Environment and Maternal Workbook JK Edits

Nursing Collaborative on Environment and Maternal-Child and Women’s Health

Kickoff Meeting

Wednesday, February 3, 2021

1:00PM – 3:00PM ET

Recognizing that nurses are at the forefront of health care touchpoints, the National Association

of Nurse Practitioners in Women’s Health (NPWH) and the Alliance of Nurses for Healthy

Environments (ANHE) welcome you to this effort centered on addressing the environmental

factors contributing to compromised, disparate women’ and maternal child health outcomes. Our

vision is that this Collaborative will leverage their collective knowledge to:

Identify key environmental issues affecting women’s and maternal-child health

outcomes;

Ascertain gaps in knowledge regarding the environmental factors affecting women’s and

maternal-child health outcomes.

Consider curricular components necessary to fill knowledge gaps for nurses and patients.

Identify policy solutions to facilitate increased attention, resources, and support for

environmental health interventions to improve women’s and maternal-child health

outcomes.

Create a prioritized action plan and timeline for execution.

It is our hope that this collective effort will significantly contribute to eliminating disparities in

maternal child health and improving the overall health status of women and children.

Agenda

1:00 pm Welcome and Introductions

Katie Huffling, RN, MS, CNM, FAAN

Executive Director

Alliance of Nurses for Healthy Environments

Heather Maurer, MA

Chief Executive Officer

National Association of Nurse Practitioners in Women’s Health

1:20 pm Setting the Stage: An Overview of Environmental Implications for Maternal-

Child and Women’s Health

Sandy Worthington, MSN, WHNP, CNM

ANHE Board of Directors

1:40 pm The Intersection of Environmental Health and Black Maternal Health:

Policy Implications

Jack DiMatteo

Legislative Assistant, Office of Rep. Lauren Underwood (IL-14)

2:00 pm Break

2:05 pm Small Group Discussions

(Participants will be separated into two groups for a facilitated discussion on the identified topic)

Group 1: Advocacy and Research

Facilitators: Cara Cook, MS, RN, AHN-BC and Susan Kendig, JD, MSN, WHNP-BC,

FAANP

Group 2: Education and Practice

Facilitators: Katie Huffling, RN, MS, CNM, FAAN and Heather Maurer, MA

2:35 pm Group Report and Next Steps

Facilitator: Cara Cook, MS, RN, AHN-BC

2:55 pm Conclusion Heather Maurer, MA

Chief Executive Officer

National Association of Nurse Practitioners in Women’s Health

About NPWH

The National Association of Nurse Practitioners in Women’s Health (NPWH) is a nonprofit,

professional membership association representing more than 8,000 Women’s Health Nurse

Practitioners (WHNPs). Advanced practice registered nurses and other healthcare providers rely

on NPWH for resources and education that improve women’s health and wellness through

evidence-based practice. NPWH pioneers policies to address gender disparities and forges

strategic partnerships that advance health equity and holistic models of care. For more

information, visit www.npwh.org

Contacts:

Heather Maurer: [email protected]

Susan Kendig: [email protected]

About ANHE

The Alliance of Nurses for Healthy Environments is the only national nursing organization

focused solely on the intersection of health and the environment. The mission of the Alliance is

to promote healthy people and healthy environments by educating and leading the nursing

profession, advancing research, incorporating evidence-based practice, and influencing policy.

Contacts:

Katie Huffling: [email protected]

Cara Cook: [email protected]

http://www.npwh.org/

mailto:[email protected]




Nursing Collaborative on Environment and Maternal-Child and Women’s Health

Invited Organizations

Organization Representing Name

American College of Nurse Midwives Amy Kohl

American College of Nurse Midwives Katrina Holland, BA, CAE

ANHE Cara Cook, MS, RN, AHN-BC

ANHE Katie Huffling, RN, MS, CNM, FAAN

Association of Women’s Health, Obstetric and

Neonatal Nurses (AWHONN)

Karen Crowley, DNP, APRN-BC, WHNP, ANP

Association of Women’s Health, Obstetric and

Neonatal Nurses (AWHONN)

Kathleen Hale, MS, RN, NE-BC

National Alaska Native American Indian Nurses

Association (NANAINA)

Sandy Littlejohn, BSN, MA

National Association of Hispanic Nurses

(NAHN)

Dr. Maria Perez PhD, RNC-OB, LHRM, CHEP,

HC

National Association of Neonatal Nurses Gail Bagwell, DNP, APRN, CNS

National Association of Neonatal Nurses Bobby Bellflower

National Association of Pediatric Nurse

Practitioners

Cathy S. Woodward, DNP, APRN, CPNP-AC

National Association of Pediatric Nurse

Practitioners

James Wendorf

National Association of School Nurses Kathy L. Reiner, MPH, BA, BSN, RN

National Association of School Nurses Donna Mazyck, MS, RN, NCSN, CAE, FNASN

National Association of Neonatal Nurses

(NANN)

Dionne Wilson, CAE

National Association of Neonatal Nurses

(NANN)

