Climate Change: A Health Threat for Humanity

The World Health Organization is not mincing words when it comes to climate change, calling it one of the greatest health threats for humanity. 

On this episode of the Princeton Pulse Podcast, we discuss the increasingly dire health impacts of global warming – from air pollution to water contamination, higher disease burdens, and a host of other outcomes that directly or indirectly endanger human health and wellbeing. Scientists warn that these consequences will only worsen over time if we don’t take immediate action, and that lower-income countries and communities that are least equipped to adapt will suffer the most.

Host Heather Howard, a professor at Princeton University and former New Jersey Commissioner of Health, confronts the challenges of climate change from a public health perspective with two distinguished guests: climate scientist Michael Oppenheimer, a Princeton professor and director of the university’s Center for Policy Research on Energy and the Environment; and Dr. Jeremy Hess, a professor and director of the Center for Health and the Global Environment at University of Washington. 

The panel takes a candid look at the mechanisms by which climate change  affects human health and the urgent need for mitigation. They talk about the increasing scale, frequency and intensity of extreme weather; heat-related illness; human migration; food supply threats; equity concerns; and the policy issues and implications in light of a changing administration. At the same time, they offer hope for the path forward, noting a worldwide energy revolution that will continue to drive progress, even if it’s at a slower pace.

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Watch a recent episode of RNZ’s “30 with Guyon Espiner” podcast series, where Oppenheimer discusses many aspects of global climate change.

Oppenheimer participated in a UN Climate Week symposium moderated by David Wallace-Wells, an opinion writer and columnist for The New York Times Magazine. Tipping points in the climate system was the central issue.

The panel discussed research on mortality caused by tropical cyclones in the United States. Read the paper published in Nature.

The Center for Health and the Global Environment at University of Washington developed an interactive decision tool that links heat-health risk assessment with evidence-based guidance on how to protect public health under changing climate-related environmental conditions. 

This article, co-authored by Heather Howard and published by Health Affairs, examines how state health programs

The Princeton Pulse Podcast is a production of Princeton University's Center for Health and Wellbeing (CHW). The show is hosted by Heather Howard, a professor at Princeton University and former New Jersey Commissioner of Health and Senior Services, produced by Aimee Bronfeld, and edited by Alex Brownstein. You can subscribe to The Princeton Pulse Podcast on Apple Podcasts, Spotify, or wherever you enjoy your favorite podcasts.

Transcript

 TRANSCRIPT

Climate Change: A Health Threat for Humanity 

SPEAKERS
Dr. Jeremy Hess, Heather Howard, Professor Michael Oppenheimer

Heather Howard  00:02
Hi, and welcome to the Princeton Pulse Podcast. I'm Heather Howard, professor at Princeton University and former New Jersey Commissioner of Health and Senior Services. On campus and beyond, I've dedicated my career to advancing public health. That's why I'm excited to host this podcast and shine a light on the valuable connections between health research and policy. 

 Our show will bring together scholars, policymakers and other leaders to discuss today's most pressing health policy issues, domestically and globally. We'll highlight novel research at Princeton, along with partnerships aimed at improving public health and reducing health disparities. 

I hope you'll listen in as we put our fingers on the pulse and examine the power and possibilities of evidence-informed health policy.  

Heather Howard
Welcome. The World Health Organization is not mincing words when it comes to climate change, calling it one of the greatest health threats for humanity.  

On today's episode, we confront the increasingly dire health impacts of global warming, from catastrophic weather events to air pollution, water contamination, increased spread of infectious disease, and a host of other outcomes that directly or indirectly endanger human health and wellbeing.  

Scientists warn that climate change is not a problem for the future; it's a problem now. In fact, 2024 was the hottest year on record. Rising temperatures are already having devastating health consequences that will only worsen without intervention. And while the effects are widespread, people in lower income countries that lack the infrastructure and resources to prepare and respond will suffer the most.  

With me to discuss the challenges of climate change from a public health perspective, along with the policy issues and implications in light of a changing administration, are two distinguished guests. In the studio with me is climate scientist Michael Oppenheimer, a Princeton professor and director of the University's Center for Policy Research on Energy and the Environment. Among the world's most prominent authorities on these issues, Professor Oppenheimer has been leading the fight against climate change throughout his career. And joining us remotely is Dr. Jeremy Hess, a professor and director of the Center for Health and the Global Environment at the University of Washington. Trained in emergency medicine and global environmental health, his teaching, research and service focus on the relationship between a healthier planet and healthier people. Notably, both Professor Oppenheimer and Dr. Hess are deeply engaged with the Intergovernmental Panel on Climate Change, or the IPCC, which won the Nobel Peace Prize in 2007. Michael, Jeremy, welcome to the show.

