Improving Public Health and Equity Through Climate Change Mitigation Planning

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By Erik Calloway, AICP, Evan Mallen, Tina Ansong, Jacqueline A. Teed, Jessica Nguyen, and Heather A. Joseph

The impacts of climate change are felt across every region of the United States (Figure 1) (USGCRP 2023). Climate change disproportionately affects populations that face social, economic, and health inequities caused by ongoing systemic discrimination, exclusion, and under- or disinvestment. This includes communities that have been historically underserved, people with disabilities, people experiencing homelessness, people with chronic diseases, older adults, children, and pregnant people (Hayden et al. 2023). Climate change impacts cannot be isolated to a particular region or country. For example, wildfires in Canada in the summer of 2023 had negative impacts on air quality and health in multiple regions throughout the United States (McArdle et al. 2023).

Climate action plans (CAPs) are documents that establish the actions state and local governments will take to mitigate and build resilience against the effects of climate change. Climate change mitigation planning is critical to protect public health and improve health equity, defined in this PAS Memo as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes (CMS 2024). Health equity is also inherently related to environmental justice, or the just treatment and meaningful involvement of all people with respect to the development, implementation, and enforcement of environmental decision-making, laws, regulations, policies, and other related activities (Grade et al. 2023).

Climate change mitigation planning advances health equity in two ways: first, because slowing or reversing climate change will limit climate change–related health and health equity impacts, or underlying conditions that contribute to health inequities such as unequal exposure to environmental health hazards caused by climate change; and second, because climate change mitigation strategies can directly improve public health and health equity. At the same time, incorporating public health and health equity considerations into CAPs can increase support for climate change mitigation, reduce barriers to CAP adoption, increase the range of mitigation strategies included in CAPs, and ultimately help reduce or reverse climate change.

ChangeLab Solutions, in partnership with the Climate and Health Program in the National Center for Environmental Health at the Centers for Disease Control and Prevention (CDC), collaborated to explore opportunities to advance health and health equity through climate change mitigation strategies. This project reviewed the evidence supporting positive health outcomes of climate change mitigation strategies applicable to the U.S. context. It included a scan of adopted state and local CAPs and interviews with planning and public health practitioners who contributed to adopted CAPs from the scan.

This PAS Memo shares findings from this work to help planners better connect health and health equity with climate change mitigation planning efforts. The Memo begins with an overview of the evidence-based connections between climate change mitigation, health, and health equity. It continues by sharing insights from reviewed CAPs and practitioner interviews conducted for this project. These include how common it is for health to be addressed in CAPs, what health and health equity content looks like in CAPs, and how public health partners are typically involved in climate change mitigation planning. The Memo concludes with practical and actionable guidance that planners can use to improve public health and health equity while also advancing climate change mitigation planning objectives.

The Connections Between Health, Health Equity, and Climate Action Planning

Climate change impacts population health by altering environmental conditions in ways that increase the severity or frequency of diseases or health risks that already occur in a population, and by creating new and unanticipated health problems (USGCRP 2016). Climate change can also worsen existing environmental health inequities and injustices for communities disproportionately impacted by environmental hazards, sometimes referred to as "frontline communities" (Grade et al. 2023).

The CDC recognizes these health threats and, through its Climate and Health Program, supports state, tribal, local, and territorial public health agencies as they prepare for the health impacts of a changing climate. But addressing the health and health equity implications of climate change is not just the responsibility of public health practitioners. Planners can also improve health and health equity in the communities they serve through climate change mitigation planning.

Why Consider Health in Climate Action Plans?

Climate change is threatening the foundations of human health and well-being (Watts et al. 2019; Romanello et al. 2023). Human-generated GHG emissions continue to increase, causing rapid warming and other large-scale changes to the planet, such as rising seas, melting ice, ocean warming and acidification, changing rainfall patterns, and shifts in timing of seasonal events (Jay et al. 2023).

In the United States, harmful impacts from more frequent and severe extremes are increasing, from greater numbers of heat-related illnesses and death, more devastating costlier storms, and longer droughts to larger and more severe wildfires (Jay et al. 2023). Climate change also contributes to serious illnesses including heart, lung, and kidney disease, increases in vector- and water-borne illnesses, and other adverse impacts. Other threats to health include forced displacement, shortages of food and water, and related exacerbation of war and conflict (Hayden et al. 2023; Romanello et al. 2023). Climate health threats continue to grow in all regions of the country (Hayden et al. 2023; Romanello et al. 2023).

Climate change mitigation planning is an opportunity to take a holistic and coordinated approach to addressing these potential negative health impacts. Mitigating climate change can reduce the severity of climate-related impacts on health. Mitigating climate change can also give jurisdictions more time and make it easier for communities to adapt and build resilience to a changing climate. Both would result in improved health outcomes at the population level.

The primary cause of climate change is the burning of fossil fuels, which exact a huge toll on human health. Burning fossil fuels is estimated to cause approximately 8 to 10 million excess deaths per year, largely due to fine particulate matter, which is linked to cardiometabolic diseases such as coronary heart disease, stroke, and COPD (chronic obstructive pulmonary disease) (Lelieveld 2023; Vohra 2021). Phasing out fossil fuels would reduce these health harms in the near term while preventing catastrophic damage to the climate, ecosystem, and human well-being in the long term.

In addition to reducing direct health impacts of climate change and large-scale health impacts of burning fossil fuels, climate change mitigation strategies can improve public health at the community level through a variety of health pathways. Health pathways describe the ways a climate change mitigation strategy can influence human health, either directly or indirectly. Positive health outcomes are the specific improvements to physical, mental, or social well-being that occur through a health pathway (Figure 2).

