The NIH Climate Change and Health Initiative and Strategic Framework: addressing the threat of climate change to health

Climate change is the single greatest health hazard facing humanity, according to WHO and the UN.¹ Increasing global temperatures are altering Earth’s ecosystems and affecting the fundamentals of life, including access to clean and sufficient air, water, food, and shelter, with cascading impacts on human health. Extreme weather events associated with climate change are becoming more frequent and severe.² Climate change contributes to the emergence and spread of infectious diseases, exacerbates threats to human health across various health conditions, such as respiratory and cardiovascular diseases and mental health conditions, and increases the risk of water-borne and food-borne diseases, malnutrition, vector-borne and zoonotic diseases, and extreme-weather-related morbidities and mortality.³ Environmental and social stressors are altered by climate change, affecting people’s vulnerability to climate threats and their ability to avoid, respond to, or adapt to them. Crucially, climate change has a disproportionate effect on communities worldwide already experiencing social and environmental inequalities.⁴

The leadership of the US National Institutes of Health (NIH) recognises the urgent need for a more concerted and collective effort by the agency to advance understanding of the effects of climate change on individual and public health. Such efforts must foster innovative research to identify immediate and long-term risks to health, especially among communities with health disparities, as well as effective programmes to ensure implementation and translation of the knowledge generated by this research into interventions that will protect public health. The impacts of our changing climate on the health of individuals and populations globally touch all the missions of NIH institutes, centres, and offices. In 2010, NIH, along with the US Centers for Disease Control and Prevention (CDC), the US Environmental Protection Agency (EPA), and the National Oceanic and Atmospheric Administration (NOAA), led an interagency working group that developed the first federal climate change and health research needs assessment.⁴ NIH has conducted research and other activities in support of climate change and health science during the past two decades, but grant funding has been limited.

The time has come for NIH scientists to more vigorously engage with communities and agencies globally to address the risks that climate change poses to humanity. In 2021, in response to the White House and Executive Order 14008: Tackling the Climate Crisis at Home and Abroad,⁵ NIH committed to developing an NIH-wide Climate Change and Health (CCH) Initiative to focus attention and efforts on growing the NIH climate change and health research portfolio and investigator community.⁶ As the directors of seven NIH institutes and centres, we have, together with colleagues, formed an Executive Committee for Climate Change and Health to help develop a coordinated approach to implement the NIH-wide strategic framework for climate change and health. Additionally, more than 140 representatives from 24 out of 27 institutes, centres, and offices engage with the NIH Climate Change Working Group to assist in developing the initiative and supporting the growth of the programme and its partnerships.

Incorporating input from the broader scientific community and other stakeholders, the NIH Climate Change and Health Strategic Framework⁶ provides guidance for building a transdisciplinary programme among the biomedical and climate science communities to conduct collaborative and transformative science on climate and health intersections. Central to this strategic framework are efforts to build a community of practice of NIH-funded researchers, clinicians, public health practitioners, dissemination and implementation scientists, community partners, and others who will develop and implement best practices to translate research into actions that will benefit the wellbeing of communities. We have already begun laying the foundation for this work with a series of funding opportunities in 2022. Implementing the full health research and intervention plan, as laid out in the strategic framework, will take additional resources.

Four core elements shape the NIH Climate Change and Health Strategic Framework (figure). Health effects research is the first core element and comprises research on the health risks and outcomes associated with climate change, including at different geographical and temporal scales, across varied pathways and mechanisms, at specific times of susceptibility across the life course, and among populations at increased risk of exposures and harms related to climate change. This element includes investigating the role of health-care systems and practitioners in reducing the health effects of climate change.

Figure: NIH Climate Change and Health Initiative Strategic Framework’s core elements.

The core elements of the framework are health effects research, health equity, intervention science, and training and capacity building.⁶

Health equity is the second core element and encompasses efforts to address the needs of populations at highest risk of adverse impacts from climate change, with a focus on historically disadvantaged communities and populations in the USA and in low-income and middle-income countries (LMICs). Although LMICs have contributed the least to climate change, they are exposed to the greatest and most immediate consequences of it.⁷

Intervention research is the third core element and comprises the application of experimental, modelling, and evaluative techniques to the creation and implementation of efficient actions to prevent disease and disability and improve health and resilience.

The fourth core element is training and capacity building. This element encompasses efforts to advance the knowledge and skills required to do transdisciplinary climate and health science, design innovative supporting technologies, and translate research findings in ways that are equitable and actionable to inform decision making on the growing threat of climate change to public health.

Active, engaged, and sustainable partnerships with a diverse cadre of cross-sector global stakeholders will have a crucial role in these efforts. Such stakeholders include, but are not limited to, government, international health and environmental organisations, academia, including scientific and professional associations and students, the private sector, communities and their advocates, and the media. The success of the initiative will also depend on the contributions of the disciplines that are shown in the outer ring of the figure. Initial efforts of the initiative will focus on the development of new science and applied research in these diverse disciplines (figure) through programmes focused on the health impacts of climate change. NIH research will inform resilience and adaptation at the local, regional, and global levels by providing evidence for impacts, interventions, and system-wide solutions.

The mission of the NIH is “to seek fundamental knowledge about the nature and behaviour of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability”. The NIH CCH Initiative will work to bring NIH’s skills, capacities, and leadership to understand the varied and evolving health risks of climate change, determine solutions, and act to prevent and reduce these adverse health impacts. Understanding the current and future impacts of our changing climate and developing health-protective solutions are some of the greatest scientific challenges ever faced by humanity. The NIH will join fully with the global community to meet this challenge and to ensure health and wellbeing for generations to come.