Addressing Health Disparities Linked to Climate Issues
In April, I had the pleasure of facilitating the Alliance of Nurses for Health Environments (ANHE) two-day strategic planning retreat. The goal was to chart a path forward that incorporated equity into their work, and we conducted interviews with members of the nursing community who were familiar with ANHE to understand how ANHE could best do this work. I walked away so impressed with the organization and the individual participants. They are all doing such amazing work. In particular, I was struck by the role nurses and other health professionals play in addressing health disparities related to climate issues and asked that ANHE author a blog for Spark to share with our network.
Jacob Bornstein, MS
Director of Consulting
By Monica Harmon, MSN, MPH, RN1; Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN2; Lillian Tom-Orme, PhD, MSPH, RN, FAAN3; and Ruth McDermott-Levy, PhD, MPH, MSN, RN4
Climate changes health. The influence of climate change on health affects nursing practice, as nurses are observing the health impacts upon the people, families, and communities in their care. The Alliance of Nurses for Healthy Environments (ANHE) is addressing the impact of climate change on the health of Americans by developing tools to educate and prepare nurses to respond and advocate for climate mitigation, adaptation, and resilience strategies. ANHE nurses are also researching climate-health impacts and nursing preparation related to climate change.
In March 2018, leaders within ANHE, as well as nurse leaders representing National Black Nurses Association, National League for Nursing, National Association of Hispanic Nurses, and the National Alaska Native American Indian Nurses Association, came together in Oracle, AZ to discuss the organization’s priorities with a focus on the specific needs of underrepresented nurses in the climate and health discussion. This meeting was particularly important because, although climate change is affecting the health of everyone, socially marginalized pockets of Black, Latino, and Native American populations have additional vulnerabilities related to the health impacts of climate change.
In the United States, people with higher poverty rates have fewer choices when it comes to housing, access to health care, employment, transportation, and food. People living in poverty also are less likely to have additional resources to mitigate effects of climate change and rebuild or relocate as needed after climate problems. Race/ethnicity and socioeconomic status are shown to be determinants of health compounding public health promotion and disease prevention activities. Due to the legacy of colonialism and structural racism, Black, Latino, and Native Americans are most frequently represented as marginalized groups living in poverty. Poverty influences a group’s ability to respond to the impacts of extreme weather events seen during climate change. During Hurricane Katrina, we saw residents of New Orleans’ 9th Ward, a low-income community, unable to evacuate as a result of limited resources. Many in the community did not have transportation to get away from the event, and they were at the epicenter of the disaster.
For Native American communities, the disruption of communities as a result of the changing climate leads to loss of culture, language, access to food sources, and health effects. Many villages in Alaska, for example, rely on subsistence food sources and with ice melts, their food from the sea is moved further out and not easily obtained. Village life disintegrates as communities are relocated, families might split up, some move to urban areas to find stability but lose access to cultural ties, language use, and support systems. Generally, Native Americans who move from rural reservation or communities find it difficult to access health care services in their new community.
These phenomena mean that marginalized populations are often disproportionally impacted by weather extremes from climate change such as flooding, extreme heat, and wildfires. Additionally, such populations have higher rates of chronic illnesses such as cardiovascular disease, diabetes, kidney disease, and asthma and COPD. For example, in 2006 severe flooding in El Paso Texas led to $200 million in damages to homes and businesses. Hispanic identity was most significant health risk after taking everything else into account. Language ability is another important factor that nurses must consider when addressing climate risk in underrepresented communities. Often the plan for what to do when a crisis happens is not provided in the language of the community most at risk or in a culturally appropriate manner. Those who are most vulnerable to climate impacts are left in a situation where they cannot move forward, get away, or have resiliency. This leads to greater health impacts including psychological problems such as PTSD following climate change events.
It is critically important that Black, Latino, and Native American nurses are included in the discussion and solutions to address climate change and health. Their perspectives inform best practices to address the unique needs of each community. ANHE will continue to make the inclusion of nurses who work in and identify with marginalized communities a priority in their work to address climate change and health in nursing research, education, advocacy, and practice.
1Chapter President, National Black Nurses Association of Southeastern Pennsylvania, Ph.D. candidate student at Villanova University
2President, National Association of Hispanic Nurses; Senior Vice President of Equity, Diversity and Inclusion at Equality Health
3Former President, National Alaska Native American Indian Nurses Association; Research Assistant Professor in the Division of Epidemiology and Adjunct Assistant Professor and Diversity Coordinator for the College of Nursing, University of Utah
4AHNE Education Workgroup co-chair; Associate Professor & Director, Center for Global and Public Health, M. Louise Fitzpatrick College of Nursing, Villanova University