 Greetings, everyone. Welcome to the USGCRP listening session. My name is Sarah Curran from the University of Washington and on behalf of the National Academies Committee to advise the US Global Change Research Program, also known as the USGCRP. I welcome you to this listening session on global chain issues, global change issues with a specific focus on health related challenges and opportunities. Through USGCRP federal agencies coordinate climate and global change research and use the results to create tools and assessments to help people make decisions in the context of global changes. Through this session and others in the five part series we aim to connect more directly with users and researchers who are building on and applying global change information and tools in their work. And to gather insights and information that the USGCRP can consider as a plans implementation of its work over the coming decade. In these sessions we are welcoming many people from across the spectrum of users and researchers, including staff from the USGCRP and agencies that comprise the USGCRP members of the National Academies Committee to advise the USGCRP of which I am a member. And all of you users and researchers who are engaged in building on and applying the types of knowledge and tools that the USGCRP is charged with developing and supporting. So we'll start with our agenda. The next slide. In the next session we have a series of speakers who will provide remarks all of whom expressed interest in contributing when registering for this session. Everyone here will have opportunities to contribute through an engagement platform that we will introduce shortly representatives from the USGCRP and the committee to advise the USGCRP are attending and listening mode. Thank you for joining us and we look forward to hearing from you over the next 90 minutes. Next slide. To start, I'd like to acknowledge, I think we're going to do a next slide here. I'd like to acknowledge that while today we are gathered virtually, the National Academies is physically housed on the traditional land of the Nacochtank, Anacostan and Piscataway peoples past and present. We honor with gratitude the land itself and the people who have stewarded it throughout the generations. We honor and respect the enduring relationship that exists between these peoples and nations and this land, and we thank them for their resilience in protecting this land and aspire to uphold our responsibilities to their example. We also acknowledge that our understanding of health and global change issues are closely related to an informed by indigenous knowledge and experience and that many native communities are on the frontline of the impacts of these changes. I am joining from Seattle, the traditional land of the Coast Salish people, including the Suquamish, Duwamish, Mucletio, and Samamish peoples. Next slide. I and other members of the committee to advise the USGCRP are looking forward to these sessions to connect directly with researchers and users who are using and applying global change information in their work. As part of our regular meetings throughout the year, we provide this and other opportunities to engage with and hear from broad audiences to inform their this important work of theirs. This series of listening sessions include to gather useful information actionable input for USGCRP for implementation of its work to make connections and expand the group of researchers and users who are directly engaged with the USGCRP and its work, recognize connections across researchers users and themes of USGCRP work and products, and inform future potential engagement mechanisms and opportunities, including forms approaches and participants for such engagements. Next slide. Today we are seeking input on how USGCRP may implement its work to better understand and address global change issues. You do not need to be familiar with USGCRP to provide input. We are specifically seeking to connect with a broader audience in these sessions. If you are unfamiliar with USGCRP we hope you had a chance to view the introduction video on our event pages before the session, or we encourage you to view it afterwards. In preparing for these listening sessions USGCRP requested input and insights on the following themes to inform the implementation of its strategic priorities and activities. Diversity, equity and inclusion, which which action should be prioritized to fully incorporate these values in research, community engagement and workforce development. How do we implement them? Advancing science. What are the priority gaps in foundational science or methods that require enhanced long term investments. So far in research, how do we ensure that USGCRP science and products are better driven by and connected to users, including for example, improved use of consultation collaboration translation dissemination informing climate services socio economic sciences integration. What are the priorities for integrating socio economic sciences into our program and to inform critical decisions. Particularly helpful feedback might include ideas on emerging large scale scientific questions related to global change and or the response to global change, especially those where interagency collaboration will be critical. The information on how science is or is not being used to inform societal response to global change and why, and knowledge gaps and obstacles to implementing scientific tools or knowledge. The USGCRP is developing its next decade old strategic plan and expects to release a draft prospectus with a public comment opportunity before the end of 2021. While these listening sessions may help inform the development or implementation of this plan individual feedback on the prospectus should be submitted through the public comment mechanism. To ensure all have time to speak, we will be holding you to the five minute limit. Next slide please. So we have a few expectations for conduct, we are committed to fostering a professional respectful inclusive environment where all participants can participate fully in an atmosphere that is free of harassment