Asociación Puertorriqueños en Marcha Medical Director, a

University of Pittsburgh Medical Center attending physician, and President of the APA Hispanic Caucus.

Hector A. Colon-Rivera, MD, CMRO

We are psychiatrists who are deeply committed to addressing the devastating impacts of climate change on mental wellbeing and its differential impacts on vulnerable minority groups. Some of us came to this project steeped in knowledge and information but from a relatively privileged and comfortable place. The process of bringing together the voices of the various authors in this series, each contributing their rich and varied cultural experiences, has deepened and enriched the awareness of our interconnection.

These conversations have been challenging, but these are some of the difficult conversations we must have as a profession and as a society. Those of us who have been buffered from the devastating impacts of climate change and environmental degradation by our privilege, wealth, and class must recognize that this protection is ultimately an illusion. We are all bound by our shared vulnerability and must face our shared humanity.

We must address racism and climate change together. Hop Hopkins of the Sierra Club 

: “It’s no exaggeration to say that racism and white supremacy harm all of us, because in addition to robbing us of our humanity, racism is also killing the planet we all share." He elaborates by saying, “we will never survive the climate crisis without ending white supremacy …You can’t have climate change without sacrifice zones, and you can’t have sacrifice zones without disposable people, and you can’t have disposable people without racism.”

The articles in this series have highlighted both the tribulations and resiliency of communities of color. In particular, the Indigenous voices speak to the need for rematriation: the renunciation of the current patriarchal, fractured systems and a return to Indigenous wisdom that recognizes the unity between all living beings and the continuity between prior generations and future descendants. This embraces the essential awareness that we are all dependent on the earth as our only sustainable home.

The nonprofit organization Crear Con Salud in Puerto Rico has demonstrated resiliency, community empowerment, and local leadership as it overcomes passive reliance on a distant, unresponsive, neglectful government. Voices from Black communities remind us to confront the hard reality of climate change and its intersection with racism by exposing the daily experiences of communities tarnished by environmental pollutants. The Asian experience opens our eyes to experiences beyond our own borders, challenging our American-centric view. This section underscores both the profound impacts of the climate crisis on Asian countries as well as the huge contribution of emissions by Asian nations. We have much to learn from each other as we move forward.

These varied experiences illuminate our shared burdens. Like a woven tapestry, individual-colored threads bind together in a whole that is stronger than the separate fibers. The challenge is to both honor and acknowledge individual community experiences, and to simultaneously join together in a collective effort.

Climate change is a universal threat endangering the entire world. It is not a problem for any one group but a problem for us all. We must find common ground from our shared values, emphasizing equality, respect, and compassion for all, with a forceful commitment to collective climate action.

An essential step must be to address the current homogeneity of groups combating climate change. We cannot sustain the current situation of predominantly White-dominated climate change groups and BIPOC (Black, Indigenous, People of Color)-dominated environmental justice groups focusing primarily on local issues. Our efforts must establish collaborative ways of working together. As mental health professionals committed to understanding deep emotional wounds and addressing complexities of relationships, we have the tools to assist in bridging the current gaps.

As this series has illustrated, climate change is a devastating existential threat that can also exaggerate pre-existing inequities and health/mental health problems. Yet it also opens the possibility of repairing centuries of embedded structural racism. The solutions that emerge from our shared values must hold to the fundamental principle that climate justice is social justice, and social justice is health and mental health justice. This inevitably will include reparative justice: the possibility of repairing damages inflicted by unequal social, racial, economic structures, and climate disruption.

The Biden/Harris administration has committed itself to addressing both the legacy of our racist history and our reliance on extractive fossil fuel-based economy. One of President Joe Biden’s first actions was to sign an executive order returning the United States to the Paris Agreement. In choosing his appointments, Biden has mobilized stellar leaders who embrace equity, strive to correct massive wealth disparities, and implement climate solutions.

Policies that address climate chance will have either direct or downstream health and social benefits for us all. But particular policies and regulations that have important impacts on communities of color include restrictions on oil and gas drilling on public lands, infrastructure projects with creation of green jobs, emission and toxic exposure regulations, and housing policies including improvements in substandard housing, transportation, and health access. There are signs that the new administration will integrate climate and environmental justice into policy planning across all levels of government, from community and local to state and national.

