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The Lown Institute's Dr. Vikas Saini and Ms. Judith Garber Discuss Nonprofit Hospital CEO Compensation (March 7th)

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Listeners of this podcast are aware the US suffers from extreme wealth and income inequality.  (E.g., see my “The Unrecognized Tragedy of Working Class Immiseration” STAT News essay posted here on December 31st.)  Concerning CEO compensation in the health care industry, the highest ten paid CEO’s in 2020 were paid an average of $20 million.  By comparison, according to 2020 data from the Bureau of Labor Statistics, the average salary for a BS nurse is $80,000.    

During this 33 minute conversation Dr. Saini and Ms. Garber discuss CEO bonuses during the pandemic, discuss generally CEO compensation as an outlier in the nonprofit sector, discuss the substance of their research findings including what explains CEO compensation and conclude by discussing what criteria should be used in calculating CEO compensation.   

Dr. Vikas Saini, a clinical cardiologist, is President of the Lown Institute.   Previously he has taught and conducted research at Download Harvard.   Prior still he was in private practice for over 15 years on Cape Cod where he also founded Aspect Medical Systems.  Dr. Saini is an expert o optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation.  He has presented his research at professional meetings around the world. 


Judith Garber is a Senior Policy Analyst at the Lown Institute.  She joined the Lown team in 2016, after receiving her Master of Public Policy degree from the Heller School of Social Policy.  She previously worked at the  AspenDownload 
Aspen Institute Financial Security Program, the Midas Collaborative, and Pearson Education.   She has a BA in American Studies and Political Science from Rutgers University.   

Saini and Garber's article, "Nonprofit Hospital CEO Compensation: How Much Is Enough? "  It's at:   

Information on the Lown Institute is at:    


The Latest IPCC Report on the Climate Crisis, an "Atlas of Human Suffering" (February 28th)

Listeners are well aware I spend considerable time discussing the climate crisis.  Again, if it's not successfully addressed nothing else matters.    

Yesterday, the United Nations' Intergovernmental Panel on Climate Change (IPCC) published its latest report that the UN Secretary General aptly termed an "atlas of human suffering."   The report's 35 page summary is here:

Sadly but to no surprise, the House Energy and Commerce Committee, with jurisdiction over health, health insurance, biomedical research, the environment, clean air & the climate crisis, had nothing to say about yesterday’s report, i.e., the committee did not issue a related press release.  E&C did announce on March 9th it was holding a hearing on Daylight Savings Time.  Appreciate the irony.  As for the Senate HELP, or public health, Committee, as I was told last night by majority staff, "the Burrs [staff for Richard Burr, the Ranking Minority member] simply won’t deal with us on climate."  

Concerning the IPCC report , the last sentence of the 3,500 report’s summary reads: “Any further delay in concerted anticipatory global action on adaptation and mitigation will miss a brief and rapidly closing window of opportunity to secure a liveable and sustainable future for all.”

Among innumerable findings, here’s SPM.B.1.4: “Climate change has adversely affected physical health of people globally (very high confidence) and mental health of people in the assessed regions (very high confidence). Climate change impacts on health are mediated through natural and human systems, including economic and social conditions and disruptions (high confidence). In all regions extreme heat events have resulted in human mortality and morbidity (very high confidence). The occurrence of climate-related food-borne and water-borne diseases has increased (very high confidence). The incidence of vector-borne diseases has increased from range expansion and/or increased reproduction of disease vectors (high confidence). Animal and human diseases, including zoonoses, are emerging in new areas (high confidence). Water and food-borne disease risks have increased regionally from climate-sensitive aquatic pathogens, including Vibrio spp. (high confidence), and from toxic substances from harmful freshwater cyanobacteria (medium confidence). Although diarrheal diseases have decreased globally, higher temperatures, increased rain and flooding have increased the occurrence of diarrheal diseases, including cholera (very high confidence) and other gastrointestinal infections (high confidence). In assessed regions, some mental health challenges are associated with increasing temperatures (high confidence), trauma from weather and climate extreme events (very high confidence), and loss of livelihoods and culture (high confidence). Increased exposure to wildfire smoke, atmospheric dust, and aeroallergens have been associated with climate-sensitive cardiovascular and respiratory distress (high confidence). Health services have been disrupted by extreme events such as floods (high confidence).”  

