Public Health Agency Responses and Opportunities to Protect Against Health Impacts of Climate Change Among US Populations with Multiple Vulnerabilities

  • Sonja S. Hutchins
  • Karen Bouye
  • George Luber
  • Lisa Briseno
  • Candis Hunter
  • Liza Corso


During the past several decades, unprecedented global changes in climate have given rise to an increase in extreme weather and other climate events and their consequences such as heavy rainfall, hurricanes, flooding, heat waves, wildfires, and air pollution. These climate effects have direct impacts on human health such as premature death, injuries, exacerbation of health conditions, disruption of mental well-being, as well as indirect impacts through food- and water-related infections and illnesses. While all populations are at risk for these adverse health outcomes, some populations are at greater risk because of multiple vulnerabilities resulting from increased exposure to risk-prone areas, increased sensitivity due to underlying health conditions, and limited adaptive capacity primarily because of a lack of economic resources to respond adequately. We discuss current governmental public health responses and their future opportunities to improve resilience of special populations at greatest risk for adverse health outcomes. Vulnerability assessment, adaptation plans, public health emergency response, and public health agency accreditation are all current governmental public health actions. Governmental public health opportunities include integration of these current responses with health equity initiatives and programs in communities.


Climate change Adaptation planning Vulnerable populations Populations with multiple vulnerabilities Health equity 



We thank Dr. Benedict Truman, Associate Director of Science, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, for his editorial comments.

Compliance with Ethical Standards


This study was performed by only employees of the federal government as a part of their routine duties. There were not any external funding sources such as grants, cooperative agreements, or contracts.

