Semin Speech Lang 2024; 45(01): 046-055
DOI: 10.1055/s-0043-1777858
Review Article

The Intersectionality of Climate Change and Post-Stroke Aphasia

1   Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia
Jacqueline S. Laures-Gore
2   Department of Communication Sciences and Disorders, Georgia State University, Atlanta, Georgia
Leticia M. Nogueira
3   Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
› Author Affiliations


Persons with communication disabilities including persons with post-stroke aphasia (PWAs) possess a vulnerability to climate change as a result of their communication impairments. The disproportionate effects of climate change are likely to exacerbate preexisting inequities in social determinants of health. Communication disability intersecting with other characteristics subject to discrimination (e.g., race, age, sex, income) may lead to inequities in climate-related adaptive capacity. This article echoes earlier concerns related to climate change and further educates healthcare professionals about the impact of climate change on the global human population, with particular consideration of PWAs. The aims of this article are the following: (1) to broaden the understanding of aphasiologists and clinicians caring for PWAs about climate change and the contributions of human activity (anthropogenic) to this crisis; (2) to describe climate change and its impact on health; (3) to detail the intersectionality of climate and health; (4) to explore climate change and its potential effects on PWAs; and (5) to offer hope through emissions reduction, adaptation, resilience, and immediate change.

Publication History

Article published online:
17 January 2024

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  • References

  • ACC. (2023). Aphasia Friendly Hurricane Disaster Kit. Aphasia Community Center. Accessed December 10, 2023 at:
  • Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., … Wender, R. C. (2020). Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA: a Cancer Journal for Clinicians, 70(1), 31–46
  • Annaswamy, T., Verduzco-Gutierrez, M., Frieden, L. (2020). Telemedicine barriers and challenges for persons with disabilities: COVID-19 and beyond. Disability and Health Journal, 13(4), 100973
  • Babadjouni, R. M., Hodis, D. M., Radwanski, R., Durazo, R., Patel, A., Liu, Q., & Mack, W. J. (2017). Clinical effects of air pollution on the central nervous system; a review. Journal of Clinical Neuroscience, 43, 16–24
  • Balbus, J. M., & Malina, C. (2009). Identifying vulnerable subpopulations for climate change health effects in the United States. Journal of Occupational and Environmental Medicine, 51(1), 33–37
  • Blair, I. V., Havranek, E. P., Price, D. W., Hanratty, R., Fairclough, D. L., Farley, T., Hirsh, H. K., & Steiner, J. F. (2013). Assessment of biases against Latinos and African Americans among primary care providers and community members. American Journal of Public Health, 103(1), 92–98
  • Bressler, R. D. (2021). The mortality cost of carbon. Nature Communications, 12(1), 4467
  • Bullard, R. D. (2001). Environmental justice in the 21st century: race still matters. Phylon, 49(3/4), 151–171
  • Charlson, F., Ali, S., Benmarhnia, T., Pearl, M., Massazza, A., Augustinavicius, J., & Scott, J. G. (2021). Climate change and mental health: a scoping review. International Journal of Environmental Research and Public Health, 18(9), 4486
  • Clayton, S. (2020). Climate anxiety: psychological responses to climate change. Journal of Anxiety Disorders, 74, 102263
  • Code, C. (2020). The implications of public awareness and knowledge of aphasia around the world. Annals of Indian Academy of Neurology, 23(Suppl 2), S95–S101
