Bianca van Bavel

From improving health outcomes and health inequalities to ensuring energy and income security, the mitigation of and adaptation to climate change has extensive and diverse benefits. This paper describes a systematic evidence synthesis of climate action (co)benefits and trade-offs as well as the development of a decision-support tool that enables policy makers to explore that evidence-base. The term ‘(co)benefit’ is used deliberately to encompass both the direct benefits of averted impacts due to climate change as well as the indirect or ancillary benefits resulting from mitigation and adaptation interventions. We conducted a systematic search of the peer-reviewed literature in the IPCC 6th Assessment Report, Web of Science, and the Lancet Countdown on Health and Climate Change Reports. Our search strategy prioritised synthesised evidence (e.g. reviews, assessments) excluding primary studies and single case-studies. Data were extracted from 74 distinct records meeting our inclusion criteria and a total of 1785 rows of evidence were analysed. Scientific and technical teams then worked together to develop a tool interface that underwent iterative testing among a small group of potential users. The resulting (Co)Benefits Portal presents an assessment of the available scientific evidence of health, ecosystem, economic, energy, and socio-cultural (co)benefits and trade-offs associated with 40 different mitigation and adaptation actions for both global and regional scales. We then apply the (Co)Benefits Portal into a UK context, in combination with national policy documents and departmental guidance, to connect evidence about relevant climate interventions and reveal cross-sectoral policy implications that are essential for optimising opportunities and avoiding risks. We discuss how evidence-based tools can be developed to bridge critical climate adaptation and mitigation research, policy, and decision-making gaps.

Understanding the costs and benefits of climate change mitigation and adaptation options is crucial to justify and prioritize future decarbonization pathways to achieve net zero. Here, we quantified the co‐benefits of decarbonization for air quality and public health under scenarios that aim to limit end‐of‐century warming to 2°C and 1.5°C. We estimated the mortality burden attributable to ambient PM_2.5 exposure using population attributable fractions of relative risk, incorporating projected changes in population demographics. We found that implementation of decarbonization scenarios could produce substantial global reductions in population exposure to PM_2.5 pollution and associated premature mortality, with maximum health benefits achieved in Asia around mid‐century. The stringent 1.5ºC‐compliant decarbonization scenario (SSP1‐1.9) could reduce the PM_2.5‐attributable mortality burden by 29% in 2050 relative to a middle‐of‐the‐road scenario (SSP2‐4.5), averting around 2.9 M annual deaths worldwide. While all income groups were found to benefit from improved air quality through a combination of decarbonization and air pollution controls, the smallest health benefits are experienced by the low‐income population. The disparity in PM_2.5 exposure across income groups is projected to reduce by 2100, but a 30% disparity between high‐ and low‐income groups persists even in the strongest mitigation scenario. Further, without additional and targeted air quality measures, low‐ and lower‐middle‐income populations (predominantly in Africa and Asia) will continue to experience PM_2.5 exposures that are over three times the World Health Organization Air Quality Guideline.

The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020–August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises.

Background: The effects of food insecurity linked to climate change will be exacerbated in subsistence communities that are dependent upon food systems for their livelihoods and sustenance. Place-and community-based forms of surveillance are important for growing an equitable evidence base that integrates climate, food, and health information as well as informs our understanding of how climate change impacts health through local and Indigenous subsistence food systems.Methods: We present a case-study from southwestern Uganda with Batwa and Bakiga subsistence communities in Kanungu District. We conducted 22 key informant interviews to map what forms of monitoring and knowledge exist about health and subsistence food systems as they relate to seasonal variability. A participatory mapping exercise accompanied key informant interviews to identify who holds knowledge about health and subsistence food systems. Social network theory and analysis methods were used to explore how information flows between knowledge holders as well as the power and agency that is involved in knowledge production and exchange processes.Results: This research maps existing networks of trusted relationships that are already used for integrating diverse knowledges, information, and administrative action. Narratives reveal inventories of ongoing and repeated cycles of observations, interpretations, evaluations, and adjustments that make up existing health and subsistence food monitoring and response. These networks of local health and subsistence food systems were not supported by distinct systems of climate and meteorological information. Our findings demonstrate how integrating surveillance systems is not just aboutwhattypes of information we monitor, but alsowhoandhowknowledges are connected through existing networks of monitoring and response.Conclusion: Applying conventional approaches to surveillance, without deliberate consideration of the broader contextual and relational processes, can lead to the re-marginalization of peoples and the reproduction of inequalities in power between groups of people. We anticipate that our findings can be used to inform the initiation of a place-based integrated climate-food-health surveillance system in Kanungu District as well as other contexts with a rich diversity of knowledges and existing forms of monitoring and response.

Understanding how climate change will affect global health is a defining challenge of this century. This is predicated, however, on our ability to combine climate and health data to investigate the ways in which variations in climate, weather, and health outcomes interact. There is growing evidence to support the value of place- and community-based monitoring and surveillance efforts, which can contribute to improving both the quality and equity of data collection needed to investigate and understand the impacts of climate change on health. The inclusion of multiple and diverse knowledge systems in climate-health surveillance presents many benefits, as well as challenges. We conducted a systematic review, synthesis, and confidence assessment of the published literature on integrated monitoring and surveillance systems for climate change and public health. We examined the inclusion of diverse knowledge systems in climate-health literature, focusing on: (1) analytical framing of integrated monitoring and surveillance system processes; (2) key contributions of Indigenous knowledge and local knowledge systems to integrated monitoring and surveillance systems processes; and (3) patterns of inclusion within these processes. In total, 24 studies met the inclusion criteria and were included for data extraction, appraisal, and analysis. Our findings indicate that the inclusion of diverse knowledge systems contributes to integrated climate-health monitoring and surveillance systems across multiple processes of detection, attribution, and action. These contributions include: the definition of meaningful problems; the collection of more responsive data; the reduction of selection and source biases; the processing and interpretation of more comprehensive datasets; the reduction of scale dependent biases; the development of multi-scale policy; long-term future planning; immediate decision making and prioritization of key issues; as well as creating effective knowledge-information-action pathways. The value of our findings and this review is to demonstrate how neither scientific, Indigenous, nor local knowledge systems alone will be able to contribute the breadth and depth of information necessary to detect, attribute, and inform action along pathways of climate-health impact. Rather, it is the divergence or discordance between the methodologies and evidences of different knowledge systems that can contribute uniquely to this understanding. We critically discuss the possibility of what we, mainly local communities and experts, stand to lose if these processes of inclusion are not equitable. We explore how to shift the existing patterns of inclusion into balance by ensuring the equity of contributions and justice of inclusion in these integrated monitoring and surveillance system processes.