A framework for building Climate Resilient and Environmentally
A framework for building Climate Resilient and Environmentally Sustainable health care facilities Elena Villalobos Prats Carlos Corvalan
Pathways of climate change and human health
Pathways of climate change and human health Social infrastructure Social Infrastructure Direct exposures Climate change • Precipitation • Heat • Flood • Storm • Drought • Increased water temperature • Flood damage • Storm, drought Direct exposures: vulnerability Flood damage • Heat stress Storm vulnerability Heat stress Indirect exposures Mediated through Indirectsystems: exposures: natural Mediated through • natural Disease vectors systems: • Allergens; Water scarcity • Disease Increased water/air vectors, pollutionwater/air Increase pollution Economic and social Via economic and disruption: social disruption • Foodproduction/ production distribution and distribution Mental stress • Migration • Modified from Smith 2014 Mental stress Health impacts • Undernutrition • Heart disease • Injuries • Vector-borne diseases • Infectious diseases
IPCC: The health of human populations is sensitive to shifts in weather patterns and other aspects of climate change (very high confidence) Climate change • Precipitation • Heat • Flood • Storm • Drought • Increased water temperature Social infrastructure Social Infrastructure Direct exposures • Flood damage • Storm, drought Direct exposures: vulnerability Flood damage • Heat stress Storm vulnerability Heat stress Indirect exposures Mediated through Indirectsystems: exposures: natural Mediated through • natural Disease vectors systems: • Allergens; Water scarcity • Disease Increased water/air vectors, pollutionwater/air Increase pollution Economic and social Via economic and disruption: social disruption • Foodproduction/ production distribution and distribution Mental stress • Migration • Modified from Smith 2014 Mental stress Health impacts • Undernutrition • Heart disease • Injuries • Vector-borne diseases • Infectious diseases
Social infrastructure Social Infrastructure Direct exposures Environmental conditions Climate change • Precipitation • Heat • Flood • Storm • Drought • Increased water temperature • Baseline weather • Baseline air/ water quality • Geography • Soil/dust • Vegetation Modified from Smith 2014 • Flood damage • Storm, drought Direct exposures: vulnerability Flood damage • Heat stress Storm vulnerability Heat stress Indirect exposures Mediated through Indirectsystems: exposures: natural Mediated through • natural Disease vectors systems: • Allergens; Water scarcity • Disease Increased water/air vectors, pollutionwater/air Increase pollution Economic and social Via economic and disruption: social disruption • Foodproduction/ production distribution and distribution Mental stress • Migration • Mental stress Health impacts • Undernutrition • Heart disease • Injuries • Vector-borne diseases • Infectious diseases
Mediating factors Social infrastructure Social Infrastructure Direct exposures Environmental conditions Climate change • Precipitation • Heat • Flood • Storm • Drought • Increased water temperature • Baseline weather • Baseline air/ water quality • Geography • Soil/dust • Vegetation Modified from Smith 2014 • Flood damage • Storm, drought Direct exposures: vulnerability Flood damage • Heat stress Storm vulnerability Heat stress Indirect exposures Mediated through Indirectsystems: exposures: natural Mediated through • natural Disease vectors systems: • Allergens; Water scarcity • Disease Increased water/air vectors, contamination Increase water/air pollution Economic and social Via economic and disruption: social disruption • Foodproduction/ production distribution and distribution Mental stress • Migration • Mental stress Public health capability and adaptation • Socioeconomic status • Health and nutrition status • Primary health care • Early warning systems • Climate resilient health systems & HCF Health impacts • Undernutrition • Heart disease • Injuries • Vector-borne diseases • Infectious diseases
Mediating factors Social infrastructure Social Infrastructure Direct exposures Environmental conditions Climate change • Precipitation • Heat • Flood • Storm • Drought • Increased water temperature • Baseline weather • Baseline air/ water quality • Geography • Soil/dust • Vegetation Modified from Smith 2014 • Flood damage • Storm, drought Direct exposures: vulnerability Flood damage • Heat stress Storm vulnerability Heat stress Indirect exposures Mediated through Indirectsystems: exposures: natural Mediated through • natural Disease vectors systems: • Allergens; Water scarcity • Disease Increased water/air vectors, contamination Increase water/air pollution Economic and social Via economic and disruption: social disruption • Foodproduction/ production distribution and distribution Mental stress • Migration • Mental stress Public health capability and adaptation • Socioeconomic status • Health and nutrition status • Primary health care • Early warning systems • Resilient health systems & HCF IPCC: In recent decades, climate change has contributed to levels of ill health (likely) though the present worldwide burden of ill health from climate change is relatively small compared with other stressors on health and is not well quantified Health impacts • Undernutrition • Heart disease • Injuries • Vector-borne diseases • Infectious diseases
