With an eye on climate, a helping hand for health care’s front lines

An elderly woman struggles into a community health clinic in rural Texas amid a record-breaking heat wave. She’s having a severe asthma attack, wheezing and gasping for air. As medical staff rush over the lights and air conditioning shut down due to an overtaxed power grid.

Scenarios like this are becoming more worrisome as the planet warms, and weather events grow more numerous and extreme. In response, Harvard experts on the health impacts of climate change have teamed up with disaster relief nonprofit Americares to create a climate-change “toolkit” offering information, advice, and support for frontline health clinics that serve tens of millions of low-income Americans.

The Climate Resilience for Frontline Clinics Toolkit, unveiled in December, was devised by specialists working with the Harvard T.H. Chan School of Public Health’s Center for Climate, Health and the Global Environment (C-CHANGE), for distribution by Americares, which works with community health centers and free clinics across the nation. The toolkit contains checklists for clinic staff, guidance on how to develop action plans, and straightforward advice for patients struggling with diabetes, kidney disease, dementia, and other ailments during extreme heat.

Aaron Bernstein, C-CHANGE’s interim director and a pediatrician at Boston Children’s Hospital, said it’s clear to him that planning for climate-related health impacts hasn’t advanced as quickly as the risk. Climate change, Bernstein said, not only can impact patients with conditions like asthma and pregnancies, but some disasters — like those that affect power supplies — can hamper the ability of health care personnel to respond.

“I was motivated by how little work has been done in the intersection of climate resilience and health care,” Bernstein said. “And when we dug into that issue, it became clear that what little has been done has been done in the scope of big hospitals in big cities. If there is a way to make health care resilient to climate shocks, that may actually not be the best place to invest because our guess is that most of the need for health care around these disasters is happening on the front lines in these clinics around the country.”

Kristin Stevens, Americares’ senior director of climate and disaster resilience, said clinics are an important part of our health care system, serving the same largely low-income population that is most at risk from heat waves, flooding, and other climate disasters. In addition to bearing responsibility to care for this vulnerable population, the clinics and centers themselves are vulnerable, typically lacking in emergency managers, and often struggling with scarce resources and overburdened staff.

“One thing to understand about these health centers is they don’t have their own emergency managers. They are strapped for time; they’re strapped for money; they’re strapped for staff,” Stevens said. “They’re not in a position to do basic emergency planning, let alone be thinking about how their environment and community is going to be changing over the next five, 10, 20 years.”

The effort’s roots are in 2017’s trio of damaging storms: hurricanes Harvey, Irma, and Maria, after which Americares began to ramp up its preparedness planning. A couple of years later, Stevens said, C-CHANGE then-Director Gina McCarthy spoke at an Americares conference, which got the partnership between the two organizations off the ground.