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California Building Resilience Against Climate Effects (CalBRACE) Project

Preparing for Climate Change - A Public Health Approach

A project of the CDPH Climate Change & Health Equity Branch

Image of California farm laborers
*Note: The CDC Building Resilience Against Climate Effects Framework is undergoing updates. See BRACE Framework below for more details.

The Centers for Disease Control and Prevention (CDC) Climate and Health Program began the Climate-Ready States and Cities Initiative (CRSCI) in 2010 to help grant recipients use the five-step Building Resilience Against Climate Effects (BRACE) Framework to identify likely climate impacts, potential health effects associated with these impacts, and at-risk populations and locations. The work being done by grant recipients operationalizing the BRACE Framework contributes to positive long-term outcomes by reducing the negative health impacts of climate change among communities facing inequities. CDPH’s Climate Change and Health Equity Branch is one of the 13 current BRACE grant recipients. In California, the Santa Clara County Department of Public Health and the San Francisco Department of Public Health are also direct BRACE recipients. 

The California Building Resilience Against Climate Effects (CalBRACE) Project seeks to address the public health impacts of the climate crisis in California by establishing a robust institutional capacity to lead climate adaptation and mitigation planning, actions, and evaluations that enhance population resilience, health, and racial equity. CalBRACE engages in policy, systems, and environmental changes with communities to improve the living conditions of people facing inequities, to lessen vulnerability to the health impacts of climate change and improve population-level health and equity outcomes. Grounded in public health practice, this project leverages state, tribal, local, academic, and community partnerships to develop and maintain a climate and health equity data visualization tool, implement and evaluate adaptation actions that respond to identified climate hazards, disseminate lessons learned, and improve determinants of health equity.

The CalBRACE Project’s evidence-based tools help to prioritize resources and technical assistance for communities facing disproportionate health impacts due to climate exposures that compound existing inequities. The negative impacts of the climate crisis on health are exacerbated by structural racism, which inhibits access to transportation, healthy foods, safe places, high-road jobs, economic security, and protection from extreme weather.[1]  Explicitly naming and addressing inequities based on racism improves climate resilience and health among people of color and all people, as everyone fares better in more equal societies. [2]

Project Goals

With communications, engagement, data, tools, and technical assistance with internal CDPH and external partners and stakeholders, the CalBRACE Project aims to achieve stronger partnerships, increased knowledge of resilience actions and an enhanced evidence base for effective climate and health adaptation actions. The project incorporates activities and resources to build climate resilience for and with communities with high susceptibility to climate hazards and historical and continuing disinvestment. The project also provides consultative services and evaluation for planning and implementation strategies to improve living conditions and increase adaptive capacity and resilience and disseminates new evidence to the public health field at the nexus of climate change, health, and equity.

Desired Project outcomes include:

  1. Widespread adoption, replication, and expansion of health-protective adaptation actions by climate resilience-focused public health practitioners
  2. Reduced negative health outcomes in regions and among populations at greater risk of adverse effects of climate change
  3. Enhanced evidence base for effective climate and health adaptation and resilience actions

Project Activities

Community Health Workers, Healthy Homes, and Healthy Families Pilot Weatherization Project in Tulare County, CA

The CHWs, Healthy Homes, and Healthy Families weatherization pilot project is implementing weatherization and energy efficiency improvements as protective health interventions for low-income families and farmworker communities in Tulare County, California. Tulare County is at high risk of health impacts from increasing heat associated with the changing climate. The County experienced an average of four extreme heat days above 92.9 degrees F per year from 1961-1990, an average of six per year from 1990-2004, and there are projected to be an average of 42 days of extreme heat per year by mid-century and 70 days per year by the end of the century. With the increased frequency of heat waves in Tulare County, children, people with pre-existing health conditions, outdoor workers, financially burdened households, unhoused individuals, and populations without access to air conditioning, cooling centers, or shelters will be particularly susceptible to heat-related illnesses. In Tulare County, 14 percent of households were without air conditioning in 2009 compared to 36 percent statewide. In partnership with Kaweah Health, the Association for Energy Affordability (AEA), and Proteus, Inc, the pilot program is connecting low-income residents with energy-efficiency and weatherization services to improve housing conditions, reduce health risks and improve resilience to heat and air pollution.

Potential services available to weatherize a home
Potential services available to weatherize a home
Source: BayREN

Community Health Workers and community members supporting weatherization pilot project 

Community Health Workers and community members supporting
the weatherization pilot project

Testimonies from Farmworker Leaders Experiencing Extreme Heat and Wildfire Smoke: A Partnership with Achieving Resilient Communities and StoryCenter

Farmworkers are 20 times more likely to die from heat-related illness than the U.S. workforce overall. To increase awareness and inform policymaking and public health programming, farmworker leaders from the Mixteco Indigena Community Organizing Project (MICOP) and Lideres Campesinas participated in a digital storytelling workshop to share their lived experience with extreme heat and wildfire smoke through short videos. The CDPH CalBRACE project provided funding and support to StoryCenter and the Achieving Resilient Communities (ARC) project who led efforts to conduct the workshop and develop the videos. The ARC project is a collaboration of multiple Public Health Institute programs, including Tracking California. In-kind support for the workshop was provided by Cigna Foundation, the American Public Health Association (APHA), and the CDC.

Watch the full video series on YouTube here and view the first video below.

Storycenter Youtube Video 

The series contents are solely the responsibility of the storytellers which do not necessarily represent the official views of the CDC, the U.S. Department of Health and Human Services, the California Department of Public Health, or the California Health and Human Services Agency.