Professor Michael Oppenheimer  02:54
Thanks for having me. 

Dr. Jeremy Hess  02:55
Thank you.

Heather Howard  02:56
So I'm going to start with you, Michael. We're here to explore the fundamental threat that climate change presents to human health. Can you start us off? You've been a long-time participant in the IPCC, which has concluded that climate risks are worsening. Tell us the state of what we understand about climate change now.

Professor Michael Oppenheimer  03:18
Despite all the talk, we're still headed in the wrong direction. Emissions of greenhouse gases, particularly carbon dioxide, which comeS mostly from burning the fossil fuels, are continuing to increase, despite some slight hints of a potential slowdown and eventual plateauing of emissions. That means that the amounts of greenhouse gases in the atmosphere that trap the heat that's warming the earth are continuing to increase, and there is no evidence yet that those levels are slowing down. The last 10 years have been the warmest on record. The earth's global average temperature continues to increase, and this is causing climate changes worldwide, which have been identified as attributable to the human-made build-up of the greenhouse gases. So things are still headed in the wrong direction. 

If there is any good news, it's that there is an energy revolution progressing in the world at the same time, which, although we need to speed it up, will eventually, I hope, induce a transition away from the fossil fuels and the other sources of greenhouse gases, and allow us to stabilize the climate, and perhaps eventually, over the course of many decades, or even a few centuries, return the climate to what it would have been otherwise. We're nowhere near that, and that's because we haven't had adequate attention and action by governments. Nevertheless, things are beginning slowly to go in the right direction. The Biden administration took some very important steps in that regard. 

Heather Howard  04:58
That's great. We'll definitely want to explore those. Jeremy, you've also been deeply involved in the IPCC. Your research interest, in particular, is climate change and health. Can you set the table about the threat that climate change presents to what those of us in public health would say have been 50 years of tremendous progress in global health. 

Dr. Jeremy Hess  05:22
Absolutely. There are two health-related narratives around climate change. One is an impacts narrative, which you referred to in terms of WHO statements of concern related to the current and future burden of disease associated with climate change. We are already seeing impacts of climate change across a wide range of climate sensitive diseases and injuries, and there's very much reason for concern about that set of impacts and the likelihood that it will grow pretty substantially as climate change continues and we see additional warming. There's another narrative. It's not exclusive but a different narrative that focuses on opportunities to advance public health, and in particular, to reduce the incidence or new cases of non-communicable disease through climate action and mitigation transition to clean and renewable energy, and by reducing fossil fuel pollution, particulate air pollution, in particular, but a number of other changes that reduce our reliance on fossil fuels, increase our active mobility, and other interventions. Those are good for health, and they're good for health in really substantial ways that actually accrue very quickly, whereas the avoided climate change is also a benefit of that action. That will take decades to fully accumulate. So there are multiple arguments for climate action related to health, and we're making some progress, as Michael said, and seeing health benefits of a transition away from fossil fuels. Not fast enough, not substantial enough, but that health argument is bearing out. But because we're not making the progress we need to on climate change mitigation, we absolutely need to be doing a better job of preparing for the impacts domestically and globally, because they're here and they're growing.

Heather Howard  07:54
Both of you started with some optimism, but then a sobering reminder to the urgency, right? So let's dig in. Would love to explore with you the mechanisms by which climate change is affecting health. We know climate change affects many aspects of health, but what are the mechanisms by which it's doing it? Starting with you, Michael, can you talk about extreme weather and how that's increasing in scale, frequency and intensity -- and what that means for health?

Professor Michael Oppenheimer  08:26
So there is both the good news, bad news message on that as well. The good news is that globally and in the United States, deaths from tropical cyclones, which means hurricanes, typhoons and cyclones in the Indian Ocean, have been decreasing worldwide for decades. And that is probably due to improved weather forecasting and emergency response notification systems, which get people out of the way. And in some cases, for instance, Bangladesh, they, in addition, built concrete bunkers along the south coast. So when the early warnings went out, people actually had a place to go. There was a cyclone in 1970, Cyclone Bola, which killed uncountable numbers of people, which is estimated between or around a half a million, fantastic rates of death. And lately, similar cyclones, they still cause unfortunate levels of death, but they're much smaller in Bangladesh because Bangladesh is prepared. So maybe 4,000 or 5,000 people die as a result. So that's one example of how sound policy, thinking ahead, understanding that this is a risk which is big and getting bigger, can save a lot of lives, even in a poor country. That kind of thing is good news. 

There's similar good news in some countries on heat-related deaths, where the availability of air conditioning has markedly reduced the rates of heat-related deaths in the United States and other countries. There is some hint that around the world, it's had an effect, too. On the other hand, most of humanity doesn't have access to air conditioning. And 30 or 40 years from now, most of humanity still may not have access to air conditioning. Under the circumstances of increases in extreme heat, which is one of the most reliable, robust predictions of the models that project warming over the next few decades... in areas where people are unprepared, don't have any place to go with this cooling, or have to be outside to work during the day, like in agriculture or construction, more people are likely to die. 

So the good news is, we made some progress. The bad news is what's coming at us in terms of more extremes of heat, bigger and more intense and more often. Because it's not clear we'll be able to prepare people for it in a way that will save lives. 

Heather Howard  11:25
Jeremy, you're a practicing emergency doctor, in addition to all this amazing research you're doing. How does extreme heat present to you in the emergency room? How do you see it in your practice? 

Dr. Jeremy Hess  11:41
Well, extreme heat presents a little bit differently depending on the population that you're talking about and the population that's exposed to the hazard, but there are a lot of similarities across the board when we think about heat and heat-related illness. There's a small number of typical presentations to us, things like heat-related syncope, which is fainting, heat exhaustion, where people feel ill, often when they're exerting themselves in hot conditions. And then heat stroke. Heat stroke is a combination of an elevated core body temperature and altered mental status, and basically what's happened in those cases is that the body's mechanisms for maintaining its own temperature have failed, and as a result, a lot of physiological processes start to break down, and people aren't functioning normally, cognitively or otherwise. Heat stroke is quite dangerous. I think when people started studying it, the case fatality rate, the rate at which people with the disease died, was 25%. Now, depending on the promptness of diagnosis and care, it's closer to five to 10%. It's still a dangerous condition, but survivability has increased with prompt diagnosis, prompt treatment, and high quality clinical and critical care.

Heather Howard  13:51
So again, we're back to assuming you have access to that care. 

Dr. Jeremy Hess  13:55
Absolutely. That's the first part of my answer to your question. Those are heat-related illnesses, and we see those when it's hot. You know, Seattle is pretty temperate. We don't see extreme heat that often, though, in 2021 we had a really bracing extreme heat event in the Pacific Northwest with unprecedented temperatures with rather short warning. And it's not because we don't have a lot of experience with heat. We don't have a lot of great reflexes around heat protection at a population level, and we, despite our best efforts, are overwhelmed by this, so we saw people with those heat-related illnesses. But heat also exacerbates a lot of chronic diseases, and this plays out differently depending on the disease. If it's respiratory, you'll see flares of COPD or emphysema. Often, you'll see flares of asthma. You'll see different flares of different kinds of cardiovascular diseases, particularly diseases related to blood volume, so renal disease, changes in electrolytes, all sorts of conditions. It depends on the patients that are around you and their age and underlying conditions, but you'll often see an exacerbation of chronic disease that actually is much larger, ultimately, and more burdensome on the health system than the heat-related illness, which is more visible and typically associated with extreme heat exposure. 

Heather Howard  15:31
That's really helpful. So let's continue to pull back. We've got extreme heat, which we've just talked about. But what about the changing nature of some diseases. Jeremy, how is climate change affecting vector-borne illnesses and zoonotic diseases? 

Dr. Jeremy Hess  15:51
When I teach students about this, I start with what's happening with the climate, which we've covered. And then I talk about how that translates into environmental shifts. Essentially, there's more energy in the climate system, right? There's more thermal energy in the climate system that translates into a number of different impacts that are important. There's also more carbon dioxide in the atmosphere, and that translates into some important environmental impacts. So the energy in the climate system translates fairly directly, and Michael can correct me on the nuances here, but fairly directly to energy in extreme weather, whether it's an extreme heat event or a storm, and the amount of water that's delivered in a slow moving hurricane event. All of that's correlated, and we're seeing worsening across the board there. 

