Definition and characteristics of climate-adaptive cities: a systematic review

BACKGROUND

Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning.

METHODS

This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities.

RESULTS

Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities.

CONCLUSION

A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

Building Climate Change into Medical Education: A Society of General Internal Medicine Position Statement

Building expertise in climate and planetary health among healthcare professionals cannot come with greater urgency as the threats from climate change become increasingly apparent. Current and future healthcare professionals-particularly internists-will increasingly need to understand the interconnectedness of natural systems and human health to better serve their patients longitudinally. Despite this, few national medical societies and accreditation bodies espouse frameworks for climate change and planetary health-related education at the undergraduate (UME), graduate (GME), and continuing (CME) medical education level. As a community of medical educators with an enduring interest in climate change and planetary health, the Society of General Internal Medicine (SGIM) recognizes the need to explicitly define structured educational opportunities and core competencies in both UME and GME as well as pathways for faculty development. In this position statement, we build from the related SGIM Climate and Health position statement, and review and synthesize existing position statements made by US-based medical societies and accreditation bodies that focus on climate change and planetary health-related medical education, identify gaps using Bloom's Hierarchy, and provide recommendations on behalf of SGIM regarding the development of climate and planetary health curricula development. Identified gaps include (1) limited systematic approach to climate and planetary health medical education at all levels; (2) minimal emphasis on learner-driven approaches; (3) limited focus on physician and learner well-being; and (4) limited role for health equity and climate justice. Recommendations include a call to relevant accreditation bodies to explicitly include climate change and planetary health as a competency, extend the structural competency framework to climate change and planetary health to build climate justice, proactively include learners in curricular development and teaching, and ensure resources and support to design and implement climate and planetary health-focused education that includes well-being and resiliency.

A methodological framework for ranking communicable and non-communicable diseases due to climate change - A focus on Ireland

There is currently a significant global focus from the public health community on addressing climate-related public health issues. Globally we are witnessing geological shifts, extreme weather events, and the associated incidents that may have a significant human health impact. These include unseasonable weather, heavy rainfall, global sea-level rise and flooding, droughts, tornados, hurricanes, and wildfires. Climate change can have a direct and indirect health impact. The global challenge of climate change requires global preparedness for potential human health effects due to climate change, including vigilance for diseases carried by vectors, foodborne and waterborne diseases, deteriorated air quality, heat stress, mental health, and potential disasters. Therefore, it is essential to identify and prioritise the consequences of climate change to become future-ready. This proposed methodological framework aimed to develop an innovative modelling method using the 'Disability-Adjusted Life Year (DALY)', to rank potential direct and indirect human health impacts (communicable and non-communicable diseases) of climate change. This approach aims to ensure food safety, including water, in the wake of climate change. The novelty of the research will come from developing models with spatial mapping (Geographic Information System or GIS), which will also consider the influence of climatic variables, geographical differences in exposure and vulnerability and regulatory control on feed/food quality and abundance, range, growth, and survival of selected microorganisms. In addition, the outcome will identify and assess emerging modelling techniques and computational-efficient tools to overcome current limitations in climate change research on human health and food safety and to understand uncertainty propagation using the Monte Carlo simulation method for future climate change scenarios. It is envisaged that this research work will contribute significantly to developing a lasting network and critical mass on a national scale. It will also provide a template to implement from a core centre of excellence in other jurisdictions.

A global comprehensive analysis of ambient low temperature and non-communicable diseases burden during 1990-2019

Climate change and health are inextricably linked, especially the role of ambient temperature. This study aimed to analyze the non-communicable disease (NCD) burden attributable to low temperature globally, regionally, and temporally using data from the Global Burden of Disease (GBD) study 2019. Globally, in 2019, low temperature was responsible for 5.42% DALY and 7.18% death of NCDs, representing the age-standardized disability-adjusted life years (DALY) and death rates (per 100,000 population) of 359.6 (95% uncertainty intervals (UI): 306.09, 416.88) and 21.36 (95% UI:18.26, 24.74). Ischemic heart disease was the first leading cause of DALY and death resulting from low temperature, followed by stroke. However, age-standardized DALY and death rates attributable to low temperature have exhibited wide variability across regions, with the highest in Central Asia and Eastern Europe and the lowest in Caribbean and Western sub-Saharan Africa. During the study period (1990-2019), there has been a significant decrease in the burden of NCDs attributable to low temperature, but progress has been uneven across countries, whereas nations exhibiting high sociodemographic index (SDI) declined more significantly compared with low SDI nations. Notably, three nations, including Uzbekistan, Tajikistan, and Lesotho, had the maximum NCDs burden attributed to low temperature and displayed an upward trend. In conclusion, ambient low temperature contributes to substantial NCD burden with notable geographical variations.

Carob: A Sustainable Opportunity for Metabolic Health

Carob (Ceratonia siliqua L.) is an evergreen tree that belongs to the Leguminosae family and grows in the arid and semi-arid regions of the Mediterranean basin. The carob tree is resistant to droughts and salinity, while its deep root systems allow CO₂ to sink, mitigating global warming effects. Traditionally, carob has been used to produce animal feed, but for many years, it was excluded from the human diet. Nowadays, agricultural and industrial sectors exploit carob fruit, also referred to as carob pod, and its primary products (i.e., flour, powder and syrup) to develop a variety of foods and beverages. The nutritional composition varies depending on the carob part but also on genetic, cultivar, seasonal and environmental factors. Despite the high sugar content, the carob pod is rich in insoluble fiber and microconstituents including phenolic compounds, inositols (mainly d-pinitol) and vitamins. In the present review article, we aimed to (a) highlight the role of carob cultivation in addressing climate change challenges and the need for sustainability, and (b) summarize the effects of carob consumption on obesity and related metabolic disorders.

