Medical experts say climate change will affect nearly every aspect of public health. Many of those impacts already are being felt.

Heat deaths in the United States are severely undercounted, researchers say, with some studies putting the actual total at thousands each year. Scientists are working to understand the health effects of wildfire smoke, which is an increasing problem in many states as mega fires ravage the West.

“The more we learn, the worse it looks,” said Paul English, director of Tracking California, a data project tracking pollution and disease for the nonprofit research and advocacy Public Health Institute.

In some places, climate change is expanding the range and prevalence of mosquitoes and ticks — along with the diseases they spread. A Nature Climate Change study published earlier this week found that climate change has already worsened 58% of known infectious diseases. Scientists found that many diseases are becoming more transmissible, reaching new areas and worsening in severity.

Other regions are worried about water quality as droughts and algae blooms threaten crucial drinking water sources. Changes to growing seasons are causing severe allergy problems in some areas. And researchers all over the country say they’re just beginning to learn about the toll climate change is taking on mental health.

But even though state and federal lawmakers have poured billions into clean energy, infrastructure and projects to protect forests and coastlines, little to no climate funding has reached the budgets of many public health departments. Experts say the lack of investment in health agencies could especially harm low-income neighborhoods and communities of color, which already face disproportionate environmental health problems.

“The overall health burden of climate change is severely underestimated,” said Kai Chen, assistant professor of epidemiology at the Yale School of Public Health’s Department of Environmental Health Sciences. “What we see today is just the tip of the iceberg. If [health agencies] don’t have dedicated staff working to understand it, it’s likely that they will overlook this issue.”

Health officials in Minnesota have mapped the neighborhoods most vulnerable to heat stress, using air conditioning and tree canopy data. Leaders in Washington state want to equip schools to serve as safe places for those with respiratory issues when wildfire smoke fills the air. Washington’s Department of Health also has hired the state’s first climate epidemiologist, part of a push to fund more climate and health positions at the state and local levels.

But many public health officials say their climate change efforts are hamstrung by a lack of money and attention.

“Health departments are pretty aware of climate change and its effects on health, but the main barrier to why they aren’t doing more is funding and competing priorities, the biggest one being COVID-19,” said Shelbi Davis, senior climate change analyst with the Association of State and Territorial Health Officials.

And in some jurisdictions, political leaders still deny the reality of climate change, making it even more challenging for public health leaders to prepare for its effects.

Funding Shortfalls

Federal investment in climate and health has been hard to come by. Last month, The Washington Post reported that the Office of Climate Change and Health Equity, a new office within the Department of Health and Human Services, had not been funded by Congress, more than a year after President Joe Biden established it via executive order.

Local health leaders said they are still waiting to hear whether they would get additional money under the climate bill the Senate recently passed. The bill does include funding for air pollution monitoring in low-income areas and community-led programs to address climate change and pollution.

The federal Centers for Disease Control and Prevention helps state and local health departments prepare through its Climate-Ready States and Cities Initiative. The $10 million program helps local officials conduct research and set up resources such as cooling centers. But that program currently supports only nine states, one city, and a county, even though close to 40 jurisdictions have applied for money.

“We have more jurisdictions apply than we have available funding,” said Paul Schramm, a health scientist in the CDC’s Climate and Health Program. “If a state does not receive our funding, it’s likely they have little to no capacity to respond to the health impacts of climate change.”

The CDC’s program helps local health officials assess the vulnerability of their residents and draft plans to keep them safe from heat, pollution and other climate-related threats. Minnesota received support under the CDC program from 2009 until 2021, which funded five positions focused on research, strategic planning, and community education. But that funding was not renewed last year, leaving the state’s Department of Health with only one full-time employee focused on climate concerns.

“The funding has not really kept pace with the types of impacts that are happening,” said Kristin Raab, director of the state agency’s Climate and Health program. “That federal funding was a lifeblood for our program, and I would say [our remaining climate work] is minimal.”

Minnesota is experiencing changing precipitation cycles that have caused flooding in some areas and drought in others. It’s seeing more heat-related illnesses, longer allergy seasons, and increased threats from invasive pests.

Some states, including Florida, have adopted the CDC’s Building Resilience Against Climate Effects (BRACE) model, a framework to forecast impacts and plan and execute strategies to intervene. But Florida State University associate professor Chris Uejio, who oversaw the state’s BRACE program from 2016 to 2021, said the state has not committed adequate resources to the work.

“Florida likes to pride itself on spending the least per capita on government services, but you get what you pay for, especially on longer-term issues like climate and health,” he said.

The Florida Department of Health did not respond to a request for comment.

Medical leaders say public health investments to prepare for climate change should focus on marginalized communities, many of which suffer from underlying environmental health issues.

“States have not allocated the resources that they could or should to vulnerable communities,” said Mona Sarfaty, executive director and founder of the Medical Society Consortium on Climate and Health, a coalition of medical associations. “We need to be more honest with ourselves about where the risk is and address the risk where it is most glaring.”

Growing Awareness

Climate health experts say awareness of the problem is growing, even as many agencies struggle to keep up.

“Ten years ago, we didn’t even think to make a connection between a certain [health] outcome and the climate,” said Gregg Thomas, director of the Environmental Quality Division for the city and county of Denver.

City agencies in Denver have collaborated on a cooling center plan and deployed additional air pollution monitoring, while the Denver Department of Public Health & Environment has hired epidemiologists to connect the dots on climate exposures and health outcomes.

In Washington state, public health officials have successfully urged lawmakers to fund more climate-related positions at the state and local level.

“There’s been a huge increase in the public health system’s interest in climate change and their willingness to invest in it,” said Rad Cunningham, senior epidemiologist at the Washington State Department of Health. “The Department of Ecology and the Department of Natural Resources were the early leaders in our climate response, but there’s so much public health work in the adaptation space.”

Washington’s new climate change epidemiologist, Michelle Fredrickson, will be tasked with using climate forecasts and weather data to anticipate health effects while taking steps to prevent harmful outcomes and educate the public.

In some places, climate health work has come from outside of state agencies. Researchers and community leaders in Alabama have used federal grant funding to track heat and pollution exposure in communities throughout the state, a project known as ENACT. The group’s work has shown that outdoor workers often face dangerous levels of heat, and that heat waves are associated with an increase in pre-term births.

“Local governments don’t have the capacity to address these issues,” said Julia Gohlke, the project’s founder, and an associate professor at Virginia Tech. “Public health agencies are stretched so thin.”

Chelsea Gridley-Smith, director of environmental health at the National Association of County and City Health Officials, said that local leaders are increasingly aware of climate threats, but many agencies have not yet “woven” climate preparedness into every facet of their work.

“[Climate change’s effects] are pervasive across public health,” she said. “There are all sorts of connection points that get missed and lost.”