We're also, of course, seeing warming generally, and that's adding to sea level rise. And with sea level rise comes pressure on coastal communities and coastal ecosystems and migration. In some cases, migration is internal, in some cases it's transboundary, meaning across borders. And, you know, people are not always going to look at it and see it as migration because of climate change. It's going to look like migration for economic opportunity and other things, but there's migration associated with destruction of infrastructure. And then lastly, all that carbon dioxide in the atmosphere equilibrates in the ocean and acidifies the ocean. So you have ocean acidification, a threat to ocean food webs. Basically, the carbonic acid in sea water dissolves calcium carbonates out of shells of marine animals, and it bottoms out or threatens the bottom of the food chain, which then impacts humans and lots of other animals by threatening food supply from the sea. You have all of these different threats, and really all of them are ecological. Ultimately, I mean socio-ecological, in the sense that we live in an ecosystem. We've certainly managed it quite aggressively, but humans are part of that. 

You see impacts across a wide range of different diseases that are impactful on humans, ranging from the more direct impacts related to heat and other things we’ve already talked about, to vector-borne diseases, where we have earlier warm seasons, so vectors have a longer period of time to reproduce. Often, vector activity is correlated with outdoor temperature, so the warmer it is to a degree, the more active they are, and the more feeding they do, and the greater the number of transmission cycles in a season. It affects human activity differently too, right? Spring comes earlier. People are out hiking and doing things in their yards, so their exposure is increased. You have all of these amplifications, and then you have impacts on other creatures that are part of the ecology of certain diseases, whether it's Lyme or dengue, West Nile, et cetera. 

Heather Howard  19:23
Chikungunya. 

Dr. Jeremy Hess  19:24
Yes. You have impacts that are specific to that particular disease ecology. And often they amplify it, not always, but often they amplify the risk and burden of the disease. Though, as Michael said, for all these different diseases we have countermeasures, and a lot of them are tried and true. We have ways to manage a lot of these threats, as long as we are tracking them appropriately and intervening in the right way to protect the right people.

Heather Howard  20:00
Michael, what would you add? That was helpful. He touched on migration, food supply. What else would you add in terms of the mechanisms? 

Professor Michael Oppenheimer  20:09
Well, the major thing to worry about is that there are vast differences in the life situations of people on earth. In general, people who are poor have a harder time dealing with any problem, health-related problems which require investments by someone in advance to protect you, whether it's you buying an air conditioner, or the state building a sea wall near your property or paying you to evacuate or retreat. These are things which are harder in poor communities to implement. Poor communities don't have the political power to mobilize the state, whatever country it is, to help them. There are going to be vast differences in the future, unless we get climate change under control quickly, in the fates of people, depending on the social capital and other forms of capital that they have to deal with any problem and these health-related problems. 

There are some stark examples from the way things are now. Most cities in the United States have cooling centers, where people can go to protect themselves from heat because they're air conditioned. Well, we did a study of three cities, Chicago, New York and Phoenix. It was a senior thesis here at Princeton just a few years ago, and what we found was there is no coherence between where the populations that really need the cooling centers live and where the cooling centers are. Furthermore, they're not open all the time, because they frequently have a secondary use, something like a library, and the libraries close at night, even if it's hot. It's only recently that cities have gone, wait a minute, this can't go on. Another good example is in Chicago. More than a third of the cooling centers were located in police stations. Now think about how that dynamic works when you have a poor person who might have some past experience with law enforcement and is worrying whether to save their lives by going to the police station or to stay home without air conditioning. So those are confluences of social and economic circumstances with exposure to extreme heat. 

It's been shown that some of the poorest neighborhoods are also some of the hottest in the middle of cities, because of the urban heat island effect and because of the lack of parks. We haven't thought about how to structure a society that really protects anybody from a lot of these climate extremes, and particularly people who don't have the power and influence to demand protection.

Heather Howard  23:31
Michael's talking about this really powerful point that those who are less equipped to adapt are the most harmed, whether that's low-income countries versus high-income countries, or low-income people within high-income countries. Jeremy, how do you think about these equity issues?

