Climate Change as a Public Health Issue

JOEL BERVELL: My guest on today’s episode of The Dose is Cameron Clarke, who works with WE ACT for Environmental Justice in New York City, where he has the Cecil Corbin-Mark Environmental Health Fellow, focused on environmental health policy, toxic exposures and disparities in asthma and respiratory diseases. He previously worked as a special assistant to the commissioner of the Baltimore City Health Department, where he developed the health department’s environmental justice outreach strategy, and as a policy researcher at Planned Parenthood Federation of America.

Originally from Jersey City, Cameron studied biology and community health education at Howard University. Earned master’s degrees in social and public policy from the University of Oxford, and is currently completing his M.D. at Columbia University College of Physicians and Surgeons. We’re recording this right now during Climate Week, and I was excited to have this conversation because climate change, environmental justice: these are critical to the health care conversation, but too often aren’t centered as health related even though climate solutions are health solutions.

Cameron, thank you so much for joining me on The Dose.

CAMERON CLARKE: Thank you so much for having me. Good to be here.

JOEL BERVELL: So last year was the hottest year on Earth in recorded history. Some cities are building various strategies to deal with the fact that temperatures on Earth are rising. And this summer the New York City Council began considering a bill that would require landlords to provide air conditioning for their tenants. We also know that Black New Yorkers are twice as likely to die from heat as white residents. So I want to start by hearing about maybe the specifics of that bill and then zoom out to understanding what kind of data is there to support that this is an environmental justice issue.

CAMERON CLARKE: Absolutely. So this bill is sort of one of a series of different bills that we’re proposing as a part of an extreme heat coalition. So we have the data that shows that extreme heat is a public health issue. And so we have a few different pieces of legislation that we want to try to address that. So obviously, we want to talk about cooling outside and access to cooling centers. But one of the things that folks aren’t always necessarily aware of is that we have a significant proportion of deaths that are occurring in New York City and in cities around the country that are in homes that may not even have access to air conditioning or in homes with air conditioning that simply can’t afford to even turn the AC on. And so this bill specifically is supposed to codify a right to cooling for tenants.

So essentially what that would do is, if you’re a tenant in New York City, there would be a requirement for your landlord to provide you with an air conditioning unit and be able to keep the unit that you’re living in to a livable standard. So that would be maybe 78 degrees or 82 degrees or some level in between that. And so what we’re trying to do is we’re trying to ensure that, in the same way that New York has a codified right to heating for tenants in the winter, that we’re providing that same standard and acknowledging that same health crisis that it would be for tenants not to have that right to cooling in the summer.

JOEL BERVELL: Absolutely. Where is that bill right now in the process within the New York City Council?

CAMERON CLARKE: Yeah, so it’s currently in the committee stages, so it’s currently being heard by committees and we have a goal to try to get . . . With all our bills, the city council is a year-round process, so the goal would be to get this bill passed ideally by the end of the year.

JOEL BERVELL: And was this crafted in a way that could be replicated in other cities? You previously worked in Baltimore. Would something like this work there? Is it necessary there as well?

CAMERON CLARKE: Absolutely. We actually based a lot of the ideas for this bill on research that was crafted in legislation in Maryland. So not in Baltimore specifically, but we looked at other sort of constituencies and other jurisdictions throughout Maryland and across the United States to try to arrive at a level of cooling that would be reasonable and adequate for landlords to be able to achieve, but would still have the health benefits that we’re looking to see for folks who are experiencing these extreme temperatures.

JOEL BERVELL: And what about the impact that air conditioning itself has on climate change? It’s what we have now, but it’s not a perfect solution overall. I guess, where does your thinking go around that?

CAMERON CLARKE: Air conditioning is great. It’s our number one recommendation for folks. If you don’t have an air conditioner and it’s hot outside, one of the main things that we encourage folks to do is get inside to an air conditioner. It’s better than shade, it’s better than fans, it’s better than public pools. It’s better than basically anything you can do in the midst of a heat wave. But I think it’s super important that you’re bringing up that air conditioners obviously have this negative impact for the climate and also a negative impact for the rest of the city when it comes to the urban heat island effect. So for all that cool air that air conditioners are pumping indoors, they’re pumping hot air out into the environment and making the surrounding area, particularly within dense urban environments, much hotter and much more uncomfortable and much more dangerous, frankly, for folks who are living in some of these communities.

