From Climate Crisis to Clinical care: A Literature Review of Future Developments and Directions in Healthcare Services
- Joshua Mi
- Jan 9
- 22 min read
Department of Climate and Environmental Studies, Vanderbilt University
Abstract
This literature review examines the intersection of climate change, public health, and sustainable healthcare, all of which underscore the need for healthcare systems to adapt to climate-induced stressors. Beginning with an exploration of the public health implications of climate change, such as heat exposure, infectious diseases, and natural disasters, this review focuses on individual challenges as part of the holistic approach necessary to resolve the multifaceted challenges climate change presents for public health. This paper explores the hurdles to expanding healthcare capacity while simultaneously transforming healthcare infrastructure to be sustainable. Within this section regarding sustainability, differing frameworks emerge that focus on energy efficiency, renewable resources, and waste management. Despite the strong foundation of climate change and public health knowledge, this review also highlights significant gaps in current research, particularly regarding future directions of healthcare at the convergence of climate change’s impacts on clinical care and environmentally sustainable healthcare. Altogether, these insights are essential to addressing the future global health challenges posed by climate change.
Keywords: Healthcare Services, Climate Change, Public Health, Sustainability
Introduction
Climate change will result in severe implications for human health due to a wide variety of causes, including chronic exposure to flooding and heat, disruption of food systems, increasing severity of natural disasters, and expansion of vector-borne diseases (Abbass et al., 2022; de Souza and Weaver, 2024; Gostimirovic et al., 2020; Myers et al., 2017). Although contingent on multilateral efforts to curb greenhouse gas (GHG) emissions, these disruptions to our global systems and social foundations are projected to kill an estimated 250,000 additional people and cost $3.1 trillion per year worldwide by 2050 (Bennett, 2023; Watts et al., 2015). To optimize public health outcomes, it is necessary to understand both future demand for climate-related healthcare services and the current capabilities and structures of healthcare services. Healthcare and its adjacent industries already account for a significant percentage of global gross domestic product (GDP), with wealthy, developed nations such as the United States attributing nearly 17% of their GDP to healthcare spending as of 2022. These figures are expected to rise as the global population ages (Wager et al., 2024). As such, there is an urgent need to develop more effective healthcare that addresses the new challenges climate change presents, and both our new and existing healthcare infrastructure must join the green transition toward environmental sustainability.
Existing literature often isolates climate change and public health from sustainable clinical care despite their evident connection and impact on one another. Although there is strong scientific literature exploring the impact of climate change on health outcomes through specific case studies and quantitative models, few researchers extrapolate these findings into policy and strategic implications for government agencies and healthcare systems to best meet anticipated demand for specific healthcare services. However, given the challenges of implementation, research into the green transition in healthcare services has been scant. Thus far, environmentally-conscious healthcare has leveraged individual case studies focusing on energy efficiency, non-hazardous waste, medical waste, and barriers to change. This review offers a holistic perspective on sustainable healthcare, connecting climate change’s implications for public health with environmentally conscious clinical care that meets projected demands, and it highlights existing gaps in research, such as scalable, sustainable solutions, mental health implications, and strategies for low-income nations.
The literature comprises three main sections: beginning with the impact of climate change on public health and the ensuing demand for clinical care, followed by the sustainability of new and existing healthcare infrastructure and services. The first section focuses specifically on the multifaceted pathways that climate change affects wellness, highlighting health implications widely addressed in clinical settings. From there, this review underscores specific anticipated public health needs and the challenges of meeting this increased demand, and offers recommendations for strategic growth in healthcare systems to maximize patient outcomes. Zeroing in on clinical care, this review then analyzes the healthcare industry’s slow adoption of sustainability programs and policies to reduce environmental impact while still prioritizing patient wellness and comfort. Although other sectors may struggle to transition quickly due to economic interests, the healthcare industry faces additional challenges, such as health outcomes, patient backlash, and government regulation. This context creates internal and external hesitation for points of clinical care to adapt meaningful moves toward sustainability, but this review clarifies best practices.
