Global disparities in compound hazard exposure and infrastructure access jeopardize health equity

Global disparities in compound hazard exposure and infrastructure access jeopardize health equity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Global disparities in compound hazard exposure and infrastructure access jeopardize health equity Ying Tu, Bin Chen, Qikang Zhao, Qingyan Meng, Dabo Guan, Yida Sun, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7925624/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract Rising natural hazards amid a warming climate increasingly threaten human health and sustainable development. While infrastructure serves as a critical buffer against these risks, the relationships between hazard exposure, infrastructure access, and health outcomes remain unclear. Here, we assess global human exposure to joint flooding and extreme heat risks since 2000 and examine their interactions with infrastructure access in shaping human health. Results reveal stark inequalities, with 48% of the global population (~ 4 billion people) living in areas highly exposed to both hazards. Low-income countries are disproportionately affected, facing 5.37 times the flood exposure and 1.98 times the extreme heat exposure of other income groups, yet having only 30% of their critical infrastructure access. Enhanced infrastructure access is significantly associated with longer life expectancy (p < 0.05), but high levels of hazard exposure diminish these benefits. Future projections under the Shared Socioeconomic Pathway (SSP) 1-2.6, 2-4.5, and 5-8.5 scenarios indicate substantial increases in country-level hazard exposure by 2100 relative to baseline levels: 40%–393% for floods and 22%–161% for extreme heat. The share of areas simultaneously exposed to high levels of both hazards rises from 15%–18% in 2030 to 22%–51% by 2100, potentially widening existing gaps in infrastructure access and health disparities. These findings highlight the urgent need for targeted interventions that enhance infrastructure equity in climate adaptation and health strategies, especially for vulnerable populations. Earth and environmental sciences/Environmental social sciences/Climate-change impacts/Environmental health Earth and environmental sciences/Environmental social sciences/Climate-change adaptation Earth and environmental sciences/Environmental social sciences/Sustainability Earth and environmental sciences/Climate sciences/Climate change/Projection and prediction Scientific community and society/Developing world Full Text Additional Declarations There is NO Competing Interest. Supplementary Files supplementaryinformation251015.docx Supplementary Information Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7925624","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":537363909,"identity":"51825547-ba0a-499e-90fd-21afc6be3ecd","order_by":0,"name":"Ying 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While infrastructure serves as a critical buffer against these risks, the relationships between hazard exposure, infrastructure access, and health outcomes remain unclear. Here, we assess global human exposure to joint flooding and extreme heat risks since 2000 and examine their interactions with infrastructure access in shaping human health. Results reveal stark inequalities, with 48% of the global population (~\u0026thinsp;4\u0026nbsp;billion people) living in areas highly exposed to both hazards. Low-income countries are disproportionately affected, facing 5.37 times the flood exposure and 1.98 times the extreme heat exposure of other income groups, yet having only 30% of their critical infrastructure access. Enhanced infrastructure access is significantly associated with longer life expectancy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but high levels of hazard exposure diminish these benefits. Future projections under the Shared Socioeconomic Pathway (SSP) 1-2.6, 2-4.5, and 5-8.5 scenarios indicate substantial increases in country-level hazard exposure by 2100 relative to baseline levels: 40%\u0026ndash;393% for floods and 22%\u0026ndash;161% for extreme heat. The share of areas simultaneously exposed to high levels of both hazards rises from 15%\u0026ndash;18% in 2030 to 22%\u0026ndash;51% by 2100, potentially widening existing gaps in infrastructure access and health disparities. These findings highlight the urgent need for targeted interventions that enhance infrastructure equity in climate adaptation and health strategies, especially for vulnerable populations.\u003c/p\u003e","manuscriptTitle":"Global disparities in compound hazard exposure and infrastructure access jeopardize health equity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 04:34:40","doi":"10.21203/rs.3.rs-7925624/v1","editorialEvents":[],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nature-communications","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"NCOMMS","sideBox":"Learn more about [Nature Communications](http://www.nature.com/ncomms/)","snPcode":"","submissionUrl":"https://mts-ncomms.nature.com/","title":"Nature Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature Communications","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"565f6723-8600-414e-be4a-5ca38b90b5ee","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":57146417,"name":"Earth and environmental sciences/Environmental social sciences/Climate-change impacts/Environmental health"},{"id":57146418,"name":"Earth and environmental sciences/Environmental social sciences/Climate-change adaptation"},{"id":57146419,"name":"Earth and environmental sciences/Environmental social sciences/Sustainability"},{"id":57146420,"name":"Earth and environmental sciences/Climate sciences/Climate change/Projection and prediction"},{"id":57146421,"name":"Scientific community and society/Developing world"}],"tags":[],"updatedAt":"2025-11-25T04:34:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 04:34:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7925624","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7925624","identity":"rs-7925624","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}