A n n a l s o f G l o b a l H e a l t h

ª 2 0 1 5 T h e A u t h o r s . P u b l i s h e d b y E l s e v i e r I n c .

o n b e h a l f o f I c a h n S c h o o l o f M e d i c i n e a t M o u n t S i n a i

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h t t p : / / d x . d o i . o r g / 1 0 . 1 0 1 6 / j . a o g h . 2 0 1 5 . 0 8 . 0 0 8
Climate Change, Human Rights, and Social Justice

Barry S. Levy, MD, MPH, Jonathan A. Patz, MD, MPH

Sherborn, MA; and Madison, WI
Both autho

No external

From the D



The environmental and health consequences of climate change, which disproportionately affect

low-income countries and poor people in high-income countries, profoundly affect human rights and

social justice. Environmental consequences include increased temperature, excess precipitation in some

areas and droughts in others, extreme weather events, and increased sea level. These consequences

adversely affect agricultural production, access to safe water, and worker productivity, and, by inun-

dating land or making land uninhabitable and uncultivatable, will force many people to become envi-

ronmental refugees. Adverse health effects caused by climate change include heat-related disorders,

vector-borne diseases, foodborne and waterborne diseases, respiratory and allergic disorders, malnu-

trition, collective violence, and mental health problems.

These environmental and health consequences threaten civil and political rights and economic, social,

and cultural rights, including rights to life, access to safe food and water, health, security, shelter, and

culture. On a national or local level, those people who are most vulnerable to the adverse environmental

and health consequences of climate change include poor people, members of minority groups, women,

children, older people, people with chronic diseases and disabilities, those residing in areas with a high

prevalence of climate-related diseases, and workers exposed to extreme heat or increased weather

variability. On a global level, there is much inequity, with low-income countries, which produce the least

greenhouse gases (GHGs), being more adversely affected by climate change than high-income countries,

which produce substantially higher amounts of GHGs yet are less immediately affected. In addition, low-

income countries have far less capability to adapt to climate change than high-income countries.

Adaptation and mitigation measures to address climate change needed to protect human society must

also be planned to protect human rights, promote social justice, and avoid creating new problems or

exacerbating existing problems for vulnerable populations.
K E Y W O R D S climate change, human rights,
inequalities, low-income countries, public health

© 2015 The Authors. Published by Elsevier Inc. on behalf of Icahn School of Medicine at Mount Sinai. This is

an open access article under the CC BY-NC-ND license (
“Climate change is a global problem with grave
implications: environmental, social, economic, political
and for the distribution of goods. It represents one of the
principal challenges facing humanity in our day. Its worst
rs wrote this manuscript.

funding was used in developing this paper. Dr. Levy and Dr. Patz d

epartment of Public Health and Community Medicine, Tufts Univer

Madison, Madison, WI, Global Health Institute, the Nelson Institut

nce to B.S.L. ([email protected]).
impact will probably be felt by developing countries in
coming decades.”

Pope Francis

Laudato Si
June 2015
o not have any conflicts of interest.

sity School of Medicine, Sherborn, MA (BSL); and the University of

e, and the Department of Population Health Sciences (JAP). Address�0/

mailto:[email protected]

A n n a l s o f G l o b a l H e a l t h , V O L . 8 1 , N O . 3 , 2 0 1 5 Levy and Patz
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Human Rights and Social Justice


Climate changedthe global climate crisisdmay be
the defining moral issue of the 21st century.1,2 The
environmental and health consequences of climate
change, which disproportionately affect low-income
countries and poor people in high-income countries,
have profound effects on human rights and social jus-
tice.3-11 These consequences threaten rights embod-
ied in the Universal Declaration of Human Rights,
such as the right to security and the right to a stand-
ard of living adequate for health and well-being,
including food, clothing, housing, medical care,
and necessary social services.12 They threaten civil
and political rights, such as “the inherent right to
life” and rights related to culture, religion, and lan-
guage, as embodied in the International Covenant
on Civil and Political Rights.

