The urgency is unmistakable. Climate change is intensifying heat, fires, floods, and drought. Just in these last few days, a catastrophic debris avalanche and flash flood in Nepal was likely triggered by a glacier collapse, while in the U.S., the latest research puts summer 2026 on track to be the nation’s hottest on record – surpassing that of the devastating 1936 Dust Bowl summer.

In addition, biodiversity is declining. While extreme weather events capture headlines, it’s the health of our forests, rivers, oceans, and soils that shape our own long-term health—from the air we breathe and water we drink to the food we eat.

These changes in the world around us feel heavy and daunting. But there is also an extraordinary reason for hope: we may be entering the greatest philanthropic opportunity for conservation in history.

An estimated $124 trillion in wealth will transfer among American families and charities through 2048, even as new fortunes are being created in technology, medicine, finance, clean energy, and other industries. These two waves—the transfer of existing wealth and the rapid creation of new wealth—will reshape philanthropy over the next 20 years. If just 1% of that projected wealth transfer went toward conservation, biodiversity, and climate solutions, it would amount to $1.24 trillion.

The opportunity is not simply to raise more money. It is to rethink what conservation philanthropy can accomplish.

Today’s donors increasingly want measurable, transformational results. That means thinking about conservation differently – not as static preservation but rather as strategic, outcomes-driven investments that conserve natural resources while also strengthening community health and local economies. And successful models already exist.

At The Nature Conservancy, I’ve seen innovative financing turn philanthropy into catalytic capital:

• The Nature Conservancy’s Nature Bonds program traces back to a pioneering 2016 deal in the Seychelles, where TNC helped the island nation refinance its sovereign debt in exchange for a commitment to protect 30% of the country’s oceans. That deal became the model for TNC’s broader Nature Bonds program, which combines debt refinancing with science, planning, and policy work. Across six projects now in implementation, the program is expected to unlock roughly $1 billion for conservation, protecting or improving management of more than 242 million hectares (or about 934,600 square miles) of ocean, land, and freshwater, plus 18,000 km (≈ 11,185 miles) of rivers.

• Another example is Enduring Earth: a partnership TNC formed in 2020 with The Pew Charitable Trusts, World Wildlife Fund, and ZOMA Lab to scale up Project Finance for Permanence (PFP), a conservation-finance model that brings governments, Indigenous peoples, local communities, and public and private funders together around a single binding agreement: all conservation and community-development commitments, along with the full funding needed to carry them out, are locked in simultaneously at one “closing” moment. Since Enduring Earth’s launch, the model has been used to close deals in Brazil, Canada, Colombia, Gabon, Mexico, Mongolia, and Namibia, among others, and has helped secure more than 245 million hectares (about 945,950 square miles) of land, ocean, and freshwater under durable conservation while unlocking upwards of $2 billion in long-term financing. The most recent agreement, the Gabon Infini Project Finance for Permanence (PFP) initiative, was just formally launched a few days ago. It locks in $200 million in community and conservation investments from multiple funding sources over the next decade, while ensuring 30% of the biodiverse country’s land, ocean and freshwater ecosystems are protected.

Nature Bonds work by refinancing a country’s sovereign debt in exchange for conservation commitments, while PFPs pool grants, government funds, and other capital into a single permanent financing package. Both models have yielded measurable results and give me great hope for the future.

As a doctor, this work always comes back to health. Healthy forests protect drinking water. Wetlands reduce flooding. Trees cool our cities. Healthy oceans provide food and livelihoods.

As I previously testified before the U.S. Senate Budget Committee, we already have clear evidence that the presence of nature improves the health and resilience of the places we live. For example, a study published in Nature, which The Nature Conservancy took part in, found that wetlands avoided $625 million in direct flood damages during Hurricane Sandy.

In Kentucky, the Green Heart Project planted 8,000 trees and shrubs across a South Louisville neighborhood to test “greening” an urban neighborhood as a health intervention. The result? Residents in the greened area showed 13-20% lower levels of an important blood marker of inflammation compared to those in a control area, which corresponds to roughly a 10-15% lower risk of heart attack, cancer, or death from any disease.

With nature, communities are safer. People are healthier. The outside world shapes the health within us. Protecting nature is preventive medicine on a planetary scale.

The capital is being created. Our opportunity now is to turn it into a lasting inheritance: healthier people, thriving communities, and a richer natural world for generations to come.

This article was adapted from my August 12^th piece in Forbes. Read it here.

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Author’s Note:

As a physician, I have spent much of my career studying human health. Increasingly, I have come to believe that understanding, and protecting, the health of the planet is inseparable from protecting our own.

They had traveled hundreds of miles from the Pacific Ocean, navigating eight major dams and climbing thousands of feet to return to the cold mountain waters where their lives began.

Those five fish brought the lessons of the week into focus.

We had spent our days rafting through rapids, fishing, hiking, and talking about wildfire, climate change, biodiversity, clean energy, and Indigenous history. Sammy Matsaw Jr., a Shoshone-Bannock Tribal member and The Nature Conservancy’s Columbia Basin Program Director, taught us to see the canyon not as empty wilderness, but as ancestral homeland—a living system connecting people, wildlife, water, and place.

The experience also complicated how I think about dams.

Growing up in Tennessee, I have seen the enormous benefits of hydropower. The Tennessee Valley Authority transformed our region through electricity, navigation, flood control, and economic development. Hydropower remains an important source of reliable, carbon-free energy.

But dams also carry ecological costs.

Four federal dams on the Lower Snake River generate power and support an inland transportation system that farmers and communities depend on. Yet despite decades of fish ladders, hatcheries, and other mitigation efforts, several wild Snake River salmon populations remain deeply depressed.

The question is not whether these dams have value. They do. The question is whether we can replace the benefits they provide while restoring a river connection that cannot be recreated elsewhere.

I came away persuaded that America should begin serious preparation for the eventual removal of the four Lower Snake River dams. Preparation is the critical word.

Replacement electricity and grid services should be operating first. Rail and grain-handling capacity must be ready. Irrigation needs must be resolved. Farmers and communities should receive tangible investment before the river changes. And Tribal Nations—whose leadership has sustained salmon recovery efforts for decades—must remain central to the process.

Stewardship does not mean freezing every decision made by previous generations in place. Sometimes it means protecting what they built. Sometimes it means adapting it. And sometimes, after careful preparation, it means removing a barrier when its benefits can be preserved another way.

Those five salmon had found their way home. Our challenge is to make that extraordinary journey possible again at scale.

Read more about my Salmon River journey with The Nature Conservancy, and find examples of successful dam removal, here in Forbes.

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Author’s Note:

As a physician, I have spent much of my career studying human health. Increasingly, I have come to believe that understanding, and protecting, the health of the planet is inseparable from protecting our own.

That framework worked for deficiency diseases, but not for the chronic diseases that plague us today like obesity, diabetes, and my own specialty heart disease.

Diagnosis: Tunnel vision of food story.

Prescription: Move beyond nutrient arithmetic. Evaluate foods by now they affect metabolism, inflammation, the microbiome, and long-term health.

As kids are going back to school and starting back in fall sports and activities, extreme weather is increasingly becoming a factor.

From prolonged heat waves to flooding and severe storms, schools and educators across the country are facing increasing challenges that affect everything from student achievement, attendance and well-being, to facilities, infrastructure and budgets.

To gain a deeper understanding of multi-factor impact of our changing environment on our children and their places of learning, I’m partnering with the Tennessee State Collaborative on Reforming Education (SCORE) to host the virtual webinar, “Connecting the Dots: Extreme Weather & Student Success” on Wednesday, Aug. 26 from 11 a.m.-Noon CT. I’ll be moderating a virtual conversation with national researchers and education leaders as we explore how extreme weather is impacting student success.

