Rohan Patel: Hello everybody. Please have a seat. I want to welcome to the White
House Summit on Climate and Health on behalf of the
entire White House Climate Team. My name is Rohan Patel and
I’ll be moderating this first part of the agenda. For those of you
watching online on the stream at
whitehouse.gov, for those of you following on Twitter,
for those of you here in the audience at the
White House, welcome. Thank you for being here. Thank you for your work. We have a jam-packed agenda,
as you can see in front of you and online, with
administration announcements, with high-level speakers, but
the truth is what we really want out of this is a dialogue,
a dialogue that happens in medical schools, at
the kitchen tables, in research labs, in board
rooms, and the like. And, you know, what has
happened here today is that we’ve brought together
a set of the foremost researchers with mothers
and fathers who are caring for children dealing
with respiratory illness, with deans of medical
and nursing schools with advocates from
the public health and environmental
community. It’s a wonderful group that
we’ve got assembled here today. I’d be remiss not to
point out that we have with us Congresswoman
Eddie Bernice Johnson. Thank you for
being here today. And before we get started,
these things happen with a lot of work from the agencies,
from our staff, from interns. I want to particularly point out
Candace Vahlsing who many of you guys have probably
interacted with but who has put a lot of time,
late nights, weekends into organizing this, so a big
round of applause for Candace and the work
that she’s done. (applause) Let’s go ahead and kick off the
program with our first speaker. Brian Deese is a senior advisor
to the President and is really the driving force behind
the climate, energy, and environmental agenda. Brian Deese. (applause) Brian Deese: Thank you, Rohan. I’d be remiss to not start
by also thanking Rohan for everything he’s done to
get us to this point. Good afternoon and welcome
to all of you that are here in the room and who are
participating online. We’re incredibly excited to
have you all here to continue this conversation on climate
change and public health that many of you have been
part of for some time. For those of you who
are joining newly today, welcome and we want this
conversation to continue well beyond today. We know why we are all here. We’re here because
climate change is real. It’s being driven by human
activity and it’s affecting people’s lives right
here and right now. The impact of climate
change is particularly stark in the context
of human health. For many of us, this issue
starts at a very personal level. As a parent, I can say there’s
nothing that’s more important to me than the health and
wellbeing of my daughter and I know that parents all over
the country and here in this room feel the same way. Many of you live with the
constant fear of a child who has asthma or respiratory illness
wondering whether your child can — it is safe for
them to go outside to play and wondering whether you’ll
have access to the kind of — the kind of medicine that
we know will be necessary. The President, who was with the
Surgeon General and I at Howard University a couple months back,
put it poignantly when he said, “I’ve seen how scary it is
when your 4-year-old comes up to you and says, ‘Dad, I’m
having trouble breathing.’ That’s a moment that
you’ll never forget.” For many of us, it’s moments
like that that have spurred us to action on this issue. But for others of us, it’s the
impact on a much broader scale. From the personal, to the
community, to the state, to our nation, this issue of how
a changing climate affects the way we all think about health
is one that is increasingly difficult to ignore. So I just want to offer a
couple of words at the top of this conference about
how climate change is affecting human health
and about our actions and the President’s
actions to try to do something about that. As you all know, we are seeing
the impacts in real time. We’re seeing it in
asthma, lung disease. Climate change is
causing earlier springs and hotter summers. It is notable that we’re here
today in Washington D.C. on a day that can only be
described as very hot. I was out this morning
standing outside doing a T.V. interview with the Weather
Channel at 7:30 a.m. and even at 7:30
a.m., it was very hot. We are going to see
more days like today. We’re going to see
hotter summers. That leads to longer
allergy seasons. And we’re going to see more
frequent and intense wildfires. Those throw off
more smoke and soot, particulate matter
in the air. Higher temperatures
can increase smog. All these factors put people
with asthma and other vulnerable groups, like
children and the elderly, at greater risk of getting sick. We see the impact of climate
in the nexus with health in insect-borne diseases. The National Climate
Assessment that we released last May found the climate
change was increasing the range of deer ticks that
carried Lyme disease here in the United States. In other countries, mosquitos
that carry malaria and Dengue fever are expanding
their habitats because of higher temperatures. We also see it to the risks of
workers who labor outdoors. Yesterday the Environmental
Protection Agency issued a broad-ranging and long-awaited
report that built on the best science available and asked
the question of what will our economy and our country look
like at the end of this century in a scenario where we do
nothing about climate change and in a scenario in which we
act aggressively and one of the most stark conclusions
was in the do-nothing scenario. We will have material impact
on the productivity of our labor force. Put simply, our workers won’t
be able to work as much or as effectively because
it’s too hot or because the climate impairs that. The EPA report estimated $170
billion in lost wages annually by the end of the century. So we know that these
impacts are real. They’re growing over time. We also know that the sooner
that we act to address these impacts, the cheaper it’s going
to be and the more effective we’re going to be at
saving lives and improving our economy. We know that it’s not
too late to take action and we know that concrete
action can work. We also know that we can
do this in a way that is good for our economy. And we know that we can do
