Community-based adaptation to the health impacts of climate change

The Impact of "Soft" and "Hard" Flood Adaptation Measures on Affected Population's Mental Health: A Mixed Method Scoping Review

BACKGROUND

The frequency and severity of floods has increased in different regions of the world due to climate change. It is important to examine how adaptation measures impact the mental health of individuals affected by these disasters.

OBJECTIVE

The goal of this scoping review was to document the existing studies on the impact of flood adaptation measures in affected populations to identify the best preventive strategies and limitations that deserve further exploration.

METHODS

This study followed the PRISMA-ScR guidelines. Inclusion criteria focused on studies in English or French available in MEDLINE and Web of Science that examined the impact of adaptation measures on the mental health of flood victims. Literature reviews or non-study records were excluded from the analysis.

RESULTS

A total of 857 records were obtained from the examined databases. After 2 rounds of screening, 9 studies were included for full-text analysis. Six studies sought to identify the factors that drive resilience in flood victims, whereas 3 studies analyzed the impact of external interventions on their mental health.

CONCLUSIONS

The limited number of studies demonstrates the need for public health policies to develop flood adaptation measures that can be used to support the mental health of flood victims.

Strategies for public health adaptation to climate change in practice: social learning in the processionary Moth Knowledge Platform

Social learning theory can support understanding of how a group of diverse actors addresses complex challenges related to public health adaptation. This study focuses on one specific issue of public health adaptation: oak processionary moth (OPM) adaptation. With a social learning framework, we examined how public health adaption strategies gradually develop and are adjusted on the basis of new knowledge and experiences. For this qualitative case study, data were collected through 27 meetings of the Processionary Moth Knowledge Platform in the Netherlands and six additional interviews. Results indicate that relations between stakeholders, including experts played a major role in the learning process, facilitating the development and implementation of OPM adaptation and connecting local challenges to national adaptation strategies. Uncertainties regarding knowledge and organization were recurrent topics of discussion, highlighting the iterative and adaptive nature of public health adaptation. The study emphasizes the importance of building relationships among stakeholders and small steps in the learning process that can lead to the creation of new strategies and, if successful, the prevention of negative health impacts.

Relationships are everything: The underpinnings of grassroots community action in the COVID-19 pandemic in Toronto

Most government emergency/pandemic response plans feature top-down decision making and communication strategies and a focus on 'hard' (physical) infrastructure. There is nothing about the importance of the ideas and communications originating from communities, the social infrastructure that supports their impact locally and their contribution to the central administration. In this study, we found that the 'soft' (social) infrastructure within communities and between communities and formal institutions is key to an inclusive and more equitable response to large-scale crises like the COVID-19 pandemic. Grassroots leaders in six Toronto neighbourhoods were interviewed between the first and second waves of the COVID-19 pandemic in Toronto about what helped or hindered community action. Three themes emerged: (1) Grassroots leaders and community organizations were able to act as key connection points in a two-way flow of information and resources with residents and service providers; (2) Grassroots leaders and groups were challenged to engage in this work in a sustained capacity without adequate resourcing; and (3) there was a disconnect between community-centred grassroots approaches and the City's emergency response. We conclude that there needs to be pre-disaster investment in community level planning and preparation that fosters two-way connections between all municipal emergency/disaster and pandemic preparedness plans and community-centred organizations and grassroots leaders working in marginalized communities.

The role of family medicine and primary health care and its impact on the climate crisis

No abstract available.

Climate Change and Health: Local Government Capacity for Health Protection in Australia

Climate change is the greatest global health threat of the 21st century, with numerous direct and indirect human health consequences. Local governments play a critical role in communities' response to climate change, both through strategies to reduce emissions and adaption plans to respond to changing climate and extreme weather events. Australian local government environmental health officers (EHOs) have the relevant skills and expertise to inform and develop adaptation plans for health protection in the context of climate change. This study used an online survey followed by phone interviews of local government management to determine the extent to which EHOs are involved in adaptation planning in health protection climate change plans. Questions were also asked to determine whether local councils are aware of EHOs' capability to contribute and to gauge the willingness of management to provide EHOs with the workload capacity to do so. The findings demonstrated that although climate adaptation and mitigation planning is occurring in local government, it is not including or considering the public health impacts on the community. Primarily, it was found that this oversight was due to a lack of awareness of the health impacts of climate change outside of a disaster or emergency scenario. Currently, EHOs are an untapped source of knowledge and skills that can contribute to climate change adaption planning. To support this, a framework of local environmental health practice was developed to assist the reconceptualization of the scope of practice required for the planning and response to climate change.

Facing flood disaster: A cluster randomized trial assessing communities' knowledge, skills and preparedness utilizing a health model intervention

Floods occur when a body of water overflows and submerges normally dry terrain. Tropical cyclones or tsunamis cause flooding. Health and safety are jeopardized during a flood. As a result, proactive flood mitigation measures are required. This study aimed to increase flood disaster preparedness among Selangor communities in Malaysia by implementing a Health Belief Model-Based Intervention (HEBI). Selangor's six districts were involved in a single-blinded cluster randomized controlled trial Community-wide implementation of a Health Belief Model-Based Intervention (HEBI). A self-administered questionnaire was used. The intervention group received a HEBI module, while the control group received a health talk on non-communicable disease. The baseline variables were compared. Immediate and six-month post-intervention impacts on outcome indicators were assessed. 284 responses with a 100% response rate. At the baseline, there were no significant differences in ethnicity, monthly household income, or past disaster experience between groups (p>0.05). There were significant differences between-group for intervention on knowledge, skills, preparedness (p<0.001), Perceived Benefit Score (p = 0.02), Perceived Barrier Score (p = 0.03), and Cues to Action (p = 0.04). GEE analysis showed receiving the HEBI module had effectively improved knowledge, skills, preparedness, Perceived Benefit Score, Perceived Barrier Score, and Cues to Action in the intervention group after controlling the covariate. Finally, community flood preparedness ensured that every crisis decision had the least impact on humans. The HEBI module improved community flood preparedness by increasing knowledge, skill, preparedness, perceived benefit, perceived barrier, and action cues. As a result, the community should be aware of this module. Clinical trial registration: The trial registry name is Thai Clinical Trials Registry, trial number TCTR20200202002.