Impact of Climate Change on Public Health
This section explores the multifaceted implications of climate change on public health, mainly focusing on how these changes translate into increased demand for clinical care. Research has shown that rising temperatures, changing precipitation patterns, and the increasing frequency of extreme weather events exacerbate existing health conditions and create new challenges for healthcare systems globally. Vulnerable populations, such as those of lower socioeconomic status, are already more susceptible to these climate-related health threats (Levy and Patz, 2015; Smith et al., 2022). The literature highlights public health concerns, from heat-related illnesses and respiratory conditions to vector-borne diseases such as malaria and dengue fever (Haines et al., 2006; Gostimirovic et al., 2020). However, whereas many studies emphasize the overall burden climate change places on healthcare systems, there is a relative paucity of research addressing how specific health services can adapt to meet this rising demand, especially in low-resource settings. As such, this section delves into the specific, documented health effects of heat exposure, infectious diseases, natural disasters, and mental health.
Heat exposure is set to see dramatic consequences due to climate change, and global warming has significantly increased the proportion of the world’s population at risk of dangerous heat exposure (Ebi et al., 2021). Research thus far points to ambient heat and extreme heat events strongly correlating with a wide variety of afflictions such as cardiovascular diseases, mental illness, neurodegenerative disorders, poor birth outcomes, respiratory diseases, and more, with location and profession often being the dictator to the form of exposure and health implication (Bongioanni et al., 2021; Ebi et al., 2021; Silveira et al., 2021). In fact, one of the most significant incoming challenges for governments globally is handling the loss of economic productivity associated with increases in heat exposure due to climate change, creating financial burdens in the form of both costs of healthcare and loss of employment (Bongioanni et al., 2021; Ebi et al., 2021; Silveira et al., 2021).
Climate change significantly impacts the spread of infectious diseases by altering the environmental conditions that influence vector habitats, pathogen life cycles, and human vulnerability. Rising temperatures allow disease vectors, such as mosquitoes and ticks, to expand into new territories, increasing the incidence of diseases such as Chikungunya Virus, Dengue Fever, Malaria Virus, Lyme disease, Tick-borne encephalitis, West Nile, and Zika virus (Haines et al., 2006; Kovats et al., 2003; Romanello et al., 2022; Wu et al., 2016). Within vectors, warmer climates also accelerate pathogen development and shorten incubation periods, thereby increasing transmission rates and exposure opportunities to human populations (Wu et al., 2016). Additionally, changes in precipitation patterns can create ideal conditions for both waterborne and vector-borne diseases like schistosomiasis, a parasitic disease from contaminated drinking water (Romanello et al., 2022; Wu et al., 2016). Heavy rains and floods contaminate water supplies with pathogens, whereas droughts can force reliance on unsafe water sources, exacerbating outbreaks of diseases (Kovats et al., 2003; Romanello et al., 2022; Wu et al., 2016). Similarly, extreme weather events, such as hurricanes and floods, displace populations and disrupt public health infrastructure, leading to overcrowding that fosters the spread of infectious diseases such as tuberculosis and diarrheal illnesses (Romanello et al., 2022; Shapiro et al., 2020; Wu et al., 2016). These environmental disruptions, compounded by weakened public health responses, create devastating transmission of preventable and treatable diseases, ultimately collapsing economic systems and social order.
Climate change significantly enhances the frequency and intensity of naturally occurring disasters, which adversely impacts both human health and global economies. Current estimates attribute more than $139 billion in damages in natural disasters to climate change in the past 20 years, and projected costs are expected to grow exponentially (Abbass et al., 2020; Newman and Roy, 2023). For instance, extreme weather events exacerbated by climate change, like hurricanes, bring a suite of challenges with downpours, surges, tornadoes, and winds that all threaten human life and damage healthcare systems (Abbass et al., 2020; Seidel et al., 2024; Shapiro et al., 2020). Additionally, events such as chronic flooding, tropical storms, and wildfires not only cause immediate fatalities but also create environments for increased opportunities for infectious disease transmission, especially in traditionally under-resourced areas where healthcare infrastructure is particularly unprepared to handle the additional burden (Abbass et al., 2020; Seidel et al., 2024; Shapiro et al., 2020). Recent research suggests that climate change enhanced natural disasters like hurricanes may lead to hidden public health concerns, including mental illness and maternal morbidity (Berry et al., 2010; Kuehn and McCormick, 2017; Suter and Aagaard, 2023). Without adequate intervention and systems, these natural disasters will result in devastating consequences that maim communities’ economies and health.
