Disasters such as the Ahr Valley flood in 2021 make us aware of the importance of functioning healthcare facilities. Their functionality depends on the availability of drinking water. Water safety planning is a long-established method to increase the safety of water utilities. Our work supports the implementation of water safety planning in healthcare facilities during normal operations and emergency situations concerning the water supply. The authors conducted a stakeholder mapping exercise and problem awareness analysis. Based on these results, it was identified what is needed to overcome barriers to water safety plan (WSP). Building on the existing procedures, the WSP concept, and latest scientific findings, an event-specific risk assessment method for healthcare facilities was developed and applied in a case study. Based on an analysis of water demand, water-related processes, and infrastructure, potentially necessary components for establishing an emergency supply were identified. For these, based on technical and legal requirements, the planning principles were developed, and prototypes of components for emergency water supply were built. They were tested in pilot trials, particularly regarding hygienic safety. For the management of crises in hospitals, a survey was carried out on the command structures used in practice. Finally, recommendations were drawn based on the German Hospital Incident Command System.
Heat stress issues in healthcare workers (HCWs) have been widely recognized but no published guidelines have clearly specified healthy shift work hours and the time to experience heatstroke while performing healthcare tasks in outdoor settings. Using a rational biophysical model and hourly meteorological data collected during sixty hot summer months (June-August 2002-2021) in 34 major Chinese cities, this study determined healthy shift work hours and heatstroke risks in HCWs with three levels of body mass index (BMI = 18.0, 23.0, and 27.0 kg/m(2)) while performing healthcare tasks. Our simulation results found that HCWs should switch shifts every 2 h. HCWs with a higher BMI could see their shifts extended by 10-28 min. HCWs with 18.0 kg/m(2) BMI should finish shifts 10-23 min earlier than their counterparts. Heatstroke can strike HCWs in 143 min. HCWs should not wear impermeable PPE suits outdoors for >2 h in cities other than Guiyang, Qingdao, Kunming, Xining, and Lhasa for safety reasons. To ensure 8 h of healthy labor, HCWs are advised to wear personal cooling systems with a cooling power of >= 194.8 W/m(2) or to work in testing booths, where HVAC setpoint temperature for PPE-clad HCWs is 25.0 degrees C, with RH = 50-65 % and a fanning speed of 2.5 m/s.
BACKGROUND: Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC’s 2021 heat dome. METHODS: We conducted a review of consecutive adults presenting to 7 hospitals in BC’s Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality. RESULTS: Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3). INTERPRETATION: Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.
PURPOSE: As climate change accelerates, healthcare workers (HCW) are expected to be more frequently exposed to heat at work. Heat stress can be exacerbated by physical activity and unfavorable working requirements, such as wearing personal protective equipment (PPE). Thus, understanding its potential negative effects on HCW´s health and working performance is becoming crucial. Using wearable sensors, this study investigated the physiological effects of heat stress due to HCW-related activities. METHODS: Eighteen participants performed four experimental sessions in a controlled climatic environment following a standardized protocol. The conditions were (a) 22 °C, (b) 22 °C and PPE, (c) 27 °C and (d) 27 °C and PPE. An ear sensor (body temperature, heart rate) and a skin sensor (skin temperature) were used to record the participants´ physiological parameters. RESULTS: Heat and PPE had a significant effect on the measured physiological parameters. When wearing PPE, the median participants’ body temperature was 0.1 °C higher compared to not wearing PPE. At 27 °C, the median body temperature was 0.5 °C higher than at 22 °C. For median skin temperature, wearing PPE resulted in a 0.4 °C increase and higher temperatures in a 1.0 °C increase. An increase in median heart rate was also observed for PPE (+ 2/min) and heat (+ 3/min). CONCLUSION: Long-term health and productivity risks can be further aggravated by the predicted temperature rise due to climate change. Further physiological studies with a well-designed intervention are needed to strengthen the evidence for developing comprehensive policies to protect workers in the healthcare sector.
Healthcare governing boards, executives, medical staff, health professionals, and allied staff members should all play a role in devising, promoting, and implementing solutions for climate change mitigation, which must extend beyond the boundaries of their own workplaces and healthcare institutions. Such actions can potentially influence not only healthcare professionals and their patients but also healthcare supply chains and entire communities. Thus, leaders of healthcare organizations can play a vital role in leading by example. The authors herein propose some initiatives for promoting and implementing a culture of sustainability and climate action in medicine.
The health sector is one of the keys to sustainable development. Although it is directly related to only one Sustainable Development Goal (Goal 3, “Ensuring a healthy life and promoting well-being at all ages”), the sector itself, which aims to protect health, is paradoxically at the same time the main emitter of environmental pollutants that have a negative impact on health itself. Therefore, sustainability has become a key priority for health sector organizations, and leadership in this area is essential at all levels. Scientific research plays a particular role here, helping to more clearly define the links between environmental sustainability and the health effects of a polluted environment and climate change as well as indicating the direction of actions needed and disseminating good practices that can help accelerate the adoption of efforts towards climate neutrality and sustainable development of health sector organizations. The aim of this article is to present the current state of the art and future research scenarios in the field of green and sustainable healthcare through a literature review by using the Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) method to perform a bibliometric analysis of papers published in 2012-2022. The Web of Science Core Collection (WoSCC) database is used for this purpose. A total of 144 papers are included for analysis, categorized based on eight fields: author(s), title, year of publication, country, journal, scientific category, and number of citations. Based on the results, themes for future research on green leadership in the healthcare sector are identified and recommended.
Government financing among OPEC+ countries predominantly stems from oil investments. However, given the global prevalence of communicable and non-communicable diseases, aging, population growth, and pandemic mutations, these countries require more oil investments to finance healthcare, with potential adverse consequence on carbon emissions and climate change. This study aims to investigate the relationship between government healthcare financing and carbon emissions and climate change and propose solutions for greener healthcare financing. Quantitative data from 2000 to 2020 were extracted from the WHO and Global Economy databases. The relationship of four variables indicating government healthcare financing to government budget, to total healthcare financing, to GDP, and per-capita with oil investment were investigated using a multiple regression analysis. The analysis included the world’s ten oil-producing countries with the highest oil revenue to GDP. The results showed significant relationships between government healthcare financing to total healthcare financing, to GDP, and per-capita with oil investment among most of the included countries, thereby demonstrating the substantial contribution of OPEC+ to carbon emissions and climate change. The predominant dependence of OPEC+ on oil for financing, with no tangible future transition insight, should make them persistent contributors to carbon emissions and climate change given the considerable publicly financed part of their healthcare systems and the world’s changeable healthcare needs. Thus, oil-dependent countries should strive to free their healthcare financing from oil investment with the environmental harm that this coupling incurs and adopt transformative strategies that expedite the transition to net-zero carbon emissions. Oil-dependent countries boost oil investments to meet global healthcare demands, which could negatively affect carbon emissions and climate change.The relationship between government healthcare financing and oil investment in OPEC+ countries was investigated.Most countries and variables showed associations between government healthcare financing and oil investment.OPEC+ appeared to significantly contribute to carbon emissions and climate change.
The climate crisis calls for urgent action from every level of the US healthcare sector, starting with an acknowledgment of our own outsized contribution to greenhouse gas emissions (at least 8.5% of carbon emissions). As the climate continues to become warmer and wetter, the medical establishment must deal with increasing rates of pulmonary and cardiovascular diseases, heat-related illness, and emerging infectious diseases among many other health harms. Additionally, extreme weather events are causing healthcare delivery breakdown due to physical infrastructure damage, slowed supply chains, and workforce burden. Pathways for healthcare systems to meet these challenges are emerging. They entail significant measures to mitigate our carbon footprint, embrace shared and equity-driven governance, develop new metrics of accountability, and build more resilience into our care delivery processes. We call upon SHEA to play a unique leadership role in the fight for sustainable, equitable, and efficient health care in a rapidly changing climate that immediately threatens human well-being.
This paper examines the experiences of healthcare providers (n = 10), policymakers (n = 5), and drug users (n = 5) in Puerto Rico (PR) after Hurricane Maria hit in September 2017. We draw upon ecosocial theory and theories of coloniality to interpret the findings from semi-structured interviews conducted between 2018-2020. The data from the study reveal the unacknowledged absence of illicit drug use in public policies on emergency management in response to the catastrophe and its association with barriers in the provision of health care services (i.e. mental health, opioid agonist therapy, and harm reduction) for drug-using patients. These individuals have been largely invisible in policy discussions on healthcare post-Maria. Our analysis highlights three intersecting factors that should be addressed in post-disaster policymaking addressing substance users. First, changes in the government’s medical plan one year after the Hurricane hampered the coordination of services for patients and providers. Therefore, the aid offered tended to be exclusively economic rather than addressing disparities in health service access. Second, policies have not addressed the mistreatment and prejudice toward substance users in hospital and emergency room settings. Third, there was evidence of relapses in the use of controlled substances and the replacement of routine drugs with fentanyl due to the interruption of regular transportation, affecting supplies and illegal substances. Failure to address addiction constitutes a real threat to the survival of a significant population in PR and embodies the historical oppression wrought by colonialism, discrimination, and stigma in a society that dismisses substance users in its public and budgetary policies.
Climate change poses enormous ecological, socio-economic, health, and financial challenges. A novel extreme value theory is employed in this study to model the risk to environmental, social, and governance (ESG), healthcare, and financial sectors and assess their downside risk, extreme systemic risk, and extreme spillover risk. We use a rich set of global daily data of exchange-traded funds (ETFs) from 1 July 1999 to 30 June 2022 in the case of healthcare and financial sectors and from 1 July 2007 to 30 June 2022 in the case of ESG sector. We find that the financial sector is the riskiest when we consider the tail index, tail quantile, and tail expected shortfall. However, the ESG sector exhibits the highest tail risk in the extreme environment when we consider a shock in the form of an ETF drop of 25% or 50%. The ESG sector poses the highest extreme systemic risk when a shock comes from China. Finally, we find that ESG and healthcare sectors have lower extreme spillover risk (contagion risk) compared to the financial sector. Our study seeks to provide valuable insights for developing sustainable economic, business, and financial strategies. To achieve this, we conduct a comprehensive risk assessment of the ESG, healthcare, and financial sectors, employing an innovative approach to risk modelling in response to ecological challenges.
Forest fires release harmful pollutants, endangering public health and incurring substantial healthcare costs. This study empirically investigates the environment-health-economy relationship, utilizing a robust MM-QR approach. Findings divulge that economic growth, urbanization, and tourism drive healthcare expenditure, while environmental factors like forest fires, resource depletion, species extinction, and environmental policy stringency also increase health spending. Conversely, renewable energy consumption lowers healthcare costs, while coal extraction raises them. Empirical estimates reveal that 1%$$ 1% $$ increase in forest fires raises health spending by 0.03%-0.08%$$ 0.03%-0.08% $$, socioeconomic indicators by 0.01%-1.07%$$ 0.01%-1.07% $$, and environmental factors by 0.03%-3.74%$$ 0.03%-3.74% $$. Conversely, a 1%$$ 1% $$ rise in renewable energy usage cuts healthcare expenses by 0.06%-0.19%$$ 0.06%-0.19% $$. This study underscores the urgency of addressing environmental degradation, especially forest fires, to mitigate their impacts on human well-being.
In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and de-implementation, 6) health care outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the “neighbors”, 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article, and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the postpandemic phase) will make healthcare systems more resilient when facing future crises.
In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the “neighbors,” 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the post-pandemic phase) will make healthcare systems more resilient when facing future crises.
Natural disasters, including floods, earthquakes, and hurricanes, result in devastating consequences at the individual and community levels. To date, much of the research reflecting the consequences of natural disasters focuses heavily on victims, with little attention paid to the personnel responding to such disasters. We conducted a systematic review of the challenges faced by military, medical and public safety personnel supporting natural disaster relief operations. Specifically, we report on the current evidence reflecting challenges faced, as well as positive outcomes experienced by military, medical and public safety personnel following deployment to natural disasters. The review included 382 studies. A large proportion of the studies documented experiences of medical workers, followed by volunteers from humanitarian organizations and military personnel. The most frequently reported challenges across the studies were structural (i.e., interactions with the infrastructure or structural institutions), followed by resource limitations, psychological, physical, and social challenges. Over 60% of the articles reviewed documented positive or transformative outcomes following engagement in relief work (e.g., the provision of additional resources, support, and training), as well as self-growth and fulfillment. The current results emphasize the importance of pre-deployment training to better prepare relief workers to manage expected challenges, as well as post-deployment supportive services to mitigate adverse outcomes and support relief workers’ well-being.
BACKGROUND: Decreasing emissions of the global healthcare sector will be an important tool for decreasing the magnitude of climate change. The environmental practices of nurses can have a positive environmental impact. The purpose of this study is to identify environmental practices performed by nurses while at work and home along with their associated factors. METHODS: This study is a cross-sectional descriptive study conducted by surveying nurses from two public hospitals in Lambayeque, Peru. We utilized the Nurses’ Environmental Awareness Tool to collect information about nurses’ knowledge on environmental impacts, their risk to health, and environmental behaviors at both work and home. RESULTS: Of the 106 participants who responded, the average age was 41 years, and 29 (28%) worked in surgical services. A little more than half of nurses reported appropriate energy use (51%) and recycling (53%) at work, while 94 (89%) implemented environmental biosafety. There was an observed association between age and years of employment with appropriate energy use, recycling, implementation of environmental biosafety, appropriate chemical substance use, and preventing medication waste. CONCLUSION: Nurses reported a favorable tendency toward adequate environmental practices at work and at home. However, more studies are needed to identify the factors that increase nurses’ use of these practices. APPLICATIONS TO PRACTICE: As one of the most trusted professions, professional nurses have an opportunity to play a pivotal role in promoting environmental health and practices in both the workplace and their personal lives. This study highlights areas of potential intervention in the workplace to develop and promote appropriate environmental practices by nurses to decrease pollution by the healthcare sector.