Featured speakers and panelists include:

· Laura Schifter, Ed.D., Senior Fellow, This Is Planet Ed (Aspen Institute)

· Jonathan Klein, Co-Founder & CEO, UndauntedK12

· John English, Superintendent, Unicoi County Schools

· Jennifer Vanos, Ph.D., Associate Professor, Arizona State University’s School of Sustainability

Together, we’ll explore what the latest research tells us about the impact of extreme weather on students’ achievement and health, and how schools and districts are navigating these challenges firsthand and responding through planning, partnerships, and innovative solutions that strengthen resilience. We’ll also discuss what education leaders, parents, advocates, policymakers and state leaders can do to better protect students as extreme weather events become more frequent.

I’ll hope you’ll join us for this important conversation on August 26^th! You can register here.

Truth: Food is not just fuel. It is biological information.

The problem is not calories alone. It is what our modern food system has stripped away: fiber, healthy fats, microbial diversity, natural structure, and real nourishment. Ultra-processed foods can distort metabolism, inflammation, and the microbiome. And the consequences show up in our bodies, our communities, and our environment.

Thank you for watching, and if there’s a topic you’d like me to cover next, let me know in the comments.

I sat down for an in-depth, wide-ranging conversation with the CEO of Penn Health, Dr. Kevin Mahoney. While not an exact transcript of our discussion, below are my responses to Dr. Mahoney’s thoughtful questions on reimagining health and healthcare in an era of financial constraint, and in a changing climate.

The consistent through-line of my remarks: Sustainability is not separate from healthcare. The world around us shapes the health and wellbeing within us.

Senator Frist and Dr. Kevin Mahoney, CEO of Penn Health, kick off Vanderbilt’s 20^th Annual Healthcare Design + Construction Symposium at the University’s brand new Manhattan campus.

Fireside Chat: Value Matters: Reimagining Healthcare in an Era of Financial Constraint | July 29, 2026

Dr. Mahoney: You’ve spent your life caring for human health, first as a surgeon, then as a legislator, and now you chair the global board of the Nature Conservancy. What convinced you that caring for the planet and caring for people are the same work?

Senator Frist:

• For me, that understanding began in the operating room. As a heart and lung transplant surgeon, I saw that disease rarely begins when a patient reaches the hospital. It begins much farther upstream, in the air people breathe, the water they drink, the food they eat, the heat they endure, and the communities where they live.

• Lung transplantation also taught me that nature is not simply scenery. Cyclosporine, the drug that made successful lung transplantation possible, came from a fungus discovered in soil. Nature literally made that medical breakthrough possible.

• Over time, I came to understand that the world around us shapes the health and wellbeing within us. Clean air and water, healthy soil, stable ecosystems, and access to nature are not separate from medicine. They are part of the foundation of human health.

• That is why I see caring for people and caring for the natural world as the same work. Both are ultimately about protecting life.

The healthcare sector accounts for roughly 8.5 percent of U.S. emissions, and hospitals are among the most energy-intensive buildings we operate. As co-chair of the National Academy of Medicine’s Climate Collaborative, how do you persuade the sector to confront its own footprint? And does a program like the Joint Commission’s sustainability certification actually move the field, or are early adopters still leading the way?

• I begin with the healthcare mission: first, do no harm. Climate change is a health issue first and foremost. If our operations contribute to pollution, extreme heat, or other conditions that make people sick, then addressing our own environmental impact is part of our responsibility to patients.

• As you mentioned, the health sector accounts for approximately 8.5 percent of U.S. greenhouse gas emissions. That gives us both a responsibility and an opportunity to lead by example.

• This is about resilience as much as sustainability, and there is a compelling business case. Investments that reduce emissions can strengthen health system resilience, improve operational efficiency, lower costs over time, and better prepare hospitals for extreme weather and supply chain disruptions.

• Leaders should ask a practical question: How are energy use and climate-related risks affecting our patients, workforce, facilities, supply chain, and bottom line? When we look carefully at the numbers, the budgetary impact of a changing environment on healthcare is larger than many leaders expect.

• Many of the largest opportunities, especially in supply chains, infrastructure, and care delivery, extend beyond the walls of any single hospital. Progress at scale therefore requires collaboration across the entire health ecosystem.

• That is why the National Academy of Medicine launched its Climate Collaborative, a public-private partnership of more than 60 organizations and more than 80 health-sector leaders. It is deliberately a big tent, through both the Collaborative and the broader Accelerating the National Climate and Health Movement initiative.

• The Collaborative brings together health systems, clinicians, industry, suppliers, researchers, policymakers, accreditors, and others to develop shared approaches that no one organization could build alone.

• The emphasis is on measurable, evidence-based actions that organizations can implement today, wherever they are in their sustainability journey and at any level of maturity. Through the NAM Climate and Health Movement, any health-related organization can join the work.

• Healthcare has always advanced through collaboration. Patient safety, quality improvement, and infection prevention became standard through shared learning. Climate resilience and sustainability should follow the same model.

• I want to commend Dr. Victor Dzau, the outgoing president of the NAM, for bringing health systems together around climate solutions that benefit patient health and the long-term sustainability of American healthcare.

• On certification, both early adopters and common standards are essential. Early adopters show what is possible and develop new approaches. Standards and certification spread those practices across the field.

• The Joint Commission’s healthcare sustainability certification translates commitment into action by establishing consistent expectations, accountability, and a framework for continuous improvement. More than 250 hospital sites have achieved certification, which demonstrates growing interest across the sector.

• My longtime friend Dr. Jon Perlin, who leads the Joint Commission, described the certification as an organizing principle that helps a health system get started and unifies the organization around reducing its carbon footprint.

In the current environment in Washington, I know some organizations may not want to be publicly out front, but their clinical staff and younger employees increasingly expect a visible commitment to environmental stewardship. Certification demonstrates that commitment.

• Sustainability is increasingly being recognized as part of operational excellence, risk management, and long-term strategy, not simply as an environmental initiative.

• Practice Greenhealth’s 2026 Environmental Excellence Awards show the same momentum. A record 430 organizations submitted sustainability data representing more than 700 healthcare facilities in the United States and Canada. Those 430 organizations received 538 awards across 11 areas of sustainability, the largest awards cycle in the program’s history.

• All of these mechanisms matter. Early adopters innovate. Certification establishes common standards and accountability. Recognition highlights success. Peer learning accelerates adoption across the sector.

Throughout your career, you’ve brought people together to solve problems that improve human health. How do the people in this room make that case to their own leadership, especially the ROI case for investing in green buildings and infrastructure?

• Do not begin with an abstract climate argument. Begin with the institution’s own data and with the problems its leaders already own.

• At Select Medical, I saw how board-level visibility changed quality from an aspiration into a management discipline. We put quality and patient safety before the board, used color-coded dashboards to connect performance at individual facilities with the enterprise view, and created a Collaborative Skin Integrity Committee after the data exposed wound-care problems. Over time, measurement led to management, and management helped change the culture. Rehabilitation patient satisfaction rose from roughly 85 percent to 95 percent.

• The lesson for sustainability is the same. Give it board-level visibility. Measure it consistently. Assign responsibility. Connect each investment to clinical operations and enterprise performance.

• Translate the proposal into the language leadership uses: avoided energy and water costs, lower maintenance expense, reduced exposure to utility-price volatility, fewer disruptions, better staff retention, healthier indoor environments, and protected continuity of care.

• Use total cost of ownership, not initial construction cost alone. A cheaper building that is expensive to operate, fragile during extreme weather, or unhealthy for the people inside it is not truly lower cost.

• The ROI case is straightforward: well-designed sustainability investments can reduce operating expenses, protect capital assets, strengthen continuity of care, and create healthier conditions for patients and employees.

• Start with one project whose results can be measured. Report the health, operational, and financial outcomes together. A successful first project makes the next decision easier.

Senator Frist shares his insights on how sustainable design is central to healthcare’s mission, in conversation with Dr. Kevin Mahoney.

