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Background: The effects of climate change are seen with a rise of extreme weather and climate events (EWCEs) which lead to the closures of many healthcare facilities, such as community pharmacies. Pharmacists in community pharmacies are seen as the most accessible healthcare professional to the public and are responsible for the continued delivery of care to patients. However, amid closures due to EWCEs and the emergence of pharmacy deserts, there is decreased access to pharmacies and a disruption of care. Objective: It is important to address the preparedness and accessibility of pharmacies post-EWCEs to guide future research and policy. Additionally, to tackle health disparities that arise due to pharmacy deserts, the populations most affected by a decreased access to pharmacies should be identified. We conducted a scoping review to assess the preparedness and accessibility of pharmacies post-EWCEs and to identify populations most affected by pharmacy deserts. Methods: We searched PubMed, Embase, and Web of Science from January 1, 2012 to September 30, 2022 and included all English-language, peer-reviewed primary literature that examined the preparedness and accessibility of community pharmacies in the United States post-EWCEs and addressed disparities within pharmacy deserts. Studies meeting these criteria were screened of their titles and abstracts by the first author and discrepancies were resolved with co-authors. We used Covidence for data extraction. Results: A total of 472 studies were identified (196 duplicates removed) and after screening, 53 studies were assessed for eligibility. The results of included publications (N = 26) showed that pharmacists and pharmacies are not equipped with the necessary emergency protocols which could lead to decreased access of pharmacies in the wake of EWCEs. Pharmacy deserts disproportionately affect residents living in rural, lower income, and Black/African American and Hispanic/Latino neighborhoods. The lack of preparedness of pharmacies post-EWCEs could worsen medication access. Conclusion: This scoping review addresses challenges impacting pharmacies and patients post-EWCEs and within pharmacy deserts. In times of increased need, these challenges implicate the well-being of communities affected by EWCEs by breaking the continuum of care and access to medications. Here we offer suggestions for future research and directions for policy change. [ABSTRACT FROM AUTHOR]

Objective: Severe weather events exacerbate existing health disparities due to poorly managed non-communicable diseases (NCDs). Our objective is to understand the experiences of staff, providers, and administrators (employees) of Federally Qualified Health Centers (FQHCs) in Puerto Rico and the US Virgin Islands (USVI) in providing care to patients living with NCDs in the setting of recent climate-related extreme events., Methods: We used a convergent mixed-methods study design. A quantitative survey was distributed to employees at 2 FQHCs in Puerto Rico and the USVI, assessing experience with disasters, knowledge of disaster preparedness, the relevance of NCDs, and perceived gaps. Qualitative in-depth interviews explored their experience providing care for NCDs during recent disasters. Quantitative and qualitative data were merged using a narrative approach., Results: Through the integration of quantitative and qualitative data, we recognize: (1) significant gaps in confidence and preparedness of employees with a need for more training; (2) challenges faced by persons with multiple NCDs, especially cardiovascular and mental health disorders; and (3) most clinicians do not discuss disaster preparedness with patients but recognize their important role in community resilience., Conclusion: With these results, we recommend strengthening the capacity of FQHCs to address the needs of their patients with NCDs in disasters.

How decentralized government structure influences public service delivery has been a major focus of debate in the public finance literature. In this paper, we empirically examine the effect of fiscal decentralization on natural disaster damages across the U.S. states. We construct a unique measure of decentralization using state and local government expenditures on natural resources, which include investment in flood control and mitigation measures, among others. Using state‐level panel data from 1982 to 2011, we find that states that are more decentralized in natural resource expenditures have experienced more economic losses from floods and storms. This effect is only pronounced in states that are at higher risks of flooding. Our findings suggest that fiscal decentralization may lead to inefficient protection against natural disasters and provide implications for the assignment of disaster management responsibilities across different levels of government in the U.S. federal system. [ABSTRACT FROM AUTHOR]

• Wetlands can help protect human communities from consequences of extreme weather events. • Society has not valued the protective services of wetlands. • Coordinated and effective policy action is needed to protect wetlands to protect people. • We propose countries take policy action to create national wetland commissions. • Commissions can link wetland protection to disaster planning, infrastructure investments, and climate adaptation strategies. We elevate the undervalued role of wetland protective services for mitigating disastrous consequences of unprecedented weather-related events for human communities. Scientific evidence increasingly reveals that wetlands play critical hydrologic roles in landscapes, helping to mitigate flood, drought, and, in some cases, fire risks. However, wetland protective services have not received sufficient policy action. We propose national wetland commissions, modeled after the concept of lake and river commissions, as one way to strategically link wetland protection to other societal objectives, including human disaster risk planning, infrastructure investments, and climate adaptation strategies. We offer an example applicable to the United States, describing an institutional design for a National Interagency Wetland Commission. We suggest it could be patterned after existing federal commissions statutorily created by Congress with delegated administrative and regulatory authority and designated independent agency status within the executive branch. It is time for bold and innovative policy action to incorporate wetland protective services into societies' defenses against extreme weather events. [ABSTRACT FROM AUTHOR]

Abstract Extreme weather events often disrupt the operation of public transit systems, and challenge the capacity of transit agencies to effectively respond to them. In this paper, we draw upon a recent nationwide survey of 273 public transit agencies in metropolitan regions across the United States to understand the factors that influence their scope of adaptation to anticipated climate risks. We find that a transit agency undertakes more adaptation measures when transit officials perceive greater risks and greater adaptive capacity of the agency, or when it experiences more severe extreme weather events. We also show that local institutional environment, in particular, political ideology, affects the scope of transit adaptation activities. Transit agencies that operate in more politically liberal counties tend to engage in more adaptation actions, while the effect of state-level ideology depends on the level of perceived influence from state governments. Highlights • Greater perceived risks lead transit agencies to take more adaptation measures. • Experiences with extreme weather events precipitate transit adaptations. • Transit agencies adapt to extreme weather when perceiving greater capacity. • Local political ideology influences the scope of public transit adaptation. [ABSTRACT FROM AUTHOR]

The National Seed Strategy for Rehabilitation and Restoration was developed by a partnership of 12 federal agencies and over 300 non‐federal cooperators in the United States and launched in 2015. Implementation aims to ensure the availability of genetically appropriate native seed for ecological restoration across the country. Ecological restoration is required in response to a wide range of human impacts. The four main goals of the strategy are: identification of seed needs and availability of genetically appropriate seed; research to improve seed production and ecosystem restoration; development of decision support tools for ecological restoration; and communication and outreach. With the increasing occurrence and intensity of extreme weather events including drought and related wild fires, hurricanes and flooding, native seed is increasingly required in large quantities to build ecological resilience. Acceptance of this need will be crucial to implementation of the National Seed Strategy. [ABSTRACT FROM AUTHOR]

Strategic preparedness reduces the adverse health impacts of hurricanes and tropical storms, referred to collectively as tropical cyclones (TCs), but its protective impact could be enhanced by a more comprehensive and rigorous characterization of TC epidemiology. To generate the insights and tools necessary for high-precision TC preparedness, we introduce a machine learning approach that standardizes estimation of historic TC health impacts, discovers common patterns and sources of heterogeneity in those health impacts, and enables identification of communities at highest health risk for future TCs. The model integrates (i) a causal inference component to quantify the immediate health impacts of recent historic TCs at high spatial resolution and (ii) a predictive component that captures how TC meteorological features and socioeconomic/demographic characteristics of impacted communities are associated with health impacts. We apply it to a rich data platform containing detailed historic TC exposure information and records of all-cause mortality and cardiovascular- and respiratory-related hospitalization among Medicare recipients. We report a high degree of heterogeneity in the acute health impacts of historic TCs, both within and across TCs, and, on average, substantial TC-attributable increases in respiratory hospitalizations. TC-sustained windspeeds are found to be the primary driver of mortality and respiratory risks., (© The Author 2021. Published by Oxford University Press.)

Trends in extreme 100-y events of temperature and rainfall amounts in the continental United States are estimated, to see effects of climate change. This is a nontrivial statistical problem because climate change effects have to be extracted from "noisy" weather data within a limited time range. We use nonparametric Bayesian methods to estimate the trends of extreme events that have occurred between 1979 and 2019, based on data for temperature and rainfall. We focus on 100-y events for each month in [Formula: see text] geographical areas looking at hourly temperature and 5-d cumulative rainfall. Distribution tail models are constructed using extreme value theory (EVT) and data on 33-y events. This work shows it is possible to aggregate data from spatial points in diverse climate zones for a given month and fit an EVT model with the same parameters. This surprising result means there are enough extreme event data to see the trends in the 41-y record for each calendar month. The yearly trends of the risk of a 100-y high-temperature event show an average 2.1-fold increase over the last 41 y of data across all months, with a 2.6-fold increase for the months of July through October. The risk of high rainfall extremes increases in December and January 1.4-fold, but declines by 22% for the spring and summer months.

