Search

"Toward a Sustainable Health System: A Call to Action" speaks of the challenge that the climate crisis poses for health systems. The scale of the accelerating crisis will require that health systems adapt in response and also become visible champions for change, mitigating the environmental harms of their operation and mobilizing their social networks and leadership potential to build community resilience and transformative capacity. The authors pay principal attention to the issues of environmental sustainability and also review the linked challenges of social and economic sustainability, given the imperatives of environmental and social justice and the need for a revitalized economic vision to support livable futures. The authors' aim is to accelerate ambition in Canada, where coordinated effort and national leadership have been lacking. They close with recommendations to achieve a net-zero health system in Canada by or before 2050., (Copyright © 2020 Longwoods Publishing.)

Background Respiratory care is an important site for climate action, given that common treatments for conditions such as asthma and COPD produce significant greenhouse gas emissions, even as respiratory health is negatively impacted by climate change. Clinical guidelines provide key information for healthcare professionals and can promote approaches to healthcare that can mitigate negative environmental impacts, and optimise patient treatment, care delivery, and equitable outcomes, and bring awareness and legitimacy to sustainable healthcare practices. Methods Twenty national and international clinical respiratory guidelines were purposively selected and screened for inclusion of four principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean service delivery, and low carbon alternatives. A screening framework specific to respiratory care implications was developed and used to review each guideline for mention of relevant topics, recommendations, and explicit links to sustainability in relation to each principle. Findings Sustainable clinical care principles were evident in most guidelines reviewed, environmental sustainability was mentioned infrequently. Many guidelines emphasised prevention (more secondary than primary) and support for patient preference and streamlining care, yet there was rarely mention of how these recommendations could contribute to lowering the environmental impacts of health systems. Low carbon alternatives were mentioned in only three guidelines. Conclusions While many clinical respiratory guidelines make recommendations in accordance with the principles of prevention, patient empowerment and self-care, and lean service delivery, reducing the carbon footprint of healthcare was rarely mentioned in the guidelines. Including explicit attention to the environmental impact of clinical care in guidance could support efforts to reduce the wider harms of healthcare, meanwhile, noting the clinical benefits of sustainable approaches could promote the uptake of recommendations. [ABSTRACT FROM AUTHOR]

This paper presents the results of a detailed review of the research literature on how nomadic pastoralists are being affected by climate change, how they are adapting, and challenges with using traditional knowledge in adaptation. It focuses on research that investigates local, and particularly traditional, knowledge of water, pasture, their variability, and livestock. This knowledge underpins nomadic livelihoods, so is a foundation for effective adaptation. Changes in the total amount of precipitation, and particularly shifts in its timing, and increases in the frequency and intensity of extreme events, are having the greatest impacts on herding livelihoods. Herders in drylands worldwide face common adaptation challenges: declining traditional water sources and pasture degradation. Herders' adaptation strategies fall into five major categories: movement to areas with better water and pasture, improving seasonal access to water, improving seasonal access to feed, shifts in herd composition, and livelihood diversification. Movement is central to nomads' adaptation, yet, as climate change takes hold, restrictions on movement are increasing for both socio-economic reasons and climate reasons. Many papers emphasised the importance of combining traditional knowledge and current science to guide adaptation decision-making at household, locality, and national levels. There is widespread concern about the decline in traditional knowledge. All the papers reviewed emphasised the need to support passing on traditional know-how. Herder women's know-how, in particular, is marginalised in the research literature, so their traditional knowledge should be a focus in further research. Herders' adaptations are mostly localised, incremental, and have a relatively short-term focus. As nomadic pastoralism moves further outside the range of historical experience, the possibility of more profound transformations looms. [ABSTRACT FROM AUTHOR]

