Abstract Climate change is increasing risks to health systems in all countries with potentially catastrophic implications for public health. Complex climate events, which are expected to increase with ongoing warming, can push health systems, and the broader systems that support health, such as energy, transportation, food, and water, beyond tipping points, leading to severe consequences for individual and community health. This is particularly the case in jurisdictions already facing health and social system vulnerabilities. Guided by the World Health Organization Operational Framework for Climate Resilient and Low Carbon Health Systems we examined the literature using Embase, Medline, CAB Abstracts + Global Health, and Scopus databases to identify examples of adaptation measures for reducing risks to health and health systems from complex climate events. We also identified key gaps, in hopes of informing future research into resilience-building strategies. We found that information exists that health decision makers can use in their efforts to plan for future events. However, within the existing literature there is unequal coverage of adaptation options over health system functions as well as limited recognition of impacts from complex climate events and specific adaptation needs. Our findings revealed important deficits in knowledge on the effectiveness of adaptation measures. Many of the proposed adaptation actions do not explicitly address the interacting dynamics characteristic of complex events that may lead to more severe consequences for health and health systems. Our findings suggest that health authorities can utilize existing climate change and health guidance and tools with new approaches, such as the use of scenarios of complex climate events in table-top stress testing simulations, to plan for much higher impact emergencies and disasters. The adaptation options identified may be considered by health authorities in their vulnerability assessment and adaptation planning processes to bolster the resilience of individuals and health systems. Further research into the health implications of complex climate events and the effectiveness of adaptation options is urgently needed to inform the education and training of health professionals as they chart a path forward in preparing for a warmer world.

Climate change is increasingly impacting healthcare facilities worldwide, with those in low and middle-income countries generally facing high risks due to higher vulnerability and lower adaptive capacity. This scoping review examines resources to strengthen the climate resilience of healthcare facilities in low and middle-income countries. We used Arksey O’Malley (2005) and Levac et al. (2010) scoping review methodology to systematically search four academic databases (Scopus, PubMed, CINAHL, and Lilac), as well as Google Scholar, and the grey literature (websites from the World Health Organization, Green Climate Fund, Global Adaptation Mapping Initiative, Health Care Without Harm, and the Global Environmental Facility) between 2015 and 2024. A coding framework guided the data extraction, which was analyzed quantitatively and qualitatively (Braun and Clarke Thematic analysis). We identified 33 resources for building the climate resilience of healthcare facilities in low and middle-income countries. The resources varied in their intended audience, composition, and purpose. They produced various outputs (i.e., guidelines, checklists, or adaptation plans) that are presented in a typology to allow users to select the best resource or tool for their purposes. Our analysis identified 14 domains for building climate-resilient healthcare facilities in low and middle-income countries. We present a range of indicators under each domain for measuring the climate resilience of healthcare facilities to enable monitoring and evaluation of climate resilience-building efforts. There are a growing number of diverse resources that can be used to build climate resilience at the healthcare facilities level in low and middle-income countries. This scoping review offers a comprehensive typology of 33 resources that vary in their focus and application, enabling stakeholders to identify and apply the most appropriate tools for their specific contexts. The 14 key domains identified by this review and associated indicators provide a structured framework for assessing and enhancing climate resilience efforts within healthcare facilities. By offering a range of action-oriented resources and measurable indicators, this review supports ongoing efforts to safeguard healthcare services in low and middle-income countries against the growing impacts of climate change, contributing to the global discourse on sustainable, climate-resilient health systems.

It is critical to inform the public of the threat heat poses to health and provide actionable guidance on mitigating this risk before, during, and after heat events. To help educate the public during heat events, Health Canada works closely with Environment and Climate Change Canada (ECCC) to distribute heat-health messaging through a weather warning system. However, the warning system’s current list of messages dates back over a decade. Continually evaluating and updating messages is critical to ensure they are based on the best evidence available. A review was conducted to assess the existing heat-health messages and propose new messages based on recent empirical studies. The proposed messages were reviewed to ensure that readability and equity considerations were integrated. Academic, public health and meteorology experts across Canada reviewed the proposed messages and applied further revisions. The original list of heat-health messages included 12 messages. Based on the evidence and external reviews provided by 42 experts (academic: n = 9; public health: n = 22; meteorology: n = 11), messages were removed, merged, added and revised. The final list used by ECCC includes 30 messages. Health Canada’s heat-health messages disseminated through ECCC’s weather warning system were revised to ensure they are important, action-oriented, evidence-based, readable, equitable, regionally applicable, and timely. Ensuring these messages reflect current knowledge will be an ongoing and iterative process to support the public’s preparedness efforts to protect themselves and others during heat events.

Objectives. To describe the development, implementation, and results of a training course designed to equip health professionals from the Pan American Health Organization region with the knowledge and tools needed to adapt health systems to current climate realities. Methods. The Pan American climate resilient health systems course was a 9-week live-virtual course in March- April 2023, which was delivered through Zoom and offered in English, Spanish, and French. All lectures were delivered by local and regional climate and health experts. The curricular foundation of this initiative was the Global Consortium on Climate and Health Education core competencies for health professionals. Participants completed pre- and post-course surveys. Results. A total of 1212 participants attended at least one of the nine sessions and 489 (from 66 countries) attended at least six sessions. Of these, 291 participants completed both the pre- and post-course surveys which were used in the analysis. Longitudinal survey results suggested an improvement in participants' climate and health communication, an increased frequency of incorporating climate knowledge in professional practice, and improved confidence in engaging in climate initiatives. At the same time, many participants expressed a need for additional training. Conclusions. The results indicate that live-virtual courses have the potential to empower health professionals to contribute to climate resilience efforts by: increasing their communication skills; changing their professional practice; increasing their ability to lead climate and health activities; and preparing them to assess vulnerability and adaptation in health systems, measure and monitor environmental sustainability, and apply a health equity lens.

Abstract The increasing scale and pace of climate change impacts require rapid scaling up of actions to protect health and close the adaptation gap. Effective actions to protect health include assessing risks and vulnerabilities to current and future climate change, identifying populations that suffer disproportionately, and developing needed interventions while empowering civil society organizations and the general public. It is important to conduct a climate change and health vulnerability and adaptation assessment to understand current and projected health risks and the best adaptation options. The increasing complexity and severity of health risks requires that leaders in the health sector work closely with those in other sectors to develop climate-resilient, low-carbon health systems. Success in protecting health from climate change requires health officials to regularly monitor progress in adaptation and mitigation. Adequate investment in adaptation is critical to ensuring that individuals, communities, and health systems can effectively respond to challenges of climate change.

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.

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.

Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.

Since 2001, a synthesizing element in Intergovernmental Panel on Climate Change assessment reports has been a summary of how risks in a particular system could change with additional warming above pre-industrial levels, generally accompanied by a figure called the burning embers. We present a first effort to develop burning embers for climate change risks for heat-related morbidity and mortality, ozone-related mortality, malaria, diseases carried by Aedes sp., Lyme disease, and West Nile fever. We used an evidence-based approach to construct the embers based on a comprehensive global literature review. Projected risks for these health outcomes under 1.5 °C, 2 °C, and >2 °C of warming were used to estimate at what temperatures risk levels increased from undetectable to medium, high, and very high, from the pre-industrial baseline, under three adaptation scenarios. Recent climate change has likely increased risks from undetectable to moderate for heat-related morbidity and mortality, ozone-related mortality, dengue, and Lyme disease. Recent climate change also was assessed as likely beginning to affect the burden of West Nile fever. A detectable impact of climate change on malaria is not yet apparent but is expected to occur with additional warming. The risk for each climate-sensitive health outcome is projected to increase as global mean surface temperature increases above pre-industrial levels, with the extent and pace of adaptation expected to affect the timing and magnitude of risks. The embers may be an effective tool for informing efforts to build climate-resilient health systems including through vulnerability, capacity, and adaptation assessments and the development of national adaptation plans. The embers also can be used to raise awareness of future threats from climate change and advocate for mitigation actions to reduce the overall magnitude of health risks later this century and to expand current adaptation efforts to protect populations now.

