Climate change is 'first and foremost' a health crisis, new report finds

Working construction under the merciless Arizona sun, Eleazar Castellanos knew the signs that heat exhaustion was settling in. 

On the days when the temperature would top 100 degrees, he and his coworkers would sweat profusely. Then came the cramps in their arms and legs, and the overwhelming urge to stop: take a break, get some water, cool down.

But they couldn’t. Not if they wanted to get paid and return home to their families as breadwinners.

“Many of the employers don’t understand, we need to have breaks, to have water,” Castellanos said. “You don’t stop, because you know if you stop, you stop getting money. We try to get it done whatever the situation is.”

CLIMATE WARS: Major US spy report estimates global famine, inter-country conflict could spark from climate change

Count Castellanos among millions. New research released Wednesday by a consortium of medical and public health experts finds that the number of Americans exposed to heatwaves continues to grow, with 2020 marking the second highest level of dangerous exposure since 1986. 

But the research, led by the international health expert consortium Lancet Countdown and co-published in the United States by the American Public Health Association, doesn’t stop there. Heatwaves and their ability to exhaust and kill are only one of many public health threats on the rise, they found, as climate change warms the globe and sends weather patterns haywire.

Drought levels across most of the southwest and California are at the worst level in decades. In some cases, the problem is the worst it has been in a century. There is no sign it will let up in the foreseeable future, leaving tens of thousands of square miles unable to support crops and livestock and scores of cities without enough water to support their populations.    One state, Utah, is worse off than the rest although states adjacent to it have problems nearly as severe.    The gold standard for measuring drought conditions is the U.S. Drought Monitor, which is a joint venture among the National Drought Mitigation Center at the University of Nebraska-Lincoln, the United States Department of Agriculture and the National Oceanic and Atmospheric Administration.     The monitor ranks drought severity in states by combining five categories of drought D0 to D4, with D4 as the worst level. To identify the states hit hardest by drought, we compared every state's Drought Severity and Coverage Index (DSCI).     For reference, the year-to-date average DSCI for the continental United States is about 169. The DSCI value for the latest week of data, starting June 8, is 170. The average DSCI value for the continental U.S. has not fallen below 164 during any week of 2021. At around this time last year, the week of June 16, 2020, the DSCI value was lower by nearly half, at 79. Only six states are completely drought-free. The value for Utah is 452.    D0 is described as places where "dryland crops are struggling" and "water for cattle is limited." D1 drought levels are where "soil moisture is low and winter wheat germination is poor." D2 is described as where "pasture and water is inadequate for cattle" and "streams and ponds are dry." D3 is described as places where "fire danger increases" and "native vegetation is stressed." And D4 is the designation for places where "fire restrictions increase" and "irrigation water allotments are cut." D4 areas are also labeled places with "exceptional drought."    A recent New York Times article that examined the issue attributes much of the trouble to climate change. "But at the root of the drought are warmer temperatures and changing precipitation patterns, which are linked to emissions of carbon dioxide and other greenhouse gases into the atmosphere, where they trap the sun's heat."

Droughts lead to crop loss, obliterating jobs and the means to access health care. Wildfires send plumes of toxic air pollution into the air, which can travel thousands of miles across the country and catch those suffering from respiratory ailments off guard. Worsening pollen seasons further add to the stress for those with asthma and other conditions, spiking emergency room visits.

Most at risk are marginalized communities of Black, Latino, Indigenous and Asian Americans, who are disproportionately located near sources of pollution, or lack the means to protect themselves and access health care.

“Climate change is first and foremost a health crisis,” said Dr. Renee Salas, an attending physician and assistant professor of emergency medicine at the Harvard Medical School, and lead author of the U.S. report.

More: Climate change, heat waves affect heart health, experts say. Here's why that puts people of color at higher risk.

Salas and colleagues who presented the findings this week say the U.S. and other nations have the means to head off the growing crisis by cutting emissions to slow down global warming and marshalling resources to protect against its effects. 

 Yet each of the 44 health indicators tracked in the new report have reached “code red,” according to Jeremy Hess, a medical doctor and professor of public health and emergency medicine at the University of Washington. 

“The trends are increasingly worrisome because they are persistent in the wrong direction.”

The report arrives less than two weeks before the United Nation’s 26th Annual Climate Change Conference begins in Glasgow, Scotland. Climate experts say the hundreds of countries in attendance must find a way to ratchet down their greenhouse gas emissions if they are to avoiding the most catastrophic impacts of climate change.

Carlos Ramos hands out bottles of water and sack lunches as he works at a hydration station in front of the Union Gospel Mission in Seattle.

