Fifth National Climate Assessment
15. Human Health

Extreme Heat

In recent decades, rising temperatures have increased heat-related health impacts in the US (Figures 21.8, 22.9, 25.3, 26.2, 27.8, 28.7; KM 2.2).¹² Higher temperatures are associated with adverse pregnancy and birth outcomes, mental health impacts, and increased emergency room visits and hospitalizations related to cardiovascular disease, diabetes, electrolyte imbalance, renal failure, and respiratory outcomes.^13,14,15 Heat-related health impacts are greatest among children, adults over age 65, those with disabilities, people with mental health or substance-use disorders; and those who are pregnant, lack access to cooling, or engage in outdoor labor and activities (Figure 15.1).^{13,16,17,18,19} Black, Latinx, Asian, historically redlined, and urban communities are disproportionately exposed to heat, as are those with low wealth and people experiencing homelessness (Figures 12.4, 12.6; KM 22.2);^20,21,22 these groups also report being more worried about heat risks.^23,24,25 Certain medications for management of cardiovascular conditions and mental health disorders may accentuate heat-health risk.^26,27 Heat-related death and illness will continue to increase unless climate change adaptation and mitigation policies are implemented (KM 15.3).^28,29

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Heat does not impact all communities equally.

Figure 15.1. While anyone can be impacted by heat, location, economics, compound risks, and social and racial factors influence who is most at risk. These impacts disproportionately affect BIPOC (Black, Indigenous, and People of Color) communities as well as communities with low wealth. Figure credit: CDC, University of Colorado, NOAA NCEI, and CISESS NC. Image credits (clockwise from top left): NIEHS/Kelly Government Solutions and USGS/ASRC Federal Data Solutions; FG Trade/E+ via Getty Images; YinYang/E+ via Getty Images; Marc Dufresne/iStock via Getty Images.

Drought

Among weather and climate disasters in the US over the last 40 years that have caused more than a billion dollars of economic loss, drought is responsible for the second-highest number of climate-related deaths—approximately 99 per year (Figure A4.9).³⁰ However, these statistics probably underreport the total number of deaths, as these estimates account only for heat-related mortality that accompanies droughts.³¹ There is growing evidence of an association between drought and increased mortality in adults ages 25–64 in both rural and urban populations.^32,33 Drought can worsen air quality, resulting in adverse health outcomes such as increased cardiovascular and pulmonary disease and premature death (KM 4.2).^34,35 It can also decrease water quantity and quality, which can cause increased exposure to heavy metals, bacteria, and other harmful contaminants (KMs 30.2, 30.2).^36,37,38 Because farmers rely on the land for their livelihood, drought during the growing season is associated with worsening mental health among rural US farmers (KMs 11.2, 22.4).³⁹

Wildfires

Wildfire activity has significantly increased over the last few decades, especially in the western US (KM 14.2; Figure 28.9; Focus on Western Wildfires). Roughly half of the increase in burned areas in the US can be attributed to a warming climate.⁴⁰ Wildfires and resulting poor air quality can cause disruptions to a person’s life, including loss of livelihood and displacement, and can lead to multiple adverse health effects, including death, illnesses, injuries, adverse reproductive outcomes, poor mental health consequences, and declines in psychosocial well-being.^41,42,43,44 Exposure to smoke from wildfires is associated with emergency department visits, hospitalizations, and deaths.^{45,46,47,48,49}

