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22 June 21
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Robert Reich | America's Greatest Danger Isn't China. It's Much Closer to Home.
Robert Reich, Robert Reich's Blog
Reich writes: "China's increasingly aggressive geopolitical and economic stance in the world is unleashing a fierce bipartisan backlash in America. That's fine if it leads to more public investment in basic research, education, and infrastructure. [...] But it poses dangers as well."
More than 60 years ago, the sudden and palpable fear that the Soviet Union was lurching ahead of us shook America out of a postwar complacency and caused the nation to do what it should have been doing for many years. Even though we did it under the pretext of national defense – we called it the National Defense Education Act and the National Defense Highway Act and relied on the Defense Advanced Research Projects Administration for basic research leading to semiconductors, satellite technology, and the Internet – the result was to boost US productivity and American wages for a generation.
When the Soviet Union began to implode, America found its next foil in Japan. Japanese-made cars were taking market share away from the Big Three automakers. Meanwhile, Mitsubishi bought a substantial interest in the Rockefeller Center, Sony purchased Columbia Pictures, and Nintendo considered buying the Seattle Mariners. By the late 1980s and start of the 1990s, countless congressional hearings were held on the Japanese “challenge” to American competitiveness and the Japanese “threat” to American jobs.
A tide of books demonized Japan – Pat Choate’s Agents of Influence alleged Tokyo’s alleged payoffs to influential Americans were designed to achieve “effective political domination over the United States.“ Clyde Prestowitz’s Trading Places argued that because of our failure to respond adequately to the Japanese challenge “the power of the United States and the quality of American life is diminishing rapidly in every respect.” William S Dietrich’s In the Shadow of the Rising Sun claimed Japan “threatens our way of life and ultimately our freedoms as much as past dangers from Nazi Germany and the Soviet Union.“
Robert Zielinski and Nigel Holloway’s Unequal Equities argued that Japan rigged its capital markets to undermine American corporations. Daniel Burstein’s Yen! Japan’s New Financial Empire and Its Threat to America asserted that Japan’s growing power put the United States at risk of falling prey to a “hostile Japanese … world order.”
And on it went: The Japanese Power Game,The Coming War with Japan, Zaibatsu America: How Japanese Firms are Colonizing Vital US Industries, The Silent War, Trade Wars.
But there was no vicious plot. We failed to notice that Japan had invested heavily in its own education and infrastructure – which enabled it to make high-quality products that American consumers wanted to buy. We didn’t see that our own financial system resembled a casino and demanded immediate profits. We overlooked that our educational system left almost 80% of our young people unable to comprehend a news magazine and many others unprepared for work. And our infrastructure of unsafe bridges and potholed roads were draining our productivity.
In the present case of China, the geopolitical rivalry is palpable. Yet at the same time, American corporations and investors are quietly making bundles by running low-wage factories there and selling technology to their Chinese “partners.” And American banks and venture capitalists are busily underwriting deals in China.
I don’t mean to downplay the challenge China represents to the United States. But throughout America’s postwar history it has been easier to blame others than to blame ourselves.
The greatest danger we face today is not coming from China. It is our drift toward proto-fascism. We must be careful not to demonize China so much that we encourage a new paranoia that further distorts our priorities, encourages nativism and xenophobia, and leads to larger military outlays rather than public investments in education, infrastructure, and basic research on which America’s future prosperity and security critically depend.
The central question for America – an ever more diverse America, whose economy and culture are rapidly fusing with the economies and cultures of the rest of the globe – is whether it is possible to rediscover our identity and our mutual responsibility without creating another enemy.
Mitch McConnell. (photo: CNN)
Senate Republicans Are Poised to Block a Sweeping Elections and Ethics Bill. Now What?
Susan Davis and Rachel Treisman, NPR
Excerpt: "The U.S. Senate will vote today on new election rules, in the form of a Democratic-led proposal called the For the People Act."
The bill, which passed the House in March, would make sweeping changes to the voting process and many aspects of campaign finance and ethics laws.
Democrats consider it such a high priority that they made it Senate Bill 1, the first of the year. Republican lawmakers are calling it a power play, even though many red states are enacting new voting requirements of their own.
Montana Sen. Jon Tester, a Democrat who supports the bill, acknowledges that voting is generally a state issue but says it’s important to set federal standards for things like increasing access to the polls and transparency in campaign finance.
“If we’re going to have a democracy that works, we need to have the voices at the polls from everybody, not just a select few,” he said. Listen to his interview with Steve Inskeep.