this in a way that’s good for cleaner air and for
the health of our kids. This is what is motivating
President Obama to place this issue at the top of his
agenda both domestically and internationally for
the remainder of his term. (applause) I just came here from the State
Department where today we are holding the strategic and
economic dialogue with the Chinese government and one
of the things that was striking was that — two
things were striking. First, within the strategic
and economic dialogue between the United States
and China, climate change is no longer a side issue. It is at the center
of our strategic and economic engagement. And the second was that unlike
previous years where you — where there was potential
friction between our countries in who was responsible and
who had an obligation to act, now our countries are talking
about more and different ways that we can collaborate,
ways that we can learn from each other, ways that we
can identify win-wins, whether it’s on energy
efficiency or on public health or on electric vehicles or on
advance energy technologies. And President Obama’s
commitment is that as we move through these coming
months and years that he will put this at the top
of his agenda with every country that he’s engaging
with bilaterally as well. In order to do that, we
need to continue to show leadership here at home. That means looking across all
sectors of our economy and asking what can we do to be
aggressive to both mitigate the impact of climate change
by reducing carbon pollution and make our communities more
resilient to the effects of climate change that we
know are happening now. That’s why this summer, the Environmental Protection
Agency will propose the first ever limits on carbon
pollution from power plants. The proposed rule the EPA put
forward last summer would cut carbon emissions by 30 percent
by 2030 and we will finalize a rule this summer that
maintains that type of ambition. It’s why last week the EPA and
the Department of Transportation put forward new fuel efficiency
standards for heavy-duty vehicles, everything from
18-wheelers to garbage trucks. This rule is slated to
cut 1 billion metric tons of emissions and save $170
billion in fuel costs. It’s why we’re partnering with
industry to reduce the use of hydrofluorocarbons, which
is a complicated word but a very simple concept. HFCs are an incredibly
potent pollutant, an incredibly potent
climate change contributor, more than 10,000 times the
potency of carbon dioxide. We’re going to work to phase
out HFCs both here at home and internationally. And it’s why we’re working
through the Department of Agriculture with farmers
and ranchers and our forest industry, to look for ways to
make our domestic lands more resilient, but also reduce the
carbon pollution in the process. And at the end of the day, it’s
why we’ve asked all of you to be here today, because even as we
work with our manufacturers and our power sector, our
truckers, our farmers, to make this transition
to a lower carbon economy, we need to make sure that we’re
putting the health of our people at the center
of that effort. We need to make sure that
people know why we are pushing so hard in this fight against
climate change and at the end of the day, that comes back to
the health of our children and the health of our
families and our communities. We focus a lot here in
the White House on metric tons of carbon and
on regulatory tools. That’s our job and we’re
going to keep doing that as aggressively as possible. But we know that when it
comes to motivating action across this country, the
thing that it most important is the health of our
communities, the sustainability of our communities. Do we know how we are going to
create an environment where our kids are prosper and
our economy can thrive? So I just want to say thank
you for joining us today. Know that we are committed
to doing whatever we can to try to move
this agenda forward. Know that we cannot do
that without your help, both in being voices in your
communities to lift up these issues, but also in
challenging us, questioning us, telling us when we don’t
have the right assumption or we don’t have the right
prescription so that we can work together better
as partners going forward. And with that as an
introduction, and without further ado, I’ll introduce
our next speaker who needs no introduction and
who will join us by video, President Barack Obama. (applause) The President: Hi everybody. Welcome to the White House
Summit on Climate Change and Health. We convened this group
to address the gathering challenges and costs that
the threat of a changing climate poses to our
nation’s health. All of you participating
in the summit here at the White House and in
cities across the country know these challenges
very well. But a growing number of
everyday Americans are increasingly concerned,
too, because evidence of climate change is no
longer relegated to decades of carefully collected
scientific data. It’s something that we
can increasingly see and feel as we step out
our front doors. We know that climate change
means more extreme weather events like deeper droughts and
longer and hotter heat waves. We know that steadily
warming temperatures can contribute to more
pollution and more smog. And more intense wildfire
seasons mean increased smoke in the air, all things
that make it harder for our kids to breathe. And we know that earlier
springs and longer summers means extended allergy
seasons and bigger zones of tropical and mosquito-borne
diseases like Dengue fever and malaria. So there are a whole host of
public health impacts hitting home and while there is a lot of
work to be done by countries and corporations to combat
this threat, we also need doctors, nurses, and
citizens like all of you; people who care enough about
your communities to roll up your sleeves and get to work to
raise awareness and organize folks for real change. That’s because we recognize
that the cost of an action far outweigh the costs of
action, and that’s a message and mission that we have
little time to spare in conveying across
this country. So I look forward to seeing
the lasting accomplishments that emerge from this
summit, and I thank you all for the work that you do. (applause) Vivek Murthy: Good
afternoon, everyone. Audience: Good afternoon. Vivek Murthy: It’s good to