Infectious Diseases

Climate change is expected to alter the distribution, abundance, and seasonality of pathogens and their associated infections (Figure 15.2; Focus on COVID-19 and Climate Change).^50,51,52,53 The range of vampire bats in Texas and Florida is expected to increase due to rising temperatures, which can lead to increased human rabies exposure.^54,55 Exposure to rabies and other zoonoses like brucellosis and toxoplasmosis is also of increasing concern in Alaska, especially for residents who practice subsistence hunting and gathering (KM 29.1).⁵⁶ In the eastern US, exposure to the amoeba (Naegleria fowleri) that causes primary amebic meningoencephalitis has been documented farther north.⁵⁷ Environmental fungal diseases like blastomycosis, coccidioidomycosis (Valley fever), cryptococcosis, and histoplasmosis are expected to be impacted by climate change.^58,59,60 Valley fever is expected to spread northward as drought and temperatures increase (KM 28.4). Case numbers are projected to increase by 220% by the end of the century under a very high scenario (RCP8.5).⁶¹ Valley fever tends to afflict construction and agricultural workers,^62,63,64 and the disease disproportionately impacts Black and Latinx populations, possibly due to occupational exposure.^65,66,67,68

Lyme disease and other tick-borne diseases account for approximately 80% of all reported cases of vector-borne diseases in the US^69,70 and have steadily increased over the last 20 years due to multiple factors, including climate change (Figure 24.8).^71,72,73 Increased distribution and abundance of ticks are projected to increase human disease cases.^{74,75,76,77,78,79} Climate change has contributed to the expansion over the last 20–30 years of the Lone Star tick^{80,81,82,83,84} and the Gulf Coast tick, which transmit multiple pathogens.⁸⁵ Climate change extends ticks’ seasonal activity, prolonging human exposure.^{76,86,87,88,89}

Mosquito-borne pathogen spread is influenced by weather, climate, and social factors.^90,91,92 Climate change alters the diversity and distribution of mosquito vectors of dengue, Zika, and chikungunya viruses.^{93,94,95,96,97} Dengue is currently a risk in the contiguous US, the US Caribbean, Hawaiʻi, and US-affiliated Pacific Islands (KMs 23.1, 30.2).^98,99 Increasing weather variability (KM 4.1) may increase West Nile virus transmission. Regional West Nile virus projections indicate geographic expansion in the Northeast over the next 50 years due to climate-related changes in mosquito population distribution (KMs 22.2, 24.3).^100,101,102 Mosquito-borne transmission of other encephalitis viruses has been sporadic in the last decade and may increase as climate change extends seasonality and expands habitat suitability for mosquito species.^{103,104,105,106,107,108,109,110,111}

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Some climate-sensitive infectious diseases are expected to see expanded geographic range and extended seasonality.

Figure 15.2. The map shows select examples of regional climate-sensitive infectious diseases, based on recent changes in geographic range or incidence. Some regions will experience increases in tick- and mosquito-borne diseases, zoonotic diseases, and pathogens, both in geographic area and extended seasonality. Figure credit: Los Alamos National Laboratory, CDC, Columbia University, University of Arizona, and University of Colorado.

Food and Water

Climate change negatively impacts water quality, water security, food security, and nutrition, which harms health, particularly for communities that rely on agriculture, fishing, and subsistence lifestyles (KMs 4.1, 11.2, 22.2, 23.1, 25.3). For example, the 2021 Pacific Northwest heatwave affected the livelihoods of farmers and Tribes by damaging crops and causing a die-off of mussels, clams, and oysters.¹¹²

The incidence of certain diseases caused by foodborne and waterborne pathogens is expected to increase due to climate conditions that promote bacterial growth and geographic spread. For instance, vibriosis is a disease caused by ingesting Vibrio bacteria in contaminated shellfish or water sources. Symptoms range from food poisoning–like illness to death. Climate change–related vibriosis cases are projected to increase by 51% by 2090 under an intermediate scenario (RCP4.5)¹¹³ due to increasing Vibrio populations in warming waters, changing salinity, sea level rise–related coastal changes, and flooding (KM 9.1).^{113,114,115,116,117}

Mental and Spiritual Health

Extreme weather events, wildfires, and slow-onset disasters (e.g., drought, sea level rise) can contribute to adverse mental and spiritual health outcomes. These harms may arise from forced displacement and migration (KM 20.3), trauma, loss of sense of place and belonging, and disruption of livelihoods, lifeways, and social support systems.¹¹⁸ Under-resourced communities bear greater mental and spiritual health burdens (KMs 22.2, 25.2, 27.5).

