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A demand-driven climate services for health implementation framework: A case study for climate-sensitive diseases in Caribbean Small Island Developing States [1]

['Avriel R. Díaz', 'Department Of Earth', 'Environmental Sciences', 'Columbia University', 'New York', 'United States Of America', 'International Research Institute For Climate', 'Society', 'Iri', 'Lamont Campus']

Date: 2024-10

Here we introduce a demand-driven framework designed to implement climate services in the health sector, with a particular focus on the Caribbean region. Climate services are essential for supporting informed decision-making and response strategies in relation to climate-related health risks. Through collaborative efforts, we are co-producing a climate-driven dengue early warning system (EWS) to target vector-borne diseases effectively. While challenges exist in implementing such systems, EWSs provide valuable tools for managing epidemic risks by predicting potential disease outbreaks in advance. The scarcity of operational climate tools in the health sector underscores the need for increased investment and strategic implementation practices. To address these challenges, a demand-driven framework is proposed, emphasizing strategic planning focused on health intervention development, partnership building, data, communication, human resources, capacity building, and sustainable funding. This framework aims to integrate climate services seamlessly into health systems, thereby enhancing public health resilience and facilitating well-informed decision-making to effectively address climate-sensitive diseases.

Funding: This work was supported by: European Development Fund CRIS: FED/2019/41949 Wellcome Trust grant number 226069/Z/22/Z. Royal Society Dorothy Hodgkin Fellowship: DH150120 European Union NextGenerationEU/PRTR: RYC2021-034691-I and MCIN/AEI/10.13039/501100011033 Funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Díaz 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.

Introduction

According to the World Health Organization, “climate change is the single biggest health threat facing humanity” [1]. Changing temperature and precipitation patterns, and more frequent extreme weather events threaten human health worldwide [2,3]. These impacts are further compounded by the distribution of socioeconomic and demographic factors, placing vulnerable populations at greater risk, including low-income communities, children, the elderly, individuals with pre-existing health conditions, and those residing in low-lying coastal cities prone to flooding and sea level rise [4]. The Caribbean Small Island Developing States (SIDS) are uniquely vulnerable to climate-related health hazards due to their location within the North Atlantic hurricane belt, composition of small, low-lying islands, and dependence on natural resources and tourism. Critical climate and health concerns in the Caribbean include the increased frequency and intensity of tropical storms, heat waves, droughts, worsening air pollution, disruption of food production and supply, interruption of water supply and sanitation services, and increased transmission of infectious diseases [5]. Thus, it is critical that current and future climate-related human impacts are embedded into public health decision-making, primarily through the development of climate services for the health sector.

Climate services for health leverage climate information to support health sector decisions by improving the efficiency and effectiveness of long-term planning and short-term response. This in turn can improve the efficiency of resource mobilization in anticipation of climate-related health risks, enabling more effective prevention and response strategies. The Caribbean region is placing significant emphasis on developing climate services to improve preparedness and response to vector-borne diseases (VBDs), that is, dengue, Zika, and chikungunya [6]. To enhance regional integrated surveillance efforts for the prevention of VBD outbreaks, the Caribbean Public Health Agency (CARPHA), the Pan American Health Organization (PAHO) and the World Meteorological Organization (WMO)-designated Regional Climate Centre for the Caribbean (Caribbean RCC) hosted by the Caribbean Institute for Meteorology and Hydrology (CIMH) are focusing on the co-production of climate-driven impact based disease early warning systems (EWS) with member states in the region [Fig 1] [7–11]. At its operational core, an EWS can be defined as a system that collects, analyzes, and disseminates information about potential hazards or risks. We will hereinafter refer to this operational core as the EWS. However, it should be noted that an EWS further comprises (1) an information portal where the early warning information is stored and accessed and from where the information is disseminated; and (2) awareness, education and outreach to enhance capacity for both the providers and the users of the information."

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TIFF original image Download: Fig 1. When developing climate services for climate-sensitive infectious diseases (CSIDs), stakeholders across multiple sectors are involved. Therefore, developing comprehensive public health action requires collaboration, cooperation, communication, and an understanding of common goals and outcomes, as well as recognition of the contributions from different parts of the stakeholder community to the decision-making and response processes [12]. https://doi.org/10.1371/journal.pclm.0000282.g001

Climate variability and change have both short- and long-term effects on VBDs, interacting with many biological, social and environmental factors [13]. For example, climate impacts human interactions with pathogens, vectors, and non-human hosts, affecting the transmission dynamics, geographic spread and re-emergence of VBDs. Vector abundance, survival, and feeding activity increase with rising temperatures (up to thermal optima) due to the dependence of arthropod body temperature on the external environment. Rising temperatures may also increase viral production in the host, thus making it more infectious [14]. The relationship between precipitation and VBD is complex and context specific. Increased precipitation can fill containers and provide more suitable breeding sites for disease vectors (it is important to note that too much precipitation can also flush oviposition sites). However, drought can also increase the number of breeding sites around households due to the increased need to store water-if improperly stored [9].

