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It represents the second of two volumes of the Fourth National Climate Assessment, mandated by the Global Change Research Act of 1990." /> <meta name="citation_title" content="Fourth National Climate Assessment"> <meta name="citation_author" content="USGCRP"> <meta name="citation_publication_date" content="2018"> <meta name="citation_technical_report_institution" content="U.S. Global Change Research Program, Washington, DC"> <meta name="citation_firstpage" content="1"> <meta name="citation_lastpage" content="470"> <meta name="citation_pdf_url" content="https://nca2018.globalchange.gov/downloads/NCA2018_FullReport.pdf"> <link rel="alternate" href="/index.xml" type="application/rss+xml" title="Fourth National Climate Assessment"> <link rel="icon" href="/favicon.ico"> <title>Human Health - Fourth National Climate Assessment</title> <link rel="stylesheet" href="/css/google-fonts.css"> <link rel="stylesheet" href="/css/bootstrap.min.css"> <link rel="stylesheet" href="/css/animate.css"> <link rel="stylesheet" href="/css/slick.css"> <link rel="stylesheet" href="/css/slick-theme.css"> <link rel="stylesheet" href="/css/jquery.qtip.min.css"> <link rel='stylesheet' href='/css/leaflet.css'> <link href='https://api.mapbox.com/mapbox.js/plugins/leaflet-fullscreen/v1.0.1/leaflet.fullscreen.css' rel='stylesheet'> <link rel='stylesheet' href='/css/MarkerCluster.Default.css'> <link rel='stylesheet' href='/css/MarkerCluster.css'> <link rel="stylesheet" href="/css/leaflet.zoomhome.css"/> <link rel="stylesheet" href="/css/yamm.css"> <link rel="stylesheet" href="/css/nca4-site.css"> <link rel="stylesheet" href="/css/figures.css"> <style> #intro-header { background: url(/img/background/ch14_bg_health.jpg) no-repeat center center fixed; 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background-size: cover; } } } @media (min-width: 1200px) { #intro-header { background: url(/img/styles-bg/ch14_bg_health-1200.jpg) no-repeat center center; background-size: cover; } @media (min-width: 1200px) and (-webkit-min-device-pixel-ratio: 1.25), (min-width: 1200px) and (min-device-pixel-ratio: 1.25), (min-width: 1200px) and (min-resolution 200dpi), (min-width: 1200px) and (min-resolution 1.25dppx) { #intro-header { background: url(/img/styles-bg/ch14_bg_health-1200@2x.jpg) no-repeat center center; background-size: cover; } } } </style> <header id="intro-header"> <div class="nav-arrow"> <a id="nav-arrow-button" role="button" href="#ch14-kfs" aria-label="Scroll to chapter"><i class="fas fa-chevron-down"></i></a> </div> <div class="intro-header-outer"> <div class="container-fluid intro-header-inner no-spacer"> <div class="row no-gutters"> <div class="col-lg-12"> <h1 class="pb-0 nca4-header"> <small class="balance-text">FOURTH NATIONAL CLIMATE ASSESSMENT</small> </h1> <h1 style="line-height: 1.3;"> <span class="balance-text">CHAPTER 14: HUMAN HEALTH</span> </h1> </div> </div> </div> </div> </header> <div id="maincontent" role="main"></div> <section id="ch14-kfs" aria-label="Chapter Key Messages" class="container-fluid kfs report-section no-spacer blackish pt-0 pb-0"> <div class="row no-gutters"> <div class="col-lg-12"> <div id="slick-carousel"> <div id="finding-141" class="slick-carousel-item"> <h3>Key Message 1<br>Climate Change Affects the Health of All Americans</h3> <p><p>The health and well-being of Americans are already affected by climate change, with the adverse health consequences projected to worsen with additional climate change. Climate change affects human health by altering exposures to heat waves, floods, droughts, and other extreme events; vector-, food- and waterborne infectious diseases; changes in the quality and safety of air, food, and water; and stresses to mental health and well-being.</p> </p> <div class="supporting-evidence"> <a href="#key-message-1" class="traceable_account_a" aria-label="Read More about Key Message 1">Read More</a> </div> </div> <div id="finding-142" class="slick-carousel-item"> <h3>Key Message 2<br>Exposure and Resilience Vary Across Populations and Communities</h3> <p><p>People and communities are differentially exposed to hazards and disproportionately affected by climate-related health risks. Populations</em> experiencing greater health risks include children, older adults, low-income communities, and some communities of color.</p> </p> <div class="supporting-evidence"> <a href="#key-message-2" class="traceable_account_a" aria-label="Read More about Key Message 2">Read More</a> </div> </div> <div id="finding-143" class="slick-carousel-item"> <h3>Key Message 3<br>Adaptation Reduces Risks and Improves Health</h3> <p><p>Proactive adaptation policies and programs reduce the risks and impacts from climate-sensitive health outcomes and from disruptions in healthcare services. Additional benefits to health arise from explicitly accounting for climate change risks in infrastructure planning and urban design.</p> </p> <div class="supporting-evidence"> <a href="#key-message-3" class="traceable_account_a" aria-label="Read More about Key Message 3">Read More</a> </div> </div> <div id="finding-144" class="slick-carousel-item"> <h3>Key Message 4<br>Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits</h3> <p><p>Reducing greenhouse gas emissions would benefit the health of Americans in the near and long term. By the end of this century, thousands of American lives could be saved and hundreds of billions of dollars in health-related economic benefits gained each year under a pathway of lower greenhouse gas emissions.</p> </p> <div class="supporting-evidence"> <a href="#key-message-4" class="traceable_account_a" aria-label="Read More about Key Message 4">Read More</a> </div> </div> </div> </div> </div> </section> <div id="all-key-findings-div" class="all-key-findings-div" data-title="Human Health Key Findings"> <div id="all-key-findings-div-inner" class="view-content"> <div class="panel panel-default"> <div class="panel-heading"> <h3>Key Message 1</h3> </div> <div class="panel-body"> <p>The health and well-being of Americans are already affected by climate change, with the adverse health consequences projected to worsen with additional climate change. Climate change affects human health by altering exposures to heat waves, floods, droughts, and other extreme events; vector-, food- and waterborne infectious diseases; changes in the quality and safety of air, food, and water; and stresses to mental health and well-being.</p> </div> </div> <div class="panel panel-default"> <div class="panel-heading"> <h3>Key Message 2</h3> </div> <div class="panel-body"> <p>People and communities are differentially exposed to hazards and disproportionately affected by climate-related health risks. Populations</em> experiencing greater health risks include children, older adults, low-income communities, and some communities of color.</p> </div> </div> <div class="panel panel-default"> <div class="panel-heading"> <h3>Key Message 3</h3> </div> <div class="panel-body"> <p>Proactive adaptation policies and programs reduce the risks and impacts from climate-sensitive health outcomes and from disruptions in healthcare services. Additional benefits to health arise from explicitly accounting for climate change risks in infrastructure planning and urban design.</p> </div> </div> <div class="panel panel-default"> <div class="panel-heading"> <h3>Key Message 4</h3> </div> <div class="panel-body"> <p>Reducing greenhouse gas emissions would benefit the health of Americans in the near and long term. By the end of this century, thousands of American lives could be saved and hundreds of billions of dollars in health-related economic benefits gained each year under a pathway of lower greenhouse gas emissions.</p> </div> </div> </div> </div> <div id="likely-confidence-div"> <div class="likely-confidence-div-inner"> <h4>Likelihood</h4> <table class="table likelihood"> <tbody> <tr> <th scope="col">Virtually Certain</th> <th scope="col">Extremely Likely</th> <th scope="col">Very Likely</th> <th scope="col">Likely</th> <th scope="col">About as Likely as Not</th> <th scope="col">Unlikely</th> <th scope="col">Very Unikely</th> <th scope="col">Extremely Unlikely</th> <th scope="col">Exceptionally Unlikely</th> </tr> <tr> <td>99%–100%</td> <td>95%–100%</td> <td>90%–100%</td> <td>66%-100%</td> <td>33%-66%</td> <td>0%-33%</td> <td>0%-10%</td> <td>0%-5%</td> <td>0%-1%</td> </tr> </tbody> </table> <h4>Confidence Level</h4> <table class="table confidence"> <tbody> <tr> <th scope="col">Very High</th> <th scope="col">High</th> <th scope="col">Medium</th> <th scope="col">Low</th> </tr> <tr> <td>Strong evidence (established theory, multiple sources, consistent results, well documented and accepted methods, etc.), high consensus</td> <td>Moderate evidence (several sources, some consistency, methods vary and/or documentation limited, etc.), medium consensus</td> <td>Suggestive evidence (a few sources, limited consistency, models incomplete, methods emerging, etc.), competing schools of thought</td> <td>Inconclusive evidence (limited sources, extrapolations, inconsistent findings, poor documentation and/or methods not tested, etc.), disagreement or lack of opinions among experts</td> </tr> </tbody> </table> <div style="clear:both;">   </div> </div> <p> <strong>Documenting Uncertainty:</strong> This assessment relies on two metrics to communicate the degree of certainty in Key Findings. See <a href="/chapter/front-matter-guide">Guide to this Report</a> for more on assessments of likelihood and confidence. </p> </div> <section id="view-executive-summary" class="container-fluid"> <div class="row no-gutters"> <div class="offset-lg-1 col-lg-10"> <p class="text-center mb-0"> <button type="button" class="btn btn-outline-secondary btn-lg">VIEW THE EXECUTIVE SUMMARY <i class="fas fa-chevron-down"></i></button> </p> </div> </div> </section> <nav id="dot-nav" style="display: none;"> <ul class="nav nav-tabs flex-column" role="tablist"> <li class="header"><span class="dot-nav-close float-left" role="button"><i class="fas fa-minus-circle"></i></span> SECTIONS</li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#executive-summary">Executive Summary</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#section-1">Introduction</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#key-message-1">KM 1: Health Impacts</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#key-message-2">KM 2: Vulnerable Populations</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#key-message-3">KM 3: Adaptation Benefits</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#key-message-4">KM 4: Mitigation Benefits</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#traceable-accounts">Traceable Accounts</a></li> <li class="dot-tip nav-item" role="tab"><a class="nav-link" href="#references">References</a></li> </ul> </nav> <div id="executive-summary"> <section id="es-1" class="container-fluid report-section blackish glossary"> <div class="offset-lg-1 col-lg-10 node-narrative"> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/background/ch14_bg_health.jpg" data-fb-title="Fourth National Climate Assessment: Executive Summary" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14&text=Fourth%20National%20Climate%20Assessment:%20Chapter%20executive-summary:%20Executive%20Summary&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#chapter-executive-summary" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#chapter-executive-summary" readonly/></div> </div> </div> <h1> <small class="balance-text">EXECUTIVE SUMMARY:</small><br/> <span class="balance-text">Chapter 14: Human Health</span> </h1> </div><div class="offset-lg-1 col-lg-7"> <p>Climate-related changes in weather patterns and associated changes in air, water, food, and the environment are affecting the health and well-being of the American people, causing injuries, illnesses, and death. Increasing temperatures, increases in the frequency and intensity of heat waves (since the 1960s), changes in precipitation patterns (especially increases in heavy precipitation), and sea level rise can affect our health through multiple pathways. Changes in weather and climate can degrade air and water quality; affect the geographic range, seasonality, and intensity of transmission of infectious diseases through food, water, and disease-carrying vectors (such as mosquitoes and ticks); and increase stresses that affect mental health and well-being.</p> <p>Changing weather patterns also interact with demographic and socioeconomic factors, as well as underlying health trends, to influence the extent of the consequences of climate change for individuals and communities. While all Americans are at risk of experiencing adverse climate-related health outcomes, some populations are disproportionately vulnerable.</p> <p>The risks of climate change for human health are expected to increase in the future, with the extent of the resulting impacts dependent on the effectiveness of adaptation efforts and on the magnitude and pattern of future climate change. Individuals, communities, public health departments, health-related organizations and facilities, and others are taking action to reduce health vulnerability to current climate change and to increase resilience to the risks projected in coming decades.</p> <p>The health benefits of reducing greenhouse gas emissions could result in economic benefits of hundreds of billions of dollars each year by the end of the century. Annual health impacts and health-related costs are projected to be approximately 50% lower under a lower scenario (RCP4.5) compared to a higher scenario (RCP8.5). These estimates would be even larger if they included the benefits of health outcomes that are difficult to quantify, such as avoided mental health impacts or long-term physical health impacts.</p> </div> <section id="fig-14-2-es" class="offset-lg-1 col-lg-7 big-figure figure"> <div class="figure-social-icons"> <a role="button" href="/img/figure/figure14_2.png" aria-label="Download" title="Download" class="download_a qtip-top" download></a>  <a role="button" href="/report/nca4/chapter/human-health/figure/fig--14-x-vulnerable-populations-km2" aria-label="Metadata" title="Metadata" class="metadata_a qtip-top" ></a>  <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/figure/figure14_2.png" data-fb-title="Fourth National Climate Assessment: Vulnerable Populations" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23fig-14-2-es&text=Fourth%20National%20Climate%20Assessment:%20Figure%2014.2:%20Vulnerable%20Populations&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Check%20out%20this%20site:%20https://nca2018.globalchange.gov/chapter/14#fig-14-2-es" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#fig-14-2-es" readonly/></div> </div> </div> <h2>Vulnerable Populations</h2> <div style="width: 85%;" class="figure-inner"> <a class="lightbox" href="/img/figure/figure14_2.png" data-title='Figure 14.2 Vulnerable Populations'> <picture> <source media="(min-width: 1200px)" data-srcset="/img/styles/figure14_2-1200.png, /img/styles/figure14_2-1200@2x.png 2x"> <source media="(min-width: 992px)" data-srcset="/img/styles/figure14_2-992.png, /img/styles/figure14_2-992@2x.png 2x"> <source media="(min-width: 768px)" data-srcset="/img/styles/figure14_2-768.png, /img/styles/figure14_2-768@2x.png 2x"> <source media="(min-width: 480px)" data-srcset="/img/styles/figure14_2-480.png, /img/styles/figure14_2-480@2x.png 2x"> <source media="(min-width: 320px)" data-srcset="/img/styles/figure14_2-320.png, /img/styles/figure14_2-320@2x.png 2x"> <img data-src="/img/figure/figure14_2.png" alt="Vulnerable Populations" class="big-img img-fluid lazyload" aria-describedby="description-14-2-es" /> </picture> </a> <aside id="description-14-2-es" class="sr-only"></aside> <div class="caption" data-href="/img/figure/figure14_2.png" data-title='Figure 14.2 Vulnerable Populations'>Examples of populations at higher risk of exposure to adverse climate-related health threats are shown along with adaptation measures that can help address disproportionate impacts. When considering the full range of threats from climate change as well as other environmental exposures, these groups are among the most exposed, most sensitive, and have the least individual and community resources to prepare for and respond to health threats. White text indicates the risks faced by those communities, while dark text indicates actions that can be taken to reduce those risks. <em>From Figure 14.2 (Source: EPA)</em>.</div> </div> </section> <div id="hide-executive-summary"> <div class="offset-lg-1 col-lg-7"> <p class="text-center mb-0"> <button type="button" class="btn btn-outline-secondary btn-lg">HIDE THE EXECUTIVE SUMMARY <i class="fas fa-chevron-up"></i></button> </p> </div> </div> </section> </div> <div class="chapter-content"></div> <section id="section-1" class="container-fluid report-section no-spacer blackish glossary clearfix"> <div class="offset-lg-1 col-lg-10 node-narrative"> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/background/ch14_bg_health.jpg" data-fb-title="Fourth National Climate Assessment: Human Health" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14&text=Fourth%20National%20Climate%20Assessment:%20Chapter%2014:%20Human%20Health&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#chapter-14" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#chapter-14" readonly/></div> </div> </div> <h1> <small>CHAPTER 14</small><br/> <span class="balance-text">Human Health</span> </h1> </div> <div class="offset-lg-1 col-lg-7 node-narrative" aria-flowto="content-14-1"> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/background/ch14_bg_health.jpg" data-fb-title="Fourth National Climate Assessment: Introduction" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23section-1&text=Fourth%20National%20Climate%20Assessment:%20Introduction&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Check%20out%20this%20site:%20https://nca2018.globalchange.gov/chapter/14#section-1" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#section-1" readonly/></div> </div> </div> <h2> Introduction</h2> </div> <div class="md-3" style="z-index: 998;"> <div id="aside-accordion"> <div class="card"> <div class="card-header" id="authors-heading"> <h5 class="mb-0"> <button class="btn btn-link collapsed" data-toggle="collapse" data-target="#authors-collapse" aria-expanded="false" aria-controls="authors-collapse"> Authors </button> </h5> </div> <div id="authors-collapse" class="collapse" aria-labelledby="authors-heading" data-parent="#aside-accordion"> <div class="card-body "> <dl> <dt class="blue-lite">Federal Coordinating Lead Authors:</dt> <dd> <strong>John M. Balbus</strong>, National Institute of Environmental Health Sciences </dd> <dd> <strong>George Luber</strong>, Centers for Disease Control and Prevention </dd> <dt class="blue-lite">Chapter Lead:</dt> <dd> <strong>Kristie L. Ebi</strong>, University of Washington </dd> <dt class="blue-lite">Chapter Authors:</dt> <dd> <strong>Aparna Bole</strong>, University Hospitals Rainbow Babies & Children's Hospital, Ohio </dd> <dd> <strong>Allison Crimmins</strong>, U.S. Environmental Protection Agency </dd> <dd> <strong>Gregory Glass</strong>, University of Florida </dd> <dd> <strong>Shubhayu Saha</strong>, Centers for Disease Control and Prevention </dd> <dd> <strong>Mark M. Shimamoto</strong>, American Geophysical Union </dd> <dd> <strong>Juli Trtanj</strong>, National Oceanic and Atmospheric Administration </dd> <dd> <strong>Jalonne L. White-Newsome</strong>, The Kresge Foundation </dd> <dt class="blue-lite">Review Editor:</dt> <dd> <strong>David D'Onofrio</strong>, Atlanta Regional Commission </dd> </dl> </div> </div> </div> <div class="card"> <div class="card-header" id="tech-contributors-heading"> <h5 class="mb-0"> <button class="btn btn-link collapsed" data-toggle="collapse" data-target="#contributors-heading" aria-expanded="false" aria-controls="contributors-heading"> Contributors </button> </h5> </div> <div id="contributors-heading" class="collapse" aria-labelledby="tech-contributors-heading" data-parent="#aside-accordion"> <div class="card-body "> <dl> <dt class="blue-lite">Technical Contributor:</dt> <dd> <strong>Stasia Widerynski</strong>, Centers for Disease Control and Prevention </dd> <dt class="blue-lite">USGCRP Coordinators:</dt> <dd> <strong>Ashley Bieniek-Tobasco</strong>, Health Program Coordinator </dd> <dd> <strong>Sarah Zerbonne</strong>, Adaptation and Decision Science Coordinator </dd> <dd> <strong>Natalie Bennett</strong>, Adaptation and Assessment Analyst </dd> <dd> <strong>Christopher W. Avery</strong>, Senior Manager </dd> </dl> </div> </div> </div> <div class="card"> <div class="card-header" id="recommended-citation-heading"> <h5 class="mb-0"> <button class="btn btn-link collapsed" data-toggle="collapse" data-target="#citation-heading" aria-expanded="false" aria-controls="citation-heading"> Recommended Citation </button> </h5> </div> <div id="citation-heading" class="collapse" aria-labelledby="recommended-citation-heading" data-parent="#aside-accordion"> <div class="card-body"> <p class="recommended-citation"><b>Ebi</b>, K.L., J.M. Balbus, G. Luber, A. Bole, A. Crimmins, G. Glass, S. Saha, M.M. Shimamoto, J. Trtanj, and J.L. White-Newsome, 2018: Human Health. In <i>Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II</i> [Reidmiller, D.R., C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart (eds.)]. U.S. Global Change Research Program, Washington, DC, USA, pp. 539–571. doi: 10.7930/NCA4.2018.CH14</p> </div> </div> </div> <div class="card"> <div class="card-header" id="related-links-heading"> <h5 class="mb-0"> <button class="btn btn-link collapsed" data-toggle="collapse" data-target="#links-heading" aria-expanded="false" aria-controls="links-heading"> Related Links </button> </h5> </div> <div id="links-heading" class="collapse" aria-labelledby="related-links-heading" data-parent="#aside-accordion"> <div class="card-body"> <ul> <li><a target="_blank" href="https://toolkit.climate.gov/topics/human-health" aria-label="Chapter Related Link" title="Chapter Related Link">U.S. Climate Resilience Toolkit</a></li> <li><a target="_blank" href="https://health2016.globalchange.gov" aria-label="Chapter Related Link" title="Chapter Related Link">Climate & Health Assessment</a></li> <li><a target="_blank" href="https://scenarios.globalchange.gov" aria-label="Chapter Related Link" title="Chapter Related Link">Scenarios for the National Climate Assessment</a></li> <li><a target="_blank" href="https://www.globalchange.gov/browse/indicators" aria-label="Chapter Related Link" title="Chapter Related Link">USGCRP Indicators</a></li> </ul> </div> </div> </div> </div> </div> <div id="content-14-1"><div class="offset-lg-1 col-lg-7"> <p>A comprehensive assessment of the impacts of climate change on human health in the United States concluded that climate change exacerbates existing climate-sensitive health threats and creates new challenges, exposing more people in more places to hazardous weather and climate conditions.<sup id="fnref:f1e633d5-070a-4a7d-935b-a2281a0c9cb6"><a href="#fn:1" rel="footnote" onclick="return false;">1</a></sup> This chapter builds on that assessment and considers the extent to which modifying current, or implementing new, health system responses could prepare for and manage these risks. Please see <a href='/chapter/13'>Chapter 13: Air Quality</a> for a discussion of the health impacts associated with air quality, including ozone, wildfires, and aeroallergens.</p> </div> </div> </section> <section id="key-message-1" class="container-fluid report-section no-spacer blackish glossary clearfix"> <div id="content-14-2"><p></div> <div class="row no-gutters"> <div class="col-lg-12"> <div class="row key-message-display"> <div class="col-sm-1"> <p class="text-center"><img class="align-self-center" src="/img/km-shape-1.png" alt="Key Message 1" /></p> </div> <div class="col-sm-7 key-message-msg"></p> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov" data-fb-title="Fourth National Climate Assessment: Climate Change Affects the Health of All Americans" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23key-message-1&text=Fourth%20National%20Climate%20Assessment:%20Chapter%2014,%20Key%20Message%201:%20Climate%20Change%20Affects%20the%20Health%20of%20All%20Americans&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#key-message-1" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#key-message-1" readonly/></div> </div> </div> <p><h2 class="balance-text">Climate Change Affects the Health of All Americans</h2> <p><p>The health and well-being of Americans are already affected by climate change, with the adverse health consequences projected to worsen with additional climate change. Climate change affects human health by altering exposures to heat waves, floods, droughts, and other extreme events; vector-, food- and waterborne infectious diseases; changes in the quality and safety of air, food, and water; and stresses to mental health and well-being.