Editing IPCC:AR6/WGII/Chapter-6 (section)

=== 6.3.3 Adaptation Through Social Infrastructure ===

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Social infrastructure refers to social, cultural and financial activities and institutions as well as associated property, buildings and artefacts that can be deployed to reduce risk and recover from loss. This section examines land use planning, livelihoods and social protection, emergency and disaster risk management, health systems, education and communication, and cultural heritage.

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==== 6.3.3.1 Land Use Planning ====

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Land use planning plays a major role in the siting of settlements and infrastructure. In relation to climate change, it affects whether development takes place in locations that are exposed to hazards; similarly, it shapes the potential effects that the built environment can have on natural systems. Despite this, generally speaking, there is limited implementation of zoning and land use measures for climate adaptation from cities across diverse contexts ( ''robust evidence'' , ''high agreement'' ), see for example Maputo ( [[#Castán%20Broto--2014|Castán Broto, 2014]] ), sub-Saharan cities (Dodman et al., 2017) and Amman, Moscow and Delhi ( [[#Jabareen--2015|Jabareen, 2015]] ). Certain countries, such as South Korea, have, however, recently begun to address disaster risk reduction within their land use planning systems (Han et al., 2019).

Conventional zoning regulations (in which only one kind of use is permitted in a given area) and land use planning range in scale from the regional to the local and can be deployed to minimise risks through protection, accommodation or retreat. Protection entails, in addition to allocating zones for protective urban infrastructure (such as seawalls, levees and dykes, and slope revetments), avoidance measures that restrict or prevent urban development (e.g., through growth containment and/or no-build zones). Accommodation involves land use modifications and/or conversions while retreat requires either compulsory or voluntary relocations and may entail buyouts (Butler, Deyle and Mutnansky, 2016; [[#León--2016|León and March, 2016]] ; Lyles, Berke and Overstreet, 2018). Risk eliminating retreat measures are less widely adopted than other risk reducing zoning and land use measures (Anguelovski et al., 2016; Butler, Deyle and Mutnansky, 2016; Lyles, Berke and Overstreet, 2018). This is attributed to the controversies of relocation and to the complexities of buyouts (Butler, Deyle and Mutnansky, 2016; King et al., 2016).

Evidence from both richer countries and the Global South reveals that conventional zoning is more effective when governance systems facilitate the implementation of land use policies for climate adaptation that preclude negative human-nature interactions and that curb spatial inequity, both of which can trigger climate gentrification and increase the vulnerability of economically disadvantaged groups to climate-related risk ( ''high confidence'' ) ( [[#Marks--2015|Marks, 2015]] ; Liotta et al., 2020; Keenan, Hill and Gumber, 2018). Cascading benefits of zoning and land use planning for climate adaptation are associated with the use of soft land cover, green infrastructure and improvement of livability through better conditions for walkability and cycling. This decreases auto-dependency and contributes to health and economic development (by attracting businesses and retail that stimulate economic prosperity and increase property values) ( [[#Larsen--2015|Larsen, 2015]] ; Carter et al., 2015). Such increases in property values have also been observed in zones and areas protected from risks (such as flooding), where it may trigger spatial inequity leading to climate gentrification ( [[#Marks--2015|Marks, 2015]] ; [[#Votsis--2017|Votsis, 2017]] ; [[#Votsis--2016|Votsis and Perrels, 2016]] ; Keenan, Hill and Gumber, 2018).

Adaptation actions through zoning and land use are more effective when combined with other planning measures ( ''high confidence'' ), for example with ecosystem-based adaptations (e.g., for flood management and curbing the urban heat island effect) ( [[#Larsen--2015|Larsen, 2015]] ; [[#Nalau--2018|Nalau and Becken, 2018]] ; [[#Perera--2018|Perera and Emmanuel, 2018]] ; Anguelovski et al., 2016; Carter et al., 2015; Tsuda and Duarte, 2018; [[#Nolon--2016|Nolon, 2016]] ); with community-based adaptations (trade-offs and valuations, i.e., which land uses are valued more) ( [[#Larsen--2015|Larsen, 2015]] ; [[#Nalau--2018|Nalau and Becken, 2018]] ; [[#Perera--2018|Perera and Emmanuel, 2018]] ; Anguelovski et al., 2016; Carter et al., 2015; McPhearson et al., 2018; [[#Nolon--2016|Nolon, 2016]] ); and with built form regulations and codes ( [[#León--2016|León and March, 2016]] ; [[#Yiannakou--2017|Yiannakou and Salata, 2017]] ; [[#Perera--2018|Perera and Emmanuel, 2018]] ; [[#Straka--2019|Straka and Sodoudi, 2019]] ; [[#Larsen--2015|Larsen, 2015]] ; [[#Nolon--2016|Nolon, 2016]] ). The imposition of planning-based tools such as scenario planning, flexible zoning and development incentivisation (among others) has the capacity to influence and encourage these adaptations (United States Environmental Protection Agency, 2017). Local risk-reduction inputs can inform land use adaptation policies (accommodation and/or avoidance, specifically growth containment and no-build zones) that are better integrated within larger urban plans (Lyles, Berke and Overstreet, 2018; [[#Nalau--2018|Nalau and Becken, 2018]] ; Tsuda and Duarte, 2018) ( ''limited evidence'' , ''high agreement'' ).

