Making local health systems climate-resilient

In the annual convention of the Philippine Society of Public Health Physicians on Sept. 20 to 21, I urged our country’s public health community to expand their healing mission—to consider the Earth’s illnesses while caring for the health of individuals. The health of people and that of the planet are inextricably interlinked, an ancient wisdom long acknowledged by our country’s indigenous communities.

Climate change affects human health in diverse ways—from injuries caused by typhoons and heat stroke during torrid temperatures, to worsening undernutrition due to crop failures, and now, growing “climate anxiety” especially among young people. Climate change also impacts health systems by adding extra burden on already overwhelmed health facilities and disrupting the delivery of services and medical supplies. Ultimately, climate change will widen existing health inequalities and disproportionately affect the poor, vulnerable, and marginalized.

Given these impacts, health systems worldwide must embrace climate change as one of the new challenges that they must urgently address. Like other sectors such as agriculture, the health sector must take two types of climate action—climate mitigation, which pertains to lowering greenhouse gas emissions to slow down or stop the progression of climate change, and climate adaptation, which refers to the reduction of climate risks and tackling climate impacts. To achieve these, health systems must become environmentally sustainable and climate resilient.

In recent years, international organizations and academic institutions have developed guidance for establishing climate-resilient and environmentally sustainable health systems. Based on the health system “building blocks,” the World Health Organization (WHO) developed an operational framework for climate-resilient and low-carbon health systems to guide policymaking and planning by ministries of health worldwide. Meanwhile, the World Bank introduced the concept of “climate-smart health care” which brings together the health sector’s newfound dual responsibility of resilience building and environmental sustainability.

During the United Nations climate conference (COP28) in 2023 in Dubai, the WHO officially launched the Alliance for Transformative Action on Climate and Health (ATACH), which brings together countries that made a commitment to establish climate-resilient and low-carbon national health systems. Thanks to the leadership of Health Secretary Ted Herbosa, the Philippines became the 80th country to be “attached” to ATACH, with the Department of Health (DOH) aiming to develop a road map for climate and health for the next decades.

Additionally, the Philippines’ National Adaptation Plan, which was developed under the auspices of the Climate Change Commission, dedicated an entire chapter to the health sector. This section lays out the actions that the health sector must do to achieve climate-adaptive universal health care for all Filipinos.

To realize these national commitments and plans, there is a need to operationalize the concept of a climate-resilient and environmentally sustainable health system at the local level. However, the existing frameworks developed by the WHO and others were designed for national government agencies and are not easily translatable to local jurisdictions. Meanwhile, available frameworks for greening and enhancing the resilience of hospitals and health facilities—such as the 10 pillars of Health Care Without Harm’s Global Green and Healthy Hospitals program and the DOH’s Green and Safe Health Facilities Manual—can serve as inspiration.

A new model must be developed that is applicable to entire local health systems at the municipal, city, or provincial level. Little is known about the climate-related roles of municipal health officers, the approaches needed to mainstream climate considerations into disease prevention and control programs, or the tools for applying a climate lens to the crafting of the Local Investment Plan for Health.

We, the Philippine public health community, must work together toward developing a shared framework for building climate-resilient and environmentally sustainable local health systems. Because of the country’s vulnerability and exposure to typhoons and other calamities, the Philippine health system also has policies, protocols, and practices aimed toward disaster risk reduction and management—not perfect, but a good starting point.

If we public health doctors put our minds together while we listen to communities in the climate frontlines, we can prepare and strengthen our local health systems for this era of climate emergency. The Philippines can be a role model for climate-resilient universal health care, sharing good practices and lessons learned with the rest of the warming world.

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Renzo R. Guinto, M.D., Dr.PH., is associate professor at the SingHealth Duke-NUS Global Health Institute based at the National University of Singapore.