--- - chapter_identifier: food-safety-nutrition-and-distribution confidence: 'Given the evidence base and current uncertainties, there is high confidence that projected increases in the frequency and severity of extreme events will likely lead to damage of existing food supplies and disruptions to food distribution infrastructure. There is medium confidence that these damages and disruptions will increase risk for food damage, spoilage, or contamination, which will limit availability and access to safe and nutritious foods because of uncertainties surrounding the extent of the disruptions and individual, community, or institutional sensitivity to impacts. There are further uncertainties surrounding how the specific dynamics of the extreme event, such as the geographic location in which it occurs, as well as the social vulnerabilities or adaptive capacity of the populations at risk, will impact human health.' evidence: 'It is well documented in assessment literature that climate models project an increase in the frequency and intensity of some extreme weather events.2ad39d48-c8d4-46cf-9a5c-0bc65a4da57c,a6a312ba-6fd1-4006-9a60-45112db52190 Because the food transportation system moves large volumes at a time, has limited alternative routes, and is dependent on the timing of the growing and harvest seasons, it is likely that the projected increase in the frequency and intensity of extreme weather events089d8050-f4c8-4d07-bc35-25bf61691be3,2ad39d48-c8d4-46cf-9a5c-0bc65a4da57c will also increase the frequency of food supply chain disruptions (including risks to food availability and access)82a76f89-8c28-4fc6-aecc-31420462c4a4,8f90eee3-73f3-4782-b3e0-374f1207be77,a03f3148-6495-417f-b241-f21d677e7f0d,7a0e9531-8d92-4501-b738-b11e71c18813,2198cdb0-da69-4b2d-919f-a88f85c70091,580f7af6-b0eb-4ebb-8da4-ab0a0b8ef68b,57ffaa62-7363-4a5f-915f-b1930da3ac82 and the risk for food spoilage and contamination.580f7af6-b0eb-4ebb-8da4-ab0a0b8ef68b,b4dfdd6a-ffce-44a3-b6b7-5770f5c70fbb Recent extreme events have demonstrated a clear linkage to the disruption of food distribution and access.2198cdb0-da69-4b2d-919f-a88f85c70091,17380d26-bc60-4dcd-be46-9bf40616bfbd Case studies show that such events, particularly those that result in power outages, may also expose food to temperatures inadequate for safe storage,580f7af6-b0eb-4ebb-8da4-ab0a0b8ef68b with increased risk of illness. For example, New York City’s Department of Health and Mental Hygiene detected a statistically significant citywide increase in diarrheal illness resulting from consumption of spoiled foods due to lost refrigeration capabilities after a 2003 power outage.d03f5405-42ed-46bd-9f7f-23ba5f71bdf3' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/food-safety-nutrition-and-distribution/finding/extreme-weather-limits-access-to-safe-foods.yaml identifier: extreme-weather-limits-access-to-safe-foods ordinal: 4 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2 and 3. The author team also engaged in targeted consultations during multiple exchanges with contributing authors, who provided additional expertise on subsets of the Traceable Accounts associated with each Key Finding.

