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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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with only 20% constituting tangible adaptations.00 1 © 2011 IOP Publishing Ltd Printed in the UK . significantly surpassing the 2 ◦ C threshold believed to be indicative of ‘dangerous interference with the climate system’ [2]. H3A 1A3. Consideration for the special needs of vulnerable groups is uneven and underdeveloped. Montreal. 4]. 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]. during which over 70 000 heat related mortalities were recorded. Canada 2 Institute for Health and Social Policy. requiring changes in the way we implement health policy [10]. and 61% of adaptation initiatives are being mainstreamed into existing institutions or programs. with implications for natural ecosystems and human communities [1].e. Our knowledge of progress on adaptation. No health vulnerability was recognized by all 38 Annex I countries. Lett. particularly within those groups already considered most vulnerable to poor health outcomes. while all initiatives affect at least one health vulnerability. 80% of the actions identified consist of groundwork (i. Canada E-mail: alexandra. Extreme temperatures [5]. remains in its infancy. 1912 initiatives are systematically identified and analyzed. In 2009. extreme weather events [8]. M Barrera2 and S J Heymann2 1 Department of Geography.8 ◦ C and 4 ◦ C this century.1088/1748-9326/6/4/044009 Adapting to health impacts of climate change: a study of UNFCCC Annex I parties A C Lesnikowski1. Res. Using the Fifth National Communications of Annex I parties to the UNFCCC. J D Ford1. however. and food and water safety and security [9] will pose greater challenges to human health throughout the next century. Introduction It is widely accepted that the climate is changing. only 15% had an explicit human health component.mcgill. Recent simulations suggest that future warming will likely be toward the higher end of the IPCC projections. preparatory) action. WHO estimates placed excess annual mortality as a result of climatic change at 141 000 by 2004 [11]. further 1. 6 (2011) 044009 (9pp) doi:10. Best estimates from the International Panel on Climate Change (IPCC) indicate a rise in average global temperatures between 1. L Berrang-Ford1. Climate change is directly motivating 71% of groundwork actions. McGill University.iop. Adaptation will therefore be a critical component of the global response to our changing climate in addition to pressing needs for mitigation [1. QC. 85% of which were child Received 18 July 2011 Accepted for publication 10 October 2011 Published 31 October 2011 Online at stacks. McGill University. infectious disease [7]. Keywords: climate change.iop. Montreal. 3. adaptation. J A Paterson1 . 805 Sherbrooke Street West. UNFCCC S Online supplementary data available from stacks. We conclude that the adaptation responses to the health risks of climate change remain piecemeal. 1130 Pine Avenue West. QC. health. H3A 2K6. 1748-9326/11/044009+09$33.IOP PUBLISHING ENVIRONMENTAL RESEARCH LETTERS Environ. air quality [6].org/ERL/6/044009 Abstract Adapting to the health effects of climate change is one of the key challenges facing public health this century.lesnikowski@mail. Events such as the 2003 European heat wave. 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.

