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Institutional Betrayal: HHS’s Failure to Decarbonize the Healthcare Industry (Part 2)

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By DAVID INTROCASO

This is Part 2 of David Introcaso’s review of the attempt by the Biden admin to do something about the massive carbon footprint of the US health care system. If you haven’t read part 1, start here.

Discussion

Under Secretary Becerra, HHS’s effort to decarbonize healthcare amounted to passive obstructionism or at best an exercise in performative guilt.

Inarguably, the climate crisis constitutes a permanent Public Health Emergency (PHE). Yet, Becerra refused to declare one. His Surgeon General, Dr. Vivek Murthy, whose job was to generate debate and build consensus concerning significant public health issues, failed to make climate breakdown or healthcare’s contribution to it a priority. HHS never signed an agreement with the EPA nor with the Department of Energy. It was striking Becerra failed to say anything about the Securities and Exchange Commissions’ 2022 proposed climate disclosure rule despite knowing the highly-leveraged healthcare industry faces significant climate-related financial risk exposure. 

Because Becerra also failed to obtain Congressional funding for OCCHE, until it was eliminated in 2025 OCCHE was largely relegated to producing monthly “Climate and Health Outlook” reports that attempted to identify where the next climate disaster would threaten the public’s health.

Per a White House call to action, in April 2022 Becerra announced a voluntary climate pledge program that constituted patented greenwashing. Pledgees would self-report, were not required to use Energy Star and the program lacked oversight and enforcement.   

A month later Becerra announced an Office of Environmental Justice. It too was never funded. The OEJ did produce an Environmental Justice Index that scored by census track environmental, health and social vulnerability. Possibly a good idea in theory but in reality, as a potential climate redlining tool it threatened to formally sanction climate apartheid. 

The 2021 White House EO also directed major agencies to develop climate resilience plans. Becerra would have been wise to ignore the directive.  Instead, HHS published a Climate Action Plan that pledged to make a “concerted effort to enhance resilience.” It’s worth noting building resilience is now widely promoted despite presenting insurmountable and distressing problems. Resilience requires ceaseless adaptation to and recovery from an endless cycle of climate-charged disasters. Because resilience assumes climate harms are endemic, they are made acceptable. People are forced to live in permanent danger because there is no alternative to ecocide capitalism. Resilience teaches apathy, hopelessness and fatalism. It is anti-human agency, a form of subjectification. As value free, it is an attractive political policy allowing for infinite deferral. Resilience allows institutions like HHS to abdicate responsibility, apologizes for exploitative resource use and licenses a disaster-ridden world. Refusing to envision any alternative future, resilience is nihilism. 

Becerra could have at minimum calculated healthcare’s annual carbon footprint. Either on its own or in cooperation with the EPA, HHS could have at least conducted source attribution, sentinel site or randomized stratified sampling studies, exploited proxy data, etc. 

More productively, Becerra could have exploited the 1946 Administrative Procedures Act’s “good cause” exemption.  This would have allowed Becerra to publish an interim final regulatory rule, that would take effect immediately, requiring hospitals under COP to at minimum publicly report Energy Star scores.

CMS’ effort was non-existent.

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Institutional Betrayal: HHS’s Failure to Decarbonize the Healthcare Industry (Part 1)

By DAVID INTROCASO

The Problem

From an anthropocentric perspective, the climate crisis is fundamentally a threat to human health and survival. 

The US healthcare industry significantly contributes to this threat. US healthcare’s greenhouse gas emissions (GHG) annually account for over 600 million metric tons of carbon dioxide equivalents or ~10% of total US annual GHG emissions.[1] If US healthcare was its own country, it would rank ~12th worldwide in carbon pollution. 

Tragically, the industry and the US Department of Health and Human Services (HHS), responsible for regulating the healthcare market, remain committed to climate breakdown.  