As climate change drives increased intensity, duration and severity of weather-related events that can lead to natural disasters and mass casualties, innovative approaches are needed to develop climate-resilient healthcare systems that can deliver safe, quality healthcare under non-optimal conditions, especially in remote or underserved areas. Digital health technologies are touted as a potential contributor to healthcare climate change adaptation and mitigation, through improved access to healthcare, reduced inefficiencies, reduced costs, and increased portability of patient information. Under normal operating conditions, these systems are employed to deliver personalised healthcare and better patient and consumer involvement in their health and well-being. During the COVID-19 pandemic, digital health technologies were rapidly implemented on a mass scale in many settings to deliver healthcare in compliance with public health interventions, including lockdowns. However, the resilience and effectiveness of digital health technologies in the face of the increasing frequency and severity of natural disasters remain to be determined. In this review, using the mixed-methods review methodology, we seek to map what is known about digital health resilience in the context of natural disasters using case studies to demonstrate what works and what does not and to propose future directions to build climate-resilient digital health interventions.
During public health crises, people living with HIV (PLWH) may become disengaged from care. The goal of this study was to understand the impact of the COVID-19 pandemic and recent flooding disasters on HIV care delivery in western Kenya. We conducted ten individual in-depth interviews with HIV providers across four health facilities. We used an iterative and integrated inductive and deductive data analysis approach to generate four themes. First, increased structural interruptions created exacerbating strain on health facilities. Second, there was increased physical and psychosocial burnout among providers. Third, patient uptake of services along the HIV continuum decreased, particularly among vulnerable patients. Finally, existing community-based programs and teleconsultations could be adapted to provide differentiated HIV care. Community-centric care programs, with an emphasis on overcoming the social, economic, and structural barriers will be crucial to ensure optimal care and limit the impact of public health disruptions on HIV care globally.
The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting. METHODS: A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition-measured by increased frequency of diagnosing heat emergencies and improved management-measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention. RESULTS: Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention. CONCLUSION: The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.
OBJECTIVES: Climate change and environmental factors have an impact on human health and the ecosystem. The healthcare sector is responsible for substantial environmental pollution. Most healthcare systems rely on economic evaluation to select efficient alternatives. Nevertheless, environmental spillovers of healthcare treatments are rarely considered whether it is from a cost or a health perspective. The objective of this article is to identify economic evaluations of healthcare products and guidelines that have included any environmental dimensions. METHODS: Electronic searches of 3 literature databases (PubMed, Scopus, and EMBASE) and official health agencies guidelines were conducted. Documents were considered eligible if they assessed the environmental spillovers within the economic evaluation of a healthcare product or provided any recommendations on the inclusion of environmental spillovers in the health technology assessment process. RESULTS: From the 3878 records identified, 62 documents were deemed eligible and 18 were published in 2021 and 2022. The environmental spillovers considered were carbon dioxide (CO(2)) emissions, water or energy consumption, and waste disposal. The environmental spillovers were mainly assessed using the lifecycle assessment (LCA) approach while the economic analysis was mostly limited to costs. Only 9 documents, including the guidelines of 2 health agencies presented theoretical and practical ways to include environmental spillovers into the decision-making process. CONCLUSIONS: There is a clear lack of methods on whether environmental spillovers should be included in health economic evaluation and how this should be done. If healthcare systems want to reduce their environment footprint, the development of methodology which integrates environmental dimensions in health technology assessment will be key.
Seasonal floods pose a commonly-recognised barrier to women’s access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women’s walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS: Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS: The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS: Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access.
OBJECTIVE: To critically assess the impacts of very hot weather on (i) frontline staff in hospitals in England and (ii) on healthcare delivery and patient safety. STUDY DESIGN: A qualitative study design using key informant semi-structured interviews, preinterview survey and thematic analysis. SETTING: England. PARTICIPANTS: 14 health professionals in the National Health Service (clinicians and non-clinicians, including facilities managers and emergency preparedness, resilience and response professionals). RESULTS: Hot weather in 2019 caused significant disruption to health services, facilities and equipment, staff and patient discomfort, and an acute increase in hospital admissions. Levels of awareness varied between clinical and non-clinical staff of the Heatwave Plan for England, Heat-Health Alerts and associated guidance. Response to heatwaves was affected by competing priorities and tensions including infection control, electric fan usage and patient safety. CONCLUSIONS: Healthcare delivery staff experience difficulty in managing heat risks in hospitals. Priority should be given to workforce development and strategic, long-term planning, prevention and investment to enable staff to prepare and respond, as well as to improve health system resilience to current and future heat-health risks. Further research with a wider, larger cohort is required to develop the evidence base on the impacts, including the costs of those impacts, and to assess the effectiveness and feasibility of interventions. Forming a national picture of health system resilience to heatwaves will support national adaptation planning for health, in addition to informing strategic prevention and effective emergency response.
People impacted by disasters may have adverse non-communicable disease health effects associated with the disaster. This research examined the independent and joint impacts of federally declared disasters on the diagnosis of hypertension (HTN), diabetes (DM), anxiety, and medication changes 6 months before and after a disaster. Patients seen in zip codes that received a federal disaster declaration for Hurricanes Gustave or Ike in 2008 and who had electronic health records captured by MarketScan(®) were analyzed. The analysis included patients seen 6 months before or after Hurricanes Gustav and Ike in 2008 and who were diagnosed with HTN, DM, or anxiety. There was a statistically significant association between post-disaster and diagnosis of hypertension, X(2) (1, n = 19,328) = 3.985, p = 0.04. There was no association post-disaster and diabetes X(2) (1, n = 19,328) = 0.778, p = 0.378 or anxiety, X(2) (1, n = 19,328) = 0.017, p = 0.898. The research showed that there was a change in the diagnosis of HTN after a disaster. Changes in HTN are an additional important consideration for clinicians in disaster-prone areas. Data about non-communicable diseases help healthcare disaster planners to include primary care needs and providers in the plans to prevent the long-term health impacts of disasters and expedite recovery efforts.
Climate change is the most serious planetary emergency of our time. Carbon emissions secondary to the healthcare industry account for about ten percent of all emissions in the United States. Health professionals, including all clinicians, public health professionals, community health workers, first responders and hospital administrators, therefore, need to understand how they can make a difference in their profession, by understanding the health-related impacts of climate change and the importance of healthcare sustainability. An 8-week telementoring Climate Change Healthcare Sustainability ECHO series was developed to educate healthcare professionals in these topics, such as the health-related effects of climate change, healthcare sustainability, quality healthcare and carbon accounting. A total of 376 participants from throughout the US and 16 other countries completed this 8-week, 1 h per week virtual series and received no-cost continuing medical education credits. The evaluation consisted of pre- and post-Zoom polls, weekly post-session surveys and the registration demographics. Participants were primarily physicians and public health professionals. Participants who elected to complete the post-session survey stated that they increased their knowledge and communication skills regarding talking to patients and colleagues about sustainability. Future training will include additional quantitative and qualitative surveys to measure improvements in knowledge and behavior over time. This may include focus groups as well as surveys after 3 and 6 months.
