Foundations provide funding to address a hospital’s biggest long-term needs. Why aren’t they preparing for climate change?
Why It Matters
Climate change is the single greatest long-term threat to the health of Canadians, according to Canada’s chief public health officer – and hospital foundations are a significant source of equipment and capital spending for major hospitals.
This journalism is supported by the Future of Good editorial fellowship on climate change and human health, supported by Manulife. See our editorial ethics and standards here.
Keeping surgical instruments sterile in the cigar-like stench of a wildfire isn’t easy. For Dr. Alika Lafontaine, an anesthesiologist in Alberta and president of the Canadian Medical Association, it has proven impossible. During abnormally large and smoky wildfire seasons, Lafontaine’s hospital in Grande Prairie has been forced to shut down its operating theatres.
“I never thought I would see this in my life,” he recalls in a statement on the CMA’s website. “These are very real effects on people’s lives.”
Climate change is already upending emergency responses by hospitals across Canada. During 2021’s heat dome, heat-related visits in Vancouver’s city centre tripled. In New Westminster, B.C., firefighters were forced to call taxis to transport overheated patients to hospitals because there weren’t any available ambulances. Meanwhile, storms like 2003’s Hurricane Juan in Nova Scotia and flooding like the 2013 Calgary floods can disrupt hospital service entirely.
And those are just the impacts today. Climate modelling for the year 2050 suggests the Nanaimo Regional General Hospital will be vulnerable to overheating thanks to hotter summers. Atmospheric pollution from wildfire smoke will pose challenges to the facility’s ventilation systems that supply the hospital’s various operating rooms and intensive care units.
The solution calls for better-ventilated hospitals with ample room for patients during heatwaves, floods, wildfires, or whatever crises may befall a community thanks to climate change.
Hospitals need the equipment to not only handle crises, but also treat patients suffering from a myriad of conditions caused or exacerbated by climate change – from heat stroke due to overly hot summers to lung cancer triggered by forest fires.
One of the biggest funding sources for hospitals to do just that are hospital foundations. They act as a facility’s long-term problem solver, funding improvements – to the tune of millions of dollars a year – like new medical wings, MRIs, ventilators, and specialists who don’t fall under the province’s healthcare payroll.
With climate change considered the single greatest risk to human health across Canada, foundations have a role to play in ensuring hospitals meet this challenge. Yet based on public information on the websites of major Canadian hospital foundations, as well as annual reports, it doesn’t appear as though preparing for the shocks of climate change on healthcare is a priority to them.
On top of basic research, Future of Good reached out to 15 major hospital foundations across Canada with specific questions about whether they are fundraising to address the demands climate change will place on healthcare systems. Only two agreed to interviews, and neither said their foundation addressed these issues explicitly.
This is a trend Michael Logue, a partner at non-profit consulting firm KCI, who works with dozens of different hospital foundations, has also noticed. “I haven’t yet seen hospital foundations, per se, address the whole issue around climate change,” he says.
The issue isn’t that hospital foundations don’t care about climate change. “There are a considerable number of philanthropists who deeply care about systemic change as it relates to climate, and also are very concerned with the here and now impacts on human health,” says Krishan Mehta, an assistant vice president of engagement at Toronto Metropolitan University with extensive experience in philanthropy.
Rather, climate change’s effect on healthcare is a challenge many hospital foundations are not well-equipped to address. Canada is struggling with an acute healthcare capacity crisis. Donors aren’t easily sold on projects that address a long-term (but serious) problem like climate change – they prefer ones with tangible, immediate impacts. And then there’s the leadership question: how does one convince a hospital board to go all-in on climate change research when they desperately need new MRI machines?
Funds from the community
Hospital foundations are a mainstay of the Canadian healthcare system – and the philanthropic system as a whole. VGH & UBC Hospital Foundation alone says it has given over $1 billion worth of philanthropic funding over the past 40 years. This covers everything from Vancouver General Hospital’s first open-heart surgery in 1957, to the opening of the 16-operating room Phil & Jennie Gaglardi Surgical Centre in 2021.
Hospital foundations operate under certain caveats. They aren’t allowed to pay the salaries of healthcare workers who might otherwise be paid through a province or territory’s healthcare funding, but can purchase new medical equipment, contribute to the expansion of a facility, or fund research initiatives. VGH & UBC Foundation does all three.
A hospital foundation exists to support its parent health organization, either a single hospital, or series of affiliated medical facilities, with whatever it needs to serve its community best.
But the foundation doesn’t get to pick and choose the causes it addresses. “The priorities that we fund are driven by Vancouver Coastal Health and their priorities,” says Dany Maneely, senior vice president of community giving and engagement at VGH & UBC Foundation.