The Solution

There was a sense of relief in 2020 when the National Academy of Medicine (NAM) announced its commitment to decarbonize the industry. The NAM’s silence had been difficult to understand in part because the National Academy of Sciences had recognized climate-related public health problems as early as 1966.  That year, NAM President Dr. Victor Dzau launched the Academy’s Grand Challenge on Climate and Health. The initiative was defined by a scoping paper drafted by Dr. Don Berwick, a former CMS Administrator, and two colleagues.  The authors wrote, “as the climate change public health catastrophe smolders, the US Healthcare system largely fiddles.” “Rather than ‘doing no harm,’ healthcare is fueling the carbon fire.” They recommended healthcare leaders “respond effectively to climate change,” by measuring “HEALTH outcomes as much by the environmental and public health impacts of our work as by the outcomes of particular patients.” “The healthcare sector must,” they concluded, “reduce its carbon footprint by 50%, in absolute terms, by 2030 compared to a 2010 baseline.” The recommendation aligned with a United Nations’ 2018 report that concluded reducing GHG emissions by this percent would provide a 50-66% chance that global warming would be limited 1.5°C above pre-industrial levels and thereby avoid irreversible climate tipping points.

In September 2021, Dr. Dzau announced a NAM and HHS co-chaired effort titled the “Action Collaborative on Decarbonizing the US Health Sector.” HHS was prepared because per an early 2021 White House Executive Order titled, “Tackling the Climate Crisis at Home and Abroad,” HHS Secretary Xavier Becerra had announced one month prior the creation of HHS’s Office of Climate Change and Health Equity (OCCHE). During his OCCHE press conference Becerra promised, “we’re going to use every tool at our disposal” to decarbonize the healthcare industry.

Motivations

There are several reasons why decarbonizing the healthcare industry has enormous significance.

With a market cap of upwards of $7.5 trillion, US healthcare, arguably the largest industry in the world’s largest economy, is exceptionally energy intensive being resource heavy in buildings, technology and labor. Equipment, lighting, strict ventilation, plug-in loads and high-occupancy mean hospitals are ovens even when outside temperatures are below freezing.

The industry is equally energy inefficient. The ten-year running average ending in 2025 of hospitals EPA Energy Star certified was 88, or less than 1.5% of an American Hospital Association-estimated 6,100. Operating rooms are particularly energy sinks accounting for ~50% of a hospital’s GHG emissions largely because of significant use of disposable medical supplies.   

High entropy healthcare was nowhere near decarbonizing much less accounting for its GHG emissions. While total US GHG emissions decreased by ~5% between 2010 and 2018, healthcare’s increased by ~6%. Research published in 2022 concluded healthcare “lags far behind in terms of [climate] sustainability, management and disclosure,” because “there is no sector-wide push from academic or industry leaders, government . . . regulators . . . or payors.”

Fossil fuel combustion exposes everyone, everywhere to innumerable and unrelenting health harms. Effectively everyone worldwide breathes substandard air accounting for upwards of ~8 million deaths annually. A study published in 2018 concluded 58% of estimated excess US deaths are due to fossil fuel use. A study published in 2022 concluded an equal percent of infectious diseases are aggravated by climate-related hazards and pathways.

GHG emissions pose a meta-problem, an underlying problem about a problem. Absent their removal, every healthcare policy effort to improve access, equity, quality, spending, value and utilization are compromised.   

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And Yet It Moves

By KIM BELLARD

Science buffs will recognize the title as the (possibly apocryphal) quote Galileo muttered after he was forced by the Catholic Church to recant his assertion that the earth moved around the sun, contrary to church dogma. We’re in an era where it is the Trump Administration, not the church, forcing people and organizations to accede to things they don’t really believe in, whether they are law firms, universities, media companies, or big corporations, to name a few.  

That’s why I was so pleased when last week the National Academies of Sciences, Engineering, and Medicine (NAS) not only didn’t take a knee about the Trump Administration’s dogma about climate change being a hoax, they also didn’t just mutter their objections. They issued a lengthy report outlining how climate change is very real, is largely due to human contributions, and is extremely bad for us and the planet.  

And yet it moves indeed.

The NAS was spurred into action by an EPA announcement proposing to rescind an Endangerment Finding issued in 2009 by the Obama EPA. “With this proposal, the Trump EPA is proposing to end sixteen years of uncertainty for automakers and American consumers,” EPA Administrator Zeldin said.“In our work so far, many stakeholders have told me that the Obama and Biden EPAs twisted the law, ignored precedent, and warped science to achieve their preferred ends and stick American families with hundreds of billions of dollars in hidden taxes every single year.” He was practically giddy.

Not so fast, the NAS report says. Its overarching conclusion: “EPA’s 2009 finding that the human-caused emissions of greenhouse gases threaten human health and welfare was accurate, has stood the test of time, and is now reinforced by even stronger evidence.”

The report lists five key conclusions:

  • Emissions of greenhouse gases (GHGs) from human activities are increasing the concentration of these gases in the atmosphere.
  • Improved observations confirm unequivocally that greenhouse gas emissions are warming Earth’s surface and changing Earth’s climate.
  • Human-caused emissions of greenhouse gases and resulting climate change harm the health of people in the United States.
  • Changes in climate resulting from human-caused emissions of greenhouse gases harm the welfare of people in the United States.
  • Continued emissions of greenhouse gases from human activities will lead to more climate changes in the United States, with the severity of expected change increasing with every ton of greenhouse gases emitted.

Pulling no punches, it says:

In summary, the committee concludes that the evidence for current and future harm to human health and welfare created by human-caused GHGs is beyond scientific dispute. Much of the understanding of climate change that was uncertain or tentative in 2009 is now resolved and new threats have been identified. These new threats and the areas of remaining uncertainty are under intensive investigation by the scientific community. The United States faces a future in which climate-induced harm continues to worsen and today’s extremes become tomorrow’s norms.

i.e., “And yet we are endangering ourselves, and the planet.”

Shirley Tilghman, professor of molecular biology and public affairs, emeritus, and former president, Princeton University, and chair of the committee that wrote the report, was more diplomatic: “This study was undertaken with the ultimate aim of informing the EPA, following its call for public comments, as it considers the status of the endangerment finding. We are hopeful that the evidence summarized here shows the strong base of scientific evidence available to inform sound decision-making.”

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Does American Health Care Violate the ICJ’s Recent Climate Advisory Opinion?

By DAVID INTROCASO

In late July the UN International Court of Justice (ICJ) announced its long-awaited and highly-anticipated climate advisory opinion.  The ICJ ruling represents an historic moment in climate accountability.

“Obligations of States in Respect of Climate Change”

In a rare unanimous decision, the ICJ opinion concluded “a clean, healthy and sustainable environment” is in part a precondition for the enjoyment of human rights including the right to life and the right to health.  Consequently, the ICJ ruled states including their private actors are obligated to ensure the climate is protected from anthropogenic greenhouse gas emissions (GHGs) and can be held legally culpable by other harmed or unharmed states, groups and individuals for failing to protect the climate.

The 140-page opinion is the result of a 2023 UN resolution that requested the ICJ produce an advisory opinion answering two questions: what are states’ obligations under international law to ensure protecting the climate and what are the legal consequences for causing significant climate harm?  In a failed attempt the US State Department opposed the resolution arguing the ICJ can only consider applicable climate treaties such as the 2015 Paris Agreement and to the exclusion of other rules of international law.

In sum, the ICJ found states have substantive, urgent and enforceable obligations under UN climate treaties and international laws to prevent significant harm to the environment from GHG emissions that includes those resulting from fossil fuel use.  The court broadly defined fossil fuel use as the adoption of laws, regulatory policies and programs that promote fossil fuel production and consumption via leases, licenses and subsidies. 

States must act using “all means at their disposal” that includes adopting appropriate legal and regulatory measures, acquiring and analyzing scientific and technological information and risk and impact assessments, meeting a duty of cessation and acting in good faith that includes a duty to cooperate and collaborate internationally.  The ruling also allows for legal action to protect future generations.  The court rejected the argument attributing harm on a case-by-case basis is unachievable stating it is “scientifically possible” to determine each state’s current and historical emissions.  Without naming the US, the ICJ affirmed states not party to UN treaties must still meet their equivalent responsibilities under international law.  (Columbia’s Sabin Center Climate Change Law Blog has examined at length the ICJ opinion.)

US Healthcare’s Contribution to Anthropogenic Warming

Because the ICJ recognizes an inherent link between anthropogenic warming and human rights, the opinion implies the right to health cannot be secured without addressing US health care’s own climate obligations.  Meeting these pose a substantial challenge for the industry for several reasons.

US health care significantly contributes to anthropogenic warming.  Per Northeastern Professor Matthew Eckelman, the industry accounts for a growing amount GHG emissions currently at over 600 million metric tons of carbon dioxide equivalents (CO2e), or 9-10% of total US emissions and 25% of global healthcare emissions.  If US healthcare was its own country it would likely rank 9th, less than Saudi Arabia but more than Germany.      

Two reasons largely explain US healthcare’s carbon footprint.  The industry is immense.  Despite providing care for 4% of the world’s population, last year it constituted a $5.3 trillion market or roughly half of total global healthcare spending.  The industry wastes an enormous amount of energy.  Despite spending over $5 billion annually on energy, equivalent to at least 15% of profits, hospitals are significantly energy inefficient because they continue to consume fossil fuels to first generate heat to produce electricity that is dramatically less efficient than using renewable resources that directly generate electricity or work demand.  End-use energy inefficiency compounds the problem.  For example, only a trivial number of hospitals are EPA Energy Star certified for energy efficiency.  For the ten-year period ending in 2024, 85 or 1.4% of over 6,000 hospitals were on average certified. 

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Water, Water, Everywhere . . . but Not a Drop to Drink

By MIKE MAGEE

In the wake of last week’s human tragedy in Texas, it would be easy (and appropriate) to focus on the role played by Trump’s reckless recent dismantling of FEMA and related federal agencies. But to do so would be to accept that the event was an anomaly, or as Trump labeled it on Sunday on his way to a round of golf at Bedminster, “a hundred year catastrophe.”

In reality, tragedies like this are the direct result of global warming, and last week’s suffering and loss are destined to be followed by who knows how many others here and in communities around the world.

In 2009 President Obama joined global leaders in New York City for the Opening Session of the UN. One of the transboundary issues discussed was Global Warming. All agreed that the Kyoto Protocol had failed. It failed because the target to decrease emissions by some 5% was too low. It failed because large transitional nations like India and China were excluded. And it failed because US leadership opted out.

The global community today has a deeper hole out of which it must dig. In doing so we would do well to focus on health and safety as outcome measures, and define strategies to manage the obvious consequences of this ongoing crisis.

Two decades ago, the warnings were clear. Left unattended, we would soon not only need to plan mitigation, but also need to prepare and resource intervention to deal with inevitable human injury and disease fall-out. Of course, back then, we could not have predicted that wise disease interventions in climate ravaged hot spots around the globe, like expansion of USAID funding in the Bush and Obama administrations, would be X’d out under Trump/Musk. Who could have imagined such reckless and ultimately self-destructive moves?

And yet, here we are:

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Zombie Viruses of the Permafrost

By KIM BELLARD

We’ve had some cold weather here lately, as has much of the nation. Not necessarily record-breaking, but uncomfortable for millions of people. It’s the kind of weather that causes climate change skeptics to sneer “where’s the global warming now?” This despite 2023 being the warmest year on record — “by far” — and the fact that the ten warmest years since 1850 have all been in the last decade, according to NOAA.

One of the parts of the globe warming the fastest is the Arctic, which is warming four times as fast as the rest of the planet. That sounds like good news if you run a shipping company looking for shorter routes (or to avoid the troubled Red Sea area), but may be bad news for everyone else.  If you don’t know why, I have two words for you: zombie viruses.