  • Code, C., Mackie, N. S., Armstrong, E., Stiegler, L., Armstrong, J., Bushby, E., Carew-Price, P., Curtis, H., Haynes, P., McLeod, E., Muhleisen, V., Neate, J., Nikolas, A., olfe, D., Rubly, C., Simpson, R., & Webber, A. (2001). The public awareness of aphasia: an international survey. International Journal of Language & Communication Disorders, 36(Suppl), 1–6
  • Code, C., Papathanasiou, I., Rubio-Bruno, S., Cabana, Mde. L., Villanueva, M. M., Haaland-Johansen, L., Prizl-Jakovac, T., Leko, A., Zemva, N., Patterson, R., Berry, R., Rochon, E., Leonard, C., & Robert, A. (2016). International patterns of the public awareness of aphasia. International Journal of Language & Communication Disorders, 51(3), 276–284
  • Cohen, J., Agel, L., Barlow, M., Garfinkel, C. I., & White, I. (2021). Linking Arctic variability and change with extreme winter weather in the United States. Science, 373(6559), 1116–1121
  • Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., & Inui, T. S. (2012). The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health, 102(5), 979–987
  • Cruz-Flores, S., Rabinstein, A., Biller, J., Elkind, M. S. V., Griffith, P., Gorelick, P. B., Howard, G., Leira, E. C., Morgenstern, L. B., Ovbiagele, B., Peterson, E., Rosamond, W., Trimble, B., Valderrama, A. L., & the American Heart Association Stroke Council, & the Council on Cardiovascular Nursing, & the Council on Epidemiology and Prevention, & the Council on Quality of Care and Outcomes Research. (2011). Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(7), 2091–2116
  • Cuffey, K. M., & Marshall, S. J. (2000). Substantial contribution to sea-level rise during the last interglacial from the Greenland ice sheet. Nature, 404(6778), 591–594
  • Ebi, K. L., Balbus, J. M., Luber, G., Bole, A., Crimmins, A., Glass, G., Saha, S., Shimamoto, M. M., Trtanj, J., & White-Newsome, J. L. (Eds.). (2018). Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment (Vol. II). U.S. Global Change Research Program. Accessed December 10, 2023 at:
  • Edwards, P. N. (2011). History of climate modeling. WIREs Climate Change, 2(1), 128–139
  • El-Saed, A., Kuller, L. H., Newman, A. B., Lopez, O., Costantino, J., McTigue, K., Cushman, M., & Kronmal, R. (2006). Geographic variations in stroke incidence and mortality among older populations in four US communities. Stroke, 37(8), 1975–1979
  • Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., Abbasifard, M., Abbasi-Kangevari, M., Abd-Allah, F., Abedi, V., Abualhasan, A., Abu-Rmeileh, N. M. E., Abushouk, A. I., Adebayo, O. M., Agarwal, G., Agasthi, P., Ahinkorah, B. O., Ahmad, S., Ahmadi, S., . . . Murray, C. J. L., & the GBD 2019 Stroke Collaborators. (2021). Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurology, 20(10), 795–820
  • Fouillet, A., Rey, G., Laurent, F., Pavillon, G., Bellec, S., Guihenneuc-Jouyaux, C., Clavel, J., Jougla, E., & Hémon, D. (2006). Excess mortality related to the August 2003 heat wave in France. International Archives of Occupational and Environmental Health, 80(1), 16–24
  • Gangopadhyaya, A. (2021). Black patients are more likely than white patients to be in hospitals with worse patient safety conditions. Accessed December 10, 2023 at:
  • Gaskin, C. J., Taylor, D., Kinnear, S., Mann, J., Hillman, W., & Moran, M. (2017). Factors associated with the climate change vulnerability and the adaptive capacity of people with disability: a systematic review. Weather, Climate, and Society, 9(4), 801–814
  • GML. (2023). Carbon cycle greenhouse gases. Accessed June 14, 2023 at:
  • Grineski, S. E., Collins, T. W., & Chakraborty, J. (2022). Cascading disasters and mental health inequities: Winter Storm Uri, COVID-19 and post-traumatic stress in Texas. Social Science & Medicine, 315, 115523
  • Grönberg, A., Henriksson, I., Stenman, M., & Lindgren, A. G. (2022). Incidence of aphasia in ischemic stroke. Neuroepidemiology, 56(3), 174–182
