Towards Improved Linkage of Disaster Risk Reduction and Climate Change Adaptation in Health: A Review

A global assessment of urban extreme weather early warning systems and public health engagement

Objective

To assess extreme weather early warning systems in large cities across the world.

Methods

Among cities with populations above 1 million reporting to the Carbon Disclosure Project Cities Adaptation Actions database from 2021 to 2023, we included those providing a description of at least one adaptation action for a climate hazard in at least one year. We identified cities reporting early warning systems using the United Nations Early Warnings for All framework, which includes four pillars: risk knowledge, hazard monitoring and forecasting, warning communication and preparedness. We also tracked public health engagement in these systems.

Findings

We identified 182 cities, of which 71 described full early warning systems across the four pillars. Cities in high- and upper middle-income countries described early warning systems nearly three times more often than those in low- and lower middle-income countries. Multihazard early warning systems  were reported by 35 (49%) cities, and many of these involved institutionalized cross-sectoral coordination and funded at least one activity from their own resources. Health was reported as a goal of early warning systems by 58 (82%) cities, although just 29 (41%) indicated a specific role for public health agencies.

Conclusion

These findings suggest that many large cities are not covered by these health-protective systems. We recommend development of a city-specific framework for early warning systems that identifies roles for health, and scaling up of these tools, particularly in cities in low- and lower middle-income countries, to ensure strengthened adaptive urban resilience against climate threats.

Emergency Care, Hospitalization Rates, and Floods

Importance

Flooding is a major environmental hazard, with events increasing in intensity and frequency in the context of climate change. Floods cause significant health and economic impacts, particularly among vulnerable populations, including older adults. However, comprehensive analyses of the health consequences of flooding remain limited.

Objective

To evaluate the morbidity and health care costs among Medicare beneficiaries associated with flood exposure in the US.

Design, Setting, and Participants

This retrospective cohort study analyzed emergency department (ED) use and unplanned hospitalization among Medicare beneficiaries 65 years or older living in zip code tabulation areas (ZCTAs) that were exposed to large-scale flood events from January 1, 2008, to December 31, 2017. This analysis was conducted from April 3 to December 15, 2023.

Exposure

The primary exposure was the presence of a flood as recorded in the Multisourced Flood Inventories, a spatially distributed flood database.

Main Outcomes and Measures

A conditional fixed-effects regression approach was used to explore the incidence of all-case and cause-specific ED visits and hospitalizations before and after floods. The primary outcomes measured were the incident rate ratios (IRRs) and associated 95% CIs. Attributable risk percentages and estimated attributable excess visits were calculated. Stratified analyses were performed for evaluation of effect modification. Health care costs associated with these events were measured and standardized to 2017 US dollars.

Results

Among 11 801 527 Medicare beneficiaries 65 years or older (mean [SD] age, 74.4 [7.6] years; 56.3% female), the rate of all-cause ED visits and hospital admissions increased by 4.8% (IRR, 1.05; 95% CI, 1.04-1.05) and 7.4% (IRR, 1.07; 95% CI, 1.07-1.08) after flood exposure, respectively. The mean ZCTA-level cost was $3230 (95% CI, $3198-$3261) per ED visit and $11 310 (95% CI, $11 252-$11 367) for hospitalizations. The national costs to the Medicare system were estimated to be $69 275 429 (95% CI, $63 010 840-$76 315 210) for ED visits and $191 409 579 (95% CI, $172 782 870-$206 181 300) for hospitalizations. Stratified analyses highlighted greater impacts for certain demographic groups, including adults older than 85 years, and specific seasonal patterns.

Conclusions and Relevance

In this cohort study of Medicare beneficiaries 65 years or older, flood exposure was associated with increased health care use and costs, underscoring the need for targeted public health strategies and improved disaster preparedness, especially for older adults. These findings contribute to a more comprehensive understanding of the health-related costs of flooding and can be used to inform future climate change resilience and health care planning.

New York State Climate Impacts Assessment Chapter 07: Human Health and Safety

New Yorkers face a multitude of health and safety risks that are exacerbated by a changing climate. These risks include direct impacts from extreme weather events and other climate hazards, as well as indirect impacts occurring through a chain of interactions. Physical safety, physical health, and mental health are all part of the equation-as are the many nonclimate factors that interact with climate change to influence health outcomes. This chapter provides an updated assessment of all these topics at the intersection of climate change, public health and safety, and equity in the state of New York. Key findings are presented below.

Health systems response to climate change adaptation: a scoping review of global evidence

BACKGROUND

The health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.

METHODS

This review followed the recommendations by Arksey and O'Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.

RESULTS

We found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.

