Health System Adaptation Research Articles

Health systems response to climate change adaptation: a scoping review of global evidence

BackgroundThe health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.MethodsThis review followed the recommendations by Arksey and O’Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.ResultsWe found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.ConclusionEfforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

How are health systems in sub-Saharan Africa adapting to protect human health from climate change threats? A scoping review and case study

BackgroundSub-Saharan Africa stands out as one of the regions most affected by the climate crisis, while it has contributed to the problem only marginally. The foreseen negative effect on health adds great stress to the already overburdened health systems. Health systems' adaptation to climate change is, therefore, urgently needed to better protect human health. There is, however, scant evidence on how adaption is being planned and implemented in Africa. The aim of this study was to review the literature on health system adaptation in sub-Saharan Africa. MethodsIn this scoping review and case study, we first carried out the scoping review, searching for publications on adaptation measures using the PubMed, Science Direct, and Web of Science databases on July 1, 2023. We included papers in English and French that addressed the adaptation of health systems in countries in sub-Saharan Africa without time limit. Second, we did a case study of the design and implementation of the National Adaptation Plan of Benin, with a specific focus on the policy-making process underlying the plan, whereby we used the health policy triangle as a policy analysis framework. Data were collected through a document review of national policy plans, reports, and evaluations. FindingsA total of 14 papers met the inclusion criteria, showing that climate change adaptation remains a niche in the literature for sub-Saharan Africa. Most included papers were authored by individuals from high-income countries. Health system adaptation measures cover seven domains: health systems strengthening; policy and planning; financing and implementation; information and capacity building; societal resilience; disaster risk prevention, preparedness, response, and recovery; and mitigation. The review found that the dominant role of global agencies in supporting or steering health system adaptation planning contributes to policy mimicry across countries, as confirmed by the case study of the adaptation plan in Benin. Benin's National Adaptation Plan prioritised three climate hazards: heat, drought, and flooding. Although the financial and technical inputs of international agencies effectively support Benin's adaptation planning, these inputs might induce a more narrow focus that does not fully respond to Benin's needs in terms of climate shocks and adaptation priorities. InterpretationHealth systems in sub-Saharan Africa are already adapting to climate change. Future research could focus on how national governments could develop adaptation plans that are responsive to local needs by making the needs analysis and priority-setting processes more inclusive of local stakeholders. FundingThe Belgian Directorate-General for Development Cooperation and Humanitarian Aid.

“I think they should give primary health care a little more priority”. The primary health care in Caribbean SIDS: what can be said about adaptation to the changing climate? The case of Dominica— a qualitative study

BackgroundAdaptation to climate change (CC) is a priority for Small Island Developing States (SIDS) in the Caribbean, as these countries and territories are particularly vulnerable to climate-related events. Primary health care (PHC) is an important contributor to CC adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The aim of this paper is to discuss health system adaptation to climate change, with a focus on PHC.MethodsWe explored the perspectives of PHC professionals in Dominica on PHC adaptation to climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly.ResultsFindings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to healthcare, with a particular focus on the environmental and social determinants of vulnerability.ConclusionThe primary health care system is a key stakeholder in the design and operationalization of adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and other environmental determinants of health to guide primary care activities to protect the health of communities. This study highlights the need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans informed by contextual knowledge in the SIDS.

Medical center for remote monitoring of patients with COVID-19 as a key element in reducing the burden on the ambulance service during the pandemic