Climate change threatens the health of all Australians: without adaptation, many areas may become unlivable, in particular the tropical north. The Northern Territory (NT) health workforce is already under colliding operational pressures worsened by extreme weather events, regional staff shortages and infrastructure that is poorly adapted to climate change. The H3 Project (Healthy Patients, Workforce and Environment) explores nature-based interventions in the NT health sector aiming to strengthen the resilience and responsiveness of health infrastructure and workforce in our climate-altered future. The H3 Project engaged the health workforce, climate researchers and the wider community, in recognition that meaningful and timely climate action requires both organization-led and grassroots engagement. We recruited campus greening volunteers and sustainability champions to Royal Darwin Hospital (RDH) to develop strategies that enhance climate adaptation, build climate and health literacy, and incentivize active mobility. We implemented low-cost biophilic design within the constraints of legacy healthcare infrastructure, creating cool and restorative outdoor spaces to mitigate the impacts of heat on RDH campus users and adapt to projected warming. This case study demonstrated substantial cooling impacts and improved local biodiversity and hospital campus aesthetics. We collaborated with Indigenous healers and plant experts to harness the synergy between Aboriginal people’s traditional knowledge and connectedness to land and the modern concept of biophilic design, while seeking to improve hospital outcomes for Indigenous patients who are both disconnected from their homelands and disproportionately represented in NT hospitals.
Background: Because of its geographical location, the Philippines is vulnerable to the effects of climate change and almost all types of natural hazards such as typhoons, earth-quakes, and volcanic eruptions. Cancer is one of the leading causes of death in the Philip-pines and is one of the major public health concerns. Little is known about how climate change affects cancer services in the Philippines. As the biggest workforce in most institutions, having awareness and knowledge about disaster preparedness and management among nurses can help in reducing the devastating effects of natural disasters on health services. Thus, it is important to understand Filipino nurses’ experiences and perception of the impact of climate change on healthcare delivery and cancer care in the Philippines.Aim: This study explored Filipino nurses’ experiences and perception of the impact of climate change on healthcare delivery and cancer care in the Philippines.Methods: This is a descriptive qualitative exploratory study. Participants were recruited using the snowballing technique and completed an online survey. Forty-six nurses who were working in Luzon, Philippines at the time of the data collection were included in the analysis. Data were analysed using thematic analysis.Findings: Three themes were identified, namely: (1) effects of climate change causing disruption and delay in provision of patient care, (2) impact of climate change on nurses and a deep sense of duty, and (3) perceived impact on patients with cancer.Conclusion: Our study findings contribute to the existing literature that focuses on the impact of climate change-related events such as typhoons and floods on healthcare services and nursing staff. Several areas of cancer care are also impacted, particularly delays in treatment such as chemotherapy. Despite the challenges, the nurses in our study demonstrated a deep sense of commitment in carrying out their roles.
Since the advent of coronavirus disease 2019 (COVID-19), healthcare workers (HCWs) wearing personal protective equipment (PPE) has become a common phenomenon. COVID-19 outbreaks overlap with heat waves, and healthcare workers must unfortunately wear PPE during hot weather and experience excessive heat stress. Healthcare workers are at risk of developing heat-related health problems during hot periods in South China. The investigation of thermal response to heat stress among HCWs when they do not wear PPE and when they finish work wearing PPE, and the impact of PPE use on HCWs’ physical health were conducted. The field survey were conducted in Guangzhou, including 11 districts. In this survey, HCWs were invited to answer a questionnaire about their heat perception in the thermal environment around them. Most HCWs experienced discomfort in their back, head, face, etc., and nearly 80% of HCWs experienced “profuse sweating.” Up to 96.81% of HCWs felt “hot” or “very hot.” The air temperature had a significant impact on thermal comfort. Healthcare workers’ whole thermal sensation and local thermal sensation were increased significantly by wearing PPE and their thermal sensation vote (TSV) tended towards “very hot.” The adaptive ability of the healthcare workers would decreased while wearing PPE. In addition, the accept range of the air temperature (T (a)) were determined in this investigation. Graphical Abstract.
INTRODUCTION: Chronic musculoskeletal conditions affect billions of individuals and constitute the greatest contributor to disability worldwide. Climate change has a negative impact on these conditions, causing a rising number of patients seeking medical attention in outpatient orthopaedic and rheumatology clinics. Due to the COVID-19 pandemic, the delivery of care by these facilities tends to become more energy-intensive due to the increased usage of protective equipment and testing for the purpose of maintaining hygienic conditions. Therefore, practitioners and health bodies in the field need to take action to make their practice more environmentally sustainable and protect both the environment and their patients. METHODS: The authors searched peer reviewed and grey literature for relevant sources. RESULTS: The present review of the literature provides an overview of the environmental pollution associated with outpatient musculoskeletal care and discusses evidence-based recommendations from previous studies. CONCLUSION: Telemedicine, rationalised use of consumables and equipment, physician-led climate advocacy and patient education have a major potential to turn the tide.
IMPORTANCE: The healthcare sector is essential to human health and well-being, yet its significant carbon footprint contributes to climate change-related threats to health. OBJECTIVE: To review systematically published studies on environmental impacts, including carbon dioxide equivalent (CO(2)e) emissions, of contemporary cardiovascular healthcare of all types, from prevention through to treatment. EVIDENCE REVIEW: We followed the methods of systematic review and synthesis. We conducted searches in Medline, EMBASE and Scopus for primary studies and systematic reviews measuring environmental impacts of any type of cardiovascular healthcare published in 2011 and onwards. Studies were screened, selected and data were extracted by two independent reviewers. Studies were too heterogeneous for pooling in meta-analysis and were narratively synthesised with insights derived from content analysis. FINDINGS: A total of 12 studies estimating environmental impacts, including carbon emissions (8 studies), of cardiac imaging, pacemaker monitoring, pharmaceutical prescribing and in-hospital care including cardiac surgery were found. Of these, three studies used the gold-standard method of Life Cycle Assessment. One of these found the environmental impact of echocardiography was 1%-20% that of cardiac MR (CMR) imaging and Single Photon Emission Tomography (SPECT) scanning. Many opportunities to reduce environmental impacts were identified: carbon emissions can be reduced by choosing echocardiography as the first cardiac test before considering CT or CMR, remote monitoring of pacemaker devices and teleconsultations when clinically appropriate to do so. Several interventions may be effective for reducing waste, including rinsing bypass circuitry after cardiac surgery. Cobenefits included reduced costs, health benefits such as cell salvage blood available for perfusion, and social benefits such as reduced time away from work for patients and carers. Content analysis revealed concern about the environmental impact of cardiovascular healthcare, particularly carbon emissions and a desire for change. CONCLUSIONS AND RELEVANCE: Cardiac imaging, pharmaceutical prescribing and in-hospital care including cardiac surgery have significant environmental impacts, including CO(2)e emissions which contribute to climate-related threats to human health. Importantly, many opportunities to effectively reduce environmental impacts exist within cardiac care, and can provide economic, health and social cobenefits.
BACKGROUND: Floods and torrential rains are natural disasters caused by climate change. Unfortunately, such events are more frequent and are increasingly severe in recent times. The 2018 Japan Floods in western Japan were one of the largest such disasters. This study aimed to evaluate the effect of the 2018 Japan Floods on healthcare costs and service utilization. METHODS: This retrospective cohort study included all patients whose receipts accrued between July 2017 and June 2019 in Hiroshima, Okayama, and Ehime prefectures using the National Database of Health Insurance Claims. We used Generalized Estimating Equations (GEEs) to investigate yearly healthcare costs during the pre-and post-disaster periods, quarterly high-cost patients (top 10%), and service utilization (outpatient care, inpatient care, and dispensing pharmacy) during the post-disaster period. After the GEEs, we estimated the average marginal effects as the attributable disaster effect. RESULTS: The total number of participants was 5,534,276. Victims accounted for 0.65% of the total number of participants (n = 36,032). Although there was no significant difference in pre-disaster healthcare costs (p = 0.63), post-disaster costs were $3,382 (95% CI: 3,254-3,510) for victims and $3,027 (95% CI: 3,015-3,038) for non-victims (p < 0.001). The highest risk difference among high-cost patients was 0.8% (95% CI: 0.6-1.1) in the fourth quarter. In contrast, the highest risk difference of service utilization was in the first quarter (outpatient care: 7.0% (95% CI: 6.7-7.4), inpatient care: 1.3% (95% CI: 1.1-1.5), and dispensing pharmacy: 5.9% (95% CI: 5.5-6.4)). CONCLUSION: Victims of the 2018 Japan Floods had higher medical costs and used more healthcare services than non-victims. In addition, the risk of higher medical costs was highest at the end of the observation period. It is necessary to estimate the increase in healthcare costs according to the disaster scale and plan for appropriate post-disaster healthcare service delivery.
