Climate Change’s Compounding Pressures on Rural N.C.

Three days after returning to her hometown of Lumberton to care for her ailing father in 2018, Anita Cunningham found herself in the path of Hurricane Florence. The storm brought 130-mile-per-hour winds and dumped more than 30 inches of rain across southeastern North Carolina. Cunningham holed up inside her family’s house for four days, knee deep in floodwater. 

“I had never experienced a weather event like that,” she recalls. “It was life-changing.”

When rescuers finally reached her and she emerged into the sunlight, the landscape was almost unrecognizable. Thousands of homes had been damaged or destroyed. Roads were washed away, and local schools remained closed for five weeks.

Scientists later concluded that climate change had intensified the storm; warmer ocean temperatures and a warmer atmosphere made Florence roughly 50 miles wider and dramatically increased its rainfall.

For Cunningham, the disaster transformed what she had viewed as a political debate about climate change into lived experience. “Coming to Robeson County,” she said, “I got a chance to see how all of that plays out—and how it’s all connected.” 

The experience prompted Cunningham, who had recently retired from her job as a meeting planner, to become an environmental justice activist and community organizer in minority and underserved communities. Now she is executive director of the North Carolina Climate Solutions Coalition and director of the North Carolina Disaster Response and Resilience Network, where she raises awareness about the risks of climate change. 

While hurricanes and flooding are often a big part of conversations about climate change in North Carolina—two years before Florence, Hurricane Matthew pushed the Lumber River to record levels and left Robeson County residents without electricity for days—extreme heat is the deadliest climate-related hazard. 

Deaths linked to heat exposure surged by 53% in the past two decades in the United States to more than 4,000 between 2010 and 2020, according to a study from the Yale School of Public Health. That was more than the number of deaths linked to hurricanes, tornadoes, and flooding combined. 

The 10 hottest days on record globally have occurred since 2016, according to the nonprofit research group Climate Central; 2024 was the hottest year. 

During the summer of 2025, North Carolina recorded 5,748 heat-related emergency department visits, according to the state Department of Health and Human Services. It was the highest total in at least six years. The largest concentrations occurred across the Sandhills and southeastern Coastal Plain, where agriculture and manufacturing industries employ thousands of people who often work outdoors with limited heat protections. North Carolina is not among the handful of states that collect data on heat-related deaths.

A cluster of climate disasters in the last decade has exposed vulnerabilities in Robeson, one of the state’s poorest and most racially diverse counties. About three-fourths of the county’s 120,000 residents are Native American, Black, or Hispanic. The county ranks near the bottom of the state in health outcomes, life expectancy, and access to medical care. 

Climate change is often described as a threat multiplier. It does not create poverty, inadequate housing, or gaps in health care, but it magnifies their consequences. A 2021 Environmental Protection Agency analysis concluded that while climate change affects everyone, its most severe impacts fall disproportionately on underserved communities.

“The impacts of climate change—from extreme heat to flooding to severe storms—are expected to get worse,” then-EPA Administrator Michael Regan, a native of Goldsboro, said in 2021. “And people least able to prepare and cope are disproportionately exposed.”

Nowhere is Regan’s prediction more evident than the rural areas of his home state. 

Researchers tend to focus a lot of their attention on urban heat islands, said Ashley Ward, director of Duke University’s Heat Policy Innovation Hub. But rural communities experience some of the nation’s highest rates of heat illness. “What most people don’t know is that heat illness rates are five to seven times higher in rural communities than in urban ones.” 

Older housing, outdoor occupations, aging populations, long distances to medical care, persistent poverty, and aging and nonexistent infrastructure all combine to make the impact of extreme heat more dangerous. “What we see is that heat increases underlying risk,” said Ward. “It is the layering of burdens without the means at the individual level to overcome them.”

Occupational Hazards

Across the state, more than 100,000 agricultural workers toil on vast sweet potato, tobacco, soybean, and corn farms. For more than half a century, the Tar Heel state has been the nation’s leading producer of sweet potatoes, responsible for more than 1.8 billion pounds annually—about 60% of the entire U.S. crop. 

