Johnson & Johnson (JNJ) Earnings Call Transcript & Summary

Good morning, everybody. Welcome to day 2 of The Hub Live. My name is Jeroen Gerlag. That's a Dutch name, I'm afraid. I'm leading the Europe Office of Climate Group. I'm also the lead of the Food, Nature and Health topic at Climate Group. I'm please to see so many faces in the room and want to thank the people that attended Climate Week yesterday, today. As a remainder, we will be live streaming this session as well as were older sessions. So the website address is climateweeknyc.org. And if you want to tweet, et cetera, please also use the #climateweeknyc.org. Also to highlight, there won't be time for Q&A in this session because it's a very packed session with a lot of discussions and information already. And coming up next, we have a session focused on the synergies between climate change and health equity from a community based approach led by Johnson & Johnson. So without further ado, I would like to introduce Molly Conroy, Senior Director of Sustainability Communications at Johnson & Johnson. And Molly,I'm assuming you will lead in all the panelists. Thank you very much.

Hi, everyone, and welcome. Welcome to everyone here in the room and to everyone who's watching us online at home as well. We're so excited to have you here, and I'm particularly pleased to be here to help facilitate this discussion on climate change and HealthEquity. Specifically, we're looking at community-based approaches today. I think that over the first couple of days of Climate Week for me, I've heard a lot about really complex topics and a lot about the need for action and solutions. And that's really what we want to dig into a bit today. So I'm really excited to be here. As I mentioned, we have 2 parts of our conversation today. We're going to start with a conversation on a climate resilience program in community clinics and then have a second part of our conversation with 2 physicians who are going to walk us through some of the work that they are doing to lead at the intersection of climate change and Health Equity. So with that, I'm really pleased to introduce this incredible panel. I'm joined here today by Dr. Caleb Dresser from Harvard Chan C-CHANGE, from Julie Varughese, the Senior Vice President of Programs and the Chief Medical Officer for Americares; and Paulette Frank, Chief Sustainability Officer at J&J.

So Paulette, I'm going to start with you. This is Johnson & Johnson's sixth year here at Climate Week. Year-on-year, J&J has had a presence here at this venue. And I just wanted to hear from you why it's so important to be here?

So after 6 years, it's so exciting to see that health has finally arrived on the agenda. We've been sponsoring Climate Week, like Molly said for the past 6 years, and it's been really important to us to bring this conversation around health to the same conversations that we're having around decarbonizing our businesses and society. As the largest, most diversified healthcare products company in the world, health is pretty important to us. And what's been pretty cool is to watch the conversation, not only get bigger, there are more sessions this week on climate and health and I think any Climate Week I've ever attended, but it's also seeing how the conversation has evolved from making the connection, climate change is impacting health. We get that now. Lots of people are talking about that. We see it in our lived experience. No matter where you live in the world, you're touched by it in some way, but also the action that's happening, the real actions on the ground, in communities, and that's what we really want to focus on today.

That's great. Well, I mean, I agree. I've been to many really interesting sessions over the last couple of days on climate change and human health. And the one thing that's really clear is it's an incredibly complex topic. So specifically, when you think of J&J's role in the conversation around climate change and health and even specifically Health Equity, what's the role that Johnson & Johnson is playing?

So our role clearly starts with our own carbon footprint and reducing our carbon footprint. And we've made good progress. We still have a lot to go. But since 2016, we have reduced our carbon footprint by 41%, and we're also running our business on 67% renewable electricity. We are going to get to 100% by 2025. That's our goal. So it starts with doing our part to mitigate our own impact on climate change. The other role that we play is when we look into the health care ecosystem, that we're a part of. And what role can we help to help that health care ecosystem adapt and be resilient in the face of climate change because we are experiencing effects of climate change today. So when we thought about the health care ecosystem and where do you start, it's a very, very, very big space. We looked to our experience working with health care workers, and we have a long-standing tradition of supporting health care workers, physicians and nurses. And so we brought this desire around trying to make a difference with respect to climate change and adaptation and resilience, and we married that with our tradition and experience of working with physicians and health care workers and it brought us to the 2 partnerships that we're going to talk about today. Our support of the Climate and Health Equity fellowship with the Medical Society Consortium on Climate and Health and our support of community clinics and health equity and community clinics with Americares and Harvard. So that's some of the role that we play.

Great. Well, that's a really great setup for what we're going to be talking about first, which is an incredibly exciting initiative that's been going on for a bit, but with a big milestone that was just announced today. This is the Climate Health Equity for Community Clinics Program. We're incredibly proud of it. And I'm really looking -- going to look to you, Julie, just walk us through a bit about the program and what was announced today.

