Governing the health risks of climate change: towards multi-sector responses
Introduction
The global and shared risks associated with climate change have the potential to affect sustainable development pathways [1]. In addition to the environmental and economic risks that have long received attention, the associated health risks are becoming increasingly apparent and acknowledged. For example, an increase in the frequency and intensity of extreme weather and climate events such as droughts, floods and other extreme weather events is projected to exacerbate adverse health effects [2]. These health risks will be inequitably distributed, with the poorest and already vulnerable communities often facing the greatest burden [3, 4•, 5, 6, 7]. Further most risks arise indirectly, via the risks associated with the impacts of a changing climate in other sectors or with the policy responses to these risks [8••, 9, 10•, 11].
The two sectors with the strongest links to health risks are: first, the agriculture sector, as a result of threats to the yield, quality and affordability of food stock and the resultant impacts on undernutrition [12, 13, 14, 15, 16]; and second, the water sector, due to the risks related to water-borne and food-borne diseases such as diarrhoeal diseases [17, 18, 19]. These health outcomes — undernutrition and diarrhoeal diseases — constitute a substantial portion of the current global burden of disease, particularly in children and women, and are projected to worsen with additional climate change. Effectively preparing for and managing these and other risks requires systems-based approaches that address the multiple drivers of adverse health outcomes. Such approaches have begun to be used more widely in the health sector, although they are still relatively uncommon. Current health protection often focuses on activities undertaken by health systems alone, such as improving disease surveillance and monitoring.
Thus, there is a need to understand (and ultimately improve) partnership arrangements between sectors that have close ties to the health risks of climate change. Understanding the different organisations and networking arrangements can facilitate better governance of the magnitude and pattern of projected health risks. Because climate change and development patterns interact through multiple pathways to determine the risks in a particular location and a particular time, systems-based multi-sectoral coordination and collaboration are needed to effectively and efficiently manage risks [49•]. Partnering mechanisms include sectoral collaboration, policy coordination, and risk management approaches; all can occur at global to local scales.
Institutional challenges associated with partnering include:
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Promoting cross-sectoral and cross-scale networks when different organisations have different mandates and responsibilities. Political leadership is needed to facilitate collaborative networks between organisations, scales and sectors to integrate issues such as gender, sustainable development, and emergency management [20, 21].
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Clarifying appropriate institutional arrangements to bridge gaps among sectoral silos to support coordination and partnership; this issue has been raised in the context of the formulation of the Sustainable Development Goals (SDGs) [22], which has relevance to the health sector. As identified by Bernstein et al. [22], in the Rio + 20 main outcome document for sustainable development — The Future We Want — there are literally hundreds of appeals for integration, implementation and coherence.
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Identifying adequate sources of funding. International adaptation funding is generally within rather than across sectors, and is often structured so that it provides little incentive for individuals and organisations to collaborate [23]. This is compounded by the very low level of adaptation funds directed to the health sector [23], and the relatively low priority the health sector has placed on addressing the risks of climate change (for example via the inclusion of health projects within country-level National Adaptation Programmes of Action) [23].
Preliminary work has been conducted to evaluate cross-sectoral and cross-organisational partnerships in relation to climate change adaptation and health in the Asia Pacific region [24] however further work is needed to better understand these networks, which will ultimately assist advocacy efforts to incorporate health within climate change policies and programs.
Despite the challenges, there are a number of examples of successful health governance approaches outside of climate change that are strengthening partnerships and cross-sectoral engagement. Examples include One Health, Health in All Policies (HiAP), Commission on the Social Determinants of Health (CSDH), and Disaster Risk Management. Examining each is an opportunity to substantially enhance our understanding of governance processes within the health sector, and the sectors with links to health (see Table 1).
Section snippets
Creating collaborative networks: One Health
The strengthening of networks required for effective action on climate change involves knowledge transfer and complex negotiations among scientists, researchers, practitioners, policy makers, private actors and community members [25]. In addition, the involvement of many types of organisations may be vital for success. This is because differences in competencies and interests support the development of more insightful and nuanced understandings and solutions [26], and extend the benefits of
Demonstrating leadership: ‘HiAP’
The leadership ability required for ‘health diplomacy’ — that is, articulating the benefits for health in all relevant sectors — is now seen as important for all levels of governance [32]. In addition, the need to improve leadership, particularly within the health sector, is a strategic policy objective of the World Health Organization (WHO) [33].
The ‘HiAP’ approach (2006) adds a specific health focus to the concept of ‘Intersectoral Action’ (IA), which has been used to describe strategies that
Integrating across organisations, scales and sectors: Disaster Risk Management
For an issue such as climate change which has society-wide drivers and implications, there is a need to negotiate and integrate with a diverse range of actors (across organisations, scales and sectors) in order to achieve policy outcomes [36]. A variety of sectors across different scales, including land-use planning, building and housing, water infrastructure and transport infrastructure are identified as important to take climate change into account in developing climate change responses,
Coordinating government policies: Commission on Social Determinants of Health
There is increasing attention on the importance of coordinating policies where relevant (both the development and delivery) across government and other types of organisations (e.g. [40, 41, 42]). The CSDH is one mechanism that has garnered support in its efforts to pursue this, through the lens of health equity.
The social determinants of health are defined as: ‘the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power
Conclusion
The innate cross-sectoral nature of the risks of and responses to climate change requires systems-based approaches that include partnerships, coordination, collaboration and leadership between and within different sectors and types of organisations. The case studies presented showed the ways in which these approaches are being implemented. Supporting these types of measures will improve designing and implementing effective options to manage the multiple health risks arising from such change.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
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