Assessing Potential Impacts of Sea Level Rise on
Public Health and Vulnerable Populations in
Southeast Florida and Providing a Framework to
Frederick Bloetscher 1, *, Colin Polsky 2, Keren Bolter 2, Diana Mitsova 3,
Kristin Palbicke Garces 4, Roderick King 4, Isabel Cosio Carballo 5and Karen Hamilton 5
Department of Civil and Environmental Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA
2Center for Environmental Studies, Florida Atlantic University, Boca Raton, FL 33431, USA;
email@example.com (C.P.); firstname.lastname@example.org (K.B.)
3School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, FL 33431, USA;
4Florida Institute for Health Innovation, West Palm Beach, FL 33407, USA;
kgarces@ﬂhealthinnovation.org (K.P.G.); rking@ﬂinnovation.org (R.K.)
5South Florida Regional Planning Council, Hollywood, FL 33021, USA; email@example.com (I.C.C.);
*Correspondence: firstname.lastname@example.org; Tel.: +1-239-250-2423
Academic Editors: William D. Shuster, Audrey L. Mayer and Ahjond S. Garmestani
Received: 12 January 2016; Accepted: 25 March 2016; Published: 31 March 2016
In recent years, ongoing efforts by a multitude of universities, local governments, federal
agencies, and non-governmental organizations (NGOs) have been focused on sea-level rise (SLR)
adaptation in Florida. However, within these efforts, there has been very little attention given to
the potential impacts of sea-level rise on human health. The intent of this project is to identify
populations in Southeast Florida that are most vulnerable to sea-level rise from a topographic
perspective, determine how vulnerable these population are from a socio-economic perspective,
identify potential health impacts, develop adaptation strategies designed to assist these communities,
and produce an outreach effort that can be shared with other coastal communities. The location of
socially-vulnerable and health-vulnerable populations are correlated, but at present they are not
generally in the geographically-vulnerable areas. Projections indicate that they will become at risk
in the future but the lack of data on emerging diseases makes public health assessments difﬁcult.
We propose a redeﬁnition of “who is vulnerable?” to include health indicators and hard infrastructure
solutions for ﬂood and property protection. These tools can be used to help protect water resources
from the impacts of climate change, which would, in turn, protect public health via drinking water
supplies, and efforts to address social issues.
Keywords: sea level rise; vulnerable populations; groundwater; vector- and waterborne diseases
Climate change impacts are felt globally, but some areas and populations are recognized as being
particularly vulnerable [
]. The Southeast Florida region, with its low-lying coasts, subtropical
climate, porous geology, and distinctive hydrology, has been identiﬁed as one of the world’s most
vulnerable areas [
]. Due to these unique conditions, sea-level rise is the principal long-term,
permanent impact of climate change for the region, threatening both its natural systems and its densely
populated and highly diverse built environment [
]. With 6.6 million people, the region constitutes
Sustainability 2016,8, 315; doi:10.3390/su8040315 www.mdpi.com/journal/sustainability
Sustainability 2016,8, 315 2 of 18
one-third of the state’s total population, one third of the state’s economy, over $4 trillion in property
value, and among the highest rates of projected population growth in the state .
The mean sea level is expected to rise up to three feet (1 m) by 2100 due increased rates of thermal
expansion, glacier mass loss, groundwater losses, and discharge from land-based
The U.S. Army Corps of Engineers used Key West tidal data from 1913 to 1999 to calculate a projected
sea-level rise. Results suggested that the sea-level rise in Southeast Florida will rise one foot from
the 2010 baseline by 2040, and could raise two feet (0.65 m) by 2060 [
]. Figure 1shows the
current projections and the uncertainty associated with same which comport with the medium 2013
Figure 1. Projected sea level rise.
Much of the research focus has been on coastal communities due to the direct threat of sea level
rise (SLR). Bloetscher, et al. , Bloetscher and Romah , and Romah  noted that groundwater
levels in Southeast Florida are intrinsically linked to the sea level and, thus, while coastal populations
are particularly at risk due to erosion, inundation, and storm surge, interior populations are also
susceptible to rising water tables and extended periods of inundation. Chang, et al. [
an overall “lifting process” by which there is a 1:1 ratio in water table elevation that correlated to
sea-level rise. Higher groundwater levels mean reduced aquifer storage, thereby lessening the capacity
of soil to absorb precipitation, and thereby increasing the risk of groundwater ﬂooding [
Due to the associated loss of soil storage capacity caused by sea level rise, more intense storms will
overwhelm the current storm water infrastructure. Projections indicate the potential for severe damage
to Southeast Florida’s energy systems, transportation infrastructure, water infrastructure, agricultural
lands, and the Everglades ecosystem [18,19].
