As heat, floods and drought intensify, governments, donors and cities rely on climate risk assessments to decide who gets support and where money goes. A climate risk assessment uses information on climate hazards, exposure, vulnerability and responses to identify where, who or what is most at risk to climate impacts.

When climate shocks such as heat waves, droughts or floods strike, women are often described as vulnerable. But women are not a uniform group and they don’t all experience climate impacts in the same way.

Read more: Extreme weather affects mental health: what vulnerable women in Kenya told us

Their vulnerability to climate shocks is shaped by far more than gender alone. Factors like race, ethnicity, age, disability and class play a role in making some women more vulnerable than others. Power relations, such as ableism, racism, sexism and ageism, can also privilege some women while marginalising others.

This is known as intersectionality. Critical race theory scholar, professor of law and activist Kimberlé Crenshaw came up with the term “intersectionality” in 1989. It describes how overlapping identities can create forms of harm that remain invisible when problems are framed through only one lens. For example, separate frames for “Black people” and “women” can miss the distinct experiences of “Black women”.

If climate risk assessments don’t look at how identities and power overlap, they can miss why some women are far more at risk than others. For example, women who are impoverished and live in flood prone areas are more at risk and will find it more difficult to recover from climate disasters.

Read more: Women are seen as ‘saviours’ or ‘victims’ in climate change debates: why this is a problem

Women are more vulnerable to climate change if their opportunities are limited and if they’ve suffered as a result of economic structures that concentrate wealth and resources in the hands of a few.

Together with our co-author Songo Benya, we wanted to better understand women’s climate vulnerability in South Africa. Rather than treating women as a group of people who are all the same, we wanted to find out which women are most vulnerable to the impact of climate change and why.

Read more: Forest loss in Malawi: how having women at the table affected debates and decisions about solutions – research

We reviewed all the South African scientific literature published between 2004 and 2024 on how income, education, household roles and resources combine to shape women’s ability to respond to climate change.

Our research found that treating women as a single group can hide differences in vulnerability, exposure and responses to climate impacts. Women who lacked secure land tenure, access to credit, decision-making power or climate information often faced greater barriers to adopting adaptation strategies.

Understanding which women are worst affected by climate hazards

The country’s inequality is still rooted in apartheid, for example by shaping who gets good quality health services and who doesn’t. When climate shocks hit, these gaps decide who is most exposed and who has the means to cope or recover.

1. Economic factors

These are the biggest drivers that intersect with gender to shape climate vulnerability. We found that Black women were more often engaged in lower-income or climate-sensitive livelihoods, such as smallholder farming or informal trade. They faced barriers to accessing finance, credit and productive assets. These constraints limited women’s ability to invest in adaptation strategies or recover from climate shocks.

2. Limited land ownership

In many rural areas, customary land tenure systems favour male inheritance. They hamper women’s ability to make decisions about land use, adopt climate-resilient farming practices or access agricultural support. Access to knowledge, education and climate information also affected vulnerability.

3. The burden of housework

Household responsibilities were a major factor, intersecting with economic status and gender. Women are often primarily responsible for childcare, water collection, food provision, and caring for elderly relatives. Household labour limited the time and resources available to adopt new livelihoods or adaptation strategies. Caring for children increased risks, but also motivated women to persist and find ways through hardship.

4. Power dynamics and wider social exclusion

Women had less say in decision-making in homes led by men compared to those led by women. However, homes led by women often had lower levels of education, which limited their influence beyond the home. In some cases, women were more climate vulnerable if they lacked social ties to community leaders. This made it harder to access resources.

Read more: What does a house mean to you? We asked some women who head households in South Africa

Where women lived, and the condition of their homes and services, influenced by race and income inequalities, made some women more vulnerable. Many women, particularly Black women in peri-urban and informal settlements, faced greater exposure to climate risks like flooding due to poor housing quality, limited infrastructure and inadequate services.

What needs to happen next

All the literature we reviewed showed that women were barely coping with the impact of climate change. This included loss of life; decreased health, income, learning, wellbeing and livelihoods; and damage to resources and infrastructure.

Reported responses for the women described in the literature were often short-term measures. Sometimes these were maladaptive, such as depleting savings, taking on risky debt, or engaging in transactional sex.

Read more: Climate change is hurting Kenyan women working in coastal tourism – they explain how

Collective strategies, such as community solidarity and social learning networks, appeared less often. (These are spaces where different people involved in the issue, such as local women farmers, extension officers, non-governmental organisation representatives and others, come together to learn from each other.) Where they did appear, they tended to reduce vulnerability more effectively.

More gender-sensitive climate action is needed. In South Africa, this means prioritising women’s real, day-to-day needs, especially by strengthening women’s access to income, and in the informal trade and smallholder farming sectors. Women informal traders can be supported by governments through better planning, and infrastructure like sheltered trading areas that are protected from extreme weather.

Read more: African women entrepreneurs are a smart bet for climate change investment: research shows why

Adapting to a warming climate also requires confronting the deeper social issues that increase risk. These include patriarchal norms and unfair division of household labour. This will free up their time, security and resources to respond to climate challenges.

