Climate Change Is Already Disrupting Health Care in the U.S.

JOEL BERVELL: My guest on this episode of The Dose is Admiral Rachel L. Levine. She serves as the 17th Assistant Secretary for Health for the U.S. Department of Health and Human Services, where she oversees the Office of Climate Change and Health Equity, an unfunded office within HHS. As a physician, Admiral Levine focused on the intersection between mental and physical health, treating children, adolescents, and young adults. Previous to her federal post, she served as Pennsylvania's Physician General and Pennsylvania's Secretary of Health.

Admiral Levine, thank you so much for joining me today.

ADM. RACHEL LEVINE: Hello, Joel. I'm so pleased to be here. Thank you very much for inviting me.

JOEL BERVELL: So I'm going to jump right into it. Today, Earth is 1.14 degrees warmer than before, and in the United States thousands of people are right now still digging out of the devastation of Helene and Milton, two successive hurricanes that first made landfall in Florida but did the most damage far inland in the mountains of North Carolina. Climate change is forcing us to face many predictable challenges, but like the paths of these storms, it's not all predictable. And we'll talk about a range of these challenges.

So I just want to jump into the first question. Just about a year ago, HHS published its first-ever report on climate as a public health crisis. In the foreword to that paper, you noted that the document will have to be a dynamic one, as climate change is of course a force that is happening in real time. And while we have some scientific predictive capabilities, we can't really know exactly how things will unfold in every environment. The report calls itself a strategy paper. What are some of the specific strategies to prepare for encounter the health impacts of climate change? I know that as a government agency, you have several levers for that.

ADM. RACHEL LEVINE: Well, thank you very much for that question because you are entirely correct. Climate change is the most significant threat to human health in the 21st century, and climate change is having those serious impacts on health right now. As you've pointed out, we have extreme heat throughout the United States and throughout the world and storms that are stoked and exacerbated by climate change, as we saw with the latest hurricanes that rapidly progress from tropical storms to very high category storms that impact the United States. So because of that, we have wanted to make sure that we put health at the table, and we have formed our Office of Climate Change and Health Equity, and that office has been in existence for over three years now.

We have a number of different initiatives to inform the federal government, but also state and local governments and communities and hospitals and health systems, about climate and health. One of them is called the Climate and Health Outlook, and that is a publication that builds off NOAA's month weather forecast to add a public health lens. Our newest tool is the Heat and Health Index, and that is the first nationwide tool to combine zip code-level data on heat-related illness, preexisting health conditions, and sociodemographic factors, again at the zip code level, so that people can understand the harmful effects of extreme heat on their health. So that and many more initiatives are the product of this new office.

JOEL BERVELL: I think that's so important, especially when you talk about from the zip code level. I'm curious, how do you benchmark this progress? Is the first strategy data? And for example, what does a five-year plan look like?

ADM. RACHEL LEVINE: Well, so yes, we do have a climate change and health equity strategy supplement that we're working on, which is trying to bring together all of the different divisions across HHS to support resilience to the impacts of climate change, as well as actually to work on decreasing the carbon footprint of the health sector. So the health sector produces about 8.5 percent of the carbon emissions for the United States. It is very significant. We will not achieve President Biden and Vice President Harris's goals of carbon reductions, which is 50 percent by 2030 and to be carbon-neutral by 2050, without the health sector. And so we are working with the health sector to again, develop resilience to heat and those storms that we talked about and many more threats, as well as actually work to decarbonize the health sector.

JOEL BERVELL: Absolutely. The Office of Environmental Justice at HHS was established to acknowledge and address these disparate impacts in overlooked and underserved communities. The myriad impacts of climate change means some are obvious, others less so. One hidden crisis is blood shortages. Can you talk a little bit about why this is becoming a weather-related issue, for those that don't know, and why communities of color are hit the hardest?

ADM. RACHEL LEVINE: Sure. Well, so a steady supply of blood is essential to the health of our nation to treat a variety of acute and chronic life-threatening conditions. Blood is used after serious accidents, blood components are used for surgery, cancer treatments, blood disorders such as sickle cell disease, and more. Every two seconds somewhere in the United States, someone needs blood. And so it is so important to have regular donors to give blood all throughout the year.

Well, with extreme heat, we have less donors that are able to make the trip and to go out and to donate blood in the summer. That has been exacerbated with the extreme heat. And of course, if there are weather-related challenges, like with the current storms, one is that with accidents you might need more blood for operations and treatment in the emergency department. But second is because of the disruption, people can't go give blood in those areas. That is a health equity issue and impacts communities of color significantly, for example, sickle cell disease. Predominantly in the Black African American community, but not exclusively, we have sickle cell disease in Hispanic Latino communities, in other communities of color. And so it is so important to have specific diversity in the blood supply for people who need transfusions and sometimes chronic transfusions due to sickle cell disease.

