Hospital-level urban flood risk assessment and targeted strategies to increase hospital climate resilience in China: a modelling study

Background Hospitals, important in mitigating the health risks of climate change, are themselves increasingly vulnerable, making the enhancement of their climate resilience an urgent necessity. Although high-resolution flood risk and economic loss maps exist, they overlook hospitals. Lack of assessment of future hospital-level climate risks, economic and health impacts, and the optimisation of hospital-specific adaptation measures hinders effective and comprehensive adaptation strategies in policy making, urban planning, and emergency response to enhance hospital climate resilience amid severe urban flooding. The aim of this study is to provide such assessment for China, and to provide the optimisation of hospital-specific adaptation measures. Methods We constructed a database of China's general hospitals and an urban flooding model, integrating high spatial–temporal resolution precipitation data (9 km–15 min) to estimate the maximum water depth hospitals could face. We also quantified the direct economic losses and health impacts of urban flooding on hospitals—both with and without adaptation measures—across approximately 14 000 hospitals in 337 Chinese cities. Findings Under the medium warming scenario, even if all hospitals were to fully adapt to 2020 urban flooding levels, by the 2080s, annual direct economic losses in hospitals would soar to US$9·1 billion (95% CI 8·0–10·1), equivalent to 6·9% of China's 2022 government medical insurance expenditure, with delayed diagnoses affecting 6·8 million people (95% CI 4·5–9·6). In a higher warming scenario, these losses increase by about 50%. A uniform national adaptation strategy would require $51·2–97·4 billion to reduce losses to near zero, whereas cost-effective strategies that are city-specific and hospital-specific could achieve similar results at only $8·2–11·9 billion. Interpretation Our analysis reveals that climate change poses a severe threat to hospital systems in China, leading to substantial and direct health and economic consequences. The magnitude of the economic effects could place considerable long-term strain on hospitals’ ability to safeguard population health. Enhancing climate resilience in hospitals is therefore imperative. Funding Fundamental and Interdisciplinary Disciplines Breakthrough Plan of the Ministry of Education of China, National Natural Science Foundation of China, General Research Fund, the Croucher Foundation, and the Youth Innovation Team of China Meteorological Administration.