Climate change and the right to health of people with disabilities
Authors: Penelope J S Stein, Michael Ashley Stein
Journal: The Lancet Global Health (2021)

Climate change is directly and disproportionately threatening the right to health of people with disabilities due to higher ambient temperatures, elevated air pollutants, and increasing exposure to extreme weather events that include heatwaves, floods, hurricanes, and wildfires. Strikingly, the global mortality rate of people with disabilities in natural disasters is up to four times higher than people without disabilities due to a scarcity of inclusive planning, accessible information, early warning systems, transportation, and discriminatory attitudes within institutions and among individuals.1Izutsu T Disability-inclusive disaster risk reduction and humanitarian action: an urgent global imperative.https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2020/03/Final-Disability-inclusive-disaster.pdfDate: Nov 29, 2019Date accessed: November 19, 2021Google Scholar Disasters also disrupt access to health-care services, medications, oxygen, haemodialysis, personal care assistance, and medical devices. Heat extremes are linked with elevated emergency room visits, hospital admittance, and mortality for individuals with mental health, cardiorespiratory, and other disabilities; pre-existing psychosocial disabilities triples the risk of death during heatwaves.2Bouchama A Dehbi M Mohamed G Matthies F Shoukri M Menne B Prognostic factors in heatwave-related deaths: a meta-analysis.Arch Intern Med. 2007; 167: 2170-2176Crossref PubMed Scopus (311) Google Scholar High ambient temperatures also negatively affect the health of individuals whose disabilities are affected by temperature sensitivity or thermoregulation, including multiple sclerosis and spinal cord injuries. Likewise, numerous medications, including diuretics and antidepressants, can affect the thermoregulation of people with mental and physical disabilities.3Ebi KL Capon A Berry P et al.Hot weather and heat extremes: health risks.Lancet. 2021; 398: 698-708Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar More broadly, climate change increases the risk of undernutrition, water insecurity, stress-related psychiatric disorders, and alters the geographical distribution of infectious diseases.Climate change exacerbates existing inequalities with indirect disproportionate effects on people with disabilities due to their lack of access to health-care services and increased exposure to social determinants of health such as poverty, and lack of access to education, employment, or adequate housing. Often individuals with disabilities experience intersecting forms of multiple discrimination from belonging to specific groups including women, Indigenous people, children, racial minorities, and older people. The COVID-19 pandemic highlights and intensifies these inequalities.4Shakespeare T Ndagire F Seketi QE Triple jeopardy: disabled people and the COVID-19 pandemic.Lancet. 2021; 397: 1331-1333Summary Full Text Full Text PDF PubMed Scopus (44) Google Scholar Ironically, those with disabilities most at risk from climate change have contributed the least to greenhouse gases, including the 800 million people with disabilities living in low-income countries.5UN Department of Economic and Social AffairsFactsheet on persons with disabilities.https://www.un.org/development/desa/disabilities/resources/factsheet-on-persons-with-disabilities.htmlDate accessed: November 25, 2021Google Scholar Accordingly, climate vulnerability and the right to health of people with disabilities is being increasingly acknowledged, including within the Paris Agreement.The threat of climate change to people with disabilities' right to health urgently necessitates that governments reduce greenhouse gas emissions. States failing to comply with the Paris Agreement obligations or excluding disability from climate change mitigation and adaption efforts, are violating human rights obligations, including the UN Convention on the Rights of Persons with Disabilities.6Stein MA Stein PJ Weiss D Lang R Health care and the UN Disability Rights Convention.Lancet. 2009; 374: 1796-1798Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar In 2021, an individual with temperature-dependent multiple sclerosis, Uhthoff's syndrome, filed a law suit against the Austrian government alleging that a failure to set effective climate protection measures violated his human rights.7Mex M v Austria. European Court on Human Rights; Strasbourg, France; March 25, 2021.Google ScholarClimate change adaptation provides a global opportunity to increase health equality for people with disabilities as required by the UN Sustainable Development Goals, using the human rights principles of participation, inclusion, empowerment, non-discrimination, and accessibility. Attaining climate resilient health equality will require empowering people with disabilities and their organisations to represent their needs and identify solutions in equitable participatory planning and implementation processes, verified by disability indicators and intersectional analyses. Governments should include disability organisations as stakeholders to ensure disability-inclusive health adaption planning. Disability indicators and disaggregated data are crucial for the development of disability-inclusive policies.8The Lancet Global HealthDisability: measurement matters.Lancet Glob Health. 2021; 9e1028Summary Full Text Full Text PDF Scopus (3) Google Scholar Health-care facilities must be accessible, including post-disaster; laudably, the World Bank has committed to inclusive post-disaster reconstruction. A UN Framework Convention on Climate Change disability constituency and disability action plan, both absent from COP26, would facilitate disability leadership in climate change action.Health-care professionals, throughout their education, should receive training on the effects of climate change on the health of individuals with disabilities and disability cultural competency. Clinical trials inclusive of people with disabilities are required to determine how medications affect body temperature regulation at high temperatures. Enabling people with disabilities to enter health-care professions and collaborate in development and disaster risk reduction can provide untapped knowledge on disability discrimination and adaptation. Future research is crucially needed on the effect of climate change mitigation and adaption measures, and targeted disability-inclusive approaches, on the health of people with disabilities—particularly in low-income and middle-income countries—to