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Our Framework Part 2: Connecting Specific Impacts & Disability Groups

By: Alex Ghenis


Introduction

Today’s blog will lay out how to examine the connection between one consequence of climate change and one group of people with disabilities (PWDs), then develop strategies to improve outcomes for independence, health, well-being, and survival. So, if my last blog presented Part One of our disability-and-climate framework, this blog presents Part Two. I invite you to read along and imagine how this might apply to your work and your life, whether now or in the future.


First, a quick review. As I explained in my last blog, the nexus of climate change and disability is the confluence of every possible connection between something climate-related and something disability-related. It’s like putting together a virtually never-ending puzzle. For example, we know that climate change will lead to more wildfires and one disability category is people with mobility disabilities. Simply researching the experience of people with mobility disabilities during wildfires covers one piece of the puzzle. Developing policies to increase the well-being and survival of people with disabilities during wildfires is another piece. We can also change the size of the climate factors where, for example, something larger would be “natural disasters” and something smaller would be “wildfire evacuation shelters.” Likewise, we can change the size of the disability factors where, for example, something larger is “categories of disabilities” and something smaller is “people with spinal cord injuries.”


With that in mind, my goal today is to lay out Part Two of this climate-disability framework: what I’ll call the “flowchart” for the rest of this blog. The flowchart, which is shown in the next section, explains how we can pick apart the connections between specific climate impacts and specific disability groups, understand those connections, and paint a more complete picture of the current situation and potential outcomes. It also explains how we can use that picture to develop solutions (or partial solutions) that will improve outcomes for independence, health, survival and overall well-being.


Note: for the purposes of this flowchart, the disability group can range from a large disability category (e.g., mobility, vision, hearing, or psychological) at the broad end to a specific diagnosis at the more focused end. The climate impact can range from “natural disasters” or “economic disruption” at the broad end to “major Atlantic hurricanes” or “increased West Nile virus” on the narrower end.


An overarching theme of this flowchart is that we must address both medical and social impacts and create medical, social, technological, and other solutions. This ultimately means that stakeholders from multiple fields – medical, civil rights, public health, public policy, and more – should be a part of this collective work. We must learn together and learn to work together. Importantly, stakeholders in the medical field must understand the social model of disability, learn how climate disrupts independent living, be open to systemic and social interventions, and listen to the voices and knowledge of disability communities. Conversely, PWDs must understand that we benefit from knowing how climate change impacts us physiologically and psychologically, that knowing those impacts is a key step toward creating both medical and social interventions, and that the medical community can provide insights on impacts and potential solutions.


Most importantly, we all need to collaborate when it comes to building our climate-disability puzzle. When we come together, we’ll need to listen to each other’s perspectives, appreciate each other’s expertise, and lean on each other’s strengths. If we work as a team, we can create a more complete understanding of the climate-disability connection and build a set of complementary solutions to improve outcomes around independence, health, well-being and survival. So let’s get working – together.


The Flowchart

Overview

Our larger climate-disability framework can be broken into parts. The first part is what I covered in the first blog: how to break climate and disability into categories, then draw connections between them. This second part (I’ll just call it the “flowchart”) is a guide for evaluating one set of those connections – how a given consequence of climate change affects a given group of people with disabilities – and develop solutions to improve independence, health, well-being and survival. The flowchart first requires breaking the existing disability experience into several medical and social factors. After we collect these factors, we evaluate how the given climate impact affects each one, then gather all our insights into one big picture. We can then use that big picture to develop solutions that reduce climate-related harm to the target disability group and, ideally, improve their quality of life. These solutions can fall into several categories and each action contributes to climate justice in its own way; they also should be coordinated wherever possible to amplify their respective impact.



