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Chapter 1. Direct threats to human health as a consequence of the climate emergency

Environmental health, climate change, and equity: Understanding geographic vulnerabilities

Gina Solomon, Matthew Gribble and Sheri Weiser
p. 14-19

Abstract

Although climate change is affecting the entire planet, local effects differ in both nature and severity according to geography. Some geographic differences are readily apparent – such as the inherent vulnerability of coastal areas to sea level rise – whereas others are emerging. Geographic vulnerabilities are modified by the built environment and by disparities in the ability to adapt to climate change, further complicating the risk across the globe. The complex interactions of climate threats, local geographic and social vulnerabilities, and adaptation can best be explored at the regional level through examples relevant to other regions facing similar issues. This article will describe general principles of geography and climate change risk and explore how these play out using four examples: harmful algal blooms in Alaska, loss of glaciers in Peru, sea level rise causing increased drinking water salinity in Bangladesh, and HIV and food insecurity in Kenya related to extreme weather. The magnitude of the threat to humans from climate change will be significant, and geographic vulnerability is in many ways immutable, but much can still be done by humans to either increase or reduce risk. Lessons from one region can inform strategies in areas across the globe that share similar geographic vulnerabilities.

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Introduction

1Health status and lifespan are influenced by geography due to interactions between geographic and social factors, including economics, history, culture, development and migration. Climate change acts as a “threat multiplier”, exacerbating vulnerabilities. For example, an area prone to flooding faces higher catastrophic flood risk in the setting of climate change. Feedback loops among climate change, regional climate vulnerability, economic capacity, food and water insecurity, infectious diseases, and migration amplify impacts on human health. Further, human action can either ameliorate or exacerbate these vulnerabilities. The failure of the levees resulting in the flooding of New Orleans in the United States after Hurricane Katrina in 2005 is an example of adaptive failure on a major scale. Understanding geographic vulnerabilities and their interaction with social vulnerabilities and adaptation measures is crucial for developing informed local, regional, and global strategies to protect health and the environment.

Overview of geography, climate change and health

Shifts in the planetary system

2Climate change is driving large-scale physical changes across Planet Earth. The melting of the glaciers has caused a change in the tilt of the Earth’s axis increasing earthquake and volcano risks. Ocean currents are affected by warming sea-surface temperatures, with potential impact on local climates. Higher carbon dioxide concentrations in the atmosphere lead to more acidic oceans, as it diffuses into the water and dissociates into carbonic acid. Thus, we are racing toward a world of warmer, more acidic oceans; evolving geological hazards; and changing currents affecting local climates.

3The world’s ongoing physical and biological changes will interact to produce additional hazards. For example, heavy rains may promote vegetation that is a fire risk in the next drought; and plants dying during droughts may have reduced ability to hold soils in place affecting mudslide risks when it rains again. These changes can result in invasive species and zoonotic disease risks, alter pollen composition, increase poisoning risks (venomous animals, molds, and toxin-producing algae), and create other hazards for people living with nature. An understanding of this complex set of issues requires knowledge of global climate zones and regional factors.

Global climate zones

  • 1 See details of all categories here: Kottek, M., Grieser, J., Beck, C., Rudolf, B., & Rubel, F. (200 (...)

4German climatologist Wladimir Köppen (1846-1940) divided the world's climates into categories based upon temperature and latitude. These categories have been modified into the Köppen-Geiger climate classification system, which divides the globe into six classifications: A: tropical, B: dry, C: moist subtropical, D: moist continental, E: polar, and H: highland (mountain) climates. Each of these zones can be further classified according to precipitation and temperature patterns.1 The three-letter combination resulting from the classification system characterizes local climate zones worldwide. (Figure 1)

Figure 1: Global climate zones

Figure 1: Global climate zones

Source: Köppen-Geiger climate classification. From Kottek, M., J. Grieser, C. Beck, B. Rudolf, and F. Rubel, 2006: World Map of the Köppen-Geiger climate classification updated. Meteorol. Z., 15, 259-263.

5Widely separated regions of the globe may share the same climate. For example, Mediterranean-type ecosystems (Csa and Csb climate zones), with their characteristic climate of mild, wet winters with hot or warm, dry summers, exist in the Mediterranean, California, Chile, South Africa and South Australia. These areas, although distant from each other, share similar weather, vegetation, and climate vulnerabilities. Lessons from one of these regions may be relevant to the others.