Mental health conditions including anxiety, depression, and suicide have become more prevalent in the US in the past decade, especially among adolescents.^119,120 Climate change may increase these mental health burdens.⁵⁵ Greater need for mental health services and psychiatric medications, as well as higher rates of anxiety, have been reported following major hurricanes (KM 23.1). For example, one in six mothers with low income experienced continued post-traumatic stress symptoms 12 years after Hurricane Katrina.^{121,122,123,124} Many survivors of California’s deadliest wildfire, the 2018 Camp Fire, experienced post-traumatic stress, depression, and anxiety⁴² related to home loss and community disruption. Extreme heat exposure has been linked to worsening mental health, including suicide and interpersonal violence.^7,125

Degradation or destruction of culturally significant places and flora and fauna relatives (KM 24.2),^126,127 shifts in timing of ceremonial practices, disruption of intergenerational teachings and sharing of knowledge and wisdom, and loss of place-based spirituality and traditional livelihoods and lifeways put spiritual health at risk, especially for Indigenous communities.^128,129

Art × Climate

Amelia K.
Youth Entry, Grade 10

Cautionary tale
(2023, gouache)

Artist’s statement: In my piece, I focused on air pollution and fossil fuels. I showed factories pumping toxic gasses and fuels into the air. I also included a figure drawing childlike images of factors that have or will be destroyed by climate change. Broken green crayons symbolize the destruction of nature as climate change worsens. This is a completely possible future for our planet, with bumblebee death tolls rising due to climate change and clean water becoming inaccessible for the less fortunate. Without action this problem will only worsen.

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Artworks and artists’ statements are not official Assessment products.

Compounding and Cascading Hazards

Multiple climate-related extreme events that occur concurrently or in rapid succession (KM 2.3; Focus on Compound Events) can result in greater health impacts than singular events and limit the ability of individuals and communities to effectively prepare for, manage, and recover from these events. A singular event that cascades across multiple sectors or regions can result in compounded adverse health consequences. Examples include back-to-back heatwaves, heatwaves during wildfires, drinking-water contamination after flooding, and vector-control program breakdowns during and after flooding.¹³⁷ During 2005–2013, windstorms combined with power outages increased emergency department visits, hospital stays, and injury costs in New York, particularly for older individuals and Medicaid recipients.¹³⁸

Occupational Safety and Health Impacts

Climate-related increases in temperature are associated with increases in occupational injuries and occupational exposure to heat, potentially resulting in illness or death (KM 11.2).^139,140,141 Between 2011 and 2019, an average of 3,500 heat-related injuries, resulting in 38 fatalities per year, were reported to OSHA.¹³⁹ Between 2001 and 2018, higher-temperature days in California were associated with greatest increased risk of occupational injuries to men, lower-income workers, and young workers. Repeated heat stress coupled with dehydration in occupational environments is a risk factor for the development of kidney disease.¹⁴² Extreme heat is expected to lead to lost labor hours, particularly for workers of color, individuals with low income, and those without a high school diploma. Additionally, these groups are more likely to live in areas where labor is most impacted by extreme heat.¹⁴³ Projected estimates of annual lost wages due to unsafe heat range from $19.2 billion to $46 billion (in 2022 dollars) by midcentury (under an intermediate scenario [RCP4.5]).^144,145 Industries where workers experience increased risk of heat-related mortality include agriculture (KM 11.2), construction, transportation and warehousing, and waste management.¹³⁹ Workers can also face unsafe heat in indoor environments not equipped with adequate climate control.¹³⁹ Worker safety is also affected by climate change impacts on economic opportunity and wealth (KM 19.3), exposure to infectious diseases (Focus on COVID-19 and Climate Change), extreme events (Focus on Western Wildfires), and increased mental health risks.¹⁴⁶

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Community Health and Health Equity

