Download Hot or Not?: Recognizing and Preparing for Climate

HOT OR NOT?:
RECOGNIZING AND PREPARING FOR CLIMATE-INDUCED ILLNESS
Sabrina McCormick, PhD
University of Pennsylvania
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ABSTRACT
Climate change is already detrimentally affecting the lives and health of many people
(Houghton et al. 2001) and is resulting in 160,000 annual deaths globally, caused by vector borne
diseases, food insecurity, and heatwaves, (Campbell-Lendrum 2003). This paper presents an
analytical framework for the newly recognized and socially-contested category of “climate-induced
illnesses.” In it, I aim to first, expand the range of disaster research and theory by examining health
crises as a ‘new species of trouble’ and by applying the insights of disaster research to population
health (Erikson 1992). Second, I attempt to make contributions to medical sociology by exploring
how the social construction and framing of illness functions for illnesses identified as climateinduced. I examine three illnesses recently recognized as exacerbated by climate change: West Nile
Virus in the Northeast United States, increasing toxicological exposures in coastal Alaska Native
communities, and heat-induced illnesses in Philadelphia, Pennsylvania (Tenenbaum 2005; Balbus
and Wilson 2000; Ebi 2007). I argue that there are institutional obstacles to illness crisis management
reflected in competing illness paradigms. Responses on the part of affected communities, medical
practitioners, and governmental representatives interact to form socially shared public etiological and
epidemiological understandings that shape subsequent prevention methods. This research presents
an opportunity to apply multiple sociological theories to the pressing subject of climate change, with
special focus on its impacts.
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HOT OR NOT?:
RECOGNIZING AND PREPARING FOR CLIMATE-INDUCED ILLNESS
Although not all of the health impacts of climate change are detrimental (Haines et al. 2006),
early estimates suggest negative health effects for many individuals (IPCC 2001). Climate change
contributes to 160,000 annual deaths globally due to vector borne diseases, food insecurity,
heatwaves and other problems (Campbell-Lendrum et al. 2003). This paper presents an analytical
framework for the newly recognized and socially-contested category of “climate-induced illnesses.”
In it, I aim to first, expand the range of disaster research and theory by examining health crises as a
‘new species of trouble’ and by applying the insights of disaster research to population health
(Erikson 1992). Second, I attempt to make contributions to medical sociology by exploring how the
social construction and framing of illness functions for illnesses identified as climate-induced. This
research presents an opportunity to apply multiple sociological theories to the pressing subject of
climate change, with special focus on its impacts. It will also have important policy implications for
how to better handle illness crises generally.
In the latter half of the paper, I focus on three illnesses recently recognized as exacerbated
by climate change: West Nile Virus in New York, New York, increasing toxicological exposures in
Alaska Native communities, and heat-induced illnesses in Philadelphia, Pennsylvania (Tenenbaum
2005; Balbus and Wilson 2000; Ebi 2007). These cases have been selected strategically in order to
analyze the social, cultural, economic and ecological mechanisms through which climate change is
projected to increase disease risk in the United States (Longstreth 1999). By utilizing a comparative
design, this research intends to identify the characteristics of resilience and weakness across types of
health crises.
I argue that there are institutional obstacles to illness crisis management reflected in
competing illness paradigms. Responses on the part of affected communities, medical practitioners,
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and governmental representatives interact to form socially shared public etiological and
epidemiological understandings that shape subsequent prevention methods. In addition, the
introduction of new discourses and facts by media sources and scientists shape transition in
conceptualization at all levels of disease causation - ranging from genetic code and the human body to
home, workplace, neighborhood, or broader environment – that reflect medical paradigms. Research
results provide a framework for understanding many situations in which intersecting social and
geophysical processes are creating situations perceived as urgent by some stakeholders while
discounted by others (Parker 2007).
A burgeoning body of epidemiological literature has demonstrated health impacts of climate
change, but has left a need to understand how these illnesses are recognized, who has responsibility
to prevent or treat them, and ways responsible agencies and institutions shift to accommodate new
facts and discourses about climate change (Gusfield 1984). This research aims to fill these gaps.
Doing so is of immense importance since global warming is already having demonstrable health
effects, making programming and preparedness critical to ameliorating its most negative outcomes
(Ebi et al. 2006; Burton et al. 2006). At the same time, however, the considerable amount of effort
and education necessary for the public and political representatives to accept climate change
indicates that the acknowledgement, acceptance of and planning for these illnesses is a difficult
public policy task.