Much of the current work on adaptation to sea-level rise (SLR) focuses on understanding the
physical and economic vulnerability of infrastructure, as well as on developing adaptation strategies
for the natural and built environments using new infrastructure systems [
decisions which consider a systems approach that includes population, economics, and environmental
conditions, are essential as local governments and businesses examine long-term viability, particularly
in respect to investment decisions related to location. Property values are also dependent upon the
Sustainability 2016,8, 315 3 of 18
maintenance of transportation and utilities, especially storm water, wastewater treatment, and water
supply. The insurance industry, which has traditionally been focused on a one year vision of loss risk,
is beginning to discuss long-term risks of losses. If the insurance industry takes a longer view of risk,
there will be an accompanying impact on lending practices. Where properties are at risk, lending
options may be reduced by insurance limitations—i.e., if the insurance industry sees the potential for
signiﬁcant losses from sea level rise within 30 years, the mortgage industry will limit the length of
loans and increase interest rates due to insurance risk, thereby increasing costs to buyers and reducing
the attractiveness of the purchase for sellers. The result may be declining property values and slower
sales. Hence, it is in the community’s interest to develop a planning framework to adapt to sea-level
rise and protect vulnerable infrastructure through a long-term plan.
Climate change also has the potential to create a serious public health threat that affects human
health outcomes and disease patterns [
]. Although preventative and adaptive strategies for climate
change will help lessen negative health impacts, human health will continue to be affected from present
climate change conditions [
]. It is expected that climate change will both aggravate existing
human health risks and conditions and create new ones. Health impacts will vary and have both
direct and indirect effects [
]. Populations with combined health, socio-economic, and place-based
vulnerabilities will be most affected [
]. The health impacts will be felt to different degrees depending
on action taken to adapt [20,22,30,31].
Due to the inevitability of sea-level rise in Southeast Florida and in other low-lying coastal regions
as a consequence of climate change, the focus of this research was to identify the communities most
at risk, evaluating potential nexus points for three factors: (1) areas that will be most vulnerable to
sea-level rise using United States Army Corps of Engineers (USACE) projections; (2) locations of
populations that are socially and economically vulnerable; and (3) locations of increased health risk.
Socially-vulnerable populations that reside in these low-lying areas and already have predisposed
health vulnerabilities and economic limitations lack the resources and capacity to mitigate sea-level
rise impacts. In this investigation, current conditions were compared against incremental increases
of 0, 1, 2, and 3 feet of sea-level rise based on actual data. The increments work as threshold values
by allowing planners to know ahead of time where the next set of vulnerable areas will be, thereby
permitting an opportunity for a proactive response approach.
2. Materials and Methods
2.1. Sea Level and Groundwater Mapping
Prior to compiling data, the local community needs were assessed in order to deﬁne an acceptable
level of service (LOS) for the community. In Southeast Florida, the king tides occur annually,
in September and October. Storms may alter this pattern slightly, but these are atypical and temporal
events that may cause signiﬁcant damage and disruption to the community, but do little to affect the
long-term trends for sea level rise. Hence, storm related impacts were not considered. Figure 2shows
tidal data, graphed from highest to lowest, illustrating how the highest tides are much higher than the
average. The LOS should indicate how often it is acceptable for ﬂooding to occur in a community on
an annual basis. The failure to establish an acceptable LOS is often the cause of a loss of conﬁdence in
public ofﬁcials at a later point in time. The effects of sea-level rise on the LOS should be used to update
the mapping in terms of demonstrating changes in vulnerability and increased ﬂooding frequency.
For example, a 1% ﬂooding frequency translates to four ﬂood days per year.
Sustainability 2016,8, 315 4 of 18
Figure 2. Using the six years of tides, the 99th percentile for the City of Miami Beach which was used
as a test case—four days ﬂooding per year is shown in the red line. If sea-level rises one foot, the line
will move downward one foot (dashed red line).
Once the level of service was deﬁned, a unique method of vulnerability assessment was performed.
The purpose of sea-level rise vulnerability modeling is to evaluate the future vulnerabilities of
infrastructure, buildings, and facilities on public and private property based on their topography.
Development of the surface topography included high resolution LiDAR, “ground-truthing” by tying
it to local benchmarks and transportation plans, and USGS groundwater and NOAA tidal data from
local monitoring stations to modeled groundwater surfaces.
Groundwater was examined similarly with respect to the sea-level rise scenarios.
The groundwater levels are the result of investigating all USGS monitoring wells and those other
monitoring wells with at least 30 years of data to determine the critical junctures that would increase
vulnerability to surface ﬂooding. While the goal of this effort was not to model groundwater ﬂow,
the concept was to consider more than just static elevation to determine sea-level rise vulnerability.
Groundwater levels ﬂuctuate with rainfall, but given distinct wet (summer) and dry (winter) seasons,
and the end of the wet season coinciding with the highest tides, groundwater levels are generally
highest at the end of the wet season. In addition, groundwater levels generally increase as one
moves inland. By matching actual groundwater levels to tidal conditions, a groundwater surface can
As the greatest vulnerability to ﬂooding occurs when the groundwater was closest to the surface,
the 99 percentile (4 days/year) water levels from the wells data were interpolated ordinarily to match
the 99 percentile tidal data. The topographic LiDAR layer and the groundwater maps were used
to ﬁnd the difference between land height and peak groundwater elevation, essentially indicating
whether the soil can absorb water or is saturated and will pool or run off. As this layer may be adjusted
for soil—sand versus clay to decrease the soil storage capacity, it is a robust data layer that was used
in the modeling as a physical risk sub-index. This type of modeling is termed a “modiﬁed bathtub
model.” The three classiﬁcations delineate where the difference between topography and groundwater
is organized into levels of: vulnerable (below 0 ft), potentially vulnerable (0–2 ft), and not vulnerable
(>2 ft). The term “potentially vulnerable” is used for areas that need further investigation to deal with
the uncertainty of drainage and storm water improvements that might affect the situation.
