Coastal living is a dream for many Americans, but the effects of climate change are making it increasingly risky. Rising sea levels and stronger storms are just the beginning; the threat to public health is growing and millions living on the coast are already feeling the impact.

At the forefront, the threat to coastal living is climate change. Sea levels are quickly rising due to melting glaciers and expanding warm oceans, putting coastal areas at risk. Storm surges are becoming more intense, and high-tide flooding now occurs up to 900% more often than it did 50 years ago.

Starting in the 2030s, “sunny day” floods — floods without storms — will become common. Around 400,000 kids — mostly in New York City — live in areas that could experience major flooding by 2030. These changes will make coastal areas less livable, forcing communities to move inland and to higher elevations.

In addition to rising sea levels, dozens of coastal cities in the United States are actively sinking, largely due to excessive groundwater extraction. When water is pumped from underground for human consumption, the water table drops and causes land above to collapse. Coastal areas also face pollution linked to tourism, with emissions from out-of-state cars, planes and cruise ships adding to the strain.

In Portland, Maine, large passenger-carrying ships dock daily in the peak fall season and idle in the harbor all day, releasing fumes while passengers come ashore. In 2016, a Carnival cruise line was even found dumping waste into the water for nearly a decade, which led to stricter wastewater discharge regulations statewide.

About 40% of the U.S. population — 128 million people — live in coastal counties. The Centers for Disease Control and Prevention finds these areas more distressed than inland regions, with marginalized groups bearing the brunt. Over half of the coastal population are people of color, and low-income communities, especially in cities like New Orleans, are disproportionately affected.

Environmental changes affect public health, too. Due to these environmental changes, health risks have skyrocketed for those living in coastal counties. In addition to the obvious short-term threats associated with extreme storms and flooding like losing shelter, injury from falling debris or drowning, a variety of illnesses and injuries can stem from water contamination and mold growth long after a weather event.

Floods bring saltwater, chemicals and pesticides into local water supplies, raising the risk of hypertension, organ damage and maternal health issues. Flooding also overwhelms septic systems, releasing bacteria and pathogens into the environment, which leads to mold growth in homes.

Exposure to mold can cause hay fever-like symptoms and respiratory problems like asthma. For example, two years after Hurricane Ida hit Louisiana, residents were still getting sick from mold exposure, partly because many low-income renters lacked the resources to fix moldy homes or relocate.

Algae blooms driven by rising temperatures also threaten public health. These blooms contaminate water, fish and air, causing skin rashes, respiratory issues, gastrointestinal illness and neurological damage. A recent bloom in the largest U.S. freshwater lake was associated with increased doctor visits and pet deaths.

Health care systems are also often disrupted by extreme weather conditions, leading to difficulty in providing timely and adequate care. Power outages, road closures and damaged facilities delay treatment and access to care. After Hurricane Maria hit Puerto Rico, most of the 3,000 deaths linked to the storm occurred months later, due to medication shortages, loss of electricity and a lack of available doctors.

Protecting coastal communities requires ongoing efforts — some of which are already underway. Several hospitals across the country are installing flood walls, relocating generators to higher ground, and/or investing in high ground clearance emergency vehicles.

Drawing on Federal Emergency Management Agency guidelines, many local and state health departments are urging health care providers to take an active role in storm preparedness. This includes assisting patients in creating evacuation plans and ensuring access to extended medication supplies.

On a broader scale, researchers are developing tools to assess climate risks in vulnerable areas, city planners are factoring in land subsidence for new construction, and cities like Boston are creating climate resilience jobs from federal funding.

As the environment continues to change and storms grow stronger, we must prioritize protecting coastal communities and preventing disaster. To secure a future for coastal living in the U.S., bipartisan support is essential for investing in infrastructure, public health and climate resilience.

By building on existing efforts and innovating new solutions, we can safeguard the livelihoods of the millions who already call these areas home.