Climate Change Could Be Newest Social Determinant of Health
July 1, 2023
By Melinda Young
EXECUTIVE SUMMARY
Extreme heat events cause tens of thousands of hospitalizations and ED visits each year. Heat is particularly dangerous for older adults and patients with heart and lung illnesses. Case managers and hospitals can help prevent heat exhaustion by educating at-risk clients about how to stay cool and recognize symptoms.
- Climate change is producing more heat events that last longer and are more severe. Because these affect vulnerable populations the most, some researchers have advocated for making climate change a social determinant of health.
- The CDC offers guides and educational materials about how people can stay cool and prevent adverse health outcomes.
- The CDC’s chief message is “Stay cool, stay hydrated, be informed.”
Each year, there are more than 67,000 ED visits, 9,200 hospitalizations, and 700 deaths related to heat, and the problem is getting worse. The hot days are growing hotter and are occurring more frequently across the United States.1,2 The National Climate Assessment says there will be 20 to 30 days over 90° F in most areas of the United States by 2050.2
This worsening problem highlights a new social determinant of health case managers and providers may need to assess: How can patients — especially those who are older with chronic illnesses — recognize heat illness and learn how to prevent it? The authors of recent paper argued climate change should be included as a social determinant of health because it affects everyone, but is especially harmful to children, communities of lower socioeconomic status, and communities of color because they have fewer resources to adapt to the changing climate.3
“Extreme heat is a current and growing problem, and it isn’t a problem of the future,” says Gregory Wellenius, ScD, professor and director of the Boston University School of Public Health Center for Climate and Health. “It’s here in our communities and with our patients and families. While everyone is at risk of adverse health outcomes on days of extreme heat, some are disproportionately at higher risk.”
Heat-Related Illness on the Rise
Heat waves are increasing in number and in severity, says Paul J. Schramm, MS, MPH, a health scientist in the climate and health program for the CDC’s National Center for Environmental Health.
“Heat-related illness and deaths vary greatly from year to year,” Schramm notes. “We have seen some evidence that heat-related illnesses and deaths have been increasing.”
Among the most vulnerable are patients with heart or lung conditions, young children, older adults, pregnant women, athletes, and outdoor workers.1
“At CDC, we help health departments, people, communities, and other partners to prepare and respond to heat events to protect health,” Schramm says. “The message we use is ‘Stay cool, stay hydrated, be informed.’ Healthcare professionals should tell patients [how to prepare for heat waves], especially those who are disproportionately impacted, including those who take medicines that increase heat risk, older adults, and outside workers.”
Homeless people also are at greater risk of heat-related illness. “This isn’t just a problem in our hottest climates,” Wellenius notes. “There is research in the Anchorage [AK] area that shows when it gets unseasonably hot there, people suffer and go to the emergency department, and some die.”
People in northern climates who are unused to extreme heat days and do not have air conditioning are vulnerable to heat-related morbidity and mortality. “What is considered an extreme heat event in the Pacific Northwest is not what’s extreme in Southeast Asia, for example,” says Tony Wolf, PhD, a postdoctoral scholar at Penn State’s College of Health and Human Development. “Usually, extreme heat events are in the 90th or 95th percentile of heat and humidity for a given region.” These extreme heat events are becoming more frequent, more extreme, last longer, and are expected to lead to more deaths, he adds.
Air Quality Also a Threat
In addition to extreme heat, other poor quality environmental conditions are endangering vulnerable populations, says Mohamed Dardir, PhD, a postdoctoral fellow in the School of Environment, Enterprise, and Development at the University of Waterloo in Ontario. Dardir and colleagues found extreme heat conditions and poor air quality levels are associated with higher mortality levels and more ED visits among cardiorespiratory patients and the elderly.4 A heat and climate change report in Canada predicts upcoming heat waves will cause more deaths within the next five years, Dardir says.
The best option for preventing heat waves would be to mitigate global climate change, which is the driver of higher temperatures, more frequent heat waves, and less predictable weather, says Joan Casey, PhD, an assistant professor in environmental and occupational health sciences at the University of Washington School of Public Health.
On a community-level scale, healthcare systems and professionals can take actions to help patients at risk of heat illness. “However, we should consider whether this is the most effective pathway to preventing morbidity and mortality,” Casey notes. “Structural changes, such as clear, concise, and multilingual public health messaging about cooling centers, building upgrades to better maintain cool internal temperatures, planting trees to provide shade, and other such actions, may have more population benefit. Extremely vulnerable patients, such as those living with heart failure or electricity-dependent medical equipment, would likely benefit from targeted conversations with their clinicians about what to do if a heat wave occurs.”
