Climate Change and Human Well-Being in the 2020s: Lessons From 2020

Abstract

Behind the coronavirus headlines the year 2020 set multiple extreme weather records, including unprecedented wildfires in Australia and California, massive flooding in China, and back-to-back hurricanes in Central America. The impacts on the well-being of local populations have been devastating. We reviewed these extreme weather events, together with the year’s newly published climate and health science reports, and identified three important themes for building health resilience in the decade ahead: (1) preparing for greater magnitude and intensity of climate hazards, extreme events, and population health impacts; (2) better anticipating cascading and compound impacts on population well-being, particularly for the most vulnerable; and (3) identifying appropriate, effective preparedness tools and strategies. While decarbonizing the economy is the urgent goal to protect both human and planetary health from a changing climate, 2020 demonstrates that recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

Keywords

climate change adaptation public health extreme weather

Introduction

The first year of the 2020s was indelibly marked by the COVID-19 pandemic; yet, behind the coronavirus headlines was another stark reality: 2020 set multiple extreme weather records. The year tied 2016 as the warmest yet documented.¹ Wildfire seasons in Australia, California, Siberia, and the Pantanal were exceptional in scope and intensity.^2,3 The Atlantic hurricane season was the most active on record, producing 30 named storms, while the strongest-ever typhoon (Goni in the Philippines) and the costliest (Amphan in India and Bangladesh) made landfall in Asia.⁴ Torrential rain and flooding across much of China created one of the most massive and expensive weather disasters, while record rainfall and flooding occurred in many other parts of Asia, Africa's Sahel, and Europe.⁵ The impacts of these record-breaking events on the well-being of local populations have been devastating.

The 2020s will be critical for climate change policy. During this decade, society must make substantial progress toward decarbonizing the world economy to meet the Paris Agreement goal of remaining within 1.5 °C net global warming by the century's end—and it must also work to build sufficient, transformative local resilience to protect human populations from climate change hazards that may be unavoidable.⁶ What do the extreme weather events of 2020, and the year’s newly published climate and health science reports, suggest as lessons for the critical decade ahead? We reviewed 2020 through the lens of the health-related climate change news and science highlighted in our monthly newsletter, Climate and Health News.¹ Our focus was on wildfires and floods, two of the year's most impactful climate hazards.

Megafires: Waiting for the Rain

The term Pyrocene—coined for the current era in which fires abetted by human activity are “more frequent, more damaging, and more terrifying” ⁷—took on new relevance in 2020 with unprecedented fire seasons worldwide. Two broad, interacting factors—global warming-driven increases in aridity and land-use changes—have created conditions in many regions for rapidly spreading megafires.⁸ These large fires (burning at least 100 000 acres, or 40 500 ha) are particularly challenging to extinguish.⁹ As described by one firefighter: “We keep the fire, we do not fight it; we do not sleep, we get post-traumatic stress, and we wait for the rain.”³ Wildfires cause injury and death directly. Exposure to wildfire smoke and smokewaves (two or more days of heavy smoke¹⁰) can also damage respiratory and cardiovascular systems, as well as liver, kidney, immune, ocular, and other systems.^11–13 Exposure to PM₁₀ is the most examined wildfire smoke contaminant (1.2-10 times higher in wildfire settings), while respiratory disease is the most commonly studied association (asthma has the strongest association), and children, elderly, those with chronic disease, and firefighters are among the most vulnerable.^11,12 Longer-term effects of wildfires include mental illness, such as insomnia, depression, and posttraumatic stress disorder (PTSD) among those displaced, affected by loss, or fighting the fires.¹³ Contamination of groundwater (by ash or fire retardant) is also a concern.² The 2020 wildfire season was marked, in particular, by unusually extreme fires in Australia and California.

