Throughout this module, a recurring theme is that not everyone is affected equally when extreme weather strikes. Vulnerable populations bear a disproportionate share of the harm. These vulnerable groups include:
Disasters tend to hit hardest in poorer neighborhoods or regions.
- These communities may live in higher-risk areas (floodplains, sub-standard housing, and drought-prone rural areas) because land is cheaper.
- They also have fewer financial resources to evacuate, to prepare (e.g. to buy generators or fortify homes), and to recover afterwards.
For example, during Hurricane Katrina, many who died or were stranded in New Orleans lacked cars or money to evacuate. Likewise, farmers in developing countries might lose everything in a drought because they have no crop insurance or safety net.
Climate extremes amplify existing social inequalities, which is at the heart of environmental justice concerns. An oft-cited example: After major hurricanes that hit the United States, wealthy neighborhoods tend to rebuild quickly, while low-income communities (often communities of color) struggle with prolonged displacement and slow recovery and their health suffers accordingly.
Older adults, people with disabilities, and those with chronic illnesses are extremely vulnerable in disasters.
- They may have mobility issues or medical devices that require power. When Hurricane Maria knocked out power across Puerto Rico, many elderly and sick patients died because their oxygen concentrators or dialysis machines stopped running.
- In heat waves, many victims are older adults with underlying conditions who couldn’t escape the heat.
- Residents of nursing homes are at high risk if evacuations aren’t done or if backup generators fail. After Hurricane Irma in 2017, twelve nursing home residents in Florida died from heat exposure when the facility lost power for air conditioning.
- This tragedy underscores why healthcare facilities must have robust emergency plans (backup power, evacuation protocols, etc.) for the most vulnerable patients.
Children are:
- More sensitive to dehydration and heat.
- Can easily drown in floods.
- Suffer psychologically from trauma.
Pregnant women have special needs and can experience complications (e.g. preterm labor) due to stress or heat.
Those with existing mental illness can have conditions worsened by the chaos and stress of disasters. Also, they may have difficulty accessing their medications or usual care. And in general, individuals on medications (like insulin, which requires refrigeration, or dialysis, which requires electricity and water) are at risk when infrastructure is down.
These groups have high exposure to the elements.
- Farm workers in a heat wave or wildfire firefighters in a drought, face direct threats.
- Homeless individuals have nowhere safe to shelter from storms or extreme heat/cold, putting them at extreme risk of injury or death during such events.
Disaster planning
Effective adaptation requires addressing the social determinants that leave some people defenseless.
Understanding and considering the disparities in vulnerable populations is crucial for disaster planning. An equitable response means directing resources to those who need them most. This is why we integrate environmental justice into climate-health discussions:
- Establish early-warning systems and evacuation assistance for those who lack transportation.
- Ensure relief centers are set up in low-income neighborhoods.
- Prioritize services for hard-hit vulnerable groups (mobile clinics, mental health support, continuity of care for chronic diseases) to reduce long-term fallout.
Healthcare preparedness
On the healthcare side, preparedness is key.
- Hospitals and clinics develop emergency operation plans for events like floods or hurricanes. This includes:
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- Backup generators (and testing them regularly).
- Flood barriers.
- Evacuation drills.
- Stockpiling essential supplies (water, fuel, medications).
- Healthcare professionals might be trained in incident command systems and disaster triage, so they can coordinate with emergency services when mass casualties occur.
- A resilient health system also means keeping services running or quickly restoring them.
A resilient health system
After the 2019 Nebraska floods, some hospitals had contingency plans to transfer patients to facilities on higher ground. Telehealth was used to consult on patients in isolated areas. On the frontlines, community health centers served as hubs for aid in underprivileged areas, which bolstered their disaster resilience (through grants and infrastructure upgrades). This is an environmental justice investment.
critical insight
Discuss how preparedness failed during the 2025 Texas inland floods. What could Texas authorities have done (before, during, and after) to prepare for this disaster?
Mitigation and adaptation
Addressing climate-related extreme weather is not just about reacting, it’s about mitigation and adaptation.
- Mitigation (cutting greenhouse gas emissions): Help limit future warming and hopefully restrain the worsening of extreme events later this century.
- Adaptation:
- Build higher levees.
- Plant drought-resistant crops.
- Expand cooling centers during heat waves
Mitigation and adaptation help communities cope with the changes already in motion.
In healthcare
In the healthcare context, adaptation might include:
- Develop rapid response teams for climate disasters.
- Integrate climate predictions into infectious disease surveillance (e.g. anticipating a spike in mosquito-borne diseases after floods).
- Design “climate-smart” hospitals that can withstand floods and heat waves.
As future health professionals, you have a role in both preparedness and advocacy: Whether it’s counseling patients on disaster readiness (like having a medication go-bag and evacuation plan) or advocating for policies that address climate change and strengthen public health infrastructure, your actions can make communities safer in our changing climate.
Chalk Talk
As future health professionals, you have a role in both preparedness and advocacy: Whether it’s counseling patients on disaster readiness (like having a medication go-bag and evacuation plan) or advocating for policies that address climate change and strengthen public health infrastructure, your actions can make communities safer in our changing climate.
Question
Which statement best reflects the concept of environmental justice in the context of extreme weather?
Vulnerable groups is the correct statement. It recognizes that extreme weather events do not affect everyone equally. Instead, extreme weather events tend to hit vulnerable populations harder, which is a core concern of environmental justice.
In contrast, it is a myth that climate disasters are a “great equilizer” (in reality, disadvantaged communities lack resources to cope, so they fare worse in disasters).
It is not true that people who ignore evacuation orders are seriously harmed in disasters(many people are harmed despite doing everything they can, often because they lacked means to escape).
Engineering solutions alone is overly optimistic (engineering helps, but without considering social factors, not everyone will benefit equally).
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Droughts and Extreme Heat Waves
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Final Thoughts