Climate and Health

Abstract
The built environment is an important contributor to both climate change and public health. Transportation, land use, and buildings are three factors significantly impacting environmental and human health in urban areas. Health and built environment experts should actively collaborate to both cool cities and increase positive health outcomes.

Abstract
BACKGROUND Recognizing that health outcomes are associated with climate threats is important and requires increased attention by health care providers and policymakers. The primary goal of this report is to provide information related to the public health threats of climate change, while identifying climate-sensitive populations primarily in rural, Eastern North Carolina.

METHODS Publicly available data was used to evaluate regional (eg, Eastern, Piedmont, and Western) and county level socio-vulnerability characteristics of population groups in North Carolina, including: percent of persons living in poverty, percent of non-white persons, percent of persons under 18 years living in poverty, percent of elderly people living in poverty, percent of persons with a disability, and number of primary care physicians. One-way ANOVA was used to calculate and compare mean value estimates of population socio-vulnerability variables in Eastern North Carolina with Piedmont and Western regions.

RESULTS Across all regional categories, the eastern part of the state had considerably higher averages than the state for percent of persons living in poverty (17.2%), percent of non-white persons (13.3%), percent of persons under 18 years old living in poverty (24.9%), percent of elderly people living in poverty (10.0%), and percent of persons with a disability (13.3%). Overwhelmingly, more counties in Eastern North Carolina had fewer primary care physicians (per 10,000 persons) than the state average (8.6 per 10,000 persons).

CONCLUSION Eastern North Carolina has a disproportionally higher percent of population groups that are vulnerable to the threats of climate change. The need for health care providers to understand and communicate the challenges faced by rural, vulnerable population groups is of great public health importance. Communicating these health risks to policy makers is of equal importance.

Abstract
Climate justice is a local, national, and global movement to protect at-risk populations who are disproportionately affected by climate change. The social context for this review is the Southeastern region of the United States, which is particularly susceptible to climate change because of the geography of the area and the vulnerabilities of the inhabiting populations. Negative human health effects on variable and vulnerable populations within the Southeast region due to changing climate are concerning, as health threats are not expected to produce parallel effects among all individuals. Vulnerable communities, such as communities of color, indigenous people, the geographically isolated, and those who are socioeconomically disadvantaged and already experiencing poor environmental quality, are least able to respond and adapt to climate change. Focusing on vulnerable populations in the Southeastern United States, this review is a synthesis of the recent (2010 to 2015) literature-base on the health effects connected to climate change. This review also addresses local and regional mitigation and adaptation strategies for citizens and leaders to combat direct and indirect human health effects related to a changing climate.

Abstract
Environmental parameters, including built and sociodemographic environments, can impact diabetes control (DC). Epidemiological studies have associated specific environmental factors with DC; however, the impact of multidimensional environmental status has not been assessed. The Environmental Quality Index (EQI), a comprehensive quantitative metric capturing five environmental domains, was considered as an exposure. Age-adjusted rates of DC prevalence for each county in the United States were used as an outcome. DC was defined as the proportion of adults aged 20+ years with a previous diabetes diagnosis who currently do not have high fasting blood glucose (≥126 mg/dL) or elevated HbA1c (≥6.5). We conducted county-level analyses of DC prevalence rates for the years 2004–2012 in association with EQI for 2006–2010 and domain-specific indices using random intercept multilevel linear regression models clustered by state and controlled for county-level rates of obesity and physical inactivity. Analyses were stratified by rural–urban strata, and results are reported as prevalence rate differences (PRD) with 95% CIs comparing highest quintile/worst environmental quality to lowest quintile/best environmental quality. The association of DC with cumulative environmental quality was negative after control for all counties (PRD −0.32, 95% CI: −0.38, −0.27); suggesting that rates of DC worsen as environmental quality declines. While overall environmental quality exerts effects on DC that vary across the rural–urban spectrum, poor sociodemographic, and built environmental factors are associated with decreased DC nationally. These data suggest improvements in environmental quality mediated by larger-scale policy and practice interventions may improve glycemic control and reduce the morbidity and mortality arising from hyperglycemia.

