Creating a global climate-resilient health workforce

By Elizabeth Baca, M.D., principal, Deloitte Consulting LLP

2023 was the Earth’s warmest year on record.¹ While it is too soon to know if 2024 will be another record-breaker, climate-related emergencies, such as wildfires, tornados, floods, and extreme heat have become increasingly common around the world.²

So far this spring, India has endured a record-long heatwave,³ parts of southern Spain were flooded by torrential rains⁴, and China experienced heavy rain in the south and a severe drought in the north.⁵ In the US, a heatwave gripped much of the country before the official start of summer.⁶ Such weather events can have a significant impact on health systems, their patients, the communities they serve…and on frontline workers. In California (where I live), last year’s record-breaking heat⁷ was a significant concern for many of the health care professionals I know.

Deloitte US and Project HOPE (a global health and humanitarian organization) recently published a report that could help guide health care professionals to become more resilient and better prepared for climate-related emergencies (see Empowering the health care workforce for a climate-resilient future). The report includes insight gathered from frontline health care workers, program leaders, health system advisors, policy and advocacy professionals, and community leaders. Our goal was to identify potential solutions that could help enhance climate resilience among health care workers around the world.

I caught up with Uche Ralph-Opara, M.D., chief health officer, and Andrea Dunne-Sosa, M.P.H., senior regional director, at Project HOPE. We discussed the new report and the role health care workers might play in creating a climate-resilient future. Here is an excerpt from that conversation:

Elizabeth: What was the impetus for this report?

Andrea: There is a growing recognition around the impact climate change is having on the health of individuals, populations, and health systems. We wanted to highlight the unique role the frontline health workforce plays. They are the heart of health care systems, and they are often disproportionately affected by climate change. We want to make sure those professionals have the knowledge, skills, and resources to react to a changing environment. They need to respond to patients who are being affected by climate emergencies, but they also need to understand how those changes might be adding new stressors to their jobs, which can contribute to their own mental health issues and burnout.

Elizabeth: How is climate change impacting stress and burnout among frontline health care workers globally?

Uche: We are seeing a higher risk of burnout, anxiety, and other mental health issues among health care workers in regions of the world that experience extreme weather events. In areas prone to wildfires, for example, health care workers report higher levels of burnout and emotional exhaustion. We worked with the NYC Health + Hospitals in New York City to develop a training curriculum on mental health and resiliency for frontline workers, which is being rolled out across 40 countries. We will continue to advocate for workload-management strategies and hope to foster a culture of resilience within health care organizations.

Andrea: Health workers tend to be overworked and under resourced. Many people left the health profession after COVID-19. Now, as a result of climate change, many health systems are seeing higher patient loads and more diverse populations—sometimes due to immigration and global displacement. Some frontline workers are treating people and health conditions they haven’t seen before. And at the same time, there are often fewer resources to support those health workers. So, you have a reduced health workforce trying to meet increasing demands from more patients.

Elizabeth: Do you see parallels between the burnout that was fueled by COVID-19 and the burnout that is tied to climate change? (See Addressing health care’s talent emergency.)

Uche: The context might be different, but they are both global health issues. And burnout is burnout. Climate change can be significantly worse in some parts of the world. Some of the strategies that helped health care workers cope during the pandemic could be replicated to help them manage the stress and anxiety triggered by climate emergencies.

Andrea: Even before the pandemic, mental health issues and burnout among health workers were contributing to a workforce shortage.⁸ The world is still recovering from the pandemic, now layer the impact of climate change on top of that.⁹ Recognizing the impact the working environment has on mental health is critical. Changes need to be led from within the health systems to support the health workforce.

Elizabeth: Health systems are major contributors to climate change and greenhouse gases (see Climate change and health: What can hospitals do?). Is there an acceptance that something needs to be done on the part of health system leaders? Are they developing strategies to reduce their impact on climate?

Uche: Yes. We are seeing more focus on risk assessments and mitigation plans for climate-related emergencies. But how do you build climate-resilient systems while also implementing other programs to treat patients with HIV or tuberculosis, or to improve maternal health programs? Preparing for climate change is gaining some traction globally, but it is not the priority we want it to be. However, it does seem to be gathering some momentum.

Andrea: There is a growing recognition, but I think health systems need to be more proactive. It is one thing to recognize that climate change is a threat, and another thing to develop comprehensive, innovative, and effective strategies to address it.

Elizabeth: What might a climate-resilient workforce look like compared to a more traditional workforce?

Uche: There is no one-size-fits-all. Some health systems might hold climate-related emergency drills that are similar to the fire drills they already conduct. That could help leaders see whether health workers are prepared for climate-related emergencies. Integrating climate-related scenarios into emergency preparedness plans could also help improve the well-being of the workforce. Health care workers often don’t have any experience dealing with climate-related issues or the mental health challenges that can arise alongside them. A Canadian study found that health care facilities that developed and socialized toolkits for emergency management increased their resilience to climate crises. The toolkits included checklists for administrators, resource guidebooks, and facilitators’ guides.¹⁰

Andrea: Our paper outlines a three-tiered approach to climate resiliency. The first tier is to educate and equip frontline workers so they can effectively navigate climate-related challenges. This might require health care organizations to expand their training programs to cover mental health and well-being. At a systems level, frontline workers should have access to the resources they need to provide quality care. They also need to ensure the strength of their supply chains and contingency planning. The third tier is to foster a culture that encourages innovation and input from the workforce to help prepare for climate-related emergencies.

Elizabeth: Could a strong climate strategy help a health system recruit and retrain staff?

Uche: Employees are more likely to stay in organizations that prioritize sustainability.¹¹ A global Deloitte study found that about 70% of millennials are more inclined to work for companies that prioritize social and environmental responsibility (see Deloitte's survey on Gen Z and Millennials). Having a climate strategy that addresses the needs of staff within the health system is important.

Elizabeth: A Health Day was designated at the United Nations Climate Change Conference (COP28). The designation highlights the increasing awareness of climate change and its impact on health. Have you found any health care organizations that are leading the charge in climate-change resiliency?

Uche: Following COP28, there have been more investments in climate-change initiatives and health specifically. Traditionally, most climate investments have gone toward reducing carbon footprints. Less than 1% of climate investments have gone toward health. In terms of countries that are leading this initiative, Sweden has set some ambitious sustainability goals for its health sector.¹² They hope to achieve carbon neutrality by 2045. And in Denmark, some hospitals are relying more on renewable energy sources, and have adopted green building standards and sustainable procurement practices to help reduce the carbon footprint of hospitals.¹³

Andrea: Project HOPE has implemented a global mental health and resilience training program for frontline health workers. Some organizations are doing innovative things and are increasing visibility. But climate-change resiliency is not something that has been standardized, and there is a lot of variability. Increasing the visibility around effective strategies could help create a more universal rollout of these initiatives.

Conclusion

Climate change has been called the biggest threat to global public health in the 21st century. I have been focused on the health effects of climate change for more than a decade, and it seems that we have finally reached an inflection point. The vast majority of surveyed clinicians (80%) say their health systems should be working to address climate change and its impact. Health systems should continue to focus on ways to reduce greenhouse gas emissions and identify strategies to address the impact a changing climate can have on their patients, their communities, and their clinical staff.

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Endnotes:

^{1_{NASA analysis confirms 2023 as warmest year on record, NASA, January 12, 2024}}

^{2_{From flooding in Brazil and Houston to brutal heat in Asia, extreme weather seems nearly everywhere, AP News, May 7, 2024}}

^{3_{India summer: Eight more die as country faces 'longest' heatwave, BBC, Severe, long-lasting heat wave to scorch eastern United States, The Washington Post, June 14, 2024;}}

^{4_{Torrential rainstorm floods roads in Spain's Murcia, June 13, 2024}}

^{5_{China getting too much rain in the south; not enough rain and heat wave in the north, ABC News, June 16, 2024}}

^{6_{A heat wave is expected to bake the U.S. next week, Yahoo News, June 15, 2024}}

^{7_{Extreme heat breaking records at home and beyond, California Governor’s Office of Emergency Services, August 2, 2023}}

^{8_{Mental health and the global climate crisis, Epidemiology and Psychiatric Sciences, December 2, 2022}}

^{9_{COVID made health care burnout worse, PBS News Hour, October 27, 2023}}

^{10_{Health care facilities resilient to climate change impacts, International Journal of Environmental Research and Public Health, December 16, 2014}}

^{11_{U.S. health workers want employers to address climate change, The Commonwealth Fund, January 24, 2024}}

^{12_{Sweden and sustainability, Sweden Sverige/Swedish Institute, October 23, 2023}}

^{13_{Sustainability in Denmark, Healthcare Denmark}}

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