Objectives. To examine how the courts, which play a critical role in shaping public policy, consider public health in climate change and coal-fired power plant lawsuits.

Methods. We coded US local, state, and federal court decisions relating to climate change and coal-fired power plants from 1990 to 2016 (n = 873) and qualitatively investigated 139 cases in which litigants raised issues concerning the health impacts of climate change. We also conducted 78 interviews with key litigants, advocates, industry representatives, advising scientists, and legal experts.

Results. Health has been a critical consideration in key climate lawsuits, but in a minority of cases. Litigants have presented health arguments most frequently and effectively in terms of airborne exposures. Health impacts have typically been used to gain standing and argue that the evidence for government actions is insufficient.

Conclusions. The courts represent a pivotal branch of government in shaping climate policy. Increasing inclusion of health concerns in emergent areas of litigation could help drive more effective climate policymaking.