see so many familiar faces in the room. My name is Vivek Murthy and
I serve as Surgeon General of the United States. I would like to welcome all of
you here today and to welcome all of you who are joining
us from afar through the live webcast. And before we start, I just
want to offer a few things. One, to President Obama for
inviting me to be here today, but also particularly to Brian
Deese, his senior advisor, who has done a heroic job
bringing us all together along with Candace Vahlsing, who
we recognized earlier today. And I also want to recognize the
extraordinary work that has been done by so many of our agencies,
which are represented here in the room today including the
Department of Health and Human Services, the Environmental
Protection Agency, and certainly the
White House as well. Without them, organizing this
important summit and doing the work that led up to it would
not have been possible. I was reflecting when I was
coming over here just about how I got into health and I was
thinking about how my mother and father, when they inspired me to
go into medicine through their own practice of medicine, they
reminded me often of a very simple, simple value,
which is to tell the truth. Tell the truth to your
patients, tell the truth to your colleagues, tell
the truth to yourself. So here is a sobering truth that
I want to speak about today and that’s the climate change
poses a serious, immediate, and global threat
to human health. We are not here today to
debate whether or not climate change is real. We’re not here to debate
whether or not human activity is contributing to that. These questions have
been settled by science. But we are here today as
public health leaders, as policy makers, and as
citizens of the planet to figure out what we are in fact going
to do about climate change. That is a pressing question
that stands before us. And the truth is that the
planet is warming leading to impacts on health as well
as on the environment. And here’s what we know. We know that climate
change means higher temperatures overall. We know that higher
temperatures mean worse air for cities and more
smog and more ozone. And we know that earlier
springs and longer summers mean longer
allergy seasons. Together this means more
clinic visits and more hospital admissions for
asthma, for allergies, and for respiratory disease,
and this means more days of school missed, more
days of work missed. It means more costly
trips to the doctor. And as a physician, I remember
many times seeing patients in the hospital who were
affected by asthma and I remember still so
clearly how difficult and frightening it was for
patients to be fighting for every single breath. I still also remember on a
personal note many years ago when I was a child, receiving
a call in the middle of the night from family
members informing us that my uncle, my favorite
uncle, in fact, had just died of a severe
asthma attack. So asthma can be a
frightening illness, not just for patients but
also for their families. In addition, though,
to impacts on the air, we know that climate change
means more extreme weather events including hurricanes,
wildfires, and floods. These events take a toll on the
physical and mental health of communities and they
also threaten our health infrastructure which, in turn,
worsens disasters and leaves communities without care. We know that climate
change means longer and hotter heatwaves. Extreme heat events,
as many of you know, are associated with death
and hospitalizations, particularly for
the elderly. Extreme heat, like so many of
the consequences of climate change, is not just something
that will affect the big cities and small towns in America. It’s something that will
affect all parts of the world. These are but a few
of the many impacts of climate change on health. But what I’m encouraged
by is to see how public and private sector partners
are coming together to address climate change. We’re seeing healthcare
organizations working together with the Department of
Health and Human Services to develop sustainable
and climate-resistant health facilities. And as you will hear in a few
minutes from my colleague, Dr. Nikki Lurie at HHS, we are
also using technology to develop web tools like Empower to
help communities locate ventilator-dependent
patients and others whose health depends on electrical
power in the event of weather-related
power failures. There are just but a few of the
examples of collaborations that are taking place
within the administration and across the
private sector. But while the impacts on climate
health — of climate change on health are many, there is
perhaps one element of it that is most concerning to me and
that is that the brunt of the health impact of climate change
will be felt by those who are already vulnerable, by our
children, by the elderly, and by the poor. Climate change, it turns
out, threatens to worsen disparities in health and
that is unacceptable. Addressing climate change
is therefore not just a health issue, but it
is also a moral issue. And each of us has a
responsibility to do what we can, as much as we can,
and for as long as we can. And certainly I would say that
when scientists and doctors and public health practitioners
are coming together with everyone from Presidents
to prime ministers, even the Pope himself, it is
certainly time to take action and I would say it’s
well past time, in fact. So I thank you all
for being here today. I thank you for your commitment
to working on climate change, and I most importantly thank
you for your commitment to improving the health of
our nation and of the world. Thank you very much. (applause) Rohan Patel: Before I call
up our first moderator, I want to embarrass a
little bit one of my heroes, somebody who’s fought for labor
and public health protections for the least amongst us, the
President of the United Farm Workers, Arturo Rodriguez. It’s his birthday today so we
won’t sing him Happy Birthday, but I want everyone to give
him a big round of applause. (applause) With that, I’m not going to
read her bio and I’ve got it here in front of me. It would take me all day. But Dr. Nikki Lurie is the
Assistant Secretary for Preparedness and Response
and suffice it to say, whether it’s in the academic
realm or the corporate realm or in the government world, Dr.
