1. Climate Change: HHS Could Take Further Steps to Enhance Understanding of Public Health Risks NEHA Annual Educational Conference June 2016 Presented by: Diane Raynes and Tricia Roy U.S. Government Accountability Office Washington, D.C. http://www.gao.gov/products/GAO-16-122

2. Overview of Presentation Content Introduce GAO and the request for our study Describe study objectives and sources of information Identify federal activities, challenges and opportunities including recommendation to HHS 2

3. Background—GAO and Our Work on Climate Change GAO is an independent, nonpartisan agency that reports to Congress. High Risk designation o Every 2 years, GAO calls attention to agencies and program areas that are high risk due to their vulnerabilities to fraud, waste, abuse, and mismanagement, or are most in need of transformation. o Starting in 2013, we highlighted Limiting the Federal Government’s Fiscal Exposure by Better Managing Climate Related Risks as one of these areas. Our study on Climate Change and Public Health was requested by 15 senators. 3

4. Background The World Health Organization and others project significant adverse health outcomes from climate change. Some health effects already being felt in the U.S. o A 2006 summer heat wave in CA illustrates the potential impacts—an estimated $180 million in additional health care costs. Federal health care expenditures could increase in future years due to climate-related impacts. 4

5. Objectives of GAO’s Study 1.Discuss federal activities to enhance understanding about the risks climate change poses to public health 2.Describe federal resources used by selected state and local health departments to address these risks; and 3.Examine challenges faced by state and local health departments, and opportunities federal agencies could take to mitigate them. 5

6. Scope of GAO Study 26 Federal Agencies o All domestic-focused departments involved in the US. Global Change Research Program’s climate change and human health work group 21 States and 17 Local Health Departments o All 18 awardees of CDC’s Climate-Ready States and Cities Initiative 13 Stakeholder Groups 6

7. Overview of Key Findings Federal Agencies Have Undertaken Activities to Enhance Understanding CDC’s Climate-Ready States & Cities Initiative is the Primary Federal Investment Supporting Health Departments Communication Challenges Exist Opportunities Exist for Increased Federal Communication Other Challenges Also Exist 7

8. Finding: Federal Agencies Have Undertaken Activities to Enhance Understanding Conducting and Supporting Research o Governmentwide data on research expenditures are not available, but NIH awarded a total of $6 million in FY2014— 0.025% of its research budget Providing Data and Decision Support Tools o Data.gov o U.S. Climate Resilience Toolkit Communicating through Reports and Outreach o National Climate Assessment o Recently-issued Climate and Health Assessment by USGCRP o Web and Media Events 8

9. Finding: CDC’s Initiative is the Primary Federal Investment Supporting Health Depts. 16 states and 2 cities receive about $200,000 per year to implement a 5-step risk-management framework o Nearly all awardees have created climate and health programs States and cities also leveraged other federal resources 9 Figure 1: CDC Climate-Ready States and Cities Initiative Awardees, Fiscal Year 2015

10. Finding: Communication Challenges Exist Limited awareness of climate change as a public health issue o Within health departments (including leadership) o Among other sectors of government o Among stakeholders and public Difficulties enhancing awareness o Complexity of the issue  Technical and sensitive topic  Climate projections are inherently uncertain o Some potential effects have not been observed o Long-term public health issue 10

11. Finding: Opportunities for Increased Federal Communication Opportunity 1: Enhance public awareness via an HHS-led public awareness campaign Goal: Clear, consistent, and unified messages from the federal government would provide legitimacy to the work of state and local health departments HHS: o Had taken some steps to enhance public awareness o Reported that “climate change is one of the top public health challenges of our time.” o Committed to developing a Communications and Outreach Strategy, but issuance has been delayed from fall 2014 to July 2016 11

12. Finding: Opportunities for Increased Federal Communication Opportunity 2: Develop CDC guidance and tools for state and local health departments on how to communicate about climate change Goal: Enable health departments to enhance stakeholder awareness and understanding, which would aid ground-level efforts CDC: o Had developed communications guidance regarding heat events o Did not have plans to create new, broader guidance o Officials told us that they did not have the resources or capacity to develop such guidance 12

13. Recommendation HHS should direct CDC to identify when it will be able to issue communications guidance o CDC concurred, and said that it will develop guidance, building off of HHS’s strategy, once that is finalized. o CDC would continue to provide technical support to states regarding climate change communication while the HHS strategy is being finalized. o HHS told us they planned to release their strategy by July 2016. 13

14. Finding: Other Challenges Also Exist Health officials face difficulties identifying potential health risks. o Related to gaps in research, for example, on the spread of vector- borne diseases o Difficulty using available climate-related data, potentially as a result of lack of expertise or training o Opportunity for continued advancement of research and decision support resources Officials faced a range of other challenges, including having insufficient data and inadequate resources. o Federal action may not be able to address these challenges. 14

15. Thank you! Key Contacts: Alfredo Gomez Director, Natural Resources and Environment (NRE) ▫gomezja@gao.gov Marcia Crosse Director, Health Care ▫crossem@gao.gov Diane Raynes Assistant Director, NRE ▫raynesd@gao.gov Tricia Roy Senior Analyst, Health Care ▫royp@gao.gov 15 For additional information about GAO’s study, please see http://www.gao.gov/products /GAO-16-122. http://www.gao.gov/products /GAO-16-122