The bill is all but destined to fall short of the 60 votes needed to overcome a GOP filibuster. So what happens next? More on that here, and key takeaways below.
What would this bill do? A lot. Some examples: expand voter registration options as well as mail-in and early voting, require more disclosure for political advertisements and donations, set new ethics requirements for Supreme Court justices, require presidential candidates to disclose up to 10 years of their tax returns, and charge independent commissions with congressional redistricting.
Why are Republicans opposed? They say the bill would exert more federal control over elections; indeed, some of its provisions would likely be challenged in court. They also point to the record turnout of the 2020 election, and the fact that the ultimate vote count was not in doubt, to argue that barriers to voting don't need such a sweeping remedy.
Is compromise possible? Unlikely. Democrats see voting rights as a fundamental issue and are reluctant to budge on most major provisions of the bill. This legislation was first drafted by Democrats without any Republican input during the Trump era, in large part to address what Democrats saw as abuses of power. Republicans believe Democrats are using the legislation to give their party an edge in future elections and argue many of the provisions are constitutionally questionable.
What does this mean for the filibuster? The White House said this week that Democrats may revisit filibuster rules if the vote fails, though the party still lacks unanimous support for eliminating it.
If you want to learn more, our congressional correspondent Susan Davis offers details here.
Soldiers. (photo: PA)
Rebecca Gordon | Social Security Versus National Security: Whose Entitlement Really Makes Us Safer?
Rebecca Gordon, TomDispatch
Gordon writes: "The U.S. 'national security' budget is still the third rail of politics in this country."
As French journalist and novelist Anatole France so aptly wrote in his 1894 novel The Red Lily, “In its majestic equality, the law forbids rich and poor alike to sleep under bridges, beg in the streets, and steal loaves of bread.” More than a century and a quarter later, that could easily have been written by Mitch McConnell and pals, or just about any Republican president since Ronald Reagan. Yes, the law couldn’t be more equal for the rich and the poor when it comes to sleeping under bridges, just not, in the America of 2021, when it comes to taxes and wealth.
If you want a slogan for our moment, how about “Inequality Is Us”? After all, in terms of wealth and income, things have been growing ever less equal in recent decades. In 2017, Donald Trump and Mitch McConnell did their best to give away the shop to America’s wealthiest crew, offering them, and the corporations they’re often associated with, tax cuts from heaven, a genuine “windfall” for the 1%. And America’s billionaires responded appropriately by making an almost inconceivable further fortune amid the devastation of the Covid-19 pandemic.
As for the U.S. military, it’s now a money-making operation of the first order and I’m not just thinking about the way the Pentagon budget always rises (even when Congress hasn’t been able to fund the most basic American infrastructure), amid almost 20 years of failing wars in distant lands. I mean, just consider a figure like Secretary of Defense Lloyd Austin, who at one point commanded this country’s disastrous military operations in Iraq and then, as the head of U.S. Central Command, oversaw most of our losing wars. In 2016, he “retired” from the military, only to join the board of directors of the weapons maker Raytheon. In the process, he would reportedly rake in somewhere between $800,000 and $1.7 million, thanks to stocks he received from that outfit and two spinoff companies before heading back through that classic military-industrial-congressional revolving door to Washington to work for President Biden.
It’s in this context that TomDispatch regular Rebecca Gordon considers what the true third rails of American politics are. Watch out, if you’re a politician, you don’t want to touch either of them!
-Tom Engelhardt, TomDispatch
hese days my conversations with friends about the new administration go something like this:
“Biden’s doing better than I thought he would.”
“Yeah. Vaccinations, infrastructure, acknowledging racism in policing. A lot of pieces of the Green New Deal, without calling it that. The child subsidies. It’s kind of amazing.”
“But on the military–”
“Yeah, same old, same old.”
As my friends and I have noticed, President Joe Biden remains super-glued to the same old post-World War II agreement between the two major parties: they can differ vastly on domestic policies, but they remain united when it comes to projecting U.S. military power around the world and to the government spending that sustains it. In other words, the U.S. “national security” budget is still the third rail of politics in this country.
Assaulting the Old New Deal
It was Democratic House Speaker Tip O’Neill who first declared that Social Security is “the third rail” of American politics. In doing so, he metaphorically pointed to the high-voltage rail that runs between the tracks of subways and other light-rail systems. Touch that and you’ll electrocute yourself.
O’Neill made that observation back in 1981, early in Ronald Reagan’s first presidential term, at a moment when the new guy in Washington was already hell-bent on dismantling Franklin Delano Roosevelt’s New Deal legacy.
