Robin Fears and Volker ter Meulen

Summary

A recent project on climate change and health from the InterAcademy Partnership (IAP), the global network of academies of science, engineering and medicine, shares evidence to inform policy at national, regional and global levels. Capturing diversity within and between regions in assessing the adverse effects on health helps to identify common challenges and guide solutions for urgent action, prioritised for those who are most vulnerable.

Both mitigation and adaptation are vital and must be better coordinated. Different approaches to adaptation must be better integrated between sectors and levels of governance, involving communities in co-design and implementation, avoiding those actions that jeopardise public health and environmental sustainability or may lead to maladaptation, and recognising the continuing need to clarify impact measurements and the potential limits to adaptation.

Specific examples from the IAP project include assessment of adaptation to the threats of heat, wildfires, flooding, infectious disease, forced displacement, and malnutrition. While adaptation is often at a local scale, there are wider connotations including cross-border implications of threats to health, which may require regional action. There are many inequities in the current global response to climate change and other health crises. Transformative change in developing, financing and progressing solutions is essential to deliver objectives for health equity and climate justice and this requires the scientific community to generate robust evidence on the impact of adaptation actions in order to guide financing and implementing of solutions. Academies can help to address current imbalances and methodological weaknesses in research generation and use by communicating the voices from those who have not always been heard in the processes whereby evidence informs policy.

Introduction to the challenges for the shared global agenda

Climate change is a global health crisis as well as an environmental and financial crisis (Willetts et al., 2022) and the World Health Organization has emphasised that climate change is the single biggest health threat facing humanity. Climate change poses serious threats now to human physical and mental health and health risks will increase over time (Haines and Ebi, 2019). People and ecosystems least able to cope are being hardest hit (IPCC, 2022).

Until recently the adverse health effects of the climate crisis had been relatively neglected by policy-makers but that is beginning to change. Although the scale, nature and timing of adverse effects of climate change on physical and mental health, via both direct and indirect pathways, vary within and between regions of the world, there are common challenges. Rapid and decisive action could greatly reduce the long-term risks to health from climate change and bring near-term benefits to health and the resilience of health systems. To achieve objectives for health equity and climate justice, an increased focus on the most vulnerable groups in marginalised and disadvantaged communities is essential. There are unprecedented threats but also unprecedented opportunities to use scientific knowledge to inform policy and practice. Much can be done now to use the evidence already available: solutions for adaptation and mitigation are within reach using present knowledge, but action requires political will.

Framing the scope and scale for academies’ collective work on adaptation for health

This paper draws on the work of a project by the InterAcademy Partnership (IAP), the global network of more than 140 academies of science, engineering and medicine – including the Pontifical Academy of Sciences – enabling the voice of science to be heard in addressing societal priorities. This inter-regional, inclusive, project encouraged academies to capture diversity in evaluating evidence from their own countries on climate change and health issues. Project design encouraged expert participants to use a transdisciplinary, systems-based, planetary health approach to inform policy options for collective and customised action. Working groups from four regional academy networks were constituted: in Africa (the Network of African Science Academies, NASAC), Asia (the Association of Academies and Societies of Sciences in Asia, AASSA), the Americas (the InterAmerican Network of Academies of Science, IANAS) and Europe (the European Academies’ Science Advisory Council, EASAC). The networks agreed on the overall scientific scope and project design and on priority questions to address as the common starting points. Publication of the reports (EASAC, 2019; AASSA, 2021; IANAS, 2022; NASAC, 2022) was accompanied by engagement with the science and policy communities in the regions and at national level. The four regional reports and the feedback on them were then also used as a resource to prepare a fifth, global report (IAP, 2022).

Clarifying multiple pathways to inform the policy response

The pathways of climate change exposure are complex and health impacts are modified by social determinants. Although there are uncertainties in attribution and extrapolation, it is clear that climate change affects health and health systems in multiple ways, see Figure 1. While climate change affects everybody, a focus on solutions for the most vulnerable in society can help to stop hazards becoming disasters (Kelman, 2017; Ismail-Zadeh, 2022).

Climate change also intersects with other major health crises, in particular those occasioned by COVID-19 (Wyns and van Daalen, 2021) and the Ukraine war. For example, the three concurrent crises are leading to an amplification of pressures worldwide on food and nutrition security (Kornher and von Braun, 2022) and hence on health.

