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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.


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The Health Community Should Reframe Climate Change as a Human Health Issue

Posted on January 13, 2011

By Edward Maibach, PhD MPH & Matthew Nisbet, PhD

This essay is in response to: How can we integrate scientific evidence into our climate and energy policy choices?

The public health implications of climate change are already soberingly clear, at least to the small number of experts who have carefully studied the issue.(1,2) Dr. Georges Benjamin, Executive Director of the American Public Health Association, has concluded that: “Climate change is one of the most serious health threats facing our nation.” Dr. Margaret Chan, Director-General of the World Health Organization, put it even more bluntly: “… humanity really is the most important species endangered by climate change.” PSR, APHA, AMA, AAP, ACPM and other health associations have issued clear policy statements about the health risks associated with climate change.  

Yet, the American people – and likely our elected and appointed representatives, and many of our nations health professionals – are largely unaware of the health implications of climate change.(3) Most Americans view climate change as a distant threat: temporally (not now); geographically (not here); socially (not me and mine); and with regard to the species that they believe are likely to be seriously harmed (penguins, plants, and polar bears perhaps, but not people).(4) In the immortal words of Paul Newman’s fictional character Cool Hand Luke: “What we have here is a failure to communicate.” 

Every health professional knows that effective communication is one of our most powerful tools through which to protect and promote the public’s health.  Now is the time for members of the health community to use our collective voices to alert, inform, guide, and enable the American people participate on the issue of climate change. 

There are three compelling reasons to do so:

  • As health professionals, we have a responsibility to inform communities about the health risks associated with climate change, and how these harms can be averted.
  • Climate change public engagement efforts to date have focused primarily on the environmental consequences of the threat. These efforts have mobilized an important but relatively narrow range of Americans. Health professionals have the opportunity to convey the human consequences and implications of climate change, and to connect the issue to Americans’ deeply held health values. In doing so, research suggests that they will engage a broader range of Americans on the issue, thereby enhancing climate change understanding and decision-making capacity among members of the public, the business community, and government officials.(5)
  • Many of the actions that help limit climate change and promote effective adaptation – actions that can be taken by individuals, communities, states, regions and nations – also improve human health in important ways completely unrelated to climate change. These “co-benefits” of taking action against climate change include increased physical activity, decreased obesity, reduced motor vehicle related injuries and death, reduced air and water pollution and reduced morbidity and mortality associated with it, increased social capital in and connections across communities, and reduced levels of depression. Therefore, actions taken to address climate change are a “win-win” in that they help us make progress toward other high priority public health goals. A broad cross-section of the American public (including many people who don’t believe climate change is real) find this to be a compelling reason to embrace a range of policy changes that can help address climate change.(5)

Research over the past several decades has shown that how people “frame” an issue – i.e., how they mentally organize and discuss with others the issue’s central ideas – greatly influences how they understand the nature of the problem, who or what they see as being responsible for the problem, and what they feel should be done to address the problem.(6) Health professionals can communicate in ways that reframe climate change as a human health problem, rather than as an “environmental problem.” By responsibly communicating the potential of global climate change to harm human health, and by conveying the potential to improve human health through actions that limit climate change, health professionals can enhance public understanding of the full scope of the problem, link that understanding to deeply held health values, and help enable appropriate responses by individuals and communities. 

Moreover, by framing climate change as a public health issue, health professionals can:

  • Reveal local angles of a global problem, moving the location of impacts close to home, and thereby making the problem more concrete.
  • Help focus the public and other decision-makers on health-related adaptation decisions (such as how to prevent heat deaths during extreme heat events), thereby further making the problem more local, and more concrete.
  • Engage important new partners in the issue (e.g., community-based organizations, risk managers, the faith community) who, in turn, can help explain the issue to the public and decision-makers, and who can help develop and implement response plans.

Successfully reframing the climate debate in the United States -- from one based on environmental values to one based on health values, which are more widely held, and which cut across ideology and partisanship -- holds great promise to help American society better understand and appreciate the risks of climate change and to draw upon science when weighing climate and energy policy choices.(6,7)


1. Confalonieri, U.; Menne, B.; Akhtar, R.; Ebi, K. L.; Hauengue, M.; Kovats, R. S.; Revich, B.; Woodward, A. Human Health. In Climate Change 2007: Impacts, Adaptation and Vulnerability, Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change; Parry, M.L., Canziani, O.F., Palutikof, J.P., van der Linden, P.J., Hanson, C.E., Eds.; Cambridge University Press: Cambridge, UK, 2007, pp 391-431.

2. Karl T, Melillo J, Peterson T (Eds.) (2009) Global Climate Change Impacts in the United States.  Cambridge University Press.

3. Akerlof K, DeBono R, Berry P, Leiserowitz A, Roser-Renouf C, Clarke K, Rogaeva A, Nisbet M, Weathers M, Maibach E. (2010) Public perceptions of climate change as a human health risk: Surveys of the United States, Canada and Malta.  International Journal of Environmental Research and Public Health, 7:2559-2606.

4. Leiserowitz A, Maibach E, Roser-Renouf C (2009) Climate Change in the American Mind. Yale University Project on Climate Change & George Mason University Center for Climate Change Communication.  Available at:

5. Maibach E, Nisbet M, Baldwin P, Akerlof K & Diao G (2010).  Reframing climate change as a public health issue: An exploratory study of public reactions.  BMC Public Health. 10:299.

6. Nisbet M (2009). Communicating Climate Change: Why Frames Matter to Public Engagement. Environment, 51 (2) 12-23.

7. Maibach E, Roser-Renouf C, Leiserowitz A. (2008) Communication and Marketing as Climate Change Intervention Assets:  A Public Health Perspective.  American Journal of Preventive Medicine 35: 488-500.


Edo McGowan, MD said ..

The policy issues include modernizing standards and realizing that the regulatory community is largely clientele captured by the very industries they were established to regulate in the public interest. Until these two issues are resolved, little will change. An Environmental Scientist's look at climatology, and thus the potential impact on public health: a synoptic view. The climate scientists are estimating a return to dust bowl days within significant portions of the U.S. on a permanent basis. Surface water will grow increasingly scarce and thus the use of ground water will accelerate. These events will coincide with the increasing draw-down and overdraft of regional aquifers. Many of these aquifers are known as fossil aquifers, the water was deposited during the last ice age and the recharge is slow to non existent. Dependent populations will be placed at risk. There will be an increasing shift to recycled (reclaimed) sewer water as a replacement for potable uses and to irrigate crops consumed raw. Contrary to what the industry may like you to believe, the use of recycled water, as now produced, is not without considerable risk. My research group and others are finding worrisome levels of pathogens and antibiotic resistant microbes and antibiotic resistant genes in this recycled (reclaimed) water, notwithstanding its passage of applicable standards. This merely says that the standards are antiquated, but there seems to no move to improve the standards and thus the public is at increasing risk. As the droughts hit, then progress and the water availability is reduced, the pumping costs of bringing deep ground water to the surface in numerous areas may no longer be economically supportable by large areas now devoted to agriculture and the overlying crops and farms will be abandoned. I saw this abandonment throughout Africa when I was the Regional Environmental Advisor to USAID and the Department of State. That result in Africa is the advancing Sahel--and it will happen here. Also farmers will, in anticipation and hopes of converting ag land to urban use, cease to care for the soil and "spend it down." The reduction in the quality of their soils will make it more friable so these soils have an increased tendency to blow away with wind erosion. This then sets up these areas for major dust storms. Many people have not experienced a major dust storm. There is no way to get away from one. These storms, however, need not be the typical dense brown cloud that rises hundreds of feet into the air, blanketing the earth for miles, but may be enough to move critical pathogens to receptive airways. Examples are found in the dust lofting across the Atlantic arising from Africa and settling on the Caribbean to cause respiratory disease. The winds of the Central Valley of California picked up spore laden dust and deposited it along the California coastal cities leaving valley fever (coccidioidomycosis) in its wake. But to add insult to injury, roughly 60% of the sewage sludge containing what ever industrial and domestic waste that has been sent to the sewer including resistant microbes from hospitals is land applied in agriculture. Sewage sludge or biosolids is the accumulated waste solids that must be removed from sewage before the water is returned to the environment. Sewer plants are major generators of antibiotic resistant organisms, this is a long documented fact. Thus many of the contaminants removed in sewage processing end up in the sludge. Land application of sewage sludge has been going on for some years and thus there is a build-up within the soil profile of pathogens, heavy metals and contaminants of emerging concern such as endocrine disruptors, flame retardants pharmaceuticals, and heavy metals. From Cornell Waste Management Institute, Case for Caution Revisited, the scientists note: Once contaminated, stopping the application of pollutants such as metals and many organic chemicals that are in sewage biosolids will not correct the problem. The contamination will remain for decades or centuries. The pathogens can transfer their genetic material to soil bacteria thus setting up terrestrial lending libraries. It is also important to consider the synergistic effect of irritants and pathogens on the barrier protection of fragile respiratory tissues when exposed to dust. Mechanical or chemical irritants and the subsequent entry of pathogens through disrupted barriers is not well considered by EPA. As to pathogens, for the long-lived spore formers, as well as dried yet viable DNA containing virulence and antibiotic resistance data, this combination of pathogen and chemical-mechanical irritation of the respiratory tract may overwhelm the capacity of the immune system. It also may overwhelm the surge capacity of health care centers to deal with the incoming ill arising from a major regional dust storm. Because of the levels of antibiotic resistant pathogens within sludge and the transfer of that information to the soil bacteria, inhalation of dust may see many of the resulting respiratory infections difficult if not impossible to treat. Where, with the above in mind, is there any discussion of preparedness?

January 31, 2011
Mary Ellen Harte said ..

A reasonable idea, if from it flows the concept of getting health professionals to get the message across... through what venues? I suspect that most climate change believers probably recognize that it is and will be an ever larger health issue. But the bigger challenge is just getting the deniers into the believers column. Better to frame fossil fuels emissions as a gigantic health problem, and use it as a goad towards transitioning to clean energy, the ultimate energy solution to global warming.

January 14, 2011
Dave King said ..

Here in Portland some folks are trying to reframe the issue by bringing the issue of unemployment together with global warming. We believe that only a massive mobilization of resources on the scale of WWll will be effective in dealing with the necessary reduction of carbon emissions. Such an effort would provide work for everyone able to work and then some. Bringing this idea to unemployed people and their supporters has proved to be an effective way to interest people in learning more about climate change.

January 14, 2011

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