Climate Change and Environmental Health Disparities

Author: Corey Hazekamp, MD

Editor: Lauren Walter, MD


CLIMATE CHANGE


Climate change. We likely all first heard this term a long time ago. The earth has been experiencing global warming since at least the 1950s, if not earlier. For most of us, we probably thought this was a distant problem that would not affect our lives or would be resolved by some Nobel Prize winning scientists. In only 31 short years since the Intergovernmental Panel on Climate Change (IPCC) was created in 1988, the IPCC would release a statement that shocked the world. In August of 2021, the IPCC reported its prediction that avoiding global warming to 1.5 to 2.0 degrees Celsius is most likely unavoidable.[1] Though the entire global population will be affected, the effect of climate change and global warming will not be equally distributed. As with many Social Determinants of Health, the exacerbation of disease and adverse health effects has been and will continue to disproportionately impact impoverished populations. 


CLIMATE CHANGE AND HEALTH


It is not hard to imagine how global warming will impact health. There is literally a textbook written about this topic: “Global Climate Change and Human Health.”[2] This topic is massively broad and encompassing. As Emergency Physicians, it is important to consider how global warming will impact your patients and the population that you serve. Do you live in a coastal area where flooding is a major concern? Or perhaps a dry, arid climate where wildfires are ravaging the local forests? Or like most of the human population do you live in an urban environment where weather extremes will cause undomiciled patients to present with more complex issues? Heat stroke and severe dehydration in the summer, hypothermia or perhaps trench foot in the fall and winter. The changes we are facing have important implications for our specialty and deserve strong consideration. It's important to acknowledge that not everyone will be equally affected by these changes. As with most diseases, more impoverished patient populations will be more adversely affected, whereas more affluent patients will likely be able to adapt more quickly. Can you imagine living on the 5th floor with no air conditioning on a hot summer day and temperatures in the 110s? How about our patients who are constantly exposed to air pollution and have severe asthma? They have enough trouble managing their diseases as is; climate change will only make this worse. 


DISPARITIES IN CLIMATE CHANGE


Environmental racism is a concept which developed in the United States throughout the 1970s and 1980s. Environmental racism is used to describe environmental injustice that occurs within a racialized context both in practice and policy.[3] It can manifest in several ways and increases the risk for disease and mortality for minority communities.[4] Manifestations can include more polluted air, water and soil as well as less access to nutritious foods. Minority communities are more likely to be exposed to higher levels of air pollution leading to exacerbation of chronic diseases.[5,6] Patients who live in neighborhoods previously subjected to ‘redlining’ (a discriminatory tactic preventing minorities from obtaining favorable loans or desirable housing) lack access to green space and tree cover increasing their vulnerability to extreme heat during the summer months.[7,8] Increasing temperatures are already being associated with increased presentations to Emergency Departments for ischemic heart disease, cardiac arrhythmias, and acute renal failure.[6,9] Communities continue to be burdened by dangerously high levels of lead, whether it be in a dilapidated house, in the soil or in the water.4 Wildfire smoke in the Western U.S. has been associated with higher levels out-of-hospital cardiac arrests with increased risk among those of lower socioeconomic status.[10]  The mean daily number of heat-related presentations to Emergency Departments in in the Pacific Northwest were 7 times higher in June 2021 than in June 2019 and 69 times higher during a record breaking heat wave in Oregon and Washington.[11] The U.S. experienced a jarring amount of flooding from extreme rain in 2021, if this trend continues impoverished communities stand the risk of degraded water quality and increased exposure to vector borne disease.[3,6]


When I begin my ride to work in the Upper East Side of Manhattan, a predominately white affluent neighborhood, the life expectancy is 85.9 years, according to NYC Health.[12] When I get to work in the Mott Haven neighborhood of the South Bronx, only about 3 miles away, a predominately Black and Latinx community which is a part of the poorest congressional district in the U.S, the life expectancy is 77.6 - almost 10 years of life lost.[12] To highlight how this disparity is related to climate change, a report published this past summer by the New York Times used an infrared thermometer to record the surface temperature of sidewalks on a sunny August day in the Upper West Side of Manhattan, East Harlem and the South Bronx: 84F in the Upper West Side, 115F in East Harlem and119F in South Bronx.[13] The South Bronx has only 7% tree canopy cover, compared to 47% in Riverdale, a wealthy neighborhood at the northern edge of The Bronx.[13] I can personally attest to these shocking disparities. Mott Haven, where I spend most of my life as an intern, is surrounded by 3 major highways, creating a circle around the neighborhood, with essentially no parks or greenspace. The Mott Haven neighborhood is literally nicknamed ‘Asthma Alley” - just google it. It's hard to believe that this neighborhood, burdened by double the poverty rate experienced by the rest of New York City, will NOT be more severely affected by climate change than nearby neighborhoods in Manhattan, Queens, and Brooklyn. 


