Public Health Adaptation to Climate Change in Large Cities: A Global Baseline

Temporal dynamic effects of meteorological factors and air quality on the physical health of the older adults in Shenzhen, China

Introduction

Meteorological and environmental factors can affect people's lives and health, which is crucial among the older adults. However, it is currently unclear how they specifically affect the physical condition of older adults people.

Methods

We collected and analyzed the basic physical examination indicators of 41 older adults people for two consecutive years (2021 and 2022), and correlated them with meteorological and environmental factors. Partial correlation was also conducted to exclude unrelated factors as well.

Results

We found that among the physical examination indicators of the older adults for two consecutive years, five indicators (HB, WBC, HbAlc, CB, LDL-C) showed significant differences across the population, and they had significantly different dynamic correlation patterns with six meteorological (air pressure, temperature, humidity, precipitation, wind speed, and sunshine duration) and seven air quality factors (NO2, SO2, PM10, O3-1h, O3-8h, CO, PM2.5).

Discussion

Our study has discovered for the first time the dynamic correlation between indicators in normal basic physical examinations and meteorological factors and air quality indicators, which will provide guidance for the future development of policies that care for the healthy life of the older adults.

Heat waves and adaptation: A global systematic review

BACKGROUND

Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves.

METHOD

ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table.

RESULTS

In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design.

CONCLUSION

The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves.

PROSPERO REGISTRATION NUMBER

CRD42021257747.

A management perspective on resilience in healthcare: a framework and avenues for future research

Recent major health shocks, such as the 2014-16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.To fill this gap, this systematic literature review aims to provide a clear state of the art of the literature dealing with resilience in healthcare. Specifically, from the analysis of the theoretical articles and reviews, the key dimensions of resilience are identified, and a novel classification framework is proposed. The classification framework is then used to systematize extant empirical contributions. Two main dimensions of resilience are identified: the approach to resilience (reactive vs. proactive) and the type of crisis to deal with (acute shocks vs. chronic stressors). Four main streams of research are thus identified: (i) proactive approaches to acute shocks; (ii) proactive approaches to chronic stressors; (iii) reactive approaches to acute shocks; and (iv) reactive approaches to chronic stressors. These are scrutinised considering three additional dimensions: the level of analysis, the resources to nurture resilience, and the country context. The classification framework and the associated mapping contribute to systematising the fragmented literature on resilience in healthcare, providing a clear picture of the state of the art in this field and drawing a research agenda that opens interesting paths for future research.

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.

Adaptation to compound climate risks: A systematic global stocktake

This article provides a stocktake of the adaptation literature between 2013 and 2019 to better understand how adaptation responses affect risk under the particularly challenging conditions of compound climate events. Across 39 countries, 45 response types to compound hazards display anticipatory (9%), reactive (33%), and maladaptive (41%) characteristics, as well as hard (18%) and soft (68%) limits to adaptation. Low income, food insecurity, and access to institutional resources and finance are the most prominent of 23 vulnerabilities observed to negatively affect responses. Risk for food security, health, livelihoods, and economic outputs are commonly associated risks driving responses. Narrow geographical and sectoral foci of the literature highlight important conceptual, sectoral, and geographic areas for future research to better understand the way responses shape risk. When responses are integrated within climate risk assessment and management, there is greater potential to advance the urgency of response and safeguards for the most vulnerable.

From assembly to action: how planning language guides execution in indigenous climate adaptation

