How health care facilities should develop climate-resilient strategies

Note: This is the third in a six-part series examining decarbonization practices in the health care industry. Previous columns address the value of integrating sustainability into health care operations and sustainable innovations and practices.

A changing climate is posing an increasingly significant physical challenge to global health care systems and infrastructure in several ways. First, as extreme weather events such as hurricanes, floods and wildfires become more frequent and intense, they cause widespread disruption of medical services, loss of power and damage to critical infrastructure. Second, health emergencies spike during weather events, stressing the availability of timely and adequate medical care. Additionally, these events create cascading and prolonged infrastructural complications such as damage from flooding, displaced patients and strained emergency services. The aftermath deals with prolonged periods without essential care, particularly affecting vulnerable populations. 

Resilience is not new, but now more critical than ever 

Historical events put a spotlight on the practical need for climate-resilient infrastructure. During Hurricane Katrina in 2005, some hospitals locked their doors to manage chaos and protect patients and staff amid rising floodwaters, power outages and severe supply shortages. During Superstorm Sandy in 2012, NYU Langone Medical Center experienced severe flooding that led to a power outage. The hospital was forced to evacuate over 300 patients, including 20 babies from the neonatal intensive care unit. Hurricane Maria in 2017 devastated Puerto Rico, causing a severe shortage of IV bags due to the destruction of major manufacturing facilities on the island. This shortage impacted hospitals across the United States, leading to the rationing of IV fluids and the use of alternative methods for administering medications and fluids to patients. 

According to the World Health Organization, “Climate change presents a fundamental threat to human health.” To address climate risk and resiliency internationally, the Adaptation Action Coalition health initiative aims to enhance climate-resilient health systems through targeted sectoral initiatives. By focusing on issues such as health and water, the coalition seeks to accelerate global efforts and results. It promotes real-world actions, evidence gathering on effective adaptation strategies, and collaboration with diverse stakeholders to integrate climate risk considerations into national and sectoral planning. For health care facilities, climate action via resiliency measures is an essential risk mitigation strategy that reduces the overall cost of care and protection against catastrophic events. 

The importance of risk assessment

Climate risk needs to be part of an institution’s enterprise risk and audit strategy. The Department of Health and Human Services has comprehensive toolkits on how to systematically identify climate-related risks (physical and transition, acute and chronic) across all aspects of operations. 

Health care providers and payers, focused on population and public health, play a vital role in building community resilience by integrating several key strategies. Outreach and public education efforts are pragmatic, as they provide information on climate-related health risks and prevention strategies, empowering individuals to take proactive measures such as distributing air conditioners during heat waves or distributing power packs to individuals on oxygen or other health care equipment not affected by power disruptions. Additionally, targeted programs for vulnerable populations, such as the elderly or those with chronic conditions, ensure that at-risk groups receive the necessary support during extreme weather events. 

One effective aspect of public education is transparent monitoring and reporting to external stakeholders to demonstrate good governance and transparency. A widely recognized framework, the Task Force on Climate-related Financial Disclosures (TCFD), provides valuable structure, which is why it has been adopted by the state of California in its latest climate bill, SB 261, to report on climate-related financial risks. 

Strengthening health care facilities through climate-resilient design and preparedness

An important part of good governance is meaningful partnerships, which enhances preparedness and timeline communication. Conducting periodic regular health impact assessments and emergency drills allows institutions to evaluate community health vulnerabilities continually, informing and refining adaptation strategies to better protect public health.

Assessing and enhancing the acute and chronic physical risk and resilience of health care provider facilities involves comprehensive evaluations and infrastructure upgrades and climate-protective measures. 

Spaulding Rehabilitation Hospital, located on Boston’s waterfront, was the first hospital in the country to be designed and constructed with resiliency principles embedded into its design and construction to prepare for climate change and storms. Spaulding is designed to operate for at least four days in “island mode,” should it lose access to power and supplies. Many other hospitals and health systems through their rebuild and enhancements focused on resilience for a changing climate. 

Actionable steps

Some detailed solutions are outlined in this scoping review by the National Institutes of Health. Examples of climate-resilience measures include: 

• Against flooding: Erecting flood barriers, elevating critical equipment to safer high levels to access essential equipment, such as power generators and water pumps. 
• Against power loss: Backing up power systems, installing operable windows in patient rooms and activity areas to allow for natural ventilation during power outages and improve overall energy efficiency. 
• Against hurricanes and tornadoes: Retrofitting existing buildings to withstand high winds and prevent structural damage.
• Against long-term sea-level rise: Elevating the first floor of buildings to safeguard against projected rising tides.

For hospitals and producers of medical supplies alike, ensuring the resilience of manufacturing facilities is crucial because there are direct costs associated with business discontinuity. They should also invest in cost-saving initiatives such as relocating critical infrastructure away from high-risk areas, reinforcing buildings with protective measures and establishing equipment and process redundancy and backup in production capabilities. Manufacturers can also diversify their supply chains geographically to reduce their dependence on single locations, thereby mitigating the impact of localized climate events.

Health care payer call centers and telehealth visits play a vital role in supporting member health. They should manage and direct patient inquiries, insurance claims and care, especially during emergencies. Establishing backup call centers in different geographical locations to ensure continuity of operations is one way to enhance the resilience of these facilities. Investing in cloud-based communication systems and robust IT infrastructure has a distinct return on investment and can also facilitate seamless operations during disruptions. Readiness exercises and staff training practice sessions help prepare for crisis situations, training participants in effective response and coordination for emergencies.

Investing in climate resilience not only protects public health but also ensures health care systems can rapidly recover from natural disasters, ultimately saving lives. Resilience and climate adaptation in health care are imperative for safeguarding public health and ensuring continuous patient care. 

The views expressed in this article are those of the authors and not those of their current or former employers.