Thanks, Molly. So we're really excited to announce the next phase of our project, the Climate Health Equity for -- sorry, for Community Clinics Program. And this is a program that aims to protect patients who are most at risk for health impacts from climate change. We are launching this next phase in 3 states, Arizona, Florida and Louisiana, and we're starting with 10 pilot clinics, and we will be expanding to 100 clinics nationwide by 2025. So our first focus for the program is really on extreme heat. I think we've all seen and felt the impact of extreme heat this summer with record-breaking temperatures. I know for me, as a parent, it's the very first time my kids have been sent home from school because of the temperatures and not having air conditions in all of the classrooms. And we know that community clinics are feeling all of those same impacts when they're caring for their patients. And so the goal of this program is to really support those community clinics and staff to feel more prepared and to be able to better care for their patients that are impacted by heat and other risks of climate change.

Great. And specifically, what role does Americares play? What's your unique superpower you bring to this collaboration?

Well, we're so grateful for our collaboration with Harvard and all of the expertise they bring in the climate and health space. Specifically for the Americares side, we have decades of experience responding to emergency. So we support communities in preparing for, responding to and recovering from emergencies and natural disasters. And we know that extreme heat is really a crisis. It's becoming an emergency in and of itself. I've been at Americares for 8 years now. It's the very first summer that we've received requests from a partner for medical supplies related to heat specifically. One of our partners in Florida asked for products during the heat wave. And so even our clinic partners are really seeing heat and the risk associated with extreme heat as an emergency and requesting products just like they would for a flood or a hurricane. And so Americares has really placed that connector role for this program. We partnered with nearly 1,000 community clinics and free clinics across the country. And we have these long-standing relationships because of our ongoing work, but also our emergency work, and we're able to leverage those partnerships for this program and support them in new ways with our climate change and health equity work.

Great. And Caleb, now over to you. So in addition to the work that you do at Harvard Chan C-CHANGE, which is an incredible program, and I know you're focusing on improving climate readiness and enhancing capabilities within health care systems. You're also an emergency medical -- emergency medicine attending physician. Julie was just speaking about how that summer on record impacts of heat on human health. Can you talk us through that, what you're seeing, what your patients are experiencing?

Yes. So I think we are at a really critical juncture where we, as a society, are starting to see impacts from climate change that are happening in real time and are impacting the lives of people around us. And I think heat is one of the preeminent hazards we need to be thinking about in that space. In my practice as an emergency physician, I see people with heat stroke, heat exhaustion, and also more subtle things: a little bit of dehydration that made them light headed in church; a stroke, which we know get more common during very hot conditions; a heart attack, we see more of those in hot weather as well. And so there's an increasing amount of public health and epidemiological data showing very hot weather is dangerous and is deadly. Heat is actually the deadliest natural hazard by the numbers in the United States. And as we look at the visibility of this, we've all seen heat this summer. Some of you may be coming from places that were incredibly and very dangerously hot this summer. What we have not yet seen is real solutions to deal with this. And that's I think where this program comes in is we need approaches that keep people safe in the community. I want to share a couple of cases that illustrate how heat is not just a climate responsive health hazard, but is also a socially responsive health hazard. Because when I see patients who are dealing with heat stroke or heat exhaustion, this is not simply that it was hot that day. It's also that it was hot that day and they didn't have access to a cool space where they were on the job and they couldn't take breaks in hot weather. So to just share a couple of these anecdotes. There was a patient I took care of a couple of years ago, who was an outdoor worker working in an environment very similar to a parking lot, all day without breaks, who wound up collapsing from heat stroke. He came in with a core body temperature over 108 Fahrenheit, I put in a breathing tube. We immersed them in cold water, and they were admitted to an intensive care unit. That was someone who started the day healthy, young and ready to go to work, totally preventable. And so yes, the heat was a piece of that, but the social infrastructure, the education of people in that workplace, the education of that person around these hazards and what they can do to stay safe. That's a really important piece of this that we need to be thinking about how to address as well. Another patient, a couple of years later. She lived alone. She was getting along in years, but still lived in the community, had her own apartment and her air conditioner broke in the summer. And she ordered a new one, and it was delivered, but she didn't have the upper body strength to install it herself in a window. And there was nobody in her community that noticed this or that she felt comfortable reaching out to and she wound up sitting in front of a fan for 3 days and wound up admitted through my emergency department with heat exhaustion. Again, entirely preventable. And I think both of these cases to me, illustrate the need for engagement in the community to focus on primary prevention of heat-related illness as a way to reduce the health harms. And that I think we'll talk more about how we're going to do that is a really important focus for us to have both within healthcare and in collaboration with community groups that are also touch points in the lives of many of our patients.

