Pan American Journal Review of Public Health Carbon pollution increases health inequities: lessons in resilience from the most vulnerable Kristie L. Ebi,1 Stephen B. Fawcett,2 Jerry Spiegel,3 and Horacio Tovalin4 Suggested citation Ebi KL, Fawcett SB, Spiegel J, Tovalin H. Carbon pollution increases health inequities: lessons in resilience from the most vulnerable. Rev Panam Salud Publica. 2016;40(3):181–85. ABSTRACT Climate change is a social justice as well as an environmental issue. The magnitude and pat- tern of changes in weather and climate variables are creating differential exposures, vulnerabil- ities, and health risks that increase stress on health systems while exacerbating existing and creating new health inequities. Examples from national and local health adaptation projects highlight that developing partnerships across sectors and levels are critical for building climate-resilient health systems and communities. Strengthening current and implementing new health interventions, such as using environmental information to develop early warning systems, can be effective in protecting the most vulnerable. However, not all projected risks of climate change can be avoided by climate policies and programs, so health system strengthen- ing is also critical. Applying a health inequity lens can reduce current vulnerabilities while building resilience to longer-term climate change. Taking inequities into account is critical if societies are to effectively prepare for and manage the challenges ahead. Keywords Climate change; global warming; environmental risks; health vulnerability; disaster vulnerability; environmental exposure; United Nations Environment Programme. Health inequities arise from a range of outcomes among those groups with lim- complex environmental problems, such environmental and socioeconomic factors, ited power and resources to avoid them as pesticides and sulfur compounds, that not from inevitable forces independent (1). These inequities are rooted in social are typically more short-lived than carbon of human control. That is, there are signifi- relationships and processes that suggest dioxide, and that were relatively easily cant and preventable differences in health opportunities to respond at different and successfully controlled (4). These ne- scales (2). Climate change is affecting hu- gotiations eventually led to the 1992 man and natural systems in ways that ex- adoption of the United Nations Frame- 1 Department of Global Health, University of Washington, Seattle, Washington, United States of acerbate existing and will likely create work Convention on Climate Change America. Send correspondence to Kristie Ebi, new health inequities (3). (UNFCCC), whose stated ultimate objec- email: [email protected] In the 1970s, national and international tive was the “stabilization of greenhouse 2 World Health Organization (WHO) Center/Work Group for Community Health and Development, organizations began to seriously consider gas concentrations in the atmosphere at a University of Kansas, Lawrence, Kansas, United the possible consequences of increased at- level that would prevent dangerous an- States of America. 3 Global Health Research Program, School of mospheric concentrations of greenhouse thropogenic interference with the climate Population and Public Health, University of British gases, particularly carbon dioxide, due to system” (5). Columbia, Vancouver, British Columbia, Canada. human activity. Subsequent negotiations In the 20+ years since, the possible con- 4 Occupational Health Graduate Program, FES Zaragoza, Universidad Nacional Autónoma de to reduce greenhouse gas emissions were sequences of climate change for human México, Ciudad de México, México. informed by earlier experiences with less and natural systems have become better Rev Panam Salud Publica 40(3), 2016 181 Review Ebietal.•Carbonpollutionandhealthinequities understood, leading to a risk-based frame- CLIMATE CHANGE AS A SOCIAL and may be more vulnerable to the asso- work for managing the challenges ahead. JUSTICE ISSUE ciated consequences. As detailed in the assessments conducted At any particular concentration of by the Intergovernmental Panel on Cli- Climate change is intimately inter- atmospheric carbon dioxide, some re- mate Change and in national assessments, twined with equity, social justice, and sus- gions and sectors will experience signifi- changing temperatures and precipitation tainable development, especially evident cant risks that they perceive to be patterns associated with climate change at the macro level by the striking mis- unacceptable, while others will experi- are already causing adverse impacts on match between countries that historically ence little to no impacts (13). In general, human health and well-being, with risks and currently emit the most greenhouse wealthier countries that historically emit- projected to markedly increase during this gases and those that are particularly vul- ted more greenhouse gases are less vul- century (3, 6–8). The magnitude and pat- nerable to the consequences of climate nerable because they will have the tern of possible health risks associated change. Understanding this leads to a capabilities—financial resources, gover- with climate change depend not only on complex and nuanced perspective of so- nance, and other factors—to implement global average temperatures, but also on cial justice. proactive adaptation. Thus, addressing the status of the human and natural sys- Negotiations under the UNFCCC aim climate change is a matter of social tems being affected, their degree of under- to reduce atmospheric concentrations of justice. lying vulnerability, and their capacity to greenhouse gas emissions to prevent prepare for, respond to, cope with, and re- dangerous anthropogenic interference REDUCING VULNERABIILITY cover from exposure (9). That is, climate with the climate system by reducing at- TO CLIMATE CHANGE interacts with other environmental and mospheric concentrations of greenhouse socioeconomic drivers to increase (or de- gas emissions. The criteria for determin- Vulnerability in the context of climate crease) risk, affecting risk through multi- ing what was considered to be dangerous change is defined as the propensity or ple pathways that vary across spatial and were: allowing time for ecosystems to predisposition to be adversely affected temporal scales. Three entry points for adapt naturally; ensuring food produc- (9). Vulnerability is the summation of all preparing for and responding to the chal- tion is not threatened; and enabling eco- risk and protective factors that determine lenge of climate change and its health and nomic development in a sustainable whether an individual or subpopulation health equity impacts are: matter (5). These criteria are challenging is more likely to experience adverse to operationalize because they are not health outcomes (14). Factors determin- 1. Differential exposures to the hazards cre- easily quantified. Furthermore, the UN- ing vulnerability and resilience in a par- ated by a changing climate (e.g., ex- FCCC does not specify whether these cri- ticular location typically do not align in treme weather and climate events; teria should be considered on the global, one direction; each community and na- reductions in air quality; ecosystem regional, or national scales. And, while tion has a mix of factors that increase or changes that could facilitate water-, these criteria are important, other possi- decrease each. Reducing vulnerability food-, and vector-borne diseases chang- ble risks of climate change could have and increasing resilience are complemen- ing their incidence, geographic range, large-scale consequences; for example, tary strategies that enhance the capability and/or seasonality; and lower nutri- the availability of sufficient quantities of of a community to prepare for and cope tional quality and quantity of food); safe water in some areas; the impact of with climate variability and change. 2. Differential vulnerabilities/capabilities in changing patterns of extreme weather There is a wide range of factors that de- avoiding or protecting against harms and climate events; changes in the geo- termine vulnerability, from the geo- from exposure (e.g., a wide range of in- graphic range and incidence of climate- graphic, environmental, and demographic dividual and local to national factors sensitive health outcomes; sea level rise; situation of a country or region to its edu- from individual susceptibility, socio- and acidification of the oceans. cational, social, cultural, political, socio- economic status, and housing condi- Climate change will result in some economic, institutional, and governmental tions to the capacity of health systems, countries experiencing much greater in- circumstances. In the health sector, addi- local to regional emergency response creases in temperatures and larger shifts tional factors determining vulnerability systems, and governance); and in precipitation patterns (11). The UN- include the health status of the popula- 3. Differential consequences related to FCCC recognizes certain regions are tion, and the quality, responsiveness, and geographic location, unequal access more vulnerable to climate change, in- availability of public health facilities and to resources, and other factors (e.g., cluding least developed countries, small other infrastructure (e.g., capacity to pre- higher deaths among marginalized island states, and areas with fragile eco- pare for and manage the consequences of groups