MCH Bridges: The Official AMCHP Podcast

Episode #16: What the Health is Ecology of Homelessness?!

• AMCHP • Episode 16

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November is National Youth Homelessness Awareness Month. Severe weather, extreme temperatures, and natural disasters present vastly increased challenges for homeless communities. Listen to our latest MCH Bridges and What the Health?! crossover episode, led by AMCHP’s Youth Voice Amplified (YVA) committee, to learn about how climate change is directly affecting people experiencing homelessness. You’ll hear from guest hosts Mitra Kashani, environmental public health scientist, and Lisa Brooks, expert in the homelessness system, as they share what homelessness can look like from an individual and systems-level perspective – confronting common misconceptions, emphasizing the impacts of climate change on marginalized and rural communities, and highlighting the opportunities to address this issue by partnering with and centering people with lived experience.  

Tune in now to listen to guest host Amber Woodside and speakers Lisa and Mitra as they share their lived experiences and professional insights. In addition, as we enter into this season of giving and gratitude, consider ways you might be able to give back to your community members experiencing homelessness, especially youth.

Disclaimer: This episode discusses topics of climate change, natural disasters, loss, death, discrimination, and homelessness. Please prioritize your mental health and consider if you are ready to listen to this episode. If you or someone you know is experiencing suicidal thoughts or a crisis, please call the Suicide and Crisis Lifeline by dialing 988. You can also sign up to join virtual sharing and listening sessions for people experiencing climate anxiety at www.climateawakening.org.

Additionally, the findings and conclusions in this podcast shared by Mitra Kashani are those of the speaker and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Resources: 

Amber Woodside: [00:00:00] Welcome to MCH Bridges, where we lift up innovative ideas and inspiring stories from people in the maternal and child health [00:00:15] field. Today's episode is a quarterly feature produced in collaboration with AMCHP's Youth Voice Amplified Subcommittee, or YVA. Today's episode, What the Health is Ecology of Homelessness?!, is hosted by YVA co-chair Amber Woodside.

Resources for further learning can be [00:00:30] found in the episode's description. Before we get started, I'd like to mention that this episode deals with topics of climate change, natural disasters, loss, death, discrimination, and homelessness. Please prioritize your mental health and consider if you're ready to listen to this [00:00:45] episode.

If you or someone you know is experiencing suicidal thoughts or a crisis, please call the Suicide and Crisis Lifeline by dialing 988. You can also sign up to join virtual sharing and listening sessions for people experiencing climate anxiety at climateawakening.org. [00:01:00] More information about these resources can be found in the show notes.

I saw my dad cry for the first time when we went to his business, and we had lost everything. [00:01:15] One of my colleagues told me this about her family's experience in Puerto Rico following Hurricane Maria in 2017. Her father's grocery store, which supplied most of the neighborhood, had been destroyed. Six years later, this kind of tragedy is becoming easier to imagine every [00:01:30] day, as we are inundated with news of natural disaster after natural disaster worldwide.

Climate change is here, and so are the first of its effects. This fact is incredibly difficult to deny, even in an increasingly divisive sociopolitical climate where [00:01:45] suffering, loss, life, and death are sometimes mere talking points. The growing harshness of nature is hard to cope with on a theoretical level, but it's often nearly insurmountable when the consequences of it actually directly impact you or your loved ones.

Folks [00:02:00] currently experiencing homelessness are disproportionately bearing the burden of these consequences compared to those who are not, as well as the consequences of longer-term climate trends like severe heat waves, increased humidity, or severe cold snaps. Stable, safe housing is a critical [00:02:15] factor in health and well-being for all humans.

When people are unable to access this housing, the preparation for, immediate experience of, and recovery from severe weather is made exponentially more difficult and more dangerous. Climate change itself is making the housing [00:02:30] crisis worse every day. Not only do disasters put additional stress on the systems that aid communities experiencing homelessness, but many homes are destroyed by tropical storms, floods, fires, landslides, the list goes on.

I spoke with two [00:02:45] experts, one in the field of homelessness outreach and one in the field of environmental health tracking, to try and make some sense of how climate change and experiences of homelessness intersect, as well as find out where we might be able to go from here. Before I get to chatting with them, I want to provide a short overview of the current [00:03:00] state of climate change and the weather events it influences.

