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Executive BriefIntroductionNational HighlightsFindingsHealth OutcomesSocial and Economic FactorsPhysical EnvironmentClinical CareState RankingsInternational ComparisonAppendixMeasures TableData Source DescriptionsMethodologyState Summaries
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US SummaryAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAir and Water Quality
Three new physical environment measures were added this year: climate risks, transportation health risks and renewable energy. Improvements were made in renewable energy generation, while air pollution worsened and exceeded pre-pandemic levels. Meanwhile, approximately 115.3 million people lived in areas with high climate risks, and 78.0 million people lived in areas with high transportation health risks.
Air Pollution
Exposure to fine particle air pollution has been linked to heart and lung problems, including decreased lung function, asthma, irregular heartbeat and heart attack. According to a 2019 study, fine particle air pollution originating from human activity was responsible for an estimated 107,000 premature deaths in 2011.
Changes over time. Nationally, the average exposure of the general public to particulate matter of 2.5 microns or less increased 4% from 8.3 to 8.6 micrograms of fine particles per cubic meter between 2017-2019 and 2020-2022. During this time, air pollution increased at a rate equal to or greater than the nation in 31 states, led by 29% in Arizona (8.6 to 11.1 micrograms of fine particles per cubic meter), 25% in Nevada (8.3 to 10.4) and 24% in Idaho (6.6 to 8.2); it decreased 4% or more in eight states and the District of Columbia, led by 19% in Connecticut (7.0 to 5.7), 16% in Nebraska (7.0 to 5.9) and 15% in Hawaii (4.8 to 4.1).
Disparities. In 2020-2022, air pollution was 3.3 times higher in California (13.4 micrograms of fine particles per cubic meter) than Hawaii.
Climate and Health
Renewable Energy
Renewable energy is used to generate electricity and is produced from naturally replenishing sources, such as wind, solar, water (hydroelectric), biomass (plants, wood, or waste) or geothermal (heat). Generating electricity from clean, sustainable and affordable energy sources can improve health outcomes by reducing air and water pollutants emitted by coal and natural gas plants.
Changes over time. Nationally, the percentage of electricity generated from renewable sources increased 8% from 19.0% to 20.5% between 2021 and 2022. During this time, renewable energy generation increased at a rate equal to or greater than the nation in 18 states and the District of Columbia, led by 43% in the District of Columbia (35.0% to 49.9%), 42% in Rhode Island (7.2% to 10.2%) and 33% in Mississippi (0.6% to 0.8%); it decreased 8% or more in five states, led by 21% in Louisiana (1.4% to 1.1%) and 13% in both Arkansas (7.5% to 6.5%) and Delaware (3.2% to 2.8%). Between 2021 and 2022, the percentage of electricity generated by solar and wind increased 21% (2.8% to 3.4%) and 12% (9.2% to 10.3%), respectively. Biomass and geothermal energy generation stayed the same (both at 0.4%), and hydroelectric energy decreased 2% (6.1% to 6.0%).
Disparities. In 2022, renewable energy generation was highest in Vermont (82.7%), South Dakota (81.3%) and Washington (74.7%), and lowest in Mississippi (0.8%), Louisiana (1.1%) and Connecticut (2.7%).
Climate Risks
Natural hazards, including extreme weather events, can worsen existing medical conditions and cause injury and death, as well as stress and mental health issues. Natural disasters can also affect infrastructures that support public health, safety and medicine.
Nationally in 2022, 35.5% of the population lived in areas with high climate risks, which is defined as disadvantaged census tracts (at or above the 90th percentile) based on any of the following risks: agricultural value losses, building value losses, or fatalities and injuries due to 14 types of natural hazards (avalanche, coastal flooding, cold wave, drought, hail, heat wave, hurricane, ice storm, landslide, riverine flooding, strong wind, tornado, wildfire and winter weather); or projected flood or wildfire risk. Almost 115.3 million people were living in census tracts with high climate risks in 2022.
Disparities. In 2022, states with the highest percentage of the population living in census tracts with high climate risks included South Dakota (94.0%), Wyoming (83.3%), Utah (82.0%), Louisiana (78.7%) and Alaska (75.0%). States with the lowest percentage included Rhode Island (1.3%), Michigan (3.0%), Wisconsin (3.6%), Ohio (4.4%) and Vermont (5.6%). The percentage was also low in the District of Columbia (2.3%).
Housing and Transit
Transportation Health Risks
Traffic-related congestion creates concentrated areas of air and noise pollution, which disproportionately affect those with lower socioeconomic status. Cardiovascular disease and respiratory conditions such as wheezing and childhood asthma are associated with traffic-related air pollution.
Nationally in 2022, 24.0% of the population lived in areas with high transportation health risks, which is defined as disadvantaged census tracts (at or above the 90th percentile) based on any of the following risks: diesel particulate matter exposure, transportation barriers (related to cost and time) or traffic proximity and volume. Approximately 78.0 million people lived in census tracts with high transportation health risks in 2022.
Disparities. In 2022, states with the highest percentage of the population living in census tracts with high transportation health risks included New York (51.5%), Hawaii (47.5%), New Jersey (40.1%), Nevada (36.1%) and Louisiana (35.6%). The percentage was highest in the District of Columbia (74.2%). States with the lowest percentage included Wyoming (0.9%), South Dakota (1.0%), North Dakota (2.3%), Kansas (3.5%) and Montana (4.8%).
