When Washington Steps Back, States Hold the Keys for Health and Climate

Record-breaking drought. Devastating wildfires. Historic winter storms. In the last month, these have ravaged our country, impacting the lives and livelihoods of Americans everywhere. We don’t have to look back too far to recall the devastation of hurricanes Helene and Milton in the fall, nor too far ahead to the next summer’s blistering heat, given the increased duration and frequency of heat waves. 

In 2024, the U.S. experienced 27 separate billion-dollar weather/climate disaster events, with total costs exceeding $180 billion. And yet, these conservative estimates do not account for the disasters’ mental or physical healthcare-related costs, which can be enormous and fall mostly on vulnerable populations, including older adults whose healthcare-related costs are ultimately shouldered by all Americans through Medicare.

That’s why it is disappointing that the new administration has chosen to withdraw from the Paris Agreement, revoked executive orders to address environmental justice, and already taken action to promote the use of fossil fuels and hinder the development of clean energy sources. Not only do these steps cede America’s leadership to other nations, but they also fail to address the root causes endangering the health and well-being of Americans in every region of the country: climate change. 

While formulating climate policy has become a partisan issue, the threats it poses to public health are very real to all Americans, no matter their political ideology or party. From the mountains of Appalachia to the Pacific Northwest, from Southern California to the panhandle of Florida and everywhere in between, no area of the country has been spared from the impact of climate change. 

So, how can we continue to protect public health in a world where climate-related disasters will inevitably increase, at least, in the near-term?

First, it’s important to recognize that the loss of federal leadership and support for climate mitigation and adaptation is huge, but it doesn’t have to be devastating. States and municipalities and nongovernmental actors will continue to lead on climate action. In fact, some philanthropic organizations have already announced plans to fill in funding gaps left behind by the federal government. Addressing these gaps could lead to a groundswell of innovation as local entities do more to mitigate and adapt to climate change with fewer resources than before. 

Second, we need to track the progress of these local efforts with rigorous data collection to evaluate what works and what does not. This is especially important for health protection, a metric that is frequently ignored in climate policy. These data are critical for scaling-up solutions. We need resources and tools to better connect the dots between climate action, disease, and deaths avoided. The previous administration integrated data from a variety of sources to better understand the health impacts of climate change and health benefits of climate action. Now these efforts will need to continue at local and regional scales through multi-disciplinary partnerships across the public, private, and nonprofit sectors. 

Third, the health and healthcare sectors must do a better job documenting the health harms of climate change and ensuring that these harms are factored into policy decisions. This includes promoting expanded and more consistent use of International Classification of Disease (ICD ) codes (that healthcare providers rely on to document patients’ medical diagnoses), for climate-sensitive health outcomes. There is also a need for the development of new climate-sensitive ICD codes, such as “exposure to wildfire smoke.” These ICD codes would improve the estimates of healthcare-related burdens of climate change, and could be linked to healthcare cost data, so that damage assessments could more fully account for impacts to people—not just buildings and property.  

Finally, it’s important to recognize that climate change’s negative health impacts are exacerbated by a host of interweaving structural factors, like discriminatory housing policies that have shaped the urban landscape and left certain neighborhoods more prone to flood risk and urban heat island effects. The systems and policies that can exacerbate or mitigate the health consequences of climate change go far beyond the traditional health and environment sectors and include those touching on transportation, land use, housing, education, and public safety. Just as the concept of Health in All Policies (HiAP) reshaped policymaking across sectors to improve public health, addressing climate-related challenges requires a similar, integrated approach. Local organizations must now embed climate considerations into a broad range policies across sectors to protect health and well-being. 

As the federal government retreats from its commitments to climate action, the responsibility will continue to fall squarely on state and local governments to step up. Cities and states are already incubators of bold policy that adapts to the unique needs of the community. Now, more than ever, they will be tasked with advancing clean energy, enforcing environmental protections, and investing in climate resilience to chart a sustainable path forward. The future of our nation’s health cannot wait for Washington to act, or not act, on climate; the power to lead is in our hands.