CLIMATE CHANGE

HHS Could Take 

Further Steps to 

Enhance 

Understanding of 

Public Health Risks

Report to Congressional Requesters

October 2015

GAO-16-122

United States Government Accountability Office
Highlights of GAO-16-122, a report to 

congressional requesters

October 2015

CLIMATE CHANGE

HHS Could Take Further Steps to Enhance 

Understanding of Public Health Risks

Why GAO Did This Study

The World Health Organization 

projects climate change will adversely 

affect health significantly over the next 

several decades. Some health effects 

of climate change are already being 

felt in the United States, according to

assessments by the National Research 

Council, USGCRP, and others. Since 

the federal government is the nation’s 

largest purchaser of health care 

services, federal health care 

expenditures could increase in future 

years due to climate-related impacts.

GAO was asked to review federal 

efforts to increase public health system 

preparedness for climate change. This 

report addresses (1) federal activities 

to enhance understanding about the

risks climate change poses to public 

health, (2) federal resources used by 

selected states and localities to 

address these risks, and (3) challenges 

states and localities face and actions

federal agencies could take to mitigate 

them. GAO examined federal, state, 

and local documents, and interviewed 

officials from federal agencies such as 

CDC, NIH, USGCRP, as well as state 

and local health departments, including 

all 18 recipients of CDC’s Climate 

Ready States and Cities Initiative 

award.

What GAO Recommends

GAO recommends that HHS direct

CDC to develop a plan describing 

when it will be able to issue climate 

change communications guidance to 

state and local health departments.

CDC generally agreed with the 

recommendation, stating that it will 

issue guidance once HHS’s climate 

change communication and outreach 

strategy is final.

What GAO Found

Federal agencies are enhancing understanding of climate-related risks to public 

health by (1) supporting and conducting research, (2) providing data and 

informational resources, and (3) communicating about risks. The Department of 

Health and Human Services’ (HHS) National Institutes of Health (NIH) supports a

portfolio of research directly related to these risks. NIH reports awarding about $6

million for such research in fiscal year 2014, including for one study examining 

health risks posed by heat and air pollution. Federal agencies have also provided 

data on climate and health issues, such as the number of extreme heat days that 

state and local officials can use to assess health risks. They have also reported

about these risks, such as through the third National Climate Assessment issued 

in May 2014 by the U.S. Global Change Research Program (USGCRP).

Selected state and local health departments have used resources from HHS’s

Centers for Disease Control and Prevention (CDC) and other federal agencies to 

address and plan for the risks of climate change to public health. CDC’s Climate 

Ready States and Cities Initiative awards an average of about $200,000 per year 

each to 16 state and two local health departments to implement a risk 

management framework designed to help incorporate climate projections into 

public health planning. CDC also requires awardees to increase public 

awareness of the risks climate change poses to public health. Other federal 

resources used by health departments to prepare for these risks include funding 

provided through CDC’s National Environmental Public Health Tracking Program. 

When asked to identify challenges they face in addressing and planning for the 

risks of climate change to public health, state and local health officials identified 

challenges that GAO grouped into the three most frequently mentioned themes. 

First, the officials said they face challenges communicating about the public 

health risks of climate change, due to limited public awareness and the 

complexity of the issue. These officials reported that enhanced federal leadership 

could help address this challenge. Although HHS plans to develop a climate 

change communication and outreach strategy, its development has been delayed 

by over a year. Also, CDC currently does not have plans to issue climate change 

communications guidance, which state and local officials said would be helpful.

CDC’s limited resources are currently focused on resolving methodological and 

data issues related to its Climate Ready States and Cities Initiative. Given that 

health departments that have received awards under CDC’s initiative are 

required to take steps to enhance public awareness, such guidance may help 

awardees better meet this requirement. Issuing such guidance would also be in 

line with CDC’s core functions, which include translating climate change science 

to inform communities. Second, officials said they face challenges identifying 

health risks of climate change due to gaps in research and difficulties using 

climate data. Federal officials told GAO about actions they have taken or plan to 

take that could help address these challenges, such as issuing an assessment of 

climate change impacts on health, and creating a national heat health information 

system. Finally, the officials told GAO about other challenges they face that 

federal action may not be able to address, such as having insufficient local data 

on health outcomes, because states may not collect or have access to such data, 

and having insufficient staff resources for these activities.

View GAO-16-122. For more information, 

contact J. Alfredo Gómez at (202) 512-3841 or 

gomezj@gao.gov, or Marcia Crosse at (202) 

512-7114 or crossem@gao.gov.

United States Government Accountability Office
Letter 1

Background 8

Federal Agencies Have Undertaken Various Activities to Enhance 

Understanding of Climate Change Risks to Public Health 19

State and Local Health Departments Have Used CDC and Other 

Federal Resources to Address the Risks That Climate Change 

Poses to Public Health 26

State and Local Health Officials Identified Multiple Challenges, 

Some of Which They Said Could Be Addressed by Federal 

Action 36

Conclusions 46

Recommendation for Executive Action 47

Agency Comments and Our Evaluation 47

Appendix I List of Agencies and Stakeholders Interviewed 51

Appendix II Summary of Actions Announced by the Administration in April 2015 

to Address the Health Impacts of Climate Change 54

Appendix III Summary of Actions Announced by the Administration in June 2015 

to Address the Health Impacts of Climate Change 56

Appendix IV Examples of Climate Change and Health Research Conducted or 

Supported by Federal Agencies 58

Appendix V Examples of Federal Agency Activities on or Related to the Public 

Health Impacts of Climate Change 60

Appendix VI Examples of Activities Conducted by Awardees of CDC’s Climate 

Ready States and Cities Initiative 67

Contents

Page i GAO-16-122 Climate Change and Public Health
Appendix VII Activities of Other Selected State and Local Health Departments 

Related to Preparing for the Public Health Impacts of Climate Change 71

Appendix VIII Summary of Health-Related Recommendations Made by the 

President’s Task Force on Climate Preparedness and Resilience 74

Appendix IX Comments from the Department of Health and Human Services 77

Appendix X GAO Contacts and Staff Acknowledgments 79

Tables

Table 1: Observed and Projected Impacts of Climate Change in 

the United States 10

Table 2: Examples of Health Risks Posed by Climate Change in 

the United States 12

Table 3: Examples of Federal Data and Decision Support 

Resources for Examining the Risks That Climate Change 

Poses to Public Health 22

Table 4: Examples of Federal Agencies Supporting or Conducting 

Research on or Related to the Risks That Climate Change 

Poses to Public Health 58

Table 5: Examples of Activities Conducted by Selected Federal 

Agencies on or Related to Public Health Impacts of 

Climate Change 60

Table 6: Summary of Selected Health-Related Recommendations 

and Suggested Actions from the President’s State, Local 

and Tribal Leaders Task Force Report on Climate 

Preparedness and Resilience 75

Figures

Figure 1: Examples of Potential Health Impacts from Climate 

Change in the United States, by Region 15

Figure 2: CDC Climate Ready States and Cities Initiative 

Awardees, Fiscal Year 2015 28

Page ii GAO-16-122 Climate Change and Public Health
Figure 3: Steps and Examples of Activities Conducted under 

CDC’s Building Resilience Against Climate Effects 

Framework 30

Figure 4: Example of a Community Resilience Map Illustrating 

Vulnerabilities to Extreme Heat in San Francisco 68

Abbreviations

ASTHO Association of State and Territorial Health Officials

BRACE Building Resilience Against Climate Effects

CDC Centers for Disease Control and Prevention

CCHHG Interagency Crosscutting Group on Climate Change and

Human Health

EPA Environmental Protection Agency

HHS Department of Health and Human Services

NACCHO National Association of County and City Health Officials

NASA National Aeronautics and Space Administration

NCA National Climate Assessment

NIH National Institutes of Health

NOAA National Oceanic and Atmospheric Administration

USGCRP U.S. Global Change Research Program

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

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Page iii GAO-16-122 Climate Change and Public Health
441 G St. N.W.

Washington, DC 20548

October 5, 2015

Congressional Requesters

The effects of a changing climate are viewed as threats to human health 

in a variety of ways, and, according to assessments by the National 

Research Council, the U.S. Global Change Research Program 

(USGCRP), and the Intergovernmental Panel on Climate Change, some 

effects are already being felt across the world and within the United 

States.1 The World Health Organization projects that climate change will 

have significant adverse effects to health over the next several decades, 

including an increased number of deaths in 2030 from impacts such as 

heat exposure, malaria, diarrhea, and childhood malnutrition.2

Observations of a changing climate in the United States include trends 

such as an increase in average temperatures, shifting patterns of rainfall, 

rising sea levels, and more frequent and intense extreme weather events 

1

National Research Council, America’s Climate Choices: Panel on Adapting to the 

Impacts of Climate Change, Adapting to the Impacts of Climate Change (Washington, 

D.C.: 2010); Jerry M. Melillo, Terese (T.C.) Richmond, and Gary W. Yohe, eds., Climate 

Change Impacts in the United States: The Third National Climate Assessment, U.S. 

Global Change Research Program (Washington, D.C.: May 2014); and K.R. Smith, K.R., 

et al., Human Health: Impacts, Adaptation, and Co-Benefits in Climate Change 2014: 

Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution 

of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on 

Climate Change (Cambridge, United Kingdom: 2014). The National Research Council is 

the principal operating agency of the National Academy of Sciences and the National 

Academy of Engineering. USGCRP coordinates and integrates the activities of 13 federal 

agencies that conduct research on changes in the global environment and their 

implications for the United States. USGCRP began as a presidential initiative in 1989 and 

was codified in the Global Change Research Act of 1990 (Pub. L. No. 101-606, § 103 

(1990)). The act requires USGCRP to periodically prepare a scientific assessment—

known as the National Climate Assessment—which is an important resource for 

understanding and communicating climate change science and impacts in the United 

States. The Intergovernmental Panel on Climate Change is a scientific body under the 

auspices of the United Nations that was designed to assess the scientific, environmental, 

and socioeconomic aspects of climate change.

2

World Health Organization, Quantitative Risk Assessment of the Effects of Climate 

Change on Selected Causes of Death, 2030s and 2050s (Geneva, Switzerland: 2014). 

The World Health Organization directs and coordinates international health within the 

United Nations system. In this study, WHO modeling and simulation results estimate 

240,000 additional deaths worldwide in 2030 due to the health effects of a changing 

climate.

Letter

Page 1 GAO-16-122 Climate Change and Public Health

 
such as heat waves, heavy downpours, and drought, according to reports 

from the National Research Council and USGCRP. While it is challenging

to link any individual weather event to climate change, the National 

Research Council and USGCRP, among others, expect these climate 

trends to continue. According to assessments by the National Research 

Council and USGCRP, climate change will amplify existing health threats, 

and populations such as the elderly, children, those who are sick, and 

those living in poverty will face disproportionate health risks from climate 

change in the United States.3 In addition to being the nation’s largest 

purchaser of health care services, the federal government bears the 

expense of these services for some of the most vulnerable populations to 

climate change impacts—spending $815 billion on three such programs 

in 2014.4 As such, federal health care expenditures could increase in 

future years as a result of climate impacts. A 2006 summer heat wave in 

California illustrates the types of health impacts that could be associated 

with climate change, including increased hospitalizations for heat-related 

illnesses.5 In February 2013, we added limiting the federal government’s 

fiscal exposure by better managing climate change risks to our High Risk 

List, which calls attention to agencies and program areas that are at high 

risk due to their vulnerabilities to fraud, waste, abuse, or are most in need 

of transformation.6

State and local public health authorities have responsibility for carrying 

out most public health activities in the United States, but a number of 

3

While climate change poses health risks worldwide, this report focuses on the risks that 

climate change poses to human health within the United States.

4

In 2014, the federal government spent $815 billion on Medicare, Medicaid, and the 

Children’s Health Insurance Program, which provide coverage for the elderly, low-income 

individuals, and children, respectively. Office of Management and Budget, Analytical 

Perspectives, Budget of the United States Government, Fiscal Year 2016 (Washington, 

D.C.: Feb. 2, 2015). 

5

During this 16-day heat wave, more than 10 times the number of hospitalizations for 

heat-related illnesses occurred statewide, and more than 23 times the number of 

emergency department visits for heat-related illnesses occurred in the most affected 

region, as had been recorded in 6 days prior and 10 days following the event. One study 

estimated that this heat wave resulted in nearly $180 million in additional health care 

costs. K. Knowlton, et al., “The 2006 California Heat Wave: Impacts of Hospitalizations 

and Emergency Department Visits,” Environmental Health Perspectives117 (2009) and K. 

Knowlton, et al., “Six Climate Change-Related Events in the United States Accounted for 

About $14 Billion in Lost Lives and Health Costs,” Health Affairs 30, no. 11 (2011). 

6

GAO, High-Risk Series: An Update, GAO-13-283 (Washington, D.C.: Feb. 14, 2013). 

Page 2 GAO-16-122 Climate Change and Public Health

 
federal agencies also have a role. State and local public health agencies 

have responsibilities such as disease surveillance and responding to 

public health emergencies within their jurisdictions, including activities 

that may be related to climate change.7 The federal government’s role in 

addressing public health includes providing high-level leadership through 

setting and communicating health-related policies, goals, and standards; 

supporting state and local health department efforts; and financing 

research and higher education. In addition, federal agencies, such as the 

Environmental Protection Agency (EPA), Department of Health and 

Human Services’ (HHS) National Institutes of Health (NIH) and Centers 

for Disease Control and Prevention (CDC), and the Department of 

Commerce’s National Oceanic and Atmospheric Administration (NOAA), 

support the development of data and other information resources on 

climate change that others, including state and local health departments, 

can use to manage public health risks. CDC has also provided support to 

some state and local health departments to manage these risks.

You asked us to review federal efforts to increase the preparedness of 

the nation’s public health system for the impacts of climate change. In this 

report, we (1) discuss the types of activities that selected federal agencies 

have conducted to enhance understanding about the risks that climate 

change poses to public health; (2) describe federal resources used by 

selected state and local health departments to address or plan for the 

risks that climate change poses to public health; and (3) examine 

challenges, if any, identified by state and local officials to addressing or 

planning for the risks that climate change poses to public health, and any 

steps they identified that federal agencies could take to mitigate these 

challenges.

To describe the types of activities that federal agencies have conducted 

to enhance understanding about the risks that climate change poses to 

public health, we reviewed federal documents such as USGCRP’s 2014 

third National Climate Assessment (NCA) and a 2010 report on climate 

7

Disease surveillance is the process of reporting, collecting, analyzing, and exchanging 

information related to cases of infectious diseases. For more information on state and 

local public health agency activities related to climate change, see H. Frumkin, et al., 

“Climate Change: The Public Health Response,” American Journal of Public Health 98, 

no. 3 (2008).

Page 3 GAO-16-122 Climate Change and Public Health

 
change and human health research needs.8 We interviewed officials from 

26 federal agencies, including CDC, EPA, NIH, NOAA, and others 

participating in a USGCRP working group on climate change and human 

health.9 We also interviewed representatives of 13 stakeholder groups, 

including public health organizations, such as the American Public Health 

Association,10 and academic institutions, such as the Georgetown Climate 

Center.11 (App. I provides a complete list of agencies and stakeholders 

interviewed.) In addition, we reviewed NIH data on awards it made for 

research related to the public health risks of climate change from fiscal 

year 2011 through fiscal year 2014.12 To assess the reliability of these 

data, we discussed them with agency officials, reviewed them for 

8

The 2014 assessment summarizes the impacts of climate change on the United States, 

now and in the future. A team of several hundred experts guided by a 60-member Federal 

Advisory Committee produced the report, which was extensively reviewed by the public 

and experts, including federal agencies and a panel of the National Academy of Sciences. 

The 2010 report, developed by an ad hoc interagency working group on climate change 

and health, summarizes research needs on the human health effects of climate change. 

See, Interagency Working Group on Climate Change and Health, A Human Health 

Perspective on Climate Change: A Report Outlining the Research Needs on the Human 

Health Effects of Climate Change, National Institute of Environmental Health Sciences 

(Research Triangle Park, N.C.: April 2010).

9

Specifically, we interviewed officials from 26 federal agencies: Department of 

Commerce’s National Oceanic and Atmospheric Administration; Department of Defense’s 

Defense Health Agency, Department of Health and Human Services’ Assistant Secretary 

for Preparedness and Response, Centers for Disease Control and Prevention, Indian 

Health Service, National Institutes of Health, and Office of the Assistant Secretary for 

Health; the Department of Homeland Security’s Federal Emergency Management Agency 

and Office of Health Affairs; Department of the Interior’s Bureau of Indian Affairs, Office of 

Insular Affairs, and U.S. Geological Survey; Environmental Protection Agency; National 

Aeronautic and Space Administration; National Science Foundation, and the U.S. 

Department of Agriculture’s Agricultural Marketing Service, Animal and Plant Health 

Inspection Service, Agricultural Research Service, National Institute of Food and 

Agriculture, Economic Research Service, Forest Service, Natural Resources Conservation 

Service, and the Office of the Chief Economist, USGCRP, and the Council on 

Environmental Quality. These agencies include those that participate in USGCRP’s 

Interagency Crosscutting Group on Climate Change and Human Health and whose focus 

is on understanding risks to populations within the United States.

10The American Public Health Association is a national nonprofit organization representing 

public health officials, whose mission is to improve the health of the public and achieve 

equity in health status. 

11The Georgetown Climate Center, a nonpartisan organization of Georgetown University 

Law Center, seeks to advance policies that reduce greenhouse gas emissions and help 

communities adapt to climate change.

12We did not review governmentwide data on funding for such research because such 

data were not readily available.

Page 4 GAO-16-122 Climate Change and Public Health

 
reasonableness and consistency, and determined that they were 

sufficiently reliable for our purposes. The results of our work provide 

examples of federal activities to enhance understanding of the risks that 

climate change poses to public health, and do not represent an 

exhaustive list of federal actions in this area.13 We did not evaluate the 

effectiveness of federal efforts to enhance understanding, as this was 

outside the scope of our review.

To describe federal resources used by selected state and local health 

departments to address or plan for the risks that climate change poses to 

public health, we used a variety of approaches to obtain information from 

state and local health departments. This included information about the 

activities they have conducted related to climate change and public 

health, and how they used federal resources to support these efforts. 

