Season 2/Episode 8: Thomas LaVeist on Climate Change and Health
Thomas LaVeist
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Thomas LaVeist, public health expert and Dean of the School of Public Health and Tropical Medicine at Tulane University, talks with John about how climate change will impact health, especially for more vulnerable communities, and the role water will play.
Show Notes
Thomas' bio page at Tulane
Thomas' webpage
More on the field of Tropical Medicine
Here is an article published in the Journal of Human Behavior in the Social Environment how weather-related disasters impact disadvantaged communities.
This 2022 study published in Nature Communications found that "low- and middle-income countries are home to 89% of the world’s flood-exposed people."
Here is an article from The Conversation about the drought impacting the Mississippi River that John mentions
Health Inequities and Their Causes article by the World Health Organization mentioned in the show.
Article in TIME magazine: These Maps Show How Drastically COVID-19 Risk Varies by Neighborhood
This article in Scientific American explores tree cover and low-income communities
NIH Climate Change and Health Initiative discussed by John and Thomas
Wikipedia page on the Jackson, MS, water crisis
The UN World Water Development Report that is the "UN-Water’s flagship report on water and sanitation issues"
Transcript
START (THOMAS LAVEIST INTERVIEW)
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JOHN: Welcome to Audacious Water, the podcast about how to create a world of water abundance for everyone. I'm John Sabo, director of the ByWater Institute at Tulane University.
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JOHN: On today's show, climate change, water, and public health. My guest is Thomas LaVeist, public health expert and researcher and the dean of the School of Public Health and Tropical Medicine at Tulane University. Coming up I talk with Thomas about the impact of water-related disasters and which communities will be more vulnerable to changes in climate.
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JOHN: Thomas, welcome to the show.
THOMAS: Well, thank you for having me. It's my pleasure.
JOHN: Great. So let's start off general. So when you think about climate change and health what in your mind are the biggest challenges? What are the climate-drivers that are more pressing? What are the public health concerns that are most pressing?
THOMAS: Yeah, there's so many ways you can go with that questions because it is such an issue. Well, you know, one thing that - the thing that comes to mind first is that, you know, we have certain pathogens that really can't survive in certain climates. You know, so thus the field of tropical medicine, right? And now some of those pathogens will now be able to survive as climate changes. It'll be less predictable kind of what will happen and what regions. For example, we recently had an outbreak of (inaudible) fever in Italy where that wasn't possible or likely previously. So I think that's one of the concerns that I have. There'll also be more weather-related disasters, and these disasters disproportionately impact people who have less means and less power. And so I think human resilience and response, recovery from these disasters is going to be extremely expensive to the economy, and the impact on people's lives, and quality of life is going to be great.
JOHN: That's a great overview. That sort of, in my mind, mirrors the changes that we're seeing. I'm an ecology by training, so it's thinking about how ecology is responding to climate change. There are those exact two bookends to think about. The first is just gradual shift in species distribution. So, like, we're watching all the western forests burn down, and I like to say to people, "Well, we're going to have to choose the ones we want to save, because otherwise they're all going to burn down and that range is just going to move north, ri...?" And then the disaster piece is so important, especially when we think about droughts and floods, and the current drought that's happening in the Mississippi is a good example.
THOMAS: (Inaudible) in communities that have not - this is not necessarily well-situated to respond. So I'll give you a good example. That Hurricane Ida that hit Louisiana last year in 2021... I used to live in Baltimore in the Northeast. President of the University was President (Fisk), he used to live in Philadelphia. We both still retain our homes in those cities. Well, Hurricane Ida hit New Orleans and then continued up the Eastern Seaboard through Philadelphia and Baltimore and to New York, and did more damage to our homes in Maryland and in Pennsylvania than they did to New Orleans. So which geographic areas will have to respond to these disasters will be different than what we've become accustomed to, and they're going to have to be prepared - better prepared to respond to these disasters. I mean, this is - I think it's going to be - it's an existential threat to humanity, but in the meantime, you know, it's going to be an economic disaster that we're going to have to be able to mitigate as well as recover from these disasters. And then of course the inequity issue, which I'm sure you're going to want to talk about in terms of who is impacted and how much.
