6.6 Building a climate-resilient health system
While the WHO vulnerability and adaptation assessment guidelines primarily focus on climate-sensitive disease conditions, there is a pressing need to expand the scope to encompass the overall capacity of health systems, health institutions and health workforce in addressing health challenges posed by climate change (WHO, 2020a).
Climate-resilient health systems are defined as those ‘capable of anticipating, responding to, coping with, recovering from, and adapting to climate-related shocks and stresses to bring about sustained improvements in population health, despite an unstable climate’ (61). Countries can assess the climate resilience of their health systems using measurement indicators proposed by the WHO (2022b).
The WHO has also introduced 10 components in its Operational Framework for Building Climate Resilient and Low Carbon Health Systems (WHO, 2015b, 2023c). This framework builds on the WHO’s existing key commitments, such as universal health coverage, global health security and the health targets embedded in the Sustainable Development Goals in a manner that enhances the climate resilience of health systems. The objective is to enhance population health while simultaneously contributing to climate change mitigation. Neglecting to address climate change would jeopardise the achievement of these goals.
1. Climate-transformative leadership and governance
Strong government commitment and leadership are essential for establishing a climate-resilient health system. While many sectors have developed actions in response to climate change, health considerations have not always been adequately integrated into these efforts. Furthermore, health programs and policies often lack sufficient consideration of climate change and are not actively engaged in climate change processes at global, national and regional levels (WHO, 2023c). An example of progress in this area is the launch of the first National Health and Climate Strategy by the Australian government in December 2023.
2. Climate-smart health workforce
Climate change not only escalates the workload of health workers but also demands a new skill set spanning logistics support, care delivery and management of healthcare facilities. Health workers are well positioned to communicate effectively with communities about climate change and its health implications (WHO, 2023c). Unfortunately, the current education system falls short in providing the necessary training for a climate-smart health workforce. It is crucial to recognise that competent health workers can only optimise their performance with sufficient support from their working environments (Liu et al., 2015).
3. Assessment of climate and health risks and greenhouse gas emissions
The WHO has recommended the Climate change and health: vulnerability and adaptation assessment tool (WHO, 2021b) for assessing the risks posed by climate change to people’s health and the health system. Effective use of the tool hinges on close collaboration between academics and policy and management practitioners.
4. Integrated risk monitoring, early warning and greenhouse gas emissions tracking
This component aims to integrate climate change responses into the disease and health risk monitoring system. A climate-informed early warning system should have the capability to forecast climate-related health events and prompt early responses through effective communication channels (WHO, 2021c).
5. Health and climate research
Our current understanding of the health and health system impacts of climate change remains limited due to methodological challenges (WHO, 2023c). Boosting research capacity at local, national and global levels is crucial for monitoring and evaluating the effectiveness of climate actions, including those integrated into the health system. Equally important is translating research evidence into practice. This necessitates a multidisciplinary approach encompassing health, science, social, economic and cultural disciplines.
6. Climate-resilient and low-carbon infrastructures, technologies and supply chain
The health industry needs to adopt an innovative approach to reduce its greenhouse gas emissions throughout the entire supply chain and promote environmental sustainability in health operations. In addition to using new technologies such as virtual and telehealth services and reducing consumption, practices such as reusing (e.g. personal protective equipment) and recycling also helps emissions reduction (Bromley-Dulfano et al., 2024). Healthcare organisations can use their purchasing power to advocate for lower emissions in the supply chain. It is crucial to note that artificial intelligence consumes significant energy (de Vries, 2023).
7. Management of environmental determinants of health
Climate change poses environmental risks to health in traditional ways, such as compromised access to safe water, food and hygiene facilities, as well as newer challenges associated with extreme weather events and changing ecosystems. It exacerbates health inequities. Health workers can take strategies such as collaborating with other sectors to monitor environmental risks, raise community awareness, and prevent and manage the health consequences.
8. Climate-informed health programs
Climate-informed health programs include not only disaster risk management and public health preparedness but also initiatives targeting climate-sensitive health conditions such as malnutrition, occupational health and safety, infectious disease, non-communicable disease and injuries. Climate risks need to be factored into decision-making processes in health system development, universal health coverage, and health program planning and implementation. Unfortunately, the majority of countries have yet to integrate climate resilience into water, sanitation and hygiene (WASH) programs, which are foundational to public health (WHO, 2023a).
9. Climate-related emergency preparedness and management
Emergency preparedness and management are integral components of a climate-resilient health system, aimed at safeguarding those vulnerable to hazardous events stemming from climate change. The world has already experienced significant increases in the frequency and magnitude of climate-related emergencies and disasters. The Health Emergency and Disaster Risk Management Framework (WHO, 2019a) offers a rights-based, all-hazards and whole-of-society strategy for addressing climate risks.
10. Sustainable climate and health financing
Protecting health from the impacts of climate change necessitates dedicated funding for the health sector and related determinants of health. However, investing in health can yield significant cost–benefit returns from social and economic perspectives. Many developing countries face financial constraints, leading to the establishment of various global funding mechanisms (WHO, 2023c), including the Green Climate Fund (GCF), Global Environment Facility (GEF), Special Climate Change Fund (SCCF), the Least Developed Countries Fund (LDCF) and the Adaptation Fund (AF).
Case 1: Lowering greenhouse gas emissions through culling low-value care
The carbon-zero emission target endorsed by many health organisations through green energy initiatives represents significant progress in healthcare in addressing the challenge of climate change. However, it is important to note that the majority of CO2 emissions in the health industry are derived from clinical practices (Malik et al., 2018; Eckelman et al., 2020).
Wasteful and low-value care accounts for 40 per cent of CO2 emissions in clinical care. It has been estimated that 10 per cent to 40 per cent of haematology, biochemistry and immunology tests in the community are likely unnecessary, which amounts to at least 8 million requests in 2020 in Australia. Culling low-value care would reduce an equivalent of 8,000 kilotonnes of CO2 emissions per year in Australia (Barratt et al., 2022).
However, factors related to the individual provider, patient and social context can all jeopardise efforts to reduce low-value care (Dulmen et al., 2020). A systems approach is needed to address the challenge. Most de-implementation strategies are effective in reducing low-value care (Heus et al., 2023).