Specifically, we conducted interviews with state and local officials during 

site visits to two states—California and Maryland—and two cities—New 

York City and San Francisco—that received awards from CDC’s Climate 

Ready States and Cities Initiative, which is HHS’s primary investment in 

climate change adaptation.14 We selected these four locations from 

among the 18 awardees of CDC’s Climate Ready States and Cities 

Initiative to obtain geographic diversity, because climate change impacts 

are location-specific, and to have a mixture of state and local 

governments, because states and municipalities may have different 

approaches in preparing for the public health risks of climate change. We 

also facilitated four small group discussion sessions with officials from 22 

state and local health departments to gather additional information about 

federal resources used by state and local health officials. We worked with 

representatives of the Association of State and Territorial Health Officials 

13In identifying these examples, we did not limit the scope of our work to a specific time 

period. 

14Adaptation refers to adjustments to natural or human systems that are made in 

response to actual or expected climate changes. While our report focuses on activities 

taken to adapt to the potential health impacts of climate change, federal agencies and 

others are also involved in climate change mitigation—that is, taking actions to limit the 

magnitude or rate of climate change. EPA recently reported on the physical and monetary 

benefits in the United States of global mitigation, including that it is projected to reduce the 

impact of climate change on air quality and the corresponding adverse health effects 

related to air pollution, avoiding 57,000 premature deaths in 2100. EPA, Climate Change 

in the United States: Benefits of Global Action (Washington, D.C.: June 2015). 

Page 5 GAO-16-122 Climate Change and Public Health

 
(ASTHO)15 and the National Association of County and City Health 

Officials (NACCHO)16 to identify state and local public health officials who 

have expressed interest in climate change issues to participate in these 

sessions.17 In a third approach to gather perspectives, we interviewed 

officials from a nongeneralizable sample of 11 state and local health 

departments that reflected geographic diversity and that had either 

recently faced climate-related public health issues, had conducted work to 

plan for potential future health impacts from climate change, or had 

concerns about potential future health impacts. In total, through these 

approaches, we interviewed officials from all 18 state and local health 

departments that received awards from CDC’s Climate Ready States and 

Cities Initiative, officials from 7 local health departments in some of those 

jurisdictions, and health department officials from 13 other states and 

15ASTHO is a national nonprofit organization representing public health agencies in the 

United States, the U.S. Territories, and the District of Columbia, and over 100,000 public 

health professionals these agencies employ. ASTHO’s primary function is to track, 

evaluate, and advise members on the impact and formation of public or private health 

policy that may affect them and to provide them with guidance and technical assistance on 

improving the nation’s health.

16NACCHO’s mission is to be a leader, partner, catalyst, and voice for the 2,800 local 

health departments across the United States in order to ensure the conditions that 

promote health and equity, combat disease, and improve the quality and length of all lives.

17We conducted one small group discussion session in person with state health 

department officials during the American Public Health Association’s annual meeting, and 

we conducted three additional sessions by teleconference with state and local health 

department officials, to capture the perspectives of those who were unable to attend our 

in-person session. In total, we conducted three sessions with state health department 

officials and one session with local health department officials. In addition to working with 

ASTHO and NACCHO to identify potential participants, we also conducted some targeted 

recruitment of officials from state and local health departments receiving awards through 

CDC’s Climate Ready States and Cities Initiative to include these jurisdictions in our small 

group discussion sessions. 

Page 6 GAO-16-122 Climate Change and Public Health

 
localities.18 These interviews and small group discussions included openended questions that were not conducive to quantitative analysis. 

Therefore, using a qualitative approach, we identified examples of the 

types of federal resources that these officials have used to address and 

plan for the risks that climate change poses to human health. We also 

reviewed Climate Ready States and Cities Initiative awardees’ annual 

progress reports to CDC. To obtain more information about these 

resources, we reviewed documentation about the types of support they 

offered, such as from funding opportunity announcements. We also 

reviewed information on fiscal year 2014 funding for CDC programs cited 

by state and local officials, as presented in the agency’s congressional 

budget justification for fiscal year 2016. Furthermore, we interviewed 

officials from federal agencies, such as CDC and NOAA, and gathered 

the perspectives of stakeholders through interviews with representatives 

from groups such as ASTHO and NACCHO. The results of our review do 

not provide an exhaustive list of federal resources that state and local 

health departments could use to address and plan for the public health 

impacts of climate change, but are provided as illustrative examples of 

such resources.

To examine challenges identified by state and local officials to addressing 

or planning for the risks that climate change poses to public health, and 

any steps federal agencies could take to mitigate these challenges, we 

gathered the views of state and local health department officials during 

site visits, small group discussion sessions, and individual interviews. 

Through an inductive analysis of officials’ views, we qualitatively grouped 

them into three themes that were most frequently mentioned about the 

types of challenges these public health departments face, and, in some 

cases, the opportunities officials see for federal action to address these 

18We interviewed officials from all 16 states and two cities that were awarded funding 

through CDC’s Climate Ready States and Cities Initiative—Arizona, California, Florida, 

Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New 

York, North Carolina, Oregon, Rhode Island, Vermont, Wisconsin, as well as New York 

City and San Francisco. In addition, we interviewed officials from seven local health 

departments located in states that received the CDC award, including Baltimore (MD), 

Benton County (OR), Multnomah County (OR), San Diego County (CA), San Luis Obispo 

County (CA), Washington County (MD), and Wicomico County (MD). We also interviewed 

officials from five other state and eight other local health departments: Alaska, Hawaii, 

Louisiana, Utah, and Washington, as well as Columbus (OH), Dallas County (TX), 

Houston (TX), Portsmouth (VA), Salt Lake County (UT), Shelby County (TN), Summit 

County (OH), and Toledo (OH). We interviewed officials from a few state and local health 

departments twice, through different approaches. 

Page 7 GAO-16-122 Climate Change and Public Health

 
challenges.19 We also gathered the perspectives of stakeholder groups 

through interviews with representatives from ASTHO, NACCHO, and the 

Council of State and Territorial Epidemiologists. To gather information 

about steps federal agencies could take to mitigate these challenges, we 

interviewed officials from federal agencies such as CDC, NIH, and NOAA, 

as well as representatives from stakeholder groups. We examined federal 

documents, including those describing ongoing and planned federal 

actions aimed at reducing the impact of climate change on public health. 

We reviewed prior GAO work on the federal role in addressing challenges 

related to climate change, including challenges faced by state and local 

officials.

We conducted this performance audit from June 2014 to September 2015 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

Climate changes, including rising temperatures and shifting patterns of 

rainfall, are expected to impact public health across the nation in a variety 

of ways. Though state and local governments have primary responsibility 

for protecting the public health in their jurisdictions, the federal 

government also plays an important role in supporting state and local 

efforts by, for example, providing health departments with technical 

support and other resources. The federal government has also taken 

other targeted actions to help prepare the nation for climate change 

impacts, such as by issuing a number of orders, actions, and plans to 

provide state and local decision makers with information they need to 

manage such impacts, including impacts to public health.

19The results from our analysis identify the three themes that were commonly reported by 

a diverse group of state and local health departments. These results are not generalizable 

to other state and local health departments and do not necessarily include all challenges 

that public health departments may face. 

Background

Page 8 GAO-16-122 Climate Change and Public Health

 
Impacts from climate change in the United States have been observed, 

are projected to continue, and are likely to accelerate over the next 

several decades, with impacts varying considerably by region, according 

to assessments by the National Research Council and USGCRP.20

According to USGCRP’s third NCA, observed impacts in the United 

States include increases in average temperatures and precipitation, as 

well as changes to precipitation extremes, with variation across regions 

(see table 1). These and other climate changes are projected to continue 

over this century and beyond, according to USGCRP’s third NCA. The 

magnitude of climate change beyond the next few decades depends 

primarily on the amount of heat-trapping gasses emitted globally, and 

how sensitive the Earth’s climate is to those emissions, according to 

USGCRP’s third NCA.

21

20National Research Council, America’s Climate Choices: Panel on Adapting to the 

Impacts of Climate Change, Adapting to the Impacts of Climate Change (Washington, 

D.C.: 2010); and Melillo, Richmond, and Yohe, eds., Climate Change Impacts in the 

United States: The Third National Climate Assessment. 

21Because of greenhouse gases already in the atmosphere, another 0.5 degree 

Fahrenheit increase would occur even if all emissions from human activities were 

suddenly stopped, according to USGCRP’s third NCA. 

Climate Change Impacts 

in the United States

Page 9 GAO-16-122 Climate Change and Public Health

 
Table 1: Observed and Projected Impacts of Climate Change in the United States

Category Observed and projected impacts

Temperature • Observed impact: The last decade was the warmest on record for the contiguous United States, 

with 2012 as the warmest year on record.a The average temperature has risen by 1.3 to 1.9 

degrees Fahrenheit since record keeping began in 1895, with most of this increase occurring since 

1970.

• Projected impact: Temperature increases are projected for all regions of the country during this 

century, with projected increases of 2 to 4 degrees Fahrenheit in the next few decades in most 

areas. 

Precipitation • Observed impact: Precipitation has increased by an average of about 5 percent since 1900, with 

variation across regions. Heavy downpours have been increasing nationally in recent decades, 

with the largest increases in the Midwest and Northeast.

• Projected impact: More winter and spring precipitation is projected for the northern United States, 

and less for the Southwest, during this century. Increases in the frequency and intensity of 

extreme precipitation events are projected for all regions.

Sea levels • Observed impact: Global sea level has risen by about 8 inches over the last century.

• Projected impact: Global sea level is projected to rise another 1 to 4 feet by 2100, with additional 

increases well beyond this century.

Extreme weather events

and impacts from storms

• Observed impact: Some types of extreme weather events—such as heat waves and regional 

droughts—have become more frequent and intense in recent decades.

• Projected impact: Droughts in the Southwest and heat waves everywhere are projected to 

become more intense. Rainfall from storms such as hurricanes is expected to increase, and sea 

level rise is expected to magnify the adverse impact of storm surges on some coastal 

communities. 

Source: U.S. Global Change Research Program’s third National Climate Assessment. | GAO-16-122

a

The National Oceanic and Atmospheric Administration and the National Aeronautics and Space 

Administration have since declared 2014 as the warmest year on record since 1880.

Page 10 GAO-16-122 Climate Change and Public Health
According to USGCRP’s third NCA, climate change is expected to impact 

human health in the United States by exacerbating some existing health 

threats and by posing new risks. For example, projected changes in 

temperature are expected to increase the length of pollen seasons, which 

could increase allergies and asthma episodes. According to USGCRP’s 

third NCA, extreme weather events, which are expected to become more 

common with climate change, are linked with increases in injuries, 

deaths, and mental health problems, such as anxiety and posttraumatic 

stress disorder. Furthermore, according to this assessment, changes in 

the climate may contribute to the spread of vector-borne diseases that are 

transmitted to humans by animals, including invertebrate animals such as 

mosquitoes and ticks. Examples of vector-borne diseases that currently 

pose health risks in some regions of North America include chikungunya 

virus, dengue, Lyme disease, Rocky Mountain spotted fever, and West 

Nile virus.22 Table 2 summarizes these and additional risks that climate

change poses to human health.

22Chikungunya is a viral disease spread to people by the bite of infected mosquitoes. 

According to CDC, the first locally acquired cases of chikungunya were reported in Florida 

in 2014. Dengue is caused by any one of four related viruses transmitted by mosquitoes. 

According to CDC, dengue is endemic to Puerto Rico and the Pacific Islands, and occurs 

only infrequently in the United States. Lyme disease is a bacterial disease that is 

transmitted to humans through the bite of infected blacklegged ticks. Most Lyme disease 

cases reported to CDC through national surveillance are concentrated heavily in the 

Northeast and upper Midwest. West Nile virus is most commonly transmitted to humans 

by mosquitoes. According to CDC, the virus has been detected in all of the 48 contiguous 

United States, but not in Hawaii or Alaska. 

Climate Change and 

Human Health

What Is a Vector-Borne Disease?

Vector-borne diseases are transmitted by 

mosquitoes, ticks, and fleas. West Nile virus is 

one type of vector-borne disease and is most 

commonly transmitted to people by the bite of 

infected mosquitoes. First detected in North 

America in 1999, it has since spread to all 

states except Alaska and Hawaii, with 

outbreaks occurring every summer. Most 

people who are infected with West Nile virus 

experience no symptoms, but one in five 

infected people will develop a fever with other 

symptoms such as headaches and body 

aches, and a very small number of infected 

people—less than 1 percent—will develop a 

severe neurological illness that can result in 

paralysis or death. People who work or play 

outside are especially vulnerable because of 

greater exposures to mosquitoes.

Source: Centers for Disease Control and Prevention/James 

Gathany. | GAO-16-122

Page 11 GAO-16-122 Climate Change and Public Health

 
Table 2: Examples of Health Risks Posed by Climate Change in the United States

Health risk Exposure or event posing health risk Reason for increased risk from climate change 

Allergies, asthma, and 

other adverse 

respiratory impacts

Pollen, smoke from wildfires, and ground-level 

ozone (a key component of smog)

Pollen seasons are becoming longer because of 

climatic changes, such as increases in the number of 

frost-free days. Wildfires are projected to increase in 

some regions in part because of drought and other 

stressors exacerbated by climate change. Rising 

temperatures can also lead to higher levels of ozone 

pollution. 

Food-borne and waterborne illnessesPathogens such as disease-causing bacteria, 

viruses, and parasites from untreated water or 

other sources 

Factors that contribute to flooding, such as more 

extreme downpours, sea level rise, storm surges, and 

more rapid spring snowmelt may increase releases of 

sewage to surface waters. In addition, diarrheal 

diseases caused by pathogens such as Salmonella are 

more common when temperatures are high. 

Heat-related illnesses 

and deathsa Unusually high temperatures, including prolonged heat waves

Extreme heat events are expected to become more 

frequent and intense in coming decades because of 

climate change. 

Injuries and deaths Extreme weather events—such as winter storms 

and heavy precipitation—and their aftermaths, 

and changes to natural or built environments that 

introduce hazards 

Some types of extreme weather events are expected to 

become more frequent and severe because of climate 

change. Extreme weather events may result in direct 

injury and impact natural or built environments in ways 

that increase risk of injury. Heavy precipitation events 

may result in flash floods, which can lead to drownings.

Mental health and 

stress-related disorders

Any adverse change to an individual’s 

environment, way of life, or health, such as 

displacement following a disaster

Climate-related disasters such as floods, heat waves, 

and wildfires may result in increases in mental health 

problems, such as anxiety and post-traumatic stress 

disorder. 

Vector-borne diseases Pathogens spread by vectors—including fleas, 

ticks, and mosquitoes—cause diseases such as 

dengue, Lyme disease, Rocky Mountain spotted 

fever, and West Nile virus

Habitats of some pathogen-carrying vectors may 

expand into previously unaffected regions, in part 

because of climate change.

Source: U.S. Global Change Research Program’s third National Climate Assessment. | GAO-16-122

a

Heat-related illnesses and deaths may result from heat stroke or heat-sensitive conditions such as 

cardiovascular disease, kidney disease, cerebrovascular disease, and other conditions exacerbated 

by exposure to extreme heat.

The type and severity of health impacts that communities and individuals 

face from climate change will depend on a variety of factors, and not 

everyone is equally at risk, according to assessments by the National 

Research Council, USGCRP, and others. Populations of special concern 

include children, the elderly, those who are sick, those who are living in 

poverty, those who work outdoors, some communities of color, and 

Page 12 GAO-16-122 Climate Change and Public Health
Native American communities.23 According to the National Research 

Council and USGCRP’s third NCA, key factors in determining health risks 

include the following:

• Location. Because climate change impacts are expected to vary 

across the country, people will face different risks depending on 

where they live, work, and travel. People located in cities may be at 

increased risk for heat-related illnesses (e.g., heat stroke or heatsensitive conditions such as cardiovascular disease), for example, 

because land cover changes associated with urbanization, including 

increases in the amount of paved areas, can result in higher air 

temperatures compared to the surrounding rural areas, according to 

USGCRP’s third NCA. Those who work outdoors, such as farmers, 

fishermen, firefighters, and utility workers, may be adversely affected 

by climate impacts because they have more frequent, intense, and 

longer exposures to the climate than the general public, according to 

CDC’s website. For example, as extreme weather events such as 

floods become more frequent and severe, outdoor workers could be 

at increased risk of traumatic injury. Figure 1 provides examples of 

potential impacts by region.

23For example, Native American communities’ vulnerabilities to climate change impacts 

are exacerbated by poor socioeconomic conditions, according to USGCRP’s third NCA.

Page 13 GAO-16-122 Climate Change and Public Health

 
• Age. A person’s age also plays a role in determining his or her 

vulnerability to health impacts, including those related to climate 

change, according to USGCRP’s third NCA. For example, children 

suffer disproportionately from the effects of heat waves and other 

environmental hazards associated with climate change, according to 

USGCRP’s third NCA. One reason is that children playing outside 

during heat waves may not be aware that they need to drink more 

water as a preventative measure, according to EPA.24 Older adults 

are also vulnerable to some climate-related impacts, according to 

USGCRP’s third NCA. Specifically, this assessment states that limited 

mobility among older adults can increase their flood-related health 

risks, and that older people are at much higher risk of dying during 

extreme heat events.

• Adaptive capacity. The extent to which people and communities 

have the capacity to successfully adapt to adverse events also affects 

the health risks they face, and is influenced by characteristics such as 

disabilities and socioeconomic status. For example, according to 

USGCRP’s third NCA, limited economic resources for adapting to or 

escaping from health-sensitive situations will place the poor at higher 

risk of health impacts from climate change than higher-income 

groups. In contrast, communities that have access to early warning 

systems, such as for forecasting and alerting people about impending 

heavy precipitation events and flooding, may be better positioned to 

reduce health risks from such adverse events.

24EPA, Climate Change and Children’s Health (Washington, D.C.: December 2009). In a 

prior report, we noted that as children’s bodies are still developing, they can be more 

vulnerable than adults to certain environmental hazards, including air pollutants. See 

GAO, Environmental Health: EPA Has Made Substantial Progress but Could Improve 

Processes for Considering Children’s Health, GAO-13-254 (Washington, D.C.: Aug. 12, 

2013). 