Lurie has exemplified what public service is all about. So with that, Dr. Lurie. (applause) Dr. Nicole Lurie: Thank
you and good afternoon. As you heard, I’m
Dr. Nicole Lurie. I’m the Assistant Secretary
for Preparedness and Response at the Department of Health
and Human Services and we’re here for about the next
half-hour or so to discuss strategies not to prevent
climate change itself, but to prevent
health impacts of climate change in communities
across the country. I know that all of you
are working very hard on both of those fronts. So my office is charged with
helping the country prepare for, respond to, and recover from all
different kinds of disasters. So I’ve had the opportunity
when disaster strikes anywhere in the country. It could be an epidemic
or an outbreak. It could be a tornado or
a flood or a hurricane. I’ve had the opportunity to
travel around the country to affected areas, both helping
with response and trying to help people recover. And it was that
experience, I think, that led my office to develop
an exciting new tool that the Surgeon General just referred
to as Empower and that launches today to help states and
communities identify vulnerable people in their communities
and ultimately save lives. So does somebody
got a couple slides? You’re going to get a
real — you can go to the next one — a really
quick commercial here. So what happens? Every time I go to one
of these disasters I end up in a shelter where
there are people who live perfectly fine at home independently but use oxygen, have a ventilator, have
some piece of electrical equipment and the
power goes out and it’s going to be out for a
long time and they pick up not one, not two, but sometimes
six or eight pieces of this medical equipment. They go to a shelter. They’re separated from
their caregivers, their family,
their friends. They are at risk of having to
go back into the nursing home they just left or to a
hospital because their disease is going to get worse,
especially if they don’t have the electrical equipment. And then we need to send the
National Disaster Medical System or someone else to take care
of them in this shelter. It’s not a very functional
system but we are seeing more and more severe weather
events all the time. We are seeing more and more
times that there are prolonged power outages all the time,
and we have more and more of these kinds of people living
at home in our communities all the time. So this led us to a
collaboration with the Center for Medicare and Medicaid
Services to say, “Guess what, it turns out that most of the
people who have electrical devices are on Medicare. Medicare has
information about them. Could we collaborate in a way
that is totally protective of patients’ privacy, to
understand who these people are so that
communities can plan?” So from that came
the idea of this map, this tool that we
now call Empower. And as I said, it is
launching today so I want to give you just a
quick snapshot of this. On the left you see
what happened a couple weeks ago in Texas with
this severe flooding. Okay? This incorporates
real-time feeds from NOAA from the Weather Service
and you can see the nasty weather pattern there
across the country. If you go up to the top
right, you can see gosh, where do we see the most
electricity-dependent people in the country and you
can drill down all the way to a country
and to a zip code level on the bottom to say
what zip codes are going to be most affected by this
in one way or another. In another reiteration of
this in a dire emergency, we actually could in a
privacy-protected way, make data available for the
Health Department to send people out to knock on
their doors and save lives. But for planning, we
don’t need to do that. We just need to know
where the people are. Next slide, please. And so what is this
then help us do? Health departments all over
now can work with power companies about where to
prioritize power restoration. You can plan your shelters. You can plan how many people
you’re going to see there. Last time I went to a
hurricane, which was in Louisiana, the
shelter had planned to be able to take
care of 250 people. At 110 people, the circuit
breakers were blowing. So this helps you plan
because you know who’s in your community. You know who’s going to need
transportation assistance. You can plan for
lifesaving response. So there’s a little flier
out there and we’ll urge you to share this with your
health departments and other responders and to be
able to go ahead and use it as you see fit. It’s my pleasure now to
introduce Representative Eddie Bernice Johnson
who represents the 30th Congressional
District of Texas. It was convenient
that I showed a map of Texas, Dallas, and
its surrounding areas. She also a registered
nurse and currently serves as the ranking member on the
House Committee on Science, Space, and Technology. She’s going to give brief
remarks and then I will invite the panelists to
come up and introduce them. So Representative Johnson,
thank you for being here. (applause) Representative Johnson:
Good afternoon. Audience: Good afternoon. Representative Johnson:
I’m delighted to spend this time with you on
such an important subject and want to thank all of
those who were responsible for putting it together. Each month the scientific
evidence of climate change grows and it is confirming what
the majority of climate scientists have been saying
for a very long time. The earth is warming and
Americans everywhere are dealing with the consequences of
this new climate reality. Coastal communities are watching
the sea inch closer and closer to their doorsteps. Families in the
southwest, where I’m from, are facing increasingly severe
drought and wildfire conditions. Extreme weather events,
such as heavy precipitation, are becoming more frequent
across the nation. These are only some of the
visible impacts of climate change and while
they are varied, they each contribute
to a common dilemma, putting the health of millions
of Americans at risk. I know there are some who will
retreat from the challenge of addressing a
problem this complex. I’m not one of those and I’m
challenged every day in my work. But as the first nurse
elected to Congress, I feel a particular
obligation to work to promote health and safety of
my fellow Americans. Climate change affects
human health in many ways. Rising temperatures lead to
an increase in heatwaves that cause death and heat
stress-related illnesses, but also increase hospital
admissions for kidney stones and cardiovascular disorders. A warmer climate can cause
pathogens to become more virulent and spark the
development of entirely new strands significantly
increasing the risk of contracting a disease. The spread of infectious
diseases like Lyme disease, which we’ve had a great deal of
the last two years in Texas and north Texas where I’m from,
