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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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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.
×
Page3
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.
×
Page4
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.
×
Page5
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.
×
Page6
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.
×
Page7
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.
×
Page8
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.
×
Page9
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.
×
Page10
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.
×
Page11
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.
×
Page12

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Proceedings of a Workshop—in Brief Communities, Climate Change, and Health Equity—State-Level Implementation Proceedings of a Workshop—in Brief INTRODUCTION communities. For additional details on potential actions Climate change is exacerbating unjust health disparities suggested by workshop participants, see the table at and disproportionate environmental burdens experienced https://www.nap.edu/resource/26693/ActionActorsTable. in communities across the United States. Because The workshop was organized by an ad hoc planning of historic and ongoing discriminatory policies and committee of the Environmental Health Matters Initiative, practices, certain populations—namely people of color, a program spanning all major units of the National Indigenous people, and low-income communities— Academies of Sciences, Engineering, and Medicine that disproportionately suffer from the adverse impacts of facilitates multisector, multidisciplinary exchange around extreme weather and other disasters that are exacerbated complex environmental health challenges. The event, the by climate change.1 second in a series, built on the October 2021 workshop Communities, Climate Change, and Health Equity—A Given that much of the authority for addressing issues at New Vision, which provided an overview of how changing the intersection of climate change, health inequity, and climate conditions exacerbate health inequities in environmental justice rests at the state level, the two- communities across the United States.2 day virtual workshop Communities, Climate Change, and Health Equity—State-Level Implementation was Workshop planning committee chair Jeanne Herb held on May 24 and 26, 2022. It brought together (Rutgers University) opened the event by summarizing representatives from state and federal agencies, the key themes of the first workshop, which can universities, community-based organizations, state and be seen in more detail in Communities, Climate Change, national advocacy organizations, foundations, and private and Health Equity: Proceedings of a Workshop–in Brief.3 sector organizations to examine community-driven and state-level actions that could help improve climate- 2 See https://www.nationalacademies.org/event/10-12-2021/commu- nities-climate-change-and-health-equity-a-new-vision-workshop-1 related health outcomes in disproportionately impacted (accessed July 12, 2022). 3 National Academies of Sciences, Engineering, and Medicine. 2022. 1 National Academies of Sciences, Engineering, and Medicine. 2022. Equi- Communities, Climate Change, and Health Equity: Proceedings of a Workshop— table and Resilient Infrastructure Investments. Washington, DC: The National in Brief. Washington, DC: The National Academies Press. https://doi. Academies Press. https://doi.org/10.17226/26633. org/10.17226/26435. September 2022 | 1

She described a common recognition among participants • Identifying accurate and equitable methods for in the first workshop that climate change is a public evaluating and expanding essential, successful, and health emergency, and that there is a need for climate transformational policies. adaptation and mitigation solutions that assertively • Fostering connections and sharing of traditional/ include and prioritize those communities that bear cultural, Indigenous, scientific, and community the greatest burdens, known often as “frontline” or knowledge to help identify multisector approaches. environmental justice communities. “We left with a vision that [for] equitable climate action, in the words The workshop’s first day focused on community-driven of one of our workshop presenters, it is not enough climate and health equity action at state and local to bounce back from one crisis to another—we also levels. It included panel presentations from leaders need to address the root causes to be able to bounce who described work in their states as well as interactive forward,” Herb said. Participants in the first workshop breakout sessions in which participants focused on discussed a range of possible solutions and potential key concerns of frontline communities, public health challenges to implementing them, such as how policies capacity, and example strategies to promote systemic or bureaucratic processes that take a one-size-fits-all change. The workshop’s second day focused primarily approach (treating frontline communities the same as on state government innovations and challenges in more affluent communities) often fail to direct benefits advancing health equity and climate action. After an proactively to the communities that need them most. overview of climate laws in several states, breakout Several participants in the first workshop also stressed sessions focused on measurement and evaluation, the need for effective processes to ground strategies with government engagement with communities, how federal the people who know their communities best, though incentives can enable or hinder states, and lessons they noted that even well-meaning efforts to add seats to learned from the COVID-19 pandemic. the table for voices from frontline communities can end up falling short. This Proceedings of a Workshop—in Brief provides a high-level summary of the workshop presentations The second workshop took a deeper look at specific and discussions. Additional details can be found in state-level challenges, strengths, and opportunities, materials and videos available online.4 Although the particularly related to the deeper