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09/15/2020

Upcoming Podcasts: Patient Safety, Industry Efforts to Go Carbon Neutral & Social Determinants (September 17th)

This coming week I'll discus with Dr. Dave Meyer, Executive Director of the MedStar Institute for Quality and Safety and Patient Safety Movement Foundation board member (https://patientsafetymovement.org/), the pandemic's effects on patient safety and avoidable or excessive deaths.  In addition, he will evaluate what progress has been made over the past 20 years since the Institute of Medicine's "To Err Is Human" report was published. 

Later this month I'll speak with Austin Whitman, CEO of Climate Neutral (https://www.climateneutral.org/) about  progress companies are making to decrease their carbon footprint or go carbon neutral.  This past Monday, September 14th,  Kaiser Permanente announced that they have officially achieved carbon neutral status, becoming the first healthcare system in the U.S. to do so.

I'll also speak this month with John Gorman, Chairman and Founder of Nightingale Partners (https://www.nightingalepartners.org/) about what progress payers are making in addressing social determinants of health.     

08/31/2020

Senate Special Committee On the Climate Crisis Releases Its Report, "The Case for Climate Action" (August 31st)

This past July 12th I made note of the House Select Committee on the Climate Crisis's publication of its June 30th report, "Solving the Climate Crisis."  This past week the (Democratic) minority staff of the Senate Special Committee on the Climate Crisis released its 260-page report titled, "The Case for Climate Action, Building a Clean Economy for the American People."  The report is at: ttps://www.democrats.senate.gov/climate-report.

I am, still, now 8 weeks later, attempting to pursue an interview with the House Select Committee Chair, Rep. Kathy Castor, or a lead report author, to discuss their report.  I attempted to solicit the Senate Special Committee Chairman, Senator Schatz, for an interview however, oddly, his office is closed - as is the Senate Minority Leader Chuck Schumer's office.   Your taxpayer dollars are work. 

08/27/2020

Dr. Rachel Dolin Discusses the House Ways & Means Committee's Recent Report,"Under-Enforced and Over-Prescribed: The Antipsychotic Drug Epidemic Ravaging America’s Nursing Homes” (August 27th)

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In testimony before the House Energy and Commerce Committee in 2007, the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year from the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work.  The problem has been known to the FDA for years and years.”  Eleven years later, Human Rights Watch published a report titled, “They Want Docile: How Nursing Homes in the US Over-Medicate People with Dementia."  The report found in 2016-2017 "massive use" or abuse of anti-psychotics, e.g., Seroquel, Haldol and Risperdal, that have serious side effects including sudden cardiac death.  In testimony before the Ways and Means Committee last November Nov., Richard Mollot, Executive Director of the Long Term Care Community Coalition, concluded, “the use of antipsychotics in nursing facilities is “so extensive that it puts the US in violation of . . . international conventions and covenants on torture and cruel, inhuman and degrading treatment or punishment.”  Dedicated listeners may recall I interviewed Diana Zuckerman on this topic in December 2012 and in February 2018 interviewed Hannah Flamm author of the Human Rights Watch Report. 

During this 30 minute interview, Dr. Dolin discusses report specifics including its findings regarding the extent of overuse and misuse, what explains overuse, the success of CMS' voluntary program to reduce misuse and the consequences of Trump administration's decision to place a moratorium on skilled nursing facility regulatory enforcement and decisions to reduce civil monetary penalties.  Dr. Dolin also explains why majority staff did not offer recommendations in the report and opines on whether the report will lead the Congress to, finally, address the misuse of anti-psychotics in nursing homes.   

Rachel Dolin, Ph.D., is Democratic Professional Staff with the Committee on Ways and Means, Subcommittee on Health. Dolin_head shot She is the principle author of "Under-Enforced and Over-Prescribed."   Previously, Dr. Dolin was a 2017 David A. Winston Health Policy Fellow.  Previously still, she was a National Science Foundation Graduate Research Fellow from 2013-2017.  Prior to her doctoral work she was employed as researcher for L&M Policy Research in Washington, D.C.  Her work has been featured on NPR, in Health Affairs and in other peer-reviewed journals.  Dr. Dolin received her B.A., magna cum laude, in Political Science and History from Tufts University and completed her PhD in Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. 