Most people are at least vaguely aware of permafrost, which covers vast portions of Siberia, Alaska, and Canada. Historically, it’s been literally frozen, not just seasonally but for years, decades, centuries, millennia, or even longer. Well, it’s starting to thaw.

Now, maybe its kind of cool that we’re finding bodies of extinct species like the woolly mammoth (which some geniuses want to revive). But also buried in the permafrost are lots of microorganisms, many of which are not, in fact, dead but are in kind of a statis. As geneticist Jean-Michel Claverie of Aix-Marseille University, recently explained to The Observer: “The crucial point about permafrost is that it is cold, dark and lacks oxygen, which is perfect for preserving biological material. You could put a yoghurt in permafrost and it might still be edible 50,000 years later.”

Dr. Claverie and his team first revived such a virus – some 30,000 years old — in 2014 and last year did the same for some that were 48,000 years old. There are believed to be organisms that ae perhaps a million years old, far older than we’ve been around. Scientists prefer to call them Methuselah microbes, although “zombie viruses” is more likely to get people’s attention.

He’s worried about the risks they pose.

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Some Like It Hot! A Century-Old Disease on Our Southern Shores

By MIKE MAGEE

Naomi Orestes PhD, Professor of the History of Science at Harvard, didn’t mince words  as she placed our predicament in context when she said, “If you know your Greek tragedies you know power, hubris, and tragedy go hand in hand. If we don’t address the harmful aspects of human activities, most obviously disruptive climate change, we are headed for tragedy.”

At the time, as a member of the Anthropocene Workgroup, she and a group of international climate scientists were focused on defining and measuring nine “planetary boundaries,” environmental indicators of planetary health. At the top of the list was Climate Change because, one way or another, it negatively impacts the other eight measures.

Not the least of these “human perturbations” is the effect of global warming on access to clean, safe water, and the impact of violent weather cycles and rising sea levels on concentrated urban populations along coastal waters.

A less recognized, but historically well documented threat, is exposure to migrating vectors of disease as they contact unprepared human populations beyond their traditional camping grounds. The threat of avian flu among migratory birds has been well covered. Equally, over the past decade, North America has seen a range of novel infections, especially along our southern borders, from dengue, to chikungunya, to Zika.

The southern United States and its coastal populations are firmly in the cross-hairs. Their seas are rising at an alarming rate, and fouling fresh water supply with invasive sea water. Their soaring temperatures are only exceeded by record setting atmospheric river rainfalls and flooding events, and their “extreme poverty throughout Texas and the Gulf Coast states, where inadequate or low-quality housing, absent or broken window screens, and a pervasive dumping of tires in poor neighborhoods,” as reported in this weeks New England Journal of Medicine, assures a reemergence of one of this countries most significant, but now long forgotten killer diseases.

In 1853, the disease killed 11,000 in New Orleans, some 10% of the population. Twenty-five years later, it overwhelmed Mississippi Valley cities killing 20,000. Its latest major foray in the United States was in 1905 with 1000 deaths. Its’ absence over the past century is credited to public health and structural and engineering advances. But that was then, and this is now.

The disease is Yellow Fever, and red lights are blinking in a range of southern coastal cities from Galveston, TX, to Mobile, AL, to New Orleans, LA and Tampa, FL.. Experts say they may soon be in the same boat as Brazil was between 2016 and 2019 when it experienced a threefold increase in the historic prevalence of the disease among its population.

Public Health sleuths have uncovered that the 1878 epidemic in the Mississippi Valley was triggered by an El Nino spike the year prior. The warmer and wetter conditions are believed to have supported a large increase in Aedis aegypti mosquitos, the vector for the Yellow Fever virus.

