Climate Change Impacts Across California - Health

Climate Change Impacts Across California Health HEALTH Other Reports Summary in This Series Climate change will have a number of serious impacts on California, including public health risks, damage to property and infrastructure, life-threatening events, and impaired natural resources. This report focuses on how a changing climate CROSSCUTTING ISSUES is affecting the health of Californians and key issues the Legislature faces in responding to those impacts. This is one of a series of reports summarizing how climate change will impact different sectors across California. We find that climate change has a wide variety of direct and indirect health HOUSING effects on Californians. In particular, rising temperatures and extreme heat events are projected to increase deaths and exacerbate conditions like cardiovascular disease and kidney failure. Similarly, additional wildfire smoke driven by a changing K-12 EDUCATION climate leads to higher levels of respiratory illness, preterm births, and deaths. The adverse health effects are not uniformly distributed across regions and populations, however. Some areas are more susceptible to climate-induced disasters or other changes, or are less able to adapt to these changing conditions. Certain TRANSPORTATION populations, particularly lower-income, older, or medically compromised individuals, as well as outdoor workers, will disproportionately bear the adverse health burdens of climate change. Finally, changing climate conditions likely will challenge the state’s health care delivery system in multiple ways—including placing additional WORKERS & strain on emergency response systems and increasing demand for climate-related EMPLOYERS services—although the magnitude of these challenges is not yet well known. As the Legislature considers various climate adaptation strategies within the health policy domain, it will first want to consider how state health policies and programs fit into the broader set of actions taken by individuals, the private sector, local governments, and other state agencies. For example, state health departments can play a vital role in supporting research on the health effects of climate change; improving data collection, sharing, monitoring, and analysis; and evaluating which health-related climate adaptation activities are most effective and efficient. This information can be used to assist and support other state agencies and local governments. The Legislature also may want to consider ways to ensure health care delivery systems are adequately prepared to respond to climate change, particularly climate-induced disasters. Finally, the Legislature will want to think about how the state can reduce adverse health impacts on the most vulnerable populations. For example, state policies and funding could be targeted in ways that support populations lacking the resources to adequately protect themselves from the increasing health risks. Gabriel Petek Ap1ril 2022 LEGISLATIVE ANALYST’S OFFICE Introduction This report contains three primary sections: California Faces Five Major Climate (1) the major ways climate change affects health, Hazards. As discussed in depth in our companion (2) significant existing state-level efforts underway report, Climate Change Impacts Across California: to address climate change impacts in the health Crosscutting Issues, California faces five sector, and (3) key questions for the Legislature major hazards as the result of climate change. to consider in response to these impacts. Given Specifically, increasing temperatures, a changing the complexity of the issues, this report does hydrology, and rising sea levels will lead to: not contain explicit recommendations or a • Higher average temperatures and specific path forward; rather, it is intended as a periods of extreme heat. framing document to help the Legislature adopt a “climate lens” across the health policy area. • More frequent and intense droughts. Because some degree of climate change • Increased risk of floods. already is occurring and more changes are inevitable, this document focuses primarily on • More severe wildfires. how the Legislature can think about responding • Coastal flooding and erosion. to resulting impacts. Of note, the state is also engaged in numerous efforts to limit the Below, we discuss specific impacts degree to which climate change occurs by these hazards will have on health. enacting policies and programs to reduce emissions of greenhouse gases (GHGs). Major Climate Change Impacts On Health While climate change will have myriad and include injuries, illnesses, and deaths related to increasingly adverse health effects on Californians, extreme heat; disaster events (such as floods thus far, rising temperatures, extreme heat events, and wildfires); air pollution; changes in water and wildfire smoke are creating some of the worst quality; impacts on food and water supplies; problems, including exacerbating cardiovascular and increasing prevalence of certain diseases. disease and respiratory illnesses. Below, we In addition, there are other indirect avenues discuss (1) many of the key types of health risks through which climate change affects human associated with climate change, (2) some of health. For example, some studies have found the available research about the magnitude of that higher temperatures can reduce worker some of the major effects, (3) how these impacts productivity and student learning. Since there is are disproportionately