Climate Change and Health Equity: What Physicians Should Know About Risk to Patients of Color

Climate change is already a clinical problem, and it lands hardest on the patients many of us serve. Black, Hispanic, and Indigenous patients are more likely to live where heat, polluted air, and flooding are worst, and less likely to have the resources to escape them. The result is more heat illness, worse asthma, riskier pregnancies, and more disrupted care.

For Tampa Bay physicians, this is not abstract. Our patients live through longer, hotter summers, rising humidity, and back-to-back hurricane seasons. The good news is that much of the risk is predictable, which means much of it is preventable at the point of care.

Why the risk is unequal

The disparity is mostly about where and how people live, not biology. Decades of housing policy concentrated communities of color in neighborhoods with less shade, more pavement, more highways and industry, and older housing stock.

Redlining is the clearest example. A study of 108 U.S. cities found formerly redlined neighborhoods run about 2.6°C (4.7°F) hotter in summer than non-redlined ones, and up to 7°C hotter in some cities (Hoffman et al., Climate, 2020). Less tree canopy and more impervious surface drive most of that gap.

The EPA’s 2021 social vulnerability report found Black Americans more likely than others to live where climate harms will be greatest, across all six impacts it modeled (EPA, 2021). At 2°C of warming, Black individuals are:

40% more likely to live in areas with the highest projected increases in extreme temperature deaths
34% more likely to live in areas with the highest projected increases in childhood asthma diagnoses from fine particulate pollution
23% more likely to live in areas with the highest projected loss of work hours to extreme heat

Layered on top are factors we see in clinic every day: outdoor and essential jobs, higher rates of chronic disease, energy costs that make running the AC a hard choice, underinsurance, and less access to a car or a place to evacuate to.

Heat: the most immediate threat

Heat is the deadliest weather hazard in the U.S., and our patients of color get more of it. They are more likely to live in hotter neighborhoods, sleep in homes without reliable cooling, and work outdoors or in un-air-conditioned warehouses and kitchens.

Heat rarely shows up on a death certificate as the cause. It shows up as an MI, a stroke, acute kidney injury, a hyperglycemic crisis, or a psychiatric admission during a heat wave. Humid Tampa Bay summers make it worse, because sweat does not evaporate well and the body loses its main cooling mechanism. Warm nights matter too: without overnight relief, the body never recovers.

Outdoor workers deserve special attention. About 1.8 million nonelderly adults in Florida work outdoors, and roughly 4 in 10 are Hispanic (KFF, 2024). Florida’s HB 433, in effect since July 2024, bars cities and counties from requiring water, shade, or rest breaks for these workers. That makes clinician counseling one of the few protections many of them get.

Air quality: heat makes bad air worse

People of color breathe more fine particulate pollution (PM2.5) than white Americans, and the gap holds at every income level. A 2021 national analysis found that nearly every major emission source, from vehicles to industry to construction, contributes to that disparity (Tessum et al., Science Advances, 2021). For Black Americans, the exposure disadvantage held across all 14 source groups studied (Scientific American).

Climate change compounds this. Higher temperatures speed ground-level ozone formation, pollen seasons are getting longer and stronger, and wildfire smoke now travels thousands of miles. For patients who already carry higher rates of asthma, COPD, heart failure, and hypertension, these are acute triggers, not background noise.

In practice, that means more pediatric asthma ED visits on bad air days, more heart failure exacerbations, and more uncontrolled hypertension in the summer months.

Patients who need a closer look

Several conditions that are more common in our communities also raise climate risk. These are the patients worth flagging before summer and before storm season.

Pregnancy. A systematic review of 68 U.S. studies and more than 32 million births linked heat, ozone, and PM2.5 to preterm birth, low birth weight, and stillbirth. Black mothers were the subgroup most consistently at higher risk (Bekkar et al., JAMA Network Open, 2020).
Sickle cell disease. Dehydration and temperature extremes are recognized crisis triggers. Hot days, power outages, and disrupted access to hydroxyurea or transfusion schedules after a storm all raise the risk of vaso-occlusive events.
Chronic kidney disease. Repeated heat stress and volume depletion injure the kidney, and dialysis patients are acutely vulnerable when storms close centers.
Diabetes and obesity. Both impair thermoregulation and sweating. Patients on GLP-1 receptor agonists with nausea or vomiting, or on SGLT2 inhibitors, are more prone to volume depletion in heat.
Cardiovascular and respiratory disease. Heat strains cardiac output, and heat plus ozone is a known trigger for asthma, COPD, and heart failure exacerbations.
Mental illness and substance use. Heat waves bring more psychiatric ED visits, and many psychiatric medications impair heat tolerance.
Older adults living alone. Isolation, limited mobility, and reluctance to run the AC make this group one of the highest-risk in any heat wave.

