This month, an alarming report from the U.N. announced that there may be as little as 12 years to curb climate change and reach the target set by the 2015 Paris climate agreement. That could have serious implications for healthcare systems increasingly coming face-to-face with the realities of how climate change can directly and indirectly affect patients' well-being.
For example, the health costs of climate change events from 2000 to 2009 are estimated to total $740 million and add more than 760,000 encounters to the healthcare system.
Lessons learned—from Hurricane Katrina to the more recent devastation of Hurricane Florence in North Carolina—show that health systems must build the capability to identify those most vulnerable to climate change impacts, minimize risk factors for individuals and communities, and manage the resulting physical and mental burdens.
In the face of these challenges, health systems need a proactive strategy that leverages data and technology; addresses individual and community resiliency; and creates a more climate-ready infrastructure.
Health systems have a responsibility to patients in the face of climate-related disasters. Most at risk are vulnerable populations such as seniors. For example, adults over 65 were disproportionately impacted by Hurricane Katrina, (63% of fatalities) and Hurricane Harvey in Houston in 2017 (approximately one-third of the deaths).
There are numerous steps healthcare systems can take to ensure a rapid, effective response. First, leverage technology. Data analytics have made it possible to hot-spot vulnerable populations through programs like emPOWER, a database of 2.5 million Medicare beneficiaries reliant on electric medical and assistive equipment. The database integrates Medicare data with real-time weather tracking services to identify at-risk individuals affected by natural disasters. Healthcare systems should work with public health leaders and first responders to improve the resiliency of those in the existing emPOWER database before disasters, and develop a plan to monitor emPOWER patients after disasters.
Perhaps most importantly, they should expand emPOWER to include Medicaid and commercial claims, which will broaden its reach and improve identification of at-risk populations who face unique challenges during a disaster, including low-income individuals.
Second, clinicians can help by encouraging patients to be prepared with medication lists and supplies. The American College of Physicians and American Academy of Family Physicians offer suggestions for developing contingency plans, including data protection and retrieval during power outages. Clinicians and health systems can also help build resiliency for patients by assessing and addressing the social determinants of health.
Finally, the healthcare system has an important role to play in lessening its contribution to climate change and in building a resilient infrastructure. The Climate Resilience Toolkit from the National Institute of Environmental Health Sciences provides a framework to help systems understand their climate event risk, mitigate it and plan for the worst with system redundancy and hardening.
In addition to establishing a strong foundation to withstand disaster, healthcare systems must partner with government to extend that infrastructure. For example, during Hurricane Florence, North Carolina's statewide health information exchange partnered with its counterpart in east Tennessee, establishing an emergency connection to support medical record needs of North Carolina residents evacuating to Tennessee. Swift collaboration in the face of danger is critical; we can't wait until disaster is looming to put these systems in place.
Now is the time to take a proactive approach. No community can afford to wait for disaster to strike before strengthening its public health and healthcare system infrastructure.