The health sector component of the first U.S. National Assessment, published in 2000, synthesized the anticipated health impacts of climate variability and change for five categories of health outcomes: impacts attributable to temperature, extreme weather events (e.g., storms and floods), air pollution, water- and food-borne diseases, and vector- and rodent-borne diseases. The Health Sector Assessment (HSA) concluded that climate variability and change are likely to increase morbidity and mortality risks for several climate-sensitive health outcomes, with the net impact uncertain. The objective of this study was to update the first HSA based on recent publications that address the potential impacts of climate variability and change in the United States for the five health outcome categories. The literature published since the first HSA supports the initial conclusions, with new data refining quantitative exposure—response relationships for several health end points, particularly for extreme heat events and air pollution. The United States continues to have a very high capacity to plan for and respond to climate change, although relatively little progress has been noted in the literature on implementing adaptive strategies and measures. Large knowledge gaps remain, resulting in a substantial need for additional research to improve our understanding of how weather and climate, both directly and indirectly, can influence human health. Filling these knowledge gaps will help better define the potential health impacts of climate change and identify specific public health adaptations to increase resilience. [ABSTRACT FROM AUTHOR]

Extreme weather events (EWE) are expected to increase as climate change intensifies, leaving coastal regions exposed to higher risks. South Florida has the highest HIV infection rate in the United States, and disruptions in clinic utilization due to extreme weather conditions could affect adherence to treatment and increase community transmission. The objective of this study was to identify the association between EWE and HIV-clinic attendance rates at a large academic medical system serving the Miami-Dade communities. The following methods were utilized: (1) Extreme heat index (EHI) and extreme precipitation (EP) were identified using daily observations from 1990-2019 that were collected at the Miami International Airport weather station located 3.6 miles from the studied HIV clinics. Data on hurricanes, coastal storms and flooding were collected from the National Oceanic and Atmospheric Administration Storms Database (NOAA) for Miami-Dade County. (2) An all-HIV clinic registry identified scheduled daily visits during the study period (hurricane seasons from 2017-2019). (3) Daily weather data were linked to the all-HIV clinic registry, where patients' 'no-show' status was the variable of interest. (4) A time-stratified, case crossover model was used to estimate the relative risk of no-show on days with a high heat index, precipitation, and/or an extreme natural event. A total of 26,444 scheduled visits were analyzed during the 383-day study period. A steady increase in the relative risk of 'no-show' was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low EHI, 13% on days with EP compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident. This study represents a novel approach to improving local understanding of the impacts of EWE on the HIV-population's utilization of healthcare, particularly when the frequency and intensity of EWE is expected to increase and disproportionately affect vulnerable populations. More studies are needed to understand the impact of EWE on routine outpatient settings.

Study Objectives: Clinical benefit from positive pressure therapy is dependent on treatment adherence. Extreme weather events, such as floods, hurricanes, and tornadoes, can contribute to nonadherence by electricity loss and mandatory evacuation. We aimed to evaluate the concerns and behaviors of regular positive airway pressure users surrounding the extreme weather event Hurricane Irma., Methods: A questionnaire on positive pressure concerns surrounding Hurricane Irma was completed by 117 patients with pre-hurricane objectively confirmed treatment adherence as defined by Medicare. Responses were tabulated to identify concerns and behavior in preparation for and after Hurricane Irma. Cloud-based monitoring, available on 50 (43%) cases, was used to determine the effect of self-reported electricity loss on treatment adherence before and after the storm. Quantitative use data pre- and post-Hurricane Irma was compared by t test with P < .05 considered statistically significant., Results: Post-hurricane 78 (67%) patients were unable to use treatment with mean duration of 4.3 days. Of these, snoring, choking, and sleepiness were reported in 64%, 19%, and 42%, respectively. Loss of electricity was identified as the cause of missed treatment in 71 patients. In those with cloud monitoring, mean 14-day pre- and post-hurricane use differed by 8 minutes (P =.056). Cloud-monitored cases with loss of electricity had a decline in mean use of 33 minutes for the first 7 days post-hurricane. There was a trend towards increased use post-hurricane in those that retained electricity. Many patients expressed dissatisfaction with the availability of preparedness guidelines., Conclusions: Although common, loss of electricity was not the sole disruptor of positive pressure use after extreme weather events. Regular users of positive airway pressure experience both disruption in patterns of use and concerns regarding preparedness for extreme weather events., (© 2020 American Academy of Sleep Medicine.)

Current public health strategies, policies, and measures are being modified to enhance current health protection to climate-sensitive health outcomes. These modifications are critical to decrease vulnerability to climate variability, but do not necessarily increase resilience to future (and different) weather patterns. Communities resilient to the health risks of climate change anticipate risks; reduce vulnerability to those risks; prepare for and respond quickly and effectively to threats; and recover faster, with increased capacity to prepare for and respond to the next threat. Increasing resilience includes top-down (e.g., strengthening and maintaining disaster risk management programs) and bottom-up (e.g., increasing social capital) measures, and focuses not only on the risks presented by climate change but also on the underlying socioeconomic, geographic, and other vulnerabilities that affect the extent and magnitude of impacts. Three examples are discussed of public health programs designed for other purposes that provide opportunities for increasing the capacity of communities to avoid, prepare for, and effectively respond to the health risks of extreme weather and climate events. Incorporating elements of adaptive management into public health practice, including a strong and explicit focus on iteratively managing risks, will increase effective management of climate change risks.