Climate hazards negatively impact physical, mental, and community health.¹⁴⁷ Although extreme weather threatens all communities (Figure 15.3), health-related burdens are experienced more acutely by BIPOC and low-wealth communities that have been under-resourced and overburdened (KM 19.1; Figure 19.2).^143,148,149 Climate change creates intergenerational inequities as younger generations must endure more extreme weather events than older ones (Figure 15.4). Valuation of intergenerational inequity can inform resilience and mitigation investments. Climate change is a threat multiplier, interacting with and magnifying other life-threatening stressors (Figure 15.5).¹⁵⁰ Fenceline communities—those located adjacent to hazardous industrial facilities, which are disproportionately BIPOC and low-wealth—face higher risks from chemical and industrial disasters following extreme weather.^{151,152,153,154,155,156,157,158,159,160,161,162} Hazardous sites, threatened by flooding and sea level rise, exacerbate climate-related health inequities to BIPOC and communities with low wealth (KM 9.2).¹⁶³ Additionally, about 70% of Superfund sites—locations contaminated by hazardous materials designated for clean-up—are located within one mile of federally assisted housing, which disproportionately houses people of color, individuals with low wealth, and those with disabilities.¹⁶⁴

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The number of climate hazards a person born in North America will experience during their lifetime depends on how much Earth warms above preindustrial levels

Figure 15.4. People born in North America in 2020, on average, will be exposed to more climate-related hazards compared to people born in 1965, an indication of intergenerational inequity. Figure credit: Boston Children’s Hospital, NOAA NCEI, and CISESS NC.

Food and Water Systems

Disruptions to food and water quality pose challenges to human health and disproportionately affect BIPOC communities, households with low wealth, single-parent households, and children (KM 11.2; Box 23.1).^165,166 In 2020, 10.5% of US households were food insecure, with higher rates reported among populations that have been marginalized.¹⁶⁵ There are growing concerns about aging or inadequate water infrastructure,¹⁶⁷ especially among households, including many in the Navajo Nation, who experience unequal access to piped and treated drinking water and who are dependent on hauling large quantities of water from nearby facilities.¹⁶⁸ Chemical, physical, and microbial contaminants (e.g., algal blooms and the toxins that cause paralytic shellfish poisoning) threaten water supplies under drought conditions and high temperatures (KM 22.2), which is of particular concern among Indigenous populations who rely on subsistence fishing (KMs 10.1, 28.1, 29.1).

Healthcare Access and Delivery

Climate-related extreme events have resulted in reductions in healthcare access and an increase in illness and death that can extend for months after the acute event, especially for communities with low wealth (KM 23.1).^169,170 Extreme events can disrupt care for chronic physical and mental health conditions. After hurricanes, risk of death among patients with lung cancer rises in proportion to the length of disaster declarations,¹⁷¹ and delays in access to dialysis after Hurricane Sandy were associated with more emergency department visits and mortality among patients with chronic kidney disease.¹⁷² Infrastructure and transportation failures contribute to poor health outcomes due to closures, lack of electricity or clean water sources, and/or road failures that prevent access to healthcare providers.¹⁷³

Tribal and Indigenous Peoples’ Health

Tribal and Indigenous Peoples are disproportionately impacted by climate change, and they often equate the health of their people, culture, and traditional practices to the health of the environment (KMs 16.1, 29.1, 27.5, 30.2).^127,174,175 In addition to enduring the historical injustices of colonization, forced relocation, and land dispossession,¹⁷⁶ Indigenous Peoples are among the first to face the spiritual, physical, and mental health threats and impacts of climate change. This undermines their ability to maintain and access their cultural and economic lifeways and worsens community-wide vulnerabilities, such as limited water availability for use by humans, animals, and plants (KM 16.1).¹²⁹ Climate-related hazards such as flooding, erosion, sea level rise, and melting ice may lead to impassable roads in remote parts of Tribal territories, thereby widening gaps in the ability to access adequate healthcare (KM 29.2; Focus on Risks to Supply Chains).¹⁷⁷