Socioeconomic development, subsidence, and climate change have led to high flood risks in coastal cities, making the vulnerable, especially elderly people, more prone to floods. However, we mostly do not know how the accessibility of life-saving public resources for the elderly population will change under future scenarios. Using Shanghai as a case, this study introduced a new analytical framework to fill this gap. We integrated for the first time models of coastal flooding, local population growth, and medical resource supply-demand estimation. The results show that under an extreme scenario of coastal flooding in the year 2050, in the absence of adaptation, half of the elderly population may be exposed to floods, the supply of medical resources will be seriously insufficient compared to the demand, and the accessibility of emergency medical services will be impaired by flooding. Our methodology can be applied to gain insights for other vulnerable coastal cities, to assist robust decision making about emergency responses to flood risks for elderly populations in an uncertain future.
PURPOSE: Climate disasters have devastating effects on communities and society that encompass all aspects of daily life, including healthcare. Patients with cancer are particularly vulnerable when disaster strikes. As the number and intensity of disasters increases, it is important to understand the effects across the cancer care continuum. This systematic review investigates the effect of climate disasters on patients, the oncology healthcare workforce, and healthcare systems. METHODS: A medical librarian conducted a literature search in PubMed, Embase, CINAHL, and Web of Science from January 1, 2016, through May 11, 2022. Eligible studies included any published report on a climate disaster globally reporting on patient-, oncology healthcare workforce-, or healthcare systems-level outcomes. Study quality was assessed, and findings were narratively synthesized, given the diversity of reported evidence. RESULTS: The literature search identified 3618 records, of which 46 publications were eligible for inclusion. The most frequent climate disaster was hurricanes (N = 27) followed by tsunami (N = 10). Eighteen publications were from disasters that occurred in the mainland USA with 13 from Japan and 12 from Puerto Rico. Patient-level outcomes included treatment interruptions and inability to communicate with the healthcare team. At the workforce level, findings included distressed clinicians caring for others when their own lives have been affected by a disaster along with lack of disaster preparedness training. Health systems reported closures or shifting services post-disaster and a need to have improved emergency response plans. CONCLUSION: Response to climate disasters necessitates a holistic approach at the patient, workforce, and health systems levels. Specifically, interventions should focus on mitigating interruptions in care for patients, advanced coordination and planning for workforce and health systems, and contingency planning for allocation of resources by health systems.
Climate change is one of the major public health emergencies with already unprecedented impacts on our planet, environment and health. Climate change has already resulted in substantial increases in temperatures globally and more frequent and extreme weather in terms of heatwaves, droughts, dust storms, wildfires, rainstorms and flooding, with prolonged and altered allergen and microbial exposure as well as the introduction of new allergens to certain areas. All these exposures may have a major burden on patients with respiratory conditions, which will pose increasing challenges for respiratory clinicians and other healthcare providers. In addition, complex interactions between these different factors, along with other major environmental risk factors (e.g. air pollution), will exacerbate adverse health effects on the lung. For example, an increase in heat and sunlight in urban areas will lead to increases in ozone exposure among urban populations; effects of very high exposure to smoke and pollution from wildfires will be exacerbated by the accompanying heat and drought; and extreme precipitation events and flooding will increase exposure to humidity and mould indoors. This review aims to bring respiratory healthcare providers up to date with the newest research on the impacts of climate change on respiratory health. Respiratory clinicians and other healthcare providers need to be continually educated about the challenges of this emerging and growing public health problem and be equipped to be the key players in solutions to mitigate the impacts of climate change on patients with respiratory conditions. EDUCATIONAL AIMS: To define climate change and describe major related environmental factors that pose a threat to patients with respiratory conditions.To provide an overview of the epidemiological evidence on climate change and respiratory diseases.To explain how climate change interacts with air pollution and other related environmental hazards to pose additional challenges for patients.To outline recommendations to protect the health of patients with respiratory conditions from climate-related environmental hazards in clinical practice.To outline recommendations to clinicians and patients with respiratory conditions on how to contribute to mitigating climate change.
Climate change is a mounting pressure on private health financing in Africa – directly because of increased disease prevalence and indirectly because of its negative impact on household income. The sources and consequences of the pressure constitute an important area of policy discourse, especially as it relates to issues of poverty and inequality. Relying on a panel dataset involving 49 African countries and the period 2000-2019, as well as a random effect regression analysis, this report shows that climate change has a positive and significant impact on the level of out-of-pocket health expenditure (OPHE) in Africa, and an increase in the level of greenhouse (CO2) emissions by 1% could bring about a 0.423% increase in the level of OPHE. Indirectly, the results show that, compared with the regional average, countries that have higher government health expenditure levels, above 1.7% regional average, and face higher climate change risk may likely record an increase in OPHE. Alternatively, countries with higher per capita income (above the regional annual average of $2300.00) are likely to record a drop in OPHE. Countries with lower climate change risk and a lower than the regional average age dependency (above the regional average of 80.4%) are also likely to record a drop in OPHE. It follows that there is a need for policy alignment, especially with regard to how climate change influences primary health care funding models in Africa.Contribution: The results of this research offer policymakers in-depth knowledge of how climate change erodes healthcare financing capacity of government and shifts the burden to households. This raises concerns on the quality of accessible healthcare and the link with poverty and inequality.
The Association of South-East Asian Nations (ASEAN) member states (AMS) are among the countries most at risk to the impacts of climate change on health and outbreaks being a major hotspot of emerging infectious diseases. OBJECTIVE: To map the current policies and programs on the climate change adaptation in the ASEAN health systems, with particular focus on policies related to infectious diseases control. METHODS: This is a scoping review following the Joanna Briggs Institute (JBI) methodology. Literature search will be conducted on the ASEAN Secretariat website, government websites, Google, and six research databases (PubMed, ScienceDirect, Web of Science, Embase, World Health Organization (WHO) Institutional Repository Information Sharing (IRIS), and Google Scholar). The article screening will be based on specified inclusion and exclusion criteria. Policy analysis will be conducted in accordance with the WHO operational framework on climate-resilient health systems. Findings will be analyzed in the form of narrative report. The reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). ETHICS AND DISSEMINATION: Ethical approval is not required for this study as this is a scoping review protocol. Findings from this study will be disseminated through electronic channels.
