Abstract
Enhancing the adaptive capacity of individuals, communities, institutions and nations is pivotal to protecting and improving human health and well-being in the face of systemic social inequity plus dangerous climate change. However, research on the determinants of adaptive capacity in relation to health, particularly concerning the role of governance, is in its infancy. This paper highlights the intersections between global health, climate change and governance. It presents an overview of these key concerns, their relation to each other, and the potential that a greater understanding of governance may present opportunities to strengthen policy and action responses to the health effects of climate change. Important parallels between addressing health inequities and sustainable development practices in the face of global environmental change are also highlighted. We propose that governance can be investigated through two key lenses within the earth system governance theoretical framework; agency and architecture. These two governance concepts can be evaluated using methods of social network research and policy analysis using case studies and is the subject of further research.
Highlights
Changes in the way we govern are central to redressing current health inequities, many of which are predicted to worsen under climate change
The recent acknowledgement of the health effects of climate change brings with it the opportunity and responsibility to understand better how governance processes strengthen or impede health adaptation activities
The health sector is intimately intertwined with other sectors and organisations when it comes to the health effects of climate change and corresponding policy responses
Summary
Changes in the way we govern are central to redressing current health inequities, many of which are predicted to worsen under climate change. The causes of climate change-related health inequity both between and within countries stem from the configuration of four main groups of factors (Figure 1): (i) the societal context such as power differentials and decision-making processes–e.g., the level of inclusive participation when deciding on potential damming options in communities that reside near possible dam sites such as parts of the Mekong River Basin; (ii) differential distribution of environmental impacts, which are both direct and indirect–e.g., seasonal flooding in low-lying delta areas of the Mekong Delta affects those who live in these areas more than others; (iii) social distinctions, such as level of female education, generally lower in rural agrarian areas, which relates to number of offspring and financial demands on family; and (iv) differential daily living conditions, such as level of dependence on agricultural yields for livelihoods These four interconnected drivers are mediated by the quality, accessibility, utilisation and affordability of the formal and informal health system, and have both direct and indirect effects on health outcomes. Presented below is a brief discussion of the concepts of vulnerability and adaptive capacity frameworks in relation to health and climate change
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