Climate changes tribal and indigenous health

Climate change is today’s greatest public health challenge. While all of us will experience the health impacts of climate change, some groups, including tribal communities, are particularly vulnerable. Climate justice requires ensuring fair treatment of all people — regardless of race, gender and socioeconomic status — in creating policies and practices to address climate change. By providing resources and assistance to communities that need it most, we can create healthy environments for all. 

For almost five years, the American Public Health Association, with support from the Centers for Disease Control and Prevention, convened the Tribal Public and Environmental Health Think Tank to raise awareness about and achieve improvements to the unique public and environmental health challenges faced by the communities they serve. To highlight climate change and other public health concerns impacting tribal communities, the Think Tank released a report, Priorities in Tribal Public Health.

The report highlights six tribal public health priority issues, including climate and health, along with food sovereignty and access, infrastructure and systems development, resource extraction, clean air and clean water. Priorities in Tribal Public Health discusses these priorities and provides some of the historical, political, social and cultural contexts key to understanding the unique issues tribal communities face, including the effects of climate change.


Climate change significantly impacts air, water and food. It has resulted in rising coastal water levels; more frequentforest and grass fires; increased pests and vector-borne disease; extreme weather conditions; decreased food availability; lower inland water and underground aquifer levels and non-native plant encroachment.

As a result of geographic vulnerabilities and extreme environmental changes, some American Indian/Alaska Native communities have been displaced and traditional food practices, medicines and ceremonies threatened.

Disruption of traditional practices

Weather pattern changes and warming waters can impact the health of local animals and plants if they are unable to migrate or adapt well to changing ecosystems. By threatening the health of local plants and animals, climate change disrupts the ability of Native populations to access traditional food and medicine sources and to perform traditional ceremonies.

American Indian/Alaska Native hunting and fishing rights are limited by treaty right boundaries, which historically have been subject to encroachment and litigation. This limits access to culturally important species that have migrated to other geographic areas and native plants that are unable to survive in the changing environment. Treaty rights give Native populations legal protections over these specific geographic areas, so merely reestablishing communities elsewhere is not always an option.

Water concerns

Many tribal reservations are rural and are highly dependent on surface water — such as reservoirs, lakes and streams. Surface water is particularly susceptible to non-point source pollution that enters waterways during heavy precipitation and storms. The frequency and severity of extreme storms becomes more of a concern due to the effects of climate change.

Climate change affects another precipitation extreme as well — droughts. People living in drought conditions may be more likely to encounter certain dangerous situations, including dust storms or flash floods. Drought conditions can contribute to wildfires and wildfire smoke exposure, which reduces air quality and increases respiratory and cardiovascular hospitalizations, as well as exacerbates asthma, bronchitis and other breathing problems.

Knowledge from the source

To combat the effects of climate change, many tribal communities are looking to their respective cultural knowledge and practices. Many American Indian/Alaska Native communities have prided themselves on traditional subsistence lifestyles and cultural practices based on direct contact with the environment for thousands of years. These communities have invaluable knowledge regarding the connection between human interaction with the environment and its resulting impacts on human health and well-being.

This Traditional Ecological Knowledge is constantly evolving and passed down through generations. It gives tribal communities a holistic understanding of the impacts of climate change and a unique approach to interpreting climate research. As an essential resource, TEK is critical to anticipating climate change consequences and designing adaptation responses in tribal communities.

Working in partnership

It is important to build understanding of tribal public and environmental health issues and increase support for initiatives addressing the concerns tribal communities face. Though 567 tribes are recognized by the federal government today, there remains little national recognition of the environmental injustices and lack of health equity thatimpact Indian Country.

We must work in partnership with tribal communities, learning from their traditional ecological knowledge, to address climate change and its health impacts, to give American Indian/Alaska Native communities a healthier future, while preserving cultural traditions and practices.


Ivana Castellanos is a Policy Analyst at the Center for Public Health Policy, American Public Health Association (APHA). APHA is a founding partner of Climate for Health, a network of health leaders committed to protecting the health and well-being of Americans and leading by example on a path to a positive future for climate solutions.