I remember when fire season actually used to end every year in my home state of Colorado. It was around the same time fall actually existed as [00:03:15] a season, too, when September nights on the Front Range probably needed a cup of hot cocoa and a light blanket. This past September, I spent many nights rotating ice packs in and out of the freezer to keep my dog cool, and closing the windows against the general smoky haze of the sky outside.[00:03:30] 

I wonder simultaneously if winter should be my new favorite season now, and if maybe my grandchildren will know what the words fall or winter even mean. I wanted to talk about the human cost of severe weather events, how severe weather events are connected, and how climate [00:03:45] change drives these events.

I've always been interested in weather science, and following global weather news this year has been scary. There's no better word for it. This summer in the Northern Hemisphere was hot and dry enough that Canada faced its worst wildfire season on record, burning over [00:04:00] 6 million acres of land and costing over 770 million in damage and firefighting expenses.

This heat and lack of moisture fueled extreme and exceptional drought, the worst two drought categories, throughout most of the central United States, which is still suffering from [00:04:15] these conditions. That drought in the central U. S. has led to a saltwater intrusion crisis in Louisiana. What this term refers to is that normally the Mississippi River flows so strongly that it can keep the salt water from the Gulf of Mexico out of the freshwater supply [00:04:30] of the Mississippi.

However, due to low water levels in the Mississippi River, more saltwater has been getting into the river's freshwater supply. This has required the construction of additional underwater levees, or barriers. Normally, these levees only get added on to about once [00:04:45] every 10 years, but during this year's saltwater intrusion, they have had to be heightened twice in just the last 8 months.

High levels of drought also mean that when it does rain, especially if it rains a lot in a short time, there's severe flooding. 2023 saw unprecedented [00:05:00] flooding in the northeastern U. S. Separate floods killed one person in New York and three people in Pennsylvania in the same month, and damage totals were catastrophic in some local communities throughout the region.

Temperature also affects the severity of storms. When it's warmer, tornadoes develop [00:05:15] more easily. 2023's tornado season in the U. S. was extreme even by American standards, and that's saying something because the continental U. S., historically, already has more tornadoes than anywhere else in the world. In April, a dozen tornadoes [00:05:30] touched down in Missouri in a single day.

Just between January and March 2023, the estimated cost of damages from tornadoes in the U. S. was already about 530 million dollars. Tornadoes also tend to spawn on the edges of hurricanes, which have been hugely impactful [00:05:45] this year. Tropical storms and hurricanes are made worse and more frequent due to rising surface temperatures in the ocean, which is one of the biggest current impacts of climate change.

An impact that is also killing coral reefs in large numbers very quickly, which destabilizes the marine ecosystem [00:06:00] significantly. One of the most recent examples of ocean warming affecting storms was Hurricane Otis in the Pacific, which landed in Acapulco, Mexico in October 2023. It landed as a Category 5 hurricane, the strongest hurricane category on [00:06:15] the Saffir Simpson Wind Scale.

This storm was devastating, primarily because forecasters weren't able to predict how severe it was going to be. It went through what is termed rapid intensification. Its wind speeds went up by 115 mph in less than [00:06:30] 24 hours. Rapid intensification drastically increases the dangers of tropical storms, and it's becoming far more frequent due to human-caused climate change.

Severe weather has not been exclusive to North America this year, as Europe has seen unprecedented [00:06:45] wildfires in Greece, multiple severe heat waves in Western Europe, and the deadly tropical storm Daniel that impacted Greece, Turkey, and Bulgaria. This storm was called by some meteorologists a medicaine, or a Mediterranean hurricane, which is an [00:07:00] unprecedented weather phenomenon.

Similarly to the increase in rapid intensification, an uptick in hurricanes in the Mediterranean is an incredibly concerning sign of how global weather patterns are beginning to destabilize. Flooding fueled by Storm Daniel also severely impacted [00:07:15] Libya. A massive flood in September killed over 4, 300 people and has still left over 8, 000 missing.

All of these events together paint a striking picture of a world speeding toward a frightening new normal. And it is only part of a pattern of steadily increasing severe weather and [00:07:30] destabilized weather patterns across the globe. I want my grandchildren to know what fall and winter used to look like, and to have the opportunity to see a live coral reef.

There is certainly some hope in the field of climate science and the political realm of climate awareness, but we have a long way to go and [00:07:45] we need to go that way quickly. Even examining the past and future of climate change, though, it is the present that is most significantly impacting those of us who have the least privilege and the least protection, which brings me to the main topic of this episode.

