Overview
Individuals living in rural areas are often vulnerable due to physical isolation, economic diversity, increased poverty rates, and minimal healthcare options, especially for those with disabilities and the elderly (Hales et al., 2014). However, when human health is drastically influenced by weather and climate in addition to the aforementioned rural characteristics, PWDs face greater vulnerability. Specifically, extreme heat, severe winter storms, drought, wildfires (which increase air pollutants), floods, hurricanes, and tornadoes all contribute to the development or exacerbation of medical and mental health conditions. How well a community responds and has the resources available to handle inclement weather determines how PWDs will be impacted. For example, individuals with limited mobility (i.e., wheelchair users) are highly vulnerable when public transportation is only an option if one travels great distances. Rural localities, however, may have poor evacuation and emergency response procedures, lack adequate sidewalk and curb cuts, have dirt roads nonnegotiable for wheelchairs, and lack social or family support to help during extreme weather conditions (Balbus et al., 2016).
Although Chap. 25 focuses on natural disasters commonly encountered in rural areas, the purpose of this chapter is to specifically address weather and climate conditions (e.g., extreme heat and drought conditions) and its impact on PWDs residing in rural communities. The reader is encouraged to read this chapter and Chap. 25 as companion chapters. In this chapter, we focus particularly on six regions: Northwest, Southwest, Great Plains, Midwest, Southeast, and Northeast, each with varying weather and climate conditions affecting individuals differently based on type of disability and/or health condition. In addition, we provide an overview of four categories of extreme events which include the following: (a) heat and droughts, (b) wildfires, (c) winter storms and severe thunderstorms, and (d) flooding related to hurricanes and coastal storms. Understanding the changes in weather and climate, and the underlying exposure and sensitivity to these environmental conditions based on disability and illness, can improve the well-being outcomes when interventions and adaptation methods are provided in rural areas.
Learning Objectives
- 1.
Identify common weather and climate conditions of each region within the United States.
- 2.
Identify the weather and climate conditions and how they directly affect disability and health conditions.
- 3.
Identify strategies for improving weather and climate health inequity in rural communities.
Introduction
Major US climate trends (Note: Adapted from “Climate change and human health,” by Balbus et al. (2016))
Weather and Climate Conditions Along Six US Regions
Northeast
Northeast rural population and disability percentage
State | Total pop. | Urban/rural disabilities % | Rural pop. | % of rural pop. |
|---|---|---|---|---|
Connecticut | 3,574,097 | 11.2%/9.8% | 429,155 | 12.01% |
Delaware | 897,934 | 11.8%/14.5% | 149,985 | 16.7% |
Maine | 1,328,361 | 17.0%/15.9% | 814,819 | 61.34% |
Maryland | 5,773,552 | 10.8%/11.4% | 739,221 | 12.8% |
Massachusetts | 6,547,629 | 11.8%/10.2% | 525,640 | 8.03% |
New Hampshire | 1,316,470 | 13.1%/12.7% | 522,598 | 39.7% |
New Jersey | 8,791,894 | 10.4%/11.3% | 467,768 | 5.32% |
New York | 19,378,102 | 11.0%/13.8% | 2,349,997 | 12.13% |
Pennsylvania | 12,702,379 | 14.0%/13.5% | 2,711,092 | 21.34% |
Rhode Island | 1,052,567 | 13.8%/10.1% | 97,.524 | 9.27% |
Vermont | 625,741 | 16.1%/14.0% | 382,356 | 61.1% |
West Virginia | 1,852,994 | 18.3%/20.5% | 950,184 | 51.28% |
Southeast
Southeast rural population and disability percentage
State | Total pop. | Urban/rural disability % | Rural pop. | % of Rural pop. |
|---|---|---|---|---|
Alabama | 4,779,736 | 15.5%/18.4% | 1,957,932 | 40.96% |
Arkansas | 2,915,918 | 15.6%/19.2% | 1,278,329 | 43.84% |
Florida | 18,801,310 | 13.1%/16.5% | 1,661,466 | 8.84% |
Georgia | 9,687,653 | 11.0%/16.0% | 2,415,502 | 24.93% |
Kentucky | 4,339,367 | 15.0%/19.9% | 1,806,024 | 41.62% |
Louisiana | 4,533,372 | 14.5%/15.9% | 1,215,567 | 26.81% |
Mississippi | 2,967,297 | 14.9%/17.5% | 1,503,073 | 50.65% |
North Carolina | 9,535,483 | 12.5%/16.8% | 3,233,727 | 33.91% |
South Carolina | 4,625,364 | 13.6%/17.5% | 1,557,555 | 33.67% |
Tennessee | 6,346,105 | 14.1%/18.3% | 2,132,860 | 33.61% |
Virginia | 8,001,024 | 10.4%/14.8% | 1,963,930 | 24.55% |
Midwest
Representing 20% of the national total (61 million) and 13 million (21%) residing in rural communities (Pryor, Barthelmie, & Schoof, 2013; Stoddard, 2014), the weather conditions in the Midwest pose significant threats to public health. Specifically, this region consists of extreme heat waves and freezing temperatures, tornadoes, droughts, and increased humidity, and as a result of human-induced carbon emissions, air and water quality is relatively poor which has profound effects among PWDs. The emissions of greenhouse gases, for instance, are 20% higher than the national average and have been a significant contributing factor for increased temperatures exceeding 100 °C and increased pollen seasons (Pryor & Barthelmie, 2013).