Why Are Children Especially Vulnerable to 

Some Health Risks from Climate Change?

Children are more vulnerable than adults to 

some health risks from environmental 

hazards— including hazards exacerbated by 

climate change—because of differences in 

their biology and behavior. Children breathe 

more air relative to their body mass than 

adults do and their natural defenses are less 

developed, which makes them especially 

vulnerable to health impacts from decreased 

air quality. Asthma is one of the most common 

serious chronic diseases among children, and 

can be aggravated by poor air quality. 

Children also behave differently from adults, 

such as by spending more time outdoors and 

playing closer to the ground, which makes 

them especially vulnerable to mosquito and 

tick bites that can cause disease.

Source: Environmental Protection Agency. | GAO-16-122

Page 14 GAO-16-122 Climate Change and Public Health

 
Figure 1: Examples of Potential Health Impacts from Climate Change in the United States, by Region

Note: Impacts described for certain regions do not imply that they do or can occur only in those 

regions.

Page 15 GAO-16-122 Climate Change and Public Health
State, local, territorial, and tribal governments have primary responsibility 

for managing public health risks within their jurisdiction. Public health 

departments vary greatly in their size, responsibilities, and resource 

levels, among other factors.25 Activities that public health departments 

may undertake to help promote health and well-being include monitoring 

and investigating health problems, educating people about health issues, 

developing plans to support health efforts, and researching new solutions 

to health problems, among other activities.

The federal government’s role in managing public health includes 

providing leadership through setting and communicating health-related 

policies, goals, and standards. Federal agencies also finance research 

and higher education, support state and local health department efforts, 

and support the development of data and decision support resources that 

decision makers can use to manage for risks to public health, including 

from climate change.26 For example, through its various programs, CDC 

provides technical and financial support to state and local health 

departments to enhance their capacity to monitor and promote public 

health, including preparing for the risks posed by climate change. The 

agency’s Climate and Health Program, established in 2009, supports 

state and local health department efforts to plan for and address the 

health risks posed by climate change. According to CDC, the program’s 

three core functions are to translate climate change science into health 

policy for action by health departments and communities, create decision 

support resources to build capacity, and serve as a credible leader in 

planning for the public health impacts of climate change.

The federal government has undertaken a number of efforts to enhance 

the nation’s resilience to climate change impacts, such as strengthening 

federal agencies’ adaptation planning and providing states and localities 

with information for managing risks posed by climate change. In July 

2014, we reported that investing in resilience—actions to reduce potential 

25Each of the 50 states has a state health department and according to NACCHO, about 

2,800 local health departments exist across the nation, including those that function at the 

city, county, or multicounty level.

26Decision support resources—including tools and decision-making frameworks—can help 

decision makers to understand and apply scientific information to a particular scenario, 

and identify and assess the costs and benefits of taking various actions, among other 

things. 

Roles and Responsibilities 

for Managing Public 

Health Risks in the United 

States

Federal Efforts to Enhance 

Resilience to Climate 

Change Impacts

Page 16 GAO-16-122 Climate Change and Public Health

 
future losses rather than waiting for an event to occur and paying for 

recovery afterward—can reduce the potential impacts of climate-related 

events.27 To facilitate federal efforts, the federal government has issued 

the following orders, actions, and plans:

• Executive Order 13514. On October 5, 2009, the President issued an 

executive order calling for federal agencies to participate in the 

existing interagency Climate Change Adaptation Task Force.28 Based 

on the task force’s recommendations, the Council on Environmental 

Quality within the Executive Office of the President issued 

implementing instructions for the executive order,29 directing federal 

agencies to establish agency climate change adaptation policies, 

among other things.30

• The President’s Climate Action Plan. In June 2013, the White 

House published a climate action plan detailing actions that federal 

agencies would take to prepare the nation for the impacts of climate 

change, among other goals.31

• Executive Order 13653. On November 1, 2013, the President issued 

an executive order to help prepare the nation for the impacts of 

27Implementing resilience measures creates additional up-front costs but could also confer 

benefits, such as a reduction in future damages from climate-related events. See GAO, 

Budget Issues: Opportunities to Reduce Federal Fiscal Exposures Through Greater 

Resilience to Climate Change and Extreme Weather, GAO-14-504T (Washington, D.C.: 

July 29, 2014).

28Executive Order 13514, Federal Leadership in Environmental, Energy, and Economic 

Performance (Oct. 5, 2009). This Executive Order was revoked by Executive Order 13693 

on March 19, 2015; however, an Executive Order issued in 2013 directed agencies to 

continue developing, updating, and implementing agency adaptation plans. Executive 

Order 13653, Preparing the United States for the Impacts of Climate Change (Nov. 1, 

2013).

29The Council on Environmental Quality coordinates federal environmental efforts and 

works with agencies and other White House offices in the development of environmental 

policies and initiatives.

30Instructions for Implementing Climate Change Adaptation Planning in Accordance with 

Executive Order 13514 “Federal Leadership in Environmental, Energy, and Economic 

Performance,” (Mar. 4, 2011). 

31The President’s Climate Action Plan (June 2013). 

Page 17 GAO-16-122 Climate Change and Public Health

 
climate change.32 Among other things, the order called on certain

federal agencies to provide information, data, and decision-support 

tools on climate preparedness and resilience in support of federal, 

regional, state, local, tribal, and other efforts to prepare for the 

impacts of climate change. It also established a State, Local, and 

Tribal Leaders Task Force on Climate Preparedness and Resilience 

to inform federal efforts to support climate preparedness and 

resilience.33

• April 2015 Administrative Actions. On April 7, 2015, the White 

House announced a series of actions that the administration was 

taking to better understand, communicate, and address the health 

impacts of climate change, as well as commitments made by private 

sector entities and institutes of higher learning to further our 

knowledge in this area. Among other things, the administration 

expanded the resources available for analyzing the climate change 

impacts on health. (App. II provides a summary of these actions.)

• June 2015 Climate and Health Summit and Administrative 

Actions. On June 18, 2015, the White House hosted a summit on 

climate change and health, which included the participation of the 

President, the Surgeon General, and the HHS Assistant Secretary for 

Preparedness and Response.34 At the summit, the administration 

announced a set of actions to protect communities from the health 

impacts of climate change that cannot be avoided. (App. III provides a 

summary of these actions.)

In addition, USGCRP has undertaken efforts to support scientific research 

with the goal of improving understanding of and response to climate 

change and its impacts on the United States. To help address climate 

change impacts on human health, USGCRP coordinates an Interagency 

Crosscutting Group on Climate Change and Human Health (CCHHG); 

32Executive Order 13653, Preparing the United States for the Impacts of Climate Change 

(Nov. 1, 2013). 

33The task force consisted of 26 governors, mayors, county officials, and tribal leaders 

from across the United States, and was co-chaired by the Chair of the White House 

Council on Environmental Quality and the Director of the White House Office of 

Intergovernmental Affairs.

34The recording of the summit is available online at 

https://www.whitehouse.gov/blog/2015/06/18/public-health-climate-summit. 

Page 18 GAO-16-122 Climate Change and Public Health

 
officials from CDC, NIH, and NOAA chair this group. The mission of 

CCHHG is to promote and protect the nation’s public health by leading 

and coordinating federal scientific activities related to climate change and 

human health, from basic research through public health practice. 

CCHHG’s activities include working to address key gaps in understanding 

of the health–related impacts of climate change and developing 

informational resources.35

Federal agencies have undertaken activities to enhance understanding 

about the risks that climate change poses to public health, including 

supporting and conducting research on or related to these risks. Agencies 

have also provided some data and decision support resources, such as 

guidance and tools, for state and local officials and others to use in 

examining public health-related risks from climate change and potential 

actions to address these risks. Agencies have also communicated about 

such risks through reporting and outreach efforts to public health officials 

and the general public.

To enhance understanding of the risks that climate change poses to 

public health, many of the federal agencies included in our review have 

supported and conducted research on or related to these risks. While 

governmentwide data on funding for such research is not available, NIH, 

which awards financial assistance for research, reports that it awarded 

about $6 million to support research on the health impacts of climate 

change in fiscal year 2014.36 This amount comprised a relatively small 

portion—about 0.025 percent—of the approximately $24 billion that NIH 

awarded for research that year. Some of this research originated from an 

NIH funding opportunity—a solicitation for exploratory research projects 

on the health impacts of climate change—through which the agency 

awarded a total of about $8.3 million for research from fiscal year 2011 

through fiscal year 2014 for 21 projects. One of these projects, for 

35Additional federal agencies participating in the CCHHG are the U.S. Departments of 

Agriculture, Defense, Interior, State; EPA; National Aeronautics and Space Administration; 

the Smithsonian Institution; and the U.S. Agency for International Development. 

36Examples of funded projects include a study examining the health risks of heat and air 

pollution, and a study examining the impacts of extreme heat on inner-city minority 

children with asthma and older adults with chronic obstructive pulmonary disease. 

Federal Agencies 

Have Undertaken 

Various Activities to 

Enhance 

Understanding of 

Climate Change 

Risks to Public Health

Supporting and 

Conducting Research on 

or Related to the Risks 

Climate Change Poses to 

Public Health

Page 19 GAO-16-122 Climate Change and Public Health

 
example, examined the relationship between climate change and 

pediatric asthma.37 NIH officials told us that the agency has not issued 

additional funding opportunities for research on climate change. These 

officials said that they hoped researchers who received awards from this 

opportunity would be better positioned to submit proposals in the future 

through NIH’s most common submission process, in which researchers 

submit unsolicited proposals based on the program interests of one or 

more of the agency’s institutes or centers.38

In addition to NIH, other federal agencies, such the National Aeronautics 

and Space Administration (NASA), have also conducted or supported 

research on or related to the risks that climate change poses to public 

health, including by making awards for relevant research projects and 

providing financial support for research teams or postdoctoral students 

conducting relevant work. For example, NASA made an award to aid in 

the development of climate change indicators related to heat waves in 

urban areas through its 2012 research announcement entitled “Research 

Opportunities in Space and Earth Sciences” that intended to, among 

other things, facilitate the application of scientific knowledge to 

management decisions.39 Indicators developed through this program may 

be used by health officials to identify urban areas with increased 

vulnerabilities to health impacts due to a lack of cooling green spaces and 

other factors. Additionally, EPA sponsored a review of the effects of 

climate change on the indoor environment and health, which concluded, 

among other things, that climate change may worsen existing indoor 

37The funding opportunity for exploratory research was issued in 2010 by National 

Institute of Environmental Health Sciences with the participation of the Fogarty 

International Center, National Cancer Institute, National Center on Minority Health and 

Health Disparities, National Heart, Lung, and Blood Institute, National Institute on Aging, 

National Institute on Biomedical Imaging and Bioengineering, National Institute of Child 

Health and Human Development, National Institute of General Medical Sciences, National 

Library of Medicine, and the Office of Behavioral and Social Sciences Research. 

38NIH reported awarding a total of about $28 million for research on the health impacts of 

climate change for fiscal year 2011 through fiscal year 2014, which includes nearly all of 

the projects funded through the NIH solicitation for research proposals, as well as other 

unsolicited research. For this period, NIH also reported awarding about $579 million for 

research on exposures or conditions that are related to climate, such as research on 

melanoma. Because these categories are not mutually exclusive, funding for some 

research is included in both groups.

39An indicator is an observation or calculation that allows scientists, analysts, decision 

makers, and others to track environmental trends, understand key factors that influence 

the environment, and identify effects on ecosystems and society.

Page 20 GAO-16-122 Climate Change and Public Health

 
environmental problems that are known to exacerbate illnesses such as 

asthma and allergies, and create new problems that have adverse health 

impacts.40

Officials from some of the federal agencies included in our review told us 

that while their agencies have conducted or supported research that is 

useful for advancing understanding of climate change impacts to public 

health, the link to this topic is often indirect. For example, federally-funded 

research about health impacts from natural disasters, such as floods, 

does not always explicitly consider the associated impacts from climate 

change but can help advance understanding of these impacts, according 

to federal officials we spoke with. Appendix IV provides additional 

examples of research on or related to the risks of climate change to public 

health that some of the federal agencies included in our review have 

conducted or supported.

Federal agencies have provided some data and decision support 

resources—such as guidance and tools—that state and local officials, 

and others, can use to examine public health-related risks from climate 

change and potential actions to address these risks. Table 3 provides 

examples of these data and decision support resources.

40Institutes of Medicine, Climate Change, the Indoor Environment, and Health

(Washington, D.C.: 2011).

Providing Data and 

Decision Support 

Resources for Examining 

Risks

Page 21 GAO-16-122 Climate Change and Public Health

 
Table 3: Examples of Federal Data and Decision Support Resources for Examining the Risks That Climate Change Poses to 

Public Health

Federal agency Description of data or decision support resource 

Environmental Protection 

Agency (EPA)

EPA published a software tool in 2010—referred to as the Climate Resilience Evaluation & 

Awareness Tool—to assist drinking water and wastewater utility owners and operators in 

understanding and addressing potential climate change risks at their utilities to continue to protect 

public health, among other reasons.

Department of Health and 

Human Services (HHS)

In December 2014, HHS published a best practices document to promote resilience of health care 

facility infrastructure to climate change impacts—primarily from extreme weather events, as part of 

its Sustainable Climate Resilient Health Care Facilities Initiative. To help users implement the 

guidance, the agency subsequently published an online toolkit with links to individual tools. In June 

2015, HHS released its emPOWER map, an online interactive tool that displays information about 

vulnerable populations that rely on electricity-dependent medical equipment, to support state, local, 

and community partner emergency planning and response activities.

National Aeronautics and Space 

Administration (NASA)

NASA collects data on land surface temperature and other climate-sensitive environmental factors 

that may affect public health by, among other mechanisms, impacting the range of animals that can 

transmit harmful diseases to humans. The agency reports some data online and provides other data 

upon request.

National Oceanic and 

Atmospheric Administration 

(NOAA)

NOAA’s National Weather Service and its partners collect environmental data and provide decision 

support services to aid decision makers in their examination of the potential public health impacts of 

weather, water, and climate events.

U.S. Global Change Research 

Program (USGCRP)

In 2013, USGCRP introduced the Metadata Access Tool for Climate and Health, or MATCH, an 

online clearinghouse that provides links to thousands of government-held datasets related to health, 

the environment, and climate science.

Source: GAO. | GAO-16-122

Users of these data and decision support resources may include public 

health officials or decision makers with responsibility for managing 

systems that are necessary for protecting public health, such as hospital 

administrators or wastewater management system operators, among 

others. Other users may include researchers, community organizations, 

or other interested individuals. The following are two key interagency 

mechanisms that federal agencies leverage to provide climate and health 

data and decision support resources to potential users:

• Data.gov. In April 2015, data.gov, the federal government’s site for 

open data, launched a theme page on climate and health that 

provides information about data sources and tools maintained by 

federal agencies.41 The site includes links to data on climate, weather, 

41Executive Order 13653 directed the establishment of a data.gov portal on climate 

issues. The portal’s theme page on climate and health is available online at 

http://www.data.gov/climate/humanhealth/. 

Page 22 GAO-16-122 Climate Change and Public Health

 
and health from many federal agencies. One data source included on 

the theme page is CDC’s National Environmental Public Health 

Tracking Network, which includes heat-related health data, including 

national data on the number of extreme heat days and future 

projections of extreme heat.42 Another data source included on the 

theme page is NOAA’s Climate Data Online, which includes data on 

precipitation amounts, as well as a mapping tool and other decision 

support resources.

• The U.S. Climate Resilience Toolkit. The toolkit is an online portal 

that is intended to help individuals, communities (including tribal 

nations), and others respond to risks from climate change. Human 

health is one of the topics highlighted in the toolkit.43 One tool 

available in the toolkit is the Agency for Toxic Substances and 

Disease Registry’s Social Vulnerability Index, which uses U.S. 

Census Bureau variables to identify communities that may need 

support in preparing for climate-related or other hazards or recovering 

from disasters, and includes a mapping feature and downloadable 

data. Another tool available in the toolkit is a software package 

developed by EPA that allows users to predict levels of diseasecausing pathogens at specific beach sites, where outbreaks can result 

from climate change-related effects such as warming waters and 

intense precipitation.44

CDC has also developed some decision support resources intended to 

help state and local public health officials identify and address risks from 

climate change. In June 2014, CDC officials authored a journal article 

which described a five-step risk management framework that the agency 

developed for health officials to use in preparing for the health effects of 

42The network—which is part of CDC’s National Environmental Public Health Tracking 

Program—is a system of integrated health, exposure, and hazard information and data 

from a variety of national, state, and city sources. CDC makes awards to 26 state and 

local health departments to develop local tracking networks, which feed into the national 

network. 

43The U.S. Climate Resilience Toolkit was developed in 2014 by a partnership of federal 

agencies and organizations in response to the President’s Climate Action Plan and 

Executive Order 13653. The toolkit’s page on human health is available online at 

http://toolkit.climate.gov/topics/human-health. 

44EPA’s tool, Virtual Beach, helps users to predict levels of disease causing pathogens 

such as Escherichia coli and enterococci at freshwater and saltwater beaches.

Page 23 GAO-16-122 Climate Change and Public Health

 
climate change.45 In July 2014, CDC issued a more detailed guide for 

health departments on how to assess the vulnerability of their constituent 

populations to the health impacts of climate change—a critical step for 

health departments in planning for climate change risks to public health, 

according to CDC.46 The guide includes a case study detailing how CDC 

conducted a vulnerability assessment on heat impacts in the state of 

Georgia. In addition, CDC’s National Environmental Public Health 

Tracking Program published a communication toolkit in 2012 that focuses 

on the relationship among climate change, public health, and extreme 

heat—which is the only climate change-related area for which the tracking 

network provides data.47 Among other things, the communication toolkit 

provides health officials and other potential users with key messages and 

tips for using social media to communicate effectively about this topic.