integration of health proceedings highlights potential opportunities for action, equity into climate programs and consideration of these should not be viewed as consensus conclusions or climate justice in public health programs. It had the recommendations of the National Academies. following objectives: COMMUNITY-DRIVEN ACTION • Identifying strengths of and lessons learned from The workshop’s first day focused on community-driven current state-level approaches—both legislative action. Jackie Qataliña Schaeffer (Alaska Native Tribal and executive—and challenges to improving those Health Consortium) moderated a panel discussion approaches, particularly with respect to partnering examining conditions that may help to advance frontline with communities. community-driven action to address climate impacts and improve health equity in both state and local policies • Identifying challenges and opportunities in and systems. Following the panelists’ remarks, attendees developing state-level approaches, particularly with were invited to participate in interactive breakout respect to implementation of recent federal bills. sessions to delve deeper into the issues raised and elicit • Identifying opportunities for decision makers, suggestions for future efforts. leaders, and stakeholders at the state level to build trust and partner with communities and vice versa. 4 See https://www.nationalacademies.org/our-work/communities-cli- mate-change-and-health-equity-state-level-implementation (accessed July 12, 2022). September 2022 | 2

Panel Discussion responsive to community perceptions and preferences. The panelists shared their views on how local participation As an example, she pointed to the Green Heart Project, is essential to identifying issues clearly and implementing a partnership involving communities in Louisville, changes via legislation and other means. Ana Baptista (The Kentucky; the University of Louisville; the National New School) described her work with communities in her Institute of Environmental Health Sciences; the Nature hometown of Newark, New Jersey. Baptista’s community Conservancy; and several other organizations. The project and a coalition of advocates with the New Jersey focuses on increasing green space in an effort to reduce Environmental Justice Alliance helped pass a landmark disproportionate exposures to air pollution experienced environmental justice law in 20205 that limits industrial in certain neighborhoods. Strong community engagement pollution in neighborhoods with a high concentration helped organizers design a tree-planting effort that of people of color, low-income households, or residents was aligned with community needs. For example, when who do not speak fluent English. As part of this multiyear organizers learned that some residents were concerned effort, she said it was important that local advocates about having to deal with raking leaves and other aspects defined their own environmental justice community of tree maintenance, they decided to use trees that do instead of leaving that to the state to determine. not drop their leaves and also created a community assistance fund to help with maintenance costs. While extreme events like floods might attract attention, many communities experience impacts from climate Breakout Discussion change on a continual basis and not just during disasters. Workshop participants were each invited to join a Amee Raval (Asian Pacific Environmental Network moderated breakout session in one of nine breakout [APEN]) described how APEN, a grassroots organization rooms focused on the following aspects of community- that works with Bay Area communities of Asian driven action: needs of frontline communities, state immigrants and refugees, is working to build climate public health capacity, local public health capacity, resilience in Richmond, California, where residents short-term opportunities, systemic change, federal face chronic air pollution, oil spills, heat waves, power action, principles for engagement, a just transition outages, and wildfire smoke. Traditional emergency in states, and collaboration with tribes. After the first responses may be inadequate for this specific community breakout session, participants were invited to move because emergency plans rely on faraway sites such as to a different breakout room for a second breakout fairgrounds and do not always share alerts or information session. Participants then reconvened, and each session’s in the languages spoken in the community. APEN is moderator shared key themes and suggestions for advocating for efforts to bolster the community’s social action that emerged during the discussions, which are fabric and infrastructure through targeted investments summarized below and in a table at https://www.nap. in schools, libraries, parks and recreation sites, and edu/resource/26693/ActionActorsTable. community organizations like youth and senior centers. Facilitating community-driven action For example, Raval said APEN has been working to Several breakout discussions touched on principles turn Richmond’s RYSE Youth Center into a youth-led and approaches for effectively facilitating community- Climate Resilience and Liberation Hub to serve as a place driven action. Many participants said it is important for where residents can find respite from refinery pollution, communities to articulate their own needs and issues and wildfire smoke, and heat waves. for governments, researchers, or other organizations to form co-equal partnerships with communities to drive Health is closely connected with the natural action rather than imposing action “from the outside.” environment. Natasha DeJarnett (University of Louisville) Focusing on building up community-based organizations described how partnerships between researchers and can help communities to identify key goals, reduce communities can help to advance local action that is reliance on external organizations, and foster the next 5 Environmental Justice Bill SB232 § Title 13 (2020). https://pub.njleg. gov/bills/2020/S0500/232_U2.HTM. generation of advocates and professionals within those September 2022 | 3

communities. To inform priorities and approaches, or something that’s very important to the community several participants noted the importance of drawing […] then down the road if you learn more about each upon knowledge within the community, recognizing that other you can really start addressing climate change this may involve different ways of knowing or different and health,” said Kate Robb (American Public Health ways of approaching problems; for example, Indigenous Association). “You really need to build trust and listen communities may have a more holistic understanding of to folks who are on the front lines—who are community the community’s relationship with the environment and members, who are doing this work, who are trusted may not constrain activities within “projects” the way messengers—and really follow their lead.” government and nongovernmental organizations often do. Enabling cross-sector collaboration The importance of coalition-building was another common Many breakout discussions examined the role of theme among breakout groups. Many participants structural racism in the health and environmental stressed that collaboration across sectors—governments, inequities communities are facing. To recognize this and businesses, community groups, nongovernmental the barriers it can pose for co-production of knowledge organizations, researchers, and others—can be essential and action, some participants suggested approaching to advancing actions that help communities mitigate and action with an intersectional lens, with attention to adapt to climate change while improving health equity. histories of native trauma, racism, and discriminatory This includes partnerships with nontraditional stakeholders policies, including on the part of the U.S. federal who may have been left out of previous efforts. “When government. In some cases, restorative justice (e.g., with you reach ‘the table,’ you look around and see who’s government bodies that have promulgated discriminatory not there,” said Adrienne Hollis (Hollis Environmental policies or with industries that have a history of causing Consulting). “You have to think nontraditionally [about] disproportionate pollution or other adverse impacts in who may have input or who may be impacted or who may the community) may be necessary before communities have a different perspective that could bring more value to can truly engage as co-equal partners. In other cases, that whole engagement process.” it may be important to attend to issues such as a lack of access to healthy food or other basic necessities, In particular, many participants underscored the which can undermine community capacity. A common importance of involvement from (and connections between) participant suggestion was that states could integrate a community-based organizations; local officials; health racial equity framework into all efforts at the interface of departments; environmental, land use, and transportation climate change and health equity. planning bodies; and industries such as construction and transportation. To better incorporate climate into health When actors not from frontline communities—such as equity policy implementation, build agencies’ capacity to state agencies, academics, or many nongovernmental engage communities, and build communities’ capacity organizations—build trust with communities through to speak with their own voice, a number of participants transparency, honesty, and practical measures such suggested that the Centers for Disease Control and as language interpretation, it can help to facilitate Prevention (CDC) could play a lead role at the federal level community-driven action. This takes time; as Deborah and that agencies such as the Environmental Protection “Kim” Gaddy (Clean Water Action) noted, “We move at Agency, Department of Transportation, Department of the speed of trust.” To support this critical relationship- Energy, and Department of Health and Human Services building process, it can be useful to find areas of could provide guidance to state partners. common ground that can create entry points and lift up those who are already trusted messengers and Driving incremental and systemic change changemakers within the community. “You don’t have In articulating their vision for systemic changes to to start by talking about climate change and health. benefit communities suffering disproportionate climate You could talk about something that you all care about impacts, several participants posited that health equity September 2022 | 4

should be integral to all climate policies moving forward, one participant suggested that county or state public known as a “health in all policies” approach. Putting health agencies could partner with hospitals to access health at the center of these efforts changes the focus more neighborhood-level data. Several participants and can bring in different stakeholders who have not suggested that additional tools are needed to collect traditionally engaged in climate action. Similarly, several and access data relevant to understanding climate risks, participants noted that a just workforce transition should vulnerabilities, population sensitivities, and adaptive be an integral part of climate action; they specifically capacities at the local level. In addition to enhancing the suggested that state and local government officials can collection of these types of data, a participant suggested be instrumental in investing in relationship-building that government agencies should focus on sharing with communities and industries and creating pathways and displaying data in ways that can make them more to transition workforces over time. meaningful to communities and decision makers. The drivers of climate change are multifaceted, and Building awareness and effectively disseminating mitigating and adapting to climate change involves a information about the impacts of health inequities broad range of activities at multiple levels. A number of and the climate crisis are also useful in facilitating participants noted that infrastructure and housing can community-driven action. Several participants pointed strongly influence both future emissions and how climate to a need to identify and partner with trusted messengers change impacts will be felt in communities. For example, within communities and to incorporate health equity, an opportunity remains for weatherization and other environmental justice, and climate impacts into approaches