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First responders face direct danger of injury, illness, death, hearing loss, and muscle strain from fires, smoke inhalation, storms, floods, and landslides.⁹ Other health threats include limited access to potable water/sanitation, stress on mental wellness, and increased exposure to vector-borne diseases, heat, cold, solar radiation, and air contaminants.¹⁰

Known to be exposed to high rates of carcinogenic agents, a 2019 study found firefighters are at a higher risk of developing certain cancers.

Extreme heat, worsened by climate change, causes heat illness among military personnel in training settings in the southern U.S. Over the next thirty years, military bases in the contiguous U.S. could average an extra month of hot days with a heat index of 100°F.¹¹ Lyme disease is the most commonly reported vector-borne disease recorded in the Armed Forces Reportable Medical events, and disease-carrying ticks are expanding their geographic range due to warming temperatures.¹²

Outdoor workers affected include agricultural workers, commercial fishermen, construction workers, manufacturing workers, utility workers, and transportation workers.¹³ Farmworkers and construction workers are the highest risk populations exposed to dangerously high temperatures.¹⁴ Occupational Safety and Health Administration does not have a national heat stress standard for indoor or outdoor workers.¹⁵ There are two to three million migratory and seasonal agricultural workers in the United States, and 72% of all farmworkers are foreign-born.¹⁶  Farmworkers often work through discomfort or illness for fear of losing their jobs or risking deportation.¹⁷ Workers expressed high levels of stress regarding heat illness, agricultural injury, pesticide exposure, wildfire ash and exacerbated asthma.^{18, 19} One in four migrant farmworkers experiences a mental health disorder such as stress, depression, or anxiety, placing them further at risk to environmental health hazards.^20,21

Urban heat islands are created by impervious surfaces and minimal trees or green space.²² Low-wealth and communities of color are more likely to be located in these areas, which are usually racially segregated due to current and historical racism.²² Heat causes ground-level ozone formation in urban areas and has negative respiratory health effects.²³ People with existing lung diseases, like asthma, are especially vulnerable.²⁴ At night, cities retain much of the heat stored in structures such as roads and buildings, so people’s bodies cannot adequately cool down.²⁵ Temperatures can be up to 22°F higher in urban areas than surrounding suburban and rural areas, sometimes causing 24-hour heat stress.²⁶ A study conducted in Louisville, an urban area in Kentucky, determined that an estimated overall 413 deaths in 2015 for those aged 55 and older could have been prevented with just a small increase in greenness, including 70 (17%) deaths in areas with very low greenness, and 45 (11%) in predominantly Black or low income neighborhoods.²⁷

Rural health vulnerabilities to climate change can include physical isolation, limited or lack of public infrastructure and services, limited access to health care services, aging populations, limited education access, dependency on government funds, and drinking water insecurity due to small water systems or private wells that are prone to shortages or compromised quality. These vulnerabilities will continue to increase as rural populations continue to decrease in size.²⁸ For example, the rural Southwest U.S. could face additional water stress and water quality challenges, and the rural Southeast U.S. could face increased heat-related illness and energy costs due to air-conditioning needs during extreme heat events.²⁸ Also, in the rural Southeast U.S., many people of color will be the most impacted by challenges related to indirect and direct effects of climate change on human health.²⁹ Texas, Mississippi, Alabama, South Carolina, Louisiana, and Georgia together account for 60% of all African American farm operators and these farmers are more vulnerable to drought given their relatively limited access to resources and risk management mechanisms.³⁰ Lack of access to food, particularly healthy food, is also an important issue. Rural households show higher rates of food insecurity than their urban counterparts; 15.5% of rural residents live in food insecure households, compared to 12.5% of urban households.³¹

Sea level rise, coastal storms, and high tides have increased coastal flooding and erosion, that will continue to destroy billions of dollars of property by 2050, hitting the Atlantic and Gulf coasts the hardest.³² By 2035 under moderate sea-level rise predictions, 170 coastal U.S. communities will face chronic flood inundation and possible retreat.³³ Seventy percent of these communities are concentrated in Louisiana and Maryland.³⁴

The following sections show how racism and racialized policies and practices have created conditions that have led to and continue to play a role in the production of disproportionate vulnerability to the health impacts of climate change. The sections also highlight adaptation and ingenuity in the face of climate change and structural inequities. The populations featured here serve as examples, but are by no means comprehensive assessment of systemic racism-based vulnerability.

