalyst for a new beginning to look at everything that makes it hard to live in eastern Kentucky. And I think you're muted. Yeah, I just, I had a few points. And of course, they are very basic and generalized. And, you know, I just want to echo and reinforce what both Maureen and Margaret said, I think what they talked about in their experiences are ones that I as just a not an expert but have experienced. And I think, you know, we, we, we do well to listen to them and take their advice. And so we're still very much trying to recover here in eastern Kentucky and it's going to be a long haul but appreciate it. And I put in the chat, the link to the full 30 minute East Kentucky flood and some other videos about that and and the Buffalo Creek disaster, which was where the whole notion of PTSD really moved into the medical diagnosis because of what happened there later. Okay, thank you so much. Thank you very much for your presentation. Thanks again, very insightful. So we have about, I would say 2 or 3 minutes. So what I thought I do, there's some great questions in the chat. I'm just going to maybe just try to combine it into 1 question. That if each of the speakers can take about maybe a minute or so to just respond to, I will start with Mimi since you just finished your presentation. And I was wondering if you can comment on whether or not any of the health effects of these communities are being tracked. If there's any liability for commercial businesses and also maybe what you might think are some best practices. So kind of a three part question, maybe a 60 sec second response. I'm not sure if things are being tracked, but I would guess that, you know, the University of Kentucky has done a lot of research projects in our area, as have other schools and I would have, I would imagine that they are of course, you know, mental health services in our area are pretty limited and low resource. So, you know, that's, it's, and people don't tend to use them as much as they should. So there may be some real gaps. And as I said, I think a lot of these, you know, the trauma, the PTSD kind of surfaces later, not immediately. So it will be really good to track. In terms of liability for the flood, there definitely some citizens and some lawyers who think that the massive amounts of strip mining, mountaintop removal mining had a big impact on hillsides that couldn't hold the, this, you know, tons of rainwater and and led to part of the flooding and so there may be some lawsuits around that. And I can't remember the third question. I'll just let you move it on to the next person. What would you say are best practices for decision makers? Like if you had to suggest what would be a best practice on to address this issue? Yeah, I think that that as, you know, I think Maureen and Margaret both said it's really involving people involving, you know, people on the grassroots level who are most directly impacted by these events and also can really articulate, you know, what, what the issues are like, you know, these are folks in Eastern Kentucky, some of them who've been on their families have been on that land for seven generations. And it's going to be very difficult for them to, you know, to move to a higher ground community. And, you know, that needs to be understood and you understand that by, by being with people and talking to them and really exploring what, you know, what their issues are. And we, you know, thank you. Some of that is happening and we've, you know, our governor has really been great in responding and doing everything he can. Our legislature, not so much, but, you know, we have had some resources that are helping for sure. Great. That was really insightful. And so I'm going to turn that question next to our other speakers who as well. I'm camp if you can possibly have a 60, 60 second response to the same question. So if any of the health effects of this issue are being tracked. If there's any liability for commercial businesses and also what you might see are best practices for lawmakers and decision makers. Okay, so my house was flooded badly. I lived in a particularly bad area. I had to muck out my house. My house had to be raised. So I did all that. I've never once been contacted by anyone to inquire about health impacts, mental health impacts, anything like that. So I would have to say that from my experience and what I know about my community that there's been absolutely no effort to track. The health effects associated with hurricanes, except for possibly like an academic, you know, effort to do this on a very academic scale. But as far as actually helping people and changing policy, my experience is no. Same same answer for our, our industries whose pollution leaves their site during these floods and impacts communities downstream or they held accountable. I know they are not. And, and we are continuing to build those same industries today in floodplains. And so we haven't learned our lesson there either. And I also don't remember the last part of the question. Best practices. Best practices. Yeah, I mean, I think we need to recognize the scope of of of impacts from climate change and climate change driven flooding on communities and respond accordingly, which is going to be, which is going to require huge federal funding mechanisms to, to, you know, buy out risky properties in floodplains to help people relocate to, to, you know, help people do what they can to floodproof property that they can't leave. So I think it's going to take a huge federal response before we see significant change because I think often states are unwilling or unable to do it. Thanks. Thank you. And then if Abigail is available, 60 second response to the same question. So any health effects that are trapped. Any liability for any area businesses. I think you're on mute seconds are gone. Especially the mental health area. It's being tracked by mental health program that different universities here in Puerto Rico, and also by the government and the organization mental health because that's one of the areas that most most was impacted. I remember the last question collaboration. Best practice. We are getting a lot of collaboration between different organizations and professionals with the intentions to improve the response to improve preparedness. So hopefully, we'll improve in, in, in, in all that the mitigation and all that, but it's like they said, it's, we need, we need more help. We need more funds. We need, but yes, we're doing that. Thank you very much. And thank you to all of our speakers for just very informative presentations. I think the takeaway is that the effects are far reaching. So not just the health effects. I heard cycle social impacts. I heard. And the factors are also behavioral, their social, their cultural. And so, and also thank you for the suggestions that you have provided as well. And so, once again, I think we are at time, but I'll wait to get a cue from Audrey. Can you tell us how we're doing on time? Okay. While we wait for Audrey Ramona, I was going to ask if you had a 60 second response as well while we wait for Audrey, just in terms of same questions on any health effects that are being attract. And also any best practices that you can think of. We are looking at the health impact of flooding on lead on children from a public health perspective as the waters come in and brings