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The phrase “health equity” often brings to mind factors such as race, employment, socioeconomic status, and location—all of which can affect health outcomes. Now add to that list climate change and the resulting increase in wildfires, flooding, temperature fluctuations, and extreme weather events, which can place clean air and water in jeopardy—affecting some demographics more than others.
Courtesy John Balbus
President Biden established the Office of Climate Change and Health Equity to address the impacts of climate change upon the health of Americans. It was established in August 2021. This interview with John Balbus M.D.H., interim Director of the Office of Climate Change and Health Equity Office of Climate Change and Health EquityThe U.S. Department of Health and Human Services has been edited to improve clarity and length.
Q: How does climate change impact health equity?
A: Climate change exacerbates health inequities. We Know that certain populations—including some communities of color, recent immigrants, those with low language proficiency, children, pregnant people, the elderly, people living with disabilities, indigenous peoples, and some occupational groups— already bear the burden of health disparities; this has been made starkly clear over the past two years, as these individuals have been hardest hit by the COVID-19 pandemic. These same populations are also more vulnerable to the increasing health effects of the climate crisis.
Q: Can you give me an example?
A: People with chronic medical conditions such as hypertension, diabetes, asthma, depression and anxiety, and kidney disease—ailments that are most often linked to racial discrimination and degraded Social determinants and health—are more vulnerable to climate change-induced stressors such as severe heat, air pollution associated with wildfires and air stagnation, and exposure to extreme weather events.
Q: How could this play out?
A: It is not random where people are suffering from climate change-related vulnerability and health disparities. Instead, they’re highly correlated with historic practices of financial discrimination, such as redlining, based on race.
Q: What prompted the development of your office’s design?
A: I believe the creation of our office reflects recognition of climate change as a threat to the health of the American people—and that it’s essential that the federal government create a central home to coordinate activities to protect the country’s health in the face of climate change. The specific mandate that led to the office’s creation was Executive Order 14008, issued in late January 2021, “Climate Crisis Management at Home and Abroad.”
Q: What’s your vision for the office’s work?
A: We envision a country that protects all Americans from the effects of climate change, especially those with the greatest health disparities. We’ve focused on three priority areas. The first is optimizing funding and programs available for communities to help them adapt to climate change. The second is collaborating with the federal agencies that are working to make the country’s infrastructure more sustainable and resilient; with them, we can ensure that these changes in our cities and towns also reduce underlying health disparities by improving the determinants of health that allow people to thrive. The third involves working directly with the U.S. healthcare sector to reduce its contribution to the climate crisis, and to strengthen all health systems and facilities that are protected from climate-related threats.
Q: What are the biggest obstacles you see in making climate change action plans health equity?
A: One, the lack of awareness on how important climate changes are to health; and another is how critical it is to address climate change mitigation goals. Despite recent statements by the World Health Organization, American Public Health Association and others, these challenges continue to exist. EditorialAccording to 210 medical journals, climate change is the most serious threat to global public safety.
Q: What are your plans to tackle these problems?
A: We want climate change actions to be central to HHS’s mission and efforts to achieve equity in health care. We’re bringing our knowledge, relationships, and experience of various activities across the country to help communities prepare, respond, and recover from climate events.
Q: Can you name any promising communities that emphasize health equity in tackling climate change?
A: One promising initiative in the development of Resilience hubsThese tools empower communities to create trusted resources to meet community members’ needs during both stable times, and during disruptions. The California Department of Public Health is the government’s representative. Climate Change and Health Equity Program. The Washington State Department of Health can be contacted at Map data used to identify disadvantaged communitiesto help develop long-term plans for preparing for extreme heat and wildfire smoke events. And we’re working with many HHS regional offices to incorporate climate change considerations into the great work that was launched by regional health equity councils and collaboratives to address the COVID-19 pandemic.
Q: Do you see any other bright spots?
A: There’s been an enormous growth of interest in climate change among health care professionals. The recent editorial from the world’s leading medical journals calling for action on the climate crisis is just one example. The National Academy of Medicine also focused intensely on climate change and launched a Climate Change and Health InitiativeA new version Action Collaborative on Decarbonizing America’s Health Sector—which our office supports and that Assistant Secretary for Health Admiral Rachel Levine co-chairs.
Another exciting aspect of the climate-health field is the growing interest in training healthcare professionals to be leaders in this area. There are two fellowships available for health professionals in climate change and health equity. One at HarvardAnother run by the National Medical Association and the Medical Society Consortium on Climate and Health. And we’re in the fifth year of a successful Climate and Health Science Policy Fellowship, which I’m privileged to co-direct with Dr. Jay Lemery of the University of Colorado.
Q: How do I approach people who might be skeptical about the link between climate and health?
A: Understanding a person or community’s values is important to move people to act. People value their health. Our office’s key message is that climate change is affecting your health. It’s possible you are thinking this could happen to your aunt in Arizona or your friend from Louisiana. But, we also mean that climate change can negatively impact your health. Wildfire smoke and flooding, extreme heat and vector and foodborne diseases can all be exacerbated by climate change. The key is to provide information that can be used to help individuals and communities protect their health. We’re coordinating within the department and across the U.S. government to collect existing information on the connections between climate change and health and develop new information where needed.
Q: What can organizations doing work on climate change do to make health equity front and centre?
A: Organizations working on climate change must focus on health equity. Those working to advance equity in health need to understand how climate change stressors can threaten their mission. The increasing number of health professionals in the country who understand the connection between climate change, our health, and climate change is a great resource for organizations working on climate change. They can help raise awareness and learn how to make their actions more successful. And health equity-focused organizations need to bring in the same health care professionals, as well as others in the climate change mitigation and adaptation professions, to ensure that measures being taken to address the social determinants of health take into account the added stressors that climate change is bringing now—and will increasingly bring in the future.