</p> </p> </div> </div> </div> </div></p> <section id="fig-14-1" class="offset-lg-1 col-lg-7 big-figure figure"> <div class="figure-social-icons"> <a role="button" href="/img/figure/figure14_1.png" aria-label="Download" title="Download" class="download_a qtip-top" download></a>  <a role="button" href="/report/nca4/chapter/human-health/figure/climate-change-and-health" aria-label="Metadata" title="Metadata" class="metadata_a qtip-top" ></a>  <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/figure/figure14_1.png" data-fb-title="Fourth National Climate Assessment: Climate Change and Health" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23fig-14-1&text=Fourth%20National%20Climate%20Assessment:%20Figure%2014.1:%20Climate%20Change%20and%20Health&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Check%20out%20this%20site:%20https://nca2018.globalchange.gov/chapter/14#fig-14-1" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#fig-14-1" readonly/></div> </div> </div> <h2>Figure 14.1: Climate Change and Health</h2> <div class="figure-inner"> <a class="lightbox" href="/img/figure/figure14_1.png" data-title='Figure 14.1 Climate Change and Health'> <picture> <source media="(min-width: 1200px)" data-srcset="/img/styles/figure14_1-1200.png, /img/styles/figure14_1-1200@2x.png 2x"> <source media="(min-width: 992px)" data-srcset="/img/styles/figure14_1-992.png, /img/styles/figure14_1-992@2x.png 2x"> <source media="(min-width: 768px)" data-srcset="/img/styles/figure14_1-768.png, /img/styles/figure14_1-768@2x.png 2x"> <source media="(min-width: 480px)" data-srcset="/img/styles/figure14_1-480.png, /img/styles/figure14_1-480@2x.png 2x"> <source media="(min-width: 320px)" data-srcset="/img/styles/figure14_1-320.png, /img/styles/figure14_1-320@2x.png 2x"> <img data-src="/img/figure/figure14_1.png" alt="Climate Change and Health" class="big-img img-fluid lazyload" aria-describedby="description-14-1" /> </picture> </a> <aside id="description-14-1" class="sr-only">A flow chart illustrates the pathways by which climate change could affect human health. That is, climate drivers, such as increased temperatures and precipitation extremes, can expose humans to conditions like extreme heat and reduced food and water quality. In turn, this exposure can lead to negative health outcomes, including heat-related illness; food-, water-, and vector-borne diseases; and mental health issues. Environmental and institutional factors, such as infrastructure condition and geography, and social and behavioral factors, such as age, race and ethnicity, and education, can further influence vulnerability.</aside> <div class="caption" data-href="/img/figure/figure14_1.png" data-title='Figure 14.1 Climate Change and Health'><strong>Figure 14.1: </strong>This conceptual diagram illustrates the exposure pathways by which climate change could affect human health. Exposure pathways exist within the context of other factors that positively or negatively influence health outcomes (gray side boxes). Key factors that influence vulnerability for individuals are shown in the right box and include social determinants of health and behavioral choices. Key factors that influence vulnerability at larger scales, such as natural and built environments, governance and management, and institutions, are shown in the left box. The extent to which climate change could alter the burden of disease in any location at any point in time will depend not just on the magnitude of local climate change but also on individual and population vulnerability, exposure to changing weather patterns, and capacity to manage risks, which may also be affected by climate change. Source: Balbus et al. 2016.<sup id='fnref:6b118a80-8335-4c02-91cf-762c8bb14301'><a href='#fn:2' rel='footnote' onclick='return false;'>2</a></sup></div> <p class="text-center"><span class="view-figure"><a role="button" class="shrink" href="#">SHRINK</a></span></p> </div> </section> <div class="offset-lg-1 col-lg-7"> <p>The first paragraph in each of the following sections summarizes findings of the 2016 U.S. Climate and Health Assessment,<sup id="fnref:f1e633d5-070a-4a7d-935b-a2281a0c9cb6"><a href="#fn:1" rel="footnote" onclick="return false;">1</a></sup> and the remainder of each section assesses findings from newly published research.</p> <h3>Extreme Events</h3> <p>More frequent and/or more intense extreme events, including drought, wildfires, heavy rainfall, floods, storms, and storm surge, are expected to adversely affect population health.<sup id="fnref:0e186af3-bf5b-49ae-82cc-cf1a1a5a7c25"><a href="#fn:3" rel="footnote" onclick="return false;">3</a></sup> These events can exacerbate underlying medical conditions, increase stress, and lead to adverse mental health effects.<sup id="fnref:6b22a163-b918-48bf-993f-32e61712a455"><a href="#fn:4" rel="footnote" onclick="return false;">4</a></sup> Further, extreme weather and climate events can disrupt critical public health, healthcare, and related systems in ways that can adversely affect health long after the event.<sup id="fnref:0e186af3-bf5b-49ae-82cc-cf1a1a5a7c25"><a href="#fn:3" rel="footnote" onclick="return false;">3</a></sup></p> <p>Recent research improves identification of vulnerable population groups during and after an extreme event,<sup id="fnref:b77ebe86-7dac-4303-bee3-52e81a34b5ca"><a href="#fn:5" rel="footnote" onclick="return false;">5</a></sup> including their geographic location and needs (e.g. Bathi and Das 2016, Gotanda et al. 2015, Greenstein et al. 2016<sup id="fnref:115163fe-d259-4944-87a9-6225e5010c41"><a href="#fn:6" rel="footnote" onclick="return false;">6</a></sup><sup class="cm">,</sup><sup id="fnref:139e52f1-c486-4f93-aa79-67b3f1dc7e02"><a href="#fn:7" rel="footnote" onclick="return false;">7</a></sup><sup class="cm">,</sup><sup id="fnref:5ff5038a-349a-475c-a353-fd32d6907788"><a href="#fn:8" rel="footnote" onclick="return false;">8</a></sup>). For example, the 2017 hurricane season highlighted the unique vulnerabilities of populations residing in Puerto Rico, the U.S. Virgin Islands, and other Caribbean islands <em>(<a href="/chapter/20#box-20_1">Ch. 20: U.S. Caribbean, Box 20.1</a>)</em>.<sup id="fnref:f27d73b2-8618-4674-a111-a92276930d26"><a href="#fn:9" rel="footnote" onclick="return false;">9</a></sup></p> <aside id="box-14_1" class="section-box box clearfix"> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov" data-fb-title="Fourth National Climate Assessment: Box 14.1: Health Impacts of Drought and Periods of Unusually Dry Months" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23box-14_1&text=Fourth%20National%20Climate%20Assessment:%20Box%2014.1:%20Health%20Impacts%20of%20Drought%20and%20Periods%20of%20Unusually%20Dry%20Months&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#box-14_1" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#box-14_1" readonly/></div> </div> </div> <h2><span class="balance-text">Box 14.1: Health Impacts of Drought and Periods of Unusually Dry Months</span></h2> <div class="box-inner"> <p>In late 2015, California was in the fourth year of its most severe drought since becoming a state in 1850, with 63 emergency proclamations declared in cities, counties, tribal governments, and special districts.<sup id="fnref:dde27300-db21-434e-a44e-4aae19cbe8a4"><a href="#fn:10" rel="footnote" onclick="return false;">10</a></sup><sup class="cm">,</sup><sup id="fnref:133fec6d-8a4b-47e6-a1f0-c986ecf70780"><a href="#fn:11" rel="footnote" onclick="return false;">11</a></sup> Households in two drought-stricken counties (Tulare and Mariposa) reported a range of drought-related health impacts, including increased dust leading to allergies, asthma, and other respiratory issues and acute stress and diminished peace of mind.<sup id="fnref:dde27300-db21-434e-a44e-4aae19cbe8a4"><a href="#fn:10" rel="footnote" onclick="return false;">10</a></sup> These health effects were not evenly distributed, with more negative physical and mental health impacts reported when drought negatively affected household property and finances.</p> <p>Drier conditions can increase reproduction of a fungus found in soils, potentially leading to the disease coccidioidomycosis, or Valley fever.<sup id="fnref:0e186af3-bf5b-49ae-82cc-cf1a1a5a7c25"><a href="#fn:3" rel="footnote" onclick="return false;">3</a></sup><sup class="cm">,</sup><sup id="fnref:e7604efd-b24b-43f7-93b9-5046de36a18a"><a href="#fn:12" rel="footnote" onclick="return false;">12</a></sup> Coccidioidomycosis can cause persistent flu-like symptoms, with over 40% of cases hospitalized and 75% of patients unable to perform their normal daily activities for weeks, months, or longer. Higher numbers of cases in Arizona and California are associated with periods of drier conditions as measured by lower soil moisture in the previous winter and spring.<sup id="fnref:b4d1a19f-d19a-4a91-99f9-c1680ef0a4ad"><a href="#fn:13" rel="footnote" onclick="return false;">13</a></sup></p> <p>Overall, the impacts of drought on hospital admissions and deaths depend on drought severity and the history of droughts in a region.<sup id="fnref:c2e222fc-c5e0-4e34-8f28-ab1fad575053"><a href="#fn:14" rel="footnote" onclick="return false;">14</a></sup> Complex relationships between drought and its associated economic consequences, particularly the interactions among factors that affect vulnerability, protective factors, and coping mechanisms, can increase mood disorders, domestic violence, and suicide.<sup id="fnref:e967634e-e689-46ef-ac7b-51c962ecd582"><a href="#fn:15" rel="footnote" onclick="return false;">15</a></sup><sup class="cm">,</sup><sup id="fnref:f5b5a424-29ee-4cd3-a179-68668613933d"><a href="#fn:16" rel="footnote" onclick="return false;">16</a></sup><sup class="cm">,</sup><sup id="fnref:94b49b9c-97ea-4f0d-8f1a-53296c19afc7"><a href="#fn:17" rel="footnote" onclick="return false;">17</a></sup></p> </div> </aside> <h3>Temperature Extremes</h3> <p>High temperatures in the summer are conclusively linked to an increased risk of a range of illnesses and death, particularly among older adults, pregnant women, and children.<sup id="fnref:1ad1d794-bc57-4e48-ab28-0e2b65767cb9"><a href="#fn:18" rel="footnote" onclick="return false;">18</a></sup> People living in urban areas may experience higher ambient temperatures because of the additional heat associated with urban heat islands, exacerbating heat-related risks.<sup id="fnref:816f69e9-3a51-4ca5-9bb5-90200c842711"><a href="#fn:19" rel="footnote" onclick="return false;">19</a></sup> With continued warming, increases in heat-related deaths are projected to outweigh reductions in cold-related deaths in most regions.<sup id="fnref:1ad1d794-bc57-4e48-ab28-0e2b65767cb9"><a href="#fn:18" rel="footnote" onclick="return false;">18</a></sup></p> <p>Analyses of hospital admissions, emergency room visits, or emergency medical services calls show that hot days are associated with an increase in heat-related illnesses,<sup id="fnref:c2022b30-10b5-40f8-b14b-82c43209dd3d"><a href="#fn:20" rel="footnote" onclick="return false;">20</a></sup><sup class="cm">,</sup><sup id="fnref:b151fd56-2d07-47fb-88df-173212cd5059"><a href="#fn:21" rel="footnote" onclick="return false;">21</a></sup> including cardiovascular and respiratory complications,<sup id="fnref:5d64215d-ed74-4268-93c0-defdcfa2d5e1"><a href="#fn:22" rel="footnote" onclick="return false;">22</a></sup> renal failure,<sup id="fnref:aa10dde0-072c-459a-ab20-65ba830d43bd"><a href="#fn:23" rel="footnote" onclick="return false;">23</a></sup> electrolyte imbalance, kidney stones,<sup id="fnref:bc677c60-b904-4fd5-9f2b-981e36b3e0ac"><a href="#fn:24" rel="footnote" onclick="return false;">24</a></sup> negative impacts on fetal health,<sup id="fnref:00935259-887c-4e73-a936-90759dd846e1"><a href="#fn:25" rel="footnote" onclick="return false;">25</a></sup> and preterm birth.<sup id="fnref:fff9b83e-10cf-4700-a26e-9461fefd7e5d"><a href="#fn:26" rel="footnote" onclick="return false;">26</a></sup> Risks vary across regions <em>(<a href="/chapter/18#box-18_3">Ch. 18: Northeast, Box 18.3</a>)</em>.<sup id="fnref:42905968-c431-4930-a802-ae5e3647d665"><a href="#fn:27" rel="footnote" onclick="return false;">27</a></sup> Health risks may be higher earlier in the summer season when populations are less accustomed to experiencing elevated temperatures, and different outcomes are observed at different levels of high temperature.<sup id="fnref:7e120c1f-a9c0-4328-97a1-08650f861f79"><a href="#fn:28" rel="footnote" onclick="return false;">28</a></sup><sup class="cm">,</sup><sup id="fnref:c93425cc-9026-4a9d-abde-cb2d73327a71"><a href="#fn:29" rel="footnote" onclick="return false;">29</a></sup> See <a href="/chapter/13">Chapter 13: Air Quality</a> for a discussion of the associations between temperature, air quality, and adverse health outcomes.</p> <h3>Vector-Borne Diseases</h3> <p>Climate change is expected to alter the geographic range, seasonal distribution, and abundance of disease vectors, exposing more people in North America to ticks that carry Lyme disease or other bacterial and viral agents, and to mosquitoes that transmit West Nile, chikungunya, dengue, and Zika viruses.<sup id="fnref:dbfb7cd9-7c82-43ea-a4e2-9e2eb0b851fd"><a href="#fn:30" rel="footnote" onclick="return false;">30</a></sup><sup class="cm">,</sup><sup id="fnref:3cb1d1bf-8c3a-4e83-b5ac-2f63af2dba08"><a href="#fn:31" rel="footnote" onclick="return false;">31</a></sup><sup class="cm">,</sup><sup id="fnref:738c9d34-efbc-4759-b302-f40c5a14a50a"><a href="#fn:32" rel="footnote" onclick="return false;">32</a></sup> Changing weather patterns interact with other factors, including how pathogens adapt and change, changing ecosystems and land use, demographics, human behavior, and the status of public health infrastructure and management.<sup id="fnref:caee7e9f-762a-4b4c-a1db-1c7153933499"><a href="#fn:33" rel="footnote" onclick="return false;">33</a></sup><sup class="cm">,</sup><sup id="fnref:3a785422-a481-4ac7-b3fd-da830619c5bd"><a href="#fn:34" rel="footnote" onclick="return false;">34</a></sup></p> <p>El Niño events and other episodes of variable weather patterns may indicate the extent to which the risk of infectious disease transmission could increase with additional climate change.<sup id="fnref:caee7e9f-762a-4b4c-a1db-1c7153933499"><a href="#fn:33" rel="footnote" onclick="return false;">33</a></sup><sup class="cm">,</sup><sup id="fnref:f22294d5-f052-4908-9eb7-4d8cdbe0c5b9"><a href="#fn:35" rel="footnote" onclick="return false;">35</a></sup><sup class="cm">,</sup><sup id="fnref:7843babb-2cfa-47fd-9a27-55bc426e22af"><a href="#fn:36" rel="footnote" onclick="return false;">36</a></sup></p> <p>Increased temperatures and more frequent and intense extreme precipitation events can create conditions that favor the movement of vector-borne diseases into new geographic regions (e.g., Belova et al. 2017, Monaghan et al. 2016, Ogden and Lindsay 2016<sup id="fnref:3cb1d1bf-8c3a-4e83-b5ac-2f63af2dba08"><a href="#fn:31" rel="footnote" onclick="return false;">31</a></sup><sup class="cm">,</sup><sup id="fnref:4308e866-5976-4181-8102-24b521ff4033"><a href="#fn:37" rel="footnote" onclick="return false;">37</a></sup><sup class="cm">,</sup><sup id="fnref:fe91b27d-3625-468e-b7d2-40686e8a55a7"><a href="#fn:38" rel="footnote" onclick="return false;">38</a></sup>). At the same time, very high temperatures may reduce transmission risk for some diseases.<sup id="fnref:0fc0ccc3-c530-4099-b6e1-e04f2cfd4237"><a href="#fn:39" rel="footnote" onclick="return false;">39</a></sup><sup class="cm">,</sup><sup id="fnref:8cf42846-0671-414c-97db-42736eae5ca5"><a href="#fn:40" rel="footnote" onclick="return false;">40</a></sup> Economic development also may substantially reduce transmission risk by reducing contacts with vector populations.<sup id="fnref:7fd7397d-6896-447d-85c5-b36af651d605"><a href="#fn:41" rel="footnote" onclick="return false;">41</a></sup> In the absence of adaptation, exposure to the mosquito <em>Aedes aegypti</em>, which can transmit dengue, Zika, chikungunya, and yellow fever viruses, is projected to increase by the end of the century due to climatic, demographic, and socioeconomic changes, with some of the largest increases projected to occur in North America.<sup id="fnref:3cb1d1bf-8c3a-4e83-b5ac-2f63af2dba08"><a href="#fn:31" rel="footnote" onclick="return false;">31</a></sup><sup class="cm">,</sup><sup id="fnref:738c9d34-efbc-4759-b302-f40c5a14a50a"><a href="#fn:32" rel="footnote" onclick="return false;">32</a></sup> Similarly, changes in temperature may influence the distribution and abundance of tick species that transmit common pathogens.<sup id="fnref:fe91b27d-3625-468e-b7d2-40686e8a55a7"><a href="#fn:38" rel="footnote" onclick="return false;">38</a></sup><sup class="cm">,</sup><sup id="fnref:500125b7-cabe-43b3-bc8b-08cb5e6938c8"><a href="#fn:42" rel="footnote" onclick="return false;">42</a></sup><sup class="cm">,</sup><sup id="fnref:05669ed2-397c-40de-b3bd-c54decb66e5c"><a href="#fn:43" rel="footnote" onclick="return false;">43</a></sup></p> <aside id="box-14_2" class="section-box box clearfix"> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov" data-fb-title="Fourth National Climate Assessment: Box 14.2: Transboundary Transmission of Infectious Diseases" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23box-14_2&text=Fourth%20National%20Climate%20Assessment:%20Box%2014.2:%20Transboundary%20Transmission%20of%20Infectious%20Diseases&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#box-14_2" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#box-14_2" readonly/></div> </div> </div> <h2><span class="balance-text">Box 14.2: Transboundary Transmission of Infectious Diseases</span></h2> <div class="box-inner"> <p>Outbreaks occurring in other countries can impact U.S. populations and military personnel living abroad and can sometimes affect the United States. For example, the 2015–16 El Niño, one of the strongest on record,<sup id="fnref:14f846a7-837f-4470-a2c3-3127574e1c05"><a href="#fn:44" rel="footnote" onclick="return false;">44</a></sup> may have contributed to the 2014–16 Zika epidemic in the Americas.<sup id="fnref:3cb1d1bf-8c3a-4e83-b5ac-2f63af2dba08"><a href="#fn:31" rel="footnote" onclick="return false;">31</a></sup><sup class="cm">,</sup><sup id="fnref:b89b43e0-28a8-4b9d-9139-02f1b3f96533"><a href="#fn:45" rel="footnote" onclick="return false;">45</a></sup><sup class="cm">,</sup><sup id="fnref:7712dc94-0747-4c73-a495-585339265544"><a href="#fn:46" rel="footnote" onclick="return false;">46</a></sup><sup class="cm">,</sup><sup id="fnref:ba80e684-08bc-4d0a-ae42-ce0f0975b24e"><a href="#fn:47" rel="footnote" onclick="return false;">47</a></sup><sup class="cm">,</sup><sup id="fnref:a3bb4918-0fe2-498b-858b-e001bdf0b98d"><a href="#fn:48" rel="footnote" onclick="return false;">48</a></sup> Warmer conditions may have facilitated expansion of the geographic range of mosquito populations and increased their capacity to transmit Zika virus.<sup id="fnref:8cf42846-0671-414c-97db-42736eae5ca5"><a href="#fn:40" rel="footnote" onclick="return false;">40</a></sup> Zika virus can cause a wide range of symptoms, including fever, rash, and headaches, as well as birth defects. The outbreak began in South America and spread to areas with mosquitoes capable of transmitting the virus, including Puerto Rico, the U.S. Virgin Islands, Florida, and Texas.</p> </div> </aside> <h3>Water-Related Illnesses and Death</h3> <p>Increasing water temperatures associated with climate change are projected to alter the seasonality of growth and the geographic range of harmful algae and coastal pathogens, and runoff from more frequent and intense rainfall is projected to increasingly compromise recreational waters and sources of drinking water through increased introductions of pathogens and toxic algal blooms.<sup id="fnref:d4ed906f-cc7b-422c-aef1-96a1b1d5c80f"><a href="#fn:49" rel="footnote" onclick="return false;">49</a></sup><sup class="cm">,</sup><sup id="fnref:8640a3db-35fa-4089-8fb5-d52dc8b35c71"><a href="#fn:50" rel="footnote" onclick="return false;">50</a></sup><sup class="cm">,</sup><sup id="fnref:6ff73ba2-786f-45c7-8831-28601a554ff7"><a href="#fn:51" rel="footnote" onclick="return false;">51</a></sup><sup class="cm">,</sup><sup id="fnref:d515604c-1a1e-4ea1-8587-6d1807657ccf"><a href="#fn:52" rel="footnote" onclick="return false;">52</a></sup><sup class="cm">,</sup><sup id="fnref:4a20c891-eaac-49c6-ab6a-2ba06b3b1500"><a href="#fn:53" rel="footnote" onclick="return false;">53</a></sup><sup class="cm">,</sup><sup id="fnref:59119e0c-4e96-43ef-bf05-c83f03ece16b"><a href="#fn:54" rel="footnote" onclick="return false;">54</a></sup></p> <p>Projected increases in extreme precipitation and flooding, combined with inadequate water and sewer infrastructure, can contribute to viral and bacterial contamination from combined sewage overflows and a lack of access to potable drinking water, increasing exposure to pathogens that lead to gastrointestinal illness.<sup id="fnref:98353f95-01ba-45b3-8194-77fd674d5faa"><a href="#fn:55" rel="footnote" onclick="return false;">55</a></sup><sup class="cm">,</sup><sup id="fnref:d746e578-c6fd-4b73-8a3c-d91365668348"><a href="#fn:56" rel="footnote" onclick="return false;">56</a></sup><sup class="cm">,</sup><sup id="fnref:59a0a3c9-1495-4680-a47d-829b2bb636d4"><a href="#fn:57" rel="footnote" onclick="return false;">57</a></sup><sup class="cm">,</sup><sup id="fnref:d46e068d-361c-4b50-a96b-670a5b9a95bf"><a href="#fn:58" rel="footnote" onclick="return false;">58</a></sup><sup class="cm">,</sup><sup id="fnref:78a7d4c7-a6f8-4929-9f5f-de9a04239262"><a href="#fn:59" rel="footnote" onclick="return false;">59</a></sup> The relationship between precipitation and temperature-driven transmission of waterborne diseases is complex and site-specific, with, for example, some areas finding increased numbers of cases associated with excessive rainfall and others finding stronger associations with drought.<sup id="fnref:533454f2-efc5-4c80-9ace-318efeed90c5"><a href="#fn:60" rel="footnote" onclick="return false;">60</a></sup><sup class="cm">,</sup><sup id="fnref:06fbcf75-3eca-4b63-93ab-a34b11e3fff4"><a href="#fn:61" rel="footnote" onclick="return false;">61</a></sup><sup class="cm">,</sup><sup id="fnref:3f083c7b-2e22-43d7-9213-3a090c145bd4"><a href="#fn:62" rel="footnote" onclick="return false;">62</a></sup><sup class="cm">,</sup><sup id="fnref:79043307-9170-4454-ab9b-5ae2398b3a0b"><a href="#fn:63" rel="footnote" onclick="return false;">63</a></sup><sup class="cm">,</sup><sup id="fnref:89380a50-8b6d-471a-9d25-4332362759da"><a href="#fn:64" rel="footnote" onclick="return false;">64</a></sup><sup class="cm">,</sup><sup id="fnref:87af4d60-f45e-4673-bc60-82a1fc284943"><a href="#fn:65" rel="footnote" onclick="return false;">65</a></sup> Heavy rainfall, flooding, and high temperatures have been linked to increases in diarrheal disease<sup id="fnref:3f083c7b-2e22-43d7-9213-3a090c145bd4"><a href="#fn:62" rel="footnote" onclick="return false;">62</a></sup><sup class="cm">,</sup><sup id="fnref:89380a50-8b6d-471a-9d25-4332362759da"><a href="#fn:64" rel="footnote" onclick="return false;">64</a></sup><sup class="cm">,</sup><sup id="fnref:7d3e5952-49fd-4e34-bf11-a6f4dff67180"><a href="#fn:66" rel="footnote" onclick="return false;">66</a></sup><sup class="cm">,</sup><sup id="fnref:3c01e5df-38ae-4fbe-aa99-6727dee4b150"><a href="#fn:67" rel="footnote" onclick="return false;">67</a></sup> and can increase other bacterial and parasitic infections such as leptospirosis and cryptosporidiosis.<sup id="fnref:87af4d60-f45e-4673-bc60-82a1fc284943"><a href="#fn:65" rel="footnote" onclick="return false;">65</a></sup><sup class="cm">,</sup><sup id="fnref:02346c4a-5ec5-4adf-8067-a07210aaeed0"><a href="#fn:68" rel="footnote" onclick="return false;">68</a></sup> Increases in air temperatures and heat waves are expected to increase temperature-sensitive marine pathogens such as <em>Vibrio</em>.<sup id="fnref:533454f2-efc5-4c80-9ace-318efeed90c5"><a href="#fn:60" rel="footnote" onclick="return false;">60</a></sup><sup class="cm">,</sup><sup id="fnref:398bd28f-6c50-4650-9aa0-cc68b66815f9"><a href="#fn:69" rel="footnote" onclick="return false;">69</a></sup><sup class="cm">,</sup><sup id="fnref:3ecbab85-710a-4678-882e-6848c742efe9"><a href="#fn:70" rel="footnote" onclick="return false;">70</a></sup><sup class="cm">,</sup><sup id="fnref:f87eee42-afc9-4594-af20-4c5ddaf17c7e"><a href="#fn:71" rel="footnote" onclick="return false;">71</a></sup></p> <h3>Food Safety and Nutrition</h3> <p>Climate change, including rising temperatures and changes in weather extremes, is projected to adversely affect food security by altering exposures to certain pathogens and toxins (for example, <em>Salmonella</em>, <em>Campylobacter</em>, <em>Vibrio parahaemolyticus</em> in raw oysters, and mycotoxigenic fungi).<sup id="fnref:1ef11bf5-fb98-4f4f-905d-4990936ef52f"><a href="#fn:72" rel="footnote" onclick="return false;">72</a></sup></p> <p>Climate change, including changes in some extreme weather and climate events, can adversely affect global and U.S. food security by, for example, threatening food safety,<sup id="fnref:1b017bee-78c8-4e75-a218-cc47ae89446a"><a href="#fn:73" rel="footnote" onclick="return false;">73</a></sup><sup class="cm">,</sup><sup id="fnref:f9c23819-1207-495b-9b70-b81f37a78c8f"><a href="#fn:74" rel="footnote" onclick="return false;">74</a></sup><sup class="cm">,</sup><sup id="fnref:9a38e31c-84c2-454c-868c-0307853189ac"><a href="#fn:75" rel="footnote" onclick="return false;">75</a></sup> disrupting food availability, decreasing access to food, and increasing food prices.