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Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief (2022)

Chapter: Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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images Proceedings of a Workshop—in Brief

Communities, Climate Change, and Health Equity—State-Level Implementation

Proceedings of a Workshop—in Brief


INTRODUCTION

Climate change is exacerbating unjust health disparities and disproportionate environmental burdens experienced in communities across the United States. Because of historic and ongoing discriminatory policies and practices, certain populations—namely people of color, Indigenous people, and low-income communities—disproportionately suffer from the adverse impacts of extreme weather and other disasters that are exacerbated by climate change.1

Given that much of the authority for addressing issues at the intersection of climate change, health inequity, and environmental justice rests at the state level, the two-day virtual workshop Communities, Climate Change, and Health Equity—State-Level Implementation was held on May 24 and 26, 2022. It brought together representatives from state and federal agencies, universities, community-based organizations, state and national advocacy organizations, foundations, and private sector organizations to examine community-driven and state-level actions that could help improve climate-related health outcomes in disproportionately impacted communities. For additional details on potential actions suggested by workshop participants, see the table at https://www.nap.edu/resource/26693/ActionActorsTable. The workshop was organized by an ad hoc planning committee of the Environmental Health Matters Initiative, a program spanning all major units of the National Academies of Sciences, Engineering, and Medicine that facilitates multisector, multidisciplinary exchange around complex environmental health challenges. The event, the second in a series, built on the October 2021 workshop Communities, Climate Change, and Health Equity—A New Vision, which provided an overview of how changing climate conditions exacerbate health inequities in communities across the United States.2

Workshop planning committee chair Jeanne Herb (Rutgers University) opened the event by summarizing the key themes of the first workshop, which can be seen in more detail in Communities, Climate Change, and Health Equity: Proceedings of a Workshop–in Brief.3

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1 National Academies of Sciences, Engineering, and Medicine. 2022. Equitable and Resilient Infrastructure Investments. Washington, DC: The National Academies Press. https://doi.org/10.17226/26633.

2 See https://www.nationalacademies.org/event/10-12-2021/communities-climate-change-and-health-equity-a-new-vision-workshop-1 (accessed July 12, 2022).

3 National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/26435.

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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She described a common recognition among participants in the first workshop that climate change is a public health emergency, and that there is a need for climate adaptation and mitigation solutions that assertively include and prioritize those communities that bear the greatest burdens, known often as “frontline” or environmental justice communities. “We left with a vision that [for] equitable climate action, in the words of one of our workshop presenters, it is not enough to bounce back from one crisis to another—we also need to address the root causes to be able to bounce forward,” Herb said. Participants in the first workshop discussed a range of possible solutions and potential challenges to implementing them, such as how policies or bureaucratic processes that take a one-size-fits-all approach (treating frontline communities the same as more affluent communities) often fail to direct benefits proactively to the communities that need them most. Several participants in the first workshop also stressed the need for effective processes to ground strategies with the people who know their communities best, though they noted that even well-meaning efforts to add seats to the table for voices from frontline communities can end up falling short.

The second workshop took a deeper look at specific state-level challenges, strengths, and opportunities, particularly related to the deeper integration of health equity into climate programs and consideration of climate justice in public health programs. It had the following objectives:

  • Identifying strengths of and lessons learned from current state-level approaches—both legislative and executive—and challenges to improving those approaches, particularly with respect to partnering with communities.
  • Identifying challenges and opportunities in developing state-level approaches, particularly with respect to implementation of recent federal bills.
  • Identifying opportunities for decision makers, leaders, and stakeholders at the state level to build trust and partner with communities and vice versa.
  • Identifying accurate and equitable methods for evaluating and expanding essential, successful, and transformational policies.
  • Fostering connections and sharing of traditional/cultural, Indigenous, scientific, and community knowledge to help identify multisector approaches.

The workshop’s first day focused on community-driven climate and health equity action at state and local levels. It included panel presentations from leaders who described work in their states as well as interactive breakout sessions in which participants focused on key concerns of frontline communities, public health capacity, and example strategies to promote systemic change. The workshop’s second day focused primarily on state government innovations and challenges in advancing health equity and climate action. After an overview of climate laws in several states, breakout sessions focused on measurement and evaluation, government engagement with communities, how federal incentives can enable or hinder states, and lessons learned from the COVID-19 pandemic.

This Proceedings of a Workshop—in Brief provides a high-level summary of the workshop presentations and discussions. Additional details can be found in materials and videos available online.4 Although the proceedings highlights potential opportunities for action, these should not be viewed as consensus conclusions or recommendations of the National Academies.

