Tackling climate and health disparities: Health care’s obligation and opportunity
By Emily Mediate, U.S. Climate & Health Director, Health Care Without Harm
It was heart-wrenching to watch Hurricane Ian batter Cuba, Florida, and South Carolina last month. I sat glued to my TV for updates that might suggest how my parents-in-law were doing in Fort Myers, Florida, knowing they had lost power and cell signal just as the storm’s worst arrived in their neighborhood. Thankfully, I eventually learned they were safe, despite significant damage to their home. Many others did not fare as well, with the storm claiming more than 80 lives and gravely impacting thousands more.
Hurricane Ian was the 15th billion-dollar weather and climate disaster to hit the United States this year and another reminder of the urgent need for action. In rural areas, small towns, suburban areas, and cities across the country, we are experiencing worsening air pollution, diminishing access to clean water, and extreme weather events that impact our health and prosperity.
But we do not experience these impacts in the same way. While climate change affects everyone’s ability to thrive, underserved populations are more vulnerable to its impacts and have fewer available resources to adapt to the changing climate. These disparities are distinctly revealed by the increasing frequency of climate-fueled heat waves and hurricanes. For example, I was saddened to learn about the particularly devastating impact of Hurricane Ian in the historically Black Dunbar neighborhood of Fort Myers, Florida.
Tragically, this inequitable exposure to climate risks leads to disproportionate health impacts. Black Americans are three times more likely to die from polluted air than the population average, and they are more likely to be affected by asthma or heart and lung conditions. In fact, Black Americans are 34% more likely to currently live in areas with the highest projected increases in childhood asthma diagnoses with 2°C of global warming.
Systemic injustices create environmental and health disparities
Historical policies such as redlining and colonialism, along with ongoing political and economic marginalization, have left certain racial and ethnic communities with increased exposure to climate risk. Worse yet, the same systemic practices have left these communities with fewer resources and lower adaptive capacity to prepare for and respond to climate impacts.
In the mid-1900s, majority-Black neighborhoods across the United States were denied financial services and other investments as part of policies known as redlining. While redlining is now illegal, its legacy of disinvestment and marginalization is still felt today. Neighborhoods that suffered redlining now face a disproportionately high risk of flooding and extreme heat. A 2020 study found that historically redlined neighborhoods are nearly five degrees warmer than non-redlined neighborhoods.
Similarly, colonialism and forced concentration on federal land contributed to underinvestment in American Indian and Alaska Native communities. A combination of high wildfire potential and low adaptive capacity makes Native Americans particularly vulnerable to wildfire disasters. Further north, many Indigenous villages in Alaska experience increasingly severe sea level rise that threatens their livelihoods and cultural heritage.
Furthermore, decades of unjust civic planning and policies have disproportionately placed waste management plants in communities of color, resulting in disease and premature death due to toxic exposure. Ironically, health care has a contributing role here — producing nearly 30 pounds of waste per patient per day.
Prioritizing the voices of those most affected
Increased climate exposure sits on top of other social determinants of health and widens existing health and economic disparities. Environmental justice describes these situations where multiple factors — including environmental and socioeconomic stressors rooted in historical and present-day injustices — act cumulatively to exacerbate persistent health disparities. Communities and organizations that acknowledge, feel the effects of, and assert solutions for addressing these cumulative factors are known as “environmental justice” communities and organizations.
The environmental justice movement has deep, community-led roots going back to Latine farm workers organizing for their rights in the 1960s and the people of Warren County, North Carolina, protesting the state government’s dumping of toxic waste near their homes in 1982. Today, the movement continues advocating for action to address the systemic factors that unfairly increase climate exposure and for solutions to ensure communities are healthy.
Environmental justice communities bring profound expertise in addressing climate risks, such as Indigenous practices for preventing wildfires, from which all of us can benefit. There is much to learn from deep partnerships with environmental justice communities and their decades of resilience experience. Climate solutions that fail to integrate these voices in the decision-making process will only perpetuate the health disparities we seek to address.
The opportunity and urgent need before us
As Health Care Without Harm’s new U.S. climate and health program director, I see clear opportunities for the health care sector to address climate change, health, and equity in partnership with environmental justice communities. With the rapid acceleration of climate change and the worrisome compounding of inequities, it is more important now than ever to take action.
First, health care institutions have a moral imperative to address their contributions to climate change, especially because the sector is responsible for 8.5% of total U.S. greenhouse gas emissions. Since these emissions unfairly and disproportionately impact the health of environmental justice communities, there is elevated urgency around actions to drastically reduce or eliminate emissions.
Second, it is vital for health care institutions to build equitable climate resilience. Health institutions must ensure continuous, accessible care, particularly for communities that unfairly and disproportionately experience the health impacts of climate change and related extreme weather events.
A health institution’s resilience strategy must also move beyond the hospital’s four walls to consider community networks and local infrastructure. If local roads flood, transportation networks go out, or water or power supplies fail, even the most hardened hospital facility is rendered unusable. Health institutions must go upstream and tackle the social determinants of health to ensure community health before, during, and after a climate event. Health institutions should focus on and work in intentional partnership with environmental justice communities to achieve this aim.
Boston Medical Center’s Brockton Behavioral Health Center is an exemplary equitable, resilient health system model. The health center will offer treatment for substance use disorder and mental health care to an economically disadvantaged community in a resilient, net-zero building located in the community. It is a remarkable project, but most importantly, it emerged from an intentional partnership with residents and community leaders. Working together, health institutions and environmental justice communities can address climate change and its impacts so everyone can thrive.
In taking up the mandate to address climate, health, and equity collectively, health institutions will be reimagined — not simply as decarbonized versions of themselves, but as anchor institutions within healthier, more resilient, and more equitable communities.
We all want to live in a world in which our family, friends, and neighbors are protected against climate change. By reimagining health institutions in partnership with environmental justice communities, each of us will benefit from improved health and prosperity.