USVI Public Records

Document text

CARIBBEAN EXPLORATORY RESEARCH CENTER 2016 INSTITUTE ON PUBLIC HEALTH AND CLIMATE CHANGE VI CERC 2016 INSTITUTE ON PUBLIC HEALTH AND CLIMATE CHANGE: FINAL REPORT DISCLAIMER The CERC 2016 Health Disparities Institute was supported in part by funding from the National Institute on Minority Health and Health Disparities, Grant #P20MD0022286, the Department of the Interior’s Office of Insular Affairs, Technical Assistance Grant #D16AP00050 TAP-USVI02016-4, and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), Grant #UB6HP27878-01-00. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities, the Department of the Interior, or the Health Resources & Services Administration. ACKNOWLEDGEMENTS The Research and Planning Team from the Caribbean Exploratory (NIMHD) Research Center (CERC) wishes to acknowledge the participants that gave of their time and shared ideas about the readiness of the territory to conduct an assessment on health information and data that may be necessary for adaptation to climate change. We also acknowledge all who provided financial support, technical expertise, administrative support, and feedback on the drafts of the Final Report. CERC TEAM: Gloria B. Callwood, Noreen Michael, Janis M. Valmond, Deborah E. Brown, Lorna J. Williams-Sutton, LaVerne E. Ragster, Sherrika Industrious-Phillips WRITING TEAM: LaVerne E. Ragster, Noreen Michael EDITORIAL TEAM: Gloria B. Callwood, Noreen Michael, Janis M. Valmond Suggested Citation: Ragster, L. and Michael, N. (2017). Final Report: Caribbean Exploratory Research Center 2016 Institute on Public Health and Climate Change. Caribbean Exploratory Research Center, University of the Virgin Islands, USVI 33 pp. VI CERC 2016 Institute on Public Health and Climate Change: Final Report This page intentionally left blank. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 1 - CARIBBEAN EXPLORATORY RESEARCH CENTER 2016 INSTITUTE ON PUBLIC HEALTH AND CLIMATE CHANGE FINAL REPORT The University of the Virgin Islands Caribbean Exploratory Research Center (CERC) convened its 2016 Institute on Public Health and Climate Change on October 27, 2016 at the UVI Administration and Conference Center First Floor Conference Room (UVIACC) on the St. Thomas Campus and the Great Hall on the Albert Sheen Campus on St. Croix. The theme of the institute was “Assessing Information Needs for Climate Change Adaptation to Ensure Optimal Public Health in the US Virgin Islands”. The rationale for the thematic focus of the 2016 Institute began with the recognition that, globally, the World Health Organization has identified climate change as the largest public health challenge of the 21st Century. In addition, at the national level, the US Centers for Disease Control and Prevention (CDC) notes that because of climate change, “some existing health threats will intensify and new health threats will emerge”, and that the impact of climate change on health will vary depending on age, economic resources, and location (www.cdc.gov). Moreover, at the local level, it was recognized that the US Virgin Islands, like the rest of the Caribbean, has begun to feel the predicted manifestations of climate change, including increased air and water temperatures, droughts, and outbreaks of vector-borne diseases like Dengue Fever, Chikungunya, and Zika. Of particular concern to CERC is the anticipation that a population with the high numbers of cases of cardiovascular disease, diabetes, cancer, obesity, and other health challenges seen in the Virgin Islands will require significant adaptation initiatives to ensure any improvement in public health under climate change induced high temperatures and drought conditions. The changing environment will have a disproportionately negative impact on the poor, the elderly, and people experiencing health disparities in the community. It was determined that the US Virgin Islands would need to identify the public health challenges that are emerging as a result of climate change and develop initiatives to address the challenges on individual and institutional levels if it is going to adapt to a changing environment. Therefore, the 2016 CERC Institute was designed to provide the environment that would support Virgin Islands professionals possessing the training, experience, and knowledge about conditions and health data in the Virgin Islands to contribute to the discussions about climate change and the potential public health impacts for the US Virgin Islands. Further, the intent was that the discussions would yield outputs VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 2 - necessary for the community to assess its readiness for adaptation to climate change impacts on public health in the Territory. The Institute was seen as support for the implementation of the VI Climate Change Executive Order signed by Governor Mapp in 2015 (Executive Order No. 474-2015) through its three specific aims: 1. Provide an opportunity to identify and review the issues associated with the manifestations of climate change on public health in the US Virgin Islands and Caribbean. 