Linda Rudolph, APHA member

Linda Rudolph, MD, MPH, is a member of APHA’s Environment Section. Photo by the White House.

Last month, the White House honored APHA member Linda Rudolph, MD, MPH, with a “Champions of Change” award for her efforts to reduce greenhouse gas emissions and, as a result, chronic disease problems. Rudolph is co-director of the Public Health Institute’s Climate Change and Public Health Project, and previously served as a deputy director at the California Department of Public Health.

In a conversation with Public Health Newswire, Rudolph discusses her work with APHA’s Environment Section and more specifically how climate change is the most significant public health challenge of this century. “While it’s true that the worst impacts won’t be felt for some time, the crucial time for taking action to mitigate it is now,” she says. “We need to put the full weight of the public health community behind mobilizing to address climate change.”

APHA is co-sponsoring the development of the “Health in All Policies Guide,” a multi-sector public health strategy that releases in September. You’ve worked to implement HiAP practices, first with the California Department of Public Health and now at PHI. What have been the results, and how can the initiative be implemented nationwide?

Health in All Policies is an approach that addresses the upstream determinants of health — the root causes of chronic illness and injury and health inequities — through cross-sectoral collaboration. It’s based on our recognition that if we want to create healthy community environments that foster healthy living and better health outcomes, we have to work collaboratively with transportation, agriculture, economic development, labor, housing, education, arts and the many others who shape the environments in which we live, work, study and play. These other sectors make decisions with huge consequences for our health, but often without a full awareness of those consequences. HiAP brings people together to consider more consciously how decisions across the whole of government impact health, equity and sustainability, and to find opportunities that simultaneously promote all three.

We are starting to see real changes in the way that local, regional, state and federal government agencies make decisions; while there are many steps between those decisions and measurable changes in health outcomes, we’re also starting to see healthier communities. As transportation agencies pay more attention to building infrastructure for walking and bicycling, we see people shifting to active transportation, which will reduce heart disease, diabetes, osteoporosis and depression. Local governments are finding ways to use surplus property for community gardens, and connect farmers with residents to increase access to healthy foods. Housing agencies are implementing policies that reduce secondhand smoke exposure, and decrease asthma attacks. Cities are organizing evening family-oriented events in local parks, to build social networks and reduce violence. These are all things that are beyond the purview of public health agencies, but that will have big impacts on population health.

Now we need to move beyond thinking about health only here and there, and move to institutionalize HiAP. It will take strong leadership from the very top to embed a health, equity and sustainability lens across government. It will also take political will: If we really take health, equity and sustainability into consideration, we will see decisions that benefit disadvantaged communities, people of color and low-income children, as well as the community has a whole. It will require robust community engagement to identify areas of need, to leverage community assets and to ensure that policy and decision-makers are prioritizing strategies that benefit health and human development. PHI has been pleased to partner with the California Department of Public Health and APHA — with support from the U.S. Centers for Disease Control and Prevention — to share some of what we’ve learned about HiAP in the forthcoming guide, and we hope the guide will help spread HiAP implementation nationwide.

You are a member of our Environment Section. What are the Section’s top priorities right now?

Climate change has to be our top priority, because we are really facing a planetary emergency. This is the critical decade; we can either use all of the available tools to make dramatic reductions in greenhouse gas emissions and slow the climate change trajectory, or we can consign our children and grandchildren to a future planet that will not look like the planet on which human life evolved. We really cannot wait to take action. Of course, the many other issues that members of APHA’s Environment Section work on are also very important — like air pollution, drinking water or agricultural pesticides and fertilizers. In fact, climate change and environmental pollution and degradation go hand in hand, both in cause and in impact. They represent a fundamental misalignment between our use of resources and the Earth’s carrying capacity, a failure on the part of industrialized nations to use and allocate resources in a way that allows both for global human development now and for sustainability for future generations.

