 Hello, everyone. My name is Sabrina McCormick. I'm founder of resilience entertainment and co-chair of this committee, along with my co-chair. Hi, I'm Anna Gunns. I'm a pediatric intensivist and medical director of the Children's Environment to Health Clinic in Ontario. And we would like to very warmly welcome everyone here today, both in person and online. We are so happy and honored to have all of you participating in this incredibly important workshop, which is the third of a four-part series on communities, climate change and health equity. And if you're in the room with us, you know how important this workshop and this topic is. Today we are going to focus on really trying to identify key elements of effective and innovative actions to prevent and mitigate inequitable health risks from what we all here know to be one of climate change most pervasive and critical aspects, which is exposure to extreme heat. So first we would like to start with a land acknowledgement, which is an important part to invite different ways of knowing and perspectives in this. So while we are gathered virtually today, the National Academies is physically housed on the traditional lands of the Nakhush tank and the Piscataway peoples past and present. In honor with gratitude the land itself enters to us with relation whose relationship spans generations. We recognize that indigenous nations have distinct knowledge systems and ways of knowing that hold wisdom for how to live with the land, respecting this knowledge as we gather to discuss living with extreme health heat. Is our duty to acknowledge the colonial history that put indigenous people at the forefront of the climate crisis to listen and work with those who see with two eyes to create better, better safer communities for all is the future that we all must work and strive to be in. Thank you, Anna, and we would like to also thank before we get started today we would like to thank the planning committee, the National Academy staff and today's moderators and participants, everyone has worked so hard to bring together this very exciting and innovative, and I think what you'll find is very diverse and broadly speaking event. So before we get into today's workshop, Audrey, Tivan on from the National Academies is going to provide you some context for the workshop. Audrey floors yours. Thank you very much Sabrina. Yes, I can hear sharing my screen. Thank you all for coming today and thank you for the participation online. First, I would like to acknowledge the staff that has been working behind the scenes you have here to our core team and our I break event lifesaver we're really trying to make these workshops I breathe participatory for all and he needs a little a lot of little and so I just wanted to acknowledge the staff. A little bit of logistics. This is a zoom meeting. This is not a webinar. So all of you get the opportunity to participate. We made it that way because we really truly think that the power of all the people that are today is going to make this experience a rich. Please, if you want to participate in the chat or any other manner, put your names, rename yourself and if you have a phone number, rename yourself on the chat on the on the zoom participant. We will use two ways of participation slider which is an outside platform, you will get the link into the chat and also the actual zoom chat. Please use both of those wisely. We know that participation is difficult but we want this experience to be a rewarding for all. If you need assistance find in the chat, darling, darling gross here will be helping you with with all of this technical assistance. This workshop is recorded on our website you can find all the biographies for the speakers, the background material and everything you need to know. Sorry, there's a little bit of confusion here with and there is a closed captioning for whoever wants to be reading what we what is said. And again the recording will be put it on our website. Again, please know that we welcome all of you to be participating in this workshop in the way you can. So this activity is part of a over the overarching initiatives called the environmental health matters initiative. This is one of the only cross academies initiative really cross the silos of science engineering and medicine. There is a vision statement for these activities. The environmental matters initiative seeks to improve the health of all people, equitably by promoting evidence base which is one of the important matter for the academies. Based on evidence to the assessment the prevention, the adaptation and strategic liquidation of complex and interconnected environmental stressors. The HMI embraces complexity. We think this is a way of providing a system thinking that cross the sectors those disciplines and any other barriers that we have set for ourselves. We provide with the HMI connection, all of you today on virtually or in the room today, credibility with what we've done the academies for the past almost, you know, century and half stewardship of the people that are involved and of course neutrality the academies is a nonprofit organization we advise the government on how we are. We are a nonprofit, and we embrace this as well. I would like to also acknowledge our sponsors. The Center for Disease Controls and Prevention the National Institute of Environmental Health Sciences and the environmental protection agencies. The sponsors in addition for the continuing interest in those in tackling those most pressing issues. They also recognize the National HMI core values that are here on the slide of reporting independently for any sponsorship. So today, this workshop is part of a series of this is the third of a four, four part workshop series. This workshop aims to explore the current state of knowledge which is important for us to have as a base today about climate related health diverse disparities and specific action co produced with change makers and leaders at all level of decisions we are not differentiating between those level decision from the communities all the way to the federal government and all of these to improve climate health related health outcomes for all. The workshop one. During this workshop we brought together experts, practitioners, scientists and people with lived experience to discuss this profanate disproportionate impact of climate change on communities experiencing environmental injustice and health disparities. Depending on this workshop one the workshop to looked focus on the state level implementation do is where the decision can be critical for trickling down in the communities. And this workshop to really hand identifying actions that could help improve climate related health outcomes. In this workshop, we take a topical approach something that is on people's mind especially as we're getting into the warmer months in in United States and on this side of the atmosphere is heat related climate change impact. We have a fantastic lineup for our committees I would like to thank on behalf of the Academy thank the work that you have done co chairs and I and Sabrina, and the other member of this committee. I'm going to take it. I'm going to stop my my presentation right now and I'm going to ask for Anna to take it takes from there. Thank you I love how we can look at each other now we're in the same room it feels funny to look sideways at someone on a zoom. So, the first session the goals of the first session are to set the stage broadly for a current state of knowledge around heat and the insidious as well as issues with extreme heat, and also identify the gaps that we have in terms of health communities and policies. We have a fantastic lineup of speakers so we have David David Honjula, Rupa Basu, Chanel, Jaisal and Reverend Vernon Walker, all biographies can be found on the website. And each speaker will have the goals okay. Sorry, I was looking at the wrong thing. So we will focus on lessons learns and addressing inequalities and health related climate change impacts. During the interactive hybrid workshop the participants will identify key elements of effective actions and prevent and prevent and mitigate inequitable health risks from one of climate changes most pervasive critical aspects extreme heat. Multi day hybrid workshop will convene people with lived experience environmental health economic and racial justice experts climate scientists, energy specialists and individuals who work on sustainable planning and disaster relief. Together, they will explore a diverse set of real world challenges affecting different communities and the innovative actions being pursued to prevent, adapt it or mitigate the health consequences of extreme heat. So our agenda for today so the first session is basically the current skates of knowledge and identifying gaps as well in heat related knowledge regarding health communities and policies. Then we're going to have some shared stories where participants who are going to actually are lined with community needs with while navigating these policies. And session three will be an interactive breakout rooms to identify barriers to implementation and developing solutions and this is where we really invite the knowledge and expertise that's existing even in the in the universe out there to participate. And then the fourth will be an inspirational talk identify problems through different lessons in order to find innovative solutions. Now we can go and now to session one I'm sorry I apologize for the confusion so this is where we will have those four speakers mentioned above to tackle gaps and barriers so David Honjula, Rupa basu and Sonal Jaisal, as well as Reverend Vernon Walker and the blog biographies can be found on the website. They'll speak first each for 10 to 12 minutes and then they'll be an open Q&A session. And the zoom chat will be disabled during the session. And that's where we ask members in the audience to submit questions through Slido platform where everyone can also upvote the questions that they want to hear the most so you can sort of influence what's being asked. And that will will be in the chat the link to that we will address as many of these as possible during this session. So first I'm going to pass the floor to our first speaker Dr. David Honjula who's the director of heat response and mitigation for the city of Phoenix and a faculty member of an Arizona State School of Geographical Sciences and urban planning over to you. Good morning thanks so much Anna and confirming you can hear me okay and see the slides. We can. We can. Well thanks thanks so much to the academies for the invitation to present to the organizers for all your hard work and it's an honor to be with the rest of the panelists here. I was asked to try to set the table for us at the stage for our great conversations today and I'll be providing a bit of an overture, hoping to hit on some of the key themes we heard and describe sharing a little bit of our local experience here from from Phoenix and good morning from Arizona to the many participants. I think today's conversation is especially timely, as we are right in the middle of what I think in hope is a transformation in how communities all across the country are approaching and tackling challenges associated with extreme heat. Here in the picture is Phoenix Mayor Kate Gallego and our congressman Ruben Gallego who are two of our national leaders in trying to advance this conversation. I'll give you a local example in a moment. But just to highlight on the floor of the house right now is a proposed legislation to add extreme heat to the Stafford Act, which could potentially open doors for more funding and support for communities all across the country through traditional FEMA disaster planning and response channels so certainly something to keep our eye on again this is happening quite literally as we speak. Here in Phoenix our Mayor and City Council took action a couple of years ago now to create a publicly funded office in the structure of local government focused on heat. Here you can see the glamorous City of Phoenix organizational chart, but the key the key detail I'd like to draw your attention to is the box there, just like Phoenix has a police department a water department a neighborhood services department. Now we have a heat department charged with harnessing the power and energy of the entire organization to help our community and indeed communities across the region and state tackle the many challenges related to heat. In the responding to the prompt about the state of knowledge I wanted to share a few of our reflections on what the body of knowledge is that motivated Phoenix to take this action. And then I'll talk about some of the lessons learned through our first couple journeys that hopefully will touch on some some knowledge gaps that we can as a community work to fill. There are at least five pieces of the knowledge base that motivated Phoenix to take this action to quite literally change the structure of local government tackle heat. Recognition of the significant public health risk, hearing from the community that heat is a concern, a very strong state of knowledge I would argue about how the climate system works and how the urban climate system works. Recognition that heat is a multi sectoral multi faceted challenge involving not just environmental dimensions. And of course heat as an environmental justice topic the motivating factor for our time together today. We will hear from other speakers about public health data related to heat, but I just wanted to highlight as we're thinking about heat as a public health risk that there are wide opportunities for how we frame that risk and here locally, a particularly impactful connection came from our media partners at the Arizona Republic, who took the time to interview friends, family members and others who knew heat decedents in our community this was a story series of stories published in 2017. We found these narratives to be particularly impactful not just in influencing our local policymakers, but also in bringing institutional actors to the table. We would look at these narratives read these narratives together and ask, where could we have fit in to make a difference in how these stories played out and unfortunately, I had very tragic outcomes so not just the public health administrative records important here, but also the narratives and storytelling. We hear from the community quite a lot about heat perhaps naturally so as the hottest large city in the country. One of the indicators we saw that shows this priority is that our public budget hearings, a number of years ago when the heat office was proposed there were very few parts of the city budget that received more positive public comments than the idea that we should create a heat office and do better as a community and managing heat. So I think a particularly instrumental piece of the puzzle there in garnering and building community support has been the work of the Nature Conservancy here locally with community based nonprofits, who have been convening for the past couple of years now what they call the Urban Heat Leadership Academy, bringing neighbors residents community leaders together to come up with more of a collective vision collective voice for how we can move the community forward, and also build capacity and relationships with community academic institutions, public institutions, and neighborhood associations as well. With respect to climate knowledge and the urban climate system here at Arizona State University, we've certainly been investing a lot in this topic for many, many decades now. Where the state of the science is and the finding about how impactful urban actors are in shaping the climate of the urban environment is another motivational point that that encourages our mayor and city council to create the heat office. Here's one example published in the proceedings of the National Academy of Science, almost a decade ago now. And I know there's a lot happening on this this figure we can get into it more in the discussion. But I'll just draw your attention to the area in these yellow circles, we can see all the boxes are to the left of some zero line, and the fact that those boxes are on the left of some zero line says that it tells us that actions that cities can take can produce cities of the future that are cooler than the ones we have today, even as global warming continues all those boxes left of zero means that our cities can be cooler. That's been a very powerful message for our local elected officials here that cities can really make a difference in shaping the environment for their residents. Recognizing the multi dimensional aspect of heat I think motivated our city council to take action. This is a figure that we published a number of years ago the bars show how many heat associated deaths happened to our community. And the symbols that the lines that move up and down show how many we would have expected just based on the weather conditions. And in 2016 at the far right hand side, you can see that where the symbols wind up is nowhere near the top of the bars, something else happened in our community in 2016 that pushed heat associated deaths way above where we would have expected them to be just based on weather conditions alone and we're continuing to diagnose and unpack what what that story is. Finally, recognition that he is an environmental justice topic perhaps no topic more clearly than heat. I think many on the line have seen and produced figures like this that show in our case here in Phoenix, hot neighborhoods have a higher incidence of heat related illness. And we're seeing more and different types of data fit into that narrative as well. Here's some some work from an interview and storytelling project we had the chance to be part of with the nature conservancy community based organizations, getting a different sense here beyond dots on a figure of what the impacts of heat are in our communities. And as you can see on the slide here, kids don't really go outside to play because it's too hot concern about the long term chronic illnesses that might come about from that lack of activity in the summertime. So those are a few of the data points that have contributed to where we are today the state of knowledge that motivated our mayor and city council to take action to create a heat office. So what we need to do moving forward and I'll also offer five ideas here clearer and community rooted goals related to heat consistent and accessible health data as related to heat. I think we can make a greater investment in evaluation. I think we need to find new and better ways to get researchers