in the heavy metals. And we have an initiative called Mississippi zero lead and healthy housing initiative. As far as best practices, of course, I'm going to to our own, our horn, our own horn for the seeds model that is being now looked at as a national model for a sign of sustainability for for frontline communities. The impacts on businesses when the flood waters come in, and they shut down our water system. It has a significant economic impact on our local businesses, and just our communities as a whole so absolutely. There is a significant economic burden on our on our on our businesses. Understandably. Hello. And newly, we are going to delay the the break five minutes so you can proceed for another two minutes and then we will then return for the five minute break at 225 p.m. Okay, that's great. I'm glad that we have more time so that we can I mean these have been very compelling stories. So the fact that we get a few more minutes is great. Is there any questions from the storytellers that would like to ask a fellow storyteller I think I'll start there to see if there's any burning questions you have for anyone on the panel. If not, there was a question I actually had for Abigail I thought it was really moving that you said people are still suffering when you mentioned hurricane Katrina happening in 2017. And so I thought that's, you know, seven years ago so the fact you mentioned the word. There's a lot of people without without power, without electrical power. And we have a lot of alternative electricity methods but there are still a lot of people they can't afford those. Yes. Thank you. And I have a follow up question. You're welcome I have a follow up question for you Abigail which others can chime in if they'd like. I also thought it was pretty salient that you talked about people don't want to leave their homes. So I wondered what kind of if there are any cultural factors that you want to speak on and then after I'd like to ask anyone else on the panel if they would like to also respond to that so those people don't want to leave their homes. Yeah, that's right people that live there all their lives they they don't want to leave what they what they work for and made many of those of them are owners of the of that land and they don't want to leave they think that that's the only thing they have. And I would add you know, yeah that you know as I said people in the Appalachians sometimes their families go back generations and generations and generations and you know the land is so important to them. And so it's, you know, amazing amazing value in that sense and very hard to leave and they're, you know, there might be a family cemetery just a little bit up the hill. Just so many connections and then there's just, you know, also, where are you going to go, where are you going to get the resources to rebuild, you know, even if FEMA does a buyout. Will that be enough, you know enough money to start all over again they're just there's so many issues involved. We are we're facing, like in Letcher County, we've got for maybe 200. They're estimating 200 FEMA buyouts. So, you know, it's it's going to have a pretty big impact. That's also one of the issues that we are toiling with now in our three C one C eight communities and the Army Corps of Engineers flood management slash one lake plan. These communities were developed and they should never have been developed. So the only option may be a buyout and but how do you how do you relocate an entire culture. So someone had talked about the culture dislocation. So that's one of the things that our Community Advisory Board is taking under consideration now and having those conversations in the event the buyout is of course it's going to be the last solution that some of the properties in the home so just so at risk for flooding, it may be the only option in the best solution. It's hard. It just reminds me of urban renewal when I was a child, you know, and our communities were totally wiped out from urban renewal and the psychological impact that had on me but also my mother never recovered from losing her home. You know, so it's it's just horrible. It's saddening. It's just very saddening. We had about 75,000 structures flooded in North Carolina and an infinitesimally small, you know, percentage of those have been bought out right FEMA buyouts are extremely rare in North Carolina for these structures and so, you know, especially a family, a homeowner, you know, who is low wealth but still owns land and a home that is, you know, by far their biggest asset and so asking that person to to leave is just an impossible. There's no there's no way to buy new land in a new home. And there's, you know, just a complete loss of any generational wealth that that was developed, you know, by owning that land by passing that land down to to your children. I mean, it's just it's just an impossible ass. Nobody can do it. Nobody can leave in a really poor area and go someplace else because every place else is more expensive, especially now that your property has been devalued by the fact that it flooded. So it's not like you can just trade out. These were great comments. So we are going to go ahead and wrap it up here. So once again, thank you for the comprehensive conversation and presentations from our storytellers. I'm at this point, we are actually going to take a break and I believe we convene at 230. So once again, thank you all for your time and sharing your, your stories with us today. Thank you. Okay, thank you very much for the session one and two and now we're going to kick off the third session with Laura Laura you able to yeah I can see your camera you can unmute yourself and please take it away. Great. Thank you. And good afternoon everyone. Welcome to session three. Our focus in session three is to identify the barriers to implementation, knowledge gaps or lapses of communication and effectively addressing flooding challenges. We just heard incredibly powerful stories from across the country and thank you again to our storytellers I think that sets us up with a number of challenges. And, you know, our, our goal here is to recognize that there aren't singular solutions particularly across scales or geographies. And so in our breakout rooms will acknowledge that space between the barriers and gaps that have been identified and potential integrated solutions. And we want to in this session not only outline issues and but also look forward toward creating a vision for what will work best in the future. Some logistics, all attendees will be assigned to breakout rooms. We're using a world cafe format. So diverse perspectives are considered in each of these pre selected themes. This means that you'll have the opportunity to visit three different rooms and provide your input on different themes during the activity. You'll spend 25 minutes in the first room and then 20 minutes in the subsequent two rooms. When you enter the room. If you find they've been assigned to the same room twice then exit out leave to leave the breakout room and you'll be reassigned to a different room. And some of you have already been notified and selected as active participants in the breakout rooms in the first round. But we invite everyone to participate in the breakout room discussions, whether that's by speaking, writing them in the chat or writing your ideas on the