President Biden signed an executive order during his first week in office requiring the U.S. Department of Health and Human Services (HHS) to create an Office of Climate Change and Health Equity. This historic order establishes an office to assess the impact of climate change on the health of Americans while focusing deeply on equity. Mathematica urges the office to consider the following actions:
- Integrate health and climate data to better understand health care use driven by climate change
Climate and health data exist at the federal level, but they are not easy to link. For example, the Environmental Protection Agency reports environmental and demographic data in an environmental justice mapping and screening tool, EJSCREEN, and the National Oceanic and Atmospheric Administration provides access to climatological data through its Climate Data Online tool. Similarly, the Centers for Medicare & Medicaid Services (CMS) provides analytical research files containing health care data on enrollment and service use for all Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Sharing climate and health data across federal agencies and offices to create information about a climate event and then examine subsequent health impacts represents an opportunity to analyze climate impacts on health care use and realize the full potential of these disparate data sets.
Some states, such as California, New York, and Washington, are leading the way by developing equity maps that “track the cumulative impacts of exposure to pollution, health disparities, and economic inequality.” These tools link environmental exposures and effects, such as emission levels, lead risk from housing, and proximity to heavy traffic roadways, with health data, such as cardiovascular death rates and low birth weights, and socioeconomic factors. These states’ efforts could provide a road map for federal action to create a linked network of data and analytics. This network would enable the public to easily gain insights without the inevitable challenges that come from a patchwork of state approaches to tracking and analyzing data.
In addition, the office can support enhancements to existing federal data systems to ensure they capture the data needed to understand the connection between climate and health equity. For example, data captured at the federal level on Medicare, Medicaid, and CHIP beneficiaries and their health care use do not adequately identify the races and ethnicities of beneficiaries or individual providers, and they do not capture gender identity (although information on a beneficiary’s sex at birth is available in the data).
- Treat the impacts of climate change as a social determinant of health
In the ongoing efforts to improve health care value and quality, there is growing understanding among health payers and providers that social risks, such as housing and food insecurity, are critical factors influencing efforts to improve health care value and quality. As such, federal efforts such as CMS’s Accountable Health Communities Model were designed to promote the use of community services and assistance programs that support whole-person health and well-being. Addressing the social determinants of health (SDOH) is increasingly understood as a key component in promoting health equity. Similarly, the climate and environmental conditions in which someone lives is also a SDOH and should be addressed.
With an intersectional nature similar to that of SDOH, climate change is also a multisystem issue. The HHS Office of Climate Change and Health Equity can address SDOH and enhance the well-being of historically underserved Americans by considering the environmental and climate-related factors that unequally affect communities of color. Efforts by Medicare Advantage and certain states’ applications of Medicaid 1115 waivers to cover non-direct medical expenses, such as air conditioners, are examples of potential solutions to address the disproportionate health impacts of major climate events on marginalized communities. These programs could be expanded to include items and services not ordinarily covered that might be medically beneficial to patients whose health conditions are exacerbated by climate change. For instance, HHS could consider expanding these programs to include other types of relevant expenses, such as providing generators to power refrigerators for those who experience a climate-related event and whose health conditions require medicines that must be stored at a low temperature.
- Connect existing programs and services to reduce climate vulnerability for affected communities
A deeper understanding of the intersectionality of health and climate provides a real opportunity to tie together existing HHS programs to address climate-related issues and promote equity. For example, heat stress and high temperatures affect a number of health outcomes, including kidney disease. HHS offers programs to help combat the effects of extreme weather on health, such as the Low-Income Home Energy Assistance Program, which received a $4.5 billion funding infusion as part of the American Rescue Plan Act of 2021. Similarly, programs through the Assistant Secretary for Preparedness and Response and the Centers for Disease Control and Prevention, that provide public health preparedness and disaster response resources, can maximize their effect and reach by coordinating with Medicaid and Medicare programs to target resources to those most likely to be impacted by economic and social inequities. As HHS rolls out or expands its programs, it should take a holistic approach, looking across its programs to prioritize assisting communities most vulnerable to the health impacts of climate change. The offices should also prioritize research into the effectiveness of programs and interventions focused on building health and energy infrastructure resilience in vulnerable communities.
- Engage and center communities most affected by climate change
The effects of climate change are not borne equally across the United States; people of color are disproportionately affected. A 2017 paper in Science, and subsequent research on the topic, established that the lowest-income communities in America will be most affected by future economic damage stemming from climate change. For example, race is the number one indicator for the placement of toxic industrial facilities across the country. Black and Hispanic communities are disproportionately burdened by air pollution, whereas White Americans live in communities with better air quality than the overall average. Fifty-seven percent of people of color live in a county with a failing grade for ozone, particle pollution, or both, nearly 20 percent higher than White Americans. And 68 percent of Black Americans live within 30 miles of a coal-fired power plant, a higher proportion than the 56 percent of white Americans who live in these areas.
Although communities of color are disproportionately affected by climate change, they are too often left out of the dialogue on how to solve it. The Office of Climate Change and Health Equity should take on efforts and initiatives that seek to directly engage with these communities, so that the voices of individuals in the most affected communities are contributing to the solution. Communities and representative community organizations that empower and elevate voices of those most affected can play key roles in intervention development.