The ecology of [00:08:00] homelessness is essentially the study of how the environment interacts with and impacts experiences of homelessness. I talked with two experts to find out what the climate crisis looks like in the here and now for communities experiencing homelessness at large. My first[00:08:15] guest is Lisa Brooks, an expert with many years serving in the homelessness and youth homelessness systems. 

Lisa Brooks: I'm Lisa Brooks. I use she, her pronouns. I live in southeastern Ohio in the Appalachian [00:08:30] mountain chain area. And I am a human services associate at Abt Associates, which is a research and evaluation firm that works globally on lots and lots of different social issues. 

I have [00:08:45] probably over 15 years experience working in the homelessness system. My work started primarily doing direct street outreach specifically for youth and young adults to kind of overseeing the outreach [00:09:00] program as a whole. After transitioning to more of state level work, where I worked with the Coalition on Homelessness and Housing in Ohio to continue the vision of lots of amazing people that came before me.

So that's where I really started to work from a systems perspective [00:09:15] to bring those systems together to address youth homelessness. So a lot of the work that I do now is direct technical assistance to communities. And one of my favorite pieces of the work is partnering alongside youth action boards to [00:09:30] infuse young people's lived experience and leadership into the solutions and the strategies to ensure that everything we're doing is really authentically driven by young people's lived experience and expertise.

Amber Woodside: I also invited Mitra Kashani, an environmental public [00:09:45] health scientist originally from Virginia, to join in on this conversation. 

Mitra Kashani: Hi, my name is Mitra Kashani, and I'm an environmental public health scientist doing a postgraduate fellowship at the Centers for Disease Control and Prevention. [00:10:00] 

Amber Woodside: I wanted to start off this conversation with a discussion of what experiences of homelessness can actually look like, both from a systems perspective and an individual perspective. I see a lot of misconceptions about what homelessness means, which in turn [00:10:15] often leads to a harsh view of the people who experience it.

One of the biggest myths about homelessness is that the experience is monolithic - the same for everybody. I asked Lisa about the differences between unsheltered homelessness, which is what many people tend to think of most when considering community [00:10:30] members that are experiencing homelessness, and sheltered homelessness.

Lisa Brooks: For me, it's really important when we're talking about homelessness on the forefront to talk about homelessness as though it's a person experiencing homelessness, right? A lot of times we hear homeless people or homeless [00:10:45] person and in reality, we know that homelessness is a moment in time. It's not a lifelong label, right?

It's an experience that a person is having in this moment that we are hoping to work alongside them to end that experience, right? It's not who they are as a [00:11:00] person. So whether that person is experiencing unsheltered homelessness, meaning living in a place not meant for human habitation, which could be a park or a tent or a car.

Lots of different ways that could look as a person could be [00:11:15] experiencing unsheltered homelessness. And then sheltered homelessness or doubled up homelessness could be a person who is staying in an emergency shelter. It could be a person who is temporarily residing in a hotel room could be a person who has [00:11:30] doubled up with friends or family or even a stranger and the real kind of thing I like to think about when I'm thinking about doubled up and the distinction between unsheltered and doubled up is, is this a fixed, regular, adequate place for this person to be?[00:11:45] 

Amber Woodside: So we know that homelessness never looks the same for any individual or family going through it. Mitra was able to weigh in on what these experiences can look like from a more systemic view, as well as what can differ for those experiencing homelessness about their health outcomes. I asked her what [00:12:00] might change about social determinants of health for those experiencing homelessness versus those who aren't.

Mitra Kashani: Social determinants of health describe all the conditions, whether they're social or demographic or environmental, that affect people and how they live, where [00:12:15] they learn, where they work and play, their age, so demographic characteristics too, like race or ethnicity. These are all the social and environmental conditions that affect a person's lived experience and that lived experience includes their health [00:12:30] and quality of life outcomes and potential health risks too.

How these social determinants of health are different for people who are unstably housed or experiencing homelessness is kind of multifold. Homelessness itself [00:12:45] is actually socially determined, and homelessness is also a social determinant of health on its own, but I always like to underline that, ultimately, a person experiencing homelessness or extreme housing instability is a systemic issue. [00:13:00] So nobody should have to sacrifice safe or stable housing or secure housing because of their circumstances or adversities that they've undergone, whether influenced by these social determinants of health or otherwise.

