BArchitectural Climate Resilience, or the ability to adapt to climate hazards, defines the U.S. Department of Health and Human Services’ response to the climate crisis. The Department’s Climate Action Plan aims to “increase resilience and adaptation to climate change throughout the Department of Health and Human Services’ operations.” The department’s main climate-related program activity is the Centers for Disease Control and Prevention’s Building Resilience to Climate Impacts, or BRACE, which “enables state health departments to develop strategies and programs to prepare for the health impacts of climate change.”
It is concerning that HHS adopted resilience as a policy without explanation or public debate. Looking more closely, building resilience: of A federal agency responsible for protecting the health of Americans in the face of climate disasters.
Ecologists first used the term resilience in the 1970s to describe the ability of non-human biological systems to adapt to hazards and disasters. The concept has since become misleading. The federal government defines it simply as “the ability to adapt to changing conditions and prepare for, withstand, and recover quickly from disruptions.” Resilience now envisions the ability of organizations, communities, and individuals to quickly return to normal operations and life after a disaster. Resilience fosters the growth of a culture of preparedness because a future defined by endless cycles of disaster and recovery requires continuous adaptation. Building climate resilience for health means adapting, withstanding, and recovering from air pollution resulting from fossil fuel burning and anthropogenic warming.
For health policymakers, building resilience to climate change poses some insurmountable challenges.
Resilience fails to acknowledge that the human health harms caused by the climate crisis are countless and inexorable, likely to affect everyone everywhere, all the time. For example, the World Health Organization concluded in 2022 that 99% of the world’s population is exposed to air pollution that threatens health. More specifically, a recent study concluded that for over 60 million Medicare beneficiaries, there is no safe exposure threshold for chronic effects of fine particulate matter (particles 2.5 micrometers in diameter or smaller), which are primarily the result of fossil fuel combustion. Another study in 2022 found that roughly 60% of known infectious diseases could be exacerbated by hazards or pathways related to climate breakdown.
Building climate resilience in health care means adapting, enduring and recovering from air pollution caused by fossil fuel burning and man-made warming.
In 2022, the Sixth Assessment Report of the United Nations Intergovernmental Panel on Climate Change concluded that if current greenhouse gas emissions are not rapidly reduced in the near future, prospects for climate-resilient development will become increasingly limited, especially if average global warming exceeds 1.5°C (2.7°F). Emissions are not declining rapidly. They are the highest on record. And for the 12 consecutive months through June, global warming averaged 1.64°C. As record-breaking temperatures continued for several consecutive months, the Secretary-General of the World Meteorological Organization (WMO) announced in March that “the WMO community is on a red alert for the world.” In a June speech, the UN Secretary-General concluded that “we need a ramp to get off the highway to climate hell.”
The problem inherent in resilience, as Brad Evans, Julian Reid, and Sarah Bracke explained over a decade ago, is that it is a cause, not a solution. Resilience assumes that hazards and disasters are endemic and a fait accompli. Climate disasters are beyond our control and are accepted as acceptable. As such, resilience makes us fearful of the future and denies us the ability to imagine a future beyond climate breakdown. In a context where our lives are constantly at risk and cannot be secured, resilience is a form of subjectivization that denies human agency.
Moreover, minorities are the least climate resilient. They bear the greatest climate penalty. They are forced to accept their conditions of vulnerability. In effect, resilience creates populations that are permanently exposed to climate risk. Climate apartheid is the norm.
A life constantly exposed to climate disasters, and having to adapt or respond to climate threats, is, in a word, exhausting. In his book Learning to Die in the Anthropocene, Roy Scranton describes it as “continuing to act as if tomorrow would be the same as yesterday, investing more and more desperately in a way of life that is less prepared and less sustainable with each new disaster.” No wonder Ajay Singh Chaudhary titled his recent study of climate policy “An Exhausted Earth.” Chaudhary writes, “Resilience is an imperative for business as usual, for emergency managers to buy time. For others, resilience is Tired.”
Resilience itself may pose a significant threat. If successful, resilience may become indistinguishable from the climate disaster it was intended to overcome. For example, in the health care sector, Medicaid and other payers recently decided to pay for air conditioning, but perhaps they will also pay for the carbon pollution it emits.
Resilience is inherently reactionary and teaches apathy, fatalism, and a distorted optimism, because cultivating resilience makes it impossible to achieve desired futures or imagine a changing world. Life lacks coherence, what medical sociologist Aaron Antonovsky calls healthogenesis. In doing so, resilience negates or at least weakens resistance and efforts to prevent climate disaster. Resistance is futile, because climate threats and disasters are, after all, inevitable.
Resilience is an attractive political policy because it gives permission for a world hit by climate disaster. Human life, like non-human living systems, is a perpetual process of ongoing adaptation to disaster. As Evans and Reid wrote in 2013, policymakers “want us to abandon dreams of achieving safety and accept risk as a condition of possibility for future life.” Ecological disasters are considered necessary for our development. In the words of philosopher Frederic Jameson, “it is easier to imagine the end of the world than the end of capitalism.” Chaudhary argued that resilience justifies exploitative resource use and environmental degradation. “Clinging to the ideal of resilience only preserves a world that demands it.”
Resilience negates or at least weakens resistance and efforts to prevent climate disasters. Resistance is futile, since climate threats and disasters are, after all, inevitable.
With resilience, there would be virtually no climate crisis. There would be no need for direct federal funding to reduce greenhouse gas emissions, nor for strict federal regulations. Instead, as Adrian Buller explains in his 2022 book The Value of Whales, a combination of deregulation and prioritization of market efficiency is the superior approach to climate policy. Resilience, Evan and Reid conclude, enables a “political imagination that refuses to imagine anything other than the bleak status quo of the political landscape.” Resilience is nihilism, a will to nothing, governance without values. Chaudhary defined resilience as politically inert, since it merely “advises stasis and frugal austerity.”
For HHS, resilience as policy explains why the department, under Biden, has been unable to issue Medicare or Medicaid regulatory rules requiring the health care industry to reduce greenhouse gas emissions or improve climate-related care, for example by creating specific climate-related diagnosis codes or quality performance indicators. It is cruelly ironic that HHS allows the health care industry to emit an estimated 553 million metric tons (610 million metric tons) of greenhouse gases annually, because these emissions disproportionately harm Medicare and Medicaid beneficiaries. HHS’s mission is to “improve the health and well-being of all Americans,” yet resilience allows the department to simply issue monthly climate and health outlooks that forecast how public health will be harmed by inevitable climate disasters. According to the June report, HHS’s responsibility is to point out that “tornadoes can occur anywhere at any time,” “there are many different types of flooding,” “the 2024 Atlantic hurricane season is predicted to be ‘above normal,'” and “wildfires impact health in many different ways.”
For HHS, climate resilience would put the department in its own peril. For the American people, it would be despair.
Dr. David Introcaso is a medical research and policy consultant.
