U.S. Healthcare is the Most Vulnerable to Climate Change… and the Least Prepared

by Sam Cherubin and Bob Leonard

The American healthcare system is predicated on a stable environment and society. Our climate crisis guarantees that our environment will become more uncertain and volatile. Due to the global impacts of COVID and climate, business-as-usual no longer exists. We are living in unprecedented times.

Healthcare is at once a significant contributor to greenhouse gas emissions causing global warming, and it is one of the industries most impacted by climate change.

It should also be a key player in mitigation and adaptation to the impacts of our climate crisis.

Air pollution, heat, insect-borne diseases, water contamination, and severe weather events are causing population migrations, destructive emergencies, injuries, and deaths. Climate change will upend " brick-and-mortar” physical systems by destroying infrastructure and supply chain breakdowns.

This will also impact the physical and mental health of the providers themselves.

In the longer term, climate change leads to temperature-related illness and mortality, the spread of vector-borne disease, respiratory issues, and allergic responses, compromised fetal and child development, and threats to water, food supply, and shelter.

The effects of climate change on humans, however, go beyond physical health and are already taking a huge toll on mental health.

The most immediate effects on mental health can be seen in the aftermath of disaster events fueled by climate change, such as hurricanes, wildfires, and floods. These effects can include trauma and shock, post-traumatic stress disorder, feelings of abandonment, and anxiety and depression that can lead to suicidal ideation and risky behavior.

At the community level, these disasters can strain social relationships, reduce social cohesion, and increase interpersonal violence. (1)

Source: https://www2.deloitte.com/us/en/insights/industry/health-care/climate-change-and-health.html

Size and scope of the current health system

The healthcare system in the U.S. is, in reality, a “Medical Industrial Complex,” a series of interconnected institutions and organizations that dwarfs most other sectors of the economy.

American healthcare:

• Costs four trillion dollars a year, four times the size of our defense budget.
• Accounts for 24% of all government spending.
• Employs 22 million workers – 14% of all U.S. workers.
• Is one of the largest categories of consumer spending at 8.1%. (2)

Many sectors comprise our healthcare system:

• Biomedicine, genetics, and precision medicine
• Building, owning, and operating healthcare systems, services, and facilities
• Federal and State programs (Medicare and Medicaid)
• Medical and nursing schools
• Medical devices, technologies, equipment, and manufacturing
• Regulators, policymakers, licensing and professional organizations
• Research, development, production, and marketing of pharmaceuticals
• Software, information technology, digital health, and electronic health records.

Massive global supply chains, operations, and administrative organizations support healthcare.

Supply chain breakdowns result in the need for more medicines, devices, and other supplies. Infrastructure failures resulting from severe weather events (bridge collapses, power outages, food shortages) cause disruptions affecting staff, patients, and surrounding communities.

Healthcare’s role in global warming

The U.S. healthcare system contributes 10% of the nation’s carbon emissions and 9% of harmful non-greenhouse air pollutants. Gases used for anesthesia are emitted from hospitals directly into the atmosphere, where they harbor heat-retaining and ozone-depleting properties. (3)

Top reasons systemic change is difficult

Medical and healthcare administration curricula need to teach climate science and risk management:

“We, the WHO-Civil Society Working Group to Advance Action on Climate Change and Health, urge the deans, academics, managers, and other teaching staff of health professional educational institutes, as well as the associated accrediting, examination, and licensing bodies, to ensure graduating health professionals are prepared to identify, prevent and respond to the health impacts of climate change and environmental degradation.” (4)

1. For-profit organizations invested in the status quo have inherent conflicts of interest. Necessary adaptations and mitigations require near-term investments with long-term ROI (avoided disaster recovery expenses). Existing institutions—drug companies, pharmacy benefit managers, hospital systems, health insurers, medical device manufacturers, dialysis centers, and more—are vested in a system and culture no longer fit for purpose.
2. “Over the past 30 years, healthcare has become the largest industry by employment in the United States, which leads to increased power in the healthcare industry’s ability to influence federal policy, including blocking or limiting legislation that may lower healthcare costs by suggesting that decreased spending will result in fewer jobs. As a result, legislators are reluctant to make policy changes that may reduce jobs when grappling with rising public healthcare costs.” (5)

NOTE: A case can be made that initiatives to mitigate and adapt to our climate crisis will create jobs.

1. Greenwashing (e.g., misleading ESG and carbon footprint reporting and purchases of carbon offsets) encourages postponing authentic climate actions.
2. Inequity, unequal access, and social determinants of health disproportionately affect those least able to influence change. “Climate change exacerbates existing health and social inequities. Climate change itself worsens environmental conditions associated with chronic illness and injury, and causes social and economic dislocations that most impact disadvantaged communities.” (6)
3. The U.S. healthcare system needs to be more cohesive. Each organization or leadership structure has the power to dictate changes, making legislated climate mandates nearly impossible.
4. Climate is not the only threat impacting healthcare. Multiple trends are vying for attention (e.g., staffing shortages, attrition, the “retail-ization of health,” AI, Big Tech, and Virtual Reality.
5. Healthcare comprises closed systems, and there needs to be more exposure to or awareness of climate actions deployed by other industries and institutions. For example, much could be learned from the U.S. Department of Defense.