2.2. Southeast Florida Vulnerability Index
The modiﬁed bathtub model demonstrates that SLR not only affects coastal regions, but it can
affect low lying regions inland by affecting ground water levels which lead to localized ﬂooding.
South Florida’s climate makes these low lying, inland areas that are ﬂooded a primary target for
Sustainability 2016,8, 315 5 of 18
the negative effects of disease especially from waterborne, foodborne, and vector-borne diseases.
Unlike most of the country, South Florida provides optimal conditions for viruses, bacteria, ticks,
and mosquitoes year around. Therefore, it is important that the potential consequences of sea-level
rise be reviewed in order to mitigate the effects.
As a part of the project, indices for health and socio-economic impacts were developed. Such
indices build upon recent developments in measures seeking to quantify various aspects of community
vulnerability. The index was created using the z-score approach. A z-score approach is an appropriate
technique for variable sampling distributions that satisfy the normality assumptions. A z-score
indicates how much a particular observation deviates from the mean relative to the standard deviation,
and is calculated as follows:
The Kolmogorov–Smirnov test and other statistical techniques will be used to test the hypothesis
that the observed data approximate a normal distribution. Data transformation and/or windsorization
(i.e., trimming of the tails to the 97.5th percentile) is performed if outliers or extreme values that distort
the distribution are present [
]. Truncation can also be used to remove the effects of the outliers on
the mean and the standard deviation [
]. Truncation to the 99th percentile will preserve the extreme
values in the tails of the distribution, allowing them to still represent “best” and “worst” practices,
but reduces their undue effect on the aggregation algorithm.
Few of the existing indices have accounted for the health status of the affected populations.
In addition, there is growing attention to the anticipated health risks, such as waterborne diseases
resulting from prolonged ponding conditions related to the effects of ﬂoods and sea-level rise [
The emphasis for this project was on health and social denominators to ﬁll this gap by developing
a composite measure to quantify health-related vulnerability, such as the incidence of chronic and
acute health conditions, in conjunction with socio-economic variables and physical exposure to the
anticipated effects of sea-level rise. For those diseases with only a few cases reported during the
observation period, as in the instance with the diseases reviewed in this study, rates may be unreliable
and could be difﬁcult to interpret. This may also occur when there are no cases reported for a given
location during the period of interest. The FDOH used relative standard error (RSE) as a way of
measuring the reliability for statistical estimates. This is calculated by dividing the standard error of
the rate by the rate itself and then multiplying by 100 to convert it to a percent. For rates, this calculation
can be simpliﬁed to taking the inverse of the square root of the total number of cases and multiplying
by 100. When the RSE is large, it indicates that the rate is imprecise. The FDOH chose a cut-point of 30,
such that rates with an RSE greater than 30 in this report should be considered unreliable. This is a
cut-off used by several CDC programs. The FDOH suppressed all crude rates as well as case counts for
strata with an RSE > 30. All health data were collected and completed by the FDOH. A more detailed
explanation is presented in a companion paper.
2.3. Statistical Analysis
Ultimately, policy-makers will need more information to prioritize resources and address the most
drastically needed improvements. For example, a major goal to reduce economic vulnerability requires
identifying where economic activity occurs and where potential jobs are. At-risk populations, valuable
property (tax base), and emergency response may be drivers for policy decisions, which means data
from other sources must be considered. To better understand the differences between the subareas,
the collected data were compiled, summarized, and analyzed using an EXCEL add-on element called
(Addinsoft, New York, NY, USA). Correlation analysis was used to indicate whether the
variables are related to other variables on an individual basis. However, correlation analysis works
best when there are a limited number of variables (as opposed to the 24 variables here). Exploratory
factor analysis in XLStat
(Addinsoft, New York, NY, USA) was employed to reveal the potential
existence of underlying factors within data containing a very large number of measured variables.
Sustainability 2016,8, 315 6 of 18
Next, Principle Component Analysis (PCA) was used to reduce the number of variables by
consolidating similar correlated variables into factors, preferably two or three that explain most of
the data. PCA uses a multivariate statistical parameter called an eigenvalue, which is a measure
of the amount of variation explained by each principal component [
]. With the PCA analysis,
all factors in excess of one are kept. It is desirable that the factors represent at least 70 percent of the
resulting eigenvalues. A scree plot is used to visualize the total variance fraction explained by each
3.1. Sea-Level Rise Mapping
The sea-level rise vulnerability maps for the four counties, Broward, Miami-Dade, Palm Beach,
and Monroe, are shown in the following ﬁgures. Figure 3shows the vulnerable and potentially
vulnerable areas in Palm Beach County. Many believe that Palm Beach County is far less at risk
from sea-level rise than other southeast Florida counties as a result of higher elevations. However,
the groundwater levels in Palm Beach County show that these impacts are already a challenge. Figure 4
shows the same information for Miami-Dade and Broward Counties. Each of these ﬁgures shows that
the impacts of sea-level rise and groundwater is signiﬁcantly higher than the bathtub models project.