Are we prepared? Recent experience in fighting Dengue fever in the southern statesis not encouraging, with WHO chief scientist Jeremy Farrar warning that Dengue might soon “take off” absent better mosquito eradication and screening prevention. U.S. Public Health experts say a Dengue foothold is nearly secured and the disease is fast on its way to becoming endemic in southern coastal states.

As for Yellow Fever, there is an effective vaccine, but it is also associated with rare but serious side effects. Antivaccine activism post-Covid would be a significant barrier now say experts. Adding to the challenge, no Yellow Fever vaccine is currently available from the U.S. Strategic National Stockpile. Mosquito surveillance programs are currently marginal, and response capabilities for mass vaccination in affected areas are severely limited.

The Anthropocene Workgroup is fully aware of these human instigated crises. In the prior Holocene Epoch of 11,700, we prided ourselves with being able to co-exist with other lifeforms and in equilibrium with a healthy planet. But beginning in 1950, the new Anthropocene Epoch has aggressively chipped away at planetary health, disrupting stabilizing cycles, and critically raising the temperature and acidity of oceans that cover and buffer 70% of the planet.

The return of Aedes aegypti, and the Yellow Fever virus it carries, is a dramatic harbinger of additional challenges to come if we are unable to limit “human perturbations” of our planetary cycles.

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Mike Magee MD is a Medical Historian and regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex.

The “Green Pope” Loves Science and Is Cautious of AI

By MIKE MAGEE

By all accounts, they were mutually supportive. He was three years older and the chief scientific adviser to the world’s most powerful religious leader. The Scientific American called him “the greatest scientist of all time,” and not because he won the Nobel Prize in Chemistry a decade earlier for explaining the nuts and bolts of ozone formation. It was his blunt truthfulness and ecological advocacy that earned the organization’s respect.

Paul Crutzan is no longer alive. He died on February 4, 2021 in Mainz, Germany at the age of 87. What attracted the 86 year old “Green Pope” to Paul were three factors that were lauded at his death in the Proceedings of the National Academy of Sciences (PNAS) – “the disruptive advancement of science, the inspiring communication of science, and the responsible operationalization of science.”

It didn’t hurt that Crutzan was pleasant – or as the The Royal Society in its obituary simply described him: “a warm hearted person and a brilliant scientist.”

In 2015, he was Pope Francis’s right arm when the Catholic leader, who had purposefully chosen the name of the Patron Saint of Ecology as his own, was briefed on the Anthropocene Epoch. Crutzen had christened the label five years earlier to brand a post-human planet that was not faring well.

Crutzen was one of 74 scientists from 27 nations and Taiwan who formed the elite Pontifical Academy of Sciences in 2015. Those selected were a Who’s Who of the world’s scientific All-Stars including 14 Nobel recipients, and notables like Microbiologist Werner Arber, physicist Michael Heller, geneticist Beatrice Mintz, biochemist Maxine Singer, and astronomer Martin Rees.

On May 24, 2015, they delivered their climate conclusions to the Pope, face to face. The Pope heard these words, “We have a collection of experts from around the world who are concerned about climate change. The changes are already happening and getting worse, and the worst consequences will be felt by the world’s 3 billion poor people.”

The next month, with his release of the encyclical on the environment, Laudato Si’, Pope Francis began by embracing science, with these words, “I am well aware that in the areas of politics and philosophy there are those who firmly reject the idea of a Creator, or consider it irrelevant, and consequently dismiss as irrational the rich contribution which religions can make towards an integral ecology and the full development of humanity. Others view religions simply as a subculture to be tolerated. Nonetheless, science and religion, with their distinctive approaches to understanding reality, can enter into an intense dialogue fruitful for both.”

Further along, he celebrates scientific progress with these remarks, “We are the beneficiaries of two centuries of enormous waves of change: steam engines, railways, the telegraph, electricity, automobiles, aeroplanes, chemical industries, modern medicine, information technology and, more recently, the digital revolution, robotics, biotechnologies and nanotechnologies. It is right to rejoice in these advances and to be excited by the immense possibilities which they continue to open up before us”

But then comes the hammer: “Any technical solution which science claims to offer will be powerless to solve the serious problems of our world if humanity loses its compass, if we lose sight of the great motivations which make it possible for us to live in harmony, to make sacrifices and to treat others well.”

