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Climate Change and Health Care System Considerations
Topic Collection
February 20, 2024

Topic Collection: Climate Change and Health Care System Considerations

Climate change negatively affects national security, environmental stability, and human health. In 2020 alone, over 20 climate-related disasters occurred in the U.S., resulting in losses of over $1 billion (Smith, 2021). Climate model projections predict an increase in these adverse effects over the next century, with certain existing health threats intensifying and new health threats emerging (Crimmins, Balbus, Gamble, et al., 2016).

Climate-related events impact human health in two ways: they can directly cause illness, injury, increased mental health trauma, and loss of life (e.g., a tornado, hurricane, or other extreme weather event); and indirectly affect population health and disrupt living conditions via damage to critical infrastructure, access to care or public services, and impact to economic systems (e.g., as a secondary result of an extreme weather event). Natural disasters may also be powerful mechanisms of direct and indirect hazardous material releases.

Private and public healthcare and emergency management partners should incorporate the potential impact of climate change into emergency preparedness and future response efforts and on healthcare delivery capabilities.

The resources in this Topic Collection (TC) highlight planning considerations, educational and planning resources, and lessons learned from a variety of natural and human-caused disasters and provide guidance for healthcare practitioners who are committed to addressing climate change and the impacts on healthcare systems. This TC is focused on resources that directly address climate effects. Many additional resources on specific extreme weather hazards that have direct relationship to climate change are included in other TCs.

Stakeholders may also wish to access the following related TCs: Disasters and Healthcare Disparity, Hazard Vulnerability/Risk Assessment, Natural Disasters, Populations with Access and Functional Needs, and The LGBTQI+ Community and Disaster Preparedness and Response.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

ASPR TRACIE. (2022). Climate Change Resilience and Healthcare System Considerations.
Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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Centers for Disease Control and Prevention (2021). Climate Effects on Health.
This webpage contains links to information on the national health effects of climate change on human health, and the various impacts faced regionally.
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Crimmins, A.R., Balbus, J., Gamble, J.L., et al. (2016). The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program.
This assessment provides an in-depth description of climate change impacts and associated health outcomes. The following topics are discussed: climate change and human health; temperature-related death and illness; air quality impacts; extreme events; vector-borne diseases; water-related illness; food safety, nutrition, and distribution; mental health and well-being; and population of concern.
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Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics (e.g., air quality, indigenous peoples, agriculture, and social systems and justice), and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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Guenther, R., and Balbus, J. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate. U.S. Department of Health and Human Services.
This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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Johns Hopkins Bloomberg School of Public Health, and Trust for America’s Health (2020). Climate Change & Health: Assessing State Preparedness.
This report assessed all 50 states and the District of Columbia on their level of preparedness for the health effects of climate change and found a great deal of variation in their preparedness to protect residents’ health. Some states have made significant preparations, while others have barely begun this process.
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Office of Climate Change and Health Equity. (2022). Climate and Health Outlook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health .
Climate and Health Outlooks provide a retrospective look at how select hazards (e.g., heat and drought) affect the U.S. during certain periods of time. This webpage includes additional resources and information, including regional prospective forecasts.
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Reidmiller, D., Jay, A., Avery, C.W., et al. (2018). Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II. U.S. Global Change Research Program.
This report to Congress evaluates the effects of global change on the environment including, agriculture, energy, land and water resources, transportation, and human health. It outlines the projected risks identified by researchers and provides examples of actions that can be taken to reduce risk, increase resiliency, and improve sustainability.
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U.S. Department of Health and Human Services (2021). 2021 Climate Action Plan.
This document provides guidance on how the U.S. Department of Health and Human Services can work to protect the health of Americans from climate change-related threats. It addresses actions to help individuals and communities at greatest risk from these threats.
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U.S. Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) (2016). Climate Resilient Health Care Facilities Toolkit.
This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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U.S. Environmental Protection Agency (2016). Climate Change Impacts by State.
This website provides a breakdown of climate impacts by U.S. state and territory. Additional resources include impact data broken down by region and sectors such as agriculture, energy, transportation, and water.
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Air Quality Resources

ASHRAE. (n.d.). Planning Framework for Protecting Commercial Building Occupants from Smoke During Wildfire Events. (Accessed 6/23/2023.)
Health care building managers and emergency planners can use this framework to incorporate measures into heating, ventilation, and air conditioning, and other components that can protect patients and staff from wildfire smoke and other fine particulates. A summary document is available at https://www.epa.gov/sites/default/files/2021-05/documents/ashrae_journal_article_march_2021-tagged.pdf.
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Centers for Disease Control and Prevention. (2020). Protect Yourself from Wildfire Smoke.
The information on this webpage can help first responders and community members understand the risk and protect themselves from the effects of wildfire smoke.
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Centers for Disease Control and Prevention. (2023). Air Quality: Health Officials & Professionals.
Health care workers can use the resources on this web page to protect their patients and themselves from wildfire smoke.
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* Centers for Disease Control and Prevention. (2023). National Environmental Public Health Tracking Network.
This website brings data together from local, state, and national sources on environmental hazards, environmental health, and population health. Users can explore data by viewing dashboards on state and local tracking programs by location, metadata, and can download datasets. Links to other resources (e.g., success stories, terminology, and related publications) are also provided.
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Centers for Disease Control and Prevention. (2023). Wildfires.
This web page includes information on preparing for and staying safe during and after a wildfire. Links to information for worker safety and the effect of wildfire smoke are also included.
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Environmental Protection Agency. (2023). AirNow.
This website provides air quality data for anywhere in the United States. Users can enter their zip code, state, or city to get local air quality information. The Fire and Smoke Map shows air quality conditions from fine particulate matter generated by wildfire smoke and other sources: https://fire.airnow.gov/
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Gillings School of Global Public Health. (2020). Extreme Heat & Air Quality: Implications for Human Health. (Available for free through the train website. Free registration required.) University of North Carolina at Chapel Hill.
This evidence-based and subject matter expert reviewed training aims to inform health care and public health staff about how extreme heat can worsen air pollution. Learning objectives include defining extreme heat, understanding how heat waves impact air quality, identifying populations vulnerable to these environmental factors, and learning how communities can reduce air pollution during extreme heat.
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IQ Air. (2022). What Pollutants Should I Watch Out For?
This article describes which pollutants are most common, their sources, and similarities and differences in associated health effects.
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* Meyer, M. and Kitchen, S. (2023). Kaiser Permanente Northern California Manual for Wildfire: Air Quality Playbook.
This manual describes the management, preparation, and response to poor air quality caused by wildfires. While specific to California, emergency managers across the country can use it to better understand, plan for, and respond to changes in air quality in their jurisdictions.
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National Institute for Occupational Safety and Health. (2023). Community Respirators and Masks.
This web page provides an overview of hazards in the air (e.g., mold, wildfire smoke, and infectious diseases) and describes the use and protective features of various types of respirators and masks.
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U.S. Environmental Protection Agency. (2021). Comparative Assessment of the Impacts of Prescribed Fire Versus Wildfire (CAIF): A Case Study in the Western U.S.
The authors conducted two case studies of fires in Oregon and California to assess air quality and health impacts of prescribed versus wildfire. They used emissions data, air quality modeling, and health impact analyses and provide statistical information in various tables to illustrate their findings.
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U.S. Environmental Protection Agency. (2021). Smoke-Ready Toolbox for Wildfires.
This toolbox includes information on the effect of wildfire smoke for individuals and healthcare and public health professionals. Links to sites that provide information on current fires are also provided.
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U.S. Environmental Protection Agency. (2021). Wildfire Smoke and Indoor Air Quality: How to Create a Clean Room at Home.
During a wildfire or prescribed fire, residents may be advised to stay indoors as smoke creates unhealthy air quality. This video highlights strategies for creating a clean room to reduce exposure to wildfire smoke while indoors.
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U.S. Environmental Protection Agency. (2022). Children's Health and Wildfire Smoke Exposure Workshop Recommendations.
Public health officials can use the recommendations provided in this document to help in decision-making as it relates to children’s health and the impacts of wildfire smoke. Workshop recommendations focused on four areas: respirator use by children; indoor air quality in schools; sensor use; and school activity guidelines.
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* U.S. Environmental Protection Agency. (2023). Wildfire Smoke and Your Patients’ Health (Web Based) - WB4244R.
This one-hour web-based course can help health care professionals learn more about the health effects associated with wildfire smoke.
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U.S. Environmental Protection Agency. (2023). Wildfire Study to Advance Science Partnerships for Indoor Reductions of Smoke Exposures.
This study examines the effect of wildfire smoke in two locations: Missoula, MT and Hoopa, CA. Scientists are examining the efficacy of air filtration systems, ` air cleaners, and other innovative approaches to help reduce smoke exposure.
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U.S. Environmental Protection Agency, AirNow. (2023). Air Quality Guide for Particle Pollution.
This two-page document includes a chart that identifies the various levels of the air quality index and recommendations on what actions individuals can take to protect themselves from poor air quality.
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U.S. Environmental Protection Agency, AirNow. (2023). Wildfire Guide Factsheets.
This webpage provides a list of factsheets for the general public, which provide information on how individuals can prepare for and protect themselves from wildfires and related health impacts.
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* U.S. Environmental Protection Agency, U.S. Forest Service, Centers for Disease Control and Prevention, and California Air Resources Board. (2019). Wildfire Smoke: A Guide for Public Health Officials.
This guide was developed to help local public health officials prepare for and respond to smoke events. It includes information on protective measures and strategies for communicating with the public about wildfire smoke and health.
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Education and Training

