Think Globally, Adapt Locally

Colorado Counties Health and Climate Index

Key Takeaways

  • Climate change is affecting Coloradans’ health, but community and individual risks vary based on geography, health, and social factors.
  • Many of the counties where people are at the highest risk are also the least prepared for the health impacts of climate change.
  • Local communities can use the Health and Climate Index to assess risks and strengths and plan accordingly.
May 11, 2023

The state's most destructive wildfire on record. Air pollution from ozone and wildfires lingering over the Front Range. Ongoing droughts. Colorado's changing climate has been affecting human health and well-being in increasingly visible ways.

Colorado communities need a new focus on adapting to a changing climate and supporting resilience to preserve health and advance health equity.


The Colorado Health Institute (CHI) released the first Health and Climate Index in 2019 to illuminate how environmental exposures, demographics, and local policies and perceptions can affect vulnerability to climate change impacts such as wildfire, drought, and heat. Climate change is a global issue that will affect every Coloradan, but local environmental factors, health conditions, and social factors such as income, age, and race influence the risks faced by individuals and communities.

This 2022 Health and Climate Index, the first update to the original report, analyzes the risks Colorado counties face in four areas: Exposure to climate-related hazards, health outcomes and access to care, social factors that have been linked to climate vulnerability, and plans and perceptions related to climate change and health.

Minimizing climate change-related harm to human health requires reducing greenhouse gas emissions and taking steps to adapt to a changing environment.

The Index highlights a need for more targeted climate adaptation planning and capacity building across Colorado to respond to the changes that are already occurring and prepare for future impacts. Much of this work must take place at a local level and reflect local needs and realities.

Douglas, Teller, and western Colorado counties had high risk scores for environmental exposure. Southeastern Colorado, Adams County, and several western and northeastern counties had high risk scores for health outcomes and access to care, while southeast Colorado and the San Luis Valley had high social factor risk scores. Many rural counties had high risk scores for plans and perceptions related to the health impacts of climate change

The Health and Climate Index can help Coloradans identify vulnerabilities and develop approaches to supporting health equity in a changing climate that reflect their area’s unique needs.

How to Use the Health and Climate Index

  1. Read CHI's report to examine state trends and find guiding questions that can help communities plan for the health impacts of a changing climate; .
  2. Review county data profiles for insight into exposure, sensitive populations, and plans and perceptions at the county level.
  3. Explore the interactive mapping tool to examine each of the metrics in each county, region, and across the state. 
  4. Read the appendix (available in the PDF) for more detail on what data is included and how the Index was created.

Wondering what is already happening to address the health impacts of climate change? Read the full report for promising practices from across the state of Colorado.

County Data Profiles

Download PDF files with local data for every Colorado county.


Adapting to a Changing Climate: Acclimate Colorado

The Health and Climate Index is part of Acclimate Colorado, CHI’s campaign to build capacity, community resilience, and a policy agenda for addressing climate related health challenges in Colorado. 

CHI has built Acclimate Colorado around the Centers for Disease Control and Prevention (CDC)’s Building Resilience Against Climate Effects (BRACE) framework. This model provides an architecture for developing and implementing evidence-based strategies to adapt to a changing climate and, in the process, prevent or minimize the harmful effects of climate change and prevent or reduce health disparities.


The BRACE framework is designed to be flexible and adapted to the needs of those who use it. It has five steps:

  1. Forecasting Climate Impacts and Assessing Vulnerabilities
  2. Projecting the Disease Burden
  3. Assessing Public Health Interventions
  4. Developing and Implementing a Health and Climate Adaptation Plan
  5. Evaluating Impact and Improving Quality of Activities

The Health and Climate Index focuses on parts one and two of the BRACE framework: It uses data, research, and evidence about climate change and its impact on health to assess vulnerabilities and project areas of risk.

The Index will inform future Acclimate Colorado efforts focused on other steps in the BRACE framework, including identifying and assessing existing resources focused on climate and health adaptation (Step 3) and developing tools, policies, and programs to help address the climate and health crisis, with a focus on reducing disparities (Step 4).