Federal agencies in our review have communicated information about the 

risks that climate change poses to public health through reporting and 

outreach efforts directed at multiple audiences, such as public health 

officials and the general public. In several key communication efforts, 

federal agencies have collaborated to report on what is known about 

these risks. For example, in the third NCA published in May 2014, 

USGCRP reported on the impacts of climate change on the United 

States, including risks to human health. The report was the result of a 

large multiagency effort that included the 13 agencies participating in the 

USGCRP as well as other agencies that chose to support the production 

of the report.48 It includes a chapter on human health—prepared 

collaboratively by officials from several federal agencies participating in 

CCHHG, as well as experts from outside the federal government—

summarizing what is known about how climate change threatens human 

health and well-being, populations that are at greatest risk, the extent to 

45G.D. Marinucci, et al., “Building Resilience Against Climate Effects—A Novel Framework 

to Facilitate Climate Readiness in Public Health Agencies,” International Journal of 

Environmental Research and Public Health 11, no. 6 (2014).

46Centers for Disease Control and Prevention, Assessing Health Vulnerability to Climate 

Change: A Guide for Health Departments (2014).

47The communication toolkit, entitled “Climate Change, Extreme Heat, and Health: A Tool 

Kit,” is available online at http://ephtracking.cdc.gov/docs/CDC_ClimateChange_Final.pdf. 

48Melillo, Richmond, and Yohe, eds., Climate Change Impacts in the United States: The 

Third National Climate Assessment.

Communicating through 

Reporting and Outreach

Page 24 GAO-16-122 Climate Change and Public Health

 
which public health actions can help address these risks, and 

opportunities to improve human health while combating climate change.49

CCHHG is expanding upon this information in a report that is intended to 

provide a comprehensive, evidence-based, and, where possible, 

quantitative estimation of observed and projected climate change related 

health impacts in the United States. The report, referred to as the 

USGCRP Climate and Health Assessment, is being developed through a 

multiagency effort and is expected to be finalized in 2016.

50 The American 

Public Health Association, with the support of CDC, recently reported on 

threats that climate change poses to human health, and how state and 

local public health departments have responded to these threats using 

CDC resources.51 In addition to preparing reports, federal agencies have 

also reported on the risks that climate change poses to public health 

through their websites and through social media, and federal officials 

have reported on these risks in peer-reviewed journal articles and other 

publications.52

Federal agencies have conducted outreach to inform public health 

officials, as well as the general public, about the risks that climate change 

poses to public health. Some ways in which federal agencies have 

recently done so include the following:

• In August 2014, HHS held a departmentwide briefing on climate 

change risks to public health.53

49G. Luber, et al., Ch. 9: Human Health. Climate Change Impacts in the United States: 

The Third National Climate Assessment, J.M. Melillo, Terese (T.C.) Richmond, and G. W. 

Yohe, eds. U.S. Global Change Research Program (Washington, D.C.: U.S. Government 

Printing Office, 2014). 

50Additional information about USGCRP’s Climate and Health Assessment can be found 

at http://www.globalchange.gov/health-assessment.

51American Public Health Association, Adaptation in Action: Grantee Success Stories from 

CDC’s Climate and Health Program (Washington, D.C.: March 2015). 

52For example, CDC’s website includes information on climate change effects on health; 

see http://www.cdc.gov/climateandhealth/effects/default.htm. In addition, EPA has posted 

information about climate impacts to human health to its Facebook page; see 

https://www.facebook.com/EPA/videos/vb.39637302228/10152857564172229/?type=2&th

eater.

53This briefing is available online at 

http://videocast.nih.gov/summary.asp?Live=14490&bhcp=1. 

Page 25 GAO-16-122 Climate Change and Public Health

 
• In December 2014, CDC addressed climate change in its Public 

Health Grand Rounds—a publicly-available webcast that is intended 

to foster discussion on major public health issues.54

In addition, senior officials within HHS and EPA have also conducted 

outreach on certain occasions about the risks that climate change poses 

to public health. In April 2015, the Surgeon General spoke publicly about 

climate change impacts to health following a roundtable discussion on the 

topic with the President, the EPA Administrator, and others, and also 

used social media to solicit and respond to questions about health 

impacts from climate change. The EPA Administrator has also 

communicated about these risks to a variety of audiences, citing climate 

change as among the most significant threats to public health.55 App. V 

provides additional information about federal activities related to climate 

change risks to public health.

Selected state and local health departments included in our review have 

used a CDC climate and health award that addresses the risks that 

climate change poses to public health, as well as other federal resources, 

to address and plan for the public health risks from climate change.

54This presentation is available online at 

http://www.cdc.gov/cdcgrandrounds/archives/2014/december2014.htm. 

55EPA, “Speeches by Date,” Administrator Gina McCarthy, Keynote Remarks at the 

University of Michigan Environmental Law and Public Health Conference, As Prepared,”

http://yosemite.epa.gov/opa/admpress.nsf/8d49f7ad4bbcf4ef852573590040b7f6/ac6b921

8ba9e1e2885257bf2005a41cb!OpenDocument (accessed April 2, 2015). 

State and Local 

Health Departments 

Have Used CDC and 

Other Federal 

Resources to Address 

the Risks That 

Climate Change 

Poses to Public 

Health

Page 26 GAO-16-122 Climate Change and Public Health

 
Sixteen state and two local health departments have used awards from 

CDC’s Climate Ready States and Cities Initiative to address and plan for 

the risks that climate change poses to public health.56 The initiative is the

federal government’s primary investment in supporting state and local 

health departments in addressing the risks that climate change poses to 

public health, and is the only HHS financial resource that has been 

offered to state and local public health departments that directly targets 

these risks. In fiscal year 2014, Initiative awards to state and local health 

departments totaled $3.6 million, with individual awards averaging about 

$200,000.57 Figure 2 displays Initiative awardees as of fiscal year 2015.

56In conducting this work, we spoke with officials from all 18 health departments receiving 

the award—who we refer to as awardees—about the activities they have conducted 

related to climate change and public health. 

57In fiscal year 2014, individual awards ranged from $173,000 to $250,000. According to 

CDC officials, funding for awardees varies by award cycle, as awardees are funded under 

two cooperative agreement mechanisms—a fiscal year 2012 agreement funded 8 

awardees for 4 years, through fiscal year 2016, and a fiscal year 2013 agreement funded 

10 awardees for 3 years, through fiscal year 2016.

Selected Health 

Departments Have Used a 

CDC Award to Directly 

Address and Plan for the 

Risks That Climate 

Change Poses to Public 

Health

Page 27 GAO-16-122 Climate Change and Public Health

 
Figure 2: CDC Climate Ready States and Cities Initiative Awardees, Fiscal Year 2015

CDC’s Climate and Health Program administers the Climate Ready 

States and Cities Initiative. Under the initiative, CDC program staff are 

substantially involved in program activities, above and beyond routine 

grant monitoring. CDC activities for this program are described as 

providing ongoing guidance, resources, consultation, technical 

assistance, and training related to awardee activities.

Under the initiative, CDC requires awardees to implement CDC’s Building 

Resilience Against Climate Effects (BRACE) framework—a five-step risk 

management process intended to help public health departments identify 

Page 28 GAO-16-122 Climate Change and Public Health
and prepare for the public health impacts of climate change by, among 

other things, incorporating atmospheric data and climate projections into 

public health planning. To implement the framework, CDC requires 

awardees to work with internal and external stakeholders to forecast 

climate trends, identify disease risks and vulnerable populations, and 

develop action plans for addressing these risks, among other things. 

Figure 3 describes the five steps of the framework and provides examples 

of activities that can be included in its implementation.58 CDC officials told 

us that they developed the BRACE framework to assist state and local 

health departments in preparing for the public health impacts of climate 

change. (App. VI provides information on the types of activities 

undertaken by awardees in implementing the BRACE framework, and 

app. VII provides information on activities by other selected state and 

local health departments).

58Officials from CDC’s Climate and Health Program told us that they make information 

about the BRACE framework available on the program’s website and through a peerreviewed journal article. See http://www.cdc.gov/climateandhealth/brace.htm and G.D. 

Marinucci, et al., “Building Resilience against Climate Effects—A Novel Framework to 

Facilitate Climate Readiness in Public Health Agencies,” International Journal of 

Environmental Research and Public Health 11, no.6 (2014). 

Page 29 GAO-16-122 Climate Change and Public Health

 
Figure 3: Steps and Examples of Activities Conducted under CDC’s Building Resilience Against Climate Effects Framework

Note: According to CDC officials, the Building Resilience Against Climate Effects (BRACE) framework 

is iterative and enables the incorporation of learning into future decisions by encouraging users to 

revisit prior steps to reevaluate risks and management priorities.

a

According to CDC, qualitative methods may be used to provide a general impression of how climate 

change may affect the risk for certain outcomes, at least capturing general climatic trends and 

environmental exposures, population vulnerability, and expected human health impacts. Quantitative 

methods may be used, for example, to quantify existing climate and health exposure pathways, or to 

project disease impacts.

Under the initiative, CDC requires awardees to complete a range of 

activities that complement their work implementing the BRACE 

framework. For example, CDC requires that awardees take steps to 

increase awareness among the public and decision makers about the 

Page 30 GAO-16-122 Climate Change and Public Health
risks that climate change poses to public health, making use of available 

CDC resources.

Awardees provided examples of the types of guidance and support that 

CDC’s Climate and Health Program has provided to assist them in 

implementing the BRACE framework and addressing climate and health 

information needs in their jurisdictions. For example, CDC created 

guidance for awardees on how to develop a Climate and Health Profile—

a report detailing a jurisdiction’s climate-related exposures, health 

outcomes of concern, and vulnerabilities of certain populations—a 

required component of the first step of the BRACE framework. CDC 

officials told us that they plan to issue guidance describing how to 

approach each step of the BRACE framework. As of June 2015, CDC has 

issued two guidance documents on the first step of the framework.59

Awardees also told us about other types of support provided by CDC, 

including tools that CDC developed in response to awardees’ specific 

requests for assistance, such as a database of peer-reviewed literature 

on climate change and public health impacts and a graphic summarizing 

the impacts of climate change to public health.60 CDC has also organized 

several communities of practice among awardees as forums to discuss 

issues related to the implementation of the BRACE framework.61

According to CDC officials, some public health departments that have not 

received the Climate Ready States and Cities Initiative award have 

expressed interest in implementing the BRACE framework, and such 

departments are able to do so using the resources available on CDC’s 

website.

Although awardees told us that they are in various stages of 

implementing the framework, they also noted that they have already 

observed a variety of benefits from the award. Specifically, awardees we 

spoke with told us that the CDC award has enabled them to work on 

59See Centers for Disease Control and Prevention, Climate Models and the Use of 

Climate Projections: A Brief Overview for Health Departments (2014), and Centers for 

Disease Control and Prevention, Assessing Health Vulnerability to Climate Change: A 

Guide for Health Departments (2014). 

60CDC also makes some of these resources available on its Climate and Health Program 

website, see http://www.cdc.gov/climateandhealth/site_resources.htm.

61According to CDC officials, as of May 2015, there are five communities of practice, 

related to vector-borne diseases, water-borne diseases, conducting vulnerability 

assessments, developing disease projections, and developing evaluation plans. 

Page 31 GAO-16-122 Climate Change and Public Health

 
climate change and health issues in a formalized way that would 

otherwise not have been possible given, for example, competing priorities 

and limited staff time. According to our analysis of awardee reports to 

CDC, nearly all 18 awardees have created a climate and health program 

with dedicated staff within their departments to work on this issue, 

although doing so is not a requirement of the award. Awardees also 

reported that the program allows them to address specific needs in their 

jurisdictions and consider certain areas of interest while implementing the 

framework. For example, some awardees in state health departments told 

us that they have provided subawards to a small number of local health 

departments in their jurisdictions to participate in the implementation of 

the BRACE framework, such as by providing feedback on the usefulness 

of materials developed by the state, or to develop their own initiatives on 

or related to climate change and public health. Officials in these states 

told us that the award allows staff in the local jurisdictions to spend time 

considering the risks that climate change poses to public health and how 

these risks may impact existing priorities in their health departments. 

Additionally, some awardees have identified specific risks that climate 

change poses to public health and are interested in exploring these 

issues in further detail. For example, some awardees are examining 

potential health affects related to climate change impacts on food 

security—that is, the availability and affordability of nutritious and quality 

foods.

Furthermore, awardees told us that the CDC award has allowed for their 

programs to build relationships and engage with partners, such as 

officials from other departments in their jurisdictions or regional partners 

from federal agencies, in ways that could not be accomplished without 

such awards or without a formalized climate and health program. For 

example, officials from the New York City Department of Health and 

Mental Hygiene told us that through the department’s climate and health 

program, they worked collaboratively with their regional National Weather 

Service office to study the appropriateness of the thresholds used to 

issue heat advisories and warnings. According to these officials, the 

National Weather Service had been using a Heat Health Watch and 

Warning System in addition to heat index forecasts to determine when to 

issue heat advisories and warnings; however, health officials were 

concerned that this method was not sensitive enough for use in predicting 

Page 32 GAO-16-122 Climate Change and Public Health
public health outcomes during excessive heat events.62 The health 

department completed a retrospective study of heat-related deaths to 

evaluate metrics that could be used to estimate risks, and it found that 

maximum heat index is a useful metric for assessing public health risks 

due to hot weather in New York City. The officials said that they have 

changed the threshold at which warnings are set as a result of this study, 

and they have continued to develop a working relationship with the 

National Weather Service.

State and local public health officials we interviewed reported leveraging 

a variety of other federal resources, including funding and information 

sources, to address and plan for the risks that climate change poses to 

public health. In most cases, these federal resources were not specifically 

designed for addressing and planning for these risks, but the resources 

could be used in ways that support such efforts. State and local public 

health officials we interviewed most commonly mentioned leveraging 

resources provided by CDC’s National Environmental Public Health 

Tracking Program to support their work in addressing and planning for the 

public health risks of climate change. CDC’s Tracking Program made 

awards to 25 states and one city to develop local tracking networks, 

analyze data on local environmental exposures and related health 

outcomes, and supply selected data to a national tracking network.63 The 

national network includes indicators on climate change, among other 

environmental hazards, related to extreme heat exposure.64 State and 

local health officials we interviewed reported that this award provides an 

important core source of funding for data infrastructure and environmental 

62According to officials from the New York City Department of Health and Mental Hygiene, 

a Heat Health Watch and Warning System uses daily forecasts of the dominant local 

weather pattern to calculate predicted excess deaths from periods of excessive heat 

based on location-specific historical data.

63CDC’s National Environmental Public Health Tracking Network Reporting Tool is 

available online at 

http://ephtracking.cdc.gov/QueryPanel/EPHTNQuery/EPHTQuery.html?c=-1&i=-1&m=-1. 

64Specifically, these indicators use historical weather and health data to identify extreme 

temperatures, extreme heat days and events, deaths that might be related to heat, and 

conditions that make people vulnerable to heat. They also project future extreme heat 

events to help estimate the burden of heat-related illness in the next century. Data for 

these indicators and associated measures are available at the national, state, or county 

level, depending on the indicator and measure. According to CDC officials, the program is 

planning to adopt additional climate change-related indicators in the future. 

Selected Health 

Departments Reported 

Leveraging Other Federal 

Resources to Address and 

Plan for Risks

Page 33 GAO-16-122 Climate Change and Public Health

 
health surveillance activities in their jurisdictions, which can be leveraged 

to include activities such as monitoring patterns of heat-related illness. 

Awards provided to state and local health departments for the tracking 

program vary; in fiscal year 2014, awards totaled $22.6 million to 

participating states and localities, ranging from about $500,000 to $1.2 

million, with an average award of about $870,000.65

State and local health officials also provided examples of how their 

jurisdictions have leveraged funding resources from other CDC programs 

to address and plan for the risks that climate change poses to public 

health. For example, state and local health officials told us that they have 

leveraged awards from CDC’s Public Health Emergency Preparedness 

program—which provides state, local, tribal, and territorial health 

departments across the country with resources to build public health 

preparedness capabilities—to help consider climate change in emergency 

preparedness planning or develop systems that can be used to monitor 

climate-related public health risks. Awards provided to state and local 

health departments vary; in fiscal year 2014, for example, awards ranged 

from $325,000 to approximately $42.5 million, with an average award of 

approximately $9.9 million and a total of about $611.8 million.66 Climate 

change is not a specific focus of the program, but CDC officials 

responsible for administering this program told us that awardees have 

flexibility in determining how to use the funds while meeting CDC’s 

requirements.67 State health officials also told us that they have used 

awards from CDC’s National Institute for Occupational Safety and Health 

to consider the impacts of climate change on worker safety and health, 

such as by monitoring heat-related illnesses and deaths among worker 

65The program made 26 awards to state and local programs in fiscal year 2014 for a 3-

year award cycle. Thirteen of the 18 Climate Ready States and Cities Initiative awardees 

also received National Environmental Public Health Tracking Network awards in fiscal 

year 2015.

66CDC’s Public Health Emergency Preparedness program makes awards to public health 

departments in all 50 states, four major metropolitan areas (Chicago, Los Angeles County, 

New York City and Washington, D.C.), and eight U.S. territories and freely associated 

states (American Samoa, Guam, U.S. Virgin Islands, Northern Mariana Islands, Puerto 

Rico, Federated States of Micronesia, Republic of the Marshall Islands, and Republic of 

Palau).

67Specifically, awardees are required to build and sustain their public health preparedness 

capabilities according to standards developed by CDC. Awardees are also required to 

review their preparedness status annually by using information from a variety of sources, 

such as jurisdictional risk assessments. 

Page 34 GAO-16-122 Climate Change and Public Health

 
populations or specific industries.68 Officials from the National Institute for 

Occupational Safety and Health also noted that, while climate change is 

not a specific focus of the program, the award could be used to support 

activities in this area.