The business community is also moving forward, with several large corporations setting goals for carbon neutrality. Since a large percentage of emissions are due to the transportation sector, the dramatic steps taken by the domestic and foreign auto industry—setting net-zero carbon emissions goals and shifting production to electric vehicles—is 

 Other businesses are following suit, with Apple leading the way by pledging carbon neutrality by 2030. Additionally, Apple sustainability leader, Lisa Jackson, MS, is spearheading climate justice initiatives by putting equity and climate justice at the forefront of programs directed to support Black and Brown 

 Business leadership at this level can set the stage for others to follow.

Additionally, the growing attention to creating sustainable operations within the health delivery system is one of the ways of getting 

Mental health care professionals have important roles in creating solutions. The following recommendations are numerous and applicable across many domains. No one action, plan, or policy can address the enormity of the problems, but all in combination could decisively improve the future prospects of our communities.

While direct patient/individual recommendations are essential, climate change and the associated racial inequities are not individual issues. They must be addressed at broader systemic and community levels.

. It is important for us to examine and process our own feelings and confront our implicit biases about race, cultural differences, and climate. This is not a fleeting look but requires consistent self-reflection.

To care for diverse patients, we must incorporate culturally and linguistically appropriate material for patients with specific emphasis on climate-related mental health threats. Clinicians should integrate assessment of risk into discussions with our patients before predictable climatic events. The newly created 

 project is one attempt to expand the network of therapists and empower them to address climate related emotional issues (

We must develop ways to assist the growing group of individuals struggling with climate-related emotional difficulties and eco-distress experiences. We can offer our shared knowledge and emotional support skills and strategies. These include emotional regulation tools, group emotional supports, and integration of nature-based engagement activities into clinical suggestions for calming and sensory-affective modulation. This is particularly important for children, both for emotional regulation and to instill a sense of stewardship of the natural world.

Community/systems of care/public health model

. Our mental health system does not have the capacity to meet the increasing needs posed by climate change. We need to rethink our systems of care, expand, upon the current one-to-one treatment approach, and develop new models that focus on building the skills, resources, and social connections that are essential to prevent extensive psychological, emotional, and behavioral problems associated with climate disruption. This paradigm shift is founded on the awareness that emotional and psychic responses are not solely an individual issue, but are derived from real economic-political problems that call for social change.

There are many ways to lend emotional support to those who experience the inequities and racial disparities of the climate crisis. The Groundswell Climate Collective (GCC) is one such creative project that can be a model for 

 The GCC is committed to sharing the voices of people of color and developing community resilience. They utilize visual arts, writing, poetry, and other creative projects in efforts to prioritize youth engagement.

Additionally, we must develop collaborative relationships with other health providers, especially primary care, pediatrics, and obstetrics/gynecology. Psychiatrists can also serve as consultants and resources for paraprofessional and community leaders.

Table 2. Community and Climate Justice Groups

Fostering resilient communities is essential. Resilient communities are networks of local groups that develop emotional support and enhance community empowerment. Community Resilience relies upon strong social networks and attachments, a spirit of cooperation and altruism, trusted community leadership, and strong partnerships among schools, community organizations, faith groups, and health institutions. Providing adequate resources is essential, especially for underserved communities, and may require advocacy for funding sources (

Public health advocacy and policy: a call to action.

 There is no time to waste. Increased global temperatures have risen annually since mid-20th Century, and the polar ice caps are melting at an 

 Since the impacts of climate change on mental health are substantially influenced by social factors, influencing outcomes requires engagement in public policies. We must advocate for better governmental regulations, new laws, and funding of governmental and institutional activities as well as collaborative international agreements and treaties aimed at stopping climate change and eradicating racism.

Our professional organizations must be our voice in advocacy. Professional organizations can provide the tools and training to develop advocacy skills, and their political action committees can advocate for climate-friendly policies directly. Taking an important step, the American Psychiatric Association (APA) has recently allocated resources and attention to the climate crisis, establishing the Committee on Climate Change and Mental Health. However, there is more work to do. We must connect our organizations in order to strengthen our movement and increase its effectiveness.

Table 3. National Health and Climate Groups Committed to Equity and Environmental Justice

There are many national health organizations that focus on climate change and health with an equally strong commitment to addressing environmental justice, equity, and the impacts on vulnerable populations (

We began this series with the Persian poet Saadi’s words, which is inscribed on the United Nations Building. They remind us of our duties to each other we mobilize to address structural racism and climate change.

The sons of Adam are limbs of each other,

Having been created of one essence.
When the calamity of time affects one limb

The other limbs cannot remain at rest.
If thou hast no sympathy for the troubles of others
Thou art unworthy to be called by the name of a human.

