Climate change: an urgent priority for health policy and systems research

Effects of Climate Change on Health and Health Systems: A Systematic Review of Preparedness, Resilience, and Challenges

Climate change has a significant impact on the population's health and negatively affects the functioning of healthcare systems. Health systems must be operationally prepared to handle the challenges posed by environmental change. Resilience is required to adapt quickly to critical environmental conditions and reduce carbon emissions. In this systematic review strategies, for health system preparedness and resilience are examined to address the impacts of climate change, and the barriers and challenges faced when implementing them. To identify studies, the Scopus, PubMed and Google Scholar databases were searched three times (from April to October 2024, 21 April, 15 June, and 9 September) for the years 2018 to 2024, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Specifically, the search identified 471 articles, of which the specified inclusion and exclusion criteria (secondary studies with inclusion criteria, being in English, etc.) were met by sixteen (16) studies. According to the findings of the studies reviewed, adaptation strategies focus on structural changes, the development of training programs, the development of surveillance systems, and appropriate operational plans. The leader's ability to motivate employees to achieve defined goals, continuous evaluation of goals and interventions, and learning from previous disasters play an important role in their implementation. Similarly, key policies and strategies for mitigation include the adoption of sustainable practices, such as recycling and cultural change. However, lack of resources (human, material, financial) and increased demand for health services make it difficult to implement adaptation and mitigation strategies. The findings of the review are mainly theoretical in nature and are confirmed by other studies. It is suggested that further research on resilience and preparedness of health systems should be pursued, leading to their sustainability and the formulation of appropriate policies.

Primary healthcare's carbon footprint and sustainable strategies to mitigate its contribution: a scoping review

BACKGROUND

The escalating climate crisis poses a significant threat to global public health. The healthcare sector, designed to protect human health is a major contributor to greenhouse gas emissions, and thus, a key driver of climate degradation. This paradox endangers both planetary and human health, making the decarbonization of healthcare, including primary care, critical. However, research on primary care's contribution to emissions and strategies for mitigation remains limited.

AIM

This scoping review aimed to map how primary care contributes to healthcare's environmental footprint and determine contributing factors. Additionally, it sought to identify existing and innovative strategies to reduce the carbon footprint of primary healthcare.

METHODS

A comprehensive strategy was developed to systematically search both published databases and grey literature. Key terms were identified and employed in the exploration of relevant databases and internet search engines.

RESULTS

An initial search yielded 246 published articles and 25 grey literature sources. 14 additional articles were included following forward and backward searching of prominent authors and key articles. After screening and full-text review, 39 articles and 12 reports/toolkits were included. The majority of sources were opinion pieces, with limited quantitative, observational, or qualitative studies. Primary care's carbon footprint can be classified into clinical and non-clinical sources, with significant impacts from pharmaceuticals and inhaler propellant gases. Contributing factors include limited knowledge of emission sources, lack of awareness of sustainable practices, low prioritization of sustainability, barriers including ethical concerns and over-medicalization. Identified strategies to reduce emissions include decarbonization of patient care, increasing education and awareness, implementing non-clinical decarbonization efforts, and conducting more research to support sustainable initiatives. Developing metrics to track progress and securing policy supports to improve adoption and implementation were also highlighted as critical.

CONCLUSION

The identification of sources of carbon hotspots in primary care is an essential precursor to enable the development of targeted decarbonization strategies. Decarbonizing primary care requires a multifaceted approach that addresses the underlying factors driving unsustainable practices. This would allow healthcare professionals to effectively balance the provision of high-quality patient care, while reducing their environmental impact, ultimately improving both human and planetary health.

Climate Change, Community Action, and Health in the Anglophone Caribbean: A Scoping Review

Objective: This scoping review investigates the status of research focusing on the nexus of community action, climate change, and health and wellbeing in anglophone Caribbean Small Island Developing States (SIDS). Methods: This review was guided by Arksey and O'Malley framework and utilized the PRISMA-ScR checklist. We searched Medline/OVID, PsychInfo, VHL, Sociological Abstracts, Google Scholar, and Scopus to capture interdisciplinary studies published from 1946 to 2021. Results: The search yielded 3,828 records of which fourteen studies met the eligibility criteria. The analysis assessed study aim, geographic focus, community stakeholders, community action, climate perspective, health impact, as well as dimensions including resources/assets, education/information, organization and governance, innovation and flexibility, and efficacy and agency. Nearly all studies were case studies using mixed method approaches involving qualitative and quantitative data. Community groups organized around focal areas related to fishing, farming, food security, conservation, and the environment. Conclusion: Despite the bearing these areas have on public health, few studies explicitly examine direct links between health and climate change. Research dedicated to the nexus of community action, climate change, and health in the anglophone Caribbean warrants further study.

Pandemic preparedness and response: exploring the role of universal health coverage within the global health security architecture

In response to the COVID-19 pandemic, several international initiatives have been developed to strengthen and reform the global architecture for pandemic preparedness and response, including proposals for a pandemic treaty, a Pandemic Fund, and mechanisms for equitable access to medical countermeasures. These initiatives seek to make use of crucial lessons gleaned from the ongoing pandemic by addressing gaps in health security and traditional public health functions. However, there has been insufficient consideration of the vital role of universal health coverage in sustainably mitigating outbreaks, and the importance of robust primary health care in equitably and efficiently safeguarding communities from future health threats. The international community should not repeat the mistakes of past health security efforts that ultimately contributed to the rapid spread of the COVID-19 pandemic and disproportionately affected vulnerable and marginalised populations, especially by overlooking the importance of coherent, multisectoral health systems. This Health Policy paper outlines major (although often neglected) gaps in pandemic preparedness and response, which are applicable to broader health emergency preparedness and response efforts, and identifies opportunities to reconceptualise health security by scaling up universal health coverage. We then offer a comprehensive set of recommendations to help inform the development of key pandemic preparedness and response proposals across three themes-governance, financing, and supporting initiatives. By identifying approaches that simultaneously strengthen health systems through global health security and universal health coverage, we aim to provide tangible solutions that equitably meet the needs of all communities while ensuring resilience to future pandemic threats.

The Adoption of Digital Technologies and Artificial Intelligence in Urban Health: A Scoping Review

As more people live in cities, the impact of urban settings on population health has been increasing. One of the main strategies to cope with urbanization is adopting artificial intelligence (AI) and new digital technologies to develop new urban services that improve citizens’ health and well-being. The aim of this study is to review urban interventions and adopting digital technologies and AI-based algorithms to improve population health. A scoping review of the literature was conducted by querying MEDLINE, Web of Science, and Scopus databases. The included studies were categorized into one urban health area, suggested by the WHO, according to the type of intervention investigated. Out of 3733 records screened, 12 papers met all inclusion criteria. Four studies investigated the “outdoor and indoor pollution” area, one “climate change”, one “housing”, two “health and social services” and four “urban transport” areas. Only one article used a comprehensive approach to public health, investigating the use of AI and digital technologies both to characterize exposure conditions to health determinants and to monitor population health effects, while the others were limited to characterizing exposure conditions to health determinants, thus employing a preliminary public health perspective. From this point of view, countries should foster synergy for the development of research on digital technologies to address the determinants of health in the urban context. From a global health perspective, sharing results with the scientific community would also allow other countries to use those technologies that have been shown to be effective, paving the way for more sustainable living conditions worldwide.

Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol

Background

Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective.

Methods

The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses.

Discussion

This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07294-3.