sitting alongside city staff and indeed institutional actors at all scales, and finally I'll share a thought about heat portfolio management. Let's get to goals. I'll come back to that quote that we just shared before kids don't really go outside to play because it's too hot. So when I, especially as a new parent when I try to think about what a goal looks like for tackling that challenge. It looks to me like the picture on the left here, a very nicely shaded playground in our neighboring community of Mesa. When I think about the goals that we are writing as institutional community of heat actors. Our goals tend to be based on the picture of the right on the right, a weather station based at Sky Harbor Airport where almost nobody spends any portion of their time we're thinking about reducing the urban heat island for example. I think we're missing what the community is telling us about how they're experiencing heat as a challenge, and I think we need to find better ways to construct goals that are more related to the slide there, and less related to the temperature as we would measure an airport. Let's talk more about health data I'm sure with some of our other panelists but just to highlight the scale of the challenge we have across the United States right now. At the same time we have the National Weather Service reporting that we have about 100 heat related deaths every year, the CDC reporting about 700 in Maricopa County we reported nearly 500 last year, and in the academic community we have estimates, well north of 10,000 per year. Mayor Bloomberg was correct that if we can't measure it we can't manage it. Clearly our measurement isn't precise enough yet for heat to be able to effectively manage the public health risks. Investment in evaluation I think we have a long way to go here. And I want to applaud the street transportation department here at the city of Phoenix. It's a pioneer in trying reflective surfaces on our on our city streets. You can see on the left picture there the street that goes vertically on the slide seems to have a zebra pattern. It's halfway through receiving its cool pavement treatment, and the street transportation department invested in a very rigorous evaluation process with our partners at ASU, from which important academic and scholarship is coming forward, but also important practical to helping us think about where in the city cool pavement may make more sense, and where it might make less sense. I think this type of evaluation, we can really scale up. For example, all the dots on the map here show where our public cooling centers and hydration stations are in the Phoenix area. What is the collective impact of this service on reducing heat associated deaths and illnesses while the CDC is helping us make investments and answering that question through the building resilience against climate programs? I think we still have a long way to go there. And how do we think about other community investments as part of this evaluation story that have heat co-benefits? Like when the city opened a new shelter for people experiencing homelessness last year, I am very confident it was very heat protective, but I can't put a specific number on it yet. And as we hit the end of my introductory slides here, two final points for you. How can we get our researchers sitting alongside city staff more often? I don't know about all of you on the call, but I know I've spent a lot of time developing vulnerability maps and models at the polygon scale, the neighborhood scale, and have only recently really learned the nuances of what it takes, for example, to implement a tree planting program. Here's just a screenshot from one of our internal tools at the city, and we think about places to plant trees in Phoenix from the city government perspective. It's not these big polygons that we're concerned about. It's these little teeny tiny ones. This little green strip along the street are the actual places where the city could take action right now to plant trees. Those types of nuanced details we really need to get more in our workflow. And finally, I'll end with a little bit on our heat portfolio management. While I think we collectively have a good sense of what we can do, how much of each of those actions we should be investing in? Who should be implementing them and who do they benefit? Remain open questions, I would argue. And as we think about that, I'll leave us with these three narratives that my colleague, Melissa Bardaro, detected that emerged from interviews she conducted in our region. And here on these three narratives for different people in our community, heat is an inconvenience, heat is a manageable problem for others, and heat is a catastrophe for others. And as we're thinking about what we're doing related to heat, I think we need to be figuring out a way to measure how much of the risk related to heat is shared, falls into these three different buckets, and does that really reflect, is that really reflected in the investments we're taking right now. Thank you so much again to the academies. Looking forward to hearing from my fellow panelists and our vigorous Q&A coming up. Thanks so much. Thank you very much for that. Our next speaker is Rupa Basu, who is currently the Chief of the Air and Climate Epidemiology Section at the Office of Environmental Health Hazard Assessment of the California Environmental Protection Agency. That is a mouthful. That is a title. So today she will be talking about ambient health exposures and health, environmental justice implications as well. We can see yourself. Thank you so much for that introduction. And it's my pleasure to be here today to talk about some of the epidemiologic work that has been done on heat exposure and health, and also some of the environmental justice implications of that work. So I think we've all seen, David just showed us some deaths that have occurred in Maricopa County in Arizona, but we've all seen these headlines now, whether it's in Oregon or California or India, Australia, Russia, throughout Europe, probably the largest that we've seen so far has been the following the 2003 European heat wave where there are about 70,000 deaths following that. And we know from research that heat is the number one killer of all climate change exposure. So very important to study just for that reason alone. You have probably heard about this climate gap in that the poorest areas are not the most, even though they're the most affected by climate change, they're not the biggest carbon emitters. This we can see on a global scale. So starting with the US, Russia, India, China are some of the largest carbon emitters, but you can see here that Sub-Saharan Africa, South America are more largely impacted. Now if you take this to a national scale, same thing happens. The poorest are most affected, even though they may not be the largest emitters. And then in my work working for the state of California, we see this in California as well. And then if you go even smaller than that into local communities, we see that climate change gap as well. David just mentioned that we see about 700 annual deaths that are reported from the Centers for Disease Control. That is a very large underreporting. And I'll get into the reasons for that in a minute, but I just want to say that if you're thinking about 700 annual deaths, it doesn't sound like a whole lot. Yes, it's still a public health problem, but when we're thinking about the true implications of thousands and thousands of deaths, it's quite different. So the reasons why heat related deaths and illnesses are often underreported in the United States is that we have no systematic definition for a heat wave. It really varies by local health department or region. And the vulnerable subgroups are so different. In heat advisories, we really need to address that, that these advisories need to protect locally vulnerable subgroups. An example of a heat wave is that it's 98th percentile of temperature distribution in a specific geographic area for at least two or more days. But again, there is no systematic definition for this. When considering heat wave definitions, it's also important to think about daytime versus nighttime thresholds because when there's not a chance to cool down, that's when we see some of the largest health impacts. And also when there's a cumulative effect of heat over several days. So another reason for this underreporting is also with the outcome. There's heat related deaths or illnesses reported only during the heat wave, which causes a surveillance bias in epidemiology, or when no other cause of death or illness is suspected. So from our studies, we know that there are several other health outcomes that need to be considered when looking at heat. Previously, we would consider only mortality and then went on to look at dehydration and heat illness, which obviously has a very large impact. But other health outcomes such as cardiovascular outcomes, particularly heart attacks, ischemic stroke, respiratory such as asthma or chronic obstructive pulmonary disease, diabetes, mental health outcomes, which is fairly new in terms of epidemiologic studies. That includes suicides, homicides, as well as neurotic and psychotic outcomes, such as schizophrenia, liver and kidney diseases, infectious diseases, gastrointestinal diseases. And then finally adverse birth outcomes, preterm delivery, low birth weight and stillbirth. These have also been studied more recently in the last decade. So next I want to just talk about the mechanism of how heat stress can lead to death. As you can see, it's pretty complicated. This is a figure that my colleague and I developed for a book chapter. And I'm going to just focus on the real mechanism that is mostly seen in the literature. So dehydration, which leads to electrolyte imbalance, heat exhaustion, heat injury, heat stroke, or heat collapse, eventually leads to death. So dehydration has so many different symptoms. Some of them could just be vomiting, feeling lightheaded, dizzy, and these are often overlooked and not connected to the heat exposure. And this is really important to think about to prevent heat related illness or death. So some of the high risk populations for ambient heat exposure. When I started this research now over two decades ago, we really thought it was the elderly that was most impacted. But that is one of the subgroups. But we also need to think about other subgroups such as socially isolated populations, pregnant people, children, outdoor workers such as farm workers, taking certain medications such as beta blockers and antidepressants. As I said earlier, heart disease and mental health diseases are related to heat. So these could modify if somebody is taking some of these medications may not be able to act during heat wave. Take action. Living on high on the top floor of high rise buildings or other building infrastructure issues, poverty, which is measured in so many different ways. Young athletes, which is often a population missed. And there are others, but during heat advisories, many of these populations are currently missed. So young athletes and pregnant people, for example, are not reported as being at risk in certain areas. And this is important and has important public health implications, because if people don't know they're at increased risk, they won't be taking precautions or any kind of interventions. So some of the reasons for these disparities is in the exposure itself. So we know that there's greater exposures to heat and air pollution, which is often called environmental racism or environmental justice. Certain communities live closer to power plants, fossil fuel combustion areas, freeways, and are also more prone to the urban heat island effect, which just means that there's more black tops, cements, and other things that absorb heat and retain it, compared to rural or semi urban areas. And this is all result of, or mostly a result of historical redlining. The health outcomes themselves, if we don't even look at these exposures, if you don't look at heat or air pollution, we still see a disparity by health outcomes, primarily by race ethnicity. There is some evidence to show that lower socioeconomic status is also an issue, the high cost of using air conditioning, for example, or if there's a wildfire or a heat wave relocation may not be feasible, because of work or not having the means to go elsewhere. There's also evidence to show that there's less access to health care, or using the emergency room for primary care. But the most important thing here is that even with the same access to health care, the same socioeconomic status, there may be differential treatment. In the health care setting, this is something that really needs to be addressed, and the differential treatment is primarily by skin color, not believing patients, or not treating them the same in the same way. So here are some ways that our study results are used. We're trying to publish everything, but it's so important to not just keep this research in the scientific world. It's so important to get this information out to physicians, health care workers, populations at risk, the general public, and we try to do that in so many different ways. We present this work at workshops such as this one meetings and scientific conferences, but also develop fact sheets, provide consultations to other governments and nonprofit agencies. We deliver scientific messages to the public via media interviews, and also some shows and other ways that we've tried to convey this information. We also have implemented policy changes. We've started this with the local health departments in California. We just had a couple of bills pass. There's the SB 65 with just a mom of us. There's also a federal mom of us that is trying to improve maternal and fetal health outcomes. There's AB 2238 and 2240, for example, in California. He's just passed this year, which proposes to develop a statewide heat ranking and naming system. And then another bill that 2240 focuses primarily on perinatal infant children's health from extreme heat. So these were developed based on the epidemiologic work that I have been presenting in these slides. Another way that our research has been used in California itself, we have published this fourth climate change assessment. This was developed at the same time that the US EPA developed their fourth climate change assessment. But we thought it was really important to look at California specifically because of our micro climates and diverse population. There's so many different climate change impacts that we experienced in California alone. Temperature, which I covered here, but there's also things like sea level rise, snowpack, heavy precipitation events, which we really experienced a lot this year throughout and wildfires, which have become more severe in the past five years. So what are some of the things that we could do about the exposure? This is more individual precautions that we can take. Some things that we could do now. Some things that we could do during a heat wave. There's so many different interventions. And of course, they're very local or even individual, individually derived. And for more information, you can visit this website. And the good news is that most of this is preventable. These heat related illnesses and deaths and other health outcomes are preventable. I mentioned at the beginning of my talk the 70,000 deaths that we observed in following the 2003 heat wave in Europe. Since then, many of those countries have developed a heat health action plan, but there's been other areas that have also developed plans such as Montreal, some cities throughout the US, and counties are still trying to develop a plan in California. But most of these occur following a major heat wave episode in Chicago. Their plan followed the 1995 and 1999 heat waves. And so so much of this needs to be done as a precaution. The interventions that we talked about, I know David mentioned some of them need to be very locally derived as well. And I just wanted to thank you for your attention. And I look forward to the other panelists and the discussion following. Thank you very much for that. Our next speaker is Sanal Jaisal, who is Director of Policy at We Act for Environmental Justice. And Thank you. We just get my presentation up. I'm going to say we hear you and see you. Thank you. Wonderful. Great. Well, thanks to the two panelists before. It's great to hear from you all and learn about the work that you're doing. I think what I'm about to say will align very nicely. So my name is Sanal Jaisal. I'm the Director of Policy at We Act for Environmental Justice. We are a community based organization in Harlem in New York City. And we were started out of a fight against the placement of a sewage treatment plant in West Harlem, which was considered an active environmental racism, as at the time Harlem was already saddled with a number of environmentally hazardous facilities in the neighborhood that was already leading to environmental health impacts from air quality and water contamination. And so just another facility placed on top was an act that our founders ended up protesting, which helped us start We Act. And so to this day, what we do is we fight for environmental justice, which is that everyone deserves to live, work, play, pray, and learn in a healthy environment, and that we work to undo environmental racism, which is discrimination interpersonally, but also on that systemic level and institutional level, we're trying to undo racism and fight racism on that policy level when it comes to how we make decisions about what goes in neighborhoods and how we build healthy communities. So as was said, heat waves are increasing in severity, frequency, and duration for New York City. This is a major concern because we are a very, very dense city. And what we have is the urban heat island effect, which makes us even more vulnerable to extreme heat. So we have temperatures that can be many degrees warmer than our neighboring suburbs outside of New York City. And that's because we have just tons of buildings, cars, concretes, and all these different factors that lead us to have really hot neighborhoods. When it comes to extreme heat for We Act, we think about it from the equity perspective that not everybody is affected equally when it comes to extreme heat and not everyone actually is exposed to the same amount of extreme heat throughout the city. So like was said in presentation before, when you zoom down into that neighborhood level, you do see there's disparities in temperature and ability to kind of protect yourself from the heat. So when we