COMMUNITY-DRIVEN ACTION

The workshop’s first day focused on community-driven action. Jackie Qataliña Schaeffer (Alaska Native Tribal Health Consortium) moderated a panel discussion examining conditions that may help to advance frontline community-driven action to address climate impacts and improve health equity in both state and local policies and systems. Following the panelists’ remarks, attendees were invited to participate in interactive breakout sessions to delve deeper into the issues raised and elicit suggestions for future efforts.

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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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Panel Discussion

The panelists shared their views on how local participation is essential to identifying issues clearly and implementing changes via legislation and other means. Ana Baptista (The New School) described her work with communities in her hometown of Newark, New Jersey. Baptista’s community and a coalition of advocates with the New Jersey Environmental Justice Alliance helped pass a landmark environmental justice law in 20205 that limits industrial pollution in neighborhoods with a high concentration of people of color, low-income households, or residents who do not speak fluent English. As part of this multiyear effort, she said it was important that local advocates defined their own environmental justice community instead of leaving that to the state to determine.

While extreme events like floods might attract attention, many communities experience impacts from climate change on a continual basis and not just during disasters. Amee Raval (Asian Pacific Environmental Network [APEN]) described how APEN, a grassroots organization that works with Bay Area communities of Asian immigrants and refugees, is working to build climate resilience in Richmond, California, where residents face chronic air pollution, oil spills, heat waves, power outages, and wildfire smoke. Traditional emergency responses may be inadequate for this specific community because emergency plans rely on faraway sites such as fairgrounds and do not always share alerts or information in the languages spoken in the community. APEN is advocating for efforts to bolster the community’s social fabric and infrastructure through targeted investments in schools, libraries, parks and recreation sites, and community organizations like youth and senior centers. For example, Raval said APEN has been working to turn Richmond’s RYSE Youth Center into a youth-led Climate Resilience and Liberation Hub to serve as a place where residents can find respite from refinery pollution, wildfire smoke, and heat waves.

Health is closely connected with the natural environment. Natasha DeJarnett (University of Louisville) described how partnerships between researchers and communities can help to advance local action that is responsive to community perceptions and preferences. As an example, she pointed to the Green Heart Project, a partnership involving communities in Louisville, Kentucky; the University of Louisville; the National Institute of Environmental Health Sciences; the Nature Conservancy; and several other organizations. The project focuses on increasing green space in an effort to reduce disproportionate exposures to air pollution experienced in certain neighborhoods. Strong community engagement helped organizers design a tree-planting effort that was aligned with community needs. For example, when organizers learned that some residents were concerned about having to deal with raking leaves and other aspects of tree maintenance, they decided to use trees that do not drop their leaves and also created a community assistance fund to help with maintenance costs.

Breakout Discussion

Workshop participants were each invited to join a moderated breakout session in one of nine breakout rooms focused on the following aspects of community-driven action: needs of frontline communities, state public health capacity, local public health capacity, short-term opportunities, systemic change, federal action, principles for engagement, a just transition in states, and collaboration with tribes. After the first breakout session, participants were invited to move to a different breakout room for a second breakout session. Participants then reconvened, and each session’s moderator shared key themes and suggestions for action that emerged during the discussions, which are summarized below and in a table at https://www.nap.edu/resource/26693/ActionActorsTable.

Facilitating community-driven action

Several breakout discussions touched on principles and approaches for effectively facilitating community-driven action. Many participants said it is important for communities to articulate their own needs and issues and for governments, researchers, or other organizations to form co-equal partnerships with communities to drive action rather than imposing action “from the outside.” Focusing on building up community-based organizations can help communities to identify key goals, reduce reliance on external organizations, and foster the next generation of advocates and professionals within those

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5 Environmental Justice Bill SB232 § Title 13 (2020). https://pub.njleg.gov/bills/2020/S0500/232_U2.HTM.

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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communities. To inform priorities and approaches, several participants noted the importance of drawing upon knowledge within the community, recognizing that this may involve different ways of knowing or different ways of approaching problems; for example, Indigenous communities may have a more holistic understanding of the community’s relationship with the environment and may not constrain activities within “projects” the way government and nongovernmental organizations often do.

Many breakout discussions examined the role of structural racism in the health and environmental inequities communities are facing. To recognize this and the barriers it can pose for co-production of knowledge and action, some participants suggested approaching action with an intersectional lens, with attention to histories of native trauma, racism, and discriminatory policies, including on the part of the U.S. federal government. In some cases, restorative justice (e.g., with government bodies that have promulgated discriminatory policies or with industries that have a history of causing disproportionate pollution or other adverse impacts in the community) may be necessary before communities can truly engage as co-equal partners. In other cases, it may be important to attend to issues such as a lack of access to healthy food or other basic necessities, which can undermine community capacity. A common participant suggestion was that states could integrate a racial equity framework into all efforts at the interface of climate change and health equity.