Often, conversations around climate can break down along political lines. But there is a lot of progress happening at the city and state level, where it’s less about ideology and more about concrete steps that improve people’s lives. You’ve seen this up close, from tree planting like Green Heart Louisville to how a city like Phoenix is handling extreme heat. Why do you think that local, on-the-ground work goes further than the gridlock we keep hitting nationally?

• At the local level, leaders cannot treat extreme heat, flooding, dirty air, or failing infrastructure as an ideological abstraction. They have to solve the problem in front of them. That urgency creates room for practical action.

• Green Heart Louisville is a good example. The planting of 8,000 trees and shrubs in south Louisville neighborhoods was framed as a neighborhood health intervention. Compared with residents in nearby control areas, people in the planted neighborhoods showed reductions in chronic inflammation and cardiovascular risk, with evidence of improved immune function.

• That same investment can raise property values, lower utility costs through shade, and support mental health. A nature-based solution can produce several benefits at once and continue paying dividends across generations.

• I recently saw the same practical spirit in Phoenix. Dr. David Hondula, Cleo Warner, Assistant Fire Chief Tim Kreis, and their colleagues are treating extreme heat as a public-health emergency that can be measured and managed.

– The city uses heat-related EMS call data to decide where cooling centers should be located and when they should be open. It connects residents through a 211 hotline, an online heat-relief map, and free Lyft rides to cooling sites.

– The response is not one program. It is a coordinated system that includes the Heat Response and Mitigation Office, the Fire Department, hospitals, libraries, homeless services, faith-based respite centers, Maricopa County, and Arizona State University.

– Phoenix is also working upstream through tree planting, shade structures, cool pavement, reflective roofing, green stormwater infrastructure, and a goal of shade at every feasible bus stop by 2030.

– At Phoenix Fire, I saw how clinical practice has changed as well. Rapid whole-body cooling now begins immediately for heat stroke, because the first 20 to 30 minutes can determine brain and organ outcomes.

• Local solutions create visible results. People can see the shade, reach the cooling center, feel the lower indoor temperature, or watch emergency care improve. Visible results build trust, and proven local models can then be repeated elsewhere.

The climate crisis is a health crisis. Yet in most hospitals, sustainability is still treated as a facilities issue, set aside from patient care. How do we change that, so it’s understood as part of caring for people?

• We have to broaden our definition of care.

• Patient care is not only what happens during a clinical encounter. It includes the air inside the hospital, the food served to patients and staff, the waste generated by care, and the health effects created by the institution’s energy, transportation, and purchasing choices.

• That means sustainability cannot sit within one department. Clinical leadership, facilities, finance, procurement, emergency preparedness, food services, quality, and population health all need to share responsibility.

• Stanford Health Care offers a useful model. Its goal is to integrate sustainability into established quality and performance frameworks, embedding it within the definition of healthcare excellence rather than treating it as a facilities-only program.

– At 500 Pasteur, sustainability was translated into both clinical care and engineering operations. Nature-focused layouts and modular design support healing while reducing the disruption and waste of future renovations.

– The hospital paired a 25 percent carbon-reduction target with energy performance approximately 30 percent better than baseline. It uses carbon-free electricity, water reuse for the green roof, and healthier materials in patient-care and public spaces.

• Valley Children’s Healthcare in Madera County, California, offers another memorable example. It built a solar field in the shape of its mascot, George the Giraffe. The design makes the hospital’s commitment visible while also supporting uninterrupted patient care during brownouts or wildfire-related disruptions.

• The key is to measure sustainability through health, quality, resilience, and operational outcomes as well as emissions. What we define as quality is what the organization learns to manage.

We’ve covered why sustainability matters and how to make the case for investing in it. But what does getting the design right actually look like? When a healthcare campus has to balance clinical needs, cost, and sustainability all at once, how should the natural environment factor in, and what does a campus that strikes that balance feel like to the patients and staff inside it?

• A well-designed healthcare campus should feel healing before a clinician ever enters the room.

• Easy, convenient access to nature, even for short periods, is a relatively low-cost intervention that can measurably reduce stress and improve health and wellbeing.

• In a hospital setting, that can mean an outdoor garden, a wooded walking trail, green space beside the medical center, or simply a well-placed window with a view of trees, plantings, or water.

• I remember vividly going on hospital rounds with my physician father when I was a child. At the end of a long, colorless hallway, he would tell me that the architects should have placed a large window there. Patients would have better outcomes, he said, and nurses and other employees would be happier.

• He said the same about every patient room. Natural light and an outdoor view were not decoration. ‘They heal faster,’ he would explain. Years later, research confirmed what he understood intuitively. He went on to help found Hospital Corporation of America, where those ideas influenced hundreds of hospitals.

• Research summarized in Scientific American has found that even three to five minutes looking at views dominated by trees, flowers, or water can begin to reduce anger, anxiety, and pain and induce relaxation, with measurable changes in blood pressure, muscle tension, and heart and brain activity.

• Good design therefore serves several goals at once. It supports healing, reduces stress for families, gives clinicians moments of restoration, and can help reduce burnout.

• The natural environment should be treated as part of the clinical program from the beginning, not as landscaping added after the major decisions have been made.

You testified before Congress that food is medicine and that a healthy diet belongs in healthcare as much as anything you prescribed as a physician. Yet ultra-processed foods make up much of what we eat, including in our own hospitals. For the people here who design and run these campuses, how should that change what we build and serve around care?

• Poor nutrition is the leading risk factor for death and disability in the United States, causing more harm than major risk factors such as tobacco use, alcohol, opioids, physical inactivity, or air pollution.

• Ultra-processed foods now account for nearly 60 percent of the calories consumed by American adults and nearly 70 percent of the calories consumed by American children. That pattern increases the risk of obesity and other chronic diseases.

• Poor diets drive heart disease, type 2 diabetes, obesity, hypertension, and certain cancers. They also contribute to poor gut health, declining brain and kidney function, impaired immunity, and allergies.

• When I began my medical career, the national epidemics of obesity and type 2 diabetes we see today did not exist at this scale. Their rise has occurred within our adult lifetimes.

• It makes little sense to counsel patients about nutrition and then serve inpatients, their families, and our own employees food that works against their health. Hospitals should align what they serve with what they tell patients.

• The evidence for nutrition’s role in health is clear, and the hospital food environment deserves the same design intentionality as any other space on a healthcare campus. The people in this room are in some ways better positioned to address this than most physicians.

• Build kitchens for healthy food preparation and storage. Moving from reheat-and-serve lines to more scratch cooking requires adequate production space, ventilation, cold storage, equipment, and dock capacity for fresh produce.

• Plan patient food service and visitor or retail dining together. They are often funded and operated separately. If only one side is equipped for scratch production, the healthier-food commitment stops at the cafeteria door. Both need the right equipment and square footage from the beginning.

• Create space for food-is-medicine programs. Teaching kitchens and food pharmacies can support medically tailored meals, medically tailored groceries, and produce prescriptions as part of a patient’s treatment plan. These programs have shown benefits for both clinical outcomes and healthcare utilization.

• Design the defaults. What is at eye level, beside the register, in a vending machine, or available to a family at two in the morning matters more than a nutrition poster. Placement and convenience can nudge people, often without conscious effort, toward healthier choices.

• Make the healthy choice the easy choice. The goal is not simply to remove options or lecture people. It is to make nourishing, minimally processed, nutrient-rich food the most convenient and appealing choice.

• Connect the campus to the community through local farmers, produce-prescription partnerships, and medically tailored meal programs. Food should become part of the care plan, not an afterthought.

• These changes benefit patients and visitors, but they also reshape the daily food environment for everyone who works in the hospital, from clinicians to gift-shop staff. That can improve health and wellbeing, energy at work, and potentially the hospital’s own employee healthcare costs.

If food is medicine, then how it’s grown matters. You’ve said it starts upstream, with healthy soil and healthy land. Help us connect those dots. How does regenerative agriculture tie together the soil, the food we eat, our health, and the land itself?

