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www.thelancet.com Vol 397 May 8, 2021 1693 Climate change affects human health and wellbeing with differential impacts on populations and regions. For example, climate change disproportionally affects girls and women and can amplify conflict and violence in resource-deprived environments. The way climate change exacerbates economic and social disparities underscores the role of migration in response to climate pressures. Movement or staying in place, whether forced or voluntary, have important immediate and downstream implications for the growing numbers of people affected. Although the mechanisms through which climate impacts human health are becoming better understood, substantial knowledge gaps remain. One such gap is the role of shelter. Housing and shelter are pivotal in considering the physical and mental health impacts of climate change for individuals without shelter or who live in temporary and unfit housing. For homeless and marginally housed people, the risks related to climate change fall in two domains. First, marginally housed individuals are at risk of becoming homeless due to climate-change-related factors, including rising sea levels, extreme weather events, and economic strain due to energy, water, and food insecurity. Second, individuals who do not have shelter are exposed to an array of climate-related risks, including air pollution, extreme heat and cold, and foodborne, waterborne, and vectorborne diseases. The risks related to exposures are compounded by the compromised health of homeless populations, their inadequate access to health and social care services, and their limited inclusion in climate risk mitigation and disaster response strategies. By contrast with a much larger literature on climate-driven migration, the literature that addresses how shelter influences health outcomes is minimal, with the least information available for the places most affected by climate change. A system dynamics approach can help to understand better the many interacting socioeconomic, cultural, The climate change–homelessness nexus 12 Dubay L, Aarons J, Brown KS, Kenney GM. How risk of exposure to the coronavirus at work varies by race and ethnicity and how to protect the health and well-being of workers and their families. The Urban Institute. December, 2020. https://www.urban.org/sites/default/files/publication/ 103278/how-risk-of-exposure-to-the-coronavirus-at-work-varies.pdf (accessed April 10, 2021). 13 Chen Y-H, Glymour M, Riley A, et al. Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through October 2020. medRxiv 2021; published online Jan 22. https://doi.org/10.1101/ 2021.01.21.21250266 (preprint). 14 Cohen P. Recession with a difference: women face special burden. The New York Times, Nov 17, 2020. 15 Artiga S, Rae M, Pham O, Hamel L, Muñana C. COVID-19 risks and impacts among health care workers by race/ethnicity. Kaiser Family Foundation. Nov 11, 2020. https://www.kff.org/racial-equity-and-health-policy/issuebrief/covid-19-risks-impacts-health-care-workers-race-ethnicity/ (accessed April 16, 2021). 16 Hughes MM, Groenewold MR, Lessem SE, et al. Update: characteristics of health care personnel with COVID-19—United States, February 12–July 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1364–68. 17 Batalova J. Immigrant health-care workers in the United States. Migration Policy Institute. May 14, 2020. https://www.migrationpolicy.org/article/ immigrant-health-care-workers-united-states-2018 (accessed April 10, 2021). 18 Witters D. 50% in U.S. fear bankruptcy due to major health event. Gallup. Sept 1, 2020. https://news.gallup.com/poll/317948/fear-bankruptcy-duemajor-health-event.aspx (accessed April 10, 2021). 19 Dawes DE. The political determinants of health. Baltimore, MD: Johns Hopkins University Press, 2020. 20 Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prognosis of health care in the USA. Lancet 2020; 395: 524–33. 21 Arno P, Caper P. Medicare for all: the social transformation of US health care. Health Aff Blog, March 25, 2020. https://www.healthaffairs.org/ do/10.1377/hblog20200319.920962/full/ (accessed April 10, 2021). 22 Bidadanure JU. The political theory of universal basic income. Ann Rev Pol Sci 2019; 22: 481–501. 23 Neate R. Billionaires’ wealth rises to $10.2 trillion amid Covid crisis: super-rich increase fortunes by more than a quarter during market turmoil. The Guardian, Oct 7, 2020. 24 Alesino A, Glaeser EL. Why are welfare states in the US and Europe so different? Horizons Stratégiques 2006; 2: 51–61. 25 O’Brien F, Schneeweis Z. U.S. ranked worst for workers’ rights among major economies. Bloomberg, June 18, 2020. https://www.bloomberg.com/news articles/2020-06-18/u-s-ranked-worst-for-workers-rights-among-majoreconomies (accessed April 10, 2021). 26 Gonsalves G, Kapczynski A. The politics of care. Boston Rev, April 27, 2020. http://bostonreview.net/politics/gregg-gonsalves-amy-kapczynski-newpolitics-care (accessed April 10, 2021).