Tommie Farrell, BSN, RN-NIC

National Black Nurses Association (NBNA) Martha Dawson, DNP, RN, FACHE

National Black Nurses Association (NBNA) Millicent Gorham, PhD (Hon), MBA, FAAN

National Certification Corporation Robin Bissinger, PhD, APRN, NNP-BC, FAAN

National Certification Corporation Jacki Witt, JD, MSN, WHNP-BC, FAANP

National Organization of Nurse Practitioner

Faculties

Mary Beth Bigley, DrPH, MSN, APRN, FAAN

NPWH Susan Kendig, , JD, MSN, WHNP-BC, FAANP

NPWH Heather Maurer, MA

NPWH Donna Ruth, RN, MSN, NPD-BC

NPWH Beth Kelsey, EdD, APRN, WHNP-BC, FAANP

Philippine Nurses Association of America Riza Mauricio, RN, PNP

Philippine Nurses Association of America Mary Joy Garcia-Dia, DNP, RN, FAAN

Region III and Pediatric and Environmental

Health Specialty Unit (Villanova University )

Nurse Run

Laura Anderko

Region III and Pediatric and Environmental

Health Specialty Unit (Villanova University )

Nurse Run

Ruth McDermott Levy, PhD, MPH, RN, FAAN

Sandy Worthington, MSN,RN,WHNP

Describe Environmental Justice and Determinants if Health

Identify vulnerable populations that are at risk when exposed to toxicants and climate change.

Describe toxic substances in our environments that can affect our health.

Address where and how environmental exposures occur in our communities, homes, workplaces, personal care products.

State the effects Climate Change has on human health.

Explore where and how nurses can be leaders in influencing environmental health issues.

a stable climate

healthy living and working conditions

clean air and water

safe food and agricultural practices

products that are free from harmful chemicals

Religion

Neighborhoods

Racial and Ethnic Groups

Cultural Implications

Language

Migrants and Refugees

Disabled and Special Needs

Income and social status - higher income and social status are linked to better health.

Education – low education levels are linked with poor health, more stress and lower self-confidence.

Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions

Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.

Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.

Health services - access and use of services that prevent and treat disease influences health

Gender - Men and women suffer from different types of diseases at different ages.

Maternal Death Rates per

100,000 live Births

1987 – 7.2 deaths

2018 – 17.4 deaths

Current % by race

Women of Color 42.0

Indigenous 30.4

Asian 14.1

White 13.0

Over 80,000 chemicals are registered with the EPA

The air we breath

Water we drink and use

The food we grow and eat

Products we put on our skin

Agricultural

chemicals

Pesticides &

Cleaners

Contaminated

drinking water

Byproducts of

combustion

Chemicals in

electronics

Cosmetics

Prescription

drugs

Contaminated

food

Synthetic

materials

Chemical Exposure Adverse Health Outcome

Vinyl chloride Liver cancer Cardiovascular disease

Benzene Leukemia Aplastic anemia Neutropenia

Benzidine (various chemical formulas) Bladder cancer

Copper sulphate Anemia and blood disorders

Plastics Neurological effects

Asbestos Asbestosis Lung cancer Mesothelioma

Particulate matter Asthma Cardiovascular disease Pulmonary

disease Lung cancer

Sulphur dioxide Asthma

Environmental Tobacco Smoke Cardiovascular effects Pulmonary disease

Asthma

Carbon Monoxide Cardiovascular disease including angina

Solvents Arrhythmias Liver damage

Cotton fibers Byssinosis

Dust from cement; sandblasting; ceramics Pneumoconiosis Bronchitis

Pesticides Skin cancer

Common disruptors

Bisphenol A

Dioxins

Perchlorates

Polyfluoroalkyl Substances (PFAS)

Phthalates

Phytoestrogens

Polybrominated diphenyl ethers

Polychlorinated biphenyls

Triclosan

Examples of products

Plastic products

Epoxy resins

Waste burning

Non-stick pans

Textile coatings

Soy products

Flame retardants

Anti-micobials

Personal care products

Pollution contributes especially to Respiratory, Cardiovascular, and

Cancer Diseases

Examples of Greenhouse Gas Emissions

Carbon Dioxide

Methane

Nitrous oxide

Caused by:

Burning fossil fuels

Livestock feces

Landfills

Producing and transporting natural gas.

Mining coal

Fertilizers

Some industrial and manufacturing processes

Factories

Landfills

BusinessesHazardous

substance spills

Recreational areas

Farms

Pesticides: home, garden

Glues, adhesives

Cleaning products

Flame retardants

Exposures during home

renovation

Carbon monoxide

Radon

Cigarette smokemore…

• Chemicals

• Radiation

• Biological agents

• Pesticides in schools

• Building materials

• Waste Management

• Ventilation

Diet

Alcohol

Tobacco use

Prescription & non-prescription medications

Substance abuse

Insect repellants

Sunscreen

Cosmetics; personal care products

Personal hygiene products

Rise in average temperature

More extreme temperatures

Increased droughts and water scarcity

More frequent wildfires

Increase in precipitation and flooding

Stronger hurricanes and storm surges

Sea level rise

Ocean acidification

Clinicians Screening for Clients

at Risk

Client Educators

Green Team Leaders

Community Activists

Academic Researchers

Academic Educators

Policy and Regulation Advocacy

Activists

Key Opinion Leaders –

Editorials/Op Ed Articles, Press

Releases

Authors

1. We provide healing and safe environments for people.

2. We are a trusted source of information.

3. We are the largest healthcare occupation.

4. We work with people from a variety of cultures.

5. We effect decisions in their own homes, work settings, and communities.

6. We are good sources of information for policy makers.

7. We translate scientific health literature to make it understandable.

8. We have advanced degrees are engaged in research about the environment

and health.