• Food begins in soil, and the condition of that soil influences everything that follows.

• Healthy soil holds more water, supports biodiversity, reduces erosion, and helps farms withstand drought, heat, and heavy rain. Those are environmental benefits, but they are also food-security and health benefits.

• Regenerative practices such as crop rotation, cover crops, reduced soil disturbance, and carefully managed grazing can rebuild soil structure and biological life while reducing dependence on costly inputs.

• The connection is straightforward: healthier soil supports more resilient farms; resilient farms strengthen the food supply; and a healthier, more reliable food supply supports human health.

• Regenerative agriculture brings environmental stewardship, food security, rural prosperity, and prevention together in one system. It is another example of why caring for land and caring for people cannot be separated.

You’ve spent a career connecting where people live and what they’re exposed to with how their health turns out. AI is starting to make those same links at scale, even tracing someone’s symptoms back to the environment where they grew up. Do you see that changing how we understand the tie between environment and health?

• Yes. AI can help connect a patient’s health with the conditions that shaped it over time, including air quality, heat, housing, food access, water, occupation, and geography.

• By combining clinical information with environmental and community data, AI may reveal patterns that are difficult for any one clinician or institution to see. It could help identify who is at risk earlier and where prevention would have the greatest impact.

• The real promise is moving medicine upstream, from treating disease after it appears to predicting and preventing it.

• We must also be disciplined. Environmental data can be incomplete, clinical records can carry past bias, and correlation is not causation. Privacy, consent, data quality, transparency, and equitable performance have to be designed into these systems from the beginning.

• Used responsibly, AI can make the connection between place and health visible at a scale we have never had before, while still leaving clinical judgment and human relationships at the center of care.

Vanderbilt Civil Engineering Professor Sanjiv Gokhale welcomes Senator Frist to Vanderbilt’s new NYC-based campus on July 29, 2026.

If everyone in this room took away one thing from this conversation and acted on it, what would you want it to be?

• Ask one question inside your own institution: How is the environment we create affecting the health of the people we serve?

• Then choose one measurable action.

– Reduce energy waste.

– Improve resilience.

– Plant trees or add shade.

– Change the food you serve.

– Protect workers and patients from extreme heat.

– Examine your supply chain.

– Connect sustainability goals to patient, workforce, and operational outcomes.

• Do not wait for a perfect national policy or a complete institutional plan. Begin where you have influence, measure the result, and build from there.

• The central idea is simple: sustainability is not separate from healthcare. Protecting the world around us is one of the most important ways we protect the lives within it.

Thank you for watching, and let me know if there are any subjects you’d like me to cover next!

Thanks for watching. If there’s anything you’d like me to cover next, let me know in the comments!

Sometimes they do.

But sometimes they begin with something much simpler: one person in need, another willing to listen, and the courage to say yes.

That is how Cumberland Heights began.

As a child, I watched the story unfold through my parents, Dr. Thomas F. Frist Sr. and Dorothy Cate Frist. Today, sixty years later, it remains one of the clearest examples I know of how compassion, when organized into action, can change countless lives.

The story started with one of my father’s patients, Bob Crichton, who struggled with alcoholism. After receiving treatment at Hazelden in Minnesota, Bob returned home convinced that the South needed a residential recovery center of similar quality—one that would be accessible to families throughout our region.

My father agreed it was needed but said he couldn’t take it on.

He was already balancing a busy medical practice, hospital leadership, teaching, civic responsibilities, and raising our family. There simply wasn’t room for another major undertaking.

That evening, he shared Bob’s vision with my mother. After listening quietly, she offered a simple observation that changed everything:

“I really pray that someone will step up to make Bob’s vision happen. It could make a lot of people’s lives better.”

By the next morning, my father had changed his mind. At 7am from the kitchen table, he called Bob and told him he wanted to help make the vision a reality. When Bob asked what came next, Dad’s answer revealed the leadership philosophy that guided him throughout his life: find exceptional people who know the work, then give them the opportunity to do it well.

Looking back, I’ve often thought about that moment. Leadership isn’t always having the answer. Sometimes it’s being willing to listen deeply enough to recognize when someone else’s idea deserves your full commitment.

My parents each brought something different to Cumberland Heights. My father contributed the physician’s perspective and the ability to bring together talented people around a common mission. My mother brought moral clarity. She understood that addiction never affects just one person. It touches spouses, children, parents, friends, workplaces, and entire communities.

She also gave the organization its name, inspired by the rolling hills above the Cumberland River. “Cumberland Heights” captured not only the landscape, but also the hope, healing, and new beginnings the center would offer.

My parents were two of the many people who helped create not simply a treatment center, but a place where people could begin again. Countless others made Cumberland Heights what it is today, and each has a story worth telling. This is simply our family’s story, remembered through the eyes of a young boy who listened from the hallway outside an open bedroom door and from conversations around the kitchen table.

Over six decades, Cumberland Heights has grown from a small campus on River Road into one of the nation’s leading recovery organizations, serving thousands of patients and families each year.

But the numbers are not what stay with me.

What I remember most is watching my father listen to former patients describe finding recovery, rebuilding their families, and reclaiming their lives. After one such conversation, he quietly said, “That’s what I really care the most about, right there.”

I think about those words often.

Buildings matter because people heal inside them. Organizations matter because they preserve a mission. Leadership matters because it creates opportunities for others to flourish.

Yet every enduring institution ultimately exists for one purpose: to improve the lives of people.

This week, Cumberland Heights celebrates sixty years of hope and healing. This milestone reminds us that the greatest legacies rarely begin with ambition alone. More often, they begin with compassion, a willingness to listen, and the simple courage to say yes.

Read more of this story in my recent Forbes article.

That realization is one of the reasons we founded NashvilleHealth.

At first glance, Nashville seems like one of the healthiest cities in America. We are home to world-class hospitals, outstanding physicians and nurses, leading medical schools, innovative healthcare companies, and remarkable philanthropic organizations. Few cities possess so many healthcare assets.

Yet our health outcomes tell a different story.

Too many Nashvillians live shorter, less healthy lives than they should. Chronic disease remains pervasive, and life expectancy varies dramatically across neighborhoods. In fact, when we founded NashvilleHealth in 2016, it was in response to data from the Robert Wood Johnson Foundation’s County Health Rankings that showed Nashville behind its peer cities in nearly every health indicator. From rates of smoking and infant mortality, to obesity and hypertension – Nashville consistently trailed its peer cities of Charlotte, Austin, Denver, and Fort Worth.

Those disparities reveal an important truth: healthcare and health are not the same thing.

Healthcare is what happens in a clinic, hospital, or physician’s office. Health is shaped every day by whether someone has access to nutritious food, reliable transportation, safe places to play and exercise, stable housing, economic opportunity, and a community that supports healthy choices.

As physicians, we’re taught that healing begins by listening. The same principle applies to communities. Before we prescribe solutions, we must understand the realities people face in their daily lives.

That’s why NashvilleHealth was created—not to replace the remarkable organizations already serving our city, but to bring them together. Lasting progress requires healthcare providers, nonprofits, businesses, academic institutions, government, faith communities, and neighborhood leaders working toward shared goals, informed by shared data and guided by the voices of the communities they serve.

We’re beginning to see what that collaboration can accomplish.

By aligning key stakeholders through the Nashville Wellness Collaborative, launched by NashvilleHealth in 2022, their joint work led to the designation of North Nashville as the city’s first Wellness Opportunity Zone and to the Metro-funded, NashvilleHealth-led Heart of Nashville initiative.

Heart of Nashville demonstrates the effectiveness of NashvilleHealth’s collaborative impact approach. The initiative brings together partners across our city – including the Matthew Walker Comprehensive Health Center, The Nashville Food Project, Senior Ride Nashville, Belmont University, Meharry Medical College, and The Sycamore Institute – to create a coordinated approach for patients with uncontrolled hypertension. Participants receive high-quality clinical care combined with heart-healthy meals, transportation, fitness opportunities, and other practical supports that make healthier living possible.

