U.S. – Vermont, New York, Washington, New Jersey and Maine have the best combination of relatively low environmental risks and robust environmental policies, according to a report released this week.

West Virginia, Kentucky, Louisiana, Florida and Mississippi ranked lowest on the 50-state scorecard produced by the Commonwealth Fund, a foundation that advocates for health care improvements.

Researchers at Northeastern and Yale universities ranked states based on risks from extreme heat, flooding, poor air quality, natural hazard risks to health care facilities and greenhouse gas emissions by the health care sector. The authors of the report also analyzed states’ clean energy policies and climate change mitigation efforts.

Climate change poses a severe threat to public health, leading health organizations have warned. Poor air quality, for example, contributes to between 100,000 and 200,000 excess U.S. deaths per year. Communities of color, low-income people, outdoor workers, people  with disabilities and homeless people are  more vulnerable to health harms associated with climate change.

In Florida, for example, nearly 15% of hospital beds are in high-hazard flood zones, according to the report — the highest share of any state. Coastal states Louisiana and Mississippi, where around 10% of hospital beds are in flood zones, also fared poorly.

West Virginia, Wyoming, and North Dakota had the highest per-capita greenhouse gas emissions from the health care sector in 2020. That year, West Virginia’s health care sector emitted 2,570 kilograms of carbon dioxide equivalent —- a measure of greenhouse gases’ warming effects —- per capita.

The report comes two days after President Donald Trump rebuffed the scientific consensus on climate change in his address to the United Nations General Assembly. “This ‘climate change’ – it’s the greatest con job ever perpetrated on the world, in my opinion,” Trump said in his Tuesday speech. The assembly included leaders from highly vulnerable nations and islands around the world that are suffering drought, threats to water security and increased flooding that scientists tie to climate change.

The Trump administration has fired numerous officials and scientists at the Environmental Protection Agency and has rescinded environmental justice grants awarded to states, nonprofits and universities. The administration also shut down the Office of Climate Change and Health Equity.

In July, the EPA announced a proposal to roll back vehicle emissions standards. These are based on scientific findings over decades that tie greenhouse gas emissions to public health dangers and serve as the basis for regulations under the Clean Air Act.

California Democratic Gov. Gavin Newsom called the proposal “negligence” that will “cause great harm to the American people.”

Nevada, New Mexico and Arizona faced the greatest extreme heat-driven health risks, according to the scorecard. These states have significant Indigenous and Latino populations. Previous reports have shown American Indian and Alaska Natives have seen the greatest per-year average increase of heat-related deaths, and outdoor workers are disproportionately Black and Latino.

Arizona and California had the poorest air quality, most likely driven by ground-level ozone, wildfire smoke and dust, the researchers said. They used the federal air quality index, which estimates levels of five main air pollutants, to score the states on air quality.

Alaska and Hawaii ranked highest in air quality. Alaska’s low population density contributed to its score, while Hawaii, situated in the Pacific Ocean, benefits from winds that disperse air pollutants, the authors wrote.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

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