Global heating and the challenges for health sector resilience

Instead of speaking about ‘alarm bells’ when we cite the IPCC 6th Synthesis report, we should probably speak of ambulance sirens. Because according to the report’s projections, within your lifetime the majority of communities in Australia and Southeast Asia will be exposed to between 10 and 100 days annually where temperature and humidity conditions can cause a major increase in hyperthermic [heat-related] mortality and morbidity, even if we rein in global heating to no more than 1.7-2.3 degrees.

On our current trajectory of continuing rises in annual levels of emissions, the projections are even bleaker. At global heating of 4.2-5.4 degrees, parts of SE Asia and the Top End in Australia may become deadly for up to 365 days of the year.

The IPCC notes it is now critical the health sector be resourced to increase its resilience – financial and operational – to manage the additional patient burden. This will include those affected by heatstroke, and those with existing or underlying conditions that are exacerbated by extremes of heat.

Some of these underlying conditions are already causing the health sector stress in many regions, including Australia. Staff, facility and budget constraints are tested by high rates of cardiovascular disease, diabetes, obesity, dementia, mental health issues and respiratory illness. In Southeast Asia, nations including the Philippines, Malaysia, Indonesia and India still need to increase capacity for basic healthcare across the entire population, so the health emergency of the climate crisis widens the capacity gap.

There is a larger picture here too, of the relationship between the robustness of the health system and the wellbeing and security of the entire community. This is both at the operational level and at the individual building scale.

If you thought Covid was bad – you’ll really hate climate change

The pandemic made it obvious health is a fundamental aspect of both individual and community resilience, but this is often neglected in the wider resilience policy and funding domain. Many health facilities are not well-adapted for climate change, in general performing extremely poorly as buildings. This has multiple impacts for the health system and for the wellbeing of staff and patients.

It is necessary to approach this from what researchers writing in The Lancet term ‘implementation science’.

This holistic approach is also a sound sustainability strategy in that it addresses operational, procedural and physical facility resilience and adaptation. This has also been shown by research into the links between green buildings and community health resilience.

And as we have seen with our clients and projects, addressing one dimension initially can create a beneficial feedback loop that flows through to benefits for the others.

For example, hospitals and medical facilities in areas that experience increasingly frequent heatwaves are more expensive to operate due to the cost of cooling. Given the limited budgets for the majority of health facilities, it’s a financial trade-off - what is spent on cooling cannot be spent on patient care and maintaining wages for nursing staff, doctors, orderlies and other essential workers.

Being hot also has implications for staff wellness and the ability to manage stress, this in turn affects the operational and procedural aspects of the facility.

A prescription for health sector resilience

As a major contributor to both the cause of climate change and the ability for populations exposed to climatic events to adapt to changing conditions, the built environment represents an important component of efforts to enhance community resilience.

Introducing sustainable initiatives can come in many shapes and forms, depending on the expected end use of the building and the occupants of the building. In the health sector, there are a diverse range of end users, but the main common trait that needs to be considered in design is most users will be more ‘vulnerable’ than the general population.

Interventions to improve the passive thermal performance of the hospital as part of an adaptation strategy will have flow-on benefits for operational costs, quality of care and the contribution the building itself makes to carbon emissions, where thermal upgrades also reduce energy demand.

There are many other design, retrofit and operational interventions in the medicine chest:

• Planning for passive survivability - the ability to maintain critical life support systems during operational failure, a necessary consideration in the design of all healthcare facilities.
• Upsizing or optimising heating, ventilation and air conditioning (HVAC) plant systems for the increase in temperature, so they can adequately handle expected increased heat loads.
• Water reuse where applicable – for irrigation and any washdown areas. Most regions are also expecting an increase in rainfall intensities, so design rainfall intensities need to be increased by up to 20% in some cases.
• Design for Island mode – as part of decarbonisation/electrification and renewables strategies, find options for renewable energy storage back up power as an alternative to fossil fuel emergency generators.
• Inclusion of on-site renewable energy generation to lower the energy demand on the grid and give building/s the ability to generate power during power losses – solar is commonplace, but potentially hydrogen generation is possible for larger sites. Another consideration here will be building regional workforce skills to maintain renewable and hydrogen technologies.
• Air filtration systems should be improved and incorporate fine particulate filters to reduce rising levels of outdoor pollutants including bushfire smoke, dust and smog from contaminating indoor air.

Consider your microclimate

There are some fundamental ways to improve the microclimate in the immediate vicinity of a health facility and as a result, the climate inside the building.

Adequate shading incorporated into building design, or retrofitted for buildings, walkways, carparks and outdoor areas, will reduce thermal gain from direct sun. It will also mitigate the urban heat island effect and provide better passive protection for staff, patients and visitors.

Lowering the SRI (solar reflective index) of building materials used in construction is also beneficial to reducing the heat gain capacity and thermal conductivity. Health sector buildings generally cover large expanses of land and have opportunity to integrate passive design feature such as urban morphology design, green infrastructure, and water bodies.

Green roofs can be used to both lower the heat capacity of the space and be simultaneously an insulator for buildings. Incorporating biophilic design for internal fit out can reduce stress and enhance the well-being of building users.

Ultimately, we need to be designing buildings that consider the impact on the wider community and region – going beyond the site in understanding the impacts of our decisions within the boundary and within the building.