Background. During the COVID-19 pandemic, remote consulting and monitoring technologies began to be used in medical practice to maintain the proper level of quality of patient care, ensure the efficient use of emergency medical teams (EMT) resources in conditions of increased workload and minimize the risks of infection spread. The Tomsk Region became one of the first regions of the Russian Federation to organize on its territory a Medical center for remote monitoring of patients with COVID-19 and community–acquired pneumonia (hereinafter referred to as the Center).Aim: To assess the Center’s activities effectiveness based on the analysis of indicators of the load on the EMT service during the COVID-19 pandemic.Material and Methods. The Center’s activities effectiveness was assessed based on the analysis of the key parameters of its work, as well as the study of the dynamics of quantitative and time indicators of the load on the EMT service. The information base for the study was the daily operational data of subordinate institutions of the Department of Health of the Tomsk region in the period from 01.06.2020 to 31.12.2021.Results. The positive dynamics of quantitative and time indicators of the work EMT service after the Center’s work start the confirms effectiveness of remote monitoring of the health status of patients with COVID-19. Reducing the number of calls received by the EMT service, due to the redistribution of the “non-core” load and the routing of patients depending on the reasons for treatment and the severity of the condition, allowed to stabilize the work of the ambulance in a critical situation for the industry.Conclusion. Taking into account the proven effectiveness, the experience of the Tomsk region in creating a Center that provides remote counseling to patients with COVID-19 can be applied as a measure of adaptation of regional health systems in the event of new epidemic threats.

The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study.

People living with HIV and a non-communicable disease (NCD) experience multi-level barriers when co-managing multiple conditions. We explored the factors affecting living with multiple chronic conditions in the Dominican Republic. We conducted 21 in-depth interviews from October 2019-February 2020 with Dominican adults who participated in a food security intervention and managed HIV and at least one chronic NCD. Using thematic analysis, we explored participant lived experiences co-managing multiple chronic conditions. All participants (mean age = 45.5 years) were linked to HIV care, but only three were linked to NCD-specific care. Individual-level barriers to managing NCDs included limited education and limited self-efficacy for self-management. Interpersonally, barriers included limited rapport building with an NCD-specific specialist. Structural barriers to managing NCDs were no health insurance, poor referral systems, and limited financial assistance. Health system adaptation requires equitably considering the needs of individuals managing multiple chronic conditions. Key factors to address include patient-provider relationships, improved referral systems, accessibility and availability of specialists, and financial assistance.

Adaptation of health systems to climate change-related infectious disease outbreaks in the ASEAN: Protocol for a scoping review of national and regional policies.

The Association of South-East Asian Nations (ASEAN) member states (AMS) are among the countries most at risk to the impacts of climate change on health and outbreaks being a major hotspot of emerging infectious diseases. To map the current policies and programs on the climate change adaptation in the ASEAN health systems, with particular focus on policies related to infectious diseases control. This is a scoping review following the Joanna Briggs Institute (JBI) methodology. Literature search will be conducted on the ASEAN Secretariat website, government websites, Google, and six research databases (PubMed, ScienceDirect, Web of Science, Embase, World Health Organization (WHO) Institutional Repository Information Sharing (IRIS), and Google Scholar). The article screening will be based on specified inclusion and exclusion criteria. Policy analysis will be conducted in accordance with the WHO operational framework on climate-resilient health systems. Findings will be analyzed in the form of narrative report. The reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Ethical approval is not required for this study as this is a scoping review protocol. Findings from this study will be disseminated through electronic channels.

COVID-19: implications of SARS-CoV-2 in Colombia

COVID-19 arrived to Latin America early in March 2020. Currently, strategies are being developed in Colombia focusing on the quarantine and social and economic capital reactivation, whereby the expected results are not being obtained. In this ar-ticle, we propose to review scientific evidence-based literature where information on the operation and adaptation of health systems, and social, economic and solidarity sectors of Colombia is presented. The purpose is to identify COVID-19 implications in the network that provides health services, quality of life and health-disease prognosis in the country, which is not prepared to face crises of social nature and of health systems, as well as the economic and solidarity impacts that are brought about by pandemics and crude episodes of disease.