They threaten eco-

nomic, social, and cultural rights, as embodied in
the International Covenant on Economic, Social,
and Cultural rights, including the following14:

d The right of self-determination.
d The rights to freely determine one’s political status
and freely pursue one’s economic, social, and cultural

d The right “to the enjoyment of the highest attainable
standard of physical and mental health”.

d The right to education.

And they threaten the rights of women, as
embodied in the Convention on the Elimination
of all Forms of Discrimination against Women,
especially women living in rural areas of developing
countries, who are particularly vulnerable to the
consequences of climate change.15 National govern-
ments have a duty to ensure that all of these human
rights are promoted and protected.

The United Nations Framework Convention on
Climate Change (UNFCCC) is an international
mechanism for facilitating international cooperation
in stabilizing atmospheric concentrations of GHGs.
It states: “Parties should, in all climate change-
related actions, fully respect human rights.”16 The
UNFCCC has concluded that human-rights
considerations should guide the development,
implementation, and monitoring of policies, institu-
tions, and mechanisms related to climate that have
been established under the UNFCCC.

Adverse environmental effects caused by climate
change include increases in the following17:

d Temperature, as well as increased frequency and/or
duration of heat waves.
d Heavy precipitation events.
d Intensity and/or duration of droughts.
d Intense tropical cyclone activity.
d Sea level.

Other environmental phenomena related to climate
change include the shrinking of land-based glaciers,
increases in chemical pollutants and aeroallergens in
ambient air, and changes in ecosystems that reduce
biodiversity.17 The Intergovernmental Panel on Cli-
mate Change has performed comprehensive assess-
ments of (a) changes that have occurred and the
human contribution to these changes and (b) the
probability of further changes17 (Tables 1 and 2).

Adverse health consequences caused by climate
change include heat-related disorders, vector-borne
diseases, waterborne and foodborne diseases, respi-
ratory and allergic disorders, malnutrition, violence,
and mental health problems.18,19

There are large inequalities among countries in both
the amounts of greenhouse gas (GHG) emissions
and the magnitude and severity of adverse health
consequences experienced as a result of climate
change. Developing countries will experience the
greatest impact of climate change.20-25 In general,
those countries that contribute the least to GHG
emissions currently experience, and will likely
continue to experience, the most adverse health
consequences as a result of climate change
(Fig. 1).26 For example, in 2004, per-capita GHG
emissions in the United States, Canada, and
Australia approached 6 metric tons (mt), and those
in Japan and Western European countries ranged
from 2 to 5 mt. In contrast, annual per-capita
GHG emissions in developing countries overall
approximate 0.6 mt, and more than 50 developing
countries have annual per-capita GHG emissions
less than 0.2 mt.
Economic Impact on Poor Countries. As global
temperature increases, rich countries’ economies
continue to prosper, but the economic growth of
poor countries is seriously impaireddmore than
previously estimated.27 The consequences for eco-
nomic growth in poor countries will be substantial if
we continue on a “business-as-usual” path of
increasing carbon dioxide concentrations and rapid
climate change, with poor countries’ mean annual
growth rate decreasing from 3.2% to 2.6%.27 Poor
countries are likely to suffer a greater adverse effect
than rich countries from climate change because

Table 1. Assessment That Various Changes Have Occurred and Assessment of a Human Contribution to Observed Changes

Phenomenon and Direction of Trend

Assessment that Changes Occurred

(Typically Since 1950 unless Otherwise Indicated)

Assessment of a Human

Contribution to Observed Changes

Warmer and/or fewer cold days and

nights over most land areas

Very likely Very likely

Warmer and/or more frequent hot

days and nights over most land areas

Very likely Very likely

Warm spells/heat waves: Frequency

and/or duration increases over most

land areas

Medium confidence on a global scale

Likely in large parts of Europe, Asia, and Australia


Heavy precipitation events: Increase in

frequency, intensity, and/or amount of

heavy precipitation

Likely more land areas with increases than decreases Medium confidence

Increases in intensity and/or duration

of drought

Low confidence on a global scale

Likely in some regions

Low confidence

Increases in intense tropical cyclone


Low confidence in long-term (centennial) changes

Virtually certain in North Atlantic since 1970

Low confidence

Increased incidence and/or magnitude

of extreme high sea level

Likely, since 1970 Likely

From IPCC, 2013: Summary for Policymakers. In: Stocker TF, Qin D, Plattner GK, et al., eds. Climate Change 2013: The Physical Science Basis. Contribution of Working
Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press; 2013:7.

