 Good afternoon, everyone. My name is Sabrina McCormick. I'm founder of Resilience Entertainment and co-chair of today's meeting. And I'm Anna Guntz. I'm a pediatric intensivist and co-director of the Children's Environmental Health Clinic, Ontario. On behalf of the full planning committee, we welcome you to day two of the third in a four-part series of workshops on communities, climate change, and health equity. The overall goal of the workshop from yesterday and today is to identify key elements of effective and innovative actions to prevent and mitigate inequitable effects and health risks from one of climate change's most pervasive critical aspects, extreme heat. Yesterday, we had a number of speakers and we also had participants input information as well from breakouts. And there were about five themes that came up. One is the need to improve communication about heat and the health implications that includes involving valuing nature as well as the community knowledge. Another is the need to better characterize heat as a risk in terms of the specific definition and how we describe and define it. The need for correct assessments of the affected communities while at the same time moving towards actions and implementation, which involves also valuing local action, community knowledge and indigenous knowledge and other ways of knowing. The potential for using social change approaches for actually integrating health within social change programs to input effects of community action. And the final theme that we identified was that all interventions need to be addressed locally. And then when we have these local information strategies, how do we scale them so that other people aren't reinventing the wheel? Today's, we're gonna have a number of sessions, but we are gonna move from identifying barriers in order to actually talking about solutions and creative design. So we've created a number of sessions to help facilitate this and your participation is actually gonna be hugely important to this. So in the first session, we're gonna hear from speakers about cross-sectorial partnerships and co-creation. And in the second session, we have gathered some experts and we're going to review the barriers that were identified yesterday and ask them to think of solutions from their experience and even just their philosophy and their purview. And at the same time, we're also gonna invite audience participation to write in solutions as well. And then in the third stage, what we're gonna do is we're gonna look at the most popular solutions that have been identified by the entire group, online and in-house and break out into breakout sessions. And then these breakout sessions are actually gonna flush out these solutions in a lot more detail and test them. And then we're gonna kind of come back together and review them at the end. So at the end of this workshop series, we'll produce a report in the format of a proceedings in brief these and these workshops are gonna be designed to be highly interactive and to look at case studies reflecting people's lived experiences. And so we hope that this will help pave the way for our way forward. And so we wanna state this because we really wanna emphasize how important it is, how we value your participation either through the chat, which is open to everyone across the groups and through the Jamboards that we're gonna be using and the Q and A sessions in Slido. So let's get started. It's my pleasure to introduce the first sessions moderator, Daniel Horton. He's one of the committee members and he is also assistant professor in the Department of Earth and Planetary Science is at Northwestern University. The floor is yours. Thank you, Anna. I'm very happy to begin the transition of our discussion from barriers to solutions. The goals of this first session of day two are to understand what it takes to collaborate effectively and co-produce solutions that work for all. So that is working across sectors toward a common goal. To better understand these needs and best practices, we're first turning to the narrative format with two stories of success from a couple Midwest based practitioners. But first, a bit of logistics. Audience members are invited to submit questions at any time using Slido where everyone can upvote the questions they most want to hear our speakers answer. We'll address as many of these questions as possible during our panel discussion after the two stories. And for our presenters, you'll have about eight to 10 minutes maximum for your presentations to allow time for Q and A at the end. And at the two minute mark, we'll send you a warning via chat that your time is coming to an end. Okay, on to the stories. Our first speaker is Dr. Dana Habib. Dr. Habib is an assistant professor in the Department of Informatics at Indiana University. Today, she will share her experience around design, urban planning, public health, local sensing and local interventions for climate resilience. Dr. Habib, the floor is yours. Thank you so very much. Welcome, everyone. And thank you so much for inviting me to speak today. Today, I'll be talking about one of our programs called Beat the Heat. And talk about how we're integrating communities and equity into heat response planning. The Beat the Heat program is a two-year program funded by the Indiana Office for Community and Rural Affairs where we're working with two communities in Indiana, Richmond and Clarksville, to help them develop targeted heat response plans for their communities. Climate change is increasing extreme heat events across the globe and Clarksville and Richmond is no exception. We can see that by the year 2050, Clarksville and Richmond can expect to see a doubling and tripling of extreme heat events in both of their communities. The Beat the Heat grant is divided into five different phases. For this story, I'm gonna really talk about phase one and primarily phase two of community needs assessment. And the important for assessing our communities to really understand their vulnerability and how to tailor strategies to these communities. For phase one, I think one of the things that's really unique about the Beat the Heat program is that we hired a full-time heat relief coordinator for both of our communities. And one of the first things that the heat relief coordinators did was to establish the heat relief task force. The task force was representative of a cross-section of the communities that had stakeholders from both government sector as well as from communities. And it really provided support and guidance to our heat relief coordinators. And so here you can see different members that were in some of the task force. And then phase two, this is where we did our community needs assessment. In our community's needs assessment, we primarily looked at community input through focus groups, interviews, and surveys. We also participated in NOAA and CAPA strategies heat work campaign and created heat vulnerability and disease for both of our communities. For our surveys, we survey both of our communities and we really were wanting to understand a community's understanding of their awareness of extreme heat risk, but also to understand their adaptive capacities. And one of the most important things that we saw from the survey was really that many members and communities were really experiencing barriers to end home cooling. We saw that one in three people that took the survey experienced barriers to their home cooling systems and that the two top barriers were cost of bills and cost of repairs. Some of the quotes that we got in these surveys was, for example, heat is something I think about all the time. There are times when me and my daughters will get in the car and go for a ride because it's much cooler in the car and with air conditioning other than it is in our house. Or another individual said, our only source of cooling are fans and we place fans throughout the house, but we're unable to keep them going for too long because it dries our electric bill up and we can barely afford our electric bill as it is. And so when we're really looking at equity and climate change and extreme heat, it's so important to understand who's vulnerable in our communities to extreme heat and who has the ability to adapt to these conditions. We also conducted focus groups with different stakeholders. We conducted focus groups with outdoor workers, older adults, parents, youth and government employees. And some of the main takeaways that we saw from these focus groups, as we can imagine from government employees, a really important need for cross-organizational collaboration. For outdoor workers, the need for flexibility in their work schedules. For youth and high school athletes, we saw there's limited knowledge about heat-related illness. And so there's a lot of opportunity here for education awareness here. For older adults, we saw that they had difficulties moving around their communities during hot days. And that parents noted that access to drinking water was really critical, but also a resource that was hard to come by in their communities. We also participated in knowing Kappa Strategies' heat mapping campaign. This is a campaign that's done across the United States. I'm sure many of you are familiar with it. And it's a wonderful community, a wonderful project, but really needed in order to capture hyper-local environmental data, which is needed to really understand a community's exposure to extreme heat. And it's a great example of citizen science project. So you can see different images from our communities here, participating in this program. We're basically knowing Kappa Strategies sent us sensors that we mounted on our cars, our bikes. And with predetermined routes, we biked through each or drive through each of our communities. Days were selected by working with National Weather Service to really pick a day that was ideal for urban heat-related conditions. And just to note too, that Clarksville worked with their high school students and really integrated them into the process. So it was a great way to increase education awareness there too. So here's some of our outputs that we received from our Heat Work Campaign where we can see our hyper-local temperature data and the heat exposures in both of these communities. We use this data to create story maps as well as to use this for education and engagement. We saw community members use these for grants, applications, as well as for planning and decision support too. We also use this to create our heat vulnerability indices for both of our communities. A heat vulnerability index is where we are able to identify areas that are most vulnerable to heat. And our main indicators are looking at environmental exposures, sensitivity such as age and adaptive capacity. For our heat vulnerability index, we specifically used evening temperatures because we see that nighttime temperatures are better predictors of negative health effects due to extreme heat. And we also created a sensitivity score for our communities by combining different social demographic factors, which include age, educational attainment, race, language barrier, poverty and social isolation. You can see these different factors mapped here on the right. We combined all of those into a sensitivity score. And then we overlaid our heat exposure in our sensitivity score and identified the block groups that were ranked the highest in both heat exposure and sensitivity score. And then we ranked them in priority areas from first to third. And so here's an example. This is what our priority areas look to both of our communities. What was wonderful then to see how the communities use these types of priority areas, we saw that both communities use these to apply for grants for tree plantings and to plant trees and areas of high vulnerability and high heat exposures for the communities. And we also saw that Clarksville when working with their senior citizens were also decided to really look through bus stop amenities and how they could help with the transportation system. So also looked at areas that were high to heat exposures and how they could really improve their communities in that aspect as well. And so this pretty much wraps up our community needs assessment stage. We developed the different heat management strategy plans and now we're on phase five of the program. And in phase three, we develop our management heat management strategies as well as our heat roof wave response protocols for both of these communities. These management strategies have been passed and approved through both of their city councils too. And then this is just an overview, just to kind of show all the different strategies our communities worked on to look at with regard to their heat wave response protocols, public outreach strategies, home cooling strategies as well as climate responsive design strategies. And now we are in the process of wrapping up our continuity plan and also looking at different methods for in-home cooling. Thank you all so very much. Thank you so much, Dr. Habib. Our next speaker is Rod Mansur, who is currently the Director of Environmental Innovation at the Chicago Department of Public Health. Today, Rod will share a story about his leadership of the R-Route Chicago Tree Equity Program. Take away Rod. Thank you, Dan. Exciting to see what's been done with the Heat Watch Campaign. We're going to be doing that this year too. So thanks for sharing that. I'm going to center our initiative, R-Route Chicago, more around the community today. R-Route Chicago is an initiative to equitably increase Chicago's urban canopy with a $46 million investment over five years. So it's something like 75,000 trees. We offer some solutions to overcome some of the long-standing barriers and unwind the injustices that have led to having these low-canopied communities. So just a little data. It's data-informed, but that's just a small piece of what we're trying to do. We prioritize communities. We looked at four buckets of social, economic, environmental, and public health data. We brought it together and we were able to see where that tree canopy percentage, where the most benefit will be perceived and realized in the communities where we should be planting these trees. But the data was a small part of it. So it's data-informed, but community-driven. And what I mean by that is, you know, we didn't start out with this many people in that tree equity working group back in August of 2021, probably 20 people. And now there's 135 folks from a lot of organizations. And here it's not to impress you with the number of people that are joining our meetings that are part of this, but it's more about the concept of this three-legged stool we've coined, where you bring together community, conservation organizations, you know, researchers, and government regularly, once a month, Tuesday mornings at 9 a.m., second Tuesdays of every month. And we discuss all issues around tree equity, tree maintenance, planting, water, policies, procedures, ash trees, the list goes on and on. And I don't want to make it sound like we all agree on everything that's being presented, but we are aligned on a mission, and we are engaging, we are listening and hearing each other, and we're learning from each other. And that's one of the key things here that we have some of these community organizations sharing their best practices. So, you know, we've defined tree equity, you know, but I think what's more important is the definition the community has developed. Prioritizing historically marginalized disinvested under canopy communities on the top of the website. But when we ask what tree equity means to the individuals that are part of this working group, you can see here, health was the number one answer. Of course, you see justice, peace, community, all these add up into that definition. But we all agreed on this health as part of this strategy. So, the community led the logo design. They told us they need a website so that they can drive people to the site to answer questions. They wanted tools, they wanted door hangers, and we developed that for them. They wanted to combat misinformation in the community, some of the myths that center around trees. And then we launched on Arbor Day of 2022. But how do you convince residents that something like this, where there are no trees in the community in Chicago, is something that can be someday look like this? And the answer is by going to the community, speaking to those that have been working on the ground on this work and walk their neighborhoods and talk to them. They have the solutions, but there's a need of resources. So, combined with understanding what the communities need, lean in when needed, and lean back when not. And what the city can do. So, we launched this Tree Ambassador program where we trained and paid community organizations to submit tree requests on behalf of residents instead of waiting for someone to request the tree. And we learned what our foresters do in the city, and we passed that along to the community. We created Tree Ambassadors, and you can see in Little Village and in North Lawndale, and Pilsen and in Roseland. We go out to the community and train, and they then train the trainers. They go out into their communities, and hopefully the forced multiplier effect of not only educating about the benefits of trees and seeing if a tree does fit within the parkway of the city, of the publicly owned area, but to engage the residents because 30% of trees are on public property, the rest are on private. So, this train, the trainer's model was developed so that the number of Tree Ambassadors can increase in the community, and they can help shape, this is important, shape the character of their own neighborhood. We planted the 18,000 