Third in a series on health equity, which ties into the theme of APHA’s 2018 Annual Meeting and Expo: “Creating the Healthiest Nation: Health Equity Now.”
Climate change is here, happening right now. And it is most harming people who are already facing health and economic hardships.
Mother Isamar holds her child, Saniel, age 9 months, as her husband, Samiel, mixes concrete at their makeshift home in San Isidro, Puerto Rico, in December. The family’s neighborhood was without power three months after Hurricane Maria. Climate change is creating new challenges for health equity.
Photo by Mario Tama, courtesy Getty Images
Climate change has the worst effects on people who have low health equity — those who do not have adequate opportunities to be healthier. People who lack health equity are more likely to be impacted negatively by social determinants of health, which are the conditions in which people live, learn, work and play.
“There are lots of connections between climate change and health equity, so they’re actually inextricably interconnected,” Linda Rudolph, MD, MPH, director of the Center for Climate Change and Health at the Public Health Institute and an APHA member, told The Nation’s Health. “Health inequities themselves contribute to placing individuals and communities at risk of climate change’s effects.”
The risks of climate change are not spread equally among people in cities, states, countries or globally. People who are most affected are likely to be part of vulnerable populations, and their health might already be poor. The effects of climate change hit those groups hardest, and make their health even worse.
“Though we are all at risk to the health threats of climate change, some groups are more vulnerable, and thereby less resilient, to the health threats,” Natasha DeJarnett, PhD, MPH, an environmental health policy analyst at APHA, told The Nation’s Health. “In fact, climate change intensifies the risks for these populations.”
In 2018, the World Health Organization noted that specific populations are more vulnerable to climate change: People living on small islands or other coastal regions, megacities and mountainous and polar regions are especially at risk, as are children, particularly in poor countries. Health effects are also more severe for elderly people and people with pre-existing medical conditions.
Jalonne White-Newsome, PhD, MS, has seen the effects of climate change on vulnerable populations firsthand. Now the senior program officer in the environment program at the Kresge Foundation and an APHA member, White-Newsome was spurred into working on climate and health equity more than a decade ago, when she was the primary caregiver for her elderly grandparents, who lived in Detroit. Her grandparents had chronic health problems, including heart disease, and in the summertime heat their health got worse. Because her grandparents were facing dementia and Alzheimer’s disease, they did not recognize that their environment — the heat, no air conditioning — was putting them at risk. It moved White-Newsome to take action.
“There’s a certain set of folks that are always dealing with multiple risks, multiple health issues, and often they’re the most impacted by climate change,” she told The Nation’s Health.
Rudolph noted that often the same systems contributing to poor health also contribute to climate change: Poverty keeps people from accessing health care, meaning they do not get the preventive care that might protect them from health issues such as asthma until they are already sick. Poverty also keeps people from accessing homeowners’ or renters’ insurance, which means they may not be able to make home improvements to protect their health, such as mold remediation. They also may not have the means to move somewhere with fewer health risks from climate change, such as a home with air conditioning, or further from polluting industry. And when disaster strikes and displaces them, people in poverty do not have the resources to rebound.
According to WHO, areas with weak health infrastructure — particularly developing countries — are least able to cope with, prepare for and respond to climate change. But areas that do not see investment in the health and support of their populations also are at great risk. Often, the people in such areas have low socio-economic status. People of color are disproportionately affected. People who work outside — in the U.S., disproportionately people without legal U.S. residency — are at high risk too.
One example of how a lack of investment can harm health is 2017’s Hurricane Maria, which devastated Puerto Rico, leaving all of the U.S. territory’s 3.8 million residents without power. The U.S. Census Bureau reports that nearly 100 percent of Puerto Ricans are Hispanic, and more than 43 percent live in poverty. In a report released July 12, the U.S. Federal Emergency Management Agency acknowledged it was ill-prepared to respond to the hurricane, as many disaster supplies in Puerto Rico were rerouted to the U.S. Virgin Islands, and it did not have enough or strong communications tools and strategies in place to assess the scope of the damage in Puerto Rico.