British Medical Journal (2015). Climate Change and Health Impacts.
This infographic depicts the direct impacts of the climate crisis on human health including vector, food, and water borne diseases, air quality, nutrition, and extreme weather.
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* Brubaker, M. (2019). Climate Change and Community Health in Rural Alaska. National Network of Libraries of Medicine Pacific Northwest Region.
The speaker in this one-hour webinar provides an overview of climate change in rural Alaska and highlights related environmental impacts and observed health effects. He also provides specific community examples, and shares adaptations that are being used throughout the state's tribal health system to increase preparedness and bolster resilience.
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Center for Climate and Energy Solutions (2021). Wildfires and Climate Change.
This resource addresses climate change and the key factors that contribute to the increase in frequency of wildfires.
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Crowley, R.A. (2016). Climate Change and Health: A Position Paper of the American College of Physicians. Annals of Internal Medicine.
In this paper, American College of Physicians contributors make recommendations for how healthcare practices can engage in more environmentally sustainable practices and how they can support initiatives to reduce the effects of climate change. It includes information on educating communities and colleagues about the dangers of climate change on human health.
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Global Consortium on Climate and Health Education. (2023). Climate & Health Core Concepts for Health Professionals. Columbia Mailman School of Public Health.
This document provides climate change education core concepts for health care providers. It is a living, flexible document that provides context on the role of health care professionals in protecting patients before and during climate change-related disasters. Core competencies covered include knowledge and analytic skills, communication and collaboration, policy, public health practice, and clinical practice.
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Harvard T.H. Chan School of Public Health (n.d.). Coronavirus, Climate Change, and the Environment a Conversation on COVID-19 with Dr. Aaron Bernstein, Director of Harvard Chan C-CHANGE. (Accessed 2/3/2022.)
This resource summarizes an interview with Harvard public health leadership on how climate change has affected coronavirus transmission, the impacts of air pollution on disease risk, and the importance of health officials addressing climate change.
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Lemery, J., Balbus, J., Sorensen, C., et al. (2020). Training Clinical and Public Health Leaders in Climate and Health. Health Affairs.
This article describes actions being taken to train future leaders and health professionals in understanding the connection between climate change and human health in graduate, postgraduate, and continuing education settings.
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National Center for Disaster Medicine and Public Health. (2018). State of Science. Uniformed Services University of the Health Sciences.
This is the first webinar in a series that discusses the current state and future direction of critical healthcare infrastructure modeling for disaster events including climate change influences. This project focuses on developing a platform that integrates several variables (“extreme event forecasts, health risk/impact assessment and population simulations, critical infrastructure (electrical, water, transportation, communication) impact and response models, healthcare facility-specific vulnerability and failure assessments, and health system/patient flow responses”) to improve regional healthcare system resilience.
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* The National Academies of Sciences, Engineering, and Medicine (2021). Communities, Climate Change, and Health Equity- A New Vision.
This workshop addresses climate change issues related to communities experiencing health disparities and environmental injustice. It includes presentations from environmental health experts, resilience practitioners, climate scientists, and individuals with lived experience.
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U.S. Environmental Protection Agency. (2021). Strategies for Effective Health Risk Communication During Wildfire Smoke Webinar Archive.
This webinar features information for health care communicators on encouraging community members to use the Smoke Sense app and adjust their behaviors depending on local air quality levels.
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U.S. Environmental Protection Agency. (2022). Preparing for Wildland Fire Smoke.
This webinar can help health care emergency planners and building managers prepare for and reduce smoke exposures that can occur indoors during wildfires and prescribed burning.
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* U.S. Environmental Protection Agency. (2023). Wildfire Smoke and Your Patients’ Health (Web Based) - WB4244R.
This one-hour web-based course can help health care professionals learn more about the health effects associated with wildfire smoke.
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Guidance, Frameworks, and Reports

