An open source web application for the surveillance and prevention of the impacts on public health of extreme meteorological events: the SUPREME system

Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis

Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.

Funding

This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.

Estimating the heat-related mortality and morbidity burden in the province of Quebec, Canada

BACKGROUND

As climate change increases the frequency and intensity of extreme heat events, there is an urgent need to quantify the heat-related health burden. However, most past studies have focussed on a single health outcome (mainly mortality) or on specific heatwaves, thus providing limited knowledge of the total pressure heat exerts on health services.

OBJECTIVES

This study aims to quantify the heat-related mortality and morbidity burden for five different health outcomes including all-cause mortality, hospitalizations, emergency department (ED) visits, ambulance transports and calls to a health hotline, using the province of Quebec (Canada) as a case study.

METHODS

A two-step statistical analysis was employed to estimate regional heat-health relationships using Distributed Lag Non-Linear Models (DLNM) and pooled estimates using a multivariate meta-regression. Heat burden was quantified by attributable fraction (AF) and attributable number (AN) for two temperature ranges: all heat (above the minimum mortality/morbidity temperature) and extreme heat (above the 95th percentile of temperature).

RESULTS

Higher temperatures were associated with greater risk ratios for all health outcomes studied, but at different levels. Significant AF ranging from 2 to 3% for the all heat effect and 0.4-1.0% for extreme heat were found for all health outcomes, except for hospitalizations that had an AF of 0.1% for both heat exposures. The estimated burden of all heat (and extreme heat) every summer across the province was 470 (200) deaths, 225 (170) hospitalizations, 36 000 (6 200) ED visits, 7 200 (1 500) ambulance transports and 15 000 (3 300) calls to a health hotline, all figures significant.

DISCUSSION

This new knowledge on the total heat load will help public health authorities to target appropriate actions to reduce its burden now and in the future. The proposed state-of-the-art framework can easily be applied to other regions also experiencing the adverse effects of extreme heat.

The pathogenesis and therapeutic strategies of heat stroke-induced myocardial injury

Heat stroke (HS) is a febrile illness characterized by an elevation in the core body temperature to over 40°C, accompanied by central nervous system impairment and subsequent multi-organ dysfunction syndrome. In recent years, the mortality rate from HS has been increasing as ambient temperatures continue to rise each year. The cardiovascular system plays an important role in the pathogenesis process of HS, as it functions as one of the key system for thermoregulation and its stability is associated with the severity of HS. Systemic inflammatory response and endothelial cell damage constitute pivotal attributes of HS, other factors such as ferroptosis, disturbances in myocardial metabolism and heat shock protein dysregulation are also involved in the damage to myocardial tissue in HS. In this review, a comprehensively detailed description of the pathogenesis of HS-induced myocardial injury is provided. The current treatment strategies and the promising therapeutic targets for HS are also discussed.

Digital health for climate change mitigation and response: a scoping review

OBJECTIVE

Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change.

MATERIALS AND METHODS

We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant.

RESULTS

The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas.

DISCUSSION

While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation.

CONCLUSION

Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.

Heat-related mortality prediction using low-frequency climate oscillation indices: Case studies of the cities of Montréal and Québec, Canada

Heat-related mortality is an increasingly important public health burden that is expected to worsen with climate change. In addition to long-term trends, there are also interannual variations in heat-related mortality that are of interest for efficient planning of health services. Large-scale climate patterns have an important influence on summer weather and therefore constitute important tools to understand and predict the variations in heat-related mortality.

Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.

A heat-health watch and warning system with extended season and evolving thresholds

BACKGROUND

Many countries have developed heat-health watch and warning systems (HHWWS) or early-warning systems to mitigate the health consequences of extreme heat events. HHWWS usually focuses on the four hottest months of the year and imposes the same threshold over these months. However, according to climate projections, the warm season is expected to extend and/or shift. Some studies demonstrated that health impacts of heat waves are more severe when the human body is not acclimatized to the heat. In order to adapt those systems to potential heat waves occurring outside the hottest months of the season, this study proposes specific health-based monthly heat indicators and thresholds over an extended season from April to October in the northern hemisphere.

METHODS

The proposed approach, an adoption and extension of the HHWWS methodology currently implemented in Quebec (Canada). The latter is developed and applied to the Greater Montreal area (current population 4.3 million) based on historical health and meteorological data over the years. This approach consists of determining excess mortality episodes and then choosing monthly indicators and thresholds that may involve excess mortality.

RESULTS

We obtain thresholds for the maximum and minimum temperature couple (in °C) that range from (respectively, 23 and 12) in April, to (32 and 21) in July and back to (25 and 13) in October. The resulting HHWWS is flexible, with health-related thresholds taking into account the seasonality and the monthly variability of temperatures over an extended summer season.

CONCLUSIONS

This adaptive and more realistic system has the potential to prevent, by data-driven health alerts, heat-related mortality outside the typical July-August months of heat waves. The proposed methodology is general and can be applied to other regions and situations based on their characteristics.

Towards an integrated animal health surveillance system in Tanzania: making better use of existing and potential data sources for early warning surveillance

BACKGROUND

Effective animal health surveillance systems require reliable, high-quality, and timely data for decision making. In Tanzania, the animal health surveillance system has been relying on a few data sources, which suffer from delays in reporting, underreporting, and high cost of data collection and transmission. The integration of data from multiple sources can enhance early detection and response to animal diseases and facilitate the early control of outbreaks. This study aimed to identify and assess existing and potential data sources for the animal health surveillance system in Tanzania and how they can be better used for early warning surveillance. The study used a mixed-method design to identify and assess data sources. Data were collected through document reviews, internet search, cross-sectional survey, key informant interviews, site visits, and non-participant observation. The assessment was done using pre-defined criteria.

RESULTS

A total of 13 data sources were identified and assessed. Most surveillance data came from livestock farmers, slaughter facilities, and livestock markets; while animal dip sites were the least used sources. Commercial farms and veterinary shops, electronic surveillance tools like AfyaData and Event Mobile Application (EMA-i) and information systems such as the Tanzania National Livestock Identification and Traceability System (TANLITS) and Agricultural Routine Data System (ARDS) show potential to generate relevant data for the national animal health surveillance system. The common variables found across most sources were: the name of the place (12/13), animal type/species (12/13), syndromes (10/13) and number of affected animals (8/13). The majority of the sources had good surveillance data contents and were accessible with medium to maximum spatial coverage. However, there was significant variation in terms of data frequency, accuracy and cost. There were limited integration and coordination of data flow from the identified sources with minimum to non-existing automated data entry and transmission.

CONCLUSION

The study demonstrated how the available data sources have great potential for early warning surveillance in Tanzania. Both existing and potential data sources had complementary strengths and weaknesses; a multi-source surveillance system would be best placed to harness these different strengths.

A cold-health watch and warning system, applied to the province of Quebec (Canada)

CONTEXT

A number of studies have shown that cold has an important impact on human health. However, almost no studies focused on cold warning systems to prevent those health effects. For Nordic regions, like the province of Quebec in Canada, winter is long and usually very cold with an observed increase in mortality and hospitalizations throughout the season. However, there is no existing system specifically designed to follow in real-time this mortality increase throughout the season and to alert public health authorities prior to cold waves.

OBJECTIVE

The aim is to establish a watch and warning system specifically for health impacts of cold, applied to different climatic regions of the province of Quebec.

METHODOLOGY

A methodology previously used to establish the health-heat warning system in Quebec is adapted to cold. The approach identifies cold weather indicators and establishes thresholds related to extreme over-mortality or over-hospitalization events in the province of Quebec, Canada.

RESULTS AND CONCLUSION

The final health-related thresholds proposed are between (-15 °C, -23 °C) and (-20 °C, -29 °C) according to the climatic region for excesses of mortality, and between (-13 °C, -23 °C) and (-17 °C, -30 °C) for excesses of hospitalization. These results suggest that the system model has a high sensitivity and an acceptable number of false alarms. This could lead to the establishment of a cold-health watch and warning system with valid indicators and thresholds for each climatic region of Quebec. It can be seen as a complementary system to the existing one for heat warnings, in order to help the public health authorities to be well prepared during an extreme cold event.

A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats

BACKGROUND

Health surveillance is an important element of disease prevention, control, and management. During the past two decades, there have been several initiatives to integrate health surveillance systems using various mechanisms ranging from the integration of data sources to changing organizational structures and responses. The need for integration is caused by an increasing demand for joint data collection, use and preparedness for emerging infectious diseases.

OBJECTIVE

To review the integration mechanisms in human and animal health surveillance systems and identify their contributions in strengthening surveillance systems attributes.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Peer-reviewed articles were searched from PubMed, HINARI, Web of Science, Science Direct and advanced Google search engines. The review included articles published in English from 1900 to 2018. The study selection considered all articles that used quantitative, qualitative or mixed research methods. Eligible articles were assessed independently for quality by two authors using the QualSyst Tool and relevant information including year of publication, field, continent, addressed attributes and integration mechanism were extracted.

