Background: climate change has been described as the greatest health threat of the 21st century. The health impacts of climate change include direct impacts, impacts mediated through ecosystems, and impacts heavily mediated through human institutions. Although it is crucial to mitigate the effects of climate change by reducing CO2 emissions, adaptation (the process of adjustment to actual or expected climate and its effects) is also essential for protecting populations. Adaptation interventions (e.g. planning for heat adaptation, managing vector-borne diseases, or developing green infrastructure) may often have health co-benefits. We sought to understand the effectiveness of adaptation interventions in addressing health issues by conducting a scoping review; in this process, we encountered a number of methodological challenges.
Objective: to outline the methodological challenges in conducting a scoping review evaluating effectiveness of climate change adaptation measures in creating health benefits. The primary research question is, 'Globally, what adaptation measures have been effective in reducing the negative impacts of climate change on human health?'
Methods: while developing our scoping review protocol, challenges arose, which we analyzed and reported using a thematic analysis. We addressed these challenges through consultation with subject-matter experts and methods specialists.
Results: the themes included:
- operationalizing a workable definition of adaptation;
- questions about appropriate measures for assessing effectiveness;
- the complexity and unpredictability of climate change, which means that much adaptation work is based on predictions and uncertainty, so evaluation can be complex;
- common environmental health research issues such as confounding and difficulties in finding counter-factuals or controls;
- simultaneous implementation of multiple interventions;
- challenges in attributing health outcomes to adaptation interventions; and,
- limited assessment of health co-benefits (as much adaptation planning is not done from a health perspective).
During this presentation we will discuss these challenges and how we addressed them in the protocol.
Conclusions: the impacts of climate change will be more deeply felt around the world in the coming decades so it is essential to identify the most effective measures for protecting human health. This topic is highly complex due to the varied sources of impact, the diverse types of health impacts, and the widespread populations and geographic areas affected; hence, adaptation interventions will necessarily be numerous, complex and multi-faceted and will need to draw on multiple disciplines. This complexity also impacts the approach to knowledge synthesis, which will be essential to ensure that decisions around the globe are founded on best evidence, and local experiences are shared and scaled as appropriate.
Patient/consumer involvement: none