Little systematic research has examined individual experiences with illnesses linked to climate
change, medical practitioners’ perceptions of causes and treatment, and institutional mechanisms in
place for disease management. These topics are of import due to both their theoretical significance
in medical sociology and their policy significance for disaster research, as well as their pragmatic
relevance to at-risk populations. New or newly exacerbated illnesses signify trends that are projected
to expand rapidly and require additional resources for appropriate public health responses. This
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project is timely in that it captures a moment in which several illnesses have recently emerged and
for which scientific, public and governmental perceptions are currently shifting to incorporate the
role of climate change in causation. It is also immediately necessary in order to alleviate the gravity
of pending health crises.
Theoretical Background
This research is informed by, and seeks to make contributions to, the medical sociology and
disaster research literatures. Researchers have extensively studied the social construction of illness
that shapes illness experience (Pierret 2003), health inequalities (House 2002; Phelan et al. 2004),
processes of diagnosis (Stockl 2007; Madden and Sim 2006) and risk paradigms (Quah 2007; Smoyer
1998). Understanding the ways in which these illnesses arise and are managed has import for these
theories. By studying climate-induced illness crises, we can also expand disaster research regarding
institutions and environmental processes (Smoyer 1998) to illness, and to climate change. Bringing
these two literatures together will illustrate the similarities and differences between health and other
disaster processes. As such, this research builds upon and supplements the knowledge base of other
case studies of health crises such as Ebola (Joffe and Haarhoff 2002), Lyme Disease (Aronowitz
1991), and the Avian flu (Ozonoff 2005). Researchers have effectively explored and theorized the
social processes that lead to the creation of a disaster. Medical sociological theory explains how the
social construction of illness shapes lay, medical and governmental responses to new illnesses.
Bridging these two literatures informs how health crises may arise and be managed.
Disasters and Illness Crises
There is an important distinction between the growing body of research that has investigated
the health impacts of disasters, and the research proposed here which conceptualizes new disease
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emergence as a disaster. Most disasters are regarded as taking place outside of the biological body,
but affecting health. Broadly defined, disasters are “…non-routine events in societies or their larger
subsystems (e.g. regions and communities) that involve conjunctions of physical conditions with
social definitions of human harm and social disruption (Kreps 2001: 3718).” Most disasters are
categorized as natural or technological. While illness crises may fit into the former category, they
may also be a distinct type of disaster because of their unique characteristics. Conceptualizing illness
crises as disasters, rather than just the outcome of man-made or natural events, recognizes the
broad-scale societal disruption of emergent illnesses and the conceptual similarities between disease
and disaster emergence. This approach also aims to recognize communities vulnerable to climate
change as a growing target of vulnerability (Perrow 2007) and to articulate how risk reduction for
them is distinct from populations vulnerable to other types of disasters. In sum, the study of
disasters can be applied to health crises (Fischhoff et al. 2006), and consequently to the study of
climate-induced illnesses, in order to articulate the obstacles to their effective identification and
management.
In beginning to study health crises, researchers have pointed out a number of social
structural dimensions that lead to their emergence. Possibly the most well-cited analysis of a health
disaster is Klinenberg’s (2002) study of the 1995 Chicago heatwave. He demonstrated how social
isolation of elderly minorities in crime-ridden areas with poorly ventilated housing and inadequate
social services, as well as an uncoordinated response among health, fire, and police departments
were interacting factors that caused the disproportionate number of deaths. Studies of e coli
emergence in Canada reveal how regulations had not yet accounted for a shifting agroecosystem that
added new pollutants to water resulting in changing yet unaccounted for risks (Ali 2004). In the case
of a possible Avian flu epidemic, scientists have not established how to best prevent the disease due
to a lack of government support for innovation and/or preparation (Davis 2005). These studies
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mark a new critical area of research; however, such events can be better understood by connecting
social structural dimensions to public perception and medical practice. This research aims to make
those connections and also place them within recently established policy frameworks developed to
manage a growing number of illness crises.
New Policies
Health crises have recently become a new emphasis in policy-making; although this
phenomena is not yet well-studied by researchers. The Model State Health Emergencies Act was
proposed in 2001 in response to the 9/11 terrorist attacks, and was meant to prevent and prepare
for massive disease outbreaks, bioterrorism, and other public health crises (Gostin et al. 2002).
Passed in the majority of states across the U.S., the Act changed preparatory strategies and
communication pathways across state and federal agencies (Bayer and Colgrove 2002). This new Act
raised issues regarding health management that had long been of note for disasters more broadly,
such as the power of federal agencies over state representatives, the provision of resources, and the
address of phenomena that crosses state boundaries (Greenberger 2005).
