Drought and Public Health

Sherry L. Burrer Author

11/15/2016 Added

111 Plays

Description

Drought is a common phenomenon in the United States and poses a serious public health threat to our communities. Drought can be a slow evolving event and its many direct and indirect impacts on behavioral and physical health can be easily overlooked. Awareness and education on drought-related public health issues is key to making sure that drought in the United States is not the forgotten disaster in public health.

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[00:00:00.230]Like she said, my name is Sherry,
[00:00:03.208]and I'm here to talk to you about drought and public health,
[00:00:06.896]and talking with a few of my colleagues,
[00:00:12.101]in particular, Jessie Bell and George Luber
[00:00:16.523]and so many other people.
[00:00:18.798]We talked about how this goes on for a long time,
[00:00:21.360]and how, how this...
[00:00:24.442]We don't know when it starts, necessarily,
[00:00:26.579]and we're not sure when it stops sometimes,
[00:00:28.188]and how do we connect these health effects to drought
[00:00:33.435]and causal pathways and everything,
[00:00:35.743]and so, we thought,
[00:00:38.187]let's not let drought become the forgotten disaster,
[00:00:42.387]because it's easy to see that a hurricane
[00:00:44.849]is headed your way on the radar.
[00:00:48.858]It is very dramatic when a tornado touches down.
[00:00:53.710]And heatwaves are well established,
[00:00:57.751]but drought isn't talked about much,
[00:00:59.902]and its effects aren't talked about much,
[00:01:02.198]and we want to make sure that people that work with weather
[00:01:06.262]and climate, and also the people that work in public health,
[00:01:10.289]are aware of it and that they're working together
[00:01:12.360]to try and make these connections.
[00:01:14.920]So I'm sure, as most of you know that,
[00:01:19.334]looking at me here on the podium,
[00:01:20.917]you can tell that I'm in a uniform.
[00:01:24.340]I am not an airplane pilot and I am not in the Navy,
[00:01:29.300]but I am in the Public Health Service,
[00:01:33.102]and it is one of the seven uniformed services
[00:01:37.910]that have been in the United States, and I have served
[00:01:39.764]in the Public Health Service since 2008
[00:01:41.881]when I entered CDC, and if you would like
[00:01:44.209]to learn a little bit more about that,
[00:01:46.089]afterwards, I have some extra slides,
[00:01:47.863]or we can just chat after
[00:01:49.327]if you'd like to understand more about that.
[00:01:52.019]'Cause I often get a question of, "Why the uniform?"
[00:01:55.142]So I have to start off with this
[00:01:57.002]because I work for the federal government,
[00:01:58.645]so I'm required to let you know that the findings
[00:02:02.068]and conclusions in this talk are those of mine, the author,
[00:02:07.738]and do not necessarily represent the official position
[00:02:10.031]of Centers for Disease Control and Prevention.
[00:02:13.579]So let's get started.
[00:02:15.324]When I was (mumbles) by Nicole, she said,
[00:02:17.947]"Can you please give me a presentation
[00:02:21.717]"on drought and public health?"
[00:02:22.668]I was like, wow, that's big.
[00:02:25.087]Well, there's a lot to talk about there,
[00:02:27.265]and so it took me a while to sit down
[00:02:28.677]and really think about what I wanted to address,
[00:02:32.940]and there are some slides with a lot of words,
[00:02:35.303]and there are kind of a lot of slides,
[00:02:36.618]but we'll suffer through it together.
[00:02:37.803]I'll try and make it as entertaining as possible,
[00:02:40.977]but what we're gonna talk about today in general is, like,
[00:02:43.987]what is drought and how has it affected the United States?
[00:02:48.016]It's gonna be a brief, an abbreviated version of that,
[00:02:50.815]just to give you some very recent highlights.
[00:02:54.075]And then the potential health effects of drought.
[00:02:57.215]Some of the national drought organizations
[00:02:59.021]that are out there.
[00:02:59.854]You should be very proud you have one of them
[00:03:01.660]right here on this campus.
[00:03:03.370]And then, what is Centers for Disease Control
[00:03:06.565]and Prevention or CDC doing about drought
[00:03:09.943]in that area of study?
[00:03:13.171]So let's start with the drought in the United States.
[00:03:17.557]So what is drought?
[00:03:19.606]I'm gonna give you one definition.
[00:03:22.113]There could be a thousand.
[00:03:24.083]People could argue on this, we could spend a day arguing
[00:03:27.188]on how you exactly define drought.
[00:03:29.920]How do you know when it starts and stops?
[00:03:31.979]How do you know the exact parameters that you're using?
[00:03:34.488]Where we'll focus on this talk, let's call it,
[00:03:37.742]and this is from the National Weather Service fact sheet.
[00:03:41.390]It's a natural phenomenon in which levels of rainfall
[00:03:43.995]or other types of precipitation are lower than average
[00:03:46.865]for an extended period of time,
[00:03:48.806]resulting in inadequate water supply,
[00:03:50.696]causing adverse impacts on vegetation,
[00:03:52.962]animals and/or people.
[00:03:55.013]And basically, it's your general water cycle, right?
[00:03:59.021]And I'm certain we're at the School of Natural Resources.
[00:04:01.013]I'm sure people are very, very familiar
[00:04:03.192]with the water cycle,
[00:04:05.081]but it's actually your precipitation equals the storage,
[00:04:11.507]the runoff and evaporation of the total amount
[00:04:13.624]of water you have at your disposal.
[00:04:16.921]So I don't know if, I didn't put any source on these photos
[00:04:21.633]because I am the source of these photos,
[00:04:24.507]and I don't know if any of you guys can guess.
[00:04:26.270]Where do you think did these pictures come from?
[00:04:31.220](laughing) It's a good guess.
[00:04:32.053]One of them does.
[00:04:33.949]The one with the boat dock, not in the water anymore,
[00:04:38.150]that was actually, I took that the end of last month
[00:04:42.260]while on a bicycle ride in northern Georgia
[00:04:45.884]on the border of South Carolina.
[00:04:48.174]And you can see the water has receded quite drastically,
[00:04:52.276]and It's gonna be a while before you're gonna be able
[00:04:54.310]to put a boat in the water on that one.
[00:04:56.291]Do you know where the other one was taken?
[00:05:01.410]I don't know that you'd guess this one.
[00:05:02.807]I was recently in California, in Mariposa County,
[00:05:06.035]doing a community assessment related to drought,
[00:05:10.318]and this was, actually, we were crossing a bridge
[00:05:13.440]and it said, "No fishing or swimming."
[00:05:16.167]And this is what I took a picture of.
[00:05:19.779]The only water that you see there,
[00:05:21.934]the silvery stuff is stones,
[00:05:24.112]the only water that you see there is on the bottom
[00:05:25.929]with a little green patch of water covered in algae.
[00:05:30.425]That's the only thing that's left there,
[00:05:32.578]at this time, for that community, in that particular river.
[00:05:38.569]So the recent history and economic impact
[00:05:40.797]of drought in the United States, there's a lot,
[00:05:43.927]but we're only gonna go over a couple of things
[00:05:45.797]and make this short.
[00:05:46.944]So drought is actually, and I didn't realize this
[00:05:49.661]until I got started in this topic,
[00:05:51.747]is one of the most costly climate-related events
[00:05:54.092]that you can have.
[00:05:55.725]In between 1980 to 2014, the US had over 22 droughts,
[00:06:02.169]which I did not know either,
[00:06:03.672]and we're only counting droughts
[00:06:07.500]that cost over a billion dollars.
[00:06:09.533]So there were over 22 droughts in the United States,
[00:06:11.505]each coasting over a billion dollars.
[00:06:13.555]It does not count any droughts that cost less than that
[00:06:16.083]because it's a, there's a,
[00:06:17.911]the National Weather Service
[00:06:19.044]has a Billion-Dollar Weather and Climate Disasters
[00:06:21.529]table of events,
[00:06:22.603]which I was able to get this information from,
[00:06:24.685]and it's a very interesting table on it.
[00:06:28.611]You can use filters and different disaster types on,
[00:06:31.036]it's very interesting.
[00:06:33.152]And some of the things that I will pull out for you,
[00:06:35.617]the drought of 2012.
[00:06:37.423]Anyone that does drought knows that drought.
[00:06:40.513]And basically, it covered over 50%
[00:06:43.359]of the country, geographically,
[00:06:45.611]and what that means is that that is the biggest area,
[00:06:52.287]I'm not sure, exactly, the Dust Bowl in the 1930s,
[00:06:57.215]how much geography that covered,
[00:06:58.920]but it's close or maybe even a little more,
[00:07:03.488]so it was scary big and I think a lot of people
[00:07:07.230]in the United States didn't realize it
[00:07:08.691]unless they were actually in it,
[00:07:10.955]in those areas that were very severely affected.
[00:07:13.027]It cost 31 billion dollars, just that 2012 drought,
[00:07:18.547]and it was accompanied by a heatwave
[00:07:20.649]that caused probably a total of 123 direct deaths,
[00:07:25.983]which is pretty devastating, in and of itself.
[00:07:28.983]And the Western Drought, as you know,
[00:07:30.375]there is one still one going on.
[00:07:32.543]It affects California, and California expected,
[00:07:35.785]thus far, up through 2015,
[00:07:38.652]it's cost more than 4.9 billion dollars,
[00:07:41.979]and it's contributed to the loss of more than 21,000 jobs,
[00:07:46.043]so something that they're taking very seriously
[00:07:48.585]and something, one of the reasons
[00:07:49.997]why we're doing the community assessment.
[00:07:51.842]They're in their fifth year now of drought.
[00:07:54.916]So just an example, this is August 21st of 2012
[00:07:59.047]on the U.S. Drought Monitor.
[00:08:00.621]I'm sure you guys are very familiar
[00:08:02.063]with the Drought Monitor.