Australia’s Black Summer

The year 2020 opened in the midst of Australia's unprecedented bushfire crisis, in a summer of extreme heat and drought. The Black Summer fires (November 2019-February 2020) burned 19 million hectares (about 2% of the country's land and more than 20% of its forests), causing 33 direct deaths, destroying more than 3000 homes, displacing tens of thousands of people, and leading to some $100 billion in damages.¹⁴ The Gospers Mountain fire (which burned more than 500 000 ha) is thought to be the largest single-point fire ever recorded; combining with others in the Central Coast, it created a massive blaze, dwarfing the largest fires in California or the Mediterranean.¹⁵ Such continent-wide impacts led to warnings of “the end of Australia as we know it”¹⁶ and concern that more such fires “might destroy the future of Australia.”¹⁷ Sydney and Canberra endured weeks of hazardous smoke, with PM₁₀ exceeding regulatory limits by 10-fold or more, leading to 417 estimated excess deaths and nearly 4500 hospital visits or admissions.¹⁴ Concern has been raised about a looming mental health crisis in the country: depression, PTSD, anxiety, alcohol use, domestic violence, suicide, and child learning delays are all thought to have risen.^18,19 Estimates suggest more than 8 million people, one-third of the country’s population, may have been impacted in some way.¹⁵ As the bushfire season wound down, the COVID-19 pandemic began, and rainfall brought the mosquito-borne Ross River virus to some regions; these interacting hazards burdened an already overstretched public health system.²⁰ Australia has established a National Bushfire Recovery Agency,¹⁹ and experts have called for a national fire monitoring agency.²¹ However, the 2020 Black Summer bushfire season caused some to wonder if Australia's health system was equipped to handle what became a national humanitarian crisis.²²

California’s Gigafire Year

California’s 2020 wildfire season (July-November) resulted in the burning of 1.8 million hectares or 4% of the state’s territory (one-tenth of Australia’s total), making it the most extensive California wildfire season in the modern record; the fires caused 33 deaths, destruction of more than 10 000 homes and other structures, displacement of tens of thousands of people, and led to more than $12 billion in damages.²³ The region's complex winds, extreme heat and increasingly dry landscape, residential development in forested areas, and restrictive forest management practices combined to dramatically enhance risk.²⁴ The August Complex fire in Northern California eventually spread to 1 million acres (405 000 ha), leading to a new term: gigafire.²⁵ The smokewave produced by the fires made air quality in San Francisco the world’s worst at the peak of the fires,²⁶ reddening the daylight skies. Smoke traveled thousands of miles, reaching the East Coast. A total of 1 in 7 Americans, or about 46 million people, were estimated to have experienced wildfire-related dangerous air quality.²⁷ The co-occurrence of wildfire season and the pandemic made evacuation and sheltering a challenge, with smoke worsening COVID-19 symptoms and exacerbating the mental stress of what one firefighter called “a disaster within a disaster”.²⁸ Electric power lines played a role in sparking some fires; Pacific Gas and Electric (PG&E) has been found liable for some damages in the 2017 to 2019 fire seasons²⁹ and potentially also for 2020.³⁰ Record heat and aridity led PG&E to preventively shut off hundreds of thousands of electric power consumers, further complicating management of extreme heat through loss of refrigeration and air conditioning³¹ and indicating the intimate linkage of wildfire hazard, electric power infrastructure, and community well-being.

New Health and Wildfire Research in 2020

Previously identified health and wildfire research gaps have included differentiating wildfire smoke from background PM sources, association of wildfire smoke with morbidity from nonrespiratory diseases (particularly cardiovascular disease and mental illness),^11,12 and need for enhanced preparedness research.¹² Many of these gaps were the focus of 2020 research. For example, a review of Australia's bushfire smoke and brain health concluded that wildfire PM is likely more toxic than ambient PM.³² A study of the association of cardiac arrest and smoke from the 2015 to 2017 California wildfires showed increasing risk with exposure that was greatest among those of lower socioeconomic status.³³ Another review recommended strategies for monitoring and treating mental health and strengthening community resilience.³⁴ A systematic review protocol set out plans to identify health impacts of wildfires on firefighters and ways to reduce their risks.³⁵ A review of health effects in children called for enhanced preparedness, prioritizing low-cost smoke sensors, masks, and air filtration,³⁶ while a review of Australia's Black Summer proposed monitoring preparedness indicators, including household smoke alarms, response time for fires, and numbers of firefighting personnel and aircraft.¹⁴ A new comprehensive review of wildfire causality and health effects provides a useful summary of research to date.¹³