Human Responses and Adaptation in a Changing Climate: A Framework Integrating Biological, Psychological, and Behavioural Aspects

Climate change is one of the biggest challenges of our times. Its impact on human populations is not yet completely understood. Many studies have focused on single aspects with contradictory observations. However, climate change is a complex phenomenon that cannot be adequately addressed from a single discipline’s perspective. Hence, we propose a comprehensive conceptual framework on the relationships between climate change and human responses. This framework includes biological, psychological, and behavioural aspects and provides a multidisciplinary overview and critical information for focused interventions. The role of tipping points and regime shifts is explored, and a historical perspective is presented to describe the relationship between climate evolution and socio-cultural crisis. Vulnerability, resilience, and adaptation are analysed from an individual and a community point of view. Finally, emergent behaviours and mass effect phenomena are examined that account for mental maladjustment and conflicts.

Impact of Climate Change on Health and Well-Being of People in Hindu Kush Himalayan Region: A Narrative Review

Climate change and variability affect virtually everyone and every region of the world but the effects are nowhere more prominent than in mountain regions and people living therein. The Hindu Kush Himalayan (HKH) region is a vast expanse encompassing 18% of the world’s mountainous area. Sprawling over 4.3 million km², the HKH region occupies areas of eight countries namely Nepal, Bhutan, Afghanistan, Bangladesh, China, India, Myanmar, and Pakistan. The HKH region is warming at a rate higher than the global average and precipitation has also increased significantly over the last 6 decades along with increased frequency and intensity of some extreme events. Changes in temperature and precipitation have affected and will like to affect the climate-dependent sectors such as hydrology, agriculture, biodiversity, and human health. This paper aims to document how climate change has impacted and will impact, health and well-being of the people in the HKH region and offers adaptation and mitigation measures to reduce the impacts of climate change on health and well-being of the people. In the HKH region, climate change boosts infectious diseases, non-communicable diseases (NCDs), malnutrition, and injuries. Hence, climate change adaptation and mitigation measures are needed urgently to safeguard vulnerable populations residing in the HKH region.

Understanding linkages between environmental risk factors and noncommunicable diseases-A review

Environmental factors such as climate change are now underway, which have substantial impacts on health and well-being of human kind, but still imprecisely quantified, implications for human health. At present, one of the most significant discussions among scientists worldwide is interdependency of escalating environmental risk factors and the increasing rates of noncommunicable diseases (NCDs), which are the leading cause of death and disability worldwide. Climate change also triggers the occurrence of NCDs through a variety of direct and indirect pathways. Therefore, it is likely that the interdependence of climate change, environmental risk factors, and NCDs as a whole poses great threat to global health. Hence, this paper aims to review the latest evidence on impacts of environmental risk factors on NCDs and methods used in establishing the cause or correlation of environmental risk factors and NCDs. The literature review leveraged online databases such as PubMed and Google Scholar with articles that matched keywords "climate change", "environmental risk factors," and "noncommunicable diseases". This review shows that the burden of NCDs is increasing globally and attribution of environmental risk factors such as climate change is significant. Understanding the nature of the relation between NCDs and the environment is complex and has relied on evidence generated from multiple study designs. This paper reviews eight types of study designs that can be used to identify and measure causal and correlational nature between environment and NCDs. Future projections suggest that increases in temperatures will continue and also increase the public health burden of NCDs.

Health impacts of climate change on smallholder farmers

The health of smallholder farmers is crucial for ensuring food and nutritional security for two billion people. However, their health is in jeopardy for several reasons including challenges from climate change impacts. Using a narrative literature review supported by field observations and informal interviews with key informants in India, Bangladesh and Malawi, this paper identifies and discusses the health impacts of climate change under four categories: (i) communicable diseases, (ii) non-communicable diseases, (iii) mental health, and (iv) occupational health, safety and other health issues. The health impacts of climate change on smallholder farmers will hamper the realization of many of the United Nations' Sustainable Development Goals, and a series of recommendations are made to regional and country governments to address the increasing health impacts of accelerating climate change among smallholder farmers.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

Seasons, weather, and device-measured movement behaviors: a scoping review from 2006 to 2020

BACKGROUND

This scoping review summarized research on (a) seasonal differences in physical activity and sedentary behavior, and (b) specific weather indices associated with those behaviors.

METHODS

PubMed, CINAHL, and SPORTDiscus were searched to identify relevant studies. After identifying and screening 1459 articles, data were extracted from 110 articles with 118,189 participants from 30 countries (almost exclusively high-income countries) on five continents.

RESULTS

Both physical activity volume and moderate-to-vigorous physical activity (MVPA) were greater in summer than winter. Sedentary behavior was greater in winter than either spring or summer, and insufficient evidence existed to draw conclusions about seasonal differences in light physical activity. Physical activity volume and MVPA duration were positively associated with both the photoperiod and temperature, and negatively associated with precipitation. Sedentary behavior was negatively associated with photoperiod and positively associated with precipitation. Insufficient evidence existed to draw conclusions about light physical activity and specific weather indices. Many weather indices have been neglected in this literature (e.g., air quality, barometric pressure, cloud coverage, humidity, snow, visibility, windchill).

CONCLUSIONS

The natural environment can influence health by facilitating or inhibiting physical activity. Behavioral interventions should be sensitive to potential weather impacts. Extreme weather conditions brought about by climate change may compromise health-enhancing physical activity in the short term and, over longer periods of time, stimulate human migration in search of more suitable environmental niches.

Extreme weather events in europe and their health consequences - A systematic review

BACKGROUND

Due to climate change, the frequency, intensity and severity of extreme weather events, such as heat waves, cold waves, storms, heavy precipitation causing wildfires, floods, and droughts are increasing, which could adversely affect human health. The purpose of this systematic review is therefore to assess the current literature about the association between these extreme weather events and their impact on the health of the European population.

METHODS

Observational studies published from January 1, 2007 to May 17, 2020 on health effects of extreme weather events in Europe were searched systematically in Medline, Embase and Cochrane Central Register of Controlled Trials. The exposures of interest included extreme temperature, heat waves, cold waves, droughts, floods, storms and wildfires. The health impacts included total mortality, cardiovascular mortality and morbidity, respiratory mortality and morbidity, and mental health. We conducted the systematic review following PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis). The quality of the included studies was assessed using the NICE quality appraisal checklist (National Institute for Health and Care Excellence).

RESULTS

The search yielded 1472 articles, of which 35 met the inclusion criteria and were included in our review. Studies regarding five extreme weather events (extreme heat events, extreme cold events, wildfires, floods, droughts) were found. A positive association between extreme heat/cold events and overall, cardiovascular and respiratory mortality was reported from most studies. Wildfires are likely to increase the overall and cardiovascular mortality. Floods might be associated with the deterioration of mental health instead of mortality. Depending on their length, droughts could have an influence on both respiratory and cardiovascular mortality. Contradictory evidence was found in heat-associated morbidity and wildfire-associated respiratory mortality. The associations are inconclusive due to the heterogeneous study designs, study quality, exposure and outcome assessment.

CONCLUSIONS

Evidence from most of the included studies showed that extreme heat and cold events, droughts, wildfires and floods in Europe have negative impacts on human health including mental health, although some of the associations are not conclusive. Additional high-quality studies are needed to confirm our results and further studies regarding the effects of other extreme weather events in Europe are to be expected.

An integrated physical and mental health awareness education intervention to reduce non-communicable diseases among Syrian refugees and Jordanians in host communities: A natural experiment study

The Syrian crisis has had a devastating impact on displaced populations and among host communities in neighboring countries such as Jordan. Many of these individuals are at risk for non-communicable diseases (NCD) and mental health disorders, yet do not have access to services designed to manage or prevent these conditions. The purpose of this study was to examine the efficacy of a non-communicable disease (NCD) awareness educational intervention and an integrated NCD and mental health education intervention on reducing cardiovascular disease (CVD) risk among Jordanians and displaced Syrians. This natural experiment study was conducted in three health centers in Irbid, Jordan with 213 Syrian participants and 382 Jordanians. Participants were assigned to one of three study conditions: the Healthy Community Clinic (HCC), a non-communicable disease educational intervention; the HCC with added mental health awareness sessions; standard healthcare. CVD risk factors were assessed at baseline, 12 and 18 months. The HCC education group yielded significant improvements in three CVD risk factors including: body mass index (BMI) -1.91 (95% CI: -2.09, -1.73); systolic blood pressure (SBP) -12.80 mmHg (95% CI: -16.35, -9.25); and diastolic blood pressure (DBP) -5.78 mmHg (95% CI: -7.96, -3.60) compared to standard care. The HCC-mental health treatment arm also demonstrated significant improvements in BMI, SBP, and DBP compared to standard care. Significant improvements in fasting blood glucose -20.32 (CI: -28.87, -11.77) and HbA1c -0.43 (-0.62, -0.24) were also illustrated in the HCC-mental health treatment arm. The HCC-mental health group sustained greater reductions in CVD risk than the HCC education group at 18-months. This study is among the first to our knowledge illustrating an integrated health and mental health educational intervention can reduce CVD risk among Syrian refugees and Jordanians. Continued investment and research in CVD prevention interventions is needed to enhance health, reduce costs, and have lasting benefits for conflict-affected individuals and communities.

Association of urban built environment and socioeconomic factors with suicide mortality in high-density cities: A case study of Hong Kong

Population ageing, climate change and urbanization have been occurring rapidly globally. Evidence-based healthy city development is required to improve living quality and mitigate the adverse impact of city living on both physical and mental health. We took a high-density city as an example to explore the association of built environment and suicide mortality and preferably to offer some implications for better future city development. Poisson generalized linear models with generalized estimation equations were employed to regress suicide mortality rate on four urban built environment variables (frontal area density (FAD), sky view factor (SVF), ground coverage ratio (GCR), and street coverage ratio (SCR)), as well as socioeconomic factors, population density, and greenery. The association for different causes of death and within different subgroups was also investigated. Generally, higher FAD and GCR were associated with higher suicide mortality while higher SVF and SCR were associated with lower suicide mortality. Age was a significant effect modifier. An interquartile range increase in FAD, SVF, and GCR was associated with 0.81 (95% confidence interval (CI) 0.71-0.92), 1.41 (95% CI 1.04-1.91), and 0.70 (95% CI 0.50-0.98) times the risk of suicide among the people aged over 70, respectively. Higher population density and unmarried status were generally associated with higher suicide rate whereas higher education level was associated with a decreased risk. Unfavorable built environment could increase risks for successful suicide attempts. Better urban development with morphological control mitigating intensifying urban heat island and other micro-environment changes are warranted to promote not only physical but psychological health.

Controlling and preventing climate-sensitive noncommunicable diseases in urban sub-Saharan Africa

Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.

Bibliometric analysis of peer-reviewed literature on climate change and human health with an emphasis on infectious diseases

Background

Assessing research activity is important for planning future protective and adaptive policies. The objective of the current study was to assess research activity on climate change and health with an emphasis on infectious diseases.

Method

A bibliometric method was applied using SciVerse Scopus. Documents on climate change and human health were called “health-related literature” while documents on climate change and infectious diseases were called “infection-related literature”. The study period was from 1980 to 2019.

Results

The search query found 4247 documents in the health-related literature and 1207 in the infection-related literature. The growth of publications showed a steep increase after 2007. There were four research themes in the health-related literature: (1) climate change and infectious diseases; (2) climate change, public health and food security; (3) heat waves, mortality, and non-communicable diseases; and (4) climate change, air pollution, allergy, and respiratory health. The most frequently encountered pathogens/infectious diseases in the infection-related literature were malaria and dengue. Documents in infection-related literature had a higher h-index than documents in the health-related literature. The top-cited documents in the health-related literature focused on food security, public health, and infectious diseases while those in infection-related literature focused on water-, vector-, and mosquito-borne diseases. The European region had the highest contribution in health-related literature (n = 1626; 38.3%) and infection-related literature (n = 497; 41.2%). The USA led with 1235 (29.1%) documents in health-related literature and 365 (30.2%) documents in infection-related literature. The Australian National University ranked first in the health-related literature while the London School of Hygiene & Tropical Medicine ranked first in the infection-related literature. International research collaboration was inadequate. Documents published in the Environmental Health Perspectives journal received the highest citations per document. A total of 1416 (33.3%) documents in the health-related literature were funded while 419 (34.7%) documents in the infection-related literature were funded.