Jamboard. All participants will be unable to use their mic and video if they choose. And the room themes will be posted in the chat and are as follows. Green, blue and gray infrastructure is group one. This could include stormwater infrastructure remote sensing and hydrological cycle cost and challenges for the municipality to take on the work. The second is economic recovery resilience and stability. This could include economy at different scales, small, rural, larger cities, economic impacts for residents and the prosperity of the locality health and health care. This could include the health risks and health impacts of flooding, food security access to health care facilities and emergency responses. This could include social cohesion and housing. This could include lower income housing prone to flooding multi generational housing insurance coverage relocation and rebuilding of affordable housing. I'll break out attendees love access to the chat and can participate by populating the Jamboard just mentioned that it will be important to note that only room three health and health care will be recorded and posted to the website. This will be in the main room with me and the other rooms will be recorded for reporting purposes only. And with that, I think we'll all be assigned to our breakout rooms. So hold tight. Okay, so if you are remaining you are likely supposed to be here in the health and health care breakout room. I invite you to turn on your camera if you would like to. Great. Nice to see some faces. Welcome. So now I'm going to, I hope that there's a staff person joining us and can help us with the Jamboard which is one of the main ways that we're going to work through some questions together. Hi. I posted the link on the chat. So if you like to open it, if you have any issue accessing it, we can also share our screen but we also want to have this room with camera on to being able to have a conversation. So let us know if you have any issues. Go ahead. Go ahead, Laura. Do you want to? I think it'd be maybe good to go walk through the Jamboard for a minute and maybe share the screen and walk through it. Let's do that. Share my screen. Excuse me. May I ask how I get to another room? You, so why would you want to go in the other room? Maybe I'm going to have that question. I like this room. I like the topic of housing and social cohesion because that's related to the work that I do. So we are going to do a ward cafe meaning that you're going to stay in this room for 20 minutes, then you're going to go to another room and then another room. So I'm saying we're going to have all perspective mixed in and you'll get to probably go to the, if at the third one, you're not in the one you want, then you can ask that person, hey, we really want to go in that one. But we really want the mix of perspective and experiences here. All of you have something to share. Okay, so let me, I'm not sharing. Am I sharing the right screen? Yeah. Good. Okay. So there is a few slides here. We have our little space on the back out room three. This is health and healthcare. However, like I said, you're just here for 20 minutes and then after you're going to be moved to another room. So today and during the day you've heard about those different stories, we're going to be identifying the barriers and implementation. So this is really your space to continue on that conversation, what you've heard, what really resonated with with you when you heard some stories or what personal experience that you have. This is going to be in the second slide here that you can if you if you have the ability to get to the Jamboard you have sticky notes can take the color that you fancy. And then you can't write here your barriers that you have identified as being important in a conversation that we have today. That's great. So, um, oops, I don't know who is moving the information do not play with this. We're going to go through this. There is an opportunity for you to either put that in the chat if you do not want to play with sticky notes, you can put in a chat and then us as a staff we can put it in on a sticky note you can also talk. This is really made to be accessible for all type of, of, of participants the one who like to write, they like the way to talk, or the one who really don't want to go on Jamboard. And, and that's it. And then you'll be moving. Okay, thank you. So my suggestion is that we all take a couple minutes and work on this slide of barriers. So, um, we can all write a couple of the posted notes for what is the biggest challenge you have identified and faced related to flooding. And then tell us about a problem that you don't have the power to change related to flooding. So add your add your thoughts with a few sticky notes and then, and then we'll have a conversation about what we see, and then move on to the the second slide. Okay, everyone, give it if you haven't used Jamboard, give it a shot and let me know if you have any questions. I'm going to stop sharing my screen. So the time think also about those barriers in the context of solutions that last slide slide number four is also for solutions we don't want to lose any of those. So, while you're thinking about the barriers, you can also have the, the holding spot for solutions. It's just working for folks are you able to add. And see Sharon does says here a big talents that I've faced is that there's an aquifer under my house and everyone on my block experiences fresh water flowing into our basements during heavy rain. Thank you. So that sounds like it's also the, maybe an infrastructure challenge to address that. Maybe also governance one of getting the attention in your community toward that issue. I just posted the second part of it, which was similar to that as you were saying it. Yeah, I was just saying that maybe they should tap into it as like a fresh water source of fresh water well, because it comes right out of like a hole in my basement wall. It is the cleanest, crispest, purest water I'm like, I should taste it but I'm like, oh it might be contaminated but it's amazing. And, but I will say to add for myself, my mother, this, my mother owns my house that I live in, and she lives somewhere else but she was at the Home Depot or something, I think it was. And you know I used to use the sun pump and have to dump it out. And the gentleman said, you know what are you doing here you know they were talking and he suggested that she used a swimming pool pump to suck the water out. You know when it gets flooded like that, you know the water gets sucked out really quickly and it just goes right into the sink, but then after a while I guess some of the chips off the paint from the floor of course, the paint chips up. I guess it got clogged up so it doesn't work very well now. But that was the remedy that we did have a homegrown solutions and I think that also gets to some of the comments in the in the stories of like, it's communities helping each other. I should have said to reminder that our focus here is health and health care so again that that covers a broad range but especially be thinking about emergency services. Some of the access after flooding events to medication to power supply to clean water contamination. So, you know, especially on on these issues. So, let me just add the water like last month sometime I don't know who else lives in New