When actors not from frontline communities—such as state agencies, academics, or many nongovernmental organizations—build trust with communities through transparency, honesty, and practical measures such as language interpretation, it can help to facilitate community-driven action. This takes time; as Deborah “Kim” Gaddy (Clean Water Action) noted, “We move at the speed of trust.” To support this critical relationship-building process, it can be useful to find areas of common ground that can create entry points and lift up those who are already trusted messengers and changemakers within the community. “You don’t have to start by talking about climate change and health. You could talk about something that you all care about or something that’s very important to the community […] then down the road if you learn more about each other you can really start addressing climate change and health,” said Kate Robb (American Public Health Association). “You really need to build trust and listen to folks who are on the front lines—who are community members, who are doing this work, who are trusted messengers—and really follow their lead.”

Enabling cross-sector collaboration

The importance of coalition-building was another common theme among breakout groups. Many participants stressed that collaboration across sectors—governments, businesses, community groups, nongovernmental organizations, researchers, and others—can be essential to advancing actions that help communities mitigate and adapt to climate change while improving health equity. This includes partnerships with nontraditional stakeholders who may have been left out of previous efforts. “When you reach ‘the table,’ you look around and see who’s not there,” said Adrienne Hollis (Hollis Environmental Consulting). “You have to think nontraditionally [about] who may have input or who may be impacted or who may have a different perspective that could bring more value to that whole engagement process.”

In particular, many participants underscored the importance of involvement from (and connections between) community-based organizations; local officials; health departments; environmental, land use, and transportation planning bodies; and industries such as construction and transportation. To better incorporate climate into health equity policy implementation, build agencies’ capacity to engage communities, and build communities’ capacity to speak with their own voice, a number of participants suggested that the Centers for Disease Control and Prevention (CDC) could play a lead role at the federal level and that agencies such as the Environmental Protection Agency, Department of Transportation, Department of Energy, and Department of Health and Human Services could provide guidance to state partners.

Driving incremental and systemic change

In articulating their vision for systemic changes to benefit communities suffering disproportionate climate impacts, several participants posited that health equity

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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should be integral to all climate policies moving forward, known as a “health in all policies” approach. Putting health at the center of these efforts changes the focus and can bring in different stakeholders who have not traditionally engaged in climate action. Similarly, several participants noted that a just workforce transition should be an integral part of climate action; they specifically suggested that state and local government officials can be instrumental in investing in relationship-building with communities and industries and creating pathways to transition workforces over time.

The drivers of climate change are multifaceted, and mitigating and adapting to climate change involves a broad range of activities at multiple levels. A number of participants noted that infrastructure and housing can strongly influence both future emissions and how climate change impacts will be felt in communities. For example, an opportunity remains for weatherization and other approaches to improve energy efficiency in buildings, especially in low-income housing; agencies such as the Department of Housing and Urban Development and CDC could invest in such activities. This example also underscores the importance of collaboration involving parties who may not traditionally perceive health equity or climate change as part of their purview. “For systemic change, it has to be incorporated across the culture […] with time, we will all see ourselves in this space and how our work connects,” said DeJarnett. On the part of communities, some participants noted that political engagement, specifically through voting and the protection of voting rights, is an important driver of incremental changes that can lead to systemic change. “Systemic change is incremental change,” said DeJarnett. “This is the marathon and not the sprint.”

Building knowledge and awareness

Informing local-scale action can be improved via the use of local-scale data. Several participants highlighted important gaps in available data relevant to the climate risks and health impacts faced in particular neighborhoods; even county-level health data, for example, may not reflect important trends at the neighborhood level. To address this gap in order to help guide priorities and inform decision making, one participant suggested that county or state public health agencies could partner with hospitals to access more neighborhood-level data. Several participants suggested that additional tools are needed to collect and access data relevant to understanding climate risks, vulnerabilities, population sensitivities, and adaptive capacities at the local level. In addition to enhancing the collection of these types of data, a participant suggested that government agencies should focus on sharing and displaying data in ways that can make them more meaningful to communities and decision makers.

Building awareness and effectively disseminating information about the impacts of health inequities and the climate crisis are also useful in facilitating community-driven action. Several participants pointed to a need to identify and partner with trusted messengers within communities and to incorporate health equity, environmental justice, and climate impacts into educational curricula—from pre-K to medical school—to lay the groundwork for community engagement and behavioral change. This could help increase awareness of the drivers of climate change and how individual decisions, such as moving toward a more plant-based diet, can help mitigate climate change. Some participants suggested a continuous communication campaign to highlight the health equity impacts of climate change that could be funded by federal and state governments, foundations, and the private sector. Several participants emphasized the importance of engaging young people, both through formal education (which includes involvement on the part of educators, administrators, and school boards) and with activities such as school gardens that involve the broader community (which can benefit from donations, funding, or volunteer effort from businesses and community groups). They also pointed to the need to educate decision makers about the climate and health equity issues communities face; one participant suggested that public health professionals could help raise awareness by writing op-eds about the connections between climate and health.