spread across regions often a link between economic outcomes (such and populations, and (4) how climate change as income) and human health, adverse effects on could affect health care delivery systems. economic outcomes caused by climate change (such as reduced wages or gross domestic Climate Change Has a Wide Variety product) can affect human health indirectly. of Health Effects. As shown in Figure 1, climate change has a wide variety of human health effects. Some of the most direct impacts 2 LEGISLATIVE ANALYST’S OFFICE Extreme Heat Is Likely One of the Most for which heat was the primary cause of death, Significant Factors Impacting Mortality and other analyses that attempt to measure in California. Temperature-related mortality impacts on overall mortality estimate an additional (including from extreme heat) is projected to 3,300 deaths for which heat was a contributing be among the most deadly and costly impacts factor. The number of heat health events (HHEs)— of climate change in certain locations around defined as a set of temperature and humidity the globe. Higher temperatures and extreme conditions over a period of several days that heat can lead to heat stroke and increase the are known to result in significant negative health risk of or exacerbate cardiovascular disease, effects—are projected to grow in California in the respiratory disease, kidney failure, and preterm coming decades. Under a moderate-emissions births. Extreme heat is already one of the top scenario—which assumes that international contributors to weather-related deaths in the practices result in the rate of worldwide GHG United States and California. For example, emissions slowly declining in the coming decades, data from the California Department of Public somewhat constraining the magnitude of global Health (CDPH) show that from 2010 through temperature increases—annual net mortality 2019, California experienced roughly 600 deaths effects related to increased temperatures are Figure 1 Climate Change Has a Variety of Health Effects Climate Change Impact Examples of Health Effects Heat-related illness and death, including heat More frequent and severe extreme heat events. stroke, dehydration, cardiovascular failure, and kidney disease. Air pollution, including particulate matter, from Death and illnesses related to asthma, chronic wildfire smoke. obstructive pulmonary disease, and pneumonia. Injuries and fatalities from disasters, inability to More frequent and severe disasters, such as operate certain medical equipment during Public floods and wildfires. Safety Power Shutoffs, and behavioral health impacts related to traumatic events. Less secure water and food supply due to more Higher incidence of malnutrition frequent drought and warming temperatures. and diarrheal disease. Reduced water quality due to runoff from extreme Increased prevalence of cholera precipitation events and warming water temperatures. and harmful algal blooms in rivers and lakes. Changes in the climate conditions that support Higher incidence of vector-borne diseases, different diseases. such as Lyme disease and West Nile virus. Source: Adapted from Centers for Disease Control and Prevention and Senate Office of Research. LEGISLATIVE ANALYST’S OFFICE 3 projected to be 9 deaths per 100,000 people in researchers estimates that a 50 percent increase California. (While the U.S. average is close to zero, in wildfire smoke could increase deaths of older projections vary state by state.) By comparison, adults by an additional 9 to 20 per 100,000 people the 2019 annual mortality rate from automobile annually, an impact that is similar to the projected accidents in California was about 9 deaths per temperature-related mortality discussed earlier. 100,000 people and from drug overdose about Type and Magnitude of Impacts Vary 15 deaths per 100,000 people. As discussed Substantially by Region and Community. in more detail below, adverse health effects of The type of climate impacts and the magnitude of hotter temperatures will be particularly significant those effects will vary by location. For example, the in some locations and for certain populations. projected number of HHEs will differ significantly New Research Suggests Adverse Health across different regions of the state. Under a Effects From Wildfire Smoke Also Are high-emissions climate scenario where annual Substantial. Poor air quality has been linked to GHG emissions grow substantially over the next a wide variety of adverse health effects, including several decades, some regions—such as parts increased risk of asthma, cardiovascular disease, of Riverside and Placer Counties—are expected cognitive impairment, and premature births. to experience five additional HHEs annually California already has some of the most significant by mid-century, compared to fewer than one air quality challenges in the country, largely related additional HHE annually in other regions such as to human activities (such as driving gasoline- and many coastal areas and large areas of Northern diesel-powered vehicles) and the geography California. Notably, even though extreme heat will of certain regions that trap air pollutants. For be more frequent and severe in hotter regions, example, the San Joaquin Valley and South one national study by researchers from the Coast air basins have some of the worst air National Bureau of Economic Research estimates pollution in the nation. In recent years, smoke from that temperature-related mortality is actually wildfires