Comment Justice should be at the centre of assessments of climate change impacts on health Several reports, such as the Lancet Countdown on health heatwave showed a 1·5:1 mortality ratio for Black and climate change,1,2 analyse and quantify the impacts residents compared with White residents, partly due to of a changing climate on human health, bring attention deteriorated public spaces in neighbourhoods with a to the compounding effects of climate stressors on majority of Black residents.5 Nowadays, similar trends health, and call for reducing the use of fossil fuels as are observed with public green spaces that could be an important mitigation measure with health co- heat refuges, of which there are not enough in most benefits. However, the health community should not low-income neighbourhoods and neighbourhoods with treat climate change as an equalising threat separate high numbers of migrants. This is an environmental and from the historical injustices that affect the differential health inequity that cities such as Barcelona or Paris are positions of people in relation to health risks at both trying to address with the creation of so-called climate global and local levels. There is too little attention given shelters.6 to the underpinning forms of exclusion and oppression Vulnerable residents are also affected by climate that drive unequal health impacts of climate change at gentrification, which has further negative effects local levels. Furthermore, vulnerability analyses are too on health.7 In Philadelphia, green, climate-resilient often restricted to physiological health determinants, infrastructure has been located in areas with wealthy, such as age, underlying health conditions, or place of White residents, displacing poor, racialised, and residence (eg, urban vs rural).1 Analyses of heat-related minority ethnic communities to less climate-protected risks in relation to physical activity, for example, do not neighbourhoods by use of land speculation and consider physical activity related to labour in domestic increased housing costs.8 Informal settlements, such as care, construction, or agricultural sectors, which mostly the favelas in Brazil, are sometimes directly displaced employ low-paid and undervalued workers who are as part of this so-called resilience building, and luxury racialised and minority ethnic, and usually only consider real estate is built in those same ecologically fragile and how heat might negatively affect people’s capacity to newly protected spaces. This process adversely affects work, and thus their incomes and the economy.1 the poorest and most marginalised residents via food, In Europe, undocumented migrant farm workers housing, and labour insecurities.9,10 face deportation risks and have little political voice We call for a better understanding of risk, vulnerability, while being exposed to labour exploitation, extreme and adaptation as deeply political questions. When weather, and other climate-related risks (eg, diseases referring to vulnerable populations in climate and from mosquitos).3 In India, migrants are exposed to health research, it is important to go beyond the idea of intersecting forms of environmental marginalisation uniform individuals whose only distinctive and relevant and climate injustice as they have no social networks, characteristics in relation to climate health risks are do not have their legal rights enforced, and often work their age or underlying health conditions, or whose in precarious jobs (eg, physically dangerous or at risk of vulnerability is fixed in space or time. Climate health being fired at any time) with restricted access to public assessments should consider and respond to multiple and financial services.4 Labour justice is also health injustices and their health implications. Historically justice and climate justice, but these connections remain marginalised and minoritised groups have contributed understudied. to climate change the least, are most exposed to its Underlying and intersectional vulnerabilities affect the impacts, have the worst access to interventions, and extent to which people benefit from climate-protective are the most likely to be displaced by poorly conceived interventions, an aspect that is also overlooked in climate-resilient infrastructure.7 many reports. Historically, low-income, racialised, Interdisciplinary research is crucial because climate and minority ethnic communities have little access to change is exacerbating existing health inequities, climate-resilient infrastructure. In 1995, the Chicago social inequality increases climate vulnerability, and www.thelancet.com/public-health Vol 8 January 2023 e11 Comment such vulnerabilities are intersectional and affected 3 Kotsila P, Kallis G. Biopolitics of public health and immigration in times of crisis: the malaria epidemic in Greece (2009–2014). Geoforum 2019; by historical processes, such as colonisation and its 106: 223–33. ongoing legacy. Issues of social and environmental 4 Chu E, Michael K. Recognition in urban climate justice: marginality and exclusion of migrants in Indian cities. Environ Urban 2019; 31: 139–56. justice and the environmental privileges at the centre 5 Klinenberg E. Heat wave: a social autopsy of disaster in Chicago. Chicago: of climate and health questions need to be urgently University of Chicago Press, 2015. 6 Amorim-Maia AT, Anguelovski I, Chu E, Connolly J. Intersectional climate addressed. justice: a conceptual pathway for bridging adaptation planning, We declare no competing interests. transformative action, and social equity. Urban Clim 2022; 41: 101053. 7 Anguelovski I, Connolly JJT, Pearsall H, et al. Opinion: why green ‘climate Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open gentrification’ threatens poor and vulnerable populations. Access article under the CC BY-NC-ND 4.0 license. Proc Natl Acad Science USA 2019; 116: 26139–43. 8 Shokry G, Connolly JJT, Anguelovski I. Understanding climate gentrification *Panagiota Kotsila, Isabelle Anguelovski and shifting landscapes of protection and vulnerability in green resilient panagiota.kotsila@uab.cat Philadelphia. Urban Clim 2020; 31: 100539. 9 Anguelovski I, Shi L, Chu E, et al. Equity impacts of urban land use planning Catalan Institution for Research and Advanced Studies, Barcelona, Spain (IA); for climate adaptation critical perspectives from the Global North and Institute of Environmental Science and Technology, Universitat Autònoma de South. J Plan Educ Res 2016; 36: 333–48. Barcelona, Barcelona, Spain (PK, IA) 10 Barbosa LM, Coates R. 2021. Resisting disaster chronopolitics: favelas and 1 van Daalen KR, Romanello M, Rocklöv J, et al. The 2022 Europe report of forced displacement in Rio de Janeiro, Brazil. Int J Disaster Risk Reduct 2021; the Lancet Countdown on health and climate change: towards a climate 63: 102447. resilient future. Lancet Public Health 2022; 7: e942–65 2 Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet 2022; 400: 1619–54. e12 www.thelancet.com/public-health Vol 8 January 2023