Background: Extreme heat and wildfire smoke events have significant health impacts that are not evenly distributed. The communities with the heaviest health burden are the ones most exposed and least likely to have the economic, social, or political resources needed to respond. There is a critical need to implement community-level interventions to mitigate negative health effects.

Proposed Solution to the Problem: To date, there have been limited efforts to engage communities in the design and implementation of community-level strategies despite success being dependent on matching strategies to local needs and priorities. Using principles of community-based participatory action research, the project team proposes to build a sustainable partnership with community stakeholders who will be equal partners to identify, develop, lead, and disseminate patient-centered outcomes research (PCOR) and comparative clinical effectiveness research (CER). The team will provide neutral spaces to facilitate bidirectional informational exchange; equip community stakeholders with necessary skills to offset power imbalances; and prioritize community-stakeholder engagement on the leadership team.

Objectives: By bringing together community stakeholders, municipality stakeholders, including the San Francisco (SF) Department of Public Health (DPH) and Office of Resilience and Capital Planning (ORCP), and UCSF researchers with comparative effectiveness research expertise, the team will build capacity for engagement and research related to climate and health. Through this new partnership, the team aims to:

• Build and engage a community stakeholder group from San Francisco neighborhoods and community-based organizations serving areas disproportionately impacted by extreme heat and poor air quality
• With community partners, identify priority climate-related health conditions, patient-centered outcomes, and acceptable community-level interventions strategies
• Prioritize through a stakeholder partnership process acceptable interventions that target climate-related health priorities and patient-centered outcomes to develop a comparative effectiveness research agenda to guide future testing

Activities: Initiated by SF DPH and ORCP, the Heat and Air Quality Resilience (HAQR) project has resulted in a cross-municipality collaboration around climate effects that is ripe for community stakeholder engagement. This stakeholder group will be central to prioritizing climate-related health conditions and outcomes and identifying acceptable community-level interventions. The team will also conduct surveys and focus groups with residents and patients from high-risk neighborhoods to prioritize community-level interventions.

Projected Outcomes and Outputs: At the conclusion of this award, the team will have engaged a group of community stakeholders to serve as research partners for future PCOR and identified community priority health conditions to focus on two to three acceptable interventions that address priority health conditions, and a PCOR/CER research agenda to test such interventions.

Patient and Stakeholder Engagement Plan: The project team has a history of working closely with diverse communities and advocacy groups to address environmental contributors to poor health. The team will engage with advocacy groups, use word-of-mouth, and place advertisements in high-susceptibility neighborhoods to identify five patients and advocates to compose the community stakeholder group. This group will be integrated as an equal partner in HAQR.

Project Collaborators: San Francisco Department of Public Health and San Francisco Office of Resilience and Capital Planning.