Implementation of zoning and land use measures for climate adaptation from cities across diverse contexts remains limited ( ''high agreement'' , ''robust evidence'' ) owing to a range of challenges. A range of evidence from multiple locations indicates the challenges of mainstreaming land use planning for climate adaptation, including in Bangkok, Thailand ( [[#Marks--2015|Marks, 2015]] ), Legazpi City and Camalig Municipality in the Philippines (Cuevas et al., 2016; [[#Cuevas--2016|Cuevas, 2016]] ), the USA (Cuevas et al., 2016; [[#Cuevas--2016|Cuevas, 2016]] ), British Columbia, Canada ( [[#Stevens--2017|Stevens and Senbel, 2017]] ), and Australia (Serrao-Neumann et al., 2017). Mainstreaming is hindered by a lack of clarity of implementation strategies for climate adaptation, insufficient funding, competing priorities (especially among professional planners and politicians), institutional challenges (see Jabareen’s [2015] study of 20 cities globally) and the need to fill data gaps and continuously update weather statistics ( [[#Oberlack--2018|Oberlack and Eisenack, 2018]] ) ( ''medium evidence'' , ''high agreement'' ). At the same time, however, limited evidence from cities around the world such as the urban regions of Stuttgart and Berlin in Germany ( [[#Larsen--2015|Larsen, 2015]] ), Greater Manchester in the UK (Carter et al., 2015), and Colombo in Sri Lanka ( [[#Perera--2018|Perera and Emmanuel, 2018]] ) reveals that risk reduction through zoning and land use can effectively protect and expand green infrastructure and soft land cover to alleviate pluvial flooding and decrease the urban heat island effect. This evidence points that one of the primary roles of land use planning is to guide the development of the urban form. As such, it underpins and establishes the basis for other infrastructure systems such as physical infrastructure and nature-based solutions (Morrissey, Moloney and Moore, 2018).

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==== 6.3.3.2 Livelihoods and Social Protection ====

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Understanding how livelihoods, particularly of the urban poor, are both impacted by climate risk and how they might be strengthened is central to understanding climate adaptation in cities and settlements (Dobson et al. 2015). Rapid urbanisation and expanding physical infrastructure do not have a clear relationship with improved outcomes for urban livelihoods of low-income residents (Soltesova et al., 2014). Municipal and national efforts need to be closely aligned with building adaptive capacity of residents themselves, often through community-based adaptation (Soltesova et al., 2014; Dobson, Nyamweru and Dodman, 2015). Social safety nets protect individuals or households from falling below a defined standard of living by providing cash, in kind and other social transfers to fight vulnerabilities ( [[#Islam--2019|Islam and Hasan, 2019]] ) including those associated with climate change impacts including food shocks. Strengthening the financial and social infrastructure of poor households is a critical component of adaptive and transformative capacity (Haque, Dodman and Hossain, 2014; Ziervogel, Cowen and Ziniades, 2016). Social safety nets are one mechanism for strengthening this capacity.

Social protection, or social security, is defined as the set of policies and programmes designed to reduce and prevent poverty and vulnerability throughout the lifecycle ( [[#ILO--2017|ILO, 2017]] ). Safety nets are intended to protect vulnerable households from impacts of economic shocks, natural hazards and disasters, and other crises. The UN policy frameworks for sustainable development, including the Sendai Framework for Disaster Risk Reduction 2015–2030, the new Strategic Framework 2018–2030 of the United Nations Convention to Combat Desertification (UNCCD) and UNFCCC, highlight the essential role of social protection in promoting comprehensive risk management ( [[#Aleksandrova--2019|Aleksandrova, 2019]] ). Since the term Adaptive Aocial Protection was introduced by the [[#World%20Bank--2015|World Bank (2015)]] and the [[#IPCC--2014|IPCC (2014)]] , it has been an emerging strategic tool to integrate poverty reduction, disaster risk reduction and humanitarian development into adaptation to climate change (Béné, Cornelius and Howland, 2018; [[#Aleksandrova--2019|Aleksandrova, 2019]] ; Watson et al., 2016).