And when you compound that with lack of tree cover and automotive exhaust and all of these other things and asphalt and cement and steel, you create essentially a hot box for folks who are living in these communities that make it really, really dangerous to be outside. We actually had a study a couple years ago where we took kids around from the community, we had them use sort of just air temperature monitors. And they went to Central Park and they went to East Harlem, and they found that it could get on average up to 30 degrees hotter in East Harlem than it was in Central Park. So that’s on a regular temperature day, 70 degrees. Imagine how much hotter it would be in East Harlem during some of these heat advisers that we were experiencing this summer.

JOEL BERVELL: Absolutely, I mean, that just touched on so much, but the environmental justice aspect of it too. How specifically areas that are more likely to have people of color in them often are, like you said, hotter, leading to more deaths, leading to other environmental, but also medical issues that can occur. I want to turn to your portfolio at WE ACT. Asthma affects the lives of 4 million children in 20 million adults in the United States. Those are the most recent statistics from the CDC. And people of color are disproportionately impacted. WE ACT has a 2024 asthma policy agenda. Can you talk about how that was developed?

CAMERON CLARKE: Yeah, so this was something that we wanted to do to bring together all of the different aspects of someone’s life that can be touched by asthma. So we understand, and I think a lot of folks innately understand, that if you’re living in an environment in say the South Bronx where you’re surrounded by polluting facilities, where you’re surrounded by maybe sewage treatment plants or landfills or other things that are producing compounds that you can smell and are irritating your lungs, people are more inclined to associate that with asthma exacerbations and asthma attacks. But I think one thing that people may not always necessarily be familiar with is with some of the exposures that they might have in their home. So you can have increased risk of asthma simply due to being in a home that’s infested with rats or rodents or roaches or mice. You can have increased likelihood of asthma from having poor maintenance issues in your building that can expose you to damp, mold, mildew, and other sort of toxic exposures.

And you can have increased asthma simply from having a gas burning stove in your home. So essentially what we wanted to do with this sort of asthma policy agenda was tie together all these disparate factors. So we wanted to talk about housing, transportation, education, the actual landscape of the built environment, and craft a policy agenda that connects all of these different things to environmental justice, but looks at it through the lens of asthma and is able to really capture and tell a compelling story to folks about, “Hey, your asthma could be due to any of these things.” So we have to have a holistic approach when it comes to our policy to address all of these contributing factors.

JOEL BERVELL: And speaking of some of those contributing factors, I want to focus also on persistent issues like bus pollution and other outdoor aggravators. I know, for example, that New York City has a clean bus and even a clean school bus initiative to help reduce the burden of particulate matter in the air. Are things like that working?

CAMERON CLARKE: Yeah, we actually were successful in passing a bill that would get a commitment from the city government to turn its entire school bus fleet into zero-emissions school buses. We got commitments from the MTA to turn sort of their bus fleet and start converting that bus fleet into zero-emissions public city buses. But I think one of the things that it’s really important to acknowledge is that it takes continuous pressure on these organizations to ensure that they actually follow through on their commitments. When you have an organization like the MTA or like New York City schools that’s facing such tight budgets and they’re facing all of these additional constraints, one of the things that can easily get left on the cutting room floor is an initiative that’s aspirational, like clean school buses. So it’s important, and that’s one of the things that we have sort of continuous advocates for is ensuring that these institutions are held accountable to continue to give us updates towards those progress to those standards that we set in law a few years ago.

JOEL BERVELL: What are the accountability measures for clean buses right now through that initiative?