CLIMATE CHANGE AND EMERGENCY MEDICINE


As frontline workers, Emergency Physicians will inevitably be tasked with identifying and treating the sequelae that climate change will have on health, especially for those of us who treat underserved communities. As our planet experiences worsening air, food, and water quality the demands for emergency services will likely increase, which could result in increased stress on an already overwhelmed system.[6] If so, the consequences experienced by Emergency Departments, believe it or not, could be even more prolonged wait times, boarding times, worker fatigue, burnout and worst of all, worsening patient outcomes. Many of us work in safety net hospitals for vulnerable populations and our specialty thrives in leading responses to natural disasters. Sorenson et al. have already highlighted how Emergency Medicine can adopt unique clinical interventions and address current and future risks related to climate change.[6] Whatever your initial impression was when you first heard the term ‘climate change,’ the reality is that it is here. We are currently experiencing the changes. We may not be winning any Nobel Prizes for our work, but each one of us can arm ourselves with the knowledge to help drive the change necessary to help our patients. Especially our most impoverished patients who are positioned to suffer the most from actions that we have collectively taken as a human population. 



  1. Allan, R. P., Hawkins, E., Bellouin, N., & Collins, B. (2021). IPCC, 2021: Summary for Policymakers.

  2. Lemery, J., Knowlton, K., & Sorensen, C. (Eds.). (2021). Global climate change and human health: from science to practice. John Wiley & Sons.

  3. Bullard, Robert D. Environmental Justice in the 21st Century: Race Still Matters. Phylon 2001, 49;3/4:151–71.

  4. Njoku, A. U. (2021). COVID-19 and environmental racism: Challenges and recommendations. Eur. J. Environ. Public Health, 5, em0079.

  5. Wu, X., Nethery, R. C., Sabath, M. B., Braun, D., & Dominici, F. (2020). Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. Science advances, 6(45), eabd4049.

  6. Sorensen, C. J., Salas, R. N., Rublee, C., Hill, K., Bartlett, E. S., Charlton, P., ... & Lemery, J. (2020). Clinical implications of climate change on US emergency medicine: Challenges and opportunities. Annals of Emergency Medicine, 76(2), 168-178.

  7. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Beagley, J., Belesova, K., ... & Costello, A. (2021). The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. The Lancet, 397(10269), 129-170.

  8. Salas, R. N., Shultz, J. M., & Solomon, C. G. (2020). The climate crisis and COVID-19—a major threat to the pandemic response. New England Journal of Medicine, 383(11), e70.

  9. Basu, R., Pearson, D., Malig, B., Broadwin, R., & Green, R. (2012). The effect of high ambient temperature on emergency room visits. Epidemiology, 813-820.

  10. Jones, C. G., Rappold, A. G., Vargo, J., Cascio, W. E., Kharrazi, M., McNally, B., ... & with the CARES Surveillance Group. (2020). Out‐of‐Hospital Cardiac Arrests and Wildfire‐Related Particulate Matter During 2015–2017 California Wildfires. Journal of the American Heart Association, 9(8), e014125.

  11. Schramm, P. J., Vaidyanathan, A., Radhakrishnan, L., Gates, A., Hartnett, K., & Breysse, P. (2021). Heat-Related Emergency Department Visits During the Northwestern Heat Wave—United States, June 2021. Morbidity and Mortality Weekly Report, 70(29), 1020.

  12. NYC Health: New York City Community Health Profiles. https://www1.nyc.gov/site/doh/data/data-publications/profiles.page; Accessed December 2021

  13. Lelan J. (2021) Why an East Harlem Street Is 31 Degress Hotter Than Central Park West

https://www.nytimes.com/2021/08/20/nyregion/climate-inequality-nyc.html; Accessed December 2021





John PurakalComment