  • 2 Seager, R., Feldman, J., Lis, N., Ting, M., Williams, A. P., Nakamura, J., Liu, H., & Henderson, N. (...)
  • 3 These maps, based on the average annual minimum temperature of any location, establish predictions (...)

6The world’s climate zones are shifting. Shrinking of the polar icecaps and polar movement of the permafrost line have been well-documented. Desert regions, including the Sahara, are growing, as are drier continental regions. For example, the line between the arid Western climate and the moist Eastern continental climate in the United States has moved about 140 miles eastward since 1980,2 resulting in shifts between areas where wheat (a more drought-tolerant crop) and corn can readily grow. Farmers can adapt to these shifts with added irrigation, up to a point. Eventually, shifting climate zones will be challenging for farmers to adapt to, as plant hardiness zones are indicated to be moving northward globally at about 13 miles per decade,3 and invasive plant and insect species also move northward, threatening crops and ecosystems.

7The effect of geography on climate vulnerability extends beyond climate zones. Geographic predictors of vulnerability also include elevation above sea level, location relative to the coast and to rivers that may flood. Dike or levee systems can significantly reduce the risk of flooding in these areas, but can also result in secondary harm (e.g., loss of river deltas, increased coastal erosion), as well as increased sediment run-off resulting in “dead zones”, both of which are observed today in Coastal Louisiana and the Gulf of Mexico. Engineered systems may also fail catastrophically, resulting in massive loss of life and damage.

8Location of a community relative to the wildland-urban interface, related to human incursion on natural areas, is a predictor of risk from wildfires; percentage of ground surface that is paved is a predictor of both flood risk and heat vulnerability. Although communities in similar climate zones share comparable risks from climate change, actual risk can vary significantly based on other local geographic factors and the built environment.

Global geographic impacts of climate change

9Climate change is already causing widespread harm to public health, and the impacts will become more severe over the coming decades. It primarily manifests as extreme events, ranging from heat waves to fires, major storms and floods. These events cause direct and indirect health effects through population displacement, conflict over resources, and mental health problems. Although climate change affects everyone, its specific impacts differ, both in nature and in magnitude, by geography. Examples of these disparate impacts across the globe are shown in Figure 2, while specific impacts across the European sub-continent are shown in Figure 3.

Figure 2: Regional risks of climate change worldwide

Figure 2: Regional risks of climate change worldwide

Source: IPCC, 2014: Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, R.K. Pachauri and L.A. Meyer (eds.)]. IPCC, Geneva, Switzerland, 151 pp.

Figure 3: Climate change across the European sub-continent

Figure 3: Climate change across the European sub-continent

Source: IOM UN Migration, https://environmentalmigration.iom.int/​resources/​europe-and-africa.

  • Heat: The most direct effect from climate change is from heat. Average temperatures are rising globally, and extreme heat events will become common. From 2000 to 2019, approximately 489,000 heat-related deaths occurred each year, with 45% of these in Asia and 36% in Europe.4 Besides, 60% of global episodes of health-threatening temperatures were made more than twice as likely to occur by human-caused climate change.5 Some areas of the globe, mainly in South Asia and the Persian Gulf, already experience temperatures in excess of the “noncompensible heat threshold”6 at least once per decade. The areas at risk are predicted to expand to encompass as much as 25% of the globe with 2.0 degrees Celsius of warming.

  • Extreme Weather and Coastal Damage: Increased heat causes turbulence in the earth’s atmosphere. This energy can manifest as dramatic weather fluctuations, including more violent storms. Sea level rise will result in inundation of low-lying coastal areas, destruction of coastal wetlands and mangroves, and erosion of coastal bluffs, especially during high tides and storm surges. Tropical cyclones are projected to become more powerful due to warming oceans. Taiwan, Japan, the Philippines, Southeast China, Southern India, Mexico, the Caribbean, the Southeastern U.S. and Northwest Australia, already vulnerable to these major events, are all the more exposed to severe storms.