to improve energy efficiency in buildings, educational curricula—from pre-K to medical school— especially in low-income housing; agencies such as the to lay the groundwork for community engagement and Department of Housing and Urban Development and behavioral change. This could help increase awareness CDC could invest in such activities. This example also of the drivers of climate change and how individual underscores the importance of collaboration involving decisions, such as moving toward a more plant-based parties who may not traditionally perceive health diet, can help mitigate climate change. Some participants equity or climate change as part of their purview. “For suggested a continuous communication campaign to systemic change, it has to be incorporated across the highlight the health equity impacts of climate change culture […] with time, we will all see ourselves in this that could be funded by federal and state governments, space and how our work connects,” said DeJarnett. On foundations, and the private sector. Several participants the part of communities, some participants noted that emphasized the importance of engaging young people, political engagement, specifically through voting and both through formal education (which includes the protection of voting rights, is an important driver of involvement on the part of educators, administrators, incremental changes that can lead to systemic change. and school boards) and with activities such as school “Systemic change is incremental change,” said DeJarnett. gardens that involve the broader community (which “This is the marathon and not the sprint.” can benefit from donations, funding, or volunteer effort from businesses and community groups). They also Building knowledge and awareness pointed to the need to educate decision makers about the Informing local-scale action can be improved via the climate and health equity issues communities face; one use of local-scale data. Several participants highlighted participant suggested that public health professionals important gaps in available data relevant to the could help raise awareness by writing op-eds about the climate risks and health impacts faced in particular connections between climate and health. neighborhoods; even county-level health data, for example, may not reflect important trends at the Informing funding strategies neighborhood level. To address this gap in order to Funding can support effective and sustained action at help guide priorities and inform decision making, the intersection of climate and health. Many participants September 2022 | 5

underscored the need for adequate funding to incentivize funding is used appropriately and in alignment with and support community-driven initiatives, including community needs and priorities. funding to enable governments, researchers, and organizations to engage with communities; funding to STATE-LEVEL INNOVATIONS AND CHALLENGES build capacity and provide technical support at the local Herb set the stage for the workshop’s second day by level, especially in environmental justice communities; outlining trends in state climate laws. She highlighted and funding to compensate communities for their time examples of how state government actions have and contributions to these efforts. One participant become more focused on creating concrete paths to encouraged particular attention to providing funding emissions reduction; advancing community-oriented for engagement with tribal groups, without restricting and community-driven actions designed specifically to this funding to tribes that have obtained official federal benefit historically disadvantaged groups; facilitating just recognition. transitions to a clean energy economy; and advancing health equity. Some participants suggested that funding could come primarily from the federal government and In contrast to an earlier wave of state climate laws from nongovernmental organizations. Some noted passed in the mid 1990s and early 2000s, which focused that the new federal infrastructure bill could be one on statewide goals, capital investments, and voluntary vehicle for funding this work but emphasized that planning provisions, many states are now moving beyond federal agencies should provide guidance to state and aspirational targets toward enforceable limits. As part local implementers to ensure accountability. Several of this, states are updating statewide emissions and participants suggested that federal funders could require clean energy targets from early laws to reflect the latest community engagement as part of federal grants in science. For example, Herb noted that Massachusetts order to make community-driven approaches an integral has made updates to emissions limits for electric power, feature of federal investments in climate research and industrial processes, and natural gas distribution. In action. To support training and work at the intersection New York, new legislation allows the state’s Department of climate and health equity on the part of community of Environmental Conservation to establish and enforce health workers and state health departments, several limits on greenhouse gas emissions.6 States are also participants suggested that funding could come from the incorporating changes in utility regulations to promote federal government (particularly CDC) and from states. equity and advance clean energy goals, and statutory efforts in several states specifically require that benefits Some participants expressed concerns about companies be directed to frontline communities. For example, in industries such as oil and gas funding initiatives to New York’s 2019 Climate Leadership and Community address climate and health equity, since the interests Protection Act7 requires the state to invest or direct or legacy of such companies may not always be aligned resources so that disadvantaged communities receive with the interests of communities. This underscores at least 35 percent—with the goal of 40 percent—of the importance of transparency and, in some cases, clean energy and energy efficiency investments. In restorative justice to lay the groundwork for establishing Washington, state law requires utilities to develop a co-equal partnerships. One participant also suggested process to receive public feedback and assess the impacts that communities should focus on investing in their own of their operations on frontline communities. infrastructure, based on their particular strengths and priorities, in order to build resilience and reduce their Reiterating a major theme from the first workshop in reliance on external assistance, which can disappear this series, Herb stressed the importance of focusing quickly as the political environment changes. Finally, actions on geographic locations and demographic to ensure best practices and support accountability, a 6 See https://www.dec.ny.gov/docs/administration_pdf/revrissum496. pdf (accessed July 21, 2022). number of participants said it is important to employ 7 Climate Leadership and Community Protection Act SB6599 § Environ- appropriate guidelines and adequate guardrails to ensure mental Conservation Law (2019). https://www.nysenate.gov/legislation/ bills/2019/S6599. September 2022 | 6