CAMERON CLARKE: Yeah, we actually had a couple of hearings at the city council. So that’s one of the measures that we can have to hold some of those institutions accountable is bringing before the city council and asking what is the progress towards electrifying your fleet? How many buses have you electrified so far? What are the obstacles towards bringing that fleet to fully electric? A lot of times the challenges that these organizations are facing is charging infrastructure and being able to charge those fleets in a way that actually enables all of them to be electrified. We in New York, we deal a lot with Con Edison. We deal a lot with these large, quasi-public, quasi-private corporations that have these restrictions on the amount of charging that some of these fleets can receive, and that places a strain on the electrification of the fleet. So we try to both keep that continuous pressure on those organizations while also allowing for the possibility that there might be advocacy that we can do with some of these utility providers to ensure that we’re making it as easy as possible for that electrification process to continue.

JOEL BERVELL: And then how are the Upper Manhattan and Bronx benefiting? Are you focusing on specific communities, boroughs?

CAMERON CLARKE: When it comes to Upper Manhattan and The Bronx, WE ACT — we’re an organization that we were founded in Harlem, we’ve been working in northern Manhattan since the ‘80s. And so that’s always been our focus is on our community because we have been continuously adversely impacted by these emissions and we’ve understood that some of the cumulative impacts, so that’s layers and layers of emissions from different facilities stacked on top of each other, creates a situation, a health situation for our residents that is worse than the sum of its parts.

So when you’re dealing with sewage treatment plants and polluting facilities and diesel bus depots all in the same community, it creates a lot of different pollutants that are all being breathed in by our residents, that are all adversely impacting their health. So it’s not a surprise to anyone who lives here that East Harlem and the South Bronx have some of the highest rates of asthma by a factor of two greater than the rest of the city and by a factor of 10 greater than the rest of New York State. And so when we look at the advocacy that we can do, some of that advocacy is trying to fight the siting of those plants by using some of those cumulative impact calculations. But some of the advocacy is doing stuff like trying to electrify those fleets so that the facilities themselves are less harmful and less damaging to our neighborhoods.

JOEL BERVELL: Part of your agenda is also reducing barriers that makes it difficult to access medications right now. Can you talk a little bit more about what you’re doing there?

CAMERON CLARKE: Absolutely. I think one of the challenges that we face is that asthma, like any other chronic condition, you have to get medications for it, you have to receive specialty care for it, and that can make a huge difference in terms of your long-term outcomes. But just like any other person who’s touched the health care system, there can be tremendous barriers that come to accessing medication, whether that’s dealing with coinsurance or copayments or medication restrictions or prior authorizations or refill restrictions. All of these things make it incredibly difficult, both for folks who are low-income and for folks who might not have the same relationship with their physicians or the same ability to call up their doctor and say like, “Hey, I need a refill really quickly. Can you write something into the pharmacy for me?” So all of the things that we’re trying to do in this asthma policy agenda is trying to address some of those systemic barriers that are in place in front of folks in our community and make it easier for them to get the lifesaving asthma medications that they need.

So that’s stuff like removing some of those prior authorization requirements and reforming the process so that if a medication needs to be changed, the review is being done by a licensed medical professional and not somebody who has no experience in reviewing prior authorization or reviewing prescriptions. Stuff like providing assistance or payment assistance at the point of sale so that nobody is having to come out of pocket when it comes to getting their asthma medication. So nobody has to choose between groceries or asthma. And that’s stuff like making sure that the refill process is a lot more streamlined and so that if folks are ever unable to get in contact with their physician, they can still get a refill of their basic medication until the time when they can reach back out to their doctor.

JOEL BERVELL: And in terms of helping people navigate, what is, as we know, a difficult system when it comes to this, are you doing that through things like peer education? How are you reaching patients to help them understand how they can get access to lifesaving medication?

CAMERON CLARKE: Yeah, I think there’s . . . As an environmental justice organization, I think one of the things that we really try to focus is on making sure that folks have access to the resources that already exist when it comes to navigating these super complex webs. One of the things that’s in the policy agenda is sort of like a New York Health Act, which is a universal style, single-payer health program. And that would be the dream, obviously. But I think when we’re working within this existing system, one of the things that we want to do is make the existing system a little bit more bearable for people who are experiencing asthma.

