CommonHealth Live! with Dr. John Balbus

This transcript is from a CSIS event hosted on October 17, 2024. Watch the full video here.

Katherine E. Bliss: The period from September 2023 to August 2024 has been recognized as one of the hottest on record. Heat can warm ocean temperatures. Warmer temperatures can contribute to increased potential for dramatic hurricanes and tropical storms. Increased rainfall increases the likelihood of an abundance of disease vectors such as mosquitoes. And changing weather patterns can also create drought conditions, leading to wildfires, heavy smoke, and air pollution.

In this context, many people have been thinking about the intersection of climate change and public health. Today, on The CommonHealth Live, Dr. John Balbus, director of the Office of Climate Change and Health Equity at the U.S. Department of Health and Human Services, will speak about the intersection, about new research regarding climate change and health, and the role that the U.S. government is playing in working to mitigate the impacts of climate change on human health today and into the future.

(Music plays.)

J. Stephen Morrison: This is the CommonHealth from the CSIS Bipartisan Alliance for Global Health Security, engaging senior leaders on questions of how to address our common health security challenges in this post-COVID moment.

(Music ends.)

Ms. Bliss: Hello, and welcome to the CommonHealth Live. I’m Katherine Bliss with the CSIS Global Health Policy Center.

It’s my pleasure to speak today with Dr. John Balbus, director of the Office of Climate Change and Health Equity at HHS. John is a physician and public health professional with several decades of experience working at the intersection of health and climate change. He’s done this both as a policymaker and a researcher in federal government and academia. And we’ll talk today about the ways in which climate variability affects human health, what’s important to keep in mind when communicating with the public about the links between climate and health, and the steps the U.S. government is taking to mitigate the risks to the population’s health from climate change.

John, welcome to The CommonHealth.

John Balbus, M.D.: Thanks for having me today.

Ms. Bliss: So I want to start with the new office that you direct, the Office of Climate Change and Health Equity. The U.S. government has had various entities or initiatives related to health and climate change since at least the early 2000s, particularly focused on research, but the Office of Climate Change and Health Equity was set up in 2021, if I’m not mistaken, after the executive order, really, I think on tackling the climate crisis at home and abroad.

Dr. Balbus: Exactly.

Ms. Bliss: And so I wanted to ask you to say a bit about the origins of the office, the links to the environmental justice agenda in particular, and why health equity is part of the name.

Dr. Balbus: So, as you say, it was part of the Biden administration’s suite of executive orders to both address the climate crisis but also health equity and environmental justice. And our office was created with a mandate to protect the health of everybody in the United States, especially those most vulnerable. So the primary mandate was a health equity mandate. And that’s because, you know, the stressors of climate change are cumulative to the other stressors that a lot of communities in our country face. You know, the same communities that experienced the brunt of COVID, because of, you know, all of the social factors there – you know, occupational factors, residential factors.

The same communities that bear the brunt of environmental exposures like air pollution are the exact – you know, many places the same – places with the worst exposure to heat and urban heat islands, or most likely to experience severe flooding, as we see, you know, in some of the hurricanes in the Gulf Coast. So these things all relate together. Climate change, you know, is a cross-cutting factor that affects the lives of people who are being affected by other things and thinking about other things at the same time.

Ms. Bliss: So these challenges are really compounded, particularly for some of the most vulnerable sectors of society. But, you know, just in talking there, you talked about air pollution, you talked about – I don’t know if you talked about sea level rise, but you talked about extreme heat and weather. And so, you know, climate change and health is – climate change is a big topic. Health is a big topic. When you bring the two together, you know, you’ve got a lot of different issues. And then if we start bringing health security and national security into the mix, it’s – there’s a lot to talk about. Do emerging infectious diseases, or waterborne disease, or health effects of pollution – when you’re looking at the issues of the climate change and health equity agenda, how does your office – you know, what are the specific priorities of your office? And how do you decide what’s included and what’s not?

Dr. Balbus: So from our office’s perspective, you know, we came into being in 2021. We are a very small office. We’re a new office, in the midst of a department that, you know, as you say, has always had some elements of it working on climate change, but most elements not working at all on it. You know, I think it’s very telling, if you look at the climate adaptation plan, or the Climate Action Plan from 2021, you know, at the start of the Biden administration, and you look at the priorities for HHS, one priority is to grow the existing offices – you know, the climate and health program at CDC and the climate and health work at NIH, mostly led by NIEHS, where I was. And then the next thing was, and then everybody else, and it was blank. There was not – you know, just, we’re going to do something with everybody else. And that’s where our office stepped in.