Adaptive social protection (ASP) is defined as a resilience-building approach by combining elements of social protection, disaster risk reduction and climate change adaptation, so as to break the cycle of poverty and vulnerability of household by investing in their capacity to prepare for, cope with and adapt to all types of shocks, especially under climate change and other global challenges (Bowen et al., 2020; Ivaschenko et al., 2018). ASP has been justified as an effective instrument to build household and community resilience to climate extremes and slow-onset climate events such as sea level rise and environmental degradation ( [[#Schwan--2018|Schwan and Yu, 2018]] ; [[#Aleksandrova--2019|Aleksandrova, 2019]] ). In contexts of extreme poverty or climatic extremes, international development organisations, national provisions and market charities are complementary where family and kinship networks are weak and inadequate. To deal with short-term vulnerability to climate shocks, ASP can act as a crucial complement to risk management tools provided by communities and markets, tools which tend to be insufficient in the face of large or systemic shocks, by providing predictable transfers, developing human capital and diversifying livelihoods (Hallegatte et al., 2016). ASP can also facilitate long-term change and adaptation by improving education and health levels, as well as providing a proactive approach to managing climate-induced migration in both rural and urban areas ( [[#Schwan--2018|Schwan and Yu, 2018]] ; Adger et al., 2014).

Many national ASP programmes are established to cover both rural and urban areas, however, only a small number of researchers pay attention to urban cases ( [[#Aleksandrova--2019|Aleksandrova, 2019]] ). ASP instruments can be classified into four major types as presented in Table 6.5 (Ivaschenko et al., 2018; [[#ILO--2017|ILO, 2017]] ). ASP can contribute to both incremental and transformative interventions both at the system level (short-term and long-term coping strategies from communities) and at the beneficiaries’ level (vulnerable populations) (Béné, Cornelius and Howland, 2018; [[#World%20Bank--2015|World Bank, 2015]] ; [[#Aleksandrova--2019|Aleksandrova, 2019]] ; Ivaschenko et al., 2018).

'''Table 6.5 |''' Four categories and examples of adaptive social protection.

{| class="wikitable"
|-
! '''Category'''

! '''Example'''

! '''Urban cases'''

! '''Function'''

|-
| Social safety nets (or social assistance)

| Conditional and unconditional cash transfers, including non-contributory pensions and disability, birth and death allowances;

Food stamps, rations, emergency food distribution, school feeding and subsidies;

Cash or food for work programmes;

Free or subsidised health services;

Housing and utility subsidies;

Scholarships and fee waivers, etc.

| * A targeted asset transfer project for urban extreme poor in Dhaka city ( [[#Hossain--2018|Hossain and Rahman, 2018]] )
* Emergency food stockpiling in Japan; safety net food stocks in India, Indonesia and Malaysia (Lassa et al., 2019)
* Household cash transfer programme in contingency planning in Mexico (Ivaschenko et al., 2018)
* Governmental transfer to hurricane affected households in USA (Bowen et al., 2020)
* Non-contributory disability cash benefits ( [[#ILO--2017|ILO, 2017]] )

| Incremental adaptation; protective measures

|-
| Social insurance

| Old age, survivor and disability contributory pensions;

Occupational injury benefit, sick or maternity leave;

Health insurance, etc.

| Old-age social pensions (Ivaschenko et al., 2018)

| Incremental adaptation and ''ex ante'' prevention

|-
| Labour market policies

| Unemployment, severance and early retirement compensation;

Training, job sharing and labour market services;

Wage subsidises and other employment incentives, including for disabled people, etc.

| Public works and employment protection in Africa, Asia cases ( [[#World%20Bank--2015|World Bank, 2015]] ; [[#ILO--2017|ILO, 2017]] ; Ivaschenko et al., 2018)

| ''Ex post'' protection and ''ex ante'' prevention measures, incremental adaptation

|-
| Livelihood development measures

| Income diversification, employment support, weather-index insurance, housing subsidies, post-disaster construction, relocation planning, livelihood shift strategies, etc.

| Multiple programmes for differing household needs in Philippines (Bowen et al., 2020);

Weather-index insurance in Chinese coastal cities ( [[#Rao--2019|Rao and Li, 2019]] );