trees. There's a picture of some of our officials, and this is this year. We're planning to plant 15,000 minimum, and on the right there, you see the Chicago Architectural Center worked with us to have a tree exhibit called Recover, and some of the Tree Working Group folks who says that you can't have fun doing this. So, I'll leave it at that. Here's my contact information, and feel free to visit Chicago.gov. That's our route. Thank you. Thank you so much, Rod. Thank you so much, Rod. We have plenty of time for Q&A, so if you have questions, please put them in the Slido. I'll start out with a question for you, Rod. I think it's rather interesting that in Chicago, the tree planting program is run out of the health department. I'm curious, how does that work, and how do you mesh with the other agencies that might care about trees in the city? I wouldn't say lead. Co-led is probably, but yeah, it did originate out of public health. Public health does not plant or maintain any trees in the city of Chicago. We don't have foresters. But I think bringing in that expertise of community engagement, community collaboration, and the public health data, bring it to the silo department. The folks that plant trees are parks, streets and sanitation, department transportation. The landscape ordinance is run under the Department of Planning and Development, and then we have a Chief Sustainability Officer, and you can see how that can be spread across different departments. So we thought, how can we create an umbrella? And the Tree Equity Working Group was part of that solution, where every month, it's not just community organizations and conservation organizations and researchers that are meeting at this working group. Government representatives regularly all the time from all the departments and agencies. And we come together, and it's an opportunity for community who address the Tree Equity in one meeting, in one sitting, now emailing or calling different people trying to find an answer. We work on that together. And I think public health convenes this and leads it. And I think that's important, especially when you see the definition of Tree Equity where all the members thought health could be at the center of this work. Thank you. Thank you. My next question is for Dr. Habib. I know that you indicated that some of the data that you acquired during the NOAA campaign is part of what underlies your heat vulnerability indices. I'm curious about your perspective on the value of local generation of data or cogeneration of data and knowledge to building community trust and having the community adapt the policy suggestions that you're making. Yeah, I think that's a wonderful question. And so important to be able to engage the community, both in giving them a voice and power and also building that trust with them. So one thing that I thought that was really wonderful that came from Richmond was that not only did we create our HVIs, our heat vulnerability index and our priority areas in order to really target policies, but we used that approach to really be able to educate the communities and have the communities around their different vulnerabilities to heat, but also to create volunteers with the communities around tree planting. And so Richmond had specifically created tree tenders, which have never had a volunteer for tree planting before. And so tree tenders specifically came about from this grant and another where training was done for tree planting, but also the focus on really prioritizing that planting in the most heat-vulnerable areas. So I think bridging those two together was really great to see both the data coming in, but then also the community organization that happened as well. The other thing that was really important with building trust with the community is getting access to our most vulnerable community members. And this is something that's really difficult. And we saw it was difficult in both of our communities. And so really being able to work with the stakeholders who have already built that trust and be able to power them and give them the resources in order to work with these communities. So a lot of our housing insecure residents in our communities, both of our heat relief coronas, really worked with stakeholders that they identified that had already built those trust and then developed things such as cool kits distributions too by figuring out things that they would need. And so coming together by creating these cool kits and then working with different community members to distribute those. So that was another great example of seeing both the data coming in, but also seeing that engagement with the communities and the important stakeholders there. So both of you have touched on building green canopies or tree planting. And we had a lot of discussion yesterday and it's come up again in the slide out chat. So here's a question for both of you. One ongoing concern I hear from communities is the fear of green gentrification. And I'm curious for both of your perspectives on ways to prevent this practice. That's a great question. This came up early on. First posed by researchers who kind of, you know, came up and thought that that was a risk. And it was immediately addressed by community members. Those that have been working on the ground in trying to increase the tree canopies in their community. And I'm going to quote her, Anna Maria from North Laundale, who stopped and said, it's not gentrification when the community is running. And so I couldn't, I couldn't have said it any better. The idea of having community members go door to door engaging with residents, surveying the parkway where trees can go is at the essence of what we're trying to do. Having the community shape the character of their neighborhood, not the city, not only decided by the city or by others. So it is a true, you know, community driven initiative. And just to kind of add on to that, I think the important thing to note here is that housing stability is so important when we look at the adaptive capacity of our communities with climate change. And this is something that plagues our communities across the country is that ability for housing stability. And so I think this is a larger issue of really what's driving instability. We don't want to keep our communities from having healthy environments because that might raise property value, but instead these more core issues need to be addressed and really, you know, tackling housing stability, because we can't talk about, you know, having adaptive capacity and building resilience if our communities don't have that stability. Both of you spoke quite a bit about engaging with the community and you're coming from one from government and one from academia. And certainly there's challenges with working with community organizations and vice versa. And so I'm curious about the development of these relationship with community organizations from a government perspective, from an academic perspective. What are some barriers that you ran into and what are some ways that you got beyond that? And then how long did this take to develop? I know that relationships can take a long time to build. And so what are your perspectives on this? Hard to put a number on the time frame. Some are easier, some are harder. I think the thing that should be emphasized is get out of the office and meet with the community and understand what they're going through and what their needs are. I did say in my presentation to lean in and lean back when not needed. And that's important. I think sometimes we want to do onto or do for instead of doing with. And so that can create a lot of problems because it's not coming from community. Having conversations and being honest, there's always this total government line I think sometimes where we're very careful about what we say. But I think that if you just let down the guard and understand that a lot of the distrust and sometimes the advocacy and push is not directed personally like myself. It is an opening and an avenue to talk about issues that they've been aggravated by to put, you know, not only aggravated but also affected by the way the bureaucracy is set up where they don't have a voice. And so listening is a key part of this. And don't worry about defending past whatever. We're here to change that. And I think going out there and talking and listening and being a part of it when they invite you over, you can't say you're busy. When they have their community meetings that they want you to join at 7pm on a Tuesday, you join. You know, it is a rough schedule sometimes being there on Saturday and Sunday and having them having your telephone number. But that's, I think, a part of that overall building trust. So we all know where we're coming from and it can be lead to real genuine relationship. I think the time aspect can't be underestimated. It takes so much time to build that trust and those connections. And it's one of those things that can't just happen at the beginning of a project. And so understanding who has built those already, those establishments, those stress, those connections. And whether you're doing that work or you're giving the resources to the people that already have that connection too. I think it's always this like tension between realizing that a lot of communities are often over strain too. And so that fine line between engagement but not putting burden on the community. And so meeting them at their needs and kind of as what was mentioned too, you know, going to them for, for meetings and really understanding that time cost too and engagement and that, that importance to it. I really love that idea of our task force and really bringing in community members into this. And so when making these types of policies or plans or even trying to understand assessments that I really felt like both of the community's task force were so important for our heat relief coordinators to understand who were the important people to go to and talk to that had the connections to be able to reach the most vulnerable communities in need. And so I think bringing, making sure you're bringing people to the table to give them the voice and to have, you know, power over how decisions are made or maybe how policies are directed too was really helpful and overarching plan for, for beat the heat. All right, I have a couple of nitty gritty questions for each of you from the Slido. The first is for Dr. Habib was the heat vulnerability index used for the mapping in Indiana different from the social vulnerability index. So the question is asking was the heat vulnerability index different than the social vulnerability index? Yeah, I believe we're looking for a little bit of clarification on the distinction between the two. So what we did was we created a social vulnerability index. And then what we, for our heat vulnerability index, what we did was that was our index, but then we overlay social vulnerability and heat exposure. We didn't combine those into the exposure. One thing that we did, one thing that was really great about our program and it's still great is that there was a ton of education that went into our program with both of our communities. We had many webinars on looking at extreme heat and engagement with communities, how to do focus groups was important for asset mapping, looking at extreme heat and extreme heat thresholds. So there was so much education that went in through this phase and the very, especially the very beginning of the program, which I find to be very valuable. But then we also went and we talked about our heat vulnerability index to understand that indices can be misleading. And so it was important to understand which characteristics you want to strategize for and to prioritize. And so that's when we had all of our maps separate and said, if you want to focus specifically on elders that live in isolation, then these are the block groups for that and you can target policies specifically for that. But if you want to look at all the different types of all the different demographic characteristics together, then we have it indicated for that. If you just want to look at heat exposure, you can look at that separately. If you want to combine the two, these are our priority areas. And so we really walked through that entire process talking about the pros and cons of this and really understanding also the limitations that we have with a lot of our demographics and systems data being at such low spatial resolution and the power that we have from working with Kappa and Noah getting that really high resolution heat exposure data too. And one last question for you, Rod, on the governance structure of the R-Root's tree equity program, how does that work? I lead the tree equity working group meetings. I collect agenda items. We have the chief sustainability officer who drives across all the departments and strategizes with them individually. We don't have it as formal as you think it would be because it coalesces easily individually. If public health brings in the community part and the foresters bring in their know-how and the chief sustainability can oversee all that, that's basically that loose kind of internal piece. Now the working group members though, in empowering them, there's a lot of conservation organizations that are integral to making this work. Open Lands, the Chicago Region Trees initiative at Morton Arboretum, the Trust for Public Land, they're already working with community members, but we figured out how to leverage some of their existing work. And without them, there's just government people meeting about trees. So that piece is more important, I think, than us. If we bring the money and they bring the engagement and it comes together, we don't micro-manage how a lot of that happens. So they've done a great job reaching out to community and we don't want to interrupt that. Like I said, they'll come to us and say, this is what we need. As minimal as a community organization that says, can you create 200 flyers for us? I mean, it's very laid back and it's worked. Although others have tried to formalize it more and structure it more, I feel like we might lose that ability to pivot and be more dynamic and address problems that come up. Like we're at a severe drought right now in Chicago. And do we wait for change of command? Do we go through outside departments that will now be given the power, I guess, to overshadow a lot of what we do. So I think this shared power is the best way to go. Wonderful. Well, thank you both for sharing some of your perspectives and your successes. But more importantly, thank you for the work that you've been doing in your communities. We're going to transition now to session number two, which is moderated by my fellow committee member, Cecilia Sorenson, who is the director of the Global Consortium on Climate and Health Education and Associate Professor of Emergency Medicine and Environmental Health Sciences, all at Columbia University. Thank you so much, Daniel. And in this session, we're going to continue to build on solutions. This session is entitled Interactive Cross-Sectoral and Transdisciplinary Solution Building Panel Discussions. So let's get started. The goal of this session is to explore an integrated multi-sectoral approach with the hope of arriving at a set of effective innovative actions for addressing some of the identified problems and challenges related to extreme heat that were brought to the forefront from day one. So for this, I will facilitate a collaborative discussion with panelists from different sectors and ask you as the audience to also propose solutions, actors and actions. So to accomplish this, this session is going to be divided into three parts. The first part is where the panelists will each provide a two-minute opening remarks given their names, their positions and actions they are taking at their levels towards solving specific heat issues. Then our facilitators from yesterday's four different breakout rooms will briefly present a summary of barriers or challenges to the panel. And our panel will have 10 to 15 minutes to debate and explore innovative integrated solutions that align with the needs of all sectors represented. In parallel, we invite you the audience to submit your ideas for solutions during this time as our facilitators are presenting the challenges and barriers that were identified and all of this will be woven into our meeting summary report. So with that, I would like to welcome our esteemed panel. If we can bring them on to the screen. Our first panelist is Hunter Jones, who is representing a federal government perspective. Hunter, your two minutes are starting now. Thank you very much and hi everyone. I'm with the National Oceanic Atmospheric Administration and representing the National Integrated Heat Health Information System, NIHIS, which we launched in 2015. It was actually jointly launched by NOAA and the Centers for Disease Control and Prevention. But at this point, we have a ton of agencies that are a part of our group. I wouldn't want to start listing them because it would take a while. But if you go to heat.gov, you can see all the agencies we work with. And the idea behind launching NIHIS was really to provide a coordinated federal response to extreme heat. And so we were responding to a number of issues that we saw and that have been discussed already in this wonderful session. So in this wonderful workshop, the impacts are often invisible and delayed and hard to quantify of heat. And so we've been trying to change that. Heat governance has been a challenge at all levels, including the federal level. And so that's one reason why we wanted to bring all these agencies together to work on heat. We also identified the issue of heat affecting marginalized groups differently