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

== 7.1 Introduction ==

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This chapter assesses peer-reviewed and selected grey literature published since the IPCC’s Fifth Assessment Report (AR5) on the impacts and projected future risks of climate change for health, well-being, migration and conflict, taking into consideration determinants of vulnerability and the dynamic structure of human populations and communities. Particular attention is given to potential adaptation challenges and actions as well as potential co-benefits for health associated with mitigation actions. AR5 presented strong evidence-based statements regarding the ''likely'' [[#footnote-000|2]] impacts of climate change on health, migration and conflict in two separate chapters on Human Health (Chapter 11) and Human Security (Chapter 12). The present chapter covers all topics found in AR5 [[IPCC:Wg2:Chapter:Chapter-11|Chapter 11]] and Sections 12.4 (Migration and Mobility Dimensions of Human Security), 12.5 (Climate Change and Armed Conflict) and 12.6 (State Integrity and Geopolitical Rivalry) and provides an additional, expanded assessment of mental health impacts, gender dimensions of climate risks and solution pathways.

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=== 7.1.1 Major Health-Related Statements in AR5 ===

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AR5 stated with ''very high confidence'' that the health of human populations is sensitive to climate change ( [[#Smith--2014|Smith et al., 2014]] ). Specific observations of current impacts included the expansion of the geographical ranges of some diseases into previously unaffected areas and changes in the distributions of some food-, water- and vector-borne diseases ''(high confidence)'' . Increasing future health risks were projected from injury, disease and death due to more intense heatwaves and fires ''(very high confidence)'' , undernutrition in poor regions ''(high confidence)'' , food- and waterborne diseases ''(very high confidence)'' and VBDs ''(medium confidence)'' . AR5 found that climate change is a multiplier of existing health vulnerabilities, including food insecurity and limited access to safe water, improved sanitation, healthcare and education, and that the most effective measures to reduce vulnerability in the near term are programmes that implement and improve basic public health ''(very high confidence)'' . Opportunities for co-benefits from mitigation actions were identified through such actions as reducing local emissions of short-lived climate pollutants from energy systems ''(very high confidence)'' and expanding transport systems that promote active travel ''(high confidence)'' . The significant growth in peer-reviewed publications on links between climate change and human health and well-being since AR5 allowed for a more detailed and wider reaching assessment in the present chapter and stronger confidence statements for many climate-sensitive health outcomes.

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=== 7.1.2 Major Statements About Migration and Conflict in AR5 ===

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Key statements made in AR5 [[IPCC:Wg2:Chapter:Chapter-12|Chapter 12]] (Human Security) about the impacts of climate change on migration were that climate change will have significant impacts on forms of migration that compromise human security and that mobility is a widely used strategy to maintain livelihoods in response to social and environmental changes ( ''high agreement, medium evidence'' ). Research on the influence of climate change and climate extremes on multiple forms of migration (including voluntary migration, involuntary displacement and immobility) has expanded significantly since AR5, which has allowed for a more robust assessment in this chapter, with migration also featuring in most other sectoral and regional chapters of this report. With respect to violent conflict, AR5 [[IPCC:Wg2:Chapter:Chapter-12|Chapter 12]] found that people living in places affected by violent conflict are particularly vulnerable to climate change ( ''medium evidence, high agreement'' ), that some of the factors increasing the risk of violent conflict within states are sensitive to climate change ( ''medium evidence, medium agreement'' ) and that climate change will lead to new challenges to states and will increasingly shape both conditions of security and national security policies ( ''medium evidence, medium agreement'' ). As with other subjects assessed in this chapter, there has been significant growth in the number of assessable studies, but there remain shortcomings with respect to the availability of evidence regarding the specific nature of causal linkages and the attributability of particular outcomes to climate events or conditions.

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=== 7.1.3 Important Developments Since AR5 ===

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==== 7.1.3.1 International Agreements ====

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Since AR5, several new international agreements have come into effect that have implications for international responses to the climate risks assessed in this chapter. The 2015 Paris Agreement, which explicitly mentions health in three separate sections, set new goals for adaptation and established a working group to study the effects of climate change on population displacement. The 17 United Nations (UN) SDGs for 2030, adopted in 2015, are all important for building adaptive capacity in general, with goals 13 (‘Take urgent action to combat climate change and its impacts’) and 3 (‘Ensure healthy lives and promote well-being for all at all ages’) being directly relevant to this chapter. Other SDGs contain specific targets that are also relevant for this chapter, including Target 10.7 (‘Well-managed migration policies’), Target 8.3 (‘Decent work for all’) and Target 5.4 (‘Promotion of peaceful and inclusive societies’) ( [[#Piper--2017|Piper, 2017]] ). The 2015 Sendai Framework for Disaster Risk Reduction puts an emphasis on health and well-being ( [[#Aitsi-Selmi--2016|Aitsi-Selmi and Murray, 2016]] ) In 2018, UN member states negotiated Global Compacts for Safe, Orderly and Regular Migration and on Refugees that, taken together with the Paris Agreement, provide pathways for coordinated international responses to climate-related migration and displacement ( [[#Warner--2018|Warner, 2018]] ).

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==== 7.1.3.2 IPCC Special Reports ====

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All three post-AR5 IPCC Special Reports considered some of the research that is assessed here in greater detail. The 2018 report on 1.5°C (SR1.5) included a review of climate change and health literature published since AR5 and called for further efforts for protecting health and well-being of vulnerable people and regions ( [[#Ebi--2018b|Ebi et al., 2018b]] ) and highlighted links between climate change hazards, poverty, food security, migration and conflict. The 2019 Special Report on Climate Change and Land (SRCCL) ( [[#IPCC--2019b|IPCC, 2019b]] ) emphasised the impacts of climate change on food security; highlighted links between reduced resilience of dryland populations, land degradation, migration and conflict; and raised concerns about the impacts of climate extremes. The 2019 Special Report on the Ocean and Cryosphere in a Changing Climate ( [[#IPCC--2019a|IPCC, 2019a]] ) detailed how changes in the cryosphere and ocean systems have impacted people and ecosystem services, particularly food security, water resources, water quality, livelihoods, health and well-being, infrastructure, transportation, tourism and recreation as well as the culture of human societies, particularly for Indigenous Peoples. It also noted the risks of future displacements due to rising sea levels and associated coastal hazards.

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=== 7.1.4 Interpretation of ‘Health and Well-Being’ Used in This Chapter ===

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Assessing the links between human health, well-being and climate change is a new task for AR6, reflecting a broad perspective on health that increasingly acknowledges the importance of well-being and its interactions with individual and population health. The World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ ( [[#WHO--1946|WHO, 1946]] ). Although this chapter assesses physical health, mental health and general well-being separately, they are inter-connected; any type of health problem can reduce overall well-being and vice versa. For example, a child receiving inadequate nutrition may not be sick but is experiencing a clear threat to well-being that has implications for future physical and mental health.