Dr. Jeremy Hess  23:49
Well, I completely agree with Michael's analysis, and I would broaden it to note that the same pertains to fossil fuel pollution, that communities of color and poor communities are often closer to fossil fuel infrastructure. They're more highly exposed to pollution from motor vehicles, they're closer to roadways and other things, and it's like a fractal. At every level that you look, you see this pattern recapitulated from local all the way up to global, and that there are high emitters who externalize the adverse health impacts of their fossil fuel use onto lower emitters that are generally poorer and have fewer opportunities to protect themselves against both the immediate causes of fossil, fuel use related to air pollution, but also the downstream causes that manifest years later with climate change. We see the global North exporting its impacts essentially onto the global South, and we see it within the United States, and then we see it within local communities.

Professor Michael Oppenheimer  25:20
By the way, that reminds me of a study that one of my former graduate students just published with an economist at Stanford. It was part of her Ph.D. dissertation here, and what it showed is that the nominal deaths from hurricanes in the United States are actually just a fraction of the overall death rates from hurricanes because of these lagged effects. They looked 15 years into the future after every hurricane that made landfall in the United States in the last 40 years or so, and they showed that the effects linger. So if you get somebody who's hurt or damaged, it may be that there's an injury because the wind blew something on them, and that caused them, years later, to not be able to function as well, not get health care, and then they die. Or maybe it's a psychic trauma from experiencing something like Hurricane Katrina, which was just absolutely devastating. These things ripple through people's lives, and the more we're dealing with really extreme events of the type that are unprecedented, like the heat wave you had in the Pacific Northwest that never occurred in written history, the more we're going to have situations where people are traumatized because the events that happened not only never happened in their neighborhood, but they never heard of it happening to anyone they know, and they just don't know how to deal with it psychologically or just physically. 

Heather Howard  27:04
Jeremy, would you want to add something on the mental health impacts?

Dr. Jeremy Hess  27:08
Well, I do. I want to pick up on what Michael said. That was a very important study, and it highlights and recapitulates a pattern that we see across several different studies of health impacts, of extreme weather impacts, which we then extrapolate to try and assess disease burden associated with climate change. If you look directly at the relationship, you see a small set of impacts relatively, and it's like what I was saying about heat. Direct exposure to heat causes heat-related illness. You see a big spike, because most of the time you don't see that, but really the total burden actually comes from that set of the bunch of flares of chronic disease that impact the rest of the population. Same thing with that hurricane study. If you look at the direct impacts from injuries, et cetera, drownings, it's relatively small, and thankfully, has gone down over the years, as Michael mentioned. But the overall burden, when you look at all of the downstream impact, is really substantial, and that's the right way to look at these impacts. And so you see this pattern recapitulated. 

And, of course, the equity dimensions ripple through all of it. A lot of it is mediated through mental health. It's also mediated through insults to finances and the capital that individuals, households, and communities have available to them. And so, of course, we see differences across communities, and the amount of total capital they have, socially and financially. Michael and I worked on an IPCC report on extreme events and disasters. One of the themes that came out in that work is a disaster can be a really big event that everybody would recognize as a disaster, because it overwhelms local resources, or it can have a really substantial impact through a series of small impacts that just erode your ability to recover over time and erode your resource base, both individually and collectively. We have mechanisms in this country to insure against some of these losses and to transfer huge amounts of wealth when we need to facilitate recovery. We don't know whether those will remain intact over time. There's already been threats sometimes that the federal government is delaying disaster relief for climate-related disasters, historically. That may worsen in the future. But there's an important dimension of repeat injury, trauma, and recovery, and that plays out with mental health as well as physical health. Of course, they're intertwined. 

Professor Michael Oppenheimer  29:56
Picking up on that thread, one of the things you have to remember is that one of the most notable aspects of warming is, even if the average temperature changes just a little bit, the numbers of events that are in the extreme end of what might look like normal distribution increases by an order of magnitude, in some cases or more. It's those events which are causing, probably, and will cause, over time, most of the damage. And what we're worried about -- this picks up on something that Jeremy said -- is the recovery, the rebuilding, the expense. That you wind up in a situation where, as these events come more and more often, there is no chance to fully recover, and you're permanently living in a depressed economic situation, and perhaps, as we mentioned, a depressed health situation, which just never improves back to where it was. That, to me, is the most troubling aspect of climate change. If it keeps accelerating like it is now, and these extreme events, whether it's heat waves, floods, droughts, tropical cyclones, keep increasing even more than the mean is changing, you're going to basically suppress the nature of life, of civilization, of economies, of infrastructure, of people everywhere.