Needless to say I highly recommend reading the report's summary. 



My Latest Essay re: the Climate Crisis (February 21st)

Today 3 Quarks Daily posted my essay, "The World's Most Powerful Public Health Governing Committee's Flagrant Violation of Reality." 

The opening paragraph reads:

"In late January the United States Senate Health, Education, Labor and Pensions (HELP) Committee released a draft discussion of its COVID-prompted public health bill titled, “Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act” (PREVENT Pandemics Act). Patty Murray, HELP Committee Chairwoman and Washington State senator, defined the bill as one that would “improve the nation’s preparedness for future public health emergencies.”  We need to, Senator Murray stated further, “take every step we can to make sure we are never in this situation again.” The draft is fatally flawed because inexplicably the HELP Committee, the Senate “public health” committee, does not address much less recognize ever-increasing health harms caused by the climate crisis. As a result, the committee’s bill is what Orwell would term a “flagrant violation of reality.” 

The article is at:  


Prof. Robert Costanza Discusses Ecological Economics (January 25th)

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Our economy is frequently defined as one of unpaid costs.  (Think: Garret Hardin and the tragedy of the commons.)  Nature or natural resources are considered either inexhaustible and/or the byproducts of their use, such as polluted air and degraded water quality, are externalized costs borne by society, i.e., no one.   Our economic model perfectly well explains the climate crisis.  Treating our atmosphere and our oceans as open sewers has resulted in both global warming and helps to explain the planet's ongoing and accelerating biological annihilation, or the sixth mass extinction.  The field of ecological economics attempts to, in two words, internalize externalities.   

During this 30-minute interview Professor Costanza begins by briefly describing the field of ecological economics.   The interview progresses to his discussion of the valuing nature, here costal wetlands, he explains common asset trusts, the development of more rational measures of economic development (beyond GDP) such as the Genuine Progress Indicator and of course provides comment regarding the climate crisis (including the use of motivational interviewing in defining climate goals).   

Robert Costanza is Professor of Ecological Economics at the Institute for Global Prosperity (IGP) at University College London (UCL).  He is also currently a Senior Fellow at the Stockholm Resilience Centre in Stockholm, Sweden, and Honorary Professor at the Australian National University, an Affiliate Fellow at the Gund Institute at the University of Vermont, and a deTao Master of Ecological Economics at the deTao Masters Academy in Shanghai, China.   Previously, he taught at the Crawford School of Public Policy at the Robertconstanza_biophoto_700x350_webrez
Australian National University.  He has also taught at Portland State University, was Gund Professor of Ecological Economics and Director  of the Gund Institute for Ecological Economics at the University of Vermont, prior still he was Director of the University of Maryland Institute for Ecological Economics and Professor at the University of Maryland's Center for Estuarine and Environmental Science at the Chesapeake Biological Lab.  Professor Costanza is a Fellow in the Academy of Social Sciences in Australia (ASSA) and the Royal Society of Arts (RSA) in the UK, and is an Overseas Expert in the Chinese Academy of Sciences (CAS).  He is co-founder and past-president of the International Society for Ecological Economics and was founding chief editor of the society’s journal Ecological Economics. He currently serves on the editorial board of ten other international academic journals.  He is also founding co-editor in chief of Solutions a unique hybrid academic/popular journal and editor in chief of the Anthropocene Review.   He currently serves on the editorial board of eight other international academic journals and is past president of the Intl. Society for Ecosystem Health.  He is a Senior Fellow of the Stockholm Resilience Centre, a Senior Fellow of the National Council for Science and the Environment and a Distinguished Visiting Professor at Lincoln University in New Zealand.