RESULTS

A total of 102 publications were identified and categorized into four pre-set integration mechanisms: interoperability (35), convergent integration (27), semantic consistency (21) and interconnectivity (19). Most integration mechanisms focused on sensitivity (44.1%), timeliness (41.2%), data quality (23.5%) and acceptability (17.6%) of the surveillance systems. Generally, the majority of the surveillance system integrations were centered on addressing infectious diseases and all hazards. The sensitivity of the integrated systems reported in these studies ranged from 63.9 to 100% (median = 79.6%, n = 16) and the rate of data quality improvement ranged from 73 to 95.4% (median = 87%, n = 4). The integrated systems were also shown improve timeliness where the recorded changes were reported to be ranging from 10 to 91% (median = 67.3%, n = 8).

CONCLUSION

Interoperability and semantic consistency are the common integration mechanisms in human and animal health surveillance systems. Surveillance system integration is a relatively new concept but has already been shown to enhance surveillance performance. More studies are needed to gain information on further surveillance attributes.

Toward an Improved Air Pollution Warning System in Quebec

The nature of pollutants involved in smog episodes can vary significantly in various cities and contexts and will impact local populations differently due to actual exposure and pre-existing sensitivities for cardiovascular or respiratory diseases. While regulated standards and guidance remain important, it is relevant for cities to have local warning systems related to air pollution. The present paper proposes indicators and thresholds for an air pollution warning system in the metropolitan areas of Montreal and Quebec City (Canada). It takes into account past and current local health impacts to launch its public health warnings for short-term episodes. This warning system considers fine particulate matter (PM_2.5) as well as the combined oxidant capacity of ozone and nitrogen dioxide (O_x) as environmental exposures. The methodology used to determine indicators and thresholds consists in identifying extreme excess mortality episodes in the data and then choosing the indicators and thresholds to optimize the detection of these episodes. The thresholds found for the summer were 31 μg/m³ for PM_2.5 and 43 ppb for O_x in Montreal, and 32 μg/m³ and 23 ppb in Quebec City. In winter, thresholds found were 25 μg/m³ and 26 ppb in Montreal, and 33 μg/m³ and 21 ppb in Quebec City. These results are in line with different guidelines existing concerning air quality, but more adapted to the cities examined. In addition, a sensitivity analysis is conducted which suggests that O_x is more determinant than PM_2.5 in detecting excess mortality episodes.

Share Our Cultural Heritage (SOCH): Worldwide 3D Heritage Reconstruction and Visualization via Web and Mobile GIS

Despite being of paramount importance to humanity, tangible cultural heritage is often at risk from natural and anthropogenic threats worldwide. As a result, heritage discovery and conservation remain a huge challenge for both developed and developing countries, with heritage sites often inadequately cared for, be it due to a lack of resources, nonrecognition of the value by local people or authorities, human conflict, or some other reason. This paper presents an online geo-crowdsourcing system, termed Share Our Cultural Heritage (SOCH), which can be utilized for large-scale heritage documentation and sharing. Supported by web and mobile GIS, cultural heritage data such as textual stories, locations, and images can be acquired via portable devices. These data are georeferenced and presented to the public via web-mapping. Using photogrammetric modelling, acquired images are used to reconstruct heritage structures or artefacts into 3D digital models, which are then visualized on the SOCH web interface to enable public interaction. This end-to-end system incubates an online virtual community to encourage public engagement, raise awareness, and stimulate cultural heritage ownership. It also provides valuable resources for cultural heritage exploitation, management, education, and monitoring over time.

The Effects of Climate Change on Patients With Chronic Lung Disease. A Systematic Literature Review

BACKGROUND

Ever since higher overall mortality rates due to heat stress were reported during the European heat waves of 2003 and 2006, the relation between heat waves and disease-specific events has been an object of scientific study. The effects of heat waves on the morbidity and mortality of persons with chronic lung disease remain unclear.

METHODS

We conducted a systematic search using PubMed, the Cochrane Library, and Google Advanced Search to identify relevant studies published between 1990 and 2015. The reference lists of the primarily included articles were searched for further pertinent articles. All articles were selected according to the PRISMA guidelines. The heat-wave-related relative excess mortality was descriptively expressed as a mean daily rate ratio ([incidence 1]/[incidence 2]), and the cumulative excess risk (CER) was expressed in percent.

