Equitable Law and Policy Solutions to Mitigate Health Risks from Climate Change and COVID-19
September 23, 2020
Overview
As the COVID-19 pandemic persists in the United States, climate change and weather-related health risks, such as hurricanes, wildfires, and extreme heat, will put even greater pressure on the nation’s health and healthcare resources. This convergence of factors was evident in the recent landfall of Hurricane Hanna in the Rio Grande Valley and Corpus Christi areas of Texas, whose healthcare systems have been overwhelmed by the spread of COVID-19. Black, Hispanic, and American Indian people, who have been disproportionately impacted by COVID-19, are also at greater risk of adverse impacts from extreme weather events.
There are short-term actions that can be taken to protect the health of vulnerable people along with longer-term solutions that can create equitable and resilient communities that can better respond to future disasters.
Extreme Heat
Heat is an often-underestimated health threat that disproportionately impacts communities of color. As climate change causes the earth’s temperature to rise, we can expect increased heat-related illnesses and deaths as the United States experiences more frequent and severe heat waves, particularly in urban heat islands, where surface heat temperatures are higher than surrounding rural areas due to a lack of cooling tree cover and excess heat captured by a higher concentration of impervious surfaces that do not allow water to seep into the ground, such as parking lots and roads.
Heat-related illness accounts for more than 65,000 emergency room visits each summer and extreme heat kills more people per year in the U.S. than any other weather-related event. Exposure to extreme heat can cause heat rash, heat exhaustionand heat stroke. Extreme heat events can also negatively affect mental health and aggravate underlying health conditions such as cardiovascular and respiratory diseases and diabetes. The highest rates of heat related deaths are found in American Indian and Black communities, both in large urban centers with significant heat island impacts and rural areas that may lack air conditioning and access to healthcare.
Hurricanes
Hurricane season has started – running from May 15 (Eastern Pacific) or June 1 (Atlantic and Central Pacific) to November 30 each year. There have been eight named hurricanes in the Atlantic and three in the Pacific, and for only the second time since 1953 the National Hurricane Center has already gone through its list of names for the current Atlantic hurricane season. Hurricanes bring a variety of health risks associated with storm surge, wind damage, tornadoes and flooding. In the U.S., storm surge is the leading cause of hurricane-related deaths. Other health risks can include interrupted utility services, which can increase heat-related illness if air conditioning use is disrupted; interruption of necessary medical services, affecting the management and treatment of chronic disease; transmission of infectious disease due to shelter crowding, disrupted sanitation, or standing water that leads to an increase in vector-borne illness; and behavioral health challenges due to stress and trauma.
States have used the same emergency management laws to declare disasters due to both COVID-19 and hurricanes. It is imperative that states coordinate disaster response efforts in an equitable manner to combat all disaster-associated impacts, including transportation, shelter, utilities, and access to food, medicine, and health care, as well as the effects on the health and safety of first responders.
Wildfires
Wildfires lead to the displacement of individuals, either temporarily or permanently, and can have devastating economic and psychological impacts on communities. Majority Black, Hispanic, or American Indian census tracts were found to be more vulnerable to wildfires than other census tracts. While in the past, there were four-month fire seasons, wildfire seasons have now lengthened to six or eight months. This has occurred in part due to climate changes that have led to hotter and drier conditions, creating areas more susceptible to wildfires.
Fighting wildfires during the COVID-19 pandemic brings additional challenges for firefighters. CDC released FAQs for wildland firefighters with suggestions for specific guidelines, including planning for fire crews traveling to different geographical areas. The U.S. Department of the Interior has also provided information on the work done in collaboration with interagency partners to address these additional challenges.