Positive health outcomes associated with climate change mitigation strategies are often referred to as health co-benefits. For example, one way in which active transportation strategies that reduce GHG emissions benefit health is by increasing levels of physical activity (Besser and Dannenberg 2005; Filigrana et al. 2022). Positive health outcomes associated with this strategy include decreased Type 2 diabetes, cardiovascular disease, respiratory disease, and some cancers, as well as improved physical well-being and mental health (Avila-Palencia et al. 2018; Celis-Morales et al. 2017; Dinu et al. 2019; Gordon-Larsen et al. 2009; Humphreys, Goodman, and Ogilvie 2013; Maizlish et al. 2013; Negev et al. 2022; Oja et al. 2011; Smith et al. 2017). Appendix A presents an evidence-based summary of health pathways and health outcomes associated with different mitigation strategies.

Many of the climate change mitigation strategies that can improve health involve changes to the built environment that are regulated by state and local planning policies and regulations, such as comprehensive plans (also known as general plans), active transportation or open space master plans, urban forestry master plans, sustainability plans, neighborhood or community improvement district plans, zoning codes, and complete streets ordinances (ChangeLab Solutions 2019). These policies and regulations affect transportation and infrastructure (complete streets design, parking requirements), development (requiring, permitting, or incentivizing green buildings, green space, or green infrastructure), and land use (regulating density and mixed use). CAPs can help coordinate changes to these planning policies and regulations by aligning them around climate-related goals.

Finally, planners offer a valuable perspective on climate action planning because their activities touch so many aspects of daily life, such as economic development, housing, transportation, and sustainability. This makes planners especially well-positioned to balance the many needs and interests of community members affected by climate change and the cross-sector actors who play a part in implementing mitigation strategies.

Why Consider Health Equity in Climate Action Plans?

While everyone is affected by climate change, some communities and populations — such as children, older adults, people with disabilities, communities of color, low-income communities, and communities with lower access to resources — are at higher risk of experiencing negative impacts of climate change (APHA 2024; Caderyn et al. 2017). These populations are vulnerable to heat illness, respiratory illness, water-related illness, food systems impacts, insect-related diseases, and mental health effects (U.S. EPA 2024b). Environmental risk factors that these communities and populations face include residing in floodprone areas (Tate et al. 2021; Bathi and Das 2016), areas prone to extreme heat (urban heat island) (U.S. EPA 2024b), and areas adjacent to highways (Samuels and Freemark 2022). Many of these communities are already overburdened by the cumulative effects of adverse environmental, health, economic, or social conditions resulting from historic and ongoing systemic discrimination, exclusion, and under- or disinvestment. Climate change worsens these long-standing inequities (Jay et al. 2023).

Applying an equity lens to climate change mitigation planning, also known as taking a climate justice approach (U.S. CDC 2024), can lead to a more equitable distribution of the benefits of climate change mitigation and the burdens of climate change impacts. As a result, planners can help to address health inequities and build community resilience against the effects of climate change for the populations most vulnerable to climate change.

Neglecting to center health equity when designing, prioritizing, and implementing strategies to reduce climate change can run the risk of exacerbating health inequities even while improvements to health overall at the population level are made. For example, investments in active transportation facilities to promote mode shifts to bicycling, rolling, and walking are common climate change mitigation strategies. However, where those investments are prioritized will determine who benefits and who does not. If these investments are only made in neighborhoods with higher levels of resources while underresourced neighborhoods are left out, the gap in health outcomes between the residents of highly resourced and historically underresourced neighborhoods will continue to widen, even as health outcomes at the jurisdiction level may improve overall.

What Do Climate Action Plans Say About Health and Health Equity Today?

Planners and decision-makers can learn from how other communities have integrated health and health equity considerations into their climate change mitigation planning processes and CAPs. This includes understanding how common it is for health to be included in CAPs, what health and health equity content looks like in CAPs, and how public health partners are typically involved in climate change mitigation planning.

How Often do Climate Action Plans Discuss Health?

The project team conducted a search of existing online databases and lists of adopted state, regional, and local CAPs and created a database of 313 state and local CAPs adopted between 2007 and 2022. We reviewed these CAPs to assess the degree to which they discussed health generally, the health impacts of climate change, and the health co-benefits of climate change mitigation strategies.

Of the 313 CAPs reviewed, 277 (88 percent) discussed health generally, 225 (72 percent) discussed the health impacts of climate change, and 209 (67 percent) discussed the health co-benefits of mitigation actions specifically; 36 (12 percent) of the CAPs made no mention of health (Table 1).

Table 1. Inclusion of Health Discussions in CAPs by Jurisdiction Type

City and town population size may play a role in how extensively CAPs include health considerations (Figure 3). A larger percentage of CAPs from medium (50 percent), large (75 percent), and very large (46 percent) cities included an extensive discussion of health compared to CAPs from rural (10 percent), very small (36 percent), and small (34 percent) towns and cities.

There was variability in the degree to which CAPs discussed health. Some CAPs only addressed health in a cursory way, with minimal discussion of the health impacts of climate change. Some CAPs included a moderate discussion of the health impacts of climate change and addressed health co-benefits of mitigation strategies. And some CAPs included an extensive discussion of health, including sections, chapters, analysis, or metrics focused on both health and health co-benefits.

The depth of health discussions in plans adopted between 2007 and 2022 was relatively evenly split between minimal (33 percent), moderate (27 percent), and extensive (29 percent). However, extensive discussions of health have been trending upwards over time (Figure 4). Of the 103 CAPs adopted between 2019 and 2021 (2022 excluded due to incomplete data), 46 percent discussed health extensively, compared to 28 percent of the 54 CAPs adopted in 2016–2018 and 22 percent of the 49 CAPs adopted in 2013–2015.

Implications for practice. These findings show that discussing health in CAPs is already a common practice across a range of jurisdiction types, sizes, and locations. Communities should be assured that including health discussions in a CAP is feasible. The increasing frequency and depth of health conversations in adopted CAPs across the country indicates an opportunity for planners to use the action steps presented below to integrate health into CAPs even more moving forward.

What Does Health and Health Equity Content Look Like in Climate Action Plans?

