HEALTH CARE WITHOUT HARM | JANUARY 2018 1 Safe haven in the storm Protecting lives and margins with climate-smart health care 2 FINANCIAL SAFE HAVEN IN THE STORM: A FISCAL CASE FOR CLIMATE SMART HEALTHCARE HEALTH CARE WITHOUT HARM | JANUARY 2018 1 Extreme weather events are a growing risk to health care margins and an opportunity to differentiate With the continuing squeeze on In response, a growing number of forward- health care margins, health leaders thinking health leaders are increasing are highly attuned to the potential for even the smallest changes in preparedness so that when the time demographic, economic, regulatory, comes, they can continue full operations or competitive conditions to have a material impact on mission fulfilment and be economic and health anchors for and organizational profitability. their communities. They are also educating Many health systems are already falling short of anticipated earnings policy makers so governments' efforts both due to increased costs and falling support health care resilience, and connect the dots between reimbursement. In this precarious environment, events like heat waves, climate, public health, and the control of health care costs. wildfires, or severe storms can There may be no better way to stand out from the crowd. threaten business continuity and wreak fiscal havoc. Hospitals and health systems US billion-dollar weather/climate disasters (1980 – mid 2017)¹ are at the front line of natural disasters, reducing mortality rates, and responding to public Frequency health impacts. As climate change increases the intensity, duration, Economic issues and geographic reach of extreme weather events, development grows in high-risk regions, and communities Mortality struggle with weak infrastructure, more health care organizations are % 0 20 40 60 80 100 asking how these factors might make their margins more vulnerable. ■ rought ■ xtreme winter storms ■ Wildfire ■ Flooding ■ Severe storms 2 SAFE HAVEN IN THE STORM: PROTECTING LIVES AND MARGINS WITH CLIMATE-SMART HEALTH CARE Weather-related risks are rising throughout the US The yearly average for US well-publicized, and expensive events events – including multiple extreme weather events costing are often storms and floods, but all hurricanes and wildfires – over $1 billion has shot up from a regions are at risk, whether through foreshadow increasing harm, historic 5.5 events in 2012 to 10.5 extreme heat, wildfire, drought, or fatalities, financial damage, events in 2016.² The most damaging, severe winter storms.³ 2017 and displaced populations. Regional climate trends (2014)4 4 Wildfire Drought Extreme heat Rising temperatures Warmer temperatures and drought The West is recording more Western states have seen an US temperatures have increased linked to climate change have persistent droughts. In higher increase in heat wave severity and 1.3-1.9°F since 1895, the majority increased wildfires in the Northwest emissions scenarios, droughts are frequency. The number of extremely occurring since 1970, with the and Rocky Mountain regions. Hotter, projected to become more common hot days is projected to increase by greatest increases in the North and drier summers are projected to across most of the Central and late century. West. Temperatures are expected cause even more large wildfires. Southern US. to continue to rise with the rate of change dependent on greenhouse gas emission volume. Extreme winter storms Flooding Severe storms Extreme precipitation Since the 1950s, winter storm tracks Increased precipitation and changes The Southeast has seen an Over the past 3-5 decades, the have shifted northward with an in soil moisture have caused severe increased intensity, duration, and US, especially in the Midwest and increased frequency and intensity. flooding in the Mississippi and frequency of hurricanes (including Northeast, has experienced frequent Future trends in severe storms Missouri River Basins. Flood patterns category 4 & 5) since the 1980s. heavy downpours, particularly in (thunderstorms, tornadoes, hail) in this region are expected to worsen Storm impacts are exacerbated the winter and spring. are still uncertain. over time. by population growth and urban development patterns – 10 of the 15 fastest-growing US cities are in the South (including Texas). HEALTH CARE WITHOUT HARM | JANUARY 2018 3 Collaborate and innovate to weather the storm Major events like hurricanes, including reliable infrastructure gas emissions is critical to floods, and heat waves endanger (e.g., transportation, energy, water), addressing climate change, and lives and shatter economies. secure supply chains, functioning as energy- and resource-intensive Hurricane Katrina, for example, markets, and an agile workforce. enterprises, hospitals