The early results are encouraging. More than 226 patients have been served, thousands of meals have reached families, and many participants with elevated hypertension have improved by at least one full hypertension stage. But what excites me most is what they represent: proof that addressing the conditions that shape health can improve lives.

This lesson extends far beyond Nashville.

Every community already has dedicated people working to improve health. What many communities lack is the trusted infrastructure to align those efforts, reduce duplication, measure outcomes, and sustain collaboration over time.

Building healthier communities isn’t simply about expanding healthcare. It’s about creating a culture of health—one in which every sector recognizes that it has a role to play in helping people live longer, healthier, and more fulfilling lives.

The city thrives when its residents thrive. That simple idea inspired NashvilleHealth more than a decade ago. Today, I believe it offers a model that communities across America can adapt in their own pursuit of better health.

Read more about why we founded NashvilleHealth in my recent Forbes article, and learn more about NashvilleHealth’s work at NashvilleHealth.org.

VANDERBILT TRANSPLANT CENTER

#1 IN THE NATION

960 TRANSPLANTS IN 2025

“THE MOST IMPORTANT RECORD IN MUSIC CITY”

In my remarks, I shared the origin story.

The Foundation is Set: 1983–1993

Remarks by Bill Frist, MD, Founding Director

June 26, 2026

Vanderbilt Transplant Center Milestone of No. 1 in the Nation

The Thread That Connects Us

I want to begin with a man who walked the halls of our medical school at Vanderbilt four decades before I arrived at Stanford to train under him.

Norman Shumway entered Vanderbilt University School of Medicine in 1945 — immersed in the creative culture of Alfred Blalock and Barney Brooks, where experimental surgery was pursued with disciplined boldness. He left with his MD in 1949, later went to Stanford, and became what the world now calls the Father of Heart Transplantation. On January 6, 1968, he performed the first human heart transplant in the United States.

In 1983, I arrived at Stanford as his fellow. As my training drew to a close, Dr. Shumway, across the operating table one night, said words I have never forgotten:

“Dream big. Master the heart — no one yet has transplanted single lungs …. But the big vision is to create a unified multidisciplinary, multi-organ transplant center. That is what takes transplant to scale. “

He was sending me home — home to Nashville, home to the very medical school where he had been trained — to build something the world had never seen.

The Dream and the Blueprint

The vision was this: instead of isolated programs for kidneys, hearts, and later the still experimental lungs and livers— each siloed in its own department — bring them all under a single interdisciplinary roof with a single mission, religiously centered on the patient. Why? Because the knowledge that makes transplantation possible — immunology, rejection, immunosuppression, social work, rehabilitation, donor organ availability — is the same knowledge across all organs.

Let the specialists share it. Let infectious disease serve every program. Let one ethicist guide every team. Integrate, collaborate, unify. Truly, multidisciplinary.

While at Stanford, I put that vision into a 45-page planning document — part business plan, part clinical blueprint, part research agenda — and out of the blue sent it to Vice Chancellor Ike Robinson to see if Vanderbilt might have an interest. He read it, grasped it, committed the seed funding, and recruited me home to Nashville. The dream suddenly had an address.

The Foundation We Built On

When I joined the faculty in 1986, I found a stronger base than I could ever have hoped for. Dr. Keith Johnson and Dr. Bob Richie had built one of the great kidney transplant programs in the country — 1,600 transplants by 1988, the 14th largest program in the nation — and with it an institutional depth of knowledge about clinical immunosuppression that became the scientific foundation for everything else. The first kidney transplant at Vanderbilt was performed in 1962 by Dr. William Scott and Dr. Charles Zukoski.

Walter Merrill, with whom I had spent a couple of days at Stanford in 1984 as he prepared the heart transplant program, was already here, having performed Vanderbilt’s first adult heart transplant in 1985. Walter would become my indispensable, indefatigable partner in every endeavor that followed.

The Center Takes Shape

In January 1987, Walter and I performed Tennessee’s first heart-lung transplant — the first successful such operation in the Southeast. Two months later, Tennessee’s first pediatric heart transplant. In 1988, Dr. Hal Helderman and I were named Medical and Surgical Directors respectively of the new Vanderbilt Transplant Center.

On September 21, 1989, the center was formally chartered. The document declared: “The Vanderbilt Transplant Center is the first of its kind in the nation.” The stated mission:

“To propel and direct transplantation research, medicine, technology, education and public education of transplantation issues into the future as the recognized leader and national authority of multi-organ transplantation in the United States and abroad.”

Those words: “The recognized leader and national authority.” Remember this was written in 1989 before we had begun lung, before we had begun liver. Yes, it was aspirational at the time. Yet 37 years later that is the precise description of what stands in this room tonight.

In our founding year we performed 28 heart transplants — 66 total since 1985 — 111 kidney transplants, and 75 bone marrow transplants under Dr. Steven Wolff. We hired the first full-time, center-based transplant ethicist in the country — Dr. Richard Zaner — and recruited Dr. Steve Dummer to build a dedicated transplant infectious disease program. Tracy Frazier served as our first administrative officer, making the grand vision operational day by day. Our first home was the entire ninth floor of the Oxford House. Janie Webb in social work. Jan Muirhead in nursing.

In December 1989, we launched the single-lung transplant program, collaborating closely with pulmonologist Dr. Jim Loyd, in a field still regarded experimental. One of our first lung patients — Pam Everett-Smith, transplanted in 1990 — last week was in town for her 36^th annual wellness check, and is in the Guinness Book of World Records as the longest-surviving single-lung recipient in the world.

In 1990, we recruited Dr. Wright Pinson — a genius in the OR and out — who rapidly built our liver transplant program from scratch. With the liver program’s launch in 1991, every organ envisioned in the original blueprint was now operational: heart, lung, kidney, liver, pancreas, bone marrow — all under one roof, one mission, one culture.

The foundation was built … and it was strong: outcomes excellent, operationally multidisciplinary, published research bold and prolific, obsessively centered on the patient and families.

No other university medical center in America had built a foundational launching pad as for what was to come.

The Baton

In 1994, I left for the United States Senate. Wright Pinson took the directorship, and the founding chapter closed.

Norman Shumway trained at Vanderbilt. He told us to dream big and build what transplantation needed to go to scale. Together we built that foundation. What it has become — what we are celebrating tonight with the 960 patients transplanted last year and the tens of thousands of patients and families whose lives have been transformed over time — is the fullest answer we could give to the man who first imagined it.

Article originally appeared in Forbes on June 30, 2026.

Thanks for watching, and if there’s a topic you’d like me to cover next, let me know in the comments.

In 2024, Phoenix experienced a record 113 straight days with temperatures over 100 degrees Fahrenheit, including 70 days where temperatures topped 110°F. In this part of the country, heat can be a matter of life or death.

Beyond physical discomfort, Phoenix’s extreme heat also affects the city’s bottom line. Research shows worker productivity drops by as much as 2.5% per degree when temperatures rise above 80°F. With 100-degree days beginning in April, outdoor work, including construction, becomes more difficult and more dangerous.

A recent analysis by AECOM and The Nature Conservancy estimated that without mitigation or adaptation, annual labor productivity losses would reach $850 million annually in the Phoenix metro region. Heatwaves can also damage critical infrastructure and electrical transmission networks, costing an estimated $4 million annually to Phoenix road maintenance.

Heat is no longer a seasonal inconvenience. It is a persistent stress test of health, infrastructure, and daily life.

A city responding in real time

I began my visit at Phoenix City Hall with Mayor Kate Gallego, who has helped make heat response a defining priority for the city. In 2021, Phoenix became the first city in the country to establish a dedicated Office of Heat Response and Mitigation. Led by Dr. David Hondula, the office reflects a practical understanding of what extreme heat now demands: coordinated public health, infrastructure, planning, and communication.