Figure 3. Cont.
Sustainability 2016,8, 315 7 of 18
Palm Beach County Vulnerability at 0, 1, 2, 3 ft SLR at 99 percentile groundwater/tidal
elevations (ignoring current infrastructure).
Figure 4. Cont.
Sustainability 2016,8, 315 8 of 18
Miami-Dade and Broward Counties—vulnerability at 0, 1, 2, 3 ft SLR at 99 percentile
groundwater/tidal elevations (ignoring current infrastructure).
3.2. Results from the Statistical Analysis
(Addinsoft, New York, NY, USA) an add-on to EXCEL
WA, USA), statistical analysis was conducted for the sea-level rise potential, demographic data and
disease incidences. First, sea-level rise data were analyzed, for the current, 1, 2, and 3 foot sea-level rise
scenarios, showing the vulnerable and potentially vulnerable land. Figure 5compares these numbers
directly, illustrating that more land is vulnerable as sea-level rises.
Average land area vulnerable and potentially vulnerable in the four county area for the
current, 1, 2, and 3 foot sea-level rise scenarios. (
) vulnerable property percentage; (
vulnerable property percentage.
Sustainability 2016,8, 315 9 of 18
Various analyses were undertaken. Exploring disease versus demographic characteristics, PCA
found that six factors explained 80% of the variation in the data. For all analyses, there was strong
correlation between social and health vulnerability as measured by lower income, percent of minority
populations, lower educational attainment, lack of ﬂuency in English, low penetration of medical
services, disability status, and age. Figure 6shows a varimax PCA plot of social and health indicators
versus income above the median. Not surprisingly, there was an inverse correlation between higher
income and social and health vulnerability. Figure 7indicates the result when income and social
indicators are compared to sea level rise vulnerability. This plot shows that a higher income level is
correlated with SLR vulnerability—the wealthier people live in more geographically vulnerable areas
(the coast and newer houses in the western areas) but that, with time, the vulnerability rotates toward
increased social and health vulnerability. The results indicate that an increase in vulnerable land area
affects a larger and more diverse population.
Varimax rotation showing that disease and social vulnerability mostly lie together in
Sustainability 2016,8, 315 10 of 18
Figure 7. Varimax plot for sea-level rise and disease incidence.
Outreach activities with local stakeholders from June through November of 2015 were focused on
discussions of some of the key ﬁndings of this study, including (i) the possible expansion of vulnerable
area over time; (ii) the lack of evidence that the most vulnerable land areas are currently correlated
with the most vulnerable populations; (iii) the lack of knowledge on future distributions of vector and
waterborne diseases; (iv) the need for incremental strategies as new data become available; (v) the need
for planning actions to reduce both socio-economic and place-based vulnerability; and (vi) the need
for better monitoring/reporting of disease. Other messages were that adaptation must be coordinated;
strategies must be incremental, and there is a need for a plan for impacts to both socioeconomically- and
geographically-vulnerable populations. In all, these issues are designed to raise awareness among
key stakeholders and policy-makers of the correlation between non-chronic health impacts and
socioeconomic and geographic vulnerable populations. It also permitted the research team to compile
framework tools of options that might be useful in dealing with the social and health vulnerability.
The South Florida Regional Planning Council initiated the dialogue with policy-makers and
planners. The Council reached out to the Southeast Florida Regional Climate Change Compact,
a seven-county organization focused on climate change. Within the next two years, the Southeast
Florida Regional Climate Change Compact will amend their action plan, and begin to prioritize areas
for adaptation implementation. This provided the opportunity for a Health Impact Assessment (HIA)
to be performed to ensure that human health is considered throughout the update and implementation
]. In the screening phase, the HIA was designed to be timely such that its ﬁndings and
recommendations are able to assist jurisdictions and decision-makers in understanding the local health
implications of climate change in each of the six sections of the Climate Change Compact’s Action Plan.
Sustainability 2016,8, 315 11 of 18
4.1. Proposed Frameowrks
Based on ﬁndings of the vulnerable areas, the next task involves the development of scenarios
whereby various options can be utilized to address community vulnerability. The goal is to identify
successful ﬂood mitigation strategies used by other cities that face similar drainage and construction
problems based on identiﬁed vulnerabilities and cost effectiveness. These two issues are then combined
to develop a framework to evaluate the impacts of climate change on infrastructure and urban
development (as they are intrinsically intertwined). Figure 8outlines a simpliﬁed ﬂow chart used as a
basis for the evaluation.
Figure 8. Analytical framework for toolbox development.
The strength of this framework lies in the proposed holistic and incremental approach to
addressing climate change impacts which entails understanding of combined social and health
vulnerabilities in the context of higher exposure of the physical infrastructure to hazards. As such,
it combines physical vulnerability with health indicators and social evaluation criteria, and conveys
the notion that a plan is not a ﬁxed document, but rather a process that evolves with the changing
environment. The ﬁnal two steps occur at regular intervals at the community level with associated
adjustments made to the initial plans for improvements to various infrastructure systems.