Informing funding strategies

Funding can support effective and sustained action at the intersection of climate and health. Many participants

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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underscored the need for adequate funding to incentivize and support community-driven initiatives, including funding to enable governments, researchers, and organizations to engage with communities; funding to build capacity and provide technical support at the local level, especially in environmental justice communities; and funding to compensate communities for their time and contributions to these efforts. One participant encouraged particular attention to providing funding for engagement with tribal groups, without restricting this funding to tribes that have obtained official federal recognition.

Some participants suggested that funding could come primarily from the federal government and from nongovernmental organizations. Some noted that the new federal infrastructure bill could be one vehicle for funding this work but emphasized that federal agencies should provide guidance to state and local implementers to ensure accountability. Several participants suggested that federal funders could require community engagement as part of federal grants in order to make community-driven approaches an integral feature of federal investments in climate research and action. To support training and work at the intersection of climate and health equity on the part of community health workers and state health departments, several participants suggested that funding could come from the federal government (particularly CDC) and from states.

Some participants expressed concerns about companies in industries such as oil and gas funding initiatives to address climate and health equity, since the interests or legacy of such companies may not always be aligned with the interests of communities. This underscores the importance of transparency and, in some cases, restorative justice to lay the groundwork for establishing co-equal partnerships. One participant also suggested that communities should focus on investing in their own infrastructure, based on their particular strengths and priorities, in order to build resilience and reduce their reliance on external assistance, which can disappear quickly as the political environment changes. Finally, to ensure best practices and support accountability, a number of participants said it is important to employ appropriate guidelines and adequate guardrails to ensure funding is used appropriately and in alignment with community needs and priorities.

STATE-LEVEL INNOVATIONS AND CHALLENGES

Herb set the stage for the workshop’s second day by outlining trends in state climate laws. She highlighted examples of how state government actions have become more focused on creating concrete paths to emissions reduction; advancing community-oriented and community-driven actions designed specifically to benefit historically disadvantaged groups; facilitating just transitions to a clean energy economy; and advancing health equity.

In contrast to an earlier wave of state climate laws passed in the mid 1990s and early 2000s, which focused on statewide goals, capital investments, and voluntary planning provisions, many states are now moving beyond aspirational targets toward enforceable limits. As part of this, states are updating statewide emissions and clean energy targets from early laws to reflect the latest science. For example, Herb noted that Massachusetts has made updates to emissions limits for electric power, industrial processes, and natural gas distribution. In New York, new legislation allows the state’s Department of Environmental Conservation to establish and enforce limits on greenhouse gas emissions.6 States are also incorporating changes in utility regulations to promote equity and advance clean energy goals, and statutory efforts in several states specifically require that benefits be directed to frontline communities. For example, New York’s 2019 Climate Leadership and Community Protection Act7 requires the state to invest or direct resources so that disadvantaged communities receive at least 35 percent—with the goal of 40 percent—of clean energy and energy efficiency investments. In Washington, state law requires utilities to develop a process to receive public feedback and assess the impacts of their operations on frontline communities.

Reiterating a major theme from the first workshop in this series, Herb stressed the importance of focusing actions on geographic locations and demographic

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6 See https://www.dec.ny.gov/docs/administration_pdf/revrissum496.pdf (accessed July 21, 2022).

7 Climate Leadership and Community Protection Act SB6599 § Environmental Conservation Law (2019). https://www.nysenate.gov/legislation/bills/2019/S6599.

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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sectors that face disproportionate burdens from climate change because of unjust historic and ongoing policy that leads to disenfranchisement and oppression. She said that recent state climate laws have increasingly been driven by grassroots, cross-sector coalitions and focus on the connections between climate and health equity. For example, several state laws include provisions that recognize and are designed to address the longstanding, disproportionate burden of air pollution in certain communities. An air quality monitoring program mandated in New York led the state to identify 10 communities with a high air pollution burden; the state subsequently launched a collaborative effort with community-based organizations to support mobile air screening and data collection in these communities. Similarly, the state of Washington is working to identify overburdened communities in which to expand air monitoring networks, and California agencies are now required to prioritize the most polluted communities for air monitoring and air pollution reductions and impose higher penalties on polluters that exceed limitations in areas with more vulnerable populations.

