clinicaltrials.gov Identifier: NCT00197587.

ABSTRACT. The need to track climate change adaptation progress is being increasingly recognized but our ability to do the tracking is constrained by the complex nature of adaptation and the absence of measurable outcomes or indicators by which to judge if and how adaptation is occurring. We developed a typology of approaches by which climate change adaptation can be tracked globally at a national level. On the one hand, outcome-based approaches directly measure adaptation progress and effectiveness with reference to avoided climate change impacts. However, given that full exposure to climate change impacts will not happen for decades, alternative approaches focus on developing indicators or proxies by which adaptation can be monitored. These include systematic measures of adaptation readiness, processes undertaken to advance adaptation, policies and programs implemented to adapt, and measures of the impacts of these policies and programs on changing vulnerability. While these approaches employ various methods and data sources, and identify different components of adaptation progress to track at the national level, they all seek to characterize the current status of adaptation by which progress over time can be monitored. However, there are significant challenges to operationalizing these approaches, including an absence of systematically collected data on adaptation actions and outcomes, underlying difficulties of defining what constitutes "adaptation", and a disconnect between the timescale over which adaptation plays out and the practical need for evaluation to inform policy. Given the development of new adaptation funding streams, it is imperative that tools for monitoring progress are developed and validated for identifying trends and gaps in adaptation response.

Adapting to the health effects of climate change is one of the key challenges facing public health this century. Our knowledge of progress on adaptation, however, remains in its infancy.Using the Fifth National Communications of Annex I parties to the UNFCCC, 1912 initiatives are systematically identified and analyzed. 80% of the actions identified consist of groundwork (i.e. preparatory) action, with only 20% constituting tangible adaptations. No health vulnerability was recognized by all 38 Annex I countries. Furthermore, while all initiatives affect at least one health vulnerability, only 15% had an explicit human health component. Consideration for the special needs of vulnerable groups is uneven and underdeveloped. Climate change is directly motivating 71% of groundwork actions, and 61% of adaptation initiatives are being mainstreamed into existing institutions or programs. We conclude that the adaptation responses to the health risks of climate change remain piecemeal. 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, particularly within those groups already considered most vulnerable to poor health outcomes.

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Historically, reforms that have increased the duration of job‐protected paid parental leave have improved women's economic outcomes. By targeting the period around childbirth, access to paid parental leave also appears to reduce rates of infant mortality, with breastfeeding representing one potential mechanism. The provision of more generous paid leave entitlements in countries that offer unpaid or short durations of paid leave could help families strike a balance between the competing demands of earning income and attending to personal and family well‐being. Context Policies legislating paid leave from work for new parents, and to attend to individual and family illness, are common across Organisation for Economic Co‐operation and Development (OECD) countries. However, there exists no comprehensive review of their potential impacts on economic, social, and health outcomes. Methods We conducted a systematic review of the peer‐reviewed literature on paid leave and socioeconomic and health outcomes. We reviewed 5,538 abstracts and selected 85 published papers on the impact of parental leave policies, 22 papers on the impact of medical leave policies, and 2 papers that evaluated both types of policies. We synthesized the main findings through a narrative description; a meta‐analysis was precluded by heterogeneity in policy attributes, policy changes, outcomes, and study designs. Findings We were able to draw several conclusions about the impact of parental leave policies. First, extensions in the duration of paid parental leave to between 6 and 12 months were accompanied by attendant increases in leave‐taking and longer durations of leave. Second, there was little evidence that extending the duration of paid leave had negative employment or economic consequences. Third, unpaid leave does not appear to confer the same benefits as paid leave. Fourth, from a population health perspective, increases in paid parental leave were consistently associated with better infant and child health, particularly in terms of lower mortality rates. Fifth, paid paternal leave policies of adequate length and generosity have induced fathers to take additional time off from work following the birth of a child. How medical leave policies for personal or family illness influence health has not been widely studied. Conclusions There is substantial quasi‐experimental evidence to support expansions in the duration of job‐protected paid parental leave as an instrument for supporting women's labor force participation, safeguarding women's incomes and earnings, and improving child survival. This has implications, in particular, for countries that offer shorter durations of job‐protected paid leave or lack a national paid leave entitlement altogether.