by Kirsten Minor

As a public health professional, I feel I must speak out on last month’s Supreme Court ruling in West Virginia v. EPA. The decision complicates the EPA’s authority to regulate greenhouse gas emissions from energy production, even as Justice Elena Kagan calls climate change “the most pressing environmental challenge of our time.” There’s no other way to say it: this is a major setback for federal-level action addressing air pollution and climate.

But even with federal action delayed, North Carolinians can still mobilize at the local and state levels. And as luck would have it, we have a major opportunity this year to reshape North Carolina’s clean energy future through the ongoing state Carbon Planning process.

We’ll need significant interagency collaboration and an activated and engaged public providing input to ensure a strong, equitable Carbon Plan centered around public health.

Get Involved

Don’t give Duke Energy the final word on how North Carolina cuts carbon. Tell the NC Utilities Commission you want a strong Carbon Plan centered around clean energy and people, not dirty fossil fuel and polluter interests.

So what exactly is the health significance of WV v. EPA, and how does it relate to North Carolina’s developing Carbon Plan?

Transitioning Away From Fossil Fuels For A Cleaner, Healthier Future

Source: North Carolina Greenhouse Gas Inventory, N.C. Department of Environmental Quality

The burning of fossil fuels, primarily in our transportation and electricity sectors, remains the greatest source of greenhouse gas emissions and is the greatest threat to both our climate and global public health. Fossil fuel combustion also emits other dangerous air pollutants including fine particulate matter (PM 2.5), nitrogen oxide, and sulfur dioxide.

And if that weren’t enough, climate change also amplifies the health risks of air pollution exposure; it increases risk for the onset and exacerbation of both infectious and noncommunicable diseases, worsening health disparities and impacts the entire human body.

Air Pollution & Climate Change Harm Our Health:
Respiratory System
  • Increased risk of the development of respiratory disease, particularly asthma,¹ asthma hospitalization, asthma exacerbations and morbidities (i.e. asthma-COPD), and a decline in lung function² ³
  • Early-life development of allergic rhinitis, eczema, and enhanced allergic response⁴ ⁵
  • Increased lung cancer incidence and mortality (even among never-smokers)⁶⁷
  • Increased risk of developing acute respiratory distress syndrome (ARDS)
  • Increased risk of pulmonary embolism
  • Increased Emergency Department (ED) visits for upper respiratory infections and pneumonia in children¹⁰
  • Increased COVID-19 incidence and mortality¹¹ ¹² ¹³
Cardiovascular System
  • Onset and advancement of coronary artery disease, including heart disease¹⁴ ¹⁵ and hypertension (high blood pressure)¹⁶
  • Increased risk for cardiovascular mortality from ischemic heart disease, arrhythmias, heart attack, and heart failure¹⁷
  • Increased heart failure hospitalizations.¹⁸
Immune System
  • Increased risk of systemic autoimmune disease¹⁹
  • Increased incidence of rheumatoid arthritis
  • Advance juvenile-onset systemic lupus erythematosus²⁰ ²¹
  • Increased risk of all-cancer mortality²²
  • Defects in DNA repair and replication²³
Gastrointestinal System
  • Early-onset Crohn’s disease and ulcerative colitis²⁴
  • Metabolic dysfunction-associated fatty liver disease²⁵
Reproductive System
  • Increased risk for preterm birth, low birth weight (LBW), and stillbirth²⁶
Endocrine and Urinary System
  • Increased risk for the development of diabetes²⁷ ²⁸
  • Increased risk of chronic kidney disease, end-stage renal disease, and decline in glomerular filtration rate (GFR)²⁹
Neurologic and Psychiatric System
  • Increased risk of stroke and associated mortality
  • Increased risk of dementia and Parkinson’s disease³⁰
  • Increased risk of suicide³¹

Each year approximately 8.7 million people die worldwide due to air pollution caused by fossil fuel combustion.³² In fact, exposure to air pollution is one of the primary risk factors for premature death.³³ In North Carolina, 9 out of  the 10 leading causes of death are caused by or exacerbated by air pollution: 1) heart disease, 2) cancer, 3) COVID-19, 4) stroke, 5) chronic lower respiratory diseases, 6) alzheimer’s disease, 7) diabetes, 8) kidney disease, and 9) influenza/pneumonia.³⁴ 

The number of deaths directly or indirectly associated with climate change are more difficult to estimate. Still, the World Health Organization’s declaration that climate change is “the single biggest health threat facing humanity” should be taken seriously, with subsequent legislative actions to mitigate threats and risks to the public.³⁵  

Climate change threatens the affordability, accessibility, and availability of basic human needs including global food security, infrastructure (e.g. housing, education, legal, transportation, waste management, and sanitation), and the healthcare systems and medical supply chain that are essential for human life. 

