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Analysing health system capacity and preparedness for climate change

Nature Climate Change (2024)Cite this article

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Abstract

While increasing literature demonstrating the direct and indirect impacts of climate change focuses on health, the capacity and preparedness of healthcare systems to deal with these impacts are less frequently considered. Here we performed a systematic analysis of peer-reviewed and grey literature to assess the current and projected coping capacity for healthcare systems under climate change. Data from the 129 included publications focused broadly on seven topics: workforce, tools and frameworks, infrastructure and urban planning, communication, surge capacity and increased system burden, service interruption and financial costs. Publications were biased towards high-level representation of acute disaster events, particularly in Global North countries. Non-peer-reviewed literature such as policy and planning documents, which may offer further insights into preparedness, were under-represented and could be a feature of next-generation research. Health systems need to be future proofed through effective policies, adequately trained workforces and redesigned infrastructure to meet the increasing burdens of climate change.

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Fig. 1: Setting of included publications by country.
Fig. 2: Frequency of climate hazards discussed in included publications.
Fig. 3: A rich picture depicting the seven topics identified in the literature.

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Data availability

All datasets generated and analysed for this study, including the search strategy, list of the included and excluded studies, data extracted, analysis plans and quality assessment are available in the article or Supplementary Information. This includes all data used for creating display items. No individual participant data was used for this study.

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Acknowledgements

Thanks to S. Wijekulasuriya and R. Patel for providing desktop support for the project. We also thank M. Simons, a Clinical Librarian at Macquarie University who we consulted to devise the search strategy. J.B., E.C. and J.W. report funding from the National Health and Medical Research Council (NHMRC) for the Partnership Centre for Health System Sustainability to support this work (grant ID 9100002). J.B., E.C. and J.W. are in receipt of NHMRC Leadership Fellowships (IG GNT1176620, IG GNT2008645 and IG GNT1174021, respectively). The agencies providing funding sources had no role in data collection, data analysis, data interpretation or writing of the report.

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Authors and Affiliations

  1. Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia

    Jeffrey Braithwaite, Elle Leask, Carolynn L. Smith, Genevieve Dammery, Ann Carrigan, Ella McQuillan, Lauren Ehrenfeld & Yvonne Zurynski

  2. NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia

    Jeffrey Braithwaite, Carolynn L. Smith, Genevieve Dammery & Yvonne Zurynski

  3. International Society for Quality in Health Care, Dublin, Ireland

    Jeffrey Braithwaite

  4. Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia

    Kalissa Brooke-Cowden

  5. Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia

    Johanna Westbrook

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Contributions

J.B. conceived of the project and led the work. C.L.S. and Y.Z. co-conceived the project. L.E., E.L., G.D., C.L.S., A.C., K.B.-C. and E.M. screened the publications. E.L., G.D., K.B.-C., A.C., C.L.S. and E.M. extracted data from the publications and synthesized the findings from the review. J.B. directly accessed and verified the underlying data reported in the manuscript. J.B. drafted the manuscript with co-authorship from E.L., G.D., K.B.-C., A.C., C.L.S. and E.M. E.C., J.W. and Y.Z. made critical comments on the emerging draft. All authors critically reviewed the final manuscript and take responsibility for its accuracy and presentation.

Corresponding authors

Correspondence to Jeffrey Braithwaite or Carolynn L. Smith.

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Competing interests

J.B., E.C., J.W., Y.Z. and C.L.S. report grants from the NHMRC during the conduct of the review. J.B., E.C., J.W. and Y.Z. report multiple grants from a range of sources, which are all administered by the Macquarie University Research Office. C.L.S. reports a grant from Research Australia. J.B., E.C. and J.W. report financial support for travel from various conferences and invited keynote addresses. J.B. reports financial support for air travel from the International Society for Quality in Health Care. J.B. reports being the Chair of the Board of the International Society for Quality in Health Care and a member of various committees for the OECD and WHO (all unpaid roles). Y.Z. reports being a member of several governance committees such as Australian Health and Hospitals Association, The Deeble Institute for Policy Research and Rare Voices Australia (all unpaid roles). E.L., G.D., L.E., K.B.-C., A.C. and E.M. declare no competing interests.

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Nature Climate Change thanks Rachel Lookadoo and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Extended data

Extended Data Fig. 1 Included publications by year of publication, and trendline.

Results showing the number of publications by year, and the trend in publications. The graph includes publications between 1990 and May 2022, resulting in fewer publications identified in the final year.

Extended Data Fig. 2 Comparison of tropical cyclone-specific publications to other weather and disease-related publications by topic.

Number of tropical cyclone-specific publications (including hurricanes, typhoons, and tropical storms) discussing one or more of the seven topics identified from the full literature set compared to those discussing other climate-related impacts (for example, droughts, floods, heatwaves, vector-bone diseases). Filled bars represent tropical-cyclone specific publications. Unfilled indicates all other publications.

Extended Data Fig. 3 Percentage of publications covering key topics at each health system level.

Percentage of publications discussing identified topic areas from the included literature within a specific level of the health system (micro: ranging from the clinic or department level to whole hospital or facility level; meso: ranging from a local governance level to the provincial or state level; macro: at the whole-system, or at the national to global level).

Supplementary information

Supplementary Information

Supplementary Fig. 1, Tables 1–3, Information 1 and 2 and References.

Supplementary Data 1

Extracted data from included manuscripts (1A and 1B), reason for exclusion of studies at full-text review (1C) and risk of bias assessment and quality appraisal for included studies (1D–1G).

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Braithwaite, J., Leask, E., Smith, C.L. et al. Analysing health system capacity and preparedness for climate change. Nat. Clim. Chang. (2024). https://doi.org/10.1038/s41558-024-01994-4

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