Sinking Shores, Rising Rents / Cheryl Holder, Jesse Keenan, Nicole Crooks

“As we enter into a time of climate change, one of the things we are realizing is these communities that have been systematically oppressed are now the spaces people with money want to be in because all around us is sinking” – Nicole Crooks

In this bonus episode of AMERICAN DIAGNOSIS, we’re going to look at how climate change is impacting the health of people… and their communities in South Florida. We’ll hear from a physician working to change the way her colleagues think about how climate impacts health, and we’ll talk to two people working to make sure that residents can keep their homes when developers start looking to higher ground as sea levels rise.

Nicole Crooks: As we are now entering into climate change the spaces that people with money wants to be in because all around us is sinking.

Dr. Cheryl Holder: That triggered the conversation for me. We need to reorient our conversations where we find out what’s going on more in our patient homes.

Jesse Keenan: So you can lobby against one project and you can stand up and try to, you know, protect a particular community, and I think rightfully so. But once you see a broader shift in consumer preferences, it becomes very difficult, I think, to forestall that.

Celine Gounder: Hi Everyone, Dr. Celine Gounder here. I’m the host of AMERICAN DIAGNOSIS. The podcast about health and social justice. 

Dr. Cheryl Holder is a physician in south Florida. One day, a patient of hers came in with a problem that — at first — didn’t seem like it had anything to do with her health. She couldn’t afford her electricity bill.

Dr. Cheryl Holder: Annie-Mae, I call her Annie-Mae. It was about 2016. She was one of my regular patients and she’s an older lady and she needed me to sign off on her Florida power light bill. 

Celine Gounder: In Florida, people on a fixed income can get a waiver from the state to help pay their electricity bill if there’s a medical reason. But Cheryl was surprised to hear this from Annie-Mae.

Dr. Cheryl Holder: She was not a person who would normally ask me for any waivers of any sort. I don’t know, back a lot of the old, um, Southern migrants to the South. They were all very proud people who worked all their whole lives. So for somebody like this to come in and ask me to try and find a way to have a government or program like this help her. It’s very unusual. 

Celine Gounder: But the reasons became more clear as Annie-Mae began to tell her story. 

Dr. Cheryl Holder: She was, couldn’t afford her air conditioning. And she had to use it. And it was a very hot summer. 

Celine Gounder: Not being able to cool your home in the summer can be dangerous — especially for those who have other health conditions, like Miss Annie-Mae. 

Dr. Cheryl Holder: She had asthma with overlapping COPD.

Celine Gounder: Chronic obstructive pulmonary disease, or COPD, is when you have tight airways… which makes it harder to blow out air, and with it, carbon dioxide, from your lungs. The damage can’t be reversed… it only gets worse.

Dr. Cheryl Holder: Much of the poor folks in Miami live in an older home where the humidity and moisture increases mold. So that thing gives her more exacerbations. 

Celine Gounder: Allergies can trigger a flare of asthma and COPD, sometimes landing people in the hospital. And rising temperatures make those allergies a whole lot worse.  Scientists also note that allergy seasons are starting earlier and lasting longer. This means that people need more medicine and for longer periods of time.

Dr. Cheryl Holder: So she would have to increase the type of medicines, which adds another prescription cost. And when you’re a low-income worker, your social security checks are not huge. So even an extra $10 copay is something you don’t have. 

Celine Gounder: Annie-Mae’s situation is not unique. Another one of Cheryl’s patients is a fruit vendor who works outdoors in the hot Miami summers. 

Dr. Cheryl Holder: And that is brutal work. So when I saw him, he had other complications and then, but his kidney function. Started going up. And there’s a special thing that you see when people get dehydrated. So another time it got better and like, Oh, what did you do different this time? And he had been off for a few days. So he wasn’t selling, like he would normally sell and he got better. 

Celine Gounder: But for people who already live below the poverty line, not working because it’s hot outside is not an option. The kidney troubles, asthma, and other illnesses could all be tied back to one thing: climate change. 

In this bonus episode of AMERICAN DIAGNOSIS, we’re going to look at how climate change is impacting the health of people and their communities in South Florida. We’ll hear what Cheryl did next. And we’ll talk to two people working to make sure that people like Annie-Mae can keep their homes when developers start looking to higher ground as sea levels rise.

Cheryl started changing the way she spoke with her patients. She told them to be aware of how the heat was affecting their health.

Dr. Cheryl Holder:  I target more my diabetics, my hypertensives, my folks with allergies, anyone with any lung and heart condition, making them aware that heat does impact their health and how to find safer places to go. 

Celine Gounder: But she knew she couldn’t be the only physician seeing these climate-related complications.

Dr. Cheryl Holder: So this is kind of what I do now in getting other clinicians to advocate and make the systemic changes. 

Celine Gounder: Cheryl now co-chairs Florida Clinicians for Climate Action. Her mission is to convince other physicians that climate issues are crucial when it comes to treating their patients. 

