(C) PLOS One
This story was originally published by PLOS One and is unaltered.
. . . . . . . . . .



Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica [1]

['Giulia Loffreda', 'Research Unit On Health In Situations Of Fragility', 'Institute For Global Health', 'Development', 'Queen Margaret University', 'Edinburgh', 'United Kingdom', 'Ivdity Chikovani', 'Curatio International Foundation', 'Tbilisi']

Date: 2023-05

Abstract While scientific research supporting mitigation of further global temperature rise remains a major priority, CoP26 and CoP27 saw increased recognition of the importance of research that informs adaptation to irreversible changes in climate and the increasing threats of extreme weather events. Such work is inevitably and appropriately contextual, but efforts to generalise principles that inform local strategies for adaptation and resilience are likely crucial. Systems approaches are particularly promising in this regard. This study adopted a system dynamics framing to consider linkages between climate change and population health across four low- and middle-income country settings with a view to identifying priority inter-sectoral adaptation measures in each. On the basis of a focused literature review in each setting, we developed preliminary causal loop diagrams (CLD) addressing dynamics operating in Mozambique, Lebanon, Costa Rica, and Georgia. Participatory workshops in each setting convened technical experts from different disciplines to review and refine this causal loop analysis, and identify key drivers and leverage points for adaptation strategy. While analyses reflected the unique dynamics of each setting, common leverage points were identified across sites. These comprised: i) early warning/preparedness regarding extreme events (thus mitigating risk exposure); ii) adapted agricultural practices (to sustain food security and community livelihoods in changing environmental conditions); iii) urban planning (to strengthen the quality of housing and infrastructure and thus reduce population exposure to risks); iv) health systems resilience (to maintain access to quality healthcare for treatment of disease associated with increased risk exposure and other conditions for which access may be disrupted by extreme events); and v) social security (supporting the livelihoods of vulnerable communities and enabling their access to public services, including healthcare). System dynamics modelling methods can provide a valuable mechanism for convening actors across multiple sectors to consider the development of adaptation strategies.

Citation: Loffreda G, Chikovani I, Mocumbi AO, Asmar MK, Blanco LC, Grant L, et al. (2023) Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica. PLOS Clim 2(4): e0000184. https://doi.org/10.1371/journal.pclm.0000184 Editor: Shouro Dasgupta, Centro Euro-Mediterraneo sui Cambiamenti Climatici, ITALY Received: November 12, 2022; Accepted: March 20, 2023; Published: April 19, 2023 Copyright: © 2023 Loffreda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Causal loop diagrams refined during workshop discussion comprise the major data source of the study and are included in the submitted manuscript. Search terms and the extraction matrix used for the literature search to develop preliminary causal loop models are included as Supplementary material. Listing of the literature accessed and data extracted are lodged on the QMU eData repository: https://eresearch.qmu.ac.uk/handle/20.500.12289/12889. Funding: This work was supported by an NIHR grant (16/136/100) to AA (PI) and through a CoP26 International Climate Change Network award by the Royal Society of Edinburgh (RSE) to AA and LG for the work of the Research Unit on Heath in Fragility at Queen Margaret University, Edinburgh. This grant funded GL's role as research coordinator of the project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist.

