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Climate change is already hitting Alaska hard, but it’s not just that coastlines are eroding and permafrost is thawing. For the people of Alaska, warming will mean new diseases, more mental illness, and an inability to live off the land the way many do now.

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A report out Monday from the state’s Department of Health and Social Services makes this clear. The report states that West Nile Virus, which hasn’t been locally transmitted yet in Alaska, could start making its way north as the state warms. Residents could succumb to solastalgia, a stress resulting from unwanted environmental changes near a person’s home. And Alaskans could see their food sources changing under a rapidly-transforming climate, in ways that impact both their health and culture.

It’s a scary future to imagine, especially in light of Interior Secretary Ryan Zinke’s new offshore drilling plan, which aims to open up the Arctic Ocean, potentially triggering additional environmental problems for vulnerable communities to deal with.

“Of all the states in the United States, Alaska’s certainly on the front lines [of climate change] as the only state in the Arctic,” said Bob Shavelson, the advocacy director for Inlet Keeper, an environmental organization based along Alaska’s Cook Inlet, to Earther.

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Each part of the state has its own set of issues and concerns, but they’re all feeling the impacts of climate change. As the state health report points out, wildfires—which are growing more frequent and severe as temperatures rise—will continue to burn across the state, reducing air quality and destroying essential habitat for wildlife that people would, otherwise, hunt. The ice will continue thinning, making it harder for hunters to go out and harvest their traditional and highly nutritious, foods. 

The report points to this as a source of anxiety and depression as people feel a sense of loss and helplessness. This is especially true for Alaska Natives. The report is clear that their health—along with that of elders, children, and people in rural areas—will be impacted by climate change the most.

“On top of all that is the emotional, mental, and spiritual degradation of our people that live in these isolated areas and see declines and the physical problems that these animals exhibit,” said Alaska Native George Pletnikoff, to Earther. He’s a member of the Unangan Tribe and lives on Alaska’s St. George Island.

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Pletnikoff is especially concerned about how his people will handle any offshore drilling to come. The warming climate is making it easier for ships and vessels to access the ocean, increasing the opportunity for oil exploration. An oil spill or gas explosion—even the surveying for resources before any drilling begins—could prove disastrous to Alaska’s coastal ecosystems and people.

“Without the ocean, the communities cannot and will not be able to survive,” Pletnikoff told Earther.

The Arctic Ocean’s waters are home to whales, walruses, polar bears, and are a rich subsistence area. With climate change, these waters will warm and acidify, potentially altering the marine food web. This could result in fewer fish, farther-away fish, and even contaminated shellfish. Without these foods, communities would be forced to turn to expensive imported food that often lacks the nutritional content of traditional diets.

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It’s more than that, though. For some Alaskan Natives, food is their culture. The way they gather or hunt their food is a crucial part of their way of life.

“You’re talking not just a food security and justice issue, but you’re also talking about a cultural sovereignty issue,” said Marissa Knodel, an Earthjustice legislative counsel who’s lived in Alaska and works on issues related to the Arctic, to Earther.

Pletnikoff echoed this sentiment.

“The greatest implication [of climate change] for those communities is the death of communities and all that the communities are: our culture, our way of life, our traditions, our knowledge of the environment, and the use of the resources that our waters and our environment produce,” he said.

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Alaskans are feeling climate change today—and the impacts on communities’ health and well-being are just starting to become apparent. Those impacts will only worsen as climate change progresses and if offshore drilling hits the Arctic coast.