Heather Howard  31:32
That's the recurring injury, I think. Jeremy, did you call it that? Yeah. So you both mentioned some important recent research. One of the things we like to explore on this podcast is how research can affect policy. So I'd love to hear what's on your research agenda now, and how that research can affect policy at this important moment in time. Jeremy, I'll start with you. 

Dr. Jeremy Hess  31:58
I direct a center that focuses on the intersections between health and climate change. We are trying to bring health into climate action and climate into health protection. And so I support a broad range of research activities through our center, including research on what we call the health co-benefits of mitigation, which is a bit of a mouthful, but basically means benefits that come from efforts to reduce greenhouse gas emissions, and we already touched on some of those things. And then we do a lot of research on the health impacts of climate change, understanding what those are, assessing them, and then supporting efforts to manage them. That's where I personally am putting all of my energy now, because while I'm heartened by the progress we're seeing around mitigation, it's very clear to me that that mitigation is not going to avoid pretty dangerous climate change for some communities, or climate change that will be pretty dangerous for some communities, and that we are not moving quickly enough, at least in health protections, to stave off some of the more significant health impacts. So I'm pretty laser focused at this point on understanding interventions that will help protect people, and implementing those interventions at scale. What can we do to address those three things?

Professor Michael Oppenheimer  33:41
Picking up on that… One thing that I got interested in over the last few years is the nature of federal policy as it intersects with the need to build resilience and adapt to these risks, which are going to increase for decades no matter how good we are at reducing emissions. This is not going to be turned around quickly. It turns out that despite some very admirable efforts by the Biden administration, almost no attention had been paid to adaptation, to thinking ahead, towards changing the system by which resources become available to local communities that have to deal with most of the problem. The Biden administration made some progress, some interesting progress, but not nearly enough. As Jeremy hinted, in the United States, we're nowhere near where we need to be in terms of capabilities, institutional arrangements, and finance to deal with this problem. It requires a lot of long-term thinking. And just to mention one aspect, most of the funding that eventually is available for climate adaptation is through the federal tax base, and a lot of the responsibility, not all of it, but a lot of it, is at the state and local level. You can't make investments on building local resilience if you can't count on a continual flow of money from the federal government. Everybody knows how crazy the federal budget process has become. There is no mechanism by which, say somebody wanting to issue bonds to cover an expense at the local level, could rely on this federal flow of money to assure that they'd be able to pay off the bonds. That's one reason why big projects like surge barriers don't get done. 

There are other reasons. They're not necessarily the best solution. Part of my research has been on how to have improved policy on adaptation, and particularly with regard to the coast, which I'm particularly interested in. But there's another strain to my research, which Jeremy mentioned briefly at the very beginning, which is human migration. The world is burning up with regard to the migration issue right now. The governments don't have coherent, sensible, forward-looking policy that would allow us to, for instance, improve the conditions where people live already, so that if climate change is going to add an extra stress, that they just won't decide it’s time to move. They're going to go somewhere. The destination countries are usually not well-prepared, as we saw with the flow of migrants into Europe, starting 10 or 15 years ago. It turned into a politically incendiary situation. We see the ongoing situation with Central American and Mexican migration at the U.S. border, which is politically potent here too, and a lot of that is unnecessary if governments thought in advance that this is going to happen. If we could think about where it's going to happen in large numbers, which borders, maybe we can do something to slow the need to migrate, that people feel in some cases. And if they're going to migrate, make it easier for them when they arrive somewhere, rather than making it harder for both the population that's there already and the people who want to move in. It's an area which could be handled much better than it is now, or it could continue to be handled incoherently, in which case we're going to have periodic political problems arising from it, not to mention the misery that people suffer who were stuck in a bad migration system.

Heather Howard  37:56
Jeremy, do you want to react to that? 

Dr. Jeremy Hess  38:00
I agree. 

Heather Howard  38:02
Thank you. So Michael, you mentioned federal policy. We'd be remiss if we didn't sort of address what feels like a pivotal moment with the change in administration in Washington coming. I'd love to hear both of you reflect on what we might expect and if you have any thoughts on what to look for. Is the progress we've been making threatened?