Thank you for that. I mean that certainly brings us to life. And also, actually, I think, tease up a video that we're going to show that does bring this program to life a bit. So if you could share the video, please. [Presentation]

So Julie, I mean, that's certainly a sobering video and the line, I can't work if I'm dead, it really sticks out. And I think almost equally powerful is the voice of the health care providers saying that patients are looking to health care providers for answers and solutions. Love to hear a bit about how this program is going to support those health care providers in those clinics?

Yes, absolutely, our program really is intended to be in collaboration with the clinics. So you see firsthand the important role that community clinics play in the lives of their patients. And so Americares and Harvard Chan C-CHANGE are collaborating with those pilot clinics to develop an online assessment tool around heat risks. So there will be a series of questions that clinics will go through and answer and then they will receive an adapted plan for heat action for their patients. So we really want to make sure that the resources and the tools that we provide are based on the communities that are using them. So ensuring that the resources and tools make sense for the patients that are going to be using them. And so that partnership and really listening to the voice and the expertise of the clinics is going to be really critical for this program. So just to share a couple of examples around some of the interventions that a clinic might receive. It sounds very basic, but in the day-to-day clinical operations and mix even notifying patients that might be really at risk or very vulnerable for extreme heat and making sure that they take the necessary precautions. So having mechanisms in place for clinic staff to do that or for example, helping patients to have access to a cooling center or perhaps they could receive help with their energy or utility bills and just not know that those resources are available to them in their communities. It's also about leveraging existing resources. So we know that there are food service programs that go out to people's homes to deliver food. How can we leverage those resources to perhaps do a wellness check on patients that are most at risk for extreme heat or other climate-related risks. So we really want to tailor the interventions and the resources that we're supporting these clinics with in a way that really makes sense for the patients that they're serving.

That's great. Thank you. And Paulette, you spoke about Johnson & Johnson's long-standing commitment to health workers. Why is this program special? Why is this the one to support?

I think this program is so special because it puts faces and voices to the topic. Carbon, which I spend a lot of my time thinking about, it's invisible. It's hard to wrap your head around it, if you're just sort of an average person on the street. But this program brings this big topic down to the ground, down to the human beings that are actually feeling the impact and the wonderful people who are trying to help them. That's what's so special about this, putting the community at the center of the action that has to happen, making them a part of it, empathizing, being compassionate to their lived experience and helping them be part of this solution. I love the idea of working within the resource constraints that they may have in the community that doesn't have to stop action, work with it, use it to an advantage and a benefit to the community. So for me, it's just the personalization, it's the community engagement aspect that makes this so special. And as a sustainability practitioner, me and my team, we spend a lot of time listening to stakeholders, trying to understand what their expectations are, trying to learn what we can do differently. And so that listening, we kind of have that muscle, and I love the fact that this program is listening to people in the community, listening to the physicians and the community that are serving them and making their voice as part of the solution. So that's what makes it special to me.

Well, we mentioned at the beginning that this collaboration has been going on for a bit. I think we actually even spoke about very early stages of it last year at Climate Week. Caleb, can you talk to us a bit about what's happened over the last months to get to the point that brought this all together?

Absolutely. So I think the theme of listening is really important. So we're dealing with an unprecedented crisis as climate change impacts people all around the country. And so the first step here was to go out and ask some questions and listen to the answers. And so a needs assessment survey was conducted that reached almost 300 providers and administrators working in frontline clinics to try and understand what are they seeing? What are the impacts? What are the opportunities to address these impacts? And what do they need? And a couple of things that came out of that was that, first of all, almost 9 out of every 10 respondents to that survey identified extreme heat as a major concern impacting the health of their patients. And a lot of people want resources to help them address that. Another big theme as we've moved from surveying people to talking with them one-on-one to understand their lived experience and their work with their patients, I was in a conversation last week with an individual who was describing leveraging community partnerships to help with nutrition, and how she can refer people to nutrition programs in the community, and she's able to identify the people who are most likely to benefit out of her patient population and are most in need and connect them up with the right resources. And so there's a lot of interest in figuring out ways to do similar multi-organizational relationship-based work to connect up high-risk individuals with resources in the community that can help prevent heat-related illness. For the patient I talked about a minute ago, what if she had just one neighbor that was able to help her install the air conditioner. For the outdoor worker, what if everyone on that job site knew how to recognize heat-related illness. These are steps we can take that don't necessarily require huge new applications of technology. They require information, access to resources and a framework to apply those in. And so that's what we're trying to put together, and listen to these clinics that have been doing this work in other areas, for example, nutrition in doing a really good job. How do we adapt some of that learned experience and combine it with technical information on heat and health and other climate responsive hazards to put together packages that work for clinics to connect their patients with resources to keep them safe. So I think we have more to talk about there, but I will pause for now.

No. I'd love to actually hear a little bit more. So you have this needs assessment, you understand now where the needs are within communities. How do you see the best way to implement it, hearing from health care professionals?