Both mitigation and adaptation approaches are essential as solutions to tackle climate change and its drivers and develop climate-resilient health systems (Blom et al., 2022), but they have often been applied in a fragmented way and they should be better integrated with the aim of achieving resilient, net-zero emission societies. Adaptation becomes more feasible when there is decisive mitigation and there will be limits to adaptation beyond which adverse impacts cannot be prevented. Some key issues for evidence generation and use for guiding selection and implementation of solutions are summarised in Box 1, drawing on the IAP project reports.

What is the current status of policy responses worldwide and their underpinning by evidence? Many countries have developed National Adaptation Plans, and establishing linkages with Nationally Determined Contributions is important to support integrated mitigation and adaptation interventions, increase accountability and avoid duplication of governance structures. While an increasing number of countries have identified climate-related health risks and started to implement early-warning systems for adaptation, the focus is usually narrow and has mostly pertained to heat-related impacts and (vector-borne) infectious disease risks. Other threats, for example from water-borne diseases, malnutrition and the multiple impacts of climate change on mental health have often been relatively neglected. Concerns remain about the low level of political commitment and lack of ambition in developing national responses; limited allocation of human and financial resources; poor linkages with the Sustainable Development Goals; lack of prioritisation; poor use of evidence to inform policy-making; and low level of implementation. There is progress: the health services in more than 80 countries are now connected with the corresponding national meteorological services to assist in using knowledge for health adaptation planning, including through heat-health early-warning systems.

Cross-sectoral action informed by stakeholder engagement (Oktari et al., 2022) is essential to realise the health potential for both mitigation and adaptation (Buse et al., 2022). This includes integrating interventions on health infrastructure, urban planning, housing and building design, nature-based solutions, early-warning systems, policy and management, and perception and behaviour.

Progress also depends on better integration of currently disconnected global policy initiatives, for example to tackle both climate change and biodiversity loss together. This requires coordination at the level of the intergovernmental institutions (UN Framework Convention on Climate Change and Convention on Biological Diversity) (Willetts and Grant, 2022) and by the corresponding international advisory bodies (IPCC and IPBES).

Setting the overall context for adaptation strategies

There will likely be complementary adaptation approaches to a given hazard. For example, adaptation to heat can be technical (e.g., insulation, green walls), societal (e.g., urban greening), physiological (e.g., individual acclimatisation), institutional (e.g., within public health services), economic (e.g., subsidies for building and renovation) and behavioural (e.g., seeking cooler environments). Integrated adaptation preparedness and responsiveness require decision-makers to address both shorter-term (e.g., education and awareness-raising) and longer-term (e.g., city planning) interventions, involving different levels of governance, including local authorities. However, literature surveys demonstrate that for many local adaptation initiatives, for example in medium-sized cities worldwide, the extent of cross-sectoral involvement, including the public health sector, varies greatly and planning may be unbalanced (Gopfert et al., 2019).

In addition to integration between sectors and different levels of governance, there are a number of other general considerations to be taken into account when devising and implementing adaptation plans (Figure 2). Achieving “triple win” objectives necessitates prioritisation of those adaptation solutions that are value-creating and sustainable, avoiding practices and business models that jeopardise public health and environmental sustainability (Guerriero et al., 2020). The framework for assessing such interventions requires transdisciplinary support (Bell et al., 2019). The measurement of impact of adaptation actions is challenging and, unlike mitigation where the effectiveness of action can be measured in terms of “GHG emissions reduced”, no universally accepted metric for assessment of adaptation effectiveness exists – we emphasise that health indicators must be at the core. Evidence for adaptation success in national adaptation plans, is mixed (Watts et al., 2021) and the evidence base, for the ex-ante evaluation of adaptation responses is particularly limited in low- and middle-income countries (LMICs) (Scheelbeek et al., 2021).

Without impact measurement it is difficult to know whether an intervention is appropriate for sharing more widely as good practice or, indeed, if there is potential for the intervention to worsen the situation. Some internationally-funded interventions in LMICs may inadvertently reinforce, redistribute or create new sources of vulnerability to climate change (maladaptation in Figure 2), particularly if community stakeholders have not been involved in co-design and implementation of the action (Eriksen et al., 2021).

Limits to adaptation (Figure 2) will apply to the exposure to various hazards. For example, in seeking adaptation to flooding there may be physical limits (e.g., low-lying islands or other localities), behavioural limits (e.g., for populations living in vulnerable areas), technological limits (e.g., nature of flood defences) and financial limits (e.g., who pays and what are the cost-benefit considerations). An evaluative approach using the IPCC ‘burning ember’ representations, to illustrate risk (Ebi et al., 2021), recently characterised limits to adaptation to heat-related morbidity and mortality, O₃-related mortality, malaria, dengue and Lyme disease, if temperature increases were to exceed 2°C.

