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Adapting to health impacts of climate change: a study of UNFCCC Annex I parties

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2011 Environ. Res. Lett. 6 044009
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during which over 70 000 heat related mortalities were recorded.IOP PUBLISHING ENVIRONMENTAL RESEARCH LETTERS Environ. Policymakers in the health sector must engage with stakeholders to implement adaptation that considers how climate change will impact the health of each segment of the population. L Berrang-Ford1. preparatory) action. J D Ford1. 1748-9326/11/044009+09$33. while all initiatives affect at least one health vulnerability. further 1. Recent simulations suggest that future warming will likely be toward the higher end of the IPCC projections. 805 Sherbrooke Street West. WHO estimates placed excess annual mortality as a result of climatic change at 141 000 by 2004 [11]. air quality [6]. extreme weather events [8]. health. significantly surpassing the 2 ◦ C threshold believed to be indicative of ‘dangerous interference with the climate system’ [2].lesnikowski@mail. Introduction It is widely accepted that the climate is changing. with implications for natural ecosystems and human communities [1]. 3. Keywords: climate change. Extreme temperatures [5]. Canada 2 Institute for Health and Social Policy. remains in its infancy. M Barrera2 and S J Heymann2 1 Department of Geography. 6 (2011) 044009 (9pp) doi:10. Consideration for the special needs of vulnerable groups is uneven and underdeveloped.e. 80% of the actions identified consist of groundwork (i. In A growing body of academic literature concerning the risks of climate change for health demonstrates a wide range of expected impacts and populations at risk [1]. McGill University. Montreal. adaptation. Adaptation will therefore be a critical component of the global response to our changing climate in addition to pressing needs for mitigation [1. QC. Using the Fifth National Communications of Annex I parties to the UNFCCC.iop. only 15% had an explicit human health component. Canada E-mail: alexandra. H3A 1A3. Best estimates from the International Panel on Climate Change (IPCC) indicate a rise in average global temperatures between 1.1088/1748-9326/6/4/044009 Adapting to health impacts of climate change: a study of UNFCCC Annex I parties A C Lesnikowski1. We conclude that the adaptation responses to the health risks of climate change remain piecemeal. Climate change is directly motivating 71% of groundwork actions. requiring changes in the way we implement health policy [10]. Montreal. and 61% of adaptation initiatives are being mainstreamed into existing institutions or programs. particularly within those groups already considered most vulnerable to poor health outcomes. Abstract Adapting to the health effects of climate change is one of the key challenges facing public health this century. Furthermore.8 ◦ C and 4 ◦ C this century.iop.mcgill. UNFCCC S Online supplementary data available from stacks. 4]. however. H3A 2K6. Events such as the 2003 European heat wave. No health vulnerability was recognized by all 38 Annex I countries. infectious disease [7]. Our knowledge of progress on Received 18 July 2011 Accepted for publication 10 October 2011 Published 31 October 2011 Online at stacks. with only 20% constituting tangible adaptations. McGill University. QC. and food and water safety and security [9] will pose greater challenges to human health throughout the next century. 1130 Pine Avenue West. J A Paterson1 . 1912 initiatives are systematically identified and analyzed. Lett.00 1 © 2011 IOP Publishing Ltd Printed in the UK . 85% of which were child deaths.

