Climate Readiness in North Carolina Safety Net Clinics

"I am full-heartedly in support of working to improve climate solutions. This support is separate to me from patient education. There are so many priorities in a clinical visit. It is challenging to task a primary care provider office to do yet another thing - we already serve as the backbone of so many other services."

"We have several Farm Workers as patients - they need to understand the importance of sunscreen, staying hydrated while working and how heat impacts the body."

• 91% of clinics recognize North Carolina's current climate impacts, with most expressing concern over patient health risks.

• Air pollution (92%), heat-related illnesses (90%), and seasonal allergies (87%) are top concerns. Pregnancy complications, STIs, and vector-borne diseases are less worrisome, despite evidence linking them to climate change.

• Challenges include time constraints, lack of training, and low institutional priority. Only 20% have conducted hazard assessments, 13% provide staff training, and fewer than 10% engage in regional collaborations to strengthen resilience.

• Limited educational resources and a lack of anticipatory guidance reduce clinicians' confidence in addressing climate impacts. 
• This lack of preparedness is reflected in their confidence in guiding patients during extreme weather events, particularly for vulnerable groups. Providers feel most confident providing guidance to older adults (55%), yet only 37% feel prepared to advise pregnant patients, 40% children, and 43% non-English speakers or workers in high-risk occupations.
• Less than 10% screening for climate-related factors.

Safety net clinics including Community Health Centers (CHCs) and Free and Charitable Clinics (FCCs) provide critical care to populations facing economic, geographic, and cultural barriers to healthcare. However, these clinics are increasingly vulnerable to climate-driven extreme weather events like hurricanes, heatwaves, and flooding. The recurring nature of these events strain already limited resources and staff. Nonetheless, safety net clinics are uniquely positioned to integrate climate resilience into their care models, safeguarding their communities from the health impacts of climate change.

In 2024,  Carolina Advocates for Climate, Health, and Equity  (CACHE) and the  Carolinas Climate Adaptation Partnership  (CAP) partnered Harvard and Americares as well as the NC Community Health Center Association and NC Association of Free and Charitable Clinics to develop a comprehensive survey assessing:

• Perceptions of climate-related extreme weather risks.
• Barriers to addressing climate concerns.
• Progress in adopting sustainable, resilient practices.

In early 2025, the next phase of this project will involve testing the efficacy of various hazard vulnerability mapping and risk communication strategies. 

CACHE and the Carolinas CAP are committed to supporting climate resilience for North Carolina’s safety net clinics. If your clinic would be interested in exploring opportunities to collaborate further, please reach out to  info@carolinaadvocates.org . 

Thanks to our partnering organizations:  Carolinas Climate Adaptation Partnership (CAP) ,  Harvard Chan C-CHANGE ,  Americares ,  NC Community Health Center Association   and the  NC Association of Free and Charitable Clinics 

• Survey count: 174 Administrators, Clinicians, and Staff of safety net clinics across North Carolina
• Geographic distribution: 91% of respondents work at clinics located in the Piedmont region.
• Gender identity: 86% of respondents identified as women and 10% identified as men.
• Age: The largest age group was 25-39 (40%) followed by age 40-49 (23%).
• Clinic type: 73% work in a Community Health Center (CHC) and 26% work in a Free or Charitable Clinic (FCC).
• Position:
  • 35% work as Clinic Staff (e.g. Outreach, Clerical Support, Facilities Maintenance, Care Coordinator, Medical Assistant)
  • 27% are Administrators
  • 24% are Providers (e.g. MD or DO, RN, NP, PA, LPN, PharmD, PT or OT).
• Length of employment: 60% of respondents have worked at their clinic for less than 5 years.

Efforts are underway to create and implement screening tools that evaluate environmental and social factors affecting health. These tools aim to overcome barriers such as clinician hesitation and the challenge of integrating these discussions into routine care.

Time constraints were identified by 47% of respondents as a significant barrier to implementing climate health screenings. Other challenges include insufficient staff, lack of screening tools, and the inability to address factors identified during screenings.

