CR4HC Case Study: University of Nebraska

Community-Centered Climate Resilience Planning

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A Multidisciplinary, Collaborative Approach to Resilience Planning

The University of Nebraska Medical Center (UNMC) and Nebraska Medicine (NM), the largest healthcare system in Nebraska, employ a multi-stakeholder approach to climate resiliency planning that centers community health and health equity. The health system is preparing to face unpredictable disasters caused by climate change that will require adaptive preparation and response. UNMC/NM recognizes that sustainable operations, decarbonization, and all-hazard preparedness can positively affect community health, and is committed to increasing interdisciplinary collaborations across the system to enhance sustainability and climate resilience. The UNMC Office of Sustainability team uses prospective risk assessment tools to identify climate hazards and their risk profiles. The team uses this information alongside community input to identify and anticipate critical needs in emergency situations. This approach informs UNMC/NM’s adaptation measures to build resilience in a changing climate.

Planning for Sustainability  

For years, UNMC/NM clinics have been dedicated to increasing sustainability and minimizing their carbon footprint. In 2014, UNMC/NM published its first Sustainability Master Plan (University of Nebraska Medical Center & Nebraska Medicine, 2016). As of May 2023, UNMC/NM reports making strides toward reducing emissions of greenhouse gases, water usage, and waste; utilizing alternative transportation methods; and increasing engagement within their communities (University of Nebraska Medical Center & Nebraska Medicine, 2023). The need for expanding UNMC/NM’s activities around resiliency was highlighted by the 2019 Winter Storm Ulmer, which caused $2.6 billion in damages and made one-third of Nebraska highway systems temporarily impassable (University of Nebraska - Lincoln, 2022). Although UNMC/NM was internally prepared to provide care to patients during this kind of disaster, the flood disrupted community infrastructure, including roads and public transportation, and prevented people from reaching UNMC/NM facilities. After the event, UMNC/NM reevaluated opportunities to align internal planning efforts with community emergency planning to better prepare for future weather-related hazards.  

Prospective Assessment of Risk and Community Vulnerabilities 

UNMC/NM campuses recognized the need to augment the system’s emergency preparedness efforts with a forward-looking, community-centered approach to climate resilience. A member of the UNMC/NM sustainability team noted, “Climate impacts will touch every corner of the organization. Ensuring that… as many departments as possible are thinking about what specific, concrete impacts climate change will have on their work [is] essential.” To this end, UNMC/UM gathered representatives of architecture and planning, business operations and finance, education, human resources, patient care, public safety, research, and supply chain management. To create a tailored Climate Vulnerability Assessment (CVA) process, these representatives used a combination of 

• community engagement,  
• Climate Impacts Research Consortium (CIRC) toolkit (Federal Emergency Management Agency, 2024b), 
• Federal Emergency Management Agency (FEMA) National Risk Index (Federal Emergency Management Agency, 2024a), 
• Environmental Protection Agency (EPA)’s Environmental Justice Screening and Mapping Tool (U.S. Environmental Protection Agency, 2014), 
• U.S. Climate Vulnerability Index (Environmental Defense Fund, 2024), and  
• local tools designed specifically for Nebraska (High Plains Regional Climate Center, n.d.), including tools developed for local Tribal communities (High Plains Regional Climate Center, 2024b). 

The resulting CVA measures institutional vulnerability by establishing climate projections and prospective risk levels and by assessing available evidence connecting climate and non-climate stressors and adaptive capacity throughout the health system. Special attention was paid to patient groups who are at high risk of negative health outcomes after exposure to climate change–related events and those who may benefit from increased support in accessing healthcare.  

The CVA identified several areas of vulnerability, including 

• power grid reliance,  
• energy supply disruptions,  
• barriers to safe travel, and  
• supply chain interruptions. 

The team recognized the need for crisis response planning to provide adequate community support during climate-related disruptions and stressors.  

Understanding the strengths and vulnerabilities of the UNMC/NM health system and its relationship with community infrastructure resulted in a robust climate resilience strategy for future emergencies. For example, the medical center has increased resiliency in its power supply systems and cold-water supply systems for critical patient and research areas and is developing an emergency cooling plan to combat hot weather events. Furthermore, the UNMC/NM design guidelines are treated as living documents and are continually revised to incorporate best practices such as enhancing infrastructure; incorporating permeable surfaces for rainwater management; and contributing to multi-modal transportation infrastructure for public and private vehicles, bikes, and pedestrians.  

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Sustained Community Partnership

By involving the community in the development and implementation of the health system’s resilience planning process, including incorporating information from trusted community sources, UNMC/NM is facilitating community connections and building trust. One member of the sustainability team noted, “We know that strength in strategy development and identifying tensions and barriers comes from a diverse set of perspectives.” Thus, the health system seeks to integrate information from the High Plains Regional Climate Center as well as hazard plans developed by the Nebraska state government and local communities (High Plains Regional Climate Center, 2024a). UNMC/NM also plans to sustain and strengthen community engagement through its newly established Community Wellness Collaborative (CWC) in the Highlander development of North Omaha. The CWC is a non-clinical, community-serving space with a vision to provide support and resources through education, training, and building of career pathways. Climate resilience at the community level requires a community response that is fully integrated and well communicated to enable seamless action when hazardous weather events occur. UNMC/NM has leaned into its role as a key contributor to community climate resilience; its efforts to engage and connect beyond the walls of its facilities have paid dividends by fostering strategic partnerships and cooperation.