appendix B available at stacks. This letter aims to address this gap by assessing the status of national governments submit these reports as documentation of policy priorities and progress. indigenous groups [14]. and urged governments to put health at the center of climate policy [18].7 billion people. appendix B available at stacks. Australia and Canada. they do demonstrate priorities and trends in national leadership. These limitations underline our interpretation of results as a proxy for national policy priorities and general trends in health indicate that disproportionably greater health impacts will fall on vulnerable groups like the elderly [12]. Specifically.1. and prioritizing areas for further support [3]. while adaptations occurring within regional and local jurisdictions are not as widely reflected in these documents. 19]. Second. Other groups with heightened vulnerability to climate change include women [13]. including the Russian Federation). and hence whether the policy response to date is adequate. with only a general level of detail provided as per NC guidelines (supplementary information. to systematically gather data on adaptation we required a consistent data source available for a large number of developed countries and accessible in at least one of the five UN languages (English. Adapting to changes in climate will be one of the main challenges facing public health this century [1]. While these documents offer only a summary of adaptation initiatives being pursued and not a complete inventory of action. these reports are national-level documents. The most recent report is the NC5. including assessing adaptation needs. include 41 developed and transition economies committed to reducing emissions levels primarily below 1990 levels. but we can interpret these results as proxies for assessing the depth of health adaptation. There are also several limitations in using the NC5.iop. In 2008 the World Health Assembly passed a resolution requiring the WHO to create a workplan for addressing climate change [4. These analyses demonstrate an urgent need to implement responses that reach all segments of society. and provide insights into how sub-national adaptation is emerging in different national contexts. with a key objective the strengthening of health systems to cope with the threats posed. The NCs were considered the most appropriate data source for two reasons. In doing so it develops a systematic methodology to track and characterize adaptation focusing specifically on human health. Chinese). For this reason national government websites and information materials were eliminated as a potential data source. 044009/mmedia). 2.iop. Monaco and Turkey) had not submitted the NC5 by September 2010 and were excluded. This is a significant gap constraining our understanding of if and how adaptation is taking place.Environ. Countries party to the Annex I sub-group. Annex I nations have a combined population of approximately 1. 2 . Despite the risks and importance of adaptation however. Data source The Fifth National Communication (NC5) of Annex I parties to the UNFCCC Secretariat was selected as the data source for this analysis. appendix A available at stacks. Arabic. French. National Communications (NCs) are periodically prepared by national governments in accordance with guidelines established by the Secretariat and deadlines set by the Conference of the Parties (COP) (supplementary information. Spanish. and climate-relevant policies and programs. but do not capture a wide enough range of countries to provide a sufficient sample size. Using data from the UNFCCC provided an adequate sample size and consistent information guidelines. individuals with preexisting or chronic conditions [15] and individuals living in poverty [16]. information provided in the NC5 may already be dated given the time gap between document preparation and release by the UNFCCC. GHG projections. Thirty-eight Annex I countries were selected for inclusion in this analysis (supplementary information. the paper examines five research questions that give an adaptation profile of each country: (1) Which health vulnerabilities are provoking the greatest level of adaptation response? (2) What stage of adaptation have UNFCCC Annex I countries reached in regards to health risks of climate change? (3) What types of adaptation are being taken? (4) Which populations are being targeted in adaptation planning and implementation? (5) Are the health implications of climate change and adaptation being explicitly identified in adaptation reporting? Together these questions allow us to characterize and assess the status of national leadership on health adaptation among developed countries. 21]. Res. provide detailed information on climate change policy. NC reports contain information on national greenhouse gas (GHG) emissions. Variations in level of information and language accessibility would have over-represented large. Other international organizations. we only have limited information on current efforts being undertaken to react to and prepare for health impacts of climate change [20. These include 28 of the 30 member states of the OECD and several Economies in Transition that are not part of the OECD (Eastern European nations. Methods 2. Pressure within the health sector for greater prioritization of adaptation has been growing throughout the last decade [1. however. Three countries (Malta. We cannot assume that the initiatives discussed in the NCs constitute the totality of adaptation efforts among developed countries. First. English-speaking countries like the United Kingdom. such as the Organization for Economic Cooperation and Development (OECD) or EU. evaluating current policies. national-level adaptations to the health impacts of climate change among Annex I parties to the United Nations Framework Convention on Climate Change (UNFCCC). 6 (2011) 044009 A C Lesnikowski et al vulnerability and adaptation. which was submitted by Annex I parties during 2009 and 2010. 17]. Furthermore. or 25% of the global population.iop. WHO Director-General Margaret Chan identified climate change as ‘one of the greatest challenges of our time’.org/ERL/ 6/044009/mmedia). Russian. Results demonstrate that the content of the communications draws heavily on actions occurring either exclusively through or in cooperation with national governments. First.