And while exposure to air pollution and climate change impacts us all, the threats are not shared equally. Black, Brown, Indigenous, and other People of Color (BIPOC), young children, pregnant women, seniors, people with underlying health conditions, low-income households, and outdoor workers carry the greatest health burdens from air pollution and climate change due to systemic racism and structural inequities. These disparities place an even greater strain on healthcare workers and our healthcare system by creating avoidable costs and waste.³⁶

The Public Health Benefits of Reducing Carbon Emissions

It is critical that the NC Carbon Plan we ultimately adopt prioritizes both health and equity in our state. Reducing air pollution in the United States alone could prevent an estimated 53,200 premature deaths each year. Meanwhile heatwaves are the deadliest weather-related event we face, increasing both mortality and morbidity. EJ communities are facing a disproportionate energy burden, forcing some households to make the impossible decision between paying their energy bill (i.e. air conditioning) or purchasing other basic necessities such as life-saving medications or food.  

And beyond our public health, shifting to renewable energy sources will also yield tremendous economic and societal benefits:

Economic Benefits

Economic benefits would include saving an average of $608 billion in healthcare spending as well as boosting the creation of millions of green-economy jobs (e.g., solar panel installer, civil and electrical engineers, environmental specialist, green architecture, electric vehicle charging installer, sustainability director, climatologist, project manager, etc.).³⁷

Societal Benefits

Societal benefits include improved air quality that supports safer outdoor recreation and a more stable climate to reduce incidence of severe weather events such as flooding from hurricanes, wildfires, droughts, and heatwaves that can improve global food security and reduce strain on healthcare workers and our healthcare system.

What Can We Do: Individual, Community, & Societal Interventions

Equitable public policies that reign in greenhouse gas emissions are the gold standard for creating long-term, sustainable climate solutions. But that does not mean we can’t create systemic actions as individuals or communities. The following are a few actions we can take in our homes, workplaces, and neighborhoods to protect our health:

Individual Actions

  • Engage with the NC Carbon Plan

    The ongoing Carbon Planning process is an opportunity to protect the health of all North Carolinians. I cannot overstate the influence healthcare professionals can have, adding their trusted voices to support NC’s transition to clean energy.

  • Regularly check your local air quality

    There are many air quality apps or sites that provide AQ data that can support you in making an informed decision that protects your health. AirNow is just one major example.

  • Use indoor HEPA air filters

    While we may be limited in our control of outdoor pollutant exposures, we can mitigate the exposures within our households.

  • Wear an N95 or similar particulate mask on poor air quality days

    We have all become familiar with mask-wearing as a protective measure during the pandemic—masks such as N95s can filter out particulate pollution.

  • Walk, bike, or ride public transit

    Transportation, particularly fossil fuel combustion vehicles, are our greatest source of GHG emissions. If possible, consider walking or biking to your next destination—as a bonus, you’ll also reduce your risk for cardiovascular disease. You can also explore public transit options where you live.

  • Go to preventative care doctor visits

    Having a trusted primary care doctor you see regularly is key to the prevention and management of chronic diseases, including those associated with air pollution and climate change.

  • Plant a garden

    Community gardens can inspire collective activities that may support the adaptation of healthy community behaviors (i.e. eating local fruits and vegetables, which reduces emissions from supply chains) and increase sustainability.

Community Actions

  • Support or create a community garden

    Community gardens can inspire collective activities that may support the adaptation of healthy community behaviors (i.e. eating local fruits and vegetables, which reduces emissions from supply chains) and increase sustainability.

  • Start a local green district initiative

    A great example of what this may look like is CleanAIRE NC’s collaboration with the Historic West End Green District of Charlotte.

  • Advocate and strategically coordinate for local changes

    Collaborate with other community agencies that share similar goals calling for the adaptation and implementation of policies that promote environmental public health. There is strength in numbers and organizing!

Your voice matters for the future health of North Carolina! If you are interested in supporting the growth of clean, healthy energy in our state, sign up for our newsletter to learn how you can get involved. Just over the next few weeks, we’ll need people who can attend or speak at the upcoming Carbon Plan public hearings. If you are not comfortable with public speaking, you may also submit written comments. Beyond that, there are always new and exciting opportunities for us to make a difference.

Doctors, nurses, and other healthcare professionals are among our most trusted voices on the health effects of climate change and air pollution. If you are a healthcare professional (clinical or non-clinical) interested in supporting policies that prioritize health and equity, you can also click here to become a member of the Medical Advocates for Healthy Air (MAHA) network. You’ll receive additional training and resources to help you leverage your trusted voice and sway the public conversation.


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