Some public health officials we interviewed also reported leveraging 

federal resources from agencies other than from CDC to address or 

consider the risks that climate change poses to public health. Specifically, 

officials provided examples of other awards and informational resources 

that they had used in their work on this issue. For example, an official 

from one state told us that the state used an award from U.S. Geological 

Survey to assess the vulnerability and health risks of the state’s 

watersheds to flooding and drought under a changing climate. Some state 

and local health officials reported using the health and regional chapters 

of USGCRP’s third NCA as key sources of information. Some officials 

also told us that they have relied on a variety of NOAA information 

resources, such as those provided through NOAA’s National Centers for 

Environmental Information or through NOAA-funded Regional Integrated 

Sciences and Assessment teams.69 For example, one state health official 

told us that the state has relied on support from a NOAA Regional 

Integrated Sciences and Assessment team to translate technical 

information about climate change. In conducting work to address the risks 

that climate change poses to public health, local health officials from one 

jurisdiction also provided an example of using demographic information 

from the American Community Survey—an official U.S. Census Bureau 

survey that is part of the Decennial Census Program—to identify 

populations in its locality that are vulnerable to the health-related impacts 

of climate change.

68Through its State-Based Occupational Health and Safety Surveillance program, the 

National Institute for Occupational Safety and Health provides awards to 23 states to 

collect data on occupational safety and health hazards and effects, identify new sources of 

occupational safety and health data, conduct surveillance, interpret findings, and develop 

or recommend related interventions. According to officials from the National Institute for 

Occupational Safety and Health, the program awarded nearly $6.5 million to state health 

departments in fiscal year 2014, with individual awards ranging from about $100,000 to 

nearly $900,000. Twelve of the 18 Climate Ready States and Cities Initiative awardees 

were also awardees of the State-Based Occupational Health and Safety Surveillance 

program in fiscal year 2014. 

69NOAA’s Regional Integrated Sciences and Assessment teams are university-based 

research partnerships that help build the nation’s capacity to prepare for and adapt to 

climate variability and change.

Page 35 GAO-16-122 Climate Change and Public Health

 
When asked to identify challenges related to their work planning for and 

addressing the risks that climate change poses to public health, state and 

local public health officials we interviewed identified challenges that we 

grouped into the three most frequently reported themes, noting that some 

of these challenges could be addressed by federal action, while others 

could not. According to state and local officials, they face challenges 

communicating about the risks that climate change poses to public health. 

Officials identified related opportunities for federal agencies to enhance 

public understanding of these risks. The officials also stated that they face 

challenges in identifying potential health risks of climate change, for 

example, as a result of research gaps. Officials said that federal agencies 

may be able to address this challenge by continuing to advance research 

and enhance decision support resources. Finally, state and local public 

health officials said they face other challenges that federal action may not 

be able to address, such as having insufficient data on health impacts in 

areas where agreements between states and hospitals limit access by 

health departments.

According to our discussions with selected state and local health officials, 

officials face challenges communicating about the risks that climate 

change poses to public health, in part because of limited awareness 

about climate change as a public health issue. The officials also identified 

opportunities for federal agencies to address these communication 

challenges.

Selected state and local health officials told us during interviews, site 

visits, and small group discussion sessions that they face challenges 

resulting from limited awareness about climate change as a public health 

issue within their own health departments, among other state and local 

partners, such as other agencies in their jurisdictions, and among the 

public. As we have previously found, public awareness can play an 

important role in the prioritization of climate change adaptation efforts.70

70GAO, Climate Change Adaptation: Strategic Federal Planning Could Help Government 

Officials Make More Informed Decisions, GAO-10-113 (Washington, D.C.: Oct. 7, 2009). 

State and Local 

Health Officials 

Identified Multiple 

Challenges, Some of 

Which They Said 

Could Be Addressed 

by Federal Action

Selected Health Officials 

Face Challenges 

Communicating about the 

Risks That Climate 

Change Poses to Public 

Health and Identified 

Opportunities for Federal 

Action

Challenges Identified

Page 36 GAO-16-122 Climate Change and Public Health

 
In addition, if public health officials are aware of the risks that climate 

change poses to public health, they can better assess the importance of 

these risks and allocate resources appropriately. However, health 

department leadership and staff are often not aware of the public health 

impacts of climate change, or do not understand how the issue fits into 

the health department’s priorities, according to state and local health 

officials.71 This observation is consistent with results from a 2012 

NACCHO survey of 174 local health department officials, which showed 

that just over one-third of respondents thought that other relevant senior 

managers in their health departments were knowledgeable about the 

potential public health impacts of climate change.72

Some local health officials also reported that officials from other sectors of 

government in their jurisdictions, such as environmental agencies 

responsible for climate change adaptation planning efforts, have a limited 

awareness of climate change as a public health issue. This has resulted 

in health officials having limited involvement in climate change adaptation 

planning within their localities, according to officials we interviewed. Some 

officials believe that progress has been made in this area in recent years, 

but, according to our review of a 2014 analysis of states’ climate change 

adaptation planning activities, only about one-quarter of all states have 

incorporated public health considerations into their statewide climate 

change adaptation plans.73

In addition, health officials told us that stakeholders and the public have 

limited awareness about climate change as a public health issue, in part 

because climate change has historically been framed as an 

environmental issue. State and local health officials discussed climate 

change impacts on health as an emerging issue that they became aware 

of within the last decade, in part as a result of educational efforts of the 

American Public Health Association. In 2008, for example, the association 

71Some awardees of CDC’s Climate Ready States and Cities Initiative told us that they 

have begun to provide briefings or trainings on climate and health issues for departmental 

staff. 

72National Association of County and City Health Officials. Are We Ready? Report 2 

Preparing for the Public Health Challenges of Climate Change (Washington, D.C.: 2014). 

73According to our review of this analysis, 22 states have finalized climate change 

adaptation plans or have such planning underway. See Georgetown Climate Center, State 

and Local Adaptation Plans, http://www.georgetownclimate.org/adaptation/state-and-localplans (accessed May 15, 2015).

Page 37 GAO-16-122 Climate Change and Public Health

 
made climate change a focus of its National Public Health Week, issuing 

communications to highlight climate change as a public health issue.74

State and local health officials also told us that they face challenges in 

communicating or enhancing awareness about projected changes to local 

climate that can impact public health because of the complexity of the 

issue.75 Specifically, officials told us that it is difficult to develop messages 

about climate change impacts on health because of uncertainties inherent 

in climate change projections. For example, officials from one state health 

department told us that the state has faced challenges describing climate 

projections for its jurisdiction in a way that is accurate but not overly 

technical, while adequately acknowledging the uncertainties of these 

projections. State and local health officials also said that it is challenging 

for them to communicate about the risks that climate change poses to 

public health because some of the potential effects have not yet been 

observed in their jurisdictions and, therefore, are not perceived by the 

public as risks. For example, officials in some states that do not frequently 

experience heat waves told us that they face challenges convincing their 

constituents that the risks of heat-related illnesses will increase. Officials 

told us that they have used a variety of strategies to attempt to interest 

their constituents and stakeholders in these risks, such as framing the 

issue as planning for emergency preparedness or severe weather events. 

However, state and local health officials find it difficult to communicate 

and bring attention to long-term issues, such as climate change, when 

74See American Public Health Association, Climate Change Is a Public Health Issue

(Washington, D.C.: 2008), and American Public Health Association, Climate Change: Our 

Health in the Balance. National Public Health Week 2008 Partner Toolkit (Washington, 

D.C.: 2008).

75In our previous work on climate change adaptation, we also found that climate change 

adaptation is a complicated issue to communicate with the public because the impacts 

vary by location and may occur well into the future. See GAO-10-113.

Page 38 GAO-16-122 Climate Change and Public Health

 
there are more immediate public health concerns drawing attention, such 

as the 2014 Ebola virus outbreak.76

State and local health officials, as well as representatives from 

associations representing these officials, identified opportunities for 

federal action to help address challenges the officials face in 

communicating about the risks that climate change poses to public health. 

These opportunities were generally in two areas: enhancing public 

awareness on climate change as a public health issue, and providing 

guidance and tools on how to communicate about this issue.

Concerning enhancing public awareness, state and local health officials, 

as well as representatives from associations representing these officials, 

told us that federal agencies could help address this challenge by taking a 

sustained leadership role in enhancing public and stakeholder awareness 

and understanding. Specifically, officials told us that a federally-led public 

awareness campaign on this issue could assist in informing decision 

makers and the public. They also said a campaign could help and provide 

legitimacy to the work of public health officials in addressing and planning 

for these risks. Officials particularly pointed to the need for a sustained 

leadership role from HHS and its component agencies, which could draw 

on the department’s experience from engaging in previous successful 

public health campaigns, such as the campaign to reduce tobacco use. In 

a November 2014 report, the President’s State, Local, and Tribal Task 

Force on Climate Preparedness and Resilience also recommended 

actions that federal agencies should take to increase climate literacy and 

public awareness, among other things.77 These actions included 

coordinating federal communications on climate change to develop clear, 

consistent and unified messages, and ensuring that communications 

76While Ebola did not present a significant risk to the U.S. public, two imported cases, and 

two locally acquired cases in health care workers were reported in the United States. 

According to ASTHO and NACCHO, state and local health departments worked to 

enhance preparedness in their jurisdictions, including by collaborating with health care 

providers in their jurisdictions to ensure they had adequate information on screening, 

isolating, and diagnosing potential patients, reiterating the importance of infection control 

procedures for health care givers, working with laboratories to provide guidance on safe 

handling of specimens, and creating and providing timely and consistent messages for the 

public about the disease.

77President’s State, Local, and Tribal Leaders Task Force on Climate Preparedness and 

Resilience, Recommendations to the President (Washington, D.C.: Nov. 17, 2014). The 

task force was established by Executive Order 13653.

Opportunities Identified

Page 39 GAO-16-122 Climate Change and Public Health

 
resources are accessible to state and local governments. (See app. VII 

for a summary of the task force’s health-related recommendations.)

Federal officials, including those from HHS, told us that they are taking 

steps to enhance public awareness. For example, as previously 

mentioned, the White House held a climate change and health summit in 

June 2015, which included the participation of the U.S. Surgeon General, 

the HHS Assistant Secretary for Preparedness and Response, and the 

EPA Administrator. In addition, CDC officials told us that through awards 

the agency provides, the FrameWorks Institute is developing a series of 

fact sheets for the general public that explain various impacts of climate 

change on human health.78 In its 2014 Climate Adaptation Plan, HHS 

reported that it considers climate change to be one of the top public 

health challenges of our time, and it noted that its Office of the Assistant 

Secretary for Health will develop a climate change communication and 

outreach strategy to, among other things, promote outreach and 

awareness among its stakeholders about climate change and its impact 

on public health.79 The plan further notes that outreach and 

communication to at-risk populations will be a significant part of this 

strategy, and that the department will leverage its comprehensive network 

of stakeholders involved in the receipt or delivery of health and human 

services to disseminate climate change and health information. HHS 

reported in its Strategic Sustainability Performance Plan that the strategy 

was to be developed by the fall of 2014.80 In March 2015, a senior HHS 

official from the HHS component responsible for developing this strategy 

told us that limited progress had been made in developing the strategy, 

and that the strategy was not anticipated to be formalized in a written 

78The FrameWorks Institute is an independent nonprofit organization with a mission of 

advancing the nonprofit sector’s communications capacity by identifying, translating and 

modeling relevant scholarly research for framing the public discourse about social 

problems. As of August 11, 2015, these fact sheets had not yet been finalized. CDC is 

providing funding for this effort through a cooperative agreement with the American Public 

Health Association.

79See HHS, HHS Climate Adaptation Plan 2014 (Washington, D.C., July 3, 2014), p.7. A 

senior HHS official from HHS component responsible for developing this strategy also told 

us that the strategy is intended to have multiple goals, including communicating to the 

general public on the risks that climate change poses to public health, as well as multiple 

audiences such as health care providers, public health officials, and other decision 

makers.

80See HHS, Strategic Sustainability Performance Plan (Washington, D.C.; July 17, 2014), 

p.50. 

Page 40 GAO-16-122 Climate Change and Public Health

 
document. However, in July 2015, HHS officials told us that they plan to 

refine and document the strategy over the next 12 months.

Concerning guidance and tools, state and local health officials, as well as 

a representative from an association representing them told us it would 

be helpful if federal agencies, including CDC, developed communications 

guidance on a number of topics. For example, they said they could 

benefit from guidance on how to frame climate change as a public health 

issue or communicate based on best practices from the social sciences. 

They also suggested the development of communication tools, such as 

talking points or training on how to communicate about this issue. 

Because protecting public health requires the participation of a variety of 

stakeholders—including state and local public health departments and 

other state and local entities—enhancing stakeholder awareness and 

understanding about climate change as a public health issue could 

bolster state and local preparedness for the risks that climate change 

poses. In addition, as noted earlier in this report, enhancing awareness 

among the public and decision makers about the risks that climate 

change poses to health is a requirement of the Climate Ready States and 

Cities Initiative. According to state and local health officials, including 

Initiative awardees, communication guidance and tools would help them 

enhance stakeholder awareness and understanding of the risks climate 

change poses to public health.

CDC has developed limited guidance regarding communicating the risks 

that climate change poses to public health for state and local health 

officials. CDC has developed a toolkit related to communicating the 

connections between climate change, extreme heat, and health. 

However, the content of this document is focused on how awardees and 

partners of the National Environmental Public Health Tracking Network 

can use Tracking Network data to communicate about this issue, and is 

therefore not as applicable to a wider audience.81 CDC officials were not 

aware of any other agency guidance documents on communicating about 

81Centers for Disease Control and Prevention, Climate Change, Extreme Heat, and 

Health: A Tool Kit, http://ephtracking.cdc.gov/docs/CDC_ClimateChange_Final.pdf

(accessed May 1, 2015). 

Page 41 GAO-16-122 Climate Change and Public Health

 
the risks climate change poses to public health.82 Officials from CDC’s 

Climate and Health Program acknowledged that a commitment to 

communicating about the risks that climate change poses to public health 

is needed, and they identified some actions to help Climate Ready States 

and Cities Initiative awardees address this challenge, such as reviewing 

and sharing research findings on best practices for communicating about 

climate change and providing technical assistance to state and local 

health departments regarding communication upon their request. 

However, these officials also told us that they do not currently have plans 

to develop communication guidance for state and local health 

departments on how to communicate about climate change because they 

do not have the resources or capacity to develop such guidance at this 

time. CDC officials told us that they have been focusing on assisting 

awardees with resolving methodological and data issues related to 

implementing the BRACE framework, such as identifying models for use 

in developing projections of climate change in their jurisdictions.

As we noted earlier, the agency’s Climate and Health Program supports 

state and local health department efforts to plan for and address the 

health risks posed by climate change. CDC’s website states that the 

program’s core functions involve translating climate change science to 

inform health departments and communities, serving as a credible leader 

in planning for the public health impacts of climate change, and creating 

decision support resources to assist officials in preparing for climate 

change.83 As the administrator of the Climate Ready States and Cities 

Initiative, CDC is to provide ongoing guidance, resources, and technical 

assistance, among other things, related to awardee activities. Because 

CDC requires that awardees of this initiative take steps to enhance public 

awareness of the risks that climate change poses to human health, 

developing communications guidance would support their efforts. While 

CDC’s current resources are focused on addressing methodological and 

82CDC has issued a document that describes the risks posed by extreme heat events, and 

includes some information that could be used in developing communications to the public 

about heat. However, this document is not focused on how to communicate on a broader 

level about the risks climate change poses to public health. Centers for Disease Control 

and Prevention, Climate Change and Extreme Heat Events,

http://www.cdc.gov/climateandhealth/pubs/ClimateChangeandExtremeHeatEvents.pdf

(accessed July 16, 2015). 

83The program has also identified priority actions to meet these core functions, such as 

communicating the health-related aspects of climate change, including risks and ways to 

reduce those risks, to the public, decision makers, and healthcare providers. 

Page 42 GAO-16-122 Climate Change and Public Health

 
data issues related to the implementation of the BRACE framework, it is 

also critical for the agency to establish a plan describing when it will 

develop future communications guidance, to help ensure that health 

officials have the tools they need to effectively implement the BRACE 

framework and address required aspects of the award.

According to our discussions with selected state and local health officials, 

they face challenges identifying potential health risks from climate change 

and have identified related opportunities for federal action. Specifically, 

officials noted how gaps in research have made it difficult for them to 

understand and plan for potential health impacts. For example, some 

state and local public health officials said that limited research has been 

conducted on how climate change may affect certain aspects of public 

health, such as the spread of vector-borne diseases, the costs of climate 

change impacts on human health, and the effectiveness of specific 

management options. Other officials we interviewed told us that they had 

difficulty using some of the climate-related data that federal agencies 

have made available for decision makers. Officials we interviewed 

explained that they typically do not have the scientific or technical 

expertise to fully understand or use some federal data, particularly those 

related to climatology. Public health officials have generally not been 

trained in using geographic information systems, atmospheric data, and 

climate projections, according to officials.84 In addition, conducting 

analyses with these data can be complex and time-intensive. 

Consequently, they said that the availability of technical assistance in 

using such data, as well as in translating the results so that officials can 

apply them at the local level, has been very helpful.85

State and local public health officials we interviewed said that federal 

agencies could help address these challenges by continuing to advance 

the research they support, and by enhancing decision support resources, 

84According to HHS officials, geographic information systems can be used to overlay 

public health disease data with climatic datasets, such as temperature and precipitation 

information, to determine if associations exist. 

85We previously reported that future federal adaptation efforts could better focus on 

providing local climate change assistance, including with regard to translating climate data 

for decision makers. See GAO, Climate Change: Future Federal Adaptation Efforts Could 

Better Support Local Infrastructure Decision Makers, GAO-13-242 (Washington, D.C.: 

Apr. 12, 2013).

Selected Health Officials 

Face Challenges 

Identifying Potential Health 

Risks of Climate Change 

and Identified 

Opportunities for Federal 

Action

Page 43 GAO-16-122 Climate Change and Public Health

 
including resources to assist decision makers in using federal datasets. 

State officials noted that an expansion of interagency research 

opportunities on the public health impacts of climate change, which is a 

crosscutting research area, could be helpful. State and local public health 

officials we interviewed said that federal agencies could also enhance the 

decision support resources they provide, including through technical 

assistance that would better position public health departments to 

effectively use available datasets. For example, a Climate Ready States 

and Cities Initiative awardee said that it would be helpful if CDC could 

provide awardees with programming language to assist them in using 

federal datasets to assess health vulnerabilities associated with climate 

change.