<sup id="fnref:d429eeff-a10c-42e2-861e-5ce4506d77cf"><a href="#fn:76" rel="footnote" onclick="return false;">76</a></sup><sup class="cm">,</sup><sup id="fnref:2312e80f-cec5-445e-aad0-ce60c9ea29e2"><a href="#fn:77" rel="footnote" onclick="return false;">77</a></sup><sup class="cm">,</sup><sup id="fnref:9ba7142c-520b-43fa-a8a1-76dc546eb883"><a href="#fn:78" rel="footnote" onclick="return false;">78</a></sup><sup class="cm">,</sup><sup id="fnref:bcbd5def-bcf4-454a-b744-ff131acdbf39"><a href="#fn:79" rel="footnote" onclick="return false;">79</a></sup><sup class="cm">,</sup><sup id="fnref:22dc1579-7325-4f43-bac6-949f59609066"><a href="#fn:80" rel="footnote" onclick="return false;">80</a></sup><sup class="cm">,</sup><sup id="fnref:9dbe51b2-f829-4774-841f-9ff6a27f1ccb"><a href="#fn:81" rel="footnote" onclick="return false;">81</a></sup><sup class="cm">,</sup><sup id="fnref:d51156cc-0034-4afc-b2b7-1ad99efde458"><a href="#fn:82" rel="footnote" onclick="return false;">82</a></sup> Food quality also is expected to be affected by rising CO<sub>2</sub> concentrations that decrease dietary iron,<sup id="fnref:1839c00f-e69e-4e50-a22b-57324daaaa32"><a href="#fn:83" rel="footnote" onclick="return false;">83</a></sup> zinc,<sup id="fnref:ffc5112e-8b2d-4768-afac-f65d1545dbef"><a href="#fn:84" rel="footnote" onclick="return false;">84</a></sup> protein,<sup id="fnref:3708a23a-9176-4183-8f2b-51bf2f8e430d"><a href="#fn:85" rel="footnote" onclick="return false;">85</a></sup> and other macro- and micronutrients in crops<sup id="fnref:25f24b69-e072-4bba-9a18-282938f62190"><a href="#fn:86" rel="footnote" onclick="return false;">86</a></sup><sup class="cm">,</sup><sup id="fnref:acc94ddf-05f0-4e5b-9ef8-47ef05db2e64"><a href="#fn:87" rel="footnote" onclick="return false;">87</a></sup><sup class="cm">,</sup><sup id="fnref:646126e1-2c39-4498-891f-a7d36d902899"><a href="#fn:88" rel="footnote" onclick="return false;">88</a></sup> and seafood.<sup id="fnref:c11491c3-1997-4aff-aecc-fdc3f6bbd58a"><a href="#fn:89" rel="footnote" onclick="return false;">89</a></sup><sup class="cm">,</sup><sup id="fnref:6bed1f1c-2255-4414-ab05-23ab6a18b198"><a href="#fn:90" rel="footnote" onclick="return false;">90</a></sup> Projected changes in carbon dioxide concentrations and climate change could diminish expected gains in global nutrition; however, any impact on human health will depend on the many other drivers of global food security and factors such as food chain management, human behavior, and food safety governance.<sup id="fnref:bf93d053-588d-4611-a824-94f52018ef18"><a href="#fn:91" rel="footnote" onclick="return false;">91</a></sup><sup class="cm">,</sup><sup id="fnref:e68d35d6-086b-4044-a56a-d023149c0551"><a href="#fn:92" rel="footnote" onclick="return false;">92</a></sup><sup class="cm">,</sup><sup id="fnref:a67f6a58-73d3-49be-b161-1e4f4aab248e"><a href="#fn:93" rel="footnote" onclick="return false;">93</a></sup><sup class="cm">,</sup><sup id="fnref:5b4253b9-b385-4f2f-baa3-cba68ec4376c"><a href="#fn:94" rel="footnote" onclick="return false;">94</a></sup></p> <h3>Mental Health</h3> <p>Mental health consequences, ranging from minimal stress and distress symptoms to clinical disorders, such as anxiety, depression, post-traumatic stress, and suicidality, can result from exposures to short-lived or prolonged climate- or weather-related events and their health consequences.<sup id="fnref:6b22a163-b918-48bf-993f-32e61712a455"><a href="#fn:4" rel="footnote" onclick="return false;">4</a></sup> These mental health impacts can interact with other health, social, and environmental stressors to diminish an individual’s well-being. Some groups are more vulnerable than others, including the elderly, pregnant women, people with preexisting mental illness, the economically disadvantaged, tribal and Indigenous communities, and first responders.<sup id="fnref:6b22a163-b918-48bf-993f-32e61712a455"><a href="#fn:4" rel="footnote" onclick="return false;">4</a></sup></p> <p>Individuals whose households experienced a flood or risk of flood report higher levels of depression and anxiety, and these impacts can persist several years after the event.<sup id="fnref:0bbad3bb-b424-4f35-8cb3-2b7c883852be"><a href="#fn:95" rel="footnote" onclick="return false;">95</a></sup><sup class="cm">,</sup><sup id="fnref:5a3645b9-d9eb-47de-95fa-3c30ee007f1d"><a href="#fn:96" rel="footnote" onclick="return false;">96</a></sup><sup class="cm">,</sup><sup id="fnref:c6947fa0-0aa6-43c4-bd6c-3af95cc1dd03"><a href="#fn:97" rel="footnote" onclick="return false;">97</a></sup><sup class="cm">,</sup><sup id="fnref:39f86476-5b69-4807-9280-ac77f7dfe586"><a href="#fn:98" rel="footnote" onclick="return false;">98</a></sup> Disasters present a heavy burden on the mental health of children when there is forced displacement from their home or a loss of family and community stability.<sup id="fnref:3d08a677-5bfe-4c4f-b062-f61ffd73b4f8"><a href="#fn:99" rel="footnote" onclick="return false;">99</a></sup> Increased use of alcohol and tobacco are common following disasters as well as droughts.<sup id="fnref:e967634e-e689-46ef-ac7b-51c962ecd582"><a href="#fn:15" rel="footnote" onclick="return false;">15</a></sup><sup class="cm">,</sup><sup id="fnref:f5b5a424-29ee-4cd3-a179-68668613933d"><a href="#fn:16" rel="footnote" onclick="return false;">16</a></sup><sup class="cm">,</sup><sup id="fnref:61e41988-b106-41e4-9157-3a469503fd5f"><a href="#fn:100" rel="footnote" onclick="return false;">100</a></sup><sup class="cm">,</sup><sup id="fnref:92a32e2b-0b6f-448e-b387-a81fb75bbcd3"><a href="#fn:101" rel="footnote" onclick="return false;">101</a></sup> Higher temperatures can lead to an increase in aggressive behaviors, including homicide.<sup id="fnref:349d443c-b692-4b9d-8b1b-a22887a292a7"><a href="#fn:102" rel="footnote" onclick="return false;">102</a></sup><sup class="cm">,</sup><sup id="fnref:736eb62c-3f9f-48fc-b7d0-189ff408aef2"><a href="#fn:103" rel="footnote" onclick="return false;">103</a></sup> Social cohesion, good coping skills, and preemptive disaster planning are examples of adaptive measures that can help reduce the risk of prolonged psychological impacts.<sup id="fnref:349d443c-b692-4b9d-8b1b-a22887a292a7"><a href="#fn:102" rel="footnote" onclick="return false;">102</a></sup><sup class="cm">,</sup><sup id="fnref:bf23355b-aa5e-48f6-916a-d2d32e46fe2b"><a href="#fn:104" rel="footnote" onclick="return false;">104</a></sup><sup class="cm">,</sup><sup id="fnref:f0d93632-880b-473f-9ab3-a39c815a9d17"><a href="#fn:105" rel="footnote" onclick="return false;">105</a></sup></p> </div> </div> </section> <section id="key-message-2" 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<p><h2 class="balance-text">Exposure and Resilience Vary Across Populations and Communities</h2> <p><p>People and communities are differentially exposed to hazards and disproportionately affected by climate-related health risks. Populations</em> experiencing greater health risks include children, older adults, low-income communities, and some communities of color.</p> </p> </div> </div> </div> </div></p> <div class="offset-lg-1 col-lg-7"> <p>The health impacts of climate change are not felt equally, and some populations are at higher risk than others.<sup id="fnref:c76d7935-9da3-4c4b-9186-86dc658bcc74"><a href="#fn:106" rel="footnote" onclick="return false;">106</a></sup> Low-income communities and some communities of color are often already overburdened with poor environmental conditions and are disproportionately affected by, and less resilient to, the health impacts of climate change.<sup id="fnref:c76d7935-9da3-4c4b-9186-86dc658bcc74"><a href="#fn:106" rel="footnote" onclick="return false;">106</a></sup><sup class="cm">,</sup><sup id="fnref:efed1341-a8a0-4743-8ec6-5fa87142a4e3"><a href="#fn:107" rel="footnote" onclick="return false;">107</a></sup><sup class="cm">,</sup><sup id="fnref:b9638744-8ff8-41bd-a741-27b2fda9face"><a href="#fn:108" rel="footnote" onclick="return false;">108</a></sup><sup class="cm">,</sup><sup id="fnref:409668a7-2e7b-461b-953a-ac0d6fb90725"><a href="#fn:109" rel="footnote" onclick="return false;">109</a></sup><sup class="cm">,</sup><sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup> The health risks of climate change are expected to compound existing health issues in Native American and Alaska Native communities, in part due to the loss of traditional foods and practices, the mental stress from permanent community displacement, increased injuries from lack of permafrost, storm damage and flooding, smoke inhalation, damage to water and sanitation systems, decreased food security, and new infectious diseases <em>(<a href="/chapter/15">Ch. 15: Tribes</a>; <a href="/chapter/26">Ch. 26: Alaska</a>)</em>.<sup id="fnref:cdf943a1-008a-4b9a-93d4-d0e49df114ae"><a href="#fn:111" rel="footnote" onclick="return false;">111</a></sup><sup class="cm">,</sup><sup id="fnref:5b754441-464c-49fd-90e8-c184fc2ba1f5"><a href="#fn:112" rel="footnote" onclick="return false;">112</a></sup></p> <p>Across all climate risks, children, older adults, low-income communities, some communities of color, and those experiencing discrimination are disproportionately affected by extreme weather and climate events, partially because they are often excluded in planning processes.<sup id="fnref:228aa11c-d3bb-4307-ada4-d30c60feafed"><a href="#fn:113" rel="footnote" onclick="return false;">113</a></sup> Other populations might experience increased climate risks due to a combination of exposure and sensitivity, such as outdoor workers, communities disproportionately burdened by poor environmental quality, and some communities in the rural Southeastern United States <em>(<a href="/chapter/19">Ch. 19: Southeast</a>)</em>.<sup id="fnref:bbb07cf9-3d20-441b-8d01-8371f67f27d0"><a href="#fn:114" rel="footnote" onclick="return false;">114</a></sup><sup class="cm">,</sup><sup id="fnref:25a6aed4-2794-45bc-8211-03d093ddc35b"><a href="#fn:115" rel="footnote" onclick="return false;">115</a></sup><sup class="cm">,</sup><sup id="fnref:b079422e-dafb-4221-83be-0b6a176acbb6"><a href="#fn:116" rel="footnote" onclick="return false;">116</a></sup></p> <p>Additional populations with increased health and social vulnerability typically have less access to information, resources, institutions, and other factors to prepare for and avoid the health risks of climate change. Some of these communities include poor people in high-income regions, minority groups, women, pregnant women, those experiencing discrimination, children under five, persons with physical and mental illness, persons with physical and cognitive disabilities, the homeless, those living alone, Indigenous people, people displaced because of weather and climate, the socially isolated, poorly planned communities, the disenfranchised, those with less access to healthcare, the uninsured and underinsured, those living in inadequate housing, and those with limited financial resources to rebound from disasters.<sup id="fnref:efed1341-a8a0-4743-8ec6-5fa87142a4e3"><a href="#fn:107" rel="footnote" onclick="return false;">107</a></sup><sup class="cm">,</sup><sup id="fnref:409668a7-2e7b-461b-953a-ac0d6fb90725"><a href="#fn:109" rel="footnote" onclick="return false;">109</a></sup><sup class="cm">,</sup><sup id="fnref:9412b3d0-6f9c-4612-bca1-b6bf62f1746a"><a href="#fn:117" rel="footnote" onclick="return false;">117</a></sup><sup class="cm">,</sup><sup id="fnref:f85a7ac1-b6ad-49b6-ba44-881259d28775"><a href="#fn:118" rel="footnote" onclick="return false;">118</a></sup> Figure 14.2 depicts some of the populations vulnerable to weather, climate, and climate change.</p> </div> <section id="fig-14-2" class="offset-lg-1 col-lg-7 big-figure figure"> <div class="figure-social-icons"> <a role="button" href="/img/figure/figure14_2.png" aria-label="Download" title="Download" class="download_a qtip-top" download></a>  <a role="button" href="/report/nca4/chapter/human-health/figure/fig--14-x-vulnerable-populations-km2" aria-label="Metadata" title="Metadata" class="metadata_a qtip-top" ></a>  <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/figure/figure14_2.png" data-fb-title="Fourth National Climate Assessment: Vulnerable Populations" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23fig-14-2&text=Fourth%20National%20Climate%20Assessment:%20Figure%2014.2:%20Vulnerable%20Populations&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Check%20out%20this%20site:%20https://nca2018.globalchange.gov/chapter/14#fig-14-2" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#fig-14-2" readonly/></div> </div> </div> <h2>Figure 14.2: Vulnerable Populations</h2> <div style="width: 85%;" class="figure-inner"> <a class="lightbox" href="/img/figure/figure14_2.png" data-title='Figure 14.2 Vulnerable Populations'> <picture> <source media="(min-width: 1200px)" data-srcset="/img/styles/figure14_2-1200.png, /img/styles/figure14_2-1200@2x.png 2x"> <source media="(min-width: 992px)" data-srcset="/img/styles/figure14_2-992.png, /img/styles/figure14_2-992@2x.png 2x"> <source media="(min-width: 768px)" data-srcset="/img/styles/figure14_2-768.png, /img/styles/figure14_2-768@2x.png 2x"> <source media="(min-width: 480px)" data-srcset="/img/styles/figure14_2-480.png, /img/styles/figure14_2-480@2x.png 2x"> <source media="(min-width: 320px)" data-srcset="/img/styles/figure14_2-320.png, /img/styles/figure14_2-320@2x.png 2x"> <img data-src="/img/figure/figure14_2.png" alt="Vulnerable Populations" class="big-img img-fluid lazyload" aria-describedby="description-14-2" /> </picture> </a> <aside id="description-14-2" class="sr-only"></aside> <div class="caption" data-href="/img/figure/figure14_2.png" data-title='Figure 14.2 Vulnerable Populations'><strong>Figure 14.2: </strong>Examples of populations at higher risk of exposure to adverse climate-related health threats are shown along with adaptation measures that can help address disproportionate impacts. When considering the full range of threats from climate change as well as other environmental exposures, these groups are among the most exposed, most sensitive, and have the least individual and community resources to prepare for and respond to health threats. White text indicates the risks faced by those communities, while dark text indicates actions that can be taken to reduce those risks. Source: EPA.</div> <p class="text-center"><span class="view-figure"><a role="button" class="shrink" href="#">SHRINK</a></span></p> </div> </section> <div class="offset-lg-1 col-lg-7"> <h3>Building Resilient Communities</h3> <p>Projections of climate change-related changes in the incidence of adverse health outcomes, associated treatment costs, and health disparities can promote understanding of the ethical and human rights dimensions of climate change, including the disproportionate share of climate-related risk experienced by socially marginalized and poor populations. Such projections can also highlight options to increase population resilience.<sup id="fnref:4347eda8-3db1-4eea-8adc-bbb079fd648f"><a href="#fn:119" rel="footnote" onclick="return false;">119</a></sup><sup class="cm">,</sup><sup id="fnref:176f1216-a5cf-4ad9-852d-3bf41a0d87ec"><a href="#fn:120" rel="footnote" onclick="return false;">120</a></sup><sup class="cm">,</sup><sup id="fnref:3071bfc6-69ad-40df-9de2-37ffdf8dc58a"><a href="#fn:121" rel="footnote" onclick="return false;">121</a></sup> The ability of a community to anticipate, plan for, and reduce impacts is enhanced when these efforts build on other environmental and social programs directed at sustainably and equitably addressing human needs.<sup id="fnref:e00dbf25-7f96-4894-9182-5a9955bb2df3"><a href="#fn:122" rel="footnote" onclick="return false;">122</a></sup> Resilience is enhanced by community-driven planning processes where residents of vulnerable and impacted communities define for themselves the complex climate challenges they face and the climate solutions most relevant to their unique vulnerabilities.<sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup><sup class="cm">,</sup><sup id="fnref:ec4d3830-c3b9-491b-9bc0-facccd717e00"><a href="#fn:123" rel="footnote" onclick="return false;">123</a></sup><sup class="cm">,</sup><sup id="fnref:7f89e40a-7681-4475-a754-91e81baabd95"><a href="#fn:124" rel="footnote" onclick="return false;">124</a></sup><sup class="cm">,</sup><sup id="fnref:35b1782d-ec59-40d5-b051-c5a80e2516e1"><a href="#fn:125" rel="footnote" onclick="return false;">125</a></sup> A flood-related disaster in central Appalachia in spring 2013 highlighted how community-based coping strategies related to faith and spirituality, cultural values and heritage, and social support can enhance resilience post-disaster.<sup id="fnref:9262e94a-1bbc-4a1c-ad59-a907fa894576"><a href="#fn:126" rel="footnote" onclick="return false;">126</a></sup></p> <p>Communities in Louisiana and New Jersey, for example, are already experiencing a host of negative environmental exposures coupled with extreme coastal and inland flooding. Language-appropriate educational campaigns can highlight the effectiveness of ecological protective measures (such as restoring marshes and dunes to prevent or reduce surge flooding) for increasing resilience. Resilience also can be built by creating institutional readiness, recognizing the importance of resident mobility (geographic movements at various scales such as commuting, migration, and evacuation), acknowledging the importance and support of social networks (such as family, church, and community), and facilitating adaptation to changing conditions.<sup id="fnref:cab3885c-a808-40f4-9b4a-79808bbdf202"><a href="#fn:127" rel="footnote" onclick="return false;">127</a></sup><sup class="cm">,</sup><sup id="fnref:6ffe484d-3eb7-494b-ad4c-678657585f98"><a href="#fn:128" rel="footnote" onclick="return false;">128</a></sup></p> </div> </div> </section> <section id="key-message-3" class="container-fluid report-section no-spacer blackish glossary clearfix"> <div id="content-14-4"><p></div> <div class="row no-gutters"> <div class="col-lg-12"> <div class="row key-message-display"> <div class="col-sm-1"> <p class="text-center"><img class="align-self-center" src="/img/km-shape-3.png" alt="Key Message 3" /></p> </div> <div class="col-sm-7 key-message-msg"></p> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov" data-fb-title="Fourth National Climate Assessment: Adaptation Reduces Risks and Improves Health" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23key-message-3&text=Fourth%20National%20Climate%20Assessment:%20Chapter%2014,%20Key%20Message%203:%20Adaptation%20Reduces%20Risks%20and%20Improves%20Health&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#key-message-3" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#key-message-3" readonly/></div> </div> </div> <p><h2 class="balance-text">Adaptation Reduces Risks and Improves Health</h2> <p><p>Proactive adaptation policies and programs reduce the risks and impacts from climate-sensitive health outcomes and from disruptions in healthcare services. Additional benefits to health arise from explicitly accounting for climate change risks in infrastructure planning and urban design.</p> </p> </div> </div> </div> </div></p> <div class="offset-lg-1 col-lg-7"> <h3>Adapting to the Health Risks of Climate Change</h3> <p>Individuals, communities, public health departments, healthcare facilities, organizations, and others are taking action to reduce health and social vulnerabilities to current climate change and to increase resilience to the risks projected in coming decades.<sup id="fnref:a6d2d472-b084-4805-9f08-cc5e1f95f668"><a href="#fn:129" rel="footnote" onclick="return false;">129</a></sup></p> <p>Examples of state-level adaptation actions include conducting vulnerability and adaptation assessments, developing comprehensive response plans (for example, extreme heat),<sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup><sup class="cm">,</sup><sup id="fnref:310a452b-67cd-458c-8a4d-056dba42ecef"><a href="#fn:130" rel="footnote" onclick="return false;">130</a></sup> climate-proofing healthcare infrastructure, and implementing integrated surveillance of climate-sensitive infectious disease (for example, Lyme disease). Incorporating short-term to seasonal forecasts into public health programs and activities can protect population health today and under a warming climate.<sup id="fnref:a6d2d472-b084-4805-9f08-cc5e1f95f668"><a href="#fn:129" rel="footnote" onclick="return false;">129</a></sup> Over decades or longer, emergency preparedness and disaster risk reduction planning can benefit from incorporating climate projections to ensure communities are prepared for changing weather patterns.<sup id="fnref:e3c4d3b0-5fa1-446c-8af4-1f466e312f99"><a href="#fn:131" rel="footnote" onclick="return false;">131</a></sup></p> <p>Local efforts include altering urban design (for example, by using cool roofs, tree shades, and green walkways) and improving water management (for example, via desalination plants or watershed protection). These can provide health and social justice benefits, elicit neighborhood participation, and increase resilience for specific populations, such as outdoor workers.<sup id="fnref:efed1341-a8a0-4743-8ec6-5fa87142a4e3"><a href="#fn:107" rel="footnote" onclick="return false;">107</a></sup><sup class="cm">,</sup><sup id="fnref:85c390fe-4d9b-4713-95d1-2e6b83c01478"><a href="#fn:132" rel="footnote" onclick="return false;">132</a></sup><sup class="cm">,</sup><sup id="fnref:edf0082f-a1b6-48ef-b8d4-e20a458e4bc8"><a href="#fn:133" rel="footnote" onclick="return false;">133</a></sup></p> <p>Adaptation options at multiple scales are needed to prepare for and manage health risks in a changing climate. For example, options to manage heat-related mortality include individual acclimatization (the process of adjusting to higher temperatures) as well as protective measures, such as heat wave early warnings,<sup id="fnref:126dc0cf-87a4-472a-80ac-619a1c258fa0"><a href="#fn:134" rel="footnote" onclick="return false;">134</a></sup> air conditioning at home, cooling shelters,<sup id="fnref:f0f92922-8e59-42f9-b94b-1ca2f2b239f4"><a href="#fn:135" rel="footnote" onclick="return false;">135</a></sup> green space in the neighborhood,<sup id="fnref:9ef14c5c-9a31-498c-916c-c64bca251d0e"><a href="#fn:136" rel="footnote" onclick="return false;">136</a></sup><sup class="cm">,</sup><sup id="fnref:bb6cb91e-fd58-4222-8d22-023901f265eb"><a href="#fn:137" rel="footnote" onclick="return false;">137</a></sup> and resilient power grids to avoid power outages during extreme weather events.<sup id="fnref:"><a href="#fn:138" rel="footnote" onclick="return false;">138</a></sup></p> <p>Early warning and response systems can protect population health now and provide a basis for more effective adaptation to future climate.<sup id="fnref:d903a4ad-f3f6-484a-baaa-468f5928e740"><a href="#fn:139" rel="footnote" onclick="return false;">139</a></sup><sup class="cm">,</sup><sup id="fnref:a719e703-0c8d-4b9a-9b2b-baf66da770f7"><a href="#fn:140" rel="footnote" onclick="return false;">140</a></sup><sup class="cm">,</sup><sup id="fnref:5e7c131d-ae7e-41e0-a707-a85d72218947"><a href="#fn:141" rel="footnote" onclick="return false;">141</a></sup> Improvements in forecasting weather and climate conditions and in environmental observation systems, in combination with social factors, can provide information on when and where changing weather patterns could result in increasing numbers of cases of, for example, heat stress or an infectious disease.<sup id="fnref:3cb1d1bf-8c3a-4e83-b5ac-2f63af2dba08"><a href="#fn:31" rel="footnote" onclick="return false;">31</a></sup><sup class="cm">,</sup><sup id="fnref:b89b43e0-28a8-4b9d-9139-02f1b3f96533"><a href="#fn:45" rel="footnote" onclick="return false;">45</a></sup><sup class="cm">,</sup><sup id="fnref:a3de6246-8f40-448e-91e8-0abe57e79d6e"><a href="#fn:142" rel="footnote" onclick="return false;">142</a></sup><sup class="cm">,</sup><sup id="fnref:d802722a-1f2c-4b64-932e-74e17a1c2209"><a href="#fn:143" rel="footnote" onclick="return false;">143</a></sup><sup class="cm">,</sup><sup id="fnref:71197580-c1b9-4d22-85c4-ce84fecce1f8"><a href="#fn:144" rel="footnote" onclick="return false;">144</a></sup> Such early warning systems can provide more time to pre-position resources and implement control programs, thereby preventing adverse health outcomes. For example, to help communities prepare for extreme heat, federal agencies are partnering with local entities to bring together stakeholders across the fields of public health, meteorology, emergency management, and policy to develop useful information systems that can prevent heat-related illnesses and deaths.<sup id="fnref:12ce2788-69d3-4b06-9799-34d7130b090c"><a href="#fn:145" rel="footnote" onclick="return false;">145</a></sup> Adaptation efforts outside the health sector can have health benefits when, for example, infrastructure planning is designed to cool ambient temperatures and attenuate storm water runoff<sup id="fnref:ea8728bd-b961-4115-98d9-f834d50568ab"><a href="#fn:146" rel="footnote" onclick="return false;">146</a></sup><sup class="cm">,</sup><sup id="fnref:3c3cc09b-c2d7-4c52-bf8f-c064efa78e93"><a href="#fn:147" rel="footnote" onclick="return false;">147</a></sup> and when interagency planning initiatives involve transportation, ecosystem management, urban planning, and water management.<sup id="fnref:2e9e29a1-e420-4d1f-b12b-53ccde149660"><a href="#fn:148" rel="footnote" onclick="return false;">148</a></sup> Adaptation measures developed and deployed in other sectors can harm population health if they are developed and implemented without taking health into consideration.</p> <aside id="box-14_3" class="section-box box clearfix"> <div class="figure-social-icons"> <a role="button" href="https://toolkit.climate.gov/case-studies/retrofitting-childrens-hospital-hurricane-resistant-shell" aria-label="See related content from the U.S. Climate Resilience Toolkit or the USGCRP Indicator Platform" target="'' " title=" See related content from the U.S. Climate Resilience Toolkit " class="climatelink qtip-bottom"></a>  <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov" data-fb-title="Fourth National Climate Assessment: Box 14.3: Healthcare" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23box-14_3&text=Fourth%20National%20Climate%20Assessment:%20Box%2014.3:%20Healthcare&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#box-14_3" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#box-14_3" readonly/></div> </div> </div> <h2><span class="balance-text">Box 14.3: Healthcare</span></h2> <div class="box-inner"> <p>The U.S. healthcare sector is a significant contributor to climate change, accounting for about 10% of total U.S. greenhouse gas emissions.