Health Systems Resiliency and Opportunities for Health Services Research
Part 1 of this blog series discussed how health services research can inform climate change responses within health systems with attention to quality, cost, and health outcomes, as well as help policymakers identify what health care services are essential before, during, and after climate emergencies. The following topics include research areas receiving a lot of attention and understudied topics that should be prioritized to fill persisting gaps.
ESTABLISHED AND EMERGING RESEARCH AREAS
Climate-impacts on health and well-being
The widespread impact of climate change on population health has been well established. An overview of systematic reviews on the health impacts of climate change identifies adverse climate-related effects on respiratory, cardiovascular, reproductive, neurological, nutritional, psychological, and occupational health. A recent study in Nature found that not only are large-scale weather disasters costly on municipal and federal budgets, but they are also associated with excess ED visits and mortality in Medicare beneficiaries. The Environmental Protection Agency (EPA) has documented the harmful health impacts of extreme heat events and identifies extreme heat as one of the leading causes of weather-related deaths. Marginalized racial and ethnic communities in urban areas experience disproportionate vulnerability to extreme heat due to systemic racism and residential segregation which shapes “thermal inequity.”
New care delivery models and emerging technologies
Another area that received increased research attention since the COVID-19 pandemic is digital-based care delivery models like telehealth. Telehealth could be an important tool for lowering health care-related greenhouse gas emissions by reducing the carbon footprint associated with facility usage, travel, and equipment costs.
Health informatics and biomedical research is also focusing on the use of digital health technologies and wearable devices in assessing individual-level climate risks and exposures. A scoping review identified 142 studies examining how digital health technologies have been used to help manage climate change-triggered environmental health risks and infectious diseases and reduce the health care system’s contribution to greenhouse gases. For example, wearable devices (e.g., Fitbits) can monitor the effect of heat stress and poor air quality on heart rate, sleep, and physical activity. Smart phones and other mobile devices can be used to record data on how climate events impact dietary behavior and physical activity.
UNDERSTUDIED TOPICS AND AREAS FOR FURTHER HSR CONTRIBUTIONS
Improving data collection and reporting of the health system’s impact on climate change
In April of this year, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule which would, among many other things, support more streamlined collection and sharing of greenhouse gas emissions data between health systems and CMS. Should this new rule be implemented, participating states could voluntarily report metrics related to greenhouse gas emissions and receive technical assistance from CMS to help address threats to patient health due to climate change. Future health services research could evaluate the effectiveness of such climate-response mechanisms and whether there is sufficient uptake or whether increased organizational carbon footprint awareness results in downstream population health improvements. Another health services research topic of growing interest is how savings from health system decarbonization initiatives can be reinvested into expanding equitable access to health care resources.
Collecting and analyzing climate-driven population health outcomes
How climate-related morbidities are recorded in electronic health records (EHR) and health insurance claims data is also understudied. With advancements in health data collection and reporting, health services researchers can pool longitudinal health insurance claims data together following climate events in specific geographic locations to understand risk factors, health care utilization patterns, and health care spending trends. EHR data can be used to link patient outcomes with region-specific climate events, environmental vulnerabilities, access to health care resources services, and community protective factors. The National Center for Health Statistics (NCHS) is integral to shaping priorities for national health data collection, analysis and dissemination of statistical reports. During the pandemic, NCHS quickly mobilized to develop a robust surveillance system of real-time COVID-19 mortality data. NCHS can adapt lessons learned during the pandemic to monitor and evaluate the collection of climate-related morbidities to guide health policy and public health practice.
Comparing region-specific climate exposures, disparities, and inequities
Health services researchers can employ analytic methods to compare the impact of climate-related risk exposures across an array of contrasting settings including comparisons between Medicaid-expansion versus non-expansion states, rural versus urban settings, and land-locked versus coastal regions. For example, health services researchers may explore whether Medicaid expansion and implementation of demonstration projects have resulted in meaningful improvements in health outcomes in climate-stricken areas. In addition, health services researchers can add to the literature documenting how residential segregation and historic redlining practices have systematically placed toxic environmental exposures (e.g., landfills, waste treatment facilities, industrial agriculture farms) while simultaneously underinvesting in health-promoting infrastructure and health care resources in Black, Latino, and Indigenous neighborhoods.
CONCLUSION
While several research areas related to health and climate change have received increased attention in the last decade, the evidence base surrounding health services and delivery reforms needed in response to adverse climate effects is still very nascent. Concerted efforts are needed across the health sector to build a resilient health system. Health services research can help bring these efforts together by generating evidence on the finance mechanisms, care delivery models, public health interventions, organizational structures, and workforce competencies needed to ensure our health system can withstand the pressures of climate change.