adaptation. Actions with a deliberate health component were distinguished as having ‘explicit’ recognition of a human health dimension.5% of adaptation actions documented an assessment or research initiative as the driver of the action. extreme weather events (e. water safety and security. rather than an exhaustive description of adaptations occurring at every governance level. and Canada—included over 100 actions.Environ. infrastructure development and technology. 80% were groundwork actions (1534). in cases where the distribution of particular actions is relevant. research on adaptation options. Examples of adaptation actions include legislation. Groundwork actions are considered first steps necessary to inform and prepare for adaptation.iop. Adaptations were categorized as follows: Statements of recognition constitute the most basic demonstration that countries can identify experienced or anticipated impacts of climate change. Luxembourg. food safety and security. financial support for autonomous adaptation. 2. the delivery of government services. storms. type of action. Res. Results Of 1912 health-relevant groundwork and adaptation actions in the Fifth National Communications. Descriptive analyses were conducted in Stata (Intercooled Stata v. Results primarily present country counts. Adaptation remains primarily in the groundwork stage All 38 Annex I parties reported climate change impact assessments at some stage of completion. Countries with the lowest number of initiatives (fewer than 25) included Croatia. conceptual tools.g. linkages between research and policy outputs are not clearly defined in country reporting. All NC5s were reviewed and double coded to ensure consistency in information selection and classification. These results are an indicator of the status of adaptation action in the health sector and among health-relevant sectors that can be compared across nations and also monitored over time with the release of subsequent NCs.g. status of action. water).2. Only 3. and role of climate change as a driver (primary or mainstreamed). organizational mandates. Fewer than half of the 38 Annex I countries were found to be responding to any one health vulnerability with adaptation-level action. Reporting on adaptation actions was considerably weaker than on groundwork actions (tables 1–3). rural. unless a distinction is noted. evidence of explicit linkage to health. or droughts). regardless of whether a health component is explicitly identified. assessing national leadership on health adaptation is critical in analyzing efforts to adapt. 6 (2011) 044009 A C Lesnikowski et al resilience. Iceland. These types of action consist of impact and vulnerability assessments. evaluations of program effectiveness.iop. 11 countries provided descriptions of public awareness and outreach programs addressing extreme heat risks. or regulations in response to predicted or experienced impacts of climate change. multiple observations were included if actions addressed more than one type of action or health vulnerability.g. Adaptations may therefore occur in non-health sectors that have implications for human health. public awareness and outreach. government jurisdiction. developing and distributing treatments for climate related illness. as well as aggregated data at the country level. nongovernment participation. departmental development. Rather than exclude relevant adaptations in non-health sectors. Lett. however. The countries reporting the highest number of initiatives—the United Kingdom. 3. health vulnerability targeted. org/ERL/6/044009/mmedia). surveillance and monitoring. spatial planning. and vector and rodent-borne disease. Results are presented using individual observations. Finland. or general). StataCorp).2. target population (urban. agriculture. These vulnerabilities include extreme temperatures. and Slovenia. stakeholder and networking opportunities. available in the supplemental materials (available at stacks. or revising emergency room standards to accommodate greater influxes of patients following extreme events). 27 countries reported research on adaptation options in addition to risk assessments. but do not explicitly indicate tangible changes in policy or delivery of government services that improve 3. Adaptation actions are understood as changes made to built environments. and medical interventions (e. The results presented in this paper consider explicit and implicit health adaptation together. acknowledgment of vulnerable initiatives addressing these vulnerabilities were included whether they occurred in the health sector or in non-health sectors (e. air quality. such as the frequency of adaptation response types. We define and categorize health vulnerabilities to climate change as per the IPCC Fourth Assessment Report [22]. land shifts. evidence of improved health outcomes (for adaptation actions only). and recommendations for adaptation action. Liechtenstein. Despite emphasis on assessments and research in the NC5. with only 378 constituting adaptation interventions.9.1. These statements give no indication that any action has been taken to better understand or adapt to vulnerability. while all other actions were considered to have an ‘implicit’ health dimension. The following variables were collected for each unique reference or initiative: level of action. Given the essential role national governments play in determining policy priorities and distributing resources and support. Data analysis A codebook was designed to quantitatively and systematically extract data related to health adaptation references or initiatives in the NC5 (supplementary materials. such as Plan Canicule in France or the Heat Health Watch Warning System 3 . Many of these vulnerabilities also have implications for sectors beyond public health. sectoral involvement. floods. Detailed variable and coding definitions are provided in the codebook. indicating the frequency with which specified initiatives are documented among Annex I nations in their NC5. Data were analyzed using unique statements or initiatives as observations. Australia. appendix C available at stacks. Any reference or initiative responding to the health vulnerabilities of climate change was considered eligible for inclusion as an observation in the database.