The ﬁnal task was to develop a series of strategies that could be used to improve the regional
resiliency to sea level rise. The ﬁrst set of strategies focuses on hard infrastructure systems. Roadways
are the ﬁrst areas that will see more frequent ﬂooding since roadways are traditionally built at
elevations lower than the ﬁnished ﬂoor of structures. In addition, most infrastructure systems are
co-located with roadways (water, sewer, storm water, power, etc.). As a result, there is a need
to prioritize where funds are spent on transportation infrastructure and other major investments.
Table 1outlines hard infrastructure solutions for ﬂood and property protection. Catastrophic ﬂooding
would be expected during heavy rain events because of reduced capacity of the drainage system.
The vulnerability of transportation infrastructure will require the design of more resistant and adaptive
infrastructure and network systems. This would, in turn, involve the development of new performance
measures to assess the ability of transportation infrastructure (e.g., roadways, bridges, rail, sea ports,
and airports) in preparation for sea-level rise and to enhance resiliency standards and guidelines
for design and construction of transportation facilities. Speciﬁcally, considerations must include
retroﬁtting, material protective measures, rehabilitation and, in some cases, the relocation of a facility
to accommodate sea-level rise impacts. As they are related, groundwater is, similarly, expected to have
a signiﬁcant impact on ﬂooding in these low-lying areas as a result of the loss of soil storage capacity;
yet, this continues to not be the focus of many planning efforts.
Sustainability 2016,8, 315 12 of 18
Table 1. Hard Infrastructure Improvements.
Implementation Strategy Beneﬁts Cost Barriers to Implementation Point When Action May Need to
Exﬁltration Trenches Excess water drains to aquifer,
some treatment provided $250/ft
Signiﬁcant damage to roadways for
installation, maintenance needed,
clogging issues reduce beneﬁts
If groundwater table is above
exﬁltration piping, the exﬁltatrion
efﬁciency diminishes quickly
Excess water gathered from soil
and drained to pump stations,
creating storage capacity of soil
to store runoff, soil treatment
$250/ft plus pump station
Signiﬁcant damage to roadways for
installation, maintenance needed,
clogging issues, costs for
Complete inundation means pumps
run constantly and pump the same
water over and over
Install stormwater pumping
stations in low lying areas to
reduce storm water ﬂooding
(requires studies to identify
appropriate areas, sites and
Removes water from streets,
Start at $1.5 to 5 million each,
number unclear without
NPDES permits, maintenance cost,
land acquisition, discharge quality
When full area served is inundated
(>3–5 ft SLR)
Added dry retention Removes water from streets,
reduces ﬂooding $200,000/acre Land availability, maintenance of
pond, discharge location When full area served is inundated
Armoring the sewer system
Keeps stormwater out of
sanitary sewer system and
reduces potential for disease
spread from sewage overﬂows.
Major public health solution
$500/manhole limited expense beyond capital cost none
Central sewer installation in
Public health beneﬁt of
reducing discharges to lawns,
canals and groundwater from
$15,000 per household Cost, assessments against
property owners none
Raise roadways Keeps trafﬁc above ﬂoodwaters $2–4 million/lane mile Runoff, cost, utility relocation When full area served is inundated
Class V gravity wells Means to drain neighborhoods $250,000 ea Needs bafﬂe box, limited ﬂow
volume (1 MGD) When full area served is inundated
Class I injection wells Means to drain neighborhoods,
15 MGD capacity $6 million Needs bafﬂe box When full area served is inundated
Sustainability 2016,8, 315 13 of 18
Table 1. Cont.
Implementation Strategy Beneﬁts Cost Barriers to Implementation Point When Action May Need to
Bioswales Means to drain neighborhoods,
provides treatment of water $0.5 million/mile land area, ﬂow volume, maintenance When full area served is inundated
Raise sea walls Protects property $0.1–1 million/property Private property rights, neighbors n/a
$20 million assuming locations
can be permitted in
$20 million assuming locations
can be permitted in
Cost, concern over saltwater
intrusion east and west, inundation
of wellﬁelds, permitting by SFWMD
When well is inundated
Salinity/lock structures Keeps sea out, reduces
Up to $10 million, may require
ancillary storm water pumping
stations at $2–5 million each
SFWMD, western residents, private
property rights arguments
n/a—solution to retard sea
encroachment and saltwater
Regional relocation of locks
and/or conversion to
Creates regional system to use
coastal ridge to protect inland
property, keeps saltwater out
$200 million each SFWMD, western residents, private
property rights arguments
n/a—solution to retard sea
encroachment and protect property
which can exist at levels below
Pump to Tide huge volume of water can be
removed from urban area unknown
Water quality to reefs, sea grasses, etc.
When full area served is inundated
Sustainability 2016,8, 315 14 of 18
A number of strategies can be considered for improving water supplies, although the applicability
will vary from one location to the other. Table 2summarizes the tools that can be used to help protect
water resources from the impacts of climate change, which would in turn protect public health by
protecting drinking water supplies. Table 3outlines efforts to address social issues. At the center
of these planning efforts should also be provisions for an adequate drainage system, designed to
accommodate increased volume of water from precipitation events and rising tides. This provision will
be critical in protecting the roadway base and the infrastructure beneath it. Since these systems will not
be viable as sea-levels rise, future storm water systems should be designed like sanitary sewers with
tight piping, with minimal allowances for inﬁltration, and adequately-sized pumping stations that
permit discharge points and means for associated treatment of the stormwater. Discharges of storm
water to water bodies may portend poorly to vital seagrasses and reefs, so some effort will be required
to determine the level of treatment needed to protect the ecosystem in the face of excessive water levels.