[00:08:04.078]And this is the geographic extent to which the drought
[00:08:08.390]was being suffered during that time,
[00:08:10.893]and so it's pretty significant, just to give you an idea
[00:08:13.373]of what that looked like back then.
[00:08:15.584]And then this is in September 30th of 2014,
[00:08:20.893]and this is, of course, the Western Drought,
[00:08:24.557]and you can see how significantly,
[00:08:26.781]that so much of the state of California
[00:08:29.171]and other states are being affected there.
[00:08:33.470]So what we're gonna do is now we're gonna move on
[00:08:35.319]to the potential health effects of drought,
[00:08:38.141]and first, I wanna talk about,
[00:08:40.191]there are some significant challenges
[00:08:41.908]in assessing health effects in drought,
[00:08:44.026]and those of you that work in the field know that pain,
[00:08:48.437]and there's different reasons for that.
[00:08:52.806]One is that drought can be slowly evolving.
[00:08:55.724]Sometimes you're like, I don't know,
[00:08:57.614]it seems like it's been dry.
[00:08:58.570]Do you think you we're in drought, I don't know.
[00:08:59.798]Are we in drought yet?
[00:09:00.890]Then all of a sudden, yep, this is a drought.
[00:09:03.144]And when do you start the clock?
[00:09:05.500]When do you start the clock on that?
[00:09:06.380]When do you officially declare it as a drought?
[00:09:09.543]And then, sometimes, it's difficult,
[00:09:12.186]you'll find, when it ends.
[00:09:14.606]Are we done yet?
[00:09:15.592]Have we had enough rain?
[00:09:16.862]Are we out of it?
[00:09:19.092]Do we have a consistent agreed-upon definition
[00:09:22.626]of the end of drought?
[00:09:24.874]How are we gonna define it for our study?
[00:09:27.332]That kind of thing.
[00:09:28.677]And the impacts are generally not immediate.
[00:09:32.664]They can take a while for the effects
[00:09:36.281]of drought to accumulate, and it can take a while
[00:09:39.427]for some of the health effects
[00:09:40.994]to actually show themselves.
[00:09:43.047]Often, this requires intermediate steps,
[00:09:46.562]for these health outcomes,
[00:09:48.270]and so drought can cause primary effects
[00:09:50.845]but it also has a lot do with secondary
[00:09:53.305]and tertiary effects, and on and on.
[00:09:56.803]I think a lot of times, you don't really realize
[00:09:59.187]how much drought affects things
[00:10:00.953]because it's not the primary thing
[00:10:02.980]but it is definitely like a secondary, tertiary and beyond.
[00:10:06.278]And then, oftentimes, the surveillance is not designed
[00:10:11.621]to connect drought and health.
[00:10:14.241]The data that we use to surveil climate and weather
[00:10:17.233]is not immediately connected to data
[00:10:19.222]that we use to surveil health,
[00:10:21.601]and there is, oftentimes, a challenge
[00:10:23.668]in trying to figure out how to connect them.
[00:10:26.126]What is reasonable to connect?
[00:10:28.022]On what geographic scale?
[00:10:29.599]On what granularity of data do we connect these things
[00:10:34.665]or can we connect these things?
[00:10:36.548]And then surveillance is often not long enough
[00:10:39.169]to determine some of these outcomes,
[00:10:41.635]especially when you talk about connecting them
[00:10:44.985]and looking at them seriously on that aspect.
[00:10:48.236]And then we have, for health effects,
[00:10:50.629]and especially in public health,
[00:10:51.778]we talked about vulnerable populations.
[00:10:54.513]The health implications of drought
[00:10:56.094]are numerous and far-reaching,
[00:10:58.407]and the research has shown that health impacts
[00:11:01.942]of climate change are felt most deeply
[00:11:06.249]by vulnerable populations,
[00:11:08.382]and the impact of drought depends, as I'm sure you've seen
[00:11:13.328]on different droughts, how long the droughts lasts,
[00:11:16.165]the demographics, and location,
[00:11:17.805]and vulnerabilities of the population affected,
[00:11:20.965]and there's the traditional categories
[00:11:22.813]of vulnerable populations, which we look at age extremes,
[00:11:26.041]the very old, the very young,
[00:11:27.462]low socioeconomic status, chronic disease and disabilities.
[00:11:32.268]But when you start looking at drought, you start thinking,
[00:11:35.066]"Well, there's other types of populations
[00:11:37.320]"that are more vulnerable here,"
[00:11:38.730]and it becomes pretty obvious pretty quickly,
[00:11:41.223]who's being most heavily affected by this,
[00:11:43.948]and some of these categories we've expanded
[00:11:45.887]into people with, have a private well
[00:11:48.353]as their primary water source.
[00:11:49.960]They're definitely at risk
[00:11:50.917]when the water table starts to drop.
[00:11:53.040]And the people who are dependent on water
[00:11:55.757]for their livelihood, it's not only agriculture,
[00:11:58.056]it's recreation, it's landscaping,
[00:12:02.715]and all sorts of different livelihoods
[00:12:04.649]that we don't often think about,
[00:12:06.723]and then, there's also some people from, my family included,
[00:12:11.746]back in the day, we were reliant,
[00:12:14.603]to some extent, on subsistence farming,
[00:12:17.138]so if you're reliant on the food that you can grow
[00:12:21.672]to feed your family, a drought can be pretty devastating.
[00:12:26.033]So what now, getting down to it,
[00:12:28.565]what are the potential effects of drought?
[00:12:31.342]These are the categories that the document
[00:12:35.432]that was published in 2010, the short name of it
[00:12:38.730]is When Every Drop Counts.
[00:12:40.503]It has a much longer name we'll look at later,
[00:12:43.183]and this is the list of categories
[00:12:46.994]that they came up with, okay?
[00:12:48.881]It's compromised quantity and quality of portable water,
[00:12:52.681]diminished living conditions,
[00:12:53.831]which can include the impacts on behavioral health,
[00:12:57.239]decreased air quality and increased risk of injury.
[00:13:01.059]And then you have, sometimes, increased disease incidents,
[00:13:04.274]and compromised food and nutrition.
[00:13:07.087]And when I'm talking about this, just so I'm clear,
[00:13:11.051]when I talk about the potential effects of drought
[00:13:13.819]and the potential health effects,
[00:13:17.897]I'm talking to you in reference of a more resourced country
[00:13:21.858]at this time.
[00:13:22.817]I'm not gonna go into the less resourced country issues,
[00:13:27.640]where sometimes you look at massive crop failures,
[00:13:31.187]famine, starvation, and stuff like that.
[00:13:33.849]That is certainly a conversation that should be had.
[00:13:37.126]It is very important, but I'm going to restrict
[00:13:40.220]this particular talk to more resourced countries,
[00:13:43.004]in particular, the United States.
[00:13:46.074]So let's talk about compromised quantity
[00:13:49.228]and quality of potable water.
[00:13:51.316]So increased temperatures and reduced rainfall
[00:13:54.713]have direct impacts on the quantity
[00:13:56.627]and quality of potable water,
[00:13:57.811]both surface and ground, okay?
[00:14:00.400]It can cause decreases in the flow in rivers
[00:14:04.026]and lower lake level,
[00:14:06.181]and when those amounts of water decrease,
[00:14:09.744]you can find increased concentrations of contaminants,
[00:14:12.826]and those can include everything from pharmaceuticals,
[00:14:15.878]to total organic carbon, to other chemicals and metals,
[00:14:21.713]heavy metals, things like that.
[00:14:23.749]And this also often creates an environment
[00:14:27.155]that is more suitable for the proliferation of pathogens
[00:14:31.083]and algal blooms come to mind, first off, for most people,
[00:14:34.857]but also some conditions are created
[00:14:39.092]that cause the proliferation of gastrointestinal pathogens
[00:14:43.732]that can be Giardian, Crypto.
[00:14:47.145]One of the examples that I pulled out of the literature
[00:14:50.116]was the deterioration of western Europe,
[00:14:53.142]and they didn't have a pronunciation on this river
[00:14:55.121]so I am just gonna call it the Meuse river,
[00:14:58.448]but the water quality during droughts,
[00:15:01.928]they noticed that if the water temperature, eutrophication,
[00:15:06.303]and some heavy metals were actually getting to the point
[00:15:12.149]where, in severe drought periods, that these variables,
[00:15:18.857]they deteriorated in this particular river.
[00:15:21.717]And the years, in particular, were 1976,
[00:15:26.109]when we had a severe drought in 2003.
[00:15:30.648]And there's a lot of information that you can share
[00:15:33.684]about this particular topic.
[00:15:36.294]Drought can create an overly dry soil,
[00:15:40.410]and I saw some of the research
[00:15:43.290]that was noting that cyanotoxins
[00:15:45.969]and sea water intrusion were at risk with this,
[00:15:48.959]and then also, increased runoff from heavy rain.
[00:15:52.555]So when you get overly dry soil,
[00:15:55.643]sometimes it can cause severe cracking,
[00:15:58.186]and what they have found is that
[00:16:01.446]once that cracked soil happens, it can actually be,
[00:16:05.925]the cyanotoxins, if they are there
[00:16:09.389]and the water then hits those cracks,
[00:16:11.320]they can actually wind up contaminating some ground water.
[00:16:15.376]And then also, sea water intrusion,
[00:16:20.661]what I found was interesting
[00:16:21.907]is that only a 5% level of contamination
[00:16:25.636]can actually reduce fresh water's usability,
[00:16:28.666]and so it doesn't have to be much,
[00:16:30.575]and you can get some serious issues.
[00:16:32.196]And then, for the increased runoff from heavy rains,
[00:16:34.686]what happens is that soil gets really dry
[00:16:37.042]and becomes more loose, it's not packed down as much,
[00:16:40.417]and if heavy rains come and they just,
[00:16:43.189]all of that surface soil that is not sort of stuck together
[00:16:47.749]as well as before, just gets washed off,
[00:16:50.710]and then they also can find then
[00:16:53.064]that runoff runs into lakes and streams
[00:16:55.751]and things like that, and causes a lot of contamination.