Climate change and structural racism threaten us all. We must recognize our interdependence and interconnection with the entire world population and join collectively to face this existential threat. It is through effective collective actions that we can create a more fair, equitable, and sustainable future for ourselves, our children, and our grandchildren.

is clinical associate professor in the Department of Psychiatry at the University of California, San Francisco.

is in the psychiatry and behavioral sciences in the Vanderbilt University Medical Center. 

is Clinical professor of psychiatry and behavioral sciences at the University of California, Davis, and received the Kung Po Soo Award from the APA in 2015 for contributions to understanding Asian American patients with mental health issues. 

is the Asociación Puertorriqueños en Marcha Medical Director, a University of Pittsburgh Medical Center attending physician, and President of the APA Hispanic Caucus.

is a practicing psychiatrist at Garnet Health in New York. 

is a child and adolescent psychiatry fellow at Northwell Health. 

is a psychiatry resident at Garnet Health Medical Center in Middletown, New York.

 is the first woman Navajo psychiatrist to provide Indian Health Service clinical care in New Mexico and a Distinguished Fellow of the American Psychiatric Association. 

is Chairman of the Department of Psychiatry at Garnet Health Medical Center and is on the editorial board for Academic Psychiatry.

To see more on race and climate change, see 

The Tangled Roots of Racism and Climate Change.

General motors intends to lead the auto industry and the world to a net-zero-carbon future

. LinkedIn. January 28, 2021. Accessed May 7, 2021. 

. Climate.gov. March 15, 2021. Accessed May 7, 2021. 

Articles

Climate change is a devastating existential threat that can exaggerate preexisting inequities and health/mental health problems. As mental health professionals committed to understanding deep emotional wounds and addressing complexities of relationships, psychiatrists have the tools to assist in bridging the current gaps. 

Next Steps: Solutions and Recommendations For Healing

United States Hispanic/Latinx communities comprise a people made up of many different cultures, countries of origin, migration trajectories, social classes, ages, and genders, among other characteristics. As of the 2010 Census, there were 50.5 million Hispanics in the United States, representing 16% of the total population, and by 2060, population projections indicate that 29% of the US population will be Hispanic.

 However, Hispanic/Latinx heterogeneity shapes different patterns of environmental injustice. Migration history, socio-demographics, and acculturation are critical features that have influenced environmental injustice patterns in the United States.

Mass migration and population displacement from Central America and the Caribbean are among the most profound impacts of climate change. As climate change is making extreme weather events more common, we are seeing more vulnerable Hispanic/Latinx leaving their home countries.

 This is the result of a combination of factors, including lack of work, food, and shelter, all of which are in part due to the degradation of local ecosystems. The Pentagon has recognized climate change as a 

 with the potential to exacerbate not only environmental degradation, but also unstable governmental structures that can ultimately add pressure to the more obvious current drivers of migration, including gang violence, political upheaval, and corruption.

Climate change has had a profound effect on agriculture in Central America. Along the Pacific coast (also know as the dry corridor), a drought has demolished crops since 2014 and threatened smallholder farmers’ livelihoods in Guatemala, Honduras, and El Salvador.

 A United Nations climate change report showed that crop shortages linked to climate change led to extreme poverty and hunger.

 The same report noted that the loss of crops is the second-largest migration factor among those living in the dry corridor. It also found that migration from this region increased significantly since 2014, and by 2050, Mexico and Central America could see as many as 2 million climate migrants.

Research has long shown that racial and ethnic minorities in the US, particularly Hispanic/Latinx, receive lower-quality health care, suffer worse health outcomes, and have higher rates of certain illnesses.

 Climate change affects social and environmental health determinants including clean air, safe drinking water, sufficient food, and secure shelter. Furthermore, a Natural Resources Defense Council report found more than half of the US Hispanic/Latinx population resided in states with the highest levels of climate change threats, such as air pollution, extreme heat, and flooding.

 Many Hispanic/Latinx communities face serious health risks caused by air pollution, as they tend to live within a short distance of existing oil and gas facilities. As a result, they suffer from an elevated risk of cancer. Additionally, due to toxic air emissions, asthma rates are relatively higher in Hispanic/Latinx communities, and these individuals are more likely to be admitted to the hospital for asthma than are non-Hispanic Whites.