The Act also initiated questions regarding the distinctions, conflicts and overlaps between
state, federal and transnational institutions in the management of health crises (MacKellar 2007;
Salisbury 2006). Conflicts between government jurisdictions and spheres of responsibility can occur
during disasters (Clarke 1989) often resulting in a garbage can approach where multiple
organizations do not coordinate effectively but rather make ad hoc decisions (Cohen et al. 1972).
These recent policy developments also beg multiple questions: (1) how institutional recognition or
awareness of new illnesses occurs, (2) under what conditions is the emergence of new diseases
categorized as disasters or crises, (3) what stakeholders are involved in contests to define disasters or
crises, (4) what are the axes of differentiation over which stakeholders debate, and (5) what are the
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normalized dimensions of preparatory responses. By examining these questions, we can see the
interplay between the institutional actors responsible for public health, environmental policy and
disaster management. We can see as well how each set of institutional actors builds collaborative
networks with or seek to silence local communities.
Disaster Incubation
In order to understand health crises resultant from or linked to climate change, we must
examine the phases leading up to their emergence. Researchers have established that in the phase
leading up to an illness crisis or disaster, existing problems often considered systematically “normal”
(Perrow 1984) go unaddressed. An event that acts as an “internal” or “external” trigger generates an
urgent threat by undermining not only the coping capacity of existing systems (Boin et al. 2005), but
also the public trust in them. Such events exacerbate a structured set of social inequalities, one of
whose measures is health disparities (Fothergill et al. 1999). Health inequalities are often exacerbated
by illness crises, consequently revealing otherwise disguised or ignored social problems (Clarke 2005;
Hilgartner and Bosk 1988, Gamson and Modigliani 1989). Once the trigger has been pulled, social
resolution is a dynamic process. One aim of this project is to provide a dynamic understanding of
the naming and framing of health crises (Brown 1995), the networks that are formed to create a
socially shared understanding, and the specific issues likely to trigger the next crisis. A second aim of
the proposed research is to describe media framings of discord among those involved in the crisis.
From initial frames we will see the emerging social understandings take form, a set of labels floated,
repeated, ignored, and narrowed. Temporary social agreements encode the contended turf of the
next crisis.
Because crises are produced by the normal operation of the nested political, economic,
social, and cultural systems, a health threat to the community is presented as if it were of sudden
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origin. However, normalcy often masks system defects and disaster incubation (Turner 1976). In
the case of the Challenger Disaster, Vaughn (1996) demonstrated that this incubation phase
involved the normalization of defects in high-risk technologies to the degree that officials were blind
to serious problems like those that caused the crash. Problematic communication between agencies
within the National Aerospace Administration (NASA) facilitated the accumulation of defects
without warnings being issued. Beamish (2002) argued that many of these problems in the
incubation phase can be characterized as “crescive troubles.” A number of features are likely
characterize crescive problems of which the following two are the most important: (1) they grow
over an extended period of time and (2) they become recognizable only after government officials
are trained to detect their occurrence. These cases and others demonstrate how organizational
cultures are filtered through a variety of local understandings and frames deployed by public media
(Mileti et al. 2002; Gamson and Modigliani 1989). When attributed to climate change, local health
crises are indeed a “new species of trouble” (Erikson 1992).
The transformation of environmental change into a frame for climate-induced health risks
unsettles understandings of what is ‘natural’ (Smith 2001b). In the case of chikunguya in Italy,
despite temperature change and the growth of mosquito populations, nothing was done to prevent
disease emergence. As the director of the regional health program in that area said, residents and
officials, “had peace of mind because they knew this didn’t happen in Italy (Rosenthal 2007).” Many
cases also went undiagnosed due to lack of experience with the disease (Beltrame et al. 2007).
Affected populations and government institutions normalize changing environmental circumstances,
and medical practitioners have little training or information that would help them anticipate new
illnesses. While preparedness for disasters is the broadest and most well-substantiated area of
disaster research (Perrow 2007), little is known about preparedness for the ecological change that
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engenders climate-induced illness. Such measures are necessarily distinct from other types of disaster
preparedness.
Responses to Illness Crises and Medical Paradigms
Professional, public, and personal understandings of illness, especially responses to ‘sudden’
epidemics, creates health crises at the same time that it instigates empirical outcome measures to
assess policies of containment and control. In this way, illness experiences and local responses are
interlinked with scientific developments and public policy. Affected communities respond first to
disasters and health crises, fundamentally shaping how crises expand or contract (Clarke 2003).
Although few studies have looked at these responses specifically, research on health social
movements (Brown et al. 2007), and mobilization more generally, demonstrate that government
framing (Zavestoski et al. 2004), media framing (Flic 2004), pre-existing social movement framing
(Snow et al. 1986), and trust or distrust of government officials (Edelstein 2003; Brown and
Mikklesen 1990; Zavestoski et al. 2002) determine how first responders react to illness events.
