White House Public Health and Climate Change Summit

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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).

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