The toll of climate change on healthcare workers 

In response to climate-related hazards, healthcare workers are under increasing pressure, suffering from burnout and mental health issues. Christopher Buse, Sandra Smiley, and Tim Takaro highlight the need for better preparation, infrastructure, and support for those working on the frontlines during emergencies. Read the original piece at The Conversation. 

Christopher Buse is an assistant professor of health sciences at Simon Fraser University, Canada. Sandra Smiley is a doctor of medicine at the University of British Columbia, Canada, and Tim Takaro is a physician-scientist and professor emeritus in the Faculty of Health Sciences at Simon Fraser University, Canada.
 

Image by Pexels.

In British Columbia, like elsewhere in Canada, the effects of climate change on health and health services are apparent. In recent years, the province has experienced a range of climate change-related extreme weather events, with considerable negative consequences.

The 2021 heat dome caused wide disruptions to emergency services and led to more than 600 heat-related deaths. Wildfires have resulted in increased reports of illness and the evacuation of tens of thousands of people from their homes.

BC’s health system, still recovering from the staffing issues and burnout of the Covid-19 pandemic, has stepped up to respond to these emergencies.

Health systems are made up of people who are often members of the same hazard-stricken communities they serve. However, to date, existing studies have focused primarily on health service provision during climate-related emergencies rather than their specific effects on health system workers.

In order to understand the unique challenges they face during these events, we interviewed health service workers from across BC in a wide range of roles, including doctors, nurses, allied health professionals, and emergency responders.

Mental and physical health risks

Although the nature of their experiences varied depending on their position, a majority of our interviewees reported experiencing some form of physical or mental health threat during and after climate-related emergencies.

These health service workers, and particularly those in front-line positions like paramedics, home health workers, and clinical staff, described being exposed to heat and poor air quality. This was the case for those working in the community as well as in health facilities, especially when facilities were not equipped with cooling and air filtration technologies.

Health service workers also described suffering negative mental health effects like stress, trauma, and anxiety. Participants reported experiencing burnout due to the challenges related to organising logistics during an emergency, compounded by long hours and back-to-back periods of intense activity.

Climate-related events that overwhelmed infrastructure, such as the 2021 heat dome, during which wait times for an ambulance stretched up to 16 hours in some areas, caused trauma to health service workers, who were placed in situations where they were unable to provide sufficient care to all who needed it.

System problems aggravate impact

Interviewees also explained that these mental and physical health effects were aggravated by pre-existing health system challenges, like the ongoing Covid-19 pandemic and staffing shortages. 

As described by one interviewee, concerns about Covid-19 transmission complicated clinical decision-making and created ethical dilemmas: “It was really challenging during the heat dome to provide adequate cooling for people when you’re supposed to follow infection prevention and control guidelines about not having fans… How do I prioritise the acute risk of heat versus the more delayed risk of Covid infection?”

Meanwhile, staffing shortages meant health service workers had to work longer shifts and with greater frequency during climate-related events. They also experienced challenges getting to and from work because of flooded or blocked roads or concerns for their family and homes. All of these factors can contribute to burnout.

Adaptations to protect workers

The good news is that adaptations are being implemented to protect against the risks shouldered by health service workers during climate-related emergencies. In our interviews, we heard about measures like facility upgrades, emergency response training, climate change education, mental health supports, and the development of occupational health and safety plans.

However, these adaptations are not happening uniformly across BC’s health system. In many cases, participants knew of occupational health, safety, and emergency response plans for climate-related events but were unfamiliar with or had not received direct guidance on how to follow them.

Moreover, while the growing focus by BC’s healthcare leaders on reducing carbon emissions is laudable, going ‘all-in’ on mitigation may compete with resources needed to help health service workers adapt to the ongoing climate crisis. An overly technocratic approach focused exclusively on reducing carbon emissions risks, undermining necessary preparation for the people responsible for keeping health systems going in emergencies.

Building resilience and reducing systems risk

Recognising health service workers as community members and understanding how they are affected by climate-related events in their work and personal lives is essential to building resilience.

This research suggests that central to building this resilience in health service workers is an organisational culture led by transformative leadership that:

• Fosters a sense of trust;
• Prioritises open communication, flexibility and training; and
• Encourages the use of mental health supports.

In our interviews, we were heartened to hear this type of leadership within health systems is emerging.

But there are, of course, limits to personal resilience. It is both unrealistic and unfair to expect health service workers to shoulder alone the burden of increasingly frequent and severe climate-related emergencies in the absence of systemic change, including the energy transition required to reduce emissions.

Ultimately, the health system must continue to shift towards a culture of risk reduction to prepare for climate-related emergencies, increasing co-ordination and collaboration within and among health regions and authorities, governments, and communities. This includes addressing chronic health system issues such as work-life balance and staffing shortages.

Creating organisational cultures that are proactive and mindful that health service workers are community members first is key to adapting health systems to climate change in BC and beyond.

This piece was originally published by The Conversation and can be found here.