The MART, Chicago, IL. Image Courtesy of Vornado Realty Trust from Fitwel

Climate Change is a Public Health Crisis: Building a Healthier Future

By Sara Karerat and Grace Dickinson, Center for Active Design/Fitwel


Sarah Karerat and Grace Dickenson Center for Active Design at FitwellAbove: The MART, Chicago, IL. Image Courtesy of Vornado Realty Trust

Today’s headlines echo the stark reality of our world, marked by surging heat, rising sea level, and frequent natural disasters. The impacts extend beyond environmental degradation, creating a public health crisis, amplifying the risks associated with displacement, injuries, infectious diseases, stress and anxiety, and worsening of chronic conditions. In this article, we delve into climate change’s profound implications on health, focusing on extreme heat and flooding. We also present investments and interventions to counter these effects, emphasizing our shared duty as socially conscious professionals to mitigate climate change’s dire consequences for the environment and humanity.

We Need to Beat the Heat

When we consider the dangerous consequences of climate change, you might expect severe storms like news-making hurricanes to be the most fatal. However, heat is the leading weather-related cause of death in the United States. Summer brings sweltering heat to our communities, worsened by urban heat islands where heat-absorbing materials like concrete and asphalt amplify temperatures. Vulnerable groups, like children and the elderly, face heightened risks in these oppressively hot urban areas.

Other heat-related health consequences range from dehydration and sunburn to heat exhaustion and stroke. For anyone with a pre-existing cardiac or respiratory condition, impacts can be even more severe. The toll of extreme heat also greatly influences our mental health, spiking irritability and shifting our mood, dragging our attention and memory, and worsening sleep cycles. Societally, extreme heat has been linked to increased rates of emergency room visits for mental health-related conditions, and incidents of assault are shown to increase by 10 percent when high temperatures are in effect.1

Extreme heat’s repercussions are grave, but we can invest in simple, non-technological solutions to cool our neighborhoods and cities through smarter building and community design.

901 Market, San Francisco, CA - Photo courtesy of Hudson Pacific Properties
901 Market, San Francisco, CA. Photo courtesy of Hudson Pacific Properties

Nature Can Keep Us Cool

In addition to recreation, parks and open spaces help build social connections and mental health through our inherent human connection to nature. Parks, regardless of size, cool rising temperatures in addition to providing social benefits. Natural elements like grass, shrubs, and landscaping work as nature’s air conditioners, reducing local temperatures through a phenomenon known as the “Park Cool Island” or “Green Cool Island.”2 Essentially, hot air rises, creating a pressure difference that generates a cooling breeze radiating from the park. Studies reveal that parks can lower local temperatures by over 4 degrees Celsius (or approximately 8 degrees Fahrenheit).3

Even smaller-scale greening initiatives yield notable impact. Planting trees, installing rooftop gardens, and erecting green walls all contribute to cooling urban areas by shading structures and deflecting sunlight. Established street trees not only cool sidewalks but also alleviate the physical and mental impacts of heat on daily commuters. Ground-level landscaping with native plants can also reduce local temperatures by nearly 5 degrees Celsius (or approximately 9 degrees Fahrenheit) in a decade.4 Moreover, these interventions translate into substantial savings, with effective tree coverage around buildings potentially slashing air conditioning needs by 30 percent.5

Urban density worsens extreme heat, but smart construction choices can help. Developers can use heat-resistant materials to naturally cool buildings, cutting energy use and costs. Light-colored stone and concrete, known as albedo surfaces, reflect sunlight and reduce heat absorption. Sidewalks with design elements like colonnades or paneled structures improve walkability while keeping things cool. Even the simple act of painting concrete white, a cost-effective approach, can lower temperatures by 2-3 degrees Celsius.6

The key to addressing heat issues in existing and upcoming properties is evident: prioritize green infrastructure investments, including increased green spaces, landscaping, and strategic material choices to counteract rising temperatures. The total sum of these strategies can reduce operating costs, reduce heat-related emergency room visits, improve individual mental health, and support more meaningful community building.7

The MART, Chicago, IL.Image Courtesy of Vornado Realty Trust
The MART, Chicago, IL. Image Courtesy of Vornado Realty Trust

Water Risks

While heat may be the deadliest climate category, data released by the United Nations in 2015 show that in the past 20 years, floods have emerged as the silent giants, responsible for almost half of all weather-induced disasters.8 The evidence is unequivocal: our world is witnessing an alarming uptick in flood exposure, surpassing earlier estimates, with rising waters posing a profound threat to both our environment and humanity.9

Flooding can be catastrophic to our environment, where erosion and major flood events can lead to a vanishing of our land masses. For humans, the risk is equally dire. Beyond the immediate havoc wreaked upon buildings and infrastructure, flooding leaves an indelible mark on physical and mental health, and amplifies social disparities. Flooding also poses various health risks. Increased dampness can lead to indoor mold growth, causing respiratory issues. Floodwater carries pathogens and hazardous substances, potentially causing waterborne diseases, flu-like symptoms, and gastrointestinal illnesses.10 Flood victims also face a 1.5 times higher likelihood of serious mental illness compared to unaffected individuals, supported by multiple studies linking flooding to elevated levels of depression, anxiety, and post-traumatic stress disorder.11

The significant personal and environmental risks of flooding are further compounded by the substantial financial risks they pose. According to FEMA, even one inch of water can cause $25,000 in building damages, and at a larger scale, floods can reduce community employment by 4 percent.12 As a consequence of the reduced economic activity during recovery, evidence also suggests that disaster recovery assistance often declines, resulting in community financial losses of up to eight figures.13

Fighting Floods

While the threat of flooding may feel inevitable and daunting, there are multiple strategies that can make all of us, and our communities, more resilient against rising waters.