From the dataset of 313 CAPs, the team selected 25 CAPs that discussed health co-benefits extensively, included cross-sector partnerships, and represented a range of jurisdiction types, sizes, and climate regions. We conducted a more in-depth qualitative analysis of the content in these 25 CAPs. We evaluated the health pathways most frequently identified in these CAPs by reviewing if and how the CAPs distinguished between health pathways and health outcomes associated with climate change mitigation strategies. We noted whether CAPs used a combination of text and graphics to identify and describe connections between climate change mitigation and health. We also evaluated how frequently these CAPs discussed health equity.

Health pathways and outcomes discussed in CAPs

It is common for CAPs to connect mitigation strategies with the health pathways of "improved air quality" and "increased physical activity." These were the most frequently identified health pathways in the CAPs reviewed. Both physical activity and air quality as health pathways were most frequently connected to transportation-related mitigation strategies (Figure 5).

CAPs can describe more specific health outcomes. Although all the reviewed CAPs made at least one connection between a mitigation strategy and a health pathway, just over two-thirds went on to describe how a health pathway might lead to potential health outcomes. The most frequently identified potential health outcomes in the reviewed CAPs were improved general health, decreased respiratory disease, and improved mental health. General health was most frequently cited in relation to vegetation-related and building systems and performance–related mitigation strategies. Respiratory health was most frequently cited in relation to transportation-related, building systems and performance–related, and vegetation-related mitigation strategies. Mental health was most cited in relation to vegetation-related and transportation-related mitigation strategies (Figure 6).

Overall, transportation and vegetation were the classes of strategies most frequently cited as having health pathways and health outcomes. We hypothesize that this is due to the evidence base and literature describing the variety of ways that active transportation and vegetation can improve health (see Appendix A). Additionally, the transportation sector is the largest contributor of GHG emissions in the United States (U.S. EPA 2024a). Thus, we suspect that transportation mitigation strategies may feature more prominently in CAPs because they may be more feasible in terms of political will, funding, or capacity of local government implementation.

Implications for practice. Strong evidence for and widespread inclusion of health pathways associated with transportation-related and vegetation-related mitigation strategies indicate that these strategies may be good starting points for planners interested in formally integrating health into their communities' climate change mitigation planning efforts. The benefits of improved air quality and increased physical activity associated with transportation-related and vegetation-related mitigation strategies can be realized and experienced both locally and in short-term timeframes. These tangible and visible improvements may be an effective strategy for gaining support from community members and decision-makers. This can be a meaningful contrast to some of the more global and long-term outcomes of climate change mitigation. Once community members and decision-makers become more familiar with the health benefits of climate action planning, planners may have an opportunity to begin introducing additional climate change mitigation strategies beyond transportation and vegetation with other health pathways and benefits.

Health equity descriptions in CAPs

All but one of the 25 reviewed CAPs described how climate change will or has already disproportionately affected the health and general well-being of communities facing economic and social challenges. This broad recognition across CAPs indicates an opportunity to pursue climate change mitigation strategies that will benefit communities most exposed to climate risks but with fewer resources or capacity to respond to those risks.

Across the 25 CAPs, health equity was most frequently associated with transportation-related and vegetation-related mitigation strategies. Air quality was the health pathway most associated with health equity.

Implications for practice. Because transportation-related mitigation strategies, vegetation-related mitigation strategies, and air quality are frequently associated with health outcomes in CAPs, they are common opportunities to introduce discussions of health equity into climate change mitigation planning processes. The frequency of these connections in CAPs may also mean there are opportunities to use discussions about disparities in transportation options, vegetation, and air quality as entry points to broader discussions about climate change. Despite these commonly cited connections between transportation, vegetation, air quality, and equity, however, improving health equity outcomes will require more holistic climate change mitigation planning processes and CAPs that include actions to address the health equity implications of other mitigation strategies. This underscores the importance of taking a multisector approach to climate change mitigation.

How CAPs identify and illustrate connections to health and health equity

The 25 reviewed CAPs identified and described connections to health and health equity in a variety of ways. It was common to have a paragraph or subsection in the message from leadership, introduction, or executive summary that identified or described the fact that climate change affects health or health equity. Addressing health equity was sometimes described as an objective or an integral part of a CAP's community engagement process. Some CAPs had chapters dedicated to discussing the health and health equity impacts of climate change and climate change mitigation. Sometimes these chapters established goals or strategies for improving health or health equity, as demonstrated by the City of Kansas City, Missouri, Climate Protection & Resilience Plan (Figure 7). It was common for CAPs to use icons to identify if a mitigation strategy is associated with health pathways or has health or health equity co-benefits, as demonstrated by the Town of Chapel Hill, North Carolina, Climate Action and Response Plan (Figure 8). And as demonstrated by that same plan, it was common for CAPs that identified health pathways to list those pathways within mitigation strategy tables (Figure 9).

Implications for practice. Health and health equity are cross-cutting topics or themes in CAPs. Establishing the connections between climate change, climate change mitigation strategies, health, and health equity requires a range of approaches. This includes framing the connection between climate change, health, and health equity up front; dedicating sections to health and health equity goals and strategies; highlighting the health pathways and outcomes of mitigation strategies throughout CAPs; and reporting on health outcomes as part of tracking CAP implementation.

How Are Public Health Partners Involved in Climate Change Mitigation Planning?

Partner engagement and cross-sector collaboration emerged as integral components of CAP development and implementation in the CAPs reviewed. Health partners that were involved in the 25 reviewed CAPs included public health foundations, institutions of higher education, and local public health departments. Ways that health partners contributed to CAP development included attending and presenting at community meetings, identifying and assessing relevant health data, identifying alignment between climate change mitigation actions and local health needs, assessing CAP policies through a health lens, supporting community engagement, and communicating about the health benefits of climate change mitigation. Notably, CAPs that stated any level of public health involvement averaged almost twice as many references to health co-benefits as CAPs that did not.