There is no consensus definition of well-being, but it is generally agreed that it includes a predominance of positive emotions and moods (e.g., happiness) compared with extreme negative emotions (e.g., anxiety), satisfaction with life, a sense of meaning and positive functioning, including the capacity for unimpaired cognitive functioning and economic productivity ( [[#Diener--2015|Diener and Tay, 2015]] ; [[#Piekałkiewicz--2017|Piekałkiewicz, 2017]] ). A capabilities approach ( [[#Sen--2001|Sen, 2001]] ) focuses on the opportunity for people to achieve their goals in life ( [[#Vik--2018|Vik and Carlquist, 2018]] ) or the ability to take part in society in a meaningful way, and is reflected in personal freedoms, human agency, self-efficacy, ability to self-actualise, dignity and relatedness to others ( [[#Markussen--2018|Markussen et al., 2018]] ). An indigenous perspective on well-being is broad and typically incorporates a healthy relationship with the natural world ( [[#Sangha--2018|Sangha et al., 2018]] ); emotional and mental health have also been linked to a strong cultural identity ( [[#Butler--2019|Butler et al., 2019]] ; [[#Dockery--2020|Dockery, 2020]] ). ‘Health’ itself is sometimes described as including relationships between humans and nature as well as links to community and culture ( [[#Donatuto--2020|Donatuto et al., 2020]] ; [[#Dudgeon--2017|Dudgeon et al., 2017]] ).

Subjective well-being is consistently associated with personal indicators such as higher income, greater economic productivity, better physical health ( [[#Diener--2015|Diener and Tay, 2015]] ; [[#Delhey--2016|Delhey and Dragolov, 2016]] ; [[#De%20Neve--2013|De Neve et al., 2013]] ) and environmental health, and it is reflected in societal indicators such as social cohesion and equality ( [[#Delhey--2016|Delhey and Dragolov, 2016]] ). In a global survey of over 1 million people taken between 2004 and 2008 via the Gallup World Poll, annual income and access to food were strong predictors of subjective well-being and a healthy environment. In particular, access to clean water was important even when household income was controlled ( [[#Diener--2015|Diener and Tay, 2015]] ). Access to green spaces was also closely associated with well-being ( ''high confidence'' ) ( [[#Lovell--2018|Lovell et al., 2018]] ; [[#Yuan--2018|Yuan et al., 2018]] ).

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=== 7.1.5 Towards Socioecological Perspectives on Health, Well-Being, and Loss and Damage ===

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Since AR5, more comprehensive frameworks for framing and studying global health issues, including planetary health, ‘One Health’ and eco-health, have gained traction. These frameworks share an ecological perspective, emphasise the role of complex systems and highlight the need for inter-disciplinary approaches related to human health research and practice ( [[#Lerner--2015|Lerner and Berg, 2015]] ; [[#Zinsstag--2018|Zinsstag et al., 2018]] ; [[#Whitmee--2015|Whitmee et al., 2015]] ; [[#Steffen--2015|Steffen et al., 2015]] ). These frameworks increasingly shape the evidence related to climate change health impacts and response options, highlight the dynamics of complex systems in risk management and direct risk management efforts in new directions.

Building on these frameworks and perspectives, there is increasing overlap in the literature on global health, climate change impacts and estimates of loss and damage. The Global Burden of Disease study for 2019 for the first time included non-optimal temperature as a risk factor ( [[#Murray--2020|Murray et al., 2020]] ). Work by social scientists continues to explore how climate change indirectly affects resource availability, productivity, migration and conflict ( [[#Burke--2015a|Burke et al., 2015a]] ; [[#Carleton--2016|Carleton and Hsiang, 2016]] ; [[#Hsiang--2017|Hsiang et al., 2017]] ), bringing multiple lines of inquiry together to study the associations between global environmental changes, socioeconomic dynamics and impacts on health and well-being. Morbidity associated with migration and displacement, especially in the context of small island states, has been identified as a non-material form of loss and damage ( [[#Thomas--2020|Thomas and Benjamin, 2020]] ; [[#McNamara--2021|McNamara et al., 2021]] ). Social costs of carbon estimates have been updated to include excess mortality associated with climate change, increasing estimates substantially (Dressler, 2021).

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=== 7.1.6 Developments Relevant to Tracking and Assessing Climate Change Impacts on Health ===

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Since AR5, there has been a steady increase in standardised, globally scoped, data-driven health impact assessments, such as the ongoing Global Burden of Disease study ( [[#James--2018|James et al., 2018]] ) that now includes scenario-based projections ( [[#Foreman--2018|Foreman et al., 2018]] ), that make linkages with other global priorities, including the SDGs ( [[#Fullman--2017|Fullman et al., 2017]] ). Attention has turned from prioritising specific diseases like HIV/AIDS, malaria and tuberculosis, to strengthening health systems and providing universal health coverage ( [[#Chang--2019|Chang et al., 2019]] ), with an ongoing emphasis on the social determinants of health. Several climate-sensitive health outcomes are now tracked in the annual Lancet Countdown reports ( [[#Watts--2015|Watts et al., 2015]] ; [[#Watts--2017|Watts et al., 2017]] ; [[#Watts--2018b|Watts et al., 2018b]] ; [[#Watts--2019|Watts et al., 2019]] ; [[#Watts--2021|Watts et al., 2021]] ). The Global Burden of Disease study is beginning to examine climate-sensitive disease burdens, incorporate temperature as a risk factor ( [[#Murray--2020|Murray et al., 2020]] ) and project future cause-specific disease burdens in a warming world ( [[#Burkart--2021|Burkart et al., 2021]] ). Although not assessed in this chapter, there are numerous ongoing assessments of climate change impacts on health and well-being being undertaken by national and local health authorities that continue to generate insights into climate-related health impacts and suggest response options relevant for decision makers.

While the knowledge base regarding global health has increased, a comprehensive framework is not in place that fully integrates health, well-being and environmental impacts from climate change allowing for the cumulative assessment of their impact. Moreover, significant cracks in the foundation of global health governance that affect preparedness and adaptive capacity for climate change, among other threats, have been identified ( [[#Phelan--2020|Phelan et al., 2020]] ; [[#Defor--2020|Defor and Oheneba-Dornyo, 2020]] ; Ostergard et al., 2020; [[#Shaffie--2021|Shaffie, 2021]] ). While attention to climate change and health has increased and there is evidence of increasing adaptation activity in the health sector ( [[#Watts--2019|Watts et al., 2019]] ), there is also continued evidence of substantial adaptation gaps ( [[#UNEP--2018|UNEP, 2018]] ; [[#UNEP--2021|UNEP, 2021]] ) including gaps in humanitarian response capacity for climate-related disasters ( [[#Watts--2021|Watts et al., 2021]] ) that appear to be widening as adverse climate change impacts on health and well-being accrue.

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=== 7.1.7 Hazards, Exposure and Vulnerability in the Context of Human Health, Well-Being and the Changing Structure of Communities ===

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==== 7.1.7.1 Possible Climate Futures and Hazards ====

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This chapter uses the conceptual framing described in Chapter 1, in which risks emerging from climate change are described in terms of hazard, exposure and vulnerability, with adaptation and climate resilient development being responses that have the potential to reduce or modify risk. The observed and projected future risks to health well-being, involuntary population displacements and conflict identified in this chapter are associated with a range of hazards that are manifested at a variety of geographical and temporal scales. These include observed and projected changes in climate normals; changes in the frequency, duration, and/or severity of extreme events; and hazards such as rising sea levels and extreme temperatures where the impacts have only begun to be widely experienced. The 2021 report of IPCC WGI (IPCC, 2021) provides an assessment of observed and projected changes in these hazards and is the backdrop against which assessments of future risks and adaptation options identified in the present chapter should be considered.