The social construction of illness shapes the experience of affected groups and medical
response. The social construction of illness relates to contemporary moral, ethical and political
beliefs, socialization of medical practitioners, medical institutions, and larger social structures
(Brown 1995). The biomedical model is the predominant approach of most medical practitioners
and institutions in the United States. It encompasses a basis on germ theory and genetics, which
conceptualizes illness as described by a particular etiology, depends on a focus on the internal body,
and utilizes the metaphor of body-as-machine (Conrad 2001). For most conditions, the framing of
illness focuses on the risk of “lifestyle” choices, emphasizing individual identity and self-control
(Lupton 2001). Illness narratives reflect the predominance of this paradigm in the public, shaping
how at-risk groups form and perceive responsibility for prevention (Wong and King 2008). The
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prevalence of this paradigm presents a challenge to disease recognition, cause identification, and the
creation of effective prevention strategies in the case of environmentally-related illness (Smith 2001).
For example, little attention is paid in medical education to the environmental hazards that cause
illness. In fact, health professionals have negative attitudes about environmental illness (Brown and
Kelley 2000). An emphasis and investment in genetic science and technology coupled with a
powerlessness as medical professionals to intervene and change the environment or climate only
reinforces hostility to environmental explanations for illness.
Medical paradigmatic and institutional issues intersect in the process of disease identification,
and in disaster medicine specifically (Hogan and Burstein 2007). When physicians are presented with
a seemingly disjointed set of symptoms, they must organize them into a diagnosis with a treatment
regimen (Balint 1972). This process incorporates past medical practices and contemporary illness
conceptions (Brown 1995; Blaxter 1978) that together indicate how even biological evidence is
differentially interpreted based on lay perceptions, politics of disease, medical training of physicians,
and referral to scientific evidence or available treatment technologies (Aronowitz 1991). Traditional
medical paradigms are reflected in institutional constraints to the identification and management of
an emergent illness. The public health care infrastructure required to handle unexpected illness crises
lacks specification. Strategies of public non-recognition, or patterns of delay in recognizing the
legitimacy of affected groups’ claims to treatment creates a ‘doubled’ sense of suffering as sufferers
need to prove their afflictions are ‘real’ (Zavestoski et al. 2004). It can also result in sustained anxiety
and stress about everyday risk (Nettleton 2006).
Many groups affected by environmentally-induced illness create a broader conception of
disease causation and prevention in order to gain credibility and resolve anxiety (Brown 2007). Their
claims are reinforced when they form alliances with researchers and officials who share their point
of view (McCormick 2003; Brown et al. 2002). Environmental health considerations span a wider
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context of location, space and broadened responsibility (Hofrichter 2005). The “ecosystem health”
or “socio-ecological” framework provides an alternative conception to the biomedical model that
takes into account social structures, such as housing and urban infrastructures, political dimension,
like policies and institutions, and ecological processes such as agricultural change and biodiversity
(Ali 2004). Environmental epidemiologists have included four main dimensions in this framework:
geography, seasonality, individual characteristics, and access (Suk et al. 2004). Through this
approach, they detect issues related to geographic scale and affects of location, a temporal measure
that is interrelated with changes in landscape, characteristics of affected populations, and structural
dimensions of healthcare and public health systems. Since climate-induced illnesses are inherently
connected to ecological change, their causal processes, identification factors, and prevention
strategies are more effectively established through the socio-ecological framework than a biomedical
one.
Consequent Prevention
There are three important factors that shape preventive measures that happen in response to
illness crises or events. They include: (1) the effects of scientific uncertainty, (2) characteristics of ill
individuals and diseases, and (3) the role of framing in preparedness for climate-induced illnesses.
Although scientific uncertainty surrounds climate-induced illness—its definition, its prevalence, and
policies required to ameliorate its impacts-- we are able to witness science in action as new facts are
formed, implications debated and disease constituencies coalesce around shared interests (LaTour.
1994). Developing prevention measures requires establishing a muscular evidentiary base explaining
disease etiology and epidemiology. However, the geophysical processes that engender climateinduced illnesses are incompletely understood. Scientific uncertainty has played a critical role in
shaping understanding and acceptance of global warming (Ingham et al. 2007), and it has also made
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it difficult to gauge when and how illnesses emerge. Climate models represent the most ubiquitously
important type of climate research, but are themselves quite uncertain (Sundberg 2007). Applying
global models to the sub-regional level is a particularly vexing technical issue (González-Rouco et al.