and discrimination. If you have any identity based factors, please report misconduct immediately to Steven sifter whose email is at the bottom of this slide. Now I'm going to turn it over to Steven for a few housekeeping details. Great. Thank you Sarah, and welcome to everybody who's joined us. If you would go to the next slide please. Today we're using two different platforms for a couple of ways of having you engage and give input to USGCRP. First of all, we're all joined together via zoom for the video and audio portions of this of this session. And we encourage you to view and seek in speaker view we will have a series of speakers who will be following this introduction and that's the best mode for seeing them as they're speaking. We'd like people to find you if they wish to and encourage you to change your name the name on your, your screen which I see I have not yet to your full name and your affiliation so people can more easily find you in the list. We're also providing a live closed captioning of this event. If you wish to display that closed captioning please choose the live transcript option in the bottom of your screen. And finally if you need assistance with zoom please, if you are on on the platform and having trouble using it. Please send a chat to one of the hosts myself or Rob Green Greenway, or send an email to Rob Greenway, our Greenway at nas.edu. Next slide please. In addition, we will be, we will be using the Slido engagement platform for text input for for the sessions. So we encourage you to join us on Slido, and there are a couple of different ways to do that. You can if you're using a mobile device you can use the QR code that's shown on the screen. You can go to Slido.com and then enter this event code. And then we will also put a link in the chat so that you can join Slido. And a couple of notes on that will be using the Q&A function. And even though it's Q&A we're asking you to put your thoughts and ideas and recommendations, rather than questions as Sarah noted USG CRP and the advisory committee are in, in listening mode here so we're not going to be answering specific questions that are raised. But we welcome all of your input through this platform. We will within the question and answer mode, and you will have up to 300 characters per, per entry that you put into the, into the Slido platform. But if you have additional comments that you want to make there's opportunities to reply either to your own thread or a thread that somebody else has started. Again, all those contributions are up to 300 characters and we encourage you to, this will be part of the record for these, for these sessions, we will not be producing a report out of this but USG CRP and the advisory committee will access to these recordings and also the, the outputs of this engagement platform so we encourage you to, to join with us in all of these different modes and finally in, in whatever way you are contributing on the next slide please. As I noted, we, these are the sessions are part of our public. They fall under the Federal Advisory Committee Act and we are the outputs of these sessions are part of our public rest record for this event. And so please be aware as you're participating in this in these sessions that the event will be recorded and the outputs of our engagement platform will also be included in the public access file for this event. With that I'd like to invite Mike Cooper Berg to give a welcome on behalf of USG CRP. Hello, good afternoon, Steven and Sarah thank you so much for your welcome and opening comments. My name is Mike Cooper Berg, I am the executive director of the US global change research program. The USG CRP as we call it is managed by the subcommittee on global change research, which consists of representatives from the 13 federal agencies that make up the program, you can think of that subcommittee as our board of directors. We're representing those 13 agencies. And we want you to know that we're serious about our legislative mandate, which tells us to assist the nation and the world to understand, assess, predict and respond to human induced and natural processes of global change. On behalf of USG CRP. Thank you for your interest for your time and your expertise we look forward to what you have to say. The input will be heard and considered as we draft and implement a 10 year strategic plan for USG CRP a new 10 year strategic plan. In addition to the staff from the National Academies and yourselves, there are a number of federal agency representatives and folks from the USG CRP National Coordination Office on the line today. Be careful in taking notes. Those notes will inform our discussions and writing for the new plan. That plan will be completed late next year. Between now and then, you can expect to see a prospectus a very high level outline the plan coming out for public comment soon, hopefully the next month, and a full draft of the plan that will be released for public comment and review by the National Academies in the middle of 2022. Please watch for these opportunities to comment both on the prospectus and on the draft plan. Finally, on behalf of USG CRP are sincere thanks to you for taking the time to speak with us today to the committee to advise USG CRP and the staff of the National Academies for organizing these sessions. My name is Sarah Curran Steven Stitcher, Amanda Stout and Amanda Purcell. We very much appreciate it. My sincere thanks to Katie Reeves and Julie Morris from the USG CRP National Coordination Office for their roles in making this possible. We very much look forward to your comments and your input and we'll be listening carefully. Thank you very much. Sarah back to you. Thank you Mike. This is great. I would now like to, we would like to hear from you and really thank you all for making time today to join us and to participate. I think what we'd like to do now is turn to our first speaker Caleb dresser from the Beth Israel Deaconess Medical Center Caleb, I think you can unmute yourself now. Hello. You are audible. Alrighty. Thank you for having all of us here today to provide our perspectives. I appreciate your commitment to soliciting a diverse array of viewpoints through these listening sessions. My name is Caleb dresser. I'm an emergency physician I practice in Boston, Massachusetts, and much of my research focuses on understanding population health implications of climate related disasters. There are two big picture suggestions I would like to share with this group. First, in terms of communication around this issue, I think it's important to make health a more visible issue in the discussion of global change. Many of the policymakers I've interacted with are not particularly aware of the health implications of climate change and other global changes. But those health implications have a lot of meaning for the people that they represent. And what this means is that health facilities emergency medical services public health issues in general are sometimes left out of municipal or regional resilience planning initiatives. And given the immediacy of health to those of us who are going through this process. I think it's really important that in future assessments reports communications and other products that we include some reference to health, as a key implication of the hazards referenced throughout the text, so that we don't wind up with all of the health information being aimed at health people, but instead make this a core piece of how we talk about these issues. And this can help ensure that policymakers other key decision makers and the general public are exposed to the health aspects of this shared future we are now in and understand what those human impacts are. And the second key issue I want to mention is that a lot of the health impacts of climate change are being measured and talked about on a very grand scale. But these are experienced at a very local level, and are mediated by a variety of factors that are intimately related to local geography socio economics governance and community characteristics. And how we respond to these challenges has to be guided guided by a combination of sound science, and also knowledge from the populations that are affected. To this end, I have a couple of thoughts on programs or initiatives that could support place based multidisciplinary research in keeping with the big picture goals of the US gcrp that would support population health protection. There are a couple of things I want to mention here. First item. Health equity is a really big concern as we talk about the impacts of global change and our efforts to protect populations from health impacts. To this end, I would argue that future calls for funding and future programming should either require or incentivize involvement of members of affected communities as key participants or leaders in projects that are place, place focused or location oriented. And that the inclusion of these people in real decision making roles on those projects will help me and the solutions we arrive at are equitable and are effective for the communities of question. Second, I would argue that in many situations there are people in organizations that are concerned about climate change and other global changes may understand what some of the hazards are, but don't necessarily know how these people are working with or what to do with this information. And so we need to be continuing to work on small grant programs focused on translational rather than basic research tool kits for health protection models such as the brace framework and publication of regional studies so that concerned communities can emulate what has been successful for others nearby. A lot of work is being done at local levels by individual municipalities nonprofit organizations healthcare systems, which need access to good data. And a lot of this data is technically complex, but many of these organizations don't have full time science staff. And so the more that can be done to create a perhaps cross agency clearinghouse of global change data that is an easily accessible format for organizations without specialists in climate change would be really helpful, particularly as we talk about adaptation planning at all levels of society. I will pause there. Thank you for all of your efforts to address the global change issues we are facing and your work to highlight human health in the forthcoming USG CRP digital plan. Your work is essential. I look forward to seeing you. Thank you. Thank you Kayla. That was helpful. I now like to turn to Teddy Potter from the University of Minnesota. Thank you for the invitation to speak about health of the USG CRP listening session. I'm also grateful to the 13 federal agencies at the USG CRP collaboration for your ongoing commitment to quality science to protect the health of our nation's citizens. My name is Dr Teddy Potter and I am director of planetary health at the University of Minnesota School of Nursing. I am the chair of the American Academy of Nursing's expert panel on the environment and public health, and I am a member of the steering committee for the planetary health Alliance at Harvard. I live, work and study on the land of the Dakota people, the original planetary health experts. Today I bring concerns from the global planetary health community, especially underrepresented communities, including our youth. We are witnessing the failure of many national and international leaders to make the necessary changes to keep global warming below 1.5 degrees Celsius. We therefore are turning to non governmental entities and community partnerships to get the work done. We rely on you to provide good science to inform our actions. I define health with a planetary health lens. Planetary health is a solutions oriented transdisciplinary field and social movement focused on analyzing and addressing the impacts of human disruptions to earth's natural systems on human health and all life on earth. In September, the Apollo declaration on planetary health was released by the planetary health Alliance. The decision written by many global experts from all sectors states, we need a fundamental shift in how we live on earth that we are calling the great transition, achieving the great transition will require rapid and deep structural changes across most dimensions of human activity. The declaration makes the following recommendations for the research sector, and therefore it's pertinent for the discussion today. Interagency collaboration and research must engage with the engage with and initiate transdisciplinary efforts to inform and operationalize planetary health focus research policy and practice, and that's what you're doing today. But note this addition in the declaration with an emphasis on solution focused inquiry and applications that are inclusive of all ways of knowing and backgrounds. Research must promote open science principles and practices, elevate co designed and participatory based research with communities, and better communicate methods and collaborations to increase public and political awareness about planetary health. In closing, I want to emphasize that every human system much must change if we are to solve the planetary health crisis crises before us previously previously research has primarily focused on the nature and urgency of the problem. We must pivot and ensure that our national programs provide science based solutions that individuals families and communities can take to protect their health and health of all life on the planet. Thank you. Thank you. I would like to, and thank you for staying within the timeframe. I would like to invite Rebecca rare from eco America to join us. Thank you. Thank you for hosting these sessions and for the opportunity to provide comment. My name is Rebecca rear and I'm the director of climate for health at eco America. I will talk about three topics mental health impacts of climate change, engaging environmental justice communities through paid opportunities and focusing on solutions to climate change. This released the 2021 edition of mental health and our changing climate with the American psychological association. The impacts of a changing climate on mental health stem from both acute events and longer term change individual mental health impacts from climate disasters include trauma and shock PTSD and anxiety and depression. Community wide impacts include strains on social relationships reduce social cohesion and interpersonal violence. Longer term climate change can cause equally significant mental health impacts. For example, air pollution has been linked to increase anxiety and use of mental health services, lower happiness and life satisfaction and other negative well being impacts. Climate change coupled with worry about the future can lead to fear anger feelings of powerlessness exhaustion stress and sadness referred to as eco anxiety and climate anxiety. The inequities of climate change are vast and significant. While the destructive impacts of climate change will be felt by everyone. As with other climate impacts the burdens of the mental health impacts will fall heavily on those oppressed by historic and present social economic and political power dynamics. Importantly climate solutions build mental health resiliency, mitigating temperature rise, better air quality and access to nature all bolster physical mental and community health. The report delves into levels of engagement and responses for mental health providers, local governments communities and individuals. USG CRP can use its convening power and cross agency reach and engagement to incorporate information about mental health and well being into climate research and solutions. Please make sure to engage with the substance abuse and mental health services administration and the National Institutes of Mental Health. Mental health did get one mention in the global change research needs and opportunities for 2022 to 2031 report, and I hope that grows in the decadal plan. The second point about environmental justice is, we need to start valuing community wisdom and qualitative data, the same way we value quantitative data. The needs and opportunities report does talk about community driven solutions that address immediate vulnerabilities while building resilience and protecting livelihoods in the long term. This is a great start and can be further detailed and framed through grant requirements for community engagement and also proper training for scientists engaging with communities, going further than community based participatory research to make community owned and manage research models the gold standard pay for community input and leadership folks on the ground and community should be paid for their intellectual property the same way scientists and researchers are. Finally, solutions USG CRP and its member agencies have done a comprehensive job documenting the problem of climate change and impacts to the environment and our health. Majorities of Americans are now concerned about climate change, but they need support to act. In my work, the question I get most often is not, what is climate change, where is it happening does it impact me it's, what can I do about it. I highly recommend the USG CRP helps people answer that question. I applaud the needs and opportunities report for its focus on the interactions of multiple systems and on reducing inequities, which are important anchors for climate solutions. The integrated risk framing approach to identify research priorities is also a step in the right direction, as long as those research priorities include studying solutions and support engagement in action. We're going to use solution science, studying what works resilient energy grids clean transportation more green space efficiency measures youth leadership, and how to scale it. USG CRP has for 30 years taken an all of government approach to climate change because that's what solutions will take to all of us. Thank you. Rebecca. Thank you so much. Now I'd like to turn to Vijay Limaye from the Natural Resources Defense Council. Great. Thank you. Just pull it up. Hi there good afternoon. I'm Vijay I want to thank USG CRP for organizing this listening session. I'm trained as an environmental epidemiologist and I'm also a former EPA staffer so I'm very thankful for all of your work. I now work at NRDC as a climate and health scientist. This year now and USG CRP should enhance its focus on supporting interagency efforts to investigate climate sensitive health problems and their associated financial costs on individuals, families, employers, insurers and the federal government itself through Medicare and Medicaid. We know from the science that burning fossil fuels is contributing to extremes and each of these climate problems is causing a range of premature deaths, illnesses and costly injuries. These worsening climate hazards have very real consequences both in people's pain and suffering, and in the associated financial costs that are largely absent from our public federal accounting of climate rate related damages. Moreover, these costs pose a wider array of impacts, especially on vulnerable groups, least able to access affordable medical insurance. As noted in NCA for climate sensitive events are expected to increase in frequency, intensity, duration and scope in the future. In fact, NCA for of course spoke to quote hundreds and billions of dollars in economic risks tied to the climate problem. NOAA tracks the damages inflicted by these costly disasters, but neither NCA nor the NOAA billion dollar disaster compendium delves into really any detail on the health role of those skyrocketing costs. NOAA's focus is understandably on things that can count property damage, infrastructure losses and crop failures, things that are insured, but the health and health cost data is an important gap for USG CRP to try to tell health and fill, especially because public polling indicates that more than a third of American adults currently experiences medical financial hardship. That is an inability to afford necessary prescribed medical care. The science indicates that delaying or completely foregoing necessary care as millions of Americans are doing right now can make them even more vulnerable to the health problems from climate stressors. The projected future burden on health and health related economic costs will be enormous if climate pollution continues unabated and communities are not prepared. But those costs are not only a future concern they're right here right now and burdening American families. I led a 2019 peer reviewed analysis demonstrating $10 billion in health costs related to climate sense of events from nearly 1000 premature deaths. 20,000 hospitalizations and approaching 18,000 emergency department visits, all associated with just a sample of climate sensitive health problems in a single year across the United States. These are the damages that Americans are paying for right now but unfortunately efforts like the NCA are not shedding needed light on this financial issue. Our study identified Medicare and Medicaid patients are most vulnerable neighbors as the disproportionate numbers of the illness costs identified in our study, but we lacked visibility into these costs in terms of who's paying them right now, individuals and families are being stressed by medical bills worsened by the climate crisis but we lack needed visibility into that problem. Now is the time for USGCRP to step up and coordinate federal efforts to better understand the terrible public health and financial burden of climate change. This is a key equity problem that has gone unmentioned in major federal reports. USGCRP should also work to establish a federal integrated data tracking system that can help the public and researchers to better grasp the current and future burden of climate change and public health. Right now we lack real-time visibility in that problem we're relying on journalists and press reports in order to understand what's happening across the country. In 2021, we certainly should be relying on CDC, NOAA and EPA to support more comprehensive analysis of the health impacts and costs of climate change. This indicates that actions to achieve climate pollution reductions and bolster preparedness can help our country to avoid or reduce tens or even hundreds of billions of dollars in future health costs by keeping people out of harm's way. But we need USGCRP to facilitate more federal action to make those costs of inaction and benefits of strong climate policies even more clear to policymakers in the public. Thank you. Thank you, Vijay. Now I'd like to welcome Dan Buchelich from the Association of Medical Device Reprocessors. Well, thank you very much. I'm Dan Buchelich. I'm president of the Association of Medical Device Reprocessors or AMDR. This is our first opportunity to speak or introduce our issue or issues of concern to the GCRP. So thank you. I'll stay on topic and I'll certainly take advantage of the opportunities outlined here as future perspective reports are put out and we'll submit comments. My members are FDA regulated firms that reprocess or remanufacture devices that have been labeled for single use by their original manufacturer. So that entails collection of devices that have been used in American hospitals, cleaning, disinfection, testing and sending them back. But we do so meeting the same standards that would be required as if these devices were sold new. We serve most hospitals in America. We serve all of the US news and world reports on a role hospitals. We serve nearly all DOD facilities. We serve nearly every private or public healthcare integrated delivery network. The one institution we do not serve is the United States Veterans Health Administration. And we think this is a huge loss opportunity for the government to be taking care of our veterans by literally throwing away medical device assets after one use. In our experience, and what's happened of late with COVID is that the US healthcare system is addicted to disposable medical equipment. Unlike most industrialized nations we have nearly twice the global greenhouse gas impact from the American healthcare sector is the rest of the industrialized world. And this was data that was available pre COVID and everybody is now intimately aware of how many syringes, masks, gloves are being thrown away, which means they're being incinerated. Unfortunately, in a field where we take the mantra to do no harm healthcare is doing exactly that in our zealous treatment of patients in front of us under the guise of infection control, we're just throwing everything away in America. And that waste needs to be incinerated. The incineration of all this medical waste literally causes harm to our patient populations with as other speakers have pointed out increased asthma increase cancer because we're putting toxins into the environment. The healthcare sector is responsible for 4.4 to 4.6% of worldwide greenhouse gas emissions, according to data published in the journal health affairs last December. That's twice the aviation industry. How irresponsible of it of us who are in charge of healthcare for our patients to be making your own patient population sicker, not just by emitting greenhouse gas emissions, but by literally burning the trash we're we're creating that makes our population sicker of the emissions that healthcare is creating over 80% are coming from the supply chain or scope three. And so we believe that research that focuses in particular on ways that we can solve problems with the healthcare supply chain by encouraging reuse, reusability or reprocessing, we think would be advantageous for American healthcare purchasers. We've started by conducting lifecycle assessments of some of our products compared to disposable. We've begun with one device at cardiac catheter. These are devices that are thread into the heart to make a diagnostic image. They range between $500 and $2,500 apiece, but the data shows that on 13 of 16 environmental measures the re-manufactured or reprocessed device was preferable in a lifecycle analysis than just throwing away and using a disposable version, and just as safe and effective as using a brand new device. We're also moving forward in the rest of the world. NHS in England did not sort of take a break these last four years. They are pressing forward and pushing for a net zero healthcare system. And so they're really getting behind efforts like medical device reprocessing and remanufacturing. And so we think collaboration with what other countries are doing to help elevate and bring attention to these issues would be would be beneficial. And so lastly looking at the things that we think that would be beneficial to help clean up the toxic healthcare supply chain that we have would be more lifecycle assessments to demonstrate to purchasers the preferability of reusable or reprocess equipment versus this disposable culture. More research to underscore that perhaps just slapping single use on everything isn't always needed to protect patient safety. And so actually adequately informing our healthcare practitioners as to what needs to be disposable and whatnot. And we'd also like to see research or regulatory oversight over manufacturers used to force obsolescence to put kill chips or software into their devices to ensure they stop working after just one use. Thanks for this opportunity. I appreciate it. Thank you Dan. Now I'd like to turn to Guto Elval. Elval from the Georgetown University. Hi. Thank you very much for this invitation to. We have two assignments one is here jarred Talbot also has a Zodicor Foundation Brazil, where the senior researcher there, and that the point I want to make here is more looking into the global health community and how the global health community can be engaging in this very important initiative on the US GCRP. So, all the materials from from these initiatives have been used worldwide in many different places with different use of a search or dedication. I think Dr Potter and Dr here because they already advanced most of the arguments I want to make so I will keep only the, the, the part that have to do with the international part of that so I, my first point point was about planetary health as an emerging area that incorporates not only human health but also the well being of the earth and the equity all together. And that, as was said here before, after the some public declaration, there are a very important momentum on planetary health so I think that is an important point to leverage national efforts not only us but also globally, and that will help to look into solutions for the, the global change, we are seeing happy now. The second point is about the specific populations and Dr Harold already talks about that. But I want to make a point on the very specific population that's the homeless the people who are in the homeless situation are the most vulnerable people for climate change. The, the acting on that particular situation where it's everywhere in the world will from advanced not only social justice but equity and inclusion, and also gave a focus and a very practical point for the intersection of action and so on particular problems so I want also to promote that particular idea and particular action in this population. And finally, is about the materials and the documents and all the reference at the US GCR RP, providing us, and has been used as a reference for research and teaching. And I think a global network of the people who are using this educationally or in his search will improve the formation and also will promote the interchange between different realities like I do that all the time between Brazil and US but also with Africa, and that may be increase the, the basis for the case for global change and how important and how usually is to act on the on this many crisis and health crisis we are having now in the world. So, if you use the approach of open science and the field proofs have a very important experience on that we can accelerate the energy and also promote not only the global change ideas and actions out of the 13 very important agents that are doing this efforts here in the US but maybe engaging other agencies other people around the world. Thank you very much for this opportunity. Thank you very much. And now I'd like to invite Max Kiefer from the CDC and NiO SH. Hello. Thank you for the opportunity to speak. And my name is Max Kiefer and I'm retired from the CDC. I've been asked to. There we go. I have recently retired from the Center for Disease Control and NIOSH, but I'm here trying to take advantage of this opportunity and thank you again to advocate for research on occupational safety and health, and give a pitch for ensuring that we remember occupational health is a core component of public health. Workers are often the tip of the spear and are certainly the most at risk to the health impacts of climate change. I'll give some examples of both from primary impacts as well as secondary impacts of this of these vulnerable populations we call workers. Just an example would be wildland firefighters. We know that fire extremes are occurring more rapidly at a greater strength, and that the fire season is increased by approximately 80 days over the last 30 years. We also know that wildland firefighters such as hotshot crews have a lung deficit measurable after the end of the fire season, and then have a recovery period before the next fire season starts. But we don't know with what the impact of an additional 80 to 100 days of firefighting has on their health. Those are questions that need to be answered. We also know that outdoor workers are more at risk to Lyme disease, for example, than indoor workers has the range and the reproductive cycles of those vectors increases, what's going to be the impact of that. For example, toxicity or demarcosis or valley fever is now endemic in the state of Washington, and certainly workers, whether it's construction installing solar panels etc are very much at risk. And on the topic of infectious diseases were saying the use of pesticides in areas where they were not used before, which certainly has a health impact on the applicators. I'd also like to affirm and echo the comments from the gentleman from NRDC, I think surveillance is key to all of this, both from an attribution standpoint, as well as intervention effectiveness. It's something we can measure. It's going to take a lot of work to design those types of surveillance systems and epidemiology to provide the necessary attribution and the effectiveness of the interventions. But there are some agencies that are equipped to do that, for example, in the Senate for Disease Control, the National Institute for Occupational Safety and Health, certainly has the talent and researcher researchers necessary to do that kind of work. With the secondary response to climate change that I referred to earlier, I'm talking about the safety and health impacts of our response to climate change, whether it's carbon capture construction implementation and maintenance of, for example, wind towers. People have to go up to the nacelle, they have to climb up the tunnels, the towers, and go into all sorts of environments that we don't have much data on. So one organization that possibly could help with that is the National Renewable Energy Laboratory in Denver, Colorado, a DOE funded organization that could do that type of research, as well as ensuring they are considering worker safety and health impacts as they're conducting their research on new designs to address climate change. Finally, I think health communications are all too important. As I'm sure we all know in communicating the impact of climate change on public health. In my case, my interest is on workers. Thank you. Thank you very much. I want to turn now to Carl Mayer from Salisbury University. Hi, thanks for the chance to share my thoughts here. I have an interdisciplinary background in psychology and behavioral medicine, so I've been applying that for the past several years developing curriculum that integrates the social sciences with climate change and health. And so my scholarship likewise includes transdisciplinary systems thinking around environmental change. And some of this may help address each of the four themes identified for the listening sessions. But mostly I want to suggest a conceptual framework that fits with the Academy's consensus report that I'm sure they're all familiar with now. And that recommendation is integrated risk framing approach and that recommendation response to the need of course to have greater coordination and communication about complex interactions. And that's between, you know, physical and human systems. So, on that note, I think it's critical to include biodiversity, since that is impacted by many of the same drivers of climate change and it's probably really a more immediate threat to the population, give it's the implications really for zoonotic diseases like COVID and our food web. And also to echo some of the prior speakers, this integration really should be framed around communities. And so kind of community based participatory research should be kind of reinforced through the program. And so this all fits with my main suggestion about how to integrate across this complex set of problems and risks and complexity, of course, makes the job of global change reporting difficult. But we also know that it's important to have a simple way to represent that complexity. So the researchers and also consumers can talk about it and collaborate and organize what's known and also identify what's not known. You know, many of you may be familiar with the biopsychosocial model, and that for over 40 years it's helped shape a more complete understanding of health and disease that really integrates biological factors with behavioral and social factors. So that basic concept has been extended to an ecological framework, where we can look at these biophysical, psychological and social domains at multiple levels, kind of from the micro level factors like cells and genes, all the way to the most distal influences like climate and economic forces so think of the basic biopsychosocial concept but stratified according to different levels of scale and system complexity. All these domains and levels then kind of interact as one ecological system. Now, if that sounds a little confusing. It's actually pretty simply illustrated in a rectangular grid format, and that provides a heuristic that can help organize thinking and research findings. And there really is a need for that, because just today in PubMed if you search climate