Environmental public health indicators (EPHIs) are used by local, state, and federal health agencies to track the status of environmental hazards; exposure to those hazards; health effects of exposure; and public health interventions designed to reduce or prevent the hazard, exposure, or resulting health effect. Climate and health EPHIs have been developed at the state, federal, and international levels. However, they are also needed at the local level to track variations in community vulnerability and to evaluate the effectiveness of interventions designed to enhance community resilience. This review draws on a guidance document developed by the U.S. Council of State and Territorial Epidemiologists’ State Environmental Health Indicators Collaborative climate change working group to present a three-tiered approach to develop local climate change EPHIs. Local climate change EPHIs can assist local health departments (LHDs) in implementing key steps of the 10 essential public health services and the U.S. Centers for Disease Control and Prevention’s Building Resilience Against Climate Effects framework. They also allow LHDs to incorporate climate-related trends into the larger health department planning process and can be used to perform vulnerability assessments which can be leveraged to ensure that interventions designed to address climate change do not exacerbate existing health disparities. 1. Introduction In the last two decades, there has been an increasing awareness and interest in the connection between climate change and health, beginning with the publication of the first report of the UN’s Intergovernmental Panel on Climate Change in 1991 [1]. Researchers estimate that the global burden of disease attributable to climate change in 2000 was greater than 150,000 deaths (0.3% of global deaths), although this estimate only includes risks from temperature, diarrhea, malnutrition, floods, and malaria [2, 3]. This risk is increasing, and a significant proportion of the health burden due to climate change falls on children [4]. In order to better understand connections between climate change and human health, several groups are developing climate-sensitive indicators of environmental health, including the Council of State and Territorial Epidemiologists (CSTE) [5], the National Environmental Public Health Tracking Program (NEHTP) run by the U.S. Centers for Disease Control and Prevention (CDC) [6], the U.S. Environmental Protection Agency (EPA) [7], the National Research Council [8], the World Health Organization/Europe [9, 10], and the National Climate
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