Conflict of Interest

All authors are employees of the federal government and have no conflicts. Authors report on public health programs grounded in science.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    IPCC. Climate Change 2014 Synthesis Report Summary for Policymakers at Accessed 11 April 2017.
  2. 2.
    Watts N, Adger WN, Agnolucci P, et al. The lancet commissions. Health and climate change: policy response to protect public health 2015. doi: Accessed 11 April 2016.
  3. 3.
    Walsh, JD, Wuebbles, K, Hayhoe, J, et al. Ch. 2: our changing climate. In: Melillo JM, Richmond TC, Yohe GW, editors. Climate Change Impacts in the United States: The Third National Climate Assessment, US Global Change Research Program; 2014. p. 19–67. doi: 10.7930/J0KW5CXT.Google Scholar
  4. 4.
    NOAA. National Centers for Environmental Information, State of the Climate: Global Analysis for Annual 2016. Accessed 03 April 2017.
  5. 5.
    Luber G, Knowlton K, Balbus J, et al. Ch. 9: Human health. In: Melillo JM, Richmond TC, Yohe GW, editors. Climate Change Impacts in the United States: The Third National Climate Assessment, U.S. Global Change Research Program, 2014. pp 220–256. doi:
  6. 6.
    USGCRP. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. Crimmons A, Balbus J, Gamble JL, et al.. US Global Change Research Program, Washington, DC; 2016. pp 312. doi: 10.7930/JOR49NQX. Accessed 04 April 2017.Google Scholar
  7. 7.
    Luber G, Lemery J, editors. Global climate change and human health: from science to practice. San Francisco: Josey-Bass; 2015.Google Scholar
  8. 8.
    WHO. Quantitative Risk Assessment of the Health Effects of Climate Change on Selected Causes of Deaths, 2030s and 2050s. 2014 Accessed 04 April 2017.
  9. 9.
    WHO. Climate and Health Fact Sheet, 2016. 2016. Accessed 04 April 2017.
  10. 10.
    Census Bureau. American FactFinder: annual estimates of the resident population by sex, race, and Hispanic origin for the United States, states, and counties: April 1, 2010 to July 1, 2015. Accessed 04 April 2017.
  11. 11.
    DeNavas-Walt C, Proctor BD. Income and Poverty in the United States: 2013, US Census Bureau, Current Population Reports. Washington, DC: US Government Printing Office; 2014. p. 60–249.Google Scholar
  12. 12.
    Zong J, Batalova J. Limited English proficient population of the United States. Migration Policy Institute July 25, 2015. Accessed 04 April 2017.
  13. 13.
    Passel JS, Cohn D. Unauthorized Immigrant Population: National and State Trends. Washington, DC: Pew Research Center; 2010. February 1, 2011. Accessed 04 April 2017Google Scholar
  14. 14.
    National Research Council. Adapting to the impacts of climate change. Washington, DC: The National Academies Press; 2010.Google Scholar
  15. 15.
    President’s Climate Action Plan. Accessed 04 April 2017.
  16. 16.
    US Department of Health and Human Services. 2012 Environmental justice strategy and implementation plan. Washington, DC, 2012. Accessed 04 April 2017.
  17. 17.
    Frey W. The new metro minority map: regional shifts in Hispanics, Asians, and blacks from census 2010. Accessed 11 April 2017.
  18. 18.
    Harlan SL, Brazel AJ, Prashad L, et al. Neighborhood microclimates and vulnerability to heat stress. Soc Sci Med. 2006;63:2847–63.CrossRefPubMedGoogle Scholar
  19. 19.
    Uejio CK, Wilhelmi OV, Golden JS, Mills DM, Gulino SP, Samenow JP. Intra-urban societal vulnerability to extreme heat: the role of heat exposure and the built environment, socioeconomics, and neighborhood stability. Health Place. 2011;17(2):498–507.CrossRefPubMedGoogle Scholar
  20. 20.
    Jesdale B, Morello-Frosch R. Cushing L the racial/ethnic distribution of heat risk-related land cover in relation to residential segregation. Environ Health Perspect. 2013;121:811–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Basu R, Ostro BD. A multicounty analysis identifying the populations vulnerable to mortality associated with high ambient temperature in California. Am J Epidemiol. 2008;168:632–7.CrossRefPubMedGoogle Scholar
  22. 22.
    McGeehin M, Mirabelli M. The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect. 2001;109(S2):185–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Luber G. And M McGeehin. Climate change and extreme heat events. Am J Prev Med. 2008;35(5):429–35.CrossRefPubMedGoogle Scholar
  24. 24.
    Semenza G, McCullough JE, Flanders D, McGeehin MA, Lumpkin JR. Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med. 1999;16:269–77.CrossRefPubMedGoogle Scholar
  25. 25.
    Knowlton K, Rotkin-Ellman M, King G, et al. The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect. 2009;117(1):61–7.CrossRefPubMedGoogle Scholar
  26. 26.
    McMichael AJ. Globalization, climate change, and human health. N Engl J Med. 2013;368:1335–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Ramlow JM, Kuller LH. Effects of the summer heat wave of 1988 on daily mortality in Allegheny County, PA. Public Health Rep. 1990;105:283–9.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Weisskopf MG, Anderson HA, Foldy S, Hanrahan LP, Blair K, Török TJ, et al. Heat wave morbidity and mortality, Milwaukee, Wisconsin, 1999 vs 1995: an improved response? Am J Public Health. 2002;92:830–3.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Shonkoff SB, Morello-Frosch R, Pastor M, et al. Minding the climate gpa: environmental health and equity implications of climate change mitigation policies in California. Environ Just. 2009;2:173–7.CrossRefGoogle Scholar
  30. 30.
    Donner W, Rodriguez H. Population composition, migration and inequality: the influence of demographic changes on disaster risk and vulnerability. Soc Forces. 2008;87:1089–114.CrossRefGoogle Scholar