Persons with Disabilities’ Health

Climate change disproportionately and differentially harms the health of persons with disabilities, magnifies existing health and socioeconomic inequalities, creates unique challenges, and compounds disparities due to multiple discrimination.¹⁷⁸ During climate disasters, persons with disabilities are at heightened risk of mortality and injury, and they experience disruptions accessing assistive devices, medication, dialysis, other health services, and social support.^178,179 During periods of higher ambient temperatures and heatwaves, persons with physical and mental disabilities experience adverse health impacts, increased emergency room visits, and higher rates of mortality; cooling measures may be physically or financially inaccessible.^178,180 Persons with disabilities are also at elevated risk of exposure to chronic air pollution, as they disproportionately live in neighborhoods with heightened exposure to fine particulate matter due to lower wealth, higher unemployment, and undereducation relative to nondisabled peers.¹⁸¹

African American and Latinx Peoples’ Health

Climate change has had and will continue to have disproportionate adverse health impacts on communities with low wealth and BIPOC communities, worsening already-existing health disparities. Discriminatory policies and practices in housing, education, and siting of polluting facilities, including disinvestment in infrastructure and healthcare, amplify adverse climate-related health impacts (KM 22.2; Focus on Risks to Supply Chains).¹⁵⁰ Latinx populations, compared to other demographic groups, are 43% more likely to live in areas that will experience the highest labor reduction hours due to extreme high temperatures (with 2°C (3.6°F) of global warming by 2085–2095 compared to the 1986–2005 reference period).^143,145 African Americans are also expected to face disproportionately greater risks from climate change. African Americans and individuals with low income face higher risks of death from climate-driven floods and air pollution compared to White people (Box 4.2).¹⁴³ People of color are disproportionately exposed to greenhouse gas co-pollutants like small particulate matter and face adverse health impacts as a result.^182,183 Due to housing discrimination and redlining, African Americans are more likely to live in neighborhoods with fewer trees and more pavement, suffer disproportionately from heat-related deaths, be exposed to worse air quality, and experience higher rates of asthma-related emergency room visits (KM 22.2; Figures 12.4, 12.6),^{184,185,186,187} all of which are compounded by climate change. Latinx and other BIPOC communities face similar challenges (KM 14.3).^188,189

Women’s Health

Women disproportionately experience the burden of climate change because of unique mental, sexual, and reproductive health needs that intersect with existing social, racial, and economic disparities. Women, and particularly women of color, are more likely to live in communities with low wealth,^190,191 which is associated with food insecurity¹⁹² and exposure to particulate matter, extreme heat,² and climate-related disasters.^193,194 Pregnant cisgender women are particularly vulnerable because exposure to heat, particulate matter, and disaster-associated stressors leads to poor pregnancy outcomes, including miscarriages and low birth weight.^1,195 These factors contribute to maternal mortality, which is more prevalent in the US than in any other developed nation.¹⁹⁶ These outcomes are more likely in groups that have been marginalized, particularly Black pregnant people,^197,198 exacerbating existing social inequities.

In utero exposure to maternal stress during climate-related disasters is linked to subsequent psychiatric disorders in early childhood.¹⁹⁹ Additionally, women have higher caregiving burdens and decreased healthcare access, which makes recovering from climate-driven exposures more difficult. Transgender women may be required to stay in male-only shelters during climate-related disasters, negatively impacting their mental and physical health.^200,201

Sexual and Gender Minorities’ Health

Sexual and gender minorities (SGMs) face social, economic, and health disparities and, as a result, experience greater risk of harm from climate change. SGMs are found in all populations, including frontline communities, and can experience compounding disparities and impacts on the basis of sexual orientation and gender identity. In 2015, Black and Latinx transgender individuals were more than three times as likely as the overall US population to be living below the poverty line (KMs 19.1, 23.1).¹⁹⁰ Indigenous SGMs face heightened health disparities as climate change continues to impact lifeways and economies.²⁰² SGMs may lack access to critical services during extreme events and are often not included in disaster preparedness and response plans due to discrimination and institutional structures that prioritize the needs of cisgender, heterosexual individuals;²⁰⁰ may not recognize “chosen families”; and increasingly rely on faith-based organizations as first responders during disasters, which in some cases have blamed SGMs for devastating hurricanes and wildfires as a punishment from God.¹⁹³ These discriminatory beliefs have led some SGMs to not seek services at faith-based organizations for fear of being turned away or their SGM status being outed.²⁰³ Because of religious bias, healthcare workers may also refuse to provide health services to or discriminate against SGMs during disasters.²⁰⁴

