is a practicing psychiatrist at Garnet Health in New York.

Roger Maginley, MD

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

James Baldwin, the iconic American novelist, playwright, poet, and activist uttered these words in the 1960s during the civil rights movement: “To be a Negro in this country and to be relatively conscious is to be in a rage almost all the time.”

 Fifty years later, racism is still a systemic scourge, a grave pathology that continues to imprison all of humanity. This must change for our biological, psychological, social, and spiritual health to take root and flourish. Generations of structural racism and trauma have laid the foundation for the current adverse sequelae of climate change, and ultimately that of environmental toxic exposures, for the Black community.

To be a Black individual in this country is an opportunity to model to all of humanity the meaning of grit, resiliency, empathy, healing, and morality. To survive in the face of historical systemic oppression that chokes humanity is a victory that transcends generations. Time and time again, Black people have had to rise from the ashes of oppression like newborn phoenixes, each time stronger and more resilient, despite having been burned by countless acts of hatred. Yet as history repeats itself, we are provided with new instances of injustice too.

Institutionalized racism contributes to environmental injustice. From American chattel slavery to the present-day issue of climate change, Blacks have always been set up to fail, and climate change is directly fueled by economic exploitation. Genocide, slavery, and colonialism have all contributed to deep, unconscious racial views that influence behaviors and responses to climate disasters, as well as public policies guiding climate mitigation, adaptation, and disaster response within vulnerable populations.

According to the National Association for the Advancement of Colored People (NAACP) 2012 “Coal Blooded” study, communities of color breathe in 40% more polluted air than white communities across the US.

 As a result of environmental racism, people of color are more likely to live near sites of industrial pollution and toxic waste. African Americans make up 13% of the US population, and 68% of African Americans live within a 30-mile radius of coal-fired power plants compared with 56% of White Americans.

 Living in these areas exposes them to toxins that can lead to many medical problems such as heart disease, asthma, cancer, birth defects, and neuroinflammatory processes that contribute to neurocognitive disorders across the entire lifespan.

Climate injustice is the unequal distribution of benefits and damages related to climate change. When financial stakeholders are not held accountable for the adverse impacts, forces leading to pollution of air, land, water, and global climate warming are left unchecked. Individuals who are poor and disadvantaged often bear the brunt of climate change, including acidifying oceans, droughts, floods, rising sea levels, heatwaves, and wildfires. The negative effects of climate change are further exacerbated by environmental toxic exposures; both are rooted in the reliance on a fossil fuel economy, which not only drives global warming but is the source of air, water, and land pollution.

The inequalities that turn extreme weather events into disasters or human catastrophes mirror the inequalities that cause the disproportionate loss of Black and economically disadvantaged life across the globe. Classic examples include Hurricane Katrina, the 1995 Chicago Heatwave, Altgeld Gardens in Chicago, and Louisiana’s Chemical Corridor, among many others. These events demonstrate the role that climate change and racism play in making the Black community vulnerable.

Hurricane Katrina was an awakening to the human costs of climate change. In 2005, this category 5 hurricane hit the primarily African American neighborhoods of New Orleans East and the Lower Ninth Ward, resulting in the loss of more than 80% of African American homes.

 Although Black residents had been hit hardest by the storm, they once again found themselves shunted to the back of the line for government disaster assistance. Areas slated for immediate redevelopment were those that had received the least amount of water — areas where White citizens lived. New Orleans East and the Lower Ninth Ward were not slated for redevelopment and were instead to be converted to green space.

Slow federal, state, and local responses helped shed light on the way America sees race and racism. As stated by Nils Gilman, PhD:

Katrina provides an unprecedented opportunity to communicate that ‘racism’ is not just a matter of the psychology of hatred but is instead also a matter of the racial structure of political and economic inclusion and exclusion. This is one lesson from Katrina that social science should help communicate. Moreover, we should not blinker ourselves: this message is one that is deeply opposed by powerful political forces in the United States today.

The effects of Hurricane Katrina revealed how racial discrimination before the natural disaster helped contribute to the damages and impacts it had on the communities of the Gulf Coast, mainly people of color. Tens of thousands of residents fled the city and never returned; nearly 1 in 3 Black residents have not returned to the city after the storm.

The slow rebuilding of Black communities and neighborhoods as well as the environmental hazards from floodwaters pose major health risks for these communities, making it difficult to for them return. The response to Katrina, Hurricane Harvey, and more recently the extreme cold spell in Houston, demonstrates how racial injustice is fostered by the nation’s belief that the economy is more important than basic human needs during disasters. Katrina’s differential impacts on the Black community is well documented, with acute disaster impacts, recurrent posttraumatic stress disorder, as well as the repeated and complex trauma of the many displaced African Americans.