9. Health organizations recognize nurses’ roles in environmental health.

10. The education and standards of nursing practice require that we know how

to reduce exposures to environmental health hazards.

Bekkar B, Pacheco S, Basu r, DeNicola N. Association of Air Pollution and Heat Exposure with Preterm Birth, Low Birth Weight, and Stillbirth in the US. JAMA, June 2020.

Sorensen C, Murray V, Lemery J, Balbus J. Climate Change and Women’s Health: Impact and Policy Directions. PLOS Medicine July 2018.

Hess JJ, Eidson M, Tlumak J, Raab K, Luber G. An Evidence-Based Public Health Approach to Climate Change Adaptation. Environ Health Perspect. 2014; 122(11): 1177–1186.

Hess JJ, Marinucci G, Schramm PJ, Manangan A, Luber G. Management of Climate Change Adaptation at the United States Centers for Disease Control and Prevention. Chapter 20 in Climate Change and Global Public Health. Editors: Pinkerton K and Rom W. New York: Springer, 2013.

Burt P, DeWitt S. Environmental Information for Everyone. Journal of Environmental Health. 2015; 77(7):38-39.

Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM, Barfield W. Vital signs: Pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. MMWR Morb Mortal WklyRep. 2019;68:423–429.

Li, S., Williams, G., Jalaludin, B., Baker, P. Panel studies of air pollution on children’s lung and function and respiratory symptoms: A literature review. Journal of Asthma. 2012; 49(9), 895-910.

Dressel,A., Anderko, L., & Koepsel, B. (August 2013). The Westlawn Partnership for a Healthier Environment: Promoting environmental justice and building community capacity. Environmental Justice,2013; 6(4): 127-132.

Protecting Moms and Babies Against Climate Change Act

Recent research assessing more than 32 million births in the United States found that “exacerbation of air pollution and heat exposure related to climate change may be significantly associated with risk to pregnancy outcomes in the US” and the “subpopulations at highest risk were persons with asthma and minority groups, especially [Black] mothers.”1 The Protecting Moms and Babies Against Climate Change Act will address these climate change-related risks, making robust investments in initiatives to reduce levels of and exposure to extreme heat, air pollution, and other environmental threats to pregnant and postpartum people and their infants.

The Protecting Moms and Babies Against Climate Change Act will:

1. Invest in community-based programs to identify climate change-related risks for pregnant and postpartum people and their infants, provide supports to those patients, and mitigate levels of and exposure to those risks, particularly in communities of color. This funding supports initiatives such as:

➢ Providing training to health care providers to be able to identify climate change-related

risks for patients;

➢ Supporting doulas, community health workers, and other perinatal health workers

who can identify climate change-related risks and support patients;

➢ Providing patients with air conditioning units, appliances, filtration systems,

weatherization support, and direct financial assistance;

➢ Providing support, including housing and transportation assistance, for patients who

face the risk of extreme weather events like hurricanes, wildfires, and droughts;

➢ Promoting community forestry initiatives and tree canopy covers;

➢ Improving infrastructure and blacktop surfaces; and

➢ Improving monitoring systems and data sharing for climate change-related risks.

2. Provide funding to health professional schools to prepare future nurses, doctors, and other

health care workers to address climate climate-related risks for patients.

3. Establish an NIH consortium to advance research on climate change and maternal & infant

health.

4. Design a program to identify and designate climate change risk zones for pregnant and

postpartum people and their babies.

For more information, contact Jack DiMatteo in Rep. Underwood’s office at [email protected].

1 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260

BACKGROUND

BILL SUMMARY

CONTACT


https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260

.....................................................................

(Original Signature of Member)

117TH CONGRESS 1ST SESSION H. R. ll

To direct the Secretary of Health and Human Services to establish a grant

program to protect vulnerable mothers and babies from climate change

risks, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

Ms. UNDERWOOD introduced the following bill; which was referred to the

Committee on llllllllllllll

A BILL To direct the Secretary of Health and Human Services to

establish a grant program to protect vulnerable mothers

and babies from climate change risks, and for other

purposes.

Be it enacted by the Senate and House of Representa-1

tives of the United States of America in Congress assembled, 2

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3

(a) SHORT TITLE.—This Act may be cited as the 4

‘‘Protecting Moms and Babies Against Climate Change 5

Act’’. 6

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(b) TABLE OF CONTENTS.—The table of contents for 1

this Act is as follows: 2

Sec. 1. Short title; table of contents.

Sec. 2. Grant program to protect vulnerable mothers and babies from climate

change risks.

Sec. 3. Grant program for education and training at health profession schools.

Sec. 4. NIH Consortium on Birth and Climate Change Research.

Sec. 5. Strategy for identifying climate change risk zones for vulnerable moth-

ers and babies.

Sec. 6. Definitions.

