Coastal populations with greater vulnerability to health impacts from coastal flooding include persons with disabilities or other access and functional needs, certain populations of color, older adults, pregnant women and children, low-income populations, and some occupational groups [High Confidence]. Climate change will increase exposure risk to coastal flooding due to increases in extreme precipitation and in hurricane intensity and rainfall rates, as well as sea level rise and the resulting increases in storm surge [High Confidence].

This finding is from chapter 4 of The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment.

Process for developing key messages: The chapter was developed through technical discussions of relevant evidence and expert deliberation of the report authors at several workshops, teleconferences, and email exchanges. Authors considered inputs and comments submitted by the public, the National Academies of Sciences, and Federal agencies. For additional information on the overall report process, please see Appendices 2–3.

The health outcomes selected and prioritized for the chapter were based primarily on those that had substantial peer-reviewed literature to support statements. While many connections between changes in extreme events due to climate change and human health impacts appear intuitive, in some cases there may not be a robust body of peer-reviewed literature to support statements about direct effects. For example, while it is believed that droughts have the ability to impact water quality, which could in turn impact health, there are few studies documenting specific health consequences in the United States.f60a6281-fa30-444d-9acd-0d132a6d1683

In addition, due to space constraints, the authors did not intend to exhaustively identify all possible health impacts from every type of extreme event addressed in this chapter. Instead, the authors have provided an overview of possible impacts from different types of extreme events and provided a framework for understanding what additional factors (for example, population vulnerability, existing quality of infrastructure, etc.) can exacerbate or reduce adverse health outcomes.

Due to limited space and the uncertainty around future projections of tornadoes, we do not include detailed discussion of this topic in this chapter. We recognize that tornadoes can cause significant infrastructure damage and significant health impacts, and understanding how climate change will impact tornado intensity, frequency, and geographic distribution is an area of active scientific investigation.

Description of evidence base: The evidence in the peer-reviewed literature that climate change will increase coastal flooding in the future is very robust.dd5b893d-4462-4bb3-9205-67b532919566 089d8050-f4c8-4d07-bc35-25bf61691be3 Global sea level has risen by about 8 inches since reliable record keeping began in 1880 and it is projected to rise another 1 to 4 feet by 2100.dd5b893d-4462-4bb3-9205-67b532919566 Rates of sea level rise are not uniform along U.S. coasts and can be exacerbated locally by land subsidence or reduced by uplift. In the next several decades, storm surges and high tides could combine with sea level rise and land subsidence to further increase coastal flooding in many regions. The U.S. East and Gulf coasts, Hawaii, and the U.S.-affiliated Pacific Islands are particularly at risk. In addition, recurrent weather-related stressors, such as “nuisance flooding” (frequent coastal flooding causing public inconveniences), contribute to overall deterioration of infrastructure like stormwater drainage systems and roads (see Ch. 6: Water-Related Illness).bbf3043e-9999-4f0e-8d0c-6012450d9d84 These systems are important in the context of health because drainage helps to avoid sewage overflows and maintain water quality,067c087d-ac72-448f-8a8f-c554d7897519 and roads are vital for evacuations and emergency response during and after extreme events.53acdf32-e868-45b1-a669-83c0fa419f53

There is strong, consistent evidence in the literature that coastal flooding will increase exposure to a variety of health hazards—for example, direct physical impacts and impacts associated with disruption of essential infrastructure—which can result in death, injury, or illness; exacerbation of underlying medical conditions; and adverse effects on mental health.3be13957-eae2-4796-8504-ef2597b91b09 57f88e8c-2e4f-4e00-91e8-aea256ca3128 c43fa066-6d7b-481b-9a85-22da8c27243a aa29148e-c86c-443d-9c1d-5a1d7fbc3437 858d9e98-4217-4278-92bf-d113e5561c39 692dfb63-86b7-4268-be18-725585651b27 3a569dc6-4596-488a-8c30-c0b6f884677f 60be18ee-b5bc-4503-8f77-102561b193fb Multiple studies also consistently identify certain populations as especially vulnerable to the health impacts of coastal flooding. These populations include older adults (especially those who are frail, medically incapacitated, or residing in nursing or assisted living facilities), children, those reliant on electrically powered medical equipment like ventilators and oxygen supplies, those with preexisting health conditions, and people with disabilities.3be13957-eae2-4796-8504-ef2597b91b09 61b95c91-09b7-4f17-b551-dce616662ae6 b00a1349-fb5f-4e2d-b1bc-cfceb0863de2 13d048c9-77d7-4bbb-beeb-ee49842d2719 dd072932-2da1-4e6c-b18a-6f7649969625 3a569dc6-4596-488a-8c30-c0b6f884677f 81e4da11-12ba-4f0e-8bdb-ca6a8dadd63d 6a74b0ff-705b-433e-8b26-59b7284cca88 fd7edbac-5131-49ad-9f44-d3f05e098b75 8204e372-0cb0-48ee-8d15-f6a7318d0fda In addition, differences in exposure, sensitivity, and adaptive capacity lead to a disproportionate number of flood-related fatalities among older adults, males, and some low-income communities of color.57f88e8c-2e4f-4e00-91e8-aea256ca3128 Floods and storms also create occupational health risks to first responders and other emergency workers and to people involved in cleanup activities, construction, public utilities restoration, and security/policing.3be13957-eae2-4796-8504-ef2597b91b09 c4dc57e5-707f-4967-ab31-2b6e2b94fde5 e3439854-edb7-4acd-9e4f-b6ae0477f688 895a462d-2faa-44e3-a888-31efb349f44d

New information and remaining uncertainties: It is nearly certain that coastal flooding will increase in the United States. There are varying estimates regarding the exact degree of flooding at any particular location along the coast. Modeling does provide estimated ranges with varying levels of confidence depending on the location. There is greater uncertainty about how coastal flooding will impact the health of specific populations. There are various ways in which these key risk factors interact with and contribute to the vulnerability (comprised of exposure, sensitivity, and adaptive capacity) of a population. Some uncertainties exist regarding the relative importance of each of these factors in determining a population’s vulnerability to health impacts from extreme events. In addition, there is some uncertainty regarding how future demographic and population changes may affect the relative importance of each of these factors.

Assessment of confidence based on evidence: Based on the evidence presented in the peer-reviewed literature, there is high confidence that coastal flooding will increase in the United States, and that age, health status, socioeconomic status, race/ethnicity, and occupation are key risk factors that individually and collectively affect a population’s vulnerability to health impacts from coastal flooding. Many qualitative studies have been published regarding how these key risk factors interact with and contribute to the exposure, sensitivity, and adaptive capacity of a population, and this evidence is of good quality and consistent.

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