In this article, on behalf of The Shadow Places Network, we outline a working manifesto of politics and practice. We mobilise the format of the manifesto to speak to an uncertain and damaged future, to begin to imagine other possible worlds. For feminist philosopher Val Plumwood, whose thinking inspires this network, shadow places are the underside of the capitalist fantasy, 'the multiple disregarded places of economic and ecological support'. In turning towards shadow places, and the unjust and unsustainable processes that produce them, we call for an environmental humanities that reaches beyond abstraction, fosters new responsibilities, considers the uncomfortable, and generates reparative possibilities and alternative futures. We aim to continue to trace out a world of shadow places. We acknowledge that these shadow places cannot be known in full, but through a willingness to engage in careful conversation with the beings and places harmed by (or strategically shielded from) processes of the Anthropocene, we can learn how to relate to each other and these places in more just ways. Recognising that shadow places are impermanent and contingent, this working manifesto does not look to predetermine or prescribe but rather invites conversation, encounter and exchange. In so doing we choose to contribute to making different worlds possible by pursuing new collaborations, new methods and new politics. [ABSTRACT FROM AUTHOR]

• State-led resettlement is increasingly justified on environmental grounds. • A mixed-methods approach captures people's lived experience after resettlement. • Structural and proximate forces shape people's livelihoods after resettlement. • Inequalities are apparent in the way many are not able to recover and adapt in-place. • Increased out-migration after resettlement represents a form of double displacement. Migration is an expression of shifting human-environment relations in response to changing risks and opportunities. Under modernist development regimes, the perceived environmental qualities of a locality have been used to justify state-led initiatives to encourage people to settle in particular places, in order to exploit favourable conditions and resources. In more recent decades, as the environmental consequences of modernist development intensify, environmental risks increasingly form part of the justification for state-led resettlement schemes to protect people or, purportedly, to protect the environment from people. The success of such resettlement schemes, in terms of contributing to improved livelihood outcomes for affected people, is greatly undermined however by the lack of large-scale support required to recover livelihoods. This paper looks at the complex relations between environmental change, resettlement and migration. It is based on research of two resettlement schemes in the Mekong Delta, Vietnam undertaken in the 2000s, that sought to reduce people's exposure to environment risks. Subsequent environmental deterioration in the resettlement areas, together with key agrarian changes, has undermined the capacity of people to recover from the disruption of resettlement and adapt their livelihoods to new risks and opportunities, resulting in increased outmigration. We argue that whilst large-scale, state-led resettlement schemes are often designed in response to life-threatening risks, without supporting the capacity of people to adapt to the everyday risks of deteriorating environmental conditions, reduced access to resources and limited employment opportunities, then livelihood precarity will persist resulting in a kind of double displacement. As such the increased out-migration from resettlement sites should not be seen as indicative of new adaptation pathways but, due to the largely involuntary nature of such migration, it should rather be understood as an expression of the limits of adaptation in the new localities. The underestimation of the level of support required for people to recover and adapt following resettlement reflects the technocratic way in which resettlement is approached and the failure to appreciate the scale of disruption associated with the cumulative and combined effect of slow-onset environmental deterioration. [ABSTRACT FROM AUTHOR]

Climate change will affect communities in diverse and differentiated ways, so adaptation approaches must strive to address social justice in order to reduce inequality. This paper applies a social justice framework to examine planning for sea level rise in a densely populated coastal settlement in eastern Australia. The Lake Macquarie area is highly vulnerable to sea level rise with local adaptation planning already underway. An in-depth case study is presented that draws upon 19 interviews with key informants and householders and a structured document and media analysis from 12 newspapers. This qualitative data was analysed to identify: the range of understandings of what is just in planning for sea level rise; and key factors that influence perceptions of justice in planned retreat scenarios. The study concludes that there is a need for guiding principles in decision-making that explicitly address social justice in order to realise more equitable outcomes. [ABSTRACT FROM AUTHOR]

