Building resilience to climate change in Florida’s public health system

Whitney Reynier Rachel M. Gregg
Posted on: 6/25/2019 - Updated on: 3/02/2020

Posted by

Rachel Gregg

Project Summary

The Florida Building Resilience Against Climate Effects (BRACE) Program is building awareness and capacity in county health departments to address climate-related health impacts. The program has conducted a state-level vulnerability assessment to identify priority climate hazards, and used GIS mapping to better understand geographical differences in social and medical vulnerability to those hazards. Since 2016, the Florida BRACE Program has been providing support to four counties as they plan for climate change and implement and monitor health interventions. The BRACE Program serves in an advisory and capacity building role, helping connect county health practitioners to needed resources, tools, and expertise using webinars, trainings, social media, and other tools. In addition, the nonprofit Florida Institute for Health Innovation has engaged in several climate change efforts.


Florida’s BRACE Program launched in 2012 with funding from the Centers for Disease Control and Prevention (CDC). The Florida Department of Health led the Florida BRACE Program from 2012-2016 and in 2016, Florida State University took over leadership. This transition occurred in part because the Florida Department of Health lacked internal staff capacity, and because there was interest in having an independent arbitrator lead climate adaptation activities.

The primary goal of the Florida BRACE Program is to build awareness in county health departments and at the community level on health-related risks of climate change. The program strives to support county health departments in designing, implementing, and evaluating health interventions to address climate risks. The Florida BRACE Program largely serves in an advisory and capacity building role by providing resources, technical support, and evaluative capacity to county health departments to support local-level implementation. They act as an information repository, helping connect people doing on-the-ground work with needed resources and tools, and also helping connect county staff with a broader network of practitioners. The Florida BRACE Program has funding from the CDC through 2021.


From 2012-2016, under the leadership of the Florida Department of Health, the Florida BRACE Program was primarily focused on better understanding and communicating climate change impacts on public health. Program staff collaborated with the University of South Carolina Hazards and Vulnerability Research Institute to conduct a vulnerability assessment, which identified seven priority climate hazards for the state: hurricane winds, storm surge, flash flooding, sea level rise, extreme heat, drought, and wildfire. The program also identified and mapped the most at-risk areas by comparing medical and social vulnerability indices with hazard projection maps. Using this information, the program generated several communication products to inform health practitioners and the public about climate change risks. Products include profiles for the seven priority hazards, which outline risks and potential health outcomes, and touchstone event summaries, which highlight historical extreme events (e.g., drought, wildfires, flooding) and associated health outcomes in Florida.

Since 2016, the Florida BRACE Program has been focused on providing support to counties for planning, policy development, and implementing and monitoring health interventions to respond to climate change. The new leads at Florida State University are currently working with four counties, which were the first to express interest in collaborating with the BRACE program by applying for support through a statewide RFP process. The BRACE Program relies on county partners to identify climate hazards and associated health interventions of interest at the local level. BRACE Program staff help counties think through project processes and evaluative efforts, and provide technical support and assistance with county outreach and education efforts. Example engagements include:

  • In east-central Florida, the BRACE Program collaborated with a county in implementing and evaluating an extreme heat education campaign. The county wanted to evaluate (1) if the campaign was reaching the right people; (2) if it had the right scope and used effective messaging; (3) how many people it reached; and (4) if the messaging was changing behavior. The BRACE Program helped the county develop different campaign components, identify tracking indicators, and better identify what type of data would need to be collected to measure progress, ultimately resulting in a detailed implementation plan. This plan will be evaluated during subsequent summer heat events.
  • In southern Florida, the BRACE Program is working with a county to evaluate outcomes from Hurricane Irma in order to better prepare for future events. For example, they are evaluating the effectiveness of different evacuation and shelter procedures with the hope of minimizing hurricane impacts in the future.
  • In southwest Florida, the BRACE Program worked with a county to develop an implementation and monitoring plan for a localized health impact assessment. The county wanted to identify local climate vulnerabilities, such as storm surge, and evaluate how those vulnerabilities may affect transportation and healthcare infrastructure. The BRACE Program provided advisory support in plan development by providing guidance on what questions to ask and how to monitor implementation outcomes. This resulting document now serves as a foundation for future adaptation efforts and can be shared with emergency management personnel.

