Toward climate resilience in Israel's healthcare system: decision-makers' perspectives

Climate change is increasingly recognized as a major global health threat, highlighting the need to enhance climate resilience within health systems. The World Health Organization (WHO) defines key components for climate-resilient health systems, including governance, financing, workforce, and emergency preparedness. Israel is particularly vulnerable to climate change, which is expected to exacerbate the strain on a healthcare system already facing budget cuts, staff shortages, equipment deficits, and security challenges. We aimed to analyze the barriers to and facilitators of climate resilience initiatives in Israel's healthcare system from the perspective of decision-makers. Understanding the unique contextual factors within Israel's healthcare system can inform the development of a tailored climate and health framework and shape national policy.

In this qualitative study, semi-structured interviews were conducted with 25 decision-makers, administrators, and professionals from the Ministry of Health, hospitals, and health maintenance organizations (HMOs). Participants were selected using purposive sampling to ensure diverse representation. Data were analyzed through deductive thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR).

The absence of a national policy framework, including dedicated funding and binding regulations, emerged as a central barrier to advancing climate resilience within the Israeli healthcare system. Additionally, the study revealed that climate issues are deprioritized due to security and budgetary constraints, coupled with limited awareness of climate risks. Economic incentives were frequently cited as enablers for promoting climate resilience. Despite challenges, the findings highlight the potential for integrating climate resilience into existing emergency preparedness systems.

The study underscores significant gaps in climate resilience within Israel's healthcare system, particularly the lack of a coordinated, government-led framework for climate adaptation. Although local efforts exist, they remain fragmented and unsustainable without national leadership and funding. Key recommendations include developing a comprehensive national health and climate plan, securing dedicated funding, and increasing awareness/training for healthcare professionals.