Officials from federal agencies told us about actions that they have taken 

or that they have planned that could help address some of these 

challenges. Specifically, federal officials have acknowledged the need for 

additional research on the public health impacts of climate change and 

have taken some steps to fill those needs. In 2010, an ad hoc interagency 

working group on climate change and health developed a white paper 

summarizing research needs on the human health effects of climate 

change.86 The intent of this paper was to provide a baseline picture of 

research needs in this area that agencies could then build upon as new 

information became available, according to the paper. Subsequently, NIH 

officials analyzed the agency’s portfolio of research on climate change 

and health, and summarized their results in an article published in 2013.87

The article includes a discussion of challenges related to conducting this 

research and opportunities to advance the research, including 

opportunities to take a multidisciplinary approach through enhanced 

interagency research opportunities.88 More recently, in an April 2015 

Federal Register notice, EPA, on behalf of USGCRP, announced that a 

86Interagency Working Group on Climate Change and Health, A Human Health 

Perspective on Climate Change: A Report Outlining the Research Needs on the Human 

Health Effects of Climate Change.

87C. Jessup, et al., “Climate Change, Human Health, and Biomedical Research: Analysis 

of the National Institutes of Health Research Portfolio,” Environmental Health Perspectives 

121, no. 4 (2013). 

88Among other things, the authors noted that research in this area requires 

multidisciplinary teams that can include meteorologists, climatologists, mathematicians, 

statisticians, computational scientists, and a diversity of health scientists, and most 

researchers are not cross-trained to meet these needs. 

Page 44 GAO-16-122 Climate Change and Public Health

 
draft of the CCHHG assessment of climate change impacts on health was 

available for comment.89 According to the CCHHG co-chairs, the report 

contains results that should advance the research in some needed areas, 

and is likely to include some information on research needs. The CCHHG 

co-chairs told us that they hope to use information on research needs 

included in the final assessment to help inform the development of a 

prioritized and focused research agenda for use in addressing research 

needs. CCHHG officials also told that they would like to continue to help 

foster a collaborative interagency approach to researching climate 

change impacts on health.

Federal agencies, such as HHS, EPA, and NOAA, have also recently 

taken steps to enhance data and decision support resources available to 

state and local decision makers, for example, by enhancing air quality 

surveillance and creating a national heat health information system. 

These enhanced resources may address some needs of state and local 

decision makers. CCHHG officials said that they have plans to solicit 

feedback from state and local decision makers about these enhanced 

decision support resources through town hall meetings and other 

mechanisms.

According to selected state and local public health officials we 

interviewed, they face a range of other challenges related to planning for 

and addressing the health impacts of climate change that federal action 

may not be able to address. For example, they said that insufficient data 

and inadequate resources impede their ability to address or plan for these 

risks. While some federal programs collect local data and provide 

financial resources to selected states and localities, such as CDC’s 

National Environmental Public Health Tracking Program, the federal 

government does not collect local data on climate impacts or health 

outcomes in all locations, and does not make awards to support the 

climate and health activities of all state and local health departments.

89The goals of the assessment, which is expected to be finalized in 2016, are to 

summarize the state of the science for climate change impacts to health, and to 

quantitatively assess observed and projected impacts for selected impacts. Release of 

this report and other federal actions discussed here were taken after we met with and 

obtained most information from state and local public health officials for this report. 80 

Fed. Reg. 18619 (Apr. 7, 2015).

Selected State and Local 

Health Officials Face 

Other Challenges That 

Federal Action May Not Be 

Able to Address

Page 45 GAO-16-122 Climate Change and Public Health

 
State and local public health officials told us that some environmental 

surveillance data that could help inform research on the health risks of 

climate change—such as data on air quality, water quality, and pollen—

are often not collected by their states and localities given limited 

surveillance systems. Additionally, state and local officials explained that 

some health outcome data can be difficult to obtain. State officials 

explained that their access to health outcome data, such as the medical 

conditions cited for emergency room visits, is limited by agreements that 

states have with hospitals regarding the amount and type of information 

that hospitals will share with state officials.

Some state and local officials told us that their health departments did not 

have dedicated staff or funding to address and plan for climate change 

impacts or that their staff resources and funding were not sufficient for 

maintaining the ideal quality or quantity of work in this area. These 

statements are consistent with findings from NACCHO’s 2012 survey of 

local health department officials, in which less than 10 percent of 

respondents said that their health departments had sufficient resources to 

effectively protect local residents from the health impacts of climate 

change, and less than 20 percent of respondents said their health 

departments had sufficient expertise to assess the potential impacts from 

climate change.90

Federal agencies have taken steps to enhance understanding about the 

risks of climate change to public health. They have also supported state 

and local efforts to address and plan for these risks, in keeping with an 

executive order that calls on federal agencies to provide them with data, 

information, and decision support tools on climate preparedness and 

resilience. Nevertheless, state and local officials face challenges resulting 

from limited awareness of climate change as a public health issue among 

their own departments and the public. As we have previously found, 

public awareness can play an important role in the prioritization of work 

on climate change. HHS has acknowledged climate change as one of the 

top public health challenges of our time and is developing a climate 

change communication and outreach strategy, which has been delayed 

by over a year, but is expected to be finalized by July 2016.

90National Association of County and City Health Officials. Are We Ready? Report 2 

Preparing for the Public Health Challenges of Climate Change (Washington, D.C.: 2014).

Conclusions

Page 46 GAO-16-122 Climate Change and Public Health

 
CDC requires public health departments participating in its Climate Ready 

States and Cities Initiative to take steps to raise public awareness about 

the risks that climate change poses to public health, and also engage 

stakeholders in their planning. As the administrator of the Climate Ready 

States and Cities Initiative, CDC is to provide ongoing guidance, 

resources, and technical assistance to support state and local health 

department work on this issue. Although the agency has provided 

guidance on some topics, such as extreme heat events, it has not 

provided specific guidance on how public health departments should 

communicate about the risks that climate change poses to public health. 

Officials from CDC’s Climate and Health Program acknowledged that a 

commitment to communicating about the risks that climate change poses 

to public health is needed. However, the agency does not currently have 

plans to develop guidance on this topic, as it has been focused on other 

priorities. Issuing such guidance would also be in line with the core 

functions of CDC’s Climate and Health Program, which include translating 

climate change science to inform communities. By developing such 

guidance, CDC may help public health departments better meet the 

requirements of the Climate Ready States and Cities Initiative and better 

position all health departments to make progress in planning for the 

health impacts of climate change.

To enhance HHS’s ability to protect public health from the impacts of 

climate change, we recommend that the Secretary of HHS direct CDC to 

develop a plan describing when it will be able to issue climate change 

communication guidance to state and local health departments, to better

position relevant officials to effectively communicate about the risks that 

climate change poses to public health and address requirements of the 

Climate Ready States and Cities Initiative.

We provided a draft of this product to HHS, EPA, NOAA, USGCRP, the 

Council on Environmental Quality, the Department of the Interior, and the 

National Science Foundation for comment. In its written comments, 

reproduced in appendix IX, HHS stated that CDC generally concurred 

with our recommendation. CDC noted its plans to develop and issue 

climate change communication guidance to state and local health 

departments after HHS finalizes its climate change communication and 

outreach strategy, which is expected by July 2016. CDC stated that it 

would use HHS’s strategy to inform their development of guidance, and to 

build off of the same strategy. CDC said that the agency currently 

provides support and technical assistance to state and local health 

Recommendation for 

Executive Action

Agency Comments 

and Our Evaluation

Page 47 GAO-16-122 Climate Change and Public Health
departments regarding communication upon their request, and would 

continue to do so while HHS finalizes its strategy. CDC remarked that the 

agency is also working with partner and professional organizations to 

disseminate messages on the health impacts of climate change.

We also received technical comments from HHS, EPA, NOAA, USGCRP, 

the Council on Environmental Quality, the Department of the Interior, and 

the National Science Foundation, which we incorporated as appropriate

As agreed with your offices, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies to the appropriate 

congressional committees; the Secretaries of Agriculture, Commerce, 

Defense, Health and Human Services, Homeland Security, the Interior, 

and the Smithsonian Institution; the Administrators of the Environmental 

Protection Agency and the National Aeronautics and Space 

Administration; the Director of the National Science Foundation; the 

Executive Director of the United States Global Change Research 

Program; and the Managing Director of the Council on Environmental 

Quality; as well as other interested parties. In addition, the report will be 

available at no charge on the GAO website at http://www.gao.gov.

If you or your staff members have any questions about this report, please 

contact J. Alfredo Gómez at (202) 512-3841 or gomezj@gao.gov, or 

Marcia Crosse at (202) 512-7114 or crossem@gao.gov. Contact points 

for our Offices of Congressional Relations and Public Affairs may be 

found on the last page of this report. GAO staff who made key 

contributions to this report are listed in appendix X.

J. Alfredo Gómez

Director, Natural Resources and Environment

Marcia Crosse

Director, Health Care

Page 48 GAO-16-122 Climate Change and Public Health
List of Requesters

The Honorable Barbara Boxer

Ranking Member

Committee on Environment and Public Works

United States Senate

The Honorable Patty Murray

Ranking Member

Committee on Health, Education, Labor, and Pensions

United States Senate

The Honorable Bernard Sanders

Ranking Member

Subcommittee on Primary Health and Retirement Security

Committee on Health, Education, Labor, and Pensions

United States Senate

The Honorable Michael F. Bennet

United States Senate

The Honorable Benjamin L. Cardin

United States Senate

The Honorable Al Franken

United States Senate

The Honorable Kirsten E. Gillibrand

United States Senate

The Honorable Martin Heinrich

United States Senate

The Honorable Robert Menendez

United States Senate

The Honorable Jack Reed

United States Senate

The Honorable Brian Schatz

United States Senate

Page 49 GAO-16-122 Climate Change and Public Health
The Honorable Jeanne Shaheen

United States Senate

The Honorable Tom Udall

United States Senate

The Honorable Elizabeth Warren

United States Senate

The Honorable Sheldon Whitehouse

United States Senate

Page 50 GAO-16-122 Climate Change and Public Health
Appendix I: List of Agencies and Stakeholders 

Interviewed

We interviewed officials from federal, state, and local government 

agencies, as well as representatives of stakeholder groups involved in 

public health and climate change.

Federal Agencies and Entities

1. Department of Commerce, National Oceanic and Atmospheric 

Administration

2. Department of Defense, Defense Health Agency

3. Department of Health and Human Services

• Office of the Assistant Secretary for Preparedness and Response

• Centers for Disease Control and Prevention

• Indian Health Service

• National Institutes of Health

• Office of the Assistant Secretary for Health

4. Department of Homeland Security

• Federal Emergency Management Agency

• Office of Health Affairs

5. Department of the Interior

• Bureau of Indian Affairs

• Office of Insular Affairs

• U.S. Geological Survey

6. Environmental Protection Agency

7. National Aeronautic and Space Administration

8. National Science Foundation

9. Smithsonian Institution

10. United States Department of Agriculture

• Agricultural Marketing Service

• Animal and Plant Health Inspection Service

• Agricultural Research Service

• National Institute of Food and Agriculture

• Economic Research Service

• Forest Service

• Natural Resources Conservation Service

• Office of the Chief Economist

11. United States Global Change Research Program

Appendix I: List of Agencies and 

Stakeholders Interviewed

Government Agencies

Page 51 GAO-16-122 Climate Change and Public Health
Appendix I: List of Agencies and Stakeholders 

Interviewed

12. Council on Environmental Quality

1. Alaska

2. Arizona

3. California

4. Florida

5. Hawaii

6. Illinois

7. Louisiana

8. Maine

9. Maryland

10. Massachusetts

11. Michigan

12. Minnesota

13. New Hampshire

14. New York

15. North Carolina

16. Oregon

17. Rhode Island

18. Utah

19. Vermont

20. Washington

21. Wisconsin

1. Baltimore (MD)

2. Benton County (OR)

3. Columbus (OH)

4. Dallas County (TX)

5. Houston (TX)

6. Multnomah County (OR)

7. New York City (NY)

State Public Health 

Departments

Local Public Health 

Departments

Page 52 GAO-16-122 Climate Change and Public Health
Appendix I: List of Agencies and Stakeholders 

Interviewed

8. Portsmouth (VA)

9. Salt Lake County (UT)

10. San Diego County (CA)

11. San Francisco (CA)

12. San Luis Obispo County (CA)

13. Shelby County (TN)

14. Summit County (OH)

15. Toledo-Lucas County (OH)

16. Washington County (MD)

17. Wicomico County (MD)

1. American Lung Association

2. American Public Health Association

3. Association of State and Territorial Health Officials

4. Council of State and Territorial Epidemiologists

5. George Mason University Center for Climate Change Communication

6. Georgetown Climate Center

7. Health Care Without Harm

8. National Association of County and City Health Officials

9. National Resources Defense Council

10. Public Health Institute

11. Trust for America’s Health

12. Yale Climate and Energy Institute

13. Selected Lead Authors of the Third National Climate Assessment’s 

Chapter on Human Health1

1

Each of the individual chapters of the third National Climate Assessment were developed 

by a team of convening lead authors and lead authors.

Stakeholder Groups

Page 53 GAO-16-122 Climate Change and Public Health

 
Appendix II: Summary of Actions Announced 

by the Administration in April 2015 to Address 

the Health Impacts of Climate Change

In April 2015, the administration announced a series of actions and 

commitments that were intended to enhance the nation’s ability to 

understand, communicate, and reduce the health impacts of climate 

change.1 Specifically, the administration announced the following 12 

actions that it plans to take to address this issue:

1. hosting a climate change and health summit at the White House;

2. issuing a report highlighting actions taken by state and local leaders to 

reduce the impact of climate change on public health;2

3. releasing a health care facilities toolkit consisting of fact sheets, 

checklists, case studies, and other resources to assist local decision 

makers in promoting resilient health care infrastructure;3

4. circulating a draft climate and health assessment report that is 

intended to synthesize the best available information on the public 

health impacts of climate change;4

5. holding a community, culture, and mental health workshop to identify 

factors that enhance resilience to climate change;

6. integrating climate considerations into the Department of the Interior’s 

health and safety policies;

7. hosting a climate and health data challenge, whereby coders, 

analysts, and researchers will use available government datasets to 

generate insights into unresolved questions about the health impacts 

of climate change;

8. offer climate and health data to participants during the national day of 

civic hacking (June 6, 2015) to encourage participants to develop new 

climate and health solutions;

1

The White House, “Administration Announces Actions To Protect Communities From The 

Impacts Of Climate Change” (Washington, D.C.: Apr. 7, 2015). 

2

American Public Health Association, Adaptation in Action: Grantee Success Stories from 

CDC’s Climate and Health Program (Washington, D.C.: March 2015).

3

The Sustainable and Climate Resilient Health Care Facilities Toolkit is available online at 

http://toolkit.climate.gov/tool/sustainable-and-climate-resilient-health-care-facilities-toolkit. 

4

The draft assessment report was published for public comment in April 2015. 80 Fed. 

Reg. 18619 (Apr. 7, 2015).

Appendix II: Summary of Actions Announced 

by the Administration in April 2015 to Address 

the Health Impacts of Climate Change

Page 54 GAO-16-122 Climate Change and Public Health

 
Appendix II: Summary of Actions Announced 

by the Administration in April 2015 to Address 

the Health Impacts of Climate Change

9. improving air quality data with the Environmental Protection Agency’s 

release of six new village green stations that measure air quality and 

meteorological data;

10. challenging researchers to develop new models to forecast epidemics 

of dengue and other infectious diseases through the consolidation of 

federal and nonfederal data sets;

11. awarding prizes to those who have developed predictive modeling 

capabilities that can assist government and health organizations to 

predict the spread of chikungunya, a vector-borne disease; and

12. measuring nutrient pollution through a competition whereby federal 

datasets are leveraged to develop educational and decision support 

resources.

Additionally, the administration announced that it has secured 

commitments with 14 businesses and other organizations to collect and 

share data regarding the health impacts of climate change. For example, 

Microsoft has committed to improve vector-borne disease surveillance 

capabilities by developing and deploying drones that are capable of 

collecting large amounts of mosquitos and automatically analyzing them 

for various pathogens. Finally, the administration announced that a 

coalition of deans from 30 medical, nursing, and public health schools 

had committed to train their students to address the health impacts of 

climate change.

Page 55 GAO-16-122 Climate Change and Public Health
Appendix III: Summary of Actions Announced 

by the Administration in June 2015 to Address 

the Health Impacts of Climate Change

In June 2015, the administration announced a set of actions and 

commitments that were intended to protect our communities from the 

health impacts of climate change.1 Specifically, the administration 

announced the following actions to address this issue:

1. creation of a map tool by the Department of Health and Human 

Services to improve the ability of health officials and emergency 

managers to rapidly identify residential areas where people who 

depend on electricity to power life-critical durable medical equipment 

live;

2. development of a national integrated heat health information system 

by the Centers for Disease Control and Prevention and the National 

Oceanic and Atmospheric Administration, which is intended to provide 

a suite of decision support resources that better serve public health 

needs;

3. launch of a climate and health innovation challenge series by the 

National Institutes of Health and others to promote innovative 

approaches and highlight technologies available for understanding the 

health implications of climate change and improving resilience to 

adverse effects;

4. creation of a climate change impacts subcommittee within the Federal 

Interagency Working Group on Environmental Justice, and the 

workgroup’s launch of a climate justice initiative that is focused on 

incorporating equity into climate adaptation planning;

5. announcement of a local climate and energy webcast series on 

climate change, heat islands, and public health, to be hosted by the 

Environmental Protection Agency;

6. plans to highlight examples of policy actions related to children’s 

health during national Children’s Health Month;

7. a commitment by CDP, a private organization, to release publicly 

disclosed data from 61 U.S. cities that summarize the climate risks 

that the cities are facing and the actions they are taking to improve 

resilience; and

1

The White House, “Fact Sheet: Obama Administration Announces Actions to Protect 

Communities from the Health Impacts of Climate Change at White House Summit”

(Washington, D.C.: June 23, 2015). 

Appendix III: Summary of Actions Announced 

by the Administration in June 2015 to Address 

the Health Impacts of Climate Change

Page 56 GAO-16-122 Climate Change and Public Health

 
Appendix III: Summary of Actions Announced 

by the Administration in June 2015 to Address 

the Health Impacts of Climate Change

8. an expansion in the number of medical, public health, and nursing 

schools that have committed to educate and train their students about 

the risks of climate change to public health.