JOHN: For sure. And let's dive into that. I do want to come back to the disaster idea in the context of "should I stay or should I go?" retreats - unmanaged retreat, managed retreat, the hard questions that nobody wants to talk about. We'll come back to that at the end, okay?
THOMAS: Oh, sure.
JOHN: Let's dive into the equity piece. So World Health Organization says the following: "There is ample evidence that social factors including education, employment status, income level, gender, and ethnicity have a market influence on how healthy a person is. In all countries, whether low-, middle-, or high-income, there are wide disparities in health status of different social groups. The lower an individual's socioeconomic position the higher risk or poor health." Give me some examples of these in the context of climate.
THOMAS: So the one that comes to mind most readily is - so in New Orleans, where you and I both now live, we're a city where significant portions of the city are substantially below sea level, right, and we're surrounded by water, right, on all sides. We have a levee system that was very successful in managing Hurricane Ida, which was the largest storm to ever hit the city. But when you look at the terrain here in this city, when I moved here and was looking for a house I got an altitude app for my phone where I would check the altitude of the homes that I was visiting? There's a correlation - at least I didn't do a study here, but I sort of found anecdotally a correlation between altitude and affluence, so the community. So the more affluent the community the higher the altitude; the poorer the community the lower the altitude. And so these are the communities that are going to be most severely impacted, and so the health implications of disasters are going to have disproportionate impacts on those types of communities. So that's just one pathway where it occurs.
JOHN: Just an anecdote, Ida was my first hurricane. I sheltered in place. I sheltered in place because I felt like it was so relevant to my job at Tulane to see not the storm--because I'm not a storm-chaser--but rather see what unfolds afterwards. As a naïve westerner my first observation wasn't - the storm doesn’t matter; it's everything that happens in the few days to weeks after the storm passes.
THOMAS: Exactly. That's exactly (inaudible).
JOHN: So tell me about - let's think about this globally. We're talking about New Orleans. Tell me about how this unravels, like, in Global Health in the developing world, for example. What kinds of questions do we have there that are different in the United States?
THOMAS: So again, I mean, I think it comes down to who has the power and the resources to mitigate. When you look at mudslides that we see happening and these disasters that are happening... I recently Googled the word "flooding," which may seem like a strange thing to Google. But when you're a public health person and you live in New Orleans flooding is sort of top-of-mind (inaudible) than most other places. And the number of articles published in just the last sixty days about, you know, sort of water-related disasters around the world was stunning. And you look at the countries, you know, they vary quite a bit--fairly affluent countries, Germany for example was one--but they tended to be the poorer countries, countries that had fewer resources to mitigate. So, you know, if you're not able to do that and you have a city that's built on a hill, or a mountain that's nearby, when you're going to have these mudslides they're going to disproportionately happen in those types of communities where they haven't been able to allocate the resources to prepare for those sorts of disasters. But then as you pointed out earlier, after the disaster how quickly can you recover is impacted by the economic status of the community that you're talking about, the country that you're in, whether or not they'll have the resources to do what's necessary to get the power grid back online to be able to bring clean water, safe drinking water to people, and food. So it's - again, when you have power, when you have economic resources, you're able to in a sense purchase your way out of harm's way. And if you can't purchase your way out of harm's way you can purchase your way, you know, into a quick recovery. And, you know, countries that don't have those types of resources just don't have the ability to do that.
JOHN: Well, let's come back to New Orleans and the United States. You and I have talked a lot about the pandemic in the context of this topic. And one of the things that I really was aware of sheltering in place is we were going through I think either the delta or the omicron wave when Ida hit, and that - the interaction between that disaster and Ida was poignant. Like, I could feel it, right? Because people didn't know whether to do physical distancing, because they had to flee together, right, and be in places that were shelters they weren't familiar with. Talk to me about COVID, about what we've learned from it, and sort of the intersection with climate as a disaster.