Midwest rural population and disability percentage
State | Total pop. | Urban/rural disability % | Rural pop. | % of rural pop. |
|---|---|---|---|---|
Illinois | 12,830,632 | 10.4%/12.8% | 1,477,079 | 11.51 |
Indiana | 6,483,802 | 13.8%/13.6% | 1,786,702 | 27.56 |
Iowa | 1,567,582 | 11.9%/12.0% | 461,212 | 29.42 |
Michigan | 9,883,640 | 14.4%/14.4% | 2,513,683 | 25.43 |
Minnesota | 5,303,925 | 10.8%/11.4% | 1,417,614 | 26.73 |
Missouri | 5,988,927 | 13.6%/16.8% | 1,770,556 | 29.56 |
Ohio | 11,536,504 | 13.9%/13.9% | 2,546,810 | 22.08 |
Wisconsin | 5,686,986 | 12.2%/11.4% | 1,697,348 | 29.85 |
Great Plains
Great Plains rural population and disability percentage
State | Total pop. | Urban/rural disability % | Rural pop. | % of rural pop. |
|---|---|---|---|---|
Kansas | 2,853,118 | 12.5%/13.8% | 736,157 | 25.8% |
Montana | 989,415 | 13.4%/14.2% | 436,401 | 44.11% |
Nebraska | 1,826,341 | 10.7%/12.5% | 490,655 | 26.87% |
North Dakota | 672,591 | 11.0%/10.2% | 269,719 | 40.1% |
Oklahoma | 3,751,351 | 14.4%/17.9% | 1,266,322 | 33.76% |
South Dakota | 814,180 | 11.9%/12.1% | 352,933 | 43.35% |
Texas | 25,145,561 | 11.0%/14.8% | 3,847,522 | 15.3% |
Wyoming | 563,626 | 12.2%/12.8% | 198,633 | 35.24% |
Southwest
Southwest rural population and disability percentage
State | Total pop. | Urban/rural disability % | Rural pop. | % of rural pop. |
|---|---|---|---|---|
Arizona | 6,392,017 | 12.4%/16.7% | 651,358 | 10.19% |
California | 37,253,956 | 10.4%/14.3% | 1,880,350 | 5.05% |
Colorado | 5,029,196 | 10.1%/11.6% | 696,435 | 13.85% |
Nevada | 2,700,551 | 13.3%/15.9% | 156,754 | 5.8% |
New Mexico | 2,059,179 | 14.8%/15.4% | 464,818 | 22.57% |
Utah | 2,763,885 | 9.7%/11.3% | 260,290 | 9.42% |
Northwest
Northwest rural population and disability percentage
State | Total pop. | Urban/rural disability % | Rural pop. | % of rural pop. |
|---|---|---|---|---|
Idaho | 1,567,582 | 13.1%/15.4% | 461,212 | 29.42% |
Oregon | 3,831,074 | 14.5%/18.1% | 726,692 | 18.97% |
Washington | 6,724,540 | 12.3%/15.6% | 1,072,671 | 15.95% |
Weather and Climate Conditions and Their Impact Toward Disability and Health
As demonstrated, weather and climate conditions vary significantly among each region, though some overlap does exist. Depending on social, political, and economic factors, otherwise known as social determinants of health, people and communities can be more vulnerable to health risks (Braveman, Egerter, & Williams, 2011). Even more so, PWDs have extreme challenges during severe weather and climate events which directly cause and/or exacerbate medical and mental health conditions. Though a few examples of extreme event types and their impact toward disability have been provided, we will explore the significance of extreme heat, droughts and wildfires, flooding, and severe winter storms among PWDs in rural and small towns.