Unsafe, inadequate housing, barriers to educational achievement, persistent generational poverty, historical trauma, societal and institutional racism, displacement and discrimination, compounded with devastating climate events, have contributed to poor health outcomes in American Indian and Alaska Native communities.³⁵

Climate change threatens lands and natural resources that are central to indigenous sustenance and culture. Climate impacts on the availability of traditional foods may result in poor nutrition, increased obesity and diabetes. For example, harmful algal blooms caused by increasing water temperatures threaten subsistence fishing and the traditions that depend upon it by poisoning shellfish.³⁶

For many Alaska Natives, the threat is imminent. Among Alaska Native villages, 184 out of 213 are susceptible to flooding and erosion, with 31 villages qualifying for permanent relocation.³⁷ Relocation or displacement from ancestral tribal lands and reservations will impact tribal sovereignty and access to culturally significant resources.³⁸ The separation of tribal people from their natural resources poses a threat to Indigenous identity, health and healing, especially for Alaska Natives where 80% of their diet comes from the immediate surroundings.³⁹

For many remote American Indian nations and reservations, public health is already compromised. Many remote reservations have some residents without indoor plumbing and some rely on well and surface water that are vulnerable to drought and contamination. As a result, diarrhea-associated hospitalization rate in American Indian and Alaska Native infants and children remains higher than for other U.S. infants and children.⁴⁰

Tribes throughout the U.S. are developing and implementing tribal climate vulnerability assessments and climate change adaptation plans.⁴¹

Black, Indigenous and People of Color (BIPOC) higher rates of exposures to pollution has contributed to high public and environmental health disparities in African American, Black, and minority communities.⁴² The preexisting conditions associated with disproportionate exposure to air and other forms of pollution increase vulnerability to climate impacts to health. The upstream, systemic factors that drive or result from these disparities in exposure to pollution include, but are not limited to:

• Residential segregation
• Unsafe, inadequate housing
• Low quality education and achievement
• Lack of employment and livable wage
• Deeply rooted historical and contemporary trauma
• Generational poverty
• Discriminatory practices
• Racial disparities in the justice system
• Community profiling
• Lack of access to health care and limited access to opportunities for health

Climate change exacerbates existing inequities and disproportionate impacts of disease burden while widening social inequality.⁴³ BIPOC Americans are often found in fenceline communities, also known as sacrifice zones, which are characterized by poverty, higher exposure to pollution, lack of community investment, lack of green space, and access opportunities for health.⁴⁴ For decades, many policies have limited housing options and economic opportunities for communities of color and, thereby, put them at higher risk for negative health outcomes.⁴⁵ Redlining in the real estate and mortgage industries have pushed lower-income communities to live in homes and neighborhoods that are less desirable and more climate-vulnerable, such as flood zones and urban heat islands.⁴⁶ Poor construction and low availability of affordable housing add to the unjust burden during and after a disaster.

Climate change increases exposure to warming and heat, air pollution, vector-borne diseases, occupational hazards, and climate-related natural disasters. Poverty and lack of access to resources exacerbate vulnerabilities. For example, over 1.8 million Latinx live within a half-mile radius of oil and gas development (in the U.S.).⁴⁷ In addition, populations exposed to higher temperatures and air pollution have been linked to negative birth outcomes--preterm, low birth weight, and stillbirth pregnancies. African American mothers are 2.4 times more likely to have children with low birth weight than Caucasian women.⁴⁸

For communities of color, if inequity is not addressed, the gaps of inequality will continue to widen. Over 14 million people of color live in areas where they are exposed to short and long-term particle pollution and ozone.⁴⁹ African Americans and Blacks are more likely to live near landfills and industrial plants that pollute water, air, and land which negatively impacts quality of life and traditions of self-sufficiency. Historically segregated housing and lending policies, and community development practices, isolated communities of color to industrial, manufacturing, and commercial areas with little to no community development investments. Institutional racism and the practice of displacement, exclusion, and segregation have caused generational trauma, inequity, and suffering in communities of color hindering prosperity and opportunity for change.

