preparedness. The survey reveals concerns about availability of expertise on climatechangehealth impacts within the publichealth community and the level of planning and capacity building initiated to respond to this shortfall. Additional training and capacity building are necessary to prepare publichealth professionals to deal with the urgent threats of climatechange. This training needs to include approaches to identifying climate-related novel health problems at an early stage, quantifying possible future health risks at local and regional scales, and identifying and deploying effective adaptation and mitigation measures to address those risks. There also needs to be better coordination and collaboration across sectors, as choices taken and tech- nologies implemented in other sectors will influence human health. Support from federal, state and local policymakers and funders to bolster publichealth agencies will not only improve the ability of those agencies to respond effectively to future health threats, it will also provide greater capacity for publichealth agencies to lend their expertise in critical policy decisions that have significant publichealth implications.
This study suggests that publichealth adaptation requires higher levels of government effort, particularly provincial publichealth policies on climatechange adap- tation and the continued support from federal depart- ments and agencies. The province needs to undertake a comprehensive climatechange vulnerability assessment in the health sector to inform research and policy gaps. Provincial publichealth agencies need to adopt anticipa- tory adaptation strategies by investing in climatechange research to inform effective policies on local publichealth adaptation efforts and ensure that climatechange is integrated into health risk management. There is a need for higher resolution climate projection models, improved and standardized surveillance, and monitoring and early warning systems to manage climate related health risks. Ontario publichealth departments would benefit from a research center aimed at advancing envir- onmental health surveillance and warning systems, to support local research pilot projects, epidemiological studies and to establish long-term monitoring systems to track climatechange driven health outcomes and pro- gram and policy effectiveness to reduce those risks. Health department adaptation resources will be required for enhancing programs and will need to come from higher government sources. The province already sup- ports the development of risk management tools to manage heat related risks and works closely with publichealth units to raise awareness of health hazards asso- ciated with Lyme disease . Further efforts could capitalize on the recently released Ontario Climate Ready Adaptation Plan , which calls for enhanced provincial health policies on climatechange. The provin- cial plan provides the impetus to allocate resources to climatechange and health initiatives, a source to identify available health policy adaptation tools (Climate Model- ing Collaborative) and to identify opportunities to main- stream publichealth considerations into adaptations occurring in other sectors.
Several government and non-government organizations are working in the cyclone affected area. For each FGD a maximum of 10 persons, one from each organization working in the affected area was selected. As the participants were non-English speakers, the interview guide was translated into Bengali. Written consent was taken from the participants before recording the interviews and played back to them. During the interviews the researcher used the Bengali language, which was again translated into English by the researcher for the purpose of analysis. Respondents were found to have tremendous memories of the Sidr experience. The following steps insured the validity and reliability of the data collection instrument. Firstly a thorough literature review has been carried out related to climatechange, health and natural disasters. Secondly the experts in the field of climatechange and publichealth verified the interview guide for the Focus Group Discussion. To attain accuracy and reliability of the data, care and caution were taken during data collection. The participants were found to be co-operative and simple language was used for smooth flow of the discussion. The present research being a pilot one has of course some limitations, for example, in selecting small number of respondents and selection of qualitative method. However, future research may focus on a larger sample which will help avoiding selection bias in the results.
The newly-formed California Department of PublicHealth (CDPH) can play an important role in refining these tools and in defining the publichealth sector’s role in climate policy more generally. To date, the CDPH has not taken an active role in the state’s climatechange policy process. By taking a leadership role on climatechange issues, the CDPH can make several important contributions: (i) help guide the development of climate-related information that will be useful for the publichealth community, (ii) provide a means to refine and evaluate existing adaptation tools for publichealth agencies, (iii) increase involvement in climate-related decisionmaking by the publichealth community, and (iv) maximize the publichealth co-benefits associated with policy decisions (e.g., well-planned walkable communities can provide publichealth benefits associated with increased exercise and reduce emissions associated with traditional transportation sources). All of these contributions will help the publichealth sector be best prepared to cope with the publichealth impacts associated with a changing climate.
responsibilities, and top-down and bottom-up influence, along with questions regarding the interviewee’s role, the agency’s administrative structure and progress on adaptation, and the role of NGOs (Appendix C). Interviewees were asked a variety of open questions related to adaptive capacity, such as the level of priority given to climatechange adaptation relative to other health issues in the region, their level of knowledge on climatechange impacts and adaptation, and their capacity (e.g. knowledge, resources and skills) to implement adaptation initiatives. Local-level interviewees were also asked questions regarding how upper-level governments have enabled or could support local publichealth adaptation. The same interview guides were used in both countries for comparative analysis. This consistent semi-structured interview style allowed interviewees to guide the discussion to areas of greatest importance or concern to them.
In Germany, the Federal Environment Agency (UBA) has invested a high level of resources in developing measures to address the issue of climatechange and publichealth, in particular through establishing the national Competence Centre on Climate Impacts and Adaptation 1 , which created a catalogue of climatechange and health data that is and will be used by all decision-making bodies. A climatechange adaptation plan has been developed, including measures such as awareness-raising at both national and local levels. The plan involved 15 sectors, including health, and included a database for sharing the information between stakeholders, rapid alert system and climatechange guide for small and medium- sized businesses, which provides advice on issues such as pest control, the health impacts of organisms such as pollen, and adaptation measures. A national conference on the impacts of weather extremes was held in September 2010 in which the need to optimize appropriate adaptation measures was discussed. It was agreed that it is vital to learn from the experiences of the heat health warning system and to establish further early warning systems.
Three key governance dimensions of publichealth adaptation have received greater consensus in academic literature: cross-sectoral collaboration, vertical coordination, and national adaptation planning [23,25,50–53]. These three dimensions stand out in the literature as highly necessary, pertinent to publichealth adaptation challenges, and applicable across country contexts. First, the health risks posed by climatechange are cross-sectoral in nature, impacting health through multiple pathways, and involving a diversity of actors with varying roles and responsibilities, and different types of communities and populations with diverse vulnerabilities . One of the primary recommendations from the 2015 Lancet Commission on ClimateChange and Health is for governments to facilitate collaboration between ministries of health and other departments, such as environment . A multi-sectoral approach is required to address multiple drivers of adverse health outcomes of climatechange and identify the most effective and efficient interventions. Second, as discussed above, national governments play a key role in coordinating or facilitating adaptation across scales and are uniquely positioned to carry out a variety of influential roles [38,40,54]. Without coordination, adaptation may take an isolated and piecemeal approach thereby increasing the chances of maladaptation (increasing vulnerability to climatechange in the long term or of other sectors, social groups or systems) [55,56]. Climatechange requires coordination of demands and needs across scales, to create synergies and avoid trade-offs between scales and at minimum to clarify jurisdictional roles and responsibilities in adaptation [37–39]. Other studies find most national governments have not taken a large leadership or steering role to date, and national adaptation policies are often disconnected from sub-national levels [39–42]. Lastly, national adaptation planning can serve to overcome challenges of horizontal and vertical coordination, provide a coherent and consistent publichealth adaptation policy, and enable and include private sector adaptation to invest resources (e.g., time, money) if or when needed. National adaptation plans may also be used to clearly outline the roles and responsibilities of sectors, agencies or scales, create consistency and synergy between national strategies, or meet regional adaptation planning requirements [42,44]. In this study we identify practical options for national governments to incorporate these three key governing dimensions into national-level publichealth adaptation planning in different contexts based on country experiences.
The National Communications reports were retrieved from the UNFCCC website. From the preliminary analysis, 35 categories of adaptive measures in the publichealth sector emerged and these were later re-organised into six thematic areas, which included early warning systems, public education and awareness, surveillance, research and monitoring, enhanced infectious disease control programmes, policies development, improved publichealth infrastructure and technology. Details of the themes and number of categories in each of the themes are presented in Table 2. Following Patrick and Munro’s (2004) framework, this article also employed a literature survey approach on the impacts of climatechange on publichealth system and a review of online submitted adaptation measures. In addition, the grounded theory approach by Glaser and Strauss (1967), which was documented later by Hussein et al. (2014), was also employed. Grounded theory entails the use of literature as data and in this case, data were retrieved from the National Communications reports. The grounded theory approach aims to find a theory from data systematically obtained from social research. It further explores integral social relationships and provides contextual meaning (Crooks 2001). The meaning was then derived from the retrieved information. Grounded theory approach provides comparative advantages such as its richness in imaginative concepts that are easy to apply, ability to develop new ideas, and quick and easy for
vulnerabilities and adaptation in the province. Similar to the United Kingdom Climate Impacts Program (UKCIP), Ouranos functions as a boundary organization that seeks to bridge science and policy to increase engagement of decision-makers, build adaptive capacity and create a network of knowledge ; such boundary organizations have been identified as an important component of institutional development for promoting readiness for adaptation [18,75]. Ouranos emerged in response to several extreme weather events (1998 ice storm and 2000 flooding in Quebec, and the European heat wave in 2003) which incited support for climatechange research . Gosselin et al. suggest adaptation to the health impacts of climatechange in Quebec is taking place because of stable financing (money from the province’s carbon tax funds its climatechange action plan), willingness for transdisciplinary collaboration, openness to publichealth innovation, and the knowledge provided by Ouranos on the current and projected impact of climatechange in the province .
The extreme weather events of 2011 in Cook County appear to be in accordance with the current climatechange predictions. With two 100-year storms occurring during the summer of 2011, as well as the 20 inches of snow, which fell in 24 hours in February 2011, it is obvious that officials in Cook County must plan and prepare for both summer and winter weather emergencies. We recommend that Cook County officials improve surveillance of these extreme weather events, identify vulnerable populations, improve communication with the public during these extreme weather events, and review their emergency operations plans. We also recommend that certain specialists like geriatricians, community health physicians who care for low-income, minority residents, and homeless advocates be consulted in creating the emergency operations plans so that all vulnerable populations are included. From
Rapid urbanization along with poor sanitation, inadequate waste management, deforestation and fuel burning is increasing the risk of heat, flood, cyclones, earthquakes and sea level rise. The ultimate result is loss of lives and livelihoods, massive migration, increased vector borne diseases, malnutrition and psychological stress. Inade- quate publichealth infrastructure is a major challenge for Bangladesh, especially in vulnerable areas. Measures should be taken to cope with the inevitable changes including construction of floodwalls, development of drought tolerant crops, adoption of irrigation methods that use less water, ensuring no settlements in vulnerable areas. Better urban design and planning measures have to be put in place to reduce urban crowding and reduce exposures. There are many possible co-benefits in implementing adaptation measures. Such as, by putting in place the measure for controlling diarrhoeal diseases, safe water supply and sanitation facilities will also help in the control of other water borne diseases such as Typhoid and Hepatitis A. There will be an overall reduction in mortality and morbidity of the general population. Reforestation to mitigate effects of climatechange will pre- vent soil erosion and improve air quality. Hospitals and schools built in coastal areas may be used as flood shel- ters thus will enhance the quality of life for vulnerable populations. Improved urban management, including better housing design and zoning measures will result in enhanced quality of life and will create a less-polluted environment. Adaptation measures will be more effective with strong community participation.
The impact of climatechange on health, depend on several factors. These factors include the effectiveness of a community’s publichealth and safety systems to prepare for the risk and the behavior, age, gender and economic status of individuals, affected impacts will likely to vary by regions. Heat waves increase due to global warming and combine with the buildup of pollution, including ozone, a primary component of smog. Air temperature and ozone may be bad for the heart because they influence the way the automatic nervous system functions. The automatic nervous system is a part of the central nervous system that helps the body adapt to its environment. It regulates body functions including the heart’s electrical activity and airflow into the lungs. Higher temperatures may also make the body more sensitive to toxins, such as ozone.
