Protectng Vulnerable Populations

Not everyone is equally at risk from the health impacts of climate change (CCSP, 2008a; Confalonieri, 2007). For example, in the United States, cities with cooler climates generally experience more heat-related mortality than cities with warmer climates. This difference is attributed to the ability of populations to acclimatize to different levels of temperature through physiological, behavioral, and technological mechanisms (Haines and Patz, 2004). The heat island effect can result in residents of high-density urban areas being more vulnerable to heat-related health effects (CCSP, 2008a). Residents of low-lying coastal areas could be particularly vulnerable to the health impacts associated with sea level rise, coastal erosion, and more intense storms (CCSP, 2008a). Other reasons for geographic differences in vulnerability include differences in physical, ecological, and activity-related exposure to the risks within and across countries; differences in sensitivity due to the overlap with other changes and stresses in particular regions or populations; and widely varying adaptive capacities. In addition to geographic variations, certain subpopulations could also be more susceptible to the health impacts of climate change. These groups include infants and children, pregnant women, older adults, impoverished populations, people with chronic conditions, people with mobility and cognitive restraints, certain occupational groups, and recent migrants and immigrants. The specific vulnerabilities of these population groups are outlined in Table 11.1.

Responses to recent extreme weather and climate events such as Hurricane Katrina show that, even in the United States, current levels of adaptation are insufficient (US-GCRP, 2009a). Substantial inequities exist in access to public heath infrastructure, both in the United States and elsewhere (Pellow and Brulle, 2007), so health risks will be disproportionately high for the poor, elderly, and otherwise disadvantaged. Additionally, analysis has shown that, without further investment, the public health infrastructure most important for addressing the challenges of climate change could be insufficient (Ebi et al., 2009). Concerted efforts will be needed to reduce the vulnerability of populations in both this country and the world, particularly the poorest and most marginalized.

The companion report Adapting to the Impacts of Climate Change provides a summary of potential adaptation strategies for human health (NRC, 2010a). For example, public health systems need to be strengthened to enable rapid monitoring, identification of, and response to new climate change-related health risks as they arise. Other societal stresses such as poverty or economic disadvantages, chronic work-related risks or exposure to otherwise unhealthy environmental conditions, lack of access to preventive and ongoing health care, insufficient emergency preparedness, and related

TABLE 11.1 Population Groups with Specific Vulnerabilities to Climate-Sensitive Health Outcomes

Groups with Increased Vulnerability

Climate-Related Exposures

Infants and children

Heat stress, ozone air pollution, water- and foodborne

illnesses, psychological consequences of extreme

events

Pregnant women

Heat stress, extreme weather events, water- and

foodborne illnesses

Older adults

Heat stress, air pollution, extreme weather events, water-

and foodborne illnesses

Impoverished populations

Heat stress, extreme weather events, air pollution, vector-

borne illnesses

People with chronic conditions and

Heat stress, extreme weather events, air pollution

mobility and cognitive restraints

Outdoor workers

Heat stress, ozone air pollution, vector-borne illnesses

Recent migrants and immigrants

Heat stress, vector-borne illnesses, extreme weather

events

SOURCE: Modified from NRC (2010a) with information from CCSP (2008a).

SOURCE: Modified from NRC (2010a) with information from CCSP (2008a).

institutional gaps or lack of effective collaboration (as was apparent in the response to Hurricane Katrina) will make effective preparation for and adaptation to climate change impacts on health more difficult. However, adaptive capacity and preparedness can be enhanced by addressing those underlying chronic problems where they persist. In addition, explicit consideration of climate change is needed within federal, state, and local programs (including nongovernmental services) and research activities to ensure that they have maximum effectiveness.

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