Measuring Climate and Health Readiness: Indicators for a Resilient Future

In 2008, along with wonderful colleagues, I published a report and a paper that were among the first to ask this question of the US public health system: Are we ready for addressing the health impacts of climate change? Seventeen years and many similar reports later, we are still asking the question, now of both our health care and public health systems, and the answers we get are not overly reassuring.

Under the Global Goal on Adaptation (GGA)—the Paris Agreement’s framework for assessing worldwide progress in building resilience—the United Nations Framework Convention on Climate Change (UNFCCC) and the World Health Organization (WHO) have tasked experts to define a set of climate and health indicators that countries can use to track preparedness, adaptation, and recovery. My previous Health Currents examined the first set of three indicators which measured climate-sensitive health outcomes. In this edition, I examine a set of five indicators that all measure outcomes and resilience related to health systems and services.

Mental Health Preparedness and Support (Indicator 9c4)

One of the most innovative additions is an indicator tracking the extent of implementation of mental health and psychosocial support (MHPSS) preparedness and response for climate change–sensitive events. It represents a milestone in acknowledging that climate change affects mental as well as physical health.

The indicator description suggests it will attempt to measure MHPSS implementation not just in disaster response, but in the context of more chronic, less severe climate change impacts as well. It suggests the countries should bring this to a local context as much as possible, given the variations in local hazards and disasters experienced, with reporting at a sub-national level.

There will be challenges in deciding whether MHPSS needs to be specifically designed for climate change impacts, or just available to persons exposed to climate change stressors, and how that implementation is assessed. But I expect the process of even considering how to respond to the survey questions, once they are determined, will speed country-level progress in addressing mental health and psychosocial issues related to climate change.

Health System Damage and Service Disruption (Indicator 9c5)

A second key indicator measures the number of destroyed or damaged health facilities and disruptions to health services associated with climate-related events.

Tracking climate-related damage and disruption to the nation’s health facilities is clearly important and should be straightforward except for one thing: the US doesn’t collect this information. There is no government survey, and no systematic analysis of post-disaster reports to identify incidences of health care facility damage or disruption. The fact that most US health care is in the private sector makes such information more sensitive from a business perspective, contributing to the difficulty collecting systematic data.

Assuming there was interest in developing such an indicator in the United States, what might be the workaround? The American Hospital Association, which routinely surveys hospitals on issues like health care workplace violence, another sensitive topic, could survey their members to track damage and disruption. The Association called on the federal government in 2021 to fund resilience retrofits, demonstrating clear interest in the issue. Accreditation bodies, like the Joint Commission, could also be in a position to routinely collect such data. Lastly, organizations like Practice Greenhealth, which currently produces the most authoritative reports on health care system sustainability, could also theoretically collect some of this information from their members. With the cuts to most of the already meager programs aiming to enhance extreme weather resilience of the nation’s health systems, such systematic collection of data in the private sector will be essential to make the case for more investment and attention.

Climate-Resilient Health Infrastructure (Indicator 9c6)

If the previous indicator measured the adverse health systems outcomes of extreme weather, the next indicator, the percentage of health facilities built or retrofitted to be climate resilient based on national, regional, or global guidance, tracks the adaptation interventions to reduce those outcomes.

Again, there is no systematic collection of such data, and the fragmented private sector nature of the US health system makes such data collection difficult. But the same entities mentioned in the previous section could also collect these kinds of data in addition to the damage and disruption data.

The indicator language refers to national, regional or global guidance. Does that at least exist? Fortunately, it does. Resources like the Climate Resilience for Health Care (CR4HC) toolkit, developed by the HHS Office of Climate Change and Health Equity (OCCHE), provide robust examples and case studies of resilience measures. Perhaps even more importantly, the new LEED v5 for requires resilience assessments, offers resilience credits and even provides a resilience pathway for certification that combines multiple resilience credits. This is a gamechanger because it gives the clearest definition yet of exactly how resilience for health care facilities and other buildings will be measured for the purposes of the influential LEED building certification. And while the certification is focused on the building itself, the resilience credits include more community-facing initiatives like resilience hubs.

Climate-Informed Early Warning Systems for Health (Indicator 9c8)

The next indicator, the level of operationalization of climate-informed health early warning systems for climate change–related health risks accessible to vulnerable groups, asks three questions. First does a country have climate-informed early warning systems? The phrase “climate-informed” underscores the need for systems that integrate forecasts on multiple time scales — from near-term alerts to seasonal and multi-year outlooks. To get there, we need to close the forecast skill gap in the annual to decadal time scale. This would enable governments and private sector entities to more effectively plan capital investments and manage climate change-related risks on a longer, but still human, time scale.

The second question: what is the level of operationalization of those systems? That needs to be defined more. It could involve:

• the number of threats that have early warning systems (heat, wildfire, vector borne diseases, etc.)

• the geographic completeness of early warning systems

• perhaps most importantly, the connection of the early warning system to intervention and response systems.

And then last, are the systems accessible to vulnerable groups? Accessibility is an interesting word. Those most vulnerable will need not just access to the warning, but support in responding despite their heightened vulnerability. The goal is a continuum of early warnings linked to actionable response plans that protect all populations, especially the most vulnerable.

Health Vulnerability and Adaptation Assessments (Indicator 9c9)

Finally, the level of implementation of climate change and health vulnerability and adaptation (V&A) assessments aims to measure how well countries are identifying risks and acting on them. I’m not sure why this indicator focuses on implementation of assessments rather than implementation of actual National Adaptation Plans for health (H-NAPs). Conducting a vulnerability assessment is an essential first step, but we should also be measuring implementation of adaptation steps identified in the V and A. Perhaps the indicator will be modified to reflect this need in its final form.

The US has a good V and A: the fifth National Climate Assessment. But it doesn’t have a comprehensive H-NAP. OCCHE laid the foundation for federal actions with the Climate Change and Health Equity Strategy Supplement to the HHS Climate Action Plan, but a true H-NAP requires far more co-creation and inclusive processes than we were able to do with the time and resources we had.

For large countries with decentralized health systems like the US, India, Canada, etc., this indicator will need to reflect implementation at the subnational level. While state-level health adaptation planning in the US still has a long way to go (see our recent paper), several states are far along in assessing health risks and developing adaptation plans. This indicator should reflect this reality of partial, heterogeneous implementation.

From Indicators to Action

These indicators reflect a significant step forward in defining what climate readiness looks like for public health and health care. They emphasize not only physical resilience but also mental well-being, operational continuity, and inclusive preparedness.

This set is solid but hopefully can be further strengthened at COP30. Good definitions and the inclusion of H-NAPs in Indicator 9c9 will provide health ministries around the world with a robust road map for health protection and system strengthening.