The exposure to hazards of populations, infrastructure, ecosystem capital, socioeconomic systems and cultural assets critical to health and well-being varies considerably across and within regions ''(high confidence).'' Exposure is also projected to vary across and within regions over time, depending on future GHG emissions pathways, development trajectories and differential vulnerability, particularly for exposure to extreme events and conditions, such as floods and droughts (Figures 7.1a, 7.1b) (Winsemius et al. 2018). For this reason, region-specific assessments of climate-related risks for health, displacement and conflict are found in each of the regional chapters of this report in addition to the general assessment that appears in this chapter.

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[[File:e283bf54d3b843d6000814a575f0d3b0 IPCC_AR6_WGII_Figure_7_001.png]]

'''Figure 7.1 |''' '''Projected exposure of poor people to''' '''a)''' '''floods respectively''' '''b)''' '''droughts in selected regions by 2050 under a high emissions scenario (RCP''' '''8.''' '''5) (adapted from [[#Winsemius--2018|Winsemius et al., 2018]] ).'''

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==== 7.1.7.2 Differential Vulnerability and Cascading Effects ====

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Vulnerability to climate change varies across time and location, across communities, and among individuals within communities; it reflects variations and changes in macro-scale non-climatic factors (such as changes in population, economic development, education, infrastructure, behaviour, technology and ecosystems) and individual- or household-specific characteristics, such as age, socioeconomic status, access to livelihood assets, pre-existing health conditions and ability (US Global Change Research Program, 2016; Chapter 1).

Many direct and indirect effects of climate change pose multiple threats to human health and well-being and can occur simultaneously, resulting in compounding or cascading impacts for vulnerable populations. For example, many of the long-term impacts of climate change on NCDs and injury described in Sections 7.2 and 7.3 are associated with future increases in air temperature and levels of air pollution; in many regions, and especially in large urban centres in Asia and Africa, these particular hazards are already causing substantial increases in morbidity and mortality due to respiratory illnesses ( [[#Tong--2016|Tong et al., 2016]] ). Climate change can therefore be expected to magnify such health risks over the long term.

At the same time, urban populations will also be experiencing indirect risks through climate change impacts on food and potable water systems, variations in the distribution and seasonality of infectious diseases and growing demand for shelter due to increased in-migration. The accumulation of these risks over time can be expected to generate accelerating declines in community resilience and health, with future vulnerability potentially expanding in a nonlinear fashion ( [[#Dilling--2017|Dilling et al., 2017]] ; [[#Liang--2017|Liang and Gong, 2017]] ; [[#El-Zein--2017|El-Zein and Tonmoy, 2017]] ; see also Chapter 6). Further, although each individual risk in isolation may be transitory or temporary for the individuals or groups exposed, taken cumulatively, the impacts could create conditions of chronic lack of well-being, and early life experiences with specific illnesses and conditions could have lifelong consequences ( [[#Watts--2015|Watts et al., 2015]] ; [[#Otto--2017|Otto et al., 2017]] ; WHO, 2018a). In this context, there is a distinct need for greater longitudinal research on vulnerability to multiple climatic and non-climatic health and well-being hazards over time ( [[#Fawcett--2017|Fawcett et al., 2017]] ). There is also need for more research to identify critical thresholds in social vulnerability to climate change ( [[#Otto--2017|Otto et al., 2017]] ); these include rapid, stepwise changes in vulnerability that emerge from changes in exposure (for example, air temperatures above which mortality rates or impacts on pre-natal health accelerate ( [[#Arroyo--2016|Arroyo et al., 2016]] ; [[#Ngo--2016|Ngo and Horton, 2016]] ; [[#Abiona--2017|Abiona, 2017]] ; [[#Auger--2017|Auger et al., 2017]] ; [[#Molina--2017|Molina and Saldarriaga, 2017]] ; [[#Zhang--2017b|Zhang et al., 2017b]] )) and thresholds in adaptation processes (such as when rural out-migration rates grow due to climate-related crop failures ( [[#McLeman--2017|McLeman, 2017]] )).

In virtually all of the research identifying particular climate-related risks to health, well-being, migration and conflict, specific types of individuals are identified as having higher levels of vulnerability and exposure to climate-related health hazards: people who are impoverished, undernourished, struggle with chronic or repeated illnesses, live in insecure housing in polluted or heavily degraded environments, work in unsafe conditions, are disabled, have limited education and/or have poor access to health and social infrastructure (WHO, 2018a). Their disproportionate exposure to ongoing climate hazards and their inability to recover from extreme events increase not only their own vulnerability but also that of the wider communities in which they live (US Global Change Research Program, 2016). Highly vulnerable populations are not evenly distributed across regions (Figure 7.2) nor within countries. Yet, even those fortunate enough to live in better neighbourhoods with greater financial means, higher-paying jobs and good access to resources and services, may experience adverse climate-related outcomes through community-level interactions and linkages (Haines and [[#Ebi--2019|Ebi, 2019]] ). Increased inequity itself threatens well-being and an effective response to climate change should not only avoid increased inequity but identify ways in which to reduce existing inequity.

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[[File:e6e2b15653e8ee9129644087d68d8a1d IPCC_AR6_WGII_Figure_7_002.png]]

'''Figure 7.2 |''' '''Global distribution of vulnerable people from two indices, with examples (see also Technical Summary, this report).'''

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==== 7.1.7.3 Heightened Vulnerability to Climate-Related Impacts on Health and Well-Being Experienced by Specific Groups and Through Specific Pathways ====

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===== 7.1.7.3.1 Women and Girls =====

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Climate change poses distinct risks to women’s health. Vulnerability to climate-related impacts on health and well-being shows notable differentiations according to gender, beyond implications for pregnant women. In many societies, differential exposure to such risks relate to gendered livelihood practices and mobility options. Pregnancy and maternal status heighten vulnerability to heat, infectious diseases, food-borne infections and air pollution ( [[#Arroyo--2016|Arroyo et al., 2016]] ; [[#Ngo--2016|Ngo and Horton, 2016]] ; [[#Zhang--2017b|Zhang et al., 2017b]] ). Extreme heat events, high ambient temperatures, high concentrations of airborne particulates, water-related illnesses and natural hazards are associated with higher rates of adverse pregnancy outcomes such as spontaneous abortion, stillbirth, low birth weight and pre-term birth ( [[#Arroyo--2016|Arroyo et al., 2016]] ; [[#Ngo--2016|Ngo and Horton, 2016]] ; [[#Abiona--2017|Abiona, 2017]] ; [[#Auger--2017|Auger et al., 2017]] ; [[#Molina--2017|Molina and Saldarriaga, 2017]] ; [[#Zhang--2017b|Zhang et al., 2017b]] ). Women and girls are at greater risk of food insecurity (FAO, 2018; [[#Alston--2016|Alston and Akhter, 2016]] ), which is particularly problematic in combination with the nutritional needs associated with pregnancy or breastfeeding. Women and girls are more likely to die in extreme weather events ( [[#Garcia--2016|Garcia and Sheehan, 2016]] ; [[#Yang--2019|Yang et al., 2019]] ). Women are also expected to face a greater mental health burden in a changing climate ( [[#Manning--2018|Manning and Clayton, 2018]] ). Further, climatic extremes and water scarcity are associated with increases in violence against girls and women ( [[#Anwar--2019|Anwar et al., 2019]] ; [[#Opondo--2016|Opondo et al., 2016]] ; [[#Le%20Masson--2016|Le Masson et al., 2016]] ; [[#Udas--2019|Udas et al., 2019]] ).