Extreme Floods: Roads Become Rivers

Globally, floods are the most common type of weather-related disaster and are mainly associated with extreme precipitation.³⁷ Flood types differ, from coastal flooding and storm surge to fluvial (river) or pluvial (runoff) flooding, flash floods, and compound flooding of multiple types.³⁸ Health effects vary depending on flood type and differ over time.³⁷ Floods, particularly from storm surge and flash flooding, pose immediate danger to human health from drowning and injuries, whereas concerns in the days and weeks after flooding include increased risk of complications from cardiovascular disease and diabetes; infectious disease outbreaks, such as hepatitis E, gastrointestinal disease, and leptospirosis; and in some cases inadequate nutrition.³⁹ Storm-related flooding impacts can also include poisoning and skin infections.⁴⁰ Mental health impacts, including depression and PTSD associated with displacement, sheltering, and loss, have been found to remain for years after floods.^37,39 In 2020, two catastrophic examples were compound flooding across much of central and southern China due to rains so intense “roads became rivers”⁴¹ and coastal and flash flooding in Central America caused by two back-to-back major hurricanes.

China’s Unrelenting Plum Rains

Severe flooding affected 27 provinces of central and southern China in the summer of 2020, with the country's June to August “plum rain” wet season bringing unusually intense precipitation for 41 consecutive days.⁴² The rains led to 33 rivers reaching record highs, including China’s largest Yangtze and Yellow Rivers.⁴³ At least 219 people lost their lives through drowning and accidents, 400 000 homes were destroyed, some 820 000 people required emergency assistance, and more than 4 million were evacuated or displaced; more than 63 million people, about 4.5% of the country’s population, are estimated to have been affected in some way.⁴² Flow releases from the massive Three Gorges Dam are thought to have helped reduce the impact of flooding overall,⁴⁴ although water released to alleviate risk also may have compounded fluvial flooding in some areas.⁴³ The economic costs of the flooding damage were estimated at $32 billion.⁴² To combat risks of urban flooding and improve water resource management, the Chinese government had introduced in 2014 the Sponge City program, which supports investment in local urban drainage works designed to absorb excess rainfall runoff (into soils or retaining storage facilities where it can be reused).⁴⁵ After several years of implementation, reviews have begun to draw the lessons from this ambitious program.⁴⁶ While flood management has been enhanced in many cities, some concerns have been expressed—for example, 19 of 30 participating pilot cities still experienced flooding due, in part, to lack of local integration of newer initiatives with larger flood control infrastructure.⁴⁵

Central America’s Twin Hurricanes

In November 2020, two Category 4 Atlantic hurricanes struck Central America, with particularly dire impacts felt in Honduras and Nicaragua, two of the region’s poorest countries (Nicaragua is the second-poorest nation in Latin America, while two-thirds of Hondurans live below the poverty line). Hurricane Eta lingered for three days over the region and unleashed more than 20 inches of rain; Hurricane Iota followed two weeks later, just 15 miles from where Eta made landfall and before residents had a chance to recover.⁴⁷ The losses from the two storms combined included more than 300 dead or missing, with damages estimated at more than 40% of Honduras’ gross domestic product (GDP) and more than 6% of Nicaragua's GDP.⁴⁸ In hardest-hit Honduras, storm-related flooding destroyed tens of thousands of homes, displaced 1 million people, and affected 4.5 million people in some way.⁴⁹ Striking during the COVID-19 pandemic, the storms made safe sheltering difficult for those evacuated. According to one observer: “you don’t see mask use…the shelters are just overwhelmed.”⁵⁰ Dengue fever outbreaks compounded the public health challenge. The World Bank has supported both countries’ hurricane response and recovery efforts: in Honduras, providing $150 million for emergency relief, community and infrastructure facilities (reconstruction of roads, electric power and water services, schools, and health clinics), and disaster response capacity,⁴⁹ and $80 million for Nicaragua for emergency relief and rehabilitation of the damaged fishing sector.⁵¹ Yet the devastation has driven waves of migration to the United States and elsewhere,⁴⁷ as those who were evacuated from the disaster had “more reason than ever to migrate north.”⁵²