Optimizing spinal cord injury care in Canada: Development of a framework for strategy and action

National health strategies are integral in defining the vision and strategic direction for ensuring the health of a population or for a specific health area. To facilitate a national coordinated approach in spinal cord injury (SCI) research and care in Canada, Praxis Spinal Cord Institute, with support from national experts and funding from the Government of Canada, developed a national strategy to advance SCI care, health, and wellness based on previous SCI strategic documents. This paper describes the development process of the SCI Care for Canada: A Framework for Strategy and Action. Specifically, it covers the process of building on historical and existing work of SCI in Canada through a thorough review of literature to inform community consultations and co-creation design. Furthermore, this paper describes planning for communication, dissemination, and evaluation. The SCI Care Strategic Framework promotes an updated common understanding of the goals and vision of the SCI community, as well as strengths and priorities within the SCI system regarding care, health, and wellness. Additionally, it supports the coordination and scaling up of SCI advancements to make a sustainable impact nationwide focusing on the needs of people living with SCI.

Health Security, Quality of Life and Democracy during the COVID-19 Pandemic: Comparative Approach in the EU-27 Countries

The aim of this paper is to emphasize the role played by the social, economic and political variables in shaping models of sustainable healthcare systems and strategies able to support and improve the quality of life during and after the COVID-19 pandemic. The context of our research is represented by the medical and socioeconomic crises generated by the COVID-19 pandemic. The current pandemic negatively affects healthcare systems, quality of life and the global economy. In this respect, this paper aims to thoroughly scrutinize the effects of the COVID-19 pandemic on the social and healthcare systems of EU countries, to analyze the impact of human development in the field of the Global Health Security Index and to estimate the relation between resilience and quality of life during the COVID-19 pandemic. The research design is quantitative, resorting to the use of both descriptive and inferential statistics, against the background of a long-term comparative approach to the respective situations in the EU-27 countries. Empirical findings are relevant for emphasizing the fact that human development and social progress are predictors for the dynamics of health security measures. Moreover, the quality of the political regime, particularly in the case of full and flawed democracies, is strongly related to a high level of resilience and could influence the perception of quality of life. All of these empirical results could prove valuable for scholars interested in understanding the relationships between democracy, healthcare systems and quality of life, and for political decision makers involved in the effort of reducing the negative effects of COVID-19 in EU-27 countries.

Impact of climate change on human health: evidence from riverine island dwellers of Bangladesh

This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers' health issues.

A Systematic Review on an Optimal Dose of Disaster Preparedness Intervention Utilizing Health Belief Model Theory

Disaster preparedness is an issue that receives little attention in the community. Communities must take preventative measures to overcome obstacles and improve community preparedness. This review identifies the optimal dose of disaster preparedness intervention in the community. A systematic literature search was conducted to examine a study about the optimal dose of disaster preparedness intervention developed for implementation at a community level. A scoping review based on the PRISMA diagram was conducted from four databases. A combination of keywords was adapted for each database. Inclusion and exclusion criteria were applied. A total of eight articles were synthesized based on the intervention dose of disaster preparedness among community interventions. The summarized studies provided evidence that the optimal dose for disaster preparedness intervention in the community can be prevented with an educational intervention program with a minimal dosage of intervention. The Health Belief Model Theory was the most often cited theory by researchers. The best dose for disaster preparedness intervention in a community can be mitigated with a single dose of education. Nonetheless, we cannot disregard alternative disaster preparedness theories because each has its advantages and disadvantages.

Public Health Aspects of Climate Change Adaptation in Three Cities: A Qualitative Study

Climate change presents an unprecedented public health challenge as it has a great impact on population health outcomes across the global population. The key to addressing these health challenges is adaptation carried out in cities through collaboration between institutions, including public health ones. Through semi-structured interviews (n = 16), this study investigated experiences and perceptions of what public health aspects are considered by urban and public health planners and researchers when planning climate change adaptation in the coastal cities of Söderhamn (Sweden), Porto (Portugal) and Navotas (the Philippines). Results of the thematic analysis indicated that participating stakeholders were aware of the main climate risks threatening their cities (rising water levels and flooding, extreme temperatures, and air pollution). In addition, the interviewees talked about collaboration with other sectors, including the public health sector, in implementing climate change adaptation plans. However, the inclusion of the public health sector as a partner in the process was identified in only two cities, Navotas and Porto. Furthermore, the study found that there were few aspects pertaining to public health (water and sanitation, prevention of heat-related and water-borne diseases, and prevention of the consequences associated with heat waves in vulnerable groups such as children and elderly persons) in the latest climate change adaptation plans posted on each city's website. Moreover, participants pointed to different difficulties: insufficient financial resources, limited intersectoral collaboration for climate change adaptation, and lack of involvement of the public health sector in the adaptation processes, especially in one of the cities in which climate change adaptation was solely the responsibility of the urban planners. Studies using larger samples of stakeholders in larger cities are needed to better understand why the public health sector is still almost absent in efforts to adapt to climate change.

Progress of Local Health Department Planning Actions for Climate Change: Perspectives from California, USA

Public health departments are on the frontlines of protecting vulnerable groups and working to eliminate health disparities through prevention interventions, disease surveillance and community education. Exploration of the roles national, state and local health departments (LHDs) play in advancing climate change planning and actions to protect public health is a developing arena of research. This paper presents insights from local public health departments in California, USA on how they addressed the barriers to climate adaptation planning with support from the California Department of Public Health’s Office of Health Equity Climate Change and Health Equity Section (OHE), which administers the California Building Resilience Against Climate Effects Project (CalBRACE). With support from the U.S. Centers for Disease Control and Prevention (CDC) Climate-Ready States and Cities Initiative (CRSCI), CalBRACE initiated an adaptation project to seed climate planning and actions in county health departments. In this study, we compared the barriers and strategies of twenty-two urban and rural LHDs and explored potential options for climate change adaptation in the public health framework. Using key informant interviews and document reviews, the results showed how engagement with CalBRACE’s Local Health Department Partnership on Climate Change influenced the county departments’ ability to overcome barriers to adaptation through the diversification of funding sources, the leveraging strategic collaborations, extensive public education and communication campaigns, and the development of political capital and champions. The lessons learned and recommendations from this research may provide pathways and practices for national, state and local level health departments to collaborate in developing protocols and integrating systems to respond to health-related climate change impacts, adaptation and implementation.