There were, however, some successes in the response to Hurricane Maria: The FEMA report commended “health brigades” of local volunteers who went door to door to identify and assist people who could not evacuate on their own. FEMA said encouraging citizen involvement can improve health outcomes and build resilience in communities.
Of course, one way to build such resilience is to offer communities themselves the ability to share their strengths and needs. Rudolph pointed to work done by health officials in Minneapolis, which in 2016 developed heat maps as part of its climate change vulnerability assessment. Once the maps were developed, health department workers visited the communities located in the urban heat islands — places where infrastructure has replaced vegetation, causing temperatures to rise — and asked residents to get involved.
Students in Richmond, California, learn construction skills in a green job programs for disadvantaged youth in June. Once they have gained skills, the workers go on to install solar panels. Climate change is creating new opportunities and challenges for health equity in communities across the nation.
Photo by Giles Mingasson, courtesy Getty Images
“(The health department) really used those maps to engage in a series of conversations with people at the neighborhood level: ‘What’s your experience; what do you need from the city; what are the strengths in your community that you need to withstand going into the future,’” Rudolph said.
Alameda County, California, has also centered health equity in its response to climate change. The Alameda County Public Health Department has developed guidelines to promote health and equity, called Healthy Development Guidelines, with the City of Oakland and community-based organizations East Oakland Building Healthy Communities, Communities for a Better Environment, East Bay Housing Organizations and Health for Oakland’s People and Environment Collaborative, according to Anna Lee, MS, a management analyst with the health department.
Within the guidelines, the department recommends steps for adapting to climate change. The department will present its work to the Oakland City Council this month.
Partnering with other organizations and departments is critical for public health to succeed in improving health equity while fighting climate change, Lee said. Funding and capacity for public health are limited. Support from partners can help finance climate efforts, or get messaging to vulnerable populations who might not touch the public health department regularly.
Lee noted the Alameda County Public Health Department’s work with other departments, such as local emergency, food assistance, child, senior and disability programs helped to spread the word to communities about how the recent North Bay wildfires and rising temperatures can increase risks for poor air quality, and how those risks can affect sensitive populations.
The public health department also plans to address health equity through climate change prevention programs. Tree-planting efforts will target Ashland and Cherryland, two areas of the county that face significant health burdens.
“A health department can’t do climate equity (or) justice work alone — having community partners is crucial,” Lee told The Nation’s Health. “It also helps to find angles where existing public health work will be impacted by climate change and use that as an opportunity to catalyze action within a health department.”
Such collaboration can have lasting impact on how a community changes and thrives. Rudolph pointed to transportation efforts as one way to decrease the effects of climate change while increasing health equity: Getting residents to use public transportation, or biking and walking more, can reduce pollution. But it also lessens the economic burden of commuting by car for many people, offering some relief for poverty. And it also increases both physical activity and mental well-being.
“There are these huge benefits, and the benefits really accrue most in chronic disease,” Rudolph added. “That’s what’s driving the most health inequities in the U.S., in every community.”
Communities looking to take steps on climate change and health equity have new resources available to them. APHA is releasing “An Introduction to Climate Change, Health and Equity: A Guide for Local Health Departments.” The guide offers instructions on how climate affects health and health equity, explains how climate affects the work of local health departments and provides examples of how local health departments can put climate change work into practice in their communities.
The resource includes chapters on each vulnerable population, showing how climate change might affect them differently. For more on the guide and an overview of APHA’s climate change work, visit www.apha.org/climate.
APHA’s 2018 Annual Meeting and Expo’s theme is “Creating the Healthiest Nation: Health Equity Now.” Many sessions will cover how health equity and climate change intersect.
For more information on the Annual Meeting, visit www.apha.org/annualmeeting. For resources on health equity from APHA, visit www.apha.org/health-equity.
- Copyright The Nation’s Health, American Public Health Association