CONCLUSION

Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

How can the Sendai framework be implemented for disaster risk reduction and sustainable development? A qualitative study in Iran

BACKGROUND

The Sendai Framework is the United Nations' most significant approach to reducing the risk of disasters from 2015 to 2030. This framework designed for all communities. However, communities should create operational and remedial strategies based on their unique circumstances. Considering the gaps in the implementation of Sendai framework strategies in Iran, as a developing country, the present study was designed.

METHOD

This study was conducted by using a qualitative direct content analysis method to find out the expert's opinions on the implementation of the Sendai framework in Iran from 2021 to 2023. 35 experts in the focus group discussion and 9 experts in the interview were the participants of the study.

RESULTS

Study findings were merged and reported as one main theme entitled Executive actions for implementing the Sendai Framework, four categories, and 37 codes. Eleven codes for the strategy of understanding disaster risk, 11 codes for the strategy of strengthening disaster risk governance to manage disaster risk, eight codes for the strategy of Investing in disaster risk reduction for resilience, and finally, seven codes for the strategy of enhancing disaster preparedness for effective response and to "Build Back Better" in recovery, rehabilitation, and reconstruction were identified as implementation solutions.

CONCLUSION

The Sendai Framework has not provided any detailed implementation solutions because the countries' economic, social, level of development, etc., are different. The study's findings can be used as a guide for other developing countries.

Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review

PURPOSE OF REVIEW

Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change.

RECENT FINDINGS

This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.

Food Insecurity in the Rural South in the Wake of the COVID-19 Pandemic

Food insecurity in rural communities in the Southern US continues to grow, especially in the wake of the COVID-19 pandemic. Understanding the characteristics of food-insecure individuals and families in this region is critical for developing creative strategies for eliminating this health disparity issue. A food insecurity survey was given to attendees at food-security events held in several counties in one Southern US state. A descriptive analysis of food insecurity in this region is presented, and recommendations for addressing food insecurity among underserved and disadvantaged populations are suggested.

Heat waves and adaptation: A global systematic review

BACKGROUND

Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves.

METHOD

ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table.

RESULTS

In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design.

CONCLUSION

The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves.

PROSPERO REGISTRATION NUMBER

CRD42021257747.

The potential for property-level flood adaptation as a flood disaster mental health intervention

OBJECTIVES

This study aimed to discuss the overlap between property-level flood adaptation and public health and flood risk management and identify areas of future research.

DESIGN AND METHODS

A short essay-based contribution arguing in favour of a future research direction from the perspective of a disaster risk researcher.

RESULTS

Promoting property-level flood adaption has multiple areas of benefit to both flooding and mental health risk management as a potential invention. This is because both fields display common interests in enabling and promoting personal responsibility to limit disaster consequences and build resilience.

CONCLUSIONS

The promotion and development of property-level flood adaptation strategies can be a productive locus of behaviour for further active collaboration and research, as well as a joint intervention for improving human welfare postdisaster. However, more proactive research is required.

Heat wave adaptation paradigm and adaptation strategies of community: A qualitative phenomenological study in Iran

BACKGROUND

Heat wave adaptation is a new concept related to experiencing heat. The present study aims at investigating a conceptual definition, that is, the mental framework of heat wave adaptation and its strategies.

MATERIALS AND METHODS

A phenomenological study was performed to explain the mental concept. At the same time with the data collection process, data analysis was also performed using Colaizzi method. Semi-structured interview method and purposeful sampling with maximum variety were used. Interviews were conducted with 23 different subjects in the community. The accuracy of the data was guaranteed using Lincoln & Guba scientific accuracy criteria.

RESULTS

The two main themes of the adaptation paradigm as well as its strategies were divided into the main categories of theoretical and operational concepts, as well as personal care measures and government measures. Under the category of individual measures, we obtained "clothing, nutrition, building, place of residence and lifestyle," and under the category of governance actions, the "managerial, research, health, organizational" subcategories were obtained.

CONCLUSION

According to the results of the conceptual-operational definition, heat wave adaptation is an active process and an effort to reduce the adverse effects of heat waves on individual and social life, and striking a balance that will not only result in individual awareness and actions that will lead to lifestyle changes, but also mostly requires integrated and comprehensive planning in the community. On the one hand, heat waves could not only be regarded as a threat or danger, but can also become an opportunity for the development of a community through identification and smart measures, and for adaptation, the community must take it as a risk. The community should have a plan in advance, apply the necessary rules and training, and use the new facilities and rules where necessary. This practical concept definition includes the main features of heat wave adaptation.