Short-term health interventions
Illness and death due to heat, smoke, hurricane-related storm surge, wind damage and flooding are preventable, although there may be areas that continue to be at risk due to structural inequities that impact Black, Hispanic, and American Indian communities to a greater degree. Short term health interventions to reduce the burden of extreme weather on vulnerable communities include:
- Proactive identification of vulnerable populations and areas
- Warning and outreach programs and materials that provide information on extreme weather events and the risk of COVID-19, taking into account language, cultureand accessibility
- Emergency preparedness planning tools and guidelines for individuals and communities (such as Heat Response Plans)
- Disaster shelters, cooling centers, and clean air shelters and spaces for individuals who may have to evacuate or who do not otherwise have access to a safe, cool and clean space for the duration of the disaster or event
- Energy assistance programs that can reduce the cost of energy consumed with the use of air conditioning
- Distribution of supplies, including water bottles, sanitizer and face masks
- Enhanced access to health and behavioral health care via telemedicine tools and widespread access to reliable broadband service and connected devices
The COVID-19 pandemic may require modifications to shelters and spaces to reduce transmission. These modifications include identifying alternative spaces for shelters and safe spaces that allow for physical distancing and isolation of sick individuals, and enhanced air exchange systems and cleaning protocols. Testing and screening should also be implemented as resources permit.
The health and safety of workers must also be considered, as shelter employees, first responders, utility workers, and others are at increased risk, including anyone whose primary duties have them working outdoors and are exposed to extreme heat, flooding, or wildfires and wildfire smoke. Protections can include screening protocols, updated attendance and sick leave policies, engineering controls to reduce the effect of heat and increase air flow, and training all workers to recognize and respond to the risks and hazards. Under the continued threat of COVID-19, it will also be critical to implement testing, tracing, and control measures for disaster recovery workers who may move between disasters across state lines.
Even with these modifications and additional safeguards, the COVID-19 pandemic has compromised the community effectiveness of disaster shelters, cooling centers, and clean air shelters and spaces, as these facilities have reduced capacity and individuals may be unwilling to utilize these shelters for fear of contracting COVID-19. It is essential to consider longer-term, preventative interventions that can more equitably mitigate health threats posed by extreme weather events, which also may occur in the midst of future disease outbreaks.
Longer-term solutions
Absent efforts to mitigate climate change we can anticipate future increases in frequency, duration, and severity of extreme weather events and associated health dangers. Policymakers and public health professionals should consider equitable longer-term interventions that can reduce the incidence and impact of these events. Examples of such interventions include:
- Developing local policies and ordinances to facilitate infrastructure improvements like increasing tree cover to offset dangerous temperatures, remove carbon dioxide from the air, lower electricity demand, and mitigate urban heat islands; flood controls and stormwater management; adoption and enforcement of updated building codes; and relocation of toxic or dangerous sites located near neighborhoods
- Proactively identifying trends and risks, and using data to target resources during response and recovery efforts and inform future planning (examples include the Texas Flood Registry and the Community Health-Vulnerability Index)
- Ensuring a transportation infrastructure that supports safe and equitable evacuation where necessary and ensuring that there are safe spaces for people who are displaced
- Creating and supporting partnerships to build community resiliency, like Community Emergency Response Teams or the Lean on Me program
- Creating a behavioral health system with multiple access points and a network of providers who are representative of the clients they serve to address the stress, depression and anxiety that come with illness, loss of job or income, and loss of insurance post-disaster
- Enacting policies that reduce emissions of greenhouse gases to mitigate climate change and reduce the potential for extreme heat events, hurricanes and wildfires
Implementing these recommendations can help remedy current health inequities resulting from racist and inequitable laws and policies. Residential segregation due to redlining and other discriminatory policies has led to people of color being concentrated in communities that are often more exposed to various forms of pollution, have inadequate transportation infrastructure, and are more likely to experience extreme heat events. Efforts to address the health impacts of climate change, particularly those that engage communities to develop local solutions and advance environmental justice, can promote health equity while simultaneously providing climate adaptation and climate mitigation benefits. As with all policies aimed at improving public health, these efforts should carefully consider the equity implications using an equity assessment framework.
This post was written by Betsy Lawton, Senior Staff Attorney, Network for Public Health Law –Northern Region Office, Dawn Hunter, Deputy Director, Network for Public Health Law – Southeastern Region, and Leila Barraza, Consultant, Network for Public Health Law – Western Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.