States are also aiming to support workforce transitions for communities whose income has historically been dependent on fossil fuels, for example by supporting workforce development opportunities for residents of frontline communities to participate in and benefit from the clean energy economy. The Illinois Climate and Equitable Jobs Act8 is one of the most far-reaching state laws focused on this, Herb said. Among other provisions, the law creates hubs to facilitate collaboration among frontline communities and the organizations they trust to conduct outreach to residents, increase awareness of workforce development programs, and support residents’ ability to enter the career pipeline for clean energy jobs.

Recent state climate actions are also increasingly centered on health. In Massachusetts, a 2050 roadmap that informed the state’s adoption of its most recent climate law found that achieving net-zero emissions will deliver significant benefits to residents, including a drop in air pollution, particularly in environmental justice communities currently overburdened with poor air quality, resulting in an estimated health cost savings of $1 million per year by 2030.9 Finally, the new wave of legislation has brought a growing trend toward participatory processes leading to state policy. In fact, Herb shared that some state laws require highly participatory processes. In New York, the state’s leadership established a 22-member Climate Action Council that developed a plan to implement the state’s climate act. In Washington, the Environmental Justice Council advises on the development of the state’s environmental health disparity map, which helps drive the state’s climate policies.

Panel Discussion

During the panel presentations, speakers highlighted lessons from state government climate action in California, Maryland, and Illinois. Linda Rudolph (Public Health Institute) discussed recent efforts in California to develop a scoping plan outlining actions for all sectors over the next 5 to 20 years. She said that the proposal being supported by the California Air Resources Board (CARB) staff is not aligned with the most aggressive targets, nor does it optimize the health benefits because it lacks a mechanism for integrating health and health equity analysis into the development of proposed solutions. As a result, the plan promoted by CARB relies heavily on unproven and expensive technology, like carbon capture, utilization and storage, while also allowing for new fossil fuel infrastructure. She suggested modeling advocacy campaigns after public health–based campaigns that drove past changes in areas such as tobacco control and auto safety, so as to counter the narrative of the fossil fuel industry and move in a direction that stops new investment in fossil fuel infrastructure while prioritizing health.

Sacoby Wilson (University of Maryland) discussed the Maryland Climate Solutions Now Act,10 which calls for a 60 percent reduction of emissions by 2031 and for the Maryland economy to generate zero emissions by 2045. The law, which is more ambitious than any

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8 Climate and Equitable Jobs Act SB2408 § Article 5. Energy Transition (2021). https://www.ilga.gov/legislation/publicacts/102/PDF/102-0662.pdf.

9 See https://www.mass.gov/doc/ma-2050-decarbonization-roadmap/download (accessed July 21, 2022).

10 Climate Solutions Now Act of 2022 SB0528 § Article II, Section 17(b) (2022). https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0528.

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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previous legislation passed by a U.S. state, includes provisions to transition existing buildings to meet new energy performance standards and to use electricity rather than fossil fuels for heating and cooking. It also provides resources to help schools transition to net-zero emissions and convert school bus fleets to zero-emission vehicles. To target the state’s investments toward the communities that need them most, Wilson and colleagues helped to guide how the state commission will define underserved and overburdened communities when establishing goals for giving out state funding and developing strategies to reduce greenhouse gas emissions in communities designated as disadvantaged or environmental justice communities.

Carol Hays (The Strategic Collaboration Group) discussed Illinois’ Future Energy Jobs Act,11 passed in 2016, which laid the groundwork to expand solar energy in the state with an emphasis on job creation. The legislation was propelled largely by policy-oriented environmental organizations based in Chicago, and developments since the law’s enactment illustrate how coalitions can remain involved even after legislation passes. To expand on the legislation, the Strategic Collaboration Group developed what they call a “Listen. Lead. Share.” approach to identify what it would take to get various groups on board with further clean energy action. This helped to build relationships so that community members have an ongoing opportunity to interact with those in the policy space. In these efforts, Hays said it was important to go beyond listening by inviting people to share their leadership and vision of what they wanted to see in their community and across the state, and to take capacity building beyond providing resources to focus on helping frontline organizations learn about clean energy and become strong advocates themselves. This process created a very broad, diverse coalition of more than 200 organizations that worked together across the state on various initiatives, including advocacy for the subsequent Climate and Equitable Jobs Act.12

Looking at these various efforts across states, panelists highlighted the importance of identifying ways to bridge climate legislation to other benefits, such as job opportunities and the clean energy economy. Connecting climate change with health is also important for pushing forward state legislation. This involves looking at how improving climate-friendly infrastructure can improve health outcomes and reduce health disparities, with a focus on the most vulnerable populations. In addition, Wilson said that regional approaches can help widen the impact of state-based legislation, pointing to the MidAtlantic Justice Coalition as an example, which works on environmental justice issues across Virginia; Washington, D.C.; Maryland; and Delaware.