Because the impacts of climate change on food production, prices, and trade for the United States and globally have been widely examined elsewhere, including in the most recent report from the Intergovernmental Panel on Climate Change,fcd24eab-974a-46aa-8434-78b8cd3f0ef0,c04c5716-c318-4a4c-9774-ae61ce97d305,d0c735f3-4b2c-4dec-907c-09e81818b288,67bff3c8-bddd-4bbb-975d-bec307df5f72,3baf471f-751f-4d68-9227-4197fdbb6e5d,c390e13f-8517-40a9-a236-ac4dede3a7a0 this chapter focuses only on the impacts of climate change on food safety, nutrition, and distribution in the context of human health in the United States. Many nutritional deficiencies and food-related illnesses are of critical importance globally, particularly those causing diarrheal epidemics or mycotoxin poisoning, and affect U.S. interests abroad; but the primary focus of this chapter is to address climate impacts on the food safety concerns most important in the United States. Thus, the literature cited in this chapter is specific to the United States or of demonstrated relevance to developed countries. The placement of health threats from seafood was determined based on pre- and post-ingestion risks: while ingestion of contaminated seafood is discussed in this chapter, details on the exposure pathways of water-related pathogens (for example, through recreational or drinking water) are discussed in Chapter 6: Water-Related Illness.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'Increases in the frequency or intensity of some extreme weather events associated with climate change will increase disruptions of food distribution by damaging existing infrastructure or slowing food shipments [Likely, High Confidence]. These impediments lead to increased risk for food damage, spoilage, or contamination, which will limit availability of and access to safe and nutritious food, depending on the extent of disruption and the resilience of food distribution infrastructure [Medium Confidence].' uncertainties: 'The extent to which climate-related disruptions to the food distribution system will affect food supply, safety, and human health, including incidences of illnesses, remains uncertain. This is because the impacts of any one extreme weather event are determined by the type, severity, and intensity of the event, the geographic location in which it occurs, infrastructure resiliency, and the social vulnerabilities or adaptive capacity of the populations at risk.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/food-safety-nutrition-and-distribution/finding/extreme-weather-limits-access-to-safe-foods url: ~ - chapter_identifier: mental-health-and-well-being confidence: 'Numerous and recent studies have examined the mental health and wellness impacts of climate- and weather-related events among a variety of populations. Taken as a whole, the strength of this scientific evidence provides very high confidence regarding the adverse impacts of environmental changes and events associated with global climate change on individual and societal mental health and well-being, and high confidence that these impacts will be long-lasting for a significant portion of the impacted population.' evidence: 'Very strong evidence from multiple studies shows a consensus that many people exposed to climate- or weather-related natural disasters experience stress reactions and serious psychological harm, which often occur simultaneously.ef435f7f-82b0-426c-b518-cb23f76612ff,9502bb11-b920-48a6-a4ae-c6453a55d3a7,1357006d-175e-4414-9793-761618338c8d,a9cc82e3-1eb0-451c-90d3-dbe883c203d7,f8e99ff1-f5d6-4b9b-a844-2007310584f8 Though many of these studies describe the mental health impacts of specific historical events, they demonstrate the types of mental health issues that will continue to arise as climate change leads to increases in the frequency, severity, and duration of extreme climate- and weather-related events such as floods, hurricanes, droughts, and wildfires.c3776534-f010-44e8-ae2f-6d069cfaba37,569a5671-661e-457c-aa75-8a221911ac26,8702da89-76d0-44e1-9eda-b04dc6a26385,a95f121c-2fa2-4d4a-affe-576dad344217,9047c320-e8cb-4429-920d-b2d2d7f01ffc,0acc2713-8395-425c-b4ff-9754b7257048,15b8a671-4186-4cdb-aa80-d9e7012840e5,4489b5a2-b658-4e62-8a8a-c3805b6dccf1,1617ae90-36e2-48f5-b5ef-f5fb1aafb399,89d2438b-bddd-4ded-8e17-1cf498b28571,1a78f1ef-1f10-44b7-b040-b8109748255c,7d8b53d6-8f6b-4933-a116-41f415292792,0e71e17a-442f-46d8-b62f-cc3213f85208,8abc0ed4-9d56-40bf-8995-35313552618c,a7957dc8-1ead-4328-8250-a695f5f62c30 Strong support is found in a number of recent studies for the potential for climate change-related psychological effects, including grief/bereavement, increased substance use or misuse, and thoughts of suicide.8702da89-76d0-44e1-9eda-b04dc6a26385,dd605fa4-98b4-486a-8d7c-07311b957d30,de8ce512-2778-48ef-8874-aae2ed5afce8,895a462d-2faa-44e3-a888-31efb349f44d,d49018ea-2172-4983-8a51-f61feccb6e11,1231497d-b014-4c16-abda-cb4e00b2b695

Research on individual resilience and recovery shows that a majority of individuals psychologically affected by a traumatic event will recover over time. However, a convincing body of recent research shows that a significant proportion (typically up to 20%) of individuals directly exposed to the event will develop chronic levels of psychological dysfunction, which may not get better or be resolved.9047c320-e8cb-4429-920d-b2d2d7f01ffc,dd605fa4-98b4-486a-8d7c-07311b957d30,5aff4109-04b3-4ac6-a945-58664490b6fe,11180485-b3b5-4d33-85df-be175655dcca,11ed1918-b422-41d3-b704-05d14e45b278,97358ea1-2cd7-4dcf-a444-cbe7cd2e9cf0,a8e44cff-cd49-46f4-a54c-7a365097cbdf,3bc7615b-d281-4fd6-a367-c94022d367a8' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/exposure-weather-related-disasters-results-mental-health-consequences.yaml identifier: exposure-weather-related-disasters-results-mental-health-consequences ordinal: 1 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