Levy and Patz A n n a l s o f G l o b a l H e a l t h , V O L . 8 1 , N O . 3 , 2 0 1 5

Human Rights and Social Justice
M a y eJ u n e 2 0 1 5 : 3 1 0 – 3 2 2

(a) they are more often exposed to very high tem-
peratures; (b) their economies heavily rely on agri-
culture, natural resource extraction, and other
sectors exposed to extreme weather variability;
and (c) air conditioning, insurance, and other
risk-management approaches are less available in
poor countries than in rich countries.


Risk Factors. Various socioeconomic, demographic,
health-related, geographic, and other risk factors,
Table 2. Assessment of the Likelihood of Further Changes in the E

Phenomenon and Direction of Trend

Likelihood o

Early 21st C

Warmer and/or fewer cold days and

nights over most land areas


Warmer and/or more frequent hot days

and nights over most land areas


Warm spells/heat waves: Frequency and/or

duration increases over most land areas

Not formall

Heavy precipitation events: Increase in frequency,

intensity, and/or amount of heavy precipitation

Likely over

Increases in intensity and/or duration of drought Low confide

Increases in intense tropical cyclone activity Low confide

Increased incidence and/or magnitude of extreme

high sea level


From IPCC, 2013: Summary for Policymakers. In: Stocker TF, Qin D, Plattner GK, et al
Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climat
such as poverty, minority status, female gender,
young age or old age, and various diseases and dis-
abilities, make populations or subgroups within
populations more vulnerable to the adverse health
effects of climate change. Adverse health effects
caused by climate change will likely be heavily con-
centrated in low-income populations at low latitudes,
places where important climate-sensitive health
outcomes (eg, malnutrition, diarrhea, and malaria)
arly and Late 21st Century

f Further Changes in the Early and Late 21st Century

entury Late 21st Century

Virtually certain

Virtually certain

y assessed Very likely

many land areas Very likely over most of the mid-latitude

land masses and over wet tropical regions

nce Likely (medium confidence) on a regional

to global scale

nce More likely than not in the Western

North Pacific and North Atlantic

Very likely

., eds. Climate Change 2013: The Physical Science Basis. Contribution of Working
e Change. Cambridge, UK: Cambridge University Press; 2013:7.

Figure 1. Data-driven cartogram maps demonstrating (A) relative proportions of cumulative carbon dioxide emissions, by country, and (B) magnitude and
severity of the consequences of climate change for malaria, malnutrition, diarrhea, and drownings, by country. (From Patz JA, Gibbs HK, Foley JA, et al. Climate
change and global health: quantifying a growing ethical crisis. EcoHealth. 2007; doi.10.1007/s10393-007-0141-1.)

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Human Rights and Social Justice

are highly prevalent and where vulnerability to these
outcomes is greatest.28 Other geographic risk factors
include residing in areas with (a) epidemic disease
associated with climate patterns, such as cholera
linked to the El Niño Southern Oscillation; (b)
decreased access to water or food as a result of drought
or other consequences of climate change; and (c)
increased risk of vector-borne or waterborne disease.