Breakout Discussion

For the second day’s breakout discussion, workshop participants were invited to join one of nine moderated breakout sessions focused on the following topics related to state-level climate action: federal mandates and incentives, community-driven measurement and evaluation, government measurement and evaluation, government engagement with communities, whole-of-government approach, lessons learned, systemic change, health as an enabling framework for climate action, and government capacity and lessons learned from COVID-19. Each session’s moderator then shared key themes and suggestions for action that emerged during the discussions, which are summarized below and in a table at https://www.nap.edu/resource/26693/ActionActorsTable.

Building coalitions and facilitating collaborative action

Addressing climate change and health equity can benefit from coalitions and collaborative action to leverage programs, people, and funding for greater impact. To attract partners and build coalitions, one participant noted that it is critical to articulate a vision clearly and make a compelling case for it. The vision and desired outcomes determine who should be brought to the table, since who participates depends on the issues involved.

Many participants pointed to community engagement as a crucial component of collaborative climate action, and some suggested that funders of climate initiatives could require community engagement and the demonstration of engagement through appropriate metrics. However, other participants noted that not all partnerships must

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11 Future Energy Jobs Act SB2814 § Public Act 99-0906 (2016). https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099-0906.

12 Climate and Equitable Jobs Act SB2408 § Article 5. Energy Transition (2021). https://www.ilga.gov/legislation/publicacts/102/PDF/102-0662.pdf.

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×

be driven by communities; federal, state, business, and other stakeholders can all potentially play a lead role. In either case, several participants underscored the importance of bridging silos through cross-agency collaboration on a day-to-day basis (beyond holding occasional meetings or simply sharing data), as well as facilitating cross-sector collaboration by engaging community-based organizations and the business community. Pointing to the COVID-19 pandemic response as an illustrative example of the value of building partnerships to bridge gaps across agencies and sectors, a number of participants suggested that state and county public health departments and community-based organizations could learn from the COVID-19 experience to form partnerships for a “health in all policies” approach to addressing climate change. Several others suggested bringing in partners beyond those that have traditionally engaged in climate action, such as transportation departments or federally qualified clinics that work with communities.

One participant suggested that formal structures may be needed to mandate and facilitate sustained interagency collaboration and robust and authentic community engagement, citing California’s Strategic Growth Council13 and Transformative Climate Communities program14 as examples. Formal structures can be important to overcoming common barriers such as a lack of bandwidth among state agency staff or a perception that communities lack the expertise to engage on health issues. Several participants suggested that state agencies, state administrators, and legislators could lead efforts to create these structures, and some suggested that coordinating bodies could also be important for building broad coalitions and sustaining engagement on an ongoing basis.

Identifying priorities and strategies

Priorities for climate action often emerge from the community level, while the climate action programs that state governments implement often come from the federal level. Participants considered ways to enhance states’ capacity to implement federal policies and state-level initiatives in ways that are aligned with community needs.

The federal government has taken important steps in incentivizing and funding state-level climate action. Examples include the Justice40 Initiative,15 which aims to deliver 40 percent of benefits from federal investments in climate and clean energy to disadvantaged communities, and the Infrastructure Investment and Jobs Act,16 which provides funding to increase infrastructure resilience in the face of climate impacts and encourage the shift to cleaner energy sources, among other goals. While such developments are welcome news, some participants said that states need more tools and guidance to make best use of the resources and implement federal policies in alignment with goals for health and environmental equity. For example, states could benefit from screening tools (contextualized to each state) to identify priority needs; scorecards and tools for tracking the use of funds and the types of communities benefitting from the investments; and consortia and “capacity hubs” to help states and cities exchange information and models, learn from each other, and cooperate on shared goals. In particular, some participants suggested that the White House, Department of Health and Human Services, and the Council on Environmental Quality could provide more guidance to states on the implementation of Executive Orders, while organizations such as the U.S. Conference of Mayors and the National Governors Association could facilitate consortia to facilitate exchange among state and local governments.

Research connecting climate mitigation, adaptation, and resilience with health outcomes could also help to inform transformative action. A number of participants said that academic researchers, government agencies, chambers of commerce, scientific societies, foundations, and

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13 See https://sgc.ca.gov/ (accessed July 14, 2022).

14 See https://sgc.ca.gov/programs/tcc/ (accessed July 14, 2022).

15 See https://www.whitehouse.gov/environmentaljustice/justice40/ (accessed July 21, 2022).

16 U.S.C. Infrastructure Investment and Jobs Act HR3684 Public Law 117-58 (2021). https://www.congress.gov/bill/117th-congress/house-bill/3684/text.

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×

communities all have important roles in conducting and supporting research to advance understanding of, and approaches to, the nexus of climate, water, and health.