The Multi-Dimensional Impacts of Extreme Weather Events on Human Health in a Changing Climate and the Evaluation of Climate Risks Specific to Vectoral Diseases

İklim değişikliği insan sağlığını doğrudan ve dolaylı olarak kısa veya uzun süreli etkileyebilir. Aşırı hava sıcakları kalp-damar hastalıklarına, solunum rahatsızlıklarına ve ruhsal problemlere neden olabildiği gibi doğrudan ölümlere de yol açabilmektedir. Kuraklık insan sağlığını dolaylı olarak gıda ve su güvenliğinin bozulması açısından etkilerken, sel ve kasırga gibi ani gelişen aşırı hava olayları önemli ölçüde can kaybına sebep olmakta, yakınlarını kaybeden bireyler için çeşitli ruhsal problemlerin kaynağı hâline gelmektedir. Sellerin doğrudan fiziksel etkilerinin yanında, dolaylı olarak güvenli suya erişimi etkilediği ve su yoluyla bulaşan hastalıklara neden olduğu bilinmektedir. Diğer taraftan sıcaklık ve yağış rejimindeki değişimler birçok canlının göç etmesi yoluyla vektör kaynaklı hastalıkların alansal genişlemesine ve enfekte olan kişi sayısının artmasına yol açmaktadır. Bu gelişmeler dikkate alınarak çalışmada iklim değişikliği kaynaklı hastalıklar genel boyutuyla araştırılmış ve spesifik olarak vektörel hastalıklar detaylıca incelenerek, bu hastalıkların ortaya çıkmasına neden olan iklimsel riskler değerlendirilmiştir. Çalışmada ayrıca mevcut iklimsel değişimlere bağlı ortaya çıkan hastalıklar ile yakın ve orta vade projeksiyonları kapsamında iklim değişikliğinin Türkiye’de sağlık etkileri boyutu araştırılmıştır. Ayrıca iklim değişikliği kapsamında ulusların sağlık etkilenebilirliği ve sağlık sistemi uyumu değerlendirmelerine de yer verilmiştir. Araştırma sonucunda, aşırı hava olaylarının yaşanma süresi, sıklığı ve şiddetinin giderek artmasıyla insan sağlığı için risk teşkil eden hastalıklarda ve buna bağlı etki boyutlarında artış olacağı bulgusuna ulaşılmıştır. İklim değişikliği ve aşırı hava olayları ile yaşam alanları genişleyen ve göç eden vektörlerin insan sağlığı açısından büyük risk oluşturacağı elde edilen bir diğer bulgudur. Araştırmada uzun vadede aşırı hava olaylarının su ve gıda güvenliği açısından oluşturabileceği risklerin, hâlihazırda açlık, yetersiz beslenme ve yetersiz sanitasyon sonucu ortaya çıkan hastalıkların görüldüğü bölge ve insan popülasyonunu arttırabileceği sonucuna varılmıştır. Bu kapsamda aşırı hava olaylarından etkilenme düzeyi ve potansiyel riskleri ele alan çalışmalardan hareketle, Türkiye’de gelecekte birçok vektörün yaşayabileceği ideal iklim koşullarının oluşması ve vektörel hastalıklarda artış görülmesi beklenebilir.

Integrating public health in European climate change adaptation policy and planning