and having greater impacts. And so we wanted to start to illuminate that more and help communities take on heat. And then also we wanted to really focus on the timescale issues with respect to heat. So heat is something that you can respond to in the moment, but it's also something you can plan for and prepare for and be resilient to. So we really wanted to kind of think on all these different timescales about how we would help people manage heat. So I'm really looking forward to this discussion with the other panelists. Thank you for having me. Thank you so much, Hunter. I know you'll have a lot to add to this. And next, I'll turn it over to Vivek Shondas. It's great following Hunter. Hi everyone, Vivek Shondas. He, him, his. I introduced myself and some of the projects yesterday and well just quickly note is just several tensions that exist in this field right now and ways like this forum to be able to directly confront and explore what those tensions might look like. A few of those tensions include what we were just hearing about from Raed is the idea of formal versus informal approaches. That's something that comes up over and over in the work that I'm doing. Another is related is the relationship between lived experience of heat and the tension of technical expertise brought into that understanding. Another one is letting perfect the enemy of the good and that is something I continuously see a lot of preventable debts that could occur as trying to get this exact perfect and a fourth one of five that I'll just mention here is the idea of kind of characterizing risks first and then leading to actions as I was mentioning in yesterday's session and finally slow and planned response versus the fast and responsive approach and that gets to Hunter's point about timeliness and these are things that I'm consistently seeing play out and there may be several others that I could point to as we explore the conversation a bit more but things that we're doing to try to get at these tensions is trying to understand exposure pathways what are the means by which people are getting direct exposure to heat. I'm not sure of evidence and data on that we also don't have a lot of evidence on evaluating effectiveness of particular interventions. This is a long game and we really are throwing lots at this right now and we really need to get into that zone of evaluating so I'll stop there for now and look forward to the conversation with others. Thank you so much. You're coming in and out just a little bit so if there's anything you can do on your end to adjust your connection that would be great. Our third panelist is Jessica who is representing an industry perspective. Hi everybody my name is Jessica Trudinic I know that last time is challenging to pronounce so as you say I do bring the industry perspective I also I am an occupational health and safety professional by background so I bring that perspective also and of course also finally the perspective of a concerned member of the public and I'm interested in this conversation for many reasons first the space between occupational and home or private exposures is narrowing in this day and age what is a worker what is a member of the public workers are increasingly driven by the gig economy seasonal workers things like that so these populations are not disparate from each other and of course as we've discussed the exposures to heat via personal life and also via workplace life interact with each other so I think that the most important exposure sources are important to consider and I think this workshop has done a really good job of that so far I'm particularly interested in the workplace conversation because as we've talked about today and yesterday workers have historically often not been considered at risk populations but of course we understand today that they are particularly at risk because they cannot avoid their exposures by reducing physical exertion or staying indoors in cool places and so workers need particularly proactive interventions and finally my interest in the conversation is driven by my experience in occupational health so while it's true that heat risk can be difficult to predict and difficult to characterize we do have roadmaps available to us to help us do this both for occupational exposures and also for home life or personal life exposures so there are three examples that I have of how we can pull occupational health practices into this I know I don't have a lot of time but very briefly in occupational hygiene we aim always to anticipate first recognize characterize and control risks and as others have said I think that's the approach we need to take to the challenge of extreme heat we have also a very proven practice of creating similar exposure groups I haven't heard this concept mentioned specifically in that term but that's the practice of creating subpopulations of individuals whose risk can reasonably expected to be the same and then you design controls and protections for those groups and that's a way to amplify the impact of actions taken and then finally the hierarchy of controls so in situations where we get to that place where we need to control a risk we need to make sure to follow the hierarchy of controls in order to prioritize the actions that we identify that we should take and also to inform decision making about which actions to take and there are plenty of examples about how we should prioritize first the elimination of the hazard and then controlling the hazard through engineering controls all the way down to possible personal individual protective solutions and we can I'm sure during the session explore that in greater detail I'm happy to be here thanks everybody thank you so much Jessica and over to Dr. Rupa Basu who is representing a state government perspective Hi everyone I'm Rupa Basu thank you Cecilia for that introduction I'm currently at the Air and Climate Epidemiology section at one of the California EPA's offices with the Office of Environment and Health Hazard Assessment and I'd like to kind of come from an epidemiologist by training I started this work really half my life ago I had 25 years ago and I at that time we were really basing our work on case reports following heat waves so we have come a long way we've developed epidemiologic methods we've looked at mortality identified high-risk populations also considered morbidity outcomes and I think at this point I agree with the other panelists something that's been repeated over again from this morning and also yesterday is that we are at this point now where we have done this work and we need to move forward with interventions really thinking about high-risk populations and communities getting community workers involved it's kind of like we now have this big picture we know what's going on we need to kind of hone in on and use the knowledge that we've created so far over the past 20-30 years to develop interventions I think we all agree that it's not going to be the same interventions for every community so we have to really try to think about what will work in each location and it has to be very specific to that location based on vulnerable populations high-risk groups but also what is feasible a lot of times we hear about cooling centers as an intervention in some places that works great movie theaters for example shopping malls senior centers in other places people lack the transportation to even get to these cooling centers or may not even think about going there so we really have to think about this in terms of each community and of course we can develop plans that we can as a state government employee think about working with local health departments but I think we have to take it a step further and again include community members to think about what will work and this I want to say again and again a lot of the heat-related mortality morbidity is preventable so we can get there thank you so much dr. Bessie and I'll turn it over next to Nikki Cooley who is representing an indigenous perspective over to you Nikki. My name is Nikki Cooley I'm from the next nation we're commonly known as the Navajo people I live here in Arizona Flagstaff Arizona the rightful homelands of the Navajo Hopi Walapai Havasupai and many other Pi tribes I am the co-director of the Institute for Tribal Environmental Professionals Northern Arizona University and I also co-managed the tribes and climate change program we work with tribes across the country on climate adaptation and mitigation via workshops we have introductory and advanced courses webinars we offer technical assistance to assist tribes in addressing climate impacts and one of the things that we are largely focusing on is the inclusion ever the always mentioning of traditional knowledges, indigenous knowledges so the Biden Harris Administration submitted federal guidelines for decision making processes using indigenous knowledges and that is a huge victory for us because in our work we stress the use of indigenous knowledges even in every sector and right now we are talking about the impacts of heat on indigenous peoples and we are trying to have the federal government even at the regional local community level, governance level to consider indigenous ways of knowing because these types of knowledges have been knownly and intentionally excluded from every conversation because we feel that there are indigenous ways of doing like traditional structures that can help with cooling of you know communities that are facing high heat such as we are facing here in Arizona so that is one of the things that we are working with tribes on and I'll talk a little bit more about what I do and I just want to mention to everyone here don't speak for any specific tribe even though I am from the Dine tribe we work with tribes and some of the information that I will be sharing I have been given permission but I don't speak for all indigenous people so I'll pass it back over to you Cecilia Thank you so much Niki and now I'll turn it over to Jane Gilbert who is representing a local government perspective Thank you Cecilia and thank you National Academies this has been great to hear everybody's comments and discussion Yes Jane Gilbert chief officer in Miami-Dade County I was appointed two years ago by our mayor to address the increasing risks health and economic risks associated with extreme heat in our region and it's great to hear everyone talk about involving community sectoral solutions because the way I was charged to address this issue was exactly that was to one we did hire some researchers to do a heat vulnerability assessment and access heat study to really understand the conditions at which people were most at risk and the areas geographies and demographics of people that were most at risk in our particular region but we also engaged through our place-based foundation across Miami-Dade County has 34 municipalities within it we have our state health department our community-based organizations our university partners all of which were involved in our climate and heat health task force and we did a community-wide call for people with lived experience from low-income communities from a stipend to participate as an official task force member we then did a series of public workshops where we had our community partners, our municipalities, etc do a big outreach to make sure we got as many voices in the room as possible to address the different issues related to extreme heat so our heat action plan which was released last year is a collective action strategy it's not a county-owned strategy it's actually under our resilient 305 rubric or framework we have other entities a national weather service or community-based organizations or our school district leading on different actions within that strategy it's under three main goals and we talk about short medium long-term solutions it's got all of those engaged on it we're moving forward on all of them now but some of them will take longer and we'll talk about a few fruition so our first one is about informing we gotta keep it super brief just for the introduction three main goals inform, prepare, and protect people cool our homes and emergency facilities and then cooling our neighborhoods and I can get into more detail thank you so much and over to Gary Harris who is representing a non-profit perspective thanks thanks so much Gary Harris I'm managing director for the center for sustainable communities we're about making communities greener, cleaner, healthier, safer and more climate resilient and we do that through an equity and environmental justice lens and I'll approach to this to the effects of heat is in an umbrella program called building a weather-ready nation for all and this really came out of a low storm event that happened in Atlanta a long time ago and since then we've built a number of programs to handle severe weather which includes heat and tornadoes and hurricanes etc etc and we do this by capacity building in communities we do this by meaningful community engagement by exchanging technical knowledge by actually developing computer-based technology by education through environmental justice etc etc example we work with Raytheon to produce an animated series of severe weather interactive tools that will guide the communities through heat-related measures next we work with the State of South Carolina in developing their EJ Strong program which looks at risk and hazards and capacities and vulnerabilities of particular community as it relates to heat and other vulnerabilities and such and from there driving out action plans from there we focus on communities where we want to empower them and in 2017 we won the females award for community engagement for our rally for resilience and that's where we're getting everybody together in the community along with experts and specialists to exchange, to have dialogue and such and talk about heat and other severe weather related matters in one interactive session next we're working with the NWCP with their climate and energy justice program and there we develop guidelines for community engagement and projects and programs that may cause heat-out effects etc etc and lastly we work with something called the building EJ tool or the building environmental justice tool where we work with AutoCase and a number of developers and planners and such to develop a tool that would ask the question if we build this, how will it affect the community including the heat-out effect so a number of things we're doing under building a weather ready nation for all. Thank you so much Gary and as I think we all can see we have an incredible range of expertise on this panel we also have this incredible audience everyone here so thank you all so much so for being here today we are going to have each of our facilitators from day one give a two-minute summary of some of the main challenges and barriers that were identified and we're going to put these problems in front of this panel and let your incredible expertise come to bear on them we hope this will be really exciting and engaging I want to caution everybody to limit your remarks to 30 seconds if you're not available so for those of you in the audience there will be a link put in the chat where you can join a Slido and we invite you to propose solutions as we go through the different challenges that will be presented and now we will turn to our first set of challenges and Carlos you represent the natural and built environment breakout group and what were your major takeaways from the discussion yesterday? for those of you who were in the group yesterday that was led by Mikhail Chester don't be thrown off Mikhail is not able to join us today so I will be pinch hitting stuff the right sports analogies pinch hitting I will be substituting for him today so just as a reminder natural and built environment included a range of blue, green and grey infrastructure and facilities like cooling sensors etc so I'm going to quickly go through three themes obviously there was a lot of conversation we invite you all to go back to the gem board to see some of those but the three how to go rising some of these in three themes I will describe the themes and pose it as a question for you designated panelists to respond to the first is a challenge with the most diffused current intervention for heat emergencies in the natural built environment and that would be cooling sensors there's a lot of discussion about restrictions including federal restrictions around cooling sensors and what the alternatives to cooling sensors could be such as resilient subs etc so that's number one so who I'm going to ask all the designated panelists who are the agents that are controlling these what is their jurisdictional authorities their constitutional authorities and how those could be altered into feasible solutions for dealing with cooling sensors as the first intervention the second is the challenge with less diffused intervention and I'm going to be lumping greening green space and land use change overall and so that's a barrier that there was a range of barriers to local land use changes in greening some of the ones that were mentioned were municipal planning zoning Dr. Chester himself mentioned his own homeowner's association as being responsible for this so these agents the local government versus county state federal roles so particularly those of you that are representing local government state federal roles Jane I'm going to be pulling on you to certainly talk about Miami-Dade with a very forward thinking mayor but who has very clear constitutional divisions about land use rules and so I'm happy to hear your comments on that third challenge is with the less diffused excuse me the challenge that we have least with the least understood phenomenon