Climate change adaptation: no one size fits all
Authors: Alana Hansen, Peng Bi
Journal: The Lancet Planetary Health (2017)

Increased global temperatures as a result of climate change can have a number of effects on human health, and it is important to know how these will vary across the globe. In The Lancet Planetary Health, Antonio Gasparrini and colleagues1Gasparrini A Guo Y Sera F et al.Projections of temperature-related excess mortality under climate change scenarios.Lancet Planet Health. 2017; 1: e360-e437Summary Full Text Full Text PDF PubMed Scopus (354) Google Scholar comprehensively calculate projections of temperature-related mortality under varying climate change scenarios across 451 locations in 23 countries. Their findings suggest that by the end of the century, under defined scenarios, a net increase will occur in temperature-related excess mortality in the absence of efforts to limit global warming. A key message from this work is that high-emission climate change scenarios could have varying impacts in different regions of the world. Increases in heat-related mortality will be greatest under high-emission scenarios in the warmer and poorer regions, including central and southern America and southeast Asia. With the burden highly dependent on greenhouse gas emissions, the authors argue the importance of mitigation policies to limit emissions and reduce net temperature-related excess mortality.1Gasparrini A Guo Y Sera F et al.Projections of temperature-related excess mortality under climate change scenarios.Lancet Planet Health. 2017; 1: e360-e437Summary Full Text Full Text PDF PubMed Scopus (354) Google Scholar Although mitigation will reduce the emissions, policies are highly reliant on current political environments and economic barriers to social acceptance, and, to date, the slow pace of global action has failed to impede the observed warming trend. Adaptation was not accounted for in the study, yet projected heat-related impacts would be expected to be lower if humans, like many other species, adapt to changing environmental conditions. Indeed, in warmer regions of the world identified in this study,1Gasparrini A Guo Y Sera F et al.Projections of temperature-related excess mortality under climate change scenarios.Lancet Planet Health. 2017; 1: e360-e437Summary Full Text Full Text PDF PubMed Scopus (354) Google Scholar adaptation will probably be the primary means of prevention against the health impacts of climate change. However, adaptive capacity varies greatly between different populations, communities, and individuals, depending on levels of vulnerability, resilience, and available resources.2McMichael AJ Globalization, climate change, and human health.N Engl J Med. 2013; 368: 1335-1343Crossref PubMed Scopus (328) Google Scholar Approaching adaptation from a collectivist viewpoint fails to acknowledge these differences. Means to boost adaptive capacity therefore might require careful consideration by local decision makers because no one size fits all. Adaptation plans can benefit from an interdisciplinary approach at the local level. This approach can encompass a sociological understanding of community health under climate change, with adaptation strategies formulated through good governance combined with community engagement and community-based participatory approaches.3Sullivan J Parras B St Marie R et al.Public talks and science listens: a community-based participatory approach to characterizing environmental health risk perceptions and assessing recovery needs in the wake of Hurricanes Katrina and Rita.Environ Health Insights. 2009; 3: 37-51Crossref Scopus (11) Google Scholar The small islands in the Asia-Pacific region facing numerous climate change threats are a case in point. There, planning has included building climate-resilient health systems, addressing health governance and surveillance, and prevention and control measures for climate-sensitive diseases.4Kim R Costello A Campbell-Lendrum D Climate change and health in Pacific island states.Bull World Health Organ. 2015; 93: 819Crossref Scopus (10) Google Scholar Adaptation plans and health vulnerability assessments formulated through stakeholder engagement and interdisciplinary collaboration are part of the developed framework for action on climate change in the region.5McIver L Kim R Woodward A et al.Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities.Environ Health Perspect. 2016; 124: 1707-1714Crossref PubMed Scopus (95) Google Scholar In developing countries with warm, tropical climates, outdoor workers will be particularly at risk of heat-related morbidity and mortality as global warming ensues. Studies in Central America and Thailand, for example, have shown that heat exposure results in losses in work capacity and a range of acute and chronic health outcomes in workers.6Lundgren K Kuklane K Gao C Holmer I Effects of heat stress on working populations when facing climate change.Ind Health. 2013; 51: 3-15Crossref PubMed Scopus (159) Google Scholar Occupational adaptation and prevention measures will become more salient, and should not be overshadowed by productivity concerns. For more affluent countries, the impacts of climate change will still be evident, albeit less harsh than in poorer countries. Where individuals have ready access to health-care professionals, tailored advice could be provided about heat health as a form of so-called precision adaptation. Ideally, precision adaptation to climate change would take into account individual and regional variability, in much the same way as the precision medicine concept has become a novel approach to prevention and treatment in the clinical setting.7Collins FS Varmus H A new initiative on precision medicine.N Engl J Med. 2015; 372: 793-795Crossref PubMed Scopus (3189) Google Scholar Adaptive health professionals could aid in the reduction of vulnerability to climate change in those whose health can be compromised in hot conditions, including those with pre-existing conditions often associated with ageing, and those facing socioeconomic disadvantage. One argument is that medical educators should integrate climate change into the medical curriculum to better enable physicians to have this adaptive expertise.8Bell E Horton G Blashki G Seidel BM Climate change: could it help develop 'adaptive expertise'?.Adv Health Sci Educ Theory Pract. 2012; 17: 211-224Crossref PubMed Scopus (17) Google Scholar, 9Maxwell J Blashki G Teaching about climate change in medical education: an opportunity.J Public Health Res. 2016; 5: 673Crossref PubMed Scopus (75) Google Scholar This could encompass a diverse content of course material including global climate risks, eco-health, health promotion, and emergency preparedness, thereby equipping graduating health professionals with problem-solving skills to manage human health in the face of climate change-driven emergencies and extreme weather events.9Maxwell J Blashki G Teaching about climate change in medical education: an opportunity.J Public Health Res. 2016; 5: 673Crossref PubMed Scopus (75) Google Scholar This work by Gasparrini and colleagues1Gasparrini A Guo Y Sera F et al.Projections of temperature-related excess mortality under climate change scenarios.Lancet Planet Health. 2017; 1: e360-e437Summary Full Text Full Text PDF PubMed Scopus (354) Google Scholar will be valuable to researchers and policymakers in planning for the adverse health impacts of climate change in their region. No other study has examined such a breadth of locations using this methodology, and the evidence generated could be informative for global leaders, highlighting the urgent need for mitigation policies to limit further warming. However, as pointed out by the authors, large expanses of the world were not considered. If data were to become available, further research should be undertaken to include countries in the Indian subcontinent and sub-Saharan Africa to gain a broader view of global health effects. Regional estimates of other health impacts on an increasing and ageing global population would also be useful in forward planning for, and adaptation to, a warmer climate. We declare no competing interests. Projections of temperature-related excess mortality under climate change scenariosThis study shows the negative health impacts of climate change that, under high-emission scenarios, would disproportionately affect warmer and poorer regions of the world. Comparison with lower emission scenarios emphasises the importance of mitigation policies for limiting global warming and reducing the associated health risks. Full-Text PDF Open Access