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WASHINGTON -- Mum's still the word when it comes to the new Office of Climate Change and Health Equity at HHS, but advocates on the subject seem happy with what they've seen so far.

The office's creation was mandated by President Biden in a on "Tackling the Climate Crisis at Home and Abroad."

"The Secretary of Health and Human Services shall ... establish an Office of Climate Change and Health Equity to address the impact of climate change on the health of the American people," the order said. It also directs the agency to "establish an Interagency Working Group to Decrease Risk of Climate Change to Children, the Elderly, People with Disabilities, and the Vulnerable as well as a biennial Health Care System Readiness Advisory Council, both of which shall report their progress and findings regularly to the [interdepartmental National Climate] Task Force."

More Expertise Needed

How far has the agency gotten with the new office, 6 months later? It's hard to tell since nothing has yet been formally announced, although the office is funded in the president's fiscal year 2022 discretionary budget for $3 million and eight full-time employees, pending approval by Congress. But those in the know say the agency has been making some positive moves.

"They are working on setting up the office," said Mona Sarfaty, MD, executive director of the Medical Society Consortium on Climate and Health, a group of medical societies concerned about climate change and its effects on health. "They have declared the 'all-of-government' approach, and so they are putting a lot of effort into getting the various parts of the government set up to be able to work on climate change. I think they're showing they're serious."

"Obviously it's a significant challenge and it's going to take some time to do the things that need to be done," she said in a phone call. "HHS, which is actually the largest department of the federal government, needs to have much more expertise in all its various agencies and offices than it has had in the past; the only part of HHS which has had any serious focus on climate change is the CDC," which has had an office on climate change going back a number of years, Sarfaty said.

Howard Frumkin, MD, former dean of the School of Public Health at the University of Washington in Seattle, said in an email that the agency's initial steps were "highly encouraging."

"Arsenio Mataka, the Department's Senior Advisor for Climate Change and Health Equity, is top-notch," said Frumkin, who is also former director of the CDC's National Center for Environmental Health. "The emphasis on equity in the HHS response is right on target, because the impacts of climate change fall so heavily on poor communities and communities of color, on the very young and very old, and on other vulnerable groups."

"The president's budget request, which includes over $100 million each for NIH and CDC to tackle climate-related health issues, is a huge step in the right direction; it's essential that Congress fund it," he added. "The challenges now will be to fund and staff the HHS office at a sufficient level, and to achieve rapid, innovative action across HHS despite considerable inertia."

Late But Welcome

"Building health into our climate policies has the potential to save hundreds of thousands of additional lives per year," noted Jeni Miller, PhD, executive director of the Global Climate and Health Alliance, in an email. "To reap these benefits, we need health leaders at the table, with the expertise, resources, and mandate to actively contribute to climate policies and decision making, and to anticipate climate impacts on the health of Americans and ensure we are best prepared to respond. The establishment of the Office of Climate Change and Health Equity within HHS is therefore an important development. The office should be made operational ASAP, and should be given a budget commensurate with the need -- which is enormous."

HHS "is coming to the party late, which is unfortunate because human health should be the central guiding consideration in any nation's climate response, but it is vital and very welcome that they are getting involved now," Miller said. "The sooner the Office of Climate Change and Health Equity can get up and running, the better!"

HHS has not announced who will run the new office, but one name mentioned prominently is John Balbus, MD, a senior advisor for public health at the National Institute of Environmental Health Sciences. Balbus is the "government's top expert on health and climate change" and would bring "deep experience," said Frumkin. Balbus worked with Health Care Without Harm (HCWH), a group promoting environmentally responsible healthcare, to create a within the healthcare sector.

Comprehensive Plan Needed

Jessica Wolff, MBA, MSN, HCWH's U.S. director of climate and health, pointed out that Biden's order marks the first time HHS has been directed to have a full departmental approach to climate change. "The full engagement and accountability of HHS is really the linchpin to build a resilient, low-carbon healthcare system and to ensure that as we work to prevent the worst impacts of climate change, we simultaneously improve health outcomes and health equity," she wrote in an email. "It starts with HHS developing a comprehensive national strategic plan to address the physical and operational risks from climate change to public health systems and healthcare facilities, and to assist communities, public health departments, and safety-net and rural hospitals in preparing for and responding to the public health risks of the climate crisis, including mental health and food insecurity."

In April, HCWH and more than 70 other healthcare and environmental organizations sent HHS a related to climate, health, and equity, including specific steps for implementing them. The broad recommendations included:

• Advance knowledge on how to protect human health from climate change, equitably
• Build health-based climate adaptation and resilience
• Ensure that the transition to a clean economy promotes health, especially for vulnerable populations
• Advance health equity and climate justice
• Achieve a climate-ready, low-carbon-footprint health system
• Build a health workforce capable of understanding and responding to climate change and health

"Climate change is both an unprecedented challenge to health, equity, and prosperity, and an unprecedented opportunity to create healthier, more secure, and more sustainable lives for all," the recommendation authors wrote.

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