Climate change acts as a threat multiplier for our many other environmental challenges; it worsens the significant problems we face with diminished availability of fresh water, it worsens ozone pollution, it magnifies collapse of fisheries, and so on. And just as many of the strategies to reduce greenhouse gas emissions have great health co-benefits, so too do those strategies address our other environmental challenges. Vehicle fuel efficiency and controls on power plant greenhouse gas emissions can also reduce air pollution. Agricultural practices that improve carbon storage in soil can also build up depleted soils and increase crop productivity. Urban trees and greening can sequester carbon and reduce the risks of urban heat islands. We have a lot to gain by implementing smart climate action strategies and we need to incorporate climate change into all of our environmental action strategies.

In June, President Barack Obama released his Climate Action Plan, which attempts to improve the health sector’s capacity to safeguard health in a changing environment. As a nation, what are our strengths and weaknesses in combating climate change?

I was heartened by the President Obama’s speech, because the new climate action plan is definitely a step in the right direction. One of our key weaknesses has been the failure of our leaders to speak out truthfully about how grave and urgent an issue climate change is, and to acknowledge that climate change threatens the life systems on which human beings depend for survival.

I understand that there are political challenges to speaking out on this issue, but it is certainly our responsibility as public health professionals to speak out about the science of climate change, and about the serious threats that climate change poses to our health. We need to counter the efforts of a small group of well-funded people, with support from the fossil fuels industry, who have worked hard to intentionally make climate change a political issue, and to obscure the fact that there is an overwhelming scientific consensus about the urgent need to do something about it. It is really reminiscent of the tobacco wars, but the consequences this time are even greater.

One of our biggest challenges is that, as I mentioned earlier, the worst impacts of climate change won’t be felt for decades. But if we don’t act immediately to change our greenhouse gas emissions trajectory a lot, we won’t be able to reduce these risks. By the time we see the full impacts, it will be too late. On a global scale, we’re like the 20-year-old smoker who feels nothing now, but will look back to regret not having addressed his tobacco addiction when he gets the diagnosis of incurable lung cancer 30 years from now. Our current addiction to fossil fuels is leading inevitably to a global climate catastrophe, and we need to kick the habit now to avoid the consequences later.

We have so many available ways to reduce carbon pollution and other greenhouse gases in transportation, agriculture, energy systems, housing and buildings. We need investment to scale up implementation of the things we know work, and research to identify new strategies. And we need to pay attention to climate readiness, helping our communities be more resilient in the face of climate change and better prepared for its impacts.

In the U.S., we are fortunate to have a strong tradition of technical and scientific innovation both in research universities and in the private sector. We have a tremendous amount of knowledge about solutions that can reduce greenhouse gases emissions and improve health, equity and sustainability, waiting to be brought to scale. We have great wealth circulating in our economy that could be invested in addressing climate change. And we have an advanced public health infrastructure that, if well funded and well trained on climate change, could both prepare for climate change impacts and advise on policies that can mitigate or address climate change while offering health co-benefits. In addition, the U.S. is a major player on the global stage, and leadership here on climate change could profoundly shape the directions other countries take.

We have so much potential to address this issue. Our greatest weakness with respect to climate change is simply that we’re not yet bringing all of that capacity to the table. What we need is the focused and collective will, at all levels from individual daily choices all the way up to our national decisions and actions. We need comprehensive climate change policies at all levels of government and throughout our organizations and institutions. Those of us in public health are in a unique position to influence this. Since we are a credible voice on issues affecting health, we can have a powerful impact by speaking out about just how serious and urgent climate change is.

People all over the U.S. and the world are waking up to the climate change challenge. People in communities all over the country are working on climate action plans, both to reduce greenhouse gas emissions and to build more climate-resilient communities. Every one of those plans offers an opportunity for public health workers to get involved and promote the climate action strategies that also promote health and reduce health inequities. We can also continue to call for, support, and help shape state and federal climate plans and policies, like California’s climate legislation, the President’s Climate Action Plan, and like the bills that have been introduced in Congress to curb carbon emissions or to improve public health readiness for climate change.

Thus far, there hasn’t really been an easy way for our public health and health care colleagues, who want to get involved in climate change, to get help and peer support.  Ditto for journalists and policymakers to find experts on climate and health. It’s a complex issue and it can feel overwhelming. That’s why PHI is working with others across the country to form a Climate and Health Alliance.