Climate Change and Health Equity

Drought Narrative

What is the climate change challenge?

Increasing temperatures and changes in precipitation already contribute to droughts in California and are expected to lead to longer, more severe droughts in the future.¹ A lack of rainfall over an extended period of time can lead to an undersupply of water in reservoirs, groundwater basins, and facilities that transport water from one place to another.¹

Increases in temperature can worsen the impacts of drought which include drier soil and vegetation, earlier snowmelt, and less snowpack.²⁻³ In California, the Sierra Nevada snowpack is an important source of water for urban, agricultural, and environmental uses in the state and is projected to decrease by half or more by the end of the century.¹,³ Earlier snowmelt and less snowpack can cause problems for government agencies that fight wildfires, ranchers and farmers, and rural residents relying on wells or small water systems that rely on water from snow melt.¹,³ Drier soil and vegetation increase the risk of dust storms, and dust is linked to coccidioidomycosis (Valley fever), a disease caused by breathing in a fungus that grows in the dirt and soil in parts of California.¹,⁴ Dry soil also increases the risk of flash floods because drought makes soil hard, compact, and less effective at absorbing rain.⁵

Lack of water can also compromise hydropower production, which can result in electricity shortages and increased electricity prices.⁶

The years 2021and 2022 had some of the driest months on record in California.⁷ More than 1,000 and 1,200 wells ran dry in 2021 and 2022, respectively.⁸,⁹ Across the Southwestern United States, a 21-year drought persisted from 2000 to 2021.¹⁰ Although it snowed enough in 2023 to end drought conditions in California, high snowfall years, such as 2023, are predicted to occur only once or twice per century, and their frequency is expected to further decrease over time.¹¹ The risk of drought in California is projected to increase in the future with the possibility of droughts lasting more than 10 to 20 years.³,¹²

Why is this climate change impact important to health?

The public health impacts of drought are numerous and can include:

Reduction in the quality and quantity of drinking water and irrigation water for growing food.²
Reduction in air quality due to wildfires, dry soil, and dry vegetation which add fine particulates to the air.²
Increased risk of exposure to water contaminated by pollutants, bacteria, or harmful algal blooms during recreational activities.²
Increased incidence of disease and illness that can spread when people try to conserve water by reducing water use for personal hygiene, cleaning, or washing produce.²,¹³
Possible increased incidence of coccidioidomycosis (Valley fever).¹⁴⁻¹⁶ There is some scientific evidence that cases of Valley fever increase after multi-year droughts are followed by winter rain.¹⁴⁻¹⁶ This may be because while growth of the fungus that causes Valley fever is limited without rain, fungal spores that remain after the drought may grow more intensely after a rainy winter season because there are fewer competitors in the soil.¹⁴⁻¹⁶ Also, rodent populations, whose bodies may contain spores of the fungus that cause Valley fever, may increase after a rainy season.¹⁷ After rodent’s death, the spores turn into filaments of the fungus which feed on the rodent’s keratin, promoting its growth.¹⁶⁻¹⁷

Infectious disease
Lowered water levels may also lead to stagnant water, which can act as a breeding ground for mosquitos; droughts can lead to more West Nile Virus cases.²,¹⁸ During droughts, rodents are more likely to seek water sources near humans and ticks are more likely to congregate in areas with moist vegetation, which can create opportunities for the spread of diseases between ticks, rodents, and humans such as Lyme Disease and Hantavirus.¹³ Farmers may use recycled water instead of fresh water for crop irrigation when there are water shortages which increases the risk of foodborne illness, such as gastrointestinal illness caused by Salmonella and E. coli.²

Food security and malnutrition
Drought can impact food access and nutrition by reducing water availability for crops and farm animals, which can shorten growing seasons and increase vulnerability of crops to insect infestation and plant diseases.²,¹⁹ A lack of water stresses farm animals, which can lead to higher rates of malnourishment, disease, and death among these animals.² These combined effects can decrease overall food supply and raise the costs of food.² Higher food prices can lead to food insecurity and malnutrition in households with low income.¹⁴,²⁰

Mental and behavioral health
Employees of industries that depend on rainfall such as farmworkers, among others, may experience financial stress or job loss and increasing costs which can put them at increased risk of mental and behavioral health impacts such as stress, anxiety, and depression.²,¹³⁻¹⁴,²¹⁻²² Drought is associated with higher rates of suicide among working-age male farmers living in rural areas.²² Increases in property crime due to increased stress and behavior changes have also been associated with drought.²³

From 2012-2016, a drought impacted the majority of California counties.²² Interviews of households in Tulare County revealed a range of negative impacts including negative impacts on their property (39.2 percent), finances (38.7 percent), health (10.1 percent), and peace of mind (33.1 percent).²² Drought has many physical and mental health impacts, which may vary in intensity based on the duration and severity of drought conditions.⁷

Who is most impacted?