Indigenous Peoples of the USA are already feeling the disproportionate impacts of climate change and the challenges created to their resource-based livelihoods from effects like sea level rise, species migration and extinction, and more severe and frequent storms. In response, American Indigenous communities have initiated hundreds of adaptation actions. At the center of the Indigenous climate response are efforts to identify local climate threats and prioritize adaptation actions through careful planning. To better understand their potential, 14 tribal climate adaptation plans were reviewed to decipher different types of proposed adaptation actions and evaluated based on 11 criteria often associated with successful plan implementation. Adaptation actions were dominated by "soft" measures such as capacity building with neighboring jurisdictions, policy reform, and information gathering. The most common criteria present in the tribal plans were identification of a party to implement an action and mainstreaming of climate activities into other documents, such as resource management plans. In-depth interviews with tribal climate specialists found that actual implementation has been slowed by funding shortages, lack of staff expertise, and weak communication and coordination across tribal government departments. Successful implementation has occurred through the mainstreaming of adaptation priorities into other environmental concerns, such as hazard mitigation or emergency preparedness, that benefit from more stable funding. Training staff, developing dedicated funding streams, and the integration of adaptation efforts into all areas of tribal government operations is needed to ensure Indigenous communities can protect vital cultural resources and steward lands under rapidly changing climatic conditions.

Climate Change Prevention through Community Actions and Empowerment: A Scoping Review

As society tries to tackle climate change around the globe, communities need to reduce its impact on human health. The purpose of this review is to identify key stakeholders involved in mitigating and adapting to climate change, as well as the type and characteristics of community empowerment actions implemented so far to address the problem. Published and unpublished studies from January 2005 to March 2022 in English and Portuguese were included in this review. The search, conducted on PubMed, CINAHL, Scopus, MEDLINE, Scopus, Web of Science, SciELO, and RCAAP (Repositório Científico de Acesso Aberto de Portugal), followed a three-step search strategy. Data extraction was performed by two independent reviewers, using an extraction tool specifically designed for the review questions. Twenty-seven studies were eligible for inclusion: six used interviews as a qualitative method, three were systematic reviews, three were case study analyses, three used surveys and questionnaires as quantitative methods, two used integrative baseline reviews, and three utilized a process model design. Six studies targeted local, public and private stakeholders. Community settings were the context target of fifteen studies, whereas twelve specifically referred to urban settings. Seven types of community actions were acknowledged across the globe, characterised as hybrid interventions and referring to the leading stakeholders: local governments, non-governmental organizations, civil society, universities, public health, and private sectors.

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.

Transformation towards Risk-Sensitive Urban Development: A Systematic Review of the Issues and Challenges

Risk-sensitive urban development is an innovative planning approach that can transform the way cities are built in order to face the uncertainties that arise from climate-induced disaster risks. However, the potential to initiate such a transformative approach has not materialized because of the many underlying issues that need to be understood properly. Therefore, this study conducted a systematic review to gather empirical evidence on the issues and challenges in implementing risk-sensitive urban development. The study identified forty-six issues and challenges under seven key themes that need addressing in order to facilitate the desirable transition: trade-offs, governance, fragmentation and silos, capacity, design and development, data, and funding. The issues and challenges that exist under trade-offs for negotiating solutions for risk-sensitive urban development and the governance of multiple stakeholders were identified as the top two areas that need attention in facilitating the desirable transition. This study also revealed that important information, such as scientific information, hazard and risk information, temporal and spatial information, and critical local details are not being produced and shared between stakeholders in decision-making. A profound participatory process that involves all the stakeholders in the decision-making process was identified as the pathway to ensure equitable outcomes in risk-sensitive urban development.

Systematic mapping of global research on climate and health: a machine learning review

BACKGROUND

The global literature on the links between climate change and human health is large, increasing exponentially, and it is no longer feasible to collate and synthesise using traditional systematic evidence mapping approaches. We aimed to use machine learning methods to systematically synthesise an evidence base on climate change and human health.

METHODS

We used supervised machine learning and other natural language processing methods (topic modelling and geoparsing) to systematically identify and map the scientific literature on climate change and health published between Jan 1, 2013, and April 9, 2020. Only literature indexed in English were included. We searched Web of Science Core Collection, Scopus, and PubMed using title, abstract, and keywords only. We searched for papers including both a health component and an explicit mention of either climate change, climate variability, or climate change-relevant weather phenomena. We classified relevant publications according to the fields of climate research, climate drivers, health impact, date, and geography. We used supervised and unsupervised machine learning to identify and classify relevant articles in the field of climate and health, with outputs including evidence heat maps, geographical maps, and narrative synthesis of trends in climate health-related publications. We included empirical literature of any study design that reported on health pathways associated with climate impacts, mitigation, or adaptation.

