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The risks to health posed by climate change are the product of the nature of the climate-related hazard (e.g. extreme heat, drought, floods, etc.), exposure to the hazard, and vulnerability which depends on factors such as social determinants of health.
Some social determinants are modifiable, such as socioeconomic status, access to health services, and housing conditions (e.g. access to safe water and sanitation). So, accelerating and amplifying efforts to address social determinants of health could reduce the negative effects of a changing climate on health.
Therefore, climate adaptation strategies should focus on practical approaches to effectively sequence, layer, and integrate interventions that address the range of context-specific factors contributing to adverse health outcomes. This inclues ‘upstream' drivers, such as climate change and increased exposure to climate-related hazards, as well the underlying structural inequities (e.g. unequal access to infrastructure and services), and the more immediate consequences of increasing stress on scarce natural resources
(e.g. conflict, displacement).
A Systems Approach to Climate and Health
Many determinants of health fall outside of the health sector's responsibilities. For example, activities in the energy, transport, and agriculture sectors contribute to climate change and, at the same time, affect health.
The relationship between climate change and health also can be nonlinear and involve time delays and feedback interactions among the many factors. This complexity can lead to health outcomes which are hard to predict and result in unintended consequences, including disproportionate adverse impacts on underprivileged groups such as children, women, and people living in poverty. As a result, a multi-sectoral systems-based approach is needed to address climate and health.
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A systems approach can help us see the big picture, integrate knowledge from different sectors and disciplines, and understand interconnections so that we can identify root causes rather than symptoms.
Interventions can then be designed to target these causes while minimising the potential for adverse consequences. SC is taking this approach to address climate, health, and equity together in order to achieve the following goals:
• Sustain health
• Target climate drivers and the social determinants of ill health that drive health inequity
• Support multisectoral governance
inclusive of community engagement
A systems approach can help us see the big picture, integrate knowledge from different sectors and disciplines, and understand interconnections so that we can identify root causes rather than symptoms
Community-based engagement is critical to building a shared understanding of the problem in context
• Routine monitoring of health risks over changing environmental conditions
• Forecasting health impacts of climate variability
• Designing evidence-based, costeffective actions Community-based engagement is critical to building a shared understanding of the problem in context so that communities can co-design interventions and co-implement them to achieve the vision they want for their future.
At SC, we are testing a model for active community engagement through developing systems-based mapping tools to visualise how climate, health, and equity are interconnected. The maps we will develop will assist in the identification of cause and effect relationships, feedback loops (which could involve non-health but health-influencing sectors), and intervention points for priority actions.
This will enable communities to target root causes while minimising the potential for adverse consequences for the climate and for health, especially that of underprivileged groups.
In doing so, systems mapping could show the value of an inclusive, participatory process which can strengthen skills and leadership capacity.
SC'S climate and health strategy operationalises a systems-based approach to
climate and health with equity in mind. Our work is organised around overcoming five key barriers to addressing climate, health and equity together:
• To overcome limited awareness that there are common drivers of climate change and of health, we are improving understanding of the multi-sectoral impacts of, and interconnections between, human activities, climate and health as well as the social determinants which contribute to it.
• To overcome inadequate recognition of co-benefits of actions on climate and health, we are fostering community actions to identify, test, and evaluate interventions to help communities prevent or reduce adverse impacts.
• To overcome siloed interventions, we are supporting multisectoral governance through the use of integrated decision support tools which can facilitate information sharing and interaction across relevant ministries and/or sectors.
• To overcome limited participation of communities, including insufficient leadership of young people and women in the design and implementation of actions, we are strengthening their skills and leadership capacity to engage in actions on climate and health.
• To overcome the lack of resources (human and financial) to support climate and health interventions, we are developing multiple-benefits based advocacy to engage public and private sectors to increase finance for climate and health.
Conclusion
Taking these pathways will lead to communities with the capacity to prioritise the climate risks impacting their health; stronger health systems to track, plan for, and respond to climaterelated health risks; the development of national and sub-national plans which reflect an understanding of climate and health relationships; and, the elevation of voices of underprivileged groups in advocacy and policy to drive solutions on the ground.
To overcome inadequate recognition of co-benefits of actions on climate and health, we are fostering community actions to identify, test, and evaluate interventions