So the first part of what we were trying to do was recognizing that HHS, you know, is the biggest grantmaking organization in the world, is the safety net for so much of our country, not just on the health side but also on the human services side. It was – and yet, you know, the prevailing attitude in healthcare – as a physician, I can say this – you know, until very, very recently, was, you know, climate change is an environmental issue. Climate change is a future issue. I have a patient, you know, I’m seeing right now. I can’t worry about what’s going to happen 10, 15, 30, 100 years from now.

And so there was a lot to kind of get people on board in all of these different departments. So a lot of our initial goal in trying to serve the most vulnerable populations is actually to take the, you know, hundreds of millions and billions of dollars that are targeted to things like energy and security, that are targeted to water and security, that are, you know, supporting the health care systems for low-income communities, and make sure that they were climate smart, make sure that they were understanding where the stresses are coming, and where they’re kind of exceeding capacity. So that was, you know, a part of what we were doing.

The other part was while our stated mandate was to protect the people and the public health, we very quickly took on a very ambitious goal which was also to take on the actual health sector of the United States, public and private, and to move it towards being climate smart. Which means, you know, having it address its own contribution to climate change. In the United States, it’s estimated that the health sector contributes 8 ½ percent of the nation’s total greenhouse gas through its activities. That’s a huge amount. That’s – you know, globally, it’s about 4 to 5 percent. It’s more than the airline industry. So, you know, as – with an ethical duty to do no harm, with an ethical duty to protect the health of people, there’s a big role for the health sector there. And then, of course, as we’re seeing, you know, play out, you know, again and again in this country, when health systems go down, people are harmed. And you know, when the safety net health system goes down, or the urban hospitals, or you know, really, you know, any major hospital, the people who suffer the most are low-income people who have trouble moving to another place or trouble getting the care they need. So we very – you know, very soon took on the need to address the vulnerabilities of the health system as well, especially the safety next health systems.

Ms. Bliss: So it sounds like, you know, you’ve had a couple of really big wins. I mean, one is just raising awareness across the HHS. All the different agencies may have been doing a little bit here and there, you know, but not necessarily in a coordinated way, but now it’s much more visible through the work that you’ve been doing. But also really getting that agenda with respect to the health – you know, the – as you said, the mitigation, you know, side, from the health sector its own contributions to climate change, kind of raising awareness of that, two very important things in a fairly short period of time. What would you say has been one of the biggest challenges that you’ve faced in really kind of trying to raise the visibility of these issues within the agency and more broadly?

Dr. Balbus: So, you know, within the agency, it really – first of all, let me start by saying what has been gratifying and remarkable has been the support that we’ve received. You know, we convene a working group that has all of the divisions of HHS in it. After COP-28 last year in December, we published a supplement to that Climate Adaptation Strategy that I had commented on where, you know, that goal number two that was blank now had 50 accomplishments and – 40 accomplishments and another 50 commitments for the coming year from every single operating division of HHS. So, you know, there has been a lot of support.

You know, the challenge is that – the first challenge, I have to say, is a complete absence of funding for this work. Our office has not received congressional appropriation, despite being in the president’s budget. And you know, with the Inflation Reduction Act, which has been historic and the most important piece of climate legislation ever, and is doing amazing things – and we’re working very closely – we can talk about that more – with the agencies that receive funding from it – but there was no climate funding for HHS in that, for any of the other divisions. So, you know, when – you know, budgets drive staffing. They drive – they drive focus. They drive prioritization. They drive accountability. So lacking that has been a challenge.

And you know, the other challenge is just overcoming, you know, what’s a pretty longstanding attitude among people working on health that climate change is an environmental issue, not a health issue.

Ms. Bliss: Well, yeah, I mean, that’s one of the big challenges I’ve always seen with environmental health, is that you have the environmental impacts on the health sector, the response comes from the health sector, but the view is that, well, it’s the water sector that needs to deal with it, or it’s the industry that needs to reduce pollution. And so the causes, you know are elsewhere. At the same time, I mean, even when we’re talking about looking at climate and health, I mean, when you are talking about forecasting or gathering data or anticipating the conditions that might lead to impacts on human health, if you’re looking at remote sensing or analyzing satellite data or something, again, that’s probably coming from a different agency.