The role of communication, building relationships, and adaptability in non-profit organisational capacity for health promotion

While the non-profit sector has an integral role in health promotion, it is unclear whether these organisations have the capacity for health promotion activities. This study aims to explore and describe capacity changes of a non-profit organisation during a 3-year community-based nutrition intervention. The non-profit organisation, with 3800 members throughout the state of Queensland, Australia, implemented a 3-year food literacy community-based intervention. A team of qualified nutritionists delivered the program in partnership with community-based volunteers. A separate aim of the intervention was to build capacity of the non-profit organisation for health promotion. A qualitative study was undertaken, using a social constructivist approach to explore organisational capacity changes longitudinally. All relevant participants including non-profit executive managers and nutritionists were included in the study (100% response rate). Data collection included semi-structured interviews (n = 17) at multiple intervention time points and document analysis of program newsletters (n = 21). Interview transcripts and documents were analysed separately using thematic and content analysis. Codes and categories between the two data sources were then compared and contrasted to build themes. Organisational capacity was predominantly influenced by four themes; ‘communicating’, ‘changing relationships’, ‘limited organisational learning’ and ‘adaptability and resistance to change’. Developing non-profit organisational health promotion capacity appears to require focusing on fostering communication processes and building positive relationships over time. Capacity changes of the non-profit organisation were not linear, fluctuating across various levels over time. Assessing non-profit organisational capacity to implement community interventions by describing adaptive capacity, may help researchers focus on the processes that influence capacity development.

Analyzing changes to U.S. municipal heat response plans during the COVID-19 pandemic

Extreme heat events are the deadliest weather-related event in the United States. Cities throughout the United States have worked to develop heat adaptation strategies to limit the impact of extreme heat on vulnerable populations. However, the COVID-19 pandemic presented unprecedented challenges to local governments. This paper provides a preliminary review of strategies and interventions used to manage compound COVID-19-extreme heat events in the 25 most populous cities of the United States. Heat adaptation strategies employed prior to the COVID-19 pandemic were not adequate to meet during the co-occurring compound hazard of COVID-19-EHE. Long-term climate-adaptation strategies will require leveraging physical, financial, and community resources across multiple city departments to meet the needs of compound hazards, such as COVID-19 and extreme heat.

A Connected Community Approach: Citizens and Formal Institutions Working Together to Build Community-Centred Resilience

Urban resilience research is recognizing the need to complement a mainstream preoccupation with “hard” infrastructure (electrical grid, storm sewers, etc.) with attention to the “soft” (social) infrastructure issues that include the increased visibility of and role for civil society, moving from (top-down, paternalistic) government to (participatory) governance. Analyses of past shock events invariably point to the need for more concerted efforts in building effective governance and networked relations between civil society groupings and formal institutions before, during, and after crisis. However, the literature contains little advice on how to go about this. In this paper, we advance a Connected Community Approach (CCA) to building community resilience with a specific focus on the relationship between community and formal institutions. In the literature review that informs this work, we assess the current, limited models for connecting communities to formal institutions, as well as the emerging role of community-based organizations in this work, and we offer our own assessment of some of the key tensions, lacunae, and trends in the community resilience field. Principally, we explore the potential of the CCA model, as spearheaded by the East Scarborough Storefront and the Centre for Connected Communities in Toronto, Canada, as a promising approach for building the relational space between civil society and the state that is so often called for in the literature. The paper concludes with future directions for research and practice.

A connected community response to COVID-19 in Toronto

In this commentary, we describe initial learnings from a community-based research project that explored how the relational space between residents and formal institutions in six marginalised communities in Toronto, Ontario, Canada impacted grassroots responses to the health and psycho-social stresses that were created and amplified by the coronavirus disease 2019 (COVID-19) pandemic. Our research found that grassroots community leaders stepped up to fill the gaps left by Toronto’s formal public health and emergency management systems and were essential for mitigating the psycho-social and socioeconomic impacts of the pandemic that exacerbated pre-existing inequities and systemic failures. We suggest that building community resilience in marginalised communities in Toronto can embody health promotion in action where community members, organisational, institutional and government players create the social infrastructure necessary to build on local assets and work together to promote health by strengthening community action, advocating for healthy public policy and creating supportive environments.

Health system adaptation to climate change: a Peruvian case study

Despite mitigation attempts, the trajectory of climate change remains on an accelerated path, with devastating health impacts. As a response to the United Nations Framework Convention on Climate Change call for National Adaptation Plans, Peru has developed a national and decentralized regional adaptation plans. The purpose of this article is to understand the role and priority status of health within the adaptation planning and process. Peru was used as a case study to analyse the policy process in the creation of adaptation plans, encompassing the need to address climate change impacts on health with a particular focus on marginalized people. An actor, content and context policy analyses were conducted to analyse 17 out of 25 regional adaptation plans, which are available. The national adaptation plans (2002, 2015) do not include health as a priority or health adaptation strategies. In a decentralized health care system, regional plans demonstrate an increased improvement of complexity, systematization and structure over time (2009-17). In general, health has not been identified as a priority but as another area of impact. There is no cohesiveness between plans in format, content, planning and execution and only a limited consideration for marginalized populations. In conclusion, the regional departments of Peru stand on unequal footing regarding adapting the health sector to climate change. Findings in the strategies call into question how mitigation and adaption to climate change may be achieved. The lack of local research on health impacts due to climate change and a particular focus on marginalized people creates a policy vacuum. The Peruvian case study resembles global challenges to put health in the centre of national and regional adaptation plans. In-depth cross-country analysis is still missing but urgently needed to learn from other experiences.

Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.