American Public Health Association (APHA) (2018). APHA’s Climate Change and Health Needs Assessment.
This APHA report summarizes the organizations efforts to assess the needs of the public health community to adequately address climate change and integrate it as a health issue. It surveyed a variety of healthcare leaders, representatives, and professionals on two main questions, what does the field of public health need to make progress on climate change, and second, how can APHA members and partners support these efforts.
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Anderko, L., Chalupka, S., Afzal, B.M.. (n.d.). Climate Change and Health: Is There a Role for the Health Sector? (Accessed 2/3/2022.) Catholic Health Association of the United States.
This resource outlines the role of healthcare providers in helping to mitigate the myriad of adverse health outcomes related to climate change and the climate crisis. It discusses respiratory illness, food insecurity, resource scarcity, and addresses at-risk and impoverished populations.
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* ASPR TRACIE. (2022). Climate Change Resilience and Healthcare System Considerations.
Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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Capita Social, Inc. and the Aspen Institute. (2023). Flourishing Children, Healthy Communities and a Stronger Nation: The U.S. Early Years Climate Action Plan.
This plan, developed by a taskforce of twenty parents and climate and health leaders, highlights how climate change affects children under age 8, with a focus on children and families, child- and family-facing programs, and communities. Recommendations for federal, state, and local government and community groups include strategies such as monitoring air quality where children play, designing outdoor spaces with kids in mind, and efforts to make a healthier planet for children are accompanied by examples.
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Centers for Disease Control and Prevention (2021). Climate Effects on Health.
This webpage contains links to information on the national health effects of climate change on human health, and the various impacts faced regionally.
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Centers for Disease Control and Prevention, Climate and Health Program (2020). Preparing for the Regional Health Impacts of Climate Change in the United States.
This report addresses the multitude of health impacts that climate change will have on the various regions of the U.S. It is based on the Fourth National Climate Assessment (NCA4). It also describes actions taken by the Centers for Disease Control and Prevention Climate and Health Program’s health department partners to prepare for and respond to climate change in their communities.
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* Climate Impact Lab. (2020). Global Death Rate from Rising Temperatures Projected to Surpass the Current Death Rate of All Infectious Diseases Combined.
This report summarizes findings from scientists, economists, and data engineers on the disproportionate risk of extreme heat-related death in people who live/work in settings that put them at increased/higher risk of becoming infected or exposed to hazards. It discusses the relationship between increased temperature and higher rates of mortality among those in low-income settings.
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Crimmins, A.R., Balbus, J., Gamble, J.L., et al. (2016). The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program.
This assessment provides an in-depth description of climate change impacts and associated health outcomes. The following topics are discussed: climate change and human health; temperature-related death and illness; air quality impacts; extreme events; vector-borne diseases; water-related illness; food safety, nutrition, and distribution; mental health and well-being; and population of concern.
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Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics (e.g., air quality, indigenous peoples, agriculture, and social systems and justice), and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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DeAlwis, D., Limaye, V.S.. (n.d.). The Costs of Inaction: The Economic Burden of Fossil Fuels and Climate Change on Health in the United States. (Accessed 2/3/2022.) The Medical Society Consortium on Climate and Health, Natural Resources Defense Council, and Wisconsin Health Professionals for Climate Action.
This report estimates the financial impact of climate change on healthcare costs specifically highlighting the harm of fossil fuels, vector-borne disease, and extreme weather events. It tallies the economic toll of each environmental issue and provides recommendations for individuals, communities, and health professionals to mitigate further consequences.
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ecoAmerica (2021). Mental Health and Our Changing Climate, 2021 Edition.
This report explains the impacts of climate change on individual’s mental health and well-being in the U.S. It also provides guidance and resources for action steps for communities, individuals, practitioners, and policymakers.
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Federal Emergency Management Agency (2021). FEMA Resources for Climate Resilience.
This document provides an overview on the U.S. Federal Emergency Management Agency’s role in supporting community resilience and climate change adaptation. It also addresses assessing climate change risks, mitigation planning, and mitigation funding and community capacity building.
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* Georgetown Climate Center (2021). Community-Informed Heat Relief: Policy Options for Addressing Urban Extreme Heat in High-Risk Communities.
This report outlines a new heat plan, originally developed by the District of Columbia, to address cities impacted by urban extreme heat. It provides guidance on supporting at-risk populations experiencing extreme heat events and highlights case studies and policy options.
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* Guenther, R., and Balbus, J. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate. U.S. Department of Health and Human Services.
This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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Hariharan, K., and Zeldin, R. (2021). Outlook on Climate Change as a Healthcare Crisis. Oliver Wyman.
This industry-developed report discusses how the healthcare sector will be impacted by climate change and how they can help mitigate a health crisis. It includes an infographic on the interconnected pathways between climate hazards and adverse health outcomes and includes links to additional reports and statistics on increased mortality risk, disease burden, and mental health issues.
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* Healthcare Ready (2021). Community Disaster Resilience Tool (CDRT).
The CDRT is a map-based interactive tool that can be utilized to help local officials, emergency managers, community leaders, and researchers to identify the risks their communities face due to various vulnerabilities, healthcare infrastructure, and exposure to hazards. It provides an illustration of how public health issues can be exacerbated by natural disasters, and which counties are most at risk.
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InterAcademy Partnership. (2022). Health in the Climate Emergency: A Global Perspective.
This report identifies the detrimental effects of climate change on human health and suggests policy solutions for addressing and countering those effects.
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Johns Hopkins Bloomberg School of Public Health, and Trust for America’s Health (2020). Climate Change & Health: Assessing State Preparedness.
This report assessed all 50 states and the District of Columbia on their level of preparedness for the health effects of climate change and found a great deal of variation in their preparedness to protect residents’ health. Some states have made significant preparations, while others have barely begun this process.
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National Institute of Environmental Health Sciences. (2022). Temperature Effects on Health. National Institutes of Health.
This article includes information on how extreme heat affects human health and how climate change can lead to other extreme weather events, such as extreme cold. It includes a map of how extreme heat may affect mortality, opportunities for public health improvement, research needs, and related links.
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Office of Climate Change and Health Equity. (2022). Climate and Health Outlook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health .
Climate and Health Outlooks provide a retrospective look at how select hazards (e.g., heat and drought) affect the U.S. during certain periods of time. This webpage includes additional resources and information, including regional prospective forecasts.
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Office of Climate Change and Health Equity. (2022). Climate and Health Outlook: Extreme Heat. U.S. Department of Health and Human Services.
This "outlook" is based on temperature projections from the National Oceanic and Atmospheric Administration and others and highlights areas of the U.S. and populations at higher health risk from extreme heat exposure. It also provides related strategies and resources for individuals, healthcare professionals, and public health officials.
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Office of the Director of National Intelligence, National Intelligence Council (2021). Climate Change and International Responses Increasing Challenges to US National Security Through 2040.
This federal report summarizes key climate change challenges to U.S national security as identified by the intelligence community. It focuses on geopolitical tensions, international policies, and specific global conditions such as rising temperatures and their effects on water, at-risk populations, food supply, and migration. The report includes graphics, statistics, maps, and breakdown of international climate conditions and risks.
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Reidmiller, D., Jay, A., Avery, C.W., et al. (2018). Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II. U.S. Global Change Research Program.
This report to Congress evaluates the effects of global change on the environment including, agriculture, energy, land and water resources, transportation, and human health. It outlines the projected risks identified by researchers and provides examples of actions that can be taken to reduce risk, increase resiliency, and improve sustainability.
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Romanello, M., McGushin, A, Di Napoli, C., et al. (2021). The 2021 Report of the Lancet Countdown on Health and Climate Change: Code Red for a Healthy Future. The Lancet.
This report addresses the health impacts of climate change and the health consequences of a delayed response by countries on a global level.
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* Rudolph, L. and Harrison, C. (2016). A Physician’s Guide to Climate Change, Health and Equity. Public Health Institute.
This guide provides an overview of current climate change issues impacting human health and outlines how physicians can affect change as individuals, in practice, and within their organizations. Subsequent sections review specific climate change health impact concerns including extreme heat, droughts, air quality, and infectious diseases.
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* Rudolph, L., Harrison, C., Buckley, L., et al. (2018). Climate Change, Health, and Equity: A Guide for Local Health Departments. Public Health Institute Center for Climate Change and Health.
This guide summarizes key climate impact information related to public health needs and the connection to local health departments. It provides examples for how local health departments can help address the climate crisis and enact change.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2022). Disaster Behavioral Health Information Series Resource Center: Climate Change.
This resource collection includes information on the impact of climate change on behavioral health. Resources cover the psychological impacts of climate change, adaptation, resilience, extreme weather, information for policymakers, trauma, children’s health, and planning for hazards.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2022). The Dialogue: Disaster Behavioral Health in an Era of Climate Change. The Dialogue. 17(3).
This issue of The Dialogue discusses how communities can address vulnerabilities due to climate change. It includes an article on building resilience to the impacts of climate change and an overview of recent technical assistance requests fielded by SAMHSA’s Disaster Technical Assistance Center.
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The CNA Corporation (n.d.). National Security and the Threat of Climate Change. (Accessed 2/3/2022.)
This document examines the impacts of climate change on a national security level. It addresses how climate change has the potential to create sustained natural and humanitarian disasters on a larger scale, and how some of those effects may foster political instability where social demands exceed the capacity of governments to cope.
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The Intergovernmental Panel on Climate Change (n.d.). AR6 Climate Change 2021: The Physical Science Basis. (Accessed 2/3/2022.)
The webpage contains links to the sixth assessment report on climate systems, climate change, and advances in climate science. It includes a summary of the AR6 report for policy makers, a technical summary, and the full report as well as information on data access and an interactive atlas.
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The Intergovernmental Panel on Climate Change. (2022). Climate Change 2022: Impacts, Adaptation and Vulnerability.
This report is the sixth assessment report developed by the Intergovernmental Panel on Climate Change. It provides current and future implications for the negative effects of climate change on the physical and mental health. It includes observed and projected climate change impacts and risks, adaptation measures and enabling conditions, and conditions for climate resilient development.
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The White House (2021). Report on the Impact of Climate Change on Migration.
This federal report outlines geopolitical implications of climate change on migration, conflict, and political instability. It discusses U.S. foreign assistance, policies, and efforts for global capacity building as well as specific regional considerations.
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Trust for America's Health. (2024). Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism.
This report provides an annual assessment of states’ level of readiness to respond to public health emergencies and includes recommendations for policy actions to ensure that the health of communities is protected during such events. Access the 2021 report which focused on steps suggested for states to take to improve their readiness levels while battling the COVID-19 pandemic here: https://www.tfah.org/wp-content/uploads/2021/03/TFAH_ReadyOrNot2021_Fnl.pdf
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U.S. Department of Defense (2021). Climate Adaptation Plan.
This federal report describes the U.S. Department of Defense strategy to maintain operability amid climate change. The framework discusses training, equipment, and supply chain adaptations, as well as how to assess vulnerabilities and enhance resilience.
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U.S. Department of Defense (2021). Climate Risk Analysis.
This federal report discusses the impacts of climate change on the U.S Department of Defense including specific risks and security implications. It outlines strategies and policies the department will incorporate to help combat the climate crisis.
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U.S. Department of Health and Human Services (2021). 2021 Climate Action Plan.
This document provides guidance on how the U.S. Department of Health and Human Services can work to protect the health of Americans from climate change-related threats. It addresses actions to help individuals and communities at greatest risk from these threats.
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* U.S. Department of Health and Human Services (2021). Climate Change, Health and Equity at the Department of Health and Human Services.
This document outlines the U.S. Department of Health and Human Service’s role in addressing climate change as part of the Biden Administration’s climate crisis agenda. Actions include expanding the knowledge base on the impacts of climate change on health outcomes, equity, moving towards greener health systems, and educating the public and workforce.
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U.S. Department of Homeland Security (2021). DHS Strategic Framework for Addressing Climate Change.
This federal framework describes the specific goals and principles of the Department of Homeland Security to combat the climate crisis. These include integrating climate science into future DHS activities, incorporating innovative technologies, and unify leadership and collaboration across the agency and between partners.
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U.S. Environmental Protection Agency. (n.d.). Climate Change Indicators: Health and Society. (Accessed 2/3/2022.)
This EPA webpage explains how changes to the earth’s climate adversely affect human health and discusses the direct and indirect environmental factors associated with these impacts. Additional information includes data on heat-related deaths and illness, greenhouse gases, diseases, and other indicators of climate change.
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* World Health Organization. (n.d.). Health Impacts of Climate Change. (Accessed 2/3/2022.)
This toolkit includes information and resources related to the effects of climate change on health outcomes. It discusses clean air, safe water, sufficient food, and adequate shelter and provides links to health analysis reports, surveys, risk assessments, and guidance documents on climate change and human health.
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* World Health Organization (2020). WHO Publishes Guidance on Climate Resilient and Environmentally Sustainable Health Care Facilities.
This document provides guidance to healthcare professionals and healthcare facility managers to strengthen their facilities from the elements of climate change. The objective is to enable healthcare facilities to prepare for, respond to, recover from and adapt to climate-related events, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it.
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World Health Organization (2021). Quality Criteria for the Evaluation of Climate-Informed Early Warning Systems for Infectious Diseases.
This report documents the criteria needed to measure the effectiveness of using weather-related data to predict disease outbreaks. It outlines the core objectives of an early warning surveillance system that incorporates climate forecast data.
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World Meteorological Organization (2021). WMO Atlas of Mortality and Economic Losses from Weather, Climate and Water Extremes (1970–2019).
This report provides information on the impacts from weather, climate and water extremes globally from 1970 to 2019 based on disaster data from the Emergency Events Database.
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Young, S., Mallory, B., and McCarthy, G. (2021). The Path to Achieving Justice40. The White House.
This website provides information on President Joe Biden’s Justice40 Initiative, which “is a whole-of-government effort to ensure that Federal agencies work with states and local communities to make good on President Biden’s promise to deliver at least 40 percent of the overall benefits from Federal investments in climate and clean energy to disadvantaged communities.”
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Healthcare System Resiliency and Climate Change Footprint Resources