RESULTS

33 studies with evaluable raw data concerning the effect of heat waves on patients with chronic lung disease (chronic obstructive pulmonary disease, bronchial asthma, pulmonary arterial hypertension, and idiopathic pulmonary fibrosis) were analyzed in this review. By deriving statistics from the overall data set, we arrived at the conclusion that future heat waves will-with at least 90% probability-result in a mean daily excess mortality (expressed as a rate ratio) of at least 1.018, and-with 50% probability-in a mean daily excess mortality of at least 1.028. These figures correspond, respectively, to 1.8% and 2.8% rises in the daily risk of death.

CONCLUSION

Heat waves significantly increase morbidity and mortality in patients with chronic lung disease. The argument that the excess mortality during heat waves is compensated for by a decrease in mortality in the subsequent weeks/months (mortality displacement) should not be used as an excuse for delay in implementing adaptive strategies to protect lung patients from this risk to their health.

WWOSC 2014: research needs for better health resilience to weather hazards

The first World Weather Open Science Conference (WWOSC, held from 17–21 August 2014 in Montreal, Québec), provided an open forum where the experience and perspective of a variety of weather information providers and users was combined with the latest application advances in social sciences. A special session devoted to health focused on how best the most recent weather information and communication technologies (ICT) could improve the health emergency responses to disasters resulting from natural hazards. Speakers from a plenary presentation and its corresponding panel shared lessons learnt from different international multidisciplinary initiatives against weather-related epidemics, such as malaria, leptospirosis and meningitis and from public health responses to floods and heat waves such as in Ontario and Quebec, Canada. Participants could bear witness to recent progress made in the use of forecasting tools and in the application of increased spatiotemporal resolutions in the management of weather related health risks through anticipative interventions, early alert and warning and early responses especially by vulnerable groups. There was an agreement that resilience to weather hazards is best developed based on evidence of their health impact and when, at local level, there is a close interaction between health care providers, epidemiologists, climate services, public health authorities and communities. Using near real time health data (such as hospital admission, disease incidence monitoring…) combined with weather information has been recommended to appraise the relevance of decisions and the effectiveness of interventions and to make adjustments when needed. It also helps appraising how people may be more or less vulnerable to a particular hazard depending on the resilience infrastructures and services. This session was mainly attended by climate, environment and social scientists from North American and European countries. Producing a commentary appears to be an effective way to share this session’s conclusions to research institutions and public health experts worldwide. It also advocates for better linking operational research and decision making and for appraising the impact of ICT and public health interventions on health.

An evidence-based public health approach to climate change adaptation

BACKGROUND

Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation.

OBJECTIVES

Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change.

METHODS

We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders.

DISCUSSION

A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers.

CONCLUSIONS

The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

Perceived adverse health effects of heat and their determinants in deprived neighbourhoods: a cross-sectional survey of nine cities in Canada

This study identifies several characteristics of individuals who report their physical and/or mental health as being adversely affected by summertime heat and humidity, within the most disadvantaged neighbourhoods of the nine largest cities of Québec (Canada). The study is cross-sectional by stratified representative sample; 3485 people were interviewed in their residence. The prevalence of reported impacts was 46%, mostly physical health. Female gender and long-term medical leave are two impact risk indicators in people <65 years of age. Low income and air conditioning at home are risk indicators at all ages. Results for having ≥2 diagnoses of chronic diseases, particularly for people self-describing as in poor health (odds ratio, OR_<65 = 5.6; OR_≥65 = 4.2), and perceiving daily stress, are independent of age. The prevalence of reported heat-related health impacts is thus very high in those inner cities, with notable differences according to age, stress levels and long-term medical leave, previously unmentioned in the literature. Finally, the total number of pre-existing medical conditions seems to be a preponderant risk factor. This study complements the epidemiologic studies based on mortality or severe morbidity and shows that the heat-related burden of disease appears very important in those communities, affecting several subgroups differentially.

Health impacts of the July 2010 heat wave in Québec, Canada

BACKGROUND

One of the consequences of climate change is the increased frequency and intensity of heat waves which can cause serious health impacts. In Québec, July 2010 was marked by an unprecedented heat wave in recent history. The purpose of this study is to estimate certain health impacts of this heat wave.

METHODS

The crude daily death and emergency department admission rates during the heat wave were analyzed in relation to comparison periods using 95% confidence intervals.

RESULTS

During the heat wave, the crude daily rates showed a significant increase of 33% for deaths and 4% for emergency department admissions in relation to comparison periods. No displacement of mortality was observed over a 60-day horizon.