Finally, in bringing people together around these issues and navigating relationships between communities and various industries and government bodies, one participant noted that it can be important to recognize the legacy of slavery, stolen lands, and racism and to address complex issues such as the privatization of food systems and how this interacts with climate and health. Another participant emphasized that state environmental departments need dedicated staff and funding to truly achieve meaningful community engagement, particularly with rural communities who have often been overlooked.

Devoting and leveraging resources

Achieving meaningful progress can be linked to the availability of adequate resources. The COVID-19 pandemic led to a large influx of resources for public health infrastructure. While this infrastructure has been essential to the pandemic response and can potentially be instrumental in addressing health impacts of climate change, some participants expressed a fear that it could go away once pandemic funding streams become dry. Others noted that the urgency of the COVID-19 response resulted in some agency staff and resources being redirected away from climate work, potentially slowing progress.

Looking ahead, participants discussed how states and community-based organizations can leverage partnerships in new and creative ways to get more mileage out of investments in public health infrastructure and climate initiatives. As one example, states could prioritize contracts benefitting overburdened or disadvantaged communities when selecting contractors to support climate investments. To do this effectively, however, states may need to define which communities are considered overburdened or disadvantaged and codify those definitions into law. This speaks to the importance of accountability structures to ensure that the resources that are being devoted are advancing the desired outcomes. Several participants suggested rigorous requirements for funding and performance measures, and one participant noted that metrics can be particularly crucial to attracting and retaining funding from sources such as philanthropic grants.

Collecting and using metrics

Many participants emphasized the need to align goals with appropriate metrics to incentivize meaningful engagement and outcomes. Specifically, a number of participants suggested that state and local governmental agencies, community members, and nongovernmental organizations could collect quantitative data to better understand the baseline needs of frontline communities, particularly communities that have historically experienced redlining and other forms of disenfranchisement. One participant, for example, suggested that tools such as the Climate and Economic Justice Screening Tool,17 CalEnviroScreen,18 and California’s Healthy Places Index19 should be developed and employed to identify the communities at higher risk and track where investments are being directed and where the impacts are felt. In addition, several participants said better metrics are needed to measure community engagement, program participation, and leadership development and capacity within communities.

Data can reveal both the positive impacts of an action and its unintended consequences. One participant noted that even well-intended climate actions, such as state mandates to shift to electric vehicles, can result in unintended harms to communities already suffering disproportionate environmental burdens, such as increased local air pollution in areas near power plants as plants increase energy generation to meet growing electricity demand. Tools such as scorecards can be very useful to help states identify priorities and gauge progress. To this end, a participant suggested that local and state governments could contract with private entities and academic research institutions to establish

__________________

17 See https://screeningtool.geoplatform.gov/en/#3/33.47/-97.5 (accessed July 14, 2022).

18 See https://oehha.ca.gov/calenviroscreen (accessed July 14, 2022).

19 See https://www.healthyplacesindex.org/ (accessed July 14, 2022).

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×

statewide hubs for data collection and sharing, where they do not already exist. In addition, several participants suggested that state agencies and administrators could collect more robust health and equity data that can be incorporated into regulatory decisions, perhaps with help from public health departments and hospitals or other healthcare organizations, at the scale of 1-year, 5-year, and 10-year outcomes. At the federal level, one participant said the Department of Health and Human Services Office of Climate Change and Health Equity can play a lead role in collecting and integrating relevant data.

Communicating with the public

Finally, many participants stressed the importance of effective communication around climate and health equity. Several participants noted that the COVID-19 experience has helped agencies and organizations hone their approaches to educating the public about a health crisis. Federal agencies, state health departments, and community groups could leverage these skills to improve climate communication strategies in order to help people better understand the health impacts of climate change.

Particularly at the community level, it is important to tailor messages to the audiences one is trying to reach and to connect information about climate and health with impacts to daily life and economic concerns that are important to people. One participant noted that even community members who do not recognize the existence of human-caused climate change may be more likely to support actions aligned with climate and health equity if the problem is framed in terms of costs (e.g., healthcare costs or business risks); another participant added that the case also becomes stronger if framed in terms of the costs of inaction (rather than the costs of climate mitigation or adaptation efforts). To support plain-language communication about climate change and health equity science and data, some participants suggested developing state-funded communication campaigns, which could be enhanced by partnerships with organizations such as the National Science Foundation and the American Association for the Advancement of Science.