  31. 31.
    Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report—United States, 2011. MMWR 2011; 60(Suppl): [inclusive all page numbers].Google Scholar
  32. 32.
    Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report—United States, 2013. MMWR 2013; 62(Suppl 3): [inclusive page numbers].Google Scholar
  33. 33.
    Eisenman DP, Cordasco KM, Asch S, et al. Disaster planning and risks communication with vulnerable communities: lessons from hurricane Katrina. Am J Public Health. 2007;97:109–15.CrossRefGoogle Scholar
  34. 34.
    Zoraster RM. Vulnerable populations: hurricane Katrina as a case study. Prehosp Disaster Med. 2010;25(1):74–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Schreiber MD, Yin R, Omaish M, Broderick JE. Snapshot from superstorm Sandy: American red Cross mental health risk surveillance in lower New York state. Ann Emerg Med. 2014;64(1):59–65. doi:
  36. 36.
    Brunkard J, Namulanda G, Ratard R. Hurricane Katrina deaths, Louisiana, 2005. Disaster Med Public Health Prep. 2008;2:215–23.CrossRefPubMedGoogle Scholar
  37. 37.
    Thethi TK, Yau CL, Shi L, Leger S, Nagireddy P, Waddadar J, et al. Time to recovery in diabetes and comorbidities following Hurricane Katrina. Disaster Med Public Health Prep. 2010;4(Suppl 1):S33–8. doi:
  38. 38.
    Joseph NT, Matthews KA, Myers HF. Conceptualizing health consequences of hurricane Katrina from the perspective of socioeconomic status decline. Health Psychol. 2014;33(2):139–46.CrossRefPubMedGoogle Scholar
  39. 39.
    Vargas Bustamante A, Fang H, Garza J, et al. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. J Immigr Minor Health. 2012;14(1):146–55. doi: Accessed 11 April 2017.
  40. 40.
    Fuentes-Afflick E, Hessol NA. Immigration status and use of health services among Latina women in the San Francisco Bay Area. J Womens Health (Larchmt). 2009;18(8):1275–80. doi: Accessed 04 April 2017
  41. 41.
    Maldonado CZ, Rodriguez RM, Torres JR, Flores YS, Lovato LM. Fear of discovery among Latino immigrants presenting to the emergency department. Acad Emerg Med. 2013;20(2):155–61. doi: Accessed 11 April 2017
  42. 42.
    Ortega AN, Fang H, Perez VH, et al. Health care access, use of services, and experiences among undocumented Mexicans and other Latinos. Arch Intern Med. 2007;167(21):2354–60. Accessed 04 April 2017CrossRefPubMedGoogle Scholar
  43. 43.
    U.S. Environmental Protection Agency. Our Nation’s Air: Status and Trends Through 2015. Accessed 11 April 2017.
  44. 44.
    Miranda ML, Edwards SE, Keating MH, Paul CJ. Making the environmental justice grade: the relative burden of air pollution exposure in the United States. Int J Environ Res Public Health. 2011;8:1755–71.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Lopez R. Segregation and black/white differences to exposure to air toxics in 1990. Environ Health Perspect. 2002;110(S2):289–95.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Perlin S, Sexton K, Wong D. An examination of race and poverty for populations living near industrial sources of air pollution. J Expo Anal Environ Epidemiol. 1999;9(1):29–48.CrossRefPubMedGoogle Scholar
  47. 47.
    Keating M, Davis F. Air of Injustice: African Americans and Power Plant Pollution Accessed 11 April 2017.
  48. 48.
    Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat 2014; 10(260).Google Scholar
  49. 49.
    US Department of Health and Human Services. 2013 National healthcare disparities report. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. AHRQ publication; 2013. No 14-0006. p. 233–70.Google Scholar
  50. 50.
    Eneriz-Wiemer M, Sanders LM, Barr DA, Mendoza FS. Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review. Acad Pediatr. 2014;14(2):128–36. doi: Accessed 10 April 2017.
  51. 51.
    Riera A, Navas-Nazario A, Shabanova V, Vaca FE. The impact of limited English proficiency on asthma action plan use. J Asthma. 2014;51(2):178–84. doi: . Accessed 10 April 2017
  52. 52.
    Lin S, Xiu L, Le LH, et al. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008;116:1725–30.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Donaldson K, Gilmour I, MacNee W. Asthma and PM10. Respir Res. 2000;1(1):12–5.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Leikauf G. Hazardous air pollutants and asthma. Environ Health Perspect. 2002;110(S4):505–26.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Pope C, Dockery D. Epidemiology of particle effects. In: Holgate S, Samet J, Koren H, Maynard R, editors. Air pollution and health. London: Academic Press; 1999. p. 673–706.CrossRefGoogle Scholar
  56. 56.
    Peden D. Pollutants and asthma: role of air toxics. Environ Health Perspect. 2002;110(S4):565–8.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Pope C, Burnett R, Thun M, Calle E, Krewski D, Ito K, et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA. 2002;287:1132–41.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Gwynn R, Thurston G. The burden of air pollution: impacts among racial minorities. Environ Health Perspect. 2001;109(S4):501–6.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Finkelstein M, Jerrett M, DeLuca P, Finkelstein N, Verma D, Chapman K, et al. Relation between income, air pollution and mortality: a cohort study. CMAJ. 2003;169(5):397–402.Google Scholar
  60. 60.