This work will be done in collaboration with partners across the state who are also interested in helping build a Colorado where all communities are prepared to meet the urgent health challenges caused by a changing climate.

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Interactive Mapping Tool

Colorado's Environment, Coloradans' Health

Climate change is affecting Colorado’s environment. Earlier snow melts, drier soils, and bark beetle invasions have taken a toll on Colorado’s ecological systems. Colorado’s average temperature has increased by about 2 degrees Fahrenheit in the past 30 years.1 Projections suggest it could increase by an additional 2.5 to 5 degrees Fahrenheit by 2050.2

Most Coloradans are aware that the state’s vegetation and wildlife are deeply affected by these changes, but less than half of residents consider their own health to be in jeopardy.3

Climate change’s impacts on human health include an increase in disasters like wildfires, mudslides, and floods, and more persistent changes like the growing number of days with extreme heat, which affects the cardiovascular, respiratory, and nervous systems and exacerbates air pollution. Climate change is also affecting mental health, including stress, anxiety, and depression.4

Climate change is likely to increase many health disparities: Certain populations, including people who work outside, people living in poverty, children, people with chronic diseases, and many communities of color, are more vulnerable to these and other impacts.

The need to prepare to support human health in a changing climate is becoming increasingly urgent. In 2019, the state recorded its highest ever temperature: 115 degrees Fahrenheit in Lamar.5 In the summer of 2021, high ozone alerts were a daily occurrence along the Front Range, and wildfire smoke affected air quality across the state. In fact, three of the most destructive and far-reaching wildfires on record occurred in 2020 and 2021.

Mitigation and Adaptation 

Climate change policy has two general categories: mitigation and adaptation. Mitigation is preventing or reducing greenhouse gas emissions that are warming the planet. Adaptation is preparing for life in a warmer world. Many actions are co-beneficial — they can serve both purposes.

Reducing greenhouse gas emissions supports human health by helping to reduce air pollutants and prevent additional climate change. Colorado has an ambitious Greenhouse Gas Pollution Reduction Roadmap that aims to cut emissions to 90% of 2005 levels by 2050.

But climate change is already happening, and even the most ambitious mitigation policies will take time to bear fruit. In the meantime, it is critical that policies and plans also focus explicitly on adaptation and on the impacts of climate on health.

Federal, state, and local leaders have recently taken steps to prioritize protecting the health and well-being of communities. A 2021 law created a unit at the Colorado Department of Public Health & Environment to lead work to reduce environmental health disparities in communities of color and low-income communities. In 2022, legislators passed a bill creating an Office of Climate Preparedness.

Much of this adaptation work must take place at the local level. Communities across Colorado have already started adapting to the impacts of climate change on health, but the degree of preparedness varies widely across the state. CHI’s Health and Climate Index is designed to provide data and highlight local dynamics and vulnerabilities that can inform this urgent work.

COVID-19 and Climate Change

The COVID-19 pandemic holds lessons for climate adaptation planning. Like the pandemic, climate change affects all Coloradans, but some are more vulnerable than others.6 Research suggests that people with fewer financial resources, some communities of color, people with chronic conditions like asthma, cardiovascular disease, and diabetes, and older Coloradans are likely to be more affected by a changing climate.7 These same groups were particularly vulnerable to COVID-19.8 Some lessons for organizations and governments working to improve health and reduce disparities include:

  • Share Information Openly With the Community. Partner with community-based organizations and use existing relationships; to share important information about risk and resources to those most disproportionately affected by climate exposures.
  • Foster Authentic Community Involvement. People in groups identified as more vulnerable should be directly involved in the climate adaptation planning process. This includes identifying needs and possible solutions and participating in decisions that may affect their health or environmental conditions in their communities.
  • Invest Now or Pay Later. Health systems, local governments, and community-based organizations should invest now in staff, training, resources, and infrastructure to prepare for current and future climate risks.

Health and Climate Index: Findings

The Health and Climate Index analyzes risk in four categories: Exposure to climate-related hazards, health outcomes and access to care, social factors that have been linked to climate vulnerability, and plans and perceptions related to climate change and health. For each of these categories, Colorado’s counties are sorted into quadrants that indicate their position relative to the rest of the state: Highest risk, high risk, moderate risk, and lowest risk. The mapping tool includes a complete list of data for each category. 