Responses to reduce the risk of the negative burden on health may be implemented at several levels: by specific individual or population level adaptation interventions or by strengthening the resilience of the system that enables it to respond effectively to a perturbation (Figure 2). Some of the approaches for developing effective near-term adaptation solutions are summarised in Table 1; further detail and references, including discussion of successful adaptation in response to each of these hazards, are provided in the IAP project reports. There is much work still to be done to clarify the positive effects of health adaptation (Rocklov et al., 2021). And, to maximise impact, specific adaptation solutions must be accompanied by action to understand and address the social determinants of disadvantage in vulnerable populations. For example, recent research reviewing data from 32 LMICs shows that the extent of adverse climate-health effects of infectious disease-precipitation relationships in young children were dependent on the degree of deprivation in household living conditions (Dimitrova et al., 2022). Academies and their networks are well-placed to help lead the scientific community to generate robust, validated and contextualised, evidence on the impact of adaptation actions in order to guide policy decisions

While many of the adaptation actions may be customised at a local scale, there are often wider connotations including cross-border implications of health threats, such as those arising from air pollution, infectious disease and forced displacement. Moreover, there may also be wider regional implications for adaptation and maladaptation if national action leads, inadvertently or not, to adverse consequences elsewhere. For example, many nations are currently exporting their lack of environmental sustainability (Wiedmann and Lenzen, 2018) by importing food, feed and biomass generated unsustainably elsewhere. Regional coordination can also help if there is a lack of data for a particular country: academies and their regional networks can advise national policy makers to consider relevant data from elsewhere.

Focusing on climate justice

There are many inequities in the global response to climate change (Romanello et al., 2021) and the IAP reports highlight the imperative for implementing solutions that focus on vulnerable groups in different regions. The present inequality in climate change impacts and in implementation of solutions brings major costs for society: transformative changes require a fundamental shift from a current emphasis on individualist lifestyles to a sharing economy based on equitable, inclusive, sustainable development paths (Anon. 2022).

These solutions also depend on transforming the present funding pathways. Global finance for adaptation across all sectors is only a small fraction of the finance for mitigation actions and finance flows to the health sector are particularly low (less than 1% of climate adaptation finance (Watkiss and Ebi, 2020). This neglect of health adaptation solutions must be corrected. Furthermore, current spending on harmful subsidies for fossil fuels or unsustainable agriculture, should be redirected to support universal health coverage, public transport, affordable healthy food choices and other policies that improve health, reduce GHG emissions and promote equity. This reform could be key to achieving public and political support for climate change action (Buchs et al. 2021; Watkiss and Ebi, 2022).

In tackling health inequities and pursuing climate justice, academies can play an important role by taking account of local health profiles, ecosystems and cultures in research using validated methodologies to quantify adaptation solutions, and linking local action with the national, regional and global pathways of change as these emerge. Collectively academies can help to highlight the imperative for climate justice worldwide and to articulate to decision-makers the human cost of failing to meet ambitious and equity-related goals. The very wide geographical coverage of IAP, both in terms of its evidence gathering and analysis, and its subsequent reach-out with key messages, is valuable in representing the voices of those from LMICs and other vulnerable populations who are not always heard during the processes whereby evidence informs international policy. We emphasise the need to correct the current global imbalances, by engaging with vulnerable communities in the design and use of research and in clarifying and scaling up the implementation of effective adaptation interventions. There is much still to be done to embody health equity and climate justice in the evaluation and implementation of adaptation solutions.

References

AASSA (2021). The imperative of climate action to promote and protect health in Asia.

Anon (2022). The cost of inequality. Nature Sustainability 5, 89.

Bell R, Khan M, Romeo-Velilla M et al. (2019). Ten lessons for good practice for the INHERIT triple win: health, equity and environmental sustainability. International Journal of Environmental Research and Public Health 16, 4546.

Blom IM, Beagley J and Quintana AV (2022). The COP26 health commitments: a springboard towards environmentally sustainable and climate-resilient health care systems? Journal of Climate Change and Health doi: https://doi.org/10.1016/j.joclim.2022.100136. 

Buchs M, Ivanova D and Schnepf SV (2021). Fairness, effectiveness, and needs satisfaction: new options for designing climate policies. Environmental Research Letters 16, 124026.

Buse, K., Tomson, G., Kuruvilla, S. et al. (2022). Tackling the politics of intersectoral action for the health of people and the planet, BMJ, 376 e068124.