Together with the CARPHA, PAHO, CIMH and other regional partners, we are working to co-develop tailored statistical climate-and-health models and simultaneously co-design sustainable tools that can be implemented and operationalized to support long-term decision-making and help build resilience to climate-sensitive infectious disease threats [Fig 2]. Here, ‘operationalization’ is defined as the act to turn disease surveillance, demographic data and climate indicators into valuable tools and information that health practitioners and disease control and prevention teams can use to protect the public from climate-related health risks. We define climate tools as a resource, application, or technology designed to help decision-makers; these tools can encompass a range of functionalities, such as climate data visualization, vulnerability mapping, and decision-support. Finally, we distinguish between partner and stakeholder as the following: a partner is actively involved in the co-creation and decision-making processes of a project, while a stakeholder is affected by or has an interest in the outcomes of the project but may not be directly involved in its execution.

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TIFF original image Download: Fig 2. Partners involved in the co-production of the Early Warning System (EWS). Top left: National-level partners; top right: Regional partners; bottom right: Academic institutions and inter-governmental organizations; bottom left: Funders who have supported this process. All partners excluding funders were present at the 2022 regional meeting where we discussed early warning system opportunities and challenges for implementation. Partners present at the meeting are co-authors on the paper. https://doi.org/10.1371/journal.pclm.0000282.g002

Developing climate services for the health sector is a prominent subject in climate adaptation [15,16]. However, transitioning from theoretical models to practical implementation can be challenging [17]. Disease early warning systems provide tools for decision-makers in the health sector to proactively manage and mitigate epidemic risks, enabling more targeted and timely responses to protect public health. EWSs which employ seasonal climate forecasts can predict changes in impending disease risk up to 3–4 months in advance [18]. This is critical in resource-limited areas where sufficient lead time permits the timely optimization of resource allocation and preventive measures, reducing the overall burden on healthcare systems. The extended disease response time provided by early warnings can improve the likelihood that community members, hospitals and healthcare facilities are prepared and do not collapse [19], particularly in resource-constrained contexts such as Caribbean Small Island Developing States (SIDS). Further, the health sector can develop tailored interventions to support communities in taking action to prevent an outbreak from occurring [Fig 3] [20].

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TIFF original image Download: Fig 3. The co-production of climate services, information, and resources for the health sector is an important step in addressing the health impacts of climate change and variability. It is critical that the health sector is equipped with proper climate services that can help to reduce negative health outcomes and crises [21,22]. https://doi.org/10.1371/journal.pclm.0000282.g003

Although EWSs are invaluable climate-and-health services, few of these systems have been implemented and operationalized. A 2021 landscaping analysis on available climate tools for infectious diseases [23] showed that globally over the last ten years, of the 9,500 papers identified in the literature review, only 37 tools were available for use by decision-makers. One example is the AeDES interactive map room climate-and-health service which incorporates four different environmental suitability models, considering climate factors and mosquito life cycles, that allow decision-makers to monitor and forecast diseases in several parts of the Americas [24]. However, the low number of available tools suggests a lack of investment or incentives for researchers in academia or companies to develop operational climate tools for the health sector. Finally, most of the identified tools (81.1%) were focused on vector-borne diseases, demonstrating a shortage of tools for respiratory, foodborne, and waterborne diseases [23].

The 2021 landscaping study also featured interviews with worldwide experts to determine the top barriers that prevent decision-makers from using climate tools in the health sector [25]. Key barriers included a lack of funding to move from tool to service, lack of political mandate for the health sector to address climate issues, lack of communication between decision-makers and scientists, language barriers, lack of formal education (e.g., university curriculum or professional training), and lack of formal collaboration agreements between climate and health sectors to facilitate joint work plans [10]. A 2021 literature review of climate change and health in the Caribbean found very few examples of integrated early warning information systems to increase the availability and dissemination of climate information to inform health sector planning. The study recognised the need for more comprehensive and responsive national systems based on multi-sectoral design and implementation approaches [26].

Implementing climate services can be challenging. Here, a demand-driven implementation guideline is proposed. This guideline was developed through years of capacity building dialogues and stakeholder meetings across the Caribbean region and further refined during a 2022 multi-sectoral national workshop held in Barbados, which focused on implementing a climate-driven dengue early warning system with key stakeholders across the climate and health sectors. This study aims to create a general implementation framework for climate services for the health sector that is useful for scientists and decision-makers in the Latin America and Caribbean (LAC) region. Here, a case study from Barbados is being used to validate guidelines for the implementation process. Finally, the objective of this work is to provide a framework for the effective design, development, and integration of climate services into health systems, with the aim of enhancing public health resilience, reducing climate-related health risks, and promoting informed decision-making in response to and in anticipation of changing climate conditions.

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[1] Url: https://journals.plos.org/climate/article?id=10.1371/journal.pclm.0000282

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