To enhance climate resilience and preparedness, clinics need support to address gaps in funding, staffing, and expertise over the next five years. These steps are crucial for building robust systems capable of responding to climate-related health challenges.

There is a need for educational initiatives that equip healthcare providers with the knowledge to support high-risk populations—such as pregnant women, children, and non-English speaking patients—during extreme weather events.

Quantitative data revealed low levels of regional collaboration, yet qualitative feedback emphasized the critical role of regional partnerships in fostering resilience. Establishing resilience hubs was highlighted as a key strategy for enhancing local and regional preparedness and response efforts.

In the wake of Hurricane Helene, the urgency of building resilience to climate change has become forefront. Despite being directly impacted by Helene, community health centers and free and charitable clinics in Western North Carolina served on the frontline of response and recovery for their communities in the some of the  following ways :

• Utilizing mobile health units and all-terrain vehicles to bring health care and pharmacy services to communities hardest hit and vulnerable populations including senior living facilities, public housing authorities, and homeless shelters.

• Rapidly reopening health centers and pharmacies despite ongoing power outages, supply shortages, and staff being personally impacted.

• Distributing essential supplies and resources to community members including food, water, cleaning supplies, and assisting patients with applications for FEMA disaster assistance.

The critical role that these clinics played and continue to play in providing care, social services, and resources to their communities demonstrates incredible resilience and highlights some of the ways that these clinics can be better supported to meet their community’s needs in the face of worsening climate events.

In early 2025, Phase II of this survey will involve testing the efficacy of various hazard vulnerability mapping and risk communication strategies. If you or your clinic is interested in participating, please contact kelly@carolinaadvocates.org to sign up.

• Download the  Climate Resilience for Frontline Clinics Toolkit  developed by Harvard and Americares which includes critical resources for health care providers, patients, and administrators at safety net clinics with hazard specific guidance on:
  • General weather
  • Extreme heat
  • Wildfire and smoke
  • Hurricanes
  • Flooding
• Enroll in the free  Climate for Health Ambassador Training  (3 CE credits) to gain knowledge, practical experience, and tools to effectively communicate and take action on climate change.
• Sign up for the NC DHHS  Heat Health Alert System  to receive alerts when the forecast is projected to reach unhealthy levels.
• The  National Center for Farmworker Health Education Resources  provide guidance on climate-informed care for farmworker populations with topics including:
  • Heat Stress
  •  Allergies 
  • Emergency Preparedness

•  Community Health Access to Resilient Green Energy (CHARGE)  partnership offers education, assessment, design, installation, and financing options to make accessing clean and reliable energy easy and affordable for health centers.
•  The Duke Energy Foundation  accepts grant applications on a rolling basis for projects that are focused on preparing communities for and mitigating the effects of climate change and natural disaster preparedness and response programming.
•  The North Carolina Community Foundation Disaster Relief Fund  provides grants to nonprofit and charitable organizations in communities impacted by disasters that address long-term recovery and resiliency and strengthen emergency preparedness.
•  Waste Reduction Partners  provides free energy, solid waste, and water usage assessments across North Carolina. They have experience in healthcare settings, will do an in-person audit, and can provide a detailed report with cost savings and recommendations for the most cost-effective ways to be more sustainable.

 Carolina Advocates for Climate, Health, and Equity (CACHE)  is a network of health professionals and advocates who work to provide education around and advocate for equitable climate solutions.

Interested in partnering with CACHE to advance resilience efforts at your clinic? Connect with us at info@carolinaadvocates.org.

Interested in staying in the loop on future opportunities to engage in this work?

 The Carolinas Climate Adaptation Partnership (CAP)  is a multi-institutional collaboration of physical and social scientists, community leaders, researchers, outreach professionals, and students dedicated to advancing climate resilience and the health and economic well-being of communities across the Carolinas. Working with local partners, we assess exposure and vulnerability to climate threats like wildfire, flooding, and extreme heat, integrating social and physical sciences with regional knowledge to co-produce tailored solutions that build a more climate-resilient future.