Early warning forecast system and public meteorological service information in Beijing (Song, Zheng and Lin, 2021)

| Promotive and anticipatory measures; transformational adaptation

|}

ASP may be very good at reducing extreme poverty by helping to meet individual or household needs but not collective needs to mitigate long-term climate shocks. For example, few programmes consider risk assessment and climate-proof infrastructures as anticipatory measures to foster early action and preparedness ( [[#Aleksandrova--2019|Aleksandrova, 2019]] ; Costella et al., 2017). They therefore need to enable the adoption of forward-looking strategies for long-lasting adaptation ( [[#Tenzing--2020|Tenzing, 2020]] ). Some examples from China show social protection can improve adaptive capacity of urban communities with social medical insurance, housing subsidies, weather-index insurance, post-disaster construction, relocation planning, livelihood shift strategies, and so on. (Pan et al., 2015; Zheng et al., 2018b; [[#Rao--2019|Rao and Li, 2019]] ; Song, Zheng and Lin, 2021). However, social protection may lead to maladaptation in urban policy when social security, or similar tools (for example insurance) to compensate for exposure deincentivise risk reduction ( [[#Grove--2021|Grove, 2021]] ). In many developing countries, high concentrations of poor and vulnerable groups living in disaster-prone zones of urban centres, new urban dwellers and informal residents are often excluded from community-based networks and social services ( [[#Aleksandrova--2019|Aleksandrova, 2019]] ). Risk transfer tools (such as insurance) and risk retention measures (such as social safety nets) can avoid and minimise the burden of loss and damage and limit secondary and indirect effects ( [[#Aleksandrova--2019|Aleksandrova, 2019]] ; [[#Roberts--2018|Roberts and Pelling, 2018]] ).

Inclusive, targeted, responsive and equitable social protection can support long-term transition toward more sustainable, adaptive and resilient societies (Hallegatte et al., 2016; Shi et al., 2018; Béné, Cornelius and Howland, 2018; [[#Carter--2018|Carter and Janzen, 2018]] ; Adger et al., 2014). ASP systems can be cost effective and equitable when targeting accuracy, timely risk sharing (disaster assistance) and improved policy coherence. [[#Carter--2018|Carter and Janzen (2018)]] find that the long-term level and depth of poverty can be improved by incorporating vulnerability targeted social protection into a conventional social protection system. Countries at all income levels can set up ASP systems that increase resilience to natural hazards, but the systems need to identify cost–benefits and be scalable and flexible to adjust to future, increasing climate risk. [[#Bastagli--2014|Bastagli (2014)]] suggested a new design for effective social protection including: (i) increasing the amount or value of transfer; (ii) extending the coverage of beneficiaries; and (iii) introducing payments or new programmes of social protections. For social protection programmes to contribute more effectively to adaptation, they need to be better coordinated across a range of agencies; better integrated with climate data to anticipate times of need for vulnerable groups; and better aligned with other risk management instruments such as insurance (Agrawal et al., 2019).

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==== 6.3.3.3 Emergency and Disaster Risk Management ====

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There is growing evidence of the benefits of early warning systems for urban preparedness decision making and action for climate and weather-related hazards such as cyclones, hurricanes and floods ( ''medium evidence'' ; ''high agreement'' ) (Lumbroso, Brown and Ranger, 2016; [[#Zia--2015|Zia and Wagner, 2015]] ; Marchezini et al., 2017). Climate forecasting is constantly evolving and becoming increasingly accurate. Global organisations such as the World Meteorological Organizations are increasingly focusing on new and emerging technologies such as crowdsourced data collection to support integrated city services and early warning systems (Baklanov et al., 2018). However, while climate forecasting is an increasingly central tool for risk management agencies, a focus on urban areas or key infrastructure is still considerably rare (Lourenço et al., 2015; Nissan et al., 2019; Harvey et al., 2019). The significant rise in urban risks poses significant challenges to humanitarian agencies. Humanitarian responses and local emergency management are vital for disaster risk reduction yet are compromised in urban contexts where it is difficult to confirm property ownership and where renters and informal dwellers are often excluded from decision-making and planning ( [[#Parker--2015|Parker and Maynard, 2015]] ; Maynard et al., 2017). Disaster survivors and growing urban refugee populations are often displaced across the city thereby complicating efforts to track and provide support (Maynard et al., 2017).