Professor Costanza's UCL webpage is at:



Engineering Professor John Abraham Discusses Rapidly Rising Ocean Temperatures and Their Contribution to the Climate Crisis and Health Harm (January 18, 2022)

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Over the past several years the earth's oceans, that cover 70% of the planet's surface, have dramatically warmed.  In a paper published last week in Advances in Atmospheric Sciences researchers concluded for the sixth consecutive year ocean temperatures in 2021 reached record levels.  Compared to 2020, 2021 ocean temperatures were 14 zettajoules (14 followed by 21 zeros) warmer.  This amount of energy is 145 times greater than the world's annual electricity generation - equal to a half a zettajoule.  Warming oceans can/do essentially explain or account for human-caused (Anthropocene) global warming, oceans absorb 90% of climate-crisis related warming, the climate crisis in sum and resulting human health harm.   Sadly however this reality is seldom if ever discussed in health care policy circles.  For example, the only mention of rising ocean temperatures and/or resulting health effects in Health Affairs is my discussion in my December 2018 Health Affairs Blog post on climate crisis-caused health effects.   

During this 34-minute interview Professor John Abraham begins by providing an overview of his Advances in Atmospheric Sciences (AAS) paper.  (He is the paper's second author.)  Moreover, he unpacks the extent of rising ocean temperatures, e.g., 2021 warming would be comparable in energy to exploding an Hiroshima bomb every second of every minute, day, week, month and year).  He discusses resulting increasing ocean acidity and the effect of undermining marine food stock that feeds over 3 billion people worldwide, how rising ocean temperatures affect global climate and weather patterns and weather disasters, the effect ocean warming is having on AMOC (Atlantic Meridional Overturning Circulation) and the extent to which we will be able to build resilience in responding to the climate crisis.   

John Abraham, Ph.D., is a Professor and Program Director in the Mechanical Engineering Department at the University of St. Thomas in Minnesota.  He studies include the geophysical Abraham-John science related to the climate crisis that includes the rate at which the planet is warming, particularly oceans.  His team’s warming measurements provide insights on future climate crisis effects over the coming decades.  Professor Abraham also studies the impact of increasing heat on the human body - information that has important health consequences, particularly for vulnerable populations.   Professor has conducted approximately 400 scientific studies that have been published widely.  He is a frequent television and radio guest having participated in over 100 television and radio interviews.

Professor Abraham's January 11 article in The Guardian concerning his AAS publication are at:



The Unrecognized Tragedy of Working Class Immiseration (December 31st)

I'll end 2021 by noting my most recent essay published in STAT News this past Wednesday.  It's titled, "Deaths of Despair: The Unrecognized Tragedy of Working Class Immiseration." 

It opens with: "Given the socioeconomic effects of the ongoing Covid-19 pandemic, it should have come as no surprise that the Centers for Disease Control and Prevention recently reported more than 100,000 drug overdose deaths during the 12-month period ending in April 2021, a 28.5% increase over the prior year. Most of these deaths were attributed to the use of synthetic opioids by middle-aged white men. The question immediately begged is: What is the U.S. Department of Health and Human Services (HHS) doing about these so-called deaths of despair?  The answer is sobering."



Professor Kristie Ebi Discusses The Lancet Series, "Heat and Health" (November 23rd)

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The climate crisis threatens human health in innumerable ways including injury from extreme weather events, respiratory illness, zoonoses, water-borne, vector borne, and non-communicable diseases, malnutrition, behavioral health and psychosocial problems and finally heat related illnesses and death. Climate crisis-related health effects are and will be particularly be hard felt by the elderly and children and within minority communities.  For example, The Lancet's most recent “Countdown on Health and Climate Change” report found heat-related deaths in people older than 65 reached a record high of 345,000 in 2019, or 81% higher than the 2000-2005 average. Children under one year of age experienced an estimated 626 million additional person days of heatwave exposure in 2020 comparted to a 1986-2005 baseline average. Despite these numbers, a recent World Health Organization (WHO) report found countries’ Nationally Determined Contributions (NDCs), or pledges by governments to reduce their carbon emissions, found that only 13% of NDCs commit to quantifying the health co-benefits of carbon emission reduction policies. Listeners may recall I interviewed Professor Ebi in November 2018 concerning the UN IPCC's landmark report, "Global Warming at 1.5º C."  At:

During this 3o minute interview Professor Ebi begins by making brief comment on the just concluded COP 26 meeting. Professor Ebi then explains the impetus for the "Heat and Health" series,  explains the physiological responses to heat stress, discusses health threats via occupation and the urban heat island effect.  She next discusses the second article in the series that identified strategies to address heat extremes in senior care settings and in hospitals and nursing homes ,or the importance of response planning for heat waves including the use of action plans and early warning systems by among others emergency and public health departments.  The discussion concludes with comments concerning related core competency education efforts at the University of Washington and the economic benefits resulting from climate crisis mitigation efforts.               

