Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions

Regional organisations supporting health sector responses to climate change in Southeast Asia
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However, they provide an institutional mechanism with generic program requirements that are able to manage climate-related risks. Therefore public health officials in Ontario do not require additional guidance, although specific information on how to integrate findings from climate scenarios and models to understand future risks and vulnerabilities Kovats et al.

The findings from the interviews of Canadian public health authorities suggest that climate change adaptations have yet to be implemented in many regions across Canada Canadian Public Health Association This suggests that factors other than institutional mechanisms are necessary for public health authorities to address climate change impacts. Elements identified as being essential for implementing climate change adaptation measures into public health policy and programs include additional resources, increased awareness and climate specific information about risks to health Fussel and Klein The key informant interviews revealed a broad awareness of climate change and related health issues.

Respondents who did report that climate change was considered an important public health issue in their jurisdiction also indicated that it was not considered a high priority Canadian Public Health Association Key challenges in addressing climate-related health risks included a lack of resources, a lack of prioritization of climate impacts on public health and a lack of adequate knowledge about potential linkages between climate change and health Canadian Public Health Association Many identified that climate-related information pertaining to extreme weather warnings, air quality reports, West Nile virus surveillance and monitoring for flooding is used in planning and program development.

When identifying the various challenges faced in reducing climate-related health risks, the respondents did not identify a lack of tools or frameworks for managing risks Canadian Public Health Association The comparative analysis and key informant interviews suggest that regular population health assessments and risk management activities by local public health units in Ontario can address many risks related to climate hazards and emergencies, when information about such risks is made available to health officials.

Many activities identified in the Ontario Public Health Standards mirror those proposed by the climate change and health adaptation frameworks. The overlap between these standards and the frameworks therefore suggests that public health practices in Ontario are theoretically able to accommodate many of the proposed climate considerations and adaptation strategy development measures.

For example, emergency management activities—such as planning and preparedness for weather-related emergencies, which are expected to increase in frequency and severity with climate change Intergovernmental Panel on Climate Change IPCC —flow directly from the hazards identification phase within the Ontario Public Health Standards. What is needed is information about increased health risks associated with climate change.

Some studies have identified general health risks related to climate change for people living in Ontario Abelsohn et al. However, information is lacking about the direct and indirect climate-mediated processes involved at local scales within the time frames needed to inform decision making Tamerius et al.

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Challenges exist in the development of new knowledge about the expected impacts of climate change on health given the very complex causal sources and pathways and intertwined interactions between them Forastiere ; Xun et al. Once current or near-term health risks related to climate variability are identified, activities to protect health before, during and after a health emergency can be adopted.

The Ontario Public Health Standards can address existing diseases that are being exacerbated by climate change e.

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Given that the requirements in Ontario already provide direction for addressing many health concerns that are climate sensitive, new processes or risk management steps are not required in order to mainstream climate change. In order to mainstream climate change concerns, public health decision making requires information about climate-related health risks to inform existing risk management activities. These activities, such as population health assessment, surveillance and public education and outreach can only account for climate factors if information on climate-related risks is available to public health practitioners and researchers e. For example, while it is known that extreme heat can impact morbidity Green et al.

If such information is not available to be considered in the assessment step of existing frameworks, important risks to human health cannot be mainstreamed. However, information in these time scales about projected risks to health is often not available to decision makers. The need in Canada for better understanding of health risks associated with climate change, as reported in the key informant interviews, is also reflected in resolutions or declarations passed by the Canadian Public Health Association , the World Health Organization World Health Organization Department of Communications May 22, and the World Medical Association World Medical Association ; these call for more research into the health impacts of climate change.

A lack of information about risks was also identified as a major barrier to public health adaptation in a recent survey of local health departments in the United States Balbus et al. The development, analysis and transfer of knowledge among local, provincial, federal and international health authorities showing how climate change might impact the health of local populations is critical for facilitating adaptation efforts in the health sector, and should be made a priority area of collaborative efforts in the future Ebi ; Yohe and Ebi At the national level, Health Canada has completed a country-wide assessment of health vulnerabilities to climate change impacts that can help inform the development of needed adaptations by health authorities at local and regional levels Sequin and Clarke Moreover, new knowledge is being developed at the national level on climate-related health risks pertaining to extreme heat events Health Canada , vector-borne diseases and challenges faced by northern populations Government of Canada ; Health Canada A key finding of this study is that a strong foundation for developing and implementing adaptive actions to protect health already exists through current public health requirements and activities in Ontario.

Existing risk management practices can be applied to reduce some climate-related risks, such as air pollution, extreme weather events, infectious diseases e. Thus, the current risk management practices already allow for the mainstreaming of most climate-related health risks.

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There is no need to implement or adopt separate climate change and health adaptation frameworks, particularly given limited resources and competing demands faced by public health officials. For this reason, frameworks that advocate, or propose, new climate change risk management processes and procedures for reducing health risks, will have limited applicability for public health and emergency management decision makers in Ontario and other provinces in Canada, as well as in other countries with similar risk management systems in place.