Reagan would fight his campaign to do so on two key fronts. First, he would attack labor unions, whose power had expanded in the years since the 1935 Wagner Act (officially the National Labor Relations Act) guaranteed workers the right to bargain collectively with their employers over wages and workplace rules. Such organizing rights had been hard-won indeed. Not a few workers died at the hands of the police or domestic mercenaries like Pinkerton agents, especially in the early 1930s. By the mid-1950s, union membership would peak at around 35% of workers, while wages would continue to grow into the late 1970s, when they stagnated and began their long decline.
Reagan’s campaign began with an attack on PATCO, a union of well-paid professionals — federally-employed air-traffic controllers — which his National Labor Relations Board eventually decertified. That initial move signaled the Republican Party’s willingness, even enthusiasm, for breaking with decades of bipartisan support for organized labor. By the time Donald Trump took office in the next century, it was a given that Republicans would openly support anti-union measures like federal “right-to-work” laws, which, if passed, would make it illegal for employers to agree to a union-only workplace and so effectively destroy the bargaining power of unions. (Fortunately, opponents were able to forestall that move during Trump’s presidency, but in February 2021, Republicans reintroduced their National Right To Work Act.)
The Second Front and the Third Rail
There was a second front in Reagan’s war on the New Deal. He targeted a group of programs from that era that came to be known collectively as “entitlements.” Three of the most important were Aid to Dependent Children, unemployment insurance, and Social Security. In addition, in 1965, a Democratic Congress had added a healthcare entitlement, Medicare, which helps cover medical expenses for those over 65 and younger people with specific chronic conditions, as well as Medicaid, which does the same for poor people who qualify. These, too, would soon be in the Republican gunsights.
The story of Reagan’s racially inflected attacks on welfare programs is well-known. His administration’s urge to go after unemployment insurance, which provided payments to laid-off workers, was less commonly acknowledged. In language eerily echoed by Republican congressional representatives today, the Reagan administration sought to reduce the length of unemployment benefits, so that workers would be forced to take any job at any wage. A 1981 New York Times report, for instance, quoted Reagan Assistant Secretary of Labor Albert Agrisani as saying:
“‘The bottom line… is that we have developed two standards of work, available work and desirable work.’ Because of the availability of unemployment insurance and extended benefits, he said, ‘there are jobs out there that people don’t want to take.’”
Reagan did indeed get his way with unemployment insurance, but when he turned his sights on Social Security, he touched Tip O’Neill’s third rail.
Unlike welfare, whose recipients are often framed as lazy moochers, and unemployment benefits, which critics claim keep people from working, Social Security was then and remains today a hugely popular program. Because workers contribute to the fund with every paycheck and usually collect benefits only after retirement, beneficiaries appear deserving in the public eye. Of all the entitlement programs, it’s the one most Americans believe that they and their compatriots are genuinely entitled to. They’ve earned it. They deserve it.
So, when the president moved to reduce Social Security benefits, ostensibly to offset a rising deficit in its fund, he was shocked by the near-unanimous bipartisan resistance he met. His White House put together a plan to cut $80 billion over five years by — among other things — immediately cutting benefits and raising the age at which people could begin fully collecting them. Under that plan, a worker who retired early at 62 and was entitled to $248 a month would suddenly see that payout reduced to $162.
Access to early retirement was, and remains, a justice issue for workers with shorter life expectancies — especially when those lives have been shortened by the hazards of the work they do. As South Carolina Republican Congressman Carroll Campbell complained to the White House at the time: “I’ve got thousands of sixty-year-old textile workers who think it’s the end of the world. What the hell am I supposed to tell them?”
After the Senate voted 96-0 to oppose any plan that would “precipitously and unfairly reduce early retirees’ benefits,” the Reagan administration regrouped and worked out a compromise with O’Neill and the Democrats. Economist (later Federal Reserve chair) Alan Greenspan would lead a commission that put together a plan, approved in 1983, to gradually raise the full retirement age, increase the premiums paid by self-employed workers, start taxing benefits received by people with high incomes, and delay cost-of-living adjustments. Those changes were rolled out gradually, the country adjusted, and no politicians were electrocuted in the process.
Panic! The System Is Going Broke!
With its monies maintained in a separately sequestered trust fund, Social Security, unlike most government programs, is designed to be self-sustaining. Periodically, as economist and New York Times columnist Paul Krugman might put it, serious politicians claim to be concerned about that fund running out of money. There’s a dirty little secret that those right-wing deficit slayers never tell you, though: when the Social Security trust fund runs a surplus, as it did from 1983 to 2009, it’s required to invest it in government bonds, indirectly helping to underwrite the federal government’s general fund.
They also aren’t going to mention that one group who contributes to that surplus will never see a penny in benefits: undocumented immigrant workers who pay into the system but won’t ever collect Social Security. Indeed, in 2016, such workers provided an estimated $13 billion out of about $957 billion in Social Security taxes, or almost 3% of total revenues. That may not sound like much, but over the years it adds up. In that way, undocumented workers help subsidize the trust fund and, in surplus years, the entire government.
How, then, is Social Security funded? Each year, employees contribute 6.2% of their wages (up to a cap amount). Employers match that, for a total of 12.4% of wages paid, and both put out another 1.45% each for Medicare. Self-employed people pay both shares or a total of 15.3% of their income, including Medicare. And those contributions add up to about nine-tenths of the fund’s annual income (89% in 2019). The rest comes from interest on government bonds.
So, is the Social Security system finally in trouble? It could be. When the benefits due to a growing number of retirees exceed the fund’s income, its administrators will have to dip into its reserves to make up the difference. As people born in the post-World War II baby boom reach retirement, at a moment when the American population is beginning to age rapidly, dire predictions are resounding about the potential bankruptcy of the system. And there is, in fact, a consensus that the fund will begin drawing down its reserves, possibly starting this year, and could exhaust them as soon as 2034. At that point, relying only on the current year’s income to pay benefits could reduce Social Security payouts to perhaps 79% of what’s promised at present.
You can already hear the cries that the system is going broke!
But it doesn’t have to be that way. Employees and employers only pay Social Security tax on income up to a certain cap. This year it’s $142,800. In other words, employees who make a million dollars in 2021 will contribute no more to Social Security than those who make $142,800. To rescue Social Security, all it would take is raising that cap — or better yet, removing it altogether.
In fact, the Congressional Budget Office has run the numbers and identified two different methods of raising it to eventually tax all wage income. Either would keep the trust fund solvent.
Naturally, plutocrats and their congressional minions don’t want to raise the Social Security cap. They’d rather starve the entitlement beast and blame possible shortfalls on greedy boomers who grew up addicted to government handouts. Under the circumstances, we, and succeeding generations, had better hope that Social Security remains, as it was in 1981, the third rail in American politics.
Welfare for Weapons Makers
Of course, there’s a second high-voltage, untouchable rail in American politics and that’s funding for the military and weapons manufacturers. It takes a brave politician indeed to suggest even the most minor of reductions in Pentagon spending, which has for years been the single largest item of discretionary spending in the federal budget.
It’s notoriously difficult to identify how much money the government actually spends annually on the military. President Trump’s last Pentagon budget, for the fiscal year ending on September 30th, offered about $740 billion to the armed services (not including outlays for veteran services and pensions). Or maybe it was only $705.4 billion. Or perhaps, including Department of Energy outlays involving nuclear weapons, $753.5 billion. (And none of those figures even faintly reflected full national-security spending, which is certainly well over a trillion dollars annually.)
Most estimates put President Biden’s 2022 military budget at $753 billion — about the same as Trump’s for the previous year. As former Senator Everett Dirksen is once supposed to have said, “A billion here, a billion there, and pretty soon you’re talking real money.”
Indeed, we’re talking real money and real entitlements here that can’t be touched in Washington without risking political electrocution. Unlike actual citizens, U.S. arms manufacturers seem entitled to ever-increasing government subsidies — welfare for weapons, if you like. Beyond the billions spent to directly fund the development and purchase of various weapons systems, every time the government permits arms sales to other countries, it’s expanding the coffers of companies like Lockheed-Martin, Northrup-Grumman, Boeing, and Raytheon Technologies. The real beneficiaries of Donald Trump’s so-called Abraham Accords between Israel and the majority Muslim states of Morocco, the United Arab Emirates, Bahrain, and Sudan were the U.S. companies that sell the weaponry that sweetened those deals for Israel’s new friends.
When Americans talk about undeserved entitlements, they’re usually thinking about welfare for families, not welfare for arms manufacturers. But military entitlements make the annual federal appropriation of $16.5 billion for Temporary Aid to Needy Families (TANF) look puny by comparison. In fact, during Republican and Democratic administrations alike, the yearly federal outlay for TANF hasn’t changed since it was established through the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, known in the Clinton era as “welfare reform.” Inflation has, however, eroded its value by about 40% in the intervening years.
And what do Americans get for those billions no one dares to question? National security, right?
But how is it that the country that spends more on “defense” than the next seven, or possibly 10, countries combined is so insecure that every year’s Pentagon budget must exceed the last one? Why is it that, despite those billions for military entitlements, our critical infrastructure, including hospitals, gas pipelines, and subways (not to mention Cape Cod steamships), lies exposed to hackers?
And if, thanks to that “defense” budget, we’re so secure, why is it that, in my wealthy home city of San Francisco, residents now stand patiently in lines many blocks long to receive boxes of groceries? Why is “national security” more important than food security, or health security, or housing security? Or, to put it another way, which would you rather be entitled to: food, housing, education, and healthcare, or your personal share of a shiny new hypersonic missile?
But wait! Maybe defense spending contributes to our economic security by creating, as Donald Trump boasted in promoting his arms deals with Saudi Arabia, “jobs, jobs, jobs.” It’s true that spending on weaponry does, in fact, create jobs, just not nearly as many as investing taxpayer dollars in a variety of far less lethal endeavors would. As Brown University’s Costs of War project reports:
“Military spending creates fewer jobs than the same amount of money would have, if invested in other sectors. Clean energy and health care spending create 50% more jobs than the equivalent amount of spending on the military. Education spending creates more than twice as many jobs.”
It seems that President Joe Biden is ready to shake things up by attacking child poverty, the coronavirus pandemic, and climate change, even if he has to do it without any Republican support. But he’s still hewing to the old Cold War bipartisan alliance when it comes to the real third rail of American politics — military spending. Until the power can be cut to that metaphorical conduit, real national security remains an elusive dream.
Follow TomDispatch on Twitter and join us on Facebook. Check out the newest Dispatch Books, John Feffer’s new dystopian novel, Songlands (the final one in his Splinterlands series), Beverly Gologorsky’s novel Every Body Has a Story, and Tom Engelhardt’s A Nation Unmade by War, as well as Alfred McCoy’s In the Shadows of the American Century: The Rise and Decline of U.S. Global Power and John Dower’s The Violent American Century: War and Terror Since World War II.
Rebecca Gordon, a TomDispatch regular, teaches at the University of San Francisco. She is the author of American Nuremberg: The U.S. Officials Who Should Stand Trial for Post-9/11 War Crimes and is now at work on a new book on the history of torture in the United States.
An employee checks the chamber of an assault-style rifle at a shooting range. (photo: Jewel Samad/AFP/Getty Images)
Federal Appeals Court Blocks Repeal of California's 30-Year Assault Weapons Ban
Rebecca Falconer, Axios
Falconer writes: "California has one of the lowest firearm mortality rates in the U.S."
federal appeals court on Monday blocked a judge's ruling that overturned California's 30-year assault weapons ban.
Driving the news: U.S. District Judge Roger Benitez ruled earlier this month that the ban was unconstitutional and likened the AR-15 to a Swiss Army knife, but the U.S. 9th Circuit Court of Appeals has now granted a stay, pending appeal.
- This stay issued by the three-judge panel is "pending decisions in other gun cases that are now before the court," the Los Angeles Times notes.
Why it matters: California has one of the lowest firearm mortality rates in the U.S., and Gov. Gavin Newsom (D) and Attorney General Rob Bonta cited this fact as proof that the state's law worked.
- Bonta, who filed the appeal against Benitez's ruling, welcomed the judges' decision in a statement issued to Twitter:
Transgender veteran Charlotte Clymer speaks at a rally in Washington, D.C. (photo: Joy Asico/AP/Shutterstock)
VA to Cover Gender-Confirmation Surgery for Transgender Veterans for the First Time
Daniel Politi, Slate
Politi writes: "The Department of Veterans Affairs will be launching a process to start providing gender-confirmation surgery to veterans through its health care coverage."
READ MORE
Raisi became Iran's eighth president in an election on Friday. (photo: Atta Kenare/AFP)
ALSO SEE: Iran's President-Elect Addresses Ties to Mass Executions by
Saying It Was in Defence of Human Rights
Iran: Ebrahim Raisi Must Be Investigated for Crimes Against Humanity
Amnesty International
Excerpt: "In 2018, our organization documented how Ebrahim Raisi had been a member of the 'death commission' which forcibly disappeared and extrajudicially executed in secret thousands of political dissidents in Evin and Gohardasht prisons near Tehran in 1988."
esponding to today’s announcement declaring Ebrahim Raisi as Iran’s next president, Amnesty International’s Secretary General Agnès Callamard said:
“That Ebrahim Raisi has risen to the presidency instead of being investigated for the crimes against humanity of murder, enforced disappearance and torture, is a grim reminder that impunity reigns supreme in Iran. In 2018, our organization documented how Ebrahim Raisi had been a member of the ‘death commission’ which forcibly disappeared and extrajudicially executed in secret thousands of political dissidents in Evin and Gohardasht prisons near Tehran in 1988. The circumstances surrounding the fate of the victims and the whereabouts of their bodies are, to this day, systematically concealed by the Iranian authorities, amounting to ongoing crimes against humanity.
‘As Head of the Iranian Judiciary, Ebrahim Raisi has presided over a spiralling crackdown on human rights which has seen hundreds of peaceful dissidents, human rights defenders and members of persecuted minority groups arbitrarily detained. Under his watch, the judiciary has also granted blanket impunity to government officials and security forces responsible for unlawfully killing hundreds of men, women and children and subjecting thousands of protesters to mass arrests and at least hundreds to enforced disappearance, and torture and other ill-treatment during and in the aftermath of the nationwide protests of November 2019.
“Ebrahim Raisi’s rise to the presidency follows an electoral process that was conducted in a highly repressive environment and barred women, members of religious minorities and candidates with opposing views from running for office.
“We continue to call for Ebrahim Raisi to be investigated for his involvement in past and ongoing crimes under international law, including by states that exercise universal jurisdiction.
“It is now more urgent than ever for member states of the UN Human Rights Council to take concrete steps to address the crisis of systematic impunity in Iran including by establishing an impartial mechanism to collect and analyse evidence of the most serious crimes under international law committed in Iran to facilitate fair and independent criminal proceedings.”
For more information see:
Iran: Presidency of Ebrahim Raisi a grim reminder of the crisis of impunity
Dr. Anthony Fauci. (photo: Greg Nash/Getty Images)
The Search for the Dr. Fauci of Climate Change
Clare Fieseler, Grist
Excerpt: "A growing number of physicians are trying to transform the medical profession to meet the health challenges posed by climate change."
t’s easy to think about the global climate crisis in the abstract. Ella Adoo-Kissi-Debrah’s death gave it a face. The 9-year-old girl’s fatal asthma attack might have passed without public notice except for the fact that, after a long legal fight, it became the first British death officially attributed to fossil fuel-caused air pollution. When she died in 2013, no doctors mentioned environmental causes. Had her mother known that their southeast London neighborhood’s air was so toxic — and could worsen with dramatic temperature change — she said she would have moved the family somewhere safer.
The question remains: Did the medical profession have a responsibility to tell her?
Preventing this kind of tragedy, most doctors and medical associations now agree, starts with better training. In the U.S., where recent research has found that one in ten premature deaths are caused by air-polluting fossil fuels, medical schools have only begun grappling with a lack of curricula focused on climate change in the last couple of years. Now, a small group of physicians are arguing that only a broader reckoning can help their profession meet the challenge posed by climate change.
“In the mind of the public, health and climate change represent different and separate realms of knowledge and concern,” laments the latest annual report on health and climate change published by the leading medical journal The Lancet earlier this year. The report, which has become the most globally respected pulse-taking of human health in a changing climate since its first publication after the 2016 Paris Agreement, shows just how high the stakes are.
The paper says that climate change is already affecting human health in every country on earth. It’s worsening the spread of infectious diseases, like dengue across South America, increasing the possibility of global pandemics in the near future. Continued reliance on fossil fuels is causing 7 million additional deaths worldwide from air pollution, and extreme heat is killing more people than ever before.
In 2018, about 280,000 people died from extreme heat worldwide, a nearly 55 percent increase from 20 years ago. Europe’s aging population remains the most vulnerable to heat exposure overall, as the continent endures heatwaves made 10 percent worse by climate change. Conditions in China and India, which lost 62,000 and 31,000 people to heat in 2018, respectively, are raising new red flags. The past five years have been the hottest on record for the planet, with 2020 being an especially hot and deadly year in the American Southwest, according to reporting by NPR. Arizona alone reported 494 heat-related deaths, its worst annual toll ever.
Americans are already showing up in emergency rooms with more surprising climate-related ailments, too — like diarrhea.