Existing early warning systems remain insufficient and the complexity of urban landforms makes accurate and detailed early warning difficult ( ''medium evidence'' ; ''high agreement'' ) (Jones et al., 2015). This is particularly the case in low- and middle-income countries (LMICs) where urban centres are often characterised by rapid expansion of interlinked formal and informal human settlements and land use zones. In such contexts, early warning services vary in effectiveness within the same urban centre (Allen et al., 2020c; Rangwala et al., 2018). Often, forecast-based action follows linear structures where forecast information is applied mainly for responding to negative impacts rather than anticipatory decision-making and preparation to avoid such impacts (Marchezini et al., 2017). Early warning systems are effective for warning of threshold breaching events including cyclonic activity and riverine flooding but less able to provide localised warning, though capability is rapidly increasing. Probabilistic risk forecasting and forecast based early action are only beginning to be applied to urban contexts and often those that are most vulnerable do not receive warnings regarding hazardous events (Nissan et al., 2019). There is less capacity for early warning systems in LMICs with key challenges linked to a lack of well-established risk baseline information; accessibility, communication and understanding of forecast information, as well as political and institutional barriers and limited resources and capacities to act on such information (Jones et al., 2015; Mustafa et al., 2015; [[#Zia--2015|Zia and Wagner, 2015]] ; Marchezini et al., 2017; Gotgelf, Roggero and Eisenack, 2020). Political and institutional barriers to the incorporation of climate information to decision-making are not limited to LMICs (Harvey et al., 2019). For example, comprehensive studies on sectoral use of climate information in Europe revealed that, despite climate services becoming increasingly accessible and well resourced, there is limited organisational uptake of seasonal climate forecasts across key sectors (e.g., energy, transport, water and infrastructure) in informing their decision making processes ( [[#Soares--2016|Soares and Dessai, 2016]] ; Soares, Alexander and Dessai, 2018). This is due both to technical and non-technical barriers such as lack of awareness and knowledge of climate information and forecasting ( [[#Soares--2016|Soares and Dessai, 2016]] ; Soares, Alexander and Dessai, 2018).

Globally, a considerable diversity of tools and frameworks for urban resilience assessments are being developed at multiple scales ( [[#Arup%20and%20Rockefeller--2015|Arup and Rockefeller, 2015]] ; Elias-Trostmann et al., 2018). These include hybrids such as ecosystem-based disaster risk reduction (Eco-DRR) (Begum et al., 2014).While important advances have been made in assessing urban resilience, much debate remains around such tools and assessment approaches regarding issues such as validation, dynamics in exposure and vulnerability, and appropriateness of generic methods in high-density urban settlements (Leitner et al., 2018; Cardoso et al., 2020; Rufat et al., 2019). Disaster impact and recovery time are strongly influenced by the behaviour and actions of individuals, communities, businesses, and government organisations ( [[#Meriläinen--2020|Meriläinen, 2020]] ; Räsänen et al., 2020). For example, the review by Aaerts et al. (2018) shows how the limitations of existing flood risk assessment methods (which tend to account for human behaviour in limited terms) can be addressed through innovative flood-risk assessments that integrate behavioural adaptation dynamics. The study by [[#Moghadas--2019|Moghadas et al. (2019)]] highlights the importance of hybrid multi-criteria approaches for assessing urban flood resilience in Tehran, Iran. A growing literature shows how multidisciplinary and inclusive approaches that include Local knowledge can achieve greater accuracy in risk characterisation and support lasting impact of investments into more robust climate services (Aerts et al., 2018; Lourenço et al., 2015; Sword-Daniels et al., 2018; Singh et al., 2018; Nissan et al., 2019; Harvey et al., 2019; [[#Simon--2020|Simon and Palmer, 2020]] ). This literature highlights the need for innovative approaches in urban contexts that transcend traditional approaches of local knowledge inclusion widely applied in rural contexts, such as participatory rural appraisal.

The inclusion of Local knowledge and Indigenous knowledge in urban vulnerability and risk assessments can strongly enhance local resilience, but its effectiveness is constrained by wider decision making and policy contexts dominated by top-down approaches ( ''medium evidence'' ; ''high agreement'' ) (Jones et al., 2015; Sword-Daniels et al., 2018; Nissan et al., 2019). Established non-state actors such as Shack and Slum Dwellers International are particularly effective at implementing inclusive approaches for local knowledge incorporation into urban decision-making. Climate change and disaster risk exacerbate existing problems of economic development, yet macro-economic planning seldom incorporates adaptation. Recent evidence also confirms the role of Indigenous knowledge and local knowledge in management practices to reduce climate risks through early warning preparedness and response (see also [[#6.3.2|Section 6.3.2.3]] ). These practices are particularly important where alternative early warning methods are absent. For instance, Abudu Kasei et al. (2019) show that Indigenous knowledge gathered through observations on changes in natural indicators (such as links between rainfall patterns, certain flora and fauna, and temperature changes) could be applied to develop early warning of climate hazards (floods and droughts) in informal urban settlements in African countries such as Ghana. Similarly, Hiwaski et al. (2015) show that observations of changes in the environment and celestial bodies are used to predict climate-related hazards in Indonesia, the Philippines and Timor-Leste where communities in turn use local materials and methods, and customary practices to respond to the impacts of climate change.