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===== 7.1.7.3.2 Children =====

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Children are particularly vulnerable to climate change impacts. Children often have unique pathways of exposure and sensitivity to climate hazards, given their immature physiology and metabolism and high intake of air, food and water relative to their body weight as compared with adults (US Global Change Research Group, 2016). Climate change is expected to increase childhood risks of malnutrition and infectious disease for children in low-income countries through its impacts on household food access, dietary diversity, nutrient quality, water and changes in maternal and childcare access and breastfeeding ( [[#Tirado--2017|Tirado, 2017]] ; [[#FAO--2018|FAO et al., 2018]] ; [[#Perera--2017|Perera, 2017]] ). Children living in locations with poor sanitation are especially vulnerable to GI illnesses, with future rates of diarrhoeal diseases among children expected to rise under many climate change scenarios ( [[#Cissé--2018|Cissé et al., 2018]] ; [[#WHO--2014|WHO, 2014]] ). Outdoor recreational opportunities for children may be reduced by extreme weather events, heat and poor air quality ( [[#Evans--2019|Evans, 2019]] ). Children and adolescents are particularly vulnerable to post-traumatic stress after extreme weather events; the effects may even be long-lasting, with impacts on their adult functioning ( [[#Brown--2017|Brown et al., 2017]] ; [[#UNICEF--2021|UNICEF, 2021]] ; [[#Thiery--2021|Thiery et al., 2021]] )

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===== 7.1.7.3.3 Elderly =====

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Population age structures and changes over time have a significant influence on vulnerability to the impacts of weather and climate. Older adults (generally defined as persons aged 65 and older) are disproportionately vulnerable to the health impacts associated with climate change and weather extremes, including a greater risk of succumbing to waterborne pathogens due to poorer functioning thermoregulatory mechanisms, greater sensitivity to dehydration, changes in their immune systems and greater likelihood of having pre-existing chronic illnesses such as diabetes or respiratory, cardiovascular and pulmonary illnesses ( [[#Benmarhnia--2016|Benmarhnia et al., 2016]] ; [[#Diaz--2015|Diaz et al., 2015]] ; [[#Mayrhuber--2018|Mayrhuber et al., 2018]] ; [[#Paavola--2017|Paavola, 2017]] ). Older adults may be less prompt in seeking medical attention when suffering from GI illnesses, which can lead to dehydration ( [[#Haq--2014|Haq and Gutman, 2014]] ). [[#Åström--2017|Åström et al. (2017)]] anticipate heat-related mortality among the elderly in Europe to rise in the 2050s under RCP4.5 and RCP8.5 in the absence of significant preventative measures. In a study of the combined effects of warming temperatures and an aging population in Korea, [[#Lee--2016|Lee and Kim (2016)]] projected a four- to six-fold increase in heat-related mortality by the 2090s when accounting for temperature and age structure.

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===== 7.1.7.3.4 Socioeconomically Marginalised Populations and People with Disabilities =====

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People living in poverty are more likely to be exposed to extreme heat and air pollution and have poorer access to clean water and sanitation, accentuating their exposure to climate change-associated health risks ( [[#UNEP--2021|UNEP, 2021]] ; [[#FAO--2018|FAO et al., 2018]] ). Poverty influences how people perceive the risks to which they are exposed, how they respond to evacuation orders and other emergency warnings and their ability to evacuate or relocate to a less risk-prone location (US Global Change Research Program, 2016). Poorer households, who often live in highly exposed locations, are more likely to be forced into low-agency migration as a means of adapting to climate risks and at the same time are the most likely to be immobile or trapped in deteriorating circumstances where migration would be a preferred response ( [[#Leichenko--2014|Leichenko and Silva, 2014]] ; [[#Fazey--2016|Fazey et al., 2016]] ; [[#Sheller--2018|Sheller, 2018]] ). Climate emergencies disproportionally affect people with disabilities because of their inherent vulnerabilities, which may impair their ability to take protective action; they are also frequently excluded from adaptation planning ( [[#Gaskin--2017|Gaskin et al., 2017]] ).

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===== 7.1.7.3.5 Urban Compared with Rural Populations =====

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Rural and urban populations are often exposed to different types of climate-related health risks. For example, because of the UHI effect and high concentrations of air pollution from motor vehicles and industrial activity, people who live in urban areas may have higher rates of extreme heat stress and respiratory illnesses than their rural counterparts ( [[#Hondula--2014|Hondula et al., 2014]] ; [[#Heaviside--2016|Heaviside et al., 2016]] ; [[#Macintyre--2018|Macintyre et al., 2018]] ; [[#Schinasi--2018|Schinasi et al., 2018]] ). Conversely, rural populations, especially those dependent on resource-based livelihoods, may have a greater exposure to climate impacts on food production or natural hazard events, which have subsequent effects on household nutrition and food security ( [[#Springmann--2016a|Springmann et al., 2016a]] ; see also Chapters 5 and 6 of this report).

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===== 7.1.7.3.6 Indigenous Peoples =====

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Indigenous Peoples, especially those who live in geographically isolated, resource-dependent and/or impoverished communities, are often at greater risk of health impacts of climate change ( [[#Ford--2020|Ford et al., 2020]] ) (US Global Change Research Program, 2016). The close inter-connection of land-based livelihoods and cultural identity of many indigenous groups exposes them to multiple health- and nutrition-related hazards ( [[#Durkalec--2015|Durkalec et al., 2015]] ; [[#Sioui--2019|Sioui, 2019]] ) with potential implications for community social relations and individual mental health ( [[#Cunsolo%20Willox--2013|Cunsolo Willox et al., 2013]] ; [[#Cunsolo%20Willox--2015|Cunsolo Willox et al., 2015]] ). Climate change risk exposures may be complicated by changes in lifestyle, diet and morbidity driven by socioeconomic processes, further increasing health risks for Indigenous Peoples ( [[#Jaakkola--2018|Jaakkola et al., 2018]] ). Environmental consequences of climate change can also affect social ties and spiritual well-being, in part because land is often an integral part of their culture and spiritual identity.

