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New report: As climate change worsens, so does the physical and mental health of people in the Portland metro region

A climate health report released today by Washington, Multnomah and Clackamas counties is the third in a series of Regional Climate and Health Monitoring Reports that document the health impacts of extreme weather and poor air quality.
Media release

A climate health report released today by Washington, Multnomah and Clackamas counties is the third in a series of Regional Climate and Health Monitoring Reports that document the health impacts of extreme weather and poor air quality.

The report adds two years of new data (2021-2022) to the last report, which documented health impacts of climate change through the end of 2020.

Some of the key takeaways in the new report include:

  • During summer 2021, when the region experienced a record-setting heat dome event, 94 people died, compared to a typical summer when the region would see only one heat-related death.
  • Emergency department (ED) visits for heat-related illness during summer 2021 more than doubled compared to the average number of visits from 2016-2019. That trend continued in 2022 when there were 40% more visits than in past years.
  • Since 2014, 236 people in the region have lost their lives due to extreme weather events. Most people died due to extreme heat, but 84 of those people died because of exposure to extreme cold, which is also a growing concern.
  • More people visit the emergency room for air quality-related illness (including pollen allergies) than for any of the other health conditions included in the report.
  • To assess mental health impacts of climate change, researchers interviewed emergency and community responders who were working during the wildfires of 2020 and the heat dome of 2021. The most prominent theme identified during these interviews was a lack of mental health providers and services. Responders said that extreme weather events compounded trauma from the COVID-19 pandemic, historic inequities and systemic racism.

Climate change and health equity

“This report documents the uneven health impacts of climate change on the region’s most vulnerable residents,” said Kathleen Johnson, senior environmental health coordinator in Washington County who co-authored the report with colleagues from Multnomah and Clackamas counties.

Johnson says health impacts are more severe among older adults, children, people experiencing houselessness, communities of color, communities that are geographically isolated without access to backup water and power systems, people who work outdoors, and those who lack access to emergency communications systems.

During heat waves, many of these communities are less likely to have air conditioning and access to resources to stay cool. In 2016, the tri-county region saw 13 days over 90 degrees. By 2022, that number had more than doubled, with 29 days over 90 degrees.

"As average temperatures continue to increase, we know our most vulnerable residents will bear the burden of the health effects related to climate change,” said Dr. Sarah Present, Clackamas County health officer. "Each of us can play a part in minimizing these impacts by cutting back on our use of fossil fuels and getting involved locally to help advocate for continued change.”

"This report calls on policymakers, government, health systems, and community groups to remain vigilant to protect health through climate resilience,” said Brendon Haggerty, Healthy Homes and Communities supervisor for Multnomah County. “The report also emphasizes that the communities most impacted by climate change should guide the planning and response effort.

Mental health impacts

Something else that is new in this report are interviews with emergency first responders, mental health and disability service providers, and representatives from community-based organizations to assess mental health impacts of the 2021 heat dome and 2020 wildfires.

The most common theme during these interviews was a lack of access to mental health providers and services, which compounded trauma from previous events.

“Before these weather events, we were already having challenges with access to mental health services due to the pandemic,” said Rich Roell, program director of the Washington County Crisis Team, operated by Lifeworks NW. “Vulnerable people then also had to postpone getting the mental health help they needed to find air conditioning, cooling spaces and a way to escape from wildfire smoke.”

Responders also mentioned a lack of information in languages other than English.

“The vast majority of information comes out in English first and then it comes out in Spanish next and then it rarely even comes out in other indigenous languages... it creates fear and distrust in communities because they have to wait several days for information, and they know something important came out, but they don't know what it is.” – CBO representative

Interviewees made several recommendations including creating new ways to reach out to vulnerable residents before and during weather-related emergencies.

“We need to go to people that don't have the ability to reach out and ask for help...because they don't know how to ask for help, or that there is help to ask for.” – Emergency responder


The first Regional Climate and Health Monitoring Report was issued in 2019 with baseline health indicators that are most likely to be affected by climate change.

Researchers gathered data going back to 2012 to determine if worsening weather patterns and poor air quality correlated with changes in the health indicators.

There are 11 indicators in this report including ED visits and hospitalizations related to extreme weather; ED visits for respiratory illness and allergies related to poor air quality; the number of insect-related illness like West Nile virus and Lyme disease; and rates of communicable diseases that are more likely to spread during warmer conditions.

While this report includes only qualitative data (i.e., interviews) to measure changes in mental health, the researchers are looking for an appropriate quantitative measure for mental health impacts to include in future reports.

Find the 2023 report on Washington County’s website.

Media Contacts:
Wendy Gordon, Washington County
[email protected]

Sarah Dean, Multnomah County
[email protected]

Bryan Hockaday, Clackamas County
[email protected]