Advancing Climate Resilience for Community Health

Colorado’s Opportunity 

Six of the eight hottest years on record in Colorado have happened in the past decade.⁴ Colorado’s average temperature has increased by about 2 degrees Fahrenheit in just the past 30 years.⁵ Projections suggest it could increase by an additional 2.5 to 5 degrees Fahrenheit by 2050.5 Residents of Colorado’s urban and suburban areas — where a majority of the state’s population resides — see and feel days of poor air quality each year. Denver-Aurora, Fort Collins, and Colorado Springs rank among the worst metropolitan areas in the United States for air pollution, particularly for ozone, which can irritate the lungs and exacerbate chronic health conditions. In fact, in 2021, the Denver metro area recorded a record 65 ozone alert days from May through August — the four months of the ozone season.⁶ 

Southern and southeastern Colorado continue to face extreme drought conditions, affecting local food and economic security and the mental health of local communities.⁷ These areas are home to some of the more sensitive populations such as adults over 65 years old, people with chronic diseases, people who are housing insecure, and households earning a low income. 

Climate change is a health equity issue. Health systems — including their health care delivery, workforce, research, and philanthropic divisions — have an opportunity to take a lead role in tackling the climate crisis. Addressing climate change is similarly aligned with philanthropic organizations’ and health foundations’ commitment to advancing racial equity, environmental justice, and health. Coloradans are already feeling the health impacts of climate change and need leaders from the health care and philanthropic sectors to help address them. 

Building community resilience to climate change is essential for preserving the physical and mental health of Coloradans, especially for people of color, immigrant groups, households earning low-incomes, children, and older adults who are particularly sensitive to climate change impacts due to chronic conditions and physical vulnerabilities.

Many agencies and organizations across Colorado are working to address climate change, and many more are interested in and positioned to join and advance these efforts. Health systems and philanthropic organizations are recognizing their role as environmental stewards with a responsibility to protect the natural environment and human health, which are interconnected and interdependent. Health care and philanthropic groups have an opportunity to leverage their resources, infrastructure, workforce, and community connections to foster healthy, thriving, and resilient communities.

This report presents a call to action to health systems and philanthropic organizations to learn about and pursue opportunities to protect and advance the health and well-being of communities from the impacts of climate change in Colorado.

Background and Methods 

Kaiser Permanente Colorado commissioned the Colorado Health Institute (CHI) to identify recommendations for health systems and philanthropic organizations to support, lead, and advance climate change mitigation and adaptation efforts in Colorado. 

For its assessment, CHI collected and analyzed data to identify and map needs within each of Kaiser Permanente Colorado’s service areas, then conducted a landscape scan of existing programs, needs, and opportunities across those areas (Map 1) to inform the recommendations included in this report. 

While not inclusive of the state’s entire geography, Kaiser Permanente Colorado’s service area encompasses a majority of Colorado’s population at nearly 5 million people (or 86% of Colorado residents).
 

Data Collection and Analysis

While climate change affects everyone, some populations are more likely to experience vulnerabilities to their health. Research has identified certain social, health, and demographic-based communities that are particularly sensitive to the impacts of a changing climate (Table 1). 

CHI assessed the relationship between climate-related environmental exposures (extreme heat, wildfire risk, flood risk, drought, and air quality) and the social and demographic factors that have been known to elevate health risks in communities. CHI’s assessment included qualitative and quantitative data collection and analysis and secondary data analysis. During this data-driven and community-engaged process, CHI met with various stakeholders across Colorado. They are listed in the Appendix.

Findings from CHI’s assessment are available upon request.

Landscape Scan 

During the second phase of this work, CHI met with 20 local and statewide key informants to discuss current programs, partnerships, funding, evaluation efforts, needs, and gaps related to climate change and its impact on health. Key informants represented 15 organizations, including local departments of public health and environment, climate offices and organizations, safety net clinics, community-based organizations and associations, and K–12 education partners. 

Findings from CHI’s landscape scan are available upon request.

Educate health professionals about the effects of climate change on patient health and train them on screening and referral for climate-related health impacts. 