ABSTRACT The study assesses the extent to which public health is integrated into European national and urban climate change adaptation policy and planning. We analyse national adaptation documents from the 27 European Union member states and interview city-level experts (n = 17) on the integration of three categories of adaptation efforts: general efforts to minimize health impacts related to climate change, targeted efforts to enhance resilience in health systems, and supportive efforts to foster the potential of the first two categories. At a national level, general efforts to address vector-borne diseases and heat-related illness are covered comprehensively, whereas efforts addressing several climate-related health risks are neglected (e.g. water-borne diseases, injuries from extreme weather and cardiopulmonary health) or overlooked (e.g. malnutrition and mental health). Targeted efforts to inform policy decisions, such as carrying out research, risk monitoring and assessments, are often described in detail, but efforts to manage day-to-day health care delivery and emergency situations receive little attention. At the urban level, health issues receive less attention in climate adaptation policy and planning. If health topics are included, they are often described as indirect benefits of adaptation efforts in other sectors and not perceived as the priority of the involved authorities. This effectively means that general and targeted efforts are the responsibility of other sectoral departments, while supportive efforts are the responsibility of the national government or external organizations. As a result, at an urban level, climate-related health system adaptation is not a policy aim in its own right, and many potentially high health risks are being ignored. In order for health risks to be better integrated into adaptation policy and planning, it is critical to interconnect national and urban levels, reduce sectoral thinking and welcome external expertize and facilitate large-scale data collection and sharing of health and climate indicators. Key policy insights We recommend focussing on cooperatively drafting strategies for integrating health issues into climate policy and planning with stakeholders at the national and urban levels, in different policy sectors and in society. Policy planners can build on the strengths of adaptation documents from other countries or cities and take note of any weaknesses. We advocate to foster co-benefits for health and climate action of various adaptation measures (e.g. by promoting active mobility and urban greenery, health impacts related to heat, (mental and physical) stress and air pollution are reduced). Large-scale data collection and sharing of health and climate indicators should be facilitated to support learning and pro-active decision-making.

Dam-mediated flooding impact on outpatient attendance and diarrhoea cases in northern Ghana: a mixed methods study

BackgroundFloods are the most frequently occurring natural disaster and constitute a significant public health risk. Several operational satellite-based flood detection systems quantify flooding extent, but it is unclear how far the choice of satellite-based flood product affects the findings of epidemiological studies of associated public health risks. Few studies of flooding’s health impacts have used mixed methods to enrich understanding of these impacts. This study therefore aims to evaluate the relationship between two satellite-derived flood products with outpatient attendance and diarrhoeal disease in northern Ghana, identifying plausible reasons for observed relationships via qualitative interviews.MethodsA convergent parallel mixed methods design combined an ecological time series with focus group discussions and key informant interviews. Through an ecological time series component, monthly outpatient attendance and diarrhoea case counts from health facilities in two flood-prone districts for 2016–2020 were integrated with monthly flooding map layers classified via the Moderate Resolution Imaging Spectroradiometer (MODIS) and Landsat satellite sensors. The relationship between reported diarrhoea and outpatient attendance with flooding was examined using Poisson regression, controlling for seasonality and facility catchment population. Four focus group discussions with affected community members and four key informant interviews with health professionals explored flooding’s impact on healthcare delivery and access.ResultsFlooding detected via Landsat better predicted outpatient attendance and diarrhoea than flooding via MODIS. Outpatient attendance significantly reduced as LandSat-derived flood area per facility catchment increased (adjusted Incidence Rate Ratio = 0.78, 95% CI: 0.61–0.99, p < 0.05), whilst reported diarrhoea significantly increased with flood area per facility catchment (adjusted Incidence Rate Ratio = 4.27, 95% CI: 2.74—6.63, p < 0.001). Key informants noted how flooding affected access to health services as patients and health professionals could not reach the health facility and emergency referrals were unable to travel.ConclusionsThe significant reduction in outpatient attendance during flooding suggests that flooding impairs healthcare delivery. The relationship is sensitive to the choice of satellite-derived flood product, so future studies should consider integrating multiple sources of satellite imagery for more robust exposure assessment. Health teams and communities should plan spatially targeted flood mitigation and health system adaptation strategies that explicitly address population and workforce mobility issues.

Family and community doctors in the context of covid-19: approaches to integrated care

The objective of this work was to perform a reflective analysis of family and community doctors' role, their approaches and needs in the context of COVID-19 pandemic in Primary Health Care. COVID-19 pandemic has a dynamic profile and has led to a great adaptation of professionals and health systems. Family and community physicians are responsible for providing specific health care, serving within a defined range, without distinction of age, sex, socioeconomic level to individuals, families and communities. Clinical care protocols based on scientific evidence help make decisions about patient care. Primary Health Care is the user's gateway to the system and is essential to control COVID-19 cases through preventive actions and health surveillance. The effect of COVID-19 on medical education is considerable, given the need to strengthen public health as competent human resources. A robust healthcare system is essential to provide quality responses to public emergencies. Primary Health Care has a great responsibility in this global pandemic challenge of COVID-19. Health promotion and disease prevention actions are essential, especially for risk groups. The family and community doctor is inserted in this context, being fundamental in the provision of care. The adaptation of the medical curriculum becomes urgent and necessary to respond to this challenge.

Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review.

BackgroundThe COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown.ObjectiveThe aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic.MethodsWe performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis.ResultsA total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies.ConclusionsThe results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service.

Impact of COVID-19 and containment measures on burn care: A qualitative exploratory study

BackgroundBurn care in India is limited by multiple constraints. The COVID-19 pandemic and the containment measures restricted access to non-COVID emergency conditions, including burns. The aim of this study was to explore the impact of the pandemic on burn care in India. MethodsUsing the qualitative exploratory methods, we conducted in-depth interviews (IDI) with plastic and general surgeons representing burn units from across India. Participants were selected purposively to ensure representation and diversity and the sample size was guided by thematic saturation. Thematic analysis was undertaken adopting an inductive coding using NVivo 12 Pro. Results19 participants from diverse geographic locations and provider types were interviewed. Three major emerging themes were, change in patient and burn injury characteristics; health system barriers, adaptation, and challenges; and lessons and emerging recommendations for policy and practice. There was change in patient load, risk factors, and distribution of burns. The emergency services were intermittently disrupted, the routine and surgical services were rationally curtailed, follow-up and rehabilitation services were most affected. Measures like telemedicine and decentralising burn services emerged as the most important lesson. ConclusionsThe ongoing pandemic has compounded the challenges for burns care in India. Urgent action is required to prioritise targeted prevention, emergency transport, decentralise service delivery, and harnessing technology for ensuring resilience in burns services.

Location-specific health impacts of climate change require location-specific responses

<p indent="0mm">Left unmitigated, climate change poses a catastrophic risk to human health, demanding an urgent and concerted response from every country. The 2015 <italic>Lancet Commission on Health and Climate Change</italic> and <italic>The Lancet Countdown: Tracking Progress on Health and Climate Chang</italic>e have been initiated to map out the impacts of climate change and the necessary policy responses. To meet these challenges, Tsinghua University, partnering with the University College London and 17 Chinese and international institutions, has prepared the Chinese Lancet Countdown report, which has a national focus and builds on the work of the global <italic>Lancet Countdown: Tracking Progress on Health and Climate Change</italic>. Drawing on international methodologies and frameworks, this report aims to deepen the understanding of the links between public health and climate change at the national level and track them with 23 indicators. This work is part of the Lancet’s Countdown broader efforts to develop regional expertise on this topic, and coincides with the launch of the Lancet Countdown Regional Centre in Asia, based at Tsinghua University. The data and results of this report are presented at the provincial level, where possible, to facilitate targeted response strategies for local decision-makers. Based on the data and findings of the 2020 Chinese Lancet Countdown report, five recommendations are proposed to key stakeholders in health and climate change in China: <bold/> (1) Enhance inter-departmental cooperation. Climate change is a challenge that demands an integrated response from all sectors, urgently requiring substantial inter-departmental cooperation among health, environment, energy, economic, financial, and education authorities. (2) Strengthen health emergency preparedness. Knowledge and findings on current and future climate-related health threats still lack the required attention and should be fully integrated into the emergency preparedness and response system. (3) Support research and raise awareness. Additional financial support should be allocated to health and climate change research in China to enhance health system adaptation, mitigation measures, and their health benefits. At the same time, media and academia should be fully motivated to raise the public and politicians’ awareness of this topic. (4) Increase climate change mitigation. Speeding up the phasing out of coal is necessary to be consistent with China’s pledge to be carbon neutral by 2060 and to continue to reduce air pollution. Fossil fuel subsidies must also be phased out. (5) Ensure the recovery from COVID-19 to protect health now and in the future. China’s efforts to recover from COVID-19 will shape public health for years to come. Climate change should be a priority in these interventions.

