Bolstering Health Systems for the Climate Crisis: Lessons from the Pacific

In 2021, months after a heat wave on the U.S. West Coast killed hundreds, the foreign minister of Tuvalu addressed the 26th U.N. Climate Change Conference (COP) while knee-deep in water on what used to be a beach. Though they are thousands of miles apart, both the United States and the Pacific islands are grappling with the relentless impacts of the climate crisis, including the effects on their health systems.

U.S. federal health care delivery systems like the Veterans Health Administration, Indian Health Service , and Military Health System are trying to anticipate climate shocks in order to minimize the potential damage. As highlighted in the recent COP27 announcement by the U.S. Department of Health and Human Services, these systems are now beginning to implement mitigation strategies , starting with emissions-reduction commitments.

On the other side of the world, however, the Pacific islands are taking a more comprehensive approach as they adapt their health systems to climate change. What can the U.S. learn from our neighbors on the front lines of the climate crisis?

The Western Pacific Bracing for the Deluge

In a 2015 report, the World Health Organization (WHO) outlined how the climate crisis is disrupting the health and health systems of Pacific islanders. It found that extreme weather events, rising sea levels, and rising temperatures are compromising food and water supplies, disrupting health services, and accelerating disease — including chronic and foodborne diseases and those transmitted by animals and other organisms.

The report inspired a five-year-project partnership between the WHO, the U.N. Development Programme, and the Global Environment Facility and the health ministries of Kiribati, the Solomon Islands, Tuvalu, and Vanuatu to increase each country’s capacity to manage the long-term health effects of climate change. The project is working toward four key outcomes:

1. Integrating climate-related risk and resiliency into all aspects of health policy and health systems, including building the climate-related knowledge of health decision-makers.
2. Strengthening the capacity of health systems to anticipate climate events and their potential health impacts through early-warning systems and other tools.
3. Improving the ability of systems to respond to climate-related diseases and reduce disruptions, like through community-based strategies.
4. Exchanging best practices between countries in the region, with a view to replicating successful interventions.

While we may not know the full range of challenges to implementing a plan like this until a midterm evaluation is completed, the partnership represents a major step in preparing western Pacific health systems for the climate crisis.

How Can the U.S. Move Beyond Mitigation?

The U.S. has often left it to individual health care delivery systems to deal with the impacts of climate change. Some have made major strides in measuring their carbon footprint. Others have gone even further: Kaiser Permanente , the nation’s largest nonprofit integrated health system, achieved carbon-neutral status in September 2020. These are critical steps to take, as the U.S. health system alone produces more CO2 emissions than all the islands mentioned above . Yet decarbonization measures may be too little too late — even to meet the modest White House goal of a 50 percent reduction in carbon emissions for federal facilities by 2030.

Climate change is also already exacerbating health problems and overloading health care delivery systems in the U.S. A recent study predicted a 22 percent increase in hospital flooding within the next 80 years alone. Federal agencies are taking the right steps towards mitigating the climate disaster, but they have yet to sufficiently respond to the clear need for climate adaptation. In this area, the U.S. could take inspiration from efforts by the WHO and western Pacific islands.

In the U.S., a major barrier to implementing widescale climate adaptation is the reluctance of many state and local health care delivery systems to commit to action. What’s needed is a detailed federal framework for mobilizing stakeholders to undertake reforms that can entail years of planning and massive costs.

Pacific island nations are modeling an approach that centers regional cooperation and coordinated reforms to address the health effects of climate change that are already at their doorstep. While taking place on a much smaller scale than what would be necessary in the United States, there are certainly lessons to be learned.

* The author thanks Shanoor Seervai , Emily Hough , and Lovisa Gustafsson for their contributions.