Cara Cook, MS, RN, AHN-BC, Director of Programs, Alliance of Nurses for Healthy Environments
Kalpana Ramiah, DrPH, MPH, MSc, CPH, Vice President of Innovation and Director of the Essential Hospitals Institute, America’s Essential Hospitals
Melissa Jones, Executive Director, Bay Area Regional Health Inequities Initiative
Erica Browne, DrPH, MPH, Program Officer, The Kresge Foundation
When The Kresge Foundation’s Climate Change, Health and Equity (CCHE) initiative launched in 2018, community power mobilization was integral because too often the people closest to viable climate resilience solutions were excluded from decisionmaking. Since then, the leadership of CCHE’s community-based, health practitioner, and health institution partners has underscored the significance of community power to transform climate policy and public health practice.
As the CCHE initiative field of practice expands and coalesces towards signals of growth, the convening, relationship building, and support provided by funders helps strengthen the national field of practice at the intersection of climate, health, and equity beyond grantmaking dollars.
Collective leadership among hospitals, public health institutions, and health practitioners can accelerate the adoption of equitable climate resilience policies and practices that promote accountability and prioritize decisionmaking among disproportionately impacted communities. CCHE partners at the Essential Hospitals Institute, Alliance of Nurses for Healthy Environments, and the Bay Area Regional Health Inequities Initiative have provided invaluable insights about the opportunities and tensions found in strengthening a national field of practice with community power at the center.
From educating health leaders to implementing equitable climate and health solutions, hospitals, public health departments, and health practitioners can contribute to a national field of practice by deepening community partnerships, promoting accountability, and creating more participatory decisionmaking opportunities that help mobilize—rather than hinder—community power and climate resilience.
Seeing Community Power as the Key to Climate Resilience Requires Organizational Shifts
The Essential Hospitals Institute (EHI) leads research, education, and leadership development for more than 300 essential hospitals that share a mission to care for all people, especially marginalized communities with systemic and structural barriers to care. While essential hospitals work with their community partners to address social determinants of health (SDoH), the impact of climate change and climate resilience being considered a SDoH is still a nascent idea. Essential hospitals are thinking about resilience in terms of survival of facilities, carbon footprint, and how best to care for members of the community during a disaster. As such, hospital leaders and staff new to equitable sustainability efforts need tailored and nuanced education.
Although hospitals have heard the call to reduce emissions, emphasizing the connection between community power, climate change, and their mission to serve communities with high rates of poverty, systemic and structural marginalization, and people with complex clinical needs is key. Using climate resilience as a first step toward mitigation may be an efficient pathway for essential hospitals to make sure they are functional during climate threats in order to serve the community. Additionally, internal infrastructure stability may be a pathway to community collaboration and integration. For example, EHI is creating resources for organizations new to this journey that includes practical guidance, such as where to start, options for actions, what to measure, and how to measure to correct the perception that reducing emissions is prohibitively expensive. A toolkit can help to share low-cost options to reduce emissions and waste in ways that align with quality care, community benefit priorities, and participatory approaches.
Because the health care sector is still learning to recognize connections between climate change, health and power, training health practitioners to support community-centered climate resilience requires navigating challenges with institutions and communities. This cultural shift is challenging to advance, and the Alliance of Nurses for Healthy Environments (ANHE) Environmental Health Nurse Fellowship supports fellows to collect data on the economic, health, and climate co-benefits that can promote institutional change in a health care sector heavily skewed towards return on investment.
Nurse fellows receive a tailored training on health equity, anti-racism, community engagement, advocacy, grant opportunities, and other relevant topics. Over the past two years, ANHE nurse fellows have collaborated with community-based organizations (CBOs) to develop health screening tools, policy advocacy toolkits, and educational resources to address health inequities related to climate change; they also continue to provide educational training within their health care institutions.
For leaders in public health and the public sector, the Bay Area Regional Health Inequities Initiative (BARHII) is providing practical strategies for senior local government equity leaders, public health departments, and CBOs to advocate for and implement equitable responses to climate-driven disasters and build long-term resilience in communities. Key to their work is a new approach to embedding equity into government decisionmaking in order to spread and scale the work, and promote the equity officer model in local, regional, state, and national settings.
For example, BARHII has established a multi-year contract with the California Department of Public Health (CDPH) to support equity officers across the state of California and will be contracting with the National Association of County and City Health Officials (NACCHO) to provide support to up to 47 other jurisdictions across the United States.
Supporting Community Partnerships Helps to Strengthen a National Field of Practice
Building a community of practice to advance collective climate resilience goals requires strong partnerships and well-resourced coalitions. For example, ANHE trains nurses to collaborate with communities on projects that tackle serious environmental health issues with equity implications. Partnerships with community-based organizations, nonprofit organizations, governmental agencies, and health institutions are leveraged throughout the year-long program. Some nurse fellows partnered with other CCHE network members, including Eastside Community Network and the Fairmount Indigo CDC Collaborative, to develop resources to support disproportionately affected communities and advocate for the implementation of equitable climate and health solutions.
ANHE also partners with Healthcare Without Harm, academic institutions, and health departments to help fellows navigate the institutional challenges they encounter when promoting and implementing climate change, health, and equity solutions. Recently, a growing number of professional nursing organizations have sought out ANHE’s support with increasing awareness among health professionals on climate change and health equity.
For the Essential Hospitals Institute, sharing knowledge and learnings developed from sustainability efforts helps to foster connections within hospitals and externally. Internally, collaboration across departments helps to build the necessary strength and cohesion to identify and achieve appropriate goals. Externally, essential hospital leaders identify and support a variety of networking and information-sharing opportunities that promote the adoption of best practices and enhance motivation for climate action. From working with utility companies, local governments, and the business sector, to partnering with community organizations to increase hospital engagement in community-wide efforts, essential hospitals benefit from strong external partnerships. The recently launched Essential Communities provides a resource for hospitals on the journey to community-integrated health care and climate resilience.
Spreading awareness about the importance of public health departments and their engagement in climate change and health equity efforts also requires strong, diverse, and mutually beneficial partnerships. For example, in collaboration with the Asian Pacific Environmental Network and the San Francisco Department of Public Health, BARHII kicked off California’s extreme heat season with a Bay Area Equity Officer learning session regarding how equity officers can play a supportive role in resilience efforts.
And equity officers are having an impact on the field: Sonoma County’s equity officer recently transformed their county’s planning process to allocate nearly $100 million in American Rescue Plan Act (ARPA) funds to center equity. A recent report prepared by BARHII in partnership with the Public Health Alliance of Southern California and Urban Resilience Strategies underscores the need to ensure that community partnership and collaboration are foundational to all climate change activities in order to achieve community-developed health equity and resilience solutions.
Although funders have recognized the importance of supporting collaboration at the intersection of climate, health, and equity, allocating funding and other resources to mobilize community power is an important next step. Funders can contribute to a national field of practice at the intersection of climate, health, and equity by building and strengthening relationships within, across, and outside our own organizations so that the decision to generously support community-determined climate resilience solutions is clear, compelling, and constant.
Resource Links
- Alliance of Nurses for Healthy Environments
- Advancing Climate Resilience and Mitigation at Essential Hospitals
- ANHE Environmental Health Nurse Fellowship
- Bay Area Regional Health Inequities Initiative
- CCHE Outcome Evaluation (Learning Cycle 2): Reflections on Cross-Strategy Activities & Progress for Health Institution and Health Practitioner Partners
- Centering Racial Justice and Health Equity: The Power of Communities to Drive Climate Policy and Practice
- Climate Change, Health and Equity (CCHE) Initiative
- Essential Communities
- Essential Hospitals Institute
- Investing at the Frontlines of Climate Change: A Funder Toolkit on Climate, Health, and Equity
- Local Health Departments and Subject Matter Experts Address Climate Change Readiness in California: Findings and Recommendations
This Views from the Field article is part of “Learning What it Takes,” a special series from The Kresge Foundation and Grantmakers In Health that explores the lessons learned from Kresge’s Climate Change, Health & Equity (CCHE) initiative. Click here to learn more.