Eng PDF
Eng PDF
Eng PDF
VU
LNE IT Y &
GEM S
C A P AT I O N
AD SSMENT
ENT
P R E PA R N C Y
ES
ASS
APT
RABI
EDN
AC
E
E
EMERG
L I T Y,
& MA N A
C L I M AT E
H E A LT H P
RISK
NG &
NING
M O R AT E D
I N F MME
E A N I TO R I
ROG
WA R
OR
EG
RA
R LY
ME
INT
D
S
NA
A
VIG
EN
RO EME &
ET
CH
ER N M E N T O F
D
LT H EAR
OF M IN N TA INFR A STRUC TURE,
A
H E E R ES
HE AN L T
AL TS T EC H N O MA
TH LO G IE S A N D CLI
PR ODU
C TS TO ENHANCE
CLIMATE RESILIENCE
WHO Library Cataloguing-in-Publication Data
Operational framework for building climate resilient health systems.
I.World Health Organization.
All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World
Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).
Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press
through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World
Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in
preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital
letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material
is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In
no event shall the World Health Organization be liable for damages arising from its use.
Cover illustration: Building climate resilience requires strengthening of a range of health system functions, from disease surveillance, to enhanced health action in
emergencies. Health facilities are at the front line. The photograph shows a health clinic in Nepal, which uses solar panels to ensure reliable energy access to provide
essential medical services, including during extreme weather events.
Printed in Geneva, Switzerland.
Operational framework for
building climate resilient
health systems
Acknowledgements
Prepared by Joy Shumake-Guillemot (World Meteorological Organization (WMO)/World Health
Organization (WHO) Joint Office), Elena Villalobos-Prats, Diarmid Campbell-Lendrum (WHO Public
health, environmental and social determinants of health (PHE)).
WHO gratefully acknowledges the financial support provided by the Department for International
Development (DFID), United Kingdom and comments and technical inputs from Guy Howard and
Alexandra Chittenden at DFID.
This framework builds on relevant frameworks and work plans on climate change and health adopted
across WHO regions such as the WHO Regional Office for Africa (AFRO) “Adaptation to climate change
in Africa: Plan of action 2012–2016”; the WHO Regional Office for the Americas (AMRO) “Strategy and
plan of action on climate change”; the WHO Regional Office for Europe (EURO) “Protecting health in an
environment challenged by climate change: European regional framework for action”; the WHO Regional
Office for South-East Asia (SEARO) “Regional strategy for protecting health from climate change”; and
guidance given in resolutions on climate change and health by the WHO Regional Office for the Eastern
Mediterranean (EMRO) and WHO Regional Office for the Western Pacific (WPRO).
It also benefits from the experience gained in country projects funded by Norway, Deutsche Gesellschaft
für Internationale Zusammenarbeit (GIZ), the German Federal Ministry for the Environment, Nature
Conservation and Nuclear Safety (BMU), Spain through the Millennium Development Goals Fund
(MDG-F), and the Global Environment Facility (GEF).
WHO also wishes to extend its gratitude to the following reviewers within WHO:
Jonathan Abrahams, Magaran Bagayoko, Mariam Otmani del Barrio, Hamed Bakir, Carlos Corvalan,
Nasir Hassan, Rokho Kim, Waltaji Terfa Kutane, Marina Maiero, Bettina Menne, Maria Neira and Jung
Sub Yeom.
Furthermore, WHO acknowledges the insightful comments and contributions provided by the par-
ticipants of the inception meeting of the DFID-funded project on “Building adaptation to climate
change in health in least developed countries through resilient WASH”, held in Geneva, Switzerland
in October 2013, and the final meeting of the GEF/UNDP/WHO Project Managers and International
Project Board for the Global Project “Piloting health adaptation to climate change”, held in Bridgetown,
Barbados in May 2015, who provided insightful inputs for the finalization of the framework. Participants
of the first meeting were: Elias Bartholomew Maiga Chinamo, Semunesh Golla, AM Zakir Hussain,
Iqbal Kabir, Neema Minja Kileo, Waltaji Terfa Kutane, Shamsul Gafur Mahmud, Abadh Kishore Mishra,
Abul Khair Mohammad, Dorisia Mulashani, Sudan Raj Panthi, Badri Pokhrel, Khom Bahadur Subedi
and Dangew Tadesse. Participants of the second meeting were: Tonya Brathwaite, Lester Cumberbatch,
Steve Daniel, Rada Dukpa, Kris Ebi, Sally Edwards, Guto Galvao, Winfred Austin Greaves, Simon Hales,
Joy St. John, Vladimir Kendrovski, Desmond King, Mazen Malkawi, Sonia Nurse, Kepha Ombacho,
MeciuselaTuicakau, Dorji Wangchuk and Nima Wangchuk.
Contents
Acronyms and abbreviations__________________________________________________________ iv
1. Introduction______________________________________________________________________1
2. Background_____________________________________________________________________ 2
2.1 Public health rationale__________________________________________________________ 2
2.2 Policy context__________________________________________________________________5
Components_______________________________________________________________________14
4.1 Component 1: Leadership and governance___________________________________________ 14
4.2 Component 2: Health workforce__________________________________________________ 16
4.3 Component 3: Vulnerability, capacity and adaptation assessment_________________________ 19
4.4 Component 4: Integrated risk monitoring and early warning____________________________ 21
4.5 Component 5: Health and climate research__________________________________________23
4.6 Component 6: Climate resilient and sustainable technologies and infrastructure_____________25
4.7 Component 7: Management of environmental determinants of health_____________________27
4.8 Component 8: Climate-informed health programmes__________________________________29
4.9 Component 9: Emergency preparedness and management______________________________32
4.10 Component 10: Climate and health financing________________________________________34
5. Monitoring progress_____________________________________________________________ 36
6. Conclusions____________________________________________________________________ 43
Terminology______________________________________________________________________ 44
References________________________________________________________________________ 47
Acronyms and abbreviations
COP Conference of the Parties
DFID Department for International Development
EDRM-H Emergency and Disaster Risk Management for Health
GEF Global Environmental Facility
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
H-NAP health component of NAP
IPCC Intergovernmental Panel on Climate Change
NAP National Adaptation Plan
UNFCCC United Nations Framework Convention on Climate Change
V&A vulnerability and adaptation
WHA World Health Assembly
WHO World Health Organization
Primarily intended for public health professionals and health managers, this framework
would also help guide decision-makers in other health-determining sectors, such as
nutrition, water and sanitation, and emergency management. International development
agencies could use this framework to focus investments and country support for public
health, health system strengthening and climate change adaptation.
