Climate Change Is Already Exacerbating Current Social Inequities

Although climate change is a public health emergency—a situation that requires urgent attention—it might be more aptly described as a crisis, a crucial moment when a decision needs to be made. Although climate change can be described as both an emergency and a crisis, we are at a critical point in how we will respond as a society. Many may balk at using the term “crisis” to describe how climate change is affecting the world; we still have government officials and the media posing questions and arguing on whether they “believe” in climate change (e.g., see the 2020 presidential and vice-presidential debates).

There is no doubt that climate change is real and human caused, and we are in a real crisis when it comes to our response. This year alone in the United States, there have been record-breaking heat waves in the West and Southwest, wildfires from Washington to California with hazardous levels of smoke blanketing the nation, and a very active Atlantic hurricane season bringing numerous storms to the Gulf and East coasts¹—all while under pandemic conditions, with COVID-19 spreading rapidly across the country. During these disasters, our public health systems were tested and shown to be a “colossal failure,”² allowing our communities to become vulnerable and suffer health consequences related to climate disasters and COVID-19, with COVID-19 killing more than 240 000 people in the United States.

In 2019, the Lancet Countdown on health and climate change stated that a child born today would experience a warmer world, with climate-related health consequences felt from infancy to old age. Children are acutely susceptible to climate change events, particularly those that increase food and water insecurity, vector-borne diseases, and air pollutants. Additional events, such as heat waves, extreme storms, flooding, and wildfires, affect humans at all life stages, causing both acute and long-term health effects.³ Climate events happen with or without warning and require comprehensive planning to build resilience in our communities.

The way our current health care systems are set up allows them to be compromised by damage from events such as floods and extreme storms or inundated with patients affected by heat waves or disease outbreaks. Additionally, climate events compound societal and health disparities already found throughout the United States and around the globe. Poverty, homelessness, underlying health conditions, racism, and other disparities exacerbate how climate events affect populations. Local and national planning activities are needed to improve community and individual adaptation and resiliency and to institute equitable and just reforms as we respond to climate change.

The immediate health effects of climate change are well known and documented. Physical trauma from extreme storms, diarrheal illness attributable to waterborne pathogens, and heatstroke from extreme temperatures are notable examples. Researchers and public officials have also been gathering evidence on the long-term consequences of climate change. These have focused mainly on the mental health consequences from events such as drought and sea level rise as these events change our livelihoods and landscapes. Climate change affects every part of our lives: our health, our economy and jobs, and even how we enjoy recreation. The better we understand the impacts, the better we will be able to reduce or adapt to the effects of climate change.

LASTING PHYSICAL TRAUMA

In this issue of AJPH, Zacher et al. (p. 127) contribute to the field by examining the long-term physical effects of climate events. The authors surveyed low-income mothers living in New Orleans, Louisiana, before and during Hurricane Katrina, with survey follow-ups over a 15-year period after the storm. They point out that although there is a large body of work assessing the mental health consequences, there are few studies on the physical health symptoms of individuals affected by climate disasters. Many physical health issues that stem from climate events, such as hurricanes, may be owing to physical trauma sustained during the event itself, but physical symptoms may also result from the psychosocial trauma or stress sustained during the event, as the authors point out.

In brief, the authors examine three physical health symptoms—headaches or migraines, back problems, and digestive problems—owing to the impact of Hurricane Katrina on the study population. They found that these physical health symptoms increased between 26% and 30% from after Hurricane Katrina to the latest survey results in 2018. The authors emphasize that those who experience more hurricane-related trauma are more likely to develop physical health issues, which may be particularly pertinent to those who experience these underlying health issues before a climate-related disaster.

This research demonstrates what was stated in the 2014 Intergovernmental Panel on Climate Change synthesis report: those who are socially, economically, or otherwise marginalized will be most vulnerable to the effects of climate change, and this vulnerability is rarely attributable to a single cause.⁴ The population in the study by Zacher et al.—low-income people of color, mostly women—are potentially at a higher risk for other social and health disparities that were likely compounded by Hurricane Katrina. The authors identify the need to assess multiple pathways that may cause lasting phy-sical symptoms related to climate disasters.

Another key feature of this research is the importance of gathering data to track the long-term health consequences of climate change. Expansive reports from the Lancet and the Intergovernmental Panel on Climate Change have made projections and identified theories on how climate change will exacerbate current inequities, but the authors demonstrate how this is already happening, especially when it comes to physical health. Population health surveillance along with individual health data over time are key to identifying and describing key factors related to the long-term health vulnerabilities associated with climate change.

PUBLIC HEALTH RESPONSE

Recently, the 10 essential public health services were updated, and they encapsulate perfectly how we need to respond to the climate crisis.⁵ In their article, Zacher et al. demonstrate the use of longitudinal data to determine the root causes of health disparities and inequities as they relate to long-term physical health symptoms caused by Hurricane Katrina. This is part of the “assessment” category in the essential public health services, which helps to inform us of the health issues that may be related to climate change. These assessments drive policy developments to ensure that effective solutions are implemented. To succeed, the public health service that identifies building and maintaining a strong organizational infrastructure for public health is one of the most important components. This requires our leaders to support a strong national public health program and allocate needed resources to our local public health departments that are on the ground working with individuals and communities to educate, strengthen, and build resilience in our populations.

We are at a critical juncture in our response to the climate crisis. We have the tools to respond and prepare, but we lack the financial, political, and collective will to prepare for and respond to our changing climate. This failure to act has had devastating consequences during the COVID-19 pandemic and should be a wake-up call showing us what climate change is capable of inflicting on our health and our society.