Only 15% of the total number of actions explicitly linked impacts from climate change with the human health dimension of vulnerability.g. Status of response to health risks of climate change. few demonstrate an explicit recognition of a causal association with human health (table 4). food. Integrated Coastal Safety Plan. No health vulnerability was recognized by all 38 Annex I countries. The least widely recognized health vulnerability was extreme cold—recognized by only Greece. 4 . Food safety and security and general extreme weather events were recognized by 30 countries and 26 countries.g.g. Discussions about increases in medical preparedness were notably absent.2. developing alternative seed varieties (e. Tallinn. Groundwork responses to health vulnerabilities of climate change. Estonia). 6 (2011) 044009 A C Lesnikowski et al country. and Lithuania. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category. Res. Japan). Canada. Descriptions of developments in infrastructure and technology include expanding city sewage systems to accommodate higher volumes of water (e. discussing plans for improving health care standards to accommodate climate change risks. 11 countries discussed changes in legislation that integrated climate change into regulations on water safety and security. while 14 have taken actions addressing food safety and security. Belgium). (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category. flooding and extreme heat than any other vulnerability. 13 1 4 13 17 5 5 8 8 17 14 7 3 24 a Indeterminate refers to groundwork or adaptation actions described without explicit reference to any climate change vulnerability. Only 13 countries reported adaptations concerning extreme heat. with 34 countries making statements recognizing increased risk in a changing climate.g. Actions classified as Infrastructure Development and Technology. Recognition of the health implications of adaptation is not being widely made in adaptations outside the health sector in Italy. with fewer than 1% of the total number of actions making an explicit link. rarely recognized the impact of the action on health. 17 countries have pursued adaptation on the issues of flooding and water safety and security. with more countries reporting adaptation action on water. with only one Despite all 1912 actions recorded in the database affecting health in some capacity. Lett.) Level of action Health vulnerability Recognition Groundwork Adaptation Extreme heat Extreme cold Air quality UV radiation General extremes Floods Storms Fires Droughts Land shifts Water safety and security Food safety and security Infectious disease General health Indeterminatea 25 3 17 7 31 34 21 20 22 24 26 30 24 11 26 3 11 1 24 32 21 18 29 23 32 33 18 17 33 3. constructing protective barriers along waterfronts to reduce flooding from storm surges and rising sea levels (e.) Type of action (groundwork) Health vulnerability Impact/vulnerability assessments Extreme heat Extreme cold Air quality UV radiation General extremes Floods Storms Fires Droughts Land shifts Water safety and security Food safety and security Infectious disease General health Indeterminatea Total 21 1 7 1 18 28 20 12 23 18 27 27 11 7 20 38 a Assessments/adaptation research 3 Conceptual Stakeholder tools networking 2 1 1 7 1 5 6 11 3 3 2 5 11 12 2 7 21 27 12 15 5 6 7 6 18 13 3 6 29 33 3 5 Recommendation 7 2 2 4 2 2 17 20 7 12 2 5 7 3 12 14 5 4 8 22 Indeterminate refers to groundwork actions described without explicit reference to any climate change vulnerability. and improving drainage and irrigation systems (e.Environ. Lithuania. 3. Major health vulnerabilities are not addressed by all countries Flooding was the most widely recognized vulnerability. respectively. Table 1.3. This trend was mirrored in reporting on adaptation actions (table 3). Public awareness and outreach and evaluations had the strongest Table 2. while extreme heat was recognized by 25 countries. Czech Republic). in particular.