    Reynolds P, Von Behren J, Gunier R, Goldberg D, Hertz A, Smith D. Childhood cancer incidence rates and hazardous air pollutants in California: an exploratory analysis. Environ Health Perspect. 2003;111(4):663–8.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Hennessy T, et al. The relationship between in-home water service and the risk of respiratory tract, skin, and gastrointestinal tract infections among rural Alaska Natives. Am J Public Health. 2008;98(11):2072–8. XXCrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Ramos MM, Mohammed H, Zielinski-Gutierrez E, et al. Epidemic dengue and dengue hemorrhagic fever at the Texas-Mexico border: results of a household –based seroepidemiologic survey, December 2005. Am J Trop Med Hyg. 2008;78:364–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Reiter P, Lathrop S, Bunning M, et al. Texas lifestyle limits transmission of dengue virus. Emerg Infect Dis. 2003;9:86–9. Accessed 10 April 2017CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Coleman-Jensen A, Nord M, Andrews M, et al. Household Food Security in the United States in 2011 USDA 2011. Accessed 10 April 2017.
  65. 65.
    Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44:189–95.CrossRefPubMedGoogle Scholar
  66. 66.
    Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods. Am J Prev Med. 2009;36:74–81.CrossRefPubMedGoogle Scholar
  67. 67.
    Satia JA. Diet-related disparities: understanding the problems and accelerating the solutions. J Am Diet Assoc. 2010;109:610–5.CrossRefGoogle Scholar
  68. 68.
    U.S. Department of Health and Human Services. Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 2001.CrossRefGoogle Scholar
  69. 69.
    Weishler RH, Barbee JG, Townsend MH. Mental health and recovery in the Gulf coast after hurricanes Katrina and Rita. JAMA. 2006;296(5):585–8.CrossRefGoogle Scholar
  70. 70.
    Census Bureau. Income and Poverty. Accessed 10 April 2017.
  71. 71.
    Census Bureau. Overview of Race and Hispanic Origin: 2010: 2010 Census Briefs, Issued March 2011. Accessed 10 April 2017.
  72. 72.
    Census Bureau. Undocumented Immigrants. Accessed 10 April 2017.
  73. 73.
    Frumkin H, Hess J, Luber G, et al. Climate change: the public health response. Am J Public Health. 2008:435–45.Google Scholar
  74. 74.
    CDC. Climate and Health. Accessed 10 April 2017.
  75. 75.
    PHAB. Accredited Health Departments. Accessed 10 April 2017.
  76. 76.
    CDC. All-Hazards Preparedness Guide. Accessed 10 April 2017.
  77. 77.
    CDC. National Prevention Strategy. Accessed 10 April 2017.
  78. 78.
    US Department of Health and Human Services. National Partnership for Action to End Health Disparities. Accessed 10 April 2017.
  79. 79.
    ASTHO. Programs. Accessed 10 April 2017.
  80. 80.
    NACCHO. Health Equity and Social Justice. Accessed 10 April 2017.
  81. 81.
    APHA.Topics and Issues. Accessed 10 April 2017.
  82. 82.
    Kreuter MW, Lukwago SN, Bucholtz DC, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav. 2002;30(2):133–46., Accessed 10 April 2017CrossRefGoogle Scholar
  83. 83.
    Vanderford ML, Nastoff T, Telfer JL, Bonzo SE. Emergency communication challenges in response to hurricane Katrina: lessons from the Centers for Disease Control and Prevention. J Appl Commun Res. 2007;35(1):9–25. Accessed 10 April 2017
  84. 84.
    Glick DC. Risk communication for public health emergencies. Annu Rev Public Health. 2007;28:33–54. doi: Accessed 10 April 2017
  85. 85.
    CDC. Crises and Emergency Risk Communication Manual, 20A4 Edition. Crisis and Emergency Risk Communication Manual, 2014, p. 21. Accessed 10 April 2017.Google Scholar
  86. 86.
    Hutchins SS, Jiles R, Bernier R. Elimination of measles and of disparities in measles childhood vaccine coverage among racial and ethnic minority populations in the United States. J Infect Dis. 2003;189(Suppl 1):S146–52.Google Scholar
  87. 87.
    Williams WW, Hutchins SS, Orenstein WA, Rodewald L. Immunization and preventive care. In: Satcher D, Pamies RR, editors. Multicultural medicine and health disparities. New York: McGraw-Hill; 2006. p. 233–49.Google Scholar
  88. 88.
    US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Accessed 10 April 2017.
  89. 89.
    US Department of Health and Human Services. National Stakeholder Strategy for Achieving Health Equity. Accessed 10 April 2017.
  90. 90.
    US Department of Health and Human Services. Office of Minority Health: Regional Health Equity Councils. Accessed 10 April 2017.
  91. 91.
    US Department of Health and Human Services. Office of Minority Health: State Minority Health Contacts. Accessed 10 April 2017.
  92. 92.
    APHA. Health in All Polices: A Guide for States and Local Governments. Accessed 10 April 2017.
  93. 93.
    Institute of Medicine. The Future of the Public's Health in the 21st Century.
  94. 94.
    World Health Organization. Protecting health from climate change: vulnerability and adaptation assessment. Published 2013. Accessed 10 April 2017.
  95. 95.
    Panic M, Ford JD. A review of national-level adaptation planning with regards to the risks posed by climate change on infectious diseases in 14 OECD nations. Int J Environ Res Public Health. 2013;10(12):7083–109. doi: Accessed 10 April 2017
  96. 96.

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection  2017

Authors and Affiliations

  • Sonja S. Hutchins
    • 1
    • 2
  • Karen Bouye
    • 1
  • George Luber
    • 2
  • Lisa Briseno
    • 3
  • Candis Hunter
    • 4
  • Liza Corso
    • 5
  1. 1.Department of Community Health and Preventive MedicineMorehouse School of MedicineAtlantaUSA
  2. 2.Climate and Health Program, National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Office of Public Health Preparedness and ResponseCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Agency for Toxic Substances and Disease RegistryAtlantaUSA
  5. 5.Office for State, Tribal, Local and Territorial SupportCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations