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Abstract
Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness and response; (iii) extreme heat plans (including heat early warning); (iv) non-heat early warning (e.g., flooding, vector-borne disease); and (v) climate-health monitoring and outcome surveillance. We found most (90%) city adaptation plans reported actions in at least three of these five activity areas. However, only 73% of these health-focused plans reported involvement of a public health agency (though the share was higher for cities in low- and middle-income countries). We detected differences across the five activities, including an ascending pattern of public health engagement starting with heat plans and including activities such as preparedness and mapping as health agency involvement increased. We also identified substantial presence of other city agencies–notably urban planning, emergency management and public utilities–in implementing these health-associated activities. With every world region likely to experience more widespread and intensifying climate impacts, and growing pressure on local public health agencies in conjunction with the Covid-19 pandemic, we identify opportunities for enhancing public health engagement in climate adaptation in large cities with a view to scaling up their ability to contribute to climate adaptation goals.
Highlights
The world’s cities are major consumers of fossil-fuel energy and producers of greenhouse gas (GHG) emissions [1], making their actions to decarbonize essential to reversing anthropogenic global warming and achieving the goal of the Paris Agreement to remain within 1.5 degree C of additional global surface warming this century
For this comparative review of large health-adaptive cities, we took the following four methodological steps: We first identified a group of highly health-active large cities; second, we searched for and retrieved climate adaptation plans for these cities from public sources available on the internet; third, we used the tools of systematic review to extract comparable data from all city plans; and fourth, we synthesized results and compared them across the city plans
A recent overview of systematic reviews pointed out that extreme weather exposures and mortality and infectious disease outcomes receive the most research attention [55]; in contrast, our findings suggest cities are primarily concerned about heat-related morbidity ( heat-related illness (HRI)), impacts of extreme events on injury, displacement and loss-associated mental health, effects of drought on nutrition and infectious disease, and of temperature and extreme events on mental health
Summary
The world’s cities are major consumers of fossil-fuel energy and producers of greenhouse gas (GHG) emissions [1], making their actions to decarbonize essential to reversing anthropogenic global warming and achieving the goal of the Paris Agreement to remain within 1.5 degree C of additional global surface warming this century. With growing awareness of urban vulnerability to short-term hazards such as heat, storms and flooding, and of likely irreversibility in human generational timescales of some longer-term hazards such as sea-level rise [4] and drought [5], city decision-makers have increasingly understood the parallel imperative of adaptive action to protect urban residents. City decision-makers often have greater awareness of local adaptation priorities than those at other government levels [9], and cities in many regions have responsibility for functions affecting population wellbeing, including public health agencies or departments, often with some degree of autonomy over health-related activities. Large cities (those with populations over one million) present important population health and wellbeing risks due to the sheer number of people potentially affected by climate-driven extreme events and their interactions with complex urban infrastructure systems [11]. While large cities in high-income countries have borne significant damage to physical assets with recent extreme weather events, fast-growing large cities in lowand middle-income countries are among those with the greatest numbers of people at risk [12]
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