In their work with different counties, the Florida BRACE Program acts as a clearinghouse of different resources, tools, and expertise. They find and share tools, publications, and resources depending on the needs of each county. For example, they have collected and shared CDC best practices, publications and tools developed by other CDC grantees, and sea level rise viewers and models. They also connect county health departments with other individuals and organizations that can support their work. 

The Florida BRACE Program is comprised of a diverse set of partners that span a broad range of expertise and interest. They have a Technical Advisory Group (TAG), which provides technical support as well as proposal, project, and data review. The TAG is comprised of numerous different area experts (e.g., health, urban and regional planning, climate science, communications), health practitioners, and policy makers. There is also a Community Advisory Group, which strategically partners with community groups all over Florida to build a community of practice and advance resilience work. Partners include county health departments, Physicians for Social Responsibility, Organize Florida, and Catalyst Miami.

The Florida BRACE Program is using a variety of methods to communicate ongoing activities and best practices, and build capacity across the state. The program’s outreach efforts are mainly focused on county health departments. For example, they recently hosted an evaluation webinar, which introduced county health departments to the importance of evaluating adaptation activities and how to best conduct evaluation efforts at the local level. The program also participated in a climate change symposium hosted by Florida State Libraries, sharing current projects and lessons learned. Staff are also using social media (primarily Twitter and Facebook) to connect practitioners with relevant resources and other organizations working on climate change.

Outcomes and Conclusions

County engagements to date have been limited due to several factors, including available funding, county department staff capacity, and the learning curve for applying public health initiatives in a climate change context. Additionally, one overarching challenge is that state leadership does not acknowledge climate change. This has limited conversations and knowledge exchange by restricting the use of certain terminology (e.g., “climate change”), and limited adaptation progress because counties are not required to take action by the state. The Florida BRACE Program is focusing on incremental progress, providing whatever information, resources, support, and feedback they can to counties tackling adaptation in a politically unsupportive environment. 

Despite these challenges, the Florida BRACE Program has found success through several mechanisms. They are focusing on geographic areas where conditions are ripe for work. For example, they are working with counties that have expressed interest, and have capitalized on existing synergies created by the Southeast Florida Regional Climate Change Compact and a newly established regional resilience initiative in southwest Florida. They have also found success by framing their work through a resilience lens, focusing on community resilience to all disturbances, including climate change. Disaster events, although challenging, also provide opportunities for education and outreach by heightening awareness about connections between climate change and community health. Other factors that have supported Florida BRACE activities include an interdisciplinary and diverse project team, and continued funding and support from the CDC and its network of practitioners.

The Florida BRACE Program hopes to expand in the future by engaging with more county health departments across Florida’s 63 counties. In addition, they hope to develop more outreach and engagement opportunities. They are particularly interested in opportunities such as workshops, meetings, symposia, and webinars, which help connect local practitioners and create space for creative thinking and generating new ideas.


Reynier W & Gregg RM. 2019. Building resilience to climate change in Florida’s public health system [Case study on a project of the Florida BRACE Program]. Product of EcoAdapt's State of Adaptation Program. Retrieved from CAKE: (Last updated June 2019)

Project Contact

Dr. Tisha Holmes, [email protected]

Dr. Ava Holt, [email protected]

Affiliated Organizations

Florida Department of Health

Affiliated Organizations

Florida State University is a comprehensive, national graduate research university that puts research into action for the benefit of our students and society. Florida State offers leading undergraduate, graduate and professional programs. Many units have programs that consistently rank among the nation’s top twenty-five public universities, including those in Physics, Chemistry, Statistics, Ecology and Evolutionary Biology, Meteorology, Political Science, Psychology, Sociology, Criminology, Information, Creative Writing, Public Policy, Business and Law.