Prior to discussing these four natural disasters, however, the reader should be aware of how federal, and in all likelihood, local municipalities are prepared to deal with emergency response and rescue in the United States. Specifically, the September 11, 2001, attack and its aftermath drew to the awareness of those with disabilities during emergency response and rescue (ERR) from upper floors in high-rise buildings necessitated improved evacuation procedures since elevators were powered off. Subsequent to that event was Hurricane Katrina, where federal and local emergency response for all New Orleans citizens and surrounding rural areas was slow and ill-prepared for flash floods, bacterial floodwaters, and power outages lasting weeks. Despite the abovementioned occurrences and the Emergency Management Reform Act of 2006 (designed to plan and implement emergency evacuation and shelters equipped for persons with disabilities), enactment continues to be stagnant.
Weibgen (2015) in the Yale Law Review cited the fallout after the 2011 and 2012 respective hurricanes Irene and Sandy in New York and New Jersey. Emergency response and rescue and emergency shelters were not set up for urban or rural residents with disabilities. In the Brooklyn Center for Independent Living of the Disabled v. Bloomberg class-action lawsuit that followed, the city of New York was cited for numerous violations. Mayor Bloomberg and the city of New York were found guilty of cutting all transportation, not having a coordinated plan to evacuate those with disabilities, waiting over 2 weeks to send first responders to high-rise buildings without power, and providing no education to 311 and 911 operators on how to evacuate persons in wheelchairs. In addition, the judge cited “benign neglect” of persons with disabilities where shelters and other evacuation centers were either inadequate or inaccessible (Weibgen). This is one of two such lawsuits in the United States, and it remains highly likely that ERR and education for first responders are still woefully inadequate. The implications for these inadequacies for rural persons with disabilities become even more troubling in the event of natural disasters. In rural areas with scarce services, persons with disabilities may have to rely upon the kindness of family and neighbors to evacuate them or keep them safe.
Extreme Heat
High ambient heat occurs among all six regions and affects a substantial range of illnesses and mental health. Persons with preexisting medical conditions such as cardiovascular disease, respiratory disease, diabetes, asthma, obesity, mobility impairments, and mental illnesses are at increased risk for exacerbating their health conditions when exposed to extreme heat (Gamble et al., 2016). Mental, behavioral, and cognitive disorders can also be triggered or exacerbated by heat waves, specifically, dementia, mood disorders, neurosis and stress, and substance abuse (Balbus & Melina, 2009; Hansen, Nitschke, Ryan, Pisaniello, & Tucker, 2008; Martin-Latry et al., 2007; Page, Hajat, Kovats, & Howard, 2012). While both medical and mental health can be directly affected by heat waves, side effects from prescription medication and heat exposure can occur. Research has identified the association between increased temperatures, respiratory and cardiovascular conditions requiring hospitalization, emergency room admittance, and death (Gamble et al., 2016). Medications used to treat mental health disorders (i.e., depression, anxiety, etc.) can also interfere with the body’s ability to regulate temperature and increase susceptibility to the effect of heat, and dehydration from heat exposure can influence how medications such as lithium (used for bipolar disorder) are absorbed by the body (Berko, Ingram, Saha, & Parker, 2014).
When we think of infrastructure damage, we rarely consider heat waves as the resulting cause; however, consider the 2003 Northeastern blackout indirectly caused by a heat wave, leaving many rural communities without power for weeks (Bell et al., 2016). For PWDs who require an uninterrupted source of electricity, this can pose a significant health concern and reduce quality of life , and for individuals with physical disabilities utilizing assistive technology, mobility can be impaired (i.e., motorized wheelchairs require recharging from an electrical power source). Such power outages and rotating blackouts can be life-threatening for those with respiratory diseases or paralysis requiring a ventilator. For many with these disabilities living in rural areas and low income, backup generator and charged backup batteries are critical necessities.
In addition, those with certain types of disabilities such as tetraplegia, cerebral palsy, and other medical conditions where body temperature regulation is impaired, heat exhaustion and heatstroke can quickly become life-threatening if the individual is not in an air-conditioned environment with temperature control. PWDs with these types of chronic illnesses and disabilities also have to consistently drink fluids to hydrate and flush their bladder and kidneys to avoid urinary infections since their condition (i.e., paralysis and neurogenic bladder) poses an inability for them to void on their own. As indicated within the overview of the six regions, overall disability rates tend to be proportionately higher than urban communities, and with high ambient heat, a significant portion of PWDs in rural communities are affected across the country.
Droughts and Wildfires
The Southwest, Southeast, Great Plains, and Midwest all experience droughts , while western regions have higher proportions of wildfires from extreme heat. Both contribute to reduced water quality, degraded air quality, reduced water quantity (only from droughts), and decreased life satisfaction, and, to a lesser extent, impact mental health (Bell et al., 2016). Of primary concern is the degraded air quality associated with wildfire smoke and air particles linked to droughts, affecting individuals differently based on age, illness, and type of disability. There is an increase in hospital admissions and deaths associated with cardiovascular and respiratory illnesses (e.g., asthma and chronic obstructive pulmonary disease) that involve decreased lung function (e.g., spinal cord injury at the cervical and thoracic level; Baja et al., 2010). While wildfires and droughts can worsen preexisting health conditions, they also account for premature deaths and increased risk for cardiovascular disease (Garcia, Yap, Park, & Weller, 2016; Gold et al., 2000; Pope et al., 2004, 2015). To improve health conditions from these effects, persons with the aforementioned health conditions should limit outdoor activities and decrease home ventilation to lower the inhalation of outdoor smoke (Laumbach, Meng, & Kipen, 2015; Weinhold, 2011). As noted earlier however, decreased life satisfaction is commonly associated with droughts and wildfires, particularly from the limitations imposed (i.e., reduced outdoor activity). Furthermore, research has indicated a strong association between these two event types and a negative impact toward mental health including grief/bereavement, increased substance use, and suicidal ideation (North, Ringwalt, Downs, Derzon, & Galvin, 2011).
In the case of wildfires in dry rural areas such as California often involving high winds, persons with mobility impairments are particularly vulnerable and must evacuate before the situation becomes dire. Rural disaster response and preparation for those with disabilities in most urban and rural areas across the United States are still inadequate despite Pres. George W. Bush’s Executive Order in 2004 and enacted as the Emergency Management Reform Act of 2006 (Weibgen, 2015). Post Hurricane Katrina and the almost complete breakdown in federal and local emergency response preparedness for all Americans disabled and otherwise, the Emergency Management Reform Act was signed into law to better prepare these entities to evacuate and rescue individuals from such disasters as well as provide accessible shelter. Unfortunately, enacting this law has been slow to occur concerning those with disabilities, and as such, persons with mobility disabilities in fast-moving wildfire situations need to be evacuated many hours or perhaps days in front of the wildfire’s path.
Flooding
Traumatic injury and death from drowning (associated with flash flooding)
Mental health impact (longer term)
Respiratory illnesses
Preterm birth and low birth rate
Carbon monoxide poisoning from related power outages
Blunt trauma from falling debris or quick moving objects in floodwater
Electrocution
Puncture wounds
Burns
Sprains/strains
Hypothermia
Water contamination
Post-event disease spread from infrastructure disruption (Bell et al., 2016)
The aforementioned injuries and infections have been observed more commonly in rural areas (Špitalar et al., 2014). Because rural areas are highly susceptible to flash flooding conditions developing rapidly, these communities have reduced time to notify residents to respond and prepare during emergency procedures such as warnings, road closures, and evacuations (Bell et al., 2016). Furthermore, approximately 40% of country roads are inadequate for travel, bridges longer than 20 feet structurally deficient, and transportation safety continuing to be a concern (U.S. Department of Transportation, 2012); many rural residents are unable to evacuate during extreme flood events. Moreover, the ability to respond to a flooding emergency poses challenges for the aging population living alone and PWDs with mobility impairments and disabilities which reduce reaction time and require assistance (i.e., dementia, traumatic brain injury, Down syndrome, etc.). Flooding and all the other inclement weather conditions again involve the potential for power outages, and the concerns for those with disabilities requiring power were noted earlier.