Each worker is expected to gather roughly 1,200 pounds of sweet potatoes per hour, a 47-pound bucket every three minutes, according to Leticia Zavala, a farmworker organizer based in Goldsboro. Much of the work is performed in the open sun, where the heat index can rise well above 100 degrees.

Seven states—California, Colorado, Maryland, Minnesota, Nevada, Oregon, and Washington—have enacted farmworker protections like shade and scheduled rest breaks. Legislation for heat safety regulations doubled from 2024 to 2025, with eighteen states proposing workplace temperature protections. North Carolina is not among them.

“The growers are not obligated to give breaks or take certain heat precautions,” said Zavala. “Maybe there’s water on the tractor, but maybe it’s not cold or clean, and you’re not allowed to drink water until you finish your row.”

Zavala was just 6 when she arrived in the United States with her migrant farmworker family four decades ago. Following the harvest patterns, they picked strawberries and citrus in Florida, cucumbers and tomatoes in Ohio, and apples in Michigan and Pennsylvania before returning south again.

After earning a sociology degree from Florida Southern College, Zavala returned to farms not to harvest, but to organize workers. In 2022, she co-founded El Futuro Es Nuestro (It’s Our Future), which advocates for better working and living conditions in North Carolina. 

“Trying to get workers to understand climate change can be difficult,” Zavala said. “But with heat, it’s pretty easy to make that connection because you can feel it. It makes the job physically harder.” She said her organization hears almost daily about workers passing out, throwing up, becoming dehydrated, needing medical attention during the summer months. Some have even gone back to Mexico because the conditions are so harsh. 

In September 2023, 30-year-old José Arturo González Mendoza was harvesting sweet potatoes for Barnes Farming in Nash County when he collapsed in the 90-degree heat and later died of cardiac arrest. Less than a year later, Juan José Ceballos, 32, suffered a heat stroke and later died while working for a grower in Johnston County where the heat index reportedly reached 108 degrees. 

Agricultural workers are at least 35 times more likely to die from heat-related causes than workers in other industries, according to the Federation of American Scientists.

And the dangers do not end with the workday. Most migrant workers and those who hold temporary H-2A agricultural visas live in housing provided by the growers. Zavala says the accommodations haven’t changed since she was a kid—crowded, poorly insulated, unairconditioned structures that are subject to pesticide drift. 

The climate, however, has changed in a way that makes living there even more perilous. A Climate Central analysis this year found that the southern U.S. has experienced 33 to 35 more warmer-than-normal summer nights since 1970. When Wake Forest University researchers Thomas Arcury and Sara Quandt visited 170 North Carolina farmworker camps during the summer of 2010, they found that nighttime temperatures in sleeping quarters exceeded the danger threshold. The heat index—what it feels like when air temperature is combined with humidity—routinely reached 90 degrees. 

Even those who don’t work on farms can be in danger. In August 2025, three family members were found dead in their Rocky Mount home after neighbors said their electricity was shut off due to late payments. The family was reportedly using a generator. 

A Reinforcing Cycle

Courtney Steed, a member of the Lumbee Tribe of North Carolina, traces her family’s roots in the Coastal Plain to the mid-1700s. “It’s all farmland and swamps. Our survival was dependent on the landscape.”

After earning fine arts degrees from UNC Wilmington and Appalachian State University, Steed returned to her hometown of Pembroke to be near her family. Her community, she says, is “as rural as you can get” and “at the bottom socioeconomically.” Still, she said, “we are a really strong, resilient people.”

Persistent poverty, however, is now colliding with increasingly dangerous summer heat. For many families, it’s tough keeping the lights on and the air conditioner running.

“I was over at my aunt’s house, and she’s like, ‘I can’t get my husband’s diabetic medicine because it went up to $500 a month,’” Steed recalls. “There’s no air conditioning in that house because that’s a luxury. But it’s not a luxury when you’ve got this extreme heat—it’s an essential, and we don’t have any way to provide that essential.”