The most effective decision is to avoid flood-prone areas in the first place. A number of new online resources are available to gain a better understanding of flood risks for homes and businesses, from research sources such as Flood Factor to educational resources from FEMA. Locating these properties outside of flood-prone areas is the number one way to protect not only an asset, but also to avoid bodily harm. This is particularly pertinent as there will likely come a time when physical assets within flood zones will become uninsurable due to the billowing associated costs to insure. However, as flood prone areas expand, there will become an increasing number of buildings, businesses, and people who cannot relocate. Fortunately, there are also strategies that can help mitigate the worst of flooding’s harmful effects.

To minimize flood risk and damage to buildings, both structural and interior preparations are vital. Structural adaptation involves fortifying foundations and waterproofing cellar walls. Internally, using waterproof materials, sealing walls, and relocating utilities to higher floors are key strategies. Studies show that adapting building use and interiors can decrease damage by 46% and 53%,14 respectively. Smaller-scale measures include sewage water backup systems and maintenance of gutters and downspouts. On a larger scale, stormwater management infrastructure like retention ponds, rain barrels, rain gardens, and permeable pavements can mitigate flood risks by reducing on-site stormwater accumulation, while blue and green roofs help absorb excess water. These interventions aren’t without cost, but studies show that for every dollar invested in flood mitigation, seven dollars is potentially saved.15

Let’s Build a Better World

In conclusion, climate change poses an imminent and escalating threat to public health and the environment. The looming perils of extreme climate events demand swift action to safeguard our properties and quality of life. As our world shifts, with soaring temperatures and rising seas, we must transform our environments to safeguard health and our societal well-being. Shielding our assets and communities from the consequences of extreme climate is a crucial step towards resilience. Achieving this, demands resolute action and wise investments. Fortunately, there are proven, evidence-based strategies available to investors, property owners, and managers to prepare for this new reality. We have the knowledge; now, let’s act on it.

The intersection of climate change and health & well-being is at the core of the Fitwel® Certification Standard, the world’s leading healthy building certification system designed to drive value, mitigate risk, and put people at the center of real estate decision making. Learn more at 


Article by Sara Karerat and Grace Dickinson of the Center for Active Design/Fitwel.

 Sara Karerat is Managing Director at the Center for Active Design (CfAD), where she leads the organization’s translation of public health research into actionable solutions that optimize the built environment for health, both domestically and internationally. During her time with CfAD, Karerat has authored several publications on the intersection of health and the built environment, including Healthcare: A Cure for Housing and a series titled Research to Action: Building Health for All® in the Face of COVID-19. Previously, Karerat worked at the Partnership for a Healthier America, where she developed strategic campaigns to motivate healthy behavior change among target populations. Karerat holds a Master of Public Health from Columbia University with a certificate in Health Promotion Research and Practice and a Bachelor of Arts from Hamilton College, where she majored in Public Policy.  

Grace Dickinson is an Associate Director on the applied research team at the Center for Active Design (CfAD), Grace Dickinson supports the translation of public health research into solutions and strategies that optimize the built environment for health and well-being. Prior to her time at CfAD, she completed a dual degree program at Columbia University for a Master of Public Health, focused on population and family health, and a Master of Science in urban planning, centered on the built environment.


 [1] Tiihonen, J., et. al. (2017). The Association of Ambient Temperature and Violent Crime. Scientific Reports, 7.

 [2]  DeWeert, S., 2016. (2016). Parks provide islands of cool in urban areas. Daily Science.

 [3]  Aram, F., Garcia, E.H., Solgi, E. & Mansournia, S. (2019). Urban green space cooling effect in cities. Heliyon, 5.

 [4]  University of Waterloo. (2020). Planting native trees, greenery can cool off your backyard. Retrieved from:

 [5]  Trees for Cities. (2022). How Trees Keep Things Cool Retrieved from:

 [6] Pearce. F. (2018). Urban Heat: Can White Roofs Help Cure World’s Warming Cities. Yale Environment 360. Retrieved from:

 [7]  Aswani, K. The Benefits of Green Infrastructure Investments in Urban Planning. Retrieved from:

 [8]  UNISDR. (2015). The Human Cost of Weather-Related Disasters. Retrieved from:

 [9]  Tellman, B., et. al. (2021). Satellite imaging reveals increased proportion of population exposed to floods. Nature, 596.

 [10]  Quist, A.J.L., et. al. (2021). Hurricane flooding and acute gastrointestinal illness in North Carolina. Science of the Total Environment.

 [11]  Fernandez, A., et. al. (2015). Flooding and Mental Health: A Systematic Mapping Review. PLOS ONE, 10(4).

 [12]  Sarmiento, C. & Miller, T.R. (2008). Costs and Consequences of Flooding and the Impact of the National Flood Insurance Program. FEMA Evaluation of the National Flood Insurance Program. Retrieved from:

13  Ibid.

14  Kreibich, H., et. al. (2005). Flood loss reduction of private households due to building precautionary measures– lessons learned from the Elbe flood in August 2002. Natural Hazards and Earth System Sciences, 5.

15  FEMA. (2018). Natural Hazard Mitigation Saves: Interim Report. Retrieved from:

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