Areas of focus for the Mental Health and Well-Being chapter were determined based on the most relevant available scientific literature relating to mental health, wellness, and climate change, as well as the mental health impacts of events associated with climate change. Much of the evidence on these impacts has been compiled in countries outside the United States; however, the scenarios are similar and the evidence directly relevant to the situation in the United States, and thus this literature has been considered in the chapter. The evidence-base on mental health and wellness following extreme weather disasters is both well-established and relevant to climate change. The existence of highly relevant scientific literature on specific concerns directly influenced by climate change—such as the effects of extreme heat, stress associated with the threat and perception of climate change, and special population risks—resulted in the inclusion of these more targeted topics. Although significant scientific literature for resilience exists, in-depth discussions of adaptation, coping, and treatment approaches are outside the scope of this chapter, but are discussed in brief in the Resilience and Recovery section.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'Many people exposed to climate-related or weather-related disasters experience stress and serious mental health consequences. Depending on the type of the disaster, these serious mental health consequences include post-traumatic stress disorder (PTSD), depression, and general anxiety, which often occur at the same time [Very High Confidence]. The majority of affected people recover over time, although a significant proportion of exposed individuals develop chronic psychological dysfunction [High Confidence].' uncertainties: 'There remains some uncertainty about the degree to which future extreme weather and climate events will impact mental health and wellness. An increase in the scope, frequency, or severity of these events will increase the number of people impacted and the degree to which they are affected. However, efforts that effectively increase preparation for both the physical and psychological consequences of extreme weather- and climate-related events could decrease the impact on mental health and well-being.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/exposure-weather-related-disasters-results-mental-health-consequences url: ~ - chapter_identifier: mental-health-and-well-being confidence: The combined breadth and strength of the scientific literature supports high confidence that certain vulnerable populations will face psychological tolls in the aftermath of climate-related disasters. An increase in adverse climate-related events will result in increased exposure of such populations of concern and an increased likelihood of elevated risk for mental health consequences. There is also high confidence that natural-resource-dependent communities and populations living in areas most susceptible to specific climate change events are at increased risk for adverse mental health outcomes. evidence: 'Multiple studies have identified specific populations within the United States that are particularly vulnerable to the mental health impacts of climate change events.34647534-8863-4fde-b8d0-f24bcdc4fcc6,9467cf71-753b-49a7-891b-04da863e71ad,67687fbe-a13c-48f9-99a3-158b1dae0fff,abe2ce03-59c1-461d-8801-3e12df93a8e1,30024cab-09f2-4778-86b0-e848ccf603c7,faadfa3a-2035-4c63-99e1-642f0c1d4e4e Some evidence suggests that children are at particular risk for distress, anxiety, and PTSD.36e4a94f-8c92-4eab-be3d-4521b7770716,800172f5-06ce-47cd-8e88-2860961c2c40,db242424-f22c-4d81-943d-7e1f583bc866 Highly cited studies of the elderly show that high rates of physical and mental health disorders leave them more vulnerable to the impacts of climate change.c3776534-f010-44e8-ae2f-6d069cfaba37,30024cab-09f2-4778-86b0-e848ccf603c7,d025518a-8085-4ef9-ba42-c0ac239d98f1,88885fc4-a6c8-454f-881d-51a8e2739bb5 A large body of post-disaster studies shows that women often have a higher prevalence of PTSD9c789c49-b1dd-4ed8-ac02-5942fb6674de and other adverse psychological outcomes. f66b946f-c672-4a4b-8f71-1b05738e029e,de2250cc-0ffe-40c6-b7f7-5de37d4b4131,9845a991-d58b-409b-91b9-670cc383d030,871e1113-59cb-4f06-a415-284137b17c51,36e4a94f-8c92-4eab-be3d-4521b7770716,66c76115-365d-4a76-9087-cf38d6afdc2e,e52c6b87-47d7-47dc-9018-f78cad2a35af,12114eeb-754e-46a7-92af-abce1e9d23cf,5f6029f9-9de1-4d32-b772-cf836ac4e048 Research strongly suggests that people who currently suffer from psychological disorders will face additional challenges from climate change impacts.922bcd50-dd07-4e05-afc7-fe3bcb1a953a,1e9a7907-02f2-4da8-9e93-131f92515dbc,2a9775ae-a280-4260-985f-0e66d0ef8c11,987707c1-8e54-41d8-8555-c5e1d4bcc661,17cd07d1-5250-4980-8b98-689b4caf0bb1 Strong evidence suggests that people living in poverty disproportionately experience the most negative impacts,abe2ce03-59c1-461d-8801-3e12df93a8e1,faadfa3a-2035-4c63-99e1-642f0c1d4e4e in part because they have less capacity to evacuate to avoid natural disasters, and because they are more frequently exposed to harmful environmental conditions such as heat waves and poor air quality.8dd99031-877d-4006-96c8-0890df6d1d8c Similarly, the majority (91%) of homeless populations live in urban and suburban areas, where they are more vulnerable to certain weather- and climate-related health risks.6a74b0ff-705b-433e-8b26-59b7284cca88

A number of studies of disaster responders point to an increased risk of mental and physical health problems following climate-related disasters.eb4e88e8-fdd1-492f-94a0-a8af7ffc598e,c1170f20-6345-4a49-b0fd-455bbd1c3264,12326139-d074-4882-9ac6-555855b08a51,ce9790d9-36c1-483d-a5c8-e8f21bf4e07d More frequent and intense weather events will increase the likelihood of this threat.895a462d-2faa-44e3-a888-31efb349f44d,ca705054-749f-4c0a-b184-9d14fbbf79e9,76c677ab-1bce-4095-adbe-90322f33d6af

Several studies show that those living in drought-prone areas are vulnerable to high levels of distress.67687fbe-a13c-48f9-99a3-158b1dae0fff,6cd7a528-3fc0-4e91-bec3-86e4eeee0cdb,61272d35-f059-4d3f-bc66-8556455ebd87 In addition, evidence suggests those living in Arctic or other coastal areas, such as Indigenous communities or tribes, tend to be more reliant on natural resources that could be diminished by climate change, which can lead to an increased risk of poor mental health outcomes.a6856e1f-e371-40f1-83d0-bce369e2289f,42269c56-1785-48ec-a81b-6eeb784de417,e46294e5-1bf3-4384-af37-7739b0a8f693,905ad03b-729c-447b-b894-c4ce8f9fec30,ef2b1084-10a4-475b-aeff-6093f8000e17,0a222ad6-2bcb-4fdc-91c8-de37bb70b04f' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/specific-groups-people-higher-risk.yaml identifier: specific-groups-people-higher-risk ordinal: 2 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