SEC. 2. GRANT PROGRAM TO PROTECT VULNERABLE 3

MOTHERS AND BABIES FROM CLIMATE 4

CHANGE RISKS. 5

(a) IN GENERAL.—Not later than 180 days after the 6

date of the enactment of this Act, the Secretary of Health 7

and Human Services shall establish a grant program (in 8

this section referred to as the ‘‘Program’’) to protect vul-9

nerable individuals from risks associated with climate 10

change. 11

(b) GRANT AUTHORITY.—In carrying out the Pro-12

gram, the Secretary may award, on a competitive basis, 13

grants to 10 covered entities. 14

(c) APPLICATIONS.—To be eligible for a grant under 15

the Program, a covered entity shall submit to the Sec-16

retary an application at such time, in such form, and con-17

taining such information as the Secretary may require, 18

which shall include, at a minimum, a description of the 19

following: 20



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3

(1) Plans for the use of grant funds awarded 1

under the Program and how patients and stake-2

holder organizations were involved in the develop-3

ment of such plans. 4

(2) How such grant funds will be targeted to 5

geographic areas that have disproportionately high 6

levels of risks associated with climate change for vul-7

nerable individuals. 8

(3) How such grant funds will be used to ad-9

dress racial and ethnic disparities in— 10

(A) adverse maternal and infant health 11

outcomes; and 12

(B) exposure to risks associated with cli-13

mate change for vulnerable individuals. 14

(4) Strategies to prevent an initiative assisted 15

with such grant funds from causing— 16

(A) adverse environmental impacts; 17

(B) displacement of residents and busi-18

nesses; 19

(C) rent and housing price increases; or 20

(D) disproportionate adverse impacts on 21

racial and ethnic minority groups and other un-22

derserved populations. 23

(d) SELECTION OF GRANT RECIPIENTS.— 24



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4

(1) TIMING.—Not later than 270 days after the 1

date of the enactment of this Act, the Secretary 2

shall select the recipients of grants under the Pro-3

gram. 4

(2) CONSULTATION.—In selecting covered enti-5

ties for grants under the Program, the Secretary 6

shall consult with— 7

(A) representatives of stakeholder organi-8

zations; 9

(B) the Administrator of the Environ-10

mental Protection Agency; 11

(C) the Administrator of the National Oce-12

anic and Atmospheric Administration; and 13

(D) from the Department of Health and 14

Human Services— 15

(i) the Deputy Assistant Secretary for 16

Minority Health; 17

(ii) the Administrator of the Centers 18

for Medicare & Medicaid Services; 19

(iii) the Administrator of the Health 20

Resources and Services Administration; 21

(iv) the Director of the National Insti-22

tutes of Health; and 23

(v) the Director of the Centers for 24

Disease Control and Prevention. 25



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5

(3) PRIORITY.—In selecting a covered entity to 1

be awarded a grant under the Program, the Sec-2

retary shall give priority to covered entities that 3

serve a county— 4

(A) designated, or located in an area des-5

ignated, as a nonattainment area pursuant to 6

section 107 of the Clean Air Act (42 U.S.C. 7

7407) for any air pollutant for which air quality 8

criteria have been issued under section 108(a) 9

of such Act (42 U.S.C. 7408(a)); 10

(B) with a level of vulnerability of mod-11

erate-to-high or higher, according to the Social 12

Vulnerability Index of the Centers for Disease 13

Control and Prevention; or 14

(C) with temperatures that pose a risk to 15

human health, as determined by the Secretary, 16

in consultation with the Administrator of the 17

National Oceanic and Atmospheric Administra-18

tion and the Chair of the United States Global 19

Change Research Program, based on the best 20

available science. 21

(4) LIMITATION.—A recipient of grant funds 22

under the Program may not use such grant funds to 23

serve a county that is served by any other recipient 24

of a grant under the Program. 25



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6

(e) USE OF FUNDS.—A covered entity awarded grant 1

funds under the Program may only use such grant funds 2

for the following: 3

(1) Initiatives to identify risks associated with 4

climate change for vulnerable individuals and to pro-5

vide services and support to such individuals that 6

address such risks, which may include— 7

(A) training for health care providers, 8

doulas, and other employees in hospitals, birth 9

centers, midwifery practices, and other health 10

care practices that provide prenatal or labor 11

and delivery services to vulnerable individuals 12

on the identification of, and patient counseling 13

relating to, risks associated with climate change 14

for vulnerable individuals; 15

(B) hiring, training, or providing resources 16

to community health workers and perinatal 17

health workers who can help identify risks asso-18

ciated with climate change for vulnerable indi-19

viduals, provide patient counseling about such 20

risks, and carry out the distribution of relevant 21

services and support; 22

(C) enhancing the monitoring of risks as-23

sociated with climate change for vulnerable in-24

dividuals, including by— 25



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7

(i) collecting data on such risks in 1

specific census tracts, neighborhoods, or 2

other geographic areas; and 3

(ii) sharing such data with local 4

health care providers, doulas, and other 5

employees in hospitals, birth centers, mid-6

wifery practices, and other health care 7

practices that provide prenatal or labor 8

and delivery services to local vulnerable in-9

dividuals; and 10