[00:16:59.946]And then, also, sort of a more obvious thing
[00:17:02.862]is that the decrease or elimination
[00:17:04.564]of pumpable well water volume.
[00:17:06.899]The decreased water in aquifers often lowers water tables
[00:17:11.280]and increases the concentrations of contaminants
[00:17:15.283]within some of those wells also.
[00:17:18.254]An example is in Western, the Western drought in California.
[00:17:21.188]As you can see here, here is a graph.
[00:17:23.376]It's the number of the ports of supply shortage in reports
[00:17:29.363]and it runs from July 2014 to September of 2016.
[00:17:33.505]You can see it just climbing,
[00:17:35.625]and this is part of their five-year drought,
[00:17:39.004]and the struggles that they have,
[00:17:40.146]and these reported outages, we've got households
[00:17:42.773]with active outages, and water supply problems
[00:17:46.148]from a dry well, creek, or other surface water supply,
[00:17:50.243]so it's a combination of a lot of things,
[00:17:52.108]but this is a phenomenal number of people with a problem.
[00:17:58.930]And then we will move on to behavioral health.
[00:18:02.655]There's vulnerabilities.
[00:18:03.887]One of the main vulnerabilities is living
[00:18:06.104]in a rural community, and why, why is that?
[00:18:08.991]You know why, or why are we picking on people
[00:18:10.335]living in rural communities?
[00:18:12.179]Well, because a lot of these people are farmers.
[00:18:15.975]They are dependent on water for their livelihood.
[00:18:20.445]Good farming is not a business
[00:18:23.400]in which there is always consistent and great income,
[00:18:28.559]so some of these people have a lower socioeconomic status
[00:18:32.466]and there is often less access to or more stigma
[00:18:37.104]surrounding behavioral health services
[00:18:38.933]'cause in rural areas, sometimes you have to travel further,
[00:18:41.756]or there just isn't the clinic
[00:18:45.130]or the doctor down the street
[00:18:47.979]that you can just go to for that.
[00:18:50.622]And there's stress coming from multiple areas.
[00:18:53.349]There's employment changes.
[00:18:55.182]You can see decrease in hours, you can see job loss.
[00:18:57.851]Those financial changes.
[00:19:00.079]Because you're getting decreased hours,
[00:19:01.543]your income decreases.
[00:19:03.563]Because the food is not being produced as much,
[00:19:08.979]there's gonna be increased food costs,
[00:19:11.176]and so, you have increased household costs for yourself,
[00:19:14.418]to be able to feed your family.
[00:19:16.184]There's a disruption of normal routine.
[00:19:18.019]If you're having to go get water because your well ran dry,
[00:19:21.671]you don't get to do the other fun things
[00:19:23.648]that your family used to do.
[00:19:24.889]You've got to go get water on the weekend.
[00:19:28.011]And then, there's decreased community connectedness
[00:19:31.013]because oftentimes, people start thinking,
[00:19:32.993]"Maybe I should leave," or their business goes under
[00:19:36.079]and they have to leave.
[00:19:37.698]And then, even people who aren't necessarily farmers,
[00:19:42.066]we saw this in California, even with just the sense of loss
[00:19:47.629]and grieving for the land.
[00:19:49.570]The farmers, yes, they're devastated,
[00:19:51.232]their crops are dying, their animals are struggling,
[00:19:54.121]but there's also people that see the land that they love
[00:19:56.723]and land that they've seen all their life,
[00:19:59.074]and it's being decimated.
[00:20:01.313]The plants and the wildlife are being decimated
[00:20:03.879]by the drought, and in people get concerned about it.
[00:20:08.015]The tree loss in California is one of the things
[00:20:10.339]that people, it's a real conversation.
[00:20:14.552]People are talking about it, they're concerned about it,
[00:20:16.880]and bothers them, and it worries them.
[00:20:20.823]And so, when we looked at this behavioral health topic,
[00:20:27.359]I found that I can sort of spread it into, okay, well,
[00:20:30.748]there seems to be a lot of work that's being done
[00:20:32.292]in Australia, and there seems to be
[00:20:34.606]just a little bit of work being done here in the US,
[00:20:37.871]and so Australia seems to lead a lot
[00:20:40.647]of the peer review literature in drought research
[00:20:44.702]and in particular, in behavioral health research.
[00:20:47.881]In the US, we saw a lot less of peer review research
[00:20:53.125]on the topic of drought, and in particular,
[00:20:55.338]in the behavioral health research.
[00:20:57.521]So there's just a couple of studies here.
[00:20:59.904]Basically, what we're looking at is Obrien et al.
[00:21:04.442]They made longitudinal records of monthly rainfall from 2007
[00:21:09.478]to 2000, excuse me,
[00:21:12.066]linked longitudinal records of monthly rainfall
[00:21:14.302]to the 2007-2008 Household Income and Labour Dynamics
[00:21:17.711]in Australia, and what they found was that rural residents
[00:21:23.261]had higher levels of distress than urban residents,
[00:21:30.113]and a lot of these things were, like, well, duh,
[00:21:33.033]but I think that as scientists,
[00:21:36.211]as public health professionals, our job is to,
[00:21:40.180]"Okay, well this isn't a goal, this is what everyone thinks.
[00:21:43.229]"Can we prove it?"
[00:21:44.732]Can we say that yes, this is actually what happens,
[00:21:48.065]so now we have evidence-based information
[00:21:52.100]so we can use the evidence-based information
[00:21:54.832]to push forward actions, policies, things like that
[00:21:59.879]because people, actions and policies don't usually happen
[00:22:04.233]very well on anecdotal results.
[00:22:08.115]So they saw that these people in the urban area
[00:22:12.873]experiencing a higher number of months under drought,
[00:22:19.196]whether it was a consistent, cumulative 20 to 30 months
[00:22:22.836]of drought, and in a recent long period of drought,
[00:22:26.345]with 12 months or more, this is during their Big Dry,
[00:22:30.104]that they had significantly higher levels of distress
[00:22:33.885]than urban residents under the same kind of conditions.
[00:22:39.403]Okay, and then Hanigan, they assessed if suicide risk rose
[00:22:42.485]with increasing duration of drought,
[00:22:45.239]and that's something that's definitely concerning
[00:22:47.163]because that's sort of the permanent solution
[00:22:51.266]to a temporary problem, that we have with behavioral health,
[00:22:56.818]and here, they saw increased rates
[00:22:58.975]of suicide during drought in males aged 30 to 49
[00:23:03.065]in rural communities.
[00:23:04.683]So they were able to establish that with a study
[00:23:09.823]that was looking, I think it was from 1970 to 2007,
[00:23:14.686]so looking at suicide results and then comparing that
[00:23:17.912]to them, the level of drought.
[00:23:21.798]And then we have Gunn, which found farmer's age
[00:23:26.024]that was associated with different coping strategies,
[00:23:28.874]and what I found interesting was that the 25 to 44 age group
[00:23:34.169]use alcohol and drugs to cope more than any other group,
[00:23:38.107]so this is certainly something
[00:23:39.195]that could be a target group for people who are
[00:23:45.125]looking into that topic area, and then,
[00:23:47.762]the older groups were more,
[00:23:50.076]slightly more likely to use religion,
[00:23:52.859]and so that is something that,
[00:23:55.374]I think that working in communities,
[00:23:57.905]faith-based organizations and actually getting to
[00:24:05.047]get relationships with those organizations
[00:24:07.999]and work with them and have them work
[00:24:09.482]with their populations can be a very powerful
[00:24:12.748]and effective way to make change in the community.
[00:24:17.283]And then we get to behavioral health research in the US.
[00:24:21.544]I found a study,
[00:24:24.414]and Safi created a vulnerability index
[00:24:28.065]just to assess the climate change risk perceptions
[00:24:31.479]among Nevada ranchers and farmers,
[00:24:33.974]and they found that believing that climate change
[00:24:36.588]is a possible cause of drought,
[00:24:38.824]this experience in Nevada,
[00:24:40.551]increases people's risk perception, and as you know,
[00:24:43.399]if you have an increased amount of risk perception,
[00:24:47.541]there's a more likelihood
[00:24:48.509]that you're actually taking action,
[00:24:50.618]so they're looking for reasons for people to take actions
[00:24:55.387]and things that you can do to cause people to take action.
[00:24:58.597]Now, there is a study by Vins,
[00:25:01.160]but this is not specifically US, but it was conducted
[00:25:04.585]by people who are in the US, and one of those
[00:25:06.487]being Jesse Bell who I work with quite a bit these days,
[00:25:10.923]and they conducted a systematic literature review
[00:25:13.215]for mental health effects of drought
[00:25:14.901]and created causal process diagrams
[00:25:17.195]linking drought effects to mental health outcomes,
[00:25:19.884]and just as an example, they found 82 articles
[00:25:24.860]that applied in this systematic literature review.
[00:25:29.760]Only seven of them came from the US.
[00:25:32.877]So that shows you how new studies that are being done
[00:25:38.912]on drought-related behavioral health issues in the US.
[00:25:42.697]58 came from other developed countries,
[00:25:45.879]many of them from Australia, and then the other seven,
[00:25:49.015]I don't think have locations described, but,
[00:25:52.357]so I'll show you this next diagram.
[00:25:53.699]This is their causal process diagram
[00:25:56.076]for mental health outcomes.
[00:25:57.169]I'm not expecting you to memorize this.
[00:25:58.579]There will be no quiz, but if you can see
[00:26:01.898]that drought is over, way over there,
[00:26:04.419]sort of on the bottom left side,
[00:26:06.834]and it points to three, four different things,
[00:26:10.441]and then the rest just spreads,
[00:26:12.805]because once you cause something to one effect,
[00:26:16.261]it can then bounce over and cause another effect
[00:26:19.343]and then that effect can come back
[00:26:20.685]and potentiate something else,
[00:26:23.453]and this just shows you the complexity
[00:26:26.388]that though this may have started as an effect from drought,
[00:26:30.977]it just can explode within a person, a community,
[00:26:34.919]a household, and so, it just sort of shows you
[00:26:38.965]how profound and pervasive the effects can be.