Areas of focus for the Mental Health and Well-Being chapter were determined based on the most relevant available scientific literature relating to mental health, wellness, and climate change, as well as the mental health impacts of events associated with climate change. Much of the evidence on these impacts has been compiled in countries outside the United States; however, the scenarios are similar and the evidence directly relevant to the situation in the United States, and thus this literature has been considered in the chapter. The evidence-base on mental health and wellness following extreme weather disasters is both well-established and relevant to climate change. The existence of highly relevant scientific literature on specific concerns directly influenced by climate change—such as the effects of extreme heat, stress associated with the threat and perception of climate change, and special population risks—resulted in the inclusion of these more targeted topics. Although significant scientific literature for resilience exists, in-depth discussions of adaptation, coping, and treatment approaches are outside the scope of this chapter, but are discussed in brief in the Resilience and Recovery section.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'Specific groups of people are at higher risk for distress and other adverse mental health consequences from exposure to climate-related or weather-related disasters. These groups include children, the elderly, women (especially pregnant and post-partum women), people with preexisting mental illness, the economically disadvantaged, the homeless, and first responders [High Confidence]. Communities that rely on the natural environment for sustenance and livelihood, as well as populations living in areas most susceptible to specific climate change events, are at increased risk for adverse mental health outcomes [High Confidence].' uncertainties: 'While there is uncertainty around the magnitude of effect, there is general agreement that climate-related disasters cause emotional and behavioral responses that will increase the likelihood of a mental illness or effect. Understanding how exposure, sensitivity, and adaptive capacity change over time and location for specific populations of concern is challenging. Uncertainties remain with respect to the underlying social determinants of health, public health interventions or outreach, adaptation options, and climate impacts at fine local scales.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/specific-groups-people-higher-risk url: ~ - chapter_identifier: mental-health-and-well-being confidence: 'The large body of well-documented scientific evidence provides high confidence that adverse mental health outcomes and social impacts can result from the threat of climate change, the perceived experience of climate change,and changes to one’s local environment. Emerging evidence suggests there is medium confidence that media representations of climate change influence stress responses and mental health and well-being.' evidence: 'A strong combination of mental health epidemiological research, social science-based national survey research, social and clinical psychology, environmental risk perception research, and disaster mental health research supports the finding that the threat of climate change and perceptions of its related physical environment changes and extreme events together constitute a significant environmental stressor.1497a2db-b62f-4bcb-8e53-f22692c416b4,9fcf79bd-416e-4ede-9e00-262b39095cab,9467cf71-753b-49a7-891b-04da863e71ad,9ce52883-f68f-48dc-875f-88f932e8f916,efd704ca-586c-4ba0-a447-4bcb800c6792,a7957dc8-1ead-4328-8250-a695f5f62c30,1033040b-fcff-419e-ad20-8a3a7b0c5013,1dad28b6-fe27-4e03-9630-8fda36305ec5,bd32de10-ebf5-44eb-9f99-4857be1f5ad4,40b214b0-1829-4411-9371-4aa06136f493,ca70d728-88f3-44ae-aa3b-e67710ea350b,de7e26bd-2384-4c8f-ae73-96417407d9f5,7ad54684-f950-46c7-a03a-92535cea27bf,6488df22-3c4d-4530-b988-10e3e5b9ab3e,c55d46b4-accb-418b-84fe-cda125422327,a2ef9cb1-3891-49f7-aa87-7d232b1bc47b

A large number of recent studies that have evaluated responses to the hybrid risk (risk that is part natural and part human-caused) of climate change impacts specifically reveal that many individuals experience a range of adverse psychological responses.34647534-8863-4fde-b8d0-f24bcdc4fcc6,dc84de0a-35da-4c00-a6e1-a0ba66dcaea0,f66b946f-c672-4a4b-8f71-1b05738e029e,8eccc146-c874-49ff-ba79-160c0e12c158,9845a991-d58b-409b-91b9-670cc383d030,2a7f3b81-6429-4752-904e-7f5fa3686d29,947e6dc0-63cf-4a74-947b-b24b9f2ab9c9,169b6908-d301-4da7-aeee-43cce986c86c,b8589fd7-68ca-4045-aadf-f7be886662ed,26a30317-5e80-4272-9f1e-eb6d2a800a4d' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/climate-change-threats-result-mental-health-consequences-social-impacts.yaml identifier: climate-change-threats-result-mental-health-consequences-social-impacts ordinal: 3 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