And oftentimes there are these compounding factors [00:13:15] that corner people into housing instability, that corner them into homelessness. So that is where I feel homelessness is socially determined. But then once a person finds themselves experiencing homelessness, it can also be a social [00:13:30] determinant of health, living on the street, living in congregate settings or shelters, these shared spaces for multiple people who aren't necessarily related, live in close proximity to each other, can increase the risk for, you know, being exposed to communicable diseases.

Um, or [00:13:45] infectious diseases, it can also exacerbate already existing conditions or diseases like high blood pressure or diabetes or different challenges with mental or behavioral health. The experience of housing instability can further worsen and exacerbate [00:14:00] those experiences. Homelessness can also make it difficult for a person to adhere to, you know, treatment or adhere to medication.

So if you don't have somewhere to properly store your medication or have very regular [00:14:15] visits with your primary care physician or doctor, a lot of people who are experiencing homelessness ultimately find themselves getting medical care when it's too late. So they're usually receiving medical care at emergency departments or in hospitals because it's difficult to access [00:14:30] preventative and primary health care services.

Also, I think there's an air of mistrust with health care systems too, for people experiencing homelessness, and this is often rooted in an array of traumatic experiences, life experiences, or potentially negative [00:14:45] experiences with health care systems. I also want to highlight that while I say people experiencing homelessness as kind of like an umbrella term, these conditions and social determinants of health vary vastly for different [00:15:00] subpopulations within populations of people experiencing homelessness.

So, for example, youth experiencing homelessness and people with other marginalized identities, for example, lesbian, gay, bisexual, trans, queer and women, black, brown and [00:15:15] indigenous, people of color, people with disabilities, these folks that have additional social factors that can influence how they are at risk for or how they experience different exposures that can impact their health find themselves with these kind of [00:15:30] multiplicative effects on their health.

Amber Woodside: It's so important to talk about how multiple marginalization impacts all experiences, but especially when we're talking about both health conditions and homelessness. One of the demographics that can impact both of these things [00:15:45] is living in a rural area instead of an urban area. I'm from an extremely rural part of Colorado, and I chatted with Lisa about how the treatment and perception of folks experiencing homelessness can look in rural communities.

Lisa Brooks: You know, one thing I always like to say when I'm talking about rural [00:16:00] communities, and I'm, I refer to myself as a rural person, right, I'm like Appalachia born and bred, still here, still doing it, and working with rural communities all around the country, and so I'm proud and also a little bit protective of rural communities, [00:16:15] and I think that one of the first things I think of is, I'm Uh, a lot of times in our communications and the way we think about and talk about and write about rural communities, we are often describing them as a monolith or all [00:16:30] one thing, right?

That every rural community is kind of the same and that's just not my experience, and that's not the experience of people that I know and talk to in rural communities, so there's no one way that anything looks, but I think there are some [00:16:45] commonalities in rural communities around what homelessness tends to look like and what we tend to see.

We tend to have less visibility of unsheltered homelessness. So we have encampments along rivers and [00:17:00] streams all over the country. And sometimes in more urban settings, those will be bigger clusters, right? Whereas in a rural community, there might be miles and miles between a family or a person experiencing homelessness.

And why might someone want to be near the river so they can have [00:17:15] access to water, right? So by default, they're kind of more hidden. But they're also more at risk for the things we think of when we think of environmental impacts, right? I mean, a person could be sleeping in a tent near a stream and that tent could be washed away overnight in a [00:17:30] flash flood when trying to solve their own homelessness issues on their own.

And, you know, to no fault of their own. They may not have control over what that risk might look like. It tends to be a challenge in rural communities [00:17:45] because that lack of visibility for there to be community buy-in and belief about the true challenge. I cannot tell you how many times I've worked in rural communities and we're trying to do some data collection and we're [00:18:00] reaching out to schools, law enforcement, businesses, community partners and saying like, what are you seeing?

And nine times out of 10, the response will be, we don't have homelessness in this community. What are you talking about? And so that to me signals this [00:18:15] kind of invisibility of rural homelessness. 

Amber Woodside: This was such an important point for me, having grown up in a rural community. I remember as a teenager, seeing folks panhandling near the only Walmart in town. And so many of the people I worked with and hung out with would [00:18:30] complain about how all the homeless people from the city come up here to ask for money and then they go back down. And I remember thinking that was a wild thing to say. I would tell them, you know that gentleman lives here in town, right? And they wouldn't believe me. 

