The Asia Pacific Women thought leadership series brings focus to the status of women in the Asia-Pacific region through expert commentary on women’s social inclusion and economic engagement in several aspects of life.

The COVID-19 pandemic is increasingly spreading into low and middle-income countries that are stretched in resources, equipment, and staff. We are seeing communities and governments struggling to manage the WHO recommended comprehensive approach of test, trace, and isolate. The pandemic has shown that those most vulnerable to this disease are living in inequitable conditions. Women’s inequality in society means that they and other vulnerable groups often lack the resources to be able to prepare for and respond to the health crisis through lockdowns and social distancing measures.

COVID-19 has exacerbated race, gender, economic, employment and health inequalities. Climate change—and the attendant environmental and health impacts—will create the same shock and devastation to our economies and living conditions. Bushfires, drought, flooding, mosquito borne illnesses and novel zoonotic illness, will all increase if we do not address the climate emergency. Since this pandemic, the climate emergency has lost its immediacy and relevance. It is tempting to think that the problem is too big and distant. Climate change is not a virus that we can test, trace, and isolate. Its effects and consequences are seen as unpredictable. But we need to recognise that climate change will affect us in unpredictable and devastating waves like this virus. And like COVID-19, it is the impoverished, marginalised and discriminated who will be most vulnerable to its effects. These inequalities intersect and create different effects for different communities in experiencing the current health emergency and the consequences of climate change.

With this in mind, how then can societies re-orient health services to reflect a climate-just intersectional feminist lens? First, there needs to be recognition of the unique set of expectations and risks that female healthcare workers face. Female healthcare workers make up the majority of the world’s health care workforce. This has led to female healthcare workers experiencing a higher risk of COVID-19 infection, and in climate-related health disasters, they will be relied upon in great numbers to manage and respond to these events.

Putting climate-resilient health care policy and gender justice at the heart and mind of clinical and hospital management is essential.

There have been meaningful discussions on concepts such as value-based, patient-centred healthcare and connected health, but there are few concrete operational strategies and standards for how to ‘future-proof’ a hospital to be climate change responsive, health care worker centred and patient inclusive.  

We explore two examples where ‘future-proofing’ a hospital to be climate change responsive is leading to innovative practices of inclusion: a community engagement program that connects people with disabilities and their carers in preparation for natural disasters; and a ‘future proof’ retrofit of personal protective equipment (PPE) that is intended to benefit female healthcare workers.

Nurse and patient (Chinese sign language “thank you”)
Image provided by Tzu Chi Hospital

First, Tzu Chi Hospital, a teaching hospital in Taichung city (Taiwan) is providing a health care service that reaches out to rural neighbourhoods and the suburban community in preparation for public health emergencies, whether a pandemic or weather disaster event. The hospital has dedicated time and resources to bringing together inter-speciality medical staff who have developed a hospital-community collaborative network to improve the quality of care for people living with disabilities (especially dementia). This service provides outreach and support to the carers, most of whom are women (a family member and/or foreign migrant workers). The idea was to map and integrate the 12 district care centres’ resources, connect vital stakeholders and develop a communication and learning platform to enhance continuity and coordination of care. Members of the network include leaders of the district, villages and neighbourhoods, with representatives from the local health centre, community development association and local volunteer organisations.

At the early stage of the program (2012), 30 (8 males; 22 females) retirees joined as community health volunteers and helped facilitate regular health promotion activities. Since 2012, the members have provided at least 140 hours of service annually, serving more than 30,000 community members. The initial purpose—to provide the disabled persons with a collaborative network of care during a natural disaster—has led to an active and vibrant support group for the disabled, their carers, the community and the hospital.

The network now incorporates sustainability elements, including plant-based diet cooking classes, waste recycling, growing vegetables and tree planting to reduce their personal carbon footprint. The network—prepared to coordinate support during natural disasters—is now in action during the current COVID-19 outbreak. It ensures the provision of a health service that is rights-based, inclusive and sustainable. This best practice approach has established a secure channel of care and delivery for health care workers, patients and carers.

Health services need to remain alert and focused on mitigating the effects of the pandemic and build resilience for future waves.

Conversely, the response to COVID-19 is not a justification to ignore ongoing health care needs and health services, especially for the marginalised. Recognising and alleviating the mental stress and physical strain on healthcare workers remains critical during the COVID-19 pandemic and during climate-fuelled disasters.

During the pandemic, it has been reported that frontline health workers in India had to wear diapers and avoid drinking or eating because of PPE scarcity. Personal care activities would require dispensing old PPE to change into new PPE. The majority of healthcare workers who lived through these conditions were women. Thick airtight-material causes excessive sweating in hospitals, especially during summer. In low and middle income countries, air-conditioners and fans have been switched off to prevent the virus from spreading in healthcare facilities without proper air ventilation systems. Amid a crisis, the well-being of the health workforce and their physical ability to maintain proper use of PPE is vital to securing the health of their patients.

The second example of innovation came from observing healthcare workers going about their day-to-day work activity and specifically, asking female healthcare workers (irrespective of seniority) what can be done to support their work with physical comfort. This project commenced before the outbreak of COVID-19, but has been accelerated during the pandemic. Collaborating with an inter-departmental team at a hospital in Taiwan, we implemented a sealed window barrier featuring a pair of gloves that allows clinicians (nurses and doctors) to perform nasal swab tests with less PPE. This helps tackle the shortage of PPE and reduced 45-59% of healthcare waste per COVID-19 testing in the hospital.

A clinician conducts a nasal swab using a low cost medical device designed to reduce PPE waste.

This proactive research approach—to ask healthcare workers most at risk what would be comfortable, what would make them feel safe—led to a solution that was not just safer for clinicians, but also better for the environment.

The retrofitting process factored in a feminist and climate justice approach: the purpose was to provide better PPE that was environmentally sustainable, protective and physically comfortable for healthcare workers.

COVID-19 has not paused the climate emergency. The pandemic has accelerated and magnified multiple and intersectional inequalities and injustices. There are solutions to be found and it requires lifting all ships together, so we don’t come out from one crisis to face another. Hospitals are institutions of care but also of business. They need to be inclusive, responsive and sustainable. Like communities, hospitals are experiencing rapid change within the health system like never before. These two examples show that climate change preparedness helps prepare for emergencies in general. The feminist intersectional approaches used in both examples helped pivot our research to inclusive-based solutions. A feminist intersectional climate resilient health service is possible; we need to identify and scale up these isolated practices to steer everyone towards a more just and inclusive pandemic recovery.

AUTHOR

Connie Cai Ru Gan is an eco-feminist and public health researcher working on climate action in healthcare settings. She serves as the sustainability coordinator of the International Health Promoting Hospitals & Health Services (HPH) Network Task Force on Environment, where she invites many more people to work hand-in-hand to implement strategies that will enable us to protect our health and the environment. Connie is a doctoral candidate in the Centre for Environment and Population Health, School of Medicine at Griffith University.

Sara E Davies is a Professor of International Relations at the School of Government and International Relations, Griffith University and a researcher at the Griffith Asia Institute.