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REVIEW
Climate Change, Human Rights, and Social Justice
Barry S. Levy, MD, MPH, Jonathan A. Patz, MD, MPH
Sherborn, MA; and Madison, WI
Abstract
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.
KEY WORDS 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 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
“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
impact will probably be felt by developing countries in
coming decades.”
Pope Francis
Laudato Si
June 2015
Both authors wrote this manuscript.
No external funding was used in developing this paper. Dr. Levy and Dr. Patz do not have any conflicts of interest.
From the Department of Public Health and Community Medicine, Tufts University School of Medicine, Sherborn, MA (BSL); and the University of
WisconsineMadison, Madison, WI, Global Health Institute, the Nelson Institute, and the Department of Population Health Sciences (JAP). Address
correspondence to B.S.L. (blevy@igc.org).
Annals of Global Health
ª2015 The Authors. Publish ed by Elsevier Inc.
on behalf of Icahn School of Medicine at Mount Sinai
VOL. 81, NO. 3, 2015
ISSN 2214-9996
http://dx.doi.org/10.1016/j.aogh.2015.08.008
INTRODUCTION
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.
13
They threaten eco-
nomic, social, and cultural rights, as embodied in
the International Covenant on Economic, Social,
and Cultural rights, including the following
14
:
dThe right of self-determination.
dThe rights to freely determine one’s political status
and freely pursue one’s economic, social, and cultural
development.
dThe right “to the enjoyment of the highest attainable
standard of physical and mental health”.
dThe 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 following
17
:
dTemperature, as well as increased frequency and/or
duration of heat waves.
dHeavy precipitation events.
dIntensity and/or duration of droughts.
dIntense tropical cyclone activity.
dSea 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 changes
17
(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
DISPARITIES AMONG COUNTRIES
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
Annals of Global Health, VOL. 81, NO. 3, 2015 Levy and Patz
MayeJune 2015: 310–322 Human Rights and Social Justice
311
(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.
27
Risk Factors. Various socioeconomic, demographic,
health-related, geographic, and other risk factors,
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)
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
Likely
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
activity
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.
Table 2. Assessment of the Likelihood of Further Changes in the Early and Late 21st Century
Phenomenon and Direction of Trend
Likelihood of Further Changes in the Early and Late 21st Century
Early 21st Century Late 21st Century
Warmer and/or fewer cold days and
nights over most land areas
Likely Virtually certain
Warmer and/or more frequent hot days
and nights over most land areas
Likely Virtually certain
Warm spells/heat waves: Frequency and/or
duration increases over most land areas
Not formally assessed Very likely
Heavy precipitation events: Increase in frequency,
intensity, and/or amount of heavy precipitation
Likely over many land areas Very likely over most of the mid-latitude
land masses and over wet tropical regions
Increases in intensity and/or duration of drought Low confidence Likely (medium confidence) on a regional
to global scale
Increases in intense tropical cyclone activity Low confidence More likely than not in the Western
North Pacific and North Atlantic
Increased incidence and/or magnitude of extreme
high sea level
Likely Very 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 AnnalsofGlobalHealth,VOL.81,NO.3,2015
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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.
DISPARITIES AMONG POPULATION
SUBGROUPS
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
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.)
Annals of Global Health, VOL. 81, NO. 3, 2015 Levy and Patz
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313
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
rape.
30
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
events.
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.
28
Climate change will likely increase the occurrence
of all of the following
28
:
dDiarrhea in regions comprised mainly of developing
countries by 8% to 9% by 2030.
dMalnutrition in a subregion of the WHO South-East
Asian Region that includes India, Bangladesh, and
5 smaller countries by 17% by 2030.
dMortality 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.
dMortality 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.
dFalciparum 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 following
35
:
dOutdoor workers performing jobs in extreme heat.
dOther workers exposed to extremes of temperature or
precipitation.
dWorkers exposed to air pollutants, infectious agents,
wildfires, extreme weather events, and/or psycho-
logical stress.
dWorkers in specific industries: utilities, transportation,
emergency response, health care, environmental
remediation, construction, demolition, landscaping,
agriculture, forestry, wildlife management, heavy
manufacturing, and warehouse work.