Lisa Brooks: And so [00:18:45] that's a paradigm we need and want to shift, right? It's not invisible. It's very much happening. We have to help people understand how it looks different in their community. That visibility factor is so important to developing a community [00:19:00] wide buy-in to get that solution, to get people, to bring funds to the table, to address it, to get developers into the community, to bring new units online.

We talked a little bit about the difference between unsheltered homelessness and. and imminently at risk or doubled [00:19:15] up homelessness. And in rural communities, you know, you have a lot of, uh, individuals who are residing in places not meant for human habitation, which could very well be a home that has been passed down in their family for [00:19:30] generations, but they have never had the resources to actually maintain that property.

So now you have communities of people who are living in places not meant for human habitation, could be a mobile home, could just be a severely aged house with no running water, [00:19:45] no heat. I've worked with so many folks where you can't even access their driveway. You may not even be able to access the road they live on.

So you think about trying to identify and get these folks connected to services and help them plug into the resources that they need, [00:20:00] like taking their child to a healthcare appointment even, or going to see a property so that they can identify a unit that's going to be the right fit for them. 

Amber Woodside: This idea of systems workers having access to and the capacity for helping people experiencing homelessness is a [00:20:15] crucial operational function that's being shaped by the climate crisis.

It's well documented that homelessness is a systemic issue, and environmental management and environmental health systems not only impact the institutions that directly affect experiences of homelessness, but they [00:20:30] also impact health trends and health care gaps that disproportionately negatively affect homeless communities.

Mitra Kashani: Climate change, I mean, not only does it have biological and physical [00:20:45] manifestations on a person's health, it can also impact the systems and health care facilities that a person is getting care and treatment from. For example, if there is a natural disaster like a hurricane that impacts a medical facility's power, and [00:21:00] it leads to a power outage, or it causes added infrastructure damage that can all impact how a person is attaining and getting the care that they need to manage their condition.

I also think of transportation, access to [00:21:15] roadways access using public transportation to get to a medical care facility during a natural disaster or some other climate event is much more challenging and much more difficult. Then you also have the risk of more infectious [00:21:30] disease and vector-borne disease exposure.

So for example, tropical cyclone or hurricane events or flooding events, something that we often get as an outcome is water contamination. So, you'll have floodwaters mixing [00:21:45] potentially with sewage waters and if you are in a situation where you have to wade out of that water, you are being exposed to like highly contaminated water sources that can potentially make you sick.

A lot of times there's an increased risk for different gastrointestinal [00:22:00] illnesses, infectious diseases during these flooding events where, yeah, your neighborhood or your community is fraught with water contamination. There is the risks of having those same pathogens introduced to recreational water or drinking water too, so you are [00:22:15] ingesting that water. 

And then same with vector borne illnesses. So this is something we're really seeing increase in the last few years. Lyme disease, which is a bacterial infection that's caused by ticks. Lyme disease incidence has doubled in the [00:22:30] U. S. since the 1990s. So this is where land management, climate change, they're all kind of meeting at this confluence.

We are coming into closer and closer contact with environments where these potentially disease-causing ticks and other wildlife that carry them [00:22:45] are also living. 

Lisa Brooks: I think what's really important for me is helping people understand how overtaxed and under-resourced the homelessness system is to begin with.

So we're talking about a system that [00:23:00] is serving So many people and it operates in a crisis response approach at all times. It's typically understaffed. There is extreme staff turnover in the homelessness system, and it typically does not [00:23:15] have enough funding to meet the needs in the community to begin with.

So when you add anything at all. It stretches this already stretched system, even just something small. And then you think about much more [00:23:30] extreme things like extreme weather and how that could take services offline. And then you just think about the impacts of the way in which our environment is changing every day.

So the slow [00:23:45] increase of heat, the day-to-day environment change have amounts of impact on these services. What kind of impacts are you thinking of? And for me, you're immediately thinking about less. Availability of resources online right away, and that could be [00:24:00] that you could have less staff people available to support people experiencing homelessness in the space.

They themselves may need to be taking care of their own family, their own responsibilities, their own space and health. The other thing to think about [00:24:15] is because the homelessness system operates as a crisis response system, many times providers within the homelessness system don't have preparedness planning baked into their normal [00:24:30] protocols and daily work, and/or they may have a great plan, but they don't actually have the tools, the resources and the capacity to enact that plan.