  • Wildfires: A warming climate places enormous stress on many species of trees, as weather conditions become too warm and either too wet or too dry for the climate to which the forests are adapted. Stressed trees are more susceptible to fungal infestations and pests. The combined stresses of heat, drought and infestations kill large numbers of trees, while so-called “ladder fuels” such as grasses and shrubs become more prevalent. Forest stress is fueling fires in places ranging from Australia and Indonesia to Canada.

    • 7 Nations that withdraw 25% or more of their renewable freshwater resources to meet water demand (Wat (...)

    Water Insecurity: Today, 2.4 billion people live in water-stressed countries.7 The water stress in parts of Southern and Central Asia and North Africa is already critical. Within the next few years, 1.8 billion people are likely to face critical water scarcity and two-thirds of the global population is expected to be in water-stressed countries. Drought can lead to malnutrition and dehydration, which can impair immune response and increase susceptibility to infections.

  • Flooding: Flooding can increase the spread of water-borne illnesses like cholera and cause direct injury and death. At least 15% of all deaths related to natural disasters are due to floods, which are particularly harmful for elderly and disabled people who are less able to evacuate before a major storm. Testing after flooding in Louisiana and Texas revealed toxic petroleum chemicals, heavy metals, and pesticides in the sediment left behind in flooded neighborhoods.

    • 8 Food and Agriculture Organization, International Fund for Agricultural Development, United Nations (...)
    • 9 Dasgupta, S., & Robinson, E. J. Z. (2022). Attributing changes in food insecurity to a changing cli (...)

    Food insecurity: Nearly one in three people globally did not have access to adequate food in 2020. Of these, nearly 40% faced severe food insecurity.8 Roughly half of people experiencing food insecurity are in Asia, one-third are in Africa, and 11% are in Latin America and the Caribbean. A recent study9 based on data from 83 countries found that every 1°C increase in local average temperature over time led to a 1.6% increase in moderate to severe food insecurity.

    • 10 International Organization for Migration. (2023, October 9). IDM second session 2023 - Think about (...)

    Migration: Climate change is expected to drive the largest mass movement of people in human history. While estimates vary, it is predicted that approximately 200 million people in climate-vulnerable areas of the world will be forced to migrate by 2050.10 A feedback loop can emerge wherein the inability to meet food and other basic needs forces people to migrate, and the challenges arising from displacement, including homelessness and poverty, amplify hunger further. Migration also places political stress in ‘receiving’ geographic areas, which can result in political instability and conflict.

  • Inequality: Climate change amplifies existing disparities, leading those who contribute the least to greenhouse gas emissions (GHG) to suffer first and worst from its harmful health effects. These populations have greater exposure due to deprivation and injustices like racism and colonialism. Countries with the highest per-capita GHG emissions (i.e., the greatest consumers), including the U.S., Canada, Australia, and Russia, also have the lowest mortality linked to climate change. Meanwhile, Southern American and African countries, which have some of the lowest per-capita emissions, suffer some of the highest climate-related mortality rates.

Geographic case studies

Harmful algal blooms in Alaska

10Paralytic shellfish poisoning (PSP) is an acute syndrome that has a range of presentations from mild (e.g., tingling around the lips), to moderate (e.g., temporary paralysis of the limbs), to severe (e.g., paralysis of the lungs resulting in death). PSP is caused by a type of harmful algal bloom (HAB) that occurs worldwide in temperate waters and is worsening as oceans warm. Shellfish are filter-feeders and accumulate the toxin, resulting in potential poisoning of animals and humans that consume them. This problem is of particular concern for Alaska’s native communities as they rely on traditional foods such as butter clams and have been subject to recent outbreaks of PSP.

11In response to the growing health threat, native communities around the Gulf of Alaska have banded together to provide scientific leadership on PSP prevention. The Southeast Alaska Tribal Ocean Research Consortium (SEATOR) coordinates efforts across the Gulf of Alaska to monitor for toxin risks, and the Sitka Tribe of Alaska Environmental Research Lab provides toxin testing services both for the larger monitoring program and for individual community members who want their shellfish tested for safety.