Little is known about the effects of temperature on healthcare-associated infections (HAIs). A distributed lag non-linear model was used to estimate the association between ambient temperature and HAIs in Hefei, China. In total, 9,592 HAIs were included. The effect of low temperature (-0.1°C, 2.5th percentile) was significant on the current day (RR = 1.108, 95%CI:1.003-1.222), and then appeared on the 4th day (RR = 1.045, 95%CI:1.007-1.084) and the 5th day (RR = 1.033, 95%CI:1.006-1.061). The cumulative lag effects of low temperature lasted from the 5th to 10th days (RR = 1.123-1.143), and a long-term cumulative lag effect was observed on the 14th day (RR = 1.157, 95%CI:1.001-1.338). The lag effect of high temperature (31.0°C, 97.5th percentile) was not statistically significant. However, the effects of temperatures on HAIs were not significant among gender or age subgroups. This study suggests that the low temperatures have acute and lag effects on HAIs in Hefei, China.
Healthcare decision-makers are becoming increasingly aware that climate change poses significant threats to population health and continued delivery of quality care. Challengingly, responding to climate change requires complex, often expensive, and multi-faceted actions to limit new emissions from worsening climate trajectories, while investing in climate-resilient systems. We present a Climate Resilience Maturity Matrix that brings together both mitigation and adaptation actions into a high-level tool for health leaders, for supporting organizational review, assessment, and decision-making for climate change readiness. This tool is designed to (i) support leaders in Canadian health facilities and regional health authorities in designing mitigation and adaptation roadmaps, (ii) support decision-making for climate change-related strategic planning processes, and (iii) create a high-level overview of organizational readiness. This tool is intended to consolidate key data, provide a clear communication tool, allow for objective rapid baselining, enable system-level gap analysis, facilitate comparability/transparency, and support rapid learning cycles.
Under heat problem, the combined effects of heatwaves and urban heat island effects, has been one of the deadliest climate-related disasters. Uncovering heat-induced health problems is of significance to inform people of urban heat impacts and improve people’s awareness of addressing urban heat problems. Existing studies have primarily done this through panel analysis based on second-hand data from local or national authorities. However, there are limited studies directly concentrating on the heat responses of people. To address this gap, this study aims to investigate public responses to urban heat and heat-related illness on the individual side. The study was conducted through a questionnaire survey in three Chinese cities including Nanchang, Shenyang and Xi’an. Based on 1154 valid responses, this study analysed respondents’ understanding of urban heat problems, symptoms of physiological illnesses and their behaviours of hospitalisation. The results indicate that the knowledge of heat-related risks (2.29 out of 5) was significantly lower than the perceived urban heat severity (3.24) and the perceived severity of physiological impacts (2.40). The skin heat damage (44.7%), among 873 respondents who underwent physiological impacts, was the most frequent physiological illness, followed by the digestive systems (34.0%) and then respiratory (24.1%) and cardiovascular diseases (18.2%). Among the 873 respondents, only 4.0% and 17.7% of respondents would like or were mostly yes to visit hospitals, while 14.2% and 26.4% of the respondents would not like or were mostly not to visit hospitals. Moreover, perceived urban heat severity, knowledge of heat-related risks, perceived severity of physiological impacts, symptoms of physiological illnesses and behaviours of hospitalisation were city-specific and demography-dependent. Overall, the empirical analysis provides new evidence of urban heat problems and generates theoretical and policy implications for heat-induced impact estimation and prevention.
OBJECTIVE: Health system resilience can increase a system’s ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods. DESIGN: A qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework. SETTING: Public sector healthcare facilities and health departments in two districts exposed to flooding. PARTICIPANTS: Twenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding. RESULTS: The theme ‘Collaboration across the system creates adaptability in the response’ reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response. CONCLUSION: The capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience.
BACKGROUND: Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. OBJECTIVES: We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. METHODS: This multicenter time-series study leveraged administrative data on 3.8 million ED visits by children and adolescents ≤ 18 years of age to the EDs of 47 U.S. children’s hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association. RESULTS: Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders (RR = 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. CONCLUSION: During the warm season, days with higher temperatures were associated with higher rates of visits to children’s hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083.
BACKGROUND: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures. METHODS: A time series analysis using a distributed lag nonlinear model was used to explore the exposure-response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014-2017) and future periods (2034-2037 and 2054-2057) under three climate representative concentration pathways (RCPs). RESULTS: The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s. CONCLUSIONS: Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.
OBJECTIVES: Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO(2) equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost. DESIGN: We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies. First, we calculated the number of patients with chronic obstructive pulmonary disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of pMDIs and NPIs including DPIs and soft mist inhalers, as well as the number of dispensed spacers per patient (2020). Third, we estimated the potential emission reduction in CO(2) equivalents if 70% of patients would switch from using pMDIs to using NPIs. Fourth, we performed a budget impact analysis. SETTING: Dutch respiratory healthcare. PRIMARY AND SECONDARY OUTCOME MEASURES: The carbon footprint of current inhalation medication and the environmental and financial impact of replacing pMDIs with NPIs. RESULTS: In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 364 million defined daily doses from inhalers were dispensed of which 49.6% were dispensed through pMDIs. We estimated that this could be reduced by 70% which would lead to an annual reduction in greenhouse gas emission of 63 million kg.CO2 equivalents saving at best EUR 49.1 million per year. CONCLUSIONS: In the Netherlands, substitution of pMDIs to NPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing greenhouse gas emission by 63 million kg.CO2 equivalents on average and saving at best EUR 49.1 million per year. This study confirms the potential climate and economic benefit of delivering a more eco-friendly respiratory care.
The monsoon flood was inevitable for Malaysia. Nevertheless, no one expected that it would be as severe as the Kelantan Flood 2014. Total collapse of communication disruption had made it difficult for centric top-down emergency management to reach out to the healthcare workers. Not only the public were severely affected yet even healthcare workers and their families felt the impact of that disaster. This study aims to explore the challenges faced by the healthcare workers and look into the management that really helped them survive this crisis. Nine (9) healthcare workers under the ministry of health working at hospitals and affected clinics narrated their experience and their transcriptions were coded by a panel of experts. It was found that the common challenge occurred when they had to deal with patients and emergency circumstances with total cut down of necessities like electric supply, food and most of these healthcare workers were burned out when there were limited human resources during that critical phase. They also had to deal with their own inner turmoil and psychological concerns while mending the needs of their patient and the other staff. Breakdowns of communication and handling emergency cases really put them to the test. In handling most of these challenges, all agreed on the importance of having a leader to coordinate and motivate them, to form a crisis management centre as the core place for communication to be synchronized and the importance of soft skills in getting help from locals and the Non-Governmental Organizations (NGOs). This study has affirmed the importance for emergency management to focus on creating proactive response in empowering the bottom-up kind of management as a complement to the existing preparedness system. Hence there is no better way to do that than to pay heed on the soft skills aspect of an emergency management plan in the future.