Visualizing Environmental & Climate Injustice in Rockport, Texas

I often struggle to instill in undergraduate nursing students the concept of inequity and why this is an important concept to understand for their nursing practice. I use the well-known slide of equality/equity of youth looking at a baseball game as it clearly shows why some people do need a redistribution of services in order to be successful and healthy. However being able to “see” inequity on a slide and “seeing” it in reality are two different matters. This is even more of a challenge when it comes to discussing how current inequities amplify the undue burden that some people will experience with climate change.

Hurricane Harvey, a Category 4 storm, made landfall on August 2017, the largest storm to strike the US in over a decade. The costliest and wettest tropical cyclone on record, it inflicted nearly $200 billion in damage, primarily from widespread flooding in southeast Texas.(1) In Rockport/Fulton, a coastal community where Harvey made landfall, high winds and resulting floods inundated thousands of homes and severely damaged infrastructure. Now, many months later, Rockport is still reeling from the aftermath of Harvey.

In order to ensure health equity and prepare communities for the impacts of a changing climate on health, we must include evaluation of how populations are disproportionately affected in climate mitigation and adaptation planning. Currently, about 10,000 people live in the Rockport area year-round and they sustained disproportionate damage during Harvey.(2) Damage to health care infrastructure is creating or exacerbating existing health disparities among the residents of Rockport/Fulton, which includes diabetes, hypertension and cardiovascular disease.

Nurses work in a variety of community settings and are professionally obligated to address health disparities in the health sector and in caring for affected populations, making nurses uniquely positioned to foster the equitable solutions needed to promote health.

Thus, when UT Health San Antonio School of Nursing received funding (3) to provide health care support during Harvey recovery, the undergraduate Population Health faculty used it as teachable moment in understanding inequity. We are now providing a variety of health services at no cost: assessment; screening; administering Hepatitis A, tetanus and flu vaccines; and providing minor urgent care services. Students also had an opportunity to canvas the neighborhoods, going door-to-door to ensure that residents were well and that no cost health care was available if needed.

Now nursing students are able to “see” inequity due to consequences of climate change by the following: 1) year-round residents have not been able to fix their roofs and homes as they did not have insurance and did not receive enough from FEMA while seasonal residents who have second homes in Rockport were able to fix their homes quickly because they have sufficient resources to be able to do so; 2) year-long residents were not able to receive timely health care as Rockport’s healthcare infrastructure has been slow in returning while seasonal residents were able to receive timely health care; and 3) many year-long residents lost their employment because local businesses were unable to recover and now a food bank has started at a local ministry and continues to have a robust crowd coming for needed sustenance. As in all cases of severe weather events that are exacerbated by climate change; existing disparities and inequities are worsened. Rockport has become a case study of this phenomenon.

Student reflections of their experience have been very meaningful, often explaining how the students were awe struck by the devastation and the importance of giving voice and advocating for those most impacted. They describe the inequity that they were able to “see” and more importantly, have a positive impact because of their delivery of nursing care, bringing better into focus their reasons for choosing nursing as a career.

Adelita Cantu is a member of the Alliance of Nurses for Healthy Environments (ANHE) and the National Association of Hispanic Nurses (NAHN). NAHN is a member of the Nursing Collaborative on Climate Change and Health, a partnership between ANHE and Climate for Health. Learn more about the NAHN and their work here. The Nursing Collaborative is a joint effort between national nursing organizations to elevate climate change as a priority issue among the nursing profession. Learn more about the Nursing Collaborative and how nurses can move climate action forward here.


1. Eberhart, George. “Hurricanes Harvey and Irma: Assistance for libraries still needed.” American Libraries. 1 November 2017. 

2. Frazee, Gretchen. “Ripped apart by Hurricane Harvey, this Texas community needs tourists to come back.” PBS Newshour.  29 January 2018. 

3. Sansom, Will. “School of Nursing aiding Harvey victims with Paul Simon gift.” UT Health San Antonio Newsroom. 22 September 2017. 



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