Jersey. But it rained so bad that everybody's roof was like leaking my water dripping in my bedroom for the first time ever was crazy. So my mother had to put on in the roof but one thing that we can connect this to with health is that with this water and the flooding. It creates mold conditions and it affects health and people don't realize the neurological problems and health issues that people can, you know, develop because of vicky water, water damage and mold in your home or in your school. Thank you. Let's see, I see one here, representation mismatch of health care workforce and decision makers. And the communities being served bias and empathy. So anyone who wants to speak to that to the person who wrote that down like to explain that a little more. I wrote that one. And that just comes from, I think, the mismatch one just kind of positionality. I'm a civil engineer. I'm sorry to be a black woman in civil engineering. It's it's been there's not many of us. So then outside of that communicating that type of knowledge that you bring that it's slightly different in the way you view things so like representation just generally in the spaces you occupy. And also in the in the communities that we're trying to reach and target if we think about like justice 40 trying to target certain communities but then realizing we don't have the workforce that represents those communities and thus tend to still not know how to work within those capacities or how to manage those resources. But then also, again, this is speaking from being a black woman so like very much my perspective but going to a hospital, looking for black doctors, people who perceive what you feel, whether it's how they perceive your pain levels, and those type of things so In terms of this which is health. I was thinking more of the lines of that of what it's like for black individuals residents community members to go into healthcare facilities and the trust that's built there and what could be fixed truly through representation and workforce development within the communities that are kind of dealing with some of these issues so that's what I kind of all encapsulated in that one little comment. You brought up a lot so the workforce piece super important building that out and also having that reflects the communities that they're serving but also the like the idea of trusted spaces right so like in disaster knowing that you can go to a hospital or go to a shelter and know that you will be treated respectfully and appropriately and so and having that. That's one of those kind of, you know, we talk a lot in natural disasters about the hard infrastructure but that kind of like human capital and social infrastructure is really important so to the person who said that that their work was especially on the social capital side and the social cohesion side I think there's a real overlap here on health and health care. And I welcome anyone else to add on to that comment or to raise one another challenge that that you identified on the Jamboard. Someone else who hasn't spoken. I joined a bit late. But one of the real challenge that I'm having in Toledo Ohio is we have a fund to help residents when their basements are flooded. They don't access it because what they need to have a front that their front cost before they can access what the city can can provide is very little or none and what we provide does not we provide about 2000. And we know that any cleanup will be way more than that. The challenge I'm having is how do I want lower the lower the amount that the residents are required to have a front so that they can at least access the resources that the city has and also increase the amount that the city is making available and be able to take that to city council and the city council agreeing to put more funding towards that. So that's so I don't know whether any other community has been faced with us situation but it's really a mean we every year we budget about 200, 200,000 for this program. And we only get, we are only able to give out 62,000. And the equity part of this is the people who end up qualifying for the grant, or for the support. Are people who were able to have the money at the front end so that they can show that they need it to be compensated. So while the framing of the problem was equity, the implementation of the project, of the funding takes away equity. I think the funding piece is huge and I think and I would love us to try to figure it like incorporate that into our solutions right I mean that's like, and to be thinking if we can with with funding solutions thinking how can we multi solve potentially like are there ways that we can use funding to do multiple things at once given those, you know, as you're saying, really limited municipal budgets. And I think that like the solution of looking for funding at the from our state or from our federal we saw the figures showing that, you know, the costs are going up everywhere and so there's scarce resources. I'm going to read, Michaela has a comment here I work on the sustainability department of a hospital and we have limited grant funding for building climate resilience because of this we are focusing only on our most pressing climate risk wildfires and wildfire smoke. Yeah, so that's Michaela to some extent that's that's this funded the the limited resources piece and and that you know the challenge of not having enough to cover all of all of the climate risks. So, let's move to. Let me look at this. Let's move to the second so it's slide three, and we're just going to start, we won't make it through this but know that your colleagues who join in the next session. And as we move around will be able to add to it. So, the next slide, what barriers exist in providing emergency medical services to marginalize populations during and after floods, and what knowledge gaps exist about the health impacts of flooding. I just want to add that I saw signed on to this because I wanted to make sure that Midwestern kind of non hurricane areas were represented and so the comments from previous speakers, I think really resonated with me. As a Southeast Michigan resident and someone who works with community partners in Detroit. A lot of these issues relate to the home, the quality of the home that may be poor as a result of like historical discriminatory lending and redlining issues. So it's really tied to other issues like energy efficiency, which we're also working on right now at University of Michigan. Thank you. Yeah, I fully agree and you know on the health and health care side that leads to the some of the post storm impacts the post flood impacts on on mold and you know exposure to other exposure to pathogens that were discussed in the other in the other presentations. And it's also, you know, you can imagine and or maybe you can tell us Karina. Then that may be tied to access to emergency services or the quality of or that the proximity of hospitals to address the health effects of flooding. Often that's co occurring with our communities and and lower quality housing. Yeah, it's a definitely huge concern. There was an NIH climate and health scholar last summer who was very focused on issues around access to hospitals during emergencies, including but not limited to flooding. And it's not just hospitals. It's also pharmacies to renew your prescriptions and you know