Understanding the Situation

Our first step is to understand the lived experience of the disability group and how the climate impact affects them. We can often break the lived experience of people with disabilities into medical and social spheres (although there is some overlap). The flowchart includes three examples of medical factors and three of social ones – which are major focus areas but do not represent a complete list. The medical side of the flowchart includes PWDs’ baseline health, medical risk factors, and health care needs. The social side includes economic barriers, accessibility needs, and independent living needs. We can understand how the climate impact affects the disability group by going through each of those parts of the medical or social experience.


The outcome is what I call a set of “considerations”: climate-disability connections we should care about and use to inform our strategies and solutions. Ultimately, the inquiries on the medical side create a set of medical considerations, while inquiries on the social side create a set of systemic considerations (I say “systemic” because climate change disrupts social systems). And while most considerations represent problems, not every consideration needs to be negative: a drop in snow days, for example, might be good for the independence of people with mobility disabilities. These good parts, however rare, are still important pieces of the puzzle.


Let’s explore how understanding the situation would work in practice. Imagine we are evaluating the experiences of people with spinal muscular atrophy (SMA) during wildfires. We can start by choosing whichever medical or social factor we like – and in this example, we’ll check out one medical piece and one social piece. On the medical side, a baseline health aspect of SMA is weak intercostal muscles that help with breathing; smoke from wildfires understandably takes a disproportionately large toll on people with SMA’s comfort and health around breathing. On the social side, people with SMA are financially disadvantaged, with lower income and fewer assets than the able-bodied population; because it costs money to prepare for, react to, and recover from wildfire, people with SMA will thus have an especially hard time doing all three and will come out even more financially disadvantaged. It’s also worth asking how social factors might exacerbate medical ones. We can keep evaluating how wildfire affects each part of the lived experience of people with SMA, gathering considerations along the way.


It’s not enough to keep these health and structural considerations separate: we need a more comprehensive picture to inform comprehensive strategies. We must gather medical and systemic considerations, examine how they might interact with each other, and even prioritize them in terms of urgency. Returning to the example above: people with SMA, like people with most disabilities, disproportionately live in lower-quality housing that’s less likely to have good windows, ventilation and filtration – and this exposes people with SMA to more smoke in a way that exacerbates the health consideration on respiratory harm. We will never have a truly complete picture, but we can continue to improve it and use it to inform the next step: designing solutions to improve independence, health, well-being, and even survival.


Developing Solutions

The next step is to use our suite of considerations to develop solutions that reduce disproportionate harm and even improve quality of life. The solutions should be diverse and can include some combination of medical and rehabilitative strategies; recommended personal actions for that disability group; infrastructure investments; improved government response to climate impacts; providing and safeguarding sufficient services for that disability group; and increasing climate action, including by disability and medical stakeholders. This is by no means a complete list and one solution can easily fall into multiple categories, so this section of the flowchart is relatively flexible. It’s also worth noting that the flowchart does not jump directly from health considerations down to medical and rehabilitative solutions. This is because we should also do our best to examine if any social factors exacerbate a medical consideration – and the relative influence of the medical and structural sides. Knowing the causes will give us a better foundation on which to design our solutions.


Solutions can be novel, or they can involve changing the size or details of existing practices and programs. Actions at the individual level – ranging from health interventions to building an emergency kit – can and should be supported through institutions including government, nonprofits, medical systems, and community groups. Ideally, government will take a leading or at least regulatory role, but this is not always appropriate, possible, or the best course of action. We also recommend that climate action be a part of the suite of solutions and that disability and health stakeholders get involved wherever possible. This is important because climate action reduces the intensity of climate impacts in the first place; PWDs and health stakeholders get psychological and social benefits from their own climate action; and PWDs who land climate-related jobs can improve their economic situation, with related benefits for personal climate resilience.


These next two paragraphs build off our example of people with SMA during wildfires. I’ll just lay out a whole set of considerations first – the list is a simplification, and each piece is worthy of inquiry. Among other things, wildfire affects them through:

  • smoke disproportionately irritating their lungs (with all its health consequences);

  • disrupting power they need for their electric equipment (e.g., power wheelchairs and CPAPs); and

  • requiring them to either take medical supplies and equipment during evacuations or separating them from their supplies and equipment.