To further public health goals in many communities of color, distrust in institutionalized health services, inequity in policy, and structural racism need to be addressed in tandem with disease and injury prevention and reduction efforts. The most prominent indicator for living near an area of heavy pollution is race.⁵⁰ African Americans or Blacks are more than twice as likely to live in homes with below average plumbing systems.⁵¹ Compared to less than 0.5 percent of Caucasians, over 1 percent of African Americans or Black people live without potable water and modern sanitation. It is noteworthy that due to this disparity, Black communities are twice as likely to mistrust their water sources and water flow into their homes.⁵²

Adaptation planning with JEDI principles gives public health practitioners and policymakers a powerful tool to identify the structural drivers of disproportionate exposure to pollution and climate impacts such as heat, flooding, wildfires and drought. Narratives from communities of color along with data from countless health studies can drive adoption of strategies that can simultaneously dismantle inequitable policies and regulations while also driving investments that promote environmental justice and climate adaptation.

(Tracy Loeffelholz Dunn / The Nation. Shutterstock images from Lorelyn Medina, Augusto Cabral)

Environmental Racism is Nothing New

• Race is the most significant predictor of a person living near contaminated air, water or soil.
• 56% of the population near toxic waste sites are people of color
• People of color:
  •  Have seen 95% of their claims against polluters denied by the EPA
  •  Have 38% higher nitrogen-dioxide exposure
  •  Are two times more likely to live without potable water and modern sanitation

Women are more deeply impacted by displacement and evacuation scenarios. Pregnant people, and women lead households with small children are disproportionately living in conditions of poverty and hindered in preparation and response to extreme weather events and disasters.

Many LGBTQ people may experience the greatest impacts of climate change since they are most likely to lack safe and stable housing. LGBTQ young adults are more than 120 times more likely to report homelessness compared to their heterosexual and cisgender peers, putting them at greater risk for heat illness, injury and displacement during emergencies.⁵³ LGBTQ seniors are more likely to be socially isolated than other seniors, increasing risk of illness or death in an emergency. Also, disproportionate exposures may contribute to LGBTQ people experiencing disparate burdens from health conditions such as cancer and asthma, which have well-established links to air pollution.⁵⁴ LGBTQ people may be reluctant to seek evacuation or emergency shelter and support for fear of discrimination, misgendering or rejection from gender based shelters.

The following climate hazards increase health risks differently for individuals due to a variety of factors. Each section features populations that may be particularly vulnerable to climate hazards due to JEDI-related circumstances. Additionally, there is an increasing incidence of complex and overlapping hazards, such as wildfires, heatwaves, and pandemic — just for a recent example. These complex and coinciding events will affect BIPOC and low income communities more severely need to be considered by those planning CC adaptations.

Floods result in differing health outcomes according to age and gender. Women, older adults, and children are at greater risk of psychological and physical health effects (i.e. gastrointestinal, injury, psychological distress, hypothermia, near-drowning) during floods. Men 10 to 29 years old have a greater risk of mortality (i.e. drowning, physical trauma, heart attack, electrocution, carbon monoxide poisoning, car crash). Post-flood, populations over 65 years and men are at increased risk of physical health effects (i.e. carbon monoxide poisoning, chemical exposure, sprains, respiratory illness, kidney infection, and gastrointestinal issues), while women are at a greater risk of psychological health effects (i.e. distress, anxiety, PTSD, and insomnia). The health impacts of floods are magnified when mold grows, especially for children under 18 and people with asthma.^55,56 Increased incidence of shigella, cholera, norovirus, and dengue have all been associated with flooding.⁵⁷ Medication interruptions and pre-existing health conditions are additional risk factors for all ages and genders.⁵⁸

Race and ethnicity also play a key role in an individual’s health experience during and following a flood event. Following a 2006 flood in El Paso, Texas, Hispanic ethnicity was identified as a significant risk factor for adverse health effects.⁵⁹ Tailoring educational messages to high-risk groups may increase their effectiveness,⁶⁰ though not all warning systems are designed to reach some communities of color. Disparities also exist during the rebuilding process, beginning with government aid. After Hurricane Katrina, black homeowners received $8,000 less in government disaster aid than white homeowners because of differences in property values instead of the cost of repairs.⁶¹

Trusted sources, such as faith organizations or culturally-specific media are effective at reaching diverse audiences.^62,63  Further, providing transportation during evacuations or employment assistance during recovery may help reduce or eliminate health impact disparities.⁶⁴

Rising temperatures contribute to increased formation of ground-level ozone and smog. Heat and drought are increasing wildfires, wildfire smoke, and dust levels. The changing climate is lengthening the pollen season and increasing pollen levels in some areas.⁶⁴