Yes. I mean one other key point that we have seen as we've been analyzing that survey data is that a lot of the people who were most concerned and most active on addressing climate-related health harms with their patients, also were very active on other social determinants of health, which when I went through medical school was a key new piece of the curriculum at the time was understanding food deserts and do you have access to a safe place to exercise, all of these things that combine to make for a healthy life aside from whatever medications we might prescribe. And so a lot of people in this group seem to be viewing and acting on things like is your workplace a safe place in hot weather? Or is your home a safe place in hot weather? In the same way that they might think about is your home a place you feel safe leaving the windows open at night? Do you have a place that you can exercise? Can you get green vegetables? And so we have frameworks for nurse practitioners and doctors and social workers to think about what goes into making for a healthy life. And we can leverage those frameworks. People are busy. Clinics are stressed. We're dealing with a lot of tough things in health care right now. But we do have a framework for engaging with social determinants of health. And so leveraging that existing thought process for clinicians like me and leveraging some of these community-oriented approaches that clinics have been developing for other topic areas, I think we have a real opportunity to improve primary prevention and connect patients with resources to stay safe and prevent them from becoming my patients in the emergency department. And I think we need to urgently be testing these, learning how to do this well and scaling it up to keep people safe.

[indiscernible] about the clinics and the health care workforce being really, really stretched. This is something we also hear in our sustainability work when we go and visit customers and doctors, and we ask them in one conversation that I'm thinking of right now about recycling. And that thought of one more step could be too much. So how important it is to be empathetic to their experience and to work within the resources and the time constraints that, that work -- the health care worker has, again, that listening and collaborating with them is so important.

That's great. And I just want to actually -- I think we've used the word community a lot in this conversation, which is, of course, really important and Julie, you spoke earlier about the -- hearing from community clinics and seeing heat and other climate impacts is now kind of a health emergency. What is -- tell us about how a community clinic operates in the role that it really plays?

Yes, that's a great question. I really can't emphasize enough the critical role that community clinics play. You saw in the video these are low resourced, low-income communities, and there's a tremendous amount of trust that patients have in their clinic team. So Americares runs 4 free clinics of our own, and I see firsthand the incredible trust that our patients have in our clinic team. They also, as Caleb mentioned, have a deep knowledge of all of those different factors that patients are dealing with day in and day out. So it's so much more than just their medical diagnosis or conditions. They know who doesn't have air conditioning. They know who doesn't have transportation to a cooling center. They know who's working outdoors for hours at a time. And so they really know their patients from all of those different perspective. So I think that trust, that deep knowledge and then the community clinics really have those deep partnerships with the social service organizations and other resources in their communities to really build those bridges, I would say. And the patients then because of that trust will then trust the resources that the clinic staff are bringing to them. So I think all of those different pieces really play a valuable role in terms of this work and how we're able to leverage the clinic expertise and to support their patients.

Great. Thank you. I mean this has been really informative, right, to hear about this program, community-based approach, insights-driven, really starting with data [indiscernible] as I said, we talked about a bit, I think, last year, even at this time, if we are all back here, and I hope we are on the stage next year and this program, which is really just kind of getting underway in the clinics right now, what would you all hope to be sharing? I'm going to start with you, Caleb.

I think there are 2 big things we need to be thinking about. First of all, we're trying to keep people safe. And so I would want to be hearing stories from clinics explaining how they implemented this set of resources and how it was able to keep people safe. And second, we need to be learning. We are facing enormous impacts, and we desperately need solutions that are based on good evidence and that are applicable and feasible in the settings that most need them. And frontline clinics are resource limited. The patients that are at highest risk are dealing with a lot of challenges in their lives. And so I think there is both a big opportunity here to get something out there, get people working on implementing this, and I would like to see impacts from that. But I think we also need to learn from this type of experience so that as we move forward as a society, we're learning how to do this better and scale that knowledge across health care.

I'm going to echo what Caleb said, this time next year, we'll have gone through another summer and there's going to be tremendous learnings from that. My hope is that many more clinics will be using the resources and the tools. And we will have feedback from them, what's working, what's not working, and we'll be able to take that feedback and continue to make our resources and tools and program even stronger so that more and more clinics will be able to utilize the tools and resources.

Two things, I guess. One, I hope that we're hearing from the health care workers and the clinics that they feel more confident, empowered and have the ability to serve their communities even when things are really, really tough when their communities need them the most that they feel supported and confident. Also, it would be nice to see that more clinics around the world are being supported. Maybe there's someone in this audience today that gets a spark of an idea, makes a connection and reaches out to one of our partners to get involved. That'd be cool, too.

