Climate Risks and Inequalities in Access to Health Services: A National Mixed-Methods Study

Abstract

Abstract Background Climate change threatens public health, increasing morbidity, mortality, and inequalities. In Southern Israel, Bedouin communities in unrecognized villages are particularly vulnerable. However, the impact of extreme climate events on healthcare utilization remains understudied, particularly in underserved settings. Objectives To map exposure to climate risks and assess their impact on access to health services across population groups in Israel. Methods A mixed-methods study (2024–2025) combined a national survey with oversampling of vulnerable populations (N = 1,705) and qualitative data. The survey assessed healthcare access and climate risk exposure (e.g., outdoor work, housing conditions), with analyses by region and ethnicity. Findings were triangulated with focus groups (N = 69) and in-depth interviews with policymakers (N = 25). An innovative policy lab approach was used to translate the findings into policy challenges and actionable recommendations to strengthen climate resilience in health systems. Results Exposure was higher in peripheral regions (South M = 1.79±0.69 on a 0-3 scale; Center 0.76±0.71, p < 0.01), among minorities (Bedouins M = 1.99±0.59; Jews 0.92±0.79, p < 0.01), and low-income groups. Appointment cancellations due to extreme weather were higher in the South (2.38±1.34 on a 1-5 scale) vs. North (1.90±1.13) and Center (1.93±1.02) (p < 0.01), and among Bedouins (2.76±1.41) vs. other Arabs (2.22±1.22) and Jews (1.57±0.98). Qualitative findings highlighted structural barriers, including extreme heat, dust storms, poor transport, and ambulance delays. Conclusions Climate-related disruptions to healthcare access are driven by structural inequalities, including poverty and infrastructural gaps, exacerbating existing disparities. Strengthening climate resilience in health systems, particularly transport, infrastructure, and service continuity, is essential. These findings have relevance for other climate-vulnerable and underserved settings globally. Key messages • Climate risks disproportionately limit healthcare access among vulnerable populations, especially in peripheral regions, amplifying existing health inequalities. • Climate resilience must address structural inequalities to ensure equitable access to health services during extreme weather events.