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Public Health Approach to Climate Mental Health

What is public health?

Public health is a discipline that is concerned with preventing illness and promoting health in society via a range of activities or services that reach groups or populations. It is distinct from healthcare disciplines, in which providers treat one person at a time for a specific injury or disease. In contrast to this individual approach to improving health, public health focusses on the health of populations. Public health aims not only to promote health, but also to proactively prevent health problems. Public health plays a key role in addressing many global problems, such as the COVID-19 pandemic and climate change.  

Frameworks for public health

To distinguish public health from healthcare, it can be useful to understand the activities, or services, in which public health professionals engage. The Essential Public Health Services (EPHS) is a widely accepted framework of public health services, developed in 1994 and updated in 2020 by a task force of public and private stakeholders. It contains a set of 10 services in 3 categories:

Assessment

  1. Assess and monitor population health, factors that influence health, and community needs.
  2. Investigate, diagnose, and address health problems affecting the population.

For example, a city’s public health agency might collect data on the prevalence of a health problem, and work with other agencies in the city to share information about how to mitigate it.

Policy Development

  1. Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it.
  2. Strengthen, support, and mobilize communities and partnerships to improve health.
  3. Create and implement policies, plans, and laws that impact health.
  4. Use legal and regulatory actions designed to improve and protect the public’s health.

For instance, a community agency might work in coalition with similar groups to lobby for and educate the public about a law that could help prevent a certain health problem.

Assurance

  1. Assure an effective system that enables equitable access to services and care.
  2. Build and support a diverse and skilled public health workforce.
  3. Improve and innovate public health functions through ongoing evaluation, research, and quality improvement.
  4. Build and maintain a strong organizational infrastructure for public health.

An example: a governmental public health agency could work on projects to increase people’s access to healthcare. Assurance also could involve public health professionals working as educators.

The World Health Organization (WHO) conceptualizes public health in terms of a set of 12 essential functions, which, similar to EPHS, includes population health monitoring, disease prevention, community engagement, resilience building, and workforce development. The WHO’s recommendations for building public health service capacity may vary for different countries, since sociocultural and political circumstances can affect risk for health problems.

Key terms in public health

Public health practice is concerned with preparedness: governments proactively taking actions to prevent or be ready to manage large-scale health events, including emergencies and disasters.

Factors that are known to affect health are called determinants of health. Social determinants of health are factors related to the environments in which people live, such as their neighborhood, socioeconomic status, access to education, access to healthcare, and more. The Centers for Disease Control and Prevention (CDC) recommends addressing social determinants of health in all 10 EPHS. For example, public health practitioners should engage affected communities in developing projects.

Systemic factors cause groups or subpopulations to have differential health outcomes; for instance, mental health risks associated with climate change are concentrated in geographic areas which are already facing other social vulnerabilities. This is referred to as health disparities or health inequities.

What is a public health approach to climate change?

A public health approach to climate change starts from the recognition that climate change will have many significant negative effects on human health. The approach aims “to anticipate, manage, and ameliorate the health burdens” that climate change imposes. Globally, multiple entities concerned with public health have called for urgent action on climate change. Such actions include research (ie., measuring health problems that result from burning fossil fuels); prevention efforts preparing communities for disasters caused or exacerbated by climate change; educating the public about the health effects of climate change; and advocating for laws that protect health.

The public health approach considers relative levels of health risks posed by climate change, and how they interact with pre-existing vulnerabilities. The WHO describes climate change as a “threat multiplier” because it affects multiple dimensions of human health, and undermines systems such as healthcare delivery, with the most significant effects in the most vulnerable places. As one example, public health researchers help cities predict in which neighborhoods extremely hot temperatures will most affect health, based on vulnerabilities like poor air quality.

An important concept in the public health approach to climate change is co-benefits – the idea that taking action against climate change will benefit not only the environment, but also human health. Most importantly, millions of premature or excess deaths would be prevented by reducing greenhouse gas emissions. Many other policy changes to reduce emissions would also have health co-benefits. One example is that policies which make it safer and easier to move around cities by bike instead of car have been shown not only to reduce emissions, but additionally to reduce people’s risks of health issues like diabetes or heart problems.

