Amid the coronavirus pandemic, state officials have continued to plan for and address another looming public health crisis – climate change. In recognition of Earth Day, the National Academy for State Health Policy (NASHP) interviewed state officials to learn how they are preparing for the health impacts of climate change. The interviews revealed a wealth of long-term planning and work as state leaders:
These threats also exacerbate existing inequities and weaknesses in the health care system. As evidenced by the recent winter storm in Texas and wildfires in Oregon and California, events triggered by climate change also overlap with other crises, especially during the pandemic, making them even more difficult to confront.
Many state leaders have focused on the health impacts of climate change for some time, and that didn’t stop with the onset of COVID-19. State efforts to mitigate climate impacts on health include addressing the factors that contribute to climate change itself. States have a variety of existing tools to address climate change, including state environmental standards, environmental health regulations, energy efficiency incentives, and other tools. Beyond existing policy levers, states have also taken the lead to convene committees or stakeholder councils to focus on additional long-term planning for climate impacts.
Despite the COVID-19 crisis, groups such as the Maine Climate Council, which released its four-year plan for climate action in December 2020, have continued their work. In March 2021, Massachusetts Gov. Charlie Baker signed a law to create a “next-generation roadmap” for Massachusetts climate policy. Clearly, state momentum on climate change has not paused for the pandemic.
COVID-19 and Climate Change
In many ways, COVID-19 has given states a preview of how converging crises that impact health can strain state finances, public health infrastructure, and local economies. It has also demonstrated how a future disease outbreak, which could be spurred by climate change, can disrupt daily life.
While COVID-19 has not been directly linked to climate change, evidence suggests that climate change is impacting a number of factors that can increase pandemics and alter the way diseases behave. Climate change has already made conditions more favorable to the spread of some infectious diseases, including Lyme disease, certain waterborne diseases, and mosquito-borne diseases such as malaria and dengue fever.
Additionally, as a recent Oregon report on climate and health highlights, populations most vulnerable to COVID-19 are the same as those most exposed to the effects of climate change such as extreme heat, air pollution, and other hazards. Research shows that people who live in areas with poor air quality are at a greater risk of dying from COVID-19, even when accounting for other factors such as pre-existing medical conditions, socioeconomic status, and access to health care.
COVID-19 is proving instructive not only as a warning bell for the large-scale impacts of climate change, but for how it is testing state officials’ ability to develop cross-agency responses to complex health threats. COVID-19 has reinforced the importance of basing policy decisions and actions on available scientific research and evidence, a lesson many states are applying to climate change action. Additionally, COVID-19 has shown the public the importance of a strong public health infrastructure and the domino effect a health crisis, one brought on by COVID-19 or climate change, can have in a community.
Focus on Equity and “Bouncing Back Better”
States had previously identified the connection between climate impacts and racial equity, but the COVID-19 pandemic has brought even more inequities and issues to light. Multiple officials referred to climate change, COVID-19, and racial injustice as inter-related, converging crises as each exposes economic and social injustices in the nation’s government and health care systems. Climate change and COVID-19 also have a disproportionate impact on certain communities, especially people of color and low-income communities.
States, such as California, have worked to make their climate change initiatives more equity-driven. The Climate Change and Health Equity Section within the California Department of Health collaborates across state agencies and departments to ensure health and equity are embedded in all of California’s climate change policies. In addition, through programs such as the Partners Advancing Climate Equity Program, California is investing in community-driven, equitable climate solutions.
As states work to address the effects of both COVID-19 and climate change, they share a theme of “bouncing forward” or “bouncing back better.” In other words, officials are using climate change interventions as an opportunity to give more people improved economic stability or better health outcomes. States are striving to become more climate-resilient by developing polices that simultaneously improve the economic status, health, and safety of individuals. For example, policies that aim to add more stable, good-paying green jobs, such as those in the energy sector, could help reduce climate change and give people better economic opportunities. Additionally, policies that target air and water quality can positively impact both environmental and population health, particularly in communities that have historically seen higher pollution levels.
Leadership Pushes for Climate Action
According to officials interviewed by NASHP, executive leadership is the most powerful ingredient to move beyond conversations and create immediate action on climate change. They also emphasized that having consensus in state legislatures can be helpful in reaffirming a state’s dedication to climate action through legislative mandates and additional funding.
In the past few years, several governors have created multi-sector committees tasked with assessing their state’s climate impact, tracking their state’s climate action progress, and creating benchmarks to work toward to meet state policy goals, such as Maine’s Climate Council, New Jersey’s Energy Master Plan Committee, and Washington State’s Disaster Resiliency Work Group. Many of these governors are making investments and commitments that will outlast their tenure in office.
A strong evidence base is necessary to understand and assess the impact of climate change in states. Having this information allows state leaders to take action on climate change when the right political moment presents itself.