[00:26:43.572]So we'll move on to decreased air quality.
[00:26:46.029]Droughts increase the incidence of wildfires and haboobs.
[00:26:49.350]Haboobs are dust storms.
[00:26:51.229]That's the top picture, and of course,
[00:26:52.732]the bottom picture's a wildfire.
[00:26:53.993]It increases the smoke and particulate matter,
[00:26:56.124]both PM 2.5 and PM 10, and it increases the incidence
[00:27:00.123]of mortality and morbidity, it's particularly in asthma
[00:27:04.719]and chronic obstructive pulmonary disease
[00:27:06.512]and cardiovascular disease.
[00:27:08.494]There are several studies, one in Australia,
[00:27:11.094]that they saw increases in non-accidental mortality,
[00:27:16.357]and with these particular issues, both smoke events
[00:27:20.255]and dust events, and then,
[00:27:22.456]BioSense, which is a CDC-related system,
[00:27:26.918]actually saw more diagnoses and hospital visits
[00:27:30.485]for asthma after a wildfire in California.
[00:27:35.818]So there is also increased risk of injury,
[00:27:38.743]and you'll see, sometimes you'll see a side
[00:27:40.329]where we're like,
[00:27:41.162]we already talked about decreased air quality
[00:27:43.443]and here, you talked about, the wildfires and haboobs,
[00:27:47.568]well, they're coming in back on another side
[00:27:49.241]because now, we have increased injury,
[00:27:50.856]so some of these things that drought potentiates
[00:27:54.180]or causes primarily, or secondary, or tertiary,
[00:27:57.291]they actually belong to a lot of different ways
[00:28:00.543]that this can affect your health.
[00:28:03.285]So, heatwaves.
[00:28:04.445]Heatwaves are, they're intensified by drought,
[00:28:09.328]and it increases the risk of heat-related injury and death,
[00:28:12.139]one of the most common environmental injuries
[00:28:16.883]that we have in the United States,
[00:28:19.329]with heat exhaustion and stroke,
[00:28:21.143]and as you remember, I talked about earlier,
[00:28:23.586]the 2012 drought, it had a heatwave that killed 123 people.
[00:28:28.216]That's an impressive, that's just by direct,
[00:28:30.673]not indirect, but just direct.
[00:28:32.744]Indirect's number's gonna be larger,
[00:28:35.187]and that is something that cities are (mumbles)
[00:28:42.728]Europe, cities in Europe, cities in the US
[00:28:45.138]are constantly struggling with how do you deal
[00:28:47.053]with heatwaves and keep our communities safe,
[00:28:50.074]and what about cooling centers,
[00:28:51.727]how do you message all of that,
[00:28:53.280]but all the topic on the radar for people.
[00:28:56.665]Recreationally, there's not a lot of research on that,
[00:29:01.547]but drought does lower water levels,
[00:29:04.977]and there's a potential there to increase the risk
[00:29:09.023]of trauma in recreational waters,
[00:29:11.020]such as boats hitting objects that used to be way lower
[00:29:16.132]in the water that are now higher
[00:29:17.690]and they don't realize that they hit it,
[00:29:18.991]or diving, you think the water's deeper, and it's not
[00:29:22.272]because the drought has really decreased the depth
[00:29:23.964]of the water.
[00:29:24.971](mumbles) In Wisconsin in 1988, they did document
[00:29:29.558]that there were seven people that were in diving accidents
[00:29:33.872]that suffered spinal injuries,
[00:29:35.379]and the lowering of the water there was related to drought.
[00:29:39.141]And then the wildfire and haboobs,
[00:29:41.574]like we said, drought increases their incidence,
[00:29:44.240]and then, then you're looking at personal
[00:29:47.599]and occupational injury.
[00:29:49.455]This can be automobile accidents.
[00:29:51.466]Haboobs decrease, and the dust storms and smoke,
[00:29:55.192]they decrease your visibility,
[00:29:56.972]and you can easily have an accident in decreased visibility,
[00:30:01.028]and then also, firefighting.
[00:30:04.635]There are professional firefighters
[00:30:06.509]and then there are also people who try to stay behind
[00:30:09.329]to protect their homes,
[00:30:10.663]and that is a considerable potential risk for injury.
[00:30:17.615]And then we have increased disease incidents.
[00:30:19.473]I just made a couple of slides on this,
[00:30:21.104]and I didn't list them all.
[00:30:22.799]We don't have all the diseases that drought
[00:30:24.724]can potentiate in the US, so here's just a few of them.
[00:30:28.260]There's toxin exposures.
[00:30:29.563]We have harmful algal blooms that produce cyanotoxins.
[00:30:33.105]This can cause skin irritation and GI symptoms,
[00:30:37.973]and it increases, it occurs when there's increased nutrients
[00:30:41.981]in the water, and there's stagnant water,
[00:30:43.670]and that is very common when you have drought conditions,
[00:30:47.911]and there were drought,
[00:30:49.443]there was a drought-related situation in 2004.
[00:30:53.442]They're saying the bacteria algal blooms
[00:30:55.658]here in Nebraska lakes
[00:30:57.255]caused deaths of dogs, wildlife, and livestock,
[00:31:00.320]and increased human skin rashes, lesions,
[00:31:02.297]and gastrointestinal illness.
[00:31:04.237]So it can hit, anywhere the drought hits,
[00:31:08.927]there's a potential for this,
[00:31:10.510]if the right conditions come about.
[00:31:12.933]There's also another condition
[00:31:15.026]called primary amoebic meningoencephalitis,
[00:31:19.066]and it's caused by Naegleria fowleri,
[00:31:24.288]and it's an amoeba found in warm freshwater and soil,
[00:31:28.012]and they have an increased incidence of this disease
[00:31:32.191]when there is stagnant water with an increased temperature.
[00:31:34.955]Again, a condition that is commonly seen
[00:31:37.986]as a consequence of drought.
[00:31:41.098]And then there has been some proof that there's increase
[00:31:44.864]in the West Nile virus.
[00:31:46.700]West Nile virus is an arboviral virus,
[00:31:49.875]which means that it's spread by mosquitoes.
[00:31:52.192]It causes a febrile illness or encephalitis
[00:31:55.995]and meningitis, and it can be anything
[00:31:58.716]from oh, I feel like I might have the flu
[00:32:00.547]to I'm seizuring, going into a coma
[00:32:04.837]and dying from this disease,
[00:32:06.688]depending on how it affects the individual person.
[00:32:10.402]And you can see increased mosquito population
[00:32:13.523]with stagnant water, because stagnant water
[00:32:16.412]is a very popular for,
[00:32:18.342]especially for the mosquitoes specific to West Nile,
[00:32:21.389]very popular breeding ground.
[00:32:23.550]And then, the higher prevalence of the virus
[00:32:26.999]in the mosquitoes and the bird population
[00:32:29.341]can come about because you see a closer contact
[00:32:32.125]between the birds and the mosquitoes,
[00:32:34.417]because they're all huddled around the stagnant water
[00:32:37.730]that's left for them, and as you can see
[00:32:40.349]in the illustration, this runs in a natural cycle
[00:32:44.225]between the mosquitoes and birds,
[00:32:46.033]but it can then branch out when certain mosquitoes
[00:32:50.094]then go to bite the more dead-end hosts
[00:32:53.084]which, of course, is also human beings.
[00:32:57.416]And then, it continues.
[00:32:59.550]And I don't think that we think
[00:33:02.162]about drought increasing the incidence
[00:33:03.934]of disease all the time, and I don't think we realize
[00:33:06.745]how many diseases it actually can have an effect on,
[00:33:09.823]and this is just a small sampling.
[00:33:12.532]So, there's the coccidioidomycosis,
[00:33:15.831]or valley fever as they call it,
[00:33:17.738]that's more in the Southwest.
[00:33:18.962]It's a Coccidioides fungus in the soil,
[00:33:21.699]and it causes a respiratory infection
[00:33:24.292]and is dispersed by the land and dust storms,
[00:33:26.437]which we discussed before, and especially,
[00:33:30.406]after, like, you had a previous wet period,
[00:33:32.673]and you get nice fungal growth,
[00:33:34.895]and then you have a drought, and it dries out the soil,
[00:33:37.819]and then, the soil gets then dispersed by the rain
[00:33:41.429]or dust storms into the air,
[00:33:42.861]and then you have exposure to an increased number of people.
[00:33:46.954]Whoops.
[00:33:47.869]Almost forgot Hantavirus.
[00:33:48.867]Hantavirus Pulmonary Syndrome,
[00:33:51.041]it's a virus spread to humans via rodents,
[00:33:53.781]direct contact with rodents or contact with their urine
[00:33:57.494]and their droppings, and it can cause respiratory failure,
[00:34:01.739]and the, there's this weird,
[00:34:07.048]I think not everything is caused just by drought,
[00:34:09.406]sometimes I think it's caused by a combination
[00:34:11.702]of weather or climate events, and they've seen
[00:34:15.295]some association between droughts
[00:34:17.972]followed by heavy rainfall
[00:34:19.869]associated with increased rodent populations,
[00:34:21.832]and then they increase in population, they start,
[00:34:24.412]they were exploding, they're gonna spread out
[00:34:27.617]into the areas where humans are also there,
[00:34:31.112]and that can cause a problem, and they did associate that
[00:34:35.179]with a 1993 Hantavirus outbreak.
[00:34:40.973]And then we're gonna go on
[00:34:42.506]to compromised food and nutrition.
[00:34:45.715]Yes, we get compromised food and nutrition
[00:34:48.230]in more resourced countries.
[00:34:49.986]Is it as severe as total crop death, famine, starvation?