has grown substantially and has been projected to be higher in cooler regions because a major contributor to air pollution in the western they are less prepared for the heat (for example, United States—making up roughly half of small fewer buildings have air conditioning). There also particulate matter in some regions, compared to are significant differences in the projected number less than 20 percent a decade ago. Overall health of heat-related deaths within a particular region effects from wildfire smoke are still being studied, or city. For example, urban areas with a large but a rough estimate suggests wildfire smoke in percentage of impervious surfaces and relatively 2020 caused about 20 deaths per 100,000 adults little shade—also known as urban heat islands— over the age of 65. Wildfire smoke also can have tend to be hotter than surrounding areas. These long-term health effects. For example, it has been urban heat island effects tend to be more severe linked to an increase in preterm births, which in neighborhoods that were the subject of historical in turn increases the risk of various long-term discriminatory housing policies, such as redlining. health problems for those children. The degree Similarly, the effects of wildfire on health will to which climate change will impact particulate vary across regions. The direct impacts—such matter emissions in the future is subject to some as deaths and injuries occurring in and adjacent uncertainty, but one study of California wildfires to the fires—will be concentrated in areas where estimates that particulate matter in fire-prone areas people live near fire-prone landscapes, typically could roughly double by the end of the century. in rural areas or in the wildland-urban interface. Another recent study by Stanford University 4 LEGISLATIVE ANALYST’S OFFICE While communities near fire-prone areas also Climate Impacts Will Have a Wide Variety will experience more significant impacts from of Effects on Health Care Delivery Systems. wildfire smoke and loss of power during Public Changing conditions and more frequent Safety Power Shutoff (PSPS) events, these emergency events will challenge health care indirect effects also can impact other regions of delivery systems in multiple ways, including: the state (as well as other states). For example, • Additional Strain on Emergency effects can be more widespread when wind Operations. Climate change can strain transports wildfire smoke to other parts health care professionals and facilities of the state and if utilities shut down a major needed to treat patients during more frequent electricity transmission line during a PSPS event. and severe emergencies. When facilities, workers, and transportation and power Vulnerable Populations Will Bear a systems themselves are affected by the Disproportionate Burden of Impacts. Within a emergency (for example, if a hospital and particular region or community, some populations its workers must evacuate during a wildfire), will be more impacted by climate change than capacity in nearby areas and the ability others. In general, low-income households to deliver timely care could be impaired. and communities are expected to bear a Following the 2018 Camp Fire, for example, disproportionate burden because they have fewer nearby health systems in Butte County resources to adapt to various climate impacts. experienced increased demand due to the For example, low-income households have less loss of 100 staffed hospital beds in Paradise. money to purchase and operate air conditioning units during extreme heat events, air filters to • Increased Demand for Certain Services. moderate wildfire smoke, or back-up electricity A changing climate also could increase generators to provide electricity during PSPS ongoing demand for services to treat events. In addition, some of the most significant certain conditions that are exacerbated climate impacts—such as heat and wildfire by climate change, such as heat-related smoke—disproportionately affect certain medically illnesses, respiratory diseases, and vulnerable populations, including children and the behavioral health needs related to trauma elderly, populations that have underlying medical and anxiety. This could amplify the need conditions (such as asthma and cardiovascular for professionals trained to treat these disease), and populations that spend a lot of time increasingly common conditions. outdoors (such as homeless populations and outdoor workers). Extreme heat and wildfire smoke • Greater Need for Information Sharing. that make it dangerous to spend time outside Currently, only limited data sharing occurs during certain times also could disproportionately among health plans, public agencies, affect people who are institutionalized (such as providers, and facilities, making planning patients at State Hospitals and individuals in state for emergencies and treating patients prisons and county jails). These populations might during disasters more difficult. As noted not have an opportunity to go outside for days at below, the state has developed a system a time because they are only allowed to spend for emergency responders to access time outside during specific hours of the day. some patient health information during an emergency—the California Patient Unified Lookup System for Emergencies (PULSE)— LEGISLATIVE ANALYST’S OFFICE 5 but it has limited functionality. A more health care workers and facilities in particular systematic exchange of information would