Areas of focus for the Mental Health and Well-Being chapter were determined based on the most relevant available scientific literature relating to mental health, wellness, and climate change, as well as the mental health impacts of events associated with climate change. Much of the evidence on these impacts has been compiled in countries outside the United States; however, the scenarios are similar and the evidence directly relevant to the situation in the United States, and thus this literature has been considered in the chapter. The evidence-base on mental health and wellness following extreme weather disasters is both well-established and relevant to climate change. The existence of highly relevant scientific literature on specific concerns directly influenced by climate change—such as the effects of extreme heat, stress associated with the threat and perception of climate change, and special population risks—resulted in the inclusion of these more targeted topics. Although significant scientific literature for resilience exists, in-depth discussions of adaptation, coping, and treatment approaches are outside the scope of this chapter, but are discussed in brief in the Resilience and Recovery section.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'Many people will experience adverse mental health outcomes and social impacts from the threat of climate change, the perceived direct experience of climate change, and changes to one’s local environment [High Confidence]. Media and popular culture representations of climate change influence stress responses and mental health and well-being [Medium Confidence].' uncertainties: 'Major uncertainties derive from the distinction between people’s objective and subjective exposure and experience of environmental threats. The multimedia information environment to which individuals are exposed and its coverage of climate change and related events can contribute to complicated public perceptions and strong emotional responses related to climate change as a social, environmental, and political issue.9fcf79bd-416e-4ede-9e00-262b39095cab,ee00465f-610d-41e8-9505-77214f0d31bd,88a64708-aabf-40b4-8677-0021edda378f If media exposure is inaccurate or discouraging, that could cause undue stress. However, accurate risk information dissemination can result in adaptive and preventive individual and collective action.dc84de0a-35da-4c00-a6e1-a0ba66dcaea0,f66b946f-c672-4a4b-8f71-1b05738e029e,a9f1a3ec-7f21-4d47-9a4c-84f0029ff6a2,d9ae20d0-403b-4871-b0f8-e0ed301e841b,e360e51f-21af-42d7-b4b3-293e10615681,56e6c997-9cde-4f3e-8dd7-e6e737a5a157 The relative dearth of long term impact assessment and monitoring programs relating to the psychosocial impacts of climate change necessitates reliance on smaller-scale, typically cross-sectional studies and research surveys that are often limited by their use of single-item indicators rather than standardized, climate change-specific, multi-item psychometric measures.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/climate-change-threats-result-mental-health-consequences-social-impacts url: ~ - chapter_identifier: mental-health-and-well-being confidence: 'A large body of established scientific evidence shows there is high confidence that people with mental illness are at greater risk for poor physical and mental health outcomes from climate change. Similarly, there is high confidence that exposure to extreme heat will exacerbate such outcomes, particularly for the elderly and those who take certain prescription medications to treat their mental illnesses. Given predictions of growth in the subgroup of the population who have mental health conditions and who take pharmaceuticals that sensitize them to heat, increases in the number of people experiencing related negative health outcomes due to climate change is expected to occur.' evidence: 'Mental, behavioral, and cognitive disorders can be triggered or exacerbated by heat waves. An increased susceptibility to heat due to medication use for psychiatric and other mental health disorders, as well as for alcohol- and drug-dependent people, is supported by numerous studies,922bcd50-dd07-4e05-afc7-fe3bcb1a953a,898dabcf-7205-4007-8782-7f8fb4afa797,682bbf49-5c57-4e69-b031-d185d2480cf2,c142a857-65af-499e-9f99-3e1666903eca,7ed50d22-b382-4c8a-8794-7ec131587ebe,35822aeb-7ea0-4f88-8b90-6b8bd6c9c9cf,459504bb-a64e-4d70-8643-144ca33cb7fb and the influence of dehydration on the effects of psychotropic medications is well-documented.1e9a7907-02f2-4da8-9e93-131f92515dbc,898dabcf-7205-4007-8782-7f8fb4afa797,114cd0b9-5577-4c58-b5b1-24c822dd4ad7

A significant body of evidence shows that the combination of mental illness and extreme heat can result in increases in hospitalizations and even death.922bcd50-dd07-4e05-afc7-fe3bcb1a953a,1e9a7907-02f2-4da8-9e93-131f92515dbc,2a9775ae-a280-4260-985f-0e66d0ef8c11,987707c1-8e54-41d8-8555-c5e1d4bcc661,17cd07d1-5250-4980-8b98-689b4caf0bb1 Furthermore, six case-control studies, involving 1,065 heat wave-related deaths, have found that preexisting mental illness tripled the risk of death.e7927819-0782-42ff-a491-6e125f61600e In a more recent heat wave study, close to 52% of the heat-related fatalities were of people with at least one mental illness and half of those were taking a psychotropic medication.222f1cca-24a5-4d3f-b436-39ec256114ba' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/extreme-heat-increases-risks-people-mental-illness.yaml identifier: extreme-heat-increases-risks-people-mental-illness ordinal: 4 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

Areas of focus for the Mental Health and Well-Being chapter were determined based on the most relevant available scientific literature relating to mental health, wellness, and climate change, as well as the mental health impacts of events associated with climate change. Much of the evidence on these impacts has been compiled in countries outside the United States; however, the scenarios are similar and the evidence directly relevant to the situation in the United States, and thus this literature has been considered in the chapter. The evidence-base on mental health and wellness following extreme weather disasters is both well-established and relevant to climate change. The existence of highly relevant scientific literature on specific concerns directly influenced by climate change—such as the effects of extreme heat, stress associated with the threat and perception of climate change, and special population risks—resulted in the inclusion of these more targeted topics. Although significant scientific literature for resilience exists, in-depth discussions of adaptation, coping, and treatment approaches are outside the scope of this chapter, but are discussed in brief in the Resilience and Recovery section.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'People with mental illness are at higher risk for poor physical and mental health due to extreme heat [High Confidence]. Increases in extreme heat will increase the risk of disease and death for people with mental illness, including elderly populations and those taking prescription medications that impair the body’s ability to regulate temperature [High Confidence].' uncertainties: 'Uncertainties include whether pharmaceutical companies will develop new medications to treat mental illness and other health conditions that make individuals less susceptible to heat, whether strategies for prevention of heat-related illness and death are implemented, and whether individuals begin to adapt over time to increases in heat. Prevention, detection, and treatment of mental illness without the use of medications that negatively impact the body’s ability to regulate heat could moderate the magnitude of extreme heat’s impact on those predicted to have psychiatric and stress related disorders.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/mental-health-and-well-being/finding/extreme-heat-increases-risks-people-mental-illness url: ~ - chapter_identifier: populations-of-concern confidence: 'Based on the evidence presented in the peer-reviewed literature, there is very high confidence that climate change impacts on health will vary across place and time, as demonstrated by the complex factors driving vulnerability. Many qualitative and quantitative studies have been published with consistent findings and strong consensus that the impacts of climate change on human health will vary according to differential exposure, sensitivity, and adaptive capacity, which change over time and across places. These conclusions are well-documented and supported by high-quality evidence from multiple sources.' evidence: 'There is strong evidence from multiple current epidemiological studies on climate-sensitive health outcomes in the United States that health impacts will differ by location, pathways of exposure, underlying susceptibility, and adaptive capacity. The literature consistently finds that these disparities in health impacts will largely result from differences in the distribution of individual attributes in a population that confers vulnerability (such as age, socioeconomic status, and race), attributes of place that reduce or amplify exposure (such as floodplain, coastal zone, and urban heat island), and the resilience of public health infrastructure.

