Exploring the health impacts of climate change: Challenges and considerations for health services research

Unofficial AI-generated summary based on the public title and abstract. Not an official translation.

🔬研究者:Researchers can gain an overview of methodological pitfalls (exposure definition, data gaps, harvesting effect) when studying climate-related health outcomes.

🏛政策担当者:Policymakers should note the complexity of attributing health impacts to climate change, informing realistic targets for climate resilience in public health.

The United Nations has declared a state of climate emergency regarding the unmitigated effects of global climate change, in large part due to its impacts on human safety and well-being.1 While climate scientists have worked to develop a deeper understanding of the influence of global warming on the environment, exploration of the human health dimensions are ongoing. One particular area of growing investigation is that of climate change's impacts on health services and outcomes. Indeed, the issue has been deemed critical enough such that the Agency for Healthcare Research and Quality (AHRQ) convened a roundtable discussion with the Department of Health and Human Services (HHS) in 2023 on the subject of measuring climate resiliency for healthcare delivery organizations.2 Underlying the relationship between environment and health are a series of methodological questions about how best to develop assessments of these relationships for exploring health services outcomes. The National Institutes of Health have also been working with stakeholders and the scientific community to create a strategic framework upon which to evaluate climate outcomes combined with an institute-wide initiative into this field. The goal of this endeavor appears to be reducing health threats from climate change by examining how climate drivers lead to populations being exposed to new environmental factors while identifying the health outcomes of these conditions, and also addressing the socioeconomic context within which these problems occur.3 Health services researchers are, and will continue to be, playing a major role in such efforts. In this commentary, we highlight three different manifestations of global warming: extreme precipitation events, wildfires, and heat waves, as illustrative examples of the challenges they can pose for health services researchers. For each of these phenomena, we briefly review what is known about their climate links and their relationship with human health, then provide some methodologic considerations in examining their effects on health systems and outcomes. While not a comprehensive review of the myriad ways in which our changing climate is impacting our well-being, we hope this discussion provides some points for contemplation among investigators and policymakers in this growing scientific field. Perhaps the most visible manifestation of climate change for the United States has been that of extreme precipitation events, chief among them worsened hurricane and storm seasons. Rising global temperatures are elevating surface ocean temperatures, resulting in more intense and extreme precipitation events: storms have presented with higher total rainfall, more powerful winds, and more severe storm surges.4 In addition to stronger sea-based storms, climate change is also affecting inland storms through fluctuant temperatures, leading to dangerous anomalous phenomena such as off-season tornadoes, polar vortexes, and precipitation-associated flash flooding.5 These natural disasters can have significant health impacts in a variety of ways. Traumatic injuries and deaths frequently follow their physical devastation, as has recently been tragically demonstrated by the death toll of Hurricane Helene in the eastern United States, with over 220 mortalities and rising at this time of this writing.6 Yet exposure to these weather events has also been found to be associated with lingering long-term health impacts at the community level.7 For example, studies conducted in New Orleans have shown that hospital admissions for heart attacks at the Tulane Medical Center increased threefold in the decade following Hurricane Katrina.8 These were found to be accompanied by a significant rise in key risk factors for cardiovascular disease such as high blood pressure, diabetes, elevated cholesterol levels, and tobacco smoking.8 In addition, mental health crises from sustained emotional trauma, stress, difficulty accessing resources, and a host of other healthcare delivery complications can create lasting medical problems during natural disasters.9 Regrettably, such weather catastrophes are not limited to the warm weather months. Winter blizzards and colder snaps have been shown to cause a rise in cardiovascular emergencies, with lower temperatures and large-scale temperature swings being correlated to increased heart attack and stroke rates.10-13 While anomalous weather events have the potential for massive impacts across large populations (there are currently more than 126 million people in North America living in regions at risk for a major hurricane), and discrete disasters are easy to define, measuring their resultant harms can be challenging.14 Such disasters can have destructive effects on healthcare