Drainage wells could be an essential component to improving drainage systems. These wells require
splitter boxes and ﬁlters to remove solids, regular inspections, and regular maintenance which would
all need to be included in budget considerations.
Table 2. Tools for Protection Water Resources from Climate Change Impacts (adapted from ).
Water Resource Adaptation Alternatives
Reducing requirements for additional treatment capacity and development of alternative water supplies (AWS)
Reducing the impact of sea-level rise on existing water sources
Hydrodynamic barriers: aquifer injection/inﬁltration trenches to counteract saltwater intrusion using treated
Salinity structures and locks control advance of saltwater intrusion
Relocation of wellﬁelds when saltwater intrusion or other threats render wellﬁeld operations impractical
Gaining access to alternative water resources
Desalination of brackish waters
Regional alternative water supplies
Capture and storage of stormwater in reservoirs and impoundments
Aquifer storage and recovery (ASR)
Wastewater reclaim and reuse
Irrigation to conserve water and recharge aquifer
Industrial use and for cooling water
Indirect aquifer recharge for potable water
Reengineering canal systems, control structures and pumping
Sustainability 2016,8, 315 15 of 18
Table 3. Soft Infrastructure Improvements.
Implementation Strategy Beneﬁts Cost Barriers to Implementation Point When Action May Need
to be Abandoned
Increase Access to Health Care
Improved health care access should
reduce impacts, e.g., vaccinations
will not be possible for all
climate-related conditions, because
of the state of the art in vaccines
unknown Cost, ongoing operations Would occur only if the entire
region was abandoned.
Reduce potential for
Lessens risk of socially-vulnerable
people moving out vulnerable areas
unknown Pressure from developers, rental
properties at risk n/a
ordinances and policies
reduces competition for land by
removing land from redevelopment
Pressure from developers, rental
properties at risk, property
Would occur only if the entire
region was abandoned
Assessments for hard
provides funding to support
social efforts see Tables 1and 2Public resistance or public support Would occur only if the entire
region was abandoned
Public acquisition of at
reduces potential for migration to
vulnerable property by taking
property out of circulation
various land regulatory tools:
land lease, outright purchase,
condemnation; may provide
Public resistance or public support n/a
Vaccinations reduces risk n/a Public resistance or public support n/a
Risk Communication improves communication to
residents about their vulnerability unknown Public awareness n/a
Outreach improves communication to
residents about vulnerability unknown Public awareness n/a
Sustainability 2016,8, 315 16 of 18
To address the gaps in knowledge a number of tools could be developed. Models of population
migration should be reviewed to determine if sufﬁcient data exists to probabilistically evaluate potential
patterns of migration. A second effort may be to develop a probabilistic model that combines sea-level
rise (as it affects the amount of livable property, the projected increases in population, the project
property values, and projected growth in economic activity in the future). Such an effort might be
useful as a predecessor to population migration as a means to address the tipping point. A third
effort would be to evaluate current data overseas regarding disease incidence and develop predictive
models of growth in Southeast Florida. Limited data might suggest another Bayesian exercise, but the
application would need further evaluation given altered conditions that exist in Southeast Florida.
A fourth effort would be to develop tools to assess the impacts of sea level rise to chronic conditions
given that little impacts could be discerned in this project. There is insufﬁcient evidence to determine if
chronic conditions are exacerbated by sea level rise, so an effort should be developed to engage health
practitioners in developing long-term data on disease incidence, long-term strategies to address the
effects of climate change, and a means to communicate these strategies to the public.
This study has found that, at present, there is a strong correlation between vulnerability associated
with a number of health indicators and social vulnerability in the study area. Spatially, the most
vulnerable populations are not found in the most physically vulnerable areas at present, but exposure
will increase with time. However, the lack of data on emerging diseases makes future projections
regarding the health impacts of sea level rise a challenge.
Preliminary results from this study indicate that the future effects of sea level rise requires a
multidimensional perspective which incorporates the need to address physical, social, and health
vulnerabilities conjointly and in a cohesive manner. An outcome of this study is a series of options
to assist decision-makers in addressing the anticipated vulnerabilities based on more detailed local
studies. In this context, it is ever more important to continue research in climate change and sea-level
rise and its impacts on the natural and built environment.
Sea level rise will decrease available land, increase competition for development, and will require
additional infrastructure and costs. Given the growing population and the constraints on land
availability, altered redevelopment patterns will increase competition for lower prices and higher
ground, challenging the ability of socially-vulnerable populations to respond to the impacts of sea-level
rise. Processes of migration will likely lead to an increase of the number of people at risk. A better
understanding of future trends in mosquito-spread diseases like Zika, dengue fever, or chikungunya,
or waterborne diseases, like giardia and cryptosporidium, is also necessary to adequately address
the challenges posed by climate change. Adaptation strategies depend on funding, and preliminary
assessment of availability of resources is needed to address social and infrastructure needs in the future.
