North Carolina residents call one small state office when they want to know how to prevent dangerous mold or test drinking water for contamination as they recover from Hurricane Helene.
Staff at the Occupational and Environmental Epidemiology Branch can tell a caller how to restore flood-damaged carpets or accurately read well test kits. This winter, the health department branch will do a door-to-door survey of hurricane victims to find out their longer-term health needs.
Experts say such work is vital to hurricane recovery. But it’s at risk in North Carolina — and in many other states — if President-elect Donald Trump zeroes out funding for the Centers for Disease Control and Prevention’s Climate and Health Program.
For the past 15 years, the program has helped fund roughly a dozen state and local health departments as they respond to extreme heat and the spread of vector-borne diseases as the climate warms. North Carolina’s health department, for example, gets the majority of its budget, some $500,000 in annual funding, from the CDC.
Trump repeatedly — and unsuccessfully — proposed eliminating the office’s $11 million budget during his first term. Advocates of the program fear that the second Trump administration will be more successful in cutting its funding, with the help of a Republican-controlled Congress. The current House appropriations bill would eliminate it.
That doesn’t bode well for a program environmental health experts call the nation’s “thought leader” on protecting human health from climate change.
“Even if you don’t zero out the program, it could be significantly curtailed in what it does,” said Adriane Casalotti, chief of government and public affairs at the National Association of City and County Health Officials. “And that can have a big impact because the natural disasters, the new vectors coming down the pipe, are only going to have more impact on health.”
The Trump transition team did not respond to questions about the president-elect’s plans for the CDC’s climate program.
Trump said earlier this month he intends to nominate environmental-advocate-turned-anti-vaccine-activist Robert F. Kennedy Jr., to lead the Department of Health and Human Services and “go wild” on food and health policy. Kennedy’s intentions for the CDC program, which sits in HHS, are unclear. But Project 2025 — the conservative blueprint for Trump’s second term — lays out plans for only “limited” public health recommendations. His pick to lead the CDC, former Republican Rep. Dave Weldon, does not appear to have a record on climate issues.
Advocates worry that any interference with the CDC’s Climate and Health Program could leave local health officials without needed guidance.
“If we lose that technical expertise, we would leave a lot of local health departments flailing to figure out how to address the impacts of the climate crisis,” said Howard Frumkin, who was special assistant to the CDC director for climate change and health in 2009, when the program was created.
A national blueprint
With just 12 federal employees and a handful of rotating fellows and guest researchers, the CDC’s Climate and Health Program helps “enhance capacity” of local health departments through grants and communicates health risks of climate change through online tools.
This spring, the program helped launch a HeatRisk online tool with the National Weather Service. The tool uses historical hospital data coupled with meteorological forecasts to predict not just heat and humidity, but also the risk those temperatures pose to local residents with different underlying health conditions at a county level.
“That’s a national-level tool now being used by meteorologists and health departments and others to assess levels of risk during the summer heat,” said Claudia Brown, a health scientist at the Climate and Health Program.
The CDC made Brown available for an interview on the condition that she would not talk about presidential administrations or the program’s budget. The climate program, Brown said, is “the national leader in empowering communities to prepare for and respond to the health effects of climate change.”
The program has also funded state and local health departments to track and respond to heat’s health effects, particularly in areas where air conditioning is not common.
For more than a decade, for example, CDC grants funded the Michigan Department of Health and Human Services’ Climate and Health Adaptation Program. Those grants helped pay the salary of a staff member often tasked with monitoring heat-related emergency room visits.
“If we see an increase in emergency visits, we are able to push out alert messaging about how people can protect themselves,” said Aaron Ferguson, who manages the program as head of the Climate and Tracking Unit.
That work now gets state funding under Democratic Gov. Gretchen Whitmer’s administration, but “it started under the CDC grant,” Ferguson said.
“When we were funded by the CDC, it helped us see that there was a need for including climate change in hazard mitigation, planning and different emergency management plans,” he said.
The CDC’s climate program also provides technical assistance and advice. Multiple health officials said that the agency’s Building Resilience Against Climate Effects (BRACE) framework serves as a blueprint for all of the nation’s 3,300 local health departments as they consider how climate change may impact their jurisdictions.
“Climate change is pretty massive and it can seem daunting — like where do you start and how do you keep that work going? — because it really is pervasive across all public health issues,” said Casalotti of the National Association of City and County Health Officials (NACCHO).
The BRACE framework, available on the CDC website, shows officials how to start by forecasting climate’s impacts, then projecting how climate change will affect disease burdens, assessing potential interventions, and then developing and implementing an adaptation plan.
The framework, Brown of CDC said, is “really meant to help put the information and the tools into the hands of those working on the ground to do climate and health work.”
