Preparing for the
health consequences
of the climate crisis

Summer of 2023 was dominated by record-high temperatures, coming to a close with the hottest recorded August in Earth’s history, according to Yale Climate Connections. This intense heat has major implications for human health. In the U.S., heat-related deaths are one of the deadliest weather-related health outcomes, according to the Centers for Disease Control and Prevention.

“When you talk about heat-related illness, there’s this whole range from obvious dehydration to heat, stress, to heat exhaustion, to heatstroke, which can be quite fatal,” said Dr. Japhia Jayasingh-Ramkumar, executive committee member for Illinois Clinicians for Climate Change. “All of this is exacerbated in many of our patients with preexisting conditions like heart disease and respiratory disease.”

“All of this is exacerbated in many of our patients with preexisting conditions like heart disease and respiratory disease.”
Dr. Japhia Jayasingh-Ramkumar, Illinois Clinicians for Climate Change

Extreme heat is just one of many consequences of climate change with significant implications for human health. Rising global temperatures are also contributing to more frequent and intense events such as severe storms, wildfires and flooding. These factors are expected to alter the patterns of disease vectors such as mosquitoes and ticks, ushering in new potential epidemics and pandemics.

As these environmental circumstances unfold, provider organizations must understand how patient needs will change, according to Dr. Albert Rizzo, chief medical officer for the American Lung Association.

“Patients with lung disease are going to be going to the emergency room so much more frequently on bad air quality days,” he said. “Healthcare systems need to be aware that not only are they going to get more volume of patients like this, but those volumes are going to be in the more disadvantaged populations.”

Leveraging data to make proactive decisions

To mitigate the impact that climate change will have on health outcomes, healthcare providers must first address their own contributions to the problem—specifically scope three emissions. This is a major undertaking in itself. But they must also identify and anticipate what their specific patient populations will face, whether it’s greater risk of asthma from working out in the heat, or increased risk of diabetes from a hurricane interrupting access to nutrition.

“We need to plan for future events that exceed anything we have seen in the past, particularly in certain regions of the country and of the world,” said Dr. Caleb Dresser, director of healthcare solutions at Harvard Chan C-CHANGE.

One way to anticipate challenges is by monitoring trends in climate modeling for the regions in which an organization operates, according to Dresser. Data that is already collected through EHRs can also be analyzed to identify needs for certain populations, allowing leaders to make proactive decisions regarding resource allocation and investments.

Other resources, such as the CDC Heat & Health Tracker, offer insight into what events of concern are affecting specific areas. Searchable by zip code, the CDC’s tracker shows the rate of emergency department visits associated with heat-related illness.

This data has the potential to inform proactive outreach, telehealth utilization and other community health strategies. But while health systems have multiple resources for anticipating environment-related health risks, there are notable challenges.

First, health systems need employees with the right skillset for activities such as carbon accounting, data analysis and technical support. They’re also up against limitations in data collection.

“The CDC has estimates, but it’s not required that you report heat stroke or heat exhaustion to public health agencies, like you would have to report other communicable diseases,” said Jayasingh-Ramkumar.

One reflection of this challenge is how the health consequences of combusting fossil fuels such as coal and diesel are regularly under-estimated. Global deaths from fossil fuels were estimated to number 4.2 million in 2015, but more recent research from Harvard University found that more than 8 million people died in 2018 from fossil fuel pollution. Five years later, after a summer characterized by record-breaking heat, the picture is presumably grimmer.

“That becomes a real problem when you’re trying to get data that drives policy,” Jayasingh-Ramkumar said.

Equipping the workforce for success

Another challenge for healthcare provider organizations will be equipping the entire workforce to identify, understand and address the health risks of climate change, beginning with incorporating climate education into medical curriculum. The Carle Illinois College of Medicine is on this journey, according to Jayasingh-Ramkumar, with new electives such as food systems in the age of climate change, and a first-year lecture connecting planetary health to human health.

However, many caregivers won’t have the opportunity to undergo years of dedicated training on climate change. This makes ongoing training essential.

“Many institutions are now looking at providing small-scale training around issues at the intersection of climate change, health and sustainability,” said Dresser. To this end, Harvard C-CHANGE operates a Climate Resilience for Frontline Clinics program, which develops low-cost materials for clinic administrators, physicians and patients.