Beyond physical health, climate change also directly and indirectly impacts mental well-being, causing disruptions of physical health, community structures, and social environments (Berry et al., 2010; Smith et al., 2022; Figueiredo et al., 2024). Extreme weather events such as hurricanes, floods, and wildfires expose people to traumatic events, leading to opportunities for the development of disorders like anxiety, depression, and post-traumatic stress disorder (PTSD) (Shapiro et al., 2020; Watts et al., 2015). Initial research has also suggested that the increasing frequency and intensity of prolonged heat waves may lead to higher suicide rates and chronic mental health issues (Berry et al., 2010; Haines et al., 2006).
The complex interplay between climate change and public health presents formidable challenges for healthcare systems worldwide. From natural disasters that foster infectious diseases to heat exposure that amplifies cardiovascular disease, climate change will exacerbate health disparities on a global scale, disrupting healthcare infrastructure and straining clinical services (Abbass et al., 2020; Ebi et al., 2021). Additionally, vulnerable populations face disproportionate risks, underscoring the need for targeted interventions, and mental health implications require greater research and policy investment (Berry et al., 2010; Levy and Patz, 2015; Smith et al., 2022; Watts et al., 2015). Effectively addressing the multifaceted public health impacts of climate change requires equitable public policies and healthcare system strategies that meet clinical demand, prioritize patient outcomes, and move toward sustainability, but these efforts must be grounded in a strong understanding of the implications of climate change (Berry et al., 2010; Haines et al., 2006).
Climate-Induced Healthcare Demand and Stressors
Given the significant climate change-induced implications for public health, government agencies and healthcare systems must develop a holistic understanding of adaptation to best estimate future capacity and maximize operational efficiency, but existing research is scant and largely anecdotal (Abbass et al., 2022; Jones, 2010). Creating additional urgency for wealthier, developed nations like the United States to generate strategic plans is the broad societal dependence on formal health infrastructure as compared to developing, lower-income nations (Richardson and Berdzuli, 2017; Tran et al., 2019). Additionally, climate change will induce stress on current healthcare services through three main avenues, all of which are challenging to manage: damaging physical healthcare infrastructure and related systems, generating demand directly through ailments like heat exposure and infectious diseases, and creating demand indirectly by making populations vulnerable to sickness (Abbass et al., 2022; Ebi et al., 2021; Myers et al., 2017).
Climate change will severely strain physical healthcare infrastructure through increased frequency and intensity of natural disasters, (Abbass et al., 2022; Banholzer et al., 2014; Ebi et al., 2021). Extreme weather events such as floods, hurricanes, and tornadoes can cause widespread damage to the electrical grid, compromising hospital operations that rely on electricity for essential services (Bates, 2019; Haines et al., 2006). The increased strain on healthcare systems will likely exacerbate existing vulnerabilities, particularly in lower-income regions and populations already suffering from inadequate infrastructure (Smith et al., 2022). Ultimately, climate change will damage the vital physical healthcare infrastructure necessary for optimal clinical care.
Aforementioned climate-induced public health concerns, such as heat exposure and infectious diseases, will significantly strain existing healthcare services, but our current understanding of specific stressors, such as extreme heat events, is limited to anecdotal models and retrospective narratives (Sapari et al., 2023; Woolf et al., 2023). Notably, there is negligible research modeling clinical care demand as a result of climate change related stressors. Heatwaves are projected to increase the demand for emergency services, including ambulance callouts, resulting in considerable financial burdens and physical constraints on healthcare systems globally, especially given the relative cost of acute care as compared to preventative care (Lugten and Hariharan, 2022; Romanello et al., 2022; Sapari et al., 2023). Simultaneously, infectious diseases, aided by climate change, contribute further to hospital overcrowding and misdiagnosis challenges during co-epidemics with other diseases like COVID-19 (de Souza and Weaver, 2024; Sapari et al., 2023). This confluence of heat-related stress and infectious diseases increases mortality and overwhelms existing health infrastructure through acute, ambulatory, and emergency care settings (Lugten and Hariharan, 2022; Romanello et al., 2022; Sapari et al., 2023; Woolf et al., 2023).