ENVIRONMENTAL AND HEALTH
CONSEQUENCES AFFECTING
VULNERABLE POPULATIONS
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
Levy and Patz AnnalsofGlobalHealth,VOL.81,NO.3,2015
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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-
tries.
38
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.
44
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.
50-55
Resul-
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.
68-71
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 illness
84
; 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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315
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.
ADDRESSING CLIMATE CHANGE WHILE
PROTECTING HUMAN RIGHTS
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
measures
95-97
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 emissions. Mitigation can also be accom-
plished by increasing GHG removal from the
atmosphere with carbon dioxide sinks (such as forests)
and implementing land-use policies that promote use
and expansion of forests. In addition, reducing pop-
ulation growth rates can play an important role in
mitigation by energy demands.
Mitigation measures can be developed and imple-
mented in a manner to both decrease GHG emissions
Levy and Patz AnnalsofGlobalHealth,VOL.81,NO.3,2015
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and improve human health. For example, transporta-
tion policies that promote and facilitate safe active
transport can reduce GHG emissions and also
increase physical activity, improve health status, and
prevent cardiovascular diseases and other disorders.
Biofuels and food price shocks. Mitigation
measures can potentially have unintended conse-
quences that adversely affect vulnerable populations.
Some mitigation measures that are designed to reduce
GHG emissions and other causes of climate change
may disproportionately harm the poor. For example,
using agricultural land to grow crops for biofuels can
decrease available land for growing food, thereby
increasing food prices and reducing access to food.
26
Biofuel policy affects commodity prices of food
grains by linking oilseed to biodiesel prices and link-
ing corn to ethanol prices. Biofuel production has
been linked to food price shocks, which aggravate
food insecurity, especially for the poorest people in
the world, who spend the highest proportions of their
income on food. Diverting food and feed to biofuel
production has substantially increased food prices
globally. In 2011 it was estimated that biofuels
accounted for 20% to 40% of increases in food pri-
ces.
103
Ethanol and corn prices are closely linked;
as the ethanol price increases by 1 cent per gallon,
the corn price increases 4 cents per bushel.
104
The average US household spends a lower
proportion of income on food than the average house-
hold in any other countrydonly 6% compared with
up to 80% in the poorest households in low-income
countries.
105
Poor people in urban areas are especially
vulnerable to food price shocks because they purchase
most of their food, instead of growing it.
Carbon tax and equity. In any country, increases
in fuel prices disproportionately affect poor popula-
tions. Globally, many households are considered to
be in “fuel poverty”(needing to spend more than
10% of their income on fuel).
106
People in the
household must therefore rely on cheaper energy
sources, such as biomass fuel, that produce high
concentrations of harmful indoor air pollutants. An
estimated 2.4 billion people use biomass fuel for
cooking, and an estimated 4.3 million people die
annually from indoor pollution from stoves that are
inefficient and/or unvented.
107
In addition, time
spent collecting wood or manure for fuel precludes
spending time on education, especially for girls.
108
In
sum, mitigation measures can adversely affect health
by raising energy prices and forcing people to use
highly polluting fuels.
Centralized versus distributed electric power. Power
outages are frequent in low-income countries,
averaging more than 144 hours per month in about
17% of low-income countries.
109
Rural electrification is uncommon in the
least-developed countries, such as Ethiopia, where
85% of the population lives in rural areas.
110
From
both economic and engineering perspectives,
providing electricity to such dispersed people using
traditional electrification models based on central-
ized power generation, transmission, and distribu-
tion is impractical. In contrast, the “bottom-up
and widely distributed”electrification paradigm
using microgrid technology, such as with small
hydroelectric dams, windmills, and solar panels,
offers a practical and more equitable
alternative.