Conclusion

Research on climate change and human health is on the rise with research on infection-related issues making a good share. International research collaboration should be funded and supported. Future research needs to focus on the impact of climate change on psychosocial, mental, innovations, policies, and preparedness of health systems.

Paradigm Shift: New Ideas for a Structural Approach to NCD Prevention Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention"

It is a well-documented fact that transnational corporations engaged in the production and distribution of health-harmful commodities have been able to steer policy approaches to address the associated burden of non-communicable diseases (NCDs). While the political influence that corporations wield stems in part from significant financial resources, it has also been enabled and magnified by what has been referred to as global health’s neoliberal deep core, which has subjected health policy to the individualisation of risk and responsibility and the privileging of market-based policy responses. The accompanying perspective article from Lencucha and Thow draws attention to neoliberalism in the NCD space and the way it has historically structured patterns of thinking and doing that foreground economic interests over health considerations. In this commentary, we explore how shifting from a focus on material power to discursive power creates space to see the NCD agenda as a battle of economic ideas as well as dollars, and consequently the importance of public health engagement in the next vision for the economy.

Horses as a Crucial Part of One Health

One Health (OH) is a crucial concept, where the interference between humans, animals and the environment matters. This review article focusses on the role of horses in maintaining the health of humans and the environment. Horses' impact on environmental health includes their influence on soil and the biodiversity of animal and plant species. Nevertheless, the effect of horses is not usually linear and several factors like plant-animal coevolutionary history, climate and animal density play significant roles. The long history of the relationship between horses and humans is shaped by the service of horses in wars or even in mines. Moreover, horses were essential in developing the first antidote to cure diphtheria. Nowadays, horses do have an influential role in animal assisted therapy, in supporting livelihoods in low income countries and as a leisure partner. Horses are of relevance in the spillover of zoonotic and emerging diseases from wildlife to human (e.g., Hendra Virus), and in non-communicable diseases (e.g., post-traumatic osteoarthritis in horses and back pain in horse riders). Furthermore, many risk factors-such as climate change and antimicrobial resistance-threaten the health of both horses and humans. Finally, the horse is a valuable factor in sustaining the health of humans and the environment, and must be incorporated in any roadmap to achieve OH.

Moderate-intensity physical activity reduces systemic inflammation and maintains cardiorespiratory function following chronic particulate matter2.5 exposure in rats

Aims

The purpose of the current study is to 1) examine the beneficial effects of moderate levels of physical activity (PA) on functional and biochemical markers of the cardiorespiratory system, 2) establish the detrimental effects of a single, daily particulate matter (PM) exposure event on cardiorespiratory function and 3) determine if exercising during daily PM exposure increases the deleterious effects caused by PM exposure due to increased inhalation of particulates on cardiorespiratory function.

Methods

Four groups of 16 rats were used: control (CON), PA, PM_2.5 exposed and PA combined with PM_2.5 exposure (PA + PM). Animals were purchased at 4 weeks old. However, both PA and PM exposure was initiated when the animals reached 8 weeks of age, for 8 weeks.

Results

PA alone did not alter body weight or blood pressure (BP) compared to control animals. However, there was a significant decrease in epididymal fat pad mass in the PA group. The PM exposed rats were hypertensive, showed increased systemic inflammation and oxidative stress, and had decreased spleen mass without pathological changes in the cardiac action potential or impaired vascular function. PA was able to decrease systemic inflammation in PM exposed animals, including a reduction in IL-6 serum levels, however, this did not translate to an improvement in BP or vascular reactivity. Smooth muscle relaxation in the trachea from the combination PA + PM group was not significantly different to CON and PA groups but was significantly higher than the PM group.

Conclusions

The current study showed that while there is an increased cardiovascular disease (CVD) risk associated with PM exposure, engaging in PA during exposure events imposes no increased risk with exercise providing a protective mechanism against some of the biochemical signaling changes caused by inhaled PM.

"There's Not Really Much Consideration Given to the Effect of the Climate on NCDs"-Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados

Despite widespread awareness of the rise of non-communicable diseases (NCDs) and the growing threat of climate change, little research has explored future health outcomes that will occur at the intersection of these challenges. Ten Barbadian health professionals were interviewed to assess their knowledge of health risks of climate change as it relates to NCDs in Barbados as a case study of a small island state at risk. There is widespread concern among health professionals about the current and future prevalence of non-communicable diseases among Barbadians. There is less concern about the future burden of NCDs in the context of a changing climate, largely because of a lack of knowledge among the majority of the health experts interviewed. Those knowledgeable about potential connections noted the difficulty that climate change would pose to the prevention and management of NCDs, given the impacts of climate stressors to food security, the built environment, and physiological and psychosocial health impacts. Lack of awareness among health professionals of the risk climate change poses to NCD prevalence and impact is reflective of the country’s health priorities that fail to recognize the risk of climate change. We recommend efforts to disseminate information about climate change to stakeholders in the health sector to increase awareness.

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases.

