According to NOAA, an average Atlantic hurricane season includes about 14 named storms, seven hurricanes, and three major hurricanes. This year’s below-average Atlantic season is consistent with current El Niño conditions, which generally bring more hurricane activity in the Pacific basins and less in the Atlantic basin. The Eastern Pacific has seen a very active hurricane season this year with nine named tropical storms and twelve hurricanes, of which ten were major hurricanes so far. Similarly, the Central Pacific has seen an above-average hurricane season with three named tropical storms and five hurricanes, of which four were major hurricanes. The higher proportion of major hurricanes observed in the Pacific basins this season aligns with several studies that have suggested that hurricanes are growing more intense due to climate change.

Hurricane Lala made a close pass by Hawai’i on August 14th-16th as a Category 1 hurricane, bringing an average of 11.4 inches of rain across the state and marking one of the significant tropical cyclone impacts to Hawai’i in decades. The community of Na’alehu was particularly devastated by the storm due to flash flooding caused by heavy rainfall and sloping topography, with damages to an elementary school displacing students for almost two months. In an article published by The Guardian on August 17th, it was estimated that Lala brought millions of dollars in damages across Hawai’i, left over 100,000 people without power, and resulted in one death. However, as noted by Hawai’i’s emergency management director in the article, the hurricane clean-up process can continue to present major health risks as officials work to clean up downed power lines, homes face mold damage from floodwaters, and households increasingly rely on power from generators, potentially leading to carbon monoxide poisoning from improper use. In addition to these risks, damages and power outages caused by hurricanes can lead to disruptions in healthcare services such as those observed after Hurricane Maria hit Puerto Rico in 2017 and the Island was left grappling with a damaged electric grid for nearly 11 months.

Visit the U.S. Seasonal Forecast for Health Portal to explore the NOAA/National Weather Service (NWS) seven-day tropical weather outlook and learn more about hurricane-related health risks, related hazards, and resources to protect yourself and others. With hurricane season winding down, El Niño’s next big effect in the U.S. is expected to be winter storms on the West Coast.

California takes action on a seasonal forecast

On September 21st, California proclaimed a statewide state of emergency, citing an August 13th seasonal forecast and El Niño Advisory from the NOAA/NWS CPC. The seasonal outlooks favor above-normal precipitation across Southern California, with the wettest months for much of the state likely falling between January and March. Anticipated impacts include flooding, coastal erosion, mudslides, power outages, road closures, evacuation orders, damage to homes and critical infrastructure, and disruption of essential services. California has proclaimed El Niño emergencies before, but never so far in advance of a weather pattern arriving.

What the proclamation directs

The proclamation mobilizes state resources and streamlines procurement processes; agencies will lead flood-risk reduction by pre-positioning supplies like sandbags, rock for levee repair, and Caltrans road-closure and snow-removal equipment. The National Guard is readied for flood response, search and rescue, engineering and logistics. The California Conservation Corps is prepared to deploy. Permitting is fast-tracked for flood, landslide and debris-flow work. The Energy Commission, the Office of Energy Infrastructure Safety, the Public Utilities Commission and the water boards all have assignments to coordinate in the timely restoration of essential services after storms. The California Governor’s Office of Emergency Services (Cal OES) is directed to expand accessible, multilingual preparedness communications on alerts, evacuation readiness, power outages, safe travel, disaster assistance, and household planning.

The proclamation emphasizes preparedness for the state’s infrastructure, but fails to direct any state or local health agency to take similar precautions. It’s not just California; much of the emphasis of El Niño preparation around the world has been on the agriculture, water and other physical sectors, despite the clear potential for myriad health impacts. Let’s consider what this super El Niño could mean for the health of Californians, and how health systems and agencies might consider preparing themselves.

What “disruption of essential services” means in health terms

The proclamation does identify who is at risk. It singles out low-income communities, farmworker families, rural residents, seniors, people with disabilities, residents with limited transportation access, people experiencing homelessness, and communities in flood-prone, coastal, or post-fire areas as facing disproportionate risk. It’s a small leap to concrete steps health departments and systems can take to prepare these populations for likely disruptions to infrastructure and essential services such as:

Power. Outages interrupt electricity-dependent medical equipment. The Department of Health and Human Services (HHS) emPOWER Map gives counts of affected Medicare beneficiaries down to the ZIP code, updated monthly, with hazard layers built in. Health systems can also identify individuals in their catchment with durable medical equipment, and of course in the setting of a disaster, health departments can request assistance for HHS Administration for Strategic Preparedness and Response (ASPR) to identify individuals at risk through the emPOWER database. Generators and portable heaters brought indoors are a recurring cause of carbon monoxide poisoning after storms. Health agencies and systems can amplify their warnings around this risk as well.

Care continuity. Dialysis, home oxygen, infusion, pharmacy access and skilled nursing all depend on roads being passable and facilities powered. ASPR TRACIE’s storm health and medical implications guidance covers facility evacuation, patient movement, surge, and reopening assessment.

Water and sanitation. Floodwater carries sewage, agricultural runoff and chemicals. When the Pajaro River levee failed in March 2023 and roughly 1,700 residents of a farmworker community were evacuated, the county health department advised returning residents that contamination would not be made safe by boiling or disinfection. Private wells and septic systems in rural areas need their own guidance.

Housing. Homes that are not dried within 24 to 48 hours grow mold. The Environmental Protection Agency’s (EPA) flood cleanup guidance and ASPR TRACIE’s mold resource collection are the standard references, and both assume someone has the means to act quickly.

The equity through-line

Each of these disruptions of service depends on resources that the at-risk populations the proclamation names are least likely to have. Drying a house in two days assumes control over the property, which renters do not have. Reaching a dialysis appointment assumes transportation. Acting on an alert assumes receiving it in a language you can read. Farmworkers in low-lying agricultural areas face flood exposure at home and at work, in communities whose infrastructure has often waited longest for repair. The proclamation may not direct state agencies to address these potential disproportionate health impacts, but it definitely gives health agencies and systems as well as community resilience organizations enough lead time to identify those most at risk, pre-position necessary materials and alert systems, and ensure their needs can be met in the event of extreme weather from El Niño.

County-level hazard detail is in the SF4H Portal. For individual and household preparedness, Dr. Matt Willis and the team at Your Local Epidemiologist in California covered what to do now on September 24th.

Explore the Portal now

Regional Climate Hazard Summaries

About the icons: The ❄️ icon indicates potential for below average temperatures*, the 🔥 icon indicates above average wildland fire potential, the 🪾 icon indicates drought development and/or persistence, and the 💨 icon indicates above average PM_2.5 concentrations.

*Please note that we focus our summary reports on above average temperatures during April-September (to align with the potential for extreme heat) and below average temperatures during October-March (to align with the potential for extreme winter weather).

Alaska: There are no hazard forecasts to report for Alaska in October.

🔥🪾Caribbean: Above normal wildland fire potential is predicted across Puerto Rico and the U.S. Virgin Islands in October. Drought persistence is forecast across southern Puerto Rico and the U.S. Virgin Islands.

Hawai’i and U.S. Pacific Islands: There are no hazard forecasts to report for Hawai’i and the U.S. Pacific Islands in October.

🔥🪾Midwest: Above normal wildland fire potential is predicted in northern Wisconsin, northeastern Minnesota, and northwestern Michigan in October. Drought persistence is forecast across northern Wisconsin, eastern + northwestern Minnesota, and northwestern Michigan.

Northeast: There are no hazard forecasts to report for the Northeast in October.

🪾💨Northern Great Plains: Drought persistence is forecast across much of Wyoming, western North Dakota, South Dakota, + Nebraska, and southern + central Montana in October. Above average PM_2.5 concentrations are forecast in west-central Montana and southeastern Wyoming.

🪾💨Northwest: Drought persistence is forecast across much of Oregon, eastern, central, + northwestern Washington, and northern + southern Idaho in October. Above average PM_2.5 concentrations are forecast in scattered areas of Idaho, northeastern Washington, and west-central Oregon.

🔥Southeast: Above normal wildland fire potential is predicted in Arkansas, Mississippi, much of Louisiana, and western Tennessee in October.

🔥Southern Great Plains: Above normal wildland fire potential is predicted in central Oklahoma and eastern + northcentral Texas in October.

🔥🪾💨Southwest: Above normal wildland fire potential is predicted in west-central Nevada in October. Drought persistence is forecast in much of Nevada + Utah, northwestern Colorado + Arizona, and northern + southeastern California. Above average PM_2.5 concentrations are forecast in northwestern + central California, areas of west-central Nevada, and north-central Colorado.

Data Sources

Our wildfire forecast information comes from the National Interagency Coordination Center’s (NIFC) National Significant Wildland Fire Potential Outlook, drought potential from the National Oceanic and Atmospheric Administration (NOAA)/National Weather Service (NWS) Climate Prediction Center (CPC) U.S. Drought Outlook, and temperature potential from the NOAA/NWS CPC U.S. Monthly Temperature Outlook. Our PM_2.5 forecast information comes from the National Aeronautics and Space Administration (NASA) Global Modeling and Assimilation Office (GMAO) GEOS-S2S-V3 system.

We want your feedback!

We would love feedback from our users. Please visit the Climate Care Consulting, LLC SF4H website and scroll to the bottom of the page to complete our feedback form.

Fill out our feedback form

Explore the Portal now

Regional Climate Hazard Summaries

About the icons: The 🌡️ icon indicates potential for above average temperatures*. The 🔥 icon indicates above average wildland fire potential, the 🪾 icon indicates drought development and/or persistence, and the 💨 icon indicates above average PM_2.5 concentrations.

*Please note that we focus our summary reports on above average temperatures during April-September (to align with the potential for extreme heat) and below average temperatures during October-March (to align with the potential for extreme winter weather).

🌡️🪾💨Alaska: Above normal temperatures are predicted in southeastern Alaska in September. Drought persistence is forecast in the southeasternmost part of Alaska. Above average PM_2.5 concentrations are forecast in northcentral Alaska.

🔥🪾💨Caribbean: Above normal wildland fire potential is predicted across Puerto Rico and the U.S. Virgin Islands in September. Drought development + persistence is forecast across much of Puerto Rico and the U.S. Virgin Islands. Above average PM_2.5 concentrations are forecast across Puerto Rico and the U.S. Virgin Islands.

💨Hawai’i and U.S. Pacific Islands: Above average PM_2.5 concentrations are forecast across Kauai, Ni’ihau, O’ahu, Moloka’i, Lanai, Kaho’olawe, and Maui in September.

🌡️🔥🪾Midwest: Above normal temperatures are predicted across the Midwest in September, with a ≥50% chance of above average temperatures in Missouri, southern + western Iowa, west-central Illinois, and southwestern Minnesota. Above normal wildland fire potential is predicted in northern Minnesota + Wisconsin and northwestern Michigan. Drought development + persistence is forecast across much of Minnesota, northern Wisconsin, southern Missouri + scattered areas of northern Missouri, northwestern Iowa, southern Illinois, and northwestern + central Michigan.

🌡️🪾Northeast: Above normal temperatures are predicted in West Virginia, Maryland, Delaware, much of Pennsylvania, southern + central New Jersey, and western New York in September. Drought persistence is forecast in central Maryland, eastern West Virginia, and southern Pennsylvania.

🌡️🪾💨Northern Great Plains: Above normal temperatures are predicted in North Dakota, South Dakota, Nebraska, much of Wyoming, and eastern Montana in September, with a ≥50% chance of above average temperatures in southeastern South Dakota and central + eastern Nebraska. Drought persistence is forecast across much of Wyoming, North Dakota, South Dakota, northern + western Nebraska, and southern, northcentral, + northwestern Montana. Above average PM_2.5 concentrations are forecast in western Montana and southern Wyoming.

🌡️🔥🪾💨Northwest: Above normal temperatures are predicted in southeastern Idaho in September. Above normal wildland fire potential is predicted in much of Oregon, eastern + central Washington, and southwestern Idaho. Drought persistence is forecast across eastern + central Washington + Oregon and southern + western Idaho. Above average PM_2.5 concentrations are forecast in western Oregon and central Washington.

🌡️🔥🪾Southeast: Above normal temperatures are predicted across the Southeast in September, with a ≥50% chance of above average temperatures in Arkansas, northern Louisiana + Mississippi, northwestern Alabama, and western Tennessee. Above normal wildland fire potential is predicted Louisiana, Arkansas, Mississippi, southern Florida, and southwestern Alabama. Drought development + persistence is forecast in Arkansas, northern + central Louisiana, western + southern Mississippi, western Tennessee + Kentucky, areas of Virginia, North Carolina, South Carolina, Georgia, and southwestern Alabama.

🌡️🔥🪾Southern Great Plains: Above normal temperatures are predicted across the Southern Great Plains in September, with a ≥50% chance of above average temperatures in Kansas, Oklahoma, and much of Texas. Above normal wildland fire potential is predicted in Oklahoma and eastern + northern Texas. Drought development + persistence is forecast in Oklahoma, southern + northcentral Nebraska, and much of Texas.