sectors that face disproportionate burdens from climate justice communities currently overburdened with change because of unjust historic and ongoing policy poor air quality, resulting in an estimated health cost that leads to disenfranchisement and oppression. She savings of $1 million per year by 2030.9 Finally, the said that recent state climate laws have increasingly new wave of legislation has brought a growing trend been driven by grassroots, cross-sector coalitions toward participatory processes leading to state policy. and focus on the connections between climate and In fact, Herb shared that some state laws require health equity. For example, several state laws include highly participatory processes. In New York, the state’s provisions that recognize and are designed to address the leadership established a 22-member Climate Action longstanding, disproportionate burden of air pollution Council that developed a plan to implement the state’s in certain communities. An air quality monitoring climate act. In Washington, the Environmental Justice program mandated in New York led the state to identify Council advises on the development of the state’s 10 communities with a high air pollution burden; the environmental health disparity map, which helps drive state subsequently launched a collaborative effort with the state’s climate policies. community-based organizations to support mobile air Panel Discussion screening and data collection in these communities. During the panel presentations, speakers highlighted Similarly, the state of Washington is working to identify lessons from state government climate action in overburdened communities in which to expand air California, Maryland, and Illinois. Linda Rudolph monitoring networks, and California agencies are now (Public Health Institute) discussed recent efforts in required to prioritize the most polluted communities for California to develop a scoping plan outlining actions air monitoring and air pollution reductions and impose for all sectors over the next 5 to 20 years. She said higher penalties on polluters that exceed limitations in that the proposal being supported by the California Air areas with more vulnerable populations. Resources Board (CARB) staff is not aligned with the most aggressive targets, nor does it optimize the health States are also aiming to support workforce transitions benefits because it lacks a mechanism for integrating for communities whose income has historically been health and health equity analysis into the development dependent on fossil fuels, for example by supporting of proposed solutions. As a result, the plan promoted workforce development opportunities for residents of by CARB relies heavily on unproven and expensive frontline communities to participate in and benefit from technology, like carbon capture, utilization and storage, the clean energy economy. The Illinois Climate and while also allowing for new fossil fuel infrastructure. Equitable Jobs Act8 is one of the most far-reaching state She suggested modeling advocacy campaigns after public laws focused on this, Herb said. Among other provisions, health–based campaigns that drove past changes in the law creates hubs to facilitate collaboration among areas such as tobacco control and auto safety, so as to frontline communities and the organizations they trust counter the narrative of the fossil fuel industry and move to conduct outreach to residents, increase awareness of in a direction that stops new investment in fossil fuel workforce development programs, and support residents’ infrastructure while prioritizing health. ability to enter the career pipeline for clean energy jobs. Sacoby Wilson (University of Maryland) discussed the Recent state climate actions are also increasingly Maryland Climate Solutions Now Act,10 which calls centered on health. In Massachusetts, a 2050 roadmap for a 60 percent reduction of emissions by 2031 and that informed the state’s adoption of its most recent for the Maryland economy to generate zero emissions climate law found that achieving net-zero emissions by 2045. The law, which is more ambitious than any will deliver significant benefits to residents, including a drop in air pollution, particularly in environmental 9 See https://www.mass.gov/doc/ma-2050-decarbonization-roadmap/ download (accessed July 21, 2022). 8 Climate and Equitable Jobs Act SB2408 § Article 5. Energy Transition 10 Climate Solutions Now Act of 2022 SB0528 § Article II, Section 17(b) (2021). https://www.ilga.gov/legislation/publicacts/102/PDF/102-0662. (2022). https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/ pdf. sb0528. September 2022 | 7

previous legislation passed by a U.S. state, includes bridge climate legislation to other benefits, such as job provisions to transition existing buildings to meet new opportunities and the clean energy economy. Connecting energy performance standards and to use electricity climate change with health is also important for pushing rather than fossil fuels for heating and cooking. It also forward state legislation. This involves looking at how provides resources to help schools transition to net-zero improving climate-friendly infrastructure can improve emissions and convert school bus fleets to zero-emission health outcomes and reduce health disparities, with a vehicles. To target the state’s investments toward focus on the most vulnerable populations. In addition, the communities that need them most, Wilson and Wilson said that regional approaches can help widen colleagues helped to guide how the state commission the impact of state-based legislation, pointing to the will define underserved and overburdened communities MidAtlantic Justice Coalition as an example, which when establishing goals for giving out state funding works on environmental justice issues across Virginia; and developing strategies to reduce greenhouse gas Washington, D.C.; Maryland; and Delaware. emissions in communities designated as disadvantaged Breakout Discussion or environmental justice communities. For the second day’s breakout discussion, workshop participants were invited to join one of nine moderated Carol Hays (The Strategic Collaboration Group) discussed breakout sessions focused on the following topics Illinois’ Future Energy Jobs Act,11 passed in 2016, which laid related to state-level climate action: federal mandates the groundwork to expand solar energy in the state with and incentives, community-driven measurement and an emphasis on job creation. The legislation was propelled evaluation, government measurement and evaluation, largely by policy-oriented environmental organizations government engagement with communities, whole- based in Chicago, and developments since the law’s of-government approach, lessons learned, systemic enactment illustrate how coalitions can remain involved change, health as an enabling framework for climate even after legislation passes. To expand on the legislation, action, and government capacity and lessons learned the Strategic Collaboration Group developed what they from COVID-19. Each session’s moderator then shared call a “Listen. Lead. Share.” approach to identify what it key themes and suggestions for action that emerged would take to get various groups on board with further during the discussions, which are summarized below clean energy action. This helped to build relationships so and in a table at https://www.nap.edu/resource/26693/ that community members have an ongoing opportunity ActionActorsTable. to interact with those in the policy space. In these efforts, Hays said it was important to go beyond listening by Building coalitions and facilitating collaborative action inviting people to share their leadership and vision of what Addressing climate change and health equity can benefit they wanted to see in their community and across the state, from coalitions and collaborative action to leverage and to take capacity building beyond providing resources programs, people, and funding for greater impact. To to focus on helping frontline organizations learn about attract partners and build coalitions, one participant clean energy and become strong advocates themselves. This noted that it is critical to articulate a vision clearly and process created a very broad, diverse coalition of more than make a compelling case for it. The vision and desired 200 organizations that worked together across the state on outcomes determine who should be brought to the table, various initiatives, including advocacy for the subsequent since who participates depends on the issues involved. Climate and Equitable Jobs Act.12 Many participants pointed to community engagement as Looking at these various efforts across states, panelists a crucial component of collaborative climate action, and highlighted the importance of identifying ways to some suggested that funders of climate initiatives could 11 Future Energy Jobs Act SB2814 § Public Act 99-0906 (2016). https:// require community engagement and the demonstration www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099-0906. 12 Climate and Equitable Jobs Act SB2408 § Article 5. Energy Transition of engagement through appropriate metrics. However, (2021). https://www.ilga.gov/legislation/publicacts/102/PDF/102-0662. pdf. other participants noted that not all partnerships must September 2022 | 8

be driven by communities; federal, state, business, federal level. Participants considered ways to enhance and other stakeholders can all potentially play a lead states’ capacity to implement federal policies and state- role. In either case, several participants underscored level initiatives in ways that are aligned with community the importance of bridging silos through cross-agency needs. collaboration on a day-to-day basis (beyond holding occasional meetings or simply sharing data), as well The federal government has taken important steps in as facilitating cross-sector collaboration by engaging incentivizing and funding state-level climate action. community-based organizations and the business Examples include the Justice40 Initiative,15 which aims to community. Pointing to the COVID-19 pandemic deliver 40 percent of benefits from federal investments in response as an illustrative example of the value of climate and clean energy to disadvantaged communities, building partnerships to bridge gaps across agencies and and the Infrastructure Investment and Jobs Act,16 which sectors, a number of participants suggested that state provides funding to increase infrastructure resilience in and county public health departments and community- the face of climate impacts and encourage the shift to based organizations could learn from the COVID-19 cleaner energy sources, among other goals. While such experience to form partnerships for a “health in all developments are welcome news, some participants policies” approach to addressing climate change. Several said that states need more tools and guidance to make others suggested bringing in partners beyond those that best use of the resources and implement federal policies have traditionally engaged in climate action, such as in alignment with goals for health and environmental transportation departments or federally qualified clinics equity. For example, states could benefit from screening that work with communities. tools (contextualized to each state) to identify priority needs; scorecards and tools for tracking the use of One participant suggested that formal structures may be funds and the types of communities benefitting from needed to mandate and facilitate sustained interagency the investments; and consortia and “capacity hubs” to collaboration and robust and authentic community help states and cities exchange information and models, engagement, citing California’s Strategic Growth learn from each other, and cooperate on shared goals. In Council13 and Transformative Climate Communities particular, some participants suggested that the White program as examples. Formal structures can be 14 House, Department of Health and Human Services, and important to overcoming common barriers such as a lack the Council on Environmental Quality could provide more of bandwidth among state agency staff or a perception guidance to states on the implementation of Executive that communities lack the expertise to engage on health Orders, while organizations such as the U.S. Conference issues. Several participants suggested that state agencies, of Mayors and the National Governors Association could state administrators, and legislators could lead efforts facilitate consortia to facilitate exchange among state and to create these structures, and some suggested that local governments. coordinating bodies could also be important for building broad coalitions and sustaining engagement on an Research connecting climate mitigation, adaptation, and ongoing basis. resilience with health outcomes could also help to inform transformative action. A number of participants said that Identifying priorities and strategies academic researchers, government agencies, chambers Priorities for climate action often emerge from the of commerce, scientific societies, foundations, and community level, while the climate action programs that state governments implement often come from the 15 See https://www.whitehouse.gov/environmentaljustice/justice40/ (accessed July 21, 2022). 16 U.S.C. Infrastructure Investment and Jobs Act HR3684 Public 13 See https://sgc.ca.gov/ (accessed July 14, 2022). Law 117-58 (2021). https://www.congress.gov/bill/117th-congress/ 14 See https://sgc.ca.gov/programs/tcc/ (accessed July 14, 2022). house-bill/3684/text. September 2022 | 9

communities all have important roles in conducting and outcomes. Several participants suggested rigorous supporting research to advance understanding of, and requirements for funding and performance measures, approaches to, the nexus of climate, water, and health. and one participant noted that metrics can be particularly crucial to attracting and retaining funding from sources Finally, in bringing people together around these issues such as philanthropic grants. and navigating relationships between communities Collecting and using metrics and various industries and government bodies, one Many participants emphasized the need to align goals participant noted that it can be important to recognize with appropriate metrics to incentivize meaningful the legacy of slavery, stolen lands, and racism and engagement and outcomes. Specifically, a number of to address complex issues such as the privatization participants suggested that state and local governmental of food systems and how this interacts with climate agencies, community members, and nongovernmental and health. Another participant emphasized that organizations could collect quantitative data to state environmental departments need dedicated staff better understand the baseline needs of frontline and funding to truly achieve meaningful community communities, particularly communities that have engagement, particularly with rural communities who historically experienced redlining and other forms of have often been overlooked. disenfranchisement. One participant, for example, Devoting and leveraging resources suggested that tools such as the Climate and Economic Achieving meaningful progress can be linked to the Justice Screening Tool,17 CalEnviroScreen,18 and availability of adequate resources. The COVID-19 California’s Healthy Places Index19 should be developed pandemic led to a large influx of resources for public and employed to identify the communities at higher health infrastructure. While this infrastructure has been risk and track where investments are being directed essential to the pandemic response and can potentially and where the impacts are felt. In addition, several be instrumental in addressing health impacts of climate participants said better metrics are needed to measure change, some participants expressed a fear that it could community engagement, program participation, go away once pandemic funding streams become dry. and leadership development and capacity within Others noted that the urgency of the COVID-19 response communities. resulted in some agency staff and resources being redirected away from climate work, potentially slowing Data can reveal both the positive impacts of an action progress. and its unintended consequences. One participant noted that even well-intended climate actions, such as Looking ahead, participants discussed how states state mandates to shift to electric vehicles, can result and community-based organizations can leverage in unintended harms to communities already suffering partnerships in new and creative ways to get more disproportionate environmental burdens, such as mileage out of investments in public health infrastructure increased local air pollution in areas near power plants and climate initiatives. As one example, states could as plants increase energy generation to meet growing prioritize contracts benefitting overburdened or electricity demand. Tools such as scorecards can be disadvantaged communities when selecting contractors very useful to help states identify priorities and gauge to support climate investments. To do this effectively, progress. To this end, a participant suggested that local however, states may need to define which communities and state governments could contract with private are considered overburdened or disadvantaged and codify entities and academic research institutions to establish those definitions into law. This speaks to the importance 17 See https://screeningtool.geoplatform.gov/en/#3/33.47/-97.5 (accessed of accountability structures to ensure that the resources July 14, 2022). 18 See https://oehha.ca.gov/calenviroscreen (accessed July 14, 2022). that are being devoted are advancing the desired 19 See https://www.healthyplacesindex.org/ (accessed July 14, 2022). September 2022 | 10

