Abstract Title:

Using a Scorecard Method to Describe Health Vulnerability Data

Authors:
Thie, Lauren-North Carolina Department of Health and Human Services
Ankem, Gayatri-Clean Air Carolina
Presentation Format:
Whats Going On
Keywords:
climate, health, vulnerability, asthma, heat
Abstract:
Introduction: The Building Resilience Against Climate Effects program housed within the Occupational
and Environmental Epidemiology Branch and funded by the Centers for Disease Control and Prevention,
has collected comprehensive vulnerability data on the potential health impacts of climate in North
Carolina. The goal for which is to assess climate related hazards and outcomes including populations and
geographic locations most at risk. In an effort to increase the broad access to this data, we have
synthesized it using a scorecard method. This method has been used by the National Association of City
and County Health Officials in determining health priorities, but has not previously been used in climate
and health planning.
Methods: The Hanlon Method for Prioritizing Health Problems is a method developed by JJ Hanlon that
has been utilized as an objective means to integrate criteria and feasibility. Using the Hanlon method,
health data may be categorized to produce a list of health priorities, incorporating baseline figures. In
addition to the Hanlon method, the National Association of City and County Health Officials
prioritization method was used. The prioritization method was used to develop weights for our
vulnerability data (National). For this scorecard, a program employee created the scoring, with feedback
from twenty or so advisory group members. In the future, the program intends to survey a larger group
of advisory members and subject area experts to limit objectivity.
Results: Climate and health indicator data were categorized as follows: asthma or air pollution, cancer,
extreme weather injuries, heat-related illness, mental health, water borne illness, and vector borne
illness. Rankings were established for the population burden of the outcome, urgency of the issue,
vulnerabilities, and strength of evidence. Specifically, burden describes the size of population exposed or
affected High (4-5), Medium (2-3), or Low (0-1). Urgency was developed by the North Carolina ClimateRelated Health Working Group and reflects the need to act soon and rather than later High (within 5
years, 4-5), Medium (within 10 years, 2-3), or Low (within 25 years, 0-1). Vulnerability describes the
environmental, population, or geographical distribution of the outcome High (4-5), Medium (2-3), or
Low (0-1). Strength of evidence implies the amount of scientific evidence that measures the strength of
association between climate change and the outcome Yes (3), Yes/Research Needed (2), or Research
Needed (1). The overall score for each health area was equal to A + 2B + 2C + 0.5D.

After evaluating the health impact areas, the two highest scored health impacts were asthma or air
pollution (26.5) and heat-related illness (25.5). The two lowest scored health impacts were winter
weather along the coast (7), piedmont (13), or mountains (11), and tornado deaths and injuries in the
mountains (14).
Discussion: As health impact indicator data related to climate and health are collected at the state or
local levels, it is imperative that the data are accessible and easily interpretable to a broad range of
stakeholders. The Hanlon Method was helpful in synthesizing large volumes of data. The method is
however subjective and can be improved by having multiple independent stakeholders score the data.
Source:
National Association of City and County Health Officials. First things first: prioritizing health problems.
Available at: http://www.naccho.org/topics/infrastructure/accreditation/upload/PrioritizationSummaries-and-Examples.pdf. Accessed January 16, 2014.