Climate change and emergency care in Africa: A scoping review

Introduction

Climate change is a global public health emergency with implications for access to care and emergency care service disruptions. The African continent is particularly vulnerable to climate-related extreme weather events due to an already overburdened health system, lack of early warning signs, poverty, inadequate infrastructure, and variable adaptive capacity. Emergency care services are not only utilized during these events but also threatened by these hazards. Considering that the effects of climate change are expected to increase in intensity and prevalence, it is increasingly important for emergency care to prepare to respond to the changes in presentation and demand. The aim of this study was to perform a scoping review of the available literature on the relationship between climate change and emergency care on the African continent.

Methods

A scoping review was completed using five databases: Pubmed, Web of Science, GreenFILE, Africa Wide Information, and Google Scholar. A 'grey' literature search was done to identify key reports and references from included articles. Two independent reviewers screened articles and a third reviewer decided conflicts. A total of 1,382 individual articles were initially screened with 17 meeting full text review. A total of six articles were included in the final analysis. Data from four countries were represented including Uganda, Ghana, Tanzania, and Nigeria.

Results

Analysis of the six articles yielded three key themes that were identified: climate-related health impacts that contribute to surges in demand and resource utilization, opportunities for health sector engagement, and solutions to improve emergency preparedness. Authors used the outcomes of the review to propose 10 recommendations for decision-makers and leaders.

DXDiscussion

Incorporating these key recommendations at the local and national level could help improve preparedness and adaptation measures in highly vulnerable, populated areas on the African continent.

Indonesia’s Climate-Related Disasters and Health Adaptation Policy in the Build-Up to COP26 and Beyond

In recent years, Indonesia has experienced rapid increases in severe climate-related disasters have dramatically impacted populations unevenly; the poor and the vulnerable populations are most affected, and adaptive measures are urgently needed to protect and mitigate the impact on their health. However, very little is known about the existing measures addressing climate-related disasters and health impacts among vulnerable groups. WHO established a Health Emergency and Disaster Risk Management framework to urge governments and relevant actors to systematically collect evidence to develop science-based feasible adaptive strategies for priority groups. This study used scoping review methods to identify the action areas of Health-EDRM in policy documents in Indonesia, its content, and any potential gaps that require further study. The results from the documents’ review were then reported and discussed at a national stakeholder consultation meeting. This study has identified several achievements, lessons learned, and challenges from strategies and policies for health adaptation in facing climate-related disasters in Indonesia. This study also proposed strategies and recommendations to support mobilizing and accelerating health adaptation actions towards climate-related disasters in Indonesia.

Extreme Weather and Climate Change: Population Health and Health System Implications

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.

Using Implementation Science For Health Adaptation: Opportunities For Pacific Island Countries

The health risks of a changing climate are immediate and multifaceted. Policies, plans, and programs to reduce climate-related health impacts exist, but multiple barriers hinder the uptake of these strategies, and information remains limited on the factors affecting implementation. Implementation science-a discipline focused on systematically examining the gap between knowledge and action-can address questions related to implementation and help the health sector scale up successful adaptation measures in response to climate change. Implementation science, in the context of a changing climate, can guide decision makers in introducing and prioritizing potential health adaptation and disaster risk management solutions, advancing sustainability initiatives, and evaluating and improving intervention strategies. In this article we highlight examples from Pacific Island countries and outline approaches based on implementation science to enhance the capacity of health systems to anticipate, prepare for, respond to, and recover from climate-related exposures.

Climate and climate-sensitive diseases in semi-arid regions: a systematic review

OBJECTIVES

We aim to describe the relationships between climate variables and climate-sensitive diseases (CSDs) in semi-arid regions, highlighting the different main groups of CSDs and their climate patterns.

METHODS

This systematic review considered Medline, Science Direct, Scopus and Web of Science. The data collection period was August and September 2019 and included studies published between 2008 and 2019. This study followed a protocol based on the PRISMA statement. Data analysis was done in a qualitative way.

RESULTS

The most of works were from Africa, Asia and Iran (71%), where temperature was the main climatic variable. Although the studies provide climatic conditions that are more favorable for the incidence of vector-borne and respiratory diseases, the influence of seasonal patterns on the onset, development and end of CSDs is still poorly understood, especially for gastrointestinal disorders. Moreover, little is known about the impact of droughts on CSDs.

CONCLUSIONS

This review summarized the state of art of the relationship between climate and CSDs in semi-arid regions. Moreover, a research agenda was provided, which is fundamental for health policy development, priority setting and public health management.

