Discussion leaders: Agnes Fleming and Pat Kocagil

Notes by Keith Benson

Overall the group found the draft report to be informative and a good start to covering an important subject.

The proposed adaptive index model for examining health risks was well received; participants provided vital feedback for improving the model.

- Concern about the messages: For example, the number of cases of Lyme Disease indicated by the baseline assessment appear to be significant, yet the draft does not assess how climate change would affect this disease.

Diseases included in the report seem to have a lower economic impact than other diseases listed in the baseline. Perhaps add a paragraph discussing each disease.

The draft lacks a discussion of public health infrastructure and its current trends (such as decreasing funding). Because the majority of health risks associated with climate change are non-voluntarily (versus voluntarily - e.g., smoking) public health departments within the MAR will be part of a front-line defense. Thus, it might be useful to discuss the future capabilities of public health provision.

Clarify table of future trends. Trends are marked as positive or negative, but without citations or justifications. Some trends have both a positive and negative component; need to capture these nuances.

The draft assesses a limited set of health risks. Perhaps add a page or appendix listing other possible risks.

Aside from heat-related mortality, the draft lacks any predictions on mortality or morbidity that might result from climate change.

Discuss health implications of unusual events or surprises resulting from climate change.

The report would be strengthened by discussing how policy decisions might affect health risks, including a review of secondary effects of policy interventions. Discuss how climate might be a contributing factor to certain risks, such as the link between temperature and violence or food-borne illnesses (in context, such as current food-borne illness within the region).