despite well recognized vulnerabilities of this group during extreme weather events. In contrast. Res. 17 countries demonstrated an awareness of particular vulnerability among individuals with chronic or pre-existing conditions across a range of health risks. respectively. disabled individuals. Explanations about how the special needs of vulnerable groups are incorporated into adaptation actions were negligible. 6 (2011) 044009 A C Lesnikowski et al Table 3. Involvement of the health sector in adaptations like extreme heat warning systems (categorized as public awareness and outreach) accounts for higher levels of health linkage within these initiatives. individuals with chronic or pre-existing conditions. 71% of infrastructure development and technology initiatives consisted of integrating a climate change lens into existing procedures. or people living in poverty. we see that most adaptation initiatives result from mainstreaming a climate change focus into existing frameworks. Conversely. Only five countries discussed special accommodations for the elderly in public awareness and outreach programs. particularly in the health sector. 3. assess adaptation needs. only 39% of adaptation actions were new initiatives being implemented in direct response to climate change risks. and children. 11 countries recognized risks to children from health vulnerabilities. Mainstreaming is prevalent among adaptation actions When climate change as a general (i. Concern for vulnerable populations was most frequently tied to extreme heat and air quality. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category. There was limited discussion of other vulnerable groups such as women. evaluate current policies. with limited reference to other vulnerable groups (table 5). non-health specific) issue is analyzed as a motivator for adaptation. 19 countries identified the elderly at least once in their NC5. 85% of Departmental Developments occurred primarily in response to climate change. most frequently from extreme heat. Recognition of the vulnerability of Indigenous groups was broader across health vulnerabilities. Notably.e. but restricted to Canada. table 4). The majority of groundwork actions extracted from the NC5 were initiated in direct response to climate change (71%. Reporting on groups is inconsistent across vulnerabilities and populations Reporting on vulnerable groups focused most frequently on the elderly. Lett.Environ. and 88% of legislative responses to climate change were the mainstreaming of climate change issues into existing laws and regulations. and prioritize areas where further support is required—key objectives of the WHO’s climate change workplan. The methodology allows for broad comparison among Annex I nations of the state of adaptation both directly 5 . Finally. related to vulnerable groups was predominantly restricted to public awareness and outreach activities. this recognition was concentrated in extreme heat and declining air quality. New Zealand.) Type of Action (Adaptation) Health vulnerability Extreme heat Extreme cold Air quality UV radiation General extremes Floods Storms Fires Droughts Land shifts Water safety and security Food safety and security Infectious disease General health Indeterminatea Total a Departmental Legislation development 3 Infrastructure development and technology 1 1 6 8 1 1 3 11 2 6 13 4 3 3 3 11 2 1 12 2 1 12 24 2 15 18 4 26 Public awareness and Surveillance and Financial Medical outreach monitoring Evaluation support intervention Other 11 1 2 2 3 1 1 5 4 2 1 2 2 5 4 4 1 2 2 1 4 6 3 3 3 2 9 24 1 18 1 1 1 1 1 1 1 1 3 1 1 1 4 7 3 7 1 1 Indeterminate refers to groundwork actions described without explicit reference to any climate change vulnerability. Discussion Scholarship tracking and characterizing climate change adaptation actions is in its infancy. with 30% and 36% of actions recognizing a link with human health. 17 in connection with extreme heat. Here we develop a methodology to systematically assess health adaptation at a national level that allows us to document interventions. the United States and Australia. recognition of health linkages. Reporting on adaptation actions 4.5. Adaptation responses to health impacts of climate change.4. 3.

