Is This
The United Fate
Of America?

Enact legislation requiring a national strategic plan.

The United States urgently needs a strategic action plan to address the health impacts of climate change. Legislation should be enacted requiring the U.S. Department of Health and Human Services to develop such a plan and to fund development and ongoing maintenance of health system capacity specifically for this purpose.

The Climate Change Health Protection and Promotion Act of 2019, which requires the creation of such a plan, provides a valuable starting point for legislation that could address the concerns presented in this report. It mandates that federal agencies engage in forecasting and modeling, and that they track both environmental and disease data, expanding an understanding of the relationship between climate change and health outcomes. Importantly, the bill explicitly recognizes that “climate change disproportionately impacts communities of color and low-income communities,” and it calls for the federal government to use all practicable climate-related means and measures to improve health equity, including by prioritizing such communities in the plan and by requiring the inclusion of people with “practical or lived experience with relevant issues” in a newly formed science advisory board.

Fully fund the CDC’s Climate and Health program.

Congress and the CDC should ensure sufficient funding to support every state, locality, U.S. territory, and tribe that wishes to become a Climate-Ready States & Cities Initiative (CRSCI) grantee. Through training and other technical assistance, CRSCI helps grantees use the five-step Building Resilience Against Climate Effects (BRACE) framework to identify likely climate impacts in their communities, potential health effects, and their most at-risk populations and locations. Additional funding should also enable the CDC to bolster its guidance on evidence-based adaptation interventions.

Importantly, the CDC’s Climate and Health Program is part of a broader array of critical preparedness programs, including the CDC’s Public Health Preparedness Program, the Office of the Assistant Secretary for Preparedness and Response’s Hospital Preparedness Program, and grants to states made by FEMA and the EPA.

Provide funding for adaptation research and scientific training.

Federal priorities should include research funding via the National Institutes of Health or other agencies for academic centers of excellence, training of skilled researchers, and educational programming conducted by academic institutions. Research should study the effectiveness of promising interventions and risk-reduction initiatives in order to advance implementation science. These efforts would help build a full-fledged, evidence-based climate adaptation program to protect health.

Fully fund the CDC’s National Environmental Public Health Tracking Network.

This program works with a network of partners to collect, integrate, and analyze disease and environmental data to help public health and other practitioners identify and target health risks. The agency’s Climate and Health Program and Tracking Network collaborate often, with mutual benefits, including the provision of climate data. But the CDC is only able to fund participation in the Tracking Network for about half the states, many of which are already using the data to support their climate and health work. The CDC has estimated that it needs roughly $75 million to expand the program to all 50 states, the District of Columbia, and U.S. territories. Additional funding, alongside technical improvements to make reporting as smooth and straightforward as possible, would also allow the program to expand the type of health data available to policymakers, public health professionals, and the public.

Strengthen the public health infrastructure and workforce, including by modernizing data and surveillance capacities.

Public health and climate change work relies on good data that is comprehensive, comparable across jurisdictions, near real-time, and granular enough to allow for disaggregation by key factors of vulnerability (e.g., income, race, age, disability status, etc.). The nation needs mechanisms to collect these data to ensure they are being critically analyzed and used to drive policy. Federal leaders should establish a Core Public Health Infrastructure Program at the CDC, awarding grants to state, local, tribal, and territorial health departments to ensure they have the tools, highly trained workforce, and systems in place to address existing and emerging health threats. A critical imperative is filling the gap in relevant data on American Indian and Native Alaska tribal nations and U.S. territories, a priority made even more important by the acute threat that climate change poses to many of their residents.

Prioritize equity and resilience by supporting and protecting high-risk populations, and by addressing the social determinants of health.

As this report has documented, the health impacts of climate change will not be felt equally. Some people, owing to a mix of environmental, social, and demographic factors, will bear a disproportionate burden. Therefore, all relevant federal policies, programs, and funding must maintain a constant focus on the identification of these areas and people, and persistently intervene to reduce vulnerability and work side by side with high-risk groups to protect their health and safety.

Governments at all levels should direct funding to programs that address the social determinants of health—factors that improve the conditions in people’s lives and that impact their health and resilience. The CDC and other federal agencies should be funded to address social determinants through cross-sector collaboration, policy change, and community partnerships. One concrete step would be enacting the Improving Social Determinants of Health Act of 2020, which would create a program at the CDC to provide capacity-building grants to public health departments, community organizations, nonprofit organizations, and institutions of higher education.

Bolster states’ core public health preparedness capabilities.

State decision-makers—from governors to legislators to agency directors—must adequately fund core public health functions, including surveillance and epidemiological investigation capabilities, environmental monitoring, incident and information management, and healthcare readiness. Moreover, they must strengthen collaboration across stakeholders and work to earn public trust and build social cohesion, essential intangibles of effective preparedness.

Build health equity leadership in state and local governments.

All state and local governments, including health departments, should build up internal infrastructure to drive equity, including identifying a chief health equity or health resilience officer. Health equity and emergency preparedness officials should work across programs to incorporate equity issues and goals into preparedness policies and plans, improve staff understanding of how the legacies of structural and systemic racism affect disaster resilience and recovery, and collect and leverage data to identify unique community assets and advance equity on an ongoing basis.

Complete all steps of the CDC’s BRACE framework, and continuously work to enhance and refine preparations.

State agencies must conduct and facilitate rigorous vulnerability assessments at the state and local levels. The assessments should focus especially on populations at highest risk and the health threats most pertinent to them. States must also push ahead to complete all steps of the framework, including identifying and implementing evidence-based interventions to protect residents. Finally, as agencies implement interventions, they should continually evaluate effectiveness, and strive for quality improvement.

Establish ongoing, dedicated funding and staff for climate-related preparations.

Given the many competing demands on the public health workforce, health departments must designate at least one staff person to dedicate their time to preparing for and responding to climate change. Climate change preparations, however, do not just need to happen in health departments; agencies such as environmental and emergency management departments should designate similar positions. All these individuals should coordinate with each other across the state via regular meetings and common goals. To ensure accountability, climate change work should appear in the position descriptions and be part of these employees’ annual review process. Goals for these positions should be specific, measurable, achievable, results-oriented, and time-bound.

Engage in close coordination with local and federal partners.

Given the complex natures of both the climate and health, creating and funding positions at one level of government is not enough. Those on the front lines must drive planning and implementation at the state level. Where possible, state health departments should provide mechanisms for regular communication with local departments and tribal nations. This might take the form of calls or meetings. Similarly, state-level needs and successes must inform what happens at the federal level. State health departments should work with the Association of State and Territorial Health Officials to ensure agencies such as the CDC, EPA, and FEMA are aware of state needs.

Plan with communities, not for them.

Preparedness officials must include members of communities at greatest risk—and compensate them for their involvement, when appropriate—in planning and decision-making. Health departments and emergency management agencies should rely on the expertise of those who may bear a disproportionate risk, such as older adults, people with disabilities, and individuals with chronic health conditions, to ensure plans and procedures meet the needs of everyone. Community-driven planning strengthens resilience, as residents play a lead role in defining the challenges they face and the solutions most relevant to their unique circumstances.