Understanding Public Health Adaptation to Climate Change: An Explorative Study on the Development of Adaptation Strategies Relating to the Oak Processionary Moth in The Netherlands

Understanding of public health adaptation (PHA) to climate change and implementation is limited. This study therefore focuses on one specific PHA issue: adaptation to the oak processionary moth (OPM). The aim is to examine the development of OPM adaptation in order to offer a problem description of the complexities involved in OPM adaptation. In this explorative case study, we investigate adaptation strategies based on semi-structured interviews with 26 actors involved in OPM adaptation in The Netherlands. The results indicate that the context of OPM adaptation is relatively complex, given the involvement of many interdependent actors. OPM adaptation was developed with limited knowledge and strategies were based on ad hoc approaches in which there was ambiguity about tasks and expertise. In addition, different actors have different perceptions and values concerning health, sustainability, risks and responsibilities influencing decision-making processes, while also posing a challenge to collaboration and the development of a coordinated approach. The generation of knowledge and its translation into practical strategies calls for interdisciplinary cooperation in knowledge development. PHA adaptation involves more than technical and organisational solutions alone. It also entails the development of a shared problem perception and solution space in which citizens are also engaged.

Using the Theory of Planned Behavior to Predict the Adoption of Heat and Flood Adaptation Behaviors by Municipal Authorities in the Province of Quebec, Canada

The aim of this study is to identify which psychosocial factors of the theory of planned behavior better predict and explain the adoption of heat and flood adaptation behaviors by municipal authorities in the Province of Quebec, Canada, and to explore the cognitive structures motivating municipal officers to adopt adaptation behaviors. The results of structural equation analyses showed that municipal authorities’ attitude toward the adoption of adaptation behaviors (i.e., the degree to which the performance of an adaptive behavior is positively or negatively valued by municipal officers) and perceived control (barriers) over adaptation behaviors significantly contributed to the prediction of readiness to adopt the behavior.

Environmental impacts on the transmission and evolution of COVID-19 combing the knowledge of pathogenic respiratory coronaviruses

The emergence of a novel coronavirus named SARS-CoV-2 during December 2019, has caused the global outbreak of coronavirus disease 2019 (COVID-19), which is officially announced to be a pandemic by the World Health Organization (WHO). The increasing burden from this pandemic is seriously affecting everyone's life, and threating the global public health. Understanding the transmission, survival, and evolution of the virus in the environment will assist in the prevention, control, treatment, and eradication of its infection. Herein, we aimed to elucidate the environmental impacts on the transmission and evolution of SARS-CoV-2, based on briefly introducing this respiratory virus. Future research objectives for the prevention and control of these contagious viruses and their related diseases are highlighted from the perspective of environmental science. This review should be of great help to prevent and control the epidemics caused by emerging respiratory coronaviruses (CoVs).

Neighbourhood climate resilience: lessons from the Lighthouse Project

OBJECTIVE

The Lighthouse Project (2017-2018) explored the role that faith-based organizations (FBOs) might play as resilience hubs for climate-related stresses and extreme weather emergencies in disadvantaged urban environments of three cities. This paper discusses the role that public health played in these initiatives and makes an appeal for more participatory, community-engaged public health in light of the persistent gaps in its approach to equitable climate change preparedness.

METHODS

Pilots were initiated in the Greater Toronto and Hamilton Area (GTHA): Brampton's Emergency Managers offered pre-selected FBO volunteers specialized training to be part of the city's emergency response in establishing FBO sites as emergency muster stations. An environmental organization in Hamilton explored how its existing networks could rally around a local social resilience challenge, and a community organizer in Toronto undertook network building to support mostly newcomer populations in one inner-city neighbourhood. All pilots used a mix of cold calling, workshops, municipal presentations, and participation in local programming and public events. Two convened local working groups.

RESULTS

By the end of the pilot, Brampton's Emergency Management Office had made one contractual relationship with an FBO and its volunteers. In Hamilton, a multi-stakeholder network emerged to support the climate preparedness of agencies serving local vulnerable populations. In Toronto, a residents' working group was established to address neighbour well-being and emergency response in one apartment tower. Work in all three communities is ongoing.

CONCLUSION

Multi-stakeholder support for community organizations and local volunteers can enable partnerships in neighbourhood-level climate resilience-before, during and after extreme weather events. Public Health, while not typically top-of-mind as a key ally in this work, is well positioned to make a contribution. Consistent with place-based approaches, an emergent community development design enabled community animators to catalyze collaborations to suit the on-the-ground realities of each site.

Climate change impacts and adaptations on health of Internally Displaced People (IDP): An exploratory study on coastal areas of Bangladesh

Every year thousands of people are being displaced in coastal areas of Bangladesh due to natural calamities associated with climate change, known as Internally Displaced Peoples (IDPs). Climate change adaptation measures play a significant role in coping with the alteration of climatic components, while various forms of barriers hinder the sustainability of adaptation. This research was conducted to understand the perception of IDPs on climate change impact on health in the coastal areas of Bangladesh, including the adaptation practices and barriers to the coping strategies. To fulfill the objective, 420 individual surveys were conducted randomly in two Sub-districts of Khulna district in Bangladesh. The findings reveal that the riverbank erosion and cyclones were the primary reasons for displacement, and the social relationships were hampered in the new places of living. Also, the temperature in summer and winter, and the rainfall intensity increased, whereas rainfall slightly decreased over the last ten years. Differences of opinion were identified about the effects of the changing climatic variables on the respondents' health between the previous and present locations. Despite practicing different adaptive strategies, the weak financial condition and a lack of access to health care information are mostly hindering the sustainability of adaptation. This research may help policymakers in taking proper initiatives to ensure sustainable adaptation practices in the coastal areas.