A challenge based learning experience in forensic medicine

Learning about forensic sciences is a crucial part of the formation of professionals working in medicine and health areas; this includes a range of coverage from legal-medical cases to forensic autopsies. However, knowledge of forensics by medical students is limited, because the teaching focus has been on the fundamentals of procedures in this field. To develop the necessary skills, specific support, and targeted learning tasks should be designed to enable the integration of interdisciplinary work in processes, infrastructure, and equipment used in a high-quality-forensic investigation. The innovative educational experience of the Crime Scene Investigation CSI Lab was a week-long activity using the pedagogical strategy of Challenge-Based Learning. It addresses the problem that students need training in an authentic setting. The intervention, in September 2017, included 33 students from different disciplines such as medicine, law, and marketing. They participated in various learning settings in multidisciplinary teams and were challenged by experts from the State Institute for Forensic Sciences to analyze specific processes. The outcomes of the CSI Lab implementations provided evidence of how the students benefited from the experience. The results showed that 80% of the teams had an excellent approach to the solution, justification of the proposal and feasibility assessment. However, only 60% achieved a solution that met the requirements. The educational process was assessed by their perceptions of the educational strategy of the CSI Lab experience. The results indicated that 88.9% of the students believed that the experience broadened their perspectives on forensic sciences. 73.1% thought that the design of the activities, visits, and plenaries added value to their academic training, and 88.9% found it to be interesting. Regarding whether or not the activities helped the participants to understand and perform a legal-medicine investigation, 92.6% believed that it did help them recognize and understand the interventional areas and processes necessary for the investigation. CONCLUSION: Students demonstrated high acceptance of the context-rich design of the practical activities and educational experiences that were grounded in active learning. The effect on curriculum design is that the interactions and interdisciplinarity of the programs must be assessed, as these experiences could motivate them to engage in solving the social challenges of the 21st century.

How will climate change impact microbial foodborne disease in Canada?

Foodborne disease is a major concern in Canada and represents a significant climate change-related threat to public health. Climate variables, including temperature and precipitation patterns, extreme weather events and ocean warming and acidification, are known to exert significant, complicated and interrelated effects along the entire length of the food chain. Foodborne diseases are caused by a range of bacteria, fungi, parasites and viruses, and the prevalence of these diseases is modified by climate change through alterations in the abundance, growth, range and survival of many pathogens, as well as through alterations in human behaviours and in transmission factors such as wildlife vectors. As climate change continues and/or intensifies, it will increase the risk of an adverse effect on food safety in Canada ranging from increased public health burden to the emergence of risks not currently seen in our food chain. Clinical and public health practitioners need to be aware of the existing and emerging risks to respond accordingly.

Global Environmental Change and Noncommunicable Disease Risks

Multiple global environmental changes (GECs) now under way, including climate change, biodiversity loss, freshwater depletion, tropical deforestation, overexploitation of fisheries, ocean acidification, and soil degradation, have substantial, but still imperfectly understood, implications for human health. Noncommunicable diseases (NCDs) make a major contribution to the global burden of disease. Many of the driving forces responsible for GEC also influence NCD risk through a range of mechanisms. This article provides an overview of pathways linking GEC and NCDs, focusing on five pathways: ( a) energy, air pollution, and climate change; ( b) urbanization; ( c) food, nutrition, and agriculture; ( d) the deposition of persistent chemicals in the environment; and ( e) biodiversity loss.

Earth Observation: Investigating Noncommunicable Diseases from Space

The United Nations has called on all nations to take immediate actions to fight noncommunicable diseases (NCDs), which have become an increasingly significant burden to public health systems around the world. NCDs tend to be more common in developed countries but are also becoming of growing concern in low- and middle-income countries. Earth observation (EO) technologies have been used in many infectious disease studies but have been less commonly employed in NCD studies. This review discusses the roles that EO data and technologies can play in NCD research, including ( a) integrating natural and built environment factors into NCD research, ( b) explaining individual-environment interactions, ( c) scaling up local studies and interventions, ( d) providing repeated measurements for longitudinal studies including cohorts, and ( e) advancing methodologies in NCD research. Such extensions hold great potential for overcoming the challenges of inaccurate and infrequent measurements of environmental exposure at the level of both the individual and the population, which is of great importance to NCD research, practice, and policy.

Priority focus areas for a sub-national response to climate change and health: A South African provincial case study

INTRODUCTION

The intersection of health and climate change is often absent or under-represented in sub-national government strategies. This analysis of the literature, using a new methodological framework, highlights priority focus areas for a sub-national government response to health and climate change, using the Western Cape (WC) province of South Africa as a case study.

METHODS

A methodological framework was created to conduct a review of priority focus areas relevant for sub-national governments. The framework encompassed the establishment of a Project Steering Group consisting of relevant, sub-national stakeholders (e.g. provincial officials, public and environmental health specialists and academics); an analysis of local climatic projections as well as an analysis of global, national and sub-national health risk factors and impacts.

RESULTS

Globally, the discussion of health and climate change adaptation strategies in sub-national, or provincial government is often limited. For the case study presented, multiple health risk factors were identified. WC climatic projections include a warmer and potentially drier future with an increased frequency and intensity of extreme weather events. WC government priority focus areas requiring further research on health risk factors include: population migration and environmental refugees, land use change, violence and human conflict and vulnerable groups. WC government priority focus areas for further research on health impacts include: mental ill-health, non-communicable diseases, injuries, poisonings (e.g. pesticides), food and nutrition insecurity-related diseases, water- and food-borne diseases and reproductive health. These areas are currently under-addressed, or not addressed at all, in the current provincial climate change strategy.

CONCLUSIONS

Sub-national government adaptation strategies often display limited discussion on the health and climate change intersect. The methodological framework presented in this case study can be globally utilized by other sub-national governments for decision-making and development of climate change and health adaptation strategies. Additionally, due to the broad range of sectoral issues identified, a primary recommendation from this study is that sub-national governments internationally should consider a "health and climate change in all policies" approach when developing adaptation and mitigation strategies to address climate change.

Excess burden of non-communicable disease years of life lost from heat in rural Burkina Faso: a time series analysis of the years 2000-2010

OBJECTIVES

Investigate the association of heat exposure on years of life lost (YLL) from non-communicable diseases (NCD) in Nouna, Burkina Faso, between 2000 and 2010.