Implications for practice. Collaborating with public health partners early and throughout a CAP development process as well as after CAP adoption can help make CAPs more equitable and impactful. Overall, public health partners can add capacity to the team and help support activities that might otherwise not be possible. This includes bringing a perspective on the connections between health, equity, and climate change mitigation strategies, which makes it more likely that health and health equity will be integral components of CAP goals, policies, and implementation. Public health partners can be messengers and champions of climate change mitigation. And they can connect the team with more resources from a greater diversity of sources and funding streams to support CAP development and implementation. Through connections with local community leaders, public health practitioners can also support meaningful engagement with frontline communities. Following adoption, public health partners can help track and assess the health benefits of CAP implementation.

Action Steps for Planners

Successfully addressing health and health equity through climate change mitigation requires actions in all phases of the planning process as well as tools to integrate health and health equity content into CAPs. Making climate change mitigation a community priority and partnering with public health and other sectors can set a community up to discuss health and health equity in climate change mitigation planning processes. Prioritizing health equity in planning processes can ensure CAPs include strategies to reduce or eliminate the unfair distribution of climate change health impacts and improve public health equitably across communities. Applying the evidence and emphasizing the health benefits of climate action both during the planning process and in CAPs can increase support for and effectiveness of CAPs. Taking these steps can help planners realize the health and health equity benefits of climate mitigation strategies in their communities.

1. Make Climate Change Mitigation a Community Priority

Making climate change mitigation a community priority can help communities realize the health benefits of these strategies by advancing climate action in a coordinated way across a range of city policies, procedures, and investments. Planners can prioritize climate change mitigation by highlighting connections to these strategies wherever they are relevant to other planning activities, such as comprehensive plans, land use policies and zoning, and capital improvement planning.

• Comprehensive plans. Comprehensive plans are one of the most powerful tools available to planners because these plans can regulate so many aspects of the built environment across a community and are legally binding in many jurisdictions. Prioritizing climate change mitigation, adaptation, and resilience in comprehensive plans can facilitate planning and coordinating climate change mitigation actions that touch virtually all aspects of a community, including high-GHG-emitting sectors like transportation and buildings.
• Land use policies and zoning. To prioritize climate change mitigation strategies, zoning ordinances may incentivize or require building and site design features with mitigation benefits such as site coverage, landscaping, building orientation, facade design, roof design, and building materials. Land use policies can shape transportation behavior by supporting active transportation through increased density, mixed-use, and transit-oriented development. They can also shape vegetation by requiring green space, trees, and landscaping.
• Capital improvement planning. Capital improvement plans can prioritize infrastructure projects with climate change mitigation benefits such as complete streets, green streets, green infrastructure, low-impact development, and green space.

2. Partner with Public Health and Other Sectors

Climate change mitigation strategies span a wide range of sectors. Successful planning and implementation of these strategies require expertise and resources from multiple partners across different sectors, including public health. Involving a wider range of partners in climate action planning can improve outcomes and enrich processes.

Many climate action planning processes already involve cross-sector collaboration to some extent. However, making this a more intentional and integrated part of the process can have many benefits. Collaborating with cross-sector partners that have a diversity of perspectives about climate change mitigation can improve climate action planning in the following ways.

• Increased number and diversity of actions. Partnering with a greater diversity of sectors can expand the number and diversity of actions included in CAPs. This can increase the capacity for plan implementation because involving more partners can increase the range of positive plan outcomes and accelerate mitigation. Such collaboration could include internal and external interagency departments, local community organizations, or faith-based organizations.
• Increased support for plan adoption. Cross-sector partners can propose mitigation strategies and actions that speak to a diversity of values and goals. They can also help identify issues that could limit support from interest holders in various sectors so that partners can co-create mutually beneficial solutions together. It is easier for representatives of different sectors to support plan adoption when their values and goals are reflected in the plan's climate actions.
• Increased support for plan implementation and improved plan outcomes. Cross-sector partners are more likely to contribute to a CAP's implementation when their sectors contribute to plan development and their values and goals are reflected in the plan's climate actions. Expanding the diversity of partners involved in plan development can create a broader and more diverse network of partners involved in CAP implementation, which can lead to improved climate change mitigation, health, and health equity outcomes.

Health partners can provide significant value to planners seeking to integrate health into climate change mitigation planning processes and CAPs. Health partners can support community engagement, communicate about health, assess health impacts of climate change mitigation, and support monitoring and evaluation. These partners may include local public health departments, public health nurses, health foundations, and hospital systems. They can play the following roles in climate change mitigation planning and implementation.

• Prioritization of neighborhoods and populations. Health partners can use their understanding of community health risks and root causes to help identify key neighborhoods and populations in a community. These include those who face the greatest vulnerability to climate change-related health impacts, those who have experienced health disparities due to historical discriminatory policies, and those for whom potential climate change mitigation strategies align with opportunities to address local root causes of poor health outcomes. This understanding can inform decisions about community engagement activities and mitigation strategy selection.
• Community engagement recruitment. Health partners can help recruit for and plan community engagement activities, such as public workshops, focus groups, listening sessions, and surveys. This can ensure that community participation is representative of the community's diversity. And health partners may already have existing and strong relationships with community members and organizations, which can help increase community trust in climate action planning efforts.
• Community engagement implementation. Health partners can also participate and lead community engagement activities. At outreach events or activities, health partners can provide subject matter and respond to health-related questions or concerns. Nurses can be especially effective messengers about climate change (Gaudreau et al 2024; Kurth 2018). Health partners can help qualitatively and quantitatively assess community input to ensure a complete and nuanced understanding of community-wide and individual health risks, opportunities, and experiences. This understanding can provide insight into how climate change mitigation can address community-specific health risks and leverage community-specific opportunities for improvement.
• Communication. Health partners can support communication about climate action planning efforts. They can add more specificity and depth to content about the health impacts of climate change and health co-benefits of mitigation strategies captured in CAPs. They can also help communicate these benefits to the public, climate action planners, and elected officials. This includes translating evidence into accessible language and providing alternative approaches to framing health and health equity outcomes (Calanan et al. 2023).
• Health impact assessment. Health partners can assess the potential local health benefits of climate action. This information can support the process of selecting and prioritizing potential mitigation strategies. Health impacts of climate action can be assessed and described qualitatively (through anecdotes, community listening sessions and interviews, and surveys) and quantitatively (through GHG inventories, social vulnerability indexes, and environmental health risks data). These insights can also be used as support for a community's decision to take action. Having a better understanding of these health connections also helps to identify other areas in which goals and priorities might align across different departments' projects or plans.
• Monitoring and evaluation. Health partners can help identify performance metrics as well as gather and analyze data to track progress toward community climate and health goals. They can help report this progress to support revisions to a CAP over time. And they can publish their findings to contribute to the broader body of literature about the health benefits of climate action.

Planners can use the Building Resilience and Climate Equity (BRACE) framework developed by the CDC's Climate and Health Program in 2011 to guide collaboration with public health practitioners around efforts to prepare for and respond to the health effects of climate change. Revised in 2023 (Lemon et al. 2023), the updated BRACE framework includes guidance on integrating mitigation-focused strategies in public health climate action to realize local health co-benefits.

3. Prioritize Health Equity in Climate Change Mitigation

Health equity should be prioritized in both the climate change mitigation planning process and in CAP documents. Taking this approach can help reduce or eliminate the unfair distribution of climate change health impacts and improve public health equitably across communities in the following ways:

• Creating a process that is more inclusive and aligned with the strengths and aspirations of communities that bear the brunt of climate change

• Developing an understanding of the climate-related health risks and concerns in communities that are disproportionately affected
• Identifying potential risks for negative outcomes associated with prospective actions
• Ensuring mitigation activities align with community health needs
• Tracking the health and health equity outcomes of plan implementation
• Assessing progress made towards planned goals to guide adjustments to action over time
• Collaboratively setting health equity goals that are prioritized and measurable

Three tactics that can be employed to prioritize health equity in climate change mitigation planning processes are equitable, inclusive, and authentic community engagement; asset-based approaches; and health equity assessments.

Community engagement. Equitable engagement seeks to be inclusive of diverse perspectives that come with differences such as gender, age, income, or racial background. Diversity and inclusivity are essential to center the perspectives, needs, and values of populations most impacted by climate change. This is an important part of procedural equity, or fair decision-making (ChangeLab Solutions 2020).

Equitable community engagement seeks to be community-oriented through processes that are as collaborative and empowering as possible along the spectrum of public participation (IAP2 2018). These types of community-oriented processes help CAPs better align with the communities' priorities, strengths, skills, and assets.

Equitable engagement values expertise gained through lived experiences alongside more academic forms of expertise gained through research and professional experience. Planners should center local knowledge in developing and presenting options and making decisions. This type of engagement shifts away from transactional, or extractive, interactions and toward long-term, sustained relationships between climate action planners and the communities they represent. When the public is respected and engaged equitably in this way, they may be more likely to support new initiatives or policies and be satisfied with initiatives that reflect their needs.

Asset-based approaches. Focusing on the harms of and vulnerability to climate change can result in conversations that stigmatize people, lead to disagreements about who is responsible for climate change, and make it difficult to take shared responsibility for mitigation. These dynamics can prevent coalition building and thereby limit the number of CAP supporters, diminish the diversity of CAP supporters, and generate active opposition to climate action.

An asset-based approach focuses on the community's aspirations, strengths, skills, and assets (Gomez 2021; Martin-Kerry et al. 2023; Ramos Montañez 2023). This shifts the focus of the planning process to what the community cares about. This may involve designing initial community engagement activities to be primarily dedicated to listening and then using the outputs of those activities to shape subsequent engagements. Following the listening phase, the planning process can focus on aligning the community around a shared vision for health and health equity in the context of mitigation and resilience. From there, the climate action planning process can prioritize actions that address climate change in ways that align with aspirations for improved community health and remove barriers to community health. This approach can result in a CAP that better aligns with a community's health equity and environmental justice aspirations and has a larger and more diverse group of supporters.

Health equity assessments. Applying a health equity lens to the assessment phase can require planners to access data and use mapping tools (such as CDC Climate and Health Data Tools, Climate Mapping for Resilience and Adaptation, the U.S. Climate Vulnerability Map, and CDC Places Data) to identify and locate populations that should be prioritized due to high levels of social and environmental vulnerability to climate change. This involves disaggregating data to reveal different levels of vulnerability to climate change by population (such as race, income, language isolation, or age) and mapping this data to reveal different levels of vulnerability to climate change by location. Understanding vulnerability to climate change can be enhanced by comparing vulnerability maps with patterns of projected climate change–related hazards (Figure 10). Data stories that involve qualitative and quantitative data, visualizations, and narratives can be particularly effective in discerning and communicating key insights. These approaches can demonstrate objective justification for prioritizing investments needed for climate mitigation and resilience.

Health equity should also be considered central to the assessment of proposed strategies as well as the evaluation and monitoring of implemented strategies. Monitoring the impact of implemented strategies should also involve disaggregating data to reflect differential outcomes in terms of benefits and harms. This is essential to identifying and understanding unintended consequences of CAP implementation. Communities can then amend CAPs and adjust mitigation strategies to respond to or avoid such outcomes in the future.

When a community prioritizes health equity in a climate change mitigation planning process, it is important for the resulting CAP document to reflect that priority. CAPs can do this by making a commitment to achieving health equity such as in a letter from leadership, the introduction, or as a stated goal. CAPs can include summaries that highlight equitable community engagement processes and describe how content was shaped by community engagement outputs and health equity assessments. CAPs can highlight mitigation strategies that have health equity co-benefits. And CAPs can establish mitigation strategy priorities that reflect the results of community engagement and health equity assessments.

4. Emphasize the Health Benefits of Climate Action

Emphasizing the health benefits of climate change mitigation can increase public support for CAP adoption and implementation. Planners can do so by communicating about health benefits during planning processes and illustrating and describing health benefits in CAP documents.

Climate change is not a priority for everyone. But a growing number of Americans think global warming will increasingly harm health over the next 10 years (Roser-Renouf et al. 2021). Framing climate change in terms of public health may help build support for climate change mitigation by increasing the likelihood that people will engage with the issue, especially when their perspective on climate change is cautious, disengaged, or dismissive (Myers et al. 2012).

Describing the potential positive health outcomes of climate change mitigation can make it easier for people to understand the short-term and local community benefits of climate action. Describing the health pathways that lead to these positive health outcomes can make it easier for people to consider health when identifying and implementing climate change mitigation strategies. Appendix A provides an overview of evidence-based health pathways and health outcomes associated with a range of climate change mitigation strategies. Planners can use this overview as a starting point to guide health discussions in their climate change mitigation planning processes.

In community conversations, it can be helpful to use frameworks such as CDC's Health in All Policies, Community Commons' Vital Conditions, or ChangeLab Solutions' elements of healthy communities to explain the importance of considering health when climate change mitigation planning. These conversations can be supported by health pathway diagrams to help explain how specific mitigation activities lead to positive health outcomes (Figure 11).

Planners can draw from examples of how the health and health equity benefits of climate change mitigation strategies are represented in CAPs from other communities, as described in this PAS Memo. This includes using health equity icons or other graphics to highlight (1) which mitigation strategies can lead to positive health and health equity outcomes, (2) which health pathways are associated with each mitigation strategy, and (3) where health pathway synergies exist between different mitigation strategies. Going beyond pathways to highlight specific health outcomes can create opportunities to use those outcomes as progress indicators. These indicators can then be used to track and report on how CAP implementation is improving public health over time.

Illustrating and highlighting the connections between climate change mitigation strategies and health outcomes can lead to CAP planning decisions that are informed by health and health equity considerations. But establishing goals in CAP documents specifically focused on improving health and health equity can establish a commitment to improving health and health equity through climate change mitigation. Including health and health equity goals also creates an opportunity to track and assess health improvements over time.

5. Apply Evidence for Health Benefits of Climate Change Mitigation

A strong evidence base about the health impacts of climate change and the health pathways and health outcomes that can result from mitigation strategies supports increased awareness, urgency, and direction for climate action planning and implementation. While evidence is growing, it is limited in scope and scale. Below are ways practitioners can expand, strengthen, and clarify the evidence for health outcomes associated with climate action planning.

Promote plain language. Translating the language of technical and scientific evidence into policy action can be challenging. Evidence must clearly explain the pathways connecting climate actions to potential health outcomes, including the scale of potential health improvements and mitigation benefits. Planners should include this evidence in CAP documents. This is especially true when communities are considering how their actions to mitigate climate change at global scales over long timeframes can help achieve shorter-term outcomes at local scales.

Add to the body of evidence. Successfully integrating health into more CAPs in more communities will require more evidence. Planners can contribute to this evidence in the following ways:

• Including implementation actions in CAPs that establish processes to gather, track, and assess the health outcomes observed from plan implementation over time
• Gathering data, monitoring and evaluating health outcomes, and preparing reports to communicate observed health and health equity outcomes resulting from plan implementation
• Sharing local data that is gathered to track CAP implementation with academics

Planners should consider collaborating with local academic institutions to shape what data is gathered and how it is gathered to best support research that uses rigorous methods to assess observable health and health equity outcomes at the population scale, research that isolates specific aspects of the built environment and examines potential health outcomes of interventions, and research about the potential for mitigation to reduce health inequities at the local scale.

Conclusion

Integrating public health into climate action planning is critical to mitigating and preventing further damage to human health caused by climate change. There are many synergies between the fields of planning, climate change mitigation, and public health. CAPs are a powerful platform for coordinating between and aligning action by all three fields. Cross-sector collaboration will advance and enhance the reach and efficacy of climate change mitigation, especially as it relates to issues around health equity. This Memo gives planners ideas and insights into how they can better collaborate with health partners and improve health equity in their climate action planning work.

Acknowledgments

The primary authors of this PAS Memo are Erik Calloway, AICP, Tina Ansong, and Jessica Nguyen of ChangeLab Solutions and Evan Mallen, Jacqueline A. Teed, and Heather A. Joseph of the Centers for Disease Control and Prevention.

Additional support for this PAS Memo from ChangeLab Solutions was provided by Edgar Camero, Christine Camilleri-Onishi, Kimberly Libman, Tyra Satchell, Vincent Young, and Tina Yuen.

Additional support for this PAS Memo from the Climate and Health Program in the National Center for Environmental Health at the Centers for Disease Control and Prevention was provided by Bharat Balyan, Claudia Brown, Megan McLaughlin, and Paul Schramm.

References

American Public Health Association (APHA). 2024. Climate Changes Health: Vulnerable Populations.