Dr. Cheryl Holder: The other areas that we’re looking at, especially Florida Clinicians is increasing climate literacy. None of this is taught in health professional schools. So most of the practicing physicians and in Florida, if you look at the ages most are over 50. So this definitely was not on the, any schools. If it’s not here now it’s not even discussed.

Celine Gounder: This means changing the sort of questions doctors ask their patients. 

Dr. Cheryl Holder: And we do have to change our history to have it incorporate more questions about the climate and how our patients are adjusting to the climate. So now my elderly patients. I don’t leave without knowing if in the summers it’s getting pretty hot. How is your home? Do You have cooling anywhere? I realized We need to reorient our conversations where we find out what’s going on more in our patient homes with COPD, with asthma, with any problem, especially children. If your kids are out there playing sports, what questions are the physicians asking?

Celine Gounder: But Cheryl has faced some obstacles spreading that message to other physicians. 

Dr. Cheryl Holder: Now I’m very understanding of physicians. Because we are constantly bombarded with statistics and data that three years or two months later, you get the opposite. So why am I going to really adjust my practice, which is not easy for data that may not be as good.

Celine Gounder: Diversity is another issue. 

Dr. Cheryl Holder:  Asthma is much more prevalent in Hispanics and Blacks. So if your population doesn’t have a good diversity, you’re not going to see the asthma issues as much as if you have a diverse population. 

Celine Gounder: These racial disparities in health extend to the very homes where many of Cheryl’s patients live. 

Dr. Cheryl Holder: Florida, where I am in Miami was developed based on racial laws, Post civil war, and then Jim Crow era. So it puts Blacks in certain communities and they’ve pretty much stayed in these communities. So the housing and the codes and the ignoring of certain things have always been.  That’s how it is and when you’re poor, you live in poor homes. 

Celine Gounder: And things are taking a turn for the worse. 

Dr. Cheryl Holder: So much of my communities now are under siege for gentrification, but they’re in higher ground, which is unfortunate because now my folks who didn’t have to deal with flooding per se, they had to deal with old homes and mold and water leakage, but never flooding or being going into cheaper, lower rent areas, which are now zero feet above sea level.

Celine Gounder: And the incentives to move are difficult to pass up. 

Dr. Cheryl Holder: The housing is newer looking. So in many instances, the homes look very nice compared to where they’re leaving. It’s just a risk. And if you paid $40,000, $50,000 for a house and somebody is dangling $300,000 in front of you. It’s hard not to take that money. 

Celine Gounder: This trend of pushing people of color to flood-prone areas troubles Cheryl.

Dr. Cheryl Holder: We went through Katrina. So we’re creating a system right now. We’re going to put folks at risk of being like Katrina. 

Celine Gounder: Jesse Keenan has been studying this trend.

Jesse Keenan: Sure. my name’s Jesse Keenan and I’m an associate professor at the school of architecture at Tulane University.

Celine Gounder: A 2018 study Jesse did found that properties in Miami-Dade county located on higher ground are increasing in value at a faster rate than those near the water. What this means for lower-income individuals who live in higher elevation neighborhoods is that they can no longer afford the skyrocketing rents. This phenomenon is called climate gentrification. 

Jesse Keenan:  Climate gentrification is a theory that people are in a state of transition, not only away from high-risk areas, but also moving towards lower risk areas.

Celine Gounder: And because of the way Miami was developed, this trend is mostly affecting communities of color.

Jesse Keenan: If you recognize the history of Miami, much of this high elevation is areas of, low to moderate income, historically Black communities in Miami that are sensitive to ongoing economic stress uh, and the risk of frankly, even homelessness on the extreme end. We begin to see measures of displacement and that comes in the form of housing, displacement, cultural community, displacement. So what’s happening in Miami? I think it’s probably a combination of just a classic gentrification model, but also likely behavior can, um, attributable to climate.

Celine Gounder: The need for affordable housing in Miami is a big problem, especially for older residents like Annie-Mae.

Jesse Keenan: I think often overlooked in Miami is the elderly and senior housing component as well. 

Celine Gounder: But even building homes has become more complicated as the climate changes in places like South Florida.

Jesse Keenan: We’re seeing greater heat stress. So buildings are experiencing a greater material degradation because of the sustained moisture, as well as heat stress on the buildings. So buildings are, for a number of different reasons, not cooling down at night. All of these things are working in concert with climate change to undermine public health considerations.

Celine Gounder: Climate change may not be an explicit selling point for developers, Jesse says. But it influences where investment goes in the long run. 

Jesse: It’s generally not the primary consideration, but I’m not sure that really matters because I think in the long run, as long as climate is part of that decision-making,  I think it it’s okay to attribute climate and maybe even climate gentrification to this broader phenomenon And this is the argument that I have made, is that, when consumers change their preferences, it’s hard to stop that. So you can lobby against one project and you can stand up and try to, you know, protect a particular community. And I think rightfully so, but once you see uh, a broader shift in demography, a broader shift in consumer preferences, it becomes very difficult, I think, to forestall that.