* American College of Physicians. (n.d.). Climate Change Toolkit. (Accessed 2/3/2022.)
This toolkit includes information on how to reduce energy use and greenhouse gas emissions in a healthcare facility or practice. Resources includes power point slides, patient education facts, and talking points broken down by region.
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American Meteorological Society. (2014). A Prescription for the 21st Century: Improving Resilience to High-Impact Weather for Healthcare Facilities and Services.
This report shares workshop findings on increasing and improving the resilience of healthcare facilities and services to high-impact weather events. The workshop grouped their findings into three main categories: hardening structures, making incremental adaptations, and implementing innovative practices.
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Backman, I., and Abbott, F. (2021). Stanford Explainer: Social Cost of Carbon. Stanford News.
This webpage explains the work done by Marshall Burke and Lawrence Goulder, two economists at Stanford University, who describe the social cost of carbon, how it is calculated and used in policymaking, and how it relates to environmental justice.
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Blumenthal, D. and Seervai, S. (2018). To Be High Performing, the U.S. Health System Will Need to Adapt to Climate Change. The Commonwealth Fund.
The authors of this article state that the U.S. healthcare system is the world’s seventh-largest producer of carbon dioxide, which makes the U.S. a major contributor to air pollution. The U.S. must take action to reduce greenhouse gas emissions and take proactive steps to mitigate climate change impacts.
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Budd, K. (2019). Hospitals Race to Save Patients- and the Planet. Association of American Medical Colleges.
This article highlights hospital contributions to greenhouse gas emissions and waste amid the climate crisis. It details specific actions that can be taken to reduce the carbon footprint of a healthcare facility with specific examples and case studies.
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Chen, A., and Murthy, V. (2019). How Health Systems are Meeting the Challenge of Climate Change. Harvard Business Review.
This article summarizes discussions with four major health systems taking action against the climate crisis by moving to make their facilities carbon neutral and building climate resiliency. It summarizes specific efforts being taken at the Cleveland Clinic, Kaiser Permanente, Boston Medical Center, and Partners Healthcare.
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Cooper, R. (2019). States Take the Lead to Address Climate Change. National Academy for State Health Policy.
This article summarizes recent state actions to mitigate the climate crisis and includes specific information on state policy goals, partnerships, and collaborations. It addresses protection of public health, environmental justice, and equity as well as how health systems can reduce emissions.
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Cummings, M. (2019). Health Care Industry is a Major Source of Harmful Emissions. Yale News.
The author states that the U.S. healthcare system contributes 10% of the nation’s carbon emissions and 9% of harmful non-greenhouse air pollutants. He also notes that the rate of greenhouse emissions from the healthcare sector increased by 30% between 2006 and 2016.
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DeAlwis, D. and Limaye, V.S. (n.d.). The Costs of Inaction: The Economic Burden of Fossil Fuels and Climate Change on Health in the United States. (Accessed 3/9/2022.) The Medical Society Consortium on Climate and Health, Natural Resources Defense Council, and Wisconsin Health Professionals for Climate Action.
This report estimates the financial impact of climate change on healthcare costs specifically highlighting the harm of fossil fuels, vector-borne disease, and extreme weather events. It tallies the economic toll of each environmental issue and provides recommendations for individuals, communities, and health professionals to mitigate further consequences.
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* Deitchman, S.D., Kirsch, T.D., Auerbach, P.S., et al. (2021). Climate Resilience: It is Time for a National Approach. Health Security.
This article addresses how climate-related disasters impact human health in two ways: they can directly cause illness, injury, increased mental health trauma, and loss of life (e.g., a hurricane or other extreme weather event); and indirectly affect population health and disrupt living conditions via damage to critical infrastructure, public services, and economic systems (e.g., as a secondary result of an extreme weather event).
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Frentzel, E., Roberson, B., Madan, I., et al. (2019). The State of Climate Resilience and Climate Mitigation Efforts at Essential Hospitals. Essential Hospitals Institute.
This report presents findings and recommendations related to building climate resilience at essential health practices and outlines how they can help mitigate climate change, engage communities, and educate partners.
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* Gan, C.C.R., Banwell, N., Pascual, R.S., et al. (2019). Hospital Climate Actions and Assessment Tools: A Scoping Review Protocol. BMJ Open. 9:e032561.
This review, a part of the climate-smart healthcare initiative, assesses current hospital climate actions and the existing tools available to measure progress.
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Global Green and Healthy Hospitals. (n.d.). Climate Change. (Accessed 2/3/2022.)
This webpage provides information on the Global Green and Healthy Hospitals initiative to move hospitals and healthcare facilities towards more sustainable green practices. It outlines how hospitals can contribute to reducing the impact of the climate crisis, opportunities for action, and resources for reducing climate-related impacts on health.
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* Guenther, R., and Balbus, J. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate. U.S. Department of Health and Human Services.
This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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Health Care Without Harm. (2019). Health Care’s Climate Footprint: How the Health Sector Contributes to the Climate Crisis and Opportunities for Action. Associated Regional and University Pathologists.
This research paper includes information on the healthcare sector’s impact on climate change. It includes a roadmap and policy recommendations for decarbonizing the healthcare industry and how to support climate-smart healthcare practices.
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* Healthcare Climate Council (2020). Climate Action: A Playbook for Hospitals.
This playbook discusses how hospitals are operationalizing solutions to mitigate climate impacts in the healthcare sector. It includes sections on energy, food, waste, operating rooms, purchasing, and community resilience.
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Kaiser Health News. (2021). Hospitals Confront Climate Change as Patients Sick from Floods, Fires Crowd ERs.
This article explains how the healthcare industry is having a negative impact on climate change. It states that U.S. healthcare facilities consume more energy than any industry except for food service. Hospitals consume 2.5 times as much energy per square foot as typical office buildings, contribute to tons of medical waste, and emit atmosphere-damaging gases used in surgery and other procedures.
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Mercer, C. (2019). How Health Care Contributes to Climate Change. Canadian Medical Association Journal. 191(14): E403–E404.
This article addresses the impacts that the healthcare industry in Canada has had on climate change. It states that from 2009-2015, healthcare in Canada was accountable for 4.6% of national greenhouse gas emissions. The author claims that research has indicated that healthcare emissions (through the relationship between air pollution and human health) results in 23,000 years of life lost due to disability or early death.
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Meyer, M. (2021). Doctors Pledge to Do No Harm. The Entire Health Care Sector Should Do the Same by Battling Climate Change. Stat News.
This article outlines key aspects of climate change on human health, including recent statistics on impacts and initiatives taken in healthcare. It provides specific recommendations to reduce waste, pollution, and carbon footprint.
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Paterson, P.B., Berry, P., Ebi, K., et al. (2014). Health Care Facilities Resilient to Climate Change Impacts. International Journal of Environmental Research and Public Health. 11(12): 13097–13116.
This article focuses on how to make healthcare facilities more resilient to climate change and how to identify gaps in preparedness. It also addresses how “healthcare facilities contribute significantly to greenhouse gas emissions through the energy intensive 24-hour operation of services and to environmental degradation through the high demand of healthcare services and operations on natural resources (energy, water, and food procurement).”
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* Practice Greenhealth. (n.d.). Energy and Health Impact Calculator. (Accessed 2/3/2022.)
This web-based tool utilizes the U.S. Environmental Protection Agency and U.S. Department of Energy data to calculate the negative health impacts caused by fossil fuel use. It estimates the number of health-related incidents such as premature deaths, hospitalizations, respiratory issues, and emergency room visits as well as the associated dollar value per unit of emissions.
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Practice Greenhealth (2020). Climate and Health.
This webpage provides information on the Practice Greenhealth initiative to provide solutions that improve patient, employee, and community resilience, environmental stewardship, and sustainability in healthcare.
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Resilient Cities Network. (n.d.). Urban Resilience. (Accessed 2/3/2022.)
This project, started by the Rockefeller Foundation, is a network of cities, officials, community leaders, and businesses committed to increasing the capacity of urban areas to recover from and adapt to social, economic, and environmental stressors that impact their ability to thrive. This includes creating programs around climate change, natural disasters, and social inequity.
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Shankar, D. and Ahsanuddin, S. (2019). It’s Time for the Health Care System to Reckon with the Human Costs of Climate Change. Health Affairs.
The authors of this article state that the U.S. healthcare sector produces about 10% of the nation’s total annual carbon emissions. In 2011, the healthcare sector produced 655 million metric tons of carbon dioxide and other greenhouse gases. The authors also highlight how healthcare organizations lag behind every other economic sector in sustainability reporting.
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Sherman, J.D., McGain, F., Lem, M., et al. (2021). Net Zero Healthcare: A Call for Clinical Action. British Medical Journal. 374:n1323.
This article identifies several ways in which the healthcare sector can support sustainability initiatives, such as clinicians having the ability to determine whether monitoring and treatment of patients can be administered at home, clinic, or the hospital, which has the highest resource and emissions intensity. The authors also explain how providing care virtually as appropriate can reduce fuel and clinic emissions.
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Tennison, I., Roschnik, S., Ashby, B., et al. (2021). Health Care’s Response to Climate Change: A Carbon Footprint Assessment of the NHS in England. The Lancet Planetary Health. 5(2). E84-E92.
The authors of this article note that the healthcare sector is responsible for approximately 4-5% of global greenhouse gas emissions. They also state that mitigation efforts will result in substantial reductions of emissions, which can also lead to enhanced patient care, staff satisfaction, and cost savings.
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The Commonwealth Fund. (2022). How the U.S. Health Care System Contributes to Climate Change.
The authors describe how health care in the U.S. contributes to greenhouse gas emissions, focusing on three different scopes of impact: direct emissions, indirect emissions from electricity, and all other indirect emissions. They also provide information on carbon neutrality for health care, why reducing health care’s carbon footprint is important, and next steps toward reducing health care system emissions.
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* U.S. Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) (2016). Climate Resilient Health Care Facilities Toolkit.
This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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* World Health Organization (2020). WHO Publishes Guidance on Climate Resilient and Environmentally Sustainable Health Care Facilities.
This document provides guidance to healthcare professionals and healthcare facility managers to strengthen their facilities from the elements of climate change. The objective is to enable healthcare facilities to prepare for, respond to, recover from and adapt to climate-related events, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it.
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Health Access, Equity, and Climate Resources

