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Climate change is affecting all corners of the world, but historically marginalized communities are disproportionally bearing its health and economic consequences. Gaurab Basu, a physician with the Cambridge Health Alliance and a health equity fellow at the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, discusses how a legacy of racist policies in the U.S. have left communities of color ill-prepared for climate change and why applying a racial justice framework to climate action is instrumental to overcoming these challenges and closing the equity gap.

Q: How do you see issues of climate change and racial justice intersecting?

A: I believe deeply that climate change is fundamentally an issue of racial justice. To understand the intersection of the two I look to history and think about how decisions were made that enabled structural racism. One definition of racism that I like to start with comes from Camara Jones,  a physician and epidemiologist at the Morehouse School of Medicine. She defines racism as a system of structuring opportunity and assigning value based on the social interpretation of how one looks. She further adds that structural racism enables systems that unfairly disadvantage some individuals and communities, unfairly advantage other individuals and communities, and sap the strength of the whole society through the waste of human resources.

When I look back at history through that lens, I can see that a lot of decisions that enabled structural racism were made through bad policy, through racist policy that are deeply embedded in our society now. Redlining, the New Deal–era federal policy that encouraged banks not to invest in communities of color, is a great example. That was policy that structured opportunity for some by taking away opportunity for others.

The impacts of climate change follow the same fault lines of injustice. Why is it that we find fossil fuel infrastructure disproportionally in communities of color? We cannot simply say that racist policies were made in the past. Structural racism is still at work. Dirty fossil fuel infrastructure has not been removed from communities of color and, in fact, more dirty infrastructure has been built in those communities. As a physician, this matters to me a lot because it is my patients who are exposed to air pollution and severe heat, which increases the risks of heart attackschildhood asthmapremature labor, and low birthweight among newborns. My patients, and others like them, also have their financial security threatened by the disproportionate risks of flooding and damage to their homes associated with climate change.

We have to challenge ourselves to ask painful questions about our history and reckon with the hard fact that in some communities we didn’t prioritize the health of people and children. We have to be honest with ourselves; we mostly didn’t put that fossil fuel infrastructure in wealthier or whiter communities.

Q: What are some of the long-term health and environmental outcomes of racist policies that concern you and how do we start undoing their effects?

A: Let’s look again at redlining, a practice that was in place for 34 years. The lack of investment for that span of time meant that communities of color didn’t get investment which likely would have created vibrant public spaces—parks, tree canopies, and other green infrastructure, and so now these communities are significantly hotter and residents are at an increased risk for heat-related illnesses. Research led by Jeremy Hoffman, chief scientist at the Science Museum of Virginia, shows that formerly redlined neighborhoods are on average 2.6 degrees Celsius hotter than nonredlined neighborhoods in the U.S., and sometimes the difference is as much as 7 degrees Celsius. That’s a significant difference and it has major health impacts.

Communities of color also bear a disproportionately high burden of air pollution. And studies have found that individuals who have had chronic exposure to fine particulate matter, or PM2.5, are more likely to die if they get infected with coronavirus.

To start addressing these issues, we need to have a restorative justice framework guiding our work on climate change. We must look at communities that have been disproportionally impacted by environmental injustice and economic injustice and think about climate solutions that can help undo that historical harm, whether it’s building better and more affordable public transportation, increasing tree canopies, developing climate resilience projects, or removing dirty fossil fuel infrastructure.

We also need to look globally, where cycles of poverty and illness are exacerbated by the climate crisis. I work with a nonprofit called the Child in Need Institute (CINI) in West Bengal, India that works painstakingly to support rural villages along the coast of the Bay of Bengal with child nutrition and education programs. With increasing frequency, places like West Bengal and Bangladesh are being hit by severe cyclones like Cyclone Amphan, which hit in the middle of the COVID-19 pandemic. Such natural disasters have created unimaginable suffering, and we can expect the impacts of severe weather to increase in developing countries as the planet continues to warm. As workers from organizations like CINI help communities recover from natural disasters, they are seeing profound disruptions to the progress made on important health outcomes, such as improved child nutrition and access to clean water, and they worry these problems will get worse when the next natural disaster strikes.

The local and global impacts of climate change must push us to work with great urgency to get to net zero emissions. The good news is that we have a tremendous opportunity to build a healthier future. Acting on climate change is a benefit multiplier that releases a cascade of health benefits and improves health equity in profound ways. In that sense, climate action is racial justice.

Q: There’s been a lot of discussion about how COVID-19 has changed how people think about climate change and climate action. What’s your perception?

A: For many of us, COVID-19 has highlighted the need to promote bold climate action.

In the early part of the pandemic, we saw a dramatic decrease in air pollution and greenhouse gas emissions. This has helped raise some important questions about whether people need to drive into their offices every day, which causes transportation emissions, and whether we need to use large buildings that have their own emissions. Perhaps instead, we can reimagine our built environment. Can we, for instance, take some of our roads and transform them into public spaces with active transportation infrastructure such as protected bike lanes and walking space, which are interventions that improve individual health and the health of the planet simultaneously?

I should point out that many of my patients are essential workers and didn’t have a choice of going into work during the surges of COVID-19 cases. As a primary care physician who’s one of the clinical leads of our COVID-19 community management team, it has been really hard to see the ravages of this pandemic. At a deeper level, COVID-19 taught us that we must confront the converging crises of our time—not just a pandemic, but racial justice, income inequality, and the climate crisis.

It’s also critical to recognize that COVID-19 is a zoonotic disease, coming from animals. I believe the most critical piece to pandemic risk mitigation is fundamentally changing practices like deforestation and runaway agriculture. We must sustain the ecological buffers that mitigate the risks of these viruses spilling over into the human population.

Q: How have you seen public perception of climate change evolve in recent years?

A: People are now seeing more clearly how the health of their communities is being harmed by more days of severe heat and more pollution. People are now seeing the connections between increased cycles of flooding and drought where perhaps they weren’t previously making the connections between extreme weather and climate change.

As a result, our sense of urgency to act has increased dramatically over the last few years. Climate change became a top voting issue in 2020. And I credit the youth movement for that. What brings a lot of us together is a commitment to intergenerational justice and a sense of responsibility that we need to be stewards of this earth so that our children can be healthy and thrive.

Q: Climate change, racial justice, COVID-19—these are all big, complex challenges. Do the problems we’re facing ever feel overwhelming to you?

A: The climate crisis is a big, all-encompassing, and interconnected problem that touches every facet of human society and human health, so it’s natural to feel overwhelmed. As a doctor and a parent, I too can feel scared.

But these days, I am mostly motivated by a picture of the world we can create together. A world in which climate action improves so many of the deeper structural barriers that have caused health inequities and structural racism. We have to stop burning fossil fuels. But thanks to the miracle of human innovation and creativity, we have solutions that can help stabilize our climate, clear our air, and keep my patients out of the hospital and allow them to thrive. I picture clean energy systems, great public transportation, healthier food systems, and a fundamentally better relationship with nature. We have to recognize our interconnectedness and our common humanity. We have everything we need to replace the systems that have caused harm with systems that heal. Investing in our planet and acting boldly on climate change is at the center of how we can transform our society, take better care one another, and take joy in watching everyone have better health and thrive.

– Chris Sweeney

Reprinted from Harvard Chan News, April 9, 2021


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Gaurab Basu

Gaurab Basu MD, MPH

Gaurab's work focuses on the intersection of climate change, health equity, medical education, and advocacy.

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Dr. Renee Salas

Renee N. Salas MD, MPH, MS

Renee's work focuses on the intersection of the climate crisis, health, and healthcare delivery.

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