Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.4.7.1 Fully Implementing the World Health Organization Operational Framework ====

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The WHO Operational Framework for building climate-resilient health systems was designed to increase the capacity of health systems and public health programming to protect health in an unstable and changing climate ( [[#WHO--2015b|WHO, 2015b]] ). The guidance defines a climate-resilient health system as ''one that is capable to anticipate, respond to, cope with, recover from and adapt to climate-related shocks and stress, so as to bring sustained improvements in population health despite an unstable climate'' . Full implementation of this framework has the potential to achieve transformational adaptation; the fundamental attributes of health systems would change to anticipate and effectively manage the population health and healthcare risks of climate change. This includes having the knowledge, capacity, tools and human and financial resources for health systems to extend beyond soft limits to adaptation.

The WHO framework outlines 10 key components (Figure 7.15) that, when achieved, will:

* Guide professionals working in health systems and in health determining sectors (e.g., water and sanitation, food and agriculture, energy, and urban planning) to understand and effectively prepare for the additional health risks posed by climate variability and change
* Identify the main health functions that need to be strengthened to build climate resilience, and to use these to develop comprehensive and practical plans (e.g., the health component of National Adaptation Plans (H-NAP))
* Support health decision makers to identify roles and responsibilities to implement this plan for actors within and outside the formal health sector

[[File:41456f250ec9aaf0cf80c4ba91cab066 IPCC_AR6_WGII_Figure_7_015.png]]

'''Figure 7.15 |''' '''Ten components of the WHO operational framework for building climate-resilient health systems with links to the building blocks of health systems.''' Source: [[#WHO--2015b|WHO (2015b)]] .

Achieving full implementation of the WHO Operational Framework requires determination and commitment—with associated funding—from the health community specifically and health-determining sectors more generally. Identifying priority areas is an immediate step required to commence this implementation process, which will vary across different contexts. Active engagement with Communities of Practice to share lessons and experiences would be a useful approach to support national and sub-national efforts; examples of this already exist (e.g., the Climate Change Community of Practice in Canada and the ‘weADAPT’ initiative under the auspices of the Stockholm Environment Institute).

Table 7.9 summarises selected characteristics of health systems as they might be under SSP1 (a world aiming to sustainable development), SSP2 (a world continuing current trends) and SSP3 (a world with high challenges to adaptation and mitigation), with systems under SSP1 being most consistent with climate resilient development. The table highlights the importance of investments that promote sustainable and resilient development to decrease vulnerability, no matter the magnitude and pattern of climate change. Adapting under SSP3 would be challenging even under pathways of limited additional climate change.

'''Table 7.9 |''' Characteristics of future health systems under three SSPs; modified from [[#Sellers--2017|Sellers and Ebi (2017)]] .

{| class="wikitable"
|-
!
! SSP3

! SSP2

! SSP1

|-
| Basic characteristics

| Reactive; failure to adapt; siloed information channels and national governance; limited partnerships

| Incomplete planning; new information incorporated as convenient; occasional partnerships

| Proactive; adaptively managed; frequent partnerships; inter-disciplinary

|-
| Leadership and governance

| Little focus at national and international levels on climate change and health; minimal planning conducted

| Planning for climate change and health, but not comprehensive and often side-tracked by other issues

| Strong climate change and health planning apparatus, including health components of national adaptation plans; regional/international partnerships

|-
| Health workforce

| Climate change and health not often incorporated into training; few provisions for new training programmes or funding for increase health worker positions in climate change-relevant specialties; health disparities not addressed

| Climate change and health not systematically incorporated into training; new training programmes insufficient to fill gaps in demand; limited attention to addressing health disparities

| Systematic inclusion of climate change and health in worker training; expansion of funding and training; financing and incentive mechanisms to address health disparities

|-
| Health information systems

| Assessments of vulnerability and adaptation rarely conducted, if ever; information not useful for planning; minimal risk monitoring or research

| Vulnerability and adaptation assessments occasionally conducted, but generally of poor quality; early warnings incomplete; fiscal and political constraints on research

| Vulnerability and adaptation assessments regularly conducted and used in planning; robust early warning networks; research agenda focused on vulnerable communities

|-
| Climate-resilient and sustainable technologies and infrastructure

| Facilities sited and constructed without climate consideration incorporated; medical supply chains not modified

| Capital cost serves as a key factor in siting and construction; increasing vulnerability of facilities to shocks

| Health infrastructure designed to be robust to storms/floods, with redundant systems added to ensure continuity of care

|-
| Service delivery

| Policies to manage environmental health hazards generally not followed; care practices not modified to accommodate climate information; few changes to emergency management procedures; health inequities worsen

| Environmental health policies are not robust; marginal improvements in care practices; risk assessments and communication inadequate; no shift in health inequities

| Policies to manage environmental health hazards regularly reviewed; practitioners review care practices and adjust as appropriate based on local climate and health conditions; robust communication tools developed; health service improvements reduce health inequities

|-
| Climate and health financing

| Few funds devoted to climate change and health activities, particularly in low- and middle-income countries; few if any financing partnerships between high-, low- and middle-income countries; very weak regional and international coordinating bodies due to funding constraints

| High-income countries generally form robust financing mechanisms; fiscal pressures in low- and middle-income countries constrain their financing abilities; financial partnerships formed across countries, but financing often not robust; regional and international coordinating bodies receive inadequate funds

| Robust funding streams for climate change and health; climate change and health activities receive continuing financial support; effective financing partnerships; regional and international coordinating bodies effectively funded

|}

Stress testing is an approach for evaluating the extent to which health systems are prepared for a future different from today ( [[#Ebi--2018a|Ebi et al., 2018a]] ). These desk-based exercises identify a desirable future outcome, such as successfully managing an extreme heatwave, flood or storm with characteristics outside the range of recent experiences. The exercises move beyond identifying ''likely'' challenges from hazardous exposures to specifying policies and measures that could be successful under a different climate and development pathway. The exercises consider socioeconomic and political factors that can influence the extent of health system vulnerability and other factors that can affect health system demands by impacting population health. Stress testing is designed to identify conditions under which it would be difficult for the health system to maintain its essential functions and to identify interventions that could maintain essential system functions despite climate-related shocks and stresses.

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