(D) providing vulnerable individuals— 11

(i) air conditioning units, residential 12

weatherization support, filtration systems, 13

household appliances, or related items; 14

(ii) direct financial assistance; and 15

(iii) services and support, including 16

housing and transportation assistance, to 17

prepare for or recover from extreme weath-18

er events, which may include floods, hurri-19

canes, wildfires, droughts, and related 20

events. 21

(2) Initiatives to mitigate levels of and exposure 22

to risks associated with climate change for vulner-23

able individuals, which shall be based on the best 24



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8

available science and which may include initiatives 1

to— 2

(A) develop, maintain, or expand urban or 3

community forestry initiatives and tree canopy 4

coverage initiatives; 5

(B) improve infrastructure, including 6

buildings and paved surfaces; 7

(C) develop or improve community out-8

reach networks to provide culturally and lin-9

guistically appropriate information and notifica-10

tions about risks associated with climate change 11

for vulnerable individuals; and 12

(D) provide enhanced services to racial and 13

ethnic minority groups and other underserved 14

populations. 15

(f) LENGTH OF AWARD.—A grant under this section 16

shall be disbursed over 4 fiscal years. 17

(g) TECHNICAL ASSISTANCE.—The Secretary shall 18

provide technical assistance to a covered entity awarded 19

a grant under the Program to support the development, 20

implementation, and evaluation of activities funded with 21

such grant. 22

(h) REPORTS TO SECRETARY.— 23

(1) ANNUAL REPORT.—For each fiscal year 24

during which a covered entity is disbursed grant 25



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9

funds under the Program, such covered entity shall 1

submit to the Secretary a report that summarizes 2

the activities carried out by such covered entity with 3

such grant funds during such fiscal year, which shall 4

include a description of the following: 5

(A) The involvement of stakeholder organi-6

zations in the implementation of initiatives as-7

sisted with such grant funds. 8

(B) Relevant health and environmental 9

data, disaggregated, to the extent practicable, 10

by race, ethnicity, gender, and pregnancy sta-11

tus. 12

(C) Qualitative feedback received from vul-13

nerable individuals with respect to initiatives 14

assisted with such grant funds. 15

(D) Criteria used in selecting the geo-16

graphic areas assisted with such grant funds. 17

(E) Efforts to address racial and ethnic 18

disparities in adverse maternal and infant 19

health outcomes and in exposure to risks associ-20

ated with climate change for vulnerable individ-21

uals. 22

(F) Any negative and unintended impacts 23

of initiatives assisted with such grant funds, in-24

cluding— 25



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10

(i) adverse environmental impacts; 1

(ii) displacement of residents and 2

businesses; 3

(iii) rent and housing price increases; 4

and 5

(iv) disproportionate adverse impacts 6

on racial and ethnic minority groups and 7

other underserved populations. 8

(G) How the covered entity will address 9

and prevent any impacts described in subpara-10

graph (F). 11

(2) PUBLICATION.—Not later than 30 days 12

after the date on which a report is submitted under 13

paragraph (1), the Secretary shall publish such re-14

port on a public website of the Department of 15

Health and Human Services. 16

(i) REPORT TO CONGRESS.—Not later than the date 17

that is 5 years after the date on which the Program is 18

established, the Secretary shall submit to Congress and 19

publish on a public website of the Department of Health 20

and Human Services a report on the results of the Pro-21

gram, including the following: 22

(1) Summaries of the annual reports submitted 23

under subsection (h). 24



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11

(2) Evaluations of the initiatives assisted with 1

grant funds under the Program. 2

(3) An assessment of the effectiveness of the 3

Program in— 4

(A) identifying risks associated with cli-5

mate change for vulnerable individuals; 6

(B) providing services and support to such 7

individuals; 8

(C) mitigating levels of and exposure to 9

such risks; and 10

(D) addressing racial and ethnic disparities 11

in adverse maternal and infant health outcomes 12

and in exposure to such risks. 13

(4) A description of how the Program could be 14

expanded, including— 15

(A) monitoring efforts or data collection 16

that would be required to identify areas with 17

high levels of risks associated with climate 18

change for vulnerable individuals; 19

(B) how such areas could be identified 20

using the strategy developed under section 5; 21

and 22

(C) recommendations for additional fund-23

ing. 24



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12

(j) COVERED ENTITY DEFINED.—In this section, the 1

term ‘‘covered entity’’ means a consortium of organiza-2

tions serving a county that— 3

(1) shall include a community-based organiza-4

tion; and 5

(2) may include— 6

(A) another stakeholder organization; 7

(B) the government of such county; 8

(C) the governments of one or more mu-9

nicipalities within such county; 10

(D) a State or local public health depart-11

ment or emergency management agency; 12

(E) a local health care practice, which may 13

include a licensed and accredited hospital, birth 14

center, midwifery practice, or other health care 15

practice that provides prenatal or labor and de-16

livery services to vulnerable individuals; 17

(F) an Indian tribe or tribal organization 18

(as such terms are defined in section 4 of the 19

