Preparing for the future: Hospital climate resilience plans challenged by cost, uncertainty

Climate change could take a toll on health systems. More frequent and intense heat waves, heavier rainfall and flooding, a more extreme hurricane season — as weather events exacerbated by climate change ramp up in frequency, hospitals could see a surge of patients. But extreme weather also poses a risk to hospital operations, threatening to leave communities without access to care in an emergency. From 2000 to 2017 alone, hospitals were forced to evacuate patients 114 times due to natural disasters like hurricanes, wildfires, floods and storms, according to one study. 

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U.S. hospitals have struggled during extreme weather events. Hurricane Sandy, which hit the East Coast more than a decade ago, infamously strained hospital resources, and an analysis published in 2018 found one-third of the deaths reported in the wake of Hurricane Maria in Puerto Rico were attributed to delayed or interrupted healthcare. Climate resilience planning, where facilities prepare to adapt and respond to climate-related disruptions, is critical to keep facilities open in the midst of a disaster, experts say. But industry-wide financial and workforce challenges, uncertainty around future climate events and health systems’ growing geographic footprints make that crucial preparation a challenge. 

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Currently, the federal government recommends five elements for healthcare climate resilience plans, starting with a prospective risk assessment that uses forward-looking climate data to prepare for current and future vulnerabilities. Hospitals typically use historic data to build out hazard vulnerability analyses, where they review potential threats like mass casualty events, power outages or severe weather that could affect their facilities or communities. But past events don’t necessarily predict the future in a world with a changing climate.

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Providers should also look to the community and see where partnerships are possible, like working with local governments to shore up facilities that are nearby other key infrastructure, like electrical. “This is expensive, this can't be addressed overnight,” Biddinger said. “But we should know that people are aware of the risks and trying to take action, and it shouldn't be acceptable to not be working on this as a major challenge to the delivery of healthcare.”

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