CDC-RFA-EH21-2101.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR ENVIRONMENTAL HEALTH

Building Resilience Against Climate Effects: Implementing and Evaluating Adaptation Strategies that Protect and Promote Human Health

CDC-RFA-EH21-2101

06/18/2021

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- EH21-2101. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Building Resilience Against Climate Effects: Implementing and Evaluating Adaptation Strategies that Protect and Promote Human Health C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-EH21-2101

E. Assistance Listings Number:

93.070 F. Dates:

1. Due Date for Letter of Intent (LOI):

The LOI date will generate once the Synopsis is published if Days or a Date are entered.

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

2. Due Date for Applications:

06/18/2021 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Date added, wesite updated. 21 days from the publication date, May 10, 2021, 2:00 PM Eastern Time. 1-877-954-4821 Passcode: 57457322 # A summary of questions and responses will be posted on the following website:

https://www.cdc.gov/climateandhealth/whats-new.htm

G. Executive Summary:

1. Summary Paragraph The Centers for Disease Control and Prevention announces the availability of Fiscal Year (FY) 2021 funds CDC-RFA-EH21-2101, Building Resilience Against Climate Effects: Implementing and Evaluating Adaptation Strategies that Protect and Promote Human Health. The purpose of this NOFO is to build and enhance the resilience of U.S. cities and states to the health impacts of climate change. Resilience, the ability to prepare for, absorb, recover from, and adapt to the health impacts of climate change, will be enhanced through three overarching strategies implemented by funded recipients. These strategies include 1) collaboration with stakeholders to create a Climate Impact Compendium that includes data on local climate projections, health effects, social determinants of health, and current adaptive capacity; 2) implementation and evaluation of adaptation actions that address the threats identified in the Compendium; and 3) use and dissemination of evaluation results to improve adaptation actions and enhance understanding of effective climate resilience adaptations in public health and related fields.

Recipients will select and implement adaptation actions that enhance health equity by focusing on populations most vulnerable to the health effects of climate change and addressing social determinants of health in the context of climate change. Key outcomes will be increased knowledge of adaptation actions that reduce adverse health effects of climate change and an enhanced evidence base for effective climate and health adaptation actions. This NOFO will contribute to positive long-term outcomes to reduce the negative health outcomes of climate change in vulnerable populations. NOFO includes Core and Optional Components.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards Approximate number of awards for Core Component.

d. Total Period of Performance Funding:

$ 20,000,000 Approximate funding for Core Component.

e. Average One Year Award Amount:

$ 400,000 Average one year award amount for Core Component.

https://www.grants.gov/ https://www.cdc.gov/climateandhealth/whats-new.htm

f. Total Period of Performance Length:

g. Estimated Award Date:

September 01, 2021

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Leveraging other resources is strongly encouraged but it will not affect scoring.

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview Climate change intensifies existing climate-sensitive health threats and creates new challenges by exposing more people in more places to hazardous weather and climate conditions (National Climate Assessment). Increasing temperatures, frequency and intensity of heat waves, heavy precipitation, and flooding affect health in a number of ways. Region of the United States experiences climate change and its impacts on health differently, due to the location-specific climate exposures. The changing climate also interacts with demographic and social determinants of health to influence the extent of consequences; that is, not everyone is affected equally. Vulnerable groups include those with low income, some communities of color, immigrant groups (including those with limited English proficiency), Indigenous peoples, children and pregnant women, older adults, vulnerable occupational groups, persons with disabilities, and persons with preexisting or chronic medical conditions (National Climate Assessment).

This Notice of Funding Opportunity (NOFO) describes a systematic approach for applicants to identify their climate-related challenges and subsequent opportunities to facilitate social system reorganization, changes, and learning, e.g.,. implementing and evaluating adaptation actions (Cutter, 2008). In implementing and evaluating adaptation actions, this NOFO intends to develop health department and community resilience, advance health equity, and generate evidence for use in larger-scale and more widespread adaptation actions designed to protect health from climate-related hazards.

This NOFO includes a Core Component and three Optional Components, Component A - Expanded Implementation and Evaluation, Component B - Climate Mitigation, and Component C - Data Modernization. The Core Component is the foundation this NOFO. The applicant must apply for the Core Component and may apply for one, two, three, or none of the Optional Components. If an applicant does not apply for the Core Component, applications for Optional Components will not be forwarded for further review.

b. Statutory Authorities This program is authorized under Sections 311 and 317(k)(2) of the Public Health Service Act, [42 U.S.C. Sections 243 and 247b(k)(2)], as amended.

c. Healthy People 2030 https://health2016.globalchange.gov/ https://health2016.globalchange.gov/ https://health2016.globalchange.gov/

This NOFO supports several objectives of Healthy People 2030, including reduce heat-related morbidity and mortality, reduce the number of days people are exposed to unhealthy air, reduce fatal injuries, improve respiratory health, improve mental health, improve emergency preparedness and response by building community resilience, reduce indoor allergen levels, and promote healthier environments to improve health (https://health.gov/healthypeople/objectives-and-data/browse-objectives/environmental-health).

d. Other National Public Health Priorities and Strategies This NOFO aligns with CDC priorities to support state, local, and tribal health departments, advance evidence-based health policies, and prevent illness, injury, disability, and premature death.

