WAshington – Ask 10 people how a federal health care agency might approach “environmental justice,” and you’ll get 10 answers.
For residents of Jackson, Missouri, it guarantees potable water after weeks of danger from a damaged sewage system. For people in “asthma alley,” where northern New York City communities straddle major highways, it’s slowing the flow of emissions-related respiratory problems, even as New laws can divert more traffic on their way. In the meantime, Angelenos want to see repercussions on nearby factories spewing metallic pollutants into the air.
The only unifying thread is that the issues are huge, amorphous, and potentially intractable. Which makes it even more difficult for the only two employees currently fired for the Office of Environmental Justice, one of whom is due to leave soon. Although the office was launched in May, it also lacks any formal funding. Still struggling to figure out exactly where to go from here, or how.
If the parent office, the also emerging (which also remains unfunded) office of Climate Change and Health Equality, is a small group with a noble purpose, its environmental sanitation arm is on the Apollo mission.
Sharonda Buchanan, the interim director who joined in May from the Centers for Disease Control and Prevention, where she still works as a technician, said most of the office’s first four months focused on a listening tour with fellow health officials and community advocates. Although others were on loan to the office, she would soon be the only employee.
“There are all of these environmental sanitation issues — clean water, lead poisoning, exposure to chemicals — that will only be exacerbated,” she told STAT. “[Even] Without this aggravation, these are the issues that societies have been grappling with for a long time.”
Even if it can figure out what it wants to achieve, experts question how effectively it can do so, since the agency lacks regulatory authority over environmental quality, zoning and other societal structures. Looming over those still early discussions, too, is a kind of existential deadline. With the congressional midterms and the upcoming presidential elections looming, the Office of Environmental Justice may have less than two years to fully justify its existence.
“It’s a tremendous opportunity and responsibility,” said Renee Salas, a climate and health fellow at Harvard T.H. Chan School of Public Health. “I hope they are given the resources to do that.”
THis new office grew out of President Biden’s January executive order directing agencies to make administration-specific plans to combat climate change, fulfilling a key campaign promise.
HHS’ efforts are one of the first. The Justice Department office was also formed in May, just a few weeks ago. But while the Department of Justice has set out a four-year strategy and a relatively straightforward initial goal – enforcing environmental protection measures – the fledgling HHS office is in uncharted territory. This spring, the agency requested input on a new strategy and in the meantime set initial goals, including developing that strategy, supporting the HHS Office of Civil Rights, and developing a relevant environmental data plan.
However, the office remains unfunded, and neither is the main office on climate change and health justice. HHS has asked Congress for $3 million to manage climate change overall, a request that was ignored in the 2022 budget and still reluctant for next year.
This summer saw a significant achievement in climate change financing, with the passage of the Inflation Reduction Act, including nearly $3 billion in environmental sanitation grants channeled through the Environmental Protection Agency (plus ambitious clean-energy industrialization plans and emissions targets.) Funding HHS Small Office is not included; Currently attached to the budget for the fiscal year 2023.
“Of course, that will take some time,” Buchanan said. “Slow and easy win the race,” but she admits, “I would like the speed to go a little faster.”
The work of some agencies related to the environment is more direct: the Department for Children and Families, for example, Subsidies are already issued To help low-income families with energy bills.
For other departments, the relationship with environmental justice is more fragile. Buchanan hopes the FDA will help reduce some of the toxic chemicals found in hair products marketed to black women, for example. But the agency does not approve of hair products; can only really Issuing advisory and warning messages.
There are other significant hurdles for HHS to make a difference in environmental justice as well. First, the agency has no regulatory authority over environmental quality or regularly handles these issues. This is much more than the jurisdiction of the Environmental Protection Agency and the Department of Justice.
Environmental issues are typically fought at the state and local levels through zoning, land management and anti-discrimination policies, said Lawrence Justin, a professor of health law at Georgetown University.
“HHS can, and should, partner with the Environmental Protection Agency as well as state and local officials, and they can make grants targeting better environmental justice. But the tools in their fund are very limited,” Justin said.
One health agency that has become the focal point of many climate change advocates is the Universal Centers for Medicare and Medicaid Services, which oversees billions of dollars in federal funding for hospitals and providers.
Advocates say the health care program could require hospitals that want to participate in the program to reduce their carbon footprint and establish green practices — climate change priorities that intersect with environmental justice in communities surrounding major service providers.
Many major hospital networks insist they are already working for smaller footprints without federal requirements. Several hospitals and related organizations — including American Essential Hospitals, the American Association of Medical Colleges, and the National Academy of Medicine — met with top White House and health officials in June and pledged to cut carbon emissions.
However, critics argue that management cannot rely on the industry to regulate itself.
“It’s the industry that really runs the regulators,” said David Introcaso, a health policy advisor and former HHS official who has publicly called for Medicare to implement climate change rules. Introcaso has pushed federal officials to require hospitals to report their current emissions and provide auditable plans to reduce them.
WAs the Office of Environmental Justice grapples with its future goals, it has embarked on one measurable project: collaborating with the Centers for Disease Control and Prevention to build the Environmental Justice Index, an effort located in the CDC office where Buchanan has worked for decades.
The index collects data from the Environmental Protection Agency, the CDC, the Census Bureau and mining regulators to assign environmental justice scores to each community based on the risks around them and obstacles such as access to health care, low income, or other “social vulnerabilities” that may mean that communities do not I know what resources to draw on to fight in their local government.
For advocates like Bobby Jones, that’s not nearly enough. Jones, a retired North Carolina health official, has been urging officials to regulate toxic coal ash dumps for energy companies for a decade — an increasingly pressing issue as major hurricanes expose thousands of largely low-income people to toxic waste and unsafe water. .
Data and Tracking Tools – “This is not the help we need,” Jones told STAT after a meeting with Buchanan’s team.
Even this relatively modest federal goal is fraught with challenges.
Just under 4% of city governments publicly provide resources and data on climate change, according to Study 2020 at The Lancet. Nearly 40% of states have similar web pages but the actual data is fragmented or “too local,” said Harvard’s Salas, making it difficult to apply at scale.
“There is a gap right now” between researchers and government officials looking to make a difference, Salas said. “We don’t have those bridges that connect the two and bring the right people to the table at the right time.”
Buchanan told STAT that the office and the CDC had begun doing demos about the program to various agencies. When it is ready, officials will hold workshops for community leaders.
“I tell the team we are small and strong, and we will get bigger and stronger with time,” she said.