States Take the Lead to Address Climate Change

Scientists agree that climate change poses a great threat to the environment, impacting people’s health directly and indirectly, and many states are rapidly taking steps to reduce carbon emissions. From seasonal allergies to heart and lung disease, the changing climate poses serious consequences for  vulnerable populations, specifically children, pregnant women, and the elderly.

At the National Academy for State Health Policy’s (NASHP) annual 2019 conference in August, environmental health pioneer Gary Cohen explained that states have a variety of ways to take action. For example, 24 states and Puerto Rico have joined the US Climate Alliance to advance the agenda of the Paris Agreement. They are tracking and reporting progress and creating new policies designed to reduce carbon pollution and promote clean energy at state and federal levels.

Some states have set goals more ambitious than those laid out by the Paris Agreement, and a recent NASHP analysis highlighted states’ commitment to addressing factors to mitigate climate change. For example, California set a statewide target to reach carbon neutrality by 2045, and New Mexico has a statewide goal to reduce greenhouse gas emissions by 45 percent of 2005 levels by 2030.

Here are some of the levers that states have employed to address the climate crisis.

Convening across Sectors

To ensure work is aligned across their state agencies, several governors have created multi-sector committees tasked with activities such as assessing their state’s climate impact, tracking their state’s climate action progress, and creating benchmarks to work toward to meet state policy goals.

• In June 2019, Maine Gov. Janet Mills signed bipartisan legislation to establish the Maine Climate Council, tasked with drastically reducing Maine’s greenhouse gas emissions by 2050. The multi-sector council includes policymakers, commissioners from agricultural, economic, environmental, transportation, health, and housing agencies, as well as other appointees who represent state interests affected by climate change. These members represent marine fisheries, municipal government, forestry, state tribes, organized labor, and more. The council will develop action plans to meet reduction goals by promoting jobs and economic benefits for Mainers in the transition to a low-carbon economy.
• In 2018, New Jersey Gov. Philip Murphy signed an executive order establishing an interagency Energy Master Plan Committee to create a blueprint for conversion of the state’s energy production to 100 percent clean energy sources by Jan. 1, 2050. The committee must include a senior staff person from the Economic Development Authority and departments of Community Affairs, Environmental Protections, Health, Human Services, Transportation, and Treasury.

• In May 2019, Washington Gov. Jay Inslee signed legislation establishing the Washington Disaster Resiliency Work Group, comprised of 30 individuals including lawmakers, tribal leaders, and representatives from state agencies, private entities, local municipalities, and the insurance industry. The group is tasked with reviewing Washington’s natural disaster resiliency activities and will make a recommendation to the state legislature and the governor on the progress and relevance of the program by November 2020. The governor also signed into law a suite of clean energy legislation requiring various state agencies to set benchmarks toward transitioning out of coal-powered electricity and becoming 100 percent carbon neutral and carbon-free by 2045. The policies outlined in this legislation are designed to reduce greenhouse gas emissions and super-pollutants, electrify the transportation infrastructure, create jobs, and ensure all workers and vulnerable communities’ health benefits from these changes.

Protecting Public Health, Environmental Justice, and Equity

Because the effects of climate change disproportionately affect certain communities, such as those living in poverty, tribal communities, children, and elderly people, states are paying particular attention to their needs.

• As part of Colorado’s roadmap to 100 percent renewable energy by 2040, in May 2019, Gov. Jared Polis signed into law a bill creating an office of just transition to deliver programming and funding to communities disproportionately impacted by pollution. The legislation directs funding to coal transition workers, which will allow them to access education and training to transition into new work opportunities. Colorado also is one of several states that allows public housing authority participation, through the Colorado Property-Assessed Clean Energy (C-PACE) program. The program enables property owners to finance clean energy improvements and other home energy efficiency projects through a special assessment on their property tax bill.
• The Hawaii Climate Change Mitigation and Adaptation Commission was established in 2017 to create “ambitious, climate-neutral, culturally responsive strategies” for climate adaption and mitigation. A subcommittee is charged with recognizing and addressing the inequitable distribution of benefits, burdens, and processes caused by climate change.
• Rhode Island Gov. Gina Raimondo has committed to achieving 100 percent renewable energy by 2025 and is requiring the state to fleet to purchase a minimum of 25 percent zero-emission vehicles by 2025. Rhode Island will also purchase up to 20 all-electric buses and will continue to install charging stations for electric cars. Every replacement of a zero-emission bus for a diesel bus is expected to eliminate nearly 230,000 pounds of carbon emissions a year. These zero-emission buses will be routed through asthma “hot-spot” zones to mitigate the effects of diesel emissions on the environment and on chronic health conditions.

Working with Health Systems to Mitigate their Emissions

The health care system contributes significantly to greenhouse gas emissions, smog formation, and other toxic pollutant emissions. As Cohen noted at the NASHP annual conference, if all the hospitals in the United States were a country, they would be the 13th-largest emitter of greenhouse gases in the world. States can play a role in reducing these emissions to mitigate the negative effects of climate change on health as regulators and payers. And, states have a public health opportunity as improving the health care system’s environmental performance would benefit everyone.

•  In 2008, under Massachusetts’ Determination of Need (DON) legal framework, the state adopted a requirement that new hospitals and major renovations within hospitals must meet established national green (LEED Silver requirements) building standards. Massachusetts uses the DON process to promote population health and support development of innovative health care delivery methods while ensuring resources are reasonably and equitably available in the state. This hospital DON requirement is designed to save energy, reduce hospital emissions, and protect the health of patients, visitors, and staff.
• The Community Health Needs Assessment (CHNA) process – federally required of all tax-exempt hospitals – provides an opportunity for communities to identify their greatest health priorities, many of which are affected by the changing climate. Many state requirements for community involvement in the CHNA process go beyond those at the federal level, and states are also aligning hospital community benefits investments with broader state health priorities, which can include climate change.
• More than 1,400 hospitals and health systems across the country have joined the Healthier Hospitals coalition to address the health and environmental impacts of their sector. Members are committing to reduce their greenhouse gas emissions and are taking steps to become carbon neutral. States can look to these Healthier Hospitals care systems as leaders in addressing their impact on the environment.

A World Health Organization report, Health and Climate Change, details the health benefits gained by addressing climate change, including the potential to improve air and water quality, food security, and reduce risks of extreme weather. While there is more work to do to comprehensively address the harmful effects of climate change on health, states and health systems are continuing to work on innovative solutions to mitigate its effects.