Fortunately, there appears to be mounting interest in climate change resilience among future and current practitioners. One indicator: 50% of Gen Z and 46% of Millennials said they and their colleagues are pressuring businesses to take action on climate change, according to a 2023 survey by Deloitte. Therefore, health systems may want to showcase their sustainability as a recruitment and retention tactic.

“Hospitals need to be able to monitor the potential increasing risks of these events occurring and be able to monitor it in a way that they know when staffing (for example, in emergency rooms or intensive care) may need to be ramped up.”
Dr. Albert Rizzo, American Lung Association

“There are roles for everyone in addressing climate change, its causes and its impact,” said Dresser. “In the emergency department, we obviously are seeing people impacted by acute emergencies, but for something like oncology, the continuity of care for patients is really important for their treatment and their survival. We need to be alert to the impacts that climate change may have on the care of our patients, whatever our field.”

With the help of technology, organizations can develop more flexible staffing strategies, distribute burden, and implement measures to ensure patients and staff have uninterrupted access.

“Hospitals need to be able to monitor the potential increasing risks of these events occurring and be able to monitor it in a way that they know when staffing (for example, in emergency rooms or intensive care) may need to be ramped up,” Rizzo said.

Much like during the COVID-19 pandemic, infectious disease specialists and epidemiologists may take on additional strain, along with public health and preventive medicine experts. Pediatric and geriatric specialists will care for some of the most acutely vulnerable populations, and emergency medicine teams could see significant increases in trauma cases, mental health admissions, or other illnesses requiring immediate attention.

Moreover, primary care physicians will need to provide appropriate care for health circumstances related to the environment, including referrals to specialists such as cardiology, pulmonology and dermatology.

Burnout, workloads and mental well-being may be major concerns for these fields in particular, but many other areas could be similarly affected, requiring health systems’ attention and strategic support.

Aligning mission and business incentives

Despite data and workforce constraints, the introduction of new standards and policies can help crystallize the business advantages of climate-conscious care.

“Hospitals are starting to look at changing their business models in ways that are incentivizing the right type of care – care that is not just good from the standpoint of better outcomes for the patient, but also delivered in a manner that shows a metric of climate change improvement,” said Rizzo.

The Joint Commission’s Sustainable Healthcare Certification, announced in September and effective Jan. 1, 2024, was in part created for this purpose. While the certification might be readily attainable for organizations that are already leading in sustainability – requiring that they have environmental sustainability as a written strategic priority, defined oversight of these efforts, and basic measurement and mitigation of greenhouse gas emissions – it can also help other organizations that are still trying to find their footing, said Dr. Jonathan Perlin, president and CEO of The Joint Commission Enterprise.

“The Sustainable Healthcare Certification provides a framework to set priorities for leadership ratification by governance,” Perlin said. “It identifies a set of areas in which to measure greenhouse gases and waste, and creates baselines to reduce waste and greenhouse gas emissions.”

Healthcare leaders may also be guided toward more sustainable decisions by government-created green incentives, or financial benefits such as tax breaks that encourage investments with reduced environmental harm.

The Ohio Hospital Association, for instance, is engaged in helping member hospitals recapitalize aging infrastructure with green credits and payments. The organization claims that in 2022, participants saved $11.9 million in utility costs from OHA Energy & Sustainability Program Benchmarking, energy efficiency support and technical assistance, demonstrating the potential real-world impact of green incentives.

Breaking down the challenge

The actions healthcare institutions must take to address the climate impact on health can be summarized in two parts, said Dresser.

“First, they can make sure that they are able to provide patient-centered, climate-aware care that meets the needs of patients experiencing these hazards,” he explained. “Second, they can leverage their role as anchor institutions in their community – to help those patients that they serve address these health threats through primary prevention, advocacy and community-based solutions.”

Providers can also look back at what they’ve already overcome – past epidemics and pandemics – as they develop forward-looking strategies.

Regardless of what action is taken or not around climate change, healthcare providers will be left to deal with the fallout.

“COVID-19 taught us a lot, and most importantly, that we need to be better prepared,” said Rizzo. “The question is, will we follow through on what we learned?

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