Indian Self-Determination and Education As-20

sistance Act (25 U.S.C. 5304)); 21

(G) an Urban Indian organization (as de-22

fined in section 4 of the Indian Health Care 23

Improvement Act (25 U.S.C. 1603)); and 24

(H) an institution of higher education. 25



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13

(k) AUTHORIZATION OF APPROPRIATIONS.—There is 1

authorized to be appropriated to carry out this section 2

$100,000,000 for fiscal years 2022 through 2025. 3

SEC. 3. GRANT PROGRAM FOR EDUCATION AND TRAINING 4

AT HEALTH PROFESSION SCHOOLS. 5

(a) IN GENERAL.—Not later than 1 year after the 6

date of the enactment of this Act, the Secretary of Health 7

and Human Services shall establish a grant program (in 8

this section referred to as the ‘‘Program’’) to provide 9

funds to health profession schools to support the develop-10

ment and integration of education and training programs 11

for identifying and addressing risks associated with cli-12

mate change for vulnerable individuals. 13

(b) GRANT AUTHORITY.—In carrying out the Pro-14

gram, the Secretary may award, on a competitive basis, 15

grants to health profession schools. 16

(c) APPLICATION.—To be eligible for a grant under 17

the Program, a health profession school shall submit to 18

the Secretary an application at such time, in such form, 19

and containing such information as the Secretary may re-20

quire, which shall include, at a minimum, a description 21

of the following: 22

(1) How such health profession school will en-23

gage with vulnerable individuals, and stakeholder or-24

ganizations representing such individuals, in devel-25



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14

oping and implementing the education and training 1

programs supported by grant funds awarded under 2

the Program. 3

(2) How such health profession school will en-4

sure that such education and training programs will 5

address racial and ethnic disparities in exposure to, 6

and the effects of, risks associated with climate 7

change for vulnerable individuals. 8

(d) USE OF FUNDS.—A health profession school 9

awarded a grant under the Program shall use the grant 10

funds to develop, and integrate into the curriculum and 11

continuing education of such health profession school, edu-12

cation and training on each of the following: 13

(1) Identifying risks associated with climate 14

change for vulnerable individuals and individuals 15

with the intent to become pregnant. 16

(2) How risks associated with climate change 17

affect vulnerable individuals and individuals with the 18

intent to become pregnant. 19

(3) Racial and ethnic disparities in exposure to, 20

and the effects of, risks associated with climate 21

change for vulnerable individuals and individuals 22

with the intent to become pregnant. 23



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15

(4) Patient counseling and mitigation strategies 1

relating to risks associated with climate change for 2

vulnerable individuals. 3

(5) Relevant services and support for vulnerable 4

individuals relating to risks associated with climate 5

change and strategies for ensuring vulnerable indi-6

viduals have access to such services and support. 7

(6) Implicit and explicit bias, racism, and dis-8

crimination. 9

(7) Related topics identified by such health pro-10

fession school based on the engagement of such 11

health profession school with vulnerable individuals 12

and stakeholder organizations representing such in-13

dividuals. 14

(e) PARTNERSHIPS.—In carrying out activities with 15

grant funds, a health profession school awarded a grant 16

under the Program may partner with one or more of the 17

following: 18

(1) A State or local public health department. 19

(2) A health care professional membership or-20

ganization. 21

(3) A stakeholder organization. 22

(4) A health profession school. 23

(5) An institution of higher education. 24

(f) REPORTS TO SECRETARY.— 25



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16

(1) ANNUAL REPORT.—For each fiscal year 1

during which a health profession school is disbursed 2

grant funds under the Program, such health profes-3

sion school shall submit to the Secretary a report 4

that describes the activities carried out with such 5

grant funds during such fiscal year. 6

(2) FINAL REPORT.—Not later than the date 7

that is 1 year after the end of the last fiscal year 8

during which a health profession school is disbursed 9

grant funds under the Program, the health profes-10

sion school shall submit to the Secretary a final re-11

port that summarizes the activities carried out with 12

such grant funds. 13

(g) REPORT TO CONGRESS.—Not later than the date 14

that is 6 years after the date on which the Program is 15

established, the Secretary shall submit to Congress and 16


and Human Services a report that includes the following: 18

(1) A summary of the reports submitted under 19

subsection (f). 20

(2) Recommendations to improve education and 21

training programs at health profession schools with 22

respect to identifying and addressing risks associ-23

ated with climate change for vulnerable individuals. 24



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17

(h) HEALTH PROFESSION SCHOOL DEFINED.—In 1

this section, the term ‘‘health profession school’’ means 2

an accredited— 3

(1) medical school; 4

(2) school of nursing; 5

(3) midwifery program; 6

(4) physician assistant education program; 7

(5) teaching hospital; 8

(6) residency or fellowship program; or 9

(7) other school or program determined appro-10

priate by the Secretary. 11

(i) AUTHORIZATION OF APPROPRIATIONS.—There is 12

authorized to be appropriated to carry out this section 13