Insurance is a risk transfer mechanism for middle- and high-income countries, yet is less widely available in LMICs ( [[#Surminski--2017|Surminski and Thieken, 2017]] ). Additionally, where insurance options do exist in LMICs, these are not usually available to large populations living or operating in the informal sector. Flood insurance is widely available in many Organisation for Economic Co-operation and Development (OECD) countries but the demand and uptake differ significantly across countries (Hanger et al., 2018). This financial tool is subject to increasing pressure under the changing climate, with growing concerns around affordability and availability. More integrative approaches are required, such as where changes in the insurance industry are closely linked to adaptation strategies, building standards and land use planning and their application (Cremades et al., 2018). This is particularly important in LMICs and of central concern for all insurance schemes is ensuring access, fairness and affordability for the most poor and vulnerable. However, there are some notable examples of low-income communities setting up their own disaster insurance mechanisms. For example, the Community Development Funds for the Baan Mankong upgrading programme in Thailand include disaster funds as insurance against housing damage ( [[#Archer--2012|Archer, 2012]] ). Such approaches also need to be more closely linked to existing urban risk management planning approaches where urban livelihoods are seldom integrated and informed by more dynamic risk reduction frameworks that consider adaptive cycles and how resilience changes over time ( [[#Beringer--2018|Beringer and Kaewsuk, 2018]] ; Cremades et al., 2018).

Disaster risk management systems face increasing challenges in adapting to evolving risk profiles, shaped by expanding urban areas and changing environmental conditions associated with climate change. In addition to flooding, risk monitoring and management systems have recently shown considerable shortfalls in planning for and responding to increased fire risk such as the devastating Californian wildfires in October 2019 ( [[#Morley--2020|Morley, 2020]] ) and Australia’s unprecedented and catastrophic 2019–2020 wildfire season. Risk management has also been challenged by new risk experiences including wild/bush fires encroaching on expanding urban areas and fire outbreaks in densely populated informal settlements pose increasing threats to livelihoods, human health and habitats globally (see also Sections 2.4.4.2 and 2.5.5.2).

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==== 6.3.3.4 Climate Resilient Health Systems ====

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Climate resilient health systems are a vital part of adaptation to protect the most vulnerable from climate change ( [[#WHO--2020|WHO, 2020]] ). Cardiovascular fitness for example is a root cause of morbidity and mortality form heat stress (Schuster et al., 2017). The World Health Organization has developed a framework of climate-resilient health systems that addresses both mitigation and adaptation goals ( [[#WHO--2015|WHO, 2015]] ). Universal health coverage (UHC) is an essential component of climate-resilient health systems. In most countries, access to health services is better in urban than in rural areas. However, there remain large urban populations with insufficient coverage of health services ( [[#WHO%20and%20WB--2015|WHO and WB, 2015]] ) and UHC tracking needs to take better account of inequalities in coverage, including differences in access within cities and further disaggregation of urban populations by income. Thus, health sector investment is an important tool in adaptive action and capacity. Analyses of health survey data shows that, globally, access to health care is increasing toward UHC targets (Lozano et al., 2020). Financing for global health has increased steadily in the last two decades and modelling shows this trend is ''likely'' to continue to 2050, but at a slower pace of growth and the current disparities in per-capita health spending persist between high and low/middle income countries, leading to insufficient health service coverage for the poorest populations (Chang et al., 2019a). Out-of-pocket spending is projected to remain substantial in LMIC and will remain the only means to access health care for many poor urban populations.

The WHO Operational Framework highlights the components that can be strengthened to adapt to extreme weather (e.g., health care workforce, information systems, etc.). The evidence is greatest for impacts on larger health facilities (such as hospitals) and there is less evidence regarding impacts on health service delivery outside these settings (smaller health facilities, pharmacies, first responders, public health inspectors, etc.). Improved building design and spatial urban planning (where facilities are located) are essential to increase resilience for higher temperature and flood risk ( ''medium evidence'' ; ''high agreement'' ) ( [[#WHO--2021|WHO, 2021]] ; [[#Codjoe--2020|Codjoe et al., 2020]] ; [[#Korah--2017|Korah and Cobbinah, 2017]] ). Public health systems rely on information systems (including disease and vector surveillance and monitoring) to identify new and emergent public health risks. Improvements to health surveillance will increase resilience, particularly for populations in informal settlements that are absent from health and vital registration systems.