The adverse human-rights consequences of climate
change are likely to have the greatest impact on
populations already suffering from human rights
violations, such as residents of low-income countries
and residents of low-income communities in
high-income countries, as well as minority groups,
unemployed people, individuals with chronic dis-
eases and disabilities, and people living in unsafe
or marginal environments.
Women. There are many ways in which climate
change disproportionately affects women.29-31 In
low-income countries, women generally assume
primary responsibility for gathering water, food, and
fuel for their households. Climate changeeinduced
droughts make this work much more difficult
because water becomes less accessible, agricultural


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Human Rights and Social Justice
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production decreases, and wood used for fuel needs
to be obtained from increasingly distant places. As
women face greater challenges in gathering water,
they may develop increased risks of injury and

Women have higher rates of death than men
from extreme weather events, such as hurricanes
and other storms. Pregnant women are especially
susceptible to vector-borne disease, such as
malaria, and waterborne disease. Because of
longstanding bias and discrimination, in many
countries women have fewer resources to deal
with damage and loss from extreme weather
Children. Climate change adversely affects children
in many ways.32,33 According to the World Health
Organization (WHO), 88% of the burden of disease
that can be attributed to climate change affects
children younger than 5 years of age. Shortages of
water and food lead to increased occurrence
of childhood malnutrition and make it less likely
that children will receive adequate education. In
addition, children are more vulnerable than adults to
extreme weather events and other disasters because
they have less physical strength and during the
disasters they may be separated from their parents.
Like women, children are especially susceptible
to vector-borne disease, such as malaria, and
waterborne disease.

Because climate-sensitive health outcomes, such
as malnutrition, diarrhea, and malaria, primarily
affect children, the aggregate disease burden as a
result of climate change appears to be borne mainly
by children living in developing countries.


Climate change will likely increase the occurrence
of all of the following28:
d Diarrhea in regions comprised mainly of developing
countries by 8% to 9% by 2030.

d Malnutrition in a subregion of the WHO South-East
Asian Region that includes India, Bangladesh, and
5 smaller countries by 17% by 2030.

d Mortality as a result of coastal floods in a subregion of
the WHO European Region that includes Albania,
Bulgaria, Poland, Romania, Turkey, and 11 other
countries by 630% by 2030.

d Mortality as a result of inland floods in a subregion
of the WHO Region of the Americas that includes
the United States, Canada, and Cuba by 800%
by 2030.

d Falciparum malaria, especially in African regions
where it is highly endemic.
Indigenous People. Indigenous people are
especially vulnerable to the adverse consequences
of climate change, in part because their lives are
closely tied to the natural environment. Environ-
mental consequences of climate change can affect
the physical well-being of indigenous people, such
as their ability to obtain adequate food, water, and
shelter, but also their spiritual well-being, in part
because land is often an integral part of their culture
and spiritual identity.

Geographic factors can also influence vulnerability
of indigenous people to the adverse effects of climate
change. For example, the Inuit and other Arctic
peoples are experiencing major consequences of
climate change because of the unusual warming
in the Arctic region.34 Settlements on low-lying
deltas or floodplains are at risk from sea level rise and
flooding. Mountain settlements, such as those in the
Andes and Himalayas that are dependent on snow
pack for freshwater, are also at high risk.
Workers. Workers in many occupations are also at
increased risk. They include the following35:

d Outdoor workers performing jobs in extreme heat.
d Other workers exposed to extremes of temperature or

d Workers exposed to air pollutants, infectious agents,
wildfires, extreme weather events, and/or psycho-
logical stress.

d Workers in specific industries: utilities, transportation,
emergency response, health care, environmental
remediation, construction, demolition, landscaping,
agriculture, forestry, wildlife management, heavy
manufacturing, and warehouse work.


Heat Waves. Heat waves, which have increased in
frequency in recent years, cause a variety of heat-
related disorders and exacerbations of car-
diovascular diseases, respiratory disorders, and other
chronic conditions. (In addition, increased heat has
adverse consequences on work productivity and
activities of daily life.) Studies of heat waves and
their adverse health consequences have identified
vulnerable populations at especially high risk of
morbidity and mortality, including older people,
people living alone, urban populations, and those
living in homes without air conditioning.36 A study
in Europe demonstrated geographic differences in
mortality as a result of heat waves.37

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Human Rights and Social Justice

Extreme Weather Events. Climate change has
increased and is likely to produce more extreme
weather events, such as cyclones or hurricanes, and
has increased precipitation and flooding in some
areas. In addition, climate change in other areas is
increasing the number, intensity, and duration of
droughts. Poor and marginalized people who live
in flood plains and drought-prone areas are espe-
cially vulnerable to extreme weather events and their
adverse consequences on health and human rights.
Compared with other populations, they generally
lack access to protective and preventive services and
lack the socioeconomic resilience to withstand the
adverse consequences of these events.

