Lightening the Load: Combatting Stressors Due to Climate Change & Social Determinants of Health

October 20, 2021

Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous podcasts here.

Poverty. Violence. Environmental disasters. The stress from living with these challenges can have physiological impacts on those who must endure them. In this episode of The Intersect, Abt’s Lisanne Brown and Karen Carney discuss how we can use data to identify the communities that most need support to mitigate the allostatic load created by these stressors.

Read the Transcript

Eric Tischler: Hi and welcome to The Intersect; I'm Eric Tischler. Abt Associates tackles complex challenges around the world, ranging from improving health and education, to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening, and maybe even fun, to pair up colleagues from different disciplines so they can share their ideas and perhaps spark new thinking about how we solve these challenges. Today I'm joined by two of those colleagues, Lisanne Brown and Karen Carney.

Lisanne has more than 20 years of experience in public health and environmental assessment and evaluation. Her areas of expertise include disaster preparedness and response, health care, access, community centered health, and the integration of primary care and behavioral health. Karen is an ecosystem ecologist with more than 20 years of experience developing and implementing analytical efforts focused on understanding, mitigating, and adapting to the impacts of climate change. This work has been cited in and influenced the EPA's national climate assessment.

Welcome!

Lisanne Brown: Hi Eric!

Karen Carney: Hi, thanks.

Eric: Poor nutrition, poverty, crime. These challenges are disproportionately faced by low income communities and people of color, and the cumulative weight of these challenges has an impact on health, but these same communities also are often the first to suffer the effects of climate change. How can we help address both the socioeconomic and climate related impacts that are weighing on these communities? Lisanne, I'm going to start with you first by asking you to explain allostatic load. Because that's what we're talking about. Right?

Lisanne: Right. Thanks Eric. So allostatic load is the wear and tear on the body, which accumulates with repeated exposure to chronic stress. And this can include violence, poverty, poor health, and it causes physiological consequences, and can have significant impacts on health, including coronary heart disease, as well as other causes of mortality. In New Orleans, where I worked for many years, we saw that communities, especially in inner city New Orleans, suffered from high crime, poor access to healthcare, food desert--so they didn't have access to good food. And then on top of it, live in a disaster zone that's constantly at risk of hurricanes and other natural disasters, which adds to the stress. So for example, we recently experienced Hurricane Ida, which had just a devastating impact on coastal Louisiana, including communities that are already suffering from multiple stressors.

Eric: So, Karen, that's a great segue to you because adding to the challenges of allostatic load then is climate load. And you want to explain that term for us?

Karen: Sure. So people facing the highest allostatic loads, which essentially means, again, as Lisanne said, people facing the highest cumulative stress from the environment, everyone facing those high loads are also those who are the most likely to face the most intense impacts from climate change. And that's the climate load. So, storm related flooding most often happens in low value real estate areas in poor neighborhoods. Intense heat is often the worst in really tightly packed urban areas and, and wildfire can make existing health conditions, like diabetes or pulmonary conditions, worse because you're exposing people to particulates in the air, which can make those conditions flare up. So climate load, this kind of cumulative impact from climate actually adds to allostatic load, making it worse and making the stresses on the cumulative stress that these people are facing worse as well.

Eric: So how can we address these accumulating stressors?

Karen: Well, understanding where climate load will be the worst for these people can really help target interventions to help people mitigate or lessen the impacts of both climate change and these allostatic stressors. So for example, if we know where extreme heat is going to be the worst and where that intersects with high poverty and reduced access to cooling centers or healthcare, we can better target programs that are meant to mitigate potential impacts of heat, like through the creation of cooling centers that can prevent heat related death and illness. Similarly, if you think about how to help the people that are the most vulnerable to wildfires, knowing where those wildfires will be most intense, where the people that are the most vulnerable to smoke related illnesses are, you can better target your interventions in terms of evacuating people from areas when you know wildfires are going to occur.