For each of these categories, Colorado’s counties are sorted into quadrants that indicate their position relative to the rest of the state: Highest risk, high risk, moderate risk, and lowest risk.  

Most counties were identified as high or highest risk in at least one category. Five counties — Delta, Fremont, Moffat, Montrose, and Prowers — were identified as high or highest risk in each category. This points to a need for resources and capacity-building to ensure that residents of these rural counties are as equipped as possible to deal with the increasing impacts of climate change.

But these risk scores are relative: Every county in Colorado is home to vulnerable populations and faces environmental exposures due to a changing climate. The county profiles available through the drop-down menu on this site include the data used in this Index for each county and can be used to explore local risks and identify opportunities.

A Snapshot, Not a Prediction

The Health and Climate Index is not intended to predict future changes in variables. It serves instead as a snapshot of climate factors in Colorado. The exposure variables, which include factors like wildfires and extreme heat, are most likely to change from year to year. Scores for plans and preparations will change as communities shift or adopt new policies. Health and social factor scores will evolve with migration, aging, and other trends. 

Environmental Exposure

Counties in western Colorado had higher risk scores for climate-influenced environmental exposures such as wildfire, flooding, drought, and extreme heat. La Plata County had the state’s highest risk score. Counties in southeast and eastern Colorado had lower risk scores, due largely to their lower vulnerability to wildfire and drought.

Douglas and Teller counties had higher risk scores due to high percentages of land identified as vulnerable to wildfire and high shares of their populations living in drought or in a wildland-urban interface, or WUI — the area where structures and human developments intermingle with undeveloped wildland. Population growth within the WUI increases risk from wildfire.

Vulnerability can vary within county lines. In Jefferson County, for instance, there are many fewer extreme heat days in Evergreen than in Golden.  

Counties with lower risk scores on this Index still encounter climate-related environmental exposures. While Denver County had the state’s  lowest risk score, it had a high number of extreme heat days. Pueblo and Adams counties face similar dynamics. And while Alamosa County had a low overall risk score, some of its residents spent more than a third of the year experiencing serious drought conditions. Boulder County had a lower risk score in this category than many counties, and yet the Marshall Fire, which covered a small percentage of the county’s land, was profoundly destructive. 

Government agencies, community organizations and businesses, and individuals can take steps to plan and prepare for exposures that are more salient in their counties by creating and implementing plans, identifying needed resources, and creating programs tailored to local needs. 


Questions to Consider

Expand to Read More

  • What are the most prominent environmental exposures in your county identified in the Index? (See county profiles)
  • What additional climate exposures, such as poor air quality, infectious diseases, or changes to water or food systems, does your county experience?
  • What exposures are likely to become more common over time?
  • Are these exposures addressed in current individual or community planning efforts? What additional plans or resources are needed?
  • What programs are available in your community to assist with personal and property damages caused by floods, wildfires, or other hazards?
  • Do your county’s residents have access to broadband internet or other ways to receive emergency alerts?

Sensitive Populations: Health Outcomes and Access

Climate change can influence health by intensifying existing threats and conditions, including asthma, depression, and heart conditions.9 Ensuring residents have access to health care is a critical piece of preparing for emerging health needs. 

Counties in southeast and western Colorado had the highest risk scores in this category. In Otero County, the state’s highest-risk county, 10% of residents were uninsured and 21% did not get health care when it was needed, while many residents have conditions like diabetes and depression that can indicate vulnerability to climate change. Pueblo, Adams, and Mesa counties also had high risk scores. 

Some counties with low risk scores have limited access to care: In Summit County, for one, 24% of residents did not get health care when they needed it.  

Risk scores in this category can point to opportunities for providers, health systems, policymakers, and others to provide information, education, and health services that reflect local needs. For instance, a health system in an area with high rates of asthma might create resources focused on managing the condition when air quality is poor, while counties with high uninsured rates might take steps to increase coverage. 