and that is the lack of knowledge around indoor heat quality this came up repeatedly yesterday because the over emphasis on outdoor heat exposures but certainly existing residential commercial properties so many of the heat deaths and heat health hazards that we see are indoors so thinking a little bit more about who are the responsible parties here how could city governments landlords those who control indoor air qualities not just for new so I'm cautioning the group not to focus on solutions like building codes which are helpful but looking at existing properties and how one can provide solutions for that built environment set would be helpful and those are the three so I'm going to pass it to the designated panelists who I believe is going to we're going to start with Jane yeah let's start with Jane right go ahead Jane okay my internet has been a little unstable so apologies just on the first one thank you Carlos the concern I think I actually was in the group been expressed was really evacuation facilities that in the event of a widespread and extended power outage we don't have in several of them enough backup power to keep some cool and when we went to try to apply for grants there was challenges through FEMA to actually provide those kind of that kind of support so I wanted to be specific on the challenge I don't have the solution to that one but what we did do is pivot and try to work and get a brick grant for a cooling center slash resilience hub that's more a daytime facility in terms of some of the land use questions that you had Carlos I think what we try to do at the county is through our comprehensive plan through our land use is to try to create some that are our ground level that all our municipalities have to live up to and then if they want to do a stronger code they can and so that's what we work towards with our landscape and Street Tree Master Plan code in terms of that but we are revisiting that as we speak we've got a whole urban forestry plan as part of our heat plan so that's another piece that we're looking at. Thank you so much and I wonder if Jessica have any thoughts on our challenge of a lack of knowledge about indoor heat and temperature quality? It is absolutely a challenge of course to characterize the hazards that are present in a way that we know that they're going to represent the day-to-day minute-to-minute realities but I'm not sure honestly how extensively sensor technologies real time detection capabilities have been explored as a way to sort of characterize and zone in real time it looks like Jane has knowledge on that topic. Yeah so sorry but we used university partners to place sensors in homes and then they did research, I forget with the IRB rules or whatever but they made sure they could interview them and do extensive interviews so they could match the temperature humidities with the experience of the people inside and then with NOAA actually Hunter was involved with this we placed sensors outside those homes to understand the correlation between inside and outdoor heat it's helping but we still lack data on really understanding where all the people are that are ACN secure and energy burdened in our county. Let's move towards solutions I want to push you guys to think about what are the solutions to this and maybe Hunter you have some thoughts in terms of some of the data you've received and how we can improve our lack of knowledge. Yeah so I'm kind of reflecting on some of these things that came out of the first group when it comes to the you know making changes in the built environment one solution that we supported that actually is building on a lot of the urban handling mapping campaigns that we worked on throughout the years is with a group at the University of Arizona and Arizona State University that not only developed an authoritative guide on how urban planners and design and other professionals can mitigate heat in the built environment but they also built on previously developed approach called PERS the plan integration for resilience scorecard and they extended it to heat and what it is essentially a planning tool to look across a number of different documents your resilience plan, your sustainability plan a number of different planning documents and just with a focus on heat see what net impact you were having that you know in some places they were having a positive impact on heat, they were mitigating it in other places they were having a negative impact unintentionally because they were focused on another hazard perhaps and so just looking across all those plans and getting a good handle on what was being accomplished was a really good step and so now that approach is being ruled out in a number of other places and there's a lot of interest to do more of it yeah that's great to hear Hunter and you know we do have a lot of guidance and I think this is one of the things that's great more guidance is emerging but I'd like to hear maybe Gary and Nicky what do you think, how do we translate this guidance to the vulnerable populations so that they can take action, what are your thoughts on that maybe Nicky first and then Gary when you're talking about vulnerable communities the indigenous peoples are always part of that group I come from that group where the poverty rate is below 40 it's like not below, it's at 40 more percent on the Navajo Nation but also remember that a lot of our community members are rural so just having been inclusive of that perspective is so important, I know what it's like to live without electricity, running water and I think all of the other panelists we all live in these urban areas and I think to have that perspective we need to really get down into the community and hear from the people I think someone was talking about community meaningful engagement what does that look like, it's not just taking surveys and handing out flyers and saying we need your perspective it's really getting to know the community that you really want to assist so I'll stop right there for now thanks so much Nicky and Gary I'm going to push you towards giving us some solutions here okay quickly here it's all about capacity building and with that I mean getting in community and just not informing them just not consulting them just not letting them know but moving them towards empowerment having ownership of these issues that's the person foremost and also let's move these cooling centers out of government control and into communities and build resilience hubs and such and have those hubs maintained by the community they're accessible, they're maintained and also that the community understands the importance of the treatment as well and it also gets down to the very homes in which people live in a lot of people in underserved communities live in not so nice housing it's not well insulated it was built before so some of the latest it's old and etc so healthy homes, we need to make sure that populations in those communities are living in healthy homes so establishing healthy homes programs with an emphasis on extreme need you walk around the community sometimes you see a home with a single air conditioner stuck in the window what if the air conditioner goes out and it's a 90 degree day another thing that we're doing quickly here is really working with NASA data NASA opened up their information center today and everybody was there and so we're using NASA data from satellites or science data and we're gathering community both together and saying here's a way for you to mitigate your environmental justice challenges via using NASA data we've had two workshops so far and we're feeding back to NASA how can we empower these communities with your data including extreme need yeah I love that thank you Gary so we've been talking quite a bit about how we address this lack of knowledge around indoor heat and temperature and thinking about solutions there let's spend a little time thinking about this cooling centers and evacuation facilities issue Rupa is this something that you've encountered in your work in California and any solutions that really come to the forefront for this yeah so I guess I first want to start with some of the barriers that you discussed one of the biggest things is that we're really silo even among the state workers our state agencies aren't so great about working together and this is why it's so important to have conversations like what we're having right now whether it's academics or government or you know communities it's really important and like Nikki said when we're talking about communities not to just go pass out a flyer and put a questionnaire in and then kind of leave and not do anything about the issues travel communities, unhoused populations and outdoor workers are these high-risk populations that we just don't have data on the indoor air also or indoor temperature excuse me is really important but it's expensive to get that data we need personal monitoring for that that's why it's so much easier to do these large scale studies so as far as interventions go we do have some heat action plans that we can learn from again I don't think that those really capture the root of the problem and also doesn't capture the very vulnerable populations that are not included in these larger data sets but it still gives us a start as to what we can do what kind of interventions we can take as far as cooling centers go Zilly asked that question I don't think that's been a valid solution for most places but in some areas especially in urban areas that does seem to work just because they're more accessible you know there's libraries I mentioned before movie theaters and those types of things that people would probably visit anyway but we have to think about areas that don't have these types of areas rural, semi-urban smaller communities and that's where I think more of this work needs to be done we've done a better job in urban areas just because that's where we have the data we don't have the data in those other places and that's where I see a huge gap Thanks Rupa and over to Hunter I just wanted to add one thought about cooling centers and that is we often focus so much on the centers themselves and not on the people that are using them and who they are and why and I think we need to think more about the groups of people that go to the centers anecdotally I know it's a lot of groups of people like first of all the unhoused population but then there's also another category which is people who are poorly housed older adults that maybe feel like they can't run their air conditioning or something so really getting more paying more attention to who's going and why they're going you might be able to address different issues that are driving people to need to use cooling centers when it comes to poorly housed individuals for example or people who maybe don't feel like they have who don't have air conditioning or don't have the means to run their air conditioning that's potentially a different solution that you can implement as opposed to expecting them to go to a cooling center so really breaking down these issues a little bit more thanks and we have about 30 seconds left I'll turn over to Jessica thank you I know we are trying to focus on solutions and not challenges but I do want to mention that there are parts of the country where historically public buildings have not needed to be climate controlled so there actually is not a capability currently to do things like manage the air quality manage the temperature inside buildings buildings like schools community centers food shelves even sometimes movie theaters don't have air conditioning systems because previous to current times they weren't needed and so I think there's a particular need to evaluate public spaces because we know from occupational hygiene and other practices that relying on engineering controls rather than administrative controls which involve altering human behavior is more reliable so control the climate in those spaces where humans spend their time anyway thank you so much alright well we're going to move on to the next set of challenges and hope audiences following along in Slido and I'd like to invite Juanita to come on screen and present some challenges from the workers and economic productivity group we had yesterday thanks so much Cecilia so my name is Juanita Constable and I'm with the natural resources defense council a lot of the barriers we discussed in the workers and economic productivity session yesterday echoed what we've been hearing all through these main sessions so I'll just group them in three broad categories first there are wide information gaps among and between employers health and safety professionals and workers about the perils of heat and how to address them so many workers aren't aware of their workplace rights many industrial hygienists don't have adequate training on heat which was a big surprise for me to hear yesterday and many employers don't understand that they'll save money by protecting their workers from heat second even when workers and employers understand the health harms of heat they may not have the tools to address them small business owners may not have the staff or the technological expertise they need to develop a robust heat emergency plan or workers may be blocked from organizing themselves to collectively demand the protections they deserve finally as someone just a little talked about yesterday in the context of community members if you have a problem with heat you face a lot of other threats in your life that means that even if a worker has the information they need and the tools to address the harms of heat they may be afraid to use those tools so workers may be afraid of being other for being pregnant they may be afraid of being deported to another country back home to their home they may not be safe for them or lacks economic opportunity they may be afraid of losing the only job available to them and these fears stem directly from the major institutional structural and economic forces that put workers and especially low wage workers of color workers of color in harm's way and keeps them there so we have this nested set of barriers at multiple scales that all contribute to one another how we deal with these nested barriers in a holistic way that doesn't just nibble at the edges of the threat of heat to worker health and productivity and who needs to be contributing to those solutions and how do we best engage those contributors thanks thank you so much and why don't we start this one off with the fact because we didn't hear from you in the last panel if you're ready to respond sure I hope my internet is also stable at least for these 30 seconds that I just quickly respond this is really interesting Juanita lots of work is happening in this area I think one of the things that comes to mind is that when we're thinking about innovative solutions a lot of the my definition of innovation is just old ideas that are put to new application and in this case things like things that have been around IHEAP these early assistance programs even federal agencies like FEMA they don't recognize heat in LIHEAP's case they don't recognize summertime heat as a necessary a lot of states who apply to federal agencies for those resources don't see heat necessarily as a direct opportunity to shore up some resources and that can be directly applicable to workers to to entities and that could be a direct way to address some of the countervailing arguments that I've often heard from private agencies that often say you know we don't have the money to be able to put in air conditioning or we don't have the money to be able to do X, Y, or Z and there are programs that I think do exist already where you can quickly catalyze a lot of activity in terms of reducing exposure particularly those workers who are outdoor workers I'd be really curious to hear from others on the panel about opportunities that might be available or innovations that might be available for getting an outdoor workers outside of the city and I'm curious to know what your thoughts are among any of these themes of communication gaps not workers not having tools and the sort of the fear of retribution that workers experience there's so much to say here I want to start by acknowledging that these challenges are not unique to extreme heat these challenges impact workforces with respect to a lot of different aspects of occupational health and safety there's that and that actually brings me to again the fact that we do have a lot of proven practices that I think we should tap into here when addressing the challenge of extreme heat and its impact on workforces I know Vivek you had challenged us to think about solutions that are not regulations but I do think regulatory framework is absolutely essential there is a state heat illness prevention standard in California that I think is a really great example for other states to follow but we do also need a federal level regulation in place that specifies and requires mandates specific programmatic elements to be put in place in workplaces we don't have that there's a lot of research out there about practices that are effective to address challenges in workplaces we need to tap into the research and the learnings tap into the best practices there are lots of resources recommended guides out there for how to implement a heat illness prevention program but we need those program elements to be mandated by federal OSHA and again there are great examples and I want to point to respiratory protection programs as an example where federal OSHA has mandated specific program requirements that help employers make sure they're putting everything in place they need to to effectively protect workers I can say a lot more but I want to give other people a chance