Places around the world are being affected by climate change through
devastating floods, wildfires and extreme heat-waves. Many healthcare
facilities are simply not prepared and therefore there is a pressing
need to address this through awareness of climate resilience.
Climate change has impacted the prevalence of infectious diseases,
such as dengue, malaria and zika virus, which has sparked a rise in
cases during periods of increasing temperatures and rainfall. The
effect of climate change on diseases has been taking its toll on the
ability of healthcare facilities to deliver safe and reliable services.
Cambodian citizens volunteer to help during a seasonal flood | Ny Mengho / Unsplash
Professor Guy Howard is the Global Research Chair in Infrastructure
and Environmental Resilience, as well as the Associate Director
(International) of the Cabot Institute of the Environment at the
University of Bristol. Addressing the concerning threat of the lack
of resilience within healthcare services and the challenges ahead, he
highlighted four key components of healthcare facilities: the health
workforce; water, sanitation and healthcare waste management; energy;
and infrastructure, technology and products.
The resilience of each element is crucial in the process of
administering aid to those who come into hospitals and other healthcare
facilities. An individual admitted to a hospital without access to
toilets and clean water to wash their hands will have their health
compromised through coming into contact with an unsafe health service.
Add more problems, such as a tired workforce and unreliable
power-generating system, and an unforeseen climate event may collapse
the whole service.
‘Wildfires are the biggest threat to healthcare facilities in Australia and the USA.’
Professor Howard goes on to explain why having climate-resilient and
safe health services is vital. First, in ideal conditions, very few
services in the world have all four mentioned components to
secure a safe and resilient environment for patients. Additionally,
around 900 million people in the world use facilities with no access
to clean water, which is equivalent to 4% of all hospitals.
Services that are already lacking basic resources such as water,
sanitation and thermoregulation (cooling systems or heating) are
already facing major obstacles. The latter of which has become
increasingly significant, since many buildings that are designed for
cold weather cannot withstand the extreme temperatures seen recently
due to global warming. Additionally, there are many climate threats,
including wildfires, droughts, and floods, which will physically
impact healthcare facilities around the world.
Hospital patients struggle to cope with intense heat-waves as
buildings are not designed with appropriate cooling systems (left).
In 2021, citizens seek refuge from extreme temperatures in cooling
centres. Such measures may help healthcare facilities being overrun
with people affected by heat stroke (right) | Martin Bureau / AFP / Getty Images.
Resilience in healthcare matters
The concept of resilience goes hand in hand with sustainability,
because resilient services and infrastructure can cope with ‘stresses’
and ‘shocks’ that may put many hospitals out of service and bring harm
to the most vulnerable people.
Professor Howard explains that resilience is about
response—authorities are much quicker to address shocks to services
that are perceived as dramatic or imminent. For example,
devastating floods alarm the authorities and the public, and because
they often lead to disasters, such as power outages and bridge collapses,
everyone is forced to act quickly. However, at this stage it is too
late to take any significant preventative measures and many lives are
sadly lost.
On the other hand, responding to stresses does not necessarily make
the authorities aware of the problem. An example of this is when there
may be a temporary heat-wave, in which services are put under stress,
but not enough to evoke much-needed changes to infrastructure. In
these cases, Professor Howard marks the importance of efficient
thermoregulated buildings and contingency plans for power outages.
Doctors and healthcare workers were not prepared for the events that
took place at Memorial Medical Centre, New Orleans on the 29th of August
2005. Hurricane Katrina flooded the hospital, there was no
electricity, food or water. Temperatures rose to 43°C for several
days which ended in the most vulnerable patients being euthanized
due to lack of preparedness and understanding of how to respond to
this type of disaster| Bill Haber / AP file.
In summary, it is easier to respond to shocks than to stresses,
however with stress, people are less likely to wake up to the problem
due to its long-term, non-immediate nature. By changing our focus to
address stresses, we can ensure that we create resilient and strong
services, which are better prepared for operating during the shocks.
Both shocks and stresses impact the healthcare system. They add strain
to workers who are already over-worked and to the infrastructure, by
damaging life-saving equipment, lifts to safely transfer patients, and
by cutting off water and sanitation.
In June 2021, an unprecedented heat-wave put an immense strain on US
and Canadian healthcare services. A measure of preparedness for the
disaster was observed through the set-up of cooling centres across the
affected regions. These centres sheltered citizens from the heat, and
may be a useful strategy in preparing for future heat-waves in places
not accustomed to such high temperatures.
Tackling a lack of resilience within healthcare facilities
Facilities may wish to reinforce their current basic services, such
as ensuring a clean water supply, optimizing food and sanitation, and
preparing their workforce through relevant training and communication.
The WHO Operational Framework currently offers recommendations into
these preparedness solutions and additional information on how to get
support to tackle a lack of resilience. Unfortunately, however, many
communities around the world do not have the resources to implement
such improvements.
Low-income and rural communities are the most at risk due to a lack of
basic coverage of healthcare services. The UN and the 17 Sustainable
Development Goals (SDGs) agree that adopting climate-resilient
healthcare facilities is part of the same strategy to end poverty and
reduce inequalities. By aiming to execute the SDGs, there may be hope
to relieve some suffering on less-developed populations regarding the
vulnerability of their healthcare facilities to climate change.
A climate resilience recommendation by the WHO for maintaining water
supply to healthcare facilities should consider local weather such
as a history of hurricanes and typhoons. The image shows how a
raised water tower which may be vulnerable to strong winds and not
climate-resilient | L.Filipe C.Sousa / Unsplash
Professor Howard and colleagues acknowledge that the lack of basic
coverage needs to be tackled, and help address proposals by the WHO
guidelines for climate resilience. For example, in areas affected by
drought, hospitals may look to adapt to collect rainwater during the
rainy season through the use of certain water towers.
In reality, however, these recommendations are not universally
suitable. For instance, raised towers may not be appropriate for
certain local climates, and could easily collapse during a hurricane
due to their structural design. More climate (and regional) appropriate
measures should be carefully explored to protect low-income and rural
communities in the event of future natural disasters.
‘5% of [greenhouse gas] emissions in England come from the NHS.’
Environmental sustainable healthcare facilities
Climate resilience and preparedness are both environmentally
sustainable measures. Ensuring services run with clean water and
sanitation may also contribute to a healthy environment through the
reduction of pollutants. This may also be true as services deprived of
water and sanitation often become the sources of infectious diseases.
Additionally, running safe services benefit all people, especially
the most vulnerable patients, as well as allowing the workforce to
withstand future emergencies.
Climate resilience emphasises the importance of preparedness and
awareness towards climate change and its effects on worldwide
healthcare facilities. The lack of resilient healthcare facility
measures may become a source of stress and cause healthcare workers
to be unprepared to tackle shocks, such as a flood or drought.
On the other hand, it may be also important to recognise that in richer
countries, implementing climate resilience means lowering the release
of contaminants into the air and environment, which will reduce the
risk of diseases through better waste management. To conclude, without
resilient healthcare services and facilities, the health and
well-being of the world’s population are undoubtedly at risk,
particularly when facing the consequences of climate change.
‘If you have healthy people, then you have a healthy environment. By
achieving this, then we can promote environmental sustainability’.
Featured Image: Magdiel Lago / Ian Anderson / Fas Khan | Unsplash
Corvalan C., Villalobos Prats E., Sena A., et al. (2020) 'Towards climate resilient and environmentally sustainable health care facilities.'
International Journal of Environmental Research and Public Health. Volume 17, issue 23.