Professor Michael Oppenheimer  38:29
I think the bottom line is that progress on climate change will be slower with the Trump administration but will not be zero and will not be totally turned around. And the reason for that is that a lot of the initiatives that were undertaken under the Biden administration to enhance development of renewable energy and energy transition away from fossil fuels are there. They're burnt in already, they're baked in, and a lot of the money that was dedicated in the Inflation Reduction Act to incentivize non-carbon energy investments were in so-called red states. That was intentional, essentially to make it politically more bulletproof, and it seems to me one of those issues on which there'll be bipartisan resistance to ending those programs. Now, some of them are more vulnerable than others, and there'll be some symbolic efforts so the administration can claim that they save a gazillion dollars by destroying some unnecessary program. But on the whole, I think the money will be there. The other side of it is regulation. The Biden administration reinstated and improved tough regulations on automobile emissions, and on power plant emissions that the first Trump administration had destroyed, that the Obama administration had initially implemented. You could say, well, they're just going to destroy them again. Well, it's not that easy because the automobile industry is well on the road toward electrification, transforming the fleet to become powered by electricity over the next 20 or 30 years. They've made investments, and most of the car companies have already stated that they're against reversing the regulations that assure that they don't have some company competing with them that isn't interested in electric vehicles. So it gets the whole system moving forward. The emissions from electric power, I think that there is scope there for the administration should it want to destroy some important pieces of that regulatory package. And the third part, everybody asks if Trump will quit the international climate negotiations. At this point, that's the least important thing. The most important thing is what we and other countries are going to get done domestically. And I see that as more or less holding together, but slowed down.  

Heather Howard  41:25
Jeremy?

Dr. Jeremy Hess  41:26
I agree with Michael that progress will be slowed but not stopped overall. I think that's the headline message. On all of those specifics, I defer to Michael. He's much more of an expert in that space than me. I think, speaking about health policy, it's pretty difficult right now to get a good beat on what health policy is likely to be under the incoming administration. It seems unlikely it will gain coherence relative to health policy today. But it might. I don't really know. I mean, I think one thing that we will see with this administration is openness to some disruption and re-examining some assumptions and approaches to things, and that may create some opportunities for advances in health policy. I don't know. One thing that I am kind of worried about with this administration... and, frankly, I was worried about it with the Biden administration... and I'd like to hear Michael's thoughts on... is that there's a lot of unmanaged financial risk related to climate change. There were some considerations in the Biden administration to take that on in a more forthright way. That didn't really happen, from my vantage point. The incoming administration, I think, is going to be more open to introducing opportunities for risk and at least removing regulation around financial risk, and I think that that could be a real problem when it comes to climate change. But I don't know exactly. From my point of view, that's just a determinant of health. It undermines a lot of things that ultimately support population health. The specifics, I defer to Mike on.

Professor Michael Oppenheimer  43:36
I think you're exactly right. The Biden administration took some actions, and to the extent they did, they won't change. It doesn't change the whole picture. What's necessary is for the people who basically invest in these companies to eventually demand transparency on both the risks to companies’ operations and the risks to the markets that the companies sell their goods in, essentially the demand side. And there hasn't been much progress on that. The companies that were trying to do something, a lot of them just backed off. And I don't expect Trump to put any additional pressure on them. Quite the opposite, as you say. But the market eventually will put pressure on these companies. You know, once things are being battered around and a company that thought it could do X has lower profits because of the climate episodes, that will have an effect. I don't believe you should leave stuff like that to the free market to determine, but unfortunately, that's probably where we are. I want to make one other point, which is, as I said, the Biden administration made some good initiatives on adaptation. They didn't complete it. They didn't grow it enough, and I think there will be a hiatus under Trump because a lot of them don't care about climate change. But the damages that start to accrue will yield demands from people living in and running the states that support Trump to say, "No, this can't go on. We need federal help, and we need people to think ahead." So again, it's a mixed picture, like everything else. Unfortunately, we can't afford a mixed picture at this point. We've got to accelerate progress, or else things are going to be really bad three or four decades from now, and it's already getting bad, so let's hope for the opposite.

Heather Howard  45:43
I think that's a good point at which to end and to give Michael the last word. Jeremy, Michael, thank you. This has been a really important and sobering conversation. Thank you for joining us. 

Professor Michael Oppenheimer  45:56
Thank you. 

Dr. Jeremy Hess  45:57
Thank you both.

Heather Howard  46:00
Thank you for listening to the Princeton Pulse Podcast, a production of Princeton University's Center for Health and Wellbeing. The show was hosted by me, Professor Heather Howard, produced by Aimee Bronfeld, and edited by Alex Brownstein. We invite you to subscribe to the Princeton Pulse Podcast on Apple podcasts, Spotify, or wherever you enjoy your podcasts.