areas. For example, in the short term, the aid state and regional planning for health availability of health care workers is impacted care workforce, equipment, and supply when a disaster damages their homes or the needs. Increased data sharing also would facilities at which they work or leads to an facilitate better real-time notification across evacuation order. In the long run, providers provider systems about disease spread might choose to work elsewhere due to or anticipated health threats from disaster climate change risks. Given the essential events. Moreover, when a patient has to be role of health care systems, particularly transported from one facility to another during in emergency situations, even short-term an emergency, reliable access to the patient shortages could complicate the state’s record is vital to ensuring continuity of care. long-term planning efforts to ensure there are sufficient providers in all areas of the state. • Reduced Availability of Workforce and The overall magnitude of these different Care. Similar to many other industries, effects on health care delivery systems in climate change could affect the supply of the coming decades still is unclear. Significant Existing Efforts and Funding The state already has undertaken some plan for the health impacts of climate change. steps to begin addressing how the changing California’s program, California Building Resilience climate impacts Californians’ health. Some of Against Climate Effects (CalBRACE), housed these activities have been in direct response to in CDPH’s OHE, is focused on the health climate change, while others—such as those impacts of rising temperatures and extreme that seek to address the social determinants of heat, wildfire, and sea-level rise. CalBRACE health or to improve responses to emergencies— provides tools to local governments to aid in have complementary primary goals that also their planning efforts, such as county-level have climate-related benefits. Below, we profiles on climate change and health, and highlight some of these recent efforts. data visualizations on health vulnerabilities. CDPH Climate Change and Health Equity Medi-Cal Reforms to Address Social Section. Within CDPH’s Office of Health Determinants of Health. The recently Equity (OHE), the Climate Change and Health approved California Advancing and Improving Equity Section consults and collaborates with Medi-Cal (CalAIM) reform effort seeks to other state and local agencies to ensure social improve the health of Medi-Cal’s highest-need determinants of health are addressed in their beneficiaries by addressing the social climate adaptation activities. Activities include determinants of health, which also helps these providing technical assistance, data, research, individuals adapt to the health impacts of toolkits, and interactive web resources. climate change. For example, under CalAIM, Medi-Cal plans have the option to pay for air CALBRACE Tool. California is one of conditioners and asthma remediation services. 16 states and 2 cities receiving special Centers for Disease Control and Prevention funding to 6 LEGISLATIVE ANALYST’S OFFICE Ensuring Access to Health Care During emergency medical response to disaster events. and After States of Emergency. State law The 2021-22 state budget augmented EMSA’s requires health plans to ensure continued access funding by $36 million one-time across three to medically necessary health care services years and $3.3 million ongoing to increase for enrollees affected by a state of emergency the authority’s capacity, including for medical and allows them certain flexibilities (such as surge staffing, storage and maintenance suspending prescription refill limitations). Existing of emergency equipment and supplies, state and federal Medicaid laws also allow the regional disaster medical health response, waiver of Medi-Cal program rules during and and planning for development of a statewide after emergencies. For example, providers may emergency services data resources system. receive reimbursement for services delivered Access to Patient Health Care Information via telehealth and the state may presume During Emergencies. EMSA manages the Medi-Cal eligibility for likely eligible applicants. PULSE system, which provides specified Development of New Data Exchange health care workers who are volunteering during Framework. Chapter 143 of 2021 (AB 133, an emergency short-term access to patients’ Committee on Health) requires that the California personal health information. The system has Health and Human Services Agency create a been activated during recent years’ wildfires. data exchange framework to facilitate sharing Climate Adaptation Funding Included of health and social services information across in 2021-22 Budget. The most recent state health care entities (health plans, providers, budget included various multiyear funding facilities, and labs) and government agencies packages that are meant to promote climate over the next several years. While not specifically adaptation, including $3.7 billion for climate proposed in response to climate change, this effort resilience activities (including for extreme heat), will enable sharing of additional real-time health $4.6 billion for drought and water resilience information during climate-driven emergencies. activities, and $988 million to address wildfire and Augmentations to Emergency Medical forest resilience. The funds will be administered Services Authority (EMSA) Budget. primarily by natural