City-level and local government adaptation planning is facilitated by information on health impacts (Reckien et al., 2015), highlighting the need for monitoring and surveillance and the need for local evidence-based risk assessments. Adaptation in the health sector can be limited by lack of collaboration between health and other sectors, although this is often easier to facilitate at the local level (Woodhall, Landeg and Kovats, 2021).

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==== 6.3.3.5 Education and Communication ====

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Since AR5, there has been significant growth in research about climate education and activism (Simpson, Napawan and Snyder, 2019; O’Brien, Selboe and Hayward, 2018; [[#Hayward--2021|Hayward, 2021]] ). Access to knowledge is an important determinant of well-being, inclusivity and livelihood mobility and of driving human behaviour. Knowledge systems include formal educational provision (capital assets, syllabus and human capital), informal learning based in social interaction and customary institutions (including through social media) and public communication (news media, government and other information systems including commercial messaging). There is a growing body of literature addressing the role of information and communication technology in shaping behaviour in disaster response and recovery and climate action, with particular focus on social media use and serious gaming (Houston et al., 2015; Carson et al., 2018) (see [[#6.3.4.3|Section 6.3.4.3]] )

Given the amount of time that children spend in school settings, adapting educational infrastructure and programmes to climate change is highly important. This includes not only making physical structures safe, but also providing students with the knowledge and confidence to support individual and family-based adaptation. Several UN agencies (e.g., UNICEF and UNDRR) and international non-governmental agencies (e.g., Plan International) have prioritised safer schools and child-centred risk management that often focus on schools as places that should be prioritised for retrofitting and safe construction, but also as focal points for knowledge dissemination and community organising where impacts can extend beyond the school to reduce risk among students’ families. Universities and think tanks, as well as the third and private sector are key support mechanisms, particularly at the local level and when working in collaboration with local government and communities. They can support the development of critical educational resources and innovative communication methods, as well as facilitate the design and implementation of climate policies and related action plans.

Youth, adult communities, social media and the commercial media can have a significant impact on advancing climate awareness and the legitimacy of adaptive action, particularly in large urban areas ( ''medium evidence'' , ''high agreement'' ). Climate change education in urban settlements has increasingly focused on enhancing children and young people’s political agency in schools, universities, and in formal and informal media settings ( [[#Cutter-Mackenzie--2019|Cutter-Mackenzie and Rousell, 2019]] ). However, an ambiguous framing of climate impacts and adaptation, for example around the science of urban heat islands by the media, can also exacerbate local community confusion and uncertainty (Iping et al., 2019) and further training and capacity building opportunities such as for vocational qualifications is still required across diverse settings ( [[#Simmons--2021|Simmons, 2021]] ). Communication strategies deployed in formal education and social media can be highly influential in exchanging information and establishing narratives and viewpoints that frame what adaptive action is legitimate, especially in large cities (Simpson, Napawan and Snyder, 2019). However, the effectiveness of communication strategies for change, for example from Mayoral offices, can also be influenced by wider political and structural drivers including community literacy or political partisanship (Boussalis, Coan and Holman, 2019). Recent research (e.g., Macintyre et al., 2018) highlights the need for new learning approaches to climate education from school age to adult education. Emphasis is on inclusivity in learning and recognising diverse perspectives across multiple levels and settings, from formal and informal education to wider social learning. Informal learning that takes place outside of school settings, such as in libraries and botanical gardens, in everyday life is increasingly recognised as a key arena for climate education, life-long learning and nurturing environmental citizenship and activism (Paraskeva-Hadjichambi et al., 2020).

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==== 6.3.3.6 Cultural heritage/institutions ====

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The integration of culture into urban policy and planning is increasingly recognised as critical to developing sustainable and resilient cities, and features in international agreements such as the SDGs ( ''limited evidence'' ; ''high agreement'' ) ( [[#Sitas--2020|Sitas, 2020]] ). However, urban cultural policies are still limited, for example, Cape Town is the only African city to have developed a city-level cultural policy ( [[#Sitas--2020|Sitas, 2020]] ). Cultural heritage refers to both tangible (e.g., historic buildings and sites) and intangible (e.g., oral traditions and social practices) resources inherited from the past ( [[#Fatorić--2020|Fatorić and Egberts, 2020]] ; Jackson, Dugmore and Riede, 2018). Learning about past societal and environment changes through heritage offers opportunity for reflection and transfer of knowledge and skills. This takes place in multiple contexts such as museums and cultural landscapes, and in everyday life ( [[#Fatorić--2020|Fatorić and Egberts, 2020]] ; Jackson, Dugmore and Riede, 2018). Cultural heritage is primarily associated with identity and is closely intertwined with the complexities of history, politics, economics and memory. Climate change adds another layer of complexity to cultural heritage and resource management ( [[#Fatorić--2017b|Fatorić and Seekamp, 2017b]] ). Changing climatic conditions are already negatively impacting World Heritage Sites such as the Cordilleras’ Rice Terraces of the Philippines and earthen architecture sites, for example the Djenné mosque in Mali, are particularly vulnerable to changes in temperature and water interactions ( [[#UNESCO--2021|UNESCO, 2021]] ). Climate change impacts intangible cultural heritage across diverse settings such as in the Caribbean and Pacific Small Island Developing States (SIDS) where traditional ways of life and related aspects such as oral traditions and performing arts are under threat from extreme weather events ( [[#UNESCO--2021|UNESCO, 2021]] ).