The objective of this framework is to provide guidance for health systems and public health
programming to increase their capacity for protecting health in an unstable and changing
climate. By implementing the 10 key components laid out in this framework, health
organizations, authorities and programmes will be better able to anticipate, prevent, prepare
for and manage climate-related health risks. Least developed countries and countries in the
process of developing the health components of National Adaptation Plans (NAPs) under
the UN Framework Convention on Climate Change (UNFCCC) (4) may find this document
particularly useful in their efforts to design a comprehensive response to the risks presented
by short-term climate variability and long-term climate change.
Introduction 1
2
Background
2.1 Public health rationale
There is clear evidence that human actions, principally the burning of fossil fuels and
associated release of climate pollutants, are causing significant changes in global climate.
This in turn is creating observed consequences in environmental and social conditions
across all continents (5). As many of the largest health concerns are strongly influenced by
weather and climate conditions, this inevitably presents risks for human health that can be
grouped into:
• Direct impacts, such as those arising from damages and illness due to increased frequency
and severity of extreme weather events.
• Environmental system mediated impacts, such as rising air pollution and changing
patterns of vector-, food- and water-borne diseases.
• Socially mediated effects that occur via effect of climate change on social and human
systems, such as health effects resulting from undernutrition, occupational heat stress
and mental illness, as well as potential increases in population displacement, slowing of
economic growth and poverty aggravation.
Table 1 shows some of the main climate-related health risks, that have been assessed as
having medium-to-strong evidence by the Intergovernmental Panel on Climate Change
(IPCC). In addition, the IPCC identifies a series of key reasons for concern with regard
to effects of climate change which are either particularly severe or irreversible (5). This
includes the potential: (i) increase in severity and frequency of extreme weather events, such
as storms and floods causing mass displacement and disruption of livelihoods in low-lying
coastal zones and small island states due to storm surges and rise in sea level; (ii) breakdown
of food systems resulting in food shortages and volatile prices, particularly in low- and
middle-income countries; (iii) potential increase in risk of violent conflict associated with
resource scarcity and population movements; and (iv) slowing down of economic growth
and exacerbation of poverty, with associated reversal of global health progress, achievement
of the Millennium Development Goals, and the objectives of the forthcoming post-2015
development agenda.
Despite these challenges, a lot can be done to protect deterioration of health due to climatic
conditions. Over the long term, mitigation is necessary to avoid continued degradation of
the environmental determinants of health. In the short-to-medium term (i.e. up to the next
20–30 years) well-planned adaptation measures can avoid much of the projected health
impacts.
Note: The final column refers to the level of confidence in the evidence for expected health impacts, as presented in the Fifth assessment
report of the IPCC (1). Other health impacts are possible (see text), but were not assigned evidence grading by the IPCC.
Background 3
Figure 1 provides a qualitative assessment of the future burden (for the period 2030–2040)
of ill-health due to current climate change, in which the world will inevitably experience
approximately 1.5 °C of warming due to past and present greenhouse gas emissions (1,5).
Figure 1 also presents the period 2080–2100, for which the global mean temperature is
expected to increase by approximately 4 °C above preindustrial levels, unless vigorous
mitigation efforts are undertaken soon (1,5). The different colours indicate the extent to
which disease burdens could be avoided by effective adaptation measures in each period.
Figure 1: Conceptual presentation of health risks due to climate change and the potential for risk
reduction through adaptation
Present
Undernutrition
Vector-borne
diseases
Heat 2030–2040
"Era of committed climate change"
+ 1.5°C Undernutrition
Occupational
Food- and health
water-borne Vector-borne
infections diseases
Mental health Heat
and violence
Extreme
weather
Air quality events
Occupational
Food- and
2080–2100 water-borne
health
"Era of climate options" infections
Mental health
+ 4°C Undernutrition and violence
Extreme
weather
Air quality events
Vector-borne
diseases
Heat
Occupational
Food- and health Risk level with
water-borne current adaptation
infections
Potential for
Mental health adaptation to
and violence
Risk level with reduce risk
Extreme high adaptation
weather
Air quality events
Note: The width of the slices gives a qualitative indication of the relative burden of ill health at the global level. For
each timeframe, impact levels are estimated for the current state of adaptation and for a hypothetical highly adapted
state, indicated by different colours.
Source: Reproduced from the health chapter, Working group II of the IPCC Fifth assessment report (1).
This document therefore aims to support national ministries of health and their partners to
identify the key functions that need to be strengthened in order to provide a comprehensive
public health response to climate change, within an overall intersectoral NAP (4).
Background 5
3
Applying a resilience
approach to health systems
3.1 Goal and objectives
Framework goal
The goal is to enhance the capacity of health systems to protect and improve population
health in an unstable and changing climate. Ultimately, health systems should be
increasingly strengthened and continue to be efficient and responsive to improve health,
reduce inequities and vulnerability, and provide adequate social and financial protection,
in light of the shocks and stresses they may face from climate variability and change. The
framework therefore aims to achieve its goal through activities that build capacity to
effectively monitor, anticipate, manage and adapt to the health risks associated with climate
variability and change.
Framework objectives
Specifically, this framework aims to:
• guide professionals working in health systems, and in health determining sectors (e.g.
water and sanitation, food and agriculture, energy, urban planning) to understand and
effectively prepare for the additional health risks posed by climate variability and change,
through a resilience approach;
• identify the main health functions that need to be strengthened to build up climate
resilience, and use these as the basis for developing a comprehensive and practical plan
(e.g. as the health component of NAP (H-NAP)) (4); and
• support health decision-makers to identify roles and responsibilities to implement this
plan, for actors both within and outside the formal health sector.
IPCC defines ‘resilience’ as the “capacity of a social-ecological system to cope with a hazardous
event or disturbance, responding or reorganizing in ways that maintain its essential function,
identity, and structure, while also maintaining the capacity for adaptation, learning and
transformation.” (6)
Adaptations to climate change and climate resilience building are closely related, but not
synonymous. ‘Adaptation’, as defined by the IPCC in its Fifth assessment report, is the “process
of adjustment to actual or expected climate and its effects. In human systems, adaptation seeks
to moderate harm or exploit beneficial opportunities. In natural systems, human intervention
may facilitate adjustment to expected climate and its effects” (6).