Agency for Toxic Substances and Disease Registry. (2021). CDC/ATSDR Social Vulnerability Index. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
The CDC/ATSDR Social Vulnerability Index (CDC/ATSDR SVI) uses 15 U.S. census variables to help local public health officials and emergency response planners meet the needs of socially vulnerable populations in emergency response and recovery efforts.
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American Psychiatric Association. (2023). How Extreme Weather Events Affect Mental Health.
This webpage describes how extreme weather such as floods and droughts can affect behavioral health. It outlines populations which may be more affected by these events, such as children, people living with chronic illness, older adults, or people experiencing poverty. Information on long-term and interconnected effects of climate change is highlighted, and links to related resources are also provided.
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ASPR TRACIE. (2021). Disasters and Healthcare Disparity.
Healthcare inequity has always been a challenge across the U.S. The rate of disasters has increased over the years and the COVID-19 pandemic has ravaged the country, striking communities of color and other underserved populations especially hard. Healthcare professionals and emergency managers may benefit from a better understanding of the complex relationships that affect fair access to healthcare. The resources in this Topic Collection highlight these considerations, factors, and lessons learned from a variety of natural and human-caused disasters and provide guidance for healthcare practitioners who are committed to addressing healthcare disparity.
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Climate Central. (n.d.). Special Topic: Seniors at Risk. (Accessed 1/5/2024.)
This report discusses the impacts to older adult populations living in coastal areas affected by global warming, sea level rise, and extreme weather conditions such as flooding and hurricanes. It emphasizes areas such as Florida where nursing homes and assisted living facilities account for a large percentage of the community.
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Dodgen, D., Donato, D., Kelly, N., et al. (2016). Chapter 8: Mental Health and Well-Being. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This book chapter explores the effects of climate change on mental health. It covers extreme weather events such as flooding, extreme heat, climate change as a cause of stress, resilience, recovery, and populations at risk, emerging issues at the intersection of climate and health, and potential avenues for future research.
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* Georgetown Climate Center. (n.d.). Equitable Adaptation Legal and Policy Toolkit. (Accessed 2/3/2022.)
This toolkit includes best practices for how cities can address disproportionate socioeconomic risks associated with climate change. It includes information on equitable adaptation planning, social equity, and climate resilience initiatives.
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* Home Health Care News. (2021). It’s Impacting the Entire Industry: The Threat Climate Change Poses to Home-Based Care.
This article discusses the issues home healthcare providers face when caring for older adults in areas continuously impacted by extreme weather conditions, including extreme heat, hurricanes, and extreme rains or flooding.
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Office of Climate Change and Health Equity. (2023). Protecting Vulnerable Patient Populations from Climate Hazards: A Referral Guide for Health Professionals. Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.
This webpage aims to educate human services and health care providers on how social determinants of health may affect their clients’ wellbeing in the context of extreme weather (e.g., heat waves, wildfires) which may be exacerbated by climate change. The page includes links to programs such as the Low-Income Home Energy Assistance Program and the Weatherization Assistance Program.
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* Rudolph, L. and Harrison, C. (2016). A Physician’s Guide to Climate Change, Health and Equity. Public Health Institute.
This guide provides an overview of current climate change issues impacting human health and outlines how physicians can affect change as individuals, in practice, and within their organizations. Subsequent sections review specific climate change health impact concerns including extreme heat, droughts, air quality, and infectious diseases.
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* Rudolph, L., Harrison, C., Buckley, L., et al. (2018). Climate Change, Health, and Equity: A Guide for Local Health Departments. Public Health Institute Center for Climate Change and Health.
This guide summarizes key climate impact information related to public health needs and the connection to local health departments. It provides examples for how local health departments can help address the climate crisis and enact change.
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Smiley, K., Noy, I., Wehner, M., et al. (2022). Social Inequalities in Climate Change-Attributed Impacts of Hurricane Harvey. Nature Communications. 13, 3418. .
Using land-parcel and census tract socio-economic data, the authors examine the relationship between social inequalities and climate change-related (specifically due to Hurricane Harvey) extreme weather event effects. They found that Latina/x/o neighborhoods--specifically those that were low-income and located outside of FEMA’s 100-year floodplain--were disproportionately affected. They emphasize the need to address the impact climate change is already disproportionately having on certain populations in addition to planning for future events.
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Substance Abuse and Mental Health Services Administration. (2023). Climate Change and Health Equity.
This webpage provides an overview of the impact of severe weather exacerbated by climate change on health, information on risk assessment, planning, outreach, education, disaster response, and adaptations after a disaster has occurred. Links to related resources are also provided on the page.
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* The National Academies of Sciences, Engineering, and Medicine (2021). Communities, Climate Change, and Health Equity- A New Vision.
This workshop addresses climate change issues related to communities experiencing health disparities and environmental injustice. It includes presentations from environmental health experts, resilience practitioners, climate scientists, and individuals with lived experience.
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Trust for America’s Health (2021). Climate Change Case Studies Series.
As a follow up to the Climate Change & Health: Assessing State Preparedness document developed in 2020 by the Johns Hopkins Bloomberg School of Public Health and Trust for America’s Health (cited in this document), this case study series is focused on two factors of equity. The first is procedural equity, which addresses to the inclusiveness and accessibility of the process employed to conceptualize, design, and administer programs. The second is distributional equity, which addresses to the level of fairness in allocating program benefits and burdens. In part one of this series, case studies are focused on disadvantaged communities in California, coastal communities in Louisiana, and populations affected by extreme heat in Philadelphia. Part two of this series includes adaptation efforts that result in distributional equity and allocation of benefits.
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* U.S. Department of Health and Human Services (2021). Climate Change, Health and Equity at the Department of Health and Human Services.
This document outlines the U.S. Department of Health and Human Service’s role in addressing climate change as part of the Biden Administration’s climate crisis agenda. Actions include expanding the knowledge base on the impacts of climate change on health outcomes, equity, moving towards greener health systems, and educating the public and workforce.
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U.S. Department of Health and Human Services. (2023). Climate Change and Health Equity Actions.
This website contains information on the Office of Climate Change and Health Equity’ three primary goals: reduce the impact of climate change for people living in the U.S. (especially the most vulnerable), improve the sustainability and resilience of the U.S. health system, address social determinants of health while addressing climate change through domestic actions and the coordination of departments in the federal government.
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U.S. Environmental Protection Agency. (2022). Understanding the Connections Between Climate Change and Human Health.
This article explains how climate change affects human health and includes a diagram of the factors that contribute to health impacts. The authors outline determinants of vulnerability to extreme weather events, including exposure, sensitivity, and ability to adapt.
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* United States Census Bureau. (2021). Community Resilience Estimates for Equity Dashboard.
The Community Resilience Estimates (CRE) program provides metrics of social vulnerability at the local neighborhood-level in the U.S. to the impacts of disasters, including COVID-19. The program helps provide context as to why certain areas may be vulnerable or resilient. This dashboard combines data from the 2019 Community Resilience Estimates and the 2015-2019 American Community Survey five-year estimates. Note that this resource should be paired with natural hazard mapping tools to understand at-risk community vulnerabilities.
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Lessons Learned

