Editing IPCC:AR6/WGII/Chapter-13 (section)

=== 13.7.2 Solution Space and Adaptation Options ===

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Adaptation to health impacts has generally received less attention compared with other climate impacts across Europe ( [[#EASAC--2019|EASAC, 2019]] ). Progress on health adaptation can be observed. Between 2012 and 2017, at least 20 European countries instituted new governance mechanisms, such as interdepartmental coordinating bodies for health adaptation and adopted health adaptation plans ( [[#Kendrovski--2019|Kendrovski and Schmoll, 2019]] ). Progress on city-level health adaptation is generally limited ( [[#Araos--2015|Araos et al., 2015]] ), with most activities occurring in SEU ( ''high agreement, medium evidence'' ) ( [[#Paz--2016|Paz et al., 2016]] ).

Figure 13.24 presents the assessment of the feasibility and effectiveness of key heat-related health adaptation actions. It shows that substantial social–cultural and institutional barriers complicate widespread implementation of measures; studies on the implementation of new blue–green spaces in existing urban structures in, for example, Sweden ( [[#Wihlborg--2019|Wihlborg et al., 2019]] ), the UK ( [[#Carter--2018|Carter et al., 2018]] ) and the Netherlands ( [[#Aalbers--2019|Aalbers et al., 2019]] ), point to important feasibility challenges (e.g., access to financial resources, societal opposition, competition for space) ( ''high confidence'' ). Lower perception of health risks has been observed among vulnerable groups which, in conjunction with perceived high costs of protective measures, act as barriers to implementing health adaptation plans ( [[#van%20Loenhout--2016|van Loenhout et al., 2016]] ; [[#Macintyre--2018|Macintyre et al., 2018]] ; [[#Martinez--2019|Martinez et al., 2019]] ). Key barriers to mental health adaptation actions include lack of funding, coordination, monitoring and training (e.g., psychological first aid) ( [[#Hayes--2018|Hayes and Poland, 2018]] ). Existing health measures, such as monitoring and early warning systems, play an important role in detecting and communicating emerging climate risks and weather extremes ( ''high confidence'' ) ( [[#Confalonieri--2015|Confalonieri et al., 2015]] ; [[#Casanueva--2019|Casanueva et al., 2019]] ; [[#Linares--2020|Linares et al., 2020]] ). Stricter enforcement of existing health regulations and policies can have a positive effect in reducing risks ( [[#Berry--2018|Berry et al., 2018]] ).

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[[File:4d08dd38d4fa8cdf114c5eef90b863f0 IPCC_AR6_WGII_Figure_13_024.png]]

'''Figure 13.24 |''' '''Effectiveness and feasibility of the main adaptation options to reduce heat-related impacts and health risks in Europe''' (Section SM13.9, Table SM 13.19)

The effectiveness of most options in reducing climate-induced health risks is determined by many co-founding factors, including the extent of the risk, existing sociopolitical structure and culture, and other adaptation options in place ( ''high agreement, medium evidence'' ). Successful examples include the implementation of heatwave plans ( [[#Schifano--2012|Schifano et al., 2012]] ; [[#van%20Loenhout--2016|]] [[#van%20Loenhout--2016|van Loenhout and Guha-Sapir, 2016]] ; de’Donato et al., 2018), improvements in health services and infrastructure of homes ( [[#13.10.2.1|Section 13.10.2.1]] ; [[#Vandentorren--2006|Vandentorren et al., 2006]] ). A study of nine European cities, for example, showed lower numbers of heat-related deaths in SEU and attributed this to the implementation of heat prevention plans, a greater level of individual and household adaptation, and growing awareness about exposure to heat ( [[#de’Donato--2015|de’Donato et al., 2015]] ). Long-term national prevention programmes in NEU have been shown to reduce temperature-related suicide ( [[#Helama--2013|Helama et al., 2013]] ). The physical fitness of individuals may increase resilience to extreme heat ( [[#Schuster--2017|Schuster et al., 2017]] ). Combining multiple types of adaptation options into a consistent policy portfolio may have an amplifying effect in reducing risks, particularly at higher GWL ( ''medium confidence'' ) (Chapter 7; [[#Lesnikowski--2019|Lesnikowski et al., 2019]] ).

Health adaptation actions have demonstrable synergies and trade-offs (Cross-Chapter Box HEALTH in Chapter 7). For example, increasing green–blue spaces in Europe’s densely populated areas can be effective in improving microclimates, reducing the impact of heatwaves, improving air quality and improving mental health by increasing access to fresh air and green (restorative) environments ( [[#Gascon--2015|Gascon et al., 2015]] ; [[#Kondo--2018|Kondo et al., 2018]] ; [[#Kumar--2019|Kumar et al., 2019]] ). Health adaptations can also have negative trade-offs, be inconsistent with mitigation ambitions and could lead to maladaptation. Green–blue spaces, for example, may create new nesting grounds for carriers of vector-borne diseases, increase pollen and allergies ( [[#Kabisch--2016|Kabisch et al., 2016]] ), enlarge freshwater use for irrigation ( [[#Reyes-Paecke--2019|Reyes-Paecke et al., 2019]] ) and could raise climate equity and justice issues such as green gentrification ( [[#Yazar--2019|Yazar et al., 2019]] ). Similarly, air conditioning and cooling devices are considered highly effective but have low economic and social feasibility as well as negative trade-offs due to increasing energy consumption, raising energy costs which is particularly challenging for the poor ( [[#13.8.1.1|Section 13.8.1.1]] ), enhancing the UHI effect and increasing noise pollution ( [[#Fernandez%20Milan--2015|Fernandez Milan and Creutzig, 2015]] ; [[#Hunt--2017|Hunt et al., 2017]] ; [[#Macintyre--2018|Macintyre et al., 2018]] ).

The solution space for implementing health adaptation options is slowly expanding in Europe. Health adaptation can build on, and integrate into, established health system infrastructures, but these differ significantly across Europe, as do existing capacities to deal with climate-related extreme events ( [[#Austin--2016|Austin et al., 2016]] ; [[#Austin--2018|Austin et al., 2018]] ; [[#Orru--2018|Orru et al., 2018]] ; [[#Watts--2018|Watts et al., 2018]] ; [[#Austin--2019|Austin et al., 2019]] ; [[#Martinez--2019|Martinez et al., 2019]] ). Despite some progress, limited mainstreaming of climate change has been observed, particularly due to low societal pressure to change, confidence in existing health systems and lack of awareness of links between human health and climate change ( ''medium confidence'' ) ( [[#Austin--2016|Austin et al., 2016]] ; [[#WHO--2018b|WHO, 2018b]] ; [[#Watts--2021|Watts et al., 2021]] ). Coordination of health adaptation actions across scales and between public sectors is needed to ensure timely and effective responses for a diversity of health impacts ( ''high confidence'' ) ( [[#Austin--2018|Austin et al., 2018]] ; [[#Ebi--2018|Ebi et al., 2018]] ). Key enabling conditions to extend the solution space include increasing the role for national and regional governments in facilitating knowledge sharing across scales, allocating dedicated financial resources, and creating dedicated knowledge and policy programmes on climate and health ( [[#Wolf--2014|Wolf et al., 2014]] ; [[#Akin--2015|Akin et al., 2015]] ; [[#Curtis--2017|Curtis et al., 2017]] ). Investing in public healthcare systems more broadly increases their capacity to respond to climate-related extreme events and will ensure wider societal benefits as the COVID-19 pandemic has demonstrated (Cross-Chapter Box COVID in Chapter 7).

Despite a range of options available, there are limits to how much adaptation can take place, and residual risks remain. These risks are predominantly discussed in the context of excess mortality and morbidity due to heat extremes ( [[#Hanna--2015|Hanna and Tait, 2015]] ; [[#Martinez--2019|Martinez et al., 2019]] ). Future heatwaves are expected to stretch existing adaptation interventions well beyond levels observed in response to the observed events of 2003 and 2010 ( [[#13.10.2.1|Section 13.10.2.1]] ; [[#Hanna--2015|Hanna and Tait, 2015]] ).

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