🌡️🔥🪾💨Southwest: Above normal temperatures are predicted in Colorado, New Mexico, Arizona, much of Utah, and southern Nevada + California in September, with a ≥50% chance of above average temperatures in eastern Colorado + New Mexico. Above normal wildland fire potential is predicted in northern Nevada and northeastern California. Drought persistence is forecast in much of Nevada, eastern Colorado + New Mexico, areas of northeastern + southeastern California, and northwestern Utah. Above average PM_2.5 concentrations are forecast in northern + central California and northern Colorado + Utah.

Data Sources

Our wildfire forecast information comes from the National Interagency Coordination Center’s (NIFC) National Significant Wildland Fire Potential Outlook, drought potential from the National Oceanic and Atmospheric Administration (NOAA)/National Weather Service (NWS) Climate Prediction Center (CPC) U.S. Drought Outlook, and temperature potential from the NOAA/NWS CPC U.S. Monthly Temperature Outlook. Our PM_2.5 forecast information comes from the National Aeronautics and Space Administration (NASA) Global Modeling and Assimilation Office (GMAO) GEOS-S2S-V3 system. The PM_2.5 data is not currently integrated in our SF4H Portal, but you can find forecast maps up to nine months in advance on their website.

We want your feedback!

We would love feedback from our users. Please visit the Climate Care Consulting, LLC SF4H website and scroll to the bottom of the page to complete our feedback form.

Fill out our feedback form

Through the Portal, we integrate 30-day forecasts for temperature, drought, and wildfire risk, along with the 7-day HeatRisk outlook, 7-day tropical weather outlook, and social vulnerability, helping users anticipate health threats before they become emergencies. By linking climate outlooks to health risk and vulnerability, the portal supports more timely, targeted, and equitable preparedness.

We aim for this tool to be used by public health leaders, health systems, emergency managers, and community partners to:

• Anticipate climate-related health risks

• Target preparedness and outreach

• Support operational and emergency response planning

Explore the Portal now

Along with the launch of this new tool, we are planning to transition away from our monthly PDF U.S. SF4H to a more active blog-style publication shared directly through our Substack. We will continue to share monthly regional forecast summaries as well as regular articles regarding recent news, research, and resources related to climate hazards and human health. To stay engaged with this resource, please subscribe to this Substack, and continue to watch this space. And as always, we welcome your feedback and suggestions for improvement!

This edition features outlooks for drought, wildfire, extreme heat and air pollution, along with an update on hurricane season, information on trends in tickborne diseases and prevention strategies, and a summary of Climate Central's mid-year Billion-Dollar disasters report. Learn more about how these hazards affect your health and find resources to stay protected in the August SF4H.

With the launch of our new air pollution forecast, we would also like to request feedback from our users on this forecast, as well as our publication as a whole. Please visit the Climate Care Consulting, LLC website and scroll to the bottom of the U.S. SF4H page to complete our feedback form.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

This edition features outlooks for drought, wildfire, and extreme heat in July along with a new air pollution forecast, NOAA’s hurricane season predictions, and reflections on historic and present-day temperature trends in the U.S. Learn more about how these hazards affect your health and find resources to stay protected in the July SF4H.

With the launch of our new air pollution forecast, we would also like to request feedback from our users on this forecast, as well as our publication as a whole. Please visit the Climate Care Consulting, LLC website and scroll to the bottom of the U.S. SF4H page to complete our feedback form.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

This edition features outlooks for drought, wildfire, and extreme heat in June along with a new air pollution forecast and NOAA’s 2026 hurricane season predictions. Learn more about how these hazards affect your health and find resources to stay protected in the June SF4H.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

As healthcare organizations make procurement decisions that may shape their technology ecosystems for years, few are considering the environmental and public health consequences of the infrastructure required to power these systems.

While maybe a third of the growth in data centers will be self-powered (“behind the meter”), the rest won’t. And while the explosion in renewables has helped support the global growth in grid demand from new data centers, a large part of the next chunk of capacity is going to come from expanded natural gas generation and, in some regions, continued reliance on coal.

In the meantime, we are moving into the El Niño phase of the ENSO cycle, with high probability of a strong or very strong (“Super”) El Niño. Heat waves will almost certainly intensify this year compared to last. Records for heat are likely to become memories as this El Nino takes global temperatures into unprecedented territory.

Data centers need a lot of electricity (and water) to cool themselves. And that’s not all. New studies are showing that data centers significantly heat the air and land surface around them, creating or worsening existing urban heat islands. (NOTE: the study showing major land surface warming is not yet peer reviewed, but the study showing downwind heating of the air in Phoenix has been.)

So this explosion of data centers is creating a cascade of unintended hazards including heat pollution, air pollution and also noise pollution because of the arrays of extremely loud fans employed.

People need electricity to cool themselves, but in the US, they are finding it increasingly unaffordable. Many are tragically (and needlessly) having to choose between buying food and keeping their house at a survivable temperature.

PJM, the biggest power grid in North America that powers the world’s largest cluster of data center, has clarified that it has the authority to cut off power to data centers in an emergency to avoid power blackouts. And last year Texas as the first state to pass a law that allowed utilities to cut off power to data centers during emergencies.

So at least the utilities are trying to avoid feeding data centers while people starve and succumb to overwhelming heat. (Although it looks like that disconnection itself can destabilize grids where data centers are highly concentrated, like in Northern Virginia!!)

Nonetheless, the grid could get stressed to and beyond capacity this summer. The New York Independent System Operator (NYISO) in their summer 2026 capacity assessment announced they will fail at the 99^th percentile estimate of peak demand, even with emergency measures. They fail at the 90^th percentile without them. The North American Electric Reliability Corporation warned in their 2025 Long Term Reliability Assessment that the grid could fail to meet demand in 2028. High risk areas cover much of the country, including parts of the Mid-Atlantic and Midwest, South Central and Northwest regions. But that’s baseline demand. If there are widespread extreme heat waves this summer, places beyond New York may see demand exceed capacity. As extreme heat conditions spike data centers’ demand for cooling, we could see utilities having to manage difficult tradeoffs between maintaining data center operations and meeting critical community needs.

What happens if electricity demand exceeds capacity and power shuts down during a heat wave? One study analyzed the health impacts of a grid failure during a heatwave in major US cities and found that not only did heat-related mortality double overall, but in Phoenix, a staggering 50% of the urban population would require medical attention. The city’s hospitals certainly don’t have that kind of surge capacity.

And so as healthcare makes this massive investment in implementation, who is paying attention to these alarms? Who is sounding the watch?