statewide hubs for data collection and sharing, where REFLECTIONS they do not already exist. In addition, several participants Herb offered closing remarks reflecting on the key themes suggested that state agencies and administrators could that emerged from the workshop’s panel discussions and collect more robust health and equity data that can be interactive breakout sessions (which are summarized incorporated into regulatory decisions, perhaps with in a table at https://www.nap.edu/resource/26693/ help from public health departments and hospitals or ActionActorsTable). The workshop amplified many of other healthcare organizations, at the scale of 1-year, the issues raised in the first workshop in this series and 5-year, and 10-year outcomes. At the federal level, one surfaced additional considerations specific to state-level participant said the Department of Health and Human action. Panelists and participants examined a variety Services Office of Climate Change and Health Equity can of opportunities and models for advancing climate and play a lead role in collecting and integrating relevant health equity action at the state level through work led data. by state agencies or communities themselves. While the examples shared at the workshop highlighted important Communicating with the public bright spots, Herb emphasized that much work remains. Finally, many participants stressed the importance of “We see that health is in some locations measured as a effective communication around climate and health benefit of climate action, but it is not integrated as a full equity. Several participants noted that the COVID-19 driver of [decisions in] climate policies and programs,” experience has helped agencies and organizations hone Herb said. Centering health as a driver of climate action their approaches to educating the public about a health would likely benefit from a baseline understanding crisis. Federal agencies, state health departments, and of health inequities and their relationships with community groups could leverage these skills to improve environmental burdens and climate impacts, strategic climate communication strategies in order to help people actions to address those inequities and advance a just better understand the health impacts of climate change. transition, and measurement of relevant health outcomes to assess impacts. Particularly at the community level, it is important to tailor messages to the audiences one is trying to reach The metrics for success in state climate policies are and to connect information about climate and health not always aligned with the priorities expressed at the with impacts to daily life and economic concerns that community level. Throughout the workshop, participants are important to people. One participant noted that explored the growing emphasis on community-driven even community members who do not recognize the action and an expanding view of what this means existence of human-caused climate change may be in terms of research methods, program design, and more likely to support actions aligned with climate funding structures. Many participants described models and health equity if the problem is framed in terms of that move away from the traditional framework of costs (e.g., healthcare costs or business risks); another community-engaged research (where the research participant added that the case also becomes stronger questions and methods are ultimately determined by if framed in terms of the costs of inaction (rather than researchers and funding agencies) and toward models the costs of climate mitigation or adaptation efforts). in which communities and researchers act as co-equal To support plain-language communication about partners to determine the questions and goals and co- climate change and health equity science and data, develop knowledge and solutions to address them. “We some participants suggested developing state-funded have come a long way, but we still have a very long way communication campaigns, which could be enhanced to go to ensure that the choices associated with policy by partnerships with organizations such as the National and programs for climate action really reflect the voices Science Foundation and the American Association for the of those populations that are most affected by changing Advancement of Science. climate conditions,” said Herb. This shift likely involves new models of collaboration in which power is shared September 2022 | 11

equally and communities are compensated fairly for their Finally, partnerships that are grounded in health equity contributions, with implications for research methods will increasingly focus on the challenges that are and structures, community capacity building, and driving existing health disparities and inequities. Many approaches to financial accountability. participants emphasized the importance of addressing the root causes, or the “causes behind the causes,” that are States have made important inroads at the nexus of climate driving the climate crisis as well as the disproportionate and health in recent legislation and emerging programs. impacts of climate change on certain populations and Federal policies and funding streams also provide communities. This means that issues across many facets opportunities to advance action in ways that prioritize the of society—from housing and transportation, to systemic needs of overburdened and disadvantaged communities. To racism and disenfranchisement, to education and job inform future efforts and investments, it may be useful to opportunities—will likely be involved in advancing have increased exchange of knowledge and lessons learned, environmental justice and health equity in the face of a both from the perspective of traditional decision makers changing climate, with a goal of achieving meaningful and frontline communities. It will also be important to changes that improve the lives of people throughout ensure health-centered climate efforts are sustainable and society. systemic, which requires coalitions, capacity, resources, mandates, and metrics, Herb said. 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. 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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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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