foster best practices for enhancing climate resilience. Climate change is directly and disproportionately threatening the right to health of people with disabilities due to higher ambient temperatures, elevated air pollutants, and increasing exposure to extreme weather events that include heatwaves, floods, hurricanes, and wildfires. Strikingly, the global mortality rate of people with disabilities in natural disasters is up to four times higher than people without disabilities due to a scarcity of inclusive planning, accessible information, early warning systems, transportation, and discriminatory attitudes within institutions and among individuals.1Izutsu T Disability-inclusive disaster risk reduction and humanitarian action: an urgent global imperative.https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2020/03/Final-Disability-inclusive-disaster.pdfDate: Nov 29, 2019Date accessed: November 19, 2021Google Scholar Disasters also disrupt access to health-care services, medications, oxygen, haemodialysis, personal care assistance, and medical devices. Heat extremes are linked with elevated emergency room visits, hospital admittance, and mortality for individuals with mental health, cardiorespiratory, and other disabilities; pre-existing psychosocial disabilities triples the risk of death during heatwaves.2Bouchama A Dehbi M Mohamed G Matthies F Shoukri M Menne B Prognostic factors in heatwave-related deaths: a meta-analysis.Arch Intern Med. 2007; 167: 2170-2176Crossref PubMed Scopus (311) Google Scholar High ambient temperatures also negatively affect the health of individuals whose disabilities are affected by temperature sensitivity or thermoregulation, including multiple sclerosis and spinal cord injuries. Likewise, numerous medications, including diuretics and antidepressants, can affect the thermoregulation of people with mental and physical disabilities.3Ebi KL Capon A Berry P et al.Hot weather and heat extremes: health risks.Lancet. 2021; 398: 698-708Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar More broadly, climate change increases the risk of undernutrition, water insecurity, stress-related psychiatric disorders, and alters the geographical distribution of infectious diseases. Climate change exacerbates existing inequalities with indirect disproportionate effects on people with disabilities due to their lack of access to health-care services and increased exposure to social determinants of health such as poverty, and lack of access to education, employment, or adequate housing. Often individuals with disabilities experience intersecting forms of multiple discrimination from belonging to specific groups including women, Indigenous people, children, racial minorities, and older people. The COVID-19 pandemic highlights and intensifies these inequalities.4Shakespeare T Ndagire F Seketi QE Triple jeopardy: disabled people and the COVID-19 pandemic.Lancet. 2021; 397: 1331-1333Summary Full Text Full Text PDF PubMed Scopus (44) Google Scholar Ironically, those with disabilities most at risk from climate change have contributed the least to greenhouse gases, including the 800 million people with disabilities living in low-income countries.5UN Department of Economic and Social AffairsFactsheet on persons with disabilities.https://www.un.org/development/desa/disabilities/resources/factsheet-on-persons-with-disabilities.htmlDate accessed: November 25, 2021Google Scholar Accordingly, climate vulnerability and the right to health of people with disabilities is being increasingly acknowledged, including within the Paris Agreement. The threat of climate change to people with disabilities' right to health urgently necessitates that governments reduce greenhouse gas emissions. States failing to comply with the Paris Agreement obligations or excluding disability from climate change mitigation and adaption efforts, are violating human rights obligations, including the UN Convention on the Rights of Persons with Disabilities.6Stein MA Stein PJ Weiss D Lang R Health care and the UN Disability Rights Convention.Lancet. 2009; 374: 1796-1798Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar In 2021, an individual with temperature-dependent multiple sclerosis, Uhthoff's syndrome, filed a law suit against the Austrian government alleging that a failure to set effective climate protection measures violated his human rights.7Mex M v Austria. European Court on Human Rights; Strasbourg, France; March 25, 2021.Google Scholar Climate change adaptation provides a global opportunity to increase health equality for people with disabilities as required by the UN Sustainable Development Goals, using the human rights principles of participation, inclusion, empowerment, non-discrimination, and accessibility. Attaining climate resilient health equality will require empowering people with disabilities and their organisations to represent their needs and identify solutions in equitable participatory planning and implementation processes, verified by disability indicators and intersectional analyses. Governments should include disability organisations as stakeholders to ensure disability-inclusive health adaption planning. Disability indicators and disaggregated data are crucial for the development of disability-inclusive policies.8The Lancet Global HealthDisability: measurement matters.Lancet Glob Health. 2021; 9e1028Summary Full Text Full Text PDF Scopus (3) Google Scholar Health-care facilities must be accessible, including post-disaster; laudably, the World Bank has committed to inclusive post-disaster reconstruction. A UN Framework Convention on Climate Change disability constituency and disability action plan, both absent from COP26, would facilitate disability leadership in climate change action. Health-care professionals, throughout their education, should receive training on the effects of climate change on the health of individuals with disabilities and disability cultural competency. Clinical trials inclusive of people with disabilities are required to determine how medications affect body temperature regulation at high temperatures. Enabling people with disabilities to enter health-care professions and collaborate in development and disaster risk reduction can provide untapped knowledge on disability discrimination and adaptation. Future research is crucially needed on the effect of climate change mitigation and adaption measures, and targeted disability-inclusive approaches, on the health of people with disabilities—particularly in low-income and middle-income countries—to foster best practices for enhancing climate resilience. We declare no competing interests.