II 

116TH CONGRESS 

1ST SESSION S. 523 

To direct the Secretary of Health and Human Services to develop a national 

strategic action plan and program to assist health professionals and 

systems in preparing for and responding to the public health effects 

of climate change, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 14, 2019 

Mr. MARKEY (for himself, Mr. SCHATZ, Mr. WHITEHOUSE, Ms. WARREN, Mr. 

MERKLEY, and Ms. KLOBUCHAR) introduced the following bill; which was 

read twice and referred to the Committee on Health, Education, Labor, 

and Pensions 

A BILL 

To direct the Secretary of Health and Human Services to 

develop a national strategic action plan and program 

to assist health professionals and systems in preparing 

for and responding to the public health effects of climate 

change, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Climate Change Health 

5 Protection and Promotion Act of 2019’’. 


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1 SEC. 2. SENSE OF CONGRESS ON PUBLIC HEALTH AND CLI2 MATE CHANGE. 

3 (a) FINDINGS.—The U.S. Global Change Research 

4 Program Climate and Health Assessment states that— 

5 (1) the impacts of human-induced climate 

6 change are increasing nationwide; 

7 (2) rising greenhouse gas concentrations result 

8 in increases in temperature, changes in precipitation, 

9 increases in the frequency and intensity of some ex10 treme weather events, and rising sea levels; 

11 (3) these climate change impacts endanger our 

12 health by affecting our food and water sources, the 

13 air we breathe, the weather we experience, and our 

14 interactions with the built and natural environments; 

15 and 

16 (4) as the climate continues to change, the risks 

17 to human health continue to grow. 

18 (b) SENSE OF CONGRESS.—It is the sense of Con19 gress that— 

20 (1) climate change is real; 

21 (2) human activity significantly contributes to 

22 climate change; 

23 (3) climate change negatively impacts health; 

24 (4) climate change disproportionately impacts 

25 communities of color and low-income communities; 

26 and 


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1 (5) the Federal Government, in cooperation 

2 with international, State, tribal, and local govern3 ments, concerned public, private and Native Amer4 ican organizations, and citizens, should use all prac5 ticable means and measures— 

6 (A) to assist the efforts of public health 

7 and health care professionals, first responders, 

8 health care systems, States, the District of Co9 lumbia, territories, municipalities, and Native 

10 American and local communities to incorporate 

11 measures to prepare public health and health 

12 care systems to respond to the impacts of cli13 mate change; 

14 (B) to ensure— 

15 (i) that the Nation’s public health and 

16 health care professionals have sufficient in17 formation to prepare for and respond to 

18 the adverse health impacts of climate 

19 change; 

20 (ii) the application of scientific re21 search in advancing understanding of— 

22 (I) the health impacts of climate 

23 change; and 


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1 (II) strategies to prepare for and 

2 respond to the health impacts of cli3 mate change; 

4 (iii) the identification of communities 

5 and populations vulnerable to the health 

6 impacts of climate change, including in7 fants, children, pregnant women, the elder8 ly, individuals with disabilities or pre-exist9 ing illnesses, low-income populations, and 

10 unhoused individuals, and the development 

11 of strategic response plans to be carried 

12 out by public health and health care pro13 fessionals for those communities; 

14 (iv) the improvement of health status 

15 and health equity through efforts to pre16 pare for and respond to climate change; 

17 and 

18 (v) the inclusion of health impacts in 

19 the development of climate change re20 sponses; 

21 (C) to encourage further research, inter22 disciplinary partnership, and collaboration 

23 among stakeholders in order to— 

24 (i) understand and monitor the health 

25 impacts of climate change; 


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1 (ii) improve public health knowledge 

2 and response strategies to climate change; 

3 (iii) identify actions and policies that 

4 are beneficial to health and that mitigate 

5 climate health impacts; and 

6 (iv) develop strategies to address 

7 water-, food-, and vector-borne infectious 

8 diseases and other public health emer9 gencies; 

10 (D) to enhance preparedness activities, and 

11 health care and public health infrastructure, re12 lating to climate change and health; 

13 (E) to encourage each and every commu14 nity to learn about the impacts of climate 

15 change on health; and 

16 (F) to assist the efforts of developing na17 tions to incorporate measures to prepare public 

18 health and health care systems to respond to 

19 the impacts of climate change. 

20 SEC. 3. RELATIONSHIP TO OTHER LAWS. 

21 Nothing in this Act limits the authority provided to 

22 or responsibility conferred on any Federal department or 

23 agency by any provision of any law (including regulations) 

24 or authorizes any violation of any provision of any law (inVerDate Sep 11 2014 01:08 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S523.IS S523

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1 cluding regulations), including any health, energy, envi2 ronmental, transportation, or any other law or regulation. 

