Beyond mitigation: Adaptation,policy and resilience for health services facing climate change

Institutional recognition and cultural framing

First, health services research should examine how environmental pressures are recognised and framed within institutional contexts. Health services do not respond to disruption in a neutral way. They respond through familiar categories, narratives and routines that shape what counts as a legitimate service pressure. In the UK, NHS planning has long been organised around “winter pressures” – the annual combination of cold weather and increased illness that puts services under extra strain. ⁴ Climate change raises the question of whether some environmental risks, especially extreme heat, remain less visible because they do not fit established assumptions about what service strain looks like. Research is needed to examine how institutional cultures, service routines and public expectations influence preparedness, utilisation and the translation of environmental risk into operational planning.

Intervention targeting and scale

Second, health services research should assess where adaptation strategies are targeted and what scale of effect they are likely to produce. Evidence from implementation science suggests that intervention level matters. Median absolute improvements are often modest for printed educational materials, educational meetings and audit and feedback, but larger for strategies using local opinion leaders. ⁵ The point is not to prioritize one intervention type over another. Rather, climate adaptation strategies should be designed and evaluated with explicit attention to whether they target frontline professionals, influential intermediaries, organisations or wider governance structures. There is a risk of over-investing in attempts to change individual behaviour when the more consequential levers may lie in management, estates, procurement, regulation and policy design.

Consequences and risks of maladaptation

Third, health services research should anticipate the risks of maladaptation. Adaptation is necessary, but it is not automatically beneficial. Maladaptation occurs when adaptation efforts increase rather than reduce vulnerability. ⁶ This can happen when planners do not fully understand what drives vulnerability, focus on the wrong actors, ignore the wider context, or create lock-in through costly infrastructure investment. For health services, this warning is highly relevant. Measures introduced to reduce immediate heat risk, for example, may create new costs, energy dependencies, inequities or operational trade-offs elsewhere. The question is therefore not only whether services are adapting, but whether they are adapting in ways that are equitable and sustainable over time.

Shared learning and coordination

Fourth, health services research should analyse how emerging infrastructures for shared learning support coordination and knowledge reuse across systems and organisations. One barrier to progress is that lessons from adaptation are often scattered across projects, sectors and jurisdictions. Yet infrastructures for shared learning are beginning to develop. In the UK, the Maximising UK Adaptation to Climate Change (MACC) Hub provides resources on transformational adaptation, including the UK Adapt Map and a knowledge base intended to support exchange and practical action. ⁷ At European level, Climate-ADAPT and the EU Mission on Adaptation portal provide case studies, tools, indicators and planning resources. ⁸ The challenge is not simply to catalogue the resources, but to understand how these infrastructures support coordination and learning across organisations. Adaptation requires generating new evidence and mobilising existing and shared knowledge so that health organisations do not have to start from scratch as pressures from extreme weather intensify.

Enabling conditions for adaptation

Fifth, health services research should identify the conditions that enable adaptation, including knowledge management and digital innovation. These function as cross-cutting supports not just stand-alone solutions. Knowledge-sharing processes can support organisational resilience, improve decision-making and strengthen leadership for sustainable innovation in health systems. ⁹ Related work on digital health and climate-health-sustainability synergies highlights the potential of telemedicine, digital education, disease tracking, climate literacy tools and early warning systems to support both mitigation and adaptation. ¹⁰ These tools are not substitutes for governance or capital planning, but they can help health systems to monitor risk, preserve access and respond more effectively to environmental change. At the same time, they raise concerns around data quality, uneven infrastructure, misinformation and digital exclusion.

Climate change should therefore be seen as a foundational issue for the organisation of health services. The task for health services research now is to go beyond documenting climate challenges to clarify how services adapt, which interventions are effective, how maladaptation can be avoided and how adaptation knowledge can be organised and mobilised. If mitigation dominated the first phase of health care climate policy, the next phase must give equal weight to adaptation.

We hope this argument encourages further contributions, including to the Journal of Health Services Research & Policy’s ¹¹ virtual collection on environmental sustainability and the healthcare system. We particularly hope to see work that helps health services move from aspiration to actionable adaptation. The question is no longer whether climate change affects health services, but how rapidly and how effectively health systems can reorganise to sustain service delivery under its pressures.