A systematic global stocktake of evidence on human adaptation to climate changeAssessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses.

Extreme heat events impact people and ecosystems across the globe, and they are becoming more frequent and intense in a warming climate. Responses to heat span sectors and geographic boundaries. Prior research has documented technologies or options that can be deployed to manage extreme heat and examples of how individuals, communities, governments, and other stakeholder groups are adapting to heat. However, a comprehensive understanding of the current state of implemented heat adaptations—where, why, how, and to what extent they are occurring—has not been established. Here, we combine data from the Global Adaptation Mapping Initiative with a heat-specific systematic review to analyze the global extent and diversity of documented heat adaptation actions (n = 301 peer-reviewed articles). Data from 98 countries suggest that documented heat adaptations fundamentally differ by geographic region and national income. In high-income, developed countries, heat is overwhelmingly treated as a health issue, particularly in urban areas. However, in low and middle income, developing countries, heat adaptations focus on agricultural and livelihood-based impacts, primarily considering heat as a compound hazard with drought and other hydrological hazards. 63% of the heat-adaptation articles feature individuals or communities autonomously adapting, highlighting how responses to date have largely consisted of coping strategies. The current global status of responses to intensifying extreme heat, largely autonomous and incremental yet widespread, establishes a foundation for informed decision making as heat impacts around the world continue to increase.

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the ‘Global Adaptation Mapping Initiative’ database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

We present the first systematic, global stocktake of the academic literature on human adaptation. We screen 48,316 documents and identify 1,682 articles that present empirical research documenting human efforts to reduce risk from climate change and associated hazards. Coding and synthesizing this literature highlights that the overall extent of adaptation across global regions and sectors is low. Adaptations are largely local and incremental rather than transformative. Behavioural adjustments by individuals and households are more prevalent than any other type of response, largely motivated by drought and precipitation variability. Local governments and civil society are engaging in risk reduction across all sectors and regions, particularly in response to flooding. Urban technological and infrastructural adaptations to flood risk are prevalent in Europe, while shifts in farming practices dominate reporting from Africa and Asia. Despite increasing evidence of adaptation responses, evidence that these responses are reducing risks (observed and projected) remains limited.

People affected by conflict are particularly vulnerable to climate shocks and climate change, yet little is known about climate change adaptation in fragile contexts. While climate events are one of the many contributing drivers of conflict, feedback from conflict increases vulnerability, thereby creating conditions for a vicious cycle of conflict. In this study, we carry out a systematic review of peer-reviewed literature, taking from the Global Adaptation Mapping Initiative (GAMI) dataset to documenting climate change adaptation occurring in 15 conflict-affected countries and compare the findings with records of climate adaptation finance flows and climate-related disasters in each country. Academic literature is sparse for most conflict-affected countries, and available studies tend to have a narrow focus, particularly on agriculture-related adaptation in rural contexts and adaptation by low-income actors. In contrast, multilateral and bilateral funding for climate change adaptation addresses a greater diversity of adaptation needs, including water systems, humanitarian programming, and urban areas. Even among the conflict-affected countries selected, we find disparity, with several countries being the focus of substantial research and funding, and others seeing little to none. Results indicate that people in conflict-affected contexts are adapting to climate change, but there is a pressing need for diverse scholarship across various sectors that documents a broader range of adaptation types and their results.

Objective: To develop an online food composition database of locally consumed foods among an Indigenous population in south-western Uganda. Design: Using a community-based approach and collaboration with local nutritionists, we collected a list of foods for inclusion in the database through focus group discussions, an individual dietary survey and markets and shops assessment. The food database was then created using seven steps: identification of foods for inclusion in the database; initial data cleaning and removal of duplicate items; linkage of foods to existing generic food composition tables; mapping and calculation of the nutrient content of recipes and foods; allocating portion sizes and accompanying foods; quality checks with local and international nutritionists; translation into relevant local languages. Setting: Kanungu District, south-western Uganda. Participants: 74 participants, 36 Indigenous Batwa and 38 Bakiga, were randomly selected and interviewed to inform the development of a food list prior the construction of the food database. Results: We developed an online food database for south-western Uganda including 148 commonly consumed foods complete with values for 120 micronutrients and macronutrients. This was for use with the online dietary assessment tool myfood24. Of the locally reported foods included, 56% (n=82 items) of the items were already available in the myfood24 database, while 25% (n= 37 items) were found in existing Ugandan and Tanzanian food databases, 18% (n= 27 items) came from generated recipes, and 1% (n=2 items) from food packaging labels. Conclusion: Locally relevant food databases are sparse for African Indigenous communities. Here we created a tool that can be used for assessing food intake and for tracking under-nutrition among the communities living in Kanungu District. This will help to develop locally relevant food and nutrition policies.

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Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.