How does a public health approach to climate change affect mental health?

Public health recognizes mental health as an aspect of overall health. A public health approach to mental health would be tailored to a group, such as individuals who have risk factors for a certain mental health problem, or a whole population, such as everyone living in a certain region, in contrast to the traditional clinical treatment model, in which a provider treats one person at a time.

A public health perspective on climate mental health leads to some important points: 

  1. Climate change has the potential to affect mental health on a community or population level, because climate-related phenomena happen on a large scale (e.g. heat waves or sea level rise).
  2. The negative mental health effects of climate change are disproportionately concentrated among groups that already face more risk factors for mental health problems. 

Globally, research has shown that people who are affected by extreme weather events are at increased risk of mental health problems, particularly anxiety and post-traumatic stress disorder (PTSD), and in some cases depression. For instance, Americans who directly experienced Hurricane Katrina developed PTSD at higher rates than other Americans, and these higher rates persisted when data was collected 12 years after the hurricane. Disproportionate effects on mental health and wellbeing are particularly evidenced internationally in low- and middle-income countries.

Leading organizations like WHO and the American Psychological Association (APA) have highlighted the importance of integrating mental health plans into climate change plans, such as widespread access to mental health services. The APA first published a resolution on psychologists’ role in addressing climate change in 2011.

Public health professionals recognize many possible mental health co-benefits of climate action. Mitigating climate change would mean fewer negative mental health consequences arise in the first place. Improving population resilience could boost mental health and wellbeing. For instance, emergency preparedness programs might also foster a sense of connection and psychological safety.

Unequal impacts on different people

Addressing health inequities is a core goal of public health. The EPHS framework states that it is essential to “enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression.”.

Climate change negatively impacts multiple social determinants of health, such as people’s livelihoods, access to healthcare, and social support networks. These impacts are greater for populations that already have elevated risk for climate change-related mental health problems, including people taking certain medications (antipsychotics, hypnotics, and anxiolytics), people living in lower income nations, children and youth, the elderly, people with unstable social or family support, indigenous people, and people at lower socioeconomic status.

Public health takes a global perspective, because factors that affect health are not necessarily location- or nation-specific. A global perspective considers historical and sociocultural factors. For instance, people who live in low- or middle-income countries are at higher risk for health, and mental health, problems associated with climate change. Historically, and in an ongoing way, colonization and global extractive environmental practices limited these countries’ access to economic resources, with a consequence of higher rates of risk factors for health problems and fewer resources for health services. Climate migration is an emerging issue, with people leaving places affected by climate change and related problems; these migrants are at elevated risk for mental health problems.

Research on public health and climate mental health

Research on the public health implications of climate change began to rise dramatically from around 2006. Seminal peer-reviewed publications include: Frumkin, Hess, Luber, Malilay, & McGeehin, 2008; Frumkin & McMichael, 2008; McMichael, Woodruff, & Hales, 2006. Recent scientific research shows:

  • A 2019 paper reviewed 10 years of public health work on climate change, framed by the field’s three overarching activities (assessment, policy development, and assurance). The authors found that extensive work had been done on assessment of public health impacts of climate change, such as local government projects to monitor health risks in areas vulnerable to climate change. The authors suggested more attention to policy development, assurance, and emerging areas like governance.
  • A 2021 review paper indicated that research has firmly established a relationship between the effects of climate change and worsening mental health impacts, particularly for people with other vulnerabilities. The authors suggested continued research on prevention programs, and related investigations, such as studies of cost effectiveness.

Experts agree that more public health and discipline-specific research about mitigation and adaptation is needed.