Avila-Palencia, Ione, Luc Int Panis, Evi Dons, Mailin Gaupp-Berghausen, Elisabeth Raser, Thomas Götschi, Regine Gerike, et al. 2018. "The Effects of Transport Mode Use on Self-Perceived Health, Mental Health, and Social Contact Measures: A Cross-Sectional and Longitudinal Study." Environment International 120 (2018): 199-206. doi:10.1016/j.envint.2018.08.002

Bathi, Jejal Reddy, and Himangshu S. Das. 2016. "Vulnerability of Coastal Communities from Storm Surge and Flood Disasters." International Journal of Environmental Research and Public Health 13(2): 239. doi:10.3390/ijerph13020239

Besser, Lilah M., and Andrew L. Dannenberg. 2005. "Walking to Public Transit: Steps to Help Meet Physical Activity Recommendations." American Journal of Preventive Medicine. 29(4): 273–80. doi: 10.1016/j.amepre.2005.06.010

Cadeyrn J. Gasking, Davina Taylor, Susan Kinnear, Julie Mann, Wendy Hillman, and Monica Moran. 2017. "Factors Associated with the Climate Change Vulnerability and the Adaptive Capacity of People with Disability: A Systemic Review." Weather Climate and Society 9(4): 801–14. doi: 10.1175/WCAS-D-16-0126.1

Calanan, Renee M., Michelle E. Bonds, Sara R. Bedrosian, Susan K. Laird, Delight Satter, and Ana Penman-Aguilar. 2023. "CDC's Guiding Principles to Promote an Equity-Centered Approach to Public Health Communication." Preventing Chronic Disease 20: 230061. doi: 10.5888/pcd20.230061

Celis-Morales, Carlos A., Donald M. Lyall, Paul Welsh, Jana Anderson, Lewis Steell, Yibing Guo, Reno Maldonado, et al. 2017. "Association Between Active Commuting and Incident Cardiovascular Disease, Cancer, and Mortality: Prospective Cohort Study." BMJ 357: j1456. doi: 10.1136/bmj.j1456

Center for Climate and Energy Solutions (C2ES). 2024. U.S. State Climate Action Plans.

Centers for Medicare and Medicaid Services (CMS). 2024. Health Equity. U.S. Department of Health and Human Services.

ChangeLab Solutions. 2019. Long-Range Planning for Health, Equity & Prosperity: A Primer for Local Governments.

———. 2020. The Planner's Playbook: A Community-Centered Approach to Improving Health & Equity.

Chapel Hill (North Carolina), Town of. 2021. Climate Action and Response Plan.

Dinu, Monica, Guiditta Pagliai, Claudio Macchi, Francesco Sofi. 2018. "Active Commuting and Multiple Health Outcomes: A Systematic Review and Meta-Analysis." Sports Medicine 49(3): 437–52. doi: 10.1007/s40279-018-1023-0

Harris, Cynthia R. 2022. "Best Practices in Local Climate Action Planning. Part III: Common Shortcomings and A California Case." Environmental Law Institute, Vibrant Environment, January 19.

Filigrana, Paola, Jonathan I. Levy, Josette Gauthier, Stuart Batterman, and Sara D. Adar. 2022. "Health Benefits from Cleaner Vehicles and Increased Active Transportation in Seattle, Washington." Journal of Exposure Science & Environmental Epidemiology 32(4): 538–44. doi: 10.1038/s41370-022-00423-y

Gaudreau, Coralie, Laurence Guillaumie, Édith Jobin, and Thierno Amadou Diallo. 2024. "Nurses and Climate Change: A Narrative Review of Nursing Associations' Recommendations for Integrating Climate Change Mitigation Strategies." Canadian Journal of Nursing Research 56(3): 193–203. doi: 10.1177/08445621241229932

Gomez, Alexsandra. 2021. "Asset-Based Community Development." PAS QuickNotes 97.

Gordon-Larsen, Penny, Janne Boone-Heinonen, Steve Sidney, Barbara Sternfeld, David R. Jacobs Jr., and Cora E. Lewis. 2009. "Active Commuting and Cardiovascular Disease Risk: The CARDIA Study." Archives of Internal Medicine 169(13): 1216–23. doi: 10.1001/archinternmed.2009.163

Grade, A.M., A.R. Crimmins, S. Basile, M.R. Essig, L. Goldsmith, A.R. Lustig, et al. 2023. "Appendix 5: Glossary." In Fifth National Climate Assessment. Edited by A.R. Crimmins, C.W. Avery, D.R. Easterling, K.E. Kunkel, B.C. Stewart, and T.K. Maycock. Washington, D.C.: U.S. Global Change Research Program. doi: 10.7930/NCA5.2023.A5

Hayden M.H., P.J. Schramm, C.B. Beard, J.E. Bell, A.S. Bernstein, A. Bieniek-Tobasco, et al. 2023. "Chapter 15: Human Health." In Fifth National Climate Assessment. Edited by A.R. Crimmins, C.W. Avery, D.R. Easterling, K.E. Kunkel, B.C. Stewart, and T.K. Maycock. Washington, D.C.: U.S. Global Change Research Program. doi: 10.7930/NCA5.2023.CH15

Humphreys, David K., Anna Goodman, and David Ogilvie. 2013. "Associations Between Active Commuting And Physical And Mental Wellbeing." Preventive Medicine 57(2): 135–39. doi: 10.1016/j.ypmed.2013.04.008

Institute for Local Government. n.d. Climate Action Plans.

International Association for Public Participation (IAP2). 2018. IAP2 Spectrum of Public Participation.

Jay, A.K., A.R. Crimmins, C.W. Avery, T.A. Dahl, R.S. Dodder, B.D. Hamlington, et al. 2023. "Chapter 1: Overview: Understanding Risks, Impacts, and Responses." In Fifth National Climate Assessment. Edited by A.R. Crimmins, C.W. Avery, D.R. Easterling, K.E. Kunkel, B.C. Stewart, and T.K. Maycock. Washington, D.C.: U.S. Global Change Research Program. doi: 10.7930/NCA5.2023.CH1

Kansas City (Missouri), City of. 2022. Climate Protection & Resilience Plan.