Sensitive Populations: Social Factors

Social factors such as financial resources, education status, age, and race and ethnicity play a role in climate risk.10  Language can influence access to health care and other services.11  Climate change is likely to exacerbate existing inequities in health and other areas of life.12 

Pueblo, Denver, and counties in the San Luis Valley and southeast Colorado had the highest risk scores in this category. These areas had higher rates of people with incomes below the federal poverty level ($26,500 annually for a family of four in 2021) and higher rates of people living in older houses. Rural Costilla County had the state’s highest risk score. Douglas and Elbert counties had lower risk scores, as did counties in the central western part of the state. 

Scores in this category can inform climate-related planning and highlight communities’ unique needs. For instance, a local government where many residents speak Spanish might provide resources in that language, while a community organization in an area with many old homes without air conditioning might create resources focused on navigating extreme heat.


Questions to Consider

Expand to Read More

  • What social factors are affecting climate risk for the most people in your county? (See county profiles)
  • What populations not included in the Index, including people experiencing homelessness or people who work outside, are sensitive to the health impacts of a changing climate?
  • How can climate-related policies and programs be inclusive of the perspectives and needs of community members who are most at risk?
  • What steps can be taken to make sure climate mitigation and adaptation efforts do not exacerbate existing inequities?
  • What resources do health providers, public health, and other concerned groups need to communicate and work effectively with all people in your community?
  • To what extent are emergency alerts and climate-related materials available in multiple languages?
  • To what extent are they available and accessible to others identified as sensitive populations, including seniors and young children and their families?

Plans and Perceptions

The impacts of a changing climate are not fully predictable. But planning to respond to likely impacts can help save and improve lives. Having a greater share of residents who believe that climate is likely to affect their health can help create the political will to develop such plans.14 

Boulder and Pitkin counties had the lowest risk scores in this category: These counties had drought and wildfire preparedness plans as well as climate plans. Such plans cannot prevent disasters or change decisions made before the plans were created, but they can help communities respond to exposures effectively. La Plata County, which had the state’s highest risk of climate-related exposures, had a low risk score in this category due to its climate-related plans and high percentage of residents who believe climate change will affect their health. 

Most counties with higher risk scores in this category were rural. Eastern Plains counties had higher risk scores, as did counties in northwest Colorado. Moffat, Rio Blanco, Mesa, Dolores, and Fremont counties had high risk scores for exposure, health outcomes and access, and social factors, and also had high risk scores in this category. 

Some of these counties lack resources to adopt or implement climate-focused plans. Counties where people were less likely to believe that climate change will impact their health were also less likely to have plans to prepare for a changing climate.

Since climate change can be a politically contentious issue, communities may take steps to address climate change-related risks without highlighting the role of climate change. For instance, a county where fewer people believe in climate change might create an effective plan to prepare for increasing periods of drought. Communities, organizations, and individuals may also take actions to adapt to climate change that are not included in an official plan, such as creating more green spaces or introducing asphalt that is less likely to absorb heat. 


Questions to Consider

Expand to Read More

  • What messages and communication materials are likely to be most effective in creating community agreement on the need for climate adaptation?
  • What plans to respond to climate-related exposures are in place in your community? Who is responsible for implementing them? How is it going?
  • Where are there opportunities for more robust or updated planning? Are there notable barriers to developing or implementing new plans?
  • What resources, such as funding or infrastructure, are available? What resources are needed?
  • Do climate-related plans in your community address the health needs and sensitive populations identified through the Index? Do planning processes include those most likely to be affected by a changing climate?
  • What collaborative partnerships with neighboring communities, counties, and regions should be in place to address local needs?
  • What efforts are happening outside of local government? For instance, what are nonprofits, businesses, schools, or individuals in your community doing to respond to a changing climate?


Colorado’s communities are experiencing the health impacts of climate change. CHI’s Health and Climate Index, part of the Acclimate Colorado initiative, highlights the risks Coloradans face in the places they live. This knowledge can inform and shape state and local plans to adapt to a changing climate.

Climate change is a health equity issue. Plans to adapt to a changing climate must be driven by the needs and experiences of communities.

The Health and Climate Index can help communities gauge areas of concern in different parts of Colorado and begin to connect the dots between a changing climate and the health of people in Colorado.