Facilitating Climate Justice through Community-Based
Adaptation in the Health Sector
Kristie L. Ebi
ABSTRACT
Climate change presents real risks to human health, with the impacts unevenly distributed because of
biogeophysical factors and population vulnerabilities. Although everyone is at some level susceptible to the
health consequences of changing weather patterns and alterations in the geographic distribution and inci-
dence of climate-sensitive health outcomes, there are populations and geographic regions that have en-
hanced vulnerability. Low-income communities and communities of color are disproportionately
represented in vulnerable groups, which include the elderly, pregnant women and children, those with
chronic medical conditions, people with mobility and cognitive constraints, and the urban and rural poor.
Public health interventions designed and deployed in conjunction with these groups and other relevant
stakeholders increases individual and community acceptance of, and the success of, the intervention, along
with reducing constraints to implementation. Community-based adaptations that address the societal,
cultural, environmental, political, and economic contexts that increase vulnerability enhance community
resilience to climate change as well as other stressors, providing multiple benefits. Instead of creating new
mechanisms for implementing community-based adaptation, there are multiple opportunities for aug-
menting current programs to address the health risks of climate change. One possibility is to build on
Healthy Cities or Health in Cities programs.
INTRODUCTION
Climate change presents real risks to humanhealth in the U.S. and worldwide (Confalonieri et al.
2007; Ebi et al. 2008). Health impacts of climate change
will arise from increases in the frequency and intensity of
extreme weather events, including heat waves, floods,
droughts, and wildfires; from food-, water-, and vector-
borne diseases; from the health impacts of poor air quality
due to increases in the concentration of ozone and pollen;
and from the health impacts of alterations in food systems
and food supply in some regions. Changing patterns of
health burdens are expected to challenge the ability of
public health institutions and organizations to maintain
the same level of population health, partly because the
impacts will be unevenly distributed due to biogeophy-
sical factors and population vulnerabilities that arise from
societal, cultural, environmental, political, and economic
factors (Confalonieri et al. 2007; Ebi et al. 2008; Haines
et al. 2006; McMichael et al. 2004).
Although everyone is at some level susceptible to the
health consequences of changing weather patterns and
alterations in the geographic distribution and incidence of
climate-sensitive health outcomes, there are populations
and geographic regions that have enhanced vulnerability.
Low-income communities and communities of color are
disproportionatelyrepresentedinvulnerablegroups,which
include the elderly, pregnant women and children, those
with chronic medical conditions, people with mobility
and cognitive constraints, and the urban and rural poor
(Balbus and Malina 2009). Social justice can be addressed
within policies and measures designed to increase the
resilience of these groups.
Successful adaptation to climate change will require
implementation of specific policies and measures to man-
agenewandchangingclimatic conditions, aswell as actions
to address underlying population vulnerabilities. Ensuring
that communities are partners in identifying, prioritizing,
implementing, and monitoring adaptation options will
enhance their likely effectiveness. Community-basedDr. Ebi is President at ESS, LLC in Stanford, CA.
ENVIRONMENTAL JUSTICE
Volume 2, Number 4, 2009
ª Mary Ann Liebert, Inc.
DOI: 10.1089=env.2009.0031
191

adaptation engages stakeholders in a proactive problem
solving process that enhances social capital, which in-
creases resilience to a wide range of stressors in addition
to climate change.
COMMUNITY-BASED ADAPTATION
The focus of public health responses to climate change
in the United States has been on interventions that are the
responsibility of national and state public health agencies,
such as developing and deploying early warning systems
for heatwaves and other extreme weather events, and im-
proving the quality and extent of surveillance and control
programs for infectious diseases (Ebi 2009; Frumkin et al.
2008; Jackson and Shield 2008). However, public health
interventions may not address the root causes of vulner-
ability (such as fear of crime in older adults that results in
windows remaining closed during a heatwave), and
generally have been less effective in populations with a
lower socioeconomic status (Beaglehole 1990). In addition,
interventions are not implemented in all regions (i.e., not
every city has an operational heatwave early warning sys-
tem, and surveillance programs for vectorborne and other
diseases are not equally comprehensive). Although these
interventions are critical, they will not be sufficient to
protect the U.S. population from the health impacts of
climate change.
