Climate affects both physical and economic health of people and states. Extreme weather and climate events cost the U.S. $603 billion and resulted in 1,996 premature deaths from 2019 to 2023. Reports from the National Oceanic and Atmospheric Administration (NOAA) show that states in the South, Central, and Southeast regions have experienced the highest cumulative costs from 1980 to 2023.
The health sector contributes significantly to climate impacts and plays a major role in responding and building resilience to extreme weather events. Health leaders are amplifying calls to prevent and mitigate the effects of climate and extreme weather events through reducing the carbon footprint of the health ecosystem and promoting environmentally preferred practices. For example, the National Academy of Medicine’s Action Collaborative on Decarbonizing the U.S. Health Sector and the Agency for Health Care Research and Quality provide actionable, evidence-based strategies for reducing the sector’s carbon footprint impact while building resilience. Initiatives such as Practice Greenhealth feature collaborative commitments by health care organizations to implement sustainable practices that protect the health of patients, staff, and communities.
In addition to these contributions, states are leveraging cross-sector partnerships, health payer strategies, clean energy plans, data tools, and environmentally focused legislation to address the growing effects of climate and extreme weather events while mitigating future impacts.
NASHP hosted a cross-sector group of state officials from Maine, South Carolina, Alabama, Wisconsin, Louisiana, Washington state, Connecticut, Minnesota, Arizona, Utah, Massachusetts, and Oregon to exchange best practices, strategies, and resources to advance health policy in prevention and remediation the impacts of climate and extreme weather events. Discussion was informed by national subject matter experts and focused on three areas of policy: payment and financing mechanisms, data-driven policies, and cross-sector collaboration.
Payment and Financing Strategies: Aligning Resources for Climate and Extreme Weather Resiliency
States have a variety of payment levers to implement policy innovations that can address the effects of climate and extreme weather. Examples of strategies are detailed in the table below.
Payment and Financing Levers
| Strategy | Example |
|---|---|
| Medicaid 1115 Demonstration Waivers | Oregon has started to implement its approved 1115 Medicaid Waiver to provide air conditioners, air filtration systems, and other devices for Medicaid beneficiaries during climate events declared by the governor or federal government. This demonstration waiver falls within the scope of the Centers for Medicare and Medicaid Services’ new initiative to address health-related social needs. |
| Medicaid Incentive Payments | The Washington State Health Care Authority, which administers the state’s Medicaid program, has added an incentive payment for hospitals completing a survey on climate adaptation and mitigation in 2022 and a survey on greenhouse gas reporting in 2023. |
| Public-Private Partnerships and Investments | The Connecticut Department of Insurance is partnering with the state’s Green Bank to effectively use climate-smart technology to help people with a higher likelihood of experiencing poor health effects due to extreme weather remain in their apartments with access to power during these climate events. This would ensure they can remain in a comfortable environment with access to electric-powered medical devices and refrigerated medications (e.g., insulin). |
The discussion also focused on aligning investments to achieve health policy, community resilience, and energy-related goals. Federal investments, including those from , the Centers for Disease Control and Prevention’s Climate-Ready States and Cities Initiative, and the Low-Income Home Energy Assistance Program could be leveraged for a whole-of-government approach, complementing Medicaid and public health investments.
Using Data to Visualize and Communicate the Impacts of Extreme Weather on Communities and Population Health
Policymakers can access community-level data to understand the implications of extreme weather and climate by:
- Informing cross-agency collaboration toward common policy agendas
- Creating multipurpose state-based data platforms for decision-making and communication with partners
- Helping communities make informed decisions about health as it relates to their infrastructure priorities
For example, ClimaWATCH (Climate and Weather Analytics, Trends and Community Health), developed by Mathematica, facilitates community heat vulnerability assessments via a dynamic dashboard tool designed to identify heatwave impact on communities; assess vulnerability based on demographic, social, environmental, and infrastructural features; and quantify excess health service use and spending in Medicaid attributable to heatwaves.
Data Tools
Massachusetts
Massachusetts’Environmental Justice tool, Environmental Public Health Tracking website, and Emergency Preparedness Populations Planning Tool provide interactive mapping layers to overlay health conditions with environmental, demographic, and population vulnerability data to help communities make informed decisions regarding mitigation and adaptation in response to climate and extreme weather events. Data can also be used to evaluate the potential benefits of climate adaptation.