These are not abstract strategies. They are practical interventions visible across the city.

Phoenix has piloted one of the nation’s largest cool pavement programs, applying reflective coatings to asphalt that reduce surface temperatures and slow heat retention overnight. That matters because the danger in extreme heat is not just the daytime high, but the lack of nighttime relief.

The city has also expanded urban shade, combining tree planting with built structures that function as both infrastructure and public art. In a desert environment where native trees do not always provide large canopies, this hybrid approach is essential.

And importantly, Phoenix voters have supported this work directly. In a recent bond initiative, investments in heat mitigation—from shade to building design—received broad, bipartisan backing. Residents understood something simple: these changes improve daily life.

From observation to understanding

The city’s response has been creative, but it’s also been informed by data from the outset. Some of the leading researchers on heat and human health are located just fifteen minutes from the Mayor’s office at Arizona State University.

As a physician who once logged dozens of hours in the research lab studying hearts and lungs, I wanted to see the science in action.

At Arizona State University’s Rob and Melani Walton Center for Planetary Health, I met researchers and city partners who are turning extreme heat into something public health can act on, not just endure.

That’s why one word I heard in Phoenix stayed with me: livability. It’s more than climate, resilience, or mitigation. It’s the basic promise of public health: that ordinary life stays safe and possible even as conditions change around us. And it turns a polarized argument into simple questions:

Can you live and work here?
Can your child play outside?
Can your neighbor get home safely at the end of a shift?

One of the strongest voices on this came from Dr. Jennifer Vanos, an associate professor at ASU who directs the Human Biometeorology Lab. The lab studies how extreme heat affects human health in cities, especially for children and outdoor workers. Dr. Vanos put it plainly: if you use the wrong terms, “you can lose half your audience.”

I heard that same point reinforced by Dr. David Hondula, an ASU associate professor who serves as the City of Phoenix’s Director of Heat Response and Mitigation. He understands both the science and the on-the-ground realities of city governance, and he echoed why heat can be a bridge issue across political identity in a way that many climate terms cannot.

But livability, and the idea of thriving instead of just surviving, creates common ground because it speaks to what people value in everyday life: kids, work, mobility, and dignity.

At ASU’s Human Biometeorology Lab, the team demonstrated two tools that turn heat into decision-ready data.

• ANDI, a sweating, breathing, walking thermal manikin, models human thermoregulation and quantifies heat strain without putting real people in unsafe conditions.

• MaRTy, a mobile heat robot, measures how the built environment changes exposure—radiant heat from asphalt and buildings, airflow, and microclimate.

Together, they link the city’s heat exposure with what happens inside the body. That pairing is exactly what cities need: not just weather readings, but health-relevant intelligence that guides where shade, trees, cool materials, and operational changes will prevent harm.

Protection can be practical

Phoenix is already putting that insight to work.

Data from street-level heat measurements has helped guide where to prioritize shade structures, tree canopy, and cooling interventions, especially in neighborhoods with the highest exposure and vulnerability.

The city’s “Shade Phoenix” plan has already resulted in thousands of new trees and dozens of new shade structures, with a focus on walkability and public safety.

At the same time, researchers and city leaders are working together on HeatReady Schools, redesigning outdoor spaces and schedules so children can safely remain active even during extreme heat. In some schools, recess had been canceled for weeks at a time. The goal now is not avoidance, but adaptation.

There are also simple but scalable material solutions. Advances in cool roofs and reflective building materials are reaching a point where they can be implemented at little to no additional cost during normal replacement cycles, delivering long-term energy savings and measurable health benefits.

Even transportation connects back to heat. As Dr. Hondula noted, people are far more likely to walk, bike, or use transit if they can do so comfortably. In that sense, shade and cooling are not just adaptation strategies. They are enabling changes that reduce emissions over time.

Phoenix is also showing what it looks like to count heat correctly. Heat deaths are undercounted nationally; Maricopa County’s surveillance distinguishes “heat-caused” from “heat-contributed” and strengthens case review. It offers a model other jurisdictions can learn from.

And then there was a small, human moment that captured the whole point.

Dr. Konrad Rykaczewski walked us through his research on one of the least-understood parts of cooling: not how much we sweat, but how sweat evaporates on the skin. It sounds like a detail until you realize what it governs: how long someone can safely work a shift outdoors, which fabrics help the body cool, and when “toughing it out” becomes dangerous.

Then he reached for a hat he keeps in the lab: a Tennessine hat. His father, a nuclear physicist at Tennessee’s Oak Ridge National Laboratory, played a role in discovering element 117—Tennessine—and Konrad shared that family connection with me.

It was a reminder that science becomes protection when it’s connected to real lives—when discovery moves from the lab bench to the street corner.

The hat stayed with me for another reason. Discovery isn’t just a paper or a periodic-table entry; it’s a chain of curiosity and mentorship, passed from parent to child, teacher to student, lab to community. And those stories travel.

Tennessee to Phoenix. A father’s work, a son’s research, a city’s need. The distance between Nashville and Phoenix felt smaller. Not because the miles changed, but because the meaning did.

Discoveries are being made every day that will become the stories our children and grandchildren tell—about how we chose to protect one another, and what kind of communities we decided to build. If we want heat solutions that last, we need more than data. We need stories people can repeat—stories that make science feel like something we share, not something that happens “somewhere else.”

That’s where livability matters.

Livability is the goal.
Discovery and curiosity are how we get there.
Stories are the why.

With that shared goal, measurement shows us where the risk is highest, and design turns insight into protection. That protection can look very practical: cool roofs at replacement cycles, HeatReady Schools that keep kids safe and learning, and shade and trees that make streets walkable again.

Heat is now a persistent stress test of health, infrastructure, and community. But I left Phoenix hopeful. When we measure heat honestly—and speak about it in the language of livability—we can move from endurance to protection, and toward a future our children can thrive in.

Now another challenge is emerging—one that many organizations remain unprepared for.

Extreme weather.

For too long, hurricanes, floods, heat waves, wildfires, and severe storms have been viewed primarily as environmental concerns. More recently, we have begun to recognize them as public health challenges. But for employers, they have become something even more immediate: workforce challenges.

The numbers are difficult to ignore. More than four in five American workers report experiencing at least one weather-related disruption on the job in the past year. Nearly two-thirds say those disruptions affected their productivity. Yet only a small fraction of employers – four percent – have assessed the weather-related risks facing their workforce.

This gap between exposure and preparedness should concern every business leader.

When we think about extreme weather, we often focus on damaged buildings, flooded roads, or disrupted supply chains. Those costs are real. But there is another set of costs that receives far less attention: missed workdays, staffing instability, rising healthcare expenses, caregiver strain, and mental health challenges.

The weather risk is increasingly a people risk.

A heat wave may begin as a safety concern for outdoor workers. But it quickly becomes a health issue when employees experience dehydration or cardiovascular stress. It becomes an absenteeism issue when schools close. It becomes a mental health issue when families face unsafe living conditions or financial hardship. And ultimately, it becomes a business continuity issue when staffing becomes unpredictable and operations slow.

We saw these cascading effects after Hurricane Helene struck the Southeast in 2024. Recovery was not simply about restoring infrastructure. It was about supporting workers and their families through weeks and months of disruption. The companies that recovered fastest were the ones that had already built flexibility into their leave, pay, and communication policies.

This is why preparedness can no longer sit solely within facilities management or emergency response planning. It must become part of workforce strategy.

Employers should begin by assessing where workers are most vulnerable, aligning HR and operational teams around preparedness plans, updating leave and communication policies, and listening directly to employees about the challenges they face.

The organizations that act now will be better positioned to protect their people, maintain operations, and reduce avoidable costs. Those that wait may find themselves reacting to one crisis after another.

Extreme weather is already reshaping how Americans live and work. Labor disruptions like extreme heat were estimated to cost $100 billion in 2021, a number that is expected to grow to $500 billion per year by 2050.