Engagement of individuals and communities is needed
to ensure that messages designed to reach vulnerable
groups provide the information and motivation necessary
for individuals to make appropriate choices. For example,
obesity, in addition to its other health implications,
increases the likelihood of suffering adverse health con-
sequences during a heat wave (O’Neill et al. 2003).
Therefore, public service announcements and other inter-
ventions during heatwaves should be developed and
tested specifically for the obese; single messages will not
serve all vulnerable groups equally (Ebi and Semenza
2008). Working with stakeholders can help ensure indi-
vidual and community acceptance of, and the success of,
the intervention, along with reducing constraints to im-
plementation (Lim et al. 2005). Interventions that help
address the societal, cultural, environmental, political,
and economic contexts that increase vulnerability are
potentially very efficacious (Bentley 2007). Engaging
communities in this broader process of adaptation will
not only enhance their resilience to climate stressors, but
will likely provide a wide range of other benefits.
Effective community-based adaptation increases social
capital, which is the potential embedded in social relation-
ships that enables residents to coordinate community
action to achieve sharedgoals, suchas adaptation to climate
change (Bourdieu 1986; Coleman 1988). Ebi and Semenza
(2008) developed a framework (Figure 1) for facilitating
community-based adaptation to the health impacts of cli-
mate change, with each step designed to enhance compo-
nents of social capital.
Ideally, individuals, communities, and government
will work together to ensure the broadest support for
adaptation activities. The steps are:
1. Community outreach to determine the broad project
outline based on concerns of the possible health
impacts of climate change.Adaptation options should
be designed to reduce the current health impacts of
climate variability and change, taking into consid-
eration how these impacts are likely to change with
increasing climate change—and should be designed
to increase social capital so that the neighborhood or
community will have greater resilience to deal with
stressors other than climate change. Because many
communities face multiple risks, it is important to
conduct outreach activities to vulnerable popula-
tions to identify the risks of highest concern, such as
increased mortality from heatwaves, increased
flooding events, poorer air quality, or increased
threat of climate-sensitive infectious diseases. The
outreach should be as specific as possible to help
identify effective interventions. For example, in com-
munities where there are significant numbers of
grandparents raising their grandchildren, interven-
tions during a heatwave will need to do more than
communicate the risks to adults; there also should be
outreach to teachers and school children so that they
understand the warning signs of heat stress and how
to effectively intervene. Outreach may require edu-
cation of vulnerable populations about the risks of
climate-sensitive health outcomes and actions to take
to reduce adverse impacts.
2. Conduct a situational analysis to describe commu-
nity needs and constraints to adaptation, as well as
to assess factors that could influence vulnerability,
such as social inequities. The characterization can be
qualitative (i.e., the health burdens are small, inter-
mediate, or large) or quantitative (i.e., based on
model projections of the health impacts of climate
change). The degree to which health impacts will
occur depends as much on local factors as on pro-
jected changes in temperature, precipitation, and
other weather factors. The same extent of flooding in
one region can have significantly different impacts
than in another region; the differences depend on the
degree of community and individual preparedness,
the status of infrastructure, etc. The situational anal-
ysis also should describe institutional considerations;
i.e., are the community leaders concerned about cli-
mate change impacts? How credible are the commu-
nity leaders? Are there the necessary organizations
and institutions for taking action? How effectively
have social inequities been addressed in other pro-
grams? Understanding the local context is a critical
step in developing adaptation options.
3. Map community assets, including financial and
human resources, individuals whose expertise and
talent could support adaptation activities (colleges
and universities; national, state, and local agencies;
non-governmental organizations, etc.), and other rele-
vant factors. The purpose of this step is to identify
what the project will have to work with, including not
only the financial resources but also the people who
can be called upon to develop and support adaptation
192 EBI