When Minnesota regulators decided last month to raise the state’s social cost of carbon emissions, much of the focus centered on climate change and utilities’ next-generation planning.

Yet public health advocates say the decision is important for keeping the air clean of particulates and other pollutants that can having damaging health impacts across the state’s population.

“It’s good news that we’re updating the prices, it’s long overdue to do an increase — at that level, it’s a positive win,” said Jon Hunter, director of the American Lung Association in Minnesota. “This recognizes that there are costs on our power bills that effect our hospital bills. To reflect that in our power planning is a much-needed change.”

The Minnesota Public Utilities Commission’s (PUC) decision, passed 3-2, raises the cost of carbon to a range of $9.05 to $43.06 per short ton, from 44 cents to $4.53. It was the first update to the state’s cost of carbon in 20 years.

Minnesota utilities have no plans to open coal plants and are, in fact, closing several of them over the next decade. The decision will most likely impact consideration of new natural gas-powered plants.

Meanwhile, much of the debate over climate change has focused on rising sea levels, torrential rainfall, drought, and other physical manifestations. Yet dozens of studies point to perhaps an equally disturbing outcome that increases chances of disease, heat exhaustion, morbidity and other health struggles and impacts health care costs significantly.

“It’s a good start,” Bruce D. Snyder, a member of Health Professionals for a Healthy Climate, said of Minnesota regulators’ action. “It really levels the playing field for regulators when they’re looking at the renewable energy facilities versus fossil fuel facilities.”

Thomas Kottke, a cardiologist and associate medical director at HealthPartners, called the PUC’s decision a good one because “the cost of carbon-based energy is huge.”

“The untold story is the science of the direct health implications of particulate matter and ozone …We’ve had number of bad consequences of climate change and it’s not getting any better,” Kottke said.

Particulates and mortality

Kottke said a recent New England Journal of Medicine article points clearly to the problem of particulates. The study found that from 2000 to 2012 mortality rates increased in areas where particulate matter increased.

All-cause mortality increased 7.3 percent in the study, and the people most effected were those least equipped to deal with it. “This effect was most pronounced among self-identified racial minorities and people with low income,” the report said, referring to increasing particulate rates.

Hunter cited a 2015 Minnesota Department of Health and Minnesota Pollution Control Agency report that used 2008 data to look at the impact of air pollution.

The study suggests that particulate pollution that year caused roughly 2,000 deaths, 400 hospitalizations, and 600 emergency room visits. Those numbers will only grow with more fossil-fuel-based power generation, he said.

American Lung Association of Minnesota board member Dr. Gail Brottman, who works for Hennepin County Medical Center, said in a statement after the PUC decision that asthma is the most chronic childhood disease and the science is clear of the connection between it and particulate pollution.

The county’s medical center spent $11 million last year on admissions for asthma, she said. “There are broader costs of an asthma attack beyond the hospital costs as well,” Brottman said. “A child having an asthma attack missed school and that means parents missed work. This hurts both a child’s education and results in lost revenue to the parents’ employers. There is an emotional toll as well.”

Prolonged illness

Meanwhile, Snyder points out rising heat-related illnesses will likely increase substantially, as will the energy costs to cool homes and businesses.

One result of warming temperatures can be seen now in the growing incidence of deer and black legged ticks, he said. The latter was once confined to southeastern Minnesota but “has now spread throughout the state,” Snyder noted.

A report on Minnesota in Tickcheck — a website devoted to tracking tick cases in every state using Centers for Disease Control and Prevention data — showed the level of Lyme disease increasing from 2007 to 2015.

More than 20,000 tick cases in Minnesota were reported from 2000 to 2015, and the website suggests those numbers tend to be underestimated. The median number of cases has grown from 464 from 1996 to 2005 to 1,121 from 2006 to 2015, state data show.

Tick bites can result in Lyme disease, which “is going up exponentially. These diseases cost a lot in medical care and can be prolonged illnesses,” Snyder said, adding that variations of Lyme disease have gotten deadlier.

As temperatures grow hotter and the state’s many waterways, marshes and bogs become warmer the tick population will only increase, he said.

Those same rising temperatures that threaten to sink Miami and New York will also cause greater pulmonary issues to the residents of Minnesota, Snyder suggested. For example, lung disease caused by rising ozone will bring more emergency room visits and higher morbidity.

Increased pressure on lungs from air pollution — especially in people with asthma and cardiopulmonary problems — will also bring more disease, Kottke said.

Even pre-term births increase with air pollution. A recent study showed 18 percent of pre-term births are attributed to high levels of particulate matter in the air, he said.

“That’s a much larger problem in China” because of air pollution, Kottke said, “but it’s not a trivial issue in the United States, either.”

Additionally, one of the best foods for neurological development is fish, Kottke said, but the mercury in it can be dangerous. The challenge is especially acute in northeastern Minnesota lakes because air pollution from North Dakota’s coal plants have made mercury a more pervasive problem in that region, he said.

HealthPartners has created a website called “Choose Your Fish” to help families select fish with low mercury content, Kottke said.

Minnesota impact

Snyder pointed out that the Minnesota Department of Health’s “Minnesota Climate Change Vulnerabilities Assessment” summarizes the potential impacts of climate change in rich detail.

The 2014 report states that Minnesota is seeing record temperature increases during both daytime and overnight, higher humidity and greater precipitation.

As the climate changes Minnesota will see more extreme heat, especially in the densely populated Twin Cities. Extreme heat particularly affects young children, people living in poverty, the elderly and workers with outdoor occupations in construction and other fields.

The report also uses data to detail the negative impacts of ozone pollution, vector-borne diseases, flooding and drought on the health of the state.

While the state has not seen a drought in several years, the wild fires out west a few years ago brought the worst air quality the Twin Cities and Minnesota has seen in years, said Hunter, of the American Lung Association.

While the Minnesota report largely shows how the oldest, youngest and poorest will feel the brunt of climate change, Snyder said mental health is also overlooked in the climate change discussion.

The challenge goes beyond the simple shock of a major climatic event, and the Department of Health’s website points out the mental health aftermath can be just as heart wrenching.

“Many people who experience disaster struggle with displacement (temporary or long-term), unstable or unknown housing circumstances, difficulty finding temporary shelter, lack of access to support services, and loss of employment and possessions,” the authors said.

Snyder believes the mental anguish never evaporates. “You can look at major climate events, such as Hurricane Sandy and Hurricane Katrina, and see a marked increase of post-traumatic stress, anxiety and depression,” he said.

“We’ve had something like four 1,000-year floods in Minnesota in the last few years. I can tell you without any hesitation that the people who lived through those things — whose houses where flooded, whose businesses were ruined, whose crops and livestock were destroyed — live with the residual of that in their minds and in their hearts,” he added.

What Minnesota regulators did by increasing the cost of carbon when planning new energy generation, Snyder said, “is important in moving us forward.”