It aligns with the following other National Public Health Priorities:

The Guide to Community Preventive Services The Institute of Medicine’s Primary Care and Public Health: Exploring Integration to

Improve Population Health National Stakeholder Strategy for Achieving Health Equity; specifically o Strategy 2. Develop and support partnerships among public, nonprofit, and private entities to provide a comprehensive infrastructure to increase awareness, drive action, and ensure accountability in efforts to end health disparities and achieve health equity across the lifespan o Strategy 13. Support and implement policies that create the social, environmental, and economic conditions required to realize healthy outcomes

This NOFO also aligns with the goals of the United States Global Change Research Program.

e. Relevant Work Since its inception, the CDC Climate and Health Program (CHP) has funded state and local health departments or their agents as they prepare for and respond to the health effects that a changing climate will bring to the communities they serve. This NOFO will build upon CDC RFA-EH16-1606, Building Resilience Against Climate Effects: Enhancing Community Resilience by Implementing Health Adaptations and the program’s and grantees recipients' work under EH-12-1202 and EH 13-1305. The Climate-Ready States and Cities Initiative (CRSCI) supports cooperative agreement recipients from 16 states and two cities to use the five-step Building Resilience Against Climate Effects (BRACE) framework to identify likely climate impacts in their communities, potential health effects associated with these impacts, and disproportionately affected groups and geographies.

(https://www.cdc.gov/climateandhealth/BRACE.htm). The BRACE framework helps health departments develop, implement, and evaluate health adaptations and addresses gaps in critical public health functions and services.

2. CDC Project Description

a. Approach Bold indicates period of performance outcome.

Logic Model - Core and Expanded Components CDC-RFA-EH21-2101: Building Resilience Against Climate Effects: Implementing and https://health.gov/healthypeople/objectives-and-data/browse-objectives/environmental-health https://health.gov/healthypeople/objectives-and-data/browse-objectives/environmental-health https://www.globalchange.gov/ https://www.cdc.gov/climateandhealth/BRACE.htm

Evaluating Adaptation Strategies that Protect and Promote Human Health

Bold indicates period of performance outcome.

Strategies and Activities

Short-term Outcomes Intermediate Outcomes

Long-Term Outcomes

Enhance Program Management and Leadership Build Internal Capacity

Position Climate and Health as a High Priority Within the Recipient Organization

Provide Leadership

Enhance and Expand Partnerships Identify and Strengthen Relationships with Existing and New Stakeholders

Compile Evidence and Best Practices to Develop Adaptation Plans Create and Update Climate Impact Compendium Findings

Identify Specific Climate-Related

Increased stakeholder (SH) knowledge of climate hazards, health effects, vulnerabilities, and available adaptation action options for reducing negative health outcomes of climate change

SH are active in the implementation of the adaptation action plans

Among community members targeted by the adaptation action, increased climate resilience through increased knowledge, positive behavior changes, and access to resources

Among the communities targeted by the adaptation action, increased climate resilience through social, community, institutional, or policy system(s).

Routine quality improvement and increased effectiveness of adaptation actions

Reduced adverse health outcomes due to climate change among community members targeted by the adaptation actions

Increased knowledge of adaptation actions that reduce adverse health effects of climate change

Enhanced evidence base for effective climate and health adaptation actions

Widespread adoption, replication, and expansion of health-protective adaptation actions by climate resilience-focused public health practitioners

Reduced negative health outcomes in regions and among populations vulnerable to the adverse effects of climate change

Threats to Health to be Addressed

Identify Evaluation Approach for Adaption Actions Identify Evaluation Approach for Adaptation Actions

Write and Implement Adaptation Action and Evaluation Plan

Share Program Activities and Products with the Public

Build Climate Resilience through Implementation of Adaptation Actions

Implement and Evaluate the Adaptation Action and Evaluation Plan

Identify, Use, and Disseminate Lessons Learned on Effective Adaptation Actions

Use Evaluation Results to Improve Adaptation Actions

Disseminate Evaluation Results

(Optional Component B -

Implement partners use of process evaluation results to improve/inform their adaption action plans

Optional Component B Stakeholders are active in the implementation of the mitigation strategies

