In a career spanning more than 30 years, Dr. John Balbus has witnessed the climate crisis evolve from a distant environmental concern to what he describes as "humanity's most widespread health threat." Recently honored with the Visionary Leader Award from Health Care Without Harm, Balbus has been at the forefront of integrating climate action into the health care sector and policies.
As the former United States Department of Health and Human Services (HHS) deputy assistant secretary for Climate Change and Health Equity and founding director of the HHS Office of Climate Change and Health Equity (OCCHE), Balbus led federal efforts to prepare the health care sector for climate challenges while reducing its environmental impact, including the groundbreaking Health Sector Climate Pledge. The health care sector is responsible for 8.5% of U.S. greenhouse gas emissions – and are the highest per capita in the world.
Balbus received the Visionary Leader Award award on May 7 during Health Care Without Harm and Practice Greenhealth’s annual CleanMed conference.
We sat down with Balbus to discuss his journey from academic researcher to government change-maker, the challenges of prioritizing climate action in health care, and his vision for a climate-resilient, equitable health sector.
The Visionary Leader Award
The Visionary Leader Award honors leaders who have made significant contributions to the climate-smart health care movement. It celebrates passionate change makers whose work has supported groundbreaking solutions, revolutionary new practices, or the mobilization of broader industry collaboration. The award recognizes individuals whose leadership, vision, and innovation have helped shift momentum toward a zero-emissions, climate-resilient, and equitable future – inspiring transformative change across the health sector and beyond.
What does receiving the Visionary Leader Award mean to you personally and professionally?
"This is an award that comes after working on climate change and health issues for over 30 years. For most of those years, I was coming at it from more or less of an academic stance, trying to estimate the health impacts of climate change and understand where they were going to happen and who was going to be affected. But in the last four years, I've made a transition to doing transformative work within health care, transformative action for communities, and the health sector.
It was a big challenge coming over to OCCHE and figuring out what an office at the core of HHS could do with all of the different resources and levers of the federal government to actually create change on the ground. This was both the best opportunity I could have had in my professional life, but also the biggest challenge."
Balbus noted his longstanding relationship with Health Care Without Harm, dating back to the start of his federal career and beyond, which helped inspire his work on the first sustainable, climate-resilient health care facilities initiative in 2013-2014.
What key challenges have you faced in advocating for climate-smart health care and health equity?
"The biggest challenge throughout the world of health, public health, and health care is getting attention and support. There has always been some crisis, urgency, or priority that has led senior leadership to put climate change issues on the back burner.
When I started working at the beginning of the Obama administration, it became very clear that passage of the Affordable Care Act was absorbing all of HHS senior leadership's attention.
It was even hard to get traction integrating climate change into mainstream HHS initiatives at the beginning of the Biden administration. Understandably, the priority was COVID and navigating our way through the second half of the pandemic. What was so frustrating is that addressing climate issues was part and parcel of what they were trying to do. It was central to the affordability of health care. It was central to being able to understand and combat mistrust of health guidelines, and central to issues of access to care."
Balbus' approach was to integrate climate resilience into existing health care priorities rather than treating it as a separate issue. For example, For example, when addressing energy insecurity as a social determinant of health, his team helped target existing low-income home energy assistance program funding to communities identified as most vulnerable to heat.
Game-changing solutions for a climate-smart health care sector
What are some of the most promising solutions you've seen that could help accelerate the transition to a zero-emissions, climate-resilient, and equitable health sector?
"The two biggest game changers we've seen so far are the development of cost-effective renewable energy microgrids and the development of finance mechanisms.
Solar power with battery backups and the ability to go off-grid gives a health system a much more reliable energy source – especially in areas that are subject to brownouts, wildfires, hurricanes, and widespread loss of power. The microgrid is a way to continue operations in the face of disruptions. In addition, the reduction in cost of solar power over the last decade has meant that, once installed, these microgrids reduce annual operating costs and allow more money in an annual budget to be given over to patient care.”
Balbus credits these benefits as the reason why there is such a wide adoption of renewable energy systems across the health care spectrum, from major medical centers to community health clinics serving vulnerable populations.
He also highlighted the critical role of financing mechanisms through the Inflation Reduction Act, which OCCHE worked to decode for health systems, particularly safety-net facilities with limited capital for infrastructure investments. The third emerging solution Balbus identified is the integration of artificial intelligence, big data, and electronic health records to optimize operations and clinical practices, from reducing waste anesthetic gases to minimizing unnecessary medical imaging and patient travel.
How can health care systems ensure that efforts to address climate change also prioritize the most vulnerable communities who are disproportionately impacted by climate-related health risks?
"Where we (OCCHE) focused our attention was to make sure that the parts of our nation's health system essential to providing services to those at greatest risk received all of the benefits of becoming more resilient and more efficient and less wasteful, so that they could have more resources to devote to their clients who needed the most protection from climate change health impacts.
The first priority is to make sure that community health centers and essential urban hospitals and rural hospitals are all built to withstand increasingly severe weather events so that they can continue to provide services, because when they go down, people lose care and suffer extreme health consequences."
Balbus emphasized the importance of health care facilities serving as anchor institutions in their communities, leveraging their purchasing power, employment practices, and community benefits to address social determinants of health that give people more resilience to climate impacts.
Looking back, what moments or achievements in your career have been the most meaningful to you?
"The work of the last four years with the OCCHE and the mobilization of the health sector through our pledge and the education of hundreds of health care institutions on financing options.
I am very proud of the accomplishments of the Climate Change and Human Health group that I helped to start up and lead for a dozen years, especially the work that we did to create the Human Health Assessment under the Global Change Research Program in 2016.
I'm also proud of the work that was done under the Obama administration to try to make climate change more than an environmental health issue and to get it on the radar of HHS. One of the greatest moments was when we were able to have Secretary Sebelius use a 'Good for you, good for the planet' theme for messaging at the HHS ‘Night at the Ballpark’ event.”
Balbus shared how he created the "Elegant 11" – a two-page document outlining the top climate adaptation actions for each of the 11 operating divisions of HHS. "I shared that with the assistant secretary of health at that time, and that was what led to the sustainable, climate-resilient health care facilities toolkit," he explained. This initial outcome was significant, but the document's impact continued years later when it became a strategic blueprint that informed the broader strategy during the establishment of OCCHE.
As climate impacts intensify and health care systems face mounting pressures from extreme weather events, workforce shortages, and financial constraints, the path forward requires both urgency and hope. Balbus draws his motivation from deeply personal sources.
What keeps you motivated and driven in this challenging, yet rewarding, work? What are you most hopeful for in the future of health care and climate change?
"My motivation, like many people, comes from being a parent and being a grandparent and having an incredibly strong sense that we should be leaving future generations a planet that is as safe for them as it was for us growing up.
The second thing is, I just feel such gratitude for being able to do work that contributes to the solution side of this problem. The third thing is that the people who do this work with me are some of the best people I know in the world. I'm very motivated by the love and friendship that is within this climate and health community."
As for his hopes for the future, Balbus sees enormous potential in the health care sector's ability to lead broader societal transformation.
"I continue to be hopeful about the confluence of climate action and economic opportunities in the health sector. We can transform the health sector – and transforming the health sector will be a fulcrum because of its moral authority, because of its mission, because of the people who are in this sector – that keeps me going."