Social inequities mean that:

  • smoke is more likely to get into people with SMA’s disproportionately lower-quality homes;

  • people with SMA will have a more difficult time evacuating or may be unable to evacuate due to lower personal vehicle ownership and a lack of accessible transportation options during evacuations;

  • people with SMA will face barriers securing shelter and services while evacuated due to financial and accessibility constraints;

  • they will have a harder time financially recovering and, if their home is destroyed, securing a new residence; and

  • a lack of government planning for accessible disaster readiness, response and recovery (DRR) amplifies these problems.

We can next develop solutions to the confluence of every consideration above - or focus in on one part of the problem. This paragraph will focus on health problems from smoke. On the medical side, people with SMA have increased respiratory problems from smoke. On the social side, smoke is more likely to enter their homes because their homes are disproportionately lower quality, while power problems may disrupt their breathing equipment. What might our solutions be? Individual-level solutions could include renovating one’s windows or having a landlord do so; adding air filtration devices or improving a home’s HVAC; or getting a CPAP or other machine with high quality filters that catch wildfire smoke. Non-individual solutions could involve government subsidizing and coordinating home renovations (for owners and renters); cities allowing and encouraging the development of new well-sealed, accessible housing at all income levels; utilities reinforcing the grid so there aren’t power outages that affect electric equipment; and health insurance (public and private) providing CPAP and other breathing machines with high quality filters. Government should be a key actor in the ensuring the non-individual solutions come to fruition and work well, whether through direct action, incentives or regulation. Finally, any climate action to reduce the rate of warming will limit the rise in intensity of wildfires and their consequences.


The flowchart’s solutions are not intended to entirely eliminate disparate harm between people with a certain type of disability and people without that disability. (Some solutions may eliminate specific disparities, but they are the exception, not the rule.) Instead, solutions can work individually and in concert to make a difference and chip away at problems over time. It’s also important to examine the outcome of any implemented solutions, replicate ones that prove successful, de-prioritize ones that seem less effective (especially when considering cost), and avoid strategies that are ineffective or make situations worse.


Conclusion

We are early in the process of understanding and addressing the nexus of climate and disability, and the journey will be a never-ending learning experience. These first two blogs propose a framework for understanding and addressing the nexus. This flowchart – the second major part of the climate-disability framework – provides a strategy to explore a given climate impact’s effect on a given group of people with disabilities, then take actions to limit disparities and increase health, independence, well-being, and survival. It’s also a flexible flowchart where pieces can be added or taken away. For example, some disability groups are more likely than others to be medically affected by climate impacts, while some groups may be medically affected by one impact and not another. Medical considerations are often exacerbated by social ones but that’s not always the case. The list goes on.


Considerations and solutions can be applicable to multiple climate-disability flowcharts. For example, existing or future research may examine how wildfires affect people with mobility disabilities: this knowledge could be used for flowcharts addressing spinal cord injury (SCI), cerebral palsy (CP), SMA, and more. A solution about evacuations for people with mobility disabilities could likewise apply to people with SCI, CP, and SMA. We can also combine solutions within or across flowcharts to be more efficient and effective for people with assorted disabilities.


We should have realistic expectations for our solutions. In the case that one or more considerations are too intense to stop, a solution may still reduce the amount of excess and/or disproportionate harm. In other cases, solutions will improve at least parts of the lives of people with disabilities – such as their baseline health, quality of housing, transportation, employment, or community inclusion. We should also be mindful of each solution’s relative cost, benefit, and resource needs, when either alone or paired with another solution. We should then assess our available resources (financial, physical and human) and develop a realistic mix of actions to make the largest impact possible. We can repeat this process for other climate-disability connections – and continue to change the world.


As always, thanks for following along. We would love to hear your thoughts and any ideas for future blogs. If you have anything to share, leave a comment below or email us through our contact form.

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