Optional Component C Improved awareness and understanding of the current status, gaps, and opportunities related to climate

Optional Component B In communities benefitting from the mitigation strategy, environmental hazards are reduced or health promoting changes to the built environment are implemented

Enhanced evidence base supporting climate change mitigation strategies with health co-benefits

Optional Component C Improved workforce capabilities, and data and health information systems and processes related to climate

Climate Mitigation)

(Optional Component C - Data Modernization) change data systems change

i. Purpose The purpose of this NOFO is to support recipients to develop, implement, and evaluate adaption actions that will build climate resilience in their jurisdictions. The overarching strategies include: 1) collaborating with stakeholders to create a Climate Impact Compendium that includes data on local climate projections, health effects, social determinants of health, and current adaptive capacity; 2) planning, implementing, and evaluating adaptation actions that respond to the threats identified in the Climate Impact Compendium; and 3) using and disseminating of evaluation results to improve adaptation actions and enhance understanding of effective climate resilience adaptations.

ii. Outcomes Core Component

The logic model reflects outcomes that are expected to result from the recipients’ activities.

By planning and implementing adaptations that promote population health, the following short-term an intermediate outcomes will occur:

Short-term outcome A. Increased stakeholder (SH) knowledge of climate hazards, health effects, vulnerabilities, and available adaptation action options for reducing negative health outcomes of climate change

Short-term outcome B. SH are active in the implementation of the adaptation action plans Short-term outcome C. Among community members targeted by the adaptation action, increased climate resilience through increased knowledge, positive behavior changes, and access to resources

Short-term outcome D. Among the communities targeted by the adaptation action, increased climate resilience through social, community, institutional, or policy system(s)

Short-term outcome E. Routine quality improvement and increased effectiveness of adaptation actions

Short-term outcome F. Implementation partners use process evaluation results to improve/inform their adaptation action plans

Intermediate outcome A. Reduced adverse health outcomes due to climate change in the populations among community members targeted by the adaptation actions

Intermediate outcome B. Increased knowledge of adaptation actions that reduce adverse health effects of climate change

Although not required to be achieved during the performance period, applicants should understand how the short term outcomes will contribute to the Intermediate and Long-Term Outcomes reflected in the logic model.

Stemming from short-term outcomes, the intermediate outcomes will be:

Intermediate outcome A. Reduced adverse health outcomes (e.g., reduction in flood-related illness and injury) due to climate change in the populations targeted by the adaptation actions

By evaluating population-facing adaptation, the following outcomes will occur:

Short-term outcome E. Increased knowledge of adaptation action implementation methodologies and impacts

Short-term outcome F. Routine quality improvement and increased effectiveness of adaptation actions

Short-term outcome G. Additional health departments and organizations use process evaluation results to improve/inform their adaptation action plans.

All recipients are expected to report achievement of Core Component outcomes via annual Performance Measures.

Optional Component A – Expanded Implementation and Evaluation Because Optional Component A is an expansion of the Core Component, no additional outcomes beyond the Core Component outcomes are expected or will be measured.

Optional Component B - Climate Mitigation In addition to the Core Component outcomes, one short term outcome will be achieved in the program period:

Short-term outcome G. Stakeholders are active in the implementation of the mitigation strategies

Optional Component C - Data Modernization In addition to the Core Component outcomes, one short term outcome for Optional Component C will be achieved during the program period:

Short term outcome H. Improved awareness and understanding of the current status, gaps, and opportunities related to climate change data systems

iii. Strategies and Activities

CORE COMPONENT

During the period of performance, recipients will conduct strategies and activities in two major categories, Category I. Enhance Program Infrastructure and Category II. Planning and Implementation.

I. ENHANCE PROGRAM INFRASTRUCTURE

Strategy A. Enhance Program Management and Leadership

Activity 1. Build Internal Capacity. Applicants should work to enhance staff capacity to collaborate with stakeholders and implement high quality programs to increase climate resilience (e.g., capacity can be built through staff training on climate and health, epidemiological analysis, or evaluation related skills).

Activity 2. Position Climate and Health as a High Priority Within the Recipient Organization. Applicants should promote and integrate climate resiliency among other internal programs and departments. For example, applicants can work towards integrating health considerations into all-hazard preparedness plans or elevating climate change as a priority topic within the recipient’s jurisdiction health improvement plan or other strategic plans.

Activity 3. Provide Leadership. Applicants should serve as catalysts and champions to encourage planning, coordination, and expansion of climate and health activities and the adoption of evidence-based practices. This could include internal presentations to department leadership or promotion of cross-jurisdictional collaboration.

