Climate change and HHS: How to build back healthier

When two really big facts collide with each other, it can be jarring. Consider these two facts.

Fact one: Climate change is one of the most pressing challenges confronting not only our country, but our species. It threatens our economy and our biosphere. It is a public health threat that will eclipse the COVID-19 pandemic and the threat is accelerating. We must meet the climate challenge boldly and successfully, in order to ensure success.

Fact two: The mission of the U.S Department of Health and Human Services (HHS) is to “enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.” HHS has the largest budget in the federal government — roughly $1.37 trillion, nearly 25 percent higher than the next highest (Social Security), and nearly twice the Department of Defense budget. A negligible amount of this funding goes to addressing climate change.

At first glance, climate change might not seem to be an HHS concern. After all, many climate action efforts lie in the bailiwick of the Department of Energy, Department of Transportation, USDA and other federal agencies. But climate change is indisputably a health issue. A 2019 study by the Natural Resources Defense Council looked at just 10 climate-linked events in one year; they accounted for more than 900 deaths, 20,000 hospitalizations and 17,000 emergency department visits at a cost of over $10 billion.

As the Biden administration launches an all-hands-on-deck effort to tackle the climate crisis, HHS must play a major role in the response.

Public health preparedness and response:

To protect the public from climate change impacts, we need to assess risks and vulnerabilities and prepare for what’s coming. Depending on location, this might mean heat wave preparedness plans, infectious disease surveillance, improved water treatment or mental health services.

We need a stronger public health system, with adequate capacity for preparedness planning, disease surveillance, epidemiology, environmental monitoring and risk communication — assets that, as COVID has demonstrated, are now woefully deficient.

The Centers for Disease Control and Prevention Climate and Health program supports health departments in just 16 states, two cities and four tribes — of a total of more than 3,000 health departments nationally. The CDC needs the resources and capacity to up its game.

Research on health impacts of climate change, and on healthy solutions:

While there is much we know about the impacts of climate change on health, there is much we still don’t know. Our knowledge base is inadequate on ways to mitigate the spread of climate-related infectious diseases. We need better understanding of the impact of climate change on the nutritional content of crops, and of optimal strategies to protect outdoor workers from heat waves. The National Institutes of Health, with a budget of more than $40 billion, devotes a miniscule level of resources ($9 million) to research on climate change and health. NIH needs to up its game.

Climate-ready health care systems:

Health care accounts for nearly 20 percent of the U.S. economy, and an estimated 8.5 percent of U.S. greenhouse gas emissions. Health care lags other industry sectors in cutting its carbon emissions. 

Our hospitals and clinics need innovative, low-carbon treatment methods; clean energy sources; reduced travel demand (for example using telehealth); and sustainably produced foods. Pharmaceutical and medical equipment manufacturers need to drive toward net-zero greenhouse gas emissions. Hospitals and clinics need to be “climate-ready” — resilient and prepared for climate-related disasters. 

Key support can come from the Center for Medicare and Medicaid Services (through its Conditions for Coverage and reimbursement policies), the Food and Drug Administration (by incorporating environmental performance into its drug and device regulations) and the Agency for Healthcare Research and Quality (through research and guidelines on health care institution environmental performance).

Healthy infrastructure:

The Biden administration’s “Build Back Better “initiative can drive unprecedented investments in the nation’s infrastructure. Done correctly, this is a golden opportunity to improve health as a primary benefit: through healthy energy, healthy transportation, healthy agriculture and healthy housing. HHS can provide needed expertise and evidence.

HHS can be the catalyst for building back better — and healthier. In fact, a broad coalition of health professionals and organizations recently offered recommendations on how HHS can do just that.

The COVID pandemic demonstrates the devastation that a global infectious disease can cause. Climate change will be worse. We must not let that happen. Fighting climate change and protecting health and health equity are essential linked goals. HHS must fulfill its mission to “enhance the health and well-being of all Americans” by leading in tackling the climate crisis.

Howard Frumkin, MD, MPH, DrPH is a  public health physician, former dean of Public Health at the University of Washington and former director of CDC’s National Center for Environmental Health. 

Georges C. Benjamin, MD, is a public health physician and former secretary of the Maryland Department of Health and Mental Hygiene. He is executive director of the American Public Health Association.