Kristie L. Ebi is Professor in the Center for Health and the Global Environment at the University of Washington. She has been conducting research and practice on the health risks of climate variability and change Kristie_Ebi - Marci Burden for nearly 25 years, focusing on understanding sources of vulnerability; estimating current impacts and future health risks; designing adaptation policies and measures to reduce the risks of the climate crisis in multi-stressor environments; and estimating the health co-benefits of mitigation policies. She has supported multiple countries in Central America, Europe, Africa, Asia, and the Pacific in assessing their vulnerability and implementing adaptation measures. She has been an author on multiple national and international climate change assessments. She has more than 200 publications and has edited fours books on aspects of the climate crisis.  Professor Ebi earned her BS at Michigan State, her MS at MIT and her MPH and Ph.D. at the University of Michigan. 

The Lancet's recently published "Heat and Health" series is at:

The World Health Organization's (WHO's) recent report, "The Health Argument for Climate Action," referenced during this interview, is at:



250th Podcast: Harvard's Dr. Aaron Bernstein Discusses COP 26, the National Academy's Climate Crisis Effort and Related Issues (November 19th)

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Concerning the recent United Nation’s COP 26 meeting in Glasgow, again unverifiable pledges were made moreover to cut methane gas emissions by 30% by 2030, limit deforestation and adequately finance converting to a green economy.  The US continued to exhibit intransience and/or fecklessness moreover by refusing to sign a pledge to phase out coal despite the fact it is the single biggest source of CO2 emissions worldwide and the fact the US still generates 20% of its electricity from coal. The US also continued to oppose adequately funding countries to recover (termed "loss and damage") from climate-fueled disasters - disproportionately caused by US carbon emissions.  The US is responsible for 40% of excess carbon emissions since 1750. Concerning the US's performance, the Third World Network's Meena Raman commented, "You walk out of the Kyoto Protocol [1997].  You walk out of Paris.  You come back and want us to think you're doing more?  What you're actually encouraging is people to walk out and then come back.  And then you're applauded."  Concerning the credibility of the US "doing more," earlier this week the Biden administration announced it would launch the largest ever auction of oil and gas drilling leases in the Gulf of Mexico. A decision Earthjustice defined as amounting to a “climate bomb.” As a related aside, the Biden administration has been to date issuing oil and gas drilling permits at a faster pace than the Trump administration. In sum, based on an analysis of countries’ 2030 GHG emissions goals, the latest Climate Action Tracker finding shows global warming doubling to 2.4 Celsius above pre-industrial levels, considerably warmer than the 2015 Paris Accord goal of 1.5 Celsius of warming - that substantially runs the risk of causing runaway global warming, or what's been termed Hothouse Earth.  As for the US healthcare industry’s considerable contribution to the climate crisis, the industry has still not taken any meaningful action.  This past Friday the House passed the Build Back Better (BBB) Act that would in part provide $550 billion to address the climate crisis, or in sum allow the US to get halfway to the Biden administration's goal to reduce emissions by approximately 50% (over a 2005 baseline) by 2030. Passage of BBB in the Senate is, as widely reported, in doubt.

Listeners may recall I interviewed Dr. Bernstein’s colleague, Dr. Renee Salas, in June and again in December 2019 regarding the climate crisis.

During this 33 minute conversation Dr. Bernstein begins by commenting on the COP 26 meeting and its results, comments on the clinicians' knowledge of the climate crisis (i.e., the John Kotcher survey that I discussed with Professor Kotcher on May 27th), C-CHANGE's policy work, use of Conditions of Participation and/or a value based payment system to regulatorily require hospitals to limit their carbon emissions (and the financial benefit thereof to hospitals), argues regulation is unnecessary to decarbonize healthcare if legislatively carbon fuels can be appropriately priced (i.e., externalize costs are accounted for), if not, use of regulatory payment incentives can be used to persuade providers.  Dr. Bernstein discusses the National Academy of Medicine's Action Collaborative's effort to decarbonize the healthcare industry and concludes with comments regarding the climate crisis in context of the current sixth mass extinction and in context of improving health equity.              