$5,000,000 for fiscal years 2022 through 2025. 14

SEC. 4. NIH CONSORTIUM ON BIRTH AND CLIMATE CHANGE 15

RESEARCH. 16

(a) ESTABLISHMENT.—Not later than 1 year after 17

the date of the enactment of this Act, the Director of the 18

National Institutes of Health shall establish the Consor-19

tium on Birth and Climate Change Research (in this sec-20

tion referred to as the ‘‘Consortium’’). 21

(b) DUTIES.— 22

(1) IN GENERAL.—The Consortium shall co-23

ordinate, across the institutes, centers, and offices of 24

the National Institutes of Health, research on the 25



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18

risks associated with climate change for vulnerable 1

individuals. 2

(2) REQUIRED ACTIVITIES.—In carrying out 3

paragraph (1), the Consortium shall— 4

(A) establish research priorities, including 5

by prioritizing research that— 6

(i) identifies the risks associated with 7

climate change for vulnerable individuals 8

with a particular focus on disparities in 9

such risks among racial and ethnic minor-10

ity groups and other underserved popu-11

lations; and 12

(ii) identifies strategies to reduce lev-13

els of, and exposure to, such risks, with a 14

particular focus on risks among racial and 15

ethnic minority groups and other under-16

served populations; 17

(B) identify gaps in available data related 18

to such risks; 19

(C) identify gaps in, and opportunities for, 20

research collaborations; 21

(D) identify funding opportunities for com-22

munity-based organizations and researchers 23

from racially, ethnically, and geographically di-24

verse backgrounds; and 25



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19

(E) publish annual reports on the work 1

and findings of the Consortium on a public 2

website of the National Institutes of Health. 3

(c) MEMBERSHIP.—The Director shall appoint to the 4

Consortium representatives of such institutes, centers, and 5

offices of the National Institutes of Health as the Director 6

considers appropriate, including, at a minimum, rep-7

resentatives of— 8

(1) the National Institute of Environmental 9

Health Sciences; 10

(2) the National Institute on Minority Health 11

and Health Disparities; 12

(3) the Eunice Kennedy Shriver National Insti-13

tute of Child Health and Human Development; 14

(4) the National Institute of Nursing Research; 15

and 16

(5) the Office of Research on Women’s Health. 17

(d) CHAIRPERSON.—The Chairperson of the Consor-18

tium shall be designated by the Director and selected from 19

among the representatives appointed under subsection (c). 20

(e) CONSULTATION.—In carrying out the duties de-21

scribed in subsection (b), the Consortium shall consult 22

with— 23

(1) the heads of relevant Federal agencies, in-24

cluding— 25



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20

(A) the Environmental Protection Agency; 1

(B) the National Oceanic and Atmospheric 2

Administration; 3

(C) the Occupational Safety and Health 4

Administration; and 5

(D) from the Department of Health and 6

Human Services— 7

(i) the Office of Minority Health in 8

the Office of the Secretary; 9

(ii) the Centers for Medicare & Med-10

icaid Services; 11

(iii) the Health Resources and Serv-12

ices Administration; 13

(iv) the Centers for Disease Control 14

and Prevention; 15

(v) the Indian Health Service; and 16

(vi) the Administration for Children 17

and Families; and 18

(2) representatives of— 19

(A) stakeholder organizations; 20

(B) health care providers and professional 21

membership organizations with expertise in ma-22

ternal health or environmental justice; 23

(C) State and local public health depart-24

ments; 25



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21

(D) licensed and accredited hospitals, birth 1

centers, midwifery practices, or other health 2

care practices that provide prenatal or labor 3

and delivery services to vulnerable individuals; 4

and 5

(E) institutions of higher education, in-6

cluding such institutions that are minority-serv-7

ing institutions or have expertise in maternal 8

health or environmental justice. 9

SEC. 5. STRATEGY FOR IDENTIFYING CLIMATE CHANGE 10

RISK ZONES FOR VULNERABLE MOTHERS 11

AND BABIES. 12

(a) IN GENERAL.—The Secretary of Health and 13

Human Services, acting through the Director of the Cen-14

ters for Disease Control and Prevention, shall develop a 15

strategy (in this section referred to as the ‘‘Strategy’’) for 16

designating areas that the Secretary determines to have 17

a high risk of adverse maternal and infant health out-18

comes among vulnerable individuals as a result of risks 19

associated with climate change. 20

(b) STRATEGY REQUIREMENTS.— 21

(1) IN GENERAL.—In developing the Strategy, 22

the Secretary shall establish a process to identify 23

areas where vulnerable individuals are exposed to a 24

high risk of adverse maternal and infant health out-25



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22

comes as a result of risks associated with climate 1

change in conjunction with other factors that can 2

impact such health outcomes, including— 3

(A) the incidence of diseases associated 4

with air pollution, extreme heat, and other envi-5

ronmental factors; 6

(B) the availability and accessibility of ma-7

ternal and infant health care providers; 8

(C) English-language proficiency among 9

women of reproductive age; 10

(D) the health insurance status of women 11

of reproductive age; 12

(E) the number of women of reproductive 13

age who are members of racial or ethnic groups 14

with disproportionately high rates of adverse 15

maternal and infant health outcomes; 16

(F) the socioeconomic status of women of 17

reproductive age, including with respect to— 18

