Assessing climate change and health vulnerability at the local level: Travis County, Texas

A call for the informatics community to define priority practice and research areas at the intersection of climate and health: report from 2023 mini-summit

OBJECTIVE

Although biomedical informatics has multiple roles to play in addressing the climate crisis, collaborative action and research agendas have yet to be developed. As a first step, AMIA's new Climate, Health, and Informatics Working Group held a mini-summit entitled Climate and health: How can informatics help? during the AMIA 2023 Fall Symposium to define an initial set of areas of interest and begin mobilizing informaticians to confront the urgent challenges of climate change.

MATERIALS AND METHODS

The AMIA Climate, Health, and Informatics Working Group (at the time, an AMIA Discussion Forum), the International Medical Informatics Association (IMIA), the International Academy of Health Sciences Informatics (IAHSI), and the Regenstrief Institute hosted a mini-summit entitled Climate and health: How can informatics help? on November 11, 2023, during the AMIA 2023 Annual Symposium (New Orleans, LA, USA). Using an affinity diagramming approach, the mini-summit organizers posed 2 questions to ∼50 attendees (40 in-person, 10 virtual).

RESULTS

Participants expressed a broad array of viewpoints on actions that can be undertaken now and areas needing research to support future actions. Areas of current action ranged from enhanced education to expanded telemedicine to assessment of community vulnerability. Areas of research ranged from emergency preparedness to climate-specific clinical coding to risk prediction models.

DISCUSSION

The mini-summit was intended as a first step in helping the informatics community at large set application and research priorities for climate, health, and informatics.

CONCLUSION

The working group will use these perspectives as it seeks further input, and begins to establish priorities for climate-related biomedical informatics actions and research.

Locating the built environment within existing empirical models of climate change and mental health: protocol for a global systematic scoping review

INTRODUCTION

Where a person lives, the characteristics of their housing and neighbourhood environment influence their exposure to climate-related hazards and vulnerability to associated mental health impacts. This suggests that the built environment may be a promising focus for integrated policy responses to climate change and public mental health challenges. However, few empirical studies have focused on the role of the built environment as an important mediator of climate-attributable mental health burden. The proposed scoping review seeks to identify and synthesise existing conceptual models and frameworks linking climate change to mental health via built environment pathways. We aim to provide a preliminary overview of the housing and neighbourhood pathways through which climate change may impact mental health, which will inform future empirical work in this emerging area of research.

METHODS AND ANALYSIS

A systematic scoping review of the global peer-reviewed and grey literature will be conducted in accordance with Arksey and O'Malley's methodological framework and Joanna Briggs Institute recommendations. Included articles must present a conceptual model or framework incorporating relevant built environment pathways through which climate change may impact mental health and well-being. Relevant models and frameworks will be identified through systematic searches (for English-language reports) of Medline, PsycINFO, Embase, Scopus, Web of Science and grey literature databases. Two reviewers will independently screen the article titles, abstracts and full texts, with conflicts resolved by a third reviewer. Data extraction will occur using a predefined template. The presentation of findings will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, including a narrative synthesis of the role of housing and neighbourhood factors in the relationship between climate change and mental health, as identified from the existing literature. The review will lay essential foundations for future empirical research and place-based policy responses to the mental health consequences of a changing climate.

ETHICS AND DISSEMINATION

The scoping review will be a secondary analysis of published data, for which ethics approval is not required. The results will be disseminated through a peer-reviewed publication and targeted distribution to stakeholders involved in climate change, built environment and health research and policymaking.

STUDY REGISTRATION

Open Science Framework: doi.org/10.17605/OSF.IO/XR74C.

Community-Level Characteristics Associated With Resilience After Adversity: A Scoping Review of Research in Urban Locales

The objective of this study was to document the current knowledge on characteristics measured at the community level and their relationship to individual or community well-being. The review specifically focuses on studies in urban locations. The main aim was to describe and organize evidence-based community strengths using a multidimensional portfolio approach to resilience. A scoping review using PRISMA-ScR guidelines was performed through searches of English-language articles in PsycINFO and PubMed databases. Inclusion criteria encompassed strengths or deficit factors assessed at the community-level of analysis. Our initial searches produced a pool of 2,246 articles, with 87 meeting full criteria for this review. Community-level variables were often measured as deficits or risk factors. Most studies were conducted in North America. Relationships between community variables and individual well-being showed mixed results for social characteristics but, more consistently, positive associations for strengths-based measures of natural and built environments such as access to green spaces and walkability. Models of resilience, including those focused on individuals, should include environmental characteristics. Findings of the current study suggest foundational concepts for a community resilience portfolio model to complement the more individual-focused models currently in use.

