Protecting Patients and Hospital Systems from the Devastation of Climate Change

On September 27, 2024, the United States watched as 54 patients, their families, clinicians, and staff were airlifted off the roof of Unicoi County Hospital in Erwin, Tennessee. In this mountain town on the eastern edge of the state, at an elevation of 1,600 feet above sea level, extreme precipitation from Hurricane Helene had caused the Nolichucky River to swell to unprecedented levels, rapidly surrounding the hospital with a swift current. Hospital staff evacuated seven individuals using rescue boats, while the remaining patients, visitors, and staff waded through floodwaters to reach a ladder, which they climbed to safety on the roof. When the final evacuee left by helicopter, the floodwaters were only 10 feet below their perch.

Angel Mitchell was visiting her 83-year-old mother when the evacuation order came. She described nearly being swept away by the rough currents while making her way to the roof ladder. She recounted looking down at her mother in a rescue boat—next to an oxygen tank for her pneumonia. This was far from the expected visit. A few days later, videos would show many cars, rescue boats, and ambulances still stuck in the mud and debris from the flooding.¹ The hospital remains closed as of the writing of this article, leaving the community to seek care from other facilities more than 20 miles away.

Helene produced 10 to 15 inches of rainfall across the Southeast before it even made landfall, and in some locations, landfall brought another 15 inches. Preliminary research found that climate change made this Category 4 storm 40 to 70 percent more likely,² so perhaps it should not be a surprise that Unicoi County Hospital was not the only healthcare facility impacted by the storm. Across a nearly 800-mile region, dozens of healthcare facilities were evacuated, including 39 patients from Sycamore Shoals Hospital in Elizabethton, Tennessee, and 31 facilities in Florida. Many other hospitals lost water and power, with four still lacking water and 11 depending on generators days after the storm. Hospitals closed their doors to non-emergent cases because of limited capacity to respond to anything else. Countless pharmacies were unable to provide lifesaving medications due to damage to their facilities and to the roads required for new deliveries.³   

Two weeks later, on October 9, 2024, Hurricane Milton similarly barreled its way toward the coast of Florida. HCA Florida Largo Hospital evacuated close to 240 patients because of basement flooding.⁴ Across the state, 352 healthcare facilities were evacuated, with many losing electricity and water, as had happened only weeks before.⁵

Evacuations due to extreme weather events, including hurricanes, floods, and wildfires, have become increasingly common;⁶ between 2018 and 2021, 52.8 percent of clinic staff from 43 states reported disruptions in care due to extreme weather.⁷  Some hospitals have been evacuated repeatedly, such as Adventist Health St. Helena in California, which was evacuated twice within five weeks due to wildfires in 2020.⁸ Although the eye of the media has long since moved on from these communities, their health and well-being will continue to be affected for months and years to come—as is illustrated by Hurricane Katrina’s long-lasting effects on the communities of New Orleans.⁹   

Worsening extreme weather events have short- and long-term health impacts. Floods increase the risk of waterborne illness and cutaneous and respiratory infections.¹⁰ Mold growth following floodwaters can cause headaches and irritation of the eyes, nose, and throat; it can also aggravate lung conditions such as asthma and heighten the risk of lung infections, particularly in individuals with weakened immune systems.¹¹ Wildfire smoke, containing respiratory irritants from burning vegetation and toxic chemicals from structures, can harm lung and heart health even far from the fire.¹² Extreme heat increases the risk of exhaustion, heat stroke, and death, particularly for those with chronic health conditions.¹³ The month after a hurricane, mortality rates increase by an estimated 33 percent due to injuries, infectious and parasitic diseases, cardiovascular issues, respiratory conditions, and neuropsychiatric disorders, with the mortality rate remaining elevated for months.¹⁴ Hurricanes also cause an estimated 14.5 percent more poor mental health days, including elevated stress, anxiety, depression, and substance abuse—impacts that have been shown to persist for at least seven years following a storm.¹⁵ The surges in mental health diagnoses following extreme weather events and crises are seen not only for patients but also for the clinicians and staff who care for them.¹⁶

There are also social, economic, and political effects of extreme weather events and climate change that further impact health and access to care. Globally, extreme events related to climate change are estimated to cost $143 billion per year, primarily due to loss of life. Those costs are ultimately passed onto nations and the communities impacted.¹⁷ And such events are among the drivers of climate migration; they influence the decisions of millions of people around the world to leave their homes and homelands each year, requiring communities—including health systems—to adapt.

Despite the wide-ranging consequences of a changing climate, there are tried and true ways to protect our health and healthcare systems. Some facilities have become much more prepared for the climate impacts they encounter—like Tampa General Hospital, which uses a temporary barrier that prevents flooding from swells up to 15 feet above sea level. The hospital has used this barrier successfully during multiple storms, including Hurricanes Milton and Idalia.¹⁸ In this article, we discuss the threats of climate change to health and healthcare systems and what we can do individually and collectively to address them within institutions and through policy changes. As health professionals in the United States, we want to improve the resilience of our healthcare systems and our communities, and we want to mitigate the climate change–related health risks affecting our patients, our coworkers—every single one of us.

