Climate Change:

HHS Could Take Further Steps to Enhance Understanding of Public Health Risks

GAO-16-122: Published: Oct 5, 2015. Publicly Released: Nov 3, 2015.


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    GAO-16-122: Climate Change Infographic

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J. Alfredo Gómez
(202) 512-3841


Marcia G. Crosse
(202) 512-7114


Office of Public Affairs
(202) 512-4800

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.

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.

For more information, contact J. Alfredo Gómez at (202) 512-3841 or, or Marcia Crosse at (202) 512-7114 or

Recommendation for Executive Action

  1. Status: Open

    Comments: As of December 2016, CDC has taken steps to start developing a communications strategy, and expects this process to include the development of guidance for public health officials to help them more effectively communicate about the health effects of climate change. CDC expects the strategy to be completed by the fall of 2017.

    Recommendation: To enhance HHS's ability to protect public health from the impacts of climate change, the Secretary of HHS should 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.

    Agency Affected: Department of Health and Human Services


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