Assessing Health System Preparedness for Climate Change Adaptation: A Case Study from the United States Virgin Islands

Background and Purpose:

The United States Virgin Islands (USVI) is particularly vulnerable to climate change related events. Hurricanes Irma and Maria in 2017 are such examples. The USVI’s vulnerability is both geographic, as Caribbean islands, as well as political, due to its status as a territory of the United States. Despite its placement as one of the most vulnerable locations in the United States, a comprehensive climate change assessment of the health system has not been completed. There has been no study that examines the health system’s ability to adapt to climate change in the USVI. This study intentionally used an expansive definition of health reflecting the full continuum of health-related services including: mental health, public health, social services, and healthcare.

Methods:

This study used a case study method to assess the preparedness of the health system in the USVI to adapt to climate change events. A review of secondary data included public data sets, federal and territorial government reports, meeting minutes, as well as publically available administrative data. Data was reviewed related to mental health, public health, social services, and healthcare. Additionally, coverage of climate change preparedness in the media was reviewed. Traditional adaptation measures were compared against a more expansive set of measures that focus on preparedness and mitigation. In addition to traditional health sector analysis, this study reviewed the social service, mental health, and economic systems that influence individual’s health. Special consideration was given to data captured the effect of the social determinants of health on climate change adaption.

Findings:

Analysis revealed that the USVI healthcare system was not well equipped to achieve climate change adaptation measures. The existing healthcare system was fractured due to long-term federal underfunding of health in the territories as well as negative impacts from the hurricanes in 2017. Macro-level analysis revealed that this was partially due to the fact that the role of healthcare systems in disaster and climate change adaptation has been to relegated to the system’s ability to respond to disasters. The strength and resiliency of the USVI lies beyond the walls of the hospitals and healthcare providers. It includes dimensions of a fully integrated wellness system including mental health, social services, and beyond. To date, national preparedness, as opposed to response, measures have not been fully integrated into climate change adaptation frameworks. A resilient healthcare system could help an entire society be better prepared to adapt and mitigate against the negative effects of climate change.

Conclusion and Implications:

As natural disasters related to climate change are likely to continue to increase in number and severity, there is a need for a strong research base to inform planning efforts and support the development of mitigation strategies. The USVI and other territories are uniquely vulnerable to such disasters and should be prioritized in the Social Welfare research agenda.