In other words, if a hospital’s board desperately needs to expand a hospital wing because it cannot adequately serve patients, it doesn’t matter whether a hospital foundation wants better climate change-centred programming. Logue says there is sometimes a back-and-forth discussion between foundations and hospital boards on how best to fundraise, or which projects to prioritize, but the board is in the driver’s seat.
To make matters even more complex for hospital foundations, some provinces like Ontario require them to raise money for certain types of hospital expenditures. These include 10 per cent of the cost of capital expansion – like a new ER or expanded medical wing – to 100 per cent of the cost of replacing medical equipment like MRIs.
This also comes at a time when the Canadian healthcare system is under intense strain. Scott Fortnum, president and CEO of Children’s Hospital Foundation, says a lot of healthcare funding is “very reactive, especially right now.” While his foundation plans to take a strategically longer view, right now, their efforts are focused on near-term needs.
To Chris Gallaway, executive director of Friends of Medicare, an organization that campaigns for better public financial support for Canada’s healthcare system, it isn’t surprising that foundations and hospital boards aren’t using their funds to address broad issues like climate change’s impact on health. After all, these foundations already have a lot to fund.
“It’s not really something on their mind because they are narrowly focused on capital projects, expansion, or equipment that’s needed – like a community that needs kidney dialysis or whatever it might be,” he says. “They’re responding to those kinds of needs.”
The climate pitch
Donors, especially wealthy donors, are the lifeblood of hospital foundations’ revenues in any given year. Making the case for them to donate to a new hospital wing they can see, or a device that might one day save a family member’s life, is one thing. But getting them to pitch in for ventilators specifically to deal with the damage caused by wildfire smoke specifically, or the catheters and large fans used to treat heat stroke patients, is another matter entirely.
When hospital foundations look at a project, they usually ask whether it has a solid and measurable outcome, and whether it addresses the patient care experience overall, says Michael Pogue, partner at KCI, a non-profit consulting firm who works with dozens of hospital foundations. Another consideration is donor appeal. Currently, major donors – those giving above $10 million – are concerned about big picture healthcare issues within the traditional healthcare system: access to primary care, healthcare in marginalized communities, and mental health and addictions treatment.
“These are some of the big issues that donors ask whether a foundation is really moving the needle on,” Pogue says.
If a hospital foundation were to address climate change as a health issue, Pogue suggests that focusing an appeal on climate change itself might dilute the message to donors. Instead of simply listing off the health issues associated with climate change, he believes a strategy might be to have climate change as just one of many reasons – along with Canada’s aging population, and higher rates of substance use post-COVID lockdown – to improve patient care at a hospital.
Fortnum says the Children’s Hospital Foundation would be more inclined to look at addressing the impact of climate change on kids if climate change had more of an impact on their health. At the moment, he claims, it doesn’t – and hospitals already address climate-exacerbated health conditions like heat stroke. He doesn’t even see the need to try and pitch more donors on the connections between conditions like heat stroke and its link to climate change. “We haven’t seen enough of the change in the pediatric sector that I’m aware of,” Fortnum says.
This attitude doesn’t line up with the concerns of leading climate scientists and medical experts around the world, who say children are among the most at risk for climate-triggered health issues. These include more frequent asthma attacks, complicated births, higher rates of mental health issues, and developmental delays.
“Increased greenhouse gasses in the atmosphere are leading to higher temperatures, more intense storms, and lengthy droughts – all of which can deeply affect children’s health,” according to the Center for Climate, Health and the Global Environment at Harvard University.
Maneely says that for VGH & UBC Foundation, “no conversation with our donors or Vancouver Coastal Health is off-limits.” She points to a 2016 lung cancer screening initiative launched with contributions from the foundation as a “climate adjacent” program. But the pilot, and the resulting B.C. provincial model it inspired, is for middle-aged people with a 20-year or more history of smoking specifically. Climate change isn’t mentioned.
Transformative change
While Canada’s hospital foundations, by and large, are not launching climate change-specific initiatives related to healthcare, there may still be room for them to do so. Climate change does appear to be of interest to foundation executives and experts. Addressing the impact of climate change on Canada’s health system will undoubtedly require serious long-term investment into expanded facilities, equipment, and programming – and hospital foundations could provide that.
“The commitment fundraisers have to systemic change is palpable,” Mehta says. “The way that translates into conversations about philanthropy has shifted hearts and minds in ways that I think could really make a lasting impact on both climate change and healthcare.”
Of course, government funding is still the backbone of Canadian healthcare spending. Amid all the recent debates about the privatization of healthcare and relying on philanthropy to improve the healthcare system’s resilience to climate change may seem troubling to some. But to Mehta, it is necessary.
“At the end of the day, we have rarely seen one part solve the initial problem on its own,” Mehta says. “To ask philanthropy to play a critical role in systems change is actually, in my opinion, a responsible way of pulling together all aspects of our community.”
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