Climate Change and Healthcare

Climate change is a health crisis that affects not only individual morbidity and mortality but also society’s ability to deliver healthcare and support healthy living. The World Health Organization (WHO) has called the climate crisis the greatest health challenge of the 21st century,¹⁹ yet the severity of climate-related health risks is highly dependent on how well health systems can protect people.²⁰ Over the past 100 years, civilizations globally have relied on fossil fuels to propel development and growth, resulting in the carbon dioxide concentration in our atmosphere rising from around 280 parts per million (ppm) in the pre-industrial era to approximately 419 ppm today.²¹ This chemical blanket has thrown our planet’s delicate climate systems out of balance, leading to increasing temperatures and escalating extreme heat, intensification of extreme weather (e.g., wildfires, hurricanes, flooding), and rising sea levels.²² Subsequent downstream climate exposures, such as degraded air, food, and water quality, and increases in vector-borne disease result in cascading negative health effects and healthcare disruptions.²³

Rapid climatic changes are reshaping the United States in profound ways, impacting natural ecosystems, public health, infrastructure, and economic stability. A few examples:

There are now more average flooding days across the United States.²⁴

New diseases spread by ticks and insects are appearing, such as the cases of dengue reported in Los Angeles for the first time in 2024.²⁵ Compared to the 1951–1960 average, in 2014–2023 the conditions suitable for malaria-causing P. falciparum and P. vivax increased by 39.7 percent and 32.1 percent in the United States. The length of US coastline suitable for the infection-causing Vibrio vulnificus increased by 50 percent between 2000–2004 and 2014–2023.²⁶

In the United States in 2021, there were approximately 125,800 deaths due to anthropogenic air pollution, with 39 percent attributable to fossil fuels.²⁷

Globally, 2024 was the warmest year to date,²⁸ and the United States is warming faster than the global rate, with a statistically significant increase in the frequency and number of heat waves compared to the 1960s.²⁹

Climate change and the associated health impacts are affecting every region of the United States while impacting vulnerable citizens—children, elderly, socially at-risk populations, Indigenous populations, individuals with disabilities or chronic conditions, outdoor workers, and pregnant people—the most.³⁰

Furthermore, healthcare systems are directly impacted by climate change. Annually, trillions of dollars are estimated to be spent on global health costs related to climate change and air pollution caused by fossil fuels.³¹ One extreme weather event alone can lead to billions of dollars in costs for a single healthcare system.³² Extreme weather also causes disruptions in care through damage to essential systems—water and power lines may go down, roads may be impassable, public transportation may be limited, and supply chains may be cut off. And healthcare utilization changes, which requires health systems to respond dynamically. For instance, extreme events often result in surges in demand for emergency medicine services, which may result in prolonged boarding times, staffing shortages, worker fatigue, and poor patient outcomes.³³

Healthcare systems in the United States not only are at risk from the impacts of climate change but also play a role in exacerbating the issue. These systems contribute to 8.5 percent of domestic US greenhouse gas emissions—primarily related to the purchase of goods and services rather than from direct emissions—and a quarter of all healthcare emissions worldwide.³⁴ Pollution from US healthcare is estimated to result in a loss of 388,000 disability-adjusted life-years per year,³⁵ competing with the annual number of deaths from cigarette smoking,³⁶ and above the 44,000 to 98,000 annual deaths in US hospitals as a result of preventable medical errors.³⁷ In keeping with the mission of healthcare and the time-honored oath to do no harm, the healthcare sector has ample opportunities to enact climate-smart healthcare through rapid and systematic reduction in the environmental impacts of its own activities. In 2023, the Joint Commission introduced guidelines aimed at reducing the environmental impacts of healthcare systems. However, due to significant resistance from health systems and the healthcare industry, the recommendations for monitoring and lowering emissions were made voluntary rather than mandatory for hospitals and health systems, ultimately limiting their potential effectiveness.³⁸ Strategies for moving toward a low-emission healthcare system would involve decreasing low-value care (like unnecessary diagnostic testing and procedures) and investing in preventive care to reduce the need for acute care, incentivizing the transition to a circular economy that minimizes single-use products and physical waste, and shifting toward a sustainable energy infrastructure.³⁹ Many of these strategies would reduce costs for payers, but most importantly, they would radically decrease the healthcare sector’s contributions to the climate health crisis.

What We Can Do as Health Professionals

Health professionals and our organizations—including 
unions—occupy a critical position in the response to climate change.⁴⁰ First, health professionals are charged with protecting individual and community health in the face of multiple, new, compounding health risks that will become more complicated to address as time goes on. Clinicians will increasingly care for patients whose disease processes are caused or accelerated by climate change and will be tasked with counseling and treating these individuals as well as readying healthcare systems to cope with the increasing burdens of disease. Second, health professionals’ institutional knowledge and collective voice, exercised through union organizing and membership as well as through professional associations, are indispensable in modifying health systems to become both resilient to climate threats and environmentally sustainable. As trusted members of our communities and of society, health professionals can also advocate for policy solutions inside and outside the health system.⁴¹

To protect health, now and in the future, we urgently need collective action to slow, stabilize, and reverse climate change by reducing greenhouse gas emissions while simultaneously addressing the current impacts on our patients, communities, and ourselves.