This heatwave in Chicago in 1995 is another example of how climate change has disproportionally harmed the Black community. The heatwave led to nearly 740 heat-related deaths in Chicago in less than 1 week.

 These victims were predominantly low-income, elderly African American residents who could not afford air conditioning and did not open windows or doors at night because of their fear of crime in their neighborhoods. According to Eric Klinenberg, PhD, the map of the heat-related deaths mirrors the map of poverty.

 Many Blacks lived in areas of substandard housing and less cohesive neighborhoods and, therefore, found themselves victim to the slow response of authorities; to this day no official death toll has been determined.

Factors that contributed to the heatwave include the urban heat island effect, which raised nocturnal temperatures by more than 3.6°F, inadequate warnings and responses, power failures, and a temperature inversion that resulted in stagnated air.

One of the first public housing developments built in the US, Altgeld Gardens is a Chicago Housing Authority public housing project located on the far south side of the city. It was built between 1944 and 1945 to fulfill the need for improved housing for returning African American veterans from WWII. The population is 95% African American, with a $7500 a year per capita income.

 It is infamously known as “Chicago’s toxic donut,” as a result of having the highest concentration of hazardous waste sites in the US.

Numerous manufacturing plants, landfills, steel mills, and waste dumps border the 190-acre Altgeld Gardens site. Approximately 50 landfills and 382 industrial facilities, including the Acme Steel plant and the Pullman factory, many of which were unregulated, are located in this area.10 This area has had 250 leaking underground storage tanks on sites surrounded by rivers and lakes, making the water quality toxic for human consumption and recreation.

 Toxicology studies in the 1990s found high and dangerous levels of many toxins including lead, mercury, DDT, PCBs, PAHs, xylene, and other heavy metals.

 Residents were exposed to hazardous fumes and asbestos from nearby factories and construction sites. The community’s low-income status and minority population gave them less political power to fight against toxic conditions. Residents were faced with multiple health complications secondary to these poor conditions.

Despite these deplorable conditions, Altgeld Gardens is regarded as a birthplace of the environmental justice movement.

 Hazel Johnson, a resident of Altgeld Gardens, created the People for Community Recovery in 1979 to combat the environmental injustice and racism. The group protested to improve the conditions of their community and successfully held companies responsible for cleaning the pollution and waste they created.

Johnson and her organization partly inspired President Bill Clinton to sign Executive Order 12898, which called for the Environmental Protection Agency (EPA) to instate environmental justice principles into their work so that no groups may be disproportionately burdened by the consequence of pollution.

 In March 2017, then President Donald Trump proposed his budget, which cut the EPA’s funding by at least 31% and downsized its staff by 21%.

 New proposals to reduce staff and resources for the Office of Research and Development, which provides scientific expertise to monitor polluters and prosecute those that do not comply with the Clean Air Act and Clean Water Act, were implemented as a result of these cuts. Today, Altgeld Gardens remains one of the poorest communities in the country; 90% of the population is Black and 63% live below the poverty line.

 The community accounts for the highest percentage of individuals living in poverty and the lowest per capita income in the city.

In 1987, Jacobs Drive in St Gabriel, Louisiana, received the nickname 

 after a surge in cancer cases. As cases rose in surrounding areas, the area grew to include an 85-mile stretch along the Mississippi River. Previously known as the 

 before the surge in cancer rates, the area is located along the Mississippi River between Baton Rouge and New Orleans in the River Parishes of Louisiana, and is home to numerous industrial plants. Residents are primarily low-income African Americans.

In 2000, the Toxic Release Inventory data ranked Louisiana second in the nation for total onsite chemical releases, third for total releases within the state, and fourth for total on- and offsite releases.

 To put it in perspective, in 2000 Louisiana’s population was about 4.5 million and produced almost 9.4 million pounds of waste. Seven of the 10 plants with the largest combined on- and offsite releases, and 4 of the 10 plants with the largest onsite releases are located in Cancer Alley. Meanwhile, in 2002, Louisiana had the second-highest death rate from cancer in the United States.

 The national average was 206 deaths per 100,000, and Louisiana’s rate was 237.3 deaths per 100,000.

The Chemical Corridor exemplifies how lawmakers put profit over individual’s lives. Many lawmakers and economists see the petrochemical industry as an economic gain for struggling states. Since Louisiana competes with other places for these plants, community demands for regulation are considered bad for business. This tension between economic growth and health concerns has played out for years. Beverly Wright, PhD, director of the Deep South Center for Environmental Justice, has advocated for communities in the chemical corridor for more than 3 decades. According to Wright, they have won a few fights; they prevented some plants from being built and procured relocation funds for an entire community.

