A scalable climate health justice assessment model

Abstract

This paper introduces a scalable “climate health justice” model for assessing and projecting incidence, treatment costs, and sociospatial disparities for diseases with well-documented climate change linkages. The model is designed to employ low-cost secondary data, and it is rooted in a perspective that merges normative environmental justice concerns with theoretical grounding in health inequalities. Since the model employs International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) disease codes, it is transferable to other contexts, appropriate for use across spatial scales, and suitable for comparative analyses. We demonstrate the utility of the model through analysis of 2008–2010 hospitalization discharge data at state and county levels in Texas (USA). We identified several disease categories (i.e., cardiovascular, gastrointestinal, heat-related, and respiratory) associated with climate change, and then selected corresponding ICD-9 codes with the highest hospitalization counts for further analyses. Selected diseases include ischemic heart disease, diarrhea, heat exhaustion/cramps/stroke/syncope, and asthma. Cardiovascular disease ranked first among the general categories of diseases for age-adjusted hospital admission rate (5286.37 per 100,000). In terms of specific selected diseases (per 100,000 population), asthma ranked first (517.51), followed by ischemic heart disease (195.20), diarrhea (75.35), and heat exhaustion/cramps/stroke/syncope (7.81). Charges associated with the selected diseases over the 3-year period amounted to US$5.6 billion. Blacks were disproportionately burdened by the selected diseases in comparison to non-Hispanic whites, while Hispanics were not. Spatial distributions of the selected disease rates revealed geographic zones of disproportionate risk. Based upon a downscaled regional climate-change projection model, we estimate a >5% increase in the incidence and treatment costs of asthma attributable to climate change between the baseline and 2040–2050 in Texas. Additionally, the inequalities described here will be accentuated, with blacks facing amplified health disparities in the future. These predicted trends raise both intergenerational and distributional climate health justice concerns.

Beyond Smoking: Environmental Determinants of Asthma Prevalence in Western Nepal

“…49 Another study projected that the cost of asthma could increase by more than 5% due to climate change. 50 A study based in Nepal estimated that the asthma treatment cost per case is US $73.78 without including the costs of lost productivity. 51 The per case cost of asthma is quite high in developed countries, estimated to be US $420 in 2006 in the US.…”

Justice and Equity Implications of Climate Change Adaptation: A Theoretical Evaluation Framework

“…The underlying principle of the proposed framework is an adaptation strategy’s potential for climate justice that serves as proxy indicator for effectiveness in adaptation evaluation. Our definition of climate justice refers to distributional justice [ 27 ] of the burden of adverse health effects, closely linked to the concept of environmental justice in the Public Health context. Environmental justice is based on the notion that environmental hazards and exposures disproportionately affect people with lower socio-economic capital, people of color, people in lower income regions or city districts, children, and people with less political power [ 22 ].…”

“…Considering the above mentioned unequally distributed vulnerabilities to adverse effects, evaluation approaches that specifically incorporate or address these aspects might be useful [ 27 , 28 ].…”

Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001–2010

“…Health and social inequities among low socioeconomic and minority populations can be attributed to a number of factors related to increased hospitalizations costs including, environmental justice issues, healthcare access and utilization, and lack of education [ 30 ]. A number of studies have also suggested that these marginalized groups face unequal exposures to climate hazards, referred to as the “climate gap” [ 40 , 41 ]. Our data lack the ability to answer these specific questions, though we have identified significant differences in HRI hospitalization costs among these marginalized populations, further research is needed to explore how issues of environmental justice, healthcare access, and health behaviors relate to HRI hospitalizations and increased hospital costs.…”