Anna Erickson

Title: Climate and Health Programs at Local Health Departments: Capacities, Barriers, and Facilitators

Abstract:

Climate change poses escalating and unevenly distributed public health risks, placingincreasing pressure on local health departments (LHDs) to develop climate and health (C&H)programming in the face of significant organizational, political, and resource-related constraints.This study examined barriers and facilitators to C&H program implementation outlined in theNational Association of City and County Health Officials’ (NACCHO) 2024 “Guide to Climateand Health Programs: Defining Practical Models for Investment in Climate and Health Actionfor Local Health Departments” for LHDs using the Consolidated Framework for ImplementationResearch (CFIR). Data was collected during facilitated small group discussions conducted at the2025 Preparedness Summit, where public health practitioners discussed implementationchallenges, opportunities, and workforce needs related to C&H programming. Facilitator notes,chart notes, and a Slido poll were summarized using CFIR-informed qualitative thematicanalysis. Preliminary review of results with the 2026 NACCHO Extreme Weather workgroupalso informed recommendations.

Six themes emerged from the analysis: (1) resource constraints limit programdevelopment; (2) climate work is reactive rather than institutionalized; (3) leadershipengagement determines prioritization; (4) political and policy context shapes feasibility andframing; (5) collaboration is essential but inconsistent and often informal; and (6) there is a needfor adaptable, localized, and replicable implementation approaches. Findings demonstrated thatimplementation capacity varied substantially across jurisdictions and was shaped by fundinginstability, workforce limitations, leadership support, political context, and access to externalpartnerships and technical resources. Participants frequently described C&H work as dependenton individual champions, short-term projects, and reactive emergency response systems ratherthan embedded organizational structures. At the same time, participants emphasized theimportance of adaptable implementation tools, peer learning opportunities, and flexiblecommunication strategies tailored to local political and cultural contexts.

The findings suggest that successful C&H implementation in LHDs requires more thanconceptual frameworks or guidance alone. Sustained funding, workforce development,leadership engagement, cross-sector collaboration, and adaptable implementation resources arecritical to advancing LHDs along a continuum from informal climate activities toward institutionalized and sustainable C&H programming. This study contributes practice-informedinsight into how LHD practitioners navigate implementation challenges and highlights theimportance of context-sensitive approaches to strengthening local public health climateadaptation capacity.