[00:34:55.830]No, but it does have an effect,
[00:34:58.603]especially on more vulnerable populations
[00:35:00.975]that are on the edge anyway socioeconomically.
[00:35:04.040]So you can see increased costs from lower yield.
[00:35:07.068]So you have decreased production of food,
[00:35:09.432]and increase in diseases of either the plants
[00:35:14.789]or the animals.
[00:35:16.064]2005 to 2007, Australians saw a 33% increase
[00:35:20.045]in their vegetable prices.
[00:35:21.841]That's pretty big, I like my salads
[00:35:23.695]so that would have been unfortunate.
[00:35:26.918]And then, they also saw in Australia,
[00:35:29.426]decreased milk production and increases
[00:35:31.608]in birth defects in cattle.
[00:35:35.023]I am not a cattle veterinarian
[00:35:37.080]so I don't know the exact mechanism for that
[00:35:39.583]but they did mention
[00:35:41.518]that it was a congenital chondrodystrophy of unknown origin
[00:35:47.489]that caused either early death
[00:35:50.013]or just simply just decreased birth and production.
[00:35:53.919]And then we have, sometimes, you see lower nutritious values
[00:35:56.725]from depleted soil nutrients, and there's some studies
[00:36:00.805]noted there's a decrease in zinc and iron
[00:36:03.387]in major food crops such as wheat,
[00:36:05.551]and that can worsen iron deficiencies
[00:36:07.311]in people that are counting on that in their food.
[00:36:09.909]And then there is also the potential exposure to toxins,
[00:36:14.757]and there was this study done on the figs in Turkey,
[00:36:19.415]and extended high temperatures and water stress
[00:36:21.514]from the drought increased the presence of aflatoxins
[00:36:24.242]in these dried figs.
[00:36:25.978]One, that can increase your potential exposure to a toxin,
[00:36:30.741]and two, once these aflatoxins are found,
[00:36:34.090]then that food has to be condemned,
[00:36:36.179]and so that actually decreases their sale of their product,
[00:36:40.482]which is then an economic influence.
[00:36:42.595]So, let's look at national drought information.
[00:36:44.910]There are some of you in this room
[00:36:45.855]who could tell me a lot more about that than I know,
[00:36:49.627]so I'm not gonna pretend that I know more, but I wanna talk
[00:36:53.244]about the National Drought Mitigation Center, which is here
[00:36:57.431]in the School of Natural Resources.
[00:37:00.128]My understanding is that it was founded in 1995,
[00:37:03.764]and it provides resources for monitoring,
[00:37:06.357]assessing impacts, planning,
[00:37:07.895]and K to 12 education resources.
[00:37:10.818]We've got the US Drought Monitor,
[00:37:12.245]which everybody talks about, and everybody loves that,
[00:37:16.124]at least everybody I know that works in drought,
[00:37:18.494]and then you also have the Vegetation Drought Response Index
[00:37:22.632]which I think is a newer product,
[00:37:24.803]and then also there is a community guide.
[00:37:28.254]It's the Drought-Ready Communities,
[00:37:29.690]A Guide to Community Drought Preparedness,
[00:37:31.915]which I think is amazing because you can tell communities
[00:37:36.146]to prepare all day long, but they're not gonna know how,
[00:37:40.382]they're not gonna know where to start,
[00:37:41.361]they're not gonna want to do,
[00:37:43.151]and these kinds of guides can help them in that process,
[00:37:46.728]and that, being able to prepare locals
[00:37:49.757]is a key, key to their success of any type or response.
[00:37:55.342]And then, they're also helping states,
[00:37:56.991]tribal governments, and other countries.
[00:38:00.390]Evidenced by the travel, I've heard, stories I've heard
[00:38:03.242]of recent, from people here, and they want
[00:38:07.712]to basically be able to give them drought risk management,
[00:38:13.468]write things to do that are related to monitoring
[00:38:17.655]and early warning, planning so that they can better adjust
[00:38:20.216]to drought in their area.
[00:38:22.663]And here, you can see the US Drought Monitor.
[00:38:25.058]You saw the earlier images of 2012 and 2014.
[00:38:30.569]I just pulled this one off on the day I put this,
[00:38:34.235]creating this presentation, and then also,
[00:38:36.424]the Vegetation Drought Response Index.
[00:38:38.734]There are people in this room if you want to know more
[00:38:40.836]about the National Drought Mitigation Center.
[00:38:43.214]They can tell everything you need to know about it,
[00:38:45.878]and I'm sure they'd be happy to share that with you
[00:38:48.020]if you're not aware or want to learn more.
[00:38:51.030]There's also the National Integrated
[00:38:53.015]Drought Information System.
[00:38:55.606]This was started under NOAA, and it was authorized
[00:38:59.490]by Congress, by Public Law, even, in 2006,
[00:39:03.302]and it supports drought research and provides resources,
[00:39:06.704]data, maps, and tools for drought, and they actually work
[00:39:12.104]with creating the Regional Drought Early Warning Systems,
[00:39:16.257]and these are, this isn't like a little box
[00:39:18.918]that blinks red when drought comes,
[00:39:20.923]which was kind of sort of like what I thought in my mind
[00:39:23.546]when I heard, oh, it's a system, it's early warning system,
[00:39:25.813]a siren gonna go off.
[00:39:27.264]No, it's actually better than that.
[00:39:31.028]It is new partnerships, it's existing partnerships,
[00:39:34.944]making networks, and using the science
[00:39:38.798]that's readily available and easily understandable,
[00:39:42.281]and getting it to decision makers
[00:39:44.292]so that they can see that drought is coming
[00:39:47.616]or see that drought is there,
[00:39:49.074]and see what they can do about it,
[00:39:50.823]and it can improve the capacity of its stakeholders
[00:39:54.040]to better monitor, forecast, plan for,
[00:39:56.312]and cope with the impacts of drought.
[00:39:58.963]And this, I went under the NIDIS website
[00:40:02.093]and just pulled these off the website.
[00:40:04.435]These are all resources, and tools,
[00:40:07.143]and all sorts of anything and as you can see,
[00:40:09.351]they make sure that the drought monitor from here
[00:40:12.362]is on there because they know how good it is
[00:40:15.421]and how important it is to people.
[00:40:17.714]And then this is a map of the Drought Early Warning Systems,
[00:40:21.913]the DEWS, that are throughout the United States.
[00:40:24.167]You can see that the entire geography of the US
[00:40:27.111]is not covered, but I'm sure that some point,
[00:40:31.487]they'll be working towards that.
[00:40:33.671]Then these, of course, are the more stricken areas
[00:40:36.847]of drought in the United States on the map.
[00:40:39.493]So, we're on the homestretch. (chuckles)
[00:40:42.893]I'm gonna talk to you about what CDC is doing
[00:40:44.708]and then we can sort of chat about anything
[00:40:48.189]that you'd like to have questions about
[00:40:50.070]or talk further about.
[00:40:52.940]So CDC has a Climate and Health Program.
[00:40:55.938]In 2009, it was funded by a Congressional appropriation.
[00:41:00.806]It's the only federal investment
[00:41:02.417]in climate change preparedness
[00:41:03.874]for state and local public health sector.
[00:41:06.524]And it funds 16 states and two local health departments,
[00:41:11.205]and it provides the BRACE framework
[00:41:14.651]to these particular grantees, and tools for planning,
[00:41:19.295]implementing, and evaluating climate adaptation strategies.
[00:41:22.941]The tools they use to identify populations
[00:41:26.610]and places that are vulnerable to climate impact,
[00:41:30.648]and when I say climate,
[00:41:31.607]I'm not just talking about drought now.
[00:41:33.419]It's all of climate change.
[00:41:35.821]And then there's materials to help communicate climate
[00:41:39.288]and health issues to the public,
[00:41:41.111]and there are also, the Climate and Health Program
[00:41:43.986]also provides scientific guidance and assistance,
[00:41:47.328]and creates partnerships.
[00:41:50.119]And this is a map of where the grantees are.
[00:41:52.904]There were a set of them funded in 2010
[00:41:55.846]and also another set funded in 2012.
[00:42:00.542]And then this is the BRACE program.
[00:42:02.578]So it just shows you the process at which they go through.
[00:42:05.565]They start forecasting and assessing these vulnerabilities
[00:42:09.311]and then what can you do,
[00:42:11.554]and then you assess the interventions that you've done,
[00:42:14.752]and you develop and implement adaptation plans
[00:42:18.865]and then you start the evaluation process
[00:42:20.419]and you start all over again.
[00:42:22.242]So it helps them constantly keep improving
[00:42:24.173]in a circular way.
[00:42:26.669]And the other thing that CDC has done
[00:42:28.619]is that they created the When Every Drop Counts document
[00:42:31.843]that was published in 2010.
[00:42:33.918]It introduced research-supported categories
[00:42:36.125]of drought-related health effects,
[00:42:38.167]and I think it helped people put into perspective
[00:42:40.699]that yes, drought does affect public health
[00:42:44.192]and it's something that public health professionals
[00:42:46.493]should be keeping in mind.
[00:42:48.639]It advocated for inclusion of public health
[00:42:50.940]in drought preparedness and response,
[00:42:53.164]and it listed recommended drought-associated research gaps
[00:42:56.446]and future initiatives.
[00:42:58.514]What we don't know at this point,
[00:43:01.326]since it was published in 2010,
[00:43:03.938]is what was done with it, what has been done since then.
[00:43:08.029]How far have we gotten?
[00:43:09.435]What are these gaps in these initiatives?
[00:43:12.823]Have we pursued or tried to close,
[00:43:17.633]and where are we in that process?
[00:43:20.257]And I think that that's sort of,
[00:43:22.199]some of the other projects that we see
[00:43:23.482]that that's sort of what we're trying to get to here.
[00:43:27.179]The additional work they're doing.