 Nonetheless, additional plants have been built since the 1990s.

Inadequate action to address climate change is partially due to the racism that is integral to the power structures that sustain the global socioeconomic system. About 70% of the country’s contaminated waste sites are located near low-income housing.

 An analysis by the Associated Press suggested 2 million individuals live within a mile of 1 of the 327 Superfund sites vulnerable to climate change-related flooding, and most of them are in low-income communities and communities of color.

 The EPA estimated 1.5 million people of color live in areas vulnerable to contamination.

The late honorable Martin Luther King Jr, PhD, wrote that “injustice anywhere is a threat to justice everywhere.”

 To stop climate change, we must worry about the long-term consequences of our collective behavior. At the center of climate justice movements is the fundamental principle that the threats posed by climate change are a consequence of unequal economic and social power relations. Thus, climate justice is inseparable from social justice. Solidarity with the victims of climate change will involve addressing political and economic stakeholders. It will involve campaigning for reparative justice, preparing for relocation as extreme weather strikes, and acknowledging the need to redistribute resources so individuals are not destined to leave their homes.

We must remain vigilant and insist on an analysis of climate change that encompasses many unique perspectives. There are only 2 possible endings to this story: Either we destroy the planet and subsequently destroy each other, or we rise to the occasion.

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

is a child and adolescent psychiatry fellow at Northwell Health.

To see more on race and climate change, see

1. To be in a rage, almost all the time. NPR. Accessed April 29, 2021. 

https://www.npr.org/2020/06/01/867153918/-to-be-in-a-rage-almost-all-the-time

2. Rysavy TF, Floyd A. People of color are on the front lines of the climate crisis. 

https://www.greenamerica.org/climate-justice-all/people-color-are-front-lines-climate-crisis

How the Government Response to Disaster Endangers African American Communities

4. Esri. Aftermath of Katrina: A time of environmental racism. 

Reconnaissance Coverage Geographic Information System.

https://www.arcgis.com/apps/Cascade/index.html?appid=2106693b39454f0eb0abc5c2ddf9ce40

5. Rivlin G. White New Orleans has recovered from Hurricane Katrina. Black New Orleans has not. 

https://talkpoverty.org/2016/08/29/white-new-orleans-recovered-hurricane-katrina-black-new-orleans-not/

6. Thomas M. Chicago’s deadly 1995 heat wave: An oral history. 

https://www.chicagomag.com/Chicago-Magazine/July-2015/1995-Chicago-heat-wave/

Heat Wave: A Social Autopsy of Disaster in Chicago

8. Kunkel KE, Changnon SA, Reinke BC, Arritt RW. The July 1995 heat wave in the Midwest: A climatic perspective and critical weather factors. 

Bulletin of the American Meteorological Society

https://journals.ametsoc.org/view/journals/bams/77/7/1520-0477_1996_077_1507_tjhwit_2_0_co_2.xml

9. Cosier S. What a gutted EPA could mean for Chicago’s “Toxic Doughnut.” 

https://www.nrdc.org/stories/what-gutted-epa-could-mean-chicagos-toxic-doughnut

10. McAvoy S. Lost in the shuffle: The future of traditional public housing under the CHA’s plan for transformation. 

https://southsideweekly.com/lost-in-the-shuffle/

11. Trice DT. Far South side environmental activist Hazel Johnson and her daughter ‘decide to stay here and fight’. 

12. Amer R. A bus tour stops by polluted Altgeld Gardens. 

https://www.chicagoreader.com/Bleader/archives/2015/09/04/a-bus-tour-stops-by-polluted-altgeld-gardens

Utilizing Innovative Technologies to Address the Public Health Impact of Climate Change: Emerging Research and Opportunities

14. Centers for Disease Control. Cancer Burden Data Fact Sheets, Louisiana. Cancer Prevention and Control. 2002.

15. Coyle M. Company will not build plant: Lawyers hail victory. 

16. Wendlend T. Louisiana’s chemical corridor is expanding. So are efforts to stop it. NPR

https://www.npr.org/2020/03/20/814882296/louisianas-chemical-corridor-is-expanding-so-are-efforts-to-stop-it

17. Bergman M. ‘They chose us because we were rural and poor’: when environmental racism and climate change collide. 

https://www.theguardian.com/environment/2019/mar/08/climate-changed-racism-environment-south

18. King ML. Letter from a Birmingham jail. University of Pennsylvania African Studies Center. Accessed April 23, 2021. 

https://www.africa.upenn.edu/Articles_Gen/Letter_Birmingham.html

These 4 disastrous climate change events affected Black Americans disproportionately…

Roger Maginley, MD

Articles

Next Steps: Solutions and Recommendations For Healing

Rising From the Ashes of Oppression