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Correspondence to Author: Gregory D. Kearney, DrPH ¹ , Guangxiao Hu, PhD ² , Julia Raymond Voisin, MPH ¹. 

1. East Carolina University, Brody School of Medicine, Department of Public Health, Greenville, North Carolina, USA.
2. East Carolina University, Thomas Harriot College, Department of Earth, Environment and Planning, Greenville, North Carolina, USA.

DOI: 10.52338/jocr.2026.5613

Abstract:

Climate change is altering the timing, duration, and intensity of environmental exposures, yet public health surveillance systems largely rely on calendar-based approaches that fail to capture these dynamics. In this study, we developed a climate-health, surveillance framework that positions phenology, the timing of biological flowering and pollen release events as measurable intermediary linking climate variability to respiratory health risk. Our surveillance framework integrated four primary indicators, including i) phenological exposure, ii) meteorological conditions, iii) air quality, and ⅳ) asthma-related health outcomes into a standardized composite index, using z-score normalization. Analyses were conducted at the ZIP code level to demonstrate indicator development, temporal dynamics, and spatial variation. Phenological signals function as leading indicators of exposure timing, enabling alignment of environmental conditions and health outcomes within biologically defined windows. Application of the framework illustrates how synchronization of exposure, environmental, and health indicators correspond to increased respiratory risk, while misalignment results in lower index values. Time-series outputs demonstrate the ability of the index to capture onset, escalation, and persistence of risk, and spatial summaries highlight heterogeneity in risk patterns across ZIP codes. By translating ecological signals into a unified, interpretable metric, this approach advances climate–health surveillance from a reactive to an anticipatory model. The framework is scalable, interoperable, and adaptable to multiple hazards and settings, providing for a biologically grounded pathway for integrating climate-driven ecological change into public health surveillance and decision-making.

Keywords: Air quality; climate change, pollen, environmental health, asthma.

Citation:

Dr. Gregory D. Kearney, Integrating Phenology As A Leading Indicator In Climate–Health Surveillance For Early Warning Of Seasonal Pollen And Respiratory Risk. Journal of Climate Research 2026.