[00:43:28.975]Now there's the National Drought Resilience Partnership
[00:43:31.980]that was part of the President's Climate Action Plan,
[00:43:34.921]and it was established in November of 2013.
[00:43:38.543]And then, there was a Presidential Memorandum
[00:43:42.113]that directed the creation of a Federal Action Plan
[00:43:45.734]regarding drought.
[00:43:47.328]So as you can see in March 2016,
[00:43:50.770]they created the Long-Term Drought Resiliency
[00:43:53.454]Federal Action Plan, and it has six goals
[00:43:56.673]and 27 associated actions.
[00:43:59.279]We are not going to go through all 27 associated actions,
[00:44:02.329]trust me, but what I wanted to give you
[00:44:05.901]is to let you see what the goals are,
[00:44:08.835]and then let you see where CDC
[00:44:11.199]is actually a Lead Coordinating Agency
[00:44:14.380]or a Supporting Agency, and what they're doing
[00:44:17.699]underneath those goals.
[00:44:19.743]So you can see that we're working on,
[00:44:21.787]to develop data models to identify populations at risk
[00:44:24.876]to the health effects of drought,
[00:44:26.815]and integrating existing data and information sources
[00:44:29.206]for regional-level use.
[00:44:31.646]And you can also see that we are working on
[00:44:34.957]supporting state, tribal, local,
[00:44:37.395]and territorial health departments,
[00:44:39.254]and strengthening rural drinking water contingency plans.
[00:44:44.700]And one of the main projects
[00:44:46.381]that I have actually been involved in is sort of
[00:44:49.542]this update on the state of drought and public health.
[00:44:53.374]Right now, we're trying to finish up
[00:44:55.886]the semi-structured in-depth interviews of key stakeholders.
[00:44:59.012]This will be a qualitative analysis of interviews
[00:45:02.290]of these key stateholders from one or two states
[00:45:06.209]in eight of the nine US Climate Regions.
[00:45:08.565]Why didn't I use all nine?
[00:45:09.784]Because the Northeast really doesn't get a lot of drought
[00:45:13.527]and I wanted, for at least the first nine people
[00:45:15.867]I talked to, to have somebody
[00:45:17.619]who had been significantly affected, or responded to,
[00:45:22.990]or planned for drought.
[00:45:25.620]These nine interviews, we're discussing
[00:45:28.199]with these key stakeholders, the health effects of drought,
[00:45:30.782]what they consider to be the vulnerable populations,
[00:45:34.067]their activities that they've done to address that drought,
[00:45:37.137]the data that they need and the gaps that they see,
[00:45:39.731]some of the lessons learned, and best practices.
[00:45:42.811]We've also conducted a literature review
[00:45:44.525]from 2007 to 2016.
[00:45:47.892]That is to help us see what the updated literature
[00:45:51.428]has been since the publication
[00:45:53.194]of When Every Drop Counts in 2010,
[00:45:56.893]and we've looked at both the peer-review literature
[00:45:59.960]and we're also adding a gray literature component
[00:46:01.939]because the peer review literature
[00:46:04.517]didn't seem like it was enough,
[00:46:06.498]or wasn't as much as we wanted to find
[00:46:09.294]and there wasn't as much as we thought might be there.
[00:46:11.902]And so, we're looking into the gray literature now
[00:46:14.243]to see if we can't expand on finding out other things
[00:46:21.474]that have been found in the gray literature
[00:46:22.990]but not necessarily published
[00:46:24.352]in the peer review literature
[00:46:25.368]but naturally address so many questions we have about that.
[00:46:28.845]And then there was a state drought plan review
[00:46:31.240]that has actually been completed
[00:46:32.401]by one of our NPH students, and I'll just give you
[00:46:35.953]some results on that real quick.
[00:46:37.800]The objective is to determine if health impacts
[00:46:39.701]of drought addressed and determined factors predictive
[00:46:43.877]of section dedicated to health impacts in drought plans.
[00:46:49.717]They basically looked at the
[00:46:53.371]National Drought Mitigation Center website,
[00:46:55.848]and conducted a web search with search terms
[00:46:59.093]"state drought plan" and "state hazard mitigation plan"
[00:47:02.376]to try and find as many drought plans
[00:47:04.804]as they could to assess.
[00:47:07.366]And then, what they found
[00:47:09.659]was that plans addressing environmental implications
[00:47:13.918]of drought were there, but oftentimes,
[00:47:18.174]they didn't address the actual health impacts,
[00:47:20.925]and I'll show you an image in the next slide,
[00:47:24.727]just sort of coming straight back,
[00:47:26.607]and they also found that there's increased odds
[00:47:28.864]of state drought plan including a health section
[00:47:32.566]when the state health agency is involved
[00:47:35.507]in the plan development,
[00:47:37.344]and you'll see the adjusted odds ratio there is 21.
[00:47:41.176]You'll notice that our conference interval's too wide.
[00:47:43.996]We had a small end, so it was about 47,
[00:47:51.321]so we have (mumbles) but it was statistically significant.
[00:47:56.154]And then, some of the things that we adjusted for
[00:48:00.127]was the total number of selective environmental impact terms
[00:48:03.514]mentioned in each drought plan in the states
[00:48:07.289]that have experienced exceptional drought
[00:48:09.457]or greater than the last five years.
[00:48:13.498]And you can see here the key terms
[00:48:14.894]related to environmental health impacts.
[00:48:17.397]You can see that the environmental impact terms
[00:48:20.789]were mentioned a lot more in these particular plans,
[00:48:25.932]but when it came down
[00:48:27.249]to actually identifying the health effects,
[00:48:29.592]mentioning health effects and identifying them
[00:48:31.770]and calling them out, the percentage of plans
[00:48:34.434]that mention those is much lower.
[00:48:37.349]And I just think that it's a matter of
[00:48:41.280]what are you gonna focus on,
[00:48:43.492]and it's a matter of do we have proof,
[00:48:45.968]or does this happen in our jurisdiction,
[00:48:48.820]and it's a matter of experience and knowledge, I think.
[00:48:53.929]So hopefully, as we find these things out
[00:48:57.448]and as we spread the word, we can help improve the numbers
[00:49:00.071]in some of these results.
[00:49:02.757]And then, there's what we call CASPER.
[00:49:05.680]What we have done is work
[00:49:08.137]with drought-related Community Assessment
[00:49:10.640]for Public Health Emergency Response or CASPERs.
[00:49:13.282]These particular community assessments
[00:49:17.067]are something that we've developed,
[00:49:18.955]I believe, it was like 2003 or 2009,
[00:49:21.453]way before I got there.
[00:49:23.409]It was in the team that I'm working on right now,
[00:49:26.560]so we do these CASPERs for a lot of different reasons,
[00:49:30.235]a lot of different disasters,
[00:49:32.056]but these are particularly drought-related CASPERs.
[00:49:35.802]In 2015, we did technical assistance
[00:49:38.489]for three drought CASPERs conducted
[00:49:40.874]by state and local health departments in California,
[00:49:44.226]and for 2016-2017, we were able to find funding
[00:49:48.754]and participate in (mumbles) participating
[00:49:52.813]in two drought CASPERs, one in 2016,
[00:49:55.191]which we just finished, and then one in,
[00:49:57.643]hopefully, in the spring of 2017 in Oregon,
[00:50:00.665]and some of the objectives
[00:50:01.943]for these drought-related CASPERs
[00:50:03.793]will describe the health effects.
[00:50:05.760]What these communities are experiencing,
[00:50:07.876]assess other effects of drought on the community, some,
[00:50:11.013]mainly, the one that we just conducted was tree death.
[00:50:15.373]Yes, it was a major concern.
[00:50:17.272]And develop recommendations
[00:50:18.980]for improving the community's response to drought.
[00:50:24.137]And just as a little overview,
[00:50:25.682]like what the heck is a CASPER?
[00:50:27.459]It's a two-stage probability sampling design.
[00:50:30.458]You pick a geographic sampling frame,
[00:50:33.035]which is the entire yellow area that we see,
[00:50:36.190]and then you choose 30 clusters,
[00:50:41.282]probably proportional to size,
[00:50:44.106]and that meaning the number of households in each cluster.
[00:50:47.519]Those regional census blocks, the clusters you see
[00:50:50.847]in that image are the bright blue,
[00:50:54.575]and then, volunteers go into each cluster,
[00:50:58.334]and over the course of about two, maybe three days,
[00:51:01.840]they use this systematic random sampling technique
[00:51:05.801]to try and attain seven household interviews.
[00:51:10.068]Once that is done, the data is weighed
[00:51:13.432]to adjust for the non-random sampling
[00:51:15.381]and then we create population-based estimates
[00:51:17.965]within the geographic sampling frame,
[00:51:20.494]so we can produce them for decision-makers
[00:51:22.360]so that they can be better informed
[00:51:23.867]and hopefully have actionable information.
[00:51:27.957]And I believe this might be the last one, so we're lucky.
[00:51:31.508]There's a topic of agreement that we have
[00:51:35.098]with the USGS, and it's a geological survey
[00:51:41.019]of arsenic modeling in private wells,
[00:51:43.860]and people are interested in this
[00:51:45.701]because as we talked about, as water decreases,
[00:51:49.265]concentrations can increase of certain contaminants,
[00:51:52.578]arsenic being one of them.
[00:51:54.360]So they developed regression models
[00:51:56.246]to predict the probability of high arsenic
[00:51:58.096]in domestic water supply wells in the US,
[00:52:01.353]and they're creating arsenic hazard maps
[00:52:05.057]overlaid with county-level water use data
[00:52:06.949]to determine populations at risk.
[00:52:09.559]I'm not involved in this project,
[00:52:10.906]so I can't tell you much more than that,
[00:52:12.653]what's on this slide, but I can connect you
[00:52:14.413]with the people that are.
[00:52:16.936]And so, oh we have one more thing.
[00:52:19.705]We're doing a drought, a CDC Drought Data Guide.
[00:52:23.702]The questions that we're asking about climate data
[00:52:25.762]are whatever existing data and analytic methods
[00:52:28.051]that are being used, and what drought indicator variables
[00:52:33.440]should we be using to study effects of drought?
[00:52:36.748]And for health data, it's what are the existing data
[00:52:38.930]and analysis methods for that data,
[00:52:41.316]and what health variables need to be studied?
[00:52:44.976]And so what are our intended actions?
[00:52:48.611]For climate data,
[00:52:49.500]we'd like to identify existing drought indices
[00:52:51.829]and compile a climate data set
[00:52:53.696]with relevant drought indicators and variables,
[00:52:56.443]and for health data, we would like
[00:52:57.591]to identify existing health data,
[00:52:59.358]which is a little easier on our part,
[00:53:00.999]'cause we're a public health agency,
[00:53:03.322]and then compile a health data set containing effects
[00:53:06.993]associated with drought.
[00:53:08.992]And what, in the end, what we would like to do
[00:53:12.454]with all of that is develop a guide for end users,
[00:53:16.380]especially our state and local partners,
[00:53:19.030]to be able to study the health effects of drought
[00:53:21.037]in their jurisdiction, and be able to disseminate data sets
[00:53:24.689]for use by these end users.
[00:53:27.950]Okay, now we're in the end.
[00:53:30.489]So what are some of the conclusions?
[00:53:33.283]Well, severity and spatial extent of drought in the US
[00:53:36.361]is projected to increase as a result of climate change
[00:53:39.130]and I think that's one of the reasons
[00:53:40.818]we know it's gonna continue,
[00:53:42.171]we know it's probably gonna get worse.
[00:53:43.615]It's one of the reasons why I'm standing here.
[00:53:45.767]And there's also a paucity of research
[00:53:48.648]within the peer review literature specific to drought
[00:53:50.952]and public health in the US,
[00:53:52.348]and that needs to be fixed.
[00:53:54.012]Whoops.
[00:53:55.687]Here we go.
[00:53:56.906]And though we know it needs to be fixed,
[00:54:01.493]oops, sorry, let's do this.
[00:54:03.112]It's challenging to do that research
[00:54:05.573]because it requires multiple partners
[00:54:07.634]across diverse sectors at all levels,
[00:54:10.263]and the people at the Drought Mitigation Center know this
[00:54:13.272]and they're working towards creating those partnerships,
[00:54:15.836]but it's still a constant challenge,
[00:54:18.540]and what I am here to tell you is that CDC
[00:54:21.654]is working on model projects to address the goals
[00:54:24.326]within the National Drought Resiliency Partnership
[00:54:27.407]Long-Term Drought Resiliency Plan,
[00:54:29.540]and we wanted to share that with you, and we wanted,
[00:54:33.196]we're always interested in, to the extent that we can,
[00:54:35.861]in partnering with people and sharing ideas
[00:54:37.550]and just being part of the drought community
[00:54:41.027]and trying to be part of the solution.
[00:54:45.286]So, let me do this.
[00:54:49.931]And so, if we have time, do we have time?
[00:54:52.572]Okay.
[00:54:53.405]What I'd like to do is play this.
[00:54:55.299]I believe you shared that with me, right, before?
[00:54:58.381]And where I was stunned is because this is the drought,
[00:55:01.620]this was about one of the drought CASPERs
[00:55:03.885]that we actually helped with technical assistance,
[00:55:07.001]but I didn't know the video existed
[00:55:08.683]until Nicole shared it with me,
[00:55:10.354]so that just goes to show you the power of partnerships
[00:55:12.805](chuckles) in following up on what's actually happening.
[00:55:17.404]So I think this is maybe about six minutes,
[00:55:19.438]but it's an interesting demonstration
[00:55:21.508]of how drought affects people on a personal level.
[00:55:26.793](dog barks)
[00:55:28.074]Tomas Garcia lives on a strict water budget.
[00:55:30.826]I get about nine of these cases of water,
[00:55:33.550]and I’m two cases and two gallons left for the month.
[00:55:37.075]It's halfway through the month
[00:55:37.975]and this is the only drinkable water source for Garcia,
[00:55:41.400]his wife, and two daughters.
[00:55:43.111]They also rely on this 2500-gallon water tank
[00:55:46.447]that sits in front of their home.
[00:55:48.217]This water is not drinkable.
[00:55:49.913]The family cautiously uses it for washing dishes,
[00:55:52.668]flushing toilets, and showering.
[00:55:55.177]Just over a year ago, it used to be much worse.
[00:55:58.305]The Garcias had no running water
[00:56:00.070]because the Tule River had dried up after years of drought.
[00:56:03.448]It had been the main water source
[00:56:04.906]for the well under their home
[00:56:06.498]and for many residents of East Porterville, California,
[00:56:09.329]a community of 7,000 people 75 miles southeast of Fresno.
[00:56:13.716]Of the 1,800 homes in the community,
[00:56:16.346]500 had their wells dry up completely.
[00:56:19.649]We're in desperate need for water, you know?
[00:56:21.879]And then the solutions to our problem
[00:56:25.149]is just to have a way to carry the water
[00:56:29.134]to our properties, you know?
[00:56:31.163]And the only way I have is my personal vehicle,
[00:56:33.917]my family vehicle.
[00:56:36.496]Hauling water is all that Garcia did
[00:56:38.736]with his free time.
[00:56:39.943]He works as a manager at an auto body shop.
[00:56:42.537]And it’s what the Garcia family did
[00:56:44.321]instead of Saturday brunch or Sunday church.
[00:56:47.412]My wife dislocated her shoulder,
[00:56:49.470]because it was a lot of work pushing
[00:56:52.257]those little five-gallon buckets
[00:56:54.100]from inside the van, handing it to me,
[00:56:57.943]and me dumping in those tanks, you know?
[00:57:00.886]And the stress that you came home and there’s no water
[00:57:03.189]on my property, my family in need,
[00:57:05.713]and then the health problem, you know,
[00:57:07.711]and then it was very, very difficult.
[00:57:10.842]The stress hasn’t helped
[00:57:11.885]Garcia’s high blood pressure and diabetes.
[00:57:14.450]He also worried that his daughters would get teased
[00:57:16.706]at school because people assumed families
[00:57:18.766]without running water didn’t shower.
[00:57:21.486]David Rozell is the public health emergency
[00:57:23.342]preparedness manager for the county.
[00:57:25.086]He says an ongoing drought is not a typical emergency.
[00:57:28.812]In an earthquake or something, you can treat the injuries
[00:57:30.990]and they will heal over time and get better.
[00:57:33.411]We’re several years in and the disaster is still happening.
[00:57:36.543]We are not even in the recovery phase yet.
[00:57:39.332]Rozell can’t definitively say
[00:57:40.641]what the health problems might be
[00:57:42.525]because there hasn’t been a lot of health data collected
[00:57:44.919]related to the water shortage.
[00:57:46.675]We’re coming into new territory here.
[00:57:48.577]We’re not sure the full extent of what this
[00:57:51.981]is going to do to the community.
[00:57:53.563]In order to discover those health problems,
[00:57:55.603]the state conducted its first survey
[00:57:57.644]in three of the driest communities like East Porterville.
[00:58:00.867]The results were released this summer.
[00:58:02.764]We had heard anecdotal stories about the types of things
[00:58:05.445]that they were doing to conserve water.
[00:58:07.003]Whether it was reducing their hand washing,
[00:58:09.227]reducing their food washing,
[00:58:11.241]whether it was they had observed more dust
[00:58:14.096]or felt that there was,
[00:58:15.446]the community was less healthy because of the drought.
[00:58:17.784]But we didn’t have hard and fast information
[00:58:19.289]that we could use for that.
[00:58:20.787]The survey found that two-thirds
[00:58:22.293]of East Porterville residents have reduced
[00:58:24.346]how much they shower, wash their hands, wash their food,
[00:58:28.207]or flush their toilets.
[00:58:30.168]Rozell says these habits will lead
[00:58:31.662]to more gastrointestinal illnesses.
[00:58:34.663]Residents also reported that drier conditions
[00:58:37.421]and dust have worsened chronic health conditions,
[00:58:39.817]allergies and asthma.
[00:58:41.378]Then there’s the psychological toll.
[00:58:43.693]Drought had had some negative effects
[00:58:45.281]on their mental health and their peace of mind.
[00:58:47.339]We saw about half the households that we interviewed tell us
[00:58:49.941]that the drought had negatively affected
[00:58:51.687]their peace of mind.
[00:58:53.663]Tomas Garcia knows about that.
[00:58:56.163]I spoke to different people just only last week,
[00:59:00.083]and then they mention to me,
[00:59:02.207]"You know what? I was thinking of suicide myself."
[00:59:05.926]I said, "What?" I said.
[00:59:08.151]Just because the stress they goes through.
[00:59:12.301]The most stressful days sometimes it was when I came in
[00:59:15.849]around this time and then loading the water
[00:59:18.544]and transfer from one tank to another
[00:59:20.860]and sit on myself and thinking about it,
[00:59:22.730]"Why am I doing this?" you know?
[00:59:26.498]Go through this.
[00:59:28.882]It is the worst. (sighs)
[00:59:32.557]We definitely feel frustrated when we see the struggle
[00:59:37.053]that we see the residents going through.
[00:59:39.218]Melissa Withnell is with CSET,
[00:59:41.264]a local nonprofit running East Porterville’s
[00:59:43.495]Drought Resource Center.
[00:59:45.162]These are the mobile showers that are available
[00:59:47.633]to people who do not have running water in their home.
[00:59:50.839]It has set up temporary showers stalls,
[00:59:53.143]bathrooms, and sinks in the parking lot of a local church.
[00:59:56.559]People are playing outside, people are working outside.
[00:59:58.337]We have a farm labor community.
[01:00:00.167]So, you know, it becomes a major issue
[01:00:04.263]when you cannot get in some water and rinse yourself off.