So that’s why we include stuff like increasing funding for community health advocates and navigators. So folks that can take people through that process of, all right, how do we pay for this medication? Are there any programs that you might qualify for? How do you enroll in health insurance in the first place, particularly if you’re navigating the marketplace or getting insurance through your job or through some other system? So I think we’re really trying to ensure that when you’re in the position of being a parent or a guardian or a loved one of somebody who has asthma, you’re facing as little challenges as possible between you getting that diagnosis and getting your child or your loved one into a treatment plan that works for them.

JOEL BERVELL: And let’s talk for a minute now about indoor air quality. How is that defined and what are the risk factors that people can adjust to decrease their own exposure, their own risk exposure, and hopefully reduce asthma?

CAMERON CLARKE: It’s funny that you say that because indoor air quality actually isn’t defined. And that’s one of the things that we see, and that’s one of the challenges that we’re facing when we’re doing advocacy for this. The Environmental Protection Agency has extremely . . . I wouldn’t call them stringent, but they have standards for what constitutes a level of outdoor air quality that is considered to be harmful for people. Those standards actually don’t apply to indoor air. And that’s unfortunate because when we see in practice that indoor air can actually be tens or even hundreds of times more concentrated and more polluting than outdoor air because you’re dealing with an environment that’s enclosed and you’re dealing with a lot of pollution from the things that we mentioned like gas stoves, like candles, like smoking, like cigarettes, like vapors and fumes from pests, rodents, mold, mildew, all of those things. It actually creates an environment that orders of magnitude more toxic for folks.

And that when you pound that with the fact that people are spending up to 80 percent plus of their time indoors, you create a really, really terrible situation for folks who are experiencing asthma. So I think one of the things that we want to do is create some indoor air quality standards, make sure those standards are evidence-based and actually based on health outcomes, so that we can start from a baseline of actually taking care of folks’ health. But then once we have those standards, we can use them to advocate for better policies to address indoor air quality. So increasing smoking cessation programs, increasing people’s ability to access induction cooktops or electric stoves that aren’t releasing some of these volatile compounds into your indoor air. Helping folks deal with outdoor air quality emergencies.

So I was around in New York City during some of these Canadian wildfires from last summer. And one of the things that it was really hard to talk to people about is what do you do if you’re experiencing harmful levels of outdoor air quality, but your indoor air quality is also poor and you have to cook for your family? There wasn’t really a lot of good advice that we could give folks. So we ended up just telling them, shut your windows, try to use the filter on your air conditioner and try to avoid cooking as much as possible. But that’s not like a real solution. So what we need are sort of real structural solutions for folks that enable them to actually have agency in controlling and taking better advantage of the resources that exist to improve the air that they breathe.

JOEL BERVELL: You’re someone that sees the bigger picture, the links between something like asthma, respiratory health, and community ownership. Can we talk about that for a minute? Because I think it might not be an obvious connection for everyone. Can you make it clear for people?

CAMERON CLARKE: Yeah. I think one of the really critical pieces is that a lot of our communities — whether we’re talking about Harlem, whether we’re talking about the South Bronx, whether we’re talking about Washington Heights, or even areas that are outside of our specific constituency like Central Brooklyn — a lot of these communities are treated as sacrifice zones. So that means that they’re places that industries and governments and organizations go when they want to place the things that nobody else wants in their communities. And the reason that we’re able to treat these areas like sacrifice zones — I say we, but you know we don’t mean we — is that a lot of these communities, although they may have lived on this land for generations, although they may have deep, deep cultural ties and deep connections to this land, a lot of them aren’t in a position to control the land because we don’t necessarily own the land. And when we do own the land, we’re often in positions of precarity because of gentrification and displacement that is taking place in our communities. Making property taxes unaffordably high and driving out the few folks that are actually owners in their communities.

