Climate change adaptation to extreme heat: a global systematic review of implemented action

Extreme heat events impact people and ecosystems across the globe, and they are becoming more frequent and intense in a warming climate. Responses to heat span sectors and geographic boundaries. Prior research has documented technologies or options that can be deployed to manage extreme heat and examples of how individuals, communities, governments and other stakeholder groups are adapting to heat. However, a comprehensive understanding of the current state of implemented heat adaptations—where, why, how and to what extent they are occurring—has not been established. Here, we combine data from the Global Adaptation Mapping Initiative with a heat-specific systematic review to analyze the global extent and diversity of documented heat adaptation actions (n = 301 peer-reviewed articles). Data from 98 countries suggest that documented heat adaptations fundamentally differ by geographic region and national income. In high-income, developed countries, heat is overwhelmingly treated as a health issue, particularly in urban areas. However, in low- and middle-income, developing countries, heat adaptations focus on agricultural and livelihood-based impacts, primarily considering heat as a compound hazard with drought and other hydrological hazards. 63% of the heat-adaptation articles feature individuals or communities autonomously adapting, highlighting how responses to date have largely consisted of coping strategies. The current global status of responses to intensifying extreme heat, largely autonomous and incremental yet widespread, establishes a foundation for informed decision-making as heat impacts around the world continue to increase

The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries.

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013-2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action

Waiting for the wave, but missing the tide: Case studies of climate-related (im)mobility and health

Climate change amplifies health risks, including through the health impacts of climate-related displacement. Yet diverse mobility responses in a warming world can also provide a pathway for climate change adaptation. This article examines the connections between climatic and environmental change, human mobility and health. It presents case studies across three countries: Fiji, Bangladesh, and Burkina Faso. All case studies used qualitative methods, including semi-structured interviews, storytelling, and group discussions. The Fiji case study focuses on relocation of a coastal village exposed to erosion, flooding and saltwater intrusion; it highlights self-reported health risks and opportunities following relocation. The Bangladesh case study includes seven sites that variously experience flooding, cyclones and riverbank erosion; while residents use migration and (im)mobility as a coping strategy, there are associated health risks, particularly for those who feel trapped in new sites of residence. The case study from a village in Burkina Faso examines seasonal labour migration to the Ivory Coast and Mali during times of drought and reduced agricultural productivity, and discusses health risks for men who migrate and for women who remain in sending communities. These case studies illustrate that there is no consistent figure that represents a 'climate migrant', ‘climate refugee’, or ‘trapped’ person. Accordingly, we argue that where planetary health looks to highlight ‘waves’ of climate displacement, it may miss the ‘tide’ of slower onset climatic changes and smaller-scale and diverse forms of (im)mobility. However, even where climate-related mobility is broadly adaptive - e.g. providing opportunities for livelihood diversification, or migration away from environmental risks - there can be health risks and opportunities that are shaped by socio-political contexts, access to healthcare, altered food sources, and living and working conditions. Responsive solutions are required to protect and promote the health of mobile and immobile populations in a warming world

Human mobility and health in a warming world

Humans have a long history of mobility on a spectrum from voluntary migration to forced displacement in response to social, political and environmental change. While many migration drivers exist, climate change is likely to amplify the environmental drivers of migration. At least 1.5°C of warming above pre-industrial levels between 2030 and 2052 are projected if global warming continues to increase at the current rate.1 The associated impacts are diverse and include temperature and precipitation extremes in most inhabited regions and increased probability of drought and flood.1 Migration can be an important and useful adaptive response to climate impacts when it increases household resilience and reduces socio-economic vulnerabilities,2 and yet can also have negative health consequences. The climate–migration–health nexus entails complex interactions including the following: first, climate-related risks to health faced by migrants at all stages of the migration journey. Second, the impacts of migration itself on health with possible specific health implications of climate-related migration. This article provides a brief overview of climate-related migration, identifies climate hotspots where substantial migration and displacement are anticipated and explores the health implications of climate-related migratio

\u27Calibrating to scale: A framework for humanitarian health organizations to anticipate, prevent, prepare for and manage climate-related health risks\u27

