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.
To address the impact of climate change on the health of the American people, President Biden directed the department of Health and Human Services to create the Office of Climate Change and Health Equity, established in August 2021. This interview with John Balbus, M.D., M.P.H., interim director of the Office of Climate Change and Health Equity within the U.S. Department of Health and Human Services (HHS), has been edited for length and clarity.
Q: How does climate change affect 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 susceptible to the growing health impacts of the climate crisis.
Q: Can you give 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 of 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: Where might we see this play out?
A: The places where people are bearing the burden both of health disparities and of climate change-related health vulnerability are not randomly located. Instead, they’re highly correlated with historic practices of financial discrimination, such as redlining, based on race.
Q: What spurred the development of your office?
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, “Tackling the Climate Crisis at Home and Abroad.”
Q: What’s your vision for the office’s work?
A: We envision a country that protects the health of all Americans from climate change hazards, especially those who bear the highest burden of health disparities. We’ve focused on three priority areas. The first is optimizing the programs and funding available to communities to build their resilience in the face of climate change health hazards. 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 is working directly with the U.S. health sector to reduce its contributions to the climate crisis and enhance the strength of all health systems and facilities against climate change-related threats.
Q: What are the biggest challenges you foresee in making health equity a key consideration in climate change action plans?
A: One is the lack of awareness of how important climate change is to health; another is how critical dealing with health is to achieving climate change mitigation goals. These challenges persist despite pronouncements by leaders of the World Health Organization, the American Public Health Association, and even a recent editorial from 210 leading medical journals, all calling climate change the greatest threat to global public health.
Q: How do you plan to address these challenges?
A: We want to make climate change actions central to the mission of HHS and its efforts to achieve health equity. 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: Are there any promising examples of communities emphasizing health equity as part of tackling climate change?
A: One promising initiative is the development of resilience hubs, which help empower communities to establish trusted resources to meet needs of community members in stable times as well as during disruptions. From the government side, the California Department of Public Health has a Climate Change and Health Equity Program. The Washington State Department of Health is mapping data to identify disadvantaged communities and to inform long-term preparedness plans to protect health during 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: Are there 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 has also focused intently on climate change, launching a Climate Change and Health Initiative and a new Action Collaborative on Decarbonizing the U.S. Health Sector—which our office supports and that Assistant Secretary for Health Admiral Rachel Levine co-chairs.
Another exciting aspect is the growing interest in training health care professionals to become leaders in the climate-health arena. There are now two fellowships on health equity and climate change for health professionals: one at Harvard and another run by the National Medical Association with 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 you approach people who may be skeptical of the link between climate change and health?
A: Understanding a person or community’s values is important to move people to act. People value their health, so a key message from our office is that right now, and all over the country, climate change is impacting your health. You may be reading this and thinking it could happen to your friend in Louisiana or your aunt in Arizona, but we also mean that your health is connected to, and can be negatively impacted by, the changing climate: Wildfire smoke, flooding, extreme heat, and vector and food-borne diseases can all be worsened by climate change. Additionally, providing actionable information for individuals and communities to protect their health is key. 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 working on climate change do to bring health equity front and center?
A: We need organizations working on climate change to focus on health equity, and we need those working to advance health equity to recognize how climate change stressors will challenge their mission. Organizations working on climate change should invite in the growing body of health professionals around the country who understand the close connection between climate change and our health; that way, they can raise awareness and understand how to make their actions more effective. 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.