to speak also thanks so much Jessica and panelists if you have a comment you'd like to jump in on please raise your hand so I call on you otherwise I'm going to kind of just go with it. Rupa is that you coming off mute yeah sure I could just add to that one area that is often missed is mental health especially with outdoor workers so we've done some studies now to look at heat and mental health and we know that the suicides and homicides and all these other mental health outcomes are actually elevated when temperatures increase but high risk populations such as outdoor workers are often missed and I think we haven't talked about mental health and that whole aspect as much also something that really needs to be addressed when developing these action heat action plans thanks Rupa and kind of pushing towards solutions I think one of the big challenges we see in this area is big communication gaps and so curious how this group has come up with solutions maybe for other communication gaps but how can we apply it here Jane, Nicky, Gary any thoughts on how we really improve our communication to vulnerable populations in this case being workers go ahead Gary yeah quickly here there's nothing more effective than a good old fashion inspection so let's have our inspectors not only look for safety hazards not only look for trips and falls but also for heat as well and how we can do better not only on outdoor construction sites but also indoor manufacturing facilities as well it's about educating leadership getting that CEO engaged involved making him knowledgeable that hey this is affecting folks all the way down to the assembly line and we need to do something about it he let the officials typically not well educated in this space so we need to push those guys as well the policy worker rights also we touched on laws of regulations and lastly industry operating experience industries keep good records around histories of accidents of things going wrong in certain places so let's expand that to capture history around heat effects and share that as well industry operating experience I love that any Jane any thoughts to oh we have Jessica why don't you jump in and then Jane so quickly to your question about communication challenges a basic practice we need to have in place always is understanding the languages that are spoken by the workforce and providing information both verbal and also written information via posters in the languages of the workforce that is present and then also I want to point out that one way to address communication challenges indirectly is to implement your controls in the form of everyday work day practices rather than training so if you rely less on training and more on things the controls like misting stations that are located there at the work site in the space where the workers are spending their time constructed canopies shade that is erected in the space where the workers are spending their time enforced water and cooling breaks buddy programs where no worker works alone those are our practices very specific examples of practices that can be implemented that rely a little bit less on training and communication of the workforce itself thanks so much Jessica on the theme of communication Jane and then Nicky so I'm wearing a sticker from a demonstration outside that says agua sombrae descansu it's a campaign of workers that are looking for local heat protection we've worked with them for three years trying to get a state level standard and so now we're pivoting towards a local heat protection standard we're exploring that but our heat season campaign to everybody's point was in three languages English, Spanish and Haitian Creole it all channels outdoor media social media but radio the radio stations that we heard from our community members that the Haitian Creole speaking people listening to or the Spanish speaking people listen to and just not just spots but interviews making sure that they're actually their people are representing and getting the word out so I think that's really important we did some that were specifically targeted towards outdoor workers so that we could reach out and are looking to partner with OSHA on a series of trainings this summer to engage employers on the issue so that we can try to Gary's point try to get those the employers involved and engaged on the issue. Yeah, and changing the narrative there maybe and saying you know healthy workers are productive workers right because we when health declines productivity declines how do we frame this in the positive you're actually when you're exerting energy over 90 degrees your productivity goes down 50% so with just an hour out there so if if you do take breaks though I think that's really important because it's really important to have this research that shows that you're more productive. There you go. Nikki over to you. I just quickly wanted to say that I agree with Gary when he mentioned that educating the leadership getting them on the ground and that's something that we do or try to encourage in our work at itep is to have leadership people to have leadership decisions or influence decisions to be to experience what it's like on the ground a few years ago I believe Senator Cory Booker went in the field to with the with the workers and and many other representatives have done the same thing but that kind of I think leadership is needed to educate and show you know so they know and then in the communication one of the things that we promote as well is to and somebody said in the slide out is to empower the community, empower those who are on the ground. I believe that we should see them as relatives not just machines who create products or help with the product output but see them as human beings and that's something that I think should be in management 101 so seeing them in a holistic way right I think how do we create these solutions in a holistic way and one of those ways is going back to seeing our relatives who are in the fields as just that relatives not just worker bees who help us create money so anyways I'll stop there thank you. No you don't have to stop Nikki I think we have some more questions specifically for you and I think you know bringing that indigenous perspective to this is really valuable and one thing that's occurring to me is that workers actually do have a lot of knowledge about heat and how do we bring indigenous knowledge or ancestral knowledge to the forefront and I wonder if you have any experience with raising the profile of those types of practices and maybe it applies in this situation. I live in Northern Arizona and in the area near Monument Valley like Powell area and we've been experiencing extreme heat like over 100 degrees which hasn't happened I grew up herding sheep in the cornfield and I don't remember ever it being like 95 degrees and above but I'll tell you I also live at 7000 plus feet in elevation now so I'm very spoiled my mother still wears hats long sleeve jeans in 100 degree heat and they have these cooling centers and our cooling centers are shape structures made from material off the land and it is and under trees and so we take care of our trees juniper and pinion trees and so just asking our as we say indigenous way our elders our elders are long term monitoring networks and data somebody was saying that there's a lack of data in these vulnerable low income rural communities and that's to your point Cecilia they people are data and we don't ask them enough and that's what we're trying to continually promote at ITEP and with our other partners we have a lot to speak to the people and I'll end with this the Heela River Indian Community which is located south of Phoenix and Chandler Arizona they are also facing extreme heat a lot of Haboobs you know these huge dust storms and the lack of water they are creating traditional shape structures as part of their climate adaptation planning process on the western colonized way of the four wall structures which most often if you look on tribal reservations and communities are poorly built and they're not built to last they're not built to retain heat or coolness so asking the people what it's like and going back to that traditional way of creating these structures which can help with retaining heat or cooling off our most vulnerable community members. Thank you that's so cool Niki thank you so much for sharing we have to move on to our next group now Hunter I see you and we'll come to you quickly so I'd like to turn it over to Anna to present some more challenges and let's focus on solutions we're making really great progress thanks to everyone and thanks to those of you in the audience putting stuff into Slido we really appreciate that over to you Anna I think that bridges perfectly into some of the discussion here so we were health and health systems and so we've summarized this into three take homes but I will say part of this I've taken the liberty of building on so the first one you already heard is silos so where knowledge is who's missing from the conversation who are the actors who has access to health and health care and all of this is affected by trust but it leads to I mean the truth is there's this sectional work because in health health is mental, physical, spiritual emotional health so it it actually it links to everything that we've talked to here but yet the health care system and sector is very siloed and I think that this has just been underscored perfectly in this conversation but we haven't labeled it until in this last one which is really we exist with our information our power and our funding and our scientific method are all very colonial ways of thinking we take complex problem we pick it apart and then we try and measure and then we put it back together again and like that's not a very relational way of thinking it's not helpful and I think you know in health care we're really with all of these fundamental pieces is return to relationships relationships with each other with nature with the environment in the umbrella of planetary health you know really returning and trying to understand support and legitimizing indigenous knowledge systems as really important to our health and amplifying those voices so I think there's definitely an opportunity for learning and recognition of indigenous knowledge systems as you know knowledge keepers but the barrier there is that it's not legitimized it's not recognized and even I think when people are well-meaning it takes time to really listen to learn to listen and understand and the people who are affected by these systems are the speakers so how can we enable healing capacity to share that knowledge I think is a huge piece that was brought in there the second one is data and you know that's difficult to measure you know if you're talking about time points and there's a leg with heat and then there's chronic stress and what that is often misses people's human experience and their human knowledge the scale of the granularity of the pieces getting real-time data and I think a lot of it's focusing on benchmarking but really we need to be working on action so how do you do all these things simultaneously and include these different perspectives and weight and knowledge to get that across and then there's the communication how do you disseminate it how do you counter in a way that's not defeating because there's really striking health outcomes countering disinformation and and and you know how do you also integrate the narrative of climate change in while you're doing this because that's really one of the causes and then the third one is this this chronic and acute response to heat in the health system which we do not have it's very reactive not proactive and often the solutions are outside of the health system but even within the umbrella do we have heat emergency plans do practitioners have conversations and do medication plans and hot day planning are you are we linked properly to you know I think public health and health geography and epidemiology here and then the and that's where the knowledge is but the frontline people the people supposed to be having conversations are often the ones not connected to the community organizations the activists the people having these and and they're not we're not as healthcare providers prepared and we don't have that knowledge so just to sum it up there's like three I think barriers one is the silos and part of that is this healthcare system is like siloed itself from all these other pieces and is trying to link back through we've siloed indigenous knowledge and not highlighted and enabled it the second is data and all the issues around that about who has it how we benchmark and not inhibit action and the third is this preparation for the acute and chronic health system effects like those are basically non-existent so it's a barrier but the other barrier is the fact that we're trying to integrate this on an already overburden stress system. Thanks so much Anna. Okay so let's go to Rupa first for this one. Okay I think you hit so many things right on the head Anna but the thing that I want to talk about now is we are kind of in crisis mode and that's why I think so much of our public health interventions tend to be short-term what do we do about it now even just 20 years ago we would talk about something climate change happening in the future we don't have to worry about it quite yet maybe in the next generation but we're seeing now that that's not the case regardless of where we live we're seeing impacts on climate change but it doesn't mean that we shouldn't be thinking about long-term solutions as well particularly again getting back to high-risk communities what about things like building infrastructure what about enforcing some of the guidelines because especially when I think about farm workers people know their rights but they're not enforced and so they maybe feel like not able to really take action even though they know that there's oh I should be taking a break now but other people aren't taking breaks and so maybe I would get fired because I'm the one that's doing that things like that I think that we need to think about long-term solutions I know that we're in crisis mode I know that you know from epidemiologic studies most of the health impacts are very short-term and acute and that's why we need to act quickly but we need to also plan ahead thanks for both so let's let's talk about solutions towards this how do we get out of crisis and reactive mode and I'll turn to Jane next sure thank you and I'm not going to address all the challenges but one thing we did I co-chaired our task force with an internal medicine doctor who was a co-founder of the Florida Clinicians for Climate Action her name Dr. Cheryl Holder and she got involved because her patient who had COPD came to her and asked for her to sign off to get her help with utility assistance and that speaks to Anna's point of just the intersectionality of the challenges so doctors, nurses, nurses in particular are our most trusted messengers out there so we partnered Cheryl Holder and I and our Baptist Health System and and our Health Foundation on creating a continuing education series that train nurses, doctors on why is it getting more hot both the climate change, urban heat patterns who's most vulnerable and really talked about questions and how you tease out some of that chronic exposure identify an understanding and reminding practitioners that how that could compound either medications they're on or pre-existing conditions they may have understanding what their conditions are at home and exposure that might be at home as well and what resources they could help their patients with with our utility assistance programs or knowing what what rights a worker does have even though they're limited here but what their rights they do have those were some of the so that was just one solution that we put together. That's great so thinking about education of healthcare workers making sure healthcare workers know about what resources are available to their patients right and so they're well educated and can really step in that's really wonderful and there were some of things there too that we've captured. Nikki over to you. Nikki you're muted. Thank you for that synopsis and I really appreciate it I just want to say part of the solution that we're trying to encourage and promote with our adaptation planning and our work the health of the environment is very closely tied interconnected with the people we are not different that is literally who I am and if I did say my clan system that you know we are part of these clans it's all about the environment and the animals and the plants our whole being does not honor the New York skyscrapers or the Eiffel Tower or the industrial revolution it honors our relatives our non-human relatives the plants and the environment so I really want to stress that part of the solution is acknowledging that all our healthcare officials on and off the reservations need to take into account that indigenous people's healthcare does not include always include a facility like Indian Health Service or Flagstaff Medical Center or you know and so on our healthcare comes from the environment we have medicine people I don't call them shamans but we call them medicine people men and women people who are of the two-spirit who are medicine people that provide prayers ceremonies emotional well-being practices so that's a big part of it Windflow Indian Health Center which is right down the road from Flagstaff years ago employed a medicine man who was a traditional healer who actually worked with the elders and a lot of the community members whose first language was the Navajo or Hopi and then that way they could also work with the people who had the title of