Great. Well, thank you all so much. I think we have a website that we're going to put on screen. So anybody who wants to learn more about this program, understand more about it, I understand how you can get involved, please check it out. And as I said, I do hope we are here next year at Climate Week and with many steps along the way to update on the positive progress of this work. So with that, I'm actually going to pass the stage now to Paulette, and we'll introduce our next speakers.

Okay. That's better. So I wanted to welcome Dr. Marcos Moreno and Dr. Julian Watkins to this stage. I'll give their introduction a little more justice. So Dr. Marcos Moreno is a resident physician in the Department of Psychiatry at Yale University. He's also a member of the Pascua Yaqui tribe from the Pascua Yaqui Reservation in Southern Arizona. Dr. Julian Watkins is a doctor of Internal Medicine. He serves as the Assistant Commissioner of the New York City Department of Health and Mental Hygiene Bureau of Health Equity Capacity Building. So thank you so much for being here today. We are really going to dig into community and what each of our panelists experience has been working within their communities. I also should say I mentioned that we have been supporting for the past 3 years, a program with the Medical Society Consortium on Climate and Health called the Climate Health Equity Fellows. And Dr. Moreno and Dr. Watkins are 2 of this year's fellows and are working on projects.

So again, thank you for being with us today. So I'm going to start with you, Dr. Moreno. You recently published an Op-Ed in Politico and the title was On climate change adaptation, consult the original experts: Indigenous peoples. Can you tell us why sustainability and climate change is important to indigenous communities and how that has influenced your work today?

Well, thanks for having us, Paulette. So first thing I want to kind of acknowledge and point out, Native Americans, they're not a homogenous group. There's hundreds of different tribes in the U.S., thousands throughout the Americas, each with their own unique cultures, customs, beliefs. That being said, there are some overarching themes that are present in a lot of indigenous communities because the ecosystems, these people live in, that we've lived in been inhabited by these groups for millennia. And taking care of these environments are important for a few reasons. Looking at it from the standpoint, not from extractive purposes, these groups do use resources from these communities, but it's much deeper than that. There's a much more spiritual connection at looking at these as living, breathing entities versus purely something for resources. On the resource side of things, however, what I will say is a lot of indigenous communities rely heavily on these resources for cultural purposes, whether that be ceremonial regalia, traditional hunting, fishing. All of these processes are very important for cultural preservation. So when you have a loss of one of those components, you have a loss of culture, and this is a group that has already struggled immensely with a very challenging history of cultural loss. And that brings me to the second point. Unfortunately, for a lot of groups, a lot of native nations were relocated to areas of the country that were not previously -- where they were confined to and when that happened, the politics and policies of the time typically relocated these groups to what was thought of as less desirable areas. So on the front of climate change, these have been areas of the country that are particularly vulnerable. These are communities that are seeing it worse in first. And if you look in the Pacific Northwest with tribes dealing with coastal erosion in Alaska with tribes dealing with permafrost. These are communities that are very much on the front lines of climate change in America, and they've been seeing it worst and first for years now and trying to get the attention of the national media. So in part, because this group is seeing that so prevalently and has been, it's been something that's greatly influenced my work and my passion for advocating for that group.

I'm going to just say I'm a terrible moderator because I get so entrenched in what people are saying that I forget what I'm supposed to ask next. But we're going to get back to that because that is a really interesting perspective. And I know it's part of your work in the fellows program. So Julian, for several years now, you've been working at the city -- in New York City is very different from Dr. Moreno's experience. And most recently, we're appointed to the Bureau Health Equity and capacity building. What brought you to that role? And what exactly is that?

Thanks, Paulette. Yes. So what brought me to the role? I came from a traditional medicine kind of classic background working in hospitals, working in ICUs and clinics. And then I kind of had this real inner drive to be able to do more work in communities and kind of get out of the - what felt like an endless cycle of the revolving door of sick people. You can't really do much beyond fixed whatever is going on in that short little what their chief complaint is maybe. I mean, I feel like I wanted to do more and so transitioned to the health department, was working in the preclinics and the free sexual health clinics, and working with folks to respond to the ongoing crisis of HIV. And then COVID hit. And so thinking about HIV and the communities and what was needed then, I was able to apply that need to the COVID pandemic, now it would be at a size and a scale that we have never seen. But I also knew that New York City was this epicenter. So really leaning into what community needs, knowing that people need voices from community who speak from the experience and kind of from that knowledge, that situated knowledge, this is a deeper thing beyond just lived experience, this historical cultural spiritual connection to the communities and the people that they're living with and apply that to this work. So really speaking, from that experience, not for people because I can never do that as a black Latin person knowing how the range of experience, but knowing how rich that is and really applying it to it. So transition from direct patient care to really my practice is now Public Health. I talked to community groups. I talked to different agencies. I'm coordinating with elected officials, but I'm also talking to school groups, talking to church groups. And so my work is really to build, to create, to advocate and to do what I can to create the conditions for folks to have better health knowing that we can't force people to do it. We don't really -- we aren't the only ones who can make that change is how do we help folks make the best decision, how do we give them the information and create the conditions. And so that's my work, it expands a lot around a lot of different particular public health issues. Violence is a public health issue. When we look at -- we look at climate as a public health issue to really normalize that, and my goal work is to really make it that when you go and see a doctor or hear someone from public health that you would have blinked an eye, if you hear them talk about climate and what your exposure is, just like you would have blinked an eye if someone adds you, oh, how is your blood pressure. Did you drink water? I feel like it's that deeply connected as folks advocating for human health, we have to advocate for the health of the environment, which we're so connected to.

