Climate change has been on the horizon for many years. It’s a risk that has been in the ‘important but not urgent’ box for many healthcare leaders dealing with a raft of more immediate pressures.
Fiona Armstrong is the Executive Director of the Climate and Health Alliance (CAHA), Australia’s peak body on health and climate change. As she says,
“It’s understandable that, in the daily challenge of trying to deliver care, embracing a rather complex existential threat like climate change can sometimes be put on the back burner.”
The last two years have brought the reality of climate change firmly into our lived experience. Fires, a pandemic, floods – we’ve seen the devastating health costs again and again. As Fiona Armstrong continues,
“Now that it’s becoming much more of a tangible impact, I think that there’s a willingness to engage with it. We’ve kind of moved from not tackling it to suddenly being confronted with it as a crisis and therefore without the work that should have gone on in terms of preparedness and planning over many years.”
Let’s look at the impact of climate change on healthcare and then explore the steps that healthcare leaders can take to develop climate resilience.
How climate change is affecting healthcare
As 2019 turned into 2020, Canberra was blanketed in thick smoke from the encircling bushfires that burned more than 10 million hectares of land in southern Australia. Homes were razed to the ground, people died, others fled in terror and nearly 3 billion animals were killed or displaced.
Healthcare was severely compromised too. In the nation’s capital, to the distress of clinicians and new parents, new born babies took their first breaths in smoke-filled delivery suites and operating rooms. At Canberra Hospital, air quality plummeted on hospital wards, MRI, CT scanners and pathology equipment failed and sterilised equipment was contaminated.
Sadly, it’s far from the only example of climate change affecting healthcare. In the October 2022 floods in Victoria, health services like Rochester Hospital, Elmore Health and Rumbalara Aboriginal Co-operative experienced significant and extensive inundation of water that damaged the healthcare estate.
As the CSIRO explains, “…climate change has led to longer, more intense fire seasons and an increase in the average number of elevated fire weather days.” Though the flooding situation is more complex,
“CSIRO research has shown a direct relationship between increasing greenhouse gas concentrations in the atmosphere and an increase in strong El Nino and La Nina events…the projected increase in heavy rainfall will increase flood risk in cities, built-up urban areas, and small catchments.”
Back in 2012, Hurricane Sandy was made more destructive through climate-induced factors such as sea level rise and warmer ocean temperatures. When it struck New York and knocked out the power, Bellevue Hospital in lower Manhattan had to rely on its diesel-fuelled backup generators – which also failed because flooding compromised the pumps that were sending diesel to the generator, even though they were encased with submarine doors that had rubber gaskets. Hundreds of patients had to be evacuated and the National Guard formed a bucket brigade to transport diesel up 13 flights of stairs to the generator.
We don’t have to look far to find other examples:
- Tropical Storm Allison caused US$300m of losses and damage to Texas Medical Centre in Houston
- The main hospital on Grand Bahama was rendered unusable by Hurricane Dorian
- Typhoon Haiyan damaged hospitals in the Philippines – 3 countries set up nearby tent hospitals as part of an aid response
- Eden Private Hospital on Queensland’s Sunshine Coast was deemed structurally unsound after storm damage to its roof in 2015
- In NSW, Lismore Base Hospital’s maternity ward collapsed during a rainstorm in 2015 when the scaffolding surrounding it was struck by lighting
- Several ceilings at Mt Wilga Private Hospital in Hornsby, NSW collapsed during a storm in 2009.
It’s not just damage to hospital buildings that threatens healthcare. Climate change also disrupts global medical supply chains, leading to critical shortages of key pharmaceuticals.
Puerto Rico is home to more than 500 facilities making medical products – 10% of all drugs used in the US are made there. Medical supply chains were severely disrupted when Hurricane Maria struck in 2017 and almost wiped out stock of a number of common local anaesthetics. Pfizer reportedly lost US$195 million in inventory when three of its facilities were destroyed by the hurricane. Just a year later, Pfizer, Novartis, MSD, NovoNordisk and GSK halted operations as Hurricane Florence approached the US.
Closer to home, during the Lismore floods in 2022, dedicated pharmacists were using jet skis to deliver medicine to patients in need. Supplies were dwindling though as many pharmacies had been flooded and lost their whole stock of medicines. Temporary mobile healthcare facilities offer a way to bring healthcare closer to those in need in the wake of a natural disaster.
COVID-19 and climate change
One often overlooked health impact of climate change is a likely increase in zoonotic diseases, such as COVID-19, which is thought to have spread to humans from bats.