FINDINGS

We predict that there are 15 963 studies in the field of climate and health published between 2013 and 2019. Climate health literature is dominated by impact studies, with mitigation and adaptation responses and their co-benefits and co-risks remaining niche topics. Air quality and heat stress are the most frequently studied exposures, with all-cause mortality and infectious disease incidence being the most frequently studied health outcomes. Seasonality, extreme weather events, heat, and weather variability are the most frequently studied climate-related hazards. We found major gaps in evidence on climate health research for mental health, undernutrition, and maternal and child health. Geographically, the evidence base is dominated by studies from high-income countries and China, with scant evidence from low-income counties, which often suffer most from the health consequences of climate change.

INTERPRETATION

Our findings show the importance and feasibility of using automated machine learning to comprehensively map the science on climate change and human health in the age of big literature. These can provide key inputs into global climate and health assessments. The scant evidence on climate change response options is concerning and could significantly hamper the design of evidence-based pathways to reduce the effects on health of climate change. In the post-2015 Paris Agreement era of climate solutions, we believe much more attention should be given to climate adaptation and mitigation options and their effects on human health.

FUNDING

Foreign, Commonwealth & Development Office.

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.

Piloting a city health adaptation typology with data from climate-engaged cities: Toward identification of an urban health adaptation gap

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publicly-available adaptation database. We found two-thirds of actions of these 'active adapter' cities were health-associated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly one-third addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptation-engaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

Towards Understanding Interactions between Sustainable Development Goals: The Role of Climate-Well-Being Linkages. Experiences of EU Countries

The 2030 Agenda with 17 Sustainable Development Goals (SDGs) is a challenge for all countries in the world. Their implementation may turn out to be a compromise or the creation of effective interactions that dynamize sustainable development. To achieve the SDGs, it is essential to understand how they interact with each other. It seems that in the times of the climate and health crisis caused by the COVID-19 pandemic, caring for the environment and ensuring a healthy life and promoting well-being at all ages is the basis for environmental, economic and social sustainable development. The aim of the study is to compare the degree of implementation of the goals of sustainable development in the scope of goal 13 “Climate action” and goal 3 “Good health and well-being” in the EU countries. In addition, we analyze how trade-offs and synergies between these goals have developed. Data from the Eurostat database were used to achieve the goal. The study used the method of multivariate comparative analysis—linear ordering of objects. The technique for order preference by similarity to an ideal solution (TOPSIS) method was used to measure the studied phenomenon. The results indicate a different degree of implementation of the sustainable development goals related to climate change and the improvement of health and social well-being. Only a few countries have synergy in achieving these goals, most of them compromise, manifesting themselves in improving one goal over another. In the group of analyzed EU countries, a simultaneous deterioration in the effectiveness of achieving both objectives were also noted. Our research also shows that energy policy is an important attribute in improving the achievement of these goals. The conducted analysis fills the gap in the research on the implementation of selected sustainable development goals and their interactions. It contributes to the discussion on increasing the links between them, in particular with regard to emerging compromises. This research can provide a basis for re-prioritizing and intensifying the actions where individual EU countries are lagging most behind.

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.

Integrating Public Health into Climate Change Policy and Planning: State of Practice Update

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

Population Health Adaptation Approaches to the Increasing Severity and Frequency of Weather-Related Disasters Resulting From our Changing Climate: A Literature Review and Application to Charleston, South Carolina

PURPOSE OF REVIEW

Recent changes in our planetary climate have and will continue to challenge historical knowledge and risk assumptions for weather-related disasters. While the public health community is rapidly working to develop epidemiological approaches and tools to mitigate and adapt to these weather-related disasters, recent high-profile events have exposed gaps in knowledge and response efforts. Limited work has been done to assess the climate readiness of the local public health and healthcare community as it pertains to local response planning and adaptation measures in the event of a weather-related disaster. The purpose of this paper is to review the existing literature related to climate change, weather-related disasters, and population health approaches to adapt to climate-related changes in weather-related disasters at the local level. We highlight a brief case study to illustrate an example of a local approach to adaptation planning in a coastal community.