as well as West Nile Virus, Rocky Mountain Spotted Fever
carried by insects such as ticks and mosquitos, are on
the rise due to more favorable breeding conditions. We’ve already had some
mosquitos tested and find that we are dealing with
West Nile now because of all the flooding in my area. More vigorous weed
growth and a larger, longer pollen season are
increasing the number of allergic responses. Incidents of foodborne bacterial
diseases such as salmonella or fungal infections are
also more likely to occur. Flooding and increased rainfall
from more severe weather events can lead to waterborne parasites
finding their way into drinking water and drinking supplies and
air quality can be severely impacted by the very pollution
that is contributing to climate change and by more frequent
wildfires resulting in asthma and respiratory diseases. It is worth noting that children
in communities of color are disproportionately
affected by air pollution. These are not just
environmental issues. They’re also issues
of justice. No matter where the
disaster strikes, those with the fewest
resources too often bear the brunt of the damage. Those with the least have the
harder time preparing, escaping, and ultimately recovering. The interesting thing in my
area the last few years is that it is not the minorities that
most of the swimming pools so they’ve not been the
minorities been affected by West Nile as
much as others. But that is an unusual
occurrence because most of the environmental
illnesses occur with children that are from poor areas. And children are more likely to
be active outdoors and their lungs are still developing. In addition, a 2011
analysis of the U.S. populations and air quality
found that African-Americans and Latinos are more likely
to live in counties that had worse problems
with particle pollution. African-Americans were also more
likely to live in counties with worse smog pollution,
have nearly two times the rate of current asthma
as white children, and are four times more
likely to die from it. Most of the poor
areas, of course, have closer to more of the
pollution — areas of pollution. I’m keenly aware of these
statistics because those of us from the Dallas-Fort Worth
region are very familiar with the negative effects of smog and
are accustomed to seeing orange and red alerts warning us about
being outside because the air is too polluted for it to be safe. In fact, the American Lung
Association gives the air quality of Dallas grade F. Now can you just imagine a
city that has most of the billionaires and millionaires,
the largest number of any other city in the country, with some
of the poorest children and poorest family which means
that the health of many of my constituents are
seriously at risk. It is clear that these health
impacts are very serious, very complex, and
worth our attention. And that is why I applaud
the work being done with the agencies like
CDC and the EPA. The EPA gets bashed,
bashed, bashed, but let me applaud the EPA
for standing strong looking out for the health — (applause) The world might not know it
but we know that it’s needed. The CDC will help our
communities prepare and develop solutions to minimize health
impacts and they have been preparing for this new
climate for nearly a decade, identifying vulnerable
populations, anticipating health
impacts, and developing resilience strategies. The EPA has been working to
ensure that we have clean air to breathe and clean water to
drink for the past 40 years, being bashed every day and the
volume gets louder every day, but they are standing strong
and I stand strong with them. It is worth pointing
out, however, that much — as much as we might
wish for a world where big environmental issues are
addressed voluntarily by industry and through the
workings of a free market or are best regulated
by individual states, we all know that that
is not going to happen. It has not happened up to
now and it’s not going to happen in the future. So the American people need
strong EPA to protect their rights for clean air and water. While climate change is
a challenge that we must overcome, it is also an
opportunity, an opportunity to spur research and
innovation in our universities and technology hubs, and even
an opportunity to create jobs. There has never been a time
when there was clean-up going on that jobs were
not created, not lost. For example, in my home state
of Texas, a unique place, I think, that’s different
from any other place — (laughter) The wind is abundant. Solar, hydro, natural gas
resources all are available. And we should be positioning
ourselves to become a world leader in clean
and renewable energy. But you know, like
any other time, Texas is one of those states
that don’t want nobody to tell them anything — (laughter) — and so we are
slow to get to it. But I’d like to see Texas
companies not only install, but build and sell wind
turbines, solar panels. This is the climate and
certainly we’ve got the space. I would like to see Texas
cities take the lead in adopting clean
energy technologies and creating systems to
minimize water and carbon use. And that innovation will not
just create jobs and spur economic growth, it will improve
the environment and thus help improve public health
and not just in Texas. And this is why today’s White
House summit is so important because we’re going to need to
ensure that our public health system is prepared to
address the changes that may be brought by a
changing climate. We cannot slow down. We must go forward. And I hope that today’s
discussion will lead to affirmative steps and
concrete actions that we can take to mitigate the
damage already done, and to adapt to the
changes that will occur. Ultimately we are all in this
together and though my state probably stands to benefit
most, they haven’t learned that yet,
at least by some. But by working together, we
can achieve our shared goals and a robust economy, a
healthier public which will cost the government
far less money and a cleaner
environment. So thank you. (applause) Dr. Nicole Lurie: I’m going
to ask my panelists to come join me up here. So I’m going to take a moment
and introduce you to four people who are really very much at
the front line of thinking about and working on
climate change and health. They each come at this from a
very different perspective. I’ll do a quick introduction
and then we’ll ask them each to make some brief remarks
and see if we can take time for questions. We got a late start. We’re trying to catch up a
little bit on time but want everybody to
have the opportunity. So Dr. Sumita Khatri is an
adult pulmonary critical care physician and
the co-director of the Cleveland
Clinic Asthma Center. Arturo Rodriguez, our
birthday boy here — (laughter) — is the second President of the United Farm
Workers of America. Dr. Thomas Matte is the
