Abstract
Environmental health indicators are helpful for tracking and communicating complex health trends, informing science and policy decisions, and evaluating public health actions. When provided on a national scale, they can help inform the general public, policymakers, and public health professionals about important trends in exposures and how well public health systems are preventing those exposures from causing adverse health outcomes. There is a growing need to understand national trends in exposures and health outcomes associated with climate change and the effectiveness of climate adaptation strategies for health. To date, most indicators for health implications of climate change have been designed as independent, individual metrics. This approach fails to take into account how exposure-outcome pathways for climate-attributable health outcomes involve multiple, interconnected components. We propose reframing climate change and health indicators as a linked system of indicators, which can be described as follows: upstream climate drivers affect environmental states, which then determine human exposures, which ultimately lead to health outcomes; these climate-related risks are modified by population vulnerabilities and adaptation strategies. We apply this new conceptual framework to three illustrative climate-sensitive health outcomes and associated exposure-outcome pathways: pollen allergies and asthma, West Nile virus infection, and vibriosis.
Highlights
In order to create a comprehensive, integrated indicator system that captures the critical components of causal pathways and quantifiable metrics of vulnerability and adaptation responses, we propose a new conceptual framework for a national Integrated Climate Change and Health Indicator System (Fig. 1)
One goal of applying this systems approach to developing climate change and health indicators is to facilitate a “virtuous circle” of science whereby integration of exposure-outcome pathways, vulnerability factors, and societal responses leads to the following: (1) early identification of gaps in either scientific understanding of linkages or collection of data that are relevant to proposed linkages; (2) development of indicators of human health vulnerability that are most relevant to specific pathways; (3) association of societal responses with specific exposure pathways, and specific environmental states and health outcomes, by which to measure the effectiveness of those societal responses; and (4) evaluation of gaps and trends that informs ongoing research in an iterative manner
We present the application of the conceptual framework to three distinct climate-related health outcomes, allergies related to pollen, West Nile virus (WNV) infections, and Vibrio sp. infections as illustrative examples of how this conceptual framework may be used in practice
Summary
Climate change poses one of the most significant challenges to human health around the world (Costello et al 2009). Current surveillance systems capture most deaths for which heat exposure is identified as an underlying or contributing cause on the death certificate (Vaidyanathan et al 2020), and there is a relatively robust evidence base for associations between climate change related factors like frequency of heat waves and health outcomes. For such health outcomes as heat, it should be possible to create a more complete indicator system that includes causal factors, modifying factors, and trends in outcomes. While such a systematic approach to indicators may initially be incomplete or exploratory, it may help to identify knowledge and data gaps (Beard et al 2016; Luber and McGeehin 2008; Haines et al 2006; Rogers and Randolph 2006)
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