Climate change also indirectly increases demand for clinical services by disrupting key systems vital for public health, such as food and water supplies (Abbass et al., 2022; Banholzer et al., 2014; Haines et al., 2006). These disruptions lead to malnutrition and waterborne diseases, leaving populations vulnerable to various illnesses that require medical care (Abbass et al., 2022; Banholzer et al., 2014; Haines et al., 2006). Changes in weather patterns and extreme events like floods and droughts impact agriculture, reducing food security and heightening malnutrition rates, particularly in vulnerable populations (Lugten and Hariharan, 2022; Haines et al., 2006).Climate change also affects water quality and availability by increasing the frequency and severity of floods and droughts, which contaminate and destroy drinking water sources and result in outbreaks of diseases such as cholera (Abbass et al., 2022; de Souza and Weaver, 2024; Smith et al., 2021; Suter and Aagaard, 2023). These factors significantly strain healthcare systems, leading to increased hospitalizations and emergency visits for preventable illnesses (Lugten and Hariharan, 2022; Romanello et al., 2022; Sapari et al., 2023). Consequently, healthcare infrastructure must become more resilient to manage the growing demands for clinical services resulting from climate change-induced vulnerabilities (Sapari et al., 2023).
In summary, climate change will significantly stress healthcare systems, increasing demand for clinical care while damaging essential infrastructure. The direct and indirect health effects, such as heat-related illnesses, infectious diseases, and disruptions to food and water security, will place an unprecedented burden on medical facilities and emergency services (Abbass et al., 2022; de Souza and Weaver, 2024; Ebi et al., 2021; Smith et al., 2021; Suter and Aagaard, 2023). Additionally, the costs associated with these stressors will burden global economies, healthcare systems, and government systems financially, especially in lower-income regions (Lugten and Hariharan, 2022; Woolf et al., 2023). As these issues intensify, healthcare administrators and policy makers must prioritize strategic investments in resilient healthcare infrastructure and integrate climate adaptation into health planning (Sapari et al., 2023; Romanello et al., 2022). Only through comprehensive, climate-conscious strategies can healthcare systems meaningfully support effective public health.
Environmentally Sustainable Healthcare
The relationship between climate change and the healthcare sector does not simply involve climate change’s negative repercussions on healthcare; instead, the healthcare sector also contributes to climate change, accounting for 8.5% of all GHG emissions in the United States (Abbass et al., 2022; Aboueid et al., 2023). Furthermore, climate change’s impact on public health is projected to exacerbate this issue, as spiking clinical care demand will only increase the environmental destruction of healthcare services, leading to a vicious, self-fulfilling cycle (Abbass et al., 2022; Aboueid et al., 2023; Berniak-Woźny and Rataj, 2023). As such, the climate-healthcare relationship requires careful attention to environmentally sustainable healthcare, which, in turn, requires the implementation of integrative, climate-conscious practices that reduce environmental impact while maintaining or improving the quality of patient care (Aboueid et al., 2023; Berniak-Woźny and Rataj, 2023; Spruell et al., 2021). Based on existing literature, healthcare systems can adopt an integrative, climate-conscious approach that addresses the ongoing and future challenges of climate change in the following processes: energy efficiency, non-hazardous waste, medical waste, and barriers to change (Aboueid et al., 2023; Berniak-Woźny and Rataj, 2023; Romanello et al., 2022).
Energy efficiency and green energy are foundational components of environmentally sustainable healthcare, as they underpin the entire sector's capabilities and enable financial optimization without risk to patient care. Health systems, which are energy-intensive due to the constant and complex nature of operations, can achieve substantial energy savings through measures such as adopting renewable energy sources and optimizing heating, ventilation, and air conditioning systems (Dilger and Bergmark, 2023; Lattanzio et al., 2022; Qin et al., 2022). Similarly, energy-efficient equipment and lighting, along with implementing energy management practices, reduce energy consumption and lower GHG emissions (Allwright and Abbott, 2020; Berniak-Woźny and Rataj, 2023). Reliance on natural lighting can also significantly reduce energy demand while improving healthcare worker productivity and wellness (Haines et al., 2006; Lugten and Hariharan, 2022; Naser and Al-Mamoori, 2023). Integrating renewable energy generation, like solar and wind power, into healthcare systems can also enhance the resilience of healthcare facilities against energy supply disruptions, protecting patient wellness and supporting environmental sustainability (McGain et al., 2020; Tee et al., 2024). Overall, focusing on energy efficiency enables minimizing environmental impact while continuing to provide essential services (Park and Cha, 2023; Romanello et al., 2022).