Celine Gounder: The historically Black neighborhood of Overtown in Miami is a prime example of this. 

Nicole Crooks:  My name is Nicole Crooks, and I am a community engagement coordinator for the Overtown community with Catalyst Miami.

Celine Gounder: Catalyst Miami is a non-profit that promotes social equity. Nicole didn’t grow up in Miami. But she’s  lived in Overtown long enough to notice how quickly the neighborhood is changing. 

Nicole Crooks: One of my sons shared with me. He was like, you know, you know times have changed anytime you see like young white couples walking their dogs in Overtown at night. This is not, that’s not how it was when we first moved here.

Celine Gounder: The shifting racial makeup of the area has been due in part to new interest from real estate developers.

Nicole Crooks: And that’s one of the things that has happened to Overtown and people are finding it very difficult to afford where they live. The level of homelessness in our community is tremendous.

Celine Gounder: Overtown is literally on “the other side of the tracks.”

Nicole Crooks: The railroad tracks is the delineating spot. They were, very strategic about where they were built. It needed to be built on higher land.

Celine Gounder: At its founding, it was one of the few places in Miami where Black people could live. The neighborhood became a center of Black culture in the region. 

Nicole: The creativity and the brilliance of the Black people of Overtown created this amazing Mecca where they were very self-sufficient. During segregation, all of the performers would come and they would perform over on South beach, but they were not able to stay on South beach. So they stayed over here. This is why this was called the Harlem of the South. Because this was just, it was just jumping with, with people. Some of the people that, that. Were not necessarily from Overtown, but spent a lot of time in Overtown: Joe Lewis, Jackie Robinson, um, Roy Campanella. Also was here quite frequently. Count Basie, Ella Fitzgerald, Cab Calloway, Lena Horne, Josephine Baker, Billie Holiday. Louis Armstrong, Nat King Cole, BB King, Bo Diddley, Aretha Franklin, Dionne Warwick, like all of them.

Celine Gounder: But In the 1960s, an expansion of Interstate-95 destroyed much of the community. 

Nicole Crooks: And so, people were systematically disinvested, displaced and, and all of that stuff. And, and now, what has happened is that you see the blight.

Celine Gounder: In the decades that followed, Overtown was plagued with the violence and poverty that often accompanies institutional negligence. 

Celine Gounder: But now — years later — the ground that it was built on has made the area prime real estate.

Nicole Crooks: It’s a beautiful area. It’s convenient to everything. The elevation is high. Like you can, you can get anywhere from Overtown.

Celine Gounder: The sudden spike in interest in Overtown land is not a coincidence. Some scientists say that by 2060, there will be a 14 – 34 inch rise in sea levels around Miami, making much of it uninhabitable. 

Nicole Crooks: As we are now entering into climate change, one of the things that we’re realizing is these communities that have been systematically, oppressed, really. These are the spaces that people with money want to be in because all around us is sinking.

Celine Gounder:  Nicole says a friend described it like a game of Monopoly, where the developers are the players, and the residents, the pieces. 

Nicole Crooks: And it made my heart hurt. Like these are real people just being displaced into places that are far from everything that have, that are sinking. You’re taking people from everything they’ve known, pushing them out and it’s not their choice. They just got to go for survival. They have to go.

Celine Gounder: Nicole deals with many of the issues Dr. Cheryl Holder and Jesse Keenan spoke about. 

Nicole Crooks:  If you’re in Miami, like you have to have your air conditioner on because if you go, like if you go a day, like literally, if you go a day without the air conditioner on, to kind of process all of the dampness, you’re going to start growing mold. Right? Like I have a dehumidifier in my room. I have the air conditioner on. And even with all of that, the other day, I had to throw away like three pairs of shoes because they had grown mold. That is toxic on the body.

Celine Gounder: And as a woman of color, the advocacy work that Nicole does is that much more crucial. When she attended a climate change summit in Key West, she found that she was one of few brown faces there.

Nicole Crooks: throughout the world, the people most affected by climate change look like me. And seeing the people that were in the room that were not reflective of me was disheartening to say the least. And all of these decisions are being made by people that cannot even relate to the struggles or trials.  

Celine Gounder: But Nicole says that the fight isn’t a lost cause. 

Nicole Crooks: One of the things that I can say for certain of the people of Overtown, just the Black people in general, right? Black and Brown people in general have had to be resilient. We’ve had to be creative just to survive. And so if the time is taken to stop making decisions for and about us and come to us and ask us what we need and what we want and how we can create solutions together. That’s the beginning of everything.

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I’m Dr. Celine Gounder. Thanks for listening to AMERICAN DIAGNOSIS.