Healthcare Getting It Right : Climate and Environmental Health Impacts on Human Health

Global health has matched the global interest in climate health advocacy. Global health has the opportunity to enhance partnership with the healthcare industry, as well as assume a liaison role between healthcare and non-healthcare industries.

The definition of climate health, as opposed to climate-related environmental health that impacts the public, should be used consistently and with clarity. Climate health could be devoted to the health of the climate, including mitigation of climate change. This is completely separate than climate-related environmental health that acutely impacts life.
The unnecessary gray areas between environmental health responsibilities and climate change responsibilities can be clearer. Climate-related environmental health and actions to mitigate climate changes (flood risk preparedness inclusive of water-borne illness preparation), as opposed to environmental health in the public health realm (restaurant inspections, pool inspections, waste management), can be better organized.
Global health has instituted new resources for climate health within the public health realm [1]. This is an opportunity to create structure.

Distinction between mitigation, response and climate change prevention work would help.
Distinction between everyday environmental public health and emergency preparedness would help.
Standardization of burden methodology and standards to interventions would also help. The statistic provided by climahealth.info is very misleading [2]. That every year, environmental factors “take the lives” of 13 million people is misleading. This statistic includes everything from occupational injuries resulting in HIV transmission to self-harm from access to chemicals. The data source fails to be thorough in catastrophic climate events as well; the report doesn’t detail housing, food and medication supply disruption from a flood or hurricane.

The climahealth movement is admirable and new [2]. With this:

There is opportunity to describe and align specific categories of human health burden.
There is opportunity to gain consensus on formulas for estimation.
There is opportunity to distinguish between environmental public health and climate change response. The difference between decades-old programs in mosquito abatement and new needs in vector-borne illness prevention matter. The difference between asking public health to advocate for reduced traffic pollution and asking public health to respond to cancer surveillance epidemiology is stark; these issues may involve the environment yet needn’t be grouped under the same oversight.
Stronger epidemiological oversight is necessary when a country faces a major climate catastrophe. This is an area where new global climate health organization can lead, specifically with response levels and standardized data collection tools. It matters if a hurricane in the United States disrupts pharmaceutical access for 5 days and if a flood in a LMIC disrupts pharmaceutical access for 6 months.
The opportunity for capacity assessments from burden and projection formulas should be taken. It matters if the manufacturing or trade capacity of a country is prepared for projected asthma medication needs, or not.
Tasks, quality improvement metrics and actions specific to healthcare buildings, healthcare environments, health industry needs (asthma medications, etc) and medicine would assist the healthcare industry. Tasking is lacking because the broader issues of climate and environment are not organized, and because there is confusion between healthcare participation in climate change mitigation versus environmental health. Also, there may be a disconnect between what climate advocates are passionately messaging and what public environmental health is already overseeing.

Climate change mitigation responsibilities in healthcare should be logical.

Structure to energy efficiency and ecofriendly efforts by the healthcare industry should be actionable and measured.
The serious disconnect between language messaged and healthcare priorities for patients should be acknowledged. The picture of a dramatic actor playing a physician, a physician more concerned about saving a trauma patient’s life than the unnecessary plastic waste used or energy inefficiency during care, isn’t fiction. In real life, the recent pandemic disrupted ecofriendly policies right before the public’s eyes. We experienced an immediate backburner placement of climate concerns because the acute priority of surviving is inherent. This is a reality that many in healthcare live every day, beyond pandemics. It is not enough to calculate balances, such as the offsets between low traffic pollution to plastic cups. Global health leadership needs to get serious about the healthcare industry and the public’s priorities: life will always take urgent precedence, there will always be a life-saving need, and physician and industry leadership will refocus whenever and wherever acute care is needed. A clear and better plan to mitigate climate change involving healthcare should relieve the burden from those who won’t hesitate to choose. In other words, what is the plan for automatic ecofriendly workarounds moving forward? Let’s concur, so healthcare can do its part, and so healthcare can maintain integrity to medicine’s priorities while doing so.

