Urban climate-health governance: Charting the role of public health in large global city adaptation plans

Abstract

Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness and response; (iii) extreme heat plans (including heat early warning); (iv) non-heat early warning (e.g., flooding, vector-borne disease); and (v) climate-health monitoring and outcome surveillance. We found most (90%) city adaptation plans reported actions in at least three of these five activity areas. However, only 73% of these health-focused plans reported involvement of a public health agency (though the share was higher for cities in low- and middle-income countries). We detected differences across the five activities, including an ascending pattern of public health engagement starting with heat plans and including activities such as preparedness and mapping as health agency involvement increased. We also identified substantial presence of other city agencies–notably urban planning, emergency management and public utilities–in implementing these health-associated activities. With every world region likely to experience more widespread and intensifying climate impacts, and growing pressure on local public health agencies in conjunction with the Covid-19 pandemic, we identify opportunities for enhancing public health engagement in climate adaptation in large cities with a view to scaling up their ability to contribute to climate adaptation goals.

Public Health Aspects of Climate Change Adaptation in Three Cities: A Qualitative Study

“…The lack of inclusion of public health aspects in urban settings has been reported elsewhere [ 93 , 94 , 95 ]. For instance, a recent comparative review, which aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, examined five health-associated adaptation activities as “promising practices” based on evidence synthesized from evaluation research and practical experience [ 95 ].…”

“…The lack of inclusion of public health aspects in urban settings has been reported elsewhere [ 93 , 94 , 95 ]. For instance, a recent comparative review, which aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, examined five health-associated adaptation activities as “promising practices” based on evidence synthesized from evaluation research and practical experience [ 95 ]. The five areas included: hazard and vulnerability mapping; extreme weather preparedness and response; extreme heat plans (including heat early warning); non-heat early warning (e.g., flooding or vector-borne diseases); and climate–health monitoring and outcome surveillance.…”

“…The five areas included: hazard and vulnerability mapping; extreme weather preparedness and response; extreme heat plans (including heat early warning); non-heat early warning (e.g., flooding or vector-borne diseases); and climate–health monitoring and outcome surveillance. Results of that study showed that 90% of the cities’ adaptation plans reported actions in at least three of the five activity areas but that only 73% of the health-focused plans reported involvement of a public health agency (although the share was higher for cities in low- and middle-income countries) [ 95 ]. Furthermore, a study that assessed the state of health adaptation in 401 urban areas globally found that only 10% of the sample reported any public-related initiatives, and these initiatives entailed addressing risks posed by weather events and aspects related to changes in management or behavior rather than capacity building, research, or long-term investments in infrastructure [ 93 ].…”

Urban agrobiodiversity, health and city climate adaptation plans

“…Research suggests that when the public health sector is involved, climate adaptation outcomes may be better targeted towards those in greatest need. 45 , 46 Viewing agrobiodiversity through the lens of health can increase knowledge and awareness in the population and provide compelling reasons for behaviour change. Including health-linked urban agrobiodiversity indicators within climate adaptation plans may be especially relevant.…”

The Role of Non-climate Data in Effective Climate Adaptation Planning: Lessons From Small French and American Cities

“…Insufficient attention to public health in municipal climate adaptation planning has been reported in other studies. For example, the recent analysis of climate adaptation plans of 22 large cities in 14 countries, including 16 in high-income countries by[130] indicated that even "highly health-adaptive large cities report fairly modest public health engagement in climate adaptation plans, and very few seem to have integrated a health perspective across thematic or sectoral climate adaptation priorities" (p.14).…”