Advancing climate change health adaptation through implementation science

Exploring barriers and facilitators to integrating health equity into health and climate change policies in Nepal - a qualitative study among federal level stakeholders

BACKGROUND

Health is foundational for climate action, and integrating climate and health policies to achieve health equity is widely recognized. While there is a growing global momentum for collaborative health and climate initiatives, more effort is needed to incorporate health equity into national climate policies. Achieving this necessitates identifying both barriers and facilitators of integrated policymaking. This study examines the barriers and facilitators to integrating health equity into climate change-related policies at Nepal's federal level.

METHODS

We interviewed 14 key stakeholders from three major federal ministries, a high-level government entity, and a government partner institution in Nepal, all with diverse roles and responsibilities. To facilitate discussions, we developed an interview guide informed by two policy analysis frameworks: Health Equity Policy Process Analysis Framework and Schlossberg's Framework of Environmental Justice. Using both inductive and deductive approaches, we identified five key facilitators and four major barriers to integrating health equity in climate change-related policies in Nepal. We present these barriers in relation to WHO's climate-resilient health systems framework.

RESULTS

A wide array of facilitators was identified, broadly categorized as a) acknowledgement of the need to integrate health equity in climate change policies, b) political leadership, c) global influences, d) established mechanisms and structures in place for collaboration and e) the federal structure. Barriers identified were largely systemic and encompassed a) knowledge gaps, b) ownership and accountability, c) resource constraints: human resources and budget and d) data limitations. Among these, the issue of ownership and accountability emerged as an overarching theme, cutting across all barriers. Similarly, financing and knowledge gaps were identified as significant obstacles to progress.

CONCLUSIONS

The findings underscore the need for a more structured approach, with clearly delineated responsibilities to ensure all relevant sectors contribute to the goal of health equity in climate action. Developing well-defined guidelines outlining the roles and responsibilities of different sectors involved in climate action is crucial for fostering ownership and ensuring that health equity is effectively integrated into climate change policies, as well as aiding in resource allocation. We recommend future research to explore the potential role of policy champions within ministries in advocating for and advancing health equity within climate change-related policies.

Community-based heat adaptation interventions for improving heat literacy, behaviours, and health outcomes: a systematic review

Anthropogenic climate change, resulting in a continuous rise of global temperature, has detrimental effects on human health, particularly among vulnerable populations, such as individuals with low income, older adults, and people with pre-existing health conditions. To reduce the heat-related health consequences, effective interventions targeting community members, especially vulnerable populations, are paramount. This systematic review aims to identify and evaluate the effectiveness of community-based heat adaptation behavioural interventions aimed at improving heat literacy, promoting adaptive behaviours, and enhancing health outcomes amid rising global temperatures. In this systematic review, peer-reviewed English-language articles focused on community-based heat adaptation intervention studies published in PubMed, MEDLINE via Ovid, Embase, CINAHL, Scopus, and Web of Science from database inception to Jan 1, 2024, were retrieved and reported according to the PRISMA 2020 guidelines. The quality of the articles was evaluated with the use of a mixed-methods appraisal tool. The analysis synthesised intervention effectiveness across multiple outcome domains measurable at both individual and household levels, identified key factors influencing successful implementation, and highlighted areas for future research. The initial search yielded 1266 articles, of which ten were finally included. The majority of the included studies (n=7) were from high-income countries. Most intervention modules focused on preventive measures during heat exposure, whereas only a few addressed information on disease mechanisms, risk factors, and monitoring environmental changes. Although most studies reported significant improvements in heat literacy and a reduction in heat-related symptoms, the evidence for behavioural changes and health outcomes was mixed. Our review reveals methodological shortcomings, as none of the included studies incorporated heat literacy frameworks, behavioural theory, or participatory approaches to include community input throughout the research. Our findings highlight the need for a comprehensive approach that incorporates frameworks to enhance intervention effectiveness and improve public health resilience amid rising global temperatures. Culturally appropriate community-led interventions and integration of digital tools are promising avenues for increasing uptake of interventions. This study is registered with PROSPERO (CRD42024514188).