The climate change adaptation options for built cultural heritage fall into seven categories (Rockman et al., 2016; [[#Fatorić--2017b|Fatorić and Seekamp, 2017b]] ). Financial constraints are the primary barriers that underpin the first four adaptation options: no action at all, merely monitoring and/or documenting, or annual maintenance (Xiao et al., 2019; Sesana et al., 2019; [[#Fatorić--2017a|Fatorić and Seekamp, 2017a]] ; [[#Fatorić--2017b|Fatorić and Seekamp, 2017b]] ; [[#Fatorić--2018|Fatorić and Seekamp, 2018]] ). Core and shell preservation, the fifth and sixth categories, are cost effective when they improve the condition of built cultural heritage (BCH) ( [[#Bertolin--2018|Bertolin and Loli, 2018]] ; [[#Loli--2018a|Loli and Bertolin, 2018a]] ; [[#Loli--2018b|Loli and Bertolin, 2018b]] ), while elevation and/or relocation, the final adaptation options, are extremely costly and might jeopardise the historic value (Xiao et al., 2019). To date, however, evidence indicates that adaptation actions prioritise archaeological sites (Carmichael et al., 2017; [[#Fatorić--2018|Fatorić and Seekamp, 2018]] ; Pollard et al., 2014; [[#Dawson--2013|Dawson, 2013]] ). The efficacy of adaptation of historic buildings can be increased through increased and stable funding, incentives, stakeholder engagement, and legal and political frameworks (Dutra et al., 2017; [[#Fatorić--2018|Fatorić and Seekamp, 2018]] ; [[#Fatorić--2017b|Fatorić and Seekamp, 2017b]] ; [[#Fatorić--2017a|Fatorić and Seekamp, 2017a]] ; [[#Leijonhufvud--2016|Leijonhufvud, 2016]] ; [[#Phillips--2015|Phillips, 2015]] ; Sesana et al., 2019; Sesana et al., 2018; [[#Sitas--2020|Sitas, 2020]] ).

Other barriers to implementation include harnessing expert and local knowledge (of individuals and organisations) to identify both quantitative and qualitative methods and indicators that connect cultural significance and local values vis-à-vis climatic change over time and that move beyond the prevalent high-risk or high-vulnerability centred approaches (Carmichael et al., 2017; [[#Fatorić--2018|Fatorić and Seekamp, 2018]] ; Haugen et al., 2018; [[#Leijonhufvud--2016|Leijonhufvud, 2016]] ; Pollard et al., 2014; Puente-Rodríguez et al., 2016; Richards et al., 2018; [[#Dawson--2013|Dawson, 2013]] ; Filipe, Renedo and Marston, 2017; Kotova et al., 2019). This is particularly important given that the significance of cultural heritage is often intangible, and its value cannot be determined solely through quantitative indicators. Accessing local resources (craftsmanship and materials compatible with the originals) can also improve built cultural heritage’s adaptation capacity ( [[#Phillips--2015|Phillips, 2015]] ).

Effective decision-making and practice for adapting built and intangible cultural heritage requires open dialogue and exchange of cultural, historical and technical information between diverse stakeholders and decision makers ( [[#Fatorić--2017b|Fatorić and Seekamp, 2017b]] ; Benson, Lorenzoni and Cook, 2016). As noted in [[#6.2.6|Section 6.2.6]] , human behaviour can be a driving force for adaptation impacts on BCH at risk. Despite challenges associated with intangibility, socio-cultural heritage such as Indigenous knowledge (e.g., food security and water management practices) presents important opportunities for climate adaptation and resilience building. More research is needed across diverse contexts to understand feasible climate adaptation measures, and barriers and opportunities for building the resilience of both built and intangible cultural heritage, as well as to increase awareness of cultural heritage benefits among climate change policymakers ( [[#Fatorić--2020|Fatorić and Egberts, 2020]] ).

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