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

A global assessment of policy tools to support climate adaptation

Governments, businesses, and civil society organizations have diverse policy tools to incentivize adaptation. Policy tools can shape the type and extent of adaptation, and therefore, function either as barriers or enablers for reducing risk and vulnerability. Using data from a systematic review of academic literature on global adaptation responses to climate change (n = 1549 peer-reviewed articles), we categorize the types of policy tools used to shape climate adaptation. We apply qualitative and quantitative analyses to assess the contexts where particular tools are used, along with equity implications for groups targeted by the tools, and the tools’ relationships with transformational adaptation indicators such as the depth, scope, and speed of adaptation. We find diverse types of tools documented across sectors and geographic regions. We also identify a mismatch between the tools that consider equity and those that yield more transformational adaptations. Direct regulations, plans, and capacity building are associated with higher depth and scope of adaptation (thus transformational adaptation), while economic instruments, information provisioning, and networks are not; the latter tools, however, are more likely to target marginalized groups in their design and implementation. We identify multiple research gaps, including a need to assess instrument mixes rather than single tools and to assess adaptations that result from policy implementation. Key policy insights Information-based approaches, networks, and economic instruments are the most frequently documented adaptation policy tools worldwide. Direct regulations, plans, and capacity building are associated with higher depth and scope of adaptation, and thus more transformational adaptation. Capacity building, economic instruments, networks, and information provisioning approaches are more likely to target specific marginalized groups and thus equity challenges. There are many regions and sectors where certain tools are not widely documented (e.g. regulations and plans in Africa and Asia), representing a key research gap

A systematic global stocktake of evidence on human adaptation to climate change

Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses