WASHINGTON — Ask 10 people how a federal health care agency might tackle “environmental justice,” and you’ll get 10 answers.
For Jackson, Miss., residents, it is ensuring potable water after weeks of risk from a damaged sanitation system. For people in “asthma alley,” northern New York City’s communities astride major highways, it is slowing the flow of emissions-related respiratory problems, even as new laws could divert more traffic their way. Angelenos, meanwhile, want to see repercussions for nearby factories that spout metal pollutants into the air.
The only real uniting thread is that the issues are massive, amorphous, and potentially intractable. Which makes it all the more daunting for the two lone staffers currently detailed to the Office of Environmental Justice, one of whom is set to depart soon. Though it launched in May, the office also lacks any formal funding. It’s still struggling to figure out exactly where to go from here, or how.
If its parent office, the also-nascent (and also still unfunded) Office of Climate Change and Health Equity is a tiny outfit with a lofty goal, its environmental justice arm is on an Apollo mission.
Most of the office’s first four months have been focused on a listening tour with fellow health officials and community advocates, said Sharunda Buchanan, the interim director who joined in May from the Centers for Disease Control and Prevention, where she still technically works. Though others have been on loan to the office, she soon will be its sole employee.
“There are all these environmental justice issues — clean water, lead poisoning, chemical exposure — that climate would exacerbate,” she told STAT. “[Even] without that exacerbation, these are issues that communities have been grappling with for a long time.”
Even if it can figure out what it wants to accomplish, however, experts wonder how effectively it will be able to do so, since the agency lacks regulatory authority over environmental quality, zoning and other community structures. Looming over those still-early discussions, too, is something of an existential deadline. With congressional midterms and the next presidential election on the horizon, the Office of Environmental Justice may have less than two years to justify its entire existence.
“It’s an enormous opportunity and responsibility,” said Renee Salas, a climate and health fellow at the Harvard T.H. Chan School of Public Health. “I hope that they are given the resources with which to do it.”
The new office sprung from President Biden’s January executive order directing agencies to devise department-specific plans to combat climate change, the fulfillment of a key campaign promise.
HHS’s effort is one of the first. The Justice Department’s office also formed in May, just a few weeks earlier. But while DOJ set out a four-year strategy and a relatively straightforward initial goal — enforce environmental protections — HHS’s nascent office is in unchartered territory. The agency asked this spring for input on a new strategy and in the meantime has set out initial goals, including developing that strategy, supporting HHS’s Office of Civil Rights, and drawing up a related environmental data plan.
However the office is still unfunded, as is its parent office on climate change and health equity. HHS requested $3 million from Congress for the overall climate change department, an ask snubbed in the 2022 budget and still undecided for next year.
This summer did see a significant milestone in climate change funding, with the passage of the Inflation Reduction Act, including nearly $3 billion in environmental justice block grants funneled through the Environmental Protection Agency (plus ambitious plans for clean energy manufacturing and emissions targets.) Funding for HHS’s small office was not included; that is currently attached to the fiscal year 2023 budget.
“I have visions of grandeur for a lot of things we want to do. Of course, that’s going to take time,” said Buchanan. “Slow and easy wins the race,” but, she admits, “I would like for the pace to go a little bit faster.”
Some agencies’ environment-linked work is more direct: The Administration for Children and Families, for instance, already issues subsidies to help low-income families with energy bills.
For other departments, the relationship with environmental justice is far more tenuous. Buchanan is hoping the FDA can help reduce some of the toxic chemicals included in hair products marketed to Black women, for example. But the agency doesn’t approve hair products; it can only really issue guidance and warning letters.
There are other significant hurdles for HHS to make a difference on environmental justice, too. First, the agency doesn’t have regulatory authority over environmental quality or regularly take on these cases. That is far more in the purview of the EPA and the DOJ.
Environmental issues are also usually fought on a state and local level through zoning, land management, and anti-discrimination policies, said Lawrence Gostin, a Georgetown University health law professor.
“HHS can, and should, partner with EPA as well as state and local officials, and it can make grants targeted to achieving better environmental justice. But the tools in its box are quite limited,” said Gostin.
One health agency that has become the focal point for many climate change advocates is the sweeping Centers for Medicare and Medicaid Services, which oversees billions of dollars in federal funding for hospitals and providers.
Advocates say that Medicare could require hospitals that want to participate in the program to minimize their carbon footprint and institute greener practices — climate change priorities that intersect with environmental justice in the communities around major providers.
Many of those major hospital networks insist they are already working towards smaller footprints without federal requirements. Several hospitals and related organizations — including America’s 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 slash carbon emissions.
Yet critics argue the administration can’t count on the industry to regulate itself.
“It’s really the industry running the regulators,” said David Introcaso, health policy consultant and former HHS official who has publicly called on Medicare to implement climate change rules. Introcaso has pushed for federal officials to require hospitals to report their current emissions and submit auditable plans on reducing them.
While it grapples with its future goals, the Office of Environmental Justice has embarked on one measurable project: Collaborating with the Centers for Disease Control and Prevention to build out its environmental justice index, an effort housed in the CDC office where Buchanan worked for decades.
The index collects data from EPA, CDC, the census bureau and mining regulators to assign environmental justice scores to each community based on the risks around them and hurdles like access to health care, low income or other “social vulnerabilities” that could mean communities don’t know which resources to tap to fight in their local government.
For advocates like Bobby Jones, it’s not nearly enough. Jones, a retired North Carolina health official, has been pushing officials to better regulate energy companies’ toxic coal ash dumping for a decade — an increasingly urgent issue as major hurricanes expose thousands of largely low-income people to toxic waste and unsafe water.
Data and tracking tools — “that’s not the help that we need,” Jones told STAT after a meeting with Buchanan’s team.
And even that relatively modest federal goal is riddled with challenges.
Just under 4% of city governments publicly provide climate change resources and data, according to a 2020 study in The Lancet. Roughly 40% of states have similar webpages but actual data is fragmented or “hyper-local,” making it hard to apply broadly, said Harvard’s Salas.
“There’s this gap right now” between researchers and government officials looking to institute change, said Salas. “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 have begun to run demos on the program for various agencies. When it is ready, officials will run workshops for community leaders.
“I tell the team we’re small and mighty, and we’ll get larger and mightier as time goes on,” she said.