The motley drivers of heat and cold exposure in 21st century US cities

We use a suite of decadal-length regional climate simulations to quantify potential changes in population-weighted heat and cold exposure in 47 US metropolitan regions during the 21st century. Our results show that population-weighted exposure to locally defined extreme heat (i.e., "population heat exposure") would increase by a factor of 12.7-29.5 under a high-intensity greenhouse gas (GHG) emissions and urban development pathway. Additionally, end-of-century population cold exposure is projected to rise by a factor of 1.3-2.2, relative to start-of-century population cold exposure. We identify specific metropolitan regions in which population heat exposure would increase most markedly and characterize the relative significance of various drivers responsible for this increase. The largest absolute changes in population heat exposure during the 21st century are projected to occur in major US metropolitan regions like New York City (NY), Los Angeles (CA), Atlanta (GA), and Washington DC. The largest relative changes in population heat exposure (i.e., changes relative to start-of-century) are projected to occur in rapidly growing cities across the US Sunbelt, for example Orlando (FL), Austin (TX), Miami (FL), and Atlanta. The surge in population heat exposure across the Sunbelt is driven by concurrent GHG-induced warming and population growth which, in tandem, could strongly compound population heat exposure. Our simulations provide initial guidance to inform the prioritization of urban climate adaptation measures and policy.

Implementing Community Sustainability Plans through Partnership: Examining the Relationship between Partnership Structural Features and Climate Change Mitigation Outcomes

Addressing society’s most complex challenges, such as climate change, requires bringing together stakeholders from the business, government, and nonprofit sectors. At the municipal level, multi-stakeholder partnerships are often formed to implement community sustainability plans. However, these partnerships can create new challenges, as it is cumbersome to coordinate action among a group that is made up of such diverse stakeholders. Past research suggests that it is important for these partnerships to have the appropriate structures in place to mitigate some of the coordination challenges to which they are prone. Yet, very few studies have examined the influence that different structural features have on plan outcomes. This article seeks to address this important research gap by using quantitative methods to examine five different features that can compose partnership structures—oversight, monitoring and evaluation, partner engagement, communication, and community wide-actions and their impact on climate change mitigation outcomes. Based on data collected through a global survey and publicly available greenhouse gases emission data from 72 different partnerships that implement community sustainability plans (CSPs), this study finds that structural features related to oversight and community-wide actions are positively associated with climate change mitigation outcomes. These results indicate that certain features of partnership structures may be more important for achieving desirable climate change mitigation outcomes, and thus contribute to research on collaborative governance structures and climate action.

The impact of social capital, demographic factors, and coping strategies on community adaptation in supporting people with severe mental illness

Background: People with severe mental illness have the ability to live a satisfactory and independent life with the help of the community. Their adaptation to life’s challenges is a dynamic process, and the community plays an important role. This research, therefore, aims to address the question of how social capital, demographic factors, and coping strategies affect the community’s ability to adapt to people with severe mental illness.

Design and methods: The multi-stage random sampling was used to obtain data from 137 respondents from rural society using an analytic observational design and cross-sectional approach. In addition, the Somers’ D test was used to measure the effect of social capital, demographic factors, and coping strategies on community adaptation.

Results: The results showed a significant effect of social capital, demographic factors, and the coping strategy of community adaptation (P<0.05). Based on empirical research, access to social capital is critical in fostering community adaptation through its social participation, network, trust, coping strategies, and cooperation.

Conclusions: In conclusion, social capital, demographic factors, and coping strategies are significant factors in developing community adaptation of people with severe mental illness.

Doing More Than Asking for Opinions

Health information systems (HIS) are used to manage information related to population health. The goal of this research was to conduct an evaluation of a HIS used at a hospital in south-western Uganda using participatory approaches. The evaluation structure was based on guidelines generated by the Center for Disease Control and Prevention and a series of theoretical and methodological concepts regarding participatory engagement that encouraged stakeholder participation throughout the evaluation. The primary objectives were to describe the areas of strength and limitations of the HIS, and develop potential system enhancements. Ultimately, engagement of local staff members throughout each stage of the evaluation resulted in the development of a series of recommendations considered relevant and feasible by local stakeholders. We build on these results by highlighting the value of stakeholder engagement and opportunities to apply participatory and community-based research methods and an Ecohealth framework to an HIS evaluation.

Is Sensible Heat Flux Useful for the Assessment of Thermal Vulnerability in Seoul (Korea)?

Climate change has led to increases in global temperatures, raising concerns regarding the threat of lethal heat waves and deterioration of the thermal environment. In the present study, we adopted two methods for spatial modelling of the thermal environment based on sensible heat and temperature. A vulnerability map reflecting daytime temperature was derived to plot thermal vulnerability based on sensible heat and climate change exposure factors. The correlation (0.73) between spatial distribution of sensible heat vulnerability and mortality rate was significantly greater than that (0.30) between the spatial distribution of temperature vulnerability and mortality rate. These findings indicate that deriving thermally vulnerable areas based on sensible heat are more objective than thermally vulnerable areas based on existing temperatures. Our findings support the notion that the distribution of sensible heat vulnerability at the community level is useful for evaluating the thermal environment in specific neighbourhoods. Thus, our results may aid in establishing spatial planning standards to improve environmental sustainability in a metropolitan community.

One health in the circumpolar North

The North faces significant health disparities, especially among its many Indigenous peoples. In this article we discuss historical, environmental, and cultural variables that contribute to these disparities and propose a One Health approach to address them in a holistic and culturally appropriate manner. The One Health paradigm recognizes the interdependence among the health and well-being of people, animals and the environment. As such, the framework aligns well with many Indigenous world views. This proactive, interdisciplinary, constructivist, and collaborative approach promise earlier detection of risks and threats, as well as more effective responses, in part by engaging community level stakeholders in all stages of the process. In the far North, humans, especially Indigenous peoples, continue to live closely connected to their environment, in settings that exert significant impacts on health. In recent decades, rapid warming and elevated contaminant levels have heightened environmental risks and increased uncertainty, both of which threaten individual and community health and well-being. Under these circumstances especially, One Health's comprehensive approach may provide mitigating and adaptive strategies to enhance resilience. While many of the examples used in this manuscript focus on Alaska and Canada, the authors believe similar conditions exist among the indigenous and rural residents across the entire Circumpolar North.

