When health inequities and climate disasters collide

How it works: The Climate Resilience for Frontline Clinics toolkit guides staff and providers at clinics that serve uninsured and underinsured populations on how to develop disaster preparedness plans, extreme weather alert systems and health tip sheets to give patients.

• It was developed by researchers at the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health and the nonprofit Americares and was funded by Biogen.
• Free and low-cost clinics in California, Massachusetts, Texas and North Carolina worked with Americares and the Harvard team to create the toolkit — parts of which had been previously made accessible in advance of Tuesday's launch.

By the numbers: Surveying 450 frontline clinic staff members across the U.S. last year, the organizers found that more than two-thirds said their clinic experienced "disruption due to extreme weather" at least once in the past three years.

• Less than 20% of clinic staff surveyed described their clinics as "very resilient" when faced with extreme weather, while 77% of respondents lacked "the knowledge or the tools" to fortify their clinics in preparation for a climate shock.

When it comes to disaster preparedness and resilience in the health care sector, "everything" is about hospitals, Kristin Stevens, Americares' senior director of climate and disaster resilience, tells Axios.

• "That's where the money, the attention, the media goes," Stevens said. "The health centers that we work with are on that outer ring of attention and funding. But at the same time, they see the patients who are most vulnerable to the impacts of the climate crisis."
• "And so they are seeing the patients who are most vulnerable, but they themselves are the least resourced on this front."

What they're saying: Alexis Hodges, a volunteer family nurse practitioner at North Carolina's Community Care Clinic of Dare, tells Axios that patients ran out of medications, lost power, weren't able to get to the clinic and experienced increases in respiratory illnesses due to Hurricanes Dorian and Matthew, which drove "lasting" health consequences.

• As the Outer Banks prepares for winter storms, or nor'easters, Hodges is incorporating parts of the toolkit into how she advises patients to plan ahead.

• "I'll be reminding patients to have bottled water, to have non-perishable foods ... [and] to go to the food bank and make sure they have these kits already stocked now," she said.

Yes, but: The patient resources in the new toolkit are in English, which doesn't mitigate existing language barriers in U.S. disaster warning systems and health care, especially for migrant workers, who make up a significant share of patients that many frontline clinics see.

• Organizers tell Axios they recognize the need for non-English resources, and that the toolkit is being translated into Spanish within the coming year.

The bottom line: Jessie Liu, a family medicine physician at Oakland's La Clínica de La Raza, tells Axios that many of her clinic's patients belong to historically marginalized communities, who are living with pre-existing health conditions and greater exposure to climate impacts that stem from systemic inequities.

• "Patients are unhoused or living in conditions that may not have adequate ventilation and aren't able to protect their indoors from outdoor smoke or heat, [and] many people don't have cars," Liu said. "Everything gets much more complicated when there are climate disasters."
• "There's such a constant onslaught and myriad of challenges of working in these communities that are constant, that having a toolkit like this ... is going to be helpful."