Creating Low-Carbon, Climate-Resilient Health Systems: What Frameworks, Policies, and Standards Should We Apply?

Research Objective:
In response to the worsening climate crisis, countries and organizations are developing and implementing frameworks, policies and standards to support the reduction of greenhouse gas (GHG) emissions, and to assist healthcare systems in adapting to the unavoidable effects of climate change. This is essential not only to protect human health, but also the sustainability of health systems.

Climate change directly impacts health systems’ ability to provide care through the increasing frequency and intensity of disasters, such as hurricanes and heatwaves, which can damage infrastructure and stretch resources beyond capacity. Disease outbreaks are increasing (e.g., contagious, water-borne, and vector-borne diseases). Climate-induced environmental changes also worsen chronic conditions, such as cardiovascular disease.

Health systems are significant contributors to climate change through GHG emissions. For example, the United States’ (US) healthcare system accounts for 8.5% of the country’s total GHG emissions, and the English National Health Services, 3%. Since every episode of care creates GHG emissions, healthcare systems are contributing to the very problems they are designed to address. We will discuss relevant national and international frameworks, policies, and standards for reducing GHG emission or which can aid in adaptation of health systems to climate change.

Study Design:

Seven electronic databases (Business Source Premier, CINAHL, Cochrane Reviews, Embase, Health Business (EBSCO), MEDLINE, and Web of Science) were searched from their respective inception dates, and Scopus from 1990 to May 2023 for peer-reviewed literature. Authoritative texts from national (e.g., US Center for Disease Control) and international organizations (e.g., World Health Organization) were identified through online searches. Included papers and authoritative reports discussed a relevant framework, policy, or standard for adapting health systems to the impacts of climate change or mitigating health system’s GHG emissions.

Population Studied:

Not applicable.

Principal Findings:

There are numerous national and international initiatives, such as the US CDC’s Climate and Health Program: Building Resilience Against Climate Effects (BRACE) framework, Hyogo Framework for Action, and Sendai Framework, which provide guidance to bolster response plans and preparedness.

The recently updated World Health Organization (WHO) Operational Framework for Building Climate Resilient and Low Carbon Health Systems focuses on the bi-directional nature of climate change and health systems. Laws and policy initiatives (for instance those in the US like the Inflation Reduction Act of 2022 and the UK’s Health and Care Act 2022) can and are supporting health systems to reduce their emissions and improve sustainability. National standards include the hospital certification program from the US Joint Commission designed to measure, monitor and mitigate indirect and direct sources of carbon emissions.

Conclusions:

Many countries are beginning to implement the policies needed to create low-carbon resilient health systems. However, there is a strong need to identify, evaluate, and disseminate effective policies to increase their implementation. Standards for reporting of emissions need to be mandatory. Voluntary emissions reductions will not be sufficient to meet emission reduction targets.

Implications for Policy or Practice:

The frameworks, standards, and effective policies in this presentation provide a basis for action to create low-carbon, climate resilient health systems. We also discuss the impediments to action.