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

==== 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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