Individual Actions

First, to address the health impacts of climate change at the individual level, as health professionals we can learn to identify, treat, and communicate about climate-sensitive diseases and recommend protective measures to our patients. To do this effectively, there are multiple free resources for your climate health education, as well as learning opportunities with enrollment fees (see “Building Climate Health Knowledge” on upper right). Unions can support such education efforts by facilitating training for members, coordinating training through labor-management committees, and bargaining for continuing education reimbursement and paid release time. Additionally, certain organizations, such as the Alliance of Nurses for Healthy Environments,⁴² have pledges to improve health professional education. By joining, you can serve as a liaison to help educate and empower your colleagues. By including a climate-health lens in our clinical practice, health professionals—nurses, dentists, physician assistants, physicians, and physical and occupational therapists, among others—can play a critical role in safeguarding individual and community health.

To help patients understand their specific risk profiles and increase resilience, health professionals can review patient-specific vulnerabilities and push healthcare administrators to evaluate and prepare their facilities. The Climate Resilience for Frontline Clinics Toolkit, which is available for free in English and Spanish here, offers reference documents and worksheets that clinicians can use with patients to evaluate their specific health risks. For instance, the resources for clinicians and patients include a review of heat-sensitive medications⁴³ and a handout detailing recommendations by condition, such as that patients with heart disease should weigh themselves daily when it is hot out and know their target weight to avoid dehydration.⁴⁴ (The toolkit also offers resources for health system administrators related to accessing critical roles and responsibilities, preparedness guidance for the different climate shocks and slow-onset events, response actions to consider, and communication templates.)

Additional resources and guidance are available from WHO and the US Department of Health and Human Services (HHS),⁴⁵ including the Climate Resilience for Health Care Facilities Toolkit* (available here), to raise awareness of the individual-level actions we can take to improve resilience. Unions can support all of these practices by making resources available to members and offering support as members put them into practice. Don’t forget that having your own emergency plan will enable you to help others.

Health professionals can also support decarbonization and improve clinical practice and personal sustainability. We can prescribe and advocate for access to medications with lower emissions than clinically comparable options. For instance, metered-dose inhalers in the United States generate annual greenhouse gas emissions comparable to the output of 500,000 gas-powered vehicles. In contrast, dry powder inhalers, which are often clinically equivalent, have a significantly lower carbon footprint and are widely used in other countries as a more sustainable, less-costly alternative—but some of the most effective options aren’t available in the United States.⁴⁶ To advocate for access, you can sign the open letter to encourage AstraZeneca to make its Symbicort Turbuhaler dry powder inhaler available in the United States.⁴⁷

As health professionals, we are also well equipped to emphasize the health benefits of emission reductions to patients,⁴⁸ highlight cost savings from sustainable practices, and evaluate how our specific field can reduce greenhouse gas emissions. For instance, we can consult the HealthcareLCA (life cycle assessment) database⁴⁹ or the Choosing Wisely database⁵⁰—or go above and beyond and conduct a life cycle assessment ourselves⁵¹—to evaluate the sustainability and efficacy of common materials and procedures. Additionally, when conducting research, we should consider the environmental impacts of our study designs (including the use of technologies and computation methods with significant carbon footprints, such as deep learning models^{52 †}). For example, one research group is including an environmental impact analysis in its randomized control trial on surgical and endoscopic removal of early colon cancer to assess the carbon footprint of the two interventions, along with standard clinical metrics.⁵³ Finally, individuals can personally decarbonize by using energy-efficient transportation and public transportation where possible, minimizing meat consumption, supporting sustainable food systems, using eco-friendly web browsers, such as Ecosia, and investing in renewable energy sources.

Institutional Actions

At the institutional level, health professionals can create and implement evidence-based protocols that protect patients from the health impacts of climate change. For example, we can develop heat stroke protocols to standardize treatment at our facilities.⁵⁴ We can foster interdisciplinary collaboration within healthcare systems to enhance education and awareness among staff of climate-vulnerable diseases and patients. Establishing “green teams”⁵⁵ or sustainability committees allows us to identify areas for improvement and track progress in achieving sustainability goals. For instance, at Stanford Medicine, the Green Anesthesia team successfully reduced the carbon footprint of anesthetic gases by removing desflurane; it also launched a recycling program and instituted reusable products in the operating rooms.⁵⁶ By advocating for institutional-level changes, we can not only make our own clinical practice more sustainable and aligned with climate health goals but also drive systemic transformations that benefit the broader healthcare ecosystem. (And if our employers resist these changes, we can engage our unions in negotiating them.)

We can also use our collective voice to encourage our institutions to implement policies that prioritize climate-resilient infrastructure, such as ensuring facilities are prepared for extreme weather events and equipped with energy-efficient systems. For instance, after extreme flooding at Texas Medical Center, the hospital system upgraded all its critical infrastructure to be above projected flood elevations and developed a long-term hazard mitigation plan that incorporates 42 sustainable design strategies aimed at mitigating the effects of future extreme weather events.⁵⁷ As climate impacts affect your hospital system, advocate for infrastructure investments that support improved resilience, including through bargaining for the common good.⁵⁸ Additionally, request to see the most recent climate resilience plan and healthcare vulnerability and adaptation (V&A) assessment at your hospital. If no V&A assessment exists, there are frameworks⁵⁹ to help guide implementation at your institution.

