U.S. Healthcare is Most Vulnerable Sector to Impacts of Climate Change… and the Least Prepared
Updated: Jun 21, 2022
by Sam Cherubin and Bob Leonard
(NOTE: This is the first in a series about the specific climate impacts different industries can expect, and should be preparing for. Sam's bio appears at the bottom of the post.)
The American healthcare system is predicated on a stable environment and society. Our climate crisis guarantees that our environment and our society will become ever 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 major contributor to the greenhouse gas emissions that are causing global warming, and one of the industries most impacted by climate. It must 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 will upend “brick and mortar” physical systems through destruction of infrastructure and supply chain breakdowns. This will also impact the physical and mental health of providers themselves.
Climate change-fueled acute disaster events are causing harmful impacts on human health. Longer term, climate change leads to temperature-related illness and mortality, 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
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.
Costs four trillion dollars a year, four times the size of our massive 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: 8.1%.2
There are many sectors that 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.
NOTE: Health Insurers/Payers will be covered in a separate post about the insurance industry.
Healthcare is supported by massive global supply chains, operations and administrative organizations. Supply chain breakdowns result in a lack of needed 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
There is a general lack of awareness in the healthcare sector because climate science and climate risk management are not taught in medical or healthcare administration curricula. “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
There are inherent conflicts of interest in for-profit organizations invested in the status quo. Necessary adaptations and mitigations require near term investments with long term ROI (avoided disaster recovery expenses). Existing institutions are vested in a system and culture no longer fit for purpose – drug companies, pharmacy benefit managers, hospital systems, health insurers, medical device manufacturers, dialysis centers and more.
“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.
Greenwashing (e.g. misleading ESG and carbon footprint reporting, and purchases of carbon offsets) encourage postponing authentic climate actions.
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
The U.S. healthcare system is fragmented and disjointed. There is no single organization or leadership structure with the power to dictate changes. U.S. healthcare is politicized making legislated climate mandates nearly impossible.
Climate is not the only threat impacting healthcare. There are multiple trends vying for attention (e.g. staffing shortages, the “retailization of health,” AI, blockchain, wearables, Big Tech and Virtual Reality.
Healthcare is comprised of closed systems with little exposure or awareness of climate actions being deployed by other industries and institutions. For example, there is much healthcare could learn from the U.S. Department of Defense.
Climate Vulnerabilities of U.S. Healthcare
Climate change affects every aspect of the health care system:
As a warming atmosphere and air pollution negatively affect the health of millions more people each year, increased costs of care result. Health care systems are responsible for the care of people impacted by severe weather events, as well as 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
Climate change does not affect people equally. In fact, it deepens preexisting inequities by taking the greatest toll on those already 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:
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
people with disabilities
people who are experiencing homelessness.
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.
When some hospitals are forced to close, others can become stretched beyond their capacity. Overcrowding and the boarding of patients 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 a key saline manufacturing plant in Puerto Rico, it led to dire shortages of a critical medical supply in both 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 ready… an ounce of prevention is worth a pound of cure), here are some of the near-term activities to start the journey toward climate resilience:
Set climate resiliency as an enterprise-wide strategy.
Create a C-Suite role focused on climate resiliency.
Assess the climate threats, risks and opportunities for your specific organization and its location(s). Physical risks vary widely by geography.
Be vigilant. Establish an individual or department whose sole purpose is to monitor the various trends impacting your organization to anticipate recommended actions, or to revise strategies in place.
Research, test and adopt telehealth technologies to reduce the need for patients to physically 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. That culture should be adopted by the administrative hierarchy. Our climate crisis is a decades long extended 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 is well and good, but it isn’t enough. Technology can’t improvise in the event of an emergency. Properly trained people can.
Climate adaptation will require health organizations to:
Mitigate their own 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 needs to adopt 21st century organizational structures, leadership styles and business cultures. That requires distributed authority, a networked organization, 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 months and years to come. Assessing, strategizing, planning, preparing, managing and budgeting for climate impacts is an opportunity for healthcare to catalyze a transformation of the industry.
Sam Cherubin is a Futurist working in healthcare, with a background in product management, innovation and strategy. He is passionate about building climate solutions, with a focus on mitigating climate impacts on health, reforestation and population migrations. https://www.linkedin.com/in/samcherubin/