The impact of temperature changes on the health vulnerability of migrant workers: an empirical study based on the China family panel studies

Introduction

Migrant workers constitute a significant portion of China's workforce, and their health directly affects labor supply and economic stability. Health vulnerability plays a crucial role in shaping the well-being of migrant workers, yet its determinants, particularly the impact of temperature change, remain underexplored. This study, based on the socio-ecological model, investigates how temperature variations influence the health vulnerability of migrant workers in China.

Methods

Using data from 2020, this study quantifies health vulnerability and examines the impact of temperature fluctuations across different seasons. Robustness checks, including dependent variable substitutions and model modifications, ensure the reliability of the findings. Furthermore, a mechanism analysis is conducted to explore the underlying pathways through which temperature change affects health vulnerability.

Results

The findings reveal that rising temperatures in spring, summer, and winter significantly exacerbate the health vulnerability of migrant workers, while increasing autumn temperatures mitigate it. Mechanism analysis identifies heightened psychological burden as a key channel through which temperature change worsens health vulnerability. Additionally, generational differences emerge: older migrant workers are more adversely affected by elevated spring temperatures, whereas younger workers exhibit greater sensitivity to rising summer temperatures.

Discussion

These results underscore the necessity of targeted health interventions and adaptive labor protection policies. By highlighting the seasonal and generational disparities in the effects of temperature change, this study offers theoretical and empirical support for enhancing the resilience of migrant workers to climate variations. The findings provide valuable insights for policymakers in designing strategies to safeguard the health and stability of the migrant workforce.

Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review

Background Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. Methods and Results After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. Conclusions Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.

Mapping social vulnerability indicators to understand the health impacts of climate change: a scoping review

The need to assess and measure how social vulnerability influences the health impacts of climate change has resulted in a rapidly growing body of research literature. To date, there has been no overarching, systematic examination of where this evidence is concentrated and what inferences can be made. This scoping review provides an overview of studies published between 2012 and 2022 on social vulnerability to the negative health effects of climate change. Of the 2115 studies identified from four bibliographic databases (Scopus, Web of Science, PubMed, and CAB Direct), 230 that considered indicators of social vulnerability to climate change impacts on health outcomes were selected for review. Frequency and thematic analyses were conducted to establish the scope of the social vulnerability indicators, climate change impacts, and health conditions studied, and the substantive themes and findings of this research. 113 indicators of social vulnerability covering 15 themes were identified, with a small set of indicators receiving most of the research attention, including age, sex, ethnicity, education, income, poverty, unemployment, access to green and blue spaces, access to health services, social isolation, and population density. The results reveal an undertheorisation and few indicators that conceptualise and operationalise social vulnerability beyond individual sociodemographic characteristics by identifying structural and institutional dimensions of vulnerability, and a preponderance of social vulnerability research in high-income countries. This Review highlights the need for future research, data infrastructure, and policy attention to address structural, institutional, and sociopolitical conditions, which will better support climate resilience and adaptation planning.

Residential and Race/Ethnicity Disparities in Heat Vulnerability in the United States

Adverse health outcomes caused by extreme heat represent the most direct human health threat associated with the warming of the Earth's climate. Socioeconomic, demographic, health, land cover, and temperature determinants contribute to heat vulnerability; however, nationwide patterns of residential and race/ethnicity disparities in heat vulnerability in the United States are poorly understood. This study aimed to develop a Heat Vulnerability Index (HVI) for the United States; to assess differences in heat vulnerability across geographies that have experienced historical and/or contemporary forms of marginalization; and to quantify HVI by race/ethnicity. Principal component analysis was used to calculate census tract level HVI scores based on the 2019 population characteristics of the United States. Differences in HVI scores were analyzed across the Home Owners' Loan Corporation (HOLC) "redlining" grades, the Climate and Economic Justice Screening Tool (CEJST) disadvantaged versus non-disadvantaged communities, and race/ethnicity groups. HVI scores were calculated for 55,267 U.S. census tracts. Mean HVI scores were 17.56, 18.61, 19.45, and 19.93 for HOLC grades "A"-"D," respectively. CEJST-defined disadvantaged census tracts had a significantly higher mean HVI score (19.13) than non-disadvantaged tracts (16.68). The non-Hispanic African American or Black race/ethnicity group had the highest HVI score (18.51), followed by Hispanic or Latino (18.19). Historically redlined and contemporary CEJST disadvantaged census tracts and communities of color were found to be associated with increased vulnerability to heat. These findings can help promote equitable climate change adaptation policies by informing policymakers about the national distribution of place- and race/ethnicity-based disparities in heat vulnerability.