talk about extreme heat, most kind of classically, we talk about older adults being very vulnerable, children, people that have chronic illnesses like asthma, respiratory illnesses, people who are pregnant, people who are working outdoors. For us in New York City, we have a lot of construction workers and delivery people that are moving around all the time. But there's also an addition to the story that we look at at We Act. We're thinking about people that are living in apartment buildings that are poorly maintained and are very hot. So we have an issue where apartment buildings do not cool down at night. So people are exposed to the heat 24 hours a day, which is where you see that health impact happen. People that live in crowded apartments. So you're sharing your fans or your ACs or you're just kind of cramped in a tight space. If you're living in a neighborhood that doesn't have as many trees or as many parks, which we know is all in part due to the history of redlining and as well as for neighborhoods that have air pollution issues and more industrial sites that contribute to heat and air pollution. People that are already dealing with a number of hardships where extreme heat is really an amplifier. It's a risk amplifier where if you're already dealing with issues, paying your rent, for example, extreme heat can be very hard on you because you might be having trouble paying your electricity bill to run your AC system, for example. So when we talk about extreme heat, we actually look at it from a very intersectoral and nuanced perspective in terms of the solutions. So our main focus is how are we helping to improve environmental health impacts from extreme heat? How do we reduce the fact that it is the number one rather related killer that we do see hundreds of people hospitalized or going to the ER or passing away from extreme heat? How do we really address that issue? And we know for we act a lot of that comes down to looking at policies that we consider to be have a history and environmental racism and how are we kind of shifting that and putting out policies and programs that are protecting the people that we deem are most vulnerable and haven't received investments and protections for many generations. So this is the core of what I'm talking about is just some policy examples of things that we work on when it comes to addressing extreme heat. And it is quite a nuanced and complex issue, which leads you to have a lot of really interesting solutions. I think it was kind of also mentioned in the previous presentations that a lot of time when it comes to extreme heat, creating spaces and protecting people from extreme heat tends to also be the same type of solutions for other issues that you might see in a community. So, you know, if you have a desire like Dr. Hondula mentioned the parks, children needing a place to go play. Well, there's a way to build that in a way that is also protective of extreme heat, for example, or we're talking about building a lot of green space to help with flooding to help with carbon emissions. And also what that is doing is cooling down the city and providing shade as well, which helps with extreme heat. So there's a lot of the times of policies that we push forward are really addressing multiple issues at one time. One of them is indoor extreme heat protections at something we focus on a lot we heard from our membership which is about 800 people in northern Manhattan that first and foremost when it's really hot people want to stay home and they want to stay safe in their homes. And so how do we do that that all comes down to helping low income households live in sustainable and affordable homes where they can access the cooling that they need. And so that's something that we're pursuing is not only how are we kind of transitioning away from fossil fuels but for us now this translate into the extreme heat work how do we make sure we are funding for low income buildings to actually be putting in more energy efficient systems in their buildings to help people cool down in an affordable way. So we're making sure that there's actually limits on how hot a building can get and who is responsible for that. And another aspect of that is community spaces, senior centers use centers libraries, what have you should also be responsible for providing or staying under a certain temperature maximum. Another policy bucket that we have as a neighborhood level protections so cooling centers were also mentioned that something that that New York City has. However, most people don't know about them and most people do not go to them. But we do find that in New York City, people do tend to go to cooling centers if they actually are some if there's like another reason to go. So the most frequented cooling set type of cooling center in New York City is the public libraries, because you have and senior centers as well, because you have whole populations of people that maybe would have been doing that anyway on a Saturday afternoon. So how are we looking at spaces to become cooling centers that are spaces that people actually want to go to, for reasons outside of just getting some cooling. Because we found that in schools, for example, that open as cooling centers in emergencies, they weren't really used at all. Nobody wants to sit in an empty room just to be cool and they don't pick to do that. The other thing is heat alerts that was also mentioned. That's something in New York City that we're looking at is how do we create some kind of a better alert system because we find that the perception of extreme heat risk is quite low. And then in terms of number three, and when it comes to green spaces, what is really important is ensuring that our neighborhoods have adequate tree canopy, but even beyond that because sometimes there's issues with putting tree canopy on sidewalks that maybe cannot host that anymore. How do we also make sure that we're encouraging residents to maintain the green spaces in their yard, in their front yards, in their backyards. How do we make sure that parks are not just concrete, but our green have lawns and have shade. So these are some really important different kinds of policies that we work on. I'll skip that. But then lastly, I'll also touch on for we act is that we run a heat health and equity initiative and what we create every year for the past couple of years is a policy agenda for extreme heat where we outline all of the things we would like to see done in New York City to address the issue of extreme heat. And it includes a huge range of policies, some of which I just touched on very broadly, but they they include some more specific recommendations. And we do have the 2023 agenda coming out later this month. So we encourage everyone to watch for that. Because it will also contain a lot of really good examples that I'm sure are very easy to translate into other municipalities and other places across the US. So thank you very much. Thank you very much for that. I think there was a lot of people nodding along with what you were saying is incredible work. So our last speaker for this sex session is Reverend Vernon Walker who is a program director of communities responding to extreme weather and a graduate student working towards earning a master's degree in public policy at Tufts University Department of Urban and Environmental Policy and planning department. Sorry, I'm having trouble with these ends these long titles. Thank you for joining us. Well, thank you so much. Yeah, those hands can get you caught up for a while. Well, I'm glad to be with you all in fact I'm elephant happy and hippopotamus glad to be with you all to enjoy in this conversation and it's really been insightful. So I'm going to share my screen to share with you some of the work that crew has been doing around extreme heat. So we are going to get this ball rolling here. I assume you all can see this. So yes, all right, fantastic. That's what I like. I like to hear that. And we will see here. We will we're just getting this together here. All right. There you know, the glass is shattered. And we got some really fancy transitions here. So, before we begin and before we go into the work of what we've been doing we're going to just share who crew is and give an organizational background. So crew with a young grassroots program that aims to build equitable inclusive neighborhood climate resilience and New England through hands on education and service and planning. I'm just going to explain how what that looked like in the terms of extreme heat we're based out of Kingbridge, Massachusetts. And we are a program under the better future project and crew has been in existence since 2018. I myself have been with the program since 2019. All right. So let's talk about extreme heat. So I got a chart for you all we've been hearing throughout about throughout this panel about extreme heat and devastating numbers and a number of how people are dying in New York and in Phoenix and other places. What I'm going to do is draw a national context. And this chart comes from Noah, the notion of a national oceanic and atmospheric administration. I just want to point out, and this is no surprise to all of us that are engaged in this work that extreme heat is the leading killer of extreme weather across the United States, the numbers bear it out. What we see here is that in 2021 375 people died across the United States because of extreme heat, and in some ways people feel that this number is underrepresented. And currently we see that the amount of people that died in 2021 2021 because of floods is 146 on the chart. We see that lightning has killed 11 people we see that tornadoes had killed 104 people. We see hurricanes 12 we see winter 40. And again I'm just focusing on the red bars, but this chart does not only does not only juxtapose what happened in 2021. This chart also juxtapose a 30 year average. So try verse with me if you will, to look at the yellow bars. We still see that extreme heat is the leading killer of extreme weather over a 30 year period of 1992 to 2021. Per year 164 people have died and some years it has been higher in 1995 739 people died in Chicago because of a five day heat wave, the city that I'm from Philadelphia in 1993 120 people have died because of a heat wave. So, so we realize and recognize that extreme heat is deadly dangerous and disastrous. And also, as we mentioned the numbers bear it out we've heard throughout this from our esteemed panelists and throughout this segment of how he is a multi as a threat multiplier. So, again, we see the numbers here of bearing out the day the gravity in which extreme heat should be dealt with. So we're going to go to the next slide here. All right, so now I'm going to just focus in on New England now we big big national now I'm just going to focus most of Massachusetts. And we see this is actually from the WB you are, which is our MPR station or MP or WB you are is affiliated with MPR. And we are expected to see over 31 days of extreme heat in the Massachusetts area. By 2030 by 2044. By 2084. We are expected to see and again we know there's a tipping points but this just gives us an idea of what's happening around New England. And what will happen, and what could happen that we could experience over 60 degrees of temperature over 90 degrees. And we know that in some summer time in the Boston and greater Boston area is is considered 91 days so we're talking folks that the majority of the summer will be dangerous for folks to go out and we heard the categories of people that are at risk. I'm going to just talk a little bit about what we do from the community engagement piece and from the community engagement side of things to deal with environmental justice community. So you have this chart. You see this chart. And again I'm highlighting how much extreme hot days were expected to deal with in Boston in the greater Boston area. So this is an urban heat island so we've heard urban heat islands mentioned. So this is just an area. This is just a map of the greater Boston area. So what we see here is that there are areas that are bright dark orange so for the many of you who probably flown in to Logan airport and a very familiar with Logan airport. That is that's an East Boston, and that is considered an environmental justice community, not only because they heat but also because it incessantly floods. So essentially, what we see here is that you know this dark orange here. So this is an environment E and J community. We see, we see parts of Cambridge where I live I live in Cambridge we see parts and summer bill. We see parts of it experience from there. We see parts that experienced the urban heat island effect, because a lot of the impervious surface, and then we're going to come to Ashmont. This is in the Dorchester area right here. What we see here is a lot of other dark orange and we see a lot of, you know, a lot of asphalt and black rules and lack of green space. So what we see here is that these communities that are experiencing the urban heat island effect in this other than this map comes also from WB walk. I want to focus a little bit on this area, the Ashmont area the Dorchester area. But I'll revisit that in a second so you have a visual here of what the urban heat island effect looks like for the Boston and greater Boston area. So what is crew doing about this. So we have climate resilience hubs on our website, www.climatecrew.org. We have we work we have over 130 hubs across the United States and one in Canada, and hubs are community institutions, community anchoring institutions like libraries, churches, libraries, faith communities, community centers, nature centers, etc. So these two, the reason I highlight these two right here is because crew has partnered with these two organizations, not only are they hubs, but they're, we've also partnered with them to provide a virtual picture of later air conditioner cool energy efficient air conditioner unit and cooling kits. So we essentially work with these organizations to help prepare their community members for extreme weather. And a lot of times what we do is we provide information on best practices to prepare for heat or hurricanes or floods or tornadoes fires, etc. Because and because we have because our whole program is national, different parts of the country face different threats from extreme weather. So, again, these are our hopes if you wanted more information about our hubs, please do visit our website. But again, these two hubs we partnered with in 2022 to do to conduct best practice workshop workshops, which we're going to talk about in a second. So this is a picture from last summer. This is and we're also going to be doing these workshops this summer too. So what we do is we provide these resources, but not only do we provide resources like air conditioners and cooling kits and I'll touch on cooling kits in a second, but we also have workshop on best practices to stay cool. And we partner with Mass General Hospital that's why you see Mass General Brigham, which is a system which Mass General Hospital is under. We partnered and had this event on how to stay healthy and summer heat. So there's the crew logo there we've met the Mass Audubon so that the Mass Audubon the Nature Center is one of our hub. And we also partnered with the Metapam Food and Fitness Coalition to do organizing to because we believe in working with organizations that are rooted in the community that we work with together to organize and get the word out so residents can come to these workshops. So these workshops are normally held in the evening. We also provide food because we know that in places like some parts in places like the south end and Dorchester and Maddan and Brockton people are also not only the environmental justice community but people are also dealing with food insecurity. So we also provide we buy food from local businesses and get that catered and make sure we have that. And then we wrap it off air conditioners because we don't have unlimited supply. Okay. We don't have unlimited supply and I'm going to be wrapping this up in just a second. Maybe somebody should mute because I think I hear something. I don't know if someone's talking to me or someone's talking to somebody in the background. But anyway, so yeah, just have a couple more slides and I'm going to get out your way. So that's our workshops. That's what we have been doing because we believe in powering people with knowledge so they can prepare for extreme heat not just giving, not just us giving out resources. And I also want to parenthetically say that in 2020, the city of New York provided 73,000 air conditioning units. So I didn't see evidence that they provided workshops, but they had a mass AC distribution which you know, many of you all know. And also, I should have said this in the beginning but I want to thank the National Science Academy for organizing this and putting this together so while that's belated I also wanted to throw that in there as well. So, alright, so we're coming down to the closing of this. So this is someone that received the air conditioner you can see the bright smile, you know, and we've, you know, we've got funding to pay, we received grants to pay for these air conditioners. So you see the air conditioner you see a truck full of air conditioners in the back. So that's normally how we transport the AC unit. And then you'll see like a bright orange kit. You may be wondering what's in it. Well actually I'm so glad you act because I'm here to tell you. So what's in our kits. These kits right here is water, electrolyte tablets, cool patches, thermometers, and these are designed for people to take with them when they're going outside. So they can treat heat exhaustion as you can see release for heat exhaustion. And really this is this little mobile kit is designed to be on the go, especially for outdoor workers. I mentioned earlier how outdoor workers are at risk. But also, that's what we do at crew. So we're here where we're helping prepare people on the ground. And we're targeting and J communities will do it again this summer in the city of Boston, which is about 45 to 50 minutes away from the Boston area. But also there's a building a state house and then I'm going to close with it and I'm going to, and then we're going to get into the Q&A. So building a state house is called the Massachusetts State House is called an act of promoting resilience to get the heat related impacts of climate change. So Bill s 2097 there's a hearing next month. So basically if this bill passes and our state legislator, it will provide reimbursement for folks to buy fans, not exceeding $75 and also air and