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

==== 7.4.2.2 Adaptation in Health Policies and Programmes ====

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''Health policies were historically not designed or implemented taking into consideration the risks of climate change and as currently structured are'' likely ''insufficient to manage the changing health burdens in coming decades'' ( ''very high confidence'' ) ''.'' The magnitude and pattern of future health burdens attributable to climate change, at least until mid-century, will be determined primarily by adaptation and development choices. Current and future emissions will play an increasing role in determining attributable burdens after mid-century. Increased investment in strengthening general health systems, along with targeted investments to enhance protection against specific climate-sensitive exposures (e.g., hazard early warning and response systems and integrated vector control programmes for VBDs) will increase resilience if implemented to at least keep pace with climate change ( ''high confidence'' ). Investments to address the social determinants of health can reduce inequities and increase resilience ( ''high confidence)'' ( [[#Thornton--2016|Thornton et al., 2016]] ; [[#Marmot--2020|Marmot et al., 2020]] ; [[#Wallace--2015|Wallace et al., 2015]] ; [[#Semenza--2021|Semenza and Paz, 2021]] ).

Peer-reviewed publications of health adaptation to climate change in low- and middle-income countries have typically focused on flooding, rainfall, drought and extreme heat through improving community resilience, DRR and policy, governance and finance ( [[#Berrang-Ford--2021|Berrang-Ford et al., 2021]] ; [[#Scheelbeek--2021|Scheelbeek et al., 2021]] ). Health outcomes of successful adaptation have included reductions in infectious disease incidence, improved access to water and sanitation and improved food security. Figure 7.14 shows a Sankey diagram of climate hazards, adaptation responses and health outcomes. The figure highlights the range of health adaptation responses that are discussed in more detail earlier in this chapter and demonstrates the potential health benefit of adaptation efforts that affect a broad range of health determinants.

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[[File:74b48a7ebfb82b48ec221f62634d76b3 IPCC_AR6_WGII_Figure_7_014.png]]

'''Figure 7.14 |''' '''Sankey diagram of climate hazards, adaptation responses and health outcomes.''' CSA is climate-smart agriculture. Source: [[#Scheelbeek--2021|Scheelbeek et al. (2021)]] .

Questions of the feasibility and effectiveness of health adaptation options differ from those in other sectors because public health is a societal enterprise that cuts across many different spheres of society. Consequently, there are dependencies that lie outside the jurisdiction of the health sector. All the health risks of a changing climate currently cause adverse outcomes, with policies and programmes implemented in at least some health programmes in some places. Policies and programmes are continuously modified to increase effectiveness; this will need to accelerate in a changing climate. Improvements are needed as more is understood about disease aetiology, changing socioeconomic and environmental conditions, obstacles to uptake and other factors.

Policies and programmes for climate-sensitive health outcomes are only beginning to incorporate the challenges and opportunities of climate change, although this is critical for increasing resilience. The fundamentals of many policies and programmes in a changing climate will remain the same: implementing infectious disease control programmes, preventing heat-related mortality and morbidity and reducing the burden of other climate-related health endpoints, but activities will need to explicitly account for climate change to continue to protect health. Even with such attention to climate change, there are limits to the feasibility and effectiveness of health adaptation options for extreme heat, controlling emerging infectious diseases and controlling cascading risk pathways.

As discussed in Sections 1.4.2 and 1.5, an adaptation option is feasible when it is capable of being implemented by one or more relevant actors. In the health sector, WHO, the United Nations Children’s Fund (UNICEF) and other organisations provide technical expertise to ministries of health, who then provide national to local healthcare and public health services. Generally, the question is less of overall feasibility, given the range of potential adaptation options that have yet to be fully explored and implemented, but more of readiness to buy into the adaptation efforts required from health and other sectors. In specific contexts, feasibility also depends on governance capacity, financial capacity, public opinion and the distribution of political and economic power (Chapter 17). In other words, adaptation to climate change is broadly feasible with adequate investment and engagement, although this has yet to materialise, and in specific contexts feasibility is contingent and time-varying, and needs to be assessed at national to sub-national scales. For example, a scoping review in the Pacific region noted the following areas where further and significant investment and support are needed to increase feasibility of climate and health action: (a) health workforce capacity development, (b) enhanced surveillance and monitoring systems and (c) research to address priorities and their subsequent translation into practice and policy ( [[#Bowen--2021|Bowen et al., 2021]] ). Vulnerability, adaptation and capacity assessments include consideration of the feasibility and effectiveness of priority health adaptation options and can help decision makers identify strategies for enhancing adaptation feasibility in specific contexts.

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