Health Equity Tip: Work on the Shared Root Causes of Health Inequities and Climate Injustice

By Solange Gould

Image of earth with plants on a protest sign which reads “Climate Justice is Public Health Work.” On the sides of images are other protest signs and signage depicting the recycle logo, a heart, and a scale.
Illustration by Raina Wellman

This summer many of us are deeply feeling the health impacts of the climate crisis — from the hundreds of deaths due to extreme heat, to breathing unsafe air from forest fires, to the “eco-anxiety”, depression, and other mental health impacts of this existential threat. In just a few months of summer, we have already lived through hurricanes, tornados, mudslides, wildfires, heat waves, severe drought, and flooding.

Climate change is affecting all of us, but those who face health inequities are experiencing the worst impacts. This is because climate injustice and health inequities share the same root causes. Major social determinants of health including housing, transportation, land use, parks, greening, food systems, energy, jobs, and our economic system are also the major drivers of climate change.

Inequities in these drivers of climate and health injustice are created and held in place by power imbalances and systems of advantage and oppression (primarily structural racism). Dismantling structural racism, shifting power, and changing systems will move us faster towards our vision for a future with climate and health justice.

We are talking about public health’s role in a complete systems overhaul. It’s a heavy lift, and health departments cannot and should not do it alone. That means health departments must get more aligned with community organizers and advocates to advance big systems changes in a coordinated and meaningful way.

Where to start:

It is best if you can engage with residents to directly hear their perspectives and stories, since so much of history has been suppressed. For example:

  • What is the jurisdiction’s history of stolen land from Indigenous, Japanese, and Black farmers or landowners? Who owns that land now? Who works on that land now? What forms of government subsidies or loans enabled Whites to own land or maintain solvency as an agricultural grower?
  • What is the history of redlining, segregation, White flight, urban disinvestment, and urban renewal that produced current inequities in living conditions, resources, or exposures that put BIPOC communities at greater risk of health and climate change inequities (e.g., urban heat islands, fewer trees and parks, more air pollution, food apartheid, lack of drinking water, good schools and jobs, public transportation)?

For example:

  • If your jurisdiction is involved in Climate Action Planning, Climate Adaptation or Resilience Planning, General Planning, transportation planning, or Emergency Planning, it’s critical that public health is at the table centering those who are most impacted!
  • If your colleagues in labor, workforce, business, or community development are working to address income and wealth inequities, public health should be there to ensure that they also address climate and health inequities at the center. We can provide the public health evidence, provide research, voice, and authority to these planning processes, ensuring that people we know are facing the worst health inequities are also prioritized in climate change planning.

You may not have all of the answers, and you do not need to be an expert in those sectors, but being at the table will in and of itself increase your fluency, understanding of, and capacity to engage in planning that will put climate change and health equity root causes at the center.

One example:

To understand how climate injustice and health inequities share the same root causes, we can look at farmworkers in the United States. Farmworkers are experiencing some of the worst impacts that stem from the shared root causes of climate change and health inequities. Power imbalances, racist and xenophobic immigration policy, and capitalism have produced a set of laws, policies, and social conditions that put farmworkers at high risk to climate change impacts. These workers already faced some of the worst exposures to pesticides and toxins and resultant health outcomes in the country. And COVID-19 further deepened these health inequities. Now, with extreme heat and wildfires, farmworkers are facing additional burdens of working in extreme heat and unsafe air quality. Among farmworkers, heat stroke is the leading cause of death.

Farmworkers were excluded from the National Labor Relations Act of 1935 and the Fair Labor Standards Act of 1938, which provide basic labor protections and guarantee the right of private sector employees to organize into unions, strike, and engage in collective bargaining. Many immigrant farmworkers are on H-2A visas, which require employer sponsorship and have an inherent harmful power dynamic. Employers can exploit workers by threat and control of visas or loss of jobs. Additionally, those on H-2A visas accept employer-provided housing, which is often overcrowded, unsafe, and unhealthy. During the pandemic, agricultural growers are required to provide workers with protective equipment, but many farmworkers reported not receiving any. They have been understandably afraid to access the few programs, assistance, and protections offered to them during COVID-19, due to fear of Immigration and Customs Enforcement.

These same power dynamics, policies, and conditions put farmworkers at increased risk of climate change impacts. For example, only three states have permanent heat-related worker protection rules: Washington, California, and Minnesota. There is little enforcement, and workers are afraid to report their employers. Working less during a heat wave for health and safety reasons means a smaller paycheck, and workers experiencing heat sickness have reported not stopping work for this reason. H2-A housing could be improved to be made more safe from poor outdoor air quality, heat, flooding, and other climate impacts. All of these necessary systemic changes require a coordinated strategy by communities and governmental public health and sister agencies.

Where health departments can play a role:

In our last Health Equity Tip, we described how the Santa Barbara County Public Health Department partnered with community organizers CAUSE and MICOP to protect farmworker health and safety during COVID-19 by establishing the Latinx and Indigenous Migrant COVID-19 Task Force, documenting community conditions impacting COVID-19 risk, issuing a Health Order on H2A housing, and increasing attention to Indigenous workers’ COVID-19 risks and language needs. The health department had already been working with these community power building groups for several years before COVID-19 hit. Working in partnership, these groups were able to use their respective forms of power to resist pushback against public health protections from employers, ultimately shifting the balance of power in public decision-making. They also shifted the balance of power between the powerful agricultural companies and Indigenous agricultural workers.

By shifting power, the health department-community organizer partnership has also built a foundation of resistance to protect farmworkers from the additional threats climate change poses — including smoke from wildfires and extreme heat. They can continue to work in partnership for stronger labor protections and rights, economic security policies such as paid leave, and housing affordability and conditions. Promotoras and community leaders who partnered with health departments to provide COVID testing and vaccinations in the fields can be extended to provide education about climate change’s health impacts and farmworker rights, organizing for better working and living conditions, community information and safety against ICE, and many other emerging climate, health, and equity needs.

The lessons that the pandemic taught us can be put to work right now to prevent and build resilience to climate crises. Working on the shared root causes of health inequities and climate injustice can transform systems and speed us toward our future vision where everyone enjoys dignity and health on a thriving planet.

Solange Gould is Co-Director at Human Impact Partners. Along with Lili Farhang, she’s responsible for advancing the mission and strategic direction of the organization. She has been in public health practice for over 20 years, advancing progressive policy and systems change to improve health, equity, and sustainability with government partners, advocates and organizers, and communities most impacted.

📌 Did you know? Human Impact Partners provides health equity capacity building to public health organizations. Contact us to learn more about our offerings at info[at]humanimpact.org.

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