Strategy B: Enhance and Expand Partnerships

Activity 1. Identify and Strengthen Relationships with Existing and New Stakeholders. Applicants should identify and collaborate with the stakeholders necessary to identify and effectively implement adaptation actions responsive to local needs. This must include representatives from populations disproportionately impacted by climate change. Recipients must cultivate and strengthen relationships with these stakeholders in order to involve them in the planning and development of the adaptation actions, communications, and evaluation.

II. PLANNING & IMPLEMENTATION

Strategy C: Compile Evidence and Best Practices to Develop Adaptation Plans

Activity 1. Create and Update Climate Impact Compendium Findings. The applicant should identify, update, and compile data and findings concerning 1) local climate forecasting/projections; 2) current and potential climate-related health impacts, including health disparities; 3) affected systems and social determinants of health conferring health disparities;

and 4) adaptive capacity, as they relate to climate hazards of interest for stakeholders. The Climate Impact Compendium can be in a format that meets the needs of the jurisdiction and local stakeholders. Applicant can use relevant data from a variety of sources (e.g., CDC Wide-ranging Online Data for Epidemiologic Research (WONDER), CDC National Syndromic Surveillance Program (NSSP), CDC National Environmental Public Health Tracking, state vital statistics data, National Aeronautics and Space Administration (NASA), US Census Bureau, National Oceanic and Atmospheric Administration (NOAA), National Center for Environmental Information (NCEI), data focusing on hospitalizations and emergency department visits, and others) to track trends in morbidity, mortality, and health care utilization. For example, applicant may track and report climate-related health outcomes in a syndromic surveillance system or add a new climate related metric to an existing surveillance system. These data should be incorporated into the Climate Impact Compendium and used to support adaptation actions.

The Climate Impact Compendium supports the development of adaptation action plans and should include data on the climate threats that the adaptation actions will address. The Climate Impact Compendium should be updated at least annually.

Activity 2: Identify Specific Climate-Related Threats to Health to be Addressed.

Applicants must identify at least one or more specific climate hazards that will be addressed.

Applicants are encouraged to consider compound hazards, which may involve multiple climate threats to a jurisdiction simultaneously (e.g., extreme heat and wildfires).

The climate-related threats and health effects below are derived from the Climate and Health Assessment (https://health2016.globalchange.gov), priorities of the CDC Climate and Health Program, and evaluation data from the Climate-Ready States and Cities Initiative.

Applicant’s adaptation actions must address one or more of the following categories:

Health effects from heat and cold exposure o Includes but is not limited to heat waves and impacts of ambient heat

Health effects from impaired air quality o Includes but is not limited to wildfire smoke, aeroallergens, and dust

Health effects from extreme events o Includes but is not limited to floods, drought, wildfires, winter/ice storms, and hurricanes

Activity 3. Identify Adaptation Actions. Applicants will implement at least two population-facing adaptation actions. Applicants should propose actions likely to improve health outcomes within the funding period and to advance health equity by addressing health disparities via programs, interventions, and resources, or by developing innovative solutions. Programmatic or intervention attributes recognized in the literature as contributing to achieving health equity include: input from disproportionately affected community members (1-3), cited social and behavioral science theory (if applicable), social determinants of health that confer differential health outcomes (5-10), documentation of major components of implementation (e.g., methods for and duration of delivery, resources used or provided, qualities organizational structure, staff, skills, and interorganizational networks involved in implementation) (11-12). Applicants should propose adaptation actions that possess as many of these attributes as possible or other recognized best practices for designing equitable adaptation actions.

These adaptation actions must address one or more of the climate hazards identified in Activity 2.

Adaptation action types supported by this NOFO are informed by Conlon and Austin’s typology of interventions for public health adaptation to climate change (A typology of interventions for public health adaptation to climate change. Environmental Epidemiology. October 2019, V 3:p 80 doi: 10.1097/01.EE9.0000606556.08289.6e).

For this NOFO, an adaptation action is defined as an intervention implemented to build health resilience to the effects of climate change among a specified population using one or more activities. A single adaptation action may be comprehensive and involve multiple complementary activities. To be part of a single adaptation action, activities should be implemented to achieve the same outcomes for the same population within the same time frame.

An adaptation may involve staging coordinated activities in phases over time. Each proposed adaptation action should be categorized by the recipient according to the primary strategy most critical to achieve the intended effects.

All adaptation actions must be evidence-based and must focus on the categories specified below. Applicants must propose at least one adaptation action in Category 1 and at least one from Categories 2-4.

Category 1: Facilitation of Community Access – Implement key coordination activities (e.g., establish linkages, develop tools, or plan events) to support partners who can directly implement the following adaptation actions to achieve the goals of this NOFO:

Service Access - Efforts to increase the availability of health-protective services and spaces

Infrastructure Modifications - Changes to the built environment intended to protect human health from climate-sensitive exposures

Screening Programs - Efforts to identify individuals with health risk factors for health outcomes with climate-sensitive exposures

Resource Assistance - Provision of supplies or materials intended to protect human health from climate-sensitive exposures

Environmental Modifications - Changes to the natural environment intended to protect human health from climate-sensitive exposures

In addition to Category 1, adaptation actions (Facilitation of Community Access), applicants are also required to propose at least one additional adaption from the list below (Categories 2-4).

Adaptation actions in categories 2-4 may be implemented directly by the recipient, with or without the support of other implementing partners.

Category 2: Communications - Communicate facts, ideas, and skills intended to enhance knowledge, attitudes, and behaviors around climate-sensitive exposures and their health outcomes.

Category 3: Education & Instruction - Formal instruction that communicates facts, ideas, and skills that enhance knowledge, attitudes, and behaviors around climate-sensitive exposures and their health outcomes.

Category 4: Policy Implementation - The execution and/or enforcement of climate and health plans, ordinances, rules, regulations, and laws according to their original intent.

The process involved in this activity will be used to develop an Adaptation Action and Evaluation Plan (Strategy C, Activity 6).

Activity 4. Identify Evaluation Approach for Adaptation Actions. Applicants should develop an evaluation for each adaptation action. The evaluations should adhere to the steps and standards outlined in the CDC Evaluation Framework (https://www.cdc.gov/mmwr/PDF/rr/rr4811.pdf). Additional information about the Framework can be located on CDC’s evaluation webpage (https://www.cdc.gov/eval/framework/index.htm).

In particular, recipients are encouraged to use the CDC’s Introduction to Program Evaluation for Public Health Programs: A Self Study Guide to guide the development of their evaluation plans (https://www.cdc.gov/eval/guide/index.htm).

The social ecological model conceptualizes health to be affected by the interaction between the individual, their community, and physical, social, and political environments (Israel et al., 2003;

Sallis et al., 2008; Wallerstein et al., 2003). In the context of this NOFO, recipients can use this model to identify the modifiable and measurable aspects of those environments that adaptation actions can improve. This encourages integrating approaches to change the physical and social environments rather than modifying only individual health behaviors. These environments, referred to as systems in this NOFO, include social systems (i.e., networks of beliefs, norms, and relationships), community systems (i.e., physical and social settings in which people live, work and play), institutional systems (i.e., formal and informal rules and regulations operating within organizations), and policy systems (i.e., local and state laws and policies).

Applicants are required to measure the effects of adaptation actions in terms of individual or systems-level outcomes. Applicants should also measure the resulting health outcomes, which can include direct or indirect measures, such as pharmacy records or self-report.

In sum, the proposed evaluation design should be appropriate for determining the effectiveness of an adaptation action (e.g., use of a comparison condition or pre-post analysis and adequate number of participants). Recipients should plan to assess the degree to which effects are equally distributed among the population intended to benefit and the degree to which health equity has improved.

Activity 5. Write and Implement Adaptation Action and Evaluation Plan. Applicants should document decisions about adaptation actions and their evaluations in the Adaptation Action and Evaluation Plan.

https://www.cdc.gov/mmwr/PDF/rr/rr4811.pdf https://www.cdc.gov/eval/guide/index.htm

An individual Adaptation Action and Evaluation Plan must be written for each adaptation action.

The plan should include at least two sections. The first section should describe the adaptation action and include the following:

A team roster, identifying roles and responsibilities, including facilitator(s) or leader(s).

Adaptation type(s).

Climate hazard(s) addressed.

Specific populations and locations that will be included.

Identification of stakeholders and partners necessary for both implementing and monitoring the intervention.

Methods for intervention implementation.

Timeline outlining activities, milestones, and deadlines.

The second section should describe the evaluation of the adaptation action and include the following:

Evaluation activities performed to date (about the proposed adaptation action), any relevant findings, and how findings have been used.

The type of evaluations (i.e., process, outcome, or both).

Program description and logic model.

Key evaluation questions to be addressed.

Design, methods, and data sources.

Key outcomes that will be measured and follow-up period(s).

Plans for dissemination of results and intended use of findings.

Activity 6. Share Program Activities and Products with the Public. Applicants should maintain a website where educational, surveillance, and evaluation information will be easily accessible to the public.

Strategy D: Build Climate Resilience through Implementation of Adaptation Actions

Activity 1. Implement and Evaluate the Adaptation Action and Evaluation Plan. Applicants will implement the Adaptation Action and Evaluation Plan developed in Strategy C, Activity 6. If midcourse changes are necessary, they must be reflected in an updated Adaptation Action and Evaluation Plan.

Strategy E: Identify, Use, and Disseminate Lessons Learned on Effective Adaptation Actions

Activity 1. Use Evaluation Results to Improve Adaptation Actions. Applicants are expected to use their collected evaluation findings to improve and update their adaptation actions. Recipients are expected to review their evaluation results regularly.

Activity 2. Disseminate Evaluation Results. Applicants will disseminate results to the following audiences:

Stakeholders of adaptation actions, including community members whose outcomes have been evaluated.

Wider adaptation community external to adaptation action, including other health agencies, public organizations, CBOs, universities, and adaptation professionals through presentations and publications in peer reviewed journals.

CDC cooperative agreement partners. Applicants must demonstrate the success of this activity by reporting the associated performance measures as indicated in the Performance Measurement table.

Recipients must demonstrate the success of this activity by reporting the associated performance measures as indicated in the Performance Measurement table.

OPTIONAL COMPONENTS

Component A - Expanded Implementation and Evaluation The narrative for this component is not included in the Project Narrative’s page limit but it should not exceed five pages.

This optional component allows the applicant to expand upon a subsection of the strategies and activities identified in the Core Component - II. Planning and Implementation section of this NOFO. The activities proposed under this section must be in addition to what the applicant has proposed their submission under the in the Core Section

For this Optional Component, the applicant must address at least one specific climate hazard (see Core Component - II. Planning and Implementation, Strategy C, Activity 2)

Applicants will describe how they will implement at least one adaptation action. Applicants may choose to expand adaptation(s) proposed in the Core Component or may propose new adaptation(s). Applicants should propose actions likely to improve health outcomes within the period of performance and to advance health equity by addressing health disparities via programs, interventions, and resources, or by developing innovative solutions. Applicants should propose adaptation actions that include recognized best practices for designing equitable adaptation actions (see Core Component - Strategy C, Activity 3).

Applicants will adhere to the CDC Evaluation Framework as well as best practices presented through the Climate and Health Program’s evaluation web series (https://www.cdc.gov/climateandhealth/eval.htm). (See Core Component - Strategy C, Activity 4).

Applicants should document decisions about adaptation actions and their evaluations in the Adaptation Action and Evaluation Plan. An individual Adaptation Action and Evaluation Plan must be written for each adaptation action. (see Core Component - Strategy C, Activity 5).

Recipient should maintain a website where educational, surveillance, and evaluation information will be easily accessible to the public. (see Core Component - Strategy C, Activity 6) https://www.cdc.gov/climateandhealth/eval.htm

Recipient should use their collected evaluation findings to improve and update their adaptation actions. (see Core Component - Strategy E, Activity 1)

Recipient should disseminate the results of their evaluation work through a variety of methods and to a variety of stakeholders such as community members whose outcomes have been evaluated, the wider adaptation community, as well as CDC cooperative agreement partners. (see Core Component - Strategy E, Activity 2)

Performance Measures - Progress and achievements for this Optional Component will be reported as a subcomponent of the Core Component Performance Measures.

Component B - Climate Mitigation The narrative for this component is not included in the Project Narrative’s page limit but it should not exceed five pages.

Climate mitigation involves reducing the emission of heat-trapping greenhouse gases (GHG) (e.g., carbon dioxide, methane, and nitrous oxide) into the atmosphere, either by reducing sources of these gases or enhancing the sinks that accumulate and store these gases (NASA).

Innovation and investment in environmentally sound programs, infrastructure, technologies, and policies can help to mitigate climate change and enhance resilience to climate change, thereby improving population health. Reducing GHG emissions can enhance air quality and slow climate change, serving as primary prevention for public health and generating substantial respiratory health and economic mutual benefits. Policies and programs that promote health and climate change mitigation are ideally coordinated across sectors and geographic scales.

Examples of potential strategies may include:

Conducting economic analyses of health co-benefits stemming from specific GHG mitigation strategies that are feasible in the applicant’s jurisdiction;

Conducting a health impact assessment of current or proposed GHG mitigation strategies to demonstrate health co-benefits;

Coordinating with other organizations to Implement strategies and develop policies to reduce air pollution from GHG-emitting sources, such as school and other public buses, that could help to improve air quality for people with asthma and other respiratory diseases;

Collaborating with public and private building owners to identify and implement feasible strategies to use renewable energy sources and reduce GHG emissions;

Developing a comprehensive, well-coordinated communication strategy within the health sector both for public health and health care professionals to promote knowledge, awareness, and adaptation and mitigation behaviors among the general public;

Promoting modes of transportation such as bicycling and walking through supportive policies, education, programs, and planning initiatives that would improve health and decrease GHG;

Promoting policy for regional tree planting adequate to serve as a sink and strategically implemented to also reduce extreme urban heat or improve water quality.

https://climate.nasa.gov/solutions/adaptation-mitigation/

To further efforts in climate mitigation, applicants are invited to propose innovative mitigation and health promotion strategies. Efforts must indirectly or directly address, analyze, or support reducing emissions of GHG. All strategies must be evidence-based and address health equity.

For proposals involving implementation of mitigation strategies, applicants must describe how successful mitigation would directly contribute to human health benefits. Applicants will measure and are expected to show achievement of short-term outcomes within the period of performance. Applicants will also track and report intermediate outcomes, i.e., improved health, that are expected to result from the achievement of short-term outcomes.

Applicants are required to report performance measures 1-5 regarding activities and outcomes annually.

Component C - Data Modernization Examples of capacity development have been move from the Phase II Review section to this section.

The narrative for this component is not included in the Project Narrative’s page limit but it should not exceed five pages.

Public health relies on timely, accurate information to make prompt and insight-driven decisions to inform programs, policies, and investments. These decisions require robust data and health information systems and data science talent and IT infrastructure. Public health data are too often collected and reported through antiquated means. Environmental exposure and health outcome data are often collected and stored in stand-alone spreadsheets and databases, sometimes even on paper forms. Analysis of such data and reporting of findings are slow, hindered by significant lag of data availability, a lack of interoperable systems, incongruent data and system standards, and a workforce that lacks sufficient training in the creation, use, and maintenance of new technology. There are multiple opportunities to improve data collection and reporting. For example, increased focus on syndromic surveillance provides timely understanding of emerging health threats through electronic reporting of emergency department visits. Electronic case reporting offers earlier disease detection and intervention through automated reporting of diseases and conditions from electronic health records. Modernized, automated electronic messaging to CDC for notifiable disease reporting, including laboratory reporting, reduces the burden on state and local jurisdictions. Better use of vital records data can signal changes in trends, monitor urgent public health events, and provide faster notification of cause of death.

New and non-traditional data sources can complement existing systems. The amount and nature of new data sources (e.g., databases from enhanced active surveillance using Smartphone technology) is constantly increasing and represent a wealth of possibly useful information to inform public health decision making. Adoption of, and increased reliance on, cloud storage would transform otherwise stand-alone data to meet accepted standards for formatting, analysis, and sharing. Storage systems should be interoperable, scalable, and adaptable to ensure that all data can be shared quickly and without the requirement of significant resources to manage and analyze data and to interpret findings. Further, it is important to utilize open source standards and tools that not only allows public health professionals to speak the same language, but also significantly reduces cost, which for many jurisdictions can be a major obstacle to accomplishing the goals of modernizing data.

Many public health professionals lack the knowledge and skills to transition into a modern data world. Resources must be allocated to hiring new staff that are well versed in IT infrastructure, data science, and other areas of expertise that current staff are lacking. Training on modern data systems, electronic reporting, data modeling, GIS, and cutting-edge data visualization is required. Building upon existing relationships with data stewards (e.g. hospitals, emergency departments) can help to alleviate the current lag in receiving health data that prevents the crucial timely analysis and reporting of data.

Examples of capacity development include:

Training current staff on modern data systems, electronic reporting, data modeling, Geographic Information Systems (GIS), and cutting-edge data visualization.

Hiring new staff that are well versed in IT infrastructure, data science, and other areas of expertise that current staff are lacking.

Building upon existing relationships with data stewards (e.g. hospitalization, emergency department visits, and mortality data) to alleviate the current data lag in receiving health data for timely analysis and reporting of data. Applicants should also coordinate with multiple sectors outside of public health such as transportation, education, health care delivery, and agriculture to take advantage of novel data that can inform public health actions.

The Data Modernization Optional Component is specific for work related to this NOFO. The CDC program will follow the progress of CDC's data modernization efforts and will share the appropriate information with the grantee recipients.

Applicants are encouraged to focus on one or more of the above improvements or other data modernization innovations that are responsive to the local context. In general, the overall strategies are:

Strategy 1: Understand, coordinate, and lead data modernization efforts related to climate change in the jurisdiction 1a. Lead and coordinate data modernization efforts 1b. Document and understand workforce, data, and health information system needs and opportunities Strategy 2. Accelerate data and health information system modernization related to climate change 2a. Implement workforce enhancements to accelerate data modernization 2b. Accelerate improvements to data quality, exchange, management, and use

Examples of strategy-related activities include:

Using new, and non-traditional data sources that can complement existing systems (e.g., databases from enhanced active surveillance using Smartphone technology)

Adopting short-term outcomes; and increased reliance on cloud storage, which would transform otherwise stand-alone data to meet accepted standards for formatting, analysis, and sharing. Also, storage systems that are interoperable, scalable, and adaptable to ensure that all data can be shared quickly and without the requirement of significant resources to manage and analyze data and to interpret findings.

Using new and innovative analytic tools and ways of linking datasets from different sources.

Using open source standards and tools that not only allow public health professionals to speak the same language, but also significantly reduces cost.

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

Applicants are encouraged, but not required, to collaborate with other CDC-funded programs when interests and activities align. These may include:

CDC Center for State, Tribal, Local, and Territorial Support (CSTLTS)

CDC Disability and Health Programs, for the purpose of fully engaging people with disabilities into activities regarding asthma management and control.

CDC Division of Vector-borne Diseases (DVBD) CDC National Center for Environmental Health (NCEH) Environmental Public Health

Tracking Program CDC NCEH Environmental Health Capacity Program CDC NCEH Lead Poisoning Prevention Program Emergency preparedness programs American Lung Association (ALA) American Public Health Association (APHA) Association of State and Territorial Health Officials (ASTHO) Council of State and Territorial Epidemiologists (CSTE) National Association of County and City Health Officials (NACCHO) National Environmental Health Association (NEHA) National Indian Health Board American Academy of Pediatrics

b. With organizations not funded by CDC:

Applicants are also encouraged, but not required to, collaborate with organizations that are not funded by CDC, but are essential to the effective implementation of strategies described in this NOFO. These include, but are not limited to:

NOAA’s Regional Integrated Sciences and Assessments (RISA) Program NOAA's National Centers for Environmental Information (NCEI) Local & Regional National Weather Service (NWS) Weather Forecasting Offices Local community-based organizations (CBOs) State climatologists U.S. Environmental Protection Agency (EPA) U.S. Geological Survey (USGS) U.S. National Institutes of Health (NIH) National Center for Atmospheric Research (NCAR)

U.S. Global Change Research Program (USGCRP) American Meteorological Society (AMS)

2. Target Populations Climate change disproportionately affects the health and wellness of communities of color, older adults, those who are socially and economically marginalized, children, and other groups (National Climate Assessment). These disproportionate effects are the result of more frequent, intense, and longer-lasting climate-related hazards (e.g., wildfires, hurricanes, extreme temperatures) intersecting with policies, practices, and conditions that have placed different communities at greater disadvantage. Consequently, swift and robust adaptation across public health agencies and their partners is necessary to protect health and promote health equity.

Applicants are expected to implement and evaluate adaptation actions that address the risks and public health threats particular to their communities, in order to contribute to greater health equity. In the context of this NOFO, recipients will identify, seek input from, and collaborate with those affected community members over the course of the cooperative agreements. Meaningful and sustained collaboration with these stakeholders will provide recipients a better understanding of their unique needs, priorities, experienced health disparities, and their relevant social determinants of health. Adaptation actions implemented and evaluated in collaboration with affected community members are expected to be more responsive to local needs resulting in greater health equity. Additionally, adaptation actions which focus on communities vulnerable to compound climate-related hazards (e.g., poor air quality during an extreme temperature event) are encouraged.

a. Health Disparities Social determinants of health are shaped by the systems in which public health and other agencies often have the greatest opportunity to affect change. This includes changes to how we access clean air (housing and energy systems), food (agricultural systems), water (sanitation and sewage systems), and medical care (hospital systems). These same systems are shaped by the lack of social, political, and economic power of disadvantaged communities, such as those who are low-income communities or communities of color. Additionally, changes to environmental policies, practices, or directives not designed for affected community members’ unique environmental, cultural, economic, and health needs may lead to unintentional consequences. Consequently, addressing health disparities must focus on the effects of such systems to promote greater equity while creating opportunities for health benefits. To advance the goal of achieving health equity, recipients of this NOFO are expected to directly promote and create those opportunities by leveraging partners and engaging community members in the implementation and evaluation of adaptation actions.

iv. Funding Strategy The table below provides a list of funding levels available to applicants for the Core Component, based on population size (based on US Census data - 2018 estimates or other appropriate document if the Census data is not available):

Population Funding Level < 2 million $300,000 2 million – 10 million $400,000

> 10 million $500,000

If an applicant applies for funding for the Core Component that is above the funding level for their population, the application will not be reviewed.

Applicants may apply for up to $1,000,000 for each of the Optional Components.

This NOFO includes a Core Component and three Optional Components, Component A - Expanded Implementation and Evaluation, Component B - Climate Mitigation, and Component C - Data Modernization. The Core Component is the foundation this NOFO. The applicant must apply for the Core Component and may apply for one, two, three, or none of the Optional Components. If an applicant does not apply for the Core Component, applications for Optional Components will not be forwarded for further review.

Applications for the Core Component will be reviewed and scored.