Climate resilience: the importance of strengthening healthcare facilities in the face of climate change

People | Human Health


By Isabel Rowbotham, Co-Editor-in-Chief

Published August 7, 2021

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 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, in order 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 which 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 which 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 29 August 2005. Hurricane Katrina flooded the hospital, there was no electricity, no 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 its 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 to lower 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 is 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

Howard, G. (2021, June 11) Building Climate Resilient Health Facilities. Available at: https://uob.sharepoint.com/teams/grp-ClimateChangeandHealth/Recordings/Forms/AllItems.aspx?id=%2Fteams%2Fgrp%2DClimateChangeandHealth%2FRecordings%2F20210611%5FGuyHoward%5FResilient%5FHealthcare%2Emp4&parent=%2Fteams%2Fgrp%2DClimateChangeandHealth%2FRecordings [Accessed 25 July 2021].

Corvalan, C., Villalobos Prats, E., Sena, A., Campbell-Lendrum, D., Karliner, J., Riso, A., Wilburn, S., Slotterback, S., Rathi, M., Stringer, R., Berry, P., Edwards, S., Enright, P., Hayter, A., Howard, G., Lapitan, J., Montgomery, M., Prüss-Ustün, A., Varangu, L., & Vinci, S. (2020). Towards climate resilient and environmentally sustainable health care facilities. International Journal of Environmental Research and Public Health. 17(23). https://doi.org/10.3390/ijerph17238849, https://doi.org/10.3390/ijerph17238849

Fink, S.(2009)The Deadly Choices at Memorial. The New York Times Magazine. Available at: https://www.nytimes.com/2009/08/30/magazine/30doctors.html [Accessed 3 August 2021]

McGrath, M. (July 8 2021). Climate change: US-Canada heatwave 'virtually impossible' without warming. Science & Environment. Available at: https://www.bbc.co.uk/news/science-environment-57751918 [Accessed 3 August 2021]



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