doctor the western doctors and that was so successful but it's not a practice that is promoted and there's some places that have that but it's not widely done and I also want to make sure that I talk about the national climate assessment the fifth one that's upcoming the human health chapter which I'm honored to be a co-author on is promoting or not in promoting including how there's the interconnectedness between the environment and the people and that emotional well-being of the people is directly impacted by the environment and I'll end with this example a relative in Alaska has long-term insomnia because he doesn't hear the ice crashing because the warming waters near the waters that he lives near and also he's been very stressed out and had some emotional problems and so nobody understands that and he said the only thing that can heal me is me being on the land being near ice which I and he's like 85 right now so taking that those types of taking all of that into account is important for those who are in the urban healthcare system and Indian Health Service is not the best so have in educating doctors and nurses who come from urban areas to work on the reservations need to be educated that as well so perhaps some of my co-authors are on this call and hopefully they'll comment as well and I'll stop there thank you thanks so much Nikki and over to Jessica and then Gary we got to keep it quick because we're going to move on to the next session soon thank you so much I wanted to address the communication silo challenge again this is another challenge that's not unique to the heat situation I have seen what I have seen be effective here is partnerships between schools of public health and schools of medicine within university systems incredibly powerful to have both as part of the formal education of healthcare practitioners but also as continuing education have some crossover some cross-pollination of those those two populations are public health folks who are learning in their fields and medicine professionals are learning in their fields there's an overlap of curricula some interaction some cross-disciplinary problem solving we actually practiced that when I went through my school of public health here in Minnesota and then also on the continuing education point there are programs funded public health continuing ed programs for medical practitioners geared towards that audience where I think extreme heat can be addressed to help increase access to some of the knowledge that is sort of held within public health to make sure that it is accessed by healthcare practitioners and then also on your question about how do we get out of emergency mode I honestly think that to an extent we we can't avoid the urgency of this particular challenge preparedness is the challenge for healthcare organizations healthcare operations and I think that we can learn from other public health events and a lot of the preparedness lessons that we've learned even from COVID-19 and other infectious disease outbreaks how do we prepare hospital systems to be poised and ready to respond when a situation arises when you can't always predict that it will unfortunately we've struggled to absorb some of those lessons learned even from infectious disease outbreaks but I think we should tap into them they're available things like stocking the needed supplies and materials implementing action plans and holding emergency drills to make sure that everybody involved knows what to do when an emergency situation arises. So I think that's one of the things that we've learned from COVID-19 and I think that's one of the things that we've learned from COVID-19 and and you know the global consortium on climate health education is exists solely for the purpose of educating health professionals so we do a lot of courses and training events if anyone here is interested we have one minute left for these questions and I'll put it over to Gary. Okay quickly here if we have a radio show called why our community must care about climate and so we have health professionals, we have climate experts, we have technologies on panel there and such sometimes up to 10 experts at a time again talking about health, talking about climate and talking about that intersection which includes extreme heat again why our community must care about climate. Next we have rewards program which is the continuous education program where folks go in and they take a quiz, they get rewards, they actually get cash for learning about things like extreme heat which affects their health. Next if you're doing research studies out there hey bring the community along with you let them ride in the car with the instruments and such and see the difference in tree canopies between wealthy sections and those less fortunate and then lastly here we need to promote the social determinants of health we do that all day long through social media and other means as well. Thank you so much Gary we're going to move over now to our next set of challenges and so I will introduce now Allison to lead this session. Thank you hi everyone everyone it's a turn off your computer this going to work? Okay I facilitated breakout group four which discussed how rising heat affects overall well being as well as discussed various types of programming that can build social cohesion or reduce risks in other ways such as heat risk education as well as barriers to implementing effective programming we did during our discussion start focusing some great solutions but for the purposes of this discussion I'll just highlight three of the themes among the barriers we identified with some examples for each so one thing that came up a number of times was the problem of lack of training or in some cases ineffective training on how to implement programming that mitigates heat risk so for example lack of training among health care providers on how to identify and report heat related health impacts for teachers or caregivers on how to balance the need for exercise with the need to stay cool limited understanding of how to communicate in a culturally inclusive way or programming that does not adequately incorporate non institutional or local knowledge and expertise or offer fair compensation of the participants the second category theme of barriers we talked about was the perception of individual responsibility people have often thought of heat as someone that an individual should really just deal with on their own and a lot of the potential solutions out there of course are things that someone might only typically have access to if they're well off or part of a dominant culture such as ability to pay for air conditioning or travel using a personal vehicle to a cool space so the question being how do we shift perception of cooling resources from private resources to public resources and make them more accessible to folks who are at risk and then finally the third theme of barriers we talked about was this narrow focus on heat as a standalone issue because of course people in communities at high risk of heat related health problems often face many other problems that contribute to or compound their risk from heat such as air pollution or poor access to health care or poverty and we may not want to prioritize solutions that only address heat or being narrowly focused on staying in cool spaces so the question is how can communities develop programming in a way that honors intersectional needs and priorities and that addresses heat alongside other community priorities are there existing programs through which heat related education or cooling resources can be offered Thank you so much Ali and to the audience we definitely want to hear from you as well so please use the slide you'll find the link in the chat again here and maybe we'll open up this session with maybe some reflections from you Hunter Okay I'll start by going back actually to the last two categories because I think the intervention I had was applicable to pretty much all of them and that is that I think participatory science is a really important avenue for addressing the silos that were mentioned addressing the communications issues that were mentioned that were that are it's really useful for bringing alternative thought processes and ways of thinking about heat and its impacts into the scientific process so I just want to put that out there and you know we've done that with the mapping campaigns that we run but there are a lot of other ways of doing it there are wearable sensors there are the indoor sensors that were mentioned before so and then also qualitative ways of doing other conversations with people so I wanted to get that out there because it's really I think one of the solutions to a number of these these issues and then just a quick reaction to the idea of shifting that perception of individual responsibility I think a lot of our messaging is targeted individuals and we could do we could make subtle changes to that messaging that would actually have really interesting impact so instead of our social media accounts all saying you know go drink water and seek shade and that kind of thing we could shift the messaging to make sure that the people under your care have water help your friends find shade contact your you know anyone you know in your family that might be at risk of extreme heat so just kind of shifting that messaging would probably have a really big impact yeah I really love I love that Hunter Vivek do you have any thoughts on this one sure and apologies that my camera's off I want to make sure my voice is coming through clearly here rather than seeing my face okay just real quick part of what part of what I think this social cohesion issue is and we are experiencing a national epidemic on isolation I think the Surgeon General has written about this we've seen a lot of publications and literature emerging more recently about this and what we're really trying to do in any of the work and what we're seeing over and over as solutions is really meeting people where they are like not trying to bring heat right to you know the conversation but really starting from where people are in terms of their experience of their place what are the things they see every day around a neighborhood around the farm around any place where they spend time and this is really I think one of almost a no-brainer solution that feels not really innovative but nevertheless given the kind of culture that we have of kind of attention-seeking in every possible sense for every topic I think part of what we're really talking about is how do we actually have authentic conversations with people in the places they are in the experiences they're having and then take that as a means for trying to understand a bit more about how these different changes in the environment including heat intersects with the challenge of having a job and maintaining it being able to get food on the table being able to run and pay the energy bill etc so that's really the approach that I've found to be most effective and we've used that in everything from urban forestry to public health campaigns to heat and even thinking about energy systems like heat pumps and air conditioning units so I'll just leave it at that hopefully that came through better without my camera on. Yes it absolutely did Jane over to you. Sure so just picking up on a couple of things Hunter said in terms of participatory science we have had a long time partnership with our universities and community based partners place i-button sensors throughout our community and then this last round we added in and I see one of our partners right there on the screen Bertha Howard but we've also now worked with the schools to Nikki's point at someone's point about schools and making sure the education system understood the students are now looking at the different heat and humidity and different parts of their school yards and what that means and also reporting on how they're how they're doing I definitely have shifted messaging from just individual responsibility to think about it about your employers not only your loved ones but your employers people you serve if you if you have a retail restaurant operation make sure water is available you know that just different things that everyone's thinking about their neighbor in some way group I see some head nodding there anything to add Yeah I agree with what has been said again the two basic if I could break it down into two categories health education and public health messaging and health education includes everything from elementary school kids to healthcare practitioners to the general public to high-risk communities I think it's so important to me really make that connection between the heat and symptoms many times that is not made so for example if there's some kind of lightheadedness or dizziness it might be attributed to other things but not the heat and so then it's I think different interventions would be made based on what you think the root cause is of these symptoms with public health messaging heat alerts fact sheets getting this message across to vulnerable communities but what I've seen so far and of course there's been improvement but public health messaging is so important because heat advisories right now do not include all high-risk populations so many people don't even know that they're increased risk don't know that they should be taking any kind of precautions and that even includes populations such as elderly who are maybe don't have any pre-existing diseases but just because the fact of their age could put them at higher risk or certain medications that they might be taking so I think that's really important is to talk about who is at risk and convey that message to the people who are at high risk and also their caretakers yeah absolutely Nicky or Gary any thoughts on this well you know what really comes to mind again is this intersection between community and the local health infrastructure and the medical schools etc you know here in Hampton Hills Virginia we've all come together in a collaborative where we exchange we do products together we do community-based campaigns in other words we're deliberately tearing down these silos and we do it in a very very structured manner continuous social media outreach and education campaigns formulating sub-committees sharing knowledge on upcoming webinars again continuously educating our staff but again having that fruitful meaningful engagement successfully we can reach out into communities and make a real difference and over to you Nicky thank you I just wanted to add that for many of our communities, not just indigenous we have community gatherings we have home multi-generational households and taking that into consideration when you're thinking about solutions and support for the community in emergency situations and making sure that all of these community members are informed for indigenous people a lot of our traditional indigenous health care is ceremonial you know we have multi-day ceremonies we also have multi-day gatherings and the traditional way of making decisions was done in the community but also in the matriarchal system where all the women have one to give birth and raise the children primarily were the decision makers and also in recognition of our LGBTQ two-spirit relatives who are also healers they are also part of our health care system so when you're talking about when we're talking about social cohesion I think that is something that needs to be acknowledged time and time again you know with this colonized western framework of patriarchal system that's fine I mean not fine it's fine if they are inclusive of the matriarch and the two-spirit and it hasn't been that way so part of our social network within these indigenous communities is being inclusive inclusive of all genders and making sure that you respect and acknowledge these ceremonial systems that are part of our health care and so that's what all the western health care providers need to understand when you're working with indigenous people whether they live on reservations or off reservations tribal communities but there's a large indigenous populations like in Duluth, Minnesota Los Angeles these huge urban areas they get forgotten but that's I just want to mention that so I'll stop there thank you thank you so much Nikki and we're about at the end of this session but maybe we could just go around this panel and just give sort of a one-sentence thought or idea of where you see the most bang for our buck in terms of solutions we'll start with Hunter I would target it at this particular convening and the committee that brought us here and I would say don't stop here I've been in a lot of conversations like this I always learn a lot from these conversations but it's really important that we've discovered a number of different avenues, categories we can go down we can have days of conversation about each of these and we probably should and so I just want to end with that I think we really just need to keep going with these issues to have some results great Rupa 10 words or less I think the message is clear more community engagement and we know what that looks like there's a lot of mistrust and maybe rightfully so of outside groups doesn't matter who we are we always tend to just trust our community more so I think that's the message that I'd like to end with and Jane I'll just build on that I think that the solutions need to be developed from across sectors across expertise so that you do get those transdisciplinary solutions okay Jessica I was going to say the same thing an inclusive approach to decision making both in building programs and also addressing crises when they arise great Gary lead with equity meet people where they are move towards empowerment Nikki inclusion