Across multiple studies, the following factors are consistently identified that contribute to exposure: occupation,e3439854-edb7-4acd-9e4f-b6ae0477f688 time spent in risk-prone locations,de5b6f9d-388d-4f67-8115-ad5fca6a95d5,1aca1900-c64c-4624-a696-3aab59ba6673,b79c1dff-2558-4eae-9357-054e54a67366 displacement by weather extremes,31d2b0b2-0570-48fc-8605-30e9c1922dad economic status,5f587662-8664-420f-8045-196e2bb7ec0d,218cc72e-737b-470e-89d7-6ef0ebce12c3 condition of infrastructure,60c1199f-692f-4e77-bd9b-15ae136141e7,b0818c9e-b245-44be-9851-213def5d25da and compromised mobility, cognitive function, and other mental or behavioral factors.8dcca72f-cc82-4b1c-a828-fc0d6c02ca7a

There is consensus within the scientific literature that biologic sensitivity and adaptive capacity are tied to many of the same factors that contribute to exposures, and that all of these factors can change across time and life stage.de5b6f9d-388d-4f67-8115-ad5fca6a95d5,3bd47363-8f13-4c90-b52d-26e7ff47f216,c681c3c2-48a8-4fe6-8e91-86db5bff7fa3 There is also strong evidence from multiple studies that social and economic factors affect disparities in the prevalence of chronic medical conditions that aggravate biological sensitivity.3f2402c5-22aa-4f75-861e-f6aca127cd1f,27dc34c7-af90-41db-9e6d-7cc5bf34e6cf' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/vulnerabilities-varies-over-time-place-specific.yaml identifier: vulnerabilities-varies-over-time-place-specific ordinal: 1 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

The author team identified a number of populations affected by climate change health impacts, including communities of color and low-income, immigrant, and limited English proficiency groups; Indigenous populations; children and pregnant women; older adults; certain occupational groups; persons with disabilities; and persons with chronic medical conditions. This list of populations was identified to reflect current understandings related to how the health of particular groups of people or particular places are affected by climate change in the United States. While not exhaustive, these populations of concern are those most commonly identified and discussed in reviews of climate change health impacts on vulnerable populations. In this chapter, the order of these populations is not prioritized. While there are other populations that may be threatened disproportionately by climate change, the authors focused the sections of this chapter on populations for which there is substantive literature. In addition to this chapter’s summary of vulnerable populations, each of the health outcome chapters in the report includes discussion of populations of concern. Some populations may be covered more extensively in these other chapters; for instance, homeless populations are discussed in Chapter 8: Mental Health, as the literature on this population focuses primarily on mental health.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'Across the United States, people and communities differ in their exposures, their inherent sensitivity, and their adaptive capacity to respond to and cope with climate change related health threats [Very High Confidence]. Vulnerability to climate change varies across time and location, across communities, and among individuals within communities [Very High Confidence].' uncertainties: 'Understanding how exposure, sensitivity, and adaptive capacity change over time and location for specific populations of concern is challenging, particularly when attempting to project impacts of climate change on health across long time frames (such as in the year 2100, a year for which climate projections often estimate impacts) or vast geographic areas. Uncertainties remain with respect to the underlying social determinants of health, public health interventions or outreach, adaptation options, and climate impacts at fine local scales.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/vulnerabilities-varies-over-time-place-specific url: ~ - chapter_identifier: populations-of-concern confidence: 'Based on the evidence presented in the peer-reviewed literature, there is high confidence that a wide range of health effects exacerbated by climate change will be experienced by vulnerable age groups, especially young children and older adults. Both qualitative and quantitative studies have been published about the effects of age or life stage on vulnerability to health impacts, and that evidence is consistent and of good quality.' evidence: 'There is strong, consistent evidence from multiple studies that children have inherent sensitivities to climate-related health impacts. There are multiple, high-quality studies concerning the impact of changes in ground-level ozone, particulate matter, and aeroallergens on increases in childhood asthma episodes and other adverse respiratory effects in children.3dca835b-beb7-49f5-b9c1-54753dc54ddc,bc881478-a19f-48b7-af8e-40c36deaa679,0f20f4d5-6621-41f2-a728-827975453e2c,aa39f53c-b544-4f17-9bf9-59b1e4636b56 In addition, the literature supports a finding that children are vulnerable to waterborne pathogens in drinking water and through exposures while swimming. There is a positive and statistically significant association between heavy rain and emergency department visits for children with gastrointestinal illness, though evidence comes from regional studies and is not at the national scale.197b91b6-04d3-429a-9a6c-90c784d86c1f,603e74e7-cfae-45ff-bf78-4c38f32aa678 The science also supports a finding that children’s mental health is affected by exposures to traumatic weather events, which can undermine cognitive development and contribute to psychiatric disorders.bbd5cea5-84f0-4f77-95ed-45c80f636a8a,12483624-82b7-4221-9a35-5a247289e4fe