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Some highly vulnerable areas also have high economic losses from climate hazards.

Figure 15.5. Panel (a) maps counties based on their Social Vulnerability Index (SoVI) scores for the period 2015–2019. SoVI uses 29 different inputs that characterize underlying socioeconomic and demographic factors, and the index is classified (high, medium, low) using standard deviations. Panel (b) shows counties with an increasing trend in climate-sensitive hazard losses (2000–2019) based on data from the Arizona State University/ASU Spatial Hazard Events and Losses Database for the US (SHELDUS). The data is based on property losses and excludes injuries and fatalities from climate-sensitive hazard losses. Exclusion of fatality (especially from heat) explains why some areas of the Southwest appear to have a seemingly decreasing loss trend. The composite map (c) identifies counties with high social vulnerability that have less capacity to prepare for, respond to, and rebound from increasing climate-related losses. SoVI does not fully capture the disproportionate impacts of climate hazards in specific neighborhoods, populations, and cultural groups within a county, nor does it account for risk created by historic marginalization. Figure credit: University of Central Florida, Arizona State University, NOAA NCEI, and CISESS NC.

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Risk Management and Integrated Approaches

Proactive and continuous risk management to protect at-risk groups and healthcare facilities is critical to human health and well-being (KM 31.3). This includes integrated approaches that mainstream health into food systems (KM 11.1), infrastructure, water, and sanitation policies. Mitigation options with significant health benefits include reducing point-source (e.g., coal-fired power plants) and mobile-source emissions, increasing active transport (e.g., walking), and increasing consumption of vegetables, legumes, fruits, and nuts (KMs 13.3, 32.4).²⁰⁵ The economic value of avoided hospitalizations and premature deaths from mitigation activities is larger than the cost of implementation.²⁹

Climate-Resilient and Sustainable Health Systems

A climate-resilient health system can “anticipate, respond to, cope with, recover from, and adapt to” climate change to improve the health of communities (KMs 18.2, 19.2).^206,207 Focusing on equity, proactively addressing mental health needs, and linking to community health resources such as community health workers and long-term support and services can create a climate-resilient health system. Climate-related hazards routinely stress and disrupt healthcare systems and threaten access to healthcare for many. For example, a flooding event in 2019 damaged hospitals and disrupted access to healthcare across the central US.²⁰⁸ Many hospitals (9.3%), nursing homes (10.2%), and pharmacies (12.1%) are at risk of flooding.²⁰⁹ The COVID-19 pandemic exposed the lack of resilience of the healthcare system when confronted with a large, prolonged increase in healthcare needs (Focus on COVID-19 and Climate Change). Climate-sensitive health problems are linked to a significant economic burden on the healthcare system. There are numerous tools to identify threats and vulnerabilities to healthcare systems—such as the US Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative—with frameworks to guide planning and implementation.²¹⁰

Healthcare systems can play an important role in GHG reduction. The healthcare sector is responsible for 8.5% of US GHG emissions (Figure 19.5).^211,212 Transitioning to clean energy sources and introducing sustainable technologies into healthcare systems would reduce these emissions and associated health harms (KM 32.4).

Benefits of Reducing Air Pollution

Air pollution is a leading cause of premature death worldwide (KM 14.1).²¹³ It has substantial impacts on lung, heart, and brain health; cancer; and mental health.²¹⁴ Reducing GHG emissions and human-caused air pollution would save lives and decrease the burden on the healthcare system (KMs 14.5, 32.4; Figure 32.15).