<sup id="fnref:f5ba1ac5-c7b1-4f39-9b93-fbea12e405df"><a href="#fn:149" rel="footnote" onclick="return false;">149</a></sup> Healthcare facilities are also a critical component of communities’ emergency response system and resilience to climate change. Measures within healthcare institutions that decrease greenhouse gas emissions could significantly reduce U.S. emissions, reduce operating costs, and contribute to greater resilience of healthcare infrastructure. For example, U.S. hospitals could save roughly $15 billion over 10 years by adopting basic energy efficiency and waste-reduction measures (cumulative; no discount rate reported).<sup id="fnref:24e1363e-1ab5-4385-a673-7672704d6da3"><a href="#fn:150" rel="footnote" onclick="return false;">150</a></sup> Combined heat and power systems can enhance hospitals’ resilience in the face of interruptions to the power grid while reducing costs and emissions in normal operations.<sup id="fnref:05ee299b-0f67-41b4-98c8-7f06718799fc"><a href="#fn:151" rel="footnote" onclick="return false;">151</a></sup></p> <section id="fig-14-3" class="offset-lg-1 col-lg-7 big-figure figure interactive"> <div class="figure-social-icons"> <a role="button" href="/img/figure/figure14_3.png" aria-label="Download" title="Download" class="download_a qtip-top" download></a>  <a role="button" href="/report/nca4/chapter/human-health/figure/hospitals_floodplain_sandy" aria-label="Metadata" title="Metadata" class="metadata_a 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M10,18.83c-4.87,0-8.81-3.95-8.81-8.81S5.13,1.2,10,1.2s8.81,3.95,8.81,8.81C18.81,14.89,14.87,18.83,10,18.83z"/><path class="st1" d="M14.04,5.98c-1.75-1.75-4.53-1.81-6.2-0.14C4.83,8.86,5.8,14.23,5.8,14.23s5.37,0.97,8.39-2.04C15.85,10.5,15.8,7.73,14.04,5.98z M11.88,9.87l-0.87,1.78l-0.86-1.78L8.38,9.01l1.77-0.86l0.86-1.78l0.87,1.78l1.77,0.86L11.88,9.87z"/><polygon class="st0" points="13.65,9.01 11.88,9.87 11.01,11.65 10.15,9.87 8.38,9.01 10.15,8.15 11.01,6.37 11.88,8.15 "/></g></svg>); background-repeat: no-repeat; background-position: 0 0; background-size: 65px 20px; z-index: 999; } </style> <div class='map-container'> <div class='figure14_3'> <p> <picture> <source media='(min-width: 1200px)' srcset='/interactives/14_3/figure14_3_poster-1200.jpg, /interactives/14_3/figure14_3_poster-1200@2x.jpg 2x'> <source media='(min-width: 992px)' srcset='/interactives/14_3/figure14_3_poster-992.jpg, /interactives/14_3/figure14_3_poster-992@2x.jpg 2x'> <source media='(min-width: 768px)' srcset='/interactives/14_3/figure14_3_poster-768.jpg, /interactives/14_3/figure14_3_poster-768@2x.jpg 2x'> <source media='(min-width: 480px)' srcset='/interactives/14_3/figure14_3_poster-480.jpg, /interactives/14_3/figure14_3_poster-480@2x.jpg 2x'> <source media='(min-width: 320px)' srcset='/interactives/14_3/figure14_3_poster-320.jpg, /interactives/14_3/figure14_3_poster-320@2x.jpg 2x'> <img src='/interactives/14_3/figure14_3_poster.jpg' alt='' class='lazyload' aria-describedby='description-14-3'/> </picture> </p> </div> <div class='figure14_3--legend'> <table class='map-figure-legend--group'> <thead> <tr> <th></th> <th></th> <th></th> <th></th> <th></th> <th></th> </tr> </thead> <tbody> <tr> <th class='map-legend--header'>Hurricane Flooding</th> <td><span class='map-figure-legend-flood map-figure-legend-flood--1'></span>1</td> <td><span class='map-figure-legend-flood map-figure-legend-flood--2'></span>2</td> <td><span class='map-figure-legend-flood map-figure-legend-flood--3'></span>3</td> <td><span class='map-figure-legend-flood map-figure-legend-flood--4'></span>4</td> <td><span class='map-figure-legend-flood map-figure-legend-flood--5'></span>5</td> </tr> <tr> <th class='map-legend--header'>Hospital Flooding by Hurricane Category</th> <td><span class='map-figure-legend-hospital map-figure-legend-hospital--1'></span>1</td> <td><span class='map-figure-legend-hospital map-figure-legend-hospital--2'></span>2</td> <td><span class='map-figure-legend-hospital map-figure-legend-hospital--3'></span>3</td> <td><span class='map-figure-legend-hospital map-figure-legend-hospital--4'></span>4</td> <td><span class='map-figure-legend-hospital map-figure-legend-hospital--5'></span>5</td> <td><span class='map-figure-legend-hospital map-figure-legend-hospital--none'></span>None</td> </tr> </tbody> </table> <a href='http://mapbox.com/about/maps' class='mapbox-wordmark' target='_blank'>Mapbox</a> </div> <div class='map-overlay' data-figure='14.3' onclick='hide_map_overlay_14_3(this)'> <div class='map-overlay-message'> <i class='fas fa-chart-line'></i> CLICK HERE TO INTERACT</div> </div> </div> <p class='text-center view-static'><a role='button' class='btn btn-secondary lightbox' href='/img/figure/figure14_3.png' data-title='Hospitals at Risk from Storm Surge by Hurricanes'><i class='far fa-image'></i> View static image</a></p> <script src='/interactives/14_3/figure14_3.js' async></script> <script> function hide_map_overlay_14_3(el) { /* var figure14_3 = new Figure14_3(); figure14_3.show(); */ figure14_3(); el.style.display = 'none'; jQuery('.figure14_3 p').hide(); } </script> <div class="caption" data-href="/img/figure/figure14_3.png" data-title='Figure 14.3 Hospitals at Risk from Storm Surge by Hurricanes'><strong>Figure 14.3: </strong>These maps shows the locations of hospitals in Charleston County, South Carolina, and Miami-Dade County, Florida, with respect to storm surge inundation for different categories of hurricanes making landfall at high tide. Colors indicate the lowest category hurricane affecting a given location, with darker blue shading indicating areas with the greatest susceptibility to flooding and darker red dots indicating the most vulnerable hospitals. Four of the 38 (11%) hospitals in Miami-Dade County face possible storm surge inundation following a Category 2 hurricane; this could increase to 26 (68%) following a Category 5 hurricane. Charleston hospitals are more exposed to inundation risks. Seven of the 11 (64%) hospitals in Charleston County face possible storm surge inundation following a Category 2; this could increase to 9 (82%) following a Category 4. The impacts of a storm surge will depend on the effectiveness of resilience measures, such as flood walls, deployed by the facilities. Data from National Hurricane Center 2018<sup id='fnref:6507ef2b-a68a-420c-9aac-cd1d5c0fc210'><a href='#fn:152' rel='footnote' onclick='return false;'>152</a></sup> and the Department of Homeland Security 2018.<sup id='fnref:f40f0493-f23a-476c-9900-2dd34eb7fd6a'><a href='#fn:153' rel='footnote' onclick='return false;'>153</a></sup></div> </div> </section> <p>In addition, healthcare facilities may benefit from modifications to prepare for potential consequences of climate change. For example, Nicklaus Children’s Hospital, formerly Miami Children’s, invested $11.3 million in a range of technology retrofits, including a hurricane-resistant shell, to withstand Category 4 hurricanes for uninterrupted, specialized medical care services.<sup id="fnref:05ee299b-0f67-41b4-98c8-7f06718799fc"><a href="#fn:151" rel="footnote" onclick="return false;">151</a></sup> The hospital was able to operate uninterrupted during Hurricane Irma and provided shelter for spouses and families of storm-duty staff and some storm evacuees. Assessment of climate change related risks to healthcare facilities and services can inform healthcare sector disaster preparedness efforts. For example, analyses in Los Angeles County suggest that preparing for increased wildfire risk should be a priority for area hospitals.<sup id="fnref:d256036d-2155-4037-8b60-3ac77b22adbd"><a href="#fn:154" rel="footnote" onclick="return false;">154</a></sup></p> </div> </aside> </div> </div> </section> <section id="key-message-4" class="container-fluid report-section no-spacer blackish glossary clearfix"> <div id="content-14-5"><p></div> <div class="row no-gutters"> <div class="col-lg-12"> <div class="row key-message-display"> <div class="col-sm-1"> <p class="text-center"><img class="align-self-center" src="/img/km-shape-4.png" alt="Key Message 4" /></p> </div> <div class="col-sm-7 key-message-msg"></p> <div class="figure-social-icons"> <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov" data-fb-title="Fourth National Climate Assessment: Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23key-message-4&text=Fourth%20National%20Climate%20Assessment:%20Chapter%2014,%20Key%20Message%204:%20Reducing%20Greenhouse%20Gas%20Emissions%20Results%20in%20Health%20and%20Economic%20Benefits&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Read%20this%20content%20from%20the%20Fourth%20National%20Climate%20Assessment:%20https://nca2018.globalchange.gov/chapter/14#key-message-4" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#key-message-4" readonly/></div> </div> </div> <p><h2 class="balance-text">Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits</h2> <p><p>Reducing greenhouse gas emissions would benefit the health of Americans in the near and long term. By the end of this century, thousands of American lives could be saved and hundreds of billions of dollars in health-related economic benefits gained each year under a pathway of lower greenhouse gas emissions.</p> </p> </div> </div> </div> </div></p> <div class="offset-lg-1 col-lg-7"> <p>Reducing greenhouse gas emissions <em>(<a href="/chapter/29">Ch. 29: Mitigation</a>)</em> would benefit the health of Americans in the near and long term.<sup id="fnref:f1e633d5-070a-4a7d-935b-a2281a0c9cb6"><a href="#fn:1" rel="footnote" onclick="return false;">1</a></sup><sup class="cm">,</sup><sup id="fnref:500f3756-66d0-4ff2-be29-5d3dab373b30"><a href="#fn:155" rel="footnote" onclick="return false;">155</a></sup> Adverse health effects attributed to climate change have many potential economic and social costs, including medical expenses, caregiving services, or lost productivity, as well as costs that are harder to quantify, such as those associated with pain, suffering, inconvenience, or reduced enjoyment of leisure activities.<sup id="fnref:21f384a2-0dcf-4c1a-b1c0-add8b0e7506c"><a href="#fn:156" rel="footnote" onclick="return false;">156</a></sup> These health burdens are typically borne by the affected individual as well as family, friends, employers, communities, and insurance or assistance programs.</p> <p>Under a lower scenario (RCP4.5) by the end of this century, thousands of lives could be saved and hundreds of billions of dollars of health-related costs could be avoided compared to a higher scenario (RCP8.5).<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup> Annual health impacts (including from temperature extremes, poor air quality, and vector-borne diseases) and health-related costs are projected to be approximately 50% less under a lower scenario (RCP4.5) than under a higher scenario (RCP8.5) (methods are summarized in Traceable Accounts) <em>(see also <a href="/chapter/13">Ch. 13: Air Quality</a>)</em>.<sup id="fnref:4308e866-5976-4181-8102-24b521ff4033"><a href="#fn:37" rel="footnote" onclick="return false;">37</a></sup><sup class="cm">,</sup><sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup><sup class="cm">,</sup><sup id="fnref:0006123e-10a3-4501-a89c-95a7921a9c3d"><a href="#fn:158" rel="footnote" onclick="return false;">158</a></sup><sup class="cm">,</sup><sup id="fnref:00234d41-c8e2-49c1-8b7a-8a2c0ad9b6df"><a href="#fn:159" rel="footnote" onclick="return false;">159</a></sup><sup class="cm">,</sup><sup id="fnref:6e83fde3-5f98-4fd1-ae2c-d11aced414ac"><a href="#fn:160" rel="footnote" onclick="return false;">160</a></sup><sup class="cm">,</sup><sup id="fnref:a5d430bc-5756-42d1-924f-3dbc927e69c4"><a href="#fn:161" rel="footnote" onclick="return false;">161</a></sup><sup class="cm">,</sup><sup id="fnref:f9703346-dc6b-4b3e-aad6-2643c74f5292"><a href="#fn:162" rel="footnote" onclick="return false;">162</a></sup><sup class="cm">,</sup><sup id="fnref:8e30bef3-ce8e-4df4-879b-21f809b02998"><a href="#fn:163" rel="footnote" onclick="return false;">163</a></sup><sup class="cm">,</sup><sup id="fnref:bbca6337-718b-4289-b6e7-0a2f6c1cb8f1"><a href="#fn:164" rel="footnote" onclick="return false;">164</a></sup><sup class="cm">,</sup><sup id="fnref:28077cd1-c29f-48ae-a068-2cdcef880807"><a href="#fn:165" rel="footnote" onclick="return false;">165</a></sup><sup class="cm">,</sup><sup id="fnref:54a66159-1675-43bb-b5d3-a9b7f283e4de"><a href="#fn:166" rel="footnote" onclick="return false;">166</a></sup><sup class="cm">,</sup><sup id="fnref:fad9e8ec-8951-4daa-9a9c-e093ef86af16"><a href="#fn:167" rel="footnote" onclick="return false;">167</a></sup> The projected lives saved and economic benefits are likely to underestimate the true value because they do not include benefits of impacts that are difficult to quantify, such as mental health or long-term health impacts <em>(see the <a href="/chapter/appendix-3#section-2">Scenario Products Section in App. 3</a> for more on scenarios)</em>.</p> <h3>Temperature-Related Mortality</h3> <p>The projected increase in the annual number of heat wave days is substantially reduced under a lower scenario (RCP4.5) compared to a higher scenario (RCP8.5), reducing heat wave intensities<sup id="fnref:a5d430bc-5756-42d1-924f-3dbc927e69c4"><a href="#fn:161" rel="footnote" onclick="return false;">161</a></sup><sup class="cm">,</sup><sup id="fnref:ea2ea20a-5d62-49ac-a89b-9a7951711a1b"><a href="#fn:168" rel="footnote" onclick="return false;">168</a></sup> and resulting in fewer high-mortality heat waves<sup id="fnref:f9703346-dc6b-4b3e-aad6-2643c74f5292"><a href="#fn:162" rel="footnote" onclick="return false;">162</a></sup><sup class="cm">,</sup><sup id="fnref:ea2ea20a-5d62-49ac-a89b-9a7951711a1b"><a href="#fn:168" rel="footnote" onclick="return false;">168</a></sup> without considering adaptation (Figure 14.4). In 49 large cities in the United States, changes in extreme hot and extreme cold temperatures are projected to result in more than 9,000 additional premature deaths per year under a higher scenario by the end of the century, although this number would be lower if considering acclimatization or other adaptations (for example, increased use of air conditioning). Under a lower scenario, more than half of these deaths could be avoided each year. Annual damages associated with the additional extreme temperature-related deaths in 2090 were projected to be $140 billion (in 2015 dollars) under a higher scenario (RCP8.5) and $60 billion under a lower scenario (RCP4.5).<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup></p> </div> <section id="fig-14-4" class="offset-lg-1 col-lg-7 big-figure figure"> <div class="figure-social-icons"> <a role="button" href="/img/figure/figure14_4.png" aria-label="Download" title="Download" class="download_a qtip-top" download></a>  <a role="button" href="/report/nca4/chapter/human-health/figure/projected-extreme-temperature-mortality" aria-label="Metadata" title="Metadata" class="metadata_a qtip-top" ></a>  <a role="button" href="#" aria-label="Share this content" title="Share" class="share qtip-bottom" ></a> <div class="social-icons"> <a role="button" href="#" aria-label="Share this content on Facebook" data-fb-image="https://nca2018.globalchange.gov/img/figure/figure14_4.png" data-fb-title="Fourth National Climate Assessment: Projected Change in Annual Extreme Temperature Mortality" class="social-icon facebook-icon"></a> <a role="button" href="https://www.twitter.com/intent/tweet?url=https://nca2018.globalchange.gov/chapter/14%23fig-14-4&text=Fourth%20National%20Climate%20Assessment:%20Figure%2014.4:%20Projected%20Change%20in%20Annual%20Extreme%20Temperature%20Mortality&via=usgcrp&hashtags=NCA4" aria-label="Share this content on Twitter" class="social-icon twitter-icon" target="_blank"></a> <a role="button" href="#" aria-label="Share the link to this content" class="social-icon link-icon"></a> <a role="button" href="mailto:?subject=Shared%20With%20You:%20Fourth%20National%20Climate%20Assessment&body=Check%20out%20this%20site:%20https://nca2018.globalchange.gov/chapter/14#fig-14-4" aria-label="Share this content via e-mail" class="social-icon email-icon"></a> <div class="link-content"><input aria-label="Link to content" type="text" value="https://nca2018.globalchange.gov/chapter/14#fig-14-4" readonly/></div> </div> </div> <h2>Figure 14.4: Projected Change in Annual Extreme Temperature Mortality</h2> <div style="width: 80%;" class="figure-inner"> <a class="lightbox" href="/img/figure/figure14_4.png" data-title='Figure 14.4 Projected Change in Annual Extreme Temperature Mortality'> <picture> <source media="(min-width: 1200px)" data-srcset="/img/styles/figure14_4-1200.png, /img/styles/figure14_4-1200@2x.png 2x"> <source media="(min-width: 992px)" data-srcset="/img/styles/figure14_4-992.png, /img/styles/figure14_4-992@2x.png 2x"> <source media="(min-width: 768px)" data-srcset="/img/styles/figure14_4-768.png, /img/styles/figure14_4-768@2x.png 2x"> <source media="(min-width: 480px)" data-srcset="/img/styles/figure14_4-480.png, /img/styles/figure14_4-480@2x.png 2x"> <source media="(min-width: 320px)" data-srcset="/img/styles/figure14_4-320.png, /img/styles/figure14_4-320@2x.png 2x"> <img data-src="/img/figure/figure14_4.png" alt="Projected Change in Annual Extreme Temperature Mortality" class="big-img img-fluid lazyload" aria-describedby="description-14-4" /> </picture> </a> <aside id="description-14-4" class="sr-only">Two maps of the continental United States show estimated changes in annual net mortality (in deaths per 100,000 people) due to extremely hot and cold days in 49 U.S. cities for 2080 to 2099 (compared to 1989 to 2000) under a lower scenario (RCP4.5) and a higher scenario (RCP8.5). Under the lower scenario, mortality rates across most cities are projected to increase by 210,000 to 600,000 deaths per year. Orlando, Florida, is projected to experience the greatest change—an additional 610,000 to 800,000 deaths per year. Under the higher scenario, the majority of major U.S. cities are projected to experience an additional 610,000 to 1 million deaths per year. Under both scenarios, mortality rates are higher in the eastern half of the United States.</aside> <div class="caption" data-href="/img/figure/figure14_4.png" data-title='Figure 14.4 Projected Change in Annual Extreme Temperature Mortality'><strong>Figure 14.4: </strong>The maps show estimated changes in annual net mortality due to extremely hot and cold days in 49 U.S. cities for 2080–2099 as compared to 1989–2000. Across these cities, the change in mortality is projected to be an additional 9,300 deaths each year under a higher scenario (RCP8.5) and 3,900 deaths each year under a lower scenario (RCP4.5). Assuming a future in which the human health response to extreme temperatures in all 49 cities was equal to that of Dallas today (for example, as a result of availability of air conditioning or physiological adaptation) results in an approximate 50% reduction in these mortality estimates. For example, in Atlanta, an additional 349 people are projected to die from extreme temperatures each year by the end of century under RCP8.5. Assuming residents of Atlanta in 2090 have the adaptive capacity of Dallas residents today, this number is reduced to 128 additional deaths per year. Cities without circles should not be interpreted as having no extreme temperature impact. Data not available for the U.S. Caribbean, Alaska, or Hawai‘i & U.S.-Affiliated Pacific Islands regions. Source: adapted from EPA 2017.<sup id='fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94'><a href='#fn:157' rel='footnote' onclick='return false;'>157</a></sup></div> <p class="text-center"><span class="view-figure"><a role="button" class="shrink" href="#">SHRINK</a></span></p> </div> </section> <div class="offset-lg-1 col-lg-7"> <h3>Labor Productivity</h3> <p>Under a higher scenario (RCP8.5), almost two billion labor hours are projected to be lost annually by 2090 from the impacts of temperature extremes, costing an estimated $160 billion in lost wages (in 2015 dollars) <em>(<a href="/chapter/1#fig-1-21">Ch. 1: Overview, Figure 1.21</a>)</em>.<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup><sup class="cm">,</sup><sup id="fnref:fad9e8ec-8951-4daa-9a9c-e093ef86af16"><a href="#fn:167" rel="footnote" onclick="return false;">167</a></sup><sup class="cm">,</sup><sup id="fnref:8f2308d0-7a25-4c47-82e0-cb9196f1de8b"><a href="#fn:169" rel="footnote" onclick="return false;">169</a></sup> States within the Southeast and Southern Great Plains regions are projected to experience higher impacts, with labor productivity in jobs with greater exposure to heat projected to decline by 3% <em>(<a href="/chapter/19">Ch. 19: Southeast</a>)</em>.<sup id="fnref:bbca6337-718b-4289-b6e7-0a2f6c1cb8f1"><a href="#fn:164" rel="footnote" onclick="return false;">164</a></sup><sup class="cm">,</sup><sup id="fnref:62152261-5dbb-4723-9506-ef63053863dd"><a href="#fn:170" rel="footnote" onclick="return false;">170</a></sup> Some counties in Texas and Florida are projected to experience more than 6% losses in annual labor hours by the end of the century.<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup><sup class="cm">,</sup><sup id="fnref:6e83fde3-5f98-4fd1-ae2c-d11aced414ac"><a href="#fn:160" rel="footnote" onclick="return false;">160</a></sup></p> <h3>Infectious Diseases</h3> <p>Annual national cases of West Nile neuroinvasive disease are projected to more than double by 2050 due to increasing temperatures, among other factors,<sup id="fnref:dbfb7cd9-7c82-43ea-a4e2-9e2eb0b851fd"><a href="#fn:30" rel="footnote" onclick="return false;">30</a></sup><sup class="cm">,</sup><sup id="fnref:110b6896-b3e8-4af4-9c57-70cd5dcc49b0"><a href="#fn:171" rel="footnote" onclick="return false;">171</a></sup> resulting in approximately $1 billion per year in hospitalization costs and premature deaths under a higher scenario (RCP8.5; in 2015 dollars).<sup id="fnref:4308e866-5976-4181-8102-24b521ff4033"><a href="#fn:37" rel="footnote" onclick="return false;">37</a></sup> In this same scenario, an additional 3,300 cases and $3.3 billion in costs (in 2015 dollars) are projected each year by the end of the century. Approximately half of these cases and costs would be avoided under a lower scenario (RCP4.5).<sup id="fnref:4308e866-5976-4181-8102-24b521ff4033"><a href="#fn:37" rel="footnote" onclick="return false;">37</a></sup><sup class="cm">,</sup><sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup></p> <h3>Water Quality</h3> <p>By the end of the century, warming under a higher scenario (RCP8.5) is projected to increase the length of time recreational waters have concentrations of harmful algal blooms (cyanobacteria) above the recommended public health threshold by one month annually; these bacteria can produce a range of toxins that can cause gastrointestinal illness, neurological disorders, and other illnesses.<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup><sup class="cm">,</sup><sup id="fnref:28077cd1-c29f-48ae-a068-2cdcef880807"><a href="#fn:165" rel="footnote" onclick="return false;">165</a></sup> The increase in the number of days where recreational waters pose this health risk is almost halved under a lower scenario (RCP4.5).<strong><span class="underline"><br /> </span></strong></p> </div> </div> </section> <section id="section-98" class="container-fluid report-section no-spacer-2 blackish glossary clearfix"> <div class="offset-lg-1 col-lg-7 node-narrative" aria-flowto="content-14-98"> </div> <div id="content-14-98"><section id="traceable-accounts" class="container-fluid"> <div class="row report-section"> <div class="col-lg-12 traceable-accounts-header"> <h2 role="button" class="btn-traceable-accounts">TRACEABLE ACCOUNTS <i class="fa fa-chevron-circle-down"></i></h2> </div> <div class="traceable-accounts"> <div class="offset-lg-1 col-lg-7"> <h3>Process Description</h3> <p>The chapter evaluated the scientific evidence of the health risks of climate change, focusing primarily on the literature published since the cut off date (approximately fall 2015) of the U.S. Climate and Health Assessment.<sup id="fnref:f1e633d5-070a-4a7d-935b-a2281a0c9cb6"><a href="#fn:1" rel="footnote" onclick="return false;">1</a></sup> A comprehensive literature search was performed by federal contractors in December 2016 for studies published since January 1, 2014, using PubMed, Scopus, and Web of Science. An Excel file containing 2,477 peer-reviewed studies was provided to the author team for it to consider in this assessment. In addition to the literature review, the authors considered recommended studies submitted in comments by the public, the National Academies of Sciences, Engineering, and Medicine, and federal agencies. The focus of the literature was on health risks in the United States, with limited citations from other countries providing insights into risks Americans are or will likely face with climate change. A full description of the search strategy can be found at <a href="https://www.niehs.nih.gov/CCHH_Search_Strategy_NCA4_508.pdf">https://www.niehs.nih.gov/CCHH_Search_Strategy_NCA4_508.pdf</a>. The chapter authors were chosen based on their expertise in the health risks of climate change. Teleconferences were held with interested researchers and practitioners in climate change and health and with authors in other chapters of this Fourth National Climate Assessment (NCA4).</p> <p>The U.S. Climate and Health Assessment<sup id="fnref:f1e633d5-070a-4a7d-935b-a2281a0c9cb6"><a href="#fn:1" rel="footnote" onclick="return false;">1</a></sup> did not consider adaptation or mitigation, including economic costs and benefits, so the literature cited includes research from earlier years where additional information was relevant to this assessment.