and the insertion of indigenous traditional knowledges in all decision making processes well I I can't thank this panel enough for your thoughtful and rich contributions this has been really fun exciting I think we've got a lot of material here to work with we've been capturing all of these solutions and we've put them into the Slido and for the next five minutes we want our audience to upvote the solutions that they feel like could be most impactful because the top 16 of these are going to become the discussion points for our next session after we come back from this quick break alright sorry 10 minute break we're going to reconvene at 245 so get your coffee get your water and upvote the solutions that speak to you and we'll see you back here soon hi everyone welcome back I'm Nambi Duga she her pronouns and I am with KFF's racial equity and health policy program so the goal of today's breakout sessions are to consider the proposed innovative and future looking solutions that were upvoted in Slido and discuss potential wildcards or obstacles that could hinder the implementation of such solutions the solutions shared cover many different and connected avenues of addressing the threat of extreme heat including seeking to address improve upon the built environment sharing and leveraging the expertise and knowledge from local communities and engaging meaningfully with them improving heat related data collection and translation and distribution and overall developing holistic cross sectoral and decolonized solutions so each breakout group will discuss the four solutions assigned to them as you look through the solutions and consider which breakout rooms you participate in we suggest that you push yourself outside of your comfort zones and join rooms that stress and challenge you if you notice breakout rooms with far fewer participants we ask that you join these rooms to facilitate a more robust discussion in addition to being presented on the Jamboard the solutions will also be added to the chat so the goal in your rooms will be to push the collective thinking toward a more resilient set of actions or implementation strategies in the face of sudden challenges or uncertainties these challenges can run the gamut of experiences including disease outbreaks power outages technological malfunctions extreme weather events mass shootings political instabilities social political economic movements and others so while you're in the room as your wonderful selves you will also discuss how you could promote a change of narrative we encourage you to be innovative and creative in your approaches what we have not think about what we have not thought about to improve and prioritize disproportionately impacted communities what is still needed to mitigate and adapt to the health effects of climate change how do we leverage the evolving technological landscape and how can we account for these uncertainties our indigenous groups and knowledge bases being centered in these spaces and who is missing from these solution spaces and how can they be equitably and safely included I would like to emphasize that you will get to decide which room you want to attend and the rooms are being posted in the chat you will have the access to the chat function and will be able to use it to contribute to the discussion and provide ideas for innovative solutions and also be unmuted if you want to contribute verbally we ask that these options are used wisely and that you keep your comments short and targeted so to reiterate for each solution and action provided we also ask that you provide an actor or actors and partners as needed who can act on these solutions and who needs to be a part of these solutions so thank you so much guys I look forward to discussing these solutions and try to navigate the different challenges that we have in the different breakout rooms to refer to the chats for all information all right I think we have enough thumbs up that we can move forward let's approach this in this way I'm going to go through the and Daniel's on shall I share the breakout the solutions great I was just going to do the same thing please go ahead so we're going to go through the four solutions that were identified for our breakout why don't we approach this by going through all four and then give it a moment for any overall reflections and then we'll go back into each one to talk about whether it makes sense to tweak it or expand on the actors, agents future proofing questions that we were assigned and then vote again so the first solution is we need to address the built environment that's the solution for the built environment work with nature and not against it there are many small things we could be doing that would greatly reduce the impact of heat involving city planning, architecture, etc again I'm just going to go through all four of them first and then we can come back to each one and word smith them a little bit solution to real-time sensor technologies for indoor and outdoor heat joining data and lived experiences solution proposed number three safety rules which may I'm going to keep going through all four that includes national mandates and preempting state variations and solution proposed number four health education from elementary school all the way through communicating to high-risk communities so if I can be the first in this group to make some overall provides some overall thoughts it would strike me that solution number three is better attuned to breakout room number two on workplace heat exposures and that number four is better attuned to breakout room number four which is the social programming but I will pause there and say ask if there are any other comments around that if there are conflicts with those thoughts or any other overall thoughts anybody in this breakout room and I can't unfortunately see so Laura if you can see if somebody has their hand raised or wants to comment or is putting something in the chat it's not coming up on our our zoom absolutely I'll make sure to copy any comments that are in the chat to the Jamboard and any verbal comments I'll also make sure to copy onto the Jamboard and let me know if I can help with anything else Thanks Laura so and Daniel is here taking notes in the group too so Laura and Dan are here so somebody named Roy from Pennsylvania DOT just raised his hand or their hand their hand is fine I'm working for PennDOT and I agree kind of with Solution 2 and 4 maybe belonging somewhere else but in Pennsylvania we have an interagency health equity team that has about 12 different levels state agencies working together to address critical health issues across the state so from a state level perspective all of these might fall into the state health department transportation community and economic development basket of tools we've been trying to overlay five-year plans to address some of these and we're updating our Climate Action Plan in Pennsylvania so this is a particular interest to me because my partners and the other agencies couldn't attend today so I'm okay wherever you want to move them but I have thoughts on all of them Roy if it's okay I'm going to pin you a little bit more PennDOT I'm assuming is Pennsylvania State Department of Transportation that is correct yes so given that the quality of transportation in the built-in environment and potential heat is there anything in particular transportation office is looking at so we have, I'm working in a niche within PennDOT from the governor's policy office and one of the things that we see as a challenge is our transit so the we have a number of different smaller and larger transit entities in the state especially in the urban and suburban areas we do tend to have fixed route transit and our bus stops which in many places the bus stop for a long list of reasons is a post in the ground and during heat emergencies and in the summer those are not wonderful places to be waiting for the bus especially for people in disadvantaged communities who have a whole constellation of issues to deal with besides transit so that is one piece of it we're implementing an active transportation plan we're working very hard to get our 2500 townships 2500 municipalities in 67 counties thinking about active transportation walking, biking and rolling in terms of reaching community resources so when we're thinking about they're doing that in an unprotected environment how do we do that with the street trees with the sidewalks with places to rest with access to shelter and things like that so there's a lot in here that I think would be useful maybe I was just going to ask you so a lot of the conversation that we had in this prior session was around planning and building the knowledge and research base so I'd like to push us as a group to think a little bit more about the solutions that would come not just the plan being the end but then the projects that would come out of it so from your perspective in PennDOT and I'm sorry to keep harping on your word but so far you're the only one who stepped up in this breakout room what are the solutions for example for the challenge that you identified of people waiting for buses and upgrade hunters so we'll come to you in a second Hunter sure have there been actual proposed interventions yes we have created a publication called build a better bus stop which walks through at a very basic level the ADA requirements the legal requirements is the ownership of the sidewalk the ownership of the physical bus stop itself and the placement of the bus stop for like access in four corners of them interchange where you would best do that so that you have a series of best practices to design something that's safe and comfortable for the users that's one piece of it the other piece is to try to get our transit partners to start thinking about that as they're doing their plans we don't we advise and we're a pass-through for dollars we are not in charge of the transit systems themselves so there's a lot of education pieces here and I think that as we get through the state climate action plan addressing some of these issues cross agency is going to be really helpful in getting the messaging out there so that's the big one thanks for being our guinea pig here Roy and so before we pass it to Hunter for your thoughts Hunter Laura has reminded us that we're not focusing on the same physical interventions as yesterday's breakout groups where we've been given a whole new set of solutions that so there are things that potentially Daniel and I aren't experts in that we'll be hearing so we're just here to listen to you all so Hunter you're on thanks nice to be into number two I hate to be the censor person always talking about it but urban areas are really poorly observed and it's not just urban areas rural areas are too and so I think the data challenges we're facing characterizing heat risk in part stem from a lack of observational data empirical data and so I just want to make sure that we're really emphasizing this as one of the needs is just really increasing the observations that are available of many kinds observing different variables different different ways of observing it's the where other sessions already but the wearable sensors in the indoor and outdoor and this is a really important thing for us to address because you know the program that we've been running through Nihiss has made it a dent in this issue but a very small one because it's such a large issue so just leaning into that if I may I'm curious the program that you're talking about running is called heat you're talking about heat watch is that correct that's what campus strategies calls the program yes yeah so I was curious you know I kind of struggle with this in terms of what happens after you get the grant to map your city it maps it for a day primarily maps outdoor temperatures and humidities and so is there thinking within the program that it's going to become perhaps more comprehensive or both indoor outdoor or maybe starting to prioritize the indoor along with the outdoor now or what's the thinking at NOAA here we would love to do all of those things yes and I think in general you know another much better funded example is the department of energy and their integrated field laboratories there are four of them now that are just getting spun up but they're taking place in communities across the U.S. and they are really going into an elaborate set of experiments and you know community engagements that involve a lot of different observational types not just a one-day community science or citizen science sort of snapshot so those are those kind of represent the two ends of the spectrum in terms of the kinds of observations and the level of intensity you can get to and I think lead to kind of find an approach that works in a lot of different communities you know we've reached a lot of communities with a very small and manageable program they're reaching a few communities with a very big program there's a lot in the middle that we can do we'll come back to the center conversation but I do want to pass that there's another hand raised from Robert to see actually we can go back to the sensory talk right now because that's what I was raising my hand about good and can you identify where you're coming from Robert oh yeah I'm an epidemiologist at the Rhode Island Department of Health and I primarily work in environmental health stock so there's a reason why I'm going to the sensors and a different webinar recently a lot of the talk that I was seeing was about wearable and personalized sensors and so I've been kind of this is something I've been mulling over since that last webinar I'd love to hear from you guys about we're kind of at this point where we're starting to set up useful urban sensor network so that we're able to understand the distribution of outcomes across cities but as we're doing this we're further understanding how that might be significantly different than the individual exposure with a person living in that environment and also given how much of our exposure is indoor versus outdoors what is the value of the sensor networks and as someone who is looking to set one of those up in our state it's something which I think is still valuable especially because for example with heat stress if it's hot outside even if it's not the same temperature inside you're going to have to be taking actions in order to respond to mitigate your own exposure which limits what you can do however that still means there's going to be a discrepancy between the individual exposure and what we can capture in a useful sensor network and I don't know I'd just love to hear if anyone knows about any work into putting together individual personalized exposure on data say through multiple sensors along with sensor network data to see how they compare or if there are behavioral changes that you could ease out of that sorry does that make sense to other people it's just been something that I've been rolling so it's a technical question about the interconnection between personal sensors and outdoor picture networks of sensors is that correct yeah and how we can utilize both side by side will still understanding their limitations especially because with the personalized ones the build out of capacity those are primarily going to benefit people who can afford an Apple watch is kind of what it is now which obviously goes against the health equity stuff I don't know if Hunter your hand has continued to be up or if you have any feedback yeah I was going to offer a little bit so in terms of the value of non wearable sensors which is I think one of your first questions a lot of the solutions don't follow people around and so if you're planting trees or doing some sort of a smart services implementation that's going to be a fixed location and so it still makes sense to be able to have fixed location sensors especially and this is something that's really important that's just not it's not been done enough sensors that are evaluating the long-term outcomes of a lot of these interventions we have such poor data such poor evidence on what these outcomes are and how long-term the effectiveness of a lot of these approaches that we're trying to implement for heat and it's not just about sensing environmental parameters it's also about social science studies there's such poor evidence about the effectiveness I'm drifting a little bit here but the effectiveness of different approaches to warning and alerting there's just so much research that needs to get done and a lot of it's on the social science side as well so I don't want us to lose sight of that as for connecting the sensors I also want to not maybe answer your question but add one more consideration which is the quality of the observations you know if you have fixed location really high quality observational networks how do you connect them to the lower cost sensors and make sure that everything's been calibrated they're kind of feeding off of each other so that you you have a good estimate of the uncertainty of some of those lower cost sensors if I could all of you who are discussing the sensor technology so there is a lower has put in some interest in provocations in the chat around this but I would also about the implementation challenges who are the actors where would this not work etc but I would also push you all to think a little about what the sensor what challenge the sensors are actually solving is it simply information to measure all the other potential interventions that we've been talking about or is there another outcome of interest that we're looking at that comes from the sensors so for me personally I'm kind of thinking of it from two perspectives one is leaning into the temporal trends that you can get from a sensor in order to identify for