There is also strong, consistent evidence from multiple studies that older adults have inherent sensitivities to climate-related health impacts. In particular, exposure to extreme ambient temperature is an important determinant of health in older adultse4c07020-0c97-4a6c-ab4a-1859aaebd5ab,07b2dd38-4085-4184-a498-ec32526d710f and has been associated with increased hospital admissions for cardiovascular, respiratory, and metabolic disorders.4695344e-33e4-457d-a4e8-514481c7befe,7ed57375-4f4f-4157-9784-0d09fb2beae1 In addition, older adults are particularly affected by extreme weather events that compromise the availability and safety of food and water supplies; interrupt communications, utilities, and emergency services; and destroy or damage homes and the built environment.35e05ba9-a2e0-4178-a809-8c9bfe7be898,81e4da11-12ba-4f0e-8bdb-ca6a8dadd63d,a5db04e0-2a4f-4ddf-af07-a64797095d8e,65736c68-a5c9-44e8-acb7-879ef878a275 Some functional and mobility impairments make older adults less able to evacuate when necessary.b00a1349-fb5f-4e2d-b1bc-cfceb0863de2,1964a748-c888-46f9-aedc-dc2d27930f17' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/health-impacts-vary-with-age-and-life-stage.yaml identifier: health-impacts-vary-with-age-and-life-stage ordinal: 2 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

The author team identified a number of populations affected by climate change health impacts, including communities of color and low-income, immigrant, and limited English proficiency groups; Indigenous populations; children and pregnant women; older adults; certain occupational groups; persons with disabilities; and persons with chronic medical conditions. This list of populations was identified to reflect current understandings related to how the health of particular groups of people or particular places are affected by climate change in the United States. While not exhaustive, these populations of concern are those most commonly identified and discussed in reviews of climate change health impacts on vulnerable populations. In this chapter, the order of these populations is not prioritized. While there are other populations that may be threatened disproportionately by climate change, the authors focused the sections of this chapter on populations for which there is substantive literature. In addition to this chapter’s summary of vulnerable populations, each of the health outcome chapters in the report includes discussion of populations of concern. Some populations may be covered more extensively in these other chapters; for instance, homeless populations are discussed in Chapter 8: Mental Health, as the literature on this population focuses primarily on mental health.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'People experience different inherent sensitivities to the impacts of climate change at different ages and life stages [High Confidence]. For example, the very young and the very old are particularly sensitive to climate-related health impacts.' uncertainties: 'There is less information with which to quantify climate-related impacts on children and older adults at a national level given limited data availability. Some studies of age-related vulnerability have limited geographic scope or focus on single events in particular locations. Nevertheless, multiple factors, all with some degree of uncertainty, converge to determine climate-related vulnerability across age groups.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/health-impacts-vary-with-age-and-life-stage url: ~ - chapter_identifier: populations-of-concern confidence: 'Based on the evidence presented in the peer-reviewed literature, there is high confidence that climate change threatens the health of people and communities by affecting exposure, sensitivity, and adaptive capacity. This conclusion takes into account the consistent evidence presented in multiple studies regarding the causes of vulnerability to climate-related health effects and the role of social determinants of health. There is high confidence based on many peer-reviewed studies that social determinants of health, such as those related to socioeconomic factors and health disparities, may amplify, moderate, or otherwise influence climate-related health effects across populations of concern, and the evidence presented is of good quality, consistent, and compelling.' evidence: 'The literature is consistent and the results are compelling that social determinants of health, such as those related to socioeconomic factors and health disparities, will contribute to the nature and extent of vulnerability and health effects due to climate change. The following factors illustrate the depth of the literature supporting the conclusions above regarding the relationship between climate change health threats, vulnerability (comprised of exposure, sensitivity, and adaptive capacity), and social determinants of health:


Health risks and vulnerability may increase in locations or instances where combinations of social determinants of health that amplify health threats occur simultaneously or close in time or space.a6491512-ba32-470d-934e-44c3b13d8b96,8ddfda37-f9e3-4848-aa97-6f5eb0704765 For example, people with limited economic resources living in areas with deteriorating infrastructure are more likely to experience disproportionate impacts and are less able to recover following extreme events,77ffab8c-05b9-42ab-bd76-22a19abfb429,fbc277e8-499f-4e93-9c33-1df56a674e71 increasing their vulnerability to climate-related health effects.' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/social-determinants-health-interact-climate-factors-affect-health-risk.yaml identifier: social-determinants-health-interact-climate-factors-affect-health-risk ordinal: 3 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