a reimbursement of air conditioner units, not more than $500. So what's going on is people will be in reimburse and this is designed for elderly and for for underserved folks that live in underserved communities and low income. But again this bill has not passed yet, but if you want more information bill s 2097 and I know this will be recorded. And with that I'm going to put a pin on it because I know we have to transition to Q&A, and we're really so glad to hear some questions and take some questions and answer some questions. So with that, I'm going to put a pin on it and stop my presentation as we proceed on. Thank you very much for that that was an excellent collection of talks and I think, you know, we heard from Dr. Honjula who talks about sort of the need for community interaction and research and some of the solutions and Dr. Honjula who talks about health data measurement and the importance of thinking beyond deaths to sort of the more nuances and Ms. Jessel about this intersectional thinking and action and heat is a brisk amplifier. And then to Reverend Walker there who sort of zoomed in and out through community action. So really scalable solutions so thank you all for that. For the Q&A, I think the first thing that we'd like to sort of throw back to you and, and if you could all maybe answer from your own lens and perspective is, how can we deal with the cumulative health risk so this compounding of you know even secondary factors like heat or we've heard wildfires you know evacuations gun violence like all of these things interact and you know I think with some of this there's the issue between, you know, fear and inciting action but also, you know finding building practical solutions from each of your lens. What are your perspective on those, perhaps, you know we can walk backwards maybe Reverend Walker would you like to tackle that one first or is there anyone who wants to speak to that. Yeah, could you repeat that because you repeat that again I lost a little bit of you could you repeat that question again and I'll be happy to provide a short answer. Yeah, I think it's how do we deal with that the cumulative health risks as well of, you know it's it when we talk about heat then it's you know the risks are amplified by things like air pollution. And the impacts that you see this on on the community are these are these conversations about cumulative cumulative health risks when you're dealing with it or is it focused on heat waves. For us and our workshop and thank you so much for that again, for us. That's why we partner with Mass General Hospital Center for environment and health of which I sit on a basally board at. So we we and we partner with the doctors from other medical institutions here in hospital, because we bring we want we bring these physicians and to talk about this is how you know that your experience and heat exhaustion, this is how you know that your experience and heat stroke. So in our workshops what I didn't mention, because we know this is related to climate change and I didn't really talk about that but we are very intentional about connecting what we're experiencing now to the climate crisis. So people can understand that climate change is a threat to public health. In our workshops, folks don't just walk away with resources, but they also walk away with knowledge on Oh, if I'm expecting my body is experiencing the symptom, then I must be experiencing a heat, I must be suffering from heat exhaustion, and I need to get this treated right away. In our workshops, we connected to because we understand and recognize that there's a lot of things going on in the world, particularly in underserved communities, extreme extreme heat and climate change is not at the forefront, racial justice at the forefront, you know, economic justice at the forefront, being racially not being racially profile is at the forefront and for some, you know, just going just, you know, going day to day is at the forefront and some are struggling to rub two nickels together so we're very cognizant of that. And we try to be aware and wrap it in such a way where, you know, the experiences of the extreme weather is not happening 50 years from now. It's happening. You know, the last six years have been some of the hottest temperature on human in human history so. Yeah, so we so for us, we, we tied all in together we tied public health and climate change and and social resilience, you know, I didn't mention this, but people can go and check out this on our website we also published research with some faculty at the social connections and extreme weather. And it is on the United Nations website but I could have been there, but I would hope that answers that question, from my perspective. Yeah, if I can add to that that's excellent work, Vernon, I think from my perspective, these epidemiologic studies have been very population based, larger scale, which is great for kind of generating hypotheses and making up that there's high risk communities, but it doesn't matter for thinking about heat or wildfire air pollution coven, or even these cumulative impacts, the populations at risk, we've already identified them. And the type of work that Vernon is doing is exactly what we need community level interventions, because if we can work from kind of like the inside out. That's what we need at this point. It's not enough of identifying vulnerable populations we know who they are, we know where they live. And it's time to kind of take action for those particular communities. Yeah, and, and I'll add like, you know, exactly the point that everyone's making here that usually extreme heat, at least the way that I talk about I say, if you're having an issue with extreme heat you're probably having an issue with a bunch of other things and really a lot of the solutions that we push forward are trying to address, you know, a multiple hardship issue, you know, problem that we're talking about and so air pollution is probably the biggest thing that we usually connect with extreme heat, as well as the climate crisis. And, you know, we talk about how air quality triggers as you know air quality issues triggering people's asthma for Harlem and the areas around it, there's really high rates of childhood and adult asthma. And so it helps to kind of talk about it that way of like, yeah, you know, really hot days can kind of trap air pollution in ways that can be really harmful. You know, try to kind of talk about it in ways where they're very connected, as well as, you know, for trying to ultimately reduce our emissions from buildings, which is New York City's biggest problem for greenhouse gas emissions, then actually making homes more sustainable, making homes more energy efficient is not only good for extreme heat protection, as well as reducing air quality issues inside the home, but also is helpful for climate change so that's like one example of the way that we talk about multiple kind of big issues all at once. Yeah, thanks and just to briefly add and I know we've got a very dynamic polling happening here. I would argue for the folks who are on this call that the heat champions that are out there. I think our work is in part to ensure that heat is in the conversation when there's an opportunity to talk about cumulative and combined exposures. When we read hazard mitigation plans across the country the level of detail for heat is very scarce relative to other hazards so I think, I think we need to keep working to get heat in the conversation when there is an opportunity to think about co benefits or at least avoiding contradictory mutually harmful strategies. Thank you for all of that and I think really brought into the human experience into this and these narratives that we've in, we've, we've in and out. We are very tight on time but I really want to ask the highest rated question there which is, how is California balancing the need for air conditioning. So increasing energy use possible reliance on fossil fuel with reducing greenhouse gas emissions in the state. It's not related to, to California but also I think you know it's really a question. That's a broader question, right that people bring up a lot. Does anyone have any thoughts on this. I can start because California was mentioned. I think for California specifically. It's a little bit different in that northern California, especially coastal areas, many of the homes don't have air conditioners. This is often a marker of socioeconomic status but it's kind of a paradox here in that some of these coastal homes that are very expensive. These areas don't have air conditioners and that's just because in the past, we haven't needed them. So I see that there is a big initiative to increase air conditioning use. And of course that puts potential problems on the grid right so the electrical grid between electrical car electric cars which of course we definitely need to decrease emissions but we have to think about some of the implications for increasing electric cars and putting more generating more issues in other ways. And I know that that's often the kind of end all be all like let's just put air conditioners in every house, but even in some of the epidemiologic studies we've seen is that with air conditioning use, there's still health impacts. It's not really going to kind of be a cure all, particularly in certain communities, and the vulnerable subgroups in those communities, it's not going to be that helpful to kind of mitigate all health impacts. Yeah and I can I can just quickly add that I think you know the important piece to this is that I remind folks is like air conditioning very much like an emergency response to an emergency situation where people need to not be hospitalized or died prematurely because they didn't have cooling in their homes. And the bigger picture is how are we like mitigating and adapting to climate change. And so in New York there's a lot of work going on about how are we electrifying everything which comes at a different cost and is a different conversation for us to have it another time but you know how are we moving away from fossil as our source is you know a parallel process that's going on how are we putting in more sustainable cooling systems in people's home is also a parallel process so I think it's it's also you know sort of like what's the short term thing that we're doing to immediately protect people and then what's like the longer term goals that we have when it comes to cooling in homes. I absolutely agree with what several panelists have said. I think we would definitely love to get heat cooling pumps. We just haven't found the funding. So I think while AC units do help provide indoor cooling. I think cooling pumps, which will be zero carbon emitting would be ideal. They just cost a whole lot more. And I think for us, you know, especially as a nonprofit. I think we, you know, would certainly be happy to give out cooling cooling to help people and that provide an instant and will help people connect to cooling cooling pumps and also heat pumps to we just haven't found the appropriate level of funding that would allow us to do so. But I think that would be the ideal situation where there's zero carbon emitting a mission happening because even though ACs are energy efficient and the ones leaving them out, they still do admit a level of carbon. Well, thank you everyone. Thank you also for bringing in the conversation of mitigation and climate change. Sometimes I feel like as we talk about adaptation, it gets sort of moved off the agenda and it's almost like telling people to just go smoke outside without actually, you know, tackling sort of the bigger public health emergency that's underlying. So thank you very much. So I think we're going to move on now to the, yes, okay, I'm getting a nod. Good. The shared story section. Thank you all for your expertise. So I'm going to pass this over to Sabrina. Hey, God unmuted. Thank you so much. Thank you so much to that panel and to Anna for that really, really excellent and multi perspective dialogue and for stage setting our whole workshop with some very important questions some very important insights and really getting us going for today. Really wonderful and thank you so very much to echo on us. Thank you. So this panel which I have a great pleasure of moderating is really focusing on the way that I think human beings understand information, which is through stories. We have three people who are going to share stories from different perspectives. First, healthcare workers, second communities of color, and third worker protections. The goal is to really highlight various shared experiences through these different stories which are going to be in different locations, affecting different communities working with governments and various stakeholders in different ways. So I'm going to hear a lot of different factors in the story a lot of different elements that play out in the context of exposure to extreme heat. And we're going to have some time as we did in the last panel for questions at the end, each of our speakers on this panel are going to speak for about seven minutes. And I will turn it over to our first storyteller Cecilia Sorensen. She is the director of the global consortium on climate and health education and associate professor of emergency medicine and environmental health sciences at Columbia University. So we're going to be sharing with us stories of extreme heat and clinical practice and just as a reminder as I introduce people. I'm not going to be sharing their extensive bios those bios are available on the website and should be in the chat right now. So with that I will turn it over to Cecilia we can see your slides thank you so much Cecilia. Great. Thank you so much Sabrina and I hope everyone can hear me okay. So I'm going to share my perspective as an emergency medicine physician and I hope that the stories I share will be really sort of a snapshot and a window into what we're seeing on the science of healthcare as it relates to extreme heat. So I'm going to present two case studies a little bit sort of in a medical style, but follow along and I'll try to use sort of lay terms to keep everyone together here so the first case is of a six year old male who had a history of a cardiac arrhythmia his history of hypertension. He takes multiple medications that are unknown to him he just knows that he takes them the red one the green one the blue one, and he is Spanish speaking only. And he presented to my emergency department with a chief complaint so that's why patients come to the ear of feeling lightheaded and then passing out. He was brought to the ear by his family after he was found collapsed in the backyard. When I went to his bedside he was awake he was alert and his vital signs are as you can see here his heart rate was elevated as was his blood pressure and his body temperature was elevated above what we would deem to be normal. The second case I want to share with you is that of a 36 year old male who is previously healthy. He presented with a main complaint of confusion. The story was that he had been driving in enclosed tractor all day around in summer temperatures this was in the eastern plains of Colorado, and he was found confused at the work site he arrived via an ambulance to the emergency department and I met him at the entry to the emergency department because we had gone to call ahead from the MS that they were concerned about this patient. He was ill appearing. He was difficult to arouse but he was arousal by voice his skin was very dry. His vital science he had a very elevated heart rate and he had a little bit of a low blood pressure, and his temperature was 103.3 degrees Fahrenheit which is very elevated. So, this is what he ended up looking like after we sort of instituted rapid cooling measures and I'll talk a little bit about the treatment of each of these patients but I want to sort of give you a little bit of an overview here of how we're thinking about sort of the clinical spectrum of heat related illnesses. The first patient I presented we would have sort of diagnosed him with heat exhaustion right. His core body temperature was not severely elevated. He was not of any neurologic dysfunction he was not confused he was not disoriented. His core by temperature was a little bit elevated, he felt lightheaded he did pass out. This is in contrast to heat stroke which is a life threatening situation where your core body temperature is severely elevated, and you do have some neurologic dysfunction. Now heat exhaustion can progress to heat stroke, but oftentimes we're looking at specifically heat related deaths we're looking at people who die of heat stroke. So, when we're sort of looking at patients who come into the emergency department. From a clinical perspective, each has a very unique constellation of risks or vulnerabilities, which help us. So, explain why they ended up being diagnosed with a heat related illness and so we classify these as you know, what was their exposure. What was their sensitivity, and what was their adaptive capacity that made it so they were perhaps unable to to cope with the extreme heat experiencing so just to show these an example let's look at case one a little bit of an analysis here. So just to set the context. This was during the summer they were higher than average temperatures but this was not a heat alert type of situation it was just a hot summer day. This was an elderly male, he had history of a cardiac condition. He was on multiple medications and he was Spanish speaking only. The patient also did not suspect he was vulnerable I spoke with him he was born and raised in Central California and when I revealed to him that I think he was here at the emergency department today because of heat related illness. He said, he was shocked he said, I grew up in the heat. I know he you know I was drinking water all day. He almost didn't believe me and you know what you have to explain is that the heat that we're experiencing today is like nothing that we've ever experienced in the past. And so sort of reframing that and helping patients who don't consider themselves be vulnerable to that this heat we're seeing is like nothing we've ever seen before. He also had no air conditioning in his home so we obviously need to get the reverence to this neighborhood quickly to sort of get things in order. Thinking about his his pre hospital situation, you know, his family did see him that day he was complaining of feeling lightheaded, you know, his families were reported well we weren't really sure what was going on we thought maybe it had to do with his family we were telling him to drink water, but