Identifying Cross-Sector Partnerships to Drive Innovation at the Intersection of Climate, Extreme Weather, and Health Policy
Intentional partnership among state agencies with a role in health, climate, and extreme weather-related policies and programs can catalyze collaborative action to address individual and community health and resilience affected by shifting climate conditions and extreme weather events. Mapping intersecting goals, data resources, funding requirements, and extra state partner engagement efforts (e.g. communities, private sector) is key to a comprehensive state approach.
Connecting the Health and Energy Sectors
Partnerships between health and energy sectors can inform policy decisions, as well as aligned investments and connections with community.
- The energy sector produces emissions that can negatively impact human health and the environment. Emissions can exacerbate disparate health outcomes such as childhood asthma, and the cost of utilities exacerbate financial inequities. More energy-efficient homes can help residents save on energy costs while also making homes healthier.
- Hospitals offer another key intersection between energy and health. The health care ecosystem is a contributing source of pollution and emissions. There are opportunities to improve hospital energy efficiency, while also supporting hospital investments in the communities they serve to improve health outcomes and boost community resilience.
The following examples highlight different state approaches to cross-sector partnerships, including public-private advisory councils, public health literacy programs, and community engagement.
Minnesota
Minnesota’s Department of Commerce oversees the insurance, banking, and security industries, along with an energy division, and is leveraging its unique structure to understand cross-sector opportunities to address the nexus of health and extreme weather. This includes participation by the Department of Commerce in the Governor’s Climate Subcabinet and creation of a Climate Action Framework, which resulted from cross-sector collaboration and community input; using the social cost of carbon when making utility regulations; and considering the health and social impacts of natural disasters, especially the mental health effects.
Cross-Sector Partnership
Among these states, cross-sector partnerships are aligned around promoting community resilience, both in terms of social resilience and more resilient physical infrastructure:
Massachusetts
Massachusetts’ whole-of-government approach to address climate and extreme weather is driven by an initiative from the state’s climate chief, the first cabinet-level position of its kind in the U.S. The initiative established climate officer positions for each agency to promote climate in all policies. Among Executive Office of Health and Human Services agencies, the Department of Public Health and MassHealth, the state’s Medicaid program, are collaborating on ways to establish a health literacy strategy to minimize the health-related effects of climate and extreme weather. “Recommendations of the Climate Chief” provides additional detail on collaboration related to public health and resilience, as well as how the state is incorporating a climate-in-all-policies approach across government.
Alabama
Alabama is developing a broader community resiliency strategy aimed at empowering communities with information before climate and extreme weather events to mitigate risks and improve post-event recovery. The Alabama Resilience Council was created by a governor’s executive order in May 2023. It is composed of state agencies, nonprofits, and private partners and is guided by five principles that promote proactive integration of public and private resources, reinforced infrastructures, and policies and programs that promote innovation at individual and community levels.
South Carolina
South Carolina’s Department of Insurance is collaborating with Coastal Carolina University to understand the factors that prohibit healthy, equitable, and resilient recovery in communities after extreme weather events. Recovery after extreme weather is difficult due to factors such as mold, water contamination, and inaccessible home and flood insurance. South Carolina recognizes the need to build trust with the communities the state is engaging with — communities have expressed frustration and feel disrespected by lack of action to address the barriers to recovery.
Key Takeaways
Extreme climate and weather events — such as flooding, heat domes, and wildfire smoke that results in poor air quality — are likely to continue in the U.S. and across the globe. States can leverage emerging financing and payment strategies, data-driven policymaking, and cross-agency collaboration to address growing climate-related impacts. These efforts can help improve community recovery after extreme weather events.
States can also take important steps to engage communities through public health education, health promotion, and data-sharing to improve trust, respect community knowledge and cultural ties to land, and promote resilience. NASHP will continue to support state officials as they explore policies addressing climate, extreme weather, and health. Please contact Megan D’Alessandro with any questions.
Acknowledgements
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation. Thank you to state officials from Alabama, South Carolina, Oregon, Washington, Massachusetts, Connecticut, and Minnesota as well as Mathematica staff for providing insights about climate resilience strategies across states.