If worldwide healthcare was a country, it would be the fifth largest emitter of greenhouse gases on the planet. The increase in global temperatures, combined with the negative impacts of urbanization, has made it more important than ever to introduce green spaces where possible. With climate change worsening, human health, both physically and mentally is on decline, making the effects of climate change especially pressing to the stability of healthcare systems. In order to mitigate the lasting impacts of climate change on healthcare facilities, a holistic solution is needed. Access to green space in hospitals has been shown to reduce emotional distress, improve mental health, increase socialization and community connection, increase physical activity, decrease cardiovascular and respiratory diseases, decrease pain management needs and hospital stay lengths and increase both patients’ and staffs’ overall satisfaction at the facility. Beyond benefiting those interacting with the hospital, green roofs have the ability to reduce the urban heat island effect, improve stormwater mitigation, increase biodiversity, and absorb toxins and pollutants through air filtration. Additionally, green roofs can offer lower maintenance costs and higher energy savings than traditional roofs, and improve patient satisfaction, which can result in future funding opportunities. However, the upfront and upkeep costs of installing a green roof can vary and must be considered before implementation. In this review, we explore the symbiotic relationship between urban green roofs and hospital/patient wellness through the lens of sustainability, which includes environmental, societal, and economic impacts. We review scientific journal articles investigating benefits of green space and green roofs and highlight examples of green roofs on hospitals in the United States; together, these approaches display the environmental, societal, and economic benefits of green roofs installed on healthcare facilities. This review offers insight to hospitals, decision makers, and government systems on the importance of green roofs in urban areas and how these infrastructures can support the economic growth of the institute. Using our framework, decision makers and planners for urban hospitals can evaluate how the addition of green roofs to their healthcare facilities can contribute to increased environmental resiliency, community health, and patient satisfaction.
Hurricane María had a profound impact on the way essential health services were given during the emergency period that followed its landfall on Puerto Rico. The main objective of this research was to find out what people with health conditions in need of essentials services from hospitals, clinics, and pharmacies did during the emergency period. Furthermore, we wanted to know people’s view about the government’s response to the aftermath of the hurricane. By conducting a series of interviews with different health specialists, students at the University of Puerto Rico-Cayey, and citizens of the community of Jájome Alto in Cayey, Puerto Rico, we were able to better understand aspects of the physical and social impact caused by Hurricane Maria. Interviews made at Casa Pueblo in Adjuntas, Puerto Rico, served as an inspiration for how we can prepare better for future natural disasters.
INTRODUCTION: Snakebite is a public health problem in rural areas of South Asia, Africa and South America presenting mostly in primary care. Climate change and associated extreme weather events are expected to modify the snake-human-environment interface leading to a change in the burden of snakebite. Understanding this change is essential to ensure the preparedness of primary care and public health systems. METHODS: We searched five electronic databases and supplemented them with other methods to identify eight studies on the effect of climate change on the burden of snakebite. We summarised the results thematically. RESULTS: Available evidence is limited but estimates a geographic shift in risk of snakebite: northwards in North America and southwards in South America and in Mozambique. One study from Sri Lanka estimated a 31.3% increase in the incidence of snakebite. Based on limited evidence, the incidence of snakebite was not associated with tropical storms/hurricanes and droughts in the United States but associated with heatwaves in Israel. CONCLUSION: The impact of climate change and associated extreme weather events and anthropogenic changes on mortality, morbidity and socioeconomic burden of snakebite. Transdisciplinary approaches can help understand these complex phenomena better. There is almost no evidence available in high-burden nations of South Asia and sub-Saharan Africa. Community-based approaches for biodiversity and prevention, the institution of longitudinal studies, together with improving the resilience of primary care and public health systems are required to mitigate the impact of climate change on snakebite.
BACKGROUND: Ethiopia’s exposure to the El Niño drought (2015-2016) resulted in high malnutrition, internally displaced people, and epidemics of communicable diseases, all of which strained the health system. The drought was especially challenging for mothers and children. We aimed to identify salient factors that can improve health system resilience by exploring the successes and challenges experienced by a community-based health system during the drought response. METHODS: We collected data via key informant interviews and focus group discussions to capture diverse perspectives across the health system (eg, international, national, district, facility, and community perspectives). Data were collected from communities in drought-affected regions of: 1) Somali, Sitti Zone, 2) Hawassa, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), and 3) Tigray, Eastern Zone. Data were analysed using a deductive-inductive approach using thematic content analysis applied to a conceptual framework. RESULTS: A total of 94 participants were included (71 from the communities and 23 from other levels). Key themes included the importance of: 1) organized community groups linked to the health system, 2) an effective community health workforce within strong health systems, 3) adaptable human resource structures and service delivery models, 4) training and preparedness, and 5) strong government leadership with decentralized decision making. CONCLUSIONS: The results of this study provide insights from across the health system into the successes and challenges of building resilience in community-based health systems in Ethiopia during the drought. As climate change exacerbates extreme weather events, further research is needed to understand the determinants of building resilience from a variety of shocks in multiple contexts, especially focusing on harnessing the power of communities as reservoirs of resilience.
Sustainability as a concept is found across a multitude of sectors in today’s society. This ‘sustainability turn’ as we might call it, has made its entry into educational paradigms such as ‘education for sustainable development’. The healthcare sector has embraced the notion of sustainability primarily by emphasizing how climate change impacts human health. Epitomized in the new paradigm of sustainable healthcare education (SHE), or education for sustainable healthcare (ESH), the sustainability turn has arrived with full force within medical education. This article will argue that sustainable healthcare education may be analyzed as a governmental practice. We ask: by what governmental techniques does one seek to create sustainable health subjects, i.e., self-leading future doctors? On the one hand, sustainability is a call for global engagement that goes beyond the health of the singular patients within the paradigm of SHE. On the other hand, it can risk producing individual doctors and students that are responsibilized in the name of sustainability to take on ever-increasing tasks to foster human and planetary health. In this way, we argue that the SHE paradigm might risk transferring responsibility from the state to the individual to achieve ‘sustainable health’.
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed.
Climate change is one of the greatest global threats for planetary and human health. This leads to new challenges for public health. Hospitals emit large amounts of greenhouse gases (GHG) in their healthcare delivery through transportation, waste and other resources and are considered as key players in reducing healthcare’s environmental footprint. The aim of this scoping review is to provide the state of research on hospitals’ carbon footprint and to determine their contribution to mitigating emissions. We conducted a systematic literature search in three databases for studies related to measurement and actions to reduce GHG emissions in hospitals. We identified 21 studies, the oldest being published in 2012, and the most recent study in 2021. Eight studies focused on GHG emissions hospital-wide, while thirteen studies addressed hospital-based departments. Climate actions in the areas of waste and transportation lead to significant reductions in GHG emissions. Digital transformation is a key factor in implementing climate actions and promoting equity in healthcare. The increasing number of studies published over time indicates the importance of the topic. The results suggest a need for standardization of measurement and performance indicators on climate actions to mitigate GHG emissions.
The emerging concept of planetary health needs to be discussed in a more organized and sustainable way within the global public health and healthcare disciplines. Therefore, planetary health should be considered a cardinal component of the global academic framework for healthcare professionals. The availability of related curricula and courses is crucial to equip health professionals in this relatively new discipline of planetary health. In this review article, we aimed to explore published articles and online databases of courses to summarize the available planetary health education opportunities and discussions for health professionals, to identify the gaps in resource allocation and to suggest future recommendations. We observed a visible resource inequity in the global south with the lack of a universal planetary health module for healthcare professionals. Additionally, there is minimal inclusion of allied health disciplines in this learning process. We therefore recommend a dedicated network of motivated healthcare professionals and regional hubs with an agenda to ensure a comprehensive, uniform, and inclusive planetary health education curriculum and practice.
