We develop resources that can reduce the chances of harm when disaster strikes. This pilot project is the first of its kind to focus on safety-net health clinics and the unique needs of low-income communities disproportionately affected by climate change in the U.S.

Read the latest press release 

From heatwaves in the South, to vector-borne diseases in the Northeast, to wildfires in the West, climate change threatens the ability of community health clinics to care for their patients. In an effort to address how health clinics across the country can enhance climate resilience and continue to care for patients, we are working with Americares to identify, support, and prepare clinics to address climate-related impacts on health and healthcare delivery to buffer risks to the patients they serve. Biogen is providing financial support.

Increasingly intense weather events are altering the needs of routine patient care and causing widespread disruptions at community health clinics through destroyed infrastructure, power outages, and fragmented supply chains. For example: 

    • During the 2019 wildfires in California, health clinics had to choose between keeping their electronic health records system online or running their refrigerators to protect temperature-sensitive vaccines. 
    • Hurricane Maria’s landfall on Puerto Rico devastated the island and caused national shortages of intravenous saline, a backbone of basic medical care, due to supply chain disruptions. 
    • The flooding from Hurricane Harvey was so severe that a regional medical center permanently closed and 44 surrounding hospitals and clinics had to evacuate more than 1,500 patients. 

Many of these patients are from vulnerable populations in areas that face more intense hurricanes, unprecedented wildfires, air pollution, and other challenges that can threaten the ability of community health clinics to care for their patients. 


Heatwaves create widespread health risks from climate change, yet few medical institutions are prepared to systematically address this challenge at the clinical level, starting with knowing who is at risk and ensuring they have a plan for the interventions like staying hydrated, planning for access to air conditioning, knowing where to go if the power fails, and being mindful of medications that may increase the development of heat-related illnesses. This is essential because the communities served by community health clinics are often among the most vulnerable, and often one of the few touchpoints people can look to in the community for help.

Climate Resilience Toolkit

As part of our Climate MD program, we are working with community health clinics in California, Massachusetts, North Carolina, and Texas to develop a Climate Resilience Toolkit for each region of the United States that includes: 

    • Clinician screening checklists for assessing patient vulnerability to climate change;
    • Disease management plans for patients and providers to prepare for heatwaves and other extreme events; and
    • Decision trees for clinic management during extreme weather.

“While climate resiliency is often about strengthening buildings, what makes our project so unique is our focus on the people inside those buildings. We aim to find new ways to protect people most at risk from the climate crisis and advance health equity,” said Dr. Aaron Bernstein, Interim Director of Harvard Chan C-CHANGE. “With this project, our hope is that a person with a chronic medical condition like heart disease, dementia, or asthma is better equipped to manage their care when facing routine stressors like poor air quality days when care itself is harder to get to. Climate change can compromise access to power, medications, and medical records and our goal is to work with care providers and clinics to develop resources that can reduce the chances of harm in increasingly common events like heatwaves or when disaster strikes.”

Community health clinics and organizations participating in the project include:


    • The Free Clinic of Simi Valley in southern California provides critical medical care to low-income families. Its patients live with the intensifying effects of climate change, including heat and drought.
    • Lestonnac Free Clinic, based in Orange County, Calif., has 13 clinic sites throughout Southern California. In 2020, due to the numerous wildfires, they saw a significant increase in patients coming into the clinic for upper respiratory issues and breathing problems.


    • Cambridge Health Alliance operates two safety net community hospitals and multiple primary care centers that serve several diverse communities north of Boston. Its patients are at high risk of heat-related illnesses due to urban heat-island effects, and their neighborhoods are at high risk of flooding due to rising sea levels and worsening storms.

North Carolina

    • The Community Care Clinic of Dare in the Outer Banks of North Carolina. In addition to the frequent and intensifying hurricanes that have been occurring, the clinic and patients face challenges from ongoing flooding caused by rising sea levels and increasing temperatures that have a disproportionate effect on their patients who often work outdoors.
    • Kintegra Health, a community health center in North Carolina with over 30 sites. The sites and patients face significant issues from frequent flooding washing out roads and access to healthcare, as well as deteriorating infrastructure, particularly in the rural areas.
    • The North Carolina Association of Free and Charitable Clinics (NCAFCC) supports 70 free and charitable clinics and pharmacies in the state by coordinating disaster response activities and supporting clinics as they provide healthcare for medically underserved North Carolinians. NCAFCC is feeling the effects of climate change and staff are called on to assist member clinics as climate change has acute and long-term effects on patient care and clinic operations.


    • Matagorda Episcopal Health Outreach Program provides critical health and behavioral health services for Matagorda County on the east coast of Texas. The facility was evacuated during Hurricane Harvey in 2017 and had many patients and staff members affected by the recent deep freeze. MEHOP is in a rural, underserved area with significant and growing challenges around access to healthcare, degrading infrastructure, and insufficient funds to rebuild after disasters.
    • San José Clinic, a charity clinic in Houston, Texas, serves patients directly impacted by Hurricane Harvey and the recent winter storm and related power outages.
    • Ubi Caritas, a free clinic in Beaumont, Texas, serves communities impacted by multiple hurricanes.


Project Team

Dr. Aaron Bernstein, Interim Director, Harvard Chan C-CHANGE
Maricel Braga, Research Project Coordinator