Climate change demands that health care change

In many parts of the world, the arrival of the holiday season traditionally coincides with dropping temperatures. But this year, much of the U.S. has experienced unseasonably warm weather—even as leaves fall from the trees and clocks turn back.

This calls to mind a Thursday this past July when temperatures were circling 110 degrees in Sacramento, when Carol received a call from her elderly mother, Inez (names have been changed to protect privacy). Inez was hot. Even though her house has air conditioning, it either wasn’t working or wasn’t turned on. Attempts at FaceTime failed, and since Inez couldn’t drive herself to a cooler location, Carol had to go to her—and quickly. 

Hot weather is dangerous for everyone, but it is especially risky for older people, who have greater difficulty regulating their body temperatures and often have more complicated health conditions that are made worse by heat. People who can find their way to cooling centers or take extra precautions have a better chance of staying cool, but those people who can’t—like Inez—are susceptible to heat stroke and exhaustion.

When someone’s health is in this kind of climate-driven danger—whether it’s from extreme temperatures, wildfires, or floods—what safeguards are in place to keep the most vulnerable people, like Inez, from harm? The answer, in most cases, is that there aren’t any—or the ones in place are far from adequate. In my work leading Kaiser Permanente 's community and social health portfolios, I see this play out across studies and in real life again and again.

Carol was able to get to her mother in time, but many people in her mother’s situation would not have fared as well.

With extreme weather conditions on the rise, health systems have an important role to play in addressing the mounting climate-driven health needs communities face—and must change the ways they operate. 

Getting ahead of climate-related health emergencies 

Heat waves have tripled in frequency since the 1960s, and diseases that leap from ticks, mosquitos, and bats to people in warmer, wetter environments are increasing. Hurricanes are becoming more unpredictable and devastating, as we sadly witnessed in the Southeast this fall. Extreme cold is reaching new areas, as we saw in Texas in 2021. 

As the demand for treatment swells under these conditions, the supply chains, facilities, and human resources that fuel health care will struggle to keep pace. In the face of such profound risk to our sector and to the people who rely on it, we must ready our operations and re-imagine how, when, and where people get care. 

The health sector must embrace a model that helps people and communities adapt to and prepare for extreme conditions—and that means realigning incentives to compensate providers for a different kind of work. Instead of primarily treating people when they arrive in emergency rooms with heat exhaustion or heatstroke, what if we standardized preventive interventions keep them from needing critical care in the next heat wave? This approach, even with the necessary upfront investments, would help people avoid the need for the most expensive form of care—care that, without upstream intervention, will be needed again with the next climate event.

Upstream solutions

We have already seen the value of upstream interventions that keep people from having to seek high-cost care. Medicaid programs that support low-income people have begun expanding through Section 1115 waivers to allow state and private health plans to provide crucial environmental modifications. In Portland, Oregon, an area new to the need for air conditioning, purchasing inexpensive AC units for at-risk people with Medicaid funds reduced the number of costly ER admissions in the next heat wave. Elsewhere, communities like Denver, Colorado have responded to poor air quality caused by pollution and wildfire smoke with monitoring tools deployed at health clinics and schools that allow residents to protect their health based on hyperlocal conditions. And environmental sustainability has become a priority for many health systems that see reducing their reliance on carbon-based energy as part of the solution.

But these measures only reach so many people. To pursue preparedness and prevention effectively across the U.S., care delivery and insurer incentives must align with keeping people healthy, rather than providing most care after a diagnosis. Pulling this off will require a significant reorienting of the industry, and it is the right and necessary approach.

It's not impossible. Research in Europe estimates that heat-related deaths last year were 80 percent lower than they would have been because of adaptations implemented in the last two decades, such as heat-related advance warning systems, pre-identified lists of the most vulnerable people, and more widespread air conditioning. We have an opportunity to set the same pace of progress in the next 20 years.

The most successful health care systems are going to be the ones that put patient outcomes first. The ones that invest in communities and prevention so that their patients remain healthy and don’t need emergency treatment. The ones that look beyond what is happening within the hospital walls to understand where health truly begins. The ones that think about Inez and the support she might need so that she can survive the next 110-degree day.

Health care must prepare for the worst, and that means demanding the best of ourselves.