1999), as is establishing a causal connection between specific environmental shifts and the incidence
and prevalence of illness (McMichael and Martens 2002). For example, the emergence of West Nile
has been linked to changes in rainfall patterns and droughts that foster proliferation of mosquitoes,
but other factors that might help determine when it will emerge are still a mystery (Epstein 2005). In
this way, scientific uncertainty plays a central role in prevention strategies, although there may be
other factors regarding professional credibility and conflicting framing that may be of equal
importance.
Uncertainty also reduces the exigency of prevention since the emergence of climate or
environmentally induced illness is difficult to predict. In addition, illness characteristics, such as
speed of onset and affected population also figure into the urgency of prevention measures. Illnesses
that develop gradually are perceived as less important than those that appear to strike with no
warning (Yassi et al. 2001). Immediate mortality captures official attention and speeds response.
Illnesses related to global warming are diverse in the speed at which they spread, their mortality and
the vulnerable populations that they are most likely to affect. Some illnesses act quickly, suddenly,
and with extreme gravity, while others take place over an extended period of time. While to date
changes in climate have largely been gradual, abrupt changes also occur that create immediate
catastrophes and public health crises (NRC 2004) for which adequate planning is impossible.
Traits of illness-sufferers, such as racial and/or ethnic background, socioeconomic status
and sex, shape levels of public attention and amount of resources dedicated to illness resolution
(Lorber and Moore 2002). Illness groups who do not have political power are marginalized in health
policy until they form networks and alliances for achieving political change (Epstein 2007). Climate-
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induced illnesses are projected to affect poor and minority communities more than others,
consequently exacerbating health inequalities. A second consequence is that those with political and
social capital are not as likely to notice the fate of the canaries in the coal mines of nearby
communities. Activists have attempted to create political constituencies to draw attention to the
multiple complexities of managing climate-induced illness. For example, the environmental justice
movement has begun to connect asthma and heat-induced illness with climate change (McCormick
2007a). Environmental justice activists who represent populations experiencing these illnesses tie
their experiences to the responsibility of polluters to reduce emissions and government agencies to
regulate more tightly (Dorsey 2007).
These constituents and a growing body of researchers have begun to create a new
framework for understanding and managing climate-induced illness. Illness framing arises in the
initial processes of diagnosis when an affected individual or group, or a medical practitioner or
professional makes decisions about the existence of an illness and how it should be treated (Brown
1995). These social actors have differential credibility to frame the illness and link disease processes
to a causal framework. Framing on the part of affected populations can be detected in illness
narratives that reflect the social and cultural underpinnings of an illness (Bell 2000; Hyden 1997).
Media sources are often also critical to public framing of emergent illnesses (Washer and Joffe 2006;
Washer 2006; Nerlich and Halliday 2007). The framing of disease is a part of its social construction
that both reflects and guides the determination of responsibility for etiology, treatment, and
prevention (Lantz and Booth 1998).
Medical framing is also often laden with social stigma that interferes with the effective
management of illness. Historical analysis of several illnesses dissects the impact of stigma on
effective treatment. AIDS was first framed as a disease that only affected homosexuals and
consequently citing responsibility for disease contraction in those populations and not others.
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Eventually, public interest on the part of those stigmatized forced a shift in research that
demonstrated the disease had a transmission process common to all humans (Epstein 1999). When
SARS emerged in New York City’s Chinatown, certain ethnic communities were stigmatized,
masking the structural causes of the disease (Eichelberger 2007).
Public discourses on climate change that bring emergent illnesses into the frame reshape not
only our understanding of ‘the impact of global warming’ but our conceptualizations of disease
causation and prevention as well. Scientists, public health experts, and the media have linked climate
change to WNV, Alaska Native toxic exposure and heatwaves to varying degrees (Patz et al. 2000).
The shift in illness framing to incorporate climate change is in part based on the production of new
scientific findings. Each of the illness cases in this project are based on claims of climate or
environmental change. Each case builds upon new research delineating the connections between the
ecological processes accompanying climate change and illness. As illness narratives represent the
ways that suffering individuals make sense of their experiences (Kleinman 1989), populations
affected by climate-induced illness may or may not make use of these emergent frames and findings.
