This report looks at the negative impact climate has on health risks. Arizona ranks 45th in U.S.

A new report that ranks states based on climate-related risks and how they impact human health has some not-so-great news for Arizona. The data from the Commonwealth Fund ranks Arizona 45th in the country.

The organization has been evaluating state health care system performance for a while, but recently started looking at a new set of indicators to figure out how a state population’s health was affected by the environment and specific climate-related events and disasters.

In trying to figure this out, researchers looked at a state’s geography; how they’re doing in terms of enacting policies affecting health, but not only in the health sector; and how health care systems are responding in different states.

Arizona scored well in a few areas, including the emissions produced by health care workers and the risk to health care facilities from natural disasters. But the state scored poorly in factors like air quality and health risk from extreme heat.

The Show spoke recently with two of the report’s authors: Matt Eckelman, a professor of civil and environmental engineering at Northeastern University, and Melanie Marino, a Ph.D. candidate there, and started the conversation by talking about how states can’t really do that much about one set of factors — where they’re located, but that they do have some agency over others. The Show asked how those things come together to affect how well or poorly a state is doing.

Full conversation

Matt Eckelman

MATT ECKELMAN: The drivers we were looking at, the individual indicators, they're separate. But oftentimes there's interplay in the way they affect public health. So for example, something that we found that was really important was the policy around electricity generation in each state. And this has an effect on the sorts of fuels that are used for power generation and the emissions from those power plants and then the exposure to air pollution that people downwind have.

So that's one indicator. But, oftentimes pollution is exacerbated by heat. And so if you have both of these things together, you get even more health effects. So there's a synergy there. So even though, indicator by indicator, we group them in this way, in reality they're highly connected.

MARK BRODIE: So, Melanie, let me ask you about Arizona specifically, which was ranked 45 out of the 50 states plus D.C. here. And it seems as though air quality was one of the main factors, giving it kind of a low score. Anybody who spent a lot of time in the Phoenix area especially knows that the air quality is not great.

What, specifically, did you find that led Phoenix to get the grade that it did?

MELANIE MARINO: Yeah. So for the air quality index, kind of looking at the granular data, we can look at the specific pollutants driving Arizona's AQI score. And some of those pollutants are nitrogen dioxide and also particulate matter from dust, industrial sources and wildfires, and ground-level ozone exacerbated by constant sun in Arizona's hot and dry climate.

But it's also important to mention, like you mentioned, Phoenix, Arizona — that this indicator is based on population-weighted averages of county-level AQI. So if there are a lot of areas in the state with really bad air quality and a lot of people live there, that's going to be given more weight because we chose to do this as we're focused on the health impacts on human health.

BRODIE: Well, and that is clearly the case in Arizona, where a vast majority of the people in the state live in the Phoenix metro area, and this area routinely has pretty well-documented air quality problems. Sounds like what you're saying is that played at least some amount of a role in the ranking that the state had.

MARINO: Yeah, definitely. And looking at the data, we saw that Arizona's most populated county, Maricopa County, only had 10% of recorded days in the year with good air quality, as defined by the air quality index.

BRODIE: Matt, do you get the sense that there is, within the general public, a strong enough connection between the impacts of the environment on our health?

ECKELMAN: I would say a resounding no to that one. There's many ways that the environment affects our health, and I would guess, even for me as a scientist who works on this, I still discovered new pathways and new research that's coming out.

And I think for the general public, there's a real underappreciation for both the severity of effects from the environment and also just the many ways that the environment affects our health.

BRODIE: What are some of the biggest ways that you think it would be helpful if people sort of understood that connection, understood that link?

ECKELMAN: Well of course people feel it, right? They go outside, they feel unwell if it's a high heat day or if it's a high air pollution day. Our bodies, our noses, our skin — we're really good at sensing environmental risk. But what states can do and what states are doing that's incredibly helpful is having more sensing capability, monitoring environmental conditions, putting out alerts: "Don't go outside, better not to exercise today if you have a respiratory condition."

So we're seeing more monitoring from states, we're seeing a lot more training and communication between doctors and patients about climate related risks, and all of that's really helpful.

BRODIE: Melanie, I want to ask you about some of the areas in which Arizona actually did pretty well, despite its overall score. For example, it seems like there's not a lot of concern about natural disasters like hurricanes and flooding, things like that. There's also some energy efficiency areas, and it seems like the amount of emissions for health care workers going to and from work, the state does reasonably well.

Are those enough? Obviously the heat and the air quality are significant factors against the state. But I wonder if some of the areas where you found the state doing pretty well, are those enough to start a foundation of trying to make things better here?

Melanie Marino

MARINO: I would say yes. And I think a lot of these have to do with kind of health care system-level interventions. You know, for the health care facility natural hazard risk index, it has to do with where health care facilities are located. Are they located in areas at greater risk to environmental hazards? And also for the healthcare employee commuting emissions, are these healthcare facilities located in areas closer to centers of population with greater connection to public transit infrastructure?

And all these things kind of make a difference in building climate resilience and sustainable health care.

BRODIE: So is it safe to say then that those scores, like the ones you just mentioned, it's not necessarily just what the scores are, but maybe what they represent and the factors that lead to them. Like you were just saying, you know, maybe if health care providers don't create a lot of emissions going to and from work, that's a sign that maybe hospitals and other health care facilities are near where people live, which is probably where they should be.

It sounds like it's maybe more what the numbers represent in some way than what the numbers actually are.

MARINO: Yes, I would agree with that.

ECKELMAN: The indicators are a small sample of what would be possible to measure, and they each represent a major issue, a major sustainability or environmental health issue that we see as important in the United States and the kind of variety that we have across our nation.

One of the interesting things we've seen — of course we're evaluating states. But within states, of course, there's a broad range of performance and a broad range of actions that people are taking.

So in some states that are subject to these high hazard events or risks of some sort related to geography, they of course know it. They know that it floods a lot, they know that there's a lot of high heat. And so those are areas of the country where you're seeing a lot more adaptation action.

You're seeing responses on the ground from local governments. And so those are lessons that other states can actually look to even though where they fall in the rankings doesn't necessarily tell you who's on top and who's on the bottom. We're all trying to learn from each other. And what we hope to do in the future, as this scorecard gets put out and revised periodically, is that we're going to be able to see how states are doing over time.

That's going to be a lot more important. It's going to tell us more actual, useful information about performance than comparing states against each other. Each state's unique. It has its own history, its own constraints, its own culture. And so looking over time, it's going to be also pretty valuable.