12At a global level, the Intergovernmental Oceanographic Commission (IOC) has a Harmful Algal Blooms Programme that coordinates global scientific knowledge-sharing to advance community resilience (developing solutions such as early warning systems). While HABs are natural, their occurrence is a function of nutrients and temperature. Many HABs are problematic due to oxygen depletion from decaying algae, causing massive fish kills. Others produce toxins that can devastate fish, birds and marine mammals, and harm humans. HABs affect coastal areas and island nations worldwide (Figure 4).

Figure 4: Harmful algal blooms worldwide

Figure 4: Harmful algal blooms worldwide

Source: IOC-UNESCO Harmful Algae Information System, https://data.hais.ioc-unesco.org/​.

Loss of glaciers and water scarcity in Peru

13The Cordillera Blanca has the largest area covered by glaciers in the tropics. This mountain range has lost almost half of its glaciated area since the early 20th century. Catastrophic and unpredictable flooding from melting and failure of ice dams that hold back the nearly 900 glacier lakes in the region have caused massive damage and killed livestock and people. Most worrisome is the fact that the peak flow from melting glaciers has already passed, meaning that there will be decreased flow in glacier-fed streams, which threatens the availability of fresh water for agriculture, livestock and drinking water.

14Populations in Peru have been moving from inland mountain and jungle areas to the coast, where 70% of the population now lives. These migrants are ending up in large shanty towns on the outskirts of Lima, the capital city. These shanty towns, housing 1.3 million inhabitants, have no water, sewage or electricity. Water deliveries occur sporadically from tanker trucks, and residents must pay to obtain a small amount of water, which is often contaminated, and has been associated with outbreaks of cholera, dysentery, hepatitis, typhoid fever and diarrheal disease. Sufficient water is often not available for food preparation or hygiene.

  • 11 The Peruvians Without Water Movement.

15In coastal South America, some communities are collecting water from coastal fog, an ancient practice used by the Incas. Today they use “fog catchers” that are made of inexpensive nylon, propylene or polyethylene mesh that catch fog droplets and collect the water in a reservoir for filtering. Depending on location and weather conditions, these fog collectors can be very effective, collecting about 20L of fresh water per square meter of cloth per day. Today, over 2,000 fog catchers have been installed in Peru by the NGO El Movimiento Peruanos sin Agua.11

Sea level rise and salinity in drinking water in Bangladesh

16Much of the world population lives near the ocean, where climate change threatens water supplies. Surface waters and groundwater are impacted by storm-surge flooding. In unconsolidated coastal aquifers, intrusion of salty ocean water into the drinking water supply is a major problem, especially where there is over-pumping of groundwater wells. Coastal subsidence can couple to saltwater intrusion, greatly increasing the salinity of groundwater supplies.

17Since salt intake is a major risk factor for hypertension, this could be an important dimension of the cardiovascular harm of climate change. The Government of Bangladesh and the United Nations International Children's Emergency Fund (UNICEF) attempted to address increasing drinking water salinity in southwest coastal Bangladesh by introducing managed aquifer recharge to some communities.

18The experiment was only partially successful, illustrating the limitations of engineered solutions. While the provided water was less salty than untreated groundwater, the drinking water source that had been previously consumed by some participants was fresher (rainwater and pondwater) than the provided alternative, but it is also vulnerable to surface inundation.

Drought, food insecurity and HIV in Kenya

  • 12 National Aids Control Council, & Tum, P. K. (2018). Kenya HIV Estimates Report 2018. https://nsdcc. (...)

19Kenya has been suffering increasing frequency of drought and excessive rains in the setting of climate change. This is especially problematic in the counties in the Nyanza region, bordering Lake Victoria in western Kenya, which also have the highest prevalence of HIV/AIDS in the country and made up nearly half of HIV cases nationwide in 2018.12 Despite unreliable rainfall patterns, the region is dependent on agriculture, and few income-generating alternatives exist. Drought and excessive rains in Kenya have been found to worsen HIV health along four key pathways: increased incidence of infectious diseases, food insecurity/undernutrition, migration and mobility, and alterations in health care access and behaviors (Figure 5).

Figure 5: Associations between weather extremes and HIV/AIDS

Figure 5: Associations between weather extremes and HIV/AIDS

Source: Lieber M, Chin-Hong P, Whittle HJ, Hogg R, Weiser SD. The Synergistic Relationship Between Climate Change and the HIV/AIDS Epidemic: A Conceptual Framework. AIDS Behav. 2021 Jul;25(7):2266-2277. doi: 10.1007/s10461-020-03155-y.