Coastal Climate Change Adaptation and Disaster Risk Reduction: A Review of Policy, Programme and Practice for Sustainable Planning Outcomes

Climate change and disaster risk are serious concerns considering the vulnerability of coastal areas and cities to various climate-disaster threats. Hence, the urban populace and planning stakeholders are grappling with the challenges of seeking ways to integrate adaptation measures into human livelihoods and planning systems. However, the synergy between climate change adaptation (CCA) and disaster risk reduction (DRR) remains fragmented and vague. Therefore, this review highlighted recent theoretical and practical methodologies for sustainable planning outcomes in relation to CCA and DRR themes. This paper provides a new model, Problem analysis model (PAM), designed to analyse Origin–Cause–Effect (impacts)–Risks identification and Answers to climate-related disaster at the local or community level. Lastly, three identified enablers were extensively discussed (policy, programme and practice) as a step towards the model implementation and to improve sustainable planning outcomes.

Building resilience against biological hazards and pandemics: COVID-19 and its implications for the Sendai Framework

2020 has become the year of coping with COVID-19. This year was to be the "super year" for sustainability, a year of strengthening global actions to accelerate the transformations required for achieving the 2030 agenda. We argue that 2020 can and must be a year of both. Thus we call for more utilisation of the health-emergency disaster risk management (Health-EDRM) framework to complement current responses to COVID-19 and the patent risk of similar phenomena in the future. To make our case, we examine current responses to COVID-19 and their implications for the SFDRR. We argue that current mechanisms and strategies for disaster resilience, as outlined in the SFDRR, can enhance responses to epidemics or global pandemics such as COVID-19. In this regard, we make several general and DRR-specific recommendations. These recommendations concern knowledge and science provision in understanding disaster and health-related emergency risks, the extension of disaster risk governance to manage both disaster risks and potential health-emergencies, particularly for humanitarian coordination aspects; and the strengthening of community-level preparedness and response.

Integrating Public Health into Climate Change Policy and Planning: State of Practice Update

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

Population Health Adaptation Approaches to the Increasing Severity and Frequency of Weather-Related Disasters Resulting From our Changing Climate: A Literature Review and Application to Charleston, South Carolina

PURPOSE OF REVIEW

Recent changes in our planetary climate have and will continue to challenge historical knowledge and risk assumptions for weather-related disasters. While the public health community is rapidly working to develop epidemiological approaches and tools to mitigate and adapt to these weather-related disasters, recent high-profile events have exposed gaps in knowledge and response efforts. Limited work has been done to assess the climate readiness of the local public health and healthcare community as it pertains to local response planning and adaptation measures in the event of a weather-related disaster. The purpose of this paper is to review the existing literature related to climate change, weather-related disasters, and population health approaches to adapt to climate-related changes in weather-related disasters at the local level. We highlight a brief case study to illustrate an example of a local approach to adaptation planning in a coastal community.

RECENT FINDINGS

Few studies have put forth quantitative disaster epidemiology tools to aid public health officials in preparing for and responding to these weather-related disaster events. There is a general lack of understanding within the public health community about the epidemiological tools which are available to assist local communities in their preparation for, response to, and recovery from weather-related disasters. Cities around the nation are already working to assess their vulnerability and resilience to weather-related disasters by including climate change in emergency preparedness plans and developing adaptation strategies, as well as equipping local hospitals, health departments and other critical public health systems with climate information. But more work is needed and public health funding is lagging to support local and state-level efforts in preparing for and adapting to weather-related disasters in the context of a changing climate. Our population health disaster preparedness programs need to be adapted to address the increasing risks to local public health resulting from our changing climate.

An Assessment of the Relationships between Extreme Weather Events, Vulnerability, and the Impacts on Human Wellbeing in Latin America

Climate change and variability are known to have an influence on human wellbeing in a variety of ways. In Latin America, such forces are especially conspicuous, particularly in respect of extreme climatological, hydrological, and weather events (EWEs) and climate-sensitive disasters (CSDs). Consistent with the need to study further such connections, this paper presents an analysis of some of the vulnerabilities of environmental health issues and climate-related impacts that are focusing on EWEs and CSDs in Latin American countries. The research includes an analysis of the (i) human and socio-economic development; (ii) geographical and socio-economic determinants of vulnerability and adaptability of environmental health issues (exposure, sensitivity, and adaptive capacity); (iii) occurrence of CSDs from 1988 to 2017 and their direct impacts on human wellbeing (Total death and Affected people); (iv) an online survey on the perceptions of the effects of EWEs on human wellbeing in a sample of countries in the region; and (v) discussion of possible solutions. The socio-economic and development indices, and the International Disaster Database (EM-DAT) and Climate-Risk Index (CRI) disaster statistics suggest that the impacts of CSDs are primarily related to socio-economic determinants of human wellbeing and health inequalities. Also, >80% respondents to the survey say that the leading causes of climate-related human impacts are the lack of (i) public awareness; (ii) investment and (iii) preparedness. The paper concludes by adding some suggestions that show how countries in Latin America may better cope with the impacts of Climate-sensitive Disasters.