Introduction Of all nations, low- and middle-income countries (LMIC) face the severest consequences of the climate crisis, despite having contributed the least to its occurrence [1, 2]. Climate change significantly threatens the major health gains witnessed across these settings over recent decades. Established direct and indirect pathways of influence [3] include: floods, increasing risk of water-borne disease; diminishing freshwater availability, eroding food security and sanitation; changes in temperature and rainfall impacting habitats and thus the spread of zoonotic and vector-borne disease; air pollution impacting pulmonary health and lung functions; land degradation and deforestation driving food insecurity and undernutrition; and environmental change compromising mental health [4]. Critically, highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth, exacerbate these risks [5]. Addressing these pathways therefore requires an understanding of their interaction and linkage. Adaptation and resilience measures are actions to accommodate environmental changes anticipated as a result of projected increases in global temperature, complementing mitigation actions seeking to reduce drivers of further temperature increase (centrally through reduction of carbon emissions). Resilience, a crucial theme within environmental research, has also emerged as a central concept in the health systems literature [6]. Reflecting a broader engagement in systems thinking [4, 7], research in this field has come to increasingly focus on identifying system capacities for absorption, adaptation, and transformation developed from system dynamic analyses [8, 9]. In a similar fashion, the planetary health education framework highlights the importance of using system dynamics to understand how different factors interact as part of a complex system [10]. Adaptation and resilience became focal points for CoP26: the Glasgow Climate Pact agreed by 197 countries at its conclusion set out a way forward from the 2015 Paris Agreement, emphasising the urgency of scaling up action and support to enhance adaptive capacity, strengthen resilience and reduce vulnerability [11]. The launch of the Sharm-El-Sheikh Adaptation Agenda at CoP27 then outlined thirty adaptation outcomes which can enhance resilience for up to 4 billion people living in the most climate vulnerable communities by 2030 [12]. Steps were taken to initiate a Loss and Damage Fund to pay for climate related damage for vulnerable nations made increasingly vulnerable because of the rapidity of climate related adverse events, with a Transitional Committee set up to provide recommendations on types of financing, levels of vulnerability and what the fund should cover. Understanding the interconnected nature of loss (and the amplification of different losses, such as economic impacts on the loss of cultural heritage, or habitable land) will require new data and new tools to interpret this. Systems science has strong potential in this regard [5, 7, 10, 13]. This study addressed the linkages between climate change and health, by adopting a case study approach drawing on system science. The aim was to map the complex dynamics between climate change and population health across four settings linked to the Research Unit on Health in Situations of Fragility (RUHF) network [14]. By making more explicit the interrelationships between the factors shaping climate and health in each context the aim was to identify key entry-points and pathways for targeted adaptation and resilience measures. While other studies have used system dynamics to explore the dynamics of climate change and health, they have used it for specific settings or diseases [13]. To our knowledge, this is the first study to use a comparative case study design across different settings and consider the role of broader socio-political systems in connecting climate events and human health.

Methods Theoretical framework The study adopted a socio-ecological and political ecology approach. The emerging field of planetary health reinforces the importance of the interconnections between environmental and human health and the relevance of considering these to formulate feasible solutions to the complex challenges of climate change [10]. We also drew on system thinking to better understand the non-linear relationships that exist among the complex systems under study and to address key adaptation and resilience measures. Research design We conducted case studies with partners in four low- and middle-income countries (LMICs): Mozambique, Lebanon, Georgia, and Costa Rica. These four settings each reflect some form of fragility as reflected in current OECD definitions [15], but exhibit diverse geographical, social, and political characteristics and forms of climate vulnerability. We adopted a mixed method approach incorporating a preliminary scoping literature review followed by group-based system dynamic modelling (Fig 1). PPT PowerPoint slide

PNG larger image

TIFF original image Download: Fig 1. Flow diagram of research process used to develop case studies. https://doi.org/10.1371/journal.pclm.0000184.g001 Literature review. The search strategy for the preliminary scoping literature review included key terms such as climate change, country name, and adaptation or resilience. We intentionally kept our search approach wide to ensure retrieval of a sample of papers from different disciplines. No timeframe restrictions were applied. We searched peer-reviewed articles and grey literature both in English and Spanish (for Costa Rica) in the following databases: PubMed/Medline, Google Scholar, WHO IRIS, World Bank. Based on our pre-defined inclusion criteria, we identified 36 papers. An additional six papers were shared by country partners and included for data extraction. The country specific literature was complemented and triangulated with key references from the global literature to assess accuracy of information on the more general issues. We piloted, revised, and finalised an extraction matrix covering the following information: bibliographic information; socio-ecological factors (such as climate, political, social stressors, human health, animal health) [16]; adaptation and resilience measures proposed; political ecology factors [17]; and other themes such as gender [18]. Participatory workshops and system dynamic modelling. We collated information from this preliminary scoping literature review–separately for each country—using a causal loop seed model (see Fig 2) suggested by the work of Proust and colleagues [13]. This spatially located variables identified in the reviewed literature with respect to three core domains: the state of the earth system; human made influence/activities, and human health/wellbeing. An initial causal loop diagram (CLD) was then elaborated for each country linking geographical, socio-political, health system, disease, and extreme weather event variables on the basis of the evidence presented by the reviewed literature and the research team consultations. CLDs were developed using the software package Vensim MLE. PPT PowerPoint slide