So really what you what you see is this already overstretched and under resourced [00:24:45] system being severely hindered by the severe weather. Unable to serve as many folks as normal, unable to provide that one-to-one or deep client engagement that's really needed to move folks from the experience of homelessness [00:25:00] to their best next or permanent housing or wherever they're trying to get to.

Amber Woodside: So not only is the climate crisis hindering the systems that are designed to help marginalized communities, including those experiencing homelessness, but [00:25:15] it is exacerbating the ways in which institutional discriminations further marginalized people already. 

Mitra Kashani: I was reading a story about this family who lost one house to the Camp Fire, which was in 2018, and they relocated to [00:25:30] another part of California.

And then in 2020, the North Complex Fire took their house again. And then in 2021, the Dixie Fire took their third house. So they lost three houses and three separate fires in less than five years. Yeah, I think it just kind of underpins how, [00:25:45] how little we have invested in preparation for weathering these natural disasters and how little protection we have in place for all the communities and populations that are the most vulnerable.

This kind of goes back to, you know, historic and [00:26:00] systemic discrimination and discriminatory housing policies that have placed certain communities in more vulnerable places. Nothing that we're really experiencing in terms of. The climate crisis and how different people are impacted differently by it is random.

There are [00:26:15] a lot of historic and systemic injustices that are underpinning a lot of the different ways people experience the climate crisis. I learned recently that the more affordable a house is, the more likely it is to be in a flood zone and the less likely it [00:26:30] is to be rebuilt after a disaster. And so these flood zone maps, they're historically redlined neighborhoods and we're talking about redlining as a kind of high-level overview. It's racist zoning practices from the 20th century that ultimately excluded people of [00:26:45] color from living in these more desirable neighborhoods. The data is showing us that these communities are experiencing the climate crisis first and worst.

Lisa Brooks: So when you think about ending homelessness in a rural community, you really have to think about bringing online more [00:27:00] affordable housing. It's very, very difficult because many of the properties in rural communities are in blight or foreclosure or are, uh, the housing stock is aging so dramatically [00:27:15] that it can't be used.

It's hard to get developers bought in and engaged. It's hard to find the right collaboration between ending homelessness and increasing affordable housing and a lot of times what we see when we're thinking about the solutions [00:27:30] is we get really excited because there will be new affordable units coming online, but the majority of affordable housing units are built in places that are more likely to experience severe weather.

A person may have entered the homelessness system and [00:27:45] done a tremendous amount of work and received support to finally get into an affordable housing unit, maybe even be working towards home ownership. And now they maybe even own a unit that is in an area [00:28:00] where it's likely that unit isn't something they're gonna be able to pass on to their family because it's in a floodplain, right?

So that opportunity for increasing equity within your family, accessing your own housing and making that available long term, it's so important [00:28:15] that that affordable housing in rural communities and in all communities is in a place where it has longevity and it's safe. 

Amber Woodside: Lisa also shared with me a little bit about her personal experiences relating to affordable housing being built in floodplains.

Lisa Brooks: [00:28:30] I was still living with my family as a young person. We lived in the floodplain several times and I remember multiple times that our house flooded and we had a basement and we were renting a place literally in a FEMA-designated [00:28:45] floodplain. And, you know, it was the only affordable housing for our family that was reasonable at that time.

And you could open the door to our basement and the water would be right there. If you are someone who's lived in a house that's [00:29:00] flooded, then you know that the water comes in quick, and it goes out slow. And so, you know what you're talking about then is the reality of the mold that's going to occur in the basement because of that, impacts the [00:29:15] air quality in our entire house. Your whole home doesn't have to be washed away to be impacted by this severe weather.

Amber Woodside: So knowing now how much worse the consequences of the climate crisis are [00:29:30] for people experiencing homelessness for a myriad of reasons, I really wanted to ask Mitra how climate change has been affecting mortality rates and disease in the United States as a whole.

Mitra Kashani: Climate change has definitely impacted mortality rates in the U.S. It's [00:29:45] just a little difficult right now to put exact numbers and in absolute terms, quantifying the mortality rates related to different natural disasters and climate change, mostly because the data that we often work with, they only report [00:30:00] numbers and rates for natural disasters that caused 1 billion dollars in damages.

Overall trends that we're seeing may be a lot more underreported because I think we just, we don't really have like a systemic way of assessing this data yet. And [00:30:15] in 2022, the billion-dollar weather and climate disasters report, um, reported 474 natural disaster-related fatalities. Tropical cyclones and hurricanes are the leading cause of death by natural disasters in the United States in [00:30:30] 2022.