2. Identify gaps and deficiencies in institutional and individual responses to the challenges to public health posed by climate change. 3. Generate a list of constructive and viable adaptation responses appropriate for VI institutions and individuals. ORGANIZATION OF THE INSTITUTE The Institute was organized into two phases and began with a brief Opening and Introduction session that included brief remarks from UVI CERC Director, Dr. Gloria Callwood, UVI Dean of the School of Nursing , Dr. Beverley Lansiquot, Provost (representing President Hall), Dr. Camille McKayle, and the two primary sponsors of the Institute, Director of UVI Community Engagement and Life–Long Learning (UVICELL), Ms. Ilene Heyward Garner and Director of the St. Thomas East End Medical Center Corporation (STEEMCC), Mr. Moleto Smith. In Phase 1, the objective was to expand the knowledge base of the participants on climate change linkages to public health issues through videoconference of formal presentations from local and regional resource professionals. The three presenters addressed an overview of climate change and its linkages to public health, the state of the Virgin Islands health information and data on public health and climate change, and a review of the components of climate change adaptation that support good public health. The 47 invited participants (see attached Participants Lists), who included representatives of health providers, social science and natural science university faculty, environmental non-government organizations, the media, legislators and public sector decision makers, and members of the CERC Advisory Board, were distributed between the St. Croix (18) and St. Thomas (29) institute venues. In Phase 2, participants in each venue were divided into Work Groups of 4-5 members. The Work Groups were asked to address the questions below and record their responses. WORK GROUP QUESTIONS: A. What are the database or information sources in the Territory that you feel provide information on health status of the population? What are your VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 3 - sources of data/information for incidences of illness or health statistics in the Territory? B. What do you see as the most critical gaps in information on health conditions and incidences of disease in the Territory? C. Do you have any recommendations for adapting to the various aspects of climate change that would help Virgin Islanders to improve or maintain their health? Following two and a half hours of discussion and capturing information in each Work Group, the Institute participants reconvened in a final plenary videoconference session to report on the outcomes of their efforts. Participants were asked to provide feedback on the formal presentations, the Work Group experience, and the overall Institute through evaluation forms distributed with the activity packages. SUMMARY OF PRESENTATIONS AND OUTCOMES The sections of the report which follow provide a summary of the outcomes of the 2016 CERC Institute. The 2016 Institute Program, hyperlinks to presentations, and the raw information contributed by participants during the Work Group session are included for reference as appendices to this Final Report. Presentations on Public Health and Climate Change OVERVIEW OF CLIMATE CHANGE AND ITS LINKAGES TO PUBLIC HEALTH Presenter, LaVerne E. Ragster, PhD The overview defined climate change and the conditions driving its accelerated rate in the last 100 years. All of the expected manifestations of climate change were described and a case made for climate impacting all areas of life. The linkages between increased health challenges for Virgin Islanders, especially those with chronic diseases, and the expected climate change impacts of increased temperatures, longer periods of drought with periodic flooding from intense rainfall, and more intense hurricanes and storms were the foci of the presentation. The point was made that current increases in temperature trends and lengthy drought periods were linked with challenges to agricultural production and increased incidences of illnesses, including Chikungunya, Dengue Fever, Zika outbreaks associated with biological vectors like mosquitoes, as well as exacerbated levels of asthma and respiratory distress. The charge was given to identify and implement activities and institutional responses that would decrease the impacts of the changing environment on those who are most vulnerable because of prevalent Virgin Islands health challenges, including obesity, diabetes, cardiovascular disease, HIV/AIDS and cancer. To view the PowerPoint presentation, go to: Overview to Climate Change linkages to Public Health. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 4 - STATE OF VI HEALTH INFORMATION AND DATA ON PUBLIC HEALTH AND CLIMATE CHANGE Presenter, Esther Ellis, PhD The presentation defined health surveillance, its importance, why it is a part of the work undertaken by the Department of Health, and its uses in addressing public health issues in the Territory. The US Virgin Islands is linked to the national health surveillance system at the US Centers for Disease Control and Prevention (CDC) through various agreements, regulations, and contracts. The USVI is now able to receive from and contribute data to the CDC National Electronic Disease Surveillance System (NEDSS). The presentation addressed the range of sources from which data are collected from individuals and various types of official records. Further, there was a recognition of the need to link the data from various sources to facilitate monitoring conditions in the community as well as detecting pertinent behavioral changes and disease outbreaks. The elements of USVI health surveillance programs were described, including the sources of data and the types of studies that are undertaken. It was noted that the USVI has in the past and will again participate in the national Behavioral Risk Factors Surveillance System (BRFSS), the world’s largest on-going telephone health surveillance system. Participation in the BRFSS means that USVI data are included in national trends and information, and that the Territory has specific information to use in monitoring USVI population health conditions and concerns. The steps involved in studying a disease outbreak were explained, beginning with the establishment of the existence of the disease through implementation of control and prevention measures and communications with the community. The presentation outlined the specific studies conducted for the Chikungunya and Zika outbreaks, along with examples of the types of reports and articles generated based on the outbreaks. The take-home messages included the following three points and assurance that the USVI will continue to use surveillance in support of good public health: i) Surveillance provides information on the health of the community; ii) Public health relies on information from medical care providers and takes prevention-oriented actions based on information received; and, iii) Surveillance involves taking information in, analyzing and interpreting it, and disseminating it to those who need it. To view the PowerPoint presentation, go to: State of VI Health Information and Data on Health and Climate. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 5 - COMPONENTS OF CLIMATE CHANGE ADAPTATION THAT SUPPORT GOOD PUBLIC HEALTH Presenter, Professor Fitzroy Henry, PhD The comprehensive and connectivity-orientation of the presentation offered extensive information for participants to consider. The topics covered included the challenges of climate change, the potential impact on public health and food security, and strategic approaches to enhance public health in the Caribbean. The audience was reminded of the link between accelerated climate change and human activity and the predictions of impacts on the Caribbean, especially hurricanes, tropical storms, flooding, and drought. A strong case was made for climate change affecting all the social determinants of health, including income and social status, employment conditions, healthy child development, health services, and culture, among others. Professor Henry took the time to address the new evidence on climate change and health linkages. It was noted that the impacts will vary disproportionately, and center on the poor, indigenous peoples, children, the elderly, and women. He concluded that, based on the results of evaluating impacts of climate change on determinants of health, policies, plans, projects, and regulations should be prepared to strengthen the capacity of countries to minimize climate change impacts on health. The presentation provided communication priorities and recommendations for addressing climate change impacts on health at the local and global levels. Ten actions were offered to policy-makers, beginning with recommendations to: a) advocate for strong and equitable climate change agreements; b) promote the need for “health- oriented” agreements; c) protect the most vulnerable; and d) strengthen health systems’ adaptive capacity. The final section of the presentation focused on promoting understanding of the potential impact of climate change on food security in the Caribbean. Participants were reminded of the linkages between food security and a number of the impacts of climate change, including higher air and water temperatures, flooding, sea-level rise, and increased