To support decarbonization and sustainable practices, health professionals can advocate for our healthcare organizations to adopt specific practices, such as reducing energy use, transitioning to renewable energy sources, and improving waste management systems. We can promote environmentally friendly procurement policies to help minimize the environmental footprint of medical supplies and equipment. Additionally, we can advocate for and lead initiatives to reduce the climate and environmental footprint of our clinical practice,⁶⁰ through union activism and labor-management partnerships,⁶¹ and by forming professional working groups across the organization. For instance, at the University of Pittsburgh, health professionals in Clinicians for Climate Action have reduced greenhouse gas emissions, and its various sustainability initiatives have resulted in significant cost savings for the institution.⁶² We can also encourage our healthcare systems to be more ambitious than federal and state mandates. Penn Medicine, for example, is aiming for carbon neutrality by 2042.⁶³ Advocate for your hospital to complete a carbon baseline audit to determine areas where improvements can be most effectively made. If no office of sustainability exists to make such an inquiry, band together with your fellow union members or colleagues to write a letter to your executive leadership—like Clinicians for Climate Action did⁶⁴—to start the process. By leading or supporting institutional efforts to monitor and reduce greenhouse gas emissions, you can contribute to creating more resilient healthcare systems while advocating for patient and environmental health.

Organizational and Society Actions

Federal-Level Policy Opportunities

Although the future of these policies is uncertain, there are some federal policies aimed at sustainability initiatives and reducing emissions that health professionals, organizations, unions, and professional societies can encourage healthcare systems to join. For instance, as of November 2024, 19 percent of US hospitals, including 960 private-sector hospitals, had signed on to the HHS Health Sector Climate Pledge.⁶⁵ Announced in 2022, the HHS pledge included a voluntary commitment to cut greenhouse gas emissions to 50 percent by 2030, reaching net zero by 2050; under the Biden administration, hospitals received support from the Office of Climate Change and Health Equity to meet these goals. (At the time this article was finalized for print, in March 2025, the HHS Climate Pledge website was removed; a nonprofit preserved it here. Regardless of the state of national climate leadership, hospitals can still aim for the goals of the pledge—and unions and communities can still push hospitals to honor their commitments.) Separately, hospital systems can apply for the Joint Commission’s Sustainable Healthcare Certification.⁶⁶ Hospitals earning the certification demonstrate their commitment to establishing healthy, sustainable systems for their communities. An alternative new voluntary option is the Centers for Medicare & Medicaid Services Decarbonization and Resilience Initiative.⁶⁷ We can encourage our health systems to take advantage of the Inflation Reduction Act’s Investment Tax Credit to invest in solar power and save on energy bills,⁶⁸ and participate in the Administration for Strategic Preparedness and Response’s Regional Disaster Health Response System, which is aimed at creating disaster resource hospitals that coordinate efforts across multiple hospital sites during emergencies.⁶⁹ Through advocating for these federal programs, we can encourage our hospital systems to join the green healthcare movement or even exceed federal mandates.

State-Level Policy Leadership

States are also proving to be fertile ground for climate and health innovation. They can act independently or supplement federal efforts (or the lack thereof) to decarbonize healthcare and other sectors while simultaneously building resilience. States can, for example, set their own ambitious greenhouse gas reduction targets and create incentives and regulations to achieve them. As of December 2024, 24 states and the District of Columbia had set specific greenhouse gas reduction targets, with many aligning their goals toward achieving net-zero emissions by 2050.⁷⁰ These states include major players like California, New York, and Washington, which have implemented comprehensive climate action plans to transition to cleaner energy, transportation, and industry. Additionally, some states have established intermediate milestones to ensure steady progress toward their decarbonization goals.

Healthcare organizations and healthcare unions can engage substantially on the state level to advocate for and advise on such policies. For example, the California Health Care Climate Alliance, a coalition formed by five of California’s largest health systems (Kaiser Permanente, Dignity Health, Sutter Health, Providence St. Joseph Health, and University of California Health) was established to harness the expertise and credibility of the healthcare sector to advance public policies that will protect Californians from the harms of climate change, build public health resilience, reduce emissions from healthcare facilities, and support the state’s climate goals.⁷¹ Unions and professional organizations can play a pivotal role by lobbying state legislators to integrate health considerations into climate and energy policy. By framing decarbonization as a public health imperative rather than merely an environmental one, these organizations may be able to gain bipartisan support for action, even in politically polarized states.

Private-Sector Partnerships

In addition to influencing public policy, health professionals and health systems can forge partnerships with private-sector organizations to advance sustainability goals. Collaborations with technology companies, renewable energy providers, and green building firms can help healthcare institutions reduce their carbon footprint while lowering operational costs. One notable example is the partnership between Boston Medical Center and local renewable energy companies, which led to the hospital becoming carbon-neutral while saving millions of dollars annually.⁷² Such partnerships not only are cost-effective but also provide replicable models for other institutions to follow.

Health professional organizations can also work with (and unions can advocate for) pharmaceutical and medical device companies to prioritize sustainable practices in the production, packaging, and distribution of supplies. By leveraging their collective purchasing power, hospitals and healthcare systems can push the supply chain toward environmentally friendly solutions. Even small changes, like QR codes for electronic instructions instead of paper instruction booklets, can make an impact for widely used products.⁷³ The National Academy of Medicine launched the Action Collaborative on Decarbonizing the US Health Sector as part of its Grand Challenge on Climate Change, Human Health, and Equity. This public-private partnership unites leaders across healthcare—including hospitals, health systems, academia, industry, and policymakers—to reduce the sector’s carbon footprint and enhance resilience. It emphasizes collaboration in areas such as supply chains, infrastructure, healthcare delivery, and professional education. The initiative aims to halve healthcare emissions by 2030 and achieve sustainability goals aligned with community health improvements.⁷⁴ Health professionals and organizations can join these efforts.