Hurricanes, flooding, and broken continuity of care

Tampa Bay learned in 2024, with Helene’s storm surge followed two weeks later by Milton, that the health toll of a storm stretches well past landfall. Much of the harm comes in the days and weeks after: missed dialysis, lost insulin, oxygen concentrators without power, carbon monoxide from generators, heat exposure in homes without electricity, and chronic disease that goes unmanaged while families displace.

Patients of color often face these disruptions with fewer buffers. They are more likely to rent, to lack flood insurance, to have no car for evacuation, and to depend on hourly wages they cannot afford to lose. Recovery assistance has also historically reached these communities more slowly.

The clinical takeaway is simple: a hurricane plan is part of chronic disease management in Florida. Patients who depend on electricity, refrigerated medications, or scheduled treatments need that plan in place before June 1, not when a cone appears on the map.

Medications that raise heat risk

Many of the most commonly prescribed drugs for hypertension, heart failure, and mental illness, conditions that disproportionately affect our patients, also impair the body’s response to heat. The CDC published clinician guidance on this in 2024 (CDC, updated Sept 2025). Combinations matter most: an ACE inhibitor or ARB paired with a diuretic can significantly raise risk.

Drug class	Common examples	How it raises heat risk
Diuretics	Furosemide, hydrochlorothiazide	Volume depletion, electrolyte loss, blunted thirst
ACE inhibitors, ARBs, ARNIs	Lisinopril, losartan, sacubitril/valsartan	Hypotension, blunted thirst
Beta blockers	Metoprolol, atenolol	Less skin vasodilation and sweating, hypotension
Antipsychotics	Quetiapine, olanzapine, haloperidol	Impaired sweating and central thermoregulation
Lithium	Lithium	Water loss, toxicity when dehydrated
Anticholinergic antihistamines	Diphenhydramine, promethazine	Decreased sweating
Tricyclic antidepressants	Amitriptyline	Decreased sweating
NSAIDs	Ibuprofen, naproxen	Kidney injury with dehydration
Stimulants	Amphetamine, methylphenidate	Raised body temperature

Heat also degrades insulin and can make inhalers and epinephrine auto-injectors fail, which matters for any patient without reliable refrigeration or a cool place to store them.

What physicians can do

Most of this fits into visits we are already having. The CDC’s clinician guidance offers a practical framework (CDC Quick Start Guide).

Screen for heat risk. Ask about air conditioning and whether patients can afford to run it, stable housing, outdoor work, and whether someone checks on them during heat or storms.
Review medications before summer. Flag the drug classes above, write a hot-day plan (fluid limits, dose adjustments, when to call), and remind patients never to stop medications abruptly on their own.
Teach the warning signs. Point patients to the CDC HeatRisk tool and the Air Quality Index, and make sure they know the difference between heat exhaustion and heat stroke.
Build a storm plan into chronic care. Cover refrigerated medications, extra supplies, backup power for oxygen and other devices, dialysis contingencies, and enrollment in their county’s special needs shelter registry.
Counsel outdoor workers directly. With no local protections in Florida, your advice on water, rest, shade, and acclimatization may be the only guidance they get.
Pay extra attention to pregnancy. Discuss heat and air quality as part of routine prenatal counseling, especially for Black patients and those with asthma.
Speak up. Physicians are trusted messengers. Support tree canopy, cooling centers, utility shut-off protections during heat, and worker heat standards with local officials and health systems.

The bottom line

Climate change does not create new health disparities so much as it magnifies the ones we already treat. Hotter neighborhoods, dirtier air, and fragile access to care turn ordinary chronic disease into emergencies. As physicians who serve and come from these communities, BAMA members are well placed to see the risk early, plan for it with patients, and push for the local changes that protect them.