Dr. Aaron Bernstein is an Assistant Professor of Pediatrics and the Interim Director of Harvard's Center for Climate, Health and Global Environment (C-CHANGE) at the T.H. Chan Bernstein-Aaron School of Public Health. Dr. Bernstein has been a member of the Harvard President’s Climate Change Task Force and co-Chairs the University Food Standards Committee. He serves on the American Academy of Pediatrics Council on Environmental Health Executive Committee, the Board of Scientific Counselors to the CDC’s National Center for Environmental Health and Agency for Toxic Substances and Disease Registry and is Chair of the Board of Directors of the U.S. Green Building Council. In 2015, he was awarded a Lokey-Businesswire visiting professorship at Stanford University and has also been a visiting professor at Columbia University.  After receiving his bachelor’s degree in Human Biology from Stanford University, he received graduate degrees in medicine (MD) and public health (MPH), from the University of Chicago and Harvard University, respectively. He is a recipient of Stanford University’s Firestone Medal for Research and a Harvard University Zuckerman Fellowship. An avid bicyclist, Dr. Bernstein pedals to and from work year-round

Information on Harvard's C-CHANGE program is at:


Brookings' Carol Graham Discusses America's Crisis of Despair (November 8th)

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Last November 9th I discussed declining life expectancy in the US with Dr. Steven Woolf, i.e., US life expectancy stopped increasing in 2010 and had been decreasing since 2014.  This is significantly due to increasing mortality rates among men, disproportionately white men aged 25-64, for approximately 30 disease conditions ranging from cancer, cerebrovascular, circulatory, genitourinary, infectious mental and behavioral, musculoskeletal, nervous, and respiratory diseases.   These premature deaths have become popularly termed, "deaths of despair," a phrased coined by Princeton's Anne Case and Angus Deaton and is the title of their 2020 book, “Deaths of Despair and the the Future of Capitalism."  These authors define these deaths, numbering on average 70,000 per year, as those resulting from alcohol and drug abuse and suicide.  For example, per CDC findings in July drug overdoses increased to 90,000 in 2020, or by 30% over 2019.  While deaths of despair have been identified at least since the 1890s, federal policy makers have yet to seriously address this issue. 

During this 35 minute interview Prof. Graham begins by recognizing Émile Durkheim's related anomic suicide work from the 1890s, she goes on to discuss why poverty is different or more hopeless in the US, moreover among white poor, and what explains this difference between races, discusses what helps to explain why deaths of despair, or diseases of despair, have not been addressed by federal healthcare policy makers, discusses her recommendation for the creation of a federal, interagency task force to address this problem and metrics to track, for example, anxiety, depression, life satisfaction and well being.           

Dr. Carol Graham is the Leo Pasvolsky Senior Fellow at the Brookings Institution, a College Park Professor at the University of Maryland and a Senior Scientist at Gallup.  She is the author of numerous books including : “Happiness for All? Unequal Lives and Hopes in Pursuit of the American Dream” (2017); “The Pursuit of Happiness: An Economy of Well- Download
Being” (2011); “Happiness Around the World: The Paradox of Happy Peasants and Miserable Millionaires” (2009); and, “Private Markets for Public Goods: Raising the Stakes in Economic Reform” (1998).  She is also the author of numerous articles in journals including Science, Social Science and Medicine, the Journal of Economic Behavior and Organization, the Journal of Population Economics, Economica, Perspectives in Psychological Science, the World Bank Research Observer, Health Affairs, Health Economics and  Foreign Affairs.  She is senior editor of Behavioral Science and Policy, and an associate editor at the Journal of Economic Behavior and Organization and on the editorial boards of numerous other economic journals.  She served on a National Academy of Sciences panel on well-being metrics and policy and won the Pioneer Award from the Robert Wood Johnson Foundation and a Lifetime Distinguished Scholar award from the International Society of Quality of Life Studies.   She has served as a Special Advisor to the Deputy Managing Director of the International Monetary Fund and served as a consultant at the Inter-American Development Bank, the World Bank, United Nations Development Program, and the Harvard Institute for International Development.  Born in Peru, she received her A.B. from Princeton, her M.A. from The Johns Hopkins School of Advanced International Studies, and her Ph.D. from Oxford.  She is the mother of three children.

