The Uneven Health Impacts of the Climate Crisis

The climate crisis isn't just harming our planet -- there's the real danger it'll have an impact on our day-to-day well-being. And as with other health crises, some Americans, including those with a preexisting medical condition or people with limited access to health care, will be harmed more quickly and severely.

There are factors, called social determinants of health, that decide our well-being, like where we grew up and how close we live to a medical facility. Experts are warning that these determinants also influence how someone will fare amid the environmental shifts brought on by climate change. People's ability to recover from a climate-induced health crisis, or how sick they get in the first place, will vary dramatically.

The disproportionate impact on those most vulnerable is just the latest reminder that the effects of climate change aren't fair. For years, poorer countries have been documenting the harmful consequences of climate change, which include an increasing rate of natural disasters and an erosion of people's homelands. Now that the climate crisis is becoming more noticeable in the US, with heat waves, wildfires, floods and other disasters, people in the states who've already been beset by health inequality are being hit harder.

"This is why climate change is such a moral problem," Dr. Brian Schwartz, an environmental epidemiologist and professor at the Johns Hopkins Bloomberg School of Public Health, said over email. "The persons, companies, and nations who most caused the problem and those who will be most affected are different." 

Populations can be more vulnerable to climate change because of where they live or their underlying health conditions, which often exist in the first place because of other health disparities born from lack of access, Schwartz said.

As the climate crisis starts to more obviously chip away at people's well-being in the US (as it has in other countries), here's who's most likely to be affected.

People with preexisting health conditions

The effects of climate change, which we're seeing in part through the spread of wildfires and air pollution, are exacerbating chronic conditions. 

People with asthma and heart disease may experience shortness of breath or a cough that won't go away after a wildfire, for example. Fine particles in the air from pollution, as well as exposure to ozone, a reactive gas, can decrease lung function or cause worse symptoms in people with respiratory conditions. Visits to the emergency room by people with asthma are more frequent when ozone levels are higher, according to the US Environmental Protection Agency.

The people who are more at-risk of having respiratory symptoms worsened by air pollution are the people who were more likely to develop asthma in the first place. 

Air pollution, a risk factor for developing asthma, has historically been worse in areas of the US that've been "redlined" -- the government's racist real estate practice from the 1930s that drew out areas declared less desirable because of the people who lived there. Such areas were often more polluted because they became hot spots for industrial plants or major highways. Some of the health effects are still felt today: children's asthma rates differ based on neighborhood and race, with Black and Hispanic children more affected than white children.

Structural racism that influenced social determinants of health throughout history, like school systems and differing health care access by neighborhood, makes racism itself a social determinant of health, particularly in regard to the severity of preexisting conditions like heart disease. Heart disease is 30% more deadly for Black Americans compared to white.

Beyond the influence of air pollution, people with some common underlying health conditions, including heart disease, lung disease and diabetes, are more susceptible to the direct effects of heat, Schwartz said. Diabetes can sometimes cause damage to blood vessels and nerves, for example, which can affect the way the body cools itself and lead to heat illness or stroke. High temperatures can also change the way the body uses insulin.

Heat waves coupled with higher pollution will further inflame preexisting health conditions, in varying degrees. But heat and air pollution also increase the risk of developing some health conditions we've become accustomed to as part of the "high risk" category, like diabetes or heart disease. 

"When it gets hotter, there is also more photochemical production of air pollution in the air," Schwartz noted. "Air pollution has also been implicated as a cause of diabetes." 

About one in 10 Americans have diabetes. 

Heart disease, the number one cause of death in the US, killing a person every 34 seconds, is also made worse with heat and climate change. 

Essential workers 

Some people who work jobs deemed essential are also disproportionately affected by the climate crisis because they're exposed to heat during their work day. They include people who spend a bulk of their day outside, such as construction workers, farmers and landscapers, but also those who work in hot indoor environments, like warehouses or freight trucks. Unlike people with desk jobs or those who work in air-conditioned buildings, they often can't move their work to safe environments. Many earn hourly wages and can't afford to skip work or take a sick day. 

There's also disparity in the makeup of essential workers: Black and Hispanic people hold essential jobs that expose them to heat in higher numbers, according to the US Department of Labor. 

It's long been understood that people who work outside in the heat are at higher risk of heat-related illness, including heat stroke. Heat waves becoming more frequent and severe increases the already-high risk for essential workers who build homes, work on roads and respond to maintenance calls. 

Heat also has health effects beyond immediate illness, sometimes harming kidneys, causing cardiac harm, and more, according to Dr. Korin Hudson, an emergency physician with MedStar Health and associate professor at Georgetown University. But this also makes it hard to accurately track all heat-related illnesses as the planet continues to warm, further proliferating medical problems. 

"It becomes a cause and effect," Hudson said.

To help guide construction workers and other people who work outdoors, the National Institute for Occupational Safety and Health has recommendations for employers and workers, including an app that serves as a heat index. But only four states -- California, Oregon, Washington and Colorado -- have outdoor workplace heat standards in place, according to Time. These standards include benefits like mandatory breaks in very hot weather, and the employer providing shade.

People with low mobility

Rising temperatures, outdoors and indoors, make it especially important that we're all able to get out of uncomfortable temperatures and into cooler, safer environments when necessary, like during this past summer's dangerous heat wave in the UK. But many older adults, and people with certain disabilities, may have trouble avoiding, and recovering from, heat waves. 

Natural disasters like storms or floods add another extreme wrinkle. Emergency responses often aren't designed with accessibility in mind, making fleeing a wildfire, flooded area or too-hot apartment difficult or impossible. On top of that, many treatments or ongoing medical care would be disrupted. Of the roughly 15% of people around the world who have a disability, a disproportionate number also live in poverty, adding to existing issues of emergency transportation and access to food and other resources necessary to survive a climate change-induced disaster. 

Likewise, older or elderly adults often have strict medication regimens that shouldn't be disrupted. They may also be dependent on caregivers to get them to safety. Given the hurdles involved in leaving home, they may choose to try to ride out a high-risk event at home. 

Hudson said it's especially important to check on your older neighbors during a heat wave or similar crisis. 

Looking toward the future 

Climate change is affecting (or will affect) many of the same people who've already been made sick by the country's dug-in social, racial and economic paths that direct their way through the health care system. That might lead you to be cynical about the chances of any change for the better, or any correction of course. 

That's not how many people react, though. In Bangladesh, a country that's already been devastated by climate change, young people have made an example of helping their neighbors and assisting the more-vulnerable to safety, including elderly and disabled people. In the US, activist groups have formed that are made of people who may be more likely to face the immediate health impacts of climate change.

Third Act, for instance, is an organization of experienced Americans over 60 who are devoted to lobbying for change, including on the climate crisis. Not only are older adults poised as activists because retirement opens up more time, said Dan Quinlan, a senior advisor to Third Act's up-and-coming health working group, but members also place a unique value on the state of the world they'll leave behind for younger people. 

One of the big tasks Quinlan is working on now is drawing in medical professionals on behalf of Third Act. The more that hospital systems and the public health sector view climate change as a social determinant of health, the brighter the future looks for younger people who inherit those systems.

"Older Americans, we very much are thinking about our legacy," Quinlan said. "There's a lot of concern about the legacy that we're leaving for younger generations and our families."