You talked about the Inflation Reduction Act and some of the agencies that have had funding to deal with climate issues. And so I did want to ask you how – you know, when there’s this kind of tension between cause and effect within the health sector, you know, between kind of the cause – the perhaps climate-related cause and then the impacts on health, and different agencies are all at the table, how do you get the agencies to work together? Or what are some of the incentives that you found to be most useful to kind of build that collaboration?

Dr. Balbus: So there have, first of all, just been several different platforms for interagency collaboration that are working very well. You know, certainly on the data collection, on the science side, like you were talking about, the development of prediction tools and those kinds of things. The collaboration within the Global Change Research Program, you know, has been very strong. You mentioned that I, you know, used to co-chair our working group on climate change and health. You know, there is a longstanding collaboration among the agencies that generate the data – NASA and NOAA, EPA – and organizations like the CDC and NIH.

You know, with the Inflation Reduction Act, you know, there has been a huge challenge because it’s such a big bill. There’s so many new programs, so much work to be done to stand them up and to be able to get the money spent effectively that, you know, it’s sometimes hard to be able to get the attention for something like the health sector, which wasn’t written in. But – (coughs) – excuse me – we found the agencies to be, you know, very, very receptive. And, you know, we have had a number of initiatives.

We had something called our Catalytic Program, where we had kind of a sprint. We had over, you know, four webinars every two weeks for a seven-week period, where we brought in all the agencies and all the agency staff came and spoke to the health sector to give them instructions. So, you know, the things that have worked have been shared mission. They’ve been leadership from the highest level, and the creation of platforms for this kind of collaboration. You know, in this administration it’s been the Climate Task Force on down.

Ms. Bliss: Well, and as you – as you said, you know, some of these research programs have been around for several decades. People, like, know each other. It sounds like, I mean, there’s a certain level of an extended network within the agencies that can share that vision and that mission going forward.

So 2024 is one of the hottest, if not the hottest, year on record. We’ve also seen a number of different climate-related health impacts, just here in the U.S. Dengue and the Caribbean and Puerto Rico, extreme heat waves on the East Coast in June and July, hurricanes Helene and Milton just recently, wiping out access to healthcare for thousands of people. And obviously, a great deal of news coverage recently as well about the plant Baxter International in western North Carolina that provided IV solution to so many hospitals around the country.

So I wanted – you talked a little bit about the interaction with the public and kind of awareness of the climate and health issues. But I wanted to ask you to reflect a little bit on how, you know, just the events of the past year – how you see, you know, if that has – how that has shaped the American public’s understanding around climate and health, and if you feel like there’s been kind of a shift in consciousness and kind of greater awareness over this period.

Dr. Balbus: So, you know, it’s kind of – first of all, I’ll have to confess, you know, I run an office of just a few people who are working on actual policy and programming. And we don’t do the surveys. We don’t have the means of really assessing the public’s – you know, short-term changes in the public’s attitudes. You know, what has happened in the last three years – because, of course, 2024 has not been an unusual year.

2023 was the hottest year on record before 2024 became the hottest year on record. 2021 had definitely – you know, opened up – as soon as I came over to take – to take the position to try to try to start up this Office of Climate Change and Health Equity we lost hundreds of people in the Northwest in a completely unprecedented heat event in 2021. So and if you – you know, if you look at heat-related mortality, it’s tripled since the average of the first two decades of this century. If you look at – you know, no matter where you look. If you look at billion-dollar disasters, we keep changing the y-axis because we have ever more – a greater number of billion-dollar disasters than we’ve had before.

I think of, you know, that all of these things are moving – you know, are moving health professionals and the health sector. So, you know, the biggest change that’s really happened in these three years – and, you know, our office is, you know, both a reflection of it and also, I hope, a driving force within the government, but it’s also happened, you know, through the work of the WHO and through, you know, the U.N. Framework Convention on Climate Change, which had its very first, you know, health ministers meeting at COP-28.

You know, we’re seeing in an unprecedented way the health sector take on this issue of climate change. And I do think that it’s because they are seeing the reality in their patients, in their facilities, in their communities, in a way. You know, our nation has, you know, become a place where people get their information from very different places now, and kind of very separate places. And, you know, I’m not sure – I think that has an impact on how open people are to changing long-held positions.

Ms. Bliss: Well, so, you know, during COVID-19, I mean, one of the issues that we really saw scale up quite a bit was misinformation. In that context, a lot of it was centered around vaccines, but that was within a context of skepticism around science, and around expertise. And there was a lot of misinformation that circulated on all these – you know, on the variety of different kinds of channels where people do receive their news, as you just said. You know, certainly there’s climate denialism on the one hand and mistrust of the health system on the other. And, you know, on top of that, as you mentioned at the beginning, we have some of the most vulnerable communities in the country really at the center of a lot of these natural disasters.

And I know that the surgeon general and many others have really focused on the crisis of misinformation in this country, and the importance of rebuilding confidence and trust. I just wanted to ask you to say, you know, a little bit from the perspective of the office, you know about some of the promising steps you see that can be taken to kind of address some of the skepticism around the science of climate and health, and where, you know, steps can be taken to improve health equity in that context.

Dr. Balbus: So, certainly the impact that the misinformation and communication from various sectors around the COVID pandemic, that led to health threats to public health officials in states, is an extremely disturbing development. (Laughs.) You know? Because there has always been a sense – or, always, I mean, for the last, you know, 50-70 years, anyway – a sense that health professionals are among the most trusted people in society. And that if a health professional took an opinion, that there was just an assumption that it was not self-interest, that it was actually the interest of the people that they cared for.

So to see that, you know, be attacked is very alarming because if – you know, I’ve been working on climate change for over 30 years. And in the climate community, there was always this sense, well, when we get the health sector on board, when we get doctors talking about this, then people will believe, then people will trust. And, you know, I think that assumption is – has truth to it, but I think it’s also perhaps not as reliable as it was in the past. And, you know, and then when you see things like weather forecasters being accused of actually manipulating the weather to divert horrible, tragic storms, that they actually experience devastating grief about, even though – you know, because they’re the ones that are trying to save lives. They’re the ones that are serving the public. And when they get accused of actually manipulating the weather, that’s a sorry state of understanding in our country.

So, you know, I think the paths out of it are, you know, integrity, and commitment to truth, and commitment to facts, and commitment to science, to reliance on trusted messengers of various sorts, whether those are religious figures, whether those are health figures. And, you know, ultimately quality education in this country, because, you know, if people don’t learn – don’t understand science when they, you know, come out of basic public education, it’s going to be really hard to make arguments about complex scientific things.

Ms. Bliss: So part of what is needed, then, is really bringing awareness and education about climate and health issues from elementary school on up –

Dr. Balbus: Absolutely.

Ms. Bliss: – so that people can really grapple with the changing science and think about some of that.

One thing that you’ve mentioned a couple of times is the – kind of changing tack a little bit here, but you know, around the issue of the role of the health sector in not just raising awareness and educating about the challenges that a changing climate poses for health, but just the contributions, the emissions and contributions that the, you know, manufacturing and service provision contribute to overall greenhouse gas emissions. Could you say a little bit about the potential for public-private partnerships to kind of begin to address some of these challenges? And what do you see, you know, over the next several years as kind of the most promising ways for the health sector to really kind of commit and move forward?

Dr. Balbus: So absolutely. And we’re seeing these public-private partnerships take hold, you know, all around the world, really.

If you look at where the emissions come from, you know, one of the challenges is they come from, you know, just a whole array of different sources, so there’s many, many things that need to be done. You know, about 20 percent is coming from energy use in the building, so you know, that is where people are focusing now. They’re focusing on renewable energy supplies. And you know, one of the key points there that has to be made is that, you know, virtually all of the first steps that get taken to reduce the emissions of a health-care facility actually save the facility money, actually enhance its resilience, and ultimately lead to higher quality of care.

So you know, there will be a narrative that, well, why should we make hospitals do this; you know, they need to take care of patients. It’s only going to hurt people if we make them think about energy sources. But if you – and you will see the stories come out from – I mean, they came out after Superstorm Sandy in New York. They are coming out from North Carolina. You’re going to see this in Florida, where there’s a lot of renewable energy sources. These – you know, when health-care facilities are able to have their own microgrids and battery backups, and in most cases a solar system, they often sustain these devastating storms and keep the power on and keep the patients inside the walls. Oh, and by the way, their energy costs go down and they have an investment that’s saving them money year after year. So it’s important to make the connection between reducing emissions and actually enhancing resilience and lowering the operating costs and improving outcomes.

But then there’s the whole supply chain, which is, you know, 60, 70 percent. And we say supply chain; it’s technically scope three. So it’s supply chain, it’s – the food that gets served is substantial as well, and many other things. That’s where that public-private partnership comes in. We’re seeing some leadership in some of the pharmaceutical companies that are looking at their energy supplies and ensuring that they are carbon-neutral or, you know, renewable energy sources. And some of the big ones are, you know, investing in renewable energy for their supply chain, so it’s going all the way up the value chain.

So in some ways, you know, we’re seeing, you know, these partnerships. These entities are, you know, partnering with the federal government in different ways. The Department of Energy is funding a consortium that’s doing renewable energy and microgrids for community health centers. You know, that’s the safety net, which are in the low-income communities in the Southeast. And then, of course, the National Academy of Medicine is – you know, has a new initiative on decarbonizing the health sector in the United States, which brings in the private sector along with my boss – the assistant secretary for health, Admiral Levine, is the co-chair of that. So there’s a lot of ways things are moving, but you know, the ultimate solution for, you know, some of those health-sector emissions are really economywide solutions for major industrial sectors.

Ms. Bliss: So it can – making especially the hospitals and provision of care more energy efficient can save money, improve quality of care, and just ensure that there is access to care in –

Dr. Balbus: Exactly.

Ms. Bliss: – regions that particularly experience these challenges. But it sounds like, at least with the supply chain and manufacturing, it kind of requires industrywide commitment, right; that if just one takes the step to go ahead and do it, that’s great, but they may all need to kind of band together to make kind of joint commitments to work in this way.

Dr. Balbus: Ultimately. Ultimately. You know, what we’re seeing also are more and more countries, you know, setting procurement standards for their national health systems. The United Kingdom – or England, actually, the national health system of England was the first to really step out and to, you know, send a clear signal to its suppliers that they were going to be requiring, you know, greenhouse gas reporting, and ultimately steps being taken to lower their greenhouse – their suppliers’ greenhouse gas emissions if they wanted to do business with NHS England.

Ms. Bliss: And then so if that – so let’s say the U.K. does that. I mean, does it really – does it then prompt other regulatory authorities in other countries to do the same? I mean, is there pressure, then, on them to kind of adopt the same standards?

Dr. Balbus: It’s at least a leadership example. Whether that’s pressure or not, we’re seeing it. We’re seeing – you know, so, you know, there has been a proposed – a proposed amendment to the federal acquisitions regulations that would do something very similar for all federal contractors, and so that would include the federal health systems. So our office convenes the federal health systems as part of our commitment to working on sustainability and resilience of all the health sector in the United States. About 15 percent of it is in the federal systems, mostly in the VA and the Department of Defense, and so they’re big purchasers as well.

So our office has been working with NHS England to create, you know, an informal – to find other partners, you know, in other mostly high-income countries that are looking at doing the same thing with procurement standards.

Ms. Bliss: OK. And then by, you know, really kind of showing that example through bulk procurement and really kind of making that economic impact, then that may – I guess the idea is that that would then lead other elements of the health sector to follow suit.

Dr. Balbus: Exactly. And we’re actually seeing that as well. So, you know, in the space of global health we’re seeing – first of all, we’re seeing some action within the U.S. government from PEPFAR and Roll Back Malaria to be looking at supply chain issues from a – from a sustainability standpoint as well as a resilience standpoint – you know, looking at onshoring; looking at reducing distances; looking at, you know, lower-emitting, you know, means of transportation; those kind of things. But also the Global Fund is looking very seriously in all of their purchasing.

So it’s starting to take hold. This is what’s happened in the last three years, is that entities like the Global Fund, you know, that could have said, well, climate change – you know, we worry about TB; that’s not a climate change issue, right? But they’re recognizing that climate change, in fact, affects everybody that they’re trying to help, it affects the way they do business, and ultimately that they have a responsibility to help be part of the solution.

Ms. Bliss: Well, and if they lose – you know, if their warehouse is flooded or, you know, destroyed because of a storm, then that becomes very expensive –

Dr. Balbus: Exactly.

Ms. Bliss: – for them and for all the countries that support them as well.

So thinking about these global issues, I know your office is largely focused on domestic challenges, but obviously, climate and health are issues that have been taken up internationally. As you said, last year at COP-28 was the first year there was really a health day within the climate change discussions. There’s going to be another one this year in Baku in Azerbaijan in just a month or so. I wanted to ask you to say a little bit about how you see what’s happened here in the United States, kind of the domestic agenda, influencing how the United States engages internationally on some of the issues. You’ve already talked a little bit about PEPFAR and PMI and some of the supply chain and procurement issues. But you know, are there lessons from what we’ve seen here in the United States that can be shared with other countries? And are there examples from overseas that – you’ve talked about the NHS example, but you know, are there others that would be helpful to bring back here to the domestic agenda?

Dr. Balbus: So, first, quick answer is that there are absolutely lessons to be learned from many other places in the world, especially low-income settings that are, you know, having to get by with very few resources, are dealing with, you know, a lack of any energy, with a lack of any clean water. We need to be addressing those kinds of problems in a way that’s cost effective and saves money and, you know, isn’t wasteful. So there’s a lot that we learn from what goes on in other countries.

You know, in terms of how our domestic work has an influence, you know, I think it’s hard to understate just the leadership role of the United States in all diplomatic and international, you know, contexts. When our office – I mentioned that, you know, we were given a mandate to work on – to work on protecting the health of the most vulnerable people. But a month after that was COP-26 in Glasgow. And we were invited to join the COP-26 health program, which was the first – you know, the United Kingdom was the presidency of COP-26.

And this was the first major effort to engage the actual health ministries around the world in climate change commitments. And so the fact that the United States did so early and publicly, you know, I think, had a big influence on other health ministries around the world saying, well, maybe we should sign on to this too. So that’s just – that’s just one example.

The existence of our office, the work that that we are doing, you know, is mirrored and reflected by developments throughout the U.S. government. So, you know, the PREPARE initiative of President Biden, which is focused on financing and funding for climate change in general, started out, you know, without a whole lot of health in it. But the health content of that has been building up. USAID is doing a lot of work on protecting people from heat, and convenings related to heat stress, and heat and workers, et cetera.

And, you know, our Office of Global Affairs, you know, is our diplomat – within HHS is our diplomatic arm that brings U.S. positions and support for these kinds of activities to everything from the World Health Organization, which has just set a new global program of work in which, you know, climate is number one of six priorities across all of WHO, to things like the G-7 health ministries and the G-20 health ministries – all of which are really starting to grapple with climate change and health. So, you know, it happens in the diplomatic circles. It happens in the private sector. And it happens in government-to-government relationships, the bilateral relationships.

Ms. Bliss: So your office has been around now about three years. The next COP is in a month or so. But I guess, you know, we can be hopeful that health will be a part of the conversation for some time to come. But as you look ahead five to kind of 10 years into the future, what are your hopes for kind of where the U.S. will be in terms of the – whether, you know, it’s the Office of Climate Change and Health Equity, or kind of more broadly, like, you know, in terms of, you know, the key accomplishments around climate and health in kind of the five to 10 year period, what do you most want to see?

Dr. Balbus: So we’ve made a lot of progress in these three years on ensuring that the mainstream activities of HHS are climate smart. And when that occurs, we probably won’t need much of an Office of Climate Change and Health Equity. So, you know, my 10-year plan is really to try to put us out of business. And, you know where we’re seeing – you know, we’re seeing movement in, you know, especially in the Center for Medicare and Medicaid Services, where, you know, starting with their technical assistance programs, are starting to, you know, explicitly have support for technical assistance on emergency preparedness and extreme weather resilience.

We have the new TEAM model from the Center for Medicare and Medicaid Innovation, where they are for the first time having a voluntary pilot for, you know, health facilities to start reporting on their greenhouse gasses, and collaborating with the CMS on ways to lower their emissions and reduce costs. That, you know, just got announced and will be – will be ramping up over the next few years. So, you know, if this trend continues, and the idea that, you know, healthcare facilities around the country actually fare better when they have microgrids and, you know, they’re controlling their energy supply, they’re controlling their energy costs, and lowering them. You know, ultimately that leads to everybody doing it. And that changes, you know, processes of certification, you know.

So we’ve seen the joint commission, starting with a sustainability, you know, certification. Not a condition of accreditation, but things will move in that – you know, things moving in that direction so that it’s a level playing field, and it just becomes a recognition that everybody needs to do this for us to get to the safe place we need to be in the climate crisis. That’s the 10-year vision.

Ms. Bliss: So hopefully you won’t have an office anymore, but that’s because it will have been embedded in all the different aspects of health, domestic and global, and people will have adopted these practices that you’re working very hard for the health sector to embrace, because it’s both cost effective and really leads to quality health outcomes in the longer term.

Dr. Balbus: Exactly.

Ms. Bliss: Well, it sounds like a good 10-year vision to get behind. So, John Balbus, thank you very much for taking the time to talk with me about a very timely, ambitious research and policy agenda on both the domestic and international implications of climate change and health. And thanks very much for joining me today. And thank you to our audience for joining as well.

Dr. Balbus: Great. Thanks for having me and thanks for opening the discussion on this topic.

Ms. Bliss: Thank you.

(END.)