A new state ranking published by the Commonwealth Fund compares all 50 states and Washington, D.C. on their climate risks.
The scorecard, which the organization said is the first of its kind, evaluated states on eight indicators. They include flood risk, healthcare facilities, energy efficiency policies and the health impacts of emissions from electricity generation and the healthcare sector overall. The report was written by researchers at Northeastern University and Yale University.
“The health care sector is dedicated to promoting patient health but also contributes significantly to climate change and environmental harm,” the report said. “Because of this interconnectedness, it is incumbent upon the sector to embrace sustainability measures and climate action in order to uphold its commitment to ‘do no harm.’”
Vermont, New York, Washington, New Jersey and Maine ranked safest overall, thanks to their strong energy efficiency and clean energy policies. They are also less vulnerable to environmental hazards and have lower healthcare sector emissions.
West Virginia, Kentucky, Louisiana, Florida and Mississippi ranked lowest. These states face more frequent and intense hazards and don’t have supportive energy and environmental policies, per the report.
“As a physician, I have seen firsthand how closely the environment and health are linked,” Joseph R. Betancourt, M.D., Commonwealth Fund president, said in a press release. “People are better off when they can breathe clean air and when the hospitals they depend on are prepared for extreme weather. I hope this scorecard inspires states to learn from one another’s efforts to reduce pollution, prepare for environmental risks, and better protect people’s health.”
Some states face greater natural risks than others. Nevada, New Mexico and Arizona face the greatest health risks from extreme heat—the deadliest weather-related hazard in the U.S.
Both Arizona and California have the poorest air quality, driven by ground-level ozone, wildfire smoke and dust. The states with the cleanest air were Alaska and Hawaii.
The report also ranked flood risk to hospitals. Florida has the highest share of hospital beds in high-hazard flood zones, at nearly 15%. Louisiana and Mississippi also face severe flood risks.
Healthcare accounts for 8.5% of the country’s greenhouse gas emissions. West Virginia, Wyoming and North Dakota were among the states with the highest per capita, healthcare-related emissions, reflecting heavy reliance on fossil fuels.
Mississippi, South Carolina and Alabama have the highest emissions related to healthcare worker commutes, linked to limited public transit options and longer travel distances for staff. These emissions, the report noted, significantly contribute to the sector’s carbon footprint.
The report highlighted opportunities for policies at the federal, state and health system levels. The authors recommended that policymakers strengthen clean energy and energy efficiency policies. They urged them to support healthcare facilities in assessing climate risks and preparing for extreme weather. They also recommended requiring standardized reporting of healthcare sector emissions to guide improvements and helping healthcare organizations invest in climate-resilient infrastructure, clean power and low-emission transport options for patients and staff.
“Extreme weather is no longer a distant threat—it's happening more often and disrupting care across the nation,” said Matthew Eckelman, Ph.D., Northeastern University associate professor and associate chair for research of civil and environmental engineering. “No state is spared, and every community is vulnerable. But action matters. Our scorecard shows that states with strong clean energy and resilience policies are doing a better job protecting health and health care infrastructure, while other states leave patients exposed during potential crises.”