New Health and Flooding Research in 2020

Health and flooding research gaps that were previously identified include the association of flooding and mental illness,⁴⁰ cost-effective preparedness strategies,³⁹ and health effects of flooding (nonstorm-related) alone.⁴⁰ Some of these gaps were addressed in 2020 research. For example, one analysis of Taiwan's Typhoon Morakot found significantly increased cardiovascular disease-related mortality in adults 2 years after the event,⁵³ while an evaluation of insomnia, anxiety, depression, and PTSD found an increase of 2-fold following the disaster.⁵⁴ A study of floods in the United Kingdom found higher prevalence of mental health outcomes in those flooded, including depression, anxiety, and PTSD.⁵⁵ In a study of Houston's Hurricane Harvey, Blacks and the unemployed were much more likely than Whites or the employed to have PTSD.⁵⁶ A study of New Orleans’ Hurricane Katrina found a legacy of damaged infrastructure throughout the city, 15 years after the disaster,⁵⁷ while a review of UK floods found infrastructure deterioration was a primary driver of urban flood risk.⁵⁸ Flood preparedness was also prioritized in one review,⁵⁹ while a study of Hurricane Harvey found those who took preparedness measures fared better in the storm-associated flooding.⁶⁰ A review of nonstorm flooding in Europe found heavy rainfall to be the most commonly reported driver of disease outbreaks.⁶¹ However, flood research was mainly storm-related; nonstorm flooding remains a gap.

Building Health Resilience in the 2020s

The news and science reports regarding these extreme weather events of 2020 suggest three themes for building health resilience in the decade ahead. First is preparing for greater magnitude and intensity of climate hazards, extreme weather events, and population health impacts. Population impacts in each of the four extreme-weather examples were region- or continent-wide; together, these events alone—in a year with multiple other extreme weather disasters—affected well more than 100 million people, including millions who were and remain internally displaced. There is growing recognition that the speed and synergistic nature of climate system changes have likely been underestimated; impacts seem to be occurring more rapidly and with greater intensity⁶² and will affect human health as they have in 2020. Second is better anticipating the complexity of impacts on population well-being. The examples illustrate multiple cascading effects involving climate hazards, physical infrastructure—such as electric power, water, and drainage—and health.⁶³ The further compounding of climate-related health risks with other infectious diseases, such as COVID-19 or dengue fever, can combine to overwhelm public health systems. The need for enhanced knowledge of comparatively less well-studied health risks (eg, mental illness) and populations (eg, first responders and excluded or marginalized groups) would improve knowledge of how to protect the most vulnerable.

Third is identifying appropriate, effective preparedness tools and strategies. Among these are hazard mapping, early warnings and alerts, preparedness drills, monitoring of risk-preparedness indicators, and collaborative governance arrangements that ensure public health agencies are engaged with emergency management, infrastructure utilities, and other agencies and integrated into preparedness and response. With growing awareness of hard and soft limits to adaptation, it will become increasingly important to define ways to spur transformational responses to anticipating and managing risk to human well-being,^64,65 and public health perspectives are needed. While urgently decarbonizing the economy is the overarching goal to protect both human and planetary health from a changing climate, recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Mary C. Sheehan

Notes

Author Biography

Mary C. Sheehan is a faculty associate at the Johns Hopkins University (JHU) Bloomberg School of Public Health and a lecturer at the Pompeu Fabra University (UPF), and she teaches and carries out research on climate change and well-being with the Barcelona-based joint JHU-UPF Public Policy Center. Dr Sheehan’s research involves integrating public health more centrally into climate change resilience planning and practice, particularly across the world’s large cities. She holds a PhD and MPH in environmental risk assessment from the JHU Bloomberg School of Public Health and an MA in natural resource economics from the Fletcher School at Tufts University. Prior to work in academia, Dr Sheehan held various positions over 20 years at the World Bank, where her work focused on supporting environmentally sustainable infrastructure development in low- and middle-income urban areas and postconflict settings.

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