The climate catastrophes of 2020—wildfires, hurricanes, oppressive heat—left no doubt that climate change threatens health. And the COVID-19 pandemic left no doubt that preparing for predictable health challenges is essential to preventing needless suffering and dying. The two lessons are linked. We know climate change will increasingly affect health. Research shows, for example, that global temperature changes could lead to more heat-related deaths and deaths from diseases such as dengue fever and cholera that spread via insects and water. We urgently need to prepare. But we face critical knowledge gaps in areas such as diagnosis and prevention.
We recommend a solution: the immediate creation of a new unit at the National Institutes of Health—the National Institute of Climate Change and Health. With a budget of more than $40 billion, the NIH is the world's largest, best-funded health research institution. Yet it devotes a measly $9 million annually to research directly related to climate change and health, according to its own tally.
How could the NIH spend so little on one of our greatest health threats? The long-standing culture of reductionist biomedical thinking—organizing research with an organ-by-organ approach rather than looking at population health—plays a role. (If you've ever been shunted from specialist to specialist, yearning for a doctor who'd care for you as a whole person, you know how well that works.) Political meddling and special-interest lobbying by groups such as disease advocacy organizations also inappropriately shape priorities. The new institute would support research to answer critical questions such as these:
Diagnosis: How can climate change impinge on health? What infectious diseases are coming? Where will they emerge? What nutritional problems? How are allergies affected? Who is most vulnerable?
Treatment and prevention: What are the most effective, as well as cost-effective, ways to protect people?
Co-benefits: As we work to cut carbon emissions, what are the healthiest approaches, and how do we build them in? How do we avoid unintended adverse consequences?
The health-care system: How do we reimagine hospitals, clinics and supply lines so the health sector is climate-ready, delivers high-quality care to all and reaches net zero carbon emissions as soon as possible?
Research on climate change and health needs to draw on many disciplines: such an institute should coordinate closely and co-sponsor research with federal departments such as agriculture, energy and transportation. Climate change requires an all-of-government response.
In addition to supporting research, NIH funding helps train young researchers—a critical role. The Pentagon supports military academies because leaders know that a supply of smart, competent service members is crucial for U.S. defense capability. The same is true for health and medicine, particularly in the face of inexorable threats such as climate change. We need a cutting-edge research workforce for years to come. Today, dangerously, there is no training pipeline on climate change and health comparable to the network of postgraduate programs, funded academic research centers and training grants available to scientists studying, for example, genomics and pharmacology.
It's fair to ask whether an existing NIH institute could do this job. The Biden administration has moved to establish an office of climate and environmental justice at the Department of Health and Human Services, of which NIH is a part, but it will not have responsibility for research funding and training. The NIH has the National Institute of Environmental Health Sciences, but it is focused mostly on chemical toxins and pollutants. Even with a midrange budget (by NIH standards)—say, $1 billion per year, which is less than the funding for 10 of the existing institutes—a climate and health institute would deliver needed insights to protect the public from the ravages of climate change.