Shifting from "Community-Placed" to "Community-Based" Research to Advance Health Equity: A Case Study of the Heatwaves, Housing, and Health: Increasing Climate Resiliency in Detroit (HHH) Partnership

Extreme summertime heat is a significant public health threat that disproportionately impacts vulnerable urban populations. Research on health impacts of climate change (including increasing intensity, duration, and frequency of hot weather) is sometimes designed and implemented without the involvement of the communities being studied, i.e., "community-placed" not "community-based." We describe how the Heatwaves, Housing, and Health: Increasing Climate Resiliency in Detroit (HHH) partnership engaged relevant communities by integrating a community-based participatory research (CBPR) approach into an existing, academic-designed research project through a steering committee of community and academic partners. Using a case study approach, we analyze program documentation, partnership evaluation questionnaires, and HHH steering committee meeting notes. We describe the CBPR process by which we successfully collected research data in Detroit during summer 2016, engaged in collaborative analysis of data, and shared results with Detroit residents. Evaluations of the partnership over 2 years show community involvement in research; enhanced capacities; success in securing new grant funding; and ways that CBPR strengthened the validity, relevance, and translation of research. Engaging communities as equal partners using CBPR, even after a study is underway, can strengthen research to understand and address the impacts of extreme heat on health and equity in urban communities.

Perceived Importance of Climate Change Adaptation and Mitigation According to Social and Medical Factors Among Residents of Impacted Communities in the United States

Purpose: To determine whether perceived importance of local climate change adaptation and mitigation efforts differs according to social or medical factors among residents of impacted communities.

Methods: An online survey was conducted among residents of California (Los Angeles/Orange), Florida (Miami-Dade/Broward), and Arizona (Maricopa) counties in July 2018 (n=605). Multivariable ordered logistic regression measured associations between the perceived importance of adaptation/mitigation approaches and income, race/ethnicity, and health conditions, controlling for age, political party, and county.

Results: Lower income was associated with higher perceived importance of improved emergency alerts, government-subsidized costs of household air conditioners and energy-efficient appliances, strengthening buildings against extreme weather, regulation of greenhouse gas emissions, urban planning using “cooling” technologies, and expanding community gardens/local agriculture. Black respondents perceived evacuation services for those with financial barriers during extreme weather, government-subsidized costs of energy-efficient appliances, and communication from government agencies about local climate impacts and mitigation as significantly more important compared to non-Black, non-Hispanic respondents. Hispanic respondents perceived significantly greater importance of improved emergency alerts and health care access during extreme weather, evacuation services for residents without transportation, government-subsidized costs of energy-efficient appliances, regulation of greenhouse gas emissions, communication from government agencies about local climate impacts and mitigation efforts, and intergovernmental cooperation on mitigation compared to non-Hispanic respondents.

Conclusions: Perceptions of the importance of specific local climate actions differ according to race/ethnicity and income. Community engagement is recommended to help local decisions reflect priorities of the most affected residents.

Factors Influencing the Mental Health Consequences of Climate Change in Canada

Climate change is increasing risks to the mental health of Canadians. Impacts from a changing climate may outstrip the ability of Canadians and their health-sustaining institutions to adapt effectively and could increase poor mental health outcomes, particularly amongst those most marginalized in society. A scoping review of literature published during 2000–2017 explored risks, impacts, and vulnerabilities related to climate change and mental health. In this commentary, the authors present a new assessment of evidence from this scoping review and highlight factors that influence the capacity to adapt to the mental health consequences of a changing climate. Findings from this assessment reveal eleven key factors that influence the capacity to adapt: social capital; sense of community; government assistance; access to resources; community preparedness; intersectoral/transdisciplinary collaboration; vulnerability and adaptation assessments; communication and outreach; mental health literacy; and culturally relevant resources. Attention to these factors by Canadian decision makers can support proactive and effective management of the mental health consequences of climate change.

Factors Leading Municipal Authorities to Implement Preventive Interventions for Lyme Disease

The aim of this study is to document climate change adaptation interventions targeting Lyme disease at the municipal level in the province of Quebec (Canada). This exploratory study relies on the theory of planned behavior and certain constructs from the health belief model to identify the factors leading municipal authorities to implement preventive interventions for Lyme disease (PILD). Data were obtained from an online survey sent, during the summer of 2018, to municipal officers in 820 municipalities in Quebec, in all health regions where the population is at risk of contracting Lyme disease (response rate = 36%). The questionnaire was used to measure the implementation of PILD, the intention to implement these interventions, attitudes, perceived social pressure, perceived control (levers and barriers) over interventions, perceived effectiveness of preventive measures, risk, and perceived vulnerability. Results of structural equation analyses showed that attitudes were significantly associated with municipal authorities' intention to implement PILD, while the intention to implement PILD was a significant predictor of the implementation of PILD. Additional analyses showed that perceived barriers added a moderating effect in the intention-implementation relationship. The prediction of behaviors or practices that municipal authorities could implement to prevent Lyme disease will enable the evaluation over time of the evolution of Quebec municipalities' adaptation to Lyme disease. Moreover, the examination of the associations of specific psychosocial factors revealed important implications for the design of effective behavior-change interventions, which would allow health officials doing awareness work to create personalized interventions better suited to municipal officers and their specific contexts.

Risk Inequality and the Food-Energy-Water (FEW) Nexus: A Study of 43 City Adaptation Plans

Goals aimed at adapting to climate change in sustainable and just ways are embedded in global agreements such as the Sustainable Development Goals and the New Urban Agenda. However, largely unexamined, are the ways that narrative understandings conveyed in adaptation plans consider and attempt to address inequality in climate risk to urban populations and FEW-systems. In this paper, we examine whether and how adaptation plans from C40 member cities address inequality in risk, by planning actions to reduce hazard exposure or tackling the drivers of social vulnerability. C40 is a network of 94 of the world's cities fostering policies to address climate change. We apply a mixed methods approach, including a discourse analysis and meta-analysis of adaptation plans. The discourse analysis helps to unpack framings of urban equity issues as they relate to policy actions, and the meta-analysis seeks to quantitatively investigate patterns of framing and policy across adaptation plans. Our findings suggest that FEW-nexus thinking is not yet embedded in narrative understandings of risk and planned adaptation actions, within the adaptation plans we studied. In the city adaptation plans we analyzed, we found multiple frames coexisting behind the broader adaptation visions (e.g., risk and resilience). Rather than converging, issues, and principles such as those of equality, coexist with economic issues in an imbalance of incongruent political movements and priorities. Techno-infrastructural and economic investments and concerns tend to take precedence over concerns and interests for inequality in climate risks. We discuss some of the institutional factors explaining this. Knowledge integration, for instance, is constrained by the existence of a plurality of sectors, levels of government, power, values, and ways of understanding and managing climate risk. We also suggest that the relatively low importance of equality considerations in the adaptation plans will likely limit the capacity of cities to support broader goals such as those of the New Urban Agenda and the Sustainable Development Goals.