In summary Environmental conditions Climate change H S A W IPCC: The most effective measures to reduce vulnerability in the near Social infrastructure term are programs that implement Social and improve basic public health Infrastructure Public health Direct exposures measures such as provision of clean capability and • Flood damage water and sanitation, secure adaptation • Storm, drought H Direct exposures: AS essential health care including vulnerability • Socioeconomic W Flood damage • Heat stress status vaccination and child health Storm vulnerability • Health and services, increase capacity for Heat stress nutrition status Indirect exposures disaster preparedness and • Primary health Mediated through SH response, and alleviate poverty care A Indirect exposures: natural systems: • Early warning W (very high confidence) Mediated through H S systems Mediating factors • Precipitation • Heat • Flood • Storm • Drought • Increased water temperature • Baseline weather SH WA • Baseline air/ water quality • Geography • Soil/dust • Vegetation Modified from Smith 2014 • natural Disease vectors A systems: W • Allergens; Water scarcity • Disease Increased water/air vectors, contamination Increase water/air pollution Economic and social Via economic and disruption: social disruption • Foodproduction/ production distribution and distribution Mental stress • Migration • Mental stress SH A W • Resilient health systems & HCF Health impacts • Undernutrition • Heart disease • Injuries • Vector-borne diseases • Infectious SH A diseases W
Building climate resilient and environmentally sustainable health care facilities: Framework elements
Global environment Health Care Facilities Climate change Healthy people
Global environment GHGs Health Care Facilities Wastes Air pollution Climate change Water Sanitation Healthy people GHGs Chemicals
Health Care Settings Goal: “all health care facilities and services are environmentally sustainable: using safely managed water and sanitation services and clean energy; sustainably managing their waste and procuring goods in a sustainable manner; are resilient to extreme weather events; and capable of protecting the health, safety and security of the health workforce” WHO global strategy on health, environment and climate change (2019)
Global environment Safely managed water and sanitation services Sustainable waste management Resilient to extreme weather events Climate-resilient and environmentally sustainable Health Care Facilities Climate change Healthy people Protecting the health, safety and security of the health workforce Clean energy and low-carbon health care Sustainable procurement Sustainable infrastructure and technologies
Environmental requirements for safe and quality care Health care facilities Climate change: • Floods, • Droughts, • Fires, • Storms, • Temperature extremes, • Sea-level rise • Climate sensitive diseases outbreaks Healthcare workers WASH Energy Infrastructure & technologies Healthy people, Healthy environment
Climate resilient health care facilities are those that are capable to anticipate, respond to, cope with, recover from and adapt to climate-related shocks and stress, so as to bring ongoing and sustained health care to their target populations, despite an unstable climate
Climate resilience Health care facilities Environmental requirements for safe and quality care Climate change: • Climate sensitive diseases outbreaks Climate Resilience • Floods, • Droughts, • Fires, • Storms, • Temperature extremes, • Sea-level rise Healthcare workers WASH Energy Healthy people, Healthy environment Infrastructure & technologies Climate resilience: Protect HCF from external shocks and stresses
Sample questions on resilience q Is the infrastructure of the health care facility able to withstand climate-related emergencies? q Is it able to provide safety for patients, staff and visitors? q Does the health care facility have protocols to secure back-up supplies of water in the event of an emergency? q Does the health care facility have an emergency energy plan? q Are training exercises and drills to evaluate and validate disaster plans carried out at the health care facility regularly? q Does the health care facility participate in community educational and communication programs to assist the local community in reducing climate risk and vulnerabilities?