  • Increased infectious diseases: People living with HIV reported more infections from cold and wet living conditions during floods, increased diarrhea outbreaks from contaminated flood waters, and increased incidence of malaria from stagnant waters during both floods and drought.

  • Undernutrition: Extreme flooding and drought worsened food insecurity and diet quality. These changes were documented to contribute to weight loss in all age groups and stunting in children.

  • Migration and mobility: Migration drives poor HIV outcomes through reduced access to services, and lower adherence to treatment. In Kenya, floods were a major contributor to migration due to destroyed crops, homes and infrastructure.

  • Health care: Participants reported that infrastructure damage (e.g., roads) from storms and flooding undermined their ability to access medical facilities, which led to treatment non-adherence, and negatively impacted their health.

20Climate-adaptive regenerative agriculture holds promise as a way towards sustained improvement of household income and HIV health in Kenya. In the Nyanza region across 16 health facilities, we carried out an intervention that included a farming loan to purchase agricultural implements, a human-powered water pump, seeds, and fertilizers, and training in financial management and sustainable agricultural practices. Among over 700 participants living with HIV, the study found improvements in household food security, measures of women’s empowerment, mental health, social support, and physical health status. The researchers also saw reductions in intimate partner violence and HIV stigma. Among adolescents living in the household, there was improved nutrition and sexual and reproductive health, and children under five exhibited improved growth and development.

Conclusion

21Complex interactions between global climate zones, topography, other local geographic factors, the built environment, economic and social factors result in different climate threats, vulnerabilities and potential solutions across the globe. Successes in one region may translate to other regions that face similar climate threats. Although engineered solutions can work to address some threats in some regions for some period of time, they have the potential for catastrophic failure. Solutions that build on local practices, further local traditions, and provide economic benefits can improve both health and resilience. Because climate change is a threat-multiplier, it tends to exacerbate existing social and economic inequities. Efforts to address climate change should therefore also focus on improving equity and protecting health.

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Notes

1 See details of all categories here: Kottek, M., Grieser, J., Beck, C., Rudolf, B., & Rubel, F. (2006). World map of the Köppen-Geiger climate classification updated. Meteorologische Zeitschrift, 15(3), 259–263. https://doi.org/10.1127/0941-2948/2006/0130.

2 Seager, R., Feldman, J., Lis, N., Ting, M., Williams, A. P., Nakamura, J., Liu, H., & Henderson, N. (2018). Whither the 100th Meridian? The Once and Future Physical and Human Geography of America’s Arid–Humid Divide. Part II: The Meridian Moves East. Earth Interactions, 22(5), 124. https://doi.org/10.1175/ei-d-17-0012.1.

3 These maps, based on the average annual minimum temperature of any location, establish predictions about what crops can over-winter successfully in different regions, helping growers determine which perennial plants are most likely to thrive at a location.

4 World Health Organization: WHO. (2024, May 28). Heat and health. https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health.

5 Lancet Countdown: Heat-Related mortality. (2023, November 15). https://www.lancetcountdown.org/data-platform/health-hazards-exposures-and-impacts/1-1-health-and-heat/1-1-5-heat-and-sentiment.

6 This threshold is a combined calculation of temperature and humidity that is predicted to cause death after six hours of unmitigated exposure.

7 Nations that withdraw 25% or more of their renewable freshwater resources to meet water demand (Water Scarcity | Land & Water | Food and Agriculture Organization of the United Nations. (s. d.). https://www.fao.org/land-water/water/water-scarcity/en/).

8 Food and Agriculture Organization, International Fund for Agricultural Development, United Nations Children’s Fund, World Food Programme, & World Health Organization. (2021). The state of food security and nutrition in the world 2021: Transforming food systems for food security, improved nutrition and affordable healthy diets for all. Food and Agriculture Organization. https://doi.org/10.4060/cb4474en.

9 Dasgupta, S., & Robinson, E. J. Z. (2022). Attributing changes in food insecurity to a changing climate. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-08696-x.