Page 57 GAO-16-122 Climate Change and Public Health
Appendix IV: Examples of Climate Change and 

Health Research Conducted or Supported by 

Federal Agencies

Federal agencies conduct or support research on a range of topics that 

can enhance understanding of the risks that climate change poses to 

public health. In conducting our work, we interviewed officials from some 

federal agencies involved in the United States Global Change Research 

Program’s Interagency Crosscutting Group on Climate Change and 

Human Health. Specifically, we spoke with officials from those agencies 

whose focus was on understanding climate change risks to populations 

within the United States. Table 4 provides examples of research some of

the federal agencies involved in this group have conducted or supported 

on or related to the risks that climate change poses to public health.

Table 4: Examples of Federal Agencies Supporting or Conducting Research on or Related to the Risks That Climate Change 

Poses to Public Health

Federal agency Examples of agency actions to support or conduct research

Environmental Protection 

Agency (EPA)

• Through its Science to Achieve Results program, EPA has made research awards to assess 

climate change impacts to health, including those related to air and water quality as well as 

impacts to tribal populations. For example, one project reviewed the relationship between 

extreme weather events and combined sewer overflows, which can enhance understanding of 

how climate change may affect risks from water-borne diseases associated with such overflows. 

Another project assessed a tribe’s vulnerability to waterborne disease risks. 

• EPA has conducted research on how weather events associated with climate change—

including heat, flooding and droughts—alter the risk of health impacts associated with air and 

water pollution, heat exposure, allergens, and water-borne and infectious diseases. For 

example, the agency’s National Health and Environmental Effects Research Laboratory has 

conducted research on how the combination of air pollutants and elevated temperatures affect 

human health, including in populations that may be especially sensitive to such effects.

• EPA has published information on observed trends in health-relevant indicators of climate 

change, including changes in high and low temperatures, heat-related mortality, Lyme disease, 

length of the ragweed pollen season, and extreme weather events.

Department of Health and 

Human Services (HHS)

• NIH has made research awards on or related to climate change and public health. For example, 

beginning in FY 2013, NIH made an award for a research project on climate change and heatrelated morbidity among vulnerable populations in Atlanta.

National Aeronautics and 

Space Administration (NASA)

• NASA assisted the New York City Panel on Climate Change in researching the impacts of 

climate change on New York City and the surrounding metropolitan region, including impacts to 

public health.

National Oceanic and 

Atmospheric Administration 

(NOAA)

• Some of NOAA’s regional research teams (referred to as Regional Integrated Science and 

Assessment teams) have partnered with local decision makers to provide actionable information 

related to the health impacts of climate change. For example, the team for the Great Lakes 

region has worked with local decision makers to develop a tool intended to help decision makers 

examine options for reducing morbidity and mortality related to extreme heat events in Michigan 

under changing climate conditions.

• NOAA’s Ecological Forecasting Roadmap team partners with federal and state decision makers 

to integrate climate information into predictions for harmful algal blooms and pathogens such as 

vibrio parahaemolyticus.

Appendix IV: Examples of Climate Change 

and Health Research Conducted or 

Supported by Federal Agencies

Page 58 GAO-16-122 Climate Change and Public Health
Appendix IV: Examples of Climate Change and 

Health Research Conducted or Supported by 

Federal Agencies

Federal agency Examples of agency actions to support or conduct research

National Science Foundation 

(NSF)a

• Since 2000, NSF has led a collaborative effort with other federal agencies to solicit proposals for 

research on the ecology and evolution of infectious disease. Among other things, the influence of 

environmental factors such as climate is listed as a factor that researchers may wish to consider 

as they design their work. Through this program, NSF made a research award focused on 

examining why the occurrence of Lyme disease varies significantly across regions of the eastern 

United States where blacklegged ticks, which transmit the disease to humans, are found. The 

researchers intended, in part, to help advance predictions of how climate change could impact 

the risk associated with Lyme disease.

Smithsonian Institution • Researchers with the Smithsonian Institution have conducted research on the relationship 

between environmental factors, including rainfall and vegetation cover, and infestations of fleas, 

which are known vectors for a variety of pathogens, including plague.

U.S. Department of Agriculture • The Department’s Agricultural Research Service has conducted research on the relationship 

between climate change and a variety of factors that can impact human health, including crop 

growth, levels of allergenic plant pollens, food availability, and water quantity. 

Source: GAO. | GAO-16-122

a

NSF does not typically make awards for research on the cause, diagnosis, or treatment of physical 

or mental disease in human beings, as research in these areas is supported by the National Institutes 

of Health.

Page 59 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Federal agencies have conducted a range of activities related to 

understanding, communicating, and managing for the public health 

impacts of climate change. In conducting our work, we interviewed 

officials from 26 federal agencies, including some of those involved in the 

United States Global Change Research Program’s Interagency 

Crosscutting Group on Climate Change and Human Health. Specifically, 

we interviewed officials from agencies whose focus was on understanding 

or managing for climate change risks to populations within the United 

States. We also interviewed officials from the United States Global 

Change Research Program and the Council on Environmental Quality. 

Table 5 provides information about activities conducted by these selected 

agencies.

Table 5: Examples of Activities Conducted by Selected Federal Agencies on or Related to Public Health Impacts of Climate 

Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

Department of Commerce

National Oceanic and 

Atmospheric Administration 

(NOAA)

Collects and provides data, collaborates in 

research, and develops decision support 

resources to aid decision makers in examining 

and addressing the potential health impacts of 

climate-related events.

• Develops climate change projections, including 

those used in the third National Climate 

Assessment.

• Maintains the Climate.gov portal, which includes 

scientific information and materials about climate 

change, including impacts to public health.

• Works with public health officials through its 

National Weather Service to revise thresholds for 

issuing heat alerts, and through its Climate 

Program Office to understand and provide climate 

information as part of an integrated heat health 

information system.

• Through its National Weather Service, works with 

federal, state, and local authorities to support 

hospital and community preparedness efforts. 

• Developed the Coastal Flood Exposure Mapper, a 

tool that allows users to access maps showing 

populations, places, and natural resources 

exposed to coastal flood hazards.

Department of Defense

Defense Health Agency Routinely assesses and addresses health risks 

to personnel through disease surveillance 

activities, including health risks related to 

extreme heat and cold.

• Plans to review and, as needed, modify health 

surveillance programs to better integrate climate 

change considerations into the department’s 

efforts to address health and safety risks to its 

personnel.

Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Page 60 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

Department of Health and Human Services

Office of the Assistant 

Secretary for Health 

Coordinates intra- and interagency activities 

related to climate change and health.

• Plans to develop a climate change communication 

and outreach strategy.

• Held a departmentwide briefing on climate change 

and health in August 2014. 

Assistant Secretary for 

Preparedness and 

Response

Leads the department’s efforts to prevent, 

prepare for, and respond to public health 

emergencies, some of which may stem from 

climate change.

• Leads science preparedness efforts aimed at 

establishing and sustaining a research framework 

that communities can leverage to better identify, 

collect, and analyze data and information that may 

be available only before, during, or immediately 

following a public health emergency.

• Provides awards for examining the long-term 

recovery of health systems and communities 

impacted by Hurricane Sandy.

• Provides federal support, including medical 

professionals, through its National Disaster 

Medical System, to augment state and local 

capabilities during an emergency or disaster.

• Through its emPOWER map, provides data 

regarding vulnerable populations that rely upon 

electricity-dependent medical equipment, to 

support state, local and community partner 

emergency planning and response activities.

Page 61 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

Centers for Disease Control 

and Prevention 

Works with state and local health departments 

through a variety of programs to enhance 

capacity to protect public health, including from 

the impacts of climate change.

• Through its Climate and Health Program, 

manages the Climate Ready States and Cities 

Initiative, which provides awards and technical 

resources to 18 state and local health 

departments to incorporate climate change 

considerations into public health planning, 

including by implementing a five-step risk 

management framework.

• Supports a network of 26 health departments to 

collect and make available health, exposure, and 

hazard data, including on climate change 

indicators, measures, and data related to extreme 

heat, through the National Environmental Public 

Health Tracking Program.

• Works with state and local health departments to 

prepare for and respond to public health 

emergencies, including by providing awards for 

emergency preparedness planning to all 50 

states, eight territories, and four large cities.

• Through its National Institute for Occupational 

Safety and Health, established a climate change 

initiative to, among other things, make 

recommendations for worker safety and health 

improvements related to climate change. The 

Institute also seeks to identify workers and 

facilities at an increased risk to severe weather 

events.

Indian Health Service Provides primary health care and disease 

prevention services to American Indian and 

Alaska Native people.

• Provided an award to the Alaskan Native Tribal 

Health Consortium to assess the impacts of 

climate change on sanitation facilities, including 

determining data gaps for health- and safetyrelated parameters. 

National Institutes of Health Funds research on the health impacts of climate 

change. 

• Issued a trans-institute research solicitation in 

2010 on the public health impacts of climate 

change that resulted in awards for 21 new 

research projects.

• Led an ad hoc interagency working group in 

developing a white paper on research needs for 

health impacts that may be exacerbated by 

climate change.

• Through its Worker Training Program, hosted a 

workshop on the health risks that hazardous 

waste workers face as a consequence of climate 

change.

Page 62 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

Department of Homeland Security

Office of Health Affairs Works with communities nationwide to prepare 

for and respond to emergencies, including by 

assisting officials in understanding health risks 

during emergencies.

• Developed a Community Health Resilience 

Initiative Guide and Toolset, which provides local 

decision makers with information needed to 

strengthen community resilience from a variety of 

impacts, including health impacts related to 

climate change.

• Reviews climate change impacts to its field-based 

departmental workforce, such as those working for 

U.S. Customs and Border Protection.

• Oversees the National Biosurveillance Integration 

Center, an interagency center that tracks patterns 

of disease, disease vectors, food- and waterborne pathogens, among other factors that could 

influence public health. 

Federal Emergency 

Management Agency

Works to enhance the nation’s capability to 

prepare for, protect against, respond to, recover 

from, and mitigate all hazards, including by 

providing data and tools.

• Provides data and tools such as the National 

Flood Hazard Layer, which allows users to identify 

base flood elevation and other data that can be 

used by local decision makers to identify 

vulnerable populations.

• Provides awards to state, local, tribal, and 

territorial governments to enhance their ability to 

prevent, respond to, mitigate, and recover from all 

hazards, including those related to climate 

change.

Page 63 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

Department of the Interior

U.S. Geological Survey Provides scientific information to describe and 

understand the Earth and to minimize loss of life 

and property from natural disasters, among 

other functions. 

• Through its Climate Science Centers, studies the 

impact of climate change on fish, wildlife, and their 

habitats to help decision makers address the 

impacts of climate change, some of which can 

impact human health and well-being.

• Developed the Coastal Vulnerability Index, which 

provides a preliminary overview, at a national 

scale, of the relative vulnerability of the nation’s 

coast to sea-level rise, a climate change impact 

that may affect public health, including mental 

health in impacted communities.

• Provides the Disease Maps Web page, which 

includes seasonal tracking of seven vector-borne 

diseases in the United States and territories, 

including West Nile virus and dengue, which may 

be impacted by climate change.

Bureau of Indian Affairs Provides awards for some tribes to conduct 

climate change adaptation planning, training, 

and capacity building, which could help these 

tribes address related risks to public health.

• Provided an award to a regional tribal community 

partnership in southeast Alaska to monitor 

beaches and shellfish for toxins from harmful algal 

blooms. 

Office of Insular Affairs Coordinates federal policy in the territories of 

American Samoa, Guam, the U.S. Virgin 

Islands and the Commonwealth of the Northern 

Mariana Islands.

• Hosted its first stakeholder meeting on climate 

change in June 2015 for federal officials and 

leaders from the territories that the office engages 

with to discuss climate change adaptation efforts 

in those territories. 

Environmental Protection Agency

Collects and disseminates environmental data, 

studies the impact of environmental exposures 

on human health, and provides decision support 

resources to state and local decision makers 

that can assist them in preparing for the impacts 

of climate change, among other functions.

• Developed a community edition of its Benefits 

Mapping and Analysis Program, an open-source 

computer program that helps users estimate the 

health impacts and economic value of changes in 

air quality.

• Provides awards for Pediatric Environmental 

Health Specialty Units to educate health 

professionals and others about environmental 

health risks, including some that may be 

exacerbated by climate change.

• Provides awards to states and tribes for drinking 

water and wastewater system projects that can 

help address some risks from climate change, 

such as from altered precipitation and runoff 

patterns.

• Worked with the Institute for Tribal Environmental 

Professionals at Northern Arizona University to 

develop a national training program and online 

resources to assist tribal leaders in developing 

adaptation plans to prepare for the impacts of 

climate change, including human health impacts.

Page 64 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

National Aeronautics and Space Administration (NASA)

Through its Applied Sciences Program, partners 

with public and private organizations on ways to 

apply agency data in their decision-making 

activities.

• Collects and analyzes remote sensing data, 

including data on air quality, extreme weather, 

biodiversity, and changes in land cover, which 

may be used by decision makers to assess 

climate change impacts on health.

• Working with NOAA’s National Weather Service, 

provided awards for projects in three U.S. cities to 

develop more effective heat advisory thresholds 

by using NASA land surface data to identify 

extreme hotspots and data about morbidity and 

mortality to identify neighborhoods at the highest 

risk for health effects from heat waves.

National Science Foundation

Funds a wide array of scientific research that 

could be useful in understanding climate 

change and, less directly, its impacts on human 

health. 

• Provided awards for research on climate change 

and oceans, such as impacts on rising ocean 

temperatures and increased ocean acidity 

resulting from absorption of atmospheric 

emissions, which alter the characteristics of the 

most fundamental organisms of the ocean food 

chain.

• Provided awards for research on how people 

make decisions, including those related to climate 

change, during times of uncertainty.

• Provided awards for research on the ecology and 

evolution of infectious disease, including research 

related to the spread of Lyme disease in ticks.

Smithsonian Institution

Provides knowledge about nature and culture 

through research, collections, exhibitions, and 

education efforts, among other functions. 

• Hosted a 1-day symposium in October 2014 on 

climate and health, among other topics, which 

included a panel on health in a changing climate.

• Planned and organized a June 2014 webinar on 

food security in the Arctic, which included a 

discussion of challenges to food security posed by 

climate change. 

U.S. Department of Agriculture

Office of the Chief 

Economist

Coordinates the department’s responses to 

climate change.

• Initiated an evaluation of possible changes to the 

food system, and thus to food security outcomes, 

as a result of changes in weather and climate, 

both historically and over the next 25 to 100 years.

Agricultural Research 

Service

Conducts research on agricultural problems of 

high national priority, and provides information 

to ensure high-quality, safe food and assess the 

nutritional needs of Americans, among other 

functions.

• Helped support research on improving models for 

evaluating the effects of climate change and 

adaptation on crop production, a topic that could 

be useful for understanding how climate change 

may affect food availability and prices, which may 

impact human health.

Page 65 GAO-16-122 Climate Change and Public Health
Appendix V: Examples of Federal Agency 

Activities on or Related to the Public Health 

Impacts of Climate Change

Department and

component

agency or office

Summary of work related

to climate change and health Examples of activities 

Animal and Plant Health 

Inspection Service

Administers the Animal Welfare Act and carries 

out wildlife damage management activities, 

among other functions.

• During emergencies, including any that may be 

caused or exacerbated by climate change, 

supports the evacuation of people with their pets, 

which officials told us was essential because 

some people will not evacuate without their pets.

Economic Research 

Service

Conducts economic research and provides 

information related to issues including 

agriculture, food, and the environment.

• Issues a Cost Estimates of Food-borne Illnesses 

data product, which includes data about the costs 

of major food-borne illnesses in the United States, 

including for illnesses that may increase as a 

result of climate change.

Forest Service Aims to achieve quality land management by, 

among other things, protecting and managing 

national forests and helping states and 

communities to use their forests wisely.

• Provides an online climate change resource 

center for land managers and decision makers 

interested in learning more about climate change 

and what they can do. The site focuses on forests 

and other ecosystems, but includes some 

information related to human health.

National Institute of Food 

and Agriculture

Provides leadership and funding for programs 

that advance agriculture-related sciences.

• Provided awards for basic and applied research 

related to climate change, such as research on 

how climate change may affect the water quality 

functions of on-site wastewater treatment 

systems, and identifies climate change as a 

priority research area for research it manages.

Natural Resources 

Conservation Service

Provides farmers and ranchers with financial 

and technical assistance to voluntarily enact 

conservation measures.

• Through its National Water and Climate Center, 

monitors and provides information on droughts 

and water supplies critical for both agricultural and 

urban uses.

U.S. Global Change Research Program

Aims to build a knowledge base that informs 

human responses to climate and global change 

through coordinated and integrated federal 

programs of research, education, 

communication, and decision support 

resources. 

• Included a health chapter in its third National 

Climate Assessment, published in May 2014, and, 

through its Interagency Crosscutting Group on 

Climate Change and Human Health, initiated a 

scientific assessment of the human health impacts 

of climate change, a draft of which was released 

for public comment in April 2015. 

Council on Environmental Quality

Coordinates federal environmental efforts and 

works closely with agencies and other White 

House offices in the development of 

environmental policies and initiatives.

• Co-chaired the State, Local, and Tribal Leaders 

Task Force on Climate Preparedness and 

Resilience, which published a final report in 

November 2014 that included recommendations 

for federal action on climate change and public 

health.

• Reviewed federal agencies’ climate change 

adaptation plans, which include information on 

how climate change could impact the health and 

well-being of their employees.

Source: GAO. | GAO-16-122

Page 66 GAO-16-122 Climate Change and Public Health
Appendix VI: Examples of Activities 

Conducted by Awardees of CDC’s Climate 

Ready States and Cities Initiative

State and local health officials from the 16 state and two local health 

departments receiving awards through the Center for Disease Control 

and Prevention’s (CDC) Climate Ready States and Cities Initiative told us 

that they have conducted a variety of activities to address and plan for the 

risks that climate change poses to public health. These activities support 

awardees’ efforts to implement CDC’s Building Resilience Against 

Climate Effects (BRACE) framework—a five-step risk management 

approach intended to help public health departments identify and prepare 

for the public health impacts of climate change by, among other things, 

incorporating atmospheric data and climate projections into public health 

planning. Examples of these activities include the following:

• Developing community vulnerability and resilience indicators.

