As APHA’s 2017 Annual Meeting and Expo explores all the ways “Climate Changes Health,” one might be tempted to assume other public health topics would be moved to the back burner. Au contraire! This year’s meeting may be climate-focused, but advocates are showing attendees all the ways climate intersects with every aspect of public health.

At a Monday morning session, women’s health took the forefront, as researchers and practitioners explored what they called “the feminization of poverty” and the impact of climate change and natural disasters on women. Public health experts won’t be surprised to find out that climate change and natural disasters disproportionately affect at-risk populations. But they may be shocked to find out how the systems (or lack of them) set up to prevent disasters, as well as the systems designed to address them, continually disadvantage women — again and again — feeding into a cycle of poor health and economic outcomes.

Jacqui Patterson, director of the NAACP Environmental and Climate Justice Program, kicked the session off with a look at the many ways women, particularly women of color, are placed at higher risk for worse health outcomes due to climate change and natural disasters (which, we know, are often worsened by climate change). To attack a whole problem, she said, you must start at the roots — and the roots of this problem are in a U.S. economy built on the exploitation of humans and the environment. And so it makes sense that from such a system, women, especially women of color, continue to be disadvantaged.

Presenter Dorothy Riddle, a psychologist, feminist and economic development specialist, broke down the many ways women worldwide are stressed during and after disasters. For instance, they often serve as the primary decision-makers for multiple generations of families — meaning they’re the ones who decide when to shelter in place, where to evacuate to, and what to stockpile and take with the family if and when they are able to evacuate. Women are often the primary providers of recovery services, such as search and rescue efforts, food and diaper drives, and other rebuilding efforts. They provide ongoing caregiving to older and younger generations of their own families and neighbors — even though more than 12 percent of women over 65 are living in poverty in the U.S.

And during all of this, they’re expected to provide self-care, or worse, to ignore much-needed care for their own physical and mental health. Unsurprisingly, this all trickles down into women’s earning power before and after disasters.

But this is just the tip of the iceberg. When recovering from a community trauma, women and girls have other stressors to contend with — from juggling prenatal health and care with post-traumatic stress disorder after Hurricane Katrina to girls being told to wear female condoms while walking to get potable water, as their risk for sexual assault on the journey was so high. Riddle noted that rates of domestic violence and sexual assault often spike after a disaster because men dealing with unmet mental health needs take untreated aggression out on women and children. Riddle added that researchers have also documented rises in children’s traumatic brain injuries after disasters due to such violence.

So how can public health act? By ensuring that women have multiple seats at the table. By making room for all women — women who have experienced poverty, domestic violence, trauma, trafficking and more. Riddle said public health must start by engaging women, particularly women of color, in strategy- and decision-making and in creating a community skills inventory. Such inventories offer a place for people to share their own skillset, rather than being slotted into traditional roles.

And Patterson noted that communities should also look at the women who are not present — those who left their homes because they weren’t safe or there was no clean water or healthy food to eat.

“What often doesn’t get told are the stories of women — often women of color, often indigenous women — who are disappeared, driven out of a community,” she said. “As we move toward solutions…we have to always be intersectional in our thinking as we are intersectional in our impacts.”

Women were certainly ready to act at the end of the session, as the crowd was overwhelmingly female. But maybe that’s part of the problem: If only those who are affected by a problem are willing to act on it, those in power might never let them enact solutions.