Plan guidance

• Adaptation: The process of adjusting to new (climate) conditions in order to reduce risks to valued assets.

• Resilience: The capacity of a community, business, or natural environment to prevent, withstand, respond to, and recover from a disruption. 

  • Expanded definition of Resilience: The ability of people and their communities to anticipate, accommodate and positively adapt to or thrive amidst changing climate conditions and hazard events. Resilient communities enjoy a high quality of life, healthy environments, reliable systems, and economic vitality, and they conserve resources for present and future generations.

• Climate resilience plan: A formal comprehensive hospital- or system-wide plan for continuous operations in the face of climate events that: 

  • Anticipates the needs of community groups that experience disproportionate risk of climate-related harm,

  • Was developed in partnership with community groups, and 

  • Is approved by the health care system’s leadership for deployment (HHS, 2022). 

The business imperative. Health care is on the front lines of the climate crisis. As climate events increase in frequency, duration, and intensity, hospitals and health systems face increasing vulnerabilities that impact the ability to 24/7 provide care - particularly to community members in greatest need. From pressure on operations and supply chain to capital expenses and beyond, the costs of health systems being ill-prepared for climate events are indisputable (To learn more, read Safe haven in the storm, HCWH, 2018).

Our healing mission. Fulfilling the healing mission of the health care sector requires a partnership between health systems and communities. Preparing to deliver equitable care in times of crisis underpins the need to have a plan for facility and community climate resilience that facilitates adaptation and recovery from climate impacts (to learn more, visit Climate resilience for health care and communities, HCWH, 2022). By being able to deploy a plan in times of climate crisis, the health sector can move beyond its mission to “do no harm” to a mission of “healing.” 

Health equity. The health impacts of climate change are felt right now, particularly by underserved communities that are most vulnerable such as communities of color - the same traditionally underrepresented groups that experience higher rates of health disparities. There is a health equity imperative for health care systems to act to reduce the impacts today on patient populations and other members of the community. “In taking up the mandate to address climate, health, and equity collectively, health institutions will be reimagined — not simply as decarbonized versions of themselves, but as anchor institutions within healthier, more resilient, and more equitable communities” (to learn more, read Tackling climate and health disparities, HCWH, 2022). By leveraging their leadership and purchasing power to underscore their roles as community anchor institutions, health systems realign their priorities to “support community health, community wealth, and climate resilience” (Island Press Urban Resilience Project, 2023).

However, while health systems are increasingly developing greenhouse gas inventories and emissions management plans to mitigate climate change, many systems are only in the nascent stages of building resilience at their facilities and in their community. Further, there is little guidance for health systems about what a “good” climate resilience plan looks like. 

In the U.S., increasing federal momentum has helped further underscore why it is imperative for climate action to include both mitigation and resilience components. On Earth Day in 2022, the U.S. Department of Health and Human Services (HHS) released a Health Sector Climate Pledge inviting health systems across the U.S. to publicly commit to not only decreasing greenhouse gas emissions but also to building climate resilience. As signatories of the pledge, more than 800 hospitals and health systems agree to “develop and release a climate resilience plan for continuous operations by the end of 2023, anticipating the needs of groups in their community that experience disproportionate risk of climate-related harm” (HHS, 2022). 

The Health Sector Climate Pledge is aligned in part with the Race to Zero and Race to Resilience, launched by the United Nations Framework Convention on Climate Change (UNFCCC) in 2021. The Race to Zero and Race to Resilience are international, multi-sectoral initiatives encouraging bold action in climate mitigation and resilience, respectively. 

Not all health systems embarking upon climate resilience planning need to have publicly committed to a U.N. initiative or the Health Sector Climate Pledge. However, all health systems should develop a climate resilience plan, as a key role of the sector is to protect public health. 

In order to meet compliance with the national accrediting body The Joint Commission, hospitals must have an Emergency Operations Plan (2022). The Joint Commission standards require these plans to include aspects such as hazard vulnerability assessments, communication, patient care, security, utilities, disaster recovery, training, and more (EM.09.01.01-EM.17.01.01, 2022). Climate-related emergency management topics of natural disasters, infectious disease, and power systems are required to be addressed - though they are not framed within the context of climate change. 

An Emergency Operations Plan is a natural starting point for health systems to begin drafting their resilience plan that addresses greater climate vulnerabilities to build increased facility, community, and public infrastructure resilience.