With regard to health, resilience relates to the capacity of the system itself to cope with
and manage health risks in a way that the essential functions, identity and structure of
health systems are maintained. While health adaptation seeks to moderate harm or exploit
beneficial opportunities, the preservation of a certain level of quality and sustainable
performance of the system itself is not ensured. The incorporation of a climate-resilient
approach to health systems contributes to assuring the performance of the system, and
therefore, the sustainability and maximization of value for money of health investments.
However, it is important to remember that maintaining system resilience may not always
be possible. The magnitude of climate-induced changes or shocks may be so significant that
it is outside human abilities to maintain its essential functions, and thus the system may
collapse or fail.
Figure 2 shows the conceptual framework of a resilient system, which can be applied to
communities, organizations, or other systems, including health systems.
1 2 3 4 5
CONTEXT CHALLENGE/ CAPACITY TO DEAL CHOICES & OUTCOME
DISTURBANCE WITH DISTURBANCE OPPORTUNITIES OPTIONS
Resilience =
Decreased + Increased capacity.
vulnerability Improved choices &
opportunities
Source: Adapted from Defining disaster resilience: a DFID approach paper (8).
This entails building capacity to: recognize, monitor, anticipate, communicate and prepare
for changing climate-related health risks; prevent, respond to, manage, and cope with
uncertainty, adversity and stress; adapt operations to changing risk conditions; recover from
crisis and setbacks with minimal outside support; and learn from experience and improve
system capacity for the future.
For the whole health system to become more climate-resilient, its independent building
blocks (i.e. leadership and governance, health workforce, health information systems,
essential medical products and technologies, service delivery and financing) have to also
become climate resilient.
Furthermore, in order to effectively protect the health of the population, the health sector
should strengthen and extend its sphere of influence and operations beyond itself mainly in
relation to health-determining sectors (e.g. water, energy, food and agriculture and urban
planning). While it is clear that the management of these sectors is not directly under the
control of the health sector, the development of normative guidance to determine acceptable
levels of exposure to risks for health (e.g. water and air quality guidelines) is a core health
role. In the same way, the role of monitoring health outcomes in relation to the operations
of these sectors is usually the responsibility of the health sector.
Ultimately, the health sector should effectively extend into the community level if the health
system is to protect health and facilitate community resilience. Local level dialogue, two-
way information exchange, and community mobilization should be considered essential
functions of the health system. Community empowerment can activate local capacity,
increase the scope of available information, improve understanding of vulnerability and
build foundations for local resilience.
Reduce vulnerability
A healthier population and stronger health system will be more resilient to climate change.
In order to reduce vulnerability and create resilient health systems and healthier populations
that are able to respond to potential health effects from climate change, the following
measures are recommended:
Develop capacities
Addressing current gaps and improving the current health system or programme
performance is not enough to prepare a health system to tackle climate change. Health
systems should increasingly take steps to understand how climate change will affect their
population and service delivery, evaluate the effectiveness of their interventions and systems
under diverse climatic conditions, and enhance their institutional capacity accordingly. To
do this, public health and health system capacities that are attuned to climate realities are
needed.
Starting from health sector building blocks, and taking into account existing global and
regional mandates, the operational framework elaborates on 10 components that together
provide a comprehensive approach to integrating climate resilience into existing health
systems. These can provide the structure for a health adaptation plan, including the
allocation of roles and responsibilities, as well as human and financial resources.
Figure 3: Ten components comprising the WHO operational framework for building
climate resilient health systems, and the main connections to the building blocks of
10 components to build climate resilient health systems
health systems
A TE RESILIEN
I M CE
CL LEADERSHIP &
GOVERNANCE
&
ATE NCING WO HEAL
IM A RK TH
CL FIN FO
RC
H
LT Leadership & E
A
governance
HE
Health
VU
Financing
workforce
GEM SS
LNE IT Y &
T
P R E PA R N C Y
C A P AT I O N
AD ESSMENT
EN
ASS
E
EDN
APT
RABI
AC
E
EMERG
ing bloc
ild
& MA N A
L I T Y,
Bu
ks
Health
C L I M AT E
H E A LT H
s
of
E A N I TO R I R I S K
Service information
em
ea
WA R G &
delivery
lt h s y s t
NING
systems
h
MO R AT E D
N
PRO
I N F MME
EG
GRA
OR
R LY
INT
ME S
Essential
medical
D
M N
N products &
A
V I AG E
E
R technologies
ET O N M E N & R
CH
H
D
E M T LT SEA
O F RM IN E N TA O F C L I M AT E R E S IL I E N T
A
H E E RE
HE AN L T
AL TS MA
TH & S U S TAI N A B L E CLI
TECHNOLOGIES
A N D INF
R ASTRUC TURE
Health systems vary, as do the scale and nature of the challenges with which they are faced.
Therefore, the framework is not to be used as a definitive and rigid structure, but as a flexible
approach that should be adapted to the national and local context.
The following sections provide a description of the main issues to consider under each
component, along with proposed objectives and examples of measurable outputs to enhance
climate resilience.
M
N
IP E
&
ED
PROGHEALT FORM
&
WOR
HEALTH
KFORCE
MANIRONMENTAL
AGEMEN F
N T E N E T E R M I N A N TS
TO
LTH
Within the formal health sector, political leadership and the will
S IL L E & D O F HE A
S S M I ON
RE INAB IES RE
EN
LO UCT
T
G
R
E
ST
I
RA O EA
INF CHN STA
TE & SU ATE
M RL
IN ON Y WA
TE ITO RNIN sensitive health risks. This includes ensuring collaboration between
IM R ESEAR CH GR RIN G
Policy: climate variability and change considerations reflected in main health policies and
programmes.
Governance
• Climate change and health focal points designated within the health ministry with
specific programme of action and budget allocated.
• Climate change and health focal points or units, working in collaboration with relevant
climate-sensitive health programmes (e.g. vector-borne diseases, nutrition, infectious
diseases, disaster risk reduction) to build resilience of programmes.
Policy
• National strategy on health and climate change and/or H-NAP developed.