Three Cases of Climate-Induced Illness
The proposition that climate change is increasing risk for disasters, catastrophes, and illness
is now widely accepted (United Nations 2007). The term ‘climate change’ refers not only to
temperature rise referred to by the term ‘global warming,’ but also other ecological and
meteorological processes that take place simultaneously, such as changes in rainfall or wind patterns,
melting permafrost, and altered air pollution levels. Climate change has happened slowly over time,
although sudden changes are predicted (NRC 2004), with indirect impacts on health. Since their
initial public recognition all three of the cases selected for this research -- toxic exposure to Alaskan
Natives, the Philadelphia heat wave, and West Nile Virus -- have been connected to climate change
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to varying degrees (Patz et al. 2000), with resultant varied risk projections and medical paradigms
applied to prevention. These cases have been strategically selected for their internal variaton. They
represent the range of illnesses exacerbated by climate change, show the variety of individuals who
experience these impacts, and highlight the many possible official and lay responses to this emerging
problem. Other dimensions of variation represented by these cases include, but are not limited to,
the following: levels of understanding among medical professionals and affected lay populations,
institutional awareness of the need for preparedness and organizational infrastructures capable of an
adequate response, and the interaction between geophysical processes and community ecology
fostering the emergence and awareness of new or rapidly expanding diseases.
Table 1. Differences across Cases
Disease
Vulnerable
Illness
Population
Characteristics
West Nile
Mixed; Aged Immediate
Virus
more
impact; Brief
vulnerable
illness or
mortality as
outcome
Toxic
Predominatel Incremental
Exposures
y Children;
exposures;
Native
difficult to
peoples
identify; Lifelong affects
Heat Illness
Response
Systems
Fragmented;
Local,
federal
Community
Response
Contentious
and
organized
Geophysical
Processes
Rainfall,
drought;
landuse
Research
and
monitoring
present;
Some
regulation
Multidimensional
& level
Organized
and
marginalized
Air patterns,
warming,
melting,
bioaccumulatio
n
Predominatel Short period of
Minimal
Temperature
y elderly;
exposure results
Minority and in mortality
low SES
Increases in air pollution, heat-induced illnesses, vector-borne disease, illnesses caused by
extreme weather and displacement, threatened food supplies and increased exposures to toxins are
all linked to global climate change (Parker 2007). Since the most recent Intergovernmental Panel and
Climate Change report was released in 2007 (IPCC 2007) indicating that some level of climate
change is inevitable, many government institutions, communities and researchers have begun to
promote the development of adaptation measures to prepare for these changing disease patterns.
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The cases chosen in this research project demonstrate the multiple and complex contingencies that
shape social, medical, scientific, and institutional factors in policy adaptations.
Here, I explore three cases that have recently been linked to climate change – West Nile
Virus, heat-induced illness, and toxic exposures. These case studies have been selected to vary
across several dimensions, including those listed in Table 1: the population most vulnerable to the
illness, characteristics of the illness itself, the response systems in place to deal with their emergence,
the community response to past instances of illness emergence, and the geophysical processes that
foster these diseases. Their variation is necessary in order to answer research questions regarding
illness recognition, framing and institutional response. Studying climate-induced illness crises
contributes to the small knowledge base regarding how characteristics of disasters affect
preparedness and response and answers the call for research that refines core concepts of
vulnerability and resilience to multiple types of hazards (NRC 2006).
Canaries in the Ice: Alaska Native Contamination
Climate change in frigid zones has resulted in populations being increasingly exposed to
toxins (Patz et al. 2000). Increased exposures take place through several processes such as oceanic
alterations that impact microbial agents in seafood (Rose et al. 2001), precipitation that leads to
increased freshwater toxic load (Rogers and McArthy 2000), and temperature change that magnifies
concentration of neurotoxins in food, ecosystems, and water (Parkinson and Butler 2005). In
addition, as wind patterns vary more toxins are deposited in the northern global zones (Suk et al.
2004). These new exposures result from coal-fired power plant emissions in other parts of the world
such as Canada and the United States (Miller 2000). Increased exposure also takes place as organic
pollutants stored in frozen sediment are released with warming (Tenenbaum 2005). Although they
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are already common in many areas, the impact of these diverse sources of exposure are neither well
understood nor monitored.
The metaphor of the “canary in the mine” can be applied to Arctic communities already
suffering from climate impacts. The fate of these communities serves to alert the rest of the global
community to expanding illness outcomes. Warming has increased more for the Arctic than the rest
of the globe, with temperatures rising an additional 3-4 degrees in that region rather than the global
1 average (IPCC 2001). As permafrost on which inhabitants live melts, the ecological conditions
upon which communities and their traditional ways of life are built are uniquely sensitive to this rise.
Alaska Natives have the highest toxic burden of heavy metals of any population, which
demonstrates their consistent exposure to toxics (Tenenbaum 2005). Historically, the exposure to
heavy metals has been a consequence of a diet rich in animals high in the food chain (Van Oostdam
et al. 1999) and exposure to local toxic waste or military sites. The fat of large marine and Arctic
animals is replete with bioaccumulating chemicals that are then passed on to Native consumers.