Urban-centric resilience in search of theoretical stabilisation? A phased thematic and conceptual review

Over the last decades 'resilience' has particularly arisen as an attractive perspective with respect to cities. As cities continue to expand, their susceptibility to uncertainties and new challenges, such as climate change, has increased, rendering 'urban resilience' an increasingly favoured concept in the realm of Urban Development, Planning and Management (UDPM). Despite recent reviews, an updated analysis of the concept is required to understand whether there is in fact scientific evidence to support the expansion and favouring of 'urban resilience' in UDPM. The need to understand how the concept evolved is further emphasised by the need to perceive how the distinct sciences have contributed to its development, and which were the focuses and conceptual underpinnings of such evolution. Thus, the objective of this paper is to provide a broader review of the multidimensional concept of 'urban resilience', while understanding how distinct research fields have contributed to its inception and expansion, and how distinct conceptualisations of resilience have influenced its evolution. Supported by a bibliometric analysis of urban-centric publications, this paper highlights the recent extensive growth and expanding application of 'urban resilience' to distinct research fields, as well as an apparent theoretical stabilisation of the concept, which reemphasises the idea of a three-dimensional conceptual resilience perspective in scientific literature: (1) 'engineering', (2) 'ecological', and (3) 'social-ecological resilience'. Consequently, this research emphasises that, if the related conceptual underpinnings are clear, 'urban resilience' can potentially serve as an 'integrative metaphor', adapted by diverse stakeholders, to reinforce UDPM initiatives.

The need for community-led, integrated and innovative monitoring programmes when responding to the health impacts of climate change

In Northern Canada, climate change has led to many acute and interrelated health and environmental impacts experienced among Inuit populations. Community-based monitoring, in which community members participate in monitoring initiatives using various forms of technology, is a key strategy increasingly used to detect, monitor and respond to climate change impacts. To better understand the landscape of existing environmental and health monitoring programmes mobilising different technologies and operating in the North we conducted a review that used environmental scan methodologies to explore and contextualise these programmes. We consulted with academic researchers with experience in community-led monitoring, conducted systematic searches of grey and peer-reviewed literature, and conducted a secondary search for environment-health mobile-phone applications. Following specific criteria, we identified 18 monitoring programmes using information and communication technologies in the North, and three global monitoring mobile-phone applications, which cumulatively monitored 74 environment and health indicators. Several themes emerged, including the need for: (1) community leadership, (2) indicators of environment and/or human health and (3) innovative technology. This synthesis supports the development of community-led, environment-health monitoring programmes that use innovative technology to monitor and share information related to the health implications of climate change in and around Indigenous communities throughout the Circumpolar North.

Responding to Climate and Environmental Change Impacts on Human Health via Integrated Surveillance in the Circumpolar North: A Systematic Realist Review

Environments are shifting rapidly in the Circumpolar Arctic and Subarctic regions as a result of climate change and other external stressors, and this has a substantial impact on the health of northern populations. Thus, there is a need for integrated surveillance systems designed to monitor the impacts of climate change on human health outcomes as part of broader adaptation strategies in these regions. This review aimed to identify, describe, and synthesize literature on integrated surveillance systems in Circumpolar Arctic and Subarctic regions, that are used for research or practice. Following a systematic realist review approach, relevant articles were identified using search strings developed for MEDLINE® and Web of Science™ databases, and screened by two independent reviewers. Articles that met the inclusion criteria were retained for descriptive quantitative analysis, as well as thematic qualitative analysis, using a realist lens. Of the 3431 articles retrieved in the database searches, 85 met the inclusion criteria and were analyzed. Thematic analysis identified components of integrated surveillance systems that were categorized into three main groups: structural, processual, and relational components. These components were linked to surveillance attributes and activities that supported the operations and management of integrated surveillance. This review advances understandings of the distinct contributions of integrated surveillance systems and data to discerning the nature of changes in climate and environmental conditions that affect population health outcomes and determinants in the Circumpolar North. Findings from this review can be used to inform the planning, design, and evaluation of integrated surveillance systems that support evidence-based public health research and practice in the context of increasing climate change and the need for adaptation.

Assessing Health Vulnerabilities and Adaptation to Climate Change: A Review of International Progress

Climate change is increasing risks to human health and to the health systems that seek to protect the safety and well-being of populations. Health authorities require information about current associations between health outcomes and weather or climate, vulnerable populations, projections of future risks and adaptation opportunities in order to reduce exposures, empower individuals to take needed protective actions and build climate-resilient health systems. An increasing number of health authorities from local to national levels seek this information by conducting climate change and health vulnerability and adaptation assessments. While assessments can provide valuable information to plan for climate change impacts, the results of many studies are not helping to build the global evidence-base of knowledge in this area. They are also often not integrated into adaptation decision making, sometimes because the health sector is not involved in climate change policy making processes at the national level. Significant barriers related to data accessibility, a limited number of climate and health models, uncertainty in climate projections, and a lack of funding and expertise, particularly in developing countries, challenge health authority efforts to conduct rigorous assessments and apply the findings. This paper examines the evolution of climate change and health vulnerability and adaptation assessments, including guidance developed for such projects, the number of assessments that have been conducted globally and implementation of the findings to support health adaptation action. Greater capacity building that facilitates assessments from local to national scales will support collaborative efforts to protect health from current climate hazards and future climate change. Health sector officials will benefit from additional resources and partnership opportunities to ensure that evidence about climate change impacts on health is effectively translated into needed actions to build health resilience.