DESIGN

Daily time series regression analysis using distributed lag non-linear models, assuming a quasi-Poisson distribution of YLL.

SETTING

Nouna Health and Demographic Surveillance System, Kossi Province, Rural Burkina Faso.

PARTICIPANTS

18 367 NCD-YLL corresponding to 790 NCD deaths recorded in the Nouna Health and Demographic Surveillance Site register over 11 years.

MAIN OUTCOME MEASURE

Excess mean daily NCD-YLL were generated from the relative risk of maximum daily temperature on NCD-YLL, including effects delayed up to 14 days.

RESULTS

Daily average NCD-YLL were 4.6, 2.4 and 2.1 person-years for all ages, men and women, respectively. Moderate 4-day cumulative rise in maximum temperature from 36.4°C (50th percentile) to 41.4°C (90th percentile) resulted in 4.44 (95% CI 0.24 to 12.28) excess daily NCD-YLL for all ages, rising to 7.39 (95% CI 0.32 to 24.62) at extreme temperature (42.8°C; 99th percentile). The strongest health effects manifested on the day of heat exposure (lag 0), where 0.81 (95% CI 0.13 to 1.59) excess mean NCD-YLL occurred daily at 41.7°C compared with 36.4°C, diminishing in statistical significance after 4 days. At lag 0, daily excess mean NCD-YLL were higher for men, 0.58 (95% CI 0.11 to 1.15) compared with women, 0.15 (95% CI -0.25 to 9.63) at 41.7°C vs 36.4°C.

CONCLUSION

Premature death from NCD was elevated significantly with moderate and extreme heat exposure. These findings have important implications for developing adaptation and mitigation strategies to reduce ambient heat exposure and preventive measures for limiting NCD in Africa.

Living at a Geographically Higher Elevation Is Associated with Lower Risk of Metabolic Syndrome: Prospective Analysis of the SUN Cohort

Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456 m) exhibited a significantly lower risk of developing MetS compared to those in the lowest tertile (<122 m) of altitude of residence [Model 2: Hazard ratio = 0.75 (95% Confidence interval: 0.58–0.97); p for trend = 0.029]. Living at geographically higher altitude was associated with a lower risk of developing MetS in the SUN project. Our findings suggest that geographical elevation may be an important factor linked to metabolic diseases.

Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps

Background

Climate change and the burden of noncommunicable diseases are major global challenges. Opportunities exist to investigate health and climate change co-benefits through a shift from motorized to active transport (walking and cycling) and a shift in dietary patterns away from a globalized diet to reduced consumption of meat and energy dense foods. Given the ubiquitous use and proliferation of smartphone apps, an opportunity exists to use this technology to capture individual travel and dietary behavior and the associated impact on the environment and health.

Objective

The objective of the study is to identify, describe the features, and rate the quality of existing smartphone apps which capture personal travel and dietary behavior and simultaneously estimate the carbon cost and potential health consequences of these actions.

Methods

The Google Play and Apple App Stores were searched between October 19 and November 6, 2015, and a secondary Google search using the apps filter was conducted between August 8 and September 18, 2016. Eligible apps were required to estimate the carbon cost of personal behaviors with the potential to include features to maximize health outcomes. The quality of included apps was assessed by 2 researchers using the Mobile Application Rating Scale (MARS).

Results

Out of 7213 results, 40 apps were identified and rated. Multiple travel-related apps were identified, however no apps solely focused on the carbon impact or health consequences of dietary behavior. None of the rated apps provided sufficient information on the health consequences of travel and dietary behavior. Some apps included features to maximize participant engagement and encourage behavior change towards reduced greenhouse gas emissions. Most apps were rated as acceptable quality as determined by the MARS; 1 was of poor quality and 10 apps were of good quality. Interrater reliability of the 2 evaluators was excellent (ICC=0.94, 95% CI 0.87-0.97).

Conclusions

Existing apps capturing travel and dietary behavior and the associated health and environmental impact are of mixed quality. Most apps do not include all desirable features or provide sufficient health information. Further research is needed to determine the potential of smartphone apps to evoke behavior change resulting in climate change and health co-benefits.

Health Impacts of Climate Change in Pacific Island Countries: A Regional Assessment of Vulnerabilities and Adaptation Priorities

BACKGROUND

Between 2010 and 2012, the World Health Organization Division of Pacific Technical Support led a regional climate change and health vulnerability assessment and adaptation planning project, in collaboration with health sector partners, in 13 Pacific island countries-Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu.

OBJECTIVE

We assessed the vulnerabilities of Pacific island countries to the health impacts of climate change and planned adaptation strategies to minimize such threats to health.

METHODS

This assessment involved a combination of quantitative and qualitative techniques. The former included descriptive epidemiology, time series analyses, Poisson regression, and spatial modeling of climate and climate-sensitive disease data, in the few instances where this was possible; the latter included wide stakeholder consultations, iterative consensus building, and expert opinion. Vulnerabilities were ranked using a "likelihood versus impact" matrix, and adaptation strategies were prioritized and planned accordingly.

RESULTS

The highest-priority climate-sensitive health risks in Pacific island countries included trauma from extreme weather events, heat-related illnesses, compromised safety and security of water and food, vector-borne diseases, zoonoses, respiratory illnesses, psychosocial ill-health, non-communicable diseases, population pressures, and health system deficiencies. Adaptation strategies relating to these climate change and health risks could be clustered according to categories common to many countries in the Pacific region.

CONCLUSION

Pacific island countries are among the most vulnerable in the world to the health impacts of climate change. This vulnerability is a function of their unique geographic, demographic, and socioeconomic characteristics combined with their exposure to changing weather patterns associated with climate change, the health risks entailed, and the limited capacity of the countries to manage and adapt in the face of such risks. Citation: McIver L, Kim R, Woodward A, Hales S, Spickett J, Katscherian D, Hashizume M, Honda Y, Kim H, Iddings S, Naicker J, Bambrick H, McMichael AJ, Ebi KL. 2016. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 124:1707-1714; http://dx.doi.org/10.1289/ehp.1509756.