Leveraging implementation science to solve the big problems: a scoping review of health system preparations for the effects of pandemics and climate change

As the planet warms and pandemics become more common, health systems will face disruptions to both their service delivery and their workforce. To minimise the severity of these impacts, health systems will need to efficiently and rapidly prepare, adapt, and respond. Implementation science will be crucial to the success of these actions. However, the extent to which health systems are using implementation science to address the pressures of pandemics and climate change is not currently known. In this scoping review, we aimed to address this research gap. We reviewed empirical studies that used implementation science to adapt, respond to, or prepare a health-care setting for a pandemic or climate-related event, defining components of implementation science (as proposed by Nilsen [2015]) and implementation evaluation outcomes (as proposed by Proctor and colleagues [2011]). We found a growing evidence base describing the use of implementation science in health system responses to pandemics (n=54 studies), but a dearth of similar evidence for climate change (n=2 studies). Future research could benefit from applying the principles of implementation science in pre-implementation phases and purposefully planning for long-term, ongoing evaluations, which will facilitate tailored and sustainable health system responses to climate-related and pandemic events.

Advancing adoptability and sustainability of digital prediction tools for climate-sensitive infectious disease prevention and control

Few forecasting models have been translated into digital prediction tools for prevention and control of climate-sensitive infectious diseases. We propose a 3-U (useful, usable, and used) research framework for advancing the adoptability and sustainability of these tools. We make recommendations for 1) developing a tool with a high level of accuracy and sufficient lead time to permit effective proactive interventions (useful); 2) conducting a needs assessment to ensure that a tool meets the needs of end-users (usable); and 3) demonstrating the efficacy and cost-effectiveness of a tool to secure its adoption into routine surveillance and response systems (used).

Does climate change threaten delivery of HIV care in resource-limited settings?

PURPOSE OF REVIEW

Extreme weather events (EWEs) pose a challenge to achieving UNAIDS goal of eliminating HIV as a public health threat by 2030. This review summarizes recent findings describing the disruption of HIV services by EWEs and discusses strategies for a resilient HIV care programme in resource-limited settings.

RECENT FINDINGS

EWEs impact each component of the continuum of care - HIV testing, linkage to treatment, viral suppression and other HIV prevention services. EWEs disrupt healthcare provision either through impacting the ability of the healthcare system to deliver care because of infrastructure damage and increased workload or by limiting people's ability to seek healthcare because of access challenges and forced displacements. This culminates in disengagement from care, poor treatment adherence and increase in HIV disease progression with more vulnerable groups such as women and young people being more adversely impacted.

SUMMARY

Most people affected by or at risk of HIV reside in resource-poor settings which are the region with the least capacity to adapt to climate change. Few recent studies with very limited geographical coverage show that EWEs affect the delivery of HIV care in this setting. Climate adaptation and mitigation policies are required to protect health in resource-limited settings.

Harmonizing Multisource Data to Inform Vector-Borne Disease Risk Management Strategies

In the last few decades, we have witnessed the emergence of new vector-borne diseases (VBDs), the globalization of endemic VBDs, and the urbanization of previously rural VBDs. Data harmonization forms the basis of robust decision-support systems designed to protect at-risk communities from VBD threats. Strong interdisciplinary partnerships, protocols, digital infrastructure, and capacity-building initiatives are essential for facilitating the coproduction of robust multisource data sets. This review provides a foundation for researchers and practitioners embarking on data harmonization efforts to (a) better understand the links among environmental degradation, climate change, socioeconomic inequalities, and VBD risk; (b) conduct risk assessments, health impact attribution, and projection studies; and (c) develop robust early warning and response systems. We draw upon best practices in harmonizing data for two well-studied VBDs, dengue and malaria, and provide recommendations for the evolution of research and digital technology to improve data harmonization for VBD risk management.

A qualitative exploration of barriers, enablers, and implementation strategies to replace disposable medical devices with reusable alternatives

Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified. 30 strategies were identified across six topics: external purchasing (two strategies); internal purchasing (seven strategies); incentivisation and standardised environmental decision making (three strategies); successful practical introduction of reusable devices (five strategies); identification of goals and facilitation of leadership (two strategies); and a community of practice and knowledge building (11 strategies). We present these 30 implementation strategies, from the individual to the policy level, which consist of evidence-based behaviour change techniques aimed at addressing the identified barriers to replacing single-use devices with reusable alternatives.

Implementation of climate adaptation in the public health sector in Europe: qualitative thematic analysis

BACKGROUND

Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood.

AIM

To identify key issues in climate change adaptation implementation for public health in Europe.

METHODS

Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation.

INTERVIEWS ADDRESSED

Barriers and levers for adaptation, policy alignment, networks and evidence needs.

RESULTS

Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation.

CONCLUSIONS

Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health.