[01:00:07.381]The center also hands out stacks
[01:00:08.936]of bottled water, but Whitnell says this site,
[01:00:11.650]as well as the water tanks
[01:00:12.933]or stress counseling services provided by the county,
[01:00:15.781]are only interim solutions.
[01:00:17.828]We definitely encounter mixed feelings
[01:00:20.092]because you’re trying to help people
[01:00:23.188]but there’s only such much you can do
[01:00:24.530]until a long-term solution is established.
[01:00:26.858]And so it then becomes an issue for the county
[01:00:30.584]and the state to step in
[01:00:31.595]so that this doesn’t become a public health emergency.
[01:00:34.221]Felicia Marcus is the chair
[01:00:35.397]of the State Water Resources Control Board.
[01:00:38.084]Generally, this is a local concern,
[01:00:40.203]a county concern in trying to figure it out,
[01:00:42.652]but I think that in the enormity of a crisis of this kind,
[01:00:47.615]everybody has to come together
[01:00:48.926]and try to figure out how to do it.
[01:00:50.622]Marcus recognizes
[01:00:51.762]that handing out bottled water and dropping water tanks
[01:00:54.630]in front of homes are not permanent solutions
[01:00:56.949]to the drought and growing public health concerns.
[01:00:59.282]Has it taken longer during this drought
[01:01:00.825]to get it all done than I would like?
[01:01:02.142]Absolutely.
[01:01:03.310]I think all of us who have been working on it
[01:01:05.063]would’ve liked it to have been done instantly,
[01:01:07.924]but in dealing with reality, it takes working with people,
[01:01:10.527]you have people who kept thinking,
[01:01:11.436]"Well, it’s gonna rain the next year,
[01:01:12.811]"so do we really have to go through all this?"
[01:01:15.129]Marcus says progress has been slow
[01:01:16.864]because water agencies at both the state
[01:01:18.798]and local levels have never collaborated before
[01:01:21.797]on an unexpectedly long drought.
[01:01:23.958]We’ve had to invent whole new ways of doing things
[01:01:26.535]for the state agencies to be able to step in
[01:01:29.265]to use their legal authorities and our funding tools
[01:01:33.463]to be able to come together to create a solution
[01:01:35.868]for this particular community at scale
[01:01:38.031]that will be a longer lasting answer that will help.
[01:01:41.171]After nearly three completely dry years
[01:01:43.353]in East Porterville,
[01:01:44.584]state and local water agencies pooled together resources
[01:01:47.805]and drew up a long-term plan,
[01:01:49.890]connect homes with dry wells
[01:01:51.721]to the water lines of a neighboring city.
[01:01:54.092]The first few homes turned on their taps two weeks ago.
[01:01:57.304]The Garcia family is scheduled to be hooked up
[01:01:59.053]to running water by the end of the year.
[01:02:01.897]Water is supposed to be for all, and then especially,
[01:02:05.014]we live in the United States of America.
[01:02:06.986]This is most powerful country,
[01:02:11.069]and we have the resources to come up the solutions.
[01:02:19.211]That's just a, gives you an idea of how drought
[01:02:24.617]just pervasively affects a community
[01:02:27.519]and even a household's livelihood
[01:02:30.980]and what they do everyday, and how much stress they have.
[01:02:37.174]If I can...
[01:02:41.153]There we go, we're done.
[01:02:44.019](audience applauds)
[01:02:49.025]So we'll open it up to a couple questions.
[01:02:52.402]I know we're running past the 4:30 hour
[01:02:54.640]but I'd hate to adjourn without a couple questions
[01:02:59.049]from the audience.
[01:03:08.244]In the state of Nebraska,
[01:03:09.735]when we do hazard mitigation proposals
[01:03:12.619]or plans for those, they're submitted
[01:03:15.000]to the Federal Emergency Management Agency.
[01:03:17.638]Have you collaborated in any capacity with that agency
[01:03:21.745]to expand the range of health impacts
[01:03:26.286]or addressing those impacts then you write it,
[01:03:29.086]because they're not required in talking about droughts,
[01:03:33.136]mitigation strategies in those plans.
[01:03:36.705]Right, we have not, my group anyway,
[01:03:40.274]we have not directly collaborated with FEMA
[01:03:45.343]on that particular topic.
[01:03:50.761]It's definitely not required in these plans,
[01:03:53.120]and I think that we went over that account document
[01:03:56.525]was sort of a call to action of hey,
[01:03:59.092]drought affects public health, too.
[01:04:01.266]We should get involved, we should know to be thorough
[01:04:05.036]and to protect the lives and health of our people.
[01:04:09.168]We should include this stuff in our plans,
[01:04:12.307]but we have not been able to sort of collaborate with FEMA
[01:04:17.641]to try and make any of those changes
[01:04:19.319]but that's certainly something that would be a topic
[01:04:24.071]that I can take back to my leadership
[01:04:26.315]and say, "Hey, you know, this would be good next move."
[01:04:30.214]If we can establish where we are at now,
[01:04:33.434]we can bring that to FEMA and say,
[01:04:37.079]"Here we were When Every Drop Counts.
[01:04:39.706]"Here we are now.
[01:04:41.248]"How can we move forward and you know,
[01:04:43.590]"how can we partner in that way,"
[01:04:46.561]and if it's possible, 'cause creating collaborations
[01:04:50.886]between federal agencies can sometimes be challenging
[01:04:54.001]but if it's possible, I think it'd be productive thing
[01:04:56.733]to do with the relationship.
[01:05:08.502]A while ago, we were trying to work
[01:05:09.943]with FEMA more, regular drought planning activities
[01:05:14.566]so we've been trying to foster than relationship
[01:05:18.532]for a couple years and it is moving in a positive direction
[01:05:22.179]but bringing the health component--
[01:05:23.614]Yeah, we also have an Office of Public Health Preparedness
[01:05:29.058]and Response called OPHPR, but I think they often work
[01:05:33.852]more closely with the other federal agencies,
[01:05:36.392]especially regarding the planning aspect of things,
[01:05:39.326]and it may be something that I could take to them,
[01:05:43.141]then they could start working their relationship
[01:05:46.228]on that end, just simply because
[01:05:49.392]if they have a preexisting relationship with FEMA,
[01:05:51.945]I think it would be an easier transition.
[01:05:57.419]Other questions?
[01:06:01.284]As a follow up to that question,
[01:06:03.609]all communities have to, in Nebraska,
[01:06:06.868]file a emergency response plan to DHHS,
[01:06:12.683]of the Department of Human and Health Services.
[01:06:15.136]Do you coordinate with them
[01:06:16.358]in order to follow drought impacts
[01:06:18.604]since those agencies would appear to be more aligned
[01:06:23.359]in their final goals, you would think, but--
[01:06:25.343]So you're saying that they have to submit a plan
[01:06:28.813]to federal-level HHS or your state-level health department?
[01:06:33.341]Their state-level, which coordinate
[01:06:34.963]with the natural resource districts.
[01:06:38.495]Yeah, we don't, there is no requirement for us
[01:06:41.641]to review those plans.
[01:06:43.542]Certainly, if someone came to us and said,
[01:06:45.934]"Hey, we're making a plan
[01:06:47.563]"and we would really love your input or assistance,"
[01:06:50.433]we'd be more than happy to try and facilitate that,
[01:06:55.716]but I think also, what is important for us
[01:07:01.270]is to, as CDC is a federal agency,
[01:07:05.260]to work with our state and local-level partners,
[01:07:09.123]so that we can either educate them
[01:07:13.288]or they can educate us on the importance
[01:07:15.300]of drought in their communities,
[01:07:17.475]and then work on then creating a situation
[01:07:22.261]where we can help assist them in any way that we can,
[01:07:27.675]but they are the ones driving the request
[01:07:32.062]for Public Health to be involved in the planning
[01:07:36.918]and response and recovery from drought
[01:07:41.141]because, the saying goes, "All disasters are local,"
[01:07:45.513]and I think that if you start at that grassroots level,
[01:07:48.824]at that local level, that you're gonna have more buy-in
[01:07:51.753]and more success.
[01:07:53.862]If me coming to someone and saying,
[01:07:55.534]"Hey, you have to do that," isn't, I think,
[01:07:57.820]gonna be quite as effective, but we are certainly here
[01:08:01.169]to support people in any way that we can
[01:08:04.591]as far as getting them the information
[01:08:06.451]that they need, trying to give them what we can share
[01:08:12.094]with them, and if we can come and present
[01:08:14.311]and talk to people and try and make the difference,
[01:08:16.925]we would try and help in that regard
[01:08:19.964]but yeah, I think that, at the state level,
[01:08:23.307]it's important for the state level to understand
[01:08:26.342]how they are impacted by drought
[01:08:27.699]because every location that's impacted by drought
[01:08:30.794]is impacted, I think, just a little differently,
[01:08:33.549]and the people who live there know best
[01:08:36.243]how they are impacted and how they probably need a plan,
[01:08:39.714]but what we can do is try and help move that agenda forward,
[01:08:44.755]to try and supply technical assistance,
[01:08:46.682]try and supply support and information,
[01:08:49.656]but yeah, I think the local level movement
[01:08:52.174]is also very critical.
[01:09:01.606]NOAA's Sectoral Applications Research Program,
[01:09:05.447]looking at how the local (mumbles) process
[01:09:09.231]of emergency management can incorporate drought
[01:09:13.642]and sector information, so one of the highlights
[01:09:17.228]in that research project would be
[01:09:19.270]how we can incorporate the health sector and their needs
[01:09:22.025]into drought scenarios for future planning and recording
[01:09:25.644]for appropriations at the state level.
[01:09:37.274]That's, right, good enough.
[01:09:39.975]So thanks, Sherry.
[01:09:41.623]Let's thank Sherry (mumbles).
[01:09:43.158]You're most welcome. (chuckles)
[01:09:44.553](audience applauds)

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Drought and Public Health

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