As Climate Warms, UMass Amherst Economist Finds Improved Access to Primary Care Mitigates the Harmful Effects of Heat

Research shows access to primary care services moderates the heat-mortality relationship by 14.2%, while acute treatment facilities such as hospitals reduce mortality from cold
Jamie Mullins
Jamie Mullins

AMHERST, Mass. – New research from an economist at the University of Massachusetts Amherst suggests that differential access to health care contributes to observed variation in environmental health damages, and that improving access to primary and preventative health care services may be a useful means of mitigating harm from a warming climate.

Using quasi-experimental variation in access to primary care services through the rollout of the Community Health Center (CHC) program across counties in the United States in the 1960s and ‘70s, Jamie T. Mullins, assistant professor of resource economics at UMass Amherst, and his colleague Corey White, of California Polytechnic State University and Monash University of Australia, found that the establishment of a CHC in a county mitigated the relationship between heat and all-cause mortality by approximately 14%.

While Mullins and White found little evidence that CHC access mitigated the effects of cold on all-cause mortality, by leveraging variation in access to acute treatment services arising from hospital desegregation in the American South they did, however, see evidence that improved access to acute treatment services is effective at reducing cold-induced mortality. Their study is available online and in the November edition of the Journal of Public Economics.

“We see unequal impacts of all sorts of environmental damages,” Mullins says. “It is critical that we understand the channels through which such inequities arise. In particular, it often appears that more affluent individuals and populations fair better in the face of damaging – or potentially damaging – environmental phenomena, but money doesn’t provide such protection directly, so what is it? We care about this, because we’d like to help those that are most negatively impacted through their exposures to various environmental factors, both now and in the future.

“What we show in this study is that better access to health care is associated with less health damages from high temperature events. Importantly, though, we demonstrate more than just this association, since better access to health care is correlated with all sorts of other things including general levels of affluence. We also identify a causal relationship between increases in access to health care – and primary care services in particular – and reduced health damages from high temperatures.”

To effectively design optimal public health policy, the authors stress that the health care access that is improved must address the types of ailments triggered by the environmental shock of interest. This is crucial when considering both current inequities in environmental health damages and climate change adaptation, as it suggests that expanding health care access will be an effective approach to reducing the harmful effects of adverse environmental conditions only insofar as the mode of health care can be reasonably well-targeted.

“These findings have two major implications,” Mullins says. “First, they help explain why we observe some communities suffering greater reductions in health from the same environmental changes. Our results suggest this is at least partly due to differences in access to health care. Such variation in impacts of environmental exposures exists both within and across countries, and our results suggest that the variation in access to healthcare partially explains these differences.

“Second, when we think about the damages expected from a warming climate, harm to human health is often one of the major components of expected costs. Our study suggests that one way to reduce the expected damages from climate change is to improve access to health care, and in particular, primary care services.”

The complete study, “Can access to health care mitigate the effects of temperature on mortality?” is available online via ScienceDirect.