Health professionals have an opportunity as trusted messengers to educate their patients and communities about the relationship between climate change and health and discuss solutions with them. Health systems can support these professionals by providing training and education to increase provider knowledge and confidence in assessing and addressing the impacts of climate change on health. Various organizations have developed toolkits and guides for health professionals. These include Climate for Health and ecoAmerica’s Let’s Talk Health & Climate: Communication Guidance for Health Professionals and RMI’s Health Professionals Can Play a Role in Electrification.

Provide education to patients and the community regarding the impacts of environmental exposures and climate change on health. 

Less than half of Coloradans believe they have personally experienced the effects of global warming or that global warming will harm them personally.¹¹ Yet, Coloradans are experiencing more extreme weather, natural disasters, poorer air quality, and drought. Health systems have an opportunity to educate patients and the public about the impact of climate change on health and ways to address it, as nurses, physicians, and health care workers rank among the most trustworthy professions, alongside teachers.¹² Health systems can use existing resources, such as the Environmental Protection Agency’s climate change and health factsheets, the American Public Health Association’s How Climate Change Affects Your Health infographics, and the American Red Cross’ emergency preparedness tips on extreme heat, flooding, drought, wildfires, winter storms, and other climate disasters. 

Health systems may also consider integrating environmental health history forms into electronic health record systems to assess risk among sensitive populations, discuss the relationship between climate change and health, and identify solutions. One example of such a tool is the National Environmental Education Foundation’s environmental history form for pediatric asthma.

Advocacy and Leadership 

Background 

Over half (12) of the 20 organizations CHI interviewed highlighted advocacy and leadership as a need. These organizations included K–12 education, local departments of public health and environment, community-based organizations, climate offices and organizations, and academia. Stakeholders in every Kaiser Permanente Colorado service area and those representing statewide organizations identified advocacy and leadership opportunities for health systems and philanthropic organizations. 

Further engage in efforts to decarbonize the health sector in the U.S. 

The U.S. health care system is responsible for about 27% of all global health care-related greenhouse gas emissions and 10% of all national greenhouse gas emissions.^13,14,15 Health systems can advance and model sustainable practices; train and incentivize their staff to provide high-value, low-waste care; and encourage staff at all levels to be conscious of resources and waste. Kaiser Permanente is already a leader in this space as the first health system in the U.S. to reach carbon neutrality.¹⁶

Advocate for policies that benefit both the environment and human health. 

Policies related to land use, the built environment, and public transportation can benefit both the environment and human health. For instance, designing more walkable cities and expanding public transportation infrastructure is healthy for residents and reduces vehicle emissions. 

Health systems and philanthropic organizations can also advocate for health insurance solutions. One way is through Section 1115 waivers, which allow states to test new ways to operate their Medicaid programs to fund health-related social needs. The Centers for Medicare & Medicaid Services have approved waivers in Massachusetts and Oregon that allow these states to pay for medically necessary supports to improve air quality, such as air conditioners, humidifiers, and air filtration devices.¹⁷ Colorado has several approved or pending 1115 waivers, but none are specifically related to climate and health.¹⁸

Lead cross-sector partnerships to align stakeholders’ efforts. 

Health systems and philanthropic groups are well-positioned to bring together the full array of people and organizations working on climate and health. They have the resources and networks to unite partners from local departments of public health and environment, local government, community-based organizations, and community champions to support or create local partnerships and coalitions.

Build partnerships with local community-based organizations to better connect patients to resources for climate change adaptation. 

Health systems need to strengthen their referral networks to responsibly screen for and provide education on patient sensitivities to climate change. Many health systems already screen and refer patients for social factors that influence health and can use a similar model to assess patients’ susceptibility to climate change impacts and connect them to resources. Health systems and philanthropic organizations should consider the effect that increasing referrals may have on the demand for services and work with community-based organizations to evaluate and address their capacity to meet community needs.

Community Health Initiatives 

Background 

Half of the 20 organizations CHI interviewed identified a need for additional community health initiatives. These organizations included community-based organizations, local departments of public health and environment, climate offices and organizations, and K–12 education. Stakeholders who shared this need represented both local and statewide organizations. 