PNG larger image

TIFF original image Download: Fig 2. Seed model adopted for the development of causal loop diagrams. Adapted from Proust et al. (2012) showing five key causal linkages between the state of the earth system, human influence and activities and human health and well-being. https://doi.org/10.1371/journal.pclm.0000184.g002 These CLDs were then refined during online consultations with collaborators in each setting. The consultations involved participatory workshops with health, climate and environment specialists. Each workshop lasted approximately 2.5 hours and was conducted online between July and August 2021. A total of 18 participants took part across the four workshops. Participants, selected using a snowballing approach, were predominantly academics in different fields (climate science, health, forestry, economics etc.) and all based in the countries under study. Workshops involved confirmation of the key variables of relevance and negotiation–on the basis of the local multidisciplinary expertise and evidence available–of the core dynamics linking them. Participants were asked to confirm the relevance of each variable in turn, confirm or revise its pathway of connections and suggest additional variables linked to that pathway [7]. Feedback from participants was integrated into the CLDs in an iterative manner, editing the diagram on screen. While discussions and model development followed the lead of participants (that is, the sequence of addressing variables and the pathways connecting them followed the flow of discussion of system dynamics by the group), it was ensured that all pathways were scrutinised at some stage of the workshop. Once the CLD reflected the inputs of all participants, the group was invited to indicate potential leverage points for instituting adaptation measures that would impact the dynamics mapped for their setting [13]. The implications for national and local adaptation strategies were then discussed. On the completion of each workshop the CLD was finalised by the research team, utilising a recording of the session to ensure that it reliably reflected the analysis of the group in terms of the directionality of connections and their polarity (i.e. whether they acted to increase or decrease the value of a connected variable) [7, 13]. Finally, after all four workshops were completed, researchers present at each conducted an integrative analysis, comparing the four models to identify common features and potential synergies regarding adaptation strategy. This analysis was shared and revised with input from the full research team. Ethics. Ethical approval for the research was granted through the Research Ethics Panel at Queen Margaret University (QMU).

Discussion Climate change represents a significant threat globally, but particularly for LMIC and fragile settings. Linkages with health are increasingly recognised and becoming prioritised in the global health agenda [53]. While the Sharm-El-Sheikh Adaptation Agenda [12] does not list health as one of the ‘impact systems’ targeted for adaptation, its recognition of the importance that ‘actors across several sectors see … their actions and progress mutually reinforce to overcome obstacles, break silos, enhance synergies and create catalytic action’ has clear implications for acknowledging the linkage of climate, health and other human systems. Indeed, the analyses presented illustrate how the ‘impact systems’ defined within the Sharm-El-Sheikh Adaptation Agenda –food and agriculture; water and nature; human settlement; coastal and ocean systems; infrastructure; planning; and finance–in practice richly interact with each other in shaping well-being. This research thus aimed to contribute to understanding by providing country specific findings and recommendation and by developing further the adoption of system thinking methodologies for use for climate and health research. We used a case study approach based on system dynamic modelling to identify adaptation strategies in four settings that present different fragility features. The aim is ultimately to sustain the development of climate-resilient health systems, in line with the WHO operational framework [54]. The findings also speak directly to the interventions outlined in the WHO guidance for climate resilient and environmentally sustainable healthcare facilities [55] in providing evidence of the amplification of impacts through the interconnectedness of the challenges. This not only informs adaptation and mitigation measures required but also signals the co-benefits of investments in, for example, solar power, where transition from fossil fuels reduces carbon emissions, mitigates the destabilising effects of energy systems facing outages because of adverse climate events, and reduces health risks through cleaner air. The causal loop diagrams presented in this paper act as useful starting points to identify fragility and leverage points that can support the policy development process. The use of system thinking has been recognised to be a key element to unpack climate change and build resilient health systems. Systems thinking, which stems from complexity theory, analyses the interactions between systems’ components to explain how and why they give rise to observed system outcomes and behaviours [56]. System thinking is particularly useful to support multi-sectoral collaboration through a shared understanding of the nexus between climate change and health and to foster political action by identifying effective strategies. For instance, the four models developed for this study highlighted the need to build surveillance and early warning systems. Key steps to reach these goals would include establishing key indicators [57], such as the ones suggested by The Lancet Countdown on health and climate change (e.g., risk exposures, vulnerability factors, adaptation, planning, and resilience; mitigation and health co-benefits; economics; and political engagement) [58]. In this regard, risk assessment and health impact assessments should be integrated in routine assessments to quantify climate-driven health impacts. A system thinking approach to climate change and its impact on health is well suited to support health in all policy (HiAP) approach. HiAP is required to develop a comprehensive response to the risks presented by short-term climate variability and long-term climate change [59] and to define the health components of National Health Adaptation Plans (NHAPs) under the UN Framework Convention on Climate Change (UNFCCC). By identifying vulnerabilities in the health system as well as opportunities to increase the resilience of health systems to climate change, countries will be making important steps to achieve Universal Health Care (UHC). Climate-driven health outcomes should be included in the essential health services coverage by way of workforce training on climate–health relationships, financing, and increasing resilience of health care service delivery which may be disrupted during climate-related events (e.g., storms, and flooding). These can bolster UHC to address context-specific climate-driven health effects that are already being experienced and expected to worsen over time. Overall, more research and action are required to avoid the effects of climate change aggravating even further global health inequalities. A more profound question of justice is at play, whereby climate change interacts with existing social and economic disparities and exacerbates longstanding trends within and between countries. Finally, it is essential to incorporate different types of knowledge and an indigenous lens into the conceptualisation and implementation of planetary health [60]. Limitations To our knowledge, this is the first study that presented country case studies on the link between climate change and health using system thinking. Even though we used a robust methodological approach, some limitations need to be noted. Given the qualitative nature of the approach, we acknowledge that researcher perspectives may have influenced the work and findings; however, researchers from diverse backgrounds and from local contexts collaborated on the synthesis of the CLDs, bringing in diverse positions and perspectives.