they were not really attuned to the early signs and symptoms of a heat related illness and so there was kind of a lack of family awareness and community awareness as the science and symptoms of heat related illness now when he got to our facility. We had no chilled fluids, we don't have refrigerated fluids we just don't have them. And then when we're thinking about how you know once we stabilize this patient and he's ready to go home. Make sure that he's not going back to the same environment that caused him to get sick right we need, we need a social worker we need case management to be able to help doing a home assessment to help further educate the family and educate the patient as to things they can do within the house to make this patient safe. I also had no ability to communicate with his medication prescribers for example as PCP and as cardiologists, we have massive issues in the United States with different electronic health records. He didn't have the name of the doctors. He didn't have the pill bottles, you know how much time can I spend tracking down his cardiologists and being like hey, your patient who you have on a diuretic came in after he passed out. We need you to adjust this medication right so I had no way of communicating so these are some of the barriers that we're facing when we're trying to address the health harms to patients who really have kind of I would say fall into the cracks of public health prevention measures that happen in our communities the second case, you know, again this was higher than average temperatures, but this was not a heat, a heat wave right and so what we're learning more and more is that heat injury often happens on the shoulders of heat waves. It also happens during them, but when people are not getting alerted they can still get injured. There's a big question mark here as to whether or not there were any workplace precautions in place and we're going to talk about that later on today. This was a 36 year old male. He didn't think he was vulnerable to heat. When he did end up having a positive urine drug screen for methamphetamine so he was using substances while on the job in the heat so another issue but that did contribute to his vulnerability pre hospital he was picked up by an EMS crew. No temperature was taken in the field. This is a big issue and no cooling was started in the field we know that heat stroke is an incredibly time sensitive condition we have to lower their core body temperature and 30 minutes or less to prevent organ damage we need our EMS crews to have ability in ambulances to cool patients and they need to be aware of protocols, and they need to be able to diagnose this in the field right because it took 20 minutes during transport from to get to the ER like this is precious time right. His coworkers had no idea what was wrong with this guy they're like I think he was partying last night we don't know right so really no no workplace awareness or precautions around the signs and symptoms of heat stroke. Now when he got to our emergency facility I mean it's a little bit embarrassing for me to report but we had no ability to do cold water immersion which is when you immerse the patient in a bathtub of ice slurry. We rapidly exhausted our ice machine we had our security guard go across the street to get ice from the gas station. We had no ability to monitor his core temperature we called up the ICU three or four times, trying to get a core temperature monitor. And overall our staff didn't really have experience you know we don't have we didn't have protocols in place I was like we need to pack this patient in ice and cold water I need a fan and people are looking at me like I'm crazy I mean, this is not my patient in this picture I'm like, this is kind of intense we don't do this every day in the ER. Okay, so a little bit of a breakdown there and that if we take these sort of in this little microcosms of my day in a life. And we blow them up to something like the Pacific Northwest heatwave which happened in 2021 right this was a historically unprecedented extreme heat event near surface air temperature anomalies were up to 20 degrees Celsius above normal over a very wide range of the Pacific Northwest into Canada. There was a relatively relatively short advanced warning, and this region had very little lived experience with heat. They were also acute on chronic capacity constraints this is a population area this growing faster than healthcare capacity. And this was during coven right so you can imagine this was like, you know what we're talking about climate change and compounding disasters. Here we go right. So what ended up happening was that there was a 100 fold increase in heat related visits and this is just looking at HHS region 10 this is data from the CDC. And, you know, 100 fold increase is a lot right it's a lot for an emergency department to manage one critically sick heat patient. Now imagine there's 20 or 30, or 40, and they're right. Okay, so this is this is a lot a lot going on. When we did it when not we when an analysis was done looking at who was vulnerable during this heat wave it was found not surprisingly the community deaths were higher in neighborhoods with material and social deprivation and lower levels of green space. Okay, we also know that mental illness and substance use disorders were significant risk factors for patients, and that the risk was highest among those age 65 to 85 years old, and among females. Okay, data from nature figure from New York Times. So what ended up happening on the ground and this is all anecdotal evidence that that I've gathered and gotten from various sources. So first of all 911 call centers were overwhelmed. We know that with extreme health, we have impacts on health directly. We also know that there's a rise in an accidental and non accidental trauma. We know that there's more homicides more assaults, more issues of domestic violence like things go haywire right so 911 call centers were overwhelmed. There were surges of patients in regional hospitals. Meanwhile, several facilities lost power. Okay, there was no regional disaster plans in place for heatwaves so what I heard anecdotally, what happened is that they triggered the only disaster plan they had for the region, which was specific to respond to earthquakes. They thought that was going to be the biggest thing was going to hit the region. So they activated the earthquake response plan which was good because it got everybody talking to the right people the EMS, the different hospital systems, it kind of worked but again we had no plans in place for heat hospitals quickly ran out of ice, you know, and and abilities to cool patients and so this ingenious idea kind of spread virally throughout the region. Doctors went to the morgues and they got body bags because these are their waterproof, and you can fill them with ice and water and you can submerge patients. This is how many patients there were guys so it was it was a really intense situation. And this was a sort of very much an ER, you know duct tape fixed to a situation at the time ventilators were in short supply because again this was COVID. So after this heatwave, you know the Pacific Northwest really had this, you know this never again moment like we will never let this happen again that was horrible and so what did they do they created heat action plans and effective cities. They started having closer coordination of EMS and healthcare systems with meteorologic services right can you guys give us a little more morning right like tell us what you know right. There has been more engagement of communities most impacted by heat and environmental injustice, including seniors caregivers for children communities of color to improve extreme heat plans and response there's been greater outreach to homeless and mental health populations, and they've done upgrades, so they're not going to be caught off guard again. So this is good. So when this happened in the Pacific Northwest, maybe we would think wow you know if you're sitting in a city in Montana you might be like whoa we better start getting together because this could happen here that that didn't really happen right, we seem to have this barrier as humans whereby, unless it happens directly to us we don't think it will ever happen to us right and so we're stuck in the situation but the Pacific Northwest is ready so. So thinking about sort of the health care system challenges so there's clinical challenges right. Treatment of heat stress and saving a life from heat requires first of all recognition and second of all administration of care right of the right care at the right time, and that requires trained staff right and that ranges from the paramedics to the person sitting at the front desk to the emergency department is taking a triage complaint to the nurses caring for the patients to the doctors right, and these folks have not been systematically trained. We know that widespread access to cooling resources is limited. Right we're using body bags. And we know that a whole health care system approach is really needed right we need social workers on board. We need case managers, we need our pharmacists right who are sitting in CVS drug stores around the country, dispensing diuretics during a heat wave to warn patients that they're going to make you dehydrated and there's a heat wave right. We also are suffering from a lack of research to guide evidence based practices so for example, we don't know what we should be doing to cool pregnant patients who come in with heat related illnesses. We have no idea, we have no studies, we're using our best guess so we need more research to improve our practices. We also know we have health care system challenges right so there's not been widespread adoption of triage and treatment protocols for heat related illnesses right. Heat related illnesses are incredibly time sensitive similar to a cerebral stroke, or deceptus where we've had massive national improvements and indicators because we have treatment protocols, we haven't done this for heat, there hasn't been that push. We also have no mandate to require heat or other climate related events to be part of a facilities hazard vulnerability assessment, all health care facilities have to do hazard vulnerability assessments, there is no mandate to require heat, or any other climate related risks there. We are sorry to interrupt but do you is this your last slide. That's it. Okay wonderful I will let you finish thank you so much. Okay, sorry. Anyway, we also have community challenges, lack of patient and community awareness, and, and so on and so forth. So I'll just wrap up. Thank you so much. Thank you so much Cecilia that was incredibly compelling and very very important work that you did in that context and sharing that with us so thank you so very much for that story. I'm very happy to introduce our next speaker storyteller Zilla alum will be it. She is the sorry I've lost my Zilla alum out of free is a CEO of Catalyst Miami. She is going to be speaking out today to us today about her experience working with communities of color in the context of exposure to extreme heat, which is, we've already heard so far today is an incredibly important area of work. And with that, so I will turn it over to you thank you so much for joining us today. Thank you. Thank you for having me. So I don't have slides, but I hope this story is engaging in it of itself. So hi everyone I'm Zilla I'm a deference. I'm the CEO of a nonprofit organization here in Miami Dade County, Florida, called Catalyst Miami. We were grassroots power building organization and we focus on issues of social and economic justice here in Miami Dade County, including climate justice which I came on to staff, seven years ago now to build out their climate justice programming so this is a seven year long story condensed into five to eight minutes on our work specific to heat. So basically, when I when I came on staff seven years ago my primary job was to create grassroots leadership training programs so these are free programs that we offer to community members to build up their leadership and advocacy skills. So I was asked to create a curriculum on climate justice in particular. And so that program is called clear it stands for community leadership on the environment, advocacy and resilience. And it's a 10 week program where community members learn about the specific climate threats facing Miami Dade County. And then they build up their potential solutions and then they build up their advocacy skills, such as telling a personal story how to speak to elected officials about these issues, as well as how to speak to your neighbors and bring other people on and I'm so happy to say, since this is launched in the fall of 2016 and we have well over 500 graduates, and we've replicated the program to have a health justice program and a housing justice program. But anyways, I'm the program, like I said talks about different climate impacts for Miami so we talk about sea level rise and flooding and hurricanes. We have another section on climate and health where we go through all the ways climate impacts your health from mental health to extreme heat. And basically when we go through that section of the curriculum our community members by the way this program is free. We have youth programming as well so parents turn alongside their children who have like a similar program in the room next door. And then we also provide interpretation and free transportation, everything to reduce the barriers to get people to participate so we can learn from their wisdom. And they, out of all the issues that we talked about and all the challenges. People really said they felt the heat issue the most and in particular, the statistic that we showed was that since 1972 between 1972 and 2018 Miami has added about 70 days over 90 degrees so that's about two more months of summer in an already quite hot place. And so when we asked people in the room like how many of you have noticed this as longtime residents of Miami Dade County. Everyone that had been here for long enough was like, yeah, definitely I felt like two more months of summer from, you know, back in the 70s or 80s when I was growing up here. So for us like a huge important part of this program is that those community members inform our policy and advocacy work as an organization as well as help us define future programs that we, that we create as well as direct services we do direct services as well. And so when we're hearing over and over that he extreme heat is something people are feeling, whether they're an outdoor worker, or they're just waiting for the bus stop for the bus and our we have a perpetually late public transportation system that you know has unshaded bus stops everywhere throughout the county. Clearly this was a big issue that we needed to work on. And so we approach our county to work on this issue we told them like all about the stories that our community members were sharing with us as well as the statistics. And then they told us like they had, they had gone and looked this up and unfortunately, the health department does not gather data on climate and, and heat, heat and health sorry. And so this program, this problem that we're describing doesn't exist like that. And so we were told there's no data so it doesn't exist despite what all of these residents of our county are saying and their personal experiences. And so, at that point, clearly we know this is an issue. And so we were tasked with gathering the data ourselves. We are local university Florida International University was doing citizen science stays on sea level rise at the time, at the time sea level rise was the big climate issue that our counties and cities wanted to work on. But it's not the top issue for the communities that we work with low and middle income communities who are more facing, you know, challenges paying for your electric bill, having jobs where they work outdoors and so, you know, heat was the biggest thing they're facing rather than flooding. And so we worked with our local university to take that sea level rise citizen science initiative and apply it to heat so we launched our shading date initiative, which was our heat citizen science initiative. We had very little funding, we actually have none. I don't know how if I you pulled this together, but, but they created some sensors that took heat and humidity and we worked with our community members to place them in the locations that that they were spending time in whether it was a park or a bus stop. To highlight what we found was that our readings are up to 30 degrees different than what we got on the weather service. And that when we asked the weather service why that was, it was because their sensor was at the airport it was like several feet above the ground I think like 10 to 10 to 20 feet above the ground which is totally different than being sitting down at a bus stop at a park and experiencing that urban heat island effect right so we had a massive discrepancy. And so, over the years that was in 2018, we continued to present that data grow that program. And we kept pushing and kept bringing it up that we need to address it. And I think we've been successful on several fronts, and first, and that continued pressing of the message that are that our community members have brought up that we continue to gather data to substantiate that data got recognized and picked up by media national media. And then there was an opportunity with a change of leadership in Miami Dade County to really take the lead on this on this initiative so Miami Dade County actually appointed the world's first chief governor specifically tasked to address issues of extreme heat. And that was a very controversial position to get funded. And so our community members participated in the county budget hearings to explain exactly why, like why we need this position. And we got our research published recently, I think it'll be in the upcoming journal of applied meteorology and climatology. And as a result of that the web National Weather Service has changed its heat warning system locally, because previously, I think Miami had a more winter storm warnings and it did heat over the decades, because each local National Weather Service office is in charge of defining what heat, you know what a heat event is. So we got them to drop their thresholds to be much more similar to what people are experiencing on the ground today. And we actually had a heat warning last week, it was extremely hot last week here. And so it was really cool to see that on the news is something notable here in Miami Dade County and for