The District’s dire health disparities were on the mind of D.C. native Madeline Taskier, M.D. ’19, when she chose a career in family medicine as the best way to help her community. After earning her degree at George Washington University, she pursued a family medicine residency―and encountered the tremendous barriers her patients often faced in health care.

“The other trainees and I were constantly frustrated by the way our patients were treated within the system,” Taskier said. “I’d think, ‘why is the medicine I’ve prescribed not covered by insurance? Why does my patient have to wait a month and a half for this test?’ This all relates to health policy, and I came away from residency wanting to understand why this doesn’t work for us and our patients.”

As recent extreme weather events demonstrate, climate change presents unprecedented and increasing health risks, disproportionately so for disadvantaged communities in the U.S. already experiencing health disparities. As patients in these frontline communities live through extreme weather events, socioeconomic and health stressors are compounded; thus, their healthcare teams will need tools to provide precision ecologic medicine approaches to their care. Many primary care teams are taking actionable steps to bring community-level socioeconomic data (“community vital signs”) into electronic medical records, to facilitate tailoring care based on a given patient’s circumstances. This work can be extended to include environmental risk data, thus equipping healthcare teams with an awareness of clinical and community vital signs and making them better positioned to mitigate climate impacts on health.

The National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care,¹ correctly identified that the Biden Administration’s priority goals for heath equity and a more effective and affordable health system require a sustained initiative to strengthen the nation’s fragile primary care infrastructure. In this Viewpoint, we reconsider the promise of the Primary Care Extension Program to strengthen and ensure access to high-quality primary care. The Patient Protection and Affordable Care Act (ACA)² originally directed the Agency of Healthcare Research and Quality (AHRQ) to establish the program; however, Congress did not appropriate funds to make it operational.