Steed keeps her thermostat at 80 degrees to save on her electric bill, a calculation that can come with consequences for many. High indoor temperatures paired with humidity can lead to mold, creating yet another health hazard. Researchers call this energy insecurity—the inability to afford the power needed to maintain a safe and healthy home. In her book Powerless: The People’s Struggle for Energy, sociologist Diane Hernandez argues that the southeastern U.S. is especially vulnerable because of persistent poverty, aging housing stock, and limited energy assistance. According to researchers at UNC-Chapel Hill, “more than 400,000 households in North and South Carolina face average energy burdens of 30% and 37%,” significantly above what is deemed the affordable energy threshold of 6%. 

Federal programs have not kept pace with the current climate reality. The Low Income Home Energy Assistance Program, or LIHEAP, primarily helps families pay winter heating bills. More than 40 states prohibit utility shut-offs during the coldest months, while North Carolina restricts disconnections for vulnerable populations. There are no similar protections during dangerous summer heat, however. An analysis co-authored by Noah Kittner, a public health researcher at UNC-Chapel Hill, found that extremely low-income households are about six times more vulnerable to extreme temperatures.

A 2020 survey by Duke University’s Nicholas Institute found 54% of rural voters nationwide felt that action on climate change was important, while 44% felt it was less important. Comparatively, 69% of urban and suburban voters felt climate action was important.

Kathie Cox is a public health educator for Scotland County and acts as a liaison between the state and local communities. She’s learned that talking about climate change in rural North Carolina requires a more nuanced approach. “You hear people here and there scoffing about it,” she says. “My role is to educate and inform as many as possible using as many creative ways as possible.” 

Recounting the day in 2018 when she nearly died from heat exhaustion goes a long way toward making that connection. “I led an exercise class then came home and walked my dog for two miles,” she recalls. “But instead of going inside, drinking water and cooling off, I decided to mow my grass.” In the sweltering heat, Cox became dizzy and started vomiting. She prayed not to die in her back yard and now credits her daughter for saving her life. 

“People are open to how climate change impacts our health in different ways, especially when you’re talking about a vulnerable population,” Cox said.

But as more people accept the harms that come with a warming planet, the federal government is backing policies that reduce or eliminate crucial resources that help communities prepare for the next disaster.

During President Donald Trump’s first term, a FEMA program funneled billions of dollars of federal funding to state, local, and tribal governments for natural disaster mitigation projects. North Carolina received more than $200 million. Robeson County was slated to receive $1.9 million to make vulnerable land more flood-resilient and better capable of managing stormwater runoff. 

Early in his second term, the Trump administration halted the program, including nearly $11 million targeted at Robeson and neighboring Columbus counties. The changes were part of a broader rollback of climate initiatives. One of Trump’s first actions after returning to office in 2025 was ending the Biden administration’s Justice40 initiative, which directed 40% of the overall benefits from federal climate and infrastructure investments to marginalized communities and underserved rural areas. 

Trump also withdrew the U.S. from international climate agreements, expanded support for fossil fuel production, and rolled back domestic emissions regulations. The Republican-controlled Congress approved the One Big Beautiful Bill Act, which repealed billions in clean energy tax credits and incentives.

In March, a federal judge ordered the FEMA program funding to resume. The administration agreed but with certain restrictions: no more money for hazard mitigation planning. 

North Carolina Attorney General Jeff Jackson welcomed the court decision but cautioned that communities are still waiting. “This is good news—but the money hasn’t arrived yet, so we’re not done,” Jackson said. “Our towns and cities are waiting for the dollars they were promised to get ready for the next storm.”

For residents of southeastern North Carolina, such delays in assistance are measured not in months but in years. Nearly a decade after hurricanes Matthew and Florence, some downtowns are still lined with abandoned storefronts, collapsed buildings, and schools that never reopened.

Cunningham uses her role as leader of the North Carolina Climate Solutions Coalition and the North Carolina Disaster Response and Resilience Network to inform and organize her community to speak out against more polluting and extractive industries. She remains committed to helping neighbors see climate resilience as something that must transcend politics, given what’s at stake. 

“I need to connect with people one by one, community by community,” Cunningham said. “I need to show them the devastation and how it affects them personally. It doesn’t matter how long that takes.”

This story is supported by a grant from the Pulitzer Center on Crisis Reporting’s Connected Coastlines Initiative.