people to get adequate warnings. And actually, we are working with our chief heat officer, or we had worked with her to create an extreme heat action plan we actually worked with her to develop the process to create that plan. And so a part of that was having open meetings to the community to give feedback on each of the elements, including housing and workforce. And so they had about 50 people and every single meeting they had which I think were five or six. And so we're working on the specific sections of the plan and so we have a plan that's really community informed and driven that we can implement now. You know, as we move forward to really provide material relief to the folks here in the county. So I think I may be out of time but that's my story for now and I hope to stay connected with you all. Thank you so much that. Wow, I mean I'm so impressed by the success that you've had and I mean little did I understand that we have a historic historic case study that you've brought to us here. So congratulations and thank you so much for sharing that and inspiring the rest of us. I would like to move on to our next storyteller Jora Trang who's the chiefs of staff and equity at WorkSafe. She is going to be speaking to us today about indoor and outdoor worker protections and health, which obviously we are already hearing even so far what an important area of work this is. So with that I will turn it over to you Jora. And do you have slides or are you and I don't see my share slide function here. I don't see it yet either are we having a technical issue do we need any help. Please make me the co host. I'm going to make Jora a co host so that she can share her slides are you is it not allowing you to share your slides. Yeah I don't have any ability to share my slides. Okay, so we need to make you a co host. If you all have my slides you can share my slides but I can start. I'm going to talk today about workers in the California region and the work that WorkSafe has done to ensure that they are protected and I'm still looking for my little thing to show. Here it is. Yay. Great. I know you all were saying we don't have time for any. Wonderful we can see your slides and we can hear you now. Great. Okay warehouse workers let's get into it. I'm Jora. I work at WorkSafe we are the intersection of policy advocacy worker outreach and movement building. And I want to start my story with Maria Isabel Vasquez Jimenez. Maria is the instigator. Unfortunately, what happened to her was instigator for our outdoor heat standard so we are a state plan state which means that we have our own California state plan to govern the health and safety workers I think other states might have Fed OSHA we have Cal OSHA. And I believe it was 2008 Maria was pregnant and she was out punting grapes at the Merced farm and she had worked for nine hours straight. Her body temperature reached 108 and she unfortunately collapsed and died of heat stroke within two days. She died in an outrage that along with the death of 13 other workers in 2005 earlier but as a general rule and I'm not even talking about extreme heat I'm just talking about heat. So in an extreme heat situation, it's even worse. There were, there's been a many, many deaths every year. And it prompted us to fight for the outdoor heat standard. So, when I say us, I don't mean WorkSafe just WorkSafe I mean workers worker leaders work safe and all a whole hundred of organizations that work in solidarity in California labor organizations community organizations to fight for laws that protect workers, in particular like to highlight California legal assistance, which is works a lot in the rural area, they have been able as a result of all this advocacy have a direct relationship with Cal OSHA so that they can identify any kind of outdoor situations and, and kind of like initiate Cal OSHA to come out earlier. So our first, the outdoor heat standard that we worked on became the first in the country and applies to all outdoor places of employment this is really critical because it gives Cal OSHA a tool to go out and, and cite people or inspect people. If there is not a standard for an issue it's very difficult for Cal OSHA which is our enforcement agency to go out and be able to cite. Instead they have to rely on the what we call the injury and illness prevention plan which is more of a general, general duty clause. So, so let me, I'm about to tell you how that was challenging so my story really starts with warehouse workers resource center and a collaborative that I that work safe had with warehouse with employees to try to raise the awareness of workers at Walmart, at Walmart, primarily Walmart but mostly many retail warehousing facilities out in the Inland Empire which is kind of like Riverside, San Bernardino County. There are many many warehouses out there and as you know now Amazon has become really a central place for how people shop and buy things warehousing has become a huge industry and and the movement and distribution of goods through warehousing is is a huge part of our our economy now. So my story starts with Domingo Blanca's who was a warehouse worker and Domingo I like to announce as well and alive and living in his home country, and probably not even knowing how instrumental he's been in this country, but Domingo was a warehouse worker and he worked in one of those metallic canisters you know the show that you often see in the shipping yards they're huge, probably you know ginormous and they carry goods that come off of from a boat. They get into a port and they sit there and then they go into a where they get transported to a warehouse. On the day that Domingo Blanca's collapse, it was about maybe 100, 100, 105 degrees outside. But he was working inside one of these metallic canisters and his job was to like sweep and and helped move the materials out at the same time that he was working there was a forklift in there so if you can imagine it's 100 and 205 outside inside the metallic canister it's being cooked like 110 or more Domingo Blanca's and other people are under quota they have to work, get a certain amount of stuff moving and ready. And they have like a limited amount of time to do that they also have breaks which they, in which they can go get water and use the bathroom, but the distance between where they are, and where the bathroom is over the water is or where the water is longer than 10 minutes so it's not within a 10 minute stretch which is the amount of time at the break. And Domingo's reported to me that he was unable to stop to drink water there's no water available and also he just couldn't get to the water cooler. And when he did get to the water cooler. This is what he was given to drink the water. I don't know if I can just pause for a second for you to understand what this is there's a hole at the end of this. It's a piece of paper. Not even cups were available to workers. And so you had just like an extreme situation, you know, employers often say why do you have to mandate this why do you have to mandate that because you don't even provide cups. If I don't mandate you to provide cups and water and a place to cool down you won't and so that's why we're safe fights for what we fight for. So long story short Domingo bonka collapse from heat from heat stroke is what argue our argument was. He went to his employer and said, or he couldn't go to his employer he was just faint and, and somebody reported that he was not doing well, the employer ignored him. He then went to he then tried to go up because it was one of those warehouses where you have a staffing agency in the interim in the middle. So he went higher up to the warehouse owner and they kind of ignored him and everyone just kind of pushed them away. And so the other, he had to have another worker drive him to the hospital. The other worker so I listened to the first speaker Cecilia's presentation I would say that Domingo Blanca's was maybe similar to the 76 year old patient and the worker who drove him was similar to the 30 year old patient in that they were both suffering from some kind of heat situation they both drove themselves to the hospital. Domingo Blanca's ended up being hospitalized for three days and luckily came out alive, but not well, you know still suffers to this day from that situation. So what happened as a result of this is that this case went to trial or an appeal, because we had Cal OSHA Cal OSHA came out because there's an accident they did an investigation they cited, and because there was no standard for indoor heat. So this constitutes indoor inside a canister as opposed to outdoor heat. This went to appeal and the employer hired a very expensive law firm, employer defense law firm to fight it and went all the way up to the state court and I'm just kind of emphasizing that because that's a very unusual you know for somebody to fight the case all the way up to the state court that kind of stays within this OSHA realm of appeals. So we represented Domingo Blanca's in that whole journey, and fought really hard for Cal OSHA to be able to site on this situation, even though there was no indoor heat standard at the time, and we won that case. And then that moved into allowing us to fight for SB 1167, which is just simply a rule that says hey Cal OSHA can you please issue an indoor heat standard. So that deadline had a 2019 deadline. COVID hit and we've just kind of been delayed we're still working on this it's now 2023. So it takes a very long time unfortunately for these things to kind of come to fruition. And everything that Reverend Vernon Walker talked about in terms of community building kind of stands true for me to we in order to build the case for this we went out into the communities we taught this is a picture of me and, and two of my colleagues you know trying to like inspire me to learn about indoor heat or heat and how to fix your body these two people participants won awards for the amount of information they were able to regurgitate back to me. Again, as I was saying this is really a community effort, all these organizations participated in this it's really our entire success story not just work safe. The pictures here in particular want to point out that we got workers out, you know, it's really so important to get workers out to testify what they're actually experiencing for the policy makers and lawmakers to hear from the workers experience because the workers are the experts in what they in, in explaining work environment so that is the end of my story I hope I've made an impact, and I look forward to your questions. Thank you so much, Jorah. Just another incredible story, I just, I'm so floored by, by you Jorah by our three speakers and incredible incredible work. We're going to take the next 15 minutes or so to discuss these three speakers and please, for those of you participating, please add your questions to the Slido, and we are picking up the questions that are getting the most. I don't know if their votes are are at the rising to the top, but I before I pick some questions from Slido I each one of you has worked in such a different context and was such different stakeholders communities etc. I wonder if I could just start by asking you on starting out a more of a difficult note like what has been the primary obstacles to being effective and creating heat resilience in each of your context and, and just you have in the back of your mind I next and feel like I can combine these answers if you'd like and then I want to hear what has been most critically empowering for you what has been most effective what and you know what do we want to create more of in in your context so in any particular order whoever whoever would like to go first. I'm going to take sips of coffee from my little cup here as I talk. I, for us it's been employer opposition, and the political will to pass something that there are a lot of challenges from our Chamber of Commerce, but there's also supportive employers there's also employers who out there who want to make sure that they have the right but there's some economic issues involved with for example running a warehouse like like employers feel like they have to close the doors to prevent theft. You know they don't have an AC system for the entire warehouse now that may be different now but that's I'm just talking about my the case that I had in 2011, you know, it may be different today, but it's been employer opposition every time we come out to do these to fight for these laws employers come out and they they also talk about how it's feasible whether it's practical can they do this can they do that and. And so we have kind of like discussions negotiating back and forth to figure out that sweet spot where we can empower employers to do what they need to do to prevent worker injury illness and also at the same time ensure that workers are safe. I can jump in I think that, you know, with heat it seems like my perception of it is that, you know, when it's really, really hot out everyone says, Oh shoot, it's a problem right but we don't think about it ahead of time. And so we're really lacking in in the preparedness of this right and I think the case of you know Pacific Northwest heatwave is is is perfect right it's you know a place that's completely unexpected this to happen, and it's taken off guard right. And I think at this point I mean no no place in the US should be taken off guard by the risks of climate change right we have really, really good projections for everywhere in the US. And so the biggest barrier is that you know different. I'm not going to put blame, we're not taking precautions across the board right to be able to respond to these and so the question is you know how do we bridge this gap how can we be better communicators about this and put forth options. I think that that makes sense for different communities. Yeah. Yeah, I think I would also agree with political well being and also just, I think sometimes government has so many regulations that they trip themselves up like for example, street trees, let's say we want to put a tree over a bus stop. So trees can't go near the street trees can't go near a sidewalk trees can't go near a building that's all zoning codes that makes something. You know, or you know, the tree roots might tear up some of the concrete so and then a neighbor might get charged because that tree was in front of their property and so people don't want that either they don't want to be like so you know, I think there are there are certain solutions that we're, we've kind of like tripped ourselves up on and regulatory tape and you know to effectively to put forth. So yeah I think like for us like it's that and then like a lack of, you know there's been inequitable investments across this entire country no matter where you are. It's funny like I'm representing communities of color but all of Miami Dade County is a community of color I think we're over 80% communities of color. And you know the, as the country becomes more diverse those inequitable investments. Don't serve, don't serve this nation right and I would argue nor have they ever so. So I think, if you do a one off, I'm just using trees and as an example but if we've had many cases of like one off or multiple attempts at planting trees and communities of color here in Miami, where there's no investment in the, in the care and the botany and all of that and that creates a lack of trust in communities about what people are putting into their neighborhoods only to see it crumble. And so, yeah I think like those in that particular case those are some of our, our biggest obstacles. And more, I forget, and that is Union density or the inability of workers to to organize come together and strengthen their voices that there's such there's so much activity in the last, maybe forever but the last couple of decade and the last year or so to prevent workers from forming health and safety committees meeting to talk about how to improve their workplace and just forming unions like the the workers that we previously organized, or I should say warehouse workers resource center organized, have all experienced some level of retaliation directly following our lawsuit and all those were organizers are gone. They're just gone and then we have to start over again and it's just a process that's cyclical. And it's really difficult for a place to ever improve their, their health and safety practices. Thank you, that all of that was very interesting and I think helpful for all of us to hear. I want to pull a question that's being upvoted in the Slido, which I think actually your last comment is a nice segue into which is, what do you all think about the best way to communicate better to whomever you think is the most relevant audience or audiences about the risks of heat the need for resilient strategies, policy change, accountability regarding retaliation whatever it is you think that the messaging the audience is how can we better improve our communications, because you guys, the three of you have been so effective and communicating clearly it's possible. So some of the studies around who are the best climate communicators have revealed sort of, I think two real groups that come to the forefront one being religious and spiritual communities and leaders of those communities can really be powerful messengers, as well as healthcare practitioners and so some of the work that I've been doing has really been around. How do you train nurses doctors pharmacists public health professionals to be able to incorporate a climate and heat lens into the work that they're doing. When you hear from your trusted primary care doctor like hey it's really hot outside you need to look after your mom, look for these signs and symptoms, people are, by and large going to do it right and so I think we can really, you know, harness that that public trust that health professionals have with communities and use that voice, you know for the sake of protecting the health of our of our communities we care for. So we pull in the mockily workers and that movement. As an example, mockily workers were tomato farm workers and pickers and they, they were talking about piecemeal and tomato picking and it was a wage an hour issue but they ultimately, it was the workers who are giving it making it difficult because they were the ones paying a low rate and but they ultimately created some kind of like, kind of like justice justice network justice initiative you know, where we're big fast food and other grocery stores were getting together and kind of putting forth the, the message that we all care about these workers so it's the same in with heat it's a it's a it's a