Digital health for climate change mitigation and response: a scoping review

OBJECTIVE

Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change.

MATERIALS AND METHODS

We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant.

RESULTS

The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas.

DISCUSSION

While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation.

CONCLUSION

Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.

A population-based retrospective study of the modifying effect of urban blue space on the impact of socioeconomic deprivation on mental health, 2009-2018

The incidence of mental health disorders in urban areas is increasing and there is a growing interest in using urban blue spaces (urban waterways, canals, lakes, ponds, coasts, etc.) as a tool to manage and mitigate mental health inequalities in the population. However, there is a dearth of longitudinal evidence of the mechanisms and impact of blue spaces on clinical markers of mental health to support and inform such interventions. We conducted a 10-year retrospective study, following STROBE guidelines, using routinely collected population primary care health data within the National Health Service (NHS) administrative area of Greater Glasgow and Clyde for the North of Glasgow city area. We explored whether living near blue space modifies the negative effect of socio-economic deprivation on mental health during the regeneration of an urban blue space (canal) from complete dereliction and closure. A total of 132,788 people (65,351 female) fulfilling the inclusion criteria were entered in the analysis. We established a base model estimating the effect of deprivation on the risk of mental health disorders using a Cox proportional hazards model, adjusted for age, sex and pre-existing comorbidities. We then investigated the modifying effect of living near blue space by computing a second model which included distance to blue space as an additional predicting variable and compared the results to the base model. Living near blue space modified the risk of mental health disorders deriving from socio-economic deprivation by 6% (hazard ratio 2.48, 95% confidence interval 2.39–2.57) for those living in the most deprived tertile (T1) and by 4% (hazard ratio 1.66, 95% confidence interval 1.60–1.72) for those in the medium deprivation tertile (T2). Our findings support the notion that living near blue space could play an important role in reducing the burden of mental health inequalities in urban populations.

A Systematic Review of the Development and Validation of the Heat Vulnerability Index: Major Factors, Methods, and Spatial Units

PURPOSE OF REVIEW

This review aims to identify the key factors, methods, and spatial units used in the development and validation of the heat vulnerability index (HVI) and discuss the underlying limitations of the data and methods by evaluating the performance of the HVI.

RECENT FINDINGS

Thirteen studies characterizing the factors of the HVI development and relating the index with validation data were identified. Five types of factors (i.e., hazard exposure, demographic characteristics, socioeconomic conditions, built environment, and underlying health) of the HVI development were identified, and the top five were social cohesion, race, and/or ethnicity, landscape, age, and economic status. The principal component analysis/factor analysis (PCA/FA) was often used in index development, and four types of spatial units (i.e., census tracts, administrative area, postal code, grid) were used for establishing the relationship between factors and the HVI. Moreover, although most studies showed that a higher HVI was often associated with the increase in health risk, the strength of the relationship was weak.

SUMMARY

This review provides a retrospect of the major factors, methods, and spatial units used in development and validation of the HVI and helps to define the framework for future studies. In the future, more information on the hazard exposure, underlying health, governance, and protection awareness should be considered in the HVI development, and the duration and location of validation data should be strengthened to verify the reliability of HVI.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40641-021-00173-3.

Social Vulnerability Assessment for Flood Risk Analysis

This paper proposes a methodology for the analysis of social vulnerability to floods based on the integration and weighting of a range of exposure and resistance (coping capacity) indicators. It focuses on the selection and characteristics of each proposed indicator and the integration procedure based on the analytic hierarchy process (AHP) on a large scale. The majority of data used for the calculation of the indicators comes from open public data sources, which allows the replicability of the method in any area where the same data are available. To demonstrate the feasibility of the method, a study case is presented. The flood social vulnerability assessment focuses on the municipality of Ponferrada (Spain), a medium-sized town that has high exposure to floods due to potential breakage of the dam located upstream. A detailed mapping of the social vulnerability index is generated at the urban parcel scale, which shows an affected population of 34,941 inhabitants. The capability of working with such detailed units of analysis for an entire medium-sized town provides a valuable tool to support flood risk planning and management.