change you'll find over 60,000 articles and over 400,000 articles from the Web of Science core collection so without some structure it's hard to even know what questions are being addressed and all that research, much less really draw any conclusions from it. So, one basic way this ecological framework could advance or science is that it can guide the infrastructure for data and information sharing. And I'll include an example in my text summary points on Slido in a moment where I've started some pilot work on what eventually will be a database where artificial intelligence will be used to help classify all the climate structure into that framework. And I think the global change reporting program could use this structure for organizing and presenting consensus findings, and it can also help guide gap analysis of the research. And I think inherently it can also support communication and collaboration across, you know really all the disciplines and stakeholders who typically don't have as much dialogue with one another. And I'll also finally point out that I recently used this to map out issues of equity across the different areas of the framework. So, and if I may one final point being a social scientist for the theme of integrating socio economic sciences that was listed as one of the areas. I would simply say that prefer social sciences because it's a little more inclusive of field like psychology and sociology. So, with that I appreciate consideration and I'll be happy to discuss more at any point. Thank you Carl as a sociologist I agree. I would like to now invite Elizabeth plus from USA ID. Yes, hello. My name is Elizabeth voice. I'm with the US Agency for international development. And I have a bit more of a brief question, but not one that's more simple to answer. I would be very interested in seeing research that's done focusing on financing for climate change action, especially climate change adaptation. And what are some structures that are underutilized, but could be used in the future for this purpose, both domestically and internationally. And also what are some barriers, especially in that case looking for private sector engagement, what are opportunities that are sometimes successful and the factors that lead to that success. So what are the barriers, what is standing in the way of different potential partners joining together to take action to leverage money from the private sector on adaptation and alternative financing mechanisms such as long guarantees should also be considered, as well as debt for nature swaps and grants. And I would encourage looking at which mix of those is most appropriate in different contexts and what the potentials are, and what the downsides are of some of those would be very helpful in trying to frame some of the work moving forward, especially on adaptation. Thank you. Thank you Elizabeth appreciate that. And now we'd like to turn to Nathan Patterson from Carlton College, I believe. I guess he's having trouble using his mic. Shall we go to the next person. I'm just waiting for my. I'm going to turn the mic over to Donald Edmondson from Columbia. Vanessa maybe we're out of speakers. I have a dawn here. Would you like, I guess we're out of speakers. And turn to Steven or Mike to help me out here. Where are we. Great. Well, Sarah, thanks for, for walking us through that. We, we appreciate the inputs that people have have given we have we have five sessions over the course of this set of listening sessions on various themes, but recognizing that many of these themes are cross cutting. And getting inputs from people who are engaged with, for instance, this theme of health in some of our other sessions so we, we, we were welcoming these, these inputs and future ones as well. Nikki, could you bring on the slides. Well, and the, our next steps for you go to the next, the next slide please. The next steps for this session, I mean for this series of listening sessions are that we will be following up with everybody who has registered for, for this session. And that, that follow up email will provide links to a couple of questionnaires that we'd like you to engage with. So first of all, an evaluation for this session. And also we have a broader call for input so as I said at the beginning we have a couple of different modes for you to engage with us DCRP in this listening session activity. And so one of those modes is a is this questionnaire so please pay attention, look out for a follow up email from us, and we appreciate your contributions to both of those questionnaires and evaluations. We will also be posting materials from these listening sessions on the event page. The easiest way to find those event pages is through the National Academies. And we've also included it here on the in the chat. But if you, if you search what under the board on atmospheric sciences and climate under the events you can find to find all of the sessions after the material after the sessions the materials will be available on the individual event sessions. So all of the, all of the contributions that were provided today and in other sessions will be available to us DCRP and the advisory committee, really to inform all the work that they are doing going forward. Next, next session, next slide please. So today is the second of five sessions, we invite you to engage with us in the three additional sessions that are coming up on Thursday, November 18 this week, we have a next session on energy and global change. And the first full week of December we have to two additional sessions, one on food, and the other on transportation and infrastructure. So we invite you to come and register and participate in any and all of these events and we look forward to the, to all of the contributions that you provide. Sarah, do you have a final thought from the, from the committee before we close out today's session. No, I thank you Steven it's been an honor to be here and to listen in and thank you everybody for your contributions. We just add the same thing thank you very very much fascinating conversations we very much appreciate we have to say thanks.