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Background Climate change is a defining issue and grand challenge for the health sector in North America. Synthesizing evidence on climate change impacts, climate-health adaptation, and climate-health mitigation is crucial for health practitioners and decision-makers to effectively understand, prepare for, and respond to climate change impacts on human health. This protocol paper outlines our process to systematically conduct a literature review to investigate the climate-health evidence base in North America. Methods A search string will be used to search CINAHL®, Web of Science™, Scopus®, Embase® via Ovid, and MEDLINE® via Ovid aggregator databases. Articles will be screened using inclusion/exclusion criteria by two independent reviewers. First, the inclusion/exclusion criteria will be applied to article titles and abstracts, and then to the full articles. Included articles will be analyzed using quantitative and qualitative methods. Discussion This protocol describes review methods that will be used to systematically and transparently create a database of articles published in academic journals that examine climate-health in North America.

The Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (2014) assessed the state of climate change and health knowledge, globally through the Human Health: Impacts, Adaptation, and Co-Benefits Chapter and regionally through chapters, such as the North America Chapter. With IPCC's 6th Assessment Report scheduled to be released in 2021-22, we asked: how has climate change and health research in North America advanced since the IPCC's 5th Assessment Report in 2014? Specifically, we systematically identified and examined trends in the extent, range, and nature of climate-health research conducted in North America. We used a scoping review methodology to systematically identify literature and map publication trends. A search string was used to search five academic databases. Two independent reviewers first screened titles and abstracts, and then the full texts of articles for relevance. Research articles and reviews using systematic methods published since 2013 were eligible for inclusion, and no language restrictions were applied. To be included, articles had to measure and link climatic variables or hazards to health outcomes in North America. Relevant articles were analysed using descriptive statistics to explore publication trends. The number of climate-health articles has significantly increased since the last IPCC Assessment Report. Published research about climate change impacts, heat-related mortality and morbidity, and respiratory illness taking place in urban centres and in the USA continue to dominate the North American climate-health literature, reflected by the high proportion of articles published. Important research gaps on previously neglected climate-sensitive health outcomes, however, are beginning to be filled, including climate change impacts on mental health, nutrition, and foodborne disease. We also observed progress in research that included future projections of climate-health risks; however, projection research is still relatively nascent and under-studied for many climate-sensitive health outcomes in North America, and would benefit from considering social and demographic variables in models. Important research disparities in geographical coverage were noted, including research gaps in Canada and Mexico, and in rural and remote regions. Overall, these publication trends suggest an improved understanding of exposure-response relationships and future projections of climate-health risks for many climate-sensitive health outcomes in North America, which is promising and provides an evidence-base to inform the IPCC 6th Assessment Report. Despite these advancements and considering the urgent policy and practice implications, more research is needed to deepen our understanding of climate-sensitive health outcomes, as well as examine new arising issues that have limited evidence-bases. In particular, transdisciplinary and cross-sector research, that includes the social sciences, examining current and future climate-health adaptation, mitigation, and the adaptation-mitigation nexus should become a top priority for research, given the urgent need for this evidence to inform climate change policies, actions, and interventions.

We reviewed the nature, range, and extent of literature on drinking water and human health outcomes in the context of climate change in the Circumpolar North. We used a systematic process to identify and synthesize articles. While the number of climate-water-health articles increased recently, this topic remains under-studied despite the transformational changes that the Circumpolar North has already experienced due to climate change. Of the climate-focused articles, most considered climate change to a major extent and discussed waterborne infections. Research examining and evaluating adaptation options and future impacts at the climate-water-health nexus is absent in the Circumpolar North. Responding to this research gap should become a top priority for research, given the urgent need for this evidence to inform climate change policies, actions, and interventions.