Climate action is critical for health equity. Community health clinics are key—and need more support

When Dr. Patel cares for babies born at her nursery, she coaches parents on how they can protect their newborns from climate change-driven health threats, like extreme heat and smoke.

Often, her patients live in housing without working air conditioning or insulation, in hotter neighborhoods due to pollution or are more exposed to wildfire smoke and poor air quality.

As climate change continues to pose significant health effects, with underserved communities of color enduring the greatest harm, "We can't ignore the threats," said Patel, a pediatric hospitalist at Stanford Children's Health on California's central coast. "We need to bring a climate lens to the services that we provide."

More medical providers are bringing that lens to health care to address disparities, and experts say community health centers, who primarily serve low-income people of color, are essential to addressing climate change-driven health inequities.

"They are on the frontlines of every one of our larger societal failures," Patel said. "But it's a resource-starved environment ... Our community clinics need more support to be able to do this really important work."

Last week, Johnson & Johnson, along with Americares and Harvard T.H. Chan School of Public Health's Center for Climate, Health and the Global Environment announced a $2 million grant for climate health equity programs at community health clinics across the nation.

"It's certainly a part of a wave that is starting—and I do emphasize starting—to recognize that we must have climate action if we want health equity," said Boston Children's Hospital pediatrician Dr. Aaron Bernstein, interim director at Harvard Chan C-CHANGE.

The agencies are starting to recruit up to 10 clinics for pilot programs tailored to communities' needs, with a goal of expanding to 100 clinics by 2025. The programs will focus on offering tools to battle health issues that erupt due to climate change, and making clinics more resilient to climate shocks.

Under-resourced communities of color have fewer resources to weather climate shocks and suffer disproportionate chronic illnesses that make them more vulnerable to climate-driven health problems.

"The work we're embarking on is to really try and truncate this," Bernstein said. "To work in communities where health disparities are already prominent, to try and find ways to short circuit this chain of events."

Benjamin Money, senior vice president for public health priorities at the National Association of Community Health Centers, said ongoing, rising climate events need as much attention from a health perspective as climate disasters, such as extreme heat. He's working on a program to integrate early warning systems and heat alerts for high-risk patients to help them better prepare.

"The patients our health centers see get hit first and worst," he said. "Those initial heat shock days ... there's a greater risk of illness and hospitalization."

Founding member of Georgia Clinicians for Climate Action, Dr. Neha Pathak, an internist at Atlanta VA Medical Center, treats veterans and refugees. She said caring for patients at community health centers with a climate lens is integral to addressing inequities.

"(They) are a crucial place where we deliver care to the most vulnerable, those with the highest needs," said Pathak, a volunteer physician at Clarkston Community Health Center. "They're really out there in the communities on the frontlines."

People of color are disproportionately represented in outdoor work. Many of Pathak's patients work in extreme heat conditions without sufficient breaks, water and shade, she said. Many also are older adults less able to regulate extreme heat, have chronic conditions and take medications that make them more vulnerable to heat-related illness.

"For a lot of marginalized people, being inside is also a great risk," she said, adding poor housing with less insulation can pose health problems.

While awareness is growing, Pathak said more systematic support will be needed for health centers, which are "core to our ability" to address climate health equity.

"We don't have that necessarily engrained in us yet, and we need to," she said.