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===== 7.1.7.3.7 Vulnerability Experienced through Food Systems =====

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Stresses and shocks associated with climate change are drivers of food insecurity, particularly in sub-Saharan Africa, Asia and Latin America ( [[#Betts--2018|Betts et al., 2018]] ). The most vulnerable groups include smallholder farmers, pastoralists, agricultural laborers, poorer households, refugees, indigenous groups, women, children, the elderly and those who are socioeconomically marginalised ( [[#FAO--2018|FAO et al., 2018]] ; [[#IPCC--2019b|IPCC, 2019b]] ) ''(high confidence)'' . Men, women, children, the elderly and the chronically ill have different nutritional needs and these vulnerabilities may be amplified by gendered norms and differential access to resources, information and power ( [[#IPCC--2019b|IPCC, 2019b]] ). Extreme climate events have immediate and long-term impacts on food insecurity and malnutrition in poor and vulnerable communities, including when women and girls need to undertake additional duties as laborers and caregivers ( [[#FAO--2018|FAO et al., 2018]] ).

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===== 7.1.7.3.8 Health Vulnerability Experienced through Water and Sanitation Systems =====

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Water and sanitation systems are particularly vulnerable to extreme weather events, and damage to such systems can lead to contamination of drinking water and subsequent adverse health impacts ( [[#Howard--2016|Howard et al., 2016]] ; [[#Khan--2015|Khan et al., 2015]] ; [[#Sherpa--2014|Sherpa et al., 2014]] ). In areas with only very simple traditional excreta disposal facilities (e.g., latrines) and traditional sources of water (e.g., unprotected wells), the repeated occurrence of floods and other extreme events can negatively affect water quality at household and community levels and increase the burden of food- and waterborne diseases ( [[#Cissé--2016|Cissé et al., 2016]] ; [[#Khan--2015|Khan et al., 2015]] ; [[#Kostyla--2015|Kostyla et al., 2015]] ).

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'''Box 7.1 | Indigenous Peoples’ Health and Well-Being in a Changing Climate'''
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Contributing authors: Hannah Tait Neufeld (Canada), Lena Maria Nilsson (Sweden), Rhys Griffith Jones (New Zealand)

The indigenous population worldwide is estimated at 476 million people spread across all geographic regions of the world ( [[#FAO--2021|FAO et al., 2021]] ). Indigenous Peoples globally represent a large heterogeneity of people in terms of living conditions and social determinants of health. There is no simple definition of who is indigenous. In this text, we refer to Indigenous Peoples as people self-identified and organised as indigenous, according to the principles of the International Work Group for Indigenous Affairs (IWGIA), an international non-governmental organisation (NGO) with observer status at the United Nations (UN). Indigenous Peoples are described as ‘distinct social and cultural groups that share collective ancestral ties to the lands and natural resources where they live, occupy or from which they have been displaced’ (World Bank, 2021). A common experience among Indigenous Peoples are historical traumas related to overseas and/or settler/industrial colonisation.

Studies on climate change as it affects the health of Indigenous Peoples generally focus on non-displaced indigenous groups; that is, Indigenous Peoples maintaining culturally important elements of a land-based traditional lifestyle. Here we use an eco-medicine perspective in which the impacts of climate change on health are divided into primary, secondary and tertiary effects, as discussed below ( [[#Butler--2010|Butler and Harley, 2010]] ). Many analyses of indigenous health in relation to climate change use the One Health concept ( [[#Mackenzie--2019|Mackenzie and Jeggo, 2019]] ; see [[#7.1.5|Section 7.1.5]] ).

'''Current Impacts of Climate Change on Health and Well-Being of Indigenous Peoples'''
Primary health effects of climate change include the immediate physical effects on human health, such as health hazards due to high temperatures, extreme weather events or accidents from exposure to climate-related hazards. For example, in arid and semiarid areas, an increased frequency of severe droughts is associated with immediate health problems related to overheating and lack of water for drinking, sanitation and livestock ( [[#Hall--2020|Hall and Crosby, 2020]] ; [[#Mamo--2020|Mamo, 2020]] ; [[#Rankoana--2021|Rankoana, 2021]] ). In many cases, the possibilities for Indigenous Peoples to apply traditional strategies to mitigate droughts by migration are limited by competing land use, environmental protection and national borders, with many examples across Africa ( [[#Mamo--2020|Mamo, 2020]] ). In the Jordan River Valley, the second most water stressed area in the world, water resources are not equally distributed to Indigenous Bedouin people, amplifying their immediate health threat during predictable as well as unpredictable droughts ( [[#Mamo--2020|Mamo, 2020]] ).

In Arctic and sub-Arctic areas, higher temperatures with increased numbers of freeze–thaw cycles during the winter means increased occurrences of transport-related accidents in indigenous communities due to weaker ice on travel routes that cross lakes, rivers and the sea, along with changes in the snow cover and increased risk of avalanches ( [[#Durkalec--2015|Durkalec et al., 2015]] ; [[#Jaakkola--2018|Jaakkola et al., 2018]] ). Impeded access to healthcare during extreme weather conditions is a primary health risk for Indigenous Peoples living in remote areas ( [[#Amstislavski--2013|Amstislavski et al., 2013]] ; [[#Hall--2020|Hall and Crosby, 2020]] ; [[#Mamo--2020|Mamo, 2020]] ).

Pastoralists in many regions may experience changes in livestock behaviour due to climate change, leading to increased mobility-related health hazards ( [[#Jaakkola--2018|Jaakkola et al., 2018]] ; [[#Mamo--2020|Mamo, 2020]] ). Indigenous Peoples living in low-lying coastal areas and small island states face long-term risk of flooding and the stresses of resettlement ( [[#Maldonado--2021|Maldonado et al., 2021]] ; [[#McMichael--2021|McMichael and Powell, 2021]] ).

Extreme rainfall, flooding, storms, heatwaves and wildfires lead to individual health hazards that may include injuries and thermal and respiratory traumas ( [[#Mamo--2020|Mamo, 2020]] ) There are many examples when emergency responses to extreme events have ignored the needs of displaced Indigenous Peoples ( [[#Mendez--2020|Mendez et al., 2020]] ; [[#Maldonado--2021|Maldonado et al., 2021]] ). Population-based quantitative studies documenting the direct effects of these events on Indigenous Peoples are rare. In Mexico, respiratory diseases are almost twice as common among Indigenous Peoples compared to non-Indigenous Peoples ( [[#de%20Leon-Martinez--2020|de Leon-Martinez et al., 2020]] ). In Alaska and northern Canada, alarming levels of respiratory stress and disease have been reported among Inuit and First Nation communities in relation to wildfires ( [[#Howard--2021|Howard et al., 2021]] ), as well as increased mould in houses due to flooding resulting from increased precipitation ( [[#Furgal--2006|Furgal and Seguin, 2006]] ; [[#Harper--2015|Harper et al., 2015]] ; [[#Norton-Smith--2016|Norton-]] [[#Smith--2016|Smith et al., 2016]] ). Climate- and housing-related respiratory stress is also a risk factor for severe COVID-19 infection, which has been highlighted in recent literature from an indigenous health perspective ( [[#de%20Leon-Martinez--2020|de Leon-Martinez et al., 2020]] ).