Understanding Weather and Hospital Admissions Patterns to Inform Climate Change Adaptation Strategies in the Healthcare Sector in Uganda

Background: Season and weather are associated with many health outcomes, which can influence hospital admission rates. We examined associations between hospital admissions (all diagnoses) and local meteorological parameters in Southwestern Uganda, with the aim of supporting hospital planning and preparedness in the context of climate change. Methods: Hospital admissions data and meteorological data were collected from Bwindi Community Hospital and a satellite database of weather conditions, respectively (2011 to 2014). Descriptive statistics were used to describe admission patterns. A mixed-effects Poisson regression model was fitted to investigate associations between hospital admissions and season, precipitation, and temperature. Results: Admission counts were highest for acute respiratory infections, malaria, and acute gastrointestinal illness, which are climate-sensitive diseases. Hospital admissions were 1.16 (95% CI: 1.04, 1.31; p = 0.008) times higher during extreme high temperatures (i.e., >95th percentile) on the day of admission. Hospital admissions association with season depended on year; admissions were higher in the dry season than the rainy season every year, except for 2014. Discussion: Effective adaptation strategy characteristics include being low-cost and quick and practical to implement at local scales. Herein, we illustrate how analyzing hospital data alongside meteorological parameters may inform climate-health planning in low-resource contexts.

Regional organisations supporting health sector responses to climate change in Southeast Asia

BACKGROUND

The role played by regional organisations in climate change adaptation and health is growing in Southeast Asia, with the Asian Development Bank and the Asia-Pacific Regional Forum on Health and Environment both supporting health and adaptation initiatives. There is, however, a lack of empirical research on the value that regional organisations add to national health-related adaptation. This qualitative research compares regional project and governance-based models of adaptation and health support in Southeast Asia, providing an analysis of strengths and weaknesses of each, as well as possibilities for improvement.

METHODS

An existing adaptation assessment framework was modified for this research, and used as a guide to gather and analyse data from academic and grey literature, policy documents and interviews in order to qualitatively assess two organisations and their different models of adaptation and health support.

RESULTS

This research found differing strengths in the approaches to climate change and health used by the Asian Development Bank and by the Asia-Pacific Regional Forum on Health and Environment. The regional forum has vision, high levels of perceived legitimacy, and access to 'in-house' expertise in public health and climate change. Conversely, the Asian Development Bank has strengths in project management and access to significant financial resources to support work in climate change and health.

CONCLUSION

When regional organisations, such as the Asian Development Bank and the Asia-Pacific Regional Forum on Health and Environment, have membership and mandate overlaps, their work will likely benefit from well designed, institutionalised and incentivised coordination mechanisms. Coordination can reduce redundancies as well as the administrative workload on partner government agencies. In the case-study examined, the Asian Development Bank's project management expertise complements the vision and high levels of perceived legitimacy of the Asia-Pacific Regional Forum on Health and Environment, thus a coordinated approach could deliver improved adaptation and health outcomes.

Possible impacts of sea level rise on disease transmission and potential adaptation strategies, a review

Sea levels are projected to rise in response to climate change, causing the intrusion of sea water into land. In flat coastal regions, this would generate an increase in shallow water covered areas with limited circulation. This scenario raises a concern about the consequences it could have on human health, specifically the possible impacts on disease transmission. In this review paper we identified three categories of diseases which are associated with water and whose transmission can be affected by sea level rise. These categories include: mosquitoborne diseases, naturalized organisms (Vibrio spp. and toxic algae), and fecal-oral diseases. For each disease category, we propose comprehensive adaptation strategies that would help minimize possible health risks. Finally, the City of Key West, Florida is analyzed as a case study, due to its inherent vulnerability to sea level rise. Current and projected adaptation techniques are discussed as well as the integration of additional recommendations, focused on disease transmission control. Given that sea level rise will likely continue into the future, the promotion and implementation of positive adaptation strategies is necessary to ensure community resilience.

Country, climate change adaptation and colonisation: insights from an Indigenous adaptation planning process, Australia

Indigenous peoples are going to be disproportionately affected by climate change. Developing tailored, place based, and culturally appropriate solutions will be necessary. Yet finding cultural and institutional ‘fit’ within and between competing values-based climate and environmental management governance regimes remains an ongoing challenge. This paper reports on a collaborative research project with the Arabana people of central Australia, that resulted in the production of the first Indigenous community-based climate change adaptation strategy in Australia. We aimed to try and understand what conditions are needed to support Indigenous driven adaptation initiatives, if there are any cultural differences that need accounting for and how, once developed they be integrated into existing governance arrangements. Our analysis found that climate change adaptation is based on the centrality of the connection to ‘country’ (traditional land), it needs to be aligned with cultural values, and focus on the building of adaptive capacity. We find that the development of climate change adaptation initiatives cannot be divorced from the historical context of how the Arabana experienced and collectively remember colonisation. We argue that in developing culturally responsive climate governance for and with Indigenous peoples, that that the history of colonisation and the ongoing dominance of entrenched Western governance regimes needs acknowledging and redressing into contemporary environmental/climate management.

Climate Change and the Neglected Tropical Diseases

Climate change is expected to impact across every domain of society, including health. The majority of the world's population is susceptible to pathological, infectious disease whose life cycles are sensitive to environmental factors across different physical phases including air, water and soil. Nearly all so-called neglected tropical diseases (NTDs) fall into this category, meaning that future geographic patterns of transmission of dozens of infections are likely to be affected by climate change over the short (seasonal), medium (annual) and long (decadal) term. This review offers an introduction into the terms and processes deployed in modelling climate change and reviews the state of the art in terms of research into how climate change may affect future transmission of NTDs. The 34 infections included in this chapter are drawn from the WHO NTD list and the WHO blueprint list of priority diseases. For the majority of infections, some evidence is available of which environmental factors contribute to the population biology of parasites, vectors and zoonotic hosts. There is a general paucity of published research on the potential effects of decadal climate change, with some exceptions, mainly in vector-borne diseases.