Levels of contamination have resulted in neuro-toxicological problems, especially in children
(Schwartz et al. 2000). Problems include immune suppression, slowed hand-eye coordination, and
impaired speech developed Climate change is introducing ecological shifts that increase toxic
exposure (Hinzman et al. 2005).
The formation of the Arctic Monitoring and Assessment Program in 1991 initially addressed
concerns regarding Native exposure to toxic substances. The international Arctic Council
commissioned it to evaluate exposure levels (AMAP 2002). Soon after the program’s inception,
several Native organizations were founded in the state to address exposure to persistent organic
pollutants (POPs) and other environmental and health problems. In the late 1990s and early 2000s
concern arose among these communities that climate change might be an important factor in
increased levels of health risk to the community. Even more recently, increased funding for research
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on climate change has stimulated greater interest on the part of both public officials and community
members to assess and deal with these processes. Despite rhetoric attesting to an increased interest,
governmental recognition of or response to contamination has largely been limited to the formation
of new research centers. Government agencies themselves have claimed that even broader impacts
of climate change, like displacement, are not being adequately addressed (GAO 2003). Disjuncture
between government institutions, lack of resource allocation, and difficulty diagnosing these illnesses
contributes to a growing crisis for these communities. However, the recently burgeoning body of
scientific evidence supporting a link between climate change and toxic contamination is increasing
concern outside of affected communities.
Heat-Induced Illness in Philadelphia, Pennsylvania
With an increase in global warming, extreme heat events, otherwise referred to as heatwaves,
are forecast to increase (IPCC 2001). In the United States, heat and cold-related illnesses have
become a major focus (EPA 2004) due to their salience in many areas around the country. There is a
consistent relationship between heightened mortality and extreme heat (O’Neill et al. 2005).
Approximately 400 people die of heat-related illness in the United States each year, and this number
is projected to rise dramatically with climate change (Bernard and McGeehin 2004). In the years
1979-2002, cumulative mortality due to heat was higher than floods, tornados, hurricanes, lightning,
and earthquakes combined (CDC 2005). Heatwaves lead to poor health through two main pathways.
Extreme temperature rise leads to heatstroke, while cardiopulmonary problems and respiratory
illness are linked to shifts in air pollution concentrations (Bernard et al. 2001). Ground level ozone
concentrations augmented by high temperatures results in air quality alerts and aggravates a number
of diseases. Extreme heat events differentially affect populations based on their race, gender, age
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(Diaz et al. 2002), and medical and socioeconomic status (McGeehin and Mirabelli 2001),
consequently raising concerns about health inequalities.
Philadelphia is projected to be the city with the most deaths due to warming by mid-century
(Ball 2007). This problem was first recognized in 1993 when a spike in 118 excess deaths was caused
by weeks of extreme heat (Hawkins-Bell and Rankin 1994). At that time, several influential
government officials reconceptualized the definition of heat-induced mortality from over 104 body
temperature to focus instead on the social structural environment in which the individual was
discovered (Moran 2007). The original definition was considered inadequate when government
officials claimed that many deaths were going unreported since body temperature fluctuated too
quickly to be an accurate measure of heat exposure. This shift from the micro to macro-level model
for diagnosis changed the perception of mortality trends, and has expanded concerns about heat
preparedness. This definition was consequently translated to other urban contexts through the
publication of Philadelphia’s heat-preparedness plan.
The Philadelphia plan is a ten-part program that has been economically beneficial and touted
as the most effective in the world (Ebi et al. 2004). The primary components are measurement of
temperature and air mass, alerts sent to the public, and the implementation of social programming
for vulnerable communities (Sheridan 2006). The plan has incorporated existing social capital by
utilizing a “block captain” system where local leaders are asked to notify community members of
dangerous heat. This is a particularly important measure in urban minority communities that are
more impacted by extreme heat events more than other groups and where the elderly lack the social
networks critical necessary for ameliorating potentially threatening situations (Klinenberg 2002). The
easily identifiable geophysical processes that lead to heat-induced illness, their immediate and
potentially fatal nature, and changing scientific definitions have contributed to preparedness efforts
20
in this case. Outside of the government interventions or collaborations, there has been minimal
community-based response.
West Nile Virus in New York, New York
Vector-borne illnesses have re-surged as a global health issue (Gubler 1998) and are
projected to increase in geographic reach and severity as temperatures increase (Reiter 2001;
McMichael et al. 2006). As seasons lengthen, mosquitoes and other vectors begin to inhabit areas
previously free from such vectors of transmission. Shifting weather patterns are also a factor. For
example, climate change causes more extreme weather patterns, such as drought followed by heavy
rainfall (Doyle et al. 1999; Patz et al. 2000). Standing water creates habitation for mosquitoes. A
range of vector-borne illnesses has been linked to climate, including malaria, dengue, Hantavirus,
Bluetongue, Ross River Virus, and cholera (Patz et al. 1996). These and other vector-borne diseases
are projected to increase mortality as the climate warms. The emergence of new disease is
accompanied by stigmatization and racially-based claims-making about causes (Rosenthal 2007) that
reflect the social construction of these ecological and biological processes.