resources and environmental EMSA develops and implements emergency protection departments but will support activities medical services and aids in preparing for, that could reduce negative health impacts. coordinating, and supporting state and local Key Issues for Legislative Consideration The Legislature has a wide range of potential How Should State Health Policies and state policy and budget actions it could undertake Programs Fit Within the Broader Suite of to reduce the adverse effects of climate change Adaptation Activities? The magnitude and on health. Below, we raise several questions the extent of climate change impacts on the health of Legislature will want to consider as it thinks about Californians makes it unreasonable to expect that the role of health policies, programs, and delivery state and local health departments will be able to systems in adapting to the impacts associated address them all in isolation. Rather, effectively with a changing climate. We also summarize reducing the anticipated adverse effects will these issues in Figure 2 on the next page. require a wide range of actions to be undertaken LEGISLATIVE ANALYST’S OFFICE 7 by both private and public Figure 2 actors across the state. For Climate Change Impacts on Health: example, private businesses Key Issues for Legislative Consideration and households likely will implement many adaptation 9 How should state health policies and programs fit within the broader suite of activities—such as adopting adaptation activities? air conditioners, air filters, and 9 How can the state improve monitoring and analyses of health effects? back-up power generation— 9 to reduce their own risks. How can the state evaluate which adaptation strategies best reduce Similarly, local governments health risks? are likely to respond to climate 9 How can the state support local health programs? threats by developing and 9 implementing plans to protect How can state health departments support and coordinate with other state agencies? their communities, such as by 9 establishing additional cooling How can the state help reduce impacts on the most vulnerable populations? centers where residents can 9 How can the state ensure the health care delivery system is gather during heat waves. adequately prepared? Moreover, a wide variety of state departments that do level and across state government, (3) focusing not directly work on health policy already are on the disproportionate needs of vulnerable taking and will continue to take actions to reduce populations, and (4) ensuring the health care climate risks, such as urban greening projects delivery system is adequately prepared. to provide shade and reduce heat islands, How Can the State Improve Monitoring and improved forest management activities to reduce Analyses of Health Effects? The Legislature will the severity of wildfires, and water management want to consider what additional data regarding projects to address drought-related water climate change impacts on health the state needs shortages. All of these programs can help reduce to inform its responses. First, the Legislature could climate impacts on health, but they are mostly consider opportunities to improve the state’s implemented through the state’s natural resource ongoing monitoring of current health effects related and environmental protection departments, to climate change. For example, the state currently rather than through state health departments. does not have a surveillance system for monitoring Within this broader context of public and the real-time health effects of extreme heat in private adaptation actions, the Legislature may California, including when and where heat-related want to consider what role state health programs deaths and injuries are occurring. Health and policies can and should play in adapting to outcomes—such as deaths and emergency room climate change, including how they interact with visits—are not collected in real time, and the official local adaptation activities. Below, we discuss data likely underestimate the number of deaths some of the key climate-related issues that related to extreme heat. Addressing this deficiency state health policymakers and departments also will require better linking and sharing of might wish to consider. The broad categories of public health and health care delivery data across activities include (1) assessing and addressing health plans, providers, facilities, labs, and state existing data and analysis gaps, (2) providing and local agencies. Similarly, the state currently support and coordination for efforts at the local lacks the ability to comprehensively monitor the 8 LEGISLATIVE ANALYST’S OFFICE overall health effects from exposure to wildfire How Can the State Evaluate Which smoke. For example, existing official air quality Adaptation Strategies Best Reduce Health monitoring networks often are not sufficiently Risks? In addition to assessing and addressing dense to measure the effects of smoke on existing data gaps for climate-related health ambient air quality at the local level, and relevant impacts, the Legislature also faces the challenge health outcome data is not easily accessible or of evaluating the effectiveness of potential available in real time. Establishing better systems strategies to respond to those impacts. Currently, for monitoring the effects of climate-related health only limited information is available on which outcomes could help policymakers better assess adaptation strategies are likely to