Strengthening Grassroots Advocacy and Public Engagement

Health professionals must also amplify their voices beyond hospitals and clinics. This is another venue for union activism in local communities and at the state and federal levels. Community education is essential to building public pressure for climate action. Initiatives such as town halls, op-eds, and public service campaigns can help individuals connect the dots between climate change and their personal health, galvanizing grassroots support for local and state initiatives. Unions and organizations such as the American Medical Association,⁷⁵ Health Care Without Harm,⁷⁶ and the Medical Society Consortium on Climate and Health⁷⁷ offer opportunities to amplify your voice. Additionally, training programs and leadership development initiatives can empower healthcare workers to become advocates for change.

We provide these resources and recommended actions in the hope that they will inspire you to take action to protect the health of your patients and your community. As the extreme weather events of the last several months have demonstrated, the time for urgent action on climate change is now. There are many opportunities and lots of support for conducting this important work. The next storm may come, but we don’t have to wait for it to flood.

*This toolkit is available online as of March 20, 2025. If it is removed from the internet, email hc@aft.org to request a copy. (return to article)

^†To learn more about the equitable and ethical use of deep learning models such as clinical algorithms, see “Addressing Bias in Clinical Algorithms to Advance Health Equity.” (return to article)

Hannah N. W. Weinstein, BA, is a fourth-year medical student at Columbia University Vagelos College of Physicians and Surgeons and a Global Consortium on Climate and Health Education (GCCHE) student fellow. Cassandra Thiel, PhD, is an assistant professor in population health and ophthalmology at NYU Langone Health and the founder of Clinically Sustainable Consulting. Cecilia Sorensen, MD, is the director of the GCCHE, an associate professor of environmental health sciences in the Mailman School of Public Health, and an associate professor of emergency medicine at the Columbia Irving Medical Center. 

Endnotes

1. E. Hammond et al., “Dozens Rescued from Roof of Tennessee Hospital During Flooding from Helene,” CNN, September 27, 2024, cnn.com/2024/09/27/us/unicoi-county-hospital-tennessee-flooding-helene/index.html; and A. Wittenberg, “Helene Nearly Turned a Hospital into a Death Trap,” Scientific American, October 2, 2024, scientificamerican.com/article/hurricanes-helenes-floods-swamped-a-hospital-highlighting-climate-threats-to.

2. H. Thiem and R. Lindsey, “Hurricane Helene’s Extreme Rainfall and Catastrophic Inland Flooding,” Climate.gov, National Oceanic and Atmospheric Administration, November 7, 2024, climate.gov/news-features/event-tracker/hurricane-helenes-extreme-rainfall-and-catastrophic-inland-flooding.

3. Wittenberg, “Helene Nearly Turned.”

4. HCA Healthcare, Never Alone: Hurricane Helene, Hurricane Milton and the HCA Healthcare Response, Special Edition 2024 (Nashville, TN: December 2024), magazine.hcahealthcare.com/wp-content/uploads/2024/12/20241126-never-alone-interior-pages-with-cover-DIGITAL.pdf.

5. D. Ovalle and S. Malhi, “Florida Officials Rush to Evacuate Vulnerable Patients Ahead of Milton,” Washington Post, October 9, 2024, washingtonpost.com/health/2024/10/09/milton-hospital-patients-relocate; and C. O’Donnell, “No Water, Then No Power. How One St. Petersburg Hospital Survived Milton,” Tampa Bay Times, October 22, 2024, tampabay.com/hurricane/2024/10/22/stpetersburg-hurricane-milton-baycare-stanthonys-hospital.

6. S. Mace and A. Sharma, “Hospital Evacuations Due to Disasters in the United States in the Twenty-First Century,” American Journal of Disaster Medicine 15, no. 1 (2020): 7–22.

7. Americares, “Climate Resilience for Frontline Clinics Toolkit,” 2024, americares.org/what-we-do/community-health/climate-resilient-health-clinics/#toolkit.

8. A. Paavola, “Wildfire Forces California Hospital to Evacuate for 2nd Time in a Month,” Becker’s Hospital Review, September 28, 2020, beckershospitalreview.com/patient-flow/wildfire-forces-california-hospital-to-evacuate-for-2nd-time-in-a-month.html?oly_enc_id=7076C8190145E4B.

9. E. Raker et al., “Twelve Years Later: The Long-Term Mental Health Consequences of Hurricane Katrina,” Social Science & Medicine 242 (December 2019): 112610.

10. J. Semenza and A. Ko, “Waterborne Diseases That Are Sensitive to Climate Variability and Climate Change,” New England Journal of Medicine 389, no. 23 (December 6, 2023): 2175–87; Z. Andersen et al., “Climate Change and Respiratory Disease: Clinical Guidance for Healthcare Professionals,” Breathe 19, no. 2 (July 11, 2023): 220222; and A. Belzer and E. Parker, “Climate Change, Skin Health, and Dermatologic Disease: A Guide for the Dermatologist,” American Journal of Clinical Dermatology 24, no. 4 (July 2023): 577–93.