Climate Change is adversely affecting health by increasing human vulnerability and exposure to climate-related stresses. Climate change impacts human health both directly and indirectly, through extreme weather events, changing distribution of health risks, increased risks of undernutrition, population displacement, and greater risks of injuries, disease, and death (Ebi, K., Campbell-Lendrum, D., & Wyns, A. The 1. 5 health report. WHO. 2018). This risk amplification is likely to increase the need for humanitarian support. Recent projections indicate that under a business as usual scenario of sustained greenhouse gas emissions, climate change could double the demand for humanitarian assistance by 2050 (World Health Organization. Operational Framework for building climate-resilient health systems. WHO. 2015). Humanitarian assistance is currently not meeting the existing needs, therefore, any additional burden is likely to be highly challenging.Global health advocates, researchers, and policymakers are calling for urgent action on climate change, yet there is little clarity on what that action practically entails for humanitarian organizations. While some humanitarian organizations may consider themselves well designed to respond, climate change as a transversal threat requires the incorporation of a resilience approach to humanitarian action and policy responses.By bringing together authors from two historically disparate fields - climate change and health, and humanitarian assistance – this paper aims to increase the capacity of humanitarian organizations to protect health in an unstable climate by presenting an adapted framework. We adapted the WHO operational framework for climate-resilient health systems for humanitarian organizations and present concrete case studies to demonstrate how the framework can be implemented. Rather than suggest a re-design of humanitarian operations we recommend the application of a climate-lens to humanitarian activities, or what is also referred to as mainstreaming climate and health concerns into policies and programs. The framework serves as a starting point to encourage further dialogue, and to strengthen collaboration within, between, and beyond humanitarian organizations

A Risk Exchange: Health and Mobility in the Context of Climate and Environmental Change in Bangladesh—A Qualitative Study

Background: Climate change influences patterns of human mobility and health outcomes. While much of the climate change and migration discourse is invested in quantitative predictions and debates about whether migration is adaptive or maladaptive, less attention has been paid to the voices of the people moving in the context of climate change with a focus on their health and wellbeing. This qualitative research aims to amplify the voices of migrants themselves to add nuance to dominant migration narratives and to shed light on the real-life challenges migrants face in meeting their health needs in the context of climate change. Methods: We conducted 58 semi-structured in-depth interviews with migrants purposefully selected for having moved from rural Bhola, southern Bangladesh to an urban slum in Dhaka, Bangladesh. Transcripts were analysed using thematic analysis under the philosophical underpinnings of phenomenology. Coding was conducted using NVivo Pro 12. Findings: We identified two overarching themes in the thematic analysis: Firstly, we identified the theme “A risk exchange: Exchanging climate change and health risks at origin and destination”. Rather than describing a “net positive” or “net negative” outcome in terms of migration in the context of climate change, migrants described an exchange of hazards, exposures, and vulnerabilities at origin with those at destination, which challenged their capacity to adapt. This theme included several sub-themes—income and employment factors, changing food environment, shelter and water sanitation and hygiene (WaSH) conditions, and social capital. The second overarching theme was “A changing health and healthcare environment”. This theme also included several sub-themes—changing physical and mental health status and a changing healthcare environment encompassing quality of care and barriers to accessing healthcare. Migrants described physical and mental health concerns and connected these experiences with their new environment. These two overarching themes were prevalent across the dataset, although each participant experienced and expressed them uniquely. Conclusion: Migrants who move in the context of climate change face a range of diverse health risks at the origin, en route, and at the destination. Migrating individuals, households, and communities undertake a risk exchange when they decide to move, which has diverse positive and negative consequences for their health and wellbeing. Along with changing health determinants is a changing healthcare environment where migrants face different choices, barriers, and quality of care. A more migrant-centric perspective as described in this paper could strengthen migration, climate, and health governance. Policymakers, urban planners, city corporations, and health practitioners should integrate the risk exchange into practice and policies

Circular economy and environmental health in low- and middle-income countries

Background The circular economy framework for human production and consumption is an alternative to the traditional, linear concept of ‘take, make, and dispose’. Circular economy (CE) principles comprise of ‘design out waste and pollution’, ‘retain products and materials in use’, and ‘regenerate natural systems’. This commentary considers the risks and opportunities of the CE for low- and middle-income countries (LMICs) in the context of the Sustainable Development Goals (SDGs), acknowledging that LMICs must identify their own opportunities, while recognising the potential positive and negative environmental health impacts. Main body The implementation of the CE in LMICs is mostly undertaken informally, driven by poverty and unemployment. Activities being employed towards extracting value from waste in LMICs are imposing environmental health risks including exposure to hazardous and toxic working environments, emissions and materials, and infectious diseases. The CE has the potential to aid towards the achievement of the SDGs, in particular SDG 12 (Responsible Consumption and Production) and SDG 11 (Sustainable Cities and Communities). However, since SDG 3 (Good Health and Well-Being) is critical in the pursuit of all SDGs, the negative implications of the CE should be well understood and addressed. We call on policy makers, industry, the health sector, and health-determining sectors to address these issues by defining mechanisms to protect vulnerable populations from the negative health impacts that may arise in LMICs as these countries domesticate the CE. Conclusion Striving towards a better understanding of risks should not undermine support for the CE, which requires the full agency of the public and policy communities to realise the potential to accelerate LMICs towards sustainable production and consumption, with positive synergies for several SDG