Netherlands. This is particularly important for slowonset. and demonstrating actions and policies that are considered representative of approaches to adaptation. Only 13 adaptations explicitly cited an assessment as motivation for acting.Environ. and cited the experience as a direct motivator for action. United Kingdom and Spain—highlighted the increased awareness of 6 . This is consistent with the experience of adaptation outside the health sector [20. While we cannot infer that vulnerable groups are not being integrated into adaptation.) Explicit health linkage Type of action Impact/vulnerability assessments Assessments/adaptation research Conceptual tools Stakeholder networking Recommendation Legislation Departmental development Infrastructure development and technology Public awareness/outreach Surveillance and monitoring Evaluation Financial support Medical interventions Other (specify) Total Explicit Implicit Total Adaptations driven by assessment Yes No Total Climate change as motivator Mainstreamed/preexisting Primary Total 88 507 595 152 443 595 26 153 179 43 136 179 35 13 289 55 324 68 139 8 185 60 324 68 45 5 4 323 59 50 368 64 54 4 60 54 64 54 102 56 8 266 8 46 368 64 54 1 111 112 5 107 112 79 33 112 24 57 81 3 78 81 42 39 81 6 29 35 1 34 35 31 4 35 5 1 2 9 14 14 15 2 1 1912 14 15 2 1 378 5 10 13 14 15 2 1 365 9 5 2 1 1237 14 15 2 1 1912 255 1 1657 675 extreme temperature risks provoked by the event. as scholarship in related field indicates. ‘creeping hazards’ like climate change. are rarely considered in the NCs. Across health vulnerabilities. Inclusion of vulnerable groups in policy guidelines and adaptation design is critical to reaching all population segments: UNFCCC reporting indicates that some countries are more widely incorporating vulnerable populations into planning and action than others. 16. the NCs—as official reports submitted by national governments to the UNFCCC— are particularly relevant. more and/or improved research does not necessarily translate into policy intervention [23–25]. children. Herein. but the systematic comparative methodology can be used to identify national policy priorities and characterize the role of the public health sector in climate change adaptation. Irrespective of the reason for these differences. 28]. In spite of the focus on describing national assessments of vulnerability and adaptive capacity. Drivers of groundwork and adaptation action on climate change. providing an ‘availability heuristic’ [27] that the climate is changing and adaptation is needed. but are still reported on by fewer than half of Annex I countries. this analysis highlights clear gaps in national response. Over one quarter of the sample (11 countries) failed to report on a single vulnerable group. Extreme events of this nature increase the saliency of climatic risks to the public and policy makers. 6 (2011) 044009 A C Lesnikowski et al Table 4. Switzerland. policymakers may pay special attention to adverse impacts on sectors considered vital to the economy or politically sensitive. This data source does not allow us to create an inventory of every adaptation initiative being undertaken among developed countries (indeed such a task would be impossible). we hypothesize that recent experiences with extreme events are reinforcing perceptions that certain vulnerabilities are more critical than others [21]. we can question whether an absence of national leadership on prioritizing these groups is allowing sufficient adaptation to occur. countries especially effected by the 2003 European heat wave—France. summarizing in a standardized format issues significant to governments. 21]. National responses to climate change both at the groundwork and adaptation levels focus on select health vulnerabilities. and in other sectors that have an impact on population health. The elderly. Res. the link between research and adaptation outputs is vague. and challenge the assumption that human systems are insulated from nature [26]. within the health sector. Lett. There is need for further examination of how research is influencing or linking to the policy process. These results raise questions about how much priority is being given to vulnerable groups in adaptation planning and implementation. Furthermore. while widely discussed in the literature on climate change vulnerability [13. Women and people living in poverty. countries reported far more impact and vulnerability assessments than adaptation actions. Integration of vulnerable groups into adaptation initiatives remains underdeveloped and uneven across Annex I parties. and individuals with pre-existing or chronic diseases are the most frequently discussed vulnerable groups. For instance. Herein. Italy. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category.

A C Lesnikowski et al .) Vulnerable groups 7 Health vulnerability Elderly Children Disabled persons Indigenous Extreme heat Extreme cold Air quality UV radiation General extremes Floods Storms Fires Droughts Land shifts Water safety and security Food safety and security Infectious disease General health Indeterminatea Total 17 6 1 1 5 2 1 2 2 2 1 1 1 a Chronic/pre-existing condition Nationality Race/ethnicity Language Sex/gender Social disability 11 1 8 Social position Other None 1 2 28 4 18 8 32 38 28 24 35 29 3 1 5 1 1 2 2 1 1 1 1 3 2 1 2 1 1 1 2 2 4 2 19 1 1 2 2 1 1 1 1 2 17 1 1 1 1 4 1 3 1 9 37 1 1 5 29 22 32 38 Indeterminate refers to groundwork actions described without explicit reference to any climate change vulnerability. Recognition of increased health risks to vulnerable groups.Environ. Lett. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category. 6 (2011) 044009 Table 5. Res.