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12. C. Gould et al., “Health Effects of Wildfire Smoke Exposure,” Annual Review of Medicine 75 (January 29, 2024): 277–92.

13. M. Bell, A. Gasparrini, and G. Benjamin, “Fossil-Fuel Pollution and Climate Change: Climate Change, Extreme Heat, and Health,” New England Journal of Medicine 390, no. 19 (May 15, 2024): 1793–1801.

14. R. Parks et al., “Association of Tropical Cyclones with County-Level Mortality in the US,” JAMA 327, no. 10 (2022): 946–55; and Y. Wu et al., “Climate Change, Floods, and Human Health,” New England Journal of Medicine 391, no. 20 (November 20, 2024): 1949–58.

15. Y. Civelek, “The Effect of Hurricanes on Mental Health Over the Long Term,” Economics & Human Biology 51 (December 2023): 101312.

16. A. Carroll and A. Frakt, “The Long-Term Health Consequences of Hurricane Harvey,” New York Times, August 31, 2017, nytimes.com/2017/08/31/upshot/the-long-term-health-consequences-of-hurricane-harvey.html; and M. Gaiser et al., “Mental Health Needs Due to Disasters: Implications for Behavioral Health Workforce Planning During the COVID-19 Pandemic,” Public Health Reports 138, no. 1 Suppl. (May 25, 2023): 48S–55S.

17. R. Newman and I. Noy, “The Global Costs of Extreme Weather That Are Attributable to Climate Change,” Nature Communications 14 (2023): 6103.

18. K. Toussaint, “How a Tampa Hospital Withstood Two Massive Hurricanes,” Fast Company, October 10, 2024, fastcompany.com/91207434/how-a-tampa-hospital-withstood-two-massive-hurricanes.

19. T. Ghebreyesus, S. Al Jaber, and V. Kerry, “We Must Fight One of the World’s Biggest Health Threats: Climate Change,” World Health Organization, November 3, 2023, who.int/news-room/commentaries/detail/we-must-fight-one-of-the-world-s-biggest-health-threats-climate-change.

20. H. Pörtner et al., eds., Climate Change 2022: Impacts, Adaptation, and Vulnerability—Working Group II Contribution to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (Cambridge, UK: Cambridge University Press, 2022), ipcc.ch/report/ar6/wg2/.

21. R. Lindsey, “Climate Change: Atmospheric Carbon Dioxide,” Climate.gov, National Oceanic and Atmospheric Administration, climate.gov/news-features/understanding-climate/climate-change-atmospheric-carbon-dioxide.

22. Globalchange.gov, “Climate and Health Assessment,” US Global Change Research Program, health2016.globalchange.gov/downloads.

23. M. Romanello et al., “The 2024 Report of the Lancet Countdown on Health and Climate Change: Facing Record-Breaking Threats from Delayed Action,” Lancet 404, no. 10465 (November 9, 2024): P1847–1896; World Health Organization, Health and Climate Change: Country Profile 2015: United States of America (Geneva, Switzerland: December 3, 2016), who.int/publications/i/item/WHO-FWC-PHE-EPE-15.49; and US Environmental Protection Agency, “Climate Change Impacts on Health,” epa.gov/climateimpacts/climate-change-impacts-health.

24. Wu et al., “Climate Change, Floods, and Human Health.”

25. County of Los Angeles Public Health, “More Cases of Locally Acquired Dengue Virus Identified in Baldwin Park,” October 15, 2024, publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=4853.

26. Romanello et al., “The 2024 Report”; and N. Beyeler et al., Lancet Countdown, 2024: Lancet Countdown on Health and Climate Change Policy Brief for the United States of America (London, UK: Lancet, 2024), lancetcountdownus.org/2024-lancet-countdown-u-s-brief/#disease.

27. Beyeler et al., Lancet Countdown.

28. National Oceanic and Atmospheric Administration, “2024 Was the World’s Warmest Year on Record,” US Department of Commerce, January 10, 2025, noaa.gov/news/2024-was-worlds-warmest-year-on-record.

29. US Environmental Protection Agency, “Climate Change Indicators: U.S. and Global Temperature,” February 4, 2025, epa.gov/climate-indicators/climate-change-indicators-us-and-global-temperature; and US Environmental Protection Agency, “Climate Change Indicators: Heat Waves,” January 15, 2025, epa.gov/climate-indicators/climate-change-indicators-heat-waves.

30. US Environmental Protection Agency, “State and Regional Climate Change Connections,” January 15, 2025, epa.gov/climateimpacts/state-and-regional-climate-change-connections; US Environmental Protection Agency, “Climate Change and Human Health: Who’s Most at Risk,” January 16, 2025, epa.gov/climateimpacts/climate-change-and-human-health-whos-most-risk; and Beyeler et al., Lancet Countdown.

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32. Practice Greenhealth, “NYU Langone Health: Hardening Infrastructure Against Climate Disruptions,” practicegreenhealth.org/topics/climate-and-health/nyu-langone-health-hardening-infrastructure-against-climate-disruptions.

33. Salas and Solomon, “The Climate Crisis.”

34. M. Eckelman et al., “Health Care Pollution and Public Health Damage in the United States: An Update,” Health Affairs 39, no. 12 (December 2020): 2071–79.

