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

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

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

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

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

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

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

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

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