clinics in the community. You can be cut off from all of those and and we've seen that in several hundred year floods in the past decade in Detroit where you just could not get off your blog access to dialysis. Yeah, yeah, please. Yeah, I was gonna say hi but something in the chat previously about populations with disabilities. And elder populations as well. Some of the challenges and I think not enough attention to those populations in terms of, you know, how do you get to them? How do they access medical care? How do they evacuate? Etc. Thank you. And that was really raised in the story in Puerto Rico. Really. Important considerations there. One of the things from the presentation that I hadn't thought of, I think that connects to that was someone was talking about how the community has a list is able to like the social cohesion factor of almost having an inventory of knowing who in your community would fall into those categories and being able to have a process that whether it's health agencies or just having access to that list of where those people are so you can prioritize them. And I thought that was a really great. I mean obviously a great idea but interesting about how it also depended on the social cohesion factor of how close the community is in order to feel comfortable to be sharing that information with each other. I work in New York City at the health department and we have a program called be a buddy where we fund community organizations kind of do that, do the wellness checks and sometimes are already doing them but but adding the climate lens to them. But, but it's not it's some of this happens naturally but other other pieces of this require funding and and the logistical support to organize it Carol. Thank you. I'd like to build off of, I think it was Sydney that was talking about registries for individual for individuals that would have needs. I let work for the state of New Hampshire Department of Health and for the longest time I've been at there for 19 years I've often thought about, you know, having a registry and because we have a nuclear power plant on our coast. There's a requirement by the Nuclear Regulatory Commission to have, at least within the emergency planning zone EPZ those 22 odd towns, you know would would have to establish something. There's certainly a lot of discussion and some science base in the literature that that says, you know, having a registry is is very difficult to maintain people move people die and unless you have a process that ensures somebody's committed to updating that registry. You know that's part of the challenge. The other part is people put their name to a registry and they think, Oh, I don't need to do anything. I don't need to plan. Somebody's going to come and get me because my name's on a registry. And, you know, I, I've given that a lot of thought to and I guess it really depends on the culture and the, the establishment of that community. And if it's a small community chances are people already know who's who and the emergency management director emergency management agency police department fire department might know that individual EMS might know that individual because they frequently have to, you know, come come to their, their aid. I think there's also an initiative underway nationally to invest with the centers for independent living. I love this comment. I would add, I would advocate to work with your local silk. And so please continue it with the other discussion. So we're going to, thanks everybody. And you are now going to move in your world cafe on to the other tables. Thanks again. Hopefully that will happen. We'll move. Yeah, there may be a couple minutes of silence as we get that coordinated on our end but do not worry we are on it. Okay, Carol. Any last last bits on your important comment. Yeah, I would just say work with your independent living councils. Those are the ones that work with individuals with disabilities others with access and functional needs and your home based community. So if you need more information of the federal level has a whole discussion on the importance of utilizing them in this plan. Thank you. That's great. Thank you. Laura, how do we access this board. Oh, yeah, so there's a link in the chat but let me. I have the board from the previous one but not this one. Yeah, I think we're in the chat right now, Laura. Perfect. So. So it sounds like we have some new folks and maybe my first group is in the process of moving. Sabina is that right to have a mix. So we are, I think everyone, or at least most of us are all in this room right now and we are getting, we are getting organized and reshuffling everybody we're trying to do our best to have to minimize repetition. So it's going to take us a couple of minutes. Laura, since this room is recorded for the future recording on the, on the website. If there is some folks that would want to chime in right now, you know, feel free to continue the conversation since we don't really have to interrupt the conversation in this room actually. And, and Jolly, please. I was just, you know, this comment was raised I think during the storytelling but in terms of barriers. I think sometimes it's as simple as communication platforms. So between so proactive communication which is sort of a theme that we've touched on for much of today already but I think it's often overlooked. It's really from community to community with trust. And, you know, what kind of platforms can be most effective. Can you give a couple examples of potentially useful platforms. I think one thing that I've used in my work with communities that has been that has seemed to be effective and at least a conversation starter is mapping participatory mapping and identification of resources and, you know, there you can use multiple layers but I think as an official communication platform. I think it depends whether it's public facing or internal right. And I would love to hear other people's examples because we're we're working on this problem in several communities. So I would I would open this up to people to see to learn more about communication platforms that have been successful in communities. Great. And someone else have one that they can offer raise your hand or add it to the chat. I will say part of the apple shop story. I lived for a short time in that that ton of whitesburg Kentucky they have a community radio station. But it went down in the floods and so I think I'm going to start writing Mimi if you're on please please tell it for me. I think I'm purchased I think an RV to stand out like the radio station went down in the flood. And so purchased an RV to to bring that back online quickly knowing that that was rural communities that that communication piece was really important. I didn't do that but it did take a while to do it to get it back up. But also and somebody mentioned earlier well people have cell phones they can just, you know, connect by cell phones but we lost cell phone service and one of the things was a lot of people. There were some emergency, you know, texts that went out. But since people had lost cell phone service they didn't get those. And then they didn't have cell phone service for a good while after the flood. So, you know, emergency folks couldn't get to them didn't know, you know, even what what had happened. I suppose there would need to be multiple