The aim of building climate resilient and environmentally sustainable health care facilities is: (a) to enhance their capacity to protect and improve the health of their target communities in an unstable and changing climate; and (b) to empower them to optimize the use of resources and minimize the release of pollutants and waste into the environment. Such health care facilities contribute to high quality of care and accessibility of services and, by helping reduce facility costs, also ensure better affordability. They are an important component of universal health coverage. Action is needed in at least four areas which are fundamental requirements for providing safe and quality care: having adequate numbers of skilled human resources, with decent working conditions, empowered and informed to respond to these environmental challenges; sustainable and safe management of water, sanitation and health care waste; sustainable energy services; and appropriate infrastructure and technologies, including all the operations that allow for the efficient functioning of a health care facility. Importantly, this work contributes to promoting actions to ensure that health care facilities are constantly and increasingly strengthened and continue to be efficient and responsive to improve health and contribute to reducing inequities and vulnerability within their local settings. To this end, we propose a framework to respond to these challenges.

Climate change is increasing risks to the mental health of Canadians. Impacts from a changing climate may outstrip the ability of Canadians and their health-sustaining institutions to adapt effectively and could increase poor mental health outcomes, particularly amongst those most marginalized in society. A scoping review of literature published during 2000-2017 explored risks, impacts, and vulnerabilities related to climate change and mental health. In this commentary, the authors present a new assessment of evidence from this scoping review and highlight factors that influence the capacity to adapt to the mental health consequences of a changing climate. Findings from this assessment reveal eleven key factors that influence the capacity to adapt: social capital; sense of community; government assistance; access to resources; community preparedness; intersectoral/transdisciplinary collaboration; vulnerability and adaptation assessments; communication and outreach; mental health literacy; and culturally relevant resources. Attention to these factors by Canadian decision makers can support proactive and effective management of the mental health consequences of climate change.

Climate change is likely to increase drought globally and regionally, including within Canada, by the end of the century. In recent years, drought has affected communities across Canada and can have significant impacts on individuals. Health risks relate to the exacerbation of food and waterborne diseases, inadequate nutrition, impacts on air quality, vector-borne diseases, illnesses related to the exposure of toxins, mental health effects, and impacts from injuries (e.g., traffic accidents, spinal cord injuries). In Canada, the impacts of drought on human health and well-being are not well understood and monitoring and surveillance of such impacts is limited. In addition, important factors that make people and communities vulnerable to health impacts of drought require more investigation. These factors may differ significantly among the populations (e.g., rural vs urban) and regions (prairies, coastal, and northern). Vulnerability to drought health impacts in Canada due to climate change may be affected by: (1) changes in exposure as droughts increase or combine with other extreme events (wildfires, heat waves) to harm health; (2) changes in adaptive capacity due to impacts on, for example, health services from increasing extreme weather events; and (3) changes in susceptibility related to demographic (e.g., aging, chronic diseases) and socioeconomic trends. Effective measures to increase the resiliency of Canadians to drought health impacts require proactive adaptation efforts that increase knowledge of factors that make people and their communities vulnerable to this hazard, information as to how droughts might increase in the future, and integration of this information into future policies and programs. This paper identifies a set of indicators that may be used to gauge vulnerability to the impacts of drought on health in the context of climate change in Canada to inform adaptation actions.

A climate change and health vulnerability and adaptation assessment was conducted in Dominica, a Caribbean small island developing state located in the Lesser Antilles. The assessment revealed that the country's population is already experiencing many impacts on health and health systems from climate variability and change. Infectious diseases as well as food and waterborne diseases pose continued threats as climate change may exacerbate the related health risks. Threats to food security were also identified, with particular concern for food production systems. The findings of the assessment included near-term and long-term adaptation options that can inform actions of health sector decision-makers in addressing health vulnerabilities and building resilience to climate change. Key challenges include the need for enhanced financial and human resources to build awareness of key health risks and increase adaptive capacity. Other small island developing states interested in pursuing a vulnerability and adaptation assessment may find this assessment approach, key findings, analysis, and lessons learned useful.