The risk of being affected by weather-related nat-
ural disasters is approximately 80 times greater in
developing countries than it is in developed coun-

The disproportionate adverse impact of

extreme weather events on the poor was demonstra-
ted by Hurricane Katrina in 2005.39 Warmer water
temperature in the Gulf of Mexico, resulting from
climate change, increased the power of Katrina as it
passed over the Gulf on its path to New Orleans
and adjacent areas. However, although this hurricane
affected all of New Orleans, the most vulnerable pop-
ulations, including the poor, those with little or no
political power, and people of color, suffered the
most.40,41 Whereas helicopters removed affected
people from the roofs of private hospitals, the pleas
for assistance from charity hospitals were often
ignored. Residents of rich neighborhoods were able
to leave New Orleans in their own vehicles, whereas
poor people, often from low-lying areas, were often
trapped in or near their homes, and, if they survived,
had to seek short-term shelter, such as at the over-
crowded Superdome, and long-term shelter, often
outside of New Orleans because low-income housing
there became much more limited.42,43

Sea Level Rise. Average sea level throughout the
world has increased about 20 cm (8 inches) during
the past 100 years, a far greater amount than in the
previous 2000 years.

Increased sea level will

worsen coastal erosion, exacerbate storm surges,
inundate low-lying areas, and cause salinization of
coastal aquifers. Sea level rise also threatens to inun-
date low-lying coastal nations, such as Bangladesh,
and small, low-lying island nations in the Pacific
Ocean, such as Tuvalu and Kiribati. Sea level rise and
other consequences of climate change (such as
drought) are likely to make millions of people envi-
ronmental refugees.45 There are many other reports
and studies concerning the ways in which climate
change will create forced migration.1,46-49
Air Pollution. Climate change is likely to increase
chemical air pollutants, such as ozone.


tant respiratory disorders, which are already most
prevalent among low-income and minority pop-
ulations,56 are likely to increase, with the impact
being greatest in these populations.57-61

Because carbon dioxide stimulates plant growth,
including growth of allergenic species, climate
change will likely increase the allergenicity and
distribution of pollen and other aeroallergens,
resulting in increased prevalence and severity of
allergic respiratory disorders.62-66

Food Insecurity and Malnutrition. Climate change
and related environmental conditions, such as
droughts and floods, are likely to adversely affect
the ability to grow sufficient amount of food for rap-
idly increasing populations. As a result, food and
nutrition security will likely worsen, especially for
poor people living in low-income countries. The
prevalence of acute and chronic childhood under-
nutrition, with accompanying adverse effects on
physical and mental development, is likely to
increase, especially in those low-income countries
already seriously affected by malnutrition.67 There
are many other reports and studies addressing food
insecurity and malnutrition.

Increases in food

prices resulting from climate change will also
adversely affect the nutritional status of children and
other vulnerable populations.72

Vector-borne Diseases. Climate change, along with
human population growth, increased urbanization,
political and demographic changes, and increased
international movement of people and materials, has
a profound impact on the distribution and abundance
of vectors and the pathogens that they can transmit.
As a result, there have already been, and will continue
to be, major changes in the patterns of vector-borne
diseases, including malaria,73-75 Rift Valley
fever,76,77 tick-borne encephalitis,78,79 and West Nile
virus disease.80-82 In general, people in low-income
countries and impoverished people in high-income
countries are more vulnerable to these diseases.
Waterborne and Foodborne Diseases. Climate
change affects the occurrence of waterborne and
foodborne disease in a number of ways.83 Heavy
rainfall and resultant floods can contaminate water
supply systems and result in increased gastro-
intestinal illness84; for example, a study in India
found an association between extreme precipitation
and hospital admissions related to gastrointestinal
illness.85 Droughts can reduce the availability of safe
drinking water; for example, a global study found
that childhood diarrhea may increase in incidence

