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National Assessment of
Human Health and Extreme Events
Preparing for the health and welfare implications of unusual climate episodes is likely to become more important as climatic patterns shift and landscapes change. This is likely to be particularly important because health care options for those Native American's living on reservations are limited by time and distance and have the potential to be impacted by extreme weather events. Also, Native housing is typically more sensitive to the prevailing climatic conditions than the national average for housing. As a result, increasing use of air-conditioning is not as ready a means of addressing an increasing frequency of very hot and dry conditions. In addition, increased dust and wildfire smoke could well exacerbate respiratory conditions. Because the environmental, social, and economic impacts of climate changes on human health are so interrelated they will be discussed together in this section.
Environmental, Societal, and Economic Impacts
Climate change is likely to exacerbate the delivery of and need for health services. Reservation populations are continuing to increase, as birth rates remain high, longevity increases, and tribal members move back to their home communities from urban areas. The institutional structure of health care delivery to Native peoples, however, differs sharply from the market-driven system that provides medical care for rural non-Indians. The federal government, as part of its trust responsibility for Indian people, provides the health care systems for reservation residents. The Indian Health Service (IHS), part of the United States Department of Health and Human Services, is the primary provider of medical services to Native peoples. IHS operates clinics, pharmacies, and hospitals in many tribal communities; in others, tribes have contracted with the federal government to operate health care facilities themselves.
Access to these health care facilities, however, is not always easy for reservation residents, particularly under extreme weather conditions. A single hospital, for example, serves the entire Rosebud Sioux reservation in South Dakota, where many roads are unpaved. The external boundaries of the reservation are approximately 120 miles east-to-west, and 60 miles north-to-south. The hospital is located in the southwestern part of the reservation and access can be disrupted or cut-off by extreme precipitation conditions (whether rain or snow). Because of the distances that many Native people must travel to health care facilities and the conditions of the roads, their access to health care is more subject to sharp variations in the weather than those living and working in cities. Extreme weather events are likely to cause significant interruptions in access.
Changes in climate would also create new challenges for community health. Drier summer conditions and the projected increase in forest fire incidence would likely lead to increased lofting of dust and dust-borne organisms and an increase in forest fire incidence. The poorer air quality resulting from increases in smoke and dust would likely increase respiratory illnesses such as asthma. Hypertension and adult-onset diabetes are pandemic in tribal communities. As life spans increase, larger portions of the populations are becoming increasingly vulnerable to extreme temperatures, and increasingly dependent on uninterrupted access to such therapeutic interventions as kidney dialysis. Further, direct and side effects of many standard medications are affected by climatic conditions.
The rural living conditions of many Native peoples also increase the likelihood of impacts due to variations in the weather. Due to the poor economic conditions, housing on many reservations is old and offers limited protection from the environment. Although many traditional structures are designed to take advantage of the natural warmth or coolness of the landscape (e.g., by being located below ground, having thick walls, and being exposed to or sheltered from the sun), adaptation, both physiological and through the use of appropriate clothing, is essential because homes in many areas lack effective heating and cooling systems. A recent study of energy consumption on Indian lands found that households on reservation are ten times more likely to be without electricity (14.2%) than the national average (1.4%). While warming in colder regions will reduce some home heating needs, some adaptation has already occurred so this additional warming will not significantly reduce stresses. In presently hot regions, however, there is likely to be a significant increase in natural heating that will require new acclimation and responses as new extremes are reached. While an increase in the presence of air-conditioned facilities would help, it would also require changes in behavior toward a more indoor lifestyle along with improved housing and access to electricity.
Strategies to Address Potential Impacts on Human Health
Several strategies are available as climate changes impact the health and welfare of those in the NPNH regions. Health care delivery systems that serve Native communities will need to educate health professionals, paraprofessionals, and patients on the potentials for dehydration, overexposure to sunlight, and the need to restrict activity during hot weather. This need for education and appropriate care is intensified because many Indian people live in substandard housing that exposes them to heat and cold. Much of the most effective health education in Native communities is carried out by Community Health Representatives (CHRs), paraprofessionals employed and trained by the Indian Health Service or individual tribal health programs. Specific training, focusing on climate-related health and wellness issues, and targeted towards CHRs could enhance use of a system that has already demonstrated its abilities to reduce infant mortality rates and improve care for the elderly among many Native peoples.
In addition, consideration should be given to the design and construction of appropriate housing for Native peoples. Most housing construction on many of the reservations is financed through the federal Department of Housing and Urban Development. Tribal housing authorities, however, have taken over much of the responsibility for design, construction, and management of both rental and mutual self-help (purchasable by the occupant) housing units. Given the likelihood of significant changes in average temperatures, precipitation levels, and severe weather events, training and regular updates for decision-makers and technical specialists within tribal housing authorities are needed to assist in improving the design, construction, or remodeling of homes to increase resilience to extreme weather conditions.
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