sort of parallel processes right and and before we were we were talking earlier in the morning about some of the speakers were talking about sort of these communities of practice and between academia and communities really building trust over time and having proactive conversations and participating in the community before disasters in order to build trust but I would even say to take some of those lessons within communities between government and residents and, you know, various sectors even within communities to be having those conversations proactively in order to build trust and alert people to different ways of communicating and accessing information in both direction and you know all directions really between government and residents and residents and right and in different directions, but to build that trust over time before disasters is essential. Really well said thank you. Spina should we continue in our general discussion or. Yeah, continue in your discussion we're trying to figure out how to best go about this. I'm interested in the kind of going off of that and we were talking about resilience hubs this morning, this idea of of trusted spaces and and more generally about what can we do and kind of blue sky days to prepare ourselves for flooding and the health impacts for flooding. In addition to the infrastructure that we need to do what else do we need to do on on a government, government inside or on on the, the trusted relationships, setting up communication systems and I welcome any suggestions for what we can be building the foundation well. I'll tell this, I so I mentioned this in our breakout session but I'll tell the story again I work at the New York City Health Department, and we have a program called be a buddy that works with now it's it's planning to work with older adult centers senior centers before it worked with community organizations, provided contracts and training and funding to create buddy systems. So, kind of wellness checks with vulnerable generally older adults, and, and it was, you know, we were doing the checks in on the good days to build to build a relationship. But then, when there was it was mostly for heatwaves but you could imagine it, generally for flooding as well that then it would activate the system would activate during during an emergency and check on check on their buddies, provide information and actually it was created before coven. And then when coven happened it really activated and expanded to be able to provide are you getting the food that you need can we can I drop off something for you are you do you know about do you have masks do you do you have you know the different resources that you need so it was this. It was, we were, I think lucky to have created a system that then could activate in an unforeseen event. And I'm curious if there are other ideas like that out there of systems to set in place now. I'm wondering Laura, if how, how much that's been replicated do you know of other cities and how many have replicated that program. We hear of a lot of interest in it I don't know. I see someone saying, Oh, will, will the buddy program be coming to the flow I we hear of a lot of interest in it. And, you know, our experiences that it took funding that our program had funding associated not sometimes a challenge. But you can also imagine creating, it's also just changed our messaging we try to say when we're giving advice about there's a heat you know the heat season coming up or the flooding, you know flooding is expected to remind people to check on their neighbors and give them the key pieces of information to check their neighbors, check on their neighbors about. This is the net Greer. I'm driving so I cannot cut my video on, but I wanted to say I think we need perspective planning. Like the lady who talked about the devastation and Puerto Rico where electrical infrastructure is down, where your cell towers are down, where your water is down your transportation is down. We need to have proactive means of survival for those times. So how do we prepare water that is adjustable during those times that we know is not adjustable. Do we have tablets, do we have a process. Do we have stockpiles of medical supplies talked about insulin being not available to individuals who did it. So our nation and our officials should have policies. I mean, even COVID calls such a problem, where there are stockpiles of response items that can be readily available. Instead of waiting for inefficient shipping of clean water, have a means of cleaning the water locally so it can be immediately consumed, have a ton of food that can be easily prepared so that we don't have starving children have. I just think we need a more proactive plan. Thank you, Annette. I open that to the group for discussion. Does anyone have a story, an experience that that shows a possible solution in that area. Annette, that's exactly how we started with our organization, Coalition of Nurses for Communities in Disaster. We started teaching the community how to prepare water, how to care for the other in different events of disaster. And that's that exactly was how we started. I mean, a group of volunteers who just we got together and decided to teach the communities how to do that, how to prepare water. And we have a program and there's a national program, the third program. I don't know if you know about it. It's a community emerging to response teams, and they have a good program that they have modules and they teach the communities on how to respond to, to different types of disasters, and probably that's a good start, because it creates teams and it creates it creates colleagues and all sorts of health from one another. Thanks Abigail. I have a message from the organizers, which is that we are ready to open the breakout rooms. You will be given the option of which one so you can select one you haven't been part of already. And the staff and committee members will be assigned. So, I hope you see that pop up on your screen and you can select a new breakout room to participate in. It's already been written. Look at what has already been written, and, and you can add. Add a note, you can also maybe put a star or a mark on one that you that you really agree with. So we'll do that for a minute and then, and then we'll discuss what we see here. Everybody doing okay getting through the Jamboard. Great. I see a check mark. I like it. So we're seeing some kind of physical barriers, like road closures that might stop ambulances for getting through or people from evacuating or getting to medical services. Access to electricity for charging phones that would also be for charging medical equipment. But then there's also some kind of social infrastructure or capacity kinds of issues, governance issues, everything from lack of health insurance, lack of trust in the healthcare system by marginalized populations. We talked about that a bit in the last session. Well, it's just getting lots of checks here. Those with mobility challenges, like wheelchairs visions are reluctant to evacuate because of safety concerns of where they end up or the full inability to evacuate lack of knowledge of community needs and who is most impacted during the event. Great. It's a lot of barriers. So now I think we're starting to make the shift. We have lots of barriers down starting to make a shift toward