Climate Justice and Health Equity: A Public Health of Consequence, October 2023

The year 2023 may well be remembered for the multiple and intense climate crises that wreaked havoc across the world. From scorching heat domes that gripped the western and southern United States and major cities across the world to wildfires that burned large swaths of Canadian, European, and North American forests, these escalating climate crises are having devastating impacts on our environment and population. In this past year alone, the Northeast United States witnessed highly toxic air quality caused by forest fires in Canada, parts of Vermont experienced catastrophic flooding, and more tornadoes and hurricanes struck suburban and rural areas across the world. And as of this writing, the full extent of the devastation and loss of life from the wildfires that ravaged parts of Lahaina, Maui, an area that was formerly a wetland, is still being assessed. One common thread across these climate crises is that they will continue to bring more extreme weather and endanger our natural resources and physical spaces, in turn undermining any progress that has been made in reducing health inequities among vulnerable populations. Thus, among structurally marginalized people and communities—those who contribute the least to causing climate crises yet who are most often impacted first and worst—the need for actions that reduce the impact of climate crises is a matter not only of climate justice but also of reducing further health inequities.

In reviewing the evidence base in AJPH on the health impacts of climate crises, we see that they can be categorized into two collections. First is a collection on the numerous adverse health impacts resulting from climate crises. And a second collection includes a growing number of reports on action plans and behavioral modifications that can allow communities and individuals to adapt or prepare for climate crises.

HEALTH IMPACTS OF CLIMATE CRISES

In 2011, Knowlton et al. presented simulations of heat-related mortality in the Northeast. While their findings suggested that premature mortality among urban residents would increase with little attention to reducing the causes of climate change, they also predicted increases in premature mortality among suburban and rural areas.¹

Fast-forward and simulations like that conducted by Knowlton et al. are no longer necessary. The immediate health impacts of climate crises are undeniable as a growing number of studies continue to document increased morbidity and mortality following catastrophic climate crises. Periods of excessive heat are linked to excess mortality among the elderly² as well as increased risk of infant mortality.³ And this excess mortality, while initially thought to disproportionately affect persons residing in dense, urban areas,⁴ also affects individuals in suburban and rural areas that lack infrastructure and resources to provide or support heat action plans (HAPs).⁵

The broader health-related impacts of excessive heat among vulnerable persons cannot be ignored. Excess temperatures are linked to increased hospitalizations among persons experiencing homelessness^6,7 as well as farmworkers,⁸ both where they work and in the often-substandard housing they are made to reside in. In addition, a report examining poor air quality as a function of days of heavy wildfire smoke documented increased burden from wildfire smoke to have an impact on communities with a higher proportion of structurally marginalized and vulnerable people living in underresourced settings and at greater risk for respiratory and cardiac distress.⁹ Climate crises intensify already existing health and social disparities in vulnerable communities, adding multiple and overlapping shocks—loss of housing and shelter as well as access to safe water and food—that further entrench people in poverty and widen health inequalities.

Finally, climate crises are associated with increases in unintentional and intentional injury-related deaths.¹⁰ And in already vulnerable settings, where emergency services are already stretched thin, extreme heat events place an even greater burden on police, fire, and emergency services.¹¹

ACTION PLANS FOR CLIMATE CRISES

In 2004, Bernard and McGeehin reported on their efforts to identify and review HAPs across major US cities; their findings indicated either a lack of any planning or cursory plans to mitigate the health impacts of excessive heat.¹² Fast-forward to 2023, and Randazza et al. completed a review of HAPs representing 21 large cities and counties across the United States and representing seven of the 10 US Department of Health and Human Services administrative regions.¹³ Their review suggests that HAPs can serve as templates for building strategies to facilitate cooperation across multiple agencies to mitigate the multilevel harms wrought by climate crises. However, their review also highlights key gaps that must be shored up to meet the needs of vulnerable groups that are often left behind but most often the hardest impacted by heat-related climate crises. Specifically, fostering greater outreach to and collaboration with community organizations serving vulnerable communities can build greater trust and understanding of how to manage during climate crises. In addition, providing information in multiple languages, as well as in multiple locations—in community-based organizations, places of worship, places of employment, etc.—can extend the reach as well as acceptability of information. Such efforts will yield greater impact in fostering resilience to climate crises in vulnerable populations and vulnerable settings.

CONCLUSION

Now is our time to fully and actively embrace a public health agenda that promotes comprehensive and equitable strategies to reduce the causes of climate crises and fight for environmental justice. These actions can no longer be sidelined if we seek to mitigate adverse health impacts and to slow the growing health inequities resulting from climate crises. While locally relevant and appropriate action plans will play a critical role in fostering greater resilience to climate threats, for the most vulnerable in our population, alone they are insufficient. Equally if not more necessary are the structural and societal changes that we clearly must make, and can no longer ignore, to prevent the continued rise of global temperatures. The United Nations Sustainable Development Goals (https://bit.ly/47pLHvJ) provide actions that we can take to reduce greenhouse gas emissions, prevent rising temperatures, and protect our air, water, and global home. And as evidenced by the August 2023 ruling in Held v Montana (https://bit.ly/3OM23WU), US courts are beginning to recognize the harmful impact of climate change on the constitutional right to “a clean and healthful environment.” This legal challenge is one of many that tests US states’ recognition of industry activities that continue to fuel climate crises as harmful to the health and well-being of its populations (https://bit.ly/3qSp7vd).

Living through the Anthropocene means that we are the first generation to bear witness to the devastation wrought by climate crises. It also means that we may be the last generation that has some hope for effecting the change we need.