Professor Graham's Brookings' writings discussed during this interview are at:  

(Please excuse this interview's varying sound quality.)    


Opportunity to Respond to AHRQ's Climate and Health RFI (October 31st)

I wrote this to call attention to the Agency for Healthcare Research and Quality's (AHRQ's) first ever solicitation regarding the agency, finally, addressing the climate crisis.  Please review and moreover please forward your comments to AHRQ - that are due December 13th.  

Over the past several decades federal healthcare policy makers, aided and abetted by the healthcare industry, have ignored the climate crisis.  Because the US is historically the largest emitter of greenhouse gases at 25%, US climate nihilism largely explains why today all life on earth is exposed to irreversible harm for the foreseeable future.  Though AHRQ, or AHCPR, should have addressed the climate crisis 30 years ago, on October 13 the agency posted a one-page RFI titled, “AHRQ’s Role in Climate Change and Environmental Justice.”  Considering the late date, the RFI’s publication is heartbreaking.  Simultaneously, however, it is impossible to overstate the opportunity the RFI presents for the healthcare industry.   

Current State of Federal Climate-Crisis Programming

First, it is important to note the US healthcare industry’s carbon footprint accounts for 550 metric tons of carbon equivalent emissions, or 8.5% of total annual US carbon emissions.  The health harm caused by the industry’s emissions is commensurate with upwards of 98,000 US deaths annually and three times this number globally.  If US healthcare was its own country, it would rank 13th worldwide in carbon emissions. 

On balance, the federal government today is nowhere regarding climate crisis-related health policy.  Among other realities if you search CMS’s website for “climate change” you get zero results.  This is true in part because despite the all-of-government rhetoric about addressing racial equity, CMS made no mention of the disproportionate effects the climate crisis is having on minority communities in its ubiquitous use of health equity RFIs in this year’s rulemaking.  Like COVID, the climate crisis, in effect environmental racism, significantly worsens health inequality.  Nevertheless, the HHS Office of Civil Rights has also done nothing to protect Medicare and Medicaid beneficiaries right to a healthy environment.  This assumes they have this right since in 2020 the 9th Circuit ruled in the Juliana case that Americans do not have a constitutional right to a survivable climate.

NIH’s interest in the climate crisis has been only slightly better.  Between 2013 and 2020 NIH spent a cipher of its budget, 0.55%, on climate change and climate related exposures and conditions.  MedPAC and MACPAC, both with broad authority to recommend Medicare and Medicaid policy improvements, have never discussed the issue.  Neither has PCORI.  As for related others, healthcare foundations, for example the Commonwealth Fund, Kellogg and RWFJ with $20 billion in total endowment funds, ignore the topic.  As have many health research journals and media outlets.  When two hundred health journals throughout the world recently called on world leaders to address climate crisis-caused catastrophic harm, Health Affairs and JAMA were not among themHealth Services Research has never published a single related article and Kaiser Health News, Politico Pulse and related others are indifferent.  As for clinician involvement, a recent survey found 41% said they lacked subject knowledge expertise to communicate with the public.  This is in part due in part to the fact that only 15% of medical schools include climate crisis health effects in their curriculum. 

Addressing the Problem

The only ongoing HHS program addressing the climate crisis is the CDC’s Climate and Health Program that currently funds just eight states to improve their climate resiliency.  Leaving aside the considerable financial challenged associated with successfully building resiliency, recognizing the need for more expansive programming HHS announced in late August it was standing up the Office of Climate Change and Health Equity (OCCHE).  One month later, the National Academy of Medicine publicly launched an action collaborative, co-chaired by OCCHE, to decarbonize the healthcare sector and to strengthen the sector’s sustainability and resilience.  To support these efforts, AHRQ has now followed up with its RFI.   

Again, AHRQ’s RFI presents a significant opportunity for the healthcare industry.  The RFI requests comments on 11 questions regarding climate-related health effects including: what role should AHRQ play in identifying, gathering and disseminating climate-related health risks and impacts; what are the most pressing health care-related research and actions AHRQ should address; and, what role should AHRQ play in developing related practice improvement resources and education and training tools.  Comments in response to AHRQ’s RFI are due December 13.