Mar 6, 2017


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Climate Change, Equity, & Health

by | Mar 6, 2017

Denver Department of Environmental Health

“Climate change is the greatest public health challenge of the 21st century”.  [1]

Over the past decade, rapid climate change has become the most defining concern of the 21st century. Global emissions of climate-altering greenhouse gases (GHGs) are rising, along with the temperature of the atmosphere and oceans. As a result, communities worldwide are experiencing record temperatures, increased frequency of drought, severe flooding, wildfires, and a decline in air quality.  In fact, 2016 was the hottest year on record, eclipsing the previous hottest year of 2015 and 2014 before that.[2]

These heat-related events can result in human health impacts such as increased asthma and respiratory illnesses, heart disease and heart attacks, exacerbation of existing medical conditions including diabetes, obesity and cognitive illness, and premature death.[3] Rising temperatures may reduce air quality by increasing the formation of ground-level ozone, which is a key component of smog. This may be problematic in areas such as the Denver-Metropolitan and North Front Range, which struggle to meet the national ozone standards.[4]

However, the health risks and impacts of climate change are not equally or fairly distributed across people or communities.  [5]  In the U.S., low-income communities and communities of color suffer substantially higher disease burdens and lower life expectancies than wealthier and white populations. For example, the rate of diabetes among the poor is 1.5 times higher than of those who are not poor. Diabetes increases one’s sensitivity to extreme heat.  Deaths from heart disease and stroke are higher for Blacks than any other ethnic group. Heart disease also increases sensitivity to heat stress. And adults with a high school education or less are 8 times more likely to report their health as ‘fair or poor’ than those with a college education. [6] Education and poverty are linked, and those living in poverty often lack access to air conditioning. Living conditions differ by place, race and income due to factors including historical disinvestment, housing discrimination, and higher pollution burdens in communities of color.  These factors mean that climate change has the potential to create greater ‘health inequity’, or differences in health outcomes between groups of people that are avoidable and preventable.

The City of Denver developed a Heat Vulnerability Index Map to understand which neighborhoods have residents that might be more vulnerable to extreme heat events due to a number of factors, including socioeconomic, built environment, and demographic factors. Some neighborhoods have lower amounts of tree cover for cooling, and higher areas of impervious surface like asphalt and concrete, which trap heat and raise temperatures. There are also neighborhoods with higher numbers of elderly people, people who live alone, and those with physical or cognitive disabilities who might face difficulty accessing cooler areas during extreme heat events. Finally, the map shows neighborhoods with higher numbers of people that live in poverty, which may indicate less access to air conditioning in their homes and access to a personal vehicle to get to cooling stations in extreme heat events.

The City of Denver is using this information to target planning and resources to those residents at highest risk during extreme heat events, to reduce health inequity due to climate change among Denver’s most vulnerable citizens.

In addition, the Denver Vital Signs newsletter published a recent issue on “The Health Impacts of Climate Change” to understand how climate change affects the health of Denver residents including increased particulate matter and other pollutants in the air, poor air quality, and more frequent hospital visits for asthma treatment for children in particular.

One of the primary sources of greenhouse gas emissions is motor vehicles, according to the 2015 Denver Climate Action Plan. Denver is working to reduce greenhouse gases in the City by promoting more “active transportation”, including biking, walking and transit use.  Reduced-rate transit passes are currently available to seniors, students, and those with disabilities, and efforts are underway to expand discounted pass access to those with low incomes.  City of Denver employees can purchase reduced-rate “Eco-passes” to use transit or “B-cycle” passes for bike sharing.  Denver Safe Routes to School supports local schools to increase student walking and biking with bike training programs, walking school buses, and Walk and Bike to School Days. And the newly adopted “Denver Ultra Urban Green Infrastructure Guidelines” allow City and private developers to incorporate more green treatments such as stormwater planters, green alleys, and tree trenches in urban areas to reduce local flooding and ambient temperatures and improve air quality.

These efforts can not only help reduce the human health impacts of climate change, but reduce the inequitable impacts of climate change on the most vulnerable members of our community.

[1] Center for Climate Change & Health

[2] Hot. Hot. Hot. Third Straight Year of Record Temperatures. Denver Post, 1-19-17.

[3]  Climate Change and Human Health Trends

[4] United States Environmental Protection Agency, What Climate Change Means for Colorado (August 2016). Colorado Department of Public Health & Environment, “Ozone information,” last accessed December 2016.

[5] Climate Change and Health Equity

[6] Climate Change and Health Equity

Recent articles


To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.


Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.


Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.


Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.