Taking a public health approach to climate mental health

Governments play a main role in public health activities because of the broad scope of population-level work. Governments can:

  • Implement assessment, policy development, and assurance activities that target the health effects of climate change. Such efforts should prioritize support for the most vulnerable groups.
  • Invest in community resilience: the ability of a community to prepare for, weather, and recover from emergencies or disasters, such as those associated with climate change. One resource on how to develop community resilience programs which take a public health approach to the mental health effects of climate change is the International Transformational Resilience Coalition.
  • Create workforce training to help public health professionals understand the negative effects of climate change. Governments need to overcome barriers including limited or unstable funding and lack of guidance placing climate change as a high-priority issue.
  • Within governments, interagency collaboration will make it possible to enact policies and programs to act on the mental health effects of climate change. Involved agencies might include public health agencies, transportation authorities, energy officials, water utilities, and many others.

Public health professionals and researchers can:

  • Identify groups most susceptible to the mental health impacts of climate change, and their needs.
  • Educate the public about climate change’s health and mental health effects. For instance, the American Public Health Association has published a toolkit for teaching high school students about this topic.
  • Develop interventions to mitigate the negative health and mental health effects of climate change, not just to describe them. Some interventions that public health agencies have successfully implemented include early warning systems for extreme heat, and processes to enhance disaster preparedness within healthcare systems. Others could be increasing people’s access to mental health services.
  • Calls have also been made for continued workforce development for more public health professionals to know about and work in their communities to address the health effects of climate change.

Mental health professionals and other health care professionals can:

  • Adopt a public health lens to address the effects of climate change both in their one-to-one practice and also broadly in communities and local and state policy.
  • Develop awareness of the health and mental health effects of climate change, disseminate this information to colleagues and professional networks, and teach people entering their fields.

Recognizing the prevalence of mental health problems, and relative lack of treatment resources, some psychiatrists and psychologists have called for a public health approach within their fields. To appropriately target the mental health and related needs of today’s society, this community-level approach involves addressing social determinants of health via strategies like advocating for policy change, creating systemic change within institutions like hospitals, and building or participating in community-based mental health programs. These professionals argue that the prevailing model of individual symptom-based clinical treatment is not sufficient to address or prevent the mental health problems common in society.

Everyone can:

  • Advocate to their local, state, or federal governments to attend to the health and mental effect of climate change.
  • Spread the word about the large-scale health and mental health effects that are likely to occur due to climate change.

What else might we need to know?

A public health approach could encompass a great many kinds of evidence-based interventions. There is no single prescribed method to work on public health. Approaches intended to benefit specific communities should always be developed with partners in affected communities. In addition, more research on mental health and climate change from a public health perspective is critical to making strides in improving health outcomes for all. 

Further reading

Books

Climate Change and Health Playbook: Adaptation Planning for Justice, Equity, Diversity and Inclusion, by the American Public Health Association & Centers for Disease Control and Prevention, published in 2021.

Climate Action and Global Psychology, edited by Amanda Clinton, Brian Dixon, and Terri Morrissey, published in 2022 by The New Zealand Psychological Society.

Articles and Online Sources

Climate and Youth Education Toolkit, published by the American Public Health Association.

Climate Change is Fueling a Public Health Crisis. Doctors Need to Address This, published in Scientific American on November 14, 2022, by Neelu Tummala.

Health Approaches to Climate Change, published in American Public Health Association Fact Sheets, by the American Public Health Association.

The Hidden Health Costs of Climate Change, published in TIME on March 1, 2024, by Jeffrey Kluger.

The human cost of climate-related disasters is acutely undercounted, new study says, published in NPR on February 29, 2024, by Alejandra Borunda.

The Lancet countdown on health and climate change, updated annually, by the Lancet.

Mental Health and Climate Change: Policy Brief, published in the World Health Organization Publications on June 3, 2022, by the World Health Association.

Mental Health and Our Changing Climate: Children and Youth Report 2023, published in 2023 by the American Psychological Association and ecoAmerica (lead authors Susan Clayton, Christie Manning, Alison Nicole Hill, and Meighen Speiser).

Mental Health and Stress-Related Disorders, published in Climate and Health on June 18, 2020, by the Centers for Disease Control and Prevention.

Public Health Adaptation Strategies for Climate Change, published in the Climate Change Adaptation Resource Center (ARC-X) on December 20, 2023 by the United States Environmental Protection Agency.

What is public health?, published on the American Public Health Association website in 2024 by the American Public Health Association.