surveillance things with heat specifically in mind if we're having elevated time frames that we see are related with heat can we use that to preemptively make heat warnings but also with a spatial aspect of it due to the heterogeneity within cities of the built environment you're going to have heterogeneous temperature zones and so this helps us identify which parts of the these locations might be more vulnerable and therefore a better place to say implement a cooling station or communications so I think those are the for me at least those are the two obvious which I'm currently looking at it but I'd love to hear other ones helpful to know that we're talking about this as a means to other interventions right because it's not just the information about the heat themselves is there I don't know if Hunter you wanted to comment on that question too when you combine the data you collect with stories from people it makes for a really powerful narrative so it's also a really important communication tool really important for advocacy for catalyzing change and that's one of the ways that I see it used all the time I guess maybe somebody who's coming at this room not quite the lay perspective but a very different perspective in the housing world I mean we know when it's hot and we know the stories that come out during heat wave so what are we talking about that would be different qualitatively different and there's a hand raised Julie I'm going to pass it to you in just a second but if anybody who has been either Robert or Hunter you want to respond to that I would just say that it's been really powerful to see the temperature differences in any city that we worked in and to line it up with a redlining map or some sort of environmental justice map often it just is very stark and that's still extremely valuable for telling that story even if you're kind of hearing it first hand from people seeing it as well it's so valuable because it's the invisible killer or the silent killer it's another way of making it clear what these impacts are right Julie Hansman if you can identify yourself and your affiliation sure thanks DC actually switching into the adaptation of resilience fields so I don't have an appropriate organization at this point well I'm realizing you can't go into detail about the large universe of data issues here relevant to this issue could you nonetheless please clarify the sensing data versus other kinds of data sets that are gathered I take it that sensing data is this granular really gain the micro changes by being either worn on someone's body or otherwise can you please confirm that and also clarify how that fits into the ecosystem of data collection Julie help elaborate who you're directing that question to oh gosh anyone who can answer it that would not be me I could take a shot so when we when we talk about temperature and particularly urban heat islands we're looking for heterogeneous patterns within a typically within a city it turns out that we don't have holistic coverage of temperature in these locations and so sometimes we use what are called remote sensing techniques so satellites can look down and tell you what surface temperature is but not necessarily what the air temperature is and the air temperature is typically what people experience in situ sensors some of them are gold standard sensors so you can think about national weather service Noah type sensors but they're often a few and far between and so we supplement those with what we can sometimes refer to as cheap sensing technologies and cheap sensing technologies are informative but they're not our gold standards but taken holistically all of these all of these different technologies can tell us things about the heterogeneities within a city the heat watch campaign that I mentioned before and that Noah and that the hunters talked about is a very specific campaign where cities apply for funding to have a consultancy agency come in and map temperature on one summer day so they fit cars and then they drive the cars around three times a day and tell you what the temperature is all over your city and so these are all different forms of sensing and this is kind of the constellation that we're talking about and we're getting down even further now to individual exposure where people would put a sensor on their body and walk around with it and tailoring solutions and interventions using each of these individual data sets and different answers and so a great way to improve your city's urban heat island if you're constricting your urban heat island using surface temperatures is to plant trees but that's surface temperature it's not necessarily air temperature and so these are considerations that we have to make depending on the data that's available to us thank you we've with the three minutes that we have left I believe in our time here we've only focused on solution number two I do want to if anybody in the breakout who's attendance wants to talk about one, three or four please raise your hand otherwise I will ask those who have been participating on the sensor question we have one we need to start talking about actors very quickly so Matrini Weaver can identify yourself which of the solutions you want to talk about we can hear you Matrini I'm currently deployed for Hurricane Ian in Fort Myers, Florida with FEMA so I have a concern about the EJ community that even like old folks and people are going to have a problem for the heat wave so to my view for the heat wave we're going to be there no matter whether you're going to have layers and layers data it's just a trending for the climate change it's unavoidable it's going to get warmer and warmer so I think what I would like to see and the actors is is there any emergency locations for folks that having health problems that's more likely to be provided or is there going to be household supporting system between neighborhoods each other by the time that the heat wave is coming no matter you know what's going to randomly happen with Texas right now or maybe like tornado just like popping here and there like a popcorn so I guess you know that's more doable I think it needed to be done not only just intervention of technology or policy but what we're going to do on the ground itself so I would like to propose that idea to be into action helpful to consider and certainly many of the challenges that were identified yesterday that speaks to those is there any we have one minute left is there anybody who wants to add any new proposal or any elaboration on the four proposals that we have in this breakout group we see a lot happening in the chat so that's good we'll make sure we have that documented otherwise I believe we're resorting to a five minute break according to the agenda and I think everybody who's in this breakout room you can stay here because this will become the main room as well so you don't need to transfer your rooms but otherwise we'll see you officially in five minutes now we can go into just the hearing from the different facilitators if they have if they can give a two three minute summary of what they discuss the big holes and takeaways so if we can go to room one who who wants to speak hello from room one our discussion mainly focused on two particular items the first was sensor technology and the sensor technology and kind of the difference between various forms of sensing technology and the the large the dearth of indoor sensor technology and how to improve that which federal partners are working in those different spheres and then we actually got quite granular with a second solution that was discussed and that had to do with bus stops and the built environment and in particular reducing heat exposure at bus stops and so following the framework that was provided to us if we're thinking about better design of bus stops terms of the partners that are responsible for that we talked about the departments of transportation at various levels also zoning committees and community groups that could be used to identify particular bus stops in need of help in terms of essential actions we talked about the idea at least in the particular case of one state of an umbrella directive that's coming from a state climate action plan and so the need to develop a state climate action plan that will then influence the myriad agencies that are required to make this a better situation I don't think we got into future-proofing that particular item but in terms of accounting for vulnerable populations this was the impetus of this discussion the idea that many of these bus stops are not in good neighborhoods or neighborhoods that are in need of resilience building and lastly the strategy or the communication strategy here was largely driven by the state climate action plan and how that all-encompassing document will trickle down to the various agencies that will be responsible for making this a better situation thank you and I'm happy to pass to room 2 if needed yes here we are hi everyone so we had a pretty wide-ranging conversation one of the themes that kept coming up over and over again was the concept of bringing bringing corporate partners into the conversation whether that be incentivizing good behavior amongst corporations that want to be part of the solution or whether that be making sure that there's a way to get resources into the hands of communities on the front end so if they want to do heat improvements that there's a way to structure it so that community members don't have to buy what they want and then get reimbursed afterwards so that would be there would be a big role for private public partnerships there another theme that came up is that for all of the solutions we discussed which was sorry the two main solutions that we discussed that were sort of home and neighborhood related that renters often get left out of the conversation and so solutions have to be geared not just at homeowners but making sure that there's options for people that are renting where they live and not owning them we talked a lot too about information flow between communities and various governance levels so for example creating places for communities to share the success stories that they've had and basically empower each other with the solutions that they've been leading at home but how do we make sure that everyone has access to those kinds of stories so we talked a little bit about ways to have reporting apps or tools that might be housed by a government body such as looking at you national integrated system but would actually be co-developed with communities and they would be the ones who would be community members would be the ones that would be selecting what's important to share not having some expert arbiter at the top we didn't really get into the future proofing thing because we were so excited about talking about how to make each one of these things happen but one thing that one communication strategy that kept coming up again and again as we've heard the last two days is just the importance of stories and how this can't just be techno speak we have to talk in a language and in a manner that people intuitively understand and are used to actually using in their own lives Sabina anyone else want to add any summary I think you did a really wonderful job summarizing only thought I want to add is that I think we had a conversation a lot about federal housing for these programs and if that's the best place and if so how they can collaborate with communities in new and inventive ways so that we're increasing discussion across multiple levels of government thank you sorry I'm using the wrong mic I think I'm next so we are the third group which was we only got to two of our solutions the first was around national weatherization programs and repair programs and I think you know the main main things there are that I mean we need to be future thinking the data that all of these programs need to be based on future projections and current projections and need to be constantly updated which you know we were told that often they aren't and that they really need to be incentivized and implemented at a local level so regardless of political wins and they're not sort of corporate held and led but they're actually within communities having data oh sorry I said data flex and I think the other piece is framing these as a health issue and I think that also was helpful in terms of when we had a long list of essential partners and really thinking at an intersectional level identifying partners and including health sectors and social justice sectors as well especially for the accountability to you know traditionally marginalizer underrepresentation populations and the other one that we talked about was the you know it was about education for fossil fuels and adaptation that doesn't inhibit mitigation and that was really a conversation about health messaging framing this as a health crisis and on going and then disseminating education across and putting in policies as well that then protect those that are more vulnerable so thinking of it like other public health crises so we'll talk about advertising we're talking about hot day policies for schools you know sports organizations having quotas for when to change outdoor activity and then also there was a very well stated point that we also have to think about you know emotional and mental well-being when we're thinking about this so having intentional conversations that include those aspects and dimensions when we are having when we're promoting this through education as a delicate balance that's where we got to and I will hand it over to group Dr. Hi everyone our group started out by discussing how old ideas can be applied to new situations and we narrowed in a little bit on thinking about the development or use of highly insulated buildings which could include in some scenarios you know office spaces that maybe you know not going used or in other scenarios might include in a way that the public and the indigenous communities have used for thousands of years to stay cool and so the question we were thinking through was how could new resources or new programs be brought to bear to support the use of those types of buildings or support people in accessing them so we identified as some essential sort of hazard mitigation funding that doesn't typically go towards cooling or cool spaces but getting the hazard mitigation world to support it might include engaging FEMA or Red Cross among other sort of emergency management type of folks and also in order to make those solutions resilient as possible to identify potentially multiple structures in a given area so that if something goes wrong with one of them you know you have that sort of redundancy to support your resilience then we talked about micro grids specifically and thinking about not just high tech micro grids with you know the latest solar panels and battery but also geothermal other and solutions that have you know been used by indigenous groups for many years and we recognized that power generation and use is often a very highly regulated environment and so for micro grids as a solution is can be very important to get engaged in advocacy and to engage local representatives to push for the regulatory environment to become more amenable which is already happening but could continue to sort of move forward on that path then our third solution we discussed was about regulatory frameworks really focusing more on housing and for example the concept of a maximum temperature threshold for housing which has been instituted in some places and we discussed how not only is it important to you know for the building code regulators to be hearing from advocates on this but to also be engaging civic associations and as I think somebody else mentioned earlier renters as a key stakeholder group and thinking about renters associations or other sort of housing justice advocacy type associations as partners to engage and then we also focused on solutions based journalism and when it comes to developing narratives for any of these solutions you know creating a story based on people and sort of real experiences while also trying to highlight solutions and looking for those journalists that are really interested in conveying solutions and stories about things that are being done in new ways or succeeding in new ways and then we all the last sort of category of things we talked about was different methods for empowering communities or uplifting existing community solutions and in particular we discussed the train the trainer model so ways to really engage community members and leaders in further sharing circulating disseminating information and resources that can help amplify the number of people reached in a given campaign I think that about summarizes it Nambi would you add anything from our group okay that's it from group four thank you well it is very surprising to find ourselves at the end of this two-day workshop that we have spent the past few months planning and I would just like to thank everyone very sincerely for your incredible participation the creativity the heart and of course the incredible intellect that all of you have dedicated in the past couple of days also especially to our committee members the past few months and to the National Academy staff who have been our fearless leaders throughout thank you so so very much for your leadership in this incredibly important day from this with all of the collective learnings we hope you will continue to contribute to the Jamboard contributions will be added to the proceedings report that will be developed subsequent to our meeting today so please do continue to engage there if you haven't already or if you have already thank you very much everyone have a wonderful day thank you everyone