U.S. States Most Vulnerable to Climate-Driven Health Threats

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This blog post explains a recent Commonwealth Fund scorecard that evaluates how U.S. states are both affected by climate-driven hazards and how they contribute to health-related climate risks.

Drawing on federal and state data from 2020–2024, the analysis scores states on air quality, extreme-heat vulnerability, greenhouse gas emissions, and the flood susceptibility of healthcare facilities. The scorecard offers a clear picture of where resilience and mitigation efforts are working — and where they are not.

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What the scorecard measured and why it matters

The scorecard combines public data to show two sides of the same coin: the exposure of populations and health systems to extreme weather, and the contribution of states to the problem through emissions and poor air quality.

By linking environmental metrics with healthcare vulnerabilities, the study highlights how climate change increasingly translates into concrete risks for hospitals, clinics, and patients.

Key indicators included in the assessment

The researchers evaluated a set of indicators that together illuminate both current risks and pathways to mitigation.

Important elements of the analysis include:

  • Air quality — long-term and acute pollution levels that affect respiratory and cardiovascular health.
  • Extreme heat vulnerability — population exposure and capacity to adapt, including urban heat islands.
  • Greenhouse gas emissions — statewide emissions that drive future warming and public health harms.
  • Healthcare facilities’ flood susceptibility — hospitals and clinics at risk of flooding that can disrupt services.
  • State rankings: leaders and laggards

    The results reveal strong regional variation.

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    States with aggressive clean-energy policies and lower healthcare emissions rank near the top, while those with higher exposure to hazards and weaker mitigation measures cluster at the bottom.

    These rankings are useful for policymakers, hospital administrators, and public health planners looking to prioritize investments.

    Top performers

    According to the Commonwealth Fund scorecard, the five highest-ranked states are:

  • Vermont
  • New York
  • Washington
  • New Jersey
  • Maine
  • Lowest scorers

    States with the poorest overall scores include:

  • West Virginia
  • Kentucky
  • Louisiana
  • Florida
  • Mississippi
  • Weather-related hotspots and acute hazards

    Beyond the composite rankings, the scorecard identifies places facing the most immediate weather-related threats.

    These hazards directly stress health infrastructure, from power outages to roads that become impassable for emergency vehicles.

    Florida and South Dakota stand out

    Florida is singled out for chronic coastal risks: hurricanes, storm surge-driven coastal flooding, and an increasing frequency of severe storms.

    These factors compound hospital vulnerabilities and can displace communities for weeks.

    South Dakota, by contrast, faces extremes of cold and intense convective storms that threaten rural and regional healthcare delivery in very different ways.

    Implications for healthcare resilience and policy

    The report’s findings are a clear call to action.

    As Lovisa Gustafsson of the Commonwealth Fund noted, power outages, flood-damaged facilities, and blocked transportation routes can cripple hospital operations — and those disruptions often last days or even weeks.

    Building climate resilience in health systems is no longer optional.

    Recommendations for state and health leaders

    To reduce risks and protect patients, I recommend the following steps based on decades of experience in public health and disaster preparedness:

  • Invest in grid resilience and backup power for hospitals and critical clinics.
  • Prioritize flood mitigation and site selection for new health facilities.
  • Accelerate emissions reductions in healthcare operations through clean-energy procurement.
  • Strengthen heat-mitigation strategies in urban planning and patient care settings.
  • Use scorecards as planning tools to target funding and measure progress over time.
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    Here is the source article for this story: Prescription For Disaster: Study Reveals Which States Face Critical Climate-Health Risks

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