Climate Change and Potential Impact on Disease: What are the Public Health Agenda?

Globally, the impact of climate change on human health is widely discussed. There are several mechanisms how environmental variability can influence the occurrence of diseases that are communicable or noncommunicable. The biophysical underlying causes of climate changes are not proportionately distributed between developed and developing countries. Developed countries contribute more greenhouse emissions, but the population health effects of climate change are estimated to be higher in developing countries compared to developed countries. Therefore, examination of challenges associated with climate change should be a priority. In the countries of North Africa and the Middle East, a clear public health agenda needs to be developed, even if local/regional factors contributing to unpredictable climatic changes are not well-known. Targeting risk factors associated with noncommunicable diseases, and adopting lifestyle changes are interventions to consider.

The Mental Health Outcomes of Drought: A Systematic Review and Causal Process Diagram

Little is understood about the long term, indirect health consequences of drought (a period of abnormally dry weather). In particular, the implications of drought for mental health via pathways such as loss of livelihood, diminished social support, and rupture of place bonds have not been extensively studied, leaving a knowledge gap for practitioners and researchers alike. A systematic review of literature was performed to examine the mental health effects of drought. The systematic review results were synthesized to create a causal process diagram that illustrates the pathways linking drought effects to mental health outcomes. Eighty-two articles using a variety of methods in different contexts were gathered from the systematic review. The pathways in the causal process diagram with greatest support in the literature are those focusing on the economic and migratory effects of drought. The diagram highlights the complexity of the relationships between drought and mental health, including the multiple ways that factors can interact and lead to various outcomes. The systematic review and resulting causal process diagram can be used in both practice and theory, including prevention planning, public health programming, vulnerability and risk assessment, and research question guidance. The use of a causal process diagram provides a much needed avenue for integrating the findings of diverse research to further the understanding of the mental health implications of drought.

Research Priorities for NCD Prevention and Climate Change: An International Delphi Survey

Climate change and non-communicable diseases (NCDs) are arguably the greatest global challenges of the 21st Century. However, the confluence between them remains under-examined and there is little evidence of a comprehensive, systematic approach to identifying research priorities to mitigate their joint impact. Consequently, we: (i) convened a workshop of academics (n = 25) from the Worldwide Universities Network to identify priority areas at the interface between NCDs and climate change; (ii) conducted a Delphi survey of international opinion leaders in public health and relevant other disciplines; and (iii) convened an expert panel to review and advise on final priorities. Three research areas (water security; transport; conceptualising NCD harms to support policy formation) were listed among the top 10 priorities by >90% of Delphi respondents, and ranked among the top 12 priorities by >60% of respondents who ranked the order of priority. A fourth area (reducing the carbon footprint of cities) was ranked highest by the same >60% of respondents. Our results are consistent with existing frameworks on health and climate change, and extends them by focusing specifically on NCDs. Researching these priorities could progress understanding of climate change and NCDs, and inform global and national policy decisions for mitigating associated harms.

Lack of association between drought and mental health in a cohort of 45-61 year old rural Australian women

OBJECTIVE

To evaluate the impact of drought on the mental health of rural Australian women and those in vulnerable sub-populations: women who were more isolated, poorer and less educated; and women who had histories of chronic disease or poor mental health.

METHODS

Surveys were mailed in 1996, 1998, 2001, 2004 and 2008 to 6,664 women born between 1946 and1951 who were participating in the Australian Longitudinal Study on Women's Health. The surveys included the Mental Health Index of the Medical Outcomes Study Short-Form 36 (MHI). Drought was assessed by linking the latitude and longitude of women's place of residence at each survey to the Hutchinson Drought Index. Associations between MHI and drought were assessed using linear mixed-models.

RESULTS

While 31% of the women experienced drought in 1998 and 50% experienced drought in 2007; experience of droughts was less common in the other years. Although drought varied from survey year to survey year, mental health did not vary with drought conditions for rural women or vulnerable sub-populations.

CONCLUSIONS

These findings are contrary to the long-held assumption that droughts increase mental health problems in Australia.

IMPLICATIONS

While similar results may not be true for men, empirical evidence (rather than assumptions) is required on associations between drought and mental health.

Climate change, cash transfers and health

The forecast consequences of climate change on human health are profound, especially in low- and middle-income countries and among the most disadvantaged populations. Innovative policy tools are needed to address the adverse health effects of climate change. Cash transfers are established policy tools for protecting population health before, during and after climate-related disasters. For example, the Ethiopian Productive Safety Net Programme provides cash transfers to reduce food insecurity resulting from droughts. We propose extending cash transfer interventions to more proactive measures to improve health in the context of climate change. We identify promising cash transfer schemes that could be used to prevent the adverse health consequences of climatic hazards. Cash transfers for using emission-free, active modes of transport – e.g. cash for cycling to work – could prevent future adverse health consequences by contributing to climate change mitigation and, at the same time, improving current population health. Another example is cash transfers provided to communities that decide to move to areas in which their lives and health are not threatened by climatic disasters. More research on such interventions is needed to ensure that they are effective, ethical, equitable and cost–effective.

Climate Change and Health: Transcending Silos to Find Solutions

BACKGROUND

Climate change has myriad implications for the health of humans, our ecosystems, and the ecological processes that sustain them. Projections of rising greenhouse gas emissions suggest increasing direct and indirect burden of infectious and noninfectious disease, effects on food and water security, and other societal disruptions. As the effects of climate change cannot be isolated from social and ecological determinants of disease that will mitigate or exacerbate forecasted health outcomes, multidisciplinary collaboration is critically needed.

OBJECTIVES

The aim of this article was to review the links between climate change and its upstream drivers (ie, processes leading to greenhouse gas emissions) and health outcomes, and identify existing opportunities to leverage more integrated global health and climate actions to prevent, prepare for, and respond to anthropogenic pressures.