And so, one of the things that we try to do to address this is obviously we partner with organizations like Defend Harlem, the Interfaith Commission for Housing Equality that’s been sort of fighting gentrification and fighting displacement. But we also partner with organizations like Community Land Trusts. And just to explain a little bit what a Community Land Trust is, that’s essentially a group of folks within the community that have gotten together and they said, “All right, we want to own these specific plots of land and in owning those specific plots of land, we’re going to make an agreement with whoever decides to build buildings on that land that we will sell it to you. We’ll allow you to build for an affordable price, but when you decide to sell it, you have to maintain that affordable price.” So number one, we’re going to have a say in what you build there. So you can’t just build whatever you want. It has to be something that we actually are going to benefit from. But number two, the condition of permanent affordability. So that’s something that’s really . . . We don’t see it a lot in our market economy of permanent affordability, but it’s something that enables folks to stay in their communities for generations while also addressing what the critics or the proponents of gentrification will say is like, “Don’t you want to revitalize your community? Don’t you want to improve it and have nicer things?” So we’re able to get both when Community Land Trusts are operating at their best. So that’s one of the things that we’re trying to support is enabling Community Land Trusts to get access to more land and to enable folks who are maybe tenants in of these communities to have the opportunity to buy some of the land and maybe turn it into a Community Land Trust.

JOEL BERVELL: I think that’s so powerful when you’re really giving communities that need to have the power back to them and giving them the ability to hold on to, to understand what’s actually going to be happening in that area. I think a lot about just how disenfranchisement leads to health problems down the line. And there’s areas in the United States, for example, Cancer Alley in Louisiana, where people’s risk of getting cancer is actually almost nine times higher than other places because of how close they are to pollutants, and they don’t have that ability to have power in their own communities.

So redefining what power looks like and how Community Land Trusts can be a way of resisting development, I think is so powerful. So thank you so much for that work that you’re doing there. So on the docket, your organization, WE ACT, has been advocating on the behalf of residents of Upper Manhattan for decades under the leadership of Peggy Shepard. Can you talk a little bit about how that history helps when you look into the future and prioritize what the next five or even 10 years should be in terms of working with allies to positively impact conditions for people living in places where the local climate is unhealthy?

CAMERON CLARKE: When it comes to WE ACT, I think one of the larger challenges that we see is that, in the same way that communities across the country and communities across the global south are continuing to experience the adverse impacts of climate change at a level of intensity that is far, far greater than more affluent communities, that’s the exact same adverse impact that we’re going to continue to experience in Harlem if we don’t change our path.

So that means that we’re not only advocating in Harlem and at the city level, that means we’re advocating at the state level. So we’re trying to hold state governments accountable to some of the climate pledges that they have made and accelerate our transition of our public utilities away from gas and away from fossil fuels and towards renewable energy. That means that we’re continuing to advocate at the federal level. So trying to pass the Environmental Justice Act that’s been sitting in Congress and trying to make sure that we get that across the finish line to ensure that vulnerable communities, frontline communities, are receiving the bulk . . . all of the resources that they need to tackle the environmental justice issues that are happening in their homes.

And that also means that we’re advocating transnationally. So we were previously at the UNFCCC, so the Congress of Parties or the COP Conference on Climate Change, and we’re going to continue to advocate in those settings for truly just environmental solutions that enable just transitions away from fossil fuels, preserve the dignity of the communities that may have worked in the fossil fuel industry so that folks are not being left behind as we transition into our greener future, and economies that actually work for the folks that live in them as opposed to extract from the places that live there. So I think that’s the work that we’re going to continue to do, and that’s the work that has animated this organization for as long as it’s been around.

JOEL BERVELL: Amazing. Well, Cameron, thank you so much for the incredible work that you’re doing at WE ACT and for caring about communities that so often get overlooked, especially when we think about the climate space. And like I said, it’s Climate Week, and I think it’s our reminder of how important it’s to understand these intersections between climate and health. And the work that you’re doing is going to change not just current lives, but future generations. Thank you so much for being on the podcast.

CAMERON CLARKE: Thank you so much for having me.

JOEL BERVELL: This episode of The Dose was produced by Jody Becker, Mickey Capper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There, you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Joel Bervell, and thank you for listening.