Secondary effects relate to ecosystem changes, for example, the increased risk of the acute spread of air-, soil-, vector-, food-, and waterborne infectious diseases ( [[#Hueffer--2019|Hueffer et al., 2019]] ). Higher proportions of climate-related infectious diseases are reported among indigenous groups compared to their non-indigenous neighbours, with examples from Torres Strait, Australia, showing a greater proportion of tuberculosis, dengue, Ross River virus, melioidosis, and non-tuberculous mycobacterial infections ( [[#Hall--2021|Hall et al., 2021]] ) and in the Republic of Sakha, Russia, high levels of zoonoses ( [[#Huber--2020a|Huber et al., 2020a]] ). Increasing levels of livestock and canine diseases are also reported ( [[#Mamo--2020|Mamo, 2020]] ; [[#Bogdanova--2021|Bogdanova et al., 2021]] ; [[#Hillier--2021|Hillier et al., 2021]] ). Another secondary health effect is an increase in human–animal conflicts, for example human–elephant conflicts in Namibia due to plant food scarcity ( [[#Mamo--2020|Mamo, 2020]] ), human–bear conflicts in Arctic regions within Canada ( [[#Wilder--2017|Wilder et al., 2017]] ), human–tiger conflicts in Bangladesh ( [[#Haque--2015|Haque et al., 2015]] ) and increased predatory pressure on Indigenous Peoples’ livestock and game worldwide ( [[#Haque--2015|Haque et al., 2015]] ; [[#Jaakkola--2018|Jaakkola et al., 2018]] ; [[#Mukeka--2019|Mukeka et al., 2019]] ; [[#Mamo--2020|Mamo, 2020]] ; [[#Terekhina--2021|Terekhina et al., 2021]] ). Undernutrition and metabolic disturbances associated with overnutrition and obesity due to the decreased availability or safety of local and traditional foods and increased dependency on imported substitutes affect many Indigenous Peoples worldwide ( [[#Amstislavski--2013|Amstislavski et al., 2013]] ; [[#Zavaleta--2018|Zavaleta et al., 2018]] ; [[#Houde--2020|Houde et al., 2020]] ; [[#Jones--2020|Jones et al., 2020]] ; [[#Akande--2021|Akande et al., 2021]] ; [[#Bogdanova--2021|Bogdanova et al., 2021]] ; [[#Bryson--2021|Bryson et al., 2021]] ) and are especially severe for pregnant women and small children ( [[#Mamo--2020|Mamo, 2020]] ; [[#Olson--2020|Olson and Metz, 2020]] ; [[#Bryson--2021|Bryson et al., 2021]] ); these are amplified by the combination of warming and the COVID-19 situation ( [[#Zavaleta-Cortijo--2020|Zavaleta-Cortijo et al., 2020]] ). Decreased access to wild plants and animals as food sources and medicine due to climate change is another threat to the health and wellness of indigenous communities ( [[#Greenwood--2019|Greenwood and Lindsay, 2019]] ; [[#Mamo--2020|Mamo, 2020]] ; CIAT and and, 2021; [[#Rankoana--2021|Rankoana, 2021]] ; [[#Teixidor-Toneu--2021|Teixidor-Toneu et al., 2021]] ).

Tertiary effects relate to culture-wide changes, for example, all forms of malnutrition due to climate-driven changes in food systems and anxiety, mental illness and suicidal thoughts related to cultural and spiritual losses. A wide range of tertiary, culture-related effects of climate change have been documented for Indigenous Peoples. These include anxiety, distress and other mental health impacts due to direct and indirect processes of dispossession of land and culture related to the combination of climate change and other factors ( [[#Richmond--2009|Richmond and Ross, 2009]] ; [[#Bowles--2015|Bowles, 2015]] ; [[#Norton-Smith--2016|Norton-]] [[#Smith--2016|Smith et al., 2016]] ; [[#Jaakkola--2018|Jaakkola et al., 2018]] ; [[#Fuentes--2020|Fuentes et al., 2020]] ; [[#Mamo--2020|Mamo, 2020]] ; [[#Middleton--2020b|Middleton et al., 2020b]] ; [[#Middleton--2020a|Middleton et al., 2020a]] ; [[#Olson--2020|Olson and Metz, 2020]] ; [[#Timlin--2021|Timlin et al., 2021]] ). Increased risks of conflict and abuse, including violence and homicide against females, and/or conflicts resulting from environmental activism, are other tertiary health threats for Indigenous Peoples ( [[#Mamo--2020|Mamo, 2020]] ). Between 2017 and 2019, close to 500 indigenous people were killed for activism in 19 different countries ( [[#Mamo--2020|Mamo, 2020]] ). In Uganda, climate change drives indigenous men to increase their distance and time from home and their families in search of water and food, leading to an increase in sexual violence against indigenous women and girls in their communities ( [[#Mamo--2020|Mamo, 2020]] ).

Gender inequities amplify the tertiary health effects of climate change ( [[#Williams--2018|Williams, 2018]] ; [[#Garnier--2020|Garnier et al., 2020]] ). In an Inuit community, for instance, women reported a higher level of mental stress related to climate change than men ( [[#Harper--2015|Harper et al., 2015]] ). Adverse pregnancy outcomes and altered developmental trajectories have also been associated with climate change ( [[#Hall--2021|Hall et al., 2021]] ). Indigenous Batwa women in Uganda reported experiencing more severe circumstances of food insecurity during pregnancy due to drought and unpredictable seasons negatively impacting agricultural practices ( [[#de%20Leon-Martinez--2020|de Leon-Martinez et al., 2020]] ). More studies with a gender perspective on climate change as a determinant of Indigenous Peoples’ health are needed, along with the perspectives of indigenous children and youth, displaced individuals and communities in urban settings ( [[#Kowalczewski--2018|Kowalczewski and Klein, 2018]] ).

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Box 7.1

Because cultural continuity is a recognised health factor ( [[#Lemelin--2010|Lemelin et al., 2010]] ; [[#de%20Leon-Martinez--2020|de Leon-Martinez et al., 2020]] ; [[#Middleton--2020b|Middleton et al., 2020b]] ), displaced Indigenous Peoples may suffer from climate change by worrying about impacts on non-displaced relatives and family and from traditional food staples turning into expensive commodified products. This is a knowledge gap with lasting implications not only on physical environments ( [[#Guo--2018|Guo et al., 2018]] ). Social connections and knowledge pathways are disrupted, leading to a decreased ability to share locally harvested and cultivated foods ( [[#King--2014|King and Furgal, 2014]] ; [[#Neufeld--2020|Neufeld et al., 2020]] ).

Tertiary effects of climate change on Indigenous Peoples’ health are primarily described in smaller case studies and not designed in a way allowing for systematic international comparisons, which represents an important and significant gap in our understanding of these often-complex associations and impacts ( [[#Middleton--2020b|Middleton et al., 2020b]] ).

'''Future Risks for Indigenous People’s Health and Well-Being in a Changing Climate'''
Future risks for Indigenous Peoples’ health and well-being in a changing climate will result foremost from exacerbations of observed impacts. Primary and secondary health risks are expected to increase as the frequency and/or severity of climate hazards grow in many regions. As one example, melting permafrost in the Siberian Arctic is projected to lead to more outbreaks of anthrax ( [[#Bogdanova--2021|Bogdanova et al., 2021]] ). Tertiary health threats are expected to persist even with strong global initiatives to mitigate greenhouse gases (GHGs) ( [[#Butler--2010|Butler and Harley, 2010]] ). Climate change is expected to compound non-climatic processes that lead to social exclusion and land dispossession that underlay health inequalities experienced by Indigenous Peoples ( [[#Huber--2020a|Huber et al., 2020a]] ).