Cross-sectoral collaboration
• Agreements (e.g. Memoranda of Understanding) established between the health ministry
and main stakeholders at the national level (e.g. meteorological services, ministries of
environment, food and agriculture, energy, transport, planning), include specific roles
and responsibilities in relation to protecting health from climate change.
• Health representation ensured in main climate change processes at national, regional
and global levels (e.g. UNFCCC meetings and Conference of the Parties (COP), NAP,
national communications to the UNFCCC).
• Main policies and strategies from health-determining sectors reflect climate change and
health considerations both in relation to adaptation (e.g. climate-resilient water safety
plans) and mitigation (e.g. health cobenefits in transport policies).
• Health impact assessments conducted for new mitigation and adaptation policies and
programmes in all health-determining sectors, in accordance with article 4.1.f of the
UNFCCC.
Components 15
4.2 COMPONENT 2: Health workforce
This component refers to strengthening of technical and professional
BILIT Y, I NT EGR
N ER A
VUL APACIT YO&N
C PTATI
MON ATED
EARLY ITORIN RISK
WAR G &
capacity of health personnel, the organizational capacity of health
ADASESSMENT NI N
CE AS G
systems, and their institutional capacity to work with others.
FO H
RK LT
R
WO H E A
H E L I MA R C H
C SEA
AL TE
RE
TH
&
Development of capacities specifically for climate change and
LEADERSHIP &
GOVE RN AN CE
health should build upon and support the more general effort to
CLIMATE RESILIENT
TECHNOLOGIES & ENV AGE
INFRASTRUCTURE DET IRON ME
& SUSTAINABLE ensure adequate baseline levels of health competencies in health
policy and management, research and analysis, healthcare and
TH
&H G
EAL
OF E R M ME N
TE NCIN
N
AL
A
A TH
IM I N
F
N T N TS
A
T O AL T
CL PRO EN
F GE M S S
A health system relies upon an effective health workforce to achieve
G
CLI HEARAMMES & MANAREDNE Y
MA LT H PR E PA N C
TE IN GE
FORMED E ME R
• Build on existing efforts, standards Technical and professional capacity of health staff can be developed
and best practices undertaken at all through training, education, mentoring as well as experiential trial
levels and error to: understand and use climate information for health
• Focus on actors’ needs. In order decision-making, engage in cross-sectoral monitoring, conduct
to ensure the implementation of research and interventions, and effectively manage changing risks
accurate interventions, any initiative to health and health system performance. In addition, a range of
on capacity development at any competencies would become increasingly important, such as the
level should start by a capacity ability to effectively work and communicate across disciplines,
assessment of the corresponding analytical skills to interpret and use nonhealth information for
health system decision-making, and the ability to communicate climate risks to
• Foster collaboration and health actors and the public.
partnerships, especially with and
between countries and regions, Organizational capacity refers to the availability of sufficient
and within and between related financial and human resources to cope with the health threats
departments and units of climate change. This includes the efficient and targeted use
• Enhance the sustainability of of resources, information, knowledge and processes employed
capacity building efforts by by the organization (such as resource mobilization and income
integrating climate change at early generation, human resources and staffing, programme and process
stages of professional health training management), which enhance the resilience and adaptive capacity
of a health system to address risks associated with climate change.
• Engage with wider audiences outside
of the core health community,
It is also strategically important to develop institutional capacity,
including other sectors, the media
including the ability of health systems to partner with other
and community groups.
actors. This involves the ability to define and fulfil responsibilities
in collaboration with other sectors, and communicate with the
public, including through the media. It is therefore important to build awareness and
media capacity to effectively and responsibly communicate climate risks and associated
Communities need to be aware of the challenges around them, involved in risk identification
and decision-making, and empowered to effectively protect themselves. Community groups
and leaders need to be prepared for local risks, know what role they play in prevention
and response, and be aware of potential effective solutions and resources available to them.
Communities also often have rich local information about risks, community capacity and
vulnerability that can help to guide the formulation of responses. Outreach, partnerships,
stakeholder engagement, and effective two-way dialogue are vital to improving how the
health system works with the community.
Other sectors need to be aware of the scope and scale of health risks that originate within
their sectors; and the need for effective dialogue to enable effective collaborative planning,
policy and implementation of actions with cobenefits to health.
Communications and awareness raising: raise awareness of the link between climate
variability/climate change and health outcomes among different target audiences (e.g. policy
makers, senior staff, media and communities).
Components 17
• Contingencies, adaptation costs and potential losses and damages from climate change
incorporated by management staff into investment plans.
AB T Y & N
SE T
CI ATIOENT
S
IL I
I NG T H
TY
NC EAL
SM
generate policy-relevant evidence on the scale and nature of health
,
FI NA E & H
AT
EAR
MO LY WARNING
CLIM
GRATED
local circumstances.
PREAPNAGEMENT
EMERREDNESS
RISK
GENC Y
A
Health risks vary depending on the nature of the exposure (e.g. if the
RESEIMAT &
M
CL LTH
HE A
&
AR E
location of a population makes it prone to drought or to flooding),
CH
NF TH ES
D
L MM
ME
IN
TE FRA
A
OR
R
the projected changes in climatic conditions and associated hazards
CH ST OG A
CL & SU NOLRUCTUR P R HE E I
IM STA OGIE E OF HEALTH TS AT
AT INA S & DETERMINAN L M
ER CL I
(e.g. projected change in precipitation patterns or climate suitability
ES IL BL E ENTA
IENT ENVIRONMENT OF
MANAGEM
Successful V&A assessment processes will often include inputs from academic experts, to
ensure high quality evidence, as well as managerial and operational personnel to ensure
relevance to policy and practice. The studies will examine health risks, such as heat stress,
nutrition and vector-borne diseases separately, and consider how they interact with each
other and with changes in other determinants, such as ageing and urbanization. Assessment
teams will consider opportunities and constraints for responses throughout the causal
pathway, from managing environmental health determinants, to disease surveillance, to
control and treatment of specific diseases. Critically, the process will involve a range of
stakeholders and use information from a variety of sources, including health and nonhealth
scientific information, as well as community knowledge and feedback.
Components 19
Throughout the V&A assessment process a range of additional studies, analytical exercises
and tools may be used to gain a more holistic perspective of health vulnerability to climate.
These include:
Capacity: baseline information on capacities and gaps within the health system to face the
challenges posed by climate change.
