While health impacts of climate change are increasingly evident, adaptation planning for climate health impacts in the United States (US) has lagged. In the absence of a national climate and health adaptation plan, varied approaches have been taken by states to address health in their adaptation planning. The authors reviewed state adaptation plans developed since 2008 to assess how health adaptation strategies were included and to document identified adaptation gaps and needs.

Plans were identified through Georgetown Climate Center’s State Adaptation Progress Tracker and a Google search. The authors developed a scoring rubric for consistency and evaluated plans based on such criteria as: Comprehensiveness, Inclusiveness, Monitoring and Evaluation. Adaptation priorities were noted and mapped to six categories.

19 plans met inclusion criteria. Most plans (14) identified exposure pathways impacting health. About half of plans identified vulnerable populations, but only three addressed the vulnerability of health systems. Most plans (13 of 19) did not mention a vulnerability assessment or cite a data source discussing vulnerability indicators. Only two plans had clear metrics for success. Only three mentioned an implementation timeline.

This review highlights both positive aspects and gaps in state climate and health planning. Many state plans did discuss climate and health, exposure pathways, and vulnerable populations. States lack clear metrics for monitoring and evaluation or implementation. States may benefit from federal leadership through a national-level climate and health adaptation plan or the federal government’s development of planning guidance for states, localities, tribes and territories.