ANALYSIS
in the face of increasingly substantial climate impacts. To provide services undisrupted by the impacts of climate change will require all the individual building blocks of the health system to be resilient to external stressors. These building blocks include, but are not limited to, the hospital and clinical builds and other physical infrastructure, information and data technology systems, workforce and leadership structures, and healthcare adjacent infrastructure such as road and transport networks. The ability to deliver healthcare during shocks and stressors is broken if one part of the chain is broken, such as a flooded road preventing an ambulance getting through, or a power outage in a surgical theatre. To ensure the NHS is capable of responding to provide urgent and ongoing care in the face of shocks and stressors, government and leaders within the health sector must work together to ensure resilience measures are in place for each component part. The impacts of the climate crisis are not felt uniformly across different communities. Vulnerability varies based upon the pressures experienced and the risk profiles of community members. Engagement of communities, fostering of social cohesion, and community led action have been shown to be particularly effective means to ensure resilience. The NHS must play a vital role in identifying the most vulnerable communities to enable effective allocation of resources. This approach will also allow these communities to be involved in developing community led adaptation strategies from the outset. As climate health risks align with existing socioeconomic determinants of health, by tackling such risks, the NHS will be investing more widely in the health and wellbeing of the UK population, while also attempting to tackle the health inequality caused by climate change. Moreover, promoting greater investment in community based care and community support groups, such as flood support groups, will help foster resilience beyond just the healthcare sector. How will we know what success looks like? While there is broad consensus on the need for NHS mitigation goals and adaptation plans, the “ how ” for achieving impact at scale and pace is more challenging. 40 Data are needed to support the mitigation of emissions and waste in the health sector, and to measure the success of sustainability initiatives. 41 Data, particularly pertaining to scope 1 and 2 emissions, such as the energy usage and efficiency of facilities, and the use of anaesthetic gases, should be systematically and routinely collected and published. The NHS is taking steps to systematise and integrate such data collection; for example, use of the Greener NHS dashboard — which tracks key sustainability indicators to monitor progress towards net zero commitments — is now mandatory for clinical commissioning groups and trusts. The Respiratory Carbon Impact dashboard monitors prescribing of respiratory drugs and aims to give prescribers and commissioners insights into the sustainability impact of prescribing these drugs, along with tools to monitor and improve prescribing practices. 42 Measurement and recording of metrics is only valuable if data are easy to interpret and compare, giving an accurate picture of progress and helping identify areas at risk of stalling. However, currently, metrics and indicators remain primarily uncoordinated, particularly between academic and public institutions. Data that measure health risks and vulnerability, or progress on adaptation are incomplete. 343 Well calibrated health information systems can support the monitoring of and response to climate risks by assessing system capacity, integrating climate information into disease surveillance, and enabling early warning systems and targeted interventions. Shortfalls remain in modelling adaptation strategies within various mitigation scenarios to enable more accurate health impact
Nine of the ten hottest years on record have occurred since the turn of the century, 22 heatwaves are now 30 times more likely due to climate change, 23 and more than 4500 excess deaths occurred in the UK in 2022 caused by heat stress. 24 Rising ambient air temperatures also cause higher rates of heat stroke and dehydration, as well as chronic cardiovascular, respiratory, cerebrovascular, and renal disease. 25 Older people, those with pre-existing health conditions, and those living in more socioeconomically deprived urban areas are more severely impacted. 26 Flooding Flooding events lead to direct and indirect impacts on health. Direct impacts include injuries, drowning, electrocution, and exposure related morbidity. In the medium term there is an increased risk of infections, in particular with atypical organisms and zoonoses. Those experiencing flooding events are at heightened risk of depression, anxiety, and post-traumatic stress disorder. 27 Indirect impacts result from disruption to health services because of damage to healthcare facilities, roads, electricity supply, and communication networks. Vector borne diseases With increasing ambient temperatures, a number of infectious diseases are emerging or increasing in prevalence in the UK, including vector borne diseases such as tick borne encephalitis and vibriosis. As conditions become increasingly amenable for a number of mosquito species, even infections such as malaria, dengue, and Zika might also become established, particularly in the warmer southern parts of the UK. 28 Drought and water quality Droughts will become more frequent and more severe. Reduced river flows combined with higher temperature can lead to algae blooms and impact upon freshwater quality in rivers and lakes. Combined with the environmentally destructive practices of sewage companies, there is a risk to health for those who choose to swim in rivers and coastal areas, and wildlife dependent on these water systems. Over recent years, gastroenteritis, ear, nose, and throat infections, and respiratory infections have all been described by those who have spent time in polluted water. 2930 Food insecurity Extreme weather and environmental destruction is affecting food supply chains and leading to food insecurity in the UK. As well as malnutrition, those living in food insecure households are at higher risk of a range of chronic health conditions, including diabetes, hypertension, arthritis, chronic pain, and poor oral health. 31 Food insecurity is inextricably linked to poverty and lower socioeconomic status. Air quality and pollution UK wide, there are around 40 000 excess deaths each year from air pollution, and worldwide, 7 million excess deaths each year. 3233 Along with burning of fossil fuels, increased ambient temperatures and heat waves contribute to increased concentrations of pollutants such as ozone and particulate matter (PM2.5 and PM10). These pollutants lead to increased morbidity and mortality from cardiovascular and respiratory diseases and have an impact on birth outcomes. 34 These impacts are not equally distributed and people with pre-existing medical conditions and those of lower socioeconomic status are most affected. 35 Creating a healthcare sector able to respond and adapt to the changing patterns of need, providing continuity of service delivery in spite of evolving environmental pressures, is vital to ensure broader national resilience to the climate emergency. Priority areas include formation of adaptation strategies, climate informed health programmes, broader community resilience, and empowerment of the health workforce. The NHS is already engaged with the government in a number of efforts to ensure health sector resilience through formation of national adaptation strategies, including the Adverse Weather and Health Plan. 36 -39 Implementation and accountability will be important in helping to build services that are resilient to disruption
the bmj | BMJ 2024;385:e079259 | doi: 10.1136/bmj-2024-079259
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