Organizations working to increase community resilience through climate change mitigation and adaptation efforts need additional support. Key informants told CHI that current funding is not enough to sustain and expand the programs and workforce necessary to protect communities from the impacts of climate change. Recommendations to address climate change by exposure or hazard type include: 

Support efforts to address extreme heat and poor air quality. 

As mentioned, Colorado’s average temperatures have increased over the past 30 years and will continue to rise. The increasing frequency and intensity of wildfires and increased ozone levels contribute to poor air quality. Community-based organizations are working to protect communities by increasing access to safe, comfortable living conditions, and would benefit from additional support from the health and philanthropic sectors.

Support efforts to address drought and its impact on water availability and quality. 

Regions of Colorado continue to face extreme drought conditions, which can contribute to water shortages. These shortages not only lead to poorer water quality, but also negatively affect the economy in areas that rely on agriculture. Drought is a major stressor for Colorado’s farmers, agricultural workers, and their families. Health systems and philanthropic groups could support organizations working in water conservation and provide mental health support to agricultural communities.

Data and Research 

Background 

Of the 20 organizations CHI interviewed, eight mentioned the need for additional data and research. These organizations included local departments of public health and environment, climate offices and organizations, community-based organizations, and academia. Representatives across every Kaiser Permanente Colorado service area as well as those from organizations serving Colorado statewide identified this need. 

Health and environmental researchers have identified gaps in the public’s knowledge about health impacts of climate change, climate change interventions, and policy solutions. Many opportunities exist to further understand the relationship between climate change and health in communities as well as gaps in data availability to do so. Expanding the body of climate and health research will inform next steps to advance climate change mitigation and adaptation efforts in Colorado. Health systems and philanthropic organizations may consider the following examples, identified though CHI’s research, as potential ways to meaningfully address data and research needs. 

Partner with organizations conducting studies that explore the relationship between environmental exposures and health. 

Researchers are piloting interventions to assess their effectiveness in improving air quality and other key metrics. For example, Rocky Mountain Institute (RMI) is conducting interventional pilot studies to assess the effect that switching to electric stoves from gas stoves has on indoor air quality. Pairing study data with health data would allow researchers to evaluate the effectiveness of interventions, such as home electrification, on health outcomes, such as asthma and other respiratory conditions. 

Collect data to better understand how environmental exposures and extreme weather events relate to health outcomes and health care utilization. 

A key knowledge gap in the field of climate and health research is understanding which patients are more likely to need access to health care for climate-sensitive conditions and how and when they obtain care.¹⁹ One way for health systems to fill this knowledge gap is to report, for instance, the air quality when patients are hospitalized due to asthma or the temperature when patients experience heat-related illness. Researchers and health systems also need data across the full spectrum of health care — from preventive, to urgent, to emergency care — as emergency room data alone only show the worst-case scenarios. Finally, communities, local public health departments, and local governments need access to this data to inform decision-making and advocacy efforts.

Support evaluation efforts to measure the impact of existing programs. 

Many community-based climate mitigation and adaptation efforts are just beginning. Organizations that have not historically focused on climate are stepping up to fill a need in their communities. Evaluating these programs will add to the pool of evidence-based and promising practices that can be scaled and replicated.

Assessment 

Background 

Five of the 20 organizations CHI interviewed identified assessment as an opportunity for health systems. These organizations included K–12 education, community-based organizations, and academia. Organizations across several of Kaiser Permanente Colorado’s service areas and organizations serving Colorado statewide identified this need. 

Incorporate climate and environmental metrics into community health needs assessments. 

In Colorado, nonprofit tax-exempt general hospitals are required to complete a community health needs assessment every three years.²⁰ These assessments can be an opportunity for health systems to incorporate climate and environmental metrics into both secondary data collection and community engagement efforts. Incorporating data and discussion related to climate change and its impact on health will allow health systems to identify the most urgent health needs and create tailored solutions for the communities they serve. Kaiser Permanente Colorado’s most recent community health needs assessment identified climate and the environment as a prioritized health need in its service area, which informed its climate-related implementation strategies.²¹