Organizations like the National Association to Advance Colored People (NAACP) and the Natural Resources Defense Council (NRDC) are mobilizing to protect communities, especially environmental justice communities. Virginia’s legislature commissioned a panel to re-examine state sales tax exemption for data centers and explore other policy options.

What are the regulatory options to address these interwoven risks? The policy space is complicated, dynamic, and undeveloped. Here is some of what I’m seeing and some additional thoughts:

· Public Utility Commissions control utility rates, interconnection standards, and the utility part of permitting (as opposed to land permitting). They have the power to demand financial commitments to avoid rate increases and assure data centers expand capacity when needed to avoid power shortages.

· Local governments control zoning, land use planning, and permitting. Many are already requiring environmental impact assessments and community benefits agreements. Consideration of heat-island impacts should become a routine component of these reviews.

· Communities and local governments should also incorporate projected data center growth into heat action plans, resilience strategies, and emergency preparedness planning.

· Federal agencies like the National Science Foundation and ARPA should promote research to speed discovery and development of technologies that are more energy efficient and don’t generate as much heat as present technologies.

· The current administration has sought to remove environmental guardrails from federal permitting processes for data centers. While this does not affect commercial installation on private land, it is intended to remove constraints from construction of data centers on federal lands. Congressional oversight might be able to affirm the need for less reckless approaches.

But what about the health sector? Hospitals and clinics depend on reliable supplies of electricity and water during extreme weather. They care for the patients most vulnerable to heat-related illness, respiratory disease, and power outages. And increasingly, they are among the largest purchasers of AI-enabled technologies. What can health systems, health care product and service companies, and health care professionals contribute to more intelligent build out of data centers and artificial intelligence?

· One critical concept for health to embrace is that bigger is not always better with AI-enhanced health IT tools. But bigger is always going to be hotter, dirtier, more consuming and more polluting. Scientist Sasha Luccioni offers a vision of how to right-size AI in this TED talk. Anu Ramachandran and co-authors have published a “Decision Framework to Mitigate the Energy, Emissions, and Cost of AI Implementation” in the NEJM Catalyst that guides healthcare providers and IT purchasers on considerations to right-size AI tools for healthcare. This kind of thinking needs to be rapidly expanded and implemented.

· Healthcare professionals need to get involved in procurement decisions and in creating criteria for procurement contracts. The National Academy of medicine is considering a process to create standard language for AI and EHR procurement.

The question is not whether healthcare should use artificial intelligence. It almost certainly will, and many applications may improve efficiency, quality, and patient outcomes. The question is whether healthcare can deploy AI thoughtfully enough to avoid creating new risks while solving existing ones. The signs are mixed. On the one hand, it seems very few leaders in healthcare are paying attention to the environmental damages associated with data centers as a consequence of their AI purchases. JAMA’s Summit Report on Artificial Intelligence failed to mention the harm to health from air pollution, water scarcity or noise pollution, much less the heat island effect. On the other hand, a new article suggests that health systems are slowing the breakneck rush to implementation of AI, doing more due diligence and starting fewer projects. This could be a unique opportunity to get ahead of the environmental harm curve and push for the integration of environmental considerations into healthcare’s use of AI-enhanced tools.

Healthcare has long understood that every intervention carries benefits, costs, and unintended consequences. AI should be treated no differently. As health systems, clinicians, technology companies, and policymakers shape the next generation of healthcare infrastructure, they should evaluate not only what AI can do for patients, but also what its physical footprint means for the communities those patients call home.

The platform allows users to enter the name of a drug, device, procedure, diagnostic test, or service and receive an estimate of its lifecycle-associated greenhouse gas (GHG) emissions, along with a red-yellow-green assessment of estimate quality. It draws from a curated set of lifecycle assessments (LCAs) where available and uses a multi-region input-output (MRIO) model to fill data gaps. Estimates are customized to the user’s location.

Why does this matter?

Because most health systems currently estimate Scope 3 emissions from purchased goods using environmentally extended input-output (EEIO) models rather than product-specific lifecycle assessments. LCAs remain unavailable for most healthcare products, and conducting them across the tens of thousands of products purchased by a typical health system is extraordinarily labor-intensive.

As a result, most organizations rely on spend-based models that estimate emissions from economic activity categories rather than from the actual products themselves.

Could MedZero accelerate a shift toward more hybrid approaches—combining product-level LCA data with MRIO-based estimates where gaps remain?

It certainly appears to move the field in that direction and signals a broader maturation of healthcare carbon accounting.

More importantly, will better product-level accounting actually change how health systems prioritize Scope 3 reductions?

A recent UCSF study suggests it could.

Researchers compared traditional spend-based input-output models with more bottom-up hybrid approaches for estimating emissions from purchased goods (Scope 3.1). The hybrid approaches prioritized products for LCAs based on either purchasing spend or material weight.

The findings were notable.

Although the overall emissions estimates were of similar magnitude, the more bottom-up approaches produced total Scope 3 estimates that were 24% and 48% lower, respectively, suggesting IO approaches may overestimate emissions. Because purchased healthcare goods account for roughly 20–22% of total healthcare sector GHG emissions, overestimation can significantly distort estimates of healthcare’s overall climate footprint and potentially misdirect mitigation priorities. Other components of Scope 3—including transportation, energy, construction, and general materials—are less likely to be as data-poor and subject to revision as pharmaceuticals, medical supplies, and devices.

Even more important, however, was how the different methods changed the identification of emissions “hotspots.”

Under traditional IO approaches, medical devices accounted for four of the top ten emissions sources. Under the weight-based bottom-up approach, they did not appear in the top ten at all, and under the spend-based hybrid approach only one remained. Instead, gloves and other high-volume disposable supplies—including cleansing pads and disinfectants—rose to the top.

For health systems trying to deliver high-quality care while reducing costs and environmental impacts, these are not trivial differences. Different accounting methods may lead organizations toward very different operational strategies.

Is MedZero a game changer?

It has several notable strengths: ease of access, methodological consistency, comprehensiveness (within the limits of available LCAs, with gaps filled through MRIO modeling), and transparency. Given the current fragmentation and variable methods of health sector LCA’s, the importance of a credible central repository for this information cannot be overstated.

At the same time, the first version appears to have a significant limitation: the data can only be accessed through searches for individual products. Assessing Scope 3.1 emissions for a health system is an enormous and resource-intensive undertaking. The UCSF researchers used heuristic methods to narrow their analysis to approximately 1,000 products from an inventory of more than 25,000—but even that would require extensive manual searching and downloading within MedZero.

A future version could ideally allow batch uploads of product inventories, substantially lowering the data-entry barrier.

