State-level climate action contributes to building a Culture of Health

Linnea Warren May and Jennifer Sloan are policy analysts at the RAND Corporation working on health, equity, and community engagement. Carolyn Miller is a Senior Program Officer in the Research, Evaluation and Learning unit at the Robert Wood Johnson Foundation.

The state of Maryland has 3,100 miles of beautiful tidal shoreline, making the Maryland shore a popular recreational destination and simultaneously, incredibly vulnerable to sea-level rise and coastal storms. In 2008, Maryland became the first state to publish a comprehensive strategy for reducing its vulnerability to these pressing climate-related challenges, called a Climate Action Plan. Since that time, many other states have published their own action plans to curb and prepare for the impacts of climate change, but not all have followed suit.

The summer of 2019 brought us the hottest July on record globally and above-average precipitation across the U.S., causing severe weather and flooding in much of the Midwest and mid-Atlantic regions. The results of these events, each of which are made worse by climate change, are damaging to people, structures, and economies.

The impacts of climate change on health are well-documented and range from worsening chronic conditions like lung and heart disease to increased chances of premature births to mental health effects. Climate change intensifies extreme weather events and has led to poorer air quality, more wildfires, and the rise of disease spread by insects. 

In short, the physical and mental health toll of climate change is already affecting the health of everyone in America. In the absence of significant action, it is only projected to worsen in the future.

The reality is that climate change is a major threat to any vision of a healthy future. That is why the Robert Wood Johnson Foundation (RWJF), as part of its efforts to help build a Culture of Health in America, has made responding to the harms of climate change and trying to reduce contributions to climate change one of 35 measures used to track the nation’s progress toward a Culture of Health. The Culture of Health Action Framework was designed around four Action Areas. These include: 1) Making Health a Shared Value; 2) Fostering Cross-Sector Collaboration to Improve Well-being; 3) Creating Healthier, More Equitable Communities; and 4) Strengthening Integration of Health Services and Systems. Specifically, within the Creating Healthier, More Equitable Communities Action Area, we look at whether states have created and implemented Climate Action Plans (CAPs). Tracking the number of CAPs in place, unfortunately, tells us that not enough progress is being made.

The consequence of some states developing CAPs and others not is potentially greater health disparities. We know that, while everyone is impacted, climate change disproportionately impacts already vulnerable communities. People living in states without CAPs may fall even farther behind.

 What are climate action plans?

State-level CAPs are not the only step for successful climate response, but they are an important example of how we protect communities from environmental influences on health through public policy. CAPs outline a specific set of strategies and activities that a state will deploy to reduce their environmental footprint, with the goal of helping to curb climate change. By establishing standards for air quality, targets for emissions, or requirements for housing development—CAPs benefit the health of their residents now and in the future.

One of the goals of Maryland’s CAP was to create an “adaptation and response toolkit.” In the years since Maryland’s CAP was released, the state has developed a number of tools and structures to support coastal communities to plan for the impacts of climate change. For example, the CoastSmart Communities program connects planners in coastal communities to resources, trainings, and tools to address short- and long-term hazards, such as sea-level rise, flooding, and storm surge. 

Inequity in state-level climate action across the U.S.

In 2015, when RWJF first started tracking the presence of state-level climate action plans (CAPs), 34 states and the District of Columbia had CAPs.

Despite more record-breaking temperatures, diseases like Lyme and West Nile appearing in new parts of the country, growing algal blooms, and other environmental health threats made worse by climate change, the number of states with CAPs has not changed since 2015. 

Unfortunately, many states that do not have CAPs in place are also some of the most likely to experience negative impacts from climate change moving forward, with vulnerabilities similar to those in Maryland. Southern states like Louisiana and Mississippi, both without CAPs, are expected to suffer some of the highest increases in deaths due to extreme heat in the coming decades. In the Great Plains, states like Kansas and Nebraska do not have CAPs and are projected to suffer harm to humans and livestock due to increasing frequency and intensity of high-temperature extremes. 

Moreover, data from The Yale Program on Climate Change Communication show that this is not a result of residents not recognizing the risks—in fact, a majority of people in states without CAPs think that policy action should be taken on climate change—but rather a result of other factors such as lack of government engagement. 

Increasing climate impacts on health demand action

While the health impacts of climate change are well-established, local institutions are often not responding to the evidence fast enough. Leaders at all levels can use CAPs to make sure that climate change is central to how we assess progress on health—and how health leaders hold themselves to account.  We should build on efforts already underway to inspire local climate response and better link actions that have health, equity, and climate-related goals.

Learn more about the Culture of Health Action Framework at https://www.rwjf.org/en/cultureofhealth.html