And then back in 2017, when Hurricane Maria hit, there were upwards of two to three thousand deaths or mortality events. And then, of course, we have the wildfires that are ravaging not only the Pacific Northwest and California, but [00:30:45] also more recently we saw in Hawaii and Maui, the firestorm led to almost 100 deaths alone.

And then other weather events that often lead to too many casualties include historic tornado outbreaks that we saw in the [00:31:00] Midwest and then in the southeast back in 2021, which led to nearly 100 mortality events. Climate change can not only exacerbate existing conditions that a person might have, but it's already starting to introduce other diseases, [00:31:15] other injuries, and chronic health conditions and illnesses.

So, for example, respiratory conditions, if a person is experiencing asthma or COPD, a person can Be negatively impacted even more so by air pollutants than being outside [00:31:30] when there's, you know, wildfires raging up north is going to be a lot more dangerous and it's going to put their health at risk because they have a compromised immunity that increases their vulnerability and worsens the experience of breathing in polluted air compared to somebody who [00:31:45] doesn't have that chronic condition. 

And then warmer temperatures, more rainfall, these are all prime conditions for other disease-carrying insects. Mosquitoes can transmit diseases like West Nile virus, which increases the risks of health complications for immunocompromised people. [00:32:00] And then finally, I want to highlight that, you know, there's. Not just this risk for infectious disease and chronic conditions when it comes to climate and health, mental health and behavioral health can also be influenced by a change in climate. 

Amber Woodside: It can [00:32:15] possibly feel a bit depressing to hear about all these data points and consequences of climate change. But as Lisa highlights, the measurement of how climate change impacts marginalized communities, especially in the maternal and child health space, is an absolutely vital step in making change. [00:32:30]

Lisa Brooks: It’s essential to the solutions. And really what we want to do is. work together to predict. So one of the things we do in the homelessness system where we do solutioning, and this happens on the health and maternal and child health side of things as well, is we start to kind of [00:32:45] model, where are we with the challenge?

Where are we with the resources to address it? And what's it going to take to kind of bring those things together? We need to have our child and maternal health partners at the table to connect those dots and begin to do some of that predictive [00:33:00] modeling. One of the things we can do when we think about the environment, if we can do mapping and prediction, and Abt does this, by the way, of where affordable housing is, for example, we can also do mapping and prediction of where we [00:33:15] expect to see environmental crises or issues on the health care side of things.

We can map birth rates, we can map infant mortality rates, we can overlay this really important data to begin to draw [00:33:30] conclusions and then come together to build the solutions, together. So we don't have to create something brand new. We can come together and start to build off of the things that we're already doing and then begin to evaluate and [00:33:45] adapt to what is happening.

And I think that's just the starting place. Once we can come together and start doing those things, I think that that's really where some of the solutions begin to happen. 

Amber Woodside: One of the final components in the complicated relationship between climate change and [00:34:00] experiences of homelessness is that climate change itself creates incredibly different consequences in different places. Oftentimes, regions that are prepared infrastructurally for one or two kinds of severe weather are now experiencing many more kinds, frequently. [00:34:15] This creates significant challenges. 

Mitra Kashani: We are seeing hotter than average temperatures, months and weeks where people are exposed to extreme heat. Just in the last year, we were seeing temperatures shattering all-time high [00:34:30] records in the Pacific Northwest.

And, you know, these are places that don't necessarily have the same cooling infrastructure. And then we also have these cold waves and these winter storms that are becoming more intense, where Arctic fronts are coming in and sending [00:34:45] heavy snow and ice all the way down to Texas, which I think caught a lot of Texans off guard just because we don't have the anticipation for something so intense to happen so suddenly, so the infrastructure isn't there. 

The cold wave that [00:35:00] hit Texas back in, I think, 2021 led to nearly 100 deaths. Trends where we see these more intensified, and prolonged weather events that are kind of shaking these communities at their core are only expected to worsen.

Amber Woodside: It's [00:35:15] critical to take stock of this knowledge that communities are going to be dealing with new challenges relating to weather and natural disasters as time goes on. I remember during that Texas cold snap Mitra mentioned, I had friends online who were asking me, as a Coloradan who's used to extreme cold, you know, [00:35:30] how do we prepare for this? How do we survive cold like this? 