Comprehensive evaluation framework for intervention on health effects of ambient temperature

Despite the existence of many interventions to mitigate or adapt to the health effects of climate change, their effectiveness remains unclear. Here, we introduce the Comprehensive Evaluation Framework for Intervention on Health Effects of Ambient Temperature to evaluate study designs and effects of intervention studies. The framework comprises three types of interventions: proactive, indirect, and direct, and four categories of indicators: classification, methods, scope, and effects. We trialed the framework by an evaluation of existing intervention studies. The evaluation revealed that each intervention has its own applicable characteristics in terms of effectiveness, feasibility, and generalizability scores. We expanded the framework's potential by offering a list of intervention recommendations in different scenarios. Future applications are then explored to establish models of the relationship between study designs and intervention effects, facilitating effective interventions to address the health effects of ambient temperature under climate change.

Strengthening healthcare delivery in Rwanda: Implementation science training for reproductive health researchers

BACKGROUND

Addressing the gap between research and practice is crucial for enhancing reproductive healthcare outcomes. In Rwanda and other low- and middle-income countries, bolstering health researchers' implementation science (IS) capacity is essential. We present a pre-post-intervention study assessing the influence of an intensive IS training program on Rwandan reproductive health researchers' perceived IS knowledge and self-efficacy in applying IS in their own research.

METHODS

To introduce IS principles, we held a one-day training for a diverse cohort of 25 sexual and reproductive health researchers in Rwanda. The training encompassed modules on IS concepts, methodologies, and practical applications. Pre- and post-training assessments gauged changes in participants' perceived IS knowledge and self-efficacy in applying IS in their own work.

RESULTS

The study revealed a significant improvement in self-efficacy related to performing IS related tasks. Researchers reported heightened confidence in designing and implementing evidence-based interventions. In terms of perceived knowledge, participants retained what they learned at 4 months. The training fostered a collaborative learning environment, encouraging participants to exchange ideas and experiences.

CONCLUSION

Targeted training in IS appears to enhance reproductive health researchers' capacity to translate research into practice, potentially leading to improved healthcare outcomes in Rwanda. Moving forward, we advocate for the Ministry of Health to establish structures for IS research agenda-setting, particularly for sexual and reproductive health and rights. Ideally, universities, health systems, and research institutions will incorporate IS capacity strengthening into their routine activities. Ongoing training is crucial to reinforce and expand IS knowledge. Our findings are expected to inform future interventions and guide policy development.

Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities

INTRODUCTION

Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not.

METHODS AND ANALYSIS

Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities.

ETHICS AND DISSEMINATION

This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Health-based strategies for overcoming barriers to climate change adaptation and mitigation

Climate change poses an unequivocal threat to the respiratory health of current and future generations. Human activities-largely through the release of greenhouse gases-are driving rising global temperatures. Without a concerted effort to mitigate greenhouse gas emissions or adapt to the effects of a changing climate, each increment of warming increases the risk of climate hazards (eg, heat waves, floods, and droughts) that that can adversely affect allergy and immunologic diseases. For instance, wildfires, which release large quantities of particulate matter with a diameter of less than 2.5 μm (an air pollutant), occur with greater intensity, frequency, and duration in a hotter climate. This increases the risk of associated respiratory outcomes such as allergy and asthma. Fortunately, many mitigation and adaptation strategies can be applied to limit the impacts of global warming. Adaptation strategies, ranging from promotions of behavioral changes to infrastructural improvements, have been effectively deployed to increase resilience and alleviate adverse health effects. Mitigation strategies aimed at reducing greenhouse gas emissions can not only address the problem at the source but also provide numerous direct health cobenefits. Although it is possible to limit the impacts of climate change, urgent and sustained action must be taken now. The health and scientific community can play a key role in promoting and implementing climate action to ensure a more sustainable and healthy future.

The Transformative Role of Adaptation Strategies in Designing Climate-Resilient and Sustainable Health Systems

This article describes the growing repository of evidence-informed climate-related health actions and builds a case for transformative adaptation strategies. The health impacts of climate change are far-reaching and diverse, affecting vulnerable populations disproportionately and at varying scales. While adaptation policies and plans are becoming increasingly intersectional, there is limited implementation of health-focused adaptation interventions. Securing finance at scale, for one, is a challenge. Funds are not being mobilized at the rate or scale required. Least developed countries and small island developing states are most at-risk and the least likely to recover, even under conservative global warming scenarios. Thus, this article spotlights opportunities for more resilient and equitable health systems across key dimensions of health surveillance, service delivery, infrastructure, finance, capacity development and policy coherence. Given limits to adaptation, co-benefits of mitigation and adaptation actions will need to be systematically assessed and prioritized to address the residual effects of climate disasters.

