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Resilience for all: Building health equity infrastructure for climate-driven disasters

Environment, Health

Melissa Jones, executive director, BARHII

Melissa Jones, executive director, BARHII

Matt Vander Sluis, director of policy and planning, BARHII

Matt Vander Sluis, director of policy and planning, BARHII

In the San Francisco Bay Area, we’ve experienced a wave of climate-driven disasters in recent years. This includes the most destructive wildfire season in California history, which arrived during an unprecedented heatwave that led utilities to conduct rolling power shut-offs in communities vulnerable to fire. That was on top of the COVID-19 pandemic and a decade-long housing affordability crisis.

These co-occurring disasters magnify and extend the displacement and dislocation of communities and sap the ability of government and other institutions to respond effectively. Any one of these disasters would have been a public health emergency on its own; combined, they threaten the ability to protect entire populations.

These impacts are particularly severe for communities that experience health inequities—the systemic and unjust disparities in health outcomes that exist by race, income, neighborhood, language, immigration status, and other factors. These communities are at greater risk of exposure to climate-related health threats, are more vulnerable to those threats, and have less access to the resources necessary to respond effectively.

It’s worth noting that health disparities in climate-driven disasters are similar to those experienced during COVID-19. This is driven by today’s inequitable policies and practices and a legacy of historic discrimination. For example, when the Bay Area was cloaked in eerie orange skies and thick smoke, farmworkers and bus drivers were among those without adequate governmental protections for toxic air and unhealthy heat. During COVID, “essential workers”— a population that is disproportionately Black, Latinx, and Pacific Islander—were again left exposed to elevated risks, fostering a racial divide between those who could “shelter in place” and those who could not.

Building Health Equity Infrastructure for Our Changing World

Increasing our climate resilience requires addressing the physical effects of a warming world—from wildfire smoke to rising seas to new infectious diseases. It also calls for reversing the long-standing inequities that undermine the ability of our communities to withstand and recover from climate-driven disasters. This includes addressing chronic stressors such as housing unaffordability, income inequality, and structural racism as well as acute crises such as pandemics and economic fluctuations.

To achieve this transition, we need to build a new type of health equity infrastructure, designed for our new era of climate-related emergencies.

The Bay Area Regional Health Inequities Initiative (BARHII)—the coalition of our local public health departments focused on advancing equity for the eight million people who call our region home—has been catalyzing this new infrastructure with the generous support of the Kresge Foundation. We’re particularly excited about two promising approaches—equity leadership for disasters and community-driven resilience planning structures.

In the Room Where It Happens: Equity Officers for Disaster Response

Climate-driven disasters, like wildfires and extreme heat events, often require specialized government response structures, including establishment of Emergency Operations Centers (EOCs) that serve as hubs for decision making and resource deployment, and Incident Command Systems (ICS) that delineate clear, hierarchical decision-making roles.

Unfortunately, health equity has not historically been built into California’s emergency response apparatus. Too often, disasters are treated as singular events rather than overlapping and recurrent crises that affect populations unequally—the result of long-standing patterns of differential treatment of our diverse communities.

To address these challenges, BARHII is helping local governments across our region embed equity-focused leadership roles into their emergency management structures. These leaders—frequently referred to as “Equity Officers”—are an essential part of disaster response and management. They are literally and figuratively “in the room where it happens,” part of the inner circle of decisionmakers, infusing equity considerations into all phases of a local government’s emergency actions. They also bring resources, including a staff unit to support them, to implement equity solutions and serve as a bridge between local BIPOC communities and fast-moving government processes.

For example, early in the COVID-19 pandemic, the City of San Francisco appointed an Equity Officer who guided the city’s effort to determine which groups were most in harm’s way and deploy resources accordingly. The Equity Officer partnered closely with the city’s Department of Public Health. When data showed troubling signs of racial disparities, the Department stepped up outreach and testing in Black and Latinx communities, partnering with community-based organizations and faith groups to reach across cultural barriers. The Equity Officer drove complementary strategies across the city’s emergency response structures.

We’ve been catalyzing the creation of similar success stories across the Bay Area, launching a detailed guidebook, hosting local and national trainings, drafting op-eds, and convening a regional network of government equity leaders. Today, more than half of the Bay Area’s counties have an Equity Officer engaged in emergency response.

We believe these roles need to be articulated in local government emergency response protocols so that as we experience more frequent and severe climate-driven disasters in the years ahead, equity considerations come as quickly as the first fire truck. That will take policy changes at the federal, state, and local levels.

These roles also need to be baked into our budgets. Fortunately, the California Department of Public Health has just secured a $32 million grant from the U.S. Centers for Disease Control and Prevention, which will fund local Equity Officers and other equity infrastructure. This could be an important down payment toward the robust, sustained funding needed for this essential element of health equity infrastructure.

Farther Together: Community-Driven Resilience Planning

As the saying goes, “If you want to go fast, go alone. If you want to go far, go together.” Today, communities with entrenched health inequities are too often shut out of planning for climate-driven disasters due to long-standing systemic barriers in our public engagement systems. As a result, disaster plans don’t benefit from local knowledge and can be inconsistent with local conditions, concerns, and capacities of frontline communities.

Fortunately, interest in resilience planning is growing rapidly. And many public agencies are eager to bring the voices of those most impacted by injustice into the conversation about solutions. This transition is supported by new laws and policies that establish baseline standards for community engagement and dedicate resources to support participation by historically excluded groups.

Yet while a growing number of planners and decision-makers recognize the importance of engaging communities in resilience planning, they struggle to do so effectively. Agency staff is undertrained and overburdened. Project timelines leave little room for new activities. Budgets are tight and funding sources inflexible. The prospect of change feels daunting, cumbersome, and uncomfortable.

BARHII is addressing these challenges head-on.

Earlier this year, we released Farther Together, a guidebook that lays out a path for transforming how public agencies engage communities impacted by inequities in climate resilience planning to foster a healthy, resilient future for all.

This new tool provides practical suggestions for planners on centering communities in their resilience planning efforts—from project budgeting tips to methods for leveraging public health department assets. It offers recommendations for agency leaders and policymakers on structural changes needed to position our public institutions and community-based organizations for success—including transforming public funding pipelines, agency structures, and equitable engagement mandates. And it includes case studies of promising practices and perspectives of frontline leaders from across the Bay Area.

Now it’s time for all of us to turn these ideas into action.

Here in the Bay Area, we’re serving on the leadership team of a multi-sector regional planning process to address rising sea levels, called Bay Adapt, helping public agencies pilot equitable engagement approaches and craft a shared vision for needed investments and policy changes. We’re also training resilience practitioners, transportation planners, health leaders, and others.

This is also a moment for transformative investments. Federal COVID-19 recovery funds and a historic state budget surplus have created a once-in-generation opportunity to direct government resources into equitable resilience planning. Fortunately, California is poised to make a historic investment in equitable resilience planning in this year’s state budget—just in time for what might be our worst fire season ever.

Please Borrow Freely

“As California goes, so goes the nation.” Yes, with our parched fields, unprecedented wildfires, and rising seas, in many ways California is a bellwether for the co-occurring climate-driven crises many states will experience in the years ahead.

We hope California can also be a model for responding to those coming disasters in ways that build resiliency, health, and community power for those populations most impacted by injustice—particularly BIPOC populations. We’re excited to share these promising practices to help build a national network of innovation for climate, health, and equity and look forward to more opportunities to learn from our partners across the country.

BARHII is the coalition of the eleven Bay Area public health departments, founded to address the preventable decade-long differences in life expectancy that exist by race, income, and neighborhood. With our member health departments and 250 community partners organizations, we drive programmatic, systems, and policy change for healthier communities, racial justice, and economic prosperity for all.