35. Eckelman et al., “Health Care Pollution.”

36. Centers for Disease Control and Prevention, 2014 Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress (Washington, DC: US Department of Health and Human Services, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, July 27, 2023), archive.cdc.gov/#/details?q=https://www.cdc.gov/tobacco/sgr/50th-anniversary/index.htm%20&start=0&rows=10&url=https://www.cdc.gov/tobacco/sgr/50th-anniversary/index.htm.

37. M. Eckelman and J. Sherman, “Environmental Impacts of the U.S. Health Care System and Effects on Public Health,” PLOS One 6, no. 11 (June 9, 2016): e0157014.

38. A. Rabin and E. Pinsky, “Reducing Health Care’s Climate Impact—Mission Critical or Extra Credit?,” New England Journal of Medicine 389, no. 7 (2023): 583–85.

39. C. Chen et al., “The Role of Payers in Achieving Environmentally Sustainable and Climate Resilient Health Care,” Health Affairs, May 30, 2024, healthaffairs.org/content/forefront/role-payers-achieving-environmentally-sustainable-and-climate-resilient-health-care.

40. V. Dzau et al., “Decarbonizing the U.S. Health Sector—a Call to Action,” New England Journal of Medicine 385, no. 23 (2021): 2117–19.

41. J. Charles et al., “Health Professionals as Advocates for Climate Solutions: A Case Study from Wisconsin,” Journal of Climate Change and Health 4 (October 2021): 100052. See, for example, the Medical Society Consortium on Climate and Health, medsocietiesforclimatehealth.org.

42. Alliance of Nurses for Healthy Environments, “Nurse Climate Challenge,” envirn.org/nurses-climate-challenge.

43. Americares, “Medications and Heat: For Providers,” americares.org/wp-content/uploads/HEAT_Medications_ForProviders_FINAL0904.pdf.

44. Americares, “Tips for People with Specific Health Conditions or Risk Factors: For Patients,” americares.org/wp-content/uploads/ExtremeHeat_RiskHealthConditions_Final.pdf.

45. World Health Organization, “Climate Change and Health: Building Climate-Resilient Health Systems,” who.int/teams/environment-climate-change-and-health/climate-change-and-health/country-support/building-climate-resilient-health-systems; and US Department of Health and Human Services, “Developing a Climate Resilience Plan for Healthcare Organizations: Key Considerations,” July 12, 2023, web.archive.org/web/20241130060608/https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/climate-resilience-plan/index.html.

46. P. Huffman and E. Hough, “A Hidden Contributor to Climate Change—Asthma Inhalers,” Commonwealth Fund, May 16, 2023, commonwealthfund.org/blog/2023/hidden-contributor-climate-change-asthma-inhalers.

47. W. Armand, “An Urgent Call to Bring an Affordable, Climate-Friendly Inhaler to the US,” Health Care Without Harm, September 25, 2024, us.noharm.org/news/urgent-call-bring-affordable-climate-friendly-inhaler-us.

48. C. Sorensen and L. Fried, “Defining Roles and Responsibilities of the Health Workforce to Respond to the Climate Crisis,” JAMA Network Open 7, no. 3 (2024): e241435.

49. HealthcareLCA, “HealthcareLCA Database,” healthcarelca.com/database.

50. American Academy of Pediatrics, “Choosing Wisely Campaign Toolkit,” July 18, 2023, aap.org/en/news-room/campaigns-and-toolkits/choosing-wisely/?srsltid=AfmBOoox4_mFCLkx3Cs0Ot6CCAh--H-sD9bd39r-gA1q_dwIkOabOaao.

51. Columbia University Irving Medical Center, “Life Cycle Assessment Boot Camp: LCA for the Health Sector,” Columbia Mailman School of Public Health, publichealth.columbia.edu/academics/non-degree-special-programs/professional-non-degree-programs/skills-health-research-professionals-sharp-training/life-cycle-assessment; and S. McGinnis et al., “Environmental Life Cycle Assessment in Medical Practice: A User’s Guide,” Obstetrical & Gynecological Survey 76, no. 7 (July 2021): 417–28.

52. L. Lannelongue, J. Grealey, and M. Inouye, “Green Algorithms: Quantifying the Carbon Footprint of Computation,” Advanced Science 8, no. 12 (2021): 2100707.

53. L. Nordberg et al., “Carbon-Footprint Analyses in RCTs—Toward Sustainable Clinical Practice,” New England Journal of Medicine 390, no. 24 (2024): 2234–36; and L. Bouza, A. Bugeau, and L. Lannelongue, “How to Estimate Carbon Footprint When Training Deep Learning Models? A Guide and Review,” Environmental Research Communications 5, no. 11 (November 21, 2023): 115014.

54. Office of Climate Change and Health Equity, “Impact of Extreme Heat on Health Care Facilities,” National Oceanic and Atmospheric Administration, toolkit.climate.gov/sites/default/files/Hazard_Extreme_Heat_3.0_0.pdf; and C. Sorensen and J. Hess, “Treatment and Prevention of Heat-Related Illness,” New England Journal of Medicine 387, no. 15 (2022): 1404–13.

55. Practice Greenhealth, A Guide for Creating Effective Green Teams in Health Care (Reston, VA: September 8, 2008), practicegreenhealth.org/sites/default/files/pubs/epp/GuideGreenTeams.pdf.