Investing Strategically in Climate Change Priorities
There is power in using evidence in public messaging that links climate change to specific issues affecting citizens, and then investing in programs that actually prepare for and address them. Putting funding behind climate change initiatives is necessary to make them a priority.
For example, California Climate Investments advances the state’s climate goals by investing money raised from cap-and-trade programs in projects that expand low-carbon transportation options, place affordable housing near transit and job centers, and improve water-use efficiency. These type of state investments achieve a triple aim – addressing greenhouse gas emissions, improving people’s living conditions, and in combination help improve short- and long-term health outcomes.
When making investment decisions, state health departments that are leading climate-related initiatives are also working to ensure states are maximizing health “co-benefits.” In other words, if a state agency, locality, or community-based organization is making an investment to lower greenhouse gas emissions, states are simultaneously trying to guide those investments to have the greatest impact on health to optimize the policy’s impact. For example, locating new, carbon-neutral transportation options in communities that already have high levels of air pollution could also reduce the prevalence of asthma in the area.
The Oregon Health Authority’s Public Health Division leads education on climate, health, and equity for other state agencies and has been able to bring a health focus to Oregon’s cross-state climate change response efforts. Oregon’s 2020 Climate and Health Report outlines opportunities for climate mitigation that maximize health co-benefits.
Equity considerations are also important for states in guiding new investments. A number of officials told NASHP they want to prioritize investing in the communities that are experiencing disproportionate impacts of climate change. Involving community members in meaningful ways and giving them decision-making power is also critical in creating equity in new investments.
Rising Health Care Costs Underscore Need for Action
Climate change represents a real threat to the health of citizens, but state officials know it also represents an enormous, looming cost burden. Climate change exacerbates a number of underlying and chronic health conditions that increase the need for high-cost medical interventions, including hospitalizations and prescription drugs.
According to recent studies, asthma, which is worsened by climate change, led to average annual, per-person medical costs of $3,266 between 2008 and 2013. Of that amount, $1,830 was spent on prescription medication, $640 for office visits, $529 for hospitalizations, $176 for hospital outpatient visits, and $105 for emergency room care.
Health care costs will also balloon as more extreme weather causes additional emergency department and hospital admissions for acute care. A recent GeoHealth study estimated that the health-related costs of 10 climate events in the United States in 2012, including hospital admissions, emergency department visits, and lost wages, reached $1.6 billion. When factoring in mortality costs, it reached $10 billion.
As temperatures rise, Maine officials expect additional health care dollars will be required to treat high heat risk. According to a recent report, treatment costs for 200 cases of heat illness in 2019 reached $224,000. Health care costs are forecasted to be 9 to 14 times higher in 2050, meaning heat-related illnesses in Maine could cost as much as $3.2 million annually.
Climate change will also require additional spending on important social determinants of health – housing, food, transportation, and others – as pollution threatens natural resources and extreme weather displaces communities.
Federal Leadership and Future Partnerships
While state officials are preparing for and already working to mitigate the diverse impacts of climate change on health, states can also benefit from federal action and leadership. The federal government plays an important role in national and global efforts to reduce greenhouse gas emissions and coordinate response efforts that cross state borders.
As part of his proposed infrastructure package, President Biden is aiming to pivot the US economy to green jobs, bolster infrastructure to better withstand extreme weather, and put the country on a path to net-zero carbon emissions by 2050. All of this would help states reduce the health impacts of climate change. States hope that future federal climate change efforts will be more cross-disciplinary within and across agencies, focus more on the connections between climate and public health, and take a stronger equity lens.
State officials stressed that climate change work is extremely costly to initiate and continually fund, and they lack the resources to support local and tribal governments in preparing for the impacts of climate change.
Additional federal funding dedicated to the health impacts of climate change could help. For example, the President’s preliminary FY 2022 budget request did include an additional $100 million for the Centers for Disease Control and Prevention’s Climate and Health Program, which supports state, tribal, local, and territorial public health agencies as they prepare for specific health impacts from a changing climate. This program has been critical in helping states build an evidence base on climate change and launch response efforts.
State officials also highlighted that federal support is needed to generally strengthen public health systems, both to continue to respond to the pandemic but also to face current and future climate impacts. State officials suggest the federal government could:
- Expand federal programs that invest in state, local, and tribal health departments;
- Build public health workforce capacity to better address the climate health crisis;
- Invest in climate and health research as well as a national health surveillance system that can detect climate impacts in real time;
- Lead research into and develop responses to the impact of climate change on social resiliency and mental health; and
- Better integrate health and equity into a unified climate change response across federal agencies.
To learn more about states’ responses to climate change, read NASHP’s other resources:
- Toolkit for Governors: Climate Policy One-Pager, May 2020
- Blog: States Take the Lead to Address Climate Change, December 2019