evaluating current policies. but do not capture a wide enough range of countries to provide a sufficient sample size. 19] 6/044009/mmedia). Russian. 2.7 billion people. Results demonstrate that the content of the communications draws heavily on actions occurring either exclusively through or in cooperation with national governments. and provide insights into how sub-national adaptation is emerging in different national contexts. WHO Director-General Margaret Chan identified climate change as ‘one of the greatest challenges of our time’. 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. Arabic. Specifically. Australia and Canada. These analyses demonstrate an urgent need to implement responses that reach all segments of society. which was submitted by Annex I parties during 2009 and 2010. Res. We cannot assume that the initiatives discussed in the NCs constitute the totality of adaptation efforts among developed countries. with a key objective the strengthening of health systems to cope with the threats posed.iop. these reports are national-level documents. Other groups with heightened vulnerability to climate change include women [13]. NC reports contain information on national greenhouse gas (GHG) emissions. indigenous groups [14]. we only have limited information on current efforts being undertaken to react to and prepare for health impacts of climate change [20. such as the Organization for Economic Cooperation and Development (OECD) or EU. while adaptations occurring within regional and local jurisdictions are not as widely reflected in these documents. French. and urged governments to put health at the center of climate policy [18].1. including assessing adaptation needs. national governments submit these reports as documentation of policy priorities and progress. information provided in the NC5 may already be dated given the time gap between document preparation and release by the UNFCCC. Using data from the UNFCCC provided an adequate sample size and consistent information guidelines. they do demonstrate priorities and trends in national leadership. include 41 developed and transition economies committed to reducing emissions levels primarily below 1990 levels. Methods 2. The most recent report is the NC5. individuals with preexisting or chronic conditions [15] and individuals living in poverty [16]. and prioritizing areas for further support [3]. and hence whether the policy response to date is adequate. 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]. appendix B available at stacks. 21]. Lett. Spanish. national-level adaptations to the health impacts of climate change among Annex I parties to the United Nations Framework Convention on Climate Change (UNFCCC). provide detailed information on climate change policy. Other international organizations. and climate-relevant policies and programs. 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. GHG projections. appendix B available at stacks. Second. however. This is a significant gap constraining our understanding of if and how adaptation is taking place. The NCs were considered the most appropriate data source for two reasons. 6 (2011) 044009 A C Lesnikowski et al vulnerability and adaptation. Furthermore. Data source The Fifth National Communication (NC5) of Annex I parties to the UNFCCC Secretariat was selected as the data source for this analysis. Monaco and Turkey) had not submitted the NC5 by September 2010 and were excluded. including the Russian Federation). 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. First. Chinese). This letter aims to address this gap by assessing the status of planned. Countries party to the Annex I sub-group. In doing so it develops a systematic methodology to track and characterize adaptation focusing specifically on human health. with only a general level of detail provided as per NC guidelines (supplementary information. English-speaking countries like the United Kingdom. First. but we can interpret these results as proxies for assessing the depth of health adaptation. There are also several limitations in using the NC5. Thirty-eight Annex I countries were selected for inclusion in this analysis (supplementary information. For this reason national government websites and information materials were eliminated as a potential data source. Despite the risks and importance of adaptation however. 17].Environ. Annex I nations have a combined population of approximately 1. Adapting to changes in climate will be one of the main challenges facing public health this century [1]. Pressure within the health sector for greater prioritization of adaptation has been growing throughout the last decade [ or 25% of the global population. 2 . In 2008 the World Health Assembly passed a resolution requiring the WHO to create a workplan for addressing climate change [4. Variations in level of information and language accessibility would have over-represented large. Three countries (Malta. While these documents offer only a summary of adaptation initiatives being pursued and not a complete inventory of action. 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. appendix A available at 044009/mmedia).

however. 80% were groundwork actions (1534). The following variables were collected for each unique reference or initiative: level of action. 11 countries provided descriptions of public awareness and outreach programs addressing extreme heat risks. and role of climate change as a driver (primary or mainstreamed). water). government jurisdiction. Adaptations were categorized as follows: Statements of recognition constitute the most basic demonstration that countries can identify experienced or anticipated impacts of climate change. Reporting on adaptation actions was considerably weaker than on groundwork actions (tables 1–3). initiatives addressing these vulnerabilities were included whether they occurred in the health sector or in non-health sectors (e.2. 27 countries reported research on adaptation options in addition to risk assessments. Iceland. unless a distinction is noted. infrastructure development and technology. We define and categorize health vulnerabilities to climate change as per the IPCC Fourth Assessment Report [22]. such as Plan Canicule in France or the Heat Health Watch Warning System 3 . Examples of adaptation actions include legislation. but do not explicitly indicate tangible changes in policy or delivery of government services that improve 3. Groundwork actions are considered first steps necessary to inform and prepare for adaptation. Results are presented using individual observations.1. Countries with the lowest number of initiatives (fewer than 25) included Croatia. air quality. public awareness and outreach. 3.iop. These vulnerabilities include extreme temperatures. The results presented in this paper consider explicit and implicit health adaptation together. evidence of explicit linkage to health. Any reference or initiative responding to the health vulnerabilities of climate change was considered eligible for inclusion as an observation in the database. storms. spatial planning. Many of these vulnerabilities also have implications for sectors beyond public health. as well as aggregated data at the country level. or general). and Slovenia. the delivery of government services. stakeholder and networking opportunities. Results primarily present country counts. Rather than exclude relevant adaptations in non-health sectors. Finland. Data analysis A codebook was designed to quantitatively and systematically extract data related to health adaptation references or initiatives in the NC5 (supplementary materials. floods. adaptation. and Canada—included over 100 actions. extreme weather events (e. StataCorp). evidence of improved health outcomes (for adaptation actions only). indicating the frequency with which specified initiatives are documented among Annex I nations in their NC5. All NC5s were reviewed and double coded to ensure consistency in information selection and classification.g. Liechtenstein. water safety and security. Detailed variable and coding definitions are provided in the codebook.9.g. Res. status of action. Data were analyzed using unique statements or initiatives as observations. 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. Results Of 1912 health-relevant groundwork and adaptation actions in the Fifth National Communications. appendix C available at stacks. Adaptations may therefore occur in non-health sectors that have implications for human health. or regulations in response to predicted or experienced impacts of climate change. Lett. These types of action consist of impact and vulnerability assessments. Descriptive analyses were conducted in Stata (Intercooled Stata v. conceptual tools. nongovernment participation. agriculture. and recommendations for adaptation action. land shifts. target population (urban. financial support for autonomous adaptation. multiple observations were included if actions addressed more than one type of action or health vulnerability. health vulnerability targeted. These statements give no indication that any action has been taken to better understand or adapt to vulnerability.Environ. in cases where the distribution of particular actions is relevant. Actions with a deliberate health component were distinguished as having ‘explicit’ recognition of a human health dimension. available in the supplemental materials (available at stacks. while all other actions were considered to have an ‘implicit’ health dimension. organizational mandates. The countries reporting the highest number of initiatives—the United Kingdom.iop. Adaptation remains primarily in the groundwork stage All 38 Annex I parties reported climate change impact assessments at some stage of surveillance and monitoring. and medical interventions (e. research on adaptation options. rather than an exhaustive description of adaptations occurring at every governance level. type of action. regardless of whether a health component is explicitly identified. or revising emergency room standards to accommodate greater influxes of patients following extreme events).g. Luxembourg. developing and distributing treatments for climate related illness. Australia.5% of adaptation actions documented an assessment or research initiative as the driver of the action. evaluations of program effectiveness. Only 3. Fewer than half of the 38 Annex I countries were found to be responding to any one health vulnerability with adaptation-level action. rural. org/ERL/6/044009/mmedia). food safety and security. Despite emphasis on assessments and research in the NC5. sectoral involvement. and vector and rodent-borne disease. linkages between research and policy outputs are not clearly defined in country reporting. or droughts). assessing national leadership on health adaptation is critical in analyzing efforts to adapt. 6 (2011) 044009 A C Lesnikowski et al resilience. with only 378 constituting adaptation interventions. acknowledgment of vulnerable groups. departmental development. Given the essential role national governments play in determining policy priorities and distributing resources and support. 2.2. Adaptation actions are understood as changes made to built environments. such as the frequency of adaptation response types.

