While health inequities have always existed in US healthcare, they have become even more evident with the advent of the COVID-19 pandemic. Another area of concern to public health is the impact of climate change on our health, specifically, its disproportionate impact on low-income populations and people of color.
The health inequities caused by climate change as well as ways to address them via advocacy efforts was a focus of the Nursing Leadership in Climate Change and Environmental Health conference held by Jonas Nursing and Veterans Healthcare Program earlier this week.
Anabell Castro Thompson, an NP and Senior VP of Equity, Diversity and Inclusion at Equality Health, emphasized the many reasons for these inequities, including lack of access to green spaces in low-income neighborhoods with fewer trees and more heat-trapping pavements. These populations also lack quality healthcare and medicine, have poor household conditions and crowding, and face language and cultural barriers to health information. Residing in food deserts also means lower availability to nutritious foods. Additionally, lower socioeconomic status causes higher levels of stress and mental health conditions.
“The same physical, social, and economic environments that are associated with poor health outcomes also increase exposure and vulnerabilities to the health impacts of climate change," said Thompson. “These communities are often historically disenfranchised, they lack the political and economic power and voice to ensure that their decision-makers take their perspectives, needs, and ideas fully into account. The lack of power contributes to health inequities and constrains their ability to build climate resilience and to fully contribute to climate change solutions."
African Americans face a 150 to 200% higher likelihood of heat-related death, a 36% higher chance of contracting asthma, and are three times more likely to die or be admitted to the ED from asthma than non-Hispanic Whites. Native Hawaiians and Pacific Islanders are also more susceptible to asthma due to higher pollution in their communities, which exceed federal air quality standards. Similarly, Hispanic children are twice as likely to die from asthma and have increased risk of developing type 2 diabetes.
Hispanic communities are also disproportionately affected because of the regions in which they live—a majority of their population resides in the Southwestern US which is affected by drought and wildfires. They also largely live in pollution- and flood-prone areas, as well as urban heat islands. Nearly two million Latino individuals live within a half mile of oil and gas developments, which also leads to pollution-triggered health effects.
Latinos are also at risk because of the types of work many are employed in–according to a 2015-2016 National Agricultural Workers Survey, 83 percent of all farmworkers are Hispanic, and per the U.S. Bureau of Labor Statistics, 27.3 percent of construction workers in 2014 were Hispanic or Latino. Among agricultural workers, Hispanics are three times more likely, and among construction workers, they are twice as likely to suffer heat-related death. They also have higher occupational exposure to carbon monoxide.
Thompson, who also serves as the President of the National Association of Hispanic Nurses, went on to explain how lifestyles and sustenance are also at risk for certain ethnic groups due to climate change. For instance, Native Americans and Alaska Natives (NA/AN) rely on hunting and fishing, which are threatened by changes in climate. NA/AN populations also have poor access to potable drinking water and NA/AN children are more susceptible to hospitalizations from diarrhea due to this reason.
Thompson went on to emphasize that change would require empowerment, collaboration, and advocacy. Public policy must involve improving living conditions for low-income communities with improved climate resilience and a reduction in health disparities. This requires a coordinated strategy among healthcare, government, industry, education, research, and community-based organizations, she said. Entities must also ensure that information and education on climate change is linguistically and culturally accessible to communities of color, and that they account for historical trauma and marginalization. Economic stability must also be considered, including the costs involved with carbon reduction approaches and adoption of solar and other sustainable energy sources.
A lot can be done at the individual level to effect change. “We must volunteer with agencies that educate about climate change and advocate for systems, policies, and programs that address climate change," Thompson said. “I am a big proponent of 'If you don't like what you see in your community, then volunteer and make a difference.'"
Individuals can also help mitigate climate change impact by supporting climate-conscious candidates for office, increasing household energy efficiency, driving less, and volunteering with organizations that are involved in climate action, she said.
Thompson also had a message for healthcare professionals. “As a healthcare professional I have learned over time that healthcare professionals' power is in collective action in that we need to seek allies, we need to engage. As healthcare professionals we can also promote climate literacy among healthcare workers, providers, and administrators."
For healthcare providers, Thompson emphasized the importance of promoting climate literacy, providing culturally competent care, offering climate education to vulnerable populations, supporting patient access to the social determinants of health, and taking efforts to help their own organizations in carbon footprint reduction and emergency preparedness planning.