List of goals and specific aims: Climate policies and solutions are too often implemented in silos, without health and equity as key considerations, and without fully and equitably engaging communities whose lived experience needs to be incorporated into effective solutions. The proposed initiative will begin to address these issues by forging a model community-academic partnership to protect some of San Francisco’s communities that are most systemically vulnerable to the adverse effects of climate change on health. We propose the inaugural Climate, Health, and Equity Community Action Partnership (CHE CAP) based at UCSF Mount Zion in partnership with a community-based organization (CBO) focused on climate justice. To achieve this broader goal, we propose the following specific aims:

1. Create a comprehensive listing of CBOs focused on climate justice in San Francisco and the Bay Area. We will use initial search and outreach, followed by snowball sampling to identify climate-focused CBOs as well as those beginning to express concern about how climate change will affect the communities they serve. Both types of organizations are likely to benefit from support and capacity building.
2. Conduct a landscape analysis to identify the health impact of heatwaves and wildfires, the state’s foremost health threats, on Mount Zion’s patients and health care system through focus groups and/or key informant interviews with clinical leadership and members of patient and family advisory councils (PFACs). We will also review and compile available data on the number of Mount Zion patients with climate-sensitive health risks (e.g., asthma, COPD/emphysema, immunocompromise, heart disease, anxiety, and depression).
3. Based on Aims 1 and 2, select a leading climate justice CBO to partner with the UC Center for Climate, Health, and Equity (CCHE) in designing and co-leading a multi-stakeholder convening, as described below. The primary CBO will be selected based on congruence with the shared mission of climate, health and equity, CBO interest and bandwidth, trust within at least one marginalized community, other networks of CBOs with whom they collaborate, and ability to conduct broader outreach in San Francisco
4. Plan and facilitate an inaugural multi-stakeholder Bay Area convening co-designed and co-led by the primary CBO identified in Aim 3, and attended by the CBOs identified in Aim 1. UCSF faculty, staff, and trainees interested in climate justice, policymakers and policy staff, and Department of Public Health staff, will also participate, helping to identify research and solution-based climate health equity priorities for San Francisco.
5. Select two San Francisco-based community-partnered action research projects identified as high priorities by participants at the convening described in Aim 4, which will be prioritized for future funding and support from CCHE. These projects will be jointly led by a UC partner and a CBO working on climate health equity and will focus on producing rapid research targeting a specific implementation or policy issue prioritized by the community.

The model described in Aims 3-5 is similar to the San Francisco Health Improvement Project (SFHIP) model, which was initially successfully launched at UCSF and is now supported by the San Francisco Department of Public Health, which serves as the ongoing backbone organization. Based on the learnings of this inaugural partnership, we hope to scale this model statewide by leveraging the other 9 UC campuses participating in CCHE. The long-term goal is to model new forms of equitable academic-community partnerships that can shape the direction of CCHE.

Anticipated benefit for underserved or vulnerable communities in San Francisco:

Evidence shows that the negative impacts of climate change on health disproportionately affect marginalized communities. This occurs through multiple systemic pathways including: greater exposure to extreme weather events, poorer air quality in lower-income communities and communities of color, higher rates of climate-sensitive health risks due to the stress of systemic and interpersonal oppression, and poorer access to health care to mitigate these health impacts. Mitigating the damage of climate change on health positively impacts systemically vulnerable communities and these communities must be intentionally prioritized in work to address climate change. For this project, we are intentionally partnering with CBOs that represent marginalized communities. We will select a lead CBO with strong ties in at least one marginalized community to co-design and co-lead the project.  Through the convening, we also plan to build a broader network of CBOs throughout San Francisco focused on or with burgeoning interest in climate justice. Ultimately, we expect that the CHE CAP model will be scaled statewide and will model new forms of equitable academic-community partnerships and catalyze translation of evidence to policy and action to mitigate the harms of climate change on the health of marginalized communities, which are likely to further worsen over time. Building anticipatory capacity through community and university partnerships may help create improved responses.

How the project addresses UCSF Mount Zion priorities and compelling San Francisco healthcare needs: This is an unprecedented time when health at every stage of life is being shaped by the climate crisis. Evidence is mounting that changes in temperature exacerbate infectious and chronic diseases, negatively impact mental health, and lead to injuries and premature death, and that these impacts disproportionately affect marginalized communities. San Francisco is already grappling with many of these impacts as each year our communities face more frequent and severe heat waves, poor air quality from wildfires in surrounding areas, drought, and rising sea levels. Despite nascent efforts to mitigate and adapt to the harmful effects of climate change, San Francisco’s healthcare workforce and health systems lack the preparedness and response capacity needed to address accelerating climate-health impacts.