THOMAS: Yeah, so COVID is another case where geography mattered quite a lot. And, you know, this country is dramatically segregated by race and by economic status. And so the impact of that, you know, that if you have a disease outbreak that's infectious, and it occurs in a community, it's going to circulate in that community first, right? So when COVID, you know, hit New Orleans, you know, we were one of the early hotspots along with New York City. New York and New Orleans were the two early hotspots here in the United States. The cases were disproportionately in the segregated black communities, mostly in New Orleans east and central city. And what was interesting, we early on built a map - after the data on mortality came out we built a map looking at the location of the people who died and plotted that against the location of the drive-through testing site that had been established here in the city. And you could see there was a clear disconnect. The drive-through testing sites were not where the need was, and the people that needed the testing were not able to get to the drive-through testing sites, right? And so the geography of disease is such that disease that passes on the basis of proximity--like an airborne disease like COVID--is going to circulate within a community, so it's more likely that the person that is infected - that you infect is going to be someone that is more like you, or lives with you, or lives in your community. And that's where you have these clusters of death of disease that occurred. You see the same pattern here with these disasters because, again, certain communities are at greater risk because there's less resources to mitigate, and people who don't have the resources to drive out to their weekend home and ride out the storm there, or who can't afford to incur a $2000 hotel bill to stay in a hotel somewhere for a week and a half. You know, those are the people who disproportionately find themselves riding out the storm at home and taking on what can be a significant risk, especially if you are living in a community where mitigation is more difficult and you're at greater risk because of things like a lower altitude. Or another issue is if you go to some neighborhoods in this city--and this is not just New Orleans; I'm using New Orleans as an example really because we both live here now--you notice how many streets are not tree-lined. You go into some of the communities, or the black communities, especially in the eastern part of the city, and you see houses but there are no trees, which means that there's greater heat spots and heat-related illness that's going to be higher in those communities. There are clear solutions to those problems, for example planting trees, right? But can the city afford to do that? Does the city have the resources? This is one of the poorest - second-poorest state in the country, third-poorest city. And so these sort of problems can compound each other, and they begin to create this kind of nexus of one problem impacting the other problem, and the same people being infected by the various problems that are happening, or various, you know, health risks that are occurring. These are the challenges that we face. And why climate change is such a complex problem that really requires a truly multi-disciplinary approach, because it will impact - and it is impacting every aspect of our lives. And certainly within health it's impacting every aspect of health, whether it's mental health, physical health, infectious disease, even access to healthcare is affected by (it).
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JOHN: Coming up I ask Thomas where more research is needed to help address he inequities in health that result from climate change, and the challenges of inequity when it comes to clean-water access.
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JOHN: That's great. I think you touched on a couple of things there that I just want to highlight for an audience that is mostly water-wonks, but we're talking about public health here. So one of the things that my mind immediately drifted to when we were in the middle of wave 3 or 4 of COVID and Ida hit, was people are going to be crowded together sheltering in space, and it's going to exacerbate the COVID infection rate of the city. And I don't know if the data bore that our afterwards, but it certainly seems like at least a visual for listeners to think about in terms of the interactions between climate-related disasters, in this case, but it could be heat like you said, and another illness or disease. Let's turn to research for a little bit here. You and I both know this well. The NIH recently launched a program-wide initiative on climate change and health and there's a piece of that that - a significant chunk of that that's equity-related. In my view this is super groundbreaking because I think it signals that we're literally feeling climate change in our communities at the population level, or in our households, or personally. And what I've been characterizing this effort as is viewing climate change as a novel co-morbidity, one that's acting now. You touched on a couple of things. Can you kind of stand on this? Like, what do you think - what diseases that are traditionally studied by NIH need to be studied in the context of climate change, the ones that are most pressing?
