Editing IPCC:AR6/WGII/Chapter-11 (section)

==== 11.3.6.3 Adaptation ====

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Strengthening basic public health services can rapidly reduce vulnerability to death and ill-health caused by climate change; however, this opportunity is often missed ( ''very high confidence'' ). The 2020 New Zealand ''Health and Disability System Review'' pointed to shortcomings in leadership and governance, structures that embed health inequity, lack of transparency in planning and reporting and underinvestment in public health personnel and systems ( [[#HDSR--2020|HDSR, 2020]] ). An Australian study found that without deliberate planning the health system ‘would only be able to deal with climate change in an expensive, ''ad hoc'' crisis management manner’ ( [[#Burton--2014|Burton, 2014]] ). In both Australia and New Zealand the COVID-19 epidemic has highlighted weaknesses in information systems, primary care for marginalised groups and intersectoral planning ( [[#Salvador-Carulla--2020|Salvador-Carulla et al., 2020]] ; [[#Skegg--2021|Skegg and Hill, 2021]] ): all these deficiencies are relevant to climate adaptation.

Underlying health and economic trends affect the vulnerability of the population to extreme weather ( ''high confidence'' ). Poor housing quality is a risk factor for climate-related health threats ( [[#Alam--2016|Alam et al., 2016]] ). Homeless people lack access to temperature-controlled or structurally safe housing and often are excluded from disaster preparation and responses ( [[#Every--2016|Every, 2016]] ). These inequalities are reversible. For example, a government partnership with social housing providers in Australia improved the thermal performance of housing for low-income tenants ( [[#Barnett--2013|Barnett et al., 2013]] ). A postcode-level analysis of the vulnerability of urban populations to extreme heat in Australian capital cities ( [[#Loughnan--2013|Loughnan et al., 2013]] ) led to the development of an interactive website for purposes of planning and emergency preparedness (Figure 11.5) as well as subsequent work on green urban design for cooler, more liveable cities ( [[#Tapper--2021|Tapper, 2021]] ).

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[[File:0b9ff98424a8c96b9008693fc72e5116 IPCC_AR6_WGII_Figure_11_005.png]]

'''Figure 11.5 |''' '''Housing and socioeconomic disadvantage are correlated with the use of emergency services on hot days (rho = 0''' '''.''' '''55, p&lt;0.01).''' The spatial distribution of (A) a community vulnerability index (VI) (PCA) by deciles and (B) ambulance call-outs on days above the daily mean of 34°C, in Brisbane, Australia. Ambulance call-out data are expressed as deciles based on per-capita calls during 2003–2011 ( [[#Loughnan--2013|Loughnan et al., 2013]] )

Heatwave responses, from public education to formal heat-warning systems, are the best-developed element of adaptation planning for health in Australia, but many metropolitan centres are still not covered ( ''high confidence'' ) (Nicholls et al., 2016; [[#Nitschke--2016|Nitschke et al., 2016]] ). Air conditioning (AC) in Australian homes reduces mortality in heatwaves by up to 80% ( [[#Broome--2012|Broome and Smith, 2012]] ), but heavy reliance on AC carries risks. It is estimated that a power outage on the third day of extreme heatwaves would result in an additional 10–21 deaths in Adelaide, 24–47 in Melbourne and 7–13 in Brisbane ( [[#Nairn--2019|Nairn and Williams, 2019]] ). Multiple interventions at the landscape, building and individual scale are available to reduce the negative health effects of extreme heat ( [[#Jay--2021|Jay et al., 2021]] ).

Heat extremes receive most policy attention, but the numbers of deaths are less than those resulting from more frequent exposures to moderately high temperatures ( [[#Longden--2019|Longden, 2019]] ). Melbourne, with its Urban Forest Strategy, provides a case study in long-term planning for cooler cities ( [[#Gulsrud--2018|Gulsrud et al., 2018]] ). Australian workers’ perceptions of heat and responses to high temperatures show that heat policies on their own are insufficient for full protection; workers also require knowledge and agency to slow down or take breaks on their own initiative ( [[#Singh--2015|Singh et al., 2015]] ; [[#Lao--2016|Lao et al., 2016]] ).

The first national climate change risk assessment in New Zealand ( [[#MfE--2020a|MfE, 2020a]] ) highlighted the risk to potable water supplies. An inquiry into the Havelock North outbreak recommended that all registered drinking water supplies (which supply about 80% of the national population) in New Zealand should be disinfected and have stronger oversight by a national regulatory body ( [[#Government%20Inquiry%20into%20Havelock%20North%20Drinking%20Water--2017|Government Inquiry into Havelock North Drinking Water, 2017]] ). The use of local and Indigenous knowledge strengthens interventions to protect water supplies to remote settlements that may be affected by climatic changes ( [[#Henwood--2019|Henwood et al., 2019]] ).

Adaptation requires better protection of health facilities and supply chains, but hospital managers seldom have capacity to invest in long-term improvements in infrastructure ( [[#Loosemore--2014|Loosemore et al., 2014]] ). However, health services in the region are required to prepare disaster plans: these could be expanded to explicitly cover health adaptation and local threats from climate change, including flooding events ( [[#Rychetnik--2019|Rychetnik et al., 2019]] ).

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