Climate change is expected to worsen many of the health care challenges Utahns living in rural communities already face.
Grand County is predicted to see 87 days per year of extreme heat by 2050, up 67% from its historical average. That means the Moab area — a remote region often packed with tourists — could see scorching temperatures for roughly one-quarter of the year.
Nearby Carbon County, on the other hand, isn’t used to seeing frequent hot days because it’s at a higher elevation. But by 2050, it could get roughly one month of extreme heat per year — more than four times its historical average.
Brady Bradford is the health officer with the Southeast Utah Health Department, which covers both counties. His team has posted signs and posters around Carbon County to promote awareness about heat illness and how to avoid it, he said, but they know that extreme heat just isn’t on most people’s radars there.
“Helping people understand the gravity of the situation, particularly moving forward as it gets worse … will be a challenge,” Bradford said. “Because it hasn't been a huge issue.”
When rural communities are so spread out, he said, it makes it that much more difficult for health officials to get their message to people.
And that’s on top of the physical distance and lack of community transit that can often be a barrier for people in rural communities to actually get health care. In Emery County, the third county his department covers, someone experiencing heat illness might need to drive up to 45 miles to get to a hospital.
Chelsea Gridley-Smith, director of environmental health for the National Association of County and City Health Officials, said rural health departments across the country face many of the same challenges. Rural communities often have greater physical isolation, higher poverty rates and older populations than other parts of the country.
“These challenges are known to impact health,” Gridley-Smith said. “Climate change is poised to exacerbate those health impacts.”
The inequities facing rural Utah’s health landscape are especially magnified in the state’s tribal communities.
Heather Tanana is a researcher at the S.J. Quinney College of Law at the University of Utah who studies Indigenous health and environmental justice issues. She’s also a citizen of the Navajo Nation who was born in rural southeast Utah.
On a hot summer day, she said, people in the suburbs of Salt Lake City or St. George might head to a public pool or a park with a splash pad. Or maybe a library or shopping mall where people can find the relief of a public space with shade and cool air conditioning.
“The things that a normal American would do in the summer on a hot day,” Tanana said. “Those amenities are not there on … many tribal lands.”
Roughly one-third of Navajo homes still don’t have basic necessities like running water or electricity, she said. Roughly 14,000 homes on the Navajo Nation remain without power. That means those thousands of families can’t rely on the air conditioning systems that most Americans living in warm regions take for granted.
Solutions don’t seem easy to come by.
“We know this warming climate is going to exacerbate existing challenges, and it does absolutely have health-related impacts,” Tanana said. “So what are the resources that are available there to help deal with these? Well, not much.”
The Indian Health Service that provides care to tribal members gets the least amount of government funding per capita of any major federal health program — roughly $4,000 per person. That’s about half of the per capita government funding for Medicaid and less than one-third of the per capita funding for Medicare.
That chronic underfunding has driven a host of poor health outcomes, such as diabetes, which can put someone at high risk for heat illness.
Recent federal investments in the Bipartisan Infrastructure Deal and the Inflation Reduction Act, she said, could indirectly help — funding more access to clean water and better roads, for example. But she doesn’t think those laws do enough to directly address and mitigate the coming health impacts of climate change in rural areas and tribal lands.
And with the state of health in many tribal areas already struggling, solving these issues wouldn’t be a quick fix even with a bunch of new funding.
“It's going to take a long time,” Tanana said. “Let's make sure homes have electricity, make sure that we have shaded spaces [and] access to water.”
So aside from gaining more funding, what can rural health systems do to protect their communities from the health impacts of climate change?
For most rural health departments, Gridley-Smith with the NACCHO said, the best first step could be putting resources toward community education that focuses on communicating the health effects of climate change in a way that makes it relevant to residents’ everyday lives.
If it’s a community with a high potential for flash flooding, focus on that. If the community has a large share of people with health conditions that make them vulnerable to heat or live in homes without air conditioning, talk about heat waves.
“The more specific the communication, the more impactful it will be,” Gridley-Smith said.
But in rural areas, even getting that message out can be a challenge. The Southeast Utah Health Department spreads its communication across social media and traditional outlets like local newspapers and radio, Bradford said, but they know they aren’t reaching everyone.
Even if they are able to reach people, many people in very remote places like Emery County take pride in being self-sufficient. So there can be a stigma around seeking help.
“Emery County, to its credit, is very independent,” Bradford said. “but that sometimes can lead to not asking for help when you need it.”
Some of the challenges in Grand County stem from the region’s transformation into a tourism hot spot. On summer days, local services often have their hands full treating out-of-town visitors. And with housing so expensive, Bradford said, the town has a large transient population living in vans or tents. That could make them vulnerable to heat illness if they can’t find a place to cool off.
“It's something that is kind of constantly in the back of our minds,” Bradford said.
Fortunately, he said, Moab does have a cooling center in town. Most other rural Utah communities aren’t so lucky.
With southern Utah’s limited water supply, it might not be an option for towns to create lush parks with lots of shade. But, he said, any public green space can help give people a place to cool down at least a few degrees.
“Cities really need to focus on that,” Bradford said. “Making sure that we as communities are willing to say, ‘This is important enough to us that we will establish something like a cooling center, and we will make water accessible throughout the city for people to get free so they can rehydrate.’”
As the climate across his three counties warms, Bradford could envision the health department reaching out individually each year to those who are at high risk for heat-related impacts, such as people who depend on electric medical equipment like oxygen tanks or people who don’t have an air conditioner.
But like many rural health departments, his team wouldn’t have enough staff to take on a project like that. So it would require growing the department’s group of volunteers.
In tribal communities, Tanana said, it’s vital that any solutions that come from government funding or elsewhere need to allow tribes to take the lead on saying what their communities need.
One example she pointed to is the Navajo Water Project by DigDeep, a California-based organization that partners with tribal leaders to install underground water tanks and solar panels to bring running water and electricity to individual homes for the first time.
In the meantime, she said, some short-term steps could be continuing with community education and making sure residents have a plan for what to do if temperatures get above a certain point. Having bottled water on hand to pass out. Building more community spaces that offer shade and AC.
With this year’s record snowpack and extended spring weather in much of Utah, it might feel easy to forget about or question how climate change is turning up the heat. But, Tanana said, that short-term relief doesn’t change how essential the work of improving rural health care is.
“There's no denying that as we move forward, on average, it's getting warmer,” Tanana said. “We have to prepare for it.”
