Stress Testing the Capacity of Health Systems to Manage Climate Change-Related Shocks and Stresses
2. Some Limitations of Vulnerability and Adaptation Assessments
3. Climate-Related Shocks and Stresses
4. Conducting a Climate Change and Health Stress Test
- Stage 1: Prepare the climate change and health stress test. Preparing for a climate change and health stress test includes forming the stress test team; reviewing the available data and information, as well as collecting new data and conducting necessary modeling to inform the scenarios developed; identifying priority health system functions and/or climate-sensitive health outcomes for the stress test; developing hypothetical situations (scenarios) of shocks and stresses that form the core of the stress test; and identifying stakeholders for inclusion in the exercise. Preparing the stress test can benefit from linking with a completed climate change and health V&A assessment or one being conducted in parallel. Ideally, the stress test includes multiple aspects of health systems and services, including elements addressing all six building blocks of climate resilient health services .
- Stage 2: Conduct the stress test. Various stress testing modalities could be used, alone or in conjunction. At a minimum, table-top or visioning exercises may be completed by the stress test team in a workshop setting, in which the participants discuss the scenarios and evaluate the extent to which health systems would likely be able to manage the shocks and stresses. Additional modalities could be employed, including agent-based and systems dynamics modeling to explore impacts in silico. Regardless of the approach(es) used, the team should review the findings to identify additional resources, tools, and policies that, if made available, could prevent adverse population health consequences associated with the hypothetical situations. Recommended changes in policies and measures should be prioritized to increase the capacity of communities and health systems to prepare for and manage the climate-related shocks and stresses considered.
- Stage 3: Communicate the results to key stakeholders. A summary report and other outreach materials should communicate the results to key stakeholders. This report should include an overview of climate and health risks and recommendations for actions, considering factors such as the likelihood and timing of the shocks and stresses, competing demands, windows of opportunity to build resilience based on current and planned projects, and stakeholder concerns and preferences.
5. Description of the Stages in a Climate Change and Health Stress Test
5.1. Stage 1: Prepare the Study
5.2. Stage 2: Conduct the Climate Change and Health Stress Test
- Necessity—which actions are most critical;
- Timing—when a particular facility, program or other health system function may be vulnerable to certain climate impacts and when particular actions should be taken in to prepare for and respond to the timing of the hazard and other preparation and response activities;
- Capacity—whether current surge capacity levels and available expertise are sufficient to handle projected impacts, or whether these need to be increased;
- Likely losses—expected increases in morbidity and mortality; facilities where adaptation is prohibitively expensive and should not be undertaken; areas where programs or polices will need to be reevaluated due to unavoidable impacts (e.g., health transportation and supply lines that rely on ice roads); and contingent additional losses if mutual aid is not available); and
- Costs—the economic, political, environmental, and social costs of taking actions to increase resilience, whether they are manageable and how they compare to the costs of inaction.
5.3. Stage 3: Communicate the Results to Decision-Makers and the Public
Conflicts of Interest
Appendix A. Guiding Questions for Stage 1
|Current burden of climate-sensitive health outcomes|
|Future burden of climate-sensitive health risks|
|Environmental factors that could affect population health, including |
|Social and economic context, including |
|Health systems, including factors such as |
|Geography and climate|
Appendix B. Possible Modules to Include in the Climate and Health Stress Test
- An introduction explaining the broader context of the workshop, and demonstrating the commitment of the ministry/department of health to the stress testing
- Review of the ministry/department of health’s long-term goals and relevant plans
- Background information relevant to the health risks of climate change
- Review of vulnerability, adaptation, and capacity assessments, and of adaptation and mitigation plans
- Introduction to the climate change and health stress test process and outcomes
- Facilitated breakout group discussions on the extent to which the health system could manage the hypothetical scenarios, such as changes in the geographic range, seasonality, or intensity of transmission of climate-sensitive health risks with additional climate change, or changes in the intensity of extreme weather and climate events
- Group discussions on what actions and investments are needed in addition to current policies and programs to reduce and manage increases in climate-sensitive health risks
- Conclusions and next steps
Appendix C. Guiding Questions for Discussions at a Climate Change and Health Stress Test Workshop
- What is the level of effectiveness of current control programs to manage the burden of disease? How likely could the programs adjust to manage changes in the geographic range, seasonality, and intensity of transmission of, for example, infectious diseases? Or, how quickly could delivery of health services and supply chains be established in case of an extreme weather and climate event outside of historic experience?
- Are there monitoring and surveillance systems that can provide place-based and timely information? An example is collection and analysis of environmental data that could warn when flooding events are expected, along with data on socioeconomic conditions so that vulnerable regions and populations can be identified.
- Are monitoring and surveillance data incorporated into strategic resource planning (financial, infrastructure, medical personnel and training), distribution chains, disaster preparedness, etc.? Does strategic planning consider climate change-related risks and their potential consequences?
- Are memorandums of understanding in place with other ministries and departments to facilitate timely access to data and information?
- Does experience suggest the level of social capital in the community? Are there activities underway in the community that could be extended to increase social capital?
- Has there been an evaluation of climate-related risks to healthcare infrastructure, and of any challenges to maintaining services in cases of epidemics or extreme weather and climate events? If so, what were the implications of this evaluation?
- Are there education and training programs that could easily incorporate the health risks of climate variability and change?
Appendix D. Examples of Additional Actions for Health Systems to Manage Shocks and Stresses Associated with Climate Change
- Ensure incorporation of health risks into adaptation planning, to strengthen coordination and collaboration across sectors
- Strengthen surveillance, monitoring, and control programs to prepare for climate change-related changes in the geographic range or seasonality of a disease
- Develop early warning and response systems using environmental information to warn of likely outbreaks
- Provide training and capacity building for healthcare professionals to better manage health burdens
- Project how climate-sensitive health outcomes or other risks (e.g., extreme weather and climate events) could change under different scenarios of climate change and development at time periods of interest (e.g., 2030s)
- Consider how development choices could affect future health burdens, for example, the potential consequences of planned urbanization for population vulnerability to flooding
- Improve strategic planning and coordination of policies and programs across departments
- Develop memorandums of understanding and collaborations with other organizations to ensure timely access to and sharing of information and data
- Support research to fill key knowledge gaps
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Ebi, K.L.; Berry, P.; Hayes, K.; Boyer, C.; Sellers, S.; Enright, P.M.; Hess, J.J. Stress Testing the Capacity of Health Systems to Manage Climate Change-Related Shocks and Stresses. Int. J. Environ. Res. Public Health 2018, 15, 2370. https://doi.org/10.3390/ijerph15112370
Ebi KL, Berry P, Hayes K, Boyer C, Sellers S, Enright PM, Hess JJ. Stress Testing the Capacity of Health Systems to Manage Climate Change-Related Shocks and Stresses. International Journal of Environmental Research and Public Health. 2018; 15(11):2370. https://doi.org/10.3390/ijerph15112370Chicago/Turabian Style
Ebi, Kristie L., Peter Berry, Katie Hayes, Christopher Boyer, Samuel Sellers, Paddy M. Enright, and Jeremy J. Hess. 2018. "Stress Testing the Capacity of Health Systems to Manage Climate Change-Related Shocks and Stresses" International Journal of Environmental Research and Public Health 15, no. 11: 2370. https://doi.org/10.3390/ijerph15112370