“Climate change and rising temperatures lead to the spread of zoonotic hosts and vectors, increasing the human population that is exposed to vector-borne diseases. Rising temperatures further stimulate the rate of reproduction of both pathogens and vectors.”
Australia’s preparedness: moving towards climate resilience
Some years ago, CAHA undertook a consultation for the Queensland government, talking to hospitals and healthcare providers in preparation for developing the Human Health and Wellbeing Climate Adaptation Plan for Queensland.
Only 12% of the hospitals and health services CAHA spoke to then had done a climate risk assessment. As Fiona Armstrong comments, those hospitals and health services, didn’t know what they didn’t know about the many and varied ways in which they were vulnerable to the impact of climate change.
“Was their infrastructure in a flood zone? Or were their supply chains going to be affected by extreme weather? Would it be coastal inundation or a bushfire? What would be the effect on their workforce? What types of presentations could they expect to see during that period? What would be the impact on their buildings?”
Queensland has now acted on those insights and they have the climate risk assessment tool and template for an action plan for hospitals and health services.
But they are the first in the country to do that.”
The health departments of NSW, Victoria, Queensland, ACT and WA have joined Global Green and Healthy Hospitals (GGHH), an international network of healthcare organisations dedicated to reducing their environmental footprint and promoting public and environmental health. Australia’s Climate and Health Alliance coordinates the Pacific region of GGHH.
This state-level leadership has recently been matched by a federal commitment. The 2022 federal budget included the first national allocation of funds towards climate and health. The government allocated $3.4m toward creating a National Health Sustainability and Climate Unit and developing Australia’s first National Health and Climate Strategy.
Welcoming that news, the Chair of Doctors for the Environment Australia (DEA), Dr John Van Der Kallen, said,
“There is rapidly growing support in the health profession for the Australian healthcare sector to significantly reduce its carbon footprint and be a leader in environmentally sustainable healthcare.
“This is not limited to decreasing energy use and waste, but extends to better procurement decisions, improved infrastructure and planning, public and preventive health care, and innovative care pathways.”
A disaster-proof hospital?
When a hospital basement floods, it leads to power failure and even the failure of backup generators. Suddenly, the lights go out, the heating or air con stops, and life support systems no longer work. It’s a dire situation – and it took just 2 feet of water in the basement to do all that to a New Orleans hospital during Hurricane Katrina. Two years later, 7 of the city’s 16 hospitals and acute care centres were still closed due to storm damage.
Recently a new disaster-proof hospital has opened its doors in New Orleans. Key features include:
- The ability to withstand category 3 storms
- Walls that can resist blasts, ballistic assaults and ramming
- An ‘upside down’ building design with:
- Power systems on the fourth floor
- Fill lines for the generator’s large, underground fuel tank elevated above the 500-year-flood line so they can be accessed during high waters
- The emergency department on the 2nd floor, accessed by a ramp that doubles as a boat launch for getting people into or out of the hospital during floods
- The ability to remain fully operational during a disaster because, in addition to a stable power supply, there’s a:
- Huge on-site warehouse holding food and water for 1,000 people for 5 days
- Rainwater catchment system that acts as a backup water supply
- Emergency capacity
- Every patient room can convert from single to double occupancy if the hospital becomes an emergency shelter.
Australia does not yet have a disaster-proof hospital. But many hospitals and health services have begun to improve their sustainability credentials.
Inspiring Australian examples
Some Australian hospitals and health services have already ‘greened’ their operations significantly.
Sunshine Coast Hospital and Health Service in Queensland is:
- Building a culture of waste avoidance, efficiency and innovation
- Choosing wisely in care delivery
- Setting carbon and waste targets
- Measuring, monitoring and reporting on environmental performance
- Preparing for climate change impacts.
Sunshine Coast University Hospital is the largest public healthcare facility in Australia to earn a 6-star green rating. Major spaces such as its integrated central courtyard and a large outdoor room are designed to “take advantage of the local climate, coastal lifestyle and the healing properties of natural air and light.”
In NSW, Hunter New England Local Health District has announced it will be carbon and waste neutral by 2030. This will be achieved by making significant investments in solar power, water sustainability and improved energy efficiency.
Meanwhile, Ambulance Victoria recently won two golds and a silver in the Global Green and Healthy Hospitals (GGHH) Climate Champion Awards for its progress in climate resilience. That included developing a plan to reduce its own carbon footprint, preparing for the impacts of extreme weather, addressing the shifting burden of disease, and promoting policies that protect public health from climate change.
