Climate change

‘Sense of Urgency’ for HHS Climate Change Office

Without money and permanent staff to address the public health effects of global warming, low-income and elderly populations risk devastating consequences, from weather emergencies to chronic diseases, leading to preventable deaths and costing billions of dollars to the world. government.

Meanwhile, city and state public health officials say it will take hundreds of billions of dollars to stem the climate-related health issues occurring nationwide.

“Climate change is the greatest threat to the health of mankind,” said Jeffrey Duchin, chief health officer for Seattle and King County. “And I’ve been concerned about Covid for the last two years.”

HHS created the Office of Climate Change and Health Equity in September and assigned employees from other parts of the department to outline priorities for the office while awaiting funding that was expected to arrive this year. budget. That package passed last month, but with the $3 million request dropped among dozens of other provisions — like the bloated Covid-19 relief — as lawmakers sought to cut costs.

“I believe some have a sense of urgency about climate change, and of course some don’t,” said HHS Assistant Secretary of Health Rachel Levine, who oversees the office of climate change and hopes create momentum for more funding in the years to come. years.

Levine traveled to Seattle in March to meet with Duchin and other public health officials, first responders and community advocates. Representatives painted a dire picture, saying their county’s health systems — the first to report coronavirus cases in the United States in February 2020 — were ill-prepared for a second crisis resulting in heat stroke, fires in forest and the prospect of moving critical patients out of at- risk hospitals in these scenarios.

Consider cascading effects

Nearly a year and a half after the first case of coronavirus, a new emergency has struck the same vulnerable, elderly and underserved populations devastated by the ongoing pandemic, said emergency physician Steven Mitchell, director of the emergency department of the Harborview Medical Center in downtown Seattle and the leader of city hospitals’ efforts to level treatment capacity during the pandemic.

Another area hospital called Harborview to request ventilators. South Seattle providers were especially inundated with patients from surrounding low-income neighborhoods without air conditioning. Meanwhile, extreme heat pushed people indoors at a time when public health officials were insisting on social distancing to avoid Covid infection.

“Luckily we were sort of between the Covid surges, so our system had a bit of capacity,” Mitchell said. “Because it could have been a lot more overwhelming, when you pile one disaster on top of another disaster.”

For Washington, which recorded 100 heat-related deaths following the heatwave, it was one of the deadliest weather events in state history. Oregon and the west coast of Canada have recorded even more deaths, with some predictions estimating that more than 1,000 people died from heat-related illnesses during and shortly after the emergency in late June. Most of them were elderly and low-income, reflecting broader trends in climate change and health impacts across the world.

“Heat is easy for people to get because they see it. But they may not recognize how devastating it is to a community,” said Georges Benjamin, executive director of the American Public Health Association and former secretary of the Maryland Department of Health and Mental Hygiene.

Benjamin described an urban “heat island” effect in which urban areas with little green space – often minority communities – experienced higher temperatures and poorer air quality than neighboring areas, as well as more cardiovascular problems and asthma. A Johns Hopkins study in Baltimore sought to establish a link between increased crime and warmer days.

The health costs of climate change and resulting air pollution “already far exceed” $800 billion a year between premature deaths, medical costs, related medications and indirect effects such as home and community instability, job losses and damage to mental health, according to a Analysis 2021 by the Medical Society Consortium on Climate and Health, the Natural Resources Defense Council and the Wisconsin Health Professional for Climate Action.

Some of these factors are more directly measurable than others, but even these are difficult to quantify. For example, hundreds of Americans died last summer of heatstroke causing cardiac arrest, brain damage and other organ failure. Always more drowning death as they tried to calm down. Rescuers and hospital staff have been stretched between the heat emergency and the coronavirus cases.

It’s the “cascading” impacts of climate change-related health issues, as Duchin and other public health experts call them the domino-shaped health and equity issues that are popping up.

“Our health care system was already stressed by Covid-19, and then you have the added burden of a climate-induced weather event that adds additional stress to both our emergency medical services and our system. health care delivery,” he said. “We really need to pay more attention to building the resilience of our health system to deal with these multiple threats.”

The funding challenge

Without funding, federal health department climate workers — who include Environmental Defense Fund scientists John Balbus and Arsenio Mataka, who advised current HHS Secretary Xavier Becerra on environmental policy when he was California’s attorney general — largely focused on meeting with various federal agencies to form the office’s goals and piece together the scope of the problem.

Levine said the group plans to gather data on the impact of climate change on health, some of which exists in the Environmental Protection Agency, the Centers for Disease Control and Prevention or federal care programs like Medicare and Medicaid, but must be assessed through a new lens. . Other data was in disparate state and local health systems and hospital records.

With funding, Levine hopes the climate office can embark on education and policy efforts. A key goal is to push hospitals and healthcare networks to reduce their carbon emissions, which together with other healthcare companies like drug and device makers, account for about 8.5% of the total footprint of the United States.

It’s an important goal that HHS doesn’t actually regulate, though Levine insists they can use the “bully pulpit” to nudge companies toward greener practices. Other public health experts advising the agency closely suggest that federal programs like Medicare and Medicaid could even tie payment reforms to climate goals, incentivizing telehealth, home care and preventative medicine that have all a smaller footprint than clinical care and expensive tests or operations.

“It also gives us the chance to look at how we care for people,” said National Academy of Medicine President Victor Dzau, who led task forces with public health experts Levine. and industry leaders. Liz Fowler, head of the Center for Medicare and Medicaid Innovation, which is testing different payment models, was among those groups.

Other agencies and state governments could also build carbon footprint requirements into tax incentives and facility accreditations, APHA’s Benjamin said.

The carbon footprint plan would also be in line with Biden’s goal of halving the country’s greenhouse gas emissions by 2030 and transitioning to clean energy, a mission that some proponents of the environment fear that it is already being undermined by current efforts to reduce high gas prices.

Still, administration officials and health experts worry that pandemic fatigue and lawmakers’ concern over increased federal spending could slow those goals. Congress has already cut funding for the Covid-19 response which the White House says is essential to buy more vaccines, treatments and tests, and separately the Department of Health has asked for $80 billion to fund pandemic preparedness efforts.

“People are naturally really challenged to do things about future events, even when they’re given a lot of evidence that those things are going to happen,” Duchin said. “Which may well be our undoing.”