Outlook: Newsletter of the Society of Behavorial Medicine

Summer 2022

A Call to Action: Compounded Vulnerability of Energy Insecurity, Socioeconomic Disadvantage, and Health in Climate Change

Lakeshia Cousin, PhD, APRN; Patricia Rodriguez Espinosa, PhD, MPH; Megan Shen, PhD; and Tiffany L. Carson, PhD, MPH; Health Equity SIG

Climate change is currently recognized as the greatest global health threat of the 21st century, with key implications for health equity.1 Low-income communities are often exposed to the threats of energy insecurities, environmental hazards, a higher burden of preexisting health conditions, and are least likely to have resources to address the compounding vulnerabilities that are worsened by climate change.

Energy insecurity, the inability to meet household energy needs, is increasingly becoming a source of hardship for millions around the world.2 It has dire physical, behavioral, and economic consequences.3 Yet, most research on energy-associated economic factors and policy efforts has lacked a structured approach and has not examined the compounded energy, socioeconomic, and health inequities.2 Researchers need to systematically investigate climate injustices using frameworks from health equity research (i.e., examining social inequities and vulnerabilities and understanding how to distribute and provide equitable energy to low-income, marginalized, and underserved households) and develop interventions to achieve equity. We offer key research topics associated with climate change and health equity based on the energy insecurity framework3 (see Figure 1) to raise awareness of a critical planetary health threat that merits attention in behavioral medicine research:

Figure 1. Domains from the Energy Insecurity Framework

1. Promotion of Energy Efficiency for Energy Justice

Energy insecurity disproportionately affects low-income and racial/ethnic minority households due to the history of structural racism that neglected their socioeconomic opportunities for wealth accumulation, and safe and energy-efficient housing.4 For generations, African Americans have lived in inadequate housing structures and deteriorated energy infrastructure that resulted in adverse outcomes including 1) energy burden and shut-offs, 2) extreme weather and climate impacts, 3) gentrification and displacement and 4) health inequities. Research is needed to understand the multigenerational health impacts from the disproportionate energy burden that affects low-income individuals. In turn, this can help to improve health and social outcomes while also promoting energy efficient programs such as weatherization to enhance energy efficiency and reduce costs.

2. Explore Housing Energy Pathways to Stress

Although there is evidence regarding the link between living in poverty and chronic stress among low-income populations, qualitative and quantitative data are needed to understand the associations between housing and energy-related issues and stress. Specifically, what are some of the energy-related pathways to stress that lead to negative health outcomes observed in populations at a socioeconomic disadvantage? A recent study in a South Bronx neighborhood in New York City examined associations between housing and energy-related issues and stress and found energy insecurity to be an important contributor to chronic stress in low-income households.5 Additional pathways to stress that can be examined in future research could include chronic diseases, economic hardship, and health issues.

This unequivocal call for evidence for action and a research agenda for climate solutions related to behavioral health can likely add momentum to move climate change policies faster.

Additional Resources on Climate Change and Health Equity

For more information, please visit the Intergovernmental Panel on Climate Change (IPCC) Six Assessment Report: Climate Change 2022: Impacts, Adaptation and Vulnerability at https://www.ipcc.ch/report/ar6/wg2/.



  1. Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet. 2021;398(10311):1619-1662.
  2. Jessel S, Sawyer S, Hernández D. Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature. Front Public Health. 2019;7:357.
  3. Hernández D. Understanding 'energy insecurity' and why it matters to health. Soc Sci Med. 2016;167:1-10.
  4. Lewis J, Hernández D, Geronimus AT. Energy Efficiency as Energy Justice: Addressing Racial Inequities through Investments in People and Places. Energy Effic. 2019;13(3):419-432.
  5. Hernández D, Phillips D, Siegel EL. Exploring the Housing and Household Energy Pathways to Stress: A Mixed Methods Study. Int J Environ Res Public Health. 2016;13(9):916.