Eric: And Lisanne, let me pose that question to you too.

Lisanne: Sure. I think to piggyback on Karen, what we really need is more local data at even a neighborhood level or, in some cases, we have zip code level, but to really be able to target any particular programmatic or policy interventions to address these conditions requires local data, which at the moment is lacking in many areas. We do have some information on food deserts and where healthy food is available. We have the area deprivation index, but we really need more information to be able to better address the combined allostatic and climate load.

Eric: I'll put in a plug for our work with EPA, our own TJ Pepping did a blog recently, explaining how tools we make for EPA can help us identify where some of these environmental stressors are. So it sounds like if we could corral the data that we have, we could get somewhere.

Lisanne: It would be a good start.

Eric: Yeah. And speaking of, sort of that localized information Karen, you're working in New Mexico on similar work, right?

Karen: Yeah. We're starting to, to try and really think from that local perspective with, again, as you said, a tribe in New Mexico and they have a particular challenge on their plate and that's that they are located right next to a contaminated site next to Los Alamos natural national laboratory, where there's a lot of radioactive materials. And what we started to look at with the tribe, we had been doing some health risk assessment work to understand their potential exposure to these contaminated materials in through soils and through ash that's deposited into their Pueblo. And one of the things we wanted to understand better was how climate change might actually make their health risks worse. And the way that would happen is radioactive materials could be transported into the Pueblo during intense rainfall events, that transport soils that are contaminated with this material into their Pueblo, where they fish, where they grow food, or during wildfires. Wildfires burn vegetation that has radioactive material in it, and that can be deposited into the community.

So, for them, we created a kind of climate load index that helped the tribe really understand what is going on with climate change, how much worse are heat related impacts and wildfire related impacts going to get in the future, and then using some modeling and some qualitative analysis to understand whether and how that could affect their health risks over time. So we haven't taken this step yet, but the idea is that this could really help inform how the Pueblo manages its health risks. And it can do that through restoring areas that are prone to flooding, to prevent the transport of the sediment that carries that radioactive material into the Pueblo, or it can be focused on ensuring that people have access to health care or cooling centers during high heat or a wildfire events. And that approach could work in other contexts as well.

Eric: Great. And I think, Lisanne, you were going to chime in on that.

Lisanne: Yeah. I could definitely see how that approach could benefit coastal communities that are at risk of storms and flooding, even with heavy rains, and any approach that can help reduce stress is going to have a positive impact on allostatic load. And that means, basically, you don't want it to be too high cause that's when people start burning out and just get overloaded. And trying to moderate the overall level of stress experienced by these vulnerable communities could help improve their overall quality of life and overall health.

Eric: Great. So it sounds like we're on track for... Lisanne, you mentioned earlier that we know where food deserts are. Karen, you're talking about looking at that localized view of the transporting radioactive material. So it sounds like we're already sort of working on collecting the data we need in different disparate areas. And if we could bring that together with an overlay, and apply that to different areas, then we can start maybe moving the needle, as you say, Lisanne, sort of lighten the load.

Lisanne: Right.

Karen: Yeah. I'll say that's one of the things that I find, potentially, really exciting. And that is that Abt does a lot of work in the health arena. We work with a lot of different partners on the ground and actually at a national scale. And what we could do is use all the different data sets that we have about potential factors related to allostatic load and overlay the extensive information that we've gathered through our projects. We could use that information about allostatic load and overlay that with all of the extensive research that we've done and that we continue to do understanding climate risks and really understand where people are going to need the most help to mitigate not only the effects of the current environment, but the impacts that they're going to face because of climate change, the stressors that will be exacerbated by climate change.

Eric: Well Karen, I think you just wrapped that up in a bow for us.

Karen: Good. That what I was trying to do!

Eric: Yeah, from your mouth to our clients' ears, right? Well, thank you both for joining me.

Lisanne: It was a pleasure.

Karen: Thanks Eric.

Eric: And thank you for joining us at The Intersect.