Herders in Mongolia have adapted to changing environmental conditions over thousands of years through innovations in pasture and herd management practices, knowledge, collective institutions and mobility strategies, yet they now face unprecedented climate risks threatening their livelihoods, economies and ways of life. This paper presents the results of a study into how herder communities adapt to climate change and the potential role an ecosystem services approach could play in informing the development of effective adaptation strategies. The findings are based on semi-structured interviews with herders, key informants, focus group discussions and a survey of nomadic households in Northeast Mongolia. The benefits of pasture ecosystem services have changed considerably due to climatic and socio-economic changes in the Mongolian steppe resulting in degradation of the pastureland and water resources. The ways that traditional ecological knowledge and practices can support adaptation to climate change are explored. In particular, the seasonal movement of nomads represents a valuable form of knowledge and practice of adaptation in response to the changes in temperate dryland ecosystems. To continue to maintain mobility as part of adaptation strategies other adaptation actions are required, such as the implementation of an appropriate livestock insurance systems that addresses climate and weather risks, and restoration of dryland ecosystem services, notably through reforestation and improvement of water supplies. Further changes in the pastureland ecosystems may lead to further adaptations in nomadic livelihoods, leveraging nomadic herders' knowledge of local ecosystem services. [ABSTRACT FROM AUTHOR]

The potential benefits of developing a research agenda that explicitly reconstructs a world regional political ecology are explored through a focus on climate change mitigation and adaptation in the Asia Pacific. Through an examination of scale in political ecology, world regional political ecology is identified as a promising analytical and political approach to understanding and addressing the current challenges associated with climate change. In light of this, political ecology scholarship in the region is reviewed to identify current strengths and lacunae. Whilst there is indeed a rich tradition of political ecology research across the Asia Pacific, much of this research focuses upon local/national/global dynamics with relatively little attention devoted to supra-national processes, missing important social, political, financial and material processes constructed at the world regional scale. It is argued that a world regional political ecology of climate change should build upon strengths in previous political ecology work yet extend these in three generative directions: comparative analysis of place-based, single issue research; generation of diverse counter-narratives at the regional scale; and consideration of flows and networks. We argue a rescaled political ecology that incorporates world regional scales opens a range of possibilities for practicing and pursuing more just and progressive climate politics and initiatives. [ABSTRACT FROM AUTHOR]

Connections to place and relations between people are being radically reconfigured in response to climate risks. Climate change is likely to increase the scale of displacement in the Asia Pacific region, leading to intensified patterns of migration as well as resettlement. These two processes, though differing in terms of individual agency and the role of the state, are likely to further exacerbate pressure on urban areas. As the limits to adaptation in risky places are reached, people are increasingly pursuing migration as a way of coping. This strategy demonstrates people's agency to respond to risks and opportunities. Resettlement, in contrast, tends to undermine people's agency. This risk response is increasingly being implemented by states as part of climate change adaptation plans, yet, it often results in the creation of new vulnerabilities for those forcibly resettled. Through a focus on the 'climate hotspot' of the Mekong Delta, Vietnam, this paper explores how communities and governments might anticipate and resolve some of the humanitarian, livelihood and ecological challenges associated with resettlement in an increasingly resource-constrained and risky climate future. The concept of just resilience is proposed as a lens through which the consequences of resettlement for people's connections to place, each other and familiar ways of life can be understood. It is argued that a focus on just resilience reveals opportunities and threats to procedural, distributive and recognition elements of justice associated with adapting to climate change. [ABSTRACT FROM AUTHOR]

The paper conceptualises the process of voluntary relocation undertaken by rural farmers to informal settlements in coastal cities. These are journeys that occur without formal institutional support, utilising migrants' own agency. Learning from these community‐driven relocations has merit in rethinking climate change adaptation at the regional level. In this paper we present stories of 17 families who have progressively relocated to the fringes of Khulna city in southwestern Bangladesh. We observe three key attributes: first, relocations are slow, neither singular nor immediately completed, but rather take months of careful back and forth journeys of family members between their places of origin and destination. Second, relocations rely on small networks of relatives and acquaintances at the destination. Third, relocations are built on shared responsibilities distributed among a range of actors in places of origin and destination. We conclude that these slow, small and shared relocations are likely to be realised as forms of ongoing adaptation by rural farmers if their aspirational mobilities, social relations and supports are maintained at a regional scale. This kind of migration as adaptation may bring about just outcomes for those displaced without necessarily promoting rigid planning interventions that tend to fix resettlement solutions in place and time. [ABSTRACT FROM AUTHOR]

