By Michelle Tu
Imagine a world where the familiar rhythms of life are disrupted by an invisible threat, quietly wreaking havoc into every aspect of life. Extreme heat waves, relentless storms, rising sea levels, and worsening droughts are just a few of the impacts of climate change and the reality we face today.
With the evident environmental shifts like severe weather events, it is imperative to recognize how climate change profoundly influences our health and well-being. These changes can lead to heightened rates of heat-related illnesses, exacerbate respiratory conditions, and introduce new disease vectors according to the Centers for Disease Control and Prevention (CDC). As we face the challenges of climate change, it is crucial to understand how it operates as a social driver of health (SDOH). The CDC is currently working to address SDOHs to progress health equity through a framework of six pillars: data and surveillance, evaluation and evidence building, partnerships and collaboration, community engagement, infrastructure and capacity, and policy and law. It is important to employ this framework to guide agency leadership in determining strategic allocations of resources for addressing SDOHs, ensuring a comprehensive approach to improving community well-being. By recognizing these connections, we can pave the way to a healthier, more sustainable future for everyone through public health preparedness and mitigation strategies.
Extending focus from environmental concerns alone, climate change has emerged as a SDOH, posing unique challenges for many communities, including the Asian American (AA), Native Hawaiian, and Pacific Islander (NH/PI) communities. According to the Axios-Ipsos Hard Truths Environmental Racism poll of 2,184 U.S. adults, it found that AA and NH/PI communities were less likely to report “good” air, water, and noise quality where they resided as seen in the charts below. Within AA and NH/PI communities, the confluence of cultural, linguistic, and environmental factors creates a complex web of health disparities, highlighting the urgent need for culturally responsive resources to bridge the gaps.
Fostering Cultural and Linguistic Awareness
Effective communication plays a pivotal role in today’s interconnected world. Unfortunately, many AA and NH/PI individuals face gaps in care due to a lack of cultural and linguistic responsiveness in the U.S. healthcare system. Culturally specific beliefs and practices may influence responses to climate-related emergencies and affect the adoption of protective measures. For example, in some Asian communities, there are strong beliefs of seeking protection from ancestral spirits or gods to pray for the safety and calmness during an earthquake. Consequently, modern protective measures and evacuation protocols recommended by government authorities may be disregarded, jeopardizing their safety and health.
Additionally, the scarcity of information presented in their native languages can impede their ability to access critical details about impending hazards, evacuation protocols, and available resources. This challenge is particularly evident in AA and NH/PI communities as they face greater barriers to information since English is not their first language. In a 2021 report by the U.S. Environmental Protection Agency (U.S. EPA), they found that AA and NH/PI individuals were 23% and 28%, respectively, more likely to live in coastal areas with the highest projected increases in traffic delays due to climate-driven changes in high-tide flooding.
Official communication and emergency alerts may be predominantly provided in the majority language, potentially leaving many individuals without comprehension. For many AA and NH/PI individuals who may rely on an oral tradition for communication, the simple translation of written documents often fails to effectively convey the nuances and depth of their languages. While information is always evolving, our dispersal of inclusive communication lags behind, underscoring the need for more comprehensive and accessible approaches to ensure the safety and resilience of all communities.
Language serves as a powerful conduit for communication, knowledge dissemination, and cultural preservation. In our interconnected and diverse society, the responsibility of institutions and organizations to provide messages in a variety of languages and formats cannot be understated. This commitment to linguistic inclusivity transcends blame on individuals and underscores the crucial role that higher entities play in fostering a sense of belonging and understanding among all communities, particularly within the AA and NH/PI communities. By ensuring that messages are accessible in languages and dialects spoken by these communities, institutions empower individuals to fully engage with services, resources, and opportunities. This approach not only facilitates effective communication that can help save lives, but also initiates a deeper connection between communities and the institutions that serve them. Ultimately, embracing linguistic diversity contributes to a more harmonious society, where every voice is heard and valued.
The Association of Asian Pacific Community Health Organizations (AAPCHO) has provided culturally responsive programs and care delivery models addressing specific chronic and infectious diseases that disproportionately impact AA and NH/PI patients:
- Community Health Worker Workforce Collaborative;
- Covid-19 and Other Infectious Diseases Health Equity Response Network (CHERN);
- Hep B United;
- The Pacific Islander Diabetes Prevention Program;
- The Pacific Islander Center of Primary Care Excellence; and
- The Tuberculosis Elimination Alliance.