REFLECTIONS

Herb offered closing remarks reflecting on the key themes that emerged from the workshop’s panel discussions and interactive breakout sessions (which are summarized in a table at https://www.nap.edu/resource/26693/ActionActorsTable). The workshop amplified many of the issues raised in the first workshop in this series and surfaced additional considerations specific to state-level action. Panelists and participants examined a variety of opportunities and models for advancing climate and health equity action at the state level through work led by state agencies or communities themselves. While the examples shared at the workshop highlighted important bright spots, Herb emphasized that much work remains. “We see that health is in some locations measured as a benefit of climate action, but it is not integrated as a full driver of [decisions in] climate policies and programs,” Herb said. Centering health as a driver of climate action would likely benefit from a baseline understanding of health inequities and their relationships with environmental burdens and climate impacts, strategic actions to address those inequities and advance a just transition, and measurement of relevant health outcomes to assess impacts.

The metrics for success in state climate policies are not always aligned with the priorities expressed at the community level. Throughout the workshop, participants explored the growing emphasis on community-driven action and an expanding view of what this means in terms of research methods, program design, and funding structures. Many participants described models that move away from the traditional framework of community-engaged research (where the research questions and methods are ultimately determined by researchers and funding agencies) and toward models in which communities and researchers act as co-equal partners to determine the questions and goals and co-develop knowledge and solutions to address them. “We have come a long way, but we still have a very long way to go to ensure that the choices associated with policy and programs for climate action really reflect the voices of those populations that are most affected by changing climate conditions,” said Herb. This shift likely involves new models of collaboration in which power is shared

Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×

equally and communities are compensated fairly for their contributions, with implications for research methods and structures, community capacity building, and approaches to financial accountability.

States have made important inroads at the nexus of climate and health in recent legislation and emerging programs. Federal policies and funding streams also provide opportunities to advance action in ways that prioritize the needs of overburdened and disadvantaged communities. To inform future efforts and investments, it may be useful to have increased exchange of knowledge and lessons learned, both from the perspective of traditional decision makers and frontline communities. It will also be important to ensure health-centered climate efforts are sustainable and systemic, which requires coalitions, capacity, resources, mandates, and metrics, Herb said.

Finally, partnerships that are grounded in health equity will increasingly focus on the challenges that are driving existing health disparities and inequities. Many participants emphasized the importance of addressing the root causes, or the “causes behind the causes,” that are driving the climate crisis as well as the disproportionate impacts of climate change on certain populations and communities. This means that issues across many facets of society—from housing and transportation, to systemic racism and disenfranchisement, to education and job opportunities—will likely be involved in advancing environmental justice and health equity in the face of a changing climate, with a goal of achieving meaningful changes that improve the lives of people throughout society.

DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by ANNE JOHNSON and ALEX REICH as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur(s) or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

WORKSHOP PLANNING COMMITTEE MEMBERS JEANNE HERB (Chair), Rutgers University Bloustein School of Planning and Public Policy; BRAD COLMAN, The Climate Corporation; NATASHA K. DEJARNETT, University of Louisville; DEBORAH K. GADDY, Clean Water Action; CAROLYN J. HANSON, Environmental Council of the States; LINDA HELLAND, California Department of Public Health; ABRAHAM G. KULUNGARA, Association of State and Territorial Health Officials; ANA MASCAREÑAS, Independent Consultant; MATT MCKILLOP, Trust for America’s Health; and JACKIE QATALIÑA SCHAEFFER, Alaska Native Tribal Health Consortium.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by HALLEY GOLDSTEIN, Harris County Public Health; ELENA GROSSMAN, University of Illinois Chicago; and KIRIN KUMAR, California Strategic Growth Council. LAUREN EVERETT, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator. The review comments and draft manuscript remain confidential to protect the integrity of the process.

SPONSORS This workshop was supported by the Centers for Disease Control and Prevention, the Environmental Protection Agency, and the National Institute of Environmental Health Sciences (Task Order 75N98021F00014 under Contract HHSN263201800029I).

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/26693.

Division on Earth and Life Studies

Copyright 2022 by the National Academy of Sciences. All rights reserved.

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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
×
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Suggested Citation:"Communities, Climate Change, and Health Equity - State-Level Implementation: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2022. Communities, Climate Change, and Health Equity—State-Level Implementation: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/26693.
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Because of historic and ongoing discriminatory policies and practices, certain populations - namely people of color, Indigenous people, and low-income communities - disproportionately suffer from the adverse impacts of extreme weather and other disasters that are exacerbated by climate change. To examine actions that could help improve climate-related health outcomes in disproportionately impacted communities, the Environmental Health Matters Initiative, a program spanning all major units of the National Academies of Sciences, Engineering, and Medicine, convened a two-day workshop Communities, Climate Change, and Health Equity - State-Level Implementation on May 24 and 26, 2022. The workshop brought together representatives from state and federal agencies, universities, community-based organizations, state and national advocacy organizations, foundations, and private sector organizations. This publication highlights the presentations and discussion of the workshop.

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