RECENT FINDINGS

Few studies have put forth quantitative disaster epidemiology tools to aid public health officials in preparing for and responding to these weather-related disaster events. There is a general lack of understanding within the public health community about the epidemiological tools which are available to assist local communities in their preparation for, response to, and recovery from weather-related disasters. Cities around the nation are already working to assess their vulnerability and resilience to weather-related disasters by including climate change in emergency preparedness plans and developing adaptation strategies, as well as equipping local hospitals, health departments and other critical public health systems with climate information. But more work is needed and public health funding is lagging to support local and state-level efforts in preparing for and adapting to weather-related disasters in the context of a changing climate. Our population health disaster preparedness programs need to be adapted to address the increasing risks to local public health resulting from our changing climate.

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.

Temperature Variability Differs in Urban Agroecosystems across Two Metropolitan Regions

Climatically similar regions may experience different temperature extremes and weather patterns that warrant global comparisons of local microclimates. Urban agroecosystems are interesting sites to examine the multidimensional impacts of climate changes because they rely heavily on human intervention to maintain crop production under different and changing climate conditions. Here, we used urban community gardens across the California Central Coast metropolitan region, USA, and the Melbourne metropolitan region, Australia, to investigate how habitat-scale temperatures differ across climatically similar regions, and how people may be adapting their gardening behaviors to not only regional temperatures, but also to the local weather patterns around them. We show that, while annual means are very similar, there are strong interregional differences in temperature variability likely due to differences in the scale and scope of the temperature measurements, and regional topography. However, the plants growing within these systems are largely the same. The similarities may be due to gardeners’ capacities to adapt their gardening behaviors to reduce the adverse effects of local temperature variability on the productivity of their plot. Thus, gardens can serve as sites where people build their knowledge of local weather patterns and adaptive capacity to climate change and urban heat. Climate-focused studies in urban landscapes should consider how habitat-scale temperature variability is a background for interesting and meaningful social-ecological interactions.

Adapting air quality management for a changing climate: Survey of local districts in California

Air quality can be affected by weather and thus is sensitive to a changing climate. Wildfire (influenced by weather), consecutive high temperature summer days, and other extreme events are projected to become more severe and frequent with climate change. These may create challenging conditions for managing air quality despite policy targets to reduce precursor and pollutant emissions. Although extreme events are becoming more intense and interest in climate adaptation is increasing among public health practitioners, little attention in scholarly literature and policy covers climate adaptation for air quality governance. Understanding the management and managers' perspectives at the local level provides insight about the needs for climate adaptation, including their adaptation status, perspectives, responsibilities, and roles. This study explores local manager perspectives and experiences of managing air quality within a changing climate as one puzzle piece to understand the gap in climate adaptation within the air quality sector. A broader goal is to contribute to the discussion of developing a multi-jurisdictional vision for reducing the impacts of air quality in a changing climate. In 2016 local air quality district managers in California were invited to participate in an online survey of 39 questions focused on extreme event impacts on air quality. The questionnaire focused on present air quality threats and extreme event challenges, adaptation status and strategies, adaptive capacities, perceived barriers to adaptation, and jurisdictional responsibilities and roles. Over 85 percent of the 35 local air districts in California participated in the survey, which represents 80 percent of the state's population. High awareness and knowledge of climate change among local managers indicates they are ready to adopt and take action on policies that would support climate adaptation, but barriers reported suggests they may need policies and adequate funding to take action and make necessary changes.