Disease Surveillance

Implementing surveillance programs for climate-sensitive infectious diseases and non-infectious health outcomes (e.g., heat stroke, respiratory disease, mental and behavior health indicators) is an important adaptation measure. The COVID-19 pandemic illustrated the need for modernization of the US surveillance system and the role of innovative surveillance strategies such as wastewater testing and community-based participatory surveillance (Focus on COVID-19 and Climate Change). Monitoring disease case counts, corresponding indicators (animal health and vector populations), and health outcomes facilitates identifying seasonal trends, responses to climate and environmental variability, geographic hotspots for diseases, and new or reemerging threats.^65,215,216 Enhanced disease surveillance identifies populations most at risk for contracting a disease and improves health by raising disease awareness and reducing time to diagnosis and treatment.²¹⁷ This increases capacity to plan for and prevent disease spread or outbreaks, such as by creating predictive models of disease transmission, implementing vector abatement programs, and developing and stockpiling vaccines and pharmaceuticals.^{101,218,219,220}

Extreme Heat

Increasing temperatures, urbanization, and an aging population (KM 2.2)^221,222 can result in increased heat-related deaths (KM 2.2).^221,222 Limiting warming to 1.5°C (2.7°F) above preindustrial levels (compared to 3°C, or 5.4°F) and timely adaptations could substantially decrease heat-related deaths, especially in cities.^{223,224,225,226} Adaptations range from ensuring equitable access to cool spaces and reducing social isolation to augmenting heat warning systems and improving green infrastructure (KMs 12.3, 12.4).²²⁴

Air-conditioning access is limited for unhoused populations and households with low wealth. High electricity costs prevent effective use of air-conditioning.²²⁷ Poor self-reported health and reduced life expectancy are more prevalent where families spend a large proportion of household income on residential energy.²²⁸ Government programs can help families reduce their energy costs.²²⁹ Home weatherization can improve health conditions and reduce healthcare costs while reducing GHG emissions, providing societal benefits greater than the implementation cost (KM 5.3).^230,231 There are self-reported health benefits from energy retrofits in households with low wealth.²³²

Increased air-conditioning use can exacerbate the urban heat island effect by transferring hot air from buildings to the outdoor environment (Ch. 12; Figure 12.4) and can increase electricity-related emissions of GHGs and other air pollutants.²³³ Buildings that rely on air-conditioning may become dangerously hot during prolonged power outages.^{234,235,236,237,238} Sustainable cooling strategies are in development, such as energy-efficient systems (e.g., heat pumps and fans) and affordable passive cooling (e.g., night-flush ventilation).^{239,240,241,242}

Wildfires

Under a range of future climate scenarios, wildfire pollutant emissions are expected to increase and result in significant health burdens.²⁴³ Integrated wildfire management and adaptation strategies are critical to reducing deaths and illnesses, as wildfire risk cannot be eliminated. Proactive and effective management of fuel loads (e.g., through prescribed and cultural burning) can reduce wildfire size and intensity, but there may be unintended health consequences.²⁴⁴ Strategies to reduce wildland fire smoke exposure include personal actions and community-level interventions (KM 14.2).²⁴⁵ Early warning systems identify areas and populations experiencing higher smoke exposure on a near-real-time basis.^246,247

Art × Climate

Michele Colburn
Where There's Smoke
(2021, watercolors, gunpowder residue, charcoal on archival paper)

Artist’s statement: In the summer of 2021, I created a work Where There's Smoke while wildfires raged uncontrolled in California. I have lived in Colorado and Arizona in my life and am aware of such natural events, but also know that those of late are more dangerous and larger due to climate change. It was devastation that surpassed anything I had witnessed in my lifetime.

View the full Art × Climate gallery.

Artworks and artists’ statements are not official Assessment products.

