Editing IPCC:AR6/WGII/Chapter-15 (section)

=== 15.6.2 Health-Related Adaptation Strategies ===

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The term ‘health systems’ refers to the organisation of people, institutions and resources that work to protect and promote population health. The two components of health systems are public health and healthcare; adaptation is needed in both to develop climate-resilient health systems ( [[#WHO--2015|WHO, 2015]] ). Adaptation measures focus on each of the building blocks of health systems, including leadership and governance; a knowledgeable health workforce; health information systems; essential medical products and technologies; health service delivery; and financing. Many small island states have policies to manage climate-sensitive health risks, although ministries of health are largely unprepared to adapt to a changing climate because few programmes take climate change into account ( [[#McIver--2016|McIver et al., 2016]] ). Particularly vulnerable groups, such as Indigenous Peoples, are often inadequately represented in adaptation planning processes and implementation, resulting in less effective interventions ( [[#Jones--2019|Jones, 2019]] ).

A range of climate-sensitive diseases pose threats to island communities. A vulnerability and adaptation assessment conducted in Dominica identified vector-, water- and food-borne diseases and food security as priority threats from climate change ( [[#Schnitter--2019|Schnitter et al., 2019]] ). Short-term adaptation options include strengthening solid waste management and enforcing current legislation; increasing public awareness; training health sector staff; improving the reliability and safety of water-storage practices; improving climate change and health data collection methods and enhancing environmental monitoring; enhancing the integration of climate services into health decision-making; strengthening the organisational structure of emergency response; and ensuring sufficient resources and surge capacity. Longer-term adaptation options include developing early warning and response systems for climate-sensitive health risks; enhancing data collection and information flow; increasing the capacity of laboratory facilities; and developing emergency plans. For example, rainfall is the best environmental predictor of malaria in North Guadalcanal, Solomon Islands, leading to the development of an early warning tool that could increase resilience to climate change ( [[#Smith--2017|Smith et al., 2017]] ; [[#Jeanne--2018|Jeanne et al., 2018]] ).

In small island states, water, sanitation and hygiene infrastructure are particularly vulnerable to climate change, with impacts on the burden of diarrhoeal diseases. The resilience of types of sanitation infrastructure in urban and rural households in the Solomon Islands differs under scenarios of increased rainfall and flooding versus decreased rainfall and drought, reinforcing the centrality of taking the local context into account during adaptation decision-making ( [[#Fleming--2019|Fleming et al., 2019]] ). Healthcare facilities, including hospitals, clinics and community care centres, are vulnerable to extreme weather and climate events, such as flooding and TCs, and to climate-related outbreaks of infectious diseases that overwhelm their capacity to provide critical services ( [[#WHO--2020|WHO, 2020]] ). These facilities may lack functioning infrastructure and trained health workforce, and be predisposed to inadequate energy supplies and water, sanitation and waste management services. Adaptation is needed to build resilience and contribute to environmental sustainability.

Many major healthcare facilities in small island states are in exposed coastal areas and have limited ability to provide health services during disasters when services are most needed ( [[#WHO--2018|WHO, 2018]] ). For example, in Vanuatu, TC Pam in 2015 severely damaged two hospitals, 19 healthcare centres, and 50 healthcare dispensaries in 22 affected islands ( [[#Kim--2015|Kim et al., 2015]] ). A Smart Hospital Initiative in the Caribbean focuses on improving hospital resilience, strengthening structures and operations, and installing green technologies to reduce energy consumption and provide energy autonomy during extreme events and disasters ( https://www.paho.org/en/health-emergencies/smart-hospitals ).

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