reduce future the current magnitude of these health effects and health risks at the lowest possible costs, and how identify trends that merit additional policy action. equitably the benefits and costs of those strategies are distributed across different regions and Second, there is limited quantitative information populations. For example, which strategies reduce available about the degree to which climate heat-related mortality cost-effectively is still unclear, change is projected to impact future health making it difficult for the Legislature to determine outcomes in California, such as illnesses, whether to prioritize funding for expanding the injuries, and deaths. Based on our initial urban tree canopy, additional cooling centers, review, the available studies only rarely focus subsidies to purchase or run air conditioning, on California-specific effects and generally public education campaigns, or other strategies. concentrate on past events or explore only a To address these gaps, the Legislature could limited set of climate-related health outcomes. consider supporting additional research and pilot For example, only very limited information is projects to evaluate a variety of different adaptation available on the projected impact of wildfire strategies. This information could then be used smoke on various illnesses (such as asthma) and to (1) prioritize funding for future adaptation the impact of additional disasters on behavioral programs, (2) compare the health benefits of health conditions. In addition, there is very little climate-focused programs to other programs detail about the health effects of climate change— that might improve health outcomes (such as rather than the frequency or severity of disaster separate efforts to improve the state’s Medi-Cal events—on specific communities and populations. system), and (3) provide technical assistance to The state could consider ways to support future local governments that are exploring opportunities efforts to (1) make health outcome data more to reduce future climate-related health risks. accessible to researchers, (2) consolidate and summarize the available academic research How Can the State Support Local Health on the magnitude of the potential future health Programs? Since climate impacts will vary by outcomes, and (3) support additional analyses region and community, maintaining a strong role of future climate-related health outcomes in for regional and local decision-making will help California. Better forecasts of future health ensure adaptation activities are addressing the outcomes in California could help determine the most pressing climate impacts in each area. scope of policy action that might be warranted, In addition, local governments currently play a prioritize the climate impacts on which the state critical role in implementing key health programs, should focus, and help the state strategize about such as local public health programs and potential options and align the necessary fiscal behavioral health services. However, most local resources for addressing the likely health effects. public health departments lack in-house and local expertise on assessing and responding to the LEGISLATIVE ANALYST’S OFFICE 9 impacts of climate change, which limits their ability • Financial Support. The Legislature to advise and assist local residents, businesses, could provide additional funding to local and health providers. In addition, some of these public health departments. Additional departments may not have enough staff to support state support could help local agencies and manage data collection and reporting, limiting fill some of their existing expertise and real-time surveillance. As such, the Legislature capacity deficiencies. The 2021-22 budget will want to consider how the state can support agreement between the Legislature and these local health programs as they respond Governor committed $300 million in ongoing to the challenges posed by climate change. General Fund beginning in 2022-23 for Some potential areas of focus could include: public health “infrastructure” (such as staffing, lab capacity and equipment, and • Conduct Research on Local Climate information technology systems) at the Impacts. While certain existing state state and local levels. The Legislature could efforts—such as CalBRACE, the California’s consider directing a portion of this funding Fourth Climate Change Assessment, and specifically to address climate-related gaps. Cal-Adapt—provide some region-specific climate information, the state could support How Can State Health Departments additional efforts to provide more detailed Support and Coordinate With Other State information on local health outcomes to inform Agencies? Given the crosscutting nature of local decision-making and prioritization. Local climate change impacts and the many state efforts also could be informed by the state departments that will be involved, the Legislature conducting evaluations of which adaptation may want to ensure that state-level efforts are strategies best reduce climate-related coordinated and informed by health experts. health risks, as discussed above. In particular, the Legislature could require that the expertise in the state’s health agencies • Technical Assistance. The Legislature is being used to inform the design of climate could increase mechanisms to provide adaptation programs and regulations in other state-level guidance and expertise to support agencies that might lack such expertise. activities at the local level. For example, Some examples of such interagency consultation this could include providing guidance on already exist. For instance, CDPH is providing best practices to help local governments technical assistance to the California Division of determine which adaptation interventions to Occupational Safety and Health in its efforts to pursue. It also could include funding additional develop and adopt workplace heat standards. staff with expertise in climate change Similar types of efforts from other non-health impacts and adaptation strategies at CDPH state departments likely will be considered in explicitly to provide technical assistance to future years, such as potentially establishing heat local health departments. (CDPH recently or smoke safety standards for outdoor activities helped the San Diego Health and Human at schools, updating building codes, or making Services Agency in developing a climate changes to general planning requirements. change and health plan and implementing As more agencies begin to implement programs a variety of other climate-related activities, meant to reduce adverse health effects from but the department indicates that the six climate change, the Legislature could consider staff in its Climate Change and Health adding a requirement that the administering Equity Section have limited capacity to department consult with CDPH when developing respond to requests for such assistance.) those programs’ regulations or guidelines. 10 LEGISLATIVE ANALYST’S OFFICE How Can the State Help Reduce Impacts Medi-Cal managed care plans’ role in helping their on the Most Vulnerable Populations? members prepare for and navigate services during As discussed above, certain populations—such and after emergencies. For example, the state as low-income households and medically sensitive could consider putting in place additional policies populations—generally are more vulnerable to requiring managed care plans or their contracted the effects of climate change. Targeting state providers to work more directly with their most programs in ways that support these vulnerable vulnerable members during emergencies. populations could help address some of the How Can the State Ensure the Health most significant adverse health effects of climate Care Delivery System Is Adequately change, as well as reduce the inequitable Prepared? The Legislature could consider distribution of impacts. This could include steps steps to ensure the state’s health care delivery such as establishing programs that provide free system is adequately prepared for the impacts or low-cost air filters or masks to low-income of climate change. For example, the Legislature populations, and ensuring warnings about extreme could consider requiring that providers receive heat and air quality are translated and targeted more training on emerging conditions and to reach medically and/or socially vulnerable diseases. Additionally, because managed care populations. In addition, given that Medi-Cal plans arrange and pay for the health care of provides coverage to 14 million Californians most (around 26 million) Californians, ensuring with low incomes—many of whom likely are they are well equipped to identify and address disproportionately vulnerable to climate change— climate-related health risks will be an essential the Legislature could consider the system’s role in component of an effective statewide strategy. addressing and preventing climate-related adverse Given the role the Legislature plays in setting health impacts. For example, the Legislature policies for managed health care plans, it can could expand Medi-Cal’s role in providing help ensure the impacts of climate change nonmedical benefits that address the negative are adequately incorporated in those policies. health impacts of climate change, such as by For example, the Legislature currently provides standardizing the provision of air conditioners input on what data the plans must make available and asthma remediation services as Medi-Cal to state regulators. The Legislature could consider benefits when medically necessary. (Currently, adding new data submission requirements Medi-Cal plans are not required to provide these on measures related to the health impacts of benefits, but have the option to do so.) Additionally, climate change to facilitate statewide tracking of the Legislature could consider strengthening impact trends and guide state-level responses. Conclusion Climate change already is having adverse and certain individuals face greater vulnerability health impacts across the state, and these due to their underlying health status, age, means, impacts are projected to grow over the coming type of work, or other characteristics. The more decades. The weight of these burdens will not the state can learn about these adverse health be spread uniformly across the state. Rather, impacts and which interventions are most cost some regions are disproportionately susceptible effective, the better positioned it will be to prepare, to climate-induced events and less able to adapt, plan ahead, and minimize these inevitable impacts. LEGISLATIVE ANALYST’S OFFICE 11 LAO Publications This report was prepared by prepared by Ross Brown and Sonja Petek, and reviewed by Rachel Ehlers and Carolyn Chu. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service, are available on the LAO’s website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000, Sacramento, California 95814. 12 LEGISLATIVE ANALYST’S OFFICE