Another natural starting point for this work is via a system’s Community Health Needs Assessment (CHNA), which non-profit hospitals are required to complete every three years (to learn more, visit Delivering Community Benefit: Climate and Health Toolkit, Practice Greenhealth, n.d.). Similar assessments are done at for-profit managed care organizations as well. CHNAs reveal the greatest current-state health concerns that exist within a community, which is critical information in centering health equity into climate resilience planning.

Working to merge and expand Emergency Operations Planning and Community Health Needs Assessments with responsible departments collectively establishes a much more cohesive picture of the risks to the hospital and the communities it serves.

In July 2023, the Office for Climate Change and Health Equity (OCCHE) released the following statement: "There is no required method or template for developing a climate resilience plan, but we encourage you to review the recently-published Climate Resilience Plan Elements for Healthcare Organizations, a document OCCHE developed to explain the key elements of climate resilience plans for health care facilities."  In addition to OCCHE’s elements, Health Care Without Harm recommends considering the following guidance when considering the core components of a climate resilience plan. 

The landscape of climate resilience is constantly shifting (in part due to the nature of climate change itself), as are the resources and guidance for what constitutes a climate resilience plan across industries. And while the health sector has been developing Emergency Operations Plans for years, it is relatively new to climate resilience planning. Currently, explicit climate resilience plan requirements do not exist for hospitals, nor does a comprehensive template. This is in part because the resilience plan should meet the unique needs of the community and the unique risk profile of the health system based on the geography where the system is located, among other factors.

Health Care Without Harm and Practice Greenhealth recommend aligning the core components of a climate resilience plan with our 3-pillar model for climate-resilient health systems and communities: health care facility resilience, public infrastructure resilience, and community health resilience. 

While the final product of the resilience plan will look different across health systems, all systems establishing climate resilience plans can use a similar process. Health systems should use OCCHE’s Climate Resilience Plan Elements for Healthcare Organizations and Health Care Without Harm’s 3-pillar climate resilience framework to apply tools and methodologies from the climate and health field (see “Resources”) to their own unique circumstances, as well as drawing from exemplars in sectors outside health care. Furthermore, facilities in large health systems that stretch across varying geographic areas with a wide range of social vulnerabilities each face different needs. System-level plans must be flexible enough to accommodate region-specific climate resilience that factors in diverse geographies and communities.

Due to the disproportionate impacts climate change has on the health of vulnerable communities, it is paramount to include communities not only as a core “end user” of climate resilience planning but also in plan development. To meet the needs of a community, one must first ask the community what it needs - in other words, “by the community, for the community” (to learn more, visit the National Academy of Medicine resource Assessing Meaningful Community Engagement, 2022). Therefore, health systems should engage first in stakeholder mapping exercises and take steps to include representatives of frontline communities before any “official” planning begins. Partnering for resilience: A practical guide to Community-based disaster planning (HCWH, 2022) showcases a successful approach to community-based partnerships and offers a methodology for partnering with the community in the process of establishing a climate resilience plan, including ready-to-use templates and sample materials.

Across the literature, a combination of the following steps commonly guides the creation of a climate resilience plan:

1. Understand climate exposures

2. Assess vulnerability and risk (facility, community, public infrastructure)

3. Brainstorm solutions

4. Write the plan

5. Communicate the plan

6. Reassess climate exposures and evaluate the plan

7. Revise as needed

(Adapted from USGCRP, 2021)

In working through the steps above, we suggest hospitals utilize the following guiding principles for meaningful communication and collaboration articulated in more detail in Anchored by health care: Strategies for health systems (HCWH, 2023):

• Deepen systemic and accountable anchor engagement.

• Co-create a definition of success - and share it.

• Increase diversity in planning beyond community partners.

• Build capacity and advocate for supportive policy changes that open opportunities for deeper anchor investments through hiring, purchasing, and investing. 

• Test innovative solutions for co-ownership of anchor and community strategies and community-led and owned efforts.

The final step to developing a climate resilience plan is to establish a schedule for evaluation and revision; climate resilience plans should be “living” - not static. Not only will climate impacts, risks, and communities change over time, but a health system will learn from their experiences in deploying their plan. Updating the climate resilience plan at regular intervals (e.g. every 3 years) will facilitate a more robust health system response over time, ultimately leading to healthier - and more resilient - patients and communities.