visions of solutions. So thinking about what what are ones that we can know what what are some of these challenges that that we can shift toward toward solutions. And I invite, you know, when you're looking at this barriers list, does anyone have a best practice that they know about or are they thinking about something that they that they think is an important piece of a solution to addressing either some of the infrastructure challenges or some of these other systemic challenges. Any volunteers. We can also talk, continue to talk about challenges so I think someone added a new one here. And I didn't I saw something being added but I didn't actually notice which one it was it. I didn't add a post it and wanted to raise it. This is Morgan Levison I did add a post it around the lack of knowledge of community needs. And so that that was one of the pieces that. So I'm from a health unit, which is just north of Toronto in Canada so slightly different situation in terms of some of the, the healthcare systems and processes that are in place up here but you know in terms of when our communities have some of these no flood risks or anything climate related in terms of climate emergencies. Some of the challenge are is just a lack of knowledge of what the community needs are at the time. So, you know, without having done planning before an event. It can be difficult to to know who within the community needs your help, especially when you're thinking about you know higher risk individuals such as those are socially isolated they you know sort of fall through the cracks and so if you don't have those those pieces there that can be difficult. Thank you. Yeah, we were also talking in the last session about the need to identify people but also to explain what that what that means most explaining you know they're often registries that people can add themselves to but recognizing that those registries then need to be used and and the people on the registries need to know. So what what to do in an emergency and so it's it's kind of understanding that landscape as you're talking about Morgan and then also creating the, the right kind of preparedness system to apply the planning. Yeah, any. Thanks. Sort of building off Morgan's comment and so I'm at the California Department of Public Health and sort of trying to think about how to conduct surveillance around health impacts. related to climate. And so I was curious if anyone, you know, is already conducting surveillance for flooding related health impacts and whether there are any best practices around gathering information about who has been impacted and what the community needs are, especially if they're not able to get to a hospital. You know we traditionally use things like emergency department business but that might not be a great data source. Thanks. Thanks any. Any responses to that. I'll say at the nearest to the health department. So one thing we did was that we had terrible flooding and hurricane Ida. And, and the biggest issue was basement flooding and 13 people died. Primarily in basements, maybe all of those were in basements and so our research team did a study of the of the mortality study and looked at the circumstances of death and that's been important. You know that was a small number. But it was important for them, we're looking at basement regulating basement apartments and so it helps us to understand the conditions, both of the apartments, but also of the lack of communication prior to the event and reaching the people that that were most at risk and so it's informing also our communication strategies. So, so that that's one small piece. We've been talking about doing similar surveillance for flooding as we do for heat. But, but you raise a good point that they're not always reaching, reaching the hospital system. Morgan says, we're in the same process of trying to identify surveillance practices and indicators so this is that that goes in our knowledge and the knowledge gaps here. I'll read Macy's Macy said, I added translation and interpretation of information really important during disasters. Resources are always stressed and finding quality translation interpretation of information can be difficult, especially translation and interpretation of resources are already lacking in an area. So, so maybe you're suggesting trying to pre plan for that create those materials beforehand. So how about if we shift to the, it's actually the slide this up on on the shared screen on the potential solutions. So we've got a couple that are already marked and I invite you to mark others to stronger linkages between healthcare system and home repair services that's interesting does anyone want to speak to that solution. It sounds to me like home repair services like repairing homes after flooding maybe providing funding or recommendations for flood for mold remediation. I'd be interested to know if that has been done in places and how that worked and how the funding worked for that how the referral services worked. It's a really interesting idea. What else is on here. Include disaster topics and all educational levels starting kindergarten for active communication locally tailored by the community integration of climate change considerations into healthcare policies practices and infrastructure development. You know, I think one thing that I see in this is also the need for providing templates or models for especially lower resource, but you know, generally municipalities or organizations to implement. I think, you know, we want to do all these things and a lot of times, we just don't have the person power to do these amidst all the other stresses and in a municipality and so, you know, I think, as part of these solutions, how can we ask our state governments or our federal government to provide some of these as models for us or how can we have foundations, you know, take some of this on as ways to provide something that that many of us could use. One thing about the question or the point about helping people connect with contractors. There's a lot of concern about people getting scammed, particularly older folks. So, you know, a better business bureau or some kind of vetting process that, you know, that does say these people are legit. Who can help you rebuild or whatever would be helpful I think. Is there anything like that or after the flooding in Tokyo or did you just experience the downside of not having it. Well, usually we have very few contractors very few plumbers carpenters, whatever but after the flood, you definitely saw you know their their trucks everywhere so you know I don't know if they were itinerant or just coming in from the cities but I know people there was some concern and and I did hear of a few cases where you know people got ripped off but yeah I don't I don't know of a resource. There are two good nonprofit home repair and home builder organizations in the region and they they really stepped up. And they've been great so it's good to find you know find those folks and you know help them to really raise funds and do more and you know maybe be part of that process. Yeah. Thank you. Again, this sounds like something that I. It's good to do in blue skies if we can. Be able to create those relationships support support local businesses create lists like that. So there was a note that I went through. Please feel free to to