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HHS Again Suspends Disbelief: The Medicaid Program Will Ignore the Greatest Health Threat to Medicaid Beneficiaries

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BY DAVID INTROCASO

In May the Centers for Medicare and Medicaid Services (CMS) simultaneously published two proposed Medicaid rules (here and here) intended to improve moreover access and quality.  Both discussed at length the agency’s commitment to “addressing health equity.”  The first sentence in both identified health equity as a Medicaid program priority.  The proposed “ensuring access” rule stated CMS “takes a comprehensive approach to . . . better addressing health equity issues in the Medicaid program.”  CMS went on to state “we are working to advance health equity by designing, implementing, and operationalizing policies and programs” by “eliminating avoidable differences in health and quality of life outcomes experienced by people who are disadvantaged or underserved.”

Nevertheless, CMS’ interest in health equity is entirely performative.  It is impossible to believe the agency is legitimately interested in “eliminating avoidable differences” because leadership is well aware the greatest health equity threat to Medicaid – and Medicare – beneficiaries is the climate crisis.  This is because the most climate vulnerable Americans are Medicaid and Medicare populations.  Yet, the climate crisis is never addressed much less mentioned in either proposed Medicaid rule.  The word “climate” never appears in 291 Federal Register pages. 

This is explained by the fact that despite the Biden administration’s “government-wide approach” approach to “tackle” the climate crisis, HHS has refused to address the threat the climate crisis poses by regulating the healthcare industry’s massive carbon footprint.

Children, 36 percent of whom are Medicaid beneficiaries, are uniquely vulnerable.  Fine respirable particles resulting from fossil fuel combustion are particularly harmful because children breathe more air than adults relative to their body weight.  Research published last year concluded the health effects to the fetus, infant and child include preterm and low-weight birth, infant death, hypertension, kidney and lung disease, immune-system dysregulation, structural and functional changes to the brain and a constellation of behavioral health diagnoses.   

Medicare beneficiaries, already compromised due to higher incidence rates of co-morbidities, are at even greater risk related to arthropod-borne, food-borne and water-borne diseases because the climate crisis can increase the severity of over half of known human pathogenic diseases.  Extreme heat episodes are particularly deadly.  Over the past 20 years heat-related mortality among seniors has increased 54%. 

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Air, Air, Everywhere, and Not a Breath Safe to Take

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BY KIM BELLARD

If you live, as I do, anywhere in the Eastern half of the country, for the past week you’ve probably been thinking about something you’re not used to: wildfires.  Sure, we’ve all been aware of how wildfires routinely plague the West Coast, particularly Oregon and Washington, but it’s novel for the East. So when the smoke from Canadian wildfires deluged cities through the East and Midwest, it came as kind of a shock.

For a day last week, New York City supposedly had the worst air quality in the world.  The next day Philadelphia had that dubious distinction.  The air quality index in those cities, and many others, got into the “Maroon” level, which means it was hazardous for everyone.  Not just for the elderly and other “sensitive” groups, and not just some risk for some people, but hazardous for everyone.   

If you didn’t know about AirNow.gov before, you should now.

New Yorkers are used to smog and air quality that is less than idyllic, but smoke from wildfires, containing fine particulates that easily get into the lungs, weren’t something anyone was prepared for.  “Wildfires were not really a scenario, in all honesty, that I recall us specifically contemplating,” Daniel Kass, New York City’s deputy commissioner for environmental health from 2009 to 2016, admitted to NBC News.   

“People on the East Coast aren’t used to seeing these types of situations. There was a much slower response,” Peter DeCarlo, an associate professor of environmental health and engineering at Johns Hopkins University, also told NBC News. “We can probably learn a thing or two from our West Coast friends.”

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