Climate change impacts on the Canadian food system pose risks to human health. Little attention has been paid to the climate change, food security, and human health nexus, resulting in a number of knowledge gaps regarding food system components that are most vulnerable to climate change. The lack of understanding of key dynamics and possible future impacts challenges the ability of public health officials and partners in other sectors to prepare Canadians for future health risks. A series of literature reviews were conducted to establish the relationship between climate change, food security, and human health, and to identify vulnerabilities within the Canadian food system. Evidence suggests that key activities within the food system are vulnerable to climate change. The pathways in which climate change impacts travel through the food system and affect the critical dimensions of food security to influence human health outcomes are complex. Climate-related disruptions in the food system can indirectly impact human health by diminishing food security, which is a key determinant of health. Human health may also be directly affected by the physical effects of climate change on the food system, primarily related to the impacts on nutrition and foodborne illnesses. In this study, we propose a novel analytical framework to study and respond to the climate change, food security, and human health nexus. This work is intended to help public health officials, researchers, and relevant stakeholders investigate and understand current and future risks, and inform adaptation efforts to protect the health of Canadians.

Vulnerability and adaptation assessments can provide valuable input to foster climate-resilient health systems. However, these assessments often do not explore the potential health risks of climate change far outside the range of recent experience with extreme weather events and other climate-related hazards. Climate and health stress tests are designed to increase the capacity of health systems and related sectors to manage potentially disruptive climate-related shocks and stresses. Stress tests focus on hypothetical scenarios, during which it would be difficult for the health system to maintain its essential function of providing services to protect population health. The stress test explores approaches to effectively manage acute and chronic climate-related events and conditions that could directly impact health systems, and climate-related events in non-health sectors that can indirectly impact health outcomes and/or health system function. We provide detailed methods and guidance for conducting climate and health stress tests, centering on three primary activities: (1) preparing and scoping the stress test; (2) successfully conducting the stress test; and (3) communicating the results to key stakeholders to facilitate policy and programmatic reforms.

Climate change is increasing risks to human health and to the health systems that seek to protect the safety and well-being of populations. Health authorities require information about current associations between health outcomes and weather or climate, vulnerable populations, projections of future risks and adaptation opportunities in order to reduce exposures, empower individuals to take needed protective actions and build climate-resilient health systems. An increasing number of health authorities from local to national levels seek this information by conducting climate change and health vulnerability and adaptation assessments. While assessments can provide valuable information to plan for climate change impacts, the results of many studies are not helping to build the global evidence-base of knowledge in this area. They are also often not integrated into adaptation decision making, sometimes because the health sector is not involved in climate change policy making processes at the national level. Significant barriers related to data accessibility, a limited number of climate and health models, uncertainty in climate projections, and a lack of funding and expertise, particularly in developing countries, challenge health authority efforts to conduct rigorous assessments and apply the findings. This paper examines the evolution of climate change and health vulnerability and adaptation assessments, including guidance developed for such projects, the number of assessments that have been conducted globally and implementation of the findings to support health adaptation action. Greater capacity building that facilitates assessments from local to national scales will support collaborative efforts to protect health from current climate hazards and future climate change. Health sector officials will benefit from additional resources and partnership opportunities to ensure that evidence about climate change impacts on health is effectively translated into needed actions to build health resilience.

Climate variability and change are increasing risks to the health of Canadians in communities across Canada. Addressing the challenges posed by climate change requires knowledge of risks from current climate hazards, projected impacts of future climate change, the unique vulnerabilities facing specific populations, communities or regions, and measures to effectively protect health. An increasing number of health authorities from local to national levels in Canada are undertaking assessments to expand understanding of climate change impacts on health and adaptation options, educate and engage stakeholders and the public and influence policy development. Climate change and health vulnerability and adaptation assessments: (1) Provide information on the expected distribution and severity of future climate change and health impacts to health and emergency management officials, stakeholders and the public; (2) Inform efforts to mainstream information on the health impacts of climate change into existing policies and programs and/or develop new initiatives to reduce the health impacts of climate change; and (3) Support the development of inter-sectoral relationships and collaborations to influence upstream determinants of health in the context of greater climate change stressors.Building on assessment guidance developed by the World Health Organization, Health Canada developed the "Climate Change and Health Vulnerability and Adaptation Assessment Workbook" that integrates greater considerations of gender and Indigenous Population issues and knowledge into assessment steps along with guidance and indicators for gauging the resilience of health systems and services to climate change impacts.