The idea that HHS has a responsibility to safeguard the public from climate change, including the inequities it exacerbates, is firmly rooted in U.S. public health history.
Public health and enhancing the well-being of all Americans are core aspects of HHS’ mission.1 That mission has been a consistent guidepost, even as the day-to-day work of the government has changed over time to meet the country’s evolving needs. In the 19th century, the “Great Sanitary Awakening” identified “filth” as a vehicle for disease transmission and connected urbanization with disease outbreaks.2 Sanitation became a public responsibility and many local public health agencies were established in large part to protect urban-dwelling, working-class people from contagious disease.3
Over the early 20th century, advances in medical science shifted the orientation of public health from preventing disease to prolonging life through medical treatments and promoting health education. 45 During this time, the federal government increasingly regulated, funded, and led public health campaigns. Many of these campaigns were successful. From 1930 through 1949, infant mortality rates declined by 52%.6 However, other initiatives, like the Tuskegee Syphilis Study, were unethical, racist, and resulted in tragic deaths.7 The legacy of public health contains both triumphs and structures of injustice that the country must continue to grapple with.
In 1953, President Eisenhower consolidated many ongoing public health activities into a Cabinet-level Department of Health, Education, and Welfare (HEW)8 (the predecessor of HHS). This meant that ongoing welfare programs, research initiatives, and grant-making activities could be better coordinated. One of HEW’s early victories was licensing the manufacture of the polio vaccine developed by Dr. Jonas Salk. HEW also addressed environmental health concerns including pesticide chemical residues on agricultural products and air pollution. 9
In 1970, the Environmental Protection Agency (EPA) was created to consolidate federal regulatory functions to reduce environmental pollution.10 HEW, later HHS, continued the separate but synergistic work of addressing environmental threats to health. For example, the EPA regulates drinking water and enforces certain limitations on exposure to contaminants like lead, 11 while the HHS Centers for Disease Control and Prevention (CDC) Childhood Lead Poisoning Prevention Program is dedicated to eliminating the public health problem of childhood lead poisoning through blood lead testing and surveillance, linking exposed children to recommended services, and targeted population-based interventions.12 The EPA and HHS each has distinct regulatory authorities and areas of expertise to contribute to shared objectives like improving water quality, especially for historically disadvantaged communities.
Today, the complexity of the health threats associated with climate change means that a single problem may involve multiple expert teams from HHS. For example, consider an area frequently impacted by hurricanes. The local government may apply for Hospital Preparedness Program funds to invest in healthcare system readiness.13 Many providers are also required to adhere to federal emergency preparedness regulations.14 The CDC helps prepare clinicians and health departments for potential disasters.15 And the Food and Drug Administration (FDA) works to prevent medical product shortages.16 After a disaster, Medicare will pay for the care of older and disabled community members and help them get replacement medical equipment.17 The goal is for these elements to work together seamlessly.
Unfortunately, climate change can increase the frequency and severity of extreme weather events like hurricanes. 18 HHS must coordinate its different operating divisions and work with other parts of the federal government to ensure we are as prepared as possible not only for this season’s challenges but for how future seasons may threaten Americans’ health and wellbeing. For example, HHS has implemented legislative increases in financial assistance to low-income households to pay for life-saving air conditioning19 and the majority of the states set aside a portion of these grants for weatherization purposes.20 However, over the long term, the Department must also coordinate with other agencies, like the Federal Emergency Management Administration, the Department of Energy, and the Department of Housing and Urban Development, to make communities more resilient to a future of more frequent and severe climate events such as heatwaves.
The health risks associated with climate change go far beyond hurricanes and extreme heat, and with increasing frequency and severity, these risks become more likely to occur at the same time. 2122 For example, when Hurricane Ida knocked out power to the New Orleans area, millions were put at risk from the high heat that followed the Hurricane.23 Droughts in the West can make heatwaves and wildfires more severe and, at the same time, increase the risks of infectious diseases like coccidioidomycosis (valley fever).24 Other health threats arise from warmer water temperatures, like algal blooms and shellfish poisoning.25 Changes in ambient temperature can enable ticks and mosquitoes to thrive and spread diseases like Lyme Disease and West Nile Virus.2627
Climate change does not affect all of us the same way. Just as unsanitary urban settings at the turn of the 20th century primarily affected low-income and immigrant communities, climate change likewise often hurts disadvantaged groups most. For example, if global sea levels rise by 50 centimeters, American Indian and Alaska Native individuals are 48% more likely to live in areas where land is projected to be inundated. 28 If the world warms by 2 degrees Celsius, Black and African American individuals are 34% more likely to live in areas with the highest projected increases in childhood asthma.28 Recognizing and quantifying these differences in risk is essential to directing critical resources to the communities most in need.
The incredibly broad effects of climate change and the many ways it worsens existing inequities in the United States must be met with a swift and sustained public health response. Our country helped eradicate polio and sanitized our cities. Now we must rise to meet another challenge. HHS and the Office of Climate Change and Health Equity are committed to that work.
5Hanlon, G., and J. Pickett. 1984. Public Health Administration and Practice. Times Mirror/Mosby.