SACRAMENTO, Calif. — Wildfire smoke. Drought. Brutal heat. Floods. As Californians increasingly feel the health effects of climate change, state leaders are adopting sweeping policies they hope will fend off the worst impacts — and be replicated by other countries.

Several of them attended the United Nations Framework Convention on Climate Change, known as COP28, late last year, where more than 120 countries signed a declaration acknowledging the growing health impacts of climate change and their responsibility to keep people safe.

“Leaders from around the world are coming to these climate negotiations understanding that climate change is both killing and hurting their people,” said Wade Crowfoot, secretary of the California Natural Resources Agency, who represented California in Dubai.

In August and September 2020 alone, when dozens of wildfires burned around California, as many as 3,000 older residents may have died from wildfire smoke-related causes, according to estimates from Stanford University researchers.

California has taken steps on its own to address climate change and cut greenhouse gas emissions, such as banning the sale of new gas-powered cars and light trucks by 2035 and requiring utilities to provide a growing share of electricity from renewable sources like wind and solar. The policies are intended to reduce the state’s air pollution, which consistently ranks among the worst in the nation — especially in the San Joaquin Valley and the Los Angeles basin — and contributes to the premature deaths of thousands of Californians annually.

Regulators estimate California’s climate policies could reduce the cost of hospitalizations, asthma cases, and lost work and school days by $199 billion in 2045 alone.

“If we don’t take action, it has an impact on public health. It also has a massive economic impact,” said Liane Randolph, who chairs the California Air Resources Board and also attended the conference.

Crowfoot, Randolph, and another attendee, Christina Snider-Ashtari, Democratic Gov. Gavin Newsom’s Tribal Affairs secretary, spoke with KFF Health News senior correspondent Samantha Young to explain how California is trying to keep its nearly 40 million residents safe. The interviews have been edited for length and clarity.

Q: What is the biggest health threat that climate change poses for Californians, and what is the state doing about it?

Randolph: The biggest challenges are extreme heat and wildfire smoke. And climate change is making the existing health threats worse. For example, heat increases ozone pollution. What is happening is that high-heat days are becoming more common. And while we have reduced ozone levels and nitrogen oxides in the atmosphere, we still end up with days where air quality levels are exceeded because we have more high-heat days that create additional smog.

We have a comprehensive document, called the Scoping Plan, to tackle climate change. The key piece of it is reducing the combustion of fossil fuels because those have public health impacts on the ground for air quality and they have climate impacts. We are moving to zero-emission vehicles, moving to renewable energy, moving to zero-emission space and water heaters. All of these strategies move us away from the combustion of fossil fuels.

California itself cannot tackle climate change worldwide, but what we can do is support new technologies that can then be replicated, ideally, around the country and around the world. We’re encouraging the development of zero-emission vehicles all the way from passenger vehicles to heavy-duty vehicles. We’re fostering the market for technologies like heat pumps that allow people to heat and cool their homes without using gas. All of these things need to get support and have a market. We can create markets that can percolate through the rest of the world.

Snider-Ashtari: Many tribes have been relocated to places that don’t have good access to water, and that was by design, by the federal government and the state. So, tribes are already in places where it’s designed to be inhospitable to life. As things get worse, and there are more stressors, less water, hotter summers, Indian Country are these islands of vulnerability within California.

A lot of our ancestral food sources that tribes have relied on are either not there or they are there at the wrong time of year. Salmon populations are on the decline. Native people can’t access abalone right now because of ocean acidification and overharvesting. The same thing with seaweed, which is a major supplement to diets. With certain species not able to thrive in a changing climate, you’re just not going to be able to get the same kind of nutrition in rural California that you would in other places. We will have bigger impacts on the health stressors that Native people already suffer from, like diabetes at higher rates.

One of the things that we’ve been looking at with tribes is reintroducing traditional practices to address climate issues. We’ve been reintegrating cultural burning practices so the smoke will clear out invasive pests and make sure the forest floor is healthy. We can promote forest health to prevent large-scale wildfires, which leads to the pumping of carbon into the atmosphere, and we can create better crops for Native people so they can have their critical food sources. Tribes aren’t going anywhere. The rest of us could move anywhere we want, but tribes — these are our ancestral homelands.

Crowfoot: We are experiencing multiple overlapping health threats. Wildfire, drought, and extreme heat cost lives in California. Wildfire gets a lot of attention, particularly when it’s barreling down on communities, which is a major danger. But less discussed are the smoke impacts from wildfire. During our worst wildfire seasons, weeks of dangerous air blanket the state. For Californians that have preexisting medical conditions, for the elderly, for kids, that is really dangerous.

As it relates to drought, several hundred thousand Californians lose their access to water in their homes during drought because they’re on shallow groundwater wells. That’s a major health impact in the most vulnerable, poorest, most isolated communities in California. And then there’s extreme heat. It’s now the biggest climate-driven killer in California and other parts of the world.

Building our resilience to these climate impacts is a matter of health and safety. We have really clear action plans. We have one on water resilience, specifically on water supply and how we’re going to supplant the loss of water supply in the next two decades. We have one on wildfire. Not only are we improving the ability to fight wildfires, but we’re spending a ton of money protecting communities, improving landscapes. And we have an Extreme Heat Action Plan to improve protections for people, everything from noticing when extreme heat is bearing down, providing places of refuge in communities where people don’t have air conditioning, and trying to get more shade cover at schools and on the streets.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

By Samantha Young
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.