More broadly, climate risk assessments need to consider how different identities, contexts and power relations influence women’s lives. This is especially important considering that these assessments can influence who gets climate funding and support. Climate policies may respond to climate risks. But without an intersectional approach, they’ll fail to reach the women who need the support the most.

Petra Brigitte Holden receives funding currently from the European Union, FCDO, IDRC, and Frontiers Planet Prize.

Gina Ziervogel receives funding currently from IDRC, FCDO and AFD.

Leigh Stadler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Chronic obstructive pulmonary disease, or COPD, caused 141,733 deaths in the United States in 2023 – the latest data that has been reported. That number reflects not just the effects of smoking, but a broader set of medical and social factors that shape who survives.

As of early 2026, COPD remains the fifth-leading cause of death nationwide and carries a substantial economic burden, with annual medical costs estimated at US$24 billion among adults ages 45 and older. COPD is a progressive condition that limits airflow, making it increasingly difficult to breathe and carry out everyday activities.

Nearly 16 million U.S. adults live with COPD, and many more remain undiagnosed.

COPD also encompasses chronic bronchitis, which inflames the airways, and emphysema, a condition that damages the air sacs in the lungs. Both conditions limit the flow of air in and out of the lungs.

I am a physician and doctoral researcher in public health who studies chronic disease outcomes using nationally representative U.S. data. In my research examining long-term mortality among adults living with COPD, one pattern stands out clearly: My colleagues and I found that both current and former smokers had a higher risk of death compared with those who never smoked, highlighting that smoking increases mortality risk – but it does not act alone.

How smoking and COPD are intertwined

Smoking has been recognized for over five decades as the primary cause of COPD. It is a major factor in how the disease develops and progresses, although other factors such as secondhand smoke, air pollution and occupational exposures also play a role. Even after accounting for age and other health conditions, people with COPD who have smoked face a higher risk of death than those who have never smoked.

Quitting smoking, while essential, does not fully erase the damage caused by smoking. This is because long-term exposure to tobacco smoke leads to persistent inflammation and structural damage in the lungs, changes that are not fully reversible. They continue to affect airflow and respiratory function even after a person stops smoking, although quitting significantly slows further decline.

COPD is a long-term condition that continues to affect the lungs and the pulmonary blood vessels over time, contributing to both breathing problems and other chronic conditions.

In some cases, higher risks among former smokers with COPD may reflect the lasting effects of smoking or underlying illness that led them to quit.

COPD affects more than the lungs

COPD is often described as a lung disease, but its effects extend far beyond breathing.

People living with COPD also face a higher risk of other health problems, including lung infections such as flu or pneumonia, lung cancer, heart disease, weak muscles and depression or anxiety, all of which can increase the risk of death.

One of the most noticeable ways COPD affects daily life is through persistent breathlessness, which can make even simple tasks such as walking, cooking or getting dressed more difficult. As activity declines, overall health can worsen, creating a cycle that is hard to break.

COPD is also frequently diagnosed late and progresses gradually, limiting opportunities for early treatment.

Social connections can shape survival

A growing body of research shows that social factors play a meaningful role in health outcomes with chronic diseases including COPD. Social isolation has been linked to a higher risk of premature death, with effects comparable to well-known risk factors such as smoking and obesity. This is a major problem because nearly 1 in 6 adults with COPD experience social isolation, and 1 in 5 experience loneliness.

Among people living with COPD who were single or never married, the increase in overall risk of death associated with smoking was substantially higher. In this socially isolated group, current smokers faced roughly a 50% higher risk of death and former smokers faced nearly four times the risk compared with those who never smoked, highlighting how social context can shape survival rates.

Other research has similarly found that social isolation is associated with a higher risk of death among people with COPD, reinforcing the importance of social support. Managing a demanding chronic illness alone can be difficult; without support to monitor symptoms or assist with care, the burden of disease may be grave.

One reason is that social connections influence how people manage chronic illnesses. People who are socially isolated are more likely to engage in unhealthy behaviors such as smoking, poor diet and physical inactivity, and may be less likely to follow treatment plans.

Support from family members, caregivers or community networks can improve peoples’ likelihood of following treatments, reduce their stress and make it easier to quit smoking. For people living with COPD, a condition that requires daily management, these differences can significantly affect their quality of life and how long they live.

What can help reduce COPD deaths?

Reducing deaths from COPD begins with prevention and early intervention. Avoiding or quitting smoking remains the most effective way to lower risk. Reducing exposure to tobacco smoke, air pollution and occupational hazards such as dust from mining and chemical fumes can also help prevent long-term lung damage.

For people already living with COPD, consistent access to care can improve outcomes. Treatments such as inhalers that help open the airways, pulmonary rehabilitation and oxygen therapy, along with vaccinations against respiratory infections, can help manage symptoms and reduce complications.

Improving survival in COPD depends on more than treatment alone – it also requires addressing social factors such as isolation, access to support and living conditions.

One practical step is making screening for social isolation part of routine care.

Olamide Asifat does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.