The Role of Intersectoral Action in Response to COVID-19: A Qualitative Study of the Roles of Academia and the Private Sector in Colombia.

The integration of health services with other sectors is hypothesised to support adaptation of health systems in response to coronavirus disease 2019 (COVID-19). This study identified barriers and enablers associated with intersectoral coordination at an early stage of the pandemic. The study focused on the roles played by the academic and private sector in different areas of public health planning and delivery concerning COVID-19 in Colombia. A qualitative approach was used to understand stakeholders' experiences and perceptions of intersectoral working in response to COVID-19 in three Colombian cities (Bogotá, Cali and Cartagena). Between March and November 2020, data was collected via semi-structured interviews conducted online with 42 key actors, including representatives of governmental bodies, universities, and professional associations. The dataset was analysed thematically using a combination of inductive and deductive methods. Organizations adjacent to the health system, including universities and the private sector, supported responses to COVID-19 by providing evidence to inform decision-making, additional service capacity, and supporting coordination (eg, convening intersectoral "roundtables"). The academic and private sector involvement in intersectoral coordination was stimulated by solidarity (being the "right thing to do") and motivation for supporting local companies (reopening the economy). Intersectoral working was influenced by pre-existing (substantive) and emerging (situational) enablers and barriers. This study showed that intersectoral coordination has played an important role in responding to COVID-19 in Colombia. Coordination was influenced by substantive and situational enablers and barriers. Based on our findings, policy-makers should focus on addressing substantive barriers to coordination, including the pre-existing tensions and mistrust among national and local healthcare actors, strict regulations and limited financial and human resources, while providing support for situational enablers, including alignment of public and private actors' interests, intersectoral government support and establishing frequent communication channels and formal spaces of interaction among sector, in processes of decision-making.

Extreme Weather and Climate Change: Population Health and Health System Implications.

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.

Health system adaptation to climate change: a Peruvian case study.

Despite mitigation attempts, the trajectory of climate change remains on an accelerated path, with devastating health impacts. As a response to the United Nations Framework Convention on Climate Change call for National Adaptation Plans, Peru has developed a national and decentralized regional adaptation plans. The purpose of this article is to understand the role and priority status of health within the adaptation planning and process. Peru was used as a case study to analyse the policy process in the creation of adaptation plans, encompassing the need to address climate change impacts on health with a particular focus on marginalized people. An actor, content and context policy analyses were conducted to analyse 17 out of 25 regional adaptation plans, which are available. The national adaptation plans (2002, 2015) do not include health as a priority or health adaptation strategies. In a decentralized health care system, regional plans demonstrate an increased improvement of complexity, systematization and structure over time (2009-17). In general, health has not been identified as a priority but as another area of impact. There is no cohesiveness between plans in format, content, planning and execution and only a limited consideration for marginalized populations. In conclusion, the regional departments of Peru stand on unequal footing regarding adapting the health sector to climate change. Findings in the strategies call into question how mitigation and adaption to climate change may be achieved. The lack of local research on health impacts due to climate change and a particular focus on marginalized people creates a policy vacuum. The Peruvian case study resembles global challenges to put health in the centre of national and regional adaptation plans. In-depth cross-country analysis is still missing but urgently needed to learn from other experiences.