Examination of Human Health Impacts Due to Adverse Climate Events Through the Use of Vulnerability Mapping: A Scoping Review

Government officials, health professionals, and other decision makers are tasked with characterizing vulnerability and understanding how populations experience risks associated with exposure to climate-related hazards. Spatial analyses of vulnerable locations have given rise to climate change vulnerability mapping. While not a new concept, the spatial analyses of specific health outcomes remain limited. This review explores different methodologies and data that are used to assess vulnerability and map population health impacts to climate hazards. The review retrieved scholarly articles and governmental reports concerning vulnerability mapping of human health to the impacts of climate change in the United States, published in the last decade. After review, 37 studies were selected for inclusion. Climate-related exposures were distributed across four main categories, including: high ambient temperatures; flood hazards; vector-borne diseases; and wildfires. A number of different methodologies and measures were used to assess health vulnerability to climate-related hazards, including heat vulnerability indices and regression analyses. Vulnerability maps should exemplify how variables measuring the sensitivity and adaptive capacity of different populations help to determine the potential for climate-related hazards to have an effect on human health. Recommendations address methodologies, data gaps, and communication to assist researchers and stakeholders in directing adaptations to their most efficient and effective use.

Using Earth observation images to inform risk assessment and mapping of climate change-related infectious diseases

The number of human cases of several climate-related infectious diseases, including tick- and mosquito-borne diseases, has increased in Canada and other parts of the world since the end of the last century. Predicting and mapping the risks associated with these diseases using environmental and climatic determinants derived from satellite images is an emerging method that can support research, surveillance, prevention and control activities and help to better assess the impacts of climate change in Canada. Earth observation images can be used to systematically monitor changes in the Earth's surface and atmosphere at different scales of time and space. These images can inform estimation and monitoring of environmental and climatic determinants, and thus disease prediction and risk mapping. The current array of Earth observation satellites provides access to a large quantity and variety of data. These data have different characteristics in terms of spatial, temporal and thematic precision and resolution. The objectives of this overview are to describe how Earth observation images may inform risk assessment and mapping of tick-borne and mosquito-borne diseases in Canada, their potential benefits and limitations, the implications and next steps.

Vulnerability to heatwaves and implications for public health interventions - A scoping review

BACKGROUND

Heatwaves form a serious public health threat, especially for vulnerable groups. Interventions such as active outreach programs, exposure reduction measures and monitoring and mapping of at-risk groups are increasingly implemented across the world but little is known about their effect.

OBJECTIVES

To assess how vulnerable groups are identified and reached in heat health interventions, to understand the effectiveness and efficiency of those interventions, and to identify research gaps in existing literature.

METHODS

We performed a literature search in relevant scientific literature databases and searched with a four element search model for articles published from 1995 onward. We extracted data on intervention measures, target group and evaluation of effectiveness and efficiency.

RESULTS

We identified 23 eligible studies. Patterns exist in type of interventions 1) to detect and 2) to influence extrinsic and intrinsic risk and protective factors. Results showed several intervention barriers related to the variety and intersection of these factors, as well as the self-perception of vulnerable groups, and misconceptions and unfavorable attitudes towards intervention benefits. While modest indications for the evidence on the effectiveness of interventions were found, efficiency remains unclear.

DISCUSSION

Interventions entailed logical combinations of measures, subsumed as packages. Evidence for effective and efficient intervention is limited by the difficulty to determine effects and because single measures are mutually dependent. Interventions prioritized promoting behavioral change and were based on behavioral assumptions that remain untested and mechanisms not worked out explicitly.

CONCLUSIONS

Multifaceted efforts are needed to tailor interventions, compiled in heat health warning systems and action plans for exposure reduction and protection of vulnerable populations, to fit the social, economic and geographical context. Besides adequately addressing relevant risk and protective factors, the challenge is to integrate perspectives of vulnerable groups. Future research should focus on intervention barriers and improving the methods of effectiveness and efficiency evaluation.

Health Co-Benefits of Green Building Design Strategies and Community Resilience to Urban Flooding: A Systematic Review of the Evidence

Climate change is increasingly exacerbating existing population health hazards, as well as resulting in new negative health effects. Flooding is one particularly deadly example of its amplifying and expanding effect on public health. This systematic review considered evidence linking green building strategies in the Leadership in Energy and Environmental Design^® (LEED) Rating System with the potential to reduce negative health outcomes following exposure to urban flooding events. Queries evaluated links between LEED credit requirements and risk of exposure to urban flooding, environmental determinants of health, co-benefits to public health outcomes, and co-benefits to built environment outcomes. Public health co-benefits to leveraging green building design to enhance flooding resilience included: improving the interface between humans and wildlife and reducing the risk of waterborne disease, flood-related morbidity and mortality, and psychological harm. We conclude that collaborations among the public health, climate change, civil society, and green building sectors to enhance community resilience to urban flooding could benefit population health.

An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.