In New Jersey, over 47,000 people were hospitalized for gastrointestinal illness between 2009 and 2013. That didn’t raise eyebrows until years later, when state researchers looked at these numbers next to weather data. They found a strong link between where these patients lived, how they sourced their water, and really heavy rains. The 2017 study concluded that New Jersey’s surface water systems, like reservoirs, were being contaminated by worsening deluges. The growing belief is that the state’s old water systems weren’t built for new extreme rain — and that this is what gave New Jersey residents, and kids under five especially, the kind of diarrhea that lands someone in the ER.
Detecting the fingerprints of climate change on local weather events is tricky, but dire climate predictions are motivating similar drinking water studies in other states that are getting wetter. In Massachusetts, ERs saw a spike of severe diarrhea cases after extreme rain fell in towns with especially vulnerable sewer system designs. In Georgia, very extreme rains since 1997 have been linked to salmonella infections. The U.S. National Climate Assessment predicts that all three of these states will see more rainfall in the coming decades as a direct result of climate change — and that will put more pressure on their municipal water systems.
Physicians can make a difference in cases like these. With the knowledge that these outcomes are increasingly likely, they could recommend potentially life-saving precautions like filtering water when heavy rains won’t relent.
But most physicians have not been trained to make the connection between disease and a changing environment — or to prepare patients for the fact that what made them sick may soon get worse.
In 2019, the American Medical Association, or AMA, called for climate education across all levels of medical training, and over 70 health care organizations declared climate change a “health emergency.” Senior physicians are debating the merits of this shift in focus, with at least one former medical school dean lambasting climate-focused medical education, aligning it with “woke” culture in the Wall Street Journal. (Multiple medical associations later rebuked him.)
The AMA’s new policy focuses on providing rising doctors with the “basic knowledge” about climate change so they can “counsel” patients about its health impacts.
“It’s not just about the patient-physician relationship,” said Dr. Jay Lemery, an emergency medicine physician and professor at the University of Colorado School of Medicine. He believes a doctor’s job confronting climate change is equal parts clinician and advocate. To help newly certified doctors step into this role, Lemery started the first and only climate-focused medical education fellowship in the country in 2017.
Lemery is a self-described “climate doctor” who came into the work by getting out of the hospital and into nature. While in medical school, he took a class where he spent five days at 10,000-foot altitudes in the Rocky Mountains and then three weeks on the Colorado River, learning what it takes to treat patients in remote locations.
After the class, Lemery was hooked on wilderness medicine. In 2004, he approached the president of the Wilderness Medical Society about spearheading a new committee that would train more young doctors like himself. “I developed this self-proclaimed dual mandate,” he said, “taking care of people in remote places, but also as an advocate for the beauty of those remote places.” Lemery’s “aha moment” in advocacy came while ascending the leadership ranks at the Wilderness Medical Society in the early 2000s.
As he became more involved in wilderness medicine, he envisioned its doctors, with their singular science communication training, as the perfect advocates for “the facts of science.” Their wilderness workplaces already showed the visible marks of human-caused climate change. But when Lemery became the Society’s president in 2012, members did not rally around his doctors-as-advocates vision.
“A lot of the clinicians were like, ‘You know, I’m in this to learn how to take people off scary mountain ledges. And this other stuff — advocacy — I’m not so into,” recalled Lemery. “That was kind of a bummer.”
Lemery’s tenure as president of the Wilderness Medical Society ended in 2014. But, for him, wilderness medicine became a model for what he started calling “climate medicine.” Wilderness medicine itself is fairly new. It only coalesced as a clinical practice in the 1980s from previously piecemeal medical knowledge.
“Wildness medicine pulled in disparate, almost orphaned concepts: survival in the Arctic, snakebites, and providing care on submarines,” said Lemery. “Common concepts began to emerge from there.” He envisions climate medicine similarly uniting siloed concepts like “disaster medicine” and “treating vulnerable populations.”
Treating climate medicine as an umbrella concept that has currency among medical professionals might begin to solve its funding dilemma. Currently, the U.S. has no major money pot for developing a climate and health workforce. The National Institutes of Health, or NIH, has a $40 billion budget but less than 0.025 percent goes to climate-related efforts. (President Joe Biden hopes to change that: His recent budget proposal calls for directing $110 million to climate-related health research at the NIH, as well as an additional $110 million for similar purposes at the Centers for Disease Control and Prevention.)
To overcome this hurdle, Lemery and his faculty partner at the University of Colorado turned to private money. Lemery took a Denver-based benefactor with a small group to Greenland’s Ilulissat ice fjord for a formative moment in a remote and endangered place. Melted ice dumped dramatically into the sea below. According to Lemery, that’s when the benefactor said simply, “Okay, how do we work together?”