Getting started in your hospital
Examples of peer success can be inspiring…but they can be daunting too. How do you get started in your hospital? Here are four suggestions.
1. Promote Board-level climate leadership
Individual climate champions can make a difference by changing departmental purchasing decisions, for example. They can slowly manage to build institution-wide support but it often takes a long time.
Making a significant difference requires Board-level leadership. Some Board members will act out of concern for the planet but every single member should act out of their duty to minimise risks to their hospital.
For climate change is a foreseeable risk. In a memorandum of opinion produced for the Centre for Policy Development in 2019, Noel Hutley SC argued,
“It is increasingly obvious that climate change is and will inevitably affect the economy, and it is increasingly difficult in our view for directors of companies of scale to pretend that climate change will not intersect with the interests of their firms. In turn, that means that the exposure of individual directors to “climate change litigation” is increasing, probably exponentially, with time.”
While the legal instruments and regulatory environment for public sector institutions differ, the Board’s overall responsibilities remain the same.
As CAHA’s Fiona Armstrong notes,
“All hospitals and health services and their directors – who have a duty to manage risk – ought to be making climate risks central to their strategic and operational plans. Every hospital should be working both to mitigate their own contribution to climate change and to ensure they’re resilient and prepared for the impacts of climate change.”
As noted above, the federal government has committed funding for a National Health Sustainability and Climate Unit backed by Australia’s first National Health and Climate Strategy. It is likely that more action will be expected of Australia’s hospitals in this new political climate.
2. Join Global Green and Healthy Hospitals
Once a hospital Board accepts its responsibility, a great first step is to join Global Green and Healthy Hospitals where it will benefit from access to a suite of resources and case studies that provide guidance and inspiration.
When an organisation joins GGHH, it commits to working on at least 2 of the GGHH’s 10 interconnected goals, namely:
- Environmental leadership
- Substitute harmful chemicals with safer ones
- Reduce and safely dispose of waste
- Clean and efficient energy use
- Reducing water use and ensuring potable supply
- Improving transport for patients and staff
- Healthy, sustainably sourced food
- Safely manage and dispose of pharmaceuticals
- Green and healthy hospital buildings (design and construction)
- Purchase safer and more sustainable products.
3. Stop providing low-value healthcare
Low-value healthcare refers to interventions that:
- Provide little or no benefit
- May cause patient harm,
- Yield marginal benefits at a disproportionately high cost.
Low-value care wastes scarce resources. That’s why Australia’s peak health professional bodies have highlighted tests, procedures or treatments that healthcare providers and consumers should question.
There may, in some cases, be good reasons for proceeding with some of these treatments based on clinical judgement. However, a hospital that is routinely providing a significant amount of low-value care, should seek to understand why this is happening and how practices could be changed.
As Fiona Armstrong comments,
“Eliminating low-value care is really a good way of both producing improving health outcomes, but also reducing our carbon footprint because we’re no longer wasting money and carbon on services that are not needed.”
4. Use mobile and modular healthcare facilities
Older hospital buildings seem reminiscent of diesel-guzzling 4WDs. While new or refurbished buildings can easily use climate-conscious design, transforming an older building is slow and hard work.
Mobile and modular facilities provide an easier way to make progress. They are:
- Constructed offsite, which reduces carbon emissions
- Built to comply with high clinical, safety and sustainability standards
- Energy efficient in their operations
- Flexible and can be repurposed easily as a hospital’s needs change
- Recyclable once they are no longer needed on site.
Mobile and modular healthcare facilities can also form an important component of a hospital’s natural disaster contingency plan.
Mobile facilities can be rapidly deployed in the immediate aftermath of a flood, bushfire or other natural disaster that has damaged the hospital. Yet they don’t compromise on quality – they’re fully compliant with all service standards.
When a storm damaged one of the main operating rooms at The Alfred Hospital in Melbourne, the hospital commissioned a mobile laminar flow operating room and performed open heart surgery there until the main operating room was repaired.
When Tewkesbury Hospital in Gloucestershire, UK flooded in 2018, the Trust installed a mobile day surgery unit in the grounds of a hospital in nearby Cheltenham, aiming to ensure continued provision of service to 9,000 patients waiting for surgery. When the waters receded, the mobile unit was moved to the hospital site in Tewkesbury while planned refurbishment took place. When water levels unexpectedly rose again, the mobile unit was quickly moved back down the road to Cheltenham, ensuring uninterrupted patient care.
If you’d like to learn how mobile facilities could help your hospital reduce its carbon footprint and improve its climate resilience, please contact Q-bital Healthcare Solutions.