Environmental sustainability in the health care facilities Environmental sustainability is the health care facility’s responsible interaction with the environment to avoid depletion or degradation of natural resources, ensuring long-term environmental quality and the strengthening of resilience to extreme weather events and climate change
Environmental sustainability Climate change: • Floods, • Droughts, • Fires, • Storms, • Temperature extremes, • Sea-level rise • Climate sensitive diseases outbreaks Environmental requirements for safe and quality care Healthcare workers WASH Energy Infrastructure & technologies Environmentally Sustainable Interventions Health care facilities Environmentally sustainable interventions: • Optimize consumption (e. g. water, energy) • Reduce emissions (e. g. GHGs, wastes) Healthy people, Healthy environment
Sample questions on environmental sustainability q Does the health care facility implement energy conservation? q Does the health care facility have established procedures for proper disposal of pharmaceuticals? q Does it use solar panels or other type of renewable energy such as wind? q Does it have programmes to build awareness among staff, patients and visitors of the importance of being a sustainable health care facility? q Does the health care facility have an environmentally responsible purchasing program?
Framework for climate-resilient and environmentally sustainable healthcare facilities
Framework for building climate -resilient health systems
Framework for building climate -resilient health systems Health workforce WASH + HC wastes Energy Infrastructure & technologies
Framework for building climate-resilient and environmentally sustainable health care facilities
Sample interventions on climate resilience and environmental sustainability in health care facilities Climate resilience Environmental sustainability Health workforce ☐ A disaster risk reduction plan to ☐ The health workforce is trained in prepare for, respond to and recover from extreme climate events is available the management of health care wastes WASH ☐ Water services are not affected ☐ Wastewater is safely managed by seasonality or climate change related extremes through use of on-site treatment ☐ An energy backup source is ☐ Renewable energy powers energy available if the main source fails during an extreme climate event efficient lighting ☐ Health care facilities are built or ☐ Energy Infrastructure & technology retrofitted to cope with extreme climate events Environmentally sustainable supplies are purchased from local sources
Ongoing activities & priorities at country level for CR-HCFs 1. Capacity building for healthcare workers on climate change and health (special focus on adaptation); 2. Health component of National Adaptation Plan (HNAP) – inclusion of specific action in HCF; 3. Energy access (focus on solar energy) and energy efficiency measures to lower environmental footprint; 4. WASH: access to WASH services, including environmentally friendly waste management (also waste water disposal) and development of standards for CR-WASH; CR-WSPs; 5. Infrastructure and environmentally friendly technologies in health service delivery – climate resilient buildings and promotion of non- burning technology in HCWM (e. g. autoclave); 6. Vulnerability and Adaptation Assessment (V&A) - to identify climate change vulnerable HCF and population 7. Defining scope and developing guideline for CRESHCFs; 8. Construction and maintenance of model CRESHCF; 9. Disaster risk reduction (DRR): conduct drills; development of disaster management and response plans for HCFs; and appointment of disaster focal point in disaster-prone major healthcare institutions; 10. Promotion of climate resilience measures in health programmes – as part of building climate resilient systems; 11. Research and development
Summary presentations countries: CR-HCFs Key hazards: • Extreme weather events; flooding; landslides, bush fires, heatwave, cold wave, glacial lake outburst flood (GLOF) Main challenges: 1. Baseline information on capacities and gaps in health system to face challenges posed by CC; 2. Lack of evidence linking CR-HCFs to reduced disease burden due to CC; 3. Working in silos – CC not strongly integrated in existing health program; 4. Financial issues and coordination among different stakeholders; 5. Water supply and energy back-up. High cost of installation of solar panels. 6. Lack of human resources 7. Dedicated section for environmental health and HCWM but not explicitly for Climate Change.
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