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Human Rights and Social Justice
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when there is decreased rainfall, suggesting that
when water availability is lower, poor hygiene could
account for increased gastrointestinal illness.86 In
addition, storm events can overwhelm deteriorating
sewer infrastructure in urban areas.87

Collective Violence. Climate change likely increases
the global frequency of collective violence, which
includes war and other forms of armed conflict,
state-sponsored violence (such as genocide and
torture), and organized violent crime (such as gang
warfare).88 Meta-analyses provide strong evidence
of a causal association between climate change and
violence; for example, a meta-analysis and review
based on 50 quantitative studies of the association
between climate variables and violent conflict
(as well as sociopolitical instability) found that when
temperature is high and there is extreme precip-
itation, there are increases in both sociopolitical
instability and conflict.89 This meta-analysis dem-
onstrated that the best designed studies found
strong associations between anomalies of climate
and both social instability and conflict; it also found
that climate events can influence various types of
conflict on a broad range of spatial scales.89

Scarcity of key environmental resources, such as
farmland, forests, river water, and fish, can contrib-
ute to violent conflict, such as by generating social
stresses that lead to urban unrest, clashes among
ethnic and cultural groups, and insurgency cam-
paigns.90 Collective violence is more likely to
adversely affect populations in low-income countries
and poor people in mid- and high-income
countries. Findings from a recent study in St. Louis
suggest that, even in high-income countries, neigh-
borhoods with higher levels of social disadvantage
probably experience higher levels of violence because
of unusually warm temperatures.91

Mental Health Problems. Mental health impacts of
climate change include (a) direct impacts of extreme
weather events, disasters, and a changed environ-
ment; (b) indirect vicarious impacts, based on obser-
vation of global events and concern about future
risks; and (c) indirect psychosocial impacts at the
community and regional levels.92,93 These mental
health impacts disproportionately affect people of
lower socioeconomic status.


Strategies to address climate change fall into 2 broad
categories: (a) mitigation (primary prevention), which
consists of measures to stabilize or reduce the
production of GHGs; and (b) adaptation (secondary
prevention), which consists of measures to reduce
the public health impact of climate change. The
2015 Lancet Commission on Health and Climate
Change has identified the necessary policy responses
to the impacts of climate change to “ensure the high-
est attainable standards of health for populations
worldwide.”94 Because climate change adversely
affects human rights, these rights need to be consid-
ered in designing and implementing mitigation
measures95-97 and adaptation measures.98-101

International organizations and governments at
the national, state/provincial, and local levels
should ensure that human rights are considered in
developing and implementing mitigation and
adaptation measures. Nongovernmental and
humanitarian organizations need to hold
governments accountable in protecting and
promoting these human rights. When human rights
violations occur, governments should develop and
implement monitoring systems to detect and
respond to any further violations. Governments
should coordinate multisectoral participation of
agencies and organizations, ensuring a focus on
protecting vulnerable populations. Governments
should not only address immediate problems but
also develop long-term strategies and programs
to protect and promote human rights that are
threatened by climate change.5

Mitigation. Mitigation of climate change is necessary
to attain health-protective solutions that will last.102

Stabilizing or reducing GHG production can be
done by implementing policies and using tech-
nologies. Policies to promote and facilitate mitigation
can be developed and implemented in most sectors of
society, producing large gains in efficiency in the
energy, transportation, and agriculture sectors. Energy
policies can promote use of renewable energy,
decrease use of fossil fuels, and reduce energy
demand. Transportation policies can promote walk-
ing and bicycling (active transport) as well as use of
fuel-efficient vehicles. Agriculture policies can help to
decrease meat production and meat consumption,
appropriate development of biofuels, and reduce
methane …

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