Health systems are increasingly faced with climate change driven extreme weather, disease epidemics, migration, economic downturns, and infrastructure failures. Climate-related hazards can simultaneously impact healthcare service delivery and increase the number of people needing medical attention – negatively affecting the capacity of health systems to protect and promote population health. Both acute shocks and chronic climate stressors on these systems can have a deep and lasting impact on health and human development.

A climate resilient health system is able to anticipate, respond to, cope with, recover from and adapt to climate-related shocks and stress, so as to bring sustained improvements in population health, despite an unstable climate.

For a health system to effectively prepare for climate change it must enhance the climate resilience of each of its building blocks: leadership and governance, the health workforce, health information systems, essential medical products and technologies, service delivery, and financing.

The WHO operational framework for building climate resilient health systems describes 10 components under the building blocks that, when strengthened, reduce climate change risks to health systems.

Strengthening health systems, including healthcare facilities, is a key part of health adaptation planning, and should be included in a Health National Adaptation Plan.

The process to build climate-resilient health systems includes activities such as:

• assessing health impacts of climate change and health co-benefits of mitigation actions;
• climate change and health planning;
• financing climate change and health;
• implementing climate change and health interventions; and,
• monitoring climate change and health progress.

These activities may be integrated into the overall national climate change process, such as the Nationally Determined Contributions (NDCs) and the health component of the National Adaptation Plan.

The health sector contributes to emission levels through the energy and transport it relies on, as well as the products that it purchases, uses, and disposes of. It is also at the forefront of the fight against climate impacts – preventing and responding to the health impacts of the changing environment.

The design and maintenance of public health infrastructure may be the most important, cost-effective and urgently needed strategy for healthcare systems to adapt to our changing climate. Infrastructure that is specifically designed to reduce vulnerability to climate variability can greatly enhance adaptive capacity. This applies to healthcare infrastructure – such as flood control systems, air conditioning, and building insulation – as well as public infrastructure that supports healthcare systems and healthy communities – such as water and sanitation facilities and laboratories.

WHO^{2 2}Climate-Smart Healthcare: Low-Carbon and Resilience Strategies for the Health SectorX^{3 3}WHO guidance for climate resilient and environmentally sustainable health care facilitiesX identifies four fundamental requirements for providing safe and quality care in the context of climate change:

1. Health workforce: adequate numbers of skilled human resources, with decent working conditions, empowered and informed to respond to environmental challenges.
2. Water, sanitation, hygiene and health care waste management: sustainable and safe management of water, sanitation and health care waste services.
3. Energy: sustainable energy services.
4. Infrastructure, technologies and products: appropriate infrastructure, technologies, products and processes, including all the operations that allow for the efficient functioning of a healthcare facility.

Enhancing healthcare infrastructure to withstand climate shocks presents an opportunity to reduce the sector’s climate impact. Adopting low-carbon approaches can minimize the negative environmental impacts of supply chains and buildings, while equipping the sector with resilient technologies for future climate scenarios.

In 2021, greenhouse gas (GHG) emissions from the healthcare sector were 9.5% higher than in 2020 and 36% higher than in 2016. Associated air pollution from the sector contributed to 4.6 million Disability-Adjusted Life Years (DALYs) lost in 2021.^{4 4}2024 Report of the Lancet CountdownX

Low-carbon healthcare offers a strategy for designing, building, operating, and investing in health systems that generate minimal GHG emissions. This approach aligns healthcare development with global climate goals, reducing energy and resource costs, and potentially improving quality of care across diverse settings.

Additionally, low-carbon healthcare strengthens health systems by making facilities more resilient to extreme weather and other disasters. In low-resource and energy-limited areas, low-carbon solutions can expand access to care, supporting institutional goals and advancing climate adaptation efforts.

Key elements of low-carbon healthcare include:

• Health system design and models of care based on appropriate technology, coordinated care, emphasis on local providers, and driven by public health needs;
• Building design and construction based on low carbon approaches;
• Investment programs in renewable energy and energy efficiency;
• Waste minimization and sustainable healthcare waste management;
• Sustainable transport and water consumption policies;
• Low-carbon procurement policies for pharmaceuticals, medical devices, food, and other products;
• Resilience strategies to withstand extreme weather events.