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Because the health effects of climate change are likely to be significant and far-reaching, a key component of climate change adaptation will be our public health infrastructure. Perhaps counter-intuitively, recent emphasis in public health law on preparedness for extraordinary events may be to the detriment of our ability to cope with the health impacts of climate change. While existing emergency preparedness law will necessarily be an important backdrop for health-focused climate change adaptation efforts (especially with regard to natural disasters and infectious disease outbreaks), the focus on emergency preparedness in recent years does not necessarily situate us well for handling the substantial, but slowly emerging, intensification of more routine health threats that we expect to see as an impact of climate change. This paper examines the likely demands of climate change on public health infrastructure, law, and policy and argues that the adaptation response to climate change has the potential to improve public health infrastructure in ways that will better position us to handle routine needs as they intensify and to move public health law and policy toward an approach that emphasizes “resilience” rather than “preparedness.”

Three case studies are used to illustrate the current public health law and policy response to the types of health threats that we are likely to see in the U.S. as a consequence of climate change: (1) the incompatibility of the strategic national stockpile of pharmaceutical and medical supplies with the needs of disaster victims following Hurricane Katrina; (2) privacy-based barriers to public health surveillance programs seeking to track trends in pediatric asthma; and (3) conflicts over the use of pesticides for vector control to fight West Nile Virus in the United States. Upon delving more deeply into these three examples, a picture emerges of the ways in which climate change weighs in on some of the key concerns of public health and public health law. Because the health threats associated with climate change are likely to exacerbate underlying health disparities (in that they are particularly concerning for vulnerable subpopulations such as the poor, city-dwellers, the elderly, and those who suffer from chronic health conditions), climate change adaptation will raise issues of health equity and put pressure on the traditional divide between public and private responsibility for health. Because the health impacts of climate change are predominantly local in nature but are likely to overwhelm local resources, climate change adaptation will require us to revisit jurisdictional issues regarding the funding and control of health programs to emphasize adequate support for community-based responses. Responding to severe health threats that are not immediately urgent, will require new ways of thinking about the balance between individual rights and community needs that go beyond reliance on the concept of a public health “emergency” to override more deliberative processes. Finally, because some measures that might be used to adapt to the impacts of climate change will pose potential risks of their own, adaptation planning will raise the challenge of informing public choices about risk in the context of complex risk-risk trade-offs. I argue that, taken together, these considerations have the potential to move public health law toward a new approach that emphasizes “resilience” rather than “preparedness.” This approach would be deliberative, equity-driven, and community-based, and would seek to balance respect for lay values with correction of facts regarding the various risks involved.

Publication Citation

15 Widener L. Rev. 483-519 (2010)