Winter Storms
Despite global climate change, the severity and incidence rate of winter storms have increased since the 1950s with snowstorms generally produced in greater frequency in the Northeast and Midwest regions of the United States (Bell et al., 2016; Francis & Vavrus, 2012). From loss of power to inadequate driving conditions, winter storms present an array of challenges for all persons residing in a rural community throughout the United States but pose greater challenges for PWDs. If you have ever experienced living in a geographical region which produces heavy snowfall each year, then you understand the environmental conditions generally require suitable preparation. For instance, the Department of Homeland Security (2016) recommends placing fuel-burning equipment in a well-ventilated area and purchasing at least 2 weeks of nonperishable food items during the winter season.
Older buildings with steep ramps
Freezing pipes (eliminating running water)
Poor road conditions (i.e., unpaved roads)
Blocked roads and/or road closure from heavy snowfall
Power outages for several days (affecting food, medicine, and overall personal safety)
These are just a few examples of infrastructure barriers and how PWDs can be affected as a result. Specifically, restoring power in rural communities can take several days as demonstrated in 2011 when a pre-Halloween snowstorm left several thousand homes affected in the Northeast region for approximately 10 days (Horton et al., 2014). In an effort to keep warm, individuals can resort to extreme measures, particularly through the use of gasoline-powered generators, charcoal grills, and propane heaters. All of which contribute to carbon monoxide poisoning and frequently associated with illness and death during the winter season (Bell et al., 2016).
Addressing Climate-Related Health Inequities
Governments in rural areas are generally ill-prepared to respond swiftly and effectively to extreme weather and climate events, although individuals and voluntary associations often show significant resilience. Health risks increase and can be aggravated by an ill-funded and/or inadequately trained healthcare system generally characteristic of rural areas, including long traveling distances to healthcare providers and the reduced availability of medical specialists (Hales et al., 2014). There are a few recommendations, however, provided by Friel (2013) which emphasize the need for community health organizations to focus their attention toward improving weather and climate health inequity. These include the following:
Evidence-Informed Practice
This form of practice is implemented to design health-promoting programs by obtaining reliable data on the extent of the problem and up-to-date evidence on the cause of health inequities. For the rehabilitation counselor, it means identifying the potential benefits, harm, and cost of an intervention program. What works in an urban community may not be practical in rural areas. Furthermore, bringing together local experience (i.e., PWDs who have encountered barriers and healthcare inequality) in addition to experts in developing health-promoting programs is ideal for ensuring the success of this practice.
People-Centered Practice
This method involves both person-centered thinking and planning. Rehabilitation counselors and community leaders should focus on the individual, identifying strengths and abilities, aiding individuals in connecting with their community, while identifying and addressing what PWDs are communicating as current barriers frequently encountered. For instance, persons with respiratory complications in need of uninterrupted sources of electricity to rely on medical equipment (i.e., portable oxygen), and have discussed their concerns with community leaders, should feel confident a plan is in place for addressing power outages in a timely manner.
Prevention-focused practice
To appropriately address climate and weather conditions and its impact toward health equity, public health practitioners should focus on removing barriers toward access and quality healthcare. Rather than solely focusing on behavioral change (i.e., expecting consumers to find and/or adapt to climate and weather conditions), one should center their approach by preventing or ameliorating the disadvantaged circumstances that come with living in rural communities. One example would be to incorporate or increase home healthcare services for PWDs who reside in rural areas.
Summary
The unique need of rural Americans who live with various disabilities is an area that has received limited research and attention by the government regarding ERR planning and accessible safe haven shelters. Rural Americans with and without disabilities demographically often live in small towns with scarce social services including healthcare and funding for town infrastructure. Many rural residents deal with personal isolation and limited or no local healthcare clinics with highly trained staff and rely on volunteerism or the kindness of neighbors for assistance.
In dealing with natural disasters such as those described in this chapter, persons with certain disabilities become highly vulnerable in what may become a life-threatening situation or minimally to continue to be able to maintain their health. Persons with mobility impairments may experience little or no accessible travel options for expedient evacuation, and extended power outages may threaten the lives of those who rely on ventilators to breathe or whose temperature cannot be exposed to too hot or too cold weather conditions.
Town officials can better plan for inclement weather and emergency response by meeting with their residents with disabilities and plot a rescue response plan by including rural residents with disabilities in the process. Travel alternatives, backup generators, prescription medications, medical supplies, and making shelters accessible all must be included in such planning. Finally, planning for accessing trained medical providers in cases of emergency for residents with disabilities may literally become a matter of life and death.