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

=== 7.4.3 Enabling Conditions and Constraints for Health Adaptation ===

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==== 7.4.3.1 Governance, Collaboration and Coordination ====

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''Effective governance institutions, arrangements, funding and mandates are key for adaptation to climate-related health risks'' ( ''high confidence'' ) ''.'' Without integration and collaboration across sectors, health adaptation can become siloed, leading to less effective adaptation or even maladaptation ( [[#Magnan--2016|Magnan et al., 2016]] ; [[#Fox--2019|Fox et al., 2019]] ). Integration and collaboration include working laterally across national government departments and agencies, as well as vertically from national agencies to local governments and with the private sector, academia, NGOs and civil society. In this context, top-down policy design and implementation are complemented by bottom-up approaches that engage community actors in programme design and draw upon their local practices, perspectives, opinions and experiences. Opportunities exist to better integrate public health into climate change discourse and policymaking processes, and to strengthen public health partnerships and collaborations ( [[#Awuor--2020|Awuor et al., 2020]] ). Creating networks, integration across organisations and jointly developed policies can facilitate cross-sectoral collaboration ( [[#Bowen--2017|Bowen and Ebi, 2017]] ).

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==== 7.4.3.2 Multi-sectoral Collaborations ====

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''Multi-sectoral collaborations aimed at strengthening the health sector can generate multiple co-benefits in other sectors'' ( ''high agreement, medium evidence'' ). Solutions for the health and well-being risks described in 7.2 and 7.3 often have their origins in sectors that include water, sanitation, agriculture, food systems, social protection systems, energy and key components of urban systems such as housing and employment ( [[#WHO--2015a|WHO, 2015a]] ; [[#Bowen--2014b|Bowen et al., 2014b]] ; [[#Machalaba--2015|Machalaba et al., 2015]] ; [[#Confalonieri--2015|Confalonieri et al., 2015]] ; [[#Bowen--2014a|Bowen et al., 2014a]] ; [[#Semenza--2021|Semenza, 2021]] ). Climate resilient development pursued in these other sectors, and in cooperation with the health sector, simultaneously increases the potential for adaptation and climate resilience in terms of health and well-being ''(high confidence)'' ( [[#Ahmad--2017|Ahmad et al., 2017]] ; [[#Watts--2018b|Watts et al., 2018b]] ; [[#Levy--2015|Levy and Patz, 2015]] ; WHO, 2018a; [[#Chiabai--2018a|Chiabai et al., 2018a]] ; [[#Dudley--2015|Dudley et al., 2015]] ; [[#Zinsstag--2018|Zinsstag et al., 2018]] ; [[#Sherpa--2014|Sherpa et al., 2014]] ).

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==== 7.4.3.3 Financial Constraints ====

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''Financial constraints are the most referenced barrier to health adaptation and so scaling up financial investments remains a key international priority'' ( ''very high confidence'' ) ''( [[#Wheeler--2018|Wheeler and Watts, 2018]] ; [[#UNFCCC--2017a|UNFCCC, 2017a]] )'' . AR5 estimated the costs of adaptation in developing countries at between USD 70 billion and USD 100 billion annually in the year 2050, but these are ''likely'' to be a significant underestimate, particularly in the years 2030 and beyond (UNEP, 2014). National surveys conducted by WHO identified financial constraints as a major barrier to the implementation of health adaptation priorities ( [[#WHO--2019b|WHO, 2019b]] ; [[#Watts--2021|Watts et al., 2021]] ). Novel research drawing on global financial transaction data suggests that in 2019, global financial transactions with the potential to deliver adaptation in the health and healthcare sector reached USD 18.4 billion, driven by transactions in high- and upper middle-income countries, with investment in Africa, Southeast Asia and the eastern Mediterranean mostly stagnant ( [[#Watts--2021|Watts et al., 2021]] ).