Due to its complex activities that require disposability and personalization, healthcare is a high-waste industry, producing non-hazardous waste (e.g., packaging and office waste) and medical waste, also known as hazardous waste (e.g., used syringes and infectious materials) (Dilger and Bergmark, 2023; Lattanzio et al., 2022). Beginning with non-hazardous waste disposal, anesthetic gases such as desflurane, isoflurane, and nitrogen significantly contribute to GHG emissions due to their high global warming potential (GWP) (McGain et al., 2020). These gases persist in the atmosphere, contributing to climate change despite their vital role in emergency and surgical care (McGain et al., 2020). Strategies to mitigate their environmental destruction include transitioning to lower-GWP alternatives, improving waste gas capture technologies, and adopting the "reduce, reuse, recycle" approach in operating rooms (Aboueid et al., 2023; Dilger and Bergmark, 2023). Furthermore, healthcare systems can invest in digitalization and telemedicine to limit unnecessary visits, reducing overall waste and improving access to care (Allwright and Abbott, 2020; Berniak-Woźny and Rataj, 2023; Park and Cha, 2023). These efforts, combined with comprehensive waste management practices focusing on hazardous medical waste, are essential for developing greener healthcare.
Hazardous medical waste, including infectious and toxic materials, is a critical concern in environmentally sustainable healthcare due to its potential to harm both human health and the environment. This waste, often generated in large quantities by healthcare facilities, poses risks due to their immediate potential to spread infections and contaminate their environments (Aboueid et al., 2023). The use of single-use medical devices contributes heavily to hazardous waste production, so one of the most effective approaches involves minimizing waste at the source by using fewer devices through the promotion of reusable alternatives and improving operational efficiency (Lattanzio et al., 2022; Park and Cha, 2023; Spruell et al., 2021). For single-use devices required to ensure patient outcomes, sustainable procurement practices, such as sourcing biodegradable products and packaging, reduces the environmental impact of hazardous waste (McGain et al., 2020). For unavoidable medical waste, careful segregation ensures that only truly hazardous materials are treated as such, preventing unnecessary, energy-intensive processes like incineration (Aboueid et al., 2023; McGain et al., 2020). Additionally, waste treatment technologies such as autoclaving, chemical disinfection, and microwave treatment are also sustainable alternatives to incineration (Aboueid et al., 2023; McGain et al., 2020). Overall, adopting robust auditing systems and training healthcare staff on waste management protocols and the environmental impact of hazardous waste can foster compliance and sustainability (Aboueid et al., 2023; Lattanzio et al., 2022).
Lastly, despite the potential for environmentally sustainable healthcare, barriers to change persist, including educational, financial, and institutional. Lack of awareness and education among healthcare professionals regarding the environmental impact of clinical care and the potential benefits of renewable practices leads to a lack of demand for change internally (Aboueid et al., 2023; Griggs et al., 2017; McGain et al., 2020). Without proper training and understanding, staff continue to over-rely on single-use devices, contributing to waste. Additionally, healthcare is a high-cost, low-margin industry that faces financial constraints, so the high upfront costs associated with implementing sustainable practices and processes, such as advanced waste treatment technologies and reusable equipment procurement, are prohibitive, particularly among lower-income healthcare facilities (Lattanzio et al., 2022; White et al., 2014). Lastly, there are institutional barriers, where insufficient frameworks and vague policies at the national or organizational level lead to a fragmented approach to sustainability, leaving healthcare facilities without adequate guidance or incentives to change (Aboueid et al., 2023; Griggs et al., 2017; McGain et al., 2020). Perceived challenges and risks associated with altering current practices also hinders progress especially given the sanctity of protecting human health (McGain et al., 2020).
Overall, as demand for clinical care is projected to soar in the coming decades (in part due to how climate change will impact human health), existing and future healthcare capacity must adapt accordingly to handle new demand and manage the burden of stressors, all while becoming sustainable. Adopting green practices in areas such as energy efficiency, waste management, and organizational change enables additional benefits for operational efficiency and, therefore, financial resiliency. Although there are barriers to implementation, including financial limitations and institutional resistance, the need for sustainability in healthcare has never been more urgent. With changes in education, policies, and resources, the healthcare sector can reduce its carbon footprint while providing life-saving care to a growing, increasingly climate-impacted global population.
