1. Extreme Heat-Related Health Risks for Vulnerable Populations: The Role of Energy Security and Energy Assistance Programs Jonathan White, Ph.D., LCSW-C, CPH Commander, U.S. Public Health Service Administration for Children and Families

2. How Can Extreme Temperatures Affect Human Health? Heat injury Ischemic heart disease Cardiovascular disease Stroke Asthma Allergies Respiratory disease Mosquito-borne illness Environmental pollutant exposures Accidents and burns Dehydration Food-borne illness Behavioral health/stress

3. Heat Injury Risk Outdoor Temperature Risk Indoor Temperature Risk Economic vulnerability raises both types of risk

4. Extreme Heat Health Risk High Outdoor Temperature Built/Natural Environment Pre-Existing Health Risks Home Energy Insecurity

5. Who is at heightened risk? Children (0-5) Older adults People with certain chronic health conditions Individuals experiencing homelessness Low-income individuals and families

6. Air Conditioning and Health The largest study yet attempted in the U.S., which looked at California from 1999 to 2005, “observed a significantly increased risk of hospitalization for multiple diseases, including cardiovascular disease, ischemic heart disease, ischemic stroke, respiratory disease, pneumonia, dehydration, heat stroke, diabetes, and acute renal failure, with a 10 º [Fahrenheit] increase in same-day apparent temperature. They also found that ownership and usage of ACs significantly reduced the effects of temperature on these health outcomes, after controlling for potential confounding by family income and other socioeconomic factors.” Ostro, Green, Malig, & Rasu 2010, Am J Epidemiology 172(9)

7. Indoor Air Quality Economic disadvantage and IAQ risk Energy security, extreme heat, and IAQ Key factor in respiratory disease burden –Asthma –Allergies –COPD

8. Climate Change Health Risks “The populations most vulnerable—children, elderly people, those living in poverty, people living in certain geographic areas and people with underlying health conditions—are at even greater health risk from climate change.” Luber, Knowlton, & Beard (2014), CDC Public Health Grand Rounds

9. Vector-Borne Disease

10. Mosquito Vectors (US & Territories) Aedes aegypti & Aedes Albopictus Can carry Zika, Dengue, and Chikungunya Bites day and night, but primarily daytime More active/aggressive in high summer Indoor and outdoor Culex Can carry West Nile virus Bites evening to morning More active/aggressive in high summer Primarily outdoor

11. Energy Assistance Programs: One of the Best-Kept Secrets in Public Health

12. LIHEAP and Zika Prevention Use of air conditioning to cool homes lowers mosquito home risk State, Territorial, or Tribal energy assistance programs may use LIHEAP funds for mosquito repellant-treated screens

13. Key Partnerships Energy assistance agencies Public health authorities Community Action Agencies Private sector: Building community Environmental health organizations

14. Assurance 16 Health-focused messaging in Assurance 16 activities Partnerships with public health authorities in your State, Tribe, or Territory Powerful tool to mitigate extreme heat-related heath risks to vulnerable populations

15. Contact Information Jonathan White, Ph.D., LCSW-C, CPH Commander, US Public Health Service Senior Adviser for Strategic Initiatives Immediate Office of the Assistant Secretary Administration for Children and Families Jonathan.white@acf.hhs.gov