community it's an environment, it's a social issue. I feel like we have to get the consumers, the employers and the workers all kind of in the same messaging and but we but we all come from different backgrounds like we all feel a different way about it right there are people among us who don't believe in climate change or climate justice. So you have to go to their values and the values are, you know, family based values quality of life quality job quality kind of messaging so all of you know some messaging around all of us being invested in each other, employers in particular are concerned about profit. So messaging that is around healthier workers means more productivity, you know, unfortunately something like that you know. So you, we just have to have and we have to get consumers involved, like, you know, people often for just, they're kind of like this, this outside ring of folks but the consumers are really powerful voices because because they have the ability to control the market. So there needs to be, you know, a narrative shift that includes everyone around quality jobs, which includes better standards around heat. Absolutely. And I'll just add, I think one of the most harmful messages on the back end that I've heard repeatedly I have a public health degree so I've heard this even in academic settings are is that people in the south, or people in the global south somehow have some genetic predisposition where we are not susceptible to extreme heat. And there's like, like, there's a comparison that I that I hear a lot that well people in Miami can deal with it more than people in the Northwest. That may be a little true. There's less AC and seven the Pacific Northwest but that certainly does not serve like the hundreds of thousands and millions of people like that. I hear that the stuff for every single day, you know, or the outdoor workers that work outside I think you're, there's an assumption that because we have air conditioning, you know, more of our buildings that like everyone living here can afford to pay for it and doesn't have to be exposed to the heat which is completely untrue so that's like my biggest communications wish that I think I wish we would eradicate as a field and just like you know, except that the body, the human body can only take so much and these comparisons are definitely not helpful. And that was a huge thing we had to overcome. Sorry, I want to add one more thing, maybe always be the adder. Something you said sparked my, my, my thought. So the whole thing about AC, you, some, you know, there's this, there's just thought or understanding that if you have AC in a building the workers who work in AC are okay. But what a lot of people don't realize is that AC gets turned off at a certain hour in order to save money. And so janitors for example come in and clean a building with the windows closed with no AC. So their clothes are drenching wet, they're sticking to them, they're hot. And so just, just something to note that the worker situations are so complex and nuanced that we just really need as much information as possible in order to advocate best for workers. Thank you. That I'm a theme that I'm detecting here is the importance of embedded or local or indigenous knowledge that helps actually increase the accuracy of any kind of resilience measures which I think you're, you're referring to there. I think we have time maybe for one more question in this session and one that's rising to the top in the slido is how can we make our alerts and definitions of heat risk be more useful in emergencies and this is something that Dr. Asu touched on and that Dr. Sorensen has touched on. But I think you know that even the bigger question is, each one of you are pushing the bounds of even identifying when it's a risk and raising it as a risk and how do we do that better how how can we be more effective, is that we are capturing the real risk and not the imagined risk which has really been normalized in a lot of places. Well, two things what one is that this is from the employers, the employer, the labor side, we have instituted at the federal level and then now in California reporting requirements under the previous administration a lot of the reporting requirements were kind of like weekend. And then we have reinstituted Obama era reporting it's so important that we get report reports from employers electronic reports they're supposed to submit them regularly. So we can understand what is going on in a workplace under the last administration the reporting kind of stopped around six months but you need more than six months. So we've reinstituted that under this administration presidential administration and we need to be able to see how a workplace changes seasonally, you know, with every season so that workers, medical workers field works public health workers can come in and see what needs to be put in place to prevent injury and illness. And the second thing is at least in California we know when wildfire hits when it when it's hot when so we need to be proactive ahead of time with and know that hey it's about to be wildfire season it's about to be indoor heat or outdoor heat season. Let's get all these things ready, three months ahead of time, you know not not not two weeks or whatever not when the wildfire hits and are not wanting the temperatures rise to an incredible level. So really early prevention and being very well planned ahead of time. I think it's a difficult question right because they're sort of like the alert fatigue right well if every other day is a heat alert day people are eventually going to not care anymore. And so maybe it's shifting. I'm not the communications expert I'm just shooting from hip, maybe it's shifting to saying well this is heat season right and all during heat season we have different degrees of alert right ranging from low to high I think about like me driving to a national park it's like fire risk today is low moderate high because we also know that different individuals and populations become sick at lower temperatures than others right so even in a heat wave. So we're already way beyond the threshold for some people who could get sick. I think we also need to embed this into, you know, frontline health care messaging that we do on a daily basis right so if you're a pediatrician, and you meet with a family, you ask them are there guns in the home do you wear seat belts and you wear helmets when you ride a bike, right, basic, basic things to ensure safety, and maybe a fourth question is you know do you have air conditioning in your home, and you know what the signs are of heat illness, right so how do we embed this and kind of what we do every day as as health providers right. We ask similar questions that people come into the emergency department are you safe at home right as you know, and we have these screening questions I think we can introduce something like that around heat into our sort of common everyday practice right, and I think that the other questions got introduced, because there was large advocacy around you know motor vehicle deaths around gun violence around these things that we were just able to generate enough political will to get large medical societies to start making recommendations around this. Yeah, and I'll just share some examples going off of what Dr sorenson said. First, we do we are experimenting with we have a heat season in Miami Dade County now. And I know they're experimenting with creating a ranking system like you know with our hurricanes of a category one to a category five. It's similar for extreme heat. I also think no matter where you are your heat warning system should take into account the urban heat island effect so if I'm like I said we had a 30 degree discrepancy that's significant like bringing it down a little bit to like make sure it's it's not just for that that one that those couple of spots that we're doing radar but like a reflect what people on the ground are feeling even if it's a small like portion of the land in your county I think is important because at the end of the day you're trying to alert everyone but especially those that are most vulnerable right so you want them. You want to include them in the numbers as well so that's it I'll add. Thank you, all three of you so very much. I can't say how impressed I am by all of your work and how important it is. You know, I would say from my perspective one of the key things that I'll take away from this session is the power for social change from the ground up because each of you are working with specific communities at risk in different ways. And it is really in those places that all of you have created improved health outcomes, regulatory change, I mean all kinds of social change and you know I think for those of us who've worked in the climate space a long time we see a lot of climate anxiety, a lot of feelings of powerlessness and I think stories like yours show all of us that we can actually improve situations create resilience even in the context of something as life threatening and seemingly out of our control as the temperature. So I think I'll take that away from this session and hope that we'll see more of that in the in the coming session so thank you three so very much again and with that I will turn it over to our next session moderator committee member Carlos Martin. Hello everyone. Can you hear me right. Right so I now that I am seeing my face on the screen now and I realizing that I have a picture that I just took yesterday. This is from the Kimball Art Museum exhibit on Mayan religious statuary reminding which I am thinking now is quite appropriate given that the Mayan civilization part of the reasons that the mind civilization collapse other than obviously colonization imperialism was changing environmental conditions. So, I took this last week it was the same week that Texas Governor Abbott signed HP 2127 which prohibited any municipality from allowing water breaks that differed from federal ocean requirements and so just things to think about as we enter in this next session which will be more interactive. We want to make sure we're hearing from everybody who is intending, including all of those who are in the room with breakout sessions so the breakout sessions are divvied up by four categories and I believe we're going to have these flashed up. Wow that's a big face. Sorry I didn't mean to do that. So we have four specific interventions or issue areas that we've identified and I'll go through those just in just a second. So the purpose of these is to identify barriers hindering any kind of implementation these could include policy practical barriers as well as gaps in knowledge. Again today, today's breakouts are meant to cover the landscape of barriers and problem statements to get us to tomorrow's discussions on solutions so be as expansive and comprehensive with your barriers and problems. As you can but remember and you will be prompted by specific categories of barriers like political economic social societal we will have the moderators in the room make repeat all the things that I'm saying right now. But please know that we have an immediate goal of moving to address them. So you have some additional notes in the agenda around how much time we have we have very short amount of time so let's get into those as quickly as possible. Some of you have been selected to be active participants in these breakout rooms and you will be given a mic. If you're not in the room, you'll obviously be allowed to speak in the room. So we will have some I'm assuming there are rooms with breakout identifications here great. So in person attendees can move to their breakout rooms. I'm here in the Keck Center staff will set up and start recording the breakout zoom rooms for note taking only online attendees can self select their breakout rooms. But this main room will stay open as I'm correct. Okay, and become breakout number one. I'm going to repeat those. Every group is going to have a jam board. Correct. And that will be in the room so we'll have that all set up. What else should I say non active participants can react active participants can react in the chat. We'll review everything that's populated in the jam boards afterwards. So the four topic areas. I'm not going to repeat this but in every session will ask the moderators to make sure that you're repeating these because we have to divvy things up it may not be the most artful way of having to divvy this up but we did these based on who we thought was going to be the room and why we thought they were different. So the first are natural and built environments so these are all the dimensions nature based solutions as well as indigenous knowledge. Blue, green and gray infrastructure. And this includes facilities like cooling centers, air can the residential air conditioning and commercial building air conditioning roads, other facilities like jail schools shelters transportation, etc. So that specific grouping of built environment and natural environment. So that includes workers and economic productivity. Here we want to focus on workplaces that may be separate from the facilities that we talked about before. So the consequences of occupational heat exposure on indoor and outdoor workers and their and broader impacts on economic productivity. That's the second third our health and health care. Are these flashing up as we're people know. So this is happening in the background. Health and health care is a third and that including mental and physical consequences of extreme health especially on vulnerable populations. And including the first responders and chronic emergency responses. Fourth, well being and social cohesion. So this is more focused on social programming, separate from these other kinds of emergency related interventions, or physical interventions. So this includes the effects of extreme heat on leisure and recreational activities as well as questions around community resilience social justice equity that are broader so that are broader social programming focus. Obviously all four of these sessions have equity components that we could talk about. There's a lot of interaction between these but this is how we've segregated them. Okay, so one natural and physical and built physical environments to workplaces three health and health consequences for social and physical well being social cohesion. Right now, you have until 3pm. Are we giving people a little bit more now. Okay, 302pm you have five minutes to run to your room, or staying in the room as appropriate and that includes the folks in the room and the virtual room. Take a bathroom break while you come back on say no later than 302. If you can come back because we only have 25 minutes to go through this discussion. All right, I'm all good taking myself off run to your rooms. All right, folks, I think we are ready to get going on our keynote talk, which is Professor Vivek Shondis so I am. Professor of civil environmental and sustainable engineering at Arizona State University and I'm happy to be introducing Professor Shondis. So the back I have known for a long time and I'm always impressed because he studies vulnerability, but does so in a way that embraces the complexity of the cities and environments that he works in and he's always able to sort of link everything from the built environment to, you know, social considerations to institutional to history and brings it all together so if that delighted to have you here, speaking with us and thank you again. All right, thank you so much Mike, and I'm really humbled to be amongst this esteemed audience of folks who are thinking about this seriously. I just am literally walking in from a conversation with a local municipal town called Gresham in Oregon and it's been really interesting to see how much of an uptick there was there has been in the conversations around heat. This is a municipality that hasn't really wanted to think about climate change. So seriously until very recently and heat has been something I've been bringing up over and over. Nevertheless, now is a time where a lot of these conversations are really taking shape across the country and I'm just so thrilled to be here and share some space with you in trying to understand what this might look like on a on a research side on a practice side and how to bring those two pieces together. I hope I'm sharing my I'm sharing we can see your slide. Okay, wonderful. Thank you. I'm really grateful for this opportunity and I can't imagine that I could share anything that would be beyond the collective knowledge in this room. And so I'm going to try to keep this relatively brief and really leading into kind of what are the what's the call to action here. I had the good fortune of working as a faculty member researcher also an advisor to a climate consultancy, which has been directly working with municipalities around the country and so, and increasingly world and so part of this work is kind of a bridging of the two hats that I researcher and professor one is a consultant and trying to really weave the research to practice narrative that I'm trying to own in this in this space so with that part of where I'm headed with this work is trying to think about heat action planning and centering this issue of urban inequity as we've come to recognize that heat is not something that everyone experiences equally and so just jumping right in I want to just start with a little bit many I don't I know a few of you I don't know a lot of you I grew up eight degrees above the equator in the in a country that's known for its large monuments like this Taj Mahal and India is also known for having recently experienced some of the most devastating heat waves as well as floods that have just literally washed out towns and villages and it's a personal service of mine to want to work on this field in a way that allows me to really reconnect with family members as well as others who are continuing to bear some of the first and worst on a global scale of these climate induced tragedies this this physical monument the Taj Mahal is is very similar to the city I live in now and you might be asking how is that possible. Nevertheless, what I see is the Taj Mahal and the city of Portland and it's built in environment natural environments is really artifacts of human activity these are. These are outputs from a massive owning of the planet the the Holocene which has brought us unprecedented levels of prosperity health and monumental architecture whether it's spread out or contained. And this artifact these artifacts are also kind of. Align directly with other artifacts such as heat heat is a direct in the way that