Are We Preparing the US Healthcare System for Climate Change?

We are dealing with a two-fold crisis of ill preparedness in the United States. An aging and increasingly economically disparate population that has complex chronic medical conditions resulting in fiscal challenges for hospital systems, coupled with a climate crisis that is directly affecting our nation’s health and hospital infrastructure. We have seen example after example of this. This past year, unprecedented winter storms in Buffalo resulted in healthcare workers and first responders being stranded, unable to care for patients. During summer months we see soaring temperatures and wildfires taxing power grids desperately needed to keep hospitals and medical equipment running. Flooding from atmospheric rivers and hurricanes in the west and south have taken out critical, yet aged hospital infrastructure, displaced the frail and gravely ill and further threatened their health. These previously “once in a lifetime events” are now annual occurrences, increasing in severity, frequency and affecting the health and well-being of millions as well as impeding our ability to deliver care. This begs the question, what is the United States doing to prepare the healthcare sector for climate change?

As an emergency medicine physician and first responder, I am often thinking of the multitude of health emergencies that exist. When I read news articles about severe weather events, I ask myself, what happens to our society’s most vulnerable? What becomes of the elderly with limited mobility, those with disabilities dependent on electrical equipment and historically marginalized populations? Even before disaster strikes, these individuals end up boarding in hospitals from days to weeks due to lack of access to primary care providers and long-term care facilities, leading to hospital overcrowding. This issue is compounded by climate change in that vulnerable patients often seek hospitals as a source of refuge when disaster hits. Those that require electrically powered medical equipment, need lifesaving dialysis, or are bed-bound patients, often will end up in the emergency department when the power goes out, their homes flood or when there are record breaking temperatures. Hospitals systems are built to serve their communities and are the last line of defense. They are a place for healing and care for everyone. When hospitals cannot operate due to lack of preparedness, our most vulnerable end up being disproportionately impacted and suffering otherwise preventable consequences.

Not being adequately prepared for the climate crises also comes at an enormous financial cost. One study showed that 10 climate sensitive events that occurred during 2012, ultimately cost the US health care sector $10 billion dollars. Hurricane Sandy had devastating impacts to hospital systems in New York City from flooding and evacuations. This was impart due to, like most hospitals, critical infrastructure such as generators, operating rooms and emergency departments being located on the ground floor. They subsequently were the first to flood which led to an inability to maintain hospital operations for months. It is estimated that Hurricane Sandy cost the healthcare sector about $3.1 billion dollars in damage. Without adequate preparation and strategy, we will only see numbers such as this continue to climb and lives unnecessarily lost.

There is reason to hope as some hospital systems are taking warning. To prepare for flooding, Spaulding Rehab Hospital in Boston placed the ground floor 30 inches above the 500-year projected flood line, located all critical mechanical and electrical equipment to the roof and provided for onsite storage of supplies for at least four days. To adapt to extreme heat days, Florida hospitals are required to have an external generator connection to allow for functioning during power outages. Carondelet Health in Arizona has established relationships with the regional utility provider to switch into generator mode when the power grid is being taxed to mitigate brownouts. Kaiser Permanente created a command center specifically for wildfires so when the 2019 Kincade Fire hit, they were able to start transferring patients out of hospitals in the wildfire’s path eight hours before a formal evacuation notice, allowing for critical time savings.

These hospitals, although few, serve as an example of what is needed for healthcare to continue to serve its role in disaster response and preparation for the communities they serve. For healthcare in particular, some guidance exists on an international level for healthcare sector preparation and is put forth by organizations such as The World Health Organization and The World Bank. The United States has even developed its own national resources in the form of a guide and toolkit. These existing tools should be adopted at a wide scale, enhanced and implemented for every hospital and healthcare facility in the United States. Hospitals should also leverage resources within their communities, business, government, relationships with risk/disaster managers and insurers to develop comprehensive climate change adaptation plans.

Our government and politicians are starting to direct funding and mandating measures to bolster resiliency of our hospital systems. This past year, the regulating body, The Joint Commission signed onto the White House Health Care Sector Climate Pledge, to reduce carbon emissions and commit to a goal of net-zero by 2050. When asked if Medicare payments would be cut for hospitals that don’t reduce carbon emissions, the Department of Health and Human Services Secretary, Xavier Becerra responded with “We are going to try and use every tool at our disposal.” These are big hints by regulating bodies, that change is coming whether they like it or not and it is best for hospitals to get on board with initiatives sooner rather than later. Healthcare workers are frontline and first responders to climate change and know the toll these events take on our patients and staff. Physicians as a community must also get involved with their own hospital system climate change preparedness, using first-hand experience to guide and develop climate smart preparedness plans. The safety and well-being of our nation’s health depend on the measures we take now and we cannot waste any more valuable time in being underprepared.

About the Author

Kate Weber is an emergency medicine physician and ecoAmerica Climate and Health Science Fellow at the University of Colorado. She completed her training at the University of Rochester where she worked to integrate the health effects of climate change into medical school curriculum. Her interests include hospital systems and community adaptation, emergency preparedness as well as state adaptation with a particular focus on vulnerable populations.


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Additional Resources

ClimateRx Website

Climate for Health – Ambassador Training

Climate for Health Resources

American Climate Leadership Awards 2023: Zoom Registration

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