3 SEC. 4. NATIONAL STRATEGIC ACTION PLAN AND PRO4 GRAM. 

5 (a) REQUIREMENT.— 

6 (1) IN GENERAL.—The Secretary of Health and 

7 Human Services (referred to in this Act as the ‘‘Sec8 retary’’), on the basis of the best available science, 

9 and in consultation pursuant to paragraph (2), shall 

10 publish a strategic action plan and establish a pro11 gram to ensure the public health and health care 

12 systems are prepared for and can respond to the im13 pacts of climate change on health in the United 

14 States and other nations. 

15 (2) CONSULTATION.—In developing or making 

16 any revision to the national strategic action plan and 

17 program, the Secretary shall— 

18 (A) consult with the Director of the Cen19 ters for Disease Control and Prevention, the 

20 Administrator of the Environmental Protection 

21 Agency, the Director of the National Institutes 

22 of Health, the Undersecretary of Commerce for 

23 Oceans & Atmosphere, the Administrator of the 

24 National Aeronautics and Space Administra25 tion, the Director of the Indian Health Service, 


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1 the Secretary of Defense, the Secretary of 

2 State, the Secretary of Veterans Affairs, other 

3 appropriate Federal agencies, Indian tribes, 

4 State and local governments, public health or5 ganizations, scientists, representatives of at-risk 

6 populations, and other interested stakeholders; 

7 and 

8 (B) provide opportunity for public input 

9 and consultation with Indian tribes and Native 

10 American organizations. 

11 (b) ACTIVITIES.— 

12 (1) NATIONAL STRATEGIC ACTION PLAN.— 

13 (A) IN GENERAL.—Not later than 2 years 

14 after the date of enactment of this Act, the Sec15 retary, acting through the Director of the Cen16 ters for Disease Control and Prevention, and in 

17 collaboration with other Federal agencies as ap18 propriate, shall, on the basis of the best avail19 able science, and in consultation with the enti20 ties described in subsection (a)(2)(A), publish a 

21 national strategic action plan under subpara22 graph (B) to guide the climate and health pro23 gram and assist public health and health care 

24 professionals in preparing for and responding to 

25 the impacts of climate change on public health 


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1 in the United States and other nations, particu2 larly developing nations. 

3 (B) NATIONAL STRATEGIC ACTION PLAN

4 COMPONENTS.—The national strategic plan 

5 shall include an assessment of the health sys6 tem capacity of the United States to address 

7 climate change including— 

8 (i) identifying and prioritizing commu9 nities and populations vulnerable to the 

10 health impacts of climate change; 

11 (ii) providing outreach and commu12 nication aimed at public health and health 

13 care professionals and the public to pro14 mote preparedness and response strategies; 

15 (iii) providing for programs across 

16 Federal agencies to advance research re17 lated to the impacts of climate change on 

18 health; 

19 (iv) identifying and assessing existing 

20 preparedness and response strategies for 

21 the health impacts of climate change; 

22 (v) prioritizing critical public health 

23 and health care infrastructure projects; 

24 (vi) providing modeling and fore25 casting tools of climate change health imVerDate Sep 11 2014 01:08 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S523.IS S523

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1 pacts, including local impacts, where fea2 sible; 

3 (vii) establishing academic and re4 gional centers of excellence; 

5 (viii) providing technical assistance 

6 and support for preparedness and response 

7 plans for the health threats of climate 

8 change in States, municipalities, terri9 tories, Indian tribes, and developing na10 tions; and 

11 (ix) developing, improving, inte12 grating, and maintaining domestic and 

13 international disease surveillance systems 

14 and monitoring capacity to respond to 

15 health-related impacts of climate change, 

16 including on topics addressing— 

17 (I) water-, food-, and vector18 borne infectious diseases and climate 

19 change; 

20 (II) pulmonary effects, including 

21 responses to aeroallergens and toxic 

22 exposures; 

23 (III) cardiovascular effects, in24 cluding impacts of temperature ex25 tremes; 


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1 (IV) air pollution health effects, 

2 including heightened sensitivity to air 

3 pollution; 

4 (V) harmful algal blooms; 

5 (VI) mental and behavioral 

6 health impacts of climate change; 

7 (VII) the health of migrants, ref8 ugees, displaced persons, and vulner9 able communities; 

10 (VIII) the implications for com11 munities and populations vulnerable 

12 to the health effects of climate 

13 change, as well as strategies for re14 sponding to climate change within 

15 these communities; 

16 (IX) tribal, local, and commu17 nity-based health interventions for cli18 mate-related health impacts; 

19 (X) extreme heat and weather 

20 events, including drought; 

21 (XI) decreased nutritional value 

22 of crops; and 

23 (XII) disruptions in access to 

24 routine and acute medical care. 


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1 (2) CLIMATE AND HEALTH PROGRAM.—The 

2 Secretary, acting through the Director of the Cen3 ters for Disease Control and Prevention, and in col4 laboration with other Federal agencies, as appro5 priate, shall ensure that the climate and health pro6 gram established under this section addresses pri7 ority health actions including the following: 

8 (A) Serve as a credible source of informa9 tion on the physical, mental, and behavioral 

10 health consequences of climate change for the 

11 United States population and globally. 

12 (B) Track data on environmental condi13 tions, disease risks, and disease occurrence re14 lated to climate change. 

15 (C) Expand capacity for modeling and 

16 forecasting health effects that may be climate17 related. 

18 (D) Enhance the science base to better un19 derstand the relationship between climate 

20 change and health outcomes. 