Case Managers Can Help
As climate change raises the heat index in every community, case managers and other providers can help patients prevent illness and prepare for these extreme heat events.
Mitigating the heat wave crisis takes both national and community effort. But there also are ways health systems, hospitals, and healthcare providers can help protect their most vulnerable patients. (For more information, see the story in this issue on case management tactics to prevent heat-related illnesses and deaths.) Health systems can commit to lowering emissions and strengthening resilience, an initiative by the U.S. Department of Health and Human Services. Organizations also can sign the Health Sector Climate Pledge that states they will reduce organizational emissions by 50% by 2030 from a baseline of 2008 or later. They would pledge to achieve net-zero emissions by 2050 and designate an executive to lead their work and develop a climate resilience plan for continuous operations. Part of the plan would be to anticipate the needs of community members most at risk of climate-related harm. Their work toward meeting the goals would be public.5
Rising temperatures and poor air quality can be harmful, leading to more deaths and ED visits. “The data showed an increase in [mortality and ED visits] related to poor environmental conditions — both air quality and heat,” Dardir explains.
It is not just extreme heat exposure, such as the 110° F temperatures experienced in Southern climates. It is any hot temperature that is higher than what a community has experienced regularly in the past.
Heat-related illness is caused when a person’s body struggles to adapt to a higher-than-usual temperature. “The best solution is to not wait for the disaster to happen,” Dardir says. “We need to prepare and protect people.”
Create Heat Response Plans
Some communities created heat response plans with specific tools and communication about how to prepare for heat events, Schramm says. These plans tell local governments which steps and actions to take, such as opening cooling centers and offering home energy assistance so people can run their air conditioners. “We also see health departments and communities putting in place things that can protect people,” he adds.
Cooling centers are any cool space designated to provide relief from the heat. These can be libraries, schools, community centers, religious facilities, water spray parks and shaded areas in public spaces, and even local businesses, including indoor malls, Schramm explains.
Health systems can make changes to their energy use and convert their buildings to sustainable buildings, including creating roof gardens. They can switch to clean energy transportation and embrace other kinds of nature-based solutions, Dardir suggests. “Buildings can become carbon-neutral, and companies can turn to green sustainable energy,” he adds.
Urban planning departments could focus on planting trees, developing parks, and converting empty parking lots or space into green areas, Wellenius says. These actions will reduce urban heat islands, which are areas of cities that are significantly hotter than other areas.
“Urban heat islands have very dense housing, and a lot of buildings retain heat because of concrete and not having much green space, grass, and natural landscapes,” Wellenius explains. “These places retain heat. In the daytime, their high temperatures will be higher, and at night the high temperature could be 5° to 10° hotter than surrounding places.”
Another way to reduce heat from buildings is to cover roofs with a light-colored coating to reflect heat. “If you [coat] enough buildings, it can cool the whole neighborhood,” Wellenius says. “Putting a light-color coating on flat black roofs is relatively inexpensive and can dramatically reduce the amount of heat it retains.” While putting plants on roofs could cause weight and drainage issues, covering roofs with light-reflecting material is minimal work and provides huge benefits, he adds.
Adding solar panels to roofs is another positive step to lowering temperatures. “If you put solar panels on roofs, you also increase their reflectivity,” Wellenius says. “But it works even better if you do it on a white roof [rather] than a black roof.”
REFERENCES
- Centers for Disease Control and Prevention. Heat & Health Tracker. 2023. https://ephtracking.cdc.gov/Ap...
- Center for Climate and Energy Solutions. Heat waves and climate change. 2023. https://www.c2es.org/content/h....
- Ragavan MI, Marcil LE, Garg A. Climate change as a social determinant of health. Pediatrics 2020;145:e20193169.
- Dardir M, Wilson J, Berardi U. Heat and air quality related cause-based elderly mortalities and emergency visits. Environ Res 2023;216:114640.
- U.S. Department of Health and Human Services. Health sector commitments to emissions reduction and resilience. Content last reviewed April 28, 2023. https://www.hhs.gov/climate-ch....
Extreme heat events cause tens of thousands of hospitalizations and ED visits each year. Heat is particularly dangerous for older adults and patients with heart and lung illnesses. Case managers and hospitals can help prevent heat exhaustion by educating at-risk clients about how to stay cool and recognize symptoms.
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