Increasingly the environment, and climate risks in particular, are influencing migration and planned resettlement in Vietnam, raising the spectre of increased displacement in a country already confronting serious challenges around sustainable land and water use as well as urbanisation. Planned resettlement has emerged as part of a suite of measures being pursued as part of disaster risk reduction and climate change adaptation strategies. This paper provides an historical, political, legal and environmental overview of resettlement in Vietnam identifying key challenges for framing resettlement as climate change adaptation. The paper outlines the scale of past resettlement in Vietnam, identifying the drivers and implications for vulnerability. Detailed case studies of resettlement are reviewed. Through this review, the paper reflects on the growing threat of climate change and the likelihood of increased displacement associated with worsening climate risks to identify some critical considerations for planned resettlement in climate change adaptation planning. [ABSTRACT FROM AUTHOR]

Increasingly commonplace in cities, extreme heat events introduce multi-stress vulnerability, affecting people’s health and well-being, financial situation, mobility, social relations, and access to basic services. Planning to reduce heat vulnerability has become part of government business and to some extent community-level responses, cutting across a number of sectors including public health, emergency management, social services, critical infrastructure, and housing. This planning is often framed around heat as an emergency, focusing on preventing loss of life and severe health impacts, yet a vulnerability perspective also draws attention to the chronic and persistent impacts of heat. Our research, based on interviews and desktop research in Melbourne, Australia, found tensions between addressing heat as an emergency and heat as a source of chronic stress, with emergency responses taking precedence over responses addressing the chronic dimensions of heat. Each approach results in different but nonetheless related programmatic priorities for reducing vulnerability. In complex institutional settings, improving relations between policy and programme managers, non-government organisations, and vulnerable people themselves would enable the multiple stresses associated with extreme heat to be more effectively addressed. Policy and institutional responses that better appreciate the interconnections between the emergency and chronic aspects of heat would likely reduce vulnerabilityandcontribute to more just approaches to urban sustainability. [ABSTRACT FROM PUBLISHER]

The capacity to anticipate and respond to climate change can critically shape vulnerability, influencing whether a country experiences harm from exposure to stresses or is able to cope, adapt and realize sustainable outcomes. This paper presents the results of a study that evaluates capacity in relation to the health and water sectors in Vietnam. The study presents informants’ views on the adequacy of financial resources, understanding of vulnerability and adaptation, training needs, information requirements and levels of cooperation as well as their priorities to address adaptation. The perceptions of respondents on challenges and obstacles faced in developing adaptation strategies are also examined. Training on vulnerability and increasing funds for adaptation were reported as the top priorities, indicating that the inadequacy of human and financial resources is the most significant challenge to effective adaptation in the study context. Difficult and weak cooperation was also widely considered to be a barrier. The paper concludes that there are significant interconnected constraints on adaptive capacity in Vietnam that are further exacerbated by governance issues, such as inadequate cooperation and transparency in sharing information and data. This paper identifies priorities for action to address the challenge of climate change adaptation. [ABSTRACT FROM PUBLISHER]