JOEL BERVELL: Absolutely. Thank you for that answer and for highlighting all of those different ways that climate can impact patients down the line because I think we so often focus upfront and just see climate damage, but we forget about how this impacts systems as well. Another thing I'm thinking about is the IV fluid shortage that's happening right now as well, which has been impacted by it. The hospital I'm working at right now, we have had to pause elective surgeries for that exact reason because there's not enough intravenous fluids to be used in surgery. So I think these connections are so key that you're making and it'll continue to impact.

ADM. RACHEL LEVINE: They are. So the supply chain is very fragile and often with just-in-time arrivals of different critical components, particularly for health-related products such as blood bags and such as IV fluids, et cetera.

JOEL BERVELL: We're talking about a range of climate-related health issues and one that I think about a lot is in places like rural states like Alaska, where climate threats are affecting food production as well, and that's because it's warming at about double the rate of the lower 48 states as permafrost, soil, rocks, sand, held together by ice, is releasing its contaminants as it melts. Meanwhile, the ocean waters and air currents are now carrying a growing amount of persistent organic pollutants, mostly pesticides, that then contaminate the land and water. Can you explain how is this playing out as a public health challenge for Alaskans?

ADM. RACHEL LEVINE: Thank you very much for bringing up the challenges in the environment in Alaska. I have had the opportunity and privilege of going to rural Alaska about 15 months ago, and we of course went into Anchorage, but then we were able to go out way out of Anchorage and up to the North Slope. We were in Nome, we were in Kotzebue, we were in Utqiagvik, which is the most northern tip of Alaska on the Northern Slope, and we saw the challenges of the impacts of climate change and other environmental justice issues. So in the small village of Savoonga out in the Bering Sea, we saw challenges in terms of the melting of the permafrost. We saw that in Utqiagvik as well, where because of climate change and heat, the permafrost is melting and their homes are literally sliding into the permafrost. And it is making it very difficult and they already have significant housing shortages there.

It is also impacting their food supply. So for example, there is a temperature barrier between the Pacific Ocean and the Arctic Ocean. That barrier is being degraded because of the impacts of extreme heat and climate change and Pacific fish are entering Arctic waters and, in some cases, outcompeting the Arctic fish. That changes the food supply for Alaska Native tribes who are subsistence livers, who really need to hunt and to fish to get the food that they need to survive. The climate changes are damaging the runs of salmon as well as the other mammals that they need because of course those animals eat the fish.

The other is that the Arctic ice is not going as far as it used to, and so the tribe on Savoonga has to travel farther in order to catch the fish and to hunt seal and to hunt other mammals that they need. In Utqiagvik, they were talking about changes in the Arctic ice flow as well that impacts, again, the mammals as well as the caribou runs. So all of this is impacting the lives, the housing, and the nutrition and the food supply for these Alaska native tribes. There's no roads to these areas. You have to fly in on Bering Air, and so if they have to import food, they're literally flying it in. And so a can of peaches could be $6 to $8, and it also is not their natural food supply, and so they end up with more sugar and more salt and more cases of hypertension and diabetes and heart disease. So many challenges to the environment in the Arctic as well as you talked about from pollution.

JOEL BERVELL: Mm-hmm. I just love the way that you're talking about that because I think we forget so often about rural communities and really tying these connections between how climate change is making these impacts on everyday people's lives who we may not often see all the time, but it's having direct impact today in the way they live and the way that they work and increasing costs in many different ways. As we touched on earlier, health care industry emissions are a problem. Like you said, 8.5 percent of the total emissions in the United States are linked to the health services. Let's talk about the health sector climate pledge, both as an aspirational policy tool and the practical challenges that you're seeing as institutions either strive for compliance or don't. Can you explain what the Green Hospitals Act is and is there bipartisan support for it?

ADM. RACHEL LEVINE: Well, the Green Hospital Act, which has not passed Congress at this time, would have hospitals comply with the measures in the act to reduce their carbon emission and to develop resilience to the impacts of climate change. But right now, while we are awaiting Congress's actions, we have a White House HHS Climate and Health Pledge, and this is hospitals, health systems, but other businesses in the health sector, pharma, and those in the supply chain that have a voluntary commitment to cut greenhouse gas emissions by 50 percent by 2030 and to achieve net-zero by 2050. One hundred thirty-nine organizations representing 943 hospitals have signed the pledge, also suppliers, insurance companies, pharmaceutical companies, group purchasing organizations, and others.

We also are including the federal government such as the Indian Health Service, the Veterans Administration, and the military health system. So combined private and public, we have 1,180 hospitals making such commitment, and that represents 15 percent of U.S. hospitals. So we're very pleased about the progress, but we have a long way to go. But what we have been talking about is a catalytic program to help these hospitals and health systems and other organizations to achieve these goals using billions of dollars available through the Inflation Reduction Act, through a combination of tax incentives, grants, loans, and technical assistance programming. There is money to help these organizations and these businesses achieve these goals.

JOEL BERVELL: You talked about a little bit, but I want to dive deeper on that last point actually. What about creating climate change resiliency in hospitals as to what you're talking about right there?

ADM. RACHEL LEVINE: Well, I was actually in Vermont. You don't usually think of Vermont as a state that has been impacted by climate change, but because of the impact of climate change on the weather systems, there have been . . . last summer and this summer extreme, very localized storms that have dropped many, many inches of rain that have swollen the rivers in Vermont and flooded out towns. And I was able to actually visit some of those towns that have been impacted, but it has also impacted clinics there and the ability of transportation for people to get to health care in clinics, in hospitals. So we have to be looking very broadly across the United States and work on developing resilience in the health sector to these impacts.

JOEL BERVELL: And I know you've talked about Tampa Hospital too before in terms of being ready with its water source energy plants and AquaFence flood surge protections as opposed to other places like in Tennessee or North Carolina where hospitals flooding endangered patients. Could you talk a little bit more of those examples as well?

ADM. RACHEL LEVINE: Well, there are a number of different examples of hospitals and health systems that have been able to really make progress. One is Boston Medical Center, which is using an investment tax credit to help finance Clean Power Prescription, a first-of-its-kind pilot program that provides solar energy credits to patients who report difficulty affording household utility payments. Valley Children's Healthcare is using the same tax credit to finance a new microgrid. Advent Health is using an investment tax credit to install a 3-megawatt solar photovoltaic system, which will become one of the largest privately owned solar projects in Florida. And Ohio Health is using an alternative fuel vehicle refueling property credit to finance electric vehicles. So lots of hospitals all throughout the country doing this, trying to develop resiliency to the impacts of climate change, to work towards decarbonization and using the IRA to finance it.

JOEL BERVELL: That's such a good range as well of how hospitals are going about solving this. How scalable is this when it comes to . . . are hospitals communicating with each other? Are they sharing their findings? Is it becoming that something that's scalable, and how difficult is it to scale these initiatives that hospitals are finding?

ADM. RACHEL LEVINE: Well, so it is going to scale and there is a climate collaborative through the National Academy of Medicine with President Victor Dzau. So I am cochair of that climate collaborative through the National Academy of Medicine. We are working very closely with them and really trying to reach many, many, many different members of the health sector. We work with the American Hospital Association. We work with many other stakeholders, hospitals and health systems, pharmaceutical companies, insurance companies throughout the United States in order to make those connections to have really a movement as Dr. Dzau talks towards resilience and towards decarbonization. And I'm very optimistic that all of these factors working together, these public-private partnerships, will be successful.

JOEL BERVELL: The CDC has some data visualization tools illustrating the health impacts of climate, and The Lancet keeps a dashboard on health care and climate change. The National Institutes of Health, Institute of Environmental Health Sciences has just launched another one. Can you talk with me for a minute here about how these data visualizations are useful in your work?

ADM. RACHEL LEVINE: Well, we need to have the data to be able to inform public policy. We need data-informed public health. And so our office, working with CDC, with the EPA, we have the Environmental Justice Index, which ranks the cumulative impacts of environmental justice on health for every census tract. Census tracts are subdivisions of counties for which the census collects statistical data. And the Environmental Justice Index ranks each tract on 36 environmental, social, and health factors and groups them into three overarching modules in 10 different domains. We have the EMS heat tracker mapping local emergency responses to heat-related illnesses. We have the Heat and Health Index at the zip code level, and we are working with the CDC on the Climate Ready States and Cities initiatives. So many different initiatives with CDC, with CMS, Center for Medicare and Medicaid Services as well, looking at data, looking at visualization of that data, and then looking to make an impact.

JOEL BERVELL: Absolutely. How is that visualization important? How is your team looking at it right now?

ADM. RACHEL LEVINE: Well, I think that as we've has found, it is sometimes hard to look at just tables of data and to make sense of it. And so we need to have different ways for scientists, for health care professionals, for those in the public sector, in states and communities to be able to see the data and they can understand it, and then they can take action. And you're entirely correct. Visualization of that data in different ways is very important to make sense of just those numbers in order to take the effective actions that we need.

JOEL BERVELL: Mm-hmm. Admiral Levine, thank you so much for joining me today. I know previously we talked and done an Instagram Live and there was something you said that I've now co-opted and used everywhere, but you said that climate solutions are health solutions.

ADM. RACHEL LEVINE: That's right.

JOEL BERVELL: And I think as we saw today with this conversation, there are so many ways that the world is changing right now in the way that we need to build resiliency of hospitals, and I just thank you and your team for leading the charge when it comes to making sure we're prepared for an ever-changing world, to make sure that climate doesn't become a further exacerbator of health, but that we're able to tackle these things and prepare the American people for health of the future. Thank you so much for being here, for sharing your words and for all the work that you do.

ADM. RACHEL LEVINE: My pleasure. It was just great to be here. Thank you.

JOEL BERVELL: Take care.

Just a quick note before we close, make sure to check out my recent conversation with Cameron Clark, a climate justice and health advocate with WE ACT. He's working on scalable solutions to tackle climate change in New York City and other urban areas. I hope you'll check out that episode.

This episode of The Dose was produced by Jody Becker, Mickey Capper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is "Arizona Moon" by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There you'll be able to learn more about today's episode and explore other resources. That's it for The Dose. I'm Joel Bervell, and thank you for listening.

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