Similarly, extreme summer heat in the US poses health risks for Hispanics/Latinx employed in outdoor occupations. Hispanic/Latinx account for 46% of construction laborers and 47.2% of agricultural field workers in the US.

 The World Meteorological Organization (WMO) notes that the number of heat-related deaths will double in the next 20 years.

 In the case of Hispanic/Latinx migrant and seasonal agricultural workers who depend on employers for work and wages, such occupational health hazards are particularly challenging because they typically work long hours outdoors and may be reluctant to report the work-related illness. Given the exposure among migrant and seasonal agricultural workers, they are at much higher risk for extreme heat’s effects on mental wellbeing, including impacts on mood, behavior, cognitive functioning, and psychiatric conditions.

Low-income Hispanic/Latinx communities are more likely to live in areas most vulnerable to the impact of climate change and natural disasters, and they do not always get the disaster relief they need. The socioeconomic relational factors may impede pre-hurricane actions among Hispanic/Latinx communities and create challenges. For example, Hurricane Irma hit Puerto Rico in 2017 and downed powerlines, leaving large communities without power and causing flooding that exposed the population to contaminated water and soil draining the canals. Two weeks later, Hurricane Maria hit and caused an estimated death toll of more than 2000 individuals. It also left residents in the dark for almost a year. A large proportion of the population became infected with leptospirosis, causing a additional deaths in the aftermath. Federal government staffing and funding in Puerto Rico took 3 times as long to reach comparable levels as in Texas, and 30 times as long as in Florida.

Puerto Rico is still recovering from these devastating natural disasters. For months, commentators talked about the shutdown of communications and power, the physical and mental scars from landslides and flooding, as well as the slowness and inadequacy of the government’s responses. Local nonprofits organizations were vital players during and after the hurricanes and continued recovery times. These organizations helped collect debris, distribute water, and find shelter and basic needs supplies for many communities. The nonprofit sector was the first and, in many areas of the island, the only responder to the disaster.

Hispanic/Latinx communities can experience a broad range of psychological responses to climate change’s disproportionate effects. Ultimately, the climate change crisis underlies an already growing mental health crisis. Climate change exacerbates chronic mental illness and increases risk of developing new-onset posttraumatic stress disorder, depression, anxiety, sleep disorders, attachment disorders, and substance use.

It is imperative that we look at the opportunities available for action to prevent, address, and mitigate the these climate-related threats to physical and mental health. To start, it is important to process emotional responses to these threats. This may be difficult to do, given the high mental health stigma within Hispanic/Latinx communities. Acknowledging and talking about feelings and addressing anxiety and fear can help normalize emotional responses to climate change. It is vital to spread awareness about climate change and create educational resources for our most vulnerable Hispanic/Latinx communities. Providing the tools necessary to enable self-advocacy is empowering and can increase Hispanic/Latinx communities’ strength and resiliency. However, these tools and communications need to be practical, accessible, comprehensive, and understandable by all Spanish-speaking Hispanic/Latinx. Equally important is using culturally trusted modalities of delivery for these messages and tools.

We need to support nonprofit organizations like Crear Con Salud, a group that has a mission of supporting and conducting educational, research, and advocacy activities to increase public awareness and action regarding mental health in Puerto Rico and Hispanic/Latinx communities in the US. Since it received funding in 2019, Crear Con Salud has joined the recovery effort in Puerto Rico in ways far different than their normal mission.

 The organization continues to develop community leadership, local control, and resilience in affected communities to create local solutions, rather than relying on distant, unresponsive governmental agencies. 

More importantly, to tackle climate change and the associated detrimental effects on vulnerable Hispanic/Latinx communities’ physical and mental health, it is imperative for policies and public health responses at any level (local, state, national) to address the range and diversity within the larger Hispanic/Latinx population.

Likewise, our communities will have better results if we find common ground and stand together with a strong commitment to climate action. Despite their diversity, Hispanic and Latinx communities share core values derived from our Indigenous roots, including a deep sense of respect and honor for the environment. We can build on these shared values. As we can increase climate change awareness, we must engage our community to demand real action and solutions. We must create the possibility of better outcomes for future generations of this fast-growing population and all communities.

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Ultimately, the climate change crisis underlies an already growing mental health crisis and Hispanic/Latinx heterogeneity shapes different patterns of environmental injustice. 

Hector A. Colon-Rivera, MD, CMRO

Articles

Next Steps: Solutions and Recommendations For Healing

The Effects of Climate Change on Hispanic and Latinx Communities