CONCLUSIONS

The all-cause death indicator seems to be sufficiently sensitive and specific for surveillance of exceedences of critical temperature thresholds, which makes it useful for a heat health-watch system. Many public health actions combined with the increased use of air conditioning in recent decades have contributed to a marked reduction in mortality during heat waves. However, an important residual risk remains, which needs to be more vigorously addressed by public health authorities in light of the expected increase in the frequency and severity of heat waves and the aging of the population.

How can a climate change perspective be integrated into public health surveillance?

OBJECTIVES

Climate change may be considered as a key factor for environmental change, exposure to health risks and pathogens, consequently impairing the state of health among populations. Efficient health surveillance systems are required to support adaptation to climate change. However, despite a growing awareness, the public health surveillance sector has had very little involvement in the drafting of adaptation plans. This paper proposes a method to raise awareness about climate change in the public health community, to identify possible health risks and to assess the needs for reinforced health surveillance systems.

METHODS

A working group was set up comprising surveillance experts in the following fields: environmental health; chronic diseases and; infectious diseases. Their goal was to define common objectives, to propose a framework for risk analysis, and to apply it to relevant health risks in France.

RESULTS

The framework created helped to organize available information on climate-sensitive health risks, making a distinction between three main determinants as follows: (1) environment; (2) individual and social behaviours; and (3) demography and health status. The process is illustrated using two examples: heatwaves and airborne allergens.

CONCLUSION

Health surveillance systems can be used to trigger early warning systems, to create databases which improve scientific knowledge about the health impacts of climate change, to identify and prioritize needs for intervention and adaptation measures, and to evaluate these measures. Adaptation requires public health professionals to consider climate change as a concrete input parameter in their studies and to create partnerships with professionals from other disciplines.

Open-Source web-based Geographical Information System for health exposure assessment

This paper presents the design and development of an open source web-based Geographical Information System allowing users to visualise, customise and interact with spatial data within their web browser. The developed application shows that by using solely Open Source software it was possible to develop a customisable web based GIS application that provides functions necessary to convey health and environmental data to experts and non-experts alike without the requirement of proprietary software.

The burgeoning field of transdisciplinary adaptation research in Quebec (1998-): a climate change-related public health narrative

This paper presents a public health narrative on Quebec's new climatic conditions and human health, and describes the transdisciplinary nature of the climate change adaptation research currently being adopted in Quebec, characterized by the three phases of problem identification, problem investigation, and problem transformation. A transdisciplinary approach is essential for dealing with complex ill-defined problems concerning human-environment interactions (for example, climate change), for allowing joint research, collective leadership, complex collaborations, and significant exchanges among scientists, decision makers, and knowledge users. Such an approach is widely supported in theory but has proved to be extremely difficult to implement in practice, and those who attempt it have met with heavy resistance, succeeding when they find the occasional opportunity within institutional or social contexts. In this paper we narrate the ongoing struggle involved in tackling the negative effects of climate change in multi-actor contexts at local and regional levels, a struggle that began in a quiet way in 1998. The paper will describe how public health adaptation research is supporting transdisciplinary action and implementation while also preparing for the future, and how this interaction to tackle a life-world problem (adaptation of the Quebec public health sector to climate change) in multi-actors contexts has progressively been established during the last 13 years. The first of the two sections introduces the social context of a Quebec undergoing climate changes. Current climatic conditions and expected changes will be described, and attendant health risks for the Quebec population. The second section addresses the scientific, institutional and normative dimensions of the problem. It corresponds to a "public health narrative" presented in three phases: (1) problem identification (1998-2002) beginning in northern Quebec; (2) problem investigation (2002-2006) in which the issues are successively explored, understood, and conceptualized for all of Quebec, and (3) problem transformation (2006-2009), which discusses major interactions among the stakeholders and the presentation of an Action Plan by a central actor, the Quebec government, in alliance with other stakeholders. In conclusion, we underline the importance, in the current context, of providing for a sustained transdisciplinary adaptation to climatic change. This paper should be helpful for (1) public health professionals confronted with establishing a transdisciplinary approach to a real-world problem other than climate change, (2) professionals in other sectors (such as public safety, built environment) confronted with climate change, who wish to implement transdisciplinary adaptive interventions and/or research, and (3) knowledge users (public and private actors; nongovernment organizations; citizens) from elsewhere in multi-contexts/environments/sectors who wish to promote complex collaborations (with us or not), collective leadership, and "transfrontier knowledge-to-action" for implementing climate change-related adaptation measures.