There has been limited participation of the health sector in international climate financing mechanisms ( [[#Martinez--2018|Martinez and Berry, 2018]] ). Of 149 projects listed in the Adaptation Fund database in October 2020, a large number were broad-based initiatives that may have considerable indirect benefits for health systems, such as enhanced disaster preparedness and food security, but none were explicitly aimed at strengthening health systems or had directed funds through ministries of health. A review of projects funded by the major multi-lateral climate funds showed that less than 1.5% of dispersed adaptation funding and less than 0.5% of overall funding have been allocated to projects aimed at protecting health ( [[#WHO--2015a|WHO, 2015a]] ). A survey of national public health organisation representatives from a mix of low-, middle- and high-income countries found that a lack of political commitment, insufficient coordination across sectors and inadequate funding for public health-specific adaptation initiatives were common barriers to building climate resilience ( [[#Marcus--2020|Marcus and Hanna, 2020]] ). Under-investment in climate-specific initiatives in health systems coincides with persistent under-investment in healthcare more generally, especially in low- and middle-income countries ( [[#Schaferhoff--2019|Schaferhoff et al., 2019]] ).

Adaptation financing does not often reach places where the climate-sensitivity of the health sector is greatest ( [[#Weiler--2019|Weiler, 2019]] ). Financial constraints in Africa are one of the key reasons for slow implementation of health adaptation measures ( [[#Nhamo--2019|Nhamo and Muchuru, 2019]] ). Strengthening health systems in vulnerable countries has the potential to reduce current and future economic costs related to environmental health risks, thus enabling reinvestment in the health system and sustainable development ( [[#WHO--2020a|WHO, 2020a]] ; [[#WHO--2015a|WHO, 2015a]] ). Robust and comprehensive climate and health financing builds first on core health sector investments ( [[#WHO--2015a|WHO, 2015a]] ). Other potential opportunities for resource mobilisation include health-specific funding mechanisms, climate change funding streams and investments from multi-sectoral actions and actions in health-determining sectors ( [[#WHO--2015a|WHO, 2015a]] ). Incorporating climate change and health considerations into disaster reduction and management strategies could improve funding opportunities and increase potential funding streams ( [[#Aitsi-Selmi--2015|Aitsi-Selmi et al., 2015]] ). Reinforcing cross-sectoral governance mechanisms maximises health co-benefits and economic savings by allowing for multi-sectoral costs and benefits to be comprehensively considered in decision-making ( [[#Belesova--2016|Belesova et al., 2016]] ; [[#WHO--2020a|WHO, 2020a]] ; [[#WHO--2015b|WHO, 2015b]] ). An additional financial need concerns health research, the existing funding for which does not match what is needed to support the implementation of the combined objectives of the UN 2030 Agenda for Sustainable Development, the Sendai Framework for Disaster Risk Reduction and the Paris Agreement ( [[#Green--2014|Green and Minchin, 2014]] ; [[#Ebi--2016|Ebi, 2016]] ; [[#Green--2017|Green et al., 2017]] ).

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==== 7.4.3.4 Perceptions of Climate Change Risks and Links to Adaptation ====

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''Adaptation decisions and responses to climate change can be influenced by perceptions of risks, which are shaped by individuals’ characteristics, knowledge and experience'' ( ''medium agreement, medium evidence'' ) ''.'' Institutional and governmental responses are critical for adapting to climate-related risks in health and other sectors, but individual responses also are relevant, such as choosing to implement adaptation measures. Individual responses are in turn affected not only by capabilities but also by perceptions that climate change is real and requires a response ( [[#Ogunbode--2019|Ogunbode et al., 2019]] ). Perceptions of climate risks are formed by experiences of changes in local weather and extreme weather events ( [[#Sattler--2018|Sattler et al., 2018]] ; [[#Sattler--2020|Sattler et al., 2020]] ; [[#van%20der%20Linden--2015|van der Linden, 2015]] ), observations of environmental changes ( [[#Hornsey--2016|Hornsey et al., 2016]] ), experiences of and knowledge about climate change impacts ( [[#Ngo--2020|Ngo et al., 2020]] ; [[#van%20der%20Linden--2015|van der Linden, 2015]] ) and individual characteristics such as values and worldviews ( [[#Poortinga--2019|Poortinga et al., 2019]] ) ( ''high agreement, medium evidence'' ). Risk perceptions include both logical assessments about the likelihood and severity of climate change impacts and affective feelings about those impacts. On average, affective measures of risk perception are more strongly associated with disaster preparation than cognitive measures ( [[#Bamberg--2017|Bamberg et al., 2017]] ; [[#van%20Valkengoed--2019|van Valkengoed and Steg, 2019]] ).