Assistant Commissioner for Environmental Surveillance and
Policy at the New York City Department of Health. And Deborah Hall is the National
President of the American Medical Student Association and
recently graduated from the University Of Connecticut School
Of Medicine, so congratulations. So we’re going to go ahead
and start with Dr. Khatri. Dr. Sumitra Khatri: Okay. Thank you very much for
inviting me to be part of this panel. I am so thrilled to
have health voice now to the climate change discussion
because it’s long overdue. Those of us in the front lines
have seen that very often. We interface with the air we
breathe and it’s appropriate for us to think about
things outside of ourselves and the conversation has not
just turned to health but also on what we can do about it. I’ve personally studied these
trends and seen that in Cleveland when particulate
matter levels are higher, the visits for asthma go up. The same thing in Atlanta when
the ozone levels are higher, inflammation is going
up in the airways. But you know what, who cares? I mean, not who cares, but
really the science is there already but what really matters
is what happens to patients. You know, patients don’t want
to hear about the science. The patients know what
they experience every day. We know that the science is
clear and we need to do is really come up with
an answer for them. When they ask us, “Why
is this happening to me?” We need to be able
to say, “Well, we don’t know yet what
are all the factors but we are working on it.” That’s how we need
to think about it. Patient stories matter. The gentleman who was on
life support who two years ago for asthma, he
has kids with asthma. They have
environment issues. They’re doing the best
they can in this scenario. He’s worried that his kids are
going to have the same issues that he does and these
are the things that we have to consider. Further, it’s a
global problem. Recently a patient came
to see me from India. She had the means to come. She came to see me to ask what
can she do about her asthma. Her lung capacity at 56 is
at 30 percent of where it should be. And she has the cognizance
and the awareness to know that it’s probably due
to the air pollution in the mega city that
she lives in. So this is a global issue
and on a large scale we see it and on a smaller scale in
our neighborhoods we see it. So I see personally three
issues and opportunities. The first, as Congresswoman
Johnson mentioned, is the vulnerability
and health disparities. Children and older
adults are affected disproportionately
in Cleveland. We see it as a
very big issue. In the shadows of
the Cleveland Clinic, we have smaller pockets of
basically third world economies. What are we doing? And climate resilience
results in family resilience. The bread winners need to be
able to keep their jobs so that their kids can have the
medications they need so that they can have a
future and education. So that’s the
first opportunity. The second opportunity is
innovation not just in scientific discovery, but
also in comprehensive health policies and
healthcare delivery. I see the innovation in the
pharmaceutical industry help personalized medicine and
biologics and expensive things. How about the cocoon in
which we put our people? We have to think about how
these can be intervened upon. What an opportunity that
we should not miss. There are co-benefits. When we think about reducing air
pollution from putting diesel particulate filters on school
buses, which I’ve seen, the actual in-cabin
pollution levels go down for the kids whose lungs
are actually growing. How perfect is that? Collateral good. That’s what we
should be going for. And the third opportunity I see
is the collaboration and role of healthcare institutions as
physicians and healthcare providers and the future of
— you’ll be taking care of me so I have to think
about that as well — the future of
our healthcare. We must engage in our
environment and in our communities so that we’re not
thinking about it in isolation and thinking about as
healthcare institutions, how to reduce our carbon
footprint and be energy efficient and be an
example for the world. So hold us accountable. We need to be accountable. All of us need to
be accountable. We should all strive to make our
practices and policies result in the cleanest air possible
so that collateral good from these efforts can
have positive downstream health effects on our most
valuable currency, our people. Thank you. Dr. Nicole Lurie: Thank you. (applause) So Arturo Rodriguez
is going to go next. He’s been doing some very
exciting work on protecting farm workers from heat. Go ahead. Arturo Rodriguez: Thank
you very much, Dr. Lurie. We are humbled to be here
on behalf of at least 26 California farm workers
who died from the heat in recent years harvesting
America’s food. They perished denied the
drinking water, shade, and other simple measures
that could have prevented their deaths. As important as the words
we will speak and hear today are, there are no
words more important for farm workers than those
from Pope Francis. Before his historic
encyclical on climate environment, he spoke of
our people’s plight as “the eradication of our
brother farm workers.” Pope Francis affirmed the
importance of farm workers who “care for the land, cultivating
it, and doing so in community. So let us resolve the
watering crops cannot be more important than water for
farm workers to drink. Climate change cannot be more
important than changing the lives of those who
feed the rest of us. And global warming cannot
be more important than the coldhearted cruelty that
society and government allows to go unchecked,
unnoticed, and unaddressed in this land of plenty.” This week it is once again
extremely hot as the summer harvest seasons continue
across California. The United Farm Workers helped
convince then Governor Arnold Schwarzenegger in 2005 to issue
the first heat regulation. After that, approximately
26 farm workers have died as a result of heat stress
there in the fields. These regulations are important
but if they’re not enforced, then it’s just a piece of
paper for farm workers. One example was the needless
death of a young 17-year-old woman, Maria Yzelle
Vasquez Jiminez in 2008. She weighed less than 100
pounds, was working on Lodi, California in May 2008 when
the temperature soared beyond 100 degrees. In the afternoon, after not
taking breaks because she was worried about losing her
job, she went back and forth carrying lugs of grapes
and ensuring that she met the harvest needs at
that particular time. She collapsed in the afternoon. Rather than take her
to get medical care, they drug her underneath
a tree and left her there the rest of
the afternoon. After 5:00 when the
work stopped that day, they put her into a hot
van that had been sitting in the sun all day long. By the time she finally
arrived to get medical care, at that point, the
doctor saw that her body temperature was 108 degrees. She died the following day. So farm workers whose family
members died from the heat joined the UFW in filing
lawsuits beginning in 2009 aimed at
improving enforcement. Settlement of the lawsuits
in May with the Jerry Brown administration led to a new
partnership between the UFW and the State of California
that is producing more effective, timely, and
consistent inspections of farm worksites to
protect farmworkers. Feeding America and much
of the world is honorable and important work. Farmworkers shouldn’t risk death
or illness from extreme heat when reasonable measures can
easily prevent such tragedies. Enforcement of these
protections will improve joint efforts by the State
of California and UFW as the result of the
settlement of these lawsuits. We hope to implement a similar
program nationally as well. Si, se puede. Thank you. (applause) Dr. Nicole Lurie: What a tragic
story and tragic reminder of the impacts as heat as
well as working conditions. Goodness. Dr. Matte, you’ve been
doing some very interesting surveillance work in New York
City and I hope you can tell us some about it. Dr. Thomas Matte:
Yes, thank you, Dr. Lurie and thanks to
all of you for being here and for the work you’re doing
to address this important public health challenge. I also want to acknowledge the
support of the Centers for Disease Control Climate-Ready
Cities and State program that makes possible a lot
of the work that we do. I’m going to just take a
couple of minutes to describe our climate health program
work in New York City, what we do to understand the
public health impacts of climate and extreme weather, how we
help the city to improve our responses today, and what we
do to inform how the city is adapting to climate
change in the long-term, and then I’m going to share some
lessons learned that I hope are relevant to other
public health agencies. I want to focus on extreme heat
events because that’s the most deadly extreme weather event
that we face in New York City. I think that’s true for
much of the country and we’ve done the most
work to address it. What do we do in the
climate health program? Well first, we use local data
to understand the risk as it’s experienced by the
New York City population. We ask questions like what
does hot weather that’s really dangerous look
like in New York City. What’s the heat index
that poses an imminent public health risk? And very importantly, we ask
what neighborhoods and what populations are most impacted. We share that
information to improve how the city responds
today to heatwaves. So one example is we worked with
the National Weather Service, our local forecast office,
to use the results of our mortality study to change
the threshold for issuing advisories about dangerous
heat in New York City and activating the city’s
heat emergency plan. We also have observed that the
characteristics of victims of fatal heat stroke in New York
City include that they’re usually exposed at home. There are people with chronic
physical or serious mental health problems and
they either don’t have or they’re not using
air conditioning. So we’ve used this information
to provide guidance to the public, to clinicians, and to
service providers who serve the homebound to help
them prepare for the heat season and respond
to severe heatwaves. We’re also using our
health studies to inform longer term climate
adaptation measures. So in collaboration with
colleagues at the Columbia Mailman School of
Public Health, we developed a mortality-based heat
vulnerability index so it tells us which
communities have the physical characteristics and the
demographic characteristics that increase the risk
of death during extreme hot weather and that index
can be used now to target urban heat island
mitigation efforts. That’s effort to sort of
cool the urban landscape, and other preventive strategies
to vulnerable neighborhoods. That type of approach is part
of the city’s One NYC plan, the latest update to our
city-wide sustainability plan and we’re very
proud to have been able to bring public health science
to bear on that plan. So I want to just highlight a
few lessons that we’ve learned in New York City that I
hope are helpful to others in either state or city
public health agencies. First, if you’re not working on
the topic of public health and climate impacts, a good
starting point is to look at the health risks that you
face today from extreme weather and understand them and try
to use that information, partner with other city agencies
or state agencies to improve what you do to protect
people from the health risks of extreme weather today. A second lesson we’ve
learned is that, especially in cities, infrastructure
resilience is the first line of defense for public
health protection. We’re in a — we’re
a vertical city. If we have a power outage during
any sort of extreme weather event, even with seasonal summer
or fall or winter weather, it greatly increases the risks
to health in the population. People stranded in these
high rise buildings that are so prevalent
in our city. So, it’s important for public
health professionals to be partnering with other agencies
— other disciplines to really incorporate public health risk
and vulnerability assessments into environmental adaptation
measures that are durable — that don’t require so much
human behavior change to really be effective. So, that includes things like
urban heat island mitigation, which I measured — mentioned
and flood-resilient building codes, which are very important
for us in New York City. One other point is
that it’s complicated. There are many pathways by which
climate and weather affect public health, and so, it’s
really important to be collaborating with academic
experts in a variety of disciplines including
climate science, building science, and so forth
to really get useful, actionable answers
to these questions. And then finally, as others have
mentioned, it’s true globally, and it’s true within our city,
and I suspect in most cities around the country, the climate
health risks fall mostly on the poor, the economically
marginalized people, and those with preexisting
health conditions. So, whatever we’re doing in
public health to promote health and reduce health disparities
— things like environmental changes that make it easier for
people to be physically active — getting from place to
place for people to get access to healthy food. All of those things are
supporting climate health adaptation in our city, and
I think that’s a point that’s easy to overlook. So, thank you, and I
look forward to the rest of the discussion. (applause) Dr. Nicole Lurie: Thank you. So, I have a boatload of
questions to ask our panelists. I want you to think about
whether you have questions for them, too. We’re going to hear from Dr.
