In the wake of the Supreme Court's reversal of the Chevron doctrine, federal agencies such as the Environmental Protection Agency (EPA), have fewer tools for rulemaking and weakened authority to interpret laws using the best available science to inform policy. This shifting legal landscape threatens the Biden Administration’s efforts to advance national policies on environmental protection and climate change. At the same time, climate and environment-related hazards are increasingly impacting health systems and exacerbating poor health outcomes for vulnerable populations, including Medicaid and Medicare beneficiaries. Given this context, it is more important than ever that health systems adopt proactive mitigation strategies to respond to climate shocks that adversely impact health and promulgate disease. Significant investments in health services research are needed to ensure health systems have the right tools, such as data, frameworks, policy guidance, resources, and funding, to make effective and evidence-informed decisions.
Health Systems Resiliency and the Role of Health Services Research
Health services research evidence can help us identify strategies to make our health systems more resilient, but what does that look like? Health systems resiliency has been defined as “the ability, capability and capacity of the health system to predict, prevent, prepare, absorb, adapt and transform when exposed to shocks and stresses and deliver routine health services continuously during the crisis management.” A climate-resilient health system includes infrastructure, finance mechanisms, and operating practices that facilitate strategic resource allocation and emergency preparedness.
The multidisciplinary lens health services research provides is essential for understanding the interplay of social, economic, political, and technological processes that shape health care quality and access under climate threats faced by real-life patients. Health services research can inform climate change responses within health systems with attention to quality, cost, and health outcomes. It can also help policymakers prioritize what healthcare services are essential before, during, and after climate emergencies to improve health outcomes and ensure equitable access to those services.
Contextualizing Health Services Delivery Within the Legacy of Environmental Racism
Importantly, because climate vulnerability is geographically distributed and context-dependent, it is imperative that health services researchers center patient and community decision-making across all research activities, including design, execution, implementation, and dissemination. Environmental and climate justice movements are driven by community activists and grassroots organizations, who sit at the frontlines of the climate crisis, therefore they should be engaged as key leaders in deciding what health system resiliency looks like in different contexts.
Resources that promote climate resilience such as financial freedom, mobility (via public transportation, wheelchair accessibility, walkability, bike paths), public parks, green spaces, toxic-free neighborhoods, and food access are unequally distributed due to structural racism and discrimination. Low-income people and marginalized racial and ethnic communities experience the greatest health risks associated with climate change yet contribute the least to greenhouse gas emissions. Developing health service delivery solutions within the context of environmental and climate justice provides a framework for addressing the structural factors that place a disproportionate burden of climate risks on marginalized communities. Environmental and climate justice concepts are integral to understanding how historical and contemporary environmental harms have shaped the U.S. healthcare system and its peripheries.
Policy and Funding Opportunities to Enhance HSR on Climate Resilience
Despite over a decade of research and discourse on the impact the changing climate will have on human health, the health sector remains ill-equipped to deal with the increased health burdens of the climate crisis (e.g., the impact of wildfires on air quality and respiratory illness) and unprepared to make necessary service adaptations. The policy landscape is ripe for identifying synergies between health services research and other sectors. For example, the Bipartisan Infrastructure Law (BIL) created about 50 programs within the Department of Transportation (DoT) to authorize funding towards investments in better roads and bridges, cleaner transportation (e.g., electric vehicles), safety (e.g., preventing traffic fatalities), and stronger and more accessible public transportation (e.g. building better transport in rural areas). The Inflation Reduction Act (IRA) provides funding to “reconnect communities, advance sustainable aviation fuels, and further reduce emissions by supporting cleaner transportation.” The Justice40 Initiative was created through President Biden’s executive order on revitalizing the nation’s commitment to environmental justice. These policy initiatives demonstrate the linkages between health outcomes and climate-related vulnerabilities. The evidence our field generates is needed to operationalize these federal actions with equity and quality in mind.
Additionally, the U.S. Department of Health and Human Services (HHS) has outlined collaborative strategies across the health sector to address the increasing occurrence of extreme weather and climate events and identifies the role the Agency for Healthcare Research and Quality (AHRQ) plays strengthening the health system’s resilience to climate change. For example, in partnership with the Institute for Healthcare Improvement (IHI), AHRQ developed a blueprint for strategies to reduce the health care sector’s carbon footprint and mitigate climate change. AHRQ is uniquely positioned to identify practical solutions to innovate care delivery and meet the demands of 21st century climate challenges. AHRQ-funded research can help generate an evidence base identifying what care delivery models are most useful for building a resilient health system.
Conclusion
Despite new legal hurdles and increased partisanship shaping climate policy, concerted research efforts are needed to weather the negative impacts of climate change. Health services research can help guide a policy and appropriations agenda to advance healthcare delivery, improve health outcomes, and prevent illness and disease associated climate and environmental hazards. Stay tuned for part 2 of this blog series, which will summarize emerging and understudied topics related to climate resiliency that deserve continued engagement from the health services research community.