In addition to perceptions of risk, the likelihood that an individual will implement behavioural adaptations or support relevant public policy is affected by subjective assessments of the response options ( [[#Bamberg--2017|Bamberg et al., 2017]] ; [[#van%20Valkengoed--2019|van Valkengoed and Steg, 2019]] ; [[#Akompab--2013|Akompab et al., 2013]] ; [[#Carman--2020|Carman and Zint, 2020]] ; [[#Hornsey--2016|Hornsey et al., 2016]] ; [[#Brenkert-Smith--2015|Brenkert-Smith et al., 2015]] ).

''Efficacy beliefs, social norms and subjective resilience also affect adaptation behaviour'' ( ''medium confidence'' ) '', which has implications for communication about the need for climate adaptation.'' Efficacy beliefs represent the belief in one’s ability to carry out particular action(s) and the belief that the action(s) will have the desired outcome. Belief that one is personally able to complete a behaviour is moderately associated with engaging in disaster preparations ( [[#Navarro--2021|Navarro et al., 2021]] ; [[#van%20Valkengoed--2019|van Valkengoed and Steg, 2019]] ) and with adaptation intentions ( [[#Burnham--2017|Burnham and Ma, 2017]] ). ''Collective efficacy'' , the belief that a group of people working together can achieve a desired outcome, is important for participating in community adaptation behaviours ( [[#Bandura--1982|Bandura, 1982]] ; [[#Chen--2015|Chen, 2015]] ; [[#Thaker--2015|Thaker et al., 2015]] ). Related to this is ''response efficacy'' , a belief that a behaviour will achieve its desired outcome, which is also moderately associated with engaging in disaster preparations ( [[#van%20Valkengoed--2019|van Valkengoed and Steg, 2019]] ). Collective efficacy can potentially be developed by strengthening communication networks and social ties within a community ( [[#Haas--2021|Haas et al., 2021]] ; [[#Jugert--2016|Jugert et al., 2016]] ). Norms describing the adaptation strategies of others in a community, particularly those with high social status, can either facilitate or inhibit individual adaptation decisions ( [[#Neef--2018|Neef et al., 2018]] ; [[#Smith--2021|Smith et al., 2021]] ).

Distinct from efficacy beliefs, subjective resilience is a more general optimism or belief about one’s ability ( [[#Jones--2019|Jones, 2019]] ; [[#Khanian--2019|Khanian et al., 2019]] ). Subjective resilience ( [[#Clare--2017|Clare et al., 2017]] ) can influence preferred responses to climate change via assessment of one’s ability to engage in specific response options. Identities can influence assessment of subjective resilience. Place attachment, having a strong emotional connection to a particular location, is weakly associated with disaster preparation ( [[#Brügger--2015|Brügger et al., 2015]] ). In some cases, place attachment may inhibit adaptive responses, either by reducing perceptions of risk or by making people reluctant to leave an area that is threatened ( [[#De%20Dominicis--2015|De Dominicis et al., 2015]] ; [[#van%20Valkengoed--2019|van Valkengoed and Steg, 2019]] ). Place attachment can also contribute to enhanced community resilience ( [[#Khanian--2019|Khanian et al., 2019]] ; [[#Jones--2019|Jones, 2019]] ; [[#Wang--2021|Wang et al., 2021]] ).

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