shift to another breakout session if you'd like. And we'll continue the discussion on solutions here is a common seems to be a common concern. Powering a broader force like that. Sure. It's tough to get an egg between funding availability and local priority settings. Yeah, that's great breaking down silos, centering equity isn't so. Yep. Emphasizing prevention is a really important one. Yeah, this underlying land use and economic drivers. It underlie a lot of the decisions that get made. Now creating right incentives. Avoiding priorities established by academics appreciate that one planning for the long term. Institutionalizing this kind of collaboration research. It's great to see these in one place. The need for policy change and development in all sectors. As we face this challenge. I like this, right? Sort of we're not isolating this. Yeah. Happing into communities and ways to respect their time. Makes a lot of sense. This is a great. This reads as a great. Collection and synthesis in some ways. Some of the conversations I was, I was part of. It's great to see these in one place. We're not isolating this to a single. This isn't a single department or a single. Sectors responsibility. This integration challenge. Yeah, balancing community and technical expertise. Navigating that. That line. Deeply analyzing bias root out racism. By design. I'm really digging into again. A different way, but kind of digging into these underlying drivers. Of the problems. Underline drivers of the inequities. Practice for disaster response relief. Yeah. Yeah. I agree. I like this emphasis on. Preparation ahead of time. This is great. We've got about one more minute for collecting these. If anyone has. Last thoughts, they want to make sure get captured in this. In this format. Of course, we've got our sticky notes. Got our recordings. Is any. The last. Central ones. Yeah. Including transitioning in new locations. Don't lose in social capital kind of keeping. Keeping options on the table. Moving real time experiences, real people and the willingness to change. Additional communication resources. Community community leaders. Yeah. That's great. We have to deal with real time changes as well. Sure. It's hard to, hard to perfectly predict, especially at this point, but we have to be flexible. Representation inclusion. Allyship storytelling, important data. Yeah. Really centering these experiences. Or research on individual and community resiliency. Yeah. Sort of. Really understanding what it is that. Tips the scales maybe one way or the other. Okay. Great. We're supposed to compensation for best practice. Yeah. Yes, that's great. Really investing it. Yeah. Thank you. Thank you. Thank you. Thank you. These are great. I'm going to turn it over now. To Charles, who's going to take us into. Our last, our last piece here, but these are fabulous. Thank you everyone for participating and. And sharing these, these great, great ideas, great perspectives. Hey everyone, Charles Burgers with the national academies here. Thank you all so much for joining us today. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you for your comments. Comments along with our saves. Meeting recording. For our, for our briefing next, we're going to go back to Venkat. Lakshmi. The, the co-chair of the planning committee to. Give us some concluding remarks. So. Venkat, please take it away when you're ready. Absolutely. Thank you, Charles. And thank you so very, very much to all of the participants. I think at one point. I'm going to go back to the Zoom call. So it's a, it's a testament to how important this topic is. And how interested people are in, in to contribute to learn and to move forward. So we covered a lot of ground today and the complex interactions between flooding, natural and built environment, the intersection with other social justice issues, policy, political will funding communication from ground up and back again. So I'll try to summarize a few things. I think the conversation was so nice with actually not my own comments, but also comments from most of the people in the chat. And so, so a couple of things that I have a few items, which I would like to read out and I'll share it with the, with the national academy staff so that it will be a part of the record. So one of the most important things we, I found out is that communication and connection with communities is very important. And we are trying to break down silos and bring together engineering, landscape planning, social science, social advocacy, community groups, empowering people with a shared solution. Basically the shared solution is more important than just empowering and, you know, not being equal partners. The second thing is London is a real risk and FEMA maps are FEMA maps. I mean, they have to be updated a hundred year flood today. It's not a hundred year flood next year, if you have another hundred year flood today, the statistics change. So, you know, we have to understand and communicate with federal agencies for updating these maps. And this is the job of civil engineers in conjunction with community groups. Now, one of the things which we also touched about is, you know, interventions and multiple touch points. So, so this is not a simple problem with one particular group. But if you look at this, this is a big bunch of industries, insurance industry, health, public health, clinics, zoning industry, and of course all the community groups. Now, surveillance is important. Interpretation is important. And all of the planning is great. But when you get to a disaster, reality is sometimes so much different. And, you know, getting that disaster supply chain to the disaster relief supply change to the people who are most vulnerable in case of a flood is very important. And various scenarios have to be, you know, planned in advance. One of the things, one of the comments made in these discussions was reinvesting in communities, you know, trying to figure out what really matters. And some of these investments have to be equitable, which is both the, I call it the hard stuff and the soft stuff. The hard stuff is actually building stuff. But the soft stuff is investing in developing excellence in workforce. And all of them cannot be done with the frame of five years or 10 years. We have to be looking at 20, 50, and 100 years, just like the people in climate science look at it. So I would finally try to thank our speakers and the panelists for sharing their expertise. I'd like to thank my fellow committee members. But most importantly, and this is something which I have to say over and over again because I'm so impressed with them, the National Academy staff. I mean, I want to thank Audrey, Charles, Sabina, Lalla, and Crystal. You guys are amazing. You know, you guys are the thing which holds the glue, which holds these logic together. So thank you so very, very much. So thanking them for making this happen today. And I want to thank you all in advance for going to come on Monday, the 18th and join for the second part of this workshop. And please continue to keep on populating the Jamboard and the solution slide after this webinar and integrate them into the discussion of the second day of the workshop, which is as important. And it's a real another star studded line of speakers for you. So thank you very much and have a wonderful evening. It's four o'clock.