Healthcare’s Climate Paradox

When Category 3 Hurricane Katrina tore through Louisiana and nearby states in 2005, it displaced 1.1 million people and killed between 1,300 and 1,850.

News outlets carried shocking images of nursing homes struggling to evacuate residents and hospitals flooded and without power. All but three hospitals in New Orleans were forced to close after Katrina, including the city’s largest public hospital—which was also a Level 1 trauma center for much of the Gulf Coast. More than 100 community health centers were also impacted by Katrina.

“As we see more of these big storms and extreme weather events, it is only going to increase the impact on the health system,” says Lovisa Gustafsson, vice president of the Controlling Health Care Costs program at the Commonwealth Fund. “If there is a forest fire or flood or hurricane and the power is out, the hospitals can’t operate, and there are disruptions in care in the near term and long term as well.”

It doesn’t take a Category 3 hurricane (which has winds of 111 to 129 mph) to wreak havoc on a community’s healthcare system. Hurricane Sandy was just a Category 1 when it hit the United States in 2012, followed by a storm surge that required the evacuation of more than 6,400 hospitalized patients and closure of 26 residential care facilities and six hospitals in New York City. A report on the hurricane’s impact by the American College of Emergency Physicians estimated that about 75,000 people with major health issues lived in areas affected by high water and 54,000 people with health problems lived in areas that experienced total power losses.

Closed healthcare facilities leave a large gap in care for anyone able to stay in areas hit by natural disasters. These events also impact outlying areas, where displaced people inundate the nearby healthcare system with issues related to the weather event and unrelated chronic conditions that need care.

Power is shut down, supply chains are cut off, water supplies can be compromised, and staff—if they stayed behind—may not be able to get to facilities that are open because of lack of transportation.

“Everybody within the healthcare system is impacted by this,” Gustafsson says. “There is spiking utilization because of an increased need for care, and it’s going to be insurers and employers paying those premiums.”

The healthcare system also contributes to environmentally related health issues, experts note.

The healthcare sector makes 8.5% of the emissions (including carbon dioxide, methane, and ozone) in the United States. And the industry has only been increasing its toll on the environment: healthcare emissions rose 6% between 2010 and 2018, according to a 2022 Commonwealth Fund report.

The report notes that only 20% of the emissions attributed to the sector come directly from facilities: on-site boilers, medical gasses, and emissions from energy production. The other 80% come from the production and transportation of products they purchase, like medications and medical devices. During the time period of the Commonwealth Fund report, all three areas increased equally.

In 2022, the Biden administration asked healthcare organizations to sign a climate pledge. More than 1,100 federal and private hospitals (representing about 15% of all hospitals in the United States) have committed to reduce their emissions by 50% by 2030 and reach net-zero operations by 2050; create an executive-level position at each organization to lead their efforts; inventory their supply-chain emissions by the end of this year; and build a climate resilience plan that takes into account the needs of people at high risk for impact by climate events.

“This is one of the things that hasn’t been a big part of climate conversations,” Gustafsson says. “The first premise of medicine is do no harm. But if hospitals are making air quality in a community worse or contributing to excessive heat, they are part of the problem, so they should work to be part of the solution.”