IMPLICATIONS

Downscaled global climate models project an increasing severity and frequency of extreme events. In the southwestern United States, these include wildfire, heat events, and dry periods, among others, all of which can place an extra burden on air quality managers and emitters to achieve air quality standards even as they reduce emissions. Despite climate change presenting increasing challenges to meet air quality standards, in the southwestern United States, policy and action to mitigate these impacts have been surprisingly absent. California presents a valuable case study on the topic because of its historic leadership in air quality management for the United States and also because of its initiatives in combating climate change. Yet still we found that adaptation has not been incorporated into air quality management thus far, but local managers seem sufficiently knowledgeable and willing.

The past and future in understanding the health risks of and responses to climate variability and change

Climate change and health was established as a formal field of endeavor in the early 1990s, with the number of publications increasing since the mid-2000s. The key findings in assessment reports from the Intergovernmental Panel on Climate Change in 1995, 2001, 2007, and 2014 indicate the progress in understanding the magnitude and pattern of the health risks of a changing climate. The assessments maintained a similar structure, focusing on assessing the state of knowledge of individual climate-sensitive health outcomes, with confidence in the key findings tending to increase over time with greater understanding. The knowledge base is smaller than for other key sectors (e.g., agriculture) because of limited research investment in climate change and health. Vulnerability, adaptation, and capacity assessments can inform prioritization of the significant research gaps in understanding and managing the health risks of a changing climate; filling these research gaps would provide policy- and decision-makers with insights to increase short- and longer-term resilience in health and other sectors. Research needs include to understand how climate and development pathways could interact to alter health risks over time, better understand upstream drivers of climate-sensitive health outcomes, project aggregate health impacts to understand the breadth and depth of challenges that may need to be managed at geographic scales of interest, and project the time of emergence of changes in the geographic range and intensity of transmission of infectious diseases and other climate conditions. Engagement with other sectors is needed to ensure that their mitigation and adaptation activities also promote and protect health and take the health sector's needs into account. Making progress in these areas is critical for protecting the health of future populations.

Public Health Adaptation to Climate Change in OECD Countries

Climate change is a major challenge facing public health. National governments play a key role in public health adaptation to climate change, but there are competing views on what responsibilities and obligations this will—or should—include in different nations. This study aims to: (1) examine how national-level public health adaptation is occurring in Organization for Economic Cooperation and Development (OECD) countries; (2) examine the roles national governments are taking in public health adaptation; and (3) critically appraise three key governance dimensions of national-level health adaptation—cross-sectoral collaboration, vertical coordination and national health adaptation planning—and identify practical examples suited to different contexts. We systematically reviewed publicly available public health adaptation to climate change documents and webpages by national governments in ten OECD countries using systematic web searches, assessment of self-reporting, and content analysis. Our findings suggest national governments are primarily addressing infectious disease and heat-related risks posed by climate change, typically emphasizing capacity building or information-based groundwork initiatives. We find national governments are taking a variety of approaches to public health adaptation to climate change that do not follow expected convergence and divergence by governance structure. We discuss practical options for incorporating cross-sectoral collaboration, vertical coordination and national health adaptation planning into a variety of contexts and identify leaders national governments can look to to inform their public health adaptation planning. Following the adoption of the Paris Agreement and subsequent increased momentum for adaptation, research tracking adaptation is needed to define what health adaptation looks like in practice, reveal insights that can be taken up across states and sectors, and ensure policy orientated learning.

Climate Change and Health in the Urban Context

Climate change poses huge challenges for public health, and cities are at the forefront of this process. The purpose of this paper is to present the issues climate change poses for public health in the city of Barcelona, how they are being addressed, and what are the current major challenges, trying to contribute to the development of a baseline understanding of the status of adaptation in cities from a public health perspective. The major issues related to climate change faced by the city are common to other urban centers in a Mediterranean climate: heat waves, water availability and quality, air quality, and diseases transmitted by vectors, and all are reviewed in detail with empirical data. They are not a potential threat for the future, but have actually challenged the city services and infrastructure over the last years, requiring sustainable responses and rigorous planning.