10 International Organization for Migration. (2023, October 9). IDM second session 2023 - Think about tomorrow, act today: The future of human mobility and climate change. International Organization for Migration. https://www.iom.int/international-dialogue-migration-2023-think-about-tomorrow-act-today.

11 The Peruvians Without Water Movement.

12 National Aids Control Council, & Tum, P. K. (2018). Kenya HIV Estimates Report 2018. https://nsdcc.go.ke/wp-content/uploads/2018/11/HIV-estimates-report-Kenya-20182.pdf.

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List of illustrations

URL http://journals.openedition.org/factsreports/docannexe/image/7634/img-1.jpg
File image/jpeg, 392k
Title Figure 1: Global climate zones
Credits Source: Köppen-Geiger climate classification. From Kottek, M., J. Grieser, C. Beck, B. Rudolf, and F. Rubel, 2006: World Map of the Köppen-Geiger climate classification updated. Meteorol. Z., 15, 259-263.
URL http://journals.openedition.org/factsreports/docannexe/image/7634/img-2.png
File image/png, 198k
Title Figure 2: Regional risks of climate change worldwide
Caption Source: IPCC, 2014: Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, R.K. Pachauri and L.A. Meyer (eds.)]. IPCC, Geneva, Switzerland, 151 pp.
URL http://journals.openedition.org/factsreports/docannexe/image/7634/img-3.jpg
File image/jpeg, 356k
Title Figure 3: Climate change across the European sub-continent
Credits Source: IOM UN Migration, https://environmentalmigration.iom.int/​resources/​europe-and-africa.
URL http://journals.openedition.org/factsreports/docannexe/image/7634/img-4.jpg
File image/jpeg, 432k
Title Figure 4: Harmful algal blooms worldwide
Credits Source: IOC-UNESCO Harmful Algae Information System, https://data.hais.ioc-unesco.org/​.
URL http://journals.openedition.org/factsreports/docannexe/image/7634/img-5.jpg
File image/jpeg, 128k
Title Figure 5: Associations between weather extremes and HIV/AIDS
Credits Source: Lieber M, Chin-Hong P, Whittle HJ, Hogg R, Weiser SD. The Synergistic Relationship Between Climate Change and the HIV/AIDS Epidemic: A Conceptual Framework. AIDS Behav. 2021 Jul;25(7):2266-2277. doi: 10.1007/s10461-020-03155-y.
URL http://journals.openedition.org/factsreports/docannexe/image/7634/img-6.png
File image/png, 77k
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References

Bibliographical reference

Gina Solomon, Matthew Gribble and Sheri Weiser, Environmental health, climate change, and equity: Understanding geographic vulnerabilitiesField Actions Science Reports, Special Issue 27 | 2025, 14-19.

Electronic reference

Gina Solomon, Matthew Gribble and Sheri Weiser, Environmental health, climate change, and equity: Understanding geographic vulnerabilitiesField Actions Science Reports [Online], Special Issue 27 | 2025, Online since 15 December 2024, connection on 12 February 2025. URL: http://journals.openedition.org/factsreports/7634

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About the authors

Gina Solomon

Chief of the Occupational, Environmental and Climate Medicine (OECM) Division at the University of California San Francisco (UCSF)

Gina Solomon is chief of the Occupational, Environmental and Climate Medicine (OECM) Division at the University of California San Francisco (UCSF). She previously served at the Natural Resources Defense Council, the California Environmental Protection Agency, and the Public Health Institute.

Matthew Gribble

Associate Chief for Research in Occupational, Environmental and Climate Medicine (OECM) at UCSF

Matthew Gribble, Associate Chief for Research in OECM at UCSF, addresses issues related to tribal partnerships, oceans and human health, and climate change and health equity.

Sheri Weiser

Professor of Medicine at UCSF, co-founding Director of the University of California Center for Climate, Health and Equity

Dr. Sheri Weiser is a Professor of Medicine at UCSF, co-founding Director of the University of California Center for Climate, Health and Equity, whose research focuses on the intersections of food insecurity, extreme weather HIV, and chronic diseases, aiming to improve health outcomes in vulnerable populations.

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Copyright

CC-BY-4.0

The text only may be used under licence CC BY 4.0. All other elements (illustrations, imported files) are “All rights reserved”, unless otherwise stated.

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