The author team identified a number of populations affected by climate change health impacts, including communities of color and low-income, immigrant, and limited English proficiency groups; Indigenous populations; children and pregnant women; older adults; certain occupational groups; persons with disabilities; and persons with chronic medical conditions. This list of populations was identified to reflect current understandings related to how the health of particular groups of people or particular places are affected by climate change in the United States. While not exhaustive, these populations of concern are those most commonly identified and discussed in reviews of climate change health impacts on vulnerable populations. In this chapter, the order of these populations is not prioritized. While there are other populations that may be threatened disproportionately by climate change, the authors focused the sections of this chapter on populations for which there is substantive literature. In addition to this chapter’s summary of vulnerable populations, each of the health outcome chapters in the report includes discussion of populations of concern. Some populations may be covered more extensively in these other chapters; for instance, homeless populations are discussed in Chapter 8: Mental Health, as the literature on this population focuses primarily on mental health.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'Climate change threatens the health of people and communities by affecting exposure, sensitivity, and adaptive capacity [High Confidence]. Social determinants of health, such as those related to socioeconomic factors and health disparities, may amplify, moderate, or otherwise influence climate-related health effects, particularly when these factors occur simultaneously or close in time or space [High Confidence].' uncertainties: 'A wide range of non-climate factors are expected to interact with climate change health impacts to determine population vulnerability, all with some degree of uncertainty. The extent to which social determinants of health individually and collectively affect the different components of vulnerability is, in many cases, not well understood and not readily amenable to measurement or quantification. Assessing the extent and nature of non-climate impacts as compared to impacts related to climate change is limited by data availability. Many studies of climate change vulnerability have limited geographic scope or focus on single events in particular locations, which makes drawing national-level conclusions more challenging.' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/social-determinants-health-interact-climate-factors-affect-health-risk url: ~ - chapter_identifier: populations-of-concern confidence: 'Based on the evidence presented in the peer-reviewed literature, there is high confidence that geographic data used in mapping tools and vulnerability indices can help to identify where and for whom climate health risks are greatest. A number of published studies provide consistent and good quality evidence to support a finding regarding the utility of mapping tools and vulnerability indices in a public health context, but methods are still emerging to support the application of these tools in the context of climate change. Overall, evidence is strong that mapping tools and vulnerability indices can help to identify at-risk locations and populations for whom climate health risks are greatest. As the state of the science continues to evolve, substantial improvements in mapping and spatial analytic tools and methodologies are expected that will allow researchers to predict, for a certain geographic area, the probability that human health impacts will occur across time.' evidence: 'Over the past decade, the literature on the use of GIS in a public health and vulnerability context has been steadily growing. Multiple studies provide strong, consistent evidence that spatial-analytic tools help facilitate analyses that link together spatially resolved representations of census data, data on the determinants of health (social, environmental, preexisting health conditions), measures of adaptive capacity (such as health care accessibility), and environmental data for the identification of at-risk populations.8dc8f888-18ac-4250-b07d-e744a46d70f2,399cfb21-5e6d-425a-98ec-55f42e32401a,e905bf75-5df5-4ca7-ab70-b4a35b1219f8,0cdb219f-c600-4fbf-b4c6-2d89f77d2868,96d81a21-9659-48f1-9149-35a4d10322ca,b6a2f8d3-a113-4e46-b62c-7fbaf90b4f59 Similarly, the more recent additions to the literature indicate that demographic and environmental data can be integrated to create an index that allows for analysis of the factors contributing to social vulnerability in a given geographic area.399cfb21-5e6d-425a-98ec-55f42e32401a,90ee72cf-ab21-486c-bb40-45780e31b45f Multiple studies conclude that spatial mapping that identifies factors associated with relative vulnerability is an important step in developing prevention strategies or determining where to focus or position health or emergency response resources.f48e92b8-1b15-46db-936f-249351f8c7a5,02028c63-7981-461c-8762-76105bc5ba36,a33f021d-b087-44d9-8fac-fb9507f789e8 Fewer studies explicitly focus on vulnerability mapping in a climate change context, with the notable exception of the case study of heat-related vulnerability in Georgia.399cfb21-5e6d-425a-98ec-55f42e32401a' href: https://data.globalchange.gov/report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/mapping-tools-vulnerability-indices-identify-climate-health-risks.yaml identifier: mapping-tools-vulnerability-indices-identify-climate-health-risks ordinal: 4 process: 'The chapter was developed through technical discussions of relevant evidence and expert deliberation by the report authors at several workshops, teleconferences, and email exchanges. The authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, see Appendices 2–3.

The author team identified a number of populations affected by climate change health impacts, including communities of color and low-income, immigrant, and limited English proficiency groups; Indigenous populations; children and pregnant women; older adults; certain occupational groups; persons with disabilities; and persons with chronic medical conditions. This list of populations was identified to reflect current understandings related to how the health of particular groups of people or particular places are affected by climate change in the United States. While not exhaustive, these populations of concern are those most commonly identified and discussed in reviews of climate change health impacts on vulnerable populations. In this chapter, the order of these populations is not prioritized. While there are other populations that may be threatened disproportionately by climate change, the authors focused the sections of this chapter on populations for which there is substantive literature. In addition to this chapter’s summary of vulnerable populations, each of the health outcome chapters in the report includes discussion of populations of concern. Some populations may be covered more extensively in these other chapters; for instance, homeless populations are discussed in Chapter 8: Mental Health, as the literature on this population focuses primarily on mental health.' report_identifier: usgcrp-climate-human-health-assessment-2016 statement: 'The use of geographic data and tools allows for more sophisticated mapping of risk factors and social vulnerabilities to identify and protect specific locations and groups of people [High Confidence].' uncertainties: 'Multiple factors, all with some degree of uncertainty, determine geographic vulnerability to the health impacts of climate change. Although the literature indicates that mapping tools and vulnerability indices are useful in characterizing geographically based exposures, geocoded health data (particularly those data relevant to an analysis of climate change vulnerability) are not always available in some locations of interest. In addition, the extent of uncertainty increases at smaller spatial scales, which is typically the scale most relevant for targeting vulnerable communities. For instance, mental health outcome data are particularly challenging to obtain and geocode, partly because the majority of cases are underdiagnosed or underreported (see Ch. 8: Mental Health).' uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/populations-of-concern/finding/mapping-tools-vulnerability-indices-identify-climate-health-risks url: ~