Kinésithérapie et COVID-19 : de la réanimation à la réhabilitation à domicile. Synthèse des recommandations internationales

IntroductionLa pathologie connue sous le nom de Coronavirus Disease 2019(COVID-19) est responsable d’une pandémie mondiale et de nombreux décès. Ce contexte nécessite une adaptation des services sanitaires et du rôle de chacun des intervenants, dont le masseur-kinésithérapeute (MK).État des connaissancesAfin d’optimiser les soins, de nombreuses sociétés savantes ont proposé des recommandations concernant le rôle du MK mais aucune ne propose un aperçu global de la prise en charge MK. L’objectif de cette revue est donc d’en proposer une synthèse afin de faciliter la prise en charge des patients, quel que soit le stade de la pathologie.PerspectivesÉtant donné le caractère émergent du COVID-19, les recommandations proposées dans la littérature seront amenées à être ajustées en fonction de l’évolution de l’épidémie et des moyens des secteurs hospitaliers et libéraux, notamment pour le suivi à long terme de ces patients. Les recherches en cours et à venir viseront à évaluer l’impact des interventions MK proposées aux patients.ConclusionL’apparition du COVID-19 a nécessité une adaptation très rapide du système de santé. La place du MK se justifie à toutes les étapes de la prise en charge du patient afin de limiter les conséquences fonctionnelles de la pathologie.

COVID-19: implications of SARS-CoV-2 in Colombia.

COVID-19 arrived in Latin America early in March 2020. Currently, strategies are being developed in Colombia focusing on the quarantine and social and economic capital reactivation, whereby the expected results are not being obtained. In this article, we propose to review scientific evidence-based literature where information on the operation and adaptation of health systems, and social, economic and solidarity sectors of Colombia is presented. The purpose is to identify COVID-19 implications in the network that provides health services, quality of life and health-disease prognosis in the country, which is not prepared to face crises of social nature and of health systems, as well as the economic and solidarity impacts that are brought about by pandemics and crude episodes of disease.

Migrant Health Policies in the European Union: A Comparative Policy Analysis

Research ObjectiveIn an era of increasing globalization and immigration, what extent is the state responsible for the health of resident noncitizens and how should it respond, if at all? This question relates to migrant health and health policy and has been particularly salient among European nations as they have responded to an increased flow of migrants in the last two decades. The objective of this research was to explore what are the similarities and differences in policy content that can be found among the eleven migrant health policies adopted in Europe and to what extent can they be grouped or classified?Study DesignA cross‐case study of eleven migrant health policies adopted by European nations, comparative analysis of policies that broadly share the same objective, provided insight into how a group of nations conceptualized, defined, operationalized, and responded to the health of migrant populations through a policy instrument. This study identified policy variation through a two‐phased analytic process that included content analysis followed by typological analysis.Population StudiedMigrant health policies adopted in Austria, England, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden, and Switzerland.Principal FindingsThe coding scheme from content analysis of the policies was mapped onto the typology framework, leading to the emergence of four themes that are conceptually distinct “types” of policy orientation toward migrant health that include assimilation, integration, health system adaptation, and health equity.Each theme has a unique relationship with the typology matrix’s two dimensions, access to care and quality of care that was determined by stronger or weaker levels of association. The assimilation theme has a weak association with access and quality, while health equity has a strong association with the two dimensions coming together at higher levels. The integration theme is related to access to care, while the health system adaptation theme is associated with quality of care.While the four themes are conceptually distinct, the policies seem to populate them as a continuum from assimilation to health equity, rather than being evenly distributed across all four themes. The assimilation and health equity themes have clear “anchor” policies that represent all aspects of them. The remaining policies link the end points continuum with varying levels of access and quality that increase from weak to strong, moving through the integration and health system adaptation themes toward health equity.ConclusionsProducts of this research include a comprehensive, transparent coding scheme of the data, a theme‐based migrant health policy typology, four themes that are conceptually distinct “types” of orientation toward migrant health, and a migrant health policy case continuum depicting policy case association with a theme. The typology goes beyond description and classification of policies by offering a higher level of understanding of variation across the themes and cases. This is a new framework from which to compare concepts, explore dimensionality, and identify hierarchical relationships.Implications for Policy or PracticeThis research contributes to the field of migrant health policy comparative analysis with tools to inform future policy making processes and guide future migrant health policy making processes, comparative policy analysis and migrant health outcomes research.Primary Funding SourceTokyo Foundation for Policy and Research.