The Ways and Means "Under-Enforced and Over-Prescribed" report is at: https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/WMD%20Nursing%20Home%20Report_Final.pdf

Richard Mollot's November 2019 testimony before the Ways and Means Committee is at: https://waysandmeans.house.gov/legislation/hearings/caring-aging-americans.

Dr. David Graham's 2007 testimony is at: https://www.govinfo.gov/content/pkg/CHRG-110hhrg35502/html/CHRG-110hhrg35502.htm.

 

08/18/2020

Dr. Charles Binkley Discusses Medical Ethics in the Time of COVID-19 (August 24th)

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From an ethical perspective our nation's response to the COVID-19 pandemic has been disastrous.  For example, as has been widely reported, our nation has failed to protect the most vulnerable among us, for example, nursing home residents have suffered approximately one-third of all COVID-19-related deaths.  As for other disenfranchised, African Americans have been were more than twice as likely as non-Hispanic Whites to die of COVID-19 complications.  Health care providers have been and continue to be inadequately protected requiring them to work in lethal environments.  Instead of providing service workers, moreover minorities, health insurance, sick leave and a livable wage, we now define them “essential workers” and give them a hand clap.  As for our the federal government's response, the president's sensitivity goes so far as his recently stating “it is what it is” - that the urban dictionary defines as a business phrase that can literally be translated as “fuck it.”  As for the Congress's response, 75% of direct and indirect CARES Act moneys went to corporations and any forthcoming or additional federal response must include COVID-related legal immunity protection for the health care industry.  The nation's response to the pandemic exposes the rift that continues to exist between medical ethics, that requires the health care industry to support the betterment of public health and a responsibility to seek policy reforms that are in the best interests of patients, and health care delivery ever-increasingly designed to generate financial profits.   

During this 30 minute discussion Dr. Binkley provides, in sum, an assessment of the extent to which the federal policy makers and the health care industry have lived up to their ethical obligations in response to the pandemic and what reforms national policy makers should take in providing health care that satisfies or at least approximates ethical norms.     

Dr. Charles Binkley is currently the Director of Bioethics at Santa Clara University's Markkula Center for Applied Ethics.   Previously, Dr. Binkley was a practicing hepatobiliary and pancreas surgeon with the Kaiser Permanente Medical Group. in San Francisco.  He also served as Chairman of the Kaiser's San Francisco Medical Center Ethics Committee, Charles-Binkley-photo-square-360x360President of the Professional Staff, and Chief of Inpatient Quality.  Dr. Binkley also served on the Committee on Ethical, Legal, and Judicial Affairs of the California Medical Association, as well as on the Board of Directors of the San Francisco Medical Society, and on the program committee of the Society for Surgery of the Alimentary Tract.  Dr. Binkley is also a Fellow of the American College of Surgeons.  Dr. Binkley has been an invited speaker at medical centers and hospitals in the United States and internationally, and acted as an ethics consultant to the American Gastroenterological Association.   His writings have appeared in the Journal of the American College of Surgeons, Annals of Surgery, Molecular and Cellular Biology, Cancer Research, Verdict, and Bioethics.net.  After completing his undergraduate degree in Classics and Philosophy at St. Meinrad Seminary, Dr. Binkley attended Georgetown University School of Medicine, graduating magna cum laude.  He completed his surgery residency at the University of Michigan, spending two years as an NIH-sponsored Gastrointestinal Surgery Fellow.

Information on the Markkula Center is at: https://www.scu.edu/ethics/

Don Berwick's "moral determinants" June JAMA essay noted during this discussion is at: https://jamanetwork.com/journals/jama/fullarticle/2767353 

Crosby and Annas's NEJM essay regarding medical ethics and human rights in immigration detention centers, also noted during this discussion, is at: https://www.nejm.org/doi/full/10.1056/NEJMp2003050?af=R&rss=currentIssue

The Alexander Cockburn's essay, "Elder Abuse, Nursing Homes, the Coronavirus, and the Bottom Line," appears in the September 2020 issue of Harper's Magazine.

Though unmentioned, see also, Osmundson and Nathan's, "COVID-19 and the Limits of American Moral Reasoning," in the July 30 issue of The New Republic, at: https://newrepublic.com/article/158660/covid-19-limits-american-moral-reasoning 

For information on the AMA's code of medical ethics go to: https://www.ama-assn.org/delivering-care/ethics  

08/11/2020

Dr. J. Mario Molina Discusses Medicaid Program Financing in Light of the On-Going COVID-19 Pandemic (August 11th)

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Because the economy and the Medicaid program run counter cyclically or are negative correlated (when the economy falters, Medicaid enrollment increases ), to no one's surprise the COVID-19 pandemic's effect on the economy has put the Medicaid program in jeopardy.  The US is experiencing the worst unemployment rate since the Great Depression causing state budgets, heavily reliant and income and sales taxes, to crater.  (States, in sum, are looking at over $500 billion in revenue shortfalls between FY 2020 and FY 2022.)  Simultaneously, Medicare enrollment is increasing, a Kaiser Family Foundation study found enrollment could increase by as much as 24 percent by this coming January, just as state funding for it dries up.   All this explains why the Congress in March increased the federal government's Medicaid match or its funding share (termed FMAP) by 6%.  The House in May, under its HEROES Act, increased the federal government's match to 14% and in addition appropriated more than $1 trillion to state and local governments, including $915 billion in flexible aid—which can be spent for any purpose.  However, Senate Majority Leader Mitch McConnell failed to take up the HEROES Act.  The president's executive actions this past Saturday, even if they prove legal,  ignore the Medicaid program.   For FY 2021, that began July 1 for 46 states, the aggregate revenue shortfall exceeds $300 billion.   

This 27-minute interview begins with Dr. Molina's assessment of COVID-19 care under the Medicaid program and effects the pandemic is having on Medicaid and overall health care utilization.  Dr. Molina moreover discusses the federal government's response to the pandemic, whether the federal government should fund a greater portion of Medicaid spending and, alternatively, the Trump administration's proposal to block grant federal Medicaid funding.  He discusses state budget options to sustain adequate Medicaid funding.  We conclude with Dr. Molina's work with United States of Care's, specifically its OpenSafely campaign.  

Dr. J. Mario Molina is former CEO of Molina Healthcare that provides healthcare to low-income individuals, moreover BC-US-Molina-Executive-Shakeup-IMG-jpgMedicaid recipients and so called Medicaid-Medicare duals.  He is also the former founding Dean of the Keck Graduate School of Medicine in Claremont, California.  Currently, Dr. Molina work is focused on advocating for universal healthcare coverage and development next-generation medical technologies.  His volunteer experience includes serving as Founders’ Council member of the United States of Care, board trustee for Johns Hopkins Medicine, Director for Homeboy Industries, Director for Aquarium of the Pacific, visiting committee member for Harvard Medical School, board of governors’ member for the Huntington Library and inaugural board member of the Financial Solvency Standards Board of the California Department of Managed Care.  Dr. Molina is a Los Angeles native and graduate of Cal State Long Beach and the Keck School of Medicine at USC.

Information on United States of Care is at: https://unitedstatesofcare.org/.     

07/30/2020

Georgetown Professor Judy Feder Discusses Long Term Care Policy (July 29th)

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Federal policymakers have struggled unsuccessfully since at least the 1980s to create a national long term care (LTC) policy.  LTC coverage is available however it can only be obtained by pursing a complicated asset depletion process to qualify for coverage under the Medicaid program.  (Medicare is frequently assumed to provide LTC.  It does not.)  The 2010 Affordable Care Act's CLASS Act, that would have created a voluntary, public long-term care insurance option for employees, was determined in 2011 to be actuarially unworkable and in 2013 was repealed.  The 2013 American Taxpayer Relief Act's Commission on Long Term Care produced a report that contained service delivery and workforce recommendations but did not reach agreement regarding financing.  Though most comparative countries provide for LTC, the US remains without despite the fact with a rapidly aging population the demand for LTC services will significantly increase this decade and beyond (e.g., the number of Medicare beneficiaries is expected to grow from 55 to 80 million this decade), private LTC is largely unaffordable and less than 10% of the middle income population age 45 or older owns a commercial LTC insurance policy.        

During this 28-minute interview, Prof Feder begins by explaining why the 2013 LTC C0mmission failed to reach agreement regarding financing a LTC policy.  She moreover discusses or unpacks her and her colleagues 2018 paper (noted below) that, in sum, proposes a public catastrophic insurance along with a gap-filling private long term services and supports (LTSS) insurance, i.e., who is eligible, when, the amount of the benefit, how paid and financed.  She discusses recent Congressional efforts by Rep. Frank Pallone and others to legislate a policy and provides comment regarding the recently-released Biden campaign proposal regarding caregiver support (also noted below).     

Judy Feder is a Professor of Public Policy and, from 1999 to 2008 served as Dean of what is now the McCourt School of Public Policy, at Georgetown University.  Prof. Feder's health Downloadpolicy research began at the Brookings Institution, continued at the Urban Institute, and, since 1984, has been pursued at Georgetown.   Prof. Feder previously served as the Staff Director of the Congressionally-formed Committee on Comprehensive Health Care, known as the Claude Pepper Commission in 1989-90; served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services; as a Senior Fellow at the Center for American Progress (2008-2011); and, today as an Institute Fellow at the Urban Institute.  Prof. Feder is an elected member of the National Academy of Medicine, the National Academy of Public Administration, and the National Academy of Social Insurance; a former chair and board member of AcademyHealth and former board member of the National Academy of Social Insurance; and, a member of the Center for American Progress Action Fund Board and of the Hamilton Project’s Advisory Council.  In 2006 and 2008, Prof. Feder was the Democratic nominee for Congress in Virginia’s 10th congressional district.  Prof. Feder earned her B.A. from Brandeis and her Master's and Ph.D. from Harvard.  

The 2018 paper, "A New Public-Private Partnership: Catastrophic Public and Front-End Private LTC Insurance" is at: https://www.umb.edu/mccormack.umb.edu/uploads/gerontology/Public_Catastrophic_Insurance_Paper_for_Bipartisan_Policy_Center_1-25-2018.pdf

The Biden campaign's July 21 "caregiving and education workforce" plan is at: https://www.documentcloud.org/documents/6998636-07-20-20-Caregiving-and-Education-Workforce-Plan.html.

07/26/2020

210th Podcast: Stanford's Paul Ehrlich Discusses the On-Going (and Accelerating) Sixth Mass Extinction (July 23rd)

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Our planet is currently experiencing its sixth mass extinction.  Over the past 450 million years the planet has experienced five previous mass extinctions.  Each of which destroyed or extinguished between 70% and 95% of all plants, animals and micro-organisms.  While these five previous extinctions were moreover the result of volcanization, the current extinction crisis is human caused.  According to the UN's Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (or the IPBES), the five main causes of the current mass extinction are, in descending order, man-made changes in land and sea use; man's direct exploitation of animals and plants; man-made or anthropocentric global warming, i.e., the climate catastrophe, and man-made pollution. It should go without saying policy makers cannot coherently address human health without simultaneously recognizing or accounting for the state of the biosphere.  Nevertheless, federal policy makers refuse to discuss the ongoing extinction of life on earth.  For example, the House Select Climate Crisis Committee recently released report (I've cited in a previous post) fails to make any mention of the ongoing mass extinction or the loss of biodiversty nor did the committee discuss the issue during any of it's hearings this Congressional session.  

During this 25 minute conversation, Professor Paul Ehrlich discusses moreover findings he and his colleagues make known in their two recent PNAS articles, findings by the UN's IPBES, e.g., half or more of all wildlife has disappeared from the planet over the past 50 years due in part to human caused reductions in geographic range, the relationship between the climate catastrophe and the extinction crisis, the decline in genetic variation moreover in foodstuffs, ever-increasing desperate efforts by the scientific community to bring this issue to the public's attention and comments on national policy makers perverse and tragic indifference to human-caused biological annihilation on the planet.   

Paul R. Ehrlich is President of the Center for Conservation Biology (CCB) and Bing Professor of Population Studies at Stanford University.  He is also co-founded the Millennium Assessment of Human Behavior (MAHB) with his wife, Anne (policy coordinator of the CCB) and Professor Donald Kennedy.  He is also Co-founder with Peter H. Raven of the field of co-evolution.  Professor Ehrlich is a fellow of the American Association for the Advancement of Science, the American Academy of Arts and Sciences, the American Philosophical Society, the Beijer Institute of Ecological Economics, and a member of the Paul EhrlichNational Academy of Sciences.  Professor Ehrlich has received several honorary degrees, the John Muir Award of the Sierra Club, the Gold Medal Award of the World Wildlife Fund International, a MacArthur Prize Fellowship, the Crafoord Prize of the Royal Swedish Academy of Sciences (given in lieu of a Nobel Prize in areas where the Nobel is not given), in 1993 the Volvo Environmental Prize, in 1994 the United Nations' Sasakawa Environment Prize, in 1995 the Heinz Award for the Environment, in 1998 the Tyler Prize for Environmental Achievement and the Dr. A. H. Heineken Prize for Environmental Sciences, in 1999 the Blue Planet Prize, in 2001 the Eminent Ecologist Award of the Ecological Society of America and the Distinguished Scientist Award of the American Institute of Biological Sciences, and in 2009 the Margalef Prize in Ecology and Environmental Sciences.  Professor Ehlich earned his Ph.D. from the University of Kansas.  

Professor Ehrlich's June 2020 Proceedings from the National Academy of Sciences article titled, "Vertebrates on the Brink as Indicators of Biological Annihilation and the Sixth Mass Extinction," is at: https://www.pnas.org/content/117/24/13596.

His related PNAS July 2017 article titled, "Biological Annihilation Via the Ongoing Sixth Mass Extinction Signaled by Vertebrate Population Losses and Declines" is at: https://www.pnas.org/content/114/30/E6089.  

The UN's IPBES 2019 report, "Global Assessment Report on Biodiversity and Ecosystems Services," is at: https://ipbes.net/global-assessment

The November 2019 letter by over 11,000 scientists published in BioScience warning of the climate emergency is at: https://academic.oup.com/bioscience/article/70/1/8/5610806

07/22/2020

Georgetown's Prof JoAnn Volk Discusses Health Care Sharing Ministries (July 21st)

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The Trump administration has strongly supported alternative insurance plans in the individual market or those that do not meeting regulatory requirements, for example providing what are defined as "essential health benefits," under the Affordable Care Act.  (While the administration claims the ACA reforms are responsible for higher premiums, research shows price increases are largely due to the uncertainty caused by unending efforts to repeal the ACA, the elimination of the individual mandate and the White House's decision to end subsidies to marketplace plans.)  In 2017 the president issued an Executive Order instructing federal agencies to expand the scope of what are termed Short Term Limited Duration Insurance (STLDI) plans.  (A related rule was finalized in 2018, various entities filed suit opposing the final rule's STLDI expansion and this past Friday, the DC US District Court ruled 2-1 in favor of the government.)  Related to STLDI plans and much less discussed are what are termed Health Care Sharing Ministries (HCSMs).  Though these are not defined as health insurance plans, for example they do not guarantee payment of claims, they are marketed as such.  While HCSM plans are growing in number and in subscribers they are neither regulated at the federal nor state level.  Nevertheless, the Trump administration has recently published a proposed IRS rule that would treat HCSMs the same as health insurance, i.e., allow individuals to deduct their monthly HCMS fee from their personal income taxes or be reimbursed under a Health Reimbursement Arrangement.     

During this 21 minute conversation Prof. Volk begins by discussing the history of HCSMs.  She describes or defines HCSM plans, what benefits they offer, how they're financed and marketed.  She explains the adverse selection problem they present, why they are neither regulated at the federal or state level and the recently proposed IRS regulations that would, if finalized, grant tax advantages to those purchasing HCSM plans. 