Casalotti said that even health departments without CDC grants have relied on the framework as a blueprint for how to start addressing climate impacts.
“Health departments, whether or not they have funding for climate and health or even talk about it as climate change and health, they are all doing work in this space because it is changing the health landscapes in all of the communities they serve,” she said.
NACCHO receives funding from the CDC’s climate program, which it in turn provides in smaller grants to municipal health departments to start assessing health impacts from climate change.
In 2020 and 2021, the group provided grants to the Franklin County Public Health department in Ohio. Jennie McAdams, the department’s sustainability supervisor, said that funding was crucial in allowing her team to stay focused on climate-related health goals throughout the early days of the Covid-19 pandemic.
The grants, she said, allowed her department to hire an environmental health educator, who spent part of their time writing a climate health adaptation strategy for the county.
“I’m just so grateful for that grant, because I don’t know if we could have done that work otherwise with Covid going on if we didn’t have dedicated funding saying we had to use it for climate,” McAdams said.
‘Deep distrust’
Congress has maintained funding for the CDC’s Climate and Health Program at $11 million since its inception, despite both the Trump administration’s prior requests to zero out its budget, and the Biden administration’s more recent request to boost it by $100 million.
Advocates fear that the program’s climate focus will put it on the chopping block or prompt the Trump administration to interfere with the office’s work.
Project 2025 outlines a series of steps the Trump administration could take to reverse the Biden administration’s overall climate work, referring to it as part of a broader “woke agenda.” While the chapter on the Department of Health and Human Services does not address climate change specifically, it rails against public health recommendations, calling the CDC “perhaps the most incompetent and arrogant agency in the federal government.”
The conservative blueprint proposes splitting the CDC into two agencies: one responsible for public health surveillance work and another with the “severely confined ability to make policy recommendations.”
It’s not exactly clear how Kennedy would plan to handle the CDC’s climate program if he is confirmed as HHS secretary by the Senate. Though he worked for environmental groups for nearly two decades, Kennedy has since turned his attention toward espousing unfounded medical conspiracy theories — including that vaccines are linked to autism — and has vowed to purge other HHS programs, like the National Institutes of Health.
“What I worry about is that we will back off anticipating the hazards and protecting people because the new administration will think it is just ‘too woke,’” said Frumkin, the former CDC special assistant.
A new report from George Mason University’s Center for Climate Change Communication lends credence to that fear.
The report authors interviewed policymakers in both the climate and health spheres to look at why there are not more programs addressing the intersection of climate and health. One major barrier, the report found, is “limited understanding of climate-health links among policymakers,” as well as “unsupportive presidential administrations.”
One Republican congressional staffer working on climate policy, kept anonymous in the report, told authors that climate action is polarizing “because people feel like it’s being injected in places it doesn’t belong, and there’s an alternative motive.”
While climate and health may have “legitimate” connections in some ways, the staffer said, they don’t always belong together.
“They [progressives] have caused it to [bake] into AOC [Alexandria Ocasio-Cortez] and the Green New Deal and this woke agenda and this big government,” the staffer said, according to the report.
That’s an argument report authors heard a lot from conservatives, said Ed Maibach, director of the university’s Center for Climate Change Communication.
“There is a deep mistrust among Republicans that the response to climate change is largely a Trojan horse to introduce progressivism and more government regulation and telling us what we can or can’t do,” said Maibach, who worked on the report.
Sarah Hunt, president of the Rainey Center for Public Policy, said that if the Trump administration eliminates the CDC’s climate program, climate and health work could continue under the agency’s other offices.
“You don’t have to look at everything from a climate lens to effectively address the impacts of climate change on health and communities,” said Hunt, whose group helps connect local government officials with health experts through its Leadership Alliance for a More Perfect Union. “Whether it is disease or extreme weather, our state and local governments will continue to respond to those as appropriate and needed for their communities. In that sense, I don’t think we need to be alarmed.”
Casalotti said members of her group NACCHO are working on climate effects even in Republican areas.
“For our members, they are clear in understanding that climate change is happening and that it is having an impact on them, but some of them also recognize that their job is to do the work, and in some places that means you can have a large climate program and in other places you keep your head down and focus on extreme weather events and vector-borne diseases,” she said.
None of the local government officials who received CDC grants wanted to talk about what they think might happen under the next Trump administration.
An interview with Virginia Guidry, who heads North Carolina’s Occupational and Environmental Epidemiology Branch, was interrupted by a press assistant with a reminder that department members “can’t talk about the new administration.”
“What I will say, though,” Guidry said, “is there is a body of scientific literature showing the health impacts of climate change. And when we use that information and we know there is health impacts from something, we need to take actions to address them and try to protect public health.”