AIM: To describe nursing students’ perceptions of sustainable health education in the nursing curriculum and their concerns about sustainable healthcare and the impact of climate change on nursing. BACKGROUND: Sustainable health education involves education on the impact of climate change on health and the impact of healthcare on the environment. The effectiveness of sustainable health education in improving attitudes, knowledge and skills in sustainable healthcare has been demonstrated. However, there is a need to study students’ perceptions of this and their concerns about achieving sustainable healthcare from the use and disposal of healthcare resources. DESIGN: A cohort study with an inductive content analysis of open-ended questions included in a survey. METHODS: The study was carried out with undergraduate nursing students throughout their four-year undergraduate academic program using scenario-based learning and augmented reality related to sustainability, climate change and health. As students were exposed to three educational interventions, they completed a survey of open-ended questions about their perceptions of their environmental sustainability training in the nursing curriculum, their concerns about the resources’ used in healthcare and their perceptions of the impact of climate change on the nursing profession. RESULTS: Students identified content in the nursing degree program on climate change and health and hospital waste segregation. They also demanded more content on ‘low environmental impact nursing care’ when their clinical practice training increased. Students were concerned about the excessive and unnecessary use of materials in healthcare, especially in the post-pandemic period, the lack of environmental awareness of healthcare professionals and the lack of power to change the situation. They recognised the lack of proper waste segregation in healthcare settings, no recycling bins and little reuse of materials. They were also concerned about the polluting disposal of material. They perceived important impacts of climate change on nursing, such as patient care due to increased pollution-related diseases, including foetal malformations and new health care needs arising from weather conditions. Finally, students were concerned about the impact this will have on nursing care work and require ‘nursing leadership in environmental awareness’. CONCLUSIONS: Students demand more training in low environmental impact healthcare and innovative educational practices are effective in this regard. Appropriate Sustainable Healthcare Education can make future health professionals more environmentally aware and enable them to lead the shift towards climate-smart care. TWEETABLE ABSTRACT: Students demand more training in low environmental impact healthcare and perceive significant impacts of climate change on nursing.
Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population’s interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs’ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants’ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.
Torrential rainfall following the monsoon season occurs annually in Pakistan and adversely affects health service delivery and population health. This qualitative study was undertaken in five flood-prone districts to examine district health systems’ performance during floods in Pakistan. The first of its kind study to gather an in-depth assessment of the capacity of district health systems in maintaining healthcare services during floods. Key informant interviews were conducted with 37 district stakeholders and 42 frontline healthcare providers. Nine focus group discussions were also conducted with 56 lady health workers. World Health Organization health systems’ six building blocks framework was utilized to assess the performance of district health systems. The findings illustrated increased reporting of diseases, and domestic and sexual violence against females. The damaged roads and unavailability of transportation during floods affected outreach services in the communities. The inadequate availability of funds resulted in critical gaps in the supply chain for essential medicines and supplies, impeding outreach services. Shortage of female medical staff was reported in addition to poor attention to the training of staff for disaster response. Furthermore, reporting mechansim varied across provinces with daily reporting system of acute illnesses instituted. Moreover, district health systems lacked gender-sensitive responses in responding to flood emergencies. This study identified multiple health system constraints that resulted in poor district health systems’ capacity in delivering essential healthcare services during floods. This study, therefore, highlighted a need to improve district health systems’ capacity in effectively responding to healthcare service needs during floods.
Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.
OBJECTIVE: The healthcare system accounts for 8%-10% of all greenhouse gas emissions in the United States and hospital buildings are significant contributors. Operating rooms account for 20%-33% of all hospital waste. This may contribute to significant climate change and negatively affect public health. Physicians and surgeons must act to reduce our collective carbon footprint to improve the health of our patients. The traditional graduate medical education curriculum does not routinely train future generations of physicians in healthcare sustainability. We describes a fellowship program designed to change this. DESIGN AND SETTING: The Cleveland Clinic surgical residency has implemented a unique educational program. Here we describe the 5-year results of our novel fellowship program in health care sustainability, primarily focused on greening the operating room. PARTICIPANTS: Selected General Surgery residents interested in healthcare sustainability and greening the operating room. RESULTS: We have successfully implemented a novel resident focused fellowship program in healthcare sustainability. Fellowship projects have led to significant reductions in our hospitals’ collective carbon footprint. CONCLUSIONS: Surgeons have a unique responsibility to reduce the carbon footprint of the Operating Room. Implementing a dedicated fellowship program or similar intensive educational experience in healthcare sustainability within the framework of a graduate medical education curriculum will help to ensure future generations of surgeons are thoughtful leaders in environmental stewardship.
BACKGROUND: Hurricane Maria, which hit Puerto Rico in 2017, catastrophically impacted infrastructure and severely disrupted medical services. The US Department of Veterans Affairs Caribbean Healthcare System (VA CHCS), which serves approximately 67,000 patients and has most of its facilities on the island of Puerto Rico, was able to successfully maintain operations after the hurricane. As a part of the larger VA system, VA CHCS also has a mission to support “national, state, and local emergency management, public health, safety and homeland security efforts.” The objective of this study is to better understand the ways VA and its facilities meet this mission by exploring how VA CHCS acted as a community resource following Hurricane Maria. METHODS: This study investigated experiences of five employees in critical emergency response positions for VA CHCS, Veterans Integrated Service Networks (VISN) 8, and the Office of Emergency Management. All respondents were interviewed from March to July 2019. Data were collected via semistructured interviews exploring participants’ experiences and knowledge about VA’s activities provided to the community of Puerto Rico following Hurricane Maria. Data were analyzed using thematic and in vivo coding methods. RESULTS: All respondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans, while concomitantly describing the role of VA in supporting community recovery. Three major themes emerged: continuity of operations for the San Juan VA Medical Center (VAMC) and its affiliated outpatient clinics, provision of services as a federal partner, and services provided directly to the Puerto Rican community. DISCUSSION: Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond. This case example demonstrates how a VA hospital not only continued serving its patients but, with the support from the greater VA system, also filled a wide variety of requests and resource gaps in the community. Building relationships with local VAMCs can help determine how VA could be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated regional response would benefit from involving VA as a partner during planning.
Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Metis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.
Heat-related illnesses (HRIs), such as heatstroke (HS) and heat exhaustion (HE), are common complications during Hajj pilgrims. The Saudi Ministry of Health (MoH) developed guidelines on the management of HRIs to ensure the safety of all pilgrims. This study aimed to assess healthcare workers’ (HCWs) adherence to the updated national guidelines regarding pre-hospital and in-hospital management of HRIs. This was a cross-sectional study using a questionnaire based on the updated HRI management interim guidelines for the Hajj season. Overall, compliance with HE guidelines scored 5.5 out of 10 for basic management and 4.7 out of 10 for advanced management. Medical staff showed an average to above average adherence to pre-hospital HS management, including pre-hospital considerations (7.2), recognition of HS (8.1), case assessment (7.7), stabilizing airway, breathing, and circulation (8.7), and cooling (5). The overall compliance to in-hospital guidelines for HS management were all above average, except for special conditions (4.3). In conclusion, this survey may facilitate the evaluation of the adherence to Saudi HRIs guidelines by comparing annual levels of compliance. These survey results may serve as a tool for the Saudi MoH to develop further recommendations and actions.