ASPR TRACIE. (2021). Managing the Storm After the Storm: Healthcare in TX Recovers from Severe Winter Weather.
Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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* ASPR TRACIE. (2022). Climate Change Resilience and Healthcare System Considerations.
Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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* Brubaker, M. (2019). Climate Change and Community Health in Rural Alaska. National Network of Libraries of Medicine Pacific Northwest Region.
The speaker in this one-hour webinar provides an overview of climate change in rural Alaska and highlights related environmental impacts and observed health effects. He also provides specific community examples, and shares adaptations that are being used throughout the state's tribal health system to increase preparedness and bolster resilience.
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California Air Resource Board (2021). Camp Fire Air Quality Data Analysis.
This resource provides data on the air quality and other impacts from the 2018 Camp Fire. These resources can help healthcare professionals anticipate and understand the impact wildfire smoke has on respiratory health.
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Coleman, K., Marsh, M., and Henrickson, B. (2019). Northern California Wildfires and Lessons Learned: Medical Health Response and Shelters. County of Marin Health and Human Services.
This 2.5-hour recording features speakers from the state and two counties sharing lessons learned from the northern California wildfires of 2017 specific to the medical health response and the need for shelters. The speakers highlight how lessons learned from recent extreme fire behavior can inform healthcare planning.
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Do, V., McBrien, H., Flores, N., et al. (2023). Spatiotemporal Distribution of Power Outages with Climate Events and Social Vulnerability in the USA. Nature Communications. 14. .
The authors reviewed power outages from 2018–2020, and found "an average of 520 million customer-hours total without power annually across 2447 US counties (73.7% of the US population)." Longer outages were more likely to occur in northeastern, southern, and Appalachian counties, while counties in Arkansas, Louisiana, and Michigan experienced both frequent 8+ hour outages and higher social vulnerability and prevalence of electricity-dependent durable medical equipment use. Considerations for disaster preparedness and response are included.
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Fox, M. (2019). Climate Change: What Does it Mean for the Future of Surgery? The American College of Surgeons- Bulletin.
This feature article summarizes recent findings on how climate change is affecting human health and specifically surgical practices. It discusses extreme weather and heat events, air pollution, and climate-sensitive diseases as well as how these issues disproportionately impact at-risk populations.
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Frontline Wildfire Defense (2020). California Wildfires History & Statistics.
This resource specifically addresses the history of California’s wildfires, statistics on various California wildfire events, and what causes wildfires in California. Yearly statistics and individual fire statistics are available.
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Frueh, S. (2021). Climate Change and 'A New Normal of Extremes'. The National Academies of Sciences, Engineering, and Medicine.
This article provides information on the topics that were addressed during a webinar held related to climate change and the impacts of severe weather events. Topics included planning for the unexpected, focusing on people and not only property, and revamping risk communications.
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Hersher, R. (2021). The Floods in Tennessee Aren’t Freak Accidents. They’re a New Reality. NPR.
The author addresses how climate changed has impacted Tennessee and describes the rain and deadly flash flooding incidents that inundated central Tennessee in 2021.
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* Home Health Care News. (2021). It’s Impacting the Entire Industry: The Threat Climate Change Poses to Home-Based Care.
This article discusses the issues home healthcare providers face when caring for older adults in areas continuously impacted by extreme weather conditions, including extreme heat, hurricanes, and extreme rains or flooding.
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Kacik, A. (2019). California Hospitals Adjust to a New Normal as Fires Rage. Modern Healthcare.
This article discusses how California hospitals are facing the reality of increased black outs, evacuations and wildfires which caused hospitals to increase preparedness activities in response to natural and man-made threats.
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Keefe, J., and Ramirez, R. (2021). Our Underwater Future: What Sea Level Rise Will Look Like Around the Globe. Cable News Network.
This CNN article summarizes recent analysis from organizations focused on researching and reporting the impacts of climate change focusing on predicted sea level rise.
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Pierre-Louis, K., and Schwartz, J. (2021). Why Does California Have So Many Wildfires? New York Times.
This article describes how scientist have designated two wildfire seasons in California due to lack of rainfall, increase temperatures, and Santa Ana Winds.
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Smith, A.B. (2021). 2020 U.S. Billion-dollar Weather and Climate Disasters in Historical Context. National Oceanic and Atmospheric Administration (NOAA).
This webpage explains NOAA’s National Centers for Environmental Information 2020 update to its Billion-dollar Disaster Report. The report describes what communities across the U.S. experienced in 2020 was a historic year of extremes.
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Sonoma County Ag + Open Space, and The Sonoma County Watershed Collaborative (2019). 2017 Sonoma Complex Fires.
This document describes the 2017 Sonoma Complex Fire (consisting of the Nuns, Tubbs, and Pocket Fires) that burned over 87,000 acres of Sonoma County’s lands and future mitigation strategies through landscaping and hardscaping that may reduce future damage.
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Staletovich, J., and Switalski Muñoz, C. (2021). For the Elderly in Nursing Homes, Climate Change Poses Graver Risks. WLRN Public Radio and Television.
This article discusses the dangers faced by elderly citizens, nursing home residents, and staff amid increased flooding and extreme weather conditions in Florida due to climate change. It relays real-life accounts of what it was like to evacuate and care for elderly residents after Hurricane Irma in 2017 and includes statistics and assessments from a Climate Central report on risks to seniors.
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Stanley, A. (2021). The Coming Age of Climate Trauma. The Washington Post.
This article addresses how individuals in a California community live with post-traumatic stress disorder and other mental health disorders three years after the devastating Camp Fire that occurred in 2018.
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State of California Government, California Department of Forestry and Fire Protection (CAL FIRE) (2021). Incidents Overview Homepage.
This web page provides detailed information about all fire incidents in the State of California. This chart also provides a list of the Top 20 Largest California Wildfires, and includes the fire name and cause, date, county where the fire occurred, number of acres burned, number of structures damaged, and the number of fatalities.
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The National Academies Press (2019). Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop.
Workshop participants discussed the effects of wildfires on certain populations and human health, challenges associated with recovery, improving operational response, and "the impact of mitigation and preparedness."
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United States Global Change Research Program. (2016). Following a Devastating Tornado, Town and Hospital Rebuild to Harness Wind Energy. U.S. Climate Resilience Toolkit.
This article highlights how the city of Greensburg (KS) and its hospital Kiowa County Memorial recovered and rebuilt after a 2007 tornado that damaged or destroyed more than 90% of the structures in the community.
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Plans, Tools, and Templates

* American College of Physicians. (n.d.). Climate Change Toolkit. (Accessed 2/3/2022.)
This toolkit includes information on how to reduce energy use and greenhouse gas emissions in a healthcare facility or practice. Resources includes power point slides, patient education facts, and talking points broken down by region.
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California Association of Health Facilities. (n.d.). CAFH’s Ready, Set, Go: Extreme Cold. (Accessed 2/25/2020.)
This factsheet lists components for healthcare facilities to consider when creating an extreme cold “action plan.” Information is provided under three categories: Get Ready (creating the plan); Get Set (preparing staff for cold weather); and Go! (activating the plan and policies). Additional information and links are provided at the end of the document. This document may have specific value as a starting point for communities that do not frequently experience severe cold weather events.
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California Department of Public Health (2022). Wildfire Smoke: Considerations for California's Public Health Officials.
This document contains information for California’s public health officials, emergency management professionals, and others involved in planning for and responding to wildfire smoke incidents. Information is provided on wildfire smoke and health risks, sensitive populations, strategies to reduce exposure during wildfire smoke incidents, and specific guidance for public health planning and response. Tools and best practices are included, particularly those that emphasize assessing community vulnerabilities and the protection of sensitive populations. Appendices include additional resources and links, organized by topic.
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* Centers for Disease Control and Prevention. (2023). National Environmental Public Health Tracking Network.
This website brings data together from local, state, and national sources on environmental hazards, environmental health, and population health. Users can explore data by viewing dashboards on state and local tracking programs by location, metadata, and can download datasets. Links to other resources (e.g., success stories, terminology, and related publications) are also provided.
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City of Houston (2021). Houston Climate Impact Assessment 2.0: Understanding Houston’s Past and Future Climate and What it Means for You.
This assessment report helped identify how future temperature and precipitation is expected to change in the greater Houston area through 2100. Specific indicators were used to assess the impacts, including the estimated likelihood and frequency of high intensity events (e.g., droughts, heavy rainfall, and heat waves), in addition to more chronic stressors (e.g., the annual average temperature, and number of hot days with temperatures above 100 degrees Fahrenheit).
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Climate Central (2021). Climate Change and Human Health Toolkit.
This toolkit provides information on how weather and climate change impact human health and how to decrease climate-related health risks in the future. Topics cover extreme heat events, air quality, mental health, and equity.
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Columbia Climate School International Research Institute for Climate and Society. (n.d.). IRI Climate and Society Map Room. (Accessed 2/3/2022.)
This resource is a collection of maps and data that monitor climate and societal conditions, such as health, agriculture, food security, water, and fire. The tool allows users to analyze, visualize, and download terabytes of climate related data.
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* Georgetown Climate Center. (n.d.). Equitable Adaptation Legal and Policy Toolkit. (Accessed 2/3/2022.)
This toolkit includes best practices for how cities can address disproportionate socioeconomic risks associated with climate change. It includes information on equitable adaptation planning, social equity, and climate resilience initiatives.
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* Georgetown Climate Center (2021). Community-Informed Heat Relief: Policy Options for Addressing Urban Extreme Heat in High-Risk Communities.
This report outlines a new heat plan, originally developed by the District of Columbia, to address cities impacted by urban extreme heat. It provides guidance on supporting at-risk populations experiencing extreme heat events and highlights case studies and policy options.
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* Healthcare Climate Council (2020). Climate Action: A Playbook for Hospitals.
This playbook discusses how hospitals are operationalizing solutions to mitigate climate impacts in the healthcare sector. It includes sections on energy, food, waste, operating rooms, purchasing, and community resilience.
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* Healthcare Ready (2021). Community Disaster Resilience Tool (CDRT).
The CDRT is a map-based interactive tool that can be utilized to help local officials, emergency managers, community leaders, and researchers to identify the risks their communities face due to various vulnerabilities, healthcare infrastructure, and exposure to hazards. It provides an illustration of how public health issues can be exacerbated by natural disasters, and which counties are most at risk.
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* Meyer, M. and Kitchen, S. (2023). Kaiser Permanente Northern California Manual for Wildfire: Air Quality Playbook.
This manual describes the management, preparation, and response to poor air quality caused by wildfires. While specific to California, emergency managers across the country can use it to better understand, plan for, and respond to changes in air quality in their jurisdictions.
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Nashville Mayor John Cooper’s Sustainability Advisory Committee (2021). Report on Metropolitan Government of Nashville and Davidson County’s Climate Change Mitigation Action Plan.
The report identifies recommendations and actions for Nashville to reduce its contributions to climate change, as well as ensure a health and resilient future for the community. The report also identifies potential health benefits, such as better air quality by increasing solar energy and reducing carbon emissions.
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National EMS Information System. (2023). Heat-Related EMS Activation Surveillance Dashboard.
Local, state, and federal public health, emergency management and health care workers can use this dashboard to better understand trends in emergency medical services responses to people experiencing heat-related emergencies in the pre-hospital setting.
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Office of Climate Change and Equity. (2023). Climate and Health Outlook Portal. U.S. Department of Health and Human Services.
This interactive map displays monthly county-level forecasts for heat, wildfire, and drought in the U.S. and county-level individual risk factors that may increase vulnerability to the impacts of these climate-related hazards.
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Office of Climate Change and Health Equity. (n.d.). Climate Resilience Plan Elements for Healthcare Organizations. (Accessed 7/18/2023.)
This webpage provides guidance for health systems and related stakeholders tasked with creating climate resilience plans. Guidance is categorized by five elements: prospective risk assessment, health equity and community engagement, assessment and amelioration of infrastructure and operations vulnerabilities, collaboration between health care organizations, and interdisciplinary oversight and evaluation.
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* Practice Greenhealth. (n.d.). Energy and Health Impact Calculator. (Accessed 2/3/2022.)
This web-based tool utilizes the U.S. Environmental Protection Agency and U.S. Department of Energy data to calculate the negative health impacts caused by fossil fuel use. It estimates the number of health-related incidents such as premature deaths, hospitalizations, respiratory issues, and emergency room visits as well as the associated dollar value per unit of emissions.
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* Rudolph, L. and Harrison, C. (2016). A Physician’s Guide to Climate Change, Health and Equity. Public Health Institute.
This guide provides an overview of current climate change issues impacting human health and outlines how physicians can affect change as individuals, in practice, and within their organizations. Subsequent sections review specific climate change health impact concerns including extreme heat, droughts, air quality, and infectious diseases.
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* Rudolph, L., Harrison, C., Buckley, L., et al. (2018). Climate Change, Health, and Equity: A Guide for Local Health Departments. Public Health Institute Center for Climate Change and Health.
This guide summarizes key climate impact information related to public health needs and the connection to local health departments. It provides examples for how local health departments can help address the climate crisis and enact change.
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State of California Government (2021). California’s Fourth Climate Change Assessment.
This assessment is part of California’s comprehensive strategy to address climate change by identifying the gaps that will bolster actions by decision-makers at the state, regional, and local levels to protect and build resilience in California’s communities, infrastructure, and environment.
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* U.S. Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) (2016). Climate Resilient Health Care Facilities Toolkit.
This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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U.S. Environmental Protection Agency (2016). Climate Change Impacts by State.
This website provides a breakdown of climate impacts by U.S. state and territory. Additional resources include impact data broken down by region and sectors such as agriculture, energy, transportation, and water.
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U.S. Environmental Protection Agency (2021). Climate Change Indicators in the United States.
This website provides information on the indicators related to the causes and effects of the various climate change threats.
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* U.S. Environmental Protection Agency, U.S. Forest Service, Centers for Disease Control and Prevention, and California Air Resources Board. (2019). Wildfire Smoke: A Guide for Public Health Officials.
This guide was developed to help local public health officials prepare for and respond to smoke events. It includes information on protective measures and strategies for communicating with the public about wildfire smoke and health.
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* United States Census Bureau. (2021). Community Resilience Estimates for Equity Dashboard.
The Community Resilience Estimates (CRE) program provides metrics of social vulnerability at the local neighborhood-level in the U.S. to the impacts of disasters, including COVID-19. The program helps provide context as to why certain areas may be vulnerable or resilient. This dashboard combines data from the 2019 Community Resilience Estimates and the 2015-2019 American Community Survey five-year estimates. Note that this resource should be paired with natural hazard mapping tools to understand at-risk community vulnerabilities.
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* World Health Organization. (n.d.). Health Impacts of Climate Change. (Accessed 2/3/2022.)
This toolkit includes information and resources related to the effects of climate change on health outcomes. It discusses clean air, safe water, sufficient food, and adequate shelter and provides links to health analysis reports, surveys, risk assessments, and guidance documents on climate change and human health.
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Research

