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Strengthening Climate Resilience in North Carolina's Safety Net Clinics

In response to the increasing threats posed by climate-driven extreme weather events, safety net clinics across North Carolina are stepping up to protect their communities. These clinics, including Community Health Centers (CHCs) and Free and Charitable Clinics, serve as critical lifelines for populations facing significant barriers to healthcare. Recognizing their unique position to integrate climate resilience into care models, the Carolinas Climate Adaptation Partnership (CAP) and the Carolina Advocates for Climate, Health, and Equity (CACHE), in partnership with Harvard Chan C-CHANGE and Americares, have launched an ambitious initiative aimed at strengthening local health care systems.

This collaborative effort, involving the NC Community Health Center Association and the NC Association of Free and Charitable Clinics, began with listening sessions to shape the project based on clinic needs. A subsequent survey assessed perceptions of climate risks, barriers, and progress in resilience practices. The results have been compiled into a resource guide to highlight emerging needs, map vulnerabilities, and connect clinics to relevant funding and training resources.

Do Health Clinics See Climate Change as a Major Threat to Their Patients?

North Carolina's safety net clinics are acutely aware of the impacts of climate change, with 91% of respondents agreeing that North Carolina is already experiencing the impacts of climate change, and a majority expressed concern about the health risks posed to their patients. Despite this awareness, preparedness remains limited—only 45% of staff reported having the necessary resources to address climate challenges and less than 10% report screening for climate change-related health factors.

What Challenges Do Clinics Face in Addressing Climate Change?

Safety net clinics face significant barriers to addressing climate change in their health care practice, including time constraints, lack of training, lack of funding, and insufficient institutional prioritization. A lack of expertise in hazard vulnerability, further restricts clinics' ability to conduct risk assessments, staff training, and resilience planning. Only 20% of clinics have conducted hazard vulnerability assessments, 13% provide staff training on the health impacts of climate change, and fewer than 10% participate in regional climate collaborations. These challenges highlight the urgent need for tailored resources, additional funding, and increased institutional support to enhance climate readiness, clinic resilience, and patient protection.

How Confident Are Clinicians in Protecting Their Patients from Climate Risks?

Limited educational materials and evidence-based anticipatory guidance hinder clinicians' confidence in discussing climate impacts and implementing preparedness strategies. This lack of preparedness is reflected in their low confidence in guiding patients during extreme weather events, particularly for vulnerable groups. Only 37% of clinicians felt confident advising pregnant individuals, 40% felt confident supporting children, and 43% felt prepared to assist non-English speaking patients or workers in at-risk occupations. The highest confidence was reported in supporting older adults (55%). Further, when asked about the health concerns that climate change will impact for their patients, respondents expressed the least concern about pregnancy and newborn complications, sexually transmitted infections, and vector borne diseases, despite evidence-based linkages between these health concerns and climate change. These gaps highlight the need for more targeted training and resources to empower clinicians to protect their patients during climate-related events.

Next Steps: Addressing Emerging Needs in Climate Resilience

In close partnership with CACHE and the network of safety net clinics, the Carolinas CAP will help develop and implement climate health screening tools that assess environmental and social factors impacting health, with a focus on creating more responsive tools through clinician engagement. These tools will aim to overcome barriers such as clinician hesitation and the challenge of integrating these discussions into routine care. With 47% of respondents citing time constraints as a major barrier, the Carolinas CAP will work with partners to streamline these processes and provide resources to address staffing limitations and facilitate the integration of climate screenings.

To address funding, staffing, and expertise gaps., the team will develop anticipatory guidance tools and educational materials aimed at supporting high-risk populations, including pregnant individuals, children, and non-English speaking patients, during extreme weather events. Additionally, the Carolinas CAP will promote regional collaborations and the establishment of resilience hubs, emphasizing the critical role of partnerships in enhancing local and regional preparedness. These initiatives will help to equip clinics to protect their communities from the growing impacts of climate change.