Adaptation options: information on the main adaptation options available, including their
comparative advantages, potential costs and efficiency, available for selection by health
system decision makers.
Vulnerability
• Baseline rates and climate sensitivity of health conditions, allowing selection of priority
risks, and continuous monitoring of changing risk conditions and health status assessed.
• Most vulnerable populations and areas prone to health risks of climate change identified.
• Health impact assessments for key adaptation and mitigation policies and programmes
of health-determining sectors conducted.
Capacity
• Baselines on existing human resources, technical and health service delivery capacity
established, with identification of weaknesses.
• Recommendations made for addressing gaps and building health system capacity.
Adaptation options
• Assessment results used to prioritize allocation of resources and effective interventions in
health and related sectors for high risk and vulnerable populations.
• Plan defined and mechanism established for iterative review of health vulnerability and
adaptation options.
TE ING ING
OR ARN
D
RI &
AN &
SK
CE
ERN IP
important health risks including the occurrence of extreme
G OV DER S H
LEA
weather events, and the transmission of vector-, water- and
HEALTHTE
RESEA
CLIMARCH
food-borne diseases. Building climate resilience entails:
EALTH
&
CLIMFINANCING
(i) developing adequate capacity and flexibility to understand
ATE & H
STR GIE E
A
UC S
EN N ES EN T
TU &
to anticipate changing health risks; and (iii) informing preparedness,
C S
RE
ED EM
Y
G
D OF A
EN E T E HE AN AR
surveillance and response to needs in a timely manner.
MA VIR RMINALTH & M REP ERG
N A O NM A N TS M E S P EM
GE ENT P R O G R AM
MEN AL HEALTH ED
T OF
CLIMATEINFORM
Health early warning systems are designed to anticipate and alert the public and health
professionals that a rapid-onset emergency, such as an extreme weather event or disease
outbreak, is expected. This advanced alert can provide additional lead-time to deploy
appropriate preparedness measures and responses. Effective monitoring and early warning
systems can prevent avoidable illness, injury and death when coupled with adequate
response capacity.
Components 21
Information sources on climate-risks may originate from local community knowledge, as well
as multiple fields of scientific and practice-based knowledge (epidemiology, meteorology and
climate, environment, agriculture, water resource management, etc.). Relevant information
may be qualitative or quantitative, as well as observational or modelled. Because information
on environmental and climate conditions are generally best collected and analysed by their
respective authorities, health authorities are not always expected to collect these additional
data. It is recommended to establish partnerships with meteorological agencies, hydrological
services, or others to access and appropriately interpret nonhealth information.
Monitoring
• Indicators on climate change impacts, vulnerability, response capacity and emergency
preparedness capacity, as well as climate and environmental variables included in relevant
monitoring systems at national level and reported over time.
• Periodic reviews for improvements or deterioration of capacities identified in V&A
assessments.
• Impacts of main environmental determinants of health monitored by the health sector.
Communication
• Communication strategy on climate risks to health developed and implemented, outlining
the scope of information for diverse audiences (e.g. media, public, health personnel and other
sectors) and events, including who should communicate, and the means of communication.
• Community engagement and feedback mechanisms established to empower affected
populations to respond to warnings, and to guide future development of monitoring and
warning systems.
TH TE
A SE
AS
A CH
&
gain insight into local solutions and capacities, and build evidence to
AR
E
KFO H
RC
WOR EALT
strengthen decision-making.
ATE RES
HNOL
O
Research from global to local level can be used to gather knowledge
GIES &
LEADERNANCE
ERSHIP &
I L I E N T MA
on climate risks to health; the modulating effect of social and
D
GOV
E T
HEA AN AL
N
RO
environmental determinants; climate-sensitivity of diseases and
N
LTH TS
M NT
TH
E
& CING
risks; how communities and health systems currently understand and
AL
HE
PR
AN OG CL
FIN ATE IM H E R AM M
cope with climate risks; how local conditions and vulnerabilities are
NT AT ALT ES
CL
I M & MANAGEME SS EI H
NFO
PREPAREDNEY RME
EME R GENC D
connected to broader determinants; and the degree to which communities
and local health services are prepared to cope with climate-related changes
and shocks. Applied research that can develop and test new technologies, data tools
and instruments, and strategies for risk management are also critical to evidence-based
decision-making.
Support for research: research capacity on climate change and health built by supporting
relevant multidisciplinary networks, making available financial resources and creating
training opportunities.
Connect to policy: research findings on climate change and health disseminated to and
used by policy makers.
Research agenda
• National research agenda on climate change and health defined through the organization
of a stakeholder forum involving representatives from health and other government
ministries, research institutions, nongovernmental organizations, the private sector and
vulnerable populations.
Components 23
Support research
• Access to and linkage of data on meteorological information, health determinants and
outcomes enabled.
• Multidisciplinary research partnerships, knowledge management networks and rosters
of local experts established.
• Financial backing mechanisms to support research programmes and postgraduate
training programmes established.
Connect to policy
• Mechanism established for researchers to inform planning, policy and stakeholder groups.
• Policy makers included in the definition and review of research agendas.
TEC SUS E R
O CTU
RA OL I
INF HN TA
& AT
U
EM PARE GEME
P R MA N
IM
&
R
E A
essential preventive and curative health products, from vaccines for
ST
ER DNE NT
CL
GE
NC Y S S
climate-sensitive diseases to surgical equipment. It can be further
HEALTH &
R ESEAR CH
CLIMATE
F I NAN C I NG H
reduce vulnerability to climate risks, both within and outside the
R A RING ING
T ED &
RISK
traditional health sector.
TE IT RN
IN ON Y WA
O
GO ADE
M RL
L E
VE RS
EA
G
RN
T
health facilities and the building codes that are applied account for current
and projected future climate risks, such as the potential for increased frequency
and intensity of heat waves, cyclones or storm surges. It also includes consideration of
climate resilience of essential environmental services to health facilities, such as water and
sanitation services which may be compromised by flood or drought, and electricity supply
that may be cut off during extreme weather events (13). Changing climatic conditions can
also influence the effectiveness of specific medical products. For example, antidepressants,
antihistamines, antipsychotics and diuretics may predispose their users to heat stroke or
heat stress when temperatures are high.