</p> <p>For NCA4, Air Quality was added as a report chapter. Therefore, while Key Messages in this Health chapter include consideration of threats to human health from worsened air quality, the assessment of these risks and impacts are covered in Chapter 13: Air Quality. Similarly, co-benefits of reducing greenhouse gas emissions are covered in the Air Quality chapter.</p> <hr/> <h2 class="text-center">KEY MESSAGES</h2> <nav class="nav nav-tabs justify-content-center" id="ta-tab" role="tablist"> <a class="nav-item nav-link active" id="ta-1-tab" data-toggle="tab" href="#tab-1" role="tab" aria-controls="tab-1" aria-expanded="true">1</a> <a class="nav-item nav-link" id="ta-2-tab" data-toggle="tab" href="#tab-2" role="tab" aria-controls="tab-2" aria-expanded="false">2</a> <a class="nav-item nav-link" id="ta-3-tab" data-toggle="tab" href="#tab-3" role="tab" aria-controls="tab-3" aria-expanded="false">3</a> <a class="nav-item nav-link" id="ta-4-tab" data-toggle="tab" href="#tab-4" role="tab" aria-controls="tab-4" aria-expanded="false">4</a> </nav> <div class="tab-content" id="nav-tabContent"> <div class="tab-pane fade active show" id="tab-1" role="tabpanel" aria-labelledby="ta-1-tab" aria-expanded="true"> <h3>Key Message 1: Climate Change Affects the Health of All Americans</h3> <blockquote class="blockquote"> <p>The health and well-being of Americans are already affected by climate change (<em>very high confidence</em>), with the adverse health consequences projected to worsen with additional climate change (<em>likely, high confidence</em>). Climate change affects human health by altering exposures to heat waves, floods, droughts, and other extreme events; vector-, food- and waterborne infectious diseases; changes in the quality and safety of air, food, and water; and stresses to mental health and well-being.</p> </blockquote> <h4>Description of evidence base</h4> <p>Multiple lines of evidence demonstrate statistically significant associations between temperature, precipitation, and other variables and adverse climate-sensitive health outcomes, indicating sensitivity to weather patterns.<sup id="fnref:f1e633d5-070a-4a7d-935b-a2281a0c9cb6"><a href="#fn:1" rel="footnote" onclick="return false;">1</a></sup> These lines of evidence also demonstrate that vulnerability varies across sub-populations and geographic areas; populations with higher vulnerability include poor people in high-income regions, minority groups, women, children, the disabled, those living alone, those with poor health status, Indigenous people, older adults, outdoor workers, people displaced because of weather and climate, low-income residents that lack a social network, poorly planned communities, communities disproportionately burdened by poor environmental quality, the disenfranchised, those with less access to healthcare, and those with limited financial resources to rebound from disasters.<sup id="fnref:b9638744-8ff8-41bd-a741-27b2fda9face"><a href="#fn:108" rel="footnote" onclick="return false;">108</a></sup><sup class="cm">,</sup><sup id="fnref:409668a7-2e7b-461b-953a-ac0d6fb90725"><a href="#fn:109" rel="footnote" onclick="return false;">109</a></sup><sup class="cm">,</sup><sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup><sup class="cm">,</sup><sup id="fnref:cdf943a1-008a-4b9a-93d4-d0e49df114ae"><a href="#fn:111" rel="footnote" onclick="return false;">111</a></sup><sup class="cm">,</sup><sup id="fnref:f85a7ac1-b6ad-49b6-ba44-881259d28775"><a href="#fn:118" rel="footnote" onclick="return false;">118</a></sup><sup class="cm">,</sup><sup id="fnref:dae0a009-a0ca-498e-ab92-12d1bd644db7"><a href="#fn:172" rel="footnote" onclick="return false;">172</a></sup> Recent research confirms projections that the magnitude and pattern of risks are expected to increase as climate change continues across the century.<sup id="fnref:75cf1c0b-cc62-4ca4-96a7-082afdfe2ab1"><a href="#fn:173" rel="footnote" onclick="return false;">173</a></sup></p> <h4>Major uncertainties</h4> <p>The role of non-climate factors, including socioeconomic conditions, population characteristics, and human behavior, as well as health sector policies and practices, will continue to make it challenging to attribute injuries, illnesses, and deaths to climate change. Inadequate consideration of these factors creates uncertainties in projections of the magnitude and pattern of health risks over coming decades. Certainty is higher in near-term projections where there is greater understanding of future trends.</p> <h4>Description of confidence and likelihood</h4> <p>There is <em>very high confidence</em> that climate change is affecting the health of Americans. There is <em>high confidence</em> that climate-related health risks, without additional adaptation and mitigation, will <em>likely</em> increase with additional climate change.</p> </div> <div class="tab-pane fade" id="tab-2" role="tabpanel" aria-labelledby="ta-2-tab" aria-expanded="true"> <h3>Key Message 2: Exposure and Resilience Vary Across Populations and Communities</h3> <blockquote class="blockquote"> <p>People and communities are differentially exposed to hazards and disproportionately affected by climate-related health risks (<em>high confidence</em>). Populations experiencing greater health risks include children, older adults, low-income communities, and some communities of color (<em>high confidence</em>).</p> </blockquote> <h4>Description of evidence base</h4> <p>Multiple lines of evidence demonstrate that low-income communities and some communities of color are experiencing higher rates of exposure to adverse environmental conditions and social conditions that can reduce their resilience to the impacts of climate change.<sup id="fnref:c76d7935-9da3-4c4b-9186-86dc658bcc74"><a href="#fn:106" rel="footnote" onclick="return false;">106</a></sup><sup class="cm">,</sup><sup id="fnref:efed1341-a8a0-4743-8ec6-5fa87142a4e3"><a href="#fn:107" rel="footnote" onclick="return false;">107</a></sup><sup class="cm">,</sup><sup id="fnref:b9638744-8ff8-41bd-a741-27b2fda9face"><a href="#fn:108" rel="footnote" onclick="return false;">108</a></sup><sup class="cm">,</sup><sup id="fnref:409668a7-2e7b-461b-953a-ac0d6fb90725"><a href="#fn:109" rel="footnote" onclick="return false;">109</a></sup><sup class="cm">,</sup><sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup> Populations with increased health and social vulnerability typically have less access to information, resources, institutions, and other factors to prepare for and avoid the health risks of climate change.<sup id="fnref:efed1341-a8a0-4743-8ec6-5fa87142a4e3"><a href="#fn:107" rel="footnote" onclick="return false;">107</a></sup><sup class="cm">,</sup><sup id="fnref:85c390fe-4d9b-4713-95d1-2e6b83c01478"><a href="#fn:132" rel="footnote" onclick="return false;">132</a></sup><sup class="cm">,</sup><sup id="fnref:edf0082f-a1b6-48ef-b8d4-e20a458e4bc8"><a href="#fn:133" rel="footnote" onclick="return false;">133</a></sup> Across all climate-related health risks, children, older adults, low-income communities, and some communities of color are disproportionately impacted. There is high agreement among experts but fewer analyses demonstrating that other populations with increased vulnerability include outdoor workers, communities disproportionately burdened by poor environmental quality, communities in the rural southeastern United States, women, pregnant women, those experiencing gender discrimination, persons with chronic physical and mental illness, persons with various disabilities (such as those affecting mobility, long-term health, sensory perception, cognition), the homeless, those living alone, Indigenous people, people displaced because of weather and climate, low-income residents who lack a social network, poorly planned communities, the disenfranchised, those with less access to healthcare, the uninsured and underinsured, those living in inadequate housing, and those with limited financial resources to rebound from disasters.<sup id="fnref:c76d7935-9da3-4c4b-9186-86dc658bcc74"><a href="#fn:106" rel="footnote" onclick="return false;">106</a></sup><sup class="cm">,</sup><sup id="fnref:efed1341-a8a0-4743-8ec6-5fa87142a4e3"><a href="#fn:107" rel="footnote" onclick="return false;">107</a></sup><sup class="cm">,</sup><sup id="fnref:b9638744-8ff8-41bd-a741-27b2fda9face"><a href="#fn:108" rel="footnote" onclick="return false;">108</a></sup><sup class="cm">,</sup><sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup><sup class="cm">,</sup><sup id="fnref:f85a7ac1-b6ad-49b6-ba44-881259d28775"><a href="#fn:118" rel="footnote" onclick="return false;">118</a></sup></p> <p>Adaptation can increase the climate resilience of populations when the process of developing and implementing policies and measures includes understanding the ethical and human rights dimensions of climate change, meeting human needs in a sustainable and equitable way, and engaging with representatives of the most impacted communities to assess the challenges they face and to define the climate solutions.<sup id="fnref:7f89e40a-7681-4475-a754-91e81baabd95"><a href="#fn:124" rel="footnote" onclick="return false;">124</a></sup><sup class="cm">,</sup><sup id="fnref:35b1782d-ec59-40d5-b051-c5a80e2516e1"><a href="#fn:125" rel="footnote" onclick="return false;">125</a></sup></p> <h4>Major uncertainties</h4> <p>The role of non-climate factors, including socioeconomic conditions, discrimination (racial and ethnic, gender, persons with disabilities), psychosocial stressors, and the continued challenge to measure the cumulative effects of past, present, and future environmental exposures on certain people and communities will continue to make it challenging to attribute injuries, illnesses, and deaths to climate change. While there is no universal framework for building more resilient communities that can address the unique situations across the United States, factors integral to community resilience include the importance of social networks, the value of including community voice in the planning and execution of solutions, and the co-benefits of institutional readiness to address the physical, health, and social needs of impacted communities. These remain hard to quantify.<sup id="fnref:cab3885c-a808-40f4-9b4a-79808bbdf202"><a href="#fn:127" rel="footnote" onclick="return false;">127</a></sup><sup class="cm">,</sup><sup id="fnref:6ffe484d-3eb7-494b-ad4c-678657585f98"><a href="#fn:128" rel="footnote" onclick="return false;">128</a></sup></p> <h4>Description of confidence and likelihood</h4> <p>There is <em>high confidence</em> that climate change is disproportionately affecting the health of children, older adults, low-income communities, communities of color, tribal and Indigenous communities, and many other distinct populations. And there is <em>high confidence</em> that some of the most vulnerable populations experience greater barriers to accessing resources, information, and tools to build resilience.</p> </div> <div class="tab-pane fade" id="tab-3" role="tabpanel" aria-labelledby="ta-3-tab" aria-expanded="true"> <h3>Key Message 3: Adaptation Reduces Risks and Improves Health</h3> <blockquote class="blockquote"> <p>Proactive adaptation policies and programs reduce the risks and impacts from climate-sensitive health outcomes and from disruptions in healthcare services (<em>medium confidence</em>). Additional benefits to health arise from explicitly accounting for climate change risks in infrastructure planning and urban design (<em>low confidence</em>).</p> </blockquote> <h4>Description of evidence base</h4> <p>Health adaptation is taking place from local to national scales.<sup id="fnref:a6d2d472-b084-4805-9f08-cc5e1f95f668"><a href="#fn:129" rel="footnote" onclick="return false;">129</a></sup><sup class="cm">,</sup><sup id="fnref:2e9e29a1-e420-4d1f-b12b-53ccde149660"><a href="#fn:148" rel="footnote" onclick="return false;">148</a></sup><sup class="cm">,</sup><sup id="fnref:f82a2e76-95bb-4a33-8877-8c16ca217397"><a href="#fn:174" rel="footnote" onclick="return false;">174</a></sup> Because most of the health risks of climate change are also current public health problems, strengthening standard health system policies and programs, such as monitoring and surveillance, are expected to be effective in the short term in addressing the additional health risks of climate change. Modifications to explicitly incorporate climate change are important to ensure effectiveness as the climate continues to change. Incorporating environmentally friendly practices into healthcare and infrastructure can promote resilience.<sup id="fnref:05ee299b-0f67-41b4-98c8-7f06718799fc"><a href="#fn:151" rel="footnote" onclick="return false;">151</a></sup></p> <h4>Major uncertainties</h4> <p>Overall, while there is considerable evidence of the effectiveness of public health programs,<sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup><sup class="cm">,</sup><sup id="fnref:a6d2d472-b084-4805-9f08-cc5e1f95f668"><a href="#fn:129" rel="footnote" onclick="return false;">129</a></sup><sup class="cm">,</sup><sup id="fnref:310a452b-67cd-458c-8a4d-056dba42ecef"><a href="#fn:130" rel="footnote" onclick="return false;">130</a></sup> the effectiveness of policies and programs to reduce <em>future</em> burdens of climate-sensitive health outcomes in a changing climate can only be determined over coming decades. The relatively short time period of implementing health adaptation programs means uncertainties remain about how to best incorporate climate change into existing policies and programs to manage climate-sensitive health outcomes and about which interventions will likely be most effective as the climate continues to change.<sup id="fnref:f82a2e76-95bb-4a33-8877-8c16ca217397"><a href="#fn:174" rel="footnote" onclick="return false;">174</a></sup><sup class="cm">,</sup><sup id="fnref:93b59cc9-ade0-45fe-9f08-79b0c00da931"><a href="#fn:175" rel="footnote" onclick="return false;">175</a></sup> For example, heat wave early warning and response systems save lives, but it is not clear which components most effectively contribute to morbidity and mortality reduction.</p> <h4>Description of confidence and likelihood</h4> <p>There is <em>medium confidence</em> that with sufficient human and financial resources, adaptation policies and programs can reduce the current burden of climate-sensitive health outcomes.<sup id="fnref:289728b3-ae8b-417e-920e-96af1a5e64b3"><a href="#fn:110" rel="footnote" onclick="return false;">110</a></sup><sup class="cm">,</sup><sup id="fnref:05ee299b-0f67-41b4-98c8-7f06718799fc"><a href="#fn:151" rel="footnote" onclick="return false;">151</a></sup><sup class="cm">,</sup><sup id="fnref:733c8418-ec60-42e0-b256-9800ba3816c4"><a href="#fn:176" rel="footnote" onclick="return false;">176</a></sup><sup class="cm">,</sup><sup id="fnref:46f2571e-7661-4163-9178-bee1d153a827"><a href="#fn:177" rel="footnote" onclick="return false;">177</a></sup> There is <em>low confidence</em> that the incorporation of health risks into infrastructure and urban planning and design will likely decrease climate-sensitive health impacts.</p> </div> <div class="tab-pane fade" id="tab-4" role="tabpanel" aria-labelledby="ta-4-tab" aria-expanded="true"> <h3>Key Message 4: Reducing Greenhouse Gas Emissions Results in Health and Economic Benefits</h3> <blockquote class="blockquote"> <p>Reducing greenhouse gas emissions would benefit the health of Americans in the near and long term (<em>high confidence</em>). By the end of this century, thousands of American lives could be saved and hundreds of billions of dollars in health-related economic benefits gained each year under a pathway of lower greenhouse gas emissions (<em>likely, medium confidence</em>).</p> </blockquote> <h4>Description of evidence base</h4> <p>Benefits of mitigation associated with air quality, including co-benefits of reducing greenhouse gas emissions, can be found in Chapter 13: Air Quality. This Key Message is consistent with and inclusive of those findings.</p> <p>Multiple individual lines of evidence across several health topic areas demonstrate significant benefits of greenhouse gas emission reductions, with health impacts and health-related costs reduced by approximately half under RCP4.5 compared to RCP8.5 by the end of the century, based on comprehensive multisector quantitative analyses of economic impacts projected under consistent scenarios <em>(<a href="/chapter/13">Ch. 13: Air Quality</a>)</em>.<sup id="fnref:4308e866-5976-4181-8102-24b521ff4033"><a href="#fn:37" rel="footnote" onclick="return false;">37</a></sup><sup class="cm">,</sup><sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup><sup class="cm">,</sup><sup id="fnref:0006123e-10a3-4501-a89c-95a7921a9c3d"><a href="#fn:158" rel="footnote" onclick="return false;">158</a></sup><sup class="cm">,</sup><sup id="fnref:00234d41-c8e2-49c1-8b7a-8a2c0ad9b6df"><a href="#fn:159" rel="footnote" onclick="return false;">159</a></sup><sup class="cm">,</sup><sup id="fnref:6e83fde3-5f98-4fd1-ae2c-d11aced414ac"><a href="#fn:160" rel="footnote" onclick="return false;">160</a></sup><sup class="cm">,</sup><sup id="fnref:a5d430bc-5756-42d1-924f-3dbc927e69c4"><a href="#fn:161" rel="footnote" onclick="return false;">161</a></sup><sup class="cm">,</sup><sup id="fnref:f9703346-dc6b-4b3e-aad6-2643c74f5292"><a href="#fn:162" rel="footnote" onclick="return false;">162</a></sup><sup class="cm">,</sup><sup id="fnref:8e30bef3-ce8e-4df4-879b-21f809b02998"><a href="#fn:163" rel="footnote" onclick="return false;">163</a></sup><sup class="cm">,</sup><sup id="fnref:bbca6337-718b-4289-b6e7-0a2f6c1cb8f1"><a href="#fn:164" rel="footnote" onclick="return false;">164</a></sup><sup class="cm">,</sup><sup id="fnref:28077cd1-c29f-48ae-a068-2cdcef880807"><a href="#fn:165" rel="footnote" onclick="return false;">165</a></sup><sup class="cm">,</sup><sup id="fnref:54a66159-1675-43bb-b5d3-a9b7f283e4de"><a href="#fn:166" rel="footnote" onclick="return false;">166</a></sup><sup class="cm">,</sup><sup id="fnref:fad9e8ec-8951-4daa-9a9c-e093ef86af16"><a href="#fn:167" rel="footnote" onclick="return false;">167</a></sup> The economic benefits of greenhouse gas emissions reductions to the health sector could be on the order of hundreds of billions of dollars annually by the end of the century.</p> <p><em>Heat</em>: Greenhouse gas emission reductions under RCP4.5 could substantially reduce the annual number of heat wave days (for example, by 21 in the Northwest and by 43 in the Southeast by the end of the century);<sup id="fnref:a5d430bc-5756-42d1-924f-3dbc927e69c4"><a href="#fn:161" rel="footnote" onclick="return false;">161</a></sup> the number of high-mortality heat waves;<sup id="fnref:f9703346-dc6b-4b3e-aad6-2643c74f5292"><a href="#fn:162" rel="footnote" onclick="return false;">162</a></sup><sup class="cm">,</sup><sup id="fnref:ea2ea20a-5d62-49ac-a89b-9a7951711a1b"><a href="#fn:168" rel="footnote" onclick="return false;">168</a></sup> and heat wave intensities.<sup id="fnref:a5d430bc-5756-42d1-924f-3dbc927e69c4"><a href="#fn:161" rel="footnote" onclick="return false;">161</a></sup><sup class="cm">,</sup><sup id="fnref:ea2ea20a-5d62-49ac-a89b-9a7951711a1b"><a href="#fn:168" rel="footnote" onclick="return false;">168</a></sup> The EPA (2017)<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup> estimated city-specific relationships between daily deaths (from all causes) and extreme temperatures based on historical observations that were combined with the projections of extremely hot and cold days (average of three years centered on 2050 and 2090) using city-specific extreme temperature thresholds to project future deaths from extreme heat and cold under RCP8.5 and RCP4.5 in five global climate models (GCMs). In 49 large U.S. cities, changes in extreme temperatures are projected to result in over 9,000 premature deaths per year under RCP8.5 by the end of the century without adaptation ($140 billion each year); under RCP4.5, more than half these deaths could be avoided annually ($60 billion each year).<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup></p> <p><em>Labor productivity</em>: Hsiang et al. (2017)<sup id="fnref:fad9e8ec-8951-4daa-9a9c-e093ef86af16"><a href="#fn:167" rel="footnote" onclick="return false;">167</a></sup> and the EPA (2017)<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup> estimated the number of labor hours from changes in extreme temperatures using dose–response functions for the relationship between temperature and labor from Graff Zivin and Neidell (2014).<sup id="fnref:8f2308d0-7a25-4c47-82e0-cb9196f1de8b"><a href="#fn:169" rel="footnote" onclick="return false;">169</a></sup> Under RCP8.5, almost 2 billion labor hours are projected to be lost annually by 2090 from the impacts of extreme heat and cold, costing an estimated $160 billion in lost wages. The Southeast<sup id="fnref:bbca6337-718b-4289-b6e7-0a2f6c1cb8f1"><a href="#fn:164" rel="footnote" onclick="return false;">164</a></sup><sup class="cm">,</sup><sup id="fnref:62152261-5dbb-4723-9506-ef63053863dd"><a href="#fn:170" rel="footnote" onclick="return false;">170</a></sup> and Southern Plains are projected to experience high impacts, with labor productivity in high-risk sectors projected to decline by 3%. Some counties in Texas and Florida are projected to experience more than 6% losses in annual labor hours by the end of the century.<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup><sup class="cm">,</sup><sup id="fnref:6e83fde3-5f98-4fd1-ae2c-d11aced414ac"><a href="#fn:160" rel="footnote" onclick="return false;">160</a></sup></p> <p><em>Vector-borne disease</em>: Belova et al. (2017)<sup id="fnref:4308e866-5976-4181-8102-24b521ff4033"><a href="#fn:37" rel="footnote" onclick="return false;">37</a></sup> and the EPA (2017)<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup> define health impact functions from regional associations between temperatures and the probability of above-average West Nile neuroinvasive disease (WNND) incidence to estimate county-level expected WNND incidence rates for a 1995 reference period (1986–2005) and two future years (2050: 2040–2059 and 2090: 2080–2099) using temperature data from five GCMs. Annual national cases of WNND are projected to more than double by 2050 due to increasing temperatures, resulting in approximately $1 billion per year in hospitalization costs and premature deaths. In 2090, an additional 3,300 annual cases are projected under RCP8.5, with $3.3 billion per year in costs. Greenhouse gas emission reductions under RCP4.5 could avoid approximately half these cases and costs.</p> <p><em>Water quality</em>: Chapra et al. (2017)<sup id="fnref:28077cd1-c29f-48ae-a068-2cdcef880807"><a href="#fn:165" rel="footnote" onclick="return false;">165</a></sup> and the EPA (2017)<sup id="fnref:0b30f1ab-e4c4-4837-aa8b-0e19faccdb94"><a href="#fn:157" rel="footnote" onclick="return false;">157</a></sup> evaluate the biophysical impacts of climate change on the occurrence of cyanobacterial harmful algal blooms in the contiguous United States using models that project rainfall runoff, water demand, water resources systems, water quality, and algal growth. In 2090, warming under RCP8.5 is projected to increase the length of time that recreational waters have concentrations of harmful algal blooms (cyanobacteria) above the recommended public health threshold by one month annually; greenhouse gas emissions under RCP4.5 could reduce this by two weeks.</p> <p><em>Food safety and nutrition</em>: There is limited evidence quantifying specific health outcomes or economic impacts of reduced food safety and nutrition.</p> <h4>Major uncertainties</h4> <p>While projections consistently indicate that changes in climate are expected to have negative health consequences, quantifying specific health outcomes (for example, number of cases, number of premature deaths) remains challenging, as noted in Key Message 1. Economic estimates only partially capture and monetize impacts across each health topic area, which means that damage costs are likely to be an undervaluation of the actual health impacts that would occur under any given scenario. Economic estimates in this chapter do not include costs to the healthcare system.</p> <h4>Description of confidence and likelihood</h4> <p>There is a <em>high confidence</em> that a reduction in greenhouse gas emissions would benefit the health of Americans. There is <em>medium confidence</em> that reduced greenhouse gas emissions under RCP4.5 compared to RCP8.5 will <em>likely</em> reduce lost labor hours by almost half and avoid thousands of premature deaths and illnesses projected each year from climate impacts on extreme heat, ozone and aeroallergen levels <em>(<a href="/chapter/13">Ch. 13: Air Quality</a>)</em>, and West Nile neuroinvasive disease. There is <em>medium confidence</em> that the economic benefits of greenhouse gas emissions reductions in the health sector could <em>likely</em> be on the order of hundreds of billions of dollars each year by the end of the century. Including avoided or reduced benefits of risks that are difficult to quantify, such as mental health or long-term health consequences, would increase these estimates.</p> </div> </div>  </div> </div> </section> </div> </section> <section id="section-99" class="container-fluid report-section no-spacer-2 blackish glossary clearfix"> <div class="offset-lg-1 col-lg-7 node-narrative" aria-flowto="content-14-99"> </div> <div id="content-14-99"><section id="references" class="container-fluid"> <div class="row report-section"> <div class="col-lg-12 references-header"> <h2 role="button" class="btn-footnote">REFERENCES <i class="fas fa-chevron-circle-down"></i></h2> </div> <div class="offset-lg-1 col-lg-7"> <div class='footnotes'> <ul> <li class='footnote' id='fn:154'>Adelaine, S. A., M. Sato, Y. Jin, and H. Godwin, 2017: An assessment of climate change impacts on Los Angeles (California USA) hospitals, wildfires highest priority. <i>Prehospital and Disaster Medicine</i>, <b>32</b> (5), 556–562. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/S1049023X17006586'>10.1017/S1049023X17006586</a>. <a href='#fnref:154' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:99'>Ahdoot, S., and The Council on Environmental Health, 2015: Global climate change and children's health. <i>Pediatrics</i>, <b>136</b> (5), 992–997. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1542/peds.2015-3232'>10.1542/peds.2015-3232</a>. <a href='#fnref:99' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:76'>Akil, L., H. A. Ahmad, and R. S. Reddy, 2014: Effects of climate change on Salmonella infections. <i>Foodborne Pathogens and Disease</i>, <b>11</b> (12), 974–980. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1089/fpd.2014.1802'>10.1089/fpd.2014.1802</a>. <a href='#fnref:76' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:130'>Aldunce, P., R. Beilin, J. Handmer, and M. Howden, 2016: Stakeholder participation in building resilience to disasters in a changing climate. <i>Environmental Hazards</i>, <b>15</b> (1), 58–73. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/17477891.2015.1134427'>10.1080/17477891.2015.1134427</a>. <a href='#fnref:130' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:168'>Anderson, G. B., K. W. Oleson, B. Jones, and R. D. Peng, 2016: Projected trends in high-mortality heatwaves under different scenarios of climate, population, and adaptation in 82 US communities. <i>Climatic Change</i>, doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-016-1779-x'>10.1007/s10584-016-1779-x</a>. <a href='#fnref:168' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:129'>Anderson, H., C. Brown, L. L. Cameron, M. Christenson, K. C. Conlon, S. Dorevitch, J. Dumas, M. Eidson, A. Ferguson, E. Grossman, A. Hanson, J. J. Hess, B. Hoppe, J. Horton, M. Jagger, S. Krueger, T. W. Largo, G. M. Losurdo, S. R. Mack, C. Moran, C. Mutnansky, K. Raab, S. Saha, P. J. Schramm, A. Shipp-Hilts, S. J. Smith, M. Thelen, L. Thie, and R. Walker, 2017: Climate and Health Intervention Assessment: Evidence on Public Health Interventions to Prevent the Negative Health Effects of Climate Change. Climate and Health Technical Report Series. Centers for Disease Control and Prevention, Climate and Health Program, Atlanta, GA, 92 pp. <a target='_blank' href='https://www.cdc.gov/climateandhealth/docs/ClimateAndHealthInterventionAssessment_508.pdf'>URL</a>. <a href='#fnref:129' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:57'>Aziz, R. K., M. M. Khalifa, and R. R. Sharaf, 2015: Contaminated water as a source of Helicobacter pylori infection: A review. <i>Journal of Advanced Research</i>, <b>6</b> (4), 539–547. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.jare.2013.07.007'>10.1016/j.jare.2013.07.007</a>. <a href='#fnref:57' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:60'>Baker-Austin, C., J. Trinanes, N. Gonzalez-Escalona, and J. Martinez-Urtaza, 2017: Non-cholera vibrios: The microbial barometer of climate change. <i>Trends in Microbiology</i>, <b>25</b> (1), 76–84. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.tim.2016.09.008'>10.1016/j.tim.2016.09.008</a>. <a href='#fnref:60' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:2'>Balbus, J., A. Crimmins, J. L. Gamble, D. R. Easterling, K. E. Kunkel, S. Saha, and M. C. Sarofim, 2016: Ch. 1: Introduction: Climate change and human health. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 25–42. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0VX0DFW'>10.7930/J0VX0DFW</a>. <a href='#fnref:2' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:126'>Banks, L. H., L. A. Davenport, M. H. Hayes, M. A. McArthur, S. N. Toro, C. E. King, and H. M. Vazirani, 2016: Disaster impact on impoverished area of US: An inter-professional mixed method study. <i>Prehospital and Disaster Medicine</i>, <b>31</b> (6), 583–592. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/S1049023X1600090X'>10.1017/S1049023X1600090X</a>. <a href='#fnref:126' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:10'>Barreau, T., D. Conway, K. Haught, R. Jackson, R. Kreutzer, A. Lockman, S. Minnick, R. Roisman, D. Rozell, S. Smorodinsky, D. Tafoya, and J. A. Wilken, 2017: Physical, mental, and financial impacts from drought in two California counties, 2015. <i>American Journal of Public Health</i>, <b>107</b> (5), 783–790. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.2105/ajph.2017.303695'>10.2105/ajph.2017.303695</a>. <a href='#fnref:10' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:6'>Bathi, J. R., and H. S. Das, 2016: Vulnerability of coastal communities from storm surge and flood disasters. <i>International Journal of Environmental Research and Public Health</i>, <b>13</b> (2), 239. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph13020239'>10.3390/ijerph13020239</a>. <a href='#fnref:6' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:81'>Battilani, P., P. Toscano, H. J. Van der Fels-Klerx, A. Moretti, M. Camardo Leggieri, C. Brera, A. Rortais, T. Goumperis, and T. Robinson, 2016: Aflatoxin B1 contamination in maize in Europe increases due to climate change. <i>Scientific Reports</i>, <b>6</b>, 24328. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1038/srep24328'>10.1038/srep24328</a>. <a href='#fnref:81' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:111'>Baussan, D., 2015: When You Can't Go Home: The Gulf Coast 10 Years after Katrina. Center for American Progress, Washington, DC, 10 pp. <a target='_blank' href='https://www.americanprogress.org/issues/green/reports/2015/08/18/119511/when-you-cant-go-home/'>URL</a>. <a href='#fnref:111' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:30'>Beard, C. B., R. J. Eisen, C. M. Barker, J. F. Garofalo, M. Hahn, M. Hayden, A. J. Monaghan, N. H. Ogden, and P. J. Schramm, 2016: Ch. 5: Vector-borne diseases . <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 129–156. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0765C7V'>10.7930/J0765C7V</a>. <a href='#fnref:30' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:44'>Becker, E., 2016: June 2016 ENSO Discussion: The New Neutral. National Oceanic and Atmospheric Administration, Climate.gov, Silver Spring, MD. <a target='_blank' href='https://www.climate.gov/news-features/blogs/enso/june-enso-discussion-new-neutral'>URL</a>. <a href='#fnref:44' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:3'>Bell, J. E., S. C. Herring, L. Jantarasami, C. Adrianopoli, K. Benedict, K. Conlon, V. Escobar, J. Hess, J. Luvall, C. P. Garcia-Pando, D. Quattrochi, J. Runkle, and C. J. Schreck III, 2016: Ch. 4: Impacts of extreme events on human health. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 99–128. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0BZ63ZV'>10.7930/J0BZ63ZV</a>. <a href='#fnref:3' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:37'>Belova, A., D. Mills, R. Hall, A. S. Juliana, A. Crimmins, C. Barker, and R. Jones, 2017: Impacts of increasing temperature on the future incidence of West Nile neuroinvasive disease in the United States. <i>American Journal of Climate Change</i>, <b>6</b> (1), 75278. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.4236/ajcc.2017.61010'>10.4236/ajcc.2017.61010</a>. <a href='#fnref:37' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:135'>Berisha, V., D. Hondula, M. Roach, J. R. White, B. McKinney, D. Bentz, A. Mohamed, J. Uebelherr, and K. Goodin, 2017: Assessing adaptation strategies for extreme heat: A public health evaluation of cooling centers in Maricopa County, Arizona. <i>Weather, Climate, and Society</i>, <b>9</b> (1), 71–80. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1175/wcas-d-16-0033.1'>10.1175/wcas-d-16-0033.1</a>. <a href='#fnref:135' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:14'>Berman, J. D., K. Ebisu, R. D. Peng, F. Dominici, and M. L. Bell, 2017: Drought and the risk of hospital admissions and mortality in older adults in western USA from 2000 to 2013: A retrospective study . <i>The Lancet Planetary Health</i>, <b>1</b> (1), e17–e25. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/S2542-5196(17)30002-5'>10.1016/S2542-5196(17)30002-5</a>. <a href='#fnref:14' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:89'>Bermúdez, R., Y. Feng, M. Y. Roleda, A. O. Tatters, D. A. Hutchins, T. Larsen, P. W. Boyd, C. L. Hurd, U. Riebesell, and M. Winder, 2015: Long-term conditioning to elevated pCO2 and warming influences the fatty and amino acid composition of the diatom Cylindrotheca fusiformis. <i>PLOS ONE</i>, <b>10</b> (5), e0123945. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pone.0123945'>10.1371/journal.pone.0123945</a>. <a href='#fnref:89' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:23'>Bobb, J. F., Z. Obermeyer, Y. Wang, and F. Dominici, 2014: Cause-specific risk of hospital admission related to extreme heat in older adults. <i>JAMA</i>, <b>312</b> (24), 2659–2667. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1001/jama.2014.15715'>10.1001/jama.2014.15715</a>. <a href='#fnref:23' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:46'>Bogoch, I. I., O. J. Brady, M. U. G. Kraemer, M. German, M. I. Creatore, M. A. Kulkarni, J. S. Brownstein, S. R. Mekaru, S. I. Hay, E. Groot, A. Watts, and K. Khan, 2016: Anticipating the international spread of Zika virus from Brazil. <i>The Lancet</i>, <b>387</b> (10016), 335–336. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/S0140-6736(16)00080-5'>10.1016/S0140-6736(16)00080-5</a>. <a href='#fnref:46' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:61'>Brooks, B. W., J. M. Lazorchak, M. D. A. Howard, M.-V. V. Johnson, S. L. Morton, D. A. K. Perkins, E. D. Reavie, G. I. Scott, S. A. Smith, and J. A. Steevens, 2016: Are harmful algal blooms becoming the greatest inland water quality threat to public health and aquatic ecosystems? <i>Environmental Toxicology and Chemistry</i>, <b>35</b> (1), 6–13. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1002/etc.3220'>10.1002/etc.3220</a>. <a href='#fnref:61' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:82'>Brown, M. E., J. M. Antle, P. Backlund, E. R. Carr, W. E. Easterling, M. K. Walsh, C. Ammann, W. Attavanich, C. B. Barrett, M. F. Bellemare, V. Dancheck, C. Funk, K. Grace, J. S. I. Ingram, H. Jiang, H. Maletta, T. Mata, A. Murray, M. Ngugi, D. Ojima, B. O'Neill, and C. Tebaldi, 2015: Climate Change, Global Food Security, and the U.S. Food System. U.S. Global Change Research Program, Washington, DC, 146 pp. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0862DC7'>10.7930/J0862DC7</a>. <a href='#fnref:82' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:127'>Burger, J., and M. Gochfeld, 2017: Perceptions of severe storms, climate change, ecological structures and resiliency three years post-hurricane Sandy in New Jersey. <i>Urban Ecosystems</i>, <b>20</b> (6), 1261–1275. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s11252-017-0678-x'>10.1007/s11252-017-0678-x</a>. <a href='#fnref:127' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:32'>Butterworth, M. K., C. W. Morin, and A. C. Comrie, 2017: An analysis of the potential impact of climate change on dengue transmission in the southeastern United States. <i>Environmental Health Perspectives</i>, <b>125</b>, 579–585. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/EHP218'>10.1289/EHP218</a>. <a href='#fnref:32' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:47'>Caminade, C., J. Turner, S. Metelmann, J. C. Hesson, M. S. C. Blagrove, T. Solomon, A. P. Morse, and M. Baylis, 2017: Global risk model for vector-borne transmission of Zika virus reveals the role of El Niño 2015. <i>Proceedings of the National Academy of Sciences of the United States of America</i>, <b>114</b> (1), 119–124. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1073/pnas.1614303114'>10.1073/pnas.1614303114</a>. <a href='#fnref:47' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:68'>Canyon, D. V., R. Speare, and F. M. Burkle, 2016: Forecasted impact of climate change on infectious disease and health security in Hawaii by 2050. <i>Disaster Medicine and Public Health Preparedness</i>, <b>10</b> (6), 797–804. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/dmp.2016.73'>10.1017/dmp.2016.73</a>. <a href='#fnref:68' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:48'>Carlson, C. J., E. R. Dougherty, and W. Getz, 2016: An ecological assessment of the pandemic threat of Zika virus. <i>PLOS Neglected Tropical Diseases</i>, <b>10</b> (8), e0004968. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pntd.0004968'>10.1371/journal.pntd.0004968</a>. <a href='#fnref:48' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:62'>Carlton, E. J., A. P. Woster, P. DeWitt, R. S. Goldstein, and K. Levy, 2016: A systematic review and meta-analysis of ambient temperature and diarrhoeal diseases. <i>International Journal of Epidemiology</i>, <b>45</b> (1), 117–130. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1093/ije/dyv296'>10.1093/ije/dyv296</a>. <a href='#fnref:62' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:165'>Chapra, S. C., B. Boehlert, C. Fant, V. J. Bierman, J. Henderson, D. Mills, D. M. L. Mas, L. Rennels, L. Jantarasami, J. Martinich, K. M. Strzepek, and H. W. Paerl, 2017: Climate change impacts on harmful algal blooms in U.S. freshwaters: A screening-level assessment. <i>Environmental Science & Technology</i>, <b>51</b> (16), 8933–8943. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1021/acs.est.7b01498'>10.1021/acs.est.7b01498</a>. <a href='#fnref:165' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:175'>Cheng, J. J., and P. Berry, 2013: Health co-benefits and risks of public health adaptation strategies to climate change: A review of current literature. <i>International Journal of Public Health</i>, <b>58</b> (2), 305–311. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s00038-012-0422-5'>10.1007/s00038-012-0422-5</a>. <a href='#fnref:175' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:20'>Choudhary, E., and A. Vaidyanathan, 2014: Heat stress illness hospitalizations—Environmental public health tracking program, 20 States, 2001-2010. <i>MMWR Surveillance Summaries</i>, <b>63</b> (13), 1–10. <a target='_blank' href='https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6313a1.htm'>URL</a>. <a href='#fnref:20' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:35'>Chretien, J.-P., A. Anyamba, J. Small, S. Britch, J. L. Sanchez, A. C. Halbach, C. Tucker, and K. J. Linthicum, 2015: Global climate anomalies and potential infectious disease risks: 2014-2015. <i>PLOS Currents Outbreaks</i>, <b>2015</b>, Edition 1. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/currents.outbreaks.95fbc4a8fb4695e049baabfc2fc8289f'>10.1371/currents.outbreaks.95fbc4a8fb4695e049baabfc2fc8289f</a>. <a href='#fnref:35' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:176'>Clarke, K.-L., and P. Berry, 2012: From theory to practice: A Canadian case study of the utility of climate change adaptation frameworks to address health impacts. <i>International Journal of Public Health</i>, <b>57</b> (1), 167–174. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s00038-011-0292-2'>10.1007/s00038-011-0292-2</a>. <a href='#fnref:176' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:102'>Clayton, S., C. Manning, K. Krygsman, and M. Speiser, 2017: Mental health and our changing climate: Impacts, implications, and guidance. American Psychological Association and ecoAmerica, Washington, DC, 69 pp. <a target='_blank' href='https://www.apa.org/news/press/releases/2017/03/mental-health-climate.pdf'>URL</a>. <a href='#fnref:102' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:128'>Colten, C. E., J. R. Z. Simms, A. A. Grismore, and S. A. Hemmerling, 2018: Social justice and mobility in coastal Louisiana, USA. <i>Regional Environmental Change</i>, <b>18</b> (2), 371–383. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10113-017-1115-7'>10.1007/s10113-017-1115-7</a>. <a href='#fnref:128' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:13'>Coopersmith, E. J., J. E. Bell, K. Benedict, J. Shriber, O. McCotter, and M. H. Cosh, 2017: Relating coccidioidomycosis (valley fever) incidence to soil moisture conditions. <i>GeoHealth</i>, <b>1</b> (1), 51–63. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1002/2016GH000033'>10.1002/2016GH000033</a>. <a href='#fnref:13' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:172'>Cushing, L. J., M. Wander, R. Morello-Frosch, M. Pastor, A. Zhu, and J. Sadd, 2016: A Preliminary Environmental Equity Assessment Of California's Cap-and-Trade Program. Program for Environmental and Regional Equity (PERE) Publication. USC Dornsife, Los Angeles, CA, 17 pp. <a target='_blank' href='https://dornsife.usc.edu/assets/sites/242/docs/Climate_Equity_Brief_CA_Cap_and_Trade_Sept2016_FINAL2.pdf'>URL</a>. <a href='#fnref:172' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:51'>Davidson, K., R. J. Gowen, P. J. Harrison, L. E. Fleming, P. Hoagland, and G. Moschonas, 2014: Anthropogenic nutrients and harmful algae in coastal waters. <i>Journal of Environmental Management</i>, <b>146</b>, 206–216. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.jenvman.2014.07.002'>10.1016/j.jenvman.2014.07.002</a>. <a href='#fnref:51' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:153'>DHS, 2018: Homeland Infrastructure Foundation-Level Data (HIFLD) [web tool]. U.S. Department of Homeland Security (DHS), Washington, DC. <a target='_blank' href='https://hifld-geoplatform.opendata.arcgis.com/'>URL</a>. <a href='#fnref:153' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:4'>Dodgen, D., D. Donato, N. Kelly, A. La Greca, J. Morganstein, J. Reser, J. Ruzek, S. Schweitzer, M. M. Shimamoto, K. Thigpen Tart, and R. Ursano, 2016: Ch. 8: Mental health and well-being. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 217–246. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0TX3C9H'>10.7930/J0TX3C9H</a>. <a href='#fnref:4' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:104'>Doppelt, B., 2016: Transformational Resilience: How Building Human Resilience to Climate Disruption Can Safeguard Society and Increase Wellbeing. Greenleaf Publishing (Routledge/Taylor & Francis), New York,. <a href='#fnref:104' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:170'>Dunne, J. P., R. J. Stouffer, and J. G. John, 2013: Reductions in labour capacity from heat stress under climate warming. <i>Nature Climate Change</i>, <b>3</b>, 563–566. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1038/nclimate1827'>10.1038/nclimate1827</a>. <a href='#fnref:170' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:131'>Ebi, K. L., J. J. Hess, and T. B. Isaksen, 2016: Using uncertain climate and development information in health adaptation planning. <i>Current Environmental Health Reports</i>, <b>3</b> (1), 99–105. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s40572-016-0077-0'>10.1007/s40572-016-0077-0</a>. <a href='#fnref:131' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:177'>Ebi, K. L., T. J. Teisberg, L. S. Kalkstein, L. Robinson, and R. F. Weiher, 2004: Heat watch/warning systems save lives: Estimated costs and benefits for Philadelphia 1995–98. <i>Bulletin of the American Meteorological Society</i>, <b>85</b> (8), 1067–1073. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1175/bams-85-8-1067'>10.1175/bams-85-8-1067</a>. <a href='#fnref:177' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:149'>Eckelman, M. J., and J. Sherman, 2016: Environmental impacts of the U.S. health care system and effects on public health. <i>PLOS ONE</i>, <b>11</b> (6), e0157014. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pone.0157014'>10.1371/journal.pone.0157014</a>. <a href='#fnref:149' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:157'>EPA, 2017: Multi-model Framework for Quantitative Sectoral Impacts Analysis: A Technical Report for the Fourth National Climate Assessment. EPA 430‐R‐17‐001. U.S. Environmental Protection Agency (EPA), Washington, DC, 271 pp. <a target='_blank' href='https://cfpub.epa.gov/si/si_public_record_Report.cfm?dirEntryId=335095'>URL</a>. <a href='#fnref:157' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:166'>Fann, N., C. G. Nolte, P. Dolwick, T. L. Spero, A. Curry Brown, S. Phillips, and S. Anenberg, 2015: The geographic distribution and economic value of climate change-related ozone health impacts in the United States in 2030. <i>Journal of the Air & Waste Management Association</i>, <b>65</b> (5), 570–580. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/10962247.2014.996270'>10.1080/10962247.2014.996270</a>. <a href='#fnref:166' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:36'>Fisman, D. N., A. R. Tuite, and K. A. Brown, 2016: Impact of El Niño Southern Oscillation on infectious disease hospitalization risk in the United States. <i>Proceedings of the National Academy of Sciences of the United States of America</i>, <b>113</b> (51), 14589–14594. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1073/pnas.1604980113'>10.1073/pnas.1604980113</a>. <a href='#fnref:36' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:107'>Forman, F., G. Solomon, R. Morello-Frosch, and K. Pezzoli, 2016: Chapter 8. Bending the curve and closing the gap: Climate justice and public health. <i>Collabra</i>, <b>2</b> (1), 22. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1525/collabra.67'>10.1525/collabra.67</a>. <a href='#fnref:107' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:15'>Friel, S., H. Berry, H. Dinh, L. O'Brien, and H. L. Walls, 2014: The impact of drought on the association between food security and mental health in a nationally representative Australian sample. <i>BMC Public Health</i>, <b>14</b> (1), 1102. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/1471-2458-14-1102'>10.1186/1471-2458-14-1102</a>. <a href='#fnref:15' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:63'>Froelich, B. A., and R. T. Noble, 2016: Vibrio bacteria in raw oysters: Managing risks to human health. <i>Philosophical Transactions of the Royal Society B: Biological Sciences</i>, <b>371</b> (1689), 20150209. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1098/rstb.2015.0209'>10.1098/rstb.2015.0209</a>. <a href='#fnref:63' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:100'>Fullerton, C. S., J. B. A. McKibben, D. B. Reissman, T. Scharf, K. M. Kowalski-Trakofler, J. M. Shultz, and R. J. Ursano, 2013: Posttraumatic stress disorder, depression, and alcohol and tobacco use in public health workers after the 2004 Florida hurricanes. <i>Disaster Medicine and Public Health Preparedness</i>, <b>7</b> (1), 89–95. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/dmp.2013.6'>10.1017/dmp.2013.6</a>. <a href='#fnref:100' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:58'>Galway, L. P., D. M. Allen, M. W. Parkes, and T. K. Takaro, 2014: Seasonal variation of acute gastro-intestinal illness by hydroclimatic regime and drinking water source: A retrospective population-based study. <i>Journal of Water and Health</i>, <b>12</b> (1), 122–135. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.2166/wh.2013.105'>10.2166/wh.2013.105</a>. <a href='#fnref:58' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:106'>Gamble, J. L., J. Balbus, M. Berger, K. Bouye, V. Campbell, K. Chief, K. Conlon, A. Crimmins, B. Flanagan, C. Gonzalez-Maddux, E. Hallisey, S. Hutchins, L. Jantarasami, S. Khoury, M. Kiefer, J. Kolling, K. Lynn, A. Manangan, M. McDonald, R. Morello-Frosch, M. H. Redsteer, P. Sheffield, K. Thigpen Tart, J. Watson, K. P. Whyte, and A. F. Wolkin, 2016: Ch. 9: Populations of concern. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 247–286. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0Q81B0T'>10.7930/J0Q81B0T</a>. <a href='#fnref:106' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:145'>Garfin, G. M., S. LeRoy, and H. Jones, 2017: Developing an Integrated Heat Health Information System for Long-Term Resilience to Climate and Weather Extremes in the El Paso-Juárez-Las Cruces Region. Institute of the Environment, Tucson, AZ, 63 pp. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7289/V5930R6Q'>10.7289/V5930R6Q</a>. <a href='#fnref:145' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:52'>Glibert, P. M., J. Icarus Allen, Y. Artioli, A. Beusen, L. Bouwman, J. Harle, R. Holmes, and J. Holt, 2014: Vulnerability of coastal ecosystems to changes in harmful algal bloom distribution in response to climate change: Projections based on model analysis. <i>Global Change Biology</i>, <b>20</b> (12), 3845–3858. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1111/gcb.12662'>10.1111/gcb.12662</a>. <a href='#fnref:52' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:123'>Gonzalez, R., and other contributors, 2017: Community-driven climate resilience planning: A framework, version 2.0. National Association of Climate Resilience Planners, <a target='_blank' href='http://movementstrategy.org/b/wp-content/uploads/2017/05/WEB-CD-CRP_Updated-5.11.17.pdf'>URL</a>. <a href='#fnref:123' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:160'>Gordon, K., and the Risky Business Project, 2014: The economic risks of climate change in the United States : A climate risk assessment for the United States. Risky Business Project, New York, 51 pp. <a target='_blank' href='https://riskybusiness.org/site/assets/uploads/2015/09/RiskyBusiness_Report_WEB_09_08_14.pdf'>URL</a>. <a href='#fnref:160' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:12'>Gorris, M. E., L. A. Cat, C. S. Zender, K. K. Treseder, and J. T. Randerson, 2018: Coccidioidomycosis dynamics in relation to climate in the southwestern United States. <i>GeoHealth</i>, <b>2</b> (1), 6–24. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1002/2017GH000095'>10.1002/2017GH000095</a>. <a href='#fnref:12' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:7'>Gotanda, H., J. Fogel, G. Husk, J. M. Levine, M. Peterson, K. Baumlin, and J. Habboushe, 2015: Hurricane Sandy: Impact on emergency department and hospital utilization by older adults in Lower Manhattan, New York (USA). <i>Prehospital and Disaster Medicine</i>, <b>30</b> (5), 496–502. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/S1049023X15005087'>10.1017/S1049023X15005087</a>. <a href='#fnref:7' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:169'>Graff Zivin, J., and M. Neidell, 2014: Temperature and the allocation of time: Implications for climate change. <i>Journal of Labor Economics</i>, <b>32</b> (1), 1–26. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1086/671766'>10.1086/671766</a>. <a href='#fnref:169' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:8'>Greenstein, J., J. Chacko, B. Ardolic, and N. Berwald, 2016: Impact of Hurricane Sandy on the Staten Island University Hospital Emergency Department. <i>Prehospital and Disaster Medicine</i>, <b>31</b> (3), 335–339. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/S1049023X16000261'>10.1017/S1049023X16000261</a>. <a href='#fnref:8' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:11'>Griffin, D., and K. J. Anchukaitis, 2014: How unusual is the 2012–2014 California drought? <i>Geophysical Research Letters</i>, <b>41</b> (24), 9017–9023. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1002/2014GL062433'>10.1002/2014GL062433</a>. <a href='#fnref:11' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:22'>Gronlund, C. J., A. Zanobetti, G. A. Wellenius, J. D. Schwartz, and M. S. O'Neill, 2016: Vulnerability to renal, heat and respiratory hospitalizations during extreme heat among U.S. elderly. <i>Climatic Change</i>, <b>136</b> (3), 631–645. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-016-1638-9'>10.1007/s10584-016-1638-9</a>. <a href='#fnref:22' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:136'>Gronlund, C. J., V. J. Berrocal, J. L. White-Newsome, K. C. Conlon, and M. S. O'Neill, 2015: Vulnerability to extreme heat by socio-demographic characteristics and area green space among the elderly in Michigan, 1990-2007. <i>Environmental Research</i>, <b>136</b>, 449–461. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envres.2014.08.042'>10.1016/j.envres.2014.08.042</a>. <a href='#fnref:136' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:151'>Guenther, R., and J. Balbus, 2014: Primary Protection: Enhancing Health Care Resilience for a Changing Climate. U.S. Department of Health and Human Services, <a target='_blank' href='https://toolkit.climate.gov/sites/default/files/SCRHCFI%20Best%20Practices%20Report%20final2%202014%20Web.pdf'>URL</a>. <a href='#fnref:151' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:116'>Gutierrez, K., and C. LePrevost, 2016: Climate justice in rural southeastern United States: A review of climate change impacts and effects on human health. <i>International Journal of Environmental Research and Public Health</i>, <b>13</b> (2), 189. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph13020189'>10.3390/ijerph13020189</a>. <a href='#fnref:116' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:55'>Guzman Herrador, B. R., B. F. de Blasio, E. MacDonald, G. Nichols, B. Sudre, L. Vold, J. C. Semenza, and K. Nygård, 2015: Analytical studies assessing the association between extreme precipitation or temperature and drinking water-related waterborne infections: A review. <i>Environmental Health</i>, <b>14</b> (1), 29. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/s12940-015-0014-y'>10.1186/s12940-015-0014-y</a>. <a href='#fnref:55' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:26'>Ha, S., D. Liu, Y. Zhu, S. S. Kim, S. Sherman, and P. Mendola, 2017: Ambient temperature and early delivery of singleton pregnancies. <i>Environmental Health Perspectives</i>, <b>125</b>, 453–459. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/EHP97'>10.1289/EHP97</a>. <a href='#fnref:26' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:43'>Hahn, M. B., C. S. Jarnevich, A. J. Monaghan, and R. J. Eisen, 2016: Modeling the geographic distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the contiguous United States. <i>Journal of Medical Entomology</i>, <b>53</b> (5), 1176–1191. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1093/jme/tjw076'>10.1093/jme/tjw076</a>. <a href='#fnref:43' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:92'>Hasegawa, T., S. Fujimori, K. Takahashi, T. Yokohata, and T. Masui, 2016: Economic implications of climate change impacts on human health through undernourishment. <i>Climatic Change</i>, <b>136</b> (2), 189–202. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-016-1606-4'>10.1007/s10584-016-1606-4</a>. <a href='#fnref:92' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:73'>Hellberg, R. S., and E. Chu, 2016: Effects of climate change on the persistence and dispersal of foodborne bacterial pathogens in the outdoor environment: A review. <i>Critical Reviews in Microbiology</i>, <b>42</b> (4), 548–572. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3109/1040841X.2014.972335'>10.3109/1040841X.2014.972335</a>. <a href='#fnref:73' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:90'>Hixson, S. M., and M. T. Arts, 2016: Climate warming is predicted to reduce omega-3, long-chain, polyunsaturated fatty acid production in phytoplankton. <i>Global Change Biology</i>, <b>22</b> (8), 2744–2755. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1111/gcb.13295'>10.1111/gcb.13295</a>. <a href='#fnref:90' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:164'>Houser, T., R. Kopp, S. Hsiang, M. Delgado, A. Jina, K. Larsen, M. Mastrandrea, S. Mohan, R. Muir-Wood, D. Rasmussen, J. Rising, and P. Wilson, 2014: American Climate Prospectus: Economic Risks in the United States. Rhodium Group, New York, NY, 201 pp. <a target='_blank' href='https://gspp.berkeley.edu/assets/uploads/research/pdf/American_Climate_Prospectus.pdf'>URL</a>. <a href='#fnref:164' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:167'>Hsiang, S., R. Kopp, A. Jina, J. Rising, M. Delgado, S. Mohan, D. J. Rasmussen, R. Muir-Wood, P. Wilson, M. Oppenheimer, K. Larsen, and T. Houser, 2017: Estimating economic damage from climate change in the United States. <i>Science</i>, <b>356</b> (6345), 1362–1369. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1126/science.aal4369'>10.1126/science.aal4369</a>. <a href='#fnref:167' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:93'>Ishida, H., S. Kobayashi, S. Kanae, T. Hasegawa, S. Fujimori, Y. Shin, K. Takahashi, T. Masui, A. Tanaka, and Y. Honda, 2014: Global-scale projection and its sensitivity analysis of the health burden attributable to childhood undernutrition under the latest scenario framework for climate change research. <i>Environmental Research Letters</i>, <b>9</b> (6), 064014. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1088/1748-9326/9/6/064014'>10.1088/1748-9326/9/6/064014</a>. <a href='#fnref:93' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:122'>Island Press, 2015: Bounce Forward: Urban Resilience in the Era of Climate Change. Island Press and the Kresge Foundation, Washington, DC and Troy, MI, 36 pp. <a target='_blank' href='https://kresge.org/sites/default/files/Bounce-Forward-Urban-Resilience-in-Era-of-Climate-Change-2015.pdf'>URL</a>. <a href='#fnref:122' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:50'>Jacobs, J., S. K. Moore, K. E. Kunkel, and L. Sun, 2015: A framework for examining climate-driven changes to the seasonality and geographical range of coastal pathogens and harmful algae. <i>Climate Risk Management</i>, <b>8</b>, 16–27. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.crm.2015.03.002'>10.1016/j.crm.2015.03.002</a>. <a href='#fnref:50' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:56'>Jagai, J. S., Q. Li, S. Wang, K. P. Messier, T. J. Wade, and E. D. Hilborn, 2015: Extreme precipitation and emergency room visits for gastrointestinal illness in areas with and without combined sewer systems: An analysis of Massachusetts data, 2003-2007. <i>Environmental Health Perspectives</i>, <b>123</b> (9), 873–879. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/ehp.1408971'>10.1289/ehp.1408971</a>. <a href='#fnref:56' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:77'>Jiang, C., K. S. Shaw, C. R. Upperman, D. Blythe, C. Mitchell, R. Murtugudde, A. R. Sapkota, and A. Sapkota, 2015: Climate change, extreme events and increased risk of salmonellosis in Maryland, USA: Evidence for coastal vulnerability. <i>Environment International</i>, <b>83</b>, 58–62. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envint.2015.06.006'>10.1016/j.envint.2015.06.006</a>. <a href='#fnref:77' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:162'>Jones, B., C. Tebaldi, B. C. O'Neill, K. Oleson, and J. Gao, 2018: Avoiding population exposure to heat-related extremes: Demographic change vs climate change. <i>Climatic Change</i>, <b>146</b> (3), 423–437. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-017-2133-7'>10.1007/s10584-017-2133-7</a>. <a href='#fnref:162' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:132'>Kabisch, N., H. Korn, J. Stadler, and A. Bonn, 2017: Nature-based solutions to climate change adaptation in urban areas--Linkages between science, policy and practice. <i>Nature-based solutions to climate change adaptation in urban areas: Linkages between science, policy and practice</i>. Kabisch, N., H. Korn, J. Stadler, and A. Bonn, Eds., Springer International Publishing, Cham, 1–11. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/978-3-319-56091-5_1'>10.1007/978-3-319-56091-5_1</a>. <a href='#fnref:132' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:150'>Kaplan, S., B. Sadler, K. Little, C. Franz, and P. Orris, 2012: Can sustainable hospitals help bend the health care cost curve? Commonwealth Fund Pub. 1641. The Commonwealth Fund, New York, NY, 13 pp. <a target='_blank' href='http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2012/nov/1641_kaplan_can_sustainable_hosps_bend_cost_curve_ib.pdf'>URL</a>. <a href='#fnref:150' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:114'>Kiefer, M., J. Rodríguez-Guzmán, J. Watson, B. van Wendel de Joode, D. Mergler, and A. S. da Silva, 2016: Worker health and safety and climate change in the Americas: Issues and research needs. <i>Revista panamericana de salud publica = Pan American Journal of Public Health</i>, <b>40</b> (3), 192–197. <a target='_blank' href='http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5176103/'>URL</a>. <a href='#fnref:114' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:137'>Klein Rosenthal, J., P. L. Kinney, and K. B. Metzger, 2014: Intra-urban vulnerability to heat-related mortality in New York City, 1997–2006. <i>Health & Place</i>, <b>30</b>, 45–60. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.healthplace.2014.07.014'>10.1016/j.healthplace.2014.07.014</a>. <a href='#fnref:137' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:156'>Knowlton, K., M. Rotkin-Ellman, L. Geballe, W. Max, and G. M. Solomon, 2011: Six climate change-related events in the United States accounted for about $14 billion in lost lives and health costs. <i>Health Affairs</i>, <b>30</b> (11), 2167–2176. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1377/hlthaff.2011.0229'>10.1377/hlthaff.2011.0229</a>. <a href='#fnref:156' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:74'>Lake, I. R., 2017: Food-borne disease and climate change in the United Kingdom. <i>Environmental Health</i>, <b>16</b> (1), 117. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/s12940-017-0327-0'>10.1186/s12940-017-0327-0</a>. <a href='#fnref:74' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:95'>Lamond, J. E., R. D. Joseph, and D. G. Proverbs, 2015: An exploration of factors affecting the long term psychological impact and deterioration of mental health in flooded households. <i>Environmental Research</i>, <b>140</b>, 325–334. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envres.2015.04.008'>10.1016/j.envres.2015.04.008</a>. <a href='#fnref:95' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:134'>Lane, K., K. Wheeler, K. Charles-Guzman, M. Ahmed, M. Blum, K. Gregory, N. Graber, N. Clark, and T. Matte, 2014: Extreme heat awareness and protective behaviors in New York City. <i>Journal of Urban Health</i>, <b>91</b> (3), 403–414. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s11524-013-9850-7'>10.1007/s11524-013-9850-7</a>. <a href='#fnref:134' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:142'>Lee, J.-S., M. Carabali, J. K. Lim, V. M. Herrera, I.-Y. Park, L. Villar, and A. Farlow, 2017: Early warning signal for dengue outbreaks and identification of high risk areas for dengue fever in Colombia using climate and non-climate datasets. <i>BMC Infectious Diseases</i>, <b>17</b> (1), 480. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/s12879-017-2577-4'>10.1186/s12879-017-2577-4</a>. <a href='#fnref:142' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:70'>Leight, A. K., R. Hood, R. Wood, and K. Brohawn, 2016: Climate relationships to fecal bacterial densities in Maryland shellfish harvest waters. <i>Water Research</i>, <b>89</b>, 270–281. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.watres.2015.11.055'>10.1016/j.watres.2015.11.055</a>. <a href='#fnref:70' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:143'>Lessler, J., L. H. Chaisson, L. M. Kucirka, Q. Bi, K. Grantz, H. Salje, A. C. Carcelen, C. T. Ott, J. S. Sheffield, N. M. Ferguson, D. A. T. Cummings, C. J. E. Metcalf, and I. Rodriguez-Barraquer, 2016: Assessing the global threat from Zika virus. <i>Science</i>, <b>353</b> (6300) doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1126/science.aaf8160'>10.1126/science.aaf8160</a>. <a href='#fnref:143' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:19'>Levy, B. S., and J. A. Patz, 2015: Climate change, human rights, and social justice. <i>Annals of Global Health</i>, <b>81</b> (3), 310–322. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.aogh.2015.08.008'>10.1016/j.aogh.2015.08.008</a>. <a href='#fnref:19' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:64'>Levy, K., A. P. Woster, R. S. Goldstein, and E. J. Carlton, 2016: Untangling the impacts of climate change on waterborne diseases: A systematic review of relationships between diarrheal diseases and temperature, rainfall, flooding, and drought. <i>Environmental Science & Technology</i>, <b>50</b> (10), 4905–4922. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1021/acs.est.5b06186'>10.1021/acs.est.5b06186</a>. <a href='#fnref:64' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:33'>Linthicum, K. J., A. Anyamba, S. C. Britch, J. L. Small, and C. J. Tucker, 2016: Climate teleconnections, weather extremes, and vector-borne disease outbreaks. <i>Global Health Impacts of Vector-Borne Diseases: Workshop Summary</i>. Mack, A., Ed., National Academies Press, Washington, DC, 202–220. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.17226/21792'>10.17226/21792</a>. <a href='#fnref:33' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:94'>Lloyd, S. J., R. S. Kovats, and Z. Chalabi, 2011: Climate change, crop yields, and undernutrition: Development of a model to quantify the impact of climate scenarios on child undernutrition. <i>Environmental Health Perspectives</i>, <b>119</b> (12), 1817–1823. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/ehp.1003311'>10.1289/ehp.1003311</a>. <a href='#fnref:94' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:86'>Loladze, I., 2002: Rising atmospheric CO2 and human nutrition: Toward globally imbalanced plant stoichiometry? <i>Trends in Ecology & Evolution</i>, <b>17</b> (10), 457–461. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/s0169-5347(02)02587-9'>10.1016/s0169-5347(02)02587-9</a>. <a href='#fnref:86' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:144'>Lowe, D., K. L. Ebi, and B. Forsberg, 2011: Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves. <i>International Journal of Environmental Research and Public Health</i>, <b>8</b> (12), 4623. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph8124623'>10.3390/ijerph8124623</a>. <a href='#fnref:144' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:139'>Lowe, R., C. A. Coelho, C. Barcellos, M. S. Carvalho, R. D. C. Catão, G. E. Coelho, W. M. Ramalho, T. C. Bailey, D. B. Stephenson, and Xavier Rodó, 2016: Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil. <i>eLIFE</i>, <b>5</b>, e11285. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7554/eLife.11285'>10.7554/eLife.11285</a>. <a href='#fnref:139' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:105'>Lowe, S. R., L. Sampson, O. Gruebner, and S. Galea, 2015: Psychological resilience after Hurricane Sandy: The influence of individual- and community-level factors on mental health after a large-scale natural disaster. <i>PLOS ONE</i>, <b>10</b> (5), e0125761. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pone.0125761'>10.1371/journal.pone.0125761</a>. <a href='#fnref:105' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:103'>Mares, D. M., and K. W. Moffett, 2016: Climate change and interpersonal violence: A “global” estimate and regional inequities. <i>Climatic Change</i>, <b>135</b> (2), 297–310. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-015-1566-0'>10.1007/s10584-015-1566-0</a>. <a href='#fnref:103' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:163'>Marsha, A., S. R. Sain, M. J. Heaton, A. J. Monaghan, and O. V. Wilhelmi, 2016: Influences of climatic and population changes on heat-related mortality in Houston, Texas, USA. <i>Climatic Change</i>, doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-016-1775-1'>10.1007/s10584-016-1775-1</a>. <a href='#fnref:163' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:87'>Martins, L. D., M. A. Tomaz, F. C. Lidon, F. M. DaMatta, and J. C. Ramalho, 2014: Combined effects of elevated [CO2] and high temperature on leaf mineral balance in Coffea spp. plants. <i>Climatic Change</i>, <b>126</b> (3), 365–379. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-014-1236-7'>10.1007/s10584-014-1236-7</a>. <a href='#fnref:87' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:120'>McDonald, Y. J., S. E. Grineski, T. W. Collins, and Y. A. Kim, 2015: A scalable climate health justice assessment model. <i>Social Science & Medicine</i>, <b>133</b>, 242–252. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.socscimed.2014.10.032'>10.1016/j.socscimed.2014.10.032</a>. <a href='#fnref:120' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:85'>Medek, D. E., J. Schwartz, and S. S. Myers, 2017: Estimated effects of future atmospheric CO2 concentrations on protein intake and the risk of protein deficiency by country and region. <i>Environmental Health Perspectives</i>, <b>125</b> (8), 087002. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/EHP41'>10.1289/EHP41</a>. <a href='#fnref:85' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:80'>Medina, A., A. Rodriguez, and N. Magan, 2014: Effect of climate change on Aspergillus flavus and aflatoxin B1 production. <i>Frontiers in Microbiology</i>, <b>5</b> (348) doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3389/fmicb.2014.00348'>10.3389/fmicb.2014.00348</a>. <a href='#fnref:80' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:66'>Mellor, J. E., K. Levy, J. Zimmerman, M. Elliott, J. Bartram, E. Carlton, T. Clasen, R. Dillingham, J. Eisenberg, R. Guerrant, D. Lantagne, J. Mihelcic, and K. Nelson, 2016: Planning for climate change: The need for mechanistic systems-based approaches to study climate change impacts on diarrheal diseases. <i>Science of The Total Environment</i>, <b>548</b>–<b>549</b>, 82–90. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.scitotenv.2015.12.087'>10.1016/j.scitotenv.2015.12.087</a>. <a href='#fnref:66' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:108'>Mendez, M. A., 2015: Assessing local climate action plans for public health co-benefits in environmental justice communities. <i>Local Environment</i>, <b>20</b> (6), 637–663. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/13549839.2015.1038227'>10.1080/13549839.2015.1038227</a>. <a href='#fnref:108' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:67'>Milazzo, A., L. C. Giles, Y. Zhang, A. P. Koehler, J. E. Hiller, and P. Bi, 2017: The effects of ambient temperature and heatwaves on daily Campylobacter cases in Adelaide, Australia, 1990–2012. <i>Epidemiology and Infection</i>, <b>145</b> (12), 2603–2610. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/S095026881700139X'>10.1017/S095026881700139X</a>. <a href='#fnref:67' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:5'>Mills, D., R. Jones, C. Wobus, J. Ekstrom, L. Jantarasami, A. St. Juliana, and A. Crimmins, 2018: Projecting age-stratified risk of exposure to inland flooding and wildfire smoke in the United States under two climate scenarios. <i>Environmental Health Perspectives</i>, <b>126</b> (4), 047007. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/EHP2594'>10.1289/EHP2594</a>. <a href='#fnref:5' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:96'>Milojevic, A., B. Armstrong, and P. Wilkinson, 2017: Mental health impacts of flooding: A controlled interrupted time series analysis of prescribing data in England. <i>Journal of Epidemiology and Community Health</i>, <b>71</b> (10), 970–973. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1136/jech-2017-208899'>10.1136/jech-2017-208899</a>. <a href='#fnref:96' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:31'>Monaghan, A. J., K. M. Sampson, D. F. Steinhoff, K. C. Ernst, K. L. Ebi, B. Jones, and M. H. Hayden, 2016: The potential impacts of 21st century climatic and population changes on human exposure to the virus vector mosquito Aedes aegypti. <i>Climatic Change</i>, doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-016-1679-0'>10.1007/s10584-016-1679-0</a>. <a href='#fnref:31' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:40'>Mordecai, E. A., J. M. Cohen, M. V. Evans, P. Gudapati, L. R. Johnson, C. A. Lippi, K. Miazgowicz, C. C. Murdock, J. R. Rohr, S. J. Ryan, V. Savage, M. S. Shocket, A. Stewart Ibarra, M. B. Thomas, and D. P. Weikel, 2017: Detecting the impact of temperature on transmission of Zika, dengue, and chikungunya using mechanistic models. <i>PLOS Neglected Tropical Diseases</i>, <b>11</b> (4), e0005568. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pntd.0005568'>10.1371/journal.pntd.0005568</a>. <a href='#fnref:40' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:69'>Muhling, B. A., C. F. Gaitán, C. A. Stock, V. S. Saba, D. Tommasi, and K. W. Dixon, 2017: Potential salinity and temperature futures for the Chesapeake Bay using a statistical downscaling spatial disaggregation framework. <i>Estuaries and Coasts</i>, doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s12237-017-0280-8'>10.1007/s12237-017-0280-8</a>. <a href='#fnref:69' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:97'>Munro, A., R. S. Kovats, G. J. Rubin, T. D. Waite, A. Bone, and B. Armstrong, 2017: Effect of evacuation and displacement on the association between flooding and mental health outcomes: A cross-sectional analysis of UK survey data. <i>The Lancet Planetary Health</i>, <b>1</b> (4), e134–e141. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/S2542-5196(17)30047-5'>10.1016/S2542-5196(17)30047-5</a>. <a href='#fnref:97' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:45'>Muñoz, Á. G., M. C. Thomson, A. M. Stewart-Ibarra, G. A. Vecchi, X. Chourio, P. Nájera, Z. Moran, and X. Yang, 2017: Could the recent Zika epidemic have been predicted? <i>Frontiers in Microbiology</i>, <b>8</b> (1291) doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3389/fmicb.2017.01291'>10.3389/fmicb.2017.01291</a>. <a href='#fnref:45' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:84'>Myers, S. S., K. R. Wessells, I. Kloog, A. Zanobetti, and J. Schwartz, 2015: Effect of increased concentrations of atmospheric carbon dioxide on the global threat of zinc deficiency: A modelling study. <i>The Lancet Global Health</i>, <b>3</b> (10), e639–e645. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/S2214-109X(15)00093-5'>10.1016/S2214-109X(15)00093-5</a>. <a href='#fnref:84' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:88'>Myers, S. S., M. R. Smith, S. Guth, C. D. Golden, B. Vaitla, N. D. Mueller, A. D. Dangour, and P. Huybers, 2017: Climate change and global food systems: Potential impacts on food security and undernutrition. <i>Annual Review of Public Health</i>, <b>38</b> (1), 259–277. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1146/annurev-publhealth-031816-044356'>10.1146/annurev-publhealth-031816-044356</a>. <a href='#fnref:88' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:152'>National Hurricane Center, 2018: National Storm Surge Hazard Maps — Version 2 . NOAA National Weather Service, Miami, FL. <a target='_blank' href='https://www.nhc.noaa.gov/nationalsurge/'>URL</a>. <a href='#fnref:152' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:25'>Ngo, N. S., and R. M. Horton, 2016: Climate change and fetal health: The impacts of exposure to extreme temperatures in New York City. <i>Environmental Research</i>, <b>144</b>, 158–164. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envres.2015.11.016'>10.1016/j.envres.2015.11.016</a>. <a href='#fnref:25' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:121'>Nicholas, P. K., and S. Breakey, 2017: Climate change, climate justice, and environmental health: Implications for the nursing profession. <i>Journal of Nursing Scholarship</i>, <b>49</b> (6), 606–616. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1111/jnu.12326'>10.1111/jnu.12326</a>. <a href='#fnref:121' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:112'>Norton-Smith, K., K. Lynn, K. Chief, K. Cozzetto, J. Donatuto, M. H. Redsteer, L. E. Kruger, J. Maldonado, C. Viles, and K. P. Whyte, 2016: Climate Change and Indigenous Peoples: A Synthesis of Current Impacts and Experiences. Gen. Tech. Rep. PNW-GTR-944. U.S. Department of Agriculture, Forest Service, Pacific Northwest Research Station, Portland, OR, 136 pp. <a target='_blank' href='https://www.fs.usda.gov/treesearch/pubs/53156'>URL</a>. <a href='#fnref:112' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:158'>O'Neill, B. C., J. M. Done, A. Gettelman, P. Lawrence, F. Lehner, J.-F. Lamarque, L. Lin, A. J. Monaghan, K. Oleson, X. Ren, B. M. Sanderson, C. Tebaldi, M. Weitzel, Y. Xu, B. Anderson, M. J. Fix, and S. Levis, 2017: The Benefits of Reduced Anthropogenic Climate changE (BRACE): A synthesis. <i>Climatic Change</i>, doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-017-2009-x'>10.1007/s10584-017-2009-x</a>. <a href='#fnref:158' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:38'>Ogden, N. H., and L. R. Lindsay, 2016: Effects of climate and climate change on vectors and vector-borne diseases: Ticks are different. <i>Trends in Parasitology</i>, <b>32</b> (8), 646–656. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.pt.2016.04.015'>10.1016/j.pt.2016.04.015</a>. <a href='#fnref:38' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:161'>Oleson, K. W., G. B. Anderson, B. Jones, S. A. McGinnis, and B. Sanderson, 2015: Avoided climate impacts of urban and rural heat and cold waves over the U.S. using large climate model ensembles for RCP8.5 and RCP4.5. <i>Climatic Change</i>, doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-015-1504-1'>10.1007/s10584-015-1504-1</a>. <a href='#fnref:161' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:101'>Overstreet, S., A. Salloum, and C. Badour, 2010: A school-based assessment of secondary stressors and adolescent mental health 18 months post-Katrina. <i>Journal of School Psychology</i>, <b>48</b> (5), 413–431. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.jsp.2010.06.002'>10.1016/j.jsp.2010.06.002</a>. <a href='#fnref:101' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:54'>Pacyna, J. M., I. T. Cousins, C. Halsall, A. Rautio, J. Pawlak, E. G. Pacyna, K. Sundseth, S. Wilson, and J. Munthe, 2015: Impacts on human health in the Arctic owing to climate-induced changes in contaminant cycling — The EU ArcRisk project policy outcome. <i>Environmental Science & Policy</i>, <b>50</b>, 200–213. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envsci.2015.02.010'>10.1016/j.envsci.2015.02.010</a>. <a href='#fnref:54' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:53'>Paerl, H. W., 2014: Mitigating harmful cyanobacterial blooms in a human- and climatically-impacted world. <i>Life</i>, <b>4</b> (4), 988–1012. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/life4040988'>10.3390/life4040988</a>. <a href='#fnref:53' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:171'>Paull, S. H., D. E. Horton, M. Ashfaq, D. Rastogi, L. D. Kramer, N. S. Diffenbaugh, and A. M. Kilpatrick, 2017: Drought and immunity determine the intensity of West Nile virus epidemics and climate change impacts. <i>Proceedings of the Royal Society B: Biological Sciences</i>, <b>284</b> (1848) doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1098/rspb.2016.2078'>10.1098/rspb.2016.2078</a>. <a href='#fnref:171' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:109'>Perera, F. P., 2017: Multiple threats to child health from fossil fuel combustion: Impacts of air pollution and climate change. <i>Environmental Health Perspectives</i>, <b>125</b>, 141–148. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/EHP299'>10.1289/EHP299</a>. <a href='#fnref:109' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:28'>Petitti, D. B., D. M. Hondula, S. Yang, S. L. Harlan, and G. Chowell, 2016: Multiple trigger points for quantifying heat-health impacts: New evidence from a hot climate. <i>Environmental Health Perspectives</i>, <b>124</b>, 176–183. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/ehp.1409119'>10.1289/ehp.1409119</a>. <a href='#fnref:28' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:174'>Roser-Renouf, C., E. W. Maibach, and J. Li, 2016: Adapting to the changing climate: An assessment of local health department preparations for climate change-related health threats, 2008-2012. <i>PLOS ONE</i>, <b>11</b> (3), e0151558. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pone.0151558'>10.1371/journal.pone.0151558</a>. <a href='#fnref:174' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:24'>Ross, M. E., A. M. Vicedo-Cabrera, R. E. Kopp, L. Song, D. S. Goldfarb, J. Pulido, S. Warner, S. L. Furth, and G. E. Tasian, 2018: Assessment of the combination of temperature and relative humidity on kidney stone presentations. <i>Environmental Research</i>, <b>162</b>, 97–105. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envres.2017.12.020'>10.1016/j.envres.2017.12.020</a>. <a href='#fnref:24' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:113'>Roth, M., 2018: A resilient community is one that includes and protects everyone. <i>Bulletin of the Atomic Scientists</i>, <b>74</b> (2), 91–94. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/00963402.2018.1436808'>10.1080/00963402.2018.1436808</a>. <a href='#fnref:113' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:110'>Rudolph, L., S. Gould, and J. Berko, 2015: Climate change, health, and equity: Opportunities for action. Public Health Institute, Oakland, CA, 56 pp. <a target='_blank' href='http://www.phi.org/uploads/application/files/h7fjouo1i38v3tu427p9s9kcmhs3oxsi7tsg1fovh3yesd5hxu.pdf'>URL</a>. <a href='#fnref:110' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:39'>Ryan, S. J., A. McNally, L. R. Johnson, E. A. Mordecai, T. Ben-Horin, K. Paaijmans, and K. D. Lafferty, 2015: Mapping physiological suitability limits for malaria in Africa under climate change. <i>Vector-Borne and Zoonotic Diseases</i>, <b>15</b> (12), 718–725. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1089/vbz.2015.1822'>10.1089/vbz.2015.1822</a>. <a href='#fnref:39' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:27'>Saha, S., J. W. Brock, A. Vaidyanathan, D. R. Easterling, and G. Luber, 2015: Spatial variation in hyperthermia emergency department visits among those with employer-based insurance in the United States – a case-crossover analysis. <i>Environmental Health</i>, <b>14</b> (1), 20. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/s12940-015-0005-z'>10.1186/s12940-015-0005-z</a>. <a href='#fnref:27' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:18'>Sarofim, M. C., S. Saha, M. D. Hawkins, D. M. Mills, J. Hess, R. Horton, P. Kinney, J. Schwartz, and A. St. Juliana, 2016: Ch. 2: Temperature-related death and illness. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 43–68. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0MG7MDX'>10.7930/J0MG7MDX</a>. <a href='#fnref:18' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:124'>Schrock, G., E. M. Bassett, and J. Green, 2015: Pursuing equity and justice in a changing climate: Assessing equity in local climate and sustainability plans in U.S. cities. <i>Journal of Planning Education and Research</i>, <b>35</b> (3), 282–295. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1177/0739456x15580022'>10.1177/0739456x15580022</a>. <a href='#fnref:124' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:133'>Schulte, P. A., A. Bhattacharya, C. R. Butler, H. K. Chun, B. Jacklitsch, T. Jacobs, M. Kiefer, J. Lincoln, S. Pendergrass, J. Shire, J. Watson, and G. R. Wagner, 2016: Advancing the framework for considering the effects of climate change on worker safety and health. <i>Journal of Occupational and Environmental Hygiene</i>, <b>13</b> (11), 847–865. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/15459624.2016.1179388'>10.1080/15459624.2016.1179388</a>. <a href='#fnref:133' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:71'>Semenza, J. C., J. Trinanes, W. Lohr, B. Sudre, M. Löfdahl, J. Martinez-Urtaza, G. L. Nichols, and J. Rocklöv, 2017: Environmental suitability of Vibrio infections in a warming climate: An early warning system. <i>Environmental Health Perspectives</i>, <b>125</b> (10), 107004. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1289/EHP2198'>10.1289/EHP2198</a>. <a href='#fnref:71' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:140'>Semenza, J., 2015: Prototype early warning systems for vector-borne diseases in Europe. <i>International Journal of Environmental Research and Public Health</i>, <b>12</b> (6), 6333–6351. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph120606333'>10.3390/ijerph120606333</a>. <a href='#fnref:140' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:117'>Sheffield, P., S. Uijttewaal, J. Stewart, and M. Galvez, 2017: Climate change and schools: Environmental hazards and resiliency. <i>International Journal of Environmental Research and Public Health</i>, <b>14</b> (11), 1397. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph14111397'>10.3390/ijerph14111397</a>. <a href='#fnref:117' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:119'>Shepard, P. M., and C. Corbin-Mark, 2009: Climate justice. <i>Environmental Justice</i>, <b>2</b> (4), 163–166. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1089/env.2009.2402'>10.1089/env.2009.2402</a>. <a href='#fnref:119' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:29'>Sheridan, S. C., and S. Lin, 2014: Assessing variability in the impacts of heat on health outcomes in New York City over time, season, and heat-wave duration. <i>EcoHealth</i>, <b>11</b> (4), 512–525. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10393-014-0970-7'>10.1007/s10393-014-0970-7</a>. <a href='#fnref:29' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:148'>Shimamoto, M. M., and S. McCormick, 2017: The role of health in urban climate adaptation: An analysis of six U.S. cities. <i>Weather, Climate, and Society</i>, <b>9</b> (4), 777–785. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1175/wcas-d-16-0142.1'>10.1175/wcas-d-16-0142.1</a>. <a href='#fnref:148' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:9'>Shultz, J. M., J. P. Kossin, J. M. Shepherd, J. M. Ransdell, R. Walshe, I. Kelman, and S. Galea, 2018: Risk, health consequences, and response challenges for small-island-based populations: Observations from the 2017 Atlantic hurricane season. <i>Disaster Medicine and Public Health Preparedness</i>, 1–13. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1017/dmp.2018.28'>10.1017/dmp.2018.28</a>. <a href='#fnref:9' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:155'>Smith, K. R., A. Woodward, D. Campbell-Lendrum, D. D. Chadee, Y. Honda, Q. Liu, J. M. Olwoch, B. Revich, and R. Sauerborn, 2014: Human health: Impacts, adaptation, and co-benefits. <i>Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel of Climate Change</i>. Field, C. B., V. R. Barros, D. J. Dokken, K. J. Mach, M. D. Mastrandrea, T. E. Bilir, M. Chatterjee, K. L. Ebi, Y. O. Estrada, R. C. Genova, B. Girma, E. S. Kissel, A. N. Levy, S. MacCracken, P. R. Mastrandrea, and L. L. White, Eds., Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, 709–754. <a target='_blank' href='http://www.ipcc.ch/report/ar5/wg2/'>URL</a>. <a href='#fnref:155' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:83'>Smith, M. R., C. D. Golden, and S. S. Myers, 2017: Potential rise in iron deficiency due to future anthropogenic carbon dioxide emissions. <i>GeoHealth</i>, <b>1</b> (6), 248–257. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1002/2016GH000018'>10.1002/2016GH000018</a>. <a href='#fnref:83' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:79'>Soneja, S., C. Jiang, C. Romeo Upperman, R. Murtugudde, C. S. Mitchell, D. Blythe, A. R. Sapkota, and A. Sapkota, 2016: Extreme precipitation events and increased risk of campylobacteriosis in Maryland, U.S.A. <i>Environmental Research</i>, <b>149</b>, 216–221. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.envres.2016.05.021'>10.1016/j.envres.2016.05.021</a>. <a href='#fnref:79' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:42'>Springer, Y. P., C. S. Jarnevich, D. T. Barnett, A. J. Monaghan, and R. J. Eisen, 2015: Modeling the present and future geographic distribution of the Lone Star tick, Amblyomma americanum (Ixodida: Ixodidae), in the continental United States. <i>The American Journal of Tropical Medicine and Hygiene</i>, <b>93</b> (4), 875–890. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.4269/ajtmh.15-0330'>10.4269/ajtmh.15-0330</a>. <a href='#fnref:42' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:91'>Springmann, M., D. Mason-D'Croz, S. Robinson, T. Garnett, H. C. J. Godfray, D. Gollin, M. Rayner, P. Ballon, and P. Scarborough, 2016: Global and regional health effects of future food production under climate change: A modelling study. <i>The Lancet</i>, <b>387</b> (10031), 1937–1946. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/S0140-6736(15)01156-3'>10.1016/S0140-6736(15)01156-3</a>. <a href='#fnref:91' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:159'>Tebaldi, C., and M. F. Wehner, 2016: Benefits of mitigation for future heat extremes under RCP4.5 compared to RCP8.5. <i>Climatic Change</i>, <b>First online</b>, 1–13. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1007/s10584-016-1605-5'>10.1007/s10584-016-1605-5</a>. <a href='#fnref:159' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:59'>Tornevi, A., L. Barregård, and B. Forsberg, 2015: Precipitation and primary health care visits for gastrointestinal illness in Gothenburg, Sweden. <i>PLOS ONE</i>, <b>10</b> (5), e0128487. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1371/journal.pone.0128487'>10.1371/journal.pone.0128487</a>. <a href='#fnref:59' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:49'>Trtanj, J., L. Jantarasami, J. Brunkard, T. Collier, J. Jacobs, E. Lipp, S. McLellan, S. Moore, H. Paerl, J. Ravenscroft, M. Sengco, and J. Thurston, 2016: Ch. 6: Climate impacts on water-related illness. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 157–188. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J03F4MH4'>10.7930/J03F4MH4</a>. <a href='#fnref:49' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:1'>USGCRP, 2016: The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 312 pp. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0R49NQX'>10.7930/J0R49NQX</a>. <a href='#fnref:1' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:173'>USGCRP, 2017: Climate Science Special Report: Fourth National Climate Assessment, Volume I. Wuebbles, D. J., D. W. Fahey, K. A. Hibbard, D. J. Dokken, B. C. Stewart, and T. K. Maycock, Eds. U.S. Global Change Research Program, Washington, DC, USA, 470 pp. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0J964J6'>10.7930/J0J964J6</a>. <a href='#fnref:173' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:41'>Vazquez-Prokopec, G. M., A. Lenhart, and P. Manrique-Saide, 2016: Housing improvement: A novel paradigm for urban vector-borne disease control? <i>Transactions of The Royal Society of Tropical Medicine and Hygiene</i>, <b>110</b> (10), 567–569. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1093/trstmh/trw070'>10.1093/trstmh/trw070</a>. <a href='#fnref:41' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:34'>Vazquez-Prokopec, G. M., T. A. Perkins, L. A. Waller, A. L. Lloyd, R. C. Reiner Jr., T. W. Scott, and U. Kitron, 2016: Coupled heterogeneities and their impact on parasite transmission and control. <i>Trends in Parasitology</i>, <b>32</b> (5), 356–367. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.pt.2016.01.001'>10.1016/j.pt.2016.01.001</a>. <a href='#fnref:34' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:65'>Veenema, T. G., C. P. Thornton, R. P. Lavin, A. K. Bender, S. Seal, and A. Corley, 2017: Climate change–related water disasters' impact on population health. <i>Journal of Nursing Scholarship</i>, <b>49</b> (6), 625–634. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1111/jnu.12328'>10.1111/jnu.12328</a>. <a href='#fnref:65' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:115'>Vickery, J., and L. M. Hunter, 2016: Native Americans: Where in environmental justice research? <i>Society & Natural Resources</i>, <b>29</b> (1), 36–52. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/08941920.2015.1045644'>10.1080/08941920.2015.1045644</a>. <a href='#fnref:115' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:16'>Vins, H., J. Bell, S. Saha, and J. Hess, 2015: The mental health outcomes of drought: A systematic review and causal process diagram. <i>International Journal of Environmental Research and Public Health</i>, <b>12</b> (10), 13251. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph121013251'>10.3390/ijerph121013251</a>. <a href='#fnref:16' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:147'>Vogel, J., K. M. Carney, J. B. Smith, C. Herrick, M. Stults, M. O'Grady, A. S. Juliana, H. Hosterman, and L. Giangola, 2016: Climate Adaptation — The State of Practice in U.S. Communities. Kresge Foundation, Detroit, <a target='_blank' href='http://kresge.org/sites/default/files/library/climate-adaptation-the-state-of-practice-in-us-communities-full-report.pdf'>URL</a>. <a href='#fnref:147' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:98'>Waite, T. D., K. Chaintarli, C. R. Beck, A. Bone, R. Amlôt, S. Kovats, M. Reacher, B. Armstrong, G. Leonardi, G. J. Rubin, and I. Oliver, 2017: The English national cohort study of flooding and health: Cross-sectional analysis of mental health outcomes at year one. <i>BMC Public Health</i>, <b>17</b> (1), 129. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/s12889-016-4000-2'>10.1186/s12889-016-4000-2</a>. <a href='#fnref:98' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:21'>Wang, Y., J. F. Bobb, B. Papi, Y. Wang, A. Kosheleva, Q. Di, J. D. Schwartz, and F. Dominici, 2016: Heat stroke admissions during heat waves in 1,916 US counties for the period from 1999 to 2010 and their effect modifiers. <i>Environmental Health</i>, <b>15</b> (1), 83. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/s12940-016-0167-3'>10.1186/s12940-016-0167-3</a>. <a href='#fnref:21' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:125'>White-Newsome, J. L., 2016: A policy approach toward climate justice. <i>The Black Scholar</i>, <b>46</b> (3), 12–26. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1080/00064246.2016.1188353'>10.1080/00064246.2016.1188353</a>. <a href='#fnref:125' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:146'>Wolch, J. R., J. Byrne, and J. P. Newell, 2014: Urban green space, public health, and environmental justice: The challenge of making cities “just green enough.” <i>Landscape and Urban Planning</i>, <b>125</b>, 234–244. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.landurbplan.2014.01.017'>10.1016/j.landurbplan.2014.01.017</a>. <a href='#fnref:146' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:141'>Worrall, E., S. J. Connor, and M. C. Thomson, 2008: Improving the cost-effectiveness of IRS with climate informed health surveillance systems. <i>Malaria Journal</i>, <b>7</b> (1), 263. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1186/1475-2875-7-263'>10.1186/1475-2875-7-263</a>. <a href='#fnref:141' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:78'>Young, I., K. Gropp, A. Fazil, and B. A. Smith, 2015: Knowledge synthesis to support risk assessment of climate change impacts on food and water safety: A case study of the effects of water temperature and salinity on Vibrio parahaemolyticus in raw oysters and harvest waters. <i>Food Research International</i>, <b>68</b>, 86–93. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.foodres.2014.06.035'>10.1016/j.foodres.2014.06.035</a>. <a href='#fnref:78' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:75'>Yun, J., M. Greiner, C. Höller, U. Messelhäusser, A. Rampp, and G. Klein, 2016: Association between the ambient temperature and the occurrence of human Salmonella and Campylobacter infections. <i>Scientific Reports</i>, <b>6</b>, 28442. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1038/srep28442'>10.1038/srep28442</a>. <a href='#fnref:75' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:17'>Yusa, A., P. Berry, J. J.Cheng, N. Ogden, B. Bonsal, R. Stewart, and R. Waldick, 2015: Climate change, drought and human health in Canada. <i>International Journal of Environmental Research and Public Health</i>, <b>12</b> (7), 8359. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.3390/ijerph120708359'>10.3390/ijerph120708359</a>. <a href='#fnref:17' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:118'>Ziegler, C., V. Morelli, and O. Fawibe, 2017: Climate change and underserved communities. <i>Primary Care: Clinics in Office Practice</i>, <b>44</b> (1), 171–184. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.1016/j.pop.2016.09.017'>10.1016/j.pop.2016.09.017</a>. <a href='#fnref:118' class='reversefootnote'>↩</a></li> <li class='footnote' id='fn:72'>Ziska, L., A. Crimmins, A. Auclair, S. DeGrasse, J. F. Garofalo, A. S. Khan, I. Loladze, A. A. Pérez de León, A. Showler, J. Thurston, and I. Walls, 2016: Ch. 7: Food safety, nutrition, and distribution. <i>The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment</i>., U.S. Global Change Research Program, Washington, DC, 189–216. doi:<a target='_blank' class='footnote-url' href='https://doi.org/10.7930/J0ZP4417'>10.7930/J0ZP4417</a>. <a href='#fnref:72' class='reversefootnote'>↩</a></li> </ul> </div> </div> </div> </section> </div> </section> </section> <div id="modal-lightbox" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="modal-lightbox-label" aria-hidden="true"> <div class="modal-dialog modal-lg" role="document"> <div class="modal-content"> <div class="modal-header"> <h2 class="modal-title mt-0" id="modal-lightbox-label"></h2> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> </div> <div class="modal-body"></div> </div> </div> </div> <div id="modal-external-link" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="modal-external-link-label" aria-hidden="true"> <div class="modal-dialog modal-lg modal-dialog-centered" role="document"> <div class="modal-content"> <div class="modal-header"> <h2 class="modal-title mt-0" id="modal-external-link-label">External Link <img src="/icons/external-link.svg" alt="External Link" style="vertical-align: baseline;" /></h2> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> </div> <div class="modal-body">You are leaving The Fourth National Climate Assessment and will be redirected to a new site in 5 seconds.</div> <div class="modal-footer"> <button type="button" class="btn btn-secondary btn-go" data-dismiss="modal">Leave</button> <button type="button" class="btn btn-primary btn-stay" data-dismiss="modal">Stay</button> </div> </div> </div> </div> <div class="container-fluid px-0"> <footer class="doc-footer"> <div class="logo-footer"> <p> <a href="http://globalchange.gov" style="border:none;"><img class="lazyload" data-src="/img/gc-logo.png" alt="USGCRP Globalchange.gov earth logo" /></a><br/><br/> <img class="lazyload" data-src="/img/logos-footer-1.png" alt="13 Logos #1"> <img class="lazyload" data-src="/img/logos-footer-2.png" alt="13 Logos #2"> </p> <div class="xcopyright"> <p>U.S. Global Change Research Program<br/> 1800 G Street, NW, Suite 9100, Washington, DC 20006 USA<br/> Tel: +1 202.223.6262 | Fax: +1 202.223.3065</p> <p> <a href="https://www.globalchange.gov/contact/">Contact Us</a> • <a href="/credits/">Credits</a> • <a href="https://www.globalchange.gov/privacy">Privacy Policy</a> • <a href="/sitemap">Site Map</a> </p> <p> <span class="balance-text">Some figures and images are copyright protected.</span><br/> <span class="balance-text">Permission of the copyright owner must be obtained</span><br/> <span class="balance-text">before making use of copyrighted material.</span></p> </div> </div> </footer> </div> <script src="/js/jquery-3.3.1.min.js"></script> <script src="/js/popper.min.js"></script> <script src="/js/bootstrap.min.js"></script> <script defer src="/js/fontawesome-all.min.js"></script> <script src="/js/jquery.matchHeight-min.js"></script> <script src="/js/yall-2.1.0.min.js"></script> <script src="/js/balancetext.min.js"></script> <script src="/js/jquery.waypoints.min.js"></script> <script src="/js/jquery.qtip.min.js"></script> <script src="/js/slick.js"></script> <script src="/js/jquery.glossarize.js"></script> <script src='/js/jquery.rwdImageMaps.min.js'></script> <script src='/js/leaflet.js'></script> <script src='/js/esri-leaflet.js'></script> <script src='/interactives/14_3/leaflet-ajax.min.js'></script> <script src='https://api.mapbox.com/mapbox.js/plugins/leaflet-fullscreen/v1.0.1/Leaflet.fullscreen.min.js'></script> <script src='/js/leaflet.markercluster.js'></script> <script src="/js/leaflet.zoomhome.js"></script> <script data-main="https://nca2018.globalchange.gov/js/looker.js" src="/js/require.js" async></script> <script> document.addEventListener("DOMContentLoaded", function() { yall({ lazyClass: "lazyload" }); 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