  • Hansen, J., Sato, M., Ruedy, R., Lo, K., Lea, D. W., & Medina-Elizade, M. (2006). Global temperature change. Proc. Natl. Acad. Sci. USA, 103(39), 14288–14293
  • Hinckley, J. J. (1998). Investigating the predictors of lifestyle satisfaction among younger adults with chronic aphasia. Aphasiology, 12(7), 509–518
  • Hinckley, J. J. (2002). Vocational and social outcomes of adults with chronic aphasia. Journal of Communication Disorders, 35(6), 543–560
  • Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc. Natl. Acad. Sci. USA, 113(16), 4296–4301
  • IPCC. (2022). Sixth Assessment Report of the Intergovernmental Panel on Climate Change. C. U. Press
  • Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008). Counting what counts: a framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258–280
  • Kleindorfer, D. O., Khoury, J., Moomaw, C. J., Alwell, K., Woo, D., Flaherty, M. L., Khatri, P., Adeoye, O., Ferioli, S., Broderick, J. P., & Kissela, B. M. (2010). Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke, 41(7), 1326–1331
  • Knowlton, K., Rotkin-Ellman, M., King, G., Margolis, H. G., Smith, D., Solomon, G., Trent, R., & English, P. (2009). The 2006 California heat wave: Impacts on hospitalizations and emergency department visits. Environmental Health Perspectives, 117(1), 61–67
  • Kulp, S. A., & Strauss, B. H. (2019). New elevation data triple estimates of global vulnerability to sea-level rise and coastal flooding. Nature Communications, 10(1), 4844
  • Lisiecki, L. E., & Raymo, M. E. (2005). A Pliocene-Pleistocene stack of 57 globally distributed benthic δ18O records. Paleoceanography, 20(1). Doi: 10.1029/2004PA001071
  • López, N., & Gadsden, V. L. (2016). Health inequities, social determinants, and intersectionality [Discussion Paper]. NAM Perspectives. Doi: 10.31478/201612a
  • Lynch, E. E., Malcoe, L. H., Laurent, S. E., Richardson, J., Mitchell, B. C., & Meier, H. C. S. (2021). The legacy of structural racism: associations between historic redlining, current mortgage lending, and health. SSM - Population Health, 14, 100793
  • Marshall, M. (2023). Libya floods: how climate change intensified the death and devastation. Nature, 621, 452–453
  • Members, E. C., Barbante, C., Barnola, J. M., Becagli, S., Beer, J., Bigler, M., Boutron, C., Blunier, T., Castellano, E., Cattani, O., Chappellaz, J., Dahl-Jensen, D., Debret, M., Delmonte, B., Dick, D., Falourd, S., Faria, S., Federer, U., Fischer, H., . . . Wolff, E., & the EPICA Community Members. (2006). One-to-one coupling of glacial climate variability in Greenland and Antarctica. Nature, 444(7116), 195–198
  • Miller, R. L., Schmidt, G. A., Nazarenko, L. S., Bauer, S. E., Kelley, M., Ruedy, R., Russell, G. L., Ackerman, A. S., Aleinov, I., Bauer, M., Bleck, R., Canuto, V., Cesana, G., Cheng, Y., Clune, T. L., Cook, B. I., Cruz, C. A., Del Genio, A. D., Elsaesser, G. S., . . . Yao, M.-S. (2021). CMIP6 historical simulations (1850–2014) with GISS-E2.1. Journal of Advances in Modeling Earth Systems, 13(1), e2019MS002034
  • Mochari-Greenberger, H., & Mosca, L. (2015). Differential outcomes by race and ethnicity in patients with coronary heart disease: a contemporary review. Current Cardiovascular Risk Reports, 9(5), 20 Advance online publication. Doi: 10.1007/s12170-015-0447-4
  • Mörchen, M., Ocasiones, E., Relator, R., & Lewis, D. (2021). Climate change, vulnerability, and disability: Do we “Leave no one behind”? Disaster Medicine and Public Health Preparedness, 15(5), 537–538
  • Nelson, A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666–668
  • Nicholls, R. J., & Cazenave, A. (2010). Sea-level rise and its impact on coastal zones. Science, 328(5985), 1517–1520
  • Nogueira, L. M., Yabroff, K. R., & Bernstein, A. (2020). Climate change and cancer. CA: a Cancer Journal for Clinicians, 70(4), 239–244