Source: https://practicegreenhealth.org/tools-and-resources/scope-3-ghg-emissions-accounting-tool

What does this mean for policy and practice?

Because Scope 3 emissions span so many sectors and product categories, assessing and reducing them remains an enormous challenge. On one hand, healthcare’s Scope 3 emissions are deeply intertwined with other major economic sectors—including food and agriculture, energy, transportation, and construction—meaning that healthcare’s progress depends partly on broader decarbonization trends.

On the other hand, the healthcare sector’s enormous purchasing power gives it significant leverage as a consumer. Better accounting and identification of carbon hotspots can help motivate change across supplier industries. This dynamic also operates within healthcare itself, as providers, group purchasing organizations, distributors, and others influence pharmaceutical, medical device, and supply manufacturers through procurement expectations and purchasing decisions. The National Academy of Medicine Climate Collaborative’s Health Sector Climate Action Survey is one example of this broader movement.

With only scattered mandatory reporting requirements across a subset of U.S. states and cities, market incentives for sophisticated Scope 3 auditing in healthcare remain limited. Most health systems will likely continue using simpler spend-based IO models for routine reporting in the near term.

But for organizations that have committed to emissions reduction targets—or that view waste and pollution reduction as part of broader strategic transformation—expanded access to credible product-level LCA data is highly valuable.

As the UCSF study suggests, when systems move closer to product-level analysis for their highest-volume drugs, devices, and supplies, they gain more accurate insight into emissions hotspots and can target waste-reduction and procurement strategies more effectively.

By making similar hybrid approaches incorporating product level information more accessible globally, MedZero represents an important infrastructure milestone in the maturation of healthcare Scope 3 accounting.

This edition features outlooks for drought, wildfire, and extreme heat in April along with updates on spring pollen season and El Niño predictions. Learn more about how these hazards affect your health and find resources to stay protected in the May SF4H.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

This edition features outlooks for drought, wildfire, and extreme heat in April along with information on spring hazards, including pollen and flooding. Learn more about how these hazards affect your health and find resources to stay protected in the April SF4H. You can also check out our recently published SF4H special edition, where we lookback on the impacts of climate hazards on human health in 2025.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

This special edition looks back on the impacts that climate hazards had on human health in 2025, featuring stories on Climate Central’s Billion-Dollar Weather and Climate Disasters, extreme heat, wildfires, drought and flooding, and hurricanes.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

This edition features outlooks for drought, wildfire, and cold weather along with information on spring pollen season and a projected shift in the El Niño-Southern Oscillation climate phenomenon.

Please note: This newsletter is for informational purposes only and does not constitute medical, legal, or professional advice. The interpretations and opinions expressed herein are those of the author and are not affiliated with or endorsed by any governmental agency, including NWS and NOAA. While we utilize publicly available data from official sources, we do not guarantee the accuracy, completeness, or timeliness of the information provided. Readers should consult appropriate professionals before making decisions based on the content of this newsletter.

What held: the resilience floor is intact (for now).
The enacted FY26 package preserves the backbone created under PAHPA two decades ago: stable funding for CDC’s Public Health Emergency Preparedness (PHEP) program and ASPR’s Hospital Preparedness Program (HPP), along with modest support for public health infrastructure and data modernization. This matters in a climate-disrupted world where heat waves, wildfire smoke, flooding, power outages, and supply-chain disruptions increasingly translate into care continuity crises. These are not climate-specific programs, but they are the machinery that allows states, localities, and healthcare coalitions to plan for and respond to extreme events associated with climate change.

What changed from the proposals: Congress rejected the deepest cuts and realignments.
As I flagged in September, the Administration proposed major reductions and reorganizations to preparedness, including elimination of funding for the Hospital Protection Program and slicing Public Health Emergency Preparedness in half. The enacted bill largely rejects those changes. The Senate’s more protective posture toward preparedness prevailed in key areas, preserving state and hospital readiness capacity that would have been significantly weakened under the President’s request and, in some respects, under the House approach. This doesn’t provide new support for health systems that are already struggling to finance resilience in the face of rising climate risk, but it maintains the status quo at least.

Warning lights: equity capacity and analytics cuts impair preparedness and resilience
Two other cuts matter from a climate-health perspective. First, social vulnerability and equity capacity remain underpowered relative to need, even as climate hazards disproportionately harm older adults, low-income households, and medically complex patients. Second, analytic and forecasting capacity—essential for anticipating heat illness, smoke-related respiratory surges, and vector-borne disease risk—remains fragile. Congress eliminated the $8 million in funding for CDC’s social determinants programming and cut $25 million, nearly half, from Ready Response Enterprise Data Integration Platform/Forecasting and Outbreak Analytics. Again, while not climate specific, these programs are essential infrastructure for climate resilience and preparedness in a setting of all hazards programming.

What FY26 means for public health departments.
For state, local, tribal, and territorial public health departments, the enacted FY26 budget largely preserves the core preparedness funding that keeps emergency operations, risk communication, and coordination with healthcare partners functioning (notably PHEP).. At the same time, the loss of dedicated social determinants, vector borne disease and equity-focused CDC funding degrade the federal support to local departments to proactively identify and protect the most vulnerable communities and to anticipate surges in climate-sensitive illness. In practice, FY26 sustains the “response floor” for public health—but constrains the upstream prevention, targeting, and analytic capabilities that would make preparedness more equitable and more proactive.

What this means for healthcare leaders in 2026.
The FY26 budget stabilizes federal partners—but it does not solve resilience for health systems. CEOs, CFOs, CMOs, and preparedness leads should assume:

1. core federal preparedness funding will remain a critical, but insufficient, foundation;

2. climate resilience will continue to be operationalized through existing “all-hazards” streams (PHEP/HPP, data modernization, infrastructure planning); and

3. the business case for resilience—continuity of operations, avoided surge costs, staff protection, and patient access—must increasingly be made within health system governance and capital planning, not hoping for substantial federal grants.

Bottom line.
In September, I asked whether we were “standing on solid ground.” With FY26 enacted, the answer is: the floor didn’t collapse—but the house is definitely not climate-ready. Stable funding prevents significant backsliding. The work now is, as it has always been, trying to do more with less: turning preparedness dollars into climate-smart operations that protect patients, staff, and communities, even as extreme events become more and more frequent.

Most mainstream commentary frames this shift in familiar terms: patient expectations, clinician flexibility, and operational efficiency. Those factors matter. But they overlook a more consequential implication: telehealth is also becoming a climate resilience strategy for healthcare systems and the communities they serve.