infrastructure, forcing patients to divert to other health centers or to forgo scheduled appointments. Regional registries or hospital-based medical records may thus have interrupted or missing utilization data (particularly if power outages or evacuations limit primary data collection). Additionally, regional and national medication and medical supply shortages can have ripple effects, impacting the quality of care even at distant health centers. Finally, as noted previously, it is becoming increasingly obvious that the medical sequelae of major natural disasters can persist for years, and it is unknown if they may even compound over multiple severe storm seasons. Patients often forgo necessary healthcare during disasters, and attributing elevations in adverse outcomes to the weather event can be challenging, as it involves disentangling true exposure-related effects from delayed usual presentations, impacts of delaying needed care, and the so-called “harvesting effect.” The last of these refers to a known epidemiologic phenomenon where anticipated deaths among chronically ill individuals are displaced forward in time by natural disasters, implying that some of the acute mortality burden following such events represents an acceleration of expected fatalities rather than those directly attributable to the disaster.15 Changes in maladaptive behavior in the wake of traumatic events can also be notoriously difficult to measure in vulnerable populations, particularly when there is subsequent migration away from the site of such injuries due to loss of housing or employment. The resultant compositional change could also introduce bias in community-level estimates of outcomes, necessitating careful risk adjustment. Lastly, we wish to emphasize that extreme precipitation events are not equivalent to the concept of climate change, as seasonal high-risk environmental threats such as hurricanes predate anthropogenic global warming. Rather, they are exacerbated by man-made greenhouse gas emissions, and as such, ascribing what fraction of the health impacts from a series of disasters can be directly attributed to the broader phenomenon of climate change is an ongoing field of debate and investigation.16 Regional wildland fires have become the face of climate change for much of Western North America, and their increase in frequency and severity have been tied to global warming and resultant changes in precipitation patterns.17 Recent US Environmental Protection Agency reports demonstrate that the annual extent of land burned by wildfires in the United States has increased since the 1980s, with the 10 most severe years (by total acreage burned) occurring since 2004.18 While wildfires can directly harm individuals in close proximity and destroy local infrastructure, the main threat they pose to human health is through resultant smoke plumes that contain an extraordinary collection of hazardous air pollutants. Such plumes may contain particulate matter, ground level ozone, carbon monoxide, nitrogen dioxide, and polycyclic aromatic hydrocarbons, among other dangerous airborne pollutants.19 Wildfire smoke and its component toxins can be carried for thousands of miles, impacting communities far from the site of the original fire.20 Exposure to these air pollutants has been linked to adverse health outcomes including short-term cardiovascular and respiratory events, chief among them pulmonary disease exacerbations such as asthma and reactive airway disease.21, 22 Short-term health outcomes have been measured from a variety of data sources including mortality registers, crisis line utilizations, hospital admission and billing records, emergency department visits, among other measures.23-25 Long-term impacts are harder to quantify, but associations between wildfires and poor birth outcomes and negative psychological impacts are likely to have far-reaching implications.23, 26-28 Despite this rapidly growing body of investigation, measurement of the health consequences of wildfires has been difficult, particularly in exposure definition. Health services researchers have defined wildfire exposure in a number of ways, including the National Oceanic and Atmospheric Administration's venerable hazard mapping system (consisting of satellite imaging of smoke plumes), ground-level regulatory air pollution monitors, nonregulatory investigative monitors, and air pollution models of varying complexity.29, 30 Fire smoke plumes can behave erratically and are highly dependent on local atmospheric conditions (e.g., temperature; humidity; and presence, speed, and direction of wind).31 Thus, even communities near major wildfires may not experience high air pollution days if the wind is blowing away from their location (conversely, those downwind may be heavily impacted even if further afield from the epicenter of the disaster). In fact, a recent study from our group identified that those living 150 km or further away from wildland fire centers may suffer greater mortality risks from long-term wildfire smoke exposure.32 Concurrently, rapidly changing wind patterns can quickly shift affected areas on daily and hourly bases, making individual exposures difficult to ascertain

• openalex https://pmc.ncbi.nlm.nih.gov/articles/PMC11782064/first seen 2026-08-02 17:04:07