Hall, and then, hopefully, we’ll have time to take
just a couple questions and spark some
discussion here. Deborah Hall: Hopefully,
my comments will be brief and permit for that. So, thank you for giving
me this opportunity. I’m here really to
talk about, you know, students in all fields and
across all of healthcare is the next generation
of leaders. Historically, we tend to be at
the leading edge of change, and I don’t think that this is
going to be any different than really other time in
history when you’ve seen the next generation of
leaders in a field being the ones who are
driving the change. We’re seeing the health
impacts on our patients, and we are uniquely
positioned to act. At the patient level, it’s
actually — if you’re in the medical culture,
it’s, sort of, expected that the student on a team
is going to be the one who really understands
the patient’s story to the fullest — knows about
the social determinates of health effecting
a patient and how the patient’s health
is effecting their lives in a social way. And so, we are the
collectors and the keepers of our patients’ stories to
their fullest, frequently, whether we’re nursing
students or medical students or public health students. At the policy level, we bring
those stories to the discussion along with new ideas that we
have because we’re not, sort of, steeped in the way things
have always been done. And so, we’re, sort of,
unfettered and able to have those fresh sets of perspective. And at the curriculum level
— the truth is really that students are the only ones
who actually know what’s being taught. (laughter) Teachers and administrators
can tell you what’s in a curriculum, but if you
really want to know what’s making it to students —
what they’re learning, you have to check
with the students. So, it is frequently true
that students are engaged in curricular reform, and we have
been vigorously engaged in curricular form at all levels
of medical education over the last five years, in
particular, as we’re moving to more competency-based
medical education. We’ve long been valued
partners in curricular change. So, students from all of
healthcare are acting at all of the levels that I
just described for you. We do things like what you
talked about Dr. Mehta, where we, you know, make
changes to the built environment — improving public
transportation, increasing green spaces, creating
community gardens. Those are things that improve
patient health and improve patient access to care while
also impacting the climate in the immediate and in the
long term for our patients. We decrease CO2
output, and we, also, are able to advocate
at the local, national, and even at the global
level for policy changes. It’s been said a few times
today, by several people, including the Surgeon General
that we need to tell the truth. We need to hold
people accountable. Dr. Cautrie said that patients’
stories matter and students historically occupy those
spaces where we have the patients’ stories. We tell the truth, and we
hold people accountable. We’re doing all sorts of
work across the country. Students put in over a million
hours a year of volunteer work on a variety of issues, and so,
the thing that I would want to leave all of you with is
I would want students to feel, first of all,
empowered and inspired. The fact that the White House
thought it was important to have student voices in this
conversation should point out to you that people want to
hear from students, and then, I would challenge administrators
and educators and policymakers to really bring students in
meaningful ways into the work that you’re doing — not just
as the people you’re going to send out into communities
to execute your ideas. But bring them in and
ask them for their ideas. And ask them for what they’re
seeing because I think that they are the keepers for a
lot of really wonderful ideas and resources and
energy and courage. Dr. Nicole Lurie: Thank you. Terrific comments — (applause) — (inaudible) this panel. (applause) Are there people in the
audience that want to get a word in edgewise? Go ahead. Male Speaker: The name of the —
the name of the conference is Summit on Climate
Change and Health, and a lot of us think of
health — health system. And I think some of the
comments have — I heard here have us broaden what we
think the health system is. So, Dr. Cautrie, for
example, talked about filters in school
buses that use diesel. Shouldn’t that be part
of, what we think of, the health system? Not the illness care
system, which is what we include now, but a system
that promotes health. Dr. Mehta and Hall talk
about built environment that reduce
carbon footprint. Mr. Rodriguez talked
about proper hydration. I think we need to change our
language and begin to define health system as a broader
system that includes all of these issues
that are essential for promoting health. Female Speaker: Thank you, and I
may take that a step further as we all work on this from
our vantage points and venues. Thinking about health in all
policies and thinking about climate in all policies is
something that I think we’re all challenging ourselves
and one another to do. I have a question for you,
Representative Johnson, you’ve got an audience
full of very committed and dedicated people. Same with the panelists. If there was one thing
you would want them to do in this space around
climate change and health, what would it be? Representative Johnson:
Frankly, I think we have the scientific information. We need people proponents
to talk about it — make sure that the
public is informed. Stand behind the EPA because
they’re attacked every day all day by many committees,
and all they’re trying to do is do what the
Congress mandated them to do to protect the
health of citizens. We need more
voices in support. We need more voices in
support of innovation and research to make sure
that we produce what it takes to improve these areas. (applause) Female Speaker: Great. Thank you. And I know we have people all
around the country in all of the regions who are
also listening to this conversation, and like all
of you in the room, I hope will go out and continue to
talk and educate about it. I’m going to look for the
— Candice tells me one more question. Go ahead, sir. Could you please
identify yourself –? Yogesh Shah: Sure. Female Speaker: — as you speak. Yogesh Shah: Hi, I’m Dr. Shah,
Dean of Global Health at — in Des Moines, Iowa. Question for you Deborah. Question from student’s
point of view. What kind of curricular changes
do you want colleges to make, and how would they — if
you take to a bedside, how would you use them? Example being (inaudible)
or allergy season increasing, how would you
— what kind of information do you need from
medical schools? Deborah Hall: That’s
an excellent question, and in part, I will answer
that by saying that the way to find out
about that is to ask. As a matter of fact, the
American Medical Student Association is actually
recently working as part of a consortium of schools
and organizations who will be gathering that information
from medical students across the country to
find out what we — what do students
currently know about how climate or environment
affects patient health so that we can find
where the gaps are. I think that, again, students
really tend to be — to have the luxury of time, in our history
— taking in the time that we can spend with patients to
learn about the environments that they live in and
how those impact their day-to-day health. But I think that we —
integrating that would — takes encouragement from our faculty
and mentors who can teach us to think in those ways, working
in inter-professional teams where we’re going to get that
information from our colleagues in nursing and our colleagues
in social work and our many colleagues across the
spectrum of health work. Those are changes that are
happening in medical education, now, that students are working
continuously to make broader and more deeply part
of medical education. It is an exciting
time where, I think, a lot of schools are thinking
about making meaningful changes to their curriculum that will
encompass these sorts of things. Thanks for the question. Female Speaker: So, it seems
like we’ve sparked a lot of conversation and a
lot of discussion here. You guys, who are
organizing this, tell me how you
want to proceed. I know we need to move
on to another panel. Male Speaker: I think we’ll
move on to the next panel. Female Speaker: Okay. So, we’ll go ahead and
move on to the next panel. I know there will
be some breaks. I know you can talk to one
another and to the panelists, and I don’t think this
is the beginning of a conversation for you. It’s certainly not going to
be the end but keep talking. Female Speaker: Thanks. (applause)