The policy debate around efforts to tackle global warming is divided into either mitigation or adaptation responses. Mitigation refers to the efforts to slow or even reverse cli- mate change by reducing greenhouse gas emissions. Some people would argue that we should focus on preventing the cause of global warming, whereas others point to the fact that global warming is already occurring and that we must learn to face its consequences. While primary prevention is a central tenant of publichealth, policies for climatechange mitigation must come largely from other sectors, such as energy and transportation. Work on find- ing a way for these sectors to collaborate (which usually work in isolation) is a challenge. More conventionally, publichealth has focused on preparing to face the impacts of climatechange (adaptation). As a discipline, publichealth more easily relates to adaptation, and much of the efforts have revolved around preparedness developments. However the focus on mitigation takes on a global focus, whereas the consequences of climatechange have regional implications and thus adaptation solutions tend to be state-based.
a two degrees Celsius rise in global average warming by the end of the century. Anticipated climatechange will impact the environment and health of most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. Vulnerable populations will be impacted disproportionately, raising moral concerns of equity and fairness. Those that are often the least responsible for climatechange, experience the greatest adverse impacts. This paper reviews the literature on the health impacts of climatechange, issues of inequity across vulnerable populations and generations, the health co-benefits of greenhouse gas mitigation, and potential options for adaptation to increasingly extreme weather events.
distribution of money, power, and resources at global, national, and local levels. The list of potential SDOHs is expansive and includes food insecurity, housing instability, violence exposure, structural racism, poverty, and immigration-related stressors. Addressing SDOHs within the pediatric medical home has garnered considerable interest lately as a potential solution to both improving health across the life course and mitigating health care costs. 1 However, one critical determinant is missing from the pediatric community ’ s de ﬁ nition of SDOHs: climatechange. Climatechange (also called global warming) is arguably one of the greatest publichealth threats of our time. Climatechange is caused by rising greenhouse gas emissions from human activity, resulting in higher global average temperatures and changes to environmental and human systems. The American Academy of Pediatrics (AAP) issued a policy statement in 2007 (revised in 2015) encouraging pediatricians to reduce carbon emissions and support families experiencing the effects of climatechange. 2 We agree with this call to action. However, given the current national focus of policymakers, funders, and health care systems on addressing SDOHs, along with the ubiquitous impact of the changing climate on the social and environmental circumstances in which children live, we recommend climatechange be de ﬁ ned as a critical and often overlooked social determinant. Viewing climatechange as an SDOH could potentially help coalesce a large group of ideologically different
A new publichealth movement is needed to educate, advocate, and collaborate with local and national leaders regarding the risks climatechange poses to children and the major health bene ﬁ ts associated with mitigation policy. In addition, ongoing research into the links between climate and health outcomes and the development of medical and publichealth interventions to protect individuals and communities from inevitable changes is needed. Pediatricians, as advocates for the population most vulnerable to climatechangehealth effects, have a valuable role to play in this movement.
Effective implementation of mitigation and adapta- tion strategies must involve actions from the global to local levels by governments, corporations, communities, and individuals. Furthermore, climatechange is part of generalized global change, which includes population growth, land use, economic change, and evolving tech- nology; all have effects on individual human and publichealth (Fig 2). Any solutions that address climatechange must be developed within the context of overall sustain- able development (the use of resources by the current generation to meet current needs while ensuring that
Physicians have written on the projected effects of climatechange on publichealth, but little has been written specifically on anticipated effects of climatechange on children’s health. Children represent a particularly vulnerable group that is likely to suffer disproportionately from both direct and indirect adverse health effects of climatechange. Pediatric health care professionals should under- stand these threats, anticipate their effects on children’s health, and participate as children’s advocates for strong mitigation and adaptation strategies now. Any solutions that address climatechange must be developed within the context of overall sustainability (the use of resources by the current generation to meet current needs while ensuring that future generations will be able to meet their needs). Pediatric health care professionals can be leaders in a move away from a traditional focus on disease prevention to a broad, integrated focus on sustainabil- ity as synonymous with health.