Furthermore, the Pacific Islander Diabetes Prevention Program addresses climate change as a SDOH by promoting healthier lifestyles and community resilience. Through capacity building, training, and technical assistance, the program empowers positive changes in PI communities with a focus on prevention, indirectly mitigating some of the health impacts intensified by climate change. By fostering community engagement and awareness, the program also encourages advocacy for sustainable practices and policies, contributing to the broader environmental and health response to climate change within these communities. This is one of many programs coordinated by AAPCHO that exemplify the transformative potential of addressing SDOH in tandem with climate change resilience.
Data is an imperative foundation for advancing health equity and addressing social drivers of health. It enables informed decision-making and targeted interventions to dismantle disparities and enhance overall well-being. To improve health outcomes and increase access to care for AA and NH/PI patients, we must collect quality data to address their unique health and social needs taking into account both SDOH factors and the evolving impact of climate-related complexities. AAPCHO’s Director of Research, Rosy Chang Weir, PhD, commented in a conversation that “understanding our patients’ social needs is critical in helping them better access and improve [preventable] care…steering us toward a national goal of health equity for all and lowering health care expenditures.”
AAPCHO conducts annual analyses of the Health Center Program Uniform Data System (UDS), but started reviewing optional SDOH data, such as food insecurity, housing insecurity, transportation, and financial strain in 2020. The 2021 UDS Dataset reports these rates to be 3.0%, 2.3%, 0.74%, and 4.73%, respectively, screened in 137 AA and NH/PI-serving health centers when compared to the national rates of 3.56%, 3.08%, 1.97%, and 6.82%, respectively. Data on these and other social risk factors can inform and support patient and population health needs through specific social interventions. As shifts in climate change contribute to an array of health challenges, from increased heat-related illnesses to the spread of vector-borne diseases, a nuanced understanding of these dynamics become paramount. Expanded collection of climate-related and SDOH data is needed to empower healthcare practitioners and policymakers to design interventions that not only alleviate existing health disparities, but also proactively mitigate the escalating health risks posed by our changing environment.
One of the recommendations from the 2021 UDS analysis report discusses how health centers need to tailor resources and programs for AA and NH/PI patients in order to address disproportionate rates of disease (e.g., diabetes, hepatitis B, tuberculosis). According to the World Health Organization (WHO), these types of diseases are heightened by climate change due to warming temperatures and extreme weather events. WHO reported that climate change may cause about 250,000 additional deaths per year from malnutrition, malaria, diarrhea, and heat stress between 2030–2050. Climate change impacts our health both directly and indirectly as it becomes more difficult to access safe drinking water, clean air, sufficient food, and secure shelter. The figure below illustrates an overview of climate-sensitive health risks, their exposure pathways, and vulnerability factors.
Addressing climate change as a social driver of health requires a comprehensive and equitable approach. Policymakers, community leaders, and healthcare providers must collaborate to identify and implement solutions that meet the unique needs of AA and NH/PI communities, including equitable access to healthcare services. Fostering community engagement and culturally competent outreach efforts can empower these communities to better prepare and respond to climate-related challenges.
Taking the Next Steps
It is important to accurately assess the scale and impact of many climate-sensitive health risks which are disproportionately felt by historically marginalized communities. By recognizing and addressing the specific vulnerabilities faced by AA and NH/PI communities in the context of climate change, we can work towards building resilience, reducing health disparities, and ensuring a more just and sustainable future for all. This requires a collaborative effort from researchers, clinical workers, the community, and the government. Here are some ways they can contribute:
- Research and Data Collection
- Gather comprehensive data on the health impacts of climate change within AA and NH/PI populations, emphasizing disparities and specific challenges.
- Approach research with cultural sensitivity, ensuring that studies respect and incorporate cultural beliefs and practices.
- Community Engagement
- Build community capacity for climate resilience through workshops, training, and education.
- Combine traditional practices with modern knowledge to develop holistic approaches to climate resilience.
- Clinical Practice
- Conduct training for clinical workers to provide culturally sensitive care that considers the unique health needs and climate-related concerns of AA and NH/PI patients.
- Develop protocols for healthcare delivery during climate-related emergencies and ensure access to medications and medical supplies.
- Develop and implement policies that consider the unique challenges faced by AA and NH/PI communities due to climate change, such as disaster preparedness and infrastructure improvements to reduce vulnerabilities, while focusing on health equity.
- Work in tandem with healthcare providers and community leaders to co-create strategies and targeted interventions that reflect the unique circumstances of AA and NH/PI communities.
Through these united endeavors, we can adeptly strive to combat health disparities, improve community well-being, and cultivate an improved landscape for AA and NH/PI communities.
Special Thanks: Gabrielle Peñaranda, John Nguyen-Yap, Cara Skillingstead, Vivian Nguyen, and Kristine Cecile Alarcon