periods of drought. A number of strategic approaches designed to address the impacts of climate change on food security were presented, specifically: information management as the basis for decision-making; vulnerability assessment as the basis for hazard mapping; the use of education and public awareness campaigns; and disaster management planning. The point was made of the need to prepare for climate change impacts on fisheries, agriculture, agro-forestry, water resources, and food utilization. The presentation laid the foundation for the need for assessment as part of climate change adaptation and reinforced the importance of addressing impacts on public health in the Virgin Islands and other Caribbean communities. To view the PowerPoint presentation, go to: Climate Change Adaptation and Public Health. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 6 - Work Group Outcomes The tables below offer a summary of the information shared by the participants at the Institute with respect to each of the three questions discussed by the Work Groups on both St. Thomas (STT) and St. Croix (STX). QUESTION 1. WHAT ARE THE DATABASES OR INFORMATION SOURCES IN THE TERRITORY THAT PROVIDE INFORMATION ON HEALTH STATUS OF THE VIRGIN ISLANDS POPULATION? The five Work Groups offered a diverse list of sources for health information and data, ranging from non-government organizations to VI Government departments, especially the Departments of Health, Human Services, and Education. Hospitals, the federally qualified health centers, and national databases were also seen as sources for health information and data in the Territory. The data/information sources were perceived as serving the entire Territory regardless of their geographic location. The data/information sources mentioned most often utilize technology, address confidentiality, and recognize the importance of maintaining qualified staff to collect and manage the data. DATA/INFORMATION SOURCES ON HEALTH IN VI WORK GROUP SOURCE – SITE AND NUMBER ST. CROIX ST. THOMAS 1. VI Department of Health (Division of Mental Health, Division of Vital Statistics, Division of Maternal & Child Health, Division of Environmental Health) Program data and special databases a. Vital Records Information Management System (VRIMS) b. Electronic Health Records (EHR) c. Health Professional Service Area d. Autoimmune Registry e. Immunization Database f. Central Cancer Registry (currently being developed) g. Human Immunodeficiency Virus/Sexually Transmitted Diseases Program (HIV/STD Program) h. Women Infant and Children Program (WIC) i. Emergency Medical Services (EMS) j. Substance Abuse Program k. Family Planning Program 1 & 2 3, 4 & 5 2. National Electronic Disease Surveillance System (NEDSS) 1 & 2 4 3. Behavioral Risk Factor Surveillance System - ( BRFSS - CDC) 1 & 2 4. Health Services Advisory Group/Quality Improvement Organizations (HSAG-QIO) 1 & 2 VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 7 - DATA/INFORMATION SOURCES ON HEALTH IN VI WORK GROUP SOURCE – SITE AND NUMBER ST. CROIX ST. THOMAS 5. Roy L. Schneider Medical Center and Juan Luis Hospital 1 & 2 6. Federally Qualified Health Centers - STT and STX (Uniform Data System) 1 & 2 4 7. Department of Human Services a. Medicare, SNAP, TANF, Head Start/Early Head Start programs b. Early Childhood Integrated Data System (ECIDS) 1 & 2 3 & 4 8. Department of Education - VI Virtual Information System (VIVIS) 1 & 2 3 & 5 9. Veterans Hospitals (VA) 1 10. CIGNA- VI Health Statistics and Financial Data 1 4 & 5 11. Department of Licensing and Consumer Affairs 1 12. VI Equicare 1 13. VI Police Department 2 14. VI Territorial Emergency Agency (VITEMA) 2 15. Health Service Advisory Council 2 16. VI Courts 2 17. VI Fire Service 2 18. VI Medical Institute 2 19. VI Health Insurance Board 2 20. Department of Labor - Worker’s Compensation database 2 21. UVI Caribbean Exploratory Research Center- data and studies on Intimate Partner Violence, women’s health, breast cancer, HPV, etc. 2 22. UVI Eastern Caribbean Center (Census data, VI Household Survey, etc.) 2 4 23. VI University Center for Excellence in Developmental Disabilities (VIUCEDD) 2 24. Family service NGOs – Women’s Coalition, Family Resource Center, Domestic Violence State Advisory Committee (DVSAC) 2 25. Community or sector NGOs a. Community Foundation of the VI (CFVI) Kids Count Report b. AARP 3 & 4 VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 8 - QUESTION 2. WHAT ARE THE CRITICAL GAPS IN HEALTH INFORMATION, HEALTH CONDITIONS, AND INCIDENCES OF DISEASE IN THE VIRGIN ISLANDS? The Work Groups produced a diverse list of perceived gaps in health information and data in the US Virgin Islands. It was noteworthy that all Work Groups spent time discussing the weaknesses in the current information and data systems in the Territory. There appeared to be agreement