The health impacts of climate changeClimate Change: The Importance of Place
Section snippets
Introduction, Background, and Scope
Place is one of several dimensions of risk related to harmful environmental exposures. The effects anticipated with climate change will not have a uniform spatial distribution, and place will be a major exposure determinant. As noted by Yohe and Tol,1 public health threats related to climate change are “location specific and path dependent.” Identifying locations where human health risk is heightened can facilitate vulnerability mapping and enhance local public health preparedness, an essential
Coastal Areas
Coastal areas and their unique environmental complexities strain a common definition of place, but nevertheless several common elements exist, including low elevation, the existence of a coastline, and intense human development.
The coastal U.S. includes a narrow fringe an estimated 152,000 km (94,448 miles) in length, and coastal counties in the U.S. constitute 17% of the country's contiguous land mass, with 53% of the population.13 In 2003, 23 of the 25 most densely populated counties in the
Islands
In the U.S., more than 5.5 million people live on thousands of islands, including a state and several territories (Hawaii, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands).40 These island communities, by definition coastal, will face the same stressors as their counterparts in the contiguous North American continental land mass. In addition to characteristics common to the coasts, islands are relatively physically isolated. They are dependent on
The Desert Southwest
Exemplifying the fact that climate change will bring about greater extremes, we focus next on the desert in the southwestern U.S. Geologically termed the Great Basin or the Basin and Range, the area is a large, arid region bordered to the west by the Sierra Nevada and the east by the Colorado Plateau (Figure 3). It is home to characteristic flora and fauna. It has relatively sparse rainfall in typical years. Much of the region is high desert, with elevations from 1.2 to 3.7 km (0.75–2.29
Border Regions of Vectorborne and Zoonotic Disease
A warming world will see movement of ecologic transition zones, boundaries of different populations of characteristic flora and fauna influenced by topography and climate. The implications for human health will be apparent in places where these movements result in changing infectious disease ecology, from changes in the range of arthropod vectors and zoonotic hosts. This topic is covered extensively elsewhere in this issue,60 but it bears mention here as well. Although not anticipated to be a
Cities
Cities and, in a larger sense, the built environment are major components of place. Again, while this topic is covered more extensively by Younger and colleagues67 elsewhere in this issue, it bears mention, as people in cities—and certain populations and places within cities—are at special risk from climate change. Urban dwellers face heightened risk for a host of exposures, including heatwaves, air pollution episodes, and floods.68 In particular, the urban heat island effect will intensify
U.S. Arctic (Alaska)
In the U.S., climate change will perhaps be most pronounced in Alaska, a lightly populated state one fifth the size of the lower 48 states combined. Alaska's ecology and demographics are both distinct from those of the lower 48 states, and its climate–health dynamics are also different. Although climate change will bring a host of new stressors to the region, it will also bring relief from certain health risks as well as access to new economic opportunities. The net balance of both direct and
Climate Change, Disconnection, and Displacement
Many of the exposures discussed above, including sea-level rise, movement of ecologic transition zones, and economic strain on regions and communities, are likely to complicate and undermine human relationships with place. Climate change will affect these relationships by prompting migration or by fundamentally altering a place's ecology such that established human relationships with place can no longer be maintained.
As noted in the Introduction, disruption of place attachment and identity are
The Public Health Value Added By Emphasizing Place
The public health response to climate change has been discussed at length previously, and several frameworks have been proposed, including the Essential Public Health Services93 and the familiar framework of primary, secondary, and tertiary prevention, expanded on by Ebi and Semenza94 in this issue. Place does not currently have a formal role in these frameworks, and much can be said for the importance and strategic worth of a coordinated national and international plan that pools resources and
Conclusion
Climate change will bring potentially injurious exposures to human communities the world over, although certain places and the communities they nurture will be at particular risk. Identifying places at special risk from climate change is a complex exercise in human ecology. Given the changing exposures that we know climate change will bring, we can identify places where human populations and critical infrastructure will be at particular risk. Identifying these places and highlighting these
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