People of color bear a disproportionate exposure of air pollution due to historical practices and policies rooted in structural racism. When these unjust conditions are combined with the worsening threats of climate change, many African American communities are at risk for exposure to hazards, particularly compromised air quality. Race is the number one indicator for the placement of CO2 emitting facilities in the U.S.⁶⁵ with 78% of African Americans living within 30 miles of a power plant.⁶⁶ On average, African American communities are exposed to 56% more pollution than they create.⁶⁷ 71% of African Americans live in counties that violate federal air pollution standards, compared to 58% of the white population.⁶⁸ African Americans are three times more likely than white Americans to die from exposure to air pollution⁶⁹ and nearly three times more likely to die from asthma than any other racial or ethnic group.⁷⁰

A coalition of African American, Latinx, and Asian community groups rallied to advance California's cap and trade bill in 2012 and raised $262 million for disadvantaged communities in its first year.^71,72

Older adults have the highest risk of premature death due to long-term exposure to particulate matter air pollution (year 2000 to 2012). In particular, older populations with low income or who identify as racial minorities suffer from pronounced effects of particulate matter air pollution.⁷³

Climate change influences human exposure to vector-borne disease by affecting the seasonality and the location of vectors.⁷⁴ West Nile virus and Lyme disease are particularly relevant for U.S. communities.

Higher incidence of West Nile virus disease has been linked to poverty in the southeast U.S. and urban locations in the northeast U.S. Older adults and men are at higher risk for severe West Nile virus infections.^75,76

Lyme disease is the most common vector-borne disease in the U.S. Between 2001 and 2017 there was an increase in both distribution and number of Lyme disease cases, mostly occurring in the northeast and Midwest regions, although cases have been reported in all 50 States and Washington, DC.^77,78  In 2017, there were over 42,000 reported cases of Lyme disease, illustrating an increase of 17% from the previous year.⁷⁹ Lyme disease is more frequently reported in children between 5 and 9 years of age and in adults between the ages of 50 and 55.⁸⁰ Lyme disease disproportionately affects the white population and is more common in men.⁸⁰

Because climate change does not respect geographic boundaries, hazards outside of a defined planning area may still be harmful to that planning area. For instance, a wildfire can significantly impair regional air quality, block major transportation routes, depress tourism, create refugees, and cause many other impacts that extend beyond the burned area. Communities may be affected even if they have no wildfire-prone areas in their boundaries. Wildfire hazards could affect areas of major regional employment or other large economic drivers (such as state or national parks and forests), disrupt key infrastructure (such as roads, rails, and power lines), or affect important resources that a community relies on (such as snowpack that can affect water availability).⁸¹

Populations most vulnerable to extreme heat include communities with limited financial resources, communities of color, individuals living alone, older adults, and people with diabetes. Additional social and behavioral factors include: isolation; homelessness; access and use of air conditioning; outdoor work, recreation, or commuting; chronic illness, medication use; and physical, personal, and cognitive constraints.⁸²

Heat-related illness and death trends emerge along racial lines. Non-Hispanic black populations are the most vulnerable racial group to heat health impacts due to higher rates of co-existing chronic conditions, AC access, and heat island land cover.⁸²  Recent data from 2004-2018 indicate that non-Hispanic American Indian/Alaska Natives have the highest rate of health-related deaths.⁸³  One study found that non-Hispanic blacks were two to two and a half times more likely to experience heat-related mortality compared to non-Hispanic whites and Hispanics.⁸⁴ Heat-related deaths among Native Americans are 4 per 100,000, for African Americans 2.8 per 100,000 and for whites 1.8 per 100,000.⁸⁵

Arizona case study

Poverty plays a key role in a population’s resilience to extreme heat. In Maricopa County, Arizona, 154 people died from heat-related causes in 2016, 179 in 2017, and 182 in 2018. In 2018, 35% of heat-related deaths were among the homeless. In June 2019, the Arizona Corporation Commission approved an emergency rule prohibiting power shut-offs to customers who are late on their electricity bills between May 1 and Oct. 15. The rule was a partial response to the heat-related death of a Sun City West woman after her power was disconnected over a $51 bill.⁸⁶

Certain populations are more vulnerable and disproportionately experience health harms from the impacts of climate change, widening their existing health disparities. To highlight examples of vulnerability and adaptation variability, Figure 1 shows four people impacted by an urban heatwave, which are more frequent and severe due to climate change.⁸⁷

Image also available at www.hsph.harvard.edu/c-change/news/2019-lancet-countdown/

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