that the challenges and obstacles listed below were not new issues, but they needed to be addressed if the US Virgin Islands is to have a functional, integrated data and information system supporting public health research, policy, and practice. Insufficient data integration and interagency collaboration; centralization of information/data Inadequate data collection and analysis Slow transition from paper to electronic databases Low levels of self-reporting that arise from cultural taboos Increase in communication and dialogue with at risk sectors of the population Increase in levels of valid, reliable, non-duplicative data Consistent collection of surveillance data More effective health promotion programs Improvement of accessibility to data with attention to privacy concerns Development of a VI Public Health Strategic Plan Improve strategies and processes to resolve IT workforce development, unwillingness to use data to change policies, challenges in setting priorities, personal and political willingness to address a new health information system and general opposition to change. GAPS IN HEALTH INFORMATION & DATA ON INCIDENCES OF DISEASE WORK GROUP SOURCE – SITE AND NUMBER ST. CROIX ST. THOMAS 1. Insufficient data on mental health 4 2. Poor data on “non-reportable” diseases 2 5 3. Insufficient data collection and input to current systems 1 4. Inclusion of risk factors in the BRFSS 1 5. Lack of information on underserved and vulnerable sectors (incarcerated, veterans, elderly, etc.) 1 6. Limited data on men/very young men. 1 VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 9 - GAPS IN HEALTH INFORMATION & DATA ON INCIDENCES OF DISEASE WORK GROUP SOURCE – SITE AND NUMBER ST. CROIX ST. THOMAS 7. Lacking data on food security/insecurity 1 8. Lack of registries addressing mosquitoes and other vector- borne diseases, asthma and other respiratory diseases 2 9. Consolidated data on overuse and abuse of the health care system 1 10. Data on people lost to follow-up ( e.g., non-US, undocumented foreigners, uninsured , uninsured veterans) 2 3 11. Additional data on spatial and temporal epidemiological incidences 2 12. Insufficient information about tourists and sex-workers 3 13. Data on off-island health treatment of citizens 3 14. Tracking of chronic diseases and health disparities in population 5 15. Consolidated data on people with disabilities 5 QUESTION 3. WHAT ARE POSSIBLE RECOMMENDATIONS FOR ADAPTING TO CLIMATE CHANGE IN SUPPORT OF GOOD PUBLIC HEALTH IN THE US VIRGIN ISLANDS? The recommendations offered by the Work Groups in support of adaptation to climate change impacts in the Territory focused on individual actions and initiatives for institutions and government agencies. Education/public awareness, collaboration, and improved, more effective infrastructure were dominant recommendations from the Work Groups. RECOMMENDATIONS FOR ADAPTING TO CLIMATE CHANGE IN SUPPORT OF PUBLIC HEALTH WORK GROUP SOURCE – SITE AND NUMBER ST. CROIX ST. THOMAS 1. Focused and improved public education and awareness on climate change adaptation in areas like diet, exercise and lifestyles 1 2. Inclusion of climate change in school curriculums, especially at the elementary level 1 3. Focus on collaboration with agriculture industry, especially with respect to necessary future crops and the economics of adapting to changing environmental conditions 1 4. Develop plans to address changes in infrastructure, land use, water use and storage, population relocation, landfill mitigation and relocation, waste management ( e.g., incentives on recycling and reuse), revise building practices and codes, and produce health initiative to address climate change impacts 1 3, 4, & 5 VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 10 - RECOMMENDATIONS FOR ADAPTING TO CLIMATE CHANGE IN SUPPORT OF PUBLIC HEALTH WORK GROUP SOURCE – SITE AND NUMBER ST. CROIX ST. THOMAS 5. Build the expertise for adaptation , including certified professionals and task force focused on data collection 1 3 6. Develop a communications strategy that will utilize a central data site with access regulations as well as responsible social media and include monitoring public environmental health practices, advocacy for health in all policies and advocacy for social and environmental changes 3 & 4 7. Seek collaborators for monitoring and needed data from Federal Agencies ( e.g., CDC , USDA, etc. ), private organizations (e.g., Red Cross) and other jurisdictions on climate change adaptation 1 & 2 8. Prioritize the completion of the climate change vulnerability assessment, including a review of policies and appropriate technologies 2 3 9. Complete the Supplemental Environmental Project associated with the Hovensa EPA settlement. 