Abstract
This study investigates the relationships between environmental health literacy, the characteristics of people (race, ethnicity, and socioeconomic status) associated with health disparities, and people’s willingness to engage in protective behaviors against environmental health threats. Environmental health literacy is a framework for capturing the continuum between the knowledge of environmental impacts on public health, and the skills and decisions needed to take health-protective actions. We pay particular attention to three dimensions of environmental health literacy: factual knowledge (knowing the facts), knowledge sufficiency (feeling ready to decide what to do), and response efficacy (believing that protective behaviors work). In June 2020, we collected survey data from North Carolina residents on two topics: the viral infection COVID-19 and industrial contaminants called per- and polyfluoroalkyl substances (PFAS). We used their responses to test stepwise regression models with willingness to engage in protective behaviors as a dependent variable and other characteristics as independent variables, including environmental health literacy. For both topics, our results indicated that no disparities emerged according to socioeconomic factors (level of education, household income, or renting one’s residence). We observed disparities in willingness according to race, comparing Black to White participants, but not when comparing White to American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander participants nor Hispanic to non-Hispanic participants. The disparities in willingness between Black and White participants persisted until we introduced the variables of environmental health literacy, when the difference between these groups was no longer significant in the final regression models. The findings suggest that focusing on environmental health literacy could bridge a gap in willingness to protect oneself based on factors such as race/ethnicity and socioeconomic status, which have been identified in the environmental health literature as resulting in health disparities.

Abstract
Although several empirical studies and systematic reviews have documented the mental health impacts of global climate change, the range of impacts has not been well understood. This review examines mental health impacts of three types of climate-related events: (1) acute events such as hurricanes, floods, and wildfires; (2) subacute or long-term changes such as drought and heat stress; and (3) the existential threat of long-lasting changes, including higher temperatures, rising sea levels and a permanently altered and potentially uninhabitable physical environment. The impacts represent both direct (i.e. heat stress) and indirect (i.e. economic loss, threats to health and well-being, displacement and forced migration, collective violence and civil conflict, and alienation from a degraded environment) consequences of global climate change.

Abstract
North Carolina's health care systems face dramatic risks from climate change that are here now and will last for decades, including disease outcomes and increased health risks that will disproportionately affect disadvantaged populations. At the local level, health care practitioners have to become advocates for climate mitigation; longer-term responses must involve society at all levels.

Abstract
Populations across the United States are vulnerable to- and experiencing health effects from-climate change, and North Carolina is no exception. Health professionals are vital when it comes to identifying and treating such impacts, as well as serving as trusted authorities in educating and protecting communities against climate health threats.

Abstract
Over the past century, anthropogenic activities have resulted in high levels of greenhouse gases in our environment, creating a warming effect on the Earth. As a result, global temperatures have risen, shifting climatic zones, influencing weather patterns, and intensifying storms. These changes include heavy precipitation, drought, wildfires, hurricanes, heat waves, and coastal flooding. The impacts from this climatic activity continue to contribute negatively to our environment while influencing human health.

In this special issue of the North Carolina Medical Journal, authors from universities, governmental agencies, and not-for-profit organizations address how the global impacts of climate change are affecting the health of communities across our beautiful state. This issue offers our readers research and real-life stories that underscore the need for keeping the issue of climate change at the forefront of public health for North Carolina. The information provided in these articles gives policymakers and health care providers a deeper understanding of the public health implications and challenges of climate change while highlighting the health risks to our most susceptible populations.

Because there are no direct clinical symptoms or signs, the effects of climate change are difficult to assess at the individual level. However, an abundance of peer-reviewed climate health research studies provides overwhelming scientific evidence that climate change is impacting population health with generalizable results. Mitigation and adaptability strategies are necessary for reducing carbon emissions and building climate-resilient communities. Policymakers and health care providers are in key positions for educating others, helping protect our planet, improving health outcomes, and moving North Carolina toward more sustainable solutions.