The question for business leaders is no longer whether it will affect their workforce. The question is whether they will be ready when it does.

For more information to help employers better prepare for the growing workforce impacts of extreme weather, the Health Action Alliance (HAA) recently launched Extreme Weather + Work, a new effort whose advisory board I serve on. The initiative offers free resources including a Climate Health Cost Forecaster, a Climate and Worker Health Scorecard, and role-specific leadership guides designed to help employers project costs and stay ahead of weather-related risks. Request more information about our growing membership coalition here.

This piece is adapted from my June 12th Forbes article, “Extreme Weather Is Becoming A Workforce Crisis.”

Thank you for watching, and if there are any subjects you’d like me to discuss, let me know in the comments.

For those of us who witnessed the darkest years of the AIDS epidemic, the progress achieved over the last four decades has been nothing short of extraordinary. What was once a near-certain death sentence has become a preventable and treatable condition for millions of people. Yet despite remarkable scientific advances, HIV/AIDS continues to claim hundreds of thousands of lives each year.

Our central message was straightforward: we now possess the tools, technology, and resources needed to dramatically accelerate progress toward ending AIDS, but only if we have the courage and urgency to act.

One of the most promising breakthroughs is the development of long-acting HIV prevention medications that can provide protection for months at a time. Combined with advances in diagnostics, treatment, telehealth, artificial intelligence, and innovative delivery systems, these tools have the potential to reach people in ways that were unimaginable just a decade ago.

We also highlighted the remarkable success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the bipartisan initiative launched in 2003 that has saved more than 26 million lives. In 2002, I worked across the aisle with then-Senator John Kerry to draft the legislation that went on to become the foundation of President George W. Bush’s landmark plan to address AIDS globally. That same year, Sir Elton John testified before the Senate Health, Education, Labor and Pensions Committee (of which I was a member) on the need for America to do more to address the global pandemic. “When our lives are done, won’t we want it to be said that we saw millions of people suffering with disease, millions more at risk, millions more abandoned, a whole continent in danger of dying, and we refused to let it happen,” he told the Committee.

A year later, PEPFAR became law. It stands as one of the greatest humanitarian achievements in American history and demonstrates what is possible when the United States leads with purpose and partnership.

But progress is not inevitable. Funds already appropriated by Congress must be put to work. Countries need support as they assume greater ownership of their HIV programs, community health workers must be empowered to reach vulnerable populations, and proven partnerships with faith-based and local organizations should be strengthened.

The theme of our article was “spend it to end it.” The resources exist. The science exists. The implementation strategies exist. What is needed now is the resolve to move quickly and strategically.

History has given us a rare opportunity. We can either finish the job and move toward a world free from AIDS, or risk losing hard-won gains and allowing the epidemic to resurge. I believe America should choose leadership, innovation, and action. The world is watching.

Read the full USA Today piece with Sir Elton John here.

Under the bright lights of the operating room, with a knife in my hand and a human heart before me, I learned to read the signs of disease in muscle, tissue, and blood flow. I saw it in scarred lungs, narrowed arteries, inflamed valves, and weakened hearts struggling to do what hearts are meant to do. Just outside the door, families waited in that familiar space between fear and faith, hoping that skill, judgment, and grace would be enough.

As a heart and lung transplant surgeon, I was trained to focus on the person in front of me: the anatomy, the diagnosis, the procedure, the immediate crisis. Yet over time, as I cared for patient after patient and watched the same patterns return, I began to understand something larger. The illnesses I was treating did not begin on the operating table. They did not begin when a patient arrived at the hospital short of breath, or when a scan revealed a mass, or when a blocked vessel demanded urgent intervention. In so many cases, their roots stretched much farther upstream, into the conditions of daily life and the world people moved through long before they ever entered my care.

They were shaped by the quality of water, the nourishment or emptiness in food, the burden of extreme heat, the weight of chronic stress, the condition of neighborhoods, and the health of the natural systems in which every human life is lived.

That realization changed the way I think about medicine. It also changed the way I think about nature.

For many years, we have treated human health and environmental health as separate conversations, as though one belongs to hospitals and clinics while the other belongs to forests, coastlines, and policy debates. My own life has taught me otherwise. The world around us shapes the health within us. What we now call planetary health simply gives language to something ancient and intuitive: human well-being depends upon the well-being of the living systems that sustain life.

This truth is neither abstract nor ideological. It is physiological. It is biological. It is deeply personal.

The lungs receive the atmosphere. The cardiovascular system responds to heat, pollution, and chronic strain. The immune system reacts to exposures so common they easily disappear into the background of daily life, even as they accumulate quietly over years and across populations. What surrounds us eventually enters us. What happens beyond the skin finds its way inside.

As a physician, this feels less like a revelation than a return to first principles. Life is relational. Health is shaped by connection. The water we drink, the soil that grows our food, the climate that shapes where and how we live, the biodiversity that strengthens resilience across ecosystems, all of these belong in the same frame as vaccines, medicines, and surgical care. They are part of the foundation on which human flourishing rests.

I came to medicine through science, evidence, and intervention. I came to public service through a belief that wise policy can scale healing. Through years of work in conservation and climate, I have come to see that nature itself belongs in that same frame, because it offers one of the most powerful forms of prevention we have. Nature is far more than scenery, ornament, or retreat. It cools neighborhoods, stores and filters water, buffers storms, enriches soil, supports biodiversity, and creates the conditions in which communities can thrive. In that sense, nature functions as infrastructure, resilience, and medicine all at once.

This becomes especially clear when we consider what climate change and environmental degradation mean for health. Extreme heat raises the risk of dehydration, kidney injury, cardiovascular stress, and death. Pollution worsens asthma, chronic lung disease, heart disease, stroke, and adverse pregnancy outcomes. Flooding carries contamination into homes and water systems, increasing the risk of infectious disease. Warmer temperatures expand the reach of mosquitoes, ticks, and other vectors that carry illness into places once spared. Wildfire smoke sends particulate matter deep into the lungs and bloodstream. Food systems come under strain. Sleep erodes. Anxiety grows. Mental clarity fades. What can sound, in public conversation, like a distant environmental concern becomes immediate when viewed through the lens of human health.

That shift matters. People may turn away from partisanship, but they understand a child struggling to breathe during a high-ozone day. They understand an older parent weakened by relentless heat. They understand a family whose drinking water has been compromised after a flood, or a community where repeated exposure and repeated stress slowly wear down well-being over time. Health brings the issue closer. It speaks a language of daily life, and because of that, it opens doors that other arguments sometimes leave shut.

This is one reason I have become convinced that caring for the natural world belongs at the center of any serious conversation about human flourishing. A healthy forest upstream protects drinking water downstream. Wetlands soften the force of storms before those storms reach homes and hospitals. Urban tree canopy lowers temperatures in neighborhoods where summer heat can become dangerous. Healthy soils strengthen food systems and resilience during drought. Biodiversity supports pollination, renewal, and the countless ecological relationships upon which life depends, whether or not we notice them in the moment.

Increasingly, we can measure these benefits with rigor. In Louisville, the Green Heart Project helped show that increasing neighborhood greenness can improve meaningful health markers tied to inflammation and cardiometabolic risk. That evidence matters because it grounds intuition in science. It shows that planting trees and restoring landscapes carry consequences far beyond aesthetics. These choices shape physiology. They shape risk. They shape long-term human outcomes.

In medicine, dramatic interventions often capture our imagination. The transplant. The emergency operation. The heroic rescue. Those moments matter deeply, and I have devoted much of my life to them. Yet medicine, at its wisest, has always aimed for something more enduring than rescue alone. It seeks to prevent suffering before it begins. It asks us to look upstream, to search for causes, to understand patterns, and to intervene before damage becomes irreversible.

Over the years, I found myself asking a different set of questions in the operating room. What shaped this lung before I ever touched it? What burden did this heart carry long before symptoms appeared? What exposures, habits, neighborhoods, systems, and absences helped create the disease now lying open before me? Those questions enlarged my understanding of responsibility. They reminded me that health emerges from far more than clinical care. It is shaped by community, environment, policy, culture, and the condition of the natural systems that hold us all.

This broader view also calls for humility. We have grown comfortable imagining ourselves as separate from nature, standing above it rather than within it. The deeper truth is one of dependence and reciprocity. Our lives rest upon relationships we did not invent and cannot fully command: between forests and rainfall, wetlands and coastlines, pollinators and crops, oceans and climate, microbes and soil, biodiversity and resilience. When these relationships weaken, human vulnerability grows with them.

And still, I am hopeful.

That hope is grounded in the same discipline medicine taught me. In the operating room, realism and hope live side by side. You face complexity honestly. You respect danger. You acknowledge uncertainty. Then you act, with care, focus, and determination. That spirit serves us here as well.

The challenges before us are immense, yet so is the opportunity. We have stronger science than ever before, clearer evidence, better tools, and a growing understanding that health, climate, and conservation belong in one conversation. We know that nature-based solutions, protecting forests, restoring wetlands, managing landscapes wisely, greening neighborhoods, rebuilding coastal resilience, can strengthen communities while improving health and reducing climate risk. We know that upstream investments often yield downstream healing. We know, too, that when people begin to see their own lives reflected in this story, the conversation changes.

If there is one lesson I carry from the operating room into this wider work, it is that life depends on connection. In the body, everything is connected: circulation, oxygenation, inflammation, stress, repair. The same is true in the world beyond the body. The health of a child in a city neighborhood is connected to shade, food, clean water, and the conditions of the street she walks each day. The health of a coastal family is connected to wetlands, storms, and sea-level rise. The health of a farming community is connected to soil, pollinators, rainfall, and biodiversity.

Once we begin to see those connections clearly, our obligations come into focus as well. We are called to build a society that treats nature as foundational to health, that invests upstream, that protects the systems that protect us, and that speaks about climate and conservation in language people can feel in their own lives and in their own bodies.

I learned to see disease one patient at a time, and I remain grateful for that calling. Yet medicine eventually taught me something larger: if we hope to build healthier lives, we will need a healthier world.

To care for that world is to care for one another. It is to understand that the boundaries we draw between environmental well-being and human well-being have always been far thinner than we imagined. And it is to recognize, with urgency and with hope, that some of the most powerful prescriptions for the future lie all around us, in the landscapes we restore, the communities we strengthen, and the natural systems we choose to protect.

That is where healing begins.

___________________________________________

This article originally appeared in Forbes on May 29, 2026.

Author’s Note:

As a physician, I have spent much of my career studying human health. Increasingly, I have come to believe that understanding, and protecting, the health of the planet is inseparable from protecting our own.

It’s World Ocean Day: Here’s Why Life Depends On Our Oceans

June is the month when the global community honors the crucial services the ocean provides. From World Ocean Day (June 8 this year) to the United Nations Ocean Conference [next scheduled for June 2028 in South Korea], we celebrate that the ocean sustains all life on the planet and call attention to the threats to its future.

Many don’t realize the diverse ways in which our daily life is impacted and sustained by Earth’s marine ecosystems. First, more than half the oxygen in our atmosphere comes from the ocean (primarily from phytoplankton), regardless of where we live and breathe. The ocean also regulates the global climate and influences weather patterns, driving storms that often move far inland. Third, it feeds a lot of us: at least 3.3 billion people, including the world’s poorest, rely significantly on marine products for sustenance, according to the U.N.’s Food and Agriculture Organization. And the seas contribute considerably to the global economy, with about 600 million livelihoods depending on fisheries and aquaculture.

That includes the U.S. economy. More than three-quarters of all U.S. trade relies, at least in part, on maritime transportation routes. In 2019, the U.S. “blue economy” supported 2.4 million jobs and contributed approximately $397 billion to the nation’s gross domestic product.

And as Chair of the Global Board of Directors for The Nature Conservancy, I’d be remiss if I didn’t also mention the importance of the ocean in fighting the interconnected threats of climate change and biodiversity loss. Up to 80 percent of the life on the planet is found in the ocean, and 10 percent of its species are thought to be at risk of extinction. Among those threatened species are those that make up coastal wetlands—tidal marshes, seagrass meadows and mangrove forests—that turn out to be far more efficient than terrestrial forests at protecting us from climate change, by trapping and storing greenhouse gases and creating natural barriers to storms and flooding.

A new United Nations Treaty for the High Seas

You might think that with all this at stake, the nations of the world would have reached agreement long ago on how to manage this resource in the most sustainable way possible. Instead, despite how important the ocean is to the wealth and health of nations around the world, it has been misused and faces mounting threats from overfishing, pollution, rising temperatures, and increased acidification.

About a third of the world’s monitored fisheries are overfished. We have already lost a third of our mangroves and half of all coral reefs. Marine species including some sharks, whales and turtles could face extinction.

Still, recent events have given me cause for hope, including meaningful new investments in U.S. coastal restoration and a recent landmark U.N. agreement that could lead to improved stewardship of the ocean.

Notably, in March [2023], after five years of negotiations the world’s governments finalized a new United Nations Treaty for the High Seas. Covering almost half of the planet’s surface, the high seas are those areas that lie outside territorial waters and so are open to fishing, shipping, and research by all countries. [The treaty entered into force in January 2026 after reaching 60 member nation ratifications.]

The new treaty includes important measures to conserve and sustainably use biodiversity in the open ocean, including new environmental impact assessment requirements that will bring greater consistency to the way countries measure and manage the impact of human activities. In addition, the new treaty provides a way for countries to establish new conservation areas on the high seas. These areas, already common in territorial waters, are designed to for example conserve important marine habitat, fish spawning zones, archeological treasures, or other resources.

As one might expect from any major international agreement, this pact is imperfect and there are loopholes, but the high seas treaty represents a turning point in how humanity relates to the ocean. [Of note, the U.S. has yet to ratify this treaty; it was signed by the President in 2023 but has not been put to a vote in the Senate for approval].

Learnings from Katrina and additional opportunities for U.S. leadership

Our nation should also double down on efforts to conserve and restore its coastlines, because protecting the place where the land meets the sea is absolutely critical to protecting our coastal communities and the health and livelihoods of the people who live there.

I witnessed the value of these natural ecosystems firsthand. In 2005, I was part of the medical relief team that flew to Louisiana to aid those affected by Hurricane Katrina, the costliest natural disaster in U.S. history. The devastation caused by that Category 5 hurricane, one of seven major hurricanes in that especially destructive season, was terrible to witness.

Yet Katrina helped change the way disaster planners view how natural infrastructure—such as reefs, tidal marshes and mangrove forests—protects coastal communities. In the decades leading up to the storm, Louisiana had lost coastal lands, mainly marshes, totaling around 4,900 square kilometers. However, what remained played an important role in moderating the damage. Nearly a week after the storm, NASA satellites were able to capture how the coastal wetlands soak up and retain storm water. If the wetlands had not been there, the storm surge could have penetrated much farther inland.

That point was reinforced in 2012, with Superstorm Sandy. Although it was also tremendously destructive, a 2017 study by The Nature Conservancy and risk modelers for the insurance industry showed that coastal wetlands prevented more than $625 million in property damages to coastal communities in the U.S. ….

These are just a few examples that demonstrate nature as part of the solution to the twin crises of climate change and species loss. We need commitment from Congress and the administration to ensure continued support for these life-sustaining investments in our oceans.

Our policies—both domestic and global—must do everything possible to conserve and restore this priceless resource.

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Adapted from my 2023 article in Forbes on World Ocean Day.

Author’s Note:

As a physician, I have spent much of my career studying human health. Increasingly, I have come to believe that understanding, and protecting, the health of the planet is inseparable from protecting our own.