Community involvement is critical as adaptation efforts will be organized and shaped by challenges at
the neighborhood, rather than regional, scale.
Acknowledgments: The authors would like to acknowledge the Kresge Foundation which funded this project.
Frederick Bloetscher was the primary author of the paper, developed the sea level rise
methodology and maps and conducted the statistical analysis. Colin Polsky is the Director for the Center
for Environmental Studies at Florida Atlantic University. His contribution was the review, organization and
coordination of work products and this paper. Keren Bolter and Diana Mitsova performed the research, accessed,
organized and contributed the social data sources. Keren Bolter edited the paper. Kristin Pablicke Garces
performed the research to generate the health data. Roderick King was responsible for the design of the research.
Isabel Cosio Carballo and Karen Hamilton organized and facilitated the public outreach portion of the project that
led to Table 3. All authors have reviewed and approved the paper.
Conﬂicts of Interest: The authors declare no conﬂict of interest.
Sustainability 2016,8, 315 17 of 18
Heimlich, B.N.; Bloetscher, F.; Meeroff, D.E.; Murley, J. Southeast Florida’s Resilient Water Resources: Adaptation
to Sea Level Rise and Other Impacts of Climate Change; Center for Urban and Environmental Solutions at Florida
Atlantic University: Boca Raton, FL, USA, 2009; Available online: http:/www.ces.fau.edu/ﬁles/projects/
climate_change/SE_Florida_Resilient_Water_Resources.pdf (accessed on 29 March 2016).
Bloetscher, F.; Meeroff, D.E.; Heimlich, B.N. Improving the Resilience of a Municipal Water Utility against
the Likely Impacts of Climate Change, A Case Study: City of Pompano Beach Water Utility; Florida Atlantic
University: Boca Raton, FL, USA, 2009; Available online: http://www.ces.fau.edu/ﬁles/projects/
climate_change/PompanoBeachWater_CaseStudy.pdf (accessed on 29 March 2016).
Pachauri, R.; Reisinger, A. (Eds.) Contribution of Working Groups I, II and III to the Fourth Assessment Report to
the Fourth Assessment Report of the Intergovernmental Panel on Climate Change; Climate Change 2007: Synthesis
Report; IPCC: Geneva, Switzerland, 2007.
Southeast Florida Regional Climate Change Compact Technical Ad hoc Work Group. A Uniﬁed Sea Level
Rise Projection for Southeast Florida. A document prepared for the Southeast Florida Regional Climate
Change Compact Steering Committee. 2011. Available online: http://southeastﬂoridaclimatecompact.org/
pdf/Sea%20Level%20Rise.pdf (accessed on 15 December 2014).
United States Census Bureau. State and County Quickfacts: Florida. 2012. Available online:
http://quickfacts.census.gov/qfd/states/12000.html (accessed on 15 March 2015).
Church, J.A.; White, N.J. Sea-level rise from the late 19th to the early 21st century. Surv. Geophys.
32, 585–602. [CrossRef]
Gregory, J.M.; Browne, O.J.H.; Payne, A.J.; Ridley, J.K.; Rutt, I.C. Modelling large-scale ice-sheet-climate
interactions following glacial inception. Clim. Past 2012,8, 1565–1580. [CrossRef]
Domingues, C.M.; Church, J.A.; White, N.J.; Gleckler, P.J.; Wijffels, S.E.; Barker, P.M.; Dunn, J.R. Improved
estimates of upper-ocean warming and multi-decadal sea-level rise. Nature
,453, 1090–1093. [CrossRef]
9. Gregory, J.M. Sea level Rise: What Makes Prediction So Difﬁcult?; NERC: Atlanta, GA, USA, 2008; pp. 24–27.
Vermeer, M.; Rahmstorf, S. Global sea level linked to global temperature. Proc. Natl. Acad. Sci. USA
106, 21527–21532. [CrossRef] [PubMed]
Jevrejeva, S.; Moore, J.C.; Grinsted, A. How will sea level respond to changes in natural and anthropogenic
forcings by 2100? Geophys. Res. Lett. 2010,37, 256–265. [CrossRef]
U.S. Army Corps of Engineers (USACE). Water Resource Policies and Authorities, Incorporating Sea level Change
Considerations in Civil Works Programs; Expires July 2011; CECW-CE Circular No. 1165-2-211; Department of
the Army, U.S. Army Corps of Engineers: Washington, DC, USA, 2009.
Bloetscher, F.; Romah, T.; Berry, L.; Hernandez Hammer, N.; Cahill, M.A. Identiﬁcation of Physical
Transportation Infrastructure Vulnerable to Sea Level Rise. J. Sustain. Dev. 2012,5, 40–51. [CrossRef]
Bloetscher, F.; Romah, T. Tools for assessing sea level rise vulnerability. J. Water Clim. Chang.
Romah, T. Advanced Methods in Sea Level Rise Vulnerability Assessment. Master ’s Thesis, Florida Atlantic
University, Boca Raton, FL, USA, December 2012.
Chang, S.W.; Clement, T.P.; Simpson, M.J.; Lee, K.K. Does sea-level rise have an impact on saltwater intrusion?