it's manifest in this monster that came through the Pacific Northwest is the map of British Columbia Washington Oregon. In Idaho and really getting into the fact that we had a massive heat dome in 2021 that no one anticipated nevertheless I had been crying to municipal managers public health agencies for over a decade that this was going to be an event we saw it happen in Chicago we've seen it happen in Europe we've seen it happen all over the world. Nevertheless there was very little direct attention to this issue of heat and so I've been reflecting a lot on what does it take to work with human artifacts like the like the intensity frequency and duration of heat waves that are increasing over time. In finding ways to actually move into actions that can help safeguard those communities who are hit first and worst. I want to start with a few provocations here and and really being around the idea that heat is a primary driver of climate induced change. We can talk about forest fires we can talk about drought we can talk about sea level rise those are all a result of heat I really want to underscore that as a as a means by which we're trying to grapple with something that is that the earth has not seen for over 100,000 years it really is one of those moments of transformative change and it calls us to act because this is a moment of massive transformation, unlike anything human civilizations have seen on a scale like we have never known. And so part of what we're trying to deal with is, what is the knowledge that's needed to bring this to some level of our ability to manage and I will suggest and provoke by suggest by offering the idea that the heat mitigation strategies that we're currently considering lack evaluation and assessment. We're throwing a tremendous amount of resources at this with recent passage of various acts the strategies for mitigating heat the adaptation components of this are still woefully inadequate for us to really know what's going to work and in what context. And the third provocation I want to suggest is, if we're going into action we really want to be thinking about what heat in all policies looks like how do we integrate this since it falls between the cracks for most municipalities most counties most regions and the federal agencies, how do we kind of develop an understanding of risk when we don't really have a good way of characterizing heat as it plays out in these different locations in these different contexts. Those are three, at least provocations I want to start with and I want to keep coming back to them as, as, as helpful. Given the four components that you just came out of breakout rooms the natural and built environments, what I'm going to call occupational exposure, health and health care and then well being and social cohesion. I want to suggest to you that we in order to get to actions which are implementation and interventions. We really need to first contextualize and understand the hazard. So those are kind of the top components if you will of this center target image and part of what we're trying to do is really contextualize and assess the hazard in such a way that we can lead to implementation. And that we, and that begins with an understanding of what the risks are. I want to contend that the risks that we have characterized brown heat, they're often reactive, there are things that we are discovering as we see heat waves come through a region. And that until we really are able to get a handle on those risks, we're not really able to take the necessary actions to safeguard communities. And so there's a process by which I want to suggest that we're moving from understanding of risks to then taking into taking on interventions and implementing the kinds of strategies that we understand will mitigate those risks and move forward. And so that's this idea of moving from risks to resilience that I want to at least frame this up with the next slide I just want to warn you has more animations than any slide I've ever made in the thousands of presentations I've given in classes and otherwise so please hold on to your seats. I'm going to try to walk us through at least one way of bringing these four components together it's it's a hypothesis more than it is necessarily a claim at this point but I want to start with this idea. It's a natural and built environment the idea that we have created a set of physical distribution of various forms of land use and land cover that's based in a history of decision making that has got a set of gray and green infrastructure building codes energy grids. There's various strategies like cooling centers already embedded within it. So that drives a lot of what we see in terms of occupational exposure. So what I'm going to suggest is that the way we've articulated the natural and built environment, something that we have direct control over through our land use and land policies drives much of what we talk about in terms of exposure of sensitivities, exposure pathways, even sensitivities to various heat related illnesses. And this has to do with things like how FEMA looks at or doesn't look at heat. In this case how local labor laws are enforced schools and their air conditioning, the reporting whether someone feels like their employer will actually believe them if they're going about reporting a heat incident, or something related to heat illness in their, in their workplace of course outdoor and agricultural workers who are completely agricultural workers completely outside of the 1930s during the New Deal. That is something that continues to come up as a acute and insidious impact from rising temperatures. Those occupational exposures then have effects directly to health and the health care system in which we're talking about how quickly we can respond to those exposures, what the mental and emotional health are of communities, even citizenship status coping capacities and trying to understand what access and availability might look like in terms of taking in terms of health, whether we have access to health care, as you as we all know a major issue in the US that health and health care. And I want to also suggest there's a set of capacities. Since I have, I have health care in my context, I have additional capacity to be able to partake to be able to engage and to be able to be more connected in my social network that, of course, we know drives directly the consistency of a community. When communities are better connected, they are, and more socially cohesive, they are better able to respond to acute pressures, whether be heat or otherwise. We've seen this time and time again in the natural hazards literature. So if you're on the other end, you're more isolated, we also know that directly affects our exposure and the extent to which we're able to cope with these these extremes, such as such as heat. So underlying all of these four components, I want to just encourage you to think about what it means to evaluate risk from heat in each of these different areas. That's something you've started to get into with your breakout groups. Part of what this is also about is how do we monitor and assess those natural and built environments that can cool those occupational path exposure pathways. What is it where someone does or doesn't have health care whether they're willing to access it when they do get hot and when monitoring of heat risk could also be meaningful when we have isolated communities like many of whom perished during the heat dome that I mentioned earlier in June of 2021 in the Pacific Northwest. This is a monster of a slide and I know there's a lot here. These are, this is an attempt to kind of weave together the four thematic areas because really underscoring this is not to necessarily isolate one entity. I know for convenience of conversation, it's helpful, but my point here is partly that these are incredibly interconnected and intersectional in the sense that they all contribute to our understanding of how do we characterize heat risk. So I want to get it go from the 5000 foot down to down to the ground a little bit more by identify by describing a few projects that help get us closer to the risk assessment that then leads us to an understanding of what actions might be helpful. The first is work that we've been continuing to do for the last three years in the city of Los Angeles where we're looking at the role that green space is playing. And this work more than anything else is an attempt to try to identify where are the places where risk might be the highest. And what is the level of investment or effort that could help move a needle on greening those particular areas, shading those areas is really part of what the agenda here is, is how do we think about this is with the Los Angeles first urban forest officer this is with several community based organizations working in several different parts of LA, including South, South Central LA. We're actually this, this weekend, there's a workshop in Silamar where we're actually working with community based organizations to understand what kind of risks, they might be directly experiencing the community directly for the community and trying to develop some guidebooks and direction in order for us to find ways to understand who's exposed and in what ways that can be mitigated. Second example is really getting at this natural and built environment where we took a neighborhood like you see here and we digitize them these tools are off the shelf this is for example envy met a well known tool for many for over a decade, and we did this several years ago where we took a proposal that a municipal manager was putting forward we want to take 16 units and and up zone them to 64 units in the city block, and we digitized this into the lower left here of what this particular city block would look like, then in the plans what we did was array all of the 64 units in different configurations with different amounts of green space, and in the upper right hand corner here. In this year, plan six B we pretty much did similar to what most code allows is asphalt around a multifamily residential development. All these are ways to be able to distribute space and distribute residential space at that. What we found when we ran these models is that we were able to in fact increase density at for multifamily residential residences and at the same time also keep heat down in fact ambient temperature outputs from this model suggests that in plan six s this right the plan on the far right requires a whole set of building code modifications as well as a few design modifications to allow for this horseshoe shape design tucking parking under and allowing for lightning of roadways and and rooftops green space being brought in and convective currents being moved through the space through gaps in those particular in those specific areas. So allowing for that, we would at least estimate that there is a way to reduce up to 1.7 degrees fair 1.7 degrees Celsius the ambient temperature of that overall whereas plan six B would increase temperatures by over three degrees Celsius in this example. So that's the way of getting a tool to be able to do some proactive evaluation of what might be possible. We've got papers on this. I'm happy to send a couple of other examples where we're also combining the exposure of workers at the port of Tacoma who are unloading and loading lots of massive containers coming in from parts of Asia and other parts of the world. And we wanted to look at it from a multi month multi week perspective of what are the months and weeks where there is exposure of different communities in terms of their outdoor work. And this was a way where we set up a new a number of sensors in these locations we're able to monitor over time we also brought in heat into this and looking at where are we seeing the potential worse impacts from air quality in this case particulate matter and the worst case of heat and how do we kind of put those two together over a month long and as a result of this work and the previous kind of high density development work we're already seeing kind of modifications happening at particular times of the year for outdoor workers in the port of Tacoma which has already been a very contentious conversation to begin with. A third piece I want to touch on is a project that I'm really excited about that will close and I'll kind of come around the corner here and close out in a minute. But the idea of indoor air conditioning we've been in the Pacific Northwest we've been throwing air conditioning similar to other parts of the country. At this issue of heat and what we're finding when we actually monitor the temperatures indoors of public housing these are three public housing buildings of different forms we're actually finding that AC is not necessarily bringing the temperatures down to the extent that we would have anticipated that they would be brought down. In fact there were several buildings and this is just one example on the on the right some graphs of outdoor temperatures and indoor unit temperatures where we're seeing temperatures break the 85 Fahrenheit threshold, even with units that have air conditioning running full on throughout the night and day. These are public housing buildings where people died during that heat dome event. We also do a lot of workshops to understand what are the strategies that folks will use in order to be able to cool and I think again this is not lost on many of you this is probably work very similar to what you're doing. Though I was surprised to see how little literature there is on indoor exposure to heat and the extent to which there are strategies for shoring up some of the mitigation and adaptation work. We found in fact some residences, even without AC were able to keep their temperatures lower than residences that had AC immediately adjacent to the building controlling for aspect and several other factors. We're at time. Yeah, and I'll just close out here. I'll just make a quick shout out for understanding exposure. We've done this work now across this is a 2023 map I think you're many of you are familiar with this map where we're trying to do social engagements to understand heat this has been one of the most compelling projects working with national integrated heat health information systems and municipal managers across the country. I think this is something that we're continuing to work on it's made its way into several risk monitoring and assessment programs. With that, I'll just close out with this kind of attempt to show that this requires an understanding of risk in order to get us to actions and happy to engage in conversations after as well so thanks Mike sorry took a little longer anticipated. Hopefully that was coherent at least at the end of the end of the presentation. No that was survey thanks for that and I would encourage everyone to check out Professor Sean this is work, you know always sort of at the cutting edge of how we think about vulnerability. Thanks for that. So we have come to the end of our first day of our two day workshop and on and I would like to very much thank everyone for your participation today and your thoughts insights experiences are speakers, especially who have just brought such incredible insight to the issues at hand. Um, does someone from the academies would you like to share logistics for tomorrow I don't quite have them at top of top of the Absolutely separate now why don't you go ahead and have your take home messages and I will just wrap up this 30 seconds of logistics. So on and I have just come up with a few of the highlights or themes that we've seen running through today that we hope we will take into tomorrow. And Anna of course jump in on any of this so one is improving communication about heat and the implications for health. And this in particular includes valuing nature and community knowledge of these risks and experiences. So measurement is the need to better characterize heat as a risk. And this is both in terms of measurement data collection as well as for to provide this information to people who could be at risk. Third the need for correct assessments of risk to affected communities while actions are being implemented because obviously we are in this already this year is projected to be the hottest year on record so we are experiencing it so again local indigenous community level knowledges and experience in that process of the correct assessments really has risen to the top here today. The potential for using social change approaches to address many of the issues that we've raised we've heard speakers today, who have achieved successes which probably no one expected and has have created changes that improve resilience so this is, these are some examples and some insights some lessons that we can pull from today to tomorrow as we begin to think about solutions. And finally, finally, the need to make all of the interventions and to address needs locally. As we do that, also thinking about how we amplify and scale these interventions so that other communities, localities, states, countries, etc really learn from one another so that people don't have to reinvent the wheel but also these address of risk and resilience can be done really, really locally so again with that we'd like to say thank you to everyone to our fellow committee members who I think have done such an amazing job with the National Academy staff and organizing and preparing for today. Thank you. Thank you to everyone for participating in this first day of the workshop. And to think to really putting our minds together to create solutions for the problems that we're already facing the challenges we're already facing. And then I think the last note is the Jamboard, the link for the Jamboard is continue going to continue to be live now and into tomorrow, we will be integrating what is written in the Jamboard into tomorrow's discussion. So, if you will continue to add there, it will inform how we as a group move forward into tomorrow. So please do continue to add and edit and etc in the Jamboard. And now I will turn it over to Audrey. Thank you and we're time just come back tomorrow to a 30 be ready to participate. Continue populated at Jamboard again tomorrow it's really in the solutions we're going to push you toward trying to find this innovative a little bit on the, you know, future looking type solutions with we may not have thought about before so absorb this this conversation during the night and come back ready to go to propose what you think hasn't been tried yet. Thank you very much for everybody online and thank you very much for people in the room today and thank you to committee members.