Climate resilience can also be enhanced through the use of new technologies or approaches
for better delivery of health interventions, particularly through the use of information
technology. Satellite-based remote sensing of meteorology and environmental conditions
on the ground have proven effective in improving the reliability of weather warnings,
monitoring, surveillance and risk mapping the probability of transmission of water-
borne and vector-borne diseases. Mobile communications have increased the speed and
volume of health data collection while reducing costs and improving emergency response.
Advances in information management technologies have greatly enhanced capacity to
analyse connections between environmental and health data. Systematic integration of these
technologies into disease surveillance systems can support vulnerability and adaptation
assessment, as well as surveillance and early warning.
Selection of medical technologies and products with lower environmental footprint can also
contribute to climate resilience and long-term sustainability. Processes and technologies
such as solar-powered photovoltaics, water pumps and vaccine chains can enhance
resilience by ensuring independent water and energy supplies to remote rural facilities, and
for health operations during emergencies. Use of technologies with lower energy demand
can simultaneously increase resilience and decrease the impact of the health sector on the
environment, such as reduced emissions of climate-altering pollutants associated with energy
generation. Health systems constitute a significant share of many national economies (14).
They can therefore make an important contribution to overall sustainability by taking into
account environmental impacts in relation to their procurement of medical technologies, as
well as energy, water, buildings, transport, food, waste disposal and management.
Components 25
Objectives for the implementation of this component
Adaptation of current infrastructures, technologies and processes: future climate risks
systematically considered with regard to revision or upgrading of technologies, products
and procedures for health system service delivery.
Promotion of new technologies: new technologies, processes and products selected and
deployed to increase climate resilience through enhanced health service delivery.
T O
NT
E AN
OF E R
CL FIN
M
IM AN
strongly mediated by social conditions. For this reason, some of the
ATE CING
& SUSTAINSILIENT
&H
TECHNOLOGABLE
E
most effective actions that can be taken by health systems are in
TUR
EALTH
CLIMATE RE
collaboration with other sectors, i.e. through promoting a “Health
GOVE RN A IP &
LEADERSH
in all policies” approach.
HE IMATE H
CL EARC
H&
NCE
ALT
S
RE
Scaling up multisectoral public health prevention programmes can
W H
OR
NG
avoid negative health outcomes at their source and facilitate timely and
NI & K
EA FO
AR G K ASSE LT RCE
Y W RIN I S ADAPSTSMENT H
EARL NITO TED R
CAP ATION
increasingly effective responses to changing environmental and climate-
MO GR A
I NT E VULN ACIT Y &
ERABILIT Y,
While the health sector does not usually have direct control over environmental
determinants, they have essential roles to play at both policy and programmatic levels in
providing evidence and raising awareness, joint monitoring of environmental exposures
and outcomes, defining regulatory standards and management of health risks. This requires
active coordination and intersectoral planning.
Table 2: Examples of joint actions between ministries of health and other sectors to
manage the environmental determinants of health
Components 27
Objectives for the implementation of this component
Monitoring: joint monitoring of climate-sensitive environmental risks against evidence-
based standards.
Monitoring
• Integrated monitoring systems allowing collection and analysis of data on environmental
hazards, socioeconomic factors and health outcomes established.
• Evidence-based quality standards for climate-sensitive environmental conditions defined.
Regulation
• Regulations on key environmental determinants of health (air quality, water quality, food
quality, housing safety, waste management) revised and enforced to reflect broader ranges
of expected climatic conditions.
• Building regulations and waste management infrastructure, environmentally sustainable
and resistant to likely local extreme events promoted.
Coordinated management
• Health impact assessments for policy and programmes in sectors such as transport,
agriculture and energy, implemented.
• Joint multisectoral risk management approaches to health risks related to disasters, water,
waste, food and air pollution (e.g. food safety, diarrhoeal disease control, integrated vector
management, joined-up risk communication) undertaken.
AT ED
CH ST GR A
RMLTH MES
TE FRA
E
assessment, programming and implementation. IN
AM
RES IMAT &
CL LTH
EAR E
CH
HE A
&M
PREANAGEMENT
EMERREDNESS
In addition to collaboration with other actors, the health sector
PA
GENC Y
MO LY WARNING
RISK
is also often directly responsible for programmes that address
CLIM
R
FI NA E & H
A
A
E
borne diseases), health response during extreme weather events and
T
NC EAL
CI ATIOENT
AB T Y & N
I NG T H
M
Y,
S
nutritional crises.
T
S
SE T
IL I
AS DAP A
A AP ER GO
C N LE VER
L AD N A
VU ERS NCE
CE
WORK FOR HIP
Components 29
Table 3: Examples of climate-informed health interventions
Health programming
• Medium- and long-term plans for disease control programmes revised to consider
capacities that may be stressed or exceeded by climate change.
• Investment plans defined to address identified capacity gaps.
Delivery of interventions
• Risk maps and analysis of seasonal trends in diseases used to target resources and
preventive measures for those most at risk.
• Contingency plans for healthcare provision in extreme weather events, or delivery of
interventions to control outbreaks of infectious diseases in new locations, developed and
tested.
Components 31
4.9 COMPONENT 9: Emergency preparedness and
management
ATE & H
CLIMFINANCING
EALTH LEAD Outbreaks and health emergencies triggered by climate variability
G OV ER S H
CY S ERN IP
EN NES NT
ED EME
AN &
CE are primary concerns of climate change. Climate-informed
& MREPA ERG
G
AN R
WO
HE K FO RC
R
disaster and emergency management are essential for building
ALT
D
H
OF CLIMATEINFORME
ES
VULNER ABI L
should aim to holistically manage overall public health risks and
ASSESSMENN
ADAPT
CAPACIT Y IT Y,
T
ENT TAL
MA VIR RMINALTH
I O
&
T
AG NMEN A
EN E TE HE
EA ON R A
D OF
O
M TEG
RL IT
IN
YW O
N
Risk management: strengthen health system capacity to manage risks so that overall
vulnerability and exposure to hazards are reduced and residual risks and uncertainties
effectively managed.
Risk management
• Risk assessments for current and projected future exposure to extreme weather events
routinely used to inform health sector strategic development plans.
• Health sector contingency plans for extreme weather events developed, including risk
reduction, preparedness and response, in line with the WHO emergency response
framework.
• Emergency response plans for individual health facilities defined and implemented in
case of need.
Community empowerment
• Stakeholder mechanism to support participation, dialogue and information exchange,
to empower civil society and community groups as primary actors in emergency
preparedness and response established.