Vector-Borne Diseases

Climate change is a significant contributing factor to the increase in vector-borne disease cases reported over the last 20 years.^71,72,73 To adapt to these changing risks, new technologies to prevent transmission of vector-borne diseases are urgently needed, as traditional control measures, including insecticides, are rapidly becoming ineffective.^{71,248,249,250} Recent advances include vaccines, spatial repellents, genetically modified mosquitoes, and Wolbachia (a naturally occurring bacteria that reduces transmission of viruses such as dengue).

However, these novel adaptations are not yet operational due to funding, regulatory status, and infrastructure needs. Buy-in from communities and decision-makers is critical to ensure that emerging strategies can be utilized to protect health.^{92,218,251,252,253,254} Coupling novel strategies with well-established community engagement practices, such as remediating vector habitat and increasing personal protective measures, can effectively reduce risk and empower communities.^255,256

Mental and Spiritual Health

Actions to support community social cohesion and cultural continuance, establish trusted and effective communication systems, and ensure that community members and/or officials can effectively manage disasters may buffer against adverse mental health outcomes.¹⁴⁷ A personal sense of agency to take climate action can reduce adverse mental health outcomes during extreme events. It can provide hope for survival and contribute to greater participation in community responses to climate change, which may also improve mental health resilience.²⁵⁷

Community-Level Resilience and Adaptation Strategies to Build Capacity

Communities, connected through relationships and practices,²⁵⁸ have unique priorities, traditions, and histories relevant to adaptation.²⁵⁹ Many communities are already making proactive intergenerational adaptation decisions to reduce exposure to climate impacts, build capacity, and enhance healing and self-determination in the face of historical traumas (Figure 15.6).²⁶⁰ Many Indigenous Peoples in the US practice cultural burning, a fire management approach that promotes ecosystem resilience and growth of culturally important medicinal plants^129,261 while also serving as an eco-centric adaptation strategy for improved planetary health.^262,263 The Swinomish Indian Tribal Community used values-driven data and community input in developing Indigenous health indicators and a climate change health assessment for adaptation decision-making; the indicators included community connection, self-determination, education, resilience, cultural use, and resource security.^174,264,265

External adaptation strategies can exacerbate inequities through, for example, institutional racism, uneven distribution of adaptive capacity, and resource allocation that ignores distributive and historical injustices (KM 31.1). Adaptations (e.g., tree planting) that make an area more appealing for people with higher income could push existing residents out, resulting in eco-gentrification.^266,267 There are policies and institutional barriers to implementing whole-community adaptation actions.^129,268

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Louisiana Tribal leaders are upholding sovereignty and self-determination in their climate adaptation actions following hurricane damage.

Figure 15.6. Tribal leaders from coastal Louisiana shared Indigenous and local knowledge, wisdom, and experiences of the health impacts and resilience-building recovery actions following Hurricane Ida, which made landfall in coastal Louisiana in August 2021. Interviews were recorded during a convening where the Tribal leaders came together to share how Louisiana Tribes are adapting to climate change while upholding sovereignty and working to improve health outcomes. Link to videos. Image credit: ©Craig Richard and Unitarian Universalist Service Committee, in collaboration with the First People's Conservation Council of Louisiana, Lowlander Center, Livelihoods Knowledge Exchange Network, and Disaster Justice Network, July 2022.

Addressing immediate needs and developing healthier long-term outcomes that reduce inequities²⁶⁹ and strengthen community resilience¹⁴⁷ involves collaboration and cooperation across multiple scales. Persons with disabilities, for example, are often excluded from adaptation and mitigation efforts,²⁷⁰ and there is a strong need for disability-inclusive climate planning and response.²⁷¹ The most impacted communities must be included in decision-making, from visioning and planning through implementation.^258,272,273

Community adaptation capacity is enhanced by building and sharing flexibility, humanity, spirituality, and resilience. To be effective, adaptation strategies must integrate workforce development into co-governance and promote institutional support systems for community-defined, -driven, and -led adaptation efforts that include a diversity of cultures, histories, lifeways, and knowledge systems.^129,260,274

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