Adv. Water Resour. 2011,34, 1283–1291. [CrossRef]
Bolter, K.P. Perceived Risk versus Actual Risk to Sea-Level Rise: A Case Study in Broward County; Florida Atlantic
University: Boca Raton, FL, USA, 2014.
Zhang, K. Analysis of non-linear inundation from sea-level rise using LIDAR data: A case study for
South Florida. Clim. Chang. 2011,106, 537–565. [CrossRef]
Karl, T.; Melillo, J.; Peterson, T. (Eds.) Global Climate Change Impacts in the United State;
Cambridge University Press: Cambridge, UK, 2009.
Hanson, S.; Nicholls, R.; Ranger, N.; Hallegatte, S.; Corfee-Morlot, J.; Herweijer, C.; Chateau, J. A global
ranking of port cities with high exposure to climate extremes. Clim. Chang. 2011,104, 89–111. [CrossRef]
Sustainability 2016,8, 315 18 of 18
Parkinson, R.W. Adapting to Rising Sea Level: A Florida Perspective. In Sustainability 2009: The Next
Horizon; In Proceedings of the AIP Conference, Melbourne, FL, USA, 3–4 March 2009; Available online:
on 28 March 2016).
Southeast Florida Regional Climate Compact (SFRCCC). Analysis of the Vulnerability of Southeast Florida
to Sea-Level Rise. 2012. Available online: http://www.southeastﬂoridaclimatecompact.org/wp-content/
uploads/2014/09/regional-climate-action-plan-ﬁnal-ada-compliant.pdf (accessed on 29 March 2016).
Tebaldi, C.; Strauss, B.H.; Zervas, C.E. Modelling sea level rise impacts on storm surges along US coasts.
Environ. Res. Lett. 2012,7. Article 1. [CrossRef]
Titus, J.G.; Richman, C. Maps of lands vulnerable to sea level rise: Modeled elevations along the US Atlantic
and Gulf coasts. Clim. Res. 2001,18, 205–228. [CrossRef]
Weiss, J.L.; Overpeck, J.T.; Strauss, B. Implications of recent sea level rise science for low-elevation areas in
coastal cities of the conterminous USA. Clim. Chang. 2011,105, 635–645. [CrossRef]
Haines, A.; Kovats, R.S.; Campbell-Lendrum, D.; Corvalan, C. Climate change and human health: Impacts,
vulnerability and public health. Public Health 2006,120, 585–596. [CrossRef] [PubMed]
Hess, J.J.; McDowell, J.Z.; Luber, G. Integrating climate change adaptation into public health practice: Using
adaptive management to increase adaptive capacity and build resilience. Environ. Health Perspect.
120, 171–179. [CrossRef] [PubMed]
Kjellstrom, T.; McMichael, A. Climate change threats to population health and well-being: The imperative of
protective solutions that will last. Glob. Health Act. 2013,6. [CrossRef] [PubMed]
Portier, C.; Thigpen Tart, K.; Carter, S.; Dilworth, C.; Grambsch, A.; Gohlke, J.; Hess, J.; Howard, S.; Luber, G.;
Lutz, J.; et al.A Human Health Perspective on Climate Change: A Report Outlining the Research Needs on the Human
Health Effects of Climate Change; Environmental Health Perspectives/National Institute of Environmental
Health Sciences: Research Triangle Park, NC, USA, 2010. Available online: www.niehs.nih.gov/climatereport
(accessed on 23 October 2014). [CrossRef]
Doherty, T.J.; Clayton, S. The psychological impacts of global climate change. Am. Psychol.
Rose, J.B.; Epstein, P.R.; Lipp, E.K.; Sherman, B.H.; Bernard, S.M.; Patz, J.A. Climate variability and change
in the United States: Potential impacts on water-and foodborne diseases caused by microbiologic agents.
Environ. Health Perspect. 2001,109 (Suppl. S2), 211–221. [CrossRef] [PubMed]
Pleitez Herrera, F.J. Predicting Removal Efﬁciency of Reverse Osmosis Membranes with Respect to Emerging
Substances of Concern Using a Discriminant Function Analysis. Master ’s Thesis, Florida Atlantic University,
Boca Raton, FL, USA, 2012.
Esty, D.C.; Levy, M.; Srebotnjak, T.; de Sherbinin, A. Environmental Sustainability Index: Benchmarking National
Environmental Stewardship; Yale Center for Environmental Law & Policy: New Haven, CT, USA, 2005.
Funari, E.; Manganelli, M.; Sinisi, L. Impact of climate change on waterborne diseases. Ann. Ist. Super. Sanità
2012,48, 473–487. [CrossRef] [PubMed]
Southeast Florida Regional Climate Change Compact (SEFRCCC); Health Impact Assessment (HIA).
Minimizing the Health Effects of Climate Change in the South Florida Region, Regional Climate
Action Plan. Final Report. Available online: http://www.pewtrusts.org/~/media/assets/external-sites/
health-impact-project/climatechangeinsouthﬂoridaﬁnalreport31814.pdf?la=en (accessed on 28 March 2016).
2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons by Attribution
(CC-BY) license (http://creativecommons.org/licenses/by/4.0/).