21 (E) Identify locations and population 

22 groups at greatest risk for specific health 

23 threats and effects, such as increased heat 

24 stress, degraded air and water quality, food or 

25 water-related infections, vector-borne illnesses, 


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1 pulmonary and cardiovascular effects, mental 

2 and behavioral health effects and food, water, 

3 and nutrient insecurity. 

4 (F) Communicate the health-related as5 pects of climate change, including risks and as6 sociated costs and ways to reduce them, to the 

7 public, decisionmakers, public health profes8 sionals, and health care providers. 

9 (G) Develop partnerships with other gov10 ernment agencies, the private sector, non11 governmental organizations, universities, and 

12 international organizations to more effectively 

13 address domestic and global health aspects of 

14 climate change. 

15 (H) Provide leadership to State and local 

16 governments, community leaders, health care 

17 professionals, nongovernmental organizations, 

18 environmental justice networks, faith-based 

19 communities, the private sector and the public, 

20 domestically and internationally, regarding 

21 health protection from climate change effects. 

22 (I) Develop and implement preparedness 

23 and response plans for health threats such as 

24 heat waves, severe weather events, and infec25 tious diseases. 


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1 (J) Provide technical advice and support to 

2 State and local health departments, the private 

3 sector, and others in developing and imple4 menting national and global preparedness meas5 ures related to the health effects of climate 

6 change. 

7 (K) Promote workforce development by 

8 helping to ensure the training of a new genera9 tion of competent, experienced public health 

10 and health care professionals to respond to the 

11 health threats posed by climate change. 

12 (c) PERIODIC ASSESSMENT AND REVISION.—Not 

13 later than 4 years after the date of enactment of this Act, 

14 and every 4 years thereafter, the Secretary shall periodi15 cally assess, and revise as necessary, the national strategic 

16 action plan under subsection (b)(1) and the climate and 

17 health program under subsection (b)(2), to reflect new in18 formation collected pursuant to the implementation of the 

19 national strategic action plan and program and otherwise, 

20 including information on— 

21 (1) the status of critical environmental health 

22 indicators and related human health impacts; 

23 (2) the impacts of climate change on public 

24 health; and 


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1 (3) advances in the development of strategies 

2 for preparing for and responding to the impacts of 

3 climate change on public health. 

4 (d) IMPLEMENTATION.— 

5 (1) IMPLEMENTATION THROUGH HHS.—The 

6 Secretary shall exercise the Secretary’s authority 

7 under this Act and other Federal statutes to achieve 

8 the goals and measures of the national strategic ac9 tion plan and climate and health program. 

10 (2) OTHER PUBLIC HEALTH PROGRAMS AND

11 INITIATIVES.—The Secretary and Federal officials of 

12 other relevant Federal agencies shall administer 

13 public health programs and initiatives authorized by 

14 laws other than this Act, subject to the requirements 

15 of such laws, in a manner designed to achieve the 

16 goals of the national strategic action plan and cli17 mate and health program. 

18 SEC. 5. ADVISORY BOARD. 

19 (a) ESTABLISHMENT.—The Secretary shall, pursuant 

20 to the Federal Advisory Committee Act (5 U.S.C. App.), 

21 establish a permanent science advisory board to be com22 prised of not less than 10 and not more than 20 members. 

23 (b) APPOINTMENT OF MEMBERS.—The Secretary 

24 shall appoint the members of the science advisory board 

25 from among individuals who— 


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1 (1) are recommended by the President of the 

2 National Academy of Sciences and the President of 

3 the National Academy of Medicine; and 

4 (2) have expertise in essential public health and 

5 health care services, including those related to vul6 nerable populations, climate change, and other rel7 evant disciplines. 

8 The Secretary shall ensure that the science advisory board 

9 includes members with practical or lived experience with 

10 relevant issues. 

11 (c) FUNCTIONS.—The science advisory board shall— 

12 (1) provide scientific and technical advice and 

13 recommendations to the Secretary on the domestic 

14 and international impacts of climate change on pub15 lic health, populations and regions particularly vul16 nerable to the effects of climate change, and strate17 gies and mechanisms to prepare for and respond to 

18 the impacts of climate change on public health; and 

19 (2) advise the Secretary regarding the best 

20 science available for purposes of issuing the national 

21 strategic action plan and conducting the climate and 

22 health program. 


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1 SEC. 6. CLIMATE CHANGE HEALTH PROTECTION AND PRO2 MOTION REPORTS. 

3 (a) IN GENERAL.—The Secretary shall offer to enter 

4 into an agreement with the National Academies of 

5 Sciences, Engineering, and Medicine, under which such 

6 National Academies will prepare periodic reports to aid 

7 public health and health care professionals in preparing 

8 for and responding to the adverse health effects of climate 

9 change that— 

10 (1) review scientific developments on health im11 pacts of climate change; and 

12 (2) recommend changes to the national stra13 tegic action plan and climate and health program. 

14 (b) SUBMISSION.—The agreement under subsection 

15 (a) shall require a report to be submitted to Congress and 

16 the Secretary and made publicly available not later than 

17 2 years after the date of enactment of this Act, and every 

18 4 years thereafter. 

Æ 


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