Awardees have developed indicators to measure community 

vulnerability and resilience. Florida, for example, developed indicators 

to identify relationships between measures of social and medical 

vulnerabilities, such as age and access to health care facilities, with 

risks to climate-related hazards in the state including hurricane winds 

and wildland fire.1 Officials from the city of San Francisco also created 

a series of community resilience indicators to provide quantitative 

measurements of vulnerability to climate change stressors in the city, 

by neighborhood.2 Indicators were developed in a variety of 

categories, including in areas related to the environment, health, 

housing, and the economy, and then mapped by census tract. See 

figure 4 for an example of a map developed to display areas of 

vulnerability to extreme heat based on the percentage of buildings 

with air-conditioning.

1

See C. Emrich, D. Morath, G. Bowser, R. Reeves, Climate-Sensitive Hazards in Florida: 

Identifying and Prioritizing Threats to Build Resilience against Climate Effects.

http://www.floridahealth.gov/environmental-health/climate-and-health/_documents/climatesensitive-hazards-in-florida-final-report.pdf (accessed September 10, 2014). 

2

See San Francisco Department of Public Health. San Francisco Climate & Health Profile. 

http://www.sfclimatehealth.org/wpcontent/uploads/2015/01/SFDPH_ClimateHealthProfile_FinalDraft.pdf (accessed April 15, 

2015). According to officials from San Francisco, information sources used to develop the 

indicators included data from the U.S. Census Bureau and the American Community 

Survey, and many of the indicators are based on those established by the University of 

South Carolina’s Social Vulnerability Index, which measures the social vulnerability of U.S. 

counties to environmental hazards. Data used in the development of the indicators were 

also made available for researchers, decision makers, and the public, in an effort to 

promote transparency and encourage the development of tools to address climate 

change. 

Appendix VI: Examples of Activities 

Conducted by Awardees of CDC’s Climate 

Ready States and Cities Initiative

Page 67 GAO-16-122 Climate Change and Public Health

 
Appendix VI: Examples of Activities 

Conducted by Awardees of CDC’s Climate 

Ready States and Cities Initiative

Figure 4: Example of a Community Resilience Map Illustrating Vulnerabilities to Extreme Heat in San Francisco

Note: According to the San Francisco Department of Public Health, in housing stock without other 

forms of ventilation, air conditioning can prevent the health effects of extreme heat. Residents in 

buildings with centralized air conditioning units are at far lesser risk of heat stress. In multiunit 

buildings without centralized air, personal units often place the financial burden of cooling on lowincome residents and incentivize disuse.

• Enhancing surveillance. Some awardees described taking efforts to 

enhance the amount and type of surveillance data they collect. For 

example, Vermont developed Web-based tools for the public to report 

Page 68 GAO-16-122 Climate Change and Public Health
Appendix VI: Examples of Activities 

Conducted by Awardees of CDC’s Climate 

Ready States and Cities Initiative

surveillance information related to the spread of ticks and algal 

blooms. Specifically, through its interactive tick tracker, the public can 

share information about where and what kinds of ticks have been 

observed, in order to better prevent the occurrence of tick bites in 

others.

• Incorporating climate change into emergency preparedness 

planning. Awardees told us that they have incorporated climate 

change considerations into emergency preparedness planning, such 

as by developing plans for hazards related to climate change, which 

can include heat waves or other extreme weather events. For 

example, Arizona created outreach materials on extreme heat and 

flooding emergencies to support local health departments. In addition, 

the state provided technical assistance to a county to create an 

extreme weather response plan, which included responding to 

extreme heat events. Illinois also incorporated climate change 

considerations into emergency preparedness planning by requiring 

that local health departments demonstrate that they are planning for 

an increase in the frequency and severity of extreme weather events 

in order to obtain public health emergency preparedness funding from 

the state.

• Developing communication materials. Awardees have developed 

communication materials to share information on the risks that climate 

change poses to public health in their jurisdictions, such as through 

websites for their Climate and Health programs. Officials from one 

county receiving funds through California’s Climate and Health 

Program told us that its jurisdiction developed a climate change 

communications campaign for the purpose of educating health 

department staff and the community. As part of this effort, county 

health officials developed public service announcements to air on 

county-based radio stations—in English and in Spanish—that explain

climate change and health-related topics, such as food, 

transportation, and energy.

• Engaging communities. Awardees described efforts to engage 

communities, particularly those vulnerable to the risks that climate 

change poses to public health. For example, officials from New York 

City described conducting focus groups with seniors and their 

caregivers to obtain their perspectives on awareness of heat 

warnings, prevention behaviors, and air-conditioning prevalence and 

use during heat waves. Officials from San Francisco also reported 

holding town hall style meetings with community groups from selected 

neighborhoods to discuss issues related to climate and health, 

Page 69 GAO-16-122 Climate Change and Public Health
Appendix VI: Examples of Activities 

Conducted by Awardees of CDC’s Climate 

Ready States and Cities Initiative

including heat, sea level rise, and vulnerable populations in these 

specific areas.

• Partnering with academic institutions. Awardees reported forming 

partnerships with academic institutions to, among other things, 

develop vulnerability assessments and translate climate science 

information. In some cases, these partnerships were the result of the 

health department providing a small amount of funding to the 

university to conduct these assessments, according to officials. For 

example, officials from Maryland told us that they are collaborating 

with researchers at the University of Maryland to develop vulnerability 

assessments and develop county-level projections of the burden of 

disease from climate change on particular health impacts, such as 

asthma and waterborne illness. Maryland officials noted the 

importance of partnering with the University to conduct this work, 

given the limited resources of the health department and difficulties 

associated with hiring staff to conduct this assessment.

• Collaborating with other state or local entities. Awardees have 

developed relationships with other state or local departments in 

conducting activities related to addressing and preparing for the risks 

that climate change poses to public health. Awardees mentioned that 

these partnerships help others gain a better perspective of the health 

impacts of climate change, which will help them to consider health 

impacts as they make decisions in their respective fields. Awardees 

also noted that they have shared information with partners or worked 

collaboratively on projects. For example, officials from the Michigan 

Department of Community Health reported partnering with the state’s 

Department of Environmental Quality to receive data on topics related 

to air or water quality. Some awardees also noted the importance of 

developing partnerships with their state climatologist to provide their 

health departments with technical assistance in interpreting climate 

data.

Page 70 GAO-16-122 Climate Change and Public Health
Appendix VII: Activities of Other Selected State 

and Local Health Departments Related to 

Preparing for the Public Health Impacts of 

Climate Change

Officials from some of 13 state and local health departments that we 

interviewed that have not received an award through the Centers for 

Disease Control and Prevention’s (CDC) Climate Ready States and Cities 

Initiative have conducted some activities related to addressing and 

planning for the risks that climate change poses to public health, to the 

extent that they have resources available.1 Some of these state and local 

health department officials began working on this issue as a result of 

receiving leadership direction to do so, whereas others did so in the 

absence of leadership direction, because they believe it is an important 

issue or because they have identified the need to acknowledge the issue 

based on knowledge of climate change risks in their jurisdictions.

While some departments have conducted work in this area, others did not 

have the resources to begin or sustain a robust level of activity. State and 

local health officials told us that they have few staff to work on such 

activities, and that those staff also have other assignments and 

responsibilities. Efforts related to preparing for climate change risks to 

human health are often conducted in an ad hoc manner compared to 

those receiving awards through CDC’s Climate Ready States and Cities 

Initiative. Some officials also told us that they have partnered with or 

received support from academic institutions and nonprofit organizations, 

which has been beneficial in beginning their work in this area since they 

have few resources to devote to this issue within their health 

departments.

State and local health departments not receiving the award that have 

begun planning for the risks that climate change poses to public health 

have undertaken activities such as conducting research on health impacts 

associated with climate change, such as heat-related illness or asthma, 

participating in workgroups, holding forums to raise awareness, and 

producing reports. Among the state and local health departments that we 

interviewed, Alaska and Washington were among those not receiving the 

CDC initiative award that had undertaken a number of activities directly 

related to preparing for the public health impacts of climate change.

1

According to these officials, resources used to conduct this work include federal and 

state funding sources, as well as partnerships with academic institutions or 

nongovernmental organizations.

Appendix VII: Activities of Other Selected State 

and Local Health Departments Related to 

Preparing for the Public Health Impacts of 

Climate Change

Page 71 GAO-16-122 Climate Change and Public Health

 
Appendix VII: Activities of Other Selected State 

and Local Health Departments Related to 

Preparing for the Public Health Impacts of 

Climate Change

• Alaska. Officials from the Alaska Department of Health and the 

Alaska Native Tribal Health Consortium—a nonprofit tribal health 

organization—told us that they have engaged in a number of activities 

to address and plan for the risks that climate change poses to public 

health, given that Alaska residents are already seeing climate change 

impacts to their health and livelihoods. The state’s Department of 

Health is in the early stages of developing a health impact 

assessment that seeks to identify the potential costs of climate 

change to health, ways in which to minimize adverse health effects, 

and ways in which to maximize potential health benefits. The results 

of this assessment will serve as a baseline for future climate change 

planning and preparedness activities in the state. Officials from the 

Department of Health were also involved in studying an outbreak of 

vibrio parahaemolyticus in July 2004, due, in part, to rising ocean 

temperatures.2 The Alaska Native Tribal Health Consortium has also 

conducted activities related to climate change and health. Through an 

award provided by HHS’s Indian Health Service, the center has 

conducted assessments to understand the broad range of community 

impacts from climate change, including changes in disease, mental 

health, food and water security, and infrastructure. The center is 

integrating the results of these assessments into construction design, 

operations, and maintenance considerations for specific health facility 

improvements, such as new filtration systems for water treatment 

plants. The center also developed a Local Environmental Observers 

network, consisting of tribal environmental, natural resources, and 

health professionals, to enhance monitoring of unusual events that 

are climate change-related or climate-sensitive. Observations are 

mapped on a Google maps platform and are communicated through 

an electronic newsletter to provide information to decision makers on 

current risks.3

2

Specifically, in July 2004, over 60 passengers aboard cruise ships near Alaska became ill 

after eating raw oysters, resulting in one of the largest known outbreaks of vibrio 

parahaemolyticus ever reported in the United States. During this outbreak, Department of 

Health officials worked to study the disease and process oyster samples, and later 

published the results of their study. See J. McLaughlin, et al., “Outbreak of Vibrio 

parahaemolyticus Gastroenteritis Associated with Alaskan Oysters,” The New England 

Journal of Medicine 353, no. 14 (2005).

3

The Local Environmental Observers network was developed by the Alaska Native Tribal 

Health Consortium’s Center for Climate and Health with funding from EPA and the 

Western Alaska Landscape Conservation Cooperative—a partnership of federal agencies 

and other stakeholders addressing climate change impacts on the nation’s landscapes. 

Page 72 GAO-16-122 Climate Change and Public Health

 
Appendix VII: Activities of Other Selected State 

and Local Health Departments Related to 

Preparing for the Public Health Impacts of 

Climate Change

• Washington. The Washington State Department of Health has 

recently started to engage in activities related to climate change and 

health at the direction of its Secretary of Health, who identified climate 

change as a priority issue. The department is working to identify how 

to measure and track the impacts of climate change, particularly in the 

areas of food, water, and air quality, through its Washington Tracking 

Network, which is funded by CDC’s Environmental Public Health 

Tracking Network. The department also conducted a survey to 

characterize local health jurisdiction’s perceptions, activities, and 

needs related to climate change, and compared the results to similar 

surveys of local health departments on this topic.

Page 73 GAO-16-122 Climate Change and Public Health
Appendix VIII: Summary of Health-Related 

Recommendations Made by the President’s 

Task Force on Climate Preparedness and 

Resilience

In November 2013, the President issued Executive Order 13653, 

Preparing the United States for the Impacts of Climate Change, which, 

among other things, established the State, Local, and Tribal Leaders 

Task Force on Climate Preparedness and Resilience. The mission of the 

task force was to provide recommendations to the President and 

interagency council on how the federal government could, among other 

things, support state, local, and tribal preparedness for and resilience to 

climate change.

The task force issued a report to the President in November 2014, noting 

that the federal government has an essential and unique role to play in 

preparing for and responding to climate change impacts.1 Its report 

includes 35 recommendations to the President across seven themes, and 

it also listed suggested actions that federal agencies could take to 

implement the recommendations. The themes addressed in the report are 

(1) building resilient communities, (2) improving resilience in the nation’s 

infrastructure, (3) ensuring resilience of natural resources, (4) preserving 

human health and supporting resilient populations, (5) supporting climatesmart hazard mitigation and disaster preparedness and recovery, (6)

understanding and acting on the economics of resilience, and (7) building 

capacity. Table 6 summarizes selected health-related recommendations 

and suggested actions listed across various themes of the report.

1

President’s State, Local, and Tribal Leaders Task Force on Climate Preparedness and 

Resilience, Recommendations to the President (Washington, D.C.: Nov. 17, 2014). The 

task force terminated 6 months after it provided its recommendations. In July 2015, the 

administration issued a progress report, providing examples of federal actions taken to 

address these recommendations. The White House, Progress Report: Highlighting 

Federal Actions Addressing the Recommendations of the State, Local, and Tribal Leaders 

Task Force on Climate Preparedness and Resilience (Washington, D.C.: July 2015).

Appendix VIII: Summary of Health-Related 

Recommendations Made by the President’s 

Task Force on Climate Preparedness and 

Resilience

Page 74 GAO-16-122 Climate Change and Public Health

 
Appendix VIII: Summary of Health-Related 

Recommendations Made by the President’s 

Task Force on Climate Preparedness and 

Resilience

Table 6: Summary of Selected Health-Related Recommendations and Suggested Actions from the President’s State, Local 

and Tribal Leaders Task Force Report on Climate Preparedness and Resilience

Theme Recommendation Examples of suggested actions to address the recommendation

Preserving human health and supporting resilient populations

Address the needs of vulnerable 

populations

• Develop guidance and tools to identify those most at risk the effects of 

climate change.

• Ensure that federal programs that serve vulnerable populations (for 

example, housing and senior assistance programs) evaluate how 

climate change will impact needs and service delivery.

Improve capacity to protect public 

health

• Expand and build on the Centers for Disease Control and Prevention’s 

(CDC) Climate-Ready States and Cities Initiative, to include 

mechanisms for grantees to share their experience and best practices 

with nongrantees, including all local governments.

• Encourage recipients of CDC’s Public Health Emergency 

Preparedness funding to consider climate change impacts when 

developing their required vulnerability assessments.

• Develop climate-sensitive health tracking and surveillance tools.

• Improve awareness of mental health impacts associated with climate 

change impacts, including by incorporating such impacts in 

preparedness and response planning. 

Assist communities in building food 

system security.

• U.S. Department of Agriculture should work with the Department of 

Health and Human Services and others to support research on climate 

change-related risks to food supply chains.

Improve disaster preparedness for 

communities most at-risk.

• Provide enhanced access to predisaster training on federal response 

and recovery programs.

• Develop health-sensitive extreme weather event warning systems that 

enhance response activities for at-risk populations. 

Explore the federal role in addressing 

climate change-related displacement.

• Establish a framework for responding to climate-related displacement.

Building capacity for resilience

Increase climate literacy and public 

awareness.

• Ensure that senior federal health officials such as the U.S. Surgeon 

General and the Director of CDC draw attention to the public health 

impacts of climate change.

• Coordinate federal communications on climate change to develop 

clear, consistent, and unified messages, including on the impacts of 

climate change to human health, and ensure that communications 

tools are provided to state and local governments. 

Ensuring the resilience of natural resources

Combat the spread of invasive species, 

pests, and diseases.

• Increase regional monitoring efforts, including by enhancing related 

research, identification, interagency coordination, and education 

efforts. 

Source: President’s State, Local and Tribal Leader’s Task Force Report on Climate Preparedness and Resilience, Recommendations to the President (Washington, D.C.: Nov. 17, 2014). | GAO-16-122

Page 75 GAO-16-122 Climate Change and Public Health
Appendix VIII: Summary of Health-Related 

Recommendations Made by the President’s 

Task Force on Climate Preparedness and 

Resilience

The task force also developed five overarching principles for all federal 

agencies to consider as a means to advance climate preparedness and 

resiliency. These include:

1. Require consideration of climate-related risks and vulnerabilities as 

part of all federal policies, practices, investments, and regulatory or 

other programs.

2. Maximize opportunities to take actions that have dual benefits of 

increasing community resilience and reducing greenhouse gas 

emissions.

3. Strengthen coordination and partnerships among federal agencies, 

and across federal, state, local, and tribal jurisdictions and economic 

sectors.

4. Provide actionable data and information on climate change impacts 

and related tools and assistance to support decision making.

5. Consult and cooperate with tribes and indigenous communities on all 

aspects of federal climate preparedness and resilience efforts, and 

encourage states and local communities to do the same.

Page 76 GAO-16-122 Climate Change and Public Health
Appendix IX: Comments from the Department Appendix IX of Health and Human Services : Comments from the 

Department of Health and Human Services

Page 77 GAO-16-122 Climate Change and Public Health
Appendix IX: Comments from the Department 

of Health and Human Services

Page 78 GAO-16-122 Climate Change and Public Health
Appendix X: GAO Contacts and Staff 

Acknowledgments

J. Alfredo Gómez, gomezj@gao.gov or (202) 512-3841.

Marcia Crosse, crossem@gao.gov or (202) 512-7114.

In addition to the individuals named above, Diane Raynes (Assistant 

Director), Mark Braza, Emily Hanawalt, Armetha Liles, Krista Mantsch, 

Cynthia Norris, Patricia Roy, Emily Ryan, Jeanette Soares, Andrew 

Stavisky, and Jennifer Whitworth made key contributions to this report.

Appendix X: GAO Contacts and Staff 

Acknowledgments

GAO Contacts

Staff 

Acknowledgments

(361569) Page 79 GAO-16-122 Climate Change and Public Health
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