Why Do Some Cities in the United States Integrate Health into Their Climate Plans More than Others?—Hypotheses and Tests

Many cities have integrated health co-benefits into their climate plans to address cost concerns and build multi-stakeholder support for resilient, net-zero transitions. While some studies have demonstrated that cities vary in how much they link health and climate, few have examined why this is the case. This study fills this gap by using 16 negative binomial regression models to test whether three sets of independent variables—(1) plan attributes, (2) politics, and (3) demographics—are correlated with two different measures of climate–health integration for 50 large cities in the United States. The modeling suggests that plan age is consistently associated with deeper forms of integration (links between key sectoral actions and related health–environmental and social benefits), while plan type (adaptation/mitigation-focused versus integrated) is related to shallower health references. Associations between climate–health integration and the liberal leanings of a city’s population find support in more than half the models; other political and demographic variables lack discernible or predicted relationships with health integration for most models. The study concludes that linking mitigation–adaptation actions can bring more attention to health, but regularly updating urban climate plans is the key to deepening the integration required for a sustainable future.