THOMAS: Actually, you know, there was a lot of debate, and I guess there still is some debate, about whether NIH even established a new institute to focus on this. You know, I'm frankly ambivalent about it. You know, I see pros and cons of that debate. And I think NIH is currently organized around disease states, right? So institutes for heart disease, cancer, diabetes, you know, kidney disease, that sort of thing. But that really is I think problematic. And what makes this such an important deviation from the way NIH normally functions is that they're focusing on a driver of disease rather than the disease itself. And this is where I think NIH needs to go, and I think this is a perfect example. So I think, you know, climate change has the potential of impacting all sorts of disease, so injuries and accidents. Obviously we expect that, you know, there's going to be trauma that's going to result from disasters. Heart disease obviously, you know, what are (MIs) that occur in people who are under stress and duress. The impacts of heat on the heart is also, you know, well-documented. And infectious diseases, you know, we've been talking about COVID and physical proximity, and how it's... So I think it's - I don't think it impacts a particular disease state; it impacts multiple disease states and multiple systems, which is why you need an initiative that isn't focused on just sort of climate change and heart disease, or climate change and cancer, or something like that. This is I think a way of turning the NIH organization on its head, and I think it's well overdue. So we can do this in many other areas as well. Example: socioeconomic status impacts all of these conditions. And so the focus instead of being on a disease I think should be more focused on the drivers. And so I applaud NIH for this new initiative, but I think they need to do even more - even more in this direction.
JOHN: That's super interesting and it totally makes sense. So let's pivot on this same topic to equity. What are, in your opinion, the most important--and we're talking about research here because we're in the NIH (bin) here--what do you think the most important aspects of research or research questions are that would lead us to addressing some of the inequities that you've already laid out in health as they relate to climate change?
THOMAS: That's a really tough question. I think - because there's so much we don't know, and there's so much to be done. I think there's just such a wide variety of topics that need to be addressed. I mean, we do need to understand (and mentor) how implications here... I think that is going to - that has a lot to do with how we will be able to be resilient and not to be - to recover from disasters, for example. I mean, so I think mental health is important. Substance use and abuse is critical, because we know that's a way that many people will cope with the challenges. You know, we need to understand more about how product conditions will be impacted by changes in the climate. Not that we know a lot about that. I mean, we can sort of predict that heart disease is going to be a factor. As we are impacted by weather there'll be more stress on the body, and there will be stresses on the heart. So that seems likely, but exactly how that happens, what are the mechanisms, and what are the possible interventions there, you know, I don't think we know enough about that just yet. Boy, I could just go on, right? I think it's pretty much the whole waterfront of what NIH covers is going to - you need to take a close look at it. And, you know, and there's always that (chain) that we never thought of, that unexpected relationship, and we just don't know what that'll be.
JOHN: Well, I think your example of (dengue) is a perfect example, right? Like, that's just - oh, the tropics are going to move north and we're going to have tropical disease.
THOMAS: Oh yeah, we're going to get - we're going to have a case of (chaga) - we're going to have (chaga) in Alaska one day, you know? Now, maybe neither you nor I will be around long enough to actually see that happening, but... And when that starts to happen, you know, you'll have to kind of reeducate the healthcare workforce, people who deal with those conditions. I see it - it's not necessarily climate-change-related, although it may be, but I saw that in Trinidad. You know, I hadn't been in Trinidad in many years, and visited - came back and visited and noticed something I didn't see before, which was obese people. They just didn't have - you know, there wasn't much obesity there in the past. See much more of it now. And I was at the major hospital there in Port of Spain and we were talking about kind of what's happening and what big trends and patterns that they're seeing. And they were talking about how they were all trained for infectious disease because that's what were the primary causes of death in the country, and that's now shifting. They're having much more, you know, many more problems with climate conditions. They haven't been well-trained to deal with diabetes and these other conditions that are quite expensive and can be very complicated to manage. So I think this is what we're going to be facing as the healthcare infrastructure around the world is organized to address the local problems. But as those local problems begin to shift as the climate change and we start to have different local problems, we're going to have to be nimble enough to adjust to these changing dynamics. And we're going to have to have the resources to be able to afford to do that. So here is a - yet again we have an opportunity for income inequality to play a huge role in how communities are able to respond.
