Frontline Health Clinics’ Knowledge, Motivators, and Behaviors on Climate Change
*This post was updated on January 21, 2025 with additional data on clinic administrators from a study published in The Journal of Ambulatory Care Management
Extreme weather events like hurricanes, wildfires, and heat waves can disrupt patient care, and frontline health clinics providing safety-net care to populations most vulnerable to climate-related extreme weather events are seeking ways to keep their patients protected from climate risks.
In 2021, Harvard Chan C-CHANGE and Americares conducted a national, cross-sectional survey of administrators, case workers, providers, and other staff at frontline clinics in 43 states. The survey results, published in BMC Primary Care and Journal of Ambulatory Care Management, are the first to assess climate and health knowledge, motivators, preferences, and needs of all staff at frontline safety net clinics, not just health care providers, and helps identify what clinics need to improve climate resilience.
Key Takeaways
All respondents (n=430):
- Most respondents (81.5%) say that climate-related extreme events caused some kind of disruption in clinical care delivery over the last three years.
- Disruptions from the extreme events included power outages (52.8%), closures of clinics (52.3%), problems with access to the clinic (42.5%), and staff shortages (40.2%), among others.
- About half of total respondents (54.4%) said they have plans in place to address risks to health care access and delivery during extreme weather.
- The greatest need of clinics before, during, and after extreme weather events was emergency power (63.9%), real-time information related to the impacts of the event (51.9%), access to emergency services (47.4%), and financial assistance (42.9%).
- Approximately half (52.2%) of respondents reported they were motivated to use resources to improve climate change clinical preparedness, and they prefer succinct materials like checklists, planning guides, and brief information sheets to do so.
- Respondents who agreed that climate change is caused by humans were four times more motivated to use clinic resilience resources, and those who reported higher knowledge of climate effects on health had 50% more motivation to use resources.
Providers and case workers (n=141):
- 84.4% of providers and case workers reported climate change is impacting patient health.
- Direct patient care staff like providers and case workers were more likely to discuss climate change with patients if they believe that climate change affects patient health.
- A little more than one-third (36.3%) say they discuss climate-related health risks with patients.
- The most discussed risks were extreme heat (78.4%), worsening allergy seasons (66.7%), and air pollution (60.8%).
- Almost half of the providers and case managers (44.7%) reported they lacked confidence in developing disease management plans to protect patients from climate impacts.
Administrators and other staff (n=284)
- Most respondents (80.2%) reported that humans are causing climate change, and nearly half (45.9%) are concerned about extreme weather impacting their job. Approximately half (50.7%) of respondents said they believe their supply chain is vulnerable to extreme weather events.
- Those who reported humans are causing climate change and who reported they were concerned about the effects of extreme weather on the ability to perform their job were significantly more motivated to improve the resiliency of their supply chain to extreme weather events.
- Fewer than half of respondents (46.6%) conduct annual or biennial hazard and vulnerability assessments, a requirement for health care organizations that receive funding from Centers for Medicare and Medicaid Services.
- Fewer than half (41.8%) of respondents have taken steps to protect their clinic infrastructure from extreme weather. The biggest barriers to implementing climate resiliency measures were financing (85%), not having the knowledge and tools to implement climate change preparedness (78%), and staffing (76.6%).
- For those who did report taking steps to protect clinics from climate change, the most frequently reported were installing generators or alternative power sources and installing or improving air conditioning and ventilation.
- Nearly half (46.7%) of clinic administrators said extreme weather events are increasing operational expenses, including from electrical system upgrades/back-up power, building repairs, and staffing.
- Only one third of respondents (35.2%) currently had funds to cover the costs of extreme weather events. More than half (56.1%) said they did not believe they will have adequate funds to support clinic needs for improving resiliency and preparedness over the next five years.
Recommendations
- Fund climate preparedness. As climate-fueled disasters become more expensive to recover from (with 28 billion-dollar climate and weather related disasters in the U.S. in 2023 alone), preparedness and mitigation planning is increasingly important. To maximize limited financial resources, funding should focus on preparedness activities that improve clinics’ climate resilience. Estimates suggest that for every one dollar spent on disaster risk reduction, at least seven dollars can be saved from post disaster recovery.
- Build clinics that can withstand extreme weather. Use local and state building codes, regulatory design guidelines, and zoning requirements as motivators to protect clinic infrastructure. For instance, clinics in high-risk areas for certain extreme events may be required to adhere to standards that improve their climate resilience, such as wind-resistant construction in hurricane prone areas or fire-resistant construction in wildfire risk areas.
- Diversify funding streams. Explore a breadth of funding sources to support resilience and preparedness measures, including federal funding, foundation and donor support, local revenue streams, and insurance products.
- Engage with city and state officials to ensure all clinics are prepared for climate change. Proactively include free and charitable clinics that do not receive federal funding—and are therefore not required to conduct periodic risk assessments—in regional preparedness measures to increase awareness of climate hazards and improve emergency planning.
In response to the survey, Harvard Chan C-CHANGE and Americares developed the Climate Resilience for Frontline Clinics Toolkit in 2022, which provides free online resources in English and Spanish for patients, providers, and clinic administrators on extreme heat, wildfires and wildfire smoke, hurricanes, and flooding. The toolkit has been piloted by clinics around the country, and an expanded version was released in 2024. To date, the materials in the toolkit have been downloaded over 20,000 times.
Read the study in BMC Primary Care
Read the study in Journal of Ambulatory Care Management
Authors
Wiskel, T., Miles, T.T., Fonteyn, M. et al. Frontline clinic perspectives on climate change, human health, and resilience: a national cross-sectional survey. BMC Prim. Care 25, 399 (2024). https://doi.org/10.1186/s12875-024-02622-y
Wiskel, Tess MD, MPH; Matthews-Trigg, Nathaniel MPH; Stevens, Kristin MS; Miles, Thomas T. PhD; Dresser, Caleb MD, MPH; Bernstein, Aaron MD, MPH. Frontline Clinic Administrator Perspectives on Extreme Weather Events, Clinic Operations, and Climate Resilience. Journal of Ambulatory Care Management ():10.1097/JAC.0000000000000519, January 20, 2025. | DOI: 10.1097/JAC.0000000000000519