Kurth, Ann E. 2017. "Planetary Health and the Role of Nursing: A Call to Action." Journal of Nursing Scholarship 49(6): 598–605. doi: 10.1111/jnu.12343

Lelieveld, Jos, Andy Haines, Richard Burnett, Cathryn Tonne, Klaus Klingmüller, Thomas Münzel, et al. 2023. "Air Pollution Deaths Attributable to Fossil Fuels: Observational and Modelling Study." BMJ 383: e077784. doi: 10.1136/bmj-2023-077784

Lemon, Stephenie C., Heather A. Joseph, Samantha Williams, Claudia Brown, Semra Aytur, Katherine Catalano, et al. 2023. "Reimagining the Role of Health Departments and Their Partners in Addressing Climate Change: Revising the Building Resilience against Climate Effects (BRACE) Framework." International Journal of Environmental Research and Public Health. 20(15): 6447. doi: 10.3390/ijerph20156447

Maizlish, Neil, James Woodcock, Sean Co, Bart Ostro, Amir Fanai, and David Fairley. 2013. "Health Cobenefits and Transportation-Related Reductions in Greenhouse Gas Emissions in the San Francisco Bay Area." American Journal of Public Health 103(4): 703–09. doi: 10.2105/ajph.2012.300939

Martin-Kerry, Jacqueline, Jennifer McLean, Trevor Hopkins, Antony Morgan, Laurie Dunn, Robert Walton, et al. 2023. "Characterizing Asset-Based Studies in Public Health: Development of a Framework." Health Promotion International 38(2): daad015. doi: 10.1093/heapro/daad015

McArdle, Cristin E., Tia C. Dowling, Kelly Carey, Jourdan DeVies, Dylan Johns, Abigail L. Gates, et al. 2023. "Asthma-Associated Emergency Department Visits During the Canadian Wildfire Smoke Episodes — United States, April– August 2023." Morbidity and Mortality Weekly Report 72: 926–32. doi: 10.15585/mmwr.mm7234a5

Myers, Teresa A., Matthew C. Nisbet, Edward W. Maibach, and Anthony A. Leiserowitz. 2012. "A Public Health Frame Arouses Hopeful Emotions About Climate Change." Climatic Change 113: 1105–12. doi: 10.1007/s10584-012-0513-6

Negev, Maya, Leonardo Zea-Reyes, Livio Caputo, Gudrun Weinmayr, Clive Potter, and Audrey de Nazelle. 2022. "Barriers and Enablers for Integrating Public Health Cobenefits in Urban Climate Policy." Annual Review of Public Health 43: 255–70. doi: 10.1146/annurev-publhealth-052020-010820

Oja, Pekka, Sylvia Titze, Adrian Bauman, Bas De Geus, Patricia Krenn, Bill Reger‐Nash, et al. "Health Benefits of Cycling: A Systematic Review." Scandinavian Journal of Medicine & Science in Sports 21(4): 496–509. doi: 10.1111/j.1600-0838.2011.01299.x

Ramos Montañez, Smirla. 2023. "Advancing Equity Through Research: The Importance of Asset-Based Approaches and Methods." Journal of Applied Developmental Psychology 86: 101540. doi: 10.1016/j.appdev.2023.101540

Romanello, Marina, Claudia di Napoli, Carole Green, Harry Kennard, Pete Lampard, Daniel Scamman, et al. 2023. "The 2023 Report of the Lancet Countdown on Health and Climate Change: The Imperative for a Health-Centred Response in a World Facing Irreversible Harms." Lancet 402(10419): 2346–94. doi:10.1016/S0140-6736(23)01859-7

Roser-Renouf, Connie, Neil Stenhouse, Justin Rolfe-Redding, Edward Maibach and Anthony Leiserowitz. 2021. "Engaging Diverse Audiences With Climate Change: Message Strategies for Global Warming's Six Americas." In Handbook of Environment and Communication, edited by R. Cox and H. Anders.

Samuels, Gabe, and Yonah Freemark. 2022. "The Polluted Life Near Highways: A Review of National Scholarship and a Louisville Case Study." Urban Institute, November.

Smith, Melody, Jamie Hosking, Alistair Woodward, Karen Witten, Alexandra MacMillan, Adrian Field, et al. 2017. "Systematic Literature Review of Built Environment Effects on Physical Activity and Active Transport — An Update and New Findings on Health Equity." International Journal of Behavioral Nutrition and Physical Activity 14(1):1–27. doi: 10.1186/s12966-017-0613-9

Tate, Eric, Md Asif Rahman, Christopher T. Emrich, and Christopher C. Sampson. 2021. "Flood Exposure and Social Vulnerability in the United States." Natural Hazards 106: 435–57. doi: 10.1007/s11069-020-04470-2

U.S. Centers for Disease Control and Prevention (CDC). 2024. About Justice, Equity, Diversity, and Inclusion in Climate Adaptation Planning.

U.S. Environmental Protection Agency (EPA). 2024a. Fast Facts on Transportation Greenhouse Gas Emissions.

———. 2024b. Heat Island Impacts.

U.S. Global Change Research Program (USGCRP). 2016. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. Edited by A. Crimmins, J. Balbus, J.L. Gamble, C.B. Beard, J.E. Bell, D. Dodgen, et al. Washington, D.C.: U.S. Global Change Research Program. doi: 10.7930/J0R49NQX

———. 2023. Fifth National Climate Assessment. Edited by A.R. Crimmins, C.W. Avery, D.R. Easterling, K.E. Kunkel, B.C. Stewart, and T.K. Maycock. Washington, D.C.: U.S. Global Change Research Program.

Vohra, Karn, Alina Vodonos, Joel Schwartz, Eloise A. Marais, Melissa P. Sulprizio, and Loretta J. Mickley. 2021. "Global Mortality from Outdoor Fine Particle Pollution Generated by Fossil Fuel Combustion: Results from GEOS-Chem." Environmental Research 195: 110754. doi: 10.1016/j.envres.2021.110754

Watts, Nick, Markus Amann, Nigel Arnell, Sonja Ayeb-Karlsson, Kristine Belesova, Maxwell Boykoff, et al. 2019. "The 2019 Report of the Lancet Countdown on Health and Climate Change: Ensuring that the Health of a Child Born Today Is Not Defined By a Changing Climate." Lancet 394(10211): 1836–78. doi: 10.1016/S0140-6736(19)32596-6

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