Altman, P., Lashof, D., Knowlton, K., et al. (2012). Killer Summer Heat: Projected Death Toll from Rising Temperatures in America Due to Climate Change. Natural Resources Defense Council.
The authors of this report analyze the results of independent peer-reviewed scientific papers and present the findings of increasing heat-related mortality due to global warming for the 40 largest U.S. cities. Their findings indicate that rising temperatures, driven by persistent climate change, will increase the number of life-threatening excessive heat events.
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Augustinavicius, J.L., Lowe, S.R., Massazza, A., et al. (2021). Global Climate Change and Trauma. International Society for Traumatic Stress Studies.
This briefing paper describes the linkage of climate change and trauma and identifies gaps in this topic area to assist public health, policy, clinical, and research initiatives.
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Balmes, J. R. (2018). Where There’s Wildfire, There’s Smoke. The New England Journal of Medicine. 378:881-883.
The author associates Particulate Matter (PM) as one of the causative agents for health concerns during wildfires. He noted that the Sonoma-Napa (CA) fires in 2017 was the worst air quality on record. The Tubbs Fire (CA) also created deadly carbon monoxide levels. This information has implications for future community, public health, and healthcare planning.
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Belova, A., Goldsmith, L., Greenwell, M. (2021). Future Heat Waves and Heat-Related Deaths Projected to Increase in the Pacific Northwest. ICF.
This report analyzes the reasons for high mortality during the Pacific Northwest’s extreme heat event in the summer of 2021. It outlines key findings of the assessment, health risks and vulnerabilities that contributed to the high number of fatalities, and future implications of extreme heat and climate change crises in this particular area.
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* Climate Impact Lab. (2020). Global Death Rate from Rising Temperatures Projected to Surpass the Current Death Rate of All Infectious Diseases Combined.
This report summarizes findings from scientists, economists, and data engineers on the disproportionate risk of extreme heat-related death in people who live/work in settings that put them at increased/higher risk of becoming infected or exposed to hazards. It discusses the relationship between increased temperature and higher rates of mortality among those in low-income settings.
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Council on Strategic Risks- The Center for Climate and Security (2021). New Analysis from the Center for Climate and Security- Ten Years After its Founding.
This resource provides updated information from The Center for Climate and Security on the security risks associated with climate change. The webpage also includes information on federal and international strategies to mitigate the climate crisis and links to other consortiums and groups working in the climate change space.
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* Deitchman, S.D., Kirsch, T.D., Auerbach, P.S., et al. (2021). Climate Resilience: It is Time for a National Approach. Health Security.
This article addresses how climate-related disasters impact human health in two ways: they can directly cause illness, injury, increased mental health trauma, and loss of life (e.g., a hurricane or other extreme weather event); and indirectly affect population health and disrupt living conditions via damage to critical infrastructure, public services, and economic systems (e.g., as a secondary result of an extreme weather event).
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Eckelman, M.J., and Sherman, J. (2016). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One.
The authors of this article address how the healthcare sector is highly interconnected with industrial activities that emit much of the nation’s pollution into the air, water, and soils. They note that in 2013, the healthcare sector was accountable for “significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%) criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxics (1–2%).”
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Eckelman, M.J., Huang, K., Lagasse, R., et al. (2020). Health Care Pollution and Public Health Damage In The United States: An Update. Health Affairs. 39(12).
The authors of this article examine economywide modeling to assess how much the U.S. healthcare sector accounts for harmful environmental emissions. Analysis indicates that U.S. healthcare greenhouse gas emissions increased 6% from 2010 to 2018, the highest rate among industrialized nations.
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* Gan, C.C.R., Banwell, N., Pascual, R.S., et al. (2019). Hospital Climate Actions and Assessment Tools: A Scoping Review Protocol. BMJ Open. 9:e032561.
This review, a part of the climate-smart healthcare initiative, assesses current hospital climate actions and the existing tools available to measure progress.
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Iddona, C.R., Mills, T.C., Giridharand, R., and Lomas, K.J. (2015). The Influence of Hospital Ward Design on Resilience to Heat Waves: An Exploration Using Distributed Lag Models. Energy and Buildings. 86: 573-588.
The authors use models to measure the resilience of different medical building types to excessive heat. They found that masonry and Nightingale wards (a large room without subdivisions) fared better than rooms in light-weight modular buildings.
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Mullins, J.T., White, C. (2019). Temperature and Mental Health: Evidence from the Spectrum of Mental Health Outcomes. Journal of Health Economics. 68:102240.
The authors of this article explain the data in their study, which found a direct linear relationship between temperature and incidence of suicide in the U.S.
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National Institute of Environmental Health Sciences. (2023). Disaster Research Response (DR2) Resources Portal.
This repository of data collection tools and related resources can facilitate human health research in response to disasters and public health emergencies. The webpage includes links to data on COVID-19, disaster behavioral health, respiratory impacts of wildfires, and other timely topics.
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National Institute of Environmental Health Sciences. (2023). Disaster Research Response (R2) Program. U.S. Department of Health and Human Services.
This website was developed by the National Institute of Environmental Health Sciences and the National Library of Medicine and provides links to disaster research information including data collection tools, research protocols, training, and disaster research news and events.
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Nori-Sarma, A., Sun, S., Sun, Y., et al. (2022). Association Between Ambient Heat and Risk of Emergency Department Visits for Mental Health Among US Adults, 2010 to 2019. JAMA Psychiatry. 4369.
The authors of this study analyze the correlation between extreme heat and mental health conditions, and review data from mental health-related ED visits in the U.S.. Results indicated that there were higher rates of mental health-related ED visits on days with extreme heat. Findings also suggest that there is an increased risk of adverse mental health outcomes in regions of the U.S. that are not as well adapted to heat.
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Prasad, P.A., Joshi, D., Lighter, J., et al. (2022). Environmental Footprint of Regular and Intensive Inpatient Care in a Large US Hospital. Healthcare. 27, 38-49.
The authors of this article explain the data in their study, which quantified average emissions associated with resource use in an acute inpatient unit with 49 beds and 14,427 hospitalization days and an intensive care unit (ICU) with 12 beds and 2536 hospitalization days. Results indicated that an acute care unit generates 5.5 kg of solid waste and 45 kg CO2-e per hospitalization day, while the ICU generates 7.1 kg of solid waste and 138 kg CO2-e per bed day. The authors also noted that emissions mainly originate from purchase of consumable goods, building energy consumption, purchase of capital equipment, food services, and staff travel.
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Rocklöv, J. and Forsberg, B. (2009). Comparing Approaches for Studying the Effects of Climate Extremes - A Case Study of Hospital Admissions in Sweden during an Extremely Warm Summer. Global Health Action.
The authors compare approaches for estimating outcomes associated with climate extremes, exemplified by a case study of hospital admissions during the extremely warm summer of 2006 in southern Sweden.
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Rocque, R.J., Beaudoin, C., Ndjaboue, R., et al. (2021). Health Effects of Climate Change: An Overview of Systematic Reviews. BMJ Open. 11:e046333.
This analytic paper synthesizes 94 systematic reviews on the health impacts of climate change. Reviews were categorized according to geographic region assessed, year of publication, and author affiliation. Results showed five categories of climate impacts and ten health outcomes, with the most common being extreme weather events and infectious diseases respectively.
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Rosenthal, A., Stoker, E., and Haar, R.J. (2021). Health and Social Impacts of California Wildfires and the Deficiencies in Current Recovery Resources: An Exploratory Qualitative Study of Systems-level Issues. PLOS ONE. 0248617.
This article describes a qualitative study on health and social service workers to determine the cause and effect of health and social impacts from wildfires. Factors related to the Tubbs wildfire included contaminated drinking water containing Benzene, which is a cancer agent. Mental health issues and trauma correlated to interpersonal violence. Hospitals and emergency departments were often the only medical facilities operating with the healthcare workforce being impacted by personal loss to include 210 physicians and healthcare workers who lost homes and unable to work impacting the hospital during the wildfire.
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The Lancet. (2015). Health Professionals: Be Prepared for Heatwaves.
This editorial provides an overview of factors and issues to consider during heatwaves. The article includes links to the report authored by the World Health Organization and World Meteorological Organization, guidance from the Centers for Disease Control and Prevention, and other applicable webpages.
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Thompson, R., Hornigold, R., Page, L., and Waite, T. (2018). Associations Between High Ambient Temperatures and Heat Waves with Mental Health Outcomes: A Systematic Review.
This study describes the mental health effects of high ambient temperatures and heat waves, determines whether heat-related morbidity and mortality are increased among people with known mental disorders and identifies knowledge gaps to inform targeting of future research.
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Various Authors. (2021). Climate Change and Children. Current Problems in Pediatric and Adolescent Health Care. 51(6).
This entire volume focuses on the impacts of climate change on pediatric patient care. Articles within the journal include a pediatrician’s guide to climate change-informed primary care, understanding the intersection of climate change, pediatrics, and structural racism, and the effects of the climate crisis on global pediatric health and human rights.
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Agencies and Organizations

American Public Health Association (APHA). Climate Change.
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Centers for Disease Control and Prevention. Climate and Health Program.
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Columbia University. Columbia Climate School International Research Institute for Climate and Society.
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Georgetown Law. Georgetown Climate Center.
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Global Climate and Health Alliance.
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Health Care Climate Council.
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National Aeronautics and Space Administration (NASA). Global Climate Change.
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National Oceanic and Atmospheric Administration. Climate.gov.
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The Medical Society Consortium on Climate and Health. Health Voices for Climate Action.
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Trust for America’s Health.
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U.S. Department of Health and Human Services. Office of Climate Change and Health Equity.
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U.S. Environmental Protection Agency. Climate Change.
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U.S. Global Change Research Program.
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University of Washington. Center for Health and the Global Environment (CHanGE).
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University of Washington. Climate Impacts Group.
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World Health Organization. Climate Change.
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