Climate resilience in infrastructure – a hidden gem lies within the health sector

April 2023

This month's Smart Infrastructure Blog brings focus to the relationship between climate change, human health and critical infrastructure. CSIC Research Associate Felipe Rojas Parra - working on Life Resystal project -argues that as climate change is putting human health and critical infrastructure at risk, adapting to its effects through the built environment presents an invaluable opportunity for the health sector.

Climate change is wreaking havoc upon humanity. In 2022 alone, the world experienced devastating fires in California, flash floods in Pakistan, the never-ending drought in the horn of Africa, the crushing effects of Hurricane Ida on the US and Caribbean states, and the list goes on. These climate hazards not only cause significant loss of human life but also add up to billions of dollars in infrastructure losses and create a cascade of negative effects on local and regional economies. Critical infrastructure like transportation, energy, water, telecommunications and health are severely affected by climate hazards. If the world aims to reduce the future impacts of our changing climate, it must drastically reduce emissions. Even if we are successful in addressing climate change in the future, the effects of the current situation will be felt for decades – adaptation and resilience are not an option but a necessity. In light of the COVID-19 pandemic and the growing risks of the climate crisis on human health and infrastructure, there is an opportunity to build climate resilience within the health sector.

In light of the COVID-19 pandemic and the growing risks of the climate crisis on human health and infrastructure, there is an opportunity to build climate resilience within the health sector. (...) Preparing health systems to become climate change resilient will require significant investment in the short and medium term. CSIC Research Associate Felipe Rojas Parra, Dep. of Engineering

Health systems act as a first responder when it comes to public health, regardless of the origin of the crisis. The extent of the climate emergency requires reformulating how governments and decision makers approach health systems. In 2018, the United Nations Environment Programme (UNEP) evaluated global efforts in adaptation planning, implementation and financing for health. Some progress is being made. More than 80% of the countries taking part in the UN’s Framework Convention on Climate Change (UNFCCC) have put in place adaptation plans and targets, but significant gaps remain to address climate change impacts on human health and health systems. Even though health is a priority sector, in 54% of Nationally Determined Contributions (NDCs) of the Paris agreements featuring adaptation, there are few quantitative targets against which progress can be measured. Furthermore, there is limited information on the costs of adaptation focused on improving health due to a lack of global studies. Although more than a third of the total climate investment is for adaptation purposes, the World Health Organization (WHO) in the COP24 special report on health and climate change estimates that less than 0.5% of the total is allocated to health projects.

Health professionals and institutions gathered at the COP26 to seek governmental commitment to tackle the climate crisis and make the connection with health explicit. This resulted in a 10-recommendation package in which adaptation and resilience of health systems is a priority. As climate change mitigation takes centre stage in international policy, the intensive energy use in this sector has come into question. In England, the National Health Service (NHS) represents 4% of the total carbon emissions in the country. Consequently, the NHS has pledged to reach net zero emissions by 2045 through decarbonisation of its estates, facilities, travel, transport, supply chain and medicines. The NHS is cutting emissions by applying “innovative, low-carbon materials and design that allow for flexibility” in the construction of new infrastructure. It also recognises the importance of upgrading existing infrastructure, much of which is in need of redesigning. The modernisation of lighting, air conditioning, building fabric, ventilation and hot water systems will result in millions of pounds in energy savings.

Although this strategy was born out of the national mitigation agenda, it incorporated significant adaptation strategies to build resilience in the face of the new-normal summer heatwaves and floods occurring during high intensity storms. In 2021, the NHS produced the Third Health and Care Adaptation Report in which improvements in climate and health information systems, service delivery, and leadership and workforce development are presented. Use of early weather warning systems such as the Real Time Syndromic Surveillance Team (ReSST) and the Strategic Health Asset Planning and Evaluation (SHAPE) tool help the NHS prepare for climatic hazards. It also plans to develop a “Single Adverse Weather and Health Plan” to give guidance to health estates and their communities. Adaptation actions in service delivery include the monitoring and assessment of sanitation services, acquisition of flood insurance, barrier defence implementation, the relocation of key equipment to higher floors in flood-prone areas and regular stress testing of facilities. The NHS has developed 42 Integrated Care System (ICS) leaders who act at a regional scale. These are senior officers responsible for delivering on a range of long-term outputs to meet net-zero ambitions and adaptation activities.

Preparing health systems to become climate change resilient will require significant investment in the short and medium term.  Additionally, practices at all levels of public health systems will require adopting resilience building and adaptation strategies. This can mean refurbishment of existing infrastructure, but also creation of new regulation standards for infrastructure development in the future. There is also a need to prepare the health workforces and the communities they aim to serve. Despite the challenges presented, a double opportunity exists for health sectors in England and the rest of the world. They can be the first line of defence against climate change and future health emergencies, while helping national governments reach their net-zero targets. To achieve climate resilience, infrastructure that quickly reduces its emissions and can withstand the effects of climate change is needed. A properly trained and knowledgeable workforce on the subject of climate change is equally critical as staff behaviours and organisational processes cannot be decoupled from infrastructure systems and their functionality. Decision makers have a critical task ahead if they are to safeguard health systems.

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