  • O'Brien, A. J., & Elders, A. (2022). Climate anxiety. when it's good to be worried. Journal of Psychiatric and Mental Health Nursing, 29(3), 387–389
  • Osman, M. B., Tierney, J. E., Zhu, J., Tardif, R., Hakim, G. J., King, J., & Poulsen, C. J. (2021). Globally resolved surface temperatures since the Last Glacial Maximum. Nature, 599(7884), 239–244
  • Parr, S., Byng, S., Gilpin, S., & Ireland, C. (1997). Talking about Aphasia: Living with Loss of Language After Stroke. Open University Press
  • Puumala, S. E., Burgess, K. M., Kharbanda, A. B., Zook, H. G., Castille, D. M., Pickner, W. J., & Payne, N. R. (2016). The role of bias by emergency department providers in care for American Indian children. Medical Care, 54(6), 562–569
  • Schlosberg, D. (2012). Climate justice and capabilities: a framework for adaptation policy. Ethics & International Affairs, 26(4), 445–461
  • Sherratt, S. (2021). What are the implications of climate change for speech and language therapists? International Journal of Language & Communication Disorders, 56(1), 215–227
  • Sherratt, S. (2022). Communication and swallowing disorders: the effects of climate change. Perspectives of the ASHA Special Interest Groups, 7(1), 245–258
  • Shultz, J. M., Kossin, J. P., Ettman, C., Kinney, P. L., & Galea, S. (2018). The 2017 perfect storm season, climate change, and environmental injustice. The Lancet. Planetary Health, 2(9), e370–e371
  • Silveira, S., Kornbluh, M., Withers, M. C., Grennan, G., Ramanathan, V., & Mishra, J. (2021). Chronic mental health sequelae of climate change extremes: a case study of the deadliest Californian wildfire. International Journal of Environmental Research and Public Health, 18(4), 1487. Advance online publication. Doi: 10.3390/ijerph18041487
  • Simmons-Mackie, N., Code, C., Armstrong, E., Stiegler, L., & Elman, R. J. (2002). What is aphasia? Results of an international survey. Aphasiology, 16(8), 837–848
  • Smith, D. L., & Notaro, S. J. (2015). Is emergency preparedness a ‘disaster’ for people with disabilities in the US? Results from the 2006–2012 Behavioral Risk Factor Surveillance System (BRFSS). Disability & Society, 30(3), 401–418
  • Soutar, C., & Wand, A. P. F. (2022). Understanding the spectrum of anxiety responses to climate change: a systematic review of the qualitative literature. International Journal of Environmental Research and Public Health, 19(2), 990
  • Stein, P. J. S., & Stein, M. A. (2022). Disability, human rights, and climate justice. Human Rights Quarterly, 44(1). Advance online publication. Doi: 10.1353/hrq.2022.0003
  • Taylor, N. A. (2014). Human heat adaptation. Comprehensive Physiology, 4(1), 325–365
  • Tziperman, E. (2022). Global Warming Science: A Quantitative Introduction to Climate Change and Its Consequences. Princeton University Press. Accessed December 10, 2023 at:
  • van Vuuren, D. P., Edmonds, J., Kainuma, M., Riahi, K., Thomson, A., Hibbard, K., Hurtt, G. C., Kram, T., Krey, V., Lamarque, J.-F., Masui, T., Meinshausen, M., Nakicenovic, N., Smith, S. J., & Rose, S. K. (2011). The representative concentration pathways: An overview. Climatic Change, 109(1), 5
  • Washington, W. M., Buja, L., & Craig, A. (2009). The computational future for climate and Earth system models: On the path to petaflop and beyond. Philosophical Transactions - Royal Society. Mathematical, Physical, and Engineering Sciences, 367, 833–846
  • WHO. (2011). World Report on Disability 2011
  • World Bank. (2023). World Development Indicators. World Bank. Accessed December 10, 2023 at:
  • Woychik, R. P., Bianchi, D. W., Gibbons, G. H., Glass, R. I., Gordon, J. A., Pérez-Stable, E. J., & Zenk, S. N. (2022). The NIH Climate Change and Health Initiative and Strategic Framework: addressing the threat of climate change to health. Lancet, 400(10366), 1831–1833