A Research Translation, Implementation and Impact Strategy for the Australian Healthy Environments and Lives (HEAL) Research Network

Healthy Environments And Lives (HEAL) is the Australian national research network established to support improvements to health, the Australian health system, and the environment in response to the unfolding climate crisis. The HEAL Network comprises researchers, community members and organisations, policymakers, practitioners, service providers, and other stakeholders from diverse backgrounds and sectors. HEAL seeks to protect and improve public health, reduce health inequities and inequalities, and strengthen health system sustainability and resilience in the face of environmental and climate change, all with a commitment to building on the strengths, knowledge, wisdom, and experience of Aboriginal and Torres Strait Islander people, culture, and communities. Supporting applied research that can inform policy and practice, and effective research translation, implementation, and impact are important goals across the HEAL Network and essential to achieve its intended outcomes. To aid translation approaches, a research translation, implementation, and impact strategy for the HEAL Network was developed. The strategy has been created to inform and guide research translation across HEAL, emphasising communication, trust, partnerships, and co-design with communities and community organisations as well as the decision-makers responsible for public policies and programs. Development of the strategy was guided by research translation theory and practice and the Health in All Policies and Environment in All Policies frameworks. As described in this paper, the strategy is underpinned by a set of principles and outlines preliminary actions which will be further expanded over the course of the HEAL Network's activities. Through these actions, the HEAL Network is well-positioned to ensure successful research translation and implementation across its program of work.

The current landscape of software tools for the climate-sensitive infectious disease modelling community

Climate-sensitive infectious disease modelling is crucial for public health planning and is underpinned by a complex network of software tools. We identified only 37 tools that incorporated both climate inputs and epidemiological information to produce an output of disease risk in one package, were transparently described and validated, were named (for future searching and versioning), and were accessible (ie, the code was published during the past 10 years or was available on a repository, web platform, or other user interface). We noted disproportionate representation of developers based at North American and European institutions. Most tools (n=30 [81%]) focused on vector-borne diseases, and more than half (n=16 [53%]) of these tools focused on malaria. Few tools (n=4 [11%]) focused on food-borne, respiratory, or water-borne diseases. The under-representation of tools for estimating outbreaks of directly transmitted diseases represents a major knowledge gap. Just over half (n=20 [54%]) of the tools assessed were described as operationalised, with many freely available online.

Toxic External Exposure Leading to Ocular Surface Injury

The surface of the eye is directly exposed to the external environment, protected only by a thin tear film, and may therefore be damaged by contact with ambient particulate matter, liquids, aerosols, or vapors. In the workplace or home, the eye is subject to accidental or incidental exposure to cleaning products and pesticides. Organic matter may enter the eye and cause infection. Ocular surface damage can trigger a range of symptoms such as itch, discharge, hyperemia, photophobia, blurred vision, and foreign body sensation. Toxin exposure can be assessed clinically in multiple ways, including via measurement of tear production, slit-lamp examination, corneal staining, and conjunctival staining. At the cellular level, environmental toxins can cause oxidative damage, apoptosis of corneal and conjunctival cells, cell senescence, and impaired motility. Outcomes range from transient and reversible with complete healing to severe and sight-compromising structural changes. Classically, evaluation of tolerance and safety was carried out using live animal testing; however, new in vitro and computer-based, in silico modes are superseding the gold standard Draize test. This review examines how environmental features such as pollutants, temperature, and seasonality affect the ocular surface. Chemical burns to the eye are considered, and approaches to protect the ocular surface are detailed.

The connection between slums and COVID-19 cases in Jakarta, Indonesia: A case study of Kapuk Urban Village

COVID-19 has spread world-wide, and with multiple health, social, and economic ramifications. These present a formidable challenge for those belonging to vulnerable communities, such as those living in slums. There is now a growing literature urging attention to this challenge. However, few studies have examined the actual lived realities within these areas using direct, observational research, notwithstanding commentary elsewhere that such close attention is necessary to ensure effective action. This study took this approach in relation to a particular case-study, Kapuk Urban Village, in Jakarta, Indonesia. Drawing on an existing schema involving three spatial scales of slum areas (environs, settlement, and object), the research confirms how different built and socio-economic features can exacerbate vulnerability, and COVID-19 transmission. We also add to the body of knowledge by contributing a dimension of 'ground-level' research engagement. We conclude by discussing related ideas around ensuring community resilience and effective policy implementation, and recommend an "urban acupuncture" approach to encourage government regulations and actions better tailored to such communities.