Why climate change is also a public health problem, published in ABC News on September 25, 2019, by Erin Schumaker.

Selected Research/Scientific Papers

Atwoli, L., Baqui, A. H., Benfield, T., Bosurgi, R., Godlee, F., Hancocks, S., Horton, R. C., Laybourn-Langton, L., Monteiro, C. A., Norman, I., Patrick, K., Praities, N., Olde Rikkert, M. G., Rubin, E. J., Sahni, P., Smith, R. S., Talley, N. J., Turale, S., & Vázquez, D. (2021). Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. The Medical journal of Australia, 215(5), 210–212. https://doi.org/10.5694/mja2.51221

Bouzid, M., Hooper, L., & Hunter, P. R. (2013). The effectiveness of public health interventions to reduce the health impact of climate change: a systematic review of systematic reviews. PloS one, 8(4), e62041. https://doi.org/10.1371/journal.pone.0062041

Charlson, F., Ali, S., Benmarhnia, T., Pearl, M., Massazza, A., Augustinavicius, J., & Scott, J. G. (2021). Climate Change and Mental Health: A Scoping Review. International journal of environmental research and public health, 18(9), 4486. https://doi.org/10.3390/ijerph18094486

Dodge, K. A., Prinstein, M. J., Evans, A. C., Ahuvia, I. L., Alvarez, K., Beidas, R. S., Brown, A. J., Cuijpers, P., Denton, E. G., Hoagwood, K. E., Johnson, C., Kazdin, A. E., McDanal, R., Metzger, I. W., Rowley, S. N., Schleider, J., & Shaw, D. S. (2024). Population mental health science: Guiding principles and initial agenda. The American psychologist, 10.1037/amp0001334. Advance online publication. https://doi.org/10.1037/amp0001334

Fox, M., Zuidema, C., Bauman, B., Burke, T., & Sheehan, M. (2019). Integrating Public Health into Climate Change Policy and Planning: State of Practice Update. International journal of environmental research and public health, 16(18), 3232. https://doi.org/10.3390/ijerph16183232

Frumkin, H., Hess, J., Luber, G., Malilay, J., & McGeehin, M. (2008). Climate change: the public health response. American journal of public health, 98(3), 435–445. https://doi.org/10.2105/AJPH.2007.119362

Frumkin, H., & McMichael, A. J. (2008). Climate change and public health: Thinking, communicating, acting. American Journal of Preventive Medicine, 35(5), 403-410. https://doi.org/10.1016/j.amepre.2008.08.019

Haines, A. (2017). Health co-benefits of climate action. The Lancet Planetary Health, 1(1), e4-e5. https://doi.org/10.1016/S2542-5196(17)30003-7

Hartwell, C., Lovell, S., Hess, J.J., Dolan, K., Vickery, J. & Errett, N.A. Barriers and facilitators to state public health agency climate and health action: A qualitative assessment. BMC Public Health 23, 145 (2023). https://doi.org/10.1186/s12889-023-14996-2

Lawrance, E. L., Thompson, R., Newberry Le Vay, J., Page, L., & Jennings, N. (2022). The impact of climate change on mental health and emotional wellbeing: A narrative review of current evidence, and its implications. International Review of Psychiatry, 34(5), 443-498. https://doi.org/10.1080/09540261.2022.2128725

McMichael, A. J., Woodruff, R. E., & Hales, S. (2006). Climate change and human health: Present and future risks. The Lancet, 367(9513), 859-869. https://doi.org/10.1016/S0140-6736(06)68079-3

Palinkas, L. A., & Wong, M. (2020). Global climate change and mental health. Current Opinion in Psychology, 32, 12-16. https://doi.org/10.1016/j.copsyc.2019.06.023

White, B. P., Breakey, S., Brown, M. J., Smith, J. R., Tarbet, A., Nicholas, P. K., & Ros, A. M. V. (2023). Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review. Annals of global health, 89(1), 66. https://doi.org/10.5334/aogh.4105

Author and version info

Author: Liz McLaughlin, PhD

Editor: Colleen Rollins, PhD

August 26, 2024