When Hurricane Sandy slammed into New York City in 2012, water poured into Bellevue Hospital’s basement, where the fuel pumps were stored. The elevators stopped working. At a time when its services were sorely needed, the oldest hospital in the United States was forced to close its doors, unequipped for storms of the climate change era. “One by one, all the patients in the intensive care unit, those on ventilators, and those receiving hemodialysis were carried down the stairs,” wrote physician and writer Danielle Ofri in the New England Journal of Medicine. It became all too clear, all too late, that climate change is a public health threat, and healthcare systems and policy will need to adapt.
Democratic presidential hopefuls so far have mostly debated health care policy and climate policy as separate issues, with the former getting far more debate time. Given the way the two topics intersect, it’s critical not just for climate plans to talk about public health implications, but also for any articulation of health care policy to acknowledge that health care will increasingly take place in a changed environment.
In 2015, the Lancet Commission called upon governments to ensure that “health and climate considerations are thoroughly integrated in government-wide strategies,” making clear that “a siloed approach to protecting human health from climate change will not work.” The health impacts of the climate crisis are vast, especially for the people of color, low-income people, and the uninsured most devastated by climate change. Vector-borne diseases, like dengue, malaria, and Lyme, are spreading into new regions. Super-charged storms, wildfires, drought, and flooding can disrupt infrastructure and interfere with treatment plans, not to mention trigger anxiety, depression, and PTSD. Climate shifts are also leading to crop failures as well as increased food contamination, contributing to food insecurity. Heat-related illnesses and deaths are on the rise. On the hottest days, air quality tends to deteriorate.
All of these require not just climate mitigation efforts, but also a public health response and health system responsive to conditions in the climate-change era. That includes affordability, since all of these problems can be expensive for affected individuals to deal with. “A vision of healthcare that is comprehensive is likely going to, in effect, reduce the cost of dealing with a lot of the things that will emerge in the course of climate change becoming more severe,” Justin Gundlach, a lawyer and the co-editor of the book Climate Change, Public Health, and the Law, told me over the phone.
Gundlach highlighted the need for “easier access to the kinds of interventions that we call preventative care,” which can educate people on what they might be susceptible to in their changing environments. He pointed to community health centers as a potential way to extend this type of care. A few candidates support more community health centers, including Bernie Sanders, Elizabeth Warren, and Joe Biden, though they haven’t talked in their released plans about how these centers might be useful in the era of climate change.
That’s generally true of candidates’ platforms: Health care gets a mention in climate plans, but not vice versa. Julián Castro’s climate plan mentions the need for accessible health care. “We will ensure that all people have access to universal and high-quality health care regardless of their employment status to respond to the dangerous health impacts of climate change.” Similarly, Warren’s climate plan also notes how “a simplified Medicare for All system will make it easier for the federal government to quickly tailor health care responses to specific environmental disasters.” And the principles of a Green New Deal—ensuring social equity and jobs, while directly addressing the source of climate change by setting stringent emissions goals—would likely lower the health vulnerabilities of certain populations, while also reducing the health impacts of climate change by tackling its source.
Some candidates also include public health interventions within their climate plans. Bernie Sanders is calling for a $40 billion Climate Justice Resiliency Fund, which would direct funds into areas with high climate vulnerabilities, including to address public health challenges and establish an Office of Climate Resiliency for People with Disabilities. Warren also supports more funding to environmental justice communities and adjusting permitting rules to the Clean Air Act and Clean Water Act to better measure environmental health disparities.
Many social policies indirectly affect this intersection of health and climate. For instance, affordable housing policy, which many candidates have proposed, is a way to protect people from environmental harm.
Every candidate has embraced increased healthcare access. Yet some of the candidates’ healthcare plans still have coverage gaps. For instance, Joe Biden’s plan for a public option added to the Affordable Care Act would leave 3 million people uninsured and fails to reform Medicare. This could mean that some of those most vulnerable to climate change do not receive the care they need, for example if they find themselves dealing with lyme or dengue (predicted to expand into the southeastern United States).
Then there’s mental health, so often under-discussed: “I would like to see more discussion among the candidates of policies to address the mental health aspects of climate change,” Jill Krueger, a director at the Network for Public Health Law, wrote in an e-mail. “How can federal policy address growing rates of anxiety and depression related to current and incipient effects of climate change, or what some are beginning to call ‘climate grief’?”
Last June, 70 medical groups issued a call for action highlighting the need for climate and health to be addressed together. Among other suggestions, it asked governments to “allocate resources to enable the health sector to effectively protect health in the face of climate change, starting with support for local and state health departments and a resilient hospital infrastructure,” which would help hospitals, like Bellevue, keep their doors open during disasters.
A public health response, on the scale necessary to address climate change, would involve intensive coordination across levels of government. “It’s going to require some thinking about how are we going to coordinate our responses at the state, federal and local level within the public health and health care system, which is not currently designed to do that well,” explained Jason Smith, a professor at Cal State East Bay who has researched the public health challenges of climate change. “It is a very decentralized, sort of unplanned system.”
The healthcare industry itself is also a major contributor to greenhouse gases, accounting for 10 percent of greenhouse emissions in the U.S. “What I don’t see many candidates talking about is the actual healthcare system and its contribution to climate change,” said Surili Patel, the Deputy Director for the Center for Public Health Policy at the American Public Health Association. “Whatever plan is out there, we need to make sure that most can get treated when needed in an affordable way, but also that our systems that deliver those treatments are contributing greatly to the climate crisis.”
Health policy can also help fight climate change. Project Drawdown has found that reproductive justice and family planning is one of the top solutions for reducing the world’s carbon load. By giving people the ability to choose when to have kids, it lowers the population, and therefore, the global CO2 burden.
Both effective climate policy and health policy, ultimately, answer the same question: How do we build healthy communities in the current world? It’s a question that is big and necessarily ongoing. The election cycle is one opportunity to make some headway in answering it.