Climate Vulnerabilities of U.S. Healthcare

Climate change affects every aspect of the healthcare system:

Costs

As the warming atmosphere and air pollution negatively affect the health of millions more people each year, the cost of care increases. Healthcare systems are responsible for the care of people impacted by severe weather events and those with exacerbated chronic conditions, like cardiovascular or respiratory illness. One study of 10 climate events from 2012 in the U.S. revealed that the health-related costs, including hospital admissions, emergency department visits, and lost wages, totaled $10 billion in 2018 dollars. (7)

Equity

Climate change does not affect people equally. It deepens preexisting inequities by taking the most significant toll on those at heightened risk. Exposure to climate-related stressors, individual sensitivity, and the ability to adapt all play a part in determining vulnerability to climate change. The people in gravest danger are:

• lower-income Americans
• people of color, especially Indigenous communities
• workers in certain hazardous occupations, such as first responders and construction workers
• people living in environmentally fragile areas
• people with preexisting health conditions
• older adults
• young children
• people with disabilities
• people who are experiencing homelessness

Access

Extreme climate events lead to health system disruption. Hospitals may need to be evacuated, facilities may be damaged or closed, power outages may disrupt care, and damaged roads or transit systems may prevent people from getting to health facilities. When Hurricane Sandy struck New York City in 2012, Bellevue Hospital, which serves more than 500,000 patients annually, was forced to close temporarily and move patients elsewhere.

Quality

When some hospitals are forced to close, others can stretch beyond their capacity.

Overcrowding and patient boarding in emergency departments are emblematic of decreased quality of care. In addition, disruptions to the supply chain may reduce the availability of critical medicines or medical devices. When Hurricane Maria damaged an essential saline manufacturing plant in Puerto Rico, it led to dire shortages of a crucial medical supply in the territory and the rest of the U.S. (8)

Source: Measuring the climate resilience of health systems, World Health Organization 2022

What to do

For those organizations that are ready (and if you aren’t yet, start getting prepared: an ounce of prevention is worth a pound of cure), here are some of the near-term activities to begin the journey toward climate resilience:

1. Set climate resiliency as an enterprise-wide strategy.
2. Create a C-Suite role focused on climate resiliency.
3. Assess the climate threats, risks, and opportunities for your organization and its location(s). Physical risks vary widely by geography.
4. Be vigilant. Establish a department whose sole purpose is to monitor the various trends impacting your organization to anticipate recommended actions or revise strategies.
5. Research, test, and adopt virtual technologies to reduce patients' physical need to visit healthcare facilities.

Healthcare has an advantage over many other industries in that decision-making is already pushed to the edges of the medical hierarchy. The administrative hierarchy should adopt that culture. Our climate crisis is a decades-long emergency.

People throughout the organization (administrators, C-suites, Boards of Directors, IT staff, building maintenance, clinicians, lab facility managers, HR managers, directors of patient care, directors of nursing, etc.) should all be trained in climate literacy, emergency preparedness, and disaster recovery.

Many in the healthcare industry are focused on technologies to improve healthcare outcomes and prepare for contingencies. That isn’t enough. Technology can’t improvise in an emergency, but properly trained people can.

Climate adaptation will require health organizations to:

• Mitigate their sizable carbon emissions.
• Transform their operations to meet emerging/evolving/growing needs.
• Create more sustainable and flexible supply chains.
• Understand the vulnerabilities in the patient populations they care for.
• Predict the geography-based climate impacts for the regions they serve. (9)

The U.S. healthcare system must adopt 21st-century organizational structures, leadership styles, and business cultures. That requires distributed authority, a networked organization, and a focus on the needs and well-being of all stakeholders (including the surrounding community).

Our climate crisis is readily visible today and will become even more apparent to all in the coming months and years. Assessing, strategizing, planning, preparing, managing, and budgeting for climate impacts is an opportunity for healthcare to catalyze industry transformation.

This article originally appeared on Climate Foresight Advisory: https://www.climateforesightadvisory.net/post/u-s-healthcare-is-most-vulnerable-to-impacts-of-climate-change-and-the-least-prepared

One https://www.apa.org/news/press/releases/2021/11/mental-health-effects-climate-change

Two https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/

Three https://news.yale.edu/2019/08/02/healthcare-industry-major-source-harmful-emissions

Four https://world-heart-federation.org/news/a-call-for-strengthening-climate-change-education-for-all-health-professionals/

Five https://www.healthaffairs.org/do/10.1377/forefront.20220524.257311

Six ttps://www.apha.org/-/media/files/pdf/topics/climate/apha_climate_equity_introduction.ashx

Seven https://agupubs.onlinelibrary.wiley.com/doi/10.1029/2019GH000202

Eight https://www.commonwealthfund.org/publications/explainer/2022/may/impact-climate-change-our-health-and-health-systems

Nine https://www2.deloitte.com/us/en/insights/industry/health-care/climate-change-and-health.html