Dimitrova A, McElroy S, Levy M, Gershunov A and Benmarkina T (2022). Precipitation variability and risk of infectious disease in children under 5 years for 32 countries: a global analysis using demographic and health survey data. Lancet Planetary Health 12, e147-155.

EASAC (2019). The imperative of climate action to protect human health in Europe.

Ebi KL, Capon A, Berry P et al. (2021a). Hot weather and heat extremes: health risks. The Lancet 398, 698-708.

Eriksen S, Schipper ELF, Scoville-Simonds M et al. (2021). Adaptation interventions and their effect on vulnerability in developing countries: help, hindrance or irrelevance? World Development 141, 105383.

Gopfert C, Wamsler C and Lang W (2019). A framework for the joint institutionalisation of climate change mitigation and adaptation in city administrations. Mitigation and Adaptation Strategies for Global Change 24, 1-21.

Guerriero C, Haines A and Pagano M (2020). Health and sustainability in post-pandemic economic policies. Nature Sustainability 3, 494-496.

Haines A and Ebi K (2019). The imperative for climate action to protect health. New England Journal of Medicine 380, 263-273.

IANAS (2022). Taking action against climate change will benefit health and advance health equity in the Americas.

IAP (2022) Health in the climate emergency: a global perspective.

IPCC (2022). Climate change 2022: impacts, adaptation and vulnerability.

Ismail-Zadeh A (2022). Natural hazards and climate change are not drivers of disasters. Natural Hazards 111, 2147-2154.

Kelman I (2017). Climate change and vulnerability. UNDRR Prevention Web (16 May 2017), www.preventionweb.net

Kornher L and von Braun J (2022). Higher and more volatile food prices – complex implications of the Ukraine war and the COVID-19 pandemic. ZEF Policy Brief No. 38

NASAC (2022) Protecting human health against climate change in Africa.

Oktari, R.S., Dwirahmadi, F., Gan, C.C.R. et al. (2022) Indonesia’s climate-related disasters and health adaptation policy in the build-up to COP26 and beyond, Sustainability, 14 1006.

Rocklov J, Huber V, Bowen K and Paul R (2021). Taking globally consistent health impact projections to the next level. Lancet Planetary Health 5, e487-493.

Romanello M, McGushin A, Di Napoli C et al. (2021). The 2021 report of the Lancet countdown on health and climate change: code red for a healthy future. The Lancet 398, 1619-1662

Scheelbeek PFD, Dangour AD, Jarmul S et al. (2021). The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries. Environmental Research Letters 16, 073001.

Watkiss, P. and Ebi, K.L. (2022). A lack of climate finance is harming population health, BMJ, 376 o3131.

Watts N, Amann M, Arnell N et al. (2021). The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 397, 129-170.

Wiedmann T and Lenzen M (2018). Environmental and social footprints of international trade. Nature Geoscience 11, 314-321.

Willetts L and Grant L (2022). The health-environment nexus: global negotiations at a crossroads. Lancet https://doi.org/10.1016/S0140-6736(22)00561-X

Willetts, E., Grant, L., Bansard, J. et al. (2022) Health in the global environmental agenda: a policy guide. International Institute for Sustainable Development. https://www.iisd.org/publications/health-global-environment-agenda-policy-guide

Wyns A and van Daalen KR (2021). From pandemic to Paris: the inclusion of COVID-19 response in national climate commitments. Lancet Planetary Health 5, e256-258.

Figure 1. Diverse pathways of climate change risk and potential health effects. For detailed discussion see EASAC (2019), AASSA (2021), IANAS (2022), NASAC (2022) and IAP (2022).

Box 1: Recommendations on evidence generation and use to guide decisions on selecting and implementing solutions, from IAP global and regional reports

 • Using the evidence base already available to inform policy and practice with greater urgency and ambition.

• Filling knowledge gaps by transdisciplinary research, including clarifying intersections between climate change and concurrent global health crises such as COVID-19.

• Strengthening monitoring and surveillance activities that link health and climate.

• Improving evaluation of impacts of climate mitigation and adaptation actions to assess and quantify benefits, trade-offs and costs, and document facilitators and barriers to action.

• Effective health risk communication, including countering misinformation and addressing equity in climate-health responses.

• Expanding academy roles worldwide in support of science as a public good.

Figure 2. The context for identifying and implementing health adaptation strategies in responding to, and preparing for, climate change

Table 1. Adaptation approaches discussed in the IAP regional reports