Hospital as ‘climate bunker’: How one health facility is preparing for the future

Vancouver’s St. Paul’s Hospital is shown in a concept sketch provided by Providence Health Care.

The health impacts of climate change are increasingly obvious, from heat stroke to respiratory problems due to wildfire smoke.

But extreme weather also affects the health-care system patients rely on.

During the 2021 heat dome in Vancouver, the heat made some MRI and CT scanners inoperable. According to a report by the Canadian Climate Institute, in some clinics, fire departments flooded the roofs to lower indoor air temperatures.

A report from the City of Vancouver predicts the risks to health infrastructure will increase. West coast sea levels are expected rise by approximately one meter by 2100. There will also be more poor air quality days due to wildfire smoke as well as more concentrated pollutants at ground level due to hotter weather.

That’s why St. Paul’s Hospital in Vancouver, expected to open in 2027, has made climate change resilience central to design considerations – the first hospital in Canada to do so.

Robin Hawker, a climate resilience expert at Introba, a key consultant on the project, says, “You can think of a hospital as a climate bunker.” It needs to be “designed to ensure that the staff are protected, the patients are protected, and the services can continue” even during extreme environmental events, she said.

Explaining that “our hottest day in the summer is going to become hotter in the future,” Hawker says the building was oriented so that the longest sides face north and south, rather than east and west – reducing direct sun and optimizing cooling efficiency. In addition, the building uses improved insulation and triple-pane windows with a special coating to reduce heat from the sun.

Given that the campus is located in a coastal floodplain, systems will also need to capture the “higher volumes of rain we expect under future conditions,” Hawker says. Stormwater will be collected on site, hospital entrances and vent stacks are raised, and there are flood gates to prevent water from entering the building.

In addition, the new facility will have robust backup generators to power the entire facility in case of longer outages in the future, and include MERV 14 filters to catch particulate matter from wildfire smoke.

Input from staff, patients and local stakeholders informed the design as well. For example, clinical staff asked for air filters that would reduce the spread of pathogens as well as improve air quality during wildfires.

Both patients and staff also emphasized the need for natural light and landscapes, which can have a significant impact on recovery. A literature review of 20 studies by the National Health Service in Scotland found that patients with exposure to outdoor views and natural light have shorter stays than those who can’t see out a window.

“We were able to identify a lot of benefits that the sustainable and resilient design could have for providing better clinical care,” says Hawker.

In addition to preparing for the impact of climate change on health and health care, the St. Paul’s green design team also focused on reducing the hospital’s own contribution to greenhouse gas emissions (GHGs).

The health sector contributes about 5 per cent of GHGs worldwide, a bigger carbon footprint than either aviation or shipping. In hospitals, this comes from lighting, heating and cooling, anesthetic gas and single-use plastics.

The president of the Canadian Medical Association, Dr. Joss Reimer, spoke at last year’s COP29 Summit on the need for both health system resiliency in the face of climate change and the decarbonization of the health sector.

“Health facilities are reckoning with environmental shocks and the role we play in climate change all over the world,” she said, “but upgrades to address these realities should be a particular priority in Canada, where more than 50 per cent of our health facilities are 50 years old.”

St. Paul’s is reducing GHGs in a number of ways. The hospital has been designed with heat recovery systems to reuse warm air rather than releasing it, reducing the demand on boilers. Building materials were selected based on the greenhouse gas emissions involved in their production, transport and degradation, and a plan was put in place to divert at least 75 per cent of construction waste from landfills.

The new space will also have electric car charging stations and 200 bike spots, plus lockers and showers for cyclists.

Dr. Stephan Williams, an anesthesiologist and medical comanager for carbon-neutrality/sustainability at the Centre Hospitalier de l’Université de Montréal, says the new St. Paul’s checks “a lot of sustainability boxes.”

But he points out the ongoing use of fossil fuel-powered boilers at the campus, which he called “a regrettable choice during a climate and health emergency fuelled by fossil fuel combustion.”

He would also like to see more than 10 per cent of parking spots for electric cars, as well as space for more bikes, he said, noting that Vancouver is “in Canada’s best climate for active transport,” which is both healthy for humans and sustainable for the environment.

Marc Dagneau, director of engineering and facilities management on the project, says cost is one factor in the decision to use conventional boilers: electrification of heating and cooling systems would have increased the electrical component of the hospital’s budget by 70 per cent to 100 per cent. (The electrical component of the budget currently makes up 20 per cent to 25 per cent of the total budget.)

He points out that there’s also no guarantee the substation supporting the hospital (which is due for an upgrade) could handle electric heating and cooling. Similarly, geothermal and solar energy sources were considered, but assessments suggested they would not be reliable enough for the hospital’s needs and would require more space than the St. Paul’s campus allows.

What the hospital has done is leave space around the mechanical heating and cooling systems, in case temperature extremes require more capacity and upgrades. This kind of future-proofing comes with an upfront cost too, but as Hawker explains, will ultimately save money.

“In the resilience and sustainability world, we often talk about how we can build back better after an emergency event,” said Hawker. But the opening of brand-new hospitals – increasingly common amid crumbling hospital infrastructure and growing demands for health care – “gives us the chance to build better first.”

This piece is part of a partnership between the Canadian Medical Association (CMA) and CTV News. For more information on the CMA, visit www.cma.ca.