Conclusion
As the body of research on climate change continues to grow, our understanding of its implications for public health will improve, and both governmental bodies and healthcare providers will be better prepared to address them in the clinical care setting and at a broader systems level. In particular, the effects of climate change on public health, particularly in relation to extreme heat, natural disasters, and vector-borne diseases, are relatively well documented. Studies have provided valuable insights into the vulnerabilities of certain populations, including the elderly and lower-income communities. Additionally, research has explored the economic burdens and physical strain that extreme weather events place on healthcare systems.
Despite this progress, critical gaps in the literature persist. Future research directions should address these shortfalls, particularly by integrating sustainability into healthcare practices, developing tailored strategies for lower-income nations, and addressing mental well-being. Although the need for climate-conscious clinical care is recognized, few studies offer practical, scalable strategies for achieving sustainable healthcare systems. This knowledge gap has resulted in anecdotal cases and fragmented policy. Despite the environmental scope, research must respect the healthcare industry and prioritize patient outcomes. In addition to pragmatic approaches to environmentally sustainable healthcare, strategies for developing nations also lack a comprehensive understanding. Although some research has examined the effects of heatwaves and other extreme weather events in developing and lower-income nations, findings do not offer a cohesive strategy for strengthening healthcare infrastructure to withstand climate-induced pressures. Developing a strong understanding of these regions is particularly pressing given the existing lack of social security, enabling potentially devastating consequences following a natural disaster. Additionally, there is a gap in quantitative research regarding the mental health impacts of climate change. Researchers acknowledge the link between climate change and mental illness through the pathology of stress and trauma; its potential for global ramifications requires more robust research. In particular, we need to understand the long-term consequences of this global exposure to adverse events on mental well-being and develop interventions for those most vulnerable to these effects.
Given differences in prioritization and limitations in capital, divergence in frameworks and opinions in climate adaptation and health systems arise, specifically regarding strategies to maximize public health and minimize costs. For instance, some literature emphasizes the integration and resilience of climate information into health system planning for effective adaptation. Conversely, other frameworks focus on the overarching impacts of fossil fuels on health, underscoring the importance of policy shifts toward sustainable energy as a health intervention. Other frameworks diverge in their focus on healthcare cost implications, as seen in literature discussing the economic burden of climate-induced health challenges. Leading research indicates that heat exposure imposes significant healthcare costs, particularly in vulnerable populations. Meanwhile, other viewpoints emphasize the role of social determinants of health in amplifying health risks from climate change, with frameworks highlighting how marginalized communities bear a disproportionate burden due to systemic inequities. These differences reflect a broader debate on whether climate adaptation in healthcare should prioritize immediate infrastructural adaptations, long-term drivers of public health, financial mitigation of healthcare burdens, or social inequalities that exacerbate climate vulnerability.
In light of these research gaps, future directions, and differing approaches, several research questions emerge, particularly surrounding the most effective ways to implement environmentally sustainable practices in healthcare systems without compromising patient care. Addressing this knowledge shortfall enables meeting the operational demands of healthcare delivery without contributing to the environmental factors that create demand and strain limited resources. In particular, are healthcare systems already experiencing and projecting increases in demand for specific forms of clinical care due to climate change? How are healthcare leaders and government agencies adapting to adequately address these shifts in demand and stressors induced by climate change? Additionally, how are healthcare systems updating their current and planned infrastructure and services to be more resilient and sustainable? Given the pressing nature of climate change, answering this question is critical for ensuring quality of life for billions of individuals and affected populations.
Overall, although significant progress has been made in understanding the health implications of climate change, significantly more research is required to address the gaps in environmentally sustainable healthcare, climate resilience in lower-income nations, and mental health outcomes. Each shortfall involves multifaceted approaches and considerations that require substantial investment and research, with significant real-world ramifications. Bridging these current knowledge gaps enables a holistic approach to solving our modern world’s most challenging and pressing issues – climate change and wellbeing.
Notes
1. Conflicts of interest: The author has no conflicts of interest to disclose.
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