So let's stick with you, Dr. Watkins. During breakfast today, when I asked you about your Capstone project, you said, well, it's kind of -- it's like my job. What are you hoping to get out of the fellowship experience? And what are you hoping to bring back to your job?

When we start medical training, we make this commitment to be lifelong learners. And so what I wanted out of the fellow ship is the rigor of folks who have put the time and energy and effort, heart and soul really into this work to really bring folks in from varying perspectives. We had people coming with indigenious knowledge. We have folks coming -- black farmers coming to speak with us. We have folks like governmental agencies, just to see the range of what's going on and knowing that in the work that I do, a lot of what we do, we have to cross these boundaries of what seems normal or expected. And so to make myself strong so that I could do this work, take this thing on that many people would say, well, you're just a doctor or like, how does this make sense? I want to rise to this occasion. And in doing that, I want to bring this knowledge back as this gift and bear witness to what we can do, what is being done because so often people kind of lose sight of that. We're not starting from nowhere, and we also don't have -- we're not starting out of [indiscernible], but we're not starting at 0.0. There's so much work that has been done, and this is hundreds of years, thousands of years of people who've been tending the earth, been stewards of the earth, and we've also been healing ourselves. And we've only recently lost that connection between humanity and the natural world and ourselves as natural beings. And so I think it's about how we can build those bridges to connect us to this earth and really see that if we're going to be in public health or medicine that we should definitely be leading this charge as people who understand so intimately how our bodies and our health works in these systems that we should apply that knowledge to these other large human systems that -- we've done difficult things before, and we do it really well. And we did it in COVID, and we can do it for climate change.

You're making my job very easy because that's a great segue to my next question for Dr. Moreno. Can you tell us a little bit about your fellowship project and the focus on indigenous peoples? And what -- specifically, what can we learn from indigenous peoples on the topic of climate change?

So for my project and my Capstone, what I've been working on and trying to push and advocate is that indigenous people do have a lot of knowledge and have already been in this space for adaptation and climate mitigation for a number of years now, partly because of the cultural component. And because of that, my efforts have been to compile a number of case studies of successful community programs that drives throughout the country have implemented and showing that with community buying, these projects can and are successful. Just to list up a few of the pieces of it. There's the Fond du Lac Band of Chippewa in Minnesota. This is a group that in the early 2000s, long before climate change was as widespread as it is now, implemented protocols to switch to sustainable energy to develop sustainable resources for the community and to limit greenhouse gas emissions. On top of that, there's other groups like the Mescalero Apache in New Mexico who have created a number of solar-powered greenhouse farms and are trying to switch their agriculture to pesticide-free, organic-free and again, reducing emissions and trying to implement this community-wide approach and making this important. I think -- what I don't want to be lost and why I feel like it's a big thing to keep in mind as we talk about the cost of switching to some of these more green alternatives, and that's always something that comes up as a con. But these are communities like the [indiscernible] Village in Alaska. The median income there is $11,000 per year, and this is a group that has pledged to one, move village from thawing permafrost which is a byproduct of climate change, unfortunately. But they're making these efforts, and they're pledging these resources to that at the community level, and this is a resource trap community that is making it a goal. So if these groups are doing that, we, in mainstream America, do not have an excuse to not switch. That's -- it's beyond me why that keeps coming up as a con, so to speak.

So we talk -- we use the term community quite a bit, especially during our session today. Can each of you provide your perspective on what is community and what is a community-based approach to adaptation for climate change?

I can start because I think for me, when I think about community, I think of it not in the kind of narrow, it's actually a very expansive thing. I think about community -- the community that -- and it's informed by my background as a black person, it's a Latin person understanding community, family. It's different. It extends into the future. It extends into the past. It always represents black people and African as people, but it also extends beyond that, extends LGBTQ people, extends to women and femme, extends to trans people, extends to anyone who's been a subject to oppression and a subject of the system that does not work for humans, it's anti-human system that we kind of are working in, that is time is up as we see it's -- we're literally the world is on fire. So I'm working for the people who are the most at risk because of this failed world view. And so I think about that as a community, but also it's very local. We live in New York City, yes, and it's not this community, 20% here and 20% there. We live on the same blocks. We work with people. People were taking care of each other's kids, we're neighbors. And so it's a different way to look at community than just the 5 demographic groups of racial and ethnic and the age groups. It's very different.

Yes. I think for me, obviously, community means -- holds a special place in my heart. I mean I grew up in a small reservation community. So that was something very singular, that semblance and that idea of cohesion. But I think when we talk about community and this sphere what we're looking at and what I really enjoy seeing are the boots on the ground kind of movement that these communities have made in so -- such a powerful fashion where at the community level, it can get lost on you how big that impact is. But if we look at it on the widespread level, we're talking about native Americans as communities, let's say, pocketed throughout the United States, 2%, 3%, 4% of the population, scattered throughout the U.S. and all together, moving singularly towards this idea that we should be switching to more sustainable principles, more sustainable energy. And I think that's powerful because it shows you that when you have that buy-in and when you have that kind of cohesion, you can get a lot of movement. It really is -- it's powerful to see. We just need more implementation and to scale that to really get everyone involved in to see this all as our community.

Thank you both for that. I'm going to switch gears a little bit. Dr. Moreno in your practice as a psychiatrist, can you share a little bit about your experience, what you're seeing from a mental health perspective and climate change?

Yes. So I think this is something that comes up a lot. The links between climate and health, I think are pretty easy to see. There's some skepticism even from colleagues I have in the medical field, where they kind of want to know what does it look like in psychiatry? How does that kind of fit into the picture? And just a couple of things to highlight. So right now, there is a large amount of data out there that shows after significant weather events, you have increases in rescue behaviors like substance abuse, alcohol abuse, but also suicidal behavior. There's increase in dangerous risk taking after large climate disasters like that. The other big piece of things, since 2008, one of the huge components of health -- climate health and mental health that we've seen overlap, there's roughly 20 million climate refugees per year who are being relocated because of natural disasters or from agricultural changes and the fallout from that is a lot of these people are dealing with pretty significant trauma from that relocation, whether it's surviving a storm, surviving a wildfire. I'll give you one example, which is kind of extreme, but it was something that I saw actually on our inpatient psychiatry unit. So there's a gentleman who relocated from Florida after a hurricane. This guy told me about basically wading his family in a homemade wrap with a pool, 2 kids in it. And in the aftermath of the storm, this guy is really struggling. One of his kids ended up dying in that storm. And ever since then, this guy was not the same, can't sleep, can't eat. He just is like I'll never be the same, I'm shell shocked. This guy tried to kill himself and that's when I met him on the unit. This guy was struck by this, and it's frustrating because when I talk to him about this, this is a stress and a trauma that's never going to go away. And this is something that he dealt with before, but they were dealing with back-to-back hurricanes. They didn't have a lot of time to prep. So it's frustrating because we're seeing these people in clinic now. We're seeing even older generations of people come stressed out asking, I'm really worried about the world, I'm leaving my kids, my grandkids. What is that going to look like? Are they going to be okay? And these are stresses and anxieties based in reality, but it's here and it's now. So we're seeing it in real time.

Dr. Watkins as a public health professional, how are you seeing mental health and the manifestations of that and with climate change and some of the weather events that you've experienced recently?

In 2021, New York City, we released -- we often do this like surveillance. We ask people, we do surveys annually just the health of people in New York. We did the survey on the mental health effects of the COVID pandemic, I mean looking at the increases in anxiety and depression. We even had a question about people who have children and that impact. So we've seen this building for some time just from the kind of social kind of disarray in different types of communities that are facing so many different things. COVID was this accelerant that was added to the system, and we kind of saw who kind of bore the brunt of and we look at climate change. Similar systems are happening. But I think the similar effect that if you add these rising temperatures because of fossil fuels and rising global temperatures, you see this acceleration. And what we see is these same communities are vulnerable. And so in public health, looking at it, what we do best, we are this bridge between health care and the public because we have folks who are health care professionals like myself, clinical professionals, but we have a range of folks from public health nurses to epidemiologists or whatever. And so in public health, we kind of see it -- we see it as a kind of broader coalition. How can we all kind of use all the tools that we have in the different touch points, connection to the health care system, connections to education, connection to all these other agencies? How can we address this issue like we've been addressing and try to address these other things? And we have the evidence that these approaches do work. We just have to really do our part to really raise the awareness and to really resource and really have the vision to really respond to whatever the change may come. And right now, it's climate change. But whatever the next public health -- whatever the next inevitable public health crisis that come, we have to make ourselves stronger and prepare ourselves and our communities to be resilient.