2 CONCLUSION AND NEXT STEPS Two-thirds of the health professionals and decision-makers that were invited participated in the 2016 Institute, and all participants were engaged and contributed to the discussions throughout the day. Feedback received during the wrap-up session and from the Institute evaluation indicates that the participants, despite their level of professional sophistication, found the three initial presentations useful and informative, and appreciated that the format allowed for meaningful engagement in information sharing. Though there was some concern that the discussion of adaptation strategies was not given adequate emphasis, participants conveyed appreciation for the information provided on climate change and its linkages to health, along with related initiatives underway at the VI Department of Health. All participants indicated that they felt it was important to assess the level of preparedness necessary for effective adaptation to climate change impacts and to begin the process. The professionals participating in the Institute made it very clear that they wanted to see the Territory advance its efforts to assess the current capacity to manage initiatives in support of climate change adaption for good public health under changing environmental conditions. There was a stated understanding of the need to begin the required vulnerability assessment of the health sector directed by the VI Executive Order on Climate Change (Executive Order No. 474-2015). Participants expressed considerable concern about the number of weaknesses associated with collection, analysis, and dissemination of health-related data and information in the Territory. Identification of the weaknesses in the local health data and information systems was VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 11 - followed by recommendations that more effort be made to include the VI in national databases accessible to the Territory. The importance of institutional and local-federal collaboration as part of an effective response to the infrastructure and assessment impediments was very apparent in the gaps in knowledge discussion and the recommendations offered by the participants. The list of sources of health data and information compiled from the outputs of the Institute Work Groups includes a diverse collection of institutions. The diversity of potential sources of health data and information offers additional support to the recommendations that focus on effective centralization of health data and information in a regulated, accessible system. The changing environment will present increasing physical, mental, and economic difficulties for individuals with health challenges, and the need for accurate, accessible, and meaningful health information for prevention and treatment will become even more urgent. The list of recommendations generated by the 2016 CERC Institute speaks to improved information and data systems as critical, includes the effective communications and planning, and acknowledges the power and need for collaboration on a number of levels. The most recent information that has been shared about the progress and projections of climate change impacts presents a sense of urgency to identify the information needed to put systems and initiatives in place that will allow people to live healthier lives in their more challenging and changed environments. The Virgin Islands is forced to tackle this assignment through the lens of small islands that are very vulnerable to extreme weather events and illnesses and diseases linked to increased temperatures and challenged water resources. An effective response will require assessment of the resources currently available and identification of the means to fill critical gaps in data, information, and processes. A meaningful response will require that the USVI acknowledge the underlying health disparities in the population, have difficult discussions, and make hard decisions regarding populations that are at the highest level of risk from the changing environment. A successful response to climate change impacts will result in the people and communities of the USVI adapting to a new, more hostile environment and living healthy lives. The next steps in this initiative involve sharing this report and other information on the UVI CERC web page with the participants of the 2016 Institute, the USVI Climate Change Council, the Office of the Governor, the Governor’s Cabinet, the Legislature of the USVI, and the general public. The CERC 2016 Institute sought to begin the process of assessing the types of health information and data that currently exist, identifying gaps in sources and information, and offering recommendations on a viable way forward. We are grateful to the sponsors of this event - UVI Community Engagement and Life–Long Learning (UVI CELL), the St. Thomas East End Medical Center Corporation (STEEMCC), and the UVI Caribbean Exploratory (NIMHD) Research Center (UVI CERC) – and to the participants who shared their information and ideas for making it possible to achieve these goals. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 12 - There is much work yet to be done to prepare the USVI for the impacts of climate change, particularly with respect to public health. The work accomplished through the CERC 2016 Institute is a solid start. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 13 - APPENDICES I. Program II. List of Participants III. Work Group Outputs IV. Summaries of Evaluations VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 14 - This page intentionally left blank. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 15 - APPENDIX I: Program VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 16 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 17 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 18 - This page intentionally left blank. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 19 - APPENDIX II: List of Participants VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 20 - 2016 Institute on Public Health and Climate Change Thursday, October 27, 2016 St. Croix, VI Name Agency 1. Baumann, Aletha University of the Virgin Islands 2. Barnes, Mona VI Territorial Emergency Management Agency 3. Chakroff, Paul Virgin Islands Conservation Society 4. Davis, Michelle VI Department of Health 5. Ellis, Esther VI Department of Health 6. Evangelista, Richard Gov. Juan F. Luis Hospital and Medical Center 7. Francis Jr., Novelle Legislature of the Virgin Islands 8. Gittens, Kenneth Legislature of the Virgin Islands 9. Hall, Melissa Legislature of the Virgin Islands, Rep. for Senator Sanes 10. Heyliger, Joyce CERC Advisory Board Member 11. Michael, Noreen University of the Virgin Islands, CERC 12. Navarro, Charlene Frederiksted Health Care, Inc. 13. James, Neville Legislature of the Virgin Islands 14. Rallings, Eurkres CERC Community and Outreach Core 15. Saunders, Lois University of the Virgin Islands 16. Soto, Christian University of the Virgin Islands, CERC 17. Valmond, Janis University of the Virgin Islands, CERC 18. Williams-Sutton, Lorna University of the Virgin Islands, CERC VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 21 - 2016 Institute on Public Health and Climate Thursday, October 27, 2016 St. Thomas, VI Name Agency 1. Alexandridis, Kostas University of the Virgin Islands 2. Brown, Deborah University of the Virgin Islands, CERC 3. Budsan, Jason Virgin Islands Conservation Society 4. Callwood, Gloria University of the Virgin Islands, CERC 5. Callwood, Karl Climate Change VI 6. Crawford, René St. Thomas East End MedicalCenter 7. George, Lynette CERC Advisory Board Member 8. Grimes, Kristin Wilson University of the Virgin Islands 9. Habtes, Yegin University of the Virgin Islands 10. Harrigan Sr., Justin Legislature of the Virgin Islands 11. Henry, Fitzroy University of Technology, Jamaica 12. Industrious, Sherrika University of the Virgin Islands, CERC 13. Jackson, Myron Legislature of the Virgin Islands 14. Krigger, Rudolph Legislature of the Virgin Islands Rep. of Senator Jean Forde 15. Millin Young, Janette Legislature of the Virgin Islands 16. Morris, David University of the Virgin Islands 17. Moses, Ivy Advisory Board Member 18. Nowakowski, Kelsey VI Source 19. Phillips-Dorsett, Taetia VI Department of Health 20. Plaskett, Darice Schneider Regional Medical Center 21. Ragster, LaVerne University of the Virgin Islands, CERC 22. Roach, Tregenza Legislature of the Virgin Islands 23. Ryan, Alyssa University of the Virgin Islands, CERC 24. Spivey, Shermaine Legislature of the Virgin Islands, Rep. of Senator Marvin Blyden 25. Smith, Moleto St. Thomas East End Medical Center Corporation 26. Stagger, Nyala Legislature of the Virgin Islands, Rep. of Senator Janette Millin Young 27. Thomas, Audria St. Thomas East End Medical Center Corporation 28. Watlington, Roy University of the Virgin Islands, Faculty Ameritus 29. Wright-Francis, Debra St. Thomas East End Medical Center Corporation VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 22 - This page intentionally left blank. VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 23 - APPENDIX III: Work Group Outputs VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 24 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 25 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 26 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 27 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 28 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 29 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 30 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 31 - APPENDIX IV: Summaries of Evaluations VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 32 - VI CERC 2016 Institute on Public Health and Climate Change: Final Report - 33 -