'''Options and Opportunities for Reducing Future Risks and Building Capacity/Resilience for Indigenous Peoples’ Health and Well-Being'''
Indigenous organisations worldwide stress the importance of applying a rights-based approach in responding to climate change ( [[#Mamo--2020|Mamo, 2020]] ). Although Indigenous Peoples are often identified as being vulnerable to climate change, this framing does not always reflect the diverse responses and adaptations of Indigenous Peoples to these ongoing challenges ( [[#Nursey-Bray--2020|Nursey-Bray et al., 2020]] ). An emerging body of research is focusing on the strength and resilience of indigenous communities globally as they adapt to these complex changes ( [[#Whyte--2018|Whyte, 2018]] ; [[#FAO--2021|FAO et al., 2021]] ).

During droughts and water shortages, for example, indigenous pastoralists may face additional challenges if water supply assistance provides only for human needs and neglects water requirements of livestock ( [[#Mamo--2020|Mamo, 2020]] ). Indigenous knowledge on how to adapt to drought through storing and sharing strategies, for example, is valuable ( [[#Fatehpanah--2020|Fatehpanah et al., 2020]] ; [[#Mamo--2020|Mamo, 2020]] ).

Indigenous Peoples have been adapting to changes in their environments since time immemorial by developing new practices and techniques (FAO et al, 2021). Their beliefs, value systems and principles include core elements and common values such as reciprocity, solidarity, co-responsibility and community that are expressed in the dynamism of their knowledge systems ( [[#Lewis--2020|Lewis et al., 2020]] ; [[#Schramm--2020b|Schramm et al., 2020b]] ). The relevance of these knowledge systems, which are holistic and tied to relationships between all living things, cannot be ignored at this critical time ( [[#Garnier--2020|Garnier et al., 2020]] ).

The health and equity impacts of climate change for Indigenous Peoples make mitigation efforts critical ( [[#Jones--2020|Jones et al., 2020]] ), including policies and actions that consider the effects of colonisation. Colonisation constrains the design and diversity of potential climate and health responses through its historic and ongoing suppression of Indigenous knowledge systems that are critical in supporting community-led actions to reduce future risks ( [[#Billiot--2019|Billiot et al., 2019]] ; [[#Reid--2019|Reid et al., 2019]] ; [[#Nursey-Bray--2020|Nursey-Bray et al., 2020]] ).

'''Four Brief Case Studies to Illustrate the Innovativeness of Indigenous Peoples’ Adaptation to Climate Risks'''
''Bedouin Pastoralists’ Grazing Practices Decrease the Risk of Wildfires in Israel and Increase Food Sovereignty''

Wildfires are a main cause of deforestation in Israel, and in recent years climate stress has decreased the forest resilience to fires ( [[#Klein--2019|Klein et al., 2019]] ). The original landscape, a shrubland or maquis consisting mostly of oak and ''Pistacia'' , has been used since time immemorial as grazing land for goats, sheep and camels belonging to Indigenous Bedouin people ( [[#Degen--2009|Degen and El-Meccawi, 2009]] ). Competing land use has reshaped the landscape with pine monocultures and cattle farming, reducing the availability of land suitable for herding goats the indigenous way ( [[#Perevolotsky--2011|Perevolotsky and Sheffer, 2011]] ). In addition, since 1950, plant protection legislation has decreased Bedouin forest pastoralism in Israel by defining indigenous black goats as an environmental threat ( [[#FAOLEX--2021|FAOLEX, 2021]] ). In nature reserves where no human interference has been allowed, these areas have regenerated into herbaceous shrublands susceptible to wildfires ( [[#Turco--2017|Turco et al., 2017]] ). Meanwhile, urbanised Bedouin exist on lower incomes and experience higher levels of unemployment compared to other citizens, and some keep non-pastoralised livestock in cities as a strategy for food sovereignty ( [[#Degen--2009|Degen and El-Meccawi, 2009]] ). In 2019, many severe wildfires occurred in Israel due to extreme heatwaves and, in response, plant protection legislation was repealed, allowing Bedouin pastoralists to graze their goats in areas from which they had been excluded. The amount of combustible undergrowth subsequently decreased, reducing the risk for wildfire and their related impacts, while simultaneously facilitating indigenous food sovereignty among the Bedouin ( [[#Mamo--2020|Mamo, 2020]] ).

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Box 7.1

''Gardening in the Ashes of Wildfires in the Pacific Northwest as a Strategy to Decrease Food Insecurity and Increase Connections With the Land''

In the central interior of what is now known as British Columbia (BC), 2017 was an especially severe wildfire season, with over 1.3 million hectares of land burned and 65,000 people displaced ( [[#Timler--2020|Timler and Sandy, 2020]] ). The unceded and ancestral lands of the Tsilhqot’in, Dakelh and Secwépemc were impacted by two of the largest fires ( [[#Verhaeghe--2017|Verhaeghe et al., 2017]] ). Communities affected by the BC wildfires subsequently started indigenous gardens closer to home, to protect medicine and food plants and thereby sustaining relationships with these plants, the land and the community ( [[#Timler--2020|Timler and Sandy, 2020]] ). As there are cultural teachings for fire to cleanse the territory and the land, community members and plants previously isolated became better connected because of the wildfires. The regrowth of plants is part of the healing relationship between plants, people and other animals ( [[#Timler--2020|Timler and Sandy, 2020]] ). The wildfires were seen as events to catalyse action and emphasise the importance of relationships to support foodways and gardening as responsibility.

Widening our understanding of gardening in the face of climate change and colonialism can support health and healing for Indigenous and non-Indigenous Peoples. Gardening as a means of indigenous food sovereignty has long been utilised by a variety of indigenous groups within Canada and elsewhere to address circumstances of chronic food insecurity and support health and wellness ( [[#Johnson-Jennings--2020|Johnson-Jennings et al., 2020]] ; [[#Timler--2020|Timler and Sandy, 2020]] ). The concept of gardening as both a Euro-Western agricultural practice and indigenous practice encourages an increased reverence and connection with the land and wider engagement with the natural world ( [[#Whyte--2018|Whyte, 2018]] ). Much of this is because Indigenous knowledge and land management practices encompass processes that are known to be synergistic and sustainable ( [[#Ottenhoff--2021|Ottenhoff, 2021]] ). Indigenous worldviews offer a different perspective on social resilience to environmental change, one that is based on moral relationships of responsibility that connect humans to animals, plants and habitats ( [[#Grey--2015|Grey and Patel, 2015]] ). These responsible practices not only ensure ecosystems are maintained for future generations; they centre the moral qualities necessary to carry out the responsibilities of consent, reciprocity and trust. Moral qualities of responsibility are the foundation for relying on each other when facing environmental challenges ( [[#Whyte--2018|Whyte, 2018]] ; [[#Miltenburg--2021|Miltenburg et al., 2021]] ).

