We haven’t heard much about climate change and health this election season — even though health organizations and experts around the world have recognized that a changing climate is the greatest health challenge of this century. Health professionals can play an important role in bringing this crucial issue forward by asking the candidates nine simple questions:

Question 1What steps will you take to ensure that the U.S. meets its international commitments to reduce its greenhouse gas emissions?

The concentration of CO2 in the atmosphere is now higher than at any time in the last 800,000 years. The impacts of this rapid buildup of greenhouse gas (GHG) emissions can be seen in in record-breaking temperatures, drought, rising sea level, and extreme precipitation across the globe. These changes are causing unprecedented risks to human health and safety, including direct impacts such as heat illness and deaths, displacement, reduced access to clean drinking water, food and water contamination, increased exposures to vector borne diseases, and rising food insecurity.

In fact, without rapid reductions in GHG emissions and fossil fuel use, we risk crossing into more rapid, irreversible, and dangerous climate change. That’s why health organizations representing 13 million health care professionalsjoined together last December in Paris to urge the nations of the world to sign a strong international agreement to limit GHG emissions. 195 countries agreed to voluntary emissions reductions intended to keep average global temperature increases to below 20 Celsius. Last week, the US and China formally committed to the Paris Agreement. But that doesn’t mean your local officials are off the hook. Indeed, much of the action required to meet US commitments will be taken at the state and local level.

Question 2: Do you support the Clean Power Plan, and what will you do to ensure that it is implemented?

In 2014, the US EPA released the Clean Power Plan, which will reduce emissions from power plants by 25% by 2030. The energy sector produces about a third of US GHG emissions, and while the use of coal is declining, coal accounts for a third of U.S. electricity generation. Coal kills: it causes devastating and costly health impacts at every stage of its lifecycle — from mining, to shipping, to combustion and waste products. Coal-fired power plants have a disproportionate impact on the health of people of color and low-income communities; over three quarters of African-Americans live within 30 miles of one of these polluting plants.

According to the EPA, the Clean Power Plan will cut hundreds of millions of tons of carbon pollution, along with harmful particle pollution, sulfur dioxide and nitrogen oxides. These reductions will lead to climate and health benefitsworth an estimated $55 billion to $93 billion per year in 2030, including avoiding up to 6,600 premature deaths and 150,000 asthma attacks in children. That’s why the American Lung Association, the American Thoracic Society and the American Medical Association, the American Public Health Association and many other health experts strongly support the CPP.

But 24 states have sued EPA to halt the CPP — with the support of the coal industry — and it is now stayed by the Supreme Court. State and federal implementation of the CPP is critical to a clean energy future. The rule provides considerable flexibility for states in developing their own implementation plans to reduce carbon and harmful air pollution from power plants. And the worst offenders have the most to gain: states with greater reliance on coal-burning power plants are likely to see the greatest health benefits from implementing the CPP.

Question 3: How will you promote energy efficiency and a rapid transition to a clean energy economy?

Opportunities for “decarbonizing” the economy are growing as clean andhealthy renewable energy becomes more affordable. In fact, solar and wind energy are gaining price competitiveness with fossil fuels, and jobs in the clean energy sector are being created faster than in the oil or coal industry. Many policies can hasten transition to a low-carbon future, including: Renewable Energy Portfolio Standards; ending fossil fuel subsidies; and support for distributed electricity generation. Improving energy efficiencythrough building and appliance standards or home weatherization can lower energy use and save money.

We can also reduce our reliance on fossil fuels in other sectors. For example,fuel economy standards have already reduced per-vehicle emissions; incentives and infrastructure for zero emission vehicles (ZEV) will move us toward a clean and carbon-free transportation system.

Question 4: What steps will you take to increase funding for public transit and walking and bicycling infrastructure?

Transportation produces one third of all US GHG emissions, and our current transportation system is also associated with a grim array of health effects. Air pollution from motor vehicles is a major contributor to respiratory and cardiovascular disease. Motor vehicle crashes cause thousands of injuries and fatalities each year. Traffic creates noise pollution that causes stress and cardiovascular disease. And our auto-centric transportation system is a primary contributor to sedentary lifestyles and physical inactivity that leads to chronic diseases including obesity, diabetes, heart disease, and osteoporosis.

The good news: strategies for reducing emissions from transportation — fuel efficiency standards, ZEV, low-carbon fuels, and reducing vehicle miles traveled–will all reduce air pollution and reap significant health benefits.

But only active transportation — walking, biking, and using public transit — integrates physical activity into daily life. That’s why the health co-benefits of active transportation are potentially huge. Feasible increases in active transportation would yield very substantial reductions in leading causes of death and disability — for example, reducing the burden of cardiovascular disease and diabetes by 14%. Transportation systems with good active transportation options are also more affordable, and improve access to jobs, education, and services for everyone.

To achieve more balanced transportation systems, we need funding forcomplete streets that provide safe places for walking and bicycling, and for transit. Federal funding for active transportation is currently woefully inadequate. Some local and regional governments are also raising money for active transportation and transit through bonds and sales tax measures. It’s very important that equitable active transportation investments and policies benefit all communities, not just a wealthy few.

Question 5: How will you promote climate-resilient cities?

Climate change is already increasing the frequency and severity of extreme heat and weather events. July 2016 was the planet’s hottest month every recorded, and 2015 the warmest year since record-keeping began in 1880. Climate change has also increased the likelihood of torrential downpours, such as those that caused record-breaking flooding last month in Louisiana.

Extreme heat caused nearly 8,000 deaths from 1999–2009, and that toll is expected to rise along with temperatures. Urban “heat islands” exacerbate the risks of heat illness and death, especially for the aged, people with chronic illness, and those without air conditioning. People of color and low-income families are more likely to live in areas with fewer trees and green spaces and in neighborhoods with aging or inadequate infrastructure, and are thus more likely to be exposed to flood and heat risks.

There are many strategies that reduce risks and create healthier communities.Urban greening brings parks, gardens, agriculture, forests, and other natural features to urban areas. Green infrastructure uses trees, rain gardens, permeable pavements and other strategies to better manage storm water. And new building technologies such as cool roofs can significantly lower city temperatures. These strategies also improve health — by cleaning the air and water, providing green spaces for physical activity, and enhancing well-being. Local and state planning, public works, and building agencies can encourage, and fund the use of these strategies to reduce climate vulnerability, especially in disadvantaged communities.

Question 6: What steps will you take to promote more healthy, equitable, and sustainable food systems?

Our food and agriculture systems both contribute to and are adversely impacted by climate change. Industrialized agriculture uses large amounts of herbicides and pesticides that contribute to illness and water contamination. Over-use of nitrogen fertilizer and concentrated animal feeding operations produce methane and nitrous oxide, potent short-lived climate pollutants. More than a third of the food we produce is wasted, leading to more methane from landfills. And the global supply chains of modern food systems areextraordinarily vulnerable to natural and human-made disasters.

Local, sustainable food systems and healthier diets offer important health, climate, and environmental benefits, including: greater access to fresh fruits and vegetables; reduced water, pesticide, and fertilizer use; topsoil protection; and resilience in times of crisis. Reducing food waste can also reduce food insecurity. Eating less meat reduces the risk of heart disease and cancer, and can also reduce methane emissions, water contamination, and antibiotic resistance.

Question 7: What will you do to work for climate justice and a just transition to an equitable and sustainable economy?

People of color and low-income communities currently bear adisproportionate burden from the impacts of climate change. For example, people living near ports or busy roadways are more vulnerable to increased ozone levels due to rising temperatures. Outdoor workers, such as farm laborers, are at higher risk from heat illness. People with chronic illnesses such as asthma, heart disease, and kidney disease are more vulnerable to the effects of wildfire smoke or extreme heat; people of color and with lower incomes are more likely to suffer from these chronic diseases.

Low-income families are less likely to have insurance or financial resources to rebuild their lives after a severe weather event, and less able to cope with rising food prices due to climate impacts on agriculture. And low-income communities and communities of color are often historically disenfranchised, lacking the political and economic power and voice to ensure that their perspectives, needs, and ideas are taken fully into account by decision makers.

While many climate solutions have important health co-benefits, some canexacerbate existing inequities. For example, market mechanisms such as cap and trade can allow the continued pollution of front-line communities if polluting industries like refineries can buy credits rather than reducing emissions. We need climate mitigation and resilience strategies that also promote health, equity, and climate justice, such as investments in disadvantaged communities. That will require that all impacted communities have a real and meaningful voice in determining how we address climate change, and that we consciously consider the impacts on health and equity of all climate policies.

Question 8What would you do to strengthen our public health systems to address the challenge of climate change?

Few resources have gone into building the capacity of local, state, and federal agencies to protect and promote public health in the era of climate change. The CDC’s Climate Ready Cities and States program provides limited funding to 16 states and two large city health departments — but that leaves 34 state and over 3,000 local health departments (as well as territorial and tribal health departments) without any formal support and little guidance for addressing climate change as a critical public health threat.

The current Zika outbreak underscores the importance of monitoring emerging health threats and having the capacity to respond. For example, resources are needed to: enhance domestic and global tracking capacity for infectious disease and climate and health indicators; build public health workforce capacity; develop and implement climate and health strategies; and educate the public on important health risks.

Question 9: What will you do to strengthen the resilience of the health care system in an era of climate change?

We’ve learned the hard way that extreme weather events can paralyze the hospitals and health care facilities we depend on most in an emergency. Hurricane Katrina and Superstorm Sandy both revealed the deep vulnerabilities of our health care infrastructure in the face of increasing extreme weather. During Sandy, some of New York’s leading hospitals sustained major damage and required evacuation of patients and employees; several were shut down for months.

After the devastating effects of Sandy, the US Department of Health and Human Services launched a national partnership with hospitals and health care organizations — the Climate Resilient Health Care Facilities Initiative to ensure that essential health services remain available to communities during and immediately following extreme weather events. Federal and state elected officials must work with the health care sector, hospital associations, health professional organizations and regulatory agencies to address climate risks in siting, building and operating these essential facilities.