Assessing Health Equity in Local United States Climate Action Plans: A Content Analysis

Climate change poses an escalating threat to public health through numerous exposure pathways. The health impacts of climate change are not evenly distributed across populations. Marginalized groups may experience climate-related health effects inequitably, necessitating responsive climate action planning that explicitly addresses health inequities. Climate action plans are strategic frameworks, often implemented at local levels, that outline goals and actions to reduce greenhouse gas emissions and enhance climate resilience through mitigation, adaptation, and sustainability initiatives.

More than 25 plans, including plans from the largest 25 cities, are evaluated. We categorize and analyze the content of these plans under themes related to health equity outcomes, strategies for promoting health equity, and planning for emerging health threats. We identify patterns, gaps, and areas for improvement in integrating health equity into climate action planning.

This study assesses four key considerations regarding health equity in climate action planning. First, we evaluate how and to what extent health equity outcomes are identified in the plans. We investigate which climate-related health impacts, such as heat-related morbidity and mortality, and exacerbated respiratory and cardiovascular health outcomes, are recognized in action plans as having inequitable impacts on different populations. Second, we assess whether the action plans consider (a) the inequitable experience of health hazards (e.g., heat, extreme weather, and floods) and (b) how if at all, the plans account for the differential impacts of these hazards on vulnerable groups. Third, we identify which health equity strategies are employed in planning for climate impacts, and explore municipalities' approaches to prioritizing health equity when planning locally-adapted strategies to build health resilience to climate risks. Finally, we explore preparedness by considering the extent to which the plans address emerging health threats, such as compound events and zoonotic diseases, and their potential inequitable impacts on marginalized populations.

Preliminary findings indicate variability in the inclusion and depth of health equity considerations across municipal climate action plans. While some plans demonstrate a robust integration of health equity, others lack detailed attention to these issues. Commonly recognized health equity outcomes include inequitably experienced heat-related illnesses, respiratory health impacts, and vector-borne diseases. Most plans do not identify specific health outcome measures, such as heat-related hospitalizations, and there is limited recognition of emerging health threats and how these may disproportionately affect vulnerable communities. Further, most plans lack operationalized health equity goals, and of those that do include health equity goals, few are specific, measurable, actionable, realistic, or time-bound. Finally, most plans do not identify methods to evaluate health equity outcomes after plan implementation.

This study highlights future opportunities to work with affected communities to integrate health equity into municipal climate action plans. These findings underscore the need for more consistent inclusion of health equity in climate action planning to facilitate building health resilience to climate risks in affected communities.

Keywords: climate adaptation, health equity, public health resilience, environmental justice, community engagement, emerging health threats, vulnerable populations, climate-related health impacts.