Preparing health systems to protect public health from climate change in low-and middle-income countries

Statement of Problem: Climate change is predicted to severely impact population health in many countries over the coming decades. What do initial experiences in climate adaptation for health protection in low- and middle-income countries reveal about the approaches needed to support health systems become resilient to climate change?;Specific Aims: 1. Develop conceptual tools that distinguish adaptive interventions and indicate how to reduce vulnerabilities and address climate-related health risks over time. 2. Identify barriers and enabling factors to the implementation of new climate adaptation programs and policies in the health sector of low- and middle-income countries. 3. Identify opportunities to enhance community-based adaptation for health protection from climate change. 4. Explore the concept of "climate resilient health systems" and inform global-level discussions on policy directions with national-level realities.;Methods: Participant observation in focus groups and case studies provided primary data for qualitative analysis of selected global and national climate change adaptation policy processes and programs. Analyses of fieldwork and existing frameworks were used to propose decision support tools and an adapted conceptual framework for public health adaptation to climate change (PHACC). Review of the first WHO/UNDP/GEF global pilot project for human health climate adaptation in seven countries identified common challenges and enabling factors nationally. A structured dialogue with experts and health practitioners from six countries identified opportunities to scale-up community-level adaptation actions for health. Finally, new definitions for climate resilient health systems were considered in relation to challenges reported by efforts in health adaptation and global health system strengthening.;Results and Conclusions: Functioning and robust health systems are critical for effective and strategic climate adaptation. Actions to adapt health systems must be informed by climate science, health surveillance, and local capacity realities. Leadership, multi-sectoral coordination, and core health system capacities are fundamental for national health agencies and communities to recognize, monitor, and prepare for changing risks. To help these efforts, this research reveals national realities in adaptation and proposes programmatic decision-tools to identify additional health interventions needed to adequately adapt to climate change. Conclusions propose policy approaches to further integrate climate perspectives into ongoing efforts to strengthen health systems in the most vulnerable contexts.