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Climate change is driving more severe weather events, and disasters,1The evolving array of resilience and mitigation strategies that are available to health care organizations has required them to think about. And while not all health care leaders view climate change through the same cause-and-effect lens, they are nevertheless taking action to lessen their organizations’ environmental impact and strengthen their infrastructure.
In a November 2021 survey of NEJM Catalyst Insights Council members — who are clinicians, clinical leaders, and executives at organizations around the world that are directly involved in care delivery — respondents indicate that 69% of clinicians, 67% of clinical leaders, and 54% of executives globally have high or moderate recognition of climate change health impacts (Figure 1). However, patient awareness stands in stark contrast, with 54% of respondents globally saying that their organization’s patients have little to no awareness of climate change impacts on their health (Figure 2).
David Callaway MD, FACEP. MPA is the Chief of Crisis Operations and Sustainability and Professor in Emergency Medicine at Atrium Health, Charlotte, North Carolina. He is also the Chief Medical Officer of Team Rubicon, a veteran-led disaster relief organization. He thinks that health care executives’ recognition is actually much higher than indicated in the Insights Council survey.
“I’ve spent 20 years caring for patients both in the ER and in the field after extreme weather events, and I advise our C-suite on future threats,” he says. “I don’t think there’s any health system executive who isn’t aware that climate change impacts health care. For example, in 2017, we ran out intravenous fluid after Hurricane Harvey disrupted our supply chain. It is easy to accumulate enough once-in a century weather events like these in a single year. I believe the issue is mostly resolved. The question for executives is, what are we going do about it?”
Callaway believes it is time for health organizations to take the lead. “Health care is big business, but we are a business with a moral mission — preserving health. We must use our size and mission for climate change mitigation, adaptation, resilience strategies. This takes money, courage, and prioritization.”
Callaway claims that Atrium Health’s primary role is to respond to complex crises like pandemics and mass shootings. But sustainability is also part his portfolio. “We view climate change as an existential threat to our patients and communities, and we think it’s our responsibility to act. We learned from Covid-19 that health care can lead multisector, public-private coalitions to solve difficult, far-reaching problems. The problem is that the health care sector hasn’t taken ownership of climate change, like we did with Covid-19.
“Like many organizations, we are trying to change that lack of ownership. My team has been developing an enterprise-wide framework for crisis innovation that will help us respond to current and future threats. This has been going on for approximately a year. For the climate crisis, this work crosses traditional business verticals and includes aligning efforts such as expanding virtual care, eliminating single-use plastic, redesigning supply chains, investing in renewable energy, and reimagining the next-generation academic health system.”
Charles Kilo MD MPH, CEO at GreenField Health in Portland, Oregon is a multispecialty group clinic that is owned and managed by Optum. He says that most patient-clinician interactions won’t involve a discussion on climate change impacts, despite patient awareness. The focus instead is typically on the patient’s care plan and not the external macro factors that may have led them to the clinician’s office.
“When I’m seeing patients, I don’t have a discussion about whether the patient’s health was impacted by climate change, even if this may be true,” he says. “And while I’m very aware of climate change health impacts, trying to get clinicians and patients to think this way is challenging. Our organization has certainly seen increases in people with heat stroke and heat exhaustion, for example, but asking clinicians wrap their brains around an assessment of what’s climate change–related or not isn’t really feasible. And I don’t think most patients think this way, either.”
Kilo states that raising awareness about climate change’s health effects is more of an industry issue than a health care industry issue. He cites the Covid-19 pandemic for an example. “As physicians, we ought to be addressing it as a political problem, given how during the pandemic we saw public health and sciences come under attack. And I think that we’d be more effective if we framed it that way.”
Kilo says that health care executives tend to be intensely focused on the business aspects of health care, and that reacting to climate change impacts or reducing their organization’s influence on climate change are low on their list of priorities. “Health care executives, who are often non-clinicians, are very focused on running the business and driving revenue. It can be difficult to get them interested in mitigation. But, most clinicians are very interested in climate change issues and are open to working with organizations to reduce their impact. It’s just their social orientation.”
Mark Lythgoe MBBS, MRPharmS is an Academic Clinical Fellow at Imperial College London in Medical Oncology. He believes that the United Kingdom is well aware of the impacts of climate change. He cites the recent United Nations Climate Change Conference (COP26), which was held in Glasgow, Scotland. And he is cautiously optimistic about the prospects for the U.K.’s National Health System to respond to climate change because of its centralized management structure.
“In the U.K., health care is delivered through the NHS, so at least theoretically there is more centralized control than in the U.S.,” says Lythgoe. “It’s probably easier here to form a uniform strategy for climate change across the different health care centers and hospitals. This has been the subject of many initiatives, including reducing plastic usage and trying to make the NHS carbon neutral.
“However, because it’s a public health system, we’re also very focused on trying to save costs. Unfortunately, some of the infrastructure, just like many other government infrastructures around the globe, is outdated and needs to be updated in order to reduce the risks of adverse weather events and extreme temperatures. And I think there is a lot of catching up to do.”
Lythgoe states that the U.K.’s biggest climate change risk is in its supply chain of health care supplies. “Supply chains have recently come under pressure from both Covid-19 as well as Brexit. For example, we’ve started to see shortages of some key health care resources such as the blood tubes we use for lab testing, which has been linked to Brexit. The U.K. is an island and many of the items we need are imported, and health care supply chains are not very resilient these days.”
Lythgoe doesn’t believe patients in the U.K. are necessarily making the connection between climate change and health care delivery, although he acknowledges that it may not be a priority in his cohort of patients with advanced cancer. He does however state that the NHS is not making the risks of climate change and the health services more obvious.
Miguel Sánchez-García, MD, PhD, is Director of Critical Care at Hospital Clínico San Carlos in Madrid, Spain, and Covid-19 Regional Coordinator for Intensive Care for the Community of Madrid. He says that while climate change’s impact on the country is currently being debated by Spain’s political leadership, the national health care system has taken a pragmatic approach by focusing on environmental practices such as saving energy, using less plastic, and recycling waste.
“Many of the buildings in our health system are older and need updating, and much of this work is being done for efficiency and cost-saving reasons as well as for environmental impact reasons,” he says. “For example, in Hospital Clínico San Carlos where I work, there is a real need for improvements on energy-saving measures because of leaky windows and doors and other inefficiencies. However, climate change impact on patients is not our primary concern.
“I also don’t believe this is something that our patients really think about, either. Because it is politically correct, the general public is aware of climate change. Some see connections to almost all aspects of their lives. But for most people, they aren’t worried about climate change impact on their personal health. They’re mostly thinking in terms of what we should do as a country to minimize our impact on the environment.”
Sánchez-García says that to move forward on the issue of climate change and patient health, the health care industry needs more scientific data on the cause-and-effect relationship, and he counts himself as among those looking for more information.
“I’m skeptical about some of the human causes of climate change, although I’m absolutely sensitive to our responsibilities to reduce water and air pollution, recycle waste, and use energy and natural resources responsibly,” he says. “But from a scientific point of view, I see flaws in some of the climate change thinking and think we need more data before committing to action.”