However, countries and regions with less comprehensive population health assessment, surveillance and public education and outreach activities may benefit more from the guidance provided by the adaptation frameworks examined here. The findings also indicate that risk management systems must be informed by adequate information about climate-related health risks for public health authorities to mainstream climate change concerns and take needed actions to protect at-risk populations.


Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions. BMJ ; doi. Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions - CRC Press Book.

Other research has also indicated that adaptation efforts within and outside of Canada require a better understanding of current and geographically specific risks from climate-related hazards, and projected risks due to climate change in time scales relevant to public health decision makers Haines et al.

In this regard, Huntingford et al. What is needed is more information, including case studies and community examples that aid public health officials in their efforts to obtain, analyze and integrate findings from climate scenarios and models to gauge future impacts on health.

Climate change can only be mainstreamed into health sector activities when such information is available and incorporated into existing public health risk management activities, as well as decision-making processes or standards e. Given the critical role of information about climate-related health risks, future research and program development efforts to support greater mainstreaming would benefit from investigation of the most effective and efficient ways to provide this information to governmental and non-governmental authorities charged with protecting citizens from environmental and climate-related health risks.

The complexity and uncertainty inherent in understanding climate-related health risks means that investigation into best practices for knowledge development, translation and transfer among researchers, decision makers and other stakeholders is required Balbus et al. The findings here also strongly support the call by the World Health Organization for countries to take immediate measures to strengthen existing public health systems to reduce current impacts on health from climate extremes and to prepare for future climate change World Health Organization Robust population health assessments, surveillance and public education and outreach activities, in particular, are key to protecting populations by mainstreaming climate change considerations into existing activities.

The authors are grateful to two anonymous referees for their constructive comments. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited. Skip to main content Skip to sections. Advertisement Hide. Download PDF. From theory to practice: a Canadian case study of the utility of climate change adaptation frameworks to address health impacts.

Open Access. Examples of assessments that synthesized qualitative and quantitative data are presented in Casimiro et al. The key issues that need to be communicated to decision makers and stakeholders include the specific projected health impacts, the current and projected burden of those impacts, the effectiveness of current interventions to control the health impact, the rate at which negative impacts could be detected, and the degree of certainty associated with the projections. Qualitative results can be summarized as, for example, a particular health outcome increasing from a low to medium level of concern over the next few decades with a high degree of certainty, depending on the effectiveness of interventions implemented to reduced the disease burden.

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Convening an interdisciplinary panel of experts with relevant expertise is one approach to developing a consensus assessment. Once synthesized, the information should be peer reviewed and published. Assumptions that underlie any quantitative estimates should be clearly described.

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Quantitative estimates should be clearly identified with its climate scenario. The degree of certainty of qualitative and quantitative statements should be provided, and the most vulnerable population groups should be identified. Value judgments have to be made in summarizing the assessment.

In particular, decisions should be made about how to balance near-term and long-term effects; weigh the potential effects in different population groups; balance the more certain, quantifiable potential effects with those that are less certain and not quantifiable; and balance the interests of the various stakeholder groups Lehto and Ritsatakis, unpublished data. This step identifies possible adaptation measures that could be undertaken over the short term to increase the capacity of individuals, communities, and countries to effectively cope with the weather or climate exposure of concern.

A review of adaptation measures implemented in other regions with similar health concerns may be one source of new adaptations. For example, if heat-related morbidity and mortality are health issues in an urban area and if an early warning system for heat waves has not been implemented, then would implementing such a system likely benefit population health?

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Strengths and weaknesses as well as opportunities and threats to implementation should be evaluated and priorities set. In addition, countries need to adapt to long-term climate change. The second aim of this step is to identify possible measures that can be taken today and in the future to increase the ability of individuals, communities, and institutions to effectively cope with future weather, including extreme weather events.

Consideration should be given to the lessons learned from past public health policies, including the effectiveness of various measures, such as vector control and early warning systems. Many of the possible measures for adapting to climate change lie primarily outside the direct control of the health sector. They are rooted in areas such as sanitation and water supply, education, agriculture, trade, tourism, transport, development, and housing.

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Intersectoral and cross-sectoral adaptation strategies are needed to reduce the potential health impacts of climate change. A policy analysis will determine the feasibility of and priorities among these options. Generally, many of the policies and measures identified also promote sustainable development. Criteria should be established in advance for evaluating possible adaptation measures. Evaluation should be an ongoing process both to identify opportunities for improving the effectiveness of the measures but also to identify maladaptation and unintended consequences as quickly as possible Yohe and Ebi The traditional public health methods for evaluating the efficacy and effectiveness of a particular intervention should be applied, with appropriate consideration of the local circumstances.


For example, the effectiveness of heat event early warning systems can be evaluated by determining whether mortality during heat events decreases after system implementation. This, of course, requires that evaluation criteria be built into the system when it is developed.

For an assessment to be informative, timely, and useful, key issues need to be addressed, particularly stakeholder involvement, an adequate management structure, and a communication strategy. Experiences from countries that have performed assessments have shown the importance of including stakeholders in assessment planning, implementation, and evaluation. Stakeholders include people within governments, nongovernmental organizations, research institutions, and private entities that focus on public health.