attention should be paid to identifying which adaptations are more effectively mainstreamed. Res. or can be replicated to analyze adaptation progress in the upcoming Sixth National Communications of Annex I parties.Environ. individuals with pre-existing or chronic conditions. Further analysis of the next NC will be necessary to determine how far health adaptation has progressed in the time since the NC5 was submitted. These results. but our understanding of how much adaptation is actually occurring is limited. people living in poverty. There is no evidence in the NC5 that evaluations are being undertaken. Third. Finally. however. however. almost all sectors will be responsible for adaptations that will impact human health. For example. A more detailed study of adaptation initiatives occurring at all governance levels would be necessary to determine the full extent to which particular groups are being included in the adaptation process. Reporting guidelines in subsequent NCs should be cognizant of the potential for including evaluations as a component of adaptation reporting. conceptual tools. This finding is consistent with studies that have argued that the health sector has been slow to become engaged in environmental issues [4]. this kind of comparative framework will be centrally important for future studies. descriptions of where and how climate change risks assessments are being integrated into existing heat wave warning systems and emergency medical response standards would provide a more nuanced understanding of action being taken to adapt to risks of extreme heat. A dialogue on vulnerable groups needs to be developed within UNFCCC reporting mechanisms in such a way that countries are encouraged to reflect on the participation of vulnerable populations in the adaptation process and can be held accountable for the development and implementation of effective adaptations. The results of this study have several implications for actors in the health sector considering the impacts of climate change on health. Given the nature of the risks associated with a changing climate. 21]. The methodological framework developed in this study can be expanded in future analyses to include all UN countries (e. The NC5 demonstrates that many adaptation actions are being considered without explicit recognition of their impact on human health. The absence of wider reporting such as this in the NC5 raises concerns about the likelihood of effective action given the speed of climate change. and that the heath sector needs to push further on implementing adaptation. 6 (2011) 044009 A C Lesnikowski et al planning and implementation of adaptation. or piece together an overall picture of the current state of adaptation action. adaptation research. and indigenous groups are well developed within the scientific literature. Evaluations should also examine the relative merits of mainstreaming adaptation compared to implementing new climate change initiatives. children. but the imbalance in reporting between groundwork and adaptation initiatives suggests that health-relevant action is still in its infancy. examination of NAPAs). the failure of countries to report the completion of policy evaluations suggests that health adaptations are still maturing. improving the effectiveness of adaptation initiatives on health. indicating that national leadership from the health sector is not emerging in the 8 . specific climate change interventions are required to prepare and effectively respond to projections of future change [17]. Those adaptations that are occurring are often part of other policy initiatives not specifically targeting climate change. indicate that national leadership on incorporation of vulnerable groups is lagging. which indicate that adaptation rarely occurs in response to climate change alone [20. Analyses of how climate change will impact the health of the elderly. In the future. and policy recommendations are critical first steps of adaptation and reflect the relatively recent recognition of health risks association with climate change. an awareness of the special needs of vulnerable groups in adaptation planning is necessary to ensure that adaptation efforts are effective for all segments of the population. stakeholder involvement. which indicates that a critical step in the adaptation process is missing. and which adaptations are more effectively implemented separately. A strong case for the need to adapt has been established in the scientific literature. limited window of opportunity for action. policymakers need to engage all segments of the government and facilitate broad inter-sectoral cooperation on adaptation issues. and also demonstrates how far countries are progressing in the implementation process. Lett. time lapse between reporting periods means that health adaptation may have evolved since the NC5 was submitted. women. which brings into question the effectiveness of current adaptation efforts. there is a need to move beyond groundwork actions to actual adaptations that build on assessments and prepare communities and regions for a changing climate. More information in national reporting on how climate change considerations are being integrated into existing health institutions and policy guidelines would provide a more comprehensive picture of the status of adaptation. given the risks posed by climate change and climate stationarity often assumed in existing health policy and programming. This systematic approach allows for comparative analyses that can identify leaders and laggards on adaptation. First. as it allows for better assessment and accountability of the effectiveness of adaptation initiatives. Notwithstanding. This is consistent with studies on other sectors. 29].g. Assessments. and time requirements to progress from problem identification to actual intervention [30]. the health implications of adaptation will be more widely understood and appreciated. Second. allowing climate change to be integrated into ongoing policy priorities and focus to be directed to overall health protection [17. In particular. The benefits of such mainstreaming are widely acknowledged. evaluations on the effectiveness of adaptation initiatives need to be conducted more widely in order to improve existing adaptations and to assess the relative advantages of different adaptation approaches. In engaging stakeholders from multiple sectors. In light of the growing focus on adaptation within the response to the health risks of climate change. as well as broader issues of social justice considerations in adaptation policy. It is groups vulnerable to negative health outcomes today who are most likely to be affected by future climate change.

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