Extreme weather is more common. Hospitals need to be ready

Without a rapid shift away from fossil fuels, 1 in 12 hospitals will be totally or partially shut down by extreme weather events before the end of the century, according to a 2023 estimate from the Cross Dependency Initiative, a climate risk analysis firm.

In California, for instance, around half of all inpatient beds are less than a mile from a high fire-threat zone, and researchers have found the average distance between California wildfires and inpatient facilities is shrinking.

“For people who are tasked with prioritizing the use of limited resources within institutions, it makes sense to look at this issue and substantively engage with it because each year that we move forward, the risk is going up,” Caleb Dresser, a core faculty member at the Harvard T.H. Chan School of Public Health Center for Climate, Health, and the Global Environment (C-CHANGE), told Healthcare Brew.

C-CHANGE conducts research and translates evidence into actionable steps for decisionmakers like healthcare leaders.

We talked with Dresser about how, and why, health systems should prepare for climate change.

This interview has been lightly edited for length and clarity.

What’s keeping the healthcare industry from being more prepared?

The big strategic challenge on climate readiness in healthcare in the United States is going to be financing the necessary actions at the institutions that do not currently have the financial bandwidth to take them, or that are not making them an institutional priority…It’s very hard to make a case for adding climate resilience positions or doing capital investments in long-term preparedness if you are struggling to make ends meet quarter to quarter. And so I think that’s where we have to think about larger-scale policy approaches…whether that’s block grants for flood preparedness or additional resources to institutions that are taking substantive actions to prepare for these hazards.

What are some examples of worthwhile but expensive preparations?

Examples of that might include HVAC retrofitting to ensure sufficient air filtration that you can continue to run a hospital during a wildfire smoke event without having the interior spaces of the hospital become unsafe to breathe if you have asthma or COPD. It might include physical flood barriers, for example, building landscaping or flood protection walls around facilities that are in coastal floodplains or rivering floodplains. Relocating your generator systems out of areas in the hospital that would flood is really important. Making sure you have sufficient generator fuel, and making sure that the complex system that supports having a functioning hospital or functioning clinic is actually able to function under stress in events that exceed historical maximums.

What’s one problem you’re working on right now?

In parallel with my work at Harvard C-CHANGE, I also conduct research at Beth Israel Deaconess Medical Center, where we’ve been looking increasingly at the impact of high outdoor temperatures, heat, on operational metrics in our hospital…The questions we are asking are: What does this mean for your hospital? If you are running an emergency department, if you are running an inpatient unit, what does higher outdoor air temperature mean for your operational capacity?

At individual institutional levels, we are seeing a trend toward higher case acuity mixes during hot weather. We have some ongoing work looking at other operational metrics, things like doctor times, which also do appear to be influenced by hot weather. So this is all work that is aimed at helping downscale a national-level epidemiology problem into numbers that can be understood by the manager of a single unit, or the operations department of a healthcare system, as they think about their long-term preparedness for these threats.

Do you ever encounter misconceptions or hurdles to getting healthcare leaders on board?

We recognize that talking about climate change can introduce some complexity within some institutions. But talking about reducing emergency department utilization during hot weather is something everyone can agree is a good idea.

Understanding the specific vulnerabilities in your location—whether that’s intermittent river flooding, or storm surge from hurricanes, or wildfire exposure, or heat exposure—is a reasonable first step on the road to addressing climate vulnerabilities.

What’s a positive trend you’re seeing in this space?

There are a number of large healthcare systems that are substantively engaging with this issue. We also are starting to see increased media coverage of situations where preparations either didn’t happen or were not sufficient.

I think as we see more of these events where hospitals unexpectedly flood, or where surges in patient volume exceed the capacity of an institution because of an external environmental stressor, the clearer the case becomes for why prioritization of this issue is important, and why investing resources is valuable to an institution.