To restore these sustainable relationships, a resurgence is needed of community roles and responsibilities ( [[#Cidro--2015|Cidro et al., 2015]] ) as well as a reconsideration of the concept of food security and the role of gardening within diverse indigenous contexts. Offering individual or community gardening as a solution to ‘food insecurity’, a Eurocentric measure of health, ignores colonial contexts and sovereignty ( [[#Borrows--2019|Borrows, 2019]] ; [[#Timler--2020|Timler and Sandy, 2020]] ). Indigenous communities have historic, ongoing and evolving gardening and food gathering practices, including a wide variety of land-based and aquatic foods ( [[#Turner--2008|Turner and Turner, 2008]] ; [[#Mt.%20Pleasant--2016|Mt. Pleasant, 2016]] ). Euro-Western science is beginning to recognise these longstanding relationships ( [[#Kamal--2015|Kamal et al., 2015]] ; [[#Hatfield--2018|Hatfield et al., 2018]] ; [[#Timler--2020|Timler and Sandy, 2020]] ). For many indigenous communities, reconnecting with ancestral foodways holds the potential not only to address food security but to provide the community cohesion, self-esteem and wellness ( [[#Gordon--2018|Gordon et al., 2018]] ).

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Box 7.1

''A New Food Composition Database in Uganda to Guide Local Policy in Healthy Eating Based on Indigenous Foods''

In sub-Saharan Africa, climate change is an emerging risk factor for undernutrition, particularly in countries that rely on subsistence agriculture ( [[#Sorgho--2020|Sorgho et al., 2020]] ). In Uganda, negative health effects associated with climate change are being observed, including increased rates of food insecurity, with the highest rates recorded among the Batwa of Kanungu District, where 97% of households are severely food insecure ( [[#Patterson--2017|Patterson et al., 2017]] ). For many Indigenous Peoples, food security in a changing climate is a growing concern ( [[#Guyot--2006|Guyot et al., 2006]] ; [[#Patterson--2017|Patterson et al., 2017]] ). Locally harvested indigenous foods have been adversely impacted by climate change, while connection to land is being disrupted by the processes of colonisation, discrimination and lack of representation in decision-making groups, thereby restricting adaptive capacity for indigenous communities ( [[#Bryson--2021|Bryson et al., 2021]] ). In Uganda, the Indigenous Batwa have experienced significant disparities resulting from the forced eviction from their territory, dispossessing them of their land and the ability to provide indigenous foods to their families ( [[#Patterson--2017|Patterson et al., 2017]] ; [[#Scarpa--2021|Scarpa et al., 2021]] ).

Nutrient-specific knowledge of indigenous foods is limited among many communities in Africa '''.''' A new food composition database in Uganda was constructed in dialogue with knowledge keepers from the Batwa and Bakiga Peoples to assess the nutrient density of these locally harvested foods ( [[#Scarpa--2021|Scarpa et al., 2021]] ). As in other lower resource settings, no food composition tables are available for southwestern Uganda. The only existing food database was designed for central and eastern Uganda; it does not include common recipes and local foods consumed by Batwa and Bakiga communities ( [[#Scarpa--2021|Scarpa et al., 2021]] ). Using a community-based approach and collaboration with local nutritionists, a list of foods was collected through focus group discussions, an individual dietary survey and market assessments. Including these locally familiar foods ultimately supports a focus on indigenous justice and the importance of valuing indigenous food systems and practices, which in many contexts have been found to have superior nutritional and environmental benefits for communities ( [[#Kuhnlein--2013|Kuhnlein et al., 2013]] ; [[#Scarpa--2021|Scarpa et al., 2021]] ). This new and unique database including indigenous foods will not only guide local nutrition and health initiatives, but also contribute towards policies related to indigenous food sovereignty and resilience to climate change.

''Decreased Fragmentation of Winter Grazing Increases Mental and Spiritual Well-Being in Reindeer Herding Sámi and Decreases their Dependency on Fossil Fuels''

Sami are the Indigenous Peoples of northernmost Scandinavia and the Kola Peninsula of Russia, whose livelihoods have been traditionally sustained by reindeer herding, hunting, fishing and small-scale farming ( [[#Nilsson--2011|Nilsson et al., 2011]] ). Climate change is threatening core conditions for reindeer herding, with Sami pastoralists describing the situation as ‘facing the limit of resilience’ ( [[#Furberg--2011|Furberg et al., 2011]] ). Sami pastoralists stress that an ability to continue reindeer herding is a prerequisite for their mental and spiritual health ( [[#Jaakkola--2018|Jaakkola et al., 2018]] ).

In a pilot project for climate adaptation of reindeer herding run by the Swedish Sami Parliament, reindeer herding management plans (in Swedish, ''renbruksplaner'' ) were used as a tool to develop strategies for climate adaptation ( [[#Walkepää--2019|Walkepää, 2019]] ). Four Sami reindeer herding cooperatives participated in the pilot study. They all agreed that climate change means that grazing patterns need to change. Traditionally, mountain reindeer graze in the Scandinavian mountains close to Norway in summer and in the coastal areas close to the Gulf of Bothnia in winter, representing a total migration route of up to 400 kilometres one-way. Rising temperatures are causing spring to occur earlier in the coastal winter grazing land before the calving areas in the summer land are suitable for grazing and free from snow. When the snow cover disappears, the herds are dispersed, so it is important to migrate while snow is still present ( [[#Walkepää--2019|Walkepää, 2019]] ). Migration routes are being destabilised by weaker ice cover on water and by hazardous weather events. Competing land use due to infrastructure, extractive industries, tourism, and energy production makes it difficult to find alternative grazing land. Supplementary feeding and increased use of trucks to transport reindeer is one result. Herds that are dispersed due to bad snow conditions have an increased exposure to predators ( [[#Walkepää--2019|Walkepää, 2019]] ; [[#Uboni--2020|Uboni et al., 2020]] ). By working strategically to secure adequate winter grazing and reduce fragmentation of grazing areas more generally represents win-win strategies for achieving decreased mental stress levels while reducing herders’ consumption of fossil fuels ( [[#Walkepää--2019|Walkepää, 2019]] ).

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Box 7.1

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<span id="visual-guide-to-this-chapter"></span>
=== 7.1.8 Visual Guide to this Chapter ===

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Figure 7.3 provides a visual guide to this chapter. [[#7.1|Section 7.1]] has briefly summarised major global frameworks and highlights groups that exhibit heightened vulnerability and exposure to the climatic risks assessed in this chapter. Section 7.2 assesses observed impacts on health and well-being, migration and conflicts that have emerged from interactions of climate and weather-related hazards, exposure to such hazards and vulnerability of communities and systems, while [[#7.3|Section 7.3]] assesses projected future risks. [[#7.4|Section 7.4]] assesses adaptation responses to climate risks, opportunities for transformative change, co-benefits and how solutions for reducing climate impacts on health, well-being, migration and conflicts may form part of the wider CRDPs.

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[[File:e4b17afba48ad8c00fcd9b73057a0ae3 IPCC_AR6_WGII_Figure_7_003.png]]

'''Figure 7.3 |''' '''Structure of the chapter following a pathway from hazard, exposure and vulnerability to the observed impacts, projected future risks, adaptation and climate resilient development pathways.'''

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<span id="observed-impacts-of-climate-change-on-health-well-being-migration-and-conflict"></span>