Climate change is predicted to seriously impact the ability of our healthcare system to provide care, but it has been difficult to illustrate how until now. The current pandemic has created conditions that could mirror what we see as extreme weather events and a changing climate intersect with staffing shortages and mass casualty.
- Prioritization and redeployment
During the pandemic, hospitals were forced to cancel non-urgent care and redeploy staff to units with high demand, like ICUs, medicine floors, and specially created covid clinics and field hospitals.
In Canada, 560 000 fewer surgeries occurred during the first 16 months of the pandemic than in the previous year (CIHI, para 4). Emergency departments saw 9600 fewer visits every day during the pandemic than in 2019. Care was shifted virtually, and we prioritized the most urgent cases, covid patients, by shifting our staffing and resources. The impact of these decisions on population health will not be known for many years when we can compare long-term outcomes. Whom we saw as urgent also changed during the pandemic. Public health restrictions meant that many fewer people were treated for other infectious diseases, and accidents, but also that fewer people were diagnosed with time-sensitive illnesses like cancer.
Climate change will mirror these shifts but on a larger scale. We can expect more injuries and accidents as a result of extreme weather events and an increased burden of disease due to poor air quality, heat, and climate-driven communicable disease spread. While the pandemic stripped our healthcare system down to the basics, climate change will demand more robust treatment and care for more patients.
2. Staffing
Covid-19 showcased how the healthcare system was teetering on the edge of a staffing crisis. When the pandemic first hit, the immediate concern was that large numbers of healthcare workers would sicken at the same time, and be left unable to work. There was a lot of fear that waves of patients would hit understaffed hospitals and lead to crisis standards of care: treating patients not based on need, but on their likelihood of survival. This fear was realized in some places and patients died because of inadequate access to resources. However, this reality was quickly overshadowed by the large number of healthcare workers who, burnt out from poor staffing, moral distress, and problematic workplaces, quit in droves as the pandemic progressed.
This problem is one that we will see multiply as healthcare becomes harder to provide. Healthcare providers are educated with noble principles of their roles and responsibilities and when they are unable to provide the care they believe necessary, it is incredibly damaging to morale. Demoralized workforces, quit, compounding the problem for the remaining staff. Coupled with the likelihood that more healthcare providers will be sick, injured, or unable to reach their jobs as climate change progresses, what we saw in staffing crises during the pandemic could be a mere shadow of what is to come.
3. Inequity
At the beginning of the pandemic, there was a lot of talk about how we were all in this together. Sadly, this did not prove true. How covid impacted you and your community was largely determined by race and socioeconomic class, with the most vulnerable members of our society suffering the majority of death and disability. These people were also the most likely to suffer financially from pandemic restrictions, as businesses were forced to close. 57.3% of the poorest Americans experienced job or income loss during the pandemic, while the richest Americans gained 40% more wealth (HRW, 2021). Poor families lost access to not just education, but also food programs and childcare when schools closed while wealthy families could shift their education online and continue feeding their children. American states are cutting funding to children’s programs as part of their plan to bounce back from the pandemic, despite children losing out on two years of schooling. This is a problem that will deeply impact families who cannot afford to subsidize these funding cuts while leaving the wealthy untouched.
The social determinants of health show us how different aspects of our lives collide and interact to form health outcomes. Often, one risk factor, such as race, is tied to other risk factors, like socioeconomic class or environment. The pandemic brought this into sharp focus as the poorest and most racially diverse communities suffered the most. Climate chnage will have the same effect. Although it will end up affecting everyone, the wealthiest people live in safer places and have more tools to protect themselves. It is vulnerable people who will suffer first and suffer the most from climate disasters.
The pandemic illustrated what happens when our healthcare system is pressed too far: people die unnecessarily. One critical difference between covid and climate change, is that we can expect that one day covid will end. Extreme changes in weather and temperature are becoming a part of life that will worsen, not improve. As they do, we can expect that the problems showcased during the pandemic will rear their hands again, this time on a larger scale. Right now, this reality is fresh and present in the minds of not just health professionals, but also the general public. We need to take what we learned during this pandemic and make radical changes to prepare for the crisis that we know is coming. This will protect not just the public, but also the wellbeing of our healthcare workers and the future of universal healthcare.
CIHI. (2021). Overview: COVID-19’s impact on health care systems. Retrieved March 28th, 2022 from https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture#:~:text=Hospitals%20retrained%20and%20shifted%20human,the%20pandemic%20compared%20with%202019.
Human Rights Watch. (2021), United States: Pandemic impact on people in poverty. Retrieved March 28th, 2022 from https://www.hrw.org/news/2021/03/02/united-states-pandemic-impact-people-poverty
The Avery Spectacle 