Populations with the greatest risk of health impacts from drought, due to heightened risk or proximity to drought, lack of resources, or other circumstances shaped by the social determinants of health, may include:

People with lower incomes¹⁹,²³⁻²⁴
People of color²⁴
Tribes and other communities relying on fishing for food and cultural and spiritual traditions²⁴
Agricultural workers¹³
Those relying on domestic wells, small water suppliers, and groundwater for drinking water²⁵⁻²⁶
Those living in areas with critically over-drafted groundwater basins or with poor water quality²⁴
Hospitalized patients, nursing home residents, individuals who have special needs in the event of a public health emergency, and individuals who must rely on electrical equipment for survival (if drought results in water or electricity shortages)¹³⁻¹⁴
People who are pregnant, infants, and children²¹
Older adults²¹
Those with chronic medical conditions especially cardiovascular disease, respiratory conditions, and mental illness²¹,²⁴

How can communities build resilience to the climate impact?

Strategies that communities can use to build resilience to drought include, but are not limited to, the following:

Coordinate with water systems and providers to ensure accessible water supply for all residents. Coordination actions that can help ensure water is available to all residents include:

Consolidating small water systems with larger community water systems to expand available water sources and connect domestic wells to a community water system to ensure a reliable and sustained water supply.²⁷
Implementing equitable water-pricing practices, such as:

Providing tiered rate structures that keep essential water use affordable while applying higher rates to discretionary use.²⁸
Eliminating drought surcharges (additional fees that are intended to encourage residents to limit water use during drought conditions) for customers using water at basic-need levels.²⁸
Allowing flexible payment options (e.g., flexible due dates at regular intervals, or due date extensions).²⁸
Separating water, wastewater, and sewer bills so customers can continue receiving some services even if they cannot pay the full bill.²⁸
Eliminating fines to disconnect or reconnect services.²⁸

Implement water conservation techniques and assistance/incentives such as:

Using agricultural practices that reduce water use and accessing funding, grants, and technical assistance for agricultural water efficiency like those offered through California Department of Food and Agriculture’s State Water Efficiency & Enhancement Program.
Requiring new housing developments and public facilities to install on-site water recycling, dishwashers or washing machines that are energy-efficient, and toilets, showerheads, and faucets that conserve water such as those labeled as WaterSense products by the United States Environmental Protection Agency.²⁸⁻²⁹
Providing education, coupons, and direct installment opportunities for water conservation technology, especially for low-income residents.²⁸ Refer to Cal Water's Rebates and Conservation Programs as an example.
Providing education and incentives to individuals and businesses for graywater and rainwater harvesting and use, to reduce using potable water for landscape irrigation.²⁸
Implementing water conservation strategies at the community level such as:

Minimizing washing of community-owned vehicles.³⁰
Minimizing irrigation of community-owned parks, sports fields, and other public spaces like road medians and limiting it to specific hours during the coolest part of the day.³⁰⁻³¹
Providing incentives for converting sprinkler irrigation systems to drip irrigation systems and for replacing grass with native and drought tolerant landscaping.³²
Inspecting and repairing leaks in irrigation lines.³⁰⁻³¹
Covering community pools when not in use to reduce evaporation.³⁰⁻³¹

It is recommended that protective strategies are implemented in such a way that they are:

Inclusive of whole community considerations. This means that strategies are implemented with community involvement and include community representatives affiliated with local government and non-government agencies, community-based organizations serving residents who are most vulnerable to drought and who have been historically excluded from disaster and water management planning, and community advocates with lived experience.
Feasible, accommodating, economically accessible, available in multiple languages, and implemented in such a way that they reach the whole community, including households without internet or cable.
Designed to directly reduce health inequities faced by communities that have been marginalized or disadvantaged.
Designed to help reduce greenhouse gas emissions to prevent increasingly severe climate-related air quality and health impacts in the long run.