111,112
Bikeable neighborhoods and equity. Equity issues
arise when planning for more bikeable neighbor-
hoods, because people with higher incomes are
more likely to be regular bicyclists.
113
In addition,
wealthier communities have higher tax bases to
support active transport with bicycle lanes and
sidewalks.
114
Residents of high-income neighbor-
hoods report more favorable esthetics, greater traffic
safety, less crime, and more access to recreational
facilities than residents of low-income
neighborhoods.
115
Although wealthy neighborhoods can attract
a disproportionate number of new bicycling proj-
ects, bicycling in the United States is also inversely
related to income. Car ownership is lower among
poor people and bicycling is an inexpensive and
practical form of transport.
116
Although increased
exercise from bicycling can lead to better health,
roadways are generally less safe in poorer
communities.
Adaptation. Adaptation measures are designed and
implemented to decrease the impact of climate
change on public health and social systems. For
example, planning for extreme weather events can
bring about better multisectoral preparedness,
which, in turn, can improve emergency responses
and can minimize morbidity and mortality from
these weather events. As another example, public
health surveillance to identify disease trends and
outbreaks at an early stage can lead to more effective
control and prevention of these problems.
Marginalized populations, such as low-income
people, indigenous communities, and other disad-
vantaged groups, have, in comparison with other
populations, an increased burden of adverse health
effects because of climate change as well as
decreased resources to adapt to climate change.
These populations generally have little or no input
Annals of Global Health, VOL. 81, NO. 3, 2015 Levy and Patz
MayeJune 2015: 310–322 Human Rights and Social Justice
317
into the decisions that affect their lives. As a result,
climate change threatens to worsen existing socio-
economic and health inequalities within and among
communities.
Adaptation and human rights. One group’s
adaptation measures should not create risks for
other groups. For example, waste heat from air con-
ditioning can warm outdoor air more than 1C;
therefore, air conditioning can exacerbate urban
heat exposure and pose subsequent risks to people
unable to afford air conditioners.
117
Populations vary considerably in their capacity
to adapt to an identical risk. For example, the
Netherlands, with its well-established engineered
system of dikes, has much greater capacity to adapt
to sea level rise than does a developing country with
similar flat terrain, such as Bangladesh. In addition,
different adaptation measures will have different
effects on human rights. Often an ecological
approach, rather than an engineering approach,
will benefit more people.
118
For example, as sea
level rises, seawalls have often been used to stabilize
shorelines. However, in Vietnam, planting man-
groves for storm surge protection costs almost
85% less than building and maintaining seawalls
or dikes for this purpose.
119
Mangroves also
preserve wetlands and marine food chains that
support local fisheries. Therefore, building seawalls
can threaten the livelihoods of fishermen, whereas
the ecological approach can potentially improve
their lives.
Protecting Future Generations. How much money
should the current generation spend to mitigate
climate change for the benefit of future
generations?
120-124
The claim by future gen-
erations against the current generation is partially a
function of how bad the outcome might be.
125
Is a
life that is saved today worth more than a life that is
saved in the future? Should the health and well-
being of future generations be discounted?
125
The
rationale for discounting the health benefits of
future generations include the following: people
tend to value benefits in the present more than those
in the future; the current generation is morally
entitled to care more about itself than about future
generations; and people in the future will enjoy
better health and well-being than people now.
125
Assumptions related to valuing the health and
well-being of future generations influence policy
decisions concerning climate change. For example,
Nicholas Stern, an economist at the London School
of Economics, uses a 1.4% discount rate, which sup-
ports more spending for climate change mitigation
to protect future generations.
120
In contrast, Yale
economist William Nordhaus uses a 6% discount
rate, which supports more of a focus on the current
generation.
126
CONCLUSION
The global climate crisis threatens most people and
their human rights. The adverse consequences of
climate change will worsen. Addressing climate
change is a health and human rights priority, and
action cannot be delayed. Mitigation and adaptation
measures must be equitable, protecting and promot-
ing human rights.
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