JOHN: Very good, I like - the Trinidad example is super interesting. Let's pivot to a third topic and get kind of to the water part of this segment. This is a water podcast after all. The U.N. Secretary General says this in preparation for U.N. Water Day, March 22nd: "Today 40% of the world's people are affected by water scarcity, 80% of wastewater is discharged untreated into the environment, and more than 90% of disasters are water-related." We've talked about disasters a bit already in this segment. I want to go to that wastewater piece and to water access. And this is particularly relevant given the recent disaster in Jackson, Mississippi, right? Access to clean water and sanitation. Talk to me about equity issues around sanitation and clean water access, especially in the rural South, and how climate change may affect that.
THOMAS: I think - frankly I think that the biggest effects here are economic and political, right? It's who has the resources to be able to allocate to addressing these water problems, but beyond that who has the political will? And I think in Mississippi my take on what was happening there is that this is more a matter of political will, scarce resources, and those with political power deciding to allocate those resources in different ways, in ways that disadvantage the city of Jackson. And so there's an important political dynamic here. You look at Flint, again...
JOHN: I was going to say, not much different than Flint, right?
THOMAS: Similar type - similar situation. Who had the power to make a decision, and who made a decision, and was that decision really made with the best interest of the people in that community? And I think we can all agree that that was not made in the best interest. And, you know, so the political determinants of how - have always been there. And I think, again, it's - with climate change - the decision not to seriously address climate change is a political decision. And so in many ways the level of destruction as it results from climate change and the impact that it will have on people's health will be in part a political factor.
JOHN: Right. So a little bit of follow-up on that. We - at Bywater we just produced an infographic on situations like Jackson. So we looked at cities across the south and found many examples of cities that have both combined sewer and wastewater like Jackson did, and are of similar size, and are majority black, that a Jackson could happen in. How do we prevent another Jackson from happening in these cities given what you've said about political will and things?
THOMAS: Yeah, I don't know that we could. It comes down entirely to the political will to allocate the resources to, you know, upgrade those systems. And, you know, I just don't see that here. I think that's where the problem rests. You know, we know these issues are here. One of the - very early in my time here in New Orleans I get a phone call from the Mayor's office, Mayor wants to meet with me. And it had to do with problems that she was having with the water system here in New Orleans and they needed someone to come in and do some testing, and help advise them how to respond to the fact that when the system was built here more than 100 years ago that they built hydraulics into the system because they got the bright idea that, you know, maybe they could use the water to generate some energy. And that 100-plus-year-old system now was sort of leaching chemicals into the water, and it was going to coast upwards of $30 million to correct this problem. And they needed someone to come in and do some testing and help them - help advise them on what - how urgent the problem was and how they might move forward. So these systems are there. You have to have political leadership who care about addressing these issues, and then you have to have the resources. So in the case of this mayor we had a mayor that cared about the issue and sort of wanted to bring people in to help look at this and advise on what to do. But then it came down to, well, where's she going to find $30 million to fix this problem? So you're talking about the poorest region of the country, which is also the region of the country where social and economic inequalities, and particularly inequality as it relates to race, has been, you know, a major problem, sort of been the epicenter for that. And these systems are disproportionately threatening people of color who are in many cases viewed as being less valuable. So I think the political will is the biggest problem here, followed by the economics, the fact that you just don't have the resources to mitigate.
JOHN: So that's an example, probably a rare one, of where leadership is willing to put the resources in the right places but the resources aren't there. Right now we're floating in money from infrastructure and a number - infrastructure, bipartisan infrastructure bill, and lots of other avenues for funding to get to communities.
THOMAS: It's the communities that are best organized that are going to be able to get access to those (replenishing) infrastructure. And so I'm really curious to see whether we deal with the broadband problem in the rural South from this investment. My supposition is that we're not going to adequately address that problem because those regions just don't have the political clout to ensure that their needs are at the forefront.
JOHN: I'm glad you brought that up. I was just at a meeting at the Aspen Institute on Disasters and we were talking about this exact thing, both the rural and the poor urban context. So there's a power dynamic obviously that's related to equity, but there's also an organization element of it. And one of the things that we discussed--and I'd love to hear your opinion about this--is the need for not only there to be this sort of top-down flow of resources, but organization at the community level about what futures could look like. How much of that is relevant to the intersection between public health and climate change?
THOMAS: It's critical. It's critical. Because the political will is only going to be influenced by, you know, people who are able to impact policymakers. And if communities aren't organized it's going to be those who have the resources, the people - you know, lobbyists and others who are able to get access to policymakers and ensure that their interests are at the forefront. It's going to be the poor communities, the communities that have less ability to, first of all, even identify what the issues are for their community and how to articulate them, and then be able to get access to policymakers is going to be a difficult problem for those types of communities. And so what could wind up happening is that with this investment coming from the federal government we may wind up actually exacerbating the inequities because the better-organized, better-resourced communities re going to be able to get even better, improve their infrastructure even more. And the communities that are not able to gain access to those resources will not make any progress. And so we'll have an even bigger gap between the haves and have nots.
JOHN: So do you think that that scenario plays out even in greater New Orleans area, like between downtown and uptown, and New Orleans east? Is it at that microscale, or is it more a rural-urban thing?
THOMAS: Well, the largest industry in New Orleans is tourism, and mostly tourism from the French Quarter. And the French Quarter is literally the economic engine that drives the entire state. It is the state that taxes the French Quarter, not the city of New Orleans. Those tax revenues go to the State of Louisiana, not to the city of New Orleans, which means that New Orleans, while it hosts this economic engine, just does not get (inaudible) only get a proportionate benefit from it, and the rest of the state gets more of a benefit from it. So yeah... And if you're the city, right, and you've got resources to allocate, where are you going to allocate those resources? Are you going to allocate them to the French Quarter and to the other tourist areas, because that's the economic-engine? Or you're going to allocate them into communities that are not generating revenue. It's partly an issue of will - political will; it's also an economic reality. And these are the challenges that we face.
JOHN: It's so interesting and ironic, too, because the French Quarter is there because it's on the highest ground, right, which automatically sets up this inequity that we've been discussing with respect to safe spaces for people in the face of climate-related disasters. Well, great. Well, I think that covers just about all I wanted to talk about. Is there anything that you want to - you want to add that I didn't ask you about or...?
THOMAS: Yeah, I think we're all trying to figure this out. I mean, and when I say "this," I mean those of us in higher education are trying to figure out how do we prepare the next generation of the workforce to be able to respond to this? There's so much we don't know and so much we're just trying to figure out. You know, I think that, you know, these types of conversations are really critical because we've got to figure out how climate change is going to roll out, how it's going to impact health, and how we need to educate the next generation of public health workers and other health workers to be able to respond to it. So thank you for this opportunity to have this conversation. I want us to continue to keep talking about this...
JOHN: For sure.
THOMAS: ...because we've got to figure this out. Because I think it's - you know, I don't think I'm - something with this audience I know they'll get it. But this is literally an existential threat to humanity, and we're going to have to gear up and do our part. And, you know, there are certain segments of society that - sectors of society that maybe aren't doing as much as we'd hope they would do, but we have to do as much as we can where we are.
JOHN: Thanks a lot, Thomas. It's been great talking to you.
THOMAS: Thank you.
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JOHN: That's it for this episode of Audacious Water. If you like the show please rate or review us and tell your colleagues and friends. For more information about Audacious Water visit our website at Audaciouswater.org/podcast. Until next time I'm John Sabo.
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END (THOMAS LAVEIST INTERVIEW)