Technical Assistance to California Tribes

The Local Assistance Unit of the Climate Change and Health Equity Branch provides climate and health equity technical assistance to Tribes. We equip Tribes to serve their own populations and forge partnerships that increase overall capacity to reduce risks and build resilience to climate change. Additional case studies looking at Tribes' work on climate change and health equity are being developed.

California Climate and Health Case Stories: The Local Health Department Actions

This series of case stories highlights how local health jurisdictions (LHJs) are addressing climate change as a public health threat. LHJs have important roles in helping California reduce greenhouse gas emissions and adapt to the impacts of climate change. The Building Resilience Against Climate Effects (BRACE) Framework provides LHJs an evidenced-based process to identify climate impacts in their communities, potential effects associated with these impacts, and their most at-risk populations. We are working to support LHJs and the following are profiles from counties across California who are working on climate change and health.

Climate Change and Health Equity Toolkit for Public Health

​​​The CalBRACE Climate Change and Health Equity Toolkit for Public Health is a collection of resources that includes tools, reports, and guides to help local health departments and Tribes assess, plan, and monitor to reduce and prevent health risks associated with climate change. The Climate Change and Health Toolkit for Public Health will be updated as the new BRACE 3.0 Framework is made available. Use this toolkit as a road map when beginning or continuing to integrate climate change and health equity into a jurisdiction's plans, guidance, and adaptation actions. ​

Explore the Toolkit here >>

Getting Started for Local Health Juristicions: Pre-Planning

For local health jurisdictions (LHJs) embarking on climate change work, the pre-planning stage may involve assessing analyzing existing local and regional efforts and determining ways to integrate your efforts with these activities into a shared agenda. To assist with pre-planning, CDPH has developed a checklist and a template for assessing local and regional Climate Mitigation, Adaptation, and Resilience Planning. The Template is a word document that a LHJ staff member, fellow, or consultant can complete. Reference this checklist and template to accelerate your effectiveness by gaining knowledge of planning activities in your LHJ, county government, and community-based and regional organizations. 

The BRACE Framework

*Note: The CDC Building Resilience Against Climate Effects Framework is undergoing updates. The revised framework is anticipated to center health equity, incorporate greenhouse gas mitigation strategies, and feature associated guidance and tools. For more information on the update process, see Reimagining the Role of Health Departments and Their Partners in Addressing Climate Change: Revising the Building Resilience against Climate Effects (BRACE) Framework.

Building Resilience Against Climate Effects (BRACE) Framework

The CDC developed a five-step BRACE framework that enables health departments to incorporate the best available climate projections and epidemiology analysis into a traditional preparedness planning process.  This approach supports the development and implementation of a unified climate and health adaptation strategy for a jurisdiction, while allowing flexibility for local and regional conditions and needs.  The steps should be addressed in a sequence that best aligns with local priorities, opportunities, and resources, and are not necessarily linear. 

Because justice, equity, diversity, and inclusion (JEDI) principles are crucial to climate change adaptation planning, CDC has partnered with the American Public Health Association (APHA) to create the Climate Change and Health Playbook: Adaptation Planning for Justice, Equity, Diversity, and Inclusion. This comprehensive, step-by-step resource is designed to supplement BRACE and support public health departments and adaptation planners as they blend JEDI into their climate and health efforts.

Five-Step BRACE Framework

 5 Step BRACE Framework

Step 1: Anticipate Climate Impacts and Assess Vulnerabilities

Identify the scope of the most likely climate impacts, the potential health outcomes associated with those climatic changes, and the populations and locations vulnerable to these  health impacts within a jurisdiction.

  • California County-Level Climate and Health Profile Reports
    • The reports present an overview of local and regional climate projections based on climate science and link risks to health outcomes to inform public health practitioners and their partners about climate change risks to health. Indicators in the reports include heat-related emergency department visits, adults living with multiple chronic conditions, population living in poverty, race and ethnicity, outdoor workers, air conditioning ownership, tree canopy, and public transit access.

  • Climate Change and Health Vulnerability Indicators, Data, and Narratives
    • These indicators are for assessing social vulnerability and adaptive capacity for climate change exposures in California.

  • Climate Change and Health Visualization (CCHVIz)
    • CCHVIz is the interactive data visualization platform for the Climate Change & Health Vulnerability Indicators for California (CCHVIs). The CalBRACE Project produced Climate Change and Health Vulnerability Indicators to help stakeholders better understand the people and places that are more susceptible to adverse health impacts associated with climate change. They are a suite of 21 indicators (18 available here) of climate exposure, population sensitivity, and adaptive capacity to the impacts of climate change. These indicators are being used by local and state programs to plan to meet the needs of the communities most at risk of harm from climate change.

  • Resources (PDF)

Step 2: Project the Disease Burden

Estimate or quantify the additional burden of health outcomes due to Climate Change – to support prioritization and decision making.

Step 3: Assess Public Health Interventions

Identify the most suitable health interventions for the health impacts of greatest concern.

Step 4: Develop and Implement a Climate and Health Adaptation Plan

Develop and implement a health adaptation plan (strategy) for climate change that addresses health impacts, gaps in critical public health functions/services, and a plan for enhancing adaptive capacity in the jurisdiction.

Step 5: Evaluate Impact and Improve Quality of Activities

Evaluate the processes the project has used, determine the value of utilizing the framework and the value of climate and health activities undertaken to reduce risks to health.


 [1]Baciu, A., Negussie, Y., Geller, A., & Weinstein, J.N. (Eds.). (2017). Communities in action: Pathways to health equity. National Academies Press.
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