(i) poverty; 19

(ii) unemployment; 20

(iii) household income; and 21

(iv) educational attainment; and 22

(G) access to quality housing, transpor-23

tation, and nutrition. 24



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23

(2) RESOURCES.—In developing the Strategy, 1

the Secretary shall identify, and incorporate a de-2

scription of, the following: 3

(A) Existing mapping tools or Federal pro-4

grams that identify— 5

(i) risks associated with climate 6

change for vulnerable individuals; and 7

(ii) other factors that can influence 8

maternal and infant health outcomes, in-9

cluding the factors described in paragraph 10

(1). 11

(B) Environmental, health, socioeconomic, 12

and demographic data relevant to identifying 13

risks associated with climate change for vulner-14

able individuals. 15

(C) Existing monitoring networks that col-16

lect data described in subparagraph (B), and 17

any gaps in such networks. 18

(D) Federal, State, and local stakeholders 19

involved in maintaining monitoring networks 20

identified under subparagraph (C), and how 21

such stakeholders are coordinating their moni-22

toring efforts. 23

(E) Additional monitoring networks, and 24

enhancements to existing monitoring networks, 25



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24

that would be required to address gaps identi-1

fied under subparagraph (C), including at the 2

subcounty and census tract level. 3

(F) Funding amounts required to establish 4

the monitoring networks identified under sub-5

paragraph (E) and recommendations for Fed-6

eral, State, and local coordination with respect 7

to such networks. 8

(G) Potential uses for data collected and 9

generated as a result of the Strategy, including 10

how such data may be used in determining re-11

cipients of grants under the program estab-12

lished by section 2 or other similar programs. 13

(H) Other information the Secretary con-14

siders relevant for the development of the Strat-15

egy. 16

(c) COORDINATION AND CONSULTATION.—In devel-17

oping the Strategy, the Secretary shall— 18

(1) coordinate with the Administrator of the 19

Environmental Protection Agency and the Adminis-20

trator of the National Oceanic and Atmospheric Ad-21

ministration; and 22

(2) consult with— 23

(A) stakeholder organizations; 24



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25

(B) health care providers and professional 1

membership organizations with expertise in ma-2

ternal health or environmental justice; 3

(C) State and local public health depart-4

ments; 5

(D) licensed and accredited hospitals, birth 6

centers, midwifery practices, or other health 7

care providers that provide prenatal or labor 8

and delivery services to vulnerable individuals; 9

and 10

(E) institutions of higher education, in-11

cluding such institutions that are minority-serv-12

ing institutions or have expertise in maternal 13

health or environmental justice. 14

(d) NOTICE AND COMMENT.—At least 240 days be-15

fore the date on which the Strategy is published in accord-16

ance with subsection (e), the Secretary shall provide— 17

(1) notice of the Strategy on a public website 18

of the Department of Health and Human Services; 19

and 20

(2) an opportunity for public comment of at 21

least 90 days. 22

(e) PUBLICATION.—Not later than 18 months after 23

the date of the enactment of this Act, the Secretary shall 24



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26


and Human Services— 2

(1) the Strategy; 3

(2) the public comments received under sub-4

section (d); and 5

(3) the responses of the Secretary to such pub-6

lic comments. 7

SEC. 6. DEFINITIONS. 8

In this Act, the following definitions apply: 9

(1) ADVERSE MATERNAL AND INFANT HEALTH 10

OUTCOMES.—The term ‘‘adverse maternal and in-11

fant health outcomes’’ includes the outcomes of 12

preterm birth, low birth weight, stillbirth, infant or 13

maternal mortality, and severe maternal morbidity. 14

(2) INSTITUTION OF HIGHER EDUCATION.—The 15

term ‘‘institution of higher education’’ has the 16

meaning given such term in section 101 of the High-17

er Education Act of 1965 (20 U.S.C. 1001). 18

(3) MINORITY-SERVING INSTITUTION.—The 19

term ‘‘minority-serving institution’’ means an entity 20

specified in any of paragraphs (1) through (7) of 21

section 371(a) of the Higher Education Act of 1965 22

(20 U.S.C. 1067q(a)). 23

(4) RACIAL AND ETHNIC MINORITY GROUP.— 24

The term ‘‘racial and ethnic minority group’’ has the 25



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27

meaning given such term in section 1707(g) of the 1

Public Health Service Act (42 U.S.C. 300u–6(g)). 2

(5) RISKS ASSOCIATED WITH CLIMATE 3

CHANGE.—The term ‘‘risks associated with climate 4

change’’ includes risks associated with extreme heat, 5

air pollution, extreme weather events, and other en-6

vironmental issues associated with climate change 7

that can result in adverse maternal and infant 8

health outcomes. 9

(6) STAKEHOLDER ORGANIZATION.—The term 10

‘‘stakeholder organization’’ means— 11

(A) a community-based organization with 12

expertise in providing assistance to vulnerable 13

individuals; 14

(B) a nonprofit organization with expertise 15

in maternal or infant health or environmental 16

justice; and 17

(C) a patient advocacy organization rep-18

resenting vulnerable individuals. 19

(7) VULNERABLE INDIVIDUAL.—The term ‘‘vul-20

nerable individual’’ means— 21

(A) an individual who is pregnant; 22

(B) an individual who was pregnant during 23

any portion of the preceding 1-year period; and 24

(C) an individual under 3 years of age. 25



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Documents

Environment and Maternal Workbook JK Edits