Then the following summer, I was having to ask them the same questions about heat waves. How do I keep my elderly dad cool enough when he has to go outside? How do I keep my pets cool when we only have a portable air conditioning [00:35:45] unit? Despite the fear and uncertainty that might be swirling in these circumstances, this kind of collaboration highlights one of the most powerful resources in preparing communities for the progression of the climate crisis.

Mitra Kashani: Another thing that really gives me hope amidst all of this [00:36:00] kind of doomsday apocalyptic news is the opportunity for people to come together and share resources, share their own experiences with, you know, weathering the weather, if you will, and an opportunity for more [00:36:15] community building and mutual aid and finding resilience through each other when the rest of the world seems to be burning around us.

Amber Woodside: It is so important to try and think about [00:36:30] these kinds of topics through a solutions-focused lens. For me, especially as a neurodivergent person, solutions begin with knowledge, which is what motivated me to gather all this information in one place and have these conversations for this episode. Lisa and Mitra both weighed in on what they see as [00:36:45] important components to the solutions-based approach to these issues as well.

Lisa Brooks: The very last thing I'll say as a person with lived experience of homelessness, an essential, absolutely essential element to working together as a health system and a homelessness [00:37:00] system to end and address homelessness is to partner and make space and share power with people with lived experience. We must have them at the table.

We must be compensating them while they're at the table. And it's essential to have folks [00:37:15] with lived experience. driving those solutions and that when we're thinking about working with people's lived experience, we're recognizing that BIPOC folks are the most likely to experience homelessness, particularly black and brown communities and LGBTQ plus [00:37:30] youth, just absolutely essential to be partnering with them. And at Abt, we're working so hard to do that meaningfully and authentically. And we would love to talk to anybody who wants to partner to think about solutions. 

Mitra Kashani: I think I'll maybe close off by saying [00:37:45] that in all of this discussion about climate and housing and health, access to safe and affordable housing is one of the most important predictors of someone's health, safe and accessible housing is a human right, you know, there's no reason why a person shouldn't have access [00:38:00] access to shelter that provides them security, especially in these very precarious times.

And in addition to that, not only providing shelter and affordable housing for all, but also medical services and [00:38:15] programs and healthcare systems that are culturally competent and provide affirming care and trauma-informed care as we're seeing right now. Climate change impacts everyone, but it impacts everyone differently.

Housing justice and housing [00:38:30] security impacts everyone, but it impacts people differently. So being able to have an ear to the ground assessing multiplicative vulnerabilities and risks that different marginalized populations experience is going to be really important.[00:38:45] 

Amber Woodside: One of the most important things I want to leave everyone thinking about is the fact that we know about a lot of frightening long-term consequences of climate change. But we also are seeing in recent years that there are more [00:39:00] consequences the scientific community can't even really predict. This uncertainty has the potential to be disruptive to all our lives, especially those among us who already face unpredictability and instability in many aspects of life every single day.

Talking especially to our [00:39:15] younger listeners, but this is relevant for everyone, make sure to take care of your mental health. Climate anxiety is a real phenomenon, and it gets harsher for each younger generation as the climate crisis progresses. Remember to take time to enjoy the beautiful things about your [00:39:30] own environment and the nature around you, wherever you can find it.

Even if it's just sitting in the shade of a tree, or appreciating the sunshine from your apartment balcony, which I try to do daily. Don't forget the 988 crisis hotline if you or someone you know is experiencing a mental [00:39:45] health crisis. Tackling the dual challenges of climate change and the effects of experiencing homelessness will take a global community effort, but those efforts start locally.

I'd like to encourage everyone listening to take a look at the resources available in the show notes. These include lots of [00:40:00] resources to help you take direct action to help, much of which doesn't cost a single cent. Please share media sources you find that uplift support for people experiencing homelessness, both in your personal life and your work.

November is Youth Homelessness Awareness Month, and you can post about it [00:40:15] using several popular hashtags, including hashtag kindness is free. Thank you all for joining us on this episode. Please check out our next What the Health feature episode coming out in a few months. The transcript of this episode can be found at [00:40:30] www.mchbridges.org. Be sure to follow AMCHP on social media. We hope this episode created some new connections for you. Stay well, and I hope our paths cross on the next MCH Bridges. [00:40:45] 

This project is supported by the Health Resources and Services Administration, or HRSA, of the U. S. Department of Health and Human Services, or HHS, as part of an award totaling 1,963,039 [00:41:00] dollars with 0 percent financed with non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, [00:41:15] HHS, or the U.S. government.