UCSF Mount Zion is home to general internal medicine and pediatric primary care, women’s health, hospital and surgical facilities, the Osher Center for Integrative Medicine, and dermatology, ENT, oncology, pain medicine and occupational medicine specialists, among others. Patients at UCSF Mount Zion often seek care here because of underlying health conditions that include many of the climate-sensitive health risks (e.g., asthma, COPD/emphysema, chronic allergies, skin disease, being immunocompromised, heart disease, anxiety, and depression). As described below regarding MZHF values, UCSF Mount Zion has a long history of serving the community, social justice, innovation, and education. The Covid-19 pandemic has been no exception, with the re-opening of UCSF Mount Zion’s hospital facilities initially to respond to the needs of patients hospitalized with Covid-19. As we begin to emerge from the Covid-19 pandemic, now is the time for UCSF Mount Zion to proactively prepare for and mitigate the growing crisis of climate change and its impact on the health of UCSF Mount Zion’s patients and the broader San Francisco community. This project does just that, by designing the inaugural Climate, Health, and Equity Community Action Partnership (CHE CAP) based at UCSF Mount Zion in partnership with a CBO focused on climate justice, conducting a landscape analysis of the impact of climate change on the health of UCSF Mount Zion’s patients, and hosting the first multi-stakeholder convening to identify research and solution-based climate health equity priorities for San Francisco.

Link to MZHF values: This project is based on all of Mount Zion Health Fund’s values and particularly emphasizes service (avodah), social justice (tikkun olam), community building (kehillah), and education and leadership (limud u’manhigut). The project centers on addressing what some might reasonably argue is the most pressing health need of our time—climate change. While mitigating climate change is a global challenge, each community must come together to do its part to mitigate and prepare for climate change’s threat. This project proposes to build those bridges here in San Francisco, with an eye toward modeling a partnership that can be scaled statewide and beyond. The project also explicitly seeks to correct the unjustly disproportionate impact of climate change on the health of marginalized communities in San Francisco by focusing on developing projects that will be co-led by and address the needs identified by these communities, including UCSF Mount Zion patients from these communities. The project also seeks to further develop CBO staff as statewide leaders in climate justice and to involve UCSF learners with a passion for addressing climate health equity.

Roles of UCSF and Community Partners: CCHE was launched by the UC Office of the President in 2021 to advance equitable and just climate solutions that promote human health and a healthy planet. Housed at UCSF and with strong partnerships across the UC system, CCHE is catalyzing “missing link” research on climate-health impacts, educating a 21st century health workforce to work at the climate-health interface, fostering climate-smart health systems, and maximizing health and equity in climate policy by meaningfully engaging community stakeholders. One of the aims of this project is to create a comprehensive list of CBOs in San Francisco and the Bay Area focused on climate health justice and potentially others beginning on their journey and collaborate with one leading CBO to bring them together in a multi-stakeholder convening. The CBO selected in Aim 3 to co-lead the workshops with CCHE will co-develop the content, agenda, and guest lists, as well as help design brief evaluation questions and participate in reviewing evaluation results, and it will receive significant funding to do so. Convening participants will include CBO staff, community members, and diverse Mount Zion patients (some already engaged with Dr. Griffiths’ community engaged advocacy curriculum for internal medicine residents), who will receive stipends funded through this grant.

Collaborators and Contact Information:

• Elizabeth (Beth) Griffiths, MD, MPH is Assistant Clinical Professor in the Division of General Internal Medicine (DGIM) at Mount Zion, Co-Associate Director of Training and Policy Programs at the UCSF Institute for Health Policy Studies, and Director of Advocacy and Community Engagement for the internal medicine residency Health Equity and Advocacy Pathway. To contact the team, please contact Dr. Griffiths at 1701 Divisadero St San Francisco, CA 94115, elizabeth.griffiths@ucsf.edu, or 415-353-7999.
• Arianne Teherani, PhD is Professor of Medicine, Founding Co-Director of CCHE, and Director of Program Evaluation for the UCSF School of Medicine. Dr. Teherani has launched and lead multiple programs focused on climate health and justice. As a program evaluation expert, she has worked on large-scale evaluation of national initiatives.
• Sheri Weiser MD, MPH is Professor of Medicine, Founding Co-Director of CCHE, and a member of the National Academies Climate Security Roundtable. Dr. Weiser is a social scientist and epidemiologist who leads research on how food insecurity and other social and economic factors, within the context of climate change, undermine health equity.
• Laura Schmidt PhD, MSW, MPH is Professor of Health Policy in the UCSF School of Medicine. Dr. Schmidt is a sociologist and public health researcher whose research seeks to understand how socioeconomic inequities translate into health inequities. From 2010-2016, Dr. Schmidt served as one of the lead UCSF faculty on the San Francisco Health Improvement Partnership (SFHIP.org), a robust university-community effort to reduce health inequities in San Francisco.
• Claire D. Brindis, Dr. P.H. is Distinguished Professor in the Department of Pediatrics, Strategic Advisor for CCHE, and a member of the National Academy of Medicine’s Climate Change Collaborative. She is a bi-lingual, bi-cultural Argentinean immigrant, whose career has been devoted to community-based, participatory research, program evaluation, and effective translation of research into policy.

Project start date and duration: July 1, 2023 through June 30, 2024.