Ms. JoAnn Volk is a Research Professor at the Georgetown University Center on Health Insurance Reforms (CHIR). There she directs research, authors papers, and provides technical assistance on state and federal regulation and legislation Grgtwn-Proofs-2019_0162-682x1024governing private health insurance, including health insurance marketplaces under the Affordable Care Act.  Prior to joining Georgetown, Ms. Volk represented the AFL-CIO before Congress and the Administration on a broad range of health care issues. Before that, she conducted health care research at Abt Associates and served as an aide to the Speaker of the New York State Assembly.  Ms. Volk serves as a consumer representative to the National Association of Insurance Commissioners and is a member of the Committee on Performance Measurement at the National Committee for Quality Assurance (NCQA).  She earned an MA in Public Policy from Johns Hopkins University and a BA from Franklin and Marshall College.  

The related November 2019 Congressional Research Service paper concerning HCSMs and STLDI plans is at: https://www.everycrsreport.com/files/20191113_R46003_be3db11a1571c61865168353aefa8cb572dc32dc.pdf.   

Prof. Volk's 2018 Commonwealth Fund HCSM issue brief is at: https://www.commonwealthfund.org/sites/default/files/2018-08/Volk_hlt_care_sharing_ministries.pdf

Prof. Volk's June 2020 CHIR Blog post regarding the proposed HCSM IRS rule is at: http://chirblog.org/new-federal-guidance-requires-taxpayers-subsidize-health-care-sharing-ministries/.

For a discussion of the July 17th US District Court's decision regarding the administration's final STLDI rule, see Katie Keith's July 19th review at: https://www.healthaffairs.org/do/10.1377/hblog20200719.720906/full/

07/15/2020

Project COPE, A Research Project Studying the Effects of COVID-19, Is Soliciting Study Participants (July 15th)

Researchers from the University of South Carolina School of Medicine Greenville, Clemson University, Prisma Health and Indiana University are soliciting a wide range of health care providers, professionals and students to participate in surveys and video journals investigating the impacts of the COVID -19 pandemic under the title, Project COPE (Chronicling Healthcare Providers Pandemic Experiences). 

If you are interested in participating in Project COPE, i.e., sharing your experiences with the research team, please go to: https://infoprojectcope.wixsite.com/website?fbclid=IwAR3GzwlzHFbi47y5pZ0Qi2TRttrS6369ecYUs7PWDNsvF-e_3yNbK8ft2e4 and https://uofsc.co1.qualtrics.com/jfe/form/SV_0eSysYlam9i5ARD.

I am not currently a participant in the study nor have I accepted any endorsement moneys for posting this research solicitation. 

Thank you. 

07/12/2020

House Select Committee on the Climate Crisis Releases It's "Solving the Climate Crisis" Report (July 12th)

This past June 30th the US House of Representatives' Select Committee on the Climate Crisis, specifically the Committee's Democratic majority, released a 547-page report titled, "Solving the Climate Crisis."  The report's healthcare chapter, "Improve Public Health and Manage Climate Risks to Health Infrastructure is at pages 313-338.  The report also comes with 21 one-page summaries concerning climate crisis-related subtopics ranging from agriculture to transportation.  The report text, presser, summary pages, et al., is at: https://climatecrisis.house.gov/report.  As a select committee, it cannot offer or pass legislation.  The committee was established in January 2019, is chaired by Tampa's Rep. Kathy Castor (D-FL-14) , the committee has held 16  hearings none since this past February.   The House Speaker Nancy Pelosi has moved no significant climate-crisis related legislation this session of the Congress.      

Considering my June 21 post below, the report, though expected, is far beyond disappointing. 

Possibly moreover, the report fails to recommend a carbon tax.  At page 286 the report states,"Congress could design . . . a carbon price" and goes on to list seven principles for designing carbon pricing. 

As for healthcare, first and foremost, the report concedes the catastrophic effects of the climate crisis.  The report simply recommends "investments in community preparedness and the resilience of hospitals and health infrastructure" and goes on to recommend more specifically, "strengthening national planning to address climate risks to public health," "improving data collections on climate-related health impacts," "ensuring resilient public health supply chains," "supporting community preparedness for the health impacts of disasters," "increasing the planning and preparedness of hospitals and health infrastructure," "strengthening the resilience of the veterans health systems," and "addressing the mental health implications of climate change."