UCSF

Climate change is a global crisis harming the health of communities around the world. We have known about the causes and risks of climate change since at least the 1960s, and about the health harms of climate change since the 1990s. Yet our collective inability to envision and enact alternative energy and economic systems has locked in a level of global temperature rise with devastating consequences. At current levels of warming, communities around the world are already experiencing a wide range of harmful impacts to mental and physical health and wellbeing; impacts which will grow as climate change continues unabated. As a result of systemic forms of social injustice – including those of economics, race, and gender – climate change is deepening health inequities within and between countries. Gaps in the literature hinder our ability to comprehend and effectively communicate the scale of the challenge, to identify and implement effective programs and policies to protect health in the face of climate change, and to overcome deeply entrenched political barriers to action. In this dissertation, I focus on one gap in particular: the paucity of research at the global level exploring the intersection of climate change and the social determinants of health. Using Nancy Krieger’s Ecosocial Theory of Disease Distribution as a conceptual guide, I develop three empirical case studies, each of which focuses on a distinct pathway though which climate change and the social determinants of health intersect to drive adverse health outcomes. Chapter One offers a brief overview of the current state of climate change and health and describes how a social determinants approach can respond to existing research gaps. Chapter Two utilizes a historical case study to document the engagement of the fossil fuel industry in the science of climate change and health, newly emergent in the 1990s. It identifies how the industry sought to influence the public health narrative on climate change and opens a critical new area of research for understanding and navigating political barriers to climate action. Chapter Three quantitatively assesses the relationship between drought – an environmental phenomenon becoming increasingly common and severe because of climate change – and women’s empowerment – a social determinant of women’s and children’s health. Drawing on analysis of household surveys in twenty-four countries in sub-Saharan Africa, this paper finds that drought is associated with small but significant decline in women’s empowerment, thus expanding a currently understudied area in the literature on climate change and women’s health. Chapter Four presents qualitative analysis of how climate change impacts mental health in a uniquely vulnerable population of smallholder farmers living with HIV in western Kenya. This chapter finds that mental health is predominantly mediated by profound changes in economic and social systems, and thus proposes a new conceptual framework for understanding the social determinants pathways through which climate change shapes emotional health. Finally, Chapter Five draws conclusions from these three studies, proposing directions for future research, and highlighting how a social determinants approach to global health sciences research on climate change can inform more effective community and policy interventions to reduce climate change’s health harms.