But Hess is already seeing catastrophe firsthand. In early summer, he treated patients suffering heat-related illnesses under a heat dome that struck the Pacific Northwest. Some didn’t make it, adding to a growing number of American climate casualties.

“This was the first year I can say confidently that I and my patients very clearly experienced the impacts of climate change,” Hess said. “I saw paramedics who had burns on their knees from kneeling down to care for patients who had heat stroke, and I saw far too many patients die in the evening as a result of their heat exposure.”

Measuring heat exposure

Scientists count heat exposure by the days. Each time a single American lives through a day of a heat wave, that’s one day. If a heat wave hits New York City, it adds up to 8.42 million days of heat exposure per day, one for each resident.

Nationally, the number is growing. In 2020, there were 300 million more heat wave exposures compared to the typical amount just two decades ago. And that has led to more deaths.

Across the country, 92% of households have air conditioning, preventing about 48,000 heat deaths a year, according to the new report. But in the Pacific Northwest, that number drops to nearly 70%. In Seattle, less than half of homes have access to air conditioning, contributing to a spike of at least 600 deaths across the region during this year’s heat dome, the study said, citing media reports.

“Additionally, inequitable access to weatherized, energy-efficient homes limits adaptability for low-income communities and people of color,” the U.S. report noted.

More: People of color face disproportionate harm from climate change, EPA says

The knock-on effects of all that heat adds to other the public health dangers. The number of wildfires nationwide peaked at approximately 80,000 in 2020, researchers found, an amount eight times greater than 2001. Tiny harmful air pollutants called particulate matter caused by the smoke enter lungs and increase the risk of heart disease, premature death, and preterm birth, along with worsening mental health.

In this long exposure photo, flames from the Dixie Fire spread in Genesee, Calif., on Saturday, Aug. 21, 2021.

Rising temperatures are also exacerbating drought.

In addition to the direct effects to the human body like heat stroke and disease complication, droughts create more suitable conditions for mosquitos that carry diseases such as West Nile Virus and Dengue fever, hurt water quality and add to food and economic insecurity.  

Droughts also decrease water quality and increase the risk of exposure to harmful algae, increase harms to the respiratory system, and contribute to depression and anxiety, the study said.

20. Southwest: Four Corners Region     According to the National Climate Assessment, human-induced climate change has contributed to increased heat, drought, and insect outbreaks in the Southwest and four-corners region, which includes Colorado, Utah, Arizona, and New Mexico and is the hottest and driest part of the United States. The rise in extreme weather conditions has led to increased wildfires, declines in water supplies, reductions in agricultural output, and heat-related health issues in cities. These are likely to continue to increase in the future.    ALSO READ: The Most Serious Public Health Issues America Is Facing Today

Limiting the damage

Authors of the Lancet Countdown’s U.S. report not only highlighted the public health threats brought by climate change, but offered policy solutions they say can limit the damage.

The report urges a three-prong approach: slowing the bleeding by rapidly lowering greenhouse gas emissions, treating the symptoms by rethinking public health policies and resource allocation, and assisting those with the power to make such decisions by better helping them understand the costs and benefits of taking such actions.

But recent events have shown how difficult swift transition can be. Although the burning  of coal for energy in the U.S. has halved from 2007, it still makes up 19% of the nation’s energy supply and is the largest emitter of greenhouse gases, the report said. Natural gas, another fossil fuel, makes up 40% of the supply. The use of renewables like wind, solar, and hydropower are growing but still make up just 20% of the energy mix.

The Biden administration hoped to put its thumb on the scales by implementing a $150 billion Clean Energy Payment Program to  reward energy suppliers for transitioning to renewables and penalize those who stick to fossil fuels.

But as first reported by The New York Times last Friday, U.S. Sen. Joe Manchin, a West Virginia Democrat supportive of the coal industry, has told the White House he is opposed to the measure, greatly decreasing its chances of passage.

Hospitals and local government should prepare for unprecedented scenarios, the report's authors said. Already, some cities are taking action. Earlier this month, Phoenix became the first city in the United States to use public funds to hire a director of heat response and mitigation, the Arizona Republic reported, following a similar effort with private funds in Miami.

For Castellanos, the former construction worker in Arizona who now trains workers on federal workplace safety policies with the nonprofit Arriba Las Vegas in Nevada, the urgency for change remains clear. Federal and state regulators under the banner of the Occupational Safety and Health Administration need to better enforce workplace safety, he said. 

But everyone needs better education to bring heat illness and the other health impacts of climate change out of the shadows.

“Every year it’s the same history, every year it’s the same problem,” Castellanos said. “We pretend we are used to it, but we never can do that.”

Contact Kyle Bagenstose at