US national healthcare has increased attention to climate change and climate-related environmental health.

Health impacts from climate and environment issues are clarified by the CDC [3]. Evidence strength is also specified and is welcomed.

Clarity to the differences between environmental health and climate change concerns is an opportunity. Avoiding the wanton entrance of political and social conversations about what is manmade and what can’t be helped can be accomplished with commitment to objective health conversation. When clarity between what to expect from basic environment is teased out from climate change course, objectivity steers health planning.
Data and methodology validation and standardization would be helpful.
How this methodology is applied by states and municipalities is unclear. References for the data projection [4] and formulas would be helpful. For example, it is helpful to understand if the formula that the CDC uses to project increased asthma cases in the Midwest mirrors formulas used by local, state and global health organizations [5].
Resources provided by the CDC are very different than those provided by national public health organizations, including APHA [6,7]. Messaging is also different. There is no justification for public health to be all over the place with climate-related environmental health issues.

Healthcare’s responsibilities to climate change preparation and mitigation are intentionally opaque and inattentive. “Resources for health departments” truly is no longer good enough.

Building and engineering requirements for hospitals, pharmaceutical manufacturers and other structures is a shared responsibility beyond “health departments”. The tool used for energy assessment shared by APHA may or may not be supported by major engineering and construction organizations [8]. It is unclear how public health, private healthcare, construction and engineering are aligned on ecofriendly structure.
Environmental health issues may see flexed oversight as climate-related environmental health issues draw more attention. Waste management requirements, city policies (such as reduced traffic in busy pedestrian areas) and local environmental designing (to mitigate vector borne illness, reduce energy use) are a shared responsibility yet should have designated oversight. This is the oversight that “health departments” should be able to go to for direct information and response.
Climate-related environmental health issues that impact physical medicine also require acceptance and accountability from industries and their lobbyists, including for medicine and healthcare delivery access. Increased asthma projections and increased vector-borne illness also place responsibility on higher education for the supply of clinicians, pharmaceutical planning for generics and competition, and insurance industry preparation. Climate Capacity [9] messaging by ASTHO could also be supported by specifics on clinical medicine needs.
Clarity to environmental health oversight (versus medical or clinical oversight) could be clearer. An analysis of local and state public environmental health needs and capacities, credentialing, quality accreditation and reliance on private contracting would be a good start.
Major frameworks used by the CDC, and funded as grant work to states, are organized. BRACE [10] is organized, reference by evidence and it is logical. Yet frameworks are inconsistently applied.

BRACE is not mirrored by states, national public health administration groups or national public health associations.
It is unknown if BRACE or any other framework is assessed when accrediting towns, counties, municipalities or public health departments with various quality accreditation.

Distinction between Emergency Preparedness, Clinical Public Health and Environmental Public Health should be clear in action planning. They are currently thrown into the messaging with little regard for organization and standardization across private and public organizations.

It is unclear how climate health intervention assessments are teasing out basic environmental health from climate change intervention. The CDC’s intervention documents [11] can and should improve distinction.

Concerns related to gradual change or catastrophic climate events involve other national and state departments, yet a strategic and cohesive gameplan is absent. These concerns usually include heating and cooling, water, food supply, and housing. Leaving it to the “health department” is wildly inappropriate and negates the work of these other agencies. It also sets us all up for a confused rollout with inefficiencies, duplication of response and gaps in response. When broader issues are at stake, such as agriculture, there is usually no multi-agency collaboration that involves local health either.

Mapping and maps for ecological health, impacts to human health and human health projections should be standard. As it is, map use in organizations and advocacy are as scattered as the populations and geographies they reference.
The US military has played a strong leadership role in climate change and human health impact science, yet it is unclear how they are involved on an ongoing basis. Involvement with improvements to climate-related environmental health concerns can and should be familiar. A familiar involvement between the US military and the US civilian structure is that of leadership, hierarchical structure and organization where organization lacks. The US military can and should model what it does best, helping the US 'get it together' (so to speak).