56. Stanford Medicine Health Care, “Green Teams,” stanfordhealthcare.org/sustainability-program-office/sustainability-program-office/what-we-do/green-teams.html.

57. US Climate Resilience Toolkit, “Case Study: After Record-Breaking Rains, a Major Medical Center’s Hazard Mitigation Plan Improves Resilience,” National Oceanic and Atmospheric Administration, 2015, toolkit.climate.gov/case-studies/after-record-breaking-rains-major-medical-centers-hazard-mitigation-plan-improves.

58. Bargaining for the Common Good, “Concrete Examples of Bargaining for the Common Good,” ACRE Action Center on Race & the Economy, Georgetown University, Rutgers School of Management and Labor Relations, December 20, 2019, smlr.rutgers.edu/sites/default/files/Documents/Centers/CIWO/ciwo_bcg-memo.pdf.

59. World Health Organization, “Climate Change and Health Toolkit,” who.int/teams/environment-climate-change-and-health/climate-change-and-health/capacity-building/toolkit-on-climate-change-and-health/vulnerability; Government of Canada, “Climate Change and Health Vulnerability and Adaptation Assessments: A Knowledge to Action Resource Guide,” September 12, 2022, canada.ca/en/health-canada/services/publications/healthy-living/climate-health-adapt-vulnerability-adaptation-assessments-resource-guide.html; and US Climate Resilience Toolkit, “Learn the Steps to Resilience,” National Oceanic and Atmospheric Administration, toolkit.climate.gov.

60. Sorensen and Fried, “Defining Roles.”

61. P. Lazes and M. Rudden, “Improving Working Conditions in Turbulent Times: Expanding Unions’ Toolkits,” AFT Health Care 3, no. 1 (Spring 2022): 22–23, 26–27, 29–30, 40.

62. School of Medicine Clinicians for Climate Action, “Achievements,” University of Pittsburgh, c4ca.pitt.edu/achievements; and R. Frazier, “Health Care Has a Massive Carbon Footprint. These Doctors Are Trying to Change That,” National Public Radio, October 2, 2023, npr.org/2023/10/02/1202389187/hospitals-climate-change.

63. C. Sherwood, “How Penn Medicine Is Going Green for Good Health,” Penn Medicine News, March 29, 2024, pennmedicine.org/news/publications-and-special-projects/penn-medicine-magazine/spring-summer-2024/how-penn-medicine-is-going-green-for-good-health.

64. Noe Woods et al., “Letter to Leslie C. Davis, Mark Sevco, Diane Holder, Dr. Joon Y. Lee, and UPMC Executive Leadership,” University of Pittsburgh School of Medicine Clinicians for Climate Action, April 22, 2022, c4ca.pitt.edu/sites/default/files/assets/UPMC%20Clinicians%20Climate%20Health%20Letter%20April%2028.pdf.

65. US Department of Health and Human Services, “HHS Shares Health Sector Climate Resilience and Emissions Reduction Announcements at COP29,” November 18, 2024, public3.pagefreezer.com/browse/HHS.gov/02-01-2025T05:49/https://www.hhs.gov/about/news/2024/11/18/hhs-shares-health-sector-climate-resilience-and-emissions-reduction.html.

66. Joint Commission, “Sustainable Healthcare Certification,” jointcommission.org/what-we-offer/certification/certifications-by-setting/hospital-certifications/sustainable-healthcare-certification/#86e0176ed4de46c7979498c67f86b198.

67. Centers for Medicare & Medicaid Services, “TEAM Decarbonization and Resilience Initiative,” August 1, 2024, cms.gov/team-decarbonization-and-resilience-initiative.

68. US Department of Health and Human Services, “HHS Shares Health Sector Climate Resilience.”

69. Administration for Strategic Preparedness & Response, “Building Regional Solutions,” US Department of Health and Human Services, aspr.hhs.gov/RDHRS/Pages/default.aspx.

70. Center for Climate and Energy Solutions, “State Climate Policy Maps,” c2es.org/content/state-climate-policy.

71. Health Care Without Harm, “Leading Health Systems Form Alliance to Address Climate Change in California,” August 22, 2018, us.noharm.org/news/leading-health-systems-form-alliance-address-climate-change-california.

72. Boston Medical Center, “BMC Launches Innovative Clean Power Prescription Program,” bmc.org/clean-power-prescription-program.

73. EyeSustain, “Electronic IFU,” eyesustain.org/events/electronic-ifu; and A. Keyser et al., “Analysis of Intraocular Lens Packaging Weight and Waste,” Journal of Cataract & Refractive Surgery 50, no. 12 (December 1, 2024): 1270–74.

74. National Academy of Medicine, “Action Collaborative on Decarbonizing the U.S. Health Sector,” September 2024, nam.edu/programs/climate-change-and-human-health/action-collaborative-on-decarbonizing-the-u-s-health-sector.

75. American Medical Association, “Advocacy in Action: Combatting Health Effects of Climate Change,” November 19, 2024, ama-assn.org/delivering-care/public-health/advocacy-action-combatting-health-effects-climate-change.

76. Health Care Without Harm, “US & Canada,” us.noharm.org.

77. Medical Society Consortium on Climate & Health, “Take Action,” medsocietiesforclimatehealth.org/take-action.

[Illustrations by Stephanie Dalton Cowan]