• Capacity development programmes implemented to identify and support the roles of
local communities to identify risks, prevent exposure to hazards and take action to save
lives in extreme weather events.
Components 33
4.10 COMPONENT 10: Climate and health financing
Effectively protecting health from climate change will incur financial
IP &
DERSH
costs for health systems. For example, health systems may need to
L E A E RN AN C E H
TH WOR EALTH
AL GOV KFO
HE NG RC
E
C I
expend resources to expand the geographic or seasonal range or
AN &
FIN TE
LN ACIT ION
population coverage of surveillance and control programmes for
ADSSES
CL
ER Y &
A
A SM
ABI
LIT Y
climate-sensitive infectious diseases, or to retrofit health facilities
& MANAGEMEN S
T
PREPAREDNES
EME RG E NC Y
,
EARLY WARNIN&
to withstand more extreme weather events. Additional investment
INTEGRATED RIS
MONITORING K
may also be needed in other sectors to achieve health goals, such as
MED
TE ALTH MES
OG
HE
A
R
AT CH
A
H
ALT NTS
CL
INF H E
TEC RASTRUCTURE OF HE INA NTAL F &
H M
& SUNOLOGIES & DETERONME NT O
E NV I R GE ME
In order to mobilize and apply resources to these issues, assessments
CLIM STAINABLE
ATE R
E S I L I E N T MA N A
Resources can also be mobilized by combining climate change and health considerations
in investments in key health determining sectors. For example, national governments and
donors make very large investments in water and sanitation, which improve health and
generally reduce climate vulnerability. Adding criteria for climate resilience and health
promotion to investment strategies can ensure that these investments bring the greatest
Funding for sectors influencing health: health and climate change considerations
incorporated in projects and programmes supported through development funding available
for main health determining sectors.
Climate change funding streams: climate change funding mechanisms available at national
level accessed.
The intended ultimate impact of implementing the operational framework will be a decrease
in the burden of climate-sensitive diseases, and a strengthening in the overall resilience of the
health system. The following table includes proposed indicators of progress at the outcome
level for each of the six building blocks of health systems. The examples of measurable
outputs proposed for each of the components above has also been added to the table so as
to provide a comprehensive monitoring framework.
Six building Example indicators Ten components Examples of measurable outputs to enhance climate resilience
blocks of at outcome level of the operational
health systems framework
Leadership and Main policies and Leadership and Governance
governance strategies for climate governance
• Climate change and health focal points designated within the health ministry, with specific programme of
change, health and
action and budget allocated.
health-determining
sectors (e.g. water • Climate change and health focal points or units, work in collaboration with relevant climate-sensitive health
and sanitation, food programmes (e.g. vector-borne diseases, infectious diseases, nutrition, disaster risk reduction) to build
and nutrition security) resilience of programmes.
reflect climate
change and health Policy
connections • National strategy on health and climate change and/or H-NAP developed.
Cross-sectoral collaboration
• Agreements (e.g. Memoranda of Understanding) between the health ministry and main stakeholders at
national level signed, which include specific roles and responsibilities in relation to protecting health from
climate change.
• Health representation ensured in main climate change processes at national, regional and global levels (e.g.
UNFCCC meetings and COP, NAP, national communications to the UNFCCC).
• Main policies and strategies from health-determining sectors reflect climate change and health
considerations both in relation to adaptation (e.g. climate-resilient water safety plans) and mitigation (e.g.
health cobenefits in transport policies).
• Health impact assessments conducted for new mitigation and adaptation policies and programmes in all
health determining sectors (in accordance with article 4.1.f of the UNFCCC).
Health workforce Percentage of Health workforce Human resources
healthcare personnel
• Training courses on climate change and health topics targeting health personnel conducted.
with information and
training to address • Curricula on climate change and health developed and imparted at secondary and/or tertiary levels.
climate change
and health links, Organizational capacity development
appropriate to their • Contingency plans for the deployment of sufficient health personnel in case of acute shocks, such as
role and function extreme weather events and outbreaks developed at the relevant level (i.e. national, provincial, local).
(as determined by a
survey) • Realistic and innovative capacity-building plans (e.g. from capacity or vulnerability and adaptation
assessments), developed to address identified human resources and institutional capacity gaps.
Monitoring progress
• Contingencies, adaptation costs and potential losses and damages from climate change incorporated by
management staff into investment plans.
37
38
Six building Example indicators Ten components Examples of measurable outputs to enhance climate resilience
blocks of at outcome level of the operational
health systems framework
Communications and awareness raising
• Development and implementation of internal and external communication plans (including the development
of knowledge products) to raise awareness of health and climate change and response options targeting key
audiences, such as health professionals and decision-makers, communities, the media and other sectors.
• Health professionals, the media and community leaders trained in risk communication, including
communication of uncertainty.
• Stakeholder forum on protecting health from climate change established as a way to engage health-
determining sectors and the community.
Health Number of climate- Vulnerability, Vulnerability
information sensitive diseases capacity and
• Baseline rates, and climate sensitivity of health conditions, allowing selection of priority risks, and
systems for which there are adaptation
continuous monitoring of changing risk conditions and health status assessed.
monitoring systems assessment
that are able to • Most vulnerable populations and areas prone to health risks of climate change identified.
forecast and monitor
risks and/or to monitor • Health impact assessments for key adaptation and mitigation policies and programmes of health-
disease risks posed by determining sectors conducted.
climate variability and Capacity
Monitoring progress
• Policy makers included in the definition and review of research agendas.
39
40
Six building Example indicators Ten components Examples of measurable outputs to enhance climate resilience
blocks of at outcome level of the operational
health systems framework
Essential Percentage of Climate resilient Adaptation of current technologies and processes
medical products healthcare facilities and sustainable
• Specifications for siting and construction of health facilities, and energy, water and sanitation provisions
and technologies incorporating technologies and
revised in line with projected climate risks.
climate variability infrastructure
and change in • Training and recommendations for prescription of pharmaceuticals during extreme heat conditions revised.
siting, construction,
technologies and Promotion of new technologies
procedures to ensure • New technologies such as eHealth or satellite imagery used to improve health system performance.
provision of basic
services (including Sustainability of health operations
energy, water and • Impact of health sector on the environment assessed, and appropriate mechanisms to monitor carbon
sanitation). emissions and environmental impacts developed.