As climate-related disruptions grow more frequent and more geographically widespread, the ability to maintain access to routine care—not just emergency response—has become a defining challenge for health system performance.

Access Is a Climate Vulnerability

Climate change disrupts healthcare not only through injuries and acute illness, but through interruptions to everyday access. Extreme heat, wildfire smoke, flooding, hurricanes, and winter storms all interfere with patients’ ability to travel safely, clinics’ ability to remain open, and systems’ ability to manage demand.

Research examining primary care delivery around major disasters consistently shows a drop in completed outpatient visits immediately before and after events, followed by a lagged recovery period. These disruptions are most pronounced for routine and follow-up care—exactly the care that prevents downstream emergencies.

This pattern matters because outpatient access is where much of the health system’s preventive and stabilizing work occurs. When that layer fails, pressure shifts rapidly to urgent care centers and emergency departments.

Telehealth as a Continuity Tool—Not a Substitute for Everything

Telehealth does not replace all forms of care, nor should it. But for a substantial share of outpatient and urgent encounters—respiratory symptoms, medication management, behavioral health visits, chronic disease follow-up—it can preserve continuity when in-person access is compromised.

The evidence supporting this role is emerging.

Studies examining wildfire exposure have found that patients who were already familiar with telemedicine services before a disaster experienced lower emergency department and inpatient utilization afterward for ambulatory-care–sensitive conditions such as asthma, hypertension, and diabetes. This suggests that telehealth did not merely shift where care happened—it helped prevent avoidable escalation when environmental conditions disrupted routine access.

Similarly, analyses of patient behavior during hurricanes show that patients increase use of telehealth visits and secure messaging platforms when travel is unsafe or clinics are closed. In other words, patients actively substitute virtual access when physical access is constrained, provided the option exists and is familiar.

This distinction is critical. Telehealth works best as resilience infrastructure when it is embedded before a crisis—not improvised during one.

Climate Events Are Already Driving Virtual Care Demand

Recent wildfire seasons illustrate how quickly environmental conditions can reshape access patterns. During severe wildfire smoke events, health systems have reported sharp increases in telehealth visits for respiratory and cardiovascular symptoms, precisely because remaining indoors is protective while travel increases risk.

These surges are not theoretical. They reflect real-time shifts in how patients seek care under climate stress—and they highlight the value of having scalable virtual capacity already in place.

From a systems perspective, telehealth can function as a pressure-relief valve, helping absorb spikes in demand without forcing all care into emergency settings.

Sustainability and Resilience Are Converging

Telehealth’s environmental benefits—reduced transportation emissions, lower per-visit energy use, and more efficient use of clinical space—have been documented for years. What has changed is how directly those benefits now align with resilience and access goals.

Hybrid care models allow systems to:

• Reduce unnecessary travel during hazardous conditions

• Maintain continuity for high-risk patients

• Avoid preventable emergency utilization

• Flex capacity dynamically during disruptions

This convergence matters for health system leaders because it aligns climate goals with core performance metrics: access, quality, and cost.

Equity Must be a Focus in the Virtual World, Too

But telehealth only builds resilience if it doesn’t worsen inequities.

The populations most vulnerable to climate impacts—older adults, people with chronic illness, low-income households, rural communities—are often the same populations facing barriers to digital access. Broadband availability, device access, digital literacy, language accessibility, and trust all shape whether telehealth expands or constrains access.

As health systems plan for 2026 and beyond, telehealth strategies must therefore include:

• Support for low-bandwidth and audio-only modalities where clinically appropriate

• Community-based access points and partnerships

• Culturally and linguistically appropriate platforms

• Measurement of access and outcomes, not just utilization

Without these elements, telehealth risks becoming a resilience tool for some and a barrier for others.

Looking Ahead to 2026

In 2026, telehealth will no longer be judged primarily on innovation or novelty. It will be judged on whether it is reliable, equitably accessible, and durable under stress.

Seen through a climate lens, telehealth is not simply a convenience or a cost-saving measure. It is part of the health system’s adaptive capacity—one of the ways care can continue when environmental conditions become more disruptive. And it is generally a lower-carbon option.

In the next post, I’ll turn to another mainstream healthcare prediction with major climate implications: artificial intelligence- how can it be harnessed to enhance healthcare sustainability and resilience?

Climate change is affecting the healthcare workforce in multiple, compounding ways. First, concern about the health impacts of climate change weighs heavily on many healthcare professionals. Global and U.S.-based surveys document high levels of anxiety and worry among clinicians. Younger healthcare workers likely mirror broader population trends, where nearly 60% of 16–25-year-olds report being “very” or “extremely” worried about climate change.

If health system leaders are serious about addressing burnout, they cannot ignore that a large share of their workforce carries high baseline concern about climate change—especially when organizations lack a clear strategy and investment plan for managing climate risks.

Beyond psychological stress, climate change also has direct effects on workforce safety and productivity. Clinicians working in regions affected by flooding, hurricanes, wildfires, extreme heat, and drought face physical threats, disrupted commutes, childcare challenges, and repeated surge conditions layered onto already strained systems. Stories like that of Dr. Joshua Weil who was incident commander at the Kaiser Permanente Hospital as his own home burned to the ground during 2017 Tubbs fire illustrate this with devastating clarity.

Climate is not the only driver of workforce strain—but it is an increasingly important one.

Healthcare professionals care about climate change, and importantly for executives, they care about what their employers are doing in response. The strongest U.S. evidence comes from a recent Commonwealth Fund survey, which found that nearly 80% of healthcare professionals care about their employer’s efforts to improve sustainability and climate resilience. More than half (53%) consider these efforts when deciding whether to stay in a job, and nearly two-thirds (62%) consider them when accepting a new position.

Healthcare employers should want to be seen as credible, forward-thinking, and prepared institutions in the face of growing climate-related stress.

So what can the C-suite do?

· Explicitly link sustainability, resilience, and mission: Healthy people depend on healthy environments. Most healthcare staff already understand this—leadership should state it clearly.

· Strengthen workplace safety and continuity: Visible protection from heat, air pollution, and climate disruptions builds confidence in leadership.

· Improve operational efficiency: Reducing waste and emissions often reduces workload and frustration at the same time.

· Invest in training and capability building: Climate resilience skills support workforce development and retention.

This is not climate advocacy. It is operational intelligence.

The bottom line

In 2026, sustainability can meaningfully inform workforce recruitment and retention strategies in U.S. healthcare. Making this connection tells clinicians that leadership understands the realities patients live in—and is committed to building a system capable of holding up under repeated stress.

Workforce resilience and climate resilience are no longer separate issues. Treating them as such risks losing worker trust, engagement, and stability at a moment when healthcare can least afford it.

Every January brings a familiar ritual. Lists of predictions circulate across inboxes and LinkedIn feeds, offering confident forecasts about where healthcare is headed next: more AI, tighter margins, workforce strain, consumer-centric care, continued consolidation.

These forecasts are useful. They synthesize what health system executives, consultants, investors, and analysts are seeing right now—and what they believe will matter most in the year ahead. But they also reveal a major limitation: they tend to treat climate change and sustainability as secondary concerns, rather than as forces already shaping healthcare’s core operating reality.

So instead of just asking what healthcare leaders predict for 2026, I’m going to explore a different question: what do these predictions signify when viewed through the lens of climate change, sustainability, and resilience? And conversely, what do sustainability and climate resilience forecasts imply for the future of healthcare delivery in the United States?

Two sets of predictions. Do they converge?

On one side are the mainstream healthcare outlooks—from firms like Forbes, McKinsey, and Deloitte (full disclosure: I consult with Deloitte). These analyses converge on a familiar set of themes: sustained financial pressure, the need for real productivity gains from AI, ongoing workforce strain, rising consumer expectations, access challenges, and the need to redesign operating models rather than rely on incremental fixes. As the McKinsey report puts it:

“Healthcare leaders must rethink traditional models, improve performance, and embrace technology to remain competitive.”

On the other side are global sustainability and climate outlooks, which focus on energy systems, capital markets, climate risk, and enterprise sustainability. These forecasts tell a similar story: a shift from pledges to proof, from voluntary commitments to auditable performance, from mitigation alone to adaptation and resilience as financially material concerns.

Individually, these two conversations are well-developed. But what’s missing is their integration. What can we learn from that?

Why this integration matters now

In my last post I cited a striking statistic from Deloitte’s most recent healthcare CEO survey: only 11% of U.S. healthcare CEOs say sustainability will be a strategic priority in 2026.

At first glance, this sounds like sustainability sits on the margins of healthcare strategy. But does it? Many of the higher priorities identified by CEOs, like financial resilience, access, workforce stability, digital transformation, supply chain reliability, are already being shaped by climate-related risks and sustainability constraints, whether or not they are labeled as such.

At the same time, sustainability and climate analysts are increasingly focused on issues that directly affect healthcare: physical climate risk to infrastructure, energy reliability, insurance availability, supply chain exposure, and the health impacts of extreme heat, wildfire smoke, floods, and storms. Yet healthcare delivery systems are rarely treated as central actors in these sustainability forecasts, despite their critical role in community resilience.

For years, healthcare transformation and sustainability have been treated as parallel conversations.

One focused on margins, access, workforce shortages, digital tools, and care models.
The other focused on emissions, energy, climate risk, and environmental responsibility.

In 2026, those two conversations need to come together.

Not because health leaders will suddenly decide to prioritize sustainability—but because the forces reshaping healthcare now overlap so much with the forces reshaping the global economy that separating them is starting to make less operational sense.

A shared finding: the end of incrementalism

If you read the mainstream healthcare predictions for 2026, one message comes through clearly: incremental change is no longer enough.

Health systems are operating under sustained financial pressure. Labor shortages persist. Access remains constrained. Digital investments are expected to deliver real-time productivity gains—not future promise. Executives are being asked to redesign operating models, not just optimize around the edges.

Now read the sustainability and climate outlooks for the same year.

Sustainability leaders are also declaring the end of incrementalism:

• Performative commitments are losing credibility.

• Investors and insurers are demanding auditable, decision-useful data.

• Physical climate risk—heat, storms, flooding, wildfire smoke—is being repriced as a financial and operational reality.

• Adaptation and resilience are no longer optional or deferrable.

The two domains may be using different language, but they’re basically forecasting the same thing: a shift from aspiration to execution, from pilots to performance, from stories to accountability.

Performance under stress becomes the new benchmark

One thing that unites these predictions is a subtle but powerful redefinition of success.

In healthcare, success is no longer measured solely by growth, quality metrics, or patient satisfaction in stable conditions. Increasingly, it is measured by how systems perform under stress:

• Surges in care demand

• Staffing shortages

• Supply disruptions

• Infrastructure failures

• Cost volatility and regulatory uncertainty

In sustainability and climate analysis, the same stress-test logic is taking hold. Investors, insurers, and regulators are asking:

• How do assets perform under extreme heat, storms, or floods?

• How resilient are energy and water systems?

• How exposed are operations and supply chains to disruption?

Seen together, these questions point to the same critical need: enhanced resilience throughout the system.

And resilience is not just a program. It is an operating capability.

Where the convergence is most visible

This convergence shows up most clearly in four areas that dominate 2026 healthcare predictions.

1. Digital transformation and AI

Healthcare leaders are betting heavily on AI to relieve administrative burden, improve throughput, and stabilize finances. But sustainability and energy analysts are issuing a parallel warning: AI is driving explosive growth in energy demand and placing new strain on aging grids.

For healthcare organizations, this means digital transformation is now inseparable from:

• Energy reliability

• Infrastructure resilience

• Data governance and auditability

• Equity and social justice

An AI-enabled operating model that fails during a heatwave, power outage, or grid emergency is not a transformation—it’s a liability.

2. Workforce strain

Healthcare forecasts speak of worker burnout, shortages, and productivity. Climate and sustainability forecasts have a different focus, but one that is highly relevant to healthcare. Extreme heat, disasters, and repeated emergencies disproportionately affect frontline healthcare workers and create a drag on productivity. Especially in those parts of the country hardest hit by hurricanes, drought, wildfires and extreme heat.

Workforce strategy, in this context, is no longer just about recruitment and retention. It is about:

• Designing work that is sustainable under chronic stress

• Reducing avoidable administrative load and increasing efficiency of operations

• Protecting the physical and mental health of caregivers in the face of increasingly frequent and severe natural disasters

Here again, sustainability is not a separate goal. It is embedded in the conditions under which care is delivered.

3. Access and care models

Telehealth, home-based care, and community-based delivery appear on nearly every healthcare prediction list for 2026. They are often framed as consumer choice or efficiency measures.

But from a climate lens, these models also function as continuity and resilience strategies—ways to maintain access when travel is unsafe, facilities are strained, or communities are disrupted by heat, smoke, or storms.

4. Financial pressure and risk

Healthcare leaders talk about thin margins and constrained capital. Sustainability analysts talk about physical risk, insurance retreat, and asset repricing.

They are describing the same pressure from different angles.

Climate shocks increasingly behave like financial shocks. They drive utilization spikes, staffing disruptions, facility damage, and insurance costs. In this environment, ignoring climate risk does not preserve capital, it exposes it.

Why this convergence is uncomfortable—but necessary

Part of what makes this convergence difficult is that it cuts across traditional silos.

Sustainability has often lived in strategy, facilities, or communications. Emergency preparedness has lived in safety or emergency management offices. Digital transformation has lived in IT. Finance has had a separate wing of the building.

The predictions for 2026 suggest those boundaries no longer hold.

Healthcare organizations are being asked—implicitly if not explicitly—to integrate:

• Financial planning

• Infrastructure and energy strategy

• Workforce design

• Digital governance

• Climate and physical risk assessment

Not because it is a luxury add-on, but because fragmentation is increasingly expensive.

A different way to read the predictions

My point here is not that every healthcare leader must suddenly become a climate expert. It is that climate change has become a critical part of the context in which healthcare strategy plays out, whether acknowledged or not.

Reading healthcare predictions without a climate lens misses critical risks—and opportunities. Reading sustainability predictions without a healthcare lens overlooks one of the most important resilience institutions in American communities.

The great convergence of 2026 is not a future scenario. It is already underway in many places.

The question is whether healthcare leaders will recognize it early enough to shape it, rather than being forced to react to it.

Welcome to our new blog series, where we dive into the top healthcare predictions for 2026—but with a twist. Instead of just examining what’s on the horizon for the health sector, we’ll consider these trends through the lens of climate change and sustainability.

Starting with some mainstream healthcare forecasts—like those from Forbes, McKinsey, Deloitte (full disclosure- I am a consultant for Deloitte), we’ll ask: how do these trends and predictions intersect with the urgent need for sustainability and climate resilience in healthcare?

For topics on multiple lists, like continued AI integration, consumer focus, telehealth expansion, and supply chain resilience, among others, we’ll do a deeper dive into critical considerations.

According to Deloitte’s survey, only 11% of U.S. healthcare CEOs say sustainability will be a strategic priority in 2026. While that may reflect their current mindset, sustainability can often be an integral component of what they do identify as strategic priorities. And in addition, sustainability thought leaders may be thinking about the health sector. So, we’ll also look at predictions from the sustainability and climate resilience side.

Over the coming posts, we’ll connect these predictions to real-world examples and show how the healthcare industry can become more innovative, resilient, and sustainable, even in a politically chaotic time. Stay tuned.

Let me loosen the tape, undo the ribbon, and …. Oh Dear!! The contents appear to have been damaged in shipping!!

In my last blog on the indicators from before COP30, I suggested that if fully implemented, the proposed set would provide a “concise yet comprehensive framework for assessing national progress on health adaptation to climate change”.

I was hoping that even if some did not get selected or were changed, most might survive intact.

Of the original 10, only one has survived intact. Four are completely gone. The other five have been altered in ways that make them hard to understand and consequently much harder to implement.

Completely gone are indicators for occupational heat mortality, level of operationalization of early warning systems, level of implementation of national plans, and proportion of responsible ministry staff who have been trained in climate and health. These were important content, process, and accountability indicators and their loss leaves big holes in the framework.

Operationalization of early warning systems has been wedged into the indicator for mortality from “climate impacts”, apparently as an effect modifier. Going from heat-related mortality to mortality from all climate impacts makes this indicator much harder to define and implement.

The indicators for facility resilience are now less measurable. “Percentage of retrofitted or newly built to standard facilities” is now “percentage of resilient facilities”, followed by qualifiers that are vague and hard to follow: “under different scenarios, as appropriate for regions and contexts, including as an outcome of adaptation actions where applicable”. It will require further negotiation to define those phrases, and the term “resilient” itself, and make them implementable. Number of facilities destroyed or damaged has become “extent to which climate health services have remained at full capacity”. While the number of facilities damaged or destroyed is not always easy to obtain, the new indicator will be harder to quantify.

The proposed indicator for Universal Health Coverage related to essential health services was unlikely to be adopted from the start because of political concerns. The replacement indicator, though, is very hard to interpret: “Coverage of essential health services that are supported by adaptation measures that ensure continuity during and following…events”. Again, this is unlikely to be implemented without considerable negotiations to clarify meaning and measurement.

The proposed indicator for implementation of Mental Health and Psychosocial Support preparedness and response was modified to “Proportion of the population vulnerable to climate change with access to mental health and psychosocial support”. The proposed indicator would have been challenging to measure; the modified indicator introduces a restriction of measurement to an undefined vulnerable population. Given the widespread nature of the mental health impacts of climate change, it will be very challenging to have a consensus definition of a vulnerable population for this indicator.

As mentioned, the proposed indicator for heat-related mortality was broadened to mortality from an undetermined number of climate impacts. In the adopted modifications, this has been paired with an indicator for the “rate of morbidity associated with climate impacts”. This is also an attributable burden estimate, as it is “compared with counterfactual rates”. And it includes the inscrutable qualifier “including as an outcome of adaptation actions where applicable”. But for some reason, it does not include the qualifier of the relation to “coverage of early warning systems”. This will also take a very long time to sort out and attempt to come to consensus on definitions and measurement techniques.

The sole survivor? Incidence of climate-sensitive infectious diseases. Though not without some collateral damage: this indicator is also qualified by the unclear phrase about it being an outcome of adaptation actions.

How did this happen?

How did a reasonable, well-honed set of proposed indicators, the result of many hours of expert deliberation, get adopted as a confusing morass of language?

Was there a heated debate between the experts and the country negotiators and this was the best they could manage? Or an open discussion amongst the country negotiators without the experts?

No and no. It appears this was the result of a closed-door rewrite of the indicators by the Brazilian Presidency. And a last minute, rushed vote left few options for countries other than to adopt them for now.

What comes next?

There will need to be extensive additional discussion by technical experts to clarify definitions, bound scopes, and agree on specific methods for these adopted indicators. Will the working group that developed the proposed indicators be asked to provide that ongoing service? Will they agree? That remains to be seen.

What is clear is that rather than marching off to implement the first consensus set of indicators and start tracking progress on climate adaptation for health, countries will need to wait at least a year, maybe two. Efforts will likely be fragmented, with some countries moving forward with indicators systems of their own design, others standing still. Perhaps in developing their own systems, countries will draw heavily from the language and details of the original proposed indicator set. That might allow easier harmonization down the road.

This disappointment around indicators is just one of many letdowns from COP30. Like so many challenges this year, we need to acknowledge and grieve for this. And then move on. Like kintsugi pottery, the package of GGA health indicators can and should be repaired and made fit for purpose.