West Nile Virus (WNV) has historically been endemic to Africa, but appeared in New York
City in 1999 engendering local concern and a public health response (Nash et al. 2001; Lopez 2002).
Local governments sprayed pesticides and distributed 300,000 cans of DEET to cut down on the
number of mosquitoes, the vector for the disease (Asnis et al. 1999). Resultant exposures were later
argued to potentially harm humans, wildlife and hydrological resources (Sharpe and Irvine 2004).
Communities in which outbreak occurred were divided on how to enact preventive measures; while
some fully supported wide-scale spraying of pesticides, others were concerned about possible
toxicity issues (Tickner 2002; Brown et al. 2002b). In the United States, health care practitioners and
communities in areas where new vector-borne diseases emerge lack knowledge of these illnesses or
21
how to prevent them. The lack of current expertise is the unhappy consequence of past success:
such diseases have not been seen in the United States for many decades. Most vector-borne diseases,
like malaria that mainly inhabited the southeast, were eradicated by the 1930s (Sachs and Malaney
2002). Public health officials have ‘a poor sort of memory’ recalling past effective measures (Stevens
1982).
Initial research into WNV has demonstrated the complexities of human response to new
illness and diagnosis without addressing the next step of prevention (Weick 2005). Future planning
is complicated by scientific uncertainty. The emergence of West Nile has been linked to changes in
rainfall patterns and droughts that foster proliferation of mosquitoes, but other factors that might
help determine when it will emerge are still a mystery (Epstein 2005). While there is some certainty
in the impacts of climate change on these rainfall patterns, this link is largely difficult to establish.
Diffuse geophysical processes, obstacles within responsible agencies and lack of training have
resulted in framing of WNV as “mysterious” and controversy over prevention methods.
Conclusions
Studying these illnesses as socially constructed and contested categories reveals the ways in
which medical paradigms and institutions intersect in the management of climate change outcomes.
While this research demonstrates that new types of awareness and investments need to be made in
the management of these illnesses, there are several possible broader social consequences that may.
While not all consequences can be foreseen, two that can be identified at this time include the
creation of new “at-risk” communities, and a shift in focus from climate mitigation to adaptation. As
certain communities or geographic areas are identified as “at-risk” to new illnesses, stigma and
prejudices may be attached to these groups (Eichelberger 2007). As Petryna (2002) explains in the
case of Chernobyl survivors, there were demands for “biological citizenship” which would provide
22
social welfare based on medical, scientific and legal criteria. Obtaining these benefits provided
otherwise inaccessible illness management. Legitimacy for engagement with political actors and
processes is determined in part by the biological processes that groups experience (Rose and Novas
2002). While need for services and legitimacy may drive the adoption of certain risk identities, they
may also cause new forms of stigma (Zota 2006). For example, Native groups have had historical
stigma and racist preconceptions attached to them which could be complicated by new illness
diagnoses (Ohenjo et al. 2006).
Second, developing adaptive capacities for climate change by dedicating resources to
preparing for climate-induced illness could lead to decreased attention to or resources for climate
mitigation. The vast majority of action around climate change has been dedicated to mitigation, with
a focus on reduction of greenhouse gas emissions or the development of carbon “sinks” that can
trap the chemicals causing global warming. An alternative to mitigation is a focus on adaptation.
Adaptation is the “reduction in vulnerability to climate change (Burton et al. 2002:146)” and can
involve any number of activities such as developing projections of future disease burden, planning
illness prevention strategies, and improving health care infrastructure. Groups that concentrate on
mitigation have argued that if efforts are directed to adaptation, mitigation will be undermined.
Alternatively, illness experience may be a way to engender more dedication to mitigation through the
recognition of climate impacts on human populations. This is exemplified by environmental justice
responses to climate change that acknowledge the need to address climate-induced illness, and based
on existing impacts, argue for mitigation as well (McCormick 2007a).
Ultimately, no matter what the costs of recognition and debate over climate-induced
illnesses, this process is likely to continue with a variety of social, medical and legal ramifications. As
other researchers reveal the rates and causes, social scientists have a responsibility to assess the
contexts in which emergence and management occurs. Only with this information can policy-
23
makers have effective response to what has been cited as the most pressing public health issue of the
twenty-first century.
24
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