METHODS

We conducted a literature review of current and projected health outcomes associated with climate change, drawing on findings and our collective expertise to review opportunities for adaptation and mitigation across disciplines.

FINDINGS

Health outcomes related to climate change affect a wide range of stakeholders, providing ready collaborative opportunities for interventions, which can be differentiated by addressing the upstream drivers leading to climate change or the downstream effects of climate change itself.

CONCLUSIONS

Although health professionals are challenged with risks from climate change and its drivers, the adverse health outcomes cannot be resolved by the public health community alone. A phase change in global health is needed to move from a passive responder in partnership with other societal sectors to drive innovative alternatives. It is essential for global health to step outside of its traditional boundaries to engage with other stakeholders to develop policy and practical solutions to mitigate disease burden of climate change and its drivers; this will also yield compound benefits that help address other health, environmental, and societal challenges.

Is enough attention given to climate change in health service planning? An Australian perspective

BACKGROUND

Within an Australian context, the medium to long-term health impacts of climate change are likely to be wide, varied and amplify many existing disorders and health inequities. How the health system responds to these challenges will be best considered in the context of existing health facilities and services. This paper provides a snapshot of the understanding that Australian health planners have of the potential health impacts of climate change.

METHODS

The first author interviewed (n=16) health service planners from five Australian states and territories using an interpretivist paradigm. All interviews were digitally recorded, key components transcribed and thematically analysed.

RESULTS

Results indicate that the majority of participants were aware of climate change but not of its potential health impacts. Despite this, most planners were of the opinion that they would need to plan for the health impacts of climate change on the community.

CONCLUSION

With the best available evidence pointing towards there being significant health impacts as a result of climate change, now is the time to undertake proactive service planning that address market failures within the health system. If considered planning is not undertaken then Australian health system can only deal with climate change in an expensive ad hoc, crisis management manner. Without meeting the challenges of climate change to the health system head on, Australia will remain unprepared for the health impacts of climate change with negative consequences for the health of the Australian population.

Accounting for health in climate change policies: a case study of Fiji

Background

Climate change is expected to affect the health of most populations in the coming decades, having the greatest impact on the poorest and most disadvantaged people in the world. The Pacific islands, including Fiji, are particularly vulnerable to the effects of climate change.

Objective

The three major health impacts of climate change in Fiji explored in this study were dengue fever, diarrhoeal disease, and malnutrition, as they each pose a significant threat to human health. The aim of this study was to investigate to what extent the Fiji National Climate Change Policy, and a selection of relevant sectoral policies, account for these human health effects of climate change.

Design

The study employed a three-pronged policy analysis to evaluate: 1) the content of the Fijian National Climate Change Policy and to what extent health was incorporated within this; 2) the context within which the policy was developed; 3) the relevant processes; and 4) the actors involved. A selection of relevant sectoral policies were also analysed to assess the extent to which these included climate change and health considerations.

Results

The policy analysis showed that these three health impacts of climate change were only considered to a minor extent, and often indirectly, in both the Fiji National Climate Change Policy and the corresponding National Climate Change Adaptation Strategy, as well as the Public Health Act. Furthermore, supporting documents in relevant sectors including water and agriculture made no mention of climate change and health impacts.

Conclusions

The projected health impacts of climate change should be considered as part of reviewing the Fiji National Climate Change Policy and National Climate Change Adaptation Strategy, and the Public Health Act. In the interest of public health, this should include strategies for combating dengue fever, malnutrition, and water-borne disease. Related sectoral policies in water and agriculture should also be revised to consider climate change and its impact on human health. Approaches to include health aspects of climate change within sectoral and climate change specific policies should be encouraged, via a number of mechanisms, such as the Health in All Policies approach. Future research could support the Fiji health sector in developing climate change and health programmes.

Assessment of the health impacts of climate change in Kiribati

Kiribati-a low-lying, resource-poor Pacific atoll nation-is one of the most vulnerable countries in the World to the impacts of climate change, including the likely detrimental effects on human health. We describe the preparation of a climate change and health adaptation plan for Kiribati carried out by the World Health Organization and the Kiribati Ministry of Health and Medical Services, including an assessment of risks to health, sources of vulnerability and suggestions for highest priority adaptation responses. This paper identifies advantages and disadvantages in the process that was followed, lays out a future direction of climate change and health adaptation work in Kiribati, and proposes lessons that may be applicable to other small, developing island nations as they prepare for and adapt to the impacts of climate change on health.

A multi-layered governance framework for incorporating social science insights into adapting to the health impacts of climate change

Background

Addressing climate change and its associated effects is a multi-dimensional and ongoing challenge. This includes recognizing that climate change will affect the health and wellbeing of all populations over short and longer terms, albeit in varied ways and intensities. That recognition has drawn attention to the need to take adaptive actions to lessen adverse impacts over the next few decades from unavoidable climate change, particularly in developing country settings. A range of sectors is responsible for appropriate adaptive policies and measures to address the health risks of climate change, including health services, water and sanitation, trade, agriculture, disaster management, and development.

Objectives

To broaden the framing of governance and decision-making processes by using innovative methods and assessments to illustrate the multi-sectoral nature of health-related adaptation to climate change. This is a shift from sector-specific to multi-level systems encompassing sectors and actors, across temporal and spatial scales.

Design

A review and synthesis of the current knowledge in the areas of health and climate change adaptation governance and decision-making processes.

Results

A novel framework is presented that incorporates social science insights into the formulation and implementation of adaptation activities and policies to lessen the health risks posed by climate change.

Conclusion

Clarification of the roles that different sectors, organizations, and individuals occupy in relation to the development of health-related adaptation strategies will facilitate the inclusion of health and wellbeing within multi-sector adaptation policies, thereby strengthening the overall set of responses to minimize the adverse health effects of climate change.