and health caused 1,833 fatalities and The health sector must therefore care systems have roles to play. $160 billion in damages. work together with emergency Improvements in procurement, Being resilient to these events planning departments, education resource use, transportation, and requires preparation beyond the service providers, community service other policies and practices can facility level. A health organization’s organizations, and government save money, reduce the carbon ability to survive a major disaster agencies to build stronger, more footprint, and serve as leadership depends on the surrounding resilient communities. examples to others.5 social and economic environment, Furthermore, reducing greenhouse Impact of major events on the US since 20006 160 1,833 Financial impact of extreme weather events in billions Fatalities ■ Severe storms ■ Drought 80 200 ■ looding 70 ■ Tornadoes 60 ■ Wildfire 150 ■ 50 Extreme winter storms 40 100 30 20 50 10 0 0 S S Ike Ike Ike (2005) (2005) (2008) (2003) (2008) (2003) (2012) (2011) (2001) (2008) (2011) (2012) (2011) (2001) (2008) (2011) (2005) (2012) (2005) (2012) S S A A Katrina Katrina M M C C S S C E E C E C M S M S The link between changing weather and public health While this paper focuses on the conditions, including asthma. global dengue transmission by 3-6% financial impacts of extreme Increased flooding and changing since 1990, and Scientific American weather, health care leaders cannot temperatures affect the survival, reported increases in Puerto Rico, ignore the serious impacts that distribution, and behavior of water- Florida, New York, and California.7,8 changing weather patterns have on related illnesses transmitted by Finally, any extreme weather event public health. Rising temperatures, pathogens, as well as vector-borne generates significant mental health drought, wildfires, and air pollution diseases transmitted by mosquitoes, impacts, especially for those who increase the prevalence of heat- ticks, and rodents. A recent study lose loved ones, income or jobs, related fatalities and illnesses, and published in The Lancet found that housing, or hard-earned savings. exacerbate respiratory health climate change has increased 4 SAFE HAVEN IN THE STORM: PROTECTING LIVES AND MARGINS WITH CLIMATE-SMART HEALTH CARE HEALTH CARE WITHOUT HARM | JANUARY 2018 5 H C Ev ects9 repercussions disruptions T e Traumatic injury & death, mental health Evacuation & consequences from Oating C Dect R population displacement, trauma/stress, carbon demand monoxide poisoning due to loss of property & Suspension or closure Near-term repairs for esearch losses Sver orms power outages, post-event essential infrastructure of key operations emergency fix of critical spread of disease & Hazardous materials Cancellations facilities toxic/carcinogenic Patient evacuation clean up postponements of materials Long-term investments elective treatments Damages to critical Compliance costs of infrastructure Loss of market share utility infrastructure upgrades (e.g., power outages, water as patients seek care supplies, sanitation) from other providers Transportation disruption Population loss Traumatic injury & death (e.g., road closures, Property damage, loss of F (drownings), water-borne & suspension of public essential infrastructure, respiratory diseases, transportation) contaminated drinking mental health water, evacuation, consequences from Government & population displacement trauma/stress management disruption (e.g., law enforcement) S S Iect Lower r Population displacement Temporary disruption mergency supplies Higher insurance D rates Closure or service of critical supplies of food drinks premiums curtailment at hospitals, Change in long-term Medical supplies Less favorale ncreased utilization E medical centers, clinics, I Heat-related illness, costs or availaility terms with payers R evenue pharmacies, leading to by ununderinsured respiratory impacts, of key supplies temperatures treatment delays, patients due to traumatic injury, death mpaired access Poor air & water quality, interruptions, event-related from issues such as Personnel limitations to capital research dangerous road lack of access to injuriesillnesses, direct exposure, funding conditions, property medication leakage from closed low-quality housing, car damage naility to secure accidents, hypothermia, Oating amulatory facilities, Financial pressures frostbite top talent increased poverty stemming from property andor usiness Greater electricity ecreased personnel destruction, loss of failures savings, business closures gas usage engagement lower retention rates elays reductions Overtime pay for Reduction in tax revenue in reimursements We existing personnel from over-stretched dditional hourly