What -- so what -- for both of you, what makes your work hard? What are some of the daily challenges that you encounter?

I would say day-to-day, the challenge, I guess, becomes for sometimes just becoming frustrated with the lack of movement that seems to be happening. I mean there's -- like I said, there's a lot of communities who are taking initiative and running disaster mitigation plans, resiliency, all of those things, and that's great. It can sometimes be frustrating to look at things from the state level or the federal level and question why there's not more being done or why there is that lack of urgency, why is the buck being passed on to the communities in that way. But you -- with that, you still do feel encouraged that there's people taking things into their own hands and that the community is buying in because I've seen much more over the past 10 years, I think I've seen much more engagement and people from various walks of life who 10 years ago were maybe outright climate deniers and are now buying in and saying, this is real, this is legitimate. This is something that we need to really implement and change. So it's encouraging in that regard, but it can be frustrating when you feel like there's so much more that needs to be done that just -- it's slower moving.

I think it might because frustration is the fact that a lot of the imagination, both political, I think public health and medical imagination is almost held hostage by like this failed kind of what to view and understanding of what value -- who's valuable, what's valuable, what knowledge is worth listening to, who's worth listening to, who's worth saving. And I think that's the thing that if we are really in this health space, and we've taken the hippocratic oath, if we're in this public health space, and we're looking to take care of entire communities on a local or national level, we have to understand that if we're going about this, we can't go into it with this in this head space in this hierarchy. We can't go in thinking, well, 25% of the city, they're expendable just because of how much melanin they have in their skin, right? It's really the shift that we need away from these old ways of thinking to move into the 21st century, where the world is global, where there are more than [indiscernible] in ethnic groups, where the answers are not all unknown. A lot of people have them. We just need a bit more courage to actually sit down and listen to the people who have the knowledge. And it may sound different than us, may not make sense to us. It doesn't mean that it doesn't make sense, right? But we have to really sit down and listen deeply. That's part of the work of Health Equity. And I think that's why Health Equity specifically is a really important bridge for health care, for public health to really approach such a complex problem that doesn't fit in the boxes that we're trained to operate with and around.

That theme of listening came up again. So why don't we end on a note of hope? And what gives each of you hope in your work and also for the future?

I would say, especially being a part of the Climate and Health Equity Fellowship, it's encouraging seeing colleagues who -- all shades and colors and all over the country at their own community levels, what they're able to do and how they've been able to maneuver the system and navigate it. I think that's like one of the biggest takeaways. And one of the more encouraging things I've seen is because when you get to collaborate in a room like that with people who have been able to overcome having a state government that is less than friendly to climate adaptation and mitigation strategies, how did you overcome that? How did you beat that barrier? And I think the other piece of it is seeing how now we're actually starting to bring not only health and climate together, but also Health Equity and looking at that -- recognizing that these groups that are being hurt first are, it's not by accident. I mean there's a whole social and history of why those groups are more prone and why they're more at risk and why we need to really focus on making sure that these groups have an equal shot to benefit and really, really have some of the equitable impacts of climate change and have a voice in that room. I think that's encouraging because that's something that is newer to the space and is becoming a very important topic of conversation, and I'm glad that it's much more widespread than I've seen in the past.

Thank you. Dr. Watkins?

Yes, what brings me hope is that we have the language. I think that we have -- access to the language in this age of information. We have folks who have been doing a lot of the work to help us get closer to really understanding what's going on and to really see what's beyond this veil of this civil society, the best nation. There's some deep work that we've got to do and I like that enough people are primed and ready to show up, enough people are primed and ready for solutions, primed and ready for something that feels generative. And I think people are beyond the call out. I think we've been calling out. We have to keep calling out, but people are looking for a message that calls people in to fix these problems that we are all facing, calls people in to find their place in the big ecosystem that we are in to make solutions. And that's the thing that gives me the most hope and the evidence is there. Again, I keep saying it. We've seen how we've been able to overcome things. We've triumphed over so many complicated things that we thought we never could. And we also found out that we left world views that didn't work. The world isn't flat anymore, right? So we can move beyond some of these other old played out, nonfunctional things that do not serve us. And so I'm happy that this is the most primed and ready that I've seen folks and when we start talking about these things, people really lean forward and really want to learn more. And I think that gives me the hope and kind of keeps me going in the face of all of this.

Well, I can't tell that. But what gives me hope is that I do believe we are primed and ready as evidenced by health being on so many different sessions throughout the week more than I've ever seen at Climate Week, a whole day dedicated to health at this year's COP discussions. So that gives me a lot of hope and I hope that we have done a good job at putting a face and some real voices to the topic of climate and health equity today. And I cannot thank my panelists enough for doing that and helping us to do that. So thank you so much for being with us. And thank you for being a great audience.