• Sustainability in selection of products and procurement of services including energy, water, transport and
waste management assessed and prioritized by health facilities.
Service delivery Percentage of Management of Monitoring
medium- and long- environmental
• Integrated monitoring systems allowing collection and analysis of data on environmental hazards,
term plans for determinants of
socioeconomic factors and health outcomes exist.
control programmes health
Monitoring progress
41
42
Six building Example indicators Ten components Examples of measurable outputs to enhance climate resilience
blocks of at outcome level of the operational
health systems framework
Financing Percentage of the Climate and health Health-specific funding mechanisms
national health financing
• Resources to increase resilience to climate variability and climate change included as a line item in
budget that addresses
national and/or subnational health investment plans.
risks posed by climate
variability and change • Proposals to external donors to support control of climate-sensitive diseases (e.g. GFATM on malaria
control), included climate variability and change.
Development funding in sectors influencing health
• Screening for climate variability, climate change risks and health protection, included as a criteria for
selecting investments in key health determining sectors, such as water and sanitation, and food and
nutrition security.
• Health impacts of climate change monitored in programmes funded through financial mechanisms specific
to health-determining sectors.
Climate change funding streams
• Projects and programmes on building health system resilience submitted to and granted by the main
international climate change funds (e.g. the GEF, Adaptation Fund, bilateral donors).
Conclusions 43
Terminology
This section draws upon glossaries and definitions provided by the IPCC (5), the International
Strategy for Disaster Reduction (18), and WHO (19) .
Adaptation: refers to the process of adjustment to actual or expected climate and its effects.
In human systems, adaptation seeks to moderate harm or exploit beneficial opportunities.
In natural systems, human interventions may facilitate adjustment to expected climate and
its effects. In public health, the analogous term is “prevention”. Various types of adaptations
exist, including anticipatory and reactive, private and public, autonomous and planned.
Adaptation responds to immediate threats of climate vulnerability (commonly addressed
with disaster risk reduction, emergency response and epidemic management), but primarily
seeks to identify and plan for large-scale risks and trends posed by long-term environmental
and climatic changes such as sea-level rise, changing ground and surface water availability,
changes in disease vector distribution and crop pests, changes in air quality, glacial retreat,
UV exposures, and extreme and increasing temperatures. Resilience to climate change
usually requires a capacity to anticipate climate change and plan needed adaptations.
Adaptive capacity is the ability of a system to adjust to climate change, to moderate potential
damages, to take advantage of opportunities, or to cope with the consequences.
Climate change refers to any change in the climate over time, generally decades or longer,
whether due to natural variability or as a result of human activity.
Climate variability refers to trends in variation in the mean state and other statistics of the
climate on all temporal and spatial scales beyond that of individual weather events. Extreme
weather (storms, extreme temperatures) and climate events (drought) are part of climate
variability trends.
Climate-resilient health systems have the ability to anticipate, respond to, cope with,
recover from and adapt to climate-related shocks and stresses, so as to bring sustained
improvements in population health, despite an unstable climate.
Climate-sensitive health outcome is any health outcome whose geographic range, incidence
or intensity of transmission is directly or indirectly associated with weather or climate.
Climate-related risks are additional (exacerbated) risks that people and their livelihoods
and assets face due to climate change. These risks can be direct, such as in exposure to
more frequent heat waves or floods; or indirect, such as when a drought negatively impacts
food supplies (and prices) and in effect livelihoods and nutrition. Certain groups may also
face increased risks from measures taken in response to climate change (such as adaptation
measures that protect certain areas of a city from flooding but increase flood-risks in
other areas) or for mitigation (such as new hydropower schemes displacing populations or
increasing malaria vector breeding sites).
Climate change mitigation refers to policies and measures used to reduce greenhouse gas
emissions (carbon) and/or enhance sinks such as forests, as a means to slow down and
reduce future and more dangerous climate change. Climate change mitigation is primary
prevention of future harm for decades in the future and necessitates public education and
awareness along with use of low-carbon technology.
Disaster risk is the potential loss expressed in lives, health status, livelihoods, assets and
services, which could occur in a particular community or a society due to the impact of a
natural hazard.
A health system comprises all the organizations, institutions and resources that are devoted
to producing actions principally aimed at improving, maintaining or restoring health. Health
systems involve numerous stakeholders from individual and community to government,
at local, subnational and national levels. The health system is recognized by WHO to be
made up of six key building blocks: (i) leadership and governance; (ii) health workforce; (iii)
health information systems; (iv) essential medical products and technologies; (v) financing;
all of which lead to (vi) service delivery. The goal of a health system is to deliver effective
preventive and curative health services to the full population, equitably and efficiently, while
protecting individuals from catastrophic healthcare costs.
Terminology 45
Health system strengthening refers to improving the six health system building blocks
and managing their interactions in ways that achieve more equitable and sustained
improvements across health services and health outcomes, requiring both technical and
political knowledge as well as action.
Vulnerability is the degree to which individuals and systems are susceptible to or unable
to cope with adverse effects of climate change including climate variability and extremes.
The vulnerability and coping capacity of particular populations to changing meteorological
conditions and its human and social consequences is influenced by a variety of factors. These
include biological factors, sociocultural factors and access to and control over resources.
References 47
PUBLIC HEALTH AND ENVIRONMENT
This document presents the World Health Organization (WHO) Operational framework for
building climate resilient health systems. The framework responds to the demand from
Member States and partners for guidance on how the health sector and its operational basis
and health systems can systematically and effectively address the challenges increasingly
presented by climate variability and change.
Primarily intended for public health professionals and health managers, this framework
would also help guide decision-makers in other health-determining sectors, such as
nutrition, water and sanitation, and emergency management. International development
agencies could use this framework to focus investments and country support for public
health, health system strengthening and climate change adaptation.
The objective of this framework is to provide guidance for health systems and public health
programming to increase their capacity for protecting health in an unstable and changing
climate. By implementing the 10 key components laid out in this framework, health
organizations, authorities and programmes will be better able to anticipate, prevent, prepare
for and manage climate-related health risks. Least developed countries and countries in the
process of developing the health components of National Adaptation Plans (NAPs) under
the UN Framework Convention on Climate Change (UNFCCC) may find this document
particularly useful in their efforts to design a comprehensive response to the risks presented
by short-term climate variability and long-term climate change.