Institutional capacity is an important element for climate change adaptation (CCA) and the development of such capacity is a great challenge in a Least Developed Country like Cambodia where resources are limited. An important first step to increasing capacity is via an understanding of the level of existing capacity; future priorities can then be subsequently identified. This study aimed to assess the capacity of organizations to implement climate change activities in Cambodia in order to provide such a basis for building capacity. Four elements of capacity were investigated in this research: (1) financial resources, (2) cooperation and coordination of stakeholders, (3) availability and quality of information on vulnerability and adaptation to climate change, and (4) the level of understanding of climate change vulnerability and adaptation. The data were collected through semistructured interviews with a wide range of government and non-government informants across a number of sectors. Results of the study showed that informants perceived capacity for CCA to be very constrained, especially in terms of financial resources and cooperation, and addressing these factors was ranked as the highest climate change capacity priority. Institutional capacity constraints were considered to relate more generally to weak governance of CCA. In light of our research findings, the absence of local higher education institutions in CCA activities should be addressed. The support of such institutions would provide an important mechanism to progress both capacity development as well as partnerships and coordination between different types of organizations and relevant sectors. Policy relevance Capacity for CCA within Cambodian health and water sectors was perceived to be very constrained across a range of interdependent factors. Increasing funding was ranked as the highest priority for building capacity for CCA; however, governance factors such as ‘improved cooperation’ were also ranked highly. Improving stakeholders' awareness of the availability of adaptation funds and resources, and their responsiveness to funding criteria, is an important implication of our research, as is improving the mobilization of local resources and the private sector. To address the issue of weak cooperation among stakeholders, improving the coordination function of the National Climate Change Committee (NCCC) regarding stakeholder engagement and capacity building is crucial. Ensuring that CCA activities are based on sound information and knowledge from across different disciplines and, importantly, include the perspectives of vulnerable people themselves, ultimately underpins and supports the realization of the above priorities. [ABSTRACT FROM PUBLISHER]

Changes in climatic conditions and increases in weather variability affect human health directly and indirectly, including through agricultural changes and urban warming. Adaptation to climate change is receiving increasing attention, given, now, the inevitability of further climate change and its diverse impacts. However, with increased international funding for adaptation comes challenges such as ensuring supportive national policy environments for developing and implementing effective adaptation activities. Adaptation at community and population levels is underpinned by governance processes, such as the nature by which decisions are taken and implemented by government, community and private organizations. Thus an understanding of the policy context is necessary to identify the factors that enable or inhibit adaptation policy and programmes. This article examines to what degree there exist enabling factors to support the development of adaptation policy and activities, with relevance to the health sector. Results of a policy analysis are presented, which used stakeholder participation to investigate the context in which adaptation decisions were made within organizations across different sectors in Cambodia. Five factors were identified as critical components of the governance environment: (1) policy development processes; (2) the existence of a political recognition of climate change and (3–5) the organizational barriers relating to coordination, funding and lack of information. Without achieving a supportive policy environment, future adaptation actions are likely to have limited effect. [ABSTRACT FROM PUBLISHER]

A number of challenges prevent climate change adaptation activities from contributing to vulnerability reduction. Some of these relate to the nature and quality of vulnerability assessments, while others concern how well assessments link with adaptation actions. By highlighting four persistent assumptions about the role of vulnerability assessments in adaptation, this paper seeks to identify ways in which the practice of vulnerability assessment can better support progressive adaptation actions. This paper argues that, for adaptation actions identified within vulnerability assessments to be successful, there is a need for assessment to: (i) engage with marginalized perspectives; (ii) draw upon diverse knowledge domains; (iii) integrate scales of analysis with appropriate scales of action; and (iv) build political will. This requires vulnerability assessment to be considered as more than just a method for information generation on who is most vulnerable to climate change, where they are located and the underlying reasons for their vulnerability. In addition, improving the rigor and transparency of assessments and engagement with stakeholders during the assessment process can better facilitate vulnerability-focused adaptation. [ABSTRACT FROM PUBLISHER]

There is a growing scientific consensus on climate change and the need for adaptation, yet an impasse on realizing development for the rural and urban poor. Emily Boyd et al. suggest that a resilience lens may assist development policy to consider pathways towards more successful livelihood transformations in the face of climate change. We recognize that there are also limitations to this approach. [ABSTRACT FROM AUTHOR]