discussing plans for improving health care standards to accommodate climate change risks. 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. Czech Republic).g. food.3. 17 countries have pursued adaptation on the issues of flooding and water safety and security. with only one Despite all 1912 actions recorded in the database affecting health in some capacity. flooding and extreme heat than any other vulnerability. while 14 have taken actions addressing food safety and security. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category.2. Integrated Coastal Safety Plan. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category.g. constructing protective barriers along waterfronts to reduce flooding from storm surges and rising sea levels (e. Public awareness and outreach and evaluations had the strongest Table 2. Lett. with 34 countries making statements recognizing increased risk in a changing climate. This trend was mirrored in reporting on adaptation actions (table 3).) 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. 3. 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.g. Only 15% of the total number of actions explicitly linked impacts from climate change with the human health dimension of vulnerability. 6 (2011) 044009 A C Lesnikowski et al country. with more countries reporting adaptation action on water. Table 1. 11 countries discussed changes in legislation that integrated climate change into regulations on water safety and security. while extreme heat was recognized by 25 countries. and improving drainage and irrigation systems (e. Descriptions of developments in infrastructure and technology include expanding city sewage systems to accommodate higher volumes of water (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. No health vulnerability was recognized by all 38 Annex I countries. Belgium). rarely recognized the impact of the action on health. Japan). with fewer than 1% of the total number of actions making an explicit link. Only 13 countries reported adaptations concerning extreme heat. Lithuania. Major health vulnerabilities are not addressed by all countries Flooding was the most widely recognized vulnerability. Estonia).Environ. and Lithuania. The least widely recognized health vulnerability was extreme cold—recognized by only Greece. Res. respectively. 4 . Status of response to health risks of climate change. Groundwork responses to health vulnerabilities of climate change. in particular. Food safety and security and general extreme weather events were recognized by 30 countries and 26 countries. Discussions about increases in medical preparedness were notably absent.g. few demonstrate an explicit recognition of a causal association with human health (table 4). Tallinn. developing alternative seed varieties (e. Canada.

(Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category. 17 in connection with extreme heat. 17 countries demonstrated an awareness of particular vulnerability among individuals with chronic or pre-existing conditions across a range of health risks.5. Only five countries discussed special accommodations for the elderly in public awareness and outreach programs. New Zealand. respectively. Reporting on groups is inconsistent across vulnerabilities and populations Reporting on vulnerable groups focused most frequently on the elderly. The majority of groundwork actions extracted from the NC5 were initiated in direct response to climate change (71%. Notably. 6 (2011) 044009 A C Lesnikowski et al Table 3. 3. 19 countries identified the elderly at least once in their NC5. the United States and Australia.Environ. Here we develop a methodology to systematically assess health adaptation at a national level that allows us to document interventions.e. Adaptation responses to health impacts of climate change. Finally. Concern for vulnerable populations was most frequently tied to extreme heat and air quality. In contrast. and prioritize areas where further support is required—key objectives of the WHO’s climate change workplan. and 88% of legislative responses to climate change were the mainstreaming of climate change issues into existing laws and regulations. individuals with chronic or pre-existing conditions. non-health specific) issue is analyzed as a motivator for adaptation. Discussion Scholarship tracking and characterizing climate change adaptation actions is in its infancy. related to vulnerable groups was predominantly restricted to public awareness and outreach activities. 11 countries recognized risks to children from health vulnerabilities. Res. table 4). disabled individuals. 71% of infrastructure development and technology initiatives consisted of integrating a climate change lens into existing procedures. most frequently from extreme heat. only 39% of adaptation actions were new initiatives being implemented in direct response to climate change risks. The methodology allows for broad comparison among Annex I nations of the state of adaptation both directly 5 . and children. or people living in poverty. 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. assess adaptation needs. 3. There was limited discussion of other vulnerable groups such as women. this recognition was concentrated in extreme heat and declining air quality. evaluate current policies. Recognition of the vulnerability of Indigenous groups was broader across health vulnerabilities. particularly in the health sector. with limited reference to other vulnerable groups (table 5). Lett. with 30% and 36% of actions recognizing a link with human health. Mainstreaming is prevalent among adaptation actions When climate change as a general (i. Reporting on adaptation actions 4.) 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. Explanations about how the special needs of vulnerable groups are incorporated into adaptation actions were negligible. but restricted to Canada. we see that most adaptation initiatives result from mainstreaming a climate change focus into existing frameworks. 85% of Departmental Developments occurred primarily in response to climate change. Conversely.4. despite well recognized vulnerabilities of this group during extreme weather events. recognition of health linkages.

Res. the NCs—as official reports submitted by national governments to the UNFCCC— are particularly relevant. Herein. we can question whether an absence of national leadership on prioritizing these groups is allowing sufficient adaptation to occur. Lett. are rarely considered in the NCs. providing an ‘availability heuristic’ [27] that the climate is changing and adaptation is needed. 16.Environ. The elderly. 6 (2011) 044009 A C Lesnikowski et al Table 4. but are still reported on by fewer than half of Annex I countries. and in other sectors that have an impact on population health. Across health vulnerabilities. There is need for further examination of how research is influencing or linking to the policy process. ‘creeping hazards’ like climate change. Switzerland. This is particularly important for slowonset. United Kingdom and Spain—highlighted the increased awareness of 6 . Netherlands. within the health sector. countries reported far more impact and vulnerability assessments than adaptation actions. more and/or improved research does not necessarily translate into policy intervention [23–25]. while widely discussed in the literature on climate change vulnerability [13. This is consistent with the experience of adaptation outside the health sector [20. countries especially effected by the 2003 European heat wave—France. children. While we cannot infer that vulnerable groups are not being integrated into adaptation. National responses to climate change both at the groundwork and adaptation levels focus on select health vulnerabilities. policymakers may pay special attention to adverse impacts on sectors considered vital to the economy or politically sensitive. 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. Women and people living in poverty. Furthermore. Over one quarter of the sample (11 countries) failed to report on a single vulnerable group. the link between research and adaptation outputs is vague.) 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. For instance. Extreme events of this nature increase the saliency of climatic risks to the public and policy makers. we hypothesize that recent experiences with extreme events are reinforcing perceptions that certain vulnerabilities are more critical than others [21]. summarizing in a standardized format issues significant to governments. and demonstrating actions and policies that are considered representative of approaches to adaptation. These results raise questions about how much priority is being given to vulnerable groups in adaptation planning and implementation. and cited the experience as a direct motivator for action. 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. Italy. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category. Drivers of groundwork and adaptation action on climate change. and individuals with pre-existing or chronic diseases are the most frequently discussed vulnerable groups. 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). 28]. 21]. Irrespective of the reason for these differences. this analysis highlights clear gaps in national response. Integration of vulnerable groups into adaptation initiatives remains underdeveloped and uneven across Annex I parties. Only 13 adaptations explicitly cited an assessment as motivation for acting. Herein. In spite of the focus on describing national assessments of vulnerability and adaptive capacity. and challenge the assumption that human systems are insulated from nature [26]. as scholarship in related field indicates.

6 (2011) 044009 Table 5. Recognition of increased health risks to vulnerable groups. A C Lesnikowski et al . Res. Lett. (Note: values indicate numbers of UNFCCC Annex I countries with actions reported in the given category.Environ.) 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.

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

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