Conclusions Our research highlights five important lessons. First, system dynamics modelling methods, such as participatory group model building, provide a useful mechanism for convening actors across multiple sectors to consider the development of adaptation strategies. Consultations at national and local levels using approaches informed by systems dynamics should be used to identify linkages that can promote–or, unattended, would undermine—coherent, cross-sectoral action in support of adaptation. Second, in line with the OECD multi-dimensional analysis of fragility [61], climate-related environmental risks need to be increasingly factored into appraisal of state and regional fragility, alongside issues of security and social, economic and political risks. Third, our modelling has highlighted how pathways of impact of climate change can disproportionally affect those with lower household incomes, exacerbating inequalities. Adaptation strategies need to consider a priori investments which prioritise social security of vulnerable communities and populations. Fourth, strategies focused on strengthening health systems resilience need to consider the relevant influences not only of national preparedness and early warning systems, but also of evolving agricultural (and wider livelihood) practices and patterns of settlement. Finally, fifth, effective data monitoring systems need to be prioritised at national level to integrate information from all relevant sectors, with datasets and analyses shared across all ministries. We consider these lessons to have important implications for conceptualizing adaptation both nationally and globally. In terms of the former, we have shared findings with governmental partners regarding national climate adaptation strategy and, in Mozambique, are working with the National Institute for Health on a major prospective study of community adaptation measures in three locations at particular risk for extreme weather events. In terms of the latter, the lessons have been shared in a range of fora, ranging from fringe meetings in the context of CoP26 in Scotland to the multi-stakeholder policy forum of the 2023 Prince Mahidol Award Conference in Bangkok focused on ‘Setting a New Health Agenda: at the Nexus of Climate Change, Environment and Biodiversity’. By such means we aim for findings to foster the adoption of systems thinking in the formulation of adaptation strategies reflecting the dynamic linkages between climate change, health, and other human systems.

Acknowledgments We are deeply grateful to our workshops participants who provided their knowledge, time and expertise to develop the case studies. These include: Dr Maia Uchaneishvili, Research Unit Director, Curatio International Foundation; Dr Nia Giuashvili, Environmental Health Expert, Advisor of the National Center for Disease Control and Public Health General Director on Environmental Health; Dr Mariam Maglakelidze, Head, Department of Institutional Culture Development, Petre Shotadze Tbilisi Medical Academy; Affiliate Scholar, Institute for Advanced Sustainability Studies, Potsdam, Germany; Ina Girard, Climate Change and Human Health Expert, WHO Focal Point on the Environmental Health Issues at the National Environmental Agency; Dr Tamar Kashibadze, Public Health Specialist, NCD Department, National Center for Disease Control and Public Health; Dr Tatiana Marrufo, Instituto Nacional de Saúde (INS), National Health Observatory Technical Secretariat, Program Lead of Environmental Health; Dr Fady Asmar, Forestry Expert, Lebanon; D.E.A. Pascal Girot, Head of the School of Geography, Universidad de Costa Rica; Dr Valeria Lentini, Lecturer, School of Economics, Universidad de Costa Rica; Dr Juan Robalino, Head of the Economics Research Institute, Universidad de Costa Rica; Dr Yanira Xirinachs-Salazar, Associate Professor, School of Economics, Universidad de Costa Rica; and Dr Paola Zúñiga-Brenes, Associate Professor, School of Economics, Universidad de Costa Rica.

[END]
---
[1] Url: https://journals.plos.org/climate/article?id=10.1371/journal.pclm.0000184

Published and (C) by PLOS One
Content appears here under this condition or license: Creative Commons - Attribution BY 4.0.

via Magical.Fish Gopher News Feeds:
gopher://magical.fish/1/feeds/news/plosone/

You are viewing proxied material from magical.fish. The copyright of proxied material belongs to its original authors. Any comments or complaints in relation to proxied material should be directed to the original authors of the content concerned. Please see the disclaimer for more details.