That underwriting, from the Living Closer Foundation, led to the country’s first climate and health training fellowship for physicians. The fellowship has annually funded the salary and training of one emergency medical doctor who does rotations in the ER, treating patients with an eye to the climate-related issues they face, like the state’s historic wildfires. Fellows also receive frontline climate disaster training by visiting hurricane-hit communities. Others experience the “sausage-making” of climate policy consensus-building: One fellow co-authored the country’s leading climate change report, the U.S. National Climate Assessment. The program’s goal, as Lemery and his colleagues wrote in a recent article for the journal Science Diplomacy, is to create “physicians proficient and credible in climate and health science to assume leadership, disseminate knowledge, and influence policy.”
Think Dr. Anthony Fauci — but for climate change.
The first graduate of the program, Cecilia Sorenson, works as a New York City-based ER doctor but also spends time in the sugarcane fields of Guatemala. Last year she co-authored two studies that linked a mysterious kidney disease plaguing sugarcane workers to rising temperatures in the region. Her path responds to one of Lemery’s key teachings: Climate change is a disease of vulnerability.
A new fellowship class starts next month. It will support five doctors instead of just one, and the focus on policy has grown, thanks to the Biden administration’s interest in climate-focused policy. The administration has invited these University of Colorado medical fellows into the federal government: Each fellow will now be embedded not in the ER but instead within a different federal agency focused on climate change, including the Environmental Protection Agency. These young doctors will be advocating for their patients in the very rooms (for now, Zoom rooms) where climate policy gets made.
Medical students are starting to call for changes to their future profession, too. According to George Washington University medical student Harleen Marwhah, “we can uniquely advocate for future patients and future problems.”
Marwah co-founded Medical Students for a Sustainable Future, or MS4SF, in August 2019 with just four students. By October, there were ten members; by New Year’s Day, there were 10 times that many. MS4SF now has organizational chapters at over 50 medical schools, receiving local press attention across the country for climate curriculum advocacy.
Nevertheless, physician advocacy is often treated as taboo — despite the fact that it’s what made tobacco control and municipal sanitation possible in the U.S. By the 1970s, the scientific evidence that smoking kills was clear. But it was not until two decades later, when physicians engaged with policymakers, waving evidence in the air and wielding white-coat credibility, that tobacco controls gained traction at the policy level.
The authors of The Lancet’s latest report on health and climate, who represent United Nations agencies and 35 of the world’s leading research institutions, see this as a model for what can happen with climate change: “Just as it did with advancements in sanitation and hygiene and with tobacco control, a growing and sustained engagement from the health profession … [fills] a crucial gap in the global response to climate change.”
Perry Sheffield, a New York City-based pediatrician, punctuates this kind of statement with an asterisk: The “engagement” must be upstream, with people in power.
Sheffield is a pediatrician at Mount Sinai Hospital who works on communicating the risk of threats made worse by climate change. One tool she uses are “vocalized prescriptions.” These are, essentially, questions pediatricians can ask parents — like “is mold a problem in your home?” — which can then lead to actionable solutions. (Mold-growing moisture levels will likely become more common in northeastern U.S. cities because of climate change.) Sheffield has improved on these scripts so that New York City-based doctors can answer follow-up questions that might help their patients take action: “Who do they call? What are their rights as a tenant?”
The case of nine-year-old Ella Adoo-Kissi-Debrah exemplifies Sheffield’s thinking. The landmark struggle to list “air pollution” as the cause of death was, in a sense, a mother’s attempt to legally shift a burden of proof from the patient to doctors and public health officials.
“I think that’s where doctors sometimes go wrong,” said Sheffield, “laying the burden back on the individuals who are experiencing the brunt of the environmental impact.”
Things could have been different for the young British girl with dimples and a wide smile: had the family known about the quality of their air, had they been able to leave their toxic surroundings, had London officials acted on the knowledge that the city’s particulate matter levels were much higher than World Health Organization recommendations.
A mother and her teenage daughter living in Paris suffered in a similar way and, perhaps by luck, their doctor knew enough about air pollution. “He advised me to move,” the mother said in a 2019 interview with The Guardian